Parastomal hernia prevention with an intraperitoneal prophylactic 3D-funnel mesh: review of the technique and middle-term results.

PURPOSE: Parastomal hernia (PH) stands out as a prevalent complication following end colostomies, significantly affecting patients' quality of life. Various surgical strategies, predominantly involving prophylactic mesh deployment, have been explored with variable outcomes. This study details our experience and mid-term outcomes utilizing a funnel-shaped mesh. METHODS: A single-center, prospective, non-randomized, observational study examined consecutive patients undergoing colorectal surgery with end colostomy, incorporating a 3D-funnel mesh from January 2019 to December 2021 (PM group). A historical cohort of patients with end colostomy without prophylactic mesh served as the comparison (C group). Postoperative morbidity within 30 days was documented, and clinical examinations and radiological tests were employed for parastomal hernia diagnosis during follow-up. RESULTS: Seventy-two patients participated, with thirty-four in the PM group and thirty-eight in the C group. The PM group experienced 16 postoperative complications, unrelated to the mesh, while the C group recorded 20 complications (p = 0.672). Median follow-up was 22.06 months for the PM group and 63.18 months for the C group. The PM group exhibited a lower parastomal hernia incidence during follow-up (8.8%) compared to the C group(68.4%) (p < 0.001). CONCLUSION: Prophylactic use of a 3D-funnel mesh appears effective in reducing parastomal hernia incidence in the short and mid-term, without an associated increase in postoperative morbidity.

Quality of Life in Myasthenia Gravis and Correlation of MG-QOL15 with Other Functional Scales.

Health-related quality of life (HRQOL) in myasthenia gravis (MG) is frequently decreased. Further, there are many validated clinical scales and questionnaires to evaluate the clinical status in MG. We aimed to determine if there was an improvement in HRQOL following an intensive treatment for MG, identify which demographic and clinical features influenced patients' HRQOL, and investigate if the questionnaire MG-QOL15 correlated with other evaluation scales. We recruited 45 patients with generalised MG who were starting immunomodulatory treatment with intravenous immunoglobulins and prednisone for the first time. At each visit, we administered several validated scales for MG. The mean MG-QOL15 score improved significantly at 4 and 6 weeks of the study. Additionally, the MG-QOL15 score correlated strong with the Myasthenia Gravis-Activities of Daily Living (MG-ADL) and the Neuro-QOL Fatigue and weakest with the Quantitative Myasthenia Gravis Scoring System (QMG). The QMG score prior to study enrolment was associated with HRQOL. We observed that HRQOL in MG improved after receiving an intensive immunomodulatory treatment and achieving better control of the symptoms. The questionnaire MG-QOL15 correlated positively with other clinical measures. As MG is a fluctuating condition, and some symptoms are difficult to examine, we direct physicians toward the use of scales and questionnaires composed of items perceived by the patient.

Laparoscopic Caudal Approach of the Inferior Vena Cava for Isolated Segment 1 Liver Resection.

INTRODUCTION: Isolated laparoscopic resection of the hepatic caudate lobe (segment 1) is a very challenging procedure. Very few references are available on this technique, and the aim of this paper is to show the main technical aspects of laparoscopic caudal approach for segment 1. MATERIAL AND METHODS: The subject was a 64-year-old woman with a past medical history of surgically treated breast cancer (pT1N0M0, with positive hormonal receptors). Adjuvant treatment was administered as well as radiotherapy and hormone therapy (tamoxifen). After 12 months of follow-up, an 18-mm single liver metastasis was detected in segment 1, suggestive of metastatic disease. A complementary study was conducted with magnetic resonance imaging, computed tomography and positron emission tomography, and no other lesions were identified. RESULTS: Isolated laparoscopic resection of segment 1 of the liver was performed with a caudal approach of the inferior vena cava. All the steps are extensively described. The surgery time was 120 min, and blood loss was less than 100 ml. No postoperative complications were registered. The patient was discharged on the third postoperative day. CONCLUSION: Isolated laparoscopic resection of the hepatic caudate lobe with a caudal approach of the inferior vena cava is a safe technique in selected patients and should be performed in centres with experience in liver surgery and advanced laparoscopy, because of its high complexity.

Guillain-Barré-Strohl syndrome and COVID-19: Case report and literature review.

In recent months, the new beta-coronavirus has caused a pandemic with symptoms affecting mainly the respiratory system. It is established that the virus may play a neurotropic role and in recent months several cases of Guillain-Barré-Strohl syndrome (GBS) have been reported in patients infected with COVID-19. We report the case of a 54-year-old patient with acute demyelinating polyneuropathy during infection by SARS-CoV-2 who progressed clinically to require assisted ventilation. After several weeks of specific symptomatic treatment, the patient had a favorable outcome. In conclusion, despite being a rare complication, we think it is important to consider the possibility of diffuse involvement of the peripheral nervous system in patients with COVID-19 to adjust clinical monitoring and treatment in these cases.

Intravenous immunoglobulins may prevent prednisone-exacerbation in myasthenia gravis.

Corticosteroids may produce a paradoxical worsening of myasthenia gravis (MG) symptoms within the first weeks of treatment. We therefore wanted to assess the hypothesis that a prior infusion of intravenous immunoglobulin (IVIG) may have a protective effect. Our primary objectives were to show that the coadministration of immunoglobulins and glucocorticoids is safe and effective for controlling myasthenic symptoms, and to compare the exacerbation rate with this approach and historical practice without IVIG. We recruited 45 patients with generalized MG who required corticosteroids for the first time and we gave all IVIG before starting the full doses of prednisone. Monitoring was performed with validated scales, questionnaires, and blood tests over a 6-week period. Only 4.4% had severe adverse effects related to IVIG and 86.7% improved clinically. Notably, only 2.2% had a paradoxical symptom exacerbation in the first weeks of starting prednisone, which was statistically lower than the 42% reported in a historical series. We conclude that adjuvant therapy with IVIG when starting prednisone for the first time in patients with generalized MG is safe and effective. Given that the rate of paradoxical worsening was lower than that previously reported, the addition of IVIG may have a protective effect against such exacerbations.

Análisis de diversas variables polisomnográficas y su relación con la severidad del síndrome de apnea e hipoapnea obstructiva del sueño / The analysis of polysomnographic variables and their relation with severity of obstructive sleep apnea and hypopnea syndrome

genera obstrucción de la vía aérea superior, y el estándar de oro para su diagnóstico es la polisomnografía (PSG). Objetivo: esclarecer la relación que existe entre las variables polisomnográficas y la severidad de la enfermedad, para tener más elementos objetivos al determinar el manejo y el seguimiento médico. Diseño: estudio observacional analítico de corte transversal. Metodología: se analizaron las variables polisomnográficas de 575 pacientes mediante el software STATA® VE 15.0; con la prueba Kruskal Wallis se evaluó la relación entre estas y la severidad. Resultados: la prevalencia de SAHOS en la cohorte fue de 73,04 %; a mayor duración media de apnea MAD se encontraron peores datos de SaO2. La media de Ct90 en pacientes sanos fue 2,55 %. La MAD en pacientes con SAHOS moderado y severo fue de 21 segundos, mientras que el REM IAH, el Ct90 y la duración máxima de apneas tuvieron buena relación con el IAH. Conclusiones: los microdespertares, el Ct90, la SaO2 mínima, la MAD y la frecuencia cardíaca máxima están relacionados de manera importante con la severidad de la enfermedad. El WASO, la duración mínima de apneas, la vigilia antes del sueño y la frecuencia cardíaca mínima no están relacionados. Las apneas de larga duración por encima de 18,5 segundos se asociaron significativamente a peores cifras de oxigenación. Los números de microdespertares tienen una relación fuerte con la severidad de la enfermedad y la más fuerte con los datos de peor oxigenación.

Introduction: The obstructive sleep apnea/Hypopnea syndrome (OSAHS) generates obstruction of the upper air way and the gold standard for its diagnosis is the polysomnography. Objective: To clarify the relation between the polysomnographic variables and the severity of the condition in order to have more objective elements to help choose the best management and medical follow up. Design: Cross-Sectional, analytical and observational study. Methodology: The polysomnographic variables of 575 patients were analyzed using STATA® VE 15.0 software. The relation between the variables and their severity were evaluated using the Kruskall Wallis Test. Results: The prevalence of the (OSAHS) in the cohort was 73.04 %, to longer MADs lowest SaO2 data, the media of Ct90 in healthy patients was 2.55 %. The media MAD for patients with moderate and severe OSA was 21 seconds. The REM IAH, Ct90 and maximum duration of apnea had a strong relation with the IAH. Conclusions: The arousals, the Ct90, the lowest SaO2, the MAD and the maximum cardiac frequency are crucially related to the severity of the condition. The WASO, the minimum duration of the apneas, the vigil before sleep and the minimum cardiac frequency are not related. The apneas with the longest duration, above 18.5 seconds, are significantly associated with the worst numbers of oxygenation. The number of arousals is strongly linked to the severity of the disease being the most severe related to the data associated with the worst oxygenation.

Safety and Efficacy of Chronic Extended Release Cornstarch Therapy for Glycogen Storage Disease Type I.

BACKGROUND: Glycogen storage disease type I (GSD I) causes severe hypoglycemia during periods of fasting since both glycogenolysis and gluconeogenesis are impaired. Primary treatment in North America consists of cornstarch therapy every 3-4 h. Waxy maize extended release cornstarch was introduced for maintaining overnight glucose concentrations, but no studies have assessed long-term safety and efficacy of the product. OBJECTIVE: To demonstrate the safety and efficacy of modified cornstarch in GSD I. DESIGN: An open-label overnight trial of extended release cornstarch was performed. Subjects with a successful trial (optimal metabolic control 2 or more hours longer than with traditional cornstarch) were given the option of continuing into the chronic observational phase. Subjects were assessed biochemically at baseline and after 12 months. RESULTS: Of the 106 subjects (93 GSD Ia/13 GSD Ib), efficacy was demonstrated in 82 patients (88%) with GSD Ia and 10 patients (77%) with GSD Ib. The success rate for extending fasting was 95% for females and 78% for males. Of the patients who entered the longitudinal phase, long-term data are available for 44 subjects. Mean duration of fasting on traditional cornstarch prior to study for the cohort was 4.1 and 7.8 h on the extended release cornstarch (P < 0.001). All laboratory markers of metabolic control have remained stable in the chronically treated patients. CONCLUSION: Extended release cornstarch appears to improve the quality of life of patients with GSD I without sacrificing metabolic control. Avoiding the overnight dose of cornstarch should enhance safety in this population.

Salmonella Isolates in the Introduced Asian House Gecko (Hemidactylus frenatus) with Emphasis on Salmonella Weltevreden, in Two Regions in Costa Rica.

The Asian house gecko Hemidactylus frenatus has been widely introduced in Costa Rica and tends to establish in human settlements. Some studies in other invaded countries have suggested that this gecko plays a significant role in the epidemiology of salmonellosis and it is of value to public health. To our knowledge, no studies have examined Salmonella from this species in Costa Rica. Therefore, we collected 115 geckos from houses in two Costa Rican regions. We examined gut contents for Salmonella through microbiological analysis. Presumptive Salmonella spp. were sent to a reference laboratory for serotyping and antimicrobial susceptibility testing. Molecular typing was also conducted with the main Salmonella isolates of zoonotic relevance in Costa Rica. H. frenatus was found in 95% of the houses surveyed. Salmonella was isolated in 4.3% of the samples, and four zoonotic serovars were detected. None of the isolates were resistant to the antibiotics most frequently used for salmonellosis treatment in Costa Rica. All Salmonella isolates from the lower gut of H. frenatus are associated with human salmonellosis. Pulsotypes from Salmonella enterica serotype Weltevreden were identical to the only clone previously reported from human samples in Costa Rica. Molecular typing of Salmonella Weltevreden suggested that H. frenatus harbors a serovar of public health importance in Costa Rica. Results demonstrated that H. frenatus plays a role in the epidemiology of human salmonellosis in two regions of Costa Rica. However, more detailed epidemiological studies are needed to understand better the role of the Asian house gecko with human salmonellosis, especially caused by Salmonella Weltevreden, and to quantify its risk in Costa Rica accurately.

Surgical management with intentional replantation on a tooth with palato-radicular groove.

A palato-radicular groove (PRG) is a developmental anomaly primarily found in the maxillary lateral incisors. It is a potential communication path between the root canal and the periodontium that decreases the survival prognosis of the affected tooth, therefore compromising the stability of the dental structure in the oral cavity. The aim of this case report is to present an original technique where a PRG was treated by means of intracanal disinfection, PRG sealing with glass ionomer, replantation with intentional horizontal 180 degree rotation of the tooth, and an aesthetic veneer placed to provide adequate tooth morphology. The clinical and biological benefits of this novel technique are presented and discussed.

Bioimpedancia eléctrica. Diferentes métodos de evaluación del estado nutricional en un centro periférico de hemodiálisis / Electrical bioimpedance. Different methods of assessment of the nutritional state in a peripheral haemodialysis centre

Introducción. Gracias a la bioimpedancia es posible valorar el estado de hidratación del paciente independientemente del peso corporal. También identifica las reservas proteicas/magras y reservas grasas en el paciente. Objetivos. 1. Descripción del estado nutricional de la población estable en un centro periférico medido por: bioimpedancia, antropometría, valoración global subjetiva y datos analíticos. 2. Comparación y análisis de los diferentes métodos de valoración nutricional. Metodología. Estudio analítico, prospectivo, comparativo de diferentes formas de valorar el estado nutricional de los 52 pacientes estables de nuestro centro. Estudiamos la concordancia entre variables y comparamos parámetros significativos de cada método de valoración nutricional: Resultados. Por valoración global subjetiva encontramos alto riesgo de desnutrición en un 63,46%; de los pacientes, la bioimpedancia indica una malnutrición de un 59,61%. La albúmina sérica muestra un 56,8% de los pacientes con un estado nutricional adecuado, mientras que están en este estado un 51,21% si se considera la transferrinasérica. Existen muchos métodos para valorar el estado nutricional de nuestros pacientes. Se observa correlación entre la valoración global subjetiva y la analítica nutricional (AU)

Introduction. Thanks to bioimpedance it is possible to evaluate the state of hydration of the patient independently of body weight. It also identifies the lean protein reserves and fat reserves in the patient. Objectives. 1. Description of the nutritional state of the stable population in a peripheral centre measured by: bioimpedance, anthropometrics, subjective global assessment and analytical data. 2. Comparison and analysis of the different nutritional evaluation methods. Methodology. Analytical, prospective, comparative study of the different ways of evaluating the nutritional state of the 52 stable patients in our centre. We studied the match between variables and we compared significant parameters of each nutritional evaluation method: Results. By subjective global assessment we found a high risk of malnutrition in 63.46% of patients, bioimpedance indicated malnutrition in 59.61%. Serum albumin showed 56.8% of patients in an adequate nutritional state while 51.21% are in this state if serum transferrin is considered. There are many methods for evaluating the nutritional state of our patients. A correlation is observed between the subjective global assessment and the nutritional analysis (AU)

Valoración de un programa sistemático de formación para enfermeros en hemodiálisis / Appraisal of a systematic training programme for nurses in haemodialysis

Para el buen desarrollo de nuestras funciones como enfermeros se necesita una formación complementaria y especializada por lo que nos propusimos elaborar un plan de formación que cubriera tal necesidad. Durante tres meses impartimos un curso para enfermeros que se incorporarían a las sustituciones por vacaciones en nuestra unidad. Tras la finalización del programa formativo, se realizó una evaluación del mismo por parte del alumnado y el profesorado, y se realizó un estudio comparativo de la evaluación de ambas partes. También se extrajeron datos de los cuestionarios de calidad asistencial que se realizan periódicamente a los pacientes. Como conclusiones más destacables cabe citar: 1) El programa formativo ha servido para que el alumnado adquiera conocimientos y actitudes necesarios para el desarrollo de su labor una unidad de hemodiálisis. 2) Dicho desarrollo favorece el contar con personal cualificado para sustituciones, con escasa o nula afectación de la calidad asistencial. 3) Se ha favorecido la motivación en la plantilla de Enfermería de nuestro centro, basada en el desarrollo de la faceta docente y el reciclaje en los conocimientos básicos de Enfermería Nefrológica. 4) Quince semanas parece ser un tiempo escaso para el desarrollo de todas las cualidades y actitudes, principalmente en la adquisición de conocimientos en el programa teórico. 5) Los pacientes denotan en nuestra labor y así lo reflejan en su evaluación del personal, la mejor cualificación de la plantilla (AU)

To carry out properly our work as nurses, complementary specialized training is required and we there fore proposed to draw up a training plan to cover this need. For three months we gave a course for nurses who would join our unit to cover staff on vacation. After completing the training programme, an appraisal of it was carried out by pupils and teaching staff, and a comparative study of the appraisal by both groups was carried out. Data were also extracted from the quality of care questionnaires distributed among patients on a regular basis. The most notable conclusions were: 1) The training programme has enabled pupils to acquire the necessary knowledge and attitudes to carry out their work in a haemodialysis unit. 2) This development enhances having qualified replacement staff, with little or no detriment to quality of care. 3) Motivating has been favoured in the Nursing staff of our centres based on the development of the teaching facet and refreshment of basic Kidney Nursing knowledge. 4) Fifteen weeks appear to be insufficient time to develop all the qualities and attitudes, mainly in acquiring knowledge in the theoretical programme.5) Patients observed and reflected in their evaluation that staff were better qualified (AU)