Correlation between the cervical sagittal alignment and spine - pelvic sagittal alignment in asymptomatic adults.

Background: Although there are studies that adequately document the linear correlation between pelvic incidence (PI), sacral slope, lumbar lordosis, and thoracic kyphosis, few have analyzed the pelvic-spine correlation including the cervical spine. Methods: This is a cross-sectional study, wherein the cervical spine was evaluated using radiography and computed tomography (CT) scans, the lumbosacral spine and the pelvis was evaluated using radiography, in adult patients without spinal pathology. Using the Surgimap tool, cervical and spinopelvic parameters were calculated by several investigators. To evaluate the correlation between cervical and spinopelvic parameters, Spearman's coefficient was calculated. To evaluate the concordance correlation of the measured parameters of cervical sagittal alignment on tomography and conventional radiography, Lin's coefficient was calculated and Bland-Altman plots were performed. Results: A total of 51 healthy adults were included in a follow-up from January 2019 to December 2020. Cervical sagittal alignment and sagittal spinopelvic alignment were assessed using radiography, and a correlation was observed between T1 slope (T1S) and lumbar mismatch (coefficient of 0.28, P = 0.047). Then, cervical sagittal alignment was evaluated using CT and sagittal spinopelvic alignment using radiography, and no correlation was observed between PI and thoracic inlet angle or cervical mismatch with lumbar mismatch. Conclusion: In asymptomatic patients, in whom cervical sagittal alignment and spinal-pelvic alignment were evaluated, only a positive correlation was found between lumbar mismatch and T1S, which lacks clinical significance. No concordance was identified between lumbar mismatch and cervical mismatch. Therefore, it is inferred that there is an independence between the sagittal spine-pelvic alignment with respect to the sagittal cervical alignment.

A Randomized Placebo-Controlled N-of-1 Trial: The Effect of Proton Pump Inhibitor in the Management of Gastroesophageal Reflux Disease.

Background: Gastroesophageal reflux disease (GERD) is the most frequent chronic gastrointestinal disorder. It is defined as a condition developed when the reflux of gastric contents causes troublesome symptoms (heartburn and regurgitation). This requires adequate treatment since it can lead to long-term complications including esophagus adenocarcinoma. Proton pump inhibitors (PPI) are generally used to treat GERD due to their high-security profile and efficiency on most patients. However, recurrent reflux despite initial treatment is frequent. N-of-1 trial is a study that allows the identification of the best treatment for each patient. The objective of this study is to compare the efficacy of standard dose with double dosage of esomeprazole, to improve the GERD symptoms in a single patient. Methods: A single-patient trial, placebo-controlled, randomized, double-blind, was carried out from September 25th, 2012, to April 26th, 2013. It included one outpatient at the gastroenterology service in a fourth-level hospital, diagnosed with nonerosive reflux disease (NERD). Yet, his symptoms were heartburn and reflux, and his endoscopic results were normal esophageal mucosa, without hiatal hernia, though pathological pH values. A no-obese male without any tobacco or alcohol usage received esomeprazole 40 mg/day and 40 mg/bid for 24 weeks. A standardized gastroesophageal reflux disease questionnaire (GerdQ) was used weekly to evaluate symptom frequency and severity. The consumption of 90% of the capsules was considered as an adequate treatment adherence. D'agostino-Pearson and Wilcoxon test were used to determine normal or nonnormal distribution and compare both treatments, respectively, both with a significant statistical difference of p < 0.05. Results: The patient completed the study with 96% of adherence. The double dosage of esomeprazole did not improve the control of symptoms compared with the standard dosage. Mean symptomatic score was 9.5±0.5 and 10.2±0.6 for each treatment, respectively (p > 0.05). Conclusion: There was no significant improvement in the patient GERD symptoms increasing the dose of oral esomeprazole during the 6 months of study. N-of-1 trials in chronic pathologies including GERD are recommended due to their potential value as systematic methods that evaluate therapies without strong scientific evidence.

Relación del índice nutricional pronóstico con complicaciones y mortalidad en los pacientes con cáncer gástrico sometidos a gastrectomía en un hospital de tercer nivel de Bogotá, Colombia / Relationship of the prognostic nutritional index with complications and mortality in patients with gastric cancer who underwent gastrectomy in a tertiary hospital in Bogotá, Colombia

Introducción. El cáncer gástrico es el quinto cáncer diagnosticado con mayor frecuencia y la tercera causa de muerte por cáncer en el mundo. En el tratamiento quirúrgico, la evidencia actual apoya las medidas preoperatorias e índices pronósticos para mejorar la supervivencia. El índice nutricional pronóstico, que une los valores de los linfocitos circulantes en sangre periférica con los de la albúmina sérica, ha presentado características de ser un marcador nutricional e inmunológico con valor predictivo sobre complicaciones y mortalidad. El objetivo de este estudio fue determinar la relación entre el índice nutricional pronóstico con las complicaciones y mortalidad en pacientes con cáncer gástrico sometidos a gastrectomía. Métodos. Se llevó a cabo un estudio observacional descriptivo, de corte transversal, con componente analítico, mediante la revisión retrospectiva de las historias clínicas. Resultados. Se analizaron 113 pacientes sometidos a gastrectomía total o subtotal. Se encontró asociación entre el índice nutricional pronóstico y la mortalidad; todos los pacientes que murieron tenían un índice menor o igual a 46. También se encontró asociación inversa entre el valor del índice y la presentación de complicaciones posoperatorias, como sepsis, peritonitis, fuga de la anastomosis y sangrado. Discusión. Similar a nuestro análisis, varios estudios plantean que un índice nutricional pronóstico bajo podría tener un valor predictivo sobre la frecuencia de complicaciones y supervivencia global en pacientes con cáncer gástrico llevados a cirugía. Conclusión. El índice nutricional pronóstico se asocia con la mortalidad y complicaciones posoperatorias en pacientes sometidos a gastrectomía por cáncer gástrico.

Introduction. Gastric cancer is the fifth most frequently diagnosed cancer and the third cause of cancer death in the world. In surgical treatment, current evidence supports preoperative measures and prognostic index to improve survival. The prognostic nutritional index, which unites the values of circulating lymphocytes in peripheral blood with those of serum albumin, has presented characteristics of being a nutritional and immunological marker with predictive value on complications and mortality. The objective of this study was to determine the relationship between the prognostic nutritional index with complications and mortality in patients with gastric cancer undergoing gastrectomy.Methods. A descriptive, cross-sectional, observational study with an analytical component was carried out by a retrospective review of medical records. Results. A total of 113 patients who underwent total or subtotal gastrectomy were analyzed. An association was found between mortality and the prognostic nutritional index and mortality; all patients who died had an index ≤ 46. An inverse association was also found between the value of the index and the presentation of postoperative complications, such as sepsis, peritonitis, anastomotic leak, and bleeding.Discussion. Similar to our analysis, several studies suggest that a low prognostic nutritional index could have a predictive value on the frequency of complications and overall survival in patients with gastric cancer undergoing surgery.Conclusion. The prognostic nutritional index is associated with mortality and postoperative complications in patients undergoing gastrectomy for gastric cancer.

Violencia urbana, conflicto y crimen en Medellín: una revisión de las publicaciones académicas al respecto / Urban violence, conflict and crime in Medellin: a review of academic publications on this matter / Violência urbana, conflito e crime em Medellín: uma revisão das publicações académicos na matéria

El objetivo es hacer una revisión bibliográfica de los estudios sobre la violencia urbana, el conflicto y el crimen en la ciudad de Medellín. Método: se realizó una búsqueda y selección de las investigaciones que indagaran sobre dichos temas, tanto en libros como en artículos académicos y en informes. Se aborda de forma cualitativa y poniendo énfasis en la producción académica realizada entre el 2000 y el 2015. Se describe la tendencia de las investigaciones y sus interpretaciones acerca de la disminución del homicidio en la ciudad, así como algunos factores relevantes de dichos estudios, como: enfoque conceptual, enfoques metodológicos, factores explicativos de la violencia urbana, modalidades e indicadores, actores armados, dinámicas de la violencia urbana y los impactos de la violencia en la sociedad. Resultado: se expone una situación paradójica: mientras que el homicidio en la ciudad ha decrecido en los últimos 25 años, la producción académica presenta un crecimiento importante, tanto en su cantidad como en su calidad. Además, son escasos los trabajos que abordan a fondo el problema de las reglas informales y su papel en el aumento o en la disminución de la criminalidad y la violencia.

The objective consists of reviewing the bibliography of studies made about urban violence, conflict and crime in the city of Medellin. Method: A careful search and selection of researches having explored these areas was made both in books, journals, academic articles and reports. They were approached in a qualitative manner and with emphasis on academic production between years 2000 and 2015. The trend of researches and their interpretations dealing with the decline of homicide cases in the city are described, as well as some relevant factors emerging from these studies ike, for example, conceptual approach, methodological perspective, explanatory factors for urban violence, modalities and indicators, armed actors, urban violence dynamics, and the impacts of violence on society. Result: A paradoxical situation is exposed: while homicide has declined in the past 25 years, the academic production exhibits significant growth in both quantity and quality aspects. Besides, works addressing in depth the issue of informal rules and their role in either the increase or decrease of criminality and violence are rather scarce.

O objetivo é fazer uma revisão bibliográfica dos estudos sobre a violência urbana, o conflito e o crime na cidade de Medellín. Método: uma busca e seleção das pesquisas que indagam nestes assuntos foi feita, tanto nos livros quanto em artigos académicos e relatórios. Tem uma abordagem qualitativa e ênfase na produção académica feita entre 2000 e 2015. Descreve-se a tendência das pesquisas e de suas interpretações sobre a redução do homicídio na cidade, assim como alguns fatores relevantes destes estudos, como: enfoque conceptual, aproximações metodológicas, fatores explicativos da violência urbana, modalidades e indicadores, atores armados, dinâmicas da violência urbana e os impactos da violência na sociedade. Resultado: uma situação paradoxal é exposta: visto que o homicídio na cidade diminuiu nos últimos 25 anos, a produção académica apresenta um crescimento importante, tanto em sua quantidade quanto em sua qualidade. Além, os trabalhos que abordam em profundidade o problema das regras informais e de seu papel no aumento ou redução da criminalidade e da violência são escassos.