Epistemonikos: a comprehensive database of systematic reviews for health decision-making.

BACKGROUND: Systematic reviews allow health decisions to be informed by the best available research evidence. However, their number is proliferating quickly, and many skills are required to identify all the relevant reviews for a specific question. METHODS AND FINDINGS: We screen 10 bibliographic databases on a daily or weekly basis, to identify systematic reviews relevant for health decision-making. Using a machine-based approach developed for this project we select reviews, which are then validated by a network of more than 1000 collaborators. After screening over 1,400,000 records we have identified more than 300,000 systematic reviews, which are now stored in a single place and accessible through an easy-to-use search engine. This makes Epistemonikos the largest database of its kind. CONCLUSIONS: Using a systematic approach, recruiting a broad network of collaborators and implementing automated methods, we developed a one-stop shop for systematic reviews relevant for health decision making.

[Síndrome de Paget-Schrötter: presentación de cuatro casos]. / Paget-Schrötter syndrome: description of four cases.

Deep vein thrombosis (DVT) of the upper limb is a rare entity, estimated to account for 10% of all cases of DVT. Classically, they are classified into primary (idiopathic, due to subclavian vein compression or exercise related) and secondary (cancer, thrombophilia, trauma, shoulder surgery, associated to venous catheters or due to hormonal causes). The Paget- Schrötter syndrome is a primary thrombosis of the subclavian vein in the subclavian-axillary junction, related either to repetitive movements or to exercise; leading to microtrauma in the endothelium with consequent activation of the coagulation cascade. Clinically, it presents abruptly with pain, edema and feeling of heaviness in the affected limb. The treatment varies from thrombolytics and anticoagulation to surgical intervention, depending on the time of evolution. We present four cases of exercise-related subclavian vein thrombosis.

Base-Free Direct Synthesis of Alkynylphosphonates from Alkynes and H-Phosphonates Catalyzed by Cu2O.

A simple and mild methodology for the direct synthesis of alkynylphosphonates is presented. The reaction of a variety of terminal alkynes with dialkyl phosphites in the presence Cu2O (14 mol %) led to the formation of the corresponding alkynylphosphonates in good to excellent yields. Reactions are performed under air, in acetonitrile as solvent, and in the absence of base or ligand additives. This new methodology is compatible with the presence of a wide variety of functional groups on the starting alkynes and can be scaled up to a gram scale.

From waste to food and bioinsecticides: An innovative system integrating Tenebrio molitor bioconversion and pyrolysis bio-oil production.

To achieve a waste-free clean production, the present study aimed to valorize an underused agroindustrial byproduct (rice bran) by mealworms bioconversion and produce bio-oil from pyrolysis of insect excreta (frass) as bioinsecticide. To reach the first goal, the suitability of rice bran (RB) versus standard diet, wheat bran (WB), was examined by determining feed conversion, growth performance, and nutritional profile of T. molitor larvae. RB diet was an appropriate feed substrate for breeding mealworms, as evidenced by their high survival rates, optimal feed conversion parameters, and its capability to support the growth and life cycle of this insect. Besides, RB did not affect soluble larval protein content but modified crude fat content and fatty acid profile. In order to address the second aim, egested frass from RB and WB were subjected to pyrolysis to obtain bio-oils. The main compound was acetic acid (≈37%) followed by 1,6-anhydro-ß-d-glucopyranose (from 16 to 25%), as measured by GC-MS analysis. Nitrogen-containing chemicals accounted for ≈10%. Frass bio-oils could represent a novel source of bioinsecticides due to their bioeffectiveness in insect pests of economic importance (Plodia interpunctella and Tribolium castaneum) and medical interest (Culex pipiens pipiens). For P. interpunctella adults, frass bio-oils produced insecticidal activity by fumigant and contact exposure whereas for T. castaneum adults, just fumigant. By a miniaturized model that simulates semireal storage conditions, it was seen that, on T. castaneum, frass RB bio-oil generated higher repellent effect than frass WB. Finally, bio-oils proved to have larvicidal activity against Cx. p. pipiens.

[MANAGEMENT RECOMMENDATIONS FOR DIRECT ORAL ANTICOAGULANTS (DOACs) ANTI Xa AND ANTI IIa]. / RECOMENDACIONES DE MANEJO DE LOS ANTICOAGULANTES ORALES DIRECTOS (DOACS) ANTI Xa Y ANTI IIa.

Direct oral anticoagulants have emerged as the drugs that have changed the management of the antithrombotic treatment in the last 15 years. Their advantages, like a more friendly way of anticoagulation and their lower risk of bleeding, especially in the brain, have positioned these new anticoagulants as the first drug of choice in the two most frequent indications of anticoagulation, atrial fibrillation, and the venous thromboembolic disease. However, not all the patients can receive these agents, not all the direct oral anticoagulants have the same characteristics, and most importantly, not all the diseases with an indication of an anticoagulant drug can be treated with them. Therefore, it is mandatory that all the faculties involved in the management of these drugs must know them in depth, to decide the best treatment for the patient. This position paper, from a group of experts in anticoagulation in Argentina, can help the general practitioner in the daily use of direct oral anticoagulants based on the new evidence and the experience of a wide group of professionals. The way we relate to the anticoagulant treatment has changed in the last years. The doctors who work with them must also do so.

Los anticoagulantes orales directos han surgido como una de las herramientas que ha cambiado el manejo de la enfermedad trombótica en los últimos 15 años. Sus ventajas, desde el punto de vista de la facilidad de uso y menor riesgo de sangrado, especialmente de sangrado cerebral, han posicionado a estos nuevos anticoagulantes como la primera alternativa de tratamiento en las dos indicaciones más frecuentes en que necesitamos estas drogas, la fibrilación auricular y la enfermedad tromboembólica venosa. Sin embargo, no todos los pacientes pueden recibir estos agentes, no todos los anticoagulantes directos tienen las mismas propiedades y fundamentalmente, no todas las enfermedades con indicación de un anticoagulante pueden tratarse con ellos;con lo cual es necesario que todos los profesionales que están involucrados en el manejo de estos medicamentos estén obligados a conocerlos en profundidad, para poder decidir el mejor tratamiento en cada caso particular. Este documento de posición de expertos de diferentes especialidades de Argentina, presenta lineamientos para el uso correcto de los anticoagulantes directos en base a nueva evidencia y a la experiencia de uso de un amplio grupo de profesionales. La forma de relacionarnos con el tratamiento anticoagulante ha cambiado. Los médicos que trabajamos con ellos también debemos hacerlo.

[Resection of the first rib by video thoracoscopy in Paget-Schroetter syndrome]. / Resección de la primera costilla por videotoracoscopía en síndrome de Paget-Schroetter.

Thoracic outlet syndrome (TOS) refers to a number of signs and symptoms that arise from compression of the neurovascular bundle at the costoclavicular junction. Paget-Schroetter syndrome is defined as the primary, spontaneous or effort thrombosis of the subclavian vein. The supraclavicular and trans-axillary approaches are currently the most commonly used for first rib resection. The aim of this article was to describe our experience in a minimally invasive approach (VATS) of first rib resection for primary venous thoracic outlet and the associated outcomes. This is a descriptive observational study using a retrospective analysis of a prospective database from January 2017 to March 2020. Nine patients underwent video thoracoscopic first rib resection due to Paget- Schroetter syndrome (one bilateral procedure). Ten thoracoscopic first rib resections were performed. There were 6 female and 3 male patients, with a mean age of 30.7 ± 10.7 years. The mean length of hospital stay was 3.1 ± 0.5 days. No complications were recorded intraoperatively. One patient had to be re-operated because of hemothorax. There were no recurrences in a follow-up of at least 12 months. VATS resection of the first rib is a safe and feasible procedure and can be performed under direct vision of thoracic outlet elements. However, the technique requires experience with thoracoscopic surgery. The outcomes associated with our technique are comparable with the outcomes related to other current standards of care.

El síndrome del opérculo torácico se refiere a una serie de signos y síntomas que se producen por la compresión del paquete vásculo-nervioso en la unión costo-clavicular. El síndrome de Paget- Schroetter (SPS) se define como la trombosis primaria, espontánea o de esfuerzo de la vena subclavia. Las vías de abordaje quirúrgicas tradicionales utilizadas para descomprimir el opérculo torácico son la trans axilar y las claviculares (supra e infra). El objetivo del estudio fue describir nuestra experiencia en la resección de la primera costilla por videotoracoscopía (VATS). Este es un estudio descriptivo observacional utilizando una base de datos prospectiva con análisis retrospectivo desde enero de 2017 a marzo de 2020. Se incluyeron 9 pacientes con diagnóstico de SPS en los que se resecó la primera costilla por VATS. En un paciente el procedimiento fue bilateral por presentar trombosis espontánea en ambas venas subclavias. De los 9, 6 eran mujeres. La edad media fue de 30.7 ± 10.7 años. La estadía hospitalaria media fue de 3.1 ± 0.5 días. Uno fue re-operado por hemotórax. No se detectaron recurrencias en el seguimiento a mediano-largo plazo. La resección de la primera costilla por VATS es un procedimiento seguro y factible. La misma, a diferencia de los abordajes tradicionales, puede ser resecada bajo visión directa de todos los elementos del opérculo torácico. Sin embargo, esta técnica requiere un manejo avanzado en cirugía toracoscópica.

[Viral etiology of severe acute respiratory infections in a pediatric intensive care unit]. / Etiología viral de las infecciones respiratorias agudas graves en una unidad de cuidados intensivos pediátricos.

OBJECTIVES.: To identify the main viral etiological agents in patients with severe acute respiratory infection (SARI) hospitalized in a Pediatric Intensive Care Unit (PICU) and to analyze their clinical characteristics. MATERIALS AND METHODS.: Prospective longitudinal study in children under five years of age hospitalized due to SARI at the PICU of t Instituto Nacional de Salud del Niño (National Children´s Hospital) in Lima, Peru. Real-time direct immunofluorescence and RT-PCR tests were performed for the diagnosis of respiratory viruses on tracheal aspirate or nasopharyngeal swab samples. RESULTS.: We included 117 patients. Median age was four months, 66% had comorbidity and 91% required mechanical ventilation. Respiratory virus monoinfection was identified in 47% and viral co-infection in 2.6%, with the respiratory syncytial virus subtype A (RSV-A) being the most frequent. The median length of hospitalization was 21 days and 20 (17%) patients died. An association was found between a history of chronic lung disease and RSV-A infection (p=0.045), and between Down syndrome and influenza A virus infection (p=0.01). After controlling for potential confounders, congenital heart disease (RR 3.1; 95% CI: 1.3-5.8, p=0.002) and nosocomial infection (RR 2.6; 95% CI: 1.0-5.3, p=0.01) were found to increase the risk of death in patients with SARI. CONCLUSIONS.: RSV-A was the most common viral etiology in children under five hospitalized by SARI at the PICU. No association was found between viral infection and patient survival.

OBJETIVOS.: Identificar los principales agentes etiológicos virales en pacientes con infección respiratoria aguda grave (IRAG) hospitalizados en una Unidad de Cuidados Intensivos Pediátricos (UCIP) y analizar sus características clínicas. MATERIALES Y MÉTODOS.: Estudio longitudinal prospectivo en menores de cinco años hospitalizados por IRAG en la UCIP del Instituto Nacional de Salud del Niño en Lima, Perú. Se realizaron pruebas de inmunofluorescencia directa y RT-PCR en tiempo real para el diagnóstico de virus respiratorios en muestras de aspirado traqueal o hisopado nasofaríngeo. RESULTADOS.: Se incluyeron 117 pacientes. La mediana de edad fue cuatro meses, el 66% presentaron comorbilidad y el 91% requirieron ventilación mecánica. Se identificó monoinfección por virus respiratorios en el 47% y coinfección viral en el 2,6%, siendo el virus sincicial respiratorio subtipo A (VSR-A) el más frecuente. La mediana del tiempo de hospitalización fue de 21 días y 20 (17%) pacientes fallecieron. Se encontró asociación entre el antecedente de enfermedad pulmonar crónica y la infección por el VSR-A (p=0,045) y entre el síndrome de Down y la infección por virus influenza A (p=0,01). Después de controlar por potenciales factores de confusión, se halló que la cardiopatía congénita (RR: 3,1; IC 95%: 1,3-5,8; p=0,002) y la infección nosocomial (RR: 2,6; IC 95%: 1,0-5,3; p=0,01) incrementaron el riesgo de muerte en pacientes con IRAG. CONCLUSIONES.: El VSR-A fue la etiología viral más frecuente en menores de cinco años hospitalizados por IRAG en la UCIP. No se encontró asociación entre la infección viral y la sobrevida del paciente.

Accurate sound localization behavior in a gleaning bat, Antrozous pallidus.

Acute auditory processing in bats is typically associated with echolocation. A subset of bats, called gleaners, listens to prey-generated noise to hunt surface-dwelling prey. Gleaners depend less on echolocation to hunt and, therefore, accurate localization of prey-generated noise is necessary for foraging success. Here we studied azimuth sound localization behavior in the pallid bat, a gleaning bat in which spatial encoding has been studied extensively. We tested pallid bats on a relatively difficult open loop task (single sound, duration ≤ 200 ms). The bats were trained to face the midline when stimulus was presented, and this was confirmed with video analysis. Bats localized broadband noise (5-30 kHz) from 1 out of 11 speakers spaced evenly across the horizontal plane of the frontal sound field. Approach to the correct speaker was rewarded. Pallid bats show accurate localization near the midline with mean errors between 3-6°. Remarkably, the accuracy does not decline significantly at peripheral locations with bats averaging <~7° error upto 72° off midline. Manipulation of stimulus bandwidth shows that higher frequencies (20-30 kHz) are necessary for accurate localization. Comparative studies of gleaning bats will reveal convergent adaptations across auditory systems for non-echolocation-based behaviors in bats.

Is fluid restriction needed in heart failure? / ¿Es necesario restringir el volumen en la insuficiencia cardíaca crónica?

Fluid restriction is usually recommended in chronic heart failure. However, the evidence base to support this is not that clear. Searching in Epistemonikos database, which is maintained by screening multiple databases, we identified five systematic reviews evaluating 11 studies addressing the question of this article, including seven randomized trials. We extracted data, combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded fluid restriction probably decreases hospital readmission in chronic heart failure and might decrease mortality, but the certainty of the evidence for the latter is low.

Habitualmente se recomienda la restricción de volumen en la insuficiencia cardíaca. Sin embargo, esto no necesariamente está sustentado por evidencia científica. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en múltiples bases de datos, identificamos cinco revisiones sistemáticas que en conjunto incluyen once estudios pertinentes a la pregunta, de los cuales siete corresponden a estudios controlados aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que la restricción de volumen en la insuficiencia cardíaca probablemente disminuye la readmisión hospitalaria y podría disminuir la mortalidad, aunque la certeza de la evidencia para esto último es baja.

[Detection of influenza A, B and subtypes A (H1N1) pdm09, A (H3N2) viruses by multiple qrt-pcr in clinical samples]. / Detección de virus influenza A, B y subtipos a (H1N1) pdm09, A (H3N2) por múltiple rt-pcr en muestras clínicas.

OBJECTIVES.: To describe the clinical and epidemiological characteristics of patients diagnosed with epidermolysis bullosa (EB) at the Instituto Nacional de Salud (INSN) in Lima, Peru; a National Reference Center for this disease. MATERIAL AND METHODS: . Observational, descriptive and transversal study. We reviewed the clinical histories and laboratory tests of patients diagnosed with EB treated in INSN from 1993 to 2015. RESULTS.: 93 patients were registered. The average age was 7.9 ± 5.6 years; 53.8% (n = 50) were boys. Clinical forms corresponded to dystrophic EB with 41 (44.1%) cases, simple EB with 39 (41.9%) union EB cases with 8 (8.6%) and Kindler syndrome with 4 (4.3%) cases. The clinical form could not be identified in a case. A total of 48 cases (51.6%) came from Lima and Callao, and 45 cases (48.4%) from other provinces of the country. Extracutaneous manifestations involved gastrointestinal (44.1%), ocular (37.6%), odontogenic (87.1%), and nutritional (79.6%) involvement, as well as pseudosindactilia (16.1%). Chronic malnutrition (71.6%), acute malnutrition (17.6%) and anemia (62.4%) were found. Mortality corresponded to 6 cases (6.5%). CONCLUSIONS.: 93 cases of EB were reported in INSN, the predominant clinical presentation was the dystrophic form.

OBJETIVOS.: Estandarizar la técnica de reacción en cadena de la polimerasa en tiempo real (RT-PCR) múltiple para la detección de virus influenza A, B y tipificación de subtipos A (H1N1) pdm09, A (H3N2) en muestras clínicas. MATERIALES Y MÉTODOS.: Se analizaron 300 muestras de hisopado nasofaríngeo. Esta metodología fue estandarizada en dos pasos: la primera reacción detectó el gen de la matriz del virus de influenza A, gen de la nucleoproteína del virus influenza B y el gen GAPDH de las células huésped. La segunda reacción detectó el gen de la hemaglutinina de los subtipos A (H1N1) pandémico (pdm09) y A (H3N2). RESULTADOS.: Se identificaron 109 muestras positivas a influenza A y B, de las cuales 72 fueron positivas a influenza A (36 positivas a influenza A (H1N1) pdm09 y 36 positivos a influenza A (H3N2)) y 37 muestras positivas a influenza B. 191 fueron negativas a ambos virus mediante RT-PCR en tiempo real multiplex. Se encontró una sensibilidad y especificidad del 100% al analizar los resultados de ambas reacciones. El límite de detección viral fue del rango de 7 a 9 copias/µL por virus. Los resultados no mostraron ninguna reacción cruzada con otros virus tales como adenovirus, virus sincitial respiratorio, parainfluenza (1,2 y 3), metapneumovirus, subtipos A (H1N1) estacional, A (H5N2) y VIH. CONCLUSIONES.: La RT-PCR múltiple demostró ser una prueba muy sensible y específica para la detección de virus influenza A, B y subtipos A (H1N1, H3N2) y su uso puede ser conveniente en brotes estacionales.

Recomendaciones de manejo de los anticoagulantes orales directos (DOACs) anti Xa y anti IIa / Recommendations for the practical management of the direct oral anticoagulants anti Xa and anti IIa

Resumen Los anticoagulantes orales directos han surgido como una de las herramientas que ha cambiado el manejo de la enfermedad trombótica en los últimos 15 años. Sus ventajas, desde el punto de vista de la facilidad de uso y menor riesgo de sangrado, especialmente de sangrado cerebral, han posicionado a estos nuevos anticoagulantes como la primera alternativa de tratamiento en las dos indicaciones más frecuentes en que necesitamos estas drogas, la fibrilación auricular y la enfermedad tromboembólica venosa. Sin embargo, no todos los pacientes pueden recibir estos agentes, no todos los anticoagulantes directos tienen las mismas pro piedades y fundamentalmente, no todas las enfermedades con indicación de un anticoagulante pueden tratarse con ellos;con lo cual es necesario que todos los profesionales que están involucrados en el manejo de estos medicamentos estén obligados a conocerlos en profundidad, para poder decidir el mejor tratamiento en cada caso particular. Este documento de posición de expertos de diferentes especialidades de Argentina, presenta lineamientos para el uso correcto de los anticoagulantes directos en base a nueva evidencia y a la experiencia de uso de un amplio grupo de profesionales. La forma de relacionarnos con el tratamiento anticoagulante ha cambiado. Los médicos que trabajamos con ellos también debemos hacerlo.

Abstract Direct oral anticoagulants have emerged as the drugs that have changed the man agement of the antithrombotic treatment in the last 15 years. Their advantages, like a more friendly way of anticoagulation and their lower risk of bleeding, especially in the brain, have positioned these new anticoagu lants as the first drug of choice in the two most frequent indications of anticoagulation, atrial fibrillation, and the venous thromboembolic disease. However, not all the patients can receive these agents, not all the direct oral anticoagulants have the same characteristics, and most importantly, not all the diseases with an indication of an anticoagulant drug can be treated with them. Therefore, it is mandatory that all the faculties involved in the management of these drugs must know them in depth, to decide the best treatment for the patient. This position paper, from a group of experts in anticoagulation in Argentina, can help the general practitioner in the daily use of direct oral anticoagulants based on the new evidence and the experience of a wide group of professionals. The way we relate to the anticoagulant treatment has changed in the last years. The doctors who work with them must also do so.

Is there a role for glutamine supplementation in the management of acute pancreatitis? / ¿Tiene algún rol la suplementación con glutamina en el manejo de la pancreatitis aguda?

There is no consensus about the effects of glutamine supplementation for acute pancreatitis. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified 15 systematic reviews including 31 randomized controlled trials addressing the question of this article. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded glutamine supplementation might decrease infectious complications in acute pancreatitis, but it is not clear if it affects mortality or length of hospital stay because the certainty of the evidence is very low.

No existe claridad sobre el efecto del uso de glutamina en pacientes con pancreatitis aguda. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos 15 revisiones sistemáticas que en conjunto incluyen 31 estudios aleatorizados pertinentes a la pregunta. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que la glutamina podría disminuir las complicaciones infecciosas en la pancreatitis aguda, pero no está claro si tiene algún efecto sobre la mortalidad o el tiempo de hospitalización porque la certeza de la evidencia es muy baja.

Should sodium intake be restricted in chronic heart failure? / ¿Se debe restringir el consumo de sodio en la insuficiencia cardíaca crónica?

Sodium restriction has been recommended in chronic heart failure for decades. However, the evidence about the benefit of this measure is not clear, and it might even increase risks. Searching in Epistemonikos database, which is maintained by screening multiple databases, we identified three systematic reviews incorporating 13 studies addressing the question of this article, 10 were randomized trials. We extracted data, combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded sodium restriction might increase mortality and the risk of hospital admission in chronic heart failure, but the certainty of the evidence is low.

Cabergoline or bromocriptine for prolactinoma? / ¿Cabergolina o bromocriptina para el prolactinoma?

Cabergoline and bromocriptine are among the most commonly used drugs to treat prolactinoma. Cabergoline is a long-acting dopamine receptor agonist which might offer advantages over bromocriptine. However, it is not clear if this translates into clinical benefits. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified two systematic reviews including 12 studies addressing the question of this article, including five randomized controlled trials. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded cabergoline is more effective than bromocriptine in resolution of amenorrhea/oligomenorrhea and galactorrhea, it probably increases pregnancy rate, and it is associated to less adverse effects. It is not clear whether cabergoline is also more effective with respect to tumor growth because the certainty of the evidence is very low.

Cabergolina y bromocriptina son los fármacos más utilizados en el manejo del prolactinoma. Si bien cabergolina, un agonista dopaminérgico de vida media larga, tendría algunas ventajas desde el punto de vista fisiopatológico, no está claro si esto se traduce en un real beneficio. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos dos revisiones sistemáticas que en conjunto comprenden 12 estudios relevantes para la pregunta, incluyendo cinco estudios controlados aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que la cabergolina es superior a la bromocriptina en la mejoría de la oligomenorrea/amenorrea y la galactorrea, probablemente aumenta la probabilidad de embarazo, y se asocia a menos efectos adversos. No está claro si cabergolina también es más efectiva sobre el crecimiento del tumor porque la certeza de la evidencia es muy baja.

Do branched chain amino acids improve hepatic encephalopathy in cirrhosis? / ¿Aceleran los aminoácidos de cadena ramificada la recuperación de la encefalopatía hepática en pacientes con cirrosis?

There is controversy about the effectiveness of branched chain amino acids for treatment of hepatic encephalopathy. Searching in Epistemonikos database, which is maintained by screening multiple databases, we identified seven systematic reviews including 32 randomized controlled trials, of which 30 address the question of this article. We extracted results, combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded branched chain amino acids might improve hepatic encephalopathy, but they probably lead to little or no effect on mortality.

Are probiotics effective to prevent traveler’s diarrhea? / ¿Son efectivos los probióticos para prevenir la diarrea del viajero?

La diarrea aguda es la enfermedad más común que afecta a los viajeros, principalmente aquellos que se dirigen a regiones de alto riesgo. El uso de probióticos podría prevenir su aparición, sin embargo, los datos que apoyan su uso no son consistentes y no se recomiendan en las guías clínicas actuales. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en múltiples bases de datos, identificamos cuatro revisiones sistemáticas que en conjunto incluyen siete estudios aleatorizados pertinentes a esta pregunta. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que los probióticos podrían prevenir la diarrea del viajero, pero la certeza de la evidencia es baja.

Resección de la primera costilla por videotoracoscopía en síndrome de Paget-Schroetter / Resection of the first rib by video thoracoscopy in Paget-Schroetter syndrome

Resumen El síndrome del opérculo torácico se refiere a una serie de signos y síntomas que se producen por la compresión del paquete vásculo-nervioso en la unión costo-clavicular. El síndrome de Paget-Schroetter (SPS) se define como la trombosis primaria, espontánea o de esfuerzo de la vena subclavia. Las vías de abordaje quirúrgicas tradicionales utilizadas para descomprimir el opérculo torácico son la trans axilar y las claviculares (supra e infra). El objetivo del estudio fue describir nuestra experiencia en la resección de la primera costilla por videotoracoscopía (VATS). Este es un estudio descriptivo observacional utilizando una base de datos prospectiva con análisis retrospectivo desde enero de 2017 a marzo de 2020. Se incluyeron 9 pacientes con diagnóstico de SPS en los que se resecó la primera costilla por VATS. En un paciente el procedimiento fue bilateral por presentar trombosis espontánea en ambas venas subclavias. De los 9, 6 eran mujeres. La edad media fue de 30.7 ± 10.7 años. La estadía hospitalaria media fue de 3.1 ± 0.5 días. Uno fue re-operado por hemotórax. No se detectaron recurrencias en el seguimiento a mediano-largo plazo. La resección de la primera costilla por VATS es un procedimiento seguro y factible. La misma, a diferencia de los abordajes tradicionales, puede ser resecada bajo visión directa de todos los elementos del opérculo torácico. Sin embargo, esta técnica requiere un manejo avanzado en cirugía toracoscópica.

Abstract Thoracic outlet syndrome (TOS) refers to a number of signs and symptoms that arise from compression of the neurovascular bundle at the costoclavicular junction. Paget-Schroetter syndrome is defined as the primary, spontaneous or effort thrombosis of the subclavian vein. The supraclavicular and trans-axillary approaches are currently the most commonly used for first rib resection. The aim of this article was to describe our experience in a minimally invasive approach (VATS) of first rib resection for primary venous thoracic outlet and the associated outcomes. This is a descriptive observational study using a retrospective analysis of a prospective database from January 2017 to March 2020. Nine patients underwent video thoracoscopic first rib resection due to PagetSchroetter syndrome (one bilateral procedure). Ten thoracoscopic first rib resections were performed. There were 6 female and 3 male patients, with a mean age of 30.7 ± 10.7 years. The mean length of hospital stay was 3.1 ± 0.5 days. No complications were recorded intraoperatively. One patient had to be re-operated because of hemothorax. There were no recurrences in a follow-up of at least 12 months. VATS resection of the first rib is a safe and feasible procedure and can be performed under direct vision of thoracic outlet elements. However, the technique requires experience with thoracoscopic surgery. The outcomes associated with our technique are comparable with the outcomes related to other current standards of care.

Timing of influenza epidemics and vaccines in the American tropics, 2002-2008, 2011-2014.

BACKGROUND: Influenza-associated illness results in increased morbidity and mortality in the Americas. These effects can be mitigated with an appropriately chosen and timed influenza vaccination campaign. To provide guidance in choosing the most suitable vaccine formulation and timing of administration, it is necessary to understand the timing of influenza seasonal epidemics. OBJECTIVES: Our main objective was to determine whether influenza occurs in seasonal patterns in the American tropics and when these patterns occurred. METHODS: Publicly available, monthly seasonal influenza data from the Pan American Health Organization and WHO, from countries in the American tropics, were obtained during 2002-2008 and 2011-2014 (excluding unseasonal pandemic activity during 2009-2010). For each country, we calculated the monthly proportion of samples that tested positive for influenza. We applied the monthly proportion data to a logistic regression model for each country. RESULTS: We analyzed 2002-2008 and 2011-2014 influenza surveillance data from the American tropics and identified 13 (81%) of 16 countries with influenza epidemics that, on average, started during May and lasted 4 months. CONCLUSIONS: The majority of countries in the American tropics have seasonal epidemics that start in May. Officials in these countries should consider the impact of vaccinating persons during April with the Southern Hemisphere formulation.