5G-assisted telementored surgery.

Safe and effective implementation of remote surgery and telementoring can have significant limitations. Fifth-generation (5G) wireless networks could be useful in overcoming these drawbacks. As a proof of concept, the authors present technical and clinical details of two procedures assisted by telementoring using 5G that were also broadcast live. Secure remote access advice.

Radiological study to evaluate the spreading of two volumes (10 vs. 20ml) of radiological contrast in the block of cutaneous branches of intercostal nerves in medial axillary line (BRILMA) in a porcine experimental model. / Estudio radiológico para evaluar la difusión de dos volúmenes (10 vs. 20ml) de contraste radiopaco en el bloqueo de las ramas cutáneas de los nervios intercostales en la línea medio axilar (BRILMA) en un modelo experimental porcino.

OBJECTIVE: Interfascial blocks of the thoracic wall are being developed as an alternative to central blocks in breast surgery. However, there are few studies that have evaluated the anatomical extension of the local anaesthetic. The objective of this study was to analyse, using fluoroscopy, the spreading of two volumes (10 vs. 20ml) of radiological contrast in the serratus-intercostal plane block in an experimental pig model. MATERIAL AND METHODS: Ten Large-White breed pigs were selected to have a bilateral ultrasound serratus-intercostal plane block performed, with the administering of 10ml and 20ml of iopamidol in the right and left hemithorax, respectively. The spreading of contrast was analysed by fluoroscopy. The Spearman test correlation was used to evaluate the relationship between the administered volume and radiological spreading. A value of P<.05 was considered significant. RESULTS: Twenty anaesthetic blocks were performed, being able to analyse 18 of them. The administration of 10ml of contrast was associated with a mean spreading of 2.28±0.31 (95% CI; 2.01-2.54) intercostal spaces, while the administration of 20ml showed a spreading of 3±0.25 (95% CI; 2.81-3.18) intercostal spaces. There was a significant correlation between the injected volume and the spreading of the contrast (Spearman correlation coefficient of 0.81; P=.0001). CONCLUSION: The results showed a spreading of volume subject to the serratus-intercostal plane block, although not maintaining a 1:1 ratio. Doubling the volume increased the blocked segments by 31%. These findings, if corroborated in the clinical practice, would allow a more precise adjustment in the anaesthetic volume administered.

Synthesis of the cyclohexan subunit of baconipyrones A and B from furan.

[figure: see text] The synthesis of the cyclohexan subunit of the siphonarlid metabolites baconipyrones A and B from furan is described. A key step included the alkylative ring opening of 7-oxanorbornenic sulfone 4 and oxidative desulfonylation of compound 8.

Characterisation of Helicobacter pylori isolates from the north-eastern region of Mexico.

The vacA and cagA genotypes of 50 Helicobacter pylori isolates from patients in the north-eastern region of Mexico were characterised by PCR, and the correlation between genotypes and different clinical outcomes was investigated. Strains of H. pylori that are vacA s1/m1 and cagA positive have previously been associated with more severe clinical outcomes, and some studies have shown differences in the vacA and cagA genotypes in different geographical regions. The six possible combinations of the vacA signal (s) and middle (m) regions were identified in this population, and the most frequent genotype was s2/m2. Thirty-two (64%) isolates were identified as cagA-positive. The s region was not amplified from seven of the cagA-positive isolates, and the m region was not amplified from one cagA-negative isolate, indicating that additional subfamilies of s and m genotypes may exist. The s1/m1 genotype was associated with cagA-positive strains (p < 0.05). No association was found between the vacA and cagA genotypes and clinical outcomes.

Identification of mycobacteria by mycolic acid pattern.

BACKGROUND: Tuberculosis caused by Mycobacterium tuberculosis is a public health problem which has increased in importance during the last 12 years, due in part to the increasing number of cases caused by the association of acquired immunodeficiency syndrome (AIDS) and the appearance of multiple drug-resistant strains. Other mycobacteria which are often indistinguishable from tuberculosis have also increased. METHODS: Mycolic acid patterns were obtained from 53 clinical isolates of sputum, cerebrospinal fluid, bronchial washing, corneal ulcer, and bone marrow, as well as from 11 acid-fast stain smear-positive clinical specimens. Standardized mycolic acid extraction method was used to ensure the maximal extraction of mycolic acid derivatives to enhance the sensitivity of the method. A chromatographic column different from what others have employed and a different gradient elution from those reported in the literature were used, making a correlation between retention times for the chromatographic peaks obtained in this study and those previously reported for mycolic acid patterns from a strain of Mycobacterium avium necessary. Then, a comparison of retention times of mycolic acid pattern obtained in this study and those previously reported in the literature was carried out. Strains were identified as Mycobacterium tuberculosis complex, Mycobacterium avium complex, Mycobacterium fortuitum, Mycobacterium chelonae and Mycobacterium kansasii in less than 24 hours. RESULTS: In direct analysis of acid-fast stain smearpositive from 1+ to 4+ specimens, mycolic acid patterns were identified as Mycobacterium tuberculosis complex, Mycobacterium avium complex, Mycobacterium chelonae, and Mycobacterium kansasii, with a strong signal even in light 1+ positive samples. CONCLUSIONS: The results showed that identification of mycobacteria through mycolic acid pattern is a rapid, sensitive, and very useful method for identification of mycobacteria in the early diagnosis of the mycobacteriosis.

Drug Susceptibility of Mycobacterium tuberculosisThrough the Mycolic Acid Index.

The methods accepted to determine antimicrobial drug susceptibility of mycobacteria are based on the determination of the microorganisms' growth on solid or liquid medium containing a specified concentration of a single drug.

Antibiotic susceptibility patterns of Helicobacter pylori strains isolated from northeastern Mexico.

There are reports of increased antibiotic resistance rates in Helicobacter pylori strains around the world. The aim of this study was to determine the susceptibility patterns in H. pylori strains isolated in Monterrey, Mexico. We studied 62 strains isolated from the same number of symptomatic adult patients. Metronidazole (Mtz), clarithromycin (Cla), amoxicillin (Amx) and tetracycline (Tet) were tested by the E-test method. We observed that 37.1% of the strains were resistant to Mtz (MIC > or = 8 mg/L), and 8.1% to Cla (MIC > or = 8 mg/L), but we did not observe resistance to Amx (MIC > or = 2 mg/L) or Tet (MIC > or = 4 mg/L). In northeastern Mexico, the percentage of resistant strains was similar to that observed in developed countries. These results confirm that it is necessary to evaluate the susceptibility patterns of H. pylori strains by geographic area.

[HCV and HBV seropositivity in university students of the State of Nuevo Leòn, Mexico]. / Seropositividad de la infección por HCV y HBV, en Estudiantes Universitarios del Estado de Nuevo León, México.

BACKGROUND: Viral hepatitis is a contagious disease. Patients infected with hepatitis B virus (HBV) or hepatitis C virus (HCV), may be either chronically symptomatic or asymptomatic, and suffer cirrhosis and high risk of hepatic carcinoma. AIMS: Asymptomatic carriers of HBV surface antigen (HBs-Ag) or with anti-HCV antibodies are potentially infectious, and therefore a risk to public health. METHODS: This work seeks to establish the frequency of seropositivity for HBs-Ag and anti-HCV antibodies in a population of 774 newly accepted students of the Medical School of the Autonomous University of Nuevo Leon, whose average age was 18 years. Second generation ELISA test were used to screen for HBs-Ag and anti-HCV antibodies. HBs-Ag was confirmed by a neutralization test and anti-HCV antibodies were confirmed by a RIBA test. RESULTS: Three sera were positive for HBs-Ag by ELISA and only one serum (0.13% of analyzed samples) was confirmed by the neutralization technique. On the other hand 12 sera were positive for anti-HCV antibodies by ELISA, and eight of these were confirmed by RIBA (1.03% of the analyzed samples). Intensive reactivity bands were found in two sera, and weak reactivity bands were found in six sera. ELISA screening for anti-HCV antibodies showed 0.5% of false positives. CONCLUSIONS: This study shows that the frequency of anti-HCV antibodies is 7.95% times higher than that found for HBs-Ag. All seropositive patients were asymptomatic and potentially infective. This demonstrates the need to routinely screen for HBs-Ag and anti-HCV antibodies to establish the prevalence of these diseases in our area.

Estudio prospectivo observacional para evaluar, desde la perspectiva del paciente, el consejo sanitario preoperatorio administrado en fumadores intervenidos en Cirugía Mayor Ambulatoria / Prospective observational study to evaluate from the patient’s perspective the anesthesiologist-delivered interventions to quit smoking before ambulatory surgery

Introducción: Los pacientes fumadores presentan un riesgo aumentado de complicaciones perioperatorias, incluyendo los pacientes intervenidos en cirugía ambulatoria siendo las más relevantes las complicaciones respiratorias y las de infección de la herida quirúrgica. La consulta de anestesia representa una oportunidad excelente para promover el cese del tabaquismo. Encuestas realizadas en diferentes países muestran que los anestesiólogos administran consejo sanitario de forma irregular a los pacientes fumadores que precisan una intervención quirúrgica. Sin embargo, ningún estudio ha evaluado directamente, a través del paciente intervenido en cirugía ambulatoria, el consejo administrado en relación al tabaquismo y la cirugía. Material y métodos: Estudio monocéntrico, transversal, realizado en un hospital universitario de tercer nivel. Se realizó una encuesta telefónica a pacientes fumadores vistos en la consulta de anestesia. Se evaluaron aspectos relacionados con la actitud del anestesiólogo ante el paciente fumador mediante cuestiones recomendadas para disminuir los riesgos postoperatorios: si advertía de los riesgos del tabaquismo, si aconsejaba dejar de fumar antes de la cirugía y si enviaba al paciente a una unidad de tabaquismo para favorecer la deshabituación. Al finalizar la recogida de datos, se encuestó a los anestesiólogos para evaluar la autopercepción que los mismos reportaban en relación al consejo sanitario a pacientes fumadores. Resultados: Se analizaron 615 consultas hallándose un total de 123 pacientes fumadores (mediana de paquetes año de 12 [rango intercuartil 3,6-23,12]). En relación con la intervención de los anestesiólogos, el 37 % avisó de los riesgos del tabaco y cirugía, un 23 % aconsejó dejar de fumar, y tan solo el 3 % de los mismos envió a los pacientes a una unidad de tabaquismo. En contraste, el 75 % de los anestesiólogos encuestados consideraba que frecuentemente o siempre aconsejaba dejar de fumar antes de la cirugía. Conclusiones: Este estudio muestra que existe una gran diferencia entre las evidencias que muestran la relevancia del abandono del tabaquismo antes de la cirugía y la falta de implementación de las mismas en la práctica habitual durante la consulta de anestesia (AU)

Background: Smokers undergoing surgery, including those experiencing ambulatory surgery are at a higher risk of complications than non-smokers. Preoperative evaluation by an anesthesiologist could provide an excellent opportunity to promote smoking cessation. Previous surveys of anesthesiologists have found that self-reported tobacco counselling rates have room for improvement, however there is no information from the patient’s perspective regarding the smoking cessation interventions in the preoperative ambulatory clinic. Methods: A single-center study was conducted in a tertiary teaching hospital. A telephone survey was realized to all adult cigarette smokers who visited the preoperative ambulatory clinic. The survey recorded the anesthesiologist-delivered interventions to quit smoking before surgery. At the end of the study period, a questionnaire was performed to evaluate the self-reported tobacco counseling of the anesthesiologist Results: Six hundred and fifteen patients were evaluated, of these 123 were current smokers (median packs-years [interquartile range] 12 [3,6-23,12] With regard to preoperative interventions, only 37 % advised patients about the health risks of smoking and 23 % advised them to quit before surgery. Provision of assistance to help the patient to quit was provided in 3 % of cases. In contrast, the self-reported tobacco counseling revealed that 75 % of anesthesiologists stated having advised the patients about the health risks of smoking. Conclusions: This study shows a significant gap between evidence for the advantages of preoperative smoking interventions and implementation in clinical practice. Future studies are badly needed to evaluate the provision of educational materials and other interventions to improve tobacco-counseling rates among anesthesiologists (AU)

[New challenges in the treatment of dyslipidemia and cardiovascular risk]. / Nuevos retos en el tratamiento de las dislipidemias y del riesgo cardiovascular.

Statin therapy reduces the incidence of cardiovascular (CV) disease by 30-40%. However, some risk of unprevented CV complications still persists. Thus, new drugs that when associated to the statins favorably modify the lipid profile and further reduce CV risk are needed. In this clinical commentary, we review the role of other lipids (HDL cholesterol and triglycerides) in CV risk and those potentially useful agents that could be added to statins. Fibrates are especially effective to decrease triglycerides, whilst niacin has a global effect, decreasing LDL cholesterol and triglycerides and is the most effective drug to increase HDL cholesterol. The association of statins plus niacin may be the immediate future to tackle the comprehensive treatment of dyslipidemia and potentially further reduce the risk of CV disease.

Estudio radiológico para evaluar la difusión de dos volúmenes (10 vs. 20ml) de contraste radiopaco en el bloqueo de las ramas cutáneas de los nervios intercostales en la línea medio axilar (BRILMA) en un modelo experimental porcino / Radiological study to evaluate the spreading of two volumes (10 vs. 20ml) of radiological contrast in the block of cutaneous branches of intercostal nerves in medial axillary line (BRILMA) in a porcine experimental model

Objetivo: Los bloqueos interfasciales de la pared torácica se están desarrollando como alternativa a los bloqueos centrales en la cirugía de mama. Sin embargo, existen escasos estudios que hayan evaluado la extensión anatómica del anestésico local. Nuestro objetivo fue analizar, mediante fluoroscopia, la difusión de dos volúmenes (10 vs. 20ml) de contraste radiopaco (iopamidol) en el bloqueo del plano serrato-intercostal (BRILMA) en un modelo experimental porcino. Material y métodos: Se seleccionaron 10 cerdos de la raza Large-White a los que se realizó un bloqueo BRILMA ecoguiado bilateral, administrando 10 y 20ml de iopamidol en hemitórax izquierdo y derecho, respectivamente. La difusión del contraste se analizó por fluoroscopia. Se utilizó el test de correlación de Spearman para evaluar la relación entre el volumen administrado y la difusión radiológica. Se consideró significativo un valor de p<0,05. Resultados: Se realizaron 20 bloqueos, pudiéndose analizar 18. La administración de 10ml de contraste se asoció con una difusión media de 2,28±0,31 espacios (IC 95%: 2,01-2,54), mientras que la administración de 20ml mostró una difusión de 3±0,25 espacios (IC 95%: 2,81-3,18). Hubo una correlación significativa entre el volumen inyectado y la difusión del contraste (coeficiente de correlación de Spearman de 0,81; p=0,0001). Conclusión: Nuestros resultados demuestran una difusión dependiente del volumen en el bloqueo BRILMA, aunque sin guardar una relación 1:1. Duplicar el volumen ha incrementado en un 31% los segmentos bloqueados. Estos hallazgos, si se corroboran en la práctica clínica, permitirían un ajuste más preciso en el volumen de anestésico administrado

Objective: Interfascial blocks of the thoracic wall are being developed as an alternative to central blocks in breast surgery. However, there are few studies that have evaluated the anatomical extension of the local anaesthetic. The objective of this study was to analyse, using fluoroscopy, the spreading of two volumes (10 vs. 20ml) of radiological contrast in the serratus-intercostal plane block in an experimental pig model. Material: and methods Ten Large-White breed pigs were selected to have a bilateral ultrasound serratus-intercostal plane block performed, with the administering of 10ml and 20ml of iopamidol in the right and left hemithorax, respectively. The spreading of contrast was analysed by fluoroscopy. The Spearman test correlation was used to evaluate the relationship between the administered volume and radiological spreading. A value of P<.05 was considered significant. Results: Twenty anaesthetic blocks were performed, being able to analyse 18 of them. The administration of 10ml of contrast was associated with a mean spreading of 2.28±0.31 (95% CI; 2.01-2.54) intercostal spaces, while the administration of 20ml showed a spreading of 3±0.25 (95% CI; 2.81-3.18) intercostal spaces. There was a significant correlation between the injected volume and the spreading of the contrast (Spearman correlation coefficient of 0.81; P=.0001). Conclusion: The results showed a spreading of volume subject to the serratus-intercostal plane block, although not maintaining a 1:1 ratio. Doubling the volume increased the blocked segments by 31%. These findings, if corroborated in the clinical practice, would allow a more precise adjustment in the anaesthetic volume administered

Preparation of Entamoeba histolytica antigens without enzymatic inhibitors.

The goal of this work is to report a novel assay that preserves antigenicity of extracts with high protease content without using enzymatic inhibitors. A great reduction of proteolytic activity in the insoluble chloroform/methanol and heated amoebic fraction (IC:MC) was obtained by this method, even in the presence of sodium dodecyl sulphate and 2-mercaptoethanol. The substrates azo-casein and the hide powder azure were used to determine the reduction of proteolytic activity of IC:MC compared with the activity of crude extract and crude extract with iodoacetamide. The IC:MC SDS-PAGE pattern shows a higher quantity of bands than extract with the inhibitor iodoacetamide or than crude extract. In addition, anti-Entamoeba histolytica antibodies from amoebic liver abscess patients recognized a richer antigenic Western blot pattern in the IC:MC fraction than in crude extract alone or with inhibitor. The described method has proved to be suitable to preserve amoebic antigens for its use in diagnostic tests and it can be used for immunological response studies against E. histolytica antigens. Furthermore we propose that this method to obtain the IC:MC fraction can be applied for the study of other microorganisms or cells with high enzymatic content.

Building a small polypropionate library. Synthesis of all possible stereotetrads (building blocks for polyketide synthesis) from furan.

The all diastereomeric stereotetrads (polypropionate fragments) were synthesized in a stereodivergent fashion, starting from the Diels-Alder adducts of furan with acrylic acid and (-)-2-camphanoxyacrylonitrile, respectively. The key intermediates of these sequences were the oxanorbornenic sulfones 7, (-)-53 and (+)-54. Regio- and stereocontrolled alkylative ring opening of these intermediates afforded the cyclohexenyl sulfones 14, (+)-55 and (-)-58 which were transformed into the desired stereotetrads 30, 31, 40, 41, (+)-62, (+)-63, (-)-66, and (+)-69.

Determination of drug susceptibility of Mycobacterium tuberculosis through mycolic acid analysis.

In the present work a rapid method to determine the susceptibility of Mycobacterium tuberculosis to isoniazid and streptomycin by determining levels of mycolic acids by high-performance liquid chromatography (HPLC) was developed. Mycobacterial growth kinetics in the presence and absence of antituberculosis drugs was characterized by evaluating the total area corresponding to mycolic acid peaks (TAMA). Results show a linear relationship between the logarithm of CFU per milliliter and TAMA and show that it is possible to detect growth inhibition of M. tuberculosis in the presence of isoniazid or streptomycin by using HPLC in 3 and 4 days, respectively.

Mycolic acid index susceptibility method for Mycobacterium tuberculosis.

A rapid drug susceptibility test to measure the susceptibility of Mycobacterium tuberculosis to isoniazid (INH) and rifampin (RIF) using clinical isolates and a newly defined mycolic acid index (MAI) was evaluated. A total of 200 clinical isolates of M. tuberculosis were tested for susceptibility or resistance to INH and RIF by the MAI susceptibility and indirect-proportion methods. Overall, there was agreement between the two methods for 398 (99.5%) of the 400 total tests. Specifically, the sensitivity of the MAI susceptibility method for INH and RIF was 97.6 and 100%, respectively. The specificity and positive predictive value were 100% for both drugs, and the negative predictive value for INH and RIF was 98.3 and 100%, respectively. In conclusion, the MAI susceptibility method described here can be used for rapid drug susceptibility testing of M. tuberculosis clinical isolates within 5 days after clinical isolates are incubated in the presence or absence of an antituberculosis drug.

Nuevos retos en el tratamiento de las dislipidemias y del riesgo cardiovascular / New challenges in the treatment of dyslipidemia and cardiovascular risk

Las estatinas reducen la incidencia de enfermedad cardiovascular (CV) un 30-40%, pero persiste un riesgo de complicaciones CV que no previenen. Se precisan, pues, nuevos fármacos, que asociados a las estatinas modifiquen favorablemente los lípidos y reduzcan aún más la incidencia de complicaciones CV. En este comentario clínico revisamos la importancia de otros lípidos (colesterol ligado a lipoproteínas de alta densidad [c-HDL] y triglicéridos) en el riesgo CV y los fármacos potencialmente útiles para asociar a las estatinas. Los fibratos son especialmente efectivos para reducir los triglicéridos, mientras que la niacina tiene un efecto global, reduciendo el colesterol ligado a lipoproteínas de baja densidad (c-LDL) y los triglicéridos y es el fármaco más eficaz para elevar el c-HDL. La asociación de estatinas y niacina puede ser el futuro inmediato para abordar el tratamiento de la dislipidemia de forma integral y, potencialmente, reducir aún más el riesgo de enfermedad CV (AU)

Statin therapy reduces the incidence of cardiovascular (CV) disease by 30-40%. However, some risk of unprevented CV complications still persists. Thus, new drugs that when associated to the statins favorably modify the lipid profile and further reduce CV risk are needed. In this clinical commentary, we review the role of other lipids (HDL cholesterol and triglycerides) in CV risk and those potentially useful agents that could be added to statins. Fibrates are especially effective to decrease triglycerides, whilst niacin has a global effect, decreasing LDL cholesterol and triglycerides and is the most effective drug to increase HDL cholesterol. The association of statins plus niacin may be the immediate future to tackle the comprehensive treatment of dyslipidemia and potentially further reduce the risk of CV disease (AU)