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Basile G, Gallioli A, Territo A, Verri P, Gaya JM, Afferi L, Diana P, Sanz I, Dieguez L, Uleri A, Berquin C, Gavrilov P, Algaba F, Palou J, Breda A. Cumulative morbidity of ureteroscopy for upper tract urothelial carcinoma. Actas Urol Esp 2024:S2173-5786(24)00067-2. [PMID: 38735432 DOI: 10.1016/j.acuroe.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE To assess complications after ureteroscopy (URS) for upper tract urothelial carcinoma (UTUC) management and to assess its postoperative cumulative morbidity burden using the Comprehensive Complication Index (CCI). MATERIALS AND METHODS Single center retrospective study including patients submitted to URS for UTUC suspicion. URSs were both diagnostic and operative. Postoperative complications were recorded according to the EAU Guidelines and graded according to Clavien-Dindo Classification (CDC). The cumulative postoperative morbidity burden developed by patients experiencing multiple events was assessed using the CCI. Multivariable logistic regression (MLR) analyses identified factors independently associated with the development of any grade and major postoperative complications. RESULTS Overall, 360 patients with UTUC suspicion were included with a total of 575 URSs performed. The cumulative number of all postoperative complications recorded was 111. In 86 (15%) procedures, patients experienced at least one postoperative complication, while 25 (4.3%) experienced more than one complication. Of these, 16 (14%) were severe (CDC ≥ IIIa). The most frequent type of complications were urinary (34%), bleeding (30%) and infectious (30%). The higher the CDC grade, the higher the median CCI, with a statistically significant increase in median CCI from CDC II to major complications. Patients who experienced intraoperative complications were at higher risk of developing any grade and major postoperative complications at MLR. CONCLUSIONS Complications after ureteroscopy for UTUC are relatively uncommon events. Patients who experience intraoperative complications are at higher risk of developing postoperative complications. The comprehensive complication index appeared more representative of the cumulative postoperative morbidity rather than the Clavien-Dindo classification.
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Affiliation(s)
- G Basile
- Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain; Servicio de Urología, IRCCS Hospital San Raffaele, Milán, Italy.
| | - A Gallioli
- Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - A Territo
- Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - P Verri
- Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain; Servicio de Urología, Universidad de Turín, Turín, Italy
| | - J M Gaya
- Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - L Afferi
- Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - P Diana
- Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - I Sanz
- Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - L Dieguez
- Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - A Uleri
- Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain; Servicio de Urología, Universidad Humanitas, Rozzano, Milán, Italy
| | - C Berquin
- Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain; Servicio de Urología, Hospital Universitario de Gante, Bélgica, Centro acreditado en la Red Europea de Referencia (ERN) eUROGEN, Belgium
| | - P Gavrilov
- Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - F Algaba
- Área de Anatomía Patológica, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - J Palou
- Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - A Breda
- Servicio de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
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de la Plaza Llamas R, Soto García P, Sun W, Gemio Del Rey IA, Díaz Candelas DA, Gorini L, Al Shwely Abduljabar F, Latorre Fragua RA. Comparison and combination of three data sources from patient medical records to determine optimal quantification of postoperative morbidity according to the Clavien Dindo Classification and the Comprehensive Complication Index. A prospective study. Cir Esp 2024:S2173-5077(24)00112-1. [PMID: 38705257 DOI: 10.1016/j.cireng.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 03/19/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION It is currently unknown which data sources from the clinical history, or combination thereof, should be evaluated to achieve the most complete calculation of postoperative complications (PC). The objectives of this study were: to analyze the morbidity and mortality of 200 consecutive patients undergoing major surgery, to determine which data sources or combination collect the maximum morbidity, and to determine the accuracy of the morbidity reflected in the discharge report. METHODS Observational and prospective cohort study. The sum of all PC found in the combined review of medical notes, nursing notes, and a specific form was considered the gold standard. PC were classified according to the Clavien Dindo Classification and the Comprehensive Complication Index (CCI). RESULTS The percentage of patients who presented PC according to the gold standard, medical notes, nursing notes and form were: 43.5%, 37.5%, 35% and 18.7% respectively. The combination of sources improved CCI agreement by 8%-40% in the overall series and 39.1-89.7 % in patients with PC. The correct recording of PC was inversely proportional to the complexity of the surgery, and the combination of sources increased the degree of agreement with the gold standard by 35 %-67.5% in operations of greater complexity. The CDC and CCI of the discharge report coincided with the gold-standard values in patients with PC by 46.8% and 18.2%, respectively. CONCLUSIONS The combination of data sources, particularly medical and nursing notes, considerably increases the quantification of PC in general, most notably in complex interventions.
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Affiliation(s)
- Roberto de la Plaza Llamas
- Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Spain; Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Guadalajara, Spain.
| | - Paula Soto García
- Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Spain.
| | - Wenzhong Sun
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Guadalajara, Spain.
| | - Ignacio Antonio Gemio Del Rey
- Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Spain; Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Guadalajara, Spain.
| | | | - Ludovica Gorini
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Guadalajara, Spain.
| | - Farah Al Shwely Abduljabar
- Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Spain; Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Guadalajara, Spain.
| | - Raquel Aránzazu Latorre Fragua
- Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, Spain; Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Guadalajara, Spain.
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Parrales-Mora M, Cremades M, Parés D, García RD, Pardo Aranda F, Zárate Pinedo A, Navinés López J, Espin Alvarez F, Julian-Ibanez JF, Cugat Andorra E. Morbidity and mortality of elderly patients with pancreaticobiliary disease according to age and comprehensive geriatric assessment: A prospective observational study. Gastroenterol Hepatol 2024; 47:439-447. [PMID: 37741326 DOI: 10.1016/j.gastrohep.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/11/2023] [Accepted: 09/15/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND This study was designed to analyze the influence of age and comprehensive geriatric evaluation on clinical results of pancreaticobiliary disease management in elderly patients. METHODS A prospective observational study has been undertaken, including 140 elderly patients (over 75 years) with benign pancreaticobiliary disease. Patients were divided according to age in the following groups: group 1: 75-79 years old; group 2: 80-84 years old; group 3: 85 years and older. They underwent a comprehensive geriatric assessment with different scales: Barthel Index, Pfeiffer Index, Charlson Index, and Fragility scale, at admission and had been follow-up 90 days after hospital discharge to analyze its influence on morbidity and mortality. RESULTS Overall, 140 patients have been included (group 1=51; group 2=43 and group 3=46). Most of them, 52 cases (37.8%), had acute cholecystitis, followed by 29 cases of acute cholangitis (20.2%) and acute pancreatitis with 25 cases (17.9%). Significant differences has been observed on complications in different age groups (p=0.033). Especially in patients with a Barthel Index result ≤60, which suggests that these less functional patients had more severe complications after their treatment (p=0.037). The mortality rate was 7.1% (10 patients). CONCLUSIONS No significant differences were found between age, morbidity and mortality in elderly patients with pancreaticobiliary disease. Comprehensive geriatric scales showed some utility in their association with specific complications.
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Affiliation(s)
- Mauricio Parrales-Mora
- Hepatobiliary and Pancreas Unit, Department of General and Digestive Surgery, Spain; Department of General and Digestive Surgery, School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Manel Cremades
- Hepatobiliary and Pancreas Unit, Department of General and Digestive Surgery, Spain; Department of General and Digestive Surgery, School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - David Parés
- Department of General and Digestive Surgery, School of Medicine, Universitat Autònoma de Barcelona, Spain.
| | - Rebeca D García
- Department of General and Digestive Surgery, School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Fernando Pardo Aranda
- Department of General and Digestive Surgery, School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Alba Zárate Pinedo
- Hepatobiliary and Pancreas Unit, Department of General and Digestive Surgery, Spain; Department of General and Digestive Surgery, School of Medicine, Universitat Autònoma de Barcelona, Spain
| | - Jordi Navinés López
- Hepatobiliary and Pancreas Unit, Department of General and Digestive Surgery, Spain
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Ambarika R, Said MSM, Adiutama NM, Anggraini NA, Poddar S, Abdullah BF. Knowledge and Awareness of Stroke in Rural and Urban Communities in Indonesia. Enferm Clin (Engl Ed) 2024:S2445-1479(24)00028-6. [PMID: 38641005 DOI: 10.1016/j.enfcle.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/11/2024] [Accepted: 01/28/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION The average stroke morbidity rate, especially in rural communities, is higher when compared to the national average. OBJECTIVE Identify the profile of knowledge and awareness of stroke in rural and urban communities and analyze the differences between the two. METHOD Respondents who met the requirements answered a questionnaire containing a total of 41 items regarding knowledge and awareness of stroke. Characteristic data obtained includes age, gender, education, occupation, and ethnicity. Differences in characteristics were analyzed using Mann-Whitney, and the profiles of knowledge and awareness of stroke in rural and urban groups were analyzed using independent t tests to see differences between the two. RESULT Differences in the characteristics of rural and urban groups were only in education (p = 0.036) and occupation (p = 0.021). The mean score of the knowledge domain for the rural group was 72.53 (SD = 11.04), for the urban group it was 81.06 (SD = 11.12). The mean score awareness of stroke domain in the rural group was 72.18 (SD = 11.01), the urban group was 85.51 (SD = 11.67). The profile of knowledge and awareness of stroke in rural communities was significantly lower than in urban communities. The significance value was (p = 0.004) for knowledge and (p = 0.002) for awareness of stroke. CONCLUSION Based on the findings, it is reasonable to suspect that educational and occupational factors contribute to differences in the profile of knowledge and awareness of stroke in the two groups. Therefore, the stroke awareness campaign strategy for rural communities needs to be specifically designed by emphasizing/considering educational and occupational factors.
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Affiliation(s)
| | | | | | | | - Sandeep Poddar
- Lincoln University College, Wisma Lincoln, 12-18, Jalan SS 6/12, 47301 Petaling Jaya, Selangor, Malaysia
| | - Bibi Florina Abdullah
- Lincoln University College, Wisma Lincoln, 12-18, Jalan SS 6/12, 47301 Petaling Jaya, Selangor, Malaysia
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de la Plaza Llamas R, Parés D, Soria Aledó V, Cabezali Sánchez R, Ruiz Marín M, Senent Boza A, Romero Simó M, Alonso Hernández N, Vallverdú-Cartié H, Mayol Martínez J. Assessment of postoperative morbidity in Spanish hospitals: Results from a national survey. Cir Esp 2024:S2173-5077(24)00096-6. [PMID: 38615908 DOI: 10.1016/j.cireng.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/19/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND The methodology used for recording, evaluating and reporting postoperative complications (PC) is unknown. The aim of the present study was to determine how PC are recorded, evaluated, and reported in General and Digestive Surgery Services (GDSS) in Spain, and to assess their stance on morbidity audits. METHODS Using a cross-sectional study design, an anonymous survey of 50 questions was sent to all the heads of GDSS at hospitals in Spain. RESULTS The survey was answered by 67 out of 222 services (30.2%). These services have a reference population (RP) of 15 715 174 inhabitants, representing 33% of the Spanish population. Only 15 services reported being requested to supply data on morbidity by their hospital administrators. Eighteen GDSS, with a RP of 3 241 000 (20.6%) did not record PC. Among these, 7 were accredited for some area of training. Thirty-six GDSS (RP 8 753 174 (55.7%) did not provide details on all PC in patients' discharge reports. Twenty-four (37%) of the 65 GDSS that had started using a new surgical procedure/technique had not recorded PC in any way. Sixty-five GDSS were not concerned by the prospect of their results being audited, and 65 thought that a more comprehensive knowledge of PC would help them improve their results. Out of the 37 GDSS that reported publishing their results, 27 had consulted only one source of information: medical progress records in 11 cases, and discharge reports in 9. CONCLUSIONS This study reflects serious deficiencies in the recording, evaluation and reporting of PC by GDSS in Spain.
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Affiliation(s)
- Roberto de la Plaza Llamas
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, Spain.
| | - David Parés
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Víctor Soria Aledó
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario JM Morales Meseguer, Murcia, Spain
| | | | - Miguel Ruiz Marín
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, Spain
| | - Ana Senent Boza
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Manuel Romero Simó
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Dr. Balmis de Alicante, Spain
| | - Natalia Alonso Hernández
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Son Espases, Palma de Mallorca, Spain
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Miranda-Lloret P, Plaza-Ramírez E, Simal-Julián JA, Pancucci G, Cañete A, Montoya-Filardi A, Llavador G. Lateral-type posterior fossa ependymomas in pediatric population. Neurocirugia (Astur : Engl Ed) 2024; 35:87-94. [PMID: 38244924 DOI: 10.1016/j.neucie.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/03/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Lateral-type posterior fossa ependymomas are a well-defined subtype of tumours both clinically and pathologically, with a poor prognosis. Their incidence is low and surgical management is challenging. The objective of the present work is to review our series of lateral-tye posterior fossa ependymomas and compare our results with those of previous series. METHODS Among 30 cases of ependymoma operated in our paediatric department in the last ten years, we identified seven cases of lateral-type posterior fossa ependymomas. We then performed a retrospective, descriptive study. RESULTS Mean age of our patients was 3.75 years. 6 cases presented with hydrocephalus. Mean tumour volume at diagnosis was 61 cc. A complete resection was achieved in six cases and a near-total resection in one patient. 5 patients transiently required a gastrostomy and a tracheostomy. Mean follow-up was 58 months. One case progressed along this period and eventually died. 4 cases of hydrocephalus required a ventriculoperitoneal CSF shunt and two were managed with a third ventriculostomy. At last follow-up 4 patients carried a normal life and two displayed a mild restriction according to Lansky´s scale. CONCLUSIONS The aim of surgical treatment in lateral-type posterior fossa ependymomas is complete resection. Neurological deficits associated to lower cranial nerve dysfunction are common but transient. Deeper genetic characterization of these tumours may identify risk factors that guide stratification of adjuvant therapies.
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Affiliation(s)
- Pablo Miranda-Lloret
- Servicios de Neurocirugía, Oncología Pediátrica, Radiología Pediátrica y Anatomía Patológica, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - Estela Plaza-Ramírez
- Servicios de Neurocirugía, Oncología Pediátrica, Radiología Pediátrica y Anatomía Patológica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Juan Antonio Simal-Julián
- Servicios de Neurocirugía, Oncología Pediátrica, Radiología Pediátrica y Anatomía Patológica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Giovanni Pancucci
- Servicios de Neurocirugía, Oncología Pediátrica, Radiología Pediátrica y Anatomía Patológica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Adela Cañete
- Servicios de Neurocirugía, Oncología Pediátrica, Radiología Pediátrica y Anatomía Patológica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Alejandro Montoya-Filardi
- Servicios de Neurocirugía, Oncología Pediátrica, Radiología Pediátrica y Anatomía Patológica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Gemma Llavador
- Servicios de Neurocirugía, Oncología Pediátrica, Radiología Pediátrica y Anatomía Patológica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Forcada C, Gómez-Hernández MT, Rivas C, Fuentes M, Novoa N, Varela G, Jiménez M. Operative outcomes and middle-term survival of robotic-assisted lung resection for clinical stage IA lung cancer compared with video-assisted thoracoscopic surgery. Cir Esp 2024; 102:90-98. [PMID: 37967649 DOI: 10.1016/j.cireng.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Despite limited published evidence, robotic-assisted thoracoscopic surgery (RATS) for anatomic lung resection in early-stage lung cancer continues growing. The aim of this study is to evaluate its safety and oncologic efficacy compared to video-assisted thoracoscopic surgery (VATS). METHODS Single-centre retrospective study of all patients with resected clinical stage IA NSCLC who underwent RATS or VATS anatomic lung resection from June 2018 to January 2022. RATS and VATS cases were matched by propensity scoring (PSM) according to age, sex, histology, and type of resection. Short-term outcomes were compared, and the Kaplan-Meier method and log-rank test were used to evaluate the overall survival (OS) and disease-free survival (DFS). RESULTS 321 patients (94 RATS and 227 VATS cases) were included. After PSM, 94 VATS and 94 RATS cases were compared. Demographics, pulmonary function, and comorbidity were similar in both groups. Overall postoperative morbidity was comparable for RATS and VATS cases (20.2% vs 25.5%, P = 0.385, respectively). Pathological nodal upstaging was similar in both groups (10.6% in RATS and 12.8% in VATS). During the 3.5-year follow-up period (median: 29 months; IQR: 18-39), recurrence rate was 6.4% in RATS group and 18.1% in the VATS group (P = 0.014). OS and DFS were similar in RATS and VATS groups (log rank P = 0.848 and P = 0.117, respectively). CONCLUSION RATS can be performed safely in patients with early-stage NSCLC. For clinical stage IA disease, robotic anatomic lung resection offers better oncologic outcomes in terms of recurrence, although there are no differences in OS and DFS compared with VATS.
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Affiliation(s)
- Clara Forcada
- Service of Thoracic Surgery, Salamanca University Hospital. Salamanca, Spain
| | | | - Cristina Rivas
- Service of Thoracic Surgery, Salamanca University Hospital. Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca, Salamanca, Spain
| | - Marta Fuentes
- Service of Thoracic Surgery, Salamanca University Hospital. Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca, Salamanca, Spain
| | - Nuria Novoa
- Service of Thoracic Surgery, Salamanca University Hospital. Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca, Salamanca, Spain
| | - Gonzalo Varela
- Salamanca Institute of Biomedical Research, Salamanca, Spain
| | - Marcelo Jiménez
- Service of Thoracic Surgery, Salamanca University Hospital. Salamanca, Spain; Salamanca Institute of Biomedical Research, Salamanca, Spain; University of Salamanca, Salamanca, Spain
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Suárez Álvarez Ó, Ruiz-Cantero MT. [Morbidity due to chronic diseases and their health care in Asturias: a gender analysis]. Gac Sanit 2023; 37:102334. [PMID: 37988970 DOI: 10.1016/j.gaceta.2023.102334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE To determine gender differences in the magnitude and complexity of chronic diseases and gender inequalities in health care in the adult population of Asturias in 2022. METHOD A cross-sectional population study in people (>14 years) with at least one diagnosis of chronic disease (780,566 inhabitants). SOURCES OF INFORMATION computer program for morbidity groups (Ministry of Health), Electronic medical record of primary care and hospital. Comparative analysis by sex and age, the mean values of chronic diseases and complexity index (Student's t test and one-way ANOVA), and probability (odds ratio and 95% CI) of suffering from specific chronic diseases, making one or more visits to the hospital emergency department or one or more admissions to hospital. RESULTS 89.9% of women and 82.1% of men were registered with at least one chronic disease. The mean was higher in women (4.36) than in men (3.22) (p<0.001). Complexity index: men 4.56 and women 5.85 (p<0.001). Results show that women are more likely to attend the hospital emergency department, with an attendance rate of 50% for the diseases cited, compared with men at 29%. The rate of hospital admission is higher in men in 13 of the 14 diseases studied (85%). CONCLUSIONS Gender analysis can also be applied to secondary sources of the National Health System. Despite the greater magnitude and complexity of chronic diseases in women, there is a higher frequency of hospital admissions in men compared to women with the same diseases. This implies an unequal care profile in the field of hospital admissions that the scientific literature associates with gender biases in health care.
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Affiliation(s)
- Óscar Suárez Álvarez
- Programa de Doctorado en Ciencias de la Salud, Universidad de Alicante, Alicante, España.
| | - María Teresa Ruiz-Cantero
- Grupo de Investigación en Salud Pública, Universidad de Alicante, Alicante, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
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Fra-Fernández S, Muñoz-Molina GM, Cabañero-Sánchez A, Del Campo-Albendea L, Bolufer-Nadal S, Embún-Flor R, Martínez-Hernández NJ, Moreno-Mata N. Postoperative morbidity after anatomical lung resections by VATS vs thoracotomy: Treatment and intention-to-treat analysis of the Spanish Video-Assisted Thoracic Surgery Group. Cir Esp 2023; 101:778-786. [PMID: 37422151 DOI: 10.1016/j.cireng.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/04/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES In recent years, video-assisted thoracoscopic lung resections (VATS) have been associated with lower morbidity than open surgery. The aim of our study is to compare postoperative morbidity among patients from the national database of the Spanish Group of Video-Assisted Thoracic Surgery (GE-VATS) after open and video-assisted anatomic lung resections using a propensity score analysis. METHODS From December 2016 to March 2018, a total of 3533 patients underwent anatomical lung resection at 33 centers. Pneumonectomies and extended resections were excluded. A propensity score analysis was performed to compare the morbidity of the thoracotomy group (TG) vs the VATS group (VATSG). Treatment and intention-to-treat (ITT) analyses were conducted. RESULTS In total, 2981 patients were finally included in the study: 1092 (37%) in the TG and 1889 (63%) in the VATSG for the treatment analysis; and 816 (27.4%) in the TG and 2165 patients (72.6%) in the VATSG for the ITT analysis. After propensity score matching, in the treatment analysis, the VATSG was significantly associated with fewer overall complications than the TG OR 0.680 [95%CI 0.616, 0.750]), fewer respiratory (OR 0.571 [0.529, 0.616]) cardiovascular (OR 0.529 [0.478, 0.609]) and surgical (OR 0.875 [0.802, 0.955]) complications, lower readmission rate (OR 0.669 [0.578, 0.775]) and a reduction of hospital length of stay (-1.741 ([-2.073, -1.410]). Intention-to-treat analysis showed only statistically significant differences in overall complications (OR 0.76 [0.54-0.99]) in favor of the VATSG. CONCLUSION In this multicenter population, VATS anatomical lung resections have been associated with lower morbidity than those performed by thoracotomy. However, when an intention-to-treat analysis was performed, the benefits of the VATS approach were less prominent.
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Affiliation(s)
- Sara Fra-Fernández
- Department of Thoracic Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | | | | | | | - Sergio Bolufer-Nadal
- Department of Thoracic Surgery, Hospital General Universitario de Alicante, Alicante, Spain
| | - Raúl Embún-Flor
- Department of Thoracic Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Nicolás Moreno-Mata
- Department of Thoracic Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Flores-López B, Naves-Sánchez J, Sosa-Bustamante GP, González AP, Luna-Anguiano JLF, Paque-Bautista C. [Maternal and perinatal morbidities associated to advanced age in pregnant women]. Rev Med Inst Mex Seguro Soc 2023; 61:S83-S89. [PMID: 38011150 PMCID: PMC10761194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 12/31/2022] [Indexed: 11/29/2023]
Abstract
Background Women in advanced maternal age (older than 35 years of age) are at higher risk of obstetric complications and adverse perinatal outcomes than younger women. Objective To know the maternal and perinatal morbidities associated to advanced age in pregnant women. Material and methods Analytical cross-sectional study. Women with resolution of pregnancy in the medical unit were included and distributed in two groups: group 1, advanced age, ≥ 35 years, and group 2, < 35 years. Clinical data, maternal and perinatal morbidities of the newborn (NB) were collected from the medical record. Results We included 240 patients, 120 per group; a significant association of advanced maternal age with maternal morbidities such as diseases prior to pregnancy was demonstrated (p < 0.0001), including diabetes mellitus during pregnancy (p = 0.002), hypertensive disease of pregnancy (p = 0.0001), pregnancy resolution by cesarean section (p = 0.04), obstetric hemorrhage (p = 0.0002), prenatal control with < 5 consultations (p = 0.008), as well as those with perinatal morbidities of the NB: preterm gestational age (p = 0.001), intrauterine growth retardation (p = 0.01), low weight for gestational age (p = 0.001) and admission of the NB to the neonatal intensive care unit (p = 0.007); with multivariate analysis, an association of advanced maternal age with diabetes mellitus, hypertensive disease of pregnancy and obstetric hemorrhage was observed (R2 = 0.9884; p < 0.0001). Conclusion The maternal and perinatal morbidities are associated with advanced age in pregnant women.
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Affiliation(s)
- Betsabé Flores-López
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Gineco Pediatría No. 48, Dirección de Educación e Investigación en Salud. León, Guanajuato, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Jaime Naves-Sánchez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Gineco Pediatría No. 48, Servicio de Obstetricia. León, Guanajuato, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Gloria Patricia Sosa-Bustamante
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Gineco Pediatría No. 48, Dirección de Educación e Investigación en Salud. León, Guanajuato, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Alma Patricia González
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Gineco Pediatría No. 48, Dirección de Educación e Investigación en Salud. León, Guanajuato, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - José Luis Felipe Luna-Anguiano
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Gineco Pediatría No. 48, Dirección General. León, Guanajuato, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Carlos Paque-Bautista
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Gineco Pediatría No. 48, Dirección de Educación e Investigación en Salud. León, Guanajuato, MéxicoInstituto Mexicano del Seguro SocialMéxico
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Marchán-López A, Castro-Conde BA, Cambón-Cotelo J, Quevedo-Vila V, López-Castro J. Clinical-epidemiological profile of the patient attended in a fracture liaison service (FLS) of a regional hospital in north-west of Spain. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T210-T215. [PMID: 36863519 DOI: 10.1016/j.recot.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/25/2022] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION Hip fractures constitute a capital public health issue associated with aging and frailty because of its impact on both quality of life and morbidity and mortality in older people. Fracture liaison services (FLS) have been proposed as tools to minimize this emergent problem. MATERIAL AND METHODS A prospective observational study was conducted with 101 patients treated for hip fracture by the FLS of a regional hospital between October 2019 and June 2021 (20 months). Epidemiological, clinical, surgical, and management variables were collected during admission and up to 30 days after discharge. RESULTS Mean age of patients was 87.6 ± 6.1 years and 77.2% were female. Some degree of cognitive impairment was detected at admission in 71.3% of patients using the Pfeiffer questionnaire, and 13.9% were nursing home residents, and 76.24% could walk independently before the fracture. Fractures were more commonly pertrochanteric (45.5%). Patients were receiving antiosteoporotic therapy in 10.9% of cases. The median surgical delay from admission was 26 h (RIC 15-46 h), the median length of stay was 6 days (RIC 3-9 days) and in-hospital mortality was 10.9%, and 19.8% at 30 days, with a readmission rate of 5%. DISCUSSION Patients treated in our FLS at the beginning of its activity were similar to the general picture in our country in terms of age, sex, type of fracture, and proportion of patients treated surgically. A high mortality rate was observed, and low rates of pharmacological secondary prevention were followed at discharge. Clinical results of FLS implementation in regional hospitals should be assessed prospectively in order to decide their suitability.
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Affiliation(s)
- A Marchán-López
- Servicio de Medicina Interna, Hospital Publico de Monforte, Lugo, España
| | - B A Castro-Conde
- Servicio de Medicina Interna, Hospital Publico de Monforte, Lugo, España
| | - J Cambón-Cotelo
- Servicio de Traumatología, Hospital Público de Monforte, Lugo, España
| | - V Quevedo-Vila
- Unidad de Reumatología, Servicio de Medicina Interna, Hospital Publico de Monforte, Lugo, España
| | - J López-Castro
- Servicio de Medicina Interna, Hospital Publico de Monforte, Lugo, España.
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Ruiz-Nieto N, Aparicio-Collado H, Segura-Cerdá A, Barea-Moya L, Zahonero-Ferriz A, Campillo-Alpera MS, Vilar-Fabra C. Primary central nervous system vasculitis: a diagnostic and therapeutic challenge. A series of 7 patients. Neurologia 2023:S2173-5808(23)00026-3. [PMID: 37120106 DOI: 10.1016/j.nrleng.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/06/2021] [Indexed: 05/01/2023] Open
Abstract
INTRODUCTION Primary central nervous system vasculitis (PCNSV) is a rare disease affecting medium- and small-calibre blood vessels of the central nervous system. OBJECTIVE The aim of this study was to analyse clinical findings and diagnostic aspects, with special attention to histopathological findings, as well as the treatments used and treatment response in patients diagnosed with PCNSV at our hospital. PATIENTS AND METHODS We conducted a retrospective descriptive analysis of patients with a diagnosis of PCNSV at discharge from our centre and meeting the 1988 Calabrese criteria. To this end, we analysed the hospital discharge records of Hospital General Universitario de Castellón between January 2000 and May 2020. RESULTS We analysed a series of 7 patients who were admitted with transient focal alterations and other less specific symptoms such as headache or dizziness; diagnosis was based on histological findings in 5 cases and on suggestive arteriographic findings in the remaining 2. Neuroimaging results were pathological in all cases, and CSF analysis detected alterations in 3 of the 5 patients who underwent lumbar puncture. All patients received initial treatment with megadoses of corticosteroids followed by immunosuppressive treatment. Progression was unfavorable in 6 cases, with fatal outcomes in 4. CONCLUSIONS Despite the diagnostic challenge of PCNSV, it is essential to attempt to reach a definitive diagnosis using such tools as histopathology and/or arteriography studies, in order to promptly establish appropriate treatment and thus reduce the morbidity and mortality of this condition.
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Affiliation(s)
- N Ruiz-Nieto
- Departamento de Neurología, Hospital General Universitario de Castellón, Castellón de la Plana, Spain.
| | - H Aparicio-Collado
- Departamento de Neurología, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - A Segura-Cerdá
- Departamento de Neurología, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - L Barea-Moya
- Departamento de Neurología, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - A Zahonero-Ferriz
- Departamento de Neurología, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - M S Campillo-Alpera
- Departamento de Neurología, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - C Vilar-Fabra
- Departamento de Neurología, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
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Matta M, Buisán Fernández EA, Alonso González M, López-Herrera D, Martínez JA, Orozco AIB. Evaluation of an enhanced recovery after lung surgery (ERALS) program in lung cancer lobectomy: An eight-year experience. Cir Esp 2023; 101:198-207. [PMID: 36906353 DOI: 10.1016/j.cireng.2022.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/26/2022] [Indexed: 03/13/2023]
Abstract
INTRODUCTION Enhanced recovery after lung surgery (ERALS) protocols have proven useful in reducing postoperative stay (POS) and postoperative complications (POC). We studied the performance of an ERALS program for lung cancer lobectomy in our institution, aiming to identify which factors are associated with a reduction of POC and POS. METHODS Analytic retrospective observational study conducted in a tertiary care teaching hospital involving patients submitted to lobectomy for lung cancer and included in an ERALS program. Univariable and multivariable analysis were employed to identify factors associated with increased risk of POC and prolonged POS. RESULTS A total 624 patients were enrolled in the ERALS program. The median POS was 4 days (range 1-63), with 2.9% of ICU postoperative admission. A videothoracoscopic approach was used in 66.6% of cases, and 174 patients (27.9%) experienced at least one POC. Perioperative mortality rate was 0.8% (5 cases). Mobilization to chair in the first 24h after surgery was achieved in 82.5% of cases, with 46.5% of patients achieving ambulation in the first 24h. Absence of mobilization to chair and preoperative FEV1% less than 60% predicted, were identified as independent risk factors for POC, while thoracotomy approach and the presence of POC predicted prolonged POS. CONCLUSIONS We observed a reduction in ICU admissions and POS contemporaneous with the use of an ERALS program in our institution. We demonstrated that early mobilization and videothoracoscopic approach are modifiable independent predictors of reduced POC and POS, respectively.
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Avila CA, Montezuma JM, Molano DG, Gálvez NP, Rico LA, Beltran DO, Grande ER. Role of gestational age and maternal biological factors in early term neonatal morbidity. Bol Med Hosp Infant Mex 2023; 80:183-188. [PMID: 37467438 DOI: 10.24875/bmhim.22000120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 04/13/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The morbidity of early-term newborns (ETNBs) is associated with the immaturity of their organs and maternal biological factors (MBF). In this study, we determined the relationship between MBF and early-term birth. In addition, we assessed the role of gestational age (GA) and MBF in the morbidity of ETNBs compared with full-term newborns (FTNBs). METHODS This retrospective cohort included ETNBs and FTNBs. The frequency of morbidities was compared between groups stratified by GA with the X2 test or Fisher's exact test. The association of MBF with GA and morbidity was calculated using binomial regression models between the variables that correlated with the morbidity of the ETNBs using Spearman's correlation. A significance level of 5% was estimated for all analyses. RESULTS The probability of morbidity at birth for ETNBs was 1.9-fold higher than for FTNBs (37.5% vs. 19.9%), as they required more admission to the neonatal unit and more days of hospitalization; the most frequent pathology was jaundice. The MBF associated with early term birth were hypertensive disorders of pregnancy (aRR = 1.4, 95% confidence interval (CI): 1.3-1.6), intrauterine growth restriction (aRR = 1.5, 95% CI: 1.3-1.6), and chronic hypertension (aRR = 1.6, 95% CI: 1.4-1.8). No association was found between MBF and morbidity at 37 and 38 weeks. CONCLUSIONS The morbidity among ETNBs is related to physiological immaturity. The adverse MBF favor a hostile intrauterine environment, which affects fetal and neonatal well-being.
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Škrabec CG, Carné AV, Pérez MC, Corral J, Pujol AF, Cuadrado M, Troya J, Ibáñez JJ, Parés D. Early and late anastomotic leak after colorectal surgery: A systematic review of the literature. Cir Esp 2023; 101:3-11. [PMID: 35882311 DOI: 10.1016/j.cireng.2022.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 06/24/2022] [Indexed: 01/17/2023]
Abstract
The aim of this study was to review and to assess the quality of the scientific articles regarding early and late anastomotic leak (AL) after colorectal surgery and their risk factors. An electronic systematic search for articles on Colorectal Surgery, AL and its timing was undertaken using the MEDLINE database via PubMed, Cochrane and Embase. The selected articles were thoroughly reviewed and assessed for methodological quality using a validated methodology quality score (MINCIR score). This review was registered in the PROSPERO registry under ID: CRD42022303012. 9 articles were finally reviewed in relation to the topic of early and late anastomotic leak. There is a lack of consensus regarding the exact cut-off in time to define early and late anastomotic leak, but it is clear that they are two differentiated entities. The first, occurring in relation to technical factors; whereas the latter, is related to impaired healing.
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Labastida-García D, Díaz-Gabriel G, López-Díaz F, Gutierrez-Chable LE, García-Flores MA, Méndez-Martínez S. Lactate and pH values in newborns with a history of acute fetal distress. Bol Med Hosp Infant Mex 2023; 80:247-252. [PMID: 37703551 DOI: 10.24875/bmhim.23000033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/18/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Acute fetal distress (AFD) is a condition that requires timely diagnosis because it generates hypoxia, acidosis, and even intrauterine death. This study aimed to determine lactate and pH values in the umbilical cord in full-term newborns (NBs) with a history of AFD. METHODS We conducted a cross-sectional study in full-term NBs of mothers with at least one perinatal, neonatal, or gasometric AFD antecedent. Neonatal morbidity was considered: if 1-min Apgar ≤ 6, or advanced neonatal maneuvers, or neonatal intensive care unit (NICU) admissions were necessary. The cutoff points were lactate > 4mmol/L and pH < 7.2. RESULTS Of 66 NBs, 33.3% of mothers presented at least one antecedent for developing AFD; 22.7% presented hypertensive pregnancy disease, 13.6% oligohydramnios, and 63.6% other factors. Perinatally, 28.7% required advanced neonatal resuscitation maneuvers and 7.5% admission to the NICU. In the gasometry, the lactate and pH values for the neonatal morbidity of the NBs' group were 4.726 ± 1.401 and 7.293 ± 0.056, respectively, versus 2.240 ± 0.318 and 7.359 ± 0.022 (p < 0.05) for the group without associated neonatal morbidity. CONCLUSIONS Lactate values in the umbilical cord increased by 25%, and pH decreased by one percent in NBs with a history of AFD and associated morbidity.
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Affiliation(s)
- Diana Labastida-García
- Departamento de Ginecología y Obstetricia del Hospital General de Zona No. 20 La Margarita, Órgano de Operación Administrativa Desconcentrada del Instituto Mexicano del Seguro Social de Puebla, Puebla
| | - Guzmán Díaz-Gabriel
- Departamento de Ciencias de la Salud, Universidad Popular Autónoma del Estado de Puebla, Puebla
| | - Fernando López-Díaz
- Departamento de Ginecología y Obstetricia del Hospital General de Zona No. 20 La Margarita, Órgano de Operación Administrativa Desconcentrada del Instituto Mexicano del Seguro Social de Puebla, Puebla
| | - Luis E Gutierrez-Chable
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco
| | - Máximo A García-Flores
- Coordinación Auxiliar Médica de Educación en Salud, Instituto Mexicano del Seguro Social de Puebla, Puebla
| | - Socorro Méndez-Martínez
- Coordinación de Planeación y Enlace Institucional, Instituto Mexicano del Seguro Social de Puebla, Puebla. Mexico
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Aguirre-Allende I, Enríquez-Navascués JM, Elorza G, Etxart A, Echeveste A, Borda-Arrizabalaga N, Placer C, Saralegui Y. Care burden and outcome of the surgical management of ulcerative colitis: A retrospective analysis of the last 20 years in a tertiary hospital in Spain. Cir Esp 2023; 101:12-19. [PMID: 36635025 DOI: 10.1016/j.cireng.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/03/2021] [Indexed: 01/12/2023]
Abstract
AIM To analyze the surgical burden of UC care in the last two decades, analyzing the characteristics of the patients, surgical indications along with the short and long-term results. METHOD Single-center retrospective cohort analysis of UC patients undergoing abdominal and anorectal surgery between January 2000 and December 2020. The care burden, clinical data and results were analyzed according to distribution by decades. RESULTS 128 patients, 37% female, underwent 376 surgical interventions (296 intestinal procedures and 80 anorectal). Mean follow-up for the cohort was 106±64 months. Timing from diagnosis to first surgery was under 5 years in 53.3%. In the second decade of the study there were fewer operated patients (73 vs. 48) as well as the total number of interventions per patient (2.7 vs. 2.0). The proportion between elective and urgent surgery was reversed in the second decade, observing an increase in laparoscopic surgery (70% vs. 8%) together with a decrease in major postoperative morbidity (Clavien-Dindo≥IIIa) (20% vs 8.4%). 80 patients underwent a restorative proctocolectomy, with a failure of 5% at 1 year but 23.7% in the long term. 37 patients required anorectal surgery, of which 26 (71%) were serial interventions, most due to septic complications of the pouches. CONCLUSIONS The number of colectomies and interventions per patient decreased in the last decade, while there were improvements in morbidity and surgical approach. The need for sequential surgeries and long-term active instrumental surveillance for possible functional deterioration constitutes a significant clinical burden.
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Affiliation(s)
- Ignacio Aguirre-Allende
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Jose M Enríquez-Navascués
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain.
| | - Garazi Elorza
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Ane Etxart
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Ainhoa Echeveste
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Nerea Borda-Arrizabalaga
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Carlos Placer
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Yolanda Saralegui
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
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Torres-Cantero AM, Álvarez León EE, Morán-Sánchez I, San Lázaro Campillo I, Bernal Morell E, Hernández Pereña M, Martínez-Morata I. [Health impact of COVID pandemic. SESPAS Report 2022]. Gac Sanit 2022; 36 Suppl 1:S4-S12. [PMID: 35781147 PMCID: PMC9244867 DOI: 10.1016/j.gaceta.2022.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 02/05/2022] [Accepted: 02/06/2022] [Indexed: 12/12/2022]
Abstract
Objetivo Presentar, a los 22 meses de que la Organización Mundial de la Salud declarara como pandemia la infección global por SARS-CoV-2 el 11 de marzo de 2020, el impacto hasta el momento de la pandemia en términos de salud física y mental. Método Se han revisado resultados procedentes de metaanálisis y revisiones sistemáticas, citándose para algún aspecto específico de interés artículos individuales. La información nacional procede de la Red Nacional de Vigilancia Epidemiológica (RENAVE). Resultados Hasta finales de octubre se habían producido más de 250 millones de infecciones y 5 millones de muertes. En España se han notificado 4,7 millones de infecciones, aunque la cifra real es superior a los 7 millones. Se ha reducido la esperanza de vida, con efectos especialmente dramáticos en grupos de población con comorbilidad y de edad avanzada. Se constata un empeoramiento de la salud mental general. Es previsible que algunos colectivos, como los/las profesionales sanitarios/as, en su mayoría mujeres, y trabajadores/as de primera línea, tengan un mayor riesgo de desarrollar patologías de salud mental en el futuro. La pandemia y las medidas de control han tenido otras consecuencias indeseables, como la disminución de la actividad asistencial, el aumento del sedentarismo y el aumento de la violencia de género. Conclusiones Son necesarios estudios longitudinales para determinar la magnitud de las consecuencias de la propia infección y de las medidas de control y las actuaciones necesarias.
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Affiliation(s)
- Alberto Manuel Torres-Cantero
- IMIB-Arrixaca, Murcia, España; Servicio de Medicina Preventiva, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Departamento de Ciencias Sociosanitarias, Facultad de Medicina, Universidad de Murcia, Murcia, España.
| | - Eva Elisa Álvarez León
- Servicio de Medicina Preventiva, Complejo Hospitalario Universitario Insular Materno Infantil, Servicio Canario de la Salud, Las Palmas de Gran Canaria, España; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España
| | - Inés Morán-Sánchez
- IMIB-Arrixaca, Murcia, España; CSM Cartagena, Servicio Murciano de Salud, Cartagena (Murcia), España
| | - Indra San Lázaro Campillo
- IMIB-Arrixaca, Murcia, España; Servicio de Medicina Preventiva, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Enrique Bernal Morell
- IMIB-Arrixaca, Murcia, España; Departamento de Ciencias Sociosanitarias, Facultad de Medicina, Universidad de Murcia, Murcia, España; Hospital General Universitario Reina Sofía, Murcia, España
| | - Marcos Hernández Pereña
- IMIB-Arrixaca, Murcia, España; Servicio de Medicina Preventiva, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Irene Martínez-Morata
- IMIB-Arrixaca, Murcia, España; Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, USA
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Zamudio Burbano MA, González Giraldo D, López Agudelo LD, Casas Arroyave FD. Validation in Spanish of the Ottawa scale for non-technical skills in health personnel in crisis situations. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:523-530. [PMID: 34801469 DOI: 10.1016/j.redare.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/01/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Non-technical skills are related to morbi-mortality in medicine; it has been proposed that 46% of fatal outcomes are explained to limitations in non-technical skills and only 5% to technical skills deficiencies, however, there is no validated instrument or scale in spanish that allows its evaluation in the management of medical crisis. OBJECTIVE To evaluate the psychometric properties of a Spanish-adapted version of the "Ottawa crisis resource management (CRM) global rating scale (GRS)" in medical staff involved in critical decision-making based in high-fidelity simulation, which could be beneficial to impact patient safety and improve clinical outcomes. METHODS Transversal cultural instrument validation and adaptation study, included 91 participants who simulated a medical crisis between 2018 and 2019, and to whom the Spanish version of the CRM-GRS was applied in order to evaluate its psychometric properties. RESULTS A cultural adaptation with translation into Spanish of the CRM-GRS was made. Subsequently, the scale was applied to 91 participants. An internal consistency (Cronbach's alpha) greater than 0.9 was found in each dimension. The level of inter-rater reliability, evaluated by the interclass coefficient was 0.59 to 0.69, and test-retest reliability with an interclass coefficient greater than 0.7. The validity of the convergent construct was moderate (interclass coefficient between 0.6 and 0.7 for all domains) and the validity of the divergent construct between 0.4 and 0.5 was found adequate. CONCLUSION The translated and adapted Spanish version of the CRM-GRS in crisis had adequate internal consistency, reliability, and construct validity.
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Affiliation(s)
- M A Zamudio Burbano
- Facultad de Medicina, Universidad de Antioquia; Anestesiología, IPS Universitaria, Medellín, Colombia.
| | - D González Giraldo
- Anestesiología y reanimación, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - L D López Agudelo
- Anestesiología y reanimación, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - F D Casas Arroyave
- Facultad de Medicina, Universidad de Antioquia, Anestesiología, Hospital Universitario San Vicente Fundación, Medellín, Colombia
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Guzmán-Esquivel J, Farias-Mendoza KE, Ortega-Ortíz JG, Delgado-Enciso I, Murillo-Zamora E, Guzmán-Solórzano JA, Ochoa-Castro MR. Association of acute urinary retention in postoperative patients with a urinary catheter, with and without bladder catheter clamping. ARCH ESP UROL 2021; 74:747-751. [PMID: 34605414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The use of a temporaryor permanent catheter is very common in clinical practice. Between 15.0% and 25.0% of hospitalized patients have in-dwelling bladder catheters, the majority of which are short-term. Bladder catheter clamping before catheter removal was generally regarded as useful in the past. Today, its utility is questionable. OBJECTIVE To determine the association between bladder catheter clamping and spontaneous micturition or acute urinary retention (AUR) in postoperative patients with short-term indwelling bladder catheter. MATERIALS AND METHODS A descriptive, comparative,longitudinal study was conducted at a secondary care hospital center in a western Mexican state .AUR was the outcome variable. Two study groups wereformed: patients with bladder catheter clamping (n=43) and the control patients with no bladder catheter clamping (n=41). Descriptive statistical analyses were performed, and percentage comparisons were made with the chi-squaretest. Significant predictors were subsequently added to the multivariate model. RESULTS Fourteen percent (n=12) of all the study patients, with and without bladder catheter clamping, presented with AUR and 86% (n=72) did not. In the association analysis, there was no statistically significant difference between presenting with AUR and having or not having bladder catheter clamping (p=0.59). The associations of AUR with bladder re-catheterization (p=0.001), age (p=0.01), and the presence of lower urinary symptoms (p= 0.005) were statistically significant. CONCLUSION Postoperative bladder catheter clamping was not associated with the presence of AUR.
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Affiliation(s)
- José Guzmán-Esquivel
- Unidad de Investigación en Epidemiología Clínica. Instituto Mexicano del Seguro Social. Colima. México
| | | | | | - Iván Delgado-Enciso
- Instituto Estatal de Cancerología de los Servicios de Salud del Estado de Colima. Colima. México
| | - Efrén Murillo-Zamora
- Departamento de Epidemiología. Unidad de Medicina Familiar No. 19. Instituto Mexicano del Seguro Social. Colima. México
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Zamudio Burbano MA, González Giraldo D, López Agudelo LD, Casas Arroyave FD. Validation in spanish of the Ottawa scale for non-techical skills in health personnel in crisis situations. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:S0034-9356(21)00106-7. [PMID: 34538662 DOI: 10.1016/j.redar.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Non-technical skills are related to morbi-mortality in medicine; it has been proposed that 46% of fatal outcomes are explained to limitations in non-technical skills and only 5% to technical skills deficiencies, however, there is no validated instrument or scale in spanish that allows its evaluation in the management of medical crisis. OBJECTIVE To evaluate the psychometric properties of a Spanish-adapted version of the "Ottawa crisis resource management (CRM) global rating scale (GRS)" in medical staff involved in critical decision-making based in high-fidelity simulation, which could be beneficial to impact patient safety and improve clinical outcomes. METHODS Transversal cultural instrument validation and adaptation study, included 91 participants who simulated a medical crisis between 2018 and 2019, and to whom the Spanish version of the CRM-GRS was applied in order to evaluate its psychometric properties. RESULTS A cultural adaptation with translation into Spanish of the CRM-GRS was made. Subsequently, the scale was applied to 91 participants. An internal consistency (Cronbach's alpha) greater than 0.9 was found in each dimension. The level of inter-rater reliability, evaluated by the interclass coefficient was 0.59 to 0.69, and test-retest reliability with an interclass coefficient greater than 0.7. The validity of the convergent construct was moderate (interclass coefficient between 0.6 and 0.7 for all domains) and the validity of the divergent construct between 0.4 and 0.5 was found adequate. CONCLUSION The translated and adapted Spanish version of the CRM-GRS in crisis had adequate internal consistency, reliability, and construct validity.
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Affiliation(s)
- M A Zamudio Burbano
- Facultad de Medicina, Universidad de Antioquia; Anestesiología, IPS Universitaria, Medellín, Colombia.
| | - D González Giraldo
- Anestesiología y reanimación, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - L D López Agudelo
- Anestesiología y reanimación, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - F D Casas Arroyave
- Facultad de Medicina, Universidad de Antioquia, Anestesiología, Hospital Universitario San Vicente Fundación, Medellín, Colombia
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Aguirre-Allende I, Enríquez-Navascués JM, Elorza G, Etxart A, Echeveste A, Borda-Arrizabalaga N, Placer C, Saralegui Y. Care burden and outcome of the surgical management of ulcerative colitis: A retrospective analysis of the last 20 years in a tertiary hospital in Spain. Cir Esp 2021; 101:S0009-739X(21)00259-1. [PMID: 34509292 DOI: 10.1016/j.ciresp.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/30/2022]
Abstract
AIM To analyze the surgical burden of UC care in the last two decades, analyzing the characteristics of the patients, surgical indications along with the short and long-term results. METHOD Single-center retrospective cohort analysis of UC patients undergoing abdominal and anorectal surgery between January 2000 and December 2020. The care burden, clinical data and results were analyzed according to distribution by decades. RESULTS 128 patients, 37% female, underwent 376 surgical interventions (296 intestinal procedures and 80 anorectal). Mean follow-up for the cohort was 106±64 months. Timing from diagnosis to first surgery was under 5 years in 53.3%. In the second decade of the study there were fewer operated patients (73 vs. 48) as well as the total number of interventions per patient (2.7 vs. 2.0). The proportion between elective and urgent surgery was reversed in the second decade, observing an increase in laparoscopic surgery (70% vs. 8%) together with a decrease in major postoperative morbidity (Clavien-Dindo≥IIIa) (20% vs 8.4%). 80 patients underwent a restorative proctocolectomy, with a failure of 5% at 1 year but 23.7% in the long term. 37 patients required anorectal surgery, of which 26 (71%) were serial interventions, most due to septic complications of the pouches. CONCLUSIONS The number of colectomies and interventions per patient decreased in the last decade, while there were improvements in morbidity and surgical approach. The need for sequential surgeries and long-term active instrumental surveillance for possible functional deterioration constitutes a significant clinical burden.
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Affiliation(s)
- Ignacio Aguirre-Allende
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Jose M Enríquez-Navascués
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain.
| | - Garazi Elorza
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Ane Etxart
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Ainhoa Echeveste
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Nerea Borda-Arrizabalaga
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Carlos Placer
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
| | - Yolanda Saralegui
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario Donostia, Instituto Biodonostia, Spain
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Paredes-Torres OR, García-Ruiz L, Luna-Abanto J, Meza-García K, Chávez-Passiuri I, Berrospi-Espinoza F, Luque-Vásquez Vásquez C, Ruiz-Figueroa E, Payet-Meza E. Risk factors associated with postoperative morbidity and mortality in D2 radical gastrectomy for gastric cancer. Rev Gastroenterol Mex (Engl Ed) 2021; 87:149-158. [PMID: 34362678 DOI: 10.1016/j.rgmxen.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/12/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND AIMS Surgery is the main treatment for gastric cancer. D2 radical gastrectomy is associated with a variable postoperative morbidity and mortality rate worldwide. The aim of the present study was to identify the risk factors associated with the postoperative morbidity and mortality of D2 radical gastrectomy, with curative intent, for gastric cancer. MATERIALS AND METHODS A retrospective case series was conducted, in which the medical records were reviewed of patients with gastric cancer that underwent D2 radical gastrectomy, within the time frame of January 2014 and December 2018. Univariate and multivariate analyses were carried out to identify the risk factors related to postoperative morbidity and mortality within 90 days. RESULTS The percentages of postoperative morbidity and mortality in 691 patients were 23.3% and 3.3%, respectively. In the multivariate analysis, age ≥70 years (OR = 1.85, 95% CI: 1.25-2.76), ASA III-IV (OR = 2.06, 95% CI: 1.28-3.34), total gastrectomy (OR = 1.96, 95% CI:1.19-3.23), and pancreatosplenectomy (OR = 5.41, 95% CI: 1.42-20.61) were associated with greater postoperative morbidity, and age ≥70 years (OR = 4.92, 95% CI:1.78-13.65), lower BMI (OR = 0.81, 95% CI: 0.71-0.92), and hypoalbuminemia (OR = 0.91, 95% CI: 0.85-0.98) were associated with greater mortality in distal and total D2 radical gastrectomy. CONCLUSIONS D2 radical gastrectomy for gastric cancer was shown to be a safe treatment, with low postoperative morbidity and mortality rates. Age ≥70 years, ASA III-IV, total gastrectomy, and pancreatosplenectomy were factors associated with a higher complication rate. Age ≥70 years, lower BMI, and hypoalbuminemia were mortality predictors in distal and total radical gastrectomy.
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Affiliation(s)
- O R Paredes-Torres
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru.
| | - L García-Ruiz
- Oncología Quirúrgica, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
| | - J Luna-Abanto
- Oncología Quirúrgica, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
| | - K Meza-García
- Oncología Quirúrgica, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
| | - I Chávez-Passiuri
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
| | - F Berrospi-Espinoza
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
| | - C Luque-Vásquez Vásquez
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
| | - E Ruiz-Figueroa
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
| | - E Payet-Meza
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
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Rey JR, Merino Llorens JL, Iniesta Manjavacas ÁM, Rodríguez SOR, Castrejón-Castrejón S, Arbas-Redondo E, Poveda-Pinedo ID, Tebar-Márquez D, Severo-Sánchez A, Rivero-Santana B, Juárez-Olmos V, Martínez-Cossiani M, Buño-Soto A, Gonzalez-Valle L, Herrero-Ambrosio A, López-de-Sá E, Caro-Codón J. Influence of statin treatment in a cohort of patients admitted for COVID-19. Med Clin (Barc) 2021; 158:586-595. [PMID: 34511251 PMCID: PMC8302844 DOI: 10.1016/j.medcli.2021.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 01/08/2023]
Abstract
Antecedentes y objetivos Se ha especulado que las estatinas pueden ser de utilidad en el tratamiento de pacientes con COVID-19, pero no existen evidencias clínicas sólidas. El objetivo de este trabajo es conocer su utilidad en una cohorte de gran tamaño de pacientes hospitalizados por COVID-19, así como si su retirada se asocia con un peor pronóstico. Material y métodos Estudio retrospectivo observacional. Se incluyeron 2.191 pacientes hospitalizados con infección confirmada con SARS-CoV-2. Resultados La edad media fue de 68,0 ± 17,8 años y fallecieron un total de 597 (27,3%) pacientes. Un total de 827 pacientes (37,7% de la muestra) estaban tratados previamente con estatinas. Aunque precisaron con mayor frecuencia de ingreso en camas de críticos, dicho grupo terapéutico no resultó un factor predictor independiente de muerte en el seguimiento [HR 0,95 (0,72-1,25)]. Un total de 371 pacientes (16,9%) recibió al menos una dosis de estatina durante el ingreso. A pesar de ser una población con un perfil clínico más desfavorable, tanto su uso [HR 1,03 (0,78-1,35)] como la suspensión durante el ingreso en pacientes que las recibían crónicamente [HR 1,01 (0,78-1,30)] presentaron un efecto neutro en la mortalidad. No obstante, el grupo con estatinas desarrolló con mayor frecuencia datos de citolisis hepática, rabdomiolisis y más eventos trombóticos y hemorrágicos. Conclusiones En nuestra muestra, las estatinas no se asociaron de forma independiente a una menor mortalidad en pacientes con COVID-19. En aquellos pacientes que tengan indicación de recibirlas por su patología previa es necesario monitorizar estrechamente sus potenciales efectos adversos durante el ingreso hospitalario.
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Affiliation(s)
- Juan R Rey
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España.
| | | | | | | | | | | | | | | | | | | | | | | | - Antonio Buño-Soto
- Servicio de Análisis Clínicos, Hospital Universitario La Paz, Madrid, España
| | - Luis Gonzalez-Valle
- Servicio de Farmacia Hospitalaria, Hospital Universitario La Paz, Madrid, España
| | | | | | - Juan Caro-Codón
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España
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25
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Balvis-Balvis PM, Dominguez-Prado DM, Ferradás-García L, Pérez-García M, Garcia-Reza A, Castro-Menendez M. Influence of integrated orthogeriatric care on morbidity and mortality and length of hospital stay for hip fracture. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 66:29-37. [PMID: 34147419 DOI: 10.1016/j.recot.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Compare the morbidity and mortality, the length of hospital stay and the economic cost of the fragility fracture of the hip, in two nonconsecutive years thanks to the integrated orthogeriatric care. MATERIAL AND METHOD Retrospective observational cohort study with 633 patients with hip fragility fracture with a mean age of 85.5 years, treated in the same Trauma and Orthopaedic Surgery service in two different years (2012 and 2017). Mean stay, surgical delay, perioperative mortality, one month and one year, and perioperative complications such as acute urine retention, pressure ulcers, and need for transfusion were measured. RESULTS Mortality during admission decreased from 10% in 2012 to 3.6% in 2017 (P=.004 *), while mortality at thirty days (10.5% vs 7%) (P=.123) and one year (28.9% versus 24.9%) (P=.277). Hospital stay times, surgical delay, and postoperative admission time also decreased. The estimated total annual economic savings thanks to integrated orthogeriatric care amounted to €1,017,084.94. CONCLUSIONS Integrated orthogeriatric care of the patient with fragility fracture of the hip, results in a more effective and efficient care model. Both the care and the clinical situation of patients are improved in the perioperative period, both hospital stay and mortality during admission are significantly reduced, and all this with significant associated economic savings.
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Affiliation(s)
- P M Balvis-Balvis
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Vigo, Hospital Álvaro Cunqueiro, Vigo, España.
| | - D M Dominguez-Prado
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Vigo, Hospital Álvaro Cunqueiro, Vigo, España
| | - L Ferradás-García
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Vigo, Hospital Álvaro Cunqueiro, Vigo, España
| | - M Pérez-García
- Servicio de Ortogeriatría, Complexo Hospitalario Universitario de Vigo, Hospital Álvaro Cunqueiro, Vigo, España
| | - A Garcia-Reza
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Vigo, Hospital Álvaro Cunqueiro, Vigo, España
| | - M Castro-Menendez
- Servicio de Cirugía Ortopédica y Traumatología, Complexo Hospitalario Universitario de Vigo, Hospital Álvaro Cunqueiro, Vigo, España
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Padilla López A. Statin adherence and health outcomes after st-elevation myocardial infarction: 1-year follow-up study. Rev Clin Esp 2021; 221:331-340. [PMID: 32571522 DOI: 10.1016/j.rce.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/21/2020] [Accepted: 04/17/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES There is deficient control of dyslipidaemia after ST-elevation myocardial infarction (STEMI) despite high rates of statin prescription. The aim of this study was to estimate the rate of statin treatment adherence after a first type 1 STEMI episode, the factors that determine the adherence and its impact on cardiovascular outcomes during the first year of progression. DESIGN We conducted an observational retrospective study with a cohort of patients hospitalised between 2008 and 2013, with an active statin prescription during the first year of follow-up. MATERIAL AND METHODS We determined the adherence using the proportion of days covered. The relationship between compliance and the rest of the variables was determined with a binary logistic regression analysis. Competing risk analysis assessed the relationship between cardiovascular mortality or new vascular event with adherence. RESULTS The study included 552 patients (64.7 ± 13.7; 73.9% men) of the 613 analysed. There was less adherence among foreign nationals, smokers and individuals with hepatic impairment. Compliance was greater starting at 50 years of age, among pensioners and those with dyslipidaemia, obesity and kidney failure and in cases of compliance with the rest of the groups indicated in secondary prevention. Compliance reduced cardiovascular mortality (1.9% vs. 9.1%; HR 0.201; 95% CI 0.075-0.539; p = .001) but not the onset of a new cardiovascular event (5.5% vs. 6.5%; p = .834). CONCLUSIONS Statin adherence during the first year after a STEMI is a key factor in mortality, a period in which its assessment is needed beyond the prescription.
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Affiliation(s)
- A Padilla López
- Servicio de Farmacia de Área, Departamento de Salud de Valencia Clínico-Malvarrosa, Valencia, España.
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27
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Olguín-Joseau S, Jaime N, Salinas W, Chamorro ML, Signorini F, Maldonado P, Obeide LR, Rossini AM. Short-term and oncological outcomes in laparoscopic colectomy in colon cancer stage I-III with 3-year follow-up. CIR CIR 2021; 88:314-320. [PMID: 32539009 DOI: 10.24875/ciru.19001353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Laparoscopic colectomy (LC) presents similar short-term results and oncological outcomes to conventional colectomy (CC) in colon cancer. Objectives Compare short-term and oncological outcomes at 3-year follow up between LC and CC. Materials and methods Patients who underwent LC and CC for colon cancer between January 2010 and December 2017 were retrospectively analyzed. Short-term results and oncological outcomes were studied. Results Two hundred sixty-nine patients were included in the study. CC was performed in 37.5% and LC in 62.5%. LC presented shorter operative time (157 vs. 175 min, p = 0.01), shorter length of stay (8.4 vs. 10.5 days, p = 0.02), lees readmission (6% vs. 15%, p = 0.02), and lower morbidity (40% vs. 56%, p = 0.01). No differences were found for overall survival (OAS) (LC = 87.1% vs. CC = 82.8%, p = 0.28) and disease-free survival (DFS) (LC = 78.2% vs. CC = 75.3%, p = 0.47). Recurrence was observed in 37 patients (LC = 16.1% vs. CC = 18.3%, p = 0.53). No differences were found for local recurrence (LC = 6.5% vs. CC = 8.6%, p = 0.49) and distant recurrence (LC = 12.1% vs. CC = 16.1%, p = 0.3). Stage analysis showed no difference for recurrence, OAS, and DFS. Conclusions LC is a safe procedure with short-term outcomes, OAS, DFS, and recurrence similar to CC. LC should be the initial indication in non-metastatic colon cancer in our population.
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Affiliation(s)
- Santiago Olguín-Joseau
- Departamento de Cirugía General, Hospital Privado Universitario de Córdoba. Córdoba, Argentina.,Departamento de Cirugía General, Hospital Raúl Ferreyra. Córdoba, Argentina
| | - N Jaime
- Departamento de Cirugía General, Hospital Privado Universitario de Córdoba. Córdoba, Argentina.,Departamento de Cirugía General, Hospital Raúl Ferreyra. Córdoba, Argentina
| | - Walter Salinas
- Departamento de Cirugía General, Hospital Privado Universitario de Córdoba. Córdoba, Argentina.,Departamento de Cirugía General, Hospital Raúl Ferreyra. Córdoba, Argentina
| | - Ma Luz Chamorro
- Departamento de Cirugía General, Hospital Privado Universitario de Córdoba. Córdoba, Argentina.,Departamento de Cirugía General, Hospital Raúl Ferreyra. Córdoba, Argentina
| | - Franco Signorini
- Departamento de Cirugía General, Hospital Privado Universitario de Córdoba. Córdoba, Argentina.,Departamento de Cirugía General, Hospital Raúl Ferreyra. Córdoba, Argentina
| | - Pablo Maldonado
- Departamento de Cirugía General, Hospital Privado Universitario de Córdoba. Córdoba, Argentina.,Departamento de Cirugía General, Hospital Raúl Ferreyra. Córdoba, Argentina
| | - Lucio R Obeide
- Departamento de Cirugía General, Hospital Privado Universitario de Córdoba. Córdoba, Argentina.,Departamento de Cirugía General, Hospital Raúl Ferreyra. Córdoba, Argentina
| | - Alejandro M Rossini
- Departamento de Cirugía General, Hospital Privado Universitario de Córdoba. Córdoba, Argentina.,Departamento de Cirugía General, Hospital Raúl Ferreyra. Córdoba, Argentina
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Grau Amorós J, García García JÁ, Mira Escartí JA, Serrado Iglesias A, Moreno García MC, Manzano L, Quesada Simón MA, Dávila Ramos MF, Casado Cerrada J, González Franco Á, Montero-Pérez-Barquero M. Influence of the degree of anaemia on the prognosis of older adults with heart failure (SPAN-HF study). Med Clin (Barc) 2021; 158:167-172. [PMID: 33962767 DOI: 10.1016/j.medcli.2021.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess whether a sustained optimal haemoglobin value in the 3 months after admission for heart failure (HF) decompensation reduces morbidity and mortality during the 12 months after admission for acute HF. PATIENTS AND METHOD Retrospective study of the 1408 patients older than 65 years included in the RICA registry divided into 3 groups: no anaemia (group A), recovered anaemia (group B), and persistent anaemia (group C), according to haemoglobin levels on admission, and 3 months after discharge. Kaplan-Meier curves were constructed, comparing the groups using the log-rank test and a Cox regression model was performed to analyse survival. RESULTS 578 (41.1%), 299 (21.2%) and 531 (37.7%) were included in groups A, B and C, respectively. We recorded a total of 768 deaths and readmissions. There were 23 (4%), 12 (4%) and 49 (9.2%), (p=.001) individuals who died due to HF and 154 (27%), 73 (24%) and 193 (36%) (P<.001) admissions for this pathology, respectively. Patients with persistent anaemia had a higher risk of death (RR 1.29, 95% CI 1.04-1.61, P=.024) or readmission (1.92, 95% CI 1.16-3, 19; P=.012) due to HF. CONCLUSIONS Persistent anaemia in the months after admission for HF increases morbidity and mortality in the subsequent year.
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Affiliation(s)
| | | | | | | | | | - Luis Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá (IRYCIS), Madrid, España
| | | | | | | | - Álvaro González Franco
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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Padilla López A. Statin adherence and health outcomes after st-elevation myocardial infarction: 1-year follow-up study. Rev Clin Esp 2021; 221:331-340. [PMID: 34059230 DOI: 10.1016/j.rceng.2020.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 04/17/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES There is deficient control of dyslipidaemia after ST-elevation myocardial infarction (STEMI) despite high rates of statin prescription. The aim of this study was to estimate the rate of statin treatment adherence after a first type 1 STEMI episode, the factors that determine the adherence and its impact on cardiovascular outcomes during the first year of progression. DESIGN We conducted an observational retrospective study with a cohort of patients hospitalised between 2008 and 2013, with an active statin prescription during the first year of follow-up. MATERIAL AND METHODS We determined the adherence using the proportion of days covered. The relationship between compliance and the rest of the variables was determined with a binary logistic regression analysis. Competing risk analysis assessed the relationship between cardiovascular mortality or new vascular event with adherence. RESULTS The study included 552 patients (64.7 ± 13.7; 73.9% men) of the 613 analysed. There was less adherence among foreign nationals, smokers and individuals with hepatic impairment. Compliance was greater starting at 50 years of age, among pensioners and those with dyslipidaemia, obesity and kidney failure and in cases of compliance with the rest of the groups indicated in secondary prevention. Compliance reduced cardiovascular mortality (1.9% vs. 9.1%; HR 0.201; 95% CI 0.075-0.539; p = .001) but not the onset of a new cardiovascular event (5.5% vs. 6.5%; p = .834). CONCLUSIONS Statin adherence during the first year after a STEMI is a key factor in mortality, a period in which its assessment is needed beyond the prescription.
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Affiliation(s)
- A Padilla López
- Servicio de Farmacia de Área, Departamento de Salud de Valencia Clínico-Malvarrosa, Valencia, Spain.
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Paredes-Torres OR, García-Ruiz L, Luna-Abanto J, Meza-García K, Chávez-Passiuri I, Berrospi-Espinoza F, Luque-Vásquez Vásquez C, Ruiz-Figueroa E, Payet-Meza E. Risk factors associated with postoperative morbidity and mortality in D2 radical gastrectomy for gastric cancer. Rev Gastroenterol Mex (Engl Ed) 2021; 87:S0375-0906(21)00013-6. [PMID: 33752940 DOI: 10.1016/j.rgmx.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/30/2020] [Accepted: 11/12/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND AIMS Surgery is the main treatment for gastric cancer. D2 radical gastrectomy is associated with a variable postoperative morbidity and mortality rate worldwide. The aim of the present study was to identify the risk factors associated with the postoperative morbidity and mortality of D2 radical gastrectomy, with curative intent, for gastric cancer. MATERIALS AND METHODS A retrospective case series was conducted, in which the medical records were reviewed of patients with gastric cancer that underwent D2 radical gastrectomy, within the time frame of January 2014 and December 2018. Univariate and multivariate analyses were carried out to identify the risk factors related to postoperative morbidity and mortality within 90 days. RESULTS The percentages of postoperative morbidity and mortality in 691 patients were 23.3% and 3.3%, respectively. In the multivariate analysis, age ≥ 70 years (OR=1.85, 95% CI: 1.25-2.76), ASA III-IV (OR=2.06, 95% CI: 1.28-3.34), total gastrectomy (OR=1.96, 95% CI:1.19-3.23), and pancreatosplenectomy (OR=5.41, 95% CI: 1.42-20.61) were associated with greater postoperative morbidity, and age≥70 years (OR=4.92, 95% CI:1.78-13.65), lower BMI (OR=0.81, 95% CI: 0.71-0.92), and hypoalbuminemia (OR=0.91, 95% CI: 0.85-0.98) were associated with greater mortality in distal and total D2 radical gastrectomy. CONCLUSIONS D2 radical gastrectomy for gastric cancer was shown to be a safe treatment, with low postoperative morbidity and mortality rates. Age≥70 years, ASA III-IV, total gastrectomy, and pancreatosplenectomy were factors associated with a higher complication rate. Age≥70 years, lower BMI, and hypoalbuminemia were mortality predictors in distal and total radical gastrectomy.
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Affiliation(s)
- O R Paredes-Torres
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú.
| | - L García-Ruiz
- Oncología Quirúrgica, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
| | - J Luna-Abanto
- Oncología Quirúrgica, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
| | - K Meza-García
- Oncología Quirúrgica, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
| | - I Chávez-Passiuri
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
| | - F Berrospi-Espinoza
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
| | - C Luque-Vásquez Vásquez
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
| | - E Ruiz-Figueroa
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
| | - E Payet-Meza
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
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Molina ÁM, Aristizábal AF, García Valencia J. [Complication related factors in patients undergoing open simple prostatectomy due to Benign Prostate Hyperplasia in a Colombian hospital.]. ARCH ESP UROL 2020; 73:784-793. [PMID: 33144532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Open prostatectomy is an efficacious treatment for Benign Prostatic Hyperplasia (BPH), but its complication rates and risk factors for these might vary due to the characteristics of populations and health systems. OBJECTIVE: To determine the frequency of complications and the risk factors for these, in the first three months after open prostatectomy in a hospital in Medellín (Colombia). METHODS: This is a cohort study in which patients undergoing retropubic open prostatectomy were taken. Medical records were reviewed to obtain demographic, preoperative, and intraoperative data. The main outcome was the incidence of complications in the first three postoperative months and this was divided into early (day 1 to 7 post-surgery) and late (day 8 to 90 post-surgery) complications. Risk factors were determined by estimating Relative Risks (RR). RESULTS 191 patients with a median age of 70 years were included. The frequency of complications was 34.5%,14.6% occurred early and 19.9% late. Risk factors were dyslipidemia (RR: 2.37, 95% CI: 1.25 to 4.47), irrigation time (RR: 1.31, 95% CI: 1.02 to 1.67) and duration of the postsurgical catheter (RR: 1.07, 95% CI: 1.03 to 1.12); general anesthesia was a protective risk factor compared to spinal (RR: 0.47, 95% CI: 0.24 to 0.91). CONCLUSION The frequency of complications of open prostatectomy with a retropubic approach was within the figures reported in the literature. The risk factors found could be modifiable and considered for the prevention of adverse outcomes. This study provides an updated basis for future comparisons with alternative treatments for BPH.
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Affiliation(s)
- Ángela Marcela Molina
- Médico, Residente de Urología. Facultad de Medicina. Universidad de Antioquia. Colombia
| | - Andrés Felipe Aristizábal
- Médico, Especialista en Urología. Docente de la Facultad de Medicina de la Universidad de Antioquia. Medellín. Antioquia. Colombia
| | - Jenny García Valencia
- Médico, Magister y Doctora en Epidemiología. Profesora Titular de la Facultad de Medicina de la Universidad de Antioquia. Colombia
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Lladó L, Lopez-Dominguez J, Ramos E, Cachero A, Mils K, Baliellas C, Busquets J, Fabregat J. Is Liver Retransplantation Justified in the Current Era? Cir Esp 2021; 99:339-45. [PMID: 32762955 DOI: 10.1016/j.ciresp.2020.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Liver retransplantation (LRT) is a controversial indication. Our aim was to evaluate the rate of LRT at our institution, and to analyze its indications and short- and long-term results. METHODS We conducted a retrospective study of a prospectively collected database, including 1645 LT from 1984 to 2018. Results have been analyzed depending on type of LRT (early vs late), study period and indications. RESULTS We performed 150 LRT in 140 patients. The LRT rate was 9%. Of these, 45 LRT were early (30%), and the other 70% were late LRT. The main indications were: ischemic cholangitis (27%), arterial thrombosis (19%), primary non-function (15%), and HCV recurrence (15%). Mean surgery duration (395 vs. 270 min; P = .001), cold ischemia time (435 vs. 390 min; P = .005) and transfused units required (8 vs. 5 RBC; P = .034) were higher in cases of late LRT. Postoperative mortality (10 vs. 20%; P = .01) was better in cases of late LRT. One- and 5-year actuarial survival rates were 71% and 58%, respectively, which were significantly better during the last decade (80% and 64%). Five-year actuarial survival for ischemic cholangitis is better than other indications, such as recurrence of HCV (78 vs. 51%; P = .02). CONCLUSIONS Liver retransplantation is complex and associated with high morbidity and mortality. However, indications and long-term results have improved during recent years. Therefore, LRT is justified.
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Diago CAA, Señaris JAA. Should we pay more attention to low creatinine levels? Endocrinol Diabetes Nutr (Engl Ed) 2020; 67:486-92. [PMID: 32331974 DOI: 10.1016/j.endinu.2019.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/18/2019] [Accepted: 12/27/2019] [Indexed: 12/25/2022]
Abstract
A review is made of the basic aspects of creatine/creatinine metabolism and the close relationship between creatinine and muscle mass, which makes the former a biochemical marker of the latter. Emphasis is placed on the current prognostic value of both the low urinary excretion of creatinine and low serum creatinine levels in different clinical settings in which sarcopenia probably plays a significant role in morbidity and mortality.
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Pallarés Carratalá V, Górriz-Zambrano C, Morillas Ariño C, Llisterri Caro JL, Gorriz JL. [COVID-19 and cardiovascular and kidney disease: Where are we? Where are we going?]. Semergen 2020; 46 Suppl 1:78-87. [PMID: 32448633 PMCID: PMC7211659 DOI: 10.1016/j.semerg.2020.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 12/12/2022]
Abstract
The SARS-CoV-2 pandemic is a global health emergency and we need to know more about it. Patients with cardiovascular risk and previous kidney risk have been identified as especially vulnerable for greater morbidity and mortality when they suffer from COVID-19. A considerable proportion of patients can develop a vascular lesion in the context of the disease that entails a greater lethality. Cardiovascular and renal complications represent a problem and, probably in the near future, may pose a threat to patients who have survived COVID-19. As physicians, we cannot forget that during an epidemic like this, other chronic diseases are present, and patients continue to require care. We are obliged to monitor even more intensely their treatments and control degree. Furthermore, we must not forget that urgent situations continue to arise in this pandemic situation and require prompt attention. In this current situation, it is very likely that many patients, out of fear, have not sought medical attention. The situation during the epidemic and the uncertainty of the post-COVID-19 period, requires intensification in the control and monitoring of cardiovascular and kidney disease in our patients. Primary care constitutes a key level of care for the care of the population with cardiovascular disease. Likewise, and in the face of this new health scenario, we need to promote the prevention and control measures that emanate from the studies currently underway. Now, more than ever, we need research, crucial to improve the cardiovascular and renal prognosis of our patients.
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Affiliation(s)
- V Pallarés Carratalá
- Medicina Familiar y Comunitaria, Unidad de Vigilancia de la Salud, Unión de Mutuas, Castellón, España; Departamento de Medicina, Facultad de Ciencias de la Salud, Universitat JaumeI, Castellón, España.
| | - C Górriz-Zambrano
- Medicina Familiar y Comunitaria, CAP Sant Pere, ABS Reus1, Reus, Tarragona, España
| | - C Morillas Ariño
- Servicio de Endocrinología, Hospital Universitario Dr. Peset, Valencia, España; Departamento de Medicina, Facultad de Medicina, Universitat de València, Valencia, España
| | - J L Llisterri Caro
- Medicina Familiar y Comunitaria, Fundación de Investigación SEMERGEN (Madrid), Clínica Vallada, Valencia, España
| | - J L Gorriz
- Departamento de Medicina, Facultad de Medicina, Universitat de València, Valencia, España; Servicio de Nefrología, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, España
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Gómez Alcaraz J, Pardo García JM, Sevilla Fernández J, Delgado Díaz E, Moreno Beamud JA. Primary total hip arthroplasty in elderly patients over 85 years old: risks, complications and medium-long term results. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 65:13-23. [PMID: 32665145 DOI: 10.1016/j.recot.2020.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/04/2020] [Accepted: 05/15/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The elderly population candidate for total hip arthroplasty (THA) is increasing exponentially in developed countries, due to the high prevalence of osteoarthritis (OA). The objective is to identify the overall survival in patients over 85 years with primary OA who underwent THA. MATERIAL AND METHODS Retrospective observational study in patients over 85 years with primary hip OA undergoing THA between 2012 and 2019. Demographic, clinical, comorbidity, complications, functionality and pain variables were collected. A descriptive analysis was performed, survival was estimated with the Kaplan-Meier method and the differences in pain and functionality before and after surgery with the McNemar-Bowker test. RESULTS We included 66 patients, 40 women and 26 men with a mean age of 87.22 years, of whom 15 had high comorbidity (Charlson>2). Only 14 patients presented complications in the postoperative period, the most frequent was confusional syndrome (5); and the most serious was a death (1), with a median hospital stay of 8 days. Two cases of dislocation were detected over a mean follow-up of 3.61 years, without requiring revision surgery. Improvement of pain was evident after surgery (p<.0001). The median overall survival is 6.77 years, with no difference in survival adjusted by the Charlson index (p=.75) or by ASA anaesthetic group (p=.23). CONCLUSIONS With good patient selection, THA is a good option for patients over 85 years of age with functional limitations or pain due to OA.
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Affiliation(s)
- J Gómez Alcaraz
- Servicio Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España.
| | - J M Pardo García
- Servicio Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - J Sevilla Fernández
- Servicio Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - E Delgado Díaz
- Servicio Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - J A Moreno Beamud
- Servicio Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España
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Morales-Cané I, López-Soto PJ, Rodríguez-Borrego MA. Tranexamic acid in trauma patients in the emergency department: systematic review and meta-analysis. Emergencias 2020; 31:261-269. [PMID: 31347807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The aim of this systematic review and meta-analysis was to evaluate the efficacy (mortality and functional status) and safety of emergency department (ED) use of tranexamic acid (TXA) in patients with severe trauma. MATERIAL AND METHODS MEDLINE, Embase, the Cochrane Library, the Web of Science, and ClinicalTrials.gov were searched to find relevant clinical trials published between January 1, 2008, and 1 August, 2018. The selected trials included trauma patients who received infusions of TXA within 8 hours. We extracted patient-related clinical variables and treatment variables. The main outcomes were mortality and functional status. RESULTS Five clinical trials were included in the systematic review. Four of them (20 697 patients) were included in the metaanalysis. We found that TXA versus placebo was associated with lower mortality (OR, 0.89 [95% CI, 0.83-0.96]; P = .004; 2 = 0%) and better functional status (OR, 0.60 [95% CI, 0.39-0.94]; P = .02; I2 = 0%). However, intensive care unit stays were longer in patients administered TXA (mean difference, 2.55 days [95% CI, 0.04-5.06 days]; P = .05; I2 = 0%). CONCLUSION ED infusion of TXA decreases mortality after severe trauma and improves patients' functional status.
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Affiliation(s)
- Ignacio Morales-Cané
- Departamento de Enfermería. Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Hospital Universitario Reina Sofía, Córdoba, España
| | - Pablo Jesús López-Soto
- Departamento de Enfermería. Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Hospital Universitario Reina Sofía, Córdoba, España
| | - María Aurora Rodríguez-Borrego
- Departamento de Enfermería. Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Hospital Universitario Reina Sofía, Córdoba, España
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Mora López L, Pallisera Llovera A, Serra-Aracil X, Serra Pla S, Lucas Guerrero V, Rebasa P, Tremps Domínguez C, Pujol Caballé G, Martínez Castela R, Subirana Giménez L, Martínez Cabañero J, Del Pino Zurita C, Agudo Arcos C, Carol Boeris FG, Navarro Soto S. A single-center prospective observational study on the effect of trimodal prehabilitation in colorectal surgery. Cir Esp 2020; 98:605-611. [PMID: 32430159 DOI: 10.1016/j.ciresp.2020.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A trimodal prehabilitation protocol was designed with the aim to evaluate whether it contributes to reducing postoperative morbidity, to evaluate the effect of prehabilitation on overall hospital stay, and to analyze the evolution of functional capacity before and after surgery. METHODS A single-center observational study of patients with colorectal cancer who underwent surgery with curative intent after a trimodal prehabilitation protocol. We collected data for postoperative morbidity according to the Comprehensive Complication Index and hospital stay, which were compared with a historical matrix. Functional capacity data were also collected before and after the application of the prehabilitation protocol. RESULTS Compared to the historical population, the overall Comprehensive Complication Index was reduced from 13.2 to 11.5, which was statistically significant. Analyzed by morbidity type, all decreased in percentage, although without achieving significance (surgical site infection from 11.7% to 8.4%, nosocomial infection 15.8 to 10% and medical morbidity 8.6% to 4.2%). The overall hospital stay went from 6 to 4 days, and the decrease in the percentage of patients who prepared at home was statistically significant in both cases. CONCLUSIONS Trimodal prehabilitation can contribute to lowering the postoperative morbidity and overall hospital stay of patients undergoing colorectal cancer surgery.
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Affiliation(s)
- L Mora López
- Unidad de Coloproctología, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España.
| | - A Pallisera Llovera
- Unidad de Coloproctología, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - X Serra-Aracil
- Unidad de Coloproctología, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - S Serra Pla
- Unidad de Coloproctología, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - V Lucas Guerrero
- Unidad de Coloproctología, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - P Rebasa
- Unidad de Esofagogastroesofágica, Servicio de Cirugía, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - C Tremps Domínguez
- Servicio de Anestesia y Reanimación, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - G Pujol Caballé
- Servicio de Anestesia y Reanimación, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - R Martínez Castela
- Servicio de Anestesia y Reanimación, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - L Subirana Giménez
- Servicio de Anestesia y Reanimación, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - J Martínez Cabañero
- Servicio de Anestesia y Reanimación, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - C Del Pino Zurita
- Enfermería Grupo Rehabilitación, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - C Agudo Arcos
- Enfermería Grupo Rehabilitación, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - F G Carol Boeris
- Servicio de Anestesia y Reanimación, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
| | - S Navarro Soto
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Parc Tauli, Sabadell, Barcelona, España
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Estors-Guerrero M, Lafuente-Sanchis A, Quero-Valenzuela F, Galbis-Carvajal JM, Crowley S, Carvajal Á, Paya C, Cueto A. Risk factors for the development of complications after surgical treatment for bronchopulmonary carcinoma. Cir Esp 2019; 98:226-234. [PMID: 31843191 DOI: 10.1016/j.ciresp.2019.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 04/15/2019] [Accepted: 05/24/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The most suitable treatment in most early-stage lung cancer patients is surgical resection. Despite previously assessing each patient's status being relevant to detect possible complications inherent to surgery, no consensus has been reached on which factors are "high risk" in such patients. Our study aimed to analyse the morbidity and the mortality incidence associated with this surgery in our setting with a multicentre study and to detect risk parameters. METHODS A prospective analysis study with 3,307 patients operated for bronchopulmonary carcinoma in 24 hospitals. Study variables were age, TNM, gender, stage, smoking habit, surgery approach, surgical resection, ECOG, neoadjuvant therapy, comorbidity, spirometric values, and intraoperative and postoperative morbidity and mortality. A multivariate logistic regression analysis of the morbidity and mortality predictor factors was done. RESULTS We recorded 34.2% postoperative morbidity and 2.1% postoperative mortality. Gender, myocardial infarction, angina, ECOG ≥1, COPD, DLCO <60%, clinical pathological status, surgical resection and surgery approach were shown as morbidity and mortality predictor factors in lung cancer surgery in our series. CONCLUSIONS The main variables to consider when assessing the lung cancer patients to undergo surgery are gender, myocardial infarction, angina, ECOG, COPD, DLCO, clinical pathological status, surgical resection and surgery approach.
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Affiliation(s)
- Miriam Estors-Guerrero
- Servicio de Cirugía Torácica, Hospital Universitario de La Ribera, Alzira (Valencia), España
| | - Aránzazu Lafuente-Sanchis
- Servicio de Genética-Biología Molecular, Hospital Universitario de la Ribera, Alzira (Valencia), España.
| | | | | | - Silvana Crowley
- Servicio de Cirugía Torácica, Hospital Universitario Puerta de Hierro, Madrid, España
| | - Ángel Carvajal
- Servicio de Cirugía Torácica, Hospital Son Dureta, Palma de Mallorca, España
| | - Carmen Paya
- Servicio de Cirugía Torácica, Hospital Universitario de La Ribera, Alzira (Valencia), España
| | - Antonio Cueto
- Servicio de Cirugía Torácica, Hospital Virgen de las Nieves, Granada, España
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Campos-Sañudo JA, Ballestero-Diego R, Zubillaga-Guerrero S, Rodríguez-Sanjuán JC, Asensio-Lahoz A, Monge-Miralles JM, Crespo-Santiago D. [Complications and mortality after radical nephrectomy in a low-volume hospital.]. ARCH ESP UROL 2019; 72:653-661. [PMID: 31475676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate the complications and 30-day mortality rates following open radical nephrectomy and laparoscopic radical nephrectomy using the Clavien-Dindo classification system in a low-volume hospital. METHODS We conducted a retrospective analysis of 263 patients who underwent open or laparoscopic radical nephrectomy (1996-2016) in our local district general hospital. Postoperative complications and 30- day mortalities were evaluated using the Clavien-Dindo classification. The predictors of postoperative complications were assessed using multivariate logistic regression analysis. RESULTS We found that, compared to open radical nephrectomy, laparoscopic resulted in a significantly longer operative time (112.6±41 vs 199.3±61 minutes, p < 0.01) and a shorter hospital stay (8.5±2.4 vs 5.7±3 days, p < 0.001). The most common complications were bleeding or hematoma (4.9%) and problems associated with the wound (4.5%). There were no significant differences between the ORN and LRN groups in terms of complications based on the Clavien-Dindo classification. On multivariate analysis, a longer operative time (Odds Ratio, 1.009; 95% confidence interval, 1.002- 1.015; p = 0.010) and higher body mass index (Odds Ratio, 0.898; 95% confidence interval, 0.822-0.981; p = 0.017) were found to be significant predictors of complications after nephrectomy. CONCLUSIONS Our study demonstrated that complication and 30-day mortality rates were low. There was a greater number of low-grade complications, and there were no significant differences in these rates between open and laparoscopic radical nephrectomy. A longer operative time and a higher BMI were predictors of possible complications. We provide additional evidence to support the feasibility of performing open or laparoscopic radical nephrectomy in low-volume hospitals.
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Simó V, Arredondo J, Hernán C, Jiménez LM, Ielpo B, Fernández J, Villafañe A, Pastor E. Rectal cancer treatment by transanal total mesorectal excision: Results in 100 consecutive patients. Cir Esp 2019; 97:510-516. [PMID: 31351576 DOI: 10.1016/j.ciresp.2019.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/27/2019] [Accepted: 05/30/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The aim of this study is to describe and evaluate our clinical short-term surgical results of laparoscopic transanal total mesorectal excision. METHODS Analysis of 100 consecutive patients with mid and lower rectal cancer who underwent transanal total mesorectal excision from November 2013 to September 2018. Main outcomes described are operative data, morbidities, mortality and quality of the specimen. A comparative analysis was done between gender and simultaneous vs. non simultaneous abdominal-perineal surgery. RESULTS Mean patient age was 67 years (56-75), and 67% were male. On MRI, 50% were stage T3 tumors, and 52% had positive nodes. Mean distance of the tumor from anal verge was 4.9±1.3cm. A total of 58% underwent neoadjuvant treatment. Mean operative time was 262±40.7min; it was shorter in females (P<.001) and in simultaneous 2-field surgery. Median specimen distal free margin was 1.5cm (0.5-2.4). A total of 89% of the specimens were with complete mesorectum, with better results when a simultaneous approach was used (P=.047). The mean number of retrieved lymph-nodes was 15.2±11.6, and 26% of patients had positive nodes. Median length of stay was 5.5 days (4-8). Morbidities occurred in 36% of cases, and one patient died. CONCLUSIONS According to our experience, laparoscopic transanal total mesorectal excision is safe and effective with adequate circumferential and distal free margins and high quality of the resected mesorectum specimen. Post-operative morbidity is acceptable, according to the current literature.
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Affiliation(s)
- Vicente Simó
- Unidad de Coloproctología, Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España
| | - Jorge Arredondo
- Unidad de Coloproctología, Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España.
| | - Cristina Hernán
- Servicio de Medicina Preventiva, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Luís Miguel Jiménez
- Unidad de Coloproctología, Servicio de Cirugía General, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Benedetto Ielpo
- Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España
| | - Jesús Fernández
- Unidad de Coloproctología, Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España
| | - Amaya Villafañe
- Unidad de Coloproctología, Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España
| | - Enrique Pastor
- Unidad de Coloproctología, Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España
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Carreras M, Puig G, Sánchez-Pérez I, Inoriza JM, Coderch J, Gispert R. [Morbidity and self-perception of health, two different approaches to health status]. Gac Sanit 2019; 34:601-607. [PMID: 31255397 DOI: 10.1016/j.gaceta.2019.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the degree of association between perceived health status and that obtained from information on attended morbidity. METHOD The population of four health areas of the Baix Empordà region (Catalonia, Spain) (N=91,067) was studied in 2016, by means of a sample of 1202 individuals. A health survey was conducted on sample individuals. At the same time, the respondents were classified by health status through the Clinical Risk Groups system. The degree of association was analysed by logistic regression. RESULTS 27% of patients with more than two major chronic diseases or with complex health conditions stated they were in good health. An association was detected between health perception and disease burden. Sex, work situation, social class and especially age also showed association with the perception of health. CONCLUSIONS The inference of health status from clinical records on attended morbidity approximates to the subjective perception of health and vice versa. However, certain sociodemographic factors modulate individual perception. The results obtained are encouraging in relation to the development of new methodologies for calculating quality of life indicators.
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Affiliation(s)
- Marc Carreras
- Grupo de Investigación en Servicios Sanitarios y Resultados en Salud (GRESSIRES), Serveis de Salut Integrats Baix Empordà (SSIBE), Palamós (Girona), España; Departament d'Empresa, Universitat de Girona, Girona, España.
| | - Guillem Puig
- Universitat Pompeu Fabra, Universitat Autònoma de Barcelona, Barcelona, España
| | - Inmaculada Sánchez-Pérez
- Grupo de Investigación en Servicios Sanitarios y Resultados en Salud (GRESSIRES), Serveis de Salut Integrats Baix Empordà (SSIBE), Palamós (Girona), España
| | - José María Inoriza
- Grupo de Investigación en Servicios Sanitarios y Resultados en Salud (GRESSIRES), Serveis de Salut Integrats Baix Empordà (SSIBE), Palamós (Girona), España
| | - Jordi Coderch
- Grupo de Investigación en Servicios Sanitarios y Resultados en Salud (GRESSIRES), Serveis de Salut Integrats Baix Empordà (SSIBE), Palamós (Girona), España
| | - Rosa Gispert
- Grupo de Investigación en Servicios Sanitarios y Resultados en Salud (GRESSIRES), Serveis de Salut Integrats Baix Empordà (SSIBE), Palamós (Girona), España
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Parra-Membrives P, Martínez-Baena D, Lorente-Herce JM, Jiménez-Riera G, Sánchez-Gálvez MÁ. Choledocholithiasis recurrence following laparoscopic common bile duct exploration. Cir Esp 2019; 97:336-342. [PMID: 31027833 DOI: 10.1016/j.ciresp.2019.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 02/16/2019] [Accepted: 02/19/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Choledocholithiasis may be treated following an endoscopic approach or by laparoscopic common bile duct exploration (LCBDE). Stone recurrence following endoscopic management has been extensively investigated. We analyze the risk factors associated with stone recurrence following LCBDE. METHODS Patients who underwent LCBDE from February 2004 to July 2016 were examined in an univariate and multivariate analysis to assess the association of stone recurrence with the following variables: gender; age; hepatopathy; dyslipidemia, obesity or diabetes mellitus; previous abdominal surgery; presence of cholecystitis, cholangitis or pancreatitis; preoperative liver function tests, number of retrieved stones; method of common bile duct clearance and closure; presence of impacted or intrahepatic stones; conversion to open surgery and postoperative morbidity. RESULTS A total of 156 patients were included. Recurrence rate for choledocholithiasis was 14.1% with a mean time to recurrence of 38.18 month. Age was the only independent risk factor for stone recurrence at univariate and multivariate analysis. No patient aged under 55 years developed new common bile duct stones, and 86.4% of the recurrences occurred in patients aged above 65. CONCLUSIONS Age is the only independent risk factor associated to choledocholithiasis recurrence following LCBDE. Different mechanism in common bile duct stone development may be present for younger and older patients.
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Affiliation(s)
- Pablo Parra-Membrives
- Departamento de Cirugía, Universidad de Sevilla, España; Unidad de Cirugía Hepatobiliar y Pancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario de Valme, Sevilla, España.
| | - Darío Martínez-Baena
- Unidad de Cirugía Hepatobiliar y Pancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario de Valme, Sevilla, España
| | - José Manuel Lorente-Herce
- Unidad de Cirugía Hepatobiliar y Pancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario de Valme, Sevilla, España
| | - Granada Jiménez-Riera
- Departamento de Cirugía, Universidad de Sevilla, España; Unidad de Cirugía Hepatobiliar y Pancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario de Valme, Sevilla, España
| | - María Ángeles Sánchez-Gálvez
- Unidad de Cirugía Hepatobiliar y Pancreática, Servicio de Cirugía General y Digestiva, Hospital Universitario de Valme, Sevilla, España
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Delgado-López PD, Rodríguez-Salazar A. Abandoned techniques in spine surgery. Neurocirugia (Astur) 2020; 31:37-41. [PMID: 30792110 DOI: 10.1016/j.neucir.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/05/2019] [Indexed: 11/20/2022]
Abstract
In spine surgery, certain surgical techniques and devices are currently in marked decline or have been completely abandoned. Although used in thousands of patients, such treatments failed to demonstrate durable and sound effectiveness, and sometimes associate inacceptable morbidity. Chemopapain injections, percutaneous discectomy, laser discectomy or antiadhesion gels are examples of abandoned therapies. Some other techniques are in frank decline like implantation of interspinous devices or lumbar disc prosthesis. In general, a technique is abandoned due to inefficacy, excessive associated morbidity, substituted by another more efficacious and less aggressive technique, end of commercialization, or usage prohibition. In the last decades, a great commercial pressure plus an increasing social demand have managed to convince many spine surgeons to indicate treatments not sufficiently supported by scientific evidence nor consolidated over time, many of which are eventually abandoned.
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Medrano-Guzmán R, Luna-Castillo M, Chable-Puc WJ, García-Ríos LE, González-Rodríguez D, Nájera-Domínguez FI. [Morbimortalidad de la pancreatoduodenectomía en pacientes con cáncer de páncreas y tumores periampulares en el Hospital de Oncología del Centro Médico Nacional Siglo XXI de 2008 a 2013]. CIR CIR 2019; 87:69-78. [PMID: 30600816 DOI: 10.24875/ciru.18000580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Pancreatic tumors and periampullary tumors have a similar clinical presentation; pancreatoduodenectomy represents the only possibility of cure or of increasing survival; with an average mortality of 5-10% and a morbidity of 20-40%. Objective To determine the morbidity and mortality secondary to the pancreatoduodenectomy intervention in patients with pancreatic cancer or periampullary tumors in the Oncology Hospital of Centro Médico Nacional Siglo XXI (Mexico City) from 2008 to 2013. Method Historical, observational and descriptive cohort carried out in the department of sarcomas and tumors of the upper digestive tube of the Oncology Hospital of Centro Médico Nacional Siglo XXI, postoperative pancreatoduodenectomy from 2008 to 2013. Results We included 71 patients who underwent pancreatoduodenectomy, 47 (66.2%) were female and 24 (33.8%) were male. The average age was 60.3 years. The most common histology was cancer of the Vater's ampulla (66.2%). The resections were R0 in 95.8% of the cases. Mortality was 4.22% and morbidity was 69%. The most frequent complication was pancreatic fistula (23.9%). In the statistical analysis, perioperative transfusion was associated with surgical complications (p < 0.007). Conclusions The morbidity of pancreatoduodenectomy is greater than that reported in the literature, however, it does not influence mortality that is similar to that reported in other centers. The number of lymph nodes resected; as well as the percentage of negative margins are those accepted worldwide; It is concluded that this is derived from the experience of the center where these procedures are performed. No factor with statistical significance was found, only the transfusion that increased the complications.
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Affiliation(s)
- Rafael Medrano-Guzmán
- Departamento de Sarcomas y Tumores de Tubo Digestivo Alto, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Marisol Luna-Castillo
- Departamento de Sarcomas y Tumores de Tubo Digestivo Alto, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Waldo J Chable-Puc
- Departamento de Sarcomas y Tumores de Tubo Digestivo Alto, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Luis E García-Ríos
- Departamento de Sarcomas y Tumores de Tubo Digestivo Alto, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Domingo González-Rodríguez
- Departamento de Sarcomas y Tumores de Tubo Digestivo Alto, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Francisco I Nájera-Domínguez
- Departamento de Sarcomas y Tumores de Tubo Digestivo Alto, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Ciudad de México, México
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Hernández-Vargas H, Cortes-Torres EJ, González-Ojeda A, Pérez-Landeros JE, Barrera-López FJ, Fuentes-Orozco C. [Morbilidad y mortalidad de la linfadenectomía cervical. Análisis de 311 casos]. CIR CIR 2018; 86:522-527. [PMID: 30361719 DOI: 10.24875/ciru.18000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objetivo Determinar la morbimortalidad y los factores de riesgo asociados a la linfadenectomía cervical. Métodos Estudio transversal analítico en el que se incluyeron pacientes sometidos a linfadenectomía cervical en cualquiera de sus variantes, secundarios a la recurrencia de alguna enfermedad neoplásica, desde enero de 2011 hasta noviembre de 2016. Resultados Se incluyeron 311 pacientes, de los cuales 203 (65.3%) eran mujeres, con una edad de 49 ± 17.2 años. Los diagnósticos más frecuentes fueron cáncer de tiroides, en 194 (62.4%) casos, y cáncer de laringe recurrente, en 22 (7.1%). Cursaron asintomáticos 166 (53.4%) pacientes, y 119 (38.3%) presentaron masas o nódulos en el cuello, siendo el nivel III el más afectado, con 276 (88.7%) pacientes. La morbilidad general fue del 17% y la mortalidad fue del 5.8%. Los factores relacionados con la mortalidad fueron la sintomatología presente (p = 0.006), la afectación del nivel I (p = 0.005), la disección ganglionar extensa (p = 0.01) y las complicaciones vasculares (p = 0.0001) y de la herida (p = 0.01). Conclusiones Debido al patrón de diseminación linfática de los tumores de cabeza y cuello, la linfadenectomía selectiva desempeña un papel crucial en su tratamiento. Se ha optado por la realización de cirugías más conservadoras, siempre y cuando sean preservados los principales objetivos oncológicos. Objective To determine the morbidity and mortality and the risk factors associated with cervical lymphadenectomy. Method Cross-sectional study; patients undergoing cervical lymphadenectomy were included in any of its variants, secondary to the recurrence of some neoplastic entity; from January 2011 to November 2016. Results 311 patients were included of which 65.3% were women and 49 ± 17.2 years old. The most frequent diagnoses were thyroid cancer 194 (62.4%) and recurrent laryngeal cancer 22 (7.1%). Asymptomatic patients had 53.4% of the patients and 119 (38.3%) presented masses or nodules in the neck, with level III being the most affected with 276 (88.7%) patients. Overall morbidity was 17% and mortality was 5.8%. The factors related to mortality were: present symptomatology (p = 0.006), involvement of level I (p = 0.005), extensive lymph node dissection (p = 0.01), and vascular complications (p = 0.0001) and the wound (p = 0.01). Conclusions Due to the lymphatic dissemination pattern of head and neck tumors, selective lymphadenectomy plays a crucial role in the treatment of these neoplasms. We have opted to perform more conservative surgeries, as long as the main oncological objectives are preserved.
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Affiliation(s)
- Héctor Hernández-Vargas
- Servicio de Cirugía Oncológica. Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
| | - Edgar J Cortes-Torres
- Servicio de Cirugía Oncológica. Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
| | - Alejandro González-Ojeda
- Unidad de Investigación Biomédica. Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
| | - Jacob E Pérez-Landeros
- Unidad de Investigación Biomédica. Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
| | - Francisco J Barrera-López
- Unidad de Investigación Biomédica. Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
| | - Clotilde Fuentes-Orozco
- Unidad de Investigación Biomédica. Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
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Rahy-Martín AC, Cruz-Benavides F, Sánchez-Lauro M, Rodríguez-Méndez Á, San Miguel Í, Lara P, Marchena-Gómez J. Intraoperative radiotherapy with the Intrabeam ® device for the treatment of resectable pancreatic adenocarcinoma. Cir Esp 2018; 96:482-487. [PMID: 30297032 DOI: 10.1016/j.ciresp.2018.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 02/25/2018] [Accepted: 04/24/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The application of intraoperative radiation therapy to the tumor bed after resection of pancreatic cancer has been shown to be beneficial in the local control of the disease. The objective of this study was to evaluate the preliminary outcomes after the application of a single intraoperative dose to the tumor bed with a new intraoperative radiotherapy device (Intrabeam®) in terms of viability, safety and short-term results. METHODS We studied 5 patients who underwent pancreaticoduodenectomy for resectable pancreatic cancer in which a radiotherapy boost (5Gy) was intraoperatively applied to the tumoral bed using the portable Intrabeam® device, a low-energy point-source X-ray. Postoperative complications, hospital stay and mortality, recurrences and short-term survival were analyzed. RESULTS Mean patient age was 68 years. All patients had a T3-stage tumor and one of them N1. In 3 patients, R0 resection was performed, while R1 resection was conducted in 2. Perioperative mortality was 0%. The only complications included delayed gastric emptying and postoperative hemorrhage. There were no pancreatic fistulas. During follow-up (mean: 11.2 months), there was a relapse in the patient who had undergone R1 resection. CONCLUSIONS The application of radiotherapy with the Intrabeam® device in selected patients has not resulted in increased perioperative morbidity or mortality; therefore, this is a safe procedure for the treatment of resectable cancer.
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Affiliation(s)
- Aida Cristina Rahy-Martín
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España.
| | - Francisco Cruz-Benavides
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
| | - Mar Sánchez-Lauro
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
| | - Álvaro Rodríguez-Méndez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
| | - Íñigo San Miguel
- Servicio de Oncología Radioterápica, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
| | - Pedro Lara
- Servicio de Oncología Radioterápica, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
| | - Joaquín Marchena-Gómez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
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Carbayo Herencia JA, Simarro Rueda M, Palazón Bru A, Molina Escribano F, Ponce García I, Artigao Ródenas LM, Caldevilla Bernardo D, Divisón Garrote JA, Gil Guillén VF. Evaluation of non-HDL cholesterol as a predictor of non-fatal cardiovascular events in a prospective population cohort. Clin Investig Arterioscler 2018; 30:64-71. [PMID: 29395492 DOI: 10.1016/j.arteri.2017.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Non-HDL cholesterol (non-HDL-C) is becoming relevant both in its participation in cardiovascular risk assessment and as a therapeutic target. The objective of the present study was to assess the independent predictive capacity of both non-HDL-C and LDL-C (the main priority in dyslipidemias to reduce cardiovascular risk), in cardiovascular morbidity in a population-based sample. METHODS A prospective cohort study involving 1186 individuals in the non-HDL-C group and 1177 in the LDL-C group, followed for 10.7years (SD=2.2), who had not had any previous cardiovascular event. The predictor variables included in the adjustment were: gender, age, arterial hypertension, diabetes mellitus, smoker status and non-HDL-C in one group. In the other group, consisting of patients presenting TG levels of 400mg/dL, non-HDL-C was replaced by LDL-C. Survival curves (Kaplan-Meier) were calculated and two Cox regression models were applied, one for each group. RESULTS Non-HDL-C group presented 6.2% of non-fatal cardiovascular episodes during follow-up and the LDL-C group 6.0%. After adjustment, for each 30mg/dL increase in non-HDL-C, the incidence of new non-fatal cardiovascular events increased by 31% (HR=1.31, 95%CI: 1.06-1.61; P=.018) and in the LDL-C group by 27% (HR=1.27, 95%CI: 0.97-1.61, P=.068). CONCLUSIONS After a follow-up of 10.7years, non-HDL-C has been shown in our population as a prognostic factor of non-fatal cardiovascular disease, but not LDL-C, although its HR is close to statistical significance.
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Affiliation(s)
- Julio A Carbayo Herencia
- Unidad de Lípidos, Hospital Quirónsalud, Albacete, España; Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Alicante, España; Cátedra de Riesgo Cardiovacular, Universidad Católica de San Antonio (UCAM), Murcia, España.
| | - Marta Simarro Rueda
- Medicina Familiar y Comunitaria, Centro de Salud «Zona IV», Albacete, España
| | - Antonio Palazón Bru
- Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan de Alicante, Alicante, España
| | | | - Isabel Ponce García
- Medicina Familiar y Comunitaria, Centro de Salud Ayna, Ayna, Albacete, España
| | | | | | - Juan A Divisón Garrote
- Medicina Familiar y Comunitaria, Centro de Salud Casas Ibáñez, Casas Ibáñez, Albacete, España; Cátedra de Medicina Familiar y Comunitaria, Grado de Medicina, UCAM, Murcia, España
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Blay-Domínguez E, Lajara-Marco F, Bernáldez-Silvetti PF, Veracruz-Gálvez EM, Muela-Pérez B, Palazón-Banegas MÁ, Salinas-Gilabert JE, Lozano-Requena JA. O-POSSUM score predicts morbidity and mortality in patients undergoing hip fracture surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 62:207-215. [PMID: 29191635 DOI: 10.1016/j.recot.2017.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/13/2017] [Accepted: 10/28/2017] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The aim of this study is to evaluate the O-POSSUM score capacity to predict the morbidity and mortality of patients undergoing hip fracture surgery. MATERIAL AND METHODS We retrospectively reviewed the clinical records of patients older than 65years old, operated on for hip fractures between January 2012 and December 2013. Of 229 patients, the mean age was 82.3years and 170 were women. We collected comorbidities, type of surgery, and expected morbidity and mortality O-POSSUM values. RESULTS After a minimum follow up of one year, 38 deaths were reported and 77 patients had complications. The expected mortality according to the O-POSSUM was 35 patients and expected morbidity 132. CONCLUSION By comparing the observed results with those predicted, the O-POSSUM scale is reliable in predicting mortality and overestimates morbidity.
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Affiliation(s)
- Elena Blay-Domínguez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Vega Baja, Orihuela, Alicante, España.
| | - Francisco Lajara-Marco
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Vega Baja, Orihuela, Alicante, España
| | | | | | - Beatriz Muela-Pérez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Vega Baja, Orihuela, Alicante, España
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García-Reymundo M, Demestre X, Calvo MJ, Ginovart G, Jiménez A, Hurtado JA. [Late preterm infants in Spain: Experience of the 34-36 Neonatal Group]. An Pediatr (Barc) 2018; 88:246-52. [PMID: 29100893 DOI: 10.1016/j.anpedi.2017.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/25/2017] [Accepted: 05/22/2017] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Late preterm (LP) infants (34 -36 weeks of gestation) are the largest group of preterm infants and also the least studied so far. In order to improve their care and reduce the impact of their increased morbidity and mortality, it is essential to know the current situation in Spain. POPULATION AND METHOD Clinical-epidemiological variables of the LP population of 34 participating hospitals were prospectively collected from 1 April 2011 to 31 March 2016, and were then compared with the Minimum Perinatal Data Set for term births in the database. RESULTS Of the 9,121 LP studied, 21.7% of 34, 30.8% of 35, and 47.5% of 36 weeks of gestation. The mortality rate was 2.8%. More than one-quarter (27.7%) were multiple pregnancies. Maternal disease were identified in 47.1% and 41.4% were pathological gestation. Just under half (47.9%) were by Caesarean section and 18.8% were of unknown origin or unjustified. No known cause of prematurity was found in 29%, and 3.1% were recognized as unjustified?caesarean?. Just under half (47%) of the LP were breastfed, and 58.6% required admission to neonatology, with 15.2% to Neonatal Intensive Care Unit. Coded diagnoses were recorded in 46.2%, with the most frequent being jaundice, 43.5%, hypoglycaemia, 30%, and respiratory disorders with 28.7%. CONCLUSIONS The large sample of LP studied helps us to highlight the higher neonatal mortality and morbidity that this population suffers and the unavoidable relationship of its incidence with multiparity, maternal aging, and the still numerous inductions of labour and unjustified elective caesareans.
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Rubio JA, Jiménez S, Álvarez J. Clinical characteristics and mortality in patients treated in a Multidisciplinary Diabetic Foot Unit. ACTA ACUST UNITED AC 2017; 64:241-249. [PMID: 28495319 DOI: 10.1016/j.endinu.2017.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 02/23/2017] [Accepted: 02/27/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVE This study reviews the clinical characteristics of patients with diabetic foot ulcer treated in a Multidisciplinary Diabetic Foot Unit (MDFU) and analyzes the mortality and factors associated with its survival. MATERIAL AND METHODS Data from all patients who attended the MDFU for the first time for a diabetic foot ulcer during the 2008-2014 period were analized. The patients were followed until their death or until June 30, 2016, for up to 8 years. RESULTS A total of 345 patients were included, with a median age (P25-P75) of 71 (61.5-80) years, and 321 (93%) had type 2 diabetes. They were characterized as patients with inadequate glycemic control, 48% had HbA1c ≥ 8% and high prevalence of chronic complications: 60.2% retinopathy, 43.8% nephropathy and 47.2% ischemic heart disease and/or cerebrovascular disease. A total of 126 (36.5%) patients died and 69 (54.8%) were due to cardiovascular disease. Survival measured by Kaplan-Meier declined over time to 69, 60 and 45% at 3, 5 and 7 years respectively. Cox's multivariate regression analysis showed the following variables associated with mortality, HR (95% CI): age 1.08 (1.05-1.11); previous amputation 2.24 (1.34-3.73); active smoking 2.10 (1.12-3.97); cerebrovascular disease 1.75 (1.05-2.92); renal dysfunction 1.65 (1.04-2.61) and ischemic heart disease 1.60 (1.01-2.51). CONCLUSIONS Patients with diabetic foot ulcer are characterized by high morbidity and mortality, with cardiovascular disease being the most frequent cause of death. It is necessary to pay more attention to this risk group, tailoring objectives and treatments to their situation and life expectancy.
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Affiliation(s)
- José Antonio Rubio
- Unidad de Pie Diabético, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España; Departamento de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España; Departamento de Ciencias Biomédicas, Universidad de Alcalá, Alcalá de Henares, España.
| | - Sara Jiménez
- Unidad de Pie Diabético, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España; Departamento de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España
| | - Julia Álvarez
- Unidad de Pie Diabético, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España; Departamento de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España; Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Alcalá de Henares, España
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