An atypical presentation of renal mass associated with BAP-1 tumor predisposition syndrome: Case report and review of literature

BCRA-associated protein-1 (BAP-1) mutation has been associated with the development of a familiar syndrome that predisposes to tumors with a higher incidence than in general population, including melanoma and renal carcinoma.We report a 47-year-old woman diagnosed with a BAPoma (melanocytic tumor characterized by the loss of BAP-1). Due to her extensive family history with multiple neoplasms, a FDG PET-CT was performed. Consequently, she was diagnosed with an atypical renal mass, which is rarely linked to this syndrome.We review and discuss the available literature on the screening, diagnosis and treatment of renal tumors associated with BAP-1 tumor predisposition syndrome

Educación familiar: investigación en contextos escolares

Este libro se enmarca en la línea de investigación “Educación, lenguaje y comunicación” de la Facultad de Ciencias de la Educación de la Universidad de La Salle de Bogotá y, de manera específica, en el tema: familia y mediaciones educativas. Acá se plantea la pregunta por los modos como puede abordarse y asumirse la educación familiar en políticas educativas y en contextos escolares. Se entiende la educación familiar como un escenario de posibilidades formativas y de desarrollo humano para todos los miembros de la familia, en diversas direcciones: de la familia hacia su interior; de la familia hacia el exterior; y de los entes externos hacia la familia. Creemos que este libro puede contribuir en la comprensión de lo que tanto familia como escuela significan para la educación familiar.Introducción. P. 9. Ruth Milena Páez Martínez, Natalia Angélica Pérez Pedraza Capítulo 1. P. 21. La educación familiar, un asunto de la vida en familia y de interés teórico. Zulema Elisa Rodríguez Triana Capítulo 2. P. 53. Comprensiones de la cultura intrafamiliar desde el escenario escolar. Natalia Angélica Pérez Pedraza Capítulo 3. P. 77. Apuesta para el inicio de la educación familiar en el escenario perifamiliar. Ruth Milena Páez Martínez Capítulo 4. P. 97. Educación familiar en la escuela: una mirada desde cuatro instituciones gubernamentales colombianas. Carlos Alberto Abdala Vergara, Martha Lucía Borda López, Yennifer Gómez Díaz Capítulo 5. P. 113. Las princesas sumisas y los machos dominantes aún existen. Una mirada al escenario intrafamiliar. Vilma Susana García Correal, Marianne Judith Jiménez Marín, Claudia Milena Vargas Suárez Capítulo 6. P. 123. Educación familiar, un campo educativo por intervenir desde la perspectiva de género. Ingrid Yesenia Daza Rivera Capítulo 7. P. 139. El abuelo: garante de la moral y la unidad familiar. Jairo Emiro Bravo, Heberto Enrique Campo Álvarez, Zaira Beatriz Corredor Forero Capítulo 8. P. 155. La tolerancia se vive en las familias a través de la toma de decisiones Lucía Yasmín Barón Mora, Diana Milena Leguizamón Gaitán, Rocío Navarro Molano Capítulo 9. P. 169. Escuela de padres: un paso de lo nominal a lo real Rocío Farfán Rincón, Claudia Marcela Nieto Cubillos, Diana Marcela Pérez Martínez Capítulo 10. P. 189. El acompañamiento familiar: una alternativa para mejorar procesos académicos Paola Marcela López Beltrán, Blanca Isabel Mora Moreno, Nancy Sánchez de Dussán Conclusiones. P. 207. A manera de cierr

Educación familiar: investigación en contextos escolares

Este libro se enmarca en la línea de investigación Educación, lenguaje y comunicación de la Facultad de Ciencias de la Educación de la Universidad de La Salle de Bogotá y, de manera específica, en el tema: familia y mediaciones educativas. Acá se plantea la pregunta por los modos como puede abordarse y asumirse la educación familiar en políticas educativas y en contextos escolares. Se entiende la educación familiar como un escenario de posibilidades formativas y de desarrollo humano para todos los miembros de la familia, en diversas direcciones: de la familia hacia su interior; de la familia hacia el exterior; y de los entes externos hacia la familia. Creemos que este libro puede contribuir en la comprensión de lo que tanto familia como escuela significan para la educación familiar.Introducción. P. 9. Ruth Milena Páez Martínez, Natalia Angélica Pérez Pedraza Capítulo 1. P. 21. La educación familiar, un asunto de la vida en familia y de interés teórico. Zulema Elisa Rodríguez Triana Capítulo 2. P. 53. Comprensiones de la cultura intrafamiliar desde el escenario escolar. Natalia Angélica Pérez Pedraza Capítulo 3. P. 77. Apuesta para el inicio de la educación familiar en el escenario perifamiliar. Ruth Milena Páez Martínez Capítulo 4. P. 97. Educación familiar en la escuela: una mirada desde cuatro instituciones gubernamentales colombianas. Carlos Alberto Abdala Vergara, Martha Lucía Borda López, Yennifer Gómez Díaz Capítulo 5. P. 113. Las princesas sumisas y los machos dominantes aún existen. Una mirada al escenario intrafamiliar. Vilma Susana García Correal, Marianne Judith Jiménez Marín, Claudia Milena Vargas Suárez Capítulo 6. P. 123. Educación familiar, un campo educativo por intervenir desde la perspectiva de género. Ingrid Yesenia Daza Rivera Capítulo 7. P. 139. El abuelo: garante de la moral y la unidad familiar. Jairo Emiro Bravo, Heberto Enrique Campo Álvarez, Zaira Beatriz Corredor Forero Capítulo 8. P. 155. La tolerancia se vive en las familias a través de la toma de decisiones Lucía Yasmín Barón Mora, Diana Milena Leguizamón Gaitán, Rocío Navarro Molano Capítulo 9. P. 169. Escuela de padres: un paso de lo nominal a lo real Rocío Farfán Rincón, Claudia Marcela Nieto Cubillos, Diana Marcela Pérez Martínez Capítulo 10. P. 189. El acompañamiento familiar: una alternativa para mejorar procesos académicos Paola Marcela López Beltrán, Blanca Isabel Mora Moreno, Nancy Sánchez de Dussán Conclusiones. P. 207. A manera de cierr

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58\ub75%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31\ub72%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10\ub72%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12\ub73%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9\ub74%] of 7339 patients), middle (549 [14\ub70%] of 3918 patients), and low (298 [23\ub72%] of 1282) HDI (p<0\ub7001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17\ub78%] of 574 patients in high-HDI countries; 74 [31\ub74%] of 236 patients in middle-HDI countries; 72 [39\ub78%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1\ub760, 95% credible interval 1\ub705\u20132\ub737; p=0\ub7030). 132 (21\ub76%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16\ub76%) of 295 patients in high-HDI countries, in 37 (19\ub78%) of 187 patients in middle-HDI countries, and in 46 (35\ub79%) of 128 patients in low-HDI countries (p<0\ub7001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication. Funding: DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P<0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P<0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this