Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P <0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Volvimos a las aulas... ¿y cómo? : experiencias y propuestas de enseñanza 2020-2021

Mohaded, Ana María. Universidad Nacional de Córdoba. Facultad de Artes.Departamento Académico de Cine y Televisión; Argentina.Domínguez Pesce, Agustín. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Música; Argentina.Salit, Celia. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Música; Argentina.Estarellas, Natalia. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Artes Visuales; Argentina.Menoyo, Sofía G. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Artes Visuales; Argentina.Argüello, Cecilia Beatriz. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Música; Argentina.Sajeva, Maura Jorgelina. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Teatro; Argentina.Irazusta, María Cecilia. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Artes Visuales; Argentina.Otero Gruer, Dolores. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Artes Visuales; Argentina.Mendizabal, Lilian Isabel. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Teatro; Argentina.Cáceres, Carlos Esteban. Universidad Nacional de Córdoba. Facultad de Artes.Departamento Académico de Cine y Televisión; Argentina.Fernández, Juan Manuel. Facultad de Artes.Departamento Académico de Cine y Televisión; Argentina.Menta, María Eugenia. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Música; Argentina.Hernández, Alejandra Fabiana. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Artes Visuales; Argentina.Miranda, Adriana Esther. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Artes Visuales; Argentina.Vivanco, Fernanda. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Teatro; Argentina.Serra, Mariela. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Teatro; Argentina.Altamirano, Ivana Verónica. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Teatro; Argentina.Bravo, Carolina. Universidad Nacional de Córdoba. Facultad de Artes.Departamento Académico de Cine y Televisión; Argentina.Jacobo, Mónica. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Artes Visuales; Argentina.Sequeira, Jazmín. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Teatro; Argentina.Suárez, Victoria Inés. Universidad Nacional de Córdoba. Facultad de Artes.Departamento Académico de Cine y Televisión; Argentina.Yaya Aguilar, María Marcela. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Cine y Televisión; Argentina.Curletto, Hugo Daniel. Universidad Nacional de Córdoba. Facultad de Artes.Departamento Académico de Cine y Televisión; Argentina.Checchi, Pablo Martín. Universidad Nacional de Córdoba. Facultad de Artes.Departamento Académico de Cine y Televisión; Argentina.Nuestra principal responsabilidad como institución educativa universitaria es la formación de ciudadanes, garantizando saberes con los que puedan construir y sostener proyectos de vida en marcos de libertad compartida y promoviendo pers- pectivas que aporten en la transformación de la sociedad con parámetros más jus- tos, inclusivos y fraternos. Esta tarea, que está en permanente transformación y ac- tualización, sufrió un sismo en el 2020 y 2021 a partir de las condiciones devenidas por la pandemia. La Facultad de Artes por el tipo de conocimiento y metodología que proyecta, requiere de la presencialidad como plataforma de funcionamiento. Sin embargo, inmersos en la emergencia, les docentes, nodocentes, estudiantes y egresades re- aprendimos, reorganizamos y reinventamos dinámicas que nos permitieron seguir habilitando el derecho a la educación pública, a la creación de conocimiento especí- fico en artes y a la significación solidaria de los lazos societarios. Todos estos procesos implicaron un enorme trabajo colectivo que posibilitó diversas respuestas y abanicos de experiencias, creadas, procesadas, aplicadas y so- pesadas mientras transitábamos ese común estado pantallistico que habitábamos desde cada hogar por separado. El inicio del 2022 significó una nueva mutación, con sus consecuentes incerti- dumbres. Se abría una etapa marcada por la necesidad de consolidar una pedagogía de la presencia y de desarrollar otras didácticas de los cuerpos, recuperando la ale- gría del encuentro sin descuidar las lógicas de prevención en salud.Mohaded, Ana María. Universidad Nacional de Córdoba. Facultad de Artes.Departamento Académico de Cine y Televisión; Argentina.Domínguez Pesce, Agustín. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Música; Argentina.Salit, Celia. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Música; Argentina.Estarellas, Natalia. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Artes Visuales; Argentina.Menoyo, Sofía G. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Artes Visuales; Argentina.Argüello, Cecilia Beatriz. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Música; Argentina.Sajeva, Maura Jorgelina. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Teatro; Argentina.Irazusta, María Cecilia. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Artes Visuales; Argentina.Otero Gruer, Dolores. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Artes Visuales; Argentina.Mendizabal, Lilian Isabel. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Teatro; Argentina.Cáceres, Carlos Esteban. Universidad Nacional de Córdoba. Facultad de Artes.Departamento Académico de Cine y Televisión; Argentina.Fernández, Juan Manuel. Facultad de Artes.Departamento Académico de Cine y Televisión; Argentina.Menta, María Eugenia. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Música; Argentina.Hernández, Alejandra Fabiana. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Artes Visuales; Argentina.Miranda, Adriana Esther. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Artes Visuales; Argentina.Vivanco, Fernanda. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Teatro; Argentina.Serra, Mariela. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Teatro; Argentina.Altamirano, Ivana Verónica. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Teatro; Argentina.Bravo, Carolina. Universidad Nacional de Córdoba. Facultad de Artes.Departamento Académico de Cine y Televisión; Argentina.Jacobo, Mónica. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Artes Visuales; Argentina.Sequeira, Jazmín. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Teatro; Argentina.Suárez, Victoria Inés. Universidad Nacional de Córdoba. Facultad de Artes.Departamento Académico de Cine y Televisión; Argentina.Yaya Aguilar, María Marcela. Universidad Nacional de Córdoba. Facultad de Artes. Departamento Académico de Cine y Televisión; Argentina.Curletto, Hugo Daniel. Universidad Nacional de Córdoba. Facultad de Artes.Departamento Académico de Cine y Televisión; Argentina.Checchi, Pablo Martín. Universidad Nacional de Córdoba. Facultad de Artes.Departamento Académico de Cine y Televisión; Argentina

TVI - Arquitectura y Construcción - AR323 - 202101

Descripción: El curso TVI-Arquitectura y construcción introduce al estudiante en el conocimiento de las necesidades constructivas del proyecto arquitectónico y en la aplicación de los sistema estructurales; en la coordinación de sistemas estructurales para hacer posible que los sótanos de estacionamiento calcen sobre plantas de desarrollo habitacional, que los ductos de instalaciones eléctricas y sanitarias tengan continuidad, etc. Se diseñan pequeños edificios de oficinas, fábricas, centros comerciales, clínicas, complejos deportivos, etc. Propósito: Desarrollar propuestas arquitectónicas cuya concepción involucre la necesidad de pensar en sistemas estructurales adecuados, un correcto dimensionamiento para las necesidades materiales del proyecto (tales como estacionamiento, traslado de muebles, y seguridad) La construcción implica decidir una lógica estructural, por el comportamiento del material, y la expresión arquitectónica en coherencia con el tema ¿organización y funcionamiento- y el lugar. La asignatura contribuye al desarrollo de las competencias específicas de la carrera: Diseño Fundamentado, que corresponde a los criterios NAAB PC2, PC3, PC8, PC5, SC3, SC5, así como, Técnica y Construcción que corresponde a los criterios NAAB SC1, SC4, SC6; ambas en el nivel de logro 2. Tiene como requisito la asignatura de AR309 TV - Arquitectura y Medio Ambient

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study (vol 46, pg 2021, 2022)

N/

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care