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

PhDAY 2020 -FOO (Facultad de Óptica y Optometría)

Por cuarto año consecutivo los doctorandos de la Facultad de Óptica y Optometría de la Universidad Complutense de Madrid cuentan con un congreso propio organizado por y para ellos, el 4º PhDAY- FOO. Se trata de un congreso gratuito abierto en la que estos jóvenes científicos podrán presentar sus investigaciones al resto de sus compañeros predoctorales y a toda la comunidad universitaria que quiera disfrutar de este evento. Apunta en tu agenda: el 15 de octubre de 2020. En esta ocasión será un Congreso On-line para evitar que la incertidumbre asociada a la pandemia Covid-19 pudiera condicionar su celebración

Valoración de la efectividad de una pauta analgésica con buprenorfina transdérmica en pacientes afectos de isquemia arterial crónica evolucionada de las extremidades inferiores: perfil genético

[EN]The relief of pain in patients with chronic arterial ischemia is a key pillar in the treatment of this pathology, not only to improve the quality of life of patients affected, but also to provide other medical and surgical treatments of this disease. The objectives of the study are: 1. To evaluate the efficacy of buprenorphine transdermal analgesic dose for control of ischemic pain in patients with grade III-IV artery of lower extremity Fontaine, awaiting surgery or those not eligible for surgery and its impact on quality of life of these patients. 2. To evaluate the dependence of the threshold of pain and response to treatment with respect to the personal background, sex and age of the patients studied. 3. Analyze the influence of the genetic profile of patients in pain management by opioid analgesic, by studying polymorphisms of UGT2B7, CYP3A4 and OPRM1.[ES]El alivio del dolor en los pacientes afectos de isquemia arterial crónica es un pilar fundamental en el tratamiento de esta patología, no sólo para mejorar la calidad de vida de los pacientes afectos, sino también para facilitar los demás tratamientos médicos y quirúrgicos de esta enfermedad. Los objetivos del estudio son: 1. Valorar la eficacia de una pauta analgésica con buprenorfina transdérmica para el control del dolor isquémico en los pacientes con arteriopatía grado III-IV de Fontaine de las extremidades inferiores, en espera de intervención quirúrgica o en aquellos no subsidiarios de cirugía, y su impacto sobre la calidad de vida de estos enfermos. 2. Evaluar la dependencia del umbral del dolor y de la respuesta al tratamiento, respecto a los antecedentes personales, el sexo y la edad de los pacientes estudiados. 3. Analizar la influencia que tiene el perfil genético de los pacientes en el control del dolor por el analgésico opioide, mediante el estudio de los polimorfismos de UGT2B7, CYP3A4 y OPRM1

Seminarios multimedia de metodología de investigación en ciencias odontológicas

Memoria ID-034. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2013-2014

Actividades para la enseñanza de inglés a través de contenidos en secundaria (II)

El Programa PALE (programa de apoyo al aprendizaje de lenguas extranjeras), cofinanciado por el Ministerio de Educación y Ciencia y las Comunidades Autónomas, pretende dar respuesta, desde el Sistema Educativo, a las necesidades derivadas de la mejora de la enseñanza y el aprendizaje de lenguas extranjeras en una sociedad como la actual, donde las lenguas se consideran conocimientos básicos que precisa la ciudadanía europea para su formación, para mejorar sus posibilidades de empleo, para la promoción del intercambio cultural y para la realización persona. El material incluido en este Cd-Rom ha sido realizado en la tercera fase del curso PALE 2008 para Secundaria del CPR de Oviedo, tras la formación recibida en Asturias y en el extranjero, mediante la constitución de un grupo de trabajo. Consta de una serie de presentaciones realizadas durante el desarrollo del curso PALE, de once unidades didácticas en relación con distintas áreas en las que se ejemplifica la forma de trabajar la enseñanza a través de contenidos, CLIL ('Content and Language Integrated Learning'), de una guía para la realización de presentaciones orales y de un listado de frases útiles para el profesorado. Las materias y las unidades trabajadas son: 1) Art: Multimedia language: building images. 2) Biology: Healthy habits and healthy life y 'Health and disease'. 3) Chemistry: 'Chemical reactions'. 4) Citizenship and Ethics: 'Conflicts and solutions' y 'The rights of our body'. 5) Maths: 'Equations' y 'Similarity'. 6) Music: 'The singing voice'. 7). Physical Education: 'Welcome to the world of PE' y 'Health related fitness'.AsturiasUniversidad de Oviedo. Facultad de Ciencias de la Educación; Calle Aniceto Sela s. n.; 33005 Oviedo; +34985103215; +34985103214;ES

“Long-term oncologic outcomes and risk factors for distant recurrence after pathologic complete response following neoadjuvant treatment for locally advanced rectal cancer. A nationwide, multicentre study”

Background: Pathologic complete response (pCR) after multimodal treatment for locally advanced rectal cancer (LARC) is used as surrogate marker of success as it is assumed to correlate with improved oncologic outcome. However, long-term oncologic data are scarce.Methods: This retrospective, multicentre study updated the oncologic follow-up of prospectively collected data from the Spanish Rectal Cancer Project database. pCR was described as no evidence of tumour cells in the specimen. Endpoints were distant metastases-free survival (DMFS) and overall survival (OS). Multivariate regression analyses were run to identify factors associated with survival.Results: Overall, 32 different hospitals were involved, providing data on 815 patients with pCR. At a median follow-up of 73.4 (IQR 57.7-99.5) months, distant metastases occurred in 6.4% of patients. Abdominoperineal excision (APE) (HR 2.2, 95%CI 1.2-4.1, p = 0.008) and elevated CEA levels (HR = 1.9, 95% CI 1.0-3.7, p = 0.049) were independent risk factors for distant recurrence. Age (years) (HR 1.1; 95% CI 1.05-41.09; p < 0.001) and ASA III-IV (HR = 2.0; 95%-CI 1.4-2.9; p < 0.001), were the only factors associated with OS. The estimated 12, 36 and 60-months DMFS rates were 96.9%, 91.3%, and 86.8%. The estimated 12, 36 and 60-months OS rates were 99.1%, 94.9% and 89.3%.Conclusions: The incidence of metachronous distant metastases is low after pCR, with high rates of both DMFS and OS. The oncologic prognosis in LARC patients that achieve pCR after neoadjuvant chemoradiotherapy is excellent in the long term. (c) 2023 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved

Surgeons’ practice and preferences for the anal fissure treatment: results from an international survey

The best nonoperative or operative anal fissure (AF) treatment is not yet established, and several options have been proposed. Aim is to report the surgeons' practice for the AF treatment. Thirty-four multiple-choice questions were developed. Seven questions were about to participants' demographics and, 27 questions about their clinical practice. Based on the specialty (general surgeon and colorectal surgeon), obtained data were divided and compared between two groups. Five-hundred surgeons were included (321 general and 179 colorectal surgeons). For both groups, duration of symptoms for at least 6 weeks is the most important factor for AF diagnosis (30.6%). Type of AF (acute vs chronic) is the most important factor which guide the therapeutic plan (44.4%). The first treatment of choice for acute AF is ointment application for both groups (59.6%). For the treatment of chronic AF, this data is confirmed by colorectal surgeons (57%), but not by the general surgeons who prefer the lateral internal sphincterotomy (LIS) (31.8%) (p = 0.0001). Botulin toxin injection is most performed by colorectal surgeons (58.7%) in comparison to general surgeons (20.9%) (p = 0.0001). Anal flap is mostly performed by colorectal surgeons (37.4%) in comparison to general surgeons (28.3%) (p = 0.0001). Fissurectomy alone is statistically significantly most performed by general surgeons in comparison to colorectal surgeons (57.9% and 43.6%, respectively) (p = 0.0020). This analysis provides useful information about the clinical practice for the management of a debated topic such as AF treatment. Shared guidelines and consensus especially focused on operative management are required to standardize the treatment and to improve postoperative results

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

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Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2

Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage: Development and Validation of a Prediction Model in a Large International Cohort.

Objective:To develop and validate a prediction model (STOMA score) for 1-year stoma-free survival in patients with rectal cancer (RC) with anastomotic leakage (AL).Background:AL after RC resection often results in a permanent stoma.Methods:This international retrospective cohort study (TENTACLE-Rectum) encompassed 216 participating centres and included patients who developed AL after RC surgery between 2014 and 2018. Clinically relevant predictors for 1-year stoma-free survival were included in uni and multivariable logistic regression models. The STOMA score was developed and internally validated in a cohort of patients operated between 2014 and 2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models' performance were evaluated.Results:This study included 2499 patients with AL, 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA score: sex, age, American Society of Anestesiologist classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction, and reactivation leakage. The STOMA score showed good discrimination and calibration (c-index: 0.71, 95% CI: 0.66-0.76).Conclusions:The STOMA score consists of 18 clinically relevant factors and estimates the individual risk for 1-year stoma-free survival in patients with AL after RC surgery, which may improve patient counseling and give guidance when analyzing the efficacy of different treatment strategies in future studies