Carcinoma de pene y liquen escleroso: dos entidades estrechamente relacionadas

El liquen escleroatrófico (LS) o Balanitis xerótica obliterans es un transtorno crónico de la piel de causa desconocida que puede aparecer en la región genital sobre todo en varones de mediana edad no circuncidados y que se relaciona con el cáncer de pene. Su incidencia varía en función de las serie

Incidencia de liquen escleroso en 617 circuncisiones

El liquen escleroatrófico es un transtorno crónico de la piel de causa desconocida que puede aparecer en la región genital sobre todo en varones de mediana edad no circuncidados y que se relaciona con el cáncer de pene. Su incidencia varía en función de las series

El pergamino vivo. El lector como personaje en Cien años de soledad

In addition to being the story of the Buendía family or Macondo or Latin America, One Hundred Years of Solitude is also the story of a multigenerational effort to read and understand Melquíades’ parchments, a text in which the characters’ destiny is foretold and explained. Using as a methodological instrument Paul Ricoeur’s interpretative Theory, particularly his approaches to Reception Theory, this paper aims to identify the textual strategies that involve the reader and make him or her a participant in the dynamics of the novel. The study concludes that the emphasis in representing the acts of reading and writing forces the reader to face an ethical problem: the fact that his or her role in the world is not only to read it, but also to write reality and his or her own personal narrative.Además de la historia de la familia Buendía o de Macondo o de América Latina, Cien años de soledad es también la historia de un esfuerzo multigeneracional por leer y entender los pergaminos de Melquíades, un texto donde el destino de los personajes se encuentra profetizado y explicado. Con la teoría interpretativa de Paul Ricoeur como herramienta, en especial sus consideraciones sobre la teoría de la recepción, este ensayo busca identificar las estrategias textuales que involucran al lector y lo hacen partícipe de la dinámica del texto. La conclusión central es que el énfasis en la representación de los actos de leer y escribir hace que el lector se enfrente a un problema ético: el hecho de que su papel en el mundo no consiste solo en leerlo, sino en escribir la realidad y su propio relato personal

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