Mesh Fixation Methods in Groin Hernia Surgery

No unanimous consent has been reached by surgeons in terms of a method for mesh fixation in laparoscopic and open surgery for inguinal hernia repair. Many different methods of fixation are available, and the choice of which one to use is still based on surgeons’ preferences. At present, tissue glues, sutures, and laparoscopic tacks are the most common fixating methods. In open technique, sutures have been the method of choice for their reduced costs and surgeons’ habits. Nevertheless, tissue glues have been demonstrated to be effective and safe. Similarly, tacks can be considered the most common means of fixation in laparoscopic hernia repair, but they are connected to a higher risk of complication and morbidity. In this chapter, we present these types of mesh fixation, their characteristics and potential risks, and advantages of their use

Combined Before-and-After Workplace Intervention to Promote Healthy Lifestyles in Healthcare Workers (STI-VI Study): Short-Term Assessment

Health care workers (HCWs) are prone to a heavy psycho-physical workload. Health promotion programs can help prevent the onset of chronic and work-related diseases. The aim of the STI-VI 'before-and-after' study, with assessments scheduled at 6 and 12 months, was to improve the lifestyle of HCWs with at least one cardiovascular risk factor. A tailored motivational counseling intervention, focusing on dietary habits and physical activity (PA) was administered to 167 HCWs (53 males; 114 females). BMI, waist circumference, blood pressure, and cholesterol, triglyceride, and blood glucose levels were measured before and after the intervention. The 6-month results (total sample and by gender) showed a marked effect on lifestyle: PA improved (+121.2 MET, p = 0.01), and diets became more similar to the Mediterranean model (+0.8, p < 0.001). BMI dropped (-0.2, p < 0.03), and waist circumference improved even more (-2.5 cm; p < 0.001). Other variables improved significantly: total and LDL cholesterol (-12.8 and -9.4 mg/dL, p < 0.001); systolic and diastolic blood pressure (-4.4 and -2.5 mmHg, p < 0.001); blood glucose (-1.5 mg/dL, p = 0.05); and triglycerides (significant only in women), (-8.7 mg/dL, p = 0.008); but HDL cholesterol levels dropped too. If consolidated at 12 months, these results indicate that our intervention can help HCWs maintain a healthy lifestyle and work ability

Arritmias cardíacas no contexto de pacientes com COVID-19, uma revisão narrativa

INTRODUCTION: With the evolution of knowledge about SARS-CoV-2 infection, it was possible to evaluate the importance of extrapulmonary involvement, such as cardiovascular complications. Concomitantly, the literature has been associating the virus with the emergence or worsening of cardiac arrhythmias. Thus, this article aims to verify if there is an association between COVID-19, cardiac arrhythmias, and viral myocarditis, besides reviewing the pathophysiology, diagnosis, cardiovascular signs and symptoms, and the treatments used. METHODOLOGY: This is a narrative review study conducted in EMBASE and PubMed. The PICO protocol was used to answer the following question: "Is there an association between COVID-19, cardiac arrhythmias, and viral myocarditis?" The descriptor used for the population was "coronavirus disease 2019"; with the following results: "heart arrythimia" and "virus myocarditis". Studies were considered suitable for review if: 1) they were related to COVID-19 caused by the SARS-CoV-2 virus; 2) they addressed cardiovascular involvement; and 3) they had at least one session on heart rhythm disturbances. They were considered inadequate if: 1) Were case reports; 2) Were letters to the editor; or 3) Were incomplete. RESULTS: The descriptor search resulted in 67 articles and, after applying the inclusion and exclusion criteria, only 9 articles published between the dates of January 2020 and May 2022 composed the analysis sample. DISCUSSION: The pathophysiology of arrhythmia secondary to COVID-19 involves infiltration of SARS-CoV-2 into the heart and fibrosis of cardiac tissue due to excess interleukin-6. Diagnosis is made using ECG and troponin quantification. The most prevalent symptomatology in hospitalized patients was febrile relative bradyarrhythmia. The therapy involves the use of antiviral, anti-inflammatory and/or immunosuppressive drugs. CONCLUSION: It was possible to verify that infection by the SARS-Cov-2 virus has an impact on arrhythmias pre-existing to the infection and in new cases.INTRODUÇÃO: Com a evolução do conhecimento sobre a infecção pelo vírus SARS-CoV-2, foi possível avaliar a importância dos acometimentos extrapulmonares, como as complicações cardiovasculares. Concomitante a isso, a literatura vem associando o vírus ao surgimento ou agravamento de arritmias cardíacas. Assim, este artigo tem como objetivo verificar se há associação entre a COVID-19, arritmias cardíacas e miocardite viral, além de revisar a fisiopatologia, diagnóstico, sinais e sintomas cardiovasculares e os tratamentos utilizados. METODOLOGIA: Trata-se de um estudo de revisão narrativa realizado na EMBASE e PubMed. Foi utilizado o protocolo PICO para responder à seguinte pergunta: "Existe alguma associação entre a COVID-19, arritmias cardíacas e miocardite viral?". O descritor usado para a população foi “coronavirus disease 2019”; com os seguintes desfechos: “heart arrythmia” e “virus myocarditis”. Os estudos foram considerados adequados para a revisão caso: 1) Se relacionassem à COVID-19 causada pelo vírus SARS-CoV-2; 2) Abordassem acometimento cardiovascular; e 3) Possuíssem ao menos uma sessão sobre distúrbios do ritmo cardíaco. Foram considerados inadequados se: 1) Fossem relatos de caso; 2) Fossem cartas ao editor; ou 3) Estivessem incompletos. RESULTADO: A pesquisa com descritores resultou em 67 artigos e, após aplicação dos critérios de inclusão e exclusão, apenas 9 artigos publicados entre as datas de janeiro de 2020 e maio de 2022 compuseram a amostra de análise. DISCUSSÃO: A fisiopatologia da arritmia secundária à COVID-19 envolve a infiltração do SARS-CoV-2 no coração e fibrose do tecido cardíaco devido ao excesso de interleucina-6. O diagnóstico é realizado com uso de ECG e quantificação de troponina. A sintomatologia mais prevalente em hospitalizados foi a bradiarritmia relativa febril. A terapêutica envolve o uso de medicamentos antivirais, anti-inflamatórios e/ou imunossupressores. CONCLUSÃO: Foi possível verificar que a infecção pelo vírus SARS-Cov-2 tem impacto em arritmias pré-existentes à infecção e em novos casos

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 &lt;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

The relationship between quality defects and the thermal performance of buildings

publisher: Elsevier articletitle: The relationship between quality defects and the thermal performance of buildings journaltitle: Renewable and Sustainable Energy Reviews articlelink: http://dx.doi.org/10.1016/j.rser.2017.08.029 content_type: article copyright: © 2017 Elsevier Ltd. All rights reserved