Comparación de los resultados ponderales, metabólicos y analíticos a largo plazo tras la realización de bypass gástrico, derivación biliopancreática de Larrad y cruce duodenal modificado en el tratamiento quirúrgico de la obesidad mórbida

La obesidad es considerada la epidemia del siglo XXI1. Se espera que la prevalencia de esta enfermedad en Europa llegue a ser de un 20-30% en el año 20152. Este nivel ya ha sido superado en Estados Unidos, donde se registró una prevalencia del 35% en el período 2009-20103. De manera paralela al aumento de la obesidad en nuestra sociedad, se ha observado durante los últimos años un aumento en el número de cirugías bariátricas que se realizan. Mientras que en el año 2003 se llevaron a cabo menos de 150.000 procedimientos de cirugía bariátrica, en los años 2008 y 2011 esta cifra superó los 340.000 pacientes intervenidos4-6. La cirugía bariátrica es el único tratamiento que ha demostrado ser capaz de producir una pérdida de peso significativa a largo plazo en los enfermos que padecen obesidad mórbida7. Además, existe suficiente evidencia para decir que la cirugía bariátrica mejora el pronóstico a largo plazo de estos pacientes, consiguiendo una menor mortalidad que en los pacientes tratados de manera conservadora8, 9. Por ejemplo, en el estudio SOS realizado en Suecia la mortalidad tras 11 años de seguimiento fue de un 5% en los pacientes intervenidos y un 6,3% en los pacientes tratados de manera conservadora..

Cystic fibrosis with liver involvement in adults has a benign course. Results from a tertiary referral center cohort

Cystic fibrosis liver disease is a poorly understood entity, especially in adults, in terms of its real prevalence, natural history and diagnostic criteria, despite being the most important extrapulmonary cause of mortality. The aim was to evaluate the prevalence, characteristics and potential risk factors of liver disease in adults with cystic fibrosis, according to two diagnostic criteria accepted in the scientific literature. Patients were recruited in a tertiary referral hospital, and laboratory, ultrasound, non-invasive liver fibrosis tests (AST to Platelet Ratio Index [APRI]; Fibrosis-4 Index [FIB4]) and transient elastography (Fibroscan®) were performed. The proportion of patients with liver disease according to the Debray and Koh criteria were evaluated. ninety-five patients were included, 48 (50.5 %) females, with a mean age of 30.4 (28.6-32.2) years. According to the Debray criteria, six (6.3 %) patients presented liver disease. According to the Koh criteria, prevalence increased up to 8.4 %, being statistically different from the 25 % value described in other published series (p = 0.005). Seven (7.5 %) presented ultrasonographic chronic liver disease. Eleven (13 %) presented liver fibrosis according to the APRI score; 95 (100 %) had a normal FIB-4 value. Mean liver stiffness value was 4.4 (4.1-4.7) kPa. FEV1 (OR = 0.16, p 0.05), meconium ileus (OR = 14.16, p 0.002), platelets (Pearson coefficient -0.25, p 0.05) and younger age (Pearson coefficient -0.19, p 0.05) were risk factors. prevalence and severity of liver disease in adult cystic fibrosis patients were lower than expected. Meconium ileus, platelets, age and respiratory function were confirmed as risk factors associated to cystic fibrosis liver diseas

Influence of the Human Development Index on the Maternal–Perinatal Morbidity and Mortality of Pregnant Women with SARS-CoV-2 Infection: Importance for Personalized Medical Care

This study (FIS-PI18/00912) was supported by the Instituto de Salud Carlos III (Plan Estatal de I + D + i 2013–2016) and cofinanced by the European Development Regional Fund ‘‘A way to achieve Europe’’ (ERDF) and B2017/BMD-3804 MITIC-CM.Coronavirus disease-19 (COVID-19) is perhaps the most worrisome pandemic in the 21st century, having entailed devastating consequences for the whole society during the last year. Different studies have displayed an existing association between pregnancy and COVID-19 severity due to the various physiological changes that occur during gestation. Recent data identified maternal country of origin as an important determinant of COVID-19 presentation in pregnant women. However, the explanation of this fact remains to be fully elucidated. Therefore, the purpose of this work is to analyze the possible relationship between Human Development Index (HDI) of maternal country of origin with the morbimortality of pregnant women and their newborns. Here, we conducted a multicentric, ambispective, observational case-control study (1:1 ratio) and compare with the HDI of each country (group 1—very high HDI, group 2—high HDI, group 3—medium HDI, and group 4—low HDI). In total, 1347 pregnant women with confirmed SARV-CoV-2 infection (cases) were enrolled, and each was paired with one control to give a total number of 2694 participants from 81 tertiary care centers. Among the women with SARS-CoV-2 infection, more cases were produced of perinatal mortality, overall maternal morbidity, COVID-19 maternal morbidity, C-sections, hypertensive maternal morbidity, and perinatal morbidity. Our results described an inverse association between HDI and maternofetal morbidity and mortality. Moreover, the countries with an HDI lower than 1 showed higher rates of patients with maternal COVID-19-related morbidity (6.0% vs. 2.4%, p < 0.001), a need for oxygen therapy (4.7% vs. 1.8%, p < 0.001), and maternal ICU admission (2.6% vs. 1.0%, p = 0.007). Compared to other risk factors such as overweight, obesity, preexisting and obstetric comorbidities, HDI emerged as an independent risk factor explaining much of the increased maternal–perinatal morbidity and mortality detected in our group of cases. Further research is needed to establish to confirm the real impact of this factor and its components on pregnancy outcomes.Depto. de Salud Pública y Materno - InfantilFac. de MedicinaTRUEUnión EuropeaComunidad de MadridInstituto de Salud Carlos IIIpu

Diagnostic Accuracy of Abdominal CT for Locally Advanced Colon Tumors: Can We Really Entrust Certain Decisions to the Reliability of CT?

Many different options of neoadjuvant treatments for advanced colon cancer are emerging. An accurate preoperative staging is crucial to select the most appropriate treatment option. A retrospective study was carried out on a national series of operated patients with T4 tumors. Considering the anatomo-pathological analysis of the surgical specimen as the gold standard, a diagnostic accuracy study was carried out on the variables T and N staging and the presence of peritoneal metastases (M1c). The parameters calculated were sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios, as well as the overall accuracy. A total of 50 centers participated in the study in which 1950 patients were analyzed. The sensitivity of CT for correct staging of T4 colon tumors was 57%. Regarding N staging, the overall accuracy was 63%, with a sensitivity of 64% and a specificity of 62%; however, the positive and negative likelihood ratios were 1.7 and 0.58, respectively. For the diagnosis of peritoneal metastases, the accuracy was 94.8%, with a sensitivity of 40% and specificity of 98%; in the case of peritoneal metastases, the positive and negative likelihood ratios were 24.4 and 0.61, respectively. The diagnostic accuracy of CT in the setting of advanced colon cancer still has some shortcomings for accurate diagnosis of stage T4, correct classification of lymph nodes, and preoperative detection of peritoneal metastases

The Profile of the Obstetric Patients with SARS-CoV-2 Infection According to Country of Origin of the Publication: A Systematic Review of the Literature

SARS-CoV-2 is the novel member of coronavirus responsible for the worldwide pandemic COVID-19, affecting all types of people. In this context, established research identified pregnant women as a susceptible group of SARS-CoV-2 infection, although there is still limited data regarding the real impact of COVID-19 in this group. With that purpose, we conducted a systematic review describing the maternal-fetal results of pregnant women infected by SARS-CoV-2, in aim to analyze the profile of the obstetric patients according to the country of origin of the publication. A total of 38 articles were included in this systematic review with 2670 patients from 7 countries, with 20 works published from China (52.6%). We reported significative differences according to the median maternal age, with Spain as the country with the highest age (34.6 years); The percentage of tabaquism; proportion of symptomatic patients in the triage; type of radiological exam (China and France conduct CT scans on all their patients in comparison to the use of chest X-Ray in the rest of the countries studied); percentages of C-sections (83.9% in China; 35.9% Spain, p < 0.001); maternal mortality rate, proportion of patients who need treatments, the use of antivirals, antibiotics, and anticoagulants as well as measurements of the newborns. Perinatal results are favorable in the majority of countries, with very low rates of vertical transmission in the majority of works. The studies collected in this review showed moderate to high index of quality. The different works describe the affectation during the first wave of the pandemic, where the pregnant woman with SARS-CoV-2 infection is generally symptomatic during the third trimester of gestation along with other factors associated with worse prognosis of the disease, such as higher age, body mass index, and further comorbidities developed during pregnancy. In the obstetric patient, proportion of C-sections are elevated together with prematurity, increasing maternal perinatal morbimortality. Differences found between countries could be based on the proper profile of the patient in each region, the period of the pandemic directly affecting how it was managed, and the variations regarding in situ medical attention

Comparación de los resultados ponderales, metabólicos y analíticos a largo plazo tras la realización de bypass gástrico, derivación biliopancreática de Larrad y cruce duodenal modificado en el tratamiento quirúrgico de la obesidad mórbida

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 21-09-2015La obesidad es considerada la epidemia del siglo XXI1. Se espera que la prevalencia de esta enfermedad en Europa llegue a ser de un 20-30% en el año 20152. Este nivel ya ha sido superado en Estados Unidos, donde se registró una prevalencia del 35% en el período 2009-20103. De manera paralela al aumento de la obesidad en nuestra sociedad, se ha observado durante los últimos años un aumento en el número de cirugías bariátricas que se realizan. Mientras que en el año 2003 se llevaron a cabo menos de 150.000 procedimientos de cirugía bariátrica, en los años 2008 y 2011 esta cifra superó los 340.000 pacientes intervenidos4-6. La cirugía bariátrica es el único tratamiento que ha demostrado ser capaz de producir una pérdida de peso significativa a largo plazo en los enfermos que padecen obesidad mórbida7. Además, existe suficiente evidencia para decir que la cirugía bariátrica mejora el pronóstico a largo plazo de estos pacientes, consiguiendo una menor mortalidad que en los pacientes tratados de manera conservadora8, 9. Por ejemplo, en el estudio SOS realizado en Suecia la mortalidad tras 11 años de seguimiento fue de un 5% en los pacientes intervenidos y un 6,3% en los pacientes tratados de manera conservadora...Obesity is considered the epidemic of the 21st century1. In Europe, a prevalence of 20-30% is expected for the year 20152, whilst, in the United States of America, this number was achieved long ago, with more than 35% of the population suffering for this illness in 2009-20103. With the rise in the prevalence of obesity, bariatric surgery, which includes all the surgical techniques created in order to treat obesity and metabolic disorders, is also more commonly performed. While in 2003 less than 150,000 bariatric surgery operations were performed worldwide, in 2008 and 2011 more than 340,000 morbid obese patients were operated4-6. Bariatric surgery is the only intervention that has accomplished long-term weight loss in morbid obese patients7. Moreover, there is strong evidence of the improvement in the prognosis of these patients, with a lower mortality rate, than those treated with a conservative approach8, 9. For example, in a prospective non-randomized study performed in Sweden (SOS study), the mortality after 11 years was 5% after surgery and 6.3% for the patients who were not submitted to surgery8. Besides improving the prognosis, bariatric surgery has also demonstrated other advantages for morbid obese patients. Comorbidities associated with obesity, such as diabetes or hypertension, are significantly improved or even resolved after bariatric surgery10, patient’s quality of life is better 10 years after surgery than after medical treatment11 and most authors think that it is a cost-effective intervention, with a return of the investment in no more than 2-3.5 years after the surgery...Depto. de CirugíaFac. de MedicinaTRUEunpu

Colorectal cancer and its delayed diagnosis: have we improved in the past 25 years? Cáncer colorrectal: retraso diagnóstico. ¿Hemos mejorado algo en los últimos 25 años?

Objective: to determine the current delay in diagnosing colorectal cancer (CRC) and establish whether there has been any improvement in the past 25 years in the same healthcare setting using the same methods. Patients and method: 152 patients undergoing surgery at our unit were personally interviewed during their hospital stay to determine the delay incurred for the diagnosis and treatment of their CRC. SPSS software was used for univariate and multivariate analysis of the data obtained. Results: the study population was comprised of 152 patients of mean age 71 years (SD 10; range 36 to 90 years), 82 men and 70 women (53.9 and 46.1% respectively; p > 0.05). The diagnostic delay for CRC at our unit currently runs at 7.28 months despite the fact that in 58% of patients the disease produced obvious symptoms such as rectal bleeding. Although this delay in diagnosis is reduced over that observed 25 years ago, the difference is statistically not significant in terms of both doctor-attributed or patient-attributed delay (doctor-attributed delay was 3.28 months in 1985 versus 1.89 at present and patient-attributed delay was 3.18 months versus today's 2.75; p > 0.05). Unlike the situation 25 years ago, no link was detected between diagnostic delay and tumor stage. Paradoxically, stage D disease was diagnosed earlier (at 5.71 months) than stage A disease (at 11.16 months) (p Objetivo: determinar la situación actual en cuanto al retraso diagnóstico del cáncer colorrectal (CCR) y analizar si se ha producido alguna mejora con respecto a lo acontecido hace 25 años en un mismo medio sanitario y con una misma metodología. Pacientes y método: se entrevistó personalmente a 152 pacientes durante su ingreso para tratamiento quirúrgico en nuestro Servicio con el fin de determinar el retraso acumulado para el diagnóstico y tratamiento de su CCR. Se realizó un análisis estadístico univariable y mutivariable mediante el software SPSS. Resultados: se incluyeron 152 pacientes con una edad media de 71 años con una desviación típica de 10 (edad mínima 36 y máxima 90 años), con un total de 82 varones y 70 mujeres (53,9 y 46,1% respectivamente; p > 0,05). El retraso diagnóstico del cáncer colorrectal en el momento actual en nuestro medio es de 7,28 meses, a pesar de que la mayoría de los pacientes cursa con sintomatología florida, como es la rectorragia en un 58% de pacientes. Aunque el retraso es menor que hace 25 años, la diferencia no llega a ser significativa en cuanto a retraso médico ni por parte del paciente (retraso médico 3,28 meses en 1985 frente a 1,89 en el momento actual y retraso del paciente de 3,18 en 1985 frente a 2,75 en la actualidad) (p > 0,05). A diferencia de lo que acontecía hace 25 años, no se ha encontrado relación entre retraso diagnóstico y estadio anatomopatológico, con el hecho paradójico de un menor retraso en estadio D (5,71 meses) que en A (11,16 meses) (p < 0,05). Conclusión: el retraso diagnóstico en el CCR es de 7,28 meses; cifra muy elevada para una patología que presenta sintomatología en el 90% de pacientes. En los últimos 25 años apenas ha variado el retraso global, aunque ha mejorado de forma importante el atribuible al médico. En nuestro estudio no se ha encontrado relación entre retraso diagnóstico y estadio anatomopatológico. Dada la alta prevalencia del cáncer colorrectal y la insuficiencia de las campañas para diagnóstico temprano del mismo en fase sintomática, con la ausencia de mejoría en cuanto al pronóstico, creemos necesaria la potenciación de programas de screening mediante colonoscopia

Colorectal cancer and its delayed diagnosis: have we improved in the past 25 years?

Objective: to determine the current delay in diagnosing colorectal cancer (CRC) and establish whether there has been any improvement in the past 25 years in the same healthcare setting using the same methods. Patients and method: 152 patients undergoing surgery at our unit were personally interviewed during their hospital stay to determine the delay incurred for the diagnosis and treatment of their CRC. SPSS software was used for univariate and multivariate analysis of the data obtained. Results: the study population was comprised of 152 patients of mean age 71 years (SD 10; range 36 to 90 years), 82 men and 70 women (53.9 and 46.1% respectively; p > 0.05). The diagnostic delay for CRC at our unit currently runs at 7.28 months despite the fact that in 58% of patients the disease produced obvious symptoms such as rectal bleeding. Although this delay in diagnosis is reduced over that observed 25 years ago, the difference is statistically not significant in terms of both doctor-attributed or patient-attributed delay (doctor-attributed delay was 3.28 months in 1985 versus 1.89 at present and patient-attributed delay was 3.18 months versus today's 2.75; p > 0.05). Unlike the situation 25 years ago, no link was detected between diagnostic delay and tumor stage. Paradoxically, stage D disease was diagnosed earlier (at 5.71 months) than stage A disease (at 11.16 months) (p < 0.05). Conclusion: the diagnostic delay for CRC at our centre is 7.28 months. This delay is excessive for a disease that produces evident symptoms in 90% of patients. Over the last 25 years little improvement has been noted in the overall delay in diagnosing CRC, although the delay attributed to the care provider has significantly improved. No relationship was detected between diagnostic delay and disease stage upon diagnosis. We feel the high prevalence of CRC, the failure of campaigns to increase awareness of early symptoms and no real improvement in its prognosis justify the introduction of large-scale colonoscopy screening for this disease

Workshop for Basic Gynaecological Examinations: Improving Medical Student Learning through Clinical Simulation

Introduction: This study was designed to evaluate whether the Workshop on Basic Principles for Clinical Gynaecological Exploration, offered to medical students, improves theoretical&ndash;practical knowledge, safety, confidence, global satisfaction and the achievement of the proposed objectives in the area of gynaecological clinical examinations. Materials and Methods: This was a quasi-experimental pre&ndash;post-learning study carried out at the Gynaecology and Obstetrics department of Gregorio Mara&ntilde;&oacute;n Hospital in Madrid (Spain). The volunteer participants were 4th-year students earning a degree in Medicine during the 2020&ndash;2021 and 2021&ndash;2022 academic years. The study period was divided into the following stages: pre-workshop, intra-workshop and 2 weeks post-workshop. In the pre-workshop stage, students completed a brief online course to prepare for the workshop. The effectiveness of the workshop was evaluated through multiple-choice tests and self-administered questionnaires to assess self-assurance, self-confidence, self-satisfaction and the achievement of the objectives. Results: Of the 277 students invited in both academic years, 256 attended the workshop (92.4%), with a total participation in the different stages of the study greater than 70%. A total of 82.5% of the students in the 2020&ndash;2021 academic year and 80.6% of students in the 2021&ndash;2022 academic year did not have any type of experience performing gynaecological clinical examinations. Between the pre-workshop and 2 weeks post-workshop stages, there was significant improvement in theoretical&ndash;practical knowledge (improvement mean = 1.38 and 1.21 in 2020&ndash;2021 and 2021&ndash;2022 academic years, respectively). The security and confidence of the students prior to the workshop were low (average scores less than 5 points) in both academic years. However, post-workshop scores for satisfaction and the achievement of objectives were high in the two academic years; all the values approached or exceeded 8 points. Conclusions: Our students, after outstanding participation, evaluated the BPCGE, and improved their theoretical and practical knowledge, as well as their skills in a gynaecological clinical examination. Moreover, in their view, after the workshop, they felt very satisfied, far outreaching the proposed aims. In addition, excellent results were maintained over time, year after year.Depto. de Salud Pública y Materno - InfantilFac. de MedicinaTRUEpubDescuento UC