ÍLEO BILIAR, UNA CAUSA INFRECUENTE DE OCLUSIÓN INTESTINAL: REPORTE DE UN CASO.

La obstrucción intestinal es definida como la interrupción parcial o total del tránsito y conducto intestinal. Puede llegar a constituir el 20% de las admisiones quirúrgicas en los servicios de urgencias médicas de los hospitales, y para comprender su fisiopatología se ha dividido en 3 tipos: obstrucción del lumen intestinal, lesiones intrínsecas y lesiones extrínsecas. La patología conocida como íleo biliar es una enfermedad relativamente infrecuente, fue descrita por primera vez por Bartholin en 1654. Y hoy en día representa de entre el 1 a 3% de todas las obstrucciones intestinales y menos de 0.5% de las complicaciones de la colelitiasis. Esta patología se produce como una consecuencia producto del paso de uno o varios litos a través de una fístula bilioentérica interna. Y sólo 1 a 15% de las fístulas bilioentéricas llega a producir íleo biliar. La fístula más frecuente es la colecisto-duodenal (72-80%) seguida de la colecisto-cólica (8-12%) y la colecisto-gástrica (3-5%). Los diámetros aproximados para que el lito pueda producir una oclusión intestinal es alrededor de 2.5 cm y los sitios donde más frecuentemente se impactan son íleo terminal (60%), íleo proximal (24%), yeyuno distal (9%), colon y recto (2 a 4%).El íleo biliar puede representar del 0.3 al 0.5% de las complicaciones de la colelitiasis, con una incidencia de 3/100,000 hospitalizaciones por patología biliar, se evidencia en la literatura que es más frecuente en el sexo femenino en una relación 3.5:1, con una mayor incidencia en mayores de 65 años.El poder realizar un diagnóstico adecuado es de suma importancia para un manejo oportuno. Clínicamente se describe la tríada de Mordor, que incluye un historial de colelitiasis, signos clínicos de colecistitis aguda y datos compatibles con obstrucción intestinal. Adicionalmente se puede realizar una radiografía de abdomen la cual daría inicio a la tríada de Rigler, la cual consiste en la presencia de cálculos radioopacos, signo de Gotta-Mentschler y distensión de las asas intestinales, estableciéndose el diagnóstico ante la presencia de dos de los tres signos radiológicos antes mencionados. Si dentro de todos estos signos le agregamos el cambio de posición del cálculo biliar en una segunda radiografía se forma la tétrada de Rigler, con mayor sensibilidad diagnóstica.El tratamiento de elección sigue siendo la intervención quirúrgica.Dado que el íleo biliar es una enfermedad poco común, pero con un alto riesgo de muerte, decidimos llevar a cabo la presentación del siguiente caso clínico

Comparación de la efectividad de la dosis única frente a la dosis triple de cefazolina como profilaxis antibiótica en apendicitis aguda no complicada.

Introducción. La apendicitis aguda es considerada la causa más frecuente de cirugía de emergencia no relacionada a lesiones traumáticas. La infección del sitio de la cirugía es la complicación posoperatoria más común y representa una gran amenaza para la morbilidad, la mortalidad y los costos de los servicios médicos en todo el mundo. El uso de antibióticos en pacientes sometidos a cirugía de apendicitis aguda es para prevenir las complicaciones sépticas de la apendicitis, en estos pacientes las infecciones del sitio quirúrgico son las más frecuentes, por lo que los antibióticos son las medidas prioritarias en la prevención de estos pacientes. Objetivo. Determinar si la dosis única comparada con la dosis triple de Cefazolina como profilaxis antibiótica tiene mayor eficacia para reducir las infecciones del sitio quirúrgico en la apendicitis aguda no complicada. Material y Métodos. Se realizó un estudio observacional, analítico, prospectivo, transversal y comparativo en el Servicio de Cirugía General del Hospital General Francisco de Orellana. Resultados. Aplicando la prueba de Chi-cuadrado de Pearson  podemos ver que el valor P=0.760 indica que los resultados no tuvieron una diferencia estadística significativa. Demostrando que no hay ninguna relación entre el número de dosis administradas y el desarrollo de infección del sitio quirúrgico. Conclusión. Al analizar los datos estadísticos se puede apreciar que la dosis única de Cefazolina aplicada como profilaxis antibiótica previo la inducción anestésica fue igual de efectiva que la dosis triple en cuanto a la prevención de infección del sitio quirúrgico.

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Search for stop and higgsino production using diphoton Higgs boson decays

Results are presented of a search for a "natural" supersymmetry scenario with gauge mediated symmetry breaking. It is assumed that only the supersymmetric partners of the top-quark (stop) and the Higgs boson (higgsino) are accessible. Events are examined in which there are two photons forming a Higgs boson candidate, and at least two b-quark jets. In 19.7 inverse femtobarns of proton-proton collision data at sqrt(s) = 8 TeV, recorded in the CMS experiment, no evidence of a signal is found and lower limits at the 95% confidence level are set, excluding the stop mass below 360 to 410 GeV, depending on the higgsino mass

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good