Current surgical techniques in rectal cancer

El cáncer de recto es actualmente una de las enfermedades que implican una mayor morbimortalidad en la sociedad, tanto para la persona que lo sufre como para la esfera que lo rodea. La evolución en este tipo de tumores permiten abandonar el concepto clásico de grandes incisiones y extensas resecciones, para acercarnos al abordaje mínimamente invasivo, y a realizar la resección que sea únicamente necesaria, buscando preservar la integridad esfintérica en el paciente, y tratando de evitar en la medida de lo posible la confección de ostomías. La mayoría de las investigaciones que se realizan sobre el cáncer de recto, van encaminadas a la mejora en los tratamientos complementarios a la cirugía, como los tratamientos quimioterápicos neoadyuvantes, y los fármacos posteriores a la cirugía, es decir, la quimioterapia adyuvante. Únicamente un tercio de los estudios que se llevan a cabo son para mejorar la técnica quirúrgica. En este apartado, la aparición de la cirugía laparoscópica, el uso de dispositivos a través de orificios naturales para realizar cirugía local, la aparición de la cirugía combinada TaTME, y el auge de la cirugía robótica, parecen ser la antesala de lo que se desarrollará en un futuro respecto a las mejoras quirurgicas. En esta revisión, queremos poner de manifiesto un resumen del tratamiento quirúrgico del cáncer de recto, haciendo especial hincapié en las nuevas técnicas y avances, con una breve reseña histórica y anatómica, sin olvidar la importancia y seguridad para el paciente, tanto en la misma cirugía, como en los resultados oncológicos posteriores.Rectal cancer is currently one of the diseases that imply greater morbidity and mortality in society, both for people suffering and for the people around. The evolution in this type of tumors allows us to leave the classic concept of large incisions and extensive resections towards the minimally invasive approach, and to perform the resection that is only necessary, seeking to preserve the sphincteric integrity in the patient, and trying to avoid as much as possible ostomies. Most of rectal cancer research is aimed to improving complementary treatments to surgery, such as neoadjuvant chemotherapeutic treatments, and post-surgery drugs. Only one third of the studies carried out are focused on improvig the surgical technique. In this section, the appearance of laparoscopic surgery, the use of devices through natural holes to perform local surgery, the appearance of TaTME combined surgery, and the rise of robotic surgery, seem to be the prelude to what will be developed. in the future regarding surgical improvements. In this review, we want to highlight a summary of the surgical treatment of rectal cancer, with special emphasis on new techniques and advances and also a brief historical and anatomical review, also including the importance and safety for the patient both in the surgery and subsequent cancer follow-up

Contexto de universitarios de enfermería en educación remota de emergencia

Introduction: In a pandemic, the strategy to continue the educational process has been emergency remote education (ERE), work mediated by technology in three modalities: virtual education, online teaching and Blended. In a student context, it is important to know aspects directly related to learning such as technology and the Internet, family support, study-work combination and mental well-being. Objective: To characterize the context of nursing university students in ERE. Type of study: Quantitative, descriptive, cross-sectional, exploratory. Research technique and instrument: Interview and questionnaire, explores electronic devices and the Internet, physical area for classes, remote teaching/family dynamics/learning relationship, work and study, and emotional well-being. Population and sample: Enrolled students 490, sample made up of 115 students (23% of the population). Results: Devices used, personal computer 69%, cell phone 15%, desktop computer; 14%; 65% own team, 33% shared. Internet connection, 52% telephone line, 38% cable, 8% data. Connection quality, 20% good, 76% fair, 4% poor; 67% have physical space. 87% received financial support, 67% and 65% supported for household chores and care for the person(s) in their care. 94% virtuality interferes with learning; 64% worked, 15% work related to nursing. 38% work interferes with studies. 50% worked in support of the family economy. Anxiety, worry and anguish originated in 91% more time for school activities, 87% decreased concentration. Conclusion: It is important to continue researching to propose alternatives in order to influence the areas of opportunity detected, from a socially responsible academic perspective.Introducción: En pandemia, la estrategia para continuar con el proceso educativo ha sido la educación remota de emergencia (ERE), trabajo mediado por tecnología en tres modalidades: educación virtual, enseñanza en línea y Blended. En contexto estudiantil, es importante conocer aspectos relacionados directamente con aprendizaje como tecnología e internet, soporte familiar, combinación estudio-trabajo y bienestar mental. Objetivo: Caracterizar el contexto de universitarios de enfermería en ERE. Tipo de estudio: Cuantitativo, descriptivo, transversal, exploratorio. Técnica de investigación e instrumento: Entrevista y cuestionario, explora dispositivos electrónicos e internet, área física para clases, relación enseñanza remota/dinámica familiar/aprendizaje, trabajo y estudio y bienestar emocional. Población y muestra: Alumnos inscritos 490, muestra conformada por 115 estudiantes (23% de la población). Resultados: Dispositivos utilizados, computadora personal 69%, teléfono celular 15%, computadora de escritorio; 14%; 65% equipo propio, 33% compartido. Conexión de internet, 52% línea telefónica, 38% cable, 8% datos. Calidad de conexión, 20% buena, 76% regular, 4% mala; 67% disponen de espacio físico. 87% recibieron respaldo económico, 67% y 65% apoyados para tareas hogareñas y cuidado de persona(s) a su cargo. 94% virtualidad interfiere con aprendizaje; 64% laboró, 15% trabajo relacionado con enfermería. 38% trabajo interfiere con estudios. 50% trabajó en apoyo a economía familiar. Ansiedad, preocupación y angustia originaron en91% más tiempo para actividades escolares, 87% disminución de concentración. Conclusión: Resulta importante continuar investigando para proponer alternativas a fin de incidir en las áreas de oportunidad detectadas, desde una perspectiva académica socialmente responsable

Learning styles in undergraduate students of health sciences and intercultural university from universidad veracruzana

Introducción: Durante años, se ha analizado el proceso del aprendizaje. Los resultados, generan diferentes opiniones de su origen, teorías y principios de cómo el cerebro obtiene el conocimiento y genera diversas opciones para almacenarlo y clasificarlo. Generándose así, el término “Estilo de aprendizaje”, refiriendóse al hecho de que cada persona, al aprender, utiliza su método o estrategia. Objetivo: Determinar el ó los estilos de aprendizaje en estudiantes de licenciaturas de Ciencias de la Salud, región Xalapa y Universidad Veracruzana Intercultural (UVI). Metodología: Estudio cuantitativo, descriptivo, transversal y comparativo. Población y muestra: Alumnos inscritos en el período agosto 2019-enero 2020. La muestra fue probabilística estratificada por licenciatura, con una confiabilidad de 95%. Instrumento: Honey-Alonso de Estilos de Aprendizaje (CHAEA) en línea, consta de 80 ítems dicotómicos, distribuidos aleatoriamente, evalúa cuatro estilos de aprendizaje (activo, reflexivo, teórico y pragmático). Resultados: Los estilos son similares en enfermería, medicina, psicología y UVI con 50% y 52% en el estilo reflexivo, para odontología y bioanálisis 48.1% y 45.6% respectivamente, asimismo para nutrición es el 31.4%. Conclusión: El estilo de aprendizaje encontrado en los estudiantes de ciencias de salud y UVI es el reflexivo, aunque se observaron diversas combinaciones e inclusive individuos con hasta cuatro estilos.Introduction: For years, the learning process has been analyzed. The results generate different opinions of its origin, theories and principles of how the brain obtains knowledge and generates various options to store and classify it. Thus generating the term "Learning Style", referring to the fact that each person, when learning, uses their method or strategy. Objective: To determine the learning style (s) in undergraduate students of Health Sciences, Xalapa region and Intercultural Universidad Veracruzana (UVI). Methodology: Quantitative, descriptive, cross-sectional and comparative study. Population and sample: Students enrolled in the period August 2019-January 2020. The sample was probabilistic stratified by degree, with a reliability of 95%. Instrument: Honey-Alonso of Learning Styles (CHAEA) online, consists of 80 dichotomous items, randomly distributed, assesses four learning styles (active, reflective, theoretical and pragmatic). Results: The styles are similar in nursing, medicine, psychology and ICU with 50% and 52% in the reflective style, for dentistry and bioanalysis 48.1% and 45.6% respectively, also for nutrition it is 31.4%. Conclusion:The learning style found in health sciences and ICU students is reflective, although various combinations were observed and even individuals with up to four styles

Generation of Arc-Like and OIB-Like Magmas Triggered by Slab Detachment in the Eastern Mexican Alkaline Province: Petrological Evidence from the Cenozoic Sierra de San Carlos-Cruillas Complex, Tamaulipas

The origin of the Eastern Mexican Alkaline Province has been explained by landward arc migration and subsequent asthenospheric upwelling after slab roll-back of the Farallon Plate. In this work, we present new petrographic, mineral chemical, geochemical, and geochronological data of the Sierra de San Carlos-Cruillas (SSCC), one of the most important complexes in the province. This information, together with published data, helped us to reinterpret the tectonic processes operating during the generation of this province, as well as the mantle sources involved in the partial melting process. Detailed geochemical analysis suggests the participation of two types of metasomatized mantle regions: a lithospheric source modified by past subduction processes and an asthenospheric source slightly affected by carbonatite-related metasomatism. Variations in the partial melting degrees controlled the extent of magma enrichment in the latter. Major and trace element geochemistry, together with geochronological data and field relations, evinced an older post-orogenic setting related to the arc-like rocks (Eocene) and a younger intraplate extensional environment associated with all enriched igneous rocks (Oligocene-Miocene). Bivariate diagrams of SiO2-trace element ratios and multi-element patterns indicate that magmas from the SSCC complex dominantly evolved through fractional crystallization with a limited crustal contribution. Petrographic and mineral chemistry features suggest that some of these magmas experienced open-system processes (e.g. recharge events) in a complex and dynamic magmatic feeding system. In contrast to the traditional petrotectonic model, we propound that the passage and subsequent foundering of the Hess conjugate under northeastern Mexico resulted in its eclogitization and triggered slab tearing and succeeding detachment. This latter process occasioned mantle upwelling and the partial melting of the two recognized metasomatized mantle sources, thus generating the San Carlos-Cruillas magmatism

COVID-19 : Age, Interleukin-6, C-reactive protein, and lymphocytes as key clues from a multicentre retrospective study

Background: The SARS-CoV-2 infection has widely spread to become the greatest public health challenge to date, the COVID-19 pandemic. Different fatality rates among countries are probably due to non-standardized records being carried out by local health authorities. The Spanish case-fatality rate is 11.22%, far higher than those reported in Asia or by other European countries. A multicentre retrospective study of demographic, clinical, laboratory and immunological features of 584 Spanish COVID-19 hospitalized patients and their outcomes was performed. The use of renin-angiotensin system blockers was also analysed as a risk factor. Results: In this study, 27.4% of cases presented a mild course, 42.1% a moderate one and for 30.5% of cases, the course was severe. Ages ranged from 18 to 98 (average 63). Almost 60 % (59.8%) of patients were male. Interleukin 6 was higher as severity increased. On the other hand, CD8 lymphocyte count was significantly lower as severity grew and subpopulations CD4, CD8, CD19, and NK showed concordant lowering trends. Severity-related natural killer percent descents were evidenced just within aged cases. A significant severity-related decrease of CD4 lymphocytes was found in males. The use of angiotensin-converting enzyme inhibitors was associated with a better prognosis. The angiotensin II receptor blocker use was associated with a more severe course. Conclusions: Age and age-related comorbidities, such as dyslipidaemia, hypertension or diabetes, determined more frequent severe forms of the disease in this study than in previous literature cohorts. Our cases are older than those so far reported and the clinical course of the disease is found to be impaired by age. Immunosenescence might be therefore a suitable explanation for the hampering of immune system effectors. The adaptive immunity would become exhausted and a strong but ineffective and almost deleterious innate response would account for COVID-19 severity. Angiotensin-converting enzyme inhibitors used by hypertensive patients have a protective effect in regards to COVID-19 severity in our series. Conversely, patients on angiotensin II receptor blockers showed a severer disease

COVID-19 outbreaks in a transmission control scenario: challenges posed by social and leisure activities, and for workers in vulnerable conditions, Spain, early summer 2020

Severe acute respiratory syndrome coronavirus 2 community-wide transmission declined in Spain by early May 2020, being replaced by outbreaks and sporadic cases. From mid-June to 2 August, excluding single household outbreaks, 673 outbreaks were notified nationally, 551 active (>6,200 cases) at the time. More than half of these outbreaks and cases coincided with: (i) social (family/friends’ gatherings or leisure venues) and (ii) occupational (mainly involving workers in vulnerable conditions) settings. Control measures were accordingly applied

Factors associated with mortality in patients with decompensated heart failure

Introducción: la falla cardiaca (FC) es una de las principales causas de morbimortalidad a nivel mundial, la cual ha experimentado aumento gradual de su incidencia sin variación importante en su desenlace en las dos últimas décadas. En Colombia muy pocos estudios evalúan factores asociados a mortalidad por falla cardiaca. Métodos: estudio de cohorte prospectivo en el que se incluyeron pacientes con diagnóstico de falla cardiaca descompensada al momento del ingreso a urgencias, entre febrero de 2010 y marzo de 2013. Se calculó el tamaño de muestra y se realizó un análisis multivariado para la evaluación de los factores de riesgo asociados a mortalidad intrahospitalaria y a 30 días. Resultados: se incluyeron 462 pacientes. La mortalidad hospitalaria fue de 8.9% y a 30 días de 13.8%, en el modelo multivariado para el desenlace mortalidad intrahospitalaria se observó que la única variable con significancia estadística fue el BUN ≥43 mg/dL (OR, 3.45 [IC 95% 1.54-7.74], p= 0.003). Para la mortalidad a 30 días, la estancia hospitalaria >5 días (OR, 2.23 [IC 95% 1.20-4.12], p= 0.011), el BUN ≥43 mg/dL (OR, 2.55 [IC 95% 1.31-4.94], p= 0.005) y el NT-proBNP ≥ 4630 pg/dL (OR, 2.47 [IC 95% 1.30-4.70], p= 0.006). Conclusiones: la mortalidad intrahospitalaria de los pacientes con falla cardiaca descompensada en la población evaluada fue alta. En los análisis multivariados, se encontró que el BUN ≥ 43 mg/dL fue el único factor de riesgo independiente asociado a mortalidad intrahospitalaria; mientras que la mortalidad a 30 días se relacionó además con el NT-proBNP y la estancia hospitalaria superior a cinco días.Introduction: heart failure is one of the main causes of morbidity and mortality worldwide; it has experienced a gradual increase in incidence with no significant variation in outcome in the last two decades. In Colombia there are no studies to evaluate risk factors for mortality, which is the subject of this study. Methods: prospective cohort study in which patients with diagnosis of decompensated heart failure on admission to the emergency department between February 2010 and March 2013 were included. The sample size was calculated and a multivariate analysis was performed to evaluate the risk factors associated with in-hospital and 30-day mortality. Results: 462 patients were included. Hospital mortality was 8.9% and 30-day mortality 13.8%; in the multivariate model for hospital mortality outcome was observed that the only variable with statistic significance was BUN ≥ 43 mg/dL (OR, 3.45 [95% CI 1.54- 7.74], p = 0.003). For 30 day mortality, hospital stay > 5 days (OR, 2.23 [95% CI 1.20-4.12], p = 0.011), BUN ≥43 mg/dL (OR, 2.55 [95% CI 1.31-4.94] , p = 0.005) and NT-proBNP ≥ 4630 pg/dL (OR, 2.47 [95% CI 1.30-4.70], p = 0.006). Conclusions: in-hospital mortality in patients with decompensated heart failure in the study population was high. In multivariate analysis, it was found that BUN ≥ 43 mg/dL was the only independent risk factor associated with hospital mortality, while the 30-day mortality was also associated with NT-proBNP and hospital stay greater than five days.https://orcid.org/0000-0002-7021-6769N/

Raíces y alas: recuerdos y ficciones

El segundo número de la colección Laboratorio Transmedia (ISSN: 2794-0861) contiene 36 relatos escritos durante el curso 2021/2022 por estudiantes de la Universidad para Mayores

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Pasados y presente. Estudios para el profesor Ricardo García Cárcel

Ricardo García Cárcel (Requena, 1948) estudió Historia en Valencia bajo el magisterio de Joan Reglà, con quien formó parte del primer profesorado de historia moderna en la Universidad Autónoma de Barcelona. En esta universidad, desde hace prácticamente cincuenta años, ha desarrollado una extraordinaria labor docente y de investigación marcada por un sagaz instinto histórico, que le ha convertido en pionero de casi todo lo que ha estudiado: las Germanías, la historia de la Cataluña moderna, la Inquisición, las culturas del Siglo de Oro, la Leyenda Negra, Felipe II, Felipe V, Austrias y Borbones, la guerra de la Independencia, la historia cultural, los mitos de la historia de España... Muy pocos tienen su capacidad para reflexionar, ordenar, analizar, conceptualizar y proponer una visión amplia y llena de matices sobre el pasado y las interpretaciones historiográficas. A su laboriosidad inimitable se añade una dedicación sin límites en el asesoramiento de alumnos e investigadores e impulsando revistas, dosieres, seminarios o publicaciones colectivas. Una mínima correspondencia a su generosidad lo constituye este volumen a manera de ineludible agradecimiento