Complicaciones post operatorias en pacientes apendicectomizados mediante cirugía convencional y laparoscópica en el hospital de emergencia, 2013

Objetivo. Conocer y analizar como las técnicas operatorias de apendicectomía convencional (AA) y laparoscópica (AL) influyen en las complicaciones post operatorias en los pacientes apendicectomizados del Hospital de Emergencias José Casimiro Ulloa, en el año 2013. Materiales y métodos. Estudio no experimental, descriptivo correlacional, retrospectivo, transversal. Revisión de historias clínicas de todos los pacientes apendicectomizados. El análisis estadístico se realizó en el programa SPSS 22, usando Chi cuadrado y pruebas de Odds Ratio. Resultados. Se incluyeron en este estudio un total de 280 pacientes (AA 214 y AL 66 pacientes). En la investigación se encontró mayores complicaciones post operatorias en cirugía convencional (87,50%) que en la cirugía laparoscópica (12,50%). De los pacientes con complicaciones post operatorias; el 82% presentó un tiempo pre operatorio mayor a 18 horas, el 93% tuvo conocimiento de la condición de apendicitis aguda complicada y el 93% tuvo un tiempo operatorio mayor a 60 minutos. Según la Prueba Chi Cuadrado, existe relación significativa entre las complicaciones post operatorias y las técnicas operatorias de apendicetomía (p=0.010) y el tiempo pre operatorio (p=0.000) y la condición de la agudeza de la complicación (p=0.000) y el tiempo operatorio (p=0.000). De las pruebas de Odds Ratio, se establecen como factores de riesgo a la técnica de apendicetomía convencional (OR=2.642), al tiempo Pre operatorio (OR=9.765); la condición de la Apendicitis Aguda Complicada (OR=5.561) y al tiempo operatorio OR=13.400). Como un factor de protección a la técnica de apendicetomía laparoscópica (OR=0.811). Conclusiones. Los resultados obtenidos en nuestro hospital, son similares a las investigaciones anteriores, se tiene baja tasa de comorbilidad asociada a la apendicitis aguda y a incidencia de complicaciones post operatorias, las infecciones de heridas son las complicaciones más comunes y sobre todo la asociación entre las técnicas de cirugías convencional y laparoscópica para las complicaciones post operatorias en pacientes apendicectomizados

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Modelo de simulación de apendicectomía abierta en la educación virtual para estudiantes de medicina durante la pandemia de COVID-19

Objective: To evaluate the skills achieved by the undergraduate medical student in performing an open appendectomy and purse string in the simulation model created, to evaluate the degree of satisfaction of its use and to determine its costs. Method: Pre-experimental, prospective and longitudinal study. The skills achieved by 24 undergraduate medical students in performing an open appendectomy and purse string in the simulator were evaluated using the OSATS (Objective Structured Assessment of Technical Skills) through virtual teaching. A survey was conducted to the students to evaluate the simulator and its costs were determined. Results: There was a significant increase in the OSATS of the skills achieved, from 7 (pre-test) to 26 ± 5.71 points (final post-test) (p = 0.0001) and reduction in the operative time from 12 ± 3.81 minutes (first post-test) to 8 ± 2.02 minutes (final post-test) (p = 0.0001). 41% of the students were totally satisfied with the achievements obtained and 59% partially satisfied. The cost of the simulator was 4.64 USD. Conclusions: The students achieved an improvement in their skills in the surgical technique. This simulation model is low cost and presents an adequate level in the satisfaction of the achievements obtained by the students.Objetivo: Evaluar las competencias logradas por estudiantes de medicina en la realización de una apendicectomía abierta y jareta en el modelo de simulación creado, evaluar el grado de satisfacción de su uso y determinar sus costos. Método: Estudio preexperimental de grupo único, prospectivo y longitudinal. Se evaluaron las competencias logradas por 24 alumnos de pregrado de medicina en la realización de una apendicectomía abierta y jareta en el simulador, mediante las pautas OSATS (Objective Structured Assessment of Technical Skills) a través de enseñanza virtual. Se realizó una encuesta a los alumnos para evaluar el simulador y se determinaron sus costos. Resultados: Hubo un incremento significativo en las pautas OSATS de las competencias logradas de 7 (pre-test) a 26 ± 5.71 puntos (pos-test final) (p = 0.0001) y una reducción del tiempo operatorio de 12 ± 3.81 minutos (primer pos-test) a 8 ± 2.02 minutos (pos-test final) (p = 0.0001). El 41% de los alumnos estuvieron totalmente satisfechos con los logros obtenidos y el 59% parcialmente satisfechos. El costo del simulador fue de 4.64 dólares americanos. Conclusiones: Los estudiantes lograron una mejora de sus competencias en la técnica quirúrgica. Este modelo de simulación es de bajo costo y presenta un nivel adecuado en la satisfacción de los logros obtenidos por los alumnos

Current landscape and future directions of synthetic biology in South America

Synthetic biology (SynBio) is a rapidly advancing multidisciplinary field in which South American countries such as Chile, Argentina, and Brazil have made notable contributions and have established leadership positions in the region. In recent years, efforts have strengthened SynBio in the rest of the countries, and although progress is significant, growth has not matched that of the aforementioned countries. Initiatives such as iGEM and TECNOx have introduced students and researchers from various countries to the foundations of SynBio. Several factors have hindered progress in the field, including scarce funding from both public and private sources for synthetic biology projects, an underdeveloped biotech industry, and a lack of policies to promote bio-innovation. However, open science initiatives such as the DIY movement and OSHW have helped to alleviate some of these challenges. Similarly, the abundance of natural resources and biodiversity make South America an attractive location to invest in and develop SynBio projects.</p