Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group

Peer reviewe

Carriers of ADAMTS13 Rare Variants Are at High Risk of Life-Threatening COVID-19

Thrombosis of small and large vessels is reported as a key player in COVID-19 severity. However, host genetic determinants of this susceptibility are still unclear. Congenital Thrombotic Thrombocytopenic Purpura is a severe autosomal recessive disorder characterized by uncleaved ultra-large vWF and thrombotic microangiopathy, frequently triggered by infections. Carriers are reported to be asymptomatic. Exome analysis of about 3000 SARS-CoV-2 infected subjects of different severities, belonging to the GEN-COVID cohort, revealed the specific role of vWF cleaving enzyme ADAMTS13 (A disintegrin-like and metalloprotease with thrombospondin type 1 motif, 13). We report here that ultra-rare variants in a heterozygous state lead to a rare form of COVID-19 characterized by hyper-inflammation signs, which segregates in families as an autosomal dominant disorder conditioned by SARS-CoV-2 infection, sex, and age. This has clinical relevance due to the availability of drugs such as Caplacizumab, which inhibits vWF-platelet interaction, and Crizanlizumab, which, by inhibiting P-selectin binding to its ligands, prevents leukocyte recruitment and platelet aggregation at the site of vascular damage

SARS-CoV-2 susceptibility and COVID-19 disease severity are associated with genetic variants affecting gene expression in a variety of tissues

Variability in SARS-CoV-2 susceptibility and COVID-19 disease severity between individuals is partly due to genetic factors. Here, we identify 4 genomic loci with suggestive associations for SARS-CoV-2 susceptibility and 19 for COVID-19 disease severity. Four of these 23 loci likely have an ethnicity-specific component. Genome-wide association study (GWAS) signals in 11 loci colocalize with expression quantitative trait loci (eQTLs) associated with the expression of 20 genes in 62 tissues/cell types (range: 1:43 tissues/gene), including lung, brain, heart, muscle, and skin as well as the digestive system and immune system. We perform genetic fine mapping to compute 99% credible SNP sets, which identify 10 GWAS loci that have eight or fewer SNPs in the credible set, including three loci with one single likely causal SNP. Our study suggests that the diverse symptoms and disease severity of COVID-19 observed between individuals is associated with variants across the genome, affecting gene expression levels in a wide variety of tissue types

Computerized head impulse testing: new perspectives in vestibular disorders diagnosis and rehabilitation

Se ha abordado la situación de la niñez y adolescencia víctimas de abuso sexual, realizada en la comunidad Caño el Sapote del municipio de Waslala, 2012. La metodología utilizada es cualitativa con enfoque descriptivo al abordarse casos y formas de abuso sexual en la niñez; además, se manifiestan las consecuencias que asumen cada niña, niño y adolescente sobreviviente de abuso sexual. También se ha descrito la ruta de acceso a la justicia. Las técnicas utilizadas fueron entrevistas semi- estructurada, grupo focal y revisión documental.<br /> Los resultados demuestran que el abuso sexual es una de las formas de violencias que se viven dentro de las familias y personas cercanas a ella en todos los ámbitos y espacios sociales. Los resultados reflejan desconocimientos de lo que es en sí el abuso sexual por parte de la mayoría de las personas, acontecimiento que sucede dentro de la sociedad, pero por una u otra razón no se rompe el silencio, no existe igualdad por la posición  en la pirámide social.<br />Summary <br />The present study addresses the situation of children and adolescents victims of sexual abuse, in the community of Caño El Sapote, municipality of Waslala, 2012. The methodology that was used is qualitative with a descriptive approach when addressing cases and forms of sexual abuse in children. We make use of techniques based on semi- structured interviews, focus groups and document review. The research also manifests the consequences that each girl, boy and adolescent survivors of sexual abuse assumes. As well, it describes the path to justice. <br />The results show that sexual abuse is one of the forms of violence that are experienced within families and people close to them in all areas and social spaces. The results reflect that most people are lacking information of what is sexual abuse, an event that occurs in society and has become very common, but for whatever reason the silence does not break, and there is no equality due to the position in the social pyramid

Current status of laparoscopy for acute abdomen in Italy: a critical appraisal of 2012 clinical guidelines from two consecutive nationwide surveys with analysis of 271,323 cases over 5 years

Background: Several authors have demonstrated the safety and feasibility of laparoscopy in selected cases of abdominal emergencies. The aim of the study was to analyse the current Italian practice on the use of laparoscopy in abdominal emergencies and to evaluate the impact of the 2012 national guidelines on the daily surgical activity. Methods: Two surveys (42 closed-ended questions) on the use of laparoscopy in acute abdomen were conducted nationwide with an online questionnaire, respectively, before (2010) and after (2014) the national guidelines publication. Data from two surveys were compared using Chi-square or Fisher’s exact test, and data were considered significant when p &lt; 0.05. Results: Two-hundred and one and 234 surgical units answered to the surveys in 2010 and 2014, respectively. Out of 144,310 and 127,013 overall surgical procedures, 23,407 and 20,102, respectively, were abdominal emergency operations. Respectively 24.74 % (in 2010) versus 30.27 % (in 2014) of these emergency procedures were approached laparoscopically, p = 0.42. The adoption of laparoscopy increased in all the considered clinical scenarios, with statistical significance in acute appendicitis (44 vs. 64.7 %; p = 0.004). The percentage of units approaching Hinchey III acute diverticulitis with laparoscopy in 26–75 % of cases (14.0 vs. 29.7 %; p = 0.009), those with &gt;25 % of surgeons confident with laparoscopic approach to acute diverticulitis (29.9 vs. 54 %; p = 0.0009), the units with &gt;50 % of surgeons confident with laparoscopic approach to acute appendicitis, cholecystitis and perforated duodenal ulcer, all significantly increased in the time frame. The majority of respondents declared that the 2012 national guidelines influenced their clinical practice. Conclusions: The surveys showed an increasing use of laparoscopy for patients with abdominal emergencies. The 2012 national guidelines profoundly influenced the Italian surgical practice in the laparoscopic approach to the acute abdomen