Resecciones multiviscerales en el Tratamiento Quirúrgico de las Recaídas Locoregionales de Cirugía de RectoSigma. Factibilidad, Complicaciones y Resultados Oncológicos. -Multivisceral Resections in the Surgical Treatment of Locoregional Relapses of RectoSigma Surgery. Feasibility, Complications and Oncologic Results.

Las inmunodeficiencias primarias (IDP) son enfermedades de baja prevalencia. Existen signos de alarma para su sospecha clínica. Los objetivos fueron describir características clínicas y signos de alarma de pacientes con IDP y comparar diferencias clínicas entre déficit selectivo de inmunoglobulina A (IgA) y otras IDP. Se estudiaron 89 pacientes, con mediana de edad, al momento del diagnóstico, de 6 años (4,08-11,67). 53 (59,5%) pacientes, varones. 54 (60,7%) pacientes, con déficit selectivo de IgA, y 35 (39,3%), con otras IDP. Las principales manifestaciones clínicas fueron rinofaringitis en 65 (73,03%) pacientes y atopia en 39 (43,82%) pacientes. Presentaron signos de alarma 24 (26,97%) pacientes, ninguno con déficit selectivo de IgA. En los pacientes con otras IDP, se observó mayor incidencia de infección respiratoria baja, sepsis, infecciones cutáneas, candidiasis mucocutánea, alteraciones dentales, malformaciones cardiovasculares, angioedema, internaciones y mortalidad. 10 (28,57%) pacientes recibieron gammaglobulina endovenosa; 15 (42,85%), antibiótico-profilaxis; y 2 (2,24%), antimicóticoprofilaxis. Palabras clave: infecciones respiratorias, hipersensibilidad, gammaglobulinas, síndromes de inmunodeficiencia, deficiencia de IgA

Patología apendicular: de lo frecuente a lo infrecuente

La apendicitis aguda es la patología más común en el apéndice 1 y la causa principal del abdomen quirúrgico. 2 Aproximadamente 300,000 personas se someten a apendicectomía cada año en los Estados Unidos. 3 El riesgo estimado de presentar un cuadro de apendicitis aguda en algún momento de la vida está estimado en un 7%.3 El uno por ciento de las apendicectomías corresponde a tumores apendiculares. Los tumores malignos se confirman por análisis patológico en 0,9 al 1.4% de todas las apendicetomías realizadas.4,5 Objetivos. Evaluar incidencia de patología apendicular benigna, analizar la incidencia de tumores apendiculares, determinar sobrevida y mortalidad de tumores apendiculares a 5 años

Meeting the stakeholder needs and sustaining business through sustainability risk management practices: A case study of Malaysian environmentally sensitive companies

Sustainability issues such as climate change, carbon emissions, and energy consumption have become increasingly important issues among business organisations, academics and policy makers. Considering this complexity, stakeholders currently demanding companies to have a sound risk management that are aligned to their interest. Sustaining business requires a strong foundational on the economic, environmental and social aspects to address risks and capture value. Sustainability risk management (SRM) is a process that systematically integrates environmental, social, and economic aspects to address emerging risks and other non-quantifiable risk for company survival. This study aims to examine the impact of SRM practices on the company survival among the environmentally sensitive companies in Malaysia. A case study was carried out to examine the SRM implementation among the environmentally sensitive companies. The finding shows that leadership and compliance are considered as important factors in implementing SRM programme. Other factors such as sound risk culture, adequate risk management tools, and effective business continuity planning are crucial to support SRM implementation. Overall findings revealthat the companies are at the early stage implementing SRM programme and denote there is much room for improvement in the risk management process to create long-term value creation for the stakeholders. This study provides empirical evidence on the significance of SRM factors to the company survival. Given the huge environmental and social costs arising from sustainability issues, companies should intensify their effort to fully implement SRM programme across the organisation to sustain longer

Linking Employee Stakeholders to Environmental Performance: The Role of Proactive Environmental Strategies and Shared Vision

Drawing on the natural-resource-based view (NRBV), we propose that employee stakeholder integration is linked to environmental performance through firms’ proactive environmental strategies, and that this link is contingent on shared vision. We tested our model with a cross-country and multi-industry sample. In support of our theory, results revealed that firms’ proactive environmental strategies translated employee stakeholder integration into environmental performance. This relationship was pronounced for high levels of shared vision. Our findings demonstrate that shared vision represents a key condition for advancing the corporate greening agenda through proactive environmental strategies. We discuss implications for the CSR and the environmental management literatures, with a particular focus on the NRBV and stakeholder integration debates

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Resecciones multiviscerales en el Tratamiento Quirúrgico de las Recaídas Locoregionales de Cirugía de RectoSigma. Factibilidad, Complicaciones y Resultados Oncológicos

Las inmunodeficiencias primarias (IDP) son enfermedades de baja prevalencia. Existen signos de alarma para su sospecha clínica. Los objetivos fueron describir características clínicas y signos de alarma de pacientes con IDP y comparar diferencias clínicas entre déficit selectivo de inmunoglobulina A (IgA) y otras IDP. Se estudiaron 89 pacientes, con mediana de edad, al momento del diagnóstico, de 6 años (4,08-11,67). 53 (59,5%) pacientes, varones. 54 (60,7%) pacientes, con déficit selectivo de IgA, y 35 (39,3%), con otras IDP. Las principales manifestaciones clínicas fueron rinofaringitis en 65 (73,03%) pacientes y atopia en 39 (43,82%) pacientes. Presentaron signos de alarma 24 (26,97%) pacientes, ninguno con déficit selectivo de IgA. En los pacientes con otras IDP, se observó mayor incidencia de infección respiratoria baja, sepsis, infecciones cutáneas, candidiasis mucocutánea, alteraciones dentales, malformaciones cardiovasculares, angioedema, internaciones y mortalidad. 10 (28,57%) pacientes recibieron gammaglobulina endovenosa; 15 (42,85%), antibiótico-profilaxis; y 2 (2,24%), antimicóticoprofilaxis. Palabras clave: infecciones respiratorias, hipersensibilidad, gammaglobulinas, síndromes de inmunodeficiencia, deficiencia de IgA

Patología apendicular: de lo frecuente a lo infrecuente

La apendicitis aguda es la patología más común en el apéndice 1 y la causa principal del abdomen quirúrgico. 2 Aproximadamente 300,000 personas se someten a apendicectomía cada año en los Estados Unidos. 3 El riesgo estimado de presentar un cuadro de apendicitis aguda en algún momento de la vida está estimado en un 7%.3 El uno por ciento de las apendicectomías corresponde a tumores apendiculares. Los tumores malignos se confirman por análisis patológico en 0,9 al 1.4% de todas las apendicetomías realizadas.4,5 Objetivos. Evaluar incidencia de patología apendicular benigna, analizar la incidencia de tumores apendiculares, determinar sobrevida y mortalidad de tumores apendiculares a 5 años