Efectos metabólicos de la Gastrectomía vertical en un modelo de rata diabética no obesa

Planteamiento: Se hipotetiza que la gastrectomía vertical es un tratamiento efectivo para la diabetes mellitus Tipo 2, produciendo cambios en los niveles de los péptidos del eje entero-insular, la funcionalidad del islote y la expresión génica de la insulina sin producir cambios significativos en el peso del animal de experimentación. Se realizó una gastrectomía vertical en 30 ratas Goto-Kakizaki en las cuales se controlaron los niveles de glucosa, insulina, glucagón, GLP-1, GIP , leptina, el contenido de insulina en el islote, la secreción de insulina y la expresión génica de la insulina en la célula beta RESULTADOS Y CONCLUSIONES: La gastrectomía vertical ha mejorado las cifras de glucemia basal y de insulina en el grupo intervenido. Da lugar a modificaciones significativas en los niveles de glucagón y leptina. Además, parece mejorar la capacidad secretora de la célula beta que se manifiesta con el aumento del contenido de insulina en condiciones de estímulo.Departamento de Medicina, Dermatología y Toxicologí

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

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

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Current status of liver surgery for non-colorectal non-neuroendocrine liver metastases: the NON.LI.MET. Italian Society for Endoscopic Surgery and New Technologies (SICE) and Association of Italian Surgeons in Europe (ACIE) collaborative international survey

Despite the increasing trend in liver resections for non-colorectal non-neuroendocrine liver metastases (NCNNLM), the role of surgery for these liver malignancies is still debated. Registries are an essential, reliable tool for assessing epidemiology, diagnosis, and therapeutic approach in a single hub, especially when data are dispersive and inconclusive, as in our case. The dissemination of this preliminary survey would allow us to understand if the creation of an International Registry is a viable option, while still offering a snapshot on this issue, investigating clinical practices worldwide. The steering committee designed an online questionnaire with Google Forms, which consisted of 37 questions, and was open from October 5th, 2022, to November 30th, 2022. It was disseminated using social media and mailing lists of the Italian Society of Endoscopic Surgery and New Technologies (SICE), the Association of Italian Surgeons in Europe (ACIE), and the Spanish Chapter of the American College of Surgeons (ACS). Overall, 141 surgeons (approximately 18% of the total invitations sent) from 27 countries on four continents participated in the survey. Most respondents worked in general surgery units (62%), performing less than 50 liver resections/year (57%). A multidisciplinary discussion was currently performed to validate surgical indications for NCNNLM in 96% of respondents. The most commonly adopted selection criteria were liver resectability, RECIST criteria, and absence of extrahepatic disease. Primary tumors were generally of gastrointestinal (42%), breast (31%), and pancreaticobiliary origin (13%). The most common interventions were parenchymal-sparing resections (51% of respondents) of metachronous metastases with an open approach. Major post-operative complications (Clavien-Dindo &gt; 2) occurred in up to 20% of the procedures, according to 44% of respondents. A subset analysis of data from high-volume centers (&gt; 100 cases/year) showed lower post-operative complications and better survival. The present survey shows that NCNNLM patients are frequently treated by surgeons in low-volume hospitals for liver surgery. Selection criteria are usually based on common sense. Liver resections are performed mainly with an open approach, possibly carrying a high burden of major post-operative complications. International guidelines and a specific consensus on this field are desirable, as well as strategies for collaboration between high-volume and low-volume centers. The present study can guide the elaboration of a multi-institutional document on the optimal pathway in the management of patients with NCNNLM

IV Congreso internacional 2019: memorias II

La Red de Dirección Estratégica en la Educación Superior (RED-DEES) celebró hace poco tiempo su 10mo Aniversario de constitución. Por ello, con mucho orgullo este libro permite crear un puente en el tiempo y la emoción para Ias 54 Instituciones de Educación Superior que hoy tienen el honor de ser parte de sus miembros. Hace unos 10 años pocos podrían soñar con que la Red hubiera recorrido el camino que nos ha traído hasta aquí; era una idea inicial, tan solo una semilla, que abriría las puertas a un futuro prometedor; se convirtió en un camino hacia la ilusión, ya que en los primeros años nos movíamos entre el deseo y la incertidumbre. Hoy no dejamos de reconocer que fue una decisión riesgosa, pero estábamos dispuestos a asumirla con muchos esfuerzos entre todos. (Apartes del texto)Contiene: 1. La Planificación Estratégica en la Educación Superior: Monitoreo y Seguimiento a la planificación operativa: Herramienta de apoyo para la toma de decisiones / Isaías Hernández Sánchez, María Catalina Tapia López -- La Planificación y su vinculación con los modelos para la calidad, caso UNAH / Javier Alexis Martínez Moncada -- Resultados de un trabajo planificado en la facultad de medicina de la UNNE- Argentina / Erika Sánchez, Silvia García, Patricia Demuth -- Rediseño estratégico y prospectivo de la arquitectura organizacional: experiencia en la Universidad de Managua. Nicaragua / Fernando Valle Meza, Mario Valle Dávila, Dora María Meza Cornavaca -- Factores que favorecen y dificultan la aplicación de la dirección estratégica en la educación superior / Jorge Juan Domínguez Menéndez -- La evaluación de la práctica de la planificación estratégica en instituciones de educación superior de Cuba. Metodología aplicada y principales resultados / José Luis Almuiñas Rivero, Judith Galarza López -- Modelo para el control de la estrategia institucional en la Universidad de Cienfuegos / Katia Rivero Alonso, Judith Galarza López -- Reconstrucción de la senda que se recorrió en los procesos de planificación y evaluación institucional de comunitaria intercultural / Adrián Puerta Ch., Julia Arguello M. -- 2. Evaluación Institucional y gestión de la calidad en las IES: Hacia la instauración de una cultura de mejora continua: Modelo de evaluación del desempeño en la UNAN -Managua / Isaías Hernández Sánchez, Saira del Rosario Figueroa Aguirre -- Estrategias para mejorar la gestión del proceso de autoevaluación institucional con fines de acreditación en la Universidad San Gregorio de Portoviejo / Ximena Guillén Vivas, José Luis Almuiñas Rivero, Judith Galarza López -- Visita de condiciones iniciales para la acreditación institucional en tiempos de pandemia y sus impactos. Relato de una experiencia. Fundación Universitaria Los Libertadores - Colombia / Patricia Martínez Barrios, Orlando Salinas Gómez, Luz Mercedes Flechas Mendoza -- 3. La formación profesional y la calidad de los procesos universitarios: La formación profesional y la calidad de los procesos universitarios / Observal - Honduras, Celeo Emilio Arias -- Describir la satisfacción estudiantil delos egresados del instituto tecnológico superior de tela, ubicado en la ciudad de tela, Atlantida, Honduras / Gustavo Adolfo Rodríguez, Espinoza Carlos Agurcia, Jairo Núñez -- La cadena valor percibido, satisfacción y lealtad para los egresados de la universidad / Katty Johanna Loor Avila, José Antonio Pedraza Rodríguez, Leonor Pérez Naranjo -- El avance del seguimiento a graduados en la universidad nacional de ingeniería / Melvis Daviel Martínez Cano -- Programa de seguimiento de egresados: estudio preliminar de tres servicios universitarios / Rodrigo Horjales -- La formación de valores éticos en los estudiantes de la carrera de derecho con un enfoque RSU: propuesta de una estrategia / Roger Martínez Isaac, Odette Martínez Pérez, Noemí Delgado Álvarez -- El seguimiento de graduados; oferta y demanda de profesionales veterinarios en el Uruguay / José Passarini, Paola Cabral, Brasiliano Rodríguez, Claudia Borlido -- 4. Vinculación con medio y responsabilidad social universitaria: Responsabilidad social y aprendizaje: ideas preliminares / Odette Martínez Pérez, Roxana Chiquito Chillán, Víctor Gómez Rodríguez -- Transversalización de los Objetivos de Desarrollo Sostenible en la Planeación Institucional de la UNAN-León / Marcos Vinicio Sandino Montes -- La Universidad de Pinar del Río del conocimiento y la innovación en función del desarrollo local sostenible / Maricela González Pérez, Carlos Cesar Torres Paez, Saray Nuñez González -- Educación superior socialmente responsable: propuesta de una metodología para su evaluación e implementación en la educación superior ecuatoriana / Odette Martínez Pérez, Luis Alberto Alzate Peralta, Rudy García Cobas -- 5. La Gestión de la Internacionalización de la educación superior: La gestión del proceso de internacionalización: experiencias en la movilidad académica, la formación doctoral del docente / Bernal Álava AF, Borroto Leal OE, Campozano Pluas, Vanessa Daniela -- La gestión de la internacionalización desde la perspectiva de la formación tecnológica: la experiencia del Instituto Superior Tecnológico Bolivariano de Tecnología ITB / Luis Alberto Alzate Peralta, Odette Martínez Pérez Elena Tolozano Benites -- 6.Las TIC y las Redes Sociales en la formación de los estudiantes / Las Redes sociales como gestoras de conocimiento formal en los participantes / Esteban de Jesús Gutiérrez Ortiz, Andrés Ernesto Manrique de la Cruz, Sheyla Monsait Valero Estrada, Carlos Jesús Rodríguez Saucedo -- Las NTIC como plataformas de nuevas habilidades digitales y cocreadoras de ecosistemas virtuales educomunicativos / Martín Hernández Oseguera, Oscar Ricardo Castillo BribiescaFundación Universitaria Los Libertadore

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2