Intravenous antibiotic therapy after laparoscopic appendectomy in complicated acute appendicitis: the patient's clinical response is key

INTRODUCCIÓN: Las guías sobre apendicitis aguda complicada (ACA) recomiendan 3-5 días de antibióticos intravenosos postoperatorios (VAT). Sin embargo, el tiempo seleccionado por el cirujano puede variar según la respuesta clínica del paciente, el tipo de ACA y la experiencia profesional. Una vez obtenida una respuesta clínica adecuada, el cambio de IVA a antibiótico oral (AO) podría realizarse sin el tiempo de espera establecido con resultados satisfactorios. OBJETIVO: Determinar si un ciclo corto de IVA y/o cambio a vía oral es seguro en función de la respuesta clínica del paciente. MATERIAL Y MÉTODOS: Estudio de cohortes prospectivo observacional a partir de la base de datos de un centro de referencia de cirugía general desde julio de 2019. RESULTADOS Y CONCLUSIÓN: Se incluyeron 48 pacientes con hallazgos intraoperatorios de ACA. Respecto al manejo antibiótico postoperatorio, solo IVA preoperatorio: 7 (14,58%), IVA 1-3 días: 1 (20,83%), IVA 1-3 días y cambio a OA: 21 (43,75%), IVA > 3 días: 6 (12,5%), y sólo OA: 3 (27,08%). El análisis bivariante no mostró diferencias estadísticamente significativas en reconsulta (p = 0,81), rehospitalización (p = 0,44) e infección del sitio quirúrgico (p = 0,56) entre el esquema antibiótico basado en la respuesta clínica postoperatoria y el tradicional en cuanto a la tasa de colecciones intraabdominales, las estancias hospitalarias y los costes de hospitalización. Copyright: © 2023 Permanyer. INTRODUCCIÓN: Las guías sobre apendicitis aguda complicada (AAC) recomiendan 3-5 días de antibióticos intravenosos (VIA) postoperatorios. Sin embargo, el tiempo seleccionado por el cirujano puede variar según la respuesta clínica del paciente, el tipo de ACA y la experiencia profesional. Una vez obtenida una respuesta clínica adecuada, el cambio de VIA a antibiótico oral (AO) podría realizarse sin esperar el tiempo establecido con resultados satisfactorios. OBJETIVO: Determinar si un ciclo corto de VIA y/o cambio a OA según la respuesta clínica del paciente es seguro. MATERIAL Y MÉTODOS: Estudio de cohortes observacional prospectivo a partir de la base de datos de un centro de referencia de cirugía general desde julio de 2019. RESULTADOS Y CONCLUSIÓN: Se incluyeron 48 pacientes con hallazgos intraoperatorios de ACA. En cuanto al manejo antibiótico postoperatorio, VAT solo preoperatorio: 7 (14,58%), VAT 1-3 días: 1 (20,83%), VAT 1-3 días y cambio de OA: 21 (43,75%), VAT > 3 días: 6 (12,5%) y sólo OA: 3 (27,08%). El análisis bivariante no mostró diferencias estadísticamente significativas en la reconsulta (p = 0,81), la rehospitalización (p = 0,44) y la infección del sitio operatorio (p = 0,56) entre la pauta antibiótica basada en la respuesta clínica postoperatoria y la tradicional con respecto a la tasa de recogida intraabdominal, la estancia hospitalaria y los costes de hospitalización.INTRODUCTION: The guidelines about acute complicated appendicitis (ACA) recommend 3-5 days of postoperative intravenous antibiotics (VAT). Nevertheless, the time selected by the surgeon can vary according to patient clinical response, ACA type, and professional experience. Once an adequate clinical response is obtained, the change from IVA to oral antibiotic (OA) could be realized without the waiting time established with satisfactory results. OBJECTIVE: Determine if a short course of IVA and/or switch to oral route is safe based on the patient clinical response. MATERIALS AND METHODS: Observational prospective cohort study from a general surgery reference center database since July 2019. RESULTS AND CONCLUSION: 48 patients with ACA intraoperative findings were included. Regarding postoperative antibiotic management, only preoperative IVA: 7 (14.58%), IVA 1-3 days: 1 (20.83%), IVA 1-3 days and change to OA: 21 (43.75%), IVA > 3 days: 6 (12.5%), and only OA: 3 (27.08%). The bivariate analysis did not show statistically significant differences in reconsultation (p = 0.81), rehospitalization (p = 0.44), and surgical site infection (p = 0.56) between the antibiotic scheme based on the postoperative clinical response and the traditional one regarding intra-abdominal collection rate, the hospital stays, and hospitalization costs. Copyright: © 2023 Permanyer. INTRODUCTION: Guidelines on complicated acute appendicitis (CAA) recommend 3-5 days of postoperative intravenous antibiotics (VIA). However, the time selected by the surgeon may vary according to the patient's clinical response, type of ACA and professional experience. Once an adequate clinical response is obtained, the change from VIA to oral antibiotic (OA) could be performed without waiting the established time with satisfactory results. OBJECTIVE: To determine whether a short course of VIA and/or switching to OA according to the patient's clinical response is safe. MATERIALS AND METHODS: Prospective observational cohort study from a general surgery referral center database from July 2019. RESULTS AND CONCLUSION: Forty-eight patients with intraoperative findings of ACA were included. Regarding postoperative antibiotic management, preoperative VAT only: 7 (14.58%), VAT 1-3 days: 1 (20.83%), VAT 1-3 days and OA change: 21 (43.75%), VAT > 3 days: 6 (12.5%) and OA only: 3 (27.08%). Bivariate analysis showed no statistically significant differences in reconsultation (p = 0.81), rehospitalization (p = 0.44) and operative site infection (p = 0.56) between the antibiotic schedule based on postoperative clinical response and the traditional one with respect to intra-abdominal collection rate, hospital stay and hospitalization costs

Cerámicas prerromanas del castillo de Aroche (Huelva)

Se estudia en este trabajo un conjunto cerámico de época prerromana registrado en las excavaciones del castillo medieval de Aroche (Huelva)._________________________In this work are presented the preroman pottery registered in the archaeological excavation made in the medieval castle of Aroche (Huelva, SW Spain), near to Reina's Gate

Hillings as a tillage practice in maize (Zea mays L.) in monoculture and in relay intercropped with climbing beans (Phaseolus vulgaris L.)

La práctica cultural del aporque en el cultivo del maíz está ampliamente generalizada en zonas frías del país, especialmente en las de vientos fuertes, cuando se cultivan variedades muy altas, o cuando se siembra asociado o en relevo con fríjol voluble. Para estudiar el efecto de esta práctica sobre el rendimiento y el volcamiento de maíz en monocultivo y en relevo con fríjol voluble, durante 1981 y 1982 se sembraron ensayos con tres genotipos de maíz, sin y con aporque a los 45, 60, 75, 90, 105 y 120 días después de la siembra. Los resultados indican que el aporque no produce efecto sobre los rendimientos de los maíces estudiados, pero sí en el volcamiento, tanto en monocultivo como en relevo con fríjol voluble y que para disminuirlo, dicha práctica debe ralizarse a partir de los 75 días después de la siembra. El aporque hecho al maíz no tuvo incidencia sobre el rendimiento del fríjol voluble tipo IVb, sembrado en relevo.Hilling is a generalized tillage practice in the maize crop in Colombia, mainly in the cold high altitudes where strong winds are common, or when very tall maize varieties are planted in association with or as relay intercrop with climbing beans. Research was conducted at "La Selva" ICA's Experimental Station near Medellin, during 1981 and 1982, using one bean cultivar with three maize genotypes without hilling and hilling at 45, 60, 75, 90, 105 and 120 days after planting. The objectives were to find the not hilling and hilling effect on lodging and on yield of maize and beans. The results showed not effect of hilling on the yields of corn and climbing type lVb beans planted in relay intercrop. However, maize stalk lodging was mostly increased in monoculture and in relay intercropping. 75 days after planting was the optimum time for hill tillage in the particular experiment with the three maize genotypes used. Additional.Fríjol-Phaseolus vulgarisMaíz-Zea may

Epocas de siembra de fríjol voluble (Phaseolus vulgaris) Cargamanto en relevo con maíz (Zea mays) en el oriente antioqueño.

En el Centro Regional de Investigación La Selva, localizado en el muncipio de Rionegro, departamento de Antioquia, Colombia, se realizó un estudio para determinar la mejor época de siembra de fríjol voluble (Phaseolus vulgaris) Cargamanto en relevo con maíz. Se efectuaron siembras periódicas cada 2 meses a partir de octubre de 1978 hasta agosto de 1980. La última siembra se recolectó en febrero de 1981. Como tutores se plantaron 4 genotipos de maíces obtenidos por el Programa de Maíz para clima frio moderado. Las siembras de estos tutores se hicieron periódicamente cada 2 meses, iniciando en febrero de 1978 para relevarlos 180 días después de la siembra. Los resultados indicaron que la mejor época para sembrar fríjol voluble Cargamanto fue en abril, con rendimiento de 1.428 kg/ha y en segundo lugar, la de agosto con 992 kg/haFríjol-Phaseolus vulgarisMaíz-Zea may

Prevalence of colonizing bacteria and their association with primary bacteremias in hemodialysis of a university hospital

to be from 2.5 to 5.5 cases per 1,000 catheter-day. the clinical impact is relevant and increases the cost of the HD Unit. Methods: The present study is the irst of 2 phases. It was conducted from January to December of 2012, and included all patients and nurses who were in the HD Unit. The prevalence of Gramnegative bacilli (GNB) and methicillin-resistant Staphylococcus aureus (MrSA) colonizing the nasal passages and the skin is described. Also, phenotypic association was sought by genus, species and sensitivities between colonizing bacterial strains and blood cultures with GNB and MRSA. Results: the study included 70 patients and 10 nurses. the prevalence of nasal colonization in patients by GNB was 9% and 6% in the pericatheter, and no nursing GNB colonization was discovered. The prevalence of MRSA nasal colonization was 19% and 6% in the pericatheter for patients and in the nurses the nasal colonization was 50% and 10% in the hands. We identiied 29 cases of primary bacteremia. The primary bacteremia rate is 1.5 per 1,000 catheter-day or 0.4 episodes per patient per year. Conclusion: We demonstrated a high prevalence of MrSA colonization in patients and nurses in the HD Unit. No relationship was found between primary bacteremia by GNB and patients and nurses’ bacteria colonization by the phenotypic comparison

Collaborative research groups: Advantages and impact in surgical research, a call from colombiansurg

La medicina basada en la evidencia surge como una estrategia para superar la práctica médica apoyada en la racionalidad fisiopatológica y la experiencia clínica no sistematizada 1. A lo largo de su desarrollo, ha generado la necesidad de adoptar una mayor responsabilidad frente a la investigación, como un aspecto importante del crecimiento profesional médico. Actualmente, se considera una aptitud clave en el desempeño de la medicina, asociada a la capacidad de contribuir a la investigación clínica, en beneficio de la atención del paciente. De hecho, las competencias investigativas, de comprensión y análisis crítico, de las publicaciones médico-científicas, son fundamentales para una buena práctica clínica

Mortalidad perioperatoria en Tolima, perspectivas del cuarto indicador de The Lancet Commission on Global Surgery: un análisis preliminar de la cohorte prospectiva del estudio Colombian Surgical Outcomes Study (ColSOS)

Introducción. La mortalidad perioperatoria en el mundo representa 4,2 millones de muertes anuales. El cuarto indicador de The Lancet Commission on Global Surgery permite estandarizar la mortalidad perioperatoria. En Colombia, existen aproximaciones por datos secundarios, limitando el análisis y las intervenciones aplicables a nuestra población. El objetivo de este estudio fue describir la mortalidad perioperatoria a través de datos primarios que permitan sustentar políticas públicas. Métodos. Se hizo el análisis preliminar de un estudio observacional, de cohorte prospectiva, multicéntrico en 6 instituciones del departamento de Tolima. Se incluyeron los pacientes llevados a procedimientos quirúrgicos por una semana, con posterior seguimiento hasta el egreso, fallecimiento o 30 días de hospitalización. La mortalidad perioperatoria fue el desenlace primario. Resultados. Fueron incluidos 378 pacientes, con mediana de 49 años (RIC 32-66), buen estado funcional (ASA I-II 80 %) y baja complejidad quirúrgica (42 %). Las cirugías más comunes fueron por Ortopedia (25,4 %) y Cirugía plástica (23,3 %). El 29,7 % presentaron complicaciones postoperatorias, las más comunes fueron síndrome de dificultad respiratoria agudo e íleo postoperatorio. La mortalidad perioperatoria fue de 1,3 %. Discusión. La mortalidad perioperatoria discrepó de la reportada en otros estudios nacionales, aun cuando los pacientes tenían un bajo perfil de riesgo y baja complejidad de los procedimientos. Sin embargo, coincide con la reportada internacionalmente y nos acerca a la realidad del país. Conclusión. La determinación del cuarto indicador es de vital importancia para mejorar la atención quirúrgica en Colombia. Este es el primer acercamiento con datos primarios que nos permite tener información aplicable a nuestra población

Guillain-Barré syndrome following the 2009 pandemic monovalent and seasonal trivalent influenza vaccination campaigns in Spain from 2009 to 2011: outcomes from active surveillance by a neurologist network, and records from a country-wide hospital discharge database

Background: Studies have shown a slight excess risk in Guillain-Barre syndrome (GBS) incidence associated with A(H1N1) pdm09 vaccination campaign and seasonal trivalent influenza vaccine immunisations in 2009-2010. We aimed to assess the incidence of GBS as a potential adverse effect of A(H1N1) pdm09 vaccination. Methods: A neurologist-led network, active at the neurology departments of ten general hospitals serving an adult population of 4.68 million, conducted GBS surveillance in Spain in 2009-2011. The network, established in 1996, carried out a retrospective and a prospective study to estimate monthly alarm thresholds in GBS incidence and tested them in 1998-1999 in a pilot study. Such incidence thresholds additionally to observation of GBS cases with immunisation antecedent in the 42 days prior to clinical onset were taken as alarm signals for 2009-2011, since November 2009 onwards. For purpose of surveillance, in 2009 we updated both the available centres and the populations served by the network. We also did a retrospective countrywide review of hospital-discharged patients having ICD-9-CM code 357.0 (acute infective polyneuritis) as their principal diagnosis from January 2009 to December 2011. Results: Among 141 confirmed of 148 notified cases of GBS or Miller-Fisher syndrome, Brighton 1-2 criteria in 96 %, not a single patient was identified with clinical onset during the 42-day time interval following A(H1N1) pdm09 vaccination. In contrast, seven cases were seen during a similar period after seasonal campaigns. Monthly incidence figures did not, however, exceed the upper 95 % CI limit of expected incidence. A retrospective countrywide review of the registry of hospital-discharged patients having ICD-9-CM code 357.0 (acute infective polyneuritis) as their principal diagnosis did not suggest higher admission rates in critical months across the period December 2009-February 2010. Conclusions: Despite limited power and underlying reporting bias in 2010-2011, an increase in GBS incidence over background GBS, associated with A(H1N1) pdm09 monovalent or trivalent influenza immunisations, appears unlikely

The Effect of a Physical Activity Program on the Total Number of Primary Care Visits in Inactive Patients: A 15-Month Randomized Controlled Trial

Abstract Background: Effective promotion of exercise could result in substantial savings in healthcare cost expenses in terms of direct medical costs, such as the number of medical appointments. However, this is hampered by our limited knowledge of how to achieve sustained increases in physical activity. Objectives: To assess the effectiveness of a Primary Health Care (PHC) based physical activity program in reducing the total number of visits to the healthcare center among inactive patients, over a 15-month period. Research Design: Randomized controlled trial. Subjects: Three hundred and sixty-two (n = 362) inactive patients suffering from at least one chronic condition were included. One hundred and eighty-three patients (n = 183; mean (SD); 68.3 (8.8) years; 118 women) were randomly allocated to the physical activity program (IG). One hundred and seventy-nine patients (n = 179; 67.2 (9.1) years; 106 women) were allocated to the control group (CG). The IG went through a three-month standardized physical activity program led by physical activity specialists and linked to community resources. Measures: The total number of medical appointments to the PHC, during twelve months before and after the program, was registered. Self-reported health status (SF-12 version 2) was assessed at baseline (month 0), at the end of the intervention (month 3), and at 12 months follow-up after the end of the intervention (month 15). Results: The IG had a significantly reduced number of visits during the 12 months after the intervention: 14.8 (8.5). The CG remained about the same: 18.2 (11.1) (P = .002). Conclusions: Our findings indicate that a 3-month physical activity program linked to community resources is a shortduration, effective and sustainable intervention in inactive patients to decrease rates of PHC visits. Trial Registration: ClinicalTrials.gov NCT0071483

Funerary practices or food delicatessen? Human remains with anthropic marks from the Western Mediterranean Mesolithic

The identification of unarticulated human remains with anthropic marks in archaeological contexts normally involves solving two issues: a general one associated with the analysis and description of the anthropic manipulation marks, and another with regard to the interpretation of their purpose. In this paper we present new evidence of anthropophagic behaviour amongst hunter-gatherer groups of the Mediterranean Mesolithic. A total of 30 human remains with anthropic manipulation marks have been found in the Mesolithic layers of Coves de Santa Maira (Castell de Castells, Alicante, Spain), dating from ca. 10.2-9 cal ky BP. We describe the different marks identified on both human and faunal remains at the site (lithic, tooth, percussion and fire marks on bone cortex). As well as describing these marks, and considering that both human and faunal remains at the site present similar depositional and taphonomic features, this paper also contextualizes them within the archaeological context and subsistence patterns described for Mesolithic groups in the region. We cannot entirely rule out the possibility that these practices may be the result of periodic food stress suffered by the human populations. These anthropophagic events at the site coincide with a cultural change at the regional Epipalaeolithic-Mesolithic transition