Impacto en los resultados infecciosos durante la colecistectomía laparoscópica con el uso de una bolsa de extracción de vesícula biliar casera frente a una comercial: estudio comparativo retrospectivo en un centro de gran volumen

Antecedentes La colecistectomía laparoscópica (CL) es una de las intervenciones de urgencia más frecuentes, a la que se someten aproximadamente 600.000 pacientes al año en Estados Unidos. Aunque la CL se asocia a menos complicaciones en comparación con la colecistectomía abierta, el riesgo de complicaciones infecciosas, incluida la infección del sitio quirúrgico y el absceso intraabdominal, sigue siendo una fuente importante de morbilidad postoperatoria. El objetivo de este estudio es determinar si la técnica de extracción de la vesícula biliar durante la CL afecta al riesgo de complicaciones infecciosas. Métodos y procedimientos Se realizó un estudio comparativo retrospectivo en un centro de cirugía mínimamente invasiva de alto volumen en Bogotá, Colombia. Se identificaron los pacientes sometidos a LC entre 2018 y 2020. Los pacientes se dividieron en tres grupos. Un grupo de LC realizado con bolsa de recuperación de vesícula biliar casera (HMGRB), y otro grupo de LC realizado con bolsa de recuperación de vesícula biliar comercial (CGRB). Los resultados primarios fueron las complicaciones infecciosas de infección superficial y absceso intraabdominal. Resultados Un total de 68 (7,58%) pacientes se sometieron a CL utilizando una HMGRB, y 828 (92,41%) utilizando una CGRB. No hubo diferencias significativas en la sepsis preoperatoria, ni en la distribución por sexos entre los grupos de pacientes. Utilizando la prueba t, encontramos diferencias en la distribución de edad entre los grupos (p < 0,01), los tiempos quirúrgicos (p < 0,01) y la duración de la estancia (p = 0,01). Al utilizar Chi cuadrado, encontramos diferencias en la gravedad de la escala de graduación de Tokio y Parkland (p < 0,01), el uso de antibióticos postoperatorios (p < 0,01) y el uso de drenajes (p < 0,01). Sin embargo, no hubo diferencias en la tasa de infección superficial del sitio quirúrgico (p = 0,92). Conclusión Los HMGRB no se asocian a un mayor riesgo de absceso intraabdominal postoperatorio ni de infección superficial del sitio quirúrgico en comparación con los CGRB, pero implican tiempos quirúrgicos y estancias más prolongados. El uso de HMGRB es seguro, factible y tiene menor coste durante la LC.Background Laparoscopic cholecystectomy (LC) is one of the most commonly performed emergency procedures, with approximately 600,000 patients undergoing the procedure every year in the United States. Although LC is associated with fewer complications when compared with open cholecystectomy, the risk for infectious complications, including surgical site infection and intra-abdominal abscess, remains a significant source of postoperative morbidity. The goal of this study is to determine whether the gallbladder retrieval technique during LC affects risk of infectious complications. Methods and procedures We conducted a retrospective comparative study in a minimally invasive surgery high-volume center in Bogota, Colombia. Patients who underwent LC in 2018 to 2020 were identified. The patients were divided into three groups. One group of LC performed using home-made gallbladder retrieval bag (HMGRB), and another group of LC performed using commercial gallbladder retrieval bag (CGRB). The primary outcomes were infectious complications of superficial site infection and intra-abdominal abscess. Results A total of 68 (7.58%) patients underwent LC using an HMGRB, and 828 (92.41%) using a CGRB. There was no significant difference in preoperative sepsis, or sex distribution between patient groups. Using t test, we found differences on age distribution among groups (p < 0.01), surgical times (p < 0.01), and length of stay (p = 0.01). When using Chi square, we found differences in Tokyo and Parkland Grading Scale severity (p < 0.01), use of postoperative antibiotics (p < 0.01), and drain use (p < 0.01). Nonetheless, there was no difference in the rate of superficial surgical site infection (p = 0.92). Conclusion HMGRB are not associated with increased risk of postoperative intra-abdominal abscess or superficial surgical site infection in comparison with CGRB but imply longer surgical times and length of stay. The use of HMGRB is safe, feasible, and has lower cost during LC

Sexual and Reproductive Health for Young Adults in Colombia: Teleconsultation Using Mobile Devices

Background: Sexual risk behaviors associated with poor information on sexuality have contributed to major public health problems in the area of sexual and reproductive health in teenagers and young adults in Colombia. Objective: To report our experience with the use of DoctorChat Mobile to provide sexual education and information among university students in Bogota, Colombia, and knowledge about the sexual risk factors detected among them. Methods: A mobile app that allows patients to ask about sexual and reproductive health issues was developed. Sexual and reproductive risk behaviors in a sample of young adults were measured before and after the use of the app through the validated survey Family Health International (FHI) Behavioral Surveillance Survey (BSS) for Use With Adults Between 15 and 49 Years. A nonprobabilistic convenience recruitment was undertaken through the study´s webpage. After completing the first survey, participants were allowed to download and use the app for a 6-month period (intervention), followed by completion of the same survey once again. For the inferential analysis, data was divided into 3 groups (dichotomous data, discrete quantitative data, and ordinal data) to compare the results of the questions between the first and the second survey. The study was carried out with a sample of university students between 18 and 29 years with access to mobile phones. Participation in the study was voluntary and anonymous. Results: A total of 257 subjects met the selection criteria. The preintervention survey was answered by 232 subjects, and 127 of them fully answered the postintervention survey. In total, 54.3% (69/127) of the subjects completed the survey but did not use the app, leaving an effective population of 58 subjects for analysis. Of these subjects, 53% (31/58) were women and 47% (27/58) were men. The mean age was 21 years, ranging between 18 and 29 years. The differences between the answers from both surveys were not statistically significant. The main sexual risk behaviors identified in the population were homosexual intercourse, nonuse of condoms, sexual intercourse with nonregular and commercial partners, the use of psychoactive substances, and lack of knowledge on symptoms of sexually transmitted diseases and HIV transmission. Conclusions: Although there were no differences between the pre- and postintervention results, the study revealed different risk behaviors among the participating subjects. These findings highlight the importance of promoting high-impact educational strategies on this matter and the importance of providing teenagers and young adults with easily accessible tools with reliable health information, regardless of their socioeconomic status

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

Gestión del conocimiento. Perspectiva multidisciplinaria. Volumen 10

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, Volumen 10, de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro es una publicación internacional, seriada, continua, arbitrada de acceso abierto a todas las áreas del conocimiento, que cuenta con el esfuerzo de investigadores de varios países del mundo, orientada a contribuir con procesos de gestión del conocimiento científico, tecnológico y humanístico que consoliden la transformación del conocimiento en diferentes escenarios, tanto organizacionales como universitarios, para el desarrollo de habilidades cognitivas del quehacer diario. La gestión del conocimiento es un camino para consolidar una plataforma en las empresas públicas o privadas, entidades educativas, organizaciones no gubernamentales, ya sea generando políticas para todas las jerarquías o un modelo de gestión para la administración, donde es fundamental articular el conocimiento, los trabajadores, directivos, el espacio de trabajo, hacia la creación de ambientes propicios para el desarrollo integral de las instituciones

Doble divertículo de Meckel: resección por laparoscopia Double Meckel's diverticulum

El divertículo de Meckel es la anomalía congénita más común del tubo digestivo. Usualmente, es un divertículo único y es muy raro encontrar dos divertículos de Meckel en un mismo paciente. Se presenta el caso de una mujer con dolor abdominal agudo, cuyos exámenes de laboratorio mostraban una respuesta inflamatoria. La tomografía computadorizada fue sugestiva de divertículo de Meckel. En el examen por laparoscopia se evidenciaron dos divertículos de Meckel. Cuando los hallazgos quirúrgicos son normales en la exploración inicial de un paciente con cuadro clínico de abdomen agudo, se impone la búsqueda de alteraciones que lo expliquen y determinen la causa real de la enfermedad.Meckel&#8217;s diverticulum is the most prevalent congenital anomaly of the gastrointestinal tract. Usually it appears as a single diverticulum, and it is very rare to find two Meckel's diverticula in the same patient. We report the case of a woman with acute abdominal pain, whose initial tests indicated inflammatory response and the CT scan suggested the presence of a Meckel&#8217;s diverticulum. The laparoscopic exploration showed two Meckel&#8217;s diverticula. When findings appear normal during the initial surgical exploration in a patient with acute abdominal pain, it is necessary to look for alterations that explain the symptoms and establish the real cause of the disease

Fundación Santa Fe de Bogotá : 40 años haciendo de historia 1972-2012 : Testimonio de fundadores y directivos

Magíster en AdministraciónMaestrí

Acute abdomen in the centanary patient, mesh migration into the sigmoid colon after laparoscopic inguinal hernia repair (TAPP): A case report and review of literature

Background The complications induced by mesh, such as foreign body reaction, deep-seated infection, mesh migration and perforation into viscera, have been reported sporadically. Colon erosion and penetration by laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair mesh can possibly cause perforation of the colon with acute abdomen. Case presentation A 100-year-old male, who underwent 4 years ago TAPP repair of left inguinal, presented to the emergency department with acute abdomen due to chronic mesh penetration into the sigmoid colon, the migrating mesh generated a free wall perforation with generalized fecal peritonitis. Discussion Tailoring the mesh, appropriate suture placement and adherence to principles of antisepsis during hernia repair surgery are crucial in avoiding longterm mesh-related complications. Conclusion TAPP is a safe procedure for treat groin hernias, unless, mesh complications like foreign body reaction, deep-seated infection, mesh migration and perforation

Programa de radioproteção para atendimento à vítimas de acidentes com radiação

The principal aspects of a radiological protection programfor hospitals in case of medical assistance to external and internal contaminated persons are showed. It is based on the experience obtained at Centro Médico Naval Marcilio Dias during the assistance to the victims of Goiânia accident in 1987. This paper describes the basic infrastructure of a nursery and the radiation protection procedures for the access control of people and materials, area and personal monitoring, decontamination and the support activities such as calibration of radiation monitors and waste management. Is is also estimated the necessary radiation protection materials and the daily quantity of waste generated.O objetivo deste trabalho é apresentar os principais aspectos de um programa de radioproteção a ser implantado em hospitais no caso de assistência médica a pessoas contaminadas terna e internamente por radionuclideos. Baseia-se na experiência adquirida na coordenação de radioproteção do Centro Médico Naval Marcílio Dias, Rio de Janeiro, por ocasião do atendimento ao acidente ocorrido em Goiânia em 1987. Descreve-se em linhas gerais a infra-estrutura básica necessária de uma enfermaria e os procedimentos de radioproteção para o controle de acesso, controle de entrada e saída de material, monitoração de área e de pacientes, descontaminação e as atividades nas áreas de apoio como o controle e manutenção de equipamentos de detecção, triagem de vestimentas e gerenciamento de rejeitos radioativos. Estima-se também os materiais de proteção radiológica necessários e a quantidade de rejeito radioativo gerado por paciente por dia

Necrotizing Fasciitis Due to Vibrio alginolyticus in an Immunocompetent Patient

We describe a patient with a history of asthma and remote use of steroids the development of necrotizing fascitis due to Vibrio alginolyticus after an injury from a coral reef during bathing in the Caribbean Sea off Colombia. The patient recovered with aggressive surgical debridement and antibiotics

Mielolipoma suprarrenal: reporte de un caso y revisión de la literatura Adrenal myelolipoma: case report and literature review

El mielolipoma es un tumor poco frecuente, benigno y, generalmente, asintomático, cuyo hallazgo radiológico suele ser incidental. En ocasiones, puede ser sintomático, en especial cuando el tumor alcanza un gran tamaño y se manifiesta con dolor abdominal. Se ha encontrado correlación con causas de hipertensión secundaria por su asociación esporádica con feocromocitoma y aldosteronoma. Reportamos un caso de adenoma asociado a mielolipoma en un paciente con hipertensión de difícil manejo.Adrenal myelolipoma is an uncommon and benign tumor which is generally asymptomatic. The tumor is frequently discovered as an incidental finding. It can evolve with clinical manifestations like abdominal pain, particularly when the tumor reaches a large size. Alternatively it can show association with causes of secondary hyprtension such as pheochromocytoma and aldosterone-producing adenoma. We report a case of an adrenal adenoma associated with myelolipoma in a patient with history of ten years of refractory hypertension