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

Anuario ornitológico de La Rioja 2013-2015

The present article aims to show the most interesting ornithological observations carried out between the years 2013 and 2015 in La Rioja, and is an update of the existing information so far. Furthermore, this article contains a brief description of the status, abundance, distribution, migrating habits and phenology of all the species of birds observed in La Rioja. Out of the 302 wild birds registered in La Rioja, this report provides a total of 301 records for 121 of them. Here are the first records of Canada goose (Branta canadensis), Longlegged buzzard (Buteo rufinus) in La Rioja as well as Purple swamphen (Porphyrio porphyrio), Marsh sandpiper (Tringa stagnatilis) and Great skua (Stercorarius skua). We also show the second records of Western reef heron (Egretta gularis), Glossy ibis (Plegadis falcinelus), Pallid harrier (Circus macrourus), Greater spotted aegle (Aquila clanga) and Bar-tailed godwit (Limosa lapponica). And the third of Ring-necked duck (Aythya collaris). Four new species are added to the list of exotic species escaped from captivity: American wood duck (Aix sponsa), Spot-billed duck (Anas poecilorhyncha), Chilean flamingo (Phoenicopterus chilensis) and Java sparrow (Padda oryzivora). The article includes 17 records of 12 of the 32 species that make up the list. For the first time, we get data about actual reproduction of the Canada goose (Branta canadensis) in the river Ebro in Alfaro, the Common shelduck (Tadorna tadorna) and the Black-headed gull (Chroicocephalus ridibundus) in the Lake of Herramélluri, and the Purple swamphen (Porphyrio porphyrio) in El Recuenco, Calahorra. Being sporadic, it is interesting to note the reproduction of the Gadwall (Anas strepera) in Murillo de Río Leza, the Northen shoveler (Anas clypeata) in the Lake of Herramélluri, the Back-necked grebe (Podiceps nigricollis) in the lagoon of Hervías, the Great cormorant (Phalacrocorax carbo) in the river Ebro in Gimileo, and the Little bittern (Ixobrychus minutus) in El Recuenco, Calahorra. For the first time, we get data of the regular wintering of the Black-crowned night heron (Nycticorax nycticorax) in La Rioja. Every winter, at least since 2012-13, a small population stays by the river Ebro where it crosses Logroño. In 2013 and 2014, we get many records of the Bar-tailed godwit (Limosa lapponica) during their prebreeding migration in different wetlands in La Rioja; and also one record during postbreeding migration. So far we only had one record of this species. The Bearded reedling (Panurus biarmicus) keeps spreading in La Rioja. This species is already reproducing in El Salobral of Pradejón and El Recuenco of Calahorra.En el presente artículo se exponen las observaciones ornitológicas más interesantes producidas entre los años 2013 y 2015 en La Rioja, actualizando la información existente hasta el momento. Así mismo se realiza una pequeña descripción del status, abundancia, distribución, carácter migratorio y fenología de todas las especies de aves observadas en La Rioja. Se aportan 301 citas de 121 de las 302 especies de aves silvestres observadas hasta el momento en La Rioja. Se recogen las primeras citas en La Rioja de barnacla canadiense grande (Branta canadensis), busardo moro (Buteo rufinus), calamón común (Porphyrio porphyrio), archibebe fino (Tringa stagnatilis) y págalo grande (Stercorarius skua). Las segundas citas de garceta dimorfa (Egretta gularis), morito común (Plegadis falcinelus), aguilucho papialbo (Circus macrourus), águila moteada (Aquila clanga) y aguja colipinta (Limosa lapponica). Y la tercera de porrón acollarado (Aythya collaris). Se añaden cuatro nuevas especies a la lista de las especies exóticas escapadas de cautividad: pato joyuyo (Aix sponsa), ánade picopinto (Anas poecilorhyncha), flamenco chileno (Phoenicopterus chilensis) y gorrión de Java (Padda oryzivora). Se aportan, además, 17 citas para 12 de las 32 especies que conforman la misma. Se documenta la primera reproducción segura de barnacla canadiense grande (Branta canadensis) en los Sotos de Alfaro, tarro blanco (Tadorna tadorna) y gaviota reidora (Chroicocephalus ridibundus) en El Lago de Herramélluri y de calamón común (Porphyrio porphyrio) en El Recuenco, Calahorra. Son interesantes también, por esporádicas, la reproducción de ánade friso (Anas strepera) en Murillo de Río Leza, cuchara común (Anas clypeata) en El Lago de Herramélluri, zampullín cuellinegro (Podiceps nigricollis) en la laguna de Hervías, cormorán grande (Phalacrocorax carbo) en el río Ebro en Gimileo y avetorillo común (Ixobrychus minutus) en El Recuenco, Calahorra. Por primera vez se recogen datos de la invernada regular de martinete común (Nycticorax nycticorax) en La Rioja. Una pequeña población permanece en el río Ebro a su paso por Logroño todos los inviernos, al menos, desde el 2012-13. En 2013 y 2014 se recogen numerosas observaciones de aguja colipinta (Limosa lapponica) durante el paso prenupcial en diferentes humedales riojanos y una en el paso postnupcial, una especie de la que anteriormente sólo se conocía una cita. Sigue la expansión del bigotudo (Panurus biarmicus) en La Rioja. La especie ya se reproduce en El Salobral de Pradejón y El Recuenco de Calahorra

Delayed introduction of sirolimus in paediatric intestinal transplant recipients: indications and long-term benefits

To review our experience using sirolimus in a single centre paediatric intestinal transplantation cohort. Intestinal transplant patients with more than 3 months follow-up were divided into two groups according to their immunosuppression regimen: tacrolimus, (TAC group, n = 45 grafts) or sirolimus (SRL group, n = 38 grafts), which included those partially or completely converted from tacrolimus to sirolimus. The indications to switch were tacrolimus side effects and immunological complications. Survival and complications were retrospectively analysed comparing both groups. SRL was introduced 9 months (0 months–16.9 years) after transplant. The main cause for conversion was worsening renal function (45%), followed by haemolytic anaemia (21%) and graft-versus-host-disease (16%). Both groups showed a similar overall patient/graft survival (P = 0.76/0.08) and occurrence of rejection (24%/17%, P = 0.36). Immunological complications did not recur after conversion. Renal function significantly improved in most SRL patients. After a median follow-up of 65.17 months, 28/46 survivors were on SRL, 26 with monotherapy, with good graft function. Over one-third of our patients eventually required SRL conversion that allowed to improve their kidney function and immunological events, without entailing additional complications or survival impairment. Further trials are warranted to clarify the potential improvement of the standard tacrolimus maintenance by sirolimus conversion or addition.Fil: Andres, Ane M.. Hospital Universitario la Paz; EspañaFil: Talayero, Paloma. Hospital Universitario 12 de Octubre; EspañaFil: Alcolea Sanchez, Alida. No especifíca;Fil: Sanchez Galán, Alba. Hospital Universitario la Paz; EspañaFil: Serradilla Rodríguez, Javier. Hospital Universitario la Paz; EspañaFil: Bueno Jimenez, Alba. Hospital Universitario la Paz; EspañaFil: Gonzalez Sacristan, Rocío. No especifíca;Fil: Stringa, Pablo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Estudios Inmunológicos y Fisiopatológicos. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Estudios Inmunológicos y Fisiopatológicos; ArgentinaFil: Papa Gobbi, Rodrigo. Hospital Universitario la Paz; EspañaFil: Lasa Lazaro, Maria. Hospital Universitario 12 de Octubre; EspañaFil: Díaz Almirón, Mariana. Hospital Universitario la Paz; EspañaFil: Ramos Boluda, Esther. No especifíca;Fil: Lopez Santamaría, Manuel. Hospital Universitario la Paz; EspañaFil: Hernández Oliveros, Francisco. Hospital Universitario la Paz; Españ

El juego de la oca

El trabajo obtuvo un premio de la Modalidad A de los Premios Tomás García Verdejo a las buenas prácticas educativas en la Comunidad Autónoma de Extremadura para el curso 2011-2012Se describe una experiencia que consisitió en organizar y llevar a cabo el juego de la oca en vivo en la localidad de Garganta de la Olla (Cáceres) y relacionado con los cuentos, la poesía, las rimas, las retahílas, los refranes y las adivinanzas.ExtremaduraES

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study (vol 46, pg 2021, 2022)

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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