Valoración clínica, neurofisiológica y ultrasonográfica del tratamiento con láser de baja potencia en pacientes con síndrome del túnel del carpo en el Hospital Nacional Edgardo Rebagliati Martins, durante el periodo de agosto noviembre del 2013

Evalúa la respuesta clínica al tratamiento y cambios neurofisiológicos y ultrasonográficos en pacientes con síndrome del túnel del carpo tratados con laserterapia de baja potencia. Se realizó una correlación clínico - electromiográfica - ecográfica de 30 pacientes del Departamento de Medicina Física y Rehabilitación del Hospital Nacional Edgardo Rebagliati Martins pre y pos tratamiento de laserterapia de baja potencia (20 sesiones). De los 30 pacientes estudiados, el 90% eran del sexo femenino, el promedio de edad fue de 59 años, 47% realizaba trabajo amas de casa. El 100% tenían la mano dominante la derecha. 93% tuvo un tiempo de enfermedad de 4 a 6 meses. En relación a la valoración clínica posterior al tratamiento de laserterapia se observó mejoría: dolor (De 5.3 a 1.6 según EVA), parestesias (3 pacientes de 30), fuerza de prensión (De 3.2 a 4.2), Phalen (De 30 a 3) y Tinel (De 24 a 3). Hubo correlación entre los diagnostico ecográficos y electromiográficos, no se encontró cambios significativos de los mismos posteriores al tratamiento de laserterapia. Se concluye que las amas de casa son un grupo de riesgo. Se observó mejoría clínica con el tratamiento de láser de baja potencia. No se observaron cambios ecográficos y electromiográficos posterior a tratamiento de láser.Trabajo académic

Tele-rehabilitación cardiaca en tiempos de pandemia. Experiencia en el Instituto Nacional Cardiovascular-INCOR

Objective. Cardiac Rehabilitation (CR) programs based on telehealth are an alternative in the context of a pandemic and represent an opportunity to continue in the intervention of cardiovascular diseases (CVD). The present study aims to evaluate the effect of a Cardiac Tele-Rehabilitation (CTR) program on quality of life, anxiety/depression index, exercise safety and Level Of disease awareness in patients discharged from a national referral institute in times of pandemic. Methods. A pre-experimental study in cardiac patients who entered the cardiac rehabilitation program at INCOR from August to December 2020. The study included low-risk patients who were administered a questionnaire (on cardiovascular disease, exercise safety, anxiety/depression, and quality of life) at the beginning and end of the program, which was applied through a virtual platform. Descriptive and comparative before-after analysis was used through hypothesis testing. Results. Sixty-four patients were included (71.9% male). The mean age was 63.6 ±11.1 years. Regarding exercise safety, an increase in the mean score was found after the application of the program (3.06 ± 0.8 to 3.18 ± 0.7, p=0.324). Concerning anxiety, the mean score was reduced from 8.61 to 4.75, while for depression, the reduction was from 7.27 to 2.92. Regarding the quality-of-life score, the global component improved from 111.48 to 127.92. Conclusions. The CTR program implemented through a virtual platform during the COVID-19 pandemic enhanced quality of life and decreased stress and depression in cardiac patients discharged from a national cardiovascular referral center.Objetivo. Los programas de rehabilitación cardiaca (RC) basados en telesalud son una alternativa en el contexto de pandemia y representa una oportunidad para continuar en la intervención de las enfermedades cardiovasculares (ECV). El presente estudio pretende evaluar el efecto de un programa de telerrehabilitación cardiaca (TRC) en la calidad de vida, índice de ansiedad/depresión, seguridad del ejercicio y nivel de conocimiento de la enfermedad en pacientes dados de alta de un instituto de referencia nacional en tiempos de pandemia. Metodología. Estudio pre-experimental en pacientes cardiópatas que ingresaron al programa de rehabilitación cardíaca en el INCOR durante agosto a diciembre del 2020. Se incluyó pacientes de bajo riesgo en quienes se aplicó un cuestionario (sobre enfermedades cardiovasculares, seguridad del ejercicio, ansiedad/depresión y calidad de vida) al inicio y al finalizar el programa, el cual fue aplicado a través de una plataforma virtual. Se utilizó análisis descriptivo y comparativo antes-después a través de pruebas de hipótesis. Resultados. Se incluyeron 64 pacientes (71,9% varones). La edad promedio fue 63,6 ±11,1 años, En cuanto a la seguridad del ejercicio, se encontró un incremento en la media de la puntuación tras la aplicación del programa (3,06 ± 0,8 a 3,18 ± 0,7, p=0,324). En relación con la ansiedad, la media del puntaje se redujo de 8,61 a 4,75, mientras que para la depresión la reducción fue de 7,27 a 2,92. En cuanto al puntaje de calidad de vida, el componente global mejoró de 111,48 a 127,92. Conclusiones. El programa de TRC implementado a través de una plataforma virtual durante la pandemia de la COVID-19 mejoró la calidad de vida, disminuyó el estrés y la depresión en pacientes cardiópatas dados de alta de un centro de referencia nacional cardiovascular

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AimThe SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.MethodsThis was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.ResultsOverall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P ConclusionOne in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery