Mortality in psoriasis and psoriatic arthritis: systematic review and meta-analysis

We had found contradictory results that have been reported in recent publications regarding the mortality risk of patients with psoriasis (Pso) and psoriatic arthritis (PsA). These patients have aggregated risk behaviors, which directly impacted their morbidity/mortality. We included 15 studies, with a total population of that reported mortality risk in Pso and PsA patients. We calculated crude mortality rate (CMR) of each one and pooled CMR by group and 95% confidence intervals (CI). The pooled CMR for Pso was 14/1000 (95% CI: 6-21%), 12/1000 (95% CI: 10-15%) in mild, 19/1000 (95% CI: 15-23%) in severe and 12/1000 was observed (95% CI: 10-14%) in PsA. Mortality was relatively higher in PsA patients when compared with Pso, with a RR of 1.03 (95% CI: 1.01-1.06, p<0.01). Pso was associated with increased mortality when compared to the general population. Mild Pso and PsA have the same increased mortality, then again as the severity of Pso increased, so does its mortality. The final comparative mortality between patients with PsA and those with Pso was around 3%

Tubular electrospun scaffolds tested in vivo for tissue engineering

Tissue engineering has been widely used for its great variety of functions. It has been seen as a solution to satisfy the need for vascular substitutes like small diameter vessels, veins, and nerves. One of the most used methods is electrospinning, due to the fact that it allows the use of various polymers, sizes, mandrels and it can adjust the conditions to create personalized scaffolds. For the creation of scaffolds is fundamental to understand the advantages and disadvantages of each polymer, of this, will depend the biodegradability, biocompatibility, porosity, cellular adhesion, and cell proliferation as it is essential to mimic the extracellular matrix and provide structural support for the cells. The aim of this review was to investigate which materials are being used for the creation of tubular scaffolds by electrospinning. Here we selected only in vivo evaluation to demonstrate remodeling of the grafts into native-like tissues, in vitro evaluations had been excluded from this review. We analyze the conditions like speed, distance and voltage and the modifications like growth factors and combinations of natural and synthetic polymers that allow the authors to have a functional scaffold that will suit its purpose

Endoscopic balloon dilatation in caustic-induced gastric outlet obstruction: case report

The ingestion of caustic substances is a not infrequent problem that requires multidisciplinary, medical, surgical and endoscopic management, since it can cause minor burns to total necrosis of the digestive tract wall. A 76 years old male patient with a history of chronic alcoholism presented to the emergency department complaining of heartburn and abdominal pain after ingesting muriatic acid, accidentally mistaking it for alcohol. Computed tomography (CT) scan showed no signs of perforation and endoscopy revealed grade IIIB stomach burns. On day 45 a new endoscopy was performed, documenting fibrosis scars in the antrum with significant retraction and secondary pyloric stenosis, which was managed with endoscopic balloon dilatation (EBD) without complications. In this case, as in most patients with caustic-induced gastric outlet obstruction (GOO) can be successfully treated by EBD

Effectivity of the PGA rapid Atramat® and PGA Atramat® sutures for the closure of minimal invasion and abdominal-inguinal wounds in surgery

Background: The use of suture materials for the closure of wounds is a practice described in Egyptian parchments since 3500 b.C. through the use of linen, animal hair, vegetable fiber, silk, leather and others. The election of the ideal suture material has to be based in the appropriate resistance to traction, tissue biocompatibility and resorption rates..Methods: An open longitudinal clinical trial was performed with data recollection in a prospective way, in which was calculated the incidence of complications; dehiscence, wound seroma, surgical site infection hemorrhage and abscess when PGA Atramat® and PGA rapid Atramat® was employed in laparoscopic and open surgery for treatment of inguinal and umbilical plasties.Results: During the period from January 2016 to August 2016, the procedures included: 31 laparoscopic cholecystectomies, 18 laparoscopic fundoplications, 45 laparoscopic appendicectomies, 12 abdominal plasties and 16 inguinal plasties. This series shows the null incidence of complications in 31 cholecystectomies, 18 fundoplications, 16 inguinal plasties and 12 abdominal plasties.Conclusions: The employment of the PGA Atramat® and PGA rapid Atramat® sutures maintains the features of a braided, absorbable suture, and it also results a feasible and secure resource for its use in minimal invasion surgery, abdominal and inguinal plasties, showing low incidence of surgical site infection

Transfusion related acute lung injury: a case report

Transfusion Related Acute Lung Injury (TRALI) is one of the most serious complications of blood transfusion. All blood components have been implicated and most often those that contain plasma. The diagnosis is based fundamentally on the integration of clinical, radiological and gasometry elements, once the rest of the possible causes of acute lung injury have been ruled out. The differential diagnosis of a patient who develops a sudden pattern of respiratory failure after a transfusion of blood products must include hemodynamic overload, anaphylactic reaction, bacterial contamination of transfused blood products, haemolytic transfusion reaction and TRALI. Author presented the clinical case of a 33-year-old female patient with grade III hypovolemic shock due to a ruptured ectopic pregnancy, reanimated with crystalloid solutions, globular packages and fresh frozen plasma. The patient developed TRALI for what was managed with ventilatory and hemodynamic support in ICU

Neurophysiology of learning in basic skills of laparoscopic surgery in undergraduate students

Background: The development and progress in laparoscopic surgery requires greater emphasis on surgical skills, developing skills in undergraduate students allows them to be at the forefront in health demands.Methods: An experimental and descriptive study of a group of 30 undergraduate students of the Faculty of Medicine. They attended 30 hours of theoretical and practical sessions distributed by 10 sessions, supported by basic simulators minimally invasive, being evaluated by checklist. Their brain activity was monitored with an electroencephalography before and after the development of skills.Results: It was observed that the average necessary for the acquisition of skills is 5 sessions. The competition in which further progress was observed is video assistance. There is an increase in the activity of the prefrontal cortex on the electroencephalography.Conclusions: A series of neurophysiologic processes involved in learning of laparoscopic surgery are described. Laparoscopic skills development lies in keeping them updated on the teaching-learning, where the use of simulators is growing

Clinical profile of the first 1000 fatalities for influenza A (H1N1) in Mexico

Background: Influenza is an acute respiratory disease responsible for several episodes of high mortality throughout human history. In 2009, Mexico experienced an atypical influenza outbreak caused by a mutant strain of the influenza A (H1N1) subtype, which generated significant mortality. The aim of this paper was to analyze the clinical and sociodemographic conditions of the first 1000 fatalities recorded during this outbreak.Methods: We conducted a study based on an analysis of the clinical files of patients positive for influenza A (H1N1) using Real-Time-Polymerase Chain Reaction (RT-PCR) to conduct an analysis of deaths compared to deaths in the general population.  Results: The majority of deaths occurred in patients aged 35-84 years (65.8%). Average time between symptom onset and death was 13.8 days, with an average of 7.8 days from time of hospitalization until death. Ca. 25% of deaths occurred in residents from Mexico City and from the nearby State of Mexico. In the majority of cases, we found that patients who died had a low educational and socioeconomic status along with co-morbidities such as metabolic syndrome and its individual components, as well as respiratory illnesses. In 80% of cases, patients received mechanical ventilation, and a similar percentage received antiviral therapy (oseltamivir, zanamivir).  Conclusions: The primary-care level was not utilized by patients who died from influenza. The higher prevalence of chronic degenerative diseases among deaths compared with the general population indicates that these groups of patients should be considered and prioritized in the event of future outbreaks.

Comparison of early complications using regular mesh versus Atramat® Neoflex 25 mesh in inguinal, umbilical and post incisional hernias

Background: Hernias are one of the most common reasons of primary health care with subsequent surgery and this has led to search new techniques to approach them. Comparing traditional techniques with polypropylene mesh versus one bioabsorbible mesh there has been a decrease in postoperative complications.Methods: 100 patients with inguinal hernia, umbilical and post incisional were surgically intervened and divided into two groups according to mesh material used. The patients were tracked for two months after surgery.Results: Traditional mesh was used to repair hernias in 50 patients and Atramat® Neoflex 25 mesh was used in the other half.  Two patients developed infection with traditional mesh and one patient using Atramat® Neoflex 25 mesh (p 0.558). Hernias recurred in 4 patients with traditional mesh compared with 0 patients with Atramat® Neoflex 25 mesh ( p.041 ) , seroma formation was found with a 6: 1 ratio, traditional mesh: Atramat® Neoflex 25 mesh ( p.050 ) and hematoma in a 2:1 ratio (p .558). The total of complications showed a total of 14 using traditional mesh and 3 with Atramat® Neoflex 25 mesh. The use of mesh made from absorbable materials is a better alternative to reduce chronic pain and recurrence due to its high biocompatibility.Conclusions: Using Atramat® Neoflex 25 mesh demonstrated a significant reduction of complications (recurrence and seroma formation) and length of hospital stay (2 days vs 1 day in abdominoplasty after surgery).   

Therapeutic alternatives for the prevention of intra peritoneal adhesions

Intestinal adhesions are bands of fibrous tissue created by the intimate contact of two injured surface tissues; these appear in 93% of the patient undergoing intra-abdominal or gastrointestinal surgery. The comorbidities associated with the formation of adhesions have an impact on quality care offered to patients, leading to an increase in healthcare. Goals of this study was to perform a review that includes different therapeutic alternatives in basic and clinical research to prevent the formation of postoperative abdominal peritoneal adhesions. A bibliographic search was conducted in different databases including Pub med, Medline, Cochrane, science direct, from the years 2000 to 2018 using the keywords: gastrointestinal adhesions, small bowel obstruction, prophylaxis, treatment. Only experimental and clinical articles were selected. The development of peritoneal adhesions in most of the experimental studies occurred with cecal abrasion, studying the effect of biodegradable materials, drugs and gels such as mXG Hydrogel. Nanofiber membranes, agents created with recombinant technology such as periostin antisense oligonucleotide and aerosol applications such as polysaccharide 4DryField PH, are positioned to replace in the future the actual limited mechanical barriers application commonly used in abdominal surgery such as seprafilm and interceed. There are several anti-adhesion agents in experimental phase with different mechanism of action that could be used in the short term to prevent the formation of post-surgical intestinal adhesions. The inclusion of gastrointestinal surgeons in basic research is increasing and necessary with multidisciplinary collaboration. It is expected in short term the study and development of a greater number of materials to minimize tissue trauma and decrease the formation of post-surgical adhesions

MicroRNAs in colorectal cancer

Colorectal cancer (CRC) is the third most common type of cancer worldwide, currently representing the most common gastrointestinal cancer with 13% of all malignant tumors. MicroRNAs (miRNAs) are small non-coding RNAs that repress the translation of target genes. Since their discovery, they have been shown to play an important role in the development of cancer, since they can act as tumor suppressors or oncogenes. A literature review was performed in different databases such as Medline, PubMed, Cochrane, nature, Wolters Kluwer, ScienceDirect, Scopus, SpringerLink, Wiley Online Library. Studies were included from 2003 to 2018. Colorectal cancer presents genetic heterogeneity, because it can develop in different ways, the pathway through which cancer occurs depends on the gene initially altered. The aberrant expression of microRNAs is implicated in the development of colorectal cancer and its progression. Three existing steps in the maturation of the microRNAs have been identified: 1) transcription of the pri-miRNA, 2) cleavage in the nucleus to form the pre-miRNA and 3) a final excision in the cytoplasm to form the mature microRNA. It has been discovered that miRNAs have an impact on cell proliferation, apoptosis, stress response, maintenance of stem cell potency and metabolism, all important factors in the etiology of cancer. The data analyzed in this article highlights the importance of the study of microRNAs in colorectal cancer, however, for the carcinogenic process, progression, therapeutic management and prognosis, more multicenter randomized clinical trials are needed with a detailed analysis