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%

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

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).   

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

Current perspective in the treatment of bile duct injuries

The laparoscopic cholecystectomy is considered the gold standard for the treatment of benign gallbladder disease, which is associated with an increased incidence of biliary injuries. These types of injuries are multicausal, and anatomical variations or anatomical perception errors are the most common risk factors. The objective of this study is to describe the evolution in the management of bile duct injuries and actual, diagnostic tools, incidence, prognosis and treatment. A literature research about diagnosis and treatment of iatrogenic bile duct injuries as well as their impact on the incidence of morbidity and mortality, based on a 30-year period, was performed on Medline, Cochrane, Embase, MedScape and PubMed database, for all studies that met the eligibility criteria. A thorough quality assessment of all included studies was performed. Synthesis of the results was achieved by narrative review. The bile duct injury is a complication that requires a complex therapy and multidisciplinary management. Reconstruction and treatment techniques have been evolving. The selection of adequate treatment will impact on the patient´s quality of life. The results of the existing studies reporting on iatrogenic bile duct injuries are useful; because the iatrogenic bile duct injuries are complex alterations and constitute one of the most serious complications of a cholecystectomy and require a comprehensive approach, immediate repair, proper drainage and timely referral to adequate treatment to improve long-term prognosis. According to the literature review, currently there better treatments such as absorbable prosthesis, which improve the prognosis and patient´s quality of life, and represent less risk of complications in short/long term.

Colorectal cancer: a review

Colorectal cancer (CCR) is the third most common cancer worldwide in men and women, the second largest cause of death related to cancer, and the main cause of death in gastrointestinal cancer. The risk of developing this cancer is related to bad alimentary habits, smoking, intestinal inflammatory disease, polyps, genetic factors, and aging. Of the patients that are diagnosed with colorectal cancer 90% are older than 50, with a median age of 64 years; however, the disease is more aggressive in patients that are diagnosed at younger ages. According to the American Cancer Association, it was accounted for more than 49,700 deaths in 2015. The goal is to reduce the mortality rate with early diagnosis and treatment. Currently, the survival rate is used to predict a patient’s prognosis. The patient is considered to have a positive familial history if a first-degree relative has been diagnosed with colorectal cancer or colonic polyps before the age of 60, or also if two or more first-degree relatives have been diagnosed with cancer or polyps at any age. There are several methods for detecting colorectal cancer, such as the guaiac test, immunochemical test of stool, DNA stool test, sigmoidoscopy, colonoscopy, and barium enema. The stage in which the cancer is detected determines the prognosis, survival, and treatment of the patient. Provide a review about generalities, genetic basis, risk factors, protective factors, clinical course, diagnostic methods, therapy and survival in colorectal cancer. Conducted research from different databases such as PubMed, Medline, MedScape, on the definition, genetic factors, classification, risk factors, protective factors, diagnostic methods, epidemiology, survival and treatment of colorectal cancer. Articles from 2000 to 2017 were included using the following keywords

Effectiveness of autologous lipoinjection into the hand to improve function in patients with scleroderma: pilot study

Background: Scleroderma is a rare disease of the tissues that is characterized for being inflammatory and developing fibrosis in the skin. Typically, this disease affects middle-aged women.Methods: A study was conducted in which 10 patients with scleroderma with involvement in the sclerotic stage were included. One of the hands was chosen randomly for treatment with fatty graft processed by Coleman technique and the other hand, physiological solution was placed. Patients were evaluated at 45 and 90 days after the procedure using the Cochin Hand Functional Scale (CHFS) questionnaire, modified Rodnan scale for the skin (mRSS), grip strength with dynamometer and measurement of fingertip to palm of hand in flexion.Results: The average of CHFS before treatment was 42.30 and 25.70 at 90 days p=0.007. The average strength in the experimental hand before treatment was 11.67 and 14.58 at 90 days p=0.007, in the control hand p=0.873. The mean finger-palm tip distance before treatment was 44.80 and from 36.00 to 90 days p=0.019, in the control hand p=0.149. There is a significant difference in the degree of severity at 90 days of the mRSS of the back of the hands p=0.011 and phalanges p=0.000 between the patients with lipoinjection and physiological solution.Conclusion: Significant improvement was observed in patients with scleroderma treated with autologous lipoinjection