Rendimiento diagnóstico de la relación Neutrófilos-Linfocitos en pacientes con sospecha diagnóstica de apendicitis aguda en el Hospital Escuela Carlos Roberto Huembes, Managua, Nicaragua durante el período Octubre 2018-Octubre 2020

El diagnóstico de apendicitis aguda no es simple, la clínica clásica se encuentra frecuentemente contaminada por síntomas atípicos, de manera tal que el diagnóstico correcto en la primera visita a las unidades de emergencias varía entre 50% y 70%. Con el objetivo de analizar el rendimiento diagnóstico de la relación Neutrófilos-Linfocitos en pacientes con sospecha diagnóstica de apendicitis aguda se realizó un estudio observacional, retrospectivo, transversal, correlacional de tipo pruebas diagnósticas, realizado en el Hospital Escuela “Carlos Roberto Huembes” de perfil general, ubicado en la ciudad de Managua, Nicaragua en el periodo de octubre 2018-octubre 2020, se realizo muestreo no probabilístico, por conveniencia, obteniendo 45 pacientes. Se determino una ABC (Area bajo la curva) de 0.94 comparado con la escalada de Alvarado con una ABc 0.7, con un punto de corte de 4.3 con una sensibilidad de 84.8%, especificidad 85.7%, valor predictivo positivo 97%, valor predictivo negativo 54.5%, Likelihood ratio positivo 6 y Likeliehood 0.15, por lo que a relación neutrófilo/linfocito es un marcador muy sensible con alto rendimiento diagnóstico y superior a la escala de Alvarado y consideramos oportuno incorporar la relación neutrófilo/linfocito al algoritmo diagnostico actual de la apendicitis aguda en nuestra unidad. Palabras clave: Apendicitis aguda, índice neutrófilo-linfocito, score pronóstic

La apendicectomía laparoscópica de incisión única con puerto de guante quirúrgico es rentable y fiable en la apendicitis aguda complicada: Un estudio multicéntrico de casos y controles en Colombia

Antecedentes: El abordaje laparoscópico de puerto único (SPL) y multipuerto (MPL) son el patrón oro del tratamiento de la apendicitis aguda, debido a sus múltiples ventajas sobre la cirugía abierta, principalmente por sus efectos directos sobre la recuperación, la estética y los costes del procedimiento. Sin embargo, en los países del tercer mundo, el abordaje laparoscópico aún no es totalmente reproducible debido a los costes de la técnica. La apendicectomía laparoscópica de incisión única con puerto de guante quirúrgico (SGP-SILA) se ha propuesto como una opción viable. Sin embargo, nunca ha sido estudiada en Colombia. Objetivo: Evaluar el costo-efectividad y la confiabilidad de la SGP-SILA en el manejo de la apendicitis aguda complicada, comparada con el abordaje tradicional MPL. Materiales y métodos: Se realizó un estudio retrospectivo de casos y controles comparando pacientes sometidos a apendicectomía laparoscópica por SGP-SILA vs. MPL, evaluando costos operatorios asociados a variables intraoperatorias y postoperatorias en dos centros terciarios de Bogotá, Colombia. Los datos fueron analizados y expresados según su naturaleza y distribución. Resultados: Se incluyeron 116 pacientes (SGP-SILA: 62 y MPL: 54). La mediana del tiempo quirúrgico para SGP-SILA fue de 60 min frente a 39 min para MPL. Se demostró que la SGP-SILA causaba una menor frecuencia de infección del sitio quirúrgico (4 frente a 8 pacientes; p = 0,047). Se encontró una correlación significativa entre la infección del sitio quirúrgico de grado III y el tiempo de cirugía (p = 0,047) en el grupo MPL; también, con la estancia hospitalaria (p < 0,001). Asimismo, se encontró un menor riesgo de infección del sitio quirúrgico con la técnica SGP-SILA (22% frente a 31%). La SGP-SILA generó una reducción de los costes operativos directos e indirectos de aproximadamente el 10% (616 USD frente a 683 USD). Conclusiones: La SGP-SILA y la MPL son procedimientos factibles y comparables en la resolución de la apendicitis aguda complicada. La SGP-SILA resulta ser más rentable que la MPL, debido al uso de instrumentos más fácilmente accesibles. Puede ser una técnica reproducible en países de ingresos bajos y medios.Background: The single-port (SPL) and multi-port (MPL) laparoscopic approach are the gold standard of management of acute appendicitis, due to its multiple advantages over open surgery, mainly because of its direct effects on recovery, esthetics and costs of the procedure. However, in third-world countries, the laparoscopic approach is not yet fully reproducible due to the costs of the technique. The surgical-glove port single incision laparoscopic appendectomy (SGP-SILA) has been proposed as a viable option. However, it has never been studied in Colombia. Objective: To evaluate the cost-effectiveness and reliability of SGP-SILA in the management of complicated acute appendicitis, compared to traditional MPL approach. Materials and methods: A retrospective case control study was carried out comparing patients undergoing laparoscopic appendectomy by SGP-SILA vs. MPL, evaluating operating costs asso- ciated with intraoperative and postoperative variables in two tertiary centers in Bogota, Colombia. The data were analyzed and expressed according to their nature and distribution. Results: 116 patients were included (SGP-SILA: 62 and MPL: 54). The median surgical time for SGP-SILA was 60 min vs. 39 min for MPL. SGP-SILA was shown to cause lower frequency of surgical site infection (4 vs. 8 patients; p = 0.047). It was found a significant correlation between Grade III surgical site infection and surgery time (p = 0.047) in the MPL group; also, with hospital stay (p < 0.001). Also, a lower risk of surgical site infection was found with the SGP-SILA technique (22% vs. 31%). SGP-SILA generated a reduction in both direct and indirect oper- ating costs of approximately 10% (616 USD vs. 683 USD). Conclusion: SGP-SILA and MPL are feasible and comparable procedures in the resolution of complicated acute appendicitis. SGP-SILA turns out to be more cost-effective compared to MPL, due to the use of more easily accessible instruments. This may be a reproducible technique in low- and middle-income countries

Brain Abscess and Dental Infections: A review

Odontogenic infections may cause brain abscesses. Although infrequent, infections can lead to development of aggressive brain lesions that may be life-threatening for patients. With the advent of new antibiotic treatments, dental abscesses appear to be under control but all patients with high risk of brain abscess should be assessed and treated properly. Hereby, we present an overview of the information available in the literature of the relationship between brain and dental abscesses

Surgical research in Colombia part 1 : scientific and academic productivity of the Colombian research groups in surgery

Q2Q3Introduction: Global surgery has become the undisputed starting point for addressing a myriad of problems in surgery today. Therefore, it is necessary to constantly evaluate the scientific productivity in surgery, its behavior, validity and impact. In Latin America, specifically in Colombia, there are no studies that have analyzed this production. Methods: A retrospective cross-sectional bibliometric study was carried out, in which the Colombian Ministry of Science database was consulted with the validated results up to July 2021. In the search section for research groups, the key word “Surgery” was used, and all associated GrupLAC (platform where the information of the research groups can be found) and their registered products were reviewed. Results: 40 groups were included. Only 5 (12.5%) were registered in surgery as main line of research. The great majority of the groups were in the medium-low category, 50% in category C and 22.5% in category B. The vast majority of surgical groups are located in Bogotá (19; 47.5%). The first surgery group in the country was created in 1994 and the last one in 2017. In 27 years of surgical research, a total of 4121 registered scientific articles were found, 83 books, 713 book chapters, 2891 products associated with participation in scientific events, 1221 theses directed, and 1670 projects in colombian surgical research groups. There was evidence of a high rate of underreporting of data, due to duplication of products and incomplete registration of data. Conclusions: There is a high rate of underreporting of products and data in the GrupLAC of Colombian surgical research groups. Most of the production is located in the Andes region (Antioquia, Valle del Cauca and Bogotá), and is predominantly composed of scientific articles and products associated with participation in scientific events.https://orcid.org/0000-0002-5392-7083Revista Internacional - IndexadaBN

Novel Textbook Outcomes following emergency laparotomy: Delphi exercise

Background: Textbook outcomes are composite outcome measures that reflect the ideal overall experience for patients. There are many of these in the elective surgery literature but no textbook outcomes have been proposed for patients following emergency laparotomy. The aim was to achieve international consensus amongst experts and patients for the best Textbook Outcomes for non-trauma and trauma emergency laparotomy. Methods: A modified Delphi exercise was undertaken with three planned rounds to achieve consensus regarding the best Textbook Outcomes based on the category, number and importance (Likert scale of 1–5) of individual outcome measures. There were separate questions for non-trauma and trauma. A patient engagement exercise was undertaken after round 2 to inform the final round. Results: A total of 337 participants from 53 countries participated in all three rounds of the exercise. The final Textbook Outcomes were divided into ‘early’ and ‘longer-term’. For non-trauma patients the proposed early Textbook Outcome was ‘Discharged from hospital without serious postoperative complications (Clavien–Dindo ≥ grade III; including intra-abdominal sepsis, organ failure, unplanned re-operation or death). For trauma patients it was ‘Discharged from hospital without unexpected transfusion after haemostasis, and no serious postoperative complications (adapted Clavien–Dindo for trauma ≥ grade III; including intra-abdominal sepsis, organ failure, unplanned re-operation on or death)’. The longer-term Textbook Outcome for both non-trauma and trauma was ‘Achieved the early Textbook Outcome, and restoration of baseline quality of life at 1 year’. Conclusion: Early and longer-term Textbook Outcomes have been agreed by an international consensus of experts for non-trauma and trauma emergency laparotomy. These now require clinical validation with patient data

Novel Textbook Outcomes following emergency laparotomy:Delphi exercise

Background: Textbook outcomes are composite outcome measures that reflect the ideal overall experience for patients. There are many of these in the elective surgery literature but no textbook outcomes have been proposed for patients following emergency laparotomy. The aim was to achieve international consensus amongst experts and patients for the best Textbook Outcomes for non-trauma and trauma emergency laparotomy. Methods: A modified Delphi exercise was undertaken with three planned rounds to achieve consensus regarding the best Textbook Outcomes based on the category, number and importance (Likert scale of 1–5) of individual outcome measures. There were separate questions for non-trauma and trauma. A patient engagement exercise was undertaken after round 2 to inform the final round. Results: A total of 337 participants from 53 countries participated in all three rounds of the exercise. The final Textbook Outcomes were divided into ‘early’ and ‘longer-term’. For non-trauma patients the proposed early Textbook Outcome was ‘Discharged from hospital without serious postoperative complications (Clavien–Dindo ≥ grade III; including intra-abdominal sepsis, organ failure, unplanned re-operation or death). For trauma patients it was ‘Discharged from hospital without unexpected transfusion after haemostasis, and no serious postoperative complications (adapted Clavien–Dindo for trauma ≥ grade III; including intra-abdominal sepsis, organ failure, unplanned re-operation on or death)’. The longer-term Textbook Outcome for both non-trauma and trauma was ‘Achieved the early Textbook Outcome, and restoration of baseline quality of life at 1 year’. Conclusion: Early and longer-term Textbook Outcomes have been agreed by an international consensus of experts for non-trauma and trauma emergency laparotomy. These now require clinical validation with patient data.</p

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries