Cirugia y cirujanos最新文献

Objetivo: Comparar el funcionamiento de la memoria episódica y la memoria autopercibida, y su asociación con síntomas emocionales, en personas de 60 años y mayores de 70 años durante la pandemia de COVID-19.

Método: Estudio trasversal, descriptivo, correlacional, realizado a distancia. Se obtuvieron las características sociodemográficas, de funcionamiento y autopercepción de la memoria y de la salud mental de 100 adultos mayores distribuidos en tres grupos de edad. Se realizó análisis descriptivo, con pruebas χ2, Kruskal-Wallis y ANOVA, así como coeficiente de correlación de Spearman.

Resultados: Se encontró asociación entre la edad y el nivel de desempeño global de la memoria episódica. Los tres grupos mostraron una correlación inversa entre la autopercepción del funcionamiento de la memoria y la autopercepción de la memoria como problemática. Los síntomas de depresión se correlacionaron con la autopercepción de la memoria en los tres grupos. Además, la depresión y la ansiedad rasgo presentaron más correlaciones con la memoria episódica en los más longevos.

Conclusiones: Los síntomas emocionales durante la pandemia afectaron la autopercepción de la memoria y se relacionaron con el rendimiento de la memoria episódica en el grupo más longevo.

Objective: To compare the functioning of episodic memory, self-perceived memory, and their association with emotional symptoms among people aged 60 and those over 70 during the COVID-19 pandemic.

Method: Cross-sectional, descriptive, correlational study conducted remotely. Sociodemographic characteristics, self-perception and functioning of memory, and mental health data were collected from 100 older adults grouped into three age categories. Descriptive analysis, hypothesis testing χ2 tests, Kruskal Wallis, ANOVA, and Spearman’s correlation coefficient were performed.

Results: An association was found between age and overall level of episodic memory performance. All three groups exhibited an inverse correlation between self-perception of memory functioning and self-perception of memory as problematic. Depression symptoms correlated with self-perception memory in all three groups. Additionally, depression and trait anxiety showed more correlations with episodic memory in the older age group.

Conclusions: Emotional symptoms during the pandemic affected self-perceived memory and were related to episodic memory performance in the oldest group.

Objective: This study aimed to evaluate the impact of varying altitude levels on anesthetic parameters in pregnant women undergoing cesarean sections under neuraxial anesthesia.

Method: Conducted at three different altitudes: sea level (0-10 m, Giresun-Group G), moderate altitude (810 m, Çorum-Group Ç), and high altitude (1725 m, Van-Group V), this study included 98 patients undergoing elective cesarean sections. All were administered the same anesthetic protocol. We assessed anesthetic characteristics and hemodynamic parameters.

Results: Patients at sea level showed a significantly lower upper sensory block limit than those at higher altitudes (p < 0.01). The time to reach each Modified Bromage scale level varied, with the shortest at moderate altitudes and longest at high altitudes, particularly noted at the third scale level (p < 0.01). Group G had a significantly higher cerebrospinal fluid pH (p < 0.01). Although sensory block duration differences were not significant, motor block duration was notably longer at moderate altitude (p < 0.01).

Conclusions: Minimal effect on spinal anesthetic block times was observed due to the close proximity of the altitude levels studied. Future research should include higher altitudes and more patients to determine the effect of altitude on anesthetic efficacy and safety.

Objectives: Detection of peritoneal metastasis in gastric cancer is still not successful enough despite all the tests performed. In this study, the success of five well-known and commonly used tumor markers in detecting peritoneal metastasis was investigated.

Method: A total of 361 patients with 61 peritoneal metastases and 25 distant organ metastasis were included in the study. The relationship between tumor markers and peritoneal metastases was investigated.

Results: There was a statistically significant correlation between carbohydrate antigen (CA) 125 and the presence of peritoneal metastasis in gastric cancer (p < 0.001). CA 125 values > 22.75 U/mL were significantly associated with peritoneal metastasis (Area under the curve: 0.771, Sensitivity: 73.5%, Specificity: 77.7%, 95% confidence interval: 0.667-0.875). No correlation was found between the presence of peritoneal metastasis and carcinoembryonic antigen, CA 19-9, CA 15-3, and α-fetoprotein levels (p = 0.197, p = 0.087, p = 0.497, p = 0.128, respectively).

Conclusion: CA 125 is an effective, non-invasive, easily accessible marker for predicting peritoneal metastasis. At levels > 22.75 U/mL, the risk of peritoneal metastasis in gastric cancer can be predicted.

Objective: This study aims to determine the efficacy and safety of a fixed combination of hydroxychloroquine (HCQ) + azithromycin (AZT) compared to HCQ alone or placebo in mild COVID-19 to avoid hospitalization.

Method: This is a randomized, double-blind clinical trial that included participants with mild COVID-19. They were randomly assigned to one of the three treatment arms: (1) HCQ + AZT 200 mg/250 mg every 12 h for 5 days followed by HCQ 200 mg every 12 h for 5 days; (2) HCQ 200 mg every 12 h for 10 days; or (3) placebo every 12 h for 10 days.

Results: A total of 92 participants were included. The incidence of hospitalization was 6.7% (2/30) in the HCQ + AZT group compared to the HCQ or placebo groups, in which there were no hospitalizations. Progression of disease was higher in the HCQ group (relative risk [RR] = 3.25 [95% confidence interval [CI], 1.19-8.87]) compared with the placebo group. There was a significant risk of pneumonia in the HCQ group compared with the placebo group (RR = 3.33 [95% CI, 1.01-10.9]). No lengthening of the QT interval prolongation was observed in patients receiving HCQ + AZT or HCQ.

Conclusions: The use of HCQ + AZT does not decrease the risk of hospitalization. The use of HCQ increases the risk of progression and pneumonia.

Objective: Colectomy is a standard surgical technique for colon cancer, but the prognostic indexes are limited. We aimed to evaluate clinicopathology of colectomies under emergency and elective conditions due to colon cancer, and correlate prognostic indexes with these outcomes collected before and during COVID-19 pandemic.

Method: Clinicopathological and laboratory findings of 250 patients underwent colectomies under elective and emergency conditions for left and right colon cancer between 2017 and 2021 were retrospectively analyzed. Prognostic markers, including Clavien-Dindo Classification (CDC), Frailty index (FI), hemoglobin, albumin, lymphocyte, and platelet (HALP) score, and Charlson Comorbidity Index (CCI) were used.

Results: CDC Grade 2 was the most common grade in both periods for all patients (p = 0.014) and for elective cases (p = 0.006), but not FI and HALP scores. Frequency of perineural invasion was significantly higher during COVID-19 among elective cases (19.8% vs. 40.6%; p = 0.032). Increase in CDC (OR: 0.123; 95%CI: 0.331-1.393; p = 0.007) and in CCI (OR: 0.067; 95% CI: 0.147-1.158; p = 0.028) primarily affected mortality rate during pandemic.

Conclusions: Our analyses revealed short-term influences of COVID-19 pandemic on patients' surgical care of the colon cancer patients. The operative management of comorbidities, CDC for complications, and CCI for comorbidities might be helpful tools to identify post-operative mortality of colectomies.

Objective: The present study aimed to investigate the effects of oleanolic acid (OA) on I/R injury in a rat groin flap model.

Method: 21 male Wistar albino rats were randomly divided into three groups (n = 7): Group I (sham), Group II (I/R), and Group III (OA+I/R). OA was administered intraperitoneally for five pre-operative days. Flap elevation was performed on the 6th day, and the subjects were exposed to 2 h of ischemia followed by reperfusion. Biochemical and histopathological parameters were evaluated.

Results: Group 3 presented a significantly diminished mean total oxidant stress relative to Group 2 (p = 0.002). Furthermore, a significant increase in total antioxidant capacity levels was observed in Group 3 compared to Group 2 (p = 0.048). There was no statistically significant difference between the groups in terms of inflammation and edema (p > 0.05). Necrosis did not develop in any of the samples.

Conclusion: This study revealed that OA significantly reduces oxidative stress and increases antioxidant capacity, potentially benefiting therapies for I/R injuries.

Objetivo: Conocer la concordancia entre imagen y patología de biopsias realizadas a lesiones mamarias.

Método: Estudio retrospectivo y comparativo en tres centros especializados en salud femenina (A, B y C). Se incluyeron pacientes con estudios de imagen sospechosos sometidas a biopsia entre enero de 2019 y julio de 2024. Se utilizó estadística descriptiva e inferencial, aplicando el coeficiente kappa de Cohen para evaluar la concordancia entre imagen y patología.

Resultados: Se incluyeron 434 pacientes (248 en A, 85 en B y 101 en C). La concordancia global fue del 43%, con variaciones por institución: A 39%, B 62% y C 19%. La edad media fue de 34 años. El centro B destacó por uso de hormonoterapia (22%; p = 0.001). El centro C reportó menor escolaridad (4% analfabetismo) y el A mayor pobreza (88%). La biopsia escisional prevaleció en el centro C (73%).

Conclusiones: La baja concordancia entre imagen y patología refleja disparidades institucionales. Se requiere mayor entrenamiento médico para optimizar la indicación y el análisis de biopsias mamarias.

Objective: To assess the concordance between imaging findings and pathology results from biopsied breast lesions.

Method: A retrospective, comparative study was conducted at three women’s health centers (A, B, and C). The study included patients with suspicious imaging findings who underwent breast biopsy between January 2019 and July 2024. Descriptive and inferential statistics were applied, and Cohen’s kappa coefficient was used to evaluate imaging-pathology concordance.

Results: A total of 434 patients were included (248 from A, 85 from B, and 101 from C). Overall concordance between imaging and pathology was 43%, with institutional variations: 39% at A, 62% at B, and 19% at C. The mean patient age was 34 years. Center B had the highest use of hormone therapy (22%; p = 0.001). Center A reported the lowest educational level (4% illiteracy), while A had the highest rate of poverty among its patients (88%). Excisional biopsy was the predominant technique at center C (73%).

Conclusions: The low imaging-pathology concordance observed reflects significant institutional disparities. These findings highlight the need for improved medical training to enhance the appropriate indication and interpretation of breast biopsies.

Objetivo: Determinar los cambios en el parámetro de atenuación controlada (CAP, controlled attenuation parameter) en pacientes sometidas a cirugía bariátrica.

Método: Se revisaron e incluyeron los expedientes de pacientes con obesidad a las que se realizó la medición del CAP mediante elastografía previo a la cirugía bariátrica y 6 meses después de esta. Se analizó la normalidad de los datos y se compararon con la prueba t de Student pareada o con la prueba de Wilcoxon; para la asociación del grado de esteatosis pre- y posquirúrgico se utilizó la prueba de χ2. Se consideró estadísticamente significativo un valor de p < 0.05.

Resultados: Se incluyeron 33 mujeres con una edad media de 45.76 años ± 10.1 años, de las cuales 17 fueron tratadas mediante bypass gástrico y 16 con manga gástrica. Se observó una reducción de 11 kg/m2 (10-12,5 kg/m2). Los niveles de CAP preoperatorios fueron de 282 ± 52 dB/m, y a los 6 meses de la cirugía bariátrica fueron de 238 ± dB/m (p = 0.0006). El grado de esteatosis se redujo en 20 pacientes (60.7%), no cambió en 9 (27.3%) y aumentó en 4 (12%).

Conclusiones: Se demostró que la cirugía bariátrica tiene un impacto positivo en la disminución de los niveles de CAP en pacientes con obesidad y enfermedad hepática esteatótica asociada a disfunción metabólica.

Objective: To determine the changes in controlled attenuation parameter (CAP) levels in patients undergoing bariatric surgery.

Method: The records of patients with obesity who underwent CAP measurement using the elastography prior to bariatric surgery and 6 months after it were reviewed and included. The normality of the data was analyzed and compared with the paired Student’s t test or Wilcoxon test. The association of the degree of pre- and postsurgical steatosis was analyzed using the χ2 test, considering p < 0.05 a statistically significant value.

Results: 33 female patients with a mean age of 45.76 years ± 10.1 years were included, 17 were treated by gastric bypass and 16 with gastric sleeve. A reduction of 11 kg/m2 (10-12.5 kg/m2) was observed. The preoperative CAP levels were 282 ± 52 dB/m, and 6 months after bariatric surgery were 238 ± dB/m (p = 0.0006). The degree of steatosis decreased in 20 patients (60.7%), unchanged in 9 (27.3%) and increasing in 4 (12%).

Conclusions: Bariatric surgery was shown to have a positive impact on reducing CAP levels in patients with obesity and metabolic dysfunction associated steatotic liver disease.