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[ABSTRACT]. The World Health Organization Global Hearts initiative (HEARTS) and technical package aim to improve the primary health care management of hypertension and other risk factors for cardiovascular disease at the population level. This study describes the first HEARTS implementation pilot project in Guatemala’s Ministry of Health (MOH) primary health care system. This pilot began in April 2022 in six primary health care facilities in three rural indigenous municipalities. The project consisted of HEARTS-aligned strategies adapted to enhance program sustainability in Guatemala. Outcomes were defined using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. The primary reach outcome was treatment count, defined as the absolute number of patients per month receiving medication treatment for hypertension. The primary effectiveness outcomes were mean systolic blood pressure (BP), mean diastolic BP, and proportion of patients with BP control (<130/80 mmHg). In the first month of the post-implementation period, there was a statistically significant increase of 25 patients treated per month above the baseline of 20 to 25 patients (P = .002), followed by a significant increase of 2.4 additional patients treated each month (P = .005) thereafter. The mean change in systolic BP was −4.4 (95% CI, −8.2 to −0.5; P = 0.028) mmHg, and the mean change in diastolic BP was −0.9 (95% CI, −2.8 to 1.1; P = .376) mmHg. The proportion of the cohort with BP control increased from 33.4% at baseline to 47.1% at 6 months (adjusted change, 13.7%; 95% CI, 2.2% to 25.2%; P = .027). These findings support the feasibility of implementing the HEARTS model for BP control throughout the MOH primary health care system, which is where most Guatemalans with hypertension seek care.

[RESUMEN]. El paquete técnico de la Iniciativa Global Hearts ("HEARTS") de la Organización Mundial de la Salud tiene como objetivo mejorar el control de la hipertensión y de otros factores de riesgo de enfermedades cardiovasculares a nivel poblacional en el ámbito de la atención primaria de salud de salud. Este estudio describe el primer proyecto piloto de implementación de HEARTS en el sistema de atención primaria de salud del Ministerio de Salud de Guatemala. El proyecto, que comenzó en abril del 2022 en seis centros de atención primaria de salud pertenecientes a tres municipios rurales indígenas, consistió en estrategias alineadas con HEARTS y adaptadas para mejorar la sostenibilidad del programa en Guatemala. Los criterios de valoración de los resultados se definieron mediante el marco estandarizado de evaluación de cobertura, efectividad, adopción, implementación y mantenimiento (RE-AIM, por su sigla en inglés). El criterio principal de la cobertura fue la cantidad de tratamientos, definida como el número absoluto de pacientes por mes que recibían tratamiento farmacológico para la hipertensión. Los criterios principales de la efectividad fueron la media de presión arterial (PA) sistólica, la media de PA diastólica y la proporción de pacientes con un control de la PA (<130/80 mmHg). En el primer mes del período posterior a la implementación, se registró un aumento estadísticamente significativo de 25 pacientes tratados al mes por encima del valor inicial de 20 a 25 pacientes (n = 25; p = 0,002), seguido de un aumento significativo de 2,4 pacientes adicionales tratados al mes (p = 0,005) posteriormente. El cambio en la media de la PA sistólica fue de -4,4 (IC del 95%: -8,2 a -0,5); p = 0,028) mmHg, en tanto que el cambio en la media de la PA diastólica fue de -0,9 (IC del 95%, -2,8 a 1,1); p = 0,376) mmHg. La proporción de la cohorte con control de la PA aumentó del 33,4% al inicio al 47,1% a los seis meses (cambio ajustado, 13,7%; IC del 95%, 2,2% a 25,2%; p = 0,027). Estos resultados respaldan la viabilidad de la implementación del modelo HEARTS para el control de la PA en la totalidad del sistema de atención primaria de salud del Ministerio de Salud de Guatemala, al que acude en busca de atención la mayoría de las personas con hipertensión.

[RESUMO]. O pacote de medidas técnicas da iniciativa Global Hearts (“HEARTS”) da Organização Mundial da Saúde tem como objetivo melhorar o controle da hipertensão arterial e de outros fatores de risco para doenças cardiovasculares na atenção primária à saúde em nível populacional. Este estudo descreve o primeiro projeto-piloto de implementação da iniciativa HEARTS no sistema de atenção primária à saúde do Ministério da Saúde da Guatemala. O projeto-piloto começou em abril de 2022 em seis estabelecimentos de atenção primária à saúde em três municípios indígenas rurais. O projeto consistiu em estratégias alinhadas à iniciativa HEARTS e adaptadas para melhorar a sustentabilidade do programa na Guatemala. Os desfechos foram definidos usando a estrutura de avaliação RE-AIM (sigla em inglês para alcance, efetividade, adoção, implementação e manutenção). O desfecho primário de alcance foi a quantidade de tratamentos, definida como o número absoluto de pacientes por mês que receberam tratamento medicamentoso para hipertensão. Os desfechos primários de efetividade foram pressão arterial (PA) sistólica média, PA diastólica média e proporção de pacientes com controle da PA (<130/80 mmHg). No primeiro mês do período pós-implementação, houve um aumento estatisticamente significante de 25 pacientes tratados por mês acima da linha de base de 20 a 25 pacientes (n = 25; P = 0,002), seguido de um aumento significante de 2,4 pacientes adicionais tratados a cada mês (P = 0,005) depois disso. A mudança média na PA sistólica foi de −4,4 (intervalo de confiança [IC] de 95%: −8,2 a −0,5; P = 0,028) mmHg, e a mudança média na PA diastólica foi de −0,9 (IC de 95%: −2,8 a 1,1; P = 0,376) mmHg. A proporção da coorte com controle da PA aumentou de 33,4% na linha de base para 47,1% após 6 meses (mudança ajustada, 13,7%; IC de 95%: 2,2% a 25,2%; P = 0,027). Esses achados apoiam a viabilidade da implementação do modelo HEARTS para o controle da PA em todo o sistema de atenção primária à saúde do Ministério da Saúde da Guatemala, no qual a maioria dos indivíduos com hipertensão arterial procura atendimento.

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BACKGROUND: The HEARTS technical package was developed by the World Health Organization to address the implementation gap in cardiovascular disease prevention in low- and middle-income countries. Guatemala is a middle-income country that is currently implementing HEARTS. National authorities in Guatemala are interested in exploring how hypertension and diabetes management can be integrated in HEARTS implementation. The objective of this study is to conduct a feasibility and acceptability pilot trial of integrated hypertension and diabetes management based on HEARTS in the publicly funded primary care system in Guatemala. METHODS: A single-arm pilot trial for 6 months will be carried out in 11 Ministry of Health primary care facilities starting in September 2023. A planned sample of 100 adult patients diagnosed with diabetes (n = 45), hypertension (n = 45), or both (n = 10) will be enrolled. The intervention will consist of HEARTS-aligned components: Training health workers on healthy-lifestyle counseling and evidence-based treatment protocols, strengthening access to medications and diagnostics, training on risk-based cardiovascular disease management, team-based care and task sharing, and systems monitoring and feedback, including implementation of a facility-based electronic monitoring tool at the individual level. Co-primary outcomes of feasibility and acceptability will be assessed using an explanatory sequential mixed-methods design. Secondary outcomes include clinical effectiveness (treatment with medication, glycemic control, and blood pressure control), key implementation outcomes (adoption, fidelity, usability, and sustainability), and patient-reported outcome measures (diabetes distress, disability, and treatment burden). Using an implementation mapping approach, a Technical Advisory Committee will develop implementation strategies for subsequent scale-up planning. DISCUSSION: This trial will produce evidence on implementing HEARTS-aligned hypertension and diabetes care in the MOH primary care system in Guatemala. Results also will inform future HEARTS projects in Guatemala and other low- and middle-income countries. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT06080451. The trial was prospectively registered on October 12, 2023.

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The objective of this research was to investigate the diagnostic accuracy of post-mortem ultrasound in antral follicle count (AFC) determination and compare it with visual AFC in grazing crossbred Holstein cows, at high altitude in Ecuador. Pre-mortem blood from 80 cows was collected, and AFC and ovarian characteristics were analysed post-mortem by ultrasound and visual techniques. AFC counts were stratified as high, medium or low by terciles. Mean AMH concentration in pre-mortem blood was 280.1 ± 15.53 pg/mL. The AFC obtained by visual inspection (26.9 ± 9.49 follicles) was 23.8% higher than by ultrasound (20.5 ± 7.53 follicles) in all ovaries. Body condition score, age and weight of the cattle did not interact with the count technique. In the low AFC group, visual inspection and ultrasound provided similar AFC results. However, in the Medium- and High-AFC groups, AFC by ultrasound was 14.9% lower than AFC by visual inspection. We confirm that ultrasound can be used with great accuracy for AFC >3 mm (close to the resolution limit) in grazing crossbred Holstein cows at high altitude.

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Quinoline has been proposed as a privileged molecular framework in medicinal chemistry. Although by itself it has very few applications, its derivatives have diverse biological activities. In this work, 8536 quinoline derivatives, strategically designed using the CADMA-Chem protocol, are presented. This large chemical space was sampled, analyzed and reduced using selection and elimination scores that combine their properties of bioavailability, toxicity and manufacturability. After applying several filters, 25 derivatives were selected to investigate their acid-base, antioxidant and neuroprotective properties. The antioxidant activity was predicted based on the ionization potential and bond dissociation energies, parameters directly related to the transfer of hydrogen atoms and of a single electron, respectively. These two mechanisms are typically involved in the radical scavenging processes. The antioxidant efficiency was compared with reference compounds, and the most promising antioxidants were found to be more efficient than Trolox but less efficient than ascorbate. In addition, based on molecular docking simulations, some derivatives are expected to act as inhibitors of catechol-O methyltransferase (COMT), acetylcholinesterase (AChE) and monoamine oxidase type B (MAO-B) enzymes. Some structural insights about the compounds were found to enhance or decrease the neuroprotection activity. Based on the results, four quinoline derivatives are proposed as candidates to act as multifunctional antioxidants against Alzheimer's (AD) and Parkinson's (PD) diseases.

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Ferulic acid has numerous beneficial effects on human health, which are frequently attributed to its antioxidant behavior. In this report, many of them are reviewed, and 185 new ferulic acid derivatives are computationally designed using the CADMA-Chem protocol. Consequently, their chemical space was sampled and evaluated. To that purpose, selection and elimination scores were used, which are built from a set of descriptors accounting for ADME properties, toxicity, and synthetic accessibility. After the first screening, 12 derivatives were selected and further investigated. Their potential role as antioxidants was predicted from reactivity indexes directly related to the formal hydrogen atom transfer and the single electron transfer mechanisms. The best performing molecules were identified by comparisons with the parent molecule and two references: Trolox and α-tocopherol. Their potential as polygenic neuroprotectors was investigated through the interactions with enzymes directly related to the etiologies of Parkinson's and Alzheimer's diseases. These enzymes are acetylcholinesterase, catechol-O-methyltransferase, and monoamine oxidase B. Based on the obtained results, the most promising candidates (FA-26, FA-118, and FA-138) are proposed as multifunctional antioxidants with potential neuroprotective effects. The findings derived from this investigation are encouraging and might promote further investigations on these molecules.

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A computational protocol aimed to design new antioxidants with versatile behavior is presented. It is called Computer-Assisted Design of Multifunctional Antioxidants and is based on chemical properties (CADMA-Chem). The desired multi-functionality consists of in different methods of antioxidant protection combined with neuroprotection, although the protocol can also be used to pursue other health benefits. The dM38 melatonin derivative is used as a study case to illustrate the protocol in detail. This was found to be a highly promising candidate for the treatment of neurodegeneration, in particular Parkinson's and Alzheimer's diseases. This also has the desired properties of an oral-drug, which is significantly better than Trolox for scavenging free radicals, and has chelates redox metals, prevents the ●OH production, via Fenton-like reactions, repairs oxidative damage in biomolecules (lipids, proteins, and DNA), and acts as a polygenic neuroprotector by inhibiting catechol-O-methyl transferase (COMT), acetylcholinesterase (AChE) and monoamine oxidase B (MAOB). To the best of our best knowledge, CADMA-Chem is currently the only protocol that simultaneously involves the analyses of drug-like behavior, toxicity, manufacturability, versatile antioxidant protection, and receptor-ligand binding affinities. It is expected to provide a starting point that helps to accelerate the discovery of oral drugs with the potential to prevent, or slow down, multifactorial human health disorders.

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Seawater treated with lime and sodium carbonate in different proportions to reduce magnesium and calcium contents is used in flocculation and sedimentation tests of artificial quartz and kaolin tailings. Solid complexes were separated from water by vacuum filtration, and factors such as lime/sodium carbonate ratio, kaolin content, flocculation time, and flocculant dose are evaluated. The growth of the aggregates was captured in situ by a focused beam reflectance measurement (FBRM) probe. Solid magnesium and calcium complexes are formed in raw seawater at pH 11, impairing the performance of flocculant polymers based on polyacrylamides. The results show that the settling rate improved when the treatment's lime/sodium carbonate ratio increased. That is, when a greater removal of magnesium is prioritized over calcium. The amount of magnesium required to be removed depends on the mineralogy of the system: more clay will require more significant removal of magnesium. These results respond to the structural changes of the flocs, achieving that the more magnesium is removed, the greater the size and density of the aggregates. In contrast, calcium removal does not significantly influence flocculant performance. The study suggests the necessary conditions for each type of tailing to maximize water recovery, contributing to the effective closure of the water cycle in processes that use seawater with magnesium control.

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Three experiments were conducted to determine influence of the bovine corpus luteum (CL) on morphometric and functional characteristics of oocytes, and subsequent embryonic development. Cumulus-oocyte complexes were aspirated from two types of cows: 1) with a CL in one ovary (CL+) and without a CL in the contralateral ovary (CL-), 2) and from cows without CL in either ovary (C). Intracellular activity of the enzyme glucose-6-phosphate dehydrogenase (G6PDH), oocyte diameter and thickness of the zona pellucida were determined (Experiment 1). Then, the rate of in vitro oocyte maturation for each ovarian category was evaluated and oocyte diameter and zona pellucida thickness were measured after maturation (Experiment 2). In Experiment 3, in vitro embryo production and cryotolerance were assessed. The oocyte diameter was greater (P < 0.01) and the zona pellucida was thinner in CL+ than in CL- (P > 0.05) or C (P = 0.0131) ovaries. Activity of G6PDH was lower in oocytes from CL+ than CL- (P < 0.01) and C (P = 0.0148) ovaries. Rate of oocyte maturation, oocyte diameter and thickness of the zona pellucida after maturation did not differ among groups. Rate of cleavage was greater in zygotes from CL+ than from CL- or C (P < 0.01); and CL+ ovaries produced more total embryos on day 7 (P < 0.05) and more blastocysts (P < 0.01) than CL- and C ovaries. Rate of expansion and hatching of day-7 vitrified-warmed blastocysts at 24 and 48 h of culture did not differ among groups. In conclusion, oocytes collected from CL+ ovaries were larger and metabolically more prepared to continue maturation than those from ovaries lacking a CL. Also, rates of cleavage and yield of blastocysts were greater for oocytes from CL+ ovaries than from CL- and C ovaries. These findings indicate that a CL influenced oocyte developmental competence and embryonic development, presumably through intraovarian interactions.

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In this work, we present the synthesis, characterization, electrochemical studies, DFT calculations, and in vitro amoebicidal effect of seven new heteroleptic NiII coordination compounds. The crystal structures of [H2(pdto)](NO3)2 and [Ni(pdto)(NO3)]PF6 are presented, pdto = 2,2'-[1,2-ethanediylbis-(sulfanediyl-2,1-ethanediyl)]dipyridine. The rest of the compounds have general formulae: [Ni(pdto)(NN)](PF6) where N-N = 2,2'-bipyridine (bpy), 4,4'-dimethyl-2,2'-bipyridine (44dmbpy), 5,5'-dimethyl-2,2'-bipyridine (55dmbpy), 1,10-phenanthroline (phen), 4,7-dimethyl-1,10-phenanthroline (47dmphen) and 5,6-dimethyl-1,10-phenanthroline (56dmphen). The size of NN ligand and its substituents modulate the compound electronic features and influence their antiproliferative efficiency against Entamoeba histolytica. 56dmphen derivative, shows the biggest molar volume and presents a powerful amoebicidal activity (IC50 = 1.2 µM), being seven times more effective than the first-line drug for human amoebiasis metronidazole. Also, increases the reactive oxygen species concentration within the trophozoites. This could be the trigger of the E. histolytica growth inhibition. The antiparasitic effect is described using NiII electron density, molar volume, estimated by DFT, as well as the experimental redox potential and diffusion coefficients. In general, amoebicidal efficiency is directly proportional to the increment of the molar volume and decreases when the redox potential becomes more positive.

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Herein is presented the synthesis, characterization, electrochemical studies, DFT calculations and in vitro evaluation of amoebicidal activity in trophozoites of Entamoeba histolytica of twenty ruthenium (II) mixed compounds with general formulae: [Ru(pdto)(E-E)]Clx (E-E bidentate, either neutral or negatively charged ligands). For compounds under study, O-O, N-O and N-N auxiliary donor ligands demonstrate to have a crucial impact on the electronic properties and that it is possible to modulate the antiparasitic activity. Among analyzed complexes, only four present a better performance compared to typically used metronidazole drug (IC50 < 6.80 µmol/L) to treat amebiasis disease. For studied compounds, structure-activity relationships are strongly determined by either the redox potential (E1/2) of RuII/RuIII and calculated molar volume (V) of the complexes.

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Objetivo: Evaluar la influencia de la altura en los niveles de proteína C reactiva (PCR) en adultos con adiposidad visceral abdominal. Materiales y métodos: Se realizó un estudio cuantitativo con diseño cuasi-experimental, que incluyó veinticuatro estudiantes de medicina de la Universidad Nacional de Trujillo, sexo masculino, seleccionados de manera no probabilística por conveniencia y sujeto participante, que fueron evaluados a 0 y 4386 m s. n. m. y clasificados de acuerdo al grado de adiposidad visceral abdominal: normal (G1) y elevada (G2). Resultados: El nivel de PCR de G1 en relación a G2 no tuvo diferencia significativa. Respecto a los niveles de PCR de G2 se empleó la prueba no paramétrica de Wilcoxon y para G1 se usó la prueba T-student, evidenciándose una significancia en ambos casos. Conclusiones: Las variaciones de los niveles de PCR en altura con respecto al basal de ambos grupos fueron significativos

Objective: To evaluate the influence of high altitude on C-reactive protein (CRP) levels in adults with abdominal visceral adiposity. Materials and methods: A quantitative study with quasi-experimental design, which included twenty-four (24) male medical students from the National University of Trujillo, selected by non-probability convenience sampling and study subject, evaluated at 0 and 4,386 m.a.s.l., and classified according to their degree of abdominal visceral adiposity: normal (G1) and high (G2). Results: The CRP level of G1 in relation to G2 showed no significant difference. Regarding CRP levels, Wilcoxon rank-sum (non-parametric) test was used for G2 and Student´s t-test was used for G1, with significance being shown in both cases. Conclusions: Variations on CRP levels in high altitude compared to sea level in both groups were significant

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The reaction of E-2-ferrocenylmethylidenetetralones and E,E-2,6-bis-(ferrocenylmethylidene)-cyclohexanone with 2-aminothiophenol proceed with high diastereoselectivity, forming the ~4.5:1 mixture of trans- and cis-isomers of polycyclic ferrocenylthiazepines, respectively. The reactions of E,E-2,5-bis-(ferrocenylmethylidene)cyclopentanone and E,E-3,5-bis-(ferrocenylmethylidene)-1-methyl-4-piperidone with 2-aminothiophenol take place stereo specifically to form the diastereomeric tricyclic thiazepines of cis- and trans-configuration, respectively. The structures of the obtained compounds were established by IR, 1H and 13C NMR spectroscopy and mass-spectrometry. The structures of the trans-tetralino[1,2a]-, trans-5,7-dimethyltetralino[1,2a]-2-ferrocenyl [1,5]benzo-2,3-dihydrothiazepines and cis-5-ferrocenyl-methylidenecyclopentano[1,2a]-2-ferrocenyl- [1,5]benzo-2,3-dihydrothiazepine were confirmed by X-ray diffraction analysis. An electrochemical study reveals that the diferrocenyl derivatives belong to a Class I compounds of the Robin-Day classification. This behavior is explained by the analysis of frontier orbitals as calculated by density functional theory, showing that only one ferrocenyl unit participates in the generation of HOMO and LUMO orbitals. Compounds 4a and 4c showed similar capacity to inhibit the proliferation of HM1: IMSS trophozoite cultures than the first choice drug for human amoebiasis treatment, metronidazole. Morphological changes induced in the trophozoites after drug exposure suggest a redox in balance as the probable mechanism of the parasite death.

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BACKGROUND: Paraesophageal hernias are rare and, when associated with symptoms, the risk of complications increases, becoming a surgical emergency. CLINICAL CASE: We report a case of a 53 year-old female with 3 weeks of clinical evolution including abdominal pain, nausea and occasional vomiting; 24 h prior to admission she presented intestinal occlusion. Radiographic and tomographic findings showed a paraesophageal hernia, requiring exploratory laparotomy, which demonstrated a 9 cm paraesophageal diaphragmatic defect with a hernia sac containing transverse colon, omentum, fundus and body of the stomach (this last one presented ~60% of necrosis), performing nonanatomic gastrectomy and simple diaphragmatic reconstruction. The patient had a complicated postoperative period requiring two additional surgeries attempting to correct gastrectomy dehiscence and ending with a third procedure for cervical esophagostomy and Witzel jejunostomy. CONCLUSIONS: Elective repair is recommended in all patients with asymptomatic paraesophageal hernia in order to avoid possible complications. The approach method is dependent on the surgeon's experience and the conditions of the hernia and involved structures at the time of diagnosis.

Antecedentes: las hernias paraesofágicas son de baja incidencia y generalmente asintomáticas; sin embargo, cuando provocan síntomas, el riesgo de complicaciones se incrementa y se convierten en una urgencia quirúrgica. Caso clínico: mujer de 53 años de edad, con cuadro clínico de tres semanas de evolución, caracterizado por dolor abdominal, náusea y vómito ocasionales, a lo que se agregó oclusión intestinal 24 horas antes de que acudiera a consulta. En la valoración radiográfica y tomográfica se observó una hernia paraesofágica que requería laparotomía exploradora. Se encontró un defecto diafragmático paraesofágico de 9 cm, con un saco herniario de contenido del estómago, colon transverso y epiplón, con necrosis gástrica de 60% (en el fondo y el cuerpo). Se le practicó una resección gástrica no anatómica y plastia diafragmática. El periodo postoperatorio fue complicado porque se le hicieron otras dos intervenciones quirúrgicas por dehiscencia de gastrectomía y una más por esofagostomía cervical y yeyunostomía tipo Witzel. Conclusiones: se recomienda la reparación electiva en todos los sujetos asintomáticos con hernia paraesofágica, con el fin de evitar las posibles complicaciones. El método de abordaje depende de la experiencia del cirujano y de las condiciones en que se encuentre la hernia y las estructuras involucradas al momento del diagnóstico.

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Describir la utilidad y demostrar la seguridad del Robot Da Vinci®, en la cirugía general abdominal. Estudio realizado en el Hospital de Clínicas Caracas, Caracas-Venezuela. Estudio descriptivo, retrospectivo realizado entre junio 2006 y julio 2010, en pacientes que ameritaron cirugía abdominal y que fueron operados con el robot Da Vinci® (Intuitive Surgical, Sunnyvale, CA). Se incluyeron 61 pacientes, predominando el género femenino (82%), en edades comprendidas entre 21-80 años, que acudieron a la consulta y/o emergencia y que, accedieron a realizarse el abordaje laparoscópico asistido por el robot Da Vinci®. Entre las patologías mayormente operadas se encuentran: litiasis vesicular o colecistitis aguda y la hernia hiatal con reflujo gastroesofágico. Tuvimos 8% de complicaciones (entre mayores y menores). La cirugía abdominal laparoscópica asistida por robot, recupera la visión y la habilidad perdida con la cirugía laparoscópica convencional. En nuestra serie observamos no sólo los beneficios que el robot le brinda al cirujano, sino los que esta técnica le ofrece al paciente. La cirugía robótica ha probado ser de gran utilidad y segura.

To demostrate the safety and describe the benefits in abdominal general surgery. Study performed at the Hospital de Clínicas Caracas, Caracas-Venezuela. Retrospective study performed between 2006-2010 in patients who underwent abdominal surgery with the Da Vinci® robot (Intuitive Surgical, Sunnyvale, CA). Sixty one patients were included, 82% females, between 21-80 years. Elective and/or emergency abdominal surgery was performed after they agree to have the laparoscopic approach assited by the Da Vinci® robot. Gastroesophageal reflux disease with or withouth hiatal hernia, cholecistectomy were the frecuent pathologies. Minor and/or major complications where 8%. Laparoscopic approach with the Da Vinci® System, regains the tridimentional visión and the intuitive hand movements lost with the conventional laparoscopic approach. In our series robotic surgery is safe and brings benefits to the surgeon and the patients.

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Exponer nuestra experiencia en el abordaje extraperitoneal de la columna lumbar y comparar con la literatura relacionada. Estudio realizado en el Hospital de Clínicas Caracas y en el Centro Médico Docente La Trinidad. Estudio retrospectivo, basado en la revisión de historias clínicas de 131 pacientes sometidos a 192 abordajes de columna lumbar en el perìodo comprendido entre mayo de 2004 y noviembre 2009. 47,5% de los pacientes son masculinos y 52,5% femeninos. La edad promedio fue de 42,78%. El tiempo quirúrgico promedio fue de 138,56 minutos. La tasa global de complicaciones postoperatorias fue de 18,32%. La estancia hospitalaria promedio fue de 2,33 días. Para el reemplazo de discos intervertebrales se han utilizado múltiples abordajes, siendo el extraperitoneal el más recomendado, ya que permite una amplia exposición de la anatomía, disminuye la incidencia de daño nervioso, evita el trauma muscular paraespinal y disminuye la estancia hospitalaria.

Inform our experience with extraperitoneal approach of lumbar disc compare with literature. Study performed at Hospital de Clinicas Caracas and Centro Médico Docente La Trinidad. Retrospective study based on history review ofr 131 patients with 192 lumbar approaches between May 2004 and November 2009. 47,5% males, 52,5 females, mean age was 42,78%. Mean surgical time was 138,56 minutes. Postoperative complications rate was 18,32%. Mean hospital stay was 2,33 days. Extraperitoneal approach for disc replacement is the recommended operation. It permits better anatomy identification, less trauma to muscles and nerves, and less hospital stay.

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