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Rabies is a neglected disease that affects all mammals. To determine the appropriate sanitary measures, the schedule of preventive medicine campaigns requires the proper identification of the variants of the virus circulating in the outbreaks, the species involved, and the interspecific and intraspecific virus movements. Urban rabies has been eradicated in developed countries and is being eradicated in some developing countries. In Europe and North America, oral vaccination programs for wildlife have been successful, whereas in Latin America, Asia, and Africa, rabies remains a public health problem due to the habitation of a wide variety of wild animal species that can act as rabies virus reservoirs in their environment. After obtaining recognition from the WHO/PAHO as the first country to eliminate human rabies transmitted by dogs, Mexico faces a new challenge: the control of rabies transmitted by wildlife to humans and domestic animals. In recent years, rabies outbreaks in the white-nosed coati (Nasua narica) have been detected, and it is suspected that the species plays a significant role in maintaining the wild cycle of rabies in the southeast of Mexico. In this study, we discussed cases of rabies in white-nosed coatis that were diagnosed at InDRE (in English: Institute of Epidemiological Diagnosis and Reference; in Spanish: Instituto de Diagnostico y Referencia Epidemiologicos) from 1993 to 2022. This study aimed to determine whether white-nosed coatis might be an emergent rabies reservoir in the country. A total of 13 samples were registered in the database from the Rabies laboratories of Estado de Mexico (n = 1), Jalisco (n = 1), Quintana Roo (n = 5), Sonora (n = 1), and Yucatan (n = 5). Samples from 1993 to 2002 from Estado de Mexico, Jalisco, and Sonora were not characterized because we no longer had any samples available. Nine samples were antigenically and genetically characterized. To date, coatis have not been considered important vectors of the rabies virus. The results from our research indicate that the surveillance of the rabies virus in coatis should be relevant to prevent human cases transmitted by this species.
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In 2019, the World Health Organization (WHO) and the Pan-American Health Organization (PAHO) recognized Mexico as a country free of human rabies transmitted by dogs. Nevertheless, the sylvatic cycle remains as a public health concern in the country. Although cougars (Puma concolor) are not reservoirs of any rabies virus variant (RVV), these felines could act as vectors at the top of the food chain, and their relationships with other organisms must be considered important for the regulatory effect on their prey's populations. In this study, genetic and antigenic characterization was performed on all cougar rabies cases diagnosed at the Rabies Laboratory Network of the Ministry of Health (RLNMH) in Mexico from 2000 to 2021. Samples from other species, a skunk, a horse (Equus caballus) (attacked by a cougar), and a gray fox (Urocyon cineroargenteus), were included as reference. Rabies cases in cougars were restricted to two Northern states of Mexico (Sonora and Chihuahua). Five out of six samples of cougars were RVV7 (Arizona gray fox RVV) and one from Sonora was RVV1. Interestingly, there is no evidence of RVV1 in dogs in the Northern states since the 1990s but skunk species now harbor this RVV1 in this region of the country.
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OBJECTIVE: To identify rabies virus variants (RVVs) isolated from bats and terrestrial mammals in Nuevo Leon between 2008 and 2015 and Coahuila in 2006. SAMPLE: RVVs isolated from 15 bats and terrestrial mammals in Nuevo Leon and from a cow (Bos taurus) in Coahuila, along with 46 reference rabies virus sequences. PROCEDURES: Antigenic characterization of the 16 isolates was performed with an indirect fluorescent antibody technique. Genomic sequencing of the nucleoprotein gene in the 16 isolates was performed with a reverse transcription PCR assay. Phylogenetic reconstruction of the 62 sequences was performed by means of Bayesian inference. RESULTS: 9 isolates from bats and 1 isolate from a domestic cat that became infected as a result of contact with a Mexican free-tailed bat all clustered in the lineage associated with Lasiurus spp in the Americas or the lineage associated with Tadarida brasiliensis mexicana. An isolate from a domestic dog was identified as a variant associated with the dog-coyote lineage. The RVV isolated from a fox clustered in an Arizona fox lineage. The 3 RVVs from skunks (Mephitis macroura) were placed in a lineage with variants isolated from spotted skunks (Spilogale putorius). The RVV isolated from the cow was clustered in a lineage associated with foxes in Texas and separate from the lineage for the fox from Nuevo Leon. CONCLUSIONS AND CLINICAL RELEVANCE: Results reinforced the need for Mexico to implement rabies surveillance and monitoring programs for bats and wild-living terrestrial carnivores.
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Quirópteros , Vírus da Raiva , Raiva/veterinária , Animais , Arizona , Teorema de Bayes , Gatos , Bovinos , Cães , Feminino , México , Filogenia , Saúde Pública , TexasRESUMO
INTRODUCTION: Recurrence of papillary thyroid carcinoma after initial treatment is challenging. Surgical reintervention is recommended, but cure after surgery in uncertain and surgical morbidity may be high. This study evaluates the effect of compartment-oriented lymph node dissection (LND) on clinical and biochemical cure rate as well as the related complications. PATIENTS AND METHODS: All patients who underwent LND for recurrent papillary thyroid carcinoma between 2000 and 2015 were included. Demography, the extent of the initial surgery, usage of 131I, the pattern of recurrence, diagnosis, details of the surgical reintervention, histological findings, surgical morbidity, and clinical and biochemical outcomes were analyzed. RESULTS: There were 11 (12.7%) males and 75 (87.2%) females with a mean age of 42.8 ± 14.6 years. Seventy-seven patients had undergone total thyroidectomy and in 67 (77.9%) some type of LN resection. In 76 (88.3%), 131I was administered after the initial surgery. We localized suspicious lymph nodes by US in all patients, and metastases were documented before surgery by FNA in 63. Seven (8.13%) patients underwent central LND, 63 (73.2%) lateral LND and 16 (18.6%) both, central and lateral LND. Major complications occurred in 6 patients (6.9%). Sixty-two (72.0%) patients received 131I after surgery. A second surgical re-exploration was performed in 30 (34.8%) patients, and 7 patients required 3 or more additional LND. In a mean follow-up of 59.4 ± 39 months, 51 (59.3%) patients are clinically, radiologically and biochemically free of disease. CONCLUSIONS: In this series, compartment-oriented lymph node resection of recurrent papillary thyroid carcinoma leads to a final clinical and biochemical disease-free status of 59.3% with 6.9% of major complications.
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Linfonodos/cirurgia , Esvaziamento Cervical/métodos , Recidiva Local de Neoplasia/cirurgia , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Adulto , Feminino , Humanos , Radioisótopos do Iodo , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/efeitos adversos , Recidiva Local de Neoplasia/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Reoperação , Estudos Retrospectivos , Câncer Papilífero da Tireoide/secundário , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND: Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is one of the most commonly performed bariatric procedures. Considering significant differences between populations around the world, surgical outcomes may vary widely. The aim of the study was to develop an educational patient-specific interactive application that may estimate the potential outcomes of LRYGB in the Mexican population. METHODS: A database with 76 different variables from 1002 patients who underwent LRYGB at two Mexican Institutions between 1992 and 2014 and had a minimum of 6-month follow-up was analyzed. Descriptive and inferential statistics, as well as a multivariate regression analysis, were performed for the primary analysis. Results were based on four statistical models obtained from the cohort outcomes. A tool was designed to provide estimates of absolute weight loss (AWL) and resolution of four major comorbidities: type 2 diabetes (T2D), high blood pressure (HBP), hypercholesterolemia, and the obstructive syndrome of sleep apnea (OSAS). RESULTS: There were 353 males (35.2%) and 649 females (64.8%) with a mean age of 41.9 ± 12.1 years and a mean preoperative BMI of 45.3 ± 7.9 kg/m2. Mean AWL at 2 years was 39.02 ± 12.7 kg. Mean accumulative percentage of resolution for T2D, HBP, and dyslipidemias at the same time period was 78%, 66.2%, and 84.7%, respectively. Based on these results, the educational tool was developed. CONCLUSIONS: We were able to develop an interactive estimation application to provide a population-based guidance for potential outcomes of LRYGB. This might be useful not only for health professionals but also for patients interested in learning potential outcomes in specific circumstances.
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Derivação Gástrica/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Modelos Estatísticos , Redução de Peso/fisiologia , Adulto , Estudos de Coortes , Diabetes Mellitus Tipo 2 , Feminino , Humanos , Hiperlipidemias , Hipertensão , Masculino , México , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Síndromes da Apneia do Sono , Resultado do TratamentoRESUMO
In the original version of the article, the last three column headings in Table 3 were mislabeled. The original article has been corrected. Following is the corrected table.
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BACKGROUND: Total thyroidectomy is the most common surgical procedure for the treatment of thyroid diseases. Postoperative hypocalcemia/hypoparathyroidism is the most frequent complication after total thyroidectomy. The aim of this study was to evaluate the rate of postoperative hypocalcemia and permanent hypoparathyroidism after total thyroidectomy in order to identify potential risk factors and to evaluate the impact of parathyroid autotransplantation. PATIENTS AND METHODS: We performed a retrospective analysis of 1018 patients who underwent total thyroidectomy at our institution between 2000 and 2016. Medical records were reviewed to analyze patient features, clinical presentation, management and postoperative complications. Descriptive and inferential statistics were employed based on the natural scaling of each included variable. Statistical significance was set at p ≤ 0.05. RESULTS: Mean ± SD age was 46.79 ± 15.9 years; 112 (11.7%) were males and 844 (88.3%) females. A total of 642 (67.2%) patients underwent surgery for malignant disease. The rate of postoperative hypocalcemia, transient, protracted and permanent hypoparathyroidism was 32.8%, 14.43%, 18.4% and 3.9%, respectively. Permanent hypoparathyroidism was significantly associated with the number of parathyroid glands remaining in situ (4 glands: 2.5%, 3 glands: 3.8%, 1-2 glands: 13.3%; p Ë 0.0001) [OR for 1-2 glands in situ = 5.32, CI 95% 2.61-10.82]. Other risk factors related to permanent hypoparathyroidism were obesity (OR 3.56, CI 95% 1.79-7.07), concomitant level VI lymph node dissection (OR 3.04, CI 95% 1.46-6.37) and incidental parathyroidectomy without autotransplantation (OR 3.6, CI 95% 1.85-7.02). CONCLUSIONS: Identification and in situ preservation of at least three parathyroid glands were associated with a lower rate of postoperative hypocalcemia (30.4%) and permanent postoperative hypoparathyroidism (2.79%).
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Hipoparatireoidismo/etiologia , Paratireoidectomia/efeitos adversos , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Hipocalcemia/etiologia , Período Intraoperatório , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Glândulas Paratireoides/transplante , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Transplante Autólogo , Adulto JovemRESUMO
Rabies virus (RABV), a member of the genus Lyssavirus, causes encephalitis that is almost always fatal following the onset of clinical signs. Here, we report the complete codifying sequence of an RABV isolated from a dog in Mexico. Molecular data showed that this strain belongs to the Chiapas lineage.
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AIM: The aim of this study is to compare the differences in body composition in patients with obesity with successful weight loss (SWL) and unsuccessful (USWL) 1 year after Roux-en-Y gastric bypass (RYGB). METHODS: We included 36 women and 22 men. After stratifying patients according with SWL (defined as ≥ 50% of excess weight loss), fat-free mass (FFM) and fat mass (FM) trajectories were analyzed in each group. RESULTS: The %FM in SWL women (78%) was lower than USWL (36 vs. 44, p < 0.001). The %FM in SWL men (77%) was lower than USWL (27 vs. 38, p < 0.05). A lower %FM before surgery increased the probability of success (p < 0.05). CONCLUSIONS: SWL patients have a lower %FM, and those with lower pre-surgical %FM are more likely to have SWL 1 year after RYGB.
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Composição Corporal/fisiologia , Derivação Gástrica , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/cirurgia , Redução de Peso/fisiologia , Adulto , Feminino , Seguimentos , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/metabolismo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Advanced bipolar and ultrasonic energy have demonstrated reduction of operating time and blood loss in thyroidectomy. However, these devices generate heat and thermal dispersion that may damage adjacent structures such as the recurrent laryngeal nerve (RLN). This study was designed to evaluate the safety profile of the Harmonic Focus+® (HF+) device through the evaluation of thermal injury to the RLN using different algorithms of distance and time with state of the art technology. METHODS: 25 Vietnamese pigs underwent activation of HF+ in the proximity of their RLN. They were divided into 4 groups according to activation distance (3 mm, 2 mm, 1 mm and on the RLN). Time of activation, time between tones of the ultrasonic generator, changes in the electromyographic signal using continuous nerve neuromonitoring, vocal fold mobility assessed by direct laryngoscopy and histological thermal damaged were evaluated. RESULTS: None of the pigs had loss of signal in the electromyography during the procedure; only one pig had isolated transient decrease in amplitude and one increase in latency. One pig had transient vocal fold paresis in the group with activation on the nerve. Evaluation of the nerves by histology and immunohistochemistry did not show significant changes attributed to thermal injury. CONCLUSIONS: The use of ultrasonic energy close to the RLN is safe, provided that activation time does not exceed the necessary time to safely transect the tissue.
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Hemostasia Cirúrgica/instrumentação , Complicações Intraoperatórias/prevenção & controle , Traumatismos do Nervo Laríngeo Recorrente/prevenção & controle , Procedimentos Cirúrgicos Ultrassônicos/instrumentação , Animais , Eletromiografia , Hemostasia Cirúrgica/efeitos adversos , Temperatura Alta/efeitos adversos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/patologia , Monitorização Intraoperatória , Traumatismos do Nervo Laríngeo Recorrente/diagnóstico , Traumatismos do Nervo Laríngeo Recorrente/etiologia , Traumatismos do Nervo Laríngeo Recorrente/patologia , Suínos , Tireoidectomia/efeitos adversos , Tireoidectomia/instrumentação , Tireoidectomia/métodos , Fatores de Tempo , Procedimentos Cirúrgicos Ultrassônicos/efeitos adversosRESUMO
Intraoperative continuous neural monitoring (C-IONM) during thyroid surgery has been recognized as a useful tool to identify and confirm recurrent laryngeal nerve integrity. The aim of the present study is to analyze electromyographic features and thresholds for normal vocal fold function in our initial experience with C-IONM in thyroid surgery. C-IONM was utilized in 57 patients who underwent thyroid surgery between July 2012 and December 2015. EMG parameters were analyzed looking for potential predictors of postoperative vocal fold dismotility. There were 54 females (94.7%) and 3 males (5.3%) with a mean age of 46.7 ± 11.6 years. C-IONM was successfully registered in 89 of 107 nerves at risk (83.1%). Mean basal amplitude was 727.31 ± 471.25 µV and mean final amplitude was 650.27 ± 526.87 µV (P = 0.095, CI 95% 13.83-167.91). Mean basal latency was 5.23 ± 1.42 mS and mean final latency was 5.18 ± 1.50 mS (P = 0.594, CI 95% 0.39-0.24). Four patients had transient postoperative vocal fold paresis. None of these four patients had loss of signal (LOS), three had transient decrease in amplitude, and one had a normal registry throughout the operation. C-IONM is a useful tool to identify patients in whom intraoperative RLN is at risk during surgery. Final amplitude above 500 µV and no LOS is associated with RLN integrity and normal postoperative vocal fold function.
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Nervos Laríngeos/fisiologia , Monitorização Intraoperatória/métodos , Glândula Tireoide/cirurgia , Prega Vocal/fisiologia , Eletromiografia/métodos , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-IdadeRESUMO
RESUMO Objetivo Realizar a tradução e a adaptação cultural da Escala de Despersonalização de Cambridge (EDC) para o português brasileiro. Métodos Foi realizada a tradução da escala em duas versões, seguida por retrotradução por nativo de língua inglesa. Os itens da escala foram comparados e adaptados para o contexto brasileiro e, então, transformados em uma versão-teste, que foi aplicada em 30 participantes sem diagnóstico de transtorno psiquiátrico. Resultados A versão em português da EDC mostrou boa compreensibilidade. A maior parte dos participantes relatou experiências transitórias ligadas à despersonalização nos últimos seis meses (53,3% dos casos), incluindo a sensação de ser um observador externo de si mesmo (35%) e sensação de estar fora do corpo (10%). Conclusões O presente estudo confirma a alta frequência de experiências de despersonalização. Serão necessários estudos para verificação das propriedades psicométricas da escala.
ABSTRACT Objective To perform the translation and cultural adaptation of the Cambridge Depersonalization Scale (CDS) to Brazilian Portuguese. Methods The scale translation was performed in two versions, followed by back translation by a native English speaker. Scale items were compared and adapted to the Brazilian context, and then transformed into a test version, applied to 30 participants without diagnosis of psychiatric disorders. Results The Portuguese version of the CDS showed good comprehensibility. Most participants reported depersonalization transient experiences over the last six months (53.3% of the cases), including feeling of being an outside observer of the self (35%) and feeling of being outside the body (10%). Conclusions The current study confirms the high frequency of depersonalization experiences. Further studies are needed to verify the psychometric properties of the scale.
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BACKGROUND: Laparoscopic splenectomy (LS) is considered the standard treatment for patients with refractory primary immune thrombocytopenia (ITP). PATIENTS AND METHODS: All patients with ITP who underwent LS during the last 17 years and who had a minimum follow-up of 1 year were included. Several perioperative variables such as age, platelet count, and duration of preoperative therapy were recorded and analyzed, looking for potential predictive variables of clinical response. RESULTS: In total, 150 patients were included: 108 (72%) women and 42 (28%) men, with a mean age of 37.3±15.8 years. In the evaluation 1 year after surgery, 133 (88.7%) patients had achieved complete response, 4 (2.7%) had a response, and in 13 (8.6%) there was no response. None of the analyzed preoperative variables was identified as a predictive factor of response at 1 year. Immediate responders after surgery (≥150,000 platelets/mL during the first week) had a higher platelet count and rate of complete response at 1 year (94.2%). CONCLUSIONS: LS has a high success rate in patients with refractory ITP. Potential predictive indicators of success remain to be determined.
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Laparoscopia/métodos , Púrpura Trombocitopênica Idiopática/cirurgia , Esplenectomia/métodos , Trombocitopenia/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Indução de Remissão , Esplenectomia/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) may be a technically challenging surgical technique when features such as thick abdominal wall and increased liver volume are present. Very low calorie diets in the form of liquid meal replacements given 6 weeks prior to surgery have proven to decrease liver volume. The aim of our study was to assess the effect of a 6-week preoperative low calorie/regular diet on liver volume and body weight in morbidly obese patients. METHODS: A pilot study was carried out in 20 morbidly obese patients with an 800-kcal diet for 6 weeks. They were followed weekly to ensure proper compliance. CT scan was used for determining liver volume every 2 weeks in order to assess the impact of the diet. Baseline values were taken as controls for every patient as tied measures. Statistical analysis was suitable to variable scaling and performed using SPSS v. 20.0. Parametric and non-parametric test for tied measures were done. Any p value lesser than 0.05 or 5% was considered as statistically significant. RESULTS: Twenty patients adhered to the diet intervention for 6 weeks prior to LRYGB. Median ± SD age was 34.5 ± 11.5 years and 17 were female (85%). Heart rate and blood pressure did not vary across the study. Initial median ± SD BMI was 46.02 ± 5.29 kg/m2 (range 38.7-54.8). Repeated and tied measurements across the 6 weeks of treatment within individuals resulted statistically significant for reducing BMI (p < 0.0001). CT scan assessed liver volume initially as a control and in weeks 2, 4 and 6. Parametric and non-parametric assessment for multiple measurements also showed statistical significance among these values (p < 0.0001). Diet tolerability was additionally evaluated with a questionnaire showing more than 80% of acceptability with discrete rates of nausea (15%) and diarrhoea (15%). CONCLUSIONS: Based on our results, we demonstrated that a very low calorie diet with home ingredients is capable for effectively reducing body weight and liver size in morbidly obese patients. This relatively short intervention (4 to 6 weeks) was accomplished in all our patients with a high frequency of compliance and a low rate of secondary effects.
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Restrição Calórica , Derivação Gástrica , Laparoscopia , Fígado/patologia , Obesidade Mórbida/cirurgia , Período Pré-Operatório , Redução de Peso , Adolescente , Adulto , Peso Corporal , Feminino , Humanos , Fígado/diagnóstico por imagem , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/patologia , Cooperação do Paciente , Seleção de Pacientes , Projetos Piloto , Índice de Gravidade de Doença , Inquéritos e Questionários , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: Primary adrenal malignancies are rare and have a dismal prognosis. We report our experience in both adrenocortical carcinomas and malignant pheochromocytomas who received medical care at our Institution between 1994 and 2009. MATERIAL AND METHODS: The data bases of hospital discharges, surgery and pathology were reviewed looking for patients with diagnosis of primary adrenal malignant tumors. Clinical presentation, laboratory and image characteristics, surgical details, histopathology findings and outcome were analyzed. RESULTS: A total of eight patients were identified, two men and six women with a mean age of 48.1 +/- 15.7 years (31-80). Six patients presented with adrenocortical carcinomas and two had malignant pheochromocytomas. Of the six cortical tumors four were functioning. Five were stage II, two were stage III and one was stage IV. All patients underwent surgery as initial treatment. Six patients underwent open and two, laparoscopic adrenalectomy. Three patients received adjuvant chemotherapy. In a mean follow up of 32 +/- 27 months, only three patients with stage II were alive and free of the disease. CONCLUSIONS: As in other series, primary adrenal carcinoma in our population proved to be a rare endocrine neoplasm with poor prognosis despite complete surgical resection. Treatment at initial stages provides better outcome.
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Neoplasias das Glândulas Suprarrenais , Carcinoma Adrenocortical , Feocromocitoma , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/cirurgia , Carcinoma Adrenocortical/diagnóstico , Carcinoma Adrenocortical/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Feocromocitoma/diagnóstico , Feocromocitoma/cirurgiaRESUMO
Iron constitutes the most prevalent nutritional deficiency worldwide. In Chile, anaemia epidemiological data is scarce, evaluating mainly children and women. Our objective was to determine prevalence of anaemia in an inpatient elderly population (≥60 years) and assess the usefulness of sTfR levels analyzed by other authors as a good predictor in the differential diagnosis of iron deficiency anaemia and anaemia of chronic disease. Method. We studied medical patients admitted at Hospital of Valdivia (HV), Chile, in a 2month period. World Health Organization criteria were used for anaemia. Results. 391 patients were hospitalized, average age 62.5 years, 247 elderly and 99 of which had anaemia. Anaemia was normocytic in 88.8%, and we observed: low serum iron in 46.3%, low ferritin 10.1%, high TIBC 2%, low % transferrin saturation (Tsat) 40%, and high sTfR 25%. Conclusions. As a first figure known in Chile, the prevalence of anaemia in the elderly inpatient was 40.1%. Our findings encourage us to promote the implementation of sTfR determination in the clinical setting to analyze the state of erythropoiesis in patients with chronic diseases wich commonly occurs in elderly.
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BACKGROUND: Small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass (LRYGB) may be related to the surgical technique used. The frequency and characteristics of postoperative SBO were studied in two cohorts of patients after LRYGB. METHODS: In a 4-year period, 359 patients underwent LRYGB as an initial bariatric operation at our clinic. Patients were divided into two groups. In Group 1 (n = 187), the mesentery of the jejunum was widely divided, the mesenteric defect was closed, and Petersen's space was not sutured. In Group 2 (n = 172), the mesentery was not divided, and both the mesenteric folds and Petersen's space were closed. Episodes of SBO, etiology, treatment, and outcome were analyzed and compared. RESULTS: There were 141 males and 218 females, with mean age of 41 ± 11 years. Preoperative BMI was 43.2 ± 7 kg/m(2). In Group 1, 29/187 patients (15.5%) developed SBO at a mean follow-up of 15 ± 6.4 months. In Group 2, 2/172 patients (1.1%) developed SBO at 12.3 ± 6.7 months. Internal hernia was responsible for the SBO in 29 patients (19 through the adjacent mesenteric defect and 10 through Petersen's space). Mean EWL at the time of SBO was 82.2 ± 22.7%. SBO was successfully resolved by laparoscopy in 25 patients, conversion was necessary in three, and one was treated by open surgery. One patient presented intestinal perforation after revision. CONCLUSIONS: Surgical details such as leaving the jejunal mesentery intact and closing all created defects significantly decreased the incidence of SBO due to internal hernias in antecolic antegastric LRYGB.
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Derivação Gástrica/efeitos adversos , Obstrução Intestinal/etiologia , Adulto , Feminino , Derivação Gástrica/métodos , Humanos , Incidência , Obstrução Intestinal/epidemiologia , Laparoscopia , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgiaRESUMO
BACKGROUND: Small size, high benignity rate, and sporadic nature make insulinomas suitable for laparoscopic resection. On the other hand, occult location or multicentricity mandate open surgery. This study was designed to analyze a series of patients who had pancreatic insulinomas and underwent initial treatment at our institution. METHODS: Clinical records of the 34 patients with pancreatic insulinomas who underwent surgical resection between 1995 and 2007 were reviewed. Main variables for analysis were cure of the disease and surgical complications. RESULTS: There were 20 women and 14 men with a mean age of 40 +/- 13 years. Mean size of the tumors was 2.2 +/- 1 cm. Laparoscopic resection was completed in 14 of 21 patients. Most tumors that were resected by laparoscopy were solitary, benign, and located in the body and tail of the pancreas. Open surgery was selected for 13 patients, including 7 sporadic (5 in the head), 4 related to the MEN syndrome, and 2 malignant tumors. Surgical morbidity occurred in 23 patients. The most common complication was pancreatic fistula (3/13 in open, 4/14 in laparoscopic, and 6/7 in conversions). One patient in the open group died 15 days after surgery from massive PTE. Postoperative normoglycemia was achieved in all patients and persisted for a follow-up period of 4 +/- 3.7 years. CONCLUSIONS: Most insulinomas in our series were small and benign. Tumors that were located in the body and tail were more often amenable for laparoscopic resection. The cure rate was very high. Pancreatic fistula was the most frequent complication.
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Insulinoma/cirurgia , Neoplasias Pancreáticas/cirurgia , Adulto , Distribuição de Qui-Quadrado , Diagnóstico por Imagem , Feminino , Humanos , Insulinoma/diagnóstico , Insulinoma/patologia , Laparoscopia/métodos , Masculino , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Complicações Pós-OperatóriasRESUMO
BACKGROUND: Adjustable gastric banding (AGB) and vertical banded gastroplasty (VBG) have been extensively used to treat morbid obesity. Patients with insufficient weight loss or complications may require surgical revision. The laparoscopic Roux-en-Y gastric bypass (LRYGBP) is one of the most common procedures currently used for revision. The aim of the study was to analyze surgical outcomes of 30 consecutive patients who underwent revision to LRYGBP in a 2-year period. METHODS: The prospectively constructed database and the medical records of all patients undergoing revision to LRYGBP were reviewed. Demographics, surgical details, results, and complications were analyzed. RESULTS: There were 23 women and seven men with a mean age of 41.1+/-9.7 years (r=25-61). Mean body mass index (BMI) was 40.0+/-7.5 kg/m(2) (r=27.2-65.2). Initial operation was AGB in 24, VBG in five, and both in one patient. In ten patients, the band had been removed before revision, in 13 cases, band removal and LRYGBP were performed in one surgical intervention, and in two patients, it was performed in a two-step surgery. There were two conversions to open surgery. Five patients presented major surgical complications. Hospital stay averaged 5.1 days (r=3-25). Mean percent excess body weight loss at 6 and 12 months was 61.7+/-27.5 and 81.2+/-20.5 kg/m(2), respectively. Mean percent low body mass index at 6 and 12 months was 22.5+/-9.1 and 29.1+/-11.4 kg/m(2), respectively. CONCLUSIONS: LRYGBP as a revision procedure is feasible in most patients. Surgical complications are more frequent.
Assuntos
Derivação Gástrica , Gastroplastia , Adulto , Feminino , Derivação Gástrica/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/epidemiologia , Reoperação , Falha de Tratamento , Redução de PesoRESUMO
Bat rabies and its transmission to humans and other species in Mexico were investigated. Eighty-nine samples obtained from rabid livestock, cats, dogs, and humans in Mexico were studied by antigenic typing and partial sequence analysis. Samples were further compared with enzootic rabies associated with different species of bats in the Americas. Patterns of nucleotide variation allowed the definition of at least 20 monophyletic clusters associated with 9 or more different bat species. Several lineages associated with distinctive antigenic patterns were found in rabies viruses related to rabies in vampire bats in Mexico. Vampire bat rabies virus lineages associated with antigenic variant 3 are widely spread from Mexico to South America, suggesting these lineages as the most likely ancestors of vampire bat rabies and the ones that have been moved by vampire bat populations throughout the Americas. Rabies viruses related to Lasiurus cinereus, Histiotus montanus, and some other not yet identified species of the genus Lasiurus were found circulating in Mexico. Long-range dissemination patterns of rabies are not necessarily associated with migratory bat species, as in the case of rabies in Desmodus rotundus and Histiotus montanus. Human rabies was associated with vampire bat transmission in most cases, and in one case, rabies transmission from free-tailed bats was inferred. The occurrence of rabies spillover from bats to domestic animals was also demonstrated. Genetic typing of rabies viruses allowed us to distinguish trends of disease dissemination and to address, in a preliminary fashion, aspects of the complex evolution of rabies viruses in different host-reservoir species.