Background
Prolonged postoperative ileus (PPOI) represents a frequent complication following colorectal surgery, affecting approximately 10–15% of these patients. The objective of this study was to ...evaluate the perioperative risk factors for PPOI development in colorectal surgery.
Methods
The present systematic review and meta-analysis was conducted in accordance with the PRISMA Statement. PubMed, EMBASE, SciELO, and LILACS databases were searched, without language or time restrictions, from inception until December 2018. The keywords used were: Ileus, colon, colorectal, sigmoid, rectal, postoperative, postoperatory, surgery, risk, factors. The Newcastle–Ottawa scale and the Jadad scale were used for bias assessment, while the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used for quality assessment of evidence on outcome levels.
Results
Of the 64 studies included, 42 were evaluated in the meta-analysis, comprising 29,736 patients (51.84% males; mean age 62 years), of whom 2844 (9.56%) developed PPOI. Significant risk factors for PPOI development were: male sex (OR 1.43; 95% CI 1.25–1.63), age (MD 3.17; 95% CI 1.63–4.71), cardiac comorbidities (OR 1.54; 95% CI 1.19–2.00), previous abdominal surgery (OR 1.44; 95% CI 1.19, 1.75), laparotomy (OR 2.47; 95% CI 1.77–3.44), and ostomy creation (OR 1.44; 95% CI 1.04–1.98). Included studies evidenced a moderate heterogeneity. The quality of evidence was regarded as very low-moderate according to the GRADE approach.
Conclusions
Multiple factors, including demographic characteristics, past medical history, and surgical approach, may increase the risk of developing PPOI in colorectal surgery patients. The awareness of these will allow a more accurate assessment of PPOI risk in order to take measures to decrease its impact on this population.
Objetivo: presentar el caso de un paciente masculino adulto joven, con ascitis pancreática secundaria a lesión del conducto pancreático por trauma abdominal cerrado, tratado con éxito con terapia ...conservadoraMaterial y método: datos e imágenes recopilados de la historia clínica del Hospital Universitario de Santander, previo consentimiento informadoResultado: masculino de 21 años con antecedente de trauma abdominal cerrado, quien consulta por distensión, dolor abdominal progresivo y pérdida de peso no cuantificada. Ante sospecha de lesión de conducto pancreático se solicitó pancreatografía por resonancia magnética que evidencia una alteración del segmento proximal del conducto pancreático principal asociado a lesión quística en el borde anterior de la unión de la cabeza con el cuerpo pancreático. Se decidió manejo conservador por 4 semanas con colocación de dren abdominal, reposo intestinal, asociado a nutrición parenteral total y análogos de somatostatina.Discusión: un 5% del trauma abdominal cerrado puede provocar pancreatitis y fugas en el conducto pancreático. Conclusión: la lesión del conducto pancreático principal debe sospecharse en todos los pacientes con trauma abdominal cerrado. El manejo debe realizarse con una planificación cuidadosa y exhaustiva.
Convalescent plasma (CP) has been widely used to treat COVID-19 and is under study. However, the variability in the current clinical trials has averted its wide use in the current pandemic. We aimed ...to evaluate the safety and efficacy of CP in severe coronavirus disease 2019 (COVID-19) in the early stages of the disease. A randomized controlled clinical study was conducted on 101 patients admitted to the hospital with confirmed severe COVID-19. Most participants had less than 14 days from symptoms onset and less than seven days from hospitalization. Fifty patients were assigned to receive CP plus standard therapy (ST), and 51 were assigned to receive ST alone. Participants in the CP arm received two doses of 250 mL each, transfused 24 h apart. All transfused plasma was obtained from "super donors" that fulfilled the following criteria: titers of anti-SARS-CoV-2 S1 IgG greater than or equai to 1:3200 and IgA greater than or equai to 1:800 antibodies. The effect of transfused anti-IFN antibodies and the SARS-CoV-2 variants at the entry of the study on the overall CP efficacy was evaluated. The primary outcomes were the reduction in viral load and the increase in IgG and IgA antibodies at 28 days of follow-up. The per-protocol analysis included 91 patients. An early but transient increase in IgG anti-S1-SARS-CoV-2 antibody levels at day 4 post-transfusion was observed (Estimated difference ED, - 1.36; 95% CI, - 2.33 to - 0.39; P = 0.04). However, CP was not associated with viral load reduction in any of the points evaluated. Analysis of secondary outcomes revealed that those patients in the CP arm disclosed a shorter time to discharge (ED adjusted for mortality, 3.1 days; 95% CI, 0.20 to 5.94; P = 0.0361) or a reduction of 2 points on the WHO scale when compared with the ST group (HR adjusted for mortality, 1.6; 95% CI, 1.03 to 2.5; P = 0.0376). There were no benefits from CP on the rates of intensive care unit admission (HR, 0.82; 95% CI, 0.35 to 1.9; P = 0.6399), mechanical ventilation (HR, 0.66; 95% CI, 0.25 to 1.7; P = 0.4039), or mortality (HR, 3.2; 95% CI, 0.64 to 16; P = 0.1584). Anti-IFN antibodies and SARS-CoV-2 variants did not influence these results. CP was not associated with viral load reduction, despite the early increase in IgG anti-SARS-CoV-2 antibodies. However, CP is safe and could be a therapeutic option to reduce the hospital length of stay.
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