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Laparoscopic treatment for appendicitis during pregnancy: Retrospective cohort study
No full textDisponible en: https://www.sciencedirect.com/science/article/pii/S204908012100618X?via%3DihubAbstract
Background: Acute appendicitis is the most frequent non-obstetric surgical emergency during pregnancy. The benefits of laparoscopy during pregnancy are well known, but complications can occur, and these can affect both the mother and/or the foetus.We present results of laparoscopic surgical treatment of acute appendicitis in pregnant women, analysing the occurrence of adverse postoperative, obstetric and foetal outcomes and reviewing literature.
Materials and methods: Retrospective observational study on pregnant women with a preoperative diagnosis of acute appendicitis.
Results: n = 63, mean age 28.4 years, average gestational age of 17.7 weeks (3-30 weeks). 6.4 % exploratory laparoscopies, 92 % laparoscopic appendectomies and one right colectomy were performed. Conversion rate was 3.2 %. When symptoms begun within 48 hours prior to surgery, a perforated appendicitis was found in 11 %; whereas when the time from symptom onset to surgery was greater than or equal to 48 hours, it was evident in 31 % of the cases (p 0.008). The only independent variable associated with the presence of postoperative complications was symptom duration prior to surgery greater than or equal to 48 hours (OR 4.8; 95 % CI 1.1-16.2; p 0.04). Seven minor and 2 mayor postoperative complications were observed. Patients with complications spent, on average, twice as many days hospitalized (p < 0.001); and had 8 times more risk of preterm delivery (p 0.03). Obstetric complications were more frequent in pregnant women operated during the first trimester. Foetal mortality was 1.6 %.
Conclusion: Surgical morbidity of acute appendicitis in pregnant women is linked to the delay in the diagnosis and treatment of the inflammatory condition. Laparoscopic appendectomy during pregnancy is not exempt from postoperative, obstetric and foetal complications. It is necessary to standardize the definitions of "complication" in order to collate reliably the outcomes presented in the literature.
Keywords: Acute appendicitis; Complications; Pregnancy.
© 2021 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd
Update on the epidemiology of carbapenemases in Latin America and the Caribbean
No full textDisponible en: https://www.tandfonline.com/doi/abs/10.1080/14787210.2020.1813023Abstract
Introduction: Carbapenemases are β-lactamases able to hydrolyze a wide range of β-lactam antibiotics, including carbapenems. Carbapenemase production in Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter spp., with and without the co-expression of other β-lactamases is a serious public health threat. Carbapenemases belong to three main classes according to the Ambler classification: class A, class B, and class D.
Areas covered: Carbapenemase-bearing pathogens are endemic in Latin America. In this review, we update the status of carbapenemases in Latin America and the Caribbean.
Expert opinion: Understanding the current epidemiology of carbapenemases in Latin America and the Caribbean is of critical importance to improve infection control policies limiting the dissemination of multi-drug-resistant pathogens and in implementing appropriate antimicrobial therapy.
Keywords: Acinetobacter baumannii; Klebsiella pneumoniae; Pseudomonas aeruginosa; Latin America; carbapenem resistance; carbapenem-resistant Enterobacterales (CRE); carbapenemases; carbapenems
Preeclampsia and COVID-19: results from the INTERCOVID prospective longitudinal study
No full textDisponible en: https://www.clinicalkey.es/#!/content/playContent/1-s2.0-S0002937821005615?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0002937821005615%3Fshowall%3Dtrue&referrer=https:%2F%2Fpubmed.ncbi.nlm.nih.gov%2FAbstract
Background: It is unclear whether the suggested link between COVID-19 during pregnancy and preeclampsia is an independent association or if these are caused by common risk factors.
Objective: This study aimed to quantify any independent association between COVID-19 during pregnancy and preeclampsia and to determine the effect of these variables on maternal and neonatal morbidity and mortality.
Study design: This was a large, longitudinal, prospective, unmatched diagnosed and not-diagnosed observational study assessing the effect of COVID-19 during pregnancy on mothers and neonates. Two consecutive not-diagnosed women were concomitantly enrolled immediately after each diagnosed woman was identified, at any stage during pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed until hospital discharge using the standardized INTERGROWTH-21st protocols and electronic data management system. A total of 43 institutions in 18 countries contributed to the study sample. The independent association between the 2 entities was quantified with the risk factors known to be associated with preeclampsia analyzed in each group. The outcomes were compared among women with COVID-19 alone, preeclampsia alone, both conditions, and those without either of the 2 conditions.
Results: We enrolled 2184 pregnant women; of these, 725 (33.2%) were enrolled in the COVID-19 diagnosed and 1459 (66.8%) in the COVID-19 not-diagnosed groups. Of these women, 123 had preeclampsia of which 59 of 725 (8.1%) were in the COVID-19 diagnosed group and 64 of 1459 (4.4%) were in the not-diagnosed group (risk ratio, 1.86; 95% confidence interval, 1.32-2.61). After adjustment for sociodemographic factors and conditions associated with both COVID-19 and preeclampsia, the risk ratio for preeclampsia remained significant among all women (risk ratio, 1.77; 95% confidence interval, 1.25-2.52) and nulliparous women specifically (risk ratio, 1.89; 95% confidence interval, 1.17-3.05). There was a trend but no statistical significance among parous women (risk ratio, 1.64; 95% confidence interval, 0.99-2.73). The risk ratio for preterm birth for all women diagnosed with COVID-19 and preeclampsia was 4.05 (95% confidence interval, 2.99-5.49) and 6.26 (95% confidence interval, 4.35-9.00) for nulliparous women. Compared with women with neither condition diagnosed, the composite adverse perinatal outcome showed a stepwise increase in the risk ratio for COVID-19 without preeclampsia, preeclampsia without COVID-19, and COVID-19 with preeclampsia (risk ratio, 2.16; 95% confidence interval, 1.63-2.86; risk ratio, 2.53; 95% confidence interval, 1.44-4.45; and risk ratio, 2.84; 95% confidence interval, 1.67-4.82, respectively). Similar findings were found for the composite adverse maternal outcome with risk ratios of 1.76 (95% confidence interval, 1.32-2.35), 2.07 (95% confidence interval, 1.20-3.57), and 2.77 (95% confidence interval, 1.66-4.63). The association between COVID-19 and gestational hypertension and the direction of the effects on preterm birth and adverse perinatal and maternal outcomes, were similar to preeclampsia, but confined to nulliparous women with lower risk ratios.
Conclusion: COVID-19 during pregnancy is strongly associated with preeclampsia, especially among nulliparous women. This association is independent of any risk factors and preexisting conditions. COVID-19 severity does not seem to be a factor in this association. Both conditions are associated independently of and in an additive fashion with preterm birth, severe perinatal morbidity and mortality, and adverse maternal outcomes. Women with preeclampsia should be considered a particularly vulnerable group with regard to the risks posed by COVID-19.
Keywords: SARS-CoV 2; aspirin; cohort; gestational hypertension; hypertension; hypertensive disorders in pregnancy; infection; morbidity; mortality; obesity; overweight; preeclampsia; pregnancy; preterm birth; proteinuria; relative risk; renal disease; risk ratio; small for gestational age.
Copyright © 2021. Published by Elsevier Inc.
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Abuso del derecho al voto en la sociedad por acciones simplificada en Colombia Análisis de casos fallados por la superintendencia de sociedades
No full textLa Revista Argentina de Derecho Societario es una publicación cuatrimestral especializada en los diversos temas del Derecho Societario, coordinada por el Departamento de Derecho Empresario de la Universidad Austral junto a IJ EditoresEl art. 43 de la Ley Nº 1258 de 2008, establece la figura del abuso del derecho al voto en la Sociedad por Acciones Simplificadas, señalando que el voto debe ser ejercido i) en interés de la compañía y ii) sin el propósito de causar daño a la sociedad o a otros accionistas o de obtener para sí o para una tercera persona, ventaja injustificada; no obstante, mediante la revisión de las sentencias emitidas en los procesos judiciales que pretenden la declaratoria de abuso del derecho al voto, adelantados ante la Superintendencia de Sociedades, se determinaron cuáles son las causas que generan o no los diferentes tipos de abuso del derecho al voto que se configura actualmente en el ordenamiento jurídico colombian
Extensión de quiebra automática en las sociedades de la Sección IV
No full text... Por lo expuesto, se concluye que el socio responde con todo su patrimonio, pero sólo por su cuota parte (no por todo el pasivo social) lo que hace inaplicable la extensión automática de quiebra a las sociedades de la sección IV de la LG
La conciencia delante de la pantalla. Hacia una implementación de la Psicología deportiva humanitaria en los eSports
No full text..."Se trata principalmente de una propuesta ética, que asume la desafiante tarea de intervenir desde un lugar humanitario y profesional a fin de priorizar el desarrollo personal, y teniendo como función inexorable la de acompañar a la persona, brindando lo recursos necesarios en el trayecto deportivo, el apoyo y sostén para que se produzca una búsqueda construida de sentido, que le permita al jugador su crecimiento personal.
Comment on "Shadows Behind Using Simple Risk Models in Selection of Hepatocellular Carcinoma Patients for Liver Transplantation"
No full textDisponible en: https://journals.lww.com/annalsofsurgery/Citation/2021/12000/Comment_on__Shadows_Behind_Using_Simple_Risk.256.asp
Incidence, risk factors, clinical characteristics and outcomes of deep venous thrombosis in patients with COVID-19 attending the Emergency Department: results of the UMC-19-S8
No full textDisponible: https://journals.lww.com/euro-emergencymed/abstract/2021/06000/incidence,_risk_factors,_clinical_characteristics.13.aspxAbstract
Background and importance: A higher incidence of venous thromboembolism [both pulmonary embolism and deep vein thrombosis (DVT)] in patients with coronavirus disease 2019 (COVID-19) has been described. But little is known about the true frequency of DVT in patients who attend emergency department (ED) and are diagnosed with COVID-19.
Objective: We investigated the incidence, risk factors, clinical characteristics and outcomes of DVT in patients with COVID-19 attending the ED before hospitalization.
Methods: We retrospectively reviewed all COVID patients diagnosed with DVT in 62 Spanish EDs (20% of Spanish EDs, case group) during the first 2 months of the COVID-19 outbreak. We compared DVT-COVID-19 patients with COVID-19 without DVT patients (control group). Relative frequencies of DVT were estimated in COVID and non-COVID patients visiting the ED and annual standardized incidences were estimated for both populations. Sixty-three patient characteristics and four outcomes were compared between cases and controls.
Results: We identified 112 DVT in 74 814 patients with COVID-19 attending the ED [1.50‰; 95% confidence interval (CI), 1.23-1.80‰]. This relative frequency was similar than that observed in non-COVID patients [2109/1 388 879; 1.52‰; 95% CI, 1.45-1.69‰; odds ratio (OR) = 0.98 [0.82-1.19]. Standardized incidence of DVT was higher in COVID patients (98,38 versus 42,93/100,000/year; OR, 2.20; 95% CI, 2.03-2.38). In COVID patients, the clinical characteristics associated with a higher risk of presenting DVT were older age and having a history of venous thromboembolism, recent surgery/immobilization and hypertension; chest pain and desaturation at ED arrival and some analytical disturbances were also more frequently seen, d-dimer >5000 ng/mL being the strongest. After adjustment for age and sex, hospitalization, ICU admission and prolonged hospitalization were more frequent in cases than controls, whereas mortality was similar (OR, 1.37; 95% CI, 0.77-2.45).
Conclusions: DVT was an unusual form of COVID presentation in COVID patients but was associated with a worse prognosis