Luis Carlos Domínguez

Prophylactic Antibiotics for Mesh Inguinal Hernioplasty: A Meta-analysis

Objective:To assess the effectiveness of antibiotic prophylaxis in mesh hernioplasty. Background:Antibiotic prophylaxis use in mesh inguinal hernioplasty is controversial. Available evidence is nonconclusive because of the low number of clinical trials assessing its effectiveness. Some trials have a small sample size that could overestimate or underestimate the real effectiveness of this intervention. Meta-analysis is a good method to improve these methodological flaws. Methods:Meta-analysis intended to measure the benefits of antibiotic prophylaxis on surgical site infection rate in adult patients scheduled for mesh inguinal hernioplasty. Six randomized clinical trials were found. Quality was assessed using Cochrane Collaboration criteria. Results:A total of 2507 patients were analyzed. Surgical site infection frequency was 1.38% in the antibiotic group versus 2.89% in the control group (odds ratio = 0.48; 95% confidence interval, 0.27–0.85). There was no statistical heterogeneity. Sensitivity analysis by quality did not show differences in overall results. Conclusion:Antibiotic prophylaxis use in patients submitted to mesh inguinal hernioplasty decreased the rate of surgical site infection by almost 50%.

Impacto de la estrategia de aula invertida en el ambiente de aprendizaje en cirugía: una comparación con la clase magistral

INTRODUCTION The Facultad de Medicina of the Universidad de La Sabana routinely uses lectures as the major educational strategy in clinical areas. Since 2012, a curriculum in context and a flipped classroom were introduced in the surgery course. OBJECTIVE To compare the impact of lectures versus the flipped classroom model in the learning environment in surgery. MATERIALS AND METHODS The Dundee Ready Education Environment Measure (DREEM) questionnaire was administered to four cohorts of students. The five domains and the overall scores for both strategies were analyzed, and ANOVA was used to determine the differences among the domains (p<0.05). The internal consistency was assessed using Cronbach´s alpha coefficient. RESULTS There were 207 participants (men: 36%) that completed the questionnaire (age: 21.9 ± 1.49 years old). The overall DREEM score and the subscales were higher with the flipped classroom, which suggests that this environment had a higher level of excellence. The ANOVA for each domain and the overall scores showed no differences with a flipped classroom. However, significant differences were identified in all domains and the overall scores with lectures (p<0.01). There were high levels of reliability (Cronbach>0.90) for all measurements in both environments, and there was consistency across all cohorts. CONCLUSIONS The flipped classroom strategy showed a higher score than the lecture-based approach according to the DREEM questionnaire. Identifying factors with a negative score is crucial to improving the learning environment. It is necessary to conduct further measurements over time to ensure the quality and success of the strategy.

Bilateral necrotizing fasciitis of the breast following quadrantectomy

Necrotizing fasciitis (NF) is a rare and highly lethal soft-tissue infection that involves the skin, subcutaneous tissue, and fascia. Although it can affect any part of the body, the breast is seldom involved. We describe a case of bilateral NF of the breast following elective quadrantectomy, successfully treated with antibiotics, bilateral mastectomy, and a vacuum-assisted wound closure system.

Prognosis of patients with thyroid cancer who do not undergo surgical treatment: a SEER database analysis.

BackgroundThe treatment for thyroid cancer is surgical. However, some patients do not undergo operations because of comorbidities or other reasons. There is little information about the prognosis of these patients. The aim of the present study was to describe patients with well differentiated thyroid carcinoma who did not undergo surgical treatment and to identify differences in prognostic variables and survival compared with patients treated surgically.MethodsWe conducted a retrospective review of a prospective cohort collected by the National Cancer Institute obtained from the Surveillance, Epidemiology and End Results (SEER) Program. All patient fi les with a diagnosis of thyroid cancer were selected (38,493 cases). Finally, 12,416 cases were used for the analysis. Treatment was divided into surgical or nonsurgical groups. Five-year survival rates were estimated and classifi ed by the SEER stage.ResultsEighty-six patients did not receive surgical treatment. These patients were older, had more advanced tumours and their treatment was less associated with complementary radiotherapy. Five-year overall survival rates were 96.7% for surgical patients vs. 56.8% for nonsurgical patients (p<0.001). The overall survival in the nonsurgery group for localised tumours decreased 14.9%, for regional tumours decreased 49.9% and for distant tumours decreased 61.8%.DiscussionThe patients who did not undergo surgical treatment showed less than 5-year overall survival. The SEER database does not offer information about comorbidities that could explain these differences.

Cost-effectiveness analysis regarding postoperative administration of vitamin-D and calcium after thyroidectomy to prevent hypocalcaemia

OBJECTIVE Hypocalcaemia is a frequently arising complication following total thyroidectomy. Routine postoperative prophylactic administration of vitamin D or metabolites and calcium reduce the incidence of symptomatic hypocalcaemia; this article reports evaluating its cost-effectiveness in Colombia. METHODS Meta-analysis was used for comparing the administration of vitamin D or metabolites to oral calcium or no treatment at all in patients following total thyroidectomy and a cost-effectiveness analysis was designed based on a decision-tree model with local costs. RESULTS The OR value for the comparison between calcitriol and calcium compared to no treatment and to exclusive calcium treatment groups was 0.32 (0.13-0.79 95 %CI) and 0.31 (0.14-0.70 95 %CI), respectively. The most cost-effective strategy was vitamin D or metabolites and calcium administration, having a US

Total thyroidectomy versus hemithyroidectomy for patients with follicular neoplasm. A cost-utility analysis

0.05 incremental cost-effectiveness ratio. CONCLUSION Prophylactic treatment of hypocalcaemia with vitamin D or metabolites + calcium or calcium alone is a cost-effective strategy.

Análisis de los factores de conversión durante colecistectomía laparoscópica a abierta en una cohorte prospectiva de 703 pacientes con colecistitis aguda

INTRODUCTION Thyroid nodules are a common condition. Overall, 20% of the nodules assessed with FNAB correspond to the follicular pattern. A partial thyroidectomy is the minimal procedure that should be performed to determine the nature of these nodules. Some authors have suggested performing a total thyroidectomy based on the elimination of reoperation and ultrasound follow-up. The aim of this study was to evaluate the most cost-useful surgical strategy in a patient with an undetermined nodule, assessing complications, reoperation, recurrence and costs. MATERIAL AND METHODS A cost-utility study was designed to compare hemithyroidectomy and total thyroidectomy. The outcomes were complications (definitive RLN palsy, permanent hypoparathyroidism, reoperation for cancer, and recurrence of the disease), direct costs and utility. We used the payer perspective at 5 years. A deterministic and probabilistic sensitivity analysis was completed. RESULTS In a deterministic analysis, the cost, utility and cost-utility ratio was COP

Impacto de la estrategia “flipped classroom” en el ambiente de aprendizaje en cirugía: una comparación con la clase magistral

12.981.801, 44.5 and COP

The evolution of laparoscopy in abdominal surgery: A meta-analysis of the effect on infectious outcomes

291.310 for total thyroidectomy and COP

Taking control: Is job crafting related to the intention to leave surgical training?

14.309.889, 42.0 and