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Background: Using a previously unreported Peruvian registry of patients treated for early-stage non-small cell lung cancer (NSCLC), this study explored whether wedge resection and lobectomy were equivalent regarding survival and impact on radiologic-pathologic variables. Methods: This observational, analytical, longitudinal study used propensity score-matched (PSM) analysis of a single-center retrospective registry of 2,570 patients with pathologic stage I-II NSCLC who were treated with wedge resection (n=1,845) or lobectomy (n=725) during 2000-2020. After PSM, 650 cases were analyzed (resection, n=325; lobectomy, n=325) through preoperative and clinical variables, including patients with ≥1 lymph node removed. Kaplan-Meier curves and multivariable Cox proportional hazard models were created for 5-year overall survival (OS), disease-free survival (DFS), and locoregional-recurrence-free survival (LRFS). Results: The principal complication was operative pain persisting >7 days for lobectomy versus wedge resection (58% vs. 23%, p=0.034) and shorter hospital stays for resection than for lobectomy (5.3 days vs. 12.8 days, p=0.009). The 5-year OS (84.3% vs. 81.2%, p=0.09) and DFS (79.1% vs. 74.1%, p=0.07) were similar and statistically insignificant between resections and lobectomies, respectively. LRFS was worse overall following wedge resection than lobectomy (79.8% vs. 91.1%, p<0.02). Nevertheless, in the PSM analysis, both groups experienced similar LRFS when the resection margin was >10 mm (90.9% vs. 87.3%, p<0.048) and ≥4 lymph nodes were removed (82.8% vs. 79.1%, p<0.011). Conclusion: Both techniques led to similar OS and DFS at 5 years; however, successful LRFS required a wedge resection with a surgical margin and adequate lymph node removal to obtain outcomes similar to lobectomy.

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OBJECTIVE: This study explored the current global landscape of periprocedural care of acute ischemic stroke patients undergoing endovascular thrombectomy (EVT). METHODS: An anonymous, 54-question electronic survey was sent to 354 recipients in hospitals worldwide. The responses were stratified by World Bank country income level into high-income (HICs) and low/middle-income (LMICs) countries. RESULTS: A total of 354 survey invitations were issued. Two hundred twenty-three respondents started the survey, and 87 fully completed surveys were obtained from centers in which anesthesiologists were routinely involved in EVT care (38 in HICs; 49 in LMICs). Respondents from 35 (92.1%) HICs and 14 (28.6%) LMICs reported that their centers performed >50 EVTs annually. Respondents from both HICs and LMICs reported low rates of anesthesiologist involvement in pre-EVT care, though a communication system was in place in 100% of HIC centers and 85.7% of LMIC centers to inform anesthesiologists about potential EVTs. Respondents from 71.1% of HIC centers and 51% of LMIC centers reported following a published guideline during EVT management, though the use of cognitive aids was low in both (28.9% and 24.5% in HICs and LMICs, respectively). Variability in multiple areas of practice, including choice of anesthetic techniques, monitoring and management of physiological variables during EVT, and monitoring during intrahospital transport, were reported. Quality metrics were rarely tracked or reported to the anesthesiology teams. CONCLUSIONS: This study demonstrated variability in anesthesiology involvement and in clinical care during and after EVT. Centers may consider routinely involving anesthesiologists in pre-EVT care, using evidence-based recommendations for EVT management, and tracking adherence to published guidelines and other quality metrics.

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The effects of hypertension on perioperative outcomes are still unclear. No specific systolic or diastolic blood pressure measurement has been determined as the cutoff value to continue with a surgical plan or adjourn. This study is designed as a narrative review of the available scientific evidence on the perioperative management of hypertension. A search was conducted in Pubmed considering the title and abstract; 120 articles were pre-selected of which 55 papers were selected for full-text eligibility and 16 were excluded for a total of 39 articles including ACCF/AHA 2009 and ACC/AHA 2014 on perioperative cardiovascular care; 2013 ESH/ESC, 8 JNC, and the 2017 ACC/AHA/AAPA/ABC Guideline for the Prevention, detection, and management of hypertension in adults. Blood pressure values, target organ damage, and type of surgery should be considered for decision-making in the perioperative period. If surgery is elective, blood pressure fluctuations should be avoided and potential causes should be treated. A patient with mild hypertension with values below SBP 160 and DBP 110 mmHg may be managed in the ambulatory setting during the postoperative period, as long as the clinical conditions are favorable.

Los efectos de la hipertensión sobre los desenlaces durante el periodo perioperatorio aún no han quedado claramente establecidos. No se ha determinado una medición específica para la presión sistólica ni diastólica como punto de corte para continuar con el plan quirúrgico o suspenderlo. El presente estudio está diseñado a manera de revisión narrativa de la evidencia científica disponible sobre el manejo perioperatorio de la hipertensión. Se llevó a cabo una búsqueda en Pubmed, considerando el título y el resumen; se preseleccionaron 120 artículos, de los cuales se seleccionaron 55 para elegibilidad en texto completo y 16 se excluyeron, quedando un total de 39 artículos, incluyendo ACCF/AHA 2009 y ACC/AHA 2014 sobre el cuidado cardiovascular perioperatorio; 2013 ESH/ESC, 8 JNC, y la Guía del 2017 ACC/AHA/AAPA/ABC para la prevención, detección y manejo de la hipertensión en adultos. Se deben considerar los valores de la presión arterial, el daño a órgano diana y el tipo de cirugía para la toma de decisiones en el periodo perioperatorio. Si la cirugía es electiva, deben evitarse las fluctuaciones en la presión arterial y tratar activamente cualquiera de las causas potenciales. Un paciente con hipertensión leve, con valores por debajo de PAS 160 y PAD 110 mmHg puede manejarse de manera ambulatoria durante el período postoperatorio, siempre y cuando las condiciones clínicas sean favorables.

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BACKGROUND: An institutional management protocol for patients with subarachnoid hemorrhage (SAH) based on initial cardiac assessment, permissiveness of negative fluid balances, and use of a continuous albumin infusion as the main fluid therapy for the first 5 days of the intensive care unit (ICU) stay was implemented at our hospital in 2014. It aimed at achieving and maintaining euvolemia and hemodynamic stability to prevent ischemic events and complications in the ICU by reducing periods of hypovolemia or hemodynamic instability. This study aimed at assessing the effect of the implemented management protocol on the incidence of delayed cerebral ischemia (DCI), mortality, and other relevant outcomes in patients with SAH during ICU stay. METHODS: We conducted a quasi-experimental study with historical controls based on electronic medical records of adults with SAH admitted to the ICU at a tertiary care university hospital in Cali, Colombia. The patients treated between 2011 and 2014 were the control group, and those treated between 2014 and 2018 were the intervention group. We collected baseline clinical characteristics, cointerventions, occurrence of DCI, vital status after 6 months, neurological status after 6 months, hydroelectrolytic imbalances, and other SAH complication. Multivariable and sensitivity analyses that controlled for confounding and considered the presence of competing risks were used to adequately estimate the effects of the management protocol. The study was approved by our institutional ethics review board before study start. RESULTS: One hundred eighty-nine patients were included for analysis. The management protocol was associated with a reduced incidence of DCI (hazard ratio 0.52 [95% confidence interval 0.33-0.83] from multivariable subdistribution hazards model) and hyponatremia (relative risk 0.55 [95% confidence interval 0.37-0.80]). The management protocol was not associated with higher hospital or long-term mortality, nor with a higher occurrence of other unfavorable outcomes (pulmonary edema, rebleeding, hydrocephalus, hypernatremia, pneumonia). The intervention group also had lower daily and cumulative administered fluids compared with historic controls (p < 0.0001). CONCLUSIONS: A management protocol based on hemodynamically oriented fluid therapy in combination with a continuous albumin infusion as the main fluid during the first 5 days of the ICU stay appears beneficial for patients with SAH because it was associated with reduced incidence of DCI and hyponatremia. Proposed mechanisms include improved hemodynamic stability that allows euvolemia and reduces the risk of ischemia, among others.

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Porcine epidemic diarrhoea virus (PEDV) infects pigs of all ages causing vomiting and diarrhoea. PEDV is transmitted via the oral-faecal route, and a very low dose is enough to infect susceptible pigs, resulting in significant production losses. This short communication aims to describe the introduction of PEDV into a 10,000-sow farrow-to-wean farm located in northwest Mexico. Following the onset of clinical signs, an outbreak investigation was conducted to determine the most probable route of introduction. Based on data collected from interviews, construction of a timeline of events, and the detection of PEDV RNA in feed samples and samples collected from various surfaces of feed transport vehicles, it was concluded that the most probable route for PEDV incursion into this breeding herd was contaminated feed or a contaminated feed transport vehicle. This paper describes how feed or feed transport could serve as potential routes of PEDV infection to a farm and highlights the importance of establishing biosecurity programs to mitigate these risks.

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Influenza A virus (IAV) active surveillance in pigs prior to weaning is commonly conducted by collecting individual samples, mostly nasal swabs. Recently, the use of udder skin wipes collected from lactating sows was identified as an effective sampling method to indicate IAV status of suckling piglets prior to weaning. However, there is limited information on the effect of pooling multiple udder wipes on the ability to detect IAV. We evaluated the effect of pooling 3, 5, or 10 udder wipes on the sensitivity of detecting IAV and compared the results with testing the wipes individually. The likelihood of detecting positive udder wipes decreased with pooling when the initial positive cycle threshold value was ≥31.5; pooling of up to 3 samples could be performed without affecting sensitivity significantly. Our results support pooling of udder skin wipes to conduct surveillance of IAV in pigs prior to weaning.

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Based on the conceptualizations of organized crime as both an enterprise and a form of governance, borderland as a spatial category, and borders as institutions, this paper looks at the politics of bordering practices by organized crime in the Colombian-Venezuelan borderlands. It posits that contrary to the common assumptions about transnational organized crime, criminal organizations not only blur or erode the border but rather enforce it to their own benefit. In doing so, these groups set norms to regulate socio-spatial practices, informal and illegal economies, and migration flows, creating overlapping social orders and, lastly, (re)shaping the borderland. Theoretically, the analysis brings together insights from political geography, border studies, and organized crime literature, while empirically, it draws on direct observation, criminal justice data, and in-depth interviews.

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BACKGROUND: Literature on diabetes insipidus (DI) after severe traumatic brain injury (TBI) is scarce. Some studies have reported varying frequencies of DI and have showed its association with increased mortality, suggesting it as a marker of poor outcome. This knowledge gap in the acute care consequences of DI in severe TBI patients led us to conceive this study, aimed at identifying risk factors and quantifying the effect of DI on short-term functional outcomes and mortality. METHODS: We assembled a historic cohort of adult patients with severe TBI (Glasgow Coma Scale ≤ 8) admitted to the intensive care unit (ICU) of a tertiary-care university hospital over a 6-year period. Basic demographic characteristics, clinical information, imaging findings, and laboratory results were collected. We used logistic regression models to assess potential risk factors for the development of DI, and the association of this condition with death and unfavorable functional outcomes [modified Rankin scale (mRS)] at hospital discharge. RESULTS: A total of 317 patients were included in the study. The frequency of DI was 14.82%, and it presented at a median of 2 days (IQR 1-3) after ICU admission. Severity according to the Abbreviated Injury Scale (AIS) score of the head, intracerebral hemorrhage, subdural hematoma, and skull base fracture was suggested as risk factors for DI. Diagnosis of DI was independently associated death (OR 4.34, CI 95% 1.92-10.11, p = 0.0005) and unfavorable outcome (modified Rankin Scale = 4-6) at discharge (OR 7.38; CI 95% 2.15-37.21, p = 0.0047). CONCLUSIONS: Diabetes insipidus is a frequent and early complication in patients with severe TBI in the ICU and is strongly associated with increased mortality and poor short-term outcomes. We provide clinically useful risk factors that will help detect DI early to improve prognosis and therapy of patients with severe TBI.

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South America is a subcontinent with 393 million inhabitants with widely distinct countries and diverse ethnicities, cultures, political and societal organizations. The epidemiological transition that accompanied the technological and demographic evolution is happening in South America and leading to a rise in the incidence of neurodegenerative and cardiovascular diseases that now coexist with the still high burden of infectious diseases. South America is also quite heterogeneous regarding the existence of systems of care for the various neurological emergencies, with some countries having well-organized systems for some diseases, while others have no plan of action for the care of patients with acute neurological symptoms. In this article, we discuss the existing systems of care in different countries of South America for the treatment of neurological emergencies, mainly stroke, status epilepticus, and traumatic brain injury. We also will address existing gaps between the current systems and recommendations from the literature to improve the management of such emergencies, as well as strategies on how to solve these disparities.

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Abstract Introduction: To achieve minimal physiological goals in patients with penetrating thoracoabdominal trauma (TAPT) is essential to ensure adequate outcomes. Objectives: To determine the success in meting basic standards at the end of damage control surgery in subjects with TAPT: (1) Monitoring and prevention of hyperfibrinolysis; (2) central temperature >35 °C; (3) platelet count >50,000/mm³ and serum fibrinogen >150mg/dl; (4) hemoglobin levels >7.5 mg/dl and base deficit <6. Methods: Subjects >18 years old undergoing damage control surgery as a result of TAPT were prospectively collected at a referral center between October Oct-2012 and Dec-2014. Comparisons were done according to the Injury Severity Score (ISS) with a severity value indicator of >25. A p < 0.05 value was considered significant. Results:106 subjects with TAPT were enrolled. Administration of tranexamic acid was only reported in 52.7% of the patients, particularly in the group with low severity scores [Group ISS < 25 36.3% vs. group ISS > 25 65.8%. OR 3.37 (95% CI 1.2-9.85); p = 0.01]. Although the temperature was reported in 91% of the cases, only 66.2-71.4% reached the recommended goal. Serum fibrinogen was measured in 59.5% of the cases and only 52% met the recommended level. The base deficit values of <6 at the end of surgery were only accomplished in 40-43.8% of the subjects, with a significantly lower probability in the more severe patients [53% vs. 35.9%. OR 2.04 (95% CI 1.2-6.02); p = 0.042]. Conclusions: A considerable proportion of patients with TAPT does not meet the current recommendations at the end of damage control surgery.

Introducción: El logro de metas fisiológicas mínimas en pacientes con trauma toracoabdominal penetrante (TTAP) es fundamental para garantizar adecuados desenlaces. Objetivos: Determinar el éxito en el logro de estándares básicos al final de la cirugía de control de daños en sujetos con TTAP: 1.Monitorización y prevención de hiperfibrinolisis; 2.Temperatura central > 35 °C; 3.Niveles plaquetarios>50.000/mm3 y de fibrinógeno sérico > 150 mg/dl; 4.Niveles de hemoglobina > 7.5 mg/dl y déficit de base < 6. Métodos: Se recolectaron prospectivamente sujetos > 18 años llevados a cirugía de control de daños por TTAP en un centro de remisión entre Oct-2012 y Dic-2014. Las comparaciones se realizaron según el Injury severity score (ISS) teniendo como indicador de severidad un valor >25. Se consideró significativo un valor de p < 0.05. Resultados: Se registraron 106 sujetos con TTAP. La aplicación de ácido tranexámico solo se reportó en 52.7% de los pacientes, especialmente en el grupo con puntajes de severidad bajos [Grupo ISS<25 36.3% vs. grupo ISS > 25 65.8%. OR 3.37 (IC95% 1.2-9.85); p = 0.01]. A pesar de que la temperatura fue reportada en 91% de los casos, solo 66.2-71.4% alcanzaron la meta recomendada. El fibrinógeno sérico fue valorado en 59.5% de los sujetos y solo 52% alcanzaron la recomendación. Valores de déficit de base < 6 Al final de cirugía solo se lograron en 40-43.8% de los sujetos, con una probabilidad significativamente menor en los sujetos más graves [53% vs. 35.9%. OR 2.04 (IC95% 1.2-6.02); p = 0.042]. Conclusiones: Una proporción considerable de pacientes con TTAP no logran las recomendaciones actuales al final de la cirugía de control de daños.

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