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7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK, Purpose of the study To evaluate long‐term outcomes in pts maintaining a NVP‐based regimen Methods Retrospective cohort study. Pts received a NVP regimen for at least 5 years and continued [...]

This study aims to describe the present status of robotic surgery (RS) in Latin America. A cross-sectional study was conducted, collecting data from 10 robotic programs in 6 Latin American countries through surveys of surgical specialists and heads of surgical services. The utilization of RS in Latin America exhibits significant variability depending on the specific country and healthcare facilities. This variability encompasses factors such as the annual volume of surgeries, the types of institutions involved, and the primary medical specialties employing this technology. Concerted efforts within the region to augment scientific research output about robotic procedures are imperative. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The general objective of this study is to explain differentials in prenatal care (PNC) utilization in a nationally representative sample of non-Hispanic White (Anglo), African American, and Mexican American women. METHOD: The analysis is based on the National Maternal and Infant Health Survey. Multivariate, multinomial logistic regression models were employed to adjust for demographic, socioeconomic, medical risk, and program participation factors, as well as for perceived barriers. Both race/ethnic-specific models and models with race/ethnicity as a covariate were estimated. RESULTS: Inadequate PNC use was much less common among Anglos (10.4%) as compared to African Americans and Mexican Americans (22.1% and 25.0%, respectively). In fully adjusted models, the odds ratio (OR) of African Americans receiving inadequate PNC was 1.46, while the risk for Mexican Americans was greater (OR = 1.93). Perception of obstacles to PNC access doubled the odds of receiving inadequate care, but this psychosocial variable had little impact on race/ethnic differentials. Race/ethnic-specific models uncovered potentially important racial/ethnic variations associated with perception of barriers, marital status, and program participation. CONCLUSIONS: Although the same risk factors sometimes have different effects across race/ethnic groups, and while certain findings indicate a beneficial impact of health outreach efforts and program participation, our findings support the conclusion that PNC utilization continues to be stratified along race/ethnic lines. [ABSTRACT FROM AUTHOR]

The clinical course, changes in liver function tests and the behaviour of viral markers over the course of time have been examined in 45 patients with acute hepatitis B and 14 patients with acute hepatitis caused by B and D viruses coinfection. There were no significant differences either in the clinical course or in the liver function tests, in the two groups. The changes in serum viral markers were as follows: HBV-DNA was the first marker to disappear; this was closely followed by HBeAg, and HBsAg was the last marker to become negative, during convalescence. This pattern was not altered by Delta coinfection. When we quantified serum HBV-DNA in both groups of patients, we found that Delta virus infection led to partial inhibition of HBV replication, so that serum HBV-DNA levels were significantly lower in those patients with acute hepatitis B who were simultaneously infected with Delta virus. [ABSTRACT FROM AUTHOR]

A 55 year old man with a left ventricular aneurysm, secondary to a previous myocardial infarction, was hospitalized due to a Salmonella virchow bacteraemia. During a 3-week hospital course he was persistently bacteraemic and febrile despite antibiotic treatment. Gallium isotope scanning and 2-D-echocardiography were helpful in demonstrating the presence of an infected false aneurysm at the site of a true aneurysm. Surgical resection in addition to prolonged antibiotic therapy was necessary for cure. [ABSTRACT FROM PUBLISHER]

Objective: This systematic review and meta-analysis aimed to determine the degree to which pancreaticobiliary maljunction (PBM) increases the risk of different types of biliary cancer (BC)., Methods: A systematic review and meta-analysis were carried out using the following databases: PubMed, Embase, Cochrane Library, Scopus, Web of Science, and Science Direct. We systematically searched from inception to April 2024. The search terms included were derived from the keywords "Pancreaticobiliary Maljunction" OR "Anomalous Pancreaticobiliary Junction" AND "Cancer" OR "Malignancy". Studies that provided data comparing BC rates in relation to PBM presence or vice versa were included. The Newcastle-Ottawa Scale (NOS) was used for quality assessment. The random-effects model was used., Results: Fifteen studies were included with a total sample of 8604 patients, of whom 5015 (58.29%) were female with a mean age of 54.58 years. Patients with PBM had 8.42 (95% CI = 3.57-19.87) more risk of developing any type of BC, with a higher risk of GBC than BDC (OR = 16.91 vs. OR = 3.36, p -value = 0.003). There was a higher risk of having PBM in patients with GBC than BDC only when considering the Asian population (OR = 3.12, 95% CI = 1.09-8.94). Meta-regression analysis revealed that neither mean age ( p = 0.087) nor percentage of female patients in the study population ( p = 0.197) were statistically associated with the variations in OR for the risk of BC based on the presence of PBM., Conclusions: There is a significant association between PBM and the risk of having BC, mainly GBC when compared to BDC. Most of the studies published reported data from Japanese patients, which limits the generalization of the results. The age of patients and sex were not significantly associated with the relation between PBM and BC. Further prospective studies in broader populations will provide additional details to take measures for screening and early management of PBM and BC.

Background:  Robotic metabolic and bariatric surgery (RMBS) has emerged as an innovative approach in the treatment of severe obesity by combining the ergonomic precision of robotic technology and instrumentation with the established benefits of weight loss surgery. This study employs a bibliometric approach to identify local research trends and worldwide patterns in RMBS., Materials & Methods:  The research methodology used "robotic" and "metabolic" or "bariatric surgery" to search Web of Science. Articles that were published prior to December 31st, 2023, were included. The analyses were developed using the Rayyan and Bibliometric, in R Studio., Results:  265 articles from 51 different journals were included. Scientific production of RMBS experienced a significant annual growth rate of 21.96% from 2003 to 2023, resulting in an average of 12.6 papers published per year. A high correlation (R2 = 0.94) was found between the year and number of articles. The mean number of citations per document was 13.25. Approximately 90% of the journals were classified as zone 3, according to the Bradford categorization. International collaboration was identified in 10.57% of cases, with the University of California and the University of Illinois being the most common organizations. The countries with the highest number of corresponding authors, in descending order, were the United States of America, China, and Switzerland., Conclusion:  Scientific production in RMBS has experienced sustained growth since the first original publications in 2003. While it has not yet reached the volume, impact, and international collaboration seen in studies related to non-robotic metabolic and bariatric surgery, RBMS holds potential that remains to be explored., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

The rise of robotic surgery throughout the world, particularly in Latin America, justifies an objective evaluation of research in this field. This study aimed to use bibliometric techniques to identify the research trends and patterns of robotic surgery in Latin America. The research strategy used the terms "Robotic," "Surgery," and the name of all the Latin American countries, in all fields and collections of Web of Science database. Only original articles published between 2009 and 2022 were included. The software Rayyan, Bibliometric in the R Studio, and VOSViewer were used to develop the analyses. After screening, 96 articles were included from 60 different journals. There was a 22.51% annual increase in the scientific production of robotic surgery in the period studied. The more frequent topics by specialty were: Urology (35.4%), General Surgery (34.4%), and Obstetrics and Gynecology (12%). International cooperation was observed in 65.62% of the studies. The Latin American institution with the highest production of manuscripts was the Pontificia Universidad Católica de Chile. Mexico, Chile, and Brazil were, in descending order, the nations with the highest number of corresponding authors and total citations. When considering the total number of articles, Brazil ranked ahead of Chile. Scientific production regarding robotic surgery in Latin America has experienced accelerated growth since its beginning, supported by the high degree of collaboration with leading countries in the field., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Robotic surgery (RS) is an evolution of minimally invasive surgery that combines medical science, robotics, and engineering. The first robots approved by the Food and Drug Administration (FDA) were the Da Vinci Surgical System and the ZEUS Robotic Surgical System, which have been improving over time. Through the decades, the equipment applied to RS had undergone a wide transformation as a response to the development of new techniques and facilities for the assembly and implementation of the own. RS has revolutionized the field of urology, enabling surgeons to perform complex procedures with greater precision and accuracy, and many other surgical specialties such as gynecology, general surgery, otolaryngology, cardiothoracic surgery, and neurosurgery. Several benefits, such as a better approach to the surgical site, a three-dimensional image that improves depth perception, and smaller scars, enhance range of motion, allowing the surgeon to conduct more complicated surgical operations, and reduced postoperative complications have made robotic-assisted surgery an increasingly popular approach. However, some points like the cost of surgical procedures, equipment-instrument, and maintenance are important aspects to consider. Machine learning will likely have a role to play in surgical training shortly through "automated performance metrics," where algorithms observe and "learn" individual surgeons' techniques, assess performance, and anticipate surgical outcomes with the potential to individualize surgical training and aid decision-making in real time., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Rivero-Moreno et al.)

Blunt aortic injury is the second most prevalent cause of patient fatalities post-trauma, closely following head injuries as the leading cause. In recent years, thoracic endovascular aortic repair (TEVAR) has evidently improved survival rates and reduced complications in patients suffering from blunt traumatic aortic injury (BTAI) in comparison to open surgery and non-operative management. It is difficult to characterize the appropriate criteria for the timing of TEVAR, whether early or delayed for BTAI, considering the discrepancies related to timing. Electronic databases, including PubMed, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), and Embase, were searched through April 2023. The primary outcomes were short-term mortality and hospital and intensive care unit (ICU) stays. Time to TEVAR, acute respiratory distress syndrome, sepsis, deep vein thrombosis, delayed stroke, and renal failure were also evaluated. We included a total of seven studies, comprising 4177 patients who met the inclusion criteria. Short-term mortality was significantly higher in the early TEVAR group (RR: 1.86; 95% confidence interval (CI); (1.26-2.74); p<0.001; I 2 =33%). In contrast, the ICU length of stay was significantly shorter in the early group (mean difference: -2.82 days; 95% CI; (-4.09 - -1.56); p<0.0001; I 2 =55%). There was no significant difference between both groups in the presenting profile or postoperative complications. Patients undergoing delayed TEVAR had markedly lower mortality rates but a longer ICU stay. The need for future studies with more robust designs is imperative to investigate the factors influencing the timing of repair and the associated outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Rudra et al.)

Appendicitis, an acute inflammation of the appendix, affects all demographic groups and exhibits various incidences and clinical manifestations. While acute appendicitis typically presents with colicky periumbilical abdominal pain that localizes to the right lower quadrant, atypical presentations are more common in children, geriatric, and pregnant patient populations, leading to delays in diagnosis. Clinical evaluation, clinical scoring systems, and inflammatory markers are commonly used, but their limitations have led to the increased use of diagnostic imaging in patients suspected of appendicitis. Acute appendicitis is managed by non-operative and operative management, depending on whether it is uncomplicated or complicated. Developing diagnostic pathways to improve outcomes and reduce complications is crucial. Although medical advancements have been made, diagnosing and managing appendicitis can be challenging, mainly when patients are present atypically. This literature review aims to comprehensively review typical and atypical presentations of appendicitis and their current implications for diagnosis and treatment modalities in pediatric, adult, pregnant, and geriatric patient populations., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Echevarria† et al.)

Study Objectives: We describe research methods developed to examine effects of sleep disruption on changes in immune balance, lung function, and cognitive performance in a sample of urban, ethnically diverse children with persistent asthma. Two case examples (8- and 10-year-old males) are presented to highlight methods of the current study and illustrate effects of experimentally disrupted sleep on the immune balance profile (Th1/Th2 cytokines), key sleep variables from polysomnography data, and lung function in our sample., Methods: Children follow an individualized structured sleep schedule consistent with their habitual sleep need (≥9.5 hours' time in bed) for six days before a laboratory-based experimental sleep protocol. Children then spend two successive nights in the sleep lab monitored by polysomnography: a baseline night consisting of uninterrupted sleep, and a disruption night, during which they are awoken for 2 minutes between 20-minute intervals of uninterrupted sleep. Evening and morning blood draws bracket baseline and disruption nights for immune biomarker assessment., Results: A shift towards immune imbalance following the sleep disruption protocol was observed in these illustrative cases., Conclusions: Data from these case examples provide evidence that the experimental protocol caused disruptions in sleep as observed on polysomnography and had the hypothesized downstream effects on immune balance associated with clinical asthma control. Documenting the effects of sleep disruption on immune function in children with persistent asthma is a crucial step towards understanding associations between sleep, immune balance, and asthma outcomes and provides important information for developing novel interventions for youth with asthma and suboptimal sleep., Clinical Trials: Not applicable., (© The Author(s) 2022. Published by Oxford University Press on behalf of Sleep Research Society.)

Researchers have shown that mood and sense of control over one's life are significantly affected by testimony and other forms of disclosure and that learning to control breathing has positive effects on mood and anxiety. This preliminary experiment tests whether African American and European American abused women who give testimony about their experiences of intimate partner violence and learn how to use yogic breathing techniques have reduced feelings of depression. Results indicate that learning yogic breathing techniques alone and combined with giving testimony significantly reduces feelings of depression. Recasting women as authorities on domestic violence and teaching them how to calm their minds by focusing on yogic breathing may be simple and effective ways to help women take control over their bodies and lives.

Background/aims: In our area most of the human immunodeficiency virus (HIV) infected patients are intravenous drug users; HIV and hepatitis C virus infections often coexist in these patients. Due to the repercussions of both infections, we designed a trial to evaluate the efficacy, response-related factors and tolerance during an eight-month regime of recombinant interferon alpha-2b on hepatitis C virus infection., Methodology: We included 79 patients in an open, prospective and multicentric trial with zidovudine and interferon alpha-2b. Response to interferon treatment was evaluated by biochemical and histopathological criteria., Results: A complete response (alanine aminotransferase normalization) was obtained in 57.4% of patients. The significant response-related factors were: degree of histopathological activity, CD4+ cell number and initial leukocyte number., Conclusions: Recombinant interferon therapy seems to be effective for chronic hepatitis C in HIV infected patients; the best response was in those with active chronic hepatitis and CD4+ cell counts > or = 200/mm3. General tolerance was variable, although side effects were not different from those seen in non-HIV patients. The most common side effect was flu-like syndrome (constitutional manifestations), with no interference on treatment continuity; however, hematological toxicity prevents the indiscriminate use of interferon.

Natural killer (NK) cell activity against K562 cell line, and interleukin-2 (IL-2) activity in supernatants from lectin-activated PBMC cultures from 17 patients with acute hepatitis B in the early phase of illness were studied. These patients showed enhanced NK cytotoxicity and higher levels of IL2 activity as compared with control subjects. There was a positive correlation between cytotoxicity values and levels of IL2 activity. Furthermore, in the recovery phase of illness there was a tendency towards normalization in both parameters. When patients were divided in accordance with markers of HBV replication, HBV-DNA positive patients showed increased NK cell activity and IL2 levels as compared with the control group, whereas in HBV-DNA-negative patients no differences were found. However, no differences were found between patients with HBeAg and patients with anti-HBe. These results suggest that natural cytotoxicity is increased early in the course of acute hepatitis B, while NK cell activity returns to normal later, during convalescence. Enhanced NK cell activity appears to be secondary, at least in part, to increased production of IL2. Natural cytotoxicity may be one mechanism that controls the HBV infection before other cytotoxic mechanisms become fully operative.

Forty-five patients with alcoholic cirrhosis, 20 chronic alcoholics with normal liver function tests and 36 healthy subjects were investigated. A combined index of nine anthropometric and biochemical parameters (triceps skinfold, arm muscle circumference, mid-arm muscle area, body fat percentage, creatinine-height index, serum albumin, plasma transferrin, prealbumin and retinol-binding protein levels) was used to evaluate nutritional status, allowing a distinction to be made between those patients with adequate nutrition (group I: 40 per cent of cirrhotics and 55 per cent of alcoholics), those with slight malnutrition (group II: 37.7 per cent of cirrhotics and 45 per cent of alcoholics) and those with severe malnutrition (group III: 22.2 per cent of cirrhotics and none alcoholic). Natural Killer (NK) cell activity of peripheral blood lymphocytes was determined using a 51Cr releasing cytotoxicity assay against K562 target cells. This was significantly lower in the cirrhotics than in the controls and chronic alcoholics (P less than 0.001 and P less than 0.01 respectively), but there was no difference between the latter two groups. Natural Killer activity was significantly lower in samples obtained from cirrhotics with severe malnutrition than in those with adequate nutrition, suggesting that malnutrition may play a role in the onset of the immunological disorder. No relationship could be established between nutritional status, NK activity and the clinical activity of the disease using Orrego's index on the liver function tests.