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BackgroundMany health care facilities in low- and middle-income countries are inadequately resourced. COVID-19 has the potential to decimate surgical health care services unless health systems take stringent measures to protect health care workers from viral exposure and ensure the continuity of specialized care for patients. Among these measures, the timely diagnosis of COVID-19 is paramount to ensure the use of protective measures and isolation of patients to prevent transmission to health care personnel caring for patients with an unknown COVID-19 status or contact during the pandemic. Besides molecular and antibody tests, chest computed tomography (CT) has been assessed as a potential tool to aid in the screening or diagnosis of COVID-19 and could be valuable in the emergency care setting. ObjectiveThis paper presents the protocol for an umbrella review that aims to identify and summarize the available literature on the diagnostic accuracy of chest CT for COVID-19 in trauma surgery patients requiring urgent care. The objective is to inform future recommendations on emergency care for this category of patients. MethodsWe will conduct several searches in the L·OVE (Living Overview of Evidence) platform for COVID-19, a system that performs automated regular searches in PubMed, Embase, Cochrane Central Register of Controlled Trials, and over 30 other sources. The search results will be presented according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis). This review will preferentially consider systematic reviews of diagnostic test accuracy studies, as well as individual studies of such design, if not included in the systematic reviews, that assessed the sensitivity and specificity of chest CT in emergency trauma surgery patients. Critical appraisal of the included studies for risk of bias will be conducted. Data will be extracted using a standardized data extraction tool. Findings will be summarized narratively, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach will be used to grade the certainty of evidence. ResultsEthics approval is not required for this systematic review, as there will be no patient involvement. The search for this systematic review commenced in October 2020, and we expect to publish the findings in early 2021. The plan for dissemination is to publish the findings in a peer-reviewed journal and present our results at conferences that engage the most pertinent stakeholders. ConclusionsDuring the COVID-19 pandemic, protecting health care workers from infection is essential. Up-to-date information on the efficacy of diagnostic tests for detecting COVID-19 is essential. This review will serve an important role as a thorough summary to inform evidence-based recommendations on establishing effective policy and clinical guideline recommendations. Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42020198267; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=198267 International Registered Report Identifier (IRRID)PRR1-10.2196/25207

Copyright of Revista Colombiana de Cirugía is the property of Asociacion Colombiana de Cirugia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Normal pressure hydrocephalus (NPH) leads to cognitive impairment (CI) as part of its triad of symptoms. Assessment of CI before and after a tap test can be used to inform diagnosis, differentiate NPH symptoms from alternative or concomitant causes of CI, and suggest the potential benefits of valve placement. The aims of this study are: to describe cognitive performance in patients with NPH diagnosis before and after a tap test, and to compare CI between patients with NPH meeting criteria for a dementia diagnosis (D +) and those without criteria for dementia (D−) at both baseline and after the tap-test. We performed a Before-and-after study evaluating clinical features and performance on cognitive tests (CERAD, ADAS-COG, SVF, PVF, ROCF and IFS). We included 76 NPH patients, with a median age of 81 years. 65 patients (87.8%) improved cognitive performance after tap test. ROCF (p = 0.018) and IFS (p < 0.001) scores significantly change after the tap test. Dementia was concomitant in 68.4% of patients. D + group showed higher proportion of patients with altered performance in IFS, PVF, SVF, and ROCF than D- group at baseline (p < 0.05). A significant improvement in SVF and IFS was observed exclusively in the D− group after tap test. Our results suggest that executive function and praxis are the cognitive domains more susceptible to improvement after a tap test in a 24-h interval in NPH patients. Moreover, the D− group showed a higher proportion of improvement after the tap test in executive function and verbal fluency test compared with the D + group. [ABSTRACT FROM AUTHOR]

Copyright of Revista Colombiana de Gastroenterología is the property of Asociacion Colombiana de Gastroenterologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Pediatrica de Mexico is the property of Instituto Nacional de Pediatria (INP) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Arterial trauma of the axillary subclavian segment carries considerable morbidity and mortality risks. Surgical approaches are challenging given the hidden trajectory of these vessels, which has made the endovascular approach a valid and potentially better alternative for managing these injuries. We describe the incidence of relevant outcomes for patients with traumatic axillary and/or subclavian artery injury who underwent endovascular therapy at a tertiary care university hospital over a 15-year period in Cali, Colombia., Methods: We conducted an incidence study based on clinical records that included patients aged 15 years or older with traumatic axillary subclavian arterial injury treated with endovascular therapy between 2008 and 2022. Vascular injuries caused by intra-arterial dialysis catheter insertion (iatrogenic) were excluded. We described clinical and imaging characteristics upon admission, perioperative findings, and the incidence of complications and in-hospital mortality, with accompanying 95% confidence intervals (CIs)., Results: We included 32 patients, 93.8% of whom were male, with a median (interquartile range) age of 30 (21-42) years. The type of trauma was penetrating in 75% of patients (62.5% corresponding to gunshot wounds) and blunt in 25%. Upon admission, 12 patients (37.5%) exhibited hard signs of vascular injury, and 20 patients (62.5%) exhibited soft signs. Fourteen patients (47%) had an Injury Severity Score greater than 15, and 12 (37.5%) had hemodynamic instability. All but 3 patients (90.6%) suffered subclavian artery injury (right 48.3%, left 51.7%), while 12.9% had axillary artery injury (one patient with both vessels affected). Intraoperative complications happened in one patient (3.1%, 95% CI: 0.2-18%). Pseudoaneurysms were identified in 11 patients (34.4%), thrombosis in 6 (18.8%), and dissection in 6 (18.8%). Three (9.4%) patients required hybrid management (endovascular therapy following conventional surgery). No cases of ischemia or amputation occurred. The length of hospital stay was 6 (3, 11.5) days. No cases of in-hospital mortality were reported (0%, 95% CI: 0.0-13.4%)., Conclusions: Endovascular treatment in trauma is a minimally invasive technique with favorable clinical outcomes in patients with arterial trauma in the axillary-subclavian segment. This should be a viable therapeutic option for selected cases., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: To reduce health inequities in paediatric patients with complex diseases, our hospital developed a food security programme in 2022. The programme aims to mitigate food insecurity (FI) in paediatric patients with oncological, transplantation and congenital cardiovascular diagnoses, by providing a monthly nutritious food supply that covers up to 50% of the patient's family food intake, accompanied by social and nutritional follow-up. In this study, we aimed to assess the effect of the programme on FI and nutritional status and describe its implementation., Method: We conducted a before-and-after study of patients who entered the programme in a 14-month period. We used the Escala Latinoamericana y Caribeña de Seguridad Alimentaria (ELCSA) scale score, FI level and nutritional status measures to assess the effect of the programme. We used the Wilcoxon and McNemar tests to assess changes in scores and proportions of patients with moderate and severe FI, respectively, 31.5%-14.4% (p=0.0008) and of moderate FI from 68.5% to 36.9%., Results: 111 patients were included. They had a baseline median (IQR) ELCSA score=8 (7-11) that changed to 6 (4-9) (p<0.0001). Severe FI according to ELCSA changed from 31.5% to 14.4% (p<0.001) and moderate from 68.5% to 36.9% (p<0.001). We found no differences in nutritional status regarding height for age (49.5% vs 51.3%, p=0.76), weight for height (42.5% vs 59.1%, p=0.75) or body mass index for age (38% vs 46%, p=0.42) CONCLUSION: The programme reduced FI in families by improving its level to mild or moderate. Children who entered the programme maintained an appropriate nutritional status despite the considerable risk of malnutrition described for oncological paediatric patients and paediatric solid organ transplantation receptors., Competing Interests: Competing interests: Hospital Universitario Fundación Valle del Lili is a non-profit university hospital in Cali, Colombia. Among the authors are researchers and institutional directors involved in the development of the program and the conduction of the research project. The study does not promote or recommend any medication, medical devices or services. The authors declare to have no conflict of interest regarding the conduction of this project., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)