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Background. Infection in acute pancreatitis will worsen the disease prognosis. The aim of our study was to analyze the role of procalcitonin as a prognostic biomarker for infections and clinical severity. Method. A prospective single-cohort observational study of patients diagnosed of acute pancreatitis (n = 152) was designed. PCT determination was tested on admission (first 72 hours). Infections (biliary, extrapancreatic and infected pancreatic necrosis), need for antibiotics, need for urgent ERCP and severity scores for acute pancreatitis was assessed. ROC curves were designed and the area under the curve was calculated. Logistic regression for multivariate analysis was performed to evaluate the association between procalcitonin optimal cut-off level and major complications. Results. PCT > 0.68mg/dL had higher incidence of global infection, acute cholangitis, bacteraemia, infected pancreatic necrosis, use of antibiotics in general, and need for urgent ERCP. In the multivariate regressions analysis, PCT > 0.68mg/dL at admission demonstrated to be a strong risk factor for complications in acute pancreatitis. Discussion. PCT levels can be used as a reliable laboratory test to predict infections and the clinical severity of acute pancreatitis. High levels of PCT predict antibiotics prescription as well as the need for urgent ERCP in patients with concomitant clinically severe cholangitis.

Acute pancreatitis; Comorbidity; Hospital mortality Pancreatitis aguda; Comorbilidad; Mortalidad hospitalaria Pancreatitis aguda; Comorbilitat; Mortalitat hospitalària Background The impact of pre-existing comorbidities on acute pancreatitis (AP) mortality is not clearly defined. Our study aims to determine the trend in AP hospital mortality and the role of comorbidities as a predictor of hospital mortality. Methods We analyzed patients aged ≥ 18 years hospitalized with AP diagnosis between 2016 and 2019. The data have been extracted from the Spanish National Hospital Discharge Database of the Spanish Ministry of Health. We performed a univariate and multivariable analysis of the association of age, sex, and comorbidities with hospital mortality in patients with AP. The role of the Charlson and Elixhauser comorbidity indices as predictors of mortality was evaluated. Results A total of 110,021 patients diagnosed with AP were hospitalized during the analyzed period. Hospital mortality was 3.8%, with a progressive decrease observed in the years evaluated. In multivariable analysis, age ≥ 65 years (OR: 4.11, p 1.5 (OR: 2.03, p 1.5 (OR: 2.71, p

Objective Our main purpose was to compare the modified computed tomography severity index (MCTSI), computed tomography severity index (CTSI), and acute physiological and chronic health evaluation (APACHE)-II predictions regarding severity according to the revised Atlanta classification 2012 and local complications in acute pancreatitis in a consecutive prospective cohort. Methods One hundred and forty-nine patients diagnosed with acute pancreatitis were prospectively enrolled. APACHE-II, MCTSI, and CTSI were calculated for all cases. Severity parameters included persistent organ or multiorgan failure, length of hospitalization, the need for intensive care, death, and local complications (intervention against necrosis and infected necrosis). Area under the receiver operating characteristic curve (AUROC) was calculated and the value of scoring systems was compared. Results Both CTSI and MCTSI were associated significantly with all the evaluated severity parameters and showed a correlation between imaging severity and the worst clinical outcomes. Persistent organ failure, persistent multiorgan failure, and death were found in 30 (20.1%), 20 (13.4%), and 13 (8.7%) patients, respectively. The most common extrapancreatic finding was pleural effusion in 76 (51.0%) patients. The AUROC for CTSI was higher for predicting persistent organ failure (0.749, 95% confidence interval [CI] 0.640-0.857), death (AUROC 0.793, 95% CI 0.650-0.936), intervention against necrosis (AUROC 0.862, 95% CI 0.779-0.945), and infected necrosis (AUROC 0.883, 95% CI 0.882-0.930). Conclusions CT indexes outperformed the classic APACHE-II score for evaluating severity parameters in acute pancreatitis, with a slight advantage of CTSI over MCTSI. CTSI accurately predicted pancreatic infections and the need for intervention.

Chile has a rich, but poorly known history of placer gold mining. At present, this sector is almost nonexistent and there are some restrictions for its revival: disperse and partial information on existing resources and limited technical expertise to assess the potential of placer gold mine sites. This paper presents the background, methodology and results of the prioritization process of known prospects of this kind in Chile. This research was part of a publicly funded project aimed to incentivize the development of this industry. The ranking was carried out using the analytic hierarchy process, which allowed to include different quantitative and qualitative variables related to the economic potential, technical aspects, contextual viability and socioeconomic factors in the analysis. The results show that, despite the increasing relevance of environmental and community issues in mining development, the business potential and the economic/technical aspects are the main factors in the early selection of a site to advance in exploration and development activities. Both variables represented around 40% and 37% of weights in the final selection, respectively. In contrast, contextual viability and local socioeconomic impacts only accounted for the remaining 23%. This study also shows that the inclusion of experts with different backgrounds in the process enriches the analysis and does not significantly distort the final outcome of the prioritization. Finally, the relevance of using MCDM tools when assessing the attractiveness of mine sites for their development is highlighted, particularly when public funds for subsequent exploration activities are committed.

Resumen Entre las múltiples estrategias del Instituto Jalisciense de Cirugía Reconstructiva Dr. José Guerrerosantos de Guadalajara (Jalisco, México) está la cobertura de servicios de salud y el brindar atención quirúrgica altruista y especializada a la población marginada del estado de Jalisco. Recogemos en el presente trabajo los resultados de más de 20 años de esfuerzo en conjunto con el Programa de Cirugía Extramuros, que se traducen en más de 10.000 pacientes consultados y más de 6.000 cirugías realizadas en más de 100 jornadas quirúrgicas fuera del Instituto, sin importar las condiciones sociales de pobreza y las condiciones geográficas de aislamiento de las zonas donde se trabajó. A través de este tiempo vemos como los resultados logrados implican ahora evolucionar hacia nuevas estrategias en la atención y control de calidad de los servicios quirúrgicos prestados, como gran reto a futuro para lograr soluciones quirúrgicas modernas con calidad humana y profesional.

Background: Robotic bariatric surgery (RBS) has increased in recent years. Many doubts continue to exist regarding its utility in terms of postoperative complications, costs and technical aspects. RBS has increased its number and shows a more technical challenge associated with more post-operative complications compared to primary bariatric surgery. We herein present a single institution experience and review to describe its utility in revisional surgery. Methods: A retrospective review of our experience and a review of the literature has been conducted to evaluate the impact of robotic revisional surgery in the bariatric field. Results: A total of 17 patients (5 female and 12 male) were operated on. Most frequent surgery was conversion of sleeve gastrectomy to gastric bypass (n=9). No leaks were found nor severe complications. A systematic review showed similar results including a decreased number for complications when performing robotic revisional surgery. Conclusions: Revisional robotic surgery shows better results compared to standard laparoscopic revisional bariatric surgery in terms of efficacy, safety and hospital stay. No differences were seen in rates of mortality, morbidity and reintervention between both approaches. We encourage surgeons to learn to perform the robotic technique as part of the process of democratization and standardization of bariatric surgery.

This paper proposes a framework for projects of academic programs related to information and communications technologies. The framework is intended to include sustainability issues, innovation and high social impact. It integrates four domains of practical knowledge: the practices of green information technologies, the framework in information systems research, the guide to the software engineering body of knowledge, the body of knowledge for project management and principles.

Realizado con la colaboración del CEP de Salamanca y el Seminario Permanente de Filosofía Se trata de una guía didáctica para el nuevo programa de C.O.U.inclluyendo textos de los autores que son obligatorios para la asignatura de Historia de la Filosofía de C.O.U. Trabajo elaborado con el apoyo del Seminario Didáctico de Filosofía del Instituto Universitario de Ciencias de la Educación en la programación y selección de textos complementarios. Está dirigido al alumno como libro orientador e instrumento básico del trabajo personal, bajo la dirección del profesor. El contenido se divide en dos partes principales: 1)La Programación, que incluye los contenidos mínimos cuyo conocimiento se considera esencial para entender el texto, los contenidos de ampliación, la terminología específica, la bibliografía más útil y actividades para los alumnos; 2) El Material de Apoyo, que consta de un análisis del texto (mensaje, argumento y definición de términos), y una serie de textos complementarios. Castilla y León ESP