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Abstract 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

Abstract Background The relevance of elevated serum triglyceride (TG) levels in the early stages of acute pancreatitis (AP) not induced by hypertriglyceridemia (HTG) remains unclear. Our study aims to determine the role of elevated serum TG levels at admission in developing pancreatic necrosis. Methods We analyzed the clinical data collected prospectively from patients with AP. According to TG levels measured in the first 24 h after admission, we stratified patients into four groups: Normal TG (

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. Changes in BUN have been proposed as a risk factor for complications in acute pancreatitis (AP). Our study aimed to compare changes in BUN versus the Bedside Index for Severity in Acute Pancreatitis (BISAP) score and the Acute Physiology and Chronic Health Evaluation-II score (APACHE-II), as well as other laboratory tests such as haematocrit and its variations over 24 h and C-reactive protein, in order to determine the most accurate test for predicting mortality and severity outcomes in AP. Methods. Clinical data of 410 AP patients, prospectively enrolled for study at our institution, were analyzed. We define AP according to Atlanta classification (AC) 2012. The laboratory test’s predictive accuracy was measured using area-under-the-curve receiver-operating characteristics (AUC) analysis and sensitivity and specificity tests. Results. Rise in BUN was the only score related to mortality on the multivariate analysis (p=0.000, OR: 12.7; CI 95%: 4.2−16.6). On the comparative analysis of AUC, the rise in BUN was an accurate test in predicting mortality (AUC: 0.842) and persisting multiorgan failure (AUC: 0.828), similar to the BISAP score (AUC: 0.836 and 0.850) and APACHE-II (AUC: 0.756 and 0.741). The BISAP score outperformed both APACHE-II and rise in BUN at 24 hours in predicting severe AP (AUC: 0.873 vs. 0.761 and 0.756, respectively). Conclusion. Rise in BUN at 24 hours is a quick and reliable test in predicting mortality and persisting multiorgan failure in AP patients.

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.

The Neotropic region has high fish diversity associated with freshwater habitats. However, for Maranhão state, most publications on the ichthyofauna concentrate on coastal or estuarine ecosystems. In this study, species of fish were sampled in lentic and lotic habitats in Cerrado areas (Cerradão phytophysiognomy) and in restinga areas (Atlantic Forest phytophysiognomy) in northeastern Maranhão state between January and July 2010. Thirteen species from 10 families and 6 orders were captured. Species richness was highest for the orders Characiformes and Gymnotiformes. Our results are the first records of the ichthyofauna of coastal drainage areas of northeastern Maranhão state, contributing to the understanding of the biodiversity of the Munim and Parnaíba River basins, and suggest the existence of a community that shares elements with those of the Amazon and Caatinga biomes.

This note reports the first record of Hypsiboas geographicus and Physalaemus centralis for coastal ecosystems “restinga environments” in the Maranhão state, Brazil. These records expand the geographic distribution of these species for restinga environments and contribute to the knowledge of anurofauna of Maranhão state.

Brazil has the greatest diversity of anurans and also one of the greatest speleological patrimonies in the world. However, informations about anurans in Brazilian caves including different biomes and lithologies are scarce. This study sampled 223 caves divided into different biomes (Amazon, Atlantic Forest, Caatinga, Cerrado and transition area) and lithologies (Conglomerate, Granite, Iron-ore, Limestone, Marble, Quartzite, and Sandstone) distributed in eleven Brazilian states. To determine the anuran composition (presence/absence), a single sampling event was conducted in each cave by a team of three researchers in the period 1999−2011, following acoustic and visual search methods. We recorded 54 species distributed 18 genera and 11 families. The caves in the Amazon biome had the highest number of species, followed by caves present in the Cerrado, Caatinga, transition area (Atlantic Forest and Cerrado) and the Atlantic Forest. The caves in the Iron-ore lithology had the highest number of species, followed by the Limestone, Sandstone, Quartzite, Granite, Marble and Conglomerate caves. The anurans proved to be very diverse in Brazilian caves, with this high species richness related to the large amount of biomes and lithologies sampled. The family Leiuperidae had the highest richness and the species Scinax fuscovarius the highest frequency of occurrence in the caves. Also recorded were tadpoles and immature forms inside caves suggesting that not all the species are accidental, and that some species may be using these environments for shelter, protection, food and, even reproduction.

We report two new records of anurans in the northeastern region of the state of Maranhão, Brazil. The records extend the distribution of Hypsiboas boans (Linnaeus, 1758) outside the Amazon basin, and represent the first record of Leptodactylus syphax Bokermann, 1969 for the state of Maranhão.

In this study, we present the first record of Ateuchus semicribratus, Canthon simulans, Canthon histrio, Dichotomius carinatus, Eurysternus caribaeus, Eurysternus nigrovirens, and Ontherus sulcator (Coleoptera: Scarabaeinae) for the state of Maranhão, Brazil. These records expand the currently known geographical distribution of these species and contribute to the knowledge of dung beetles in northeastern Brazil.

In this study, we present the first record of Rhinella ocellata (Günther, 1858) for the state of Maranhão and for coastal ecosystems “restinga environments” in Brazil. This note also expands the known geographic distribution of this species by approximately 895 km to the north from the closest record located in the Parque Estadual do Jalapão (10°32′59″ S, 46°45′38″ W), state of Tocantins, contributing to the knowledge of the anurofauna in the state of Maranhão.

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., (Celsius.)