Browse
Recent Submissions
Now showing 1 - 5 of 42
- PublicationRobotic Living Donor Right Hepatectomy: A Systematic Review and Meta-Analysis(2022) Lincango Naranjo, Eddy P; Garces-Delgado, Estefany; Siepmann, Timo; Mirow, Lutz; Solis-Pazmino, Paola; Alexander-Leon, Harold; Restrepo-Rodas, Gabriela; Mancero-Montalvo, Rafael; Ponce, Cristina J; Cadena-Semanate, Ramiro; Vargas-Cordova, Ronnal; Herrera-Cevallos, Glenda; Vallejo, Sebastian; Liu-Sanchez, Carolina; Prokop, Larry J; Ziogas, Ioannis A; Vailas, Michail G; Guerron, Alfredo D; Visser, Brendan C; Ponce, Oscar J; Barbas, Andrew S; Moris, DimitriosThe introduction of robotics in living donor liver transplantation has been revolutionary. We aimed to examine the safety of robotic living donor right hepatectomy (RLDRH) compared to open (ODRH) and laparoscopic (LADRH) approaches. A systematic review was carried out in Medline and six additional databases following PRISMA guidelines. Data on morbidity, postoperative liver function, and pain in donors and recipients were extracted from studies comparing RLDRH, ODRH, and LADRH published up to September 2020; PROSPERO (CRD42020214313). Dichotomous variables were pooled as risk ratios and continuous variables as weighted mean differences. Four studies with a total of 517 patients were included. In living donors, the postoperative total bilirubin level (MD: −0.7 95%CI −1.0, −0.4), length of hospital stay (MD: −0.8 95%CI −1.4, −0.3), Clavien–Dindo complications I–II (RR: 0.5 95%CI 0.2, 0.9), and pain score at day > 3 (MD: −0.6 95%CI −1.6, 0.4) were lower following RLDRH compared to ODRH. Furthermore, the pain score at day > 3 (MD: −0.4 95%CI −0.8, −0.09) was lower after RLDRH when compared to LADRH. In recipients, the postoperative AST level was lower (MD: −0.5 95%CI −0.9, −0.1) following RLDRH compared to ODRH. Moreover, the length of stay (MD: −6.4 95%CI −11.3, −1.5) was lower after RLDRH when compared to LADRH. In summary, we identified low- to unclear-quality evidence that RLDRH seems to be safe and feasible for adult living donor liver transplantation compared to the conventional approaches. No postoperative deaths were reported. Keywords: liver transplantation, robot, systematic review, meta-analysis
- PublicationThe Role of Parathyroid Hormone Level as a Predictor of Hypocalcemia After Total Thyroidectomy for Thyroid Cancer: A Cross-Sectional Study(2025) Semanate, Fernando; Tarupi, Wilmer; Fernandez Trokhimtchouk, Tatiana; Palacios, Christian; Jaramillo, OscarThis study aimed to investigate the utility of measuring parathyroid hormone (PTH) levels as a predictor of hypocalcemia in a population of patients undergoing total thyroidectomy for thyroid cancer between 2016 and 2019. We conducted an observational, analytical, descriptive, cross-sectional investigation, assessing PTH levels as a predictor of hypocalcemia following thyroidectomy. Among patients with hypoparathyroidism, 25.5% experienced hypocalcemia, while 74.5% had normal serum calcium levels. The likelihood of hypocalcemia was five times higher in patients with hypoparathyroidism (OR: 5.43; 95% CI: 1.89-15.6), a statistically significant finding (p < 0.05). Additionally, PTH values at 24 hours post-surgery averaged 28.9 pg/mL (SD: 30.8 pg/mL), ranging from 0.01 to 235 pg/mL. Serum calcium levels averaged 8.31 mg/dL (SD: 0.74), with values ranging from 6.5 to 10.6 mg/dL. The study demonstrates a statistically significant association between PTH levels and post-surgical serum calcium levels, albeit with moderate predictive power. These findings support the utility of PTH measurement in predicting hypocalcemia following thyroidectomy, underscoring its potential clinical relevance in patient management. Keywords: low calcium; open thyroidectomy; parathyroid level; postoperative parathyroid hormone (pth); thyroid cancer surgery; thyroidectomy complications.
- PublicationTrends in traffic accident mortality and social inequalities in Ecuador from 2011 to 2022(2024) Holguín-Carvajal, Juan Pablo; Otzen, Tamara; Sanhueza, Antonio; Castillo, Álvaro; Manterola, Carlos; Muñoz, Georgina; García-Aguilera, Fernanda; Salgado-Castillo, FernandaBackground: Traffic accidents (TA) remain a significant global public health concern, impacting low-and middle-income countries. This study aimed to describe the trend in TA mortality and inequalities in Ecuador for 2011-2022, distributed by year, gender, age group, geographical location, type of accident, and social inequalities. Methods: An ecological study was conducted using INEC national-level data on TA fatalities in Ecuador. Mortality rates were calculated per 100,000 population and analyzed by year, gender, age group, geographic region, and accident type. Annual percentage variation (APV) was determined using linear regression models. Inequality analyses examined associations between TA mortality and socioeconomic factors like per capita income and literacy rates. Complex measures such as the Slope Inequality Index (SII) were calculated to assess the magnitude of inequalities. Results: There were 38,355 TA fatalities in Ecuador from 2011 to 2022, with an overall mortality rate of 19.4 per 100,000 inhabitants. The rate showed a non-significant decreasing trend (APV - 0.4%, p = 0.280). Males had significantly higher mortality rates than females (31.99 vs. 7.19 per 100,000), with the gender gap widening over time (APV 0.85%, p = 0.003). The Amazon region had the highest rate (24.4 per 100,000), followed by the Coast (20.4 per 100,000). Adults aged ≥ 60 years had the highest mortality (31.0 per 100,000), followed by those aged 25-40 years (28.6 per 100,000). The ≥ 60 age group showed the most significant rate decrease over time (APV - 2.25%, p < 0.001). Pedestrians were the most affected group after excluding unspecified accidents, with a notable decreasing trend (APV - 5.68%, p < 0.001). Motorcyclist fatalities showed an increasing trend, ranking third in TA-related deaths. Lower literacy rates and per capita income were associated with higher TA mortality risks. Inequality in TA mortality between provinces with the highest and lowest per capita income increased by 247.7% from 2011 to 2019, as measured by the SII. Conclusion: While overall TA mortality slightly decreased in Ecuador, significant disparities persist across demographic groups and geographic regions. Older adults, males, pedestrians, and economically disadvantaged populations face disproportionately higher risks. The increasing trend in motorcycle-related fatalities and widening socioeconomic inequalities are particularly concerning. Keywords: Ecuador; Mortality; Traffic accidents; Trends.
- PublicationRisk factors for COVID-19 and their association with mortality in Ecuadorian patients admitted to the ICU A retrospective cohort multicentric study(2024) Fuenmayor-González, Luis; Vera-Ormaza, Jair; Shen, Hua; Corella-Ortega, Belén; Fajardo-Loaiza, Thalía; Borja-Pérez, Cristina; Ochoa-Godoy, Nancy; Vásquez-Barzallo, Sebastián; Díaz-Rodríguez, Juan; María Díaz, Ana; García, Fernanda; Ramírez, Vanessa; Sánchez, Hernán; Barberán, José Luis; Paredes, Juan Pablo; Cevallos, Mónica; Montenegro, Francisco; Puertas, Soraya; Briones, Killen; Martínez, Marlon; Vélez-Páez, Jorge; Montalvo-Villagómez, Mario; Herrera, Luis; Garrido, Santiago; Sisa, Ivan; Jibaja, Manuel
- PublicationEffect of High Altitude on the Survival of COVID-19 Patients in Intensive Care Unit: A Cohort Study(2022) Jibaja, Manuel; Roldan-Vasquez, Estefania; Rello, Jordi; Shen, Hua; Maldonado, Nelson; Grunauer, Michelle; Díaz, Ana María; García, Fernanda; Ramírez, Vanessa; Sánchez, Hernán; Barberán, José Luis; Paredes, Juan Pablo; Cevallos, Mónica; Montenegro, Francisco; Puertas, Soraya; Briones, Killen; Martínez, Marlon; Vélez-Páez, Jorge; Montalvo-Villagómez, Mario; Herrera, Luis; Garrido, Santiago; Sisa, IvanPurpose: The effect of high altitude ( ≥ 1500 m) and its potential association with mortality by COVID-19 remains controversial. We assessed the effect of high altitude on the survival/discharge of COVID-19 patients requiring intensive care unit (ICU) admission for mechanical ventilation compared to individuals treated at sea level. Methods: A retrospective cohort multi-center study of consecutive adults patients with a positive RT-PCR test for COVID-19 who were mechanically ventilated between March and November 2020. Data were collected from two sea-level hospitals and four high-altitude hospitals in Ecuador. The primary outcome was ICU and hospital survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Results: Of the study population (n = 670), 35.2% were female with a mean age of 58.3 ± 12.6 years. On admission, high-altitude patients were more likely to be younger (57.2 vs. 60.5 years old), presented with less comorbidities such as hypertension (25.9% vs. 54.9% with p-value <.001) and diabetes mellitus (20.5% vs. 37.2% with p-value <.001), less probability of having a capillary refill time > 3 sec (13.7% vs. 30.1%, p-value <.001), and less severity-of-illness condition (APACHE II score, 17.5 ± 8.1 vs. 20 ± 8.2, p < .01). After adjusting for key confounders high altitude is associated with significant higher probabilities of ICU survival/discharge (HR: 1.74 [95% CI: 1.46-2.08]) and hospital survival/discharge (HR: 1.35 [95% CI: 1.18-1.55]) than patients treated at sea level. Conclusions: Patients treated at high altitude at any time point during the study period were 74% more likely to experience ICU survival/discharge and 35% more likely to experience hospital survival/discharge than to the sea-level group. Possible reasons for these findings are genetic and physiological adaptations due to exposure to chronic hypoxia. Keywords: COVID-19; ICU; SARS-CoV-2; high altitude; sea level; survival.