ABC Medical Center Research Articles

Perioperative intravenous lidocaine infusion for postsurgical pain management in bariatric surgery patients

IntroductionObesity is one of the biggest modern health issues worldwide. Owing to the failure of both behavioral and pharmacological measures, the surgical approach has been established as the main conduct to follow, with bariatric surgery being one of the most effective and safe procedures. One of the bases for the optimal analgesic strategy is the use of adjuvants during the perioperative period. One of the main drugs in use is lidocaine.AimTo evaluate postoperative pain after perioperative lidocaine infusion in patients undergoing bariatric surgery and describe the presence of nausea and vomiting during the first 24 h.MethodsThis was a retrospective study of patients who underwent laparoscopic bariatric surgery at ABC Medical Center. Two study arms were established: a group of patients who received lidocaine infusion and a control group. The presence of pain, nausea, or vomiting was evaluated upon admission to the recovery area and 1 h and 24 h after the intervention. The normal distribution of the data was first verified via the Shapiro–Wilk test. The data are presented as medians for quantitative variables and as frequencies for qualitative variables.ResultsA total of 50 surgeries were performed, with a significant correlation between lidocaine infusion and lower pain values at 1 h (p = 0.04). Similarly, there was a marked trend in the presence of nausea in control group 4 (18.6%) vs. 15 (53.5%).ConclusionsOur data suggest that the use of intraoperative lidocaine infusion is limited in postoperative pain management; nonetheless, it significantly improves the incidence of postoperative nausea.

Endoscopic surgery in the lumbar spine: experience of the ABC Medical Center

Endoscopic surgery in the lumbar spine: experience of the ABC Medical Center

Robotic surgery at ABC Medical Center: first 500 procedures experience.

Robotic surgery is a technological advance that is used in multiple surgical specialties in the world. Its acceptance in various areas has been supported by comparative studies with laparoscopic surgery and open surgery. To document the robotic surgery program initial experience in a private hospital of Mexico City by analyzing its results and complications. The first 500 robotic surgeries practiced at ABC Medical Center were included, covering a three-year period (January 2017 to December 2019). The following was documented: specialties involved, surgeries broken down by specialty and type of surgery, surgical times, complications and number of doctors involved in the initial experience. Out of 500 patients, 367 (73.4 %) were males and 133 (26.4 %) were females. The three most common surgeries were radical prostatectomy (269), hysterectomy (64) and inguinal repair (33). Average age was 58 years (range: 18 to 90 years). A total of 40 certified surgeons from five specialties performed all the procedures. Starting a program in a private medical center has several implications. The creation of a robotic surgery committee made up of certified robotic surgery specialists from each specialty and hospital authorities for the accreditation of guidelines for both certification and recertification of their doctors can benefit programs like ours by creating a center of excellence in robotic surgery and thus reduce complications and improve results.

Clinical, Therapeutic, and Prognostic Experience in Patients With Glioblastoma.

Glioblastoma (GB) represents the most aggressive type of glioma with a poor prognosis despite the therapies used. As of today, data availability for therapeutic and prognosis experiences is limited.The cornerstone for this study is to create a framework overview of Mexico´sexperience throughout 17 years of research. Retrospective analysis from 2000 to 2017including patients with a histological diagnosis of GB was performed. Data were collected from the ABC Medical Center and the Neurology and Neurosurgery National Institute. One hundred and thirty-seven patients were included with a mean age of 54 years. Histological diagnosis was made in all patients, of which 58.1% had a total resection, 31.6% had a partial resection, and 10.3% of them underwent biopsy. In all cases, patients received treatment under the following conditions:10 patients were treated exclusively with stereotactic radiotherapy (RT). In 55 patients, a combination of RT and TMZ was used, the other 40 patients received RT plus CBP. Eighteen patients RT added to nitrosourea medication and lastly, 14 patients received a combination of RT/TMZ and Bevacizumab, a monoclonal antibody that inhibits the formation of blood vessels (BVZ). The progression-free survival (PFS) and overall survival (OS)were higher in the RT/TMZ/BVZ group (16.5 to 22.9 months) and the RT/TMZ group (11 to 17 months), the prognostic parameters included: Isocitrate dehydrogenase 1 mutation (IDH1), usage of BVZ and TMZ in the PLS and OS, considering as well, age range (<70 years) as a favorable prognostic factor. GB represents the most frequent intracranial neoplasia. Combined fractionated stereotactic RT added to Temozolomide and Bevacizumab received in our population reports favorable and superior results compared to the ones described in the literature. Further studies are necessary to know the biological behavior of our population.

279. Clinical Characteristics of Critically Ill Patients with COVID-19 and Invasive Pulmonary Aspergillosis: A Case Series From Mexico City

BackgroundCOVID-19 has emerged as a global public health emergency and has been the main cause of intensive care admission during the pandemic. COVID-19-associated pulmonary aspergillosis (CAPA) has been reported in case series of critically ill patients. However, the criteria for CAPA diagnosis has been inconsistent among most of the reports. Mexico has been widely affected by SARS-CoV-2. We present a series of CAPA cases at a teaching hospital in Mexico City.MethodsWe performed a retrospective analysis of COVID-19 patients admitted to the ABC Medical Center from May 1st, 2020, to May 1st, 2021. Including only those with critical COVID-19 who required invasive mechanical ventilation (IMV). Patients with a diagnosis of CAPA were analyzed. We followed the 2020 ECMM/ISHAM consensus criteria for CAPA diagnosis. Aspergillus antigen testing in tracheal aspirate and serum was done with Aspergillus-specific galactomannoprotein (GP) ELISA (Euroimmun Medizinische Labordiagnostika).ResultsAmong the 230 admitted patients who required IMV, we identified 49 (21.3%) cases of CAPA, 46 probable CAPA and 3 proven CAPA. Nineteen (38%) of those died in the hospital. The mean age was 64.5 ± 12.6 years and 11 were female. Proven CAPA was diagnosed with culture in three cases (one A. niger, one A. terreus and one A. fumigatus). Probable CAPA was diagnosed by a positive serum GP in 27 (55.1%) patients and by a positive bronchoalveolar lavage (BAL) GP in 29 (59.2%) cases. Seven patients had both serum and BAL positive GP. Forty-six (93.9%) patients received corticosteroids, and 22 (49.9%) were treated with tocilizumab before CAPA diagnosis. All but one received isavuconazole as CAPA treatment. We detected 35 (71.4%) patients who had a bacterial co-infection. Eighteen of those died (51.4%) compared to only one dead in the subgroup without coinfections (7.1%). The mean time from hospital admission to CAPA diagnosis was 6.2 days (SD 7.1) among those who survived compared to 13.2 (SD 6.3) days in those who died p< 0.01. ConclusionCAPA had a lower prevalence than previously reported in other series. However, it appears to be linked to high mortality when it occurs with other bacterial coinfections and when it is diagnosed late from admission. Disclosures All Authors: No reported disclosures

Correlation between the Bethesda system for thyroid nodules and post-thyroidectomy histopathological diagnosis

Thyroid nodules are a common clinical condition. Thyroid nodules may be identified with ultrasonography in roughly 50% of the population. The risk of malignancy varies between 4 and 15% of the nodules. Fine needle aspiration (FNA) with a cytopathology report using the Bethesda system is the most utilized methods to diagnose thyroid carcinoma. A retrospective, descriptive study was performed to investigate the correlation between the cytopathology of the FNA biopsies, and the final histopathology after thyroidectomy. A total of 128 nodules in 128 patients were studied; 24 males and 104 females. In the Bethesda category I, a 67% malignancy rate was reported, Bethesda II 14%, Bethesda III 28% for follicular lesions and 15% for atypia, Bethesda IV 36%, Bethesda V 79% and Bethesda VI 100%. The Bethesda system has been widely adopted internationally and has become an unassailable tool for the pathologist and clinicians for the evaluation and management of thyroid nodules. Since its implementation in the ABC Medical Center, the Bethesda system has granted the institution with favorable and reproducible results.

Creation of a primary breast cancer culture repository from patients with a BMI &gt;30 kg/m2: A Mexican endeavor.

e12574 Background: Currently there are no primary cultures or cell lines derived from patients with breast cancer and obesity. It has been postulated that breast cancer in obese women behaves differently as it does in non-obese women, as is composed of distinct biological features, as was generated in a different metabolic environment, as well as pertains to a different prognosis and different response to chemotherapy, lower rates of overall survival and a greater probability of recurrence. By creating a primary breast cancer culture bank of breast cancer tumors from women with obesity (BMI &gt; 30kg/m2), we will establish a cell line exclusive to obese women in Mexico, where targeted therapy may be tested and treatment may be individualized depending on the characteristics of the patient. Methods: This study recruited 32 women with breast cancer and a BMI &gt; 30 kg/m2, matched by 6 controls with are non-obese women with breast cancer. Elegibility criteria was determined by women with breast cancer confirmed by pathology, who had not been subjected to prior treatment regarding the neoplasm. The breast cancer removing surgeries and the patients were selected from the ABC Medical Center in Mexico City and all procedures were approved by the research and ethics committee of the hospital in question. Results: Through extensive communication a cooperative protocol was established between the departments of surgery, oncology, pathology and nursing to coordinate efforts and be able to take a 2 – 5 mm sample of the breast tumor removed from the patient. To be able to distinguish cancer cells from non-cancer cells (epithelial cells, fibroblasts, adipocytes) the Hayflick limit was be utilized. Once a primary breast cancer culture was established, 12 million cells will be injected into the subscapular area of athymic, nu-nu mice to be able to monitor tumoral growth in vivo and conduct a subsequent cellular analysis, determining it still pertains to the same characteristics of the tumor from which it was obtained. Conclusions: A primary breast cancer culture repository from patients with a BMI &gt; 30 kg/m2 was established. This is the first primary breast cancer culture for both Mexican and obese women with breast cancer, the first in vitro method of analysis of specific characteristics typical of the Mexican population. Translational research may now be conducted on these new tumoral cultures to create individualized therapy for women with the distinct, aforementioned characteristics.

Clinical, pathologic, and demographic characteristics of colorectal cancer in patients under age 50 in a third level Mexican cancer center.

e15592 Background: Colorectal cancer (CRC) is the most common gastrointestinal neoplasia, with 1.36 million cases worldwide, representing the third cause of death due to cancer. Commonly affects people after the 6th decade of life, but recently the diagnosis in patients below 50 years is increasing. Methods: We conducted an observational, retrospective, longitudinal analysis based on medical records of patients diagnosed with colorectal cancer treated in the ABC Medical Center. Information was collected between January 2016 and January 2021. Descriptive statistics were utilized regarding data analysis. Results: We identified 289 patients with CRC, of which 23 (8.2%) patients were less than 50 years of age at diagnosis. Gender distribution reflected slightly more feminine patients (56%). The median age at diagnosis was 43 years, oncologic family history in first- or second-degree family members was documented in 31.4% of patients. At diagnosis, 22% of patients presented with an early-stage neoplasm, 31% had locoregional disease and 50% had advanced disease. Left sided disease was present in 78% of patients, 8% on the right colon and 13% were in rectum. Adenocarcinoma was found in 95% of patients. Mucinous pattern was present in 39% of patients studied, intestinal tumors in 21%, singlet ring cells in 4.3%. Histologic grade was G2: 69%. Molecular analysis was conducted in 86% of tissue biopsies. Regarding RAS mutations, 15% were positive (Gly12asp, K117N and Gly13Asp), but none in NRAS. BRAF mutation was studied in 43% of patients, no mutations were found. The search for microsatellite instability was conducted in all tumors, finding it present in only one patient (5%). At median follow up of 31.8 months, 91.4% remainded alive. Patients with early stage cancer were given adjuvant therapy in 69%. mean RFS was 40 months. All patients diagnosed in stage IV disease received systemic therapy, with a medium PFS of 10 months. First line treatment was FOLFOX in 58% of patients. Target therapy with anti-EGFR and anti-VEGF was prescribed in 83.3% and 8.3% of patients in the first line respectively. Conclusions: We found that patients under 50 years with dignosis of colorectal cancer, have a family history of cancer in up to a third of patients, the most frecuent histology reported was adenocarcinoma with mucinous pattern. We observed a low frecuency of KRAS mutations compared with literature reports. A longer follow-up is requiered to asses overall survival.

AB0709 CHARACTERIZATION OF NAILFOLD CAPILLAROSCOPY IN COVID-19: A CASE CONTROL STUDY

Background:Nailfold capillaroscopy is a relatively easy-to-access, low-cost clinical tool that could help identify early coagulopathy in subjects with SARS-CoV-2, but specific findings vs. controls and its possible prognostic role has not been studied.Objectives:To describe capillaroscopic findings and their usefulness in patients with COVID-19 compared to healthy controls.Methods:We designed a cross-sectional study, carried out in a single care center for critical patients with SARS-CoV-2 pneumonia at the ABC Medical Center, Mexico City, which included patients from an intensive care unit (ICU) and internal medicine ward from March to April 2020. Demographic, biochemical and clinical features were collected. All patients signed the informed consent and the study was approved by the hospital ethics committee. All patients underwent nail capillary imaging of the 3 central fingers of each hand with a portable microscope with 60-100x magnification coupled to a smartphone with 7 megapixel images in an immersion medium. Capillaroscopy was performed in patients who did not have fever or hypothermia, or need vasopressors at the time of evaluation. Control subjects are healthy subjects matched on age and sex from a database of healthy controls without rheumatic diseases. Image evaluation of COVID-19 patients was performed in a blinded way for their characteristics. Prior to the analysis of the images, a pilot test was obtained with 4 rheumatologists in random cases, obtaining an acceptable global agreement in the visualization of capillaries and specific alterations of the nail bed. (Kappa = 0.58, p = 0.0019). Obtained data from capillaroscopies were used to be compared between severe and moderate cases of SARS-CoV-2 pneumonia. Additionally, we compared the findings against a healthy population in order to establish a reference.Results:We included data from 27 patients and 32 controls with similar demographic features. Patients with COVID-19 patients had a mean age of 43 +/- 13.8 years, 63% female. Comorbidities were present in 44.4% with: type II Diabetes Mellitus 18.5%, systemic arterial hypertension 18.5%, and rheumatoid arthritis 3.7%. The mean length of stay time was 13 +/- 7.1 days, 48.1% were admitted to the ICU, and 40.7% required invasive mechanical ventilation. In the capillaroscopic review remarkable findings of patients vs. controls were hemosiderin deposits (33 vs 12.5%, p=0.05), less frequently observable capillaries (77 vs 100%, p=0.005), any abnormality in capillaries (25.9 vs. 6.3%, p=0.03). Of notice, specific findings in COVID-19 patients were capillary tortuosities in 19%, dilatation in 9.5%, serpentine pattern in 4.8%, bush pattern in 9.5% and decreased density in only 4.8% of the cases. No avascular areas or capillaries of neoformation were observed. Finally, the presence of hemosiderin was associated with worse presentation and risk factors for severe COVID-19: Male sex 66.7 vs. 27.8%, (p = 0.024); Admission to ICU 77% vs 33% (p = 0.029); BMI &gt; 30 kg/m2 66.7 vs. 27.8% (p = 0.053). And risk for ICU admission OR = 7.0 (95% CI 1.098 - 44.6). No significant associations were found for abnormalities in capillary morphology.Conclusion:We present one of the first reports of nailfold capillaroscopic findings in patients with COVID-19 and the first to compare to healthy controls. Previous data on this regard suggests the presence of endothelial dysfunction and microvascular complications such as micro hemorrhage or micro thrombosis. Further studies may confirm these findings and prognostic value for worse outcomes in COVID-19 patients.

509. Comparision of CD4+ T Cells in Patients with Severe vs Critical COVID -19

BackgroundOver the past few years, it has been shown that T cells play an essential role in antiviral immunity, in the course of the COVID-19 pandemic some studies reported an association between lymphocytopenia and exhaustion of the surviving remaining T cells which are apparently functional in patients with acute COVID-19, specially in those with severe forms of presentation. Some studies have reported an association where less than 800 CD4 + T cells are negatively related to the survival of seriously ill patients with COVID -19.MethodsWe included 19 patients admitted to our hospital (ABC Medical Center) from May 7 to 15, 2020 with a confirmed diagnosis of COVID-19 and were randomized into 2 groups according to the severity of the presentation (severe or critical) A determination of CD4 + T cells was made at admission, we also reported the need for invasive mechanical ventilation at some point of the hospitalization for each group, all patients were followed until their hospital discharge. One patient was excluded because he was still admitted at the time of the analysis.ResultsOf the 18 patients included, 9 (50%) fulfilled criteria of severe and 9 (50%) of critical. The mean of CD4 + T cell was 455 (256–697) for the severe and 285.44 (145–430) for the critical (CI 95% P 0.46), the determination of CD8+ T cell was 212 (88–392) for the severe and 201 (59–534) for the critical (CI 95% P 1.19), of the critical patients 8 (88.9%) required invasive mechanical ventilation and only one non-invasive mechanical ventilation, while the severe patients only required support with supplemental oxygen by nasal cannula (9 (100%)).The mean lenght of hospitalization was 12.73 days (3–34) and all the patients survived until they were discharged home.ConclusionAs it has been reported in some studies, the pathogenesis of SARS-CoV-2 infection in humans is associated with a reduction and functional exhaustion of T cells in patients with COVID-19.In this study we presume that lower levels of CD4+T cells can be associated with critical forms of COVID 19 as the majority of critical patients in our report had < 300 CD4 +T cell count, while we need further studies with a greater number of patients and follow-up to establish reliable determinations, we propose than the levels of CD4+T cell count could be use as a good predictor of severity in COVID-19Disclosures All Authors: No reported disclosures

356. Clinical characteristics of critically ill patients with COVID-19 and invasive pulmonary aspergillosis: a case series from Mexico City

BackgroundCOVID-19, caused by SARS-CoV-2, has emerged as a global public health emergency and has been the main cause of intensive care admission during the pandemic. Invasive pulmonary aspergillosis (IPA) superinfection has been reported in case series of critically ill patients. Mexico has been widely affected by SARS-CoV-2. We present a case series of COVID-19-associated IPA at a teaching hospital in Mexico City.MethodsWe performed a retrospective analysis of COVID-19 patients admitted to the ABC Medical Center from March 13 to June 1, 2020. Only those with severe or critical COVID-19 were hospitalized. Patients with a diagnosis of putative IPA were analyzed. SARS-CoV-2 was diagnosed by Real-Time PCR from nasopharyngeal swabs. Aspergillus antigen testing in tracheal aspirate and serum was done with Aspergillus-specific galactomannoprotein (GP) ELISA (Euroimmun Medizinische Labordiagnostika).The study was approved by the hospital ethics committee.ResultsAmong the 47 admitted patients who required invasive mechanical ventilation (IMV), we identified seven (14.9%) cases of IPA. The mean age was 59.7 ± 17.8 years and five were male. All our patients had comorbidities, but none were under previous immunosuppressive treatment. All had critical COVID-19 pneumonia requiring IMV. All but one patient received corticosteroids, and five patients were treated with tocilizumab before IPA diagnosis. Putative IPA was diagnosed in six cases (86%) by a positive GP in tracheal aspirate, additionally in one of these, the tracheal aspirate culture also grew Aspergillus niger. The remaining one (14%) had a positive serum GP. The median time from COVID-19 to IPA diagnosis was 10 days. There were five bacterial co-infections, three with Pseudomonas aeruginosa, one with Stenotrophomonas maltophilia, and one with Mycobacterium tuberculosis. Six patients were treated with isavuconazole and one voriconazole. As of June 17, 2020, three patients had died, two patients had been discharged, and two were still in the intensive care unit receiving IMV.Aspergillus niger isolated from a tracheal aspirate of a critically-ill COVID-19 patient ConclusionCOVID-19-associated IPA had a lower prevalence than previously reported in other series. However, it appears to be linked to high mortality and could be associated with other bacterial coinfections.Disclosures All Authors: No reported disclosures

Hand Hygiene In and Out: Compliance and Sustainability Are Possible: 90/90 Program in a Mexican Tertiary-Care Center

Background: The American British Cowdray Medical Center I.A.P., also known as ABC Medical Center, is a highly specialized hospital and private assistance institution located in Mexico City. The ABC Medical Center implemented hand hygiene policies since around 2009, when Mexico committed to patient security. However, hand hygiene compliance remained low. Methods: The objective of the Hand Hygiene 90/90 program was to increase hand hygiene compliance through an integral strategy including a multidisciplinary team with leaders from different areas (nursing, physicians, human resources, quality, and educators). It was named 90/90 because it aimed to accomplish a 90% hand hygiene compliance among all health providers and hospital staff in 90 days (October 1–December 29) upon entering and exiting patient rooms (ie, In &amp; Out). The Hand Hygiene 90/90 program led by the epidemiology area consisted of 5 specific components: management, supplies, education, monitoring, and social marketing (Fig. 1). For a period of 90 days, several permanent actions were implemented; they had a positive influence on the expected outcome (Fig. 2). Results: The starting point at the ABC Medical Center upon launching the program was 70% compliance. With the Hand Hygiene 90/90 program, the first steady change was observed at the end of November 2012 (ie, the sixth measurement point). An 88% compliance was achieved, all compliance was &gt;50% from this point on. The highest compliance was achieved among health providers (doctors and nurses), followed by administrative staff. At the end of December 2012, 91% compliance was achieved by all health providers and hospital staff. Sustainability has been possible over the years through ongoing hand hygiene campaigns. In the 5 years following the implementation of the program, hand hygiene compliance remained mostly below the 90% standard (Fig. 3). Conclusions: An intervention for continuous improvement and hand hygiene compliance using the WHO 5 Moments was implemented throughout 2018, (in addition to the In &amp; Out program). This intervention also incorporated elements of the WHO Multimodal Strategy 1 to develop a comprehensive hand hygiene program together with new indicators. The ABC Medical Center, with the support and leadership of the Ministry of Health, aims to become an example of institutions that achieve national and international benchmarks in the implementation of patient safety programs that are not only successful but also sustainable.Funding: NoneDisclosures: None

El retiro digno del médico.

Retirement of physicians from their professional activity is a subject of global interest. In Mexico, there is no official regulation that determines the age at which physicians should retire from their profession as in other countries. This symposium presents the measures implemented at the ABC Medical Center in recent years about physicians' retirement, with the establishment of a committee. This has been achieved in part also with the creation of group medical practices that integrate doctors in their different specialties, whose interest among other aspects of individual and collective interest, is the establishment of a retirement fund.

1190. Hygiene of the Hands 90/90: A Program of Continuous Improvement for the Compliance of the Hygiene of the Hands

BackgroundHealthcare-associated infections (HAIs) are associated with high rates of morbidity and mortality, which translates into an increase in the days of hospitalization and costs of care. The research of hand hygiene in health workers demonstrate that this action decreases the spread of pathogens; however, the compliance of hand hygiene remains low among health workers. Hand hygiene is a cheap method to prevent infections. It has been estimated that the total cost of hand hygiene promotion represents <1% of the costs associated with the HAIs. Our goal is to strengthen the culture of hand hygiene (In and Out) in all health professionals in a period of 90 days, achieving a 90% compliance.MethodsThe ABC Medical Center is a high specialty hospital, on average it has 465 beds. The program led by the Epidemiology Unit was formed by a multidisciplinary team with the patriation of leaders of different areas (Epidemiology, Nursing, Physicians, Human resources, Quality and Teaching). We used the “WHO Guidelines on Hand Hygiene in Health Care” consisting of: (1) system change, (2) training for employees, (3) evaluation and feedback, (4) a reminder at the workplace, (5) institutional security climate, (6) monitoring of the compliance to hand hygiene: The monitoring of the evaluation personnel was carried out in two stages, when entering and leaving the patient’s room.ResultsA total of 9,732 observations were made, of which 55.32% went to the nursing staff, 22.80% to doctors and 21.87% to the hospital staff. The compliance of the hand hygiene at the beginning of the program was 70%, by the and the 91% was reached. Sustainability has been maintained through continuous campaigns of the importance of hand hygiene reaching a 98% adherence to hands hygiene in 2018. The behavior of HAIs is notorious since at the beginning of the program there was a rate of 0.95 and by 2018, with the increase in compliance to hand hygiene, it decreased to 0.56.ConclusionThe 90/90 Hand Hygiene program is a pioneer in its modality for the implementation of the program in a short period of time and excellence in its scope. It is confirmed that leadership is essential and strategic to ensure quality and safety in patient care. Through the incentive to the staff a clear sense of participation and belonging to the institution is achieved Disclosures All authors: No reported disclosures.

Sensitivity and Specificity of Computed Tomography in the Evaluation of Bone Mineral Density in Mexican Patients with Breast Cancer.

IntroductionBreast cancer (BC) is the most frequently reported cancer among women - reported in 2012 as 25% of all cancers. BC has been related to the increased life and activity of osteoclasts, conferring a higher risk for osteoporosis/osteopenia. This study aimed to determine a cut-off point in Hounsfield units (HU) as well as the sensitivity and specificity of computed axial tomography (CT) in the diagnosis of osteoporosis/osteopenia in Mexican women with BC.Material and methodsWe included 108 patients with a histopathological diagnosis of BC treated at the ABC Medical Center in Mexico City. All patients were subjected to both dual X-ray densitometry and CT. The receiver operating characteristic (ROC) curve was used to identify the cutoff point and sensitivity and specificity were calculated, as were confidence intervals for the diagnoses of osteoporosis/osteopenia.ResultsThe mean age was 58.49 ± 11.01 years. The cutoff point with the highest sensitivity (82%) and specificity (68%) was <157 HU for osteoporosis/osteopenia in patients with BC.ConclusionsWomen with BC are exposed to several risk factors for osteoporosis/osteopenia. The CT obtained for the general evaluation of these patients can also be used to evaluate bone mineral density, avoiding additional examinations and exposure to radiation, as well as the cost it confers, offering an earlier diagnosis of osteoporosis/osteopenia for its control.

Anatomical Reconstruction in Bilateral Cleft Lip With Mendoza Technique.

Description of surgical technique for BCL reconstruction and present the postoperative results obtained. Patients with BCL of the cleft lip and palate at ABC Medical Center from June 2013 to June 2017 operated with Mendoza bilateral cheiloplasty were included. The procedure includes an anatomical reconstruction of the lip with minimal resection of tissue, alignment of the orbicularis muscle, vestibule creation, and complete use of the prolabium. The evaluation was carried out by photographs analyzing parameters of quality, symmetry, and alignment of lip and nose structures. The authors included 36 patients, 15 women and 16 men. The average procedure time was 57 minutes. Photographs were evaluated 1 year postoperatively, symmetry in lip was observed in 91.6% of the patients, muscle continuity in 100%, deep gingivolabial sulcus in 94.5% of cases, closed nasal floor in 100% with no presence of nasovestibular fistulas. This technique allows an anatomical BCL reconstruction with good aesthetic and functional results.

T90. Pilot study to compare the P300 component in resident physicians with acute sleep deprivation after a night shift and non-exposed controls

Introduction Medical residency in Mexico as in many other countries is a stressful experience. Sleep deprivation among other factors to which the resident is exposed are associated with various cognitive and emotional alterations. The impact of prolonged awake in the lives of residents is already well described, the present study aims to demonstrate with an objective neurophysiological parameter (P300) cognitive alterations, particularly in selective attention, presented by resident physicians after a night shift comparing them against themselves after a night of rest and against a control group not exposed to acute or chronic sleep restriction. Methods An observational study was carried out with 40 participant cohorts and controls, 20 for the control group without sleep restriction who underwent P300 before and after a night of physiological sleep; and 20 resident physicians of different specialties at the ABC Medical Center in Mexico city, in whom P300 were performed before and after a night shift, to analyze changes in latency and amplitude associated with acute sleep deprivation. Results The mean age for residents was 29.65 ± 2.85 years and for the control group 30.30 ± 2.95 years. The mean latency for residents was 302.04 ± 23.86 ms vs 292.11 ± 36.35 ms in controls (p0.272); for amplitude was 5.52 ± 2.97 μ V in the residents group vs 6.50 ± 4.02 μ V in controls (p 0.161). When we compared latency and amplitude among the residents before and after a night shift, a mean latency of 300.63 ± 23.16 ms was found in the pre night shift group vs 303.74 ± 25.67 ms in the post night shift group (p 0.653); a mean amplitude of 6.1 ± 3.59 μ V in the pre night shift vs 3.98 ± 3.3 μ V in the post night shift (p 0.062). When we compared pre night shift residents with controls, a mean latency of 301.73 ± 22.71 ms was found vs 292.16 ± 36.36 ms in controls (p 0.322); a mean amplitude in the pre night shift of 6.12 ± 3.6 μ V vs 6.51 ± 4.02 μ V in controls (p0.751); when comparing the same parameters among the post night shift residents and controls, latency was 302.65 ± 26.16 ms vs 292.16 ± 36.36 ms (p 0.300); mean amplitude in post night shift residents of 3.99 ± 3.36 μ V vs 6.51 ± 4.02 μ V in controls, with a significant p of 0.037. Conclusion We had clinically comparable groups. With differences in visual analog scale, Epworth scores and sleep minutes before P300, as expected. The latency value maintained without significant fluctuation among the groups. When we compared the amplitude between the pre night shift vs post night shift residents a tendency to statistical significance was found. When comparing post night shift residents vs controls, we found a significant difference in amplitude, in relation to difficulty in maintaining attention after acute sleep deprivation. We concluded that residents have lower amplitude post night shift. This is a pilot study for future research and the results would help us to calculate the sample size.

Abstract P5-11-13: Experience in the ABC Medical Center of Mexico City 2010-2015 using scalp-cooling system (DigniCap) for prevention of alopecia induced by chemotherapy

Abstract Background: Alopecia is one of the secondary side effect whit the most emotionally impact for patients undergoing chemotherapy (CTX) The DigniCap System is the first scalp cooling system use to minimize alopecia. Methods: The objetive of this study was to evaluate in a restrospective trial the efficacy of DigniCap preventing alopecia in consecutive patients treated in ABC Medical Center from December 2010 to January 2015. Patients recieve different chemotherapy regimens, with different modalities, neo , adyuvant and for metastases in first and second line, as in many clinical stages whit breast cancer (BC), were evaluated with the visual scale of Dean (score 0: 0-25%, 1: 25-50%, 2: 50-75%, 3: 75-100%) with photographs of the before and after treatment. Results: 120 pts with BC in stages I-V were treated with a taxane and antraciclins regimen of chemotherapy, 66 pts receive 12 treatment weekly of paclitaxe (T)l and 4 adriamicin/cyclophosphamida (AC) every 21 days, 28 pts 6-8 cycles every 21 days AC-Taxol, 22 pts (18%)suspended the treatment because of the loss of more than 50% of hair at the 2nd an 3rd chemotherapy cycle. 98 pts actually finished the treatment (72%). Of these, 82 pts (84%) no had or had a minimal loss of hair (Dean score 0-1), 16 pts (16%) had a 50% of hair loss (Dean score 3). 8pts recieve more than one regimen of chemotherapy. In the tracing any metastases or side effects were presented with the use of DigniCap. Conclusions: The use of DigniCap minimize alopecia in a 84%, including pts with more than one chemotherapy regimen, in a a safety level. Citation Format: Hernandez RE, Gerson R, Olivares G, Rivera S, Serrano A, Villalobos A, Lazaro M. Experience in the ABC Medical Center of Mexico City 2010-2015 using scalp-cooling system (DigniCap) for prevention of alopecia induced by chemotherapy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-11-13.

Valor pronóstico de la presencia de burbujas de aire libre pericólico detectadas por tomografía computada en diverticulitis aguda

BackgroundDiverticular disease is common in industrialized countries. Computed tomography has been used as the preferred diagnostic method; although different scales haves been described to classify the disease, none of them encompass total disease aspects and behaviour. ObjetiveTo analyze the patients with acute diverticulitis confirmed by computed tomography at the ABC Medical Center Campus Observatorio from January 1, 2010 to December 31, 2012, in whom pericolic free air in the form of bubbles was identified by computed tomography and if this finding can be considered as a prognostic factor for the disease. MethodsA series of 124 patients was analyzed who had acute diverticulitis confirmed by computed tomography, in order to identify the presence of pericolic bubbles. ResultsOf the 124 patients, 29 presented with pericolic bubbles detected by computed tomography; of these, 62.1% had localized peritoneal signs at the time of the initial assessment, (P<.001); leukocytosis (13.33 vs 11.16, P<.001) and band count (0.97 vs 0.48, P<.001) was higher in this group. Patients with pericolonic bubbles had a longer hospital stay (5.5days vs 4.3days, P<.001) and started and tolerated liquids later (4.24days vs. 3.02days, P<.001) than the group of patients without this finding. ConclusionsThe presence of pericolic bubbles in patients with acute diverticulitis can be related to a more aggressive course of the disease.

Forceps, Actual Use, and Potential Cesarean Section Prevention: Study in a Selected Mexican Population.

Objective. Assessment of the frequency of complications observed with various forceps and operative vaginal delivery (OVD) techniques performed at the ABC Medical Center (Mexico City) to evaluate their safety, bearing in mind the importance of decreasing our country's high cesarean section incidence. Methods. We reviewed 5,375 deliveries performed between the years 2007 and 2012, only 146 were delivered by OVD. Results. Only 1.0% of the cases had a serious, life-threatening situation (uterine rupture). The Simpson forceps was the most favored instrument (46%) due to its simplicity of use, effectiveness, and familiarity. Prophylactic use was the most common indication (30.8%) and significant complications observed were vaginal lacerations (p = 0.016), relative risk (RR) of 3.4 (95% confidence interval [CI]: 1.15–10.04), and fourth degree perineal tear (p = 0.016), RR of 3.4 (95% CI: 1.15–10.04). Conclusions. Forceps use and other OVD techniques are a safe alternative to be considered, diminishing C-section incidence and its complications.