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Dagobeth EEV, Rojas GAN, Valdelamar JCH, Lozada-Martínez ID, Causado AS, Narvaez-Rojas AR. Surgical outcomes and factors associated with postoperative complications of colorectal cancer in a Colombian Caribbean population: Results from a regional referral hospital. Cancer Rep (Hoboken) 2023; 6:e1766. [PMID: 36538945 PMCID: PMC10075291 DOI: 10.1002/cnr2.1766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 04/06/2023] Open
Abstract
INTRODUCTION Colorectal cancer is the most common malignant neoplasm of the gastrointestinal tract. Its incidence and mortality vary markedly at a global level. Assessing the epidemiological behavior of this condition allows reevaluating diagnostic, therapeutic and prognostic options, based on new findings. In Colombia, few studies have correlated variables associated with surgical and oncological outcomes in this type of cancer. Then, the aim of this study was to evaluate the surgical outcomes and factors associated with postoperative complications of colorectal cancer in a Colombian Caribbean Population. METHODS Retrospective cross-sectional study, including patients with a histopathological diagnosis of colorectal cancer who underwent open or laparoscopic surgery, during a period of two years (2018-2020), from a regional referral hospital. Clinical history variables were collected. Frequencies and prevalence ratios were calculated. RESULTS A total of 84 patients were finally included. Adenocarcinoma of non-special type with advanced clinical stages was the most prevalent (72.6%). Rectal neoplasia (45.2%) was the most frequent anatomical subsite, followed by proximal colon (p = 0.026). The anatomical subsite of the neoplasm, intraoperative complication (PR 1.38; 95% CI, 1.21-1.59, p = 0.001) and intensive care stay (PR 1.062; 95% CI, 1.01-1.12, p = 0.048) were associated with postoperative outcome. CONCLUSIONS The anatomical subsite of the neoplasm location, the presence of intraoperative complications and the stay in intensive care may be associated with the surgical and oncological outcome of individuals with colon cancer from the Colombian Caribbean region.
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Affiliation(s)
| | | | | | - Ivan David Lozada-Martínez
- Grupo Prometeus y Biomedicina Aplicada a las Ciencias Clínicas, School of Medicine, Universidad de Cartagena, Cartagena, Colombia
- Medical and Surgical Research Center, Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia
- International Coalition on Surgical Research, Universidad Nacional Autónoma de Nicaragua, Managua, Nicaragua
| | - Amileth Suarez Causado
- Grupo Prometeus y Biomedicina Aplicada a las Ciencias Clínicas, School of Medicine, Universidad de Cartagena, Cartagena, Colombia
| | - Alexis Rafael Narvaez-Rojas
- International Coalition on Surgical Research, Universidad Nacional Autónoma de Nicaragua, Managua, Nicaragua
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Gómez DA, Mendoza Zuchini A, Pedraza M, Salcedo Miranda DF, Mantilla-Sylvain F, Pérez Rivera CJ, Lozada-Martínez ID, Domínguez-Alvarado G, Cabrera-Vargas LF, Narvaez-Rojas A. Long-Term Outcomes of Laparoscopic Common Bile Duct Exploration Through Diathermy, Choledochotomy, and Primary Closure: A 6-Year Retrospective Cohort Study. J Laparoendosc Adv Surg Tech A 2023; 33:281-286. [PMID: 36576507 DOI: 10.1089/lap.2022.0453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background and Objective: Choledocholithiasis is a frequent pathology, unfortunately when its endoscopic management fails, there is no consensus of how it should be addressed. The aim of this study was to evaluate the safety, feasibility, and long-term outcomes of laparoscopic common bile duct exploration (LCBDE) using electrosurgery (coagulation) for choledochotomy followed by primary closure after endoscopic treatment failure. Materials and Methods: A retrospective cohort study of patients who underwent LCBDE from 2013 to 2018 was conducted in Bogotá, Colombia. Clinical demographics, operative outcomes, recurrence rate of common bile duct stones, and long-term bile duct complications were analyzed. A descriptive analysis was performed. Results: A total of 168 patients were analyzed. Most of the patients were males (53.37%) with a median age of 73 years with no comorbidities (65%). Stone clearance was successful in 167 patients (99.4%). Nonlethal complications were noted in 3 patients during the surgery or in the immediate postoperative (1.79%) and managed with T-tube or endoscopically. No cases of mortality surgery related were observed. There were no signs of any type of biliary injury or stricture observed in any of the patients during the 24-month follow-up period. Conclusions: LCBDE with diathermy and primary closure is a safe and effective treatment option for choledocholithiasis for failed endoscopic retrograde cholangiopancreatography in terms of long-term outcome as well as short-term outcome.
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Affiliation(s)
| | | | | | | | | | | | - Ivan David Lozada-Martínez
- Research Unit, Medical and Surgical Research Center, Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia.,Research Unit, International Coalition on Surgical Research, Universidad Nacional Autónoma de Nicaragua, Managua, Nicaragua
| | - Gonzalo Domínguez-Alvarado
- Research Unit, Grupo de Innovación e Investigación Quirúrgica, School of Medicine, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Luis Felipe Cabrera-Vargas
- Department of Surgery, Universidad El Bosque, Bogotá, Colombia.,Research Unit, Medical and Surgical Research Center, Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia
| | - Alexis Narvaez-Rojas
- Research Unit, International Coalition on Surgical Research, Universidad Nacional Autónoma de Nicaragua, Managua, Nicaragua
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Cabrera‐Vargas LF, Mendoza‐Zuchini A, Aparicio BS, Pedraza M, Sajona‐Leguia WA, Arias JSR, Lozada‐Martinez ID, Picón‐Jaimes YA, Narvaez‐Rojas AR. Postoperative outcomes using Lichtenstein open hernioplasty versus Nyhus preperitoneal hernioplasty in inguinal hernia: A comparative analysis with 1-year follow-up. Health Sci Rep 2023; 6:e1151. [PMID: 36938140 PMCID: PMC10018801 DOI: 10.1002/hsr2.1151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/12/2023] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
Background and Aim Inguinal hernia is the most common defect of the abdominal wall in 75% and their treatment consists of surgical repair. The technique of choice is laparoscopic because of its overall benefits. However, when this is not available, open approaches may be a viable option. Currently, the most commonly used open techniques are Lichtenstein and Nyhus. However, there are few medium- or long-term studies that have compared outcomes between these two techniques. Methods This is a retrospective comparative study that included patients undergoing open inguinal hernia correction with mesh, using Lichtenstein open hernioplasty versus Nyhus preperitoneal hernioplasty, in two tertiary referral centers in Bogota, Colombia, during a period of 2 years. A bivariate analysis was performed to compare groups, according to the complications presented between the two techniques. Results A total of 193 patients were included, of whom 53.36% were men and 112 (58.03%) were approached with the Nyhus technique versus 81 patients with the Lichtenstein technique. Nonabsorbable suture fixation was performed in 100% of patients. Among the main complications, seroma (5.18%), pain (4.14%), bleeding (2.07%), recurrence (10.88%), and reoperation (0.51%) were observed, of which only recurrence showed a statistically significant difference, which is lower in the Nyhus approach (3.57% vs. 20.67%; p < 0.001). No patients died. Conclusions Both Nyhus and Lichtenstein hernioplasty techniques were shown to cause a low incidence of postoperative complications, with significantly lower recurrence using the Nyhus technique up to 1 year postoperatively.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Alexis R. Narvaez‐Rojas
- Division of Breast Surgical Oncology, DeWitt Daughtry Family Department of SurgeryJackson Health System / University of Miami Miller School of MedicineFloridaMiamiUSA
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Endoscopic sleeve gastroplasty: is it time to prioritize minimally invasive interventions for the management of metabolic syndrome? Ann Med Surg (Lond) 2023; 85:331-332. [PMID: 36845765 PMCID: PMC9949856 DOI: 10.1097/ms9.0000000000000167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 12/25/2022] [Indexed: 02/28/2023] Open
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Torregrosa L, Guevara O, Perez-Rivera C, Lozada-Martinez ID, Saavedra C, Pedraza M, Aparicio S, Narvaez-Rojas AR, Cabrera-Vargas LF. Translation, adaptation, and validation of the MeNTS score in colombian population: The MeNTS Col score. SAGE Open Med 2023; 11:20503121231162339. [PMID: 36993780 PMCID: PMC10037133 DOI: 10.1177/20503121231162339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 02/17/2023] [Indexed: 03/31/2023] Open
Abstract
Objective To evaluate and validate the medically necessary and time sensitive score by testing the variables, in order to create a surgical preoperative score for procedure prioritization in COVID-19 pandemic in Colombia. Methods A multicenter retrospective cross-sectional study of instrument validation with a cultural adaptation and translation into the Spanish language was carried out in Bogota, Colombia. Patients over 18 years of age who had undergone elective procedures of general surgery and subspecialties were included. The translation of the medically necessary and time sensitive score into Spanish was performed independently by two bilingual surgeons fluent in both English and Spanish. A final version of the Spanish questionnaire (MeNTS Col) for testing was then produced by an expert committee. After translation and cultural adaptation, it was submitted to evaluate the psychometric properties of the medically necessary and time sensitive score. Cronbach's α was used to represent and evaluate the internal consistency and assess reliability. Results A total of 172 patients were included, with a median age of 54 years; of which 96 (55.8%) patients were females. The vast majority of patients were treated for general surgery (n = 60) and colon and rectal surgery (n = 31). The evaluation of the internal consistency of the scale items in Spanish version was measured, and values of 0.5 for 0.8 were obtained. In the reliability and validation process, Cronbach's α values in all items remained higher than 0.7. The new MeNTS Col model was analyzed, and a result of 0.91 was obtained. Conclusions The Spanish version of the medically necessary and time sensitive, the MeNTS Col score, and its respective Spanish translation perform similarly to the original version. Therefore, they can be useful and reproducible in Latin American countries.
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Affiliation(s)
- Lilian Torregrosa
- Department of Surgery, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Oscar Guevara
- Department of Hepatobiliary Surgery, Universidad Nacional de Colombia, Bogotá, Colombia
| | | | - Ivan David Lozada-Martinez
- Medical and Surgical Research Center, Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia
- International Coalition on Surgical Research, Faculty of Medical Sciences. Universidad Nacional Autónoma de Nicaragua, Managua, Nicaragua
| | - Carlos Saavedra
- Department of Infectious Diseases, Universidad Nacional de Colombia, Bogotá, Colombia
| | | | - Steven Aparicio
- Deparment of Medicine, Universidad El Bosque, Bogotá, Colombia
| | - Alexis Rafael Narvaez-Rojas
- International Coalition on Surgical Research, Faculty of Medical Sciences. Universidad Nacional Autónoma de Nicaragua, Managua, Nicaragua
- Breast Surgical Oncology Division, DeWitt Daughtry Family Department of Surgery. Jackson Health System/University of Miami Miller School of Medicine, Miami, FL, USA
- Alexis Rafael Narvaez-Rojas, International Coalition on Surgical Research, Faculty of Medical Sciences, Universidad Nacional Autónoma de Nicaragua, Rotonda Universitaria Rigoberto López Pérez 150 Metros Este, Managua 663, Nicaragua.
| | - Luis Felipe Cabrera-Vargas
- Department of Surgery, Universidad El Bosque, Bogotá, Colombia
- Department of Surgery, Universidad de los Andes, Fundación Santa Fe de Bogotá, Bogotá, Colombia
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Medellin Abueta A, Senejoa NJ, Pedraza Ciro M, Fory L, Rivera CP, Jaramillo CEM, Barbosa LMM, Varela HOI, Carrera JA, Garcia Duperly R, Sanchez LA, Lozada‐Martinez ID, Cabrera‐Vargas LF, Mendoza A, Cabrera P, Sanchez Ussa S, Paez C, Wexner SD, Strassmann V, DaSilva G, Di Saverio S, Birindelli A, Florez RJR, Kestenberg A, Obando Rodallega A, Robles JCS, Carrasco CAN, Impagnatiello A, Cassini D, Baldazzi G, Roscio F, Liotta G, Marini P, Gomez D, Figueroa Avendaño CE, Villamizar DM, Cabrera L, Reyes JC, Narvaez‐Rojas A. Laparoscopic Hartmann's reversal has better clinical outcomes compared to open surgery: An international multicenter cohort study involving 502 patients. Health Sci Rep 2022; 5:e788. [PMID: 36090626 PMCID: PMC9434380 DOI: 10.1002/hsr2.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/27/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background Hartmann's procedure (HP) is used in surgical emergencies such as colonic perforation and colonic obstruction. "Temporary" colostomy performed during HP is not always reversed in part due to potential morbidity and mortality associated with reversal. There are several contributing factors for patients requiring a permanent colostomy following HP. Therefore, there is still some discussion about which technique to use. The aim of this study was to evaluate perioperative variables of patients undergoing Hartmann's reversal using a laparoscopic and open approach. Methods The multicenter retrospective cohort study was done between January 2009 and December 2019 at 14 institutions globally. Patients who underwent Hartmann's reversal laparoscopic (LS) and open (OS) approaches were evaluated and compared. Sociodemographic, preoperative, intraoperative variables, and surgical outcomes were analyzed. The main outcomes evaluated were 30-day mortality, length of stay, complications, and postoperative outcomes. Results Five hundred and two patients (264 in the LS and 238 in the OS group) were included. The most prevalent sex was male in 53.7%, the most common indication was complicated diverticular disease in 69.9%, and 85% were American Society of Anesthesiologist (ASA) II-III. Intraoperative complications were noted in 5.3% and 3.4% in the LS and OS groups, respectively. Small bowel injuries were the most common intraoperative injury in 8.3%, with a higher incidence in the OS group compared with the LS group (12.2% vs. 4.9%, p < 0.5). Inadvertent injuries were more common in the small bowel (3%) in the LS group. A total of 17.2% in the OS versus 13.3% in the LS group required intensive care unit (ICU) admission (p = 0.2). The most frequent postoperative complication was ileus (12.6% in OS vs. 9.8% in LS group, p = 0.4)). Reintervention was required mainly in the OS group (15.5% vs. 5.3% in LS group, p < 0.5); mortality rate was 1%. Conclusions Laparoscopic Hartmann's reversal is safe and feasible, associated with superior clinical outcomes compared with open surgery.
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Affiliation(s)
| | | | | | - Lina Fory
- Department of General SurgeryHospital Militar CentralBogotáColombia
| | | | | | | | | | - Javier A. Carrera
- Department of Colorectal SurgeryFundación Santa Fe de BogotáBogotáColombia
| | | | - Luis A Sanchez
- Department of Colorectal SurgeryHospital Militar CentralBogotáColombia
| | - Ivan David Lozada‐Martinez
- Medical and Surgical Research CenterFuture Surgeons Chapter, Colombian Surgery AssociationBogotáColombia
- International Coalition on Surgical ResearchUniversidad Nacional Autónoma de NicaraguaManaguaNicaragua
| | - Luis Felipe Cabrera‐Vargas
- Medical and Surgical Research CenterFuture Surgeons Chapter, Colombian Surgery AssociationBogotáColombia
- Department of Surgery Fundación Santa Fe de BogotáBogotáColombia
| | - Andres Mendoza
- Department of SurgeryUniversidad El BosqueBogotáColombia
| | - Paulo Cabrera
- Department of General SurgeryHospital Militar CentralBogotáColombia
| | | | - Cristian Paez
- Department of SurgeryFundación Universitaria SanitasBogotáColombia
| | - Steven D. Wexner
- Department of Colorectal Surgery Cleveland Clinic FloridaWestonFLUSA
| | - Victor Strassmann
- Department of Colorectal Surgery Cleveland Clinic FloridaWestonFLUSA
| | - Giovanna DaSilva
- Department of Colorectal Surgery Cleveland Clinic FloridaWestonFLUSA
| | - Salomone Di Saverio
- Emergency and General Surgery DepartmentCA Pizzardi Maggiore HospitalBolognaItaly
| | | | | | - Abraham Kestenberg
- Department of Colorectal SurgeryFundación Clínica Valle del LiliCaliColombia
| | | | | | | | | | - Diletta Cassini
- Complex Unit of General and Emergency SurgeryCittà di Sesto San Giovanni HospitalMilanItaly
| | - Gianandrea Baldazzi
- Complex Unit of General and Emergency SurgeryCittà di Sesto San Giovanni HospitalMilanItaly
| | | | - Gianluca Liotta
- Department of SurgerySan Caillo – Forlanini HospitalRomeItaly
| | | | - Daniel Gomez
- Department of SurgeryUniversidad El BosqueBogotáColombia
| | | | | | - Laura Cabrera
- Department of SurgeryUniversidad El BosqueBogotáColombia
| | - Juan Carlos Reyes
- Department of Colorectal SurgeryHospital Militar CentralBogotáColombia
| | - Alexis Narvaez‐Rojas
- International Coalition on Surgical ResearchUniversidad Nacional Autónoma de NicaraguaManaguaNicaragua
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Lozada-Martinez ID, Carvajal-Bautista J, Picón-Jaimes YA, Dominguez-Alvarado G, Cabrera-Vargas LF, Torregrosa-Almonacid L, Guevara-Cruz O, Narvaez-Rojas AR. Surgical research in Colombia part 1: Scientific and academic productivity of the Colombian research groups in surgery. Ann Med Surg (Lond) 2022; 77:103667. [PMID: 35638019 PMCID: PMC9142555 DOI: 10.1016/j.amsu.2022.103667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Global surgery has become the undisputed starting point for addressing a myriad of problems in surgery today. Therefore, it is necessary to constantly evaluate the scientific productivity in surgery, its behavior, validity and impact. In Latin America, specifically in Colombia, there are no studies that have analyzed this production. Methods A retrospective cross-sectional bibliometric study was carried out, in which the Colombian Ministry of Science database was consulted with the validated results up to July 2021. In the search section for research groups, the key word “Surgery” was used, and all associated GrupLAC (platform where the information of the research groups can be found) and their registered products were reviewed. Results 40 groups were included. Only 5 (12.5%) were registered in surgery as main line of research. The great majority of the groups were in the medium-low category, 50% in category C and 22.5% in category B. The vast majority of surgical groups are located in Bogotá (19; 47.5%). The first surgery group in the country was created in 1994 and the last one in 2017. In 27 years of surgical research, a total of 4121 registered scientific articles were found, 83 books, 713 book chapters, 2891 products associated with participation in scientific events, 1221 theses directed, and 1670 projects in colombian surgical research groups. There was evidence of a high rate of underreporting of data, due to duplication of products and incomplete registration of data. Conclusions There is a high rate of underreporting of products and data in the GrupLAC of Colombian surgical research groups. Most of the production is located in the Andes region (Antioquia, Valle del Cauca and Bogotá), and is predominantly composed of scientific articles and products associated with participation in scientific events. There is a high rate of underreporting of data in the Colombian surgical research groups. Most of the production is composed of articles and participation in scientific events. Surgical production in Colombia is centralized in the Andean region.
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Affiliation(s)
- Ivan David Lozada-Martinez
- Medical and Surgical Research Center, Future Surgeons Chapter, Colombian Surgery Association, Cartagena, Colombia.,Grupo Prometheus y Biomedicina Aplicada a las Ciencias Clínicas, School of Medicine, Universidad de Cartagena, Cartagena, Colombia
| | | | | | - Gonzalo Dominguez-Alvarado
- Grupo de Innovación e Investigación en Cirugía, Semillero de Innovación e Investigación Quirúrgica, Bucaramanga, Colombia
| | | | | | | | - Alexis Rafael Narvaez-Rojas
- Department of Surgery, Hospital Carlos Roberto Huembes, Universidad Nacional Autonoma de Nicaragua, Managua, Nicaragua
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Pinzón F, Rami M, Gaitan L, Cabrera-Vargas LF, Lozada-Martinez ID. Bariatric emergencies recommendations for the general surgeon on duty in low-to middle-income countries: An algorithm proposal – Correspondence. Int J Surg 2022; 102:106674. [DOI: 10.1016/j.ijsu.2022.106674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
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Lozada-Martinez ID. Virtual hybrid hotel care model for the surgical patient: New goal of global academic surgery to improve global outcomes. Ann Med Surg (Lond) 2022; 77:103529. [PMID: 35493412 PMCID: PMC9043351 DOI: 10.1016/j.amsu.2022.103529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/10/2022] [Accepted: 03/26/2022] [Indexed: 11/21/2022] Open
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Ethnicity, genetic variants, risk factors and cholelithiasis: The need for eco-epidemiological studies and genomic analysis in Latin American surgery. Int J Surg 2022; 99:106589. [PMID: 35248763 DOI: 10.1016/j.ijsu.2022.106589] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 11/23/2022]
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Lozada-Martinez ID, La Hoz SXGD, Montaño-Socarras D, Ovalle-Mulford FJ. Training the trainers: The fundamental basis for guaranteeing the evolution of academic surgery in third world countries. Int J Surg 2022; 99:106257. [PMID: 35181555 DOI: 10.1016/j.ijsu.2022.106257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Ivan David Lozada-Martinez
- Medical and Surgical Research Center, Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia Department of Critical Care, Hospital Clínico Doctor Félix Bulnes Cerda, Santiago de Chile, Chile Department of Medicine, Clínica Colonial, Santiago de Chile, Chile
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