Nicolas Andres Cortes-Mejia

BACKGROUND: Postoperative acute kidney injury (AKI) is a major complication after oncological surgery, associated with increased morbidity and mortality. Experimental and clinical evidence suggests that leukotriene receptor antagonists, such as montelukast, may reduce inflammation and oxidative stress, potentially protecting against renal injury. In the current study, we investigated the association of perioperative use of leukotriene receptor antagonists and postoperative AKI. Specifically, we hypothesized that leukotriene receptor antagonists, such as montelukast and zafirlukast, would be associated with a lower postoperative incidence of AKI. METHODS: This single-center retrospective study included adult patients undergoing oncological surgery between April 1, 2016, and September 30, 2025. The primary endpoint was AKI within 7 days of surgery, defined by Kidney Disease Improving Global Outcomes (KDIGO). Secondary endpoints were 30-day postoperative complications, length of hospital stay, and hospital stay costs. A propensity score–overlap weighting (OW) was applied to balance potential confounders identified through univariate analysis and biological plausibility. After balancing, a Poisson regression model with robust standard errors was used to assess associations with outcomes. RESULTS: Of the total 45,751 participants, 555 (1.2%) received a leukotriene receptor antagonist. After weighting for overlap, exposure to the leukotriene receptor antagonist was not significantly associated with AKI 7 days after surgery (risk ratio [RR], 0.79; 95% confidence interval [CI], 0.60–1.06; P = .12). The duration of post-anesthesia care unit (PACU) admission was slightly shorter in leucotriene antagonist users (adjusted mean difference of −5.84 minutes; 95% CI, −14.46 to 2.78; P = .184). A statistically significantly longer hospitalization was observed among leukotriene antagonist users, with a mean adjusted difference of 1.55 days (95% CI, 0.86–2.24; P < .001). The use of leukotriene receptor antagonists was also associated with a higher adjusted risk of surgical reintervention at 7 days: 38.37% vs 33.92%, with an adjusted risk difference of 4.45% (95% CI, 0.31–8.59; P = .035). The adjusted readmission risk at 7 days was 3.52% vs 2.02%, with an adjusted risk difference of 1.49% (95% CI, −0.07 to 3.05; P = .061). The adjusted risks of intensive care unit (ICU) admission were 2.96% vs 2.63%, with an adjusted risk difference of 0.32% (95% CI, −1.11 to 1.76; P = .658). CONCLUSIONS: Perioperative use of leukotriene receptor antagonists was not significantly associated with a lower risk of postoperative AKI following oncologic surgery. Further prospective and mechanistic studies are needed to clarify whether leukotriene receptor antagonists exert renoprotective effects in surgical patients.

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Introduction: Pediatric musculoskeletal and cancer surgeries often lead to significant postoperative pain. Augmented reality (AR), a non‐pharmacological approach to pain modulation, has been insufficiently studied for its potential role in reducing opioid use following major surgery in children. Methods: In this pilot trial, we randomly assigned pediatric patients undergoing major surgery, in a 1:1 ratio, to an AR versus non‐AR scavenging game postoperatively. Randomization was stratified according to the study site. The primary endpoint was the rate of persistent opioid use measured at 90 days after hospital discharge. Secondary endpoints included pain intensity, opioid use, inpatient ambulation or “out of bed”, movement, length of stay, and adverse events. We considered the trial a success if the rate of opioid use at 90 days postoperatively was significantly lower in the AR arm than in the non‐AR arm. Results: A total of 66 patients underwent randomization ( n = 33 in each arm). The median age of each group was 12 years old. There were more females (72.7%) in the AR group than in the non‐AR group (48.5%). Most patients (80%) had undergone oncological surgeries. The primary endpoint was met in over 95% of the patients. The overall rate of opioid use was low in both groups of patients (AR: 6.1% and non‐AR: 9.7%) and did not reach statistical significance ( p = 0.667). There were no statistically significant differences in secondary outcomes. Conclusion: In conclusion, this pilot study does not support the use of AR aimed at reducing the rate of persistent opioid use following pediatric surgery.

Background: Adjuvant therapies improve disease-free and cancer-specific survival in digestive tract malignancies. Return to intended oncological therapy (RIOT) measures how promptly patients resume these treatments after cancer resection. Because sugammadex has demonstrated superior postoperative outcomes compared to neostigmine, we hypothesize that its use may increase the likelihood and timeliness of RIOT in patients undergoing digestive tract cancer surgery. Methods: Adults (≥18 years) undergoing gastrointestinal, hepatobiliary cancer resection, or liver resection for limited metastases between January 2016 and December 2017 were retrospectively analyzed. Patients were grouped by neuromuscular blockade reversal agent (neostigmine vs. sugammadex). The primary outcome was RIOT within 90 days; secondary outcomes included RIOT within 180 days, time-to-RIOT, hospital length of stay, ICU admission, and readmissions. Results: Of 4358 records screened, 1081 met the inclusion criteria: 273 (25.2%) patients with neostigmine and 808 (74.8%) with sugammadex. Patients in the neostigmine group were slightly younger, and racial distribution differed modestly, but sex, BMI, ASA class, comorbidity, cancer type, and stage were comparable. Median reversal doses were 5 mg and 200 mg, respectively. Anesthesia duration, hospital and ICU length of stay, readmissions, and ICU use showed no significant differences. RIOT frequency was also similar across groups, except for modestly higher radiotherapy resumption with neostigmine at 90 and 180 days. Overall, perioperative and oncological outcomes were largely comparable between groups. Conclusions: Sugammadex and neostigmine showed similar RIOT rates, with only a modest difference in radiotherapy resumption. Larger studies are needed to elucidate the potential benefits of sugammadex, particularly regarding long-term oncological outcomes and treatment continuity.

The COVID-19 pandemic has revealed significant disparities in health research across regions, particularly in Latin America. This viewpoint explores the ch

Background: Nonalcoholic fatty liver disease (NAFLD) has a major impact on public health owing to its high morbidity and mortality due to its close relationship with several conditions, including metabolic syndrome, cirrhosis, and cancer. Therefore, this review aimed to systematically compile and summarize the scientific literature on early risk factors for NAFLD development. Methods: A systematic review of population‐based cohort studies was conducted. Studies reporting the risk factors associated with nonalcoholic steatohepatitis (NASH) and NAFLD were screened. Results: The search yielded 987 unique records, of which 196 articles were selected after title and abstract screening. A total of 39 articles were read in full text after quality analysis using Downs and Black criteria; 10 of the studies were excluded due to heterogeneity or inconclusive results. Finally, 30 publications were included in this systematic review. The review revealed that clinical conditions such as obesity, weight change, psoriasis, polycystic ovary syndrome, diabetes, thyroid disorders, and elevated serum uric acid levels increase the risk of developing nonalcoholic fatty liver. In addition, lifestyle factors such as sedentary behavior, active or passive smoking, poor sleep quality, and consumption of carbonated beverages are associated with this condition. Conclusions: Evidence was found on the association between different clinical and lifestyle risk factors and NAFLD. This supports the need for preventive, diagnostic, and therapeutic strategies to improve the metabolic, hepatic, and oncological outcomes related to this condition.

El síndrome de Guillain-Barré es una condición inmunomediada que afecta tanto a las fibras motoras como a las sensitivas de los nervios periféricos y las raíces dorsales del cordón espinal. El SGB es una entidad global rara cuya incidencia global puede ser tan baja como de 0.81 a 1.89 casos por 100.000 personas año. A pesar de su baja incidencia tiene un importante potencial de causar morbilidad y mortalidad. Este síndrome es usualmente desencadenado por infecciones. Dado que su presentación e historia natural son heterogéneas, hay poca disponibilidad de guías de práctica clínica para su manejo. En este reporte presentamos el caso de un hombre de 67 años, que en su quinto mes postrasplante hepático desarrolló un cuadro de diarrea no inflamatoria seguida de paresia ascendente simétrica y parestesias en las plantas de los pies de aparición súbita. Los estudios electrofisiológicos reportaron una neuropatía desmielinizante inflamatoria compatible con el SGB, particularmente en su variable polineuropatía desmielinizante aguda inflamatoria (PDAI). El déficit neurológico se asoció a una infección primaria simultánea de Citomegalovirus (CMV), una de los agentes más comunes relacionados con el SGB.

Strongyloides stercoralis infection is a common infection in tropical and subtropical regions and is considered one of the “neglected tropical diseases.” Owing to its life cycle, this infection can remain undetectable for years, preventing an early diagnosis and prompt treatment. We report the case of a 65-year-old woman who presented to us with a history of nausea, abdominal pain, bloating, and weight loss and, after initial radiologic and laboratory workup, was diagnosed with a periampullary mass with no secondary spread. She underwent an uneventful pylorus-preserving pancreatoduodenectomy, and on histopathological study of the lesion, a diagnosis of S. stercoralis infection was confirmed. This case stands out because of the importance of keeping S. stercoralis infections as a differential diagnosis of periampullary masses, particularly when the patient comes from regions where S. stercoralis is prevalent.