Vanessa Pamela Salolin Vargas

El síndrome del intestino irritable (SII) es un trastorno gastrointestinal funcional de alta prevalencia global, caracterizado por dolor abdominal crónico, distensión y alteraciones del hábito intestinal, con un impacto sustancial sobre la calidad de vida y los sistemas de salud. En los últimos años, la microbiota intestinal ha emergido como un componente central en su fisiopatología. Los pacientes con SII presentan alteraciones en la diversidad y composición microbiana —conocidas como disbiosis— que varían según el subtipo clínico: predominio diarreico, estreñimiento o mixto. Estas alteraciones se asocian con disfunción de la barrera epitelial intestinal, inflamación de bajo grado mediada por mastocitos y citocinas proinflamatorias, perturbaciones en la fermentación y producción de gases, y desregulación del eje microbiota-intestino-cerebro, un sistema de comunicación multidireccional que integra el sistema nervioso central, el sistema nervioso entérico y la microbiota. Los metabolitos microbianos —como los ácidos grasos de cadena corta, la serotonina, la triptamina y la histamina— participan activamente en la modulación de la motilidad, la sensibilidad visceral y la respuesta neuroimmune. Ante este panorama, han surgido estrategias terapéuticas dirigidas a modular la microbiota, entre ellas probióticos, prebióticos, simbióticos, la dieta baja en oligosacáridos fermentables, disacáridos, monosacáridos y polioles, la rifaximina y el trasplante de microbiota fecal, con resultados alentadores aunque heterogéneos. Terapias emergentes como los postbióticos y la fagoterapia abren nuevas perspectivas. Esta revisión analiza los mecanismos fisiopatológicos que vinculan la disbiosis con el SII y evalúa las principales intervenciones terapéuticas dirigidas a la microbiota.

Background Anxiety is a common concern among patients undergoing endoscopic procedures, affecting up to 70% of individuals. Increased anxiety can heighten pain perception, reduce procedural tolerance, and negatively impact patient satisfaction. Non-pharmacological interventions, such as music therapy, virtual reality, aromatherapy, relaxation techniques, and others, have been explored as alternatives to pharmacological anxiolytics.. This systematic review and network meta-analysis (NMA) provides an evaluation of these interventions in reducing anxiety and their impact on secondary outcomes, including pain, patient satisfaction, and procedure duration. Methods Following PRISMA guidelines, we systematically searched seven databases for randomized controlled trials (RCTs) evaluating non-pharmacological interventions for anxiety reduction in endoscopy and colonoscopy. A network meta-analysis was conducted using a random-effects model to compare intervention effectiveness, with standardized mean differences (SMDs) and 95% confidence intervals (CIs) calculated. Surface under the cumulative ranking (SUCRA) probabilities determined the rank order of interventions. Subgroup analyses were performed by type of procedure (upper vs. lower endoscopy) and sedation status. Results A total of 48 RCTs comprising 6014 participants and evaluating 12 non-pharmacological interventions were included. In the network meta-analysis (NMA) for anxiety, Reiki (SMD = − 1.51, 95% CI − 3.01 to − 0.01, p = 0.04), aromatherapy (SMD = − 1.31, 95% CI − 2.47 to − 0.14, p = 0.02), and music therapy (SMD = − 1.09, 95% CI − 1.50 to − 0.67, p < 0.01) significantly reduced anxiety compared to standard care. These interventions also ranked highest in terms of SUCRA values Reiki (0.77), aromatherapy (0.73), and music therapy (0.67). The NMA for secondary outcomes showed that music therapy significantly improved patient satisfaction (SMD = 2.21, 95% CI 1.20 to 3.22, p < 0.01), while no intervention had a statistically significant impact on pain or procedure duration. Subgroup analyses showed that music therapy was most consistent in lower endoscopic and sedated procedures, while aromatherapy and Reiki demonstrated stronger effects in upper and non-sedated procedures. Conclusion Music therapy demonstrated the strongest evidence for anxiety reduction, with potential benefits for patient satisfaction. Reiki and aromatherapy also ranked highly, though their significance varied. No intervention significantly influenced pain or procedure duration. Subgroup analyses suggested that effectiveness may vary by procedure type and sedation status, underscoring the importance of tailoring interventions to clinical context. Future research should prioritize direct intervention trials with standardized methodologies to enhance the robustness of findings and establish causal relationships.

Introduction: The Competency-Based Assessment of Robotic Surgery Skills (CARS) scale was developed as a novel approach to assess robotic surgery (RS) skills through 10 relevant RS competencies. CARS 2.0 aimed to expand on the findings of CARS by conducting a global survey study in which participants graded a blinded, edited surgical video with the CARS scale for 7 competencies measurable via video. Methods: CARS 2.0 is being conducted globally, including participants across medical specialties and training stages, from medical students to attending/consultant surgeons. Participants evaluated a blinded, edited surgical video using the CARS scale via an anonymous Google form, focusing on 7 video-measurable competencies. Results: A total of 320 responses were collected over 3 months, including 125 (39.06%) attending/consultant surgeons, 98 (30.6%) surgical specialty postgraduate trainees, 96 (30%) medical students, and 1 pre-medical student. ANOVA (analysis of variance) analysis showed that the operator scores increased with the evaluators’ level of experience, reaching statistical significance across all 7 competency categories. Spearman’s correlation indicated moderate associations between participants’ surgical experience and proficiency (ρ = 0.314, P < 0.001), as well as between their comfort with the CARS scale and proficiency (ρ = 0.337, P < 0.001). Regression analysis demonstrated that robotic stapler use and camera handling were predictors of higher CARS scores based on participants’ experience. Conclusion: CARS represents a first step toward establishing competency-based assessment of RS performance independent of specific surgical procedures. Its integration into surgical training programs can facilitate trainees’ attainment of RS competency. Longitudinal studies could further validate its effectiveness at improving surgical training with its implementation into training curricula.

Background and Objectives: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoscopic procedure that has demonstrated both safety and effectiveness in the treatment of obesity. By reducing the stomach’s volume without the need for surgical incisions, ESG promotes weight loss and can improve obesity-related comorbidities. However, patient responses to ESG can vary significantly. Materials and Methods: A comprehensive search was performed on PubMed, Embase, and Cochrane for studies with endoscopic sleeve gastroplasty; the main outcomes of interest are BMI, weight loss, and postinterventional complications. The search strategy employed a combination of keywords and Medical Subject Heading (MeSH) terms, including “endoscopic sleeve gastroplasty,” “endoscopy,” and “overweight”. To ensure the thoroughness of the review, additional manual searches of key journals and the reference lists of identified studies were performed. Grey literature, such as dissertations and conference abstracts, meta-analysis, and systematic reviews, was excluded to maintain a focus on peer-reviewed evidence. Duplicate records were identified and removed using Rayyan software to streamline the screening process. The I2 test was employed for heterogeneity assessment, while the risk of bias was evaluated utilizing ROBINS-I. Results: Our literature search resulted in the inclusion of 38 studies. Endoscopic sleeve gastroplasty for weight loss is important since it is more effective than pharmacological treatments and lifestyle changes and presents lower adverse event rates compared to bariatric surgery. Long-term weight loss outcomes varied, with total body weight loss ranging from 16% to 20.9% over a period from 2 to 5 years, while excess weight loss ranged from 13% to 79%. Revisional procedures showed higher failure rates, with up to 34.3% of patients experiencing insufficient weight loss. Most interventions led to clinically significant and sustained weight loss, though variability in outcomes highlights the need for further research to optimize long-term weight management strategies. Conclusions: Endoscopic sleeve gastroplasty (ESG) emerges as a promising minimally invasive option for weight loss, offering significant improvements in both weight reduction and obesity-related comorbidities, such as diabetes, hypertension, and dyslipidemia.

Systematic reviews and meta-analyses are essential tools in medical research. Systematic reviews are a type of literature review that uses a systematic process to identify and assess all available literature on a specific research question. A meta-analysis is a statistical method of synthesizing the results of a systematic review by quantitatively combining data. The process begins with formulating a well-defined research question using frameworks. Comprehensive literature searches across multiple databases, including PubMed, Embase, and Cochrane, to ensure the inclusion of diverse studies. Tools like EndNote and Covidence streamline reference management and study selection, enhancing efficiency and accuracy. Quality assessment using tools like the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale is crucial to evaluate the methodological rigor. Data extraction, using standardized forms to ensure consistent information capture. Qualitative synthesis is one method that integrates the results of a systematic review focusing on textual data. Meta-analysis employs statistical software such as R and RevMan to compute effect sizes, confidence intervals, and assess heterogeneity. Visual representations, including forest and funnel plots, facilitate the interpretation of results. Challenges such as publication bias and heterogeneity are addressed using statistical methods like Egger regression and the trim-and-fill technique. Sensitivity analyses further validate the robustness of findings. Common errors, including data entry mistakes and inappropriate pooling, are mitigated through rigorous methodological adherence and critical self-evaluation. Meticulously conducted, systematic reviews and meta-analyses represent the pinnacle of the evidence hierarchy, driving advancements in medical research and practice.

Introduction: Gastrointestinal (GI) cancers are associated with high morbidity and mortality. Surgical resection, the primary treatment, often induces immunosuppression and increases the risk of postoperative complications. Perioperative immunonutrition (IMN), comprising formulations enriched with omega-3 fatty acids, arginine, nucleotides, and antioxidants, has emerged as a potential strategy to improve surgical outcomes by reducing complications, enhancing immune function, and promoting recovery. Methods: A systematic search of PubMed, Scopus, and the Cochrane Library was conducted on 28 October 2024 in accordance with PRISMA guidelines. Systematic reviews and meta-analyses evaluating perioperative IMN versus standard care in adult patients undergoing GI cancer surgery were included in the search. The outcomes assessed included infectious and non-infectious complications, wound healing, hospital stay, and nutritional status. The study quality was evaluated using AMSTAR 2, and the meta-analysis was conducted using random-effects models to calculate the pooled effect sizes (risk ratios [RRs], odds ratios [ORs], mean differences [MDs]) with 95% confidence intervals (CIs). Results: Sixteen systematic reviews and meta-analyses, including a total of 41,072 patients, were included. IMN significantly reduced infectious complications (RR: 0.62, 95% CI: 0.55–0.70; I² = 63.0%), including urinary tract infections (RR: 0.74, 95% CI: 0.61–0.89; I² = 0.0%) and wound infections (OR: 0.64, 95% CI: 0.55–0.73; I² = 34.4%). Anastomotic leak rates were notably lower (RR: 0.68, 95% CI: 0.62–0.75; I² = 8.2%). While no significant reduction in pneumonia risk was observed, non-infectious complications decreased significantly (RR: 0.83, 95% CI: 0.75–0.92; I² = 30.6%). IMN also reduced the length of hospital stay by an average of 1.92 days (MD: −1.92, 95% CI: −2.36 to −1.48; I² = 73.5%). Conclusions: IMN provides significant benefits in GI cancer surgery, reducing complications and improving recovery. However, variability in protocols and populations highlight the need for standardization and further high-quality trials to optimize its application and to validate its efficacy in enhancing surgical care.

Human echinococcosis, caused by Echinococcus tapeworms, is a zoonotic disease in which ingested eggs of the tapeworm form cysts in the organs known as Hydatid cysts. These cysts are commonly found in the Liver and lungs, but in rare cases, they can also be found in the spleen, ovaries, round ligament, and peritoneal cavity. Treatment typically involves surgery. This is a case of a 32-year-old female who presented with chief complaints of pain in the abdomen for 2 months, which was associated with nausea, vomiting, reduced appetite, and increased size of mass per abdomen. Further investigations revealed the presence of multiple disseminated hydatid cysts in the upper abdomen and the peritoneal cavity. This was a rare & unusual entity that was meticulously managed by minimally invasive laparoscopic surgery. Echinococcosis can occur anywhere in the body, with concurrent localizations in the liver, spleen, round ligament, ovaries, and peritoneal cavity, which are rare and pose a diagnostic as well as a surgical management challenge. The inconvenience of multiple localization and the risk of contamination usually lead to open surgery in these cases. The presented case is unique due to the laparoscopic approach to the multiple localizations of hydatid disease, advocating for a minimally invasive first-line approach even in these particular localizations.

Lumbar disc herniation (LDH) represents a significant cause of pain and physical impairment, negatively impacting the quality of life, and burdening healthcare systems. Despite numerous treatment strategies, optimal management remains a subject of debate. This meta-analysis aims to compare the efficacy and economic impact of chemonucleolysis (CN) and discectomy in the management of LDH. An extensive search of Embase, PubMed, and Cochrane databases yielded 391 records. Following strict inclusion and exclusion criteria, twenty-one studies suitable for a comparative analysis between CN and discectomy were included. This selection was based on patient improvement, including pain scores, complications, and differences in cost and surgery time. A total of 2436 patients were included in this study. Among them, 1,121 patients (46%) underwent discectomy, while 1,315 patients (54%) received the CN approach. Our analysis revealed that discectomy had a significantly higher improvement rate compared with chymopapain CN (OR: 0.45; 95%CI 0.23,0.88) and non-chymopapain CN (OR: 0.61; 95%CI 0.38,0.97). A non-significant inclination towards complication rates was observed with chymopapain CN (OR: 1.90; 95%CI 0.68,5.29). Notably, CN was associated with a considerable cost reduction (SMD: 7.11; 95%CI -11.37,-2.85) and a shorter surgical time (MD: -53.54; 95%CI -57.91,-49.17) compared with discectomy. The evidence synthesized in this meta-analysis suggests superior clinical outcomes for discectomy when compared to CN in managing LDH. However, CN demonstrated a notable advantage in terms of cost-efficiency and operative time, marking it as a potentially preferable option in resource-constrained settings. Nonetheless, more randomized clinical trials and prospective studies are necessary to confirm these findings.