Scipedia: Collection of Articles on Medicine

Endovascular Therapy Versus Surgical Clipping for Intracranial Aneurysms: A Systematic Review and Meta-Analysis

Claudia-Andrea Vanegas-Mondragon — Wed, 03 Sep 2025 09:07:02 +0200

Intracranial aneurysms are a leading cause of subarachnoid hemorrhage (SAH), associated with high morbidity and mortality. Traditionally, microsurgical clipping was the gold standard, but endovascular coiling has emerged as a less invasive alternative. This review synthesizes current evidence comparing endovascular and surgical approaches. A systematic search was conducted across PubMed, Scopus, and the Cochrane Library, including randomized controlled trials (RCTs) and cohort studies published between 2000 and 2025. Outcomes assessed were mortality, functional independence, perioperative complications, recurrence, and retreatment rates. Twenty-seven studies encompassing 18,560 patients were analyzed. Endovascular therapy demonstrated reduced short-term mortality and higher rates of functional independence, particularly in elderly patients and those with posterior circulation aneurysms. Conversely, surgical clipping ensured greater long-term durability with fewer retreatments, especially among younger patients. Both techniques carry unique benefits and limitations; thus, treatment should be individualized, taking into account aneurysm morphology, patient age, comorbidities, and surgical risk. Risk of bias assessment was performed using Cochrane RoB2 for RCTs and the Newcastle-Ottawa Scale for observational studies, with most studies showing moderate risk. This review highlights the importance of a multidisciplinary, patient-centered approach, while emphasizing the need for future long-term RCTs and device innovations. In conclusion, endovascular therapy provides superior early safety, while surgical clipping ensures durable occlusion; an evidence-based, personalized strategy remains essential to optimize patient outcomes.

The Role of Robotic Surgery in General Surgery: Advances, Limitations, and Future Perspectives

Claudia-Andrea Vanegas-Mondragon — Tue, 02 Sep 2025 06:33:23 +0200

Background: Robotic surgery is an important advancement in minimally invasive surgery, providing enhanced precision, ergonomics, and visualization compared to laparoscopy. Its increasing adoption in general surgery reflects both its potential and its limitations.

Objective: To review the current role of robotic surgery in general surgery, emphasizing advances, limitations, and future perspectives.

Methods: A narrative review was performed using PubMed, Scopus, and Web of Science (2020-2023). Search terms included “robotic surgery,” “general surgery,” “da Vinci system,” and “cost-effectiveness.” Priority was given to guidelines, randomized controlled trials, systematic reviews, and meta-analyses.

Results: Robotic surgery shows advantages in ergonomics, dexterity, visualization, and conversion rates, particularly in colorectal, hernia, and hepatopancreatobiliary procedures.

Limitations include high cost, limited access, absence of haptic feedback, and the need for structured training. Emerging technologies such as novel robotic platforms, artificial intelligence, and augmented reality suggest promising directions.

Conclusions: Robotic surgery improves outcomes but requires addressing cost, access, and training challenges.

The Role of Robotic Surgery in General Surgery: Advances, Limitations, and Future Perspectives

Claudia-Andrea Vanegas-Mondragon — Wed, 27 Aug 2025 04:49:23 +0200

Background: Robotic surgery is an important advancement in minimally invasive surgery, providing enhanced precision, ergonomics, and visualization compared to laparoscopy. Its increasing adoption in general surgery reflects both its potential and its limitations.

Objective: To review the current role of robotic surgery in general surgery, emphasizing advances, limitations, and future perspectives.

Methods: A narrative review was performed using PubMed, Scopus, and Web of Science (2020–2023). Search terms included “robotic surgery,” “general surgery,” “da Vinci system,” and “cost-effectiveness.” Priority was given to guidelines, randomized controlled trials, systematic reviews, and meta-analyses.

Results: Robotic surgery shows advantages in ergonomics, dexterity, visualization, and conversion rates, particularly in colorectal, hernia, and hepatopancreatobiliary procedures. Limitations include high cost, limited access, absence of haptic feedback, and the need for structured training. Emerging technologies such as novel robotic platforms, artificial intelligence, and augmented reality suggest promising directions.

Conclusions: Robotic surgery improves outcomes but requires addressing cost, access, and training challenges.

Keywords: robotic surgery; general surgery; minimally invasive surgery; da Vinci system; cost-effectiveness; surgical training; future perspectives

Post-mastectomy breast reconstruction: a systematic review of surgical techniques and patient-reported quality of life outcomes

Ximena Lozano — Sat, 23 Aug 2025 07:24:36 +0200

'''Objective''': To synthesize contemporary evidence (2015–2025) comparing post-mastectomy breast reconstruction techniques—including prepectoral and subpectoral implants, as well as autologous flaps (DIEP, TRAM, latissimus dorsi)—focusing on patient-reported quality of life (QoL) and safety outcomes. '''Methods''': A systematic review was conducted following PRISMA 2020 guidelines. Searches were performed in PubMed/MEDLINE, Embase, CENTRAL, and Scopus for studies published between January 2015 and August 2025. Eligible designs included randomized controlled trials and comparative cohort studies. The primary outcome was QoL assessed with the BREAST-Q instrument. Secondary outcomes included complications (implant loss, capsular contracture), reoperations, and the impact of post-mastectomy radiotherapy (PMRT). Risk of bias was assessed using RoB-2 for RCTs and ROBINS-I for observational studies. '''Results''': Autologous reconstruction consistently achieved higher long-term BREAST-Q scores compared with implant-based techniques, despite longer recovery times. Prepectoral implant placement reduced animation deformity and capsular contracture relative to subpectoral reconstruction, with similar overall complication rates but increased rippling and seroma in selected cohorts. PMRT significantly increased the risks of implant loss and severe capsular contracture, favoring autologous approaches in patients requiring radiotherapy. BREAST-Q remains the gold standard PROM, with updated multilingual validations enhancing cross-cultural applicability. '''Conclusions''': Autologous flaps offer sustained QoL benefits in selected candidates. Prepectoral implant reconstruction, with or without acellular dermal matrix, is safe and effective, particularly in non-PMRT settings. Shared decision-making guided by BREAST-Q and aligned with NCCN/ESMO guidelines is essential.

Use of Indocyanine Green in Colorectal Surgery: Perfusion Assessment and Prevention of Anastomotic Leaks. A Systematic Review.

Ximena Lozano — Mon, 18 Aug 2025 23:18:33 +0200

Objective: To evaluate the role of indocyanine green near-infrared fluorescence angiography (ICG-FA) in colorectal surgery for perfusion assessment and prevention of anastomotic leaks. Methods: A systematic review of medical databases (2020–2025) identified randomized controlled trials, observational studies, and meta-analyses reporting outcomes of ICG-FA in colorectal resections. Results: Major RCTs demonstrated that ICG-FA modified intraoperative strategy in 10–20% of cases. While some large multicenter trials found no significant reduction in overall leak rates, consistent benefits were observed in low rectal anastomoses and high-risk subgroups. Meta-analyses confirmed a modest absolute reduction in leaks (2–3%), with observational studies highlighting improved reproducibility when using quantitative fluorescence metrics. Emerging approaches, such as intraluminal ICG-FA, showed promise in detecting hypoperfusion. Cost-effectiveness analyses suggested potential savings from reduced complications and reoperations.

''Appendicitis during Pregnancy: A Narrative Review Comparing Laparoscopic and Open Approaches''

Ximena Lozano — Mon, 18 Aug 2025 23:27:22 +0200

'''Background:''' Acute appendicitis is the most common non-obstetric surgical emergency during pregnancy. The choice between laparoscopic appendectomy (LA) and open appendectomy (OA) remains controversial due to maternal and fetal safety concerns. '''Objective:''' To analyze current evidence comparing laparoscopic and open appendectomy in pregnant women. '''Methods:''' A narrative review was conducted using PubMed, Elsevier, and ClinicalKey. Systematic reviews, meta-analyses, and observational studies published between 2000 and 2023 were included. '''Results:''' LA was associated with shorter hospital stay, fewer wound infections, and faster recovery compared to OA. Earlier meta-analyses suggested a slightly higher risk of fetal loss with LA (OR ~1.7), but more recent studies and sensitivity analyses demonstrated no significant differences. LA is increasingly considered safe throughout all trimesters when performed with appropriate surgical technique and intraoperative monitoring. '''Conclusions:''' Laparoscopic appendectomy provides maternal benefits and comparable fetal safety to open surgery. The choice of surgical approach should be guided by surgeon expertise and institutional resources.

DOENÇA POLICÍSTICA DO FÍGADO ASSOCIADA A DOENÇA POLICÍSTICA RENAL: RELATO DE CASO NA ATENÇÃO BÁSICA E REVISÃO DA LITERATURA

Vicente Leonides Prado Junco — Mon, 28 Apr 2025 01:20:13 +0200

A Doença Policística do Fígado (DPF) é caracterizada pela formação de múltiplos cistos hepáticos e pode se apresentar de forma isolada ou associada à Doença Renal Policística Autossômica Dominante (DRPAD). A maioria dos casos é assintomática, mas alguns pacientes desenvolvem sintomas compressivos e complicações. Este trabalho descreve um caso clínico de DPF diagnosticado incidentalmente em paciente sintomática e realiza uma revisão crítica da literatura recente, enfatizando aspectos etiológicos, fisiopatológicos e terapêuticos da doença.

'''Título:''' Interfaces entre Prática e Formação: Desempenho Profissional e Aquisição de Conhecimento na Pós-Graduação em Medicina de Família e Comunidade - Experiência como tutor. SP - Brasil

Vicente Leonides Prado Junco — Sat, 26 Apr 2025 03:19:23 +0200

CARACTERIZACIÓN DE CÉLULAS MADRE DEL CORDÓN UMBILICAL EN EL ESTADO DE CHIHUAHUA

Esmeralda Elizabeth Dominguez Ortiz — Fri, 21 Feb 2025 00:58:03 +0100

El presente estudio tuvo un enfoque cuantitativo, con muestreo no probabilístico por cuotas, cuyo objetivo fue identificar el grado de conocimiento que tienen las gestantes del estado de Chihuahua respecto a los beneficios de las células madre del cordón umbilical, así como su disposición. respecto a la donación y con ganas de recibir más información. La muestra estuvo constituida por 123 mujeres embarazadas aleatorias, en cualquier trimestre del embarazo, a cualquier edad, siempre que estuvieran disponibles. Los datos se obtuvieron mediante la realización de encuestas presenciales o telefónicas. Como resultado, la mayoría de las gestantes participantes tenían cero conocimiento sobre el cordón umbilical, las células madre, sus beneficios y utilidad. Sin embargo, la mayoría presentó una actitud positiva respecto a la donación del cordón umbilical y con ganas de recibir más información. En conclusión, se observa la necesidad de realizar más investigaciones dentro del estado de Chihuahua, con el fin de normalizar la utilidad de las células madre del cordón umbilical y que la población tenga conocimiento sobre su afectación, y esté dentro de sus opciones de tratamiento en cualquier patología.

Comprehensive approach, basic-clinical-psychosocial, for respiratory diseases (SARS-CoV-2 model)

Juan Carlos Carmona-Hernandez — Wed, 22 Jan 2025 20:12:02 +0100

Clinical manifestations in patients affected by severe acute respiratory syndrome coronavirus 2 have been reported and its management has been suggested and followed by different international protocols. Due to the nature of the pandemic, the World Health Organization was active from the beginning of the epidemiological event and the different national entities throughout the world shared success stories in relation to treatment. Considering diagnostic and treatment tools, not only for this viral manifestation in the world, it is advisable to make a comprehensive evaluation of the challenge faced by health administration entities. The study and management of the medical event from different fields of knowledge offers a greater number of possibilities in the health management system, which can lead to a more efficient treatment of the disease. This review is highlights the importance of the analysis of SARS-CoV-2, focused on clinical, molecular and psychosocial aspects. With the search equations developed in different databases and search engines, more than 1,450 documents were found that had common characteristics. With the use of delimitation tools, 47 documents were analyzed and reported, highlighting the importance of a multidimensional analysis of an epidemiological event.

Relación entre el Trastorno por Déficit de Atención e Hiperactividad y síntomas afectivos en estudiantes universitarios de un programa de Medicina de Manizales Caldas

Sandra Cañón — Sun, 10 May 2020 21:14:02 +0200

Introduction: Previous studies have reported high comorbidity between ADHD and anxiety and depressive spectrum disorders, however, few studies have been carried out on the subject in young university students. The present study evaluated the relationship between ADHD and the presence of depressive and anxious symptoms in university students from a medicine program in Manizales.

Materials and methods: Observational, analytical, cross-sectional research. Sample: 362 university students from a medical program. Instruments used: CAGE questionnaire, Beck's depression and anxiety scale, DSM-5 checklist for ADHD.

Results: Average age of 20.32 years. Of the total population 3.3% of a history of ADHD, of which 1.9% of treatment received. 56.36% symptoms current inattentive symptoms, 4.4% impulsive and hyperactive symptoms and 4.4% combined subtype. The absence of depressive symptoms according to the Beck scale is associated with symptoms of absence of inactive symptoms (Pvalor = 0.000), impulsive and hyperactive symptoms (Pvalor = 0.000) and mixed symptoms according to DMS-5 (Pvalor = 0.000). As the severity of depressive symptoms increases, inattentive symptoms, impulsive and hyperactive symptoms, and DSM-5 mixed symptoms increase (Pvalor = 0.000). A significant association was found between the presence of anxious symptoms and inattentive, impulsive, hyperactive and mixed symptoms according to the DSM-5 (Pvalor = 0.000).

Conclusions: ADHD symptoms are associated with the presence of anxious symptoms and depressive symptoms in university students of a medical program

Determinación de los factores de riesgo asociados a la conducta suicida en adolescentes

Esmeralda Elizabeth Dominguez Ortiz — Thu, 01 Aug 2019 16:13:02 +0200

El suicidio es un fenómeno social complejo, también reconocido como un problema de salud pública y mental, cuya pre-valencia y morbilidad en la población ha incrementado, especialmente en la población adolescente, siendo la segunda causa de muerte de este grupo etario.

Se estima que más de 800.000 personas mueren al año a causa del suicidio a nivel mundial. Por cada suicidio es probable que más de 20 personas hayan tenido un intento suicida. En cuanto a Colombia, durante 2017 se detectaron 83,62 intentos de suicidio por cada 100.000 habitantes. Mientras que en Manizales se presentaron 39 casos de auto-lesiones por intento de suicidio, y una tasa de 10,43 eventos por cada 100.000 habitantes, con tendencia al incremento.

La conducta suicida corresponde a los síntomas o comportamientos que el individuo presenta, antes de tener un intento suicida, siendo manifestada de manera verbal y no verbal. Diversos factores de riesgo interactúan entre sí, para generar una conducta suicida, y dar origen al suicidio, los cuales pueden ser biológicos, sociales, e individuales.

Siendo la conducta suicida un dato observacional, para detener la mortalidad por suicidio a nivel mundial, es relevante conocer los factores de riesgo asociados, para una detección temprana e intervención oportuna.