Moreno Alfonso, Julio César
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Moreno Alfonso
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Julio César
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Ciencias de la Salud
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Publication Open Access Blood cell indices as predictors of complicated appendicitis: a diagnostic study(Elsevier, 2023-09-29) Moreno Alfonso, Julio César; Molina Caballero, Ada; Yárnoz Irazábal, María Concepción; Pérez Martínez, Alberto; Ciencias de la Salud; Osasun ZientziakBackground: Appendicitis in children is associated with diagnostic complexity leading to delayed diagnosis. Such delays risk progression to complicated appendicitis. This study investigates the potential of cellular indices, including neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-tolymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), to differentiate uncomplicated (UA) from complicated appendicitis (CA). Methods: Diagnostic study of pediatric patients with acute appendicitis admitted to our hospital from 2021 to 2022. NLR, dNLR, PLR and MLR were compared between groups. Results: A total of 182 patients were enrolled: 116 cases with CA (63 % male, age 9.6 +/- 5.5 years) and 66 patients with UA (67 % male, age 10.6 +/- 2.7 years). All blood cell indices were significantly higher in the CA group than in the UA group (p= <0.0001). NLR, dNLR and PLR have a good area under the receiver operating characteristic (ROC) curve, whereas MLR has a regular curve (0.735). PLR was the most accurate predictor of CA with a sensitivity of 60 %, specificity of 85 %, positive predictive value of 88 %, area under the ROC curve of 0.802 (95 % CI 0.737-0.866) and a cut-off point for the diagnosis of CA of 213.3. The post-test probability of CA for a positive result on PLR was 80 % (95 % CI 69-88). Conclusions: PLR seems to be the most accurate cellular index to differentiate uncomplicated from complicated appendicitis in children. It may be useful for prioritizing cases for surgery as a predictor of intraoperative findings and early postoperative courses.Publication Open Access Divertículo esofágico de tercio medio: una causa infrecuente de disfagia(Asociación Colombiana de Cirugía, 2020) Moreno Alfonso, Julio César; Eguaras Córdoba, Inés; Yárnoz Irazábal, María Concepción; Miranda-Murua, María del Coro; Ciencias de la Salud; Osasun ZientziakMujer de 72 años estudiada por cuadro clínico de 1 año de disfagia e impactación con alimentos sólidos que han requerido tratamiento endoscópico. Se realiza endoscopia de vías digestivas altas que documenta un divertículo esofágico en tercio medio, manometría esofágica de alta resolución sin trastorno motor. El esofagograma y la tomografía axial computarizada de tórax muestran un divertículo en tercio medio de esófago lateral derecho de 7 cm de diámetro y base de 2.5 cm de diámetro. De manera programada se lleva a cabo diverticulectomía esofágica toracoscópica sin complicaciones.