Acute appendicitis during the COVID-19 pandemic: Experience in a high-level complex center in Boyacá, Colombia
Introduction. The COVID-19 pandemic varied the way health systems were attended, thus affecting pathologies not related to respiratory infections, such as acute appendicitis. Fear of SARS-CoV-2 infection and mobility restrictive measures may have implied a longer time from the onset of symptoms to c...
- Autores:
-
Támara-López, José Antonio
Tamara-Prieto, José Antonio
Sierra-Peña, Andrés Felipe
Fernández-Avila, Daniel G
- Tipo de recurso:
- Article of investigation
- Fecha de publicación:
- 2023
- Institución:
- Universidad de Ciencias Aplicadas y Ambientales U.D.C.A
- Repositorio:
- Repositorio Institucional UDCA
- Idioma:
- spa
- OAI Identifier:
- oai:repository.udca.edu.co:11158/5127
- Acceso en línea:
- https://repository.udca.edu.co/handle/11158/5127
https://doi.org/10.30944/20117582.2199
- Palabra clave:
- Infecciones por Coronavirus
Pandemias
Apendicectomía
Complicaciones Posoperatorias
Complicaciones Intraoperatorias
- Rights
- openAccess
- License
- https://creativecommons.org/licenses/by-nc-sa/4.0/legalcode.es
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Acute appendicitis during the COVID-19 pandemic: Experience in a high-level complex center in Boyacá, Colombia |
| dc.title.translated.none.fl_str_mv |
Apendicitis aguda durante la pandemia de COVID-19: experiencia en un centro de alta complejidad en Boyacá, Colombia |
| title |
Acute appendicitis during the COVID-19 pandemic: Experience in a high-level complex center in Boyacá, Colombia |
| spellingShingle |
Acute appendicitis during the COVID-19 pandemic: Experience in a high-level complex center in Boyacá, Colombia Infecciones por Coronavirus Pandemias Apendicectomía Complicaciones Posoperatorias Complicaciones Intraoperatorias |
| title_short |
Acute appendicitis during the COVID-19 pandemic: Experience in a high-level complex center in Boyacá, Colombia |
| title_full |
Acute appendicitis during the COVID-19 pandemic: Experience in a high-level complex center in Boyacá, Colombia |
| title_fullStr |
Acute appendicitis during the COVID-19 pandemic: Experience in a high-level complex center in Boyacá, Colombia |
| title_full_unstemmed |
Acute appendicitis during the COVID-19 pandemic: Experience in a high-level complex center in Boyacá, Colombia |
| title_sort |
Acute appendicitis during the COVID-19 pandemic: Experience in a high-level complex center in Boyacá, Colombia |
| dc.creator.fl_str_mv |
Támara-López, José Antonio Tamara-Prieto, José Antonio Sierra-Peña, Andrés Felipe Fernández-Avila, Daniel G |
| dc.contributor.author.none.fl_str_mv |
Támara-López, José Antonio Tamara-Prieto, José Antonio Sierra-Peña, Andrés Felipe Fernández-Avila, Daniel G |
| dc.subject.decs.none.fl_str_mv |
Infecciones por Coronavirus Pandemias Apendicectomía Complicaciones Posoperatorias Complicaciones Intraoperatorias |
| topic |
Infecciones por Coronavirus Pandemias Apendicectomía Complicaciones Posoperatorias Complicaciones Intraoperatorias |
| description |
Introduction. The COVID-19 pandemic varied the way health systems were attended, thus affecting pathologies not related to respiratory infections, such as acute appendicitis. Fear of SARS-CoV-2 infection and mobility restrictive measures may have implied a longer time from the onset of symptoms to consultation of the emergency department, leading to intraoperative and postoperative complications. Methods. Retrospective cross-sectional descriptive observational study, identifying all patients diagnosed with acute appendicitis and taken for appendectomy, divided into two groups, considered pre-pandemic, from September 1, 2018 to March 15, 2020, and pandemic, from March 16, 2020 to September 30, 2021. Results. One-thousand patients were identified, 501 patients were distributed in the pre-pandemic group and 499 in the pandemic group. The average consultation time from the time of onset of symptoms to consultation was 43 hours in the pre-pandemic group and almost 45 hours in the pandemic. Discussion. Despite the restrictions due to the disease caused by the new coronavirus and the fear that may existed due to contagion, in our center there was no evidence of a change in the management and presentation of patients diagnosed with acute appendicitis. |
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2023 |
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2023-02-14T16:21:04Z |
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2023-02-14T16:21:04Z |
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2023 |
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Tamara-López, J. A., Tamara-Prieto, J. A., Sierra-Peña, A. F., & Fernández-ávila, D. G. (2023). Acute appendicitis during the COVID-19 pandemic: Experience in a high-level complex center in boyacá, colombia. [Apendicitis aguda durante la pandemia de COVID-19: experiencia en un centro de alta complejidad en Boyacá, Colombia] Revista Colombiana De Cirugia, 38(1), 101-107. doi:10.30944/20117582.2199 |
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2011-7582 |
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Tamara-López, J. A., Tamara-Prieto, J. A., Sierra-Peña, A. F., & Fernández-ávila, D. G. (2023). Acute appendicitis during the COVID-19 pandemic: Experience in a high-level complex center in boyacá, colombia. [Apendicitis aguda durante la pandemia de COVID-19: experiencia en un centro de alta complejidad en Boyacá, Colombia] Revista Colombiana De Cirugia, 38(1), 101-107. doi:10.30944/20117582.2199 2011-7582 |
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Támara-López, José AntonioTamara-Prieto, José AntonioSierra-Peña, Andrés FelipeFernández-Avila, Daniel G2023-02-14T16:21:04Z2023-02-14T16:21:04Z2023Tamara-López, J. A., Tamara-Prieto, J. A., Sierra-Peña, A. F., & Fernández-ávila, D. G. (2023). Acute appendicitis during the COVID-19 pandemic: Experience in a high-level complex center in boyacá, colombia. [Apendicitis aguda durante la pandemia de COVID-19: experiencia en un centro de alta complejidad en Boyacá, Colombia] Revista Colombiana De Cirugia, 38(1), 101-107. doi:10.30944/20117582.21992011-7582https://repository.udca.edu.co/handle/11158/5127https://doi.org/10.30944/20117582.2199Introduction. The COVID-19 pandemic varied the way health systems were attended, thus affecting pathologies not related to respiratory infections, such as acute appendicitis. Fear of SARS-CoV-2 infection and mobility restrictive measures may have implied a longer time from the onset of symptoms to consultation of the emergency department, leading to intraoperative and postoperative complications. Methods. Retrospective cross-sectional descriptive observational study, identifying all patients diagnosed with acute appendicitis and taken for appendectomy, divided into two groups, considered pre-pandemic, from September 1, 2018 to March 15, 2020, and pandemic, from March 16, 2020 to September 30, 2021. Results. One-thousand patients were identified, 501 patients were distributed in the pre-pandemic group and 499 in the pandemic group. The average consultation time from the time of onset of symptoms to consultation was 43 hours in the pre-pandemic group and almost 45 hours in the pandemic. Discussion. Despite the restrictions due to the disease caused by the new coronavirus and the fear that may existed due to contagion, in our center there was no evidence of a change in the management and presentation of patients diagnosed with acute appendicitis.Introducción. La pandemia de COVID-19 replanteó la forma de atención en los sistemas de salud, afectando todas aquellas patologías no relacionadas con infecciones respiratorias, como la apendicitis aguda. El miedo al contagio por SARS-CoV-2 y las medidas restrictivas a la movilidad pudieron aumentar el tiempo desde el inicio de los síntomas hasta la consulta al servicio de urgencias, derivando en complicaciones intra y posoperatorias. Métodos. Estudio observacional descriptivo de corte trasversal y retrospectivo, donde se incluyeron todos los pacientes diagnosticados con apendicitis aguda llevados a apendicectomía, que fueron divididos en dos grupos, considerados pre-pandemia, desde el 1° de septiembre de 2018 al 15 de marzo de 2020, y pandemia, desde el 16 de marzo de 2020 al 30 de septiembre de 2021. Resultados. Fueron identificados 1000 pacientes, distribuidos en 501 pacientes en el grupo pre-pandemia y 499 en el grupo pandemia. El promedio de tiempo de consulta desde el momento de inicio de síntomas hasta consulta fue de 43 horas en el grupo pre-pandemia y de casi 45 horas en el grupo pandemia. Discusión. A pesar de las restricciones por la enfermedad causada por el nuevo coronavirus y el miedo que puede existir por el contagio, en nuestro centro no se evidenció un cambio en el manejo y presentación de los pacientes diagnosticados con apendicitis aguda.Incluye referencias bibliográficas.application/pdfspahttps://creativecommons.org/licenses/by-nc-sa/4.0/legalcode.eshttps://creativecommons.org/licenses/by-nc-sa/4.0/info:eu-repo/semantics/openAccessAtribución-NoComercial-CompartirIgual 4.0 Internacional (CC BY-NC-SA 4.0)http://purl.org/coar/access_right/c_abf2https://www.revistacirugia.org/index.php/cirugia/article/view/2199Acute appendicitis during the COVID-19 pandemic: Experience in a high-level complex center in Boyacá, ColombiaApendicitis aguda durante la pandemia de COVID-19: experiencia en un centro de alta complejidad en Boyacá, ColombiaArtículo de 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 nombre de la parte o las partes que el Autor Original y/o el Licenciante hubieren designado para la atribución (v.g., un instituto patrocinador, editorial, publicación) en la información de los derechos de autor del Licenciante, términos de servicios o de otras formas razonables; el título de la Obra si está provisto; en la medida de lo razonablemente factible y, si está provisto, el Identificador Uniforme de Recursos (Uniform Resource Identifier) que el Licenciante especifica para ser asociado con la Obra, salvo que tal URI no se refiera a la nota sobre los derechos de autor o a la información sobre el licenciamiento de la Obra; y en el caso de una Obra Derivada, atribuir el crédito identificando el uso de la Obra en la Obra Derivada (v.g., "Traducción Francesa de la Obra del Autor Original," o "Guión Cinematográfico basado en la Obra original del Autor Original"). Tal crédito puede ser implementado de cualquier forma razonable; en el caso, sin embargo, de Obras Derivadas u Obras Colectivas, tal crédito aparecerá, como mínimo, donde aparece el crédito de cualquier otro autor comparable y de una manera, al menos, tan destacada como el crédito de otro autor comparable.
d.	Para evitar toda confusión, el Licenciante aclara que, cuando la obra es una composición musical:
i.	Regalías por interpretación y ejecución bajo licencias generales. El Licenciante se reserva el derecho exclusivo de autorizar la ejecución pública o la ejecución pública digital de la obra y de recolectar, sea individualmente o a través de una sociedad de gestión colectiva de derechos de autor y derechos conexos (por ejemplo, SAYCO), las regalías por la ejecución pública o por la ejecución pública digital de la obra (por ejemplo Webcast) licenciada bajo licencias generales, si la interpretación o ejecución de la obra está primordialmente orientada por o dirigida a la obtención de una ventaja comercial o una compensación monetaria privada.
ii.	Regalías por Fonogramas. El Licenciante se reserva el derecho exclusivo de recolectar, individualmente o a través de una sociedad de gestión colectiva de derechos de autor y derechos conexos (por ejemplo, SAYCO), una agencia de derechos musicales o algún agente designado, las regalías por cualquier fonograma que Usted cree a partir de la obra (“versión cover”) y distribuya, en los términos del régimen de derechos de autor, si la creación o distribución de esa versión cover está primordialmente destinada o dirigida a obtener una ventaja comercial o una compensación monetaria privada.
e.	Gestión de Derechos de Autor sobre Interpretaciones y Ejecuciones Digitales (WebCasting). Para evitar toda confusión, el Licenciante aclara que, cuando la obra sea un fonograma, el Licenciante se reserva el derecho exclusivo de autorizar la ejecución pública digital de la obra (por ejemplo, webcast) y de recolectar, individualmente o a través de una sociedad de gestión colectiva de derechos de autor y derechos conexos (por ejemplo, Acinpro), las regalías por la ejecución pública digital de la obra (por ejemplo, webcast), sujeta a las disposiciones aplicables del régimen de Derecho de Autor, si esta ejecución pública digital está primordialmente dirigida a obtener una ventaja comercial o una compensación monetaria privada.
5. Representaciones, Garantías y Limitaciones de Responsabilidad.
A MENOS QUE LAS PARTES LO ACORDARAN DE OTRA FORMA POR ESCRITO, EL LICENCIANTE OFRECE LA OBRA (EN EL ESTADO EN EL QUE SE ENCUENTRA) “TAL CUAL”, SIN BRINDAR GARANTÍAS DE CLASE ALGUNA RESPECTO DE LA OBRA, YA SEA EXPRESA, IMPLÍCITA, LEGAL O CUALQUIERA OTRA, INCLUYENDO, SIN LIMITARSE A ELLAS, GARANTÍAS DE TITULARIDAD, COMERCIABILIDAD, ADAPTABILIDAD O ADECUACIÓN A PROPÓSITO DETERMINADO, AUSENCIA DE INFRACCIÓN, DE AUSENCIA DE DEFECTOS LATENTES O DE OTRO TIPO, O LA PRESENCIA O AUSENCIA DE ERRORES, SEAN O NO DESCUBRIBLES (PUEDAN O NO SER ESTOS DESCUBIERTOS). ALGUNAS JURISDICCIONES NO PERMITEN LA EXCLUSIÓN DE GARANTÍAS IMPLÍCITAS, EN CUYO CASO ESTA EXCLUSIÓN PUEDE NO APLICARSE A USTED.
6. Limitación de responsabilidad.
A MENOS QUE LO EXIJA EXPRESAMENTE LA LEY APLICABLE, EL LICENCIANTE NO SERÁ RESPONSABLE ANTE USTED POR DAÑO ALGUNO, SEA POR RESPONSABILIDAD EXTRACONTRACTUAL, PRECONTRACTUAL O CONTRACTUAL, OBJETIVA O SUBJETIVA, SE TRATE DE DAÑOS MORALES O PATRIMONIALES, DIRECTOS O INDIRECTOS, PREVISTOS O IMPREVISTOS PRODUCIDOS POR EL USO DE ESTA LICENCIA O DE LA OBRA, AUN CUANDO EL LICENCIANTE HAYA SIDO ADVERTIDO DE LA POSIBILIDAD DE DICHOS DAÑOS. ALGUNAS LEYES NO PERMITEN LA EXCLUSIÓN DE CIERTA RESPONSABILIDAD, EN CUYO CASO ESTA EXCLUSIÓN PUEDE NO APLICARSE A USTED.
7. Término.
a.	Esta Licencia y los derechos otorgados en virtud de ella terminarán automáticamente si Usted infringe alguna condición establecida en ella. Sin embargo, los individuos o entidades que han recibido Obras Derivadas o Colectivas de Usted de conformidad con esta Licencia, no verán terminadas sus licencias, siempre que estos individuos o entidades sigan cumpliendo íntegramente las condiciones de estas licencias. Las Secciones 1, 2, 5, 6, 7, y 8 subsistirán a cualquier terminación de esta Licencia.
b.	Sujeta a las condiciones y términos anteriores, la licencia otorgada aquí es perpetua (durante el período de vigencia de los derechos de autor de la obra). No obstante lo anterior, el Licenciante se reserva el derecho a publicar y/o estrenar la Obra bajo condiciones de licencia diferentes o a dejar de distribuirla en los términos de esta Licencia en cualquier momento; en el entendido, sin embargo, que esa elección no servirá para revocar esta licencia o que deba ser otorgada , bajo los términos de esta licencia), y esta licencia continuará en pleno vigor y efecto a menos que sea terminada como se expresa atrás. La Licencia revocada continuará siendo plenamente vigente y efectiva si no se le da término en las condiciones indicadas anteriormente.
8. Varios.
a.	Cada vez que Usted distribuya o ponga a disposición pública la Obra o una Obra Colectiva, el Licenciante ofrecerá al destinatario una licencia en los mismos términos y condiciones que la licencia otorgada a Usted bajo esta Licencia.
b.	Si alguna disposición de esta Licencia resulta invalidada o no exigible, según la legislación vigente, esto no afectará ni la validez ni la aplicabilidad del resto de condiciones de esta Licencia y, sin acción adicional por parte de los sujetos de este acuerdo, aquélla se entenderá reformada lo mínimo necesario para hacer que dicha disposición sea válida y exigible.
c.	Ningún término o disposición de esta Licencia se estimará renunciada y ninguna violación de ella será consentida a menos que esa renuncia o consentimiento sea otorgado por escrito y firmado por la parte que renuncie o consienta.
d.	Esta Licencia refleja el acuerdo pleno entre las partes respecto a la Obra aquí licenciada. No hay arreglos, acuerdos o declaraciones respecto a la Obra que no estén especificados en este documento. El Licenciante no se verá limitado por ninguna disposición adicional que pueda surgir en alguna comunicación emanada de Usted. Esta Licencia no puede ser modificada sin el consentimiento mutuo por escrito del Licenciante y Usted.

 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