Episiotomía estado del arte. Una muestra conductual en los partos del Hospital Universitario Hernando Moncaleano Perdomo / Episiotomy state of the art. A sample in the deliveries of the Hernando Moncaleano Perdomo Hospital Universitario

Resumen La episiotomía es una intervención común usada en las salas de partos. Se define como la realización un tipo de intervención quirúrgica en el periné́ que pretende facilitar la expulsión del producto ampliando el canal blando del parto. Este tiene unas indicaciones para su realización. El objetivo de nuestro estudio fue evaluar las razones para la realización de episiotomía en el HUHMP, analizar si esta se realiza según las indicaciones maternas-fetales, evaluar cuanto la implementación de una episiotomía selectiva puede proteger contra las laceraciones perineales y realizar una revisión de la literatura relevante y actual en este tema. El total de pacientes fue 214 en el periodo de Agosto, Septiembre y Octubre DEL 2016. De las cuales 103 (48.13%) fueron primigestantes, y las no primigestantes fueron 111(51.86%). En cuanto a la presencia de desgarros en las primigestantes se encontró desgarro grado 1 (17.51%), desgarro grado 2 ( 21.63%) desgarro grado 3 (0%) y desgarro grado 4 ( 1.03%), sin desgarro (39.14%),a este grupo de pacientes se les realizo episiotomía a (25.75%). En las no primigestantes fue desgarro grado 1 (32.19%), desgarro grado 2 ( 14.43%) desgarro grado 3 (0%) y desgarro grado 4 ( 0%), sin desgarro (68.82%),a este grupo de pacientes se les realizo episiotomía a (7.77%) Cuando se realizaron episiotomías se tuvieron como indicación periné corto y poca distensibilidad con un 19.3%, acortamiento del periodo expulsivo 16%, prevención de desgarro y acortamiento de trabajo de parto 6.4%, primigestante 3.2% Y en el 58% de las pacientes en quienes se realizó episiotomía no tenían indicación descrita.

Abstract Episiotomy is a common intervention used in maternity ward. It is defined as a type of surgery in the perineum intended to facilitate the expulsion of the product extending the birth canal. This has some indications for its realization. The objetive of our study was to evaluate the episiotomy reasons in HUHMP, analyze whether this is done by maternal-fetal indications, the assess the implementation of a selective episiotomy may protect against lacerations and a review of the relevant and current literature on this subject. The total was of 214 patients in the period of August, September and October 2016. Of which 103 (48.13%) were primigravidae, and non primigravidae were 111 (51.86%). In the primigravidae group the tearing grade 1 (17.51%), tearing grade 2 (21.63%) tearing Grade 3 (0%) and tear Grade 4 (1.03%), without tearing (39.14%); this group of Patients underwent episiotomy (25.75%). In non primigravidae I was tear grade 1 (32.19%), tear grade 2 (14.43%) tearing Grade 3 (0%) and tear Grade 4 (0%), without tearing (68.82%), this group of Patients Were episiotomy Performed (7.77%) When episiotomies were performed were taken as indication Short perineum and poorly compliant con un 19,3%, shortening the period expulsive 16%, prevention tear and shortening of Labor 6.4%, 3.2% primiparousAnd in 58% of Patients Who episiotomy was performed in they had no indication described

Correction to: PANLAR consensus statement on biosimilars.

The two co-authors of the mentioned above article were incorrect. The correct are authors should have been "P. A. Beltrán" instead of "P. A. B. Roa" and "J. F. Diaz-Coto" instead of "L. Diaz Soto".

[Non-invasive diagnosis of cardiac amyloidosis due to transthyretin. Case report]. / Diagnóstico no invasivo de amiloidosis cardiaca por transtirretina. Caso clínico.

Amyloidosis due to deposits of transthyretin (ATTR) is currently considered the most frequent form of cardiac amyloidosis and its incidence is increasing thanks to the advances in diagnostic imaging techniques. Some non-invasive diagnostic criteria have recently been published on this entity that due to the development of new drugs for the specific treatment of cardiac ATTR, have prognostic and therapeutic implications. That is why cardiac ATTR could cease to be a rare disease and become a frequent one, and become potentially treatable instead of incurable. We present the case of an 80-year-old male diagnosed with non-hereditary cardiac ATTR by means of gammagraphy with 99mTc diphosfonate scintigraphy (99mTc-DPD) following the new criteria of non-invasive diagnosis.

Use of Social Media and an Online Survey to Discuss Complex Reconstructive Surgery: A Case of Upper Lip Reconstruction with 402 Responses from International Microsurgeons.

BACKGROUND: The best reconstructive strategy for upper lip defects is still in debate. The purpose of this study was to analyze the decisions made by international microsurgeons, who were participated through online questionnaire, distributed by email and social media network. MATERIALS AND METHODS: A case of a two-thirds upper lip oncologic defect was presented via an online questionnaire and 402 microsurgeons replied their treatment options. The data were then analyzed according to the geographic area, microsurgical fellowship, seniority, and subspecialty. All the data were analyzed using SPSS 22. RESULTS: A total of 27.7% of microsurgeons chose a free flap, while 72.3% chose a local/pedicle flap as their preferred method for reconstruction. The most common choice of free and local/pedicle flaps was radial forearm (73.6%) and Abbé (36.2%), respectively. The microsurgeons in Europe preferred local/pedicle flaps than free flap when compared with Middle/South America, Asia-Pacific, Africa and South Asia/Middle East (11.6% versus 50%, 43.4%, 29.3% and 27.3%, respectively, multivariant p < 0.05). The microsurgeons with microsurgical fellowships preferred to use free flaps (32.9% versus 17.5%, multivariant p = 0.021). There was no difference for the seniority and specialty of the microsurgeons. CONCLUSIONS: The online questionnaire is valuable and feasible for obtaining experts' opinions. This study provides a current global overview of surgical preferences for this common complicated clinical scenario.

Lymph node yield in right colectomy for cancer: a comparison of open, laparoscopic and robotic approaches.

AIM: Studies have demonstrated a relationship between lymph node (LN) yield and survival after colectomy for cancer. The impact of surgical technique on LN yield has not been well explored. METHOD: This is a retrospective study of right colectomy (RC) for cancer at a single institution from 2012 to 2014. Exclusion criteria were previous colectomy and emergent and palliative operations. All data were collected by chart review. Primary outcomes were LN yield and the LN to length of surgical specimen (LN-LSS) ratio. Multivariable mixed models were created with surgeon and pathologist as random effects. Sensitivity analyses were performed to exclude Stage IV cancers and to analyse groups on an 'as-treated' basis. RESULTS: We identified 181 open (O-RC), 163 laparoscopic (L-RC) and 119 robotic (R-RC) right colectomies. O-RC was more commonly performed in women with metastatic disease. The mean LN yield was 28, 29 and 34 in O-RC, L-RC and R-RC, respectively; the respective mean LN-LSS ratios were 0.83, 0.91 and 1.0. The R-RC approach produced a higher LN yield than the other approaches (P < 0.01), and a higher LN-LSS ratio than O-RC (P < 0.01). These findings were unchanged in sensitivity analyses. CONCLUSION: Robotic right colectomy improves LN yield and the LN-LSS ratio, which may reflect better mesocolic excision. The effect of these findings on survival requires further investigation.

Incisional hernias after laparoscopic and robotic right colectomy.

PURPOSE: Incisional hernia (IH) is a common complication after colectomy, with impacts on both health care utilization and quality of life. The true incidence of IH after minimally invasive colectomy is not well described. The purpose of this study was to examine IH incidence after minimally invasive right colectomies (RC) and to compare the IH rates after laparoscopic (L-RC) and robotic (R-RC) colectomies. METHODS: This is a retrospective review of patients undergoing minimally invasive RC at a single institution from 2009 to 2014. Only patients undergoing RC for colonic neoplasia were included. Patients with previous colectomy or intraperitoneal chemotherapy were excluded. Three L-RC patients were included for each R-RC patient. The primary outcome was IH rate based on clinical examination or computed tomography (CT). Univariate and multivariate time-to-event analyses were used to assess predictors of IH. RESULTS: 276 patients where included, of which 69 had undergone R-RC and 207 L-RC. Patient and tumor characteristics were similar between the groups, except for higher tumor stage in L-RC patients. Both the median time to diagnosis (9.2 months) and the overall IH rate were similar between the groups (17.4 % for R-RC and 22.2 % for L-RC), as were all other postoperative complications. In multivariable analyses, the only significant predictor of IH was former or current tobacco use (hazard raio 3.0, p = 0.03). CONCLUSIONS: This study suggests that the incidence of IH is high after minimally invasive colectomy and that this rate is equivalent after R-RC and L-RC. Reducing the IH rate represents an important opportunity for improving quality of life and reducing health care utilization after minimally invasive colectomy.

Determinantes sociales de la salud asociados con la calidad de vida en personas con discapacidad secundaria a enfermedad vascular cerebral / Social determinants of health associated with the quality of life in people with disabilities secondary to cerebral vascular disease

La enfermedad vascular cerebral (EVC) es un trastorno de la circulación sanguínea cerebral. Se considera un problema de salud pública a nivel mundial ya que se encuentra dentro de las principales causas de muerte y la primera de discapacidad. El impacto de la EVC en la vida diaria de las personas que la padecen puede evaluarse a través del nivel de calidad de vida relacionada con la salud, sin embargo existen factores que la determinan aún más; a éstos se les conoce como Determinantes Sociales de la Salud. El objetivo de este estudio fue analizar el nivel de calidad de vida relacionada con la salud y su asociación con algunos determinantes sociales de la salud. Metodología: Estudio observacional, transversal, prolectivo, descriptivo. Muestra no aleatorizada de 121 personas que presentaron evento vascular cerebral, sin afasia o déficit auditivo severo, con puntuación <4 en Test PFEIFFER, que contestaron la encuesta de los Determinantes Sociales de la Salud y el instrumento "perfil de consecuencias de la enfermedad adaptada a la enfermedad vascular cerebral" (SIP-30). Con los resultados obtenidos se conformó una base de datos en el programa de SPSS y se realizaron análisis descriptivos e inferenciales. Resultados: La principal discapacidad que se presentó fue de tipo motriz seguida del lenguaje, el 54% de la muestra estudiada no reingresó a su vida laboral y el 68% tenía más de 12 meses de haber presentado la EVC. Se observó el nivel de calidad de vida de la siguiente manera: alta en 36%, media 33% y baja en el 31% de la muestra. Algunos de los principales determinantes sociales de la salud relacionados con la calidad de vida fueron: Lugar de residencia con p<0.005, situación laboral p<0.05, tiempo transcurrido del evento vascular p<0.05, número de discapacidades p<0.05, nivel educativo p<0.05. RM=0.371, IC95% 0.0134-1.030 en la situación laboral. Conclusiones: Evaluar los determinantes sociales de la salud y el nivel de calidad de vida de las personas con discapacidad secundaria a un EVC, permite al profesional de enfermería coadyuvar en su cuidado dentro de su propio contexto y realidad además de contribuir a la creación de políticas públicas de salud.

The cerebrovascular disease is considered a global public health problem because it is one of the principal causes of death, and the first one of disabilities. The impact of the cerebrovascular disease on the person's daily life can be readily assessed by the level of health-related quality of life; however, a broader assessment can be achieved through the Social Determinants of Health. The objective of this study was to analyze the level of health-related quality of life and identify its associations with some of the Social Determinants of Health. Methodology: This is an observational, transversal and descriptive study. The sample was not randomized and included 121 persons who had suffered a cerebrovascular accident which did not result in aphasia or severe auditory deficits, who had a score of less than 4 in the PFEIFFER test, and who answered to the Social Determinants of Health survey and the Sickness Impact Profile (SA-SIP30) instrument. With the obtained results, an SPSS database was generated and descriptive and inferential analyses were performed. Results: The main disabilities found were motor-related ones followed by languagerelated ones. Sixty five persons (54% approx.) in the sample did not return to their working lives. Eighty two persons (68% approx.) in the sample had 12 months or more of having suffered the cerebrovascular accident. The level of health-related quality of life was observed as follows: high in approximately 36% and low in approximately 31% of the sample. Some of the main Social Determinants of Health associated with the health-related quality of life were: place of residency: p<0.005; working situation: p<0.05; elapsed time since the cerebrovascular accident: p<0.05; number of disabilities: p<0.05; education level: p<0.05. MR=0.371, CI 95% 0.0134-1.030 in the working situation determinant. Conclusions: Assessing the Social Determinants of Heath and the health-related level of quality life among persons with secondary disabilities due to cerebrovascular accidents, allows the nursing staff, to better provide adequate care in the context and reality of these persons, and also to contribute to the development of the corresponding public health policies.

Ascariasis as cause of intestinal occlusion and concurrent appendicitis.

Intestinal occlusion by ascariasis is a commonly seen socio-economic status low, is associated with poor sanitary hygiene. It is rare to see a case with both intestinal occlusion and appendicitis at the same time, as described in this report.

[Short-term results of treatment with 131I in patients with multinodular goiter: effect of the associated degree of hyperthyroidism and other variables]. / Resultados a corto plazo del tratamiento con 131I en pacientes con bocio multinodular: influencia del grado de hipertiroidismo asociado y otras variables.

OBJECTIVE: To assess the effectiveness of radioactive iodine (RAI) therapy and the incidence of hypothyroidism post RAI in patients with subclinical hyperthyroidism or clinical hyperthyroidism with Multinodular Goiter (MNG). METHODS: A retrospective study of 69 consecutive patients treated with (131)I for MNG during the year 2008 observed for six months. All patients received a single fixed dose of 16 mCi (592 MBq) weighted by the gland size. They were categorized into two groups: subclinical hyperthyroidism or clinical hyperthyroidism. We compared the success rate and the incidence of hypothyroidism. RESULTS: The thyroid dysfunction was corrected in 82.09% of the patients. Success rate was 100% in the clinical hyperthyroidism group and 78.13% in the subclinical hyperthyroidism group (P=0.105). The overall incidence of hypothyroidism was 16.42%; 25.00% of patients with clinical hyperthyroidism and 14.55% with subclinical hyperthyroidism developed this secondary effect (P=0.400). No statistically significant differences were found in the success rate in the incidence of hypothyroidism when the results were analyzed according to the thyrotropin decrease in patients with subclinical hyperthyroidism. Seven patients had positive anti-thyroid peroxidase antibodies (anti-TPO) before therapy. The incidence of hypothyroidism was significantly higher in them (57.14% vs 11.67%; P=0.011). Cardiac arrhythmias were four times more frequent in patients with clinical hyperthyroidism. Previous treatment with thiamazol positively affected the outcome. CONCLUSIONS: A single fixed weighted dose of (131)I is highly effective and safe for the control of clinical and subclinical hyperthyroidism due to MNG. Patients with anti-TPO antibodies may have a high risk of developing post-iodine hypothyroidism.

[Sarcoidosis of bone. Findings in the Gallium citrate examination]. / Sarcoidosis ósea. Hallazgos en la exploración con citrato de Galio.

Sarcoidosis of bone lesions are rare, with an overall incidence of 3-9% of the cases. When they do occur, they are more frequent in the small bones of hands and feet than in long bones, spine or skull. We report a case of a male patient with sarcoidosis with multiple enlarged lymph nodes, skin and bone lesions, and the scintigraphic findings.

Application of multicriteria decision analysis to jar-test results for chemicals selection in the physical-chemical treatment of textile wastewater.

Jar-test is a well-known tool for chemicals selection for physical-chemical wastewater treatment. Jar-test results show the treatment efficiency in terms of suspended matter and organic matter removal. However, in spite of having all these results, coagulant selection is not an easy task because one coagulant can remove efficiently the suspended solids but at the same time increase the conductivity or increase considerably the sludge production containing chemicals and toxic dyes. This makes the final selection of coagulants very dependent on the relative importance assigned to each measured parameter. In this paper, the use of multicriteria decision analysis (MCDA) is proposed to help on the selection of the coagulant and its concentration in the physical-chemical wastewater treatment, since textile wastewater contains hazardous substances. Therefore, starting from the parameters fixed by the jar-test results, these techniques will allow to weight these parameters, according to the judgements of wastewater experts, and to establish priorities among coagulants. Two well-known MCDA techniques have been used: analytic hierarchic process (AHP) and preference ranking organization method for enrichment evaluations (PROMETHEEs) and their results were compared. The method proposed has been applied to the particular case of textile wastewaters. The results obtained show that MCDA techniques are useful tools to select the chemicals for the physical-technical treatment.

[Complex reconstructive surgery of cervico-urethral sclerosis after radical prostatectomy, due to endoscopic solution failure]. / Cirugía reconstructiva compleja de la esclerosis cervico-uretral tras prostatectomía radical, por fracaso de la solución endoscópica.

The sclerosis of the cervico-urethral union is one of the complications that may arise after a radical prostatectomy, in most cases, the endoscopic treatment usually solves it. We introduce repair by open approach of a sclerosis cervico-urethral after radical prostatectomy that did not respond to endoscopic management. The surgical technique had two times, the first perineal and a second time with hypogastric approach. After six months of this complex surgery an artificial sphincter was placed to patient. The patient is asymptomatic and continent after three years of follow up surgery.

[The development and preliminary validation of the IU-4 questionnaire for the clinical classification of urinary incontinence]. / Elaboración y validación preliminar del cuestionario para la clasificación clínica de la incontinencia urinaria IU-4.

RATIONALE: To prepare and validate a simple and self-administered questionnaire for the clinical rating of patients with urinary incontinence (UI) for use in the clinical practice. METHODS: The questionnaire was prepared based on a review of the literature on urinary incontinence and the views of 7 urodynamic urologists. The initial questionnaire UI-5 included 5 items related to UI symptoms that divided patients into three categories: stress incontinence (UEI), urge incontinence (UUI) or mixed urinary incontinence (MUI). An additional question evaluates the impact of UI type on the quality of life. The of construct validity was analyzed correlating the responses to UI-5 items and the question on quality of life. The area under the ROC curve was calculated for each UI type correlating the UI-5 scores and the results of the urodynamic test. The cut-off values for each scale were determined based on sensitivity (SE) and specificity (SP). RESULTS: The study included 188 females with UI (73.4% with UEI, 13.3% with UUI and 13.3% with MUI; based on the urodynamics). Only 4.3% patients did not answer some UI-5 items. One item related to the protective material used was excluded as it was not related to UI types, and so the final questionnaire included only 4 items (UI-4). The results show that UI-4 discriminates the different types of incontinence: UEI (SE: 0.69/SP: 0.76; 1 item), UUI (SE: 0.83/SP: 0.65; 2 items), MUI (SE: 0.72/SP: 0.65; 1 item). 100% patients with MUI, 84% with UUI and 59.9% with UEI report some impact on their quality of life. CONCLUSIONS: UI-4 is simple, valid and easy to administer, and can be particularly valuable in the clinical rating of UI in settings where urodynamic testing is not easily available such is primary health care.

Genetic diversity and population structure of Vibrio cholerae.

Multilocus enzyme electrophoresis (MLEE) of 397 Vibrio cholerae isolates, including 143 serogroup reference strains and 244 strains from Mexico and Guatemala, identified 279 electrophoretic types (ETs) distributed in two major divisions (I and II). Linkage disequilibrium was demonstrated in both divisions and in subdivision Ic of division I but not in subdivision Ia, which includes 76% of the ETs. Despite this evidence of relatively frequent recombination, clonal lineages may persist for periods of time measured in at least decades. In addition to the pandemic clones of serogroups O1 and O139, which form a tight cluster of four ETs in subdivision Ia, MLEE analysis identified numerous apparent clonal lineages of non-O1 strains with intercontinental distributions. A clone of serogroup O37 that demonstrated epidemic potential in the 1960s is closely related to the pandemic O1/O139 clones, but the nontoxigenic O1 Inaba El Tor reference strain is not. A strain of serogroup O22, which has been identified as the most likely donor of exogenous rfb region DNA to the O1 progenitor of the O139 clone, is distantly related to the O1/O139 clones. The close evolutionary relationships of the O1, O139, and O37 epidemic clones indicates that new cholera clones are likely to arise by the modification of a lineage that is already epidemic or is closely related to such a clone.