Composition and Antioxidant Properties of Spanish Extra Virgin Olive Oil Regarding Cultivar, Harvest Year and Crop Stage.

The health benefits of extra virgin olive oil (EVOO) are related to its chemical composition and the presence of bioactive compounds with antioxidant properties. The aim of this study was to evaluate antioxidant compounds (pigments, coenzyme Q10 (CoQ10) and phenolic compounds) and antioxidant properties of EVOO from the same region comparing different cultivars (Hojiblanca and Arbequina), harvest year and crop stage. Antioxidant properties of oils were studied before and after a gastrointestinal digestion process, by in vitro assays (DPPH, ABTS and FRAP) and antioxidant markers in Caco-2 cells (reactive oxygen species production). The content of bioactive compounds measured was significantly affected by cultivar and harvest year (except for carotenoids) and by the crop stage (except for coenzyme Q10). Higher amounts of coenzyme Q10 were observed in Hojiblanca than in Arbequina EVOO. Total phenol content and antioxidant properties were also different depending on cultivar and harvest year and the in vitro digestion process strongly improved antioxidant marker values. Antioxidant potential in bioaccessible fractions was mainly related to the content of coenzyme Q10 and phenolic compounds in EVOO. Chemometric analysis showed that the oils were clearly classified by cultivars, harvest and crop stage, according to the chemical composition and antioxidant activity analyzed in the present study.

Probable hereditary familial overlap syndrome with multiple synchronous lung tumors.

Here we report a case of a young, never-smoker Hispanic woman with a hereditary familial overlap syndrome (Li-Fraumeni plus CDH1). The patient developed multiple synchronous primary lung adenocarcinomas related to Intra-Alveolar Tumor Spread (STAS) several years after the diagnosis of a locally advanced lower limb osteosarcoma. Comprehensive genomic profiling by next generation sequencing (NGS) was performed on 90 cancer-related genes over each lung lesion (including two nodules of acinar adenocarcinoma, one lepidic spread tumor and in the STAS area). Likewise, the broad genomic analysis was performed on archival tissue from the previous bone tumor. Lung tumors were found to harbor PIK3CA (invasive lesions) and a rare in-frame insertion of nucleotides in exon 19 of EGFR (lepidic tumor). STAS area showed KRAS and BRAF mutations in two different segments, and osteosarcoma tested positive for well known PIK3CA, KRAS and CDH1 alterations. This unique case raises practical questions as to the challenges of molecular testing and highlights the potential association of germline TP53 and CDH1 mutations with concurrent somatic alterations that elucidate the basis of tumor heterogeneity.

Right mainstem bronchoplasty 18 years following thoracic spinal implant surgery.

Thoracic spinal surgery has many complications ranging from surgical site infection, chronic pain, periarticular arthrosis, displacement of spinal screws and hardware migration to a lesser degree. Reports of spinal implants penetrating the aorta have been described in the literature, however to our knowledge, lower airway obstruction due to spinal hardware migration has not been reported. Here we describe a case of a patient presenting with a right main stem bronchial obstruction and pneumonia secondary to the migration of the surgical spinal hardware into the lower airway 18 years after his initial intervention. We describe our surgical approach, management and outcomes using bronchoscopy and open thoracotomy. Bronchial obstruction is not a common complication of thoracic spinal surgery, however in remote cases patients may present with rare consequences, it is therefore important to pay close attention to patients' clinical and surgical history since surgical complications may appear years after.

Pileflebitis / Pylephlebitis

Resumen La trombosis séptica de la porta es una complicación poco frecuente y altamente mortal que se presenta en los pacientes como complicación de patología quirúrgica abdominal, principalmente en casos de apendicitis aguda y enfermedad diverticular complicada. Las manifestaciones clínicas de la condición son bizarras lo que hace el diagnóstico difícil y por ende la intervención tardía, favoreciendo así las tasas de complicaciones y desenlaces adversos. La aproximación diagnóstica se enfoca en la clínica y técnicas de imagen. Se presenta un caso en relación a trombosis séptica de la porta secundario a patología dependiente del apéndice cecal manifiestada como choque séptico. (Acta Med Colomb 2016; 41: 148-150).

Abstract Septic thrombosis of the portal vein is a rare and highly lethal complication that occurs in patients as a complication of abdominal surgical pathology, mainly in cases of acute appendicitis and complicated diverticular disease. The clinical manifestations of the condition are bizarre making the diagnosis difficult and having therefore late intervention, favoring the rates of complications and adverse outcomes. The diagnostic approach focuses on the clinical picture and imaging techniques. A case of septic portal thrombosis secondary to cecal appendix dependent pathology manifested as septic shock, is presented. (Acta Med Colomb 2016; 41: 148-150).

First non-intubated uniportal video-assisted pulmonary lobectomy in America.

The first video-assisted thoracic lobectomy in non-intubated patient in America was performed on 27th of September 2014 in Bogotá Colombia, The National Cancer Institute in Bogotá received Dr. Diego González-Rivas to make possible this kind of procedure in a 53-year-old man, with a history of papillary thyroid cancer treated with surgery and Iodine therapy, in whom two pulmonary nodules were found in the monitoring tomography. We resected the nodule located at the right upper lobe previously marked by scintigraphy, the other one required a lobectomy because it was a deep nodule with malignant radiologic appearance inside of the middle lobe. The procedure discoursed in a non-intubated patient without technical difficulties or complications, very short recovery time, minimum pain and a quiet and usual postoperative evolution. This procedure, the first reported in America was replicated after others with similar results in several countries thanks to the collaboration between surgeons, anesthesiologists, radiologists, nurses and therapists, because especially in such interventions teamwork is essential. We believe that given the benefits in terms of recovery for the patient and anesthetic time, we could go on replicating the experience in selected patients.

Impacto de la estrategia de aula invertida en el ambiente de aprendizaje en cirugía: una comparación con la clase magistral / Impact of the flipped classroom strategy in the learning environment in surgery: A comparison with the lectures

Introducción. La Facultad de Medicina de la Universidad de La Sabana utiliza rutinariamente la clase magistral como una de las principales estrategias educativas en áreas clínicas. Desde 2012, se introdujo un "currículo en contexto" y la estrategia del aula invertida en el curso de cirugía. Objetivo. Comparar el impacto de la clase magistral con el del aula invertida en el ambiente de aprendizaje en cirugía. Materiales y métodos. Se utilizó el cuestionario Dundee Ready Education Environment Measure (DREEM) en cuatro cohortes de estudiantes. Se analizaron los cinco dominios y la puntuación global del instrumento con ambas estrategias y se determinó el ANOVA (p<0,05). La consistencia interna se evaluó con el coeficiente alfa de Cronbach. Resultados. El cuestionario fue respondido por 207 participantes (hombres: 36 %; edad: 21,9 ± 1,49 años). La puntuación global del DREEM y la de sus dominios fueron mayores con la estrategia del aula invertida, lo que la situaría en un nivel de excelencia. No hubo diferencias entre el ANOVA de cada dominio y el de la puntuación global del cuestionario con el modelo de aula invertida, pero sí las hubo con la estrategia de clase magistral (p<0,01). Se encontraron elevados niveles de confiabilidad (Cronbach>0,90) para todas las mediciones en ambos ambientes y coherencia en todas las cohortes. Conclusiones. La puntuación de la estrategia de aula invertida en el cuestionario DREEM, se situó en un nivel de excelencia en comparación con la de la clase magistral. Es crucial determinar los factores que obtuvieron una puntuación negativa para promover el mejoramiento del entorno de aprendizaje, así como hacer mediciones en el tiempo para garantizar la calidad y el éxito de la estrategia.

Introduction: The Facultad de Medicina of the Universidad de La Sabana routinely uses lectures as the major educational strategy in clinical areas. Since 2012, a curriculum in context and a flipped classroom were introduced in the surgery course. Objective: To compare the impact of lectures versus the flipped classroom model in the learning environment in surgery. Materials and methods: The Dundee Ready Education Environment Measure (DREEM) questionnaire was administered to four cohorts of students. The five domains and the overall scores for both strategies were analyzed, and ANOVA was used to determine the differences among the domains (p<0.05). The internal consistency was assessed using Cronbach´s alpha coefficient. Results: There were 207 participants (men: 36%) that completed the questionnaire (age: 21.9 ± 1.49 years old). The overall DREEM score and the subscales were higher with the flipped classroom, which suggests that this environment had a higher level of excellence. The ANOVA for each domain and the overall scores showed no differences with a flipped classroom. However, significant differences were identified in all domains and the overall scores with lectures (p<0.01). There were high levels of reliability (Cronbach>0.90) for all measurements in both environments, and there was consistency across all cohorts. Conclusions: The flipped classroom strategy showed a higher score than the lecture-based approach according to the DREEM questionnaire. Identifying factors with a negative score is crucial to improving the learning environment. It is necessary to conduct further measurements over time to ensure the quality and success of the strategy.

Accuracy of a Brief Neuropsychological Battery for the Diagnosis of Dementia and Mild Cognitive Impairment: An Analysis of the NEDICES Cohort.

Early separation of mild cognitive impairment (MCI) from normal aging and mild cases of dementia remains a challenge, especially in the general population. We aimed to analyze the diagnostic accuracy of a brief neuropsychological battery (BNB) in dementia and MCI cases from the Neurological Disorders in Central Spain (NEDICES) population-based cohort study. We screened 3,891 participants into dementia and non-dementia groups using a two-phase procedure: screening (MMSE-37 and Pfeffer-11) and clinical diagnosis by specialists (DSM-IV criteria). We selected subsequently a subsample of dementia (n = 98), MCI (n = 71), and cognitively healthy (n = 123) participants matched in socio-demographic characteristics. The clinical validity of each test of the BNB was determined by the area under the ROC curve. We determined the best combination of tests to classify individuals into the diagnostic groups by logistic regression analyses. The results indicated that dementia and MCI groups could be best discriminated from the healthy control group on the basis of their scores on the semantic verbal fluency and delayed recall subtests of the BNB. As for discriminating the MCI group from the dementia group, immediate recall tasks (stories and pictures) yielded the highest level of accuracy. Probably the most interesting finding is that the verbal fluency task consistently allowed discrimination among the diagnostic groups. Overall, subtests of the BNB are more accurate in differentiating dementia patients than MCI patients from healthy controls. In this population-based sample, a more fine-grained discrimination that includes MCI patients should follow a systematic subtest-wise analysis and decision.

[Impact of the flipped classroom strategy in the learning environment in surgery: A comparison with the lectures]. / Impacto de la estrategia de aula invertida en el ambiente de aprendizaje en cirugía: una comparación con la clase magistral.

INTRODUCTION: The Facultad de Medicina of the Universidad de La Sabana routinely uses lectures as the major educational strategy in clinical areas. Since 2012, a curriculum in context and a flipped classroom were introduced in the surgery course. OBJECTIVE: To compare the impact of lectures versus the flipped classroom model in the learning environment in surgery. MATERIALS AND METHODS: The Dundee Ready Education Environment Measure (DREEM) questionnaire was administered to four cohorts of students. The five domains and the overall scores for both strategies were analyzed, and ANOVA was used to determine the differences among the domains (p<0.05). The internal consistency was assessed using Cronbach´s alpha coefficient. RESULTS: There were 207 participants (men: 36%) that completed the questionnaire (age: 21.9 ± 1.49 years old). The overall DREEM score and the subscales were higher with the flipped classroom, which suggests that this environment had a higher level of excellence. The ANOVA for each domain and the overall scores showed no differences with a flipped classroom. However, significant differences were identified in all domains and the overall scores with lectures (p<0.01). There were high levels of reliability (Cronbach>0.90) for all measurements in both environments, and there was consistency across all cohorts. CONCLUSIONS: The flipped classroom strategy showed a higher score than the lecture-based approach according to the DREEM questionnaire. Identifying factors with a negative score is crucial to improving the learning environment. It is necessary to conduct further measurements over time to ensure the quality and success of the strategy.

The evolution of laparoscopy in abdominal surgery: a meta-analysis of the effect on infectious outcomes.

BACKGROUND: Laparoscopic surgery has been recommended as an effective strategy because of its advantages in decreasing abdominal surgical site infections (SSIs). The aim of this study was to assess the effect of laparoscopy on superficial and organ/space SSIs compared with open surgery in hollow-viscus procedures over time. STUDY DESIGN: Data on SSIs from randomized-controlled trials (RCTs) evaluating open versus laparoscopic abdominal surgeries were extracted from the Cochrane Database Reviews. Re-analysis of these data was performed to assess infections. Heterogeneity was also explored. A subgroup analysis was performed according to elective/emergency surgery status. RESULTS: Data from 72 RCTs including 8218 patients were collected (4116 patients in the laparoscopic group and 4102 patients in the open group). For superficial SSI, the pooled RD was -4.4% (95% CI: -5.4% to -3.3%), which indicated a lower risk in the laparoscopic group. For organ/space SSI, the pooled RD was 0.5% (95% CI: -0.1% to 1%), which indicated similar rates between the groups. Changes in SSI frequency had occurred over time. CONCLUSION: Laparoscopic surgery significantly decreases the risk of superficial SSI but does not affect the risk of organ/space SSI. Experience with technique improves outcomes.

La visita quirúrgica ideal: elementos para su correcta implementación / The ideal surgical rounds: elements for the correct implementation

La tradición de la visita quirúrgica tiene cientos de años y hace parte de las actividades médicas cotidianas. No obstante, su metodología es variable y cada cirujano le imprime su visión, sus métodos, sus condiciones y características, asumiendo que se hace bien. En vista de la heterogeneidad propia de la actividad, se pretende ofrecer algunas recomendaciones basadas en la literatura científica que permitan darle una organización y estandarización mínimas, y que sirvan como base para una aplicación de los modelos que se esperan de una visita quirúrgica. La visita quirúrgica que cumple sus funciones requiere de una planeación y un ejercicio sistemático para que consiga sus objetivos. La manera más útil hasta ahora conocida para no olvidar los pasos, mientras se convierte en una rutina, es utilizar listas de chequeo. Es la oportunidad para evaluarnos y evaluar a los otros dentro de un contexto académico, y es una estrategia perfecta para un control de los costos hospitalarios y evaluación de las políticas de costo-efectividad de las instituciones.

Surgical round is a centennial and routine activity. Nonetheless, its methodology is heterogeneous and each surgeon put his vision, methods, requirements and characteristics on it. Due to this heterogeneity, the aim of this article is to offer some recommendations based on scientific literature in order to organize and standardize it. These suggestions could serve as a model to make more effective surgical rounds. Surgical round needs planning and a systematic development to get its objectives. The best way to remember the minimal steps and convert it in a routine, is to use a checklist. Surgical round is an opportunity to assess ourselves and other into an academic setting. It is also a very good strategy to control health costos and evalute cost-effective interventions in hospitals.

Tiempo de evolución de la apendicitis y riesgo de perforación / Time and risk of rupture in acute appendicitis

Introducción. La apendicitis es la condición quirúrgica más común a la que se enfrenta el cirujano. La relación entre el tiempo de evolución y la complicación (perforación o peritonitis) se ha asumido como lineal, sin que exista evidencia contundente de esta afirmación. El propósito fue evaluar la relación entre el tiempo de los síntomas y la complicación de la apendicitis. Materiales y métodos. Se diseñó un estudio de cohortes sobre una base de datos prospectiva previamente ensamblada y publicada por los autores, en el que se evaluaron pacientes con dolor abdominal sugestivo de apendicitis. El método de referencia fue el reporte histopatológico. Se midió el tiempo de evolución de los síntomas en horas, en función del diagnóstico de apendicitis. Resultados. Se incluyeron 206 pacientes (59,7% hombres). El tiempo de evolución del grupo de apendicitis no complicada fue de 28,1±22,9 frente a 26,5±33,4 horas en apendicitis complicada (p=0,7), mientras que el tiempo de evolución del grupo de apendicitis no perforada fue de 22,5±17,5 frente a 33,4±24,8 horas en el de perforada (p<0,001). No se demostró una relación lineal entre el tiempo de síntomas y la perforación. Discusión. Generalmente se ha afirmado que existe una relación lineal entre el tiempo de evolución de los síntomas y la progresión de la apendicitis, y asimismo, de la perforación. Nuestros resultados demuestran que independientemente del tiempo de evolución de los síntomas, la frecuencia de apendicitis no complicada es estable y que existen otros factores no relacionados con el tiempo que pueden determinar la presentación de la enfermedad.

Introduction. Acute appendicitis is the most common surgical condition faced by surgeons. Relationship between time of symptomatology and the development of complications (rupture or peritonitis) has been assumed to be lineal, but there is no evidence supporting this belief. The objective of this study was to assess the relationship between time of symptoms of appendicitis and the development of complications. Materials and methods. A cohort study was designed based on data from a previously published study by the authors that evaluated patients with lower abdominal pain suggesting appendicitis. Gold standard for diagnosis was the histopathology report. Time of symptoms in hours was determined and compared with complication rates of acute appendicitis. Results. 206 patients were included (59,7% male). Time of symptoms in the group of uncomplicated acute appendicitis was 28,1 ±22,9 versus 26,5 ±33,4 hours in ruptured appendicitis (p <0,001). There was no lineal correlation between time and symptomatology and perforation. Discussion. It has been generally stated that there is a lineal relationship time of symptomatology and the rate of rupture in patients with acute appendicitis. Our results show that independent of the time of symptomatology, the frequency of uncomplicated appendicitis is stable and that there exist others factors not related with timing that can determine rupture in acute appendicitis.

Revisión bibliográfico analítica acerca de las diversas teorías y programas de intervención del autismo infantil / A critical review of the literature an diverse theories and intervention programs about child autism

Este artículo tiene como objetivo realizar una revisión bibliográfica acerca del autismo infantil. Se hace énfasis en las diversas teorías e hipótesis psicológicas que subyacen a este singular trastorno y se complementa la información acerca de las diversas técnicas de intervención que a nivel interdisciplinario se vienen manejando, con el fin de mejorar la calidad de vida de los afectados. El autismo infantil presenta una gran heterogeneidad en sus manifestaciones sintomáticas, por lo que es posible confundirlo a nivel de diagnóstico diferencial. Se han encontrado contradicciones en los resultados de algunas investigaciones en relación con las diversas técnicas de intervención con las que se viene tratando actualmente el trastorno.

The goal of this article is to clarify the state of art related to Autism emphasizing the diverse theories and psychological hypotheses implied in this singular disorder. Also, we will relate this to the interdisciplinary and diverse present techniques of intervention. The idea is to clarify how to improve the quality of life of the affected ones with this disorder. Clarifying all of this is very important in order to do a differential diagnosis properly because this disorder presents a great heterogeneity in its symptomatic manifestations, and it is often confused with other disorders. It has been found several contradictions in the results of some investigations in relation to the diverse techniques of intervention with which this disorder is treated.

Evaluación de escalas diagnósticas en pacientes con dolor abdominal sugestivo de apendicitis / Evaluation of diagnostic scales for appendicitis in patients with lower abdominal pain

Introducción. El diagnóstico de apendicitis es difícil y existen algunas escalas que pretenden mejorar la exactitud diagnóstica. Objetivo. Determinar las características operativas de las escalas de Alvarado y Fenyõ, comparándolas con la impresión diagnóstica del cirujano y la patología en el dolor abdominal sugestivo de apendicitis. Materiales y métodos. Se trata de un estudio prospectivo de evaluación de pruebas diagnósticas. Se registraron los signos, síntomas y resultados de exámenes de laboratorio incluidos en las escalas. Se registró de manera ciega el diagnóstico del cirujano y su conducta. Se determinó la sensibilidad, especificidad, valores diagnósticos positivos y negativos, y likelihood ratio (índice de verosimilitud) de cada escala y del cirujano, discriminado por sexo. Resultados. Se analizaron 374 sujetos, sin diferencias estadísticamente significativas de variables entre sexos. Se operaron 269 pacientes. El 16,9 por ciento de los hombres y el 31,4 por ciento de las mujeres no tuvieron apendicitis. Para los hombres, la sensibilidad del diagnóstico por el cirujano fue mayor que las escalas (86,2 por ciento Vs. 73 por ciento en Alvarado Vs. 67,2 por ciento en Fenyõ) con una especificidad similar. Para las mujeres la sensibilidad del cirujano y la escala de Alvarado fueron similares y superiores a la de Fenyõ (77,1 por ciento Vs. 79,5 por ciento en Alvarado y 47 por ciento en Fenyõ) pero la especificidad fue superior para Fenyõ (92,9 por ciento Vs. 71,4 por ciento en Alvarado y 75,9 por ciento en cirujano). La frecuencia de apendicitis crece de manera proporcional al puntaje de Alvarado. Conclusión. Para hombres con dolor en la fosa iliaca derecha, el diagnóstico hecho por el cirujano es mejor que las escalas diagnósticas. Para el caso de las mujeres, la escala de Fenyõ ofrece una mejor sensibilidad. La escala de Alvarado puede facilitar la conducta en pacientes con dolor en fosa iliaca derecha.

Introduction. Diagnosis of apendicitis is difficult; however several clinical scales have been developed that attempt to improve diagnostic accuracy. Objective. The operational characteristics of Alvarado and Fenyö scales were defined in patients with abdominal pain suggestive of appendicitis and were compare with clinical and pathological diagnoses. Material and methods. A prospective trial assessed the diagnostic tests. Sign, symptoms, and laboratory tests were included in scales selected. Surgeon decision was maintained independent from the results of the scales. Sensitivity, specificity, positive and negative predictive value and positive and negative likelihood ratio for each scale was compared with the surgeon evaluation. Results. The sample included 374 patients with approximately equal sexes. Of these 269 patients underwent surgery. Howeve, 16.9% of the male and 31.4% of female patients did not have appendicitis. For men, a diagnosis made by the surgeon had better sensitivity than scales (86.2% vs. 73% for Alvarado and 67.2% for Fenyö) without significant differences in specificity. For women, surgeon and Alvarado scale diagnoses were similar, and better than Fenyö scale (77.1% vs. 79.5% for Alvarado and 47% for Fenyö), but specificity was higher for Fenyö scale (92.9% vs. 71.4% for Alvarado and 75.9% for surgeon). Accuracy in diagnosis of appendicitis increases with a higher Alvarado score. Conclusion. For men with abdominal pain on right lower quadrant, surgeon diagnosis is more accurate than scales. For women, Fenyö scale offers a better sensitivity. Alvarado score can facilitate decision-making in patients with these abdominal symptoms.

Utilidad del Hemograma de control en pacientes con Dolor abdominal sugestivo de Apendicitis / Value of the leukocite cell count in patients with abdominal pain suggesting appendicitis

Introducción: El uso de los valores de leucocitos y neutrófilos como examen de periódico control en pacientes con dolor abdominal sugestivo de apendicitis es una conducta común en los servicios de urgencias. El objetivo de este estudio fue evaluar esta determinación en pacientes con sospecha de apendicitis sometidos a observación. Materiales y métodos: Se informan los resultados de 32 pacientes de una cohorte de 374 que fueron observados y se les realizó hemograma al ingreso y de control. Se compararon los valores usando la prueba de Wilcoxon para muestras pareadas. Resultados: El valor de los leucocitos y neutrófilos disminuye durante el período de observación, independientemente del estado final de la patología. Conclusión: El uso del recuento de leucocitos y neutrófilos de control en pacientes con sospecha de apendicitis aguda y que se observan, no parece ser útil para discriminar el estado final del enfermo.

[Evaluation of diagnostic scales for appendicitis in patients with lower abdominal pain]. / Evaluación de escalas diagnósticas en pacientes con dolor abdominal sugestivo de apendicitis.

INTRODUCTION: Diagnosis of apendicitis is difficult; however several clinical scales have been developed that attempt to improve diagnostic accuracy. OBJECTIVE: The operational characteristics of Alvarado and Fenyö scales were defined in patients with abdominal pain suggestive of appendicitis and were compare with clinical and pathological diagnoses. MATERIAL AND METHODS: A prospective trial assessed the diagnostic tests. Sign, symptoms, and laboratory tests were included in scales selected. Surgeon decision was maintained independent from the results of the scales. Sensitivity, specificity, positive and negative predictive value and positive and negative likelihood ratio for each scale was compared with the surgeon evaluation. RESULTS: The sample included 374 patients with approximately equal sexes. Of these 269 patients underwent surgery. Howeve, 16.9% of the male and 31.4% of female patients did not have appendicitis. For men, a diagnosis made by the surgeon had better sensitivity than scales (86.2% vs. 73% for Alvarado and 67.2% for Fenyö) without significant differences in specificity. For women, surgeon and Alvarado scale diagnoses were similar, and better than Fenyö scale (77.1% vs. 79.5% for Alvarado and 47% for Fenyö), but specificity was higher for Fenyö scale (92.9% vs. 71.4% for Alvarado and 75.9% for surgeon). Accuracy in diagnosis of appendicitis increases with a higher Alvarado score. CONCLUSION: For men with abdominal pain on right lower quadrant, surgeon diagnosis is more accurate than scales. For women, Fenyö scale offers a better sensitivity. Alvarado score can facilitate decision-making in patients with these abdominal symptoms.

Ventajas y desventajas de la historia clínica electrónica / Advantages and disadvantages of the electronic clínical record

La historia clínica es una herramienta infaltable en la práctica clínica de los profesionales de la salud. Es un documento que debe contener la narración escrita, clara, precisa, detallada y ordenada de todos los datos y conocimientos, tanto personales como familiares, que se refieren a un paciente y que sirven de base para el juicio definitivo de su enfermedad actual o de su estado de salud. La historia clínica electrónica pretende mejorar la atención en salud, introduciendo la tecnología a la ciencia médica, permitiendo detectar posibles deficiencias y proponer estrategias que favorezcan la optimización del servicio. El objetivo principal es realizar una revisión narrativa de la literatura actual, tanto nacional como internacional, sobre la implementación, evolución, ventajas y desventajas de la Historia Clínica Electrónica. Se realizó una revisión sistemática utilizando como herramienta principal la red Internet, además de otras fuentes bibliográficas escritas y la asesoría de expertos en el tema. Los avances tecnológicos que se ven en todos los campos y la necesidad del manejo de la información han llevado al desarrollo de la Historia Clínica Electrónica como un método de seguimiento clínico y administrativo. En este trabajo se revisan los aspectos positivos y negativos de la Historia Clínica Electrónica, así como las estrategias para reforzar los primeros y resolver los segundos