How binomial (traditional rainfed olive grove-Crocus sativus) crops impact the soil bacterial community and enhance microbial capacities.

Intercropping can favour the yield of the main crop. However, because of the potential competition among woody crops, this system is rarely used by farmers. To increase knowledge about the intercropping system, we have explored three different combinations of alley cropping in rainfed olive groves compared to conventional management (CP): (i) Crocus sativus (D-S); (ii) Vicia sativa/Avena sativa in annual rotation (D-O); and (iii) Lavandula x intermedia (D-L). Different soil chemical properties were analyzed to evaluate the effects of alley cropping, while 16S rRNA amplification and enzymatic activities were determined to study the changes that occurred in soil microbial communities and activity. In addition, the influence of intercropping on the potential functionality of the soil microbial community was measured. Data revealed that the intercropping systems highly affected the microbial community and soil properties. The D-S cropping system increased soil total organic carbon and total nitrogen that were correlated with the bacterial community, indicating that both parameters were the main drivers shaping the structure of the bacterial community. The D-S soil cropping system had significantly higher relative abundances of the phyla Bacteroidetes, Proteobacteria, and Patescibacteria compared to the other systems and the genera Adhaeribacter, Arthrobacter, Rubellimicrobium, and Ramlibacter, related to C and N functions. D-S soil was also related to the highest relative abundances of Pseudoarthrobacter and Haliangium, associated with the plant growth-promoting effect, antifungal activity, and a potential P solubilizer. A potentially increase of C fixation and N fixation in soils was also observed in the D-S cropping system. These positive changes were related to the cessation of tillage and the development of a spontaneous cover crop, which increased soil protection. Thus, management practices that contribute to increasing soil cover should be encouraged to improve soil functionality.

Medium-term evaluation of the 4‰ initiative, soil organic carbon storage and stabilisation in a Mediterranean rainfed olive grove under conventional tillage: A case study.

This study aims to show the effect of conventional tillage (CT) in olive orchards in the medium term (15 years) on carbon (C) storage considering the complete soil profile, on the soil C sequestration and stabilisation capacity and on the viability for the achievement of Objective 4‰. The results obtained showed important losses in soil organic carbon (SOC) and SOC stock (SOC-S), with a significant loss of total SOC-S of 42.3%. Concerning the SOC and the SOC-S linked to the fine soil fraction (<20 µm), the evolution over time led however to a SOC increase in depth (BC and C horizons) of 58.3% and 20.9% and increases in SOC-S of 17.2%, 34.7% and 27.3% for the Ap, BC and C horizons, respectively. Finally, it was seen that the goals set by the 4‰ initiative were not met, as losses of 2.1 Mg C ha-1 yr-1 were found when considering the entire soil profile and 0.8 Mg C ha-1 yr-1 when considering only the first 40 cm. Therefore, we can affirm that medium-term CT has not only conditioned C storage in the soils studied, but also their capacity for sequestration and stabilisation, which has repercussions not only on the failure to meet the objectives of the 4‰ initiative, but also on the amount of C lost in 15 years.

Características clínico-ecográficas pre y postquirúrgicas de niños intervenidos por criptorquidia en el Hospital Sabogal, Perú

Objetivo: Determinar las características clínicoecográficas pre y postquirùrgicas de niños intervenidos por criptorquidia. Material y métodos: Estudio descriptivo y longitudinal, los datos recolectados de historias clínicas del Hospital Sabogal, las variables fueron edad del diagnóstico, tiempo de espera de orquidopexia, testículo afectado, ubicación del testículo y volumen testicular. Resultados: Se incluyeron 34 niños menores de 14 años con criptorquidia, la edad del diagnóstico fue 44 meses y de la orquidopexia 49 meses. El tiempo de espera para la orquidopexia fue 4,72 meses, el testículo más afectado fue el derecho (58,82%). Se incluyeron 39 testículos, la ubicación primaria canalicular (71,79 %), la ubicación final escrotal (50,0%), la técnica operatoria fue inguinal (91,18%). El incremento de volumen testicular fue de 0,39 cm3, p = 0,0006, IC 95% (-0,62, -0,17). Conclusiones: La edad de la orquidopexia fue 49 meses y el volumen testicular aumentó en 0,39 cm3 después de la orquidopexia.

Objective: To determine the preand post-surgical clinical-ultrasound characteristics of children operated on for cryptorchidism. Material and methods: Descriptive and longitudinal study, data collected from medical records of the Hospital Sabogal, the variables were age at diagnosis, waiting time for orchidopexy, affected testicle, location of the testicle and testicular volume. Results: We included 34 children under 14 years with cryptorchidism, the age of diagnosis was 44 months and orchidopexy 49 months. The waiting time for orchidopexy was 4.72 months, the most affected testicle was the right (58.82%). 39 testicles were included, the primary canalith location (71.79 %), the final scrotal location (50.0%), the operative technique was inguinal (91.18%). The increase in testicular volume was 0.39 cm3, p = 0.0006, 95% CI (-0.62, -0.17). Conclusions: The age of orchidopexy was 49 months and testicular volume increased by 0.39 cm3 after orchidopexy.

Long-term evaluation of the initiative 4‰ under different soil managements in Mediterranean olive groves.

The 4‰ initiative implementation has increased the emphasis and interest in soil carbon and nitrogen storage in the last few years. This study evaluated the dynamics of soil organic carbon and total nitrogen under rain-fed olive groves over a long-term period (2004-2019). The management practices associated with achieving the 4‰ initiative objectives and the depth of analysis to measure the effectiveness of the initiative have generated uncertainties and wide debate in the scientific community. To contribute to this debate from a farm level, the objective of this study was to analyse the effects of conventional tillage and no-tillage with bare soil by using herbicides (after land management change from conventional tillage) on carbon and nitrogen stocks in complete soil profiles (depth > 100 cm) over 15 years in a Mediterranean olive grove. Soil samples were collected from each farm and analysed for carbon content and physical-chemical characteristics. This study indicates that management practices evaluated resulted in soil organic carbon and total nitrogen contents decreasing in soil, with a reduction >30% in all horizons. Results highlight a significant depletion of soil organic carbon stock with a significant decarbonisation process (-1.8 Mg C ha-1 yr-1) and total nitrogen stock (-0.57 and - 0.41 Mg N ha-1 yr-1) on average under both managements (no-tillage no tillage with herbicide and conventional tillage respectively) as compared to the initial situation. Furthermore, it was demonstrated that deep horizons are significant reservoirs of carbon (>50% in all cases) and in woody crops, its analysis within the dynamics of soil organic carbon stocks proposed by the 4‰ initiative was relevant. With these results, no-tillage with bare soil by using herbicides was demonstrated as an unsustainable agricultural practice and it is proposed to change the current soil management to sustainable management that increases the C inputs to achieve the 4‰ targets.

Short-term effects of land management change linked to cover crop on soil organic carbon in Mediterranean olive grove hillsides.

The spatial distribution of soil organic carbon (SOC) is essential to estimate the SOC reserves. Therefore, the soils ability to store organic carbon is a key factor for climate regulation and for other soil functions. The soil management and the topographic position play an important role in SOC variation, especially when the landscape is not uniform (Mediterranean areas). Many researches have explored the SOC distribution according to topographic position in hillsides for long-term, but very few studies have focused on the short term. Therefore, it is necessary to know, the changes that taking place in the soil due to land management change (LMC) in these irregular surfaces for sustainable agricultural production and its implications on climate change regulation. This study aims to assess the influence of topographic position and LMC on SOC stock (SOC-S) in Mediterranean olive groves (OG) soils in short term (2 years). In this line, three experimental plots were selected in three topographical position (summit - S, backslope - B and toeslope - T). In these plots, the land management was modified from conventional tillage (CT) to no tillage (NT) with application of pruned olive branch chippings branches and vegetation cover (spontaneous vegetation) in the OG streets. The studied soils did not show important changes due to LMC in their physical properties for short term, in addition, these soils were characterized by low organic matter content (<1.2%). LMC caused a SOC reduction in surface, and a SOC increase in the Bw horizon. The N concentrations showed a similar trend to SOC and the C:N ratios were highly variable (4.37: C horizon-NT-S; 13.45 Bw/C horizon -CT-B). Normally, the SOC-S concentrations decreasing in depth. LMC for two years showed soil carbonization (S and T position) and decarbonization (B position) processes. The SOC-S increased 1.88 Mg ha-1 y-1 and 0.47 Mg ha-1 y-1 for S and T topographic position respectively, however the SOC-S decreased in B position 5.27 Mg ha-1 y-1. Therefore, LMC has a positive effect on soil carbon reserves in S and T position, conversely in B position, this effect was negative.

Pluripotency of Wolbachia against Arboviruses: the case of yellow fever.

Background: Yellow fever outbreaks have re-emerged in Brazil during 2016-18, with mortality rates up to 30%. Although urban transmission has not been reported since 1942, the risk of re-urbanization of yellow fever is significant, as Aedes aegypti is present in most tropical and sub-tropical cities in the World and still remains the main vector of urban YFV. Although the YFV vaccine is safe and effective, it does not always reach populations at greatest risk of infection and there is an acknowledged global shortage of vaccine supply. The introgression of Wolbachia bacteria into Ae. aegypti mosquito populations is being trialed in several countries ( www.worldmosquito.org) as a biocontrol method against dengue, Zika and chikungunya. Here, we studied the ability of Wolbachia to reduce the transmission potential of Ae. aegypti mosquitoes for Yellow fever virus (YFV). Methods: Two recently isolated YFV (primate and human) were used to challenge field-derived wild-type and Wolbachia-infected ( wMel +) Ae. aegypti mosquitoes. The YFV infection status was followed for 7, 14 and 21 days post-oral feeding (dpf). The YFV transmission potential of mosquitoes was evaluated via nano-injection of saliva into uninfected mosquitoes or by inoculation in mice. Results: We found that Wolbachia was able to significantly reduce the prevalence of mosquitoes with YFV infected heads and thoraces for both viral isolates. Furthermore, analyses of mosquito saliva, through indirect injection into naïve mosquitoes or via interferon-deficient mouse model, indicated Wolbachia was associated with profound reduction in the YFV transmission potential of mosquitoes (14dpf). Conclusions: Our results suggest that Wolbachia introgression could be used as a complementary strategy for prevention of urban yellow fever transmission, along with the human vaccination program.

A Conceptual Model for the Evaluation of Surgical Missions.

BACKGROUND: Medical missions to low and middle-income countries are increasingly frequent, with an estimated 6,000 trips sponsored by U.S. organizations accounting for approximately 200,000 surgical cases and $250 million in costs annually. However, these missions have received little critical evaluation. This paper describes the research program Operation Walk (Op-Walk) Boston, and proposes an evaluation model for similar surgical missions. METHODS: We propose an evaluation model, borrowing from the work of Donabedian and enriched by evidence from our research program. The model calls for evaluation of the salient contextual factors (culture and beliefs), system management (structure, process, and outcomes), and sustainability of the program's interventions. We used these domains to present findings from the quantitative and qualitative research work of Op-Walk Boston. RESULTS: Op-Walk's qualitative research findings demonstrated that cultural factors are important determinants of patients' perceptions of arthritis etiology, physical activity patterns, and treatment preferences. Quantitative assessments documented that Dominican patients had worse lower-extremity functional status (mean Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] function score of 33.6) and pain preoperatively than patients undergoing total hip or knee replacement in the U.S. (WOMAC function score of 43.3 to 54), yet they achieved excellent outcomes (50-point improvement), comparable to those of their U.S. counterparts. Assessments of the quality and sustainability of the Op-Walk program showed that the quality of care provided by Op-Walk Boston meets Blue Cross Blue Shield Centers of Excellence (Blue Distinction) criteria, and that sustainable changes were transferred to the host hospital. CONCLUSIONS: Our proposed model offers a method for formal assessment of medical missions that addresses the call for evidence of their merit. We suggest that surgical missions adopt quantitative and qualitative strategies to document their impact, identify areas of improvement, and justify program continuation, growth, and support.

Soil organic carbon distribution in Mediterranean areas under a climate change scenario via multiple linear regression analysis.

Over time, the interest on soil studies has increased due to its role in carbon sequestration in terrestrial ecosystems, which could contribute to decreasing atmospheric CO2 rates. In many studies, independent variables were related to soil organic carbon (SOC) alone, however, the contribution degree of each variable with the experimentally determined SOC content were not considered. In this study, samples from 612 soil profiles were obtained in a natural protected (Red Natura 2000) of Sierra Morena (Mediterranean area, South Spain), considering only the topsoil 0-25cm, for better comparison between results. 24 independent variables were used to define it relationship with SOC content. Subsequently, using a multiple linear regression analysis, the effects of these variables on the SOC correlation was considered. Finally, the best parameters determined with the regression analysis were used in a climatic change scenario. The model indicated that SOC in a future scenario of climate change depends on average temperature of coldest quarter (41.9%), average temperature of warmest quarter (34.5%), annual precipitation (22.2%) and annual average temperature (1.3%). When the current and future situations were compared, the SOC content in the study area was reduced a 35.4%, and a trend towards migration to higher latitude and altitude was observed.

Predictors of Patient-Reported Outcomes of Total Joint Arthroplasty in a Developing Country.

BACKGROUND: In response to the growing burden of joint disease, developing countries are starting to create their own total joint arthroplasty (TJA) programs. To date, there has been limited research on predictors of TJA outcomes in a developing country. This investigation uses patient-reported outcome measures collected by a medical mission to assess predictors of TJA outcomes in the Dominican Republic. METHODS: Baseline and postoperative information from 156 of the mission's recipients of hip and knee TJA was used. Demographics were abstracted from clinical notes, and self-reported pain and functional status were assessed using Western Ontario and McMaster University Osteoarthritis Index and Short-Form 36 measures. Bivariate analysis identified variables to include in multivariable regression models of factors associated with function and pain outcomes and improvement in these domains 1 or 2 years postoperatively. RESULTS: The cohort had a mean age of 61.3 years, 82% were female, 79% had total knee arthroplasty, and 42% of the procedures were bilateral. In multivariate analyses, at P < .05, male sex, better preoperative function, and use of bilateral procedure were associated with better functional outcome. Male sex and worse preoperative pain were associated with better pain outcome. Worse preoperative pain and function, as well as bilateral surgery were associated with greater improvement in function. Additionally, a greater number of bothersome joints was associated with greater pain reduction. CONCLUSION: Our findings of better follow-up pain scores among patients with worse pain preoperatively and better functional improvement among those undergoing bilateral replacements contrast with study results from developed countries. The explanations for these observations merit further study.

Climate and land use changes effects on soil organic carbon stocks in a Mediterranean semi-natural area.

A thorough knowledge of the effects of climate and land use changes on the soil carbon pool is critical to planning effective strategies for adaptation and mitigation in future scenarios of global climate and land use change. In this study, we used CarboSOIL model to predict changes in soil organic carbon stocks in a semi-natural area of Southern Spain in three different time horizons (2040, 2070, 2100), considering two general circulation models (BCM2 and ECHAM5) and three IPCC scenarios (A1b, A2, B2). The effects of potential land use changes from natural vegetation (Mediterranean evergreen oak woodland) to agricultural land (olive grove and cereal) on soil organic carbon stocks were also evaluated. Predicted values of SOC contents correlated well those measured (R2 ranging from 0.71 at 0-25cm to 0.97 at 50-75cm) showing the efficiency of the model. Results showed substantial differences among time horizons, climate and land use scenarios and soil depth with larger decreases of soil organic carbon stocks in the long term (2100 time horizon) and particularly in olive groves. The combination of climate and land use scenarios (in particular conversion from current 'dehesa' to olive groves) resulted in yet higher losses of soil organic carbon stocks, e.g. -30, -15 and -33% in the 0-25, 25-50 and 50-75cm sections respectively. This study shows the importance of soil organic carbon stocks assessment under both climate and land use scenarios at different soil sections and point towards possible directions for appropriate land use management in Mediterranean semi natural areas.

Long-term effects of soil management on ecosystem services and soil loss estimation in olive grove top soils.

Soil management has important effects on soil properties, runoff, soil losses and soil quality. Traditional olive grove (OG) management is based on reduced tree density, canopy size shaped by pruning and weed control by ploughing. In addition, over the last several decades, herbicide use has been introduced into conventional OG management. These management strategies cause the soil surface to be almost bare and subsequently high erosion rates take place. To avoid these high erosion rates several soil management strategies can be applied. In this study, three strategies were assessed in OG with conventional tillage in three plots of 1ha each. Soil properties were measured and soil erosion rates were estimated by means of the RUSLE model. One plot was managed with no amendments (control), and the other two were treated with olive leaves mulch and oil mill pomace applied yearly from 2003 until 2013. The control plot experienced the greatest soil loss while the use of olive leaves as mulch and olive mill pomace as an amendment resulted in a soil loss reduction of 89.4% and 65.4% respectively (assuming a 5% slope). In addition, the chemical and physical soil properties were improved with the amendments. This combined effect will created a higher quality soil over the long term that it is more resilient to erosion and can provide better ecosystem services, as its functions are improved.

Effects of soil management techniques on soil water erosion in apricot orchards.

Soil erosion is extreme in Mediterranean orchards due to management impact, high rainfall intensities, steep slopes and erodible parent material. Vall d'Albaida is a traditional fruit production area which, due to the Mediterranean climate and marly soils, produces sweet fruits. However, these highly productive soils are left bare under the prevailing land management and marly soils are vulnerable to soil water erosion when left bare. In this paper we study the impact of different agricultural land management strategies on soil properties (bulk density, soil organic matter, soil moisture), soil water erosion and runoff, by means of simulated rainfall experiments and soil analyses. Three representative land managements (tillage/herbicide/covered with vegetation) were selected, where 20 paired plots (60 plots) were established to determine soil losses and runoff. The simulated rainfall was carried out at 55mmh(-1) in the summer of 2013 (<8% soil moisture) for one hour on 0.25m(2) circular plots. The results showed that vegetation cover, soil moisture and organic matter were significantly higher in covered plots than in tilled and herbicide treated plots. However, runoff coefficient, total runoff, sediment yield and soil erosion were significantly higher in herbicide treated plots compared to the others. Runoff sediment concentration was significantly higher in tilled plots. The lowest values were identified in covered plots. Overall, tillage, but especially herbicide treatment, decreased vegetation cover, soil moisture, soil organic matter, and increased bulk density, runoff coefficient, total runoff, sediment yield and soil erosion. Soil erosion was extremely high in herbicide plots with 0.91Mgha(-1)h(-1) of soil lost; in the tilled fields erosion rates were lower with 0.51Mgha(-1)h(-1). Covered soil showed an erosion rate of 0.02Mgha(-1)h(-1). These results showed that agricultural management influenced water and sediment dynamics and that tillage and herbicide treatment should be avoided.

Impact of topographic aspect and vegetation (native and reforested areas) on soil organic carbon and nitrogen budgets in Mediterranean natural areas.

Soil organic carbon (SOC) plays a critical role in the global carbon (C) cycle, and C sequestration in forest soils can represent a C sink. A relevant question is how does SOC changes in space and time; consequently, the study of the influence of topographic aspect on SOC stocks (SOCS) is very important to build a complete understanding of the soil system. In this line, four topographic aspects, north (N), south (S), east (E) and west (W) were studied under two different plant communities; native forests (NF) and reforested areas (RF) in the Despeñaperros Natural Park (S Spain). Five soil profiles were sampled at each of six different sites, 2 sites for NF (N and E) and 4 sites for RF (N, S, E and W). Soil properties were studied at different depths using soil control sections (S1: 0-25 cm; S2: 25-50 cm; S3: 50-75 cm). The results indicate that RF (N: 147.1 Mg ha(-1); E: 137.3 Mg ha(-1); W: 124.9 Mg ha(-1) and S: 87.0 Mg ha(-1)) had increased total SOCS compared to NF (N: 110.4 Mg ha(-1) and E: 80.9 Mg ha(-1)), and that SOCS in the N position were higher than in the other topographic aspects. Therefore, the results suggest that topographic aspect should be included in SOCS models and estimations at local and regional scales.

Participation in physical activity in patients 1-4 years post total joint replacement in the Dominican Republic.

BACKGROUND: To address both the growing burden of joint disease and the gaps in medical access in developing nations, medical relief organizations have begun to launch programs to perform total joint replacement (TJR) on resident populations in developing countries. One outcome of TJR of particular interest is physical activity (PA) since it is strongly linked to general health. This study evaluates the amount of postoperative participation in PA in low-income patients who received total joint replacement in the Dominican Republic and identifies preoperative predictors of postoperative PA level. METHODS: We used the Yale Physical Activity Survey (YPAS) to assess participation in postoperative PA 1-4 years following total knee or hip replacement. We compared the amount of aerobic PA reported by postoperative TJR patients with the levels of PA recommended by the CDC and WHO. We also analyzed preoperative determinants of postoperative participation in aerobic PA in bivariate and multivariate analyses. RESULTS: 64 patients out of 170 eligible subjects (52/128 TKR and 14/42 THR) who received TJR between 2009-2012 returned for an annual follow-up visit in 2013, with a mean treatment-to-follow-up time of 2.1 years. 43.3% of respondents met CDC/WHO criteria for sufficient participation in aerobic PA. Multivariate analyses including data from 56 individuals identified that patients who were both younger than 65 and at least two years postoperative had an adjusted mean activity dimensions summary index (ADSI) 22.9 points higher than patients who were 65 or older and one year postoperative. Patients who lived with friends or family had adjusted mean ADSI 17.2 points higher than patients living alone. Patients who had the most optimistic preoperative expectations of outcome had adjusted mean ADSI scores that were 19.8 points higher than those who were less optimistic. CONCLUSION: The TJR patients in the Dominican cohort participate in less PA than recommended by the CDC/WHO. Additionally, several associations were identified that potentially affect PA in this population; specifically, participants who are older than 65, recently postoperative, less optimistic about postoperative outcomes and who live alone participate in less PA.

[Clinical integration in the chronic patient]. / Integración clínica en el paciente crónico.

Castilla-La Mancha Health Service is developing the integration of care levels due to the challenge of an aging population in the region. Aging is associated with chronic diseases and an increasing number of concomitant diseases. This poses a major care challenge care, with more fragile patients and new needs. This also requires a sustainable approach: the concurrence of several chronic diseases affects the cost of care, which is especially acute in times of severe economic crisis. One of the pillars of the strategy for dealing with chronic diseases in our region is care integration, in an effort to adapt the organization to the new needs. The Balanced Scorecard or Integrated Scorecard of the integration process was introduced as it has been designed. The integration of primary and hospital care at an organizational level has already been completed, and the development of integrated care processes has also been performed in order to achieve real integration at care level. To help finance this, a prospective capitation system is gradually being implemented, achieving a convergence of per capita costs in the different health areas integrated. Nurses has a key role in this process, their skills as educators and trainers in self-care, in the role of case managers of patients with particularly complex conditions, and the role of professional liaison to improve the transition between care areas and units.

Enhancing the quality of international orthopedic medical mission trips using the blue distinction criteria for knee and hip replacement centers.

BACKGROUND: Several organizations seek to address the growing burden of arthritis in developing countries by providing total joint replacements (TJR) to patients with advanced arthritis who otherwise would not have access to these procedures. Because these mission trips operate in resource poor environments, some of the features typically associated with high quality care may be difficult to implement. In the U.S., many hospitals that perform TJRs use the Blue Cross/Shield's Blue Distinction criteria as benchmarks of high quality care. Although these criteria were designed for use in the U.S., we applied them to Operation Walk (Op-Walk) Boston's medical mission trip to the Dominican Republic. Evaluating the program using these criteria illustrated that the program provides high quality care and, more importantly, helped the program to find areas of improvement. METHODS: We used the Blue Distinction criteria to determine if Op-Walk Boston achieves Blue Distinction. Each criterion was grouped according to the four categories included in the Blue Distinction criteria--"general and administrative", "structure", "process", or "outcomes and volume". Full points were given for criteria that the program replicates entirely and zero points were given for criteria that are not replicated entirely. Of the non-replicated criteria, Op-Walk Boston's clinical and administrative teams were asked if they compensate for failure to meet the criterion, and they were also asked to identify barriers that prevent them from meeting the criterion. RESULTS: Out of 100 possible points, the program received 71, exceeding the 60-point threshold needed to qualify as a Blue Distinction center. The program met five out of eight "required" criteria and 11 out of 19 "informational" criteria. It scored 14/27 in the "general" category, 30/36 in the "structure" category, 17/20 in the "process" category, and 10/17 in the "outcomes and volume" category. CONCLUSION: Op-Walk Boston qualified for Blue Distinction. Our analysis highlights areas of programmatic improvement and identifies targets for future quality improvement initiatives. Additionally, we note that many criteria can only be met by hospitals operating in the U.S. Future work should therefore focus on creating criteria that are applicable to TJR mission trips in the context of developing countries.

Associations between preoperative functional status and functional outcomes of total joint replacement in the Dominican Republic.

OBJECTIVE: In developed countries, the functional status scores of patients with poor preoperative scores undergoing total joint replacement (TJR) improve more following TJR than those for patients with better preoperative scores. However, those with better preoperative scores achieve the best postoperative functional outcomes. We determined whether similar associations exist in a developing country. METHODS: Dominican patients undergoing total hip or knee replacement completed WOMAC and SF-36 surveys preoperatively and at 12-month follow-up. Patients were stratified into low-, medium- and high-scoring preoperative groups based on their preoperative WOMAC function scores. We examined the associations between the baseline functional status of these groups and two outcomes-improvement in functional status over 12 months and functional status at 12 months-using analysis of variance with multivariable linear regression. RESULTS: Patients who scored the lowest preoperatively made the greatest gains in function and pain relief following their TJRs. However, there were no significant differences in pain or function at 12-month follow-up between patients who scored low and those who scored high on preoperative WOMAC and SF-36 surveys. CONCLUSION: Patients with poor preoperative functional status had greater improvement but similar 12-month functional outcomes compared with patients who had a higher level of function before surgery. These results suggest that a policy of focusing scarce resources on patients with worse functional status in developing countries may optimize improvement following TJR without threatening functional outcome. Additional research is needed to confirm these findings in other developing countries and to understand why these associations vary between patients in the Dominican Republic and patients from developed countries.

Coletiasis en niños y adolescentes en el Instituto de Salud del Niño / Cholelithiasis in children and adolescents in the Instituto de Salud del Niño

El propósito del estudio fue determinar el estado actual de la colelitiasis en niños y adolescentes en el Instituto de Salud del Niño. Se evaluó a 21 pacientes que ingresaron al Servicio de Cirugía General del Instituto entre 1992 y 1997. En dieciséis, se presentó en forma crónica y 5 en forma aguda. El dolor abdominal recurrente fue el síntoma que predominó en la colelitiasis, y el dolor en el cuadrante superior derecho, vómito y alza térmica en la colecistitis aguda litiásica. La ecografía abdominal fue de ayuda diagnóstica en un 100 por ciento. El tratamiento de la colelitiasis sintomática fue quirúrgico. Se concluye que la colelitiasis es más frecuente en niñas mayores de 12 años y que tengan factores asociados tales como, obesidad y gestación.