Ejecución presupuestal y disponibilidad de suministros médicos en establecimientos del nivel III de Lima Metropolitana / Budget execution of SIS financial transfers and availability of medical supplies in MINSA level III establishments in Lima

ABSTRACT Objective: Determine the relationship between the budget execution of financial transfers from the SIS (Seguro Integral de Salud) and the availability of medical supplies in third-level establishments of the Ministry of Health of Metropolitan Lima. Material and method: Analytical and cross-sectional study, carried out in the 20 level III establishments of the MINSA in Lima; Likewise, documentary information was used such as Closing Minutes of Financial Supervision of the Macroregional Management of the SIS from which information on budget execution was obtained and the availability of medical supplies was obtained from the Mundo IPRESS web portal (Institutions Providing Health Services). After evaluating normality with the Shapiro-Wilk test, the Spearman correlation test was used. Result: Overall budget execution was not related to the availability of medical supplies (rho=-0.014; p=0.955). The evaluation by components showed that budget execution on medicines was positively related to the availability of supplies (rho=0.417; p=0.045), which was also valid in the segmented analysis only for hospitals (rho: 0.594; p=0.032). Although budget execution in segmented materials and supplies for hospitals was related to the availability of supplies, this relationship was inverse (rho=-0.552; p=0.043). Conclusions: The general budget execution of financial transfers from the SIS was not related to the availability of medical supplies, but the spending component on medicines was.

ABSTRACT Objective: Determine the relationship between the budget execution of financial transfers from the SIS (Seguro Integral de Salud) and the availability of medical supplies in third-level establishments of the Ministry of Health of Metropolitan Lima. Material and method: Analytical and cross-sectional study, carried out in the 20 level III establishments of the MINSA in Lima; Likewise, documentary information was used such as Closing Minutes of Financial Supervision of the Macroregional Management of the SIS from which information on budget execution was obtained and the availability of medical supplies was obtained from the Mundo IPRESS web portal (Institutions Providing Health Services). After evaluating normality with the Shapiro-Wilk test, the Spearman correlation test was used. Result: Overall budget execution was not related to the availability of medical supplies (rho=-0.014; p=0.955). The evaluation by components showed that budget execution on medicines was positively related to the availability of supplies (rho=0.417; p=0.045), which was also valid in the segmented analysis only for hospitals (rho: 0.594; p=0.032). Although budget execution in segmented materials and supplies for hospitals was related to the availability of supplies, this relationship was inverse (rho=-0.552; p=0.043). Conclusions: The general budget execution of financial transfers from the SIS was not related to the availability of medical supplies, but the spending component on medicines was.

Chagas Disease: Medical and ECG Related Findings in an Indigenous Population in Colombia.

Chagas Disease (CD) is highly prevalent among the indigenous populations in the Sierra Nevada de Santa Marta, Colombia. Villages examined show prevalence rates ranging from 43.6% up to 67.4%. In the present study, associated medical conditions were assessed with a particular focus on ECG alterations. CD diagnosis was based on a rapid test, two different ELISAs, and a specific and highly sensitive Chagas real-time PCR. In both CD positive and CD negative patients, relations of the status and medical (physical examination-based, questionnaire-based) and/or electrocardiogram-based findings were investigated. As expected, CD-associated symptoms and complaints were predominantly found in CD-positive patients. Interestingly, ECG-findings were found to show the potential of leading to early CD diagnosis because ECG alterations were already seen in early stagechanges of the disease. In conclusion, although the observed ECG changes are unspecific, they should be considered as an indicator for a CD screening and, in case of positive results, an associated early treatment of the disease.

The Gut Microbiome of an Indigenous Agropastoralist Population in a Remote Area of Colombia with High Rates of Gastrointestinal Infections and Dysbiosis.

An Indigenous agropastoralist population called the Wiwa from the Sierra Nevada de Santa Marta, in North-East Colombia, shows high rates of gastrointestinal infections. Chronic gut inflammatory processes and dysbiosis could be a reason, suggesting an influence or predisposing potential of the gut microbiome composition. The latter was analyzed by 16S rRNA gene amplicon next generation sequencing from stool samples. Results of the Wiwa population microbiomes were associated with available epidemiological and morphometric data and compared to control samples from a local urban population. Indeed, locational-, age-, and gender-specific differences in the Firmicutes/Bacteriodetes ratio, core microbiome, and overall genera-level microbiome composition were shown. Alpha- and ß-diversity separated the urban site from the Indigenous locations. Urban microbiomes were dominated by Bacteriodetes, whereas Indigenous samples revealed a four times higher abundance of Proteobacteria. Even differences among the two Indigenous villages were noted. PICRUSt analysis identified several enriched location-specific bacterial pathways. Moreover, on a general comparative scale and with a high predictive accuracy, we found Sutterella associated with the abundance of enterohemorrhagic Escherichia coli (EHEC), Faecalibacteria associated with enteropathogenic Escherichia coli (EPEC) and helminth species Hymenolepsis nana and Enterobius vermicularis. Parabacteroides, Prevotella, and Butyrivibrio are enriched in cases of salmonellosis, EPEC, and helminth infections. Presence of Dialister was associated with gastrointestinal symptoms, whereas Clostridia were exclusively found in children under the age of 5 years. Odoribacter and Parabacteroides were exclusively identified in the microbiomes of the urban population of Valledupar. In summary, dysbiotic alterations in the gut microbiome in the Indigenous population with frequent episodes of self-reported gastrointestinal infections were confirmed with epidemiological and pathogen-specific associations. Our data provide strong hints of microbiome alterations associated with the clinical conditions of the Indigenous population.

Bioprocessing of Two Crop Residues for Animal Feeding into a High-Yield Lovastatin Feed Supplement.

This work aimed to evaluate the lovastatin (Lv) production by solid-state fermentation (SSF) from selected crop residues, considering the post-fermented residues as feed supplements for ruminants. The SSF was performed with two substrates (wheat bran and oat straw) and two A. terreus strains (CDBB H-194 and CDBB H-1976). The Lv yield, proximate analysis, and organic compounds by GC-MS in the post-fermented residues were assessed. The combination of the CDBB H-194 strain with oat straw at 16 d of incubation time showed the highest Lv yield (23.8 mg/g DM fed) and the corresponding degradation efficiency of hemicellulose + cellulose was low to moderate (24.1%). The other three treatments showed final Lv concentrations in decreasing order of 9.1, 6.8, and 5.67 mg/g DM fed for the oat straw + CDBB H-1976, wheat bran + CDBB H-194, and wheat bran + CDBB H-1976, respectively. An analysis of variance of the 22 factorial experiment of Lv showed a strong significant interaction between the strain and substrate factors. The kinetic of Lv production adequately fitted a zero-order model in the four treatments. GC-MS analysis identified only a couple of compounds from the residues fermented by A. terreus CDBB H-194 (1,3-dipalmitin trimethylsilyl ether in the fermented oat straw and stearic acid hydrazide in the fermented wheat bran) that could negatively affect ruminal bacteria and fungi. Solid-state fermentation of oat straw with CDBB H-194 deserves further investigation due to its high yield of Lv; low dietary proportions of this post-fermented oat straw could be used as an Lv-carrier supplement for rumen methane mitigation.

Diagnosis and Prevalence of Chagas Disease in an Indigenous Population of Colombia.

Chagas disease (CD) is one of the leading neglected tropical diseases. In the Americas, CD is endemic in about 21 countries, but only less than 1% of the patients have access to medical treatment. Indigenous populations are particularly affected because they live in socio-economic and climate conditions that favor CD infections. In this study, diagnostic strategies and regional prevalence of the Chagas disease were assessed. In nine villages of the indigenous tribe Wiwa, 1134 persons were tested with a Chagas-antibody-specific rapid test (RT), two different Chagas-antibody-specific ELISAs and a Chagas-specific real-time polymerase chain reaction. The overall prevalence of CD in the villages was 35.4%, with a variation from 24.9% to 52.8% for the different communities. Rapid tests and ELISAs showed the same results in all cases. The proportion of replication-active infections, defined by positive PCR results, was 8.7%. In conclusion, the assessed indigenous population in Colombia was shown to be severely affected by CD. For a serological diagnosis, one rapid test was shown to be sufficient. Replacements of ELISAs by RT would decrease costs, increase feasibility and would relevantly help detect positive patients, especially if combined with the applied real-time PCR protocol. Real-time PCR can be considered for the detection of acute cases, outbreaks, chronic cases with re-infection/activation, as well as for therapy management and control.

Prevalence of Common Diseases in Indigenous People in Colombia.

The Indigenous tribe called the Wiwa lives retracted in the Sierra Nevada de Santa Marta, Colombia. Little is known about their health status and whether the health care system in place covers their needs. In 2017 and 2018, a permanent physician was in charge for the Wiwa. Diseases and complaints were registered, ranked, and classified with the ICD-10 coding. Datasets from the Indigenous health care provider Dusakawi, collected from local health points and health brigades travelling sporadically into the fields for short visits, were compared. Furthermore, a list of provided medication was evaluated regarding the recorded needs. The most common complaints found were respiratory, infectious and parasitic, and digestive diseases. The top ten diagnoses collected in the health points and in the health brigade datasets were similar, although with a different ranking. The available medication showed a basic coverage only, with a critical lack of treatment for many severe, chronic, and life-threatening diseases. Most of the detected diseases in the Indigenous population are avoidable by an improvement in health care access, an expansion of the provided medication, and an increase in knowledge, hygiene, and life standards.

Anesthetic complications in children with mucopolysaccharidosis / Complicaciones anestésicas en niños con mucopolisacaridosis

Abstract: Introduction: A high percentage of mucopolysaccharidosis patients require surgery at some point. Common features like respiratory limitations and cardiovascular disease pose a high anesthetic risk. We describe the prevalence of anesthetic complications in our institution. Material and methods: Patients' medical history and reported surgery data from 18 eligible records were reviewed from a total of 29 mucopolysaccharidosis diagnosed children registered between the years 1999 to 2019 at a hospital in Mexico. Results: Median age was 11 years. 12 patients were type I, two type II, three type IV, and one type VI. Intravenous premedication was administered in 69.5% and induction was intravenous in 91.3% of the surgical procedures. Orotracheal intubation was the first attempted anesthetic method in 47.8% and a laryngeal mask in another 47.8%. Bronchospasm was the most frequent complication in 17.4% followed by difficult intubation in 13.1%. Conclusions: Bronchospasm was the most prevalent complication. A higher Cormack-Lehane grade was primarily related. The most prevalent concomitant risk factors were short neck and restrictive chest rendering airway management difficult in comparison to the general population.

Resumen: Introducción: Un alto porcentaje de pacientes con mucopolisacaridosis requieren cirugía en algún momento. Algunas características comunes como alteraciones respiratorias y enfermedades cardiovasculares constituyen un alto riesgo anestésico. Describimos la prevalencia de las complicaciones anestésicas en nuestra institución. Material y métodos: Fueron revisados los antecedentes y los datos quirúrgicos de 18 pacientes elegibles, extraídos de un total de 29 expedientes de niños con mucopolisacaridosis registrados entre los años 1999 y 2019 en un hospital de México. Resultados: La mediana de edad fue de 11 años. Doce pacientes fueron de tipo I, dos tipo II, tres tipo IV y uno tipo VI. La premedicación intravenosa se administró en 69.5% y la inducción fue intravenosa en 91.3% de los procedimientos quirúrgicos. El primer método anestésico intentado fue la intubación orotraqueal en 47.8% y la máscara laríngea en 47.8%. El broncoespasmo fue la complicación más frecuente en 17.4%, seguida de una intubación difícil en 13.1%. Conclusiones: El broncoespasmo fue la complicación más observada relacionada, primordialmente, con un grado Cormack-Lehane más alto. Los factores de riesgo concomitantes más frecuentes fueron el cuello corto y las restricciones torácicas, lo que dificulta en mayor grado el manejo de las vías respiratorias en comparación con la población general.

High Prevalence of Intestinal Pathogens in Indigenous in Colombia.

BACKGROUND: Intestinal infections remain a major public health burden in developing countries. Due to social, ecological, environmental, and cultural conditions, Indigenous peoples in Colombia are at particularly high risk. MATERIALS: 137 stool samples were analyzed by microscopy and real-time-Polymerase Chain Reaction (RT-PCR), targeting protozoan parasites (Giardia intestinalis, Entamoeba histolytica, Cryptosporidium spp., and Cyclospora cayetanensis), bacteria (Campylobacter jejuni, Salmonella spp., Shigella ssp./enteroinvasive E. coli (EIEC), Yersinia spp., enterohemorrhagic E. coli (EHEC), enteropathogenic E. coli ( EPEC), enterotoxin-producing E. coli (ETEC), enteroaggregative E. coli (EAEC), and Tropheryma whipplei), and helminths (Necator americanus, Strongyloides stercoralis, Ascaris lumbricoides, Ancylostoma spp., Trichuris. trichiura, Taenia spp., Hymenolepis nana, Enterobius vermicularis, and Schistosoma spp.). Microscopy found additional cases of helminth infections. RESULTS: At least one pathogen was detected in 93% of the samples. The overall results revealed protozoa in 79%, helminths in 69%, and bacteria in 41%. G. intestinalis (48%), Necator/hookworm (27%), and EAEC (68%) were the most common in each group. Noteworthy, T. whipplei was positive in 7% and T. trichirua in 23% of the samples. A significant association of one infection promoting the other was determined for G. intestinalis and C. jejuni, helminth infections, and EIEC. CONCLUSIONS: The results illustrate the high burden of gastrointestinal pathogens among Indigenous peoples compared to other developing countries. Countermeasures are urgently required.

Comparación de los Perfiles Farmacodinámicos de Tres Moléculas de Remifentanilo en cuanto a su Respuesta Hemodinámica a las Maniobras de Laringoscopia e Intubación Traqueal / Comparison of the pharmacodynamic profiles of three molecules of remifentanil in terms of hemodynamic response to laryngoscopy and tracheal intubation maneuvers

Introduction: Several remifentanil products are commercialized in Colombia though they have never been compared in a clinical setting. Objective: The aim of this study was to investigate the pharmacodynamic profile of the branded remifentanil molecule (group O: Glaxo SmithKline Manufacturing S.P.A.) and two unbranded molecules (group A: Laboratorios Chalver de Colombia S.A. and group B: Instituto Biológico Contemporáneo, Argentina) registered in Colombia. Methods: We carried out a double-blind, randomized, controlled trial. The branded molecule of remifentanil (group O, n = 29) was compared with the two unbranded molecules (group A, n = 29; group B, n = 32) during anesthetic induction and tracheal intubation in adult patients ASA I without predictors for difficult airway. The target controlled infusion (TCI) doses evaluated were 6, 8 and 10ng/ml with the Minto model. Induction was complemented with propofol 5 mcg/ml (TCI) with the Schneider model and rocuronium 0.6 mg/kg. The primary outcome was the difference between preintubation (TCI equilirium) and postintubation (maximum measurement within 5 min) mean arterial pressure and heart rate. Results: A similar pharmacodynamic profile was observed in all of the studied remifentanil molecules. The differences in the change in heart rate were 1.27 (95% CI -3.11;5.67) with molecule A and 1.40 (95% CI -2.65;5.46) with molecule B compared to molecule O (beats/min). The differences in the change in mean arterial pressure were 1 (95% CI -4.81;6.81) with molecule A and 1.82 (95% CI -4.08;7.74) with molecule B compared to molecule O (mmHg). There was one case of arterial hypotension in each group. Conclusion: The results suggest that, from a pharmacodynamic point of view, branded and unbranded remifentanil molecules are similar for laryngoscopy/intubation with TCI doses 6, 8 and 10ng/ml.

Introducción: En Colombia se comercializan diferentes moléculas de Remifentanil que nunca han sido comparadas en un entorno clínico. Objetivo: El objetivo de este estudio fue investigar el perfil farmacodinámico de la molécula innovadora de Remifentanil (grupo O: Glaxo SmithKline Manufacturing S.P.A.) y dos moléculas genéricas (grupo A: Laboratorios Chalver de Colombia S.A. y grupo B: Instituto Biológico Contemporáneo, Argentina) registradas en Colombia. Métodos: Se llevó a cabo un experimento clínico doble ciego, aleatorizado, controlado. Se comparó la molécula original de Remifentanil (grupo O, n = 29) frente a las dos moléculas genéricas (grupo A, n = 29; grupo B, n = 32) durante la inducción anestésica e intubación oro-traqueal de pacientes adultos ASA I sin predictores de vía aérea difícil. Se evaluaron las dosis 6, 8 y 10 ng/ml (TCI, Target Controlled Infusion) con el modelo de Minto. La inducción se complementó con Propofol 5 mcg/ml (TCI) con modelo de Schneider y Rocuronio 0.6mg/kg. El desenlace primario se evaluó como las diferencias en la presión arterial media y en la frecuencia cardiaca preintubación (momento en que se alcanza la concentración objetivo en sitio efecto) y posintubación (máximo valor alcanzado en 5 minutos). Resultados: Se observó similitud en el perfil farmacodinámico de las moléculas de Remifentanil estudiadas. Las diferencias en el cambio de frecuencia cardiaca fue de 1.27 (IC 95% -3.11;5.67) con la molécula A y 1.40 (IC 95% -2.65;5.46) con la molécula B frente a la molécula O (latidos/minuto). Las diferencias en el cambio de presión arterial media fue de 1 (CI 95% -4.81;6.81) para la molécula A y 1.82 (IC 95% -4.08;7.74) para la molécula B frente a la molécula O (mmHg). Hubo un caso de hipotensión arterial en cada grupo. Conclusión: Los resultados sugieren que desde un punto de vista farmacodinámico las moléculas innovadora y genéricas de Remifentanil son similares para la laringo-scopia/intubación con dosis TCI de 6, 8 y 10 ng/ml.

Detection of 2 immunoreactive antigens in the cell wall of Sporothrix brasiliensis and Sporothrix globosa.

The cell wall of members of the Sporothrix schenckii complex contains highly antigenic molecules which are potentially useful for the diagnosis and treatment of sporotrichosis. In this study, 2 immunoreactive antigens of 60 (Gp60) and 70 kDa (Gp70) were detected in the cell wall of the yeast morphotypes of Sporothrix brasiliensis and Sporothrix globosa.

Hiperplasia nodular focal hepática / Focal nodal hyperplasia

La hiperplasia nodal focal es el segundo tumor benigno más frecuente del hígado, y debe incluirse en el diagnóstico diferencial de las lesiones sólidas hepáticas. Se presenta el caso de una paciente adolescente con dolor abdominal crónico y hallazgo de masa abdominal al examen físico y en los estudios de imágenes. Se realizó resección quirúrgica de la masa debido a la persistencia de la sintomatología y la incertidumbre en el diagnóstico. Se realiza una revisión de la literatura sobre este tema con el objetivo de conocer las indicaciones quirúrgicas en este tipo de patología...

Focal nodal hyperplasia is the second most common benign tumor of the liver and should be included in the differential diagnosis of solid liver lesions. We present a case of an adolescent with chronic abdominal pain and abdominal mass fi nding on physical examination and imaging studies. Surgical resection of the mass was performed, due to the persistent symptoms and uncertainty in diagnosis. We make a literature review on this topic with the objective of known the surgical indications in this pathology...

Textiloma en cavidad intraabdominal: una causa de diagnóstico equívoco / Textiloma in intraabdominal cavity: a cause of wrong diagnosis

Se presenta el caso de una paciente de 71 años, con antecedente de colecistectomía hace 27 años, remitida al departamento de cirugía para evaluación de masa intraabdominal, por hallazgo imagenológico de masa calcificada sugestiva de lesión tumoral tanto por ecografía como por tomografía axial computarizada abdominal, por lo cual fue llevada a cirugía en donde se evidenció textiloma quirúrgico. El hallazgo de calcificación en la tomografía axial computarizada probablemente fue el factor de confusión causante del diagnóstico erróneo. El textiloma debe ser incluido dentro de los diagnósticos diferenciales de masas abdominales, especialmente en pacientes con antecedentes de cirugías abdominales previas, incluso ante hallazgos típicos sugestivos de características tumorales en los estudios de imágenes preoperatorias. Se exponen imágenes de los estudios prequirúrgicos del caso, de la pieza quirúrgica extraída durante el procedimiento y se realiza una revisión de la literatura.

The case of a 71 year-old patient is presented, with a history of cholecystectomy 27 years ago, who was referred to the surgery department for evaluation of an intrabdominal mass. On imaging studies there was a calcificated mass suggestive of tumoral lesion either by abdominal ecography and abdominal computed tomography, because of this she was carried to surgery where a textiloma was found. The calcification on the abdominal computed tomography probably was the factor which caused the wrong diagnosis. Textiloma should be included in the differential diagnosis of abdominal masses, especially in patients with a prior history of abdominal surgery, even with typical tumorous characteristics on preoperative imaging studies. Hereafter are exposed image of preoperative studies of the case, of the surgical piece removed during the procedure and a literature review is made.

[Deep cervical endometriosis causing profuse vaginal bleeding. Case report and literature review]. / Endometriosis cervical profunda causante de sangrado transvaginal profuso. Presentación de un caso clínico y revisión de la bibliografía.

It is reported the case of a patient with cervical endometriosis deep in the fourth decade of life, with regular menstruation, dysmenorrhea secondary progressive, disabling, dyspareunia, and chronic pelvic pain, disquesia in the last three years. Was presented in the emergency on the twentieth day of the menstrual cycle due to an abrupt and substantial transvaginal bleeding, and led to acute anemia. In gynecological exploration was observed in the posterior lip of the cervix and glandular eversion had a solitary lesion in a punch, with active bleeding from the interior of the lesion, independent of the external cervical os and the endocervical canal. The rest of the colposcopy was normal. Total hysterectomy was performed and the histopathologic report was of deep cervical endometriosis, adenomyosis and hemorrhagic salpingitis left.

Inherited dental anomalies: a review and prospects for the future role of clinicians.

Inherited dental anomalies such as hypodontia, supernumerary teeth, enamel defects, and diastema are evident in large segments of most populations. Although treatment options for many of these conditions are ever improving, much remains to be understood about their etiology and pathophysiology. In this review, the authors hope to enthuse dental professionals into aiding the human geneticist by collaborating in studies seeking the underlying genetic cause of dental anomalies and referring patients presenting these conditions to the human geneticist.

A simple method for DNA isolation from clotted blood extricated rapidly from serum separator tubes.

BACKGROUND: After clinical laboratory tests have been performed, it can be difficult to obtain DNA without further patient involvement. Although the blood clot remaining within the serum-separation tube after serum collection is a source of DNA, recovery of the clot from the tube is a significant challenge. METHOD: We devised a method to efficiently remove clotted blood from the serum-separation gel and extract DNA from clotted whole blood samples, obtaining maximum yield of the DNA without DNA contamination by the separation gel. The method involved centrifugation of the sample in the inverted original 10-mL collection tube to displace the separation gel for easy isolation of the blood clot and shearing of the blood clot by centrifugation through a 20-gauge wire mesh cone at 2000 g in a swinging-bucket rotor. After erythrocyte lysis and proteinase-K digestion of the fragmented clot, DNA was precipitated with isopropanol in the presence of glycogen. RESULTS: The mean amount of DNA obtained from a 4-mL clotted blood sample prepared by this method was 37.1 microg for clots processed soon after collection, with a reduction to 0.439 microg for clots stored for 1 month before extraction. The quality of the DNA was comparable to that extracted directly from whole blood, and it was found to be suitable for PCR-mediated analysis. CONCLUSION: We have formulated a method that overcomes the difficulties of safely extricating a blood clot from serum-separation tubes, allowing rapid DNA extraction for the purposes of genetic investigation.

A new locus for autosomal dominant amelogenesis imperfecta on chromosome 8q24.3.

Amelogenesis imperfecta (AI) is a collective term used to describe phenotypically diverse forms of defective tooth enamel development. AI has been reported to exhibit a variety of inheritance patterns, and several loci have been identified that are associated with AI. We have performed a genome-wide scan in a large Brazilian family segregating an autosomal dominant form of AI and mapped a novel locus to 8q24.3. A maximum multipoint LOD score of 7.5 was obtained at marker D8S2334 (146,101,309 bp). The disease locus lies in a 1.9 cM (2.1 Mb) region according to the Rutgers Combined Linkage-Physical map, between a VNTR marker (at 143,988,705 bp) and the telomere (146,274,826 bp). Ten candidate genes were identified based on gene ontology and microarray-facilitated gene selection using the expression of murine orthologues in dental tissue, and examined for the presence of a mutation. However, no causative mutation was identified.

[Complicated pregnancy with lithiasis and resectable gallbladder cancer. A case report and literature review]. / Embarazo con litiasis y cáncer vesicular resecable. Comunicación de un caso clínico y revisión bibliográfica.

Pregnancy complicated with gallbladder disease stone has an incidence of 2-14%, and more than 30% of patients do not respond to medical treatment; therefore, in order to reduce the morbidity and mortality in fetus and mother, surgical management would be required. The current use of ultrasound of high resolution has facilitated the diagnosis and also, in the present clinical case, this imaging modality allowed us to suspect the unusual diagnosis reported, that corresponds to a female of 34 years old with 33 weeks of pregnancy, complicated with symptomatic gallbladder disease stone, whose pain was intractable at the expectant management. The clinical diagnosis was corroborated by ultrasound and the report was: lithiasis, biliary sludge and an intragallbladder image of bilobular polypoid. The patient was submitted to cholecystectomy by laparotomy, whose histopathologic findings were: cholelithiasis and in situ gallbladder adenocarcinoma with an exophytic growing variety. The purposes of this article are to report a case and to review the literature.

[Cesarean section: current management of postoperative acute pain. Continuous and intermittent epidural analgesia with and without elastomeric infusion device]. / Cesárea: manejo contemporáneo del dolor agudo postoperatorio. Analgesia epidural continua e intermitente con y sin infusor elastomérico.

OBJECTIVE: To compare the analgesia quality obtained in the management of the acute pain in 50 puerperae post-cesarean section using one of the two therapeutic modalities. The results were evaluated using descriptive and inferential statistics. MATERIAL AND METHOD: Controlled, systematized a clinical trial, carried out from January to June of 2001. REGIMES AND RESULTS: A) Continuous epidural analgesia. With fentanyl citrate plus bupivacaine using a low flow elastomerics infuser (Single day Baxter infuser) 85% referred mild pain in rest or activity; 3% or less in analogic scale visual (VAS) in the first 24 hours of postoperative. B) Intermittent epidural analgesia. With bupivacaine plus intravenous Ketorolaco; 59% of the cases referred mild pain, 32% moderate pain and 9% severe. CONCLUSION: Management of acute pain postcesarean section should be priority with continuous epidural analgesia using the infuser and concentrations of drugs referred in order to minimize the incidence and magnitude of acute postoperative pain.

Citología cervical: hallazgos dependientes del biocolector / Cervical cytology. Findings depending from a biocollector

El objetivo del presente análisis fue evaluar prospectivamente dos biocolectores diseñados para ecto y endocérvix. (Acellón y Espátula) para lo cual dos ginecoobstetras, tomaron doble muestra cervical simultánea, en 100 pacientes que acudieron a la consulta externa, el médico patólogo desconoció cuales laminillas fueron tomadas con cual biocolector. Tanto colectores como biocolectores fueron evaluados mediante la formula Kappa y las tablas de Contingencia. La variable nominal de estudio fue la calidad de la muestra de acuerdo al criterio de Bethesda. Los hallazgos citológicos observados en las laminillas tomadas con accellón y espátula respectivamente fueron: células escamosas; 100 por ciento y 96 por ciento, aunque proporcionalmente la espátula captura mayor celularidad de epitelio escamoso. De las células metaplásicas, 17 y 8 por ciento. De las células del epitelio cilíndrico; 81 y 63 por ciento y aquí el accellón captura proporcionalmente mayor cantidad de células cilíndricas, 10 o más leucocitos en presencia de células cilíndricas vistas a IX1000 en inmersión; cuatro y 0 por ciento Hematíes; 18 y 14 por ciento sin llegar a dificultar la interpretación citológica. Y microorganismos; tres y 10 por ciento. Respecto a las concluciones: si existió concordancia entre los dos colectores, no así entre los biocolectores, los cuales sí detectan las lesiones epiteliales neoplásicas, siendo mejor recolector de componente endocervical el Accellón y favorece criterios objetivos para el diagnóstico citológico de la endocervicitis. En cambio la espátula, captura mayor componente escamoso y favorece el diagnóstico citológico de microorganismos que afectan esta área. Se requiere de ambos biocolectores para complementar sus recíprocas limitaciones y con ello mejorar los especímenes, que permitan reducir el índice de falsas negativas