The Kidney Transplant Equity Index: Improving Racial and Ethnic Minority Access to Transplantation.

OBJECTIVES: To develop a scalable metric which quantifies kidney transplant (KT) centers' performance providing equitable access to KT for minority patients, based on the individualized prelisting prevalence of end-stage renal disease (ESRD). BACKGROUND: Racial and ethnic disparities for access to transplant in patients with ESRD are well described; however, variation in care among KT centers remains unknown. Furthermore, no mechanism exists that quantifies how well a KT center provides equitable access to KT for minority patients with ESRD. METHODS: From 2013 to 2018, custom datasets from the United States Renal Data System and United Network for Organ Sharing were merged to calculate the Kidney Transplant Equity Index (KTEI), defined as the number of minority patients transplanted at a center relative to the prevalence of minority patients with ESRD in each center's health service area. Markers of socioeconomic status and recipient outcomes were compared between high and low KTEI centers. RESULTS: A total of 249 transplant centers performed 111,959 KTs relative to 475,914 nontransplanted patients with ESRD. High KTEI centers performed more KTs for Black (105.5 vs 24, P <0.001), Hispanic (55.5 vs 7, P <0.001), and American Indian (1.0 vs 0.0, P <0.001) patients than low KTEI centers. In addition, high KTEI centers transplanted more patients with higher unemployment (52 vs 44, P <0.001), worse social deprivation (53 vs 46, P <0.001), and lower educational attainment (52 vs 43, P <0.001). While providing increased access to transplant for minority and low socioeconomic status populations, high KTEI centers had improved patient survival (hazard ratio: 0.86, 95% confidence interval: 0.77-0.95). CONCLUSIONS: The KTEI is the first metric to quantify minority access to KT incorporating the prelisting ESRD prevalence individualized to transplant centers. KTEIs uncover significant national variation in transplant practices and identify highly equitable centers. This novel metric should be used to disseminate best practices for minority and low socioeconomic patients with ESRD.

The Impact of COVID-19 Pandemic Upon Non-elective Admissions and Surgery at a Safety-Net Hospital: A Retrospective Cohort Study.

INTRODUCTION: In response to the COVID-19 pandemic, hospitals reported decreased admissions for acute surgical diagnoses, but scant data was available to quantify the decrease and its consequences. The objective of this study was to examine the incidence of acute care surgery encounters before and during the COVID-19 pandemic. MATERIALS AND METHODS: A retrospective cohort study was performed at a single, urban, United States safety-net hospital. Emergency room encounters, admissions, non-elective surgical procedures, patient acuity, and surgical complications were compared before and after the start of the COVID-19 pandemic. The primary outcome of the study was the incidence rate (IR) and incidence rate ratios (IRR) for surgical admissions, laparoscopic appendectomy, and urgent laparoscopic cholecystectomy. RESULTS: During the COVID-19 (exposure) time period, the number of nonelective procedures was 143 (IR 4.76) which was significantly lower than the control periods (n = 431, IR 7.2), P < 0.001. During the COVID-19 exposure period, there were significantly fewer urgent cholecystectomies performed (1.37 per day versus 2.80-2.93 per day, P < 0.001). There was a trend toward fewer appendectomies performed, but not significant. There was little difference in patient acuity between the exposure and control periods. A higher proportion of patients that underwent urgent cholecystectomy during the COVID time period had been seen in the ED in the prior 30 d (22% versus 5.6%). CONCLUSIONS: Surgical volume significantly decreased during the COVID-19 pandemic. Management of acute cholecystitis may require re-evaluation as nonsurgical management appears to increase repeat presentations.

Non-insulinoma pancreatogenous hypoglycemia syndrome due to nesidioblastosis following bariatric Roux-en-Y gastric bypass.

A 56-year-old woman with past medical history significant for bariatric Roux-en-Y gastric bypass 3 years prior presented for evaluation of an 8-month history of severe hypoglycemia relieved by intake of carbohydrates associated with syncopal episodes. Inpatient workup revealed endogenous hyperinsulinemia concerning for insulinoma vs. nesidioblastosis. She successfully underwent pancreaticoduodenectomy (Whipple procedure), and pathology report confirmed scattered low-grade intraepithelial neoplasia within the pancreatic parenchyma consistent with nesidioblastosis. The patient has had satisfactory control of glucose levels 30 days out from surgery.

[The transvaginal approach in acute appendicitis]. / El abordaje transvaginal en la apendicitis aguda.

INTRODUCTION: The purpose of this work is to present 8 minilaparoscopic-assisted transvaginal appendectomies using rigid instruments in patients with acute appendicitis. MATERIAL AND METHODS: Eight minilaparoscopic-assisted transvaginal appendectomies were performed from the 10th of August 2009 to the 30th of June 2010. The inclusion criteria were women between 18 and 65 years of age with a diagnosis of acute appendicitis. The exclusion criteria were palpable masses, appendicular abscesses, ASA III and IV; morbid obesity (BMI > 35); gynaecological infections; virgin patients and pregnant women. The surgical intervention was performed with rigid instruments. Surgical time, the need for post-operative analgesics, and post-surgical complications. RESULTS: The age range varied between 18 and 42 years, with a mean of 29.6 years. The mean surgical time was 48.3 minutes (37-75). Analgesics were given to 2 patients after surgery (1 parenteral and 1 oral). Five patients were discharged before 24 hours and 3 at 48 hours. There were no post-operative complications. CONCLUSIONS: Minilaparoscopic-assisted transvaginal appendectomy with rigid instruments, in selected women is a feasible and safe method, and with better aesthetic results than laparoscopic appendectomy, but future studies will be required that can demonstrate its advantages.

Percepción de calidad en servicios de urgencias hospitalarias de ii nivel, risaralda colombia, 2013

Objetivo. Evaluar la percepción de la calidad en la atención y prestación de los servicios de urgencias en las Empresas Sociales del Estado (ESE) de II nivel de complejidad en el departamento de Risaralda durante 2013. Materiales y métodos. Se aplicó una encuesta a 170 usuarios (demanda) y a 16 personas de las ESE (oferta), en el período 1° de enero a 30 de junio de 2013. Es una investigación de tipo exploratorio y descriptivo, de corte transversal y análisis de correlación parcial, con técnicas cualitativas y cuantitativas, y diseño no experimental. Resultados. El 95.88% de los encuestados consideró que fue fácil acceder a urgencias, en tanto que 78.24% expresó que no era la primera vez que acudían a urgencias. El 90% manifestó haber sido atendido con amabilidad y 83.5% consideró un nivel suficiente de idoneidad del personal médico. El tiempo promedio de atención fue menos de 30 minutos para el 38.24% de los usuarios; 34.12% superó los 30 minutos y 27.64% esperó una hora o más. Conclusiones. Las variables accesibilidad, iluminación-ventilación-higiene, amabilidad e idoneidad del personal médico y auxiliar, resultaron con los porcentajes más altos (Infraestructura-Proceso). La mayoría de usuarios expresaron que no es la primera vez que acudían a los servicios de urgencias, así mismo, opinaron que tenían un mejor estado de salud después de recibir atención médica (Resultados). El tiempo de espera terminó por ser la variable más crítica en las cuatro ESE del departamento, del lado de la demanda (atención superior a 30 minutos para más del 70% de usuarios). El tiempo de espera disminuyó debido al procedimiento del triaje, del lado de la oferta.

Objective. Assess the perception of quality of care and delivery of emergency services in the State Social Companies (ESE) of II level of complexity in the department of Risaralda during 2013. Materials and methods. A survey of 170 users (demand) and 16 people from the ESE (supply) in the period 1 January to 30 June 2013 was applied. It is an investigation of exploratory and descriptive, cross-sectional and partial correlation analysis with qualitative and quantitative techniques, and non-experimental design. Results. The 95.88% of respondents felt it was easy access to the emergency room, while 78.24% said it was not the first time they came to the emergency room. 90% said they had been treated with kindness and 83.5% saw a suffixyou fitness level medical personnel. The Average call time was less than 30 minutes for the 38.24% of users; 34.12% exceeded 30 minutes 27.64% waited an hour or more Conclusions. The accessibility, lighting-ventilation-hygiene, kindness and adequacy of medical and paramedical personnel, variables were the highest percentages (Infrastructure-Process). Most users said that is not the first time they came to the emergency department, likewise, they felt that they had a better health after receiving medical attention (Results). The waiting time ended up being the most critical variable in the four ESE department, the demand side (more than 30 minutes attention for more than 70% of users). The waiting time decreased due to the process of triage, the supply side.

Introducao. Avaliar a percepção da qualidade do atendimento e prestação de serviços de emergência nas Empresas Social do Estado (ESE) do II nível de complexidade no departamento de Risaralda durante 2013. Materiais e métodos. Uma pesquisa com 170 usuários (demanda) e 16 pessoas da ESE (oferta) na 1 de Janeiro a 30 de junho de 2013 foi aplicado. É uma investigação de análise de correlação exploratório e descritivo, transversal e parcial com técnicas qualitativas e quantitativas, e design não-experimental. Resultados. O 95,88% dos entrevistados achavam que era fácil acesso à sala de emergência, enquanto 78,24% disseram que não era a primeira vez que eles vieram para a sala de emergência. 90% disseram que tinham sido tratados com gentileza e 83,5% consideraram um nível suficiente de adequação do pessoal médico. O tempo médio de atendimento foi inferior a 30 minutos para a 38,24% dos usuários; 34.12% excedeu 30 minutos 27,64% esperou uma hora ou mais. Conclusões. A acessibilidade, iluminação, ventilação e higiene, bondade e adequação do pessoal médico e paramédico, as variáveis foram os maiores percentuais (Infrastructure-processo). A maioria dos usuários disseram que não é a primeira vez que eles vieram ao departamento de emergência, de igual modo, eles sentiram que tinham uma melhor saúde depois de receber assistência médica (Resultados). O tempo de espera acabou sendo a variável mais crítica nos quatro ESE departamento, o lado da demanda (mais de 30 minutos atenção por mais de 70% dos usuários). O tempo de espera diminuiu devido ao processo de triagem, o lado da oferta.

Percepción de calidad en servicios de urgencias hospitalarias de II nivel, Risaralda Colombia, 2013 / Perception of quality in II level hospital emergency services, Risaralda Colombia, 2013 / Perceção da qualidade nos serviços de urgência hospitalar de nível II, Risaralda Colômbia, 2013

Objetivo. Evaluar la percepción de la calidad en la atención y prestación de los servicios de urgencias en las Empresas Sociales del Estado (ESE) de II nivel de complejidad en el departamento de Risaralda durante 2013. Materiales y métodos. Se aplicó una encuesta a 170 usuarios (demanda) y a 16 personas de las ESE (oferta), en el período 1° de enero a 30 de junio de 2013. Es una investigación de tipo exploratorio y descriptivo, de corte transversal y análisis de correlación parcial, con técnicas cualitativas y cuantitativas,y diseño no experimental. Resultados. El 95.88% de los encuestados consideró que fue fácil acceder a urgencias, en tanto que 78.24% expresó que no era la primera vez que acudían a urgencias. El 90% manifestó haber sido atendido con amabilidad y 83.5% consideró un nivel suficiente de idoneidad del personal médico. El tiempo promedio de atención fue menos de 30 minutos para el 38.24% de los usuarios; 34.12% superó los 30 minutos y 27.64% esperó una hora o más. Conclusiones. Las variables accesibilidad, iluminación-ventilación-higiene, amabilidad e idoneidad del personal médico y auxiliar, resultaron con los porcentajes más altos (Infraestructura-Proceso). La mayoría de usuarios expresaron que no es la primera vez que acudían a los servicios de urgencias, así mismo, opinaron que tenían un mejor estado de salud después de recibir atención médica (Resultados). El tiempo de espera terminó por ser la variable más crítica en las cuatro ESE del departamento, del lado de la demanda (atención superior a 30 minutos para más del 70% de usuarios). El tiempo de espera disminuyó debido al procedimiento del triaje, del lado de la oferta.

Objective. To evaluate the perception of quality in the care and provision of emergency services in State Social Enterprises (ESE) of II level of complexity in the department of Risaralda during 2013. Materials and methods. A survey was carried out on 170 users (demand) and 16 ESE (supply) persons in the period 1° from January to 30 June 2013. It is an exploratory and descriptive research, cross-sectional and partial correlation analysis, with qualitative and quantitative techniques, and non-experimental design. Results. 95.88% of the respondents considered that it was easy to access the emergency room, while 78.24% said that it was not the first time they came to the emergency room. Ninety percent said they had been treated with kindness and 83.5% considered a sufficient level of suitability of medical personnel. The average attention time was less than 30 minutes for 38.24% of users; 34.12% exceeded 30 minutes and 27.64% waited an hour or more. Conclusions. The variables accessibility, lighting-ventilation-hygiene, friendliness and suitability of the medical and auxiliary personnel, resulted with the highest percentages (Infrastructure-Process). The majority of users expressed that this is not the first time they have visited emergency services, and they also felt that they had a better state of health after receiving medical attention (Results). The waiting time ended up being the most critical variable in the four ESE departments, on the demand side (over 30 minutes attention for more than 70% of users). The waiting time decreased due to the triage procedure, on the supply side.

Alvo. Avaliar a percepção da qualidade no atendimento e prestação dos serviços de emergência nas Empresas Sociais do Estado (ESE) de II nível de complexidade no departamento de Risaralda durante 2013. Materiais e métodos. Foi realizado um inquérito a 170 utilizadores (procura) e 16 SEE (oferta) no período de 1° de janeiro a 30 de junho de 2013. É uma pesquisa de tipo exploratório e descritivo, de corte transversal e análise de correlação parcial, com técnicas qualitativas e quantitativas, e desenho não experimental. Resultados. 95,88% dos entrevistados consideraram que foi fácil chegar ao PS, enquanto 78,24% disseram que não foi a primeira vez que foram ao PS. Noventa por cento disseram ter sido atendidos com gentileza e 83,5 por cento consideraram um nível suficiente de idoneidade do pessoal médico. O tempo médio de atenção foi menos de 30 minutos para 38.24% dos usuários; 34.12% ultrapassou os 30 minutos e 27.64% esperou uma hora ou mais. Conclusões. As variáveis acessibilidade, iluminação-ventilação-higiene, amabilidade e idoneidade do pessoal médico e auxiliar resultaram com as percentagens mais altas (Infraestrutura-Processo). A maioria dos usuários disse que não é a primeira vez que eles vêm para os serviços de emergência, bem como, disseram que eles têm um melhor estado de saúde depois de receber cuidados médicos (Resultados). O tempo de espera terminou por ser a variável mais crítica nas quatro ESE do departamento, do lado da demanda (atenção superior a 30 minutos para mais de 70% de usuários). O tempo de espera diminuiu devido ao processo de triagem do lado da oferta.

Presentación de un caso: teratoma sacrococcígeo / A Case presentation: Sacrocoxigeal teratoma

Introducción: la palabra teratoma fue utilizada por primera vez por Virchow en 1869 para referirse a los crecimientos sacrococcígeos y es el tumor más frecuente en el período perinatal y presentan baja mortalidad en el período neonatal se revisa la literatura en lo concerniente a teratoma coccígeo. Presentación del caso: se realiza la presentación de un caso en neonato masculino, con peso de 3000 g, nacido por vía vaginal en villa Pongui, distrito Kimongo, extrahospitalario, en un puesto médico rural. Ingresa a los 5 días de nacido por tumor en región sacro-coccígea. La clínica y los complementarios permitieron el diagnóstico de teratoma sacrococcígeo benigno. Conclusiones: se realizó por primera vez en el Hospital de Dolisie, República del Congo la exéresis del tumor en dos tiempos, dado su gran tamaño. La evolución del niño fue favorable y no existió recidiva a los 12 meses.

Introduction: the term teratoma was first time used in 1869 by Virchow to refer to sacrococcygeal growths. It is the most frequent tumor in perinatal period; however it presents a low mortality rate at birth, medical literature is reviewed concerning coccygeal teratoma. Case report: the bibliography concerning coxigeal teratoma is revised. A case is presented of a male neonate, weight 3000 g, natural birth, in Pongui Village, Kimongo District, extrahospitalary, at a rural medical post. He is admitted after six days of been born, due to a tumor in the sacrocoxigeal region. The clinical study and the complementary tests allowed diagnosing a benign sacrocoxigeal teratoma. Conclusions: It was for the first time performed in the Congo Republic Dolisie Hospital, the removal of a tumor in two periods, due to its big size. The child´s evolution was favorable and it did not exist redisive after 12 months.

Contribution of intensive silvopastoral systems to animal performance and to adaptation and mitigation of climate change / Contribución de los sistemas silvopastoriles intensivos al desempeño animal y a la adaptación y mitigación al cambio climático / Contribuição dos sistemas silvipastoris intensivos no desempenho dos animais e da adaptação e mitigação às mudanças climáticas

According to FAO, world demand for animal products will double in the first half of this century as a result of increasing population and economic growth. During the same period, major changes are expected in world climate. Food security remains one of the highest priority issues in developing Latin American countries, a region where livestock production plays a fundamental role. Agricultural activities seriously threaten natural resources; therefore, it is necessary to ensure that livestock production contributes to satisfy the demand for animal products in a sustainable manner. Intensive silvopastoral systems (ISS) are becoming the technology of choice for Colombian and regional livestock sectors because it can help reduce the seasonality of plants and animal production, and therefore contribute to mitigate and adapt to the effects of climate change. We have recently gained knowledge on the nutritional and productive attributes of these systems. However, in recent years, the low carbon approach acquired importance in animal agriculture, which seeks to primarily promote the adoption of programs running parallel activities aimed at adapting to and mitigating climate change. This review outlines projections on the effects of climate change on the livestock industry, presents concepts on Greenhouse Gas flow and highlights evidence in support of the conclusion that ISS is an interesting option to allow the livestock sector in the region to adapt to climate change and to mitigate some of its effects. The adoption of ISS may help to remove up to 26.6 tons of CO2 eq/Ha/yr from the atmosphere.

Según la FAO, la demanda mundial de productos de origen animal se duplicará durante la primera mitad de este siglo como resultado del incremento de la población y del crecimiento económico y durante el mismo período se esperan grandes cambios en el clima a nivel mundial. La seguridad alimentaria sigue siendo una de las cuestiones de más alta prioridad en el desarrollo de los países latinoamericanos y la producción ganadera tiene un papel fundamental en muchos de estos países. Todos estos elementos tienen estrecha relación con la enorme presión sobre los recursos naturales, por tanto, es necesario que la producción ganadera se realice de manera sustentable. Los sistemas silvopastoriles intensivos (SSPi) se están convirtiendo en una opción tecnológica de implementación progresiva en la ganadería colombiana y de la región porque pueden reducir la estacionalidad de la producción vegetal y animal; y por lo tanto pueden mitigar los efectos del cambio climático y adaptarse a ellos. En los últimos años se ha avanzado en el conocimiento sobre los atributos nutricionales y productivos de éstos sistemas. Sin embargo, ultimamamente empieza a tener importancia el enfoque de agricultura baja en carbono que busca principalmente, adelantar programas de desarrollo donde se ejecuten paralelamente actividades orientadas a la adaptación y a la mitigación del cambio climático. La presente revisión incluye algunas proyecciones sobre los efectos del cambio climático en la ganadería, presenta algunos conceptos sobre el flujo de los gases de efecto invernadero (GEI) en los sistemas ganaderos. Resalta algunas evidencias que permiten afirmar que los SSPi son una opción interesante para que la ganadería de la región se adapte al cambio climático y mitigue algunos de sus efectos, dado que con el establecimiento de SSPi se pueden remover hasta 26,6 ton de CO2 equivalentes/Ha/año.

Segundo a FAO, a demanda mundial de produtos de origem animal se duplicará durante a primeira metade deste século como resultado do aumento da população e dos recursos económicos; durante o mesmo período se esperam grandes mudanças no clima em todo o mundo. A segurança alimentar continua a ser uma das questões de maior prioridade no desenvolvimento dos países latino-americanos e a produção pecuária tem um papel fundamental em muitos destes. Todos estes elementos têm estreita relação com a enorme pressão sobre os recursos naturais, portanto, é necessário que a produção pecuária seja feita de uma maneira sustentável. Os sistemas silvipastoris intensivos (SSPi) estão se transformando em uma opção tecnológica de implementação progressiva na pecuária colombiana e da região porque podem reduzir a estacionalidade da produção vegetal e animal, portanto, podem mitigar os efeitos das mudanças climáticas e adaptar-se a eles. Nos últimos anos ocorreram avanços no conhecimento sobre os aspectos nutricionais e produtivos destes sistemas. No entanto, recentemente começou a ter importância o enfoque da agricultura com baixa produção de carbono que visa, principalmente, delinear programas de desenvolvimento onde se executem paralelamente atividades destinadas à adaptação e mitigação das mudanças climáticas. Esta revisão apresenta algumas projeções sobre os efeitos das mudanças climáticas na pecuária, apresenta alguns conceitos sobre o fluxo de gases do efeito estufa (GEEs) em sistemas de produção animal. Destaca algumas evidências para apoiar que os SSPi são uma opção interessante para permitir que a pecuária na região se adapte às mudanças climáticas e mitigue alguns dos seus efeitos, pois a adoção dos SSPi pode ajudar a remover até 26,6 tôn. CO2 eq/Ha/ano a partir da atmosfera.

Uso de la analgesia acupuntural quirúrgica en la herniorrafía inguinal / The use of surgical acupunctural analysis in inguinal herniarhaphy

Por la importancia que ha alcanzado en nuestro país la aplicación de la medicina natural y tradicional y dentro de ésta la acupuntura, no sólo en el orden clínico sino con fines quirúrgicos, se realizó un estudio descriptivo y retrospectivo de 40 pacientes operados por hernia inguinal en el Hospital General Docente "Abel Santamaría Cuadrado" de Pinar del Río durante el período comprendido de enero a julio del año 2003, con el objetivo de evaluar la efectividad de la analgesia quirúrgica acupuntural en este tipo de cirugía. Se conformaron dos grupos (control y estudio). Al control se le aplicó anestesia espinal y al de estudio, analgesia quirúrgica acupuntural. Se comparó grado de analgesia transoperatoria y postoperatoria, así como las complicaciones. Se determinó el grado de satisfacción de los pacientes, para lo cual fue aplicada una escala analógica visual, siendo buena en un 90% de los pacientes, a los cuales se les aplicó la analgesia acupuntural. Este proceder es inocuo, de fácil aplicación, bien aceptado por el paciente, y representa un ahorro económico considerable, ya que disminuye los costos hospitalarios, por lo que recomendamos su empleo de forma sistemática. En todos los pacientes se aplicó la cirugía mayor ambulatoria.

By the importance the application of the traditional and natural medicine has gotten in our country, specially acupuncture, not only clinically but also with surgical purposes, a descriptive and retrospective study was performed with 40 patients operated on for inguinal hernia at "Abel Santamaría Cuadrado" Teaching University Hospital in Pinar del Río, from January to July 2003, with the purpose of assessing the effectiveness of the surgical acupunctural analgesia in this type of surgery. Two groups were formed (control and study). The control group was applied spinal anesthesia, and the study group was applied surgical acupunctural analgesia. The degree of transoperative and post-operative analgesia was compared, as well as the complications. The degree of the patient's satisfaction was registered, for which a visual analogical scale was applied, being good in 90% patients who underwent acupunctural analgesia. This procedure is harmless, easily applicable, well accepted by the patient, and represents a significant economical saving since it diminishes hospital costs. This is why its systematic use is recommended. All patients underwent major ambulatory surgery.

Hernia inguinal. Estudio de 2 años / Inguinal hernia. A two-year study

La hernia inguinal representó el 3,42 % de las operaciones del Servicio de Cirugía General del Hospital Universitario "Abel Santamaría Cuadrado" durante los años 2002 y 2003. De estas operaciones, más de la tercera parte (36%) de los pacientes tenían entre 41 y 50 años al ser intervenidos quirúrgicamente. El sexo masculino predominó sobre el femenino en una proporción de 16 a 2 y además, se observó en todo el estudio un ligero predominio del lado derecho sobre el izquierdo en proporción de 3 a 2. El 48,5% de los pacientes con hernia inguinal realizaron un esfuerzo físico antes de la aparición de la hernia y el 57% de los estudiados asistió al cirujano antes del año de haberse presentado la enfermedad. La hernia inguinal indirecta predominó sobre la directa en proporción de 4 a 1. La incarceración fue la complicación más frecuente encontrada. Entre las complicaciones postoperatorias locales encontradas las más destacadas fueron la sepsis de la herida, el hematoma y el seroma. La mortalidad global fue de un 0,39%. Con el objetivo de realizar un estudio del comportamiento de la hernia inguinal en nuestro hospital durante un período de dos años nos propusimos realizar este trabajo.

Inguinal hernia represented 3.42 % of surgeries from the General Surgery Service at Abel Santamaria Cuadrado General Hospital during years 2002 and 2003. in this surgeries, more than the third (36 %) of patients ranged 41 - 50 years of age when being operated on. Masculine sex prevailed over feminine sex with a ratio 16/2 and, moreover, throughout the whole study it was observed a slight predominance of the right side over the left one with a ratio 3/2. 48.5 % of herniated patients performed a physical strain before the ocurrence of the hernia and 50 % of the studied ones went to the surgeon before 1 after the onset tof the disease took place. Indirect inguinal hernia prevailed over the right one with a ratio 4/1. Incarceration was the most frequent complication found. Among local postoperative complicactions found, the most significant were sepsis of the wound, hematoma and seroma. Total mortality was 0.39 %. We decided to carry out this work in order to perform a study of the behaviour of inguinal hernias in our hospital during a period of two years.

Análisis de los costos en la atención geriátrica / Cost analysis in geriatric care

Se realizó un trabajo para conocer los costos de la atención geriátrica en el Hogar de Ancianos "Manuel Ramos Silva" de Camagüey, en el trimestre comprendido de enero a marzo de 1997, para lo cual nos apoyamos en el Departamento de Estadísticas y Contabilidad, en los vales de salida de los almacenes, pedidos de sala de la farmacia y en nóminas salariales; los datos fueron llevados a hojas de vaciamento y procesados manualmente. Se analizó la cantidad de servicios y dotación de camas, el costo unitario o costo por días paciente, el nivel de actividad y el total de gastos, que resultó ser superior al cuarto de millón de pesos, lo que muestra una vez más los esfuerzos que realiza nuestro estado revolucionario por elevar el nivel de vida y proporcionarle las mejores condiciones a las personas de la tercera edad, sin escatimar recursos, tanto humanos como materiales

Hiperbilirrubinemia externa asociada a esferocitosis y coledocolitiasis / Extreme hiperbilirubinemia secondary to sphetocytosis and choledochcolithiasis

La esferocitosis condiciona destrucción exagerada de los glóbulos rojos ocupando en esto el bazo un papel fundamental, ya que la forma esférica condiciona mayor fragilidad y labilidad del glóbulo rojo al medio esplénico. La manifestaciones clínicas son: anemia, ictericia, esplenomegalia y eventualmente ocurren crisis hemolíticas y aplásicas asociadas a infecciones virales. La colelitiasis es una manifestación que se puede encontrar desde temprana edad, aún en casos con manifestaciones leves. La coledocolitiasis es muy rara tal vez porque el tratamiento quirúrgico se instituye tempranamente. Los niveles de bilirrubina son variables pero habitualmente no mayores de 10mg/dL (117µmol/L) a expensas de la fracción indirecta; la elevación de la directa debe hacer sospechar obstrucción o daño hepático. Reportamos el caso de un niño de 10 años de edad con esferocitosis y manifestaciones severas que desarolló colelitiasis y obstrucción total del colédoco y en quien la manifestación clínica más importante fue la ictericia por elevación de la bilirrubina total a 89 mg/dL (1521.9 µmol/L)corroborada doblemente. Se le efectuó esplenectomía, colecistectomía y exploración de vías biliares. Los controles subsecuentes son normales. Estos niveles de bilirrubinas no han sido reportados previamente. Hiperbilirrubinemia; esferocitosis; coledocolitiasis