Prevalence and impact of asthma among school-aged students in Lima, Peru.

SETTING AND OBJECTIVE: The International Study of Asthma and Allergies in Childhood (ISAAC) reported asthma prevalence in Peru to be among the highest in the world. We assessed the prevalence and morbidity of self-reported asthma in an underserved, peri-urban area of Lima, Peru, with limited medical access. DESIGN: The study was conducted in the outskirts of Lima from March to May 2011. Five hundred children aged 6-18 years were selected through cluster sampling. Parents completed a modified version of the ISAAC questionnaire. Children underwent spirometry testing. Those with a forced expiratory volume in one second (FEV1% predicted) 80% were tested for reversibility using salbutamol. RESULTS: Of the 500 children selected, 71% participated. The prevalence of asthma was 16.7%. Asthma symptoms were associated with self-reported asthma (P < 0.001); 52.5% of children with asthma had ever used an inhaler (P < 0.001), and 27.1% had never been to the doctor for respiratory problems (P < 0.001). CONCLUSION: We found a high prevalence of self-reported asthma and high morbidity related to asthma symptoms in the previous 12 months among the study cohort. Symptoms were poorly controlled due to limited availability of medication and access to medical services.

Evaluation of a mobile health system for supporting postoperative patients following day surgery.

A system based on mobile phones with built-in cameras has been developed for the postoperative management of patients sent home after day surgery. The system allows patients to send pictures and pulse oximetry measurements to a hospital server in a few seconds. Health professionals can then see what patients are describing and make a more objective estimate of the patients' status. Over a five-month period, a total of 49 patients used the system. A total of 222 images were sent, the average image delivery time being 29 s (SD 11). In nine cases (18%), the availability of images modified the treatment, and a visit to an emergency unit was avoided in eight of them who had blood-stained dressings and normal haematomas. The patients who had their treatment modified sent more images (an average of 5.4/patient) than those for whom images confirmed the correct treatment (3.1/patient). Each telephone call lasted for a mean duration of 18 min (range 8-34). The patient satisfaction data showed that all the aspects studied were evaluated in a very positive way, with 96% of the patients completely satisfied with the attention received by the mobile health application.

[Our findings in the sleep endoscopy exams]. / Nuestros hallazgos en la videofibrosomnoscopia.

INTRODUCTION: Sleep endoscopy is a technique that allows a direct visualization of the pharynx during drug-induced sleep. It allows an assessment of the anatomical site of obstruction or vibration in habitual snorers. MATERIALS AND METHODS: A total of 51 patients underwent sleep endoscopy. All answered a standard questionnaire and underwent an otolaryngological exam as a part of the diagnostic procedure. RESULTS: The most frequent site of obstruction was the palate in 90.4%, followed by the base of the tongue in 38.5%. Obstruction at multiple levels was found in 60.7% of patients. No correlations were found between the level of the obstruction found in the ENT examination and the one found during the sleep endoscopy. CONCLUSIONS: Sleep endoscopy is useful for the assessment of the usual snorer and we recomend it to label the patient's obstruction.

Diverse BF recombinants have spread widely since the introduction of HIV-1 into South America.

OBJECTIVE: To describe the genetic diversity of HIV-1 in South America by full genome sequencing and analysis. METHODS: Purified peripheral blood mononuclear cell DNA from HIV-infected individuals in Argentina, Uruguay and Bolivia was used to amplify full HIV-1 genomes. These were sequenced using the ABI 3100 automated sequencer and phylogenetically analysed. RESULTS: Twenty-one HIV-1 strains from three South American countries, 17 of which were pre-screened by envelope heteroduplex mobility assay (HMA), were studied. Ten out of 10 HMA subtype F and four out of seven HMA subtype B strains were actually BF recombinants upon full genome analysis. Two BF recombinants from Argentina and two from Uruguay had the same structure, representing a new circulating recombinant form termed CRF12_BF(ARMA159). Twelve other BF recombinants had structures related to CRF12 but with additional segments of subtype B; each was unique. BF recombinants were temporally and geographically widespread, found as early as 1986-1987 in vertically infected Argentinian children and in Argentina, Uruguay, and Bolivia.

[Video fiber endoscopy during induced sleep]. / Videofibrosomnoscopia.

Video-fiberoscopy is the exploration of upper respiratory airways used in our diagnostic protocol in patients with chronic snoring and obstructive sleep apnea syndrome (OSAS). We perform a fibroscopy during propofol induced sleep without tracheal intubation; video recording and monitoring of level of sleep, pulse oximetry, blood pressure, ECG, etc. is used. This exploration allows us to asses upper respiratory airways when the patient is asleep as well as the areas of collepse and vibration both from a functional and anatomical points of view.

[Intrahepatic lithiasis]. / Litiasis intrahepatica.

The intrahepactic lithisis is unusual in the Occidental hemisphere. The prevalence in Venezuela in unknown. We study all the edoscipic retrograde cholangiography carried for lithiasic pathology, in the Servicio de Gastroenterología, Hospital Universitario de Caracas, since January 1993 until April 1995. Over 342 patients, 9 were intrahepatic lithisis (1.16%). Seven cases of Caracas and two refered of the rest of the country. The sex was female in seven patients and males in two. The age range was 15 to 67 years old. The clinic feature much frequent was abdominal pain. The diagnosis was ultrasound and endoscopic retrograde cholangiography. The treatment was endoscopic with sphincterotomy and removal stones and surgical with resection in two cases, and choledocotomy in the other four cases.

Seroprevalence of and risk factors for HIV-1 infection among South American men who have sex with men.

OBJECTIVES: Sex among men constitutes an important route of transmission for HIV type 1 (HIV-1) in Latin America. Seeking better understanding of risk behaviours in this region, we determined the seroprevalence, potential risk factors, and geographic distribution of HIV-1 among groups of men who have sex with men (MSM). METHODS: Seroepidemiological, cross sectional studies of 13,847 MSM were conducted in seven countries of South America during the years 1999-2002. Volunteers were recruited in city venues and streets where anonymous questionnaires and blood samples were obtained. HIV-1 infection was determined by enzyme linked immunosorbent assay (ELISA) screening and western blot (WB) confirmatory tests. RESULTS: HIV-1 seroprevalence varied widely (overall 12.3%, range 11.0%-20.6%). The highest HIV-1 seroprevalence was noted in Bolivia (20.6%) and the lowest in Peru (11.0%). Predictors of HIV-1 infection varied among countries; however, a history of previous sexually transmitted disease (STD) was associated with a consistent increased risk (ORs=1.9-2.9, AORs=1.8-2.7). Multiple weekly sexual contacts was found to represent a secondary risk factor in Ecuador, Peru, and Argentina (ORs=1.6-2.9, AORs=1.6-3.1), whereas use of drugs such as cocaine was found to increase risk in Bolivia, Uruguay, and Paraguay (ORs=2.5-6.5, AORs=2.6-6.1). CONCLUSION: The results of this study illustrate an elevated HIV-1 seroprevalence among MSM participants from Andean countries. A previous STD history and multiple partners predicted HIV-1 infection in the seven countries of South America. In Southern Cone countries, HIV-1 infection was also associated with use of illegal drugs such as cocaine.

Criterios de alta en cirugía ambulatoria / Discharge criteria in ambulatory surgery

Los criterios de alta para ser eficaces en cirugía ambulatoria deben ser claros y precisos. Se pretende alcanzar los mismos niveles de calidad y seguridad como si los pacientes estuviesen hospitalizados. Se repasan las fases de recuperación postoperatoria, así como aspectos como la recuperación cognitiva, tras anestesia espinal, en anestesia pediátrica o tras bloqueos nerviosos regionales. Se repasan las alternativas de cuidados después del alta, los aspectos médico-legales y las últimas controversias surgidas tras los últimos estudios sobre criterios de cuidados postanestésicos (AU)

Discharge criteria for effective outpatient surgery must be clear and precise. We aim to reach the same standards of quality and safety as if the patients were hospitalized. Are reviewed postoperative recovery phases and aspects like cognitive recovery, after spinal anesthesia, discharge after pediatric anesthesia or after regional nerve blocks. Alternatives are reviewed after discharge care, legal aspects and recent controversies arising after the latest studies on criteria post-anesthesia care (AU)

Seguimiento postoperatorio telefónico en cirugía ambulatoria / Postoperative telephone follow-up in ambulatory surgery

INTRODUCCIÓN: En el contexto de la cirugía ambulatoria (CA) es esencial el control domiciliario del paciente. Nuestro objetivo es revisar los resultados de las llamadas telefónicas estandarizadas domiciliarias, durante un periodo de seis meses, en un hospital de tercer nivel. MATERIAL Y MÉTODOS: Estudio retrospectivo de las llamadas telefónicas realizadas durante el primer semestre del año 2013 en la UCSI del Hospital Universitari I Politècnic La Fe de Valencia. Para la gestión de la información aplicamos el modelo basado en patrones de respuesta estimada tras cirugía. Cada paciente es llamado por una enfermera de la UCSI las veces necesarias, según la cirugía y el estado clínico. Se pregunta sobre 7 parámetros básicos y las respuestas son cuantificadas mediante una escala (score telefónico), que permite un registro informático de la información.RESULTADOS: De los 6.076 pacientes que se intervinieron en régimen ambulatorio, tan solo 4.026 precisaron de evaluación, pero solo se contactó con 3.645. Un 90,2 % obtuvo una puntuación mayor de 3 en el score y 13 menor de 3. Estos fueron llamados las veces necesarias hasta que consiguieron una puntuación adecuada. De estos 13 pacientes, 6 tenían puntuaciones entre 0 y 3, precisando de un tiempo de llamada medio de 3 minutos y medio perteneciendo 2 al grupo ASI 3, 3 al ASI 2 y 1 al ASI 1. Los 7 pacientes con puntuación menor de 0 requirieron 8,5 minutos de media en cada llamada. De estos 7 pacientes, tan solo uno pertenecía al grupo ASI 3 y los otros 6 al ASI 2.DISCUSIÓN: La calidad postoperatoria percibida por el paciente de CA depende en gran medida de la ausencia de complicaciones en su domicilio. Cada tipo de intervención necesita niveles de atención domiciliaria diferentes. La llamada telefónica estandarizada realizada por personal adiestrado permite la continuidad de la asistencia. Son destacables los problemas administrativos para contactar con los pacientes. Los pacientes que necesitaron de atención médica en su domicilio o necesitaron desplazarse a urgencias fueron sobre todo ASI 2. Como era de esperar, los pacientes con peores puntuaciones precisaron de mayor tiempo de atención telefónica. Los pacientes ASI 2 y ASI 3 deberían ser llamados sistemáticamente y en los pacientes ASI 1 la llamada podría obviarse, salvo que se hubiera convenido lo contrario en el momento del alta. El dolor sigue siendo la complicación más frecuente en la fase domiciliaria inicial y determina los scores más bajos. Uno de los problemas más importantes que nos hemos encontrado a la hora de explotar la información tardía es la enorme variabilidad en la introducción de diagnósticos y procedimientos a nivel de Documentación Clínica.CONCLUSIONES: La llamada telefónica estandarizada es una buena herramienta de recogida de información postoperatoria. Sin embargo, es necesaria la unifica-ción de diagnósticos y procedimientos para poder extrapolar los resultados a diferentes ámbitos. Es necesaria una adecuada dotación de recursos humanos y materiales para este seguimiento. El dolor continúa siendo el gran problema en el domicilio de los pacientes de CA. Deberemos continuar con futuros estudios encaminados a disminuir la variabilidad en cuanto a la documentación clínica

INTRODUCTION: Patient control at home is essential in ambulatory surgery (AS). Our aim is to analyze the results of the standardized telephone calls made to patients after AS.METHODS: Retrospective study of the phone calls made on the first half of the year 2013 in the AS Unit of a third level hospital. For the management of the information we used a model based on patterns of estimated behavior after AS. Each patient is phoned by a nurse as many times as necessary depending on the type of surgery and clinical morbidities. The patient is asked about 7 basic parameters and the answers are quantified by using a numerical scale (telephone score) that allows a computer register of the information.RESULTS: Only 4026 of the 6076 patients operated in AS needed a telephonic evaluation, but we were able to only contact 3645. 90.2% of them got a score over 3, and 13 bellow 3. These 13 patients were recalled as many times necessary until they achieved a correct score. Of the 13 patients, 6 had a score between 0 and 3, with an average time of 3,5 minutes each call, and they belonged to ASI 1 group, 3 of them to ASI 2 and 1 to ASI 1. The other 7 patients with a score below zero required 8,5 minutes on each phone call. Of these 7 patients, only 1 was ASI3, and 6 ASI 2.DISCUSSION: The postoperative quality perceived by the AS patient depends on the absence of complications at home. Each operation needs different home treatment levels. The standardized phone call made by trained personnel allows the continuity in assistance. We have to highlight the administrative problems we have found to communicate with some patients. Those patients who required medical attention at home o went to the hospital were mainly ASI 2. Just as expected, patients with worse punctuations required more time in the phone calls. Patients ASI 2 and ASI 3 should be phoned systematically and in patients ASI 1 the phone call could be avoided unless other actuation decided at time of discharge of AS Unit. Pain is still the more frequent complication in the immediate postoperative period and determines the lowest scores. One important problem we found is the great variability in diagnosis and procedures that difficult the analysis of the information. CONCLUSIONS: The standardized phone call is a good tool for getting information of the postoperative period. Nevertheless, unification in diagnosis and procedures is necessary to extrapolate results to other areas. An adequate dotation of human and material resources is essential for a correct monitoring. Pain is the main problem of the AS patients at home. Further studies directed towards diminishing variability in clinical documentation are desirable

Evaluación de la telemedicina aplicada a la cirugía ambulatoria / No disponible

Objetivo: El objetivo de este trabajo es evaluar la utilidad de un sistema de control mediante telefonía móvil en el contexto del postoperatorio domiciliario de cirugía ambulatoria. Material y métodos: Se elijen aleatoriamente dos grupos de60 pacientes intervenidos de la misma patología. A ambos grupos se les somete a una entrevista telefónica protocolizada y estandarizada. A los pacientes del grupo estudio se les entrega un teléfono móvil multimedia preprogramado para enviar imágenes desde el domicilio y un pulsioxímetro. A los del grupo control se le realiza el control telefónico convencional. Se realiza una encuesta de satisfacción. Resultados: Se realiza un incremento de un 9,1% en el número de llamadas efectivas para los pacientes con móvil. Se reduce en un 63,6% el número de visitas a urgencias con respecto a los pacientes sin móvil. El tiempo medio de control telefónico es mayor (41,40 minutos/paciente) en los pacientes del grupo piloto con respecto al grupo control (16 minutos/paciente). En cuanto acostes se observa que el ahorro producido por evitar que el paciente acuda a urgencias es de un 5,6% con respecto al grupo control. El 93,8% de los pacientes opinan que el sistema ha tenido un resultado positivo en su evolución. Conclusiones: El mayor impacto clínico del sistema es que evita en un 63,6% las visitas a urgencias de los pacientes del grupo estudio. Este hecho tiene un beneficio directo en el incremento de la calidad de vida del paciente así como en el incremento de la calidad del cuidado que recibe. También aumenta el tiempo que el personal tiene que dedicarle. Aunque el tiempo de control es mayor en el grupo piloto que en el grupo control, el sistema es un5,6% más barato que el control telefónico convencional. Además tiene una alta aceptación entre los usuarios llegando a un nivel de satisfacción del 93,8% (AU)

Objective: The goal of this study was to evaluate the use of a mobile telephone control system for post-operative follow-up after ambulatory surgery. Material and methods: Two groups of patients underwent a protocolized and standard telephone interview. Patients in the study group were given a multimedia mobile telephone, pre-programmed to send images from the patient’s home as well as a pulsioxymeter. The control group was followed through the usual telephone calls. A satisfaction questionnaire was given. Results: There is a 9.1% increase of effective phone calls for patients with a mobile phone. The number of patients seen as emergency visits was reduced 63.6% compared to patients without a phone. Median phone call time was higher (41.40 min/patient)in the pilot group compared to the control group (16min/patient). Regarding costs, there is a 5.6% reduction by avoiding patients going to emergency compared with the control group. 93.8% of patients thought that the system had a positive result on their evolution. Conclusions: The biggest clinical impact of this system is that it avoids 63.6% of visits to the emergency department of the patients in the study group. This has a direct benefit on patients’ increased quality of life and on the increase in quality of the care received. The time the care givers dedicate to each patient is also increased. Although the control time is high in the pilot group, this system is5.6% cheaper than conventional telephone control. It is also very well accepted by patients with a satisfaction index of 93.8% (AU)

Telemedicina para el seguimiento postoperatorio domiciliario / No disponible

No disponible

Electrocoagulación tubárica laparoscópica. Idoneidad de su realización en una unidad de cirugía sin ingreso / Laparoscopic tubal electrocoagulation. Suitability in ambulatory surgery

OBJETIVO: Analizar la conveniencia de la realización de electrocoagulación tubárica bilateral en una unidad de cirugía sin ingreso. MARCO: Intervenciones de bloqueo tubárico por laparoscopia realizadas en la Unidad de Cirugía Sin Ingreso. MATERIAL Y MÉTODO: Estudio retrospectivo de 212 pacientes sometidas a esta técnica ambulatoriamente entre el año 2000 y 2004 en el Hospital Universitario Dr. Peset de Valencia. RESULTADOS: La edad media de las pacientes es de 36,04 años, el tiempo medio de anestesia al que son sometidas es de 60,3 minutos y el tiempo medio de recuperación posquirúrgica es de 251 minutos. En 4 años, únicamente se ha producido una complicación quirúrgica y dos ingresos hospitalarios. CONCLUSIONES: Esta técnica permite el paso del paciente desde el quirófano directamente a la sala de readaptación al medio (fast-track). Su realización precisa precisa de cuidados postoperatorios específicos sin requerir para tal fin de ingreso hospitalario (nivel II de Davis JE) (AU)

OBJECTIVE: To analyse the usefulness of laparoscopic bilateral tubal electrocoagulation in Outpatient Surgical Unit. FRAMEWORK: Laparoscopic bilateral tubal electrocoagulation in an Outpatient Surgical Unit. MATERIAL AND METHOD: A retrospective study of 212 patients who underwent this ambulatory surgical procedure between 2000 and 2004 at the Dr. Peset Universitary Hospital in Valencia. RESULTS: The study population´s average age was 36.04, the average anaesthetic time was 60.3 minutes and the average time for postsurgical recovery was 251 minutes. A single surgical complication and two hospital admissions ocurred during this period. CONCLUSIONS: This technique allows the patient to go directly from the surgical theatre to the readaptation ward (fast-track). Specific postsurgical care is needed in this procedure but hospital admissionis not necessary (2nd David JE stage) (AU)

Cirugía artroscópica de rodilla en UCMA / Arthroscopic knee surgery in UCMA

OBJETIVO: Analizar los resultados obtenidos con la cirugía artroscópica de rodilla con anestesia general en una Unidad de Cirugía Mayor Ambulatoria (UCMA) comparándolos con los conseguidos en pacientes operados en régimen de cirugía programada con ingreso. MATERIAL Y MÉTODO: 156 pacientes fueron intervenidos entre junio de 2001 y Julio de 2003. Fueron divididos en dos grupos. En el grupo A (mayores de 50 años) predominó la patología degenerativa artrósica y se realizaron artroscopias de limpieza. En el grupo B (menores de 50 años) fue más frecuente la patología meniscal y patelar, y que requirió cirugía meniscal y fémoropatelar fundamentalmente. RESULTADOS: Excelentes y buenos en 95 % de los pacientes. El porcentaje de sustitución fue del 60 % y el número de estancias evitadas de 468. CONCLUSIONES: Este tipo de cirugía puede realizarse con seguridad en UCMA por su baja tasa de complicaciones y el buen control analgésico postoperatorio que procura. El ahorro logrado es otro factor importante para recomendar su utilización habitual en UCMA (AU)

OBJETIVE: To analyze the outcome of arthroscopic knee surgery under general anaesthesia in the ambulatory surgical unit and to compare it with the results obtained in patients operated on as in-patients. MATERIALS AND METHODS: 156 patients were operated on between June 2001 and July 2003 and divided into two groups. In group A (over 50 years old) degenerative pathologies predominated and arthroscopic debridement was done. In group B (younger than 50) meniscal and patellar pathologies were more common and needed meniscal and patello-femoral surgery. RESULTS: Excellent and good results were obtained in 95 % of the patients. Substitution index was 60% and 468 hospital stays were avoided. CONCLUSIONS. This kind of surgery can be done as ambulatory procedure. The rate of complications is low and post-operative pain can be controlled. The economic saving obtained is another important factor in favour of this sort of surgery (AU)

El pólipo endometrial. ¿Es posible plantear una actitud más conservadora que la resección transhisteroscópica? / Endometrial polyps. Is there a more conservative approach than transhysteroscopic removal?

OBJETIVOS: Establecer si es posible plantear una actitud más conservadora que la resección transhisteroscopica del pólipo endometrial valorando la frecuencia relativa de atipias y adenocarcinoma sobre pólipo. MARCO: Intervenciones de histeroscopia quirúrgica realizadas en la Unidad de Cirugía Sin Ingreso (UCSI). PACIENTES: 149 polipectomías realizadas por histeroscopia quirúrgica en la U.C.S.I. del Hospital Universitario Dr. Peset de Valencia entre los años 2000 y 2002. RESULTADOS: - La frecuencia relativa de hiperplasia sin atipias sobre pólipo ha sido del 34 %. - La frecuencia relativa de hiperplasia con atipias sobre pólipo ha sido del 4 %. - La frecuencia relativa de adenocarcinoma sobre pólipo ha sido del 0.6 %. CONCLUSIONES: A la vista de estos resultados y hasta que otros estudios prospectivos y más amplios aporten datos más concluyentes, debemos continuar con nuestra política de extirpar mediante histeroscopia quirúrgica bajo anetesia general todos aquellos pólipos que no podamos eliminar por histeroscopia en consultorio, por cuanto el potencial riesgo de malignización supera el riesgo de las complicaciones quirúrgicas (AU)

OBJETIVE: To establish whether a more conservative approach other than the transhysteroscopic removal of endometrial polyps is possible, taking into account the relative frequency of atypias and adenocarcinoma on the polyps removed. FRAMEWORK: hysteroscopic surgery undertaken in the outpatients surgical unit. PATIENTS: 149 polypectomies carried out by hysteroscopy in the Outpatient Surgical Unit (O.S.U.) of Dr. Peset University Hospital in Valencia between 2000 and 2002. RESULTS: - The relative frequency of non-atypical hyperplasia on the polyp was 34 %. - The relative frequency of atypical hyperplasia on the polyp was 4 %. - The relative frequency of adenocarcinoma on the polyp was 0.6 %. CONCLUSIONS: Bearing these results in mind and until the time when other prospective, more specific, studies can provide more detailed data, we must continue with our policy of using hysteroscopic surgery under general anaesthetic to remove all those polyps that we cannot eliminate by hysteroscopy in the doctor’s surgery, inasmuch as the potential risk of them becoming malignant exceeds any risk of surgical complications (AU)

Nuestros hallazgos en la videofibrosomnoscopia / Our findings in the sleep endoscopy exams

Introducción: La videofibrosomnoscopia es una técnica que permite la visualización de la faringe de un paciente al que se le ha inducido el sueño farmacológicamente. De este modo se puede diagnosticar la o las zonas causantes de la vibración y colapso de los pacientes con roncopatía crónica. Material y métodos: La prueba se realizó a un total de 51 pacientes. A todos se les realizó una anamnesis estándar y una exploración otorrinolaringológica como parte del diagnóstico habitual. Resultados: La zona de obstrucción más frecuentemente encontrada fue el velo del paladar en el 90,4%, seguido de la base de la lengua en el 38,5%. El colapso multinivel se dio en el 60,7%. No se han hallado correlaciones entre la obstrucción hallada en la consulta y la vista durante la VFS. Conclusiones: La VFS es una técnica útil en el diagnóstico del paciente con roncopatía y es aconsejable su utilización para saber con certeza el tipo de obstrucción del paciente

Introduction: Sleep endoscopy is a technique that allows a direct visualization of the pharynx during drug-induced sleep. It allows an assessment of the anatomical site of obstruction or vibration in habitual snorers. Materials and methods: A total of 51 patients underwent sleep endoscopy. All answered a standard questionnaire and underwent an otolaryngological exam as a part of the diagnostic procedure. Results: The most frequent site of obstruction was the palate in 90.4%, followed by the base of the tongue in 38.5%. Obstruction at multiple levels was found in 60.7% of patients. No correlations were found between the level of the obstruction found in the ENT examination and the one found during the sleep endoscopy. Conclusions: Sleep endoscopy is useful for the assessment of the usual snorer and we recomend it to label the patient´s obstruction