Telemedicina en cirugía vascular y endovascular: experiencia en un centro universitario / Analysis of the first 106 telemedicine consultations in a vascular surgery service

BACKGROUND: Telemedicine became a relevant means to provide healthcare without face-to-face medical evaluation during the COVID-19 pandemic. AIM: To describe the effectiveness of telemedicine in vascular surgery. Materials and Methods: Review of medical records of all vascular surgery consultations carried out in a clinical hospital between April and October 2020. The main outcome measured was the resolution of the reason for consultation. Secondary outcomes were the need to request laboratory tests or imaging, the need to evaluate the patient in person, and the need for referral to hospitalization or emergency service. RESULTS: One hundred-six new consultations and their follow-up (remotely or in person) were analyzed. A definitive diagnosis could be reached in 74% of consultations, treatment could be instituted or modified in 69% of them, and the reason for consultation could be resolved in 74% of cases. Laboratory and imaging tests were requested in 36 and 63% of consultations, respectively. Four percent of patients were referred to the emergency department or hospitalization. Conclusions: In the vast majority of consultations, it was possible to achieve a definitive diagnosis, prescribe a treatment and resolve the reason for consultation without the need for a face-to-face medical evaluation.

Terapéutica en diverticulitis aguda: una actualización de la evidencia disponible / Therapeutics in acute diverticulitis: an update of the available evidence

La prevalencia de enfermedad diverticular en Chile se estima en 28% y cada vez es más frecuente su presentación como diverticulitis complicada. Durante los últimos años ha surgido evidencia que ha hecho replantear el manejo de la diverticulitis aguda. Históricamen-te los antibióticos han sido pilar fundamental del tratamiento de la diverticulitis aguda, sin embargo, evidencia reciente muestra que pacientes con un episodio de diverticulitis aguda no complicada pueden ser tratados sin ellos. Con respecto al manejo quirúrgico, la cirugía de emergencia está indicada en peritonitis difusa, absceso no puncionable asociado a sepsis y fracaso de tratamiento; tanto la cirugía de Hartmann como resección y anastomosis primaria son opciones válidas según el escenario. La cirugía electiva debe indicarse caso a caso y se debe optar por abordaje laparoscópico dentro de lo posible. Al enfrentarse a pacientes inmunosuprimidos se debe ser más agresivo en el manejo. La indicación de colonoscopía posterior a un episodio de diverticulitis aguda se reserva para pacientes en los que se haya presentado como un episodio de diverticulitis complicada, en aquellos que corresponda realizar tamizaje para cáncer colorrectal y en los que presenten síntomas o signos sugerentes de neoplasia colorrectal.

The prevalence of diverticular disease in Chile is estimated to be 28%, and its presentation as complicated diverticulitis is becoming more common. Recently, new evidence has emerged, questioning the traditional management of acute diverticulitis. Historically, anti-biotics have been accepted as a cornerstone of the treatment for acute diverticulitis. However, current studies show that patients with documented non-complicated acute diverticulitis could be safely treated without them. Regarding surgical management, emergency surgery is indicated in those with diffuse peritonitis, percutaneously undrainable abscesses associated with sepsis and treatment failure. Both Hartmann's procedure and resection with primary anastomosis are acceptable choices according to different settings. Elective surgery should be indicated on a case-by-case basis, and a laparoscopic approach is the preferable option. When facing immunosu-ppressed patients, management should be more aggressive. Surveillance colonoscopy after an episode of acute diverticulitis is reserved for patients presenting with complicated diverticulitis, those with a formal indication of colorectal cancer screening and patients with symptoms or signs suggestive of colorectal malignancy.

Influencia de la vía de administración sobre el efecto del extracto etanólico de la semilla de Jatropha curcas L, en la motilidad intestinal en ratones albinos / Influence of the route of administration on the effect of ethanol extract of the Jatropha curcas L. seeds, on gut motility of albino mice

Objetivo: Determinar la influencia de la vía de administración sobre efecto de distintas dosis del extracto etanólico de la semilla de Jatropha curcas L en la motilidad intestinal de ratones. Materiales y Métodos: Se utilizaron ratones albinos machos con un peso promedio de 23 g, a los que, por vía oral e intraperitoneal, y a dosis escalonadas y no tóxicas, se les administraron extracto etanólico de la semilla de Jatropha curcas L. Los grupos experimentales fueron: suero fisiológico 0,1 mL/10 g, atropina 1 mg/Kg, extracto etanólico de semilla de Jatropha curcas L. 500, 750 y 1000 mg/Kg, respectivamente, y neostigmina 0,4 mg/Kg. Para la validación estadística se usó ANOVA con post-hoc de Sidak. Resultados: Se encontró diferencias significativas al analizar los porcentajes de motilidad intestinal de todos los grupos, sin embargo, al realizar la comparación por parejas solo se halló diferencias entre los grupos que recibieron atropina y neoestigmina (p=0,038), J. curcas L. vía oral a dosis de 500 mg/Kg y 1000 mg/Kg (p=0,001 en ambos casos). Se encontraron diferencias significativas (p>0,05) en las comparaciones entre la administración por vía oral y por vía peritoneal del extracto de J. curcas L. a dosis de 500 mg/Kg y 1000 mg/Kg. Conclusión: Se encontró influencia de la vía de administración, sobre el efecto del extracto etanólico de Jatropha curcas L. en la la motilidad intestinal en ratones albinos.

Objectives. To determine the influence of administration route of Jatropha curcas L. seeds ethanolic extract (in different doses) on intestinal motility of albino mice. Methods. Male albino mice were used with an average weight of 23 g., which the ethanolic extract of Jatropha curcas L. seeds were administered in different administration routes (oral and intraperitoneal), using staggered and non-toxic doses. The experimental groups were 0,1 mL/10 g physiological saline, atropine 1mg/Kg, neostigmine 0.4 mg/kg and Jatropha curcas L seed ethanolic extract in doses of 500, 750 and 1000mg/kg. One-way ANOVA test with Sidak post-hoc test were used to do a statistical inferences. Results. Significant differences were found when all-groups intestinal charcoal transit distance (%) were analyzed. However, when paired comparisons were made, significant differences were found between neostigmine group (p=0,038); and oral administration of J curcas L extracts in doses of 500 mg/Kg and 1000 mg/Kg (p=0.001 in both cases). Significant differences were found (p>0.05) in comparisons made between orally and intraperitoneal administration of J. curcas L. extract in doses of 500 mg/Kg and 1000 mg/Kg. Conclusion. There is some influence caused by route of administration of Jathropa curcas L. seeds ethanolic extract on intestinal motility in albino mice.

Beneficios de los ácidos grasos poliinsaturados de cadena larga n-3 en la enfermedad por hígado graso no alcohólico / Benefits of n-3 long-chain polyunsaturated fatty acids in non-alcoholic fatty liver disease

La enfermedad por hígado graso no alcohólico (EHGNA) se asocia comúnmente con las características clínicas del síndrome metabólico como la obesidad, resistencia a la insulina y dislipidemia. La importancia clínica se debe a su elevada prevalencia (30% de la población general) y su amplio espectro de daño histológico que va desde la esteatosis simple generalmente no progresiva, a la esteatohepatitis no alcohólica, que puede conducir a cirrosis, carcinoma hepatocelular, e insuficiencia hepática. En la actualidad, se han caracterizado diferentes factores que conllevan a esta enfermedad hepática, destacándose principalmente el alto contenido de ácidos grasos libres y la resistencia a insulina. El exceso de ácidos grasos libres puede desencadenar lipotoxicidad hepática originada por un alto consumo de ácidos grasos saturados, ácidos grasos trans y carbohidratos, así como por un aumento de los radicales libres y del estrés del retículo endoplásmico. En lo que concierne a los ácidos grasos poliinsaturados de cadena larga n-3 (AGPICL n-3), se han atribuido múltiples beneficios para la salud humana. Los AGPICL n-3 EPA y DHA tienen efectos protectores en la salud cardiovascular y en la funcionalidad e integridad del sistema nervioso central. Actualmente el uso nutricional de ambos ácidos grasos es cada vez más amplio, atribuyendo sus efectos positivos no solamente al tratamiento de las enfermedades cardiovasculares y neurodegenerativas, sino también considerándolos una alternativa eficaz en el manejo de nutricional de la EHGNA. El presente trabajo analiza el uso potencial de los AGPICL n-3 en la prevención y manejo nutricional de la EHGNA.

Nonalcoholic fatty liver disease (NAFLD) is commonly associated with the clinical features of the metabolic syndrome including obesity, insulin resistance and dyslipidemia. NAFLD. Is of clinical relevance because its high prevalence (30% of the general population) and broad spectrum of histological damage, ranging from simple steatosis that is generally non progressive, to nonalcoholic steatohepatitis which can lead to cirrhosis, hepatoce-llular carcinoma, and liver failure. At present, different factors have been identified that lead to this liver disease, highlighting the high content of free fatty acids and insulin resistance. In this regard, excess of free fatty acids caused by a high intake of sa-turated fatty acids, trans fatty acids and of carbohydrates as well the increased formation free radicals that stress the endoplasmic reticulum, can trigger liver lipotoxicity. Regarding fatty acids, n-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) have been associated to many benefits for human health. n-3 LCPUFA, such as EPA and DHA, have protective roles in cardiovascular health and in the functionality and integrity of the central nervous system. Currently, the possible therapeutic uses of these fatty acids is expanding, attributing their positive effects not only for the treatment of cardiovascular and neurodegenerative diseases, but also seeing it as an effective alternative in the management of NAFLD. The present review analyzes the potential use of n-3 LCPUFA in the treatment and protection of NAFLD.

Ácidos grasos poliinsaturados de cadena larga ω-3 y enfermedad cardiovascular / N-3 long chain polyunsaturated fatty acids and cardiovascular disease

ω-3 Long-chain polyunsaturated fatty acids (ω-3 LCPUFA) of marine origin, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) present in fatty fish or blue fish, have different beneficial effects on human health especially at the cardiovascular level. From the late observations in the 1960s, basic, clinic and epidemiological evidence have established significant cardio protective effects for these fatty acids in reducing the morbidity and mortality from the disease. The cardiovascular benefits of ω-3 LCPUFA of marine origin are targeted on various inflammatory and metabolic pathways which are regulated by these fatty acids, particularly in the vascular endothelium, the inflammatory response and cardiac cells activity. EPA and DHA are transformed into a variety of eicosanoids and docosanoids which have strong anti-inflammatory actions antagonizing the proinflammatory actions of ω-6 LCPUFA. The different molecular mechanisms by which these fatty acids exert cardio protective effects and the clinical and epidemiological evidence demonstrating the reduction in the morbidity and mortality from cardiovascular diseases are discussed.

Los ácidos grasos poliinsaturados de cadena larga ω-3 (AGPICL ω-3) de origen marino, principalmente el ácido eicosapentaenoico (EPA) y el ácido docosahexaenoico (DHA), presentes especialmente en pescados grasos o azules, producen diversos efectos saludables en la salud humana, especialmente a nivel cardiovascular. Desde la década de 1960 han surgido múltiples evidencias básico-clínicas y epidemiológicas que establecen que estos ácidos grasos ejercen un significativo efecto cardioprotector, produciendo una disminución de la morbilidad y de la mortalidad por enfermedad cardiovascular. El EPA y el DHA son transformados eicosanoides y docosanoides que tienen poderosos efectos antiinflamatorios y que antagonizan el efecto proinflamatorio de AGPICL ω-6. Los beneficios a nivel cardiovascular atribuidos a los AGPICL ω-3 de origen marino se centran, principalmente, en la regulación de vías metabólicas de la respuesta inflamatoria en el endotelio vascular y en la actividad de las células cardíacas. Esta revisión discute las diferentes evidencias metabólicas, clínicas y epidemiológicas que demuestran como el consumo de AGPICL ω-3 de origen marino puede reducir la morbilidad y mortalidad por enfermedad cardiovascular.

Ácido docosahexaenoico (DHA), un ácido graso esencial a nivel cerebral / Docosahexaenoic acid (DHA), an essential fatty acid at the brain

Docosahexaenoic acid (C22: 6 -3, DHA) is a long-chain polyun-saturated fatty acid of marine origin essential for the formation and function of the nervous system, particularly the brain and the retina of humans. It has been proposed a remarkable role of DHA during the human evolution, mainly on the growth and development of the brain, effect that allowed the emergence of the first cognitive skills that differentiated our specie from other animals. Currently, DHA is considered a critical nutrient during pregnancy and breastfeeding due to it active participation at both, the structural and functional development of the nervous system in early life. DHA and specifically one of its derivatives known as neuroprotectin D-1 (NPD-1), has neuroprotective properties against brain aging, neurodegenerative diseases and injury caused by the damage generated during brain ischemia-reperfusion episodes. This paper reviews and discusses the importance of DHA in the human brain given the importance of this fatty acid in the development of the tissue and as neuroprotective agent. It also includes a critical view about the use of this noble fatty acid in the population.

El ácido docosahexaenoico (C22:6 ω-3, DHA) es un ácido graso poliinsaturado de cadena larga de origen marino fundamental para la formación y funcionalidad del sistema nervioso, especialmente para el cerebro y la retina de los humanos. Es destacable el rol trascendental que se propone tuvo este ácido graso en la evolución humana, principalmente en el crecimiento y desarrollo cerebral, efecto que permitió el surgimiento de las primeras habilidades cognitivas y de inteligencia que diferenciaron a nuestra especie de otros animales. Actualmente se considera al DHA como un nutriente crítico durante el embarazo y la lactancia debido a su activa participación en el desarrollo del sistema nervioso tanto a nivel estructural como funcional en los primeros años de vida. DHA y específicamente uno de sus derivados conocidos como neuroprotectina D-1 (NPD-1), presenta propiedades neuroprotectoras frente al envejecimiento cerebral, algunas enfermedades neurodegenerativas y a la injuria causada por el daño durante episodios de isquemia-reperfusión cerebral. En este trabajo se revisa y discute la relevancia del DHA a nivel cerebral, considerando la importancia de este ácido graso tanto en el desarrollo cerebral como en los efectos neuroprotectores que presenta. Se incluye, además, una visión crítica sobre el consumo de este noble ácido graso en la población.

Effectiveness of a multidimensional approach for the prevention of ventilator-associated pneumonia in an adult intensive care unit in Cuba: findings of the international nosocomial infection control consortium [INICC]

This study sought to assess the effect of the multidimensional approach developed by the International Nosocomial Infection Control Consortium [INICC] on the reduction of ventilator-associated pneumonia [VAP] rates in patients hospitalized in an adult intensive care unit [AICU] in an INICC member hospital in Havana, Cuba. We conducted a prospective surveillance pre-post study in AICU patients. The study was divided into two periods: baseline and intervention. During the baseline period, we conducted active prospective surveillance of VAP using the Centers for Disease Control and Prevention [CDC] National Health Safety Network [NHSN] definition and INICC methods. During the intervention period, we implemented the INICC multidimensional approach for VAP, in addition to performing active surveillance. This multidimensional approach included the following measures: a bundle of infection control interventions, education, outcome surveillance, process surveillance, feedback of VAP rates and performance feedback of infection control practices. The baseline rates of VAP were compared to the rates obtained after intervention, and we analyzed the impact of our interventions by Poisson regression. During the baseline period, we recorded 114 mechanical ventilator [MV] days, whereas we recorded 2350 MV days during the intervention period. The baseline rate of VAP was 52.63 per 1000 MV days and 15.32 per 1000 MV days during the intervention. At the end of the study period, we achieved a 70% reduction in the rate of VAP [RR, 0.3; 95% CI, 0.12-0.7; P value, 0.003.]. The implementation the INICC multidimensional approach for VAP was associated with a significant reduction in the VAP rate in the participating AICU of Cuba

Prevalencia de obesidad en estudiantes de ingeniería civil de Barquisimeto, estado Lara / Prevalence of obesity in engineering students from Barquisimeto, Lara state

La presente investigación tuvo como objetivos compararla prevalencia de obesidad según Índice de Masa Corporal (IMC),Circunferencia de Cintura (CC) e Índice Cintura -Talla (ICT) y determinar los factores de riesgo para obesidad central por ICT. Fue diseñado un estudio de prevalencia, con una poblacion de 1298 estudiantes de Ingenieria Civil entre 18 y 24 años de edad de la Universidad Centro Occidental Lisandro Alvarado, 702 mujeres y 596 hombres. La selección de la muestra se basó en una prevalencia de obesidad central de 17%, nivel de confianza de 95% y un error de 3,6% para mujeres y 4,6% para hombres, para un tamaño de 259 mujeres y 180 hombres. Se determinaron IMC, CC e ICT. Se aplicó un cuestionario sobre antecedentes de obesidad familiar, hábitos dietéticos y sedentarismo. Los resultados reportaron 5,3% de obesos según IMC; 10% de obesidad central según CC y 41% según ICT, 37,8% mujeres y 45,6% hombres. En sujetos con antecedentes familiares de obesidad, 50,5% presentaron obesidad central mientras 37,8% sin estos antecedentes eran obesos (Razón de prevalencia = 1,33; IC95% = 1,06-1,68); 47,8% de sujetos sedentarios presentaron obesidad central respecto al 35,3% de sujetos sin sedentarismo (Razón de prevalencia = 1,35; IC95% = 1,08-1,69); 39% de los jóvenes con hábitos dietéticos inadecuados presentó obesidad central, 43% sin estos hábitos eran obesos (Razón de prevalencia = 0,90; IC95% = 0,72-1,13). Se concluye que la mayor prevalencia de obesidad central fue con el ICT y los factores de riesgo fueron antecedentes familiares de obesidad y sedentarismo. El ICT puede ser una herramienta más sensible que la CC para diagnosticar obesidad central en los jóvenes estudiado.

This research had, as objectives, to compare the obesity prevalence according to the Corporal Mass Index (CMI), Waist Circumference (WC) and Waist-Height Index (WHI) and to determine the risk factors for central obesity by WHI method. To determine antecedents of inherited obesity, dietetic habits and sedentariness, a questionnaire was applied. The estimated sample was based on a prevalence of central obesity of 17%, a level of 95% certainty and an error of 3.6% for female and 4.6% for male ones. Anthropometric measures CMI, WC and WHI were taken. Results from 702 women and 596 men aged 18 and 24 years, 259 women and 180 men were studied. 5.3% of obese subjects according to CMI, 10% central obesity according to WC and 41% according to WHI were found. A 37.8% of women and 45.6% of men displayed central obesity according to WHI. In subjects with an obesity family background, 50.5% displayed central obesity, unlike the subjects without family obesity (37.8%), (Reason of prevalence (RP) = 1,33; CI95% = 1,06-1,68). 47.8% of sedentary subjects displayed central obesity regarding to 35.3% of subjects without sedentariness (RP = 1,35; CI95% = 1,08-1,69). 39% of the young people with inadequate dietetic habits displayed central obesity, whereas 43% without these habits were obese (RP = 0,90; CI95% = 0,72-1,13). Conclusions. It was found that a greater prevalence of central obesity with the WHI and the risk factors were antecedents of family obesity and sedentariness. The WHI can be a tool more perceptible than the WC for diagnosing central obesity in this studied young people.

Primeras curvas de percentiles de la circunferencia de cintura en un grupo de adolescentes del Estado Lara Venezuela / First percentile curves of waist circumference in a group of teenagers Lara State Venezuela

Desarrollar curvas de percentiles (P) de la circunferencia de la cintura (CC) en adolescentes según edad, sexo y sitio de medición de la CC. Estudio descriptivo transversal con 7.230 adolescentes sanos (3.935 mujeres), de 10 a 19 años de edad, todas las clases sociales, seleccionados aleatoriamente en 27 instituciones educativas, urbanas y rurales, públicas y privadas de 8 parroquias de Iribarren. Se midió la CC en tres sitios anatómicos. Se construyeron curvas suavizadas para P3, P10, P25, P50, P75, P90 y P97 con el método LMS Pro. Para el sitio anatómico (1), mujeres entre 12 y 15 años superaron a los hombres. Entre 16 y 19 años los resultados se invirtieron. A los 19 años, el P90 no parece demostrar continuidad con el criterio diagnóstico de obesidad central de mujeres adultas, según el ATP III. Para el sitio anatómico (2), el P90 de hombres tampoco parece tener continuidad con el criterio diagnóstico de la Federación Internacional de Diabetes para adultos. En los sitios anatómicos (2) y (3), los percentiles siempre fueron superiores en varones. Todos los percentiles difirieron de poblaciones extranjeras. Se confirma la necesidad de desarrollar curvas de percentiles propias, con sus puntos de corte para diagnosticar obesidad central

To develop percentile curves (P) of waist circumference (WC) in adolescents according to age, sex and measurement site of WC. A representative cross-sectional study of 7230 healthy adolescents (3,935 women) aged 10-19 years, of all social classes, randomly selected from 27 urban and rural, public and private, educational institutions, in the state Lara, Venezuela was done. WC was measured at three anatomical sites. Smoothed curves were constructed for P3, P10, P25, P50, P75, P90 and P97 using the LMS Pro method. For the anatomical site (1), the women’s values, aged 12-15 years, were higher than male’s ones. For ages 16-19 years the results were reversed. In 19-year-old women, the P90 does not appear to show continuity with the diagnosticcriteria of central obesity of ATP II in adult women. For the anatomical site (2), P90 male does not seem to have continuity with the diagnostic criteria of the International Diabetes Federation among adult men. For anatomical sites (2) and (3), the percentiles were always higher in males. All percentiles differed from foreign populations. This confirms the need to develop our own percentile curves, with their cutoff points for central obesity diagnosis

Levobupivacaina al 0, 5% sin epinefrina en anestesia de plexo braquial por via axilar con neuroestimulador: Hospitales Vicente Corral y José Carrasco / 0.5% levobupivacaine without epinephrine anesthetic axillary brachial plexus with neurostimulator: Hospital Vicente Corral and José Carrasco

With a longitudinal descriptive design 101 patient ASA I-II wasincluded, to those who was administered 150 mg of L-Bupivacaína to 0.5% (30 ml) byaxillary route after identifying plexus with neuroestimulator.92.1% (n = 92) blockades were successful. 65.6% (n = 61) of taken part oneswere men. In a rank of 18 to 79 years medium one of age was of 39 years. Half of thesample had between 25 and 48 years (P25 and P75). According to body mass index(BMI) 43% of patients had overweight. Workers (32.3%) and clerks (29%) were themain occupations. The married ones were 57%.Basal constants were: pulse 75.1 ± 12.2 beats/min, SBP 145.8 ± 22.7 mm Hg, DBP79.6 ± 9.8 mm Hg and SpO2 94.1 ± 2.3%. Trans and postoperative blood pressurevaried between 0.6 and 4,7% with respect to basal average. The SpO2 was modifiednot more of 2.5% and variations of pulse were not important either.By 578.9 ± 114.4 min were analgesia (rank 360 to 840 min) and motor blockade by154, 5 ± 116.5 min (rank 460 to 30 min) for a time average of surgery of 25.7 ± 61.5min (rank 140 to 25 min). Complications nor indirect effect were not registered.As it indicates specialized medical literature, hemodinamic stability andabsence of complications turn to the plexus brachial anesthesia by axillary route amethod of election for surgery of the superior member because it avoids thephysiological upheavals and the associated answer of surgical stress to the use of thegeneral anesthesia.

Con un diseño descriptivo longitudinal se incluyeron 101 pacientes ASA I-II, a quienes se administró 150 mg de L-Bupivacaína al 0,5% (30 ml) por vía axilar luego de identificar el plexo con neuroestimulador.El 92,1% (n = 92) de bloqueos fueron exitosos. El 65,6% (n = 61) de los intervenidos fueron varones. En un rango de 18 a 79 años la mediana de edad fue de 39 años. La mitad de la muestra tuvo entre 25 y 48 años (P25 y P75). Según índice de masa corporal (IMC) el 43% de los pacientes tuvo sobrepeso. Obreros (32,3%) y oficinistas (29%) fueron las principales ocupaciones. Los casados fueron el 57%.Las constantes basales fueron: pulso 75,1 ± 12,2 latidos/min, PAS 145,8 ± 22,7 mm Hg, PAD 79,6 ± 9,8 mm Hg y SpO2 94,1 ± 2,3%. La presión sanguínea trans ypostoperatoria varió entre un 0,6 y 4.7% con respecto del promedio basal. La SpO2 se modificó no más del 2,5% y las variaciones del pulso tampoco fueron importantes.Hubo analgesia por 578,9 ± 114,4 min (rango 360 a 840 min) y bloqueo motor por 154,5 ± 116,5 min (rango 30 a 460 min) para un tiempo promedio de cirugía de 61,5 ± 25,7 min (rango 25 a 140 min). No se registraron complicaciones ni efectos secundarios.Como señala la literatura médica especializada, la estabilidadhemodinámica y la ausencia de complicaciones convierten a la anestesia de plexobraquial por vía axilar en un método de elección para cirugía del miembro superiorporque evita los trastornos fisiológicos y la respuesta del estrés quirúrgico asociados al uso de la anestesia general.

Alterações oculares de doenças sistêmicas: retinopatia diabética e oftalmopatia de Graves / Systemic diseases with ocular involvement: diabetic retinopathy, Grave's disease

Das doenças sistêmicas com alterações oculares, destacam-se a retinopatia diabética e a oftalmopatia de Graves que têm em comum vários aspectos: são alterações endócrinas e metabólicas, auto-imunes e o acometimento ocular pode ser grave, levando à perda da função visual. A orientação correta do médico generalista pode modificar o prognóstico visual dos portadores destas doenças, pois dá oportunidade para que o oftalmologista intervenha no momento adequado.No diabetes a principal alteração ocular ocorre na retina, com o desenvolvimento da retinopatia diabética que se manifesta em 30% dos casos.Na oftalmopatia de Graves é importante o esclarecimento de que nem sempre as alterações oculares estão relacionadas a alterações hormonais que possam sinalizar a atividade da doença. A doença ocular pode ocorrer no hipertireoidismo, bem como no hipotireoidismo; em pacientes sem alterações hormonais afeta principalmente os tecidos adiposo e muscular da órbita e do olho. Descreve-se neste artigo o tratamento atual da retinopatia diabética e da oftalmopatia de Graves para que os pacientes possam ser orientados e esclarecidos sobre as condutas a serem adotadas pelo oftalmologista.

Hipercolesterolemia y factores de riesgo asociados ambulatorio urbano II "Dr. Leonardo Ruíz Pineda II, San Agustín del Sur, Caracas, Venezuela: año 2002 / Hypercholesterolemia and associate risk factors, urban ambulatory II Dr. Leonardo Ruiz Pineda II San Agustin South, Caracas Venezuela year 2002

La hipercolesterolemia es uno de los principales factores de riesgo cardiovascular modificables. El presente estudio se realizó en el ambulatorio Leonardo Ruiz Pineda II, para determinar los factores de riesgo asociados a hipercolesterolemia, de los pacientes de ambos sexos, entre las edades de 20 a 85 años, que acuden a este centro. La metodología utilizada fue una investigación descriptiva mediante corte transversal, obteniendo la muestra a través de jornadas procurando una buena representatividad y llenando la encuesta de factores de riesgo cardiovascular de la Sociedad Venezolana de Cardiología. Se tomó peso,talla, presión arterial, glicemia y colesterol. Se encontró una asociación directa y significativa entre la prevalencia de hipercolesterolemia y las de: hipertensión arterial, sobrepeso u obesidad, de nivel bastante alta para las dos primeras y moderado para diabetes. En el grupo de menores de 30 años hubo mayor prevalencia de hipertensión, diabetes y sobrepeso u obesidad en el sexo masculino que en el femenino. En el grupo de mayores de 30 años, hubo mayor prevalencia de hipertensión arterial y sobrepeso u obesidad en el sexo femenino mientras la hipercolesterolemia fue mayor en el sexo masculino. Para ambos sexos se aprecia un incremento notable de la presencia de todos los factores de riesgo en el grupo etario de más de 30. Las frecuencias para los factores de riesgo difieren significativamente de las halladas en la consulta así como la odd ratio para obesidad e hipercolesterolemia

Prevalencia de anemia ferropénica en niños pre-escolares y escolares con necesidades básicas insatisfechas / Prevalence of iron deficiency anemia in a group of pre-school and school children, living in conditions of poverty

Iron deficiency is common during the first years of life. Yet, there is a paucity of data on scholar children. Our main objective was to estimate the prevalence of ferropenic anemia in children 3 to 12 years of age living under conditions of poverty. A total of 323 children were included, 171 attended to a day care institution (group A) and 152 were from the same community but not attended in the day care institution (group B). Hemoglobin (Hb), medium corpuscular volume (MCV) and serum ferritin (SF) were measured in all children. In those with Hb < or = 11 g/dl and/or MCV < or = 73 fl and/or SF < or = 15 microg/l, transferrin saturation (TS) and soluble transferrin receptors (sTR) were also measured. Iron deficiency was defined as SF < or = 15 mg/l and ferropenic anemia was defined as Hb < or = 11 g/dl or MCV < or = 73 fl with sTR > or = 38 mmol/l and SF < or = 10 microg/l or TS < or = 10%. There were no differences between the groups regarding age, weight, height, education, gender and housing conditions. Mean hemoglobin level was 12.6 g/dl (group A: 12.4 g/dl vs. group B: 12.7 g/dl; p=0.012), and mean SF was 45 mg/l, without significant differences between groups. Prevalence of iron deficiency anemia was 2.5% (8/323) and iron deficiency was 4.4% (14/317), without significant differences between groups. These results persisted after controlling for confounding variables. In this group of children living under conditions of poverty in Argentina, iron deficiency anemia was uncommon. We attribute this phenomenon to local affordability of some inexpensive cuts of red meat.

Prevalencia de colonización por Streptococcus agalactiae (grupo b) durante el embarazo pesquisado en medio de cultivo selectivo

Streptococcus agalactiae es el principal agente bacteriano responsable de la sepsis neonatal. Para evitar la infección perinatal se recomienda su pesquisa en la región vagino-anal durante el tercer trimestre, y tratamiento antibiótico durante el trabajo de parto en las gestantes colonizadas. El objetivo de este estudio es conocer la prevalencia de colonización del Streptococcus agalactie en la población de embarazadas controladas en la maternidad del Hospital Clínico de la Universidad de Chile, en el período comprendido entre el 1 de marzo y el 31 de mayo de 2003. Se tomó cultivo selectivo de Todd Hewitt, entre las 35 y 37 semanas de gestación a 185 embarazadas. Se determinó una prevalencia de colonización vagino-anal de 14,0 por ciento.

Resultados clínicos de la resincronización ventricular en pacientes con insuficiencia cardíaca severa / Results of intraventricular resynchronization in patients with severe cardiac failure

BACKGROUND: Intraventricular resynchronization with pacemakers is a promising therapy for patients with refractory cardiac failure and intraventricular conductions delay. However its long term effects are not well known. AIM: To report the results of this therapy in patients with cardiac failure. PATIENTS AND METHODS: Fourteen patients (11 male), whose mean age was 68 years, with a severe and refractory cardiac failure, have been treated in our unit using intraventricular resynchronization with pacemakers. Eight had a coronary heart disease and six a dilated myocardiopathy. The pacemaker was implanted transvenously, with conventional stimulation in atrium and right ventricle. The left ventricle was stimulated through an epicardial vein, accessed through the coronary sinus. RESULTS: In one patient the high thresholds did not allow a left ventricular stimulation. In the other 13 patients, a clinical improvement was observed in 11 (85 per cent), that has been sustained for a mean of 8.2 months. The ejection fraction improved form 23.5 to 32.4 per cent (p < 0.001), the 6 min walking test improved from 347 to 437 m (p = 0.003) and the functional capacity changes from 3.3 to 2.7 (p < 0.001). Three patients died during follow up. One was the patient in whom the stimulation failed and two had a sudden death. No complications of the procedure were observed. CONCLUSIONS: In this series, intraventricular resynchronization with pacemakers was effective in 11 of 13 patients, improving functional capacity and ejection fraction. Sudden death could be avoided adding a defibrillator to the pacemaker system.

Impacto económico de la peste bubónica en Cajamarca-Perú / Economic impact of plague in Cajamarca-Peru

Objetivos: Conocer el impacto económico de la peste en tres provincias de Cajamarca en los años 1994 y 1999. Materiales y métodos: En este estudio observacional, transversal y descriptivo se estimaron los costos directos e indirectos (institucionales, de las familias y comunidades) de la peste en las provincias de San Miguel, San Pablo y Contumazá del departamento de Cajamarca en los años 1994 y 1999. La información necesaria para el cálculo de los costos se obtuvo de diversas fuentes: recopilación de datos documentados, entrevisats a personal de salud y/o directores o jefes de instituciones o establecimientos, encuestas a hogares, etc. Resultados: En 1994, el costo total estimado de la peste ascendió a 2 333 169 dólares: insumos-MINSA (81 388 dólares), otras instituciones (106 428 dólares), de las familias (663 449 dólares) y por moetalidad (1 416 870 dólares). En tanto que en 1999, el costo total ascendió a 741 431 dólares: insumos-MINSA (322 371 dólares), atención directa-MINSA (34 063 dólares), otras instituciones (15 477 dólares), de las familias (369 550 dólares) y ningún costo por mortalidad. Conclusiones: La peste tiene un alto costo en la economía peruana a nivel regional, existiendo variaciones en el tiempo, de acuerdo a comportamiento de la enfermedad y a las políticas adoptadas para su control y prevención.

Objectives: To determine the economic impact of plague in three provinces of Cajamarca department in 1994 and 1999. Materials y methods: In this observational, cross-sectional and descriptive study, we estimated the direct and indirect costs (institutional, familial, and community costs) of plague in San Miguel, San Pablo, and Contumazá provinces in Cajamarca Department for 1994 and 1999. Data for cost calculation was obtained from different sources: data compilation, interviews to health care workers and/or directors or managers of health institutions and health facilities, home surveys, etc. Results: In 1994, the total estimated cost of plague rose to US$ 2'333,169. This cost was divided as follows: MINSA (Ministry of health, working materials) (US$ 65,034), MINSA-direct attention (US$ 81,388), institutional cost (US$ 106,428), family cost (US$ 663,449), and mortality cost (US$ 1'416,870). In 1999, the total cost rose to US$ 741,431, and it was divided as follows: MINSA-working materials (US$ 322,371), MINSA-direct attention (US$ 34,063), institutional cost (US$ 15,477), family cost (US$ 369,550) and no cost for mortality. Conclusions: Plague has a hight cost for the regional economy of Peru, and there are annual costs variations, according to the disease behavior and the policies for its control and prevention.

Gall bladder disease: an analysis of cases in the North General Hospital

An analysis of 78 patients with gall bladder disease admitted to the surgical department of the North General Hospital was made. These cases were divided into the non-operated cases (40) and the operated cases (38). There was an incidence of twice as many female as male patientsCholecystectomy and choledochostomy was the procedure of choice in this series. Unless there were signs of imminent perforation and therefore resultant peritonitis, the patients were usually subjected to a preoperative regimen designed to build them upA high incidence of ascaris in the common bile duct was noted. It is believed that the presence of ascaris in the common bile duct signifies a preceding pathology in the biliary system. (Summary)

Ascaris in the common bile duct (a report of 10 cases)

Ascaris has been found in a variety of places aside from its usual habitat in the jejunum. Its discovery in the common bile duct is notedA study of 10 cases where ascaris has been found in the common bile duct shows that this condition brings about signs and symptoms that are considered pathognomic and characteristic of a gall bladder disease. That a gall bladder disease is really coexistent with the presence of ascaris in the common bile duct seems to be borne out by the invariable observation that the gall bladder in these cases shows at least a chronic inflammatory condition. A hypothesis is, therefore, advanced to the effect that a pre-existing gall bladder disease is responsible in attracting the ascaris into the common bile duct, or at least makes it possible for the wandering ascaris to penetrate into the biliary system by causing a dysfunction in the sphincter of Oddi which normally would impede such an entrance. It is evident that, in the presence of a gall bladder disease, the removal of the ascaris alone will not cure the disease; the gall bladder disease; the removal of the ascaris alone will not cure the disease; the gall bladder may also have to be removed. (Summary)

Informe final: consulta nacional programa de modernización sector salud de Nicaragua 1998-2002 / Final report: national conference modernization program salt sector

El Ministerio de Salud ha emprendido un proceso de reforma del sector salud en un marco de politica nacional de modernización del sector con una orientación de demogrática y social, acorde con el proceso general que experimenta el país. Esta reforma surge con el propósito inicial de adaptar los servicios de salud a las nuevas circunstancias sociales, contener los problemas epidemiológicos, incrementar la demanda y disminuir las presiones operacionales en la esctructura institucional del sector. Enfoca la consolidación de los Sistemas Locales de Atención Integral a la Salud, a la descentralización de la géstíón financiera, ha precisado el papel del MINSA y sus funciones específicas de regulación, conducción a la reforma sectorial de salud. Facilita la participación comunitaria estimular innovación, la gestión y la asignación de recursos en salud para la atención de la población que mas lo requiere y que debe integrarse al proceso de desarrollo. Aborda los principales ejes de desarrollo que se enfocan en estrategias como: Democratización de la gestión; Prioridad de atención a la mujer y niñez y alternativas de financiamiento