Acute transverse colon volvulus with secondary gastric isquemia. Case report.

Acute colonic volvulus accounts for 10% of all intestinal obstructions being the transverse colon volvulus an exceptional localization (2-4%). Late diagnosis is made as there are no pathognomonic clinical or radiological findings for this pathology. We present the case of an 81 year-old male with acute transverse colon volvulus that involved the gastric antrum causing irreversible ischemia. Subtotal gastrectomy, subtotal colectomy and reconstruction with Y en Roux gastrojejunostomy and ileosigmoid anastomosis was performed given the good overall status of the patient. Decompressive colonoscopy is not advised given the high probability of ischemic lesions in these cases; surgical exploration is mandatory in these circumstances. Surgical detortion with or without colopexia carries important recurrence rates. Treatment of choice includes colectomy with or without primary anastomosis. There are no reports on gastric ischemic necrosis in the setting of a transverse colon volvulus making this case unusual and unique.

Morphology and Postnatal Development of Lower Hindlimbs in Desmodus rotundus (Chiroptera: Phyllostomidae): A Comparative Study.

The hindlimbs in bats are functionally adapted to serve as a hook to attach to the mother from birth, and to roost during independent life. Although bats exhibit different terrestrial locomotion capabilities involving hindlimbs, hindlimb morphology and postnatal development have been poorly studied. We describe in detail the postnatal development and bone morphology of hindlimbs of the nimble walker vampire bat, Desmodus rotundus, and compare adult characters with the insectivorous Molossus molossus (erratic walker) and the frugivorous Artibeus lituratus (non-walker). The advanced ossification of most hindlimb elements of D. rotundus at the newborn stage is consistent with the functional role of this structure at birth in bats. The development completion events of hindlimb bone elements and bone processes in D. rotundus coincide with the cranial bone processes completion and suture closure events. Those events occur when individuals begin to feed by themselves. There are differences in the number and position of bone processes and sesamoids in adults among the compared species, most of which are described for the first time, and in the case of D. rotundus and M. molossus mostly related to a greater and tight articulation between elements. These facts seem to be closely associated with the different terrestrial locomotion capabilities, and in the case of the exclusively sanguivorous D. rotundus with specializations for obtaining food. Anat Rec, 300:2150-2165, 2017. © 2017 Wiley Periodicals, Inc.

Factores de riesgo asociados a estancia hospitalaria prolongada en pacientes con falla cardiaca aguda / Risk factors associated with prolonged hospital stay in patients with acute heart failure

Resumen Introducción:: La falla cardiaca aguda es un motivo frecuente de consulta a urgencias, genera estancias hospitalarias prolongadas y altos costos para el sistema de salud. Objetivo: Determinar los factores asociados a estancia hospitalaria prolongada en pacientes hospitalizados por falla cardiaca aguda en un hospital universitario. Métodos: Estudio de cohorte retrospectivo, se incluyeron pacientes adultos con falla cardiaca aguda. Se obtuvieron variables demográficas, comorbilidades y resultados de laboratorios de rutina. Se definió hospitalización prolongada, como una estancia mayor a 5 y 10 días respectivamente. Resultados: Un total de 776 pacientes fueron incluidos en el análisis, 56% eran hombres, el promedio de edad fue de 71.5 años, fracción de eyección de 39.8%. Los factores asociados con estancia hospitalaria prolongada fueron: edad, elevación de troponina, hiperglucemia y albúmina < 3 g/dl. Para el corte de 10 días adicionalmente se identificaron: presión arterial sistólica, frecuencia cardiaca y elevación de péptidos natriuréticos. Conclusiones: La evaluación integral de variables clínicas y resultados de laboratorio es útil para identificar pacientes con mayor riesgo de estancias hospitalarias prolongadas.

Abstract Introduction: Acute heart failure is a frequent reason for consulting to emergency department, it generates long hospital stays and high costs for the health system. Objective: To determine the associated factors with prolonged hospital stay in patients hospitalized for acute heart failure in a teaching hospital. Methods: Retrospective cohort study, adult patients with acute heart failure were included. Demographic variables, comorbidities, and routine laboratory results were obtained. Prolonged hospitalization was defined as a stay greater than 5 and 10 days, respectively. Results: A total of 776 patients were included in the analysis, 56% were men, the mean age was 71.5 years, and ejection fraction was 39.8%. Factors associated with prolonged hospital stay were: age, elevated troponin, hyperglycemia, and albumin < 3 g/dl. For the 10-day cut-off, additionally, systolic blood pressure, heart rate and elevation of natriuretic peptides were identified. Conclusions: Comprehensive evaluation of clinical variables and laboratory results is useful to identify patients at increased risk for prolonged hospital stays.

Factores de riesgo asociados al desarrollo de eventos cardiovasculares en pacientes postrasplante renal / Risk factors associated with cardiovascular events in kidney transplant patients

Resumen Objetivo: describir el comportamiento de los factores de riesgo cardiovascular en pacientes con trasplante renal y su relación con los desenlaces cardiovasculares a uno y cinco años luego del trasplante. Métodos: se realizó un estudio analítico de cohorte retrospectivo en los pacientes con trasplante renal del Hospital Universitario San Ignacio con seguimiento institucional por lo menos de un año. Se analizaron las variables demográficas, los factores de riesgo cardiovascular y los desenlaces cardiovasculares a uno y cinco años. Resultados: se incluyeron 166 pacientes con seguimiento a un año y 79 con seguimiento a cinco años postrasplante renal. En el primer año postrasplante hubo una reducción significativa del tabaquismo y la hipertensión arterial sin cambios en el control de la dislipidemia ni de la diabetes mellitus. Se presentaron 9 eventos en el primer año con 6 casos de angina inestable, 2 infartos de miocardio y un ataque cerebrovascular. En la evaluación al quinto año se mantuvo el cese del tabaquismo con aumento de los casos de hipertensión arterial. Se presentaron 8 casos de angina inestable, cifra que corresponde a un 10% de eventos cardiovasculares. Conclusiones: en el seguimiento a uno y cinco años postrasplante renal de los pacientes del Hospital Universitario San Ignacio se identificó una tasa baja de eventos cardiovasculares con una modificación en la prevalencia de algunos factores de riesgo cardiovascular.

Abstract Objective: To describe the behaviour of the cardiovascular risk factors in kidney transplant patients, and its relationship with the outcomes at 1 and 5 years after the transplant. Methods: A retrospective analytical cohort study was performed on patients with kidney transplant from the Hospital Universitario San Ignacio with a follow-up of at least 1 year. An analysis was carried out on the demographic variables, cardiovascular risk factors, and the cardiovascular outcomes at 1 and 5 years. Results: The study included 166 patients with a follow-up of 1 year, and 79 with a follow-up of 5 years post-kidney transplant. In the first year post-transplant there was a significant reduction in smoking, as well as in blood pressure, with no changes in the control of dyslipidaemia or in diabetes mellitus. There were 9 events in the first year, with 6 cases of unstable angina, 2 myocardial infarctions, and one stroke. In the evaluation at the fifth year the quitting smoking was maintained, with an increase in arterial hypertension. There were 8 cases of unstable angina, corresponding to 10% of the cardiovascular events. Conclusions: A low rate of cardiovascular events was identified in the one year and five year follow-up of post-kidney transplant patients from the Hospital Universitario San Ignacio, with a change in the prevalence of some of cardiovascular risk factors.

Acute transverse colon volvulus with secondary gastric ischemia. Case report

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Metodología del análisis de costo-efectividad (ACE) en la práctica clínica / Methodology of Cost-effectiveness Analysis in Clinic Practice / Metodologia de análise de custo-efetividade em prática clínica

Objetivo: Ilustrar la metodología detrás del análisis de costo-efectividad en la práctica clínica actual. Métodos: Revisión narrativa de algunos de los principales aportes en esta área. Desarrollo: La primera parte se encarga de explicar la importancia que tienen las evaluaciones económicas (en especial, el análisis de costo-efectividad) para los sistemas de salud en el mundo y los hacedores de política pública. En la segunda parte, el artículo desglosa cada aspecto de la metodología para otorgar herramientas suficientes a la hora de construir una evaluación de este tipo. Se ofrecen diagramas de herramientas conocidas como los árboles de decisión y el modelo de Markov, para entender a fondo los resultados y poder interpretarlos de manera correcta. Se exponen las ventajas y las limitaciones de la evaluación de costo-efectividad. Conclusión: Se proveen las bases del análisis de costo-efectividad para soportar los estudios de este tipo.

Objective: To illustrate the methodology behind the cost-effectiveness analysis in clinical practice. Methods: Narrative revision of some of the main contributions in this area. Development: The first part explains the importance of economic evaluations (especially cost-effectiveness analysis) for health systems and policy makers around the world. In the second part, the methodology behind this type of analysis is broken down to facilitate the construction of an economic evaluation. Diagrams of tools, such as decision trees and Markov models, are used to help understand and interpret results in an appropriate fashion. Advantages and limitations of the cost-effectiveness analysis are explained thoroughly. Conclusion: The basis of cost-effectiveness analysis is provided to support studies of this type

Objetivo: Ilustrar a metodologia por trás da análise custo-eficácia na prática clínica atual. Métodos: Revisão narrativa de algumas das principais contribuições nesta área. Desenvolvimento: A primeira parte é responsável por explicar a importância que tem as avaliações econômicas, em especial a análise custo-eficácia para os sistemas de saúde no mundo e os formuladores de políticas públicas. Na segunda parte, o artigo separa cada aspecto da metodologia para fornecer ferramentas suficientes no momento de construir uma avaliação deste tipo. São oferecidos diagramas como ferramentas, conhecidos como árvores de decisão e o modelo de Markov, para entender a profundidade dos resultados e poder interpretá-los corretamente. São apresentadas as vantagens e limitações da avaliação de custo-eficácia. Conclusão: Provimento das bases de análise de custo-efetividade para apoiar os estudos deste tipo.