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The g.37190613 locus on 7p14.2-14.1 in the ELMO1 gene has a G>A polymorphism (SNP rs1345365) that has been associated with diabetic nephropathy in different populations. The genetic-association studies in type 2 diabetes mellitus (DM2) on the Mexican population are limited. The aim of this study was to estimate whether the polymorphism G>A of ELMO1 gene is associated with the development of DM2. We included 148 DM2 individuals, 156 individuals with cardiovascular risk factors without diabetes and 269 healthy proband without DM2. The polymorphism was identified by PCR amplification specific allele (PASA), PAGE and silver staining. The association was established by genetic epidemiological models; the dominant model showed a positive association (p=0.0006) as a protective factor, and the para-dominant model to heterozygous, as risk factor. In conclusion, this study revealed the association of the SNP rs1345365 of the ELMO1 gene in a Mexican population.
Subject(s)
Adaptor Proteins, Signal Transducing/genetics , Diabetes Mellitus, Type 2/genetics , Adult , Genetic Predisposition to Disease , Humans , Male , Mexico , Middle Aged , Polymorphism, Single Nucleotide , Racial GroupsABSTRACT
BACKGROUND: Estimating the burden of disease averted by vaccination can assist policymakers to implement, adjust, and communicate the value of vaccination programs. Demonstrating the use of a newly available modeling tool, we estimated the burden of influenza illnesses averted by seasonal influenza vaccination in El Salvador, Panama, and Peru during 2011-2017 among two influenza vaccine target populations: children aged 6-23 months and pregnant women. METHODS: We derived model inputs, including incidence, vaccine coverage, vaccine effectiveness, and multipliers from publicly available country-level influenza surveillance data and cohort studies. We also estimated changes in illnesses averted when countries' vaccine coverage was achieved using four different vaccine deployment strategies. RESULTS: Among children aged 6-23 months, influenza vaccination averted an estimated cumulative 2,161 hospitalizations, 81,907 medically-attended illnesses, and 126,987 overall illnesses during the study period, with a prevented fraction ranging from 0.3 % to 12.5 %. Among pregnant women, influenza vaccination averted an estimated cumulative 173 hospitalizations, 6,122 medically attended illnesses, and 16,412 overall illnesses, with a prevented fraction ranging from 0.2 % to 10.9 %. Compared to an influenza vaccine campaign with equal vaccine distribution during March-June, scenarios in which total cumulative coverage was achieved in March and April consistently resulted in the greatest increase in averted illness (23 %-3,129 % increase among young children and 22 %-3,260 % increase among pregnant women). DISCUSSION: Influenza vaccination campaigns in El Salvador, Panama, and Peru conducted between 2011 and 2018 prevented hundreds to thousands of influenza-associated hospitalizations and illnesses in young children and pregnant women. Existing vaccination programs could prevent additional illnesses, using the same number of vaccines, by achieving the highest possible coverage within the first two months of an influenza vaccine campaign.
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OBJECTIVE: To quantify rates of influenza illness and assess value of influenza vaccination among pregnant women in Panama and El Salvador. METHODS: Pregnant women were enrolled and followed each week in a prospective cohort study to identify acute respiratory illnesses (ARI). Nasopharyngeal swabs obtained from women with febrile ARI were tested by reverse-transcription polymerase chain reaction for influenza and other respiratory viruses. RESULTS: We enrolled 2556 women between October 2014 and April 2017. Sixteen percent developed at least one ARI; 59 had two ARI, and five had three ARI for a total of 463 ARI. Women in El Salvador and Panama contributed 297 person-years (py) and 293 py, respectively, during influenza circulation. Twenty-one (11%) of 196 sampled women tested positive for influenza. Influenza incidence was 5.0/100 py (5.7/100 py in El Salvador and 4.3/100 py in Panama). Only 13% of women in El Salvador and 43% in Panama had been vaccinated against influenza before influenza epidemics (P < 0.0001). CONCLUSIONS: One in six pregnant women developed ARI and more than one in ten ARI were attributable to vaccine-preventable influenza. While women were at risk of influenza, few had been vaccinated before each epidemic. Such findings suggest the utility of evaluations to optimize vaccine timing and coverage.
Subject(s)
Influenza Vaccines , Influenza, Human , Viruses , Cohort Studies , Female , Humans , Incidence , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Pregnancy , Pregnant Women , Prospective StudiesABSTRACT
BACKGROUND: We established cohorts to assess associations between viral influenza and cognitive development to inform the value proposition of vaccination. METHODS: From 2014 through 2017, we called women seeking care at four prenatal clinics in Panama and El Salvador to identify acute respiratory illnesses (ARIs). Within 2 weeks of childbirth, mothers were asked to enroll their neonates in the cognitive development study. Staff obtained nasopharyngeal swabs from children with febrile ARIs for real-time reverse transcription polymerase chain reaction (rtPCR) detection of viral RNA. Toddlers were administered Bayley developmental tests at ages 12 and 18-24 months. We used multilevel linear regression to explore associations between Bayley scores, ARIs, fever, and laboratory-confirmed influenza, controlling for maternal respiratory or Zika illnesses, infant influenza vaccination, birth during influenza epidemics, and the number of children in households. RESULTS: We enrolled 1567 neonates of which 68% (n = 1062) underwent developmental testing once and 40% (n = 623) twice. Children with previous ARIs scored an average of 3 points lower on their cognitive scores than children without ARIs (p = 0.001). Children with previous fevers scored an average of 2.1 points lower on their cognitive scores than afebrile children (p = 0.02). In the second year, children with previous laboratory-confirmed influenza scored 4 points lower on their cognitive scores than children without influenza (p = 0.04, after controlling for first Bayley cognitive scores). CONCLUSIONS: ARIs and fever during infancy were associated with lower Bayley scores at 12 months, and laboratory-confirmed influenza was associated with lower cognitive scores at 24 months suggesting the potential value of vaccination to prevent non-respiratory complications of influenza.
Subject(s)
Influenza, Human , Respiratory Tract Infections , Zika Virus Infection , Zika Virus , Birth Cohort , Child, Preschool , Cognition , Female , Fever/epidemiology , Humans , Infant , Infant, Newborn , Influenza, Human/diagnosis , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Pregnancy , Respiratory Tract Infections/epidemiology , VaccinationABSTRACT
Background: Respiratory viruses remain a key cause of early childhood illness, hospitalization, and death globally.The recent pandemic has rekindled interest in the control of respiratory viruses among paediatric populations. We estimate the burden of such viruses among children <2 years. Methods: Enrolled neonates were followed until two years of age. Weekly active symptom monitoring for the development of acute respiratory illnesses (ARI) defined as cough, rhinorrhoea, difficulty breathing, asthenia, anorexia, irritability, or vomiting was conducted. When the child had ARI and fever, nasopharyngeal swabbing was performed, and samples were tested through singleplex RT-PCR. Incidence of respiratory viruses was calculated by dividing the number of laboratory-confirmed detections by the person-time accrued during weeks when that virus was detectable through national surveillance then corrected for under-ascertainment among untested children. Findings: During December 2014-November 2017, 1567 enrolled neonates contributed 2,186.9 person-years (py). Six in ten (64·4%) children developed ARI (total 2493 episodes). Among children <2 years, incidence of respiratory syncytial virus (RSV)-associated ARI episodes (21·0, 95%CI 19·3-22·8, per 100py) and rhinovirus-associated (20·5, 95%CI 20·4-20·7) were similar and higher than parainfluenza 1-3-associated (14·2, 95%CI 12·2-16·1), human metapneumovirus-associated (9·2, 95%CI 7·7-10·8), influenza-associated (5·9, 95%CI 4·4-7·5), and adenovirus-associated ARI episodes (5·1, 95%CI 5·0-5·2). Children aged <3 months had the highest rates of RSV ARI (49·1, 95%CI 44·0-54·1 per 100py) followed by children aged 3-5 (25·1, 95%CI 20·1-30·0), 6-11 (17·6, 95%CI 13·2-21·9), and 12-23 months (11·9, 95%CI 10·8-12·9). One in ten children with RSV was referred to the hospital (2·5, 95%CI 2·1-2·8, per 100py). Interpretation: Children frequently developed viral ARI and a substantive proportion required hospital care. Such findings suggest the importance of exploring the value of new interventions and increasing uptake of existing prevention measures to mitigate burden of epidemic-prone respiratory viruses. Funding: The study was supported by the Centers for Disease Control and Prevention.
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We assessed EV-D68 epidemiology and phylogenetics among children aged ≤9 years hospitalized with severe acute respiratory illnesses at five sites in Panama and El Salvador during 2012-2013. Respiratory specimens positive for enterovirus or rhinovirus were tested by real-time RT-PCR for EV-D68, and partial VP1 gene sequences were determined. Of 715 enrolled children, 17 from sites in both countries were EV-D68-positive and commonly had a history of asthma or wheezing. Phylogenetically, 15 of 16 sequences fell into Clade B1, and one into Clade A2. The Central American EV-D68s were closely related genetically to contemporaneous strains from North America, South America, and the Caribbean.
Subject(s)
Enterovirus D, Human , Enterovirus Infections , Respiratory Tract Infections , Child , Child, Hospitalized , Disease Outbreaks , El Salvador/epidemiology , Enterovirus D, Human/genetics , Enterovirus Infections/epidemiology , Humans , Infant , Panama/epidemiology , Respiratory Tract Infections/epidemiologyABSTRACT
Eccrine spiradenoma (ES) is a benign uncommon tumor of skin adnexa with a characteristic clinical and histopathological presentation. Typically, it presents as a painful, slow growing and solitary nodule on the head or upper trunk in adult patients. We report a child with linear ES which presented with asymptomatic papulonodular lesions in a blaschkoid distribution on the face. Cases reported in the literature of multiple spiradenomas are very rare and multiple linear lesions are even rarer. To date, 21 cases of linear/multiple ES have been reported. Of these, eight were in children or adolescents. We report an additional case of this rare clinical presentation and review the literature.
Subject(s)
Adenoma, Sweat Gland/congenital , Eccrine Glands/pathology , Neoplasms, Multiple Primary/congenital , Sweat Gland Neoplasms/congenital , Adenoma, Sweat Gland/pathology , Child , Female , Humans , Neoplasms, Multiple Primary/pathology , Sweat Gland Neoplasms/pathologyABSTRACT
BACKGROUND AND OBJECTIVES: Although acute respiratory illness (ARI) is a leading cause of hospitalization among young children, few data are available about cost of hospitalization in middle-income countries. We estimated direct and indirect costs associated with severe ARI resulting in hospitalization among children aged <10 years in El Salvador and Panama through the societal perspective. METHODS: During 2012 and 2013, we surveyed caregivers of children hospitalized with ARI about their direct medical (i.e., outpatient consultation, medications, hospital fees), non-medical (transportation, childcare), and indirect costs (lost wages) at discharge and 7 days after discharge. We multiplied subsidized hospital bed costs derived from administrative data by hospitalization days to estimate provider costs. RESULTS: Overall, 638 children were enrolled with a median age of 12 months (IQR 6-23). Their median length of hospitalization was 4 days (IQR 3-6). In El Salvador, caregivers incurred a median of US$38 (IQR 22-72) in direct and indirect costs per illness episode, while the median government-paid hospitalization cost was US$118 (IQR 59-384) generating an overall societal cost of US$219 (IQR 101-416) per severe ARI episode. In Panama, caregivers incurred a median of US$75 (IQR 39-135) in direct and indirect costs, and the health-care system paid US$280 (IQR 150-420) per hospitalization producing an overall societal cost of US$393 (IQR 258-552). CONCLUSIONS: The cost of severe ARI to caregivers and the health care system was substantive. Our estimates will inform models to estimate national costs of severe ARI and cost-benefit of prevention and treatment strategies.
Subject(s)
Cost of Illness , Hospitalization , Respiratory Tract Infections/epidemiology , Virus Diseases/epidemiology , Acute Disease , Age Factors , Child , Child, Preschool , Cost-Benefit Analysis , El Salvador/epidemiology , Female , Health Expenditures , Humans , Infant , Infant, Newborn , Male , Panama/epidemiology , Patient Acceptance of Health Care , Public Health Surveillance , Socioeconomic FactorsABSTRACT
Introducción: La innovación en la atención de la salud es una fuerza impulsora en la búsqueda de un equilibrio entre la limitación de costos y la calidad de la atención médica y, en la actualidad, emerge como paradigma la innovación integral que no descuida ninguna de sus dimensiones y se desarrolla en sus distintos niveles: de país, de institución y de las personas que la llevan a vías de hecho. Objetivo: Estudiar la trayectoria de innovación que, con un enfoque integral, ha llevado al Centro Nacional de Cirugía de Mínimo Acceso a convertirse en obligada referencia cuando se habla de instituciones hospitalarias con un alto nivel de calidad del servicio que se presta, en pro de la salud pública del país. Posicionamiento: La innovación integral, que combina la introducción de tecnologías médicas con innovaciones organizacionales en sistemas de gestión, permite alcanzar resultados importantes en la calidad de la atención médica y la formación de profesionales competentes en procederes terapéuticos y quirúrgicos mínimamente invasivos. Conclusiones: El análisis realizado permitió definir cuatro etapas en la trayectoria de innovación del Centro Nacional de Cirugía de Mínimo Acceso: Núcleo (1980-1992), Fundación (1993-2005), Consolidación (2006-2015), Acreditación y Certificación (2016-2022). Se caracterizan los elementos esenciales de cada etapa hasta llegar a la actual, en la que se logra que los resultados de la innovación organizacional y en tecnologías médicas del centro sean reconocidos en diferentes instancias y contribuyan a brindar servicios de salud de alta calidad.
Introduction: Innovation in health care is a driving force in the search for a balance between cost limitation and quality of medical care; today comprehensive innovation that does not neglect any of its dimensions, emerging as a paradigm. It is developed at its different levels: country, institution and the people who take it to reality. Objective: To study the trail of innovation that, with a comprehensive approach, has led the National Center for Minimum Access Surgery to become an unavoidable reference when talking about hospital institutions with a high level of quality of service, in favor of the public health of the country. Positioning: Comprehensive innovation, which combines the introduction of medical technologies with organizational innovations in management systems, allows achieving important results in the quality of medical care and the training of competent professionals in minimally invasive therapeutic and surgical procedures. Conclusions: The analysis carried out allowed us to define four stages in the innovation trajectory of the National Center for Minimum Access Surgery: Nucleus (1980-1992), Foundation (1993-2005), Consolidation (2006-2015), Accreditation and Certification (2016- 2022). The essential elements of each stage are characterized up to reaching the current one, in which the results of this institution's organizational innovation and medical technologies are recognized at different instances, and they contribute to providing high-quality health services.
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Introducción: El Programa de Maestría en Cirugía de Mínimo Acceso responde a necesidades sociales y perspectivas del Sistema Nacional de Salud. Los resultados de sus investigaciones impactan en los Objetivos de Desarrollo Sostenible No. 3 Salud y bienestar y No. 4 Educación de calidad. Objetivo: Exponer cómo la Maestría en Cirugía de Mínimo Acceso impacta en el desarrollo sostenible, a partir de las investigaciones realizadas. Métodos: Se realizó una investigación cualitativa y retrospectiva en el Centro Nacional de Cirugía de Mínimo Acceso. La técnica de investigación empleada fue el análisis documental y bibliográfico, con la revisión de los informes de las tesis finales de maestría y de la autoevaluación del programa, en sus dos primeras ediciones (2015 y 2018), según el Sistema de Evaluación y Acreditación de Maestrías. Resultados: El Programa contó con 30 egresados, cuyas investigaciones abordaron el tratamiento laparoscópico del cáncer entre otros temas. Asimismo, la producción científica en la Edición 02 resultó de 100 publicaciones, 159 reconocimientos sociales relevantes y la edición de 3 libros. Conclusiones: La investigación y la creación de conocimiento e innovación en el Programa de Maestría en Cirugía de Mínimo Acceso han permitido fomentar soluciones de desarrollo sostenible en esta área del conocimiento. La producción científica y la socialización de los resultados obtenidos en eventos nacionales e internacionales propician su implementación en el Sistema Nacional de Salud. De esta forma, los resultados de investigación del programa contribuyen al logro de los Objetivos de Desarrollo Sostenible(AU)
Introduction:The program of the Master's degree in Minimal Access Surgery responds to social needs and perspectives of the national health system. The results of its research have an impact on Sustainable Development Goals 3, "Good health and well-being, and 4, Quality education. Objective: To present how the Master's Degree Course in Minimal Access Surgery impacts on sustainable development, upon the base of the researches conducted. Methods: A qualitative and retrospective research was carried out at the National Center for Minimal Access Surgery. The research technique used was the document and bibliographic analysis, with the review of the reports of the final master's theses and the self-evaluation of the program, in its first two editions (2015 and 2018), according to the Evaluation and Accreditation System for Master's Degree Programs. Results: The program had 30 graduates, whose researches addressed, among other topics, the laparoscopic treatment of cancer. Also, the scientific production in the Edition 02 turned out to be one hundred publications, 159 relevant social recognitions, and the edition of three books. Conclusions: Research and the creation of knowledge and innovation in the Master's Degree Program in Minimal Access Surgery have allowed fostering sustainable development solutions in this area of knowledge. The scientific production and the socialization of the results obtained in national and international events favor their implementation in the national health system. Thus, the research results of the program contribute to the achievement of the Sustainable Development Goals(AU)
Subject(s)
Humans , Publishing , Achievement , Minimally Invasive Surgical Procedures/education , Knowledge , Research Report , Sustainable Development/trends , Retrospective Studies , Qualitative Research , Health Postgraduate ProgramsABSTRACT
Introducción: El Síndrome de la Arteria Mesentérica Superior es causa poco frecuente de obstrucción duodenal. Los síntomas varían desde una obstrucción leve hasta emergencias agudas. El examen físico no siempre ayuda al diagnóstico, que se basa en los hallazgos imagenológicos. Objetivo: preconizar, recomendar el uso de las técnicas mínimamente invasivas en el manejo quirúrgico del Síndrome de la Arteria Mesentérica Superior. Presentación del caso: Mujer de 49 años de edad, antecedentes de pérdida de peso después de quimioterapia con náuseas, vómitos y dolor abdominal posprandial de dos años de evolución. Tratada exitosamente con duodenoyeyunostomía laparoscópica. El tratamiento inicial suele ser conservador. Publicaciones recientes respaldan que la duodenoyeyunostomía laparoscópica es un método seguro y efectivo para su tratamiento. Conclusiones: El tratamiento quirúrgico es cada vez más exitoso, la mayoría de los pacientes no presenta síntomas después de la cirugía(AU)
Introduction: Superior Mesenteric Artery Syndrome is an uncommon cause of duodenal obstruction. Symptoms may vary from mild obstruction to acute life-threatening emergencies. Physical examination does not always help in establishing the diagnosis which is based on findings from imaging studies. Objective: To recommend the laparoscopic approach for the surgical treatment of this entity. Case presentation: A 49-year old female patient with prior history of weight loss after chemotherapy and a two-year history of postprandial nausea, vomiting, and abdominal pain who was successfully treated by laparoscopic duodenojejunostomy is presented. Discussion: Initial treatment is usually conservative. Recently published studies support that laparoscopic duodenojejunostomy is a safe and effective method of treatment. Conclusions: Surgical treatment is becoming more successful and the majority of patients are symptom-free after surgery(AU)
Subject(s)
Female , Middle Aged , Superior Mesenteric Artery Syndrome/therapy , Abdominal Pain , Drug Therapy , Duodenal Obstruction/complications , Weight Loss , Duodenoscopy/methodsABSTRACT
Introducción: La esofagitis eosinofílica es una enfermedad emergente, caracterizada por infiltración del esófago por leucocitos eosinófilos. Sus principales síntomas son la disfagia y las frecuentes impactaciones de alimento en el esófago. Actualmente existen evidencias científicas que reconocen la enfermedad como causa posible de evolución no favorable en pacientes después de miotomía de Héller. Objetivo: Describir las evidencias biomoleculares que asocian la esofagitis eosinofílica y la acalasia esofágica. Métodos: Se realizó una revisión sistemática y crítica de las evidencias sobre los mecanismos biomoleculares asociados a la esofagitis eosinofílica y la acalasia esofágica. Se consultaron artículos publicados entre 2015 y 2020 e indexados en las bases de datos PubMed, SciELO, LILACS y Scopus. Análisis e integración de la información: Se discute sobre cuestiones medulares que han sido publicadas recientemente respecto al tema en cuestión. ¿Pueden coexistir la esofagitis eosinofílica y la acalasia esofágica? ¿Influye la esofagitis eosinofílica en el resultado del tratamiento de la acalasia esofágica? ¿Qué investigaciones serían necesarias para establecer la relación entre las dos enfermedades? Conclusiones: Los mecanismos celulares y biomoleculares desencadenados por la infiltración eosinofílica contextualizan la diferencia etiológica y fisiopatológica de la esofagitis eosinofílica y la acalasia esofágica, lo cual sustenta la evolución desfavorable posmiotomía de los pacientes y motiva la realización de estudios prospectivos y controlados con el fin de ofrecer una mejor calidad de vida(AU)
Introduction: Eosinophilic esophagitis is an emerging disease characterized by infiltration of the esophagus by eosinophilic leukocytes. Its main symptoms are dysphagia and frequent food impaction in the esophagus. Scientific evidence is now available that recognizes the disease as the possible cause of unfavorable evolution in patients undergoing Heller myotomy. Objective: Describe the biomolecular evidence associating eosinophilic esophagitis to esophageal achalasia. Methods: A systematic critical review was conducted of the evidence about biomolecular mechanisms associated to eosinophilic esophagitis and esophageal achalasia. The articles consulted were published in the databases PubMed, SciELO, LILACS and Scopus from 2015 to 2020. Data analysis and integration: A discussion is provided about crucial questions published recently concerning the study topic: Can eosinophilic esophagitis and esophageal achalasia coexist? Does eosinophilic esophagitis influence the result of esophageal achalasia treatment? What studies are required to establish the relationship between the two conditions? Conclusions: The cellular and biomolecular mechanisms triggered by eosonophilic infiltration contextualize the etiological and pathophysiological difference between eosinophilic esophagitis and esophageal achalasia. This explains the unfavorable post-myotomy evolution of patients and encourages the conduct of prospective controlled studies aimed at enhancing quality of life(AU)
Subject(s)
Humans , Esophageal Motility Disorders/complications , Deglutition Disorders/complications , Esophageal Achalasia , Eosinophilic Esophagitis , Heller Myotomy/methods , Prospective StudiesABSTRACT
Introducción: La convivencia con la infección por COVID-19 en Cuba supone un reto actual de adaptación a todos los entornos hospitalarios y de salud, creación de protocolos y nuevos modelos de asistencia. La intervención sobre la vía aérea en sus diferentes formas, conlleva un riesgo de contaminación al personal de la salud. Objetivo: Describir las consideraciones anestésicas en los procedimientos laparoscópicos y endoscópicos durante la pandemia COVID-19. Métodos: Se realizó un estudio cualitativo, de investigación-acción, apoyado en el análisis de documentos y la observación participante de las acciones tomadas en el Centro Nacional de Cirugía de Mínimo Acceso en el curso de los cuatro meses transcurridos a partir de que se identificara el primer caso de COVID-19 en Cuba. Resultados: Se establecieron las recomendaciones anestésicas para el procedimiento de actuación durante la COVID-19 en el Centro Nacional de Cirugía de Mínimo Acceso, que dictan las acciones para el tratamiento de los pacientes y la protección de los trabajadores. Esto posibilita mantener la calidad de los servicios médico quirúrgicos en estos escenarios de riesgo. Conclusiones: La evaluación y tratamiento anestésico estandarizado de los pacientes ante el brote de COVID-19 y en la fase poscovid permite optimizar la seguridad del paciente y el personal sanitario. Es importante el cumplimiento de los protocolos dirigidos hacia el control estricto de la parada quirúrgica, uso adecuado de los equipos de protección personal, disminución de los aerosoles con métodos de barrera y la desinfección del salón y equipos al concluir la intervención(AU)
Introduction: Coexistence with COVID-19 infection in Cuba is a current challenge of adaptation to all hospital and health settings, creation of protocols and new models of care. The airway approach in its different forms represents a risk of contamination of the health personnel. Objective: To describe the anesthetic considerations in laparoscopic and endoscopic procedures during the COVID-19 pandemic. Methods: A qualitative, action-research study was carried out, supported by the analysis of documents and participant observation of the actions taken in the National Center for Minimally-Invasive Surgery in the course of four months after the first case of COVID-19 was identified in Cuba. Results: Anesthetic recommendations were established for the action procedure during COVID-19 in the National Center for Minimally-Invasive Surgery, which dictate the actions for the treatment of patients and the protection of workers. This makes it possible to maintain the quality of surgical medical services in these risk settings. Conclusions: Assessment and standardized anesthetic treatment of patients in the face of the COVID-19 outbreak and in the post-COVID phase allows optimizing the safety of the patient and the healthcare personnel. It is important to comply with the protocols aimed at controlling strictly the surgical setting, proper use of personal protective equipment, reduction of aerosols with barrier methods, and disinfection of the room and equipment at the conclusion of the intervention(AU)
Subject(s)
Humans , Coronavirus Infections/prevention & control , Patient Safety , Laparoscopy/methods , Endoscopy/methods , Evaluation Studies as Topic , Anesthesia/standardsABSTRACT
BACKGROUND: Oseltamivir reduces symptom duration among children with uncomplicated influenza, but few data exist on treatment efficacy and tolerability among hospitalized children, particularly among infants aged <1 year. We evaluated tolerability and efficacy of oseltamivir treatment of children aged 0-9 years hospitalized with influenza. METHODS: We conducted a double-blind, randomized, placebo-controlled trial at tertiary care hospitals in El Salvador and Panama. Primary outcomes were length of hospitalization and increased work of breathing. Children were eligible if hospitalized <7 days after symptom onset with cough or sore throat plus tachypnea. Children were randomized 1:1 to receive oseltamivir or placebo; had swabs collected at enrollment for influenza RT-PCR testing; were assessed at enrollment and every 12 h for work of breathing; and were followed for adverse events through 7 days after discharge. Analyses were intention-to-treat. RESULTS: Overall, 683 children were randomized (oseltamivir, n = 341, placebo n = 342). Fifty-three percent were aged <1 year and 30 had influenza (oseltamivir, n = 19; placebo, n = 11). The study was terminated early after enrollment of 21% of the sample size due to lower than anticipated participant accrual. Using Kaplan-Meier analysis, there was no significant difference in median length of hospitalization (3 days, IQR 2-4 vs. 5 days, IQR 3-7, p = 0.22) and increased work of breathing (36 h, IQR 24-72 vs. 96 h, IQR 13-108, p = 0.14) between oseltamivir versus placebo recipients. There was no difference in adverse events between groups. CONCLUSION: Oseltamivir treatment was well tolerated among hospitalized children, including among infants aged <1 year.
Subject(s)
Antiviral Agents/therapeutic use , Influenza, Human/drug therapy , Oseltamivir/therapeutic use , Antiviral Agents/administration & dosage , Antiviral Agents/adverse effects , Child , Child, Preschool , Comorbidity , El Salvador , Female , Hospitalization , Humans , Infant , Infant, Newborn , Influenza, Human/diagnosis , Influenza, Human/virology , Length of Stay , Male , Oseltamivir/administration & dosage , Oseltamivir/adverse effects , Panama , Severity of Illness Index , Treatment OutcomeABSTRACT
Introducción: En 2018 la Organización Internacional de Normalización publicó la norma ISO 21001 para los sistemas de gestión de las organizaciones educativas. Su implementación en la formación académica de posgrado permitirá brindar un servicio educativo que cumpla de manera consistente con los requisitos legales, encaminado a elevar la satisfacción de todas las partes interesadas. Estos planteamientos se evidenciaron en dos organizaciones que brindan programas de maestría y de especialidad en el posgrado. Objetivo: Analizar los requisitos de la norma ISO 21001 para su uso en organizaciones que brindan servicios de formación de posgrado académico, fundamentalmente programas de maestría. Desarrollo: Con la implementación de la norma ISO 21001 se pretende ofrecer un mejor servicio educativo, a partir de evaluar el grado en el que se satisfacen los requisitos de los estudiantes, sus familias, los profesores, el mercado laboral y la sociedad en general. Para ello, el sistema de gestión de la organización educativa incluye a todos los procesos, las personas y las formas de actuación necesarias para lograr servicios y productos educativos de calidad. Para demostrar la aplicación de la norma al posgrado académico se emplearon como casos de estudio los programas de maestría del Centro de Biomateriales de la Universidad de La Habana y del Centro Nacional de Cirugía de Mínimo Acceso. Conclusiones: La norma ISO 21001, aplicada al posgrado académico, permite gestionar internamente la calidad de los servicios formativos para satisfacer las necesidades y expectativas de todas las partes interesadas y lograr categorías superiores de acreditación(AU)
Introduction: In 2018, the International Organization for Standardization published the Standard ISO 21001, Educational Organization Management System. Its implementation in postgraduate academic training will allow providing an educational service that consistently complies with the legal requirements, aimed at raising the satisfaction of all interested parties. These elements were evidenced in two organizations that provide master's and specialty programs in postgraduate education. Objective: To analyze the Standard ISO 21001's requirements for its usage in organizations that provide academic postgraduate training services, mainly master's programs. Development: With the implementation of the Standard ISO 21001, the aim is to offer better educational service, based on the evaluation of the degree to which the students', their families', professors', the labor market's, and the overall society's requirements are met. In view of this, the educational organization management system includes all the processes, people and forms of action necessary to achieve quality educational services and products. In order to show the Standard's application to the academic postgraduate course, we used, as study cases, the master's programs from the Center of Biomaterials at University of Havana and from the National Center of Minimum Access Surgery. Conclusions: The Standard ISO 21001, applied to the academic postgraduate course, allows managing internally the quality of training services, in view of fulfilling the needs and expectations of all interested parties and achieving higher accreditation categories(AU)
Subject(s)
Humans , Reference Standards , General Surgery , AccreditationABSTRACT
Introducción: En el Centro Nacional de Cirugía de Mínimo Acceso desde 2015 se implementó el Sistema de Gestión de la Calidad NC-ISO 9001:2015. Sin embargo, en el proceso de posgrado los riesgos no se han gestionado de forma sistemática e integral, lo que puede afectar su desempeño. Objetivo: Identificar los factores de riesgo que influyen en el desempeño del proceso de formación de posgrado y planificar las acciones para su tratamiento. Métodos: Se realizó un estudio de tipo cualitativo, no experimental, en el período comprendido entre febrero y marzo de 2019. Para el diagnóstico de los riesgos se emplearon las técnicas de grupo focal, la matriz DAFO, la encuesta y el análisis de causa-efecto de Ishikawa. Además, la matriz de probabilidad-consecuencia se utilizó para evaluar la prioridad de los riesgos identificados. Resultados: El diagnóstico permitió fundamentar la necesidad de gestionar integralmente los riesgos que inciden en el proceso de formación de posgrado. Nueve de los riesgos identificados se consideran altos y tienen la máxima prioridad para el establecimiento de medidas de control. Siete son moderados y también se toman medidas para su minimización. Conclusiones: Los riesgos identificados están en relación con la planificación inadecuada de los indicadores del proceso y la no inclusión de todos los aspectos que inciden sobre la gestión del posgrado. El tratamiento de los riesgos según su prioridad permitirá elevar el desempeño del proceso y cumplir los requisitos de la norma NC-ISO 9001:2015(AU)
Introduction: In the National Center for Minimally Invasive Surgery, the NC-ISO 9001: 2015 Quality Management System was implemented since 2005. However, in the postgraduate process, the risks have not been systematically and comprehensively managed, which may affect performance. Objective: To identify the risk factors that influence performance of the postgraduate training process and to plan the actions for their treatment. Methods: A qualitative, non-experimental study was carried out in the period between February and March 2019. For the diagnosis of risks, some techniques were used, such as focus group, the SWOT matrix, the survey, and Ishikawa's cause-and-effect analysis. In addition, the probability-consequence matrix was used to assess the priority of the identified risks. Results: The diagnosis allowed to provide the foundations for the need to manage comprehensively the risks that affect the postgraduate training process. Nine of the identified risks are considered high and have the highest priority for the establishment of control measures. Seven are moderate and also measures are taken for their minimization. Conclusions: The risks identified are related to inadequate planning of the process indicators and the non-inclusion of all aspects that affect management in the postgraduate level. The treatment of the risks according to their priority will allow to increase the performance of the process and meet the requirements of the NC-ISO 9001: 2015 standard(AU)
Subject(s)
Humans , Risk Factors , Health Postgraduate ProgramsABSTRACT
RESUMEN Introducción: La gestión del conocimiento es vital para las organizaciones de salud con vistas a garantizar la calidad de sus servicios. Objetivo: Evaluar la gestión del conocimiento en el Centro Nacional de Cirugía de Mínimo Acceso. Métodos: Se realizó una investigación descriptiva de tipo transversal. Se elaboró, validó y aplicó una encuesta a 20 trabajadores del Centro en los meses de noviembre y diciembre de 2018. Se estudió la variable gestión del conocimiento, a través de sus elementos caracterizadores, los cuales fueron evaluados en dos dimensiones: importancia y frecuencia. Los datos se procesaron mediante los métodos de estadística descriptiva con el uso del programa SPSS v.21. Resultados: Se identificaron el compromiso de la alta dirección del centro con la gestión del conocimiento, la existencia de una infraestructura tecnológica suficiente para apoyar sus actividades, así como la necesidad de fortalecer los intercambios entre especialistas para compartir los resultados de investigación y aprovechar las lecciones aprendidas de los errores médicos y las no conformidades, para lo cual se requirió destinar tiempo y recursos. Conclusiones: El Centro Nacional de Cirugía de Mínimo Acceso es una institución con una destacada actividad en gestión del conocimiento. La aplicación de la encuesta para evaluar la gestión del conocimiento en el centro permitió identificar las oportunidades de mejora necesarias en apoyo a la innovación y la calidad del servicio de salud que se presta, lo que potencia aún más actividades como la formación profesional y el intercambio de las lecciones aprendidas entre los especialistas para el aprendizaje organizacional.
ABSTRACT Introduction: Knowledge management is vital for health organizations in order to guarantee the quality of their services. Objective: To evaluate knowledge management at the National Center for Limited Access Surgery. Methods: A descriptive cross-sectional investigation was carried out. A survey was prepared, validated and applied to 20 employees at this institution from November to December 2018. The knowledge management variable was studied, through its characterizing elements, which were evaluated in two dimensions: importance and frequency. The data were processed through descriptive statistics methods with the use of SPSS v.21 program. Results: The investigation identified the institution top management commitment with knowledge management, the existence of a sufficient technological infrastructure to support its activities, as well as the need to strengthen exchanges between specialists to share research results and take advantage of lessons learned from medical errors and non-conformities, for which time and resources were required. Conclusions: The National Center for Limited Access Surgery is an institution with outstanding activity in knowledge management. The application of the survey to evaluate knowledge management in the institution allowed identifying the necessary improvement opportunities in support of innovation and the quality of the health service provided, which further enhances professional training and exchange of lessons learned among specialists for organizational learning.
Subject(s)
Humans , Quality of Health Care/trends , Knowledge Management , Surgicenters , Minimally Invasive Surgical ProceduresABSTRACT
RESUMEN Introducción: El desescalamiento de las medidas para controlar la epidemia por la COVID-19 en Cuba no exonera la vigilancia permanente para evitar rebrotes. Objetivo: Mostrar el diseño de un sistema de vigilancia epidemiológica hospitalaria para la detección precoz de casos sospechosos en la etapa pos COVID-19. Métodos: Investigación cualitativa. Se localizó información en las bases de datos Lilacs, Ebsco e Hinari con los descriptores: vigilancia en salud, monitoreo epidemiológico y servicios de vigilancia epidemiológica. A partir de las definiciones de casos objeto de vigilancia, se definieron los objetivos del sistema, premisas, atributos y subsistemas. Se tuvo en cuenta la metodología utilizada en un sistema de vigilancia en Cuba desarrollado y modificado por especialistas cubanos. Resultados: El sistema se estructura a partir de cuatro componentes: entrada de datos, procesamiento de los datos obtenidos de encuestas epidemiológicas aplicadas a pacientes y acompañantes, salida de la información con la descripción del tipo de caso y retroalimentación; está conformado por cuatro subsistemas: Diagnóstico Clínico, de Laboratorio, Epidemiológico y Estadístico. El sistema ha detectado precozmente casos sospechosos en pacientes hospitalizados, previo a la intervención quirúrgica y a otros procederes mínimos invasivos. Conclusiones: Se muestra el diseño de un sistema de vigilancia epidemiológica hospitalaria, como herramienta de trabajo, conformado por cuatro subsistemas para obtener los datos que facilitan la detección precoz de casos sospechosos de COVID-19 y su confirmación y establecer acciones de prevención y control del riesgo tanto para el Centro Nacional de Cirugía de Mínimo Acceso como para las organizaciones involucradas
ABSTRACT Introduction: Cuba prepares for recovery and for keeping the COVID-19 epidemic under control in the national territory. Gradual de-escalation of measures until getting into the new normal does not exempt permanent surveillance to avoid new outbreaks. Objective: Show the procedure used in the design of a hospital epidemiological surveillance´s system for the early detection of suspected cases in the pos-COVID-19 stage. Methods: Qualitative research. It was located information in the databases Lilacs, Ebsco and Hinari with the descriptors: health surveillance, epidemiological monitoring, and services of epidemiological surveillance. From the definition of cases under surveillance, there were defined the objectives of the system, premises, attributes and subsystems. It was taken into account the methodology used in a surveillance system in Cuba which was developed and modified by Cuban specialists. Results: The system is structured from four components: data entry, processing of data collected in epidemiological surveys applied to patients and their companions, and data output with the description of the type of case and feedback. This is also formed by four subsystems: clinical diagnosis, laboratory diagnosis, epidemiological diagnosis and statistical diagnosis. The system has early detected suspicious cases in hospitalized patients before surgical interventions and other minimal invasive procedures. Conclusions: A hospital epidemiological surveillance system is designed as a working tool for obtaining information that facilitates the early detection of COVID-19 suspected cases and their confirmation, and to establish risk prevention and control actions for both the National Center of Minimal Access Surgery and the organizations involved.
ABSTRACT
RESUMEN Introducción: En la actualidad, la fundoplicatura laparoscópica se considera el tratamiento de elección para la enfermedad por reflujo gastroesofágico con resultados excelentes en más del 90 por ciento de los pacientes. Sin embargo, a pesar de estos resultados, el 30 % de los pacientes presentan persistencia de los síntomas y del 3 por ciento al 10 por ciento requieren reintervención por fallo de la cirugía antirreflujo. Objetivo: Describir las causas del fracaso de la cirugía antirreflujo y las técnicas realizadas en la reintervención. Método: Se realizó un estudio descriptivo, retrospectivo y longitudinal, de una serie de pacientes a los cuales se les realizo cirugía antirreflujo en el Centro Nacional de Cirugía de Mínimo Acceso desde enero de 1994 hasta diciembre de 2016. Las variables analizadas fueron: reintervenciones y sus causas, tratamiento quirúrgico, morbilidad y el índice de conversión. Resultados: De un total de 1 550 pacientes operados, 37 (2,3 por ciento) fueron reintervenidos. Las causas más frecuentes de reintervención fueron la recidiva de los síntomas y la presencia de disfagia. La herniación de la fundoplicatura fue el hallazgo transoperatorio más frecuente. El índice de conversión fue bajo y no hubo fallecidos en las reintervenciones. La morbilidad triplicó la del total de la serie, así como la estadía hospitalaria. Conclusiones: Las reintervenciones por fallo de la cirugía antirreflujo resultan de gran complejidad pues aumentan considerablemente la morbilidad y la estadía hospitalaria. Debe realizarse en centros que acumulen una alta experiencia en estas técnicas(AU)
ABSTRACT Introduction: Nowadays, laparoscopic fundoplication is considered the treatment of choice for gastroesophageal reflux disease, showing excellent results in more than 90 percent of patients. However, despite these results, 30 percent of patients present with persistent symptoms, while 3 percent to 10 percent require reintervention for failed antireflux surgery. Objective: To describe the causes of failed antireflux surgery and the techniques performed in the reintervention. Method: A descriptive, retrospective and longitudinal study was conducted with a series of patients who underwent antireflux surgery at the National Center for Minimally Access Surgery, from January 1994 to December 2016. The variables analyzed were reinterventions and their causes, surgical treatment, morbidity and the conversion rate. Results: From among 1550 patients operated on, 37 (2.3 percent) were reintervened. The most frequent causes of reintervention were the recurrence of symptoms and the occurrence of dysphagia. The fundoplication herniation was the most frequent transoperative finding. The conversion rate was low and there were no deaths in the reinterventions. The morbidity tripled that of the total of the series, as well as hospital stay. Conclusions: Reinterventions for failed antireflux surgery are very complex, since they increase morbidity and hospital stay considerably. It must be performed in centers that accumulate a high experience in these techniques(AU)
Subject(s)
Humans , Reoperation/adverse effects , Gastroesophageal Reflux/epidemiology , Fundoplication/methods , Epidemiology, Descriptive , Retrospective Studies , Longitudinal StudiesABSTRACT
RESUMEN Introducción: La miotomía de Heller laparoscópica es considerada en la actualidad el tratamiento de elección para el alivio de la disfagia. Se ha demostrado que gracias a ella se logra una baja incidencia de reflujo gastroesofágico y una mejoría evidente de la calidad de vida Objetivo: Evaluar la calidad de vida y evolución clínica de los pacientes después de la miotomía de Heller con fundoplicatura de Dor. Método: Estudio observacional descriptivo longitudinal prospectivo mediante la aplicación del cuestionario de índice de calidad de vida gastrointestinal a pacientes operados de acalasia esofágica desde enero del 2010 hasta diciembre del 2017 en el Centro Nacional de Cirugía de Mínimo Acceso. Se aplicó un cuestionario en el preoperatorio y al año de operados. Análisis estadístico: Porcentajes para variables cualitativas, media ± desviación estándar o mediana y rango según corresponda para las cuantitativas, para la comparación de los resultados del cuestionario se emplearon pruebas de hipótesis de comparación de medias, con nivel de significación estadística α= 0,05. Resultados: Fueron incluidos en el estudio 101 pacientes. Las edades oscilaban entre 18 y 78 años con una media de 47 años. El tiempo medio de evolución de los síntomas fue de 62 meses, con una media de 3,3 en la escala de disfagia y una presión de reposo del esfínter esofágico inferior (mmHg) 38,7 ± 16,8, se obtuvo un GIQLI inicial de 85,3 ± 20,4 que aumentó al año a 131,6 ± 10,5 Conclusiones: La miotomía de Heller con fundoplicatura de Dor, mejora la calidad de vida de los pacientes con acalasia esofágica con una evolución clínica excelente(AU)
ABSTRACT Introduction: Laparoscopic Heller myotomy is now considered the treatment of choice for the relief of dysphagia. It has been shown that thanks to it a low incidence of gastroesophageal reflux and evident improvement in the quality of life is achieved. Objective: To evaluate the quality of life and clinical evolution of patients after Heller myotomy plus Dor fundoplication. Method: Prospective, longitudinal, descriptive, observational study carried out by applying the Gastrointestinal Quality of Life Index (GIQLI) questionnaire to patients operated on for esophageal achalasia, from January 2010 to December 2017, at the National Center for Minimum Access Surgery. The questionnaire was applied preoperatively and one year after surgery. Statistical analysis: Percentages for qualitative variables, mean and standard deviation, or median and range, as appropriate for quantitative variables. For the comparison of the results of the questionnaire, we used tests of hypothesis of comparison of means, with statistical significance level of 0.05. Results: The ages ranged between 18 and 78 years, with an average of 47 years. The mean time of evolution of symptoms was 62 months, with an average of 3.3 on the dysphagia scale and a resting pressure of the lower esophageal sphincter (mmHg) 38.7±16.8. An initial gastrointestinal quality of life index of 85.3±20.4 was obtained, which increased to 131.6±10.5 per year. Conclusions: Heller myotomy plus Dor fundoplication improves the quality of life of patients with esophageal achalasia and guarantees an excellent clinical evolution(AU)