Cirugía de mínimo acceso en afecciones quirúrgicas de urgencia, impacto más allá de lo estético / Minimal access surgery in emergency surgical conditions, impact beyond the aesthetic

En el año 2016, el Servicio de Cirugía General realizó 4432 intervenciones quirúrgicas, de ellas el 45 por ciento se realizó de forma urgente. Con el objetivo de mostrar el impacto que ha generado la aplicación de la cirugía de mínimo acceso en las afecciones quirúrgicas de urgencia en el orden científico, social y económico, se realizó una investigación básica, descriptiva y transversal en 187 pacientes intervenidos por cirugía de mínimo acceso de urgencia, en el Servicio de Cirugía General del Hospital Provincial Clínico Quirúrgico Docente Celia Sánchez Manduley de Manzanillo, desde enero 2012 hasta diciembre 2016. Las principales variables se compararon con una muestra similar de pacientes intervenidos por vía abierta. La apendicectomía y la colecistectomía fueron las intervenciones más representativas con un 33,15 por ciento y 29,41 por ciento respectivamente, aunque se realizaron lavados peritoneales e intervenciones sobre el tórax. La media del tiempo quirúrgico no sobrepasó los 50 minutos para toda la serie. El 9,6 por ciento de las operaciones fueron reintervenciones, con un 94,4 por ciento de evolución favorable. El 3,74 por ciento de las intervenciones fueron convertidas con solo 5 complicaciones. El 9,6 por ciento de las operaciones fueronreintervenciones. Se produjo un ahorro cuantioso derivado de la reducción de gastos hospitalarios e incorporación precoz a las actividades sociales y productivas. Las pocas molestias perioperatorias y la ambulatorización de la atención médica permitieronescasos desajustes familiares y mayor satisfacción para el paciente y la sociedad(AU)

In 2016, the General Surgery Service performed 4432 surgical procedures, of which 45 percent were performed urgently. In order to show the impact generated by the application of the minimally invasive surgery to emergency surgical conditions in the scientific, social and economic, a basic, descriptive and cross-sectional research was carried out in 187 patients operated by emergency minimally invasive surgery, in the General Surgery Service of the Celia Sánchez Manduley Provincial Teaching Surgical Clinic Hospital of Manzanillo, from January 2012 to December 2016. The main variables were compared with a similar sample of patients who underwent open surgery. Appendectomy and cholecystectomy were the most frequent interventionsrepresentative with 33.15 percent and 29.41 percent; respectively, although peritoneal lavages and interventions on the thorax were performed. The average time surgery did not exceed 50 minutes for the entire series 9.6 percent of the operations were reinterventions with a 94.4 percent favorable evolution, 3.74 percent of the interventions were converted with only 5 complications, 9.6 percent of the operations were reinterventions. There was a substantial saving derived from the reduction of hospital expenses and early incorporation into social and productive activities. The few perioperative discomforts and the ambulatoryization of medical care allowed few family imbalances and greater satisfaction for the patient and society(EU)

Situation of Occupational and Environmental Health in Mexico.

BACKGROUND: Mexico has a great diversity and richness of natural resources, but evaluations of the quality of life of Mexicans show the deep inequalities and the gap between rich and poor. While 5% of families concentrate 58% of the wealth, the health spending in environment and health is 0.2 and 2.7 of the GDP respectively. This has repercussions both on the gradual deterioration of the environment and on the insufficient health and social security coverage of the working population. OBJECTIVE: To describe the current situation of occupational and environmental health in Mexico. METHODS: A bibliographic review was performed on the socioeconomic, demographic, environmental, legal and health status of the Economically Active Population (EAP). FINDINGS: There is a constant deterioration of terrestrial and marine ecosystems, accompanied by an increase in environmental pollution in large cities. The unemployment rate of the EAP has decreased in one year to 3.4%, but the informal labor rate reached 57.3%, which translates into population without social security. Compliance with legislation for the protection of workers' health is insufficient. The recent amendments to the law have meant a setback in these respects. The reported information on accidents and occupational diseases corresponds to only 34% of workers. There has been a decrease in the rate of work accidents in the last six years, but an increase in diseases and permanent disabilities. During 2016, the first cause of occupational illness was hearing loss, but the profile was dominated by musculoskeletal diseases, which together reached 36.5%. CONCLUSIONS: To improve the occupational and environmental health situation, it is necessary to implement general and particular measures against inequalities, increase the budget in health and environment, enforce legislation and expand social security coverage to the population. These measures should be part of public policies as well as actions of academics and researchers.

Adaptación y análisis psicométrico de la versión española del índice internacional de función eréctil (IIEF) en población Chilena / Adaptation and psychometric analysis of the spanish version of the international index of erectile function in Chilean population

Contar con instrumentos validados en Chile para Disfunción Eréctil (DE), motivó el validar la versión española del Índice Internacional de Función Eréctil (IIEF), en población chilena. Se realizó un estudio cuantitativo no experimental transversal, de muestra no probabilística por conveniencia, con 95 varones adultos de tres centros de salud (Concepción, Talcahuano y Santiago), durante Noviembre 2012 y Junio 2013. Expertos ciegos realizaron entrevista clínica utilizando criterios DSM-V y causas médico-quirúrgicas de DE. Luego de aplicación piloto y adaptación del IIEF, se logró la versión IIEF-Ch aplicándola a toda la muestra. Se analizaron los resultados con SPSS 15.0, obteniéndose alta correlación entre variables (X2: 956.533) y alta adecuación muestral (0,893); dos factores que explican el 81.59% de la varianza del instrumento, con alta confiabilidad (.971) y adecuada validez de criterio, alta sensibilidad (84.5%) y especificidad aceptable (91.9%). La IIEF-Ch es un instrumento válido y confiable para estudios sobre DE en Chile.

Having instruments validated in Chile for Erectile Dysfunction (ED), motivated the validation of the Spanish version of the International Index of Erectile Function (IIEF), in Chilean population. A non-experimental quantitative study of non-probabilistic sample was carried out for convenience, with 95 adult males from three health centers (Concepción, Talcahuano and Santiago), during November 2012 and June 2013. Blind experts conducted a clinical interview using DSM-V criteria and medical-surgical causes of ED. After the pilot application and adaptation of the IIEF, version IIEF-Ch was achieved by applying it to the entire sample. The results were analyzed with SPSS 15.0, obtaining high correlation between variables (X2: 956,533) and high sample adequacy (0,893); two factors that explain 81.59% of the variance of the instrument, with high reliability (.971) and adequate criterion validity, high sensitivity (84.5%) and acceptable specificity (91.9%). The IIEF-Ch is a valid and reliable instrument for studies on ED in Chile.

Determinación del índice glucémico y la carga glucémica de productos lácteos fermentados en sujetos adultos sanos, sedentarios y deportistas.

Introducción: el índice glucémico (IG) y la carga glucémica (CG) de productos lácteos fermentados (PLF) con lactobacilos puede ser una recomendación útil para pacientes diabéticos y para la población en general.Objetivo: el objetivo del estudio fue medir el IG y la CG de PLF con lactobacilos en sujetos sedentarios y deportistas, y evaluar si existe diferencia entre ellos.Métodos: el estudio se realizó en México (DF) de acuerdo con la ISO26642:210 (Organización Internacional de Normalización). Los participantes fueron: 10 sedentarios y 10 deportistas. Los PLF analizados fueron: Soful, Yakult, Gastroprotect, BeneGastro, Bonacult, Lala Bio 4 y leche descremada con sacarosa (LDS) y la cantidad de alimento que ingirieron dependió de ajustar a 25 g los HC en la porción.Resultados: el IG de la mayoría de los PLF fue bajo para ambos grupos de sujetos; en los deportistas los PLF Yakult y Bonacult presentaron los mayores IG y solo el Yakult puede considerarse como de IG medio para este grupo; estos dos PLF presentaron la menor relación de proteína/HC. La LDS, lácteo con los HC no fermentados, presentó un IG alto para ambos grupos. La CG de los PLF se encontró entre 4 a 7,6 y solo Gastroprotect presentó estadísticamente la menor CG, lo que pudo deberse a su bajo IG, aun cuando su tamaño de ración no fue la menor, entre los PLF.Conclusión: en general los valores de IG y CG de los PLF fueron bajos para ambos grupos. Por tanto, su consumo puede recomendarse en forma moderada. El IG y CG entre productos lácteos con azúcares fermentados y con azúcares no fermentados fueron diferentes.

[Trends in labor medicine in Mexico]. / Tendencias de la medicina del trabajo en México.

Labor medicine is the natural field for searching the relation between society, work and disease. It is also the field for preventing labor diseases, and for the application resulting from search as protection measures in the laboral services. At present, tendencies in laboral medicine services are multidisciplinary where the specialists need to development competences in epidemiology, clinics, investigation, toxicology, dermatology and many other fields.

Estimating evapotranspiration by capacitance and neutron probes in a drip-irrigated apricot orchard / Estimación de la evapotranspiración por capacitancia y sondas neutrónicas en una plantación de albaricoque irrigada por goteo / Estimação da evapotranspiração por capacitância e sondas neutrônicas em uma plantação de damasco irrigada por goteejamento.

This paper describes how a neutron probe (NP) and a multi sensor capacitance probe (MCP) can be used for monitoring the soil water content in order to develop a soil water balance and to estimate the evapotranspiration (ETc) of an apricot (Prunus armeniaca L.) crop. The van Genuchten model was applied to estimate water drainage below the active root zone, based on the measurements from both devices. Average crop evapotranspiration (ETc), estimated from the soil water balance for the whole period (17 months), was 1.6 and 1.5mm/day for NP and MCP, respectively, while the crop evapotranspiration calculated by the Penman-Monteith method (ETc-FAO) was 2.3mm/day. Drainage measured by both devices was negligible. The ETc measured by MCP was better correlated with the ETc measured by FAO methodology than with that corresponding to NP. A good correlation between the ETc values measured by NP and MCP was found. However, MCP permits continuous recording of the soil water content, is cheaper and less dangerous, while NP produces more accurate measurements than MCP.

En este trabajo se describe la forma en que un sensor de neutrones (SN) y una sonda multisensor de capacitancia (SMSC) pueden ser utilizados para el monitoreo del contenido de agua del suelo, a fin de establecer un balance hídrico de agua y estimar la evapotranspiración (ETc) en un cultivo de albaricoque (Prunus armeniaca L.). El modelo de van Genuchten fue aplicado para estimar el drenaje bajo la zona activa radical, con base en las mediciones hechas con los dos artefactos. La evpotranspiración promedio de la siembra (ETc), estimada a partir del balance de agua del suelo para todo el período (17 meses) fue de 1,6 y 1,5mm/día para SN y SMSC, respectivamente, mientras que la evapotranspitación calculada por el método de Penman-Monteith (ETc-FAO) fue de 2,3mm/día. El drenaje medido por ambos artefactos fue despreciable. La ETc medida con la SMSC resultó mejor correlacionada con la medida por la metodología de la FAO que aquella correspondiente al SN. Se encontró una buena correlación entre los valores de ETc medidos por SN y por SMSC. No obstante, la SMSC permite un registro continuo del contenido de agua del suelo, es más económica y menos peligrosa, mientras que el SN produce mediciones más precisas que la SMSC.

Neste trabalho se descreve a forma em que um sensor de nêutrons (SN) e uma sonda multisensor de capacitância (SMSC) podem ser utilizados para a monitoração do conteúdo de água do solo, a fim de estabelecer um balanço edáfico hídrico e estimar a evapotranspiração (ETc) em um cultivo de damasco (Prunus armeniaca L.). O modelo de van Genuchten foi aplicado para estimar a circulação de água sob a zona ativa radical, com base nas medições feitas com os dois artefatos. A evapotranspiração media da plantação (ETc), estimada a partir do balanço de água do solo para todo o período (17 meses) foi de 1,6 e 1,5mm/dia para SN e SMSC, respectivamente, enquanto a evapotranspiração calculada pelo método de Penman-Monteith (ETs-FAO) foi de 2,3mm/dia. A circulação medida por ambos os artefatos foi desprezível. A ETs medida com a SMSC resultou melhor correlacionada com a medida pela metodologia da FAO que aquela correspondente ao SN. Encontrou-se uma boa correlação entre os valores de ETs medidos por SN e por SMSC. No entanto, a SMSC permite um registro continuo do conteúdo de água do solo, é mais econômica e menos perigosa, enquanto que o SN produz medições mais precisas que a SMSC.

[Femur overgrowth as presentation of an osteoid osteoma]. / Sobrecrecimiento de fémur secundario a osteoma osteoide.

INTRODUCTION: Osteoid osteoma is a benign tumor that typically produces night pain that improves with salicilates. This condition, rarely affects children younger than 5 years-old. CASE REPORT: We present a 2-year-old boy with lower limb discrepancy due to overgrowth of the femur as first manifestation of an osteoid osteoma. The patient did not complain of pain. The tumor localization was intramedular, and diagnosis was confirmed by pathology after broad resection of the tumor. DISCUSSION: This case report shows an unusual presentation of an osteoid osteoma in a young patient, with lower limb discrepancy caused by overgrowth of the femur in absence of pain.

Bioequivalence of two commercial preparations of trimethoprim/sulfamethoxazole: a randomized, single-dose, single-blind, crossover trial.

BACKGROUND: Trimethoprim/sulfamethoxazole (TMP/SMX) is a combination of 2 antimicrobial agents that act synergistically, sequentially blocking 2 chemical reactions essential to bacterial survival. TMP/SMX is effective against organisms that are resistant to its separate components. OBJECTIVE: The objective of this study was to compare the bioavailability of 2 commercial preparations of T:MP/SMX 40/200 mg per 5-ml, oral suspension, used in Mexico for the treatment of bacterial infection. METHODS: This study used a single-dose, randomized,single-blind, 2 x 2 crossover (2 dosing periods x 2 treatments) design to compare the 2 preparations. Healthy male volunteers aged 18 to 55 years received the trial and reference preparations in randomized sequence, under fasting conditions, with a 7-day washout period between dosing periods. Each preparation was administered as a single-dose 10-ml, oral suspension delivering 80 tng of TMP and 400 mg of SMX (equivalent to 2 doses of TMP/SMX 40/200 rig per 5 ml.). Pharmacokinetic (PK) parameters of C(max) AUC(0-t), and AUC(0-1) were determined for each component of each preparation. Schuirmann's unilateral double t test was performed. Null hypotheses indicating bioin-equivalence (P > 0.05) were rejected. Bioequivalence was determined if the quotient of the parameters of C(max), AUC(0-t), and AUC(0-infinity) were between 80% and 125%, at a power of 80% (alpha > 0.08). RESULT: Twenty-three of the 24 enrolled subjects completed the study. The subjects were all Hispanic, the mean (SD) age was 25 (6) years, and the mean (SD) body mass index was 22.54 (2.59) kg/m(2). Plasma concentration-time values of TMP and SMX were similar with both preparations. The null hypotheses of Schuirmann's unilateral double t test were rejected, and results of the analyses of the PK parameters obtained 95% CIs within the predetermined range of bioequivalence (80%-125 degrees 10). The trial and reference preparations were statistically interchangeable and appeared to be bioequivalent. CONCLUSIONS: Based on similar PK profiles and statistical analyses, the trial and reference preparations were statistically interchangeable and appeared to be bioequivalent in this population of 23 healthy male volunteers in Mexico.

Diabetes mellitus e hipertensión arterial: aspectos clínicos y epidemiológicos en la población de la La Plata / Diabetes mellitus and hypertension: clinical and epidemiological aspects in the population of La Plata

The purpose of this study was to determine socio-demographic characteristics, habits, most frequent morbid associations and degree of compliance with the control and treatment of their illness in a population of diabetic and hypertense patients of the La Plata area. A representative sample (890 people) was selected through a home survey (413 housing units). The results obtained show that diabetic and hypertense people a) are in average older than the general population and that the percentage of sedentary habits among them is also higher; b) show multiple typical symptoms of the illness but do not identify them as such and consequently diagnosis is frequently haphazardous; c) have a higher frequency of association with other risk factors, intercurrencies and hospitalization; d) are treated mainly by giving priority to drugs over changes in their detrimental habits; e) tend to ignore those indications that prescribe a change in their habits and f) control their illness at an inadequate periodicity. Consequently, it would be advisable to emphasize the incorporation of education strategies into the treatment of these patients in order to give more importance to preventive and health promoting actions. Education programmes should include not only patients and their families but also members of the health team and the community in general.

Diabetes mellitus e hipertensión arterial: aspectos clínicos y epidemiológicos en la población de la La Plata / Diabetes mellitus and hypertension: clinical and epidemiological aspects in the population of La Plata

The purpose of this study was to determine socio-demographic characteristics, habits, most frequent morbid associations and degree of compliance with the control and treatment of their illness in a population of diabetic and hypertense patients of the La Plata area. A representative sample (890 people) was selected through a home survey (413 housing units). The results obtained show that diabetic and hypertense people a) are in average older than the general population and that the percentage of sedentary habits among them is also higher; b) show multiple typical symptoms of the illness but do not identify them as such and consequently diagnosis is frequently haphazardous; c) have a higher frequency of association with other risk factors, intercurrencies and hospitalization; d) are treated mainly by giving priority to drugs over changes in their detrimental habits; e) tend to ignore those indications that prescribe a change in their habits and f) control their illness at an inadequate periodicity. Consequently, it would be advisable to emphasize the incorporation of education strategies into the treatment of these patients in order to give more importance to preventive and health promoting actions. Education programmes should include not only patients and their families but also members of the health team and the community in general.(AU)

Tratamiento de las fracturas de la clavícula con desplazamiento severo, mediante la reducción abierta y fijación interna con diversas técnicas / Treatment for the severely displaced fractures of the clavicle by open reduction and internation with several techniques

En el presente estudio se reporta la experiencia de nuestro Servicio en el tratamiento de las fracturas de la clavícula con desplazamiento acentuado, se describe el término: desplazamiento grave. Se presenta una serie de 50 fracturas de clavícula, en 47 pacientes. Siendo todos intervenidos quirúrgicamente, durante los meses comprendidos entre enero de 1991 y agosto de 1993. Se estableció que estas fracturas ocurren en su mayoría producto de accidentes de tráfico o producto de agresiones en la vía pública. Se identificó el mecanismo directo como el responsable de la lesión. Se encontró en la serie un predominio de los trazos transverso y oblicuo corto (30º). Se establece en la serie un promedio de 10.48 mm para el díametro de la diáfisis en la proyección AP a nivel del tercio medio; se encontró un promedio de 17.22 mm para el cabalgamiento y de 21.58 mm para la diastasis de los fragmentos en la serie. Los implantes utilizados fueron: clavillos antirrotacionales en tres casos, mini-fijador externo de tipo modular en un caso, siete placas de tercio de tubo, placa DCP 3.5 AO en 25 casos y placas de reconstrucción AO 3.5 en 14 casos. Se compara en la serie el resultado cosmético de los distintos abordajes. Se evaluá el tiempo de cirugía y la suficiencia de la fijación. Se obtuvieron resultados satisfactorios en todos los casos, con un promedio de 6.72 semanas para la consolidación de la fractura. Se considera que la reducción abierta y fijación interna de esta lesión es el método de elección para su tratamiento

Glucemias en el obeso: su importancia en el diagnóstico de diabetes / Blood glucose in obesity: its importance in the diagnosis of diabetes

La determinación de la glucemia de ayuno y possobrecarga con 50 g de glucosa en una muestra de 809 habitantes de la ciudad de La Plata, representativa del total, encontró que los indivíduos con sobrepeso (según conciente Body Mass Index) presentaban valores mayores que los normales. Este aumento de la glucemia es estadísticamente significativo

Glucemias en el obeso: su importancia en el diagnóstico de diabetes / Blood glucose in obesity: its importance in the diagnosis of diabetes

La determinación de la glucemia de ayuno y possobrecarga con 50 g de glucosa en una muestra de 809 habitantes de la ciudad de La Plata, representativa del total, encontró que los indivíduos con sobrepeso (según conciente Body Mass Index) presentaban valores mayores que los normales. Este aumento de la glucemia es estadísticamente significativo (AU)