Evaluación de los prerrequisitos relativos a las infraestructuras, condiciones de operación y entorno de los Food Trucks / Evaluation of the prerrequisites regarding the facilities, the operational conditions and the surroundings of Food Trucks

INTRODUCCIÓN: En los últimos años, los eventos que cuentan con la presencia de Food Trucks se han incrementado considerablemente. En ellos, la elaboración de alimentos inocuos es difícil debido a su reducido espacio, deficiencias de infraestructuras y servicios básicos (como el suministro de agua potable), así como por la gran afluencia de consumidores. OBJETIVOS: El objetivo de este trabajo ha consistido en la evaluación de las infraestructuras, las condiciones de operación y el entorno de los Food Trucks, en el contexto del sistema de Análisis de Peligros y Puntos de Control Crítico (APPCC). MÉTODOS: Se ha evaluado una muestra de 20 Food Trucks, mediante un estudio observacional y el diseño de un cuestionario para la recogida de datos. RESULTADOS: En el análisis de las condiciones de operación no se identificó ningún vehículo con medidas eficaces para evitar la entrada de plagas, y en todos ellos se comprobó que realizaban prácticas que podían atraer su presencia. En el análisis de las infraestructuras se observaron importantes deficiencias. El 46 % de los vehículos carecían de agua caliente y fría y el 46 % no disponían de jabón ni papel. DISCUSIÓN: Los resultados obtenidos en este estudio muestran la existencia de deficiencias significativas en las infraestructuras y en las condiciones de operación de los Food Trucks, que dificultan garantizar la inocuidad de los alimentos que elaboran. CONCLUSIONES: Los Food Trucks necesitan ser diseñados siguiendo criterios higiénicos y además se debería incrementar la supervisión de este tipo de establecimientos por parte de las autoridades de control

INTRODUCTION: In recent years, the events in wich Food Trucks can be found have increased dramatically. Food safety is difficult to achieve due to certain characteristics such as limited space, lack of infrastructure and basic services (such as water supply), and large influx of customers. OBJECTIVES: The objective of this work has been to evaluate the facilities, the operational conditions and the surroundings of Food Trucks, in the context of the Hazard Analysis and Critical Control Points (HACCP) system. METHODS: A 20 vehicle sample has been evaluated through an observational study and the design of three questionnaires for the data collection. RESULTS: The analysis of the operating conditions did not identify any vehicles with effective measures to prevent the entry of pests, and all of them were found to carry out practices that could attract their presence. The analysis of the infrastructure showed significant deficiencies. 46 % of the vehicles had no hot or cold water and 46 % had no soap or paper. DISCUSSION: The results indicate the existance of significant deficiences in the facilities, operational conditions and surroundings of Food Trucks. Conclussions: Food Trucks must be designed according to the premises of hygenic design and they need a better supervision by food control authorites

Evaluación de las prácticas higiénico-sanitarias en FoodTrucks. Implicaciones para la Seguridad Alimentaria / Evaluation of the hygiene and health practices in Food Trucks. Implications for Food Safety

INTRODUCCIÓN: La popularidad de los Food Truck es creciente en nuestro país. Los Food Trucks o vehículos de venta ambulante de alimentos, debido a su reducido espacio, ausencia de localización permanente y gran afluencia de clientes, favorecen las contaminaciones cruzadas durante la elaboración de los alimentos y en consecuencia, podrían contribuir a la presentación de toxiinfecciones alimentarias en la población que los frecuenta. OBJETIVOS: El objetivo de este trabajo ha consistido en la evaluación de las prácticas higiénico-sanitarias de los manipuladores de alimentos en Food Trucks, en el contexto del sistema de Análisis de Peligros y Puntos de Control Crítico (APPCC). MÉTODOS: Se ha evaluado una muestra de 20 Food Trucks, mediante un estudio observacional y el diseño de un cuestionario para la recogida de datos. RESULTADOS: En el 95 % de los vehículos analizados, los manipuladores tocaron los alimentos directamente con las manos, y en el 60 % entraron en contacto con dinero. Respecto a la higiene y limpieza personal, no se observó ningún cambio de guantes ni lavado de manos, ni tampoco se apreció ninguna limpieza de superficies o utensilios. Respecto a la realización de prácticas de riesgo, en el 70 % de los Food Trucks se observaron alimentos que precisaban refrigeración mantenidos a temperatura ambiente, en el 65 % se apreciaron prácticas causantes de contaminación cruzada y en el 95 % se identificaron fuentes potenciales de contaminación. DISCUSIÓN: Estos resultados revelaron que existe un desconocimiento generalizado sobre las buenas prácticas higiénicas de manipulación de los trabajadores de los Food Trucks. CONCLUSIONES: El estudio realizado pone de manifiesto la necesidad de potenciar la formación de los trabajadores de los Food Trucks en las buenas prácticas higiénicas de manipulación de los alimentos, así como la conveniencia de una mayor vigilancia de este tipo de vehículos por parte de los organismos de control

INTRODUCTION: The popularity of Food Trucks is growing in our country. Food Trucks or mobile food vending vehicles due to their reduced space, the lack of permanent location and the large influx of customers, increases the risk of cross-contamination during food preparation and as a consequence, foodborne illness may occur. OBJECTIVES: The objective of this work was to evaluate the hygiene and health practices of the food handlers of Food Trucks, in the context of a Hazard Analysis and Critical Control Point (HACCP). METHODS: A 20 vehicle sample have been evaluated, through an observational study and the design of a questionnaire to collect data. RESULTS: In 95 % of the vehicles, handlers touched food barehanded and in 60%, handlers touched money. Regarding the cleaning and personal hygiene, no glove changing nor hand washing was observed, moreover, no surface nor kitchenware cleaning was observed. Regarding the risky practices observed, in 70 % of Food Trucks food that required refrigeration temperatures was mantained at room temperature, in 65 % practices that can cause cross-contamination were observed and in 95 % potential contamination sources were observed. DISCUSSION: These results revealed a general lack of knowledge of the correct hygienic handling practices by the workers of Food Trucks. CONCLUSIONS: This study highlights the need to improve the workers' training in the correct hygienic handling practices and a better control of Food Trucks by the food safety authorities

Failed restrictive surgery: is sleeve gastrectomy a good revisional procedure?

The aim of this study is to evaluate the safety and efficacy of converting failed restrictive procedures such as laparoscopic adjustable gastric banding (LAGB), non-adjustable gastric banding (NAGB), and vertical banded gastroplasty (VBG) to laparoscopic sleeve gastrectomy (LSG). A prospective database was maintained of 32 patients who failed restrictive procedures. Twenty-six patients failed LAGB, three patients failed NAGB, one of which was performed open, and three patients failed VBG. These patients were converted to LSG between January 2006 and May 2010. Post-conversion outcomes, BMI, and excess weight loss (EWL) were recorded. Four patients were excluded from the weight loss statistical data secondary to short follow-up (less than 6 months since conversion); however, these patients were included in the overall number of cases and in the discussion of complications. Causes of failed restrictive procedures in our series include inadequate weight loss, 15 (47%); weight gain, six (19%); slippage, five (16%); esophageal dilatation, one (3%); unhappy with device, one (3%); tear of silastic ring, one (3%); infection, one (3%), gastrogastric fistula with VBG and weight gain, one (3%); and intractable nausea and vomiting, one (3%). The average hospital stay was 1.5 days (range, 1-3). The average length of follow-up was 26 months. The mean pre-conversion BMI was 42.69, post-conversion to SG mean BMI was 33.3, mean EWL pre-conversion was 10%, and post-conversion mean EWL was 60%. There was no mortality, no conversion to open, and there was one complication, a contained leak resolved by antibiotic treatment. Conversion to LSG from a prior restrictive procedure may be a feasible and acceptable alternative for patients. Average EWL was 60% at an average of 26 months.

Tratamiento de dolor lumbar crónico mediante radiofrecuencia pulsada y aplicación de esteroides em forma epidural: estudio comparativo / Treatment of chronic low back pain by means of pulsed radiofrequency and application of steroids in epidural form: comparative study / Tratamento da dor lombar crônica por meio da radiofrequência pulsada e a aplicação de esteroides na forma epidural: estudo comparativo

OBJETIVOS: valorar el resultado clínico de mejoría de dolor y de escala funcional lumbar de radiofrecuencia pulsada, en comparación con aplicación de esteroides epidurales, en el tratamiento de pacientes con dolor lumbar crónico. TIPO DE INVESTIGACIÓN: un ensayo clínico ciego y simple. MÉTODOS: el estudio se realizó dese mayo de 2008 a julio de 2009. Fueron 40 pacientes, de los medios institucional y privado, de la ciudad de Hermosillo, Sonora, en el México, con dolor lumbar crónico. Se aplicó el cuestionario de Roland-Morris y la escala visual análoga de dolor, previa a tratamiento, y posterior al mismo. No se registraron pérdidas de pacientes en el seguimiento. Se analizaron los resultados de las diferentes variables (edad, sexo, ocupación, evolución, trabajo de carga, incapacidad, hallazgos de imagenología), estableciendo una comparación con la prueba de χ2. RESULTADOS: fueron muy similares en ambos grupos de tratamiento (χ2=2.8283, p=0.093), con dos casos complicados por punción en el grupo de esteroides epidurales, sin casos complicados por el procedimiento de radiofrecuencia pulsada. Los valores de χ2 no muestran diferencias estadísticamente significativas, con valores de p de 0.09 a 0.9. CONCLUSIÓN: la aplicación de radiofrecuencia pulsada es tan eficaz como la aplicación de esteroides epidurales para el manejo del dolor lumbar crónico.

OBJETIVOS: avaliar o resultado clínico de melhoria da dor e da escala funcional lombar de radiofrequência pulsada, comparada com a aplicação de esteroides epidurais, no tratamento de pacientes com dor lombar crônico. TIPO DE INVESTIGAÇÃO: um ensaio clínico cego e simples. MÉTODOS: o estudo foi realizado desde maio de 2008 a julho de 2009. Foram utilizados 40 pacientes, dos meios institucional e privado, da cidade de Hermosillo, Sonora, no México, com dor lombar crônico. Foi aplicado o questionário de Roland-Morris e a escala visual análoga de dor, com tratamento prévio e posterior a este. Não foram registradas perdas de pacientes no seguimento. Analisaram-se os resultados de diferentes variáveis (idade, sexo, ocupação, evolução, trabalho de carga, incapacidade, achados de imagenologia), estabelecendo uma comparação com a teste do χ2. RESULTADOS: foram muito similares em ambos os grupos de tratamento (χ2=2,8283, p=0,093), com dois casos complicados por punção no grupo de esteroides epidurais, sem casos complicados pelo procedimento de radiofrequência pulsada. Os valores do χ2 não mostraram diferenças estatisticamente significativas com valores de p de 0,09 a 0,9. CONCLUSÃO: a aplicação da radiofrequência pulsada é tão eficaz quanto a aplicação de esteroides por via peridural no tratamento da dor lombar crônica.

OBJECTIVES: to evaluate the clinical outcome of improving pain and functional scale lumbar pulsed radiofrequency, compared to the use of epidural steroids in the treatment of patients with chronic low back pain. TYPE OF RESEARCH: a randomized single and blind. METHODS: the study was conducted from May, 2008 to July, 2009. There were 40 patients, through institutional and private means, in the city of Hermosillo, Sonora, Mexico, with chronic low back pain. The survey was conducted by Roland-Morris and visual analog scale of pain, with previous treatment, and subsequent to it. There were no losses of patients in the follow-up. We analyzed the results of different variables (age, sex, occupation, development, work load, disability, findings on imaging), and compared with the χ2 test. RESULTS: they were very similar in both treatment groups (χ2=2.8283, p=0.093), with two cases complicated by puncture in the epidural steroid group, without cases complicated by use of pulsed radiofrequency. The values of χ2 showed no statistically significant differences, with p-values from 0.09 to 0.9. CONCLUSION: the application of pulsed radiofrequency is as effective as the application of epidural steroids for management of chronic low back pain.

Laparoscopic sleeve gastrectomy: a retrospective review of 1- and 2-year results.

INTRODUCTION: Recently, laparoscopic sleeve gastrectomy (LSG) has been added as a surgical treatment for obesity. We report our 1- and 2-year results with LSG. METHODS: From September 2005, we have performed 247 LSGs. We retrospectively reviewed our 1- and 2-year data to assess weight loss, body mass index (BMI), percentage excess weight loss (%EWL), length of stay (LOS), complications, and resolution of diabetes. RESULTS: A total of 40 patients were eligible for follow-up at 2 years, and 157 patients were eligible for follow-up at 1 year. Data was available on 33/40 patients for 2 years and 131/157 patients for 1 year. Initial mean age, mean weight, and mean BMI for 1-year data were 43.2 years, 270.8 lb, and 44.3 kg/m(2), respectively. Initial mean age, mean weight, and mean BMI for 2-year data were 41.4 years, 273.3 lb, and 45.1 kg/m(2), respectively. Mean weight loss, BMI, and %EWL, for patients at 1 year and 2 years were 89.3 lb, 29.6 kg/m(2), and 78% and 87.5 lb, 30.0 kg/m(2), and 75%, respectively. There was no significant difference between use of 46-Fr, 40-Fr, and 36-Fr bougie with respect to weight loss, BMI or %EWL. Likewise, there was no difference seen between use of 7-cm versus 4-cm antral pouch. Mean LOS for both groups was 1.1 days. A total of 12 complications occurred, including one (0.6%) death and two (1.3%) leaks. A total of 39 patients were diabetic, of whom 32 (82%) were cured of diabetes and the remaining 7 patients had their medications decreased. CONCLUSION: Our results show that LSG is a safe and effective weight-loss procedure with results similar to those of gastric bypass. Additional long-term studies are still needed to accurately compare laparoscopic sleeve gastrectomy with gastric bypass and/or gastric banding.

Parámetros de práctica para el manejo del dolor en cáncer: Grupo de Consenso para el Manejo del Dolor en Cáncer / Practice guidelines for cancer pain management: Task Force for Cancer Pain Management

El dolor por cáncer es un problema frecuente en nuestro medio, se presenta en 80 a 90 % de los pacientes y en aproximadamente 90 % de ellos se resuelve con medidas relativamente sencillas. No obstante, aproximadamente 40 % de los pacientes se encuentra insatisfecho con el médico o la enfermera respecto al manejo de su dolor. Por tal motivo, se convocó a un grupo de consenso con la finalidad de generar parámetros de práctica clínica fundamentados en la evidencia publicada y en la opinión de los expertos. Este grupo estuvo integrado por 31 médicos líderes de opinión es este campo, quienes con base en 599 documentos emitieron esta serie de recomendaciones, identificadas cada una según su nivel de evidencia.

Cancer pain is a frequent medical problem in our society. This syndrome affects from 80 to 90% of cancer patients and can be solved with relatively simple measures in 90% of the cases. Approximately 40% of cancer patients reported to be unsatisfied with the physician or nurse about their pain management. For these reasons, we gathered a task force in order to generate practice guidelines based on medical evidence and on the opinion of experts in this area. These guidelines were generated by a task force of 31 physicians who were leaders in this field and based on 599 papers selected by a previous literature search. This group evaluated the results of this search in three work sessions, during which a level of evidence was assigned to each recommendation.

El epidurograma: un método de verificación del espacio epidural en un modelo animal / The epidurogram: a method of validation of epidural space an animal model

El cada vez más frecuente abordaje del espacio epidural o intratecal con fines diagnósticos, pronósticos y/o terapéuticos, que permitan la invasión de éstos en forma aguda o crónica obligan a identificar la ubicación de los catéteres instalados y la posible distribución de los agentes depositados a través de ellos; por lo que nos propusimos evaluar experimentalmente si el epidurograma cumple esta función, además de conocer algunas particularidades de la vía espinal. Con base a este objetivo se implantan 64 ratas Wistar con catéteres epidurales por microcirugía, administrando material radiopaco, efectuando estudio radiológico y evaluación neuroconductal (tiempo de retiro de las patas y cola) al frió y calor, encontrando hallasgos radiológicos que se corroboraron con el estudio necrológico, y a su vez correlacionando resultados con las estimaciones neurofuncionales, lo que sugiere que la epidurografía es un método consistente y confiable; resultando una herramienta eficaz para la exploración del espacio epidural