[Approach to percutaneous nephrolithotomy. Comparison of the procedure in a one-shot versus the sequential with metal dilata]. / Abordaje para nefrolitotomía percutánea. Comparación del procedimiento en un solo paso contra la secuencial con dilatadores metálicos.

INTRODUCTION: Percutaneous nephrolithotomy is an efficient approach for treatment of different types of kidney stones. Various types of access techniques have been described like sequential dilatation and one-shot procedure. OBJECTIVE: To determine the differences in time of exposure to X-rays and hemoglobin levels between techniques. METHODS: Controlled clinical trial. Patients older than 18 years with complex/uncomplicated kidney stones, without urine infection were included. They were assigned randomly to one of the two techniques. Response variables were determined before and 24 h after procedures. RESULTS: 59 patients were included: 30 underwent one-shot procedure (study-group) and 29 sequential dilatation (control-group). Baseline characteristics were similar. Study group had a lower postoperative hemoglobin decline than control group (0.81 vs. 2.03 g/dl, respectively; p < 0.001); X-ray exposure time (69.6 vs. 100.62 s; p < 0.001) and postoperative creatinine serum levels (0.93 ± 0.29 vs. 1.13 ± 0.4 mg/dl; p = 0.039). No significant differences in postoperative morbidity were found. CONCLUSION: One-shot technique demonstrated better results compared to sequential dilatation.

Platelet-rich plasma and its effect in bone regeneration in mandibular fractures. Controlled clinical trial / Plasma rico en plaquetas y su efecto en la regeneración ósea en fracturas mandibulares. Ensayo clínico controlado

Background: Currently there is great interest in developing clinical applications of platelet-rich plasma to enhance bone repair. Aim: To assess bone regeneration in mandibular fractures, with the application of this adjuvant. Methods: Twenty patients with mandibular fractures were included in a randomized clinical trial. Patients of the experimental group (n = 10) were submitted to internal fracture reduction and administration of platelet-rich plasma, and patients of the control group (n = 10) were submitted to the same surgical procedure without plasma application. Radiologic assessment was made before and at 1 and 3 months after surgery. X-rays were digitalized for analyze intensity and density as reflection of bone regeneration. Results: The average age was 32 ± 11.3 years and 31.2 ± 8.48 years respectively (p = 0.76). The radiographic intensity and density in the experimental group at the 1st and 3rd month were higher in contrast to the control group (p < 0.005). Bone regeneration time was 3.7 ± 0.48 and 4.5 ± 0.52 weeks respectively (p = 0.002). There was no morbidity related to the application of the platelet-rich plasma. Conclusion: The platelet-rich plasma increased the bone intensity and density in the fracture trace allowing bone regeneration and recovery in shorter time than patients in which it was not used.

Antecedentes: Actualmente existe interés en el desarrollo de aplicaciones clínicas del plasma rico en plaquetas (PRP) para mejorar la regeneración ósea (RO). Objetivo: Evaluar la RO en fracturas mandibulares con la aplicación de PRP. Métodos: Ensayo clínico controlado. Se incluyeron 20 pacientes con fractura de ángulo mandibular. El grupo de estudio (n = 10) se sometió a reducción de la fractura, fijación interna y aplicación de PRP, y el grupo control (n = 10) al mismo procedimiento sin administración de plasma. Se evaluaron en el preoperatorio y al primer y tercer mes posterior a la reducción mediante digitalización radiográfica para evaluar la regeneración ósea. Resultados: El promedio de edad fue de 32 ± 11.3 y 31.2 ± 8.48 años, respectivamente (p = 0.76). La intensidad y la densidad radiográfica al mes y a los 3 meses fueron superiores en el grupo de estudio que en el grupo control (p< 0.005). El tiempo de regeneración fue de 3.7 ± 0.48 y 4.5 ± 0.52 semanas, respectivamente (p = 0.002). Conclusiones: El PRP aumentó la intensidad y la densidad ósea en el trazo de las fracturas, sugestivas de RO, y recuperación en menor tiempo, en contraste con el grupo control.

[Cholelithiasis during pregnancy and postpartum: prevalence, presentation and consequences in a Referral Hospital in Baja California Sur]. / Colelitiasis en el embarazo y posparto. Prevalencia, presentación y consecuencias en un hospital de referencia en Baja California Sur.

INTRODUCTION: Pregnancy and the postpartum period are risk factors for developing biliary sludge, gallstones, and any of their complications. OBJECTIVE: To determine the prevalence, presentation, and consequences of cholestasis during pregnancy and postpartum in a referral hospital of Baja California Sur. MATERIAL AND METHODS: This was a retrospective, observational study that enrolled pregnant or postpartum patients diagnosed with gallstones with any presentation. RESULTS: 137 patients were included, with 22 ± 4 years of age; 33 were pregnant and 104 in the postpartum period. Only 14% of the group had a history of cholelithiasis, and overweight/obesity was observed in 66.7 and 66.3% of pregnant and postpartum patients, respectively (p = 0.94). Of pregnant patients, 33.3% presented with acute cholecystitis, a condition observed in 16.3% of the postpartum patients (p = 0.04). Pancreatitis and choledocholithiasis were slightly more common in pregnant women (21.23% vs. 19.2%; p = 0.56). There was no maternal mortality and one case of spontaneous abortion was exclusively observed. CONCLUSIONS: It is a priority to diagnose and monitor cholelithiasis in pregnant women because the acute cases observed occurred more frequently, but choledocholithiasis and pancreatitis occurred similarly in both groups.

Oral glutamine reduces myocardial damage after coronary revascularization under cardiopulmonary bypass. A randomized clinical trial.

BACKGROUND: Glutamine is the most abundant free amino acid in the body. It modulates immune cell function and is an important energy substrate for cells in critically ill patients. Reduction of injury cardiac markers had been observed in patients receiving intravenous glutamine and in a pilot study with oral glutamine. The aim of this study was to analyze the effect of preoperative oral supplementation of glutamine on postoperative serum levels of cardiac injury markers. METHODS: A randomized clinical trial was performed in 28 Mexican patients with ischemic heart disease who underwent cardiopulmonary bypass with extracorporeal circulation. Patients were randomly assigned to receive oral glutamine (0.5 g/kg/day) or maltodextrin 3 days before surgery. Cardiac injury markers as troponin-I, creatine phosphokinase, and creatine phosphokinase-Mb were measured at 1, 12, and 24 hours postoperatively. RESULTS: At 12 and 24 hours serum markers levels were significantly lower in the glutamine group compared with controls (p = 0.01 and p = 0.001, respectively) (p = 0.004 and p < 0.001, respectively). Overall, complications were significantly lower in the glutamine group (p = 0.01, RR = 0.54, 95% CI 0.31-0.93). Mortality was observed with 2 cases of multiple organ failure in control group and 1 case of pulmonary embolism in glutamine group (p = 0.50). CONCLUSION: Preoperative oral glutamine standardized at a dose of 0.5 g/kg/day in our study group showed a significant reduction in postoperative myocardial damage. Lower cardiac injury markers levels, morbidity and mortality were observed in patients receiving glutamine.

[Not Available]. / Evaluación del estado nutricional al ingreso hospitalario y su asociación con la morbilidad y mortalidad en pacientes mexicanos.

Introducción: la desnutrición intrahospitalaria se ha descrito hace más de 70 años como un problema frecuente. En México se reportan cifras de entre el 20% al 50%; sin embargo no se ha estudiado su prevalencia ni su asociación con la morbilidad y mortalidad hospitalaria.Objetivos: evaluar el estado nutricional y su relación con la morbimortalidad hospitalaria en pacientes mexicanos.Métodos: cohorte prospectiva de pacientes que ingresaron en un hospital de referencia para una estancia hospitalaria mayor de 5 días. Se capturó peso, talla, índice de masa corporal (IMC), estado nutricional de acuerdo con la valoración global subjetiva (VGS) a su ingreso y egreso hospitalario, así como diagnóstico médico, complicaciones y mortalidad. Los datos fueron analizados mediante la prueba T de Student, prueba Chi-cuadrado y prueba Exacta de Fisher.Resultados: se incluyeron 610 pacientes en total, con un promedio de edad de 50,8 ± 17,32 años, 267 mujeres (43,8%) y 343 hombres (56,2%). Del total, 154 fueron catalogados con sospecha de desnutrición o desnutrición (pacientes expuestos, 25,2%) y 456 bien nutridos (pacientes no expuestos, 74,8%), con una relación de 1 a 3. La morbilidad total de la cohorte tuvo un RR = 2,70, IC 95 % (2,06-3,55) y la mortalidad con un RR = 2,64, IC 95% (1,74-4,0), siendo ambas estadísticamente significativas (p = 0,001).Conclusiones: el diagnóstico de desnutrición al ingreso hospitalario constituye un factor de riesgo para el desarrollo de complicaciones y mortalidad. Este padecimiento al ingreso en comparación con el paciente que no presenta desnutrición incrementó el riesgo de mortalidad hasta en 2.64 veces.

Prevalence of dry eye syndrome in residents of surgical specialties.

BACKGROUND: The aim of this study was to determine the prevalence and severity of dry eye syndrome in a group of Mexican residents of different surgical specialties. METHODS: A cross-sectional descriptive study where the residents were studied using the Ocular Surface Disease Index, together with diagnostic tests for dry eye syndrome, such as tear breakup time, Oxford Schema, Schirmer's test I, and meibomian gland dysfunction testing. Statistical analyses were performed by Pearson's chi-squared test for categorical variables and student's t-test for quantitative variables. Any P value < 0.05 was considered statistically significant. RESULTS: One hundred and twenty-three residents were included (246 eyes); 90 (73 %) were male and 33 (27 %) were female. The mean age was 27.8 ± 2.1 years. A higher number of residents with dry eye syndrome was found in the cardiothoracic surgery (75 %) and otorhinolaryngology (71 %) specialties; 70 % of them reported ocular symptoms, with teardrop quality involvement in >50 % of them. CONCLUSIONS: We found a prevalence of 56 % for mild-to-moderate/severe stages of the condition. Their presence in the operating room predisposes surgical residents to dry eye syndrome because of environmental conditions.