Propuesta quirúrgica para aneurisma venoso en fístulas arteriovenosas para hemodiálisis / Surgical proposal for venous aneurysm in arteriovenous fistulas for hemodialysis

La incidencia de formación de aneurismas es aproximadamente del 5% al 6%. La expansión de aneurisma venoso no solo reduce los sitios disponibles para la canulación, sino que también puede provocar trombosis y ruptura con hemorragia mortal. Presentamos dos casos de pacientes con fistula arteriovenosa braquiocefálica para hemodiálisis que desarrollaron grandes aneurismas venosos con indicación para tratamiento quirúrgico. Se reseco el aneurisma hasta segmento sano de la vena con interposición de injerto PTFE con descripción de la técnica quirúrgica propuesta en base a mantener una vía vital con flujo adecuado para permitir al paciente continuar con secciones de hemodiálisis

The incidence of aneurysm formation is approximately 5% to 6%. The expansion of venous aneurysm not only reduces the sites available for cannulation, but can also cause thrombosis and rupture with fatal bleeding. We present two cases of patients with cephalic brachial venous artery fistula for hemodialysis who developed large venous aneurysms with indication for surgical treatment. The aneurysm to the healthy segment of the vein with PTFE graft interposition was resected, describing the proposed surgical technique based on maintaining a vital pathway with adequate flow to allow the patient to continue with hemodialysis sections

Psychometric properties of the Connor-Davidson Resilience Scale (CD-RISC) on vulnerable Colombian adolescents

The aim of the present study is to analyze the psychometric properties for the Spanish adaptation of the Connor-Davidson Resilience Scale (CD-RISC) ia sample of vulnerable teenagers of Colombia. Two psychometric studies were conducted: one for the 25-item version (CD-RISC-25) and other for the brief 10-item version (CD-RISC-10). All of the items showed good discrimination, with item-total correlations ranging from 0.29 (Item 14) to 0.75 (Item 25). Cronbach's alpha was 0.88 CI [0.86, 0.90] for the 25-item version. Subsequently, an item screening was conducted in order to test a brief version. For the brief 10-item version (CD-RISC-10), a one-factor one-dimensional structure with very good fit was found through exploratory and confirmatory factor analysis. The exploratory factor analysis suggests that CD-RISC-10 could be considered a one-dimensional measure. Importantly, both CD-RISC-25 and CD-RISC-10 showed factorial invariance as a function of sex. In conclusion, the brief 10-item version of the Connor-Davidson CD-RISC presents appropriate psychometric properties to validly and reliably estimate resilience levels for vulnerable Colombian adolescents

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Dolor abdominal en paciente con antecedente de diverticulosis colónica / Abdominal pain in a patient with a history of colonic diverticular disease

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Masa palpable en muslo con antecedente traumático / Palpable mass in thigh with trauma antecedent

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Importancia de los procesos asistenciales integrados en la acreditación de calidad de unidades de gestión clínica pediátricas / Importance of integrated care processes on quality accreditation of pediatric clinic management units

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Demandas y expectativas de padres y madres que rechazan la vacunación y perspectiva de los profesionales sanitarios sobre la negativa a vacunar / Demands and expectations of parents who refuse vaccinations and perspective of health professional on the refusal to vaccinate

OBJETIVOS: Explorar las opiniones, creencias y actitudes sobre la vacunación, de padres y madres que deciden no vacunar a sus hijos/as. Conocer las opiniones y las actitudes de profesionales sanitarios sobre el comportamiento de estas personas hacia la vacunación. MÉTODO: Investigación cualitativa basada en entrevistas semiestructuradas y grupo focal a padres/madres de Granada que deciden no vacunar a sus hijos/as y a profesionales sanitarios implicados en la vacunación infantil. Análisis de contenido de tipo semántico con categorización de respuestas en unidades temáticas. RESULTADOS: Los padres argumentan el beneficio de presentar enfermedades inmunoprevenibles de un modo natural, sin productos antinaturales, tóxicos o agresivos. Consideran la vacunación innecesaria si se dan adecuadas condiciones higiénico-sanitarias, de eficacia no demostrada, y más peligrosa que las enfermedades que evitan, especialmente las vacunas polivalentes. Piensan que los programas de vacunación están movidos por estudios sesgados e intereses distintos de la prevención de perfil comercial. Los profesionales opinan que los que rechazan la vacunación tienen temores de base seudocientífica, que es necesario mejorar los sistemas de información/comunicación, tener una postura conciliadora y una sólida formación sobre seguridad vacunal. CONCLUSIONES: Los no vacunadores han perdido la percepción del balance beneficio de la vacunación frente al riesgo individual de presentar enfermedades inmunoprevenibles y plantean la necesidad del consentimiento informado. Los profesionales consideran poco contrastadas las argumentaciones de los no vacunadores y exponen la existencia de fallos en las coberturas reales de vacunación y en los sistemas de registro de la información. Como mejoras se plantea centralizar los registros, compararlos con los listados de educación, trabajar con líderes locales e informar periódicamente sobre la situación de las enfermedades inmunoprevenibles

OBJECTIVES: To examine the opinions, beliefs and attitudes about vaccination, of parents who decide not to vaccinate their children. To determine the opinions and attitudes of the health professionals on the behaviour towards childhood vaccination. METHOD: Qualitative research based on semi-structured interviews and focal groups in Granada, Spain, including parents who chose to not vaccinate their children, and healthcare professionals who can provide a technical point of view. An analysis was made of the semantic content, and answers were categorized in thematic units. RESULTS: The parents argued on the benefit of suffering vaccine-preventable diseases in a natural way, without non-natural, aggressive or toxic products. Vaccination was considered unnecessary, if given adequate hygienic-sanitary conditions, effectiveness unproven and more dangerous than the diseases they prevent, especially the polyvalent vaccines. They believed that vaccination programs are moved by biased studies and interests other than prevention. Health care professionals believe that they had fears without scientific basis, which requires improving information systems. CONCLUSIONS: Non-vaccinators are unaware of the benefit/risk ratio between the vaccination and the individual risk for preventable diseases, and ask for informed consent. Health care professionals believe that non-vaccinators' arguments are not correctly contrasted and expose the existence of failures in actual vaccination coverage and information registration systems. It was suggested to centralize registers and compare them in schools, working with local leaders and reporting regularly on the status of vaccine-preventable diseases

Servicios de Pediatría y Medicina Preventiva: juntos resuelven mejor los brotes / Paediatric and Preventive Medicine Departments: Together, better for resolving outbreaks

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Determinación de staphylococcus aureus meticilino resistente de la comunidad (Sarm-com) en dos hospitales de Guatemala / Determination of methicillin resistant staphylococcus aureus community (Sarm-com) in two hospitals in Guatemala

El objetivo de este trabajo fue determinar cepas de Stapylococcus aureus meticilino resistente de la comunidad (SARM-com) en aislamientos provenientes de infecciones de la piel de pacientes del Hospital Roosevelt y hospital nacional Pedro de Betancourt de Guatemala. Para ello se realizó un estudio exploratorio de tipo descriptivo el cual consistió en un muestreo de 12 semanas en el laboratorio de microbiología del hospital Roosevelt y del hospital nacional Pedro de Betancourt. Se recolectaron las cepas que cumplieron con los siguientes criterios: haber sido identificadas como S. aureus, que presentaran resistencia a todos los betalactámicos, por medio de la resistencia a oxacilina y como resistencia variable a macrólidos y lincosamidas...

El consumo del probiótico Lactobacillus plantarum CECT 7315/7316 mejora el estado de salud general en personas de edad avanzada / Consumption of the probiotic lactobacillus planctarum CECT 7315/7316 improves general health in the elderly subjects

Fundamentos: Con la edad avanzada se producen cambios en la microflora intestinal que pueden afectar alestado de salud general. En este trabajo analizamos el efecto de Lactobacillus plantarum CECT 7315/7316 sobre la regulación del tránsito intestinal y el estado nutricional. Métodos: Hemos realizado un estudio clínico doble ciego, controlado por placebo y aleatorizado. Hemos evaluado la evolución de la frecuencia de defecación semana ly los niveles en sangre de proteínas totales, albúmina, colesterol y proteína C-reactiva .Resultados: Lactobacillus plantarum CECT 7315/7316ayuda a regular el tránsito intestinal y mejora el estado nutricional en personas mayores. Conclusiones: El consumo de productos funcionales que contengan L. plantarum CECT 7315/7316 mejora la calidad de vida de personas de la tercera edad (AU)

Introduction: Ageing induces changes in gut microbiota that may affect the quality of life. In this work we analyze the effect of Lactobacillus plantarum CECT7315/7316 on the regulation of intestinal transit and on nutritional status. Methods: We carried out a double-blind, randomized and controlled by placebo clinical trial. We evaluated the evolution of the weekly defecation frequency and blood levels of total proteins, albumin, cholesterol and reactive C-protein. Results: Lactobacillus plantarum CECT 7315/7316 helps to regulate intestinal transit and improves the nutritional status in elderly. Conclusions: Consumption of functional foods containingL. plantarum CECT 7315/7316 improves the quality of life in elderly subjects (AU)

Opinión de los profesionales sanitarios sobre seguridad del paciente en un hospital de primer nivel / Opinion of healthcare professionals on patient safety in a primary level hospital

Objetivo. Identificar la cultura sobre seguridad del paciente (SP) percibida por los profesionales sanitarios del Hospital Universitario Virgen de las Nieves (HUVN) de Granada. Metodología. Estudio transversal descriptivo en profesionales sanitarios del HUVN, mediante la versión española del cuestionario Hospital Survey on Patient Safety Culture (AHRQ), en julio-agosto de 2008. El tamaño muestral se estimó en 476 encuestas (incluido el 60% de pérdidas). Resultados. La tasa de respuesta fue del 62,8% (299 cuestionarios). En los últimos 12 meses, el 90,2% de los profesionales no notificó ningún evento adverso (EA). La percepción global de seguridad del paciente fue 6,57±1,82 puntos (escala, 0-10). El trabajo en equipo en la unidad/servicio para la SP fue el aspecto mejor valorado (66,9%). Se observó una correlación positiva (coeficiente Pearson) entre la percepción de SP y los años que los profesionales trabajan en la especialidad (0,21), hospital (0,197) y servicio (0,138) respectivamente (todos p<0,05). Según la categoría, fueron los facultativos los que notificaron algún EA, con una probabilidad 32,3 veces mayor que los auxiliares y los técnicos (p<0,05). La percepción general de seguridad fue valorada positivamente por el 34,1%. El soporte desde la gerencia (3,7%) y la dotación de personal (9%) fueron las principales áreas de mejora. Conclusiones. La percepción global de seguridad del paciente en el HUVN es buena, aunque la comunicación sobre errores es deficiente. La principal área de mejora es la comunicación abierta sobre los errores. Es recomendable promover programas de sensibilización y formación de los profesionales e implantar sistemas de registro de eventos adversos(AU)

Objective. To identify the patient safety (PS) culture perceived by health professionals of the Hospital Universitario Virgen de las Nieves (HUVN) in Granada. Methodology. A descriptive cross-sectional study of professionals working in HUVN using the Spanish version of the questionnaire Hospital Survey On Patient Safety Culture (AHRQ), in July-August 2008. The sample size was estimated as 476 surveys (included 60% losses). Results. The response rate was 62.8% (299 questionnaires). In the previous 12 months, 90.2% of professionals had not notified any adverse event (AE). The average perception of PS was 6.57±1.82 (scale 0-10). Teamwork in the unit for PS was the best rated dimension (66.9%). There was a positive correlation (c. Pearson) between the perception of PS and the years that professionals had worked in specialisation (0.21), hospital (0.197) and unit (0.138), respectively (all, p<0.05). According to category, the physicians have reported an AE with a likelihood 32.26 times greater than the assistants and technicians (p<0.05). The PS perception dimension was viewed favourably by 34.1%. The management support (3.7%) and staffing (9%) were the main areas for improvement. Conclusions. The perception of PS at HUVN is good, even if the communication of errors is poor. The main area for improvement is a non-punitive communication of errors. It is advisable to promote a campaign to raise public awareness of the problem, to perform training programs for professionals and to implement systems for recording adverse events(AU)

[Utility of anorectal manometry in the diagnosis and treatment of encopresis]. / Utilidad de la manometría anorrectal para el diagnóstico y tratamiento de la encopresis.

BACKGROUND: Biofeedback based on anomanometric techniques has been shown to be effective in the treatment of children with encopresis. The long-term efficacy of biofeedback and which variables of anorectal manometry (anorectal manometry) could help to establish biofeedback indications are currently the subject of debate. OBJECTIVES: To identify which variables of anorectal manometry, in addition to symptoms, could be useful in deciding which patients could benefit from biofeedback therapy and to assess the outcome of this treatment. PATIENTS AND METHODS: Anorectal manometry was performed in 88 patients, who were referred to our service complaining of soiling at least once a month for a minimum of 6 months after a period of normal continence of 1 year or more. The chronological and mental age of the patients was 4 years. All patients were otherwise in good health and had shown no response to medical treatment. The following variables were studied: anal canal profile, rectoanal inhibitory reflex (RAIR), continence reflex, rectal sensitivity, external anal sphincter (EAS) activity and defecatory maneuver. The patients were divided into two groups, according to clinical and anomanometric impairment, and the most affected patients (n = 41) underwent biofeedback therapy. The indications and outcome of biofeedback were assessed through clinical course and anorectal manometry. In the statistical analysis, the mean and standard deviation were calculated. The chi-squared test with Yates' correction was used to compare clinical and manometric qualitative parameters; Student's t-test was used to compare quantitative parameters; nonparametric tests consisted of the Mann-Whitney test and the Wilcoxon test was used for paired data. RESULTS: Patients treated with biofeedback therapy presented shorter anal canal, greater pressure in the rectal ampulla (P < 0.001), decreased pressure in the anal canal (P < 0.05), lesser distension of the EAS on provoking RAIR, lower presence of the continence reflex (P < 0.01), lower rectal sensitivity, and a worse response of the striated sphincteric muscle and of the defecatory maneuver (P < 0.001). Seventy-eight percent of the patients had a good response to biofeedback therapy. Pressure in the anal canal and rectal sensitivity improved (P < 0.001) with normality on straining in 11 out of 15 patients. These good results persisted in a long-term follow-up of 10 patients. Eight of 10 patients who did not undergo biofeedback therapy showed persistent encopresis (P < 0.001). CONCLUSIONS: Anorectal manometry detected disturbances, chiefly in the activity of the EAS, which are useful in indicating biofeedback therapy in children with secondary encopresis. Biofeedback therapy seems to produce favorable long-term results in the majority of the most severely affected patients.

Dead Ends and Detours En Route to Total Syntheses of the 1990s A list of abbreviations can be found at the end of the article.

From the very beginning organic chemistry and total synthesis have been intimately joined. In fact, one of the first things that freshmen in organic chemistry learn is how to join two molecules together to obtain a more complex one. Of course they still have a long way to go to become fully mature synthetic chemists, but they must have the primary instinct to build molecules, as synthesis is the essence of organic chemistry. With the different points of view that actually coexist in the chemical community about the maturity of the science (art, or both) of organic synthesis, it is clear that nowadays we know how to make almost all of the most complex molecules ever isolated. The primary question is how easy is it to accomplish? For the readers of papers describing the total synthesis of either simple or complex molecules, it appears that the routes followed are, most of the time, smooth and free of troubles. The synthetic scheme written on paper is, apparently, done in the laboratory with few, if any, modifications and these, essentially, seem to be based on finding the optimal experimental conditions to effect the desired reaction. Failures in the planned synthetic scheme to achieve the goal, detours imposed by unexpected reactivity, or the absence of reactivity are almost never discussed, since they may diminish the value of the work reported. This review attempts to look at total synthesis from a different side; it will focus on troubles found during the synthetic work that cause detours from the original synthetic plan, or on the dead ends that eventually may force redesign. From there, the evolution from the original route to the final successful one that achieves the synthetic target will be presented. The syntheses discussed in this paper have been selected because they contain explicit information about the failures of the original synthetic plan, together with the evolution of the final route to the target molecule. Therefore, they contain a lot of useful negative information that may otherwise be lost.