Perforación gástrica neonatal recurrente: Reporte de un caso inusual

La perforación gástrica neonatal es una patología rara pero potencialmente mortal; su recurrencia es aún más rara, son escasos los reportes en la literatura internacional. Se presenta el caso de una recién nacida prematura (32 semanas) y bajo peso al nacer (1725g) que el primer día de vida presentó una perforación gástrica corregida quirúrgicamente y al cuarto día postoperatorio es reintervenida con presunción diagnóstica de dehiscencia de rafía gástrica, hallándose una nueva perforación gástrica, la cual fue reparada quirúrgicamente. En ambas ocasiones la intervención quirúrgica fue temprana. La evolución posterior y desenlace fueron favorables.

Neonatal gastric perforation is a rare but potentially fatal pathology; its recurrence is even more infrequent, and there are few reports in the international literature. We present the case of a premature newborn (32 weeks) and low birth weight (1725g) who, on the first day of life, presented a surgically corrected gastric perforation and on the fourth postoperative day was re-operated with a presumed diagnosis of gastric raffia dehiscence, finding a new gastric perforation, which was surgically repaired. On both occasions, the surgical intervention was early. The subsequent evolution and outcome were favorable.

[Effectiveness of intercostal nerve block with ropivacaine in analgesia of patients undergoing emergency open cholecystectomy under general anesthesia]. / Eficacia del bloqueo de nervios intercostales con ropivacaína, en la analgesia de pacientes operados de colecistectomía abierta urgente bajo anestesia general.

INTRODUCTION: Postoperative pain after open cholecystectomy is associated with reduced respiratory function, longer recovery period before deambulation and oral food intake, and prolonged hospital stay. Intercostal nerve block provides satisfactory analgesia and ropivacaine is the most widely used local anesthetic agent in intercostal nerve block due to its excellent effectiveness, lower cardiovascular toxicity, and longer half-life. AIMS: To evaluate intercostal nerve block effectiveness with ropivacaine in patients undergoing emergency open cholecystectomy under general anesthesia compared with conventional management. MATERIAL AND METHODS: A controlled clinical trial was carried out on 50 patients undergoing open cholecystectomy, 25 patients without intercostal nerve block versus 25 patients with intercostal nerve block using ropivacaine at 0.5% combined with epinephrine. Intraoperative minimum alveolar concentration and inhalation anesthetic use were evaluated. Tramadol as rescue analgesic agent and pain were evaluated during immediate postoperative period by means of the Visual Analog Scale at 8, 16, and 24 hours. RESULTS: Mean inhalation anesthetic use was lower in the intercostal nerve block group with 13% vs 37% in the group without intercostal nerve block (p= 0.01). Rescue tramadol requirement was lower in the intercostal nerve block group than in the group without intercostal nerve block at 8 hours (8% vs 67%), 16 hours (0% vs 83%), and 24 hours (12% vs 79%) (p<0.0001). Visual Analog Scale for Pain results were similar in both groups. CONCLUSIONS: Intercostal nerve block reduces intraoperative inhalation anesthetic use, immediate postoperative pain, and tramadol intake as rescue analgesic agent in patients undergoing open cholecystectomy.

[Dystrophic osseus metaplasia on small bowell mesentery in a patient with multiple abdominal sugeries: a case report]. / Metaplasia ósea distrófica en el mesenterio de intestino delgado en un paciente con múltiples cirugías abdominales. Informe de un caso.

Heteropropic ossification was initially described by Riedel in 1883. This is a rare disease but well documented in gastrointestinal tract. Several mechanisms have been proposed to determine the etiology of this metaplasia. We present a 59 year old male that was treated in the National Institute of Medicine Sciences and Nutrition Salvador Zubirán in whom after various abdominal surgical procedures the presence of bowel osseous metaplasia was documented.

[Usefulness of chewing gum for the resolution of postoperative ileus in left colon resections]. / Utilidad de la goma de mascar para la resolución del íleo posoperatorio en resecciones de colon izquierdo.

BACKGROUND AND AIM: Disturbances in intestinal motility have been described since XIX century, with a not very well understood pathogenesis and few therapeutic approaches. Considering chewing as an important stimulus to promote intestinal motility we designed this study to assess the efficacy of chewing gum to improve the postoperative ileus, and the clinical relevance of this intervention. METHODS: Were included patients who underwent for elective left hemicolectomy during January 2007 to December 2008. The patients were randomly assigned to receive chewing gum or nothing during the post-surgery period. The main outcomes assessed were duration of postoperative ileus, and reduction in hospitalization days. RESULTS: During the period of the study were included 32 patients, were included mainly men (11 and 9 in treated and control patients, respectively). The first defecation after surgery procedure occurs at (44.2 ± 17.6 h) in the treated group and (55.5 ± 14.8 h) in the control group (p = 0.05). In the same way oral tolerance was achieved faster in the treated group (p= 0.05). The hospital stay duration was not different among treated and not treated patients. CONCLUSIONS: The use of chewing gum in patients after elective left hemicolectomy, reduce the duration of the postoperative ileus. However, this does not reduce the hospital stay duration.

Acute bacterial meningitis among children, in Manhiça, a rural area in Southern Mozambique

Introduction: Acute bacterial meningitis (ABM) is one of the most severe diseases in Sub-Saharan Africa. Although data for the continent is very limited, more than one million cases are estimated per year, with mortality and life-long sequelae occurring in 50% of these cases. Methods: As part of the clinical management of children admitted to the Manhiça District Hospital, information on cases of ABM was recorded. We analysed data from June 1998 to November 2003. Results: During the study period, 475 cerebrospinal-fluid (CSF) samples were collected from 20,173 children <15 years of age admitted to hospital. Culture results confirmed 71 (15%) cases of ABM. The most prevalent bacterial aetiologies were Streptotoccus pneumoniae (pneumococcus, n=31), Haemophilus influenzae (n=13) and Neisseria meningitis (n=8). Other important bacteria were Streptococcus sp. (n=7), Salmonella sp. (n=4) and Staphylococcus aureus (n=3). Crude incidence rates of ABM and pneumococcal meningitis were 20/100,000 and 10/100,000 children-year-at-risk, respectively. Incidences were more than three times higher in the <1 year age group. Overall case fatality rate was 36%, and was highest for H. influenzae and pneumococcal meningitis (55% and 45%, respectively, p=0.044). Pneumococcal susceptibility was 81% for oxacillin and 93% for chloramphenicol. For H. influenzae isolates, susceptibility was 54% for ampicillin and 62% for chloramphenicol. Conclusions: S. pneumoniae and H. influenzae are the main aetiologies responsible for the high burden of morbidity and mortality associated with ABM in rural Mozambique. These findings are important to evaluate treatment guidelines and potential impact of control measures

Evaluation of SPf66 malaria vaccine during a 22-month follow-up field trial in the Pacific coast of Colombia.

A double-blind randomized placebo-controlled field trial with the SPf66 malaria vaccine was carried out in an endemic area consisting of 14 small villages with exclusive fluvial access, in a rain forest area along the Rosario River, Colombia. A total of 1257 subjects completed the full three dose vaccination schedule on days 0, 30 and 180 (643 vaccinated group/623 placebo group) and were followed-up by passive and active surveillance over a period of 22 months. One hundred and thirty-four Plasmodium falciparum malaria episodes were detected (53 in vaccinated group/81 in placebo group), yielding an attack rate of 5.47 cases/100 person years of follow-up (pyears) in the vaccine group and 8.44/100 pyears in the placebo group. The estimated vaccine protective efficacy was 35.2% (95% CI 8.4-54.2%, P = 0.01). This result supports earlier findings that the SPf66 malaria vaccine diminishes the risk of infection by P. falciparum in endemic areas of South America.

[Education of psychologists and their role in primary health care]. / La formación del psicólogo y su papel en la atención primaria a la salud.

This paper takes as its basis the concept of comprehensive health care. The need to try out complementary approaches to health care is emphasized in order to ameliorate the effects of the epidemiological transition. The approach of Primary Health Care as a basic strategy is also presented. The importance of applying health system population approach to health care is also analyzed. A number of health care alternatives are presented in order to stabilize the health of a community. Within these alternatives the training of human resources with a focus on prevention as well as the curative approach are presented. The role that the psychologist plays within the comprehensive health care is also described. Also the authors describe an innovative training program directed to Psychologists at this stage, that integrates a Master on Public Health with emphasis in mental health with a residence program in Comprehensive Health Care as an option to contribute to replicate the alternatives of care presented in the paper. Finally, the programs and their advances are presented.

[The use of the basic drug chart at the first level of care]. / Uso del cuadro básico de medicamentos en el primer nivel de atención.

This study presents the analysis of the prescriptions given 2,782 clinical encounters. These clinical encounters were directly observed and recorded by trained observers in 164 health centers of the Federal District and nine states of the Mexican Republic. It was found that 70.9 per cent of the patients received a drug prescription. Sixty per cent of the compounds prescribed did not belong to the basic list of drugs. An strong influence of advertising by medical agents was detected in the use of some poly-drugs. Some specific needs for training and continued education of the physicians in the first level of care.

[The quality of prescriptive behavior in primary care]. / La calidad de la conducta prescriptiva en atención primaria.

Quality of care was analyzed in 2,782 clinical appointments, focusing on the evaluation of the six basic steps of medical consultation: a) questionnaire, b) physical examination, c) diagnosis, d) prescription, e) information, and f) appointment management. Serious deficiencies were found, with variations depending on the motive of the visit, the type of unit in which the service was given, etc. In order to improve the quality of care a structural change is suggested, both in the health care services and in medical education.

[Mexico: evaluation of medical training based on the results of a national test given to candidates for medical residencies]. / México: evaluación de la formación de médicos con base en los resultados de un examen nacional de aspirantes a residencias médicas.

This study assesses the current status of medical education in Mexico by evaluating the IX National Medical Residency Examination. The results indicate that the personal background of the candidates is related to the probability of their passing the examination: age; marital status; number of times they have presented the examination; length of time between graduation from medical school and the examination; place where social service was performed; and work experience. The authors observe a strong tendency toward specialization in the professional curricula of the medical schools in Mexico, with a consequent neglect of the national health system's present need for primary care. They therefore suggest that the educational institutions give thought to alternatives that would better equip the country's human resources to deal with current needs.