Assessing COVID-19 knowledge, attitudes, and practices among hospital employees: identifying sociodemographic determinants for improved public health strategies.

Background: The working environment of healthcare institution during pandemic puts all hospital employees at high-risk of being exposed to contagious infections. An individual's behavior and response are largely determined by their level of knowledge, attitudes and practices (KAP) toward a disease. Therefore, the present study aimed to evaluate and assess the KAP toward COVID-19 among hospital employees working in various positions and to identify the sociodemographic determinants associated with the level of KAP. Methods: A cross-sectional survey was conducted from July 1 to July 15, 2020 in Almoosa Specialist Hospital, Alhasa, Eastern Province, Saudi Arabia in which 221 hospital employees with varied job titles participated. The data for demographics and history of COVID-19 exposure, KAP related to COVID-19 spread and prevention were collected online using a web-based platform (Survey Monkey). Student's t-test/One-way ANOVA were used to compare total mean and standard deviation of KAP scores with demographic profiles and history of exposure. Results: 89.1% employees knew that COVID-19 virus is mostly transmitted from human-to-human, and 76.0% employees acknowledged droplet transmission. 64.7% employees preferred to take a sick person with unconfirmed COVID-19 to a health facility. Physicians had higher knowledge scores for COVID-19 infection and non-medical employees had the lowest scores (7.47 ± 1.23 and 6.47 ± 1.44, respectively). Nurses had the highest practice scores and non-medical employees lowest practice score (6.16 ± 0.74 and 5.37 ± 1.14, respectively). Attitude scores were similar among all the employees. All employees reported an increase in hand-washing frequency and physical contact avoidance. Conclusion: The study results revealed socio-demographic factors; level of education, nationality, and field of service are associated with COVID-19 KAP. The study highlights that there is a gap in the level of knowledge about COVID-19, especially among nonmedical employees. Targeted interventional programs need to be planned and implemented to improve COVID-19 awareness among non-medical employees.

Lateral tarsal strip through osteotomies for recurrent ectropion and eyelid laxity correction.

OBJECTIVE: to present a surgical technique for treating patients with recurrent ectropion and severe lower eyelid laxity. METHODS: Lateral tarsal strip and canthal fixation by osteotomy was performed in 6 patients with recurrent ectropion and 1 patient with extreme lower eyelid laxity secondary to an anophthalmic socket. Preoperative and postoperative photographs were evaluated in order to assess the outcomes of the procedure. Patients were followed up 4 weeks, 6 months, 12 months and 24 months of the postoperative period. The initial symptoms of the patients were eye redness, epiphora, foreign body sensation, aesthetic complaints, and facial asymmetry. Symptoms and aesthetic results were assessed by questioning, photographs, and fluorescein and lissamine green stains taken in each visit. RESULTS: No postoperative complications were observed. No recurrence episodes were reported during the follow-up period and physical appearance improvement and symptom severity reduction were maintained during the observation. CONCLUSION: Lateral tarsal strip through osteotomies is an effective surgical procedure for treating severe recurrent ectropion cases or lower eyelid laxity and could be considered as an alternative treatment option or even a primary surgical technique in selected difficult cases.

Extradigital Glomangioma of the Cutaneous Chest Wall.

Glomus tumors (GTs) are rare benign tumors as a result of hyperplasia of glomus body. GT most commonly involves the subungual areas and rarely involves extra-digital sites. The clinical presentation of a glomus tumor is a triad of symptoms consisting of pain, cold intolerance, and pinpoint tenderness. Even though glomus tumors are benign, they can infrequently be malignant. Despite their benign nature, these lesions can cause disabling symptoms, therefore proper diagnosis and treatment is important. In this report, we present a 35-year-old Saudi male with a painful lesion on the right side of the chest wall at the posterior axillary line for seven years, with recent progressive growth and symptoms. Diagnosis of extra-digital glomangioma of the chest wall in this patient was confirmed by histopathology. The patient was managed by complete surgical excision of the lesion with the resolution of pain and without recurrence.

Caracterización de los compuestos de aroma del aceite de sacha inchi (Plukenetia volubilis L.) por HS-SPME-GC-MS-O / Characterization of aroma compounds in sacha inchi (Plukenetia volubilis L.) by HS-SPME-GC-MS-O / Caracterização de compostos de aroma em sacha inchi (Plukenetia volubilis L.) por HS-SPME-GC-MS-O

Resumen Se identificaron los componentes aromáticos activos provenientes de muestras comerciales del aceite de sacha inchi, obtenidos de cultivos de Santa Rosa de Osos (Antioquia, Colombia), mediante la técnica de microextracción en fase sólida acoplada a cromatografía de gases, espectrometría de masas y olfatometría (HS-SPME-GC-MS-O). En la optimización de la técnica de extracción se definieron las siguientes condiciones: fibra de SPME de divinilbenceno/ carboxen/polidimetilsiloxano (DVB/CAR/PDMS), temperatura de extracción de 50 °C y tiempo de exposición de 40 min. Bajo estas condiciones, se encontraron un total de 20 compuestos aromáticos activos, donde se destacan el E-2-octenal, E-heptanal, (E,E)-3,5-octadien-2-ona, ácido hexanóico y (E,E)-2,4-heptadienal como los componentes con mayor aporte a la formación del aroma del aceite de sacha inchi.

Abstract The active aromatic components from commercial samples of sacha inchi oil obtained from Santa Rosa de Osos (Antioquia, Colombia) crops were identified by solid phase microextraction technique coupled to gas chromatography, mass spectrometry, and olfactometry (HS -SPME-GC-MS-O). In the optimization of the extraction technique, the following conditions were defined: SPME fiber of divinylbenzene/carboxen/ polydimethylsiloxane (DVB/CAR/PDMS), extraction temperature 50 °C, and exposure time 40 min. Under these conditions, a total of 20 active aromatic compounds were found, which include E-2-octenal, E-heptanal, (E,E)-3,5-octadien-2-one, hexanoic acid and (E,E)-2,4-heptadienal as the components with the greatest contribution to the aroma formation of sacha inchi oil.

Resumo Os componentes de aroma ativos de amostras comerciais de óleo de sacha inchi obtidos de Santa Rosa de Osos (Antioquia, Colômbia) foram separados pela técnica de microextração em fase sólida acoplada a cromatografia gasosa, espectrometria de massas e olfatometria para a identificação (HS-SPME-GC-MS-O). Na otimização da técnica de extração, foram definidas as seguintes condições: fibra de SPME de divinilbenzeno/carboxeno/polidimetilsiloxano (DVB/CAR/PDMS), temperatura de extração 50 °C e tempo de exposição de 40 min. Nestas condições, foi encontrado um total de 20 compostos de aroma ativos no óleo, que incluem E-2-octenal, E-heptanal, (E,E)-3,5-octadien-2-ona, ácido hexanoico e (E,E)-2,4 heptadienal como os componentes com maior contribuição para a formação do aroma.

Macrophytes as potential biomonitors in peri-urban wetlands of the Middle Parana River (Argentina).

The aims of this study were to measure the concentrations of nutrients and pollutants in peri-urban wetlands, to analyze the plant morphology of the most representative macrophyte species, and to determine their potential use as biomonitors. Four wetlands in the Middle Paraná River floodplain evidencing contamination or anthropogenic impact were studied. The studied species were Typha domingensis Pers., Eichhornia crassipes (Mart.) Solms., Alternanthera philoxeroides (Mart.) Griseb., and Pistia stratiotes L. Besides, the same plant species from an uncontaminated wetland considered as control were studied. A. philoxeroides showed the highest total phosphorus (TP) concentration in leaves throughout the study, while the other species showed a higher TP concentration in roots than in leaves. Since metal concentration in A. philoxeroides tissues was always higher than in sediment, further studies focused on its phytoremediation capacity should be carried out. T. domingensis exhibited the highest Zn concentrations in roots followed by Pb, and E. crassipes presented the highest values of Pb concentrations in roots. The aerial part height of the plants from peri-urban wetlands was significantly higher than that of the plants from the control, while the root length was significantly lower. The root length of P. stratiotes showed a negative correlation with soluble reactive phosphorus (SRP) concentration in water. All the root anatomical parameters of T. domingensis and E. crassipes showed a positive correlation with nitrate and ammonium concentrations in water. The studied macrophytes evidenced a high tolerance, enabling them to grow and survive in peri-urban wetlands that receive pollution from different sources. The use of aquatic and wetland plants as contaminant bioindicators and bioaccumulators in the Middle Paraná River floodplain is completely feasible.

Clasificación única de procedimientos en salud / Unique Classification of Health Procedures / Classificação Única de Procedimentos de Saúde

Objetivo: Presentar la experiencia del levantamiento de costos y de la valoración de procedimientos o de paquetes quirúrgicos para evaluar el impacto de los costos de estructura, de servicios y de apoyo sobre el costo final de empresas sociales del Estado (ESE) en Bogotá, mediante un sistema integral de costos en salud. Método: Se realizó el levantamiento de costos con los profesionales responsables de los procesos y con los encargados de costos de las ESE y de la Secretaría Distrital de Salud. Se tomaron los costos de 2011 y 2012 de las ESE de Bogotá, como fuente de información primaria. Esta información estaba estructurada por grupos de procesos (consultas externas, emergencias y cirugía), que no permitían identificar los procedimientos específicos para cada proceso. Por lo tanto, se ajustó la "matriz de costos", al reagrupar las unidades de negocio por proceso, definir los procedimientos que corresponden a cada uno de ellos y especificar los códigos CUPS que los caracterizan. También, se definieron cuatro distribuciones. En la primera se identificaron los costos directos; en la segunda, la carga que representa los costos de estructura (administrativos); en la tercera, los costos de servicios (apoyo al cliente, apoyo logístico y apoyo documental); y en la cuarta, los intermedios (apoyo Dx, apoyo terapéutico y apoyo médico). A la cuarta distribución se le agregó la producción por CUPS para cada centro de costo. Adicionalmente, se estructuraron las matrices necesarias que soportan la valoración de procedimientos y paquetes que se levantaron. Resultados: Definición e implementación de una matriz estructurada por clase de unidad de negocios: costos finales, intermedios, servicios y estructura e identificación de los costos promedio por procedimiento, por centro de costo y por unidad de negocio. Levantamiento de 341 procedimientos o paquetes valorados en las especialidades de ginecología, ginecoobstetricia, ortopedia, gastroenterología, cirugía general, entre otras. Conclusiones: Construcción de una matriz para la identificación de los costos por tipo de unidad de negocio, y por unidad de negocio. Definición y organización de una matriz para la valoración de costos directos e indirectos de procedimientos. Estructuración de una matriz para la valoración de procedimientos o paquetes quirúrgicos validados por expertos o mesas de expertos

Objective: Present the experience of cost lifting and assessment of procedures or surgical packages to evaluate the impact of structure, services and support costs on the final cost of State Social Enterprises (ESE) in Bogotá through a System Integral Health Costs. Method: The costs were built with the professionals responsible for the processes and with the cost managers of the ESE and the Secretaría Distrital de Salud. The costs of the years 2011 and 2012 of the ESE of Bogotá were taken as a source of primary information. This information was structured by groups of processes (External Consultations, Emergencies and Surgery) that did not allow to identify the specific procedures for each process. Therefore, the "cost matrix" was adjusted, regrouping the business units by processes and defining the procedures that correspond to each of them and specifying the CUPS codes that characterize them. Also, four distributions were defined. In the first, direct costs were identified; in the second, the burden that represents the (administrative staff) structure costs; in the third, the costs of services (customer support, logistical support and documentary support); and in the fourth, the intermediate ones (Dx support, therapeutic and medical support). The production by CUPS for each Cost Center was added to the fourth distribution. Additionally, the necessary matrices that support the valuation of procedures and packages that were built were structured. Results: Definition and implementation of a structured matrix by business unit class: final costs, intermediate costs, services and structure and identification of the average costs per procedure, per cost center and per business unit. Lifting of 341 procedures or packages valued in the specialties gynecology, gynecology-obstetrics, orthopedics, gastroenterology, general surgery among others. Conclusions: Construction of a matrix for the identification of costs by type of business unit and by business unit. Definition and organization of a matrix for the assessment of direct and indirect costs of procedures. Construction of a matrix for the valuation of procedures or surgical packages validated by experts or expert tables.

Objetivo: Apresentar a experiência da pesquisa de custos e a avaliação de procedimentos ou pacotes cirúrgicos para avaliar o impacto dos custos de estrutura, serviço e suporte no custo final das Empresas Sociais do Estado (ESE) em Bogotá, por meio de Sistema Abrangente de Custos de Saúde. Método: Os custos foram levantados com os profissionais responsáveis pelos processos e com os responsáveis pelos custos do ESE e do Departamento Distrital de Saúde. Os custos dois anos 2011 e 2012 do ESE de Bogotá foram tomados como uma fonte de informação primária. Essas informações foram estruturadas por grupos de processos (consultas externas, emergências e cirurgia) que não permitiram identificar os procedimentos específicos para cada processo. Portanto, a "matriz de custo" foi ajustada, reagrupando as unidades de negócio por processo e definindo os procedimentos que correspondem a cada um deles e especificando os códigos do CUPS que os caracterizam. Além disso, quatro distribuições foram definidas. No primeiro, os custos diretos foram identificados; no segundo, o ônus que representa os custos da estrutura (administrativa); no terceiro, os custos dos serviços (suporte ao cliente, suporte logístico e suporte documental); e no quarto, os intermediários (suporte Dx, suporte terapêutico e suporte médico). A produção por CUPS para cada centro de custo foi adicionada à quarta distribuição. Adicionalmente, as matrizes necessárias que suportam a avaliação de procedimentos e pacotes que foram levantados foram estruturadas. Resultados: Definição e implementação de uma matriz estruturada por classe de negócio: custos finais, intermediários, de serviços e estrutura e identificação dos custos médios por procedimento, por centro de custo e por unidade de negócio. Levantamento de 341 procedimentos ou pacotes valorizados nas especialidades ginecologia, ginecologia-obstetrícia, ortopedia, gastroenterologia, cirurgia geral entre outros. Conclusions: Construcción de una matriz para a identificação dos custos por tipo de unidade de negócio, e por unidade de negocio. Definição e organização de uma matriz para a valorização de custos diretos e indiretos de procedimentos. Estruturação de uma matriz para a valorização dos procedimentos cirúrgicos validados por especialistas ou mesas de especialistas

Unexpected inverse correlation between Native American ancestry and Asian American variants of HPV16 in admixed Colombian cervical cancer cases.

BACKGROUND: European (E) variants of HPV 16 are evenly distributed among world regions, meanwhile Non-European variants such as European-Asian (EAs), Asian American (AA) and African (Af) are mostly confined to Eastern Asia, The Americas and African regions respectively. Several studies have shown that genetic variation of HPV 16 is associated with the risk of cervical cancer, which also seems to be dependent on the population. This relationship between ethnicity and variants have led to the suggestion that there is co-evolution of variants with humankind. Our aim was to evaluate the relationship between the individual ancestry proportion and infection with HPV 16 variants in cervical cancer. METHODS: We examined the association between ancestry and HPV 16 variants in samples of 82 cervical cancer cases from different regions of Colombia. Individual ancestry proportions (European, African and Native American) were estimated by genotyping 106 ancestry informative markers. Variants were identified by PCR amplification of the E6 gene, followed by reverse line blot hybridization (RLB) with variants specific probes. RESULTS: Overall European (E) and Asian American (AA) variants frequency was 66.5% and 33.5% respectively. Similar distribution was observed in cases with higher proportions of European or African ancestry. A higher Native American ancestry was significantly associated with higher frequency of E variants (median ancestry>23.6%, Age and place of birth adjusted OR: 3.55, 95% CI: 1.26-10.03, p=0.01). Even further, an inverse geographic correlation between Native American ancestry and frequency of infections with AA variants was observed (ρ=-0.825, p=0.008). Regions with higher proportion of Native American ancestry had a lower frequency of AA variants of HPV 16. CONCLUSIONS: This study suggests replacement of AA variants by E variants of human papillomavirus 16 in cervical cancer cases with high Native American ancestry.

Immunosuppression in cervical cancer with special reference to arginase activity.

INTRODUCTION: Cervical cancer is characterized by an immunosuppressive microenvironment and a Th2-type cytokine profile. Expression of arginase (ASE), the enzyme that converts L-arginine into L-ornithine and urea, is stimulated by Th2-type cytokines. OBJECTIVE: To assess the association of ASE activity and L-Arg metabolism products with cervical cancer. METHODS: Sera of 87 and 41 women with histologically confirmed by colposcopy-directed biopsy SCC and CIN3 respectively and 79 with normal cytology or Low-Grade Squamous Intraepithelial Lesion (LSIL), were evaluated. Cytokines were measured using Milliplex Human cytokine/chemokine kit. Arginase (ASE) activity was determined using an enzymatic assay. Levels of L-arginine, L-ornithine, putrescine and spermine were determined by HPLC. RESULTS: Significantly higher levels of ASE activity were observed in women with CIN3 (age-adjusted OR: 24.3; 95%CI: 3.82-155) and SCC (AOR: 9.8; 95%CI: 2.34-40.8). As expected, possibly due to high levels of ASE activity, higher levels of l-Arg were negatively associated with CIN3 (AOR: 0.03; 95%CI: 0.004-0.19) and SSC (AOR: 0.06; 95%CI: 0.02-0.24). Consistent with the role of ASE in the conversion of L-arginine to L-ornithine and polyamine production therefrom, women with cervical cancer had higher levels of spermine and putrescine. A correlation analysis revealed a significant albeit weak relationship between high levels of IL-10 and high levels of ASE (Pearson r=0.32, p-value=0.003) in women with cervical cancer. CONCLUSION: This study indicates that ASE activity and L-Arg degradation mechanisms of immunosuppression are present in cervical cancer. The results foster research in the design of possible strategies to inhibit ASE activity for therapy of cervical cancer.

Validation of a method for the simultaneous quantification of chloroquine, desethylchloroquine and primaquine in plasma by HPLC-DAD.

One of the most important aspects regarding the therapeutic efficacy of antimalarials is its quantification in biologic fluids. The detection and measurement of antimalarial drug levels is important for demonstrating (1) adequate absorption of the drug being given, (2) compliance in taking the full regimen required for treatment and (3) the level of drug in the blood at any time during the test period that parasites reappear. There is a lack of validated methods that simultaneously quantify different antimalarials administered at the same time, such as the use of chloroquine (CQ) and primaquine (PQ) in infections caused by Plasmodium vivax. In this study, a bioanalytical method was validated for the simultaneous quantification of primaquine (PQ), chloroquine (CQ) and desethylchloroquine (DSCQ) in human plasma using liquid-liquid extraction and high performance liquid chromatography with a diode array detector (HPLC-DAD). The PQ was evaluated over a concentration range of 100-3000 nM and the CQ and DSCQ was evaluated over a concentration range of 20-2000 nM. The selectivity of the method was verified by checking for interference by commonly used antimalarials and plasma samples. The accuracy and precision of the method was assessed for drugs spiked into human plasma and recoveries of 83.7%, 92.3%, and 76.5% were obtained for CQ, DSCQ, and PQ, respectively. The applicability of this method was also demonstrated with blood samples from patients with vivax malaria that received combination CQ plus PQ treatment. The simultaneous detection and accurate measurement of CQ, DSCQ, and PQ levels in human plasma provides an important and economical method for validating and monitoring sensitivity/resistance of P. vivax to more common treatment regimen.

Distribución de variantes del virus del papiloma humano 16 (VPH 16) en mujeres con y sin neoplasia intraepitelial cervical grado 3 y cáncer cervical / Distribution of variants of the human papilloma virus 16 (HPV 16) in Women with and without grade 3 cervical intraepithelial neoplasia and cervical cancer

Objetivos: Describir la distribución de variantes del virus del papiloma humano 16 en mujeres con y sin neoplasia intraepitelial cervical grado 3 y cáncer cervical. Métodos: Se determinaron las variantes moleculares en casos de carcinoma escamocelular, adenocarcinoma cervical y en mujeres sin anormalidades citológicas de alto grado y positivas para el virus del papiloma humano 16. Para la detección de las variantes moleculares se amplificó el marco abierto de lectura del gen E6 del virus del papiloma humano 16 y se utilizó una técnica de hibridación reversa para la detección de los principales cambios de nucleótidos que identifican las ramas filogenéticas y las clases de variantes. Resultados:Hubo diferencias estadísticamente significativas en la distribución de variantes de virus del papiloma humano 16. Los controles no presentaron infecciones con variantes no europeas, mientras que ellas estuvieron presentes en el 30% de los casos de carcinoma escamocelular o neoplasia intraepitelial cervical grado tres. En adenocarcinoma, el 65% de las infecciones fueron del tipo no europeo. Conclusiones: La prevalencia de variantes no europeas de virus de papiloma humano 16 fue de 31,2% en neoplasia intraepitelial cervical grado 3 y cáncer escamocelular, y de 64,1% en adenocarcinoma de cérvix, mientras que estas no se observaron en mujeres sin cáncer.

Objectives: To describe the distribution of the variants of the human papilloma virus 16 in women with and without grade 3 cervical intraepithelial neoplasia and cervical cancer. Methods: Molecular variants were established in cases of squamous cell carcinoma, cervical adenocarcinoma and in women with high grade Pap smear abnormalities who tested positive for human papilloma virus 16. For the detection of molecular variants the open reading framework for the E6 gene of the human papilloma virus 16 was amplified and a reverse hybridization technique was utilized for the detection of major changes in the nucleotides which identify the phylogenetic branches and classes of variants. Results: There were statistically significant results in the distribution of the variants of the human papilloma virus 16. Control cases showed no infections with non European variants, but they were present in 30% of squamous cell carcinoma or grade three cervical intraepithelial neoplasia. For adenocarcinoma, 65% of infections were of non European type. Conclusions: The prevalence of non European variants of the human papilloma virus 16 was 31.2% in grade 3 cervical intraepithelial neoplasia and squamous cell cancer, and 64.1% in cervical adenocarcinoma; however, these were not observed among women without cancer.

Validation of a liquid chromatographic method for determination of sulphadoxine and pyrimethamine in whole blood spotted on filter paper / Validación de un método de cromatografía líquida para determinar la presencia de sulfadoxina y pirimetamina en muestra de sangre secada sobre papel de filtro

Objective: to validate an analytical method for simultaneous determination and quantification of sulphadoxine and pyrimethamine in human blood dried onto filter paper, whose cost and analysis time can be reduced. Methods: whole blood spotted on filter paper of a healthy volunteer and solutions of sulphadoxine-pyrimethamine standard mixture were used. HPLC separations were carried out on Agilent equipment using a LiChrospher® column C18 with a mobile phase acetonitrile/0.1 M potassium phosphate buffer at pH 3.0 (1:1) for eight minutes under isocratic conditions. A flow rate of 0.7 mL/min, and a 20 mL volume injection were used. External standard method for quantitation of analytes was used. Results: the HPLC method described for the simultaneous determination of sulphadoxine and pyrimethamine in 100 mL of whole blood spotted on filter paper has been found to be linear, precise, accurate and selective. In this method, the sample preparation is simple using liquid-liquid extraction, and HPLC with ultraviolet detection is used. Conclusions: a simple, fast and sensitive method for determination of sulphadoxine and pyrimethamine in human blood dried onto filter paper was validated. This method can be used for the monitoring of both metabolites in pharmacokinetic and clinical studies.

Objetivo: validar un método de análisis para la determinación y cuantificación simultánea de sulfadoxina y pirimetamina en sangre humana secada sobre papel de filtro que sea rápido y barato. Métodos: se usó sangre de un voluntario sano impregnada sobre papel de filtro y soluciones estándar de la mezcla sulfadoxina y pririmetamina. Las separaciones por cromatografía líquida de alta resolución (CLAR) se hicieron en un equipo Agilent sobre una columna C18 LiChrospher® con acetonitrilo/buffer fosfato de potasio 0,1 M a pH 3,0 como fase móvil, usando condiciones isocráticas durante 8 min. Se usó un flujo de 0,7 mL/min y un volumen de inyección de 20 mL. Para la cuantificación de los analitos se utilizó el método del estándar externo. Resultados: el método CLAR descrito para la determinación simultánea de sulfadoxina y pirimetamina en 100 mL de sangre impregnada sobre el papel de filtro mostró linealidad, precisión, exactitud y selectividad. En este método la preparación de la muestra es simple ya que usa extracción líquido-líquido y detección ultravioleta. Conclusión: se obtuvo un método validado que es simple, rápido y sensible para la determinación de sulfadoxina y pirimetamina en sangre humana impregnada sobre papel de filtro, que puede ser usado para el monitoreo de ambos metabolitos en estudios farmacocinéticos y clínicos.

Esophageal stricture and metaplasia following abdominoplasty.

Numerous complications have been reported following abdominoplasty. In this report, the case of a 48-year-old woman who developed an esophageal stricture, and subsequently Barrett's esophagus, secondary to increased intra-abdominal pressure following abdominoplasty is presented.

Heparin-induced thrombocytopenia syndrome as a cause of flap failure: a report of two cases.

BACKGROUND: Flap failure is a major complication in reconstructive plastic surgery. One of the most frequent etiologies of flap failure is venous thrombosis. However, infrequent causes also need to be explored, especially when faced with recurrent thrombosis. Heparin is frequently used in the prevention of venous thrombosis; however, the use of the medication itself may cause a serious thromboembolic state via an immune-related pathophysiological process. This adverse reaction to heparin may be life threatening. CASE PRESENTATION: We present two cases, one pedicled and one free flap, with venous congestion concomitant to heparin-induced thrombocytopenia syndrome, in conjunction with severe life-threatening sequelae. CONCLUSIONS: Heparin-induced thrombocytopenia syndrome can be the cause of postoperative venous congestion. It is necessary to be alert for this syndrome in the presence of recurrent unexplained venous thrombosis or thrombocytopenia in patients receiving anticoagulation therapy.

Outcomes in the management of sternal dehiscence by plastic surgery: a ten-year review in one university center.

PURPOSE: Infection rates following median sternotomy vary between 0.2% and 10%. These cases are associated with morbidity and mortality rates between 10% and 25% and 5% and 20%, respectively. The purpose of this study was to evaluate patient outcomes following plastic surgery correction of sternotomy dehiscence (SD). METHODS: All patients operated on for an SD following coronary artery bypass graft surgery (CABG), between 1995 and 2005, with 1 or more flaps, were included. RESULTS: Eighty cases were identified over a 10-year period. The mean age was 64 (+/-9.1) years. Two or more procedures were required in 17.5% of patients, and the mortality rate within 30 days was 12.5%. Significant variability was revealed between the cumulative mortality rates of plastic surgeons, from 0.0% to 50.0%. Multiple associations were identified for poor outcome, including chronic renal insufficiency and early mortality, and obesity with risk of reintervention. CONCLUSION: Although patients who undergo surgical correction of a deep sternal infection usually tolerate their intervention well, the mortality within 30 days remains high. This study has identified several factors explaining morbidity and mortality in this patient population.

A review of materials currently used in orbital floor reconstruction.

Orbital fractures are common fractures of the midface. As such, numerous techniques and materials exist for the repair of this region, each with inherent advantages and disadvantages. But does the ideal implant material exist? Should we stop and simply use readily available materials, or should the cycle of need and discovery continue? A comprehensive review of materials used in orbital reconstruction and possible new directions in orbital floor reconstruction are presented.

Les fractures orbitales sont des fractures courantes qui peuvent souvent affecter le milieu du visage. C'est pourquoi il existe autant de techniques et de types de matériel pour en effectuer la réparation, chacun comportant ses inconvénients et ses avantages. Mais, disposons-nous de l'implant idéal? Devons-nous simplement nous contenter du matériel existant ou vaudrait-il mieux poursuivre sur la voie de la recherche et du développement? Le présent article fait une revue exhaustive du matériel actuellement offert pour la reconstruction orbitale et des nouvelles orientations possibles pour ce type d'intervention.

Paraspinous muscle flaps for the treatment and prevention of cerebrospinal fluid fistulas in neurosurgery.

STUDY DESIGN: A prospective clinical study was conducted to evaluate the efficacy of paraspinous muscle flaps in preventing and managing cerebrospinal fluid fistulas in high-risk neurosurgery patients. OBJECTIVES: To evaluate the efficacy of paraspinous muscle flap coverage using a "vest-over-pants" closure in the prevention and treatment of cerebrospinal fluid fistulas. SUMMARY OF BACKGROUND DATA: Previous studies have described paraspinous muscle flaps for the closure of complex spinal wounds, but none has addressed their use for the prevention and treatment of cerebrospinal fluid fistulas. METHODS: This prospective clinical study evaluated nine consecutive patients with either refractory cerebrospinal fluid fistulas or high risk for cerebrospinal fluid leaks after spinal surgery. Bilateral paraspinous muscle flaps were used as primary flaps and closed using an overlapping vest-over-pants technique in eight of nine cases. The latissimus dorsi and trapezius muscles were recruited as additional muscle flaps for closure of thoracolumbar and high thoracic deficits, respectively. RESULTS: Paraspinous muscle flaps provided immediate wound coverage in seven high-risk patients undergoing spinal surgery and two patients with recurrent cerebrospinal fluid fistulas. Postoperative hospitalization averaged 14.4 days. There was no evidence of a cerebrospinal fluid fistula after an average follow-up of 176.7 days. No wound infections occurred. The only complications were a superficial hematoma, which was drained percutaneously on postoperative day 6, and a seroma, which was drained during the follow-up period and eventually resolved. CONCLUSIONS: Paraspinous muscle flaps allow effective treatment and prevention of cerebrospinal fluid fistulas in selected high-risk patients and provide simple durable coverage of complex spinal wounds with minimal morbidity.

Recurrent venous thrombosis following free flap surgery: The role of heparin-induced thrombocytopenia.

Complications following free tissue transfer have been well established in the literature. Common and rare causes of free flap failure must be addressed by the treating surgeon when microvascular patency is threatened. With the evolution and prevalence of microsurgery, 'rare' causes of free flap failure will become increasingly frequent. A high index of suspicion must be established in patients with multiple failed operative interventions. A case of recurrent free flap failure secondary to heparin-induced thrombocytopenia is presented in a patient with a history of squamous cell carcinoma of the floor of the mouth, and a long-standing history of alcohol and tobacco consumption.

Les complications fréquentes et rares des lambeaux libres sont bien décrites dans la littérature. Le chirurgien se doit d'être vigilant afin de préserver l'intégrité microvasculaire du lambeau. Les complications «rares¼ deviendront fréquentes suite de la prévalence croissante de la microchirurgie vasculaire. Par la lumière d'échecs chirurgicaux répétés, la cause devrait être recherchée par une investigation plus poussée. Voici un cas de thrombose récurrente de lambeau libre secondaire à une thrombocytopénie à l'héparine chez un patient traité pour un carcinome épidermoïde du plancher buccal et ayant des antécédents anciens de tabagisme et de consommation d'alcool.

Ventajas y desventajas de la angiografía digital por substracción como método para valoración vascular de donadores de riñón, y de arteria renal en injertos renales / Advantages of digital substraction angiography as a method for the vascular evaluation of kidney donors, an of renal artery in kidney grafts

La práctica de la angiografía ordinaria por el método de Seldinger, que lleva aunada la necesidad de internar al paciente con el alto costo económico concomitante para el mismo, obligó a estudiar métodos alternativos para valorar la vascularización renal. Se estudiaron 11 donadores de riñón y dos pacientes qye ya habían recibido un trasplante del mismo en fosa ilíaca en cuanto a los grandes vasos relacionados con este órgano. Se valoraron la calidad de la resolución y la información diagnóstica con este método de visualización vascular para el trasplante. Durante el acto quirúrgico se pudieron comprobar las observaciones radiológicas. Información obtenida, costo del estudio y cantidad de medio de contraste utilizaco en esta serie fueron sumamente satisfactorios, incluso en el paciente que se conservó ambulatorio. Este método es un instrumento que plantea riesgos mínimos para el individuo normal que se somete de manera voluntaria a valoración vascular renal. En las personas que han recibido injertos renales plantea riesgos mínimos de traumatismos e infecciones, menor exposición al material de contraste y posibilidad de proseguir como pacientes ambulatorios.