Changes in clinical characteristics and outcomes of patients hospitalized with COVID-19 during two years of the pandemic: experience in a venezuelan hospital. / Cambios en las características clínicas y desenlaces de pacientes hospitalizados por COVID-19 durante dos años de pandemia: experiencia en un hospital venezolano.

OBJECTIVES.: To determine changes in the clinical characteristics and in-hospital outcomes of patients hospitalized for COVID-19 in a private hospital in Caracas during two years of the pandemic. MATERIALS AND METHODS.: Retrospective, observational study of patients hospitalized for COVID-19. We evaluated the correspondence between waves of hospital admissions and circulating variants of SARS-CoV-2 in the general population of the Capital District and Miranda state. RESULTS.: A total of 1025 patients (569 men and 456 women) were included, with a mean age of 62.9 SD: 16.2 years. Four waves of hospital admissions were identified: first (March-November 2020) 150/1025 (14.6%) cases; second (December 2020 to May 2021) 415/1025 (40.5%) cases; third (June-December 2021) 344/1025 (33.6%) cases; fourth (January-February 2022) 116/1025 (11.3%) cases. The mean age was higher in the fourth wave (first: 64.0±15.7, second: 61.4±15.8, third: 62.1±16.5, and fourth wave: 68.5±16.4), while the proportion of male patients (first: 66.7%, second: 58.8%, third: 50.3%, and fourth wave: 44.8%), patients with severe-critical illness (first: 65.3%, second: 57%, third: 51.7%, and fourth wave: 44.8%), in-hospital stay (first: 9.1±6.0, second: 9.0±7.3, third: 8.8±7.7, and fourth wave: 6.9±5.0 days), ICU admissions (first: 23.3%, second: 15.7%, third: 14.0%, and fourth wave: 11.2%; p=0.027) and mortality (first: 21. 8%, second: 10.7%, third: 9.1%, and fourth wave: 7.1%; p<0.001) progressively decreased over time. CONCLUSIONS.: The results show lower frequency of severe cases and improvement of in-hospital outcomes in two years of the pandemic. Changes in circulating variants, improvements in disease management and vaccination are likely to have influenced these results.

OBJETIVOS.: Determinar los cambios en las características clínicas y desenlaces intrahospitalarios de los pacientes hospitalizados por COVID-19 en un hospital privado de Caracas durante dos años de pandemia. MATERIALES Y MÉTODOS.: Estudio retrospectivo, observacional, de pacientes hospitalizados por COVID-19. Se investigó la correspondencia entre las olas de ingresos hospitalarios con las variantes circulantes del SARS-CoV-2 en la población general del Distrito Capital y estado Miranda. RESULTADOS.: Se incluyeron 1025 pacientes (569 hombres y 456 mujeres), con edad promedio de 62,9 DE: 16,2 años. Cuatro olas de ingresos hospitalarios fueron identificadas: primera (marzo-noviembre 2020) 150/1025 (14,6%) casos; segunda (diciembre-2020 a mayo-2021) 415/1025 (40,5%) casos; tercera (junio-diciembre 2021) 344/1025 (33,6%) casos; cuarta (enero-febrero 2022) 116/1025 (11,3%) casos. La edad promedio fue mayor en la cuarta ola (primera 64,0±15,7, segunda 61,4±15,8, tercera 62,1±16,5, y cuarta ola 68,5±16,4), mientras que la proporción de pacientes masculinos (primera 66,7%, segunda 58,8%, tercera 50,3%, y cuarta 44,8%), los pacientes con enfermedad grave-crítica (primera 65,3%, segunda 57%, tercera 51,7% y cuarta 44,8%), la estadía intrahospitalaria (primera 9,1±6,0, segunda 9,0±7,3, tercera 8,8±7,7, y cuarta 6,9±5,0 días), los ingresos a la UCI (primera 23,3%, segunda 15,7%, tercera 14,0%, y cuarta 11,2%; p=0,027) y la mortalidad (primera 21.8%, segunda 10,7%, tercera 9,1%, y cuarta 7,1%; p<0,001) disminuyeron progresivamente con el tiempo. CONCLUSIONES.: Los resultados muestran menor frecuencia de casos severos y mejoría de los desenlaces intrahospitalarios en dos años de pandemia. Es probable que los cambios en las variantes circulantes, las mejoras del manejo de la enfermedad y la vacunación hayan influido sobre estos resultados.

Cambios en las características clínicas y desenlaces de pacientes hospitalizados por COVID-19 durante dos años de pandemia: experiencia en un hospital venezolano / Changes in clinical characteristics and outcomes of patients hospitalized with COVID-19 during two years of the pandemic: experience in a venezuelan hospital

RESUMEN Objetivos. Determinar los cambios en las características clínicas y desenlaces intrahospitalarios de los pacientes hospitalizados por COVID-19 en un hospital privado de Caracas durante dos años de pandemia. Materiales y métodos. Estudio retrospectivo, observacional, de pacientes hospitalizados por COVID-19. Se investigó la correspondencia entre las olas de ingresos hospitalarios con las variantes circulantes del SARS-CoV-2 en la población general del Distrito Capital y estado Miranda. Resultados. Se incluyeron 1025 pacientes (569 hombres y 456 mujeres), con edad promedio de 62,9 DE: 16,2 años. Cuatro olas de ingresos hospitalarios fueron identificadas: primera (marzo-noviembre 2020) 150/1025 (14,6%) casos; segunda (diciembre-2020 a mayo-2021) 415/1025 (40,5%) casos; tercera (junio-diciembre 2021) 344/1025 (33,6%) casos; cuarta (enero-febrero 2022) 116/1025 (11,3%) casos. La edad promedio fue mayor en la cuarta ola (primera 64,0±15,7, segunda 61,4±15,8, tercera 62,1±16,5, y cuarta ola 68,5±16,4), mientras que la proporción de pacientes masculinos (primera 66,7%, segunda 58,8%, tercera 50,3%, y cuarta 44,8%), los pacientes con enfermedad grave-crítica (primera 65,3%, segunda 57%, tercera 51,7% y cuarta 44,8%), la estadía intrahospitalaria (primera 9,1±6,0, segunda 9,0±7,3, tercera 8,8±7,7, y cuarta 6,9±5,0 días), los ingresos a la UCI (primera 23,3%, segunda 15,7%, tercera 14,0%, y cuarta 11,2%; p=0,027) y la mortalidad (primera 21.8%, segunda 10,7%, tercera 9,1%, y cuarta 7,1%; p<0,001) disminuyeron progresivamente con el tiempo. Conclusiones. Los resultados muestran menor frecuencia de casos severos y mejoría de los desenlaces intrahospitalarios en dos años de pandemia. Es probable que los cambios en las variantes circulantes, las mejoras del manejo de la enfermedad y la vacunación hayan influido sobre estos resultados.

ABSTRACT Objectives. To determine changes in the clinical characteristics and in-hospital outcomes of patients hospitalized for COVID-19 in a private hospital in Caracas during two years of the pandemic. Materials and Methods. Retrospective, observational study of patients hospitalized for COVID-19. We evaluated the correspondence between waves of hospital admissions and circulating variants of SARS-CoV-2 in the general population of the Capital District and Miranda state. Results. A total of 1025 patients (569 men and 456 women) were included, with a mean age of 62.9 SD: 16.2 years. Four waves of hospital admissions were identified: first (March-November 2020) 150/1025 (14.6%) cases; second (December 2020 to May 2021) 415/1025 (40.5%) cases; third (June-December 2021) 344/1025 (33.6%) cases; fourth (January-February 2022) 116/1025 (11.3%) cases. The mean age was higher in the fourth wave (first: 64.0±15.7, second: 61.4±15.8, third: 62.1±16.5, and fourth wave: 68.5±16.4), while the proportion of male patients (first: 66.7%, second: 58.8%, third: 50.3%, and fourth wave: 44.8%), patients with severe-critical illness (first: 65.3%, second: 57%, third: 51.7%, and fourth wave: 44.8%), in-hospital stay (first: 9.1±6.0, second: 9.0±7.3, third: 8.8±7.7, and fourth wave: 6.9±5.0 days), ICU admissions (first: 23.3%, second: 15.7%, third: 14.0%, and fourth wave: 11.2%; p=0.027) and mortality (first: 21. 8%, second: 10.7%, third: 9.1%, and fourth wave: 7.1%; p<0.001) progressively decreased over time. Conclusions. The results show lower frequency of severe cases and improvement of in-hospital outcomes in two years of the pandemic. Changes in circulating variants, improvements in disease management and vaccination are likely to have influenced these results.

Ex situ catalytic biomass pyrolysis using mesoporous Ti-MCM-41.

Biomass has attracted considerable attention as energy, economic, and environmental asset, as result of its abundance and range of properties. The use of mesoporous catalysts during fast pyrolysis has been a highly important route to improve efficiency as well adding value to biomass. The addition of titanium to molecular sieves increases the efficiency of the pyrolysis reaction by improving production and selectivity of products of interest. This study aims at analyzing the catalytic pyrolysis products of elephant grass using titanium catalysts prepared at different Si/Ti molar ratios, i.e., 25 and 50. The material was supported on MCM-41 for the catalytic pyrolysis of biomass. The biomass pyrolysis reactions were performed in a micropyrolyzer coupled to a GC/MS analyzer. The Ti-MCM-41 samples were characterized by XRD, BET-specific area, and UV-visible. The distribution of pyrolysis products depended on process parameters such as temperature and catalyst type. The highest yield for hydrocarbon production, such as styrene, benzene, methylbenzene, and naphthalene, was observed at 600 °C using Si/Ti equal to 50.

Sulfur removal from model fuel by Zn impregnated retorted shale and with assistance of design of experiments.

There is global concern about acid rain and other pollution which is caused by the consumption of oil. By decreasing sulfur content in the oil, we can reduce unwanted emissions and acid rain. Shale was used which is a solid waste generated in the pyrolysis of shale, impregnated with Zn as an adsorbent which removes sulfur present in fuels from the hexane/toluene model solution. An influence of the agitation time (60-180 min), temperature (25-35 °C), adsorbent mass (0.1-0.25 g), and initial sulfur concentration (100-250 ppm) factorial 24 with three central points totaling 19 experiments was applied to investigate the effect of the variables on the efficiency of sulfur removal in fuels. The values of the parameters tested for maximum sulfur removal were obtained as follows: contact time = 180 min, temperature = 35 °C, adsorbent mass = 0.25 g, and initial sulfur concentration = 100 ppm. The mathematical model proposed with R2 99.97% satisfied the experimental data. This may provide a theoretical basis for new research and alternative uses for tailings of schist industrialization in order to evaluate its potential.

Evaluation of Surface Roughness of Monolithic Zirconia after Using Different Polishing Kits

Objective: To evaluate the effect of different kits to polish monolithic zirconia on its surface roughness. Material and Methods: Five samples were fabricated using zirconia blocks. Each sintered block was divided into four areas of equal size and each area was subjected to a specific surface treatment according to the four groups of the study: GC: no surface treatment, GG: unidirectional grinding with high speed tapered bur under refrigeration, GP1: wear similar to GG followed by polishing with zirconia polishing kit Kenda at the same wear direction, and GP2: wear similar to GG followed by polishing with zirconia polishing kit Diacera at the same wear direction. Qualitative and quantitative analyses of ceramic topography and roughness were performed using a digital optical profilometer, and Roughness measurements were performed using two parameters (Ra and Rz: arithmetical mean of the absolute values of the surface departures and of the five highest peaks and valleys, respectively). Scanning electron micrographs of each ceramic surface were obtained to illustrate sample roughness. The means of each group were analyzed by 1-way ANOVA followed by Tukey's test. Results: Morphological analysis showed that polishing kits provided the same pattern of a smooth surface. To statistical analysis, this study showed that different polishing kits influenced zirconia roughness for both Ra and Rz after surface wear (p < 0.05) with both situations improved the surface roughness observed immediately after zirconia sintering. Conclusion: According to the results, both polish kits resulted in a surface texture within acceptable clinical parameters.

Effect of Zirconia and Alumina Fillers on the Microstructure and Mechanical Strength of Dental Glass Ionomer Cements.

BACKGROUND: Glass-ionomer cements perform a protective effect on the dentin-pulp complex considering the F ions release and chemical bonding to the dental structures. On the other hand, those materials have poor physic-mechanical properties in comparison with the restorative resin composite. The main aim of this work was to evaluate the influence of zirconia and/or alumina fillers on the microstructure and strength of a resin modified glass-ionomer cement after thermal cycling. METHODS: An in vitro experimental study was carried out on 9 groups (n = 10) of cylindrical samples (6 x 4 mm) made from resin modified glass-ionomer (Vitremer, 3M, USA) with different contents of alumina and/or zirconia fillers. A nano-hybrid resin composite was tested as a control group. Samples were mechanically characterized by axial compressive tests and electron scanning microscopy (SEM) coupled to energy dispersive X-ray spectrophotometry (EDS), before and after thermal cycling. Thermal cycling procedures were performed at 3000, 6000 and 10000 cycles in Fusayama´s artificial saliva at 5 and 60 (o)C. RESULTS: An improvement of compressive strength was noticed on glass-ionomer reinforced with alumina fillers in comparison with the commercial glass ionomer. SEM images revealed the morphology and distribution of alumina or zirconia in the microstructure of glass-ionomers. Also, defects such as cracks and pores were detected on the glass-ionomer cements. The materials tested were not affected by thermal cycling in artificial saliva. CONCLUSION: Addition of inorganic particles at nano-scale such as alumina can increase the mechanical properties of glass-ionomer cements. However, the presence of cracks and pores present in glass-ionomer can negatively affect the mechanical properties of the material because they are areas of stress concentration.

Evaluation of spatial and functional roughness parameters on air-abraded zirconia as a function of particle type and deposition pressure.

PURPOSE: This study evaluated the spatial and functional roughness parameters on air-abraded zirconia as a function of particle type and deposition pressure. MATERIALS AND METHODS: Polished zirconia blocks (Cercon, Degussa/Dentsply) (N=30) with dimensions of 5 × 4 × 4 mm3 were air abraded according to 2 factors: a) particle type - 30-µm silica-coated alumina (CoJet) or alumina particles (45 µm); b) deposition pressure (1.5, 2.5 and 4.5 bar). Roughness parameters (Sdr, Vi, Sci and Svi) were measured in an optical profilometer (Wyko NT 1100) at the center of the air-abraded area (301.3 × 229.2 µm). Two measurements were made for each parameter from each surface. The means of each group were analyzed by 2-way ANOVA followed by Tukey's adjustment test and Student's t-test (alpha = 0.05). RESULTS: Both the particle type (p < 0.05) and deposition pressure (p < 0.05) significantly affected the roughness parameters. Interaction terms were significant except for Sci and Svi. With the increase in pressure from 1.5 to 4.5 bar, Sdr (CoJet 1.5: 15.7 ± 0.2; CoJet 4.5: 26.6 ± 0.2; alumina 1.5: 14.7 ± 0.2; alumina 4.5: 24.4 ± 0.2) and Vi (CoJet 1.5: 0.66 ± 0.01; CoJet 4.5: 1.37 ± 0.07; alumina 1.5: 0.62 ± 0.02; alumina 4.5: 1.19 ± 0.02) parameters showed a significant increase with both alumina and CoJet particles. Mean Sci values (CoJet 1.5: 1.62 ± 0.01, CoJet 4.5: 1.49 ± 0.02; alumina 1.5: 1.6 ± 0.03; alumina 4.5: 1.42 ± 0.04) and SVi (CoJet 1.5: 0.98 ± 0.01, CoJet 4.5: 0.112 ± 0.01; alumina 1.5: 0.98 ± 0.01, alumina 4.5: 0.12 ± 0.01) decreased significantly (p < 0.05) with the increase in pressure from 1.5 to 4.5 bar. The pressure increase from 2.5 to 4.5 bar did not cause any significant difference (p > 0.05) in these parameters for either particle type. CONCLUSION: Considering roughness parameters for micromechanical retention and parameters for adsorption mechanisms of adhesion, zirconia surfaces presented better morphological features when air abraded with silica-coated alumina than alumina particles at pressures higher than 1.5 bar. Particle deposition at 2.5 bar may be preferable to 4.5 bar pressure for avoiding possible deposition-related damage on zirconia, as there were no significant differences for the functional parameters.

Mechanical and chemical analyses across dental porcelain fused to CP titanium or Ti6Al4V.

The aim of this study was to evaluate the evolution of mechanical properties and chemical variation across veneering dental porcelain fused to different titanium-based substrates. Test samples were synthesized by fusing dental feldspar-based porcelain onto commercially pure titanium grade II or Ti6Al4V alloy. Samples were cross-sectioned at angles of 10 and 90° to the interface plane. Afterwards, nanoindentation tests and Scanning Electron Microscopy (SEM) imaging coupled to an Energy Dispersive Spectroscopy (EDS) system were carried out across interfaces extending from the metal towards the porcelain area. Elemental diffusion profiles across the porcelain-to-metal interfaces were also obtained by EDS analysis. The mismatch in mechanical properties found in porcelain-to-Ti6Al4V interfaces was lower than that of porcelain-to-CP titanium. Cracking was noticed at low-thickness veneering dental porcelain regions after the nanoindentation tests of samples cross-sectioned at low angles to the interface plane. A wide reaction zone between titanium and porcelain as well as higher incidence of defects was noticed at the porcelain-to-CP titanium interfaces. This study confirmed Ti6Al4V as an improved alternative to CP-titanium as it showed to establish a better interface with the veneering dental porcelain considering the slight chemical interaction and the lower mechanical properties mismatch. The elastic modulus of porcelain-to-Ti6Al4V samples showed to be less sensitive to porcelain thickness variations.

Diagnostic role of circulating free plasma DNA detection in patients with localized prostate cancer.

To analyze the potential diagnostic relevance of free plasma DNA (FPDNA), we enrolled 64 patients with localized prostate cancer (CaP). FPDNA was quantified by real-time polymerase chain reaction assessment of the HTERT gene in blood samples from 64 patients with CaP and 45 healthy males. Methylation of the GSTP1 gene was used to confirm the neoplastic origin of FPDNA in selected cases. The mean +/- SD levels of FPDNA were higher in patients with CaP (15.4 +/- 10.9 ng/mL) than in control subjects (5.5 +/- 3.5 ng/mL; P <.001). By using the best cutoff value, the sensitivity of the test was 80%, the specificity was 82%, the area under the receiver operating characteristic curve, 0.881. High FPDNA values were significantly associated with pathologic T3 stage (P = . 035). Methylation of the GSTP1 gene was found in 4 (25%) of 16 FPDNA samples and 15 (94%) of 16 tissue samples. Quantification of FPDNA discriminates between patients with CaP and healthy subjects and correlates with pathologic tumor stage. FPDNA is a candidate biomarker for early diagnosis and monitoring of CaP.

Development and validation of the BSP-BPH (Bononian Satisfaction Profile--Benign Prostatic Hyperplasia) a "disease-specific" questionnaire for the evaluation of health related quality of life in patients with benign prostatic hyperplasia.

OBJECTIVES: Lower Urinary Tract Symptoms (LUTS) associated to Benign Prostatic Hyperplasia (BPH) are very common in middle aged and older men. Since BPH, and the related therapies have a significant impact on a patient's Quality of Life (QoL), the health related quality of life (HQoL) evaluation is becoming an important aspect to be considered. The present study deals with the development and validation of a BPH disease specific questionnaire (Bononian Satisfaction Profile - BSP-BPH), considering HQoL in patients seeking medical help for BPH. The innovation of this questionnaire is that the patients' scores achieved are related to their subjective satisfaction. MATERIALS AND METHODS: Questionnaire development: On the base of our previous experience with BSP-PC (a disease specific questionnaire assessing HQoL in prostate Cancer patients), of a careful review of other available instruments (SAT-P, SF-36, ICS-QoL, BPH-HqoL) and of three subsequent meetings with experts (10) and patients (20), we defined the ten life aspects mostly impaired by BPH. We created a first 72-item version of the BSP-BPH. Ten patients cross matched for age end education to our study population were asked to fill in the questionnaire. A 31 item questionnaire version, together with EuroQoL, an already generic validated instrument, was administered to 121 patients as well. Further meetings and statistical analysis defined the 18 items of the BSP- BPH. Questionnaire validation: the BSP-BPH was filled in by 435 patients enrolled in a campaign for detection of prostatic diseases held among the male population of Bologna. RESULTS: Questionnaire development: the participants' mean age was 63 years (N = 121); 47.1% had BPH. The 18 items were selected on the basis of the following criteria: a) r > 0.50, p < 0.05 (correlation test re-test); b) p < 0.05 (ANOVA presence vs absence of BPH); c) r > 0.50, p < 0.05 (correlation with EuroQol). Questionnaire validation: the participants' mean age was 63 years (N = 436). 16 patients with a history of neoplasia were excluded from our study. 21 were missing data. 45% of the sample had BPH. Principal component analysis identified 5 components: 1) satisfaction about sexual functionality (Cronbach alpha = 0.94); 2) satisfaction about social functionality (alpha = 0.80); 3) satisfaction about cognitive/emotional functionality (alpha = 0.82); 4) satisfaction about urinary functionality (alpha = 0.87); 5) satisfaction about physical functionality (alpha = 0.66); total Cronbach alpha was 0.88. CONCLUSIONS: The 18 items version of BSP-BPH questionnaire can be used as an instrument for HQoL evaluation in patients with BPH focusing on patients' subjective satisfaction. At the moment only the Italian version is available.

Manifestaçäo tardia do eritema nodoso hansênico com arterites necrosantes e exsudativas, arterites cicatriciais, livedo reticular, nódulos e placas reacionais, com focos de necrose / Late menifestation of erythema nodosum leprosum with necrotic and exsudative arteritis, cicatricial arteritis, reticular livedo, reactional nodules and plaques, with foci of necrosis

Os autores descrevem uma paciente portadora de hanseníase virchoviana que apresentava episódios reacionais: por sete anos após alta do tratamento, com placas e nódulos em membros inferiores associado a livedo reticular, ulceraçäo e dor. Várias biópsias foram realizadas e a mais constante alteraçäo observada foi a arterite exsudativa e necrótica na derme profunda e no subcutâneo. Raros focos de infiltrado virchoviano residual estavam presentes e bacilos (granulosos) foram vistos apenas na parede das artérias envolvidas. Arterite exsudativa e cicatricial, flebite cicatricial e alteraçöes dérmicas sugestivas de vasculite livedóide foram observadas em algumas biópsias. Os autores acreditavam que esses episódios podem depender da persistência do antígeno em parede do vaso, provavelmente devido ao intenso parasitismo dos vasos na fase mais alta da hanseníase virchoviana. O aspecto livedóide pode estar relacionado as arterites cicatriciais com obstruçäo vascular que poderia permanecer como sequela

Cardiopatía isquémica. Espectro clínico / Myocardial eschemia. Clinic spectrum

A pesar de una marcada disminución de la mortalidad por Cardiopatía Isquémica, ésta continua siendo una causa principal de muerte a nivel mundial. En el presente trabajo hacemos una revisión de la fisiopatología de la isquemia miocárdica y los mecanismos adaptativos del miocardio isquémico, la relación entre el proceso aterosclerótico y los síndromes coronarios y finalmente definimos los diferentes sub-grupos que componen el aspectro clínico de la cardiopatía isquémica

Manejo de las crisis hipertensivas / Hypertensive crisis management

Las crisis hipertensivas requieren de un rápido diagnóstico y tratamiento, ya que comprometen la función de órganos y constituyen una serie amenaza para la vida del paciente. En el presente trabajo se hace una revisión sobre la clasificación de las crisis hipertensivas y los diferentes fármacos que pueden ser utilizados en su tratamiento

La hemofiltracion en el tratamiento de la insuficiencia cardiaca congestiva refractaria a tratamiento convencional / The hemofiltration in the treatment refractary congestive heart failure of convencional treatment

El paciente con insuficiencia cardiaca congestiva refractaria con edema pulmonar persistente, la hemofiltracion lenta secuencial puede ser considerada como una nueva modalidad terapeutica. En este articulo se presenta una amplia revision de la tecnica, indicaciones y ventajas de la hemofiltracion

El uso de malla y cierres ajustables en la sepsis de origen intraabdominal / The use of net adjustable closing in the intraabdominal sepsis

Es bien conocido en las sepsis intraabdominal cursa con una alta mortalidad, es por esto que se han intentado desarrollar en los últimos años métodos de tratamiento distintos a los convencionales, entre los cuales está la laparostomía y el lavado mecánico programado de la cavidad abdominal. Este método tiene las ventajas de brindar un máximo drenaje de la cavidad abdominal, eliminando así el foco séptico y a la vez evita el cierre a tensión de la misma. En esta serie, diez pacientes con sepsis de origen intraabdominal, fueron tratados con este método en el Hospital Vargas de Caracas y el Hospital de Clínicas Caracas, desde Enero de 1987 a mayo de 1988. Se utilizaron dos variantes: 1. El uso de malla de contensión con "zipper" (cierres comerciales de plástico y nylon). 2. Cierres ajustables de plástico y polietileno. La mortalidad fue de un 30% y la morbilidad consistió en la presencia de fistulas intestinales en dos pacientes como complicación del procedimiento. Así mismo se apreció una relación entre el número de órganos con falla, su duración y la mortalidad

Monitoreo de la presión intracraneana / Intracraneal pressure monitoring

El monitoreo de la Presión Intracraneana es utilizado con frecuencia en pacientes neuroquirúrgicos que ingresan a las Unidades de Cuidados Intensivos, en los cuales el pronto reconocimiento y tratamiento de aumento de la presión Intracraneana son vitales para la preservación de la función neurológica. En el presente trabajo se hace una revisión de los principios básicos del monitoreo de Presión Intracraneana, sus metodos, indicaciones y complicaciones

Carcinoma de vesícula biliar: Revisión de 5 años / Gallbladder cancer: Review of 5 years

Se realiza un estudio retrospectivo de 20 pacientes con Carcinoma de Vesícula Biliar que ingresaron a este Centro durante los años de 1983 a 1987. El diagnóstico se confirmó mediante biopsia intra operatoria o autopsia. El 90% era del sexo femenino siendo el 70% mayor de 50 años. El 56% refería intolerancia a grasas y granos, un 44% había sido estudiado por litiasis vesicular. El dolor en hipocondrio derecho se halló en un 89%, la pérdida de peso en 83% y la ictericia en 79% de los casos. El 78% tenía masa palpable abdominal. Las fosfatasas alcalinas se hallaron elevadas en la totalidad de los casos, la bilirrubina y transaminasas en el 78% y 76% respectivamente. El ECO abdominal sugirió el diagnóstico en el 50% de los casos, un único caso al que se le realizó TAC el diagnóstico de litiasis vesicular el 25% de los casos. Adenocarcinoma de vasícula fue reportado en el 100% de los casos. De los 12 pacientes tratados quirúrgicamente, 4 (33%) fallecen en un lapso de 6 a 14 días, 8 egresan, regresando 4 a control. Tres fallecen en un lapso de 4 meses a 9 años, el restante está bajo seguimiento médico posterior a colecistectomía simple sin evidencia clínica o por imágenes de tumor a los 22 meses de intervención

Absceso hepático por Salmonella dublin: reporte de un caso / Hepatic abscess due to Salmonella dublin: report of a case

Se presenta el caso de un paciente con absceso hepático único del lóbulo izquierdo por Salmonella dublin al cual se le practicó drenaje quirúrgico. El diagnóstico etiológico microbiano se realizó por cultivo del contenido del absceso y hemocultivo. El paciente recibió tratamiento antimicrobiano con Cefoperazona, Metronidazol y Gentamicina, egresando a los 29 días del post operatorio

Colitis amibiana necrotizante: reporte de 6 casos / Necrotizing amebic colitis. Report of 6 cases

Se describen 6 casos de colitis amibiana necrotizante que ingresaron al hospital Vargas de Caracas durante los años 1981 a 1988. Todos los pacientes eran del sexo masculino con edades comprendidas entre los 14 y 68 años. Los signos y síntomas más frecuentes fueron, dolor abdominal, fiebre y diarrea, esta última con moco y sangre en tres de ellos. La distensión y la irritación peritoneal estuvo presente en la totalidad de los casos. En 4 pacientes la leucocitosis fue mayor de 20.000/mm cubicos, con desviación a la izquierda y cayados. En sólo dos casos se sospechó el diagnóstico durante el acto operatorio al evidenciarse un colon inflamado, friable, con áreas isquémicas y multiples perforaciones, indicándose tratamiento con metronidazol, sobreviviendo tan solo uno de ellos. Los procedimientos quirúrgicos empleados fueron la colectomía total con ileoetomía, la hemicolectomía derecha con anastomosis ileotransversa y la hemicolectomía izquierda con operación de Hartman. La mortalidad en esta serie alcanzó el 83%. Debe resaltarse la importancia de sospechar el diagnóstico en todo abdomen agudo con síndrome disentérico, agotándose todos los metodos diagnósticos y tener presente los hallazgos operatorios a fin de iniciar tratamiento antiamibiano y lograr así disminuir la mortalidad

Efecto del ácido ascórbico en un modelo experimental de sepsis de origen abdominal / Effect of ascorbic acid in an experimental sepsis model of abdominal origin

Ciento treinta y nueve ratones de la cepa Balb-C con edades comprendidas entre las 8 y 12 semanas fueron sometidos a sepsis intra-abdominal utilizando el modelo experimental de ligadura y perforación del ciego. Los ratones fueron divididos en un grupo control el cual recibió solución salina normal y dos grupos experimentales que recibieron ácido ascórbico a las dosis de 30 y 60 mg/kg/día. El ácido ascórbico fue administrado en pequeños volúmenes por vía intra-peritoneal inmediatamente después de producirse la ligadura y perforación del ciego y durante los dos días subsiguientes. La administracción de ácido ascórbico incrementó de forma significativa la sobrevida ante la sépsis, siendo la mortalidad del 100% en el grupo control, comparado con 79.7 y 72.5% en los grupos experimentales que recibieron ácido ascórbico a los 30 y 60 mg/kg/día respectivamente alcanzando una significancia estadística con un valor de P < 0.05 en ambos casos