Financing for pandemic preparedness and response measures: a systematic scoping review.

Objective: To obtain insights into reducing the shortfall in financing for pandemic preparedness and response measures, and reducing the risk of another pandemic with social and economic costs comparable to those of the coronavirus disease. Methods: We conducted a systematic scoping review using the databases ScienceDirect, Scopus, JSTOR, PubMed® and EconLit. We included articles published in any language until 1 August 2023, and excluded grey literature and publications on epidemics. We categorized eligible studies according to the elements of a framework proposed by the World Health Organization Council on the Economy of Health for All: (i) root/structural causes; (ii) social position/foundations; (iii) infrastructure and systems; and (iv) communities, households and individuals. Findings: Of the 188 initially identified articles, we included 60 in our review. Most (53/60) were published after 2020, when academic interest had shifted towards global financing mechanisms. Most (37/60) addressed two or more of the council framework elements. The most frequently addressed element was infrastructure and systems (54/60), discussing topics such as health systems, financial markets and innovation ecosystems. The roots/structural causes were discussed in 25 articles; communities, households and individuals in 22 articles; and social positions/foundations in 11. Conclusion: Our review identified three important gaps: a formal definition of pandemic preparedness and response, impeding the accurate quantification of the financing shortfall; research on the extent to which financing for pandemic preparedness and response has been targeted at the most vulnerable households; and an analysis of specific financial instruments and an evaluation of the feasibility of their implementation.

Comparación de los resultados oncológicos entre cirugía radical por laparotomía versus la de mínima invasión en cáncer temprano de cérvix / Comparison of oncologic outcomes between radical laparotomy surgery versus minimally invasive surgery for early cervical cancer

Introducción: la histerectomía radical con linfadenectomía pélvica es el tratamiento estándar para las pacientes con cáncer de cérvix en estadios tempranos que no desean preservar la fertilidad. Objetivos: comparar tasas de supervivencia global, periodo libre de enfermedad y recurrencia entre histerectomía radical por mínima invasión (CMI) versus cirugía abierta. Además analizar las características histopatológicas, complicaciones intraoperatorias, posoperatorias tempranas y tardías entre ambas técnicas. Metodología: estudio observacional de cohorte retrospectivo entre 2011 y 2017. Se incluyeron mayores de 18 años con diagnóstico de carcinoma de cuello uterino en estadios IA1 (invasión del espacio linfovascular) a IB1 (FIGO 2009) con seguimiento hasta diciembre 2020. Se hizo análisis bivariado utilizando chi cuadrado, prueba exacta de Fisher o U Mann Whitney para determinar las diferencias entre las técnicas quirúrgicas frente a características sociodemográficas, clínicas, complicaciones intraoperatorias, tempranas y tardías. Se calcularon tasas de supervivencia global y densidades de recurrencia con el tiempo aportado por las pacientes. Resultados: de 113 pacientes llevadas a histerectomía radical, 75 se excluyeron del análisis. La supervivencia global fue 100% para las del grupo de laparotomía versus 97.6% en CMI. La tasa de recurrencia global fue de 8 casos y la del grupo de CMI 14.1 por 1.000 personas/año de observación. El grupo de laparotomía no presentó recaídas. Hubo diferencia significativa en la mediana de sangrado intraoperatorio (600 cc laparotomía versus 100 cc laparoscopia, p= 0.002); 11.4% requirieron transfusión intraoperatoria (25% laparotomía versus 2.4% mínima invasión, p=0,006). Conclusiones: las pacientes llevadas a cirugía por laparoscopia tuvieron una mayor proporción de recurrencia y mortalidad en comparación con el abordaje por técnica abierta.

Introduction: radical hysterectomy with pelvic lymphadenectomy is the standard treatment for early cervical cancer patients who do not wish to preserve fertility. Objetives: this study compares overall survival, disease-free survival, and recurrence rates of patients undergoing minimally invasive radical hysterectomy (MIS) versus open surgery. Likewise, the histopathological characteristics, intraoperative complications, early and late postoperative complications, are analyzed for both techniques, Methodology: an observational retrospective cohort study between 2011 and 2017. Patients over 18 years of age diagnosed with cervical carcinoma in stages IA1 (lymph vascular space invasion) and IB1 (FIGO 2009) receiving follow-up care until December 2020, were included. The Chi-square test, Fisher ́s exact test or Mann Whitney U test were used for bivariate analysis, to determine the differences between the techniques with regards to sociodemographic, clinical characteristics and intraoperative early and late complications. Overall survival rates and recurrence densities were calculated with data provided by the patients. Results: of the 113 patients undergoing radical hysterectomy, 75 were excluded from the analysis. Overall survival was 100% in the laparotomy group versus 97.6% in the MIS group. The overall recurrence rate was of 8 cases, 14.1 per 1.000 person-years of observation in the MIS group. Patients in the laparotomy group developed no recurrences. There was a significant difference in median intraoperative blood loss (600 cc in laparotomy versus 100 cc in laparoscopy, p= 0.002); 11.4% of patients required intraoperative transfusion (25% in the laparotomy group versus 2.4% in the MIS group, p=0.006). Conclusions: patients who underwent laparoscopic surgery had a higher recurrence and mortality rate than that of open approach

La carga del sobrepeso y la obesidad en México de 1990 a 2021 / Burden of overweight and obesity in Mexico from 1990 to 2021

Resumen Antecedentes: El sobrepeso y la obesidad constituyen un grave desafío en México, con efectos en la salud, sociedad y economía. Factores demográficos, epidemiológicos, nutricionales, sociales y económicos han agravado esta problemática. Objetivo: Analizar la mortalidad y los años de vida saludable perdidos en México por sobrepeso y obesidad en el período de 1990 a 2021. Material y métodos: Se utilizó el Global Burden of Disease 2021 para analizar los datos sobre índice de masa corporal elevado como factor de riesgo y su evolución en México. Resultados: En 2021 se registraron 118 mil muertes atribuibles a índice de masa corporal elevado, que representaron 10.6 % del total de muertes y más de 4.2 millones de años de vida perdidos ajustados por discapacidad. Conclusiones: El ambiente obesogénico, influido por determinantes sociales, ha tenido un impacto significativo en la mortalidad, la carga de enfermedad y los costos económicos. Abordar el sobrepeso y la obesidad requiere intervenciones multisectoriales para fortalecer el sistema de salud mexicano.

Abstract Background: Overweight and obesity (OW/OB) represent a serious challenge in Mexico, with effects on health, society and economy. Demographic, epidemiological, nutritional, social and economic factors have exacerbated this problem. Objective: To analyze mortality and years of healthy life lost in Mexico due to OW/OB in the 1990-2021 period. Material and methods: The Global Burden of Disease and Risk Factors 2021 study was used to analyze data on elevated body mass index (BMI) as a risk factor and its evolution in Mexico. Results: In 2021, 118 thousand deaths attributable to high BMI were recorded, which accounted for 10.6% of total deaths and more than 4.2 million disability-adjusted life years lost. Conclusions: The obesogenic environment, influenced by social determinants of health, has had a significant impact on mortality, burden of disease, and economic costs. Addressing OW/OB requires multisector interventions to strengthen the Mexican health system.

Functional results and return to sports on recurrent anterior glenohumeral instability. Influence of the COVID-19 pandemic; Comparative retrospective study and short-term results.

AIMS: Our objective is to compare the functional results in patients that underwent surgery for recurrent anterior shoulder instability (RAGHI) during the COVID-19 pandemic with remotely-based rehabilitation, to those who had surgery before the pandemic and had in-person rehabilitation therapy. METHODS: A retrospective case series of 68 patients were included and divided into two groups: In person-group and Home-based group. Western Ontario Shoulder Instability Index (WOSI) and Subjective Shoulder Value (SSV) scores were used to evaluate objective and subjective clinical parameters. Time and level of return to sports was studied by the Subjective Patient Outcome for Return to Sports (SPORTS) score. RESULTS: The mean SSV score was 82% (40-100) on the In-Person group compared with 87% (65-100) for the Home-Based group. Results for WOSI score were similar, with an average of 210.42 (90%) for In-Person and 261.45 (88%) for the Home-Based group (p 0.12). Return to sports was carried out in an average of 6.6 (4-16) months for In-Person group, compared to 6.5 (5-8) months for Home-Based. CONCLUSION: Follow-up and rehabilitation methods for patients who underwent surgery for RAGHI, during COVID-19 lockdown, were not significantly (p 0.12) affected on functional and athletic return in comparison to traditional methods according to WOSI scale. LEVEL OF EVIDENCE: IV Retrospective series of cases.

Cost-effectiveness and economic investment to eliminate chronic hepatitis C in Mexico.

In July 2020, the Mexican Government initiated the National Program for Elimination of Hepatitis C (HCV) under a procurement agreement, securing universal, free access to HCV screening, diagnosis and treatment for 2020-2022. This analysis quantifies the clinical and economic burden of HCV (MXN) under a continuation (or end) to the agreement. A modelling and Delphi approach was used to evaluate the disease burden (2020-2030) and economic impact (2020-2035) of the Historical Base compared to Elimination, assuming the agreement continues (Elimination-Agreement to 2035) or terminates (Elimination-Agreement to 2022). We estimated cumulative costs and the per-patient treatment expenditure needed to achieve net-zero cost (the difference in cumulative costs between the scenario and the base). Elimination is defined as a 90% reduction in new infections, 90% diagnosis coverage, 80% treatment coverage and 65% reduction in mortality by 2030. A viraemic prevalence of 0.55% (0.50-0.60) was estimated on 1st January 2021, corresponding to 745,000 (95% CI 677,000-812,000) viraemic infections in Mexico. The Elimination-Agreement to 2035 would achieve net-zero cost by 2023 and accrue 31.2 billion in cumulative costs. Cumulative costs under the Elimination-Agreement to 2022 are estimated at 74.2 billion. Under Elimination-Agreement to 2022, the per-patient treatment price must decrease to 11,000 to achieve net-zero cost by 2035. The Mexican Government could extend the agreement through 2035 or reduce the cost of HCV treatment to 11,000 to achieve HCV elimination at net-zero cost.

The effect of public policy on high BMI trends of Mexican children: an interrupted time series analysis.

BACKGROUND: Mexico declared an obesity epidemic in 2000, and in response, became an early adopter of public policies in the form of natural experiments, which have not been evaluated for their effect on high BMI. We focus on children younger than 5 years due to the long-term outcomes of childhood obesity. METHODS: We used the Global Burden of Disease data to evaluate time trends in high BMI, defined as being overweight or obese based on the International Obesity Task Force standards, between 1990 and 2019. Marginalisation and poverty estimates from Mexico's Government were used to identify differences in socioeconomic groups. The time variable reflects the introduction of policies between 2006 and 2011. Our hypothesis was that poverty and marginalisation modify the effects of public policies. We tested for the change in prevalence of high BMI over time using Wald-type tests, correcting for the effect of repeated measures. We stratified the sample by gender, marginalisation index, and households under the poverty line. Ethics approval was not required. FINDINGS: Between 1990 and 2019, high BMI in children younger than 5 years increased from 23·5% (95% uncertainty interval 38·6-14·3) to 30·2% (46·0-20·4). After a period of sustained increase to 28·7% (44·8-18·6) in 2005, high BMI decreased to 27·3% (42·4-17·4; p<0·001) in 2011. Afterwards, high BMI increased constantly. We found an average gender gap of 12·2%, with a higher rate in males, in 2006, which remained constant. With respect to marginalisation and poverty, we observed a reduction in high BMI across all strata, except for the uppermost quintile of marginalisation in which high BMI remained flat. INTERPRETATION: The epidemic affected groups across different socioeconomic levels, thus weakening economic explanations for the decrease in high BMI, while gender gaps point to behavioural explanations of consumption. The observed patterns warrant investigation through more granular data and structural models to isolate the effect of the policy from secular trends in the population, including other age groups. FUNDING: Tecnológico de Monterrey Challenge-Based Research Funding Program.

Oral administration of resveratrol reduces oxidative stress generated in the hippocampus of Wistar rats in response to consumption of ethanol.

Introduction: Chronic ethanol intake has been found to favor hippocampal deterioration and alter neuronal morphological maturation; resveratrol has been suggested as an antioxidant that may counteract these effects. The objective of this study was to analyze the effect of resveratrol on oxidative stress markers, endogenous antioxidant system in the hippocampus, and the behavior of male Wistar rats administered different concentrations of ethanol. Methods: The animals, at 3 months old, were randomly distributed into 11 study groups (n = 6/group), orally administered (5 days on, 2 days off) with water (control), ethanol (10, 20, 30, 40 or 50%), or ethanol (10, 20, 30, 40 or 50%) plus resveratrol (10 mg/Kg/day) for 2 months. Subsequently, the production of nitrites, malondialdehyde, and 4-hydroxy-alkenal (HNE) and the enzymatic activity of catalase and superoxide dismutase (SOD) were quantified. Results: The levels of nitric oxide and lipid peroxidation products were significantly increased in each ethanol concentration and were statistically different compared to the control group; however, resveratrol significantly reduced oxidative stress caused by high ethanol concentration. The SOD and CAT did not present significant changes with respect to the controls in any of the study groups. In the different concentrations of ethanol used, GR increases significantly in the groups administered with resveratrol but not GPx. Resveratrol was shown to maintain the results similar to the control at most ethanol concentrations. Discussion: Our results suggest that resveratrol prevents oxidative stress induced by ethanol in the hippocampus by decreasing cellular lipid peroxidation, but does not prevent the activation of catalase or SOD enzymes; however, allows glutathione to be kept active and in adequate concentrations in its reduced form and avoids alterations in the locomotor system.

Burden of overweight and obesity in Mexico from 1990 to 2021.

BACKGROUND: Overweight and obesity (OW/OB) represent a serious challenge in Mexico, with effects on health, society and economy. Demographic, epidemiological, nutritional, social and economic factors have exacerbated this problem. OBJECTIVE: To analyze mortality and years of healthy life lost in Mexico due to OW/OB in the 1990-2021 period. MATERIAL AND METHODS: The Global Burden of Disease and Risk Factors 2021 study was used to analyze data on elevated body mass index (BMI) as a risk factor and its evolution in Mexico. RESULTS: In 2021, 118 thousand deaths attributable to high BMI were recorded, which accounted for 10.6% of total deaths and more than 4.2 million disability-adjusted life years lost. CONCLUSIONS: The obesogenic environment, influenced by social determinants of health, has had a significant impact on mortality, burden of disease, and economic costs. Addressing OW/OB requires multisector interventions to strengthen the Mexican health system.

ANTECEDENTES: El sobrepeso y la obesidad constituyen un grave desafío en México, con efectos en la salud, sociedad y economía. Factores demográficos, epidemiológicos, nutricionales, sociales y económicos han agravado esta problemática. OBJETIVO: Analizar la mortalidad y los años de vida saludable perdidos en México por sobrepeso y obesidad en el período de 1990 a 2021. MATERIAL Y MÉTODOS: Se utilizó el Global Burden of Disease 2021 para analizar los datos sobre índice de masa corporal elevado como factor de riesgo y su evolución en México. RESULTADOS: En 2021 se registraron 118 mil muertes atribuibles a índice de masa corporal elevado, que representaron 10.6 % del total de muertes y más de 4.2 millones de años de vida perdidos ajustados por discapacidad. CONCLUSIONES: El ambiente obesogénico, influido por determinantes sociales, ha tenido un impacto significativo en la mortalidad, la carga de enfermedad y los costos económicos. Abordar el sobrepeso y la obesidad requiere intervenciones multisectoriales para fortalecer el sistema de salud mexicano.

Spontaneous Osteonecrosis of the Knee: State of the Art.

Osteonecrosis is a terrible condition that can cause advanced arthritis in a number of joints, including the knee. The three types of osteonecrosis that can affect the knee are secondary, post-arthroscopic, and spontaneous osteonecrosis of the knee (SPONK). Regardless of osteonecrosis classification, treatment for this condition seeks to prevent further development or postpone the onset of knee end-stage arthritis. Joint arthroplasty is the best course of action whenever there is significant joint surface collapse or there are signs of degenerative arthritis. The non-operative options for treatment at the moment include observation, nonsteroidal anti-inflammatory medications (NSAIDs), protective weight bearing, and analgesia if needed. Depending on the severity and type of the condition, operational procedures may include unilateral knee arthroplasty (UKA), total knee arthroplasty (TKA), or joint preservation surgery. Joint preservation techniques, such as arthroscopy, core decompression, osteochondral autograft, and bone grafting, are frequently used in precollapse and some postcollapse lesions, when the articular cartilage is typically unaffected and only the underlying subchondral bone is affected. In contrast, operations that try to save the joint following significant subchondral collapse are rarely successful and joint replacement is required to ease discomfort. This article's goal is to summarise the most recent research on evaluations, clinical examinations, imaging and various therapeutic strategies for osteonecrosis of the knee, including lesion surveillance, medicines, joint preservation methods, and total joint arthroplasty.

Infecciones óseas en el Pie Diabético: reporte de la microbiología

Objetivo: Describir y caracterizar la microbiología de las osteomielitis de pie diabético en pacientes hospitalizados en el Hospital San Juan de Dios en el año 2018. Métodos: Se consultó la base de datos local de pacientes de la Unidad de Pie Diabético para obtener los datos demográficos de los pacientes hospitalizados con diagnóstico de osteomielitis además del sistema de información de la división de Microbiología del Laboratorio Clínico con el fin de obtener los datos de especies bacterianas y sus perfiles de susceptibilidad a los antimicrobianos aisladas de las respectivas muestras de hueso. Con estos datos se construyó una base de datos para el proyecto y el análisis estadístico descriptivo se realizó en hojas de cálculo de Excel. Resultados: Enterococcus faecalis fue el agente más frecuentemente aislado (21%), seguido de Staphylococcus aureus (14%), de los cuales 70% presentó fenotipo de meticilino resistencia y Escherichia coli como tercer lugar (11%). Otros bacilos Gram negativos ocuparon un cuarto lugar, con Enterobacter cloacae (8%) y Klebsiella pneumoniae (8%) como las principales especies aisladas; cabe destacar que se evidenció la presencia de 24% de cepas portadoras de ẞ-lactamasas de espectro extendido, con K. pneumoniae como la principal especie portadora de este fenotipo de resistencia. Conclusiones: Se reportó por primera vez a E. faecalis como la bacteria más aislada en OPD, lo cual permite concluir que la microbiología de estos cuadros en Costa Rica difiere a lo reportado en la literatura internacional y es necesario actualizar a la comunidad médica costarricense. Además, es importante destacar que a pesar de que el porcentaje obtenido de bacilos Gram negativos portadores de BLEE es inferior a lo reportado en la literatura, el 100% de las cepas de K. pneumoniae fueron portadoras de este fenotipo de resistencia, por lo tanto, es posible considerar a nivel local que el hallazgo preliminar de esta especie debería modificar el espectro terapéutico a utilizar en espera de reportes de PSA.

Aim: Describe and characterize the microbiology of diabetic foot osteomyelitis (DFO) in hospitalized patients of the San Juan de Dios Hospital in 2018. Methods: The local database of patients of the Diabetic Foot Unit was consulted to obtain the demographic data of hospitalized patients with a diagnosis of osteomyelitis in addition to the information system of the Microbiology division of the Clinical Laboratory to obtain data on species bacteria and their antimicrobial susceptibility profiles isolated from the respective bone samples. With these data, a database for the project was built and the descriptive statistical analysis was carried out in Excel spreadsheets. Results: Enterococcus faecalis was the most frequently isolated agent (21%), followed by Staphylococcus aureus (14%) of which 70% presented a methicillin resistance phenotype, and Escherichia coli as third place (11%). Other Gram negative bacilli occupied a fourth place, being Enterobacter cloacae (8%) and Klebsiella pneumoniae (8%) the main isolated species; it should be noted the presence of 24% of strains carrying extended spectrum ẞ-lactamases, with K. pneumoniae as the main carrier species of this resistance. Conclusion: E. faecalis was reported for the first time as the most isolated bacterium in DFO, which allows to conclude that the microbiology of these conditions in Costa Rica differ from that reported in the international literature and it is necessary to update the Costa Rican medical community. It is also important to note that even though the percentage obtained from Gram negative rods carrying ESBL is lower than that reported in the literature, 100% of the K. pneumoniae strains were carriers of this resistance phenotype, therefore it is possible consider at the local level that the preliminary finding of this species should modify the therapeutic spectrum to be used pending final reports.

Safety of Administering Live Vaccines During Pregnancy: A Systematic Review and Meta-Analysis of Pregnancy Outcomes.

Live-attenuated vaccines (LAV) are currently contraindicated during pregnancy, given uncertain safety records for the mother-infant pair. LAV might, however, play an important role to protect them against serious emerging diseases, such as Ebola and Lassa fever. For this systematic review we searched relevant databases to identify studies published up to November 2019. Controlled observational studies reporting pregnancy outcomes after maternal immunization with LAV were included. The ROBINS-I tool was used to assess risk of bias. Pooled odds ratios (OR) were obtained under a random-effects model. Of 2831 studies identified, fifteen fulfilled inclusion criteria. Smallpox, rubella, poliovirus, yellow fever and dengue vaccines were assessed in these studies. No association was found between vaccination and miscarriage (OR 0.98, 95% CI 0.87-1.10), stillbirth (OR 1.04, 95% CI 0.74-1.48), malformations (OR 1.09, 95% CI 0.98-1.21), prematurity (OR 0.99, 95% CI 0.90-1.08) or neonatal death (OR 1.06, 95% CI 0.68-1.65) overall. However, increased odds of malformations (OR 1.24; 95% CI 1.03-1.49) and miscarriage after first trimester immunization (OR 4.82; 95% CI 2.38-9.77) was found for smallpox vaccine. Thus, we did not find evidence of harm related to LAV other than smallpox with regards to pregnancy outcomes, but quality of evidence was very low. Overall risks appear to be small and have to be balanced against potential benefits for the mother-infant pair.

Síndrome de fricción femoroacetabular: tratamiento artroscópico. Resultados a mediano plazo, complicaciones y fallas / Femoroacetabular friction syndrome: arthroscopic treatment. Middle-term results, complications and failures

El éxito de la artroscopía de cadera en el tratamiento del síndrome de fricción femoroacetabular (SFFA) ha sido reportado por múltiples autores. Sus indicaciones se han ido extendiendo, provocando un incremento sustancial en el número de complicaciones. El propósito de este estudio fue evaluar retrospectivamente los resultados clínicos-radiológicos de la artroscopía de cadera en pacientes adultos con diagnóstico de SFFA, haciendo énfasis en las complicaciones y en las causas de falla.Se analizaron pacientes con un seguimiento mínimo de tres años. Se clasificó la severidad del desgaste articular y daño condral con la escala de Tönnis y Outerbridge, respectivamente.Se utilizaron los scores de Harris Hip (HHS) y de Resultados de Cadera (HOS, por sus siglas en inglés). La evaluación subjetiva fue medida a través de la Escala Visual Análoga del dolor (EVA). La serie quedó conformada por ciento catorce pacientes: cincuenta y seis (49%) de sexo masculino y cincuenta y ocho de sexo femenino con una edad promedio de 42.5 (17 ­ 59). El score de Harris registró un incremento significativo luego de la cirugía (71.06 ± 5.68 versus 87.11 ± 5.89; p<0.05). El score subjetivo de EVA demostró un descenso estadísticamente significativo (6.55 ± 1.27 versus 1.84 ± 1.42; p<0.05). El HOS evidenció valores de 91 y 87.8% con respecto a las actividades de la vida diaria y al deporte. Hubo ocho complicaciones menores (7.01%) y tres conversiones a artroplastia (2.63%).La artroscopía de cadera constituye una herramienta efectiva como técnica de preservación articular, con índices de satisfacción cercanos al 90%. Nivel de Evidencia: IV

Hip arthroscopy success for treatment of Femoro-Acetabular Impingement (FAI) has been well reported over the past decade.The indications of this procedure have increased over the past years, as well as complications. The purpose of this study was to assess of clinical-radiological outcomes of hip arthroscopy in adults over 50 years old with FAI, and their complications. We evaluated patients with a minimum of 3-years follow up. The presence of Pincer and/or CAM deformity was registered by analyzing anteroposterior and lateral x-rays. Articular and chondral damage severity was assessed with Tönnis and Outerbridge classifications, respectively. Objective analysis was performed using Harris Hip Score (HHS) and Hip Outcome Score (HOS). Subjective evaluation was made using Visual Analogue Pain Scale (VAS). Our study included one hundred fourteen patients: fifty-six (49%) was male and fifty-eight (51%) females with a mean of 42.5 years. We observed significant increase in HHS after surgery (71.06 ± 5.68 versus 87.11 ± 5.89; p<0.05). VAS demonstrated a statistically significant decrease (6.55 ± 1.27 versus 1.84 ± 1.42; p<0.05). HOS score yielded values of 91% for daily living activities and 87.8% for sports. We observed three patients that required conversion to total hip arthroplasty (2.64%).Hip Arthroscopy is a highly effective tool as joint preservation technique, being able to achieve rates up to 90%, both for daily living activities and sports, after surgery. Level of Evidence: IV

Control lipídico y eventos cardíacos durante un seguimiento de cinco años / Lipid control and cardiac events in a five-year follow-up study

Introducción: el beneficio de un estricto control lipídico ha sido puesto en evidencia tanto en estudios de prevención primaria como secundaria. Objetivo: determinar si existe asociación entre el control lipídico y la ausencia de eventos coronarios adversos durante cinco años. Métodos: se realizó un estudio observacional prospectivo con 424 pacientes atendidos en la consulta de Dislipidemias del Instituto de Cardiología y Cirugía Cardiovascular. A todos se les realizaron Lipidogramas y según la categoría de riesgo, se determinó si lograron un control o no de sus cifras lipídicas durante el seguimiento. Se calculó el Odds Ratio para la determinación de riesgo por regresión logística y para la supervivencia libre de eventos la prueba de Kaplan-Meier determinándose la diferencia entre grupos por el Test de Cox-Mantel. Resultados: existió asociación entre el control lipídico y la ausencia de eventos coronarios durante el seguimiento (p = 0,02). La necesidad de revascularización miocárdica fue más frecuente en el grupo de pacientes no controlados (p = 0,03). No existió asociación entre cada uno de los valores de las variables lipídicas con el riesgo para eventos adversos. Solo el antecedente de cardiopatía isquémica mostró relación con la incidencia de eventos coronarios. Conclusiones: aunque durante el seguimiento existió relación entre el control de las cifras lipídicas y ausencia de eventos coronarios no se observó asociación entre los valores de cada una de las lipoproteínas y la aparición de eventos coronarios adversos(AU)

Introduction: The benefits of strict lipid control have become evident in primary and secondary prevention studies. Objective: Determine whether there is an association between lipid control and the absence of adverse coronary events in a five-year period. Methods: A prospective observational study was conducted with 424 patients cared for at the Dyslipidemia Service of the Cardiology and Cardiovascular Surgery Institute. All patients underwent lipidograms, and the risk category was used as a basis to determine whether they had managed to control their lipid levels during follow-up. Odds ratios were estimated to determine risk by logistic regression, whereas the Kaplan-Meier test was used for event-free survival. The difference between the groups was determined with the Cox-Mantel test. Results: An association was found between lipid control and the absence of coronary events during follow-up (p = 0.02). The need for myocardial revascularization was more common in the non-control group (p = 0.03). No association was found between the values for each lipid variable and the risk for adverse events. A history of ischemic heart disease was the only factor that showed a relationship to the incidence of coronary events. Conclusions: Despite the fact that during follow-up there was a relationship between control of lipid levels and the absence of coronary events, no association was observed between the values for each lipoprotein and the occurrence of adverse coronary events.(AU)

Control lipídico y eventos cardíacos durante un seguimiento de cinco años / Lipid control and cardiac events in a five-year follow-up study

INTRODUCCIÓN: el beneficio de un estricto control lipídico ha sido puesto en evidencia tanto en estudios de prevención primaria como secundaria. OBJETIVO: determinar si existe asociación entre el control lipídico y la ausencia de eventos coronarios adversos durante cinco años. MÉTODOS: se realizó un estudio observacional prospectivo con 424 pacientes atendidos en la consulta de Dislipidemias del Instituto de Cardiología y Cirugía Cardiovascular. A todos se les realizaron Lipidogramas y según la categoría de riesgo, se determinó si lograron un control o no de sus cifras lipídicas durante el seguimiento. Se calculó el Odds Ratio para la determinación de riesgo por regresión logística y para la supervivencia libre de eventos la prueba de Kaplan-Meier determinándose la diferencia entre grupos por el Test de Cox-Mantel. RESULTADOS: existió asociación entre el control lipídico y la ausencia de eventos coronarios durante el seguimiento (p = 0,02). La necesidad de revascularización miocárdica fue más frecuente en el grupo de pacientes no controlados (p = 0,03). No existió asociación entre cada uno de los valores de las variables lipídicas con el riesgo para eventos adversos. Solo el antecedente de cardiopatía isquémica mostró relación con la incidencia de eventos coronarios. CONCLUSIONES: aunque durante el seguimiento existió relación entre el control de las cifras lipídicas y ausencia de eventos coronarios no se observó asociación entre los valores de cada una de las lipoproteínas y la aparición de eventos coronarios adversos.

INTRODUCTION: The benefits of strict lipid control have become evident in primary and secondary prevention studies. OBJECTIVE: Determine whether there is an association between lipid control and the absence of adverse coronary events in a five-year period. METHODS: A prospective observational study was conducted with 424 patients cared for at the Dyslipidemia Service of the Cardiology and Cardiovascular Surgery Institute. All patients underwent lipidograms, and the risk category was used as a basis to determine whether they had managed to control their lipid levels during follow-up. Odds ratios were estimated to determine risk by logistic regression, whereas the Kaplan-Meier test was used for event-free survival. The difference between the groups was determined with the Cox-Mantel test. RESULTS: An association was found between lipid control and the absence of coronary events during follow-up (p = 0.02). The need for myocardial revascularization was more common in the non-control group (p = 0.03). No association was found between the values for each lipid variable and the risk for adverse events. A history of ischemic heart disease was the only factor that showed a relationship to the incidence of coronary events. CONCLUSIONS: Despite the fact that during follow-up there was a relationship between control of lipid levels and the absence of coronary events, no association was observed between the values for each lipoprotein and the occurrence of adverse coronary events.

Manejo quirúrgico del cáncer epitelial de ovario: Guía de práctica clinica de la Asociación Colombiana de Ginecólogos Oncólogos (ASCGO) / Surgical management of epithelial ovarian cancer: Clinical Practice Guideline of the Colombian Association of Gynaecologic Oncologists (ASCGO)

Introducción: el cáncer epitelial de ovario constituye la primera causa de muerte por cáncer ginecológico a nivel mundial. En Colombia cada año se presentan 8,7 casos nuevos por cada 100.000 mujeres y se registran más de 800 muertes por causa de esta enfermedad. La cirugía constituye el pilar de manejo de las pacientes con cáncer epitelial de ovario, su realización oportuna y la adecuada combinación con otras estrategias terapéuticas busca erradicar la enfermedad o, en los estados avanzados, lograr volúmenes tumorales microscópicos para mejorar el pronóstico. El objetivo de este trabajo consiste en desarrollar recomendaciones basadas en la evidencia para el diagnóstico y tratamiento quirúrgico integral del cáncer epitelial de ovario en población colombiana. Materiales y métodos: guía de práctica clínica basada en la evidencia, desarrollada por un panel de expertos de la Asociación Colombiana de Ginecólogos Oncólogos. La Sociedad definió y validó un total de 33 preguntas de interés para el manejo quirúrgico integral. Se llevó a cabo una revisión de literatura de guías de práctica clínica y se actualizó la evidencia de las guías fuente usando revisiones de literatura y estudios primarios experimentales y observacionales acordes con la naturaleza de cada pregunta. Finalmente, se discutieron y validaron las recomendaciones en la Asociación mediante un método participativo tipo panel de expertos. Resultados: se resumen las recomendaciones basadas en la mejor evidencia disponible para la detección temprana y el diagnóstico del cáncer epitelial de ovario, el manejo quirúrgico en estados tempranos y avanzados de la enfermedad, el seguimiento y manejo de las recaídas, así como el manejo con intención paliativa. Conclusiones: esta GPC fue desarrollada utilizando procedimientos sistemáticos y la mejor evidencia disponible. Se espera que tenga un impacto positivo en el manejo y los desenlaces de las pacientes que padecen de esta enfermedad.

Introduction: Epithelial ovarian cancer is the primary cause of death from gynaecological cancer in the world. In Colombia, every year there are 8.7 new cases for 100,000 women and more than 800 deaths as a result of this disease. Surgery is the mainstay for management of patients with epithelial ovarian cancer. The aim, when performed in a timely fashion and in combination with the right therapeutic strategies, is to eradicate the disease or, in advanced stages, to achieve microscopic tumour volumes in order to improve prognosis. The objective of this work is to develop evidence-based recommendations for the diagnosis and comprehensive surgical treatment of epithelial ovarian cancer in the Colombian population. Materials and methods: Evidence-based clinical practice guideline developed by an expert panel from the Colombian Association of Gynaecologic Oncologists. A total of 33 questions of interest for comprehensive surgical management were defined and validated in the Society. A review of the literature on clinical practice guidelines was conducted. The evidence of the source guidelines was updated using reviews of the literature and primary experimental and observational studies according to the nature of each question. Finally, the recommendations were discussed and validated in the Association using a participatory expert panel method. Results: A summary of recommendations of the best available evidence for early detection and diagnosis of epithelial ovarian cancer, surgical management of early and late stages of the disease, follow-up and management of recurrences, as well as management with palliative goals. Conclusions: This CPG was developed using systematic procedures and the best available evidence. It is expected to have a positive impact on management and outcomes of patients suffering from this disease.

Neuralgia pós-herpética: dois casos clínicos / Postherpetic neuralgia: two clinical cases / Neuralgia postherpética: dos casos clínicos

A neuralgia pós-herpética (NPH) é a complicação mais frequente do herpes-zóster, caracterizando-se pela presença de dor tipo neuropática de distribuição dermatômica, após manifestação prévia de um quadro agudo de herpes-zóster, geralmente um mês depois do surgimento das vesículas. O objetivo do presente relato é apresentar dois casos clínicos de NPH e suas respostas a diferentes tratamentos. O primeiro caso apresentou intolerância à amitriptilina e uma boa resposta clínica à gabapentina na dosagem de 900 mg/dia. O segundo caso apresentou intolerância à capsaicina, mas apresentou boa resposta à combinação da pregabalina com lidocaína tópica. A gabapentina, a pregabalina e a lidocaína tópica são tratamentos eficazes para o tratamento da neuralgia pós-herpética. Todas essas recomendações vão ao encontro dos tratamentos utilizados pelos médicos de família nos dois casos apresentados neste estudo.

Postherpetic neuralgia (PHN) is the most common complication of Herpes Zoster, characterized by the presence of neuropathic-type pain limited to a dermatomic area after outbreak of Herpes Zoster (commonly known as shingles), usually a month after the appearance of vesicles on the skin . The aim of this report is to present two cases of PHN and their responses to different treatments. The first case presented intolerance to amitriptyline and a good clinical response to gabapentin at a dose of 900 mg/day. The second case showed intolerance to capsaicin but responded well to the combination of pregabalin and topical lidocaine. Gabapentin, pregabalin and lidocaine are effective for the treatment of postherpetic neuralgia. All these recommendations are consistent with those treatments used by the family physicians in the two cases study presented.

La neuralgia postherpética (NPH) es la complicación más común de herpes zoster, que se caracteriza por la presencia de dolor tipo neuropático de distribución dermatómica después de una manifestación previa de cuadro agudo de Herpes Zoster, generalmente un mes después de la aparición de las vesículas en la piel. El objetivo de este relato es presentar dos casos de NPH y sus respuestas a diferentes tratamientos. El primer caso presento intolerancia a la amitriptilina y una buena respuesta clínica a la gabapentina en la dosis de 900 mg/día. El segundo caso mostró intolerancia a la capsaicina, pero mostró una buena respuesta a la combinación de pregabalina associado con lidocaína tópica. La gabapentina, pregabalina y la lidocaína son eficaces para el tratamiento de la neuralgia postherpética. Todas estas recomendaciones son coherentes con los tratamientos utilizados por el médico de familia en dos casos presentados en este estudio.

Relación del apache II con el desarrollo de úlcera por presión en pacientes críticos por trauma / Relationship between apache II and the development of pressure ulcers in critical trauma patients

Introducción: la presencia de la úlcera por presión se considera una complicación derivada de la atención en salud que conduce al incremento de la morbilidad y la mortalidad con altos costos para los sistemas de salud. Objetivo: establecer la relación causa efecto de las variables contempladas en el APACHE II y el cuidado de la piel, como factores de riesgo para el desarrollo de úlcera por presión en pacientes críticos por trauma. Métodos: estudio de cohorte basado en revisión de historias clínicas de pacientes críticos por trauma que ingresaron a dos Unidades de Cuidado Intensivos de Cali durante 2011-2012. La variable dependiente fue la úlcera por presión y las independientes, politraumatismos y variables del APACHE II. Se aplicó regresión lineal simple y Chi-cuadrado para establecer la asociación de las variables independientes con la dependiente. El riesgo relativo se usó para conocer la magnitud de estas asociaciones. Resultados: la incidencia de úlcera por presión fue del 53 por ciento. Se evidenció asociación estadísticamente significativa entre el desarrollo de úlcera por presión con las alteraciones de temperatura, frecuencia respiratoria, hipoxemia, y sodio sérico. De los 87 pacientes con APACHE II mayor o igual a 10, el desarrollo de úlcera por presión fue del 63 por ciento. Conclusiones: la alteración de las variables fisiológicas del APACHE II son predictivas para el desarrollo de úlcera por presión en pacientes críticos por trauma, por lo cual es posible incluirlas en las escalas que utiliza enfermería para la prevención de úlcera por presión en la población y contexto estudiado(AU)

Objective: to establish the cause and effect relation of the variables considered in APACHE II and skincare, as risk factors for the development of pressure ulcers in patients critical due to trauma. Method: a cohort study based on the review of medical records of critical trauma patients admitted to two Intensive Care Units in Cali during 2011-2012. The sample was 87 medical records for exposed with an APACHE II score equal to or greater than 10, and 110 for unexposed with an APACHE II score equal to or lover than 9. Criteria inclusion: over 18 years of age, hospital stays longer than 48 hours, diagnosed with any kind of trauma requiring surgery. Exclusion: presence of pressure ulcers upon admission to the intensive care unit. The dependent variable was pressure ulcers, while the independent variables were multiple trauma; the APACHE II variables. Simple linear regression and Chi-square were used to determine the association of the independent variables with the dependent variable. The relative risk (RR) for the magnitude of these associations. Results: the incidence of pressure ulcers was 53 percent. There was significant statistical association between the development of pressure ulcers and changes in temperature (p = 0.050, RR = 1.13), respiratory rate (p = 0.035, RR = 1.14), hypoxemia (p =0.02. RR = 1.24) and serum sodium (p = 0.022, RR = 1.57). 63 percent of the 87 patients with APACHE II equal to or greater than 10, developed pressure ulcers (p = 0.017, RR = 1.2). Discussion: changes in the physiological variables of APACHE II can predict the development of pressure ulcers in critical trauma patients, making it possible to include them in the nursing scales used for prevention of pressure ulcers(AU)

Microorganismos patógenos predominantes en el surco gingival de pacientes de 24-75 años de edad, con enfermedad periodontal crónica. (Clínica de Periodoncia, Facultad de Odontología, Universidad de El Salvador) / Predominant pathogenic microorganisms in the gingival sulcus of 24-75-year-old patients with chronic periodontal disease (Clinic of Periodontology, School of Dentistry, University of El Salvador)

La presente investigación tuvo como objetivo identificar los microorganismos patógenos predominantes en el surco gingival de pacientes entre los 24 y 75 años de edad con enfermedad periodontal crónica en la Clínica de Periodoncia de la Facultad de Odontología de la Universidad de El Salvador. Se realizó en el año 2014 en los meses de Julio y Agosto, la población se obtuvo de los pacientes que acudieron a la consulta odontológica a partir de la cual se obtuvo una muestra de 20 pacientes a los que se les realizó una evaluación periodontal para diagnosticar la presencia o ausencia de periodontitis crónica. El estudio fue de tipo descriptivo, se planteó una breve reseña sobre estudios similares aplicados en otros países, para comprender mejor la importancia del mismo y de la necesidad del establecimiento de un propio perfil microbiológico, debido a que los microorganismos involucrados en la periodontitis varían en cada región dependiendo de diferentes factores. Se utilizaron estadísticas que muestran la población total así como los principales microorganismos y frecuencia con la que estos se presentan en dicha población. Para la recolección de datos se utilizó la guía de observación y una vez establecido el diagnóstico periodontal se tomaron muestras de la biopelícula subgingival para su posterior siembra, cultivo y análisis. Los resultados muestran que todos los microorganismos sujetos a investigación se encuentran presentes, mas no en todos los casos con diagnóstico de periodontitis crónica, siendo la Prevotella el patógeno más comúnmente encontrado en la población en estudio.

The present investigation was aimed to identify the prevalent pathogenic microorganisms in the gingival sulcus of patients among 24 and 75 years old diagnosed with chronic periodontitis at the clinical department of Periodontology at the Faculty of Dentistry of the National University of El Salvador. It was performed in July and August of 2014. A 20 subjects sample was selected from patients seeking for dental treatment and a periodontal diagnosis was made to confirm the presence or absence of the disease. This was a descriptive study and similar worldwide studies were taken in consideration to better understand its importance and the need to establish an own microbiological profile since microorganisms involved can vary depending on several factors. Statistics were used in order to show results concerning the total of the population, prevalent microorganisms and frequency of detection. An observation guide was used to recollect data so once the periodontal diagnosis was already established samples were collected from the periodontal pockets to be examined by culture. The results showed that all prevalent microorganisms were detected however not in all cases with chronic periodontitis, being Prevotella significantly more frequent when comparing with other pathogens in study.