Cirugía de control de daños en hemorragia obstétrica: experiencia institucional / Damage control surgery in obstetric hemorrhage: institutional experience

Resumen OBJETIVO: evaluar los resultados de la cirugía de control de daños en hemorragia obstétrica en un hospital de tercer nivel. MATERIAL Y MÉTODO: estudio retrospectivo, descriptivo y transversal efectuado en pacientes con hemorragia obstétrica que requirieron cirugía de control de daños en el Hospital de Ginecoobstetricia 3 del Centro Médico Nacional La Raza, de enero a diciembre del 2015. Para el análisis estadístico se utilizaron medidas de tendencia central y el programa SPSS, versión 16.0. RESULTADOS: se identificaron 16 pacientes con edad promedio de 34.5 años, y 33.3 semanas de gestación. La causa de la hemorragia fue: atonía uterina 31%, inserción placentaria anómala 44%, ruptura uterina 13%, otras 13%. La cirugía inicial fue programada en 6%, y de urgencia en 94%. El promedio de compresas fue de 7.6, y de ligadura de arterias hipogástricas 88%. El tiempo promedio entre la primera y segunda cirugía fue de 27.3 horas. En 81% de los casos se logró el tratamiento definitivo en la segunda cirugía. Los días de estancia en la unidad de cuidados intensivos fueron 5.3, y de estancia hospitalaria 10.9. Hubo complicaciones en 81% de los casos y las principales complicaciones quirúrgicas representaron 63%, las infecciosas 31% y las renales 81%. Se documentó una muerte materna. CONCLUSIONES: si no se consigue el control definitivo del sangrado la cirugía de control de daños debe efectuarse lo más pronto posible. En Obstetricia hay un elevado porcentaje de complicaciones quirúrgicas, infecciosas y derivadas de la hemorragia masiva.

Abstract OBJECTIVE: To evaluate the results of the damage control surgery in obstetric hemorrhage in a third level hospital. MATERIAL AND METHOD: Retrospective study. Medical records from patients with obstetric hemorrhage who required damage control surgery at the Obstetrics and Gynecology hospital number 3, "Centro Médico Nacional La Raza", a third level unit in Mexico city, from January to December 2015. Measures of central tendency were performed for the statistical analysis using Software SPSS, version 16.0. RESULTS: 16 patients were identified. The mean age of the participants was 34.5 years and for the gestational age was 33.3 weeks. The etiology of the hemorrhage included: uterine atony in 31%, abnormal placentation in 44%, uterine rupture in 13%, other causes in 13%. Planned programmed surgery was performed in 6%, while emergency surgery in 94%. The mean number of compress towels used was 7.6, and hypogastric arteries ligation was necessary in 88%. The mean time between the first and second surgeries was 27.3 hours. A definitive treatment was achieved at the second surgery in 81% of cases. The mean time of ICU stay was 5.3 days, and in hospital was 10.9 days. Complications were identified in 81% of cases, being the principal: surgical (63%), infectious (31%) and renal (81%). One death was documented. CONCLUSIONS: Damage control surgery should be done early by not achieving definitive control of bleeding. In obstetrics there is a high percentage of surgical complications, infectious and those resulting from massive hemorrhage.

Efectividad de un programa de intervención socio-motriz en población mayor con riesgo social / Effectiveness of a social-physical activity intervention program in an elderly social risk population

Introducción. El objetivo es evaluar la efectividad de un programa de intervención sociomotriz en la mejora de la calidad de vida relacionada con la salud y la condición física funcional de pacientes mayores de 65 años con riesgo social. Material y métodos. Estudio de intervención cuasi experimental (antes-después). Ámbito: actividad comunitaria; atención primaria y centro educativo público. Sujetos: 29 pacientes mayores de 65 años, atendidos en el centro de salud, con diagnóstico de riesgo social. El programa incluyó sesiones mensuales de educación para la salud, y 2 sesiones semanales de una hora de ejercicio físico durante 6 meses. Se realizaron mediciones previas y al finalizar el estudio. Las variables resultado fueron: calidad de vida valorada mediante el cuestionario SF-36 y condición física funcional mediante la batería Senior Fitness Test. Resultados. Tras la intervención mejoraron todos los tests para las cualidades físicas; en la marcha de 6min todos los sujetos mejoraron con respecto al valor basal, con un incremento medio de 62±36 m (IC 95%: 48-76). El cuestionario SF-36 mejoró en las 8 escalas y en el componente sumario mental, con un incremento mayor de 6 puntos (p<0,05). Conclusiones. El programa de intervención socio-motriz mejora la calidad de vida relacionada con la salud y la condición física funcional de los mayores con riesgo social. Este trabajo aporta resultados a favor de la implantación de actividades comunitarias socio-motrices, coordinadas entre los servicios de salud y los centros educativos, dirigidas a los mayores en riesgo (AU)

Introduction. The objective is to assess the effectiveness of a social-physical activity intervention program in the improvement of the health-related quality of life and functional physical condition of patients older than 65 years at social risk. Material and methods. Quasi-experimental intervention (pretest-posttest). Setting. Community activity; primary care and public education centres. Participants: Twenty-nine patients older than 65 years, seen at the health centre, with a diagnosis of social risk. The program included monthly health education sessions and two weekly sessions of one hour of exercise for 6 months. Measurements were taken before and at the end of the study. Outcome variables were: quality of life valued using the SF36 questionnaire and functional fitness through Senior Fitness Battery Test. Results. After intervention improved all tests for the physical qualities improved after the intervention; in the 6-minutes walk all subjects improved from baseline, with an average increase of 62±36 metres (95% CI: 48-76). The SF-36 questionnaire improved 8 scales and mental summary component with a further increase of 6 points (P<.05). Conclusions. Social-physical activity intervention program improved the health-related quality of life related and functional physical condition in older people at social risk. This paper provides evidence in favour of the implementation of social-physical community activities, coordinated between health services and education centres, aimed at the elderly at risk (AU)

Guía de practica clínica de empleo de los inhibidores de la bomba de protones en la prevención de gastropatías secundarias a fármacos / Clinical practice guide for the use of proton pump inhibitors in the prevention of gastropathies secondary to drugs

La finalidad de esta guía es proporcionar unas recomendaciones para el uso de Inhibidores de la Bomba de Protones (IBP), tanto en el ámbito de la atención primaria como en el de atención especializada. Su objetivo principal es dar a conocer las indicaciones de los IBP en prevención primaria de evento gastrointestinal en pacientes polimedicados o consumidores de fármacos potencialmente gastrolesivos. En esta GPC se aborda algún aspecto de prevención secundaria en los pacientes que ya han tenido previamente un evento gastrointestinal, para diferenciar de las actuaciones respecto a los pacientes sin antecedentes de los mismos.

[Effectiveness of a social-physical activity intervention program in an elderly social risk population]. / Efectividad de un programa de intervención socio-motriz en población mayor con riesgo social.

INTRODUCTION: The objective is to assess the effectiveness of a social-physical activity intervention program in the improvement of the health-related quality of life and functional physical condition of patients older than 65 years at social risk. MATERIAL AND METHODS: Quasi-experimental intervention (pretest-posttest). SETTING: Community activity; primary care and public education centres. PARTICIPANTS: Twenty-nine patients older than 65 years, seen at the health centre, with a diagnosis of social risk. The program included monthly health education sessions and two weekly sessions of one hour of exercise for 6 months. Measurements were taken before and at the end of the study. Outcome variables were: quality of life valued using the SF36 questionnaire and functional fitness through Senior Fitness Battery Test. RESULTS: After intervention improved all tests for the physical qualities improved after the intervention; in the 6-minutes walk all subjects improved from baseline, with an average increase of 62 +/- 36 metres (95% CI: 48-76). The SF-36 questionnaire improved 8 scales and mental summary component with a further increase of 6 points (P < .05). CONCLUSIONS: Social-physical activity intervention program improved the health-related quality of life related and functional physical condition in older people at social risk. This paper provides evidence in favour of the implementation of social-physical community activities, coordinated between health services and education centres, aimed at the elderly at risk.

PDA self-register system for eating disorders: a study on acceptability and satisfaction.

Self-monitoring techniques, such as the use of dietary registers, are considered to be central to cognitive-behavioral treatment of Eating Disorders (ED). This information allows the clinician to identify the triggers of the behaviors associated to ED as purges and/or binges, and the associated thoughts and emotions, helping to carry out a more accurate assessment. Traditionally these registers are made with paper and pencil mode, where the patient has to register every eating and the emotions/thoughts associated; but this system has some problems, as low portability, low adherence or methodological difficulties. The use of PDA for self-registers can help to solve these problems. The aim of this study is to study the levels of acceptability and satisfaction with PDAs self-register system specifically designed for assessment and treatment of ED. Samples of 30 subjects diagnosed with ED are receiving a PDA with software specifically designed for recording type and amount of food, emotions before and after eating and other behaviors. The participants are completing self-register daily during a week, and afterwards answer an acceptance and satisfaction questionnaire. This work is in progress at the moment. It is expected that the PDA system will show high levels of acceptance and satisfaction.

Selectivity of a model zeolite ring over hydrocarbons with different symmetry, travelling with different orientations and speeds.

We explore the selectivity of a model zeolite ring over representative hydrocarbons of crude oil. The model ring consists of 7 silicon tetrahedral units and one chemically active aluminum site through which hydrocarbons with symmetries varying from almost spherically symmetric to linear chains (1D), planar (2D), and pyramidal (3D) structures diffuse. The selectivity is further investigated when the hydrocarbons travel with different orientations and speeds. The semiclassical Born-Oppenheimer molecular dynamics approximation is used to characterize the chemical dynamics, as well as to determine the energetics and reaction products. The simulations reveal noticeable differences in energy profiles and charge populations. Our results are important to understand aspects of mass transport and some of the factors that control the catalytic activity in zeolites.