Utilidad de la histeroscopia en el manejo del sangrado uterino anorma / Usefulness of hysteroscopy in the management of abnormal uterine bleeding

La histeroscopia se considera actualmente la prueba que posibilita no solo el diagnóstico, sino también el tratamiento de enfermedad intrauterina en paciente con clínica de sangrado uterino anormal causado por anomalías estructurales, como pólipos, adenomiosis, miomas submucosos, hiperplasia endometrial o cáncer de endometrio. La miniaturización del diámetro de los histeroscopios con canal de trabajo, del minirresector bipolar y de los sistemas de morcelación histeroscópica han permitido el tratamiento en régimen ambulatorio, en ocasiones en el mismo tiempo que el diagnóstico histeroscópico, aportando mayor satisfacción, reducción riesgos quirúrgicos o derivados de la anestesia y posibilitando una rápida resolución coste-efectiva de los síntomas. En este artículo se revisa la utilidad de la histeroscopia para el diagnóstico y el tratamiento de la enfermedad estructural intrauterina causante de sangrado uterino anormal.(AU)

Hysteroscopy is currently considered the test that enables not only the diagnosis but also the treatment of intrauterine pathology in patients with symptoms of abnormal uterine bleeding caused by structural abnormalities such as polyps, adenomyosis, submucosal fibroids, endometrial hyperplasia, or endometrial cancer. The miniaturization of the diameter of hysteroscopes with working channels, the bipolar mini-resector, and the hysteroscopic morcellation systems have allowed outpatient treatment, sometimes at the same time as hysteroscopic diagnosis, providing greater satisfaction, reducing surgical and/or anaesthesia risks and enabling rapid cost-effective resolution of symptoms. This article reviews the usefulness of hysteroscopy for the diagnosis and treatment of intrauterine structural pathology causing abnormal uterine bleeding.(AU)

Desarrollo y evaluación de una estrategia de fortalecimiento de la calidad de atención de personas con riesgo cardiovascular global diabetes y HTA / Development implementation and assessment of a strategy to strengthen quality of care of people with global cardiovascular risk type 2 diabetes and hypertension

La apropiada estratificación de riesgo cardiovascular en el primer nivel deatención (PNA) y el seguimiento de pacientes de acuerdo con prácticasajustadas al riesgo constituyen una estrategia efectiva para la prevención deeventos cardiovasculares. El desarrollo de sistemáticas de estratificación deriesgo cardiovascular en PNA del subsistema público es de reciente aplicacióny se lleva a cabo a través del Programa Redes en el marco de los ProyectosProvinciales de Fortalecimiento de Redes de Salud (PPFRS).ObjetivosConocer el estado actual y evaluar el efecto de la aplicación de una estrategiade fortalecimiento de redes de servicios de salud en la práctica clínica y en lacalidad de atención de personas adultas con diabetes tipo 2 (DBT2), hipertensiónarterial (HTA) y riesgo cardiovascular global (RCVG) moderado, alto y muy alto.MétodosEl estudio se llevó adelante en las siguientes etapas: 1) identificación de lascaracterísticas de acceso, cobertura y práctica clínica en los efectores del PNA parael abordaje del RCVG en personas con DBT2 y HTA; 2) implementación de unaestrategia de fortalecimiento de redes de servicio de salud y de cuidado integralde las personas adultas con RCVG moderado, alto y muy alto; 3) evaluación delefecto de la estrategia desarrollada en la práctica clínica y el cuidado integral de laspersonas adultas con DBT2 y HTA, y personas con RCVG moderado, alto y muy alto.ResultadosLos resultados constituyen una evaluación de la primera experiencia deaplicación de una sistemática de atención en enfermedades crónicas(hipertensión y diabetes), que se orienta a una estrategia de prevencióncardiovascular basada en la evaluación del RCVG.ConclusionesLa información generada por esta investigación puede ser útil para mejorarel diseño de las estrategias de implementación de guías o pautas de prácticaclínica de prevención cardiovascular, llevadas adelante por el Ministerio deSalud de la Nación con el fin de mejorar la calidad de atención.

[Internal medicine in the hospital setting]. / Médecine interne hospitalière: l'année en revue.

Management of all pathologies, and in particular that of the most frequent ones, should whenever possible be based on robust evidence and arguments. New studies published this year enable rationalizing of screening in certain clinical situations, more adequate treatment of others, and open the way for novel and apparently very effective treatments. Whether it be the screening of carotid stenosis, the treatment of pericarditis, of heart failure, of chronic obstructive lung disease or spontaneous bacterial peritonitis, paradigm changes are conceivable. This selective review of the literature summarizes certain studies published this year.

[Does treatment improve prognosis of heart failure with preserved ejection fraction?]. / Insuffisance cardiaque à fraction d'éjection préservée: le traitement améliore-t-il le pronostic?

Heart failure with preserved ejection fraction (HF-PEF) represents half of all heart failure. Morbi-mortality for HF-PEF is similar to that of reduced ejection fraction HF (HF-REF). Diagnosis of HF-REF is difficult because of the lack of highly specific criteria. It is based on the presence of signs and symptoms of heart failure, associated with a preserved or moderately decreased left ventricular function, the absence of left ventricular dilatation, and the presence of relevant structural disease such as left ventricular hypertrophy. Despite the use of prognosis modifying drugs commonly used for HF-REF, no therapeutic strategy has been shown to reduce morbi-mortality of HF-PEF. Evidence based guidelines are limited. Management of HF-PEF therefore resides in treatment of high blood pressure and cardiac rate, that of comorbidities, and the use of diuretics in case of congestion.

[Atrial fibrillation and obstructive sleep apnea: a fortuitous association?]. / Fibrillation auriculaire et syndrome d'apnées du sommeil: une association fortuite?

Atrial fibrillation (AF) is a frequent arrhythmia and is associated with important morbidity and mortality. It is particularly frequent in patients with obstructive sleep apnea (OSA), occurring in 3 to 5% of these patients. Numerous studies show an association of these two pathologies, independently of classical cardiovascular risk factors and otherconfounders. A pathophysiological link between repeated apnea and cardiac modifications, inflammation and autonomic nervous system disequilibrium has also been demonstrated. The severity of OSA influences development of AF, and appears to make management more complicated. Success of catheter ablation of AF appears to be inferior in patients with OSA. Whilst more robust studies are required to better define the role of OSA in AF, the existing literature establishes a link between these two entities.

[The risk of bisphosphonate-related osteonecrosis of the jaw]. / Risque d'ostéonécrose des maxiluaires avec l'utilisation des bisphosphonates.

Bisphosphonates are widely used in the treatment of osteonecrosis and oncology related bone complications. Their use is highly beneficial for the patient, but may be associated with adverse effects. Osteonecrosis of the jaw is an often cited complication of this treatment, but is in practice rarely seen. Its prevalence is low in cases of osteoporosis but a little higher in the oncological setting. Although its pathophysiology is not completely eluci-dated, certain risk factors have been identified such as tooth extraction which often precedes the affection. Management requires a multidisciplinary approach and a conservative treatment is usually preferred. Dealing with this rare condition requires identification of at risk patients so as to apply preventative measures.

[Hospital based internal medicine in 2012]. / Médecine interne hospitalière: l'année 2012 en revue.

In an era in which primary and secondary prevention have important implications for public health and health care costs, a series of publications and guidelines give added weight or precision to current medical practice in the fields of hospital based internal medicine. This article presents a selective review of new guidelines and therapeutic options for areas of cardiovascular disease, pulmonary disease, gastroenterology and oncology.

[Early diagnosis and treatment of infective endocarditis]. / Diagnostic et prise en charge précoce des endocardites infectieuses.

Despite progress in medical and surgical treatment, morbidity and mortality remain high in infective endocarditis. Multiple diagnostic tools are now available to decrease delays in the diagnosis and instauration of appropriate treatment. Identification of patients at high risk of developing complications and those who may benefit from early surgery could improve prognosis and outcome. This article reviews some of the existing tools and options available for the diagnosis, risk evaluation and treatment of infective endocarditis, as well as the evidence for their systematic use.

[Hospital based internal medicine: a review of 2011]. / Médecine interne hospitalière: l'année 2011 en revue.

Numerous prospective randomised trials recently demonstrated the importance of an aggressive approach towards controlling cardiovascular risk factors. New studies reinforce the plethora of available data and confirm that interventional revascularisation strategies for stable coronary heart disease or cerebral vascular disease offer few benefits as compared to medical treatment, and can even lead to worse outcomes. This selective review describes some recent studies in the areas of cardiovascular disease, pulmonary disease, such as chronic obstructive pulmonary disease or screening of lung cancer, and gastroenterology.

[Specificities of diabetes in acute coronary syndromes]. / Spécificités du diabète dans le syndrome coronarien aigu.

Contrary to the decline in the prevalence of several risk factors such as hypertension, hypercholesterolemia and smoking, diabetes is an expanding health burden in the western world. Because of the proatherosclerotic, proinflammatory, and prothrombotic states associated with diabetes, diabetic patients with acute coronary syndromes (ACS) are at high risk of subsequent cardiovascular events. However, they derive greater benefit from aggressive platelet inhibition and an early invasive strategy than non-diabetic individuals. Despite the documented efficacy, diabetic patients with ACS receive evidence-based treatments less frequently than non-diabetic individuals.

[Acute coronary syndrome: guidelines and geriatrics specificity]. / Syndrome coronarien aigu: guidelines et spécificité gériatrique.

Acute coronary syndrome (ACS) includes unstable angina pectoris, myocardial infarction without ST elevation and myocardial infarction with ST elevation. ACS is more frequent in the elderly than in the general population and is associated with very high morbidity and mortality. As older individuals are often excluded from clinical trials, the geriatrician needs to take care of these subjects without specific guidelines. Although older subjects (or very old subjects) represent a group at high risk of complications, they would benefit most of an aggressive coronary revascularisation procedure. Given the current state of knowledge, biological age itself should not be the only limiting criteria when considering an invasive coronary procedure, but the existing quality of life and physical conditions of the individual should also be taken into account in the global management strategy.

[Update in hospital medicine 2008]. / Médecine interne hospitalière.

This paper summarizes several important studies published during the previous year that have an impact on the practice of inpatient internal medicine, because they either modify or reinforce current practices. The selected domains include cardiovascular disease, for example the management of hypertension in very old patients, the effects of blockade of the renin-angiotensin-aldosterone system, and the use of biomarkers in cardiology; neurovascular pathology, specifically the prognosis of transient ischemic attacks and some aspects of cardioembolic stroke due to atrial fibrillation. Other topics include pneumonia prognosis, the management of ascitis fluid or of septic shock, and methodology.

Influence of the electrical interface properties on the rheological behavior of sonicated soy lecithin dispersions.

A significant effect, on the rheological behavior, due to the electrical properties of vesicles formed from concentrated soy lecithin dispersions have been studied in this work. The rheopectic behavior of concentrated soy lecithin dispersions (120, 150, 180, 210 and 240 g L-1) prepared by swelling-light sonication-freezing-unfreezing procedure is studied and it is specially emphasized on the transition under steady shear from lamellar phase of planar sheets to closed structures as multilamellar vesicles. Samples have been exposed to a different number of sonication cycles (from 0 to 100) and the changes in the hysteresis loop area, the apparent viscosity and the electrophoretic mobility have been studied. When the number of sonication cycles increases, the size and number of bilayers of these multilamellar vesicles decrease and therefore the total number of the vesicles and the volume fraction occupied by them show an increase.

Manejo del parto del segundo gemelo / Management of second twin delivery

Objetivos: Valoración de los resultados perinatales en un estudio retrospectivo del manejo del parto del segundo gemelo, cuando se ha producido un parto vaginal del primer gemelo, en los partos gemelares asistidos por vía vaginal en el Hospital Universitario Materno Infantil de Canarias (HUMIC), durante el período comprendido desde el 1 de enero de 1998 al 31 de diciembre de 2002. Material y métodos: Análisis de 455 partos gemelares, sobre un total de 37.803 partos, desde el 1-01-1998 al 31-12-2002. Se revisaron de forma retrospectiva todos los partos gemelares por vía vaginal atendidos en dicho período. Se excluyeron los partos triples y los gemelos asistidos mediante cesárea. Se evaluaron los siguientes parámetros: número total de partos gemelares, total de recién nacidos (RN) vivos, número de partos gemelares por vía vaginal, edad materna, paridad, edad gestacional, tipo de parto, tipo de parto del segundo gemelo, peso, sexo del RN, test de Apgar, pH arterial menor de 7,10, ingreso en la unidad de cuidados intensivos neonatales (UCIN) y mortalidad. Resultados: El número de partos gemelares atendidos en dicho período fue de 454, con 902 RN vivos. El número de partos gemelares por vía vaginal fue de 262. La edad materna fue de 77,9 por ciento entre 17-34 años. La mayoría primíparas, con 135 casos (51,5 por ciento). La edad gestacional en el momento del parto fue del 39,3 por ciento de menos de 37 semanas. En cuanto a la forma del parto del segundo gemelo, 134 (51,1 por ciento) fueron eutócicos, 60 (22,9 por ciento) de versión interna y gran extracción podálica, 41 (15,6 por ciento) podálicos vía vaginal y 27 (10,3 por ciento) mediante fórceps. En cuanto a los recién nacidos, la mayoría fueron varones (133 casos), y 141 (54,6 por ciento) presentaron un peso inferior a 2.500 g. Los resultados perinatales fueron buenos, con el 96,4 por ciento de los gemelos con test de Apgar a los 5 minutos superior a 7, pH arterial mayor de 7,10 en el 79,07 por ciento, y el 26,7 por ciento ingresó en el servicio de neonatología (AU)

First Report of Colletotrichum gloeosporioides on Chinese Rose in Argentina.

Chinese rose (Hibiscus rosa-sinensis L.) is a shrub frequently planted in Argentina. In November 1999, dieback and anthracnose symptoms were detected on stems and leaves of plants cv. Hawaii cultivated in Buenos Aires. Disease prevalence was 50%. Pieces of infected tissues were surface-sterilized for 1 min in 2% NaOCl, plated on potato-dextrose agar and incubated at 24 ± 2°C. The isolate that was consistently recovered from diseased tissues was identified as Colletotrichum gloeosporioides (Penz.) Penz. and Sacc., based on morphological characteristics (1,2). Teleomorph stage was not observed. Inoculation for pathogenicity testing was carried out by spraying a conidial suspension (6.5 × 106 conidia per ml) on plants with previously punctured leaves and pruned stems. Inoculated plants with unwounded tissues, as well as noninoculated controls, were included. Five replications of each treatment were done. Plants were incubated in moist chambers at 24°C. Whitish areas of 0.3 to 0.5 cm diameter surrounded by a purple halo developed on all punctured leaves within 10 days. Stem blight and leaf drop were observed. The center of the lesions was covered by black acervuli 14 days after inoculation. Unwounded and noninoculated controls remained symptomless. The pathogen was reisolated from inoculated leaves, completing Koch's postulates. This is the first report of C. gloeosporioides causing disease on Chinese rose in Argentina. References: (1) J. A. Bailey and M. J. Jeger, eds. 1992. Colletotrichum. CAB International, Surrey, England. (2) B. C. Sutton. 1980. The Coelomycetes. CMI, Kew.

Creating the future. Nurses can shape their profession by getting involved in healthcare reform.

To remain relevant in a reformed healthcare system, nurses will have to redefine and remake themselves. Three aspects of the new healthcare age--megahospitals, managed care, and redefined professional roles--will have a significant impact on healthcare professions, including nursing. Across the United States hospitals are merging to form sophisticated networks that provide a continuum of care. Under this delivery model, nurses will play a variety of new roles and work collaboratively with the entire spectrum of health social service professionals. A related development--the growth of managed care--is an increasingly attractive option among large employers. It will also accelerate changes in the way healthcare professionals work. Managed care will force physicians to enter into appropriate group affiliations and hospitals to reconfigure themselves to meet the needs of a dynamic system that no longer requires yesterday's beds or management structures. The future will force healthcare professionals to go through regular, radical changes in their job requirements. But it will also allow nurses and others to emerge from their task-oriented past and take on work that requires them to think, judge, and intervene.

Contenido plasmídico de cepas de Neisseria gonorrhoeae aisladas en Uruguay / Plasmid contein in Neisseria gonorrhoeae strain isolates in Uruguay

Se analizó el contenido plasmídico de 40 cepas de Neisseria gonorrhoeae aisladas de exudados uretrales, provenientes de un solo centro asistencial de Montevideo. Se correlacionó el contenido plasmídico con la resistencia in vitro a la Penicilina G y con la producción de beta-lactamasa. De las cepas estudiadas, el 100 por ciento contiene un plásmido de 2,6 MDaltons. El 50 por ciento de las cepas posee además otros dos plásmidos de 3,2 MDal y 24,5 MDal, son resistentes a la penicilina y producen beta-lactamasa

Contenido plasmídico de cepas de Neisseria gonorrhoeae aisladas en Uruguay / Plasmid contein in Neisseria gonorrhoeae strain isolates in Uruguay

Se analizó el contenido plasmídico de 40 cepas de Neisseria gonorrhoeae aisladas de exudados uretrales, provenientes de un solo centro asistencial de Montevideo. Se correlacionó el contenido plasmídico con la resistencia in vitro a la Penicilina G y con la producción de beta-lactamasa. De las cepas estudiadas, el 100 por ciento contiene un plásmido de 2,6 MDaltons. El 50 por ciento de las cepas posee además otros dos plásmidos de 3,2 MDal y 24,5 MDal, son resistentes a la penicilina y producen beta-lactamasa (AU)