Regla de predicción para determinar infestación canina por Echinococcus granulosus / Prediction rule to determine canine infestation by Echinococcus granulosus

Nuestro objetivo fue determinar un score que ayude a predecir la probabilidad de infestación canina por Echinococcus en una zona endémica en hidatidosis. Se realizó un estudio longitudinal en 3 anexos de la provincia de Concepción ubicado en los andes centrales de Perú. La infección canina por Echinococcus granulosus fue definido por la presencia de antígeno identificado en la muestra de heces. El modelo predictivo se obtuvo mediante un análisis de regresión logística basado en los parámetros sociodemográficos, esta regla fue internamente validada por remuestreo de tipo bootstrap. Resultados: De 152 canes que se sometieron al estudio de heces, 76 tuvieron infección por Echinococcus confirmada por antígeno reactivo. Se identificaron 4 factores ponderados dentro de la regla de predicción que, en suma, dieron el puntaje: El can que duerme fuera de casa (3 puntos), alimentar con vísceras crudas al can (3 puntos) y sacrificar al ganado dentro de la casa (2 puntos) y el can se alimenta con croquetas (-2 puntos). Se encontró que esta regla de predicción tuvo valor del área bajo la curva ROC 0,78; (IC 95%: 0,70 ­ 0,86). Estos parámetros de predicción con un puntaje ≥ 3 tenía una sensibilidad del 75% y especificidad del 65,8%, con un valor predictivo positivo del 85,3%. Esta regla ayudará al personal de la salud a identificar a los canes infestados por Echinococcus granulosus, para su intervención anti parasitaria y preventiva en sus dueños(AU)

Cystic hydatidosis is an endemic disease in Andean regions, our objective was to determine a score that helps to predict canine Echinococcus infestation in an endemic area with hydatidosis. A longitudinal study was carried out in 3 annexes of the province of Concepción located in the central Andes of Peru. Canine echinococcosis infection was defined by the presence of E. granulosus antigen identified in the stool sample. The predictive model was obtained through a logistic regression analysis based on the sociodemographic parameters, this rule was internally validated by bootstrap type resampling. Results: Of 152 dogs that underwent the stool study, 76 had an Echinococcus infection confirmed by reactive antigen. Four weighted factors were identified within the prediction rule that, in sum, gave the score: The dog that sleeps outside the home (3 points), feeding raw viscera to the dog (3 points), slaughtering the cattle inside the house (2 points) and the dog is fed with croquettes (-2 points). This prediction rule was found to have a value of the area under the ROC curve 0.78 (95% CI: 0.70 - 0.86). At a cutoff point of ≥ 3 points, the prediction rule was found to have a sensitivity of 75% and a specificity of 65.8%, with a positive predictive value of 85.3%. This rule will help health personnel to identify canes infested by Echinococcus granulosus, for their anti-parasitic and preventive intervention in their owners(AU)

Evaluation Results of an Ontology-based Design Model of Virtual Environments for Upper Limb Motor Rehabilitation of Stroke Patients.

OBJECTIVES: 1) To enhance the content of an ontology for designing virtual environments (VEs) for upper limb motor rehabilitation of stroke patients according to the suggestions and comments of rehabilitation specialists and software developers, 2) to characterize the perceived importance level of the ontology, 3) to determine the perceived usefulness of the ontology, and 4) to identify the safety characteristics of the ontology for VEs design according to the rehabilitation specialists. METHODS: Using two semi-structured Web questionnaires, we asked six rehabilitation specialists and six software developers to provide us with their perception regarding the level of importance and the usability of the ontology. From their responses we have identified themes related to perceived and required safety characteristics of the ontology. RESULTS: Significant differences in the importance level were obtained for the Stroke Disability, VE Configuration, Outcome Measures, and Safety Calibration classes, which were perceived as highly important by rehabilitation specialists. Regarding usability, the ontology was perceived by both groups with high usefulness, ease of use, learnability and intention of use. Concerning the thematic analysis of recommendations, eight topics for safety characteristics of the ontology were identified: adjustment of therapy strategies; selection and delimitation of movements; selection and proper calibration of the interaction device; proper selection of measuring instruments; gradual modification of the difficulty of the exercise; adaptability and variability of therapy exercises; feedback according to the capabilities of the patient; and real-time support for exercise training. CONCLUSIONS: The rehabilitation specialists and software developers confirmed the importance of the information contained in the ontology regarding motor rehabilitation of the upper limb. Their recommendations highlight the safety features and the advantages of the ontology as a guide for the effective design of VEs.

Laparoscopic splenectomy for primary immune thrombocytopenia: clinical outcome and prognostic factors.

BACKGROUND: Laparoscopic splenectomy (LS) is considered the standard treatment for patients with refractory primary immune thrombocytopenia (ITP). PATIENTS AND METHODS: All patients with ITP who underwent LS during the last 17 years and who had a minimum follow-up of 1 year were included. Several perioperative variables such as age, platelet count, and duration of preoperative therapy were recorded and analyzed, looking for potential predictive variables of clinical response. RESULTS: In total, 150 patients were included: 108 (72%) women and 42 (28%) men, with a mean age of 37.3±15.8 years. In the evaluation 1 year after surgery, 133 (88.7%) patients had achieved complete response, 4 (2.7%) had a response, and in 13 (8.6%) there was no response. None of the analyzed preoperative variables was identified as a predictive factor of response at 1 year. Immediate responders after surgery (≥150,000 platelets/mL during the first week) had a higher platelet count and rate of complete response at 1 year (94.2%). CONCLUSIONS: LS has a high success rate in patients with refractory ITP. Potential predictive indicators of success remain to be determined.

Correlation between radiologic and pathologic dimensions of adrenal masses.

The size of adrenal tumors has been shown to be a good predictor of malignancy. There is still some controversy about the concordance between radiologic and real pathologic measurements. The aim of this study is to determine the correlation between direct and corrected radiologic computed tomography scan dimensions and the measurements of the resected specimen. A total of 41 adrenal tumors were included. Direct and corrected measurements of the largest diameter were contrasted with the pathologic dimensions. The Linos formula was used for the corrected measurements. Proper statistics were used considering a two-tailed significance level of 0.05. The intraclass correlations using direct and corrected measurements were 0.89 [95% confidence interval (95%CI) 0.81-0.94, p = 0.00001) and 0.90 (95%CI 0.82-0.95, p = 0.00001), respectively. The bivariate analysis using Pearson's correlation between two-dimensional group variables showed r = 0.82 (p < 0.0001) when direct and pathologic measurements were compared and r = 0.83 (p < 0.0001) when the corrected values were compared with the real dimensions. In this study, we demonstrate good correlation between radiologic and pathologic measurements of adrenal tumors. The Linos formula turned out to be significantly more accurate than direct radiologic measurements when means of the groups were compared, whereas when individual correlations were determined the two were similar. The Linos formula and radiologic measurements can be used to determine the proper management of adrenal incidentalomas in individual patients.

Tratamiento quirurgico del neumotorax espontaneo: experiencia en el Hospital Santa Clara de Bogota / Surgical treatment of spontaneous pneumothorax: experience in Hospital Santa Clara de Bogota

Se estudiaron 30 casos de neumotorax espontaneo tratados quirurgicamente de un total de 120 casos pertenecientes a la casuistica de los ultimos 7 anos en el Hospital Santa Clara. Dieciocho pacientes eran del sexo masculino y 12 del femenino, siendo la edad promedio de 29 anos. El sintoma clinico mas importante fue el dolor toracico en 27 pacientes (90%). Diecisiete pacientes presentaron neumotorax derecho, 12 izquierdo y 1 bilateral. La radiografia simple del torax se realizo en todos los casos, considerandose como el examen basico para el diagnostico. La toracoscopia se efectuo en 10 pacientes (33.3%), convirtiendose en el metodo para establecer el diagnostico etiologico, de gran ayuda para la indicacion quirurgica temprana. La toracotomia mas la reaccion quirurgica con escarificacion pleural se reconocio como el metodo definitovo de tratamiento en 29 pacientes (96.6%). La indicacion mas importante de cirugia en el presente estudio fue la recurrencia del neumotorax mas la demostracion de la ampolla o bula, en 15 pacientes (50%), la demostracion de la ampolla en 9 (30%), y la recurrencia mas fistula broncopleural en 6 (20%). No hubo mortalidad en la serie

Modificaciones acido-basicas y electroliticas en niños deshidratados antes y despues de la terapia de rehidratacion oral: Departamiento de Pediatria del Hospital Vicente Corral Moscoso / Acid-base and electrolyte modification in dehydrated children before and after oral rehydratation therapy: Pediatric Department of Hospital Vicente Corral Moscoso

En el Departamento de Pediatría del Hospital "Vicente Corral Moscoso" de Cuenca-Ecuador, se estudiaron 51 pacientes deshidratados, con el objeto de evaluar los cambios en los electrolitos y en el equilibrio ácido-base, antes y después de recibir la terapia de rehidratación oral (TRO) con las sales propuestas por la OMS-UNICEF. Los lactantes constituyen el 94.1% de la muestra; la desnutrición en sus distintos grados se presentó en el 68.6%. Se observó buena tolerancia al suero oral, así como una correcta hidratación en todos los pacientes. La normalización del sodio se produjo en el 100%; del potasio en el 88,2% y del cloro en el 100%. En ningún caso se recurrió a manejos especiales para la correlación de los electrolitos. El equilibrio ácido-base, a pesar de las diversas alteraciones que presenta al inicio, tuvo una respuesta favorable en la mayoría de los pacientes, excepto en 7 pacientes que presentaron incremento del bicarbonato en cifras discretas, en relación con su hipopotasemia

Traumatismos del diafragma / Diaphagm trauma

Mediante el presente estudio retrospectivo se revisaron 466 historias clinicas de pacientes atendidos por el servicio de urgencias quirurgicas del Hospital San Juan de Dios de Bogota, durante el periodo comprendido entre el 1 de marzo de 1981 y el 28 de febrero de 1986. Los pacientes en la serie estudiada fueron en su mayoria del sexo masculino (92%); se establecio una relacion hombre-mujer de 11:1. El grupo de edad mas afectado estuvo entre los 10 y 29 anos (58%). La mayoria de los pacientes sufrio trauma penetrante (96.3%); 17 pacientes (3.7%) sufrieron trauma cerrado. El hemidiafragma mas comprometido fue el izquierdo. Las manifestaciones clinicas mas sobresalientes fueron: dolor abdominal, hipoventilacion del hemitorax afectado, disnea, hemoneumotorax y defensa abdominal. Los metodos paraclinicos demostraron un bajo grado de especificidad diagnostica. Las lesiones asociadas en su orden de frecuencia estuvieron localizadas en nivel del higado, estomago, bazo, colon, intestino delgado, pulmon, pancreas, sistema vascular y oseo. El acceso quirurgico en 413 casos se efectuo por laparotomia, en 37 por toracolaparotomia, y el los 13 restantes por toracotomia. La hernia diafragmatica se presento en el 6%; y la mortalidad global fue del 10.5%.