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Hernia ; 24(2): 257-263, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31069579


BACKGROUND: The incidence of incisional hernia in patients with peritoneal surface malignancies treated by cytoreduction plus hyperthermic intraperitoneal chemotherapy (HIPEC) remains unclear, and the criteria commonly used to indicate their repair cannot be applied in these patients. The objective of this work was to analyze the incidence of incisional hernias in these patients, identify the risk factors associated with their appearance, and propose an algorithm for their management. METHODS: We analyzed a series of patients with malignant pathologies of the peritoneal surface treated by cytoreduction with peritonectomy and HIPEC procedures between January 2008 and June 2017. Only patients with a minimum postoperative follow-up period of 12 months were included. RESULTS: Our series included 282 patients, 28 (10%) of whom developed an incisional hernia during the follow-up period. Fifty-one patients, all with ovarian cancer with peritoneal dissemination, did not receive HIPEC after cytoreduction as they were part of the control arm of the CARCINOHIPEC clinical trial (NCT02328716) or because they did not provide specific informed consent. In the multivariate analysis, treatment with HIPEC (OR 2.56, 95% CI [1.57, 4.31], p = 0.032) and the administration of preoperative systemic chemotherapy (OR = 1.59, 95% CI [1.26, 3.58], p = 0.041) were found to be independent factors related to the appearance of an incisional hernia. CONCLUSIONS: The incidence of incisional hernia after cytoreduction and HIPEC is within the ranges described in the literature for other abdominal surgery procedures. The use of systemic chemotherapy and treatment with HIPEC, in particular, were identified as factors related to their occurrence.

J Dairy Sci ; 102(11): 9749-9762, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31495617


One of the main challenges in the food industry is to design strategies for the successful incorporation of natural sources of bioactive compounds. Recently, yogurts and other fermented dairy beverages have been proposed as ideal carriers of such bioactive compounds such as fatty acids and antioxidants that could improve consumers' health. However, the incorporation of new ingredients causes functional and structural modifications that may affect the consumers' preferences. In this work, a dairy beverage model supplemented with oleic acid has been designed by partial substitution of milk by Candida utilis single-cell protein extract. The changes in the structural properties of this new beverage were evaluated by following the fermentation process, pH, aggregate size, microstructure, and changes in rheological properties. Furthermore, molecular dynamics simulations were carried out to analyze the interaction between its main components. Our data revealed that samples with a percentage of milk substitution of 30% showed a higher viscosity as compared with the other percentages and less viscosity than the control (no substitution). These samples were then selected for fortification by incorporating oleic acid microcapsules. A concentration of 1.5 g/100 g was shown to be the optimal quantity of microcapsules for oleic acid supplementation. Molecular dynamic simulations revealed glutathione as an important component of the micro-gel structure. The present study forms the basis for novel studies where Candida utilis single-cell protein and microencapsulated essential oils could be used to design innovative bioproducts.

Bebidas/análisis , Candida/química , Proteínas en la Dieta/química , Ácido Oléico/química , Animales , Antioxidantes/análisis , Suplementos Dietéticos , Ácidos Grasos/análisis , Fermentación , Glutatión/metabolismo , Concentración de Iones de Hidrógeno , Leche/química , Aceites Volátiles/química , Reología , Viscosidad
Rev Esp Quimioter ; 32(3): 238-245, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30968675


OBJECTIVE: To assess the impact of the first months of application of a Code Sepsis in a high complexity hospital, analyzing patient´s epidemiological and clinical characteristics and prognostic factors. METHODS: A long-term observational study was carried out throughout a consecutive period of seven months (February 2015 - September 2015). The relationship with mortality of risk factors, and analytic values was analyzed using uni- and multivariate analyses. RESULTS: A total of 237 patients were included. The in-hospital mortality was 24% at 30 days and 27% at 60 days. The mortality of patients admitted to Critical Care Units was 30%. Significant differences were found between the patients who died and those who survived in mean levels of creatinine (2.30 vs 1.46 mg/dL, p <0.05), lactic acid (6.10 vs 2.62 mmol/L, p <0.05) and procalcitonin (23.27 vs 12.73 mg/dL, p<0.05). A statistically significant linear trend was found between SOFA scale rating and mortality (p<0.05). In the multivariate analysis additional independent risk factors associated with death were identified: age > 65 years (OR 5.33, p <0.05), lactic acid > 3 mmol/L (OR 5,85, p <0,05), creatinine > 1,2 mgr /dL (OR 4,54, p <0,05) and shock (OR 6,57, P <0,05). CONCLUSIONS: The epidemiological, clinical and mortality characteristics of the patients in our series are similar to the best published in the literature. The study has identified several markers that could be useful at a local level to estimate risk of death in septic patients. Studies like this one are necessary to make improvements in the Code Sepsis programs.

Protocolos Clínicos , Sepsis/terapia , APACHE , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Biomarcadores , Creatinina/sangre , Femenino , Mortalidad Hospitalaria/tendencias , Hospitales Universitarios , Humanos , Ácido Láctico/sangre , Masculino , Persona de Mediana Edad , Polipéptido alfa Relacionado con Calcitonina/sangre , Pronóstico , Factores de Riesgo , Sepsis/mortalidad , Resultado del Tratamiento
Hernia ; 23(5): 909-914, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30903515


PURPOSE: The objective of the study was to analyze the experience of the Department of Surgery of two institutions of high complexity in Colombia, with the extra peritoneal ventral hernia repair by laparoscopy during the last 2 years and characterize the clinical and surgical aspects most relevant in the procedures performed. METHODS: Observational, descriptive, retrospective study, case series type: collection of data by clinical history and analysis thereof including calculation of frequency and central tendency measurements. RESULTS: 59 Cases of Ventral Hernia Repair by laparoscopy, 41 with Transabdominal Preperitoneal approach and 18 totally Extraperitoneal. In total, 7 complications were presented as follows: 1 Case of recurrence, 1 case of chronic pain, 2 complications Dindo-Clavien IIIa and 1 complication IIIb. CONCLUSIONS: The repair of the ventral hernia by Extraperitoneal route is an innovative approach of increasing popularity, which avoids the contact of the mesh with the intestines, thus avoiding the potential complications that this situation generates with good outcomes and at a lower cost.

Hernia Ventral/cirugía , Herniorrafia , Laparoscopía/métodos , Complicaciones Posoperatorias , Adulto , Colombia/epidemiología , Femenino , Hernia Ventral/epidemiología , Herniorrafia/efectos adversos , Herniorrafia/instrumentación , Herniorrafia/métodos , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Peritoneo/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Mallas Quirúrgicas
Sci Rep ; 8(1): 17310, 2018 Nov 23.
Artículo en Inglés | MEDLINE | ID: mdl-30470826


Lutetium oxyorthosilicate (LSO) or lutetium yttrium oxyorthosilicate (LYSO) are the scintillator materials most widely used today in PET detectors due to their convenient physical properties for the detection of 511 keV annihilation photons. Natural lutetium contains 2.6% of 176Lu which decays beta to excited states of 176Hf producing a constant background signal. Although previous works have studied the background activity from LSO/LYSO, the shape of the spectrum, resulting from ß-particle and γ radiation self-detection, has not been fully explained. The present work examines the contribution of the different ß-particle and γ-ray interactions to provide a fuller comprehension of this background spectrum and to explain the differences observed when using crystals of different sizes. To this purpose we have shifted the continuous ß-particle energy spectrum of 176Lu from zero to the corresponding energy value for all combinations of the isomeric transitions of 176Hf (γ-rays/internal conversion). The area of each shifted ß-spectrum was normalized to reflect the probability of occurrence. To account for the probability of the γ-rays escaping from the crystal, Monte Carlo simulations using PENELOPE were performed in which point-like sources of monoenergetic photons were generated, inside LYSO square base prisms (all 1 cm thick) of different sizes: 1.0 cm to 5.74 cm. The analytic distributions were convolved using a varying Gaussian function to account for the measured energy resolution. The calculated spectra were compared to those obtained experimentally using monolithic crystals of the same dimensions coupled to SiPM arrays. Our results are in very good agreement with the experiment, and even explain the differences observed due to crystal size. This work may prove useful to calibrate and assess detector performance, and to measure energy resolution at different energy values.

Rev. salud pública Parag ; 7(2): [P37-P43], jul-dic. 2017.
Artículo en Español | LILACS-Express | ID: biblio-884764


Con la Telemedicina pueden desarrollarse sistemas de telediagnóstico ventajosos para mejorar la atención de la salud de poblaciones remotas que no tienen acceso a especialistas. Este estudio realizado por la Unidad de Telemedicina del Ministerio de Salud Pública y Bienestar Social (MSPBS) en colaboración con el Dpto. de Ingeniería Biomédica e Imágenes del Instituto de Investigaciones en Ciencias (IICS-UNA) y la Universidad del País Vasco (UPV/EHU) sirvió para evaluar la utilidad de un sistema de telediagnóstico para la cobertura universal en la salud pública. Para el efecto se analizaron los resultados obtenidos por el sistema de telediagnóstico implementado en 56 hospitales del MSPBS. En dicho sentido se analizaron 293.142 diagnósticos remotos realizados entre enero del 2014 y septiembre de 2017. Del total, el 37,29 % (109.311) correspondieron a estudios de tomografía, 61,44 % (180.108) a electrocardiografía (ECG), 1,26 % (3.704) a electroencefalografía (EEG) y 0,01 % (19) a ecografía. No se observaron diferencias significativas entre el diagnóstico remoto y el diagnóstico "cara a cara". Con el diagnostico remoto se logró una reducción del coste que supone un beneficio importante para cada ciudadano del interior del país. Los resultados obtenidos evidencian que la telemedicina puede contribuir para mejorar significativamente la cobertura universal de los servicios diagnósticos y programas de salud, maximizando el tiempo del profesional y su productividad, aumentando el acceso y la equidad, y disminuyendo los costos. Sin embargo antes de realizar su implementación sistemática se deberá realizar una contextualización con el perfil epidemiológico regional. Palabras claves: Telemedicina; Cobertura Universal; Telediagnóstico; TICs en Salud; Innovación Tecnológica.

Through the telemedicine, advantageous telediagnostic systems can be developed to improve the health care of remote populations that don`t have access to specialists. This study was carried out by the Telemedicine Unit of the Ministry of Public Health and Social Welfare (MSPBS) in collaboration with the Department of Biomedical Engineering and Imaging of the Health Science Research Institute (IICS-UNA) and the University of the Basque Country (UPV / EHU) to evaluate the utility of a telediagnostic system for universal coverage in public health. For this purpose, the results obtained by the telediagnosis system implemented in 56 MSPBS hospitals were analyzed. In that sense, 293,142 remote diagnoses were performed between January 2014 and September 2017. Of the total, 37.29% (109,311) corresponded to tomography studies, 61.44% (180.108) to electrocardiography (ECG), 1.26% (3,704) to electroencephalography (EEG) and 0.01% (19) to ultrasound. There were no significant differences between the remote and the "face to face" diagnosis. With the remote diagnosis a reduction of the cost was obtained, that supposes an important benefit for each citizen of the interior of the country. The results show that the telemedicine can contribute to improve significantly the universal coverage of diagnostic services and health programs, maximizing professional time and productivity, increasing access and equity, and reducing costs. However, before carrying out its systematic implementation, a contextualization with the regional epidemiological profile must be performed. Key words: Telemedicine; Universal Coverage; Telediagnosis; ICT in Health; Technological Innovation.

J Environ Radioact ; 171: 200-211, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28273600


This paper presents the results of implementing an extrajudicial environmental mediation procedure in the socioenvironmental conflict associated with routine operation of the El Cabril Disposal Facility for low- and medium- activity radioactive waste (Spain). We analyse the socio-ethical perspective of this facility's operation with regard to its nearby residents, detailing the structure and development of the environmental mediation procedure through the participation of society and interested parties who are or may become involved in such a conflict. The research, action, and participation method was used to apply the environmental mediation procedure. This experience provides lessons that could help improve decision-making processes in nuclear or radioactive facility decommissioning projects or in environmental remediation projects dealing with ageing facilities or with those in which nuclear or radioactive accidents/incidents may have occurred.

Restauración y Remediación Ambiental/métodos , Monitoreo de Radiación , Residuos Radiactivos , Restauración y Remediación Ambiental/normas , Industrias , Protección Radiológica/métodos , Radiactividad , España
Endocr Pathol ; 27(1): 46-9, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26615394


The discovery of a tumor as a primary schwannoma in the thyroid gland is rare (Andrion et al. in Virchows Arch 413:367-372, 1988). It represents less than 1 % of mesenchymal neoplasms of this gland. Therefore, few cases of this type are described in medical literature (Aron et al. in Cytopathology 16:206-209, 2005; Cashman et al. in Medscape J Med 10(8):201, 2008; Coleman et al. in AJR Am J Roentgenol 140:383-7, 1983). In this article, we introduce the clinical case of a 27-year-old female patient, who presented a nodular mass located in the neck region. This mass was not associated with other symptoms and during the imagistic investigation it appeared to be a thyroglossal duct cyst. A fine needle aspiration biopsy was performed which revealed benign mesenchymal cells. After a pathology study of the piece resected through a thyroidectomy, it was confirmed that the tumor had neural characteristics, the final diagnosis being a primary schwannoma. The importance of a cytology study is emphasized, since in this case, it made it possible to accurately diagnose a mesenchymal tumor, despite their low frequency. It constitutes a highly useful tool for diagnosing non-epithelial neoplasia of the thyroid gland.

Neurilemoma/patología , Neoplasias de la Tiroides/patología , Adulto , Biopsia con Aguja Fina , Femenino , Humanos , Neurilemoma/cirugía , Neoplasias de la Tiroides/cirugía , Tiroidectomía
Parasite Immunol ; 38(3): 193-205, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26425838


Cystic echinococcosis is the infection by the larvae of cestode parasites belonging to the Echinococcus granulosus sensu lato species complex. Local host responses are strikingly subdued in relation to the size and persistence of these larvae, which develop within mammalian organs as 'hydatid cysts' measuring up to tens of cm in diameter. In a context in which helminth-derived immune-suppressive, as well as Th2-inducing, molecules garner much interest, knowledge on the interactions between E. granulosus molecules and the immune system lags behind. Here, we discuss what is known and what are the open questions on E. granulosus molecules and structures interacting with the innate and adaptive immune systems, potentially or in demonstrated form. We attempt a global biological approach on molecules that have been given consideration primarily as protective (Eg95) or diagnostic antigens (antigen B, antigen 5). We integrate glycobiological information, which traverses the discussions on antigen 5, the mucin-based protective laminated layer and immunologically active preparations from protoscoleces. We also highlight some less well-known molecules that appear as promising candidates to possess immune-regulatory activities. Finally, we point out gaps in the molecular-level knowledge of this infectious agent that hinder our understanding of its immunology.

Antígenos Helmínticos/inmunología , Equinococosis/inmunología , Echinococcus granulosus/inmunología , Glicoproteínas/inmunología , Proteínas del Helminto/inmunología , Larva/inmunología , Lipoproteínas/inmunología , Animales , Equinococosis/parasitología , Equinococosis/patología , Células Th2/inmunología
Rev. salud pública Parag ; 5(2): [P30-P39], jul-dic. 2015.
Artículo en Español | LILACS-Express | ID: biblio-905233


En el contexto de una evaluación económica y tecnológica de las alternativas metodológicas que facilite un sistema de cobertura universal y el uso eficiente de los recursos disponibles en la salud pública, existen argumentos de costo-beneficio para que un sistema de telediagnóstico sea considerado ventajoso en los países en vías de desarrollo como una herramienta para mejorar la atención de la salud de poblaciones remotas que no tienen acceso a los especialistas. Este estudio observacional y descriptivo realizado por la Unidad de Telemedicina del Ministerio de Salud Pública y Bienestar Social (MSPBS) en colaboración con el Dpto. de Ingeniería Biomédica e Imágenes del Instituto de Investigaciones en Ciencias de la Salud de la Universidad Nacional de Asunción (IICS-UNA) y la Universidad del País Vasco (UPV/EHU) sirvió como un proyecto piloto para evaluar el costo-beneficio de un sistema de telediagnóstico en la salud pública. Para el efecto fueron analizados los resultados obtenidos en un proyecto piloto de telediagnóstico implementado en 25 hospitales regionales y distritales del MSPBS. En dicho sentido, en el marco del proyecto piloto fueron realizados 34.096 diagnósticos remotos entre enero del 2014 y mayo de 2015 a través del sistema. Del total de telediagnósticos realizados, el 38,0 % (12.966) correspondieron a estudios de tomografía, 61,1 % (21.111) a electrocardiografía (ECG) y 0,1 % (19) a ecografía. Se observó una diferencia importante en el coste de diagnóstico remoto en relación al diagnóstico "cara a cara", en el análisis se incorporaron los costos de implantación y mantenimiento de la TIC para el diagnóstico remoto y los costos de transporte, alimentación y oportunidad para el diagnóstico "cara a cara". La reducción del coste a través del diagnóstico remoto fue de 4,5 veces para ECG, 26,4 veces para tomografía y de 8,3 veces para ecografía, lo que supone un beneficio importante para cada ciudadano del interior del país toda vez que el coste promedio de diagnóstico remoto para cada hospital sea igual o inferior al coste total del diagnóstico cara a cara. Los resultados obtenidos en este estudio contribuirán en forma significativa al fortalecimiento de la cobertura universal de servicios diagnósticos, capacidad de innovación y aseguramiento de la sostenibilidad económica del sistema de telediagnóstico público. Además ayudará a mejorar sustancialmente la capacidad resolutiva local de los hospitales regionales y distritales en el interior del país. Sin embargo, antes de recomendar su utilización masiva se deberá analizar los costos para su implementación y la sostenibilidad técnico-económica del sistema acorde a los recursos disponibles. Palabras claves: Telediagnóstico, Telesalud, Telemedicina, TICs en salud, Telemática en salud.

In the context of an assessment of alternative economic and technological methods that would facilitate a universal health coverage system and the effcient use of available resources in public health, there is debate about the cost-effectiveness and advantages of a remote telediagnostic system in developing countries as a tool to improve healthcare for remote populations without access to specialists. This observational and descriptive study by the Telemedicine Unit of the Ministry of Public Health and Social Welfare (MSPBS) in collaboration with the Dept. Of Biomedical Engineering and Imaging Research of the Institute in Health Sciences of the National University of Asuncion (IICS -A) and the University of the Basque Country (UPV / EHU) served as a pilot project to assess the cost-effectiveness of a system of remote telediagnostics in public health. For this purpose, we analyzed the results of a telediagnosis pilot project implemented in 25 regional and district MSPBS hospitals MSPBS. During the pilot project timeframe, 34,096 remote telediagnoses were made between January 2014 and May 2015 throughout the system. Of the total remote telediagnoses performed, 38.0% (12,966) were of tomography studies, 61.1% (21,111) were of electrocardiography (ECG) and 0.1% (19) were ultrasound interpretations. A signifcant difference was observed in the cost of remote telediagnosis compared to"face to face" diagnosis; the analysis included implementation and maintenance costs of information technology for remote telediagnoses vs. transportation costs, meals and access options for "face to face" diagnoses. The cost reduction via remote diagnosis was 4.5 times for ECG, 26.4 times for CT scans and 8.3 times for ultrasound, which would be a major beneft for patients living in remote areas of the country, since the average cost for remote telediagnosis at each hospital is equal to or less than the total cost of "fact to face" diagnosis. The results obtained in this study are a signifcant contribution to providing universal coverage for diagnostic services, improve the capacity to innovate in the public health system and reassure policymakers regarding the economic sustainability of a public health remote telediagnosis system. It will also help to substantially improve the resolution ability of regional and district hospitals in the countryside. However, before recommending its extensive use, the implementation costs, as well as the technical and economic sustainability considering local resource availability, should be analyzed. Keywords: Remote diagnostics, telehealth, telemedicine, health information technology, health Telematics.

Clin Microbiol Infect ; 21(3): 269-73, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25658537


Since 2009, the largest reported outbreak of leishmaniasis by Leishmania infantum in Europe was reported in Fuenlabrada, Spain. In our hospital, 90 adults with localized leishmanial lymphadenopathy (LLL) or visceral leishmaniasis (VL) were treated during this outbreak; 72% were men, and the mean age was 46.2 years (range 15-95 years). A total of 17 cases (19%) were LLL, an atypical form with isolated lymphadenopathies without other symptoms. All LLL cases occurred in immunocompetent subjects, and only one subject (6%) was a native of sub-Saharan Africa. Diagnosis was performed by fine needle aspiration cytology of the lymphadenopathy. Serology was negative in 38%. LLL outcomes at 6 months were benign, even with doses of liposomal amphotericin B that were often lower (10 mg/kg) than those recommended for VL in Mediterranean areas. A total of 73 subjects (81%) presented with typical VL; 66% of this group were immunocompetent, and 50% of those who were immunocompetent were descendants of natives of sub-Saharan Africa. The rK39 test and polymerase chain reaction were the most useful tests for confirmation of the diagnosis. An initial response to treatment was observed in 99% of cases, and relapses occurred in 14% of cases. Leishmaniasis should be included in the differential diagnosis of isolated lymphadenopathies in endemic areas. LLL could be considered a more benign entity, one different than VL, and less aggressive management should be studied in future investigations.

Brotes de Enfermedades , Leishmania infantum , Leishmaniasis/epidemiología , Leishmaniasis/parasitología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Leishmania infantum/clasificación , Leishmaniasis/diagnóstico , Leishmaniasis/tratamiento farmacológico , Leishmaniasis Visceral/diagnóstico , Leishmaniasis Visceral/tratamiento farmacológico , Leishmaniasis Visceral/epidemiología , Leishmaniasis Visceral/parasitología , Enfermedades Linfáticas/diagnóstico , Enfermedades Linfáticas/tratamiento farmacológico , Enfermedades Linfáticas/epidemiología , Enfermedades Linfáticas/parasitología , Masculino , Persona de Mediana Edad , España/epidemiología , Resultado del Tratamiento , Adulto Joven
Bol. venez. infectol ; 25(2): 118-125, jul.-dic. 2014. tab, graf
Artículo en Español | LILACS | ID: lil-718903


Estudio prospectivo diseñado con el fin de evaluar a los trabajadores de salud del Hospital Universitario de Caracas que notificaran exposición a fluidos corporales al Sistema de Vigilancia de Virus de Inmunodeficiencia Humana y Hepatitis Viral, desde los años 1991 hasta 1999. Las variables estudiadas fueron: fecha y sitio del accidente, categoría del personal, edad, género, fluido involucrado, tipo de exposición, instrumento utilizado, serología basal para Virus de Inmunodeficiencia Humana y hepatitis viral del paciente índice y del TS, tipo de profilaxis antirretroviral, efectos adversos y seroconversión al Virus de Inmunodeficiencia Humana. Se utilizó el método descriptivo serie de casos los cuales fueron analizados por Epi-info. Versión 5. Durante el período de estudio fueron evaluados 242 trabajadores de la salud con exposición a fluidos corporales, 65% accidentes fueron notificados los dos últimos años. Ciento sesenta y tres femeninos y 79 masculinos, edad promedio 43 años (rango de 21-65 años). Los trabajadores de la salud que notificaron exposición a fluidos corporales procedían principalmente de los servicios de medicina interna, emergencia y cirugía. El mayor número de los accidentes correspondió a los médicos, principalmente residentes de posgrado. Exposición de tipo parenteral fue observada en 197 casos (179 percutáneas, y 18 salpicaduras en mucosas). Exposición cutánea se observó en 14 y combinada (piel y mucosas) 23 casos. El instrumento utilizado en 179 exposiciones percutáneas fue aguja con lumen en 48%. El fluido corporal involucrado fue la sangre en el 73% de los casos. La fuente fue conocida en 65% de las exposiciones. La profilaxis antirretroviral posexposición fue indicada inicialmente en 52% de los TS. Los efectos adversos se presentaron en 40%, en 7 casos fue motivo de abandono de tratamiento. El seguimiento se realizó en el 80% de los casos. Un trabajador de salud presentó Virus de Inmunodeficiencia Humana ocupacional...

Prospective study designed to assess the health workers at the Hospital Universitario de Caracas to notify body fluid exposure to Human Immunodeficiency Virus Surveillance System and Viral Hepatitis, from the years 1991-1999. The variables studied were: date and place of the accident, staff category, age, gender, fluid involved, type of exposure, instrument used, and baseline serology for Human Immunodeficiency Virus and Viral Hepatitis of health workers and index patient, type of prophylaxis antiretroviral, side effects and Human Immunodeficiency Virus seroconversion. Descriptive method was used series of cases which were analyzed by Epi-info. Version 5. During the study period were evaluated health workers 242 with body fluid exposure, 65% accidents were reported the past two years. 163 female and 79 male, mean age 43 years (range 21-65 years). Health workers who reported exposure to body fluids were mainly of Internal Medicine, Emergency and Surgery. The greatest numbers of injuries were doctors, mainly postgraduate residents. Parenteral exposure rate was observed in 197 cases (179 percutaneous, splash to mucous membranes 18). Dermal exposure was observed in 14 and combined (skin and mucosa) 23 cases. The instrument used in 179 percutaneous exposures was needle lumen in 48%. The body fluid blood was involved in 73% of cases. The source was known in 65% of exposures. Antiretroviral prophylaxis post exposure was initially indicated in 52% of the TS. Adverse events occurred in 40 %, in 7 cases was cause for withdrawals. The monitoring was performed in 80%. A case of Human Immunodeficiency Virus occupational in which it ruled out other risk factors

Femenino , Sistema de Vigilancia de Factor de Riesgo Conductual , Compartimentos de Líquidos Corporales/virología , VIH , Profilaxis Posexposición/métodos , Infectología , Vigilancia de la Salud del Trabajador
Rev. salud pública Parag ; 4(2): [P9-P15], jul.-dic. 2014.
Artículo en Español | LILACS | ID: biblio-964666


En el contexto de una cobertura universal y el uso eficiente de los recursos disponibles en la salud pública que deben estar orientados hacia una mayor equidad en la prestación de servicios, mayor preocupación por la efectividad y utilidad de las tecnologías para la salud, existe una perspectiva favorable para que la telemedicina sea considerada en los países industrializados y en vías de desarrollo como una herramienta para mejorar la atención de la salud de poblaciones remotas que no tienen acceso a los especialistas. Este estudio observacional y descriptivo realizado por la Unidad de Telemedicina del Ministerio de Salud Pública y Bienestar Social (MSPBS) en colaboración con el Dpto. de Ingeniería Biomédica e Imágenes del Instituto de Investigaciones en Ciencias de la Salud de la Universidad Nacional de Asunción (IICSUNA) y la Universidad del País Vasco (UPV/EHU) sirvió como un proyecto piloto para evaluar las potencialidades de un sistema de telemedicina en la salud pública. Para el efecto fueron analizados los resultados preliminares de un proyecto piloto de telediagnóstico implementado en algunos hospitales regionales y distritales del MSPBS. En dicho sentido, en el marco del proyecto piloto fueron realizados 15968 diagnósticos remotos entre enero y noviembre de 2014 a través del sistema. Del total de telediagnósticos realizados, el 43,9 % (7008) correspondieron a estudios de tomografía, 56,0 % (8941) a electrocardiografía (ECG) y 0,1 % (19) a ecografía. Las dificultades observadas se relacionaron: al recurso humano (capacitación de asistente técnico, reticencia a aceptar totalmente el telediagnóstico como una nueva herramienta) y el tecnológico (identificación de las señales disponibles, baja velocidad de la red interna y los modelos de aplicación referidos a standalone o web). Los resultados obtenidos a través de este estudio piloto son de vital importancia para la formulación de metodologías prácticas y viables para la implantación de un sistema de telemedicina que ayudará a mejorar sustancialmente la capacidad resolutiva local de los centros asistenciales a las poblaciones remotas y dispersas e intercambiar con mayor efectividad informaciones clínicas, administrativas y de capacitación del personal. Este estudio piloto basado en las tecnologías disponibles, las experiencias previas propias y foráneas muestra las potencialidades de un sistema de telemedicina en la salud pública. Pero, antes de recomendar su utilización masiva se deberá realizar un estudio exhaustivo y pormenorizado de los sistemas de salud, los costos para su implementación y la sustentabilidad del sistema acorde a las metodologías vigentes. Palabras claves: Telemedicina, Telesalud, Teleeducación, Telecuidado, Telemática en salud.

In the context of universal coverage and the efficient use of available resources in public health which should be directed towards greater equity in the provision of services, greater concern for the effectiveness and usefulness of health technologies, there is a favorable opportunity to develop telemedicine in both developing and industrialized countries as a tool to improve health care in remote locations without access to specialists. This observational and descriptive study, performed by the Telemedicine Unit of the Ministry of Public Health and Social Welfare (MOHSW) in collaboration with the Dept. Of Biomedical Engineering & Imaging Research Institute in Health Sciences of the National University of Asunción (IICS-UNA) and the University of the Basque Country (UPV / EHU) served as a pilot project to evaluate the potential of a telemedicine system in public health. For these purposes, we analyzed preliminary results of a pilot project using telemedicine for diagnosis implemented in some remote regional and district hospitals MSPBS. During the pilot project time period, 15968 remote diagnostics were conducted between January and November 2014 using the system. Of all remote diagnostics modalities performed, 43.9% (7008) corresponded to tomography studies, 56.0% (8941) to electrocardiography (ECG) and 0.1% (19) to ultrasound studies. The observed difficulties were: human resources (training of technical assistants, reluctance to fully accept remote diagnostics as a new tool) and technological (difficult identification of signals available, low-speed internet network and computer applications that were "standalone" or web-based). The results obtained from this pilot study are vital for the development of practical and workable methodologies for the implementation of a telemedicine system that will help to substantially improve local response capacity of health facilities to remote and dispersed populations and to more effectively exchange clinical information, and train administrative and staff personnel. This pilot study, which was based on available technology and previous experiences in other countries, shows the potential of a telemedicine system in public health. But, before recommending its widespread use there will need to be a thorough and detailed study of health systems, costs for implementation and sustainability of the system using current methodologies. Keywords: Telemedicine, Telehealth, Tele-education, telecare, Telematics health

Humanos , Telemedicina/estadística & datos numéricos , Educación Médica , Paraguay
Res Vet Sci ; 95(2): 480-2, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23850132


The endotoxin that triggers an immune response to Gram-negative bacterial infection namely lipopolysaccharide (LPS), is also associated with gastrointestinal abnormalities and induces the release of proinflammatory cytokines such as IL-1 and TNF-α. The main aim of this study was to determine the effect of cytokine release on intestinal D-fructose absorption in LPS-treated rabbits in order to provide information that could be used to understand their septic status. The results obtained, using whole tissue and brush border membrane vesicles from rabbit jejunum, showed that LPS, TNF-α and IL-1ß inhibit d-fructose absorption across the jejunum. The effect of LPS is completely reversed by a TNF-α antagonist and partially by a specific IL-1 receptor antagonist (IL-1ra) and disappears completely in the presence of both these cytokine antagonists. Similarly, the effects of TNF-α and LPS were not totally blocked by IL-1ra, whereas the effect of IL-1ß disappeared completely in the presence of a TNF antagonist. In summary, these results show that TNF-α and IL-1ß could act synergistically on sugar absorption in rabbit with LPS-induced sepsis. In addition, the effects of IL-1ß depend on, or are related to TNF-α production since this effect returns to basal (control) levels in the presence of a TNF-α antagonist.

Metabolismo de los Hidratos de Carbono/efectos de los fármacos , Yeyuno/metabolismo , Lipopolisacáridos/toxicidad , Conejos , Animales , Relación Dosis-Respuesta a Droga , Fructosa/metabolismo , Interleucina-1beta/metabolismo , Interleucina-1beta/farmacología , Receptores de Interleucina-1/antagonistas & inhibidores , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Factor de Necrosis Tumoral alfa/farmacología
Rev. venez. oncol ; 25(2): 77-84, abr.-jun. 2013. ilus, tab, graf
Artículo en Español | LILACS | ID: lil-718948


Revisamos experiencia reciente y resultados obtenidos con resecciones hepáticas mayores en pacientes referidos a nuestra institución. Revisión retrospectiva de historias clínicas de pacientes entre agosto de 1998 y agosto de 2008, con el objetivo de precisar el tipo de cirugía efectuada, indicaciones principales, complicaciones y morbimortalidad operatoria. 22 pacientes cuyas historias estuvieron disponibles para revisión. La principal indicación de cirugía fueron neoplasias malignas 86,4% de los casos, las metástasis de carcinoma colorrectal (7) la primera indicación seguida de hepatocarcinoma (4). Otras indicaciones incluyeron: colangiocarcinomas perifericos (2), metástasis de tumores neuroendocrinos (2), diversas lesiones benignas (3) otros tumores (4). La hepatectomía derecha y segmentectomías anatómicas fueron los más frecuentes con un 27,3 % cada uno, seguidos de segmentectomía lateral izquierda (II y III) en 19%. El tiempo operatorio promedio fue 270,4 min (rango: 180-560 min). El promedio de estancia hospitalaria fue 7,7 días (rango:4-30). El 8% de nuestros pacientes no requirió estancia posoperatoria inmediata en UTI. La tasa de complicaciones fue 44,5% siendo el derrame pleural reactivo y el sangrado posoperatorio más frecuentes. La tasa de reintervención fue 18,2%. La mortalidad global fue 9% (2/22), y la inherente al procedimiento quirúrgico 4,5% (1/22). Las resecciones hepáticas mayores son un procedimiento relevante en el armamento del cirujano oncólogo dedicado al tratamiento de neoplasias digestivas, la morbimortalidad operatoria en nuestra institución es similar a otros centros de mayor volumen a nivel internacional.

Review the recent experience and results of major hepatic resections of patients treated at our institution. Retrospective review of clinical records patients submitted to major hepatic resection inten years, between August 1998 to August 2008, with descriptive statistics of type of surgery, indications, complications and surgical related morbimortality. Twenty two patients with complete clinical records for review were included. The main indication for surgery were malignant neoplasms in 86,4% of the cases,being colorectal liver metastasis (7) the first one followed by hepatocarcinomas (4). Other indications included:The periferic colanghiocarcinomas (2), metastasis from neuroendocrine tumors (2), varied beningn lesions (3)and other tumors (4). Right hepatectomy and anatomical segmentectomies were the most frequent procedures 27.3% each, followed by left lateral segmentectomy (II - III) in19% of the cases. Medium operative time was 270.4 min (range: 180-560 min). Mean hospital stay was 7.7 days (range: 4-30). 8% of the patients did not required post operative ICU care. Complications rate was 44.5% being reactive pleural effusion and postoperative bleedingthe most frecuent ones. Reintervention rate was 18.2%, global mortality 9% (2/22), and surgical related mortality was 4.5% (1/22). Major hepatic resections are a relevant procedure in the armament of surgical oncologists dedicated to treatment of digestive neoplasms, the number of such procedures done at public institutions are limited. Operative morbimortality in our institution is similar to other major volume centers.

Humanos , Masculino , Femenino , Persona de Mediana Edad , Hepatectomía/métodos , Hepatectomía/mortalidad , Hígado/anomalías , Hígado/cirugía , Neoplasias del Sistema Digestivo/cirugía , Neoplasias del Sistema Digestivo/complicaciones , Neoplasias del Sistema Digestivo/terapia , Gastroenterología , Oncología Médica
Allergy ; 67(2): 175-82, 2012 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-21981059


BACKGROUND: PEST-domain-enriched tyrosine phosphatase (PEP) is a protein tyrosine phosphatase exclusively expressed in hematopoietic cells. It is a potent negative regulator of T-cell receptor signalling that acts on receptor-coupled protein tyrosine kinases. PEST-domain-enriched tyrosine phosphatase is also expressed in mast cell and is positively regulated by glucocorticoids, but its function is unknown. In this communication, the function of PEP is analysed in mast cells. METHODS: Signal transduction cascades following IgE receptor cross-linking were compared in bone marrow-derived mast cells (BMMC) from PEP(-/-) and PEP(+/+) mice. Furthermore, antigen-induced passive systemic anaphylaxis (PSA) was analysed in PEP(+/+) and PEP(-/-) mice. RESULTS: Bone marrow-derived mast cells from PEP(-/-) mice showed impaired PLCγ1 phosphorylation and Ca(2+) mobilization. Additionally, mice deficient in PEP showed impaired mast cell degranulation and were less susceptible to PSA. Treatment of wild-type BMMC or mice with an Au(I)-phosphine complex that selectively inhibits PEP activity produced defects in Ca(2+) signalling pathway and reduced anaphylaxis similar to that caused by the deletion of the PEP gene. Glucocorticoid that negatively regulates a wide range of mast cell action increased PEP expression and only partially inhibited anaphylaxis. However, glucocorticoid potently inhibited anaphylaxis when combined with the PEP inhibitor. CONCLUSIONS: PEST-domain-enriched tyrosine phosphatase is an important positive regulator of anaphylaxis. Pharmacological inhibition of its activity together with glucocorticoid administration provide an effective rescue for PSA in mice.

Anafilaxia/inmunología , Anafilaxia/metabolismo , Glucocorticoides/metabolismo , Factores Inmunológicos/metabolismo , Proteína Tirosina Fosfatasa no Receptora Tipo 12/metabolismo , Anafilaxia/genética , Animales , Señalización del Calcio , Degranulación de la Célula/efectos de los fármacos , Degranulación de la Célula/inmunología , Regulación de la Expresión Génica/efectos de los fármacos , Regulación de la Expresión Génica/inmunología , Glucocorticoides/farmacología , Factores Inmunológicos/farmacología , Sistema de Señalización de MAP Quinasas , Mastocitos/efectos de los fármacos , Mastocitos/fisiología , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Fosfolipasa C gamma/metabolismo , Proteína Tirosina Fosfatasa no Receptora Tipo 12/genética
Int. j. morphol ; 29(1): 158-163, Mar. 2011. ilus
Artículo en Español | LILACS | ID: lil-591968


El foramen venoso es una estructura inconstante que se encuentra posterior al foramen redondo y medial al foramen oval, y da paso a una vena que anastomosa al plexo venoso pterigoideo con el seno cavernoso. La existencia de éste foramen puede ser motivo de complicaciones clínicas, entre ellas que es una potencial vía de acceso al seno cavernoso de trombos infectados y constituye una posible falsa vía durante la rizotomía percutánea del trigémino pudiendo puncionar la vena y ocasionar hematomas subdurales. Se utilizó la colección de cráneos del Departamento de Anatomía de la Facultad de Medicina UANL. Se observó la frecuencia y se midieron los siguientes parámetros del foramen: Ancho y largo; en la cara interna de la base del cráneo se midieron las distancias a: foramen redondo, foramen oval, plano sagital mediano y entre forámenes venosos; en la cara externa de la base del cráneo se midieron las distancias con: foramen oval, plano sagital medio y entre los forámenes venosos. Las medidas fueron llevadas a cabo por tres observadores distintos a través de medición directa con vernier y con microfotografías con escalas milimétricas. Se encontró una frecuencia del 20 por ciento con medidas medias de 1,66mm de largo, 1,06mm de ancho; en la cara interna de la base del cráneo: 11,31mm de distancia al foramen redondo, 4,13mm al foramen oval, 17,75mm al plano sagital medio y 31,91mm entre los forámenes; en la cara externa de la base: 2,50mm al foramen oval, 19,54mm al plano sagital medio y 36,05mm entre forámenes venoso. La distancia al foramen oval varía en la cara interna y la cara externa de la base del cráneo debido a un trayecto oblicuo del foramen que tiende a aproximarse al foramen oval y por tanto a separarse del plano sagital medio. Los forámenes derechos fueron generalmente más grandes.

Foramen venosum (foramen Vesalius) is an inconstant structure which is located posterior to the foramen rotundum and medial to the foramen ovale, and it gives pace to an emissary vein that communicates the plexus pterigoideus and the sinus cavernosus. The existence of this anatomical structure can be of interest in certain procedures like percutaneous trigeminal rhizotomy where this foramen can be the cause of a false pathway and be punctured causing a subdural hematoma. It also can be an access to the sinus cavernosus for infected thrombus coming from dental and facial infections. For this study the skull collection of the Anatomy Department, Faculty of Medicine UANL, was used. We observed the frequency and measured the following parameters: Length and width; in the basis cranii we measured: Distances to the foramen rotundum, foramen ovale, planum medianum and between two foramina venosum (one on each side). In basis cranii externa we measured: distances to foramen ovale, planum medianum, and between two foramina venosum. Three independent observers blinded among them, measured the parameters using a Vernier and microphotographs with milimetrical scales. A 20 percent frequency was found and the following median measures: Length 1.66mm, width 1.06mm; basis cranii: distance to foramen rotundum 11.31mm, distance to foramen ovale 4.13mm, distance to planum medianum 17.75mm and 31.91mm between both foramina venosum. Basis cranii externa: distance to foramen ovale 2.49mm, distance to planum medianum 19.54mm and distance between foramenina venosum 36.05. The distance to the foramen ovale varies between basis cranii and basis cranii externa because the foramen has an oblique trajectory and it approximates to the foramen ovale (from superior to inferior) and separates from the planum medianum. It was found bilaterally only in one skull. There are differences between the left and right foramens, the latter being generally larger.

Humanos , Masculino , Femenino , Cráneo/anatomía & histología , Cráneo/irrigación sanguínea , Foramen Oval/anatomía & histología , Foramen Oval/patología , Fosa Craneal Media/anatomía & histología , Fosa Craneal Media/crecimiento & desarrollo , Fosa Craneal Media/patología , Hueso Esfenoides/anatomía & histología , Hueso Esfenoides/patología , México/etnología
Farm Hosp ; 35 Suppl 2: 10-7, 2011 May.
Artículo en Español | MEDLINE | ID: mdl-22445504


The aim of this study was to perform a structural sensitivity analysis of a decision model and to identify its advantages and limitations. A previously published model of dinoprostone was modified, taking two scenarios into account: eliminating postpartum hemorrhages and including both hemorrhages and uterine hyperstimulation among the adverse effects. The result of the structural sensitivity analysis shows the robustness of the underlying model and confirmed the initial results: the intrauterine device is more cost-effective than intracervical dinoprostone gel. Structural sensitivity analyses should be congruent with the situation studied and clinically validated. Although uncertainty may be only slightly reduced, these analyses provide information and add greater validity and reliability to the model.

Técnicas de Apoyo para la Decisión , Economía Farmacéutica/estadística & datos numéricos , Incertidumbre , Cuello del Útero/efectos de los fármacos , Cesárea/economía , Análisis Costo-Beneficio , Dinoprostona/administración & dosificación , Dinoprostona/efectos adversos , Dinoprostona/economía , Dinoprostona/farmacología , Femenino , Enfermedades Gastrointestinales/inducido químicamente , Enfermedades Gastrointestinales/economía , Geles , Humanos , Dispositivos Intrauterinos Medicados/economía , Trabajo de Parto Inducido/economía , Trabajo de Parto Inducido/métodos , Modelos Económicos , Oxitócicos/administración & dosificación , Oxitócicos/efectos adversos , Oxitócicos/economía , Oxitócicos/farmacología , Hemorragia Posparto/tratamiento farmacológico , Hemorragia Posparto/economía , Hemorragia Posparto/prevención & control , Embarazo , Reproducibilidad de los Resultados , Contracción Uterina/efectos de los fármacos