Incidence of major cardiovascular events at 1, 2, and 5 years and mortality in incident patients on peritoneal dialysis regarding their nutritional status by bioimpedanciometry: A multicenter study in Colombia.

BACKGROUND: The nutritional status of incident patients on peritoneal dialysis (PD) has been associated with survival outcomes. Bioimpedanciometry (BCM) enables to establish a nutritional diagnosis, the volume status, and correlates these findings with survival. METHODS: This study used a retrospective multicenter historical cohort. RESULTS: In this study, which included 420 incident patients on peritoneal dialysis with a 5-year follow-up, a cumulative incidence of major adverse cardiovascular events (MACE) of 28.8% was found, being higher in the diabetic population at 36.8%. In regard to the nutritional status in this population, it was found that approximately 44% had altered nutritional status; 34% were found to be in sarcopenia; 6.7% sarcopenic obesity; and 2.8% in obesity (p < 0.001). In the survival analysis, a lower probability of survival was found in patients with overhydration (OH) greater than 3 L (p < 0.001) and in patients with altered nutritional status due to sarcopenia, sarcopenic obesity, and obesity (p 0.016). According to survival in the subgroup of the diabetic population, a lower probability of survival was found in this group of patients (p: 0.011). The overall mortality of the study population was 18%, being higher in the first 2 years, with the most important causes of mortality being cardiovascular. Of the deceased population, 51% were diabetic patients (p: 0.012). CONCLUSION: In incident patients on peritoneal dialysis, sarcopenic obesity, sarcopenia, overhydration status determined by BCM, and having a diagnosis of diabetes are related to a lower probability of survival; MACE outcomes are more frequent in the diabetic population.

Video Validation of Tri-Axial Accelerometer for Monitoring Zoo-Housed Tamandua tetradactyla Activity Patterns in Response to Changes in Husbandry Conditions.

Accelerometers are a technology that is increasingly used in the evaluation of animal behaviour. A tri-axial accelerometer attached to a vest was used on Tamandua tetradactyla individuals (n = 10) at Biodiversity Park. First, the influence of using a vest on the animals' behaviour was evaluated (ABA-type: A1 and A2, without a vest; B, with a vest; each stage lasted 24 h), and no changes were detected. Second, their behaviour was monitored using videos and the accelerometer simultaneously (experimental room, 20 min). The observed behaviours were correlated with the accelerometer data, and summary measures (X, Y and Z axes) were obtained. Additionally, the overall dynamic body acceleration was calculated, determining a threshold to discriminate activity/inactivity events (variance = 0.0055). Then, based on a 24 h complementary test (video sampling every 5 min), the sensitivity (85.91%) and precision (100%) of the accelerometer were assessed. Animals were exposed to an ABA-type experimental design: A1 and A2: complex enclosure; B: decreased complexity (each stage lasted 24 h). An increase in total activity (%) was revealed using the accelerometer (26.15 ± 1.50, 29.29 ± 2.25, and 35.36 ± 3.15, respectively). Similar activity levels were detected using video analysis. The results demonstrate that the use of the accelerometer is reliable to determine the activity. Considering that the zoo-housed lesser anteaters exhibit a cathemeral activity pattern, this study contributes to easily monitoring their activities and responses to different management procedures supporting welfare programs, as well as ex situ conservation.

Epidemiología del trauma en Bucaramanga, Colombia: análisis del registro institucional de trauma enel Hospital Universitario de Santander / Epidemiology of trauma in Bucaramanga, Colombia: Analysis of the institutional trauma registry at the Hospital Universitario of Santander

Introducción. El trauma es una de las principales causas de mortalidad a nivel mundial y representa un problema de salud pública. En Latinoamérica y particularmente en Colombia, son escasos los registros de trauma que se han desarrollado satisfactoriamente. El objetivo del presente estudio fue describir la epidemiología del trauma en el Hospital Universitario de Santander, en el primer año de implementación del registro de trauma institucional.Métodos. Personal del Departamento de Cirugía General de la Universidad Industrial de Santander y el Hospital Universitario de Santander, iniciaron el diseño del registro de trauma en el año 2020. Se incluyeron todos los pacientes que ingresaron al hospital, incluso los que fallecieron en el servicio de urgencias. La implementación del registro se inició el 1 de agosto de 2020, previa realización de una prueba piloto. Los informes se recogieron automáticamente y se exportaron a una base de datos electrónica no identificada. Resultados. Se evaluaron 3114 pacientes, el 78,1 % de ellos hombres, con una mediana de edad de 31 años. La mediana de tiempo prehospitalario fue de tres horas y lo más frecuente fue el ingreso por propios medios (51,2 %). El mecanismo de trauma más frecuente fue el penetrante (41,8 %), siendo la mayoría de heridas por arma cortopunzante (24,9 %). El trauma cerrado se presentó en el 41,7 % de los pacientes evaluados y el 14,4 % de la población se encontraba bajo el efecto de sustancias psicoactivas. El servicio de Cirugía general fue el más interconsultado (26,9 %), seguido del servicio de cirugía plástica (21,8 %). La mediana de estancia hospitalaria fue de dos días (Q1:0; Q3:4) y 75 pacientes (2,4 %) fallecieron durante su hospitalización. Conclusión. El registro de trauma de nuestra institución se presenta como una plataforma propicia para el análisis de la atención prehospitalaria e institucional del trauma, y el desarrollo de planes de mejora en este contexto. Este registro constituye una herramienta sólida para la ejecución de nuevos de proyectos de investigación en esta área.

Introduction. Trauma is one of the main causes of mortality worldwide and represents a public health problem. In Latin America, and particularly in Colombia, few trauma registries have been successfully developed. The objective of this study is to describe the epidemiology of trauma at the Hospital Universitario of Santander in the first year of implementation of the institutional trauma registry.Methods. The Department of General Surgery of the Universidad Industrial of Santander, together with the Hospital Universitario of Santander, began the design of the trauma registry in 2020. All patients admitted to the hospital or who died in the emergency department were included. The implementation of the registry began on August 1, 2020, after carrying out a pilot test. Reports were automatically collected and exported to an unidentified electronic database.Results. 3114 patients were evaluated (M: 31 years; men: 78.1%). The median pre-hospital time was three hours and the most frequent means of transport was self-admission (51.16%). The most frequent mechanism of trauma was penetrating trauma (41.81%), with the majority being injuries caused by a sharp weapon (24.92%). Blunt trauma occurred in 41.71% of the patients evaluated and 14.4% of the population was under the influence of psychoactive substances. The general surgery service was the most consulted (26.97%), followed by the plastic surgery service (21.8%). The median hospital stay was two days (Q1:0; Q3:4) and 75 patients (2.41%) died during their hospital stay.Conclusion. The trauma registry of our institution is presented as a favorable platform for the analysis of prehospital and institutional trauma care, and the development of improvement plans in this context. This registry constitutes a solid tool for the execution of new research projects in this area.

The Development of Palliative Care in Colombia: An Analysis of Geographical Inequalities Through the Application of International Indicators.

CONTEXT: The national evaluation of an individual country is a tool used to improve the universal provision of palliative care. The evaluation of a country's internal situation, by means of an analysis of the development of palliative care by region, may also be an instrument for improvement. OBJECTIVES: The aim of this study was to understand the regional development of palliative care in Colombia, through the application of international indicators. METHODS: Regional development was analyzed for Colombia, with a country-specific adaptation of the evaluation method used in the latest edition of the Palliative Care World Map (Clark D, 2020), the need for palliative care per death with serious health-related suffering (Knaul FN, 2019), and the coverage of specialized services, following European standards (Centeno, 2016). A total of 33 of the country's regions were classified. RESULTS: Some 41% of the people who die in Colombia need palliative care. The average figure for specialized services is 0.5/100,000 inhabitants, with a maximum coverage of 51%. In Colombia, there are 12 regions with a generalized level of provision; six regions with isolated provision, nine regions developing their capacity, four with no known activity, and two at an advanced level of palliative care integration. The regions with the highest level of palliative care development coincide with higher demand and coverage of specialized services. CONCLUSION: Regional palliative care development is unequal and unbalanced. Applying international indicators to levels of regional development allows for the identification of geographical inequalities and highlights low palliative care development, especially in the rural areas of the country.

Multicenter Study of the Psychometric Properties of the New Demoralization Scale (DS-II) in Spanish-Speaking Advanced Cancer Patients.

CONTEXT: Demoralization is a state of existential distress in patients with advanced illness, typically with coping difficulties, feelings of loss of sense, and purpose in life and despair, among other things. The New Demoralization Scale (DS-II) is an evaluation tool for this syndrome, which has recently been reformulated on a shorter scale. OBJECTIVES: The objective of this study was to obtain a Spanish version of the DS-II and to assess its psychometric properties in advanced cancer patients in Spain and a number of Latin American countries. METHODS: Following a translation-back translation process, a validation study and a confirmatory analysis using structural equation models with their corresponding latent constructs were undertaken. Patients completed the DS-II in Spanish (DS-II (es)), the Hospital Anxiety and Depression Scale, and the Edmonton Symptom Assessment System-revised. Reliability was studied according to internal consistency; construct validity and concurrent validity with the Hospital Anxiety and Depression Scale and the Edmonton Symptom Assessment System-revised; discriminant validity using the Karnofsky Performance Status scale; and feasibility, with response ratio and required time. Cutoff points were established, and sensitivity and specificity were studied. RESULTS: The DS-II (es) was obtained. One hundred fifty patients completed the validation study. The confirmatory analysis showed coherence, and all items correlated positively with their subscales and with the overall scale. Cronbach's alpha for the DS-II (es) was 0.88, for the sense and purpose subscale 0.83, and for the coping ability 0.79. Demoralization correlated significantly with emotional distress (rho = 0.73, P < 0.001). The tool distinguished between patients with diverse functional levels (rho = -0.319, P = 0.001). Cutoff points at 10 and 20 out of 32 were established. The scale showed high sensitivity (81.97%) and specificity (80.90%). The prevalence of demoralization was 33% in our sample. CONCLUSION: The Spanish version of the new Kissane DS-II demoralization scale has shown to be valid, reliable, and feasible with adequate psychometric properties.

EXPERIENCES IN CLINICAL ETHICS: A PROJECT FOR MEETINGS ON CLINICAL ETHICS IN PALLIATIVE MEDICINE / EXPERIENCIAS EN ÉTICA CLÍNICA: EL PROYECTO DE "ENCUENTROS SOBRE ÉTICA CLÍNICA EN LA MEDICINA PALIATIVA" / EXPERIENCIAS NA ÉTICA CLÍNICA: O PROJETO DE "ENCONTROS SOBRE ÉTICA CLÍNICA NA MEDICINA PALIATIVA"

"Meetings on Clinical Ethics in Palliative Medicine," as outlined in this article, is a project on ethical and clinical training in the area of palliative care. The project is part of a clinical program and broader research pertaining to recovery of the anthropological and ethical roots in the clinical practice of palliative care. It is aimed at professionals and researchers in palliative care and consists of informal meetings where the human and professional values involved in actual clinical cases are analyzed. Anthropology, general ethics, medical epistemology and philosophy of medicine are considered essential in this program of ethical and clinical training, as are the valuable insights provided by the humanities. The specific objective is not only to provide a list of ethical principles, but also to promote an ethical disposition on the part of the person who acts.

"Encuentros sobre ética clínica en la medicina paliativa" es un proyecto de formación ética y clínica en el ámbito de los cuidados paliativos. Hace parte de un programa clínico y de investigación más amplio que pertenece a la línea de recuperación de las raíces antropológicas y éticas en la práctica clínica de los cuidados paliativos. Está dirigido a profesionales e investigadores en cuidados paliativos, y contempla el desarrollo de reuniones informales, donde se analizan los valores humanos y profesionales involucrados en casos clínicos reales. En este programa de formación ética y clínica, se consideran esenciales la antropología, la ética general, la epistemología médica y la filosofía de la medicina, además es valiosa la información proporcionada por las humanidades. El objetivo específico no es solo proporcionar una lista de principios éticos, sino también promover una disposición ética de parte de la persona que actúa.

"Encontros sobre ética clínica na medicina paliativa", apresentado neste artigo, é um projeto de formação ética e clínica no âmbito dos cuidados paliativos. O projeto faz parte de um programa clínico e de pesquisa mais amplo que pertence à linha de recuperação das raízes antropológicas e éticas na prática clínica dos cuidados paliativos. Está dirigido a profissionais e pesquisadores em cuidados paliativos e leva em consideração o desenvolvimento de reuniões informais, em que se analisam os valores humanos e profissionais envolvidos em casos clínicos reais. Nesse programa de formação ética e clínica, consideram-se essenciais a antropologia, a ética geral, a epistemología médica e a filosofia da medicina, além da valiosa informação proporcionada pelas humanas. O objetivo específico não é só oferecer uma lista de princípios éticos, mas também promover uma disposição ética de parte da pessoa que atua.

Tratamiento de las fracturas en mandíbulas atróficas: nuestra experiencia con la reducción abierta y fijación interna según el principio de carga soportada / Treatment of atrophic mandible fractures: our experience with open reduction and internal fixation according to the load-bearing principle

Objetivo: presentar los resultados terapéuticos obtenidos por medio de la reducción abierta y fijación interna, aplicando el principio de carga soportada, en el tratamiento de fracturas de mandíbulas atróficas. Casos clínicos: se llevaron a cabo tratamientos en 21 pacientes, con un total de 30 fracturas de mandíbula atrófica, sobre 410 pacientes ingresados por fracturas mandibulares, en un hospital municipal de tercer nivel y en la práctica privada, durante el período 1991-2014. Conclusión: la reducción abierta y fijación interna según el principio de carga soportada, es una terapéutica predecible y segura para el tratamiento de las fracturas en mandíbulas atróficas. La mayoría de las publicaciones recientes comparten resultados similares y lo consideran el procedimiento terapéutico de elección...

The contribution of undergraduate palliative care education: does it influence the clinical patient's care?

PURPOSE OF REVIEW: The aim of this 2-year systematic review is to understand how learner assessment and curriculum evaluation of education in palliative care is being undertaken and to examine whether current undergraduate education influences the clinical patient's care. RECENT FINDINGS: Almost half of the 30 studies reviewed used a qualitative approach to evaluate learning experiences. Only three of them were controlled studies and a further one was a cohort study.When students openly express themselves, they agree that there is 'something' deep as regards the core or the essence of medical practice or nursing. They feel that they become better professionals and better prepared for the patients, not only in terms of end of life care, but also as regards care, irrespective of the phase of the disease.The inclusion of palliative care in undergraduate education is a way of providing knowledge, skill, and competences about palliative care (especially communication) and also improving attitudes toward caring in advanced disease and at the end of life. Different methods of experiential learning, even brief experiences, which bring students into close contact with palliative care clinical cases or patients, are providing better results. SUMMARY: From research studies, there is only indirect evidence that palliative care training at university leads to better clinical care of patients. In the future, long-term cohort or controlled studies might answer that question.

Dextrocardia en situs solitus con ventriculo unico ­ una cardiopatia congenita inusual de mal pronóstico: Reporte de un caso / Dextrocardia in situs solitus with a single ventricle - an unusual congenital heart disease with a poor prognosis: A case report

Introducción: La dextrocardia es el desplazamiento del eje mayor del corazón a la derecha, esta es asociada con alteraciones congénitas intracardiacas como la presencia de un ventrículo único. Reporte: Paciente de sexo femenino de un año y siete meses, presenta un cuadro de aproximadamente 3 días con hallazgos clínicos de dificultad respiratoria al esfuerzo y cansancio al lactar, fiebre, con episodios de apnea y cianosis generalizada posterior al llanto. Interpretación: El ecocardiograma nos da el diagnostico de ventrículo único que destaca por las complicaciones que ocasionan con los años.(AU)

Tumor maligno rabdoide primitivo de maxilar inferior / Primitive malignant rhabdoid tumor of the mandible

El término tumor rabdoide fue utilizado en un comienzo para neoplasias renales con inclusiones citoplasmáticashialinas, que corresponden ultraestructuralmente a filamentos intermedios. Inicialmente descrito en 1978 como una variante rabdosarcomatoide del tumor de Wilms, separándose tres años después por presentar diferencias clinicopatológicas.Después de la descripción clinicohistológica del tumor rabdoide a nivel renal se han descrito tumoresmorfológicamente idénticos en tejidos blandos y órganos. La cavidad oral no es la excepción y han aparecido informes de carcinoma escamocelular con fenotipos rabdoides orales documentados en el año 1996.Se informa este caso debido a su rareza y su origen primario en el maxilar inferior.

Custom HL7 V3 message provider using web services security features.

Due the availability of new data transmission technologies and new standards for medical studies development, e-health systems have had a sustained adoption in recent years. In this scenario, the health systems are incorporating and increasing the health services offering in response to their needs. This paper presents a system able to transmit medical studies using different communication channels providing an effective use of the medical equipment, the data transmission networks and the human resources availability. This system is based on service oriented architecture (SOA) to propose different alternatives in terms of which data needs to be transmitted for the acquired medical study, in order to attend different medical diagnosis providing an efficient use of the available communication channels. About the security implemented for the data transmission, there are different configurations available for encryption and signing at message level, to ensure that messages cannot be changed without detection during the transmission. For message definition, the HL7 V3 standard is implemented and the medical studies are stored in a centralized database located in a web server accessible via Internet to enable second medical opinion from other specialists.

Teaching dying patient care in three universities in Argentina, Spain, and Italy.

We performed a multicenter comparative survey on undergraduate medical education regarding the care of dying patients at medical schools in three countries. We enrolled 380 first- and sixth-year medical students from Universidad Austral (Argentina), Universidad de Navarra (Spain), and Università Campus Biomedico di Roma (Italy). Answers to the questions were similar among the three universities. Students acknowledged interacting directly with dying patients in all cases. Attitudes toward dying patients were highly positive. Students spontaneously requested more training in end-of-life care. Some attitudes and wishes varied significantly from course to course. Students perceived that this issue received more attention in humanistic rather than in clinical subjects. Ninety-eight percent of students considered that death and helping patients to have a good death should be included in their training. Students' attitudes revealed high interest and poor training in end-of-life issues. Medical curricula should be improved to adequately address these issues.

Sindrome de Gorlin Goltz, síndrome de carcinoma basoceluar nevoide: su impacto en el área maxilofacial y cutánea / Gorlin Goltz syndrome, basal cell carcinoma syndrome: its impact on maxillofacial and cutaneous areas

El propósito de este artículo es reportar la presencia del síndrome de carcinoma basocelular nevoide (SCCBN) en todos los integrantes de una familia. Anteriormente a dicha enfermedad se la denominaba síndrome de Gorlin Goltz. El objetivo de este trabajo es alertar a los profesionales sobre el polimorfismo de la misma, la presencia de algunos elementos destacables en su orientación diagnóstica y analizar en detalle las alteraciones en el área maxilofacial, junto a una revisión bibliográfica.

Sindrome de Gorlin Goltz, síndrome de carcinoma basoceluar nevoide: su impacto en el área maxilofacial y cutánea / Gorlin Goltz syndrome, basal cell carcinoma syndrome: its impact on maxillofacial and cutaneous areas

El propósito de este artículo es reportar la presencia del síndrome de carcinoma basocelular nevoide (SCCBN) en todos los integrantes de una familia. Anteriormente a dicha enfermedad se la denominaba síndrome de Gorlin Goltz. El objetivo de este trabajo es alertar a los profesionales sobre el polimorfismo de la misma, la presencia de algunos elementos destacables en su orientación diagnóstica y analizar en detalle las alteraciones en el área maxilofacial, junto a una revisión bibliográfica.(AU)

Reconstrucción con colgajos microquirúrgicos en cirugía de cabeza y cuello: experiencia inicial multicéntrica / Microvascular free flaps to repair head and neck lesions: initial experience

Objetivo y población: Entre septiembre de 1991 y julio de 1996 se practicaron 37 colgajos libres en 35 pacientes para reparar defectos en el área de Cabeza y Cuello. La mayor parte de las lesiones que dieron lugar a la cirugía eran carcinomas espinocelulares es estadío avanzado o recidivados, siendo la piel el sitio de origen más común. Método: En 86 por ciento de los casos se practicó resección y reconstrucción inmediata. El colgajo más frecuentemente usado fue el radial, en 17 oportunidades. Resultados: Se observaron complicaciones del colgajo en un 30 por ciento de los mismos y de la zona dadora en un 19 por ciento. La necrosis irreversible del colgajo ocurrió en 5 casos (13,5 por ciento). La mortalidad perioperatoria fue de 5,4 por ciento. No se demostró influencia directa de la edad avanzada o la radioterapia en relación a complicaciones microquirúrgicas. Conclusiones: En la población estudiada, y a pesar de los resultados mejorables, la reconstrucción microquirúrgica resultó un método confiable para defectos complejos en Cabeza y Cuello

Reconstrucción con colgajos microquirúrgicos en cirugía de cabeza y cuello: experiencia inicial multicéntrica / Microvascular free flaps to repair head and neck lesions: initial experience

Objetivo y población: Entre septiembre de 1991 y julio de 1996 se practicaron 37 colgajos libres en 35 pacientes para reparar defectos en el área de Cabeza y Cuello. La mayor parte de las lesiones que dieron lugar a la cirugía eran carcinomas espinocelulares es estadío avanzado o recidivados, siendo la piel el sitio de origen más común. Método: En 86 por ciento de los casos se practicó resección y reconstrucción inmediata. El colgajo más frecuentemente usado fue el radial, en 17 oportunidades. Resultados: Se observaron complicaciones del colgajo en un 30 por ciento de los mismos y de la zona dadora en un 19 por ciento. La necrosis irreversible del colgajo ocurrió en 5 casos (13,5 por ciento). La mortalidad perioperatoria fue de 5,4 por ciento. No se demostró influencia directa de la edad avanzada o la radioterapia en relación a complicaciones microquirúrgicas. Conclusiones: En la población estudiada, y a pesar de los resultados mejorables, la reconstrucción microquirúrgica resultó un método confiable para defectos complejos en Cabeza y Cuello (AU)