Incidence, functional impact and predictive factors for the presentation of complications associated with radial access for coronary angiography evaluated through ultrasonography, hospital cohort / Incidencia, impacto funcional y factores predictores para la presentación de complicaciones asociadas al acceso radial para coronariografía evaluadas por medio de ultrasonografía, cohorte hospitalaria.

Introduction: Radial arterial access is one of the main ways to perform left heart catheterization and coronary angiography in different clinical settings, due to its lower rate of local complications and similar clinical results to when using the femoral access. Objective: To determine the incidence of complications of radial access in interventional cardiology procedures of a hemodynamic service, as well as the impact on functionality and predictive factors for presentation. Methodology: Prospective observational cohort-type study in patients undergoing radial access coronary angiography in a university hospital with collection of demographic, clinical and ultrasound data prior to the procedure and 24 hours after it; The statistical model of logistic regression was applied to evaluate the association between the variables and the complications. Results: 100 patients were obtained, 62% men, with a mean age of 64 years, 69% had arterial hypertension, 38% diabetes mellitus, 35% dyslipidemia, 2% peripheral arterial disease, and 10% chronic kidney disease. The reason for coronary angiography was non-ST-segment elevation acute coronary syndrome (NSTE-ACS) 65%, ST-segment elevation myocardial infarction (STEMI) 28%, pre-surgical 6%, and chronic coronary syndrome 1%. A 6 Fr introducer was used in all of them. 13% complications were documented, the most common being arterial occlusion and hematoma. Only one had implications for the functionality of the hand after a complication. After multivariate regression, height (<1.65 m) and dynamometry (<25 pounds) were found as predictive factors by area under the curve analysis using the Youden index. Conclusion: The present cohort had an incidence of complications detected by ultrasound of 13%, although none of these had direct clinical implications and only one reported alteration in functionality. Height less than 1.65 m and dynamometry less than 25 pounds were found as predictive factors.

Introducción: El acceso arterial radial es una de las principales vías para la realización de cateterismo cardiaco izquierdo y coronariografía en diferentes contextos clínicos, por su menor tasa de complicaciones locales y similares resultados clínicos a cuando se usa el acceso femoral. Objetivo: Determinar la incidencia de complicaciones del acceso radial en procedimientos de cardiología intervencionista de un servicio de hemodinamia, así como el impacto en la funcionalidad y los factores predictores para la presentación. Metodología: Estudio tipo cohorte observacional prospectivo en pacientes llevados a coronariografía por acceso radial en un hospital universitario con recolección de datos demográficos, clínicos y ecográficos previo al procedimiento y a las 24 horas de este; se aplicó el modelo estadístico de regresión logística para evaluar la asociación entre las variables y las complicaciones. Resultados: Se obtuvieron 100 pacientes, el 62% hombres, con media de edad 64 años, el 69% tenían hipertensión arterial, el 38% diabetes mellitus, el 35% dislipidemia, el 2% enfermedad arterial periférica y el 10% enfermedad renal crónica. El motivo de la coronariografía fue síndrome coronario agudo sin elevación del ST 65%, infarto agudo al miocardio con elevación del ST 28%, prequirúrgica 6%, y síndrome coronario crónico 1%. En todos se usó introductor 6 Fr. Se documentaron un 13% de complicaciones, las más comunes oclusión de arterial y hematoma. Solo uno tuvo implicaciones en la funcionalidad de la mano tras una complicación. Después de la regresión multivariante, se encontraron talla (< 1.65 m) y dinamometría (< 25 libras) como factores predictores mediante el análisis de área bajo la curva utilizando el índice de Youden. Conclusión: La presente cohorte tuvo una incidencia de complicaciones detectadas por ultrasonido del 13%, si bien ninguna de estas tuvo implicaciones clínicas directas y solo uno reportó alteraciones en la funcionalidad. Se encontró como factores predictores la talla menor a 1.65 m y la dinamometría menor a 25 libras.

Cirurgia pilonidal: como adequar o tratamento à enfermidade / Pilonidal surgery: how to adapt the treatment with diseases

A doença pilonidal tem o seu início quando as forças de sucçäo existentes sob a fissura dos glúteos puxa a derme da pele branda da linha média, provocando o aumento dos folículos de pêlo. Eventualmente, as forças sugam o conteúdo dos folículos aumentados para dentro da gordura subctânea. O que acontece é uma reaçäo ao corpo estranho, provocando uma inflamaçäo. O tratamento recomendado é a remoçäo do folículo rompido suturando-se as resultantes pequenas feridas de linha média. Uma incisäo feita em um dos lados proporciona a drenagem do abscesso durante a cicatrizaçäo. Esse método ataca o ponto de origem da doença e evita as feridas de linha média näo cicatrizadas. Além disso, oferece uma cicatrizaçäo garantida num período médio de três semanas, com um período médio de incapacitaçäo de um dia

Private sector logistics in population control: a case in Jamaica

The physical distribuion of contraceptives is a problem for birth control programs, yet private sector logistics have often been overlooked in planning. This paper studies the distribution of contraceptives in Jamaica in terms of sales, direct contact through manufacturers and importers, wholesalers' activities, and brand stocking-practices. The authors arrive at five essential prescriptions for the use of the private sector. First, the merchandiser views condoms just as he views less sensitive products in his line, and he responds to merchandising in the same way. Second, aggressive stimulation on the level of the supplier will probably bring about increased activity among retailers. Third, traditional drug medical distributors view distribution narrowly, and they would be encouraged to operate on a broader basis, or they should be supplimented with distributors who are more familiar with broadly mass-marketed products. Fourth, an information program may cause a lasting changein private sector behaviour. Fifth, population programs should include specialists in private-sector distribution.