Design, Construction, and Validation of an Experimental Electric Vehicle with Trajectory Tracking.

This research presents an experimental electric vehicle developed at the Tecnológico Nacional de México Celaya campus. It was decided to use a golf cart-type gasoline vehicle as a starting point. Initially, the body was removed, and the vehicle was electrified, meaning its engine was replaced with an electric one. Subsequently, sensors used to measure the vehicle states were placed, calibrated, and instrumented. Additionally, a mathematical model was developed along with a strategy for the parametric identification of this model. A communication scheme was implemented consisting of four slave devices responsible for controlling the accelerator, brake, steering wheel, and measuring the sensors related to odometry. The master device is responsible for communicating with the slaves, displaying information on a screen, creating a log, and implementing trajectory tracking techniques based on classical, geometric, and predictive control. Finally, the performance of the control algorithms implemented on the experimental prototype was compared in terms of tracking error and control input across three different types of trajectories: lane change, right-angle curve, and U-turn.

Location variance of the great vessels while undergoing side-bend positioning changes during lateral interbody fusion.

Background: Minimally invasive lateral lumbar interbody fusion (LLIF) is an increasingly popular surgical technique that facilitates minimally invasive exposure, attenuated blood loss, and potentially improved arthrodesis rates. However, there is a paucity of evidence elucidating the risk of vascular injury associated with LLIF, and no previous studies have evaluated the distance from the lumbar intervertebral space (IVS) to the abdominal vascular structures in a side-bend lateral decubitus position. Therefore, the purpose of this study is to evaluate the average distance, and changes in distance, from the lumbar IVS to the major vessels from supine to side-bend right and left lateral decubitus (RLD and LLD) positions simulating operating room positioning utilizing magnetic resonance imaging (MRI). Methods: We independently evaluated lumbar MRI scans of 10 adult patients in the supine, RLD, and LLD positions, calculating the distance from each lumbar IVS to adjacent major vascular structures. Results: At the cephalad lumbar levels (L1-L3), the aorta lies in closer proximity to the IVS in the RLD position, in contrast to the inferior vena cava (IVC), which is further from the IVS in the RLD. At the L3-S1 vertebral levels, the right and left common iliac arteries (CIA) are both further from the IVS in the LLD position, with the notable exception of the right CIA, which lies further from the IVS in the RLD at the L5-S1 level. At both the L4-5 and L5-S1 levels, the right common iliac vein (CIV) is further from the IVS in the RLD. In contrast, the left CIV is further from the IVS at the L4-5 and L5-S1 levels. Conclusion: Our results suggest that RLD positioning may be safer for LLIF as it affords greater distance away from critical venous structures, however, surgical positioning should be assessed at the discretion of the spine surgeon on a patient-specific basis.

Porous Polyetheretherketone Interbody Cages for Anterior Cervical Discectomy and Fusion at 3 or More Levels: Clinical and Radiographic Outcomes.

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) at 3 or more levels remains challenging, with reported high pseudarthrosis rates and implant-related complications. Porous surface polyetheretherketone (PEEK) interbody cages are newer implants for ACDF with limited data available for their use in ACDF procedures at 3 or more levels. The objective of this study was to assess the clinical and radiographic outcomes of porous PEEK devices for ACDF at 3 or more levels. STUDY DESIGN: Retrospective case series. METHODS: Consecutive patients who underwent primary ACDF for degenerative cervical disc disease at 3 or more levels with porous PEEK cages with anterior plate instrumentation were included. Clinical outcome scores, radiographic parameters, pseudarthrosis rates, and cage subsidence rates were assessed. Preoperative and postoperative clinical outcomes and radiographic measures were compared using paired t tests. RESULTS: A total of 33 patients with ACDF at 3 or more levels with porous PEEK cages were included, with minimum 1-year follow-up. Two patients had cage subsidence (6.1%), and 1 patient had pseudarthrosis (3.0%). There were significant postoperative increases in overall cervical lordosis, sagittal vertical axis, fusion segment lordosis, T1 slope, and disc height. Clinical outcomes showed significant improvement from the preoperative visit to the final postoperative follow-up. CONCLUSIONS: High rates of fusion (97.0%) were observed in this challenging patient cohort, which compares favorably with previously published rates of fusion in ACDF at 3 or more levels. CLINICAL RELEVANCE: The optimal management of cervical spinal pathology regarding approach, technique, and implants used is an active area of ongoing investigation. The high levels of radiographic and clinical success utilizing a relatively novel implant material in a high-risk surgical cohort reported here may influence surgical decision making.

[Clinical reasoning: practical aspects that allow the facilitation of its development]. / Razonamiento clínico: aspectos prácticos que permiten la facilitación de su desarrollo.

Clinical reasoning is a competence that the doctor develops and that is essential for his medical practice. Clinical reasoning includes aspects related to observation, critical thinking and communication skills with the patient, since it integrates the previous knowledge that the doctor has about a disease or medical problem with obtaining information from the clinical aspects that the patient provides. and with the mental process of processing the clinical information provided by the patient to the health professional during the interrogation or anamnesis, together with the interpretation of the findings in the physical examination and, where appropriate, of the complementary tests, allowing the elaboration of a set of diagnoses likely for efficient clinical decision making. The present work intends to address the subject in the simplest way possible so that the medical teacher takes it into account and facilitates its development in the doctor in training.

El razonamiento clínico es una competencia que el médico desarrolla y que es fundamental para su práctica médica. El razonamiento clínico incluye aspectos relacionados con la observación, el pensamiento crítico y las habilidades de comunicación con el paciente, ya que integra los conocimientos previos que el médico tiene sobre una enfermedad o problema médico mediante la obtención de información de los aspectos clínicos que el paciente proporciona y con el proceso mental de procesar la información clínica proporcionada por el paciente al profesional sanitario durante el interrogatorio o anamnesis, aunado a la interpretación de los hallazgos en la exploración física y, en su caso, de las pruebas complementarias, permite elaborar un conjunto de diagnósticos probables para la eficiente toma de decisiones clínicas. El presente trabajo tiene la intención de abordar el tema de la manera más sencilla posible para que el docente médico lo tome en cuenta y facilite su desarrollo en el médico en formación.

Different doses of enoxaparin in the prevention of postoperative abdominal adhesions. Experimental study.

BACKGROUND: Postoperative abdominal adhesions (PAAs) are present in more than 90% of patients undergoing abdominal surgery. They are a cause of chronic pain, hospitalizations, multiple surgeries, and infertility in women of reproductive age. The participation of three processes have been recognized: coagulation, fibrinolysis, and inflammation. The usefulness of subcutaneous enoxaparin in their prevention has been established. The objective is to establish the safest and most efficient dose for PAA prevention by testing five different doses of subcutaneous enoxaparin (0.25, 0.5, 1, 1.5, and 2 mg/kg/day) given in one dose/day for seven days. MATERIAL AND METHODS: Fifty Sprague-Dawley rats were studied, 10 in each group. Adhesions were induced through controlled rubbing of the cecum and suturing of an incision in the terminal ileum. Two independent observers recorded the degree of adhesion formation at 14 days and histologically studied the adhesions. STATISTICAL ANALYSIS: ANOVA compared group averages. The nonparametric Kruskal-Wallis test was used to identify group differences. RESULTS: The 0.5 mg/kg/day group had greater formation of adhesions (p < 0.001). There was no significant difference between the 1.5 and 2 mg/kg/day groups, though the latter group had an incidence of 27.2% of bleeding in the abdominal cavity. The degree of adhesions in the histological sections coincided with the macroscopic findings. The interobserver agreement was kappa = 0.88 (very good). CONCLUSION: The safe and effective dose of subcutaneous enoxaparin to prevent PAA formation was 0.5-1.5 mg/kg/day for seven days.

Outpatient treatment for colostomy stenosis; report of 3 cases.

INTRODUCTION AND IMPORTANCE: Stenosis of the colostomy occurs in 2-15% of patients and, they are the cause of serious discomfort for the patient due to the difficulty in evacuation, as well as the need for new surgical interventions. The purpose of this work demonstrates an outpatient surgical treatment that can be performed in the office. CASE PRESENTATION: Three patients with definitive colostomy who suffered progressive stenosis are presented. Under local anesthesia, one or two triangular segments, with their bases on the colostomy, which included the thickened and hardened skin, are removed to expand the diameter of the stoma. The mucosa of the colon is sutured to healthy skin with Vicryl 3/0 simple stitches. This method has been used in three patients older than 60 years with permanent colostomy who presented with progressive stenosis 6-7 months after surgery. The average follow-up at 14.5 months was satisfactory, without restenosis. DISCUSSION: Stoma stenosis is a complication that occurs in up to 15% of cases and requires reconstruction, most of which are carried out in the operating room. The triangular stenoplasty presented is effective and is performed under local anesthesia in the office. CONCLUSION: Triangular-section stenoplasty of a stenosed permanent colostomy is an effective outpatient treatment.

Clinical and radiographic outcomes using third-generation bioactive glass as a bone graft substitute for multi-level anterior cervical discectomy and fusion-a retrospective case series study.

BACKGROUND: Bioactive glasses have unique bone forming properties that have been used as a bone graft substitute for anterior cervical discectomy and fusions (ACDFs). Bone graft substitutes are used for achieving fusion while simultaneously avoiding donor site morbidity of iliac crest autograft. In this study, our principal intention is to assess the clinical and radiographic outcomes in patients with multi-level cervical disc disease undergoing ACDF using a third-generation bioactive glass as a bone graft substitute. METHODS: A retrospective case series study was performed of patients who underwent primary multi-level instrumented fusions for degenerative cervical disc disease with bioactive glass bone graft substitute between May 2016 and December 2017 by a single fellowship-trained spine surgeon. All patients were treated with a porous PEEK interbody spacer and with a third-generation bioactive glass synthetic bone graft substitute. Patients were assessed pre-operatively, immediately following surgery, and at 3, 6, 12, and 24 months. Accepted standard outcome measures were applied to evaluate preoperative and postoperative metrics, including Visual Analog Scale neck pain and arm pain, and Neck Disability Index. Dynamic lateral radiographs were used to assess sagittal alignment, disc space height, arthrodesis status, osseous integration, and implant migration. Sagittal plane angulation was measured by Cobb's criteria. RESULTS: Thirty-nine patients underwent multi-level instrumented fusions: seventeen (43%) were two-level; 12 (31%) were three-level; 9 (23%) were four-level; and 1 (3%) was five-levels. All patients were followed for a minimum of 6 months for mean of 16.0 months (range, 6 to 36 months); none were lost to follow-up. Significant improvements from preoperative scores in Neck Disability Index scores as well as neck and arm visual analog scale pain scores were realized. All patients either maintained or improved their neurological status. Radiographically, all patients were fused by 6 months postoperatively and showed improvement in fusion segment lordosis (Pre-Post and Pre-Final P<0.001), C2-C7 lordosis angle (Pre-Post and Pre-Final P<0.001), T1 slope (Pre-Post P=0.01, Pre-Final P=0.07) and maintenance of disc height (Post-Final P=0.02). There were no adverse events, infections, or reoperations. CONCLUSIONS: Third-generation bioactive glass synthetic graft is a viable alternative to allograft or autograft in the setting of multi-level instrumented fusions for achieving improved clinical and radiographic outcomes.

Postoperative abdominal adhesions: pathogenesis and current preventive techniques.

Post-operative abdominal adhesions (PAA) are a condition that occurs in more than 90% of patients undergoing abdomen surgery; they can cause chronic abdominal pain, female infertility and repeated bowel obstruction, requiring repetitive surgical interventions causing morbidity and mortality, as well as high costs. The formation of the PAA is due to an imbalance between the fibrinogenesis and fibrinolysis in favor of the first, associated with tissue hypoxia secondary to aggression of the peritoneum, also due to the own inflammatory response and the increase in the population of adhesion fibroblasts which inhibit the degradation of the extracellular matrix and facilitate mature collagen and supporting connective tissue. The prevention of PAA will decrease secondary complications, as well as hospitalizations, surgeries and consequently, cost containment. The PAA pathophysiologic process allows establishing research strategies in order to prevent them.

Las adherencias abdominales postoperatorias (AAP) ocurren en más del 90% de los pacientes sometidos a cirugía de abdomen; pueden causar dolor abdominal crónico, infertilidad femenina y obstrucción intestinal recurrente, que requieren intervenciones quirúrgicas que son causa de morbilidad y mortalidad, así como altos costos. La formación de AAP se debe a un desequilibrio entre la fibrinogénesis y la fibrinólisis a favor de la primera, asociada con hipoxia tisular secundaria a la agresión del peritoneo, también debido a la propia respuesta inflamatoria y al aumento en la población de fibroblastos de adherencia que inhiben la degradación de la matriz extracelular y facilitan el colágeno maduro y el tejido conectivo de sostén. La prevención de las AAP disminuye las complicaciones secundarias, así como la necesidad de hospitalizaciones y cirugías, y en consecuencia se conseguirá una contención de costos. Conocer el proceso fisiopatológico de las AAP permite establecer estrategias de investigación para poder intervenir en su formación y prevenirlas en los diferentes pasos del proceso.

Desempeño académico, y su relación con calidad de vida y hábitos saludables / Academic Performance and its Association with Quality of Life and Healthy Habits

Introducción: El estudiante de Medicina enfrenta, en muchas ocasiones, entornos de vida y condiciones de aprendizaje poco favorables, así como aspectos psicológicos que pueden impactar de modo negativo en su calidad de vida y rendimiento académico. Objetivo: Evaluar el desempeño académico de los aspirantes a estudiar Medicina en relación con la autopercepción de la calidad de vida y los hábitos saludables. Métodos: Se realizó un estudio transversal, observacional y analítico. Se aplicó una encuesta sociodemográfica y la encuesta WHOQOL-Bref a una muestra de estudiantes del curso propedéutico de Medicina. Resultados: Se encontraron diferencias entre los alumnos que aprobaron y no aprobaron el curso propedéutico en autopercepción de Calidad de Vida (p = 0,01), y los dominios de Salud Física (p = 0,04), Salud Psicológica (p = 0,02) y Ambiente (p = 0,003). También entre los alumnos que desayunaban y los que omitían el desayuno en Autopercepción de Calidad de Vida (p = 0,012), Autopercepción de Salud Física (p = 0,009), y los dominios Salud Psicológica (p = 0,009) y Ambiente (p = 0,024). Conclusiones: Los altos puntajes en la prueba WHOQOL-Bref se correlacionan con el elevado desempeño académico; además, el hábito de omitir el desayuno conlleva a un bajo rendimiento escolar y una menor calidad de vida en los discentes(AU)

Introduction: Medical students face, many times, unfavorable living environments and learning conditions, as well as psychological aspects that can impact negatively on their quality of life and academic outcomes. Objective: To assess the academic performance of applicants to study Medicine in association with self-perception of quality of life and healthy habits. Methods: A cross-sectional, observational and analytical study was carried out. A sociodemographic survey and the WHOQOL-Bref survey were conducted on a sample of medical students of the propaedeutic course. Results: Differences were found between students who passed and those who did not pass the propaedeutic course regarding self-perception of quality of life (p=0.01), and the domains of physical health (p=0.04), psychological health (p=0.02) and environment (p=0.003). Also, we found differences between students who had breakfast and those who omitted breakfast regarding self-perception of quality of life (p=0.012), physical health (p=0.009), and domains of psychological health (p=0.009) and environment (p=0.024). Conclusions: The high scores in the WHOQOL-Bref test are in correlation with high academic performance; also, the habit of omitting breakfast leads to poor school performance and lower quality of life in students(AU)

Comparative Study of Drainage and Antibiotics versus Drainage Only in the Management of Primary Subcutaneous Abscesses.

BACKGROUND: Skin and soft tissue infections are common problems dealt with in emergency departments and medical offices. It is routine practice to prescribe antibiotic agents after incision and drainage of cutaneous abscesses. However, current evidence does not support prescribing oral antibiotic agents after surgical debridement. The aim of the present study was to determine the actual role of antibiotic agents after drainage of cutaneous abscesses. PATIENTS AND METHODS: This was a prospective study of patients undergoing incision and drainage (I&D) of a subcutaneous abscess. Patients were randomly assigned either to receive antibiotic agents (group 1) or placebo (group 2) after I&D. The primary end point was resolution rate of the abscess at the seventh day. Secondary end points were pain at the seventh day and total time to full healing of the wound. P value <0.05 was considered statistically significant. RESULTS: One hundred sixty-five patients were included for analysis. Age, gender, body mass index (BMI), and comorbidities did not differ substantially between groups. Chest and peri-anal abscesses were statistically more frequent in group 2, whereas neck abscesses were more frequent in group 1 (p = 0.02). Leukocyte count was also statistically higher in group 1 (p = 0.005). Resolution rate was 96% in group 1 and 93% in group 2, with no statistical difference between both (p = 0.28). Neither pain at seventh day nor time to full healing differed statistically between groups. CONCLUSIONS: Antibiotic agents are not necessary for uncomplicated subcutaneous abscesses after I&D. These cases can be managed safely on an outpatient basis without any increase in morbidity.

Ingesta de edulcorantes no nutritivos en tres poblaciones distintas de adultos en México / Intake of non-nutritive sweeteners in three distinct populations of adults in Mexico

RESUMEN Introducción. La ingesta de edulcorantes no nutritivos ha aumentado en los últimos años. Se piensa que su uso está dirigido al control de la diabetes mellitus y la obesidad. Objetivos: Establecer el consumo de los edulcorantes no nutritivos en tres diferentes poblaciones de México. Sujetos y métodos: Se incluyeron a 332 adultos participantes que se dividieron en tres grupos: Grupo A) 131 jóvenes; Grupo B) 99 acompañantes de pacientes de un hospital de Seguridad Social, considerados como de nivel socioeconómico bajo-típico y Grupo C) 102 familiares de pacientes de un hospital privado, considerados como de nivel socioeconómico medio-alto y alto. Resultados: No hubo diferencias en las condiciones demográficas, excepto la edad en el grupo de jóvenes. El índice de masa corporal fue similar aunque el grupo de jóvenes se encuentran en peso normal y los adultos en sobrepeso. La prevalencia de diabetes entre los grupos de adultos fue de 15.1% y 21.5% respectivamente, pero el uso de edulcorantes no nutritivos y sacarosa se encuentran en la misma proporción (49% vs 51%). Conclusión: La ingesta de edulcorantes no nutritivos en la población estudiada no está dirigida al control de la diabetes mellitus ni para prevenir o tratar el sobrepeso y la obesidad.

ABSTRACT Introduction. The intake of non-nutritive sweeteners has increased in recent years. It is thought that its use is aimed at the control of diabetes and obesity. Objectives: Establish the intake of non-nutritive sweeteners in three different populations in Mexico. Subjects and methods: we included 332 participating adults who were divided into three groups: Group A) 131 young people, Group B) 99 escorts of patients of a Social Security hospital, considered to be of low-typical socio-economic level and Group C) 102 escorts of patients in a private hospital, considered as medium-high and high socioeconomic level. Results: There were no differences in the demographic conditions, except for the age group of young people. The body mass index was similar although the youth group is found in normal-weight and overweight in adults. The prevalence of diabetes among the groups of adults was 15.1% and 21.5% respectively, but the use of sucrose and non-nutritive sweeteners are in the same proportion (49% vs. 51%). Conclusion: The intake of non-nutritive sweeteners in studied population are not aimed at the control of diabetes mellitus or and obesity.

GBA mutations in Gaucher type I Venezuelan patients: ethnic origins and frequencies.

Gaucher disease (GD), the most frequent lysosomal storage disease, is caused by heterogeneous mutations in the locus coding for glucocerebrosidase (GBA). It is an autosomal recessive disorder with different phenotypes of which the most frequent is the nonneuronopathic or type 1, prevalent worldwide. To date, more than 430 mutations have been described, but their frequency distribution varies in different populations with four, N370S, L444P, IVS2 + 1G > A and 84insG, being the most frequent ones. In Venezuela, 20 unrelated index cases with GD type I were assessed for GBA mutation detection and for their in-phase haplotype identification, to gather genetic epidemiological data on the disease in the country and of its eventual ethnic origin. Ten missense mutations and two complex alleles were identified. The most frequent were N370S (42.5%), L444P (20%), IVS2+1G > A (10%) and R48W (5%); mutations R120W, P245H, H311R, R496H, W36X and R433G which were carried by a single chromosome each one. Three geographical foci were identified, displaying mutation heterogeneity. N370S had multiple genetic origins, different from the Ashkenazi's; a single common remote ancestor for this mutation in the country was dismissed, according to the haplotype analysis. All mutations have a likely European Caucasoid descent.

[Construction and validation of the "La Salle Instrument" to evaluate the ethical aspects in biomedical research on human beings]. / Construcción y validación del Instrumento «La Salle¼ para evaluar los aspectos éticos en la investigación biomédica.

INTRODUCTION: Research projects must demonstrate not only a rigorous scientific methodology, but also the ethical aspects that require profound reflection of the reviewers. Current regulations establish criteria for research projects on human health, but many of these aspects are subjective. How can the evaluation of such projects be standardized? This is the main subject of the current project. MATERIALS AND METHODS: This project comprises two phases. First, the design and construction of an instrument of evaluation based on the fundamental principles of bioethics, which are autonomy, beneficence, non-maleficence, and justice, and other aspects. The second phase consists of content validation through expert. RESULTS: During the phase of reviewing the instrument, it was necessary to make changes by adding, removing, or changing the concepts or criteria, which lead to the construction of the second version of the format. This new instrument was reviewed and analyzed by using the AGREE II instrument, and this version was validated by experts by greater than 95%. CONCLUSIONS: There are some recommendations to analyze the ethical aspects in research protocols involving human subjects, but they define the concepts and criteria to be evaluated. By presenting the criteria to be evaluated individually, the "La Salle instrument" allows the evaluation to be more objective and standardized.

Actualidad de la cirugía de las vías biliares en Cuba / Update on surgery of bile ducts in Cuba

Desde que Langenbuch realizó la primera colecistectomía en 1891, hasta nuestros días, se han producido muchos cambios en la cirugía de las vías biliares, tanto en los métodos diagnósticos como en las conductas terapéuticas de las diferentes entidades nosológicas que asientan en las vías excretoras hepáticas.Sin embargo, ha sido casi al cumplirse los 100 años, que se produce un cambio radical en la vía de abordaje de la colecistectomía, operación más frecuente sobre las vías biliares, la que no obstante, ha mantenido de forma general, los mismos principios técnicos habituales conocidos.En nuestro país dicho método operatorio, comúnmente llamado mínimo acceso, comenzó a practicarse en la tan temprana fecha de 1991, en el Hospital Hermanos Ameijeiras. A partir de entonces se produjo una rápida generalización de dicho proceder por todo el país, el que en la actualidad es el de elección para la realización de dicha intervención y fundamentalmente la vía endoscópica retrógrada para alguna de sus complicaciones como la litiasis coledociana.La amplia difusión de estos métodos ha conllevado que el 90 por ciento de estas intervenciones se realicen por estas vías, lo que ha hecho que se relegue la cirugía abierta o tradicional a un solo 10 porciento y con ella, entre otras, las técnicas conocidas de extracción de cálculos de las vías excretoras mediante coledocotomías, las anastomosis derivativas de dichas vías con el tractus gastrointestinal tal como las colédoco-duodeno-anastomosis, los problemas de las disfunciones del esfínter de Oddi, procederes que eran del dominio de nuestros cirujanos con índices de morbimortalidad comparables a los internacionales y que hoy en día se relegan a otros métodos endoscópicos con índices propios de morbimortalidad y que en ocasiones no permiten tratar debidamente la afección biliar, todo lo cual ha conllevado la inherente pérdida de habilidades de los métodos tradicionales no sustituibles, ni por otro lado, obsoletos. Es..

Actualidad de la cirugía de las vías biliares en Cuba / Update on surgery of bile ducts in Cuba

Desde que Langenbuch realizó la primera colecistectomía en 1891, hasta nuestros días, se han producido muchos cambios en la cirugía de las vías biliares, tanto en los métodos diagnósticos como en las conductas terapéuticas de las diferentes entidades nosológicas que asientan en las vías excretoras hepáticas.Sin embargo, ha sido casi al cumplirse los 100 años, que se produce un cambio radical en la vía de abordaje de la colecistectomía, operación más frecuente sobre las vías biliares, la que no obstante, ha mantenido de forma general, los mismos principios técnicos habituales conocidos.En nuestro país dicho método operatorio, comúnmente llamado mínimo acceso, comenzó a practicarse en la tan temprana fecha de 1991, en el Hospital Hermanos Ameijeiras. A partir de entonces se produjo una rápida generalización de dicho proceder por todo el país, el que en la actualidad es el de elección para la realización de dicha intervención y fundamentalmente la vía endoscópica retrógrada para alguna de sus complicaciones como la litiasis coledociana.La amplia difusión de estos métodos ha conllevado que el 90 por ciento de estas intervenciones se realicen por estas vías, lo que ha hecho que se relegue la cirugía abierta o tradicional a un solo 10 porciento y con ella, entre otras, las técnicas conocidas de extracción de cálculos de las vías excretoras mediante coledocotomías, las anastomosis derivativas de dichas vías con el tractus gastrointestinal tal como las colédoco-duodeno-anastomosis, los problemas de las disfunciones del esfínter de Oddi, procederes que eran del dominio de nuestros cirujanos con índices de morbimortalidad comparables a los internacionales y que hoy en día se relegan a otros métodos endoscópicos con índices propios de morbimortalidad y que en ocasiones no permiten tratar debidamente la afección biliar, todo lo cual ha conllevado la inherente pérdida de habilidades de los métodos tradicionales no sustituibles, ni por otro lado, obsoletos. Es..(AU)

Molecular spectrum of ß-thalassemia mutations in the admixed Venezuelan population, and their linkage to ß-globin gene haplotypes.

In order to establish the spectrum of ß-thalassemia (ß-thal) mutations in the Venezuelan population for the first time, 127 unrelated subjects either with a suspicion of ß-thal trait or with a clinically recognized ß-thal syndrome of different degrees of severity, were studied. DNA from these subjects was analyzed by a polymerase chain reaction (PCR)-based reverse dot-blot method or amplification refractory mutation system (ARMS). Prototype ß-globin gene sequencing of relevant DNA was performed to confirm the mutations. Fifteen different mutations were identified accounting for 92.0% of the mutant alleles explored, revealing a significant genetic heterogeneity at the ß-globin gene locus in this population. The most frequent mutations were codon 39 (C >T) 34.1%, IVS-I-1 (G >A) 11.1%, IVS-I-6 (T > C) 6.6%, IVS-I-110 (G >A) 6.6%, IVS-II-849 (A >G) 6.6%, -88 (C >T) 6.0%, -29 (A >G) 5.2%, followed by the less common IVS-I-5 (G >A) 3.7%, the 1,393 bp deletion 3.0%, IVS-II-1 (G >A) 3.0%, -86 (C >G) 2.2%, IVS-II-1 (G >T) 1.5%, codons 41/42 (-TCTT) 1.5%, IVS-II-745 (C >G) 0.7% and deletional δß-thal 0.7%. Overall, these data demonstrate that the major sources of ß-thal alleles in Venezuela, as expected, are of Mediterranean and African origins. This is the first large study defining the molecular spectrum of ß-thal in the highly admixed population of Venezuela and lays the foundation for genetic counseling as well as implementing comprehensive clinical care programs. Diversity of haplotypes associated with some of the ß-thal mutations can be explained by in situ recombination events in Venezuela.

Profilaxis perioperatoria en cirugía urológica en hospitales cubanos / Perioperative prophylaxis in urological surgery at Cuban hospitals

Objetivo: describir las prácticas de profilaxis perioperatoria con antibióticos en procederes urológicos en hospitales cubanos. Métodos: estudio descriptivo de corte transversal realizado en el período mayo-diciembre de 2009, mediante la aplicación de cuestionario auto administrado, en el cual se evaluó la existencia de política (documento escrito) de uso profiláctico, y de recomendaciones para la profilaxis en procederes seleccionados, el momento para administrar la dosis inicial y la duración probable del régimen profiláctico y los antimicrobianos utilizados. Resultados: se obtuvo información de 24 hospitales (36,6 por ciento de los servicios de urología cubanos), incluyendo instituciones de 11 de las provincias (84,6 por ciento). Poseen políticas escritas en 17 de los servicios (70,8 por ciento). La mayoría de ellos tienen indicaciones de profilaxis para los procederes evaluados, y en el 100 por ciento de los servicios para la resección transuretral de próstata, cirugía abierta o laparoscópica que incluye intestino, cistoscopia terapéutica y uretrotomia interna endoscópica. El 29,2 por ciento de los servicios recomiendan el momento de inicio de la profilaxis la noche antes, el 41,7 por ciento 60 minutos antes del proceder y el 29,2 por ciento en la inducción anestésica. Esquemas superiores a 24 horas se recomiendan en la mayoría de los procederes, con excepción de la cistoscopia diagnóstica o terapéutica. Variedad de antimicrobianos o combinaciones de estos son utilizados, con predominio de la ciprofloxacina y cefazolina. Conclusión: variabilidad en las prácticas de prescripción de antimicrobianos en la profilaxis perioperatoria en los servicios de urología cubanos se ha identificado, para lo que se requiere un consenso nacional que contribuya a mejorar la calidad en el cumplimiento de está práctica de prevención(AU)

Objective: to describe the practices of perioperative prophylaxis using antibiotics in urologic procedures at Cuban hospitals. Method: a cross-sectional and descriptive study was conducted over May-December, 2009 by application of self-administered questionnaire which assessed the existence of a politic (written document) of prophylactic use and of recommendations for prophylaxis en selected procedures, the moment to administer the initial dose and the potential length of prophylactic regime as well as the antimicrobials used. Results: there was information from 24 hospitals (36.6 percent of the Cuban urology services) including institutions from the eleven provinces (84.6 percent). In 17 services there are written politics (70.8 percent). Most of them have indications of prophylaxis for assessed procedures and in 100 percent of services to prostate transurethral resection, open or laparoscopic surgery including intestine, therapeutical cystoscopy and endoscopic internal urethrotomy. The 29,2 percent of services recommended that the onset of prophylaxis be the night before, the 41,7 percent 60 minutes before procedure and the 29,2 percent during the anesthetic induction. Authors recommended 24 hours-higher outlines in most of procedures, except for the diagnostic or therapeutical cystoscopy. Different antimicrobials or combinations of it are used with predominance of ciprofloxacin and cefazolin. Conclusion: there is variability in practices of antimicrobials prescription in perioperative prophylaxis in Cuban urology services being necessary a national consensus contributing to improve the quality of fulfilment of this preventive practice(AU)

Profilaxis perioperatoria en cirugía urológica en hospitales cubanos / Perioperative prophylaxis in urological surgery at Cuban hospitals

Objetivo: describir las prácticas de profilaxis perioperatoria con antibióticos en procederes urológicos en hospitales cubanos. Métodos: estudio descriptivo de corte transversal realizado en el período mayo-diciembre de 2009, mediante la aplicación de cuestionario auto administrado, en el cual se evaluó la existencia de política (documento escrito) de uso profiláctico, y de recomendaciones para la profilaxis en procederes seleccionados, el momento para administrar la dosis inicial y la duración probable del régimen profiláctico y los antimicrobianos utilizados. Resultados: se obtuvo información de 24 hospitales (36,6 por ciento de los servicios de urología cubanos), incluyendo instituciones de 11 de las provincias (84,6 por ciento). Poseen políticas escritas en 17 de los servicios (70,8 por ciento). La mayoría de ellos tienen indicaciones de profilaxis para los procederes evaluados, y en el 100 por ciento de los servicios para la resección transuretral de próstata, cirugía abierta o laparoscópica que incluye intestino, cistoscopia terapéutica y uretrotomia interna endoscópica. El 29,2 por ciento de los servicios recomiendan el momento de inicio de la profilaxis la noche antes, el 41,7 por ciento 60 minutos antes del proceder y el 29,2 por ciento en la inducción anestésica. Esquemas superiores a 24 horas se recomiendan en la mayoría de los procederes, con excepción de la cistoscopia diagnóstica o terapéutica. Variedad de antimicrobianos o combinaciones de estos son utilizados, con predominio de la ciprofloxacina y cefazolina. Conclusión: variabilidad en las prácticas de prescripción de antimicrobianos en la profilaxis perioperatoria en los servicios de urología cubanos se ha identificado, para lo que se requiere un consenso nacional que contribuya a mejorar la calidad en el cumplimiento de está práctica de prevención(AU)

Objective: to describe the practices of perioperative prophylaxis using antibiotics in urologic procedures at Cuban hospitals. Method: a cross-sectional and descriptive study was conducted over May-December, 2009 by application of self-administered questionnaire which assessed the existence of a politic (written document) of prophylactic use and of recommendations for prophylaxis en selected procedures, the moment to administer the initial dose and the potential length of prophylactic regime as well as the antimicrobials used. Results: there was information from 24 hospitals (36.6 percent of the Cuban urology services) including institutions from the eleven provinces (84.6 percent). In 17 services there are written politics (70.8 percent). Most of them have indications of prophylaxis for assessed procedures and in 100 percent of services to prostate transurethral resection, open or laparoscopic surgery including intestine, therapeutical cystoscopy and endoscopic internal urethrotomy. The 29,2 percent of services recommended that the onset of prophylaxis be the night before, the 41,7 percent 60 minutes before procedure and the 29,2 percent during the anesthetic induction. Authors recommended 24 hours-higher outlines in most of procedures, except for the diagnostic or therapeutical cystoscopy. Different antimicrobials or combinations of it are used with predominance of ciprofloxacin and cefazolin. Conclusion: there is variability in practices of antimicrobials prescription in perioperative prophylaxis in Cuban urology services being necessary a national consensus contributing to improve the quality of fulfilment of this preventive practice(AU)

[The venous thromboembolic disease]. / Enfermedad tromboembólica venosa.

Venous thromboembolic disease (VTD) is a frequent medical problem. The VTD includes deep vein thrombosis (DVT), the posthrombotic syndrome (PTS) and pulmonary embolism (PE). The generation of a thrombus in the venous system, is caused by several abnormalities that induce the loss of the most important characteristic of the blood, the liquid state. DVT is due to the formation of a thrombus. Main causes for thrombus formation are thrombophilias which may be classified as primary and secondary. All thrombophilias may affect the homeostasis favoring a hypercoagulable state. In the XIX Century, Virchow classified all the causes of hypercoagulable states as follows: due to stasis of the venous blood flow, due to damage of the endothelium an a hypercoagulable clinical condition. Several risk factors for VTD has been described, during the hospitalization to both, medical and surgical conditions. Among the last, orthopedic and vascular surgery of the legs. Although nearly 50 % of DVTs are asymptomatic and 3 % of the patients with VTD develop PE and 30 % of them die. Thromboprophylaxis is the main strategy to prevent and to diminish the incidence of DVT and its complications. Thromboprophylaxis is useful to improve the quality of life of the patients at risk and it is an effective economical strategy for health care institutions.