Prevalence and factors associated with dry socket following routine dental extractions.

BACKGROUND: Dry socket (DS) or fibrinolytic osteitis is a relatively common complication that can occur following tooth extraction. This study aimed to determine the prevalence of DS and identify its associated predictive and mediating variables. MATERIAL AND METHODS: This study is classified as prospective observational, cross-sectional, and multicenter. Patients were consecutively selected in accordance with established criteria for tooth extraction. Data on patient demographics, surgical procedures and postoperative outcomes were collected. Nominal variables were analyzed using the Chi-Square Test, while associations involving ordinal values or considering counts or layers were examined using the Kendall's Tau-B Test or Mantel-Haenszel Test for trend. The GLM Mediation Model was employed to investigate potential mediation or indirect effects or potential underlying mechanisms of predictive variables on the development of DS. Two-tailed significance level of p ≤0.05 was considered statistically significant. RESULTS: A total of 1,357 patients undergoing routine dental extractions were included. DS was observed in 13 patients (prevalence of 1%). DS was associated with younger patients (under 50 years old), longer procedures, and the presence of surgical accidents, but only when mediated by surgical complexity. Smoking, particularly in combination with complex surgeries and surgical accidents, was associated with DS. Postoperative pain for more than two days and reported at moderate to high levels, emerged as a potential warning sign for DS. The use of antibiotics was found to significantly reduce the risk of DS (RR reduction of 36% and absolute risk reduction of 0.63%). CONCLUSIONS: Routine dental extractions revealed a 1% prevalence of dry socket. The obtained results suggests that DS is a multifactorial condition influenced by various factors, including gender, age, smoking, antibiotic prescription and surgical factors such as length, technique and accidents, nevertheless, those associations were observed mainly considering the influence of one variable on another.

Programa de entrenamiento de parotidectomía en modelo cadavérico perfundido

Introducción: La parotidectomía es una cirugía infrecuente y técnicamente compleja determinada por la dificultad de disección del nervio facial, cuya lesión produce alto grado de morbilidad en los pacientes. Los modelos de simulación animales no logran reproducir las características de la anatomía regional, por lo que se hace necesario explorar otras alternativas para el entrenamiento de estas habilidades. Nuestro objetivo es evaluar un programa de entrenamiento de técnicas de parotidectomía en un modelo cadavé-rico perfundido. Métodos: Se diseñó un programa educacional de Kern de entrenamiento de residentes de Cirugía de Cabeza y Cuello para la realización de parotidectomía total en un modelo cadavérico perfundido. La evaluación se realizó mediante el modelo de Kirkpatrick, en los niveles 1 (reacción), 2A (cambio de actitudes) y 2B (adquisición de conocimientos y habilidades). Resultados: Se elaboró un programa teórico-práctico basado en cátedras y simulación de alta fidelidad. En su mayoría los participantes: recomendarían el curso (Nivel 1); tuvieron mayor motivación para el aprendizaje (Nivel 2) y presentaron mejores indicadores sobre conocimientos, habilidades y percepción de mejoría de sus competencias (Nivel 2B). Conclusión: La utilización de un programa de parotidectomía simulado en un modelo de alta fidelidad basado en modelos cadavéricos humanos perfundidos es una alternativa que mejora la calidad de entrenamiento y es útil y factible para el aprendizaje de técnicas de parotidectomía en residentes de Cirugía de Cabeza y Cuello.

Introduction: The parotidectomy is an infrequent and technically complex surgery due to a difficult dissection that may affect the facial nerve, generating high degree of morbidity in patients. Animal simulation models may not reproduce the human characteristics of cervical anatomy. Therefore, it is necessary to explore other alternatives for training dissection skills. Our objective is to evaluate a parotidectomy's techniques training program in a perfused cadaveric model. Methods: A Kern educational program was designed to train Head and Neck Surgery residents to perform total parotidectomy in a perfused cadaveric model. The evaluation was performed using Kirkpatrick model, at levels 1 (reaction), 2A (change of attitudes) and 2B (acquisition of knowledge and skills). Results: A theoretical-practical program based on lectures and high-fidelity simulation was developed. Most of the participants would recommend the course (Level 1); had greater motivation for learning (Level 2) and showed better indicators of knowledge, skills and perception of improvement in their competencies (Level 2B). Conclusion: The use of a simulated parotidectomy program in a high-fidelity model based on perfused human cadaveric models is an alternative that improves the quality of training and is useful and feasible for learning parotidectomy techniques in residents of Head and Head Surgery.

Melatonin synergizes with the antinociceptive effect of N-palmitoylethanolamide and paracetamol.

Melatonin has been shown to have an antinociceptive effect and its administration could enhance the antinociceptive effect of other drugs. This study assessed the antinociceptive effects of melatonin in combination with paracetamol and N-palmitoylethanolamide (PEA) using the formalin test in mice. Melatonin, paracetamol, and PEA were administered intraplantarly (paw) alone or combined to mice. A concentration-response curve was generated to determine the concentration needed to reach 30% of the maximal antinociceptive effect (EC30). Melatonin, paracetamol and PEA induced a concentration-dependent antinociceptive effect in both phases of the formalin test, being PEA more potent (EC30 = 7.4±0.2 mg/paw) than melatonin (EC30 = 20.5±3.1 mg/paw) or paracetamol (EC30 = 41.8±2.6 mg/paw). Combinations of melatonin with paracetamol or PEA also induced a concentration-dependent antinociceptive effect in the formalin test. Isobolographic analysis showed that melatonin interacts synergistically with either paracetamol or PEA to reduce formalin-induced inflammatory pain. However, the experimental values of EC30 were significantly smaller than those calculated theoretically.

α-Glucosidase inhibitory phenolics from Echeveria subrigida (B. L. Rob & Seaton) leaves.

Echeveria subrigida is native to Mexico and its methanol extract (ME) shows relevant biological activities for human health, including the α-glucosidase inhibitory (αGI) activity that suggests its antidiabetic potential. Fractionation of the ME based on the αGI activity (IC50 in µg/mL) showed that quercetin-3-O-ß-glucoside (131.1), isorhamnetin-3-O-ß-glucoside (166.4), and dimers to heptamers proanthocyanidins (9.6) were among the main responsible of αGI activity in the ME. The purified compounds showed better activity than acarbose (IC50 = 4426 µg/mL).

[Trend in stroke mortality in Chile from 1980 to 2015]. / Tendencia de la mortalidad por enfermedades cerebrovasculares en Chile entre 1980 y 2015.

BACKGROUND: Stroke is the third largest single cause of death in Chile, responsible for 7.3% of all deaths in 2019. Large declines in stroke mortality rates in most Latin American countries in recent decades have been reported. AIM: To analyze the trend in stroke mortality in Chile between 1980 and 2015. MATERIAL AND METHODS: We extracted data for age-standardized death rate (ASDR) stroke mortality per 100,000 inhabitants in Chile for the period 1980-2015from the WHO Mortality Database. Joinpoint regression analysis was used to analyze the trend and compute the average annual percent change (AAPC) by gender in Chile. RESULTS: The ASDR from stroke decreased from 92.8 per 100,000 in 1980 to 34.4 per 100,000 in 2015. The AAPC was -2.8% (-3.5, -2.1), with two jointpoints, 2008 and 2012. By gender, the AAPC was -2.4% and -2.9% in men and women, respectively. CONCLUSIONS: Stroke mortality rate decreased significantly between 1980 and 2015 in Chile, mainly in women.

Tendencia de la mortalidad por enfermedades cerebrovasculares en Chile entre 1980 y 2015 / Trend in stroke mortality in Chile from 1980 to 2015

Background: Stroke is the third largest single cause of death in Chile, responsible for 7.3% of all deaths in 2019. Large declines in stroke mortality rates in most Latin American countries in recent decades have been reported. Aim: To analyze the trend in stroke mortality in Chile between 1980 and 2015. Material and Methods: We extracted data for age-standardized death rate (ASDR) stroke mortality per 100,000 inhabitants in Chile for the period 1980-2015from the WHO Mortality Database. Joinpoint regression analysis was used to analyze the trend and compute the average annual percent change (AAPC) by gender in Chile. Results: The ASDR from stroke decreased from 92.8 per 100,000 in 1980 to 34.4 per 100,000 in 2015. The AAPC was −2.8% (-3.5, −2.1), with two jointpoints, 2008 and 2012. By gender, the AAPC was −2.4% and −2.9% in men and women, respectively. Conclusions: Stroke mortality rate decreased significantly between 1980 and 2015 in Chile, mainly in women.

Osteoporosis grave secundaria a enfermedad de Gaucher: reporte de caso / Severe osteoporosis secondary to Gaucher disease: case report

La enfermedad de Gaucher (EG) es un trastorno genético lisosomal autosómico recesivo infrecuente, que conduce a la acumulación de lípidos y disfunción en múltiples órganos. La afectación del esqueleto es uno de los hallazgos más frecuentes de la EG y una de las principales causas de dolor y reducción de calidad de vida. El compromiso esquelético incluye anomalías en el remodelado óseo con pérdida mineral ósea, adelgazamiento cortical, lesiones líticas, fracturas por fragilidad y deformidades articulares. A continuación presentamos el caso de una paciente 61 años con osteoporosis grave secundaria a EG diagnosticada en la vida adulta, con antecedente de dos hermanas con EG. La paciente refería dolores óseos y lumbago crónico desde los 53 años. El 2012 fue evaluada en policlínico de hematología por trombocitopenia y debido a sus antecedentes familiares se le solicitaron exámenes que fueron compatibles con EG. El año 2016 la densitometría ósea (DXA) de columna lumbar y cuello femoral izquierdo, que mostró una osteoporosis. Se inició tratamiento con Alendronato, Calcio y Vitamina D, pero la paciente tuvo escasa adherencia. El 2018 se inició tratamiento de su EG con Taliglucerasa α. Al año siguiente se le realizó nueva DXA que evidenció persistencia de la osteoporosis y por mantención del lumbago se le solicitó una TAC de columna lumbar que mostró fracturas por aplastamiento de cuerpos vertebrales dorsales bajos. Se derivó a endocrinología para manejo de su osteoporosis grave. A su ingreso a endocrinología la paciente persitía con dolor lumbar alto y destacaba una marcada cifosis. Se decidió retomar tratamiento con Alendronato, calcio y vitamina D, además, se le solicitó una nueva evaluación densitométrica junto a una radiografía de columna total y evaluación dental. Durante el seguimiento la paciente mantuvo niveles de vitamina D adecuados con funciones renal, hepática y tiroidea normales.

Gaucher disease (GD) is a rare autosomal recessive lysosomal genetic disorder, leading to the accumulation and dysfunction of lipids in multiple organs. Skeletal involvement is one of the most prevalent aspects of GD and one of the main causes of pain and reduced quality of life. Abnormalities of bones, which cause changes in the development and loss of bone mineral, cortical thinning, lytic lesions,fragility fractures and deformities. We present a case of a patient diagnosed with severe osteoporosis, secondary to GD diagnosed in adult life. The patient presents a disease pattern composed of bone pain and chronic low back pain since the age of 53. In 2012, she was evaluated at the hematology for thrombocytopenia and due to her family history, tests were performed to diagnose GD, which were compatible with it. In 2016 Bone Densitometry (DXA) of the lumbar spine and left femoral neck was requested, being consistent with osteoporosis. Treatment with Alendronate, Calcium and Vitamin D was started, however, there is little adherence. In 2018, treatment for Gaucher's disease was started with Taliglucerase α. The following year, DXA was performed with few changes and a CT scan of the lumbar spine was performed diagnosing crush fractures of the low dorsal vertebral bodies. She was referred to endocrinology. Upon admission to Endocrinology, it was decided to resume initial osteoporosis treatment and to perform skeletal evaluation with DXA of the lumbar spine and hips, total spine X-ray and dental evaluation. During follow-up, it maintains vitamin D at adequate levels and normal kidney, liver and thyroid functions.

The hallmarks of ovarian cancer: Focus on angiogenesis and micro-environment and new models for their characterisation.

Cancers develop by sustained growth, migration and invasion properties of tumour cells, supported by complex interactions with stromal cells within the tumour micro-environment. This review is focused on the latest discoveries regarding the highlighted role of angiogenesis and tumour micro-environment in ovarian cancer. This cancer milieu encompasses non-cancerous cells present in the tumour or nearby, including vessel-forming cells, fibroblasts and immune cells amongst others that work in a cooperative way with cancer cells, impacting tumour behaviour. Angiogenesis, migration and invasion, and more recently immune evasion, are cancer hallmarks clearly dependent on these supporting cells. Moreover, these stromal cells are more genetically stable than tumour cells and thus represent an attractive therapeutic target. A better understanding of the stromal cells function, and their complex interplay with cancer cells, will open additional areas to target, as the tumour-host interface.

Hipertensión intracraneal idiopática asociada a nitrofurantoína. Caso clínico / Idiopathic intracranial hypertension associated with nitrofurantoin. Case report

Resumen Introducción: La Hipertensión Intracraneal Idiopática (HICI) es un síndrome neurológico caracterizado por un aumento de la presión intracraneal en ausencia de lesión estructural o hidrocefalia. Los síntomas incluyen cefalea, tinnitus pulsátil, oscurecimientos visuales transitorios y pérdida visual. Dentro de los signos destacan diplopía por parálisis del VI par, edema de papila y disminución de la agudeza visual. Los pacientes no tienen compromiso de conciencia ni signos neurológicos focales. La principal complicación es la pérdida visual que puede ser irreversible. La asociación entre HICI y nitrofurantoína (NTF) se reportó en 1974. Caso clínico: Mujer de 42 años, con sobrepeso, que desarrolló una HICI aproximadamente 18 meses posterior al inicio de nitrofurantoína profiláctica. Consultó por cefalea frontal, opresiva que aumentaba con la maniobra de Valsalva, asociada a disminución fluctuante de la agudeza visual y episodios de oscurecimiento. Al examen destacó edema de papila bilateral, sin déficit neurológico focal. La presión del líquido cefalorraquídeo (LCR) fue de 25,5 cm de agua. La resonancia magnética mostró signos de aumento de la presión del LCR, sin lesiones estructurales ni hidrocefalia. El cuadro se recuperó concomitantemente a la suspensión de la NTF y el uso de topiramato. No se constató daño visual permanente. Conclusiones: Se debe sospechar la HICI en mujeres en edad fértil con sobrepeso. Dentro de los gatillantes del síndrome destacan varios fármacos, entre ellos la NTF. El principal objetivo del tratamiento de la HICI es preservar la función visual.

Abstract Introduction: Idiopathic intracranial hypertension (IIH) is a syndrome characterized by increased intracranial pressure without a space occupying lesion or hydrocephalus. The symptoms are headache, pulsatile tinnitus, transient visual obscurations, and visual loss. Signs are diplopia caused by sixth cranial nerve paresis and papilledema with its associated loss of sensory visual function. The patient maintains an alert and oriented mental state, but has no localizing neurologic findings. The only major morbidity with IIH is visual loss. The association between IIH and nitrofurantoin was reported in 1974. Case: A 42 years old female, overweighed, who developed IIH 18 months after the start of prophylactic nitrofurantoin. She had frontal oppressive headache that increased with the Valsalva maneuver, fluctuant visual loss and transient visual obscurations. She had bilateral papilledema without localizing neurologic findings. The cerebrospinal fluid (CSF) pressure was 25.5 cm H2O. Magnetic resonance imaging showed signs of increased CSF pressure without structural lesions or hydrocephalus. IIH recovered with the withdrawal of nitrofurantoin and the use of topiramate. There was not permanent visual loss. Conclusions: It is recommendable to suspect IIH in obese women in the childbearing years. There are several drugs associated with IIH including nitrofurantoin. The main objective of treatment is to prevent visual loss.

[Adolescents and young adults with congenital heart defects in transfer to adult care]. / Adolescentes y jóvenes portadores de cardiopatías congénitas en etapa de transferencia a la atención médica de adultos.

INTRODUCTION: Congenital heart defects (CHD), the most frequent congenital malformations, have shown an in creased survival and exponential growth of the adolescent and adult population living with CHD. Interventions that optimize the transition of patients from pediatric to adult health care services are essential for ensuring positive long-term outcomes. OBJECTIVE: To describe the knowledge and management of this disease, self-efficacy, and quality of life of young people with CHD during the transition period in two hospitals in Santiago, Chile. PATIENTS AND METHOD: Non-experimental, des criptive, cross-sectional study. Patients completed: a) a survey of socio-demographic data, knowledge and management of their condition, and use of health services; b) the Health-Related Quality of Life (Con-HRQoL) Scale in patients with CHD; and c) the Generalized Self-Efficacy (GSE) Scale. Re sults: We obtained a sample of 51 patients, 53% of them were men, and the mean age was 17 ± 2.49 years. The complexity of the CHD was mild in 22%, moderate in 29%, and high in 49%. Although patients reported high self-efficacy and good levels of quality of life, there was a lack of knowledge and self-management of their heart disease. CONCLUSIONS: The study showed that adolescents and young people with CHD are not prepared to achieve a successful transition to adult health care services, and there is a need for the implementation of transition programs focused on education, self-care, and self-management of the disease.

Adolescentes y jóvenes portadores de cardiopatías congénitas en etapa de transferencia a la atención médica de adultos / Adolescents and young adults with congenital heart defects in transfer to adult care

Resumen: Introducción: Las cardiopatías congénitas (CC), la malformación congénita más frecuente, han experimentado un aumento de sobrevida y crecimiento exponencial de la población de adolescentes y adultos portado res de CC. Para el éxito a largo plazo urgen intervenciones que optimicen la transición de cuidados de salud desde los servicios pediátricos a los de adulto. Objetivo: Describir el conocimiento y manejo de la enfermedad, autoeficacia y calidad de vida en adolescentes y jóvenes con CC en periodo de transfe rencia en dos hospitales en Santiago de Chile. Pacientes y Método: Estudio no experimental, descrip tivo, de corte transversal. Se aplicó: a) Encuesta de datos sociodemográficos, conocimiento y manejo de su enfermedad y uso de servicios de salud; b) Escala Con-Qol de Calidad de Vida Relacionada con Salud (CVRS) en pacientes con CC y c) Escala de Autoeficacia Generalizada (EAG). Resultados: Se obtuvo una muestra de 51 pacientes, 53% hombres, edad promedio de 17 ± 2,49 años. El 22% de las CC fue de complejidad simple, 29% moderada y 49% alta. Presentaron alta autoeficacia y buenos niveles de calidad de vida, sin embargo, mostraron escaso conocimiento y manejo de su enfermedad cardiaca. Conclusiones: Destaca la poca preparación para lograr una transición exitosa a servicios de adultos y jóvenes portadores de CC, siendo fundamental implementar programas de transición centrados en educación, autocuidado y automanejo de la enfermedad.

Abstract: Introduction: Congenital heart defects (CHD), the most frequent congenital malformations, have shown an in creased survival and exponential growth of the adolescent and adult population living with CHD. Interventions that optimize the transition of patients from pediatric to adult health care services are essential for ensuring positive long-term outcomes. Objective: To describe the knowledge and management of this disease, self-efficacy, and quality of life of young people with CHD during the transition period in two hospitals in Santiago, Chile. Patients and Method: Non-experimental, des criptive, cross-sectional study. Patients completed: a) a survey of socio-demographic data, knowledge and management of their condition, and use of health services; b) the Health-Related Quality of Life (Con-HRQoL) Scale in patients with CHD; and c) the Generalized Self-Efficacy (GSE) Scale. Re sults: We obtained a sample of 51 patients, 53% of them were men, and the mean age was 17 ± 2.49 years. The complexity of the CHD was mild in 22%, moderate in 29%, and high in 49%. Although patients reported high self-efficacy and good levels of quality of life, there was a lack of knowledge and self-management of their heart disease. Conclusions: The study showed that adolescents and young people with CHD are not prepared to achieve a successful transition to adult health care services, and there is a need for the implementation of transition programs focused on education, self-care, and self-management of the disease.

Management of the toxicity of chemotherapy and targeted therapies in elderly cancer patients.

The elderly form a very heterogeneous group in relation to their general health state, degree of dependence, comorbidities, performance status, physical reserve and geriatric situation, so cancer treatment in the older patient remains a therapeutic challenge. The physiological changes associated with aging increase the risk of developing a serious toxicity induced by chemotherapy treatment, as well as other undesirable consequences as hospitalizations, dependence and non-compliance with treatment, that can negatively affect survival, quality of life and treatment efficacy. The use of hematopoietic growth factors and other active supportive interventions in the elderly can help prevent and/or alleviate these toxicities. However, we have little data on the efficacy and tolerance of support treatments in the older patient. The objective of this work is to review the most frequent toxicities of oncological treatments in the elderly and their management.

Medicación potencialmente inapropiada en adultos mayores de un hospital del caribe colombiano / Potentially inappropriate medication in older adults of a Colombian Caribbean region hospital

OBJETIVO: Identificar la medicación potencialmente inapropiada en adultos mayores en un hospital del caribe colombiano. MÉTODOS: Estudio observacional descriptivo de corte transversal prospectivo, que incluyó a 181 adultos mayores (≥60 años de edad), internados en un hospital universitario del caribe colombiano. La medicación fue evaluada a través de la aplicación de los criterios STOPP contenidos en la herramienta STOPP/START. RESULTADOS: El promedio de edad fue de 75,14 años con DE +/- 9,09 años. La mayoría de los pacientes fueron de sexo masculino (50,30%). El 30,94 % de los pacientes estudiados presentó al menos un criterio de medicación potencialmente inapropiada. El criterio más prevalente fue el uso de benzodiazepinas dentro de los fármacos que aumentan en forma predecible el riesgo de caídas en personas mayores con un 22,00 %. La polimedicación y presencia de enfermedades crónicas fueron variables relacionadas con la presencia de medicación potencialmente inapropiada, con un OR= 5,14 (IC95% 1,15 - 22,82) y OR= 4,41 (IC95% 1,27 - 15,30), respectivamente. CONCLUSIÓN: La MPI es un problema frecuente en los adultos mayores, especialmente en aquellos que presentan enfermedades crónicas y polimedicación

OBJECTIVE: To identify potentially inappropriate medication (PIM) in older adults of a Colombian Caribbean region hospital. METHODS: An observational and descriptive cross-sectional study was conducted, which included 181 older adults (≥60 years old) during their inpatient period in a Colombian Caribbean region teaching hospital. PIM was obtained from STOPP criteria of the STOPP/START tool. RESULTS: The average age was 75,14 years old with a SD +/- 9,09 years. The majority of inpatient were men. A total of 30,94% of inpatients presented at least one PIM criteria. The most frequent criterion was the use of benzodiazepine within drugs that predict the higher risk for falls in older adults in a 21,52%. The polypharmacy and presence of chronic diseases were related to the presence of PIM with an OR = 5,14 (95% CI 1,15 - 22,82) and OR = 4,41 (95% CI 1,27 - 15,30) respectively. CONCLUSION: PIM represent a problem in older adults, especially in those who have chronic diseases or are exposed to polypharmacy

Tiempos de llegada de pacientes con ataque cerebrovascular en un hospital regional de alta complejidad / Arrival times of patients with stroke to a public hospital

Background: Stroke is a time-dependent emergency. Most patients with acute ischemic stroke are excluded from reperfusion therapies due to late consultation. Aims: To estimate the arrival times of patients with stroke to the Emergency Room (ER) of a public hospital. To identify factors associated with early consultation. Material and Methods: A convenience sample, 583 patients aged 71 ± 13 years (55% males) consulting for stroke at an emergency room was analyzed in terms of delay between onset of symptoms and arrival to the ER, demographics and etiology of stroke. Results: The admission diagnoses were ischemic stroke in 76%, intracerebral hemorrhage in 12%, transient ischemic attack in 9% and subarachnoid hemorrhage in 3%. The median time of arrival was 8 hours and 11 minutes after the onset of symptoms. Nineteen percent of consultations for ischemic stroke occurred within 3 hours of symptom onset, and 38% within 6 hours. In the logistic regression analysis, having an address near the hospital and the severity of stroke were associated with early consultation with a combined odds ratio of 5.97 (95% confidence intervals 3.23-11.04). Conclusions: There were significant differences in the arrival times of patients with stroke. Only a low proportion of patients with ischemic stroke consulted within the window for reperfusion therapies. Severe strokes and living near the hospital were associated with early consultation.

Factores asociados a llegada y evaluación precoz de pacientes con ataque cerebrovascular en un hospital regional de alta complejidad / Factors associated with early arrival and evaluation of stroke patients in a regional tertiary hospital

Resumen Antecedentes: El ataque cerebrovascular (ACV) es una urgencia tiempo-dependiente. La mayoría de los pacientes con infarto cerebral quedan excluidos de las terapias de reperfusión por consultar tardíamente. Se desconocen los factores asociados a llegada y evaluación precoz de pacientes con ACV agudo en nuestra población. Objetivos: Identificar los factores asociados, llegada y evaluación precoz de pacientes con ACV agudo. Pacientes y Métodos: Muestra por conveniencia de las consultas por ACV realizadas en el Turno N° 1, del SU del Hospital Dr. Hernán Henríquez de Temuco, entre enero de 2016 y diciembre de 2017. El análisis estadístico se realizó con el software STATA 14.0. Resultados: Se registraron 584 consultas por ACV. La mediana del tiempo de llegada fue de 8 h y 11 min. La mediana del tiempo para la evaluación por neurólogo(a) fue de 66 min. Tener domicilio en Temuco-Padre Las Casas y una mayor severidad del ACV se asociaron a consultar precozmente con un OR = 5,97 (3,23-11,04). Para evaluación dentro de una hora, las variables severidad, llegada en ambulancia y consulta en menos de 3 h, fueron estadísticamente significativas, con un OR combinado de 10,86 (IC 95%: 5,15-22,94). Conclusiones: Los factores más fuertemente asociados a llegada y evaluación precoz incluyen residir en comunas cercanas al hospital y presentar síntomas más severos de ACV. Se sugiere implementar estrategias para aumentar el grado de reconocimiento de síntomas de ACV y para disminuir las barreras de acceso a hospitales que traten a este tipo pacientes.

Introduction: Stroke is a time-dependent emergency. The majority of patients with Acute Ischemic Stroke are excluded from reperfusion therapies due to late consultation. The factors associated with early arrival and evaluation of patients with acute stroke in our population are unknown. The aim of the study was to identify factors associated with early arrival and evaluation of patients with acute stroke. Methods: A convenience sample of the stroke consultations made during shift # 1 at the ER between January 2016 and December 2017, was analyzed. Results: There were 584 stroke consultations in the period. 55.1% were men. The median time of arrival was 8 hours and 11 minutes. The median time for evaluation by neurologist was 66 minutes. Having an address in Temuco-Padre Las Casas and the severity of stroke was associated with early consultation with a combined OR of 5.97 (CI 95% 3.23-11.04). For an evaluation within one hour, in the logistic regression model, the variables severity, arrival in ambulance and consultation in less than 3 hours were statistically significant with a combined OR of 10.86 (CI 95% 5.15-22.94). Conclusions: The factors associated with early consultation and evaluation include residing in communes near the hospital and presenting more severe symptoms of stroke. It is suggested to implement strategies to increase the degree of recognition of stroke symptoms and to reduce barriers to access hospitals that treat patients with stroke.

[Arrival times of patients with stroke to a public hospital]. / Tiempos de llegada de pacientes con ataque cerebrovascular en un hospital regional de alta complejidad.

BACKGROUND: Stroke is a time-dependent emergency. Most patients with acute ischemic stroke are excluded from reperfusion therapies due to late consultation. AIMS: To estimate the arrival times of patients with stroke to the Emergency Room (ER) of a public hospital. To identify factors associated with early consultation. MATERIAL AND METHODS: A convenience sample, 583 patients aged 71 ± 13 years (55% males) consulting for stroke at an emergency room was analyzed in terms of delay between onset of symptoms and arrival to the ER, demographics and etiology of stroke. RESULTS: The admission diagnoses were ischemic stroke in 76%, intracerebral hemorrhage in 12%, transient ischemic attack in 9% and subarachnoid hemorrhage in 3%. The median time of arrival was 8 hours and 11 minutes after the onset of symptoms. Nineteen percent of consultations for ischemic stroke occurred within 3 hours of symptom onset, and 38% within 6 hours. In the logistic regression analysis, having an address near the hospital and the severity of stroke were associated with early consultation with a combined odds ratio of 5.97 (95% confidence intervals 3.23-11.04). CONCLUSIONS: There were significant differences in the arrival times of patients with stroke. Only a low proportion of patients with ischemic stroke consulted within the window for reperfusion therapies. Severe strokes and living near the hospital were associated with early consultation.

[Waiting times for neurological emergencies in an emergency room]. / Tiempos de atención de urgencias neurológicas en un hospital regional de alta complejidad.

BACKGROUND: Neurological emergencies constitute 10-15% of medical emergencies. Doctor Hernán Henríquez Aravena Hospital has in house neurologists present permanently at the Emergency Room since July 2013. AIM: To estimate the waiting times for neurological consultations; to compare the waiting times between neurovascular (UV) and non-vascular (UNV) emergencies; and to compare the waiting times of two prioritization (triage) models. MATERIAL AND METHODS: A convenience sample of the consultations made during shift # 1 at the emergency room between January and December 2016, was analyzed. RESULTS: There were 859 consultations in the period, 570 for UNV and 289 for UV. Mean age of consultants was 57 years and 52% were women. The median time for having an evaluation by a neurologist was 106 min (132 and 81 min for UNV and UV respectively). Twenty seven percent of patients were evaluated in less than one hour (23 and 36% of UNV and UV, respectively). The change of the prioritization model decreased the waiting time by 81 and 32 min for UNV and UV, respectively. CONCLUSIONS: There were significant differences in waiting times between neurovascular and non-vascular emergencies. Most patients were not evaluated in less than 60 minutes. The change in the initial stratification model was associated with a significant reduction in the waiting times for neurological emergencies.

Ultra-long (290 km) remote interrogation sensor network based on a random distributed feedback fiber laser.

In this work, an interferometric sensor has been interrogated 290 km away from the monitoring station, reaching the longest distance in fiber optic sensing up to date. This has been attained by employing a double-pumped random distributed feedback fiber laser as the light source for a fiber optic low-coherence interferometry scheme. Additionally, the capability of the system to achieve coherence multiplexing for ultra-long range measurements (up to 270 km) has been proved, without presenting crosstalk between the sensors. The use of coherence multiplexing together with a random distributed feedback fiber laser addresses two of the main limitations of long-range sensing setups: their limited multiplexing capability and the need to reach the maximum monitoring distance.

Tiempos de atención de urgencias neurológicas en un hospital regional de alta complejidad / Waiting times for neurological emergencies in an emergency room

Background: Neurological emergencies constitute 10-15% of medical emergencies. Doctor Hernán Henríquez Aravena Hospital has in house neurologists present permanently at the Emergency Room since July 2013. Aim: To estimate the waiting times for neurological consultations; to compare the waiting times between neurovascular (UV) and non-vascular (UNV) emergencies; and to compare the waiting times of two prioritization (triage) models. Material and Methods: A convenience sample of the consultations made during shift # 1 at the emergency room between January and December 2016, was analyzed. Results: There were 859 consultations in the period, 570 for UNV and 289 for UV. Mean age of consultants was 57 years and 52% were women. The median time for having an evaluation by a neurologist was 106 min (132 and 81 min for UNV and UV respectively). Twenty seven percent of patients were evaluated in less than one hour (23 and 36% of UNV and UV, respectively). The change of the prioritization model decreased the waiting time by 81 and 32 min for UNV and UV, respectively. Conclusions: There were significant differences in waiting times between neurovascular and non-vascular emergencies. Most patients were not evaluated in less than 60 minutes. The change in the initial stratification model was associated with a significant reduction in the waiting times for neurological emergencies.

Cirugía de rescate en casos de desplazamiento secundario crónico de la tuberosidad tibial anterior en la adolescencia: a propósito de un caso / Rescue surgery in cases of secundary chronic displatibialcement of the previus tuberosity in the adolescence. Case report

Objetivos: Presentar una nueva forma de fijación en recidivas de arrancamiento de la tuberosidad tibial anterior (TTA) en niños. Material y Métodos: Varón de 14 años intervenido tras sufrir epifisiolisis tipo III de TTA fijando el fragmento avulsionado con 2 tornillos. Cuatro meses después presentaba una importante pérdida de movilidad con atrofia cuadricipital debido a un nuevo arrancamiento de la TTA. Se reconstruyó con injerto hueso-tendón-hueso (HTH) y se fijó con dos placas Quad (proximal y distal) con 4 tornillos. Resultados: Cuatro meses después presenta flexoextensión completa y está comenzando el retorno a la actividad deportiva. Conclusión: El desplazamiento secundario crónico de una avulsión de la TTA supone una rara, aunque grave complicación en el tratamiento de las fracturas desplazadas de la TTA, que menoscaba la situación funcional del paciente y dificulta de forma considerable la reconstrucción del aparato extensor. La mayoría de ellas intervienen y son fijadas con agujas y cerclajes de alambre que, aunque efectivos, causan molestias al paciente y requieren su retirada. Presentamos una nueva forma de osteosíntesis: la placa Quad con cuatro tornillos que consigue una fijación estable sin molestias, reduciendo la necesidad de retirada

We report a case of physeal fracture type III of tibial anterior tuberosity (TTA) in a 14 years old boy who underwent surgery consisting on fixation with two screws. After 4 months, he presented with an inability to extend and quadricipital atrophy due to a new avulsion. He underwent reconstruction of the patellar tendon using a massive BTB allograft, which was fixated with a Quad plate and 4 screws. Four months after surgery, the patient had full range of extension and 95º of flexion and he is returning to sport activities. Secondary chronic TTA avulsion is a rare, but serious complication after displaced TTA fractures. They affect significantly to functional outcomes. Extensor system reconstruction is a challenging pro cedure. Most of them are fixed with wire cerclage that sometimes become symptomatic and a second surgery is required. We expose a new way of osteosynthesis: Quad plate with four screws provides stable fixation without hardware symptoms