Mortalidad en las primeras 48 horas del ingreso en un servicio de cirugía general y digestiva / Mortality in the first 4s hours of income in a general service and difestive surgery

Objetivo: Identificar las características clínicas y epidemiológicas de los pacientes quirúrgicos fallecidos dentro de las primeras 48 horas, parámetro considerado como "centinela" de la calidad asistencial en cirugía. Materiales y Método: Estudio observacional descriptivo y retrospectivo de los pacientes fallecidos antes de las 48 horas siguientes al ingreso en una planta de cirugía general y digestiva, durante el periodo comprendido entre enero del 2002 y diciembre del 2011. Se recogen variables demográficas, forma y diagnostico de ingreso, morbilidad asociada, riesgo quirúrgico y la actitud terapéutica. Excluimos a los pacientes fallecidos por traumatismos. Resultados: Desde enero del 2002 hasta diciembre del 2011 se realizaron 48716 ingresos, de los cuales fallecieron 417 pacientes (0,85%), de éstos, 28 pacientes fallecieron en las primeras 48 horas del ingreso (0,05%). La media de edad de éstos pacientes fue de 81 años (55-94), sin predominio de sexo. El 96% de los fallecidos provenían de ingresos de urgencias. La causa principal de muerte fue isquemia mesentérica aguda. El 89% de los pacientes presentaba alguna comorbilidad severa. El 75% de los fallecimientos se produjeron en los primeros 5 años del periodo estudiado. Conclusión: La mortalidad quirúrgica temprana se encuentra ligada a pacientes de edad avanzada, frágiles y a cirugía urgente. La excepcionalidad de la mortalidad postoperatoria temprana y la tipología de pacientes que la presentan, hace que este dato tenga escaso valor como criterio de calidad asistencial. En los últimos años ha disminuido el número de estas muertes lo que puede tener varias explicaciones

Aim: Early surgical mortality within the first 48 hours is a parameter used as "sentinel" of quality in surgery, so it is important to identify its clinical and epidemiological characteristics. Materials and Methods: We performed a descriptive, retrospective, observational study including patients who died within 48 hours of admission at a plant in general and digestive surgery, during the period between January 2002 and December 2011. Demographic variables were collected, mode of admission and diagnosis, comorbidity, surgical risk and therapeutic approach. We excluded patients who died of trauma. Results: From January 2002 to December 2011 were carried out 48,716 income, of which 417 patients died (0.85%) and 28 patients died within 48 hours of admission (0.057%). The average age of these patients was 81 years (55-94), there was no predominance of sex. 96% of those died within the first 48 hours had an emergency admission. The cause of death in half of the cases was acute mesenteric ischemia. 89,% of patients had a severe comorbidity (ASA III - IV). 75% of deaths occurred in the first 5 years of the study period. Conclusion: Early surgical mortality is linked to elderly patients with poor baseline health and emergency surgery. This uniqueness of early postoperative mortality and the type of patients who present it, makes this data of little value as a criterion of quality of care. The reduced early mortality in the most recent years may have several explanations

Central giant cell granuloma of the mandibular condyle: case-report

This case report describes a 19-year-old female patient with a central giant cell granuloma in the left mandibular condyle, treated with en bloc resection and reconstruction with fibula graft. This occurrence is considered very unusual.

Hábitos alimentarios de adultos mayores de dos regiones de la Provincia de Catamarca, Argentina / Older adults' eating habits in two regions of Catamarca, Argentina

Este trabajo describe los hábitos alimentarios en una población de adultos mayores de la Región Este (RE) y Región Oeste (RO) de la provincia de Catamarca, Argentina. Estudio epidemiológico, descriptivo y transversal en una muestra aleatoria (n=135) de adultos mayores (60-79 años) de ambos sexos. Para recolectar la información sobre hábitos alimentarios se construyó un cuestionario de frecuencia de consumo de alimentos (CFCA) cualitativo de una serie seleccionada de alimentos protectores y de riesgo, asociados a ECNT. La frecuencia se categorizó en: Nula; Alta; Moderada y Baja. La diferencia entre frecuencia de consumo de alimentos se cuantificó mediante el cálculo de proporciones con nivel de significación de 0,01. Para el tratamiento de los datos se empleó el paquete estadístico SPSS ( Statistical Package for the Social Science) para Windows versión 10,0 e InfoStat versión 2009 p Se observó que la población de la RO realiza una elección de alimentos más saludables, caracterizada por una mayor variedad y frecuencia de consumo diario de alimentos “protectores” con capacidad antioxidante, que el visto en el colectivo de la RE. Los alimentos de “riesgo”, ricos en carbohidratos simples y grasas saturadas, mostraron frecuencias de consumo similares entre ambas poblaciones. Los resultados no expresarían evidencias suficientes para relacionarlos independientemente con morbimortalidad por ECNT. Se ha postulado que los hábitos alimentarios adquiridos durante la infancia persisten en la edad adulta; sin embargo resulta particularmente importante, difundir que los adultos mayores adopten prácticas alimenticias y estilos de vida que minimicen el riesgo adicional de mala salud y potencien las perspectivas de un envejecimiento activo y saludable.

Hábitos alimentarios de adultos mayores de dos regiones de la Provincia de Catamarca, Argentina / Older adults eating habits in two regions of Catamarca, Argentina

Este trabajo describe los hábitos alimentarios en una población de adultos mayores de la Región Este (RE) y Región Oeste (RO) de la provincia de Catamarca, Argentina. Estudio epidemiológico, descriptivo y transversal en una muestra aleatoria (n=135) de adultos mayores (60-79 años) de ambos sexos. Para recolectar la información sobre hábitos alimentarios se construyó un cuestionario de frecuencia de consumo de alimentos (CFCA) cualitativo de una serie seleccionada de alimentos protectores y de riesgo, asociados a ECNT. La frecuencia se categorizó en: Nula; Alta; Moderada y Baja. La diferencia entre frecuencia de consumo de alimentos se cuantificó mediante el cálculo de proporciones con nivel de significación de 0,01. Para el tratamiento de los datos se empleó el paquete estadístico SPSS ( Statistical Package for the Social Science) para Windows versión 10,0 e InfoStat versión 2009 p Se observó que la población de la RO realiza una elección de alimentos más saludables, caracterizada por una mayor variedad y frecuencia de consumo diario de alimentos ¶protectores÷ con capacidad antioxidante, que el visto en el colectivo de la RE. Los alimentos de ¶riesgo÷, ricos en carbohidratos simples y grasas saturadas, mostraron frecuencias de consumo similares entre ambas poblaciones. Los resultados no expresarían evidencias suficientes para relacionarlos independientemente con morbimortalidad por ECNT. Se ha postulado que los hábitos alimentarios adquiridos durante la infancia persisten en la edad adulta; sin embargo resulta particularmente importante, difundir que los adultos mayores adopten prácticas alimenticias y estilos de vida que minimicen el riesgo adicional de mala salud y potencien las perspectivas de un envejecimiento activo y saludable.(AU)

[Quality and health care reform in Latin America and the Caribbean]. / La calidad y la reforma del sector de la salud en América Latina y el Caribe.

Improving the quality of basic health services, together with the search for equity, efficiency, sustainability, and social participation, has been one of the guiding principles of health sector reform initiatives ever since the I Summit of the Americas was held in 1994. This article addresses some basic concepts, examines the status of quality control within health systems and services in Latin America and the Caribbean, and analyzes the most important trends observed in the Region in the establishment of quality assurance programs. Finally, ways of improving and monitoring quality continuously and sustainable are recommended.

[Essential functions of public health: emerging topic in health care reform]. / Las funciones esenciales de la salud pública: un tema emergente en las reformas del sector de la salud.

In the Americas, health sector reforms are facing the challenge of strengthening the steering and leadership role of health authorities. An important part of that role consists of fulfilling the essential public health functions (EPHFs) that are incumbent on all levels of government. For that, it's crucial to improve public health practice, as well as the instruments used to assess the current state of public health practice and the areas where it needs to be strengthened. For that purpose, the Pan American Health Organization has started an initiative called "Public Health in the Americas," with the objective of defining and measuring EPHFs, as a way of improving public health practice and strengthening the leadership provided by health authorities at all levels of government. This article summarizes conceptual and methodological aspects of defining and measuring EPHFs. The article also analyzes the implications that measuring performance on these public health roles, responsibilities, and activities would have for improving public health practice in the Americas.

Long-term results of limb salvage with the Fabroni custom made endoprosthesis.

In 1972 the authors began working on a limb amputation method using custom endoprostheses. Because of the biomechanical characteristics of these prostheses, good long-term results have been achieved. The current study presents the analysis of 27 cases, including 11 total femoral replacements, with a followup between 10 to 24 years (median, 14.4 years), with an overall score of 75% using the International Symposium On Limb Salvage evaluation system. Analyzing this surviving group, the authors realize that proximal humerus and proximal femur prosthesis with total or partial joint replacement have better scores of prosthetic survival, limb function, and patient acceptance and the lowest rates of mechanical complications. However, the replacement involving the knee had more complications and worse scores. The authors conclude that the simplest prosthetic design implanted had the fewest intrinsic prosthetic complications. Reducing the stiffness of a prosthesis and increasing the range of movement of the joint involved decreasing the stress forces between the prosthesis and the bone. This may have contributed to the favorable outcomes reported in the series.

The effects of volcanoes on health: preparedness in Mexico.

The article reviews the most important aspects of volcanic eruptions and presents a summary of the harmful materials they emit. The main health effects can be classified as either physical (trauma, respiratory diseases, etc.) or psychological (depression, anxiety, nightmares, neurosis, etc.). Popocatépetl, the most famous active volcano in Mexico, lies on the borders of the States of Mexico, Puebla and Morelos. In 1993, seismic activity intensified, as did as the emission of fumaroles, followed in December 1994 by moderate tremors and strong emissions of gases and ash. In 1996, a number of seismic events led to an unexpected explosion. A daily emission of 8,000 to 15,000 tonnes of sulfur dioxide has been measured. Popocatépetl is located in a densely populated region of Mexico. A complex network to monitor the volcano using sophisticated equipment has been set up, including visual surveillance, seismic, geochemical and geodesic monitoring. An early warning system (SINAPROC/CENAPRED) has been developed to keep the population permanently informed. The warning system uses colour codes: green for normal, yellow for alert, and red for warning and evacuation. An emergency plan has been prepared, including evacuation and preparation for medical centres and hospitals in the region, as well as intense public information campaigns.

Renal hemodynamics and water excretion in Addison's disease.

Patients with Addison's disease have impaired ability to excrete free water. The mechanism of this defect is still not clear. These experiments were designed to help clarify the role of altered renal hemodynamics in the genesis of the defect. Six patients with Addison's disease were studied. Enough salt and water was administered to maintain adequate hydration throughout the study but no hormonal replacement was instituted. After a water load, the urine output (V), free water clearance (CH2O), sodium excretion (UNaV), total solute clearance (COsm), inulin clearance (CIn), and para-aminohippurate clearance (CPAH) were measured by standard clearance techniques. In the control studies V and CH2O were abnormally low. The studies were repeated after administration of DOCA, 2.5 mg daily, for a week. This medication decreased UNaV and improved the plasma electrolyte profile but did not cause a significant change in V, CH2O, GFR, or RPF. The same studies were repeated once more after administration of prednisone, 5 mg daily in divided doses, for a week. This drug induced a marked water diuresis while GFR and RPF remained unchanged. It is concluded that hypovolemia and altered renal hemodynamics are not the only mechanisms of the impaired water excretion in Addison's disease. A severe defect remains after normalization of hypovolemia and this is corrected by prednisone but not by DOCA, through mechanisms which do not involve changes in GFR or RPF.