Fresado de hueso temporal: modelo de bajo costo y aplicación sencilla / Temporal bone drilling: low-cost and easy-to-use model

Introducción: Desarrollar y potenciar las habilidades neuroquirúrgicas que se requieren en la disección del hueso temporal aplicado a la realización de abordajes quirúrgicos transtemporales, a través de modelos de bajo costo y aplicación sencilla. Materiales y métodos: Trabajamos sobre huesos temporales secos, con insumos hospitalarios descartables y con materiales básicos obtenidos en ferreterías. Se identificaron con silicona y teflón coloreados con acrílico, estructuras vasculares y nerviosas que forman los principales reparos anatómicos y se utiliza material sintético de látex adherido a la superficie endocraneal para recrear duramadre. Realizamos un estudio exhaustivo del hueso temporal con las diferentes estructuras anatómicas íntimamente relacionadas con él, abordándolo desde diferentes vistas. Una vez familiarizados con la anatomía, se ensayan abordajes neuroquirúrgicos y disecciones anatómicas profundizando el conocimiento sobre las estructuras relevantes no visibles previa a la disección. Discusión: En la formación neuroquirúrgica no solo importa el conocimiento teórico, sino que se requiere praxis eficaz aplicada al mismo y se logra sólo a través de auténticas experiencias, la cual da al practicante, la oportunidad de ensayar aspectos de un abordaje para lograr competencia previa a su aplicación en el paciente. Conclusión: El residente puede utilizar esta técnica de fácil acceso y bajo costo para realzar su experiencia de aprendizaje anatómico y fresado de huesos temporales y así poder discutir aspectos y ensayar un abordaje previo a una cirugía.

Introduction: Develop and enhance the neurosurgical skills required for temporal bone drilling applied to transtemporal surgical approaches through low cost and simple application models. Materials and methods: We worked on dry temporal bones with disposable hospital supplies and basic materials obtained in hardware stores. Vascular and nervous structures that form the main anatomical structures are identified with silicone and Teflon colored with acrylic and synthetic latex material is attached to the endocranial surface to recreate the dura mater. We carried out an exhaustive study of the temporal bone with the different anatomical structures intimately related to it, approaching it from different views. Once familiarized with the anatomy, neurosurgical approaches and anatomical dissections are practiced, increasing the understanding of the relevant structures not visible prior to dissection. Discussion: During neurosurgical training theoretical knowledge is not the only domain that matters, rather effective praxis applied to i t is needed and achieved only through authentic experiences, which gives the practitioner the opportunity to examine aspects of an approach in order to achieve expertise prior to its application to the patient. Conclusion: The resident can use this accessible and low cost technique to enhance their experience in anatomical learning and temporal b ones drilling and therefore, be able to discuss certain aspects and practice an approach prior to surgery.

Changes in HIV/AIDS knowledge among early adolescents in Puerto Rico.

INTRODUCTION: One of the factors that influences HIV risk behavior among early adolescents is their HIV/AIDS knowledge. The objectives of this study were 1) to describe the sociodemographic features and HIV/AIDS knowledge among Puerto Rican early adolescents participating in the ASUMA (A Supportive Model for HIV Risk Reduction in Early Adolescents) project; and 2) to assess changes in the knowledge of HIV/AIDS within the intervention and nonintervention groups after the first year of the study. METHODS: This is a prospective cohort study of 173 early adolescents after 12 months of participation in the ASUMA project. The setting of the study was four junior high schools. Baseline and follow-up self-administered questionnaires were issued to the entire study group. The first workshop was developed directed to increase HIV/AIDS knowledge and decrease vulnerability in the group assigned to the intervention. Descriptive and inferential analyses were performed. RESULTS: 47% of adolescents were cases and 52.6% controls. Most adolescents were 12 years old; 50.3% were boys and 49.7% were girls; 78.6% believe that they could have a good conversation with their parents; and 26.3% reported alcohol use at any time in their lives. A significant increase in HIV/AIDS knowledge was found among adolescents from the intervention group (P < .001), while a nonsignificant increase was found among control adolescents. CONCLUSIONS: An increase in HIV/AIDS knowledge was observed among adolescents who participated in the first year of the ASUMA project. This study illustrates the importance of the creation of culturally appropriate instruments and interventions to reduce HIV infection in adolescents.

Perception of parents regarding their children's weight.

BACKGROUND: The prevalence of overweight and obesity in 2003 was 63.6% in P.R. and 60.1% in USA. An overweight school-aged child with an obese parent has over 70% chance of being obese in young adulthood. OBJECTIVES: To study perceptions of parents about their children's weight and to determine which factors are associated with parent's failure to perceive when their children are overweight. METHODS: Cross sectional survey, the sample was population of children and their parents, selected by availability, between 4-12 years old in elementary schools (private and public schools), N=234. The instrument was a self-administered questionnaire of 23 questions. SSPS version 10.0 was used for analysis with significance of p<0.05. RESULTS: 51% of parents perceived themselves overweight while they perceived their children in adequate weight (62%), so they don't get professional help. There's no significant difference between genders and schools. The study revealed that children's weight follows the role modeling of their parents (p<0.001). In BMI curve (>85%) showed that 84.3% children have at least one parent with overweight (ow) or obesity (ob) while 15.7% children have no parent with ow/ob (p<0.05). Study showed that 33% of parents do nothing about their children's weight. Parents consider themselves to be responsible for childhood obesity. CONCLUSIONS: The majority of the parents does not perceive their children at risk of becoming overweight or be overweight, so they do not get help early.

A comparison of the sociodemographic, risk-behavior, and substance-abuse profile of young vs older HIV-infected Puerto Rican patients.

INTRODUCTION: As of May 2003, 17% of all reported AIDS cases in Puerto Rico had occurred among those 20-29 years of age. These individuals were likely initially infected with HIV in adolescence. The objectives of this study are to describe and compare the prevalence of the sociodemographic, risk-behavior, and substance-use profile among patients infected with HIV during their adolescence (early) and compare them with patients infected at an older age (non-early). METHODS: This is a cross-sectional study of 3151 HIV/AIDS patients admitted to the retrovirus research center of our institution between 1992 and 2002. The variables we studied include the presence or absence of early infection, sociodemographic variables, risk-behavior variables, and substance-use variables. An early-infected patient was defined as a patient with HIV/AIDS that reported his or her first positive HIV test result before the age of 21 years. Descriptive and differential analyses were performed. RESULTS: Five percent of our patients were early-infected (157/3151). A significantly higher proportion (P < or = .05) among the early-infected patients as compared to the older group was females, required inpatient hospital care at the time of study entry, and had less than a 12th-grade education. In the interview a significantly higher proportion had antisocial behavior, had been in prison at some point in their life, and had used crack-cocaine. CONCLUSIONS: The early HIV-infected patients showed a different sociodemographic, risk-behavior, and substance-use profile. Knowledge of the specific characteristics of early HIV-infected patients could be used to develop primary prevention programs directed toward reducing HIV infection among young Puerto Ricans.

Prognostic factors in patients with IVDA and bacteremia

The medical records of all the patients with bacteremia and recent use of illicit intravenous drugs admitted to Hospital Universitario Ramón Ruíz Aranau from January 1, 1988 to June 30, 1989 were reviewed. It consisted of 28 records, 21 of which were male patients and 7 females. The mortality rate among these patients was 46%. Staphhylococcus aureus was the most common pathogen recovered from blood cultures. All the S. aureus were methicillin sensitive. The presence of clinical sepsis, a low Karnofsky performance status at the time of admission and multiorgan abnormalities were the most important prognostic factors that determined outcome in these patients