Parallel oxygenators in the same circuit for refractory hypoxemia on veno-venous extracorporeal membrane oxygenation. A 3-patient series.

Extracorporeal membrane oxygenator (ECMO) is a well-established therapy for respiratory failure. Refractory hypoxemia, despite the use of ECMO, remains a challenging problem. The ECMO circuit may not provide enough oxygenation support in the presence of high cardiac output, increased physiologic demand, and impaired gas exchange. Adding a second ECMO oxygenator using the same pump (sometimes needing a second drainage cannula) can improve oxygenation and facilitate lung-protective ventilation in selected patients. We describe a 3-patient series with severe ARDS secondary to SARS-CoV-2 infection and refractory hypoxemia during ECMO support successfully treated with this approach.

Small bowel obstruction following laparoscopic Roux-en-Y gastric bypass: is it always necessary to operate? A 5-year, high volume center experience.

PURPOSE: This study aims to describe the incidence, associated factors, etiology, and management of small bowel obstructions following laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS: A retrospective analysis was conducted between January 15 and December 19 using the surgery database of our hospital. Included LRYGB patients were those that evolved with a prolonged length of stay; readmission; emergency room consult; and re-intervention due to small bowel obstruction (SBO) related symptoms with compatible radiological or intraoperative findings. The LRYGB technique implied an antecolic alimentary limb reconstruction and systematic closure of mesenteric defects. Descriptive and analytical statistics were carried out, using a parametric or non-parametric approach as needed. RESULTS: Nine hundred forty-one LRYGB were performed. 9.9% were revisional surgeries of patients with a laparoscopic sleeve gastrectomy. During the study period, 36 SBOs occurred, representing 3.8% of operated patients, with no mortality. 58.3% had successful non-operative management, while 41.7% required surgical exploration, of which 73.3% were treated laparoscopically and 20% needed conversion to open surgery. Etiologies of SBO were jejuno-jejunostomy (JJO) related stenosis (22, 61.1%), internal hernias (6, 16.7%), adherences (3, 8.3%), and other diagnoses (5, 13.9%). Regarding JJO stenosis and internal hernias, median time to diagnosis was 8 days (IQR 7-11) and 12 months (IQR 8.7-16) respectively. Previous sleeve gastrectomy, age, or sex was not associated to the incidence of small bowel obstruction. CONCLUSIONS: LRYGB is safe when performed by experienced surgeons. SBO due to internal hernias were scarce in this series. JJO stenosis could explain most cases of SBO; under this diagnosis, non-surgical management was successful frequently.

SARS-CoV-2 infection in asymptomatic healthcare workers at a clinic in Chile.

Asymptomatic SARS-CoV-2 infection of healthcare workers (HCWs) has been reported as a key player in the nosocomial spreading of COVID-19. Early detection of infected HCWs can prevent spreading of the virus in hospitals among HCWs and patients. We conducted a cross-sectional study to determine the asymptomatic infection of HCWs in a private clinic in the city of Santiago, Chile. Our study was conducted during a period of 5 weeks at the peak of transmission of SARS-CoV-2 in Chile. Nasopharyngeal samples were obtained from 413 HCWs and tested for the presence of SARS-CoV-2 using RT-qPCR. We found that a 3.14% of HCWs were positive for the presence of SARS-CoV-2 (14/413). Out of these, 7/14 were completely asymptomatic and did not develop symptoms within 3 weeks of testing. Sequencing of viral genomes showed the predominance of the GR clade; however, sequence comparison demonstrated numerous genetic differences among them suggesting community infection as the main focus of transmission among HCWs. Our study demonstrates that the protocols applied to protect HCWs and patients have been effective as no infection clusters due to asymptomatic carriers were found in the clinic. Together, these data suggest that infection with SARS-CoV-2 among HCWs of this health center is not nosocomial.

El medio ambiente sano como derecho fundamental en Colombia / A healthy environment as a fundamental right in Colombia

El presente trabajo investigativo tiene por objetivo defender la tesis que el medio ambiente sano se ha configurado en la práctica y con suficientes bases teórico normativas como un derecho fundamental en el sistema jurídico colombiano; no solo por las decisiones que sobre él han tomado las altas cortes, sino además por la gran defensa que sobre él se hace en diferentes instrumentos internacionales. Se observarán tanto fuentes legales como doctrinarias con el objetivo de mostrar esta naturaleza (AU)

The present article aims to defend the thesis that the healthy environment has been configured in practice and with sufficient theoretical and normative bases as a fundamental right in the Colombian legal system, not only because of the decisions that the High Courts have made about it. but also for the great defense that it is done in different international instruments. Both legal and doctrinal sources will be observed to show this nature (AU)

El present article té per objectiu defensar la tesi que el medi ambient sa s'ha configurat en la pràctica i amb suficients bases teòric normatives com un dret fonamental en el sistema jurídic colombià; no només per les decisions que sobre ell han pres les altes corts, sinó a més per la gran defensa que sobre ell es fa en diferents instruments internacionals. S'observaran tant fonts legals com doctrinàries amb l'objectiu de mostrar aquesta naturalesa (AU)

Prevención en la transmisión de Coronavirus-19: ¿qué tan preparado está el personal de salud en Chile?

Background: COVID-19 is highly transmissible, thus requiring strict measures to prevent its propagation. Aim: To report a survey about self-reported adherence to recommendations aimed to reduce the transmission of COVID-19, among health care personnel. Material and Methods: A cross-sectional survey among health professionals about adherence to recommendations to prevent COVID-19 transmission was carried out in a public hospital in Chile. The survey had 11 questions and was developed using Delphi methodology, according to the recommendations of the World Health Organization and the Centers for Disease Control. Results: The survey was answered by 137 of 155 invited workers. Hand washing, use of personal protection equipment, use of the elbow or tissue to sneeze, out-of-hospital hand washing and exclusive use of the uniform in the hospital, had an adherence of over 90%. The adherence to face touching avoidance during working hours, and face mask use in the public areas, was over 50%. No statistical differences were observed between gender or professionals. Conclusions: The adherence reported by health care workers was adequate in most of the evaluated recommendations.

[Adherence to COVID-19 trasmission prevention measures among health care workers]. / Prevención en la transmisión de Coronavirus-19: ¿qué tan preparado está el personal de salud en Chile?

BACKGROUND: COVID-19 is highly transmissible, thus requiring strict measures to prevent its propagation. AIM: To report a survey about self-reported adherence to recommendations aimed to reduce the transmission of COVID-19, among health care personnel. MATERIAL AND METHODS: A cross-sectional survey among health professionals about adherence to recommendations to prevent COVID-19 transmission was carried out in a public hospital in Chile. The survey had 11 questions and was developed using Delphi methodology, according to the recommendations of the World Health Organization and the Centers for Disease Control. RESULTS: The survey was answered by 137 of 155 invited workers. Hand washing, use of personal protection equipment, use of the elbow or tissue to sneeze, out-of-hospital hand washing and exclusive use of the uniform in the hospital, had an adherence of over 90%. The adherence to face touching avoidance during working hours, and face mask use in the public areas, was over 50%. No statistical differences were observed between gender or professionals. CONCLUSIONS: The adherence reported by health care workers was adequate in most of the evaluated recommendations.

[Cytarabine and hematopoietic cell transplantation for mantle cell lymphoma. Analysis of 20 patients]. / Resultados de pacientes con linfoma del manto: impacto de terapias basadas en citarabina y trasplante hematopoyético.

BACKGROUND: Mantle cell lymphoma (MCL) has high relapse and mortality rates. There is a survival benefit when treatment is intensified with cytarabine (AraC), hematopoietic cell transplantation (HCT) and maintenance with rituximab. AIM: To assess the outcomes of patients with MCL treated in a university hospital. MATERIAL AND METHODS: Review of an oncology center database and medical records identifying patients with MCL treated between 2006 and 2017. Death dates were obtained from the death certificate database of the National Identification Service. We analyzed the response rate, overall survival (OS) and progression-free survival (PFS). As a secondary objective, the survival impact of AraC, HCT and maintenance with rituximab, was also analyzed. RESULTS: Information on 20 patients aged 62 ± 11 years, followed for a median of 45 months was retrieved. Eighty-five percent were diagnosed at an advanced stage. The most used first-line regime was R-CHOP in 11 patients, followed by R-HyperCVAD in five. Only 47% achieved complete response. 4-year PFS and OS were of 30 and 77% respectively. Mantle Cell Lymphoma International Prognostic Index (MIPI) significantly predicted PFS and OS. Maintenance with rituximab or HCT was associated with better PFS (48 vs 21 months, p < 0.01). The exposure to AraC or HCT, in refractory or relapsed disease, was associated with an increase in PFS from 9 to 28 months (p = 0,02) and 4-year OS from 40 to 100% (p = 0.05). OS increased even more, from 25 to 100% in those with high-risk MIPI (p = 0.04). CONCLUSIONS: The incorporation of AraC, HCT and maintenance with rituximab in the therapeutic backbone of MCL, especially for high-risk cases, was associated with improved survival.

Resultados de pacientes con linfoma del manto: impacto de terapias basadas en citarabina y trasplante hematopoyético / Cytarabine and hematopoietic cell transplantation for mantle cell lymphoma: analysis of 20 patients

Background: Mantle cell lymphoma (MCL) has high relapse and mortality rates. There is a survival benefit when treatment is intensified with cytarabine (AraC), hematopoietic cell transplantation (HCT) and maintenance with rituximab. Aim: To assess the outcomes of patients with MCL treated in a university hospital. Material and Methods: Review of an oncology center database and medical records identifying patients with MCL treated between 2006 and 2017. Death dates were obtained from the death certificate database of the National Identification Service. We analyzed the response rate, overall survival (OS) and progression-free survival (PFS). As a secondary objective, the survival impact of AraC, HCT and maintenance with rituximab, was also analyzed. Results: Information on 20 patients aged 62 ± 11 years, followed for a median of 45 months was retrieved. Eighty-five percent were diagnosed at an advanced stage. The most used first-line regime was R-CHOP in 11 patients, followed by R-HyperCVAD in five. Only 47% achieved complete response. 4-year PFS and OS were of 30 and 77% respectively. Mantle Cell Lymphoma International Prognostic Index (MIPI) significantly predicted PFS and OS. Maintenance with rituximab or HCT was associated with better PFS (48 vs 21 months, p < 0.01). The exposure to AraC or HCT, in refractory or relapsed disease, was associated with an increase in PFS from 9 to 28 months (p = 0,02) and 4-year OS from 40 to 100% (p = 0.05). OS increased even more, from 25 to 100% in those with high-risk MIPI (p = 0.04). Conclusions: The incorporation of AraC, HCT and maintenance with rituximab in the therapeutic backbone of MCL, especially for high-risk cases, was associated with improved survival.

Automedicación en la región interandina norte del Ecuador: una práctica usual / Self-medication in the northern interandean region of Ecuador: a usual practice

Introducción: define la automedicación al uso inadecuado de medicamentos y sin prescripción médica; se la practica como medida de autocuidado. En Ecuador, la prevalencia reportada es del 36,5% y está relacionada a edad, género y grado de instrucción académica. Objetivo: determinar la prevalencia de automedicación en el sector norte de la región interandina del Ecuador, año 2018. Métodos: En el presente estudio de tipo transversal se encuestaron a 2623 sujetos que acu- dieron a farmacias de cinco provincias del sector norte de la región interandina para adquirir medicamentos sin receta médica, previo a la aplicación de la encuesta se solicitó su consentimiento de forma verbal. La base de datos se estructuró en el programa Excel© versión 10 y el análisis estadístico se realizó con el paquete SPSS© versión 24. Resultados: el 54,4% de los encuestados adquirieron los medicamentos sin prescripción médica. La prevalencia de automedicación fue mayor en mujeres (53,8%), sin relación estadística significativa entre el sexo femenino y frecuencia de automedicación (OR 0,9; IC: 0,8­1,1). Los AINEs fueron los medicamentos más adquiridos sin prescripción médica (26,9%) seguido de un analgésico (paracetamol, 11,2%). Conclusión: más de la mitad de los sujetos de las cinco provincias del sector norte de la región interandina se automedica; de ellos, 8 de cada 10 adquieren sin receta médica fármacos en farmacias distantes a unidades de salud.

Context: Self-medication is an inappropriate use of medications; it is usually practiced as a selfcare measure. In Ecuador, the reported prevalence is 36.5% and it is related to age, gender and level of education. Objective: To determine the prevalence of selfmedication in the northern sector of the interAndean region of Ecuador, year 2018. Methods: Epidemiological, observational, cross-sectional study in which 2623 subjects who went to pharmacies in five provinces of the northern sector of the inter-Andean region were surveyed to acquire non-prescription medications, just before applying the verbally consented survey. The database was structured in the Excel © version 10 program and the statistical analysis was performed with the SPSS © version 24 package. Results: 54.4% of the surveyed acquired the medications without a prescription. The prevalence of self-medication was higher in women (53.8%), with no significant statistical relationship between female sex and frequency of self-medication (OR 0.9; CI: 0.8­1.1). NSAIDs were the most commonly acquired medications without a prescription (26.9%) followed by an analgesic (paracetamol, 11.2%). Conclusion: More than half of the subjects analyzed of the five provinces of the northern sector of the highland region of Ecuador self-medicate; of these, 8 out of 10 acquire drugs without a prescription from pharmacies distant from healthcare facilities.