Sinus pericranii: diagnóstico precoz en el lactante / Sinus pericranii: early infant diagnosis

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Resultados globales en un hospital privado sobre su modelo de gestión quirúrgica / Global results in a private hospital on its management model in day surgery an inpatient surgery

Introducción: El entorno actual pone de manifiesto la necesidad de encontrar modelos de gestión sanitaria con calidad, eficientes y seguros. Las unidades de cirugía mayor ambulatoria se han convertido en un modo de gestionar parte de la actividad quirúrgica con esas características. Actualmente, sin una forma de acreditarlas oficialmente, existen variaciones sobre unas recomendaciones mínimas, originando diferentes modelos, consecuencia de adaptar dicha gestión quirúrgica a las especiales características que cada centro hospitalario tiene. Material y métodos: Proponemos en el presente trabajo nuestro particular modelo de gestión quirúrgica, nacido de nuestras circunstancias, junto a los principales indicadores objetivos de actividad y de calidad, y que han originado el reconocimiento por parte de una auditoría externa tras valorar a 163 centros hospitalarios, de una manera voluntaria, gratuita y confidencial y en todo el territorio nacional. Resultados: Nuestro modelo de gestión quirúrgica que integra, tanto la cirugía sin ingreso como la ambulatoria, basado en modelos de actuación coordinados sobre la misma estructura física y organizativa ha propiciado que un hospital, de tan solo 90 camas, consiga realizar 17.366 intervenciones anuales en base a una tasa bruta de ambulatorización del 78-80 %, con unos índices de calidad superiores a la media de otros hospitales, de similares características; una tasa bruta de mortalidad del 1,3 (0,802 si la ajustamos por riesgo), una tasa de complicaciones del 1,7 (1,04 si la ajustamos por riesgo) y una tasa de readmisiones (..) (AU)

Introduction: The actual environment outlines the need of finding high quality management models that are efficient and safe. Ambulatory surgery facilities have become a way of managing part of the surgical activity with such features. Nowadays, with no means of formal accreditation, multiple variations exist on what should be considered minimum recommendations for this type of facility. This results in different models, as a consequence of adapting such surgical management to the special features that each hospital possesses. Materials and method: In our present study, we present our own surgical management model, adapted to fit our circumstances. We also present main objective quality indicators for surgical activity that have earned us recognition from an external audit that assessed 163 hospital facilities voluntarily, confidentially and wantonly across the country . Results: Our surgical management model includes day surgery and inpatient surgery and is based on performance models coordinated on the same physical and organizational structure. This has enabled a hospital facility of only 90 beds to achieve 17,366 surgeries a year, with a gross rate of ambulatory surgery of 70-80% and with quality indicators above the majority (..) (AU)

Response entropy changes after noxius stimulus.

Small changes in the frequency of the electromyography could reflect an inadequate anesthetic or analgesic level, and it could be more specific than the hemodynamic monitors. The Datex-Ohmeda S/5 Entropy Module includes information about the electromyographic activity of the face muscles (response entropy--RE). The aim of our study is compare entropy and BIS ability to detect a nociceptive stimulus during a sevoflurane anesthesia. We designed an observational, prospective and descriptive study that included 20 patients. We performed sevoflurane anaesthesia induction, the end-tidal was kept at 3 and 4 %, during 15 min at each concentration, with no analgesic drug and no neuromuscular blocking agent, and we applied a nociceptive stimulus: tetanus 100 Hz, during 5 s. We set the standard monitorization, BIS, RE, and state entropy (SE) along the study. There was a significant difference between RE and SE post-noxious stimulus values at 3 and 4 % end-tidal sevoflurane (p < 0.05). Only RE changed significantly at the moment of the noxious stimulation at both sevoflurane concentrations studied (p < 0.05). In patients under general anesthesia only carried out with sevoflurane at concentrations that inhibit the movement to painful stimuli, the RE is a single parameter able to detect variations after the nociceptive stimulation.

Divergence between sympatric rice- and maize-infecting populations of Rhizoctonia solani AG-1 IA from Latin America.

ABSTRACT The basidiomycetous fungus Rhizoctonia solani anastomosis group (AG)-1 IA is a major pathogen in Latin America causing sheath blight (SB) of rice. Particularly in Venezuela, the fungus also causes banded leaf and sheath blight (BLSB) on maize, which is considered an emerging disease problem where maize replaced traditional rice-cropping areas or is now planted in adjacent fields. Our goals in this study were to elucidate (i) the effects of host specialization on gene flow between sympatric and allopatric rice and maize-infecting fungal populations and (ii) the reproductive mode of the fungus, looking for evidence of recombination. In total, 375 isolates of R. solani AG1 IA sampled from three sympatric rice and maize fields in Venezuela (Portuguesa State) and two allopatric rice fields from Colombia (Meta State) and Panama (Chiriquí State) were genotyped using 10 microsatellite loci. Allopatric populations from Venezuela, Colombia, and Panama were significantly differentiated (Phi(ST) of 0.16 to 0.34). Partitioning of the genetic diversity indicated differentiation between sympatric populations from different host species, with 17% of the total genetic variation distributed between hosts while only 3 to 6% was distributed geographically among the sympatric Venezuelan fields. We detected symmetrical historical migration between the rice- and the maize-infecting populations from Venezuela. Rice- and maize-derived isolates were able to infect both rice and maize but were more aggressive on their original hosts, consistent with host specialization. Because the maize- and rice-infecting populations are still cross-pathogenic, we postulate that the genetic differentiation was relatively recent and mediated via a host shift. An isolation with migration analysis indicated that the maize-infecting population diverged from the rice-infecting population between 40 and 240 years ago. Our findings also suggest that maize-infecting populations have a mainly recombining reproductive system whereas the rice-infecting populations have a mixed reproductive system in Latin America.

Infección por Staphylococcus aureus resistente a meticilina de origen comunitario con transmisión intrafamiliar / No disponible

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[The effect of age in a planning and arranging task ('Mexican pyramid') among schoolchildren]. / Efecto de la edad en una tarea de planificación y organización ('pirámide de México') en escolares.

AIM: To analyze the influence of age on the performance of a planning and organization task, two skills included in the executive functions. SUBJECTS AND METHODS: Performance of the task 'Mexican pyramid' from the Evaluacion Neuropsicologica Infantil (ENI) were analyzed on 239 school age children from México and Colombia, distributed in six age groups. Five measures were analyzed: number of correct designs, number of movements per design and execution time in the correct designs, number of correct designs built with the minimum of movements and its execution time. RESULTS: There was a significant effect of age on the five measures. Comparison between groups showed that younger children (5 to 6 years old) had a smaller number of correct designs, while children from 5 to 8 years old need more movements. Execution time showed a greater number of differences between groups. Analyzing the 11 items of the task, it was evident that difficulty level is related with the number of movements and the novelty of rules. CONCLUSIONS: Our results suggest that accuracy of performance, the number of moves as well as the speed of performance are useful markers of the development of the executive functions. Our results support the notion that the development of planning and organization; is fast in the first years of the school age, and it slows down on adolescence.

Efecto de la edad en una tarea de planificación y organización (‘pirámide de México’) en escolares / The effect of age in a planning and arranging task (‘Mexican Pyramid’) among school children

Objetivo. Conocer los cambios relacionados con la edad en una tarea de planificación y organización, como componentes de las funciones ejecutivas. Sujetos y métodos. Se analizó la ejecución en la ‘pirámide de México’ de la evaluación neuropsi-cológica infantil en 239 escolares de México y Colombia de 5 a 16 años de edad, distribuidos en seis grupos. Se utilizaron cinco medidas: número de aciertos, número de movimientos y tiempo de ejecución en los diseños correctos, número de aciertos y tiempo de ejecución en los diseños correctos realizados con el mínimo de movimientos. Resultados. Se observó un efecto de la edad sobre las cinco medidas. En comparación con los otros grupos, los niños de 5 a 6 años tienen una menorcantidad de diseños correctos; los de 5 a 8 años requieren mayor número de movimientos. El tiempo de ejecución mostró un mayor número de diferencias intragrupales. El análisis por ensayo reveló que el grado de dificultad se relaciona con la cantidadde movimientos y lo novedoso de las reglas. Conclusiones. Además del número de aciertos y de movimientos invertidos para lograr cada acierto, el tiempo de ejecución es un indicador útil del desarrollo de estas funciones, dado que la rapidez enla ejecución es la que marca diferencias mayores entre los niños. Nuestros resultados apoyan la existencia de un desarrollo acelerado de las funciones de planificación y organización durante los primeros años de la etapa escolar, que sigue un cursomás lento en la adolescencia

Aim. To analyze the influence of age on the performance of a planning and organization task, two skills includedin the executive functions. Subjects and methods. Performance of the task ‘Mexican pyramid’ from the Evaluación Neuropsicológica Infantil (ENI) were analyzed on 239 school age children from México and Colombia, distributed in six age groups.Five measures were analyzed: number of correct designs, number of movements per design and execution time in the correct designs, number of correct designs built with the minimum of movements and its execution time. Results. There was a significant effect of age on the five measures. Comparison between groups showed that younger children (5 to 6 years old) hada smaller number of correct designs, while children from 5 to 8 years old need more movements. Execution time showed a greater number of differences between groups. Analyzing the 11 items of the task, it was evident that difficulty level is related with the number of movements and the novelty of rules. Conclusions. Our results suggest that accuracy of performance, the number of moves as well as the speed of performance are useful markers of the development of the executive functions. Our results support the notion that the development of planning and organization; is fast in the first years of the school age, and it slows down on adolescence

Seguridad eléctrica en quirófano / No disponible

En nuestra actividad profesional diaria es básica la anticipación y conocimiento del entorno donde se ejerce. Los hipotéticos problemas anestésicos que puedan surgir en quirófano deben ser conocidos, detectados y corregidos cuanto antes para una satisfactoria resolución. Dentro del hospital, es el quirófano uno de los lugares donde es mayor la implicación de los sistemas eléctricos; tanto por su suministro, como por la gran cantidad de aparataje que depende de él con las consiguientes implicaciones de su mal funcionamiento. Dichas implicaciones son extrapolables a unidades de recuperación postoperatorias, salas de cuidados críticos,... Dichas complicaciones son muy temidas por los anestesiólogos, tanto por su desconocimiento como por su potencial lesivo. Se pretende realizar una revisión de conceptos básicos de electricidad, qué conocimientos y precauciones debemos manejar en nuestro entorno de trabajo para optimizar el uso de los aparatos eléctricos en quirófano: comprender su funcionamiento y prevenir los posibles daños derivados de un mal uso o un mal funcionamiento

In our daily practice is important to be ready for the unforeseen situations and to have an excellent knowledge of our environment. The problems that could arise in the operating theatre have to be known, detected and corrected as soon as possible in order to have a satisfactory resolution. In the hospital is the operating theatre where are the main electrical systems involved, being this importance based in the correct supply and in the fact that there is important equipment which work is based in such correct supply. All the items involved can be applied to all the postanesthesia and critical care units. All these inconveniences and complications are feared by the anesthesia due to the ignorance and to the injures that can be caused. The main objective is to review all the elementary electrical concepts, the knowledge and the preventive measures and steps we should take in order to optimize the electrical device used; to ensure the understanding and the correct way of working and to take the necessary steps in order to avoid the problems derived of an incorrect use

Entropía. Monitorización, fundamentos y comparación respecto al resto de monitores de profundidad anestésica / Entropy. Bases and monitoring. comparison with other anesthesia depth monitors

El uso de monitores de profundidad anestésica, basados en el electroencefalograma, ha demostrado su utilidad tanto en la disminución de los despertares intraoperatorios como en la titulación de los distintos fármacos anestésicos. Varios aparatos han sido diseñados con la intención de extraer y procesar el registro electroencefalográfico, dando como resultado un valor numérico representativo de un nivel de hipnosis. Distintos estudios analizan la diferencia entre estos monitores y el comportamiento de los mismos con los fármacos anestésicos utilizados en la práctica diaria; recientemente ha aparecido un nuevo módulo para la medición de la hipnosis, entropía, basado en un concepto termodinámico, analiza los datos según su variabilidad; aportando como novedad dos indicadores, entropía de respuesta y entropía de estado, que recogen un rango de frecuencias electroencefalográficas distintas, con la intención de poder distinguir entre electromiograma y electroencefalograma

Anaesthesia depth monitors that are based mainly on the electroencephalogram (EEG) have demonstrated but also titrating the different anaesthetic agents. Several devices have been designed to analyse and process the EEG trace and obtain a single number that represents the hypnpsis level. Different studies analyse this monitors and their response with the anaesthetics agents used on the daily practice. Recently the entropy monitor have appeared, it is based on the thermodynamic concept, analyzes the data variability and innovates to offer two different indexes: response and state entropy; that allow distinguish between electromyogram and electroencephalogram

Osteomielitis pélvica y absceso del músculo aproximador mayor / Pelvic osteomyelitis and adductor magnus muscle abscess

La osteomielitis pélvica es infrecuente, representa aproximadamente un 6-8% del total de osteomielitis agudas hematógenas. Es más frecuente en varones. Su presentación clínica es variable y poco especffica,lo que contribuyea un retraso en el diagnóstico. No existe ninguna prueba de laboratorio específica para su diagnóstico. No es infrecuente encontrar casos de pacientes con osteomielitis y cultivos negativos. Las complicaciones son infrecuentes. Se presenta el caso clínico de un niño de 10 años, sin antecedentes personales de interés, al que que se diagnostica una osteomielitis de la rama isquiopubiana izquierda complicada con un absceso del músculo aproximador mayor

Pelvic osteomyelitis is a rare disease that represents between 6-8% of the cases of acute hematogenous osteomyelitis. It is more frequent in males, and its clinical presentation is variable and non specific, circumstances that contribute to delaying the diagnosis. There is no specific laboratory test to aid in the diagnosis, and patients with osteomyelitis of ten have negative cultures. Complications are unusual. We reportt he case of a ten-year-old boy, whose medical history was unremarkable with acute osteomyelitis of the left ischio pubic region complicated by an abscess in adductor magnums uscle

[Neuropsychological predictors of reading ability in Spanish]. / Predictores neuropsicológicos de la lectura en español.

INTRODUCTION: Learning how to read has been associated with different types of linguistic and non-linguistic skills. However, few studies have looked at the association between neuropsychological test performance and reading skills at different ages during childhood. AIM: To analyze the association between neuropsychological test scores and reading performance, and to investigate the influence of age, gender and type of school (public or private) over reading test performance. SUBJECTS AND METHODS: The sample included 625 6 -to-15 year old children (207 Colombians, 418 Mexicans; 277 boys, 348 girls). The following cognitive abilities were assessed: reading speed and reading comprehension and attention, memory (coding and recall), perception, visuospatial and conceptual abilities and executive functions. RESULTS: The best neuropsychological test predictor for reading speed was Letter Cancellation, and for reading comprehension was Memory for a Story. Children from private schools performed better in most reading tests than children from public schools. Differences between boys and girls were observed in only two reading tests. CONCLUSION: Reading speed correlates mainly with attentional skills and reading comprehension with verbal memory. Reading abilities in school age children are influenced mainly by age and type of school and little by gender.

Predictores neuropsicológicos de la lectura en español / Neuropsychological predictors of reading ability in spanish

Introducción. El aprendizaje de la lectura se ha asociado con el desarrollo de habilidades tanto lingüísticas como no lingüísticas. Sin embargo, pocos estudios han analizado la relación entre las habilidades de lectura y el desempeño en pruebas cognitivas de tipo neuropsicológico en niños de diferentes edades. Objetivos. Correlacionar el desempeño lector con las puntuaciones en diferentes subpruebas neuropsicológicas y analizar el efecto de la edad, el sexo y el tipo de escuela (pública o privada) en pruebas de lectura. Sujetos y métodos. Se estudiaron 625 niños (207 colombianos, 418 mexicanos; 277 niños, 348 niñas) con edades comprendidas entre 6 y 15 años. Se evaluaron, además de las habilidades de lectura, 12 áreas cognitivas diferentes: atención, habilidades construccionales, memoria (codificación y evocación diferida), percepción, lenguaje oral, habilidades metalingüísticas, lectura, escritura, matemáticas, habilidades visuoespaciales, habilidades conceptuales y funciones ejecutivas. Resultados. Un análisis de regresión escalonado mostró que la prueba de cancelación de letras es el mejor predictor de velocidad en la lectura, y la prueba de memoria de una historia la que mejor predice puntuaciones de comprensión de lectura. Los niños de las escuelas privadas se desempeñaron mejor en pruebas de lectura que los niños de escuelas públicas. Las diferencias entre niños y niñas solamente fueron significativas en dos pruebas de lectura. Conclusiones. La velocidad en la lectura se correlaciona especialmente con habilidades atencionales, en tanto que la comprensión en la lectura se correlaciona más con pruebas de memoria verbal. Las habilidades de lectura en niños de edad escolar se ven más influidas por la edad del niño y por el tipo de escuela que por el sexo de los participantes (AU)

Introduction. Learning how to read has been associated with different types of linguistic and non-linguistic skills. However, few studies have looked at the association between neuropsychological test performance and reading skills at different ages during childhood. Aim. To analyze the association between neuropsychological test scores and reading performance, and to investigate the influence of age, gender and type of school (public or private) over reading test performance. Subjects and methods. The sample included 625 6 -to-15 year old children (207 Colombians, 418 Mexicans; 277 boys, 348 girls). The following cognitive abilities were assessed: reading speed and reading comprehension and attention, memory (coding and recall), perception, visuospatial and conceptual abilities and executive functions. Results. The best neuropsychological test predictor for reading speed was Letter Cancellation, and for reading comprehension was Memory for a Story. Children from private schools performed better in most reading tests than children from public schools. Differences between boys and girls were observed in only two reading tests. Conclusion. Reading speed correlates mainly with attentional skills and reading comprehension with verbal memory. Reading abilities in school age children are influenced mainly by age and type of school and little by gender (AU)

Follow-up of an intelligent odd-mannered teenager with del(3)(p26). Remarks on authorship and ethical commitment.

A male teenager formerly found to have a 46,XY,del(3)(p26)de novo karyotype was restudied. At the age of 14(8/12) yr, he attends the last grade of middle school and was a cooperating teenager with slender habitus, severe myopia, prominent nose, sacral dimples, pubertal stage Tanner III, and multiple surgical scars. Neuropsychological studies revealed a full scale IQ of 95 with slow performance (WISC-IV Spanish test) as well as an internalizing behavioral profile, poor social skills, a mild attention deficit, somatic complaints, and a feminized gender role. FISH with the 3p subtelomeric probe revealed that the deleted chromosome actually lacked the specific signal (n=10 cells). The patient's average intelligence confirms that euchromatic imbalances do not necessarily cause mental retardation and suggests that his deletion actually included the CALL gene, the Contactin 4 gene and other 3p26 genes related to intellectual capabilities; yet, the resulting hemizygosity either did not lead to haploinsufficiency or was minimally expressed. Moreover, the patient's peculiar cognitive and behavioral profile suggests that the 3p26 deletion is associated with a distinctive neuropsychological phenotype. Incidentally we comment on authorship and publication ethics in order to urge our institutional ethics committee to arbitrate authorship conflicts and thereby be consistent with its ethical commitment.

Analgesia postoperatoria con lornoxicam frente a metamizol en cirugía mayor ambulatoria. Estudio prospectivo aleatorio / Postoperative analgesia with lornoxicam versus metamizol for outpatient major surgery. A randomized prospective study

Objetivos:Comparar la eficacia analgésica postoperatoria en cirugíamayor ambulatoria de dos fármacos analgésicos noopioides: metamizol, habitualmente utilizado en nuestromedio, frente a lornoxicam, introducido recientemente parauso clínico. Métodos:Estudio prospectivo y aleatorio. Incluimos 73 pacientesprogramados para un procedimiento de cirugía mayor ambulatoria.Al final de la cirugía administramos una dosisúnica de metamizol i.v. a todos los pacientes. Cuando lospacientes comenzaron la tolerancia administramos medicaciónanalgésica oral aleatorizando los pacientes en dos grupos:en el grupo lornoxicam (n = 35) un comprimido delornoxicam 8 mg cada 12 horas y en el grupo metamizol (n= 38) un comprimido de metamizol 575 mg cada 8 horas.Evaluamos el dolor postoperatorio en cuatro momentosdistintos del proceso postoperatorio: en la Unidad de Reanimaciónal final de la cirugía, al inicio del tratamientoanalgésico con la tolerancia oral, al alta hospitalaria, y alas 48 horas tras la cirugía. Utilizamos la escala analógicavisual (EVA), una escala numérica sencilla para valorar eldolor por encuesta telefónica a las 48 horas, la satisfaccióndel paciente al final del procedimiento, la opinión del pacientesobre la medicación recibida, y la necesidad de medicaciónde rescate.Resultados:No encontramos diferencias estadísticamente significativasen el EVA en la Unidad de Reanimación, en el iniciodel tratamiento analgésico oral, ni en la valoración del dolora las 48 h de la cirugía. El EVA del alta domiciliaria fuemenor en el grupo metamizol que en el grupo lornoxicam(p < 0,05). La satisfacción del paciente también fue mejoren el grupo metamizol al igual que en la opinión del pacientesobre la medicación recibida (p < 0,05). En la necesidadde rescate no hubo diferencias significativas.Discusión:Ambos fármacos proporcionan una buena analgesiapostoperatoria, si bien con la pauta de administración deldiseño del estudio metamizol se muestra superior a lornoxicamtanto en la analgesia al alta hospitalaria como en lavaloración subjetiva de los pacientes sobre la medicaciónanalgésica administrada

Objectives:To compare the analgesic effectiveness for outpatientmajor surgery of two non-opiate analgesic drugs: metamizol,frequently used in our setting, versus lornoxicam, recentlyintroduced in the clinical practice.Methods:Prospective and randomized study in 73 patients scheduledfor outpatient major surgery. At the end of the procedure,all patients received a single dose of metamizol i.v.Oral analgesics were administered when patients started todevelop tolerance and were randomized to one of the followinggroups: Lornoxicam Group (n = 35), with onetablet of lornoxicam 8 mg each 12 hours; or MetamizolGroup, with one tablet of metamizol 575 mg each 8 hours.Post-operative pain was assessed at four different timepoints during the postoperative process: at the reanimationunit after surgery, at the beginning of the analgesic treatmentwith oral tolerance, upon hospital discharge and 48hours after surgery. We used the Visual Analogue Scale(VAS), a simple numerical scale to assess pain through aphone call performed at 48 hours, patient satisfaction atthe end of the procedure, patient opinion regarding themedication received and need for rescue medication.Results:We did not find any statically significant differences inVAS scores at the reanimation unit, the beginning of theoral analgesic treatment or the assessment of pain 48hours after surgery. VAS scores upon hospital dischargewere lower in the metamizol group compared to thelornoxicam group (p < 0.05). Patient satisfaction and patientopinion regarding the medication received were alsobetter in the metamizol group (p < 0.05). No significantdifferences were observed regarding the need for rescuemedication.Discussion:Both drugs provide appropriate postoperative analgesia,but perhaps the dosage regime used in the metamizolgroup provided better analgesia upon hospital dischargeand improved subjective assessment of patients regardingthe analgesic drug received