Anestesia peridural continua con bomba de infusión elastomérica en mamoplastia de aumento / Continuous epidural anesthesia with elastomeric infusion pump in augmentation mammoplasty

Introducción: La anestesia y analgesia peridural continua, además de proporcionar un adecuado control del dolor posoperatorio, aportan beneficios como la disminución del riesgo de trombosis y de sangrado intraoperatorio. Objetivo: Describir el comportamiento y los resultados de la aplicación de la anestesia peridural continua mediante bomba de infusión elastomérica en pacientes intervenidas de mamoplastia de aumento. Métodos: Se realizó un estudio observacional, descriptivo, prospectivo, longitudinal en el Hospital Clínico Quirúrgico Hermanos Ameijeiras, entre febrero 2014 y febrero 2016. Resultados: 72,8 fueron las pacientes entre 20 y 29 años, 57,6 por ciento era ASA I y 78,3 por ciento normopeso. El 50 por ciento fueron operadas por hipoplasia mamaria. La frecuencia cardiaca, la tensión arterial sistólica y diastólica disminuyeron a los 5 min después de aplicarse la técnica. La media del dolor fue menor de 3 en todos los momentos evaluados. Las complicaciones inmediatas fueron escasas y leves. El 85,9 por ciento calificó la técnica como buena. Conclusiones: El comportamiento y los resultados de la aplicación de la anestesia peridural continua mediante bomba de infusión elastomérica en la mamoplastia de aumento fue estable y segura. Existieron diferencias significativas en el comportamiento de las variables hemodinámicas intraoperatorias y de la intensidad de dolor, la cual fue leve en todas sus mediciones. Las complicaciones mediatas fueron escasas y no complejas. Más de las tres cuartas partes de las pacientes evaluaron de acuerdo al grado de satisfacción de buena la efectividad de la técnica anestésica para este tipo de procedimiento quirúrgico(AU)

Introduction: Continuous epidural anesthesia and analgesia, in addition to providing adequate control of postoperative pain, provide benefits such as decreased risk of thrombosis and intraoperative bleeding. Objective: To describe the behavior and results of the application of continuous epidural anesthesia by means of an elastomeric infusion pump in patients undergoing augmentation mammoplasty. Methods: An observational, descriptive, prospective, longitudinal study was conducted at Hermanos Ameijeiras Clinical Surgical Hospital, between February 2014 and February 2016. Results: 72.8 percent were patients 20-29 years old, 57.6 percent were ASA I, and 78.3 percent had normal weight. 50 percent were operated for mammary hypoplasia. Heart rate, as well as systolic and diastolic blood pressure decreased 5 minutes after the technique was applied. The average pain was less than 3 in all the moments evaluated. The immediate complications were minimal and mild. 85.9 (AU) described the technique as good. Conclusions: The behavior and results of the application of continuous epidural anesthesia using an elastomeric infusion pump in the augmentation mammoplasty was stable and safe. There were significant differences in the behavior of intraoperative hemodynamic variables and pain intensity, which was slight in all its measurements. The mediate complications were scarce and not complex. More than three quarters of the patients evaluated, based on the degree of satisfaction, the effectiveness of the anesthetic technique as good for this type of surgical procedure(AU)

Prognostic impact of CD133 expression in Endometrial Cancer Patients.

To assess the impact of CD133 expression on the prognosis of endometrioid endometrial carcinoma (EEC). We retrospectively assessed CD133 expression in tissue microarray of 116 surgically treated FIGO I-III EEC. Tumors with ≥10% of CD133-expressing cells were considered CD133-positive (CD133+). On the basis of CD133 expression, clinical and pathological parameters, progression-free survival (PFS) and overall survival (OS) were evaluated. Of the EEC studied 85.2% showed CD133-expressing cells. Only 61% (n = 66) of EEC presented ≥10% of CD133 expressing cells and were considered CD133+. The mean OS for CD133+ tumour patients was 161 months (95% CI, 154-168) as compared with 146 months (95% CI, 123-160) for those with CD133- tumors (p = 0.012). The mean PFS for CD133+ tumour was 159 months (95% CI, 149-168) as compared with 147 months (95% CI, 132-161) in those with a CD133-tumour (p = 0.014). CD133+ tumours were less likely to have vascular invasion (p = 0.010) and more likely to be well differentiated (p = 0.034). C133+ tumours predicted favorable OS and PFS of EEC patients, with a Hazard Ratio 4.731 (95% CI, 1.251-17.89; p = 0.022). CD133+ tumor status correlates with favorable prognosis of EEC. Our findings are in agreement with studies addressing brain and colorectal tumours.

Comparación de la calidad de obturación radicular, entre el sistema termoplastificado calamus y el sistema de compactación lateral en frío / Comparison of the quality of root obturation between the calamus thermo plasticized system and the cold lateral compaction

El objetivo de este trabajo fue establecer las diferencias en la calidad de la obturación radicular entre la técnica termoplastificada Calamus y la técnica de compactación lateral en frío, cuando se utilizan conos de gutapercha protaper universal. Se realizó una investigación cuasi-experimental in vitro, con una muestra no probabilística de 80 piezas dentarias unirradiculares, cuyos canales fueron instrumentados con el sistema Protaper Universal Manual. Posteriormente se dividieron aleatoriamente en dos grupos de 40 raíces cada uno. El grupo uno fue obturado con el sistema Calamus, y el grupo dos con el sistema de compactación lateral. Las muestras fueron sometidas a la prueba de filtración apical por difusión de tintes, diafanizadas y cortadas transversalmente para su evaluación radiográfica y microscópica. Los datos fueron analizados con la prueba exacta de Fisher. El sistema de compactación lateral obtuvo un sellado más eficiente de los canales radiculares que el sistema Calamus (p=0,229). El sistema termoplastificado presentó una mejor adaptación de la masa de gutapercha sólo a nivel del tercio medio (p=0,037) y una menor presencia de vacuolas en todo el canal (p=0,020), diferencias estadísticamente significativas. Además, el sistema Calamus presentó una mayor cantidad de canales accesorios obturados y de raíces filtradas, pero estas diferencias no fueron significativas. El sistema de compactación lateral demostró ser más eficiente que la técnica termoplastificada Calamus, pero estas diferencias no son significativas.

The aim of this work was to establish the differences in the quality of the root obturation between the Calamus thermo plasticizedgutta-percha technique, and the cold lateral compaction technique, when universal protaper gutta percha cones are used. A quasi-experimental "in vitro" investigation was developed, using a not probabilistic sample of 80 single rooted teeth whose conducts were instrumented by the Manual Protaper Universal system. They where then randomly divided in two groups of 40 each .The first group was filled with Calamus system and the second group with the lateral compaction system. The samples were submitted to the test of apical filtration for diffusion of dyes, diafanized and cut transversely for radiographic and microscopic evaluation.The information was analyzed by Fisher's exact test. The lateral compaction technique obtained a more efficient seal of the root canals than the Calamus system (p=0.229). On the other hand the Calamus thermo platicized system presented a better adjustment of the gutta-percha mass, only at the middle third (p=0.037) and a minor presence of vacuoles in the whole conduct (p=0.020), being both statistically significant differences. In addition, the Calamus system, presented both, a major quantity of accessory canals filled and a mayor number of leaked roots, but these differences were not significant. The system of lateral compaction demonstrated to be more efficient than the Calamus thermo plasticized technique, but these differences were not significant.

Device-associated infection rates in adult intensive care units of Cuban university hospitals: International Nosocomial Infection Control Consortium (INICC) findings.

OBJECTIVES: To determine the rate of device-associated healthcare-associated infection (DA-HAI), microbiological profile, length of stay (LOS), extra mortality, and hand hygiene compliance in two intensive care units (ICUs) of two hospital members of the International Infection Control Consortium (INICC) of Havana, Cuba. METHODS: An open label, prospective cohort, active DA-HAI surveillance study was conducted on adults admitted to two tertiary-care ICUs in Cuba from May 2006 to December 2009, implementing the methodology developed by INICC. Data collection was performed in the participating ICUs, and data were uploaded and analyzed at the INICC headquarters on proprietary software. DA-HAI rates were registered by applying the definitions of the US Centers for Disease Control and Prevention National Healthcare Safety Network (CDC NHSN). We analyzed the mechanical ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI), and catheter-associated urinary tract infection (CAUTI) rates, microorganism profile, extra length of stay (ELOS), extra mortality, and hand hygiene compliance. RESULTS: During 14 512 days of hospitalization, 1982 patients acquired 444 DA-HAIs, an overall rate of 22.4% (95% CI 20.6-24.3) or 30.6 (95% CI 27.8-33.5) DA-HAIs per 1000 ICU-days. The CLA-BSI rate was 2.0 (95% CI 1.2-3.1) per 1000 central line-days, the VAP rate was 52.5 (95% CI 47.2-58.3) per 1000 ventilator-days, and the CAUTI rate was 8.1 (95% CI 6.5-10.0) per 1000 catheter-days. LOS of patients was 4.9 days for those without DA-HAI, 23.3 days for those with CLA-BSI, and 23.8 days for those with VAP. CAUTI LOS was not calculated due to the lack of data. Extra mortality was 47% (relative risk (RR) 2.42; p=0.0693) for VAP and 17% (RR 1.52; p=0.5552) for CLA-BSI. The only patient with CAUTI died, but there was too little mortality data regarding this infection type to consider this significant. Escherichia coli was the most commonly isolated microorganism. The overall hand hygiene compliance was 48.6% (95% CI 42.8-54.3). CONCLUSIONS: DA-HAI rates, LOS, and mortality were found to be high, and hand hygiene low. It is of primary importance that infection control programs that include outcome and process surveillance are implemented in Cuba.

The effect of context on mother's interaction style with Down's syndrome and typically developing children.

Several studies suggest that difficulties with production or comprehension of language might be associated with the number of interactions initiated by parent or child, responsiveness or ability to sustain ongoing interactional sequences, or the distribution of parental interaction, control and reinforcement strategies. In this study Down's syndrome and typically developing preschool children were observed interacting with their mothers in free play and mealtime settings. We expected interaction patterns in the mothers of Down's syndrome children to be different from those in the mothers of typically developing children. Sixteen mother-child dyads (eight with Down's syndrome children and eight with typically developing children) served as subjects. Mothers of Down's syndrome children use more teacher and helper behaviors, particularly in meal time context, and less positive verbalizations than the mothers of typically developing children. Down's syndrome children also showed higher frequency of eye gazes during mealtime context. Patterns of such differences are discussed in terms of how mothers' style interactions during home activities might be differentially affected by different types of parent training interventions.

45,X/46,XY mosaicism: report of 27 cases.

OBJECTIVES: There exist substantial differences between prenatally and postnatally diagnosed cases of 45,X/46,XY mosaicism. Ninety percent of prenatally diagnosed cases show a normal male phenotype, whereas the postnatally diagnosed cases show a wide spectrum of phenotypes. This 10% risk of an abnormal outcome in prenatally diagnosed cases requires further attention. The purpose of the present study is to provide more information on the postnatally diagnosed 45,X/46,XY mosaicism cases. To date, only a few series have been reported. An accurate diagnosis in these patients is essential not only to their follow-up, but also to providing appropriate genetic counselling and subsequent prenatal diagnosis to their parents. METHODS: The clinical, cytogenetic, endocrinologic, histologic and molecular biological findings of 27 patients with 45, X/46,XY mosaicism are analyzed. RESULTS: The reported cases showed a wide spectrum of phenotypes as Turner syndrome, mixed gonadal dysgenesis (MGD), male pseudohermaphroditism (MPH) and apparently normal male. However, Ulrich-Turner stigmata were the most common features found in this series. Patients with MGD or MPH presented with various degrees of sex reversal such as hypospadias and/or abnormal internal genitalia. No correlation between the proportion of the 45,X/46,XY cell lines in the blood or the fibroblasts and the phenotype was found. Mild mental retardation was present in 4 of the patients and 2 patients showed signs of autism. CONCLUSIONS: Two major points are emphasized in this series: 1) the presence in 7 histologically analyzed streak gonads of a homogeneous 45,X chromosomal complement suggests that the invasion of the primitive genital ridge by a such a cell line may induce abnormal gonadal development; 2) 3 males, apparently normal at birth, developed late onset abnormalities such as dysgenetic testes leading to infertility, Ulrich-Turner stigmata, dysmorphic features, and mild mental retardation. These data indicate the importance of an accurate clinical and histologic evaluation of any patient presenting with 45, X/46,XY mosaicism.

Efecto comparativo de policosanol con dos inhibidores de la HMG-CoA reductasa en el tratamiento de la hipercolesterolemia tipo II / Comparative effects of policosanol and two HMG-CoA reductase inhibitors on type II hypercholesterolemia

Background: Policosanol is a new cholesterol lowering agent derived from sugar cane. Aim: To compare the cholesterol lowering efficacy of policosanol with HMG CoA inhibitors. Patients and methods: Patients with a LDL cholesterol over 160 mg/dl were studied. If, after 6 weeks of diet, cholesterol persisted elevated, they were doubly blind randomized to receive policosanol 10 mg/day (55 patients), lovastatin 20 mg/day (26 patients) or simvastatin 10 mg/day (25 patients). Serum cholesterol was measured again after 8 weeks of therapy. Results: Initial demographic and laboratory data were similar among treatment groups. A 24 percent LDL cholesterol reduction was obtained with policosanol, compared with a 22 percent reduction with lovastatin and a 15 percent reduction with simvastatin. HDL cholesterol significantly increased in patients on policosanol and did not change in the other treatment groups. Adverse effects of policosanol were mild and unspecific. No changes in hepatic enzymes were observed. Conclusions: Policosanol is a safe and effective cholesterol reducing agent

[Association of mixed gonadal dysgenesis and non-classic 21-hydroxylase deficiency]. / Association d'une dysgénésie gonadique mixte et d'une forme non classique de bloc de la 21-hydroxylase.

BACKGROUND: The rare association of mixed gonadal dysgenesis and non classical congenital hyperplasia by 21-hydroxylase deficiency poses the problem of their respective responsibility in the development of sexual ambiguity. CASE REPORT: In a newborn with ambiguous genitalia, blood 17-OH progesterone was moderately elevated (3.9 to 14.1 ng/mL) leading to the diagnosis of non-classical 21 hydroxylase deficiency, Molecular studies later confirmed this diagnosis. However, the presence of a palpable gonad and the karyotype (45 X/46 XY mosaicism) indicated a mixed gonadal dysgenesis as the cause of sexual ambiguity. Histological examination revealed the presence of a testis and a streak gonad. CONCLUSION: This observation emphasizes the need for a complete clinical and biological analysis in all newborns with sexual ambiguity.

[Sources of stress and burn-out in anesthesiologists. Reality and perspectives]. / Sorgenti di stress e burn-out degli anestesisti. Realtà e prospettive.

A sample of 128 anaesthesists was given the Maslach Burn-out Inventory (MBI). The purpose of the present research was to evaluate the stress level and/or burn-out in a setting which has not yet been explored. Findings indicate significant differences between groups concerning only the intensity responses. The burn-out scale used appears suitable to evaluate some modalities of response to stress, even in health workers, and stimulating to further research in order to obtain some suggestions about prevention and treatment in hospital organization.