Recuperación intensificada en cistectomía radical: rol de la enfermera / No disponible

Introducción: La recuperación intensificada en cirugía, Fast-track Surgery o Enhance Recovery After Surgery (ERAS), consiste en la aplicación de una serie de medidas y estrategias pre, intra y posoperatorias con el objetivo de disminuir el estrés secundario a la intervención quirúrgica proporcionando una mejor recuperación del paciente, disminuyendo las complicaciones y la estancia hospitalaria. Las ventajas de la aplicación de programas y protocolos de rehabilitación multimodal han sido ampliamente demostradas en ensayos clínicos y meta análisis. Objetivo: Implementar un programa de recuperación intensificada para cirugía mayor urológica (cistectomía radical) que pretende mejorar la preparación preoperatoria y la recuperación posoperatoria. Material y método: En noviembre de 2016 se creó el programa de rehabilitación multimodal integrado por urólogos, psicólogos, estoma terapeutas, personal administrativo de soporte y la Unidad de Preparación para la Cirugía (UPC),compuesta de anestesiólogos y enfermeras. La muestra estuvo formada por todos los pacientes a los que se les indicó cistectomía radical. Resultados: Los resultados preliminares de una encuesta de satisfacción que cumplimentaron los pacientes un mes después de la cirugía han sido muy satisfactorios. Sobre la información preoperatoria, trato recibido, dolor, alta hospitalaria y satisfacción general se obtuvieron valores altos. Se detectaron aspectos de mejora en la dieta posoperatoria, que fueron evaluados con un menor grado de satisfacción. Se han realizado acciones de mejora que están pendientes de evaluación. Discusión/Conclusión: El éxito del programa está en la participación y estrecha colaboración de las personas implicadas en este proceso: pacientes, familias y/o cuidadores y profesionales del programa de recuperación intensificada. La atención integral, que incluye medidas pre, intra y posoperatorias, y el papel activo de los pacientes que asumen responsabilidades, son claves en la mejora de la preparación y recuperación de la cirugía

Fast-track Surgery or Enhanced Recovery After Surgery (ERAS) is a multidisciplinary approach applied to the care of the surgical patient that requires the application of pre-, intra- and post-strategies. This approach has been designed to achieve early recovery after surgical procedures. ERAS protocol has been shown to lead to a reduction in complications and shorter length of hospital stay. Validated data are available from numerous studies to show the benefits of these protocols for patients. Objective: to implement a recovery program for patients undergoing major urologic surgery (radical cystectomy). Objective: to achieve early recovery after surgical procedures and improve and optimize preoperative preparation. Material and method: in 2016 a multimodal rehabilitation program was formed by urologists, psychologists, stoma therapists, administrative staff and surgical preparation unit (SPU) integrated by anesthetists and nursing staff. The study included patients who underwent radical cystectomy. Results: the results of a patient satisfaction survey were satisfactory after the first month of surgery. Regarding preoperative, adequacy of treatment received by patients, pain, discharge from hospital and general satisfaction. Deficiencies detected are pending evaluation. Patients were less satisfied with preoperative dietary information. Conclusion: the success of the program depends on the participation and collaboration of the persons involved in this process: patient, family and/or staff members. A comprehensive approach is the best key to improve the preparation and recovery of the patient before surgery

Asociación entre el déficit de vitamina D y los potenciales evocados visuales en la esclerosis múltiple / Relationship between vitamin D deficiency and visually evoked potentials in multiple sclerosis

OBJETIVO: Evaluar la posible relación entre los niveles séricos de 25-OH-vitamina D y los potenciales evocados visuales (PEV) de los pacientes con esclerosis múltiple (EM) residentes en la zona sur de Gran Canaria. MATERIAL Y MÉTODOS: Se incluyó a 49 pacientes con EM. Se les realizó determinación de 25-OH-vitamina D, PEV, exploración neurológica para determinar la discapacidad y se recogieron variables clínicas tales como el antecedente de neuritis óptica. RESULTADOS: El valor medio de 25-OH-vitamina D de los pacientes fue de 28,1 ± 9,5 ng/ml, la latencia de los PEV fue de 119,1 ± 23,2 ms y la amplitud de 8,5 ± 4,4 μV. Los pacientes con niveles normales de 25-OH-vitamina D tuvieron mayor número de brotes en el año previo al estudio (p = 0,049) y aquellos con déficit de vitamina D y neuritis óptica previa no presentaron reducción de la amplitud de los PEV (p = 0,006). CONCLUSIÓN: Los pacientes con déficit de vitamina D tienen menor actividad clínica de la EM y no presentan afectación axonal en PEV tras haber sufrido neuritis óptica. Estas asociaciones, aunque estadísticamente significativas, no parecen clínicamente plausibles, por lo que sería preciso realizar nuevos estudios que intentasen confirmar esta posible asociación

OBJECTIVE: To evaluate the possible relationship between serum 25-OH vitamin D levels and visually evoked potentials (VEP) in patients with multiple sclerosis (MS), residents in the south zone of Gran Canaria. MATERIAL AND METHODS: The study included 49 patients with MS, on whom 25-OH-vitamin D was determined, along with VEP, and a neurological examination to determine incapacity. Clinical variables, such as a history of optic neuritis were recorded. RESULTS: The mean value of 25-OH-vitamin D of the patients was 28.1 ± 9.5 ng/ml. The VEP latency was 119.1 ± 23.2 ms and the amplitude, 8.5 ± 4.4 μV. Patients with a higher 25-OH-vitamin D had a greater number of outbreaks in the year prior to the study (P=.049), and those with vitamin D deficiency and previous optic neuritis showed no reduction in the amplitude of the VEP (P=.006). CONCLUSION: Patients with vitamin D deficiency have lower clinical activity of the MS and show no axonal involvement in VEP after having suffered optic neuritis. These relationships, although statistically significant, do not seem clinically plausible, thus new studies are needed to try and confirm this possible relationship

Relationship between vitamin D deficiency and visually evoked potentials in multiple sclerosis. / Asociación entre el déficit de vitamina D y los potenciales evocados visuales en la esclerosis múltiple.

OBJECTIVE: To evaluate the possible relationship between serum 25-OH vitamin D levels and visually evoked potentials (VEP) in patients with multiple sclerosis (MS), residents in the south zone of Gran Canaria. MATERIAL AND METHODS: The study included 49 patients with MS, on whom 25-OH-vitamin D was determined, along with VEP, and a neurological examination to determine incapacity. Clinical variables, such as a history of optic neuritis were recorded. RESULTS: The mean value of 25-OH-vitamin D of the patients was 28.1±9.5ng/ml. The VEP latency was 119.1±23.2ms and the amplitude, 8.5±4.4 µV. Patients with a higher 25-OH-vitamin D had a greater number of outbreaks in the year prior to the study (P=.049), and those with vitamin D deficiency and previous optic neuritis showed no reduction in the amplitude of the VEP (P=.006). CONCLUSION: Patients with vitamin D deficiency have lower clinical activity of the MS and show no axonal involvement in VEP after having suffered optic neuritis. These relationships, although statistically significant, do not seem clinically plausible, thus new studies are needed to try and confirm this possible relationship.

Novel type-II material system for laser applications in the near-infrared regime.

The design and experimental realization of a type-II "W"-multiple quantum well heterostructure for emission in the λ > 1.2 µm range is presented. The experimental photoluminescence spectra for different excitation intensities are analyzed using microscopic quantum theory. On the basis of the good theory-experiment agreement, the gain properties of the system are computed using the semiconductor Bloch equations. Gain values comparable to those of type-I systems are obtained.

[Mycobacteriosis caused by Mycobacterium gordonae. First case reported in Cuba]. / Micobacteriosis por Mycobacterium gordonae. Primer caso reportado en Cuba.

Since 1990, repeated samples of a positive HIV patient were studied, who had skin lesions with ulcers and scabs, dirty bottom and prominent edges; hyperergic Mantoux and very low CD levels. As a result, a slowly growing pigmented strain was isolated and classified as Mycobacterium gordonae by using standard as well as alternative bacteriological studies such as the mycobacterial mycolic acid analysis. The patient was treated with 4 antibacilar drugs and 6 weeks after the starting of the treatment, all reported skin lesions had disappeared.

[Esophageal candidiasis in AIDS patients. A clinical and microbiological study]. / Candidiasis esofágica en pacientes con SIDA. Estudio clínico y microbiológico.

18 AIDS patients who presented high gastrointestinal symptoms or lesions in the oral cavity suggestive of candidiasis were studied. Clinical data, specimen of the oral cavity, biopsies and esophageal brushing, as well as serum from all patients were obtained. Dysphagia was the main symptom observed in the esophageal candidiasis. Candida albicans was the most isolated species with a predominance of serotype A. The protein profiles of 12 strains belonging to this species were analyzed by the polyacrylamide gel electrophoresis, and it was found that their molecular weight patterns were identical, which indicates that the same strain is in the oral cavity and in the esophagus. The response of the anti-C. albicans antibodies was evaluated. The double immunodiffusion was not useful for the diagnosis of esophageal candidiasis.

[The reactogenicity and immunogenicity of the first Cuban vaccine against human leptospirosis]. / Reactogenicidad e inmunogenicidad de la primera vacuna cubana contra la leptospirosis humana.

A controlled double-blind trial was conducted with the participation of 80 adult volunteers of both sexes, who were randomly divided into groups of 40 individuals each one. The case-base study received the vaccine and the control group was administered placebo to know the safety, the behaviour of reactogenicity, and to star the immunogenicity studies of the first Cuban vaccine against human leptospirosis. The vaccine used in the case-base study was an inactivated and trivalent vaccine containing strains of Leptospira canicola, icterohaemorrhagiae and pomona, since they have the highest circulation in the country. The results obtained showed the inocuity of the vaccine as no adverse severe reactions were detected. The general symptomatology observed was low, where as febricula was the most common general symptom. It appeared during the first 3 days of observation and there were no significant differences between the 2 group. Only a mild pain at the site of the injection was reported as a local symptom, which was more frequent in the vaccinated group than in the control group (7.8 against 1.5%, respectively). The seroconversion obtained was of 29% by microagglutination, and of 34.2% by ELISA. The final results allowed to conclude that this vaccine is safe for human adults at the ages under study, and give the possibility to continue other studies in more advanced stages to complete the requirements for obtaining its license.

[Infection by Schistosoma intercalatum and probable hybridization with Schistosoma haematobium in East Africa. Report of a case]. / Infección por Schistosoma intercalatum y probable hibridización con Schistosoma haematobium en el este de Africa. Reporte de un caso.

It is reported the infection due to Schistosoma intercalatum and the probable hybridization with Schistosoma haematobium in a patient from the eastern region of Africa, where it has not been demonstrated before. The main clinical manifestations were abdominal pain and diarrhea with blood. The diagnosis was possible thanks to the finding in the microscopic examination of the characteristic eggs of Schistosoma intercalatum in faeces and urine by the modified technique of Ziehl-Neelsen.

[Progressive disseminated histoplasmosis in AIDS patients]. / Histoplasmosis diseminada progresiva en pacientes con SIDA.

The clinical histories of 12 AIDS patients whose histoplasmosis diagnosis has been confirmed by histopathological studies were reviewed aimed at knowing the main clinical and microbiological aspects of the disseminated progressive histoplasmosis. In every case it appeared as a febrile and waste disease with an elevated hepatomegaly frequency and generalized adenopathies. More than 50% of the patients had anemia and an accelerated erythrocyte sedimentation. The chest X-ray showed pulmonary lesions in 50% of the patients, whereas, the abdominal ultrasound allowed to observe hepatomegaly and splenomegaly in 58.3 and 41.6% of the patients, respectively. A low sensitivity was found in the culture of different clinical specimens as well as in the antibody detection techniques. It is discussed the need to improve tha laboratory diagnosis methods, particularly those which make possible the antigen detection in a fast and specific way.

[The minimum dosage of praziquantel in the treatment of Taenia saginata, 1986-1993]. / Dosis mínima de praziquantel en el tratamiento de Taenia saginata, 1986-1993.

Praziquantel was used in a therapeutic trial in 50 patients presenting with Taenia saginata in a dose of 5 mg/body weight as a single dose. The most frequent symptoms were: abdominal pain (72%), nervousness (42%), and body weight loss (32%). Tolerance to the drug was excellent. In 100% of patients the elimination of proglottids and/or strobilus of Taenia saginata.

[Use of an indirect immunofluorescence probe for early detection of latent malaria]. / Utilidad de la prueba de inmunofluorescencia indirecta en la detección precoz de recidivas palúdicas.

We followed up the values of the titres of malaria antibodies by the indirect immunofluorescence (IFI) technique in 52 patients: 27 Cubans and 25 foreigners with malaria. All the subjects had previously been in endemic zones. The diagnosis of the disease was based upon the thick drop test. The prevailing species was Plasmodium falciparum. The IFI technique was used at the beginning of the treatment, weekly and after 3 months. Four patients had recurrences in the 3 first weeks of the follow-up, with increased levels of the antibody titres before parasitaemia appeared. Those titres decreased with the specific treatment. We propose that the patients with increasing antibody titres in spite of the negative results of the thick drop test be considered as having a risk of developing malaria.

[Levamisole, mebendazole, thiabendazole. Their effectiveness as helminthicides in African patients recently arrived in Cuba. From 1987 to 1988]. / Levamisol, mebendazol, tiabendazol. Su efectividad como helminticidas en pacientes africanos recién arribados a Cuba. Período 1987-1988.

Ninety one passengers coming from Africa, carriers of geohelminthes, were selected and treated with helminthicides of large use in our country (levamisole, mebendazole, thiabendazole). An excellent effective response was obtained for Ascaris lumbricoides (96.5%), and a good effective response was obtained for the rest of the parasites: Trichuri trichiura (88.5%), Strongyloides stercoralis (87.5%), and Necator americanus (78.9), according to data of therapeutical response efficiency of the WHO.

[Clinical, laparoscopic and histologic study of 60 patients with schistosomiasis mansoni]. / Estudio clínico, laparoscópico e histológico en 60 pacientes con esquistosomiasis mansoni.

Schistosomiasis mansoni was diagnosed to 60 patients coming from the African continent. Coproparasitologic study by Knight technique was performed to all of them, and presence of parasite eggs was demonstrated. The hematologic study showed eosinophilia and the study of the hepatic profile was normal. The patients were clustered into three groups in order to be treated with different drugs. Laparoscopic study and hepatic biopsy were performed to all patients at their admission to hospital and one year after treatment. Effectiveness of praziquantel accounted for 95% of oxamniquine for 75% and etrenol for 55%.

[Our experience in the treatment of Taenia saginata (Goenze, 1762) with praziquantel]. / Nuestra experiencia en el tratamiento de Taenia saginata (Goenze, 1762) con praziquantel.

This paper studies 50 Cuban patients with Taenia saginata admitted at "Pedro Kouri" Institute of Tropical Medicine from October 1982 to November 1985. There were no significant differences as far as patient sex is concerned and there was a prevalence of the age group 15-25. All cases had undergone several courses of antiparasitic treatment with niclosamide. There was proglotid passage in 100% of cases and abdominal pain in 36% of patients, as clinical elements of interest. Praziquantel was administered in a dosage of 10 mg per kg of body weight, in single doses, and the effectiveness of the drug was documented in 100% of cases, with a follow-up of more than 7 weeks.