Percepciones estudiantiles sobre las propiedades del examen clínico objetivo estructurado en Uruguay. Disponiendo un cuestionario válido para analizar la factibilidad del nuevo formato durante la transición curricular / Student perceptions on properties of the objective structured clinical examination in Uruguay. The use of a valid questionnaire to analyse the feasibility of the new format during curriculum transition

INTRODUCCIÓN: Aunque el formato de examen clínico objetivo estructurado (ECOE) se aplica en Uruguay desde 2004 proveyendo medidas confiables de rendimiento, las percepciones sobre sus propiedades y el grado de satisfacción estudiantiles no han sido exploradas. OBJETIVO: La siguiente experiencia estuvo dirigida a evaluar la validez aparente del ECOE como aporte al estudio de su factibilidad local. MATERIAL Y MÉTODOS: Al final del ciclo propedéutico, la subcohorte cursando en el Hospital Universitario contestó un cuestionario de 28 ítems dirigido a explorar las percepciones sobre las propiedades del ECOE en los potenciales factores «diseño» y «validez aparente». Tras analizar su confiabilidad, se depuró el formulario para proveer una herramienta más breve y fiable. RESULTADOS: El cuestionario original mostró una confiabilidad aceptable (alfa de Cronbach = 0,70), dominando las opiniones de «acuerdo/total acuerdo» sobre autenticidad de los estímulos, dinámica, pertinencia y justicia del examen. Los estudiantes percibieron obstáculos organizativos durante la prueba, manifestando desacuerdo en incluir alguna estación dirigida a evaluar solamente habilidades para la comunicación y requiriendo instancias de devolución (feedback) personalizada. La versión depurada del cuestionario original provee medidas consistentes sobre las percepciones estudiantiles y resulta una herramienta útil que podría aplicarse extensamente. Se discuten los aportes de esta experiencia al estudio de la factibilidad del nuevo formato durante la transición curricular. CONCLUSIONES: El ECOE es bien evaluado por los estudiantes al final del ciclo propedéutico, lo que apoya su validez. Deben aprovecharse sus potenciales formativos proveyendo feedback efectivo a estudiantes, tutores clínicos e institución

INTRODUCTION: Although an objective structured clinical examination (OSCE) format has been applied in Uruguay since 2004, and providing reliable performance measures, perceptions of it properties and level of student satisfaction have not been determined. OBJECTIVE: To evaluate the face validity of OSCE format as a contribution to its local feasibility study. MATERIAL AND METHODS: At the end of the introductory clinical course, the sub-cohort enrolled at the University Hospital responded to a 28-item questionnaire aimed at exploring perceptions about the properties of the OSCE about the potential factors 'design' and 'apparent validity'. After analysing the reliability of the original questionnaire, the questionnaire was refined in an attempt to provide a shorter and more reliable tool. RESULTS: The original questionnaire showed good internal consistency (Cronbach Alpha = 0.70), with a dominance of 'agreement/total agreement' opinions on authenticity of the stimuli, dynamic, relevance, and equity of the test. Students perceived organisational obstacles during the test, expressing disagreement to include some stations only aimed at assessing communication skills, and requiring personalised feedback sessions. The refined version of the questionnaire provides consistent measures on student perceptions and is a useful tool that can be widely applied. A discussion is presented on the contributions of this experience to a comprehensive feasibility study of the new format during curriculum transition. CONCLUSIONS: The OSCE is well evaluated by students at the end of the propaedeutic course, supporting its validity. Educational potentials of the new format should be exploited, providing effective feedback to students, clinical teachers, and institutions

Correlação entre graus de hipertensão pulmonar e achados em exames complementares / Correlation between degrees of pulmonary hypertension and findings in complementary tests

Fundamento: A hipertensão pulmonar é potencialmente fatal, com grande impacto na qualidade de vida do paciente. O tratamento pode alterar sua progressão, mas o aumento na sobrevida é relacionado ao diagnóstico e à terapêutica precoces. Objetivo: Analisar a relação entre alterações em exames usados de rotina (ecocardiografia, eletrocardiografia e tomografia computadorizada) e o aumento da pressão sistólica da artéria pulmonar. Métodos: Avaliamos fichas de pacientes portadores de hipertensão pulmonar, separando-os em dois grupos de acordo com a pressão sistólica da artéria pulmonar estimada à ecocardiografia. O Grupo 1 consistiu de pacientes com pressão sistólica da artéria pulmonar entre 35 e 65 mmHg, e o Grupo 2, de pacientes com pressão sistólica da artéria pulmonar > 65 mHg. Analisamos a prevalência de alterações sugestivas de hipertensão pulmonar em exames de ecocardiografia, eletrocardiografia e tomografia computadorizada. Foram realizadas análises descritiva dos dados e comparativa entre os grupos.Resultados: Foram analisados 101 pacientes (43 do Grupo 1 e 58 do Grupo 2). A maioria foram mulheres (82). Valores maiores de pressão sistólica da artéria pulmonar foram correlacionados com dilatação de câmaras direitas à ecocardiografia (p < 0,001). À eletrocardiografia, sinais de hipertrofia direita e presença de padrão strain ventricular foram mais prevalentes no Grupo 2 (p < 0,05). À tomografia computadorizada, observaram-se maiores diâmetros de tronco da artéria pulmonar em pacientes do Grupo 2 (p < 0,05). Houve correlação entre progressão clínica da doença pelo escore e aumento da pressão sistólica da artéria pulmonar (p < 0,05).Conclusão: É possível, em um primeiro momento, fazer uso do exame clínico e da eletrocardiografia para uma estimativa da gravidade do quadro de hipertensão pulmonar. Os achados, então, devem ser confirmados com análise secundária por tomografia computadorizada e ecocardiografia

Introduction: Pulmonary hypertension is potentially fatal and courses with important day-to-day limitation. While the treatment is capable of slowing the disease's progression, increase in life expectancy is directly linked to early diagnosis and treatment. Objectives:To analyze the relation between alterations detectable on routine exams performed on pulmonary hypertension patients (echocardiography, electrocardiography and computerized tomography) and increases on pulmonary artery systolic pressure. Methods: We analyzed the recordings of patients presented with pulmonary hypertension, and separated them in two groups based on their echocardiography-estimated pulmonary artery systolic pressure. Group 1 was composed of patients with pulmonary artery systolic pressure between 35 mmHg and 65 mmHg, and Group 2 of patients with pulmonary artery systolic pressure > 65 mmHg. We analyzed the prevalence of alterations suggestive of pulmonary hypertension on echocardiography, electrocardiography and computerized tomography. A descriptive analysis of the findings was conducted, followed by comparative analysis between the groups. Results: We analyzed 101 patients (43 from Group 1 and 58 from Group 2). Most were women (82). Higher pulmonary artery systolic pressure values were correlated with right-heart dilation on echocardiography (p < 0.001). Electrocardiography findings revealed that right-heart hypertrophy and ventricular strain pattern were more common on Group 2 (p < 0.05). Computerized tomography analysis showed Group 2 patients had superior pulmonary artery diameters (p < 0.05). There was correlation between high pulmonary artery systolic pressure and clinical progression of the disease measured via the NYHA score (p < 0.05). Conclusion: It is possible to make use of clinical examination and a simple electrocardiography to stratify the severity of a pulmonary artery patient. Computerized tomography and echocardiography should be used to confirm these findings

Reconocimientos médicos para la aptitud deportiva. Documento de consenso de la Sociedad Española de Medicina del Deporte (SEMED-FEMEDE) / Pre-participation Screening Athletes. Consensus document of the Spanish Society of Sports Medicine (SEMED-FEMEDE)

La realización de actividad física-deportiva segura precisa realizar algún tipo de investigación médica sobre el estado de salud del deportista. La mayor parte de la literatura sobre este tema se centra en el descubrimiento de las enfermedades o anomalías cardiovasculares que, más frecuentemente, tienen riesgo de desencadenar un episodio de muerte súbita. Pero la actividad física tiene repercusiones notables sobre el resto del organismo, especialmente en el aparato locomotor y en el sistema metabólico, por lo que el reconocimiento médico no se debe limitar a la exploración cardiovascular, sino ampliarse al resto de los aparatos y sistemas implicados en el esfuerzo físico. Este consenso recoge los contenidos del reconocimiento médico básico para la aptitud deportiva, incluyendo antecedentes, historia deportiva y exploración por aparatos, junto con el electrocadiograma de reposo del que se describen sus hallazgos normales y patológicos, y que forma parte inexcusable del reconocimiento. El documento describe los objetivos de realización del reconocimiento, aspectos médico-legales, consideraciones sobre su coste y utilidad, los tipos de reconocimiento y los grupos de deportistas a los que van dirigidos, así como los documentos que se deben aportar en forma de informe médico y de informe de aptitud deportiva. Se hace una descripción de las contraindicaciones para la práctica deportiva y se pospone la descripción pormenorizada de las mismas, que se contemplará en un documento independiente. Este documento se realiza desde la óptica y experiencia española, y se plantea como un amplio consenso, tanto de profesionales como sobre la literatura cientíca existente sobre los reconocimientos médico-deportivos

The realization of safe physical-sport activity needs to carry out some type of medical investigation on the state of the athlete’s health. Most of the literature on this subject focuses on the discovery of cardiovascular diseases or anomalies that are most frequently at risk of triggering an episode of sudden death. However, physical activity has a significant impact on the rest of the body, especially in the locomotor system and in the metabolic system, so that medical examination should not be limited to cardiovascular exploration but should be extended to all other devices and systems involved in the physical e ort. This consensus includes the contents of the basic medical examination for sports aptitude, including antecedents, sports history and apparatus exploration, together with electrocadiograma of rest that describes its normal and pathological findings and that is an inexcusable part of the recognition. The document describes the objectives of the recognition, medical-legal aspects, considerations about their cost and utility, the types of recognition and the groups of athletes to whom they are addressed, as well as the documents that must be provided in the form of a medical report and of fitness report. A description of the contraindications for sports practice is made and a detailed description of them is postponed to be considered in an independent document. This document is made from the Spanish perspective and experience, and is considered as a broad consensus of both professionals, as well as the existing scientific literature on medical-sports surveys

Dinamometria lombar: um teste funcional para o tronco / Lumbar dynamometry: a functional test for the torso

Contexto: A força muscular é a principal valência física. Sua avaliação clínica é realizada utilizando-se testes manuais. Esses testes, embora reprodutíveis, são muito subjetivos e pouco precisos. A avaliação do tronco vem sendo realizada por meio da dinamometria lombar (DL). Essa informação é valiosa nos exames admissionais e periódicos de colaboradores que atuam em tarefas que exigem esforço repetitivo e manejo de cargas de levantamento e transferência. Objetivos: Como a literatura não possui valores referenciais para esse teste, buscamos apresentar valores que podem ser utilizados como referência para futuros estudos de valores normativos. Métodos: O estudo foi conduzido com 691 participantes saudáveis de ambos os sexos, praticantes e não praticantes de atividade física regular, todos com índice de massa corporal (IMC) normal. A faixa etária variou entre 18 e 45 anos, sendo 382 homens, com idade média de 27,1 anos (±7,5), e 309 mulheres, com idade média 28,2 anos (±8,1). Foi utilizado um sistema de dinamometria digital portátil composto por uma plataforma, conectada a uma célula de carga por meio de uma corrente, e um indicador digital. Resultados: O valor médio de força medido com o sistema de DL, em homens, foi 114,0 kgf (±25,4), e 48,5 kgf (±18,8) nas mulheres. Portanto, a amplitude de força exercida pelos homens foi 235,1% superior à exercida pelas mulheres. Conclusão: Esse estudo apresenta uma contribuição inicial para o estabelecimento de valores normativos desse teste dinamométrico; porém, outros estudos são necessários, uma vez que as medições realizadas são preliminares e específicas para a região geográfica estudada.

Context: Muscle strength is the main physical valence. Clinical evaluation is performed using manual tests. But, these tests, although reproducible, are very subjective and imprecise. The torso evaluation has been performed by means of the the lumbar dynamometry (LD). This information is valuable in admission and periodic examinations of employees working on tasks that require repetitive effort, lifting, and transfer of loads. Objectives: As literature does not have reference values for this test, the objective of this research was to present values that can be used as reference for future study of normative values. Methods: The study was conducted with 691 healthy participants of both the genders and practitioners that do not practice regular physical activity, all with normal body mass index (BMI). Their ages ranged between 18 and 45 years, 382 were men, with an average age of 27.1 years (±7.5), and 309 women, with an average age of 28.2 years (±8.1). A portable digital system is composed of a dynamometer connected to a load cell and platform, and a digital indicator. Results: The average value of force measured in men with the LD system was 114.0 kgf (±25.4), and 48.5 kgf (±18.8) in women. Men had 235,1% more strength than women. Conclusion: This study presents an initial contribution to establish normative values for this dynamometer test, but further studies are needed, given the fact that the measurements are preliminary and specific to the geographic region studied.

The impact of "Ramadan fasting period" on total and differential white blood cells, haematological indices, inflammatory biomarker, respiratory symptoms and pulmonary function tests of healthy and asthmatic patients

BACKGROUND: There is no conclusive evidence regarding the effect of fasting on different features in asthmatic patients. In the present study, the effect of Ramadan fasting in asthmatic patients and healthy control was studied. METHODS: Haematological indices, inflammatory mediators, pulmonary function tests (PFT) and respiratory symptoms were evaluated in 15 asthmatic patients compared to 14 healthy matched control group before and after the one-month fasting period in Ramadan. The change in each parameter from the beginning to the end of Ramadan was calculated and referred to as 'variation during Ramadan'. RESULTS: The values of MCH, MCHC in both groups and monocyte counts in asthmatic patients, were significantly increased but platelet count was reduced in asthmatic and controls respectively compared to pre-Ramadan fasting period (P<0.05 to 0.001). Serum hs-CRP level in control and asthmatic groups was significantly reduced after Ramadan fasting month (P<0.001 for both groups). PFT values after Ramadan fasting month in both groups were non-significantly higher compared to pre-fasting values except FVC. Respiratory symptoms in asthmatic patients were non-significantly but wheeze-o was significantly reduced after Ramadan fasting period in asthma group (P<0.05). There was no significant difference in variations of different parameters during Ramadan fasting period between two groups, although reduction of hs-CRP in asthmatic group was non-significantly higher than control group. CONCLUSION: These results show that Ramadan fasting period has no negative impact on asthma and may have some positive effect on asthma severity with regard to reduction of hs-CRP concentration and chest wheeze

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Response to pneumococcal polysaccharide vaccine in children with asthma, and children with recurrent respiratory infections, and healthy children

BACKGROUND: To analyse specific immune response to the 23-valent pneumococcal polysaccharide vaccine by measuring pneumococcal antibodies in children with asthma and with respiratory recurrent infection (RRI) as compared to healthy children. METHODS: The study included 60 children, divided into three groups: 20 with asthma, 20 with RRI, and 20 healthy controls. Post-vaccination specific IgG antibodies against 10 pneumococcal serotypes (S1, S3, S4, S5, S6B, S9V, S14, S18C, S19F, and S23F) contained in the 23-valent pneumococcal polysaccharide vaccine (PPV) were measured. A specific IgG concentration ≥1.3μg/mL was considered a protective response to the vaccine. For statistical analysis, levels of specific IgG antibodies against each of the 10 pneumococcal serotypes were compared across the three groups of children using the x2 test. RESULTS: All of the children showed antipneumococcal antibody levels >1.3μg/mL for over 70% of the serotypes, considered within the normal range of response. Average IgG antibody levels and percentages of children protected were statistically comparable among the three groups studied. CONCLUSION: The asthmatic children without RRI had pneumococcal antibody levels and percentages of serotype-specific protection to PPV comparable to those of healthy children. Asthmatic children with recurrent infections should be evaluated for specific antibody deficiency (SAD). Because asthma patients are at high risk for invasive pneumococcal infections, it would be worthwhile to explore systematic administration of PPV in children over the age of two years who have not received a pneumococcal conjugate vaccine, considering the positive response to PPV reported here

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Concordancia diagnóstica ingreso-egreso y calidad de la indicación de complementarios en el servicio de urgencias / Diagnosis congruence on admission and on discharge and the quality of indication of laboratory testing in the emergency service

Objetivos: evaluar la correlación entre la existencia de diagnósticos concordantes al ingreso y el egreso y la calidad de la indicación de los exámenes complementarios en el servicio de urgencias. Método: estudio descriptivo transversal en 292 pacientes ingresados de urgencia en el Servicio de Medicina del Hospital Joaquín Albarrán entre enero-junio de 2011. La calidad de la indicación de los exámenes complementarios del cuerpo de guardia, se evaluaron de bien si se indicaron los exámenes necesarios o no se indicaron innecesariamente, y de mal si los exámenes indicados eran innecesarios o no se indicaron los necesarios. Se investigó la concordancia entre los diagnósticos al ingreso y egreso y se estableció su correlación con la calidad de la indicación de los exámenes complementarios. Resultados: se encontró concordancia diagnóstica entre el ingreso y el egreso en el 57,9 por ciento de los casos. La calidad de la indicación de los exámenes complementarios previos al ingreso fue mala en el 68 por ciento. En el 37,9 por ciento de los pacientes en los que la calidad de la indicación de complementarios fue buena hubo concordancia diagnóstica, y dicha indicación se consideró incorrecta en 75,6 por ciento de los casos con diagnósticos no concordantes. Conclusiones: aunque la indicación de exámenes complementarios en el cuerpo de guardia a pacientes ingresados de urgencia en medicina interna es predominantemente incorrecta y no se relaciona con una elevada correspondencia entre los diagnósticos al ingreso y egreso; dicha correspondencia es mayor en los pacientes a los que se les realiza una correcta indicación de los exámenes complementarios(AU)

Objectives: to evaluate the association between diagnosis congruence on admission and discharge and the quality of indication of laboratory testing in the emergency service. Methods: cross-sectional and descriptive study conducted in 292 hospitalized patients in the emergency medicine service of Joaquin Albarran hospital between January-June 2011. The quality of indication of laboratory testing by the emergency service staff was rated as good if the necessary testing was indicated or it was not indicated unnecessarily, and as not good when indicated testing was unnecessary or the necessary ones were ignored. The congruence between the diagnoses on admission and those of discharge was analyzed and their correlation with the quality of indication of laboratory testing.Results: there was found diagnosis congruence on admission and on discharge in 57.9 percent of cases. The quality of indication of laboratory testing before admission to hospital was unsatisfactory in 68,0 percent of patients. In 37.9 percent of cases in which the indication of testing was rated as good, there was diagnosis congruence, but in 75.6 percent where the indication was considered incorrect, the diagnoses were incongruent. Conclusions: although the indication of laboratory testing in the emergency service to patients admitted to the internal medicine service is predominantly incorrect and is not associated with the high correspondence between diagnoses on admission to and on discharge from the hospital, such correspondence index is higher in patients who are adequately indicated the performance of laboratory testing(AU)

Concordancia entre los métodos del diagnóstico micológico de la paracoccidioidomicosis / Concordance between methods of mycological diagnosis of paracoccidioidomycosis

La paracoccidioidomicosis (PCM) es una enfermedad crónica, sistémica, granulomatosa, endémica en nuestro país, producida por un hongo dimorfo denominado Paracoccidioides brasiliensis. Existen numerosas técnicas para realizar el diagnóstico de esta entidad. Nos planteamos la posibilidad de realizar un estudio para determinar la concordancia que pudiese existir entre las diferentes técnicas que se utilizan para el diagnóstico de la PCM. Se realizó un registro de historias clínicas. Se evaluaron 251 historias clínicas de pacientes con diagnóstico de PCM, de la consulta externa de la Sección de Micología Médica “Dr. Dante Borelli” del IMT-UCV, entre los años 2000 y 2010. Se determinó la concordancia entre los métodos diagnósticos por medio del análisis de concordancia de atributos para datos binarios. Entre el examen directo y el cultivo, no hubo acuerdo. Entre la serología y el examen directo, se encontró que hubo equivalencia, así como entre el cultivo y la serología. No se pudo calcular correlación alguna con la histopatología, ya que no hubo datos negativos, en vista de que todas las muestras procesadas fueron positivas. El diagnóstico de la PCM se basa en la identificación y el aislamiento del hongo. Es obligatoria la realización del examen directo en fresco de toda muestra clínica. Nuestro estudio de muestra que deben realizarse todos los métodos que estén al alcance (examen directo en fresco, cultivo, serología, histopatología) a fin de aumentar la probabilidad de llegar a un diagnóstico certero de esta patología

Paracoccidioidomycosis (PCM) is a chronic, granulomatous disease, endemic in our country, produced by a dimorphic fungus, Paracoccidioides brasiliensis. Several techniques are used for the diagnosis. A study was performed to determine the agreement that could exist between the different techniques, used for the diagnosis of PCM. Clinical records of patients with diagnosis of PCM was made. 251 clinical records were reviewed, from the Sección de Micología Médica “Dr. Dante Borelli”, IMT- UCV, between 2000 and 2010. The agreement between the methods was determined by means of the analysis of agreement of attributes for binary data. Between direct examination and culture, there was no agreement. Between serology and direct examination, there was equivalence, as well as between culture and serology. Correlation could not be calculated with histopathology, since there were no negative data, due to the fact that all the processed samples were positive. The diagnosis of the PCM is based on the identification and isolation of the fungus. Direct examination is mandatory in all clinical samples. Our study demonstrates that all the methods must be performed (direct examination, culture, serology, histopathology) in order to increase the probability of reaching an accurate diagnosis

La modelación de la actividad de interrogatorio y una aproximación a sus invariantes funcionales / Modeling the medical interview and an approach to its functional invariants

La realización del interrogatorio médico constituye una habilidad de capital importancia en la actuación profesional y su adquisición por el estudiante es un objetivo formativo de alta prioridad en la carrera de Medicina. El propósito de este artículo es contribuir a la orientación de nuestros profesores y estudiantes de Medicina para llevar a cabo sus correspondientes actividades de enseñar y aprender tan importante habilidad clínica. En el desarrollo del artículo se fundamenta, primeramente, el papel de la clínica y del interrogatorio en el diagnóstico médico; seguidamente se propone un modelo de la actividad de interrogatorio, conformado en su ejecución por cuatro momentos distinguibles entre sí por sus objetivos particulares; a partir de esos momentos se realiza una aproximación a las invariantes funcionales de la habilidad(AU)

Conducting a medical interview is a critical skill in professional practice and its acquisition by the student is a high priority training objective in medical studies. This paper aims to contribute to our professors and medical students´ counselling for performing their corresponding activities involving teaching and learning such important clinical skill. Firstly, the role of the clinical examination and interview in medical diagnosis is demonstrated; secondly, a model for conducting the interview is proposed, consisting of four phases distinguishable from each other by their particular objectives. Then, an approach to the functional invariants is performed considering those phases(AU)

Mamoplastia redutora pela técnica de pedículo inferior: estudo descritivo / Brest reduction with the lower pedicle technique: an observational study

INTRODUÇÃO: A mamoplastia redutora utilizando pedículo inferior incluindo complexo aréolopapilar é muito utilizada na América do Norte, mas pouco difundida no Brasil. Sua principal vantagem é a utilização em grandes ptoses mamárias, mantendo a sensibilidade da aréola. OBJETIVO: O objetivo é descrever as características pré e pós-operatórias de pacientes submetidos a mamoplastia redutora pela técnica do pedículo inferior areolado na Santa Casa de Campo Grande - MS em 2013. MÉTODO: Entrevista, exame físico e dados de prontuário das pacientes operadas por esta técnica nessa instituição no ano de 2013. RESULTADOS: Foram avaliadas 40 pacientes, sendo que a idade variou de 21 a 68 anos, com média de 40,62 anos. As comorbidades relatadas foram hipertensão arterial sistêmica, diabetes, retocolite ulcerativa, hérnia de disco e distúrbio de ansiedade. O peso médio de tecido mamário ressecado foi 600,6g na mama direita e 609,6g na mama esquerda. Dentre as queixas pré-operatória, a mais comum foi a lombalgia, seguida por dor nos ombros. As mais frequentes complicações no pós-operatório recente foram a deiscência do ponto médio da vertente (10%) e o hematoma (5%).O tipo de Anestesia predominante foi a anestesia geral. Todas as pacientes apresentaram displasias benignas da mama nos histopatológicos de pós-operatórios. CONCLUSÃO: A técnica do pedículo inferior areolado mostrou-se adequada para o tratamento de grandes hipertrofias e ptoses mamárias.

INTRODUCTION: Reduction mammaplasty with the inferior pedicle nipple-areolar technique is widely used in North America but not in Brazil. Its main advantage lies in maintaining the sensitivity of the areola in large mammary ptoses. To describe the preoperative and postoperative characteristics of patients who underwent reduction mammaplasty with the inferior pedicle nipple-areolar technique at the Santa Casa de Campo Grande - MS in 2013. METHOD: We performed interview, physical examination, and review of medical records of patients operated by using this technique at this institution in 2013. RESULTS: Forty patients were evaluated. Their ages ranged from 21 to 68 years, with a mean of 40.62 years. The comorbidities reported were hypertension, diabetes, ulcerative colitis, disc herniation, and anxiety disorder. The average weight of resected tissue was 600.6 g from the right breast and 609.6 g from the left breast. The most common presurgery complaint was low back pain, followed by shoulder pain. The most frequent complications in the early postoperative phase were dehiscence of the mid-point of the strand (10%) and hematoma (5%). The predominant type of anesthesia was general anesthesia. All patients showed benign breast dysplasia in the postoperative histopathological examination. CONCLUSION: The inferior pedicle nipple-areolar technique was adequate for the treatment of major hypertrophies and mammary ptoses.

Los exámenes de salud son una herramienta útil en la detección de factores predictivos de padecer dolor lumbar / Health tests are a useful tool in the detection of predictive factors of back pain

Objetivo: Determinar si los Exámenes de Salud que se realizan a los trabajadores expuestos a manipulación manual de cargas (MMC) y posturas forzadas (PF) de un hospital general, dentro de las actividades de la Vigilancia de la Salud individual, son una herramienta útil en la detección de factores predictivos de padecer dolor lumbar. Método: Estudio descriptivo sobre una muestra, obtenida aleatoriamente de un listado ordenado alfabéticamente, de 114 trabajadores con una antigüedad en el puesto de trabajo mayor de 1 año. Se les realizó un examen de salud en el que se incluyen como variables independientes del estudio el sexo, la edad, el puesto de trabajo actual, la antigüedad en el mismo, el tipo de jornada, los turnos, IMC, actividad física, antecedentes de depresión, antecedentes de dolor lumbar, el tipo de convivencia, las actividades extra laborales, la historia laboral, el tabaquismo, factores personales y familiares y la exploración física. Y como variable dependiente haber padecido dolor lumbar en el último año. Mediante cuestionario autoadministrado se recogieron los aspectos relacionados con las condiciones de trabajo y ambiente psicosocial según el modelo de demandacontrol/ apoyo social de Karasek y Johnson. Se realizó un análisis descriptivo, bivariante y multivariante de los datos obtenidos. Resultados: La incidencia de dolor lumbar fue de13,3 % (I.C.95 %6,639-30,147). Sólo la edad (>52 años), el sexo femenino y la exploración anormal se relacionan con la aparición de dolor lumbar en el estudio bivariante. La asociación de las variables edad y exploración física anormal justifican el 86% de los casos de dolor lumbar. Conclusiones: A tenor de los resultados podría concluirse que son factores predictivos de padecer dolor lumbar el tener más de 52 años y que la exploración física de la columna vertebral sea anorma (AU)

Objective: To determine whether Health Screenings performed on workers exposed to heavy handling and awkward postures in a general hospital as a part of the activities related to individual Health Surveillance, are useful as a tool in detecting predictors of developing Low Back Pain (LBP). Methods: Descriptive study on a sample of 114 workers with a period of service of work longer than 1 year. All subjects underwent a health examination where the variables gender, age, current job, seniority, type of day-shift, Body Mass Index (BMI), physical activity, history of depression, history of LBP, type of coexistence, non-work related activities, work history, smoking, personal and family factors and physical examination were included as independent variables. The dependent variable was to have had back pain in the past year. Aspects of working conditions and psychosocial environment modeled on social demanda-control/apoyo Karasek and Johnson were collected through self-administered questionnaires. A descriptive, bivariate and multivariate analysis was performed. Results: Incidence of LBP was DE13 , 3% ( 95% CI 6.639 to 20.147 ) Only age , female gender and abnormal exploration was associated with the development of LBP. The association of the variables age and abnormal physical examination justify the 86 % of cases of LBP. Conclusions: On the basis of these results we conclude that having more than 52 years and an abnormal physical examination of the spine are predictive factors for developing LBP (AU)

Preparación intestinal colónica con polietilenglicol y manitol: efectividad según la escala de Boston / Colonic bowel preparation: effectiveness of polyethyleneglycol and manitol

Comparar efectividad del polietilenglicol y manitol en la preparación intestinal mediante escala de Boston, pacientes de la consulta externa de gastroenterología, tercer trimestre, 2012. Estudio prospectivo, transversal, experimental. Muestra de 100 pacientes aleatorizados en dos grupos: polietilenglicol y manitol, 50 en cada uno. A todos se les instauró dieta líquida el día previo al estudio e indicación para la ingesta de la solución a evaluar. Se realizó colonoscopia con evaluación endoscópica según escala de Boston. La tolerancia a la preparación fue considerada fácil por 88% en el grupo polietilenglicol vs 100% del grupo manitol (p=0,041). El 98% del grupo manitol consideró que este medicamento tenía sabor agradable en comparación con polietilenglicol (78%) (p=0,002). El efecto adverso más frecuente en ambos grupos fue la náusea. El polietilenglicol alcanzó exploraciones completas con restos en un 82% colon derecho, 56% colon transverso y 72% colon izquierdo, mientras que con manitol prevaleció la exploración completa sin restos en 66%, 90% y 68% respectivamente (p<0,05). La puntuación global de la escala de Boston con polietilenglicol y manitol fue 6 vs 8 (p<0,05). Manitol resultó ser más efectivo que polietilenglicol para la preparación del colon en su totalidad y por segmentos

To compare the effectiveness of polyethyleneglycol and mannitol bowel preparation by Boston scale, in patients from the outpatient gastroenterology in the third quarter of 2012. Prospective, cross, experimental with a sample of 100 patients randomized to group polyethyleneglycol and mannitol group, 50 in each. All were introduced liquid diet the day before the test with the appropriate indication for the intake of the solution to evaluate and colonoscopy was performed endoscopic evaluation scale as Boston. Tolerance was considered easy preparation by 88% in polyethyleneglycol group vs 100% mannitol group (p=0.041). 98% mannitol group had considered that this medicine palatable compared with polyethyleneglycol (78%) (p=0.002). The most common adverse event in both groups was nausea. Polyethyleneglycol reached full scans with remains at 82% right colon, transverse colon 56% and 72% left colon, whereas mannitol prevailed without full exploration remains at 66%, 90% and 68% respectively (p<0,05). The overall rating scale was polyethyleneglycol Boston 6 vs 8 in the mannitol group (p<0,05). Mannitol was more effective for the preparation of polyethyleneglycol entire colon and segments