HCAM la historia de un grande / HCAM the story of a great

Prólogo. La obra recopiló los hitos históricos, las acciones en gestión y la visión futura de las Unidades Médicas, Administrativas y de Enfermería, en homenaje a los 50 años de función del Hospital de Especialidades Carlos Andrade Marín como ícono de la Seguridad Social del Ecuador, entre el periodo 1970 a diciembre 2020. Cada autor registró el título entrelazado un pensamiento, previo a la cronología de los hechos suscitados en los servicios brindados en beneficio de los pacientes que se atendieron en esta casa de salud. La obra se clasificó en capítulos por Unidades Médicas: Críticas, Clínicas, Quirúrgicas, Administrativas y de Enfermería, se incluyeron tablas, figuras, producción médica, patologías, cambios de técnicas o procedimientos y sustentó su accionar con citas textuales y referen-cias bibliográficas. Además, se narraron mejoras continuas transmitidas de los ilustres y legados maestros, especialistas médicos por varias generaciones, en conjunto con el personal de salud con vocación de servicio, en una reflexión profunda con mensajes vivos de su accionar. En las modalidades de publicación se realizaron aportes de visión nacional e internacional en los ámbitos asistenciales, administrativos, docente, de investigación y producción científica de alto nivel del contexto y naturaleza del emblemático hospital. Finalmente, se agradece a los funcionarios y ex trabajadores que colaboraron durante el proceso de construcción de la obra, así como a ex colaboradores que motivaron aportes de experiencias y la apreciación personal.

Prologue. The work compiled the historical milestones, management actions and future vision of the Medical, Administrative and Nursing Units, in tribute to the 50 years of function of the Carlos Andrade Marin Specialty Hospital as an icon of the Social Security of Ecuador, between 1970 and December 2020. Each author recorded the title intertwined with a thought, prior to the chronology of the events that took place in the services provided for the benefit of patients who were treated in this health center. The work was classified in chapters by Medical Units: Critical, Clinical, Surgical, Administrative and Nursing, and included tables, figures, medical production, pathologies, changes in techniques or procedures, and supported his actions with textual quotations and bibliographical references. In addition, continuous improvements were narrated and transmitted from the illustrious and legacy masters, medical specialists for several generations, together with the health personnel with vocation of service, in a deep reflection with living messages of their actions. In the publication modalities, contributions of national and international vision were made in the care, administrative, teaching, research and scientific production of high level of the context and nature of the emblematic hospital. Finally, we would like to thank the employees and former workers who collaborated during the construction process, as well as former collaborators who contributed with their experiences and personal appreciation.

Colitis ulcerativa extensa severa presentación caso / Severe extensive ulcerative colitis. Case presentation

RESUMEN La colitis ulcerativa es una enfermedad crónica recidivante del tracto gastrointestinal, que evoluciona por recaídas formando parte de las enfermedades inflamatorias intestinales (EII). Afecta la mucosa y submucosa del colon, caracterizada por un proceso ulcerativo y supurado de la mucosa. La diarrea crónica con sangre es el síntoma más importante. En su curso alternan periodos de remisión y de crisis. No existe un criterio patognomónico para su definición, su diagnóstico se basa en una serie de criterios clínicos, endoscópicos e histológicos. Esta entidad infrecuente en su forma extensa severa. Aparece en un paciente, que llega a la institución de salud refiriendo que hace aproximadamente dos años, presenta cuadros de diarreas intermitentes con sangre, tratadas en el área de salud. Se le realizó Rx y colonoscopia constatando presencia de eritema, granularidad mucosa, friabilidad, pérdida de la vascularización submucosa, erosiones y ulceraciones extensas, profundas, signos de edema, pseudopólipos, pérdida de haustras, rigidez, sangrado, tractos fibrosos y presencia de exudado luminal. Se diagnosticó colitis extensa ulcerativa severa y se orientó tratamiento médico endovenoso y se continuó por via oral, obteniendo la remisión del cuadro clínico desde el punto de vista clínico y endoscópico (AU).

ABSTRACT Ulcerative colitis is a chronic recidivist disease of the gastrointestinal tract, evolving by relapses and is one of the intestinal inflammatory diseases. It affects the colon mucosa and sub-mucosa, characterized for an ulcerative process and mucosa exudation. Chronic diarrhea with blood is the most important symptom. Periods of crisis and remission alternated in its course; there is not a pathognomonic criteria for its definition and its diagnosis is based in a series of clinical, endoscopic and histological criteria. This entity, infrequent in extensive severe form, appears in a patient arriving to the hospital referring having intermittent diarrheas with blood for two years, treated in the health area. He undergone a radiography and colonoscopy, showing the presence of an erythema, mucosa granularity, friability, lost of submucosa vascularization, deep extensive erosions and ulcerations, edema signs, pseudo polyps, haustras lost, stiffness, bleeding, fibrous tracts and presence of luminal exudates. Severe ulcerative extensive colitis was diagnosed and was prescribed an endovenous medical treatment, continued orally, achieving the disease remission from the clinical and endoscopic point of view (AU).

Impacto da autopercepção de saúde em longevos com incontinência urinária / Impact of self-perceived health on long-lived subjects with urinary incontinence

OBJETIVOS: Verificar o impacto da autopercepção de saúde sobre a chance de desenvolver incontinência urinária em longevos. MÉTODOS: Trata-se de um estudo transversal e analítico com idosos de 90 anos ou mais. Foi realizada análise estatística analítica e descritiva (frequências, média e desvio padrão, análise de regressão logística univariada e ajustada pela autopercepção de saúde) das variáveis sociodemográficas e clínicas (sexo, estado conjugal, continência, idade, sintomas depressivos, cognição, comorbidades e facilidade de realizar atividades básicas e funcionais). RESULTADOS: Participaram 182 longevos, 71% mulheres. O diagnóstico prévio de depressão, o escore de sintomas depressivos e o percentual de facilidade para atividades funcionais e básicas foram relacionados com a autopercepção de saúde (p<0,05). A perda de urina, contudo, não foi relacionada à autopercepção de saúde. A autopercepção de saúde influenciou o efeito das variáveis diagnóstico prévio de depressão, número de sintomas depressivos, pontuação do Mini Exame do Estado Mental e número de comorbidades sobre a chance de incontinência urinária na presença das mesmas. O sexo masculino, a viuvez e a facilidade no desempenho de atividades básicas e funcionais foram variáveis significativamente relacionadas com a incontinência urinária independentemente do ajuste da autopercepção de saúde. CONCLUSÕES: Não houve relação entre incontinência urinária e autopercepção de saúde, contudo, a autopercepção de saúde influenciou no efeito das variáveis sociodemográficas e clínicas sobre a chance de ter incontinência urinária.

AIMS: To verify the impact of self-perceived health on the chance of developing urinary incontinence in very-old. METHODS: This is a cross-sectional and analytical study with elderly individuals aged 90 years and over. The statistical and analytical variables (sex, marital status, continence, age, depressive symptoms, cognition, comorbidities and ability to perform activities) were analyzed analytical and descriptive statistics (frequencies, mean and standard deviation, univariate and health self-perception adjusted logistic regression analysis). RESULTS: There were 182 participants, 71% women. The previous diagnosis of depression, the score of depressive symptoms and the percentage of ease for functional and basic activities were related to self-perception of health (p<0.05). The loss of urine, however, was not related to self-perceived health. The self-perception of health influenced the effect of the variables previous diagnosis of depression, number of depressive symptoms, Mini-Mental State Examination score and number of comorbidities on the chance of urinary incontinence in the presence of these variables. Males, widowhood and ease of performance of basic and functional activities were significantly related to urinary incontinence regardless of the adjustment of health self-perception. CONCLUSIONS: There was no relationship between urinary incontinence and health self-perception. However, health self-perception influenced the effect of sociodemographic and clinical variables on the chance of having urinary incontinence.

Investigação da qualidade de vida de mulheres com incontinência urinária / Quality of life of women with urinary incontinence

Investigar a qualidade de vida de mulheres com incontinência urinária. Pesquisa do tipo observacional de caráter transversal, com abordagem quantitativa. Aplicou-se uma ficha de anamnese adaptada de Moreno (2009) e Stephenson e O´Connor (2004) para traçar o perfil social e uroginecológico das participantes. A fim de investigar a qualidade de vida em relação às perdas urinárias, foi utilizado o King's Health Questionnaire (KHQ) e International Consultation on Incontinence Questionnaire ­ Short Form (ICIQ-SF). Os dados foram analisados por meio de estatística descritiva, distribuição de frequência, percentual, média e desvio padrão. Participaram do estudo 44 mulheres com incontinência urinária, com média de idade de 67,1 (±6,1) anos. Observou-se que a qualidade de vida em relação às perdas urinárias foi considerada de fraca a moderada. Partindo-se do pressuposto que o KHQ não possui uma pontuação geral (os índices variam de 0 a 100), quanto mais próxima a pontuação de 100, pior o desempenho para aquele domínio em específico. Em relação ao questionário ICIQ-SF, o impacto da incontinência urinária apontou que a média foi de 8,79, classificado como grave, sendo que a maioria, 43%, apresentou uma pontuação muito grave. Os dois instrumentos distintos (ICQ-SF e KHQ) apresentaram valores diferentes sobre análise da qualidade de vida das mulheres pesquisadas, porém ambos remetem algum impacto negativo sobre a qualidade de vida.

Investigate the quality of life in women with urinary incontinence using two instruments. Observational and transversal study, with a quantitative approach. An anamnesis form was applied, which was adapted from Moreno (2009) and Stephenson and O'Connor (2004) to trace the social and urogynecological profile of participants. In order to investigate the quality of life compared to urinary losses, the King's Health Questionnaire (KHQ) and International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) were used. The descriptive statistical analysis used frequency distribution, percentage, mean and standard deviation. The study included 44 women with urinary incontinence, average age of 67.1 ± 6.1 years. The results showed that the quality of life in relation to urinary leakage was considered weak to moderate. Assuming that the KHQ does not have an overall score (index ranges from 0 to 100), the closer to 100, the worst the performance for that specific domain. Regarding the ICIQ-SF questionnaire, the impact of urinary incontinence pointed out an average of 8.79, classified as severe, with the majority, 43%, as very severe. The two different instruments (ICIQ-SF and KHQ) presented different values regarding the analysis on the quality of life of the surveyed women; however, both presented results showing negative impacts on the quality of life.

Negociando saberes e poderes: a Política Nacional de Atenção Integral à Saúde do Homem e a Sociedade Brasileira de Urologia / Negotiating knowledge and power: the National Policy for Comprehensive Men’ s Healthcare and the Brazilian Society of Urology

Resumo O objetivo do artigo é evidenciar as negociações e disputas entre saberes e poderes na história da Política Nacional de Atenção Integral à Saúde do Homem, a partir da criação da Área Técnica de Saúde do Homem, instituída em 2008 no Departamento de Ações Programáticas Estratégicas no Ministério da Saúde. Acompanhamos a posição da Sociedade Brasileira de Urologia no processo de constituição da política. Recuperamos a disputa colocada em discurso tendo como referência as entrevistas realizadas com gestores do Ministério da Saúde e com o representante auxiliar do Fundo de População das Nações Unidas no Brasil. Nas aparições do sujeito de direitos à saúde, analisamos a visibilidade do corpo masculino nos signos das resistências às intervenções do biopoder.

Abstract The aim of this article is to demonstrate the negotiations and disputes between different kinds of knowledge and power in the history of the Brazilian National Policy for Comprehensive Men’s Healthcare based on the creation in 2008 of the Technical Area for Men’s Health within the Ministry of Health’s Department of Strategic Programs. We observed the Brazilian Society of Urology’s position as the policy was being drawn up, including the discourse adopted, based on interviews held with managers from the Ministry of Health and the assistant representative of the United Nations Population Fund in Brazil. We analyzed the visibility of the male body in signs of resistance to the interventions of biopower in the expression of the right to health.

Comparison of the epidemiologic features and patterns of initial care for prostate cancer between public and private institutions: a survey by the Brazilian Society of Urology

OBJECTIVE: To describe the epidemiological features and patterns of initial care for prostate cancer at public and private institutions in the State of Sao Paulo, Brazil. MATERIALS AND METHODS: A total of 1,082 physicians affiliated to the Sao Paulo Section of the Brazilian Society of Urology were invited to participate in this cross-sectional, web-based survey. Between September 2004 and September 2005, participating urologists entered data on demographic, clinical and pathological characteristics of patients diagnosed with prostate cancer in their practice. Data on patients attended at public institutions were analyzed and compared with those patients attended at private practice. RESULTS: One hundred and ten society members contributed with data from 1915 patients, 1026 (53.6%) of whom from public institutions. When compared with patients attended at private institutions, those attended at public institutions were older and more likely to be black, had higher serum prostate specific antigen (PSA) levels, had a higher probability of being diagnosed with metastatic disease, but were less likely to undergo prostatectomy (all P < 0.001). In multivariate analysis, age, biopsy Gleason score, and being attended at a public institution were independently associated with metastatic disease upon diagnosis. The significant predictors of nonsurgical treatment were age, black race, and higher serum levels of PSA. CONCLUSIONS: A statewide registry provides valuable information regarding patient demographics, clinical features, and patterns of care. The results of this study suggest that significant disparities exist for patients with prostate cancer attended at different health-care systems. The relative contribution of biological versus socioeconomic features remains uncertain.

The one-stop clinic as the standard of out-patient care in a hospital urology department

PURPOSE: To evaluate the performance of a 'one-stop' clinic in terms of proportion of discharges or inclusion in surgical waiting lists. MATERIALS AND METHODS: All patients were referred from primary care facilities (population 220.646) and from different departments in the hospital. Eight senior urologists, two registered nurses and two nurse attendants participated in the experience. Prior to the start of the project, referral protocols had been agreed with the primary care physicians involved. Compliance with the protocols was periodically tested. Eventually 5537 first visits (January-December 2009) where evaluable. RESULTS: Overall, the 'one-stop' format proved feasible in 74.2 percent of the patients (4108/5537). Patients, who successfully used the 'one-stop' format, were significantly younger than those who required additional consultations (43 vs 50 years old, respectively, Student's t test < 0.001). For obvious reasons the 'one-stop' format was universally possible in male sterilization and penile phimosis patients. Similarly, the 'one-stop' policy was applied in most consultations due to male sexual dysfunction (75 percent) and urinary tract infection (73 percent). Other health problems, such as haematuria (62 percent) and renal colic (46 percent), required more than one visit so that care of the patient reverted to the traditional, outpatient care model. CONCLUSION: A 'one-stop' philosophy is feasible for a number of procedures in a urological outpatient clinic. The costs to implement such an approach would be limited to managerial expenditure.

Is the ability to perform transurethral resection of the prostate influenced by the surgeon's previous experience?

PURPOSE: To evaluate the influence of the urologist's experience on the surgical results and complications of transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Sixty-seven patients undergoing transurethral resection of the prostate without the use of a video camera were randomly allocated into three groups according to the urologist's experience: a urologist having done 25 transurethral resections of the prostate (Group I - 24 patients); a urologist having done 50 transurethral resections of the prostate (Group II - 24 patients); a senior urologist with vast transurethral resection of the prostate experience (Group III - 19 patients). The following were recorded: the weight of resected tissue, the duration of the resection procedure, the volume of irrigation used, the amount of irrigation absorbed and the hemoglobin and sodium levels in the serum during the procedure. RESULTS: There were no differences between the groups in the amount of irrigation fluid used per operation, the amount of irrigation fluid absorbed or hematocrit and hemoglobin variation during the procedure. The weight of resected tissue per minute was approximately four times higher in group III than in groups I and II. The mean absorbed irrigation fluid was similar between the groups, with no statistical difference between them (p=0.24). Four patients (6 percent) presented with TUR syndrome, without a significant difference between the groups. CONCLUSION: The senior urologist was capable of resecting four times more tissue per time unit than the more inexperienced surgeons. Therefore, a surgeon's experience may be important to reduce the risk of secondary TURP due to recurring adenomas or adenomas that were incompletely resected. However, the incidence of complications was the same between the three groups.

Síndrome de leriche: a propósito de un caso / Syndrome of leriche: a purpose of a case

EL SINDROME DE LERICHE o Síndrome de Obliteración Aorto Iliaca, es un síndrome causado por la obstrucción de la Aorta Terminal¹. Es un disturbio que afecta generalmente a varones jóvenes, entre los 30 y 40 años de edad². La enfermedad arteriosclerótica oclusiva crónica suele afectar a la Aorta abdominal distal, por debajo de las arterias renales. El síndrome se caracteriza por la triada de: disminución o ausencia de pulsos femorales, claudicación o dolor en los glúteos y las piernas al caminar y la impotencia para la erección del pene. Se presenta caso de paciente masculino de 73 años de edad con enfermedad actual de cinco meses de evolución, el cual fue ingresado al servicio de Medicina Interna del Hospital Central de San Cristóbal en el mes de abril de 2005 con el diagnóstico de Enfermedad Arterial Periférica (Síndrome de Leriche) al cual se le realizó arteriografía que revelo obstrucción total de la aorta abdominal por debajo del origen de las arterias renales, confirmado mediante laparotomía exploradora, presentando posteriormente las complicaciones clásicas principales de las arteriopatías obstructivas de las extremidades inferiores.

Seroprevalencia de anti-VHC coexistencia de AgHBs, anti-HBc y factores de riesgo de infección en pacientes con insuficiencia renal crónica unidad unidad de dialisis "Barquisimeto" / Seroprevalencia of anti-HCV coexistence de AgHBs, anti-HBc and factors of risk of infection in patients with chronic renal insufficiency unit of dialisis

Para determinar la seroprevalencia de anti-VHC la coexistencia de Ag-HBs, anti-HBc y factores de riesgo de infección de VHC en pacientes en hemodiálisis de la Unidad de Diálisis "Barquisimeto" durante Agosto-Octubre del 2002, se relizó un estudio descriptivo, transversal. la población y muestra estuvo conformada por 90 pacientes de los cuales 6 resultron anti-VHC positivo, con una seroprevalencia de 7%. El 100% de los pacientes anti-VHC positivo y el 47,62% de los anti-VHC negativo presentó coexistencia con marcadores virales por hepatitis B, 66,66 por ciento de los pacientes anti-VHC positivo y 61% de los pacientes anti-VHC pertenecen al sexo masculino, todos los pacientes anti-VHC positivo y 73,34% de los anti-VHC negativo pertenecen al sexo masculino, todos los pacientes anti-VHC positivo y 73,34% de los anti-VHC negativo pertenencen al rango de edad de 36 y más años, los pacientes anti-VHC positivo todos tienen 4 o más años sometidos a hemodiálisis y 60% de los anti-VHC negativos tienen menos de 4 años sometidos hemodiálisis, 100% de los pacientes anti-VHC positivo tuvo antecedentes de transfusión sanguínea en relación a 93% de los anti-VHC negativo, 33,3% de los pacientes anti-VHC positivo y 47,6% de los anti-VHC negativo tuvo contacto con material no esteril o de esterilidad dudosa de las cuales el uso de agujas reciclables fue la más frecuente en los dos grupos, 67% de los pacientes anti-VHC positivo y el 39% de los anti-VHC negativo tuvo contacto sexual con 3 o más parejas; 100% son heterosexual, con ocupación de bajo riesgo para adquirir la infección, desconocen la seropositividad de sus parejas sexuales y del grupo familiar donde convive.

Experiencias de telemedicina en el Instituto Docente de Urología / Telemedicine experiences in an urology education institute

En este trabajo se presenta la experiencia del Centro de Procesamiento de Imágenes (CPI) en la enseñanza de latelemedicina. Específicamente se muestra con una visión amplia todos los aspectos de este proyecto médico-tecnológico. El objetivo del curso fue dar una formación teórico-práctica a los estudiantes en el área de telemedicina, demostrando la versatilidad de esta prácticamédica a través de variadas experiencias y diversas actividades médicas. La fase experimental del curso de telemedicina se realizó dentro del Postgrado de Urología de la Universidad de Carabobo coordinado por el Instituto Docente de Urología (IDU). Este artículo describe estaexperiencia en todos sus matices, la configuración de los equipos de videoconferencia, una descripción de los periféricos médicos adaptados a la práctica de la telemedicina, la instalación de las telecomunicaciones, los espacios médicos adaptados a la telemedicina, y elcontenido mismo del curso. El curso tuvo una duración de doce semanas, se describen: los tutoriales para nivelar el grado de conocimiento de los médicos en las áreas de tecnologías de la información, las prácticas de manejo de los equipos de videoconferencia y los equiposmédicos periféricos como: ecógrafos, electrocardiógrafos y estetoscopios digitales. Esta es la primera experiencia formal de telemedicina que se ha realizado en Venezuela con fines didácticos . Este curso nos permitió observar el comportamiento de los médicos frente a losequipos y en colaboración con los estudiantes de la especialidad realizaron numerosas prácticas de telemedicina en las áreas de: teleradiología (RX y Ultrasonido) y telecistología.

Cuantificación de los niveles de eritropoyetina (EPO) endógena y su relación con variables epidemiológicas en un grupo de pacientes en hemodiálisis / Quantification of the endogenous erythropoie (EPO) levels and its relation with epidemiological varible in a group of patients in hemodialysis

Investigamos los valores de la eritropoyetina (EPO) endógena en pacientes con insuficiencia renal crónica terminal en tratamiento hemodialítico. Este estudio se llevó a cabo en 33 pacientes pertenecientes a la Unidad de Hemodiálisis Fresenius Medical Care de Venezuela, con edades compredidas entre los 22 a 77 años, 40 por ciento de raza caucásica, 22 por ciento de raza negra y 38 por ciento mestizos. Los criterios de inclusión fueron: no haber presentado en los últimos tres meses sangramiento activo, ni haber recibido EPO humana recombinante ni transfusiones de sangre en el mismo período de tiempo. Todos los pacientes recibieron tres sesiones de hemodiálisis por semana. Las muestras de sangre se obtuvieron antes de la primera y antes de la última sesión de hemodiálisis de la semana. El análisis de EPO se efectuó por quimioluminiscencia (Nichols Diagnostics Institute, USA). Los valores se expresaron en media aritmética ñ ES. Los valores de EPO endógena fueron de 10,43 ñ 1,35 mU/mL antes de la primera diálisis de la semana, y de 11,36 ñ 0,31 mU/mL antes de la última diálisis de la semana; los valores fueron menores a los descritos en la literatura para otros países. Los valores de EPO relacionados con la raza fueron 12,59 ñ 1,56 mU/mL para las caucásicos, 7,61 ñ 1,07 mU/mL para los negros y 11,09 ñ 1,62 mU/mL para los mestizos. No hubo diferencia en los valores de EPO en relación al día de la diálisis en que se tomó la muestra, ni en relación con la edad, el sexo y la patología de base, pero el tiempo en diálisis juega con 1 a 30 meses en diálisis con los pacientes que tienen de 1 a 60 meses en tratamiento