Prevention of parastomal hernia after abdominoperineal excision with a prophylactic three-dimensional funnel mesh.

AIM: A prophylactic three-dimensional (3D) funnel mesh using the keyhole technique (intraperitoneal onlay mesh position) in abdominoperineal excision (APR) may significantly decrease the parastomal hernia (PSH) index without increasing morbidity. The aim of this retrospective observational study was to analyse the incidence of PSH and postoperative complications in patients who underwent permanent colostomy with the use of a prophylactic 3D preformed mesh compared with patients without a mesh. METHOD: Patients who underwent an end-colostomy after APR for primary or recurrent rectal cancer in a colorectal surgery unit were divided into two groups: group 1 without a prophylactic mesh and group 2 with a prophylactic synthetic mesh. The main end-point was to analyse the incidence of PSH after a median follow-up of 2.8 years. RESULTS: One hundred and ten patients (64 in group 1 and 46 in group 2, without significant clinical differences) underwent a permanent colostomy after APR. In group 1 70.3% developed a PSH, compared with 13% in group 2 (P < 0.001). Age (especially for patients ≥ 75 years) represented a significant risk factor for PSH. There were no differences in postoperative complications between the groups. CONCLUSION: A prophylactic parastomal 3D mesh using the keyhole technique may reduce the incidence of PSH after permanent colostomy without an increase in postoperative complications.

[Spontaneous coronary artery dissection in the post partum: report of one case]. / Disección coronaria espontánea post parto: reporte de un caso clínico y revisión de la literatura.

Coronary artery dissection is a rare cause of acute coronary syndrome. Most cases occur in women during the peripartum period, most likely influenced by hormonal changes, hemodynamic stress and modifications in the immune system during pregnancy. The pathogenesis of coronary artery dissection is unknown, hence numerous theories have been postulated such as pregnancy-related conditions, the presence of connective tissue disorders, trauma, etc. The clinical presentation ranges from asymptomatic patients to the whole spectrum of acute coronary syndrome manifestations. The management of these patients requires a multidisciplinary approach, with two options: medical therapy or an invasive approach, with percutaneous coronary intervention or coronary artery bypass graft surgery. The choice of treatment options depends on the hemodynamic status of the patient, the extension of the dissection and the myocardial territory at risk. In this case report we present a 38-year-old female who had a coronary artery dissection seven days postpartum. Coronary catheterization showed dissection of the left main coronary artery that extended until the circumflex artery. An intra-aortic balloon pump was installed and the patient then underwent coronary artery bypass graft surgery, with satisfactory results.

Prevalence and risk factors for intestinal parasitic infections in a rural community in "consolación del sur" municipality, cuba.

Intestinal parasites are very common infections worldwide and they are responsible for significant public health problems. The World Health Organization estimates that one-third of the world population is infected and some epidemiologic factors related to the transmission have been identified. The purpose of this investigation was to study the prevalence of intestinal parasitic infections in people living in the rural community of "El Canal", Consolación del Sur municipality and the association with some epidemiologic risk factors. All participants were subjected to three methods of parasitological examinations on the stool samples and by immunodiagnostic tests which allow the detection of excretory-secretory antigens of adults with Fasciola hepatica. The global prevalence rate of intestinal parasitic infections (IPIs) was 18%, and 16.7% for protozoan infections, while the rate of helminth infection was lower (5.3%) in the population studied. The univariate analysis identified three factors associated with intestinal pathogenic protozoan infections which include livestock work, drinking water from well\river and eating unwashed fruits\vegetables. The multivariate analysis using introduction test logistic regression ratified the association of these risk factors. Contrary to what have been published in the majority of Cuban studies carried out in rural places, a higher prevalence of protozoan than helminth infection was found. This discrepancy may be explained because the majority of the workers in this rural community were stock-breeders and they are not involved in other agricultural work. The identification of risk factors is important in order to design appropriate strategies for control of IPIs in communities.

[Anemia and transfusion therapy: an update]. / Actualización en anemia y terapia transfusional.

Anemia is one of the most prevalent diseases in the general population and is a very frequently found condition in medical and surgical patients in all medical specialties. A good evaluation of its clinical impact and its therapeutic possibilities is essential. Allogenic blood transfusion is a useful procedure in anemia management, although it has important adverse effects. It is the responsibility of the clinician to know and to take into account all the available alternatives for the treatment of anemia. Blood transfusions, erythropoiesis-stimulating agents, iron therapy (oral and endovenous) and other therapeutic alternatives must be rationally used, in accordance with the currently available clinical evidence. This review article summarizes some epidemiological characteristics of anemia, its clinical evaluation and the main therapeutic possibilities based on the present knowledge, placing special emphasis on the critically ill patient.

[Repetition of microbiological tests in suspect of SARS-CoV-2 infection: utility of a score based on clinical probability]. / Repetición de las pruebas microbiológicas en la sospecha de la infección por SARS-CoV-2: utilidad de un score basado en la probabilidad clínica.

OBJECTIVE: The diagnosis of SARS-CoV-2 infection presents some limitations. RT-PCR in nasopharyngeal swabs is considered the gold standard for the diagnosis, although it can have false negative results. We aimed to analyze the accuracy of repeating nasopharyngeal swabs based on different clinical probabilities. METHODS: Retrospective observational study of the first patients admitted to a two COVID Internal Medicine wards at the University Hospital Marqués de Valdecilla, Santander, from March to April 2020. RT-PCR targering E, N, RdRP and ORFab1 genes and antibody tests detecting IgG. RESULTS: A total of 145 hospitalized patients with suspected SARS-Cov2 infection were admitted and in 98 (67.5%) diagnosis was confirmed. The independent predictive variables for SARS-CoV-2 infection were: epidemiological contact, clinical presentation as pneumonia, absence of pneumonia in the last year, onset of symptoms > 7 days, two or more of the following symptoms -dyspnea, cough or fever- and serum lactate dehydrogenase levels >350 U/L (p<0.05). A score based on these variables yielded an AUC-ROC of 0.89 (CI95%, 0.831-0.946; p<0.001). The accuracy of the first nasopharyngeal swabs was 54.9%. Repeating nasopharyngeal swabs two or three times allows to detect an additional 16% of positive cases. The overall accuracy of successive RT-PCR tests in patients with low pre-test probability was <5%. CONCLUSIONS: We have defined a pre-test probability score based on epidemiological and clinical data with a high accuracy for diagnosis of SARS-CoV-2. Repeating nasopharyngeal swabs avoids sampling errors, but only in medium of high probability pre-test clinical scenarios.

[Hypertension and Framingham general vascular risk score in retinal vein occlusion]. / La hipertensión arterial y el score de Framingham de riesgo vascular en la obstrucción venosa retiniana.

OBJECTIVES: To determine the prevalence of arterial hypertension (AHT), systolic blood pressure (SBP), the diastolic blood pressure (DPB), and the Framingham vascular risk score (FRS), in subjects with retinal vein occlusion (RVO), as well as in a control group. PATIENTS AND METHOD: A prospective, cross-sectional case and control study was conducted on all patients with a diagnosis of RVO referred to the General Medicine Clinic, and comparing them with a control group. An analysis was performed on the clinical and laboratory variables. RESULTS: A total of 253 patients with RVO were studied (132 males and 121 females) and 244 controls (112 males and 132 females) of similar age (67.9±12.3 vs. 68.1±9.2 años). The prevalence of AHT, and the SBP and DPB values in the clinic after the RVO were significantly higher in patients with RVO than in the controls (71.5% vs. 51.2%), SBP mmHg (148±22 vs. 138±18mmHg), DBP mmHg (83±10 vs. 77±10mmHg). The de novo diagnosis of AHT was made from the RVO in 23.8% of the cases. Significant differences were found in the FRS between the patients with RVO and the controls (11±8.3 vs. 8.25±6.3. There were no differences in any of the parameters studied between patients with peripheral or central RVO. CONCLUSIONS: Hypertension is very prevalent as significantly more common in patients with RVO than in controls. Its diagnosis and treatment is often established from the RVO. The FRS is greater in patients with RVO. There were no differences in any of the parameters studied between patients with peripheral or central RVO. It is suggested that RVO should be considered a vascular event when defining therapeutic objectives.

Satisfacción y calidad asistencial de la Telefarmacia durante la pandemia por COVID-19 en un hospital de primer nivel / Satisfaction with and quality of Telepharmacy care in a top-tier hospital during the COVID-19 pandemic

Objetivo: Conocer el grado de satisfacción de los pacientes o sus familiares/cuidadores con respecto a la atención recibida mediante Telefarmacia desde la Consulta de Atención Farmacéutica a Pacientes Externos de un Servicio de Farmacia Hospitalaria de primer nivel. Métodos: Estudio transversal de 5 meses de duración. Se incluyeron todos los pacientes atendidos en las Consultas de Atención Farmacéutica de manera telemática con dispensación informada de la medicación entre los meses de mayo y septiembre de 2020. Para medir el grado de satisfacción se utilizó una encuesta tipo Likert de 10 niveles. Los datos de pacientes se obtuvieron a partir del aplicativo Historia Clínica electrónica (IANUS®) y del software Silicon®. Para comparaciones entre grupos se utilizó el test t de Student de comparación de medias y el test ANOVA. Resultados: Se realizaron un total de 392 encuestas de satisfacción a 209 mujeres (53,3%) y 183 hombres (46,7%) de edad media 59,8 años (s.d. 18,5), de las cuáles 231 (58,9%) eran pacientes y 161 (41,1%) cuidadores/familiares. Se observó una puntuación de satisfacción global de 9,88 (s.d. 0,4). No se observaron diferencias estadísticamente significativas entre la puntuación obtenida de los pacientes o cuidadores/familiares (p=0,102). Conclusiones: La consulta telemática de atención farmacéutica constituye una valiosa herramienta que satisface las necesidades asistenciales de los pacientes y sus familiares y supone una oportunidad de mejora en la atención sanitaria integrada a distancia. Desde nuestra experiencia, la telefarmacia se posiciona como una importante estrategia para evitar desplazamientos al centro sanitario, con la consecuente mejoría en la calidad de vida de nuestros pacientes. (AU)

Objective: To ascertain the degree of satisfaction of patients or their relatives/caregivers with the care received via Telepharmacy at the Outpatient Pharmaceutical Care Clinic of a top-tier Hospital Pharmacy Service. Methods: Cross-sectional study lasting 5 months. All patients cared for online by the Pharmaceutical Care Clinics with informed dispensation of medication between May and September 2020 were included. A 10-point Likert-type survey was used to measure the level of satisfaction. Patient data was obtained from the electronic medical record program (IANUS®) and the Silicon® software. Student’s mean comparison t-test and ANOVA test were used for comparisons between groups. Results: A total of 392 satisfaction surveys were conducted on 209 women (53.3%) and 183 men (46.7%) with an average age of 59.8 (s.d. 18.5), of whom 231 (58.9%) were patients and 161 (41.1%) caregivers/relatives. An overall satisfaction score of 9.88 (s.d. 0.4) was observed. No statistically significant differences were observed between the score obtained from patients and that obtained from caregivers/relatives (p=0.102). Conclusions: The online pharmaceutical care clinic is a valuable tool that meets the care needs of patients and their relatives and is an opportunity for improvement in remote comprehensive healthcare. From our experience, telepharmacy is an important strategy in avoiding travel to the health centre, with the subsequent improvement in the quality of life of our patients. (AU)

Echocardiographic, electrocardiographic and blood pressure changes induced by icodextrin solution in diabetic patients on peritoneal dialysis.

The use of icodextrin as an osmotic agent in solutions for peritoneal dialysis (PD) has important cardiovascular effects related with better control of extracellular volume. Among them, reduction of arterial pressure and an improvement in echocardiographic parameters stand out. In diabetic patients, icodextrin has additional potential advantages related with better metabolic control. In a multicenter, open-label randomized controlled trial, the effects of icodextrin solutions were compared to glucose solutions on echocardiographic, electrocardiographic, and blood pressure changes in diabetic patients on PD. Two phases were noted in the follow-up. In the early phase (6 months), reduction in ambulatory blood pressure (ABP) and left ventricular end diastolic diameter were found in the icodextrin group. These changes correlated with changes in body fluids. In the late phase (12 months), a trend towards baseline values in ABP was seen. Changes in inferior vena cava diameter and in low frequency R-R variability spectral analysis in the icodextrin group suggest that icodextrin increases circulating blood volume and sympathetic tone, probably by accumulation of icodextrin metabolites in the bloodstream and improvement in diabetic neuropathy as a result of lower peritoneal glucose absorption. The effects of icodextrin in diabetic patients were related to better fluid management and metabolic control.

A 16-fold increase in organ donation in a Hispanic population.

UNLABELLED: Organ transplantation as a substitute for diseased organs in end-stage organ failure has led to a worldwide increase in this treatment modality, but donation has not kept pace with the demand, despite scientific, social, and government efforts. For many years, Hispanic donation in Puerto Rico was meager and lagged behind major centers in North America and Europe. Studies signaled mostly cultural factors in this limited donation. We report a 16-fold increase in organ donation with the development of a formal procurement organization tailored to a local culture. METHODS: The 30-year, 1400-transplant experience of the Puerto Rico Transplant Center was divided in three periods: 1977 through 1893, the latter signaling the approval of a transplant law; 1984 through 1995, signaling the commencement of a formal organ procurement organization; and 1996 through 2006. The subset of 2001 to 2006 was used in an additional calculation against 1984 to 1995. RESULTS: The comparison of the mean deceased donors from 1984 to 1995 with 1998 to 2006 shows a 12-fold increase; and the last 6 years versus 1984 to 1995, a 16.8-fold increase. CONCLUSION: Cultural and educational obstacles in a given country may be overridden by aggressive administrative and educational approaches and strategic planning tailored to local realities, with improvement in organ transplantation.

αv integrins on mesenchymal cells regulate skeletal and cardiac muscle fibrosis.

Mesenchymal cells expressing platelet-derived growth factor receptor beta (PDGFRß) are known to be important in fibrosis of organs such as the liver and kidney. Here we show that PDGFRß+ cells contribute to skeletal muscle and cardiac fibrosis via a mechanism that depends on αv integrins. Mice in which αv integrin is depleted in PDGFRß+ cells are protected from cardiotoxin and laceration-induced skeletal muscle fibrosis and angiotensin II-induced cardiac fibrosis. In addition, a small-molecule inhibitor of αv integrins attenuates fibrosis, even when pre-established, in both skeletal and cardiac muscle, and improves skeletal muscle function. αv integrin blockade also reduces TGFß activation in primary human skeletal muscle and cardiac PDGFRß+ cells, suggesting that αv integrin inhibitors may be effective for the treatment and prevention of a broad range of muscle fibroses.

Un caso raro de lesiones faciales: granulomatosis orofacial / A rare case of facial injuries: orofacial granulomatosis

No disponible

Influencia del oxígeno a alta concentración en cámara hiperbárica sobre el metabolismo óseo / Influence of high-concentration hyperbaric oxygen therapyon bone metabolism

OBJETIVOS: Conocer las acciones del oxígeno a alta concentración en cámara hiperbárica (CH) sobre la expresión de genes relacionados con el metabolismo óseo en líneas celulares osteoblásticas y hueso trabecular humano. MATERIAL Y MÉTODOS: Se analizó la expresión diferencial de varios genes relacionados con el metabolismo óseo (SOST, RUNX2, MMP14, OPG, HIF-1α y SIRT1) en dos líneas celulares osteoblásticas humanas (Saos y Super-Saos) y en fragmentos de hueso trabecular humano sometidos a una, tres o cinco sesiones de CH (90 minutos, oxígeno 100%; 2,3 atmósferas). En cada experimento se utilizó un control que no recibió CH. RESULTADOS: No encontramos diferencias significativas tras la CH en la expresión de los genes estudiados, ni en las células ni en hueso trabecular. Solo en la línea celular Super-Saos la expresión de OPG tras 5 sesiones de CH descendió 6 veces con respecto a la del grupo control (2-∆Ct de 72; p = 0,01). CONCLUSIONES: El oxígeno a alta concentración en cámara hiperbárica no parece tener influencia en la expresión de genes relacionados con el metabolismo óseo

OBJECTIVES: To learn how high concentration in hyperbaric oxygen therapy (HBO) acts on the expression of genes relatedto bone metabolism in osteoblast cell lines and human trabecular bone. MATERIAL AND METHODS: The differential expression of several genes related to bone metabolism (SOST, RUNX2, MMP14,OPG, HIF‐1α and SIRT1) in two human osteoblastic cell lines (Saos and Super‐Saos) and in human trabecular bone fragments subjected to one, three or five HBO sessions (90 minutes, 100% oxygen; 2.3 atmospheres). In each experiment, acontrol that did not receive HBO was used. RESULTS: We did not find significant differences after HBO in the expression of the genes studied, neither in the cells nor in trabecular bone. Only in the Super‐Saos cell line the expression of OPG after 5 sessions of HBO decreased 6 times with respect to that of the control group (2‐∆CtCt of 72; p = 0.01). CONCLUSIONS: High concentration oxygen in the hyperbaric chamber (HC) does not seem to influence the expression of genes related to bone metabolism

Results of living-related kidney transplantation in Puerto Rico.

A total of 103 kidney transplantations from living-related donors were performed in the Puerto Rico Kidney Transplant Program between January 1977 and June 1984. The majority of these patients were male, 76% were between 21 and 50 years of age, 33% were indigent, and 38% were either black or of mixed race. Rigid exclusion criteria were established in the selection of kidney donors. All donor operations were at least 2-antigen-compatible. Surgical technique and posttransplant management were standard, except that in 1980 the immunosuppressive policy was changed as follows: posttransplant prednisone was very rapidly tapered to 20 mg/day at two weeks after transplantation and antilymphocyte globulin was used to treat all rejections. The overall 3-year patient survival for the 7 1/2 years is 91.6%, but after 1980 it increased to 98% perhaps a reflection of the changes in immunosuppressive policy. Eight of ten deaths were due to sepsis, most of them related to rejection treatment. The 3-year kidney survival was 77%. All kidney losses were due to rejection. A low incidence of urological complications is reported. There were no technical losses. A relatively low incidence of cancer is reported. Cutaneous mycosis is highly prevalent in our patients, but systemic fungi are virtually absent.

Scorpion envenomation in Merida, Venezuela.

This study involves a review of the records of 64 children referred to the University of los Andes Hospital with the diagnosis of scorpion envenomation. The patients were divided into group 1 (local manifestations, 42.4%) and group 2 (systemic manifestations, 7.8%). Seven of these patients had severe cardiorespiratory complications, came from distinct geographical zones and received antivenin. Our results indicate that poisonous and extremely dangerous scorpions predominate in certain geographical zones within the state of Merida, Venezuela.

Successful renal vein reconstruction with a polytetrafluoroethylene vascular graft in kidney transplantation.

Very frequently, technical difficulties make renal transplantation difficult and, on occasion, impossible. Problems with short renal veins are a classic example. We have successfully repaired two exceedingly short donor renal veins of equal size using two short polytetrafluoroethylene vascular grafts interposed between the renal veins and the recipient's iliac vein. So far, the kidney has functioned normally except for one minor episode of rejection.

Low incidence of urologic complications after renal transplantation.

The incidence of urologic complications after renal transplantation has been reported to range from less than 1 to 10 percent. They are still a significant source of morbidity and mortality. We report on 111 kidney transplants performed at the San Juan Veterans Administration Hospital in 85 of whom urinary continuity was restored with a Politano-Lead-better ureteroneocystostomy, 23 with the Lich-Grégoir operation, and 3 with extravesical urinary, diversions. Important factors included meticulous attention to details during ureter manipulation, the use of prophylactic antibiotics, unabsorbable sutures in the closure of the muscular part of the bladder wall and infrequent use of drains. This resulted in a low rate of complications which included early ureteral obstruction (3.6 percent), late ureteral obstruction (1.8 percent), lithiasis (1.8 percent), urinary extravasation (0.9 percent), and ureteropelvic necrosis. No kidneys or patients were lost to technical complications, and no deep wound infections were observed. Our experience demonstrates the beneficial effects of a low complication rate on patient and graft loss.

Synthesis of branched-chain sugar derivatives from 1,2;5,6-di-O-isopropylidene-alpha-D-ribo-hexofuranos-3-ulose and 1,2;4,5-di-O-isopropylidene-beta-D-erythro-2-hexulopyranos-3-ulose.

A facile method for the formation of branched-chain sugar derivatives is described involving the reaction of lithium dianions and carboxylic acids with keto-sugar derivatives. Acetic, propanoic, phenylacetic, 3,3-dimethylacrylic, crotonic and sorbic acids were the acids used for the preparation of the lithium dianions, and glucose and fructose were used for preparation of the keto derivatives.

[A morbidity study in a general internal medicine service in a third-level hospital]. / Estudio de la morbilidad en un servicio de medicina interna general en un hospital de tercer nivel.

This study carried out at a type "C" hospital, analyses the actual pathology of 1,052 patients attended to at the internal medicine department during a period of one year. The sex distribution did not show any differences. The median age (64 years) was significantly superior in women. The more frequent diseases were from group VII (cardiovascular: 512 cases) and group VIII (respiratory: 471 cases) according to the 9th edition of the who international diseases classification. The most frequent causes for admission were: respiratory infection (19.5%), cardiac insufficiency (13.8%) and CVA (10.6%). The most frequent baseline diseases were cardiomyopathy (20.4%), chronic obstructive airways syndrome (16%), malignant neoplasia (8.5%) and hepatopathy (7.6%). The risk factors and toxic habits observed were: Chronic bronchitis (19.6%), blood hypertension (15.5%), diabetes (13.5%) and high alcohol intake (10%).

[The multiple-admissions patient in internal medicine as a special type of hospital readmission]. / El paciente multingresado en medicina interna como tipo especial de readmisión hospitalaria.

A considerable number of patients treated in hospitals register several readmissions, this being special cause for concern, not only from a clinical point of view but also in respect of the management of resources. This article analysed the clinical, epidemiological and resources variable associated with patients classified as "multiadmitted". The aim of the study is determine the possible factors which predispose the multiadmission. Multiadmitted patients are defined as those who are admitted twice in a period of 12 months or those admitted 3 times in 5 years. The type of the study carried out involved control cases. We selected 1099 admissions during a period of a year at an internal medicine department of a third-level hospital. Among the various results, we would highlight the fact that 34% of the patients were multiadmitted. The main characteristics were: mean age of 8 years older than the others, patients afflicted with chronic diseases of high prevalence (most of them of the respiratory, cardiovascular, gastrointestinal or endocrine systems). The most frequent diseases were COLD (Chronic Obstructive Lung Disease), cardiomyopathies, and chronic liver disease).