Fluctuating facial edema as a rare manifestation of cutaneous polyarteritis nodosa: Case report and review of the literature.

Polyarteritis nodosa (PAN) is a necrotizing vasculitis. The clinical manifestations are determined by the location of the compromised arteries. Cutaneous PAN can present as nodular lesions similar to erythema nodosum, palpable purpura, livedo reticularis, and ulceration. It often affects the lower limbs but other anatomical sites can also be involved. However, concomitant facial edema is an extremely rare manifestation. It has been more than 20 years since the last case report describing this unusual presentation of PAN. Furthermore, our patient is the first case presenting with hemifacial edema fluctuating every second or third day due to PAN confirmed by skin biopsy.

Plastic Surgery Response in Natural Disasters.

Disasters cause untold damage and are often unpredictable; however, with proper preparation, these events can be better managed. The initial response has the greatest impact on the overall success of the relief effort. A well-trained multidisciplinary network of providers is necessary to ensure coordinated care for the victims of these mass casualty disasters. As members of this network of providers, plastic surgeons have the ability to efficiently address injuries sustained in mass casualty disasters and are a valuable member of the relief effort. The skill set of plastic surgeons includes techniques that can address injuries sustained in large-scale emergencies, such as the management of soft-tissue injury, tissue viability, facial fractures, and extremity salvage. An approach to disaster relief, the types of disasters encountered, the management of injuries related to mass casualty disasters, the role of plastic surgeons in the relief effort, and resource management are discussed. In order to improve preparedness in future mass casualty disasters, plastic surgeons should receive training during residency regarding the utilization of plastic surgery knowledge in the disaster setting.

Frontoplasty Technique for the Mestizo Patient.

Ethnic groups can be differentiated through certain anatomical characteristics, including the morphological features of their skulls. Little information is available on the craniofacial measures of the Mestizo face. Over time, the upper third of the Mestizo face can develop a greater frontal concavity of the forehead, making the eyebrows drop and giving the face a more masculine appearance. Understanding the skeletal and vascular anatomy of this population group is the foundation for proper aesthetic rejuvenation of the upper third of the face. The purpose of this article is to present an advanced injection technique utilizing a low-viscosity and low-G prime filler to correct exaggerated frontal concavity. Using just 1 to 2mL of product, patients can be safely treated with a high satisfaction rate and a cosmetic result capable of lasting up to three years.

Complicaciones neonatales asociadas al diagnóstico de corioamnionitis histológica en pacientes con parto pretérmino espontáneo en un hospital de alta complejidad en Colombia / Neonatal complications associated with the diagnosis of histological chorioamnionitis in patients with spontaneous preterm delivery in a highly complexity hospital in Colombia

INTRODUCCIÓN: La corioamnionitis histológica (CH) es causa importante de parto pretérmino y se asocia a resultados neonatales adversos, con secuelas del neurodesarrollo. Ocurre en alrededor de un 20% de embarazos a término y 60% de pretérmino. Este proceso está asociado a varias complicaciones neonatales, entre las más frecuentes: sepsis neonatal temprana, menor edad gestacional y mayor estancia hospitalaria. OBJETIVO: Establecer la asociación de complicaciones neonatales con el diagnóstico de CH en pacientes con parto pretérmino espontáneo en un hospital de alta complejidad. MÉTODOS: Estudio retrospectivo, se incluyeron 160 pacientes con parto pretérmino espontáneo con estudio histopatológico de la placenta según protocolo institucional. Se recolectan las características basales de la gestante y complicaciones neonatales. Se calcula la prevalencia de CH, y se comparan dos grupos (con y sin) la asociación de complicaciones neonatales, distribuidas por edad gestacional y peso neonatal. RESULTADOS: La prevalencia de CH es de 69% (IC95%: 61-76). Al distribuir por edad gestacional se reporta: 87% en 34 (IC 95%: 45 -67). La CH entre las 28 - 34 y > 34 semanas, se asocia a mayor sepsis neonatal temprana (p 2000 g se asocia con sepsis neonatal (p<0.05). CONCLUSIÓN: La prevalencia de CH es alta, principalmente a menor edad gestacional, se asocia a complicaciones neonatales como la sepsis neonatal temprana.

INTRODUCTION: Histological chorioamnionitis (HC) is an important cause of preterm delivery and is associated with adverse neonatal outcomes, with sequelae of neurodevelopment. It occurs in about 20% of full-term and 60% preterm pregnancies. This process is associated with several neonatal complications, among the most frequent: early neonatal sepsis, younger gestational age, and longer hospital stay. OBJECTIVE: To establish the association of neonatal complications with HC diagnosis in patients with spontaneous preterm delivery in a highly complexity hospital in Colombia. RESULTS: The prevalence of HC is 69% (95% CI: 61-76). When distributed by gestational age, it is reported: 87% in 34 (95% CI: 45-67). HC between 28 - 34 and > 34 weeks, is associated with higher early neonatal sepsis (p 2000 g is associated with early neonatal sepsis (p <0.05). CONCLUSION: The prevalence of HC is high, mainly at a lower gestational age, it is associated with neonatal complications such as early neonatal sepsis.

Prescribing patterns and economic costs of proton pump inhibitors in Colombia.

OBJECTIVE: To determine the prescribing patterns for proton pump inhibitors and to estimate the economic cost of their use in a group of patients affiliated with the Colombian Health System. METHODS: This is a descriptive observational study. Data for analysis consisted of prescriptions dispensed between October 1st, 2010 and October 31st, 2010 and were collected from a systematic database of 4.2 million members. Socio-demographic variables were considered along with the defined daily dose,comedication, convenience of the indication for proton pump inhibitor use and costs. RESULTS: In this study, 113,560 prescriptions were dispensed in 89 cities, mostly to women (57.6%) with a mean age of 54.4 ± 18.7 years; the drugs were omeprazole (n= 111.294; 97.81%),esomeprazole (n= 1.378; 1.2%), lansoprazole (n= 524; 0.4%), pantoprazole and rabeprazole. The indication for 87.349 of the formulas (76.9%) was justified and statistically associated with the use of NSAIDs, antithrombotics, corticosteroids, anti-ulcer, antibiotics and prokinetics. No justification was found for 26.211 (23.1%) of the prescriptions, which were associated with antidiabetics, antihypertensives, hypolipidemics and others (p <0.001).The annual justified cost was estimated to be US$ 1,654,701 and the unjustified cost was estimated to be U.S. $2,202,590, as calculated using the minimum reference prices. DISCUSSION: Each month, the Colombian health system is overloaded by unjustified costs that include payments for non-approved indications of proton pump inhibitors and for drugs outside the list of essential medications. This issue is contributing to rising costs of healthcare in Colombia.

OBJETIVOS: Determinar los patrones de prescripción de inhibidores de la bomba de protones y estimar el costo económico que genera su utilización en pacientes afiliados al Sistema General de Seguridad Social en Salud de Colombia. METODOLOGÍA: Estudio descriptivo observacional. Se analizarondatos de formulas dispensadas entre 1 y 31 de octubre de 2010 de una base de datos sistematizada de 4.2 millones de afiliados.Se consideraron variables socio-demograficas, dosis diaria definida,comedicación recibida, conveniencia o no del tipo de indicación de IBP y costos. RESULTADOS: Se dispensaron 113 560 formulas en 89 municipios,principalmente a mujeres (57.6%); promedio de edad 54.4±18.7 años; los medicamentos fueron omeprazol (n= 111294, 97.8%),esomeprazol (n= 1378, 1.2%), lanzoprazol (n= 524, 0.4%), pantoprazol y rabeprazol a dosis diarias definidas adecuadas. Se halló justificación en la indicación de 87349 fórmulas (76.9%) asociadas estadísticamente con uso de AINEs, antitrombóticos, corticoides, antiulcerosos, antibióticos, procinéticos, y sin justificación 26211 (23.1%) asociadas a antidiabéticos, antihipertensivos e hipolipemiantes y otros (p <0.001). El costo anual justificado fue de US$1.654.701 y no justificado de U.S.$2,202,590 empleando mínimos precios de referencia. DISCUSIÓN: Mensualmente se está cargando al sistema de salud colombiano con costos no justificados del uso de inhibidores de bomba de protones en indicaciones no aprobadas y con medicamentos por fuera del listado de esenciales que contribuyen a encarecer la atención sanitaria.

Frequency of episiotomy and complications in the obstetrics service of Hospital Universitario San José, Popayán (Colombia), 2016. Exploration of maternal and perinatal factors associated with its performance / Frecuencia de la realización de episiotomía y complicaciones en el servicio de obstetricia del Hospital Universitario San José, Popayán (Colombia), 2016. Exploración de factores maternos y perinatales asociados a su realización

ABSTRACT Objective: To determine the frequency with which episiotomy is performed, explore factors associated with its performance, and describe maternal and perinatal outcomes in the obstetric service of San José University Hospital in the city of Popayán (Colombia) during the first semester of 2016. Materials and methods: Descriptive, cross-sectional study with secondary analysis which included pregnant women with more than 37 weeks of gestation delivered during the first semester of 2016 in a high complexity public referral centre in the Department of Cauca Colombia, which serves patients covered by both the contributive as well as the subsidised health insurance regimes. Simple random sampling was used with a sample size of 197 deliveries and a margin of error of 5%. Maternal and childbirth variables, as well as maternal and neonatal outcomes were assessed. The frequency of episiotomy was estimated and the factors associated with its performance were explored by means of bivariate and multivariate analysis. Results: The frequency with which episiotomy was performed was 30.45% (n = 60; 95% CI: 24.1-37.3), and the most frequent complication was perineal tear at 29% (95% CI: 22.9-35.5). In terms of risk factors, nulliparity was the only factor associated with the need to perform episiotomy (aOR = 16.11; 95% CI: 6.46-42.81). Conclusion: Episiotomy is performed more frequently in this institution than recommended by the World Health Organisation (WHO). Strategies should be considered for reducing this frequency to the expected levels.

RESUMEN Objetivo: determinar la frecuencia de la realización de la episiotomía, explorar los factores asociados a esta, y describir resultados maternos y perinatales en el servicio de obstetricia del Hospital Universitario San José de Popayán (Colombia) en el primer semestre del año 2016. Materiales y métodos: estudio descriptivo de corte transversal, con análisis secundario; se incluyeron gestantes con embarazo mayor de 37 semanas cuyos partos fueron atendidos el primer semestre del año 2016, en un hospital público de alta complejidad, centro de referencia del departamento del Cauca (Colombia), el cual atiende población del aseguramiento contributivo y subsidiado. Se realizó un muestreo aleatorio simple, con tamaño de muestra de 197 partos, y margen de error del 5 %. Se evaluaron variables maternas, del parto, de resultado materno y neonatal. Se estimó la frecuencia de episiotomía y se realizó exploración de los factores asociados a esta por medio de análisis bivariado y multivariado. Resultados: la frecuencia de la realización de episiotomía fue de 30,45 % (n = 60; IC 95 %: 24,1-37,3), la complicación más frecuente fue el desgarro perineal, con 29 % (IC 95 %: 22,9-35,5). En cuanto a los factores de riesgo, la nuliparidad fue el único factor asociado al uso de la episiotomía (Ora = 16,11; IC 95 %: 6,46-42,81). Conclusión: el uso de la episiotomía en esta institución es superior a lo recomendado por la Organización Mundial de la Salud (OMS). Se deben evaluar estrategias para reducir su frecuencia a los niveles esperados.

Prescribing patterns and economic costs of proton pump inhibitors in Colombia / Patrones de prescripción y costos económicos de inhibidores de bomba de protones en Colombia

Objective:To determine the prescribing patterns for protonpump inhibitors and to estimate the economic cost of their usein a group of patients affiliated with the Colombian Health Sys-tem.Methods:This is a descriptive observational study. Data foranalysis consisted of prescriptions dispensed between October1st, 2010 and October 31st, 2010 and were collected from a sys-tematic database of 4.2 million members. Socio-demographicvariables were considered along with the defined daily dose,comedication, convenience of the indication for proton pumpinhibitor use and costs.Results:In this study, 113,560 prescriptions were dispensed in89 cities, mostly to women (57.6 percent) with a mean age of 54.4 ±18.7 years; the drugs were omeprazole (n=111,294; 97.81 percent),esomeprazole (n=1,378; 1.2 percent), lansoprazole (n=524; 0.4 percent),pantoprazole and rabeprazole. The indication for 87,349 of theformulas (76.9 percent) was justified and statistically associated withthe use of NSAIDs, antithrombotics, corticosteroids, anti-ul-cer, antibiotics and prokinetics. No justification was found for26,211 (23.1 percent) of the prescriptions, which were associated withantidiabetics, antihypertensives,hypolipidemics andothers(p <0.001). The annual justified cost was estimated to beUS$ 1,654,701 and the unjustified cost was estimated tobe U.S. $ 2,202,590, as calculated using the minimum re-ference prices.

Reconocimiento de sacáridos presentes en películas adquiridas de origen salivar formadas in vitro sobre superficies de acrílico / In vitro identification of sacharides present in acquired salivary pellicles on acrylic surfaces

La cavidad oral es un complejo ecosistema en donde interactúan los microorganismos con el huésped y el medio ambiente. La adhesión bacteriana a las superficies orales se realiza por medio de la interacción entre las bacterias y una película de glicoproteínas de origen salivar que se forma sobre estas superficies. Las bacterias poseen diversos mecanismos de tipo específico e inespecífico para interactuar con esta película. Entre los mecanismos específicos se encuentra la interacción entre moléculas tipo lectina, presentes sobre las superficies bacterianas, con sacáridos terminales de las cadenas laterales de las glicoproteínas salivares. - Este estudio se ocupa de la identificación de esos sacáridos presentes en películas salivares formadas in vitro sobre superficies de acrílico.- Se trabajó con dos tipos de acrílico (termocurado y autocurado) y se utilizaron 13 lectinas específicas y una técnica histoquímica para el reconocimiento. - Se observó que el sacárido terminal presente en mayor proporción en las películas adquiridas estudiadas fue la galactosa, pero también se notó la presencia de galactosamina, manosa, glucosa y fucosa.