Factores de riesgo asociados a la hernia inguinal recurrente en el adulto mayor / Risk factors associated with recurrent inguinal hernia in the elderly

Resumen Objetivo: Evaluar la asociación entre algunos factores de riesgo y la hernia inguinal recurrente en el adulto mayor. Materiales y Método: Se realizó un estudio analítico de casos y controles en el decenio 2002-2011 en el Hospital "Celia Sánchez Manduley", de Manzanillo, Cuba. Se realizó inicialmente un análisis univariado, los factores que resultaron estadísticamente significativos en este último fueron escogidos para el análisis multivariado posterior. Resultados: En el análisis univariado se asociaron 11 variables a la recurrencia herniaria inguinal, excepto la Diabetes mellitus (p = 0,051). En el análisis multivariado se obtuvo un modelo más ajustado con las siguientes variables: demora mayor o igual a 3 años para la primera reparación (p = 0,00), cirugía urgente (p = 0,00) y deslizamiento de la hernia primaria (p = 0,00). Discusión: La demora en la cirugía implica que el paciente sea cada día más añoso y la hernia más compleja, aumentando el riesgo de padecer enfermedades crónicas que agravan el pronóstico dando lugar a la recurrencia herniaria. Por otro lado, los riesgos que implica llevar a cabo la cirugía en la hernia inguinal complicada: aumento del tiempo quirúrgico, edema y tumefacción del complejo músculo-fascioaponeurótico, así como por el riesgo de infección del sitio operatorio. En las hernias inguinales deslizadas las recidivas son más frecuentes, debiéndose probablemente al alto grado de complejidad desde el punto de vista de su reparación. Conclusión: La demora mayor o igual a 3 años para la primera reparación, la cirugía urgente y el deslizamiento de la hernia primaria se asociaron significativamente a la hernia inguinal recurrente en el adulto mayor.

Objective: To evaluate the association between some risk factors and recurrent inguinal hernia in the elderly. Materials and Method: An analytical case-control study was conducted in the 2002-2011 decade at the "Celia Sánchez Manduley" Hospital, of Manzanillo, Cuba. Initially, a univariate analysis was performed, factors that were statistically significant in the latter were chosen for the subsequent multivariate analysis. Results: In the univariate analysis, 11 variables were associated with inguinal hernia recurrence, except diabetes mellitus (p = 0.051). In the multivariate analysis a more adjusted model was obtained with the following variables: delay greater than or equal to 3 years for the first repair (p = 0.00), urgent surgery (p = 0.00) and sliding of the primary hernia (p = 0.00). Discussion: The delay in surgery implies that the patient is getting older and the hernia complex, increasing the risk of suffering from chronic diseases that aggravate the prognosis giving rise to hernia recurrence. On the other hand, the risks involved in carrying out surgery in complicated inguinal hernia: increased surgical time, edema and swelling of the muscle-fascio-aponeurotic complex, as well as the risk of infection of the operative site. In inguinal hernias slipped recurrences are more frequent, probably due to the high degree of complexity from the point of view of their repair. Conclusion: The delay greater than or equal to 3 years for the first repair, urgent surgery and the sliding of the primary hernia were associated significantly to recurrent inguinal hernia in the elderly

The efficacy of Dunstan baby language in decreasing the parenting stress levels of housewives with 0-2 month old infants: A quasi-experimental study / The Health Sciences Journal

Introduction@#Literature shows that infant distress and care-giving can be sources of stress of primary care givers, especially for first-time mothers. This study aimed to determine the efficacy of Dunstan baby Language in decreasing parenting stress among first time mothers compared with those receiving standard newborn care alone.@*Methods@#This research utilized a quasi-experimental approach, where 18 first-time mothers with babies 0-2 months old were allocated to receive standard care plus Dunstan baby language training or standard care alone. Maternal stress was measured at baseline and after the intervention period with the Parental Stress Scale. The scores were compared within and between the two study arms. A repeated measures mixed model was used for the Parental Stress Scale (PSS) results.@*Results@#A total of 27 participants were enrolled in the study. The Dunstan baby language group had 18 participants, while the control group had 9 participants. An apparent decrease was noted in the week 1 to week 2 and the week 2 to week 3 Parental Stress Scale scores in the Dunstan baby language group compared with the control group which had minimal changes in their mean scores. The mean difference between the two groups was not significant.@*Conclusion@#The use of Dunstan baby language in addition to standard care may decrease stress among first time mothers with 0-2 month old babies.

Estudio TAMARA II. Tabaquismo en médicos de la República Argentina II / The tamara ii trial. smoking among physicians in argentina

background: Smoking is the leading cause of preventable morbidity and death. It is important to know the characteristics of smoking habits among physicians and their attitude toward patients who smoke. Objective: The aim of this study is to investigate the prevalence of smoking among physicians in Argentina, the factors associated with tobacco consumption and their attitude toward their patients who smoke. Methods: An observational cross- sectional study was performed between June and December 2013 in Argentine physicians of dif-ferent specialties. Using a structured survey, the following variables were analyzed: associated cardiovascular risk factors, charac-teristics of tobacco consumption, smoking cessation training and the attitude toward the patient who smokes. results: 3,033 physicians were surveyed, ; 57% were men, and mean age was 41.3±12 years; 19.7% were current smokers and 21.7% were former smokers. The probability of being a smoker was higher among surgeons (OR 1.29) or physicians working at the emergency room (OR 1.41). Undergraduate and postgraduate tobacco cessation training was achieved by 36.6% and 40.8% of physicians, respectively. Young physicians, clinical specialties or private practice were associated with higher level of training. Tobacco cessation counseling was more frequent in physicians with higher level of training than physicians who smoked or surgeons. Former smokers presented higher prevalence of risk factors and cardiovascular events. Family history of smoking habit was more common in former smokers and current smokers. Conclusions: The prevalence of smoking among Argentine physicians is high. Different factors are involved in the probability of smoking, tobacco cessation training or the possibility of medical counseling. Higher level of training in smoking cessation must be provided.

La detención desde la perspectiva de la Policía local en España / Detention from the Perspective of the Local Police in Spain / A detenção desde a perspectiva da Polícia Local na Espanha

Desde la perspectiva de la policía local se examina de manera crítica la actividad de imputación y, en especial, la consiguiente aplicación de la medida cautelar personal que la Ley de Enjuiciamiento Criminal denomina “detención” en el ámbito procesal penal español. La aplicación de esta medida provisionalísima de privación de libertad conlleva una serie de problemas y especialidades que merecen una atención detenida y una valoración jurídica, teniendo en cuenta los presupuestos imprescindibles, las finalidades perseguidas, los límites temporales, así como el régimen jurídico de la persona privada de libertad. Todo ello, además, debe ser matizado con apuntes específicos cuando se trata de juicios rápidos, de procesos por delitos de terrorismo, de casos de cooperación internacional, de asuntos en que están imputados menores o delincuentes extranjeros. Por último, se trata de un problema importante desde el punto de vista de la valoración de las pruebas conseguidas en estos procesos y se refiere, en concreto, a la utilización de las declaraciones obtenidas por la policía para fundar la sentencia de condena que finalmente pueda recaer.

From the perspective of the local Police, the imputation and, particularly, the resulting application of the personal precautionary measure that the Law of Criminal Procedure denominates as “detention” in the Spanish criminal procedure sphere is examined in a critical way. The application of this highly urgent measure involving the deprivation of liberty implies a series of problems and specialties deserving close attention and juridical assessment, taking into account the unavoidable presuppositions, the aims pursued and the temporary limits, as well as the legal system affecting the person deprived from liberty. In addition, all of this must be tinged with specific notes where dealing with snap judgments or expeditious trials, along with prosecutions and convictions for terrorist offenses, international cooperation cases, affaires where minors or foreign criminals are involved… Finally, this is an important issue from the point of view of the assessments of proofs obtained in these procedures and refers, specifically, to the use of depositions obtained by Police to base the final convicting as required.

Desde a perspectiva da polícia local atividade de imputação é examinada de maneira crítica, em especial, a aplicação conseguente da medida cautelar pessoal que a Lei do Processo Civil denomina “detenção” no âmbito processual penal espanhol. A aplicação desta medida muito urgente (provisionalísima) da privação da liberdade envolve uma série de problemas e especialidades que merecem uma atenção detalhada e um avaliação jurídica, considerando os prussupostos essenciais, as finalidades perseguidas, os limites provisórios, assim como o regime jurídico da pessoa privada da liberdade. Tudo isso, além, deve ser esclarecido com notas específicas quando trata-se de julgamentos rápidos, dos processos por crimes do terrorismo, dos casos da cooperação internacional, dos assuntos em que os imputados são menores ou delinquentes estrangeiros. Finalmente, trata-se de um problema importante desde o ponto de vista da avaliação dos testes obtidos nestes processos e se refere, em especial, ao uso das declarações obtidas pela Polícia para fundar a sentença da condenação que finalmente pode recair.

Laboratory diagnosis of Schistosomiasis in areas of low transmission. A review of a line of research

After 57 years of successful control of schistosomiasis in Venezuela, the prevalence and intensity of infection have declined. Approximately 80 percent of the individuals eliminate less than 100 eggs/g of stools, therefore morbidity is mild and the majority are asymptomatic. The sensitivity of Kato-Katz decreases to approximately 60 percent. Available serological methods for the detection of circulating antigens only reach a 70 percent of sensitivity. Tests based on the detection of antibodies by immunoenzymatic assays have been improved. The circumoval precipitine test has shown a high sensitivity (97 percent), specificity (100 percent), and correlation with oviposition, being considered the best confirmatory diagnostic test. Additionally to the classical immunoenzymatic assays, the development of the alkaline phosphatase immunoassay, allowed to reach a 100 percent specificity with an 89 percent sensitivity. Recently, we have developed a modified ELISA in which the soluble egg antigen is treated with sodium metaperiodate (SMP-ELISA) in order to eliminate the glycosilated epitopes responsible for the false positive reactions. The specificity and sensitivity reaches 97 percent and 99 percent, respectively. Synthetic peptides from the excretory-secretory enzymes, cathepsin B (Sm31) legumain (Sm32) and cathepsin D (Sm45), have been synthesized. The combination of two peptides derived from the Sm31 have been evaluated, reaching a sensitivity of 96 percent when analyzed independently and with a 100 percent specificity. Antibodies raised in rabbits against peptides derived from the Sm31 and Sm32 are currently evaluated in two different antigen-capture-based assays. The development of a simple, cheap and reliable test that correlates with parasite activity is a major goal

Prophylaxie de l'anemie materno-infantile pendant la grossesse : experience de Sakalalina (Madagascar). [Lettre]

Les conditions de vie de la population dans la zone ou cette etude a ete effectuee refletent celles de toutes les regions de brousses de Madagascar. C'est une region a haute endemie palustre et bilharzienne; ou les habitants se nourrissent d'une maniere non equilibree et insuffisante. Cette etude realisee avec le centre de Protection Maternelle et Infantile (PMI); consiste en une evaluation de l'efficacite et de la tolerabilite de l'administration des produits contenant du fer et de l'acide folique et une mise au point d'un schema therapeutique adaptable au niveau d'un petit centre de sante de brousse

Benign cystic lymphoepithelial lesion of the parotid gland an unusual presentation of the acquired immunodeficiency syndrome

This article presents a case of a young, otherwise asymptomatic male patient with a parotid gland enlargement. The initial clinical history did not reveal any risk factors related with HIV infection. A fine needle aspiration biopsy of the lesion showed a benign cystic lymphoepithelial lesion of the parotid gland. This once unusual lesion of the salivary gland has been recently associated with infection by the human immunodeficiency virus (HIV) and is presently encountered with increased frequency in the clinical practice. The knowledge of the association between these two entities led, in this case, to the diagnosis of HIV infection in an otherwise asymptomatic patient. Early detection of HIV infection is of vital importance since it has been demonstrated that prompt treatment of these patients with AZT slows down the progression of the disease

Fine needle aspiration biopsy in the management of patients with deep seated metastatic and recurrent malignancies

La biopsia por aspiración con aguja fina esta actualmente aceptada como una técnica diagnóstica segura y confiable. En los pacientes que se presentan con enfermedad metastática diseminada de origin desconocido puede jugar un papel importante aportando un diagnóstico certero y rápido. Brindando de esta forma la oportundad de iniciar un plan terapéutico rápidamente. Esta técnica usualmente se puede realizar sin necesidad de hospitalizar al paciente con lo cual se logra reducir los costos tanto para el paciente como para el hospital. En los casos en que se llega a un diagnóstico definitivo se logra también evitarle una cirugía innecesaria al paciente. Este artículo presenta varios casos ilustrativos en los que se llegó a un diagnóstico final mediante el uso de la biopsia por aspiración con aguja fina

Exploración radisotopica de la función ventricular basal izquierda del tránsito esofágico, de la vía urinaria superior y de la función vesical en pacientes chagásicos cronicos predominantemente asintomáticos / Radioisotopic exploration of basal left ventricular function of the esophageal transit, of upper urinary duct and of bladder function of patients with chronic Chagas' disease predominantly en assymptomatic

Estudou-se em 56 pacientes chagásicos crônicos (45 assintomáticos e os restantes portadores de transtornos cardiovasculares e digestivos) a funçäo ventrícular esquerda (ejeçäo basal, motilidade parietal segmentar e o histograma); em 29 deles, o trânsito esofagiano e em outros 25 enfermos explorou-se a via urinária, respectivamente com o 99m - TC coloidal e o 99ml - TC b + PA. Observou-se que a fraçäo de ejeçäo do ventrículo esquerdo entre os indivíduos normais era de 0,66 + ou - 0,07, enquanto nos chagásicos crônicos com alteraçöes cardiovasculares (Grupo II) verificou-se 0,49 + ou - 0,21. A motilidade parietal esteve alterada em 60% do mesmo grupo de enfermos e o desvio standard do histograma foi de 1,98 + ou - 0,45, para 1,29 + ou - 0,17 no grupo de voluntários. O trânsito esofágico foi considerado normal em 9 casos e alterado em 20, sendo que em 6 foi do tipo prolongado, em 4 adinâmico e em 10 incoordenado. Nos 25 pacientes nos quais investigaram a via urinária superior, foi encontrada alteraçäo em 22 (dilataçäo piélica uni ou bilateral) e a funçäo vesical nestes pacientes foi normal em apenas quatro casos. Concluem os pesquisadores que o 99 - TC representa um grande avanço tecnológico no estudo da funçäo cardíaca, esofágica e das vias urinárias em pacientes chagásicos crônicos e assintomáticos

Colecentellografia: comunicacion preliminar sobre 50 observaciones. / Cholescintigraphy: preliminary communication of 50 observations

Se presenta un nuevo procedimiento incruento para la exploracion morfologica y funcional de la via biliar. El metodo esta basado en la administracion de compuestos marcados con 99m Tc (99mTc P G y 99mTc-HIDA) que son depurados de la sangre por el hepatocito y excretados conjuntamente con la bilis. El transito del radiofarmaco permite obtener imagenes secuenciales del relleno de la via biliar principal y accesoria, poniendo en evidencia la existencia o no, de pasaje de bilis al intestino.En la serie de pacientes estudiados fue posible observar alteraciones funcionales expresadas por el retraso de la excrecion biliar.El valor fundamental del metodo se mostro en la separacion del grupo de ictericias por obstruccion extrahepaticas, de las ictericias intrahepaticas con factor colostaticas predominante. En el grupo de las extrahepaticas se pudo evidenciar la altura de la obstruccion en relacion con la via biliar accesoria.Tambien se utilizo el procedimiento para el control de las anastomosis bilio digestivas y en el diagnostico de los cuadros agudos de origen vesicular

Centellografia osea y determinacion de parathormona en insuficientes renales en hemodialisis cronica. / Bone scintigraphy and parathormone determination in renal insufficiency in chronic hemodialysis

Con objetivo de brindar un aporte diagnostico a la interpretacion de las alteraciones del metabolismo fosfocalcico en la insuficiencia renal; se realizo el estudio combinado de PTH y centellograma oseo en un grupo de pacientes en hemodialisis cronica. Esta metodologia de estudio permitio clasificar humoralmente a los enfermos en tres grupos: normo, hipo o hipercalcemicos, frente al aumento de los niveles de PTH. A su vez la centellografia osea en la etapa prerradiologica subdividio al grupo en: normales (estadio 0), con hipercaptacion moderada (estadio I) y con hipercaptacion severa (estadio II)