Factores asociados con el éxito de una prueba de trabajo de parto después de cesárea (TOLAC) sin antecedente de parto / Factors associated with the success of a trial of labor after cesarean section (TOLAC) without a history of vaginal delivery

Resumen OBJETIVO: Determinar los factores asociados con una prueba de trabajo de parto después de una cesárea exitosa en mujeres sin antecedente de parto previo. MATERIALES Y MÉTODOS: Estudio observacional de casos y controles, longitudinal, retrospectivo y analítico efectuado en pacientes atendidas entre el 2017 y 2020 en el Hospital Ángeles Lomas, con embarazo único de más de 37 semanas, con una prueba de trabajo de parto, con una cesárea previa y sin parto previo. Se compararon las variables independientes entre el grupo que logró una prueba exitosa de trabajo de parto después de cesárea con las del grupo con prueba fallida. Para el análisis estadístico se utilizó el programa SPSS de IBM, versión 21. Todas las variables categóricas se expresan en frecuencias y porcentajes. RESULTADOS: Se incluyeron 135 pacientes con prueba de trabajo de parto después de cesárea de las que 65 (48.1%) tuvieron parto (prueba exitosa) y 70 (51.8%) cesárea (prueba fallida). Hubo una mayor proporción de trabajo de parto espontáneo en el grupo con prueba exitosa en comparación con el grupo con prueba fallida (66.2% en comparación con 37.1%). No hubo diferencias significativas en cuanto a la conducción del trabajo de parto, integridad de membranas amnióticas al ingreso, horas de trabajo de parto y peso al nacer. CONCLUSIONES: Un índice de masa corporal menor, un trabajo de parto espontáneo y una mayor dilatación al ingreso se asociaron, significativamente, con una prueba exitosa de trabajo de parto después de cesárea. La integridad de las membranas, la duración de la prueba y el peso al nacer no tuvieron diferencias significativas entre los grupos.

Abstract OBJECTIVE: To determine the factors associated with a trial of labor after a successful cesarean section in women with no history of previous delivery. MATERIALS AND METHODS: Observational case-control, longitudinal, retrospective, analytical, retrospective study performed in patient attended between 2017 and 2020 at Hospital Ángeles Lomas, with a singleton pregnancy of more than 37 weeks, with a trial of labor, with a previous cesarean section and no history of previous delivery. The independent variables were compared between the group that achieved a successful trial of labor after cesarean section with those of the group with failed trial. For statistical analysis, the IBM SPSS program, version 21, was used. All categorical variables are expressed in frequencies and percentages. RESULTS: We included 135 patients with trial of labor after cesarean section of whom 65 (48.1%) had labor (successful trial) and 70 (51.8%) had cesarean section (failed trial). There was a higher proportion of spontaneous labor in the successful trial group compared to the failed trial group (66.2% compared to 37.1%). There were no significant differences in labor conduction, amniotic membrane integrity on admission, hours of labor, and birth weight. CONCLUSIONS: Lower body mass index, spontaneous labor, and greater dilation on admission were significantly associated with a successful trial of labor after cesarean section. Membrane integrity, length of trial, and birth weight had no significant differences between groups.

Prevalencia de dispepsia funcional en adolescentes cubanos / Prevalence of Functional Dyspepsia in Cuban Adolescents

Resumen Introducción: los trastornos digestivos funcionales son frecuentes en niños; sin embargo, hay escasos datos sobre la dispepsia funcional (DF) en adolescentes cubanos. Objetivo: determinar la prevalencia de DF en adolescentes cubanos y sus posibles asociaciones. Metodología: se usó el cuestionario para síntomas digestivos pediátricos de Roma IV en español para identificar la presencia de DF en adolescentes de 3 centros escolares de La Habana, Cuba. Se tuvieron en cuenta variables sociodemográficas, personales, familiares, clínicas y epidemiológicas. Resultados: de los 318 adolescentes que participaron en el estudio, 11 adolescentes (3,5 %) de 11,4 ± 1,2 años de edad, 81,8 % de sexo femenino, presentaron DF. La DF fue más frecuente en el sexo femenino (odds ratio [OR]: 5,33; intervalo de confianza [IC] 95 %: 1,06-51,45; p = 0,019). El síndrome de dificultad posprandial (SDP) fue mayor que el síndrome de dolor epigástrico (SDE) en una proporción 1,8:1. En el 63,6 % se presentó superposición entre DF y estreñimiento funcional. Hubo predominio de DF en los niños con padres separados/divorciados (OR: 4,74; IC 95 %: 1,09-28,31; p = 0,014). Conclusión: la DF es más común en adolescentes femeninas, el SDP es el subtipo más frecuente y su presencia está asociada con padres separados/divorciados.

Abstract Introduction: functional gastrointestinal disorders (FGID) are common in children. However, data on functional dyspepsia (FD) in Cuban adolescents is scarce. Objective: to determine the prevalence of FD in Cuban adolescents and their possible associations. Methodology: the questionnaire for pediatric digestive symptoms of Rome IV was used in Spanish to identify the presence of DF in adolescents from 3 schools in La Havana, Cuba. Sociodemographic, personal, family, clinical, and epidemiological variables were considered. Results: of the 318 adolescents who participated in the study, 11 (3.5%) aged 11.4 ± 1.2 years, 81.8% female, presented FD. Functional dyspepsia was more frequent in females (odds ratio [OR]: 5.33; 95% confidence interval [CI]: 1.06-51.45; p = 0.019). The postprandial distress syndrome (PDS) was higher than the epigastric pain syndrome (SDE) by a 1.8:1 ratio. There was an overlap between DF and functional constipation in 63.6% of the patients. There was an FD predominance in children with separated or divorced parents (OR: 4.74; 95% CI: 1.09-28.31; p = 0.014). Conclusion: functional dyspepsia is most common in female adolescents, PSD is the most frequent subtype, and its presence is associated with separated or divorced parents.

Embolización de colaterales portosistémicas espontáneas como tratamiento de la encefalopatía hepática refractaria / Embolization of spontaneous portosystemic shunts as treatment for refractory hepatic encephalopathy

BACKGROUND: Hepatic encephalopathy (HE) is a common complication of cirrhosis associated with a reduced survival. The presence of high-flux spontaneous porto-systemic shunts can induce HE even in patients with preserved liver function. AIM: To evaluate the effect of spontaneous porto-systemic shunt embolization (SPSE) over HE and its long-term evolution. MATERIAL AND METHODS: Retrospective analysis of 11 patients (91% males) with severe HE non-responsive to medical treatment in whom a SPSE was performed. The grade of HE (employing West Haven score), survival, MELD and Child-Pugh score, ammonia levels, degree of disability (employing the modified Rankin scale (mRs)) were evaluated before and at thirty days after procedure. RESULTS: The most common etiology found was non-alcoholic steatohepatitis (63.6%). A reduction of at least two score points of HE was observed in all patients after thirty days. There was a significant reduction on median (IQR) West Haven score from 3 (2-3) at baseline to 1 (0-1) after the procedure (p < 0.01). Twelve months survival was 63.6%. There was a decrease in median ammonia level from 106.5 (79-165) (ug/dL) to 56 (43-61) after SPSE (p = 0.006). The median mRS score before and after the procedure was 3 (3-5) and 1 (1-2.5), respectively (p < 0.01). Conclusions: According to our experience, SPSE is a feasible and effective alternative to improve HE and functionality of patients with refractory EH.

Prevalencia de desórdenes gastrointestinales funcionales en adolescentes

RESUMEN Introducción: Los desórdenes gastrointestinales funcionales pediátricos, comprenden un conjunto de síntomas gastrointestinales crónicos o recurrentes, no explicados por anomalías estructurales o bioquímicas, con interferencia importante en la calidad de vida del niño y su familia. Objetivo: Determinar la prevalencia de los desórdenes gastrointestinales funcionales en adolescentes. Métodos: Estudio observacional, descriptivo de corte transversal, prospectivo con 318 adolescentes pertenecientes a los centros de enseñanza del reparto Camilo Cienfuegos del municipio Habana del Este, en el período comprendido entre marzo 2020 y enero del 2021. Las variables utilizadas fueron edad, sexo, antecedentes personales de dengue, antecedentes familiares de desórdenes gastrointestinales familiares, primogénito, padres separados, hijo único, prematuridad y nacimiento por cesárea. Se utilizó el cuestionario para síntomas digestivos pediátricos, basado en los criterios de Roma IV. Resultados: Un total de 93 estudiantes, para 29,2 % cumplieron los criterios diagnósticos de Roma IV para algún desorden gastrointestinal funcional. Se encontró predominio del sexo femenino (34,3 %) y del grupo de 10-12 años (30 %). El estreñimiento funcional se diagnosticó en 22,7 % de los adolescentes, seguido de la dispepsia funcional en 3,5 %. Conclusiones: Los desórdenes gastrointestinales funcionales son comunes en los adolescentes del estudio. El estreñimiento funcional es el trastorno más frecuente. Los desórdenes gastrointestinales funcionales se presentan de forma significativa en adolescentes del sexo femenino.

ABSTRACT Introduction: Pediatric functional gastrointestinal disorders comprise a set of chronic or recurrent gastrointestinal symptoms, not explained by structural or biochemical abnormalities, with significant interference in the quality of life of the child and his/her family. Objective: Determine the prevalence of functional gastrointestinal disorders in adolescents. Methods: Observational, descriptive cross-sectional, prospective study with 318 adolescents belonging to the educational centers of Camilo Cienfuegos neighborhood, Habana del Este municipality, in the period between March 2020 and January 2021. The variables used were age, sex, personal history of dengue, family history of gastrointestinal disorders, firstborn, separated parents, only child, prematurity and birth by cesarean section. The questionnaire for pediatric digestive symptoms, based on the Rome IV criteria, was used. Results: A total of 93 students (29.2%) met the diagnostic criteria of Rome IV for some functional gastrointestinal disorder. A predominance of the female sex (34.3%) and the group of 10-12 years (30%) was found. Functional constipation was diagnosed in 22.7% of adolescents, followed by functional dyspepsia (3.5%). Conclusions: Functional gastrointestinal disorders are common in the studied adolescents. Functional constipation is the most common disorder. Functional gastrointestinal disorders occur significantly in female adolescents.

Uma revisão sistemática e meta-análise em escolares e adolescentes com Distúrbios gastrointestinais funcionáis de acordo com os critérios de Roma IV / A systematic review and meta-analysis in schoolchildren and adolescents with functional gastrointestinal disorders according to rome iv criteria

ABSTRACT Objective: To determine the prevalence of functional gastrointestinal disorders (FGIDs) in children according to Rome IV criteria. Methods: We included cohorts and observational descriptive studies, including information for the prevalence of FGIDs according to Rome IV criteria in children 4 to 18 years old. We searched the MEDLINE (Ovid), EMBASE, LILACS, and CENTRAL databases from May 2016 to nowadays. Gray literature and other databases were also consulted. The risk of bias was assessed using the STROBE Statement. The results were reported in forest plots of the estimated effects of the included studies with a 95% confidence interval (95%CI). Results: We included 14 studies involving a total of 17427 participants. Three studies were conducted in Europe, two in North America, and nine in Latin America. Most studies were school-based (n=14670, 84.18%), participants were mostly female (55.49%), white (51.73%), 8 to 18 years old (77.64%), and assisted to a public school (81.53%). Thirteen studies used the Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS-RIV) to assess FGIDs. We found a global prevalence for FGIDs of 23% (95%CI 21-25%, I2 99%). Main disorders were functional constipation (FC) with 12% (95%CI 11-15%) followed by functional dyspepsia (FD) (5%, 95%CI 11-15%) and irritable bowel syndrome (IBS) (3%, 95%CI 2-4%). The prevalence of FGIDs was higher in the Americas, representing 23.67% (95%CI 21.2-26.2%, I2 91.3%). Conclusion: FGIDs are present in one of four children and adolescents, representing a common condition in this age group the central disorders were FC, FD, and IBS.

RESUMO Objetivo: Determinar a prevalência de distúrbios gastrointestinais funcionáis (DGF) em crianças de acordo com os critérios de Roma IV. Métodos: Incluímos coortes e estudos observacionais descritivos, incluindo informações para a prevalência de DGF de acordo com os critérios de Roma IV em crianças de 4 a 18 anos. Pesquisamos nas bases de dados MEDLINE (Ovid), EMBASE, LILACS e CENTRAL de maio de 2016 até os dias atuais. A literatura cinzenta e outras bases de dados também foram consultadas. O risco de viés foi avaliado usando a Declaração STROBE. Os resultados foram relatados em parcelas florestais dos efeitos estimados dos estudos incluídos com um intervalo de confiança de 95% (95%IC). Resultados: Foram incluídos 14 estudos envolvendo um total de 17.427 participantes. Três estudos foram realizados na Europa, dois na América do Norte e nove na América Latina. A maioria dos estudos foi de base escolar (n=14.670, 84,18%), os participantes eram em sua maioria do sexo feminino (55,49%), brancos (51,73%), de 8 a 18 anos (77,64%) e atendidos em escola pública (81,53%). Treze estudos usaram o Questionário de Sintomas Gastrointestinais Pediátricos (QPGS-RIV) para avaliar DGF. Encontramos uma prevalência global de DGF de 23% (95%IC 21-25%, I2 99%). Os principais distúrbios foram constipação funcional (CF) com 12% (95%IC 11-15%) seguido de dispepsia funcional (DF) (5%, 95%IC 11-15%) e síndrome do intestino irritável (SII) (3%, 95%IC 2-4%). A prevalência de DGF foi maior nas Américas, representando 23,67% (95%IC 21, 2-26,2%, I2 91,3%). Conclusão: DGF estão presentes em uma de quatro crianças e adolescentes, representando uma condição comum nessa faixa etária. Os distúrbios centrais foram CF, DF e SII.

Malformación de Arnold Chiari tipo 1 en embarazada, reporte de caso clínico / Case Report: Arnold Chiari type 1 malformation in pregnant women

Resumen ANTECEDENTES: La enfermedad de Arnold-Chiari es una malformación congénita rara del sistema nervioso central, caracterizada por el descenso del cerebelo por debajo de 5 mm del nivel del foramen magno, con o sin siringomielia asociada (tipos I o II). La edad media a la que se detecta la enfermedad tipo I son los 40 años. Es más frecuente en mujeres con una relación 3:1. Sus manifestaciones son: cefalea occipital (70-90%), dolor neuropático de segmentos cervicales (40-70%); hiperreflexia de extremidades inferiores (51%); atrofia de manos (35%) y paresias de extremidades superiores (35%) e inferiores (17%). El diagnóstico se establece con base en la resonancia magnética. OBJETIVO: Analizar el comportamiento anestésico-obstétrico en una paciente embarazada y el riesgo de complicaciones derivadas de los cambios fisiológicos y de la gestación. CASO CLÍNICO: Paciente de 30 años, con 38 semanas de embarazo y diagnóstico de enfermedad de Arnold-Chiari tipo I, con adecuado control neurológico y obstétrico y evolución satisfactoria. El embarazo finalizó por parto. CONCLUSIONES: La atención médica a la paciente del caso fue adecuada porque no se registraron complicaciones y fue posible darle el alta del hospital en muy poco tiempo.

Abstract BACKGROUND: Arnold-Chiari disease is a rare congenital malformation of the central nervous system, characterized by descent of the cerebellum below 5 mm from the level of the foramen magnum, with or without associated syringomyelia (types I or II). The average age at which type I disease is detected is 40 years. It is more frequent in women with a 3:1 ratio. Its manifestations are occipital headache (70-90%), neuropathic pain of cervical segments (40-70%); hyperreflexia of lower extremities (51%); atrophy of hands (35%) and paresis of upper (35%) and lower extremities (17%). Diagnosis is established based on magnetic resonance imaging. OBJECTIVE: To analyze the anesthetic-obstetric behavior in a pregnant patient and the risk of complications derived from physiological and gestational changes. CLINICAL CASE: 30-year-old patient, 38 weeks pregnant and diagnosed with Arnold-Chiari disease type I, with adequate neurological and obstetric control and satisfactory evolution. The pregnancy was terminated by delivery. CONCLUSIONS: The medical care of the patient in the case was adequate because no complications were recorded, and it was possible to discharge her from the hospital in a very short time.

Hallazgos en la endoscopia digestiva alta en niños con talla baja / Findings of upper gastrointestinal endoscopy in children with short stature

Resumen Introducción: en el estudio de la baja talla de origen digestivo en niños no hay un patrón de paraclínicos preestablecido; sin embargo, la endoscopia de vías digestivas puede ser una herramienta útil para tal fin. Objetivo: reportar una serie de casos de niños con diagnóstico de baja talla a quienes se les indicó una endoscopia de vías digestivas altas como parte de su estudio. Reporte de casos: se incluyeron 15 niños entre los 2 y 16 años de edad, 53,3% niñas, 26,7% desnutridos según el índice de masa corporal y la talla para la edad, 66,7% con baja talla grave y 33,3% con baja talla moderada. El 53,3% presentó dolor abdominal, el 46,7% no tuvo ganancia de peso, el 26,7% tuvo inapetencia y el 13,3% tuvo vómito, entre otros. Entre el 40,0% y el 93,4% presentaron macro- o microscópicamente esofagitis, gastritis y duodenitis. Los hallazgos microscópicos más importantes fueron duodenitis crónica con giardiasis, úlceras duodenales, hiperplasia nodular linfoide duodenal, Helicobacter pylori y duodenitis crónica eosinofílica. Conclusiones: a pesar de que la endoscopia de vías digestivas es un método poco utilizado y no bien descrito en el estudio de niños con baja talla, este reporte de casos describe organicidad en un 80,0% de los niños analizados.

Abstract Introduction: The study of short stature of digestive origin in children shows no pre-established laboratory patterns. However, endoscopy of the digestive tract may be a useful tool for this purpose. Objective: To report a series of cases of children with a diagnosis of short stature who underwent upper digestive tract endoscopy as part of their study. Case report: 15 children between the ages of 2 and 16 years were included; 53.3% were girls. 26.7% presented with malnutrition according to their body mass index and height-for-age, 66.7% had short stature, and 33.3% moderate short stature. Abdominal pain was reported in 53.3% of the cases, and no weight gain in 46.7%. Other symptoms were lack of appetite in 26.7%, vomiting in 13.3%, among others. Between 40% and 93.4% of the children presented macro and/or microscopic esophagitis, gastritis, and duodenitis. The most important microscopic findings were chronic duodenitis with giardiasis, duodenal ulcers, duodenal nodular lymphoid hyperplasia, Helicobacter pylori, and chronic eosinophilic duodenitis. Conclusions: Although endoscopy of the digestive tract is a method barely used and not well described in the study of children with short stature, this case report describes organicity in 80% of the children analyzed.

Tourniquet use for civilian extremity hemorrhage: systematic review of the literature / Uso de torniquete nas hemorragias de extremidades na população civil: revisão sistemática da literatura

ABSTRACT Introduction: extremity tourniquet (TQ) use has increased in the civilian setting; the beneficial results observed in the military has influenced acceptance by EMS and bystanders. This review aimed to analyze extremity TQ types used in the civilian setting, injury site, indications, and complications. Methods: a systematic review was conducted based on original articles published in PubMed, Embase, and Cochrane following PRISMA guidelines from 2010 to 2019. Data extraction focused on extremity TQ use for hemorrhage control in the civilian setting, demographic data, study type and duration, mechanism of injury, indications for use, injury site, TQ type, TQ time, and complications. Results: of the 1384 articles identified, 14 were selected for review with a total of 3912 civilian victims with extremity hemorrhage and 3522 extremity TQ placements analyzed. The majority of TQs were applied to male (79%) patients, with blunt or penetrating trauma. Among the indications for TQ use were hemorrhagic shock, suspicion of vascular injuries, continued bleeding, and partial or complete traumatic amputations. Upper extremity application was the most common TQ application site (56%), nearly all applied to a single extremity (99%), and only 0,6% required both upper and lower extremity applications. 80% of the applied TQs were commercial devices, and 20% improvised. Conclusions: TQ use in the civilian setting is associated with trauma-related injuries. Most are single-site TQs applied for the most part to male adults with upper extremity injury. Commercial TQs are more commonly employed, time in an urban setting is under 1 hour, with few complications described.

RESUMO Introdução: o uso de torniquete em extremidades (TQ) aumentou no ambiente civil; os resultados benéficos observados nas forças armadas influenciaram a aceitação por equipes de pré-hospitalar (PH) assim como pela população leiga. Esta revisão teve como objetivo analisar os tipos de TQ de extremidades usados em ambiente civil, local da lesão, indicações e complicações. Métodos: revisão sistemática foi conduzida com base em artigos originais publicados no PubMed, Embase e Cochrane seguindo as diretrizes do PRISMA de 2010 a 2019. Extração de dados focada no uso de TQ de extremidade para controle de hemorragia em ambiente civil, dados demográficos, tipo de estudo e duração, mecanismo de lesão, indicações de uso, local da lesão, tipo de TQ, tempo de TQ e complicações. Resultados: dos 1.384 artigos identificados, 14 foram selecionados para revisão com total de 3.912 vítimas civis com hemorragia nas extremidades e 3.522 colocações de extremidades TQ analisadas. A maioria foi aplicado em pacientes do sexo masculino (79%), com trauma contuso ou penetrante. Entre as indicações estavam choque hemorrágico, suspeita de lesões vasculares, sangramento contínuo e amputações traumáticas parciais ou completas. A aplicação na extremidade superior foi o local de aplicação mais comum (56%), quase todos aplicados a uma única extremidade (99%), e apenas 0,6% requereram aplicações nas extremidades superior e inferior. 80% dos TQs aplicados eram dispositivos comerciais e 20% improvisados. Conclusões: o uso de TQ em ambientes civis está associado a traumas. Os TQs comerciais são mais utilizados, com tempo menor que uma hora de uso e poucas complicações.

Tratamiento de quilotórax y quiloascitis refractaria en paciente cirrótico. Caso clínico

Chylous Ascites (CA) and chylothorax (CTx) are associated with obstruction, disruption or insufficiency of the lymphatic system. We report a 68-year-old male, with a history of alcoholic cirrhosis, who had recurrent events of CTx and CA. After a complete study, no other etiologies other than portal hypertension were found. Therapy with diuretics, nothing per mouth, parenteral feeding plus octreotide did not relieve symptoms. A transjugular intrahepatic portosystemic shunt (TIPS) was successfully placed and pleural effusion subsided. This case shows that CA and CTx can be caused by portal hypertension and they may subside employing a multimodal management strategy.

Estado y rasgo de ansiedad en escolares y adolescentes colombianos con y sin desórdenes gastrointestinales funcionales / Anxiety status and trait in Colombian schoolchildren and adolescents with and without functional gastrointestinal disorders

Resumen Introducción: la fisiopatología de los desórdenes gastrointestinales funcionales (DGF) incluye un eje intestino-cerebro alterado. Objetivo: determinar la prevalencia y posibles asociaciones de ansiedad en niños con DGF. Metodología: estudio de prevalencia realizado en ciudades colombianas en niños entre 8 y 18 años a quienes se les identificaron DGF según los Criterios de Roma III y ansiedad por medio del State Trait Anxiety Inventory for Children. Se incluyeron variables sociodemográficas y familiares. El análisis estadístico incluyó medidas de tendencia central, análisis uni- y multivariados, y regresión logística, teniendo en cuenta una p < 0,05 como significativa. Resultados: se incluyeron 1496 niños, 12,7 ± 2,1 años, 50,5 % niñas, 79,9 % con ansiedad transitoria y 51,5 % con tendencia a experimentar estados de ansiedad. Hubo predominio para el estado-ansiedad en adolescentes masculinos y para el rasgo-ansiedad en adolescentes femeninas con algún DGF. Los posibles factores de riesgo fueron la edad y el sexo para estado-ansiedad, y la edad, el sexo y los DGF para el rasgo-ansiedad. Conclusiones: cerca de la mitad de los niños tuvo tendencia a presentar estados de ansiedad, con predominio de las adolescentes femeninas y con factores de riesgo como la edad, el sexo y tener algún DGF.

Abstract Introduction: The pathophysiology of functional gastrointestinal disorders includes alteration of the gut-brain axis. Objective: This study measures prevalence and of functional gastrointestinal disorders and discusses possible associations with anxiety in children with these conditions. Methodology: This is a prevalence study of children between 8 and 18 years of age diagnosed with functional gastrointestinal disorders as defined by the Rome III Criteria and anxiety as defined by the State-Trait Anxiety Inventory for Children in several Colombian cities. Sociodemographic and family variables were included. Statistical analyses included measures of central tendency, univariate and multivariate analysis, and logistic regression, with p <0.05 established as significant. Results: The study included 1,496 children of whom 50.5% were girls. The boys average age was 12.7 ± 2.1 years, 79.9% had suffered transitory anxiety, and 51.5% had tendencies to experience states of anxiety. State/anxiety predominated in male adolescents while trait/anxiety predominated in female adolescents with functional gastrointestinal disorders. Possible risk factors for state/anxiety were age and sex. Possible risk factors for trait/anxiety were age, sex, and functional gastrointestinal disorders. Conclusions: About half of the children tended to states of anxiety. Female adolescents predominated with risk factors of age, sex, and some functional gastrointestinal disorders.

Desórdenes gastrointestinales funcionales en escolares con dolor abdominal crónico en una unidad de endoscopia digestiva pediátrica / Functional gastrointestinal disorders in schoolchildren with chronic abdominal pain in a pediatric digestive endoscopy unit

Introducción: La indicación de una endoscopia de vías digestivas altas (EVDA) en niños con dolor abdominal crónico (DAC) tiene poca evidencia; sin embargo, se continúa solicitando en niños con desórdenes gastrointestinales funcionales (DGFs). Objetivo: Determinar la prevalencia y posibles asociaciones de DGFs en escolares de una Unidad de Endoscopia Digestiva Pediátrica mediante los Criterios de Roma III. Materiales y métodos: Estudio de prevalencia en 37 escolares. Fueron consideradas variables sociodemográficas, antropométricas y clínicas. El análisis estadístico incluyó estimación de la proporción de niños con DGFs y su correspondiente IC95%, estimación de porcentajes, promedios, desviaciones estándar y rangos, análisis univariado, posible presencia de asociación entre las variables; prueba exacta de Fisher, a dos colas, con un valor de significancia p<0,05. Resultados: La edad media fue de 11,3±2,1 años, siendo un 62,2% mujeres, con una prevalencia de DGFs del 73%, presentando más de la mitad de ellos, dolor abdominal funcional (DAF) y síndrome de intestino irritable (SII). No hubo diferencias significativas en cuanto a las variables sociodemográficas, antropométricas y clínicas. Conclusiones: En niños a quienes se les realiza una EVDA dentro del estudio de su DAC, la prevalencia de DGFs es alta, siendo los más frecuentes el DAF y el SII.

Introduction: The indication of an upper digestive tract endoscopy (UDTE) in children with chronic abdominal pain (CAP) has little evidence. However, this test continues to be requested in children with functional gastrointestinal disorders (FGIDs). Objective: To determine the prevalence and possible associations of FGIDs in children of a Pediatric Digestive Endoscopy Unit using the Rome III Criteria. Materials and methods: A prevalence study of 37 schoolchildren. Sociodemographic, anthropometric and clinical variables were assessed. The statistical analysis included estimation of the proportion of children with FGIDs and its corresponding 95% CI. Other assessments included estimation of percentages, averages, standard deviations, ranges, univariate analysis, possible occurrence of associations between the variable, and a two-tailed Fisher's exact test with a significance set at p<0.05. Results: The mean age of child participants was 11.3±2.1 years and 62.2% of them were female. The prevalence of FGIDs was 73%, more than half of them presenting functional abdominal pain (FAP) and irritable bowel syndrome (IBS). There were no significant differences in terms of sociodemographic, anthropometric and clinical variables. Conclusions: The prevalence of FGIDs is high in children with CAP who undergo UDTE as part of the study of this disorder, being FAP and IBS the most frequent.

Adapting to an unprecedented scenario: surgery during the COVID-19 outbreak / Adaptação a um cenário sem precedente: cirurgia durante o surto de COVID-19

ABSTRACT On January 30th, 2020, the World Health Organization declared the Severe Acute Respiratory Syndrome 2 (SARSCoV-2) outbreak an international public health emergency, and one day later, the first COVID-19 case was confirmed in Gomera Island, Spain. In the following weeks, the number of cases in several Spanish cities spiked alarmingly, with thousands reported. This new coronavirus outbreak generated unprecedented changes in the Surgery Departments around the world, first in Asia, followed weeks later in Europe and America. This novel scenario of health crisis demanded a change in logistics and organization to guarantee urgent operations onCOVID-19 cases without interrupting the capability to handle emergency and oncologic surgery in the virus-free population, minimizing the viral transmission to staff and other patients. This manuscript aims to summarize the changes adopted by the General and GI Surgery Departments to address this unprecedented clinical scenario, including the restructuring of surgical schedules, staff preparation, and the departments outbreak response protocols and recommendations for surgical techniques and risk management.

RESUMO Em 30 de janeiro de 2020, a Organização Mundial da Saúde declarou o surto de Síndrome Respiratória Aguda Grave 2 (SARS-CoV-2) emergência internacional de saúde pública e, um dia depois, o primeiro caso COVID-19 foi confirmado na Ilha Gomera, na Espanha. Nas semanas seguintes, o número de casos em várias cidades espanholas aumentou de forma alarmante, com milhares de casos sendo relatados. Esse novo surto de coronavírus gerou mudanças sem precedentes nos departamentos de cirurgia em todo o mundo, primeiro na Ásia, seguido semanas depois na Europa e na América. Esse novo cenário de crise na saúde exigiu mudança na logística e na organização para garantir as operações de urgência nos casos COVID-19, sem interromper a capacidade de lidar com cirurgias oncológicas e de emergência, da população livre de vírus, minimizando a transmissão viral para as equipes e outros pacientes. O objetivo deste trabalho é apresentar de forma resumida as mudanças adotadas pelos departamentos de cirurgia geral e gastrointestinal para abordar esse cenário clínico sem precedentes. Este, inclui a reestruturação dos horários cirúrgicos, a preparação da equipe, os protocolos e as recomendações de resposta a surtos, assim como as recomendações de técnicas cirúrgicas e manejo de riscos.

Influencia de factores no médicos para el nacimiento por cesárea en un hospital privado / Influence of non-medical factors for cesarean birth in a private hospital

Resumen: OBJETIVO: Encontrar los factores no médicos que intervienen en el criterio del obstetra para elegir que la vía de nacimiento sea por parto o cesárea. MATERIALES Y MÉTODOS: Estudio transversal, retrospectivo, observacional y analítico, efectuado en pacientes atendidas entre 2016 y 2019 en el Hospital Ángeles Lomas, con más de 24 semanas de embarazo y que lo terminaron mediante parto o cesárea. Criterio de exclusión: embarazos múltiples. Variable dependiente: nacimiento por parto o cesárea. Variables independientes: sexo del obstetra, consultorio en el mismo hospital o externo, disponibilidad de asistente médico, mes del año, día de la semana y periodo vacacional. RESULTADOS: Se incluyeron 3906 nacimientos, 1495 cesáreas (38.3%) y 2411 partos (61.7%). Se observó mayor riesgo de cesárea, con significación estadística en: nacimientos atendidos por obstetras externos (OR = 3.81; IC95%: 3.07-4.73), nacimientos atendidos por obstetras del mismo hospital sin asistente médico (OR = 1.75; IC95%: 1.48-2.08), obstetras mujeres (OR = 2.55; IC95%: 2.06-3.16), abril vs diciembre (OR = 1.44; IC95%:1.04-1.98) y miércoles vs domingos (OR = 1.55; IC95%:1.14-2.05). Se registraron más cesáreas en el periodo prevacacional vs vacacional (OR = 1.51; IC95%: 0.94-2.43) sin diferencia estadísticamente significativa. CONCLUSIONES: Existen factores no médicos que aumentan la frecuencia de cesárea. Los relacionados con el obstetra incluyen: no tener el consultorio en el mismo hospital y carecer de asistente médico.

Abstract: OBJECTIVE: To find the non-medical factors that intervene in the obstetrician's criteria for choosing a birth canal or Cesarean section. MATERIALS AND METHODS: Transversal, retrospective, observational and analytical study carried out on patients attended between 2016 and 2019 at Hospital Ángeles Lomas (Mexico City), with more than 24 weeks of pregnancy and who finished it by vaginal delivery or cesarean section. Exclusion criterion: Multiple pregnancies. Dependent variable: birth by delivery or cesarean section. Independent variables: sex of the obstetrician, office in the same hospital or outside, availability of medical assistant, month of the year, day of the week and vacation period. RESULTS: 3906 births, 1495 cesarean sections (38.3%) and 2411 deliveries (61.7%) were included. A higher risk of cesarean section was observed, with statistical significance in: births attended by external obstetricians (OR = 3.81; CI95%: 3.07-4.73), births attended by obstetricians at the same hospital without a physician's assistant (OR = 1. 75; CI95%: 1.48-2.08), female obstetricians (OR = 2.55; CI95%: 2.06-3.16), April vs. December (OR = 1.44; CI95%:1.04-1.98) and Wednesday vs More cesarean sections were recorded in the pre-vacation vs. vacation period (OR = 1.51; IC95%: 0.94-2.43) with no statistically significant difference. CONCLUSIONS: There are non-medical factors that increase the frequency of cesarean section. Those related to the obstetrician included: not having the office in the same hospital and not having a medical assistant.

Morbilidad y mortalidad del recién nacido en un hospital privado de México / Newborn morbidity and mortality in a private hospital in Mexico

Resumen OBJETIVO: Estimar la morbilidad y mortalidad de los recién nacidos vivos en un hospital privado de México, a través de los ingresos a las unidades de cuidados intensivos neonatales y de terapia intermedia neonatal. MATERIALES Y MÉTODOS: Estudio de serie de casos de recién nacidos en el Hospital Ángeles Lomas, Estado de México, que ingresaron a la unidad de cuidados intensivos neonatales o a la unidad de terapia intermedia neonatal entre 2016 y 2019. Se incluyeron todos los recién nacidos vivos, mayores de 24 semanas de gestación. Se efectuó un análisis descriptivo y se calcularon medias, porcentajes y desviaciones estándar. RESULTADOS: Se registraron 4234 recién nacidos, de ellos 13.7% fueron prematuros. Ingresaron 478 (11.3%) neonatos a cuneros dedicados a la atención de sus morbilidades, 203 a la unidad de cuidados intensivos neonatales (4.8%) y 275 a la unidad de terapia intermedia neonatal (6.5%). Las principales causas de ingreso a cuidados intensivos neonatales fueron: retención de líquido pulmonar (32.5%), enfermedad de membrana hialina (27.6%) y sepsis neonatal (10.3%). Las principales causas de ingreso a la unidad de terapia intermedia neonatal fueron: retención de líquido pulmonar (41%), hiperbilirrubinemia multifactorial (15.2%) e hiperbilirrubinemia por incompatibilidad de grupo (11.6%). La tasa de mortalidad neonatal fue de 2.7 por cada 1000 nacidos vivos, las principales causas de defunción fueron: enfermedad de membranas hialinas complicadas con sepsis neonatal y asfixia perinatal. CONCLUSIÓN: No se encontraron diferencias importantes en el hospital privado estudiado en comparación con otros estudios que valoran la morbilidad y mortalidad neonatal. La tasa de mortalidad en este hospital fue menor a la del país, pero la media de días en la unidad de cuidados intensivos neonatales fue mayor y la tasa de prematuridad ligeramente mayor a la reportada en países desarrollados.

Abstract OBJECTIVE: To estimate the morbidity and mortality of live newborns born in a private hospital in Mexico, through admissions to the neonatal intensive care unit (NICU) and the neonatal intermediate therapy unit (NITU). MATERIALS AND METHODS: A series of cases were carried out of the births of the Hospital Ángeles Lomas (State of Mexico) that have entered the NICU / NITU from 2016 to 2019. All live newborns older than 24 weeks were included. A descriptive analysis was performed calculating means, percentages and standard deviations. RESULTS: 4,234 newborns were registered, of which 13.7% were premature. 478 (11.3%) newborns were admitted to pathological nurseries, 203 to the NICU (4.8%) and 275 to the NITU (6.5%). The main causes of admission to the NICU were retention of pulmonary fluid (32.5%), hyaline membrane disease (27.6%), and neonatal sepsis (10.3%). The main causes of admission to the NITU were retention of pulmonary fluid (41%), multifactorial hyperbilirubinemia (15.2%) and hyperbilirubinemia due to group incompatibility (11.6%). The neonatal mortality rate was 2.7 out of 1000 live births, the main causes of death were hyaline membrane disease complicated by neonatal sepsis and perinatal asphyxia. CONCLUSION: No significant differences were found in the private hospital studied compared to other studies evaluating neonatal morbidity and mortality. The mortality rate in this hospital was lower than that registered countrywide, however the average number of days in the NICU was higher and the prematurity rate slightly higher than that reported in developed countries.

Enfermedad celíaca en niños con síndrome de Down / Celiac disease in children with Down syndrome

INTRODUCCIÓN: La enfermedad celíaca (EC) en niños con síndrome de Down (SD) ha sido publicada por varios paí ses, sin que existan datos para Colombia. OBJETIVO: Determinar la frecuencia y factores relacionados de EC en niños con SD, comparado con un grupo de niños sin SD, analizando las manifestaciones clínicas, inmunológicas y genéticas. PACIENTES Y MÉTODO: Fueron estudiados 209 niños, 1-18 años de edad (8,4 ± 4,1 años; 55,5% sexo femenino): 97 con SD y 112 sin SD usando como marcador serológico los anticuerpos anti-transglutaminasa (tTG2); se estudiaron variables de edad, genero, raza, ori gen, peso, talla y síntomas digestivos. A los niños con tTG2 positivos, se les realizó biopsia duodenal y genotipo. Se estimó la proporción de niños con SD, sin SD y EC y su IC95%; medidas de tendencia central, análisis univariado y bivariado, siendo significativa una p < 0,05. RESULTADOS: Ocho niños con SD (8,2%) y 5 niños sin SD (4,5%) fueron tTG2 positivos (p = 0,200). Ninguno presentó deficiencia de IgA sérica. Un niño con SD presentó EC con Marsh II (1,0%); y 2 niños con SD (2,1%) y 2 sin SD (1,8%), presentaron EC potencial (p = 0,432). Tres niños fueron HLA-DQ2. Hubo mayor opor tunidad de presentar EC en el grupo de pre-escolares (OR = 6,14 IC95% = 0,41-87,35 p = 0,0462). CONCLUSIONES: La frecuencia de EC por biopsia intestinal en estos niños con SD es muy inferior a lo relatado en la literatura, estando asociada al pre-escolar, y siendo su principal alelo el DQ2, hallazgos similares a lo descrito a nivel mundial.

INTRODUCTION: Celiac disease (CD) in children with Down syndrome (DS) has been published by several countries, without available data for Colombia. OBJECTIVE: To determine the frequency and related factors of CD in children with DS, compared with a group of children without DS, analyzing the clinical, im munological, and genetic manifestations. PATIENTS AND METHOD: A total of 209 children between 1-18 years of age (8.4 ± 4.1 years, 55.5% female) were studied, 97 with DS and 112 without DS, using anti-transglutaminase antibodies as serological marker (tTG2). Variables of age, gender, race, ori gin, weight, height, and digestive symptoms were studied. Children with positive tTG2 underwent duodenal biopsy and genotype. The proportion of children with DS, without DS, and CD was esti mated and their 95% CI; measures of central tendency, univariate and bivariate analysis, considering a p < 0.05 significant. RESULTS: Eight children with DS (8.2%) and five children without DS (4.5%) were tTG2 positive (p = 0.200). None presented serum IgA deficiency. One child with DS presented CD with Marsh II (1.0%), and two children with DS (2.1%) and two without DS (1.8%), presen ted potential CD (p = 0.432). Three children were HLA-DQ2. CD was more likely in the preschool group (OR = 6.14 95%CI = 0.41-87.35 p = 0.0462). CONCLUSIONS: The CD frequency due to intestinal biopsy in children with DS is much lower than that reported in the literature, being associated with preschool, and having DQ2 as its main allele. These findings are similar to those described worldwide.

Coexistencia de trastornos gastrointestinales funcionales en lactantes y preescolares latinoamericanos / Coexistence of functional gastrointestinal disorders in Latin American infants and preschoolers

Resumen Introducción: se ha descrito la coexistencia de trastornos gastrointestinales funcionales (c-TGF) en lactantes y preescolares (LactPre); sin embargo, hay poca literatura sobre los principales c-TGF y sus características. Objetivo: describir la prevalencia y posibles asociaciones de c-TGF en un mismo LactPre latinoamericano. Metodología: estudio de prevalencia en LactPre de Colombia, Ecuador, Nicaragua y Panamá de consulta externa y urgencias, a quienes, según los criterios de Roma III en español, se identificaron regurgitación, síndrome de rumiación, síndrome del vómito cíclico, cólico, diarrea funcional, estreñimiento funcional y disquecia. Se tuvieron en cuenta la edad, el sexo y el origen. La estadística incluyó t de Student, chi cuadrado, prueba exacta de Fisher, análisis uni y multivariados y el cálculo de los OR e IC 95%, siendo una p <0,05 significativa. Resultados: se analizaron 2417 niños (2,4±19,8 meses de edad, 51,3% masculinos, con diagnóstico de por lo menos algún TGF del 35,7%). Se presentó c-TGF en el 3,6%, siendo el principal el síndrome de rumiación del lactante (SRL) más estreñimiento funcional (EF). Hubo predomino del género masculino en los lactantes y ser colombiano. Conclusión: la principal c-TGF en este grupo de LactPre de Latinoamérica es el SRL más EF, presentándose principalmente en el sexo masculino y en lactantes menores de 24 meses.

Abstract Introduction: Coexistence of functional gastrointestinal disorders (FGID) in infants and preschool children has been described, but there is little literature on the main types of FGID coexistence or their characteristics. Objective: This study describes the prevalence and possible associations of FGID coexistence among Latin American infants and preschool children. Methodology: This is a prevalence study of infants and preschool children conducted in Colombia, Ecuador, Nicaragua and Panama. Children included were outpatients and emergency patients who were identified according to the Rome III Criteria in Spanish as suffering from regurgitation, rumination syndrome, cyclic vomiting syndrome, colic, functional diarrhea, functional constipation and/or dyspepsia. Age, sex and origin of patients were registered. Statistical analyses included Student's T test, chi squared test, Fisher's exact test, univariate analysis, multivariate analysis and calculation of odds ratios and 95% confidence intervals with p <0.05 set as significant. Results: Two thousand four hundred and seventeen children were included. Their age range was 2.4 months to 19.8 months of age, and 51.3% were male. The proportion of patients with a diagnosis of at least one FGID was 35.7%. FGID coexistence was found in 3.6% of the patients. The most frequent combination was rumination syndrome plus functional constipation. There were predominances of males, infants and Colombian children in the total sample. Conclusion: The most commonly coexisting FGIDs in this group of Latin America infants and preschool children were infant rumination syndrome and functional constipation which were found together most frequently among boys who were under 24 months old.

Prevalencia de enfermedad por reflujo gastroesofágico por pH-metría en recién nacidos prematuros con síntomas sugestivos / Prevalence of gastroesophageal reflux disease found by pH measurements in preterm infants with suggestive symptoms

Resumen Introducción: el reflujo gastroesofágico (RGE), fenómeno fisiológico común en recién nacidos pretérminos (RNPreT), se diagnostica frecuentemente en neonatos, convirtiéndose en un importante fenómeno clínico en pretérminos. Objetivo: determinar la prevalencia y los síntomas de enfermedad por RGE (ERGE) por pH-metría intraesofágica ambulatoria de 24 horas (pHm) en pretérminos. Metodología: estudio de prevalencia en pretérminos de una unidad de cuidados intensivos neonatales de Cali, Colombia a quienes, por sospecha clínica de ERGE, se les solicitó una pHm, teniendo en cuenta variables sociodemográficas y clínicas. La estadística incluyó un análisis univariado por medio de medidas de tendencia central y análisis bivariado con la prueba de chi cuadrado (χ2) y la t de student, siendo significativa una p <0,05. Resultados: se analizaron 20 RNPreT de 36,5 + 27,6 días de edad postnatal; de 31,6 + 3,8 semanas de edad gestacional; 12 masculinos. 11 RNPreT (55,0 %) presentaron una pHm anormal. La presencia de residuos y cardiopatía estuvieron asociados con pHm anormal. Conclusión: La ERGE por pHm en los RNPreT estudiados tiene una prevalencia relativamente alta en comparación con la literatura mundial, sin encontrar una franca asociación con los síntomas analizados, a excepción de cardiopatía y residuos gástricos.

Abstract Introduction: Gastroesophageal reflux is a common physiological phenomenon in preterm infants and is frequently diagnosed in neonates for whom it is an important clinical phenomenon. Objective: To determine the prevalence and symptoms of gastroesophageal reflux disease (GERD) by 24-hour ambulatory esophageal pH monitoring of preterm neonates. Methodology: This is a study of the prevalence of GERD among patients in the Neonatal Intensive Care Unit of Cali, Colombia. Esophageal pH of infants was monitored when GERD was suspected. In addition, sociodemographic and clinical variables were recorded and taken into account. Univariate analysis by means of measures of central tendency and bivariate analysis were preformed using the chi-squared test and Student's T test with p <0.05 established as significant. Results: Twenty preterm newborns whose ages from birth ranged from 27.6 days to 36.5 days and whose gestational ages ranged from 3.8 weeks to 31.6 weeks were included. Twelve were male, and eleven (55.0%) had abnormal pH. Gastric waste and heart disease were associated with abnormal pH. Conclusion: The prevalence of GERD found through pH monitoring was relatively high in this group of infants compared findings in the world literature although no clear associations were found between the symptoms analyzed and other factors except for heart disease and gastric waste.

Prevalencia de desórdenes gastrointestinales funcionales y hábito intestinal en lactantes menores de 12 meses internados en el Hospital Infantil Baca Ortíz de Quito, Ecuador / Prevalence of functional gastrointestinal disorders and intestinal habit hospitalized in infants under 12 months of hospital infantil Baca Ortíz from Quito, Ecuador

Resumen Introducción: la prevalencia de desórdenes gastrointestinales funcionales en niños menores ecuatorianos se desconoce y no hay una prueba estándar para evaluar la consistencia de las heces. Objetivo: determinar la prevalencia de desórdenes gastrointestinales funcionales en lactantes menores a 12 meses e identificar el hábito intestinal. Metodología: estudio de prevalencia en lactantes internados del Hospital Infantil Baca Ortíz de Quito, Ecuador, a quienes se les diagnosticó diarrea funcional, cólico, estreñimiento funcional, disquecia, regurgitación, síndrome de vómito cíclico y rumiación. Fueron incluidas variables sociodemográficas, clínicas y preguntas sobre hábitos intestinales, basados en el Cuestionario para Síntomas Digestivos Pediátricos Roma III traducido y validado en español. Se hizo análisis uni y multivariados y el cálculo de los ORs, siendo una p<0,05 significativa. Resultados: fueron incluidos 147 lactantes, de 6,8±3,3 meses de edad, 50,3% niñas. La principal causa de hospitalización fue del sistema respiratorio. Se reportó 36,0% con algún desorden gastrointestinal funcional: cólico (12,2%), estreñimiento funcional (9,5%), disquecia (8,0%) y regurgitación (7,5%). No hubo factores de riesgo asociados. Se reportaron heces duras en 4,1% y 7,4% por Criterios de Roma III y Escala de Bristol, respectivamente. Hubo concordancia aceptable (kappa=0,3989, p=0,0221) entre el reporte de los padres por los Criterios de Roma III y la Escala de Bristol. Conclusión: un tercio de estos niños presentó algún desorden gastrointestinal funcional, siendo los más frecuentes: estreñimiento funcional, regurgitación, cólico y disquecia; sin posibles factores de riesgo; identificándose una concordancia aceptable entre lo reportado por los padres según los Criterios de Roma III y la Escala de Bristol. MÉD.UIS.2019;32(2):13-21

Abstract Introduction: the prevalence of functional gastrointestinal disorders in Ecuadorian younger infant is unknown and there is no gold standard for stool consistency. Objective: to determine the prevalence of functional gastrointestinal disorders in infants younger 12 months and to identify the intestinal habit. Methodology: prevalence study in hospitalized infants at the Hospital Infantil Baca Ortíz in Quito, Ecuador, who were diagnosed with functional diarrhea, colic, functional constipation, dyschezia, regurgitation, cyclic vomiting syndrome and rumination. Socio-demographic, clinical variables and questions about intestinal habits, based on the Questionnaire for Pediatric Digestive Symptoms Roma III translated and validated in Spanish, were included. The statistic included uni and multivariate analyzes and the calculation of the ORs, being a significant p <0.05. Results: a total of 147 infants, 6,8±3,3 months old, 50,3% girls; with the main cause of hospitalization the respiratory system. Were reported 36.0% with some functional gastrointestinal disorders: colic (12.2%), functional constipation (9,5%), dyschezia (8,0%) and regurgitation (7,5%). There were no possible associated risk factors. Hard stools were reported in 4,1% and 7,4% by Criteria of Rome III and Bristol Stool Scale, respectively. There was acceptable agreement (kappa = 0,3989, p = 0.0221) between the parents' report for the Rome Criteria III and the Bristol Stool Scale. Conclusion: one third of these children presented some functional gastrointestinal disorders, being the most frequent functional constipation, regurgitation, colic and dyschezia; without possible risk factors; identifying an acceptable concordance between what was reported by parents according to Rome Criteria III and Bristol Stool Scale. MÉD.UIS.2019;32(2):13-21

Trasplante hepático: evolución, curva de aprendizaje y resultados después de los primeros 300 casos / Liver transplantation: development, learning curve and results after the first 300 cases

Background: Liver transplantation (LT) is an option for people with liver failure who cannot be cured with other therapies and for some people with liver cancer. Aim: To describe, and analyze the first 300 LT clinical results, and to establish our learning curve. Material and Methods: Retrospective cohort study with data obtained from a prospectively collected LT Program database. We included all LT performed at a single center from March 1994 to September 2017. The database gathered demographics, diagnosis, indications for LT, surgical aspects and postoperative courses. We constructed a cumulative summation test for learning curve (LC-CUSUM) using 30-day post-LT mortality. Mortality at 30 days, and actuarial 1-, and 5-year survival rate were analyzed. Results: A total of 281 patients aged 54 (0-71) years (129 women) underwent 300 LT. Ten percent of patients were younger than 18 years old. The first, second and third indications for LT were non-alcoholic steatohepatitis, chronic autoimmune hepatitis and alcoholic liver cirrhosis, respectively. Acute liver failure was the LT indication in 51 cases (17%). The overall complication rate was 71%. Infectious and biliary complications were the most common of them (47 and 31% respectively). The LC-CUSUM curve shows that the first 30 patients corresponded to the learning curve. The peri-operative mortality was 8%. Actuarial 1 and 5-year survival rates were 82 and 71.4%, respectively. Conclusions: Outcome improvement of a LT program depends on the accumulation of experience after the first 30 transplants and the peri-operative mortality directly impacted long-term survival.