Comparison between Wright and Shukla formulas: which is better for the placement of umbilical catheters in newborns ≤ 1500 g? / Comparación entre las fórmulas de Wright y de Shukla: ¿cuál es mejor para la colocación de catéteres umbilicales en recién nacidos ≤ 1500 g?

Abstract Background: Intravascular venous (VUC) or arterial (AUC) umbilical catheter placement is the most frequent invasive procedure in the neonatal intensive care unit (NICU). Either Wright's or Shukla's formula is used to introduce the catheters. However, Shukla's formula is associated with incorrect insertion, especially for newborns < 1500 g. This study aimed to determine by chest X-ray if Wright's formula is better than Shukla's formula for the correct placement of umbilical catheters in newborns ≤ 1500 g. Methods: We included patients admitted to the NICU of a secondary-level hospital between 2021-2022 who received VUC or AUC through the Wright or Shukla formulas. Results: A total of 129 newborns were included: 78 with VUC and 51 with AUC. In VUC, 50% with Wright and 36.8% with Shukla formulas had the correct location, (p = 0.24). In AUC, 56.6 % with Wright and 52.4% with Shukla formulas were placed correctly placed, (p = 0.76). VUC with weight < 1000 g were correctly placed in 36.4% with Wright and 33.3% with Shukla formulas (p = 0.58). VUC in newborns > 1000 g were correctly placed in 66.6% with Wright and 38.4% with Shukla formulas (p = 0.065). AUC in newborns < 1000 g were correctly placed in 45% using Wright and 42.9% Shukla formulas (p = 0.63). AUC in newborns > 1000 g were correctly placed in 80% using Wright and 57.1% Shukla formulas (p = 0.23). Conclusions: We found 13% more correctly placed VUC using Wright's formula. Moreover, Wright's formula was 29% above Shukla's VUC placement in neonates > 1000 g, although there was no significant difference due to the sample size.

Resumen Introducción: La colocación de catéteres intravasculares venosos umbilicales (CVU) y arteriales (CAU) es el procedimiento invasivo más frecuente en la unidad de cuidados intensivos neonatales (UCIN). Para introducirlos se utilizan las fórmulas de Wright y de Shukla, aunque esta última podría estar asociada con una inserción incorrecta, especialmente en neonatos < 1500 g. El objetivo de este estudio fue determinar mediante radiografía de tórax cuál fórmula es mejor para la correcta colocación de catéteres umbilicales en recién nacidos ≤ 1500 g. Métodos: Se incluyeron los pacientes ingresados en la UCIN de un hospital de segundo nivel entre 2021-2022 que recibieron CVU o CAU mediante las fórmulas de Wrigth o Shukla. Resultados: Se incluyeron en total 129 recién nacidos: 78 CVU y 51 CAU. En CVU, Wright 50% y Shukla 36.8% tuvieron localización correcta, p = 0.24. En las CAU, Wright 56.6% y Shukla 52.4% tenían una ubicación correcta, p = 0.76. En CVU con peso < 1000 g, Wright 36.4% y Shukla 33.3% bien situados, p = 0.58. En CVU > 1000 g, Wright 66.6% y Shukla 38.4% bien situados, p = 0.065. En CAU < 1000 g, Wright 45% y Shukla 42.9%, p = 0.63. En CAU con peso > 1000 g, Wright 80% y Shukla 57.1%, p = 0.23. Conclusiones: La colocación del CVU fue 13% mejor con la fórmula de Wright. La fórmula de Wright superó en el 29% la colocación del CVU en los neonatos > 1000 g en comparación con la de Shukla, aunque no hubo diferencia significativa debido al tamaño de la muestra.

Esferas de hidrogel relacionadas con oclusión intestinal / Bowel obstruction related to hydrogel beads

Resumen Introducción: La obstrucción intestinal por ingesta accidental de cuerpos extraños se presenta muy rara vez en la edad pediátrica debido a que del 80 al 90% de los objetos pueden pasar libremente por el tracto gastrointestinal. Caso clínico: Se aborda el caso de una paciente de sexo femenino de 1 año 2 meses quien presentó obstrucción intestinal debido a la ingesta de esferas de hidrogel (poliacrilato de sodio). Dichas esferas, que son utilizadas como juguetes didácticos o sensoriales, aumentan de 200 a 400 veces su tamaño inicial mediante la absorción de agua. Se realizó radiografía abdominal en proyección decúbito supino, donde llamó la atención el hallazgo de defecto de llenado redondeado en asa de flanco derecho, ya que las esferas de hidrogel son radiolúcidas. El diagnóstico se estableció mediante ultrasonido abdominal, donde se reportó líquido libre peritoneal con datos de suboclusión por cuerpos extraños a nivel intestinal. Se indicó tratamiento conservador, encontrando persistencia de aumento de perímetro abdominal. Se realizó enterotomía y se encontraron las esferas impactadas a 30 centímetros de la válvula ileocecal. Conclusiones: Las esferas de hidrogel son peligrosas para la población pediátrica. La evolución de la paciente fue favorable debido al conocimiento del objeto extraño ingerido. Sobresale la conducta expectante que se tuvo que desempeñar debido a que se desconocía el crecimiento de las esferas y en qué momento no podrían continuar su paso por el tracto gastrointestinal.

Abstract Background: Bowel obstruction due to accidental ingestion of foreign objects occurs rarely in children because 80 to 90% of the objects can pass freely through the gastrointestinal tract. Case report: We report a case of a 14-month-old infant who presented bowel obstruction caused by the ingestion of hydrogel beads (sodium polyacrylate). Hydrogel beads are used as sensory and didactic toys that can increase their initial size 200 to 400 times by liquid absorption. An abdominal X-ray was perfomed in anteroposterior supine projection, where a round filling defect at the loop of the right flank was detected; this came to our attention because hydrogel beads are usually radiolucent. The diagnosis was established by abdominal ultrasound where free intraperitoneal fluid was reported with data of small bowel pseudo-obstruction by foreign objects. Conservative treatment was prescribed, finding persistence of increased abdominal perimeter, so an enterotomy was performed for their removal; finding impacted hydrogel beads 30 centimeters from the ileocecal valve. Conclusions: Hydrogel beads are dangerous for the pediatric population. The evolution of the patient was favorable thanks to the knowledge of the foreign objects ingested. The expectant behavior that had to be executed, stands out because we had no knowledge as to the maximum size of the hydrogel in the gastrointestinal tract.

Right-sided acute diverticulitis in the West: experience at a university hospital in Argentina

Purpose@#In the West, diverticular disease is located mainly in the left colon. However, it can also present in the right colon, with an incidence of 1%–2% in Caucasians. The purpose of this study was to describe our experience in right-sided acute diverticulitis (RD). @*Methods@#In this retrospective study, 410 patients with acute diverticulitis treated from 2013 to 2020 were included in a university hospital in Córdoba, Argentina. Colonic diverticulitis was stratified into 2 groups; RD and left-sided acute diverticulitis. Demographic and clinical variables, laboratory and imaging findings, type of treatment, follow-up, and recurrence were analyzed. @*Results@#Sixteen patients (3.9%) with RD were identified; 62.5% were male and the mean age was 40.7±11.7 years. A total of 81.3% were Caucasian and 18.7% Native American. Significant differences were found between both groups of diverticulitis; patients with RD were younger (P=0.001), with lower BMI (P=0.01), comorbidity rate (P=0.01), Charlson comorbidity index (P=0.02), hospital stay (P=0.01), severity according to the Hinchey classification (P=0.001) and had a lower recurrence rate (P=0.001). There were no significant differences in sex (P=0.95), duration of pain until admission (P=0.05), laboratory findings (P=0.23) and treatment (P=0.34). @*Conclusion@#Conservative treatment predominated in RD, with a lower rate of complications and recurrences, providing data that support conservative therapy as initial treatment in RD in our environment.

Dolor lumbar en el embarazo, aspectos fisiopatológicos y tratamiento / Low back pain in pregnancy, pathophysiological aspects and treatment

INTRODUCCIÓN: El dolor lumbar es una condición de alta prevalencia en la población general. La gestación genera cambios fisiológicos que favorecen la aparición de síntomas dolorosos que pueden comprometer la calidad de vida. MÉTODO: Revisión de la literatura con términos MeSH en inglés y español en las bases de datos Embase, PubMed, Lilacs, Sage, Google Academics y Scielo desde el año 1994 hasta el año 2021. Se encontraron 74 artículos y fueron seleccionados 50, basados en su impacto clínico. RESULTADOS: El dolor lumbar afecta a más del 50% de las mujeres embarazadas. Existen antecedentes gineco-obstétricos que pueden intervenirse para disminuir el riego o la intensidad de los síntomas. El diagnóstico es clínico, pero puede asociarse a imágenes diagnósticas cuando se sospechan condiciones de riesgo. El tratamiento se basa en intervenciones no farmacológicas como ejercicio y terapia física, pero pueden utilizarse algunos medicamentos e intervenciones en dolor según su riesgo-beneficio materno y fetal. CONCLUSIONES: El dolor lumbar en el embarazo es muy frecuente y debe ser conocido, diagnosticado y tratado por los profesionales de la salud que atienden esta población, dentro de un equipo multidisciplinario de tratamiento.

INTRODUCTION: Low back pain is a condition of high prevalence in the general population. Gestation generates physiological changes that favor the appearance of painful symptoms that can compromise the quality of life. METHOD: Review of the literature with MeSH terms in English and Spanish in the databases Embase, PubMed, Lilacs, Sage, Google Academics and Scielo from the year 1994 to the year 2021. Seventy-four articles were found and 50 were selected based on their clinical impact. RESULTS: Low back pain affects more than 50% of pregnant women. There are gyneco-obstetric antecedents that can be intervened to reduce the risk or intensity of symptoms. The diagnosis of this entity is clinical, but it can be associated with diagnostic imaging when risk conditions are suspected. Treatment is based on non-pharmacological interventions such as exercise and physical therapy, but some medications and pain interventions can be used according to their risk of maternal and fetal benefit. CONCLUSIONS: Low back pain in pregnancy is very frequent, it should be known, diagnosed, and treated by health professionals who care for this population, based on a multidisciplinary treatment team.

Comportamiento clínico de la infección y enfermedad causada por micobacterias no tuberculosas en Latinoamérica: Revisión de alcance

Cada vez son más frecuentes los reportes de aislamientos y enfermedades producidas por micobacterias no tuberculosas (MNT). Esta revisión de alcance describe el comportamiento epidemiológico y clínico de la infección y enfermedad por MNT en Latinoamérica. Se realizó la búsqueda en las bases de datos MEDLINE vía OVID, Embase y LILACS. Después de la depuración, se incluyeron 44 artículos que representaron una población global de 2826 sujetos, a quienes se les diagnosticó infección y enfermedad por MNT; la mayoría de las investigaciones incluyeron sujetos de Brasil y Colombia (75%); los estudios transversales fueron los más frecuentes (36,6%), el sexo masculino fue el más afectado (61,3%), mientras que la mediana de edad fue 40,1 años. En 37 artículos se reportó enfermedad por MNT, siendo la localización extrapulmonar (54%) la más frecuente; las principales comorbilidades fueron las enfermedades pulmonares, VIH/sida, fibrosis quística, diabetes y desnutrición, reportadas en 13 estudios; en 15 artículos se reportó tuberculosis previa al evento por MNT. En 12 artículos se evidenciaron procedimientos estéticos; en tres, procedimientos clínicos previos. Se reportó variedad de especies de MNT, siendo Mycobacterium avium (52%), M. abscessus (34%), M. chelonae (18%), M. fortuitum (16%) y M. kansasii (9,1%) las más frecuentes. El método más usado para diagnosticar e identificar la enfermedad por MNT fue el cultivo, recientemente se agregaron también las pruebas moleculares. La literatura científica latinoamericana sobre la infección/enfermedad por MNT es escasa. Es apremiante conducir estudios de frecuencia e impacto clínico y fortalecer la capacidad diagnóstica y las redes de organizaciones existentes enfocadas al estudio de micobacterias para conocer la verdadera morbimortalidad asociada a las MNT en Latinoamérica.

Reports of infection and/or disease caused by non-tuberculous mycobacteria (NTM) are becoming increasingly frequent. This scope review describes the epidemiological and clinical trend of infection/disease caused by NTM in Latin America. OVID MEDLINE, Embase and LILACS databases were explored for relevant articles. After filtering, we included 44 articles, representing an overall population of 2,826 subjects diagnosed with NTM infection and disease; the majority of the publications included subjects from Brazil and Colombia (75%), cross-sectional studies were the most common (36.6%), most subjects were male (61.3%) and the median age of subjects was 40.1 years. Disease by NTM was reported in 37 publications, extrapulmonary presentation was the most frequent (54%), main comorbidities were other pulmonary diseases, HIV, cystic fibrosis, diabetes and malnutrition, as reported in 13 studies; tuberculosis diagnosis previous to NTM disease was reported in 15 articles. Aesthetic procedures were reported in 12 articles while clinical procedures were reported in 3 articles. Several NTM species were reported, being Mycobacterium avium (52%), M. abscessus (34%), M. chelonae (18%), M. fortuitum (16%) and M. kansasii (9.1%) the most frequent. Culture and molecular testing were the main methods for diagnosis and identification. Scientific literature on NTM from Latin American countries is scarce. There is an urgent need to conduct studies on the frequency and clinical impact of NTM infections, in order to accurately identify the current morbidity and mortality associated with NTM in Latin American. It is also important to strengthen the local diagnostic capacity and the existing networks focused on studying NTM.

Ethnic Difference of Thrombogenicity in Patients with Cardiovascular Disease: a Pandora Box to Explain Prognostic Differences

Arterial and venous atherothrombotic events are finely regulated processes involving a complex interplay between vulnerable blood, vulnerable vessel, and blood stasis. Vulnerable blood (‘thrombogenicity’) comprises complex interactions between cellular components and plasma factors (inflammatory, procoagulant, anticoagulant, and fibrinolytic factors).The extent of thrombogenicity may determine the progression of atheroma and the clinical manifestation of atherothrombotic events, with the highest thrombogenicity in African Americans and lowest in East Asians. Inherent thrombogenicity may influence clinical efficacy and safety of specific antithrombotic treatments in high-risk patients, which may in part explain the observation that East Asian patients have reduced anti-ischemic benefits and elevated bleeding risk with antithrombotic therapy compared to Caucasian patients. In this review, we discuss available evidence regarding the racial differences inthrombogenicity and its impact on clinical outcomes among patients with atherosclerotic cardiovascular disease.

Ethnic Difference of Thrombogenicity in Patients with Cardiovascular Disease: a Pandora Box to Explain Prognostic Differences

Arterial and venous atherothrombotic events are finely regulated processes involving a complex interplay between vulnerable blood, vulnerable vessel, and blood stasis. Vulnerable blood (‘thrombogenicity’) comprises complex interactions between cellular components and plasma factors (inflammatory, procoagulant, anticoagulant, and fibrinolytic factors).The extent of thrombogenicity may determine the progression of atheroma and the clinical manifestation of atherothrombotic events, with the highest thrombogenicity in African Americans and lowest in East Asians. Inherent thrombogenicity may influence clinical efficacy and safety of specific antithrombotic treatments in high-risk patients, which may in part explain the observation that East Asian patients have reduced anti-ischemic benefits and elevated bleeding risk with antithrombotic therapy compared to Caucasian patients. In this review, we discuss available evidence regarding the racial differences inthrombogenicity and its impact on clinical outcomes among patients with atherosclerotic cardiovascular disease.

Differentials in the epidemiological profile of canine visceral leishmaniasis in the semi-arid region of Paraíba, Brazil

ABSTRACT: The objective of this study was to estimate the prevalence of canine visceral leishmaniasis (CVL) and to identify the differences in associated factors to its occurrence in urban area and countrysides in the municipality of Santa Luzia located in the semi-arid region of Paraíba. In the years 2015 and 2016, 779 blood samples from dogs were collected. The prevalence was determined by three serological techniques, ELISA-S7® Kit, DPP® Rapid Test and EIE-LVC® Kit, considering positive the samples that reacted in at least two assays. Associated factors were determined by univariate and multivariate analyzes of the guardians responses to the epidemiological questionnaire. The prevalence of anti-Leishmania infantum antibodies in the studied municipality was 15.00% (117/779), being higher in the urban area (15.20%) than in the countryside (13.60%). The neighborhood with the highest prevalence was Frei Damião with 26.40% (33/125), being considered a hotspot (OR 1.245, p=0.007). Other associated factors were the semi-domiciliary breeding (OR 1.798, p=0.025), in the urban area, and hunting dog (OR 18.505, p=0.016), contact with cattle (OR 17.298, p=0.022) and environment where the dog is raised (OR 4.802, p=0.024) in the countryside. In the municipality of Santa Luzia, the prevalence of canine visceral leishmaniasis is high and the disease is widely distributed. Epidemiological differences between urban area and the countryside could be observed demonstrating the need for more adequate control measures for each locality and proving the urbanization process.

RESUMO: O objetivo desta pesquisa foi estimar a prevalência da leishmaniose visceral canina (LVC) e identificar as diferenças nos fatores relacionados à sua ocorrência nas zonas urbana e rural do município de Santa Luzia, localizado no semiárido paraibano. Nos anos de 2015 e 2016, coletaram-se 779 amostras de sangue de cães. A prevalência foi determinada através de três técnicas sorológicas, Kit ELISA-S7®, teste rápido DPP® e Kit EIE-LVC®, considerando positivas as amostras que reagiram em, pelo menos, dois ensaios. Os fatores relacionados foram determinados por meio das análises estatísticas uni e multivariada das respostas dos tutores ao questionário epidemiológico. A prevalência de anticorpos anti-Leishmania infantum encontrada no município estudado foi de 15,00% (117/779), sendo maior na zona urbana (15,20%) do que na rural (13,60%). O bairro que apresentou maior prevalência foi o Frei Damião com 26,40% (33/125), sendo considerado um hotspot (OR 1,245; p=0,007). Outros fatores relacionados encontrados foram a criação semidomiciliar (OR 1,798; p=0,025), na zorna urbana, e cão de caça (OR 18,505; p=0,016), contato com bovinos (OR 17,298; p=0,022) e ambiente onde o cão é criado (OR 4,802; p=0,024), na zona rural. Verifica-se a elevada prevalência da leishmaniose visceral canina e a sua ampla distribuição no município de Santa Luzia. Diferenças epidemiológicas entre as zonas urbana e rural puderam ser observadas, demonstrando a necessidade de medidas de controle mais adequadas para cada localidade e comprovando o processo de urbanização.

Differentials in the epidemiological profile of canine visceral leishmaniasis in the semi-arid region of Paraíba, Brazil / Diferenciais no perfil epidemiológico da leishmaniose visceral canina no semiárido da Paraíba, Brasil

The objective of this study was to estimate the prevalence of canine visceral leishmaniasis (CVL) and to identify the differences in associated factors to its occurrence in urban area and countrysides in the municipality of Santa Luzia located in the semi-arid region of Paraíba. In the years 2015 and 2016, 779 blood samples from dogs were collected. The prevalence was determined by three serological techniques, ELISA-S7® Kit, DPP® Rapid Test and EIE-LVC® Kit, considering positive the samples that reacted in at least two assays. Associated factors were determined by univariate and multivariate analyzes of the guardians' responses to the epidemiological questionnaire. The prevalence of anti-Leishmania infantum antibodies in the studied municipality was 15.00% (117/779), being higher in the urban area (15.20%) than in the countryside (13.60%). The neighborhood with the highest prevalence was Frei Damião with 26.40% (33/125), being considered a hotspot (OR 1.245, p=0.007). Other associated factors were the semi-domiciliary breeding (OR 1.798, p=0.025), in the urban area, and hunting dog (OR 18.505, p=0.016), contact with cattle (OR 17.298, p=0.022) and environment where the dog is raised (OR 4.802, p=0.024) in the countryside. In the municipality of Santa Luzia, the prevalence of canine visceral leishmaniasis is high and the disease is widely distributed. Epidemiological differences between urban area and the countryside could be observed demonstrating the need for more adequate control measures for each locality and proving the urbanization process.(AU)

O objetivo desta pesquisa foi estimar a prevalência da leishmaniose visceral canina (LVC) e identificar as diferenças nos fatores relacionados à sua ocorrência nas zonas urbana e rural do município de Santa Luzia, localizado no semiárido paraibano. Nos anos de 2015 e 2016, coletaram-se 779 amostras de sangue de cães. A prevalência foi determinada através de três técnicas sorológicas, Kit ELISA-S7®, teste rápido DPP® e Kit EIE-LVC®, considerando positivas as amostras que reagiram em, pelo menos, dois ensaios. Os fatores relacionados foram determinados por meio das análises estatísticas uni e multivariada das respostas dos tutores ao questionário epidemiológico. A prevalência de anticorpos anti-Leishmania infantum encontrada no município estudado foi de 15,00% (117/779), sendo maior na zona urbana (15,20%) do que na rural (13,60%). O bairro que apresentou maior prevalência foi o Frei Damião com 26,40% (33/125), sendo considerado um hotspot (OR 1,245; p=0,007). Outros fatores relacionados encontrados foram a criação semidomiciliar (OR 1,798; p=0,025), na zorna urbana, e cão de caça (OR 18,505; p=0,016), contato com bovinos (OR 17,298; p=0,022) e ambiente onde o cão é criado (OR 4,802; p=0,024), na zona rural. Verifica-se a elevada prevalência da leishmaniose visceral canina e a sua ampla distribuição no município de Santa Luzia. Diferenças epidemiológicas entre as zonas urbana e rural puderam ser observadas, demonstrando a necessidade de medidas de controle mais adequadas para cada localidade e comprovando o processo de urbanização.(AU)

Técnica mínimamente invasiva en paciente con multimorbilidad crónica y hernia inguinal complicada: reporte de caso / A minimally invasive technique in a patient with chronic multimorbidity and complicated inguinal hernia: case report

El paciente con multimorbilidad crónica forma parte de una población que se ha incrementado en los últimos años. La hernia inguinal incarcerada representa una emergencia. El abordaje transabdominal preperitoneal (TAPP) presenta ventajas para evaluar el contenido de la hernia. Se presenta el caso de un hombre de 77 años con múltiples comorbilidades y cirugías abdominales previas, que se presentó con cuadro de oclusión intestinal. En tomografía computada: asa de intestino delgado incarcerada en región inguinal. Se observó asas intestinales dilatadas con cambio de calibre en región inguinal izquierda. Se retiró asa intestinal atascada en hernia directa. Se disecó defecto herniario y se colocó malla de 10 x 15 cm en espacio preperitoneal. La técnica TAPP es eficaz y segura para la reparación de hernias complicadas en pacientes con multimorbilidad crónica, en manos de cirujanos experimentados.

The patient with chronic multimorbidity is part of a population that has increased in recent years. Incarcerated inguinal hernia represents an emer-gency. The preperitoneal transabdominal approach (TAPP) has advantages to evaluate the content of the hernia. A 77-years-old man with multiple comorbidities and previous abdominal surgeries presented with intestinal occlusion. Computed tomography: small bowel loop incarcerated in the inguinal region. The cavity is inspected by observing dilated intestinal loops with a change of caliber in the left inguinal region. The intestinal loop is removed observing a direct hernia. The hernia defect is repaired, and 10 x 15 cm mesh is placed in the preperitoneal space. The TAPP te-chnique is effective and safe for the repair of complicated hernias in patients with chronic multimorbidity, in the hands of experienced surgeons.

Análisis de la gestión del saneamiento en el asentamiento informal Bajo Los Anonos, San José, Costa Rica, desde una visión social, técnica e institucional / Analysis of the sanitation management in the informal settlement Bajo Los Anonos, San José, Costa Rica, from a social, technical and institutional perspective

RESUMEN: Objetivo: Analizar desde los ámbitos social, técnico e institucional las condiciones de saneamiento que hay actualmente en el asentamiento informal Bajo Los Anonos ubicado en San José, Costa Rica. Métodos: Mediante la aplicación de encuestas a los habitantes del lugar, se realizó una caracterización técnica y social de la autogestión del saneamiento en la comunidad; además, se realizó un muestreo simple de aguas residuales en tres puntos distintos de la comunidad; finalmente, se realizó una encuesta con preguntas abiertas al gestor ambiental de la Municipalidad de Escazú para conocer su perspectiva. Resultados: Aunque un 82% coincidió en que el mal manejo de las aguas residuales es una de las principales problemáticas, más de la mitad de las personas encuestadas no encuentran relación entre el nivel de saneamiento y su injerencia en la salud. El tránsito de aguas residuales en las calles expone a la población a un nivel de riesgo. Aunque la Municipalidad de Escazú es consciente de la problemática, no se tienen planes claros para la comunidad.Conclusiones: La comunidad presenta problemas en cuanto a la correcta gestión de las aguas residuales, debido a una combinación de factores, tales como la falta de acceso a sistemas de saneamiento de calidad, malas prácticas de las vecinas y los vecinos y la falta de apoyo institucional.

ABSTRACT Objective: To analyze from a social, technical and institutional perspective the sanitation conditions that currently exist in the informal settlement Bajo Los Anonos located in San José, Costa Rica. Methods: By applying surveys to the inhabitants of the place, it was made a technical and social characterization of the self-management of sanitation in the community; in addition, it was realized a simple sampling of wastewater in three different points of the community; finally, we made a survey with open questions to the environmental manager of the Municipality of Escazú to know their perspective. Results: Although 82% agreed that poor wastewater management is one of the main problems, more than half of the people did not find a relationship between the level of sanitation and its interference in health. Transit of wastewater in the streets exposes the population to a level of risk. Even though the Municipality of Escazú is aware of the problem, there are no clear plans for the community. Conclusions: The community presents problems regarding the correct management of wastewater, due to a combination of factors, such as lack of access to quality sanitation systems, bad practices of neighbors and lack of institutional support.

Actividad física en el marco de la atención primaria de salud, mirada desde los actores / Physical activity within the framework of primary health care as perceived by the actors

RESUMEN Objetivo Identificar las acciones desarrolladas en el marco de la actividad física desde la Atención Primaria en Salud (APS), desde la voz de los actores. Metodología Investigación cualitativa, con enfoque interpretativo y método narrativo, que buscó identificar a través de entrevistas a profundidad, las acciones desarrolladas y los factores que subyacen a la implementación de programas de actividad física en la ciudad de Bogotá. Resultados En cuanto a las acciones desarrolladas se observa el trabajo individualizado y sectorial, sin evidenciar articulación entre sectores y conocimiento por parte de los actores de todos los programas presentes en el distrito. Los profesionales que se encargan de la implementación de los programas difieren de los que se encargan de la organización y gestión de los mismos, ya que no se reconocen competencias de gestión pública y social en profesiones como fisioterapia, licenciatura en educación física y profesionales de cultura física, siendo estos cargos ocupados principalmente por ingenieros y profesionales de las ciencias sociales. La contratación de los profesionales continúa siendo una barrera para dar continuidad a los programas, así mismo el desconocimiento de las normas y políticas vigentes. Conclusiones La mirada sectorial, biologicista e individual de la actividad física, no permite su abordaje dentro de políticas basadas en la APS, las cuales buscan la compresión de la salud y sus determinantes, desde enfoques analíticos y críticos, que requieren del compromiso de las entidades públicas, privadas, la comunidad y la academia.(AU)

ABSTRACT Objective To identify the actions developed within the framework of physical activity from primary health care (PHC) as manifested by the actors themselves. Methods Qualitative research, with an interpretative approach and narrative method, which sought to identify, through in-depth interviews, the actions developed and the factors underlying the implementation of physical activity programs In the city of Bogotá. Results Regarding the actions developed, individualized and sectoral work was observed, without evidence of articulation between sectors or knowledge of all the programs developed by the city government on the part of the actors. The professionals responsible for implementing the programs disagree with those who are in charge of organizing and managing said programs, since public and social management competencies are not recognized in professions such as physiotherapist, bachelors in Physical Education, and physical culture professionals, as these positions are usually held by engineers and social science professionals. The hiring of professionals continues to be a barrier to give continuity to the programs, as well as the lack of knowledge of the rules and policies in force. Conclusions A sectoral, biologicist and individual view of physical activity does not allow approaching them following the policies based on PHC, which seek to understand health and its determinants from an analytical and critical point of view. This requires the commitment of public and private entities, the community and the academia.(AU)

Validación de la escala europea de autocuidado en la falla cardiaca / Validation of the European Heart Failure Self-care Behaviour Scale

Resumen Introducción: La falla cardiaca es una enfermedad frecuente, con exacerbaciones relacionadas con la capacidad para seguir las indicaciones médicas Objetivo: Se pretende determinar la confiabilidad y la validez interna de una escala de autocuidado en la ciudad de Bogotá, Colombia. Materiales y métodos: Estudio transversal, en el que se exportaron los registros de los pacientes del programa de falla cardiaca, se identificaron las características generales de los ítems de la escala, fueron transformados a valores de 0 - 100 y se estimó la confiabilidad por el coeficiente Alfa de Cronbach (> 0,7) así como la validez interna por coeficiente de correlación intraclase para las medidas únicas y el promedio (p < 0,05). Resultados : Se revisaron 144 registros, el sexo femenino aportó el 30,6%; la hipertensión arterial el 54,9%, la fibrilación auricular el 35% y las alteraciones del funcionamiento tiroideo el 31%, fueron las comorbilidades más frecuentes; solo el 9,2% se encontraba con clase funcional baja; la escala mostró apropiados valores de confiabilidad y validez interna, el puntaje total de autocuidado se encontró en 48,30; los ítems con puntaje más alto fueron ''me vacuno contra la gripe todos los años'' (61,19 puntos) y ''me peso cada día'' (60,04 puntos); los ítems con puntaje más bajo fueron ''tomo toda la medicación como me han indicado'' (29,66 puntos), y ''realizo dieta baja en sal'' (38,59 puntos). Conclusiones : La escala de autocuidado demostró apropiadas la confiabilidad y la validez para la determinación del autocuidado en los pacientes con falla cardiaca en la ciudad de Bogotá, Colombia; se requieren estudios adicionales que permitan determinar la validez concurrente con otros instrumentos y diseños prospectivos.

Abstract Introduction: Heart failure is a frequent condition, with exacerbations related to the ability to follow medical indications. Objetive: The goal is to determine the reliability and internal validity of a self-care scale in the Colombian city of Bogotá. Material and methods: Cross-sectional study. Te registers of the heart failure program were exported, general characteristics of the scale items were identified, they were transformed into 0-100 values and Cronbach's alpha coefficient (>0.7) was estimated, as well as the internal validity by intraclass correlation coefficient for unique measurements and the average (p < 0.05). Results: 144 registers were reviewed, 30.6% of whom were female; most common comorbidities were arterial hypertension with 54.9%, atrial fibrillation with 35% and alterations of the thyroid function with 31%; only 9.2% presented low functional class. The scale showed appropriate confidence and internal validity values, the total self-care score was 48.30. Items with the highest score were ''I get a flu shot every year'' (61.19 points) and ''I weigh myself every day'' (60.04 points); items with the lowest score were ''I take all medication as instructed'' (29.66 points) and ''I follow a low-salt diet'' (38.59 points). Conclusions: The self-care scale revealed appropriate confidence and internal validity for determining self-care in patients with heart failure in the city of Bogotá, Colombia. Further research is required to determine the concurrent validity with other instruments and prospective designs.

Análisis de supervivencia según la oportunidadde atención en la enfermedad coronaria / Survival analysis according to the opportunity to receive medical care in coronary diseases

Resumen Introducción: La oportunidad en la atención de los servicios de urgencias es una determinante de la calidad en la salud asociado con la mortalidad, se pretende definir la relación entre la supervivencia de los pacientes con la enfermedad coronaria en la unidad de cuidados coronarios con la oportunidad de atención en urgencias. Materiales y métodos: Se realizó un estudio descriptivo retrospectivo, se extrajeron los registros de la unidad de cuidado coronario, urgencias y los certificados de defunción de los pacientes con diagnóstico de la enfermedad coronaria, se identificaron las características generales de los pacientes y se exploró la diferencia en la supervivencia según la oportunidad de atención en las curvas de Kapplan-Meier por subgrupos, para un nivel de confianza del 95%. Resultados: Se presentaron 266 casos, 68,4% de sexo masculino, la media de edad fue de 68 años; mediana de oportunidad de atención en urgencias de 57 minutos, de tiempo de estancia en unidad de cuidado coronario 2 días, y de supervivencia 2 días; el análisis de supervivencia para el estado de egreso, mostró mayor supervivencia en pacientes atendidos en menos de 70 minutos. Conclusiones: Los tiempos de atención en urgencias de los pacientes con la enfermedad coronaria superiores a 70 minutos se asocian con la mayor mortalidad, se requieren mejorías en los registros para evaluar los factores asociados con las demoras en la atención.

Abstract Introduction: The opportunity to receive emergency medical assistance is decisive in the health quality associated to mortality. This study aims to define the relationship between survival of patients with coronary disease in the coronary care unit who had the opportunity to receive emergency medical care. Material and methods: A descriptive retrospective study was conducted, registers for the coronary care unit, emergency room and death certificates of patients diagnosed with coronary disease were collected, general characteristics of patients were identified and differences in survival according to the opportunity of accessing to healthcare in Kapplan-Meier curves for subgroups for a confidence level of 95% was explored. Results: 266 cases were presented, 68.4% were male, average age was 68; median opportunity to receive emergency care was 57 minutes, median stay at the coronary care unit was 2 days and 2 days for survival; survival analysis for the state of the admission showed higher survival in patients who were assisted in less than 70 minutes. Conclusions: Patients with coronary disease waiting over 70 minutes in the emergency room are associated to higher mortality. Improvements in the registers are required in order to assess factors associated to the delay in the access to medical care.

Análisis del comportamiento mecánico del tejido subyacente a las tuberosidades isquiáticas por medio del método del elemento finito / Analysis of mechanical behavior of the underlying tissue to the ischial tuberosities using finite element method

Las úlceras por presión son las complicaciones secundarias más comunes a una lesión medular, las cuales ponen en riesgo tanto la salud como la vida de quienes las padecen. Las úlceras por presión más comunes en lesionados medulares aparecen en la región pélvica, principalmente en las tuberosidades isquiáticas (TI's). Una estrategia usada en la clínica es medir la presión generada entre el paciente y la superficie donde se encuentra para evaluar el riesgo que representa dicha superficie para el desarrollo de úlceras por presión sin embargo, este tipo de mediciones superficiales no garantizan que la presión en los tejidos internos subyacentes a prominencias óseas sea inocua. Con el fin de estudiar los mecanismos de formación de úlceras por presión, se realizó el análisis de un modelo de pelvis y tejido subyacente por medio del Método de los Elementos Finitos (MEF). De esta manera se puede estudiar el comportamiento de las TI's sobre su tejido circundante, así como analizar los efectos biomecánicos que provocan las úlceras. Se construyó el modelo computacional por medio de un software de CAD (Computing Aided Design) de la pelvis a partir de cortes tomográficos. El modelo fue exportado al software COMSOL y se analizaron seis casos de estudio: un análisis de la pelvis sobre bloques de tejido sano y cinco casos más, los cuales simulan lesiones en el tejido con distintas profundidades, representando úlceras superficiales e internas. Los resultados mostraron que los puntos de máximo esfuerzo, en todas las pruebas, se localizan justo debajo de la TIs además se encontró que las lesiones internas presentan mayores esfuerzos y deformaciones, los cuales pueden ser precursores de daño en el tejido.

Pressure ulcers are the most common secondary complication to a spinal cord injury, which endanger both health and life of the patients who suffer them. The most common pressure ulcers in spinal cord injuries occur in the pelvic region, mainly in the ischial tuberosities (ITs). A strategy used in clinic is to quantify the pressure generated between the patient and the surface, in order to assess the risk posed by that surface for developing pressure ulcers. Despite this, this type of surface measurements does not guarantee that pressure in the internal tissues underlying to bony prominences, to be safe. In order to study the mechanisms of formation of pressure ulcers, an analysis of a model of the pelvis and its underlying tissue was performed using the Finite Element Method (FEM). By this means we can study the behavior of ITs on its surrounding tissue, and at the same time, we analyze the biomechanical effects those cause ulcers. The computational model of the pelvis was built from tomographic slices using CAD software (Computing Aided Design). The model was exported to the finite element software COMSOL and six study cases were analyzed: an analysis of the pelvis on healthy tissue blocks and five more cases, which simulate tissue injury with different depths, representing surface and internal ulcers. The results showed that the maximum stress points in all tests are located just below the ITs it was also found that internal injuries present higher stresses and strains, which can be precursors of tissue damage.

audit evaluating anticoagulation clinic managed by clinical pharmacists in Jordan

Background and Objectives: Warfarin is the most widely prescribed oral anticoagulant; it is highly effective for the treatment and prevention of venous and arterial thrombosis. The beneficial outcomes of warfarin therapy are dependent upon achieving and maintaining an optimal international normalized ratio [INR] therapeutic range. The aim of this study was to evaluate the impact of our newly established clinic at Queen Alia Heart Institute [QAHI] in the Royal Medical Services [RMS], Jordan

Patients and Methods: An observational prospective study was carried out in a newly established anticoagulation clinic managed by two clinical pharmacists and one nutritionist in QAHI since September 2013 until June 2014. The patients [no= 250] who were on warfarin for at least two months referred to the clinic were included in our study. All patients or their care givers received a 45 minutes educational session and a warfarin booklet. Then they were followed up regularly for achieving and maintaining the target INR and developing any adverse events related either too high or low INR [>4.5 or <1.5, respectively]

Results: The age range of this group of the patients who were referred to t he clinic was wide, 5-81 years. 65% of them were males, with the most common indications for Warfarin were aortic and mitral valves replacement, and atrial fibrillation.72% of the patients were not achieving therapeutic [T] INR 43% of them achieve the TINR within the first week, 28% within the second week, 17% within the third, 4% within the fourth and 8% exceeded 4 weeks. The proportion of time within TINR for all the patients during the whole period was 75%. Only 7% of the patients had low INR, <1.5 and 5% had high INR, >4.5 for one visit. No major thromboembolic or hemorrhagic events were reported

Conclusion: The newly established clinic had achieved a considerable encouraging results and feedbacks in the short period of time since it had been established

Validação da bioimpedância elétrica por multifrequência em atletas / Validation of multifrequency bioelectrical impedance analysis in athletes

É reconhecida a importância de avaliar a composição corporal na população atlética. Para o efeito é preciso utilizar técnicas válidas na determinação dos principais componentes moleculares. A Densitometria Radiológica de Dupla Energia (DXA) é um método preciso e válido para avaliação decomposição corporal. No entanto, a DXA é uma técnica ainda pouco acessível em contextos não laboratoriais. Desta forma, é importante utilizar técnicas mais simples e práticas como a bioimpedância eléctrica (BIA). No entanto poucos estudos validaram a BIA especialmente de multifrequência na avaliação da composição corporal em atletas. Assim, o objetivo desta investigação é testar a validade da BIA de multifrequência (Tanita, modelo MC-180) na determinação do conteúdo mineral ósseo (CMO),massa gorda (MG) e massa isenta de gordura e osso (MIGO) em atletas. Um total de 79 atletas (35 homens) foram avaliados pela BIA e pela DXA. Comparação de médias, coeficiente de correlação de concordância, regressão múltipla, e o método Bland-Altman foram realizados. A Tanita apresentou um poder explicativo de 76 %, 72%, 95% e 73% da variabilidade total observada a partir do método de referência para a MG (kg), MG (%), MIGO e CMO, respectivamente. O coeficiente de correlação de concordância para a MIGO apresentou uma força de concordância substancial de 0.927. Observaram-selimites de concordância relativamente elevados na estimativa dos vários componentes corporais. Em conclusão, a Tanita MC-180 é uma alternativa válida especialmente na estimação da massa isenta de gordura e de osso, num grupo de atletas. Contudo, devido aos limites de concordância obtidos na determinação das vários componentes este equipamento apresenta uma validade limitada na estimação individual da composição corporal...

It is recognized the importance of assessing body composition in athletic populations.Therefore, it is necessary to use valid techniques for the determination of the main molecular components.Dual-energy X-ray absorptiometry (DXA) is a precise and valid method for assessing body composition.However, DXA is still not available at the clinical and field settings. Thus, it is important to use simpletechniques such as electrical bioimpedance analysis (BIA) but few studies validated this techniquespecifically multifrequency BIA in body composition assessment in athletes. Therefore, the aim of thisresearch is to test the validity of multifrequency BIA (Tanita, Model MC-180) in the determination ofbone mineral content (BMC), lean soft tissue (LST) and fat mass (FM) in athletes. A total of 79 eliteathletes (35 males) were assessed by DXA and BIA. Comparison of means, concordance coefficientcorrelation, multiple regression and Bland–Altman analysis were performed. Tanita explained 76%, 72%,95% and 73% of the total variability observed from the reference method for FM (kg), FM (%), LST andBMC, respectively. The concordance coefficient correlation for MIGO presented a substantial strength ofagreement of 0,927. However, relatively larger limits of agreement were found between BIA and DXA forthe several body components. These findings reveal that the Tanita MC-180 is a valid alternative,particularly in the estimation of LST, in a group of athletes. However, due to the limits of agreementobtained in the determination of the body components this equipment presents a more limited validity inthe estimation of individual body composition...

The 2014 Hepatology Society of the Philippines consensus statements on the management of chronic hepatitis B

Chorinic hepatitis B virus (CHB) infection is a serious problem that affects over 300 million people worldwide and is highly prevalent in the Asia Pacific region. In the Philippines an estimate 7.3 million Filipinos or 16.7% of adults are chronically infected with HBV, more than twice the average prevalence in the Western Pacific region. In view of the above, the Hepatology Society of the Philippines (HSP) embarked on the development of consensus statements on the management of hepatitis B with the primary objectives of standardizing approach to management, empowering other physicians involved in the management of hepatitis B and advancing treatment subsidy by the Philippine Health Insurance Corporation (PhilHealth). The local guidelines include screening and vaccination general management, indications for assessment of fibrosis in those who did not meet treatment criteria. indications for treatment, on-treatment and post-treatment monitoring and duration of antiviral treatment. Recommendations on the management of antiviral drug resistance, management of special populations including patients with concurrent HIV or hepatitis C infection, women of child-bearing age (pregnancy and breastfeeding), patients with decompensated liver disease, patients receiving immunosuppressive medications or chemotherapy and patients in the setting of hepatocellular carcinoma are also included. However, the guidelines did not include management for patients with liver and other solid organ transplantation, patients on renal replacement therapy, and children. The consensus statements will be amended accordingly as new therapies become available.

The 2014 Hepatology Society of the Philippines consensus statements on the diagnosis and treatment of hepatitis C

Hepatitis C virus (HCV) infection is a devastating disease that is increasingly being diagnosed among Filipinos, especially in at-risk populations. There are disease-specific nuances in the evaluation and management of this infection. Furthermore, advances in the field brought about by clinical research are rapidly moulding the way we evaluate and manage HCV patients. Evidently, consensus statements formulated by experts in the field are needed in order to serve as a guide to physicians who see HCV patients in the clinic. With this in mind, the Hepatology Society of the Philippines spearheaded the formation of these statements which aimed to address issues in the diagnosis, evaluation, treatment, and follow-up care of patients with HCV infection.Recommendations on the specific tests to perform in the evaluation of HCV patients before, during and after treatment, and first-line treatment of patients with acute and chronic HCV infection were provided. Treatment algorithms for chronic HCV infection, divided according to viral genotype, were also devised. We acknowledge the limitations brought about by the local inavailability of some drugs/treatment regimens in the local setting at the time of the formulation of these statements. As such, these statements will be revised as soon as new data become locally applicable.