ABSTRACT
Antecedente: la apendicitis aguda (AA) es la causa más común de urgencias quirúrgicas en el mundo; se estima un riesgo de padecerla durante la vida del 7% y un número de apendicetomías negativas entre 5 y 10%. Objetivo: evaluar la validez del Score AIR (respuesta inflamatoria por apendicitis) como herramienta diagnostica en pacientes con sospecha de apendicitis aguda. Metodología: se realizó un diseño epidemiológico, analítico, transversal de período, en pacientes que acudieron al Hospital Dr. Gustavo Domínguez Z., con sospecha de apendicitis aguda, entre julio y diciembre de 2015, mediante la aplicación del Score AIR más correlación con hallazgos histopatológicos. Los datos fueron ingresados en el paquete estadístico SPSS versión 21 para su análisis. Resultados: el presente estudio incluyó 210 pacientes con sospecha de apendicitis aguda, 108 mujeres y 102hombres con una edad promedio de 24.4 años; a la validación con los hallazgos histopatológicos el Score presentó una S:98.47%, E: 61.54%, VPP: 97.48%, VPN 72.72%, RV+:2.56, RV-:0.024; las muestras analizadas fueron fases necróticas con 48.57% seguidas de fases supurativas; puntajes altos de AIR se relacionaron con fases avanzadas de apendicitis con un rango de evolución entre 16 y 24 horas y cifras elevadas de leucocitosis, neutrofilia y PCR mostraron relación directa con las fases complicadas de apendicitis. Conclusión: el Score AIR sirve como herramienta de diagnóstico y pronóstico de apendicitis aguda.
Background: Acute appendicitis is the most common cause of surgical emergencies in the world, the risk of suffering during the life of 7%, is estimated a number of negative appendectomies from 5 to 10%. Objective: To evaluate the validity of AIR Score as diagnostic tool in patients with suspected acute appendicitis. Materials and Methods: A design analytical epidemiological transverse period was made in patients who attended to Dr. Gustavo Dominguez Z. Hospital with suspected acute appendicitis, between July and December 2015, applying Score AIR more correlation with histopathologic findings. The data were entered into SPSS version 21 for analysis. Results: This study included 210 patients with suspected acute appendicitis, 108 women and 102 men with an average age of 24.4 years; the Score validation with histopathological findings presented a S:98.47%, E: 61.54%, VPP:97.48%, VPN 72.72%, RV+:2.56, RV-:0.024;samples analyzed were necrotic phases in 48.57% followed with suppurative phases; high AIR scores were associated with advanced stages of appendicitis range hours of evolution between 16 and 24 hours and high levels of leukocytosis, neutrophilia and PCR showed direct relationship with the complicated stages of appendicitis. Conclusion: AIR Score serves as a tool for Diagnosis and Prognosis of Acute Appendicitis
Subject(s)
Humans , Male , Female , Adult , Appendicitis , C-Reactive Protein , Diagnosis , PrognosisABSTRACT
Se aborda de manera didáctica la temática sobre "medicina basada en pruebas evidencias" (MBE), planteado a través del "flujograma de 4 escalones": 1. Pregunta (paciente, intervención, control, desenlace); 2. Búsqueda (bibliotecas virtuales); 3. Valoración crítica o lectura crítica (jerarquía de la evidencia, grados de recomendación, variedades de estudios, los 10 criterios de valoración crítica); y 4. Aplicabilidad (validez, importancia, aplicación). De igual manera, se presentan los conceptos epidemiológicos estándares que se usan para cuantificar los riesgos y beneficios de un tratamiento experimental: años-paciente, índice de incidencia, riesgo relativo (RR), reducción del riesgo relativo (RRR), número de pacientes a tratar (NNT), reducción del riesgo absoluto (RRA), y en los estudios observacionales odds ratio (OR).
It's exposed in a didactic way the theme on "evidence based medicine" (EBM), raised through "4 steps flux diagram": 1. Question (patient, intervention, control, outcome); 2. Search (virtual libraries); 3. Critical evaluation (evidence rank, grades of recommendation, the 10 criteria of critical evaluation); and 4. Aplicability (validity, importance, application). Similarly, we present the standard epidemiological concepts used to quantify the risks and benefits of an experimental therapy: patient-years, incidence rate, relative risk (RR), relative risk reduction (RRR), number needed to treat (NNT), absolute risk reduction (ARR). In observational studies, the odds ratio (OR).
Subject(s)
Odds Ratio , Evidence-Based MedicineABSTRACT
Antecedente:la apendicitis aguda (AA) es la causa más común de emergencias quirúrgicas agudas que requieren intervención quirúrgica; se estima que el riesgo de padecerla durante la vida es del 7 %. Objetivo:analizar el papel de la proteína C reactiva (PCR), recuento de glóbulos blancos (CWB ) y porcentaje de neutrófilos (PN) para optimizar la calidad del diagnóstico de apendicitis aguda y compararlo con los hallazgos histopatológicos. Metodología:se realizó un estudio prospectivo en 210 pacientes con diagnóstico clínico de apendicitis aguda que fueron intervenidos quirúrgicamente en los que se realizó hemograma y PCR durante el período prequirúrgico. Las muestras obtenidas en el transquirúrgico fueron analizadas mediante histopatología. Se realizó una correlación diagnóstica entre los marcadores proinflamatorios y los hallazgos operatorios y patológicos. Resultados: en los pacientes con apendicitis aguda complicada se observó: conteo de leucocitos mayorde 15(×109/l), porcentaje de neutrófilos mayor de 85% y PCR mayor de 10 mg/L. Cifras elevadas de PCR, WBC y PN fueron observadas en 102 pacientes(48.57%), tomando en cuenta que los valores de PCR mayores de 21.48 mg/L se relacionaron con estadios avanzados de apendicitis. El histopatológico mostró que las apendicitis de tipo gangrenoso fue la más frecuente(51% eran mujeres y 48% hombres); el rango de edad fluctuó entre 15 y 80 años (media: 24,4). Conclusión:la medición de la PCR mejora la precisión diagnóstica de apendicitis aguda, sobre todo si se suman los valores de leucocitos y porcentaje de neutrófilos. La PCR y la neutrofilia son marcadores inflamatorios de gran sensibilidad diagnóstica y pronóstica de apendicitis aguda.
Background:Acute appendicitis (AA) is the most common acute surgical emergencies requiring surgery cause a risk of suffering during the life of an estimated 7%. Objective: To analyze the role of C-reactive protein (CRP), white blood count (WBC) and Neutrophil percentage (NP) in improving the accuracy of acute appendicitis diagnosis and to compare it with the histopathology findings. Methodology: A prospective study was conducted in 210 patients with clinical diagnosis of acute appendicitis who underwent surgery which underwent a blood test and PCR in the pre-surgical. The samples obtained in the transsurgical were analyzed by histopathology and subsequently correlated with the pro inflammatory markers was made. Results: In patients with appendicitis CRP and WBC were elevated in 126 patients (72.8%), while the NP and CRP were higher in 117 patients (67.6%) and CRP, WBC and PN were elevated in 116 patients (67.6%); taking into account that CRP values greater than 11.7 mg / dl and above 82% neutrophils correlated with advanced stages of appendicitis. Histopathological showed that gangrenous appendicitis were the most frequent type, 51% of patients were women and 48% were men, aged between 15 and 80 years with a mean of 24.4. Conclusion:Measuring PCR improves the diagnostic accuracy of acute appendicitis especially if the values of leukocytes and percentage of neutrophils are added. CRP and neutrophilic inflammatory markers are great sensitivity for the diagnosis and prognosis of acute appendicitis.
Subject(s)
Humans , Adolescent , Adult , Middle Aged , Aged , Appendicitis , C-Reactive Protein , Morphological and Microscopic Findings , Leukocytosis , NeutrophilsABSTRACT
The purpose of this ex vivo study was to determine, in "open" and "closed" systems, whether the design has an influence on the penetration length of sodium hypochlorite mixed with a radiopaque contrast medium, measured in millimeters, when delivered using positive pressure (PP) and using sonic (SI) or passive ultrasonic (PUI) activation. Sixty single-rooted teeth were divided into two groups: open and closed systems (n=30). Root canal shaping was performed to a working length of 17 mm. The samples were divided into three sub-groups (n=10) according to irrigant delivery and activation: PP, and SI or PUI activation. By using radiographs, penetration length was measured, and vapor lock was assessed. For the closed group, the penetration distance means were: PP 15.715 (±0.898) mm, SI 16.299 (±0.738) mm and PUI 16.813 (±0.465) mm, with vapor lock occurring in 53.3% of the specimens. In the open group, penetration to 17 mm occurred in 97.6% of the samples, and no vapor lock occurred. Irrigant penetration and distribution evaluation using open and closed systems provide significantly different results. For closed systems, PUI is the most effective in delivering the irrigant to working length, followed by SI.
O objetivo deste estudo in vivo foi determinar, para os sistemas "abertos" e "fechados", se o design tem influência na penetração, em milímetros, do hipoclorito de sódio misturado com um meio radiopaco quando empregado na ativação com pressão positiva (PP) e ativação sônica (SI) ou ultrassônica passiva (PUI). Sessenta dentes unirradiculares foram divididos em dois grupos: sistema aberto e sistema fechado (n=30). Os canais radiculares foram trabalhados até um comprimento de trabalho de 17 mm. Os grupos foram subdivididos em três subgrupos (n=10) de acordo com a solução irrigadora e a ativação: PP, e ativação SI ou PUI. Usando radiografias, a distância de penetração foi medida e avaliado o vapor contido. Para o grupo fechado, as distâncias médias de penetração foram PP 15,715 (±0,898) mm, SI 16,299 (±0,738) mm e PUI 16,813 (±0,465) mm e houve vapor contido em 53,3% das amostras. No grupo aberto, houve penetração de 17 mm em 97.6% das amostras, sem contenção de vapor. A penetração do irrigante e avaliação da distribuição usando sistemas aberto e fechado produziram resultados significativamente diferentes. Para os sistemas fechados, PUI é mais eficaz para levar o irrigante até preencher o comprimento de trabalho, seguido por SI.