ABSTRACT
BACKGROUND: Every year about 9 million fragility fractures (FF) occur worldwide and 80% of these are underdiagnosed or undertreated. Aiming to close the gap of diagnosis and treatment of osteoporosis, Fracture Liaison Services (FLS) were developed. AIM: To describe the implementation of the first FLS in Chile, its inclusion criteria, patient enrolment, treatment adherence and referrals during the first year. MATERIAL AND METHODS: A FLS was implemented at a health care network composed by two hospitals. The International Osteoporosis Foundation (IOF) guidelines were applied with a nurse practitioner as the coordinator. From May 2020 to April 2021 all patients diagnosed with a FF in the emergency rooms were invited to participate. Patients with pathological fractures and active cancer were excluded. Demographical data, fracture location, previous fractures, treatment and adherence, and mortality were recorded. RESULTS: From 443 patients with a diagnosis of FF, 177 patients (40%) accepted to participate. Their mean age was 74 ± 13 years and 84% (149) were female. Forty eight percent (84) had a lower extremity FF. Hip fractures were the most common (67). Ninety-five patients reported previous FF and 11,2% (20) had received anti-osteoporotic treatment. At four months of follow-up, 62% (50) had received vitamin D and calcium supplementation and 20% (16) of those patients with an indication of anti-osteoporotic drugs, had received them. CONCLUSIONS: The implementation of the FLS was successful with a 40% enrolment of patients, receiving certification by the IOF.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Osteoporosis/diagnosis , Osteoporosis/drug therapy , Osteoporotic Fractures/prevention & control , Vitamin D/therapeutic use , Bone Density Conservation Agents/therapeutic use , Secondary Prevention , Hip FracturesABSTRACT
Abstract PTH-independent hypercalcemia due to granulomatous disease is well-documented and sarcoidosis is the most characteristic disease, although there are others. We describe a case of sarcoid-like granulomatous myositis. An 87-year-old man was referred with tetraparesis and hypercalcemia (albumin-corrected calcium of 13.4 mg/dl) following a trip to the Caribbean. The evaluation showed a suppressed PTH, 25-hydroxy vitamin D of 7.5 ng/ml, 18F-FDG PET/CT showed markedly increased uptake in intercostal, back, shoulder, but tock and thigh muscles and a deltoid biopsy confirmed extensive granulomatous myositis. He was prescribed glucocorticoids which resulted in normalized plasma calcium levels and complete recovery from tetraparesis. Sarcoid-like granulomatous myositis should be incorporated into the differential diagnosis of PTH-independent hypercalcemia, especially in the absence of clinical features of sarcoidosis and with special emphasis on the use of 18F-FDG PET/CT to ensure a correct approach.
Resumen La hipercalcemia PTH-independiente asociada a enfermedades granulomatosas está bien documentada y la sarcoidosis es la enfermedad más característica, a pesar de que existen otras. Des cribimos un caso de miositis granulomatosa simil-sarcoidea. Un hombre de 87 años consultó por tetraparesia e hipercalcemia (calcio corregido por albúmina 13.4 mg/dl) luego de un viaje al Caribe. La evaluación mostró una PTH suprimida, 25-hidroxivitamina D 7.5 ng/ml, 18F-FDG PET/CT mostró marcado aumento de captación a nivel de musculatura intercostal, dorsal, deltoidea, glúteos y muslos. Una biopsia deltoidea confirmó una miositis granulomatosa extensa. Se prescribieron glucocorticoides, resultando en normalización del calcio plasmático y completa recuperación de la tetraparesia. La miositis granulomatosa simil-sarcoidea debe ser incorporada den tro del diagnóstico diferencial de la hipercalcemia PTH-independiente, especialmente en ausencia de hallazgos clínicos de sarcoidosis y con especial énfasis en el uso de 18F-FDG PET/CT para su correcta aproximación.
Subject(s)
Humans , Male , Aged, 80 and over , Sarcoidosis/complications , Sarcoidosis/diagnosis , Hypercalcemia/diagnosis , Hypercalcemia/etiology , Myositis/complications , Myositis/diagnosis , Positron Emission Tomography Computed Tomography , Granuloma/complications , Granuloma/diagnosisABSTRACT
Introducción: El Programa Nacional de Control de Aedes aegypti realiza actividades de rutina para controlar la trasmisión de arbovirosis en el país, pero siempre quedan poblaciones residuales del vector, que demandan de una vigilancia entomológica sostenible. Objetivo: Determinar la presencia de estadios inmaduros de Ae. aegypti en la provincia La Habana en el periodo 2013-2017. Métodos: Se realizó un análisis del número de criaderos larvales, detectados por los trabajadores del Programa Nacional de Control de Ae. aegypti, en La provincia La Habana entre 2013-2017. La frecuencia de los muestreos fue mensual y se siguió la metodología de encuestas del programa. Resultados: Al analizar el número de criaderos larvales por meses de los 15 municipios de provincia La Habana, se observó un incremento de estos en el periodo de junio a octubre en todos los años y un pico entre los meses de enero a marzo en los años 2014, 2016 y 2017. La incidencia de Ae. aegypti resultó homogénea al comparar las medias por año, excepto para el año 2015 en el cual se observó una disminución significativa en el número de criaderos en comparación solo con el año 2017. Conclusiones: A pesar del esfuerzo que realizan los trabajadores del programa, no se ha logrado una disminución significativa de criaderos de Ae. aegypti, lo que evidencia la necesidad de fortalecer los sistemas de vigilancia y mantener la sostenibilidad de las acciones para controlar de forma efectiva la trasmisión de arbovirosis en la provincia La Habana(AU)
Introduction: The National Aedes aegypti Control Program carries out routine activities to control the transmission of arbovirus infections in the country. However, there still exist residual populations of the vector which require sustainable entomological surveillance. Objective: Determine the presence of immature stage Ae. aegypti in the province of Havana in the period 2013-2017. Methods: An analysis was conducted of the number of larval breeding sites detected by workers from the National Ae. aegypti Control Program in the province of Havana in the period 2013-2017. Sampling was performed on a monthly basis following the surveying methodology of the Program. Results: Analysis of the data on larval breeding sites per month in the 15 municipalities of the province of Havana revealed an increase in their number in the June-October period of every year, and a peak between the months of January and March in the years 2014, 2016 and 2017. Comparison of mean values per year found that incidence of Ae. aegypti was homogeneous, except for the year 2015, when a significant decrease was observed in the number of breeding sites only with respect to the year 2017. Conclusions: Despite the effort made by workers from the Program, a significant reduction has not been achieved in the number of Ae. aegypti breeding sites, which is evidence of the need to strengthen the surveillance systems and maintain the sustainability of the actions performed to effectively control the transmission of arbovirus infections in the Havana province(AU)
Subject(s)
Pest Control, Biological/methods , Aedes/drug effects , Mosquito VectorsABSTRACT
Osteoporosis is a silent and frequent disease, which increases fracture risk. Approximately half of women and one of five men over 50 years old will suffer an osteoporotic fracture throughout their lives. Dual-energy x-ray absorptiometry (DXA) allows a real bone mineral density (BMD) measurement in different parts of the skeleton and is considered the "gold standard" for quantifying osteoporosis with high accuracy and precision. The Board of the Chilean Society of Endocrinology and Diabetes (SOCHED) required from the Bone Disease Study Group to develop a consensus about the "Correct use of bone densitometry in clinical practice in Chilean population". Therefore, we elaborated 25 questions which addressed key aspects about the indications for a DXA scan, and the details of how to perform and report this test. Since some of the evidence obtained was of low quality or inconclusive, we decided to create a multidisciplinary group of national experts in osteoporosis to develop a consensus in this subject. The group consisted of 22 physicians including endocrinologists, gynecologists, geriatricians, radiologists, rheumatologists and nuclear medicine specialists. Using the Delphi methodology to analyze previously agreed questions, we elaborated statements that were evaluated by the experts who expressed their degree of agreement. The final report of this consensus was approved by the SOCHED board.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Osteoporosis/diagnostic imaging , Absorptiometry, Photon/standards , Bone Density , Societies, Medical , Chile , Consensus , Endocrinologists/standardsABSTRACT
RESUMEN Introducción: El envejecimiento poblacional es un fenómeno demográfico de trascendencia mundial. Objetivo: Evaluar la calidad de la atención en salud y de enfermería que se brinda a los adultos mayores. Métodos: Investigación descriptiva longitudinal en el Hogar de Ancianos de Pinar del Río, durante 2013. Universo de 80 ancianos y 17 enfermeras relacionadas con la atención a los ancianos. Se evaluó la estructura, proceso y resultados. Para obtener la información se aplicó un instrumento diseñado por los autores y validado por expertos. El procesamiento de los datos se efectuó con frecuencias absolutas y porcentajes. Resultados: Existe buena cobertura de recursos humanos, siendo las asistentes para la atención de servicios de enfermería el más bajo porcentaje. El equipamiento técnico representó el 93,10 por ciento ocasionado por roturas, están los recursos materiales suficientes para atender a los adultos mayores. Existen procesos aplicados según morbilidad que aunque evaluados de aceptable se encuentran por debajo del 100 por ciento. Conclusión: La estructura no presenta insuficiencias en lo relativo a recursos humanos y materiales, lo que unido a la no presencia de problemas organizativos y de calidad de las historias clínicas, y en la instrumentación y aplicación del PAE, influyen positivamente en la calidad del proceso de atención; existe satisfacción con la calidad de la atención al adulto mayor(AU)
ABSTRACT Introduction: Population aging is a demographic phenomenon of global significance. Objective: To evaluate the quality of health care and nursing the elderly is provided. Methods: A longitudinal descriptive research in the Nursing Home of Pinar del Rio, in 2013. Universe 80 elderly and 17 nurses related to elderly care. the structure, process and results were evaluated. For information an instrument designed by the authors and validated by experts applied. The data processing was carried out with absolute frequencies and percentages. Results: There is good coverage of human resources, with the care assistants nursing the lowest percentage. The technical equipment accounted for 93.10 percent caused by breakage, material resources are sufficient to meet the elderly. There are processes applied according morbidity but acceptable are evaluated below 100 percent. Conclusion: the structure has no shortcomings in terms of human and material resources, which together with the non-presence of organizational problems and quality of medical records, and in the implementation and application of SAP positively influence the quality of the process of attention; There is satisfaction with the quality of care for the elderly(AU)
Subject(s)
Humans , Aged , Quality Assurance, Health Care/ethics , Population Dynamics , Nurses Improving Care for Health System Elders/organization & administration , Homes for the Aged/ethics , Nursing Care/methods , Epidemiology, Descriptive , Longitudinal StudiesABSTRACT
Pseudohypoparathyroidism (PHP) is a group of rare genetic disorders that share organ targeted resistance to the action of parathyroid hormone (PTH) as a common feature. Biochemically, they may present with hypocalcemia, hyperphosphatemia and elevated PTH. Some forms present with a specific phenotype: short stature, round facies, short neck, obesity, brachydactyly and subcutaneous calcifications, called Albrigth's Hereditary Osteodystrophy (AHO). This spectrum of disorders are caused by several alterations in the gene coding for the alpha subunit of the G protein (GNAS): an ubiquitous signaling protein that mediates the action of numerous hormones such as PTH, TSH, gonadotropins, and ACTH, among others. According to their inheritance with maternal or paternal imprinting, they may manifest in a diversity of clinical forms. Although most commonly diagnosed during childhood, PHP may manifest clinically during adolescence or early adulthood. We report two late presenting cases of pseudohypoparathyroidism. A 21-year-old female with biochemical abnormalities characteristic of pseudohypoparathyroidism who was misdiagnosed as epilepsy and a 13-year-old boy with the classic AHO phenotype but without alterations in phospho-calcium metabolism, compatible with pseudopseudohypoparathyrodism.
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Pseudohypoparathyroidism/diagnostic imaging , Time Factors , Tomography, X-Ray ComputedABSTRACT
Fundamento: la percepción de los profesores universitarios sobre su autoeficacia docente para abordar los cambios en la educación superior constituye un garante de la calidad de la docencia en este nivel de enseñanza. Objetivo: determinar las creencias de autoeficacia docente de los profesores de la Escuela de Bioanálisis de la Universidad de Carabobo, Sede Aragua, en dos períodos diferentes: 2011 y 2016. Métodos: se realizó un estudio mediante un diseño de campo de tipo descriptivo durante 2011 y 2016. Se utilizaron métodos teóricos para fundamentar y organizar los referentes sobre el tema; entre los métodos empíricos se aplicó el cuestionario escala de autoeficacia docente del profesor universitario. Resultados: se constató a través del diagnóstico realizado que el profesorado tiene alta percepción de su autoeficacia docente en ambos períodos analizados, en la frecuencia de uso de las distintas creencias de autoeficacia se encontraron resultados similares. Se destaca que la dimensión evaluación del aprendizaje y función docente fue la que más varió sus niveles, los cuales disminuyeron en 2016; lo que puso de manifiesto las carencias que subsisten en cuanto a la evaluación como proceso. Conclusiones: se determinó el nivel de creencias de autoeficacia docente de los profesores de la Escuela de Bioanálisis de la Universidad de Carabobo, Sede Aragua, Venezuela.
Background: the perception of the university professors on their teaching auto-efficiency to approach the changes in higher education constitutes a guaranty of teaching quality in this teaching level. Objective: to determine the auto-efficiency beliefs of professors at the Bio-analysis School of Carabobo University, Aragua site, in two different periods: 2011 and 2016. Methods: it was carried out a study by means of a descriptive field design during 2011 and 2016. Theoretical methods were used to support and organize the theoretical background on the topic; among the empiric methods the questionnaire scale of teaching auto-efficiency of the university professor was applied. Results: it was verified through the diagnosis carried out that the faculty has high perception of its teaching auto-efficiency in both analyzed periods, in the frequency of use of the different auto-efficiency beliefs similar results were found. It stands out that the learning assessment and teaching function dimension was the one that varied its levels the most, which diminished in 2016; what showed the deficiencies that subsist in the assessment as a process. Conclusions: the level of teaching auto-efficiency beliefs of the professors of the Bio-analysis School of the Carabobo University, Aragua site, Venezuela was determined.
Subject(s)
Teaching , Self Efficacy , Education, MedicalABSTRACT
Systemic mastocytosis (SM) is characterized by pathologic expansion and activation of mast cells. The main clinical manifestations of SM include skin involvement, gastrointestinal symptoms and anaphylaxis due to the release of its mediators. Thirty percent of pat ients with SM have a low bone mass and 20% fractures. At the same time, SM affects 10% of male patients with idiopathic osteoporosis. Measuring serum tryptase is essential for the screening of MS. We report two cases of SM with bone involvement. A 25-year- old woman with prior diagnosis of SM, based on skin involvement, flushing, high serum tryptase and compatible bone marrow (BM) biopsy and genetic study. Low bone mass was diagnosed and treatment was started with calcium and vitamin D plus oral bisphosphona tes with adequate response. A 47 years old man who presented with multiple osteoporotic vertebral fractures and low bone mass. Treatment with vitamin D and alendronate was started, but the patient developed new vertebral fractures. The study was extended w ith measurement of serum tryptase that was elevated. Diagnosis of SM was confirmed with BM biopsy and the patient was referred to hematology for specific care. These cases emphasize the importance of bone assessment in SM, as well as the need to rule out S M in patients with osteoporosis and no evident cause.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Osteoporosis/etiology , Mastocytosis, Systemic/complications , Osteoporosis/pathology , Biopsy , Urticaria Pigmentosa/etiology , Urticaria Pigmentosa/pathology , Risk Factors , Mastocytosis, Systemic/pathology , Densitometry , Fractures, Bone/etiology , Tryptases/bloodABSTRACT
En cirugía torácica la evaluación de un paciente con enfermedad pulmonar obstructiva crónica muy grave constituye un reto para el equipo quirúrgico, dado que los resultados espirométricos pueden contraindicar la intervención. Este reporte de caso describe los criterios seguidos para definir las intervenciones quirúrgicas; la estrategia asumida por el grupo de tórax; el manejo anestésico y la evolución posterior del paciente, al cual se le realizó cirugía reductora del volumen pulmonar, con abordaje unilateral inicial en lóbulo superior derecho y cirugía definitiva al mes, con toracotomía posterolateral izquierda ulterior para resecar un tumor de Pancoast. Se evidenció disminución de la disnea e incremento gradual en la capacidad física después de cada proceder quirúrgico. El volumen espiratorio forzado en el primer segundo con relación a los valores predichos mejoró, de 25 por ciento a 38 por ciento, después de la cirugía y 41 por ciento a los seis meses. El índice de Tiffeneau varió de 0,43 a 0,57 y 0,60 después de dos cirugías torácicas. Como única complicación el paciente presentó dolor torácico crónico para el cual mantiene tratamiento médico. Se concluye que la realización de cirugía reductora del volumen pulmonar es una alternativa a evaluar en pacientes que presenten neoplasia de pulmón y enfisema pulmonar bulloso. El enfoque multidisciplinario perioperatorio es un pilar fundamental para lograr resultados satisfactorios(AU)
In thoracic surgery, assessing a patient with very severe chronic obstructive pulmonary disease is a challenge for the surgical team, since spirometric results may contraindicate the intervention. This case report describes the criteria used to define surgical interventions, the strategy assumed by the thorax group, the anesthetic management and subsequent evolution of the patient, who underwent lung volume reduction surgery, with an initial unilateral approach in the right upper lobe and final surgery a month later, with posterior left posterolateral thoracotomy to resect a Pancoast tumor. There was a decrease in dyspnea and a gradual increase in physical capacity after each surgical procedure. The forced expiratory volume in the first second in relation to the predicted values improved from 25 percent to 38 percent after surgery, and 41 percent six months later. Tiffeneau index varied from 0.43 to 0.57 and 0.60 after two thoracic surgeries. As a single complication, the patient presented chronic chest pain for which he maintains medical treatment. It is concluded that the performance of pulmonary volume reduction surgery is an alternative to gauge in patients with lung cancer and bullous pulmonary emphysema. The multidisciplinary perioperative approach is a fundamental pillar to achieve satisfactory results(AU)
Subject(s)
Humans , Male , Middle Aged , Pancoast Syndrome/diagnosis , Pneumonectomy/methods , Thoracic Surgery/methods , Pulmonary Disease, Chronic Obstructive/etiologyABSTRACT
Introducción: el género Mycobacterium provoca infecciones pulmonares y extrapulmonares, dentro de estas últimas las localizaciones más frecuentes son; sistema nervioso linfático, central, circulatorio, genitourinario, gastrointestinal, tejido osteoarticular, y la piel. Objetivo: realizar las caracterizaciones etiológica de infecciones extra pulmonares producidas por el género Mycobacterium, destacar su importancia diagnóstica tanto en pacientes VIH- como VIH/sida. Métodos: se realiza un estudio descriptivo-prospectivo de corte transversal realizado de enero 2012 a mayo 2014. Durante este período se recibió un total de 825 muestras, 232 de pacientes VIH- y 593 de pacientes con VIH/sida. Las muestras que lo requerían se le aplicaron descontaminación cultivo, se utilizó el método de ácido sulfúrico al 4 por ciento, para el cultivo se usó el medio de Löwenstein-Jensen. Resultados: de las 825 muestras extra pulmonares en 29 (3,5 por ciento) se obtuvo cultivo positivo,14 (48,3 por ciento) con aislamiento de Mycobacterium tuberculosis (11 VIH+ y 3 VIH-), y 15 (51,7 por ciento) con aislamiento de otras especies micobacterianas (12 VIH+ y 3 VIH-), Mycobacterium avium-intracellulare, y Mycobacterium malmoense fueron las especies más aisladas. Conclusión: por todo lo anterior expuesto se recomienda mantener la vigilancia diagnóstica en este tipo de infección extra pulmonar, en especial en pacientes con sida, pues en muchos casos pueden tener fatales consecuencias por su diagnóstico tardío(AU)
Subject(s)
Humans , Lung Diseases, Fungal/diagnosis , Mycobacterium Infections/complications , Mycobacterium Infections/diagnosis , Specimen Handling/methods , Epidemiology, Descriptive , Cross-Sectional Studies , Prospective StudiesABSTRACT
Introducción: el cáncer de esófago es una de las neoplasias más agresivas del tracto digestivo. La cirugía es el método fundamental de tratamiento, con una alta frecuencia de complicaciones. Objetivo: caracterizar el cáncer de esófago en pacientes intervenidos quirúrgicamente. Método: se realizó un estudio descriptivo, longitudinal y con carácter prospectivo, en el Hospital "Dr. Carlos J. Finlay", entre enero de 2002 y diciembre de 2012. Universo de 62 pacientes. Se incluyeron pacientes con cáncer de esófago sometidos a resección. Las variables cualitativas se describieron estadísticamente mediante cifras frecuenciales y porcentuales. Resultados: el 82.3% perteneció al sexo masculino. El tercio inferior del esófago fue el más afectado en 42.2%. La variedad histológica que predominó fue el adenocarcioma en 59.7%. La mayoría de los pacientes se diagnosticaron en estadio IIb (41.9 %). La técnica quirúrgica más empleada fue la de Ivor Lewis (58.1%) y la sutura que más se realizó fue la mecánica. La estenosis de la anastomosis fue la complicación más frecuente en 12.9% y apareció solo cuando se realizó la sutura manual de la anastomosis. El tipo de sutura más utilizada fue la manual en 17.4%. La sobrevida postoperatoria fue de 17.7% a los 5 años. Conclusiones: predominaron los pacientes mayores de 60 años y pertenecientes al sexo masculino. La localización más frecuente fue en tercio inferior, con predominio del adenocarcinoma. La mayoría fueron diagnosticados en estadio IIb. La estenosis posquirúrgica fue la complicación más frecuente. La sobrevida postoperatoria fue aceptable.
Introduction: the esophagus cancer is one of the most aggressive neoplasias in the digestive tract. The surgery is the fundamental method of treatment, with a high frequency of complications. Objective: to characterize the esophagus cancer in patients intervened surgically. Method: it was done a descriptive, longitudinal study and of prospective character, in the "Dr. Carlos J. Finlay", between January of 2002 and December of 2012. The universe of the study was 62 patients. It was included patients with resection of esophagus cancer and in which the author of this paper participated on the operation. The qualitative variables were described statistically by means of frequencies and percentages. Results: 82.3% belonged to the masculine sex. The inferior third of the esophagus was the more affected in 42.2%. The histological variety that prevailed was the adenocarcioma in 59.7%. Most of the patients were diagnosed in IIb stage (41.9%). The surgical technique more carried out was Ivor Lewis (58.1%) and the type of suture was the mechanical. The stenosis of the anastomosis was the most frequent complication in 12.9% and it was appear only in cases with manual suture of the anastomosis. The type suture more used was the manual in the 17. 4%. The postoperative overlife was 17.7% at five years. Conclusions: most of patients were older than 60 years and men. The most frequent localization was in inferior third, with prevalence of the adenocarcinoma. Most was diagnosed in IIB stage. The postsurgical stenosis was the most frequent complication. The postoperative overlife was acceptable.
ABSTRACT
Introducción: la enseñanza municipalizada de la Cirugía General constituye un nuevo enfoque en la formación de los médicos generales integrales. Sin embargo, es una realidad las dificultades para lograr que los educandos adquieran las habilidades imprescindibles para un adecuado examen físico en la asignatura Cirugía General. Objetivo: valorar el mejor escenario docente para que los educandos adquieran la mayor cantidad posible de conocimientos propuestos en el programa de la asignatura Cirugía General. Material y Métodos: se realizó un estudio prospectivo y longitudinal con una muestra de 43 educandos de dos policlínicos de la Facultad "Finlay-Albarrán", cursos 2008-2009, 2009-2010 y 2010-2011, durante la rotación de Cirugía General en cuarto año de medicina. Entre las formas de educación en el trabajo estuvieron diferentes modalidades de consultas que fueron comparadas en cuanto a pacientes vistos y examinados. Al final de cada rotación se realizaron exámenes prácticos por estaciones. Resultados: con afección del cuello fueron atendidos en las consultas externas hospitalarias el 86.6 %. Con enfermedades de la mama y del tórax, fueron examinados en la consulta externa hospitalaria el 84,7%. Por enfermedades del abdomen, 163 fueron examinados por los educandos, mayoritariamente durante su estancia en la consulta hospitalaria. Enfermedades como tumores de partes blandas, proctológicas y angiológicas, sólo pudieron verse en las consultas externas hospitalarias. El 79.1 % de los 43 alumnos obtuvo calificación de cinco puntos; ocho obtuvieron calificación de cuatro (18,6 %); uno de tres (2,3 %). No hubo calificación de dos. Conclusiones: las consultas externas hospitalarias fueron los escenarios docentes que en mayor medida influyeron en el proceso de enseñanza-aprendizaje en la asignatura Cirugía General.
Introduction: the municipalized teaching of the General Surgery constitutes a new focus in the formation of the integral general doctors. However, it is a reality the difficulties to achieve that the students acquires the indispensable abilities for an appropriate physical exam in the subject General Surgery. Objective: to value about the best educational scenario in which medicine students acquires the more possible quantity of knowledge proposed in the program of the subject General Surgery. Material and Methods: it was done a prospective and longitudinal study that included to the students of fourth year of medicine of two clinics of the Faculty "Finlay-Albarrán ", in the courses 2008-2009, 2009-2010 and 2010-2011, during the rotation of General Surgery. Were excluded those students whose cards didn't gather the necessary conditions for the study, being a final sample of 43 students. Education activities were planned in the work during the stay. At the end of each rotation they do practical exams for stations which included elements of these consultations. Results: of the total of sick with affection of the neck were assisted in the hospital external clinic 86.6%. In relation with the illnesses of the breast and the thorax, were examined in the hospital external consultations, 84, 7% students. Of 260 sick persons assisted by illnesses of the abdomen, 163 were examined by the students, the most part during their stay in the hospital clinic. Other illnesses like tumors of soft parts, proctologics and angiologics entities, only could be seen in the hospital external clinics. 79.1% of the 43 students obtained qualification of five points; eight obtained qualification of four (18, 6%); one of three (2, 3%). there was not qualification of two. Conclusions: the hospital external clinic was the better educational scenarios for the formation of knowledge in medical students.
ABSTRACT
Introducción: el manejo terapéutico de la anquilosis temporomandibular ha incluido diferentes modalidades quirúrgicas. Objetivo: se realizó este estudio con el objetivo de caracterizar la muestra tratada de anquilosis socio-demográficamente, identificar causas asociadas a la anquilosis, clasificarlas topográficamente y según la clasificación de Shawhney, determinar los valores de máxima apertura bucal y excursiones mandibulares pretratamiento y evolutivos. Material y métodos: se ejecutó un estudio de casos en 14 pacientes del total de pacientes con anquilosis temporomandibular quienes acudieron a los servicios de Cirugía Maxilofacial de los Hospitales Universitarios «Miguel Enríquez¼ , "Salvador Allende" y la Facultad "Raúl González Sánchez", 2005-2012. Se realizó artrólisis e interposición de colgajo de fascia temporal. Se valoraron variables sociodemográficas, causas, tipos de anquilosis, máxima apertura bucal y excursiones mandibulares pretratamiento y evolutivas. Resultados: predominaron pacientes con edades entre 22-31 años (57,2%) y el sexo masculino (71,4%); la etiología traumática por fractura condilar (71,4%) y las anquilosis bilaterales (71,4%). El valor promedio de máxima apertura bucal pretratamiento fue de 8 milímetros, con un valor a los 12 meses de 39 milímetros. Conclusiones: la artroplastia interposicional con fascia temporal restituyó a los pacientes valores normales de excursiones mandibulares manteniéndose estables durante el año de observación.
Introduction: the therapeutic handling of the temporomandibular ankylosis has included different surgical modalities. Objective: this study was done with the objectives: to characterize the treated sample social- demographically, to identify associated causes, to classify ankylosis topographically and according to Shawhney´s Classification, to determine the values of maximum buccal opening and mandibular trajectories before and after treatment. Material and methods: a case series study was carried out in 14 patients of the total of patients with ankylosis diagnosis who attended to the Maxillofacial Departament, in the University Hospitals "Miguel Enríquez", "Salvador Allende" and Dentistry College "Raul González Sánchez", between 2002-2011. The sample was subjected to surgical treatment with arthrolysis, and interposition of temporalis fascial flap. The studied variables were: demographical, causes, types of ankylosis, maximum buccal opening and mandibular trajectories, accidents and complications. Results: patients among 22-31 years (57,2%), masculine sex (71,4%), traumatic causes with condylar fractures (71,4%), and bilateral ankylosis(71,4%). The average value of maximum buccal opening was before treatment (8 mms) and after 12 months (39 mms). Conclusions: the Interpositional arthroplasty with temporalis fascial flap restored the normal values of mandibular movements in the totality of the studied sample, with stable results.
ABSTRACT
La tuberculosis (TB) representa una de las principales complicaciones clínicas en personas inmunocomprometidas por virus de la inmunodeficiencia humana (VIH). Así, cuando las acciones diagnósticas y terapéuticas no son tempranas, el resultado puede llegar a ser letal. Metodología: Se llevó a cabo un estudio descriptivo y retrospectivo de los casos de coinfección TB/VIH en el período comprendido entre los años 2000 y 2010 en el municipio de Armenia. Se revisaron las fichas de notificación de ambos eventos (Sistema Nacional de Vigilancia en Salud Pública), actas de visitas domiciliarias, tarjetas individuales de tratamiento y certificados de defunción. Resultados: Se incluyeron 113 pacientes con diagnóstico confirmado de coinfección TB/VIH, lo que representa una prevalencia global de 6,8% en 10 años en Armenia. La edad promedio de los pacientes fue 34,3 años (11 a 68 años), y los más comprometidos fueron los del grupo de 14 a 34 años de sexo masculino (91% en formas extrapulmonares y 75% en pulmonares). La TB extrapulmonar o la miliar predominaron con un 50,4% (n = 57), sobre la TB pulmonar. Las formas extrapulmonares más comunes fueron: ganglionar 50% (n = 32), meníngea 19,3% (n = 11), miliar 8,8% (n = 5), pleural 7% (n = 4), peritoneal 7% (n = 4) y vertebral (mal de Pott) 1,8% (n = 1). En 8 casos hubo presentación mixta (pulmonar y extrapulmonar). La letalidad fue del 100% en pacientes infectados por VIH y asociados con cepas resistentes. Conclusiones: Los resultados de este estudio resaltan la importancia de implementar acciones colaborativas entre los programas de TB/VIH para mejorar el diagnóstico y reducir la mortalidad la diseminación de cepas resistentes.
Tuberculosis represents one of the top clinical complications in immunocompromised HIVinfected people. When diagnostic and therapeutic interventions are delayed, outcomes could be fatal due to imminent progress of this deadly combination. Methodology: We carried out a descriptive retrospective study from registered TB/HIV cases from 2000 to 2010 in the municipality of Armenia. Notification forms from both diseases TB and HIV (SIVIGILA), record of home visits, individual treatment cards and death certificates were used as data sources. Results: 113 patients were included with TB/HIV confirmed tests, which represents a global prevalence of 6.8% during 10 years in Armenia. The mean age among patients was 34.3 years (ranging from 11 to 68 years), and the group between 14 and 34 years and male (91% extrapulmonary and 75% pulmonary forms) was the most commonly involved. According to the disease presentation, extrapulmonary TB form (50.4%, n = 57) was more frequent than the pulmonary form. The frequency of extrapulmonary forms was: ganglionar, 50% (n = 32); meningeal, 19.3% (n = 11); miliar, 8.8% (n = 5); pleural, 7% (n = 4); peritoneal, 7% (n = 4), and Pott’s disease, 1.8% (n = 1). In eight cases both forms presented simultaneously (pulmonary and extrapulmonary). Lethality was 100% among VIH positive patients infected with resistant strains. Conclusions: Our results highlight the importance of implementing collaborative actions between TB and HIV programs to improve diagnosis and to reduce mortality and resistant strain dissemination.
Subject(s)
Humans , Male , Adolescent , Adult , Middle Aged , Tuberculosis , HIV Infections , HIV , Tuberculosis, Pulmonary , Retrospective Studies , Mortality , Colombia , Coinfection , Public Health SurveillanceABSTRACT
Las lesiones tumorales del esófago tienen un creciente impacto sobre la población cubana, pero su tratamiento quirúrgico es riesgoso, en particular por los fallos anastomóticos. Objetivo: proponer una modificación a la esófago-gastrectomía de Ivor Lewis mediante una anastomosis látero-lateral con engrapadora. Métodos: se realizaron 19 esófago-gastrectomías de Ivor Lewis con la modificación propuesta de la técnica anastomótica entre enero de 2004 y diciembre de 2010. Resultados: de los pacientes operados, dos presentaron tumores en tercio medio, once en tercio distal, y seis en la unión esófago-gástrica o estómago alto invadiendo el esófago distal. No ocurrieron muertes quirúrgicas. Las complicaciones mayores fueron: tromboembolismo pulmonar de ramas finas, fibrilación auricular, neumonía, atelectasia . En ningún caso ocurrió dehiscencia o estenosis de la anastomosis. La estadía hospitalaria promedio fue de 11 días (mínimo 8, máximo 17). Conclusiones: la anastomosis esófago-gástrica látero-lateral por engrapadora lineal permite reducir la incidencia de dehiscencia y estenosis, lo que evita complicaciones en la intervención quirúrgica esofágica...
"Esophageal tumoral lesions have a growing impact on the Cuban population. However, their surgical treatment is risky, particularly due to the occurrence of anastomotic failures. Objective: propose a modification of Ivor Lewis esophagogastrectomy by means of a side-to-side anastomosis with stapler. Methods: nineteen Ivor Lewis esophagogastrectomies were performed with the proposed modification of the anastomotic technique between January 2004 and December 2010. Results: of the patients operated on, two had tumors in the middle third, eleven in the distal third, and six in the esophagogastric junction or the upper stomach invading the distal esophagus. No surgical deaths occurred. The following were major complications: pulmonary thromboembolism of fine branch, atrial fibrillation, pneumonia and atelectasis. No case presented anastomotic dehiscence or stenosis. Average hospital stay was 11 days (minimum 8, maximum 17). Conclusions: side-to-side esophagogastric anastomosis with linear stapler reduces the incidence of dehiscence and stenosis, preventing the occurrence of complications in esophageal surgery...
ABSTRACT
Las meningoencefalitis por gérmenes oportunistas ocupan un lugar importante dentro de la patología neurológica del paciente sida, Treponema pallidum y Mycobacterium tuberculosis dentro de las bacterias, Cryptococcus neoformans dentro de los hongos, Toxoplasma gondii dentro de los protozoos y el Papovirus JC dentro de los virus, son de los gérmenes mas frecuentes dentro de cada grupo. También en los pacientes inmunodeprimidos en general y en particular en el paciente sida, se han encontrado con cierta frecuencia infecciones mixtas, precisamente por el gran deterioro en su barrera inmunológica. La meningitis tuberculosa (MTB) es la forma mas grave en que se manifiesta la tuberculosis extrapulmonar, pues la inespecificidad de sus síntomas, la lentitud en el diagnóstico etiológico y las severas secuelas neurológicas que puede producir sobre todo en este tipo de paciente, hacen de esta enfermedad un importante problema de salud, tanto en países desarrollados como en los que están en vías de desarrollo. En este estudio se describe el ¨primer caso¨ meningitis e infección diseminada por Mycobacterium tuberculosis en paciente cubano infectado por el virus de inmunodeficiencia humana
Meningoencephalitis due to opportunistic germs has an important place among the neurological diseases in AIDS patient. Treponema pallidum and Mycobacterium tuberculosis (bacteria), Cryptococcus neoformans (fungi), Toxoplasma gondii (protozoa), and Papovirus JC (virus) are the most frequently germs found in each group. Likewise, in immunodepressed patients in general and in HIV/AIDS patients in particular, mixed infections have been frequently found, basically as a consequence of the patients deteriorated immunological barrier. Tuberculosis meningitis (TBM) is the most severe form of presentation of the extrapulmonary tuberculosis. Its unspecific symptoms, the delay in the etiological diagnosis, and the severe neurological sequelae that can appear in this specific type of patient make of this disease an important health problem, in both developed and developing countries. This study describes the "first case" of meningitis and disseminated infection by Mycobacterium tuberculosis in a Cuban patient infected by the human immunodeficiency virus
Subject(s)
Humans , Male , Adult , Antitubercular Agents , HIV , Tuberculosis, Meningeal/complications , Tuberculosis, Meningeal/etiology , Mycobacterium tuberculosisABSTRACT
Background: The aim of the surgical treatment of primary hyperparathyroidism (PHPT) is to achieve its complete cure, evidenced by normal serum calcium in the postoperative period. Measurement of intraoperative serum parathormone (PTH) can be useful to predict complete cure of the disease. Aim: To assess the usefulness of intraoperative PTH measurement to predict complete cure of PHPT Material and methods: Serum PTH was measured to all patients operated for PHPT between 2003 and 2008, before and five and ten minutes after the excision of the parathyroid gland causing the disease. The criteria for complete cure were normal serum calcium at 24 hours and 6 months after surgery and the pathological confirmation of parathyroid gland excision. Results: Eighty-eight operated patients, aged 58±15 years (72 females) were studied. Sixty four percent were asymptomatic and their preoperative serum calcium was 11.6± 1.2 mg/dl. A normal serum calcium was achieved in 86 patients (98 percent) at 24 hours and 50 of 52 patients followed for six months (96 percent). The pathological study disclosed an adenoma in 69 (78 percent), and multiglandular disease in 16 (18 percent), a parathyroid cancer in one and a normal gland in one patient. Intraoperative PTH predicted early and definitive cure in 97 percent and 100 percent of patients with a single adenoma, respectively. Among patients with multiglandular disease, the predictive figures were 94 percent and 100 percent, respectively. Conclusions: Intraoperative PTH measurement efficiently predicts early and definitive surgical cure of PHPT.
Subject(s)
Female , Humans , Male , Middle Aged , Adenoma/surgery , Calcium/blood , Hyperparathyroidism/surgery , Parathyroid Hormone/blood , Parathyroid Neoplasms/surgery , Adenoma/complications , Biomarkers/blood , Hyperparathyroidism/blood , Hyperparathyroidism/etiology , Intraoperative Care , Parathyroid Neoplasms/complications , Parathyroidectomy , Predictive Value of Tests , Treatment OutcomeABSTRACT
Background: Thyroid nodules are common and associated to a low risk of malignancy. Their clinical assessment usually includes a fine neddle aspiration biopsy (FNAB). Aim To identify ultrasonographic characteristics associated to papillary thyroid carcinoma (PTC) and generate a score that predicts the risk of PTC. Material and methods: Retrospective review of all fine needle aspiration biopsies of the thyroid performed in a lapse of two years. Biopsies that were conclusive for PTC were selected and compared with an equal amount of randomly selected biopsies that disclosed a benign diagnosis. Results: One hundred twenty two biopsies of a total of 1,498 were conclusive for PTC. Univariate analysis showed associations with PTC for the presence of micro-calcifications (Odds ratio (OR) 49.2: 95 percent confidence intervals (CI) 18.7-140.9), solid predominance (OR 25.1; 95 percent CI 6-220), hypoechogenicity (OR 23.5, 95 percent CI 6.5-122.6), irregular borders (OR 17, 95 percent CI 7.2-42.9), lymph node involvement (OR 12.3, 95 percent CI2.7-112), central vascularization (OR 12.2, 95 percent CI 4.8-33.3), local invasion and hyperechogenicity (OR 0.2; CI95 percent CI 0.03-0.6). Multivariate analysis disclosed microcalcifications (OR 28.1; CI 95 percent 8.9-89), hypoechogenicity (OR 9.4; 95 percent CI 1.5-59.5) and irregular borders (OR 4.7; CI 95 percent 1.5-15) as the variables independently associated with the presence of PTC. The prevalence of PTC in the presence of the three variables was 97.6 percent (Likelihood ratio (LR) 45) and 5.4 percent in their absence (LR 0.06). Conclusions: This scale predicts the presence or absence of PTC using simple ultrasound characteristics.