Behavioural intention of hand hygiene compliance in an average Ecuadorian hospital

SUMMARY OBJECTIVE: This study aimed to characterize hand hygiene behavioural intention by hospital services clusters in a medium-sized hospital in an Ecuadorian city. METHODS: This is a cross-sectional study based on the World Health Organization Hand Hygiene Knowledge Questionnaire for Health-Care Workers. The responses on hand hygiene behavioural intention for the Five Moments for hand hygiene according to the World Health Organization were recorded in three categories: before patient contact, before and after sterile technique and management of body fluids, and after contact with the environment of the patient. The variables were the knowledge regarding the source of germs causing nosocomial infections, the optimal time to achieve disinfection with alcohol, hospital services clusters (clinical medicine, surgery, and therapeutic services), and history of previous formal hand hygiene training. The variables in each moment were analysed using a saturated log-linear model. RESULTS: The average age of participants was 34 years (Q1 32.1-Q3 36.4). Of them, 62% belonged to the clinic cluster and 87.6% had previous formal hand hygiene training. The incorrect response rates for before and after sterile technique and management of body fluids, before patient contact, and after contact with the environment of the patient were 30.2, 88.4, and 99.2%, respectively. In before patient contact, the incorrect responses for optimal time depended on the department (worse surgery cluster situation), and in before and after sterile technique and management of body fluids and after contact with the environment of the patient, the incorrect responses for source of germs depended on the previous formal hand hygiene training and the department (worse surgery and clinic clusters). CONCLUSION: The incorrect answer related to hand hygiene behavioural intention was high compared to other reports, and the worse situation was found in after contact with the environment of the patient and before patient contact. These data suggest the need of strengthening permanently the hand hygiene programme.

Anestesia total intravenosa en pacientes con síndrome oclusivo intestinal / Total Intravenous anesthesia in patients with intestinal occlusive syndrome

Introducción: La anestesia total intravenosa es una técnica de anestesia general en la que se administran los fármacos exclusivamente por vía endovenosa, en ausencia de agentes inhalatorios. Objetivo: Describir los resultados que se observaron en el empleo de la anestesia total intravenosa en los pacientes con diagnóstico de síndrome oclusivo para tratamiento quirúrgico. Métodos: Se desarrolló una investigación observacional descriptiva, longitudinal en el Hospital General Docente "Abel Santamaría Cuadrado", de enero de 2014 a enero de 2017. De un universo de 417 pacientes, se seleccionó una muestra de 205 casos que cumplieron con los criterios de inclusión y exclusión. Las variables fueron presión arterial media, frecuencia cardíaca, saturación de oxígeno, complicaciones, tiempo de recuperación, nivel de sedación y respuesta analgésica. Resultados: El 95,61 por ciento de los casos se mantuvieron normotensos y el 96,10 por ciento con frecuencia cardíaca normal. Se constataron signos clínicos de superficialidad anestésica en el 1,46 por ciento de los individuos. La mayoría de los casos se recuperaron entre 10 y 20 min para un 92,19 por ciento. Se observó un nivel de sedación insuficiente en 189 pacientes (92,19 por ciento). No se evidenciaron complicaciones posoperatorias en el 96,58 por ciento. La respuesta analgésica fue adecuada en el 95,12 por ciento de los casos. Conclusiones: La aplicación de la anestesia total intravenosa para cirugía por oclusión intestinal demostró resultados satisfactorios como método anestésico(AU)

Introduction: Total intravenous anesthesia is a general anesthesia technique in which drugs are administered exclusively intravenously, in the absence of inhalation agents. Objective: To describe the outcomes observed in the use of total intravenous anesthesia in patients diagnosed with occlusive syndrome for surgical treatment. Methods: A descriptive, longitudinal and observational research was carried out in Abel Santamaría Cuadrado General Teaching Hospital of Pinar del Río, Cuba, from January 2014 to January 2017. From a universe of 417 patients, a sample of 205 cases that met the inclusion and exclusion criteria was selected. The variables were mean arterial pressure, heart rate, oxygen saturation, complications, recovery time, level of sedation, and analgesic response. Results: 95.61 percent of the cases remained normotensive and 96.10 percent kept a normal heart rate. Clinical signs of sedation were found in 1.46 percent of the individuals. Most of the cases recovered between 10 and 20 minutes, accounting for 92.19 percent. Insufficient sedation was observed in 189 patients (92.19 percent). No postoperative complications were observed in 96.58 %. Analgesic response was adequate in 95.12 percent of cases. Conclusions: The application of total intravenous anesthesia for intestinal occlusion surgery showed satisfactory outcomes as an anesthetic method(AU)

Anestesia total intravenosa en la cirugía oncológica de mama / Total intravenous anesthesia in oncologist breast surgery

Introducción: El cáncer es la principal causa de muerte. Cada año se diagnostican millones de mujeres con cáncer de mama que necesitan tratamiento quirúrgico, para lo cual la anestesia total intravenosa parece ser una excelente opción. Objetivo: Describir los resultados de la aplicación de la anestesia total intravenosa en las pacientes a las que se les efectuó cirugía oncológica de mama. Métodos: Se realizó un estudio observacional, descriptivo, longitudinal, prospectivo, en el Servicio de Anestesiología del Hospital General Docente "Abel Santamaría Cuadrado" en el período comprendido entre enero de 2013 y enero de 2015. Se estudió una población accesible de 111 pacientes seleccionados mediante criterios de inclusión y exclusión. Para el análisis estadístico se utilizaron distribuciones de frecuencias, cálculo de medidas de tendencia central y de dispersión. Algunas de las variables fueron tensión arterial, frecuencia cardíaca, saturación de oxígeno, complicaciones, tiempo de recuperación, nivel de sedación, respuesta analgésica. Resultados: Se logró gran estabilidad hemodinámica en más del 95 por ciento de las pacientes. Se detectó superficialidad anestésica en 1,80 por ciento de los casos. El 92,80 por ciento de los casos se recuperaron entre 10 y 20 min. Se presentó sedación adecuada en 106 pacientes. Las principales complicaciones fueron las náuseas y los vómitos en 9,01 por ciento. Existió una adecuada respuesta analgésica en 93,69 por ciento de los casos. Conclusiones: La aplicación de la anestesia total intravenosa para cirugía oncológica de mama arrojó resultados muy satisfactorios como método anestésico(AU)

Introduction: Cancer is the leading cause of death worldwide. Every year millions of women are diagnosed with breast cancer and they need surgical treatment, for which total intravenous anesthesia seems to be an excellent option. Objective: Describe the results of the application of total intravenous anesthesia in patients undergoing oncological breast surgery. Methods: An observational, descriptive, longitudinal, prospective study was conducted in the Anesthesiology Service of "Abel Santamaría Cuadrado" Hospital in the period between January 2013 and January 2015. An accessible population of 111 patients selected using inclusion and exclusion criteria was studied. For the statistical analysis, frequency distributions, calculation of measures of central tendency and dispersion were used. Some of the variables were blood pressure, heart rate, oxygen saturation, complications, recovery time, level of sedation, analgesic response. Results: High hemodynamic stability was achieved in more than 95 percent of the patients. Anesthetic superficiality was detected in 1.80 percent of cases. 92.80 percent of the cases recovered after 10 to 20 minutes. Adequate sedation was present in 106 patients. The main complications were nausea and vomiting in 9.01 percent There was an adequate analgesic response in 93.69 percent of the cases. Conclusions: The application of total intravenous anesthesia for oncological breast surgery yielded very satisfactory results as an anesthetic method(AU)

Remote conferences in parasitology and entomology during the pandemic: eliminate or maintain in a post-pandemic world? That is the dilemma!

The COVID-19 pandemic brought enormous challenges for health, scientists and academic world two years ago. Social isolation and the inabilities of face-to-face activities generated the emergence of many educational and scientific initiatives. Remote activities gave information and brought company and affection to people which allowed students and professionals from different parts of the world to integrate. In this report we are showing the experience from three initiatives in South America of scientific dissemination in infectious diseases. We discuss the scope of having a permanent practice for access and integration in science using remote communication, which can give great benefits in unequal societies.

Propofol como agente inductor anestésico en la cesárea electiva / Propofol as an anesthetic inducing agent in elective caesarean section

Introducción: La decisión de realizar la inducción anestésica con propofol o tiopental en la paciente obstétrica para operación cesárea es un tema controvertido, con resultados contradictorios entre las investigaciones. Objetivo: Presentar los resultados que se publicaron en la literatura nacional e internacional sobre el uso del propofol como agente anestésico en la inducción de la anestesia general en la operación cesárea electiva. Métodos: Se realizó una revisión no sistemática de la bibliografía basada en artículos que se publicaron en bases de datos indexadas en Infomed como Hinari, Ebsco, Scielo, Pubmed, Cubmed, Cocrhane; en idioma español e inglés, durante los últimos diez años, utilizando palabras clave como: (inducción anestésica OR anestesia general OR) AND (propofol OR) AND (operación cesárea OR cesárea OR). Desarrollo: Se destacaron artículos donde se comparan los resultados del uso del propofol contra el tiopental y otros barbitúricos durante la inducción anestésica en cuanto a variables hemodinámicas, efectos adversos, calidad anestésica y desenlaces neonatales como el estado físico, capacidad de adaptación neurológica y gases arteriales. Conclusiones: El propofol es el agente más común para la inducción anestésica en la paciente obstétrica que necesita cesárea electiva. Este presenta resultados adecuados maternos y fetales, y menor incidencia de efectos adversos(AU)

Introduction: The decision to perform anesthetic induction with propofol or thiopental in obstetric patients for cesarean section is a controversial issue, with contradictory oncomes among investigations. Objective: To present the results published in the national and international literature about the use of propofol as an anesthetic agent in the induction of general anesthesia in elective cesarean section. Methods: A nonsystematic review of the bibliography was carried out, with a focus on articles in Spanish and English published, during the last ten years, in databases indexed in Infomed, such as Hinari, Ebsco, Scielo, Pubmed, Cubmed, Cocrhane, using keywords such as (inducción anestésica [anesthetic induction] OR anestesia general [general anesthesia] OR) AND (propofol OR) AND (operación cesárea [cesarean section] OR cesárea [cesarean] OR). Development: Articles were highlighted if they compared the results of propofol usage against thiopental and other barbiturates during anesthetic induction in terms of hemodynamic variables, adverse effects, anesthetic quality and neonatal outcomes such as physical state, neurological adaptation capacity and arterial gases. Conclusions: Propofol is the commonest agent for anesthetic induction in obstetric patients requiring elective caesarean section. This presents adequate maternal and fetal outcomes, as well as a lower incidence of adverse effects(AU)

Plasma rico en plaqueta en el tratamiento de la enfermedad degenerativa discal / Platelet-rich plasma in the treatment of degenerative disc disease

Introducción: La enfermedad degenerativa discal es una entidad frecuente y uno de los principales motivos de consulta. Genera altas tasas de discapacidad, años útiles perdidos, así como altos costos económicos por asistencia médica y grandes pérdidas monetarias. Su tratamiento es generalmente conservador, aunque en la actualidad se incluyen terapias biológicas novedosas. Objetivo: Describir las principales propiedades biológicas que hacen del plasma rico en plaquetas una terapéutica efectiva para la enfermedad degenerativa discal. Métodos: Se realizó una revisión no sistemática de la bibliografía basada en artículos que se publicaron en bases de datos indexadas en Infomed como Hinari, Ebsco, Scielo, Pubmed, Cubmed, Cocrhane, Scopus, LILACS; en idioma español, inglés y portugués, durante los últimos diez años. Desarrollo: Se expusieron características clínico epidemiológicas de la enfermedad degenerativa discal, así como las propiedades biológicas que le permiten al plasma rico en plaqueta tener una función activa en la regeneración del disco intervertebral o el retraso de la cascada de degradación de este. Se resaltan los principales estudios de acuerdo a la vía de administración del plasma rico en plaquetas y sus resultados. Conclusiones: De acuerdo con lo publicado por los autores, el plasma rico en plaquetas es una alternativa efectiva en el tratamiento de la enfermedad degenerativa discal por la producción de factores derivados de las plaquetas, que intervienen en la degeneración del disco intervertebral, siendo la vía intradiscal la que más se emplea(AU)

Introduction: Degenerative disc disease is a frequent condition and one of the main reasons to attend the consultation. It generates high rates of disability, useful years lost, as well as high economic costs for medical assistance and large monetary losses. Its treatment is generally conservative, although novel biological therapies are currently included. Objective: To describe the main biological properties that make platelet-rich plasma an effective therapy against degenerative disc disease. Methods: A nonsystematic review of the bibliography was carried out based on articles published, during the last ten years, in databases indexed in Infomed, such as Hinari, Ebsco, Scielo, Pubmed, Cubmed, Cocrhane, Scopus, and LILACS, in Spanish, English and Portuguese. Development: Clinical-epidemiological characteristics of degenerative disc disease were presented, as well as the biological properties that allow platelet-rich plasma to have an active function in the regeneration of the intervertebral disc or the delay of its degradation cascade. The main studies are highlighted, according to the route of administration of platelet-rich plasma and their results. Conclusions: According to what has been published by authors, platelet-rich plasma is an effective alternative in the treatment of degenerative disc disease, due to the production of factors derived from platelets, which intervene in the degeneration of the intervertebral disc, being the intradiscal pathway the most used(AU)

Tratamiento mínimamente invasivo para fracturas toracolumbares / Minimally invasive treatment for traumatic thoracolumbar fractures

Introducción: Las técnicas mínimamente invasivas para tratar las fracturas toracolumbares se han desarrollado con el objetivo de reducir, al mínimo, la morbilidad perioperatoria. El objetivo primario de este estudio fue evaluar los resultados clínicos y radio-lógicos de una serie de pacientes con diagnóstico de fractura toracolumbar por causa traumática tratados con procedimientos mínimamente invasivos. materiales y métodos: Se llevó a cabo un análisis retrospectivo de los datos demográficos, radiológicos pre y posoperatorios, y funcionales posoperatorios mediante el índice de Oswestry y la escala analógica visual para dolor, en una serie de pacientes que cumplían los criterios de inclusión. Se registraron las complicaciones y la estancia hospitalaria. Resultados: Se analizaron 15 pacientes (10 hombres) con una edad promedio de 59 años y un seguimiento promedio de 32.9 meses. Los pacientes tenían un dolor promedio posoperatorio de 2/10 y un valor promedio del índice de Oswestry de 14/100. El análisis radiológico mostró un valor promedio preoperatorio de cifosis de 16°, que se corrigió a 10° (p = 0,01). La altura promedio de la vértebra comprometida fue de 18 mm en el preoperatorio y de 21 mm en el último seguimiento (p = 0,02).Hubo tres complicaciones (20%) en tres pacientes. La estancia hospitalaria promedio fue de 9 días. Tres pacientes fueron internados nuevamente dentro de los 90 días de la cirugía. Conclusión: El tratamiento de las fracturas toracolumbares por causa traumática mediante técnicas mínimamente invasivas fue un procedimiento seguro y logró buenos resultados clínicos y radiológicos en el seguimiento a mediano plazo. Nivel de Evidencia: IV

Introduction: Minimally invasive techniques for the treatment of thoracolumbar fractures have been developed to reduce peri-operative morbidity. The primary purpose of this work is to evaluate the clinical and radiological outcomes in a group of patients with traumatic thoracolumbar fracture treated with minimally invasive procedures. materials and methods: Taking a group of patients within the inclusion criteria, we retrospectively analyzed demographic data, along with pre and postoperative radiographic measurements and postoperative functional scores, using the Oswestry Disability Index and the Visual Analog Scale for pain. We recorded the complications and the hospital stay. Results: 15 patients were analyzed (10 of them were male). The average age was 59 years, and the average follow-up was 32.9 months. The patients presented an average postoperative pain score of 2/10 and an average Oswestry Disability Index score of 14/100. The radiographic analysis showed an average preoperative segmental kyphosis value of 16° that was corrected to 10° (p = 0.01). The preoperative average height for compromised vertebrae was 18 mm, with an average height of 21 mm at the last follow-up (p = 0.02). There were 3 complications (20%) in 3 patients. Hospital stay was 9 days long on average. Three patients were rehospitalized within 90 days after surgery. Conclusion: The treatment of traumatic thoracolumbar fractures by minimally invasive techniques was a safe procedure, with good clinical and radiological results in the medium term of follow-up. Level of Evidence: IV

Peer victimization at school and associated factors in Campeche, Mexico / Victimización por pares en la escuela y factores asociados en Campeche, México

Abstract Objectives: to estimate the prevalence ofpeer victimization (VI-P) and to identify factors associated to it. Methods: a cross sectional study based on a state-representativesample; 2555 students from primary and secondary schools of Campeche, in the academic year 2015-2016 participated. They were interviewed face to face. VI-P was analyzed by sex, age and various school-related aspects with prevalence rate and 95% confidence interval. The analysis of interactions among the studied factors was carried out using a hierarchical log-lineal model. With the significant terms,a multiviarite analysis using a logistic model was performed. Based on this model, maximum and minimum predictive values for VI-P were calculated by odds inverse transformation. Results: the global prevalence of VI-P was 60.4% (CI95%= 58.6-62.3). The prevalence of violence physical, psycho-emotional, patrimonial, and sexual, were 28.8, 52.9, 26.5, and 8.7%, respectively. Students in the first year, who were male, had classes scheduled in the evening, attended a public school and resided in a municipality of high/highest margination index, had the highest probability (75.3%) of suffering VI-P. Conclusions: given the high levels of VI-P found, and its possible effects, it is necessary implement truly effective measures to prevent it.

Resumen Objetivos: estimar la prevalencia de la victimización por pares (VI-P) e identificar factores asociados. Métodos: se realizó un estudio transversal en una muestra representativa de las escuelas del estado de Campeche; se entrevistaron 2555 estudiantes de primaria y secundaria del ciclo escolar 2015-2016. Los alumnos fueron entrevistados cara a cara. Se analizó la tasa de prevalencia de VI-P según sexo, edad y varios aspectos relacionados con la escuela, con un intervalo de confianza de 95%. Las interacciones entre los factores estudiados se analizaron mediante un modelo jerárquico log-linear saturado. A partir de los términos que resultaron significativos, se realizó un análisis multivariado mediante un modelo logístico. Con base en este modelo, se calcularon los valores predictivos máximo y mínimo para la VI-P mediante la transformación inversa de probabilidades. Resultados: la prevalencia global de VI-P fue 60.4% (CI95%= 58.6-62.3). Las prevalencias de violencia física, psicoemocional, patrimonial y sexual fueron: 28.8, 52.9, 26.5 y 8.7%, respectivamente. Los estudiantes de primer grado, hombres, del turno vespertino, que asisten a una escuela pública, y de municipios con alto/muy alto índice de marginación, tuvieron la mayor prevalencia de VI-P (75.3%). Conclusiones: dados los altos niveles de VI-P encontrados, y considerando sus posibles efectos, es necesario implementar medidas realmente efectivas para prevenir este tipo de violencia.

Analgesia subaracnoidea en el trabajo de parto: bupivacaína/fentanilo vs. petidina / Subarachnoid analgesia in labor: bupivacaine/fentanyl vs pethidine

Introducción: La analgesia subaracnoidea es una alternativa para el trabajo de parto por su seguridad y adecuada relación riesgo/beneficio. Objetivo: Evaluar la efectividad de la analgesia durante el trabajo de parto con la comparación de dos métodos analgésicos. Método: Se realizó un estudio cuasiexperimental, longitudinal y prospectivo en 92 gestantes que se atendieron en el Hospital General Docente Abel Santamaría Cuadrado durante el período entre enero de 2014 y enero de 2017. Las pacientes se dividieron en dos grupos de 46 cada uno, al azar, por orden de llegada a la unidad quirúrgica. El grupo A, bupivacaína al 0,5 por ciento, en dosis de 2 mg y fentanilo en dosis de 25 mcg; y grupo B en el que se utilizó petidina en dosis de 25 mg, en todos los casos por vía intratecal. Las variables analizadas fueron: tensión arterial media, frecuencia cardíaca media, saturación parcial de oxígeno, tiempo de inicio de la analgesia, calidad analgésica, efectos adversos y nivel de satisfacción de las pacientes. Se empleó el análisis descriptivo y la diferencia de proporciones. Resultados: El grupo A mantuvo una TAM entre 84 y 88 mmHg, (Z= 6,0 significativa); FC media entre 80 y 88 lat/min, (Z= 1,94 no significativa); SpO2 con una media de 99,2 por ciento. En 46,74 por ciento (43 casos) el tiempo de inicio de la analgesia fue corto (Z= 8,47), siendo Buena en 100 por ciento de los casos (Z= 6,89 significativa), con recién nacido vigoroso en 100 por ciento (Z= 10,25 significativa). La evolución fue satisfactoria en 48,19 por ciento de las pacientes. Presentaron prurito 8,69 por ciento. En el grupo B hubo hipertensión arterial en 2,17 por ciento de los casos, con menos estabilidad de la FC, tiempos mayores de inicio de trabajo de parto en 12,96 por ciento y fue Buena en 40,22 por ciento. Estas pacientes mostraron menos satisfacción (41,30 por ciento). Conclusiones: La administración subaracnoidea de fentanilo/bupivacaína fue más efectiva que la petidina para la analgesia durante el trabajo de parto(AU)

Introduction: Subarachnoid analgesia is an alternative for labor due to its safety and suitable risk-benefit relationship. Objective: To evaluate the effectiveness of analgesia during labor with the comparison of two analgesic methods. Method: A quasiexperimental, longitudinal and prospective study was carried out in 92 pregnant women who attended Abel Santamaría Cuadrado General Teaching Hospital during the period between January 2014 and January 2017. The patients were divided into two groups of 46 each, randomly assigned, in order of arrival to the surgical unit. Group A was treated with intrathecal administration of bupivacaine 0.5 percent, in a dose of 2 mg, and fentanyl in a dose of 25 mcg; and group B was treated with intrathecal administration of pethidine, in a dose of 25 mg. The variables analyzed were mean arterial blood pressure, mean heart rate, partial oxygen saturation, time of onset of analgesia, analgesic quality, adverse effects and level of patient satisfaction. The descriptive analysis and the difference in proportions were used. Results: Group A maintained a mean arterial blood pressure between 84 and 88 mmHg, (Z=6.0 significant); heart rate averages between 80 and 88 beats per minute, (Z=1.94 not significant); partial oxygen saturation with an average of 99.2 percent. In 46.74 percent (43 cases) the time of onset of analgesia was short (Z=8.47), being good in 100 percent of the cases (Z=6.89 significant), with vigorous newborn in 100 percent (Z=10.25 significant). The evolution was satisfactory in 48.19 percent of the patients. They presented pruritus 8.69 percent. In group B, there was arterial hypertension in 2.17 percent of the cases, with less stability of the heart rate, greater times of labor beginning in 12.96 percent and it was good in 40.22 percent. These patients showed less satisfaction (41.30 percent). Conclusions: Subarachnoid administration of fentanyl/bupivacaine was more effective than pethidine for analgesia during labor(AU)

Ecuadorian infant mortality linked to socioeconomic factors during the last 30 years / Mortalidad infantil en Ecuador asociada a factores socioeconómicos durante los últimos 30 años

Abstract Objectives: to analyze the difference among geographical units and the evolution of infant mortality rate (IMR) based on Ecuadorian censuses (1990-2001-2010). Methods: artificial Neural Network analyzed the impact of sociodemographic factors over the variability of IMR. Poisson regression analyzed the variation of the standardized IMR (sIMR). Results: the decrease in the national IMR was 63.8%; however, 42.8% provinces showed an increase in 2001-2010. The variability was explained mainly by illiteracy decrease. The adjusted RR between provincial sIMR with illiteracy and poverty revealed a trend towards the unit. Conclusions: the variation of IMR reflects a complex interaction of the sociodemographic factors.

Resumen Objetivos: analizar las diferencias de la evolución de la tasa de mortalidad infantil (TMI) entre unidades geográficas basada en los censos ecuatorianos (1990-2001-2010). Métodos: la red neuronal artificial analizó el impacto de los factores sociodemográficos sobre la variabilidad de la TMI. La regresión de Poisson analizó la cuantificación de la variación de la TMI estandarizada (TMIs). Resultados: la disminución en la TMI nacional fue de 63.8%; sin embargo, 42.8% de las provincias mostraron un incremento en el periodo 2001-2010. La variabilidad se explica principalmente por la disminución del analfabetismo. El RR ajustado entre TMIs provincial con analfabetismo y pobreza reveló una tendencia hacia la unidad. Conclusiones: la variación de la TMI refleja una interacción compleja de los factores sociodemográficos estudiados.

Conducta perioperatoria de la terapia antitrombótica / Perioperative behavior of antithrombotic therapy

Introducción: El envejecimiento poblacional en Cuba ha incrementado la presencia de enfermos que requieren tratamiento con anticoagulantes y antiagregantes plaquetarios que necesitan una intervención quirúrgica. Objetivo: Exponer los aspectos fundamentales de la conducta perioperatoria en pacientes con terapia antitrombótica, tratamiento puente y anticoagulación ante diversos procederes e intervenciones quirúrgicas electivas y de urgencias, al aplicar la variabilidad interindividual en cada tratamiento. Desarrollo: Los anestesiólogos desempeñan una función protagónica en el tratamiento anestésico de estos pacientes. Son los máximos responsables de los cambios a efectuar en la conducta farmacológica, así como confeccionar estrategias de tratamiento con vista a establecer un equilibrio entre el riesgo trombótico y hemorrágico. Conclusiones: Los anestesiólogos deben cumplir los protocolos de tromboprofilaxis en el perioperatorio, para evitar la ocurrencia de enfermedades tromboembólicas, al realizar una evaluación individualizada, al tener en cuenta las propiedades farmacológicas de los anticoagulantes y de los antiagregantes plaquetarios en cirugía electiva y de urgencia(AU)

Introduction: Population aging in Cuba has increased the presence of patients who require surgical interventions and treatment with anticoagulants and antiplatelet agents. Objective: To present the fundamental aspects of perioperative behavior in patients with antithrombotic therapy, bridging and anticoagulation therapy in response to various procedures and elective and emergency surgeries, when applying interindividual variability in each treatment. Development: Anesthesiologists play a leading role in the anesthetic treatment of these patients. They are the main responsible for the changes to be made in the pharmacological behavior, as well as to formulate treatment strategies with a view to establishing a balance between thrombotic and hemorrhagic risks. Conclusions: Anesthesiologists must comply with the protocols of thromboprophylaxis in the perioperative period to avoid the occurrence of thromboembolic diseases when performing an individualized evaluation. They must also take into account the pharmacological properties of anticoagulants and antiplatelet agents in elective and emergency surgeries(AU)

Analgesia peridural torácica para el alivio del dolor posoperatorio en la cirugía torácica / Thoracic epidural analgesia for the relief of postoperative pain in thoracic surgery

Introducción: El dolor posoperatorio es un fenómeno observado con elevada frecuencia y constituye uno de los retos más importantes en el ámbito quirúrgico. Objetivo: Describir los resultados clínicos y hemodinámicos obtenidos con la utilización de anestesia peridural torácica alta como técnica analgésica durante el período posoperatorio en los pacientes intervenidos de tórax. Método: Se realizó un estudio descriptivo, longitudinal, prospectivo en el Hospital Abel Santamaría Cuadrado, entre enero de 2014 y enero de 2017. La muestra estuvo conformada por 37 pacientes que cumplieron con los criterios de inclusión y exclusión. Resultados: Predominaron los valores normales en los que no presentaron dolor posoperatorio, con 33 ± 5,23 y 33 ± 7,86 respectivamente. Se calculó una media de saturación de oxígeno de 99,48 por ciento y frecuencia respiratoria de 16 res/min. Se evidenció que 31 pacientes (83,78 por ciento) no presentaron complicaciones posoperatorias secundarias a la técnica analgésica. En la mayoría no fue necesaria la analgesia de rescate, elemento que representó el 89,19 por ciento. Resultó significativo que 32 pacientes (86,49 por ciento), manifestaron encontrarse satisfechos con el proceder y los resultados alcanzados. Conclusiones: La aplicación de la peridural con morfina para cirugía de tórax arrojó resultados muy efectivos como método analgésico con adecuada estabilidad, mínimas complicaciones requerimientos de rescate analgésico, lo que propició satisfacción por los pacientes(AU)

Introduction: Postoperative pain is a phenomenon that appears frequently and constitutes one of the most important challenges in the surgical field. Objective: To describe the clinical and hemodynamic results obtained with the use of high thoracic epidural as analgesic technique during the postoperative period in patients undergoing thoracic surgery. Method: A descriptive, longitudinal, prospective study was carried out in Abel Santamaría Cuadrado Hospital, during the period between January 2014 and January 2017. The sample consisted of 37 patients who met the inclusion and exclusion criteria. Results: In blood pressure and heart rate according to analgesic response, normal values prevailed in those without postoperative pain, with 33 ± 5.23 and 33 ± 7.86 respectively. A mean of oxygen saturation of 99.48 percent and respiratory rate of 16 res/min were calculated. It was evidenced that 31 patients (83.78 percent) did not present postoperative complications after the analgesic technique. In the majority, rescue analgesia was not necessary, an element that represented 89.19 percent. It was significant that 32 patients (86.49 percent) said they were satisfied with the procedure and the results achieved. Conclusions: The application of peridural with morphine for thoracic surgery yielded very effective results as an analgesic method with adequate stability, minimal complications and analgesic rescue requirements, which led to patient satisfaction(AU)

Conducción anestésica de un paciente con bloqueo de rama izquierda agudo / Anesthetic approach of a patient with acute left-branch block

Introducción: El bloqueo de rama izquierda del haz de His dependiente de la frecuencia cardíaca no es una entidad común en la práctica clínica del anestesiólogo, sino que se presenta como consecuencia de enfermedades cardiacas o no que ocurren por lentitud de la frecuencia ventricular sobre todo, con enfermedad de las arterias coronarias planteadas solo como diagnóstico después de haberlas descartado. Objetivo: Describir el manejo clínico-anestésico de una paciente que presentó bloqueo de rama izquierda del haz de His para cirugía torácica electiva por tumor de mediastino. Desarrollo: Se presenta un caso clínico de una paciente con bloqueo de rama izquierda dependiente de la frecuencia cardiaca que se anunció para cirugía del tórax, sin historia previa de coronariopatía. La cirugía trascurrió sin complicaciones y con buenos resultados. Conclusiones: el bloque de rama izquierda dependiente de la frecuencia cardiaca es una entidad rara y un diagnóstico excluyente de otras entidades cardiovasculares o no como la isquemia miocárdica. Un adecuado manejo intraoperatorio del paciente proporciona excelentes resultados sin traducción clínica ni complicaciones(AU)

Introduction: Rate-dependent left bundle branch block is not a rare entity for the clinical practice in anesthesiology, but appears as a consequence of heart diseases or not always due to slowness in atrial frequency above all, with coronary artery diseases diagnosed only after their being ruled out. Objective: To describe the clinical-anesthetic management of a patient who presented left bundle branch block for elective thoracic surgery due to mediastinal tumor. Findings: We present a clinical case of a female patient with rate-dependent left bundle branch block who was announced for thoracic surgery, without a previous history of coronary artery disease. The surgery proceeded without complications and with positive outcome. Conclusions: Rate-dependent left-branch block is a rare entity and a diagnosis ruling out other cardiovascular entities or not, such as myocardial ischemia. An adequate intraoperative management of the patient provides excellent outcome without clinical translation or complications(AU)

Variations in eating habits between Ecuadorian parents and children related to excess weight / Diferenças nos hábitos alimentares entre pais e filhos equatorianos relacionadas ao excesso de peso

Abstract Objectives: to evaluate the concordance of food consumption habits declared by parents and by their children, and relate it to excess weight prevalence. Methods: cross-sectional study. Concordance was analysed by Kappa and McNemar tests. The analysis of the discrepancies against excess weight was made by logistic regression. Results: we found high levels of discrepancy between parents and children: Kappa -0.02-0.31 (p≤0.01), McNemar p≤0.01. Excess weight did not vary in terms of the discrepancies, except for the affirmation of following a diet (ORadjusted: 1.79; CI95%: 1.49-2.14). Conclusions: agreement between parents and their children demonstrated discordance, but did not influenced on excess weight.

Resumo Objetivos: avaliar a concordância entre hábitos de consumo de alimentos relatados pelos pais e seus filhos e relacionar à prevalência de excesso de peso. Métodos: estudo transversal. A concordância foi analisada pelo Kappa e McNemar. As discrepâncias em relação com excesso de peso foram realizadas por regressão logística. Resultados: se observou alto grau de discordância Kappa -0.02-0.31 (p≤0.01) McNemarp≤0.01. A prevalência de excesso de peso entre escolares não mostrou nenhuma diferença em relação às discrepâncias, exceto com a declaração de fazer dieta (OR: 1.79 IC95%: 1.49-2.14). Conclusões: as informações relatadas pelos pais mostraram discordância, masnão variaram com o excesso de peso.

Usefulness of measuring renal papillae in Hounsfield units in stone - forming patients

ABSTRACT Introduction: The aim of this work is to study the density of the renal papillae in stone-forming patients and to determine its usefulness. Materials and Methods: This study included a total of 79 patients diagnosed with renal stones and on whom a computed tomography without contrast was performed from June 2014 to May 2015. The patients were divided into two groups: Group 1 (single episode) included 43 patients, and Group 2 (recurrent episodes) included 36 patients. The density of six renal papillae (3 per kidney) was measured, and the means obtained were compared between Groups 1 and 2. Statistical analysis was performed using SPSS 20.0. Results: The mean papillary density in Group 1 was 32.26 (SD 4.07) HU compared to 42.36 (SD 8.03) HU in Group 2 (P=00001). A ROC curve was constructed, obtaining an optimal cut-off point of 36.8HU [area under the curve, 0.881 (95% CI; 0.804-0.958); P=0001], with a sensitivity of 80% and a specificity of 90%. The relative risk was estimated at 40.3 (95% CI; 10.8-151.1), meaning that a patient with a mean papillary density greater than 36.8HU would have a 40 times greater risk of having recurrent renal stones. The positive predictive value (PPV) was 81% and the negative predictive value (NPV) was 90%. Conclusion: The measurement of renal papillary density could be useful in predicting recurrent stone-formers. These results need to be confirmed in future studies with a greater number of patients and a longer follow-up.

Relación entre conducta y activación de áreas cerebrales: Empleo de la técnica de AgNOR en Psicología Comparada / Relationship between behavior and activation of brain areas: Using the AgNOR technique in comparative psychology

Se presenta una revisión de distintos estudios que emplearon la técnica de AgNOR en el campo de las neurociencias del comportamiento. AgNOR es una técnica histológica que permite estudiar la activación cerebral de una región específica. Esta técnica ha sido utilizada en distintos grupos zoológicos que comprenden desde peces y anfibios hasta mamíferos, incluyendo actividad neural tanto en procesos normales como patológicos. En conjunto, la técnica de AgNOR tiene tres notables ventajas con respecto a otras técnicas histológicas como las inmunohistoquímicas. En primer lugar, su bajo costo. En segundo lugar, su robustez. Finalmente, la posibilidad de ser aplicada con facilidad a cualquier especie animal, siendo esto último particularmente relevante en el campo de la Psicología Comparada. Paradójicamente a pesar de estas ventajas, es una técnica poco conocida y empleada. El propósito de este artículo es contribuir a su difusión dentro de la comunidad de científicos del comportamiento.

In this paper we review the use of AgNOR technique in the field of behavioral neuroscience. AgNOR is a histological technique used to study the activation of a specific brain region. NORs (nucleolar organizer regions) are the cell nucleus compartments where part of the ribosomal synthesis occurs. When a neuron enhances its protein synthesis demand, for example during a learning process, NORs increase their size. Staining with silver nitrate, colors the cell nucleus in brown and the cell nucleolus in dark brown, nearly black. Thus, the size of the nucleus and the nucleolus can be easily measured in histological preparations treated with silver nitrate through any appropriated image processing software. In this manner, AgNOR technique consist in staining the tissue of subjects that have received different treatments and comparing the average size of the nucleolus of a particular brain region, which is an indirect marker of cellular activity. The use of AgNOR technique in the study of neural basis of learning, typically involves: (1) training animals in a particular task, (2) after acquisition, animals in the trained group along with animals from a control condition are sacrificed in order to obtain a brain sample, (3) brains of animals from both conditions are processed and compared. This procedure was successfully used to study telencephalic activation during spatial learning in fish (Carassius auratus). The task consisted in using visual cues to identify the correct exit from a trap. In the case of fish, the histological analysis showed an increase of the nucleolus size in the lateral pallium, proposed as homologous to the mammalian hippocampus, observing that this area is involved in spatial memory. In our laboratory this technique was also used to analyze the neural activity after spatial learning in the terrestrial toad Rhinella arenarum. We conducted several studies where dehydrated animals had to use visual cues to locate the correct position of a water source. In accordance with fish’s data, our results indicated a higher activity of the hippocampal homologous region (the amphibian medial pallium), showing a high degree of functional equivalence. On the other hand, we also studied in toads the telencephalic activity during an aversive learning task. Here, it was observed an increase in the average of NORs size in the ventrolateral telencephalic region, the striatum (proposed as homologous to the mammalian amygdala), also showing a highly preserved functional equivalence. In mammals, AgNOR technique was used with different purposes, such as the study of changes in hippocampal activity during development in rats, the comparison of the basal activity of two regions of the rats hippocampus, the CA1 and the CA3, both strongly related with learning, or the the hippocampal activity in two different situations in which the liver activity was altered (by an artificial cholestasis, or by alcohol consumption). Finally, AgNOR technique was also used in the study of human brain activity of subjects that had committed suicide. On the whole, the AgNOR technique has three distinct advantages over other histological techniques such as the immunohistochemical. First, their low cost. Second, their robustness. Finally, the fact that it can be easily applied to any animal species, which makes it particularly attractive to the field of the Comparative Psychology. But paradoxically, despite these advantages it is a poorly known and used technique. The aim of this paper is to contribute to the diffusion of the AgNOR technique in the community of behavioral scientists, showing that its use has provided a valuable contribution to research in different fields and animal species.

¿Está indicada la profilaxis antibiótica con ciprofloxacino en la realización de cistoscopia flexible? / Usefulness of antimicrobial prophylaxis with ciprofloxacin prior to flexible cystoscopy

Background: Flexible cystoscopy is a common test in clinical practice done with or without antibiotic prophylaxis. Aim: To evaluate the efficacy of antibiotic prophylaxis with ciprofloxacin to reduce the incidence of urinary infection. Material and Methods: Prospective, non-randomized observational study that included 60 patients divided into two groups. Group 1 received prophylactic ciprofloxacin 500 mg, one hour prior to the procedure and group 2 did not receive prophylaxis. The presence of bacteriuria, symptoms or signs of urinary infection or attending Emergency rooms or primary care for these symptoms were recorded during the seven days after the cystoscopy. Results: In groups 1 and 2, four and one patients had a positive urine culture, respectively. Only one patient in group 1 consulted in primary care for symptoms. No significant differences in symptoms or signs of urinary infection between groups were observed. Conclusions: In this group of patients, antibiotic prophylaxis with ciprofloxacin 500 mg prior to cystoscopy had no benefit.

Eficacia in vitro de tres endectocidas frente a Triatoma infestans / In vitro efficacy of three endectocides against Triatoma infestans

Introducción: distintos estudios han demostrado el papel preponderante que el peridomicilio cumple en la reinfestación de las viviendas por Triatoma infestans (vinchucas). Con el objetivo de eliminar focos residuales de T. infestans que habitan alrededor de los hogares se han desarrollado distintas estrategias. La administración de diferentes compuestos que tengan actividad contra T. infestans a los animales que habitan zonas cercanas a los domicilios y sirvan como fuente de alimentación a estos insectos, podría ser una buena manera de disminuir el riesgo de reinfestación domiciliaria. Objetivo: evaluar la eficacia in vitro de tres agentes antiparasitarios, doramectina (DRM), ivermectina (IVM) y eprinomectina (EPR) frente a ninfas de quinto estadio de Triatoma infestans. Métodos: se diseñaron alimentadores artificiales en donde se colocó sangre heparinizada y fortificada con distintas concentraciones de los tres endectocidas (100-0,4 ng/mL). Se utilizaron 600 ninfas de quinto estadio de T. infestans durante el experimento. Un grupo de vinchucas fue alimentada con sangre sin tratar (control). Luego de realizada la alimentación se observó el estado de los insectos cada 24 hs. durante el transcurso de una semana. Resultados: los tres endectocidas demostraron actividad frente a ninfas de quinto estadio de T. infestans. Comparando la actividad de las tres moléculas, DRM fue la que exhibió una mayor potencia contra los insectos, inclusive mantuvo su actividad frente T. infestans a 0,4 ng/mL (menor concentración evaluada). En el caso de IVM y EPR comenzaron a perder eficacia a concentraciones por debajo de los 6,25 y 3,15 ng/mL respectivamente, siendo totalmente inactivas a 0,4 ng/mL. Conclusiones: en base a estos resultados podemos aseverar que bajo nuestras condiciones experimentales, tanto IVM, EPR como DRM poseen una alta eficacia in vitro contra T. infestans, siendo la última la más efectiva de las tres evaluadas(AU)

Introduction: various studies have demonstrated the role that areas around the houses play in domiciliary re-infestation by Triatomainfestans (kissing bugs). With the aim of removing residual foci of T. infestans that inhabit in neighboring areas of houses, different strategies have been developed. The administration of different anti-T. infestans compounds to animals living in areas around the houses might be a good way to reduce the risk of domiciliary re-infestation. Objective: to evaluate the in vitro efficacy of three antiparasitic agents, doramectin (DRM), ivermectin (IVM) and eprinomectin (EPR) against fifth instar nymphs of Triatomainfestans. Methods: artificial feeders were designed , which contained heparinized and fortified blood with various concentrations of the three endectocides (100-0.4 ng/mL). We used 600 fifth instar nymphs of T. infestans during the experiment. A group of insects were fed with untreated blood (control). After feeding they were under observation to check their condition every 24 hours for a week. Results: the three molecules showed activity against T. infestans. In comparing the activity of the three molecules, DRM exhibited greater potency against insects, it even kept its activity against T. infestans at 0.4 ng/mL (lowest concentration tested). In the case of EPR and IVM, their efficacy began to lower at concentrations below 6.25 and 3.15 ng/mL respectively, being totally inactive at 0.4 ng/mL concentration. Conclusions: Based on these results, we can assert that under our experimental conditions, IVM, EPR and DRM show in vitro high efficacy against T. infestans, being the latter more effective than the other two molecules(AU)

Aprendizaje de habilidades de autorregulación en niños de 5 a 7 años / Self-regulation skills learning in children aged 5 to 7

La autorregulación es un componente de la metacognición que se relaciona con el aprendizaje eficaz. Esto puede ser especialmente relevante en entornos de desventaja social. Por ello, los objetivos de este trabajo son: (a) comprobar si la enseñanza de estrategias de autorregulación a niños pequeños con desventaja social, mejora sus habilidades de resolución de tareas; (b) evaluar la eficacia de un programa de enseñanza de estrategias de autorregulación, desde la perspectiva del profesorado. Se trabajó con una muestra de 43 sujetos con edades comprendidas entre 5 y 7 años. Los resultados indican que existen mejoras significativas, antes-después de la aplicación del programa, en habilidades: atencionales, de planificación manifiesta guiada y autónoma, de planificación encubierta y de autoevaluación en la resolución de problemas cognitivos y sociales. Paralelamente, el profesorado considera que el programa ha mejorado, en sus alumn os: los niveles atencionales y la generalización de las estrategias a otras actividades curriculares. En consecuencia, se considera, al programa de enseñanza en estrategias de autorregulación, una herramienta efectiva y motivadora para la docencia en entor nos de compensación educativa (niños pequeños en desventaja social).

Self-regulation is a component of metacognition that is related to effective learning. This may be especially relevant in social disadvantaged environments. The objectives of this work are: (a) To check whether the teaching of self-regulation strategies to young children with social disadvantage, improves their problem solving skills; (b) To evaluate the effectiveness of a self-regulation strategies teaching program from the teachers' perspective. For this purpose, a sample of 43 subjects aged between 5 and 7 was used. The results indicate that there are significant differences in skills involving attention, guided and autonomous state planning, covert planning and self-evaluation in cognitive and social problem-solving. Similarly, teachers consider that the program improved attention levels and generalization of strategies towards other curricular activities in their pupils. Consequently, the self-regulation strategies teaching program is considered as an effective and motivating tool for teaching in compensatory education environments (socially disadvantaged children).