Morbilidad por lesión de la vía biliar en un servicio de cirugía / Morbility due to Bile Duct Lesion in a Surgery Service

Introducción: Las lesiones iatrogénicas de las vías biliares representan una complicación quirúrgica grave de la colecistectomía. Objetivo: Determinar la morbilidad de las lesiones de la vía biliar en el servicio de cirugía del Hospital Universitario "Manuel Ascunce Domenech". Métodos: Se realizó un estudio descriptivo, prospectivo y observacional de pacientes que ingresaron en el servicio de cirugía del Hospital Universitario "Manuel Ascunce Domenech" con diagnóstico de lesión de la vía biliar, desde septiembre del 2018 hasta enero del 2022. El universo estuvo conformado por 12 pacientes que cumplieron con los criterios de inclusión. Se utilizaron métodos estadísticos descriptivos y cálculos con valores porcentuales. Resultados: La mayor incidencia de los pacientes fue del sexo femenino y de piel blanca, con un 61,4 por ciento y 85,7 por ciento, respectivamente. Predom inó el tipo de cirugía convencional y diagnóstico intraoperatorio con un 66,7 por ciento y 50 por ciento, respectivamente. El tipo E1 y E2 de la clasificación de Strasberg y la hepaticoyeyunostomía fue la operación con mayor frecuencia con un 66,7 por ciento. La bilirragia fue la complicación que predominó con el 70 por ciento. Conclusiones: La mayoría de los pacientes son del sexo femenino y de piel blanca, donde la cirugía convencional y el diagnóstico intraoperatorio son los hallazgos más frecuentes. Más de la mitad de los pacientes son clasificados como tipo E1 y tipo E2 según clasificación de Strasberg. La hepaticoyeyunostomía en Y de Roux y en asa de Braum transmesocólica es el proceder realizado en casi la totalidad de los pacientes. La fuga biliar es la complicación más frecuente(AU(

Introduction: Iatrogenic bile duct lesions represent a serious surgical complication of cholecystectomy. Objective: To determine the morbility of bile duct lesions in the surgical service of Hospital Universitario "Manuel Ascunce Domenech". Methods: A descriptive, prospective and observational study was carried out with patients admitted to the surgery service of Hospital Universitario "Manuel Ascunce Domenech" with a diagnosis of bile duct lesion, from September 2018 to January 2022. The study universe consisted of twelve patients who met the inclusion criteria. Descriptive statistical methods and calculations with percentage values were used. Results: The highest incidence of patients corresponded to the female sex and the white skin, accounting for 61.4 percent and 85.7(Percent(, respectively. Conventional surgery and intraoperative diagnosis predominated, accounting for 66.7 % and 50 %, respectively. Types E1 and E2 according to the Strasberg classification, together with hepaticojejunostomy, was the most frequent surgery type, accounting for 66.7 %. Biliary bleeding was the predominant complication, accounting for 70 %. Conclusions: Most of the patients belong to the female sex and have white skin, in which cases conventional surgery and intraoperative diagnosis are the most frequent findings. More than half of the patients are classified as types E1 or E2 according to the Strasberg classification. Transmesocolic Braun loop and Roux-en-Y hepaticojejunostomy is the procedure performed in almost all patients. Biliary leakage is the most frequent complication(AU)

El error en la práctica médica / Error in Medical Practice

Introducción: El error está presente en cualquier actividad humana y la práctica de la medicina no es una excepción. Debido al aumento de los conocimientos sobre la salud y las enfermedades, la posibilidad de error, relacionada con la atención de estas últimas, disminuye, pero no se ha eliminado en su totalidad. Objetivo: Exponer las experiencias de los autores acerca del error en la práctica médica. Métodos: Revisión bibliográfica entre los años 2000 y 2020. Se localizaron y consultaron fuentes bibliográficas validadas en: Medline, PubMed y SciELO, a las que se accedió a través de la biblioteca virtual de salud. Se utilizaron para la búsqueda las palabras clave error médico, iatrogenia, responsabilidad penal del médico, método clínico. Se revisaron también tres bibliografías anteriores que se consideraron de utilidad para el artículo y tres capítulos de libros con temas afines, además de las resoluciones del Ministerio de Salud Pública de Cuba que tratan acerca del error médico. Al final se seleccionaron 21 bibliografías en idiomas español e inglés. Conclusiones: Existen grandes posibilidades de errores en el proceso del diagnóstico y tratamiento de los enfermos. El desarrollo de la tecnología y la mejoría en la construcción de guías y protocolos disminuyen las probabilidades de equivocaciones, pero no las eliminan. El perfeccionamiento en la formación de recursos humanos, unido al uso correcto del método clínico es una estrategia eficaz para disminuir los errores en la práctica médica(AU)

(AU)ntroduction: Error is present in any human activity; the medical practice is not an exception. Due to an increase in knowledge about health and diseases, error possibility related to disease management is decreasing, but has not been totally eliminated. Objective: To expose the authors' experiences regarding error in medical practice. Methods: A bibliographic review was carried out, covering the years between 2000 and 2020. Validated bibliographic sources were located and consulted in Medline, PubMed and SciELO, accessed through the Virtual Health Library. The following keywords were used for the search: error médico [medical error], iatrogenia [iatrogenic error], responsabilidad penal del médico [physician criminal liability] and método clínico [clinical method]. Three previous bibliographies considered useful for the article and three book chapters with related topics were also reviewed, in addition to the resolutions of the Ministry of Public Health of Cuba dealing with the topic of medical error. Finally, 21 bibliographies in Spanish and English were selected. Conclusions: There are great possibilities of errors in the process of patient diagnosis and management. The development of technology, as well as the improvement in the construction of guides and protocols, decreases the probabilities of errors, but do not eliminate them. The improvement in the training of human resources, together with the correct use of the clinical method, is an effective strategy to reduce errors in medical practice(AU)

Selamento de perfuração radicular associado a enxerto de tecido conjuntivo em área estética: relato de caso / Sealing of root perforation associated with connective tissue graft in aesthetic area: Case report

Introdução: Perfuração radicular é a comunicação entre as paredes do canal radicular e o espaço periodontal. O tempo, a localização e a dimensão da perfuração são fatores que afetam no prognóstico do dente. Objetivo: Relatar um caso clínico de tratamento de perfuração radicular supraóssea associado a enxertia de tecido conjuntivo em área estética. Relato do caso: Paciente relatou ter sido submetido, há 3 meses, ao tratamento endodôntico do dente #22; porém, esse não foi finalizado. Ao exame clínico, o dente apresentava ausência de dor e presença de fístula na região da gengiva inserida. As imagens radiográficas e tomográficas revelaram imagem sugestiva de perfuração radicular na região vestibular do dente #22, além de área hipodensa/radiolúcida circunscrita ao ápice radicular, conduzindo ao diagnóstico de periodontite apical assintomática associada a perfuração radicular supraóssea. Inicialmente, foi realizado preparo do canal radicular e utilizada medicação intracanal por 21 dias. Posteriormente, foi realizada a obturação do canal radicular e restauração definitiva em resina composta na face palatal. Na mesma sessão, foi realizado o acesso cirúrgico para selamento da perfuração com resina composta, associado a enxertia de tecido conjuntivo no dente #22, para evitar recessão tecidual marginal. Foi observada, após 12 meses, neoformação óssea na região periapical do dente #22, com ausência de dor e preservação da estética na região periodontal. Conclusão: O diagnóstico e o planejamento multidisciplinar são fatores importantes no tratamento de perfurações radiculares, assim como a correta escolha do material selador (AU).

Introduction: Root perforation is the communication between the walls of the root canal and the periodontal space. The time, location and size of the perforation are factors that affect the prognosis of the tooth. Objective: To report a clinical case of treatment of supraosseous root perforation associated with grafting of connective tissue in aesthetic area. Case report: Patient reported that 3 months had started root canal treatment of tooth 22, but was not finalized. At the clinical examination, the tooth presented absence of pain and presence of sinus tract in the region of attached gingiva. Radiographic and tomographic images revealed an image suggestive of root perforation in the buccal region of tooth 22, as well as a hypodense / radiolucent area circumscribed to the root apex, leading to the diagnosis of asymptomatic apical periodontitis associated with supraosseous root perforation. Initially, it were performed root canal preparation and intracanal medication. After 21 days, root canal obturation and composite restoration were performed on the palatal face. In the same session, the surgical access was made to sealing the perforation with composite resin, associated to the grafting of connective tissue in tooth 22, to avoid marginal tissue recession. It was observed after 12 months new bone formation in the periapical region of tooth 22, with absence of pain and preservation of aesthetics in the periodontal region. Conclusion: Multidisciplinary diagnosis and planning are important factors in the treatment of root perforations, as well as the correct selection of materials used to seal root perforations (AU).

Conocimiento y capacitación virtual de la responsabilidad del enfermero del quirófano/ instrumentador quirúrgico / Virtual intervention and training on operating room nurses/surgical instrument technicians responsibilitynurses/

Objetivo: realizar el diagnóstico y capacitación del enfermero de quirófano/instrumentador quirúrgico (EQ/IQ) frente a la responsabilidad médica y legal como eje de la seguridad del paciente. Métodos: estudio en dos fases, la primera corresponde a un análisis descriptivo de corte trasversal con la participación de 23 EQ/IQ; la fase II es un estudio cuasi experimental con 15 EQ/IQ. Las pruebas pre y postest (aplicación de un OVA) permitieron describir la efectividad de la intervención. Resultados: la fase I, prueba piloto, evidenció la falta de conocimiento en responsabilidad legal y médica. La fase II mostró un cambio significativo después de la intervención con el OVA; la capacitación en temas básicos de responsabilidad legal y médica fue satisfactoria y se identificó el cambio posintervención. Discusión: los resultados y la literatura científica permiten establecer que existe un desconocimiento en responsabilidad médica y su influencia en la seguridad del paciente. Así, la capacitación se convierte en un aporte para la garantía de calidad en la prestación de servicios de salud.

Introduction: to assess and identify operating room nurses/surgical instrument technicians (SN/SIT) knowledge on legal and medical responsibility and train them on this topic as the essential aspect for ensuring patient safety. Methods: a two-phase study was carried out, the first phase consisted of a cross sectional descriptive analysis including 23 SN/SIT; phase II was a quasi-experimental intervention study including 15 SN/SIT. The pre and post Open Virtual Application [OVA] intervention results enabled evaluating its efficacy. Results: In Phase I a pilot test evidenced lack of knowledge on legal and medical responsibility. Phase II showed a significant change after OVA intervention; training on basic topics on legal and medical responsibility was satisfactory and a post-intervention change was identified. Discussion: the study results and the scientific literature evidenced there is a lack of understanding on legal and medical responsibility and how it affects patient safety. Thus, training contributes to guarantee quality health care services.

Meningitis tras técnica combinada raquídea-epidural para analgesia del parto: reporte de un caso / Case report of meningitis after combined spinal-epidural analgesia for labor

La meningitis pospunción es una complicación importante y poco frecuente de la anestesia neuroaxial. Describimos el caso de una paciente que ingresa para inducción del parto. Se realiza técnica espinal-epidural para analgesia del parto. Cursando 48 h de puerperio instala cefalea intensa, fotofobia y fiebre. No focalidad neurológica. Sin rigidez de nuca. Al examen, restos cavitarios que impresionan fétidos. Se plantea endometritis puerperal iniciando tratamiento antibiótico. Dado la persistencia del cuadro clínico se plantea punción lumbar para confirmación diagnóstica mediante análisis de líquido cefalorraquídeo; siendo éste turbio, por lo cual ingresa a cuidados intensivos con diagnóstico de meningitis aguda. Bacterióloga informa a los 10 días que el cultivo desarrolla estreptococo mitis oralis. La importancia esta dada porque la meningitis puede ser potencialmente devastadora si no se realiza un diagnóstico y tratamiento tempranos, existiendo medidas que se pueden adoptar para prevenir esta complicación.

Post-puncture meningitis is an important and rare complication of neuraxial anesthesia. We describe case of patient who is admitted for induction of labor. A spinal-epidural technique is performed for labor analgesia. During 48 hours of puerperium, she installed intense headache, photophobia and fever. No neurological focus. No stiff neck. On physical exam, cavitary remains that appear fetid. Puerperal endometritis arises starting antibiotic treatment. Given the persistence of the clinical picture, lumbar puncture is considered for diagnostic confirmation by analysis of cerebrospinal fluid; This being cloudy, for which he was admitted to Intensive Care with a diagnosis of acute meningitis. Bacteriologist reports 10 days later develops streptococcus mitis oralis. The importance is given because meningitis can be potentially devastating if early diagnosis and treatment is not performed, and there are measures that can be taken to prevent this complication.

Consideraciones actuales sobre la iatrogenia / Current considerations on iatrogenesis

La iatrogenia es el daño ocasionado por el profesional de la salud a pacientes, familias u otras personas, de manera no intencional, que puede provocar desde un ligero malestar emocional hasta la propia muerte. Teniendo en cuenta lo anterior se realizó una revisión bibliográfica exhaustiva sobre el tema que recoge aspectos actualizados, a saber: concepto, diferencias entre esta y la mala praxis médica, modalidades de iatrogenia (principalmente la de orden psicológico) y recomendaciones para evitarla, con el objetivo de contribuir a un mejor desempeño de los profesionales de la salud y elevar la calidad de vida de la población.

Iatrogenesis is the damage caused by the health professional to patients, families or other people, in non intentional way, that can cause either a slight emotional distress or death. Keeping this in mind an exhaustive literature review on the topic was carried out that compiles up-to-date aspects: concept, differences between this and the bad medical practice, iatrogenesis modalities (mainly the psychological type) and recommendations to avoid it, aimed at contributing to a better performance of health professionals and elevating the population life quality.

"Descansar e dormir sem riscos": o Jornal do Médico (Portugal) e o desastre da talidomida, 1960-1962 / "Risk-free rest and sleep: " Jornal do Médico (Portugal) and the thalidomide disaster, 1960-1962

Resumo O artigo analisa como o periódico Jornal do Médico, editado na cidade do Porto, em Portugal, divulgou o desastre da talidomida. A pesquisa percorreu as páginas da fonte desde o início de 1960 até o final de 1962. Aqui, objetivam-se apontar e discutir duas questões interligadas: a morosidade em publicar matérias sobre os efeitos deletérios do medicamento, vendido no país sob a denominação Softenon®, e a construção discursiva da isenção da responsabilidade do médico no fenômeno da iatrogenia medicamentosa.

Abstract This article analyzes the way the Porto-based journal Jornal do Médico reported on the thalidomide disaster. The pages of the publication are researched from the beginning of 1960 to the end of 1962 with the aim of identifying and discussing two interconnected questions: the delay in publishing news on the harmful effects of the drug, which was sold in the country under the brand name Softenon®, and the discursive construction of a lack of accountability on the part of physicians for the phenomenon of medication iatrogenesis.

Adesão de idosos ao tratamento medicamentoso em diferentes níveis de Atenção à Saúde no município de São Paulo, Brasil / Elderly adherence to drug treatment at different levels of health care in the city of São Paulo, Brazil / Adhesión de ancianos al tratamiento farmacológico en diferentes niveles de atención médica en la ciudad de São Paulo, Brasil

A qualidade de vida de idosos e a adesão a um tratamento podem ser influenciadas pela presença da polifarmácia e, até mesmo, de iatrogenias relacionadas aos medicamentos prescritos. O artigo retrata uma verificação das prescrições farmacológicas direcionadas a idosos e a adesão ao tratamento em diferentes níveis da atenção à saúde pública na cidade de São Paulo (SP), durante os anos de 2016 e 2017. É ressaltada a importância do devido conhecimento farmacológico e de técnicas de comunicação por parte dos profissionais de saúde.

The quality of life of the elderly and adherence to treatment may be influenced by the presence of polypharmacy and even iatrogenesis related to prescription drugs. The article portrays a verification of pharmacological prescriptions directed at the elderly and adherence to treatment at different levels of public health care in the city of São Paulo (SP), during 2016 and 2017. The importance of due pharmacological knowledge and communication techniques by health professionals.

La calidad de vida de los ancianos y el cumplimiento del tratamiento pueden verse influenciados por la presencia de polifarmacia e incluso de iatrogénesis relacionada con medicamentos recetados. El artículo retrata una verificación de las prescripciones farmacológicas dirigidas a los ancianos y la adherencia al tratamiento en diferentes niveles de atención de salud pública en la ciudad de Sao Paulo (SP), durante 2016 y 2017. La importancia del debido conocimiento farmacológico y las técnicas de comunicación por parte de los profesionales de la salud.

Accidente con hipoclorito de sodio durante la terapia endodóntica / Accident with sodium hypochlorite during endodontic therapy

Introducción: el accidente con hipoclorito de sodio es una de las complicaciones que pueden presentarse durante la terapia endodóntica convencional. Constituye el sobrepaso del irrigante a los tejidos periapicales ya sea durante la irrigación de los conductos radiculares o por medio de la inyección accidental en los tejidos blandos. Produce al paciente una sintomatología dolorosa inmediata, con una respuesta inmunológica exacerbada y necrosis hística. Objetivo: determinar las posibles causas del accidente con hipoclorito de sodio y exponer el protocolo de manejo clínico y farmacológico establecido para esta eventualidad. Caso clínico: se informa el caso de un sobrepaso accidental de hipoclorito de sodio hacia el periápice en la raíz distovestibular del diente 17 en un paciente de 67 años de edad, con hipertensión arterial controlada, diagnóstico de pulpa sana y requerimiento de realización de endodoncia preprotésica. Se exponen la toma de medidas clínicas y farmacológicas posterior al accidente con hipoclorito de sodio, así como el suministro de corticoterapia inmediata, analgesia, manejo del dolor por bloqueo anestésico del área comprometida y para disolución del hipoclorito de sodio, para completar el esquema de manejo medicación antibiótica profiláctica. Conclusiones: los factores predisponentes para la generación de un accidente con hipoclorito son: enfermedades que causen resorción periapical, selección inadecuada del tipo de jeringa y aguja con la que se realiza la irrigación y la no determinación adecuada de la longitud radicular. El manejo de estos accidentes con corticoides y analgesia reduce la agresividad de la sintomatología presentada por el paciente, así como la profilaxis antibiótica, disminuye el riesgo de daño hístico(AU)

Introduction: sodium hypochlorite accidents are one of the complications that may arise during conventional endodontic therapy. In hypochlorite accidents, the irrigant flows into the periapical tissue either during irrigation of root canals or by accidental injection into soft tissue. This situation causes immediate pain symptoms in the patient, with an exacerbated immune response and tissue necrosis. Objective: determine the possible causes of sodium hypochlorite accidents and present the clinical and pharmacological management protocol established for these events. Clinical case: a case is reported of accidental flowing of sodium hypochlorite to the apex of the distovestibular root of tooth 17 in a 67-year-old male patient with controlled hypertension and a diagnosis of healthy pulp requiring preprosthetic endodontic therapy. A description is provided of the clinical and pharmacological actions taken after the sodium hypochlorite accident, as well as the immediate application of corticotherapy, analgesia, pain management by anesthetic block of the compromised area and for dissolution of the sodium hypochlorite, to complete the management scheme with prophylactic antibiotic medication. Conclusions: the following are predisposing factors for the occurrence of a hypochlorite accident: conditions that cause periapical resorption, inadequate choice of the type of syringe and needle to perform the irrigation, and incorrect determination of the root length. Management of these accidents with corticosteroids and analgesia reduces the aggressiveness of symptoms, whereas antibiotic prophylaxis lessens the risk of tissue damage(AU)

Cardiac tamponade: a rare complication of central venous catheter - a clinical case report / Tamponamento cardíaco: uma complicação rara da cateterização venosa central - relato de um caso clínico

Abstract The extensive use of central venous catheters (CVC) in a hospital environment leads to increased iatrogenic complications, as more catheters are used enclosed and its maintenance is prolonged. Several complications are known to be related to central venous catheter, of which the uncommon cardiac tamponade (CT), hardly recognized and associated with high mortality. We present a clinical case, with favorable outcome, of a patient who developed a CT 17 days after CVC placement, and try to reflect on the measures that can be taken to reduce its incidence, as well as the therapeutic approaches to practice in the presence of a suspected CT.

Resumo O vasto uso dos cateteres venosos centrais (CVC) em meio hospitalar incita a um aumento da iatrogenia, uma vez que são colocados mais cateteres e a sua manutenção é mais prolongada. São conhecidas as complicações relacionadas com a cateterização venosa central, uma das quais o tamponamento cardíaco (TC), raro, dificilmente reconhecido e associado a grande mortalidade. Os autores apresentam um caso clínico, com desfecho favorável, de uma doente que desenvolveu um TC 17 dias após a colocação de um CVC e procuram refletir sobre as medidas que podem ser adotadas para reduzir a sua incidência, bem como as atitudes terapêuticas na suspeita de TC.

Eventos adversos em unidades de terapia intensiva: estudo bibliométrico / Los eventos adversos en unidades de cuidados intensivos: estudio bibliométrico / Adverse events in intensive care units: bibliometric study

Objective: To investigate the scientific productions about the adverse events that occurred in Intensive Care Units. Methods: Bibliometric study, quantitative approach of documentary base, consisting of 20 articles from the electronic database Scientific Electronic Library Online (Scielo) and Specialized Bibliographic database in the area of nursing (BDENF), and thesis and dissertations database in the period of 2004 to 2014. Results: It was possible to identify scientific productions about adverse events in ICUs of the last 10 years, highlighting the predominance of papers published by nursing, especially AEs related to medication errors and nosocomial infection, intensified by the overload of work. Conclusion: The study presents limitations as to the number of publications on the subject. Thereby the scarcity of publications regarding the subject in question, makes updates on the subject.

Objetivo: Investigar as produções científicas acerca dos eventos adversos ocorridos em Unidades de Terapia Intensiva. Métodos: Estudo bibliométrico, abordagem quantitativa, de base documental, constituído por 20 artigos da base de dados eletrônica Scientific Eletronic Library Online (Scielo), Base de Dados Bibliográficos Especializada na Área de Enfermagem (BDENF), e banco de teses e dissertações no período de 2004 a 2014. Resultados: Foi possível identificar produções cientificas acerca de eventos adversos em UTIs dos últimos 10 anos, ressalta a predominância de trabalhos publicados pela enfermagem, com destaque para EAs relacionados a erros de medicação e infecção nosocomial, intensificados pela sobrecarga de trabalho. Conclusão: O estudo apresenta limitações quanto ao número reduzido de publicações sobre a temática. Desse modo a escassez de publicações no que concerne à temática em questão, dificulta atualizações sobre o assunto.

Objetivo: Investigar las producciones científicas acerca de los eventos adversos ocurrieron en intensivo cuidado unidades. Métodos: Estudio bibliométrico, enfoque cuantitativo base documental que consta de 20 artículos de la base de datos electrónica Scientific Electronic Library Online (Scielo) y base de datos bibliográfica especializada en el área de enfermería (BDENF) y base de datos de tesis y disertaciones en el período 2004-2014. Resultados: Se logró identificar producciones científicas sobre eventos adversos en UCI de los últimos 10 años, destaca el predominio de artículos publicados por enfermería, especialmente EAs relacionados con errores de medicación y la infección nosocomial, intensificado por la sobrecarga de trabajo. Conclusión: El estudio presenta limitaciones en cuanto al número de publicaciones sobre el tema. Tal modo la escasez de publicaciones sobre el tema en cuestión, hace actualizaciones sobre el tema.

Oblitoma en la cirugía ginecoobstétrica: un problema creciente. Reporte de un caso / Oblitoma in obstetric and gynecologic surgery: a growing problem

Resumen ANTECEDENTES: Los oblitomas, u objetos extraños retenidos en el abdomen posterior a una cirugía, son consecuencia de una iatrogenia que causa morbilidad, dificultad diagnóstica, problemas médico-legales, y complicaciones para las pacientes, el médico y la institución hospitalaria. CASO CLINICO: Paciente de 27 años de edad, con un cuerpo extraño retenido en la cavidad abdominal (bulbo de la cánula de Yankauer), olvidado durante una cesárea de urgencia. El diagnóstico y tratamiento fueron expeditos, con reintervención quirúrgica para extraer el cuerpo extraño, sin complicaciones y con evolución satisfactoria de la paciente. CONCLUSIONES: El estudio actual de los oblitomas u objetos extraños retenidos es un problema creciente, con estadísticas en contra, sobre todo asociadas con elevada frecuencia de cesáreas y alta prevalencia de obesidad materna durante el embarazo, esto debe alertar a los ginecoobstetras a conducirse con más cuidado para evitar este tipo de accidentes.

Abstract BACKGROUND: Oblitomas or retained surgical items (RSI) in the abdominal cavity after surgery are cause of iatrogenic medical problems, that origin high morbidity, difficult diagnosis and medical malpractice claims to may lead complications to patients, physicians included to hospital. CLINICAL CASE: We report an exceptional case, in a 27-year-old women, with a bulb of Yankahuer cannula retained in abdominal cavity, Forgotten during an emergency cesarean section. The diagnosis and management was realized with opportunity, avoiding complications. CONCLUSION: Actually, the study of oblitoma or foreign objects retained that's considered a growing problem, with statistics against it, mainly associated with high frequency of cesarean sections and high prevalence of maternal obesity during pregnancy. In fact, that situation place the gynecologists and obstetricians at a latent risk for this event. It is important to know the predisposing factors for its prevention and to implement institutional programs to reduce complications.

Análisis de los eventos adversos en el área de rehabilitación oral de la Facultad de Odontología de la Ponticia Universidad Javeriana Bogotá / Analysis of Adverse Events in the Oral Rehabilitation Area at the Ponticia Universidad Javeriana Dentistry School in Bogotá

Antecedentes: Uno de los mecanismos para garantizar la calidad de la atención en salud es el análisis de eventos adversos en los tratamientos. El área de la rehabilitación oral es una de las más propensas, dada la complejidad de sus procedimientos. Objetivo: Analizar los eventos adversos que se presentaron en la clínica del posgrado de rehabilitación oral de la Facultad de Odontología de la Pontificia Universidad Javcriana de Bogotá durante 2013. Métodos: De 595 historias clínicas correspondientes a todos los pacientes que finalizaron su tratamiento en 2013. 590 cumplieron con el requisito de estar firmadas por el paciente y por el profesor. A partir de las historias que contenían algún reporte de evento adverso, se registraron los datos demográficos de los pacientes, los tipos de eventos adversos reportados, las posibles causas que su ocurrencia y si eran o no prevenibles. Resultados: En 36 (6,1 %) de las historias clínicas analizadas se encontró algún reporte de evento adverso. El evento más frecuente fue la perdida de la restauración (42 %). La causa más frecuente fue la fractura completa de la restauración (19 %). El 58 % se consideró evento adverso prevenible. En el 61,1 % de los casos fueron prótesis fijas dcntorrctcnidas. Conclusiones: La frecuencia de eventos adversos reportada en las historias clínicas de pacientes atendidos en el área de rehabilitación es baja. Teniendo en cuenta de condición de prevenible de estos casos, es importante registrarlos y analizarlos para asegurar la calidad en la atención de los pacientes.

Background: One of the mechanisms that ensures the health care quality is the analysis of adverse events in the treatment. The oral rehabilitation area is among the more likely because of the complex procedures involved. Objective: To analyze the adverse events that occurred in the clinic of the oral rehabilitation graduate program at the Pontificia Universidad Javeriana Dentistry School in Bogotá during 201 "i.Methods: Out of 595 medical records including all the patients who completed their treatment in 2013. 590 fulfilled the requirement of being signed both by the patient and the teacher. Based on the medical records that reported any kind of adverse event, the patient information regarding demographic data, type of reported adverse event, potential causes for their occurrence, and whether they were preventable was gathered. Results: In 36 (6.1%) of the examined medical records, at least one report of adverse event was found. The most frequently found event was the restoration loss (42%). The most frequently found cause was the full fracture of the restoration (19%). Fifty-eight (58 %) of the adverse events were preventable. Sixty-one (61.1%) of the eases were retained fixed dental prosthcscs. Conclusions: Ihc frequency of adverse events reported in the medical records of patients treated in the rehabilitation area is low. Considering that the eases arc preventable, it is important to record and examine these eases in order to ensure the health care quality for the patients.

Iatrogenics in Orthodontics and its challenges

ABSTRACT Introduction: Orthodontics has gone through remarkable advances for those who practice it with dignity and clinical quality, such as the unprecedented number of patients treated of some type of iatrogenic problems (post-treatment root resorptions; occlusal plane changes; midline discrepancies, asymmetries, etc). Several questions may raise useful reflections about the constant increase of iatrogenics. What is causing it? Does it occur when dentists are properly trained? In legal terms, how can dentists accept these patients? How should they be orthodontically treated? What are the most common problems? Objective: This study analyzed and discussed relevant aspects to understand patients with iatrogenic problems and describe a simple and efficient approach to treat complex cases associated with orthodontic iatrogenics.

RESUMO Introdução: a Ortodontia tem vivenciado momentos marcantes para quem a exerce com dignidade e qualidade clínica. Um deles é a chegada, sem precedentes, dos pacientes com algum tipo de iatrogenia, como: reabsorções radiculares pós-tratamento, alterações no plano oclusal, desvios de linha média, assimetrias, entre outras. Diversas questões permitem uma boa reflexão sobre esse constante aumento das iatrogenias. Qual o motivo? Acontecem com profissionais bem formados? Como receber, legalmente, esses pacientes? Como tratá-los ortodonticamente? Quais são os problemas mais comuns? Objetivo: o objetivo do presente trabalho é analisar e discutir pontos relevantes para melhor atender esse tipo de paciente e apresentar uma abordagem simples e eficaz na condução de casos complexos relacionados às iatrogenias ortodônticas.

Neuroética. Ética de la neurociencia / Neuroethics. Ethics of neuroscience

Actualización del extenso y variado concepto de la neuroética. Se discute la responsabilidad profesional, tanto de médicos como de otros profesionales vinculados con las diversas ramas de la neurociencia, relacionados con la salud y la enfermedad de los pacientes afectados de un proceso que comprometa al sistema nervioso central o periférico. Se analiza el espectro amplio de la neurociencia y su vinculación con la neurotecnología. Se enumeran los diversos tipos de iatrogenia. Descripción de cuatro pacientes en estado vegetativo y muerte cerebral. Se plantea la actitud y responsabilidad del profesional médico analizando y discutiendo el enfoque terapéutico correspondiente. Se recuerdan las desviaciones de la neuroética durante el período nazi, antes y durante la Segunda Guerra mundial. Se mencionan situaciones médicas especiales que plantean aspectos neuroéticos.

Update of broad concept of neuroethics. The liability of different members related to neuroscience connected to health and disease of the central and peripheral nervous system are discussed. The importance of neuroethics with neurotechnology. Different types of iatrogenic disturbances are mentioned. Four patients with vegetative state and cerebral death, and the medical responsibility in the therapeutic approach are analyzed. Deviations of neuroethics during the nazi period and the second world war are described. Some especial medical situations with neuroethics aspects are commented.

Hemorragias uterinas anormales no orgánicas / Non-organic abnormal uterine bleeding

Abnormal uterine bleeding (AUB) is a very common gynecological condition, which may have several causes. A new classification system was recently proposed to standardize the terminology used to describe Abnormal Uterine Bleeding. The International Federation of Gynecology and Obstetrics (FIGO) published guidelines in 2011 to develop universally accepted nomenclature and a classification system. The FIGO classification system (PALM-COEIN) was published to standardize the terminology used in the diagnosis and in investigations into the causes of abnormal uterine bleeding. According to the new FIGO classification, in the absence of structural etiology, the former term "dysfunctional uterine bleeding" should be avoided and clinicians should specify whether AUB is caused by coagulation disorders (AUB-C), ovulation disorder (AUB-O), or endometrial primary dysfunction (AUB-E). This system is based on the pattern and etiology of bleeding and has been adopted by other organizations. Additionally, the American College of Obstetrics and Gynecology (ACOG) has recently updated the recommendations on evaluation of abnormal uterine bleeding and the indications for endometrial biopsies. In short, AUB is a common complaint that can vary from mild to life-threatening if not recognized and treated promptly. In this review, we describe the main causes of abnormal uterine bleeding and summarize the most relevant new guidelines for the diagnosis and management of non-organic abnormal uterine bleeding that comprises AUB-C, AUB-O, AUB-E, AUB-I and AUB-N due to other non-classifiable causes

La hemorragia uterina anormal (HUA) es un trastorno ginecológico muy común, que puede deberse a varias causas. La Federación Internacional de Ginecología y Obstetricia (FIGO) publicó unas directrices en 2011 para establecer una nomenclatura que fuera universalmente aceptada y un sistema de clasificación. El sistema de clasificación de la FIGO (PALM-COEIN) se publicó para intentar estandarizar la terminología que se empleaba en el diagnóstico y en la investigación de las causas de sangrado uterino anormal. Según la nueva clasificación de la FIGO, en ausencia de una patología estructural, debe evitarse el empleo de la antes denominada "hemorragia uterina disfuncional" y los médicos deben indicar si la HUA está ocasionada por trastornos de la coagulación (HUA-C), trastorno de la ovulación (HUA-O), yatrogenia (HUA-I), disfunción primaria del endometrio (AUB-E) o causas no clasificables (HAU-N). Este sistema se basa en el patrón y la etiología de la hemorragia y ha sido adoptado por otras organizaciones. Además, el Colegio Americano de Obstetricia y Ginecología (ACOG) han actualizado recientemente las recomendaciones sobre la evaluación de sangrado uterino anormal, así como las indicaciones para la práctica de biopsias endometriales. En resumen, la HUA es una queja común que puede variar de leve a potencialmente mortal si no se reconoce y trata a tiempo. En esta revisión se describen las principales causas de sangrado uterino anormal y resumimos las nuevas directrices más relevantes para el diagnóstico y el tratamiento del sangrado uterino anormal no orgánico que comprende HUA-C, HUA-O, HUA-E, HUA-I y HUA-N

Caracterización de pacientes con lesiones quirúrgicas iatrogénicas de las vías biliares / Characterization of patients with surgical iatrogenic injuries of the biliary apparatus

Se realizó un estudio descriptivo de 35 pacientes intervenidos quirúrgicamente mediante las técnicas convencional y laparoscópica, quienes presentaron lesiones iatrogénicas de las vías biliares, en el Servicio de Cirugía General del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, en un período de 8 años (2007-2014), con vistas a caracterizarles según algunas variables de interés y determinar la mortalidad asociada. Entre los resultados preponderantes figuraron el sexo femenino y las edades de 35 a 54 años, las lesiones producidas de la colecistectomía videolaparoscópica electiva por litiasis vesicular, las formas clínicas de presentación el absceso intraabdominal con signos de peritonitis e ictericia, cuyo diagnóstico fue confirmado mediante la ecografía. Asimismo, las lesiones de tipo A y C, según la clasificación de Strasberg, fueron las más reiteradas y el procedimiento técnico reparador más común fue el drenaje y lavado de la cavidad abdominal; 88,6 % de los pacientes egresaron vivos y 4 féminas fallecieron (11,4 %), cuya causa de muerte fue el choque séptico. Pudo concluirse que el momento del diagnóstico de estas lesiones se efectuaba tardíamente, y que a pesar de la complejidad de la reparación quirúrgica, existió baja mortalidad.

A descriptive study of 35 surgically treated patients by means of conventional and laparoscopic techniques who presented iatrogenic injuries of the biliary system, was carried out in the General Surgery Service of "Saturnino Lora Torres" Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, in a 8 year period (2007-2014), with the aim of characterizing them according to some variables of interest and of determining the associated mortality. Among the predominant results there were the female sex and the ages from 35 to 54 years, the produced lesions of the elective videolaparoscopic cholecystectomy for vesicular lithiasis, the clinical forms of presentation the intraabdominal abscess with peritonitis signs and jaundice, diagnosis confirmed by means of the echography. Also, injuries A and C, according to the classification of Strasberg, were those most reiterated and the most common restorative technical procedure was drainage and washing of the abdominal cavity; 88.6% of the patients were discharged alive and 4 female patients died (11.4%) whose cause of death was the septic shock. It could be concluded that the moment of diagnosis for these lesions took place late, and that in spite of the complexity of the surgical repair, there was low mortality.

Conhecimento dos profissionais de saúde sobre eventos adversos em unidade de terapia intensiva / Health professionals' knowledge regarding adverse events in the intensive care unit / Conocimiento de los profesionales de salud sobre eventos adversos en unidad de cuidados intensivos

O objetivo deste estudo foi analisar o conhecimento dos profissionais de saúde sobre a ocorrência de eventos adversos em unidade de terapia intensiva. Trata-se de estudo descritivo, realizado com 37 profissionais de saúde de duas unidades de terapia intensiva de um hospital de ensino da cidade de Goiânia, Goiás. A coleta de dados foi de janeiro a março de 2011, com instrumento estruturado e validado, sendo realizada análise estatística descritiva. Dos 37 profissionais, 45,9% desconheciam o significado de evento adverso, mas o reconheciam como parte do processo de trabalho. Relataram a ocorrência de 152 eventos durante o tempo de atuação na unidade. Para sua prevenção, foram sugeridas ações de educação continuada e organização do serviço. Os profissionais de saúde devem ser estimulados a notificá-los e as ações educativas devem ser simuladas a partir do contexto da prática em saúde, como um caminho para a assistência segura e de qualidade.

This descriptive study to examine health professionals' knowledge of adverse events occurring in intensive care units was conducted with 37 health professionals from two intensive care units at a teaching hospital in Goiania, Goias State. Data were collected from January to March 2011 using a validated, structured instrument, and were treated with descriptive statistical analysis. Of the 37 health professionals, 45.9% were unaware of the significance of adverse events, but recognized them as part of the work process, and reported the occurrence of 152 events during their time working in the unit. Continuing professional development activities and service organization measures were suggested with a view to preventing adverse events. Health professionals should be encouraged to report adverse events, and educational actions should use simulation based on the practical health care context as a pathway to safe, quality care.

El estudio tuvo como objetivo analizar el conocimiento de los profesionales de salud sobre la ocurrencia de eventos adversos en unidad de cuidados intensivos. Se trata de un estudio descriptivo, realizado junto a 37 profesionales dela salud de dos unidades de cuidados intensivos de un hospital universitario de Goiânia, Goiás. La recolección de datos tuvolugar de enero a marzo de 2011, con instrumento estructurado y validado. Ha sido realizado el análisis estadístico descriptivo. De los 37 profesionales, un 45,9% desconocía el significado de evento adverso, sin embargo lo reconocía como parte del proceso de trabajo y relató la ocurrencia de 152 eventos durante el tiempo de actuación en la unidad. Para la prevención de eventos adversos, se han sugerido actividades de formación permanente y organización del servicio. Se debe alentar a los profesionales de salud a que informen eventos adversos y se de ben simular acciones educativas dentro del contexto de la práctica en salud, como un camino hacia una atención segura y de calidad.

Aspectos epidemiológicos de pacientes com lesões iatrogênicas das vias biliares / Epidemiological aspects of patients with iatrogenic biliary

Objetivo: avaliar os aspectos epidemiológicos de pacientes com lesões iatrogênicas das vias biliares no Serviçode Cirurgia Geral e do Aparelho Digestivo do Hospital Universitário João de Barros Barreto nos últimos 10 anos.Método: estudo transversal e retrospectivo dos prontuários de 25 pacientes com diagnóstico de lesão iatrogênica davia biliar. Foram incluídos pacientes oriundos do próprio serviço e de outras instituições. O período foi de janeirode 1999 a dezembro de 2008. Resultados: foram encontrados 25 casos de lesões iatrogênicas das vias biliares,sendo 22 consequentes de colecistectomias convencionais. Um total de 56% foi procedente de outras instituições. Asmanifestações clínicas mais prevalentes: dor abdominal (88%), icterícia (76%) e colúria (56%). O tempo de evoluçãodos sintomas variou desde 1º pós-operatório até 168 meses (14 anos). Cerca de 16% apresentavam diagnóstico decolangite no momento da internação. O método de diagnóstico mais utilizado foi a colangiopancreatografia retrógadaendoscópica (48%), seguida da colangiorressonância (28%). As estenoses classificadas como Bismuth II foramas mais encontradas (40%), seguidas de Bismuth III (32%). A cirurgia corretiva foi a hepático-jejunoanastomoseem Y de Roux (92%). As lesões vasculares foram as principais complicações intra-operatórias. O tempo médiode internação foi de 21dias. Conclusão: a maioria dos casos de iatrogenias foi proveniente de colecistectomiasconvencionais, realizadas em centros não especializados em cirurgia de vias biliares. O respeito ao rigor técnico dacirurgia permanece sendo medida preventiva mais eficaz para a diminuição da incidência de iatrogenias das viasbiliares

Objective: to evaluate the epidemiological aspects of iatrogenic injuries of bile ducts of patients seen in generalsurgery service and the digestive system of the University Hospital João de Barros Barreto in the last 10 years.Method: we performed an observational study, the type of retrospective medical records of patients with iatrogenicinjury of the biliary tract. We included patients from the service itself and other institutions. The variables studiedwere sex, age, origin, clinical manifestations, presence of cholangitis, time course, diagnostic method used, surgerythat caused the injury, surgery for the correction, the second Bismuth classification of the lesion, intraoperativecomplications surgery and hospital stay. Results: we found 25 cases of iatrogenic biliary tract, with 22 resulting fromconventional cholecystectomy. A total of 56% came other institutions. The female sex was more prevalent (80%), theaverage age of patients was 43 years. The most prevalent clinical manifestations: abdominal pain (88%), jaundice(76%) and dark urine (56%). The duration of symptoms ranged from 1 postoperative day up to 168 months (14years). About 16% had a diagnosis of cholangitis at admission. The method most frequently used is the endoscopicretrograde cholangiopancreatography (48%), followed by magnetic resonance cholangiography (28%). The stenosesclassified as Bismuth II were the most frequent (40%), followed by Bismuth III (32%). Corrective surgery washepatic-jejunoanastomose Roux-Y (92%). Vascular lesions were the major intraoperative complications. The meanhospital stay was 21 days. Conclusion: most cases of iatrogenic injuries came from conventional cholecystectomyperformed in centers not specialized in surgery of the biliary tract. Respect for the technical accuracy of the surgeryremains the most effective preventive measure for reducing the incidence of iatrogenic injuries of bile ducts.

La relación médico-paciente y su importancia en la práctica médica / Physician-patient relationship and its significance in medical practice

La práctica de la medicina combina la ciencia y la tecnología con la aplicación de conocimientos y valores. Esta combinación gira alrededor de la interacción médico-paciente, elemento necesario para que la acción del médico pueda intervenir en las necesidades del enfermo. Se realizó una valoración que incluyó el análisis de la relación médico-paciente, la práctica médica, la yatrogenia y la ética médica, para establecer la relación existente entre estas categorías. La entrevista médica es la herramienta principal para obtener una anamnesis fidedigna, y para establecer una relación médico-paciente sólida, perdurable y productiva; esta última constituye un escenario fundamental y determinante para la adecuada expresión o no del resto de los elementos que definen la práctica asistencial.

Medical practice combines science and technology with the implementation of knowledge and values. Such combination deals with the physician-patient interaction, a required element that enables the physician to intervene in the patient´s needs through his/her actions. This paper made an assessment that included the analysis of the physician/patient relationship, the medical practice, the iatrogenia and the medical ethics, in order to set the relationship among these categories. The medical interview is the key tool for a reliable anamnesis and for establishing sound, durable and productive physician-patient relationship; it is also the fundamental and determining scenario for adequate or inadequate expression of the rest of the elements defining the medical assistance practice.