ABSTRACT
Objetivo: Analizar el potencial de innovación en apósitos para tratar heridas crónicas en la Ciudad de Lima. Métodos: Se realizó un estudio cualitativo mediante una encuesta y análisis de las entrevistas realizadas a expertos médicos y gestores de compras en insumos para el tratamiento de heridas de difícil resolución en 8 instituciones representativas de salud pública con categorías 1 4 dentro de las 54 existentes solo en Lima Metropolitana, Perú - 2018. Resultados: Se determinó que en las instituciones de salud pública son atendidos un promedio 17 pacientes mensualmente (60% provenientes de hospitalización y 40% de consultorio externo). Equivale decir que 11,016 pacientes presentan heridas crónicas de difícil resolución al año, los cuales requerirán de tratamiento especializado y una demanda anual promedio de 110,160 apósitos en stock. Los apósitos con mayor demanda corresponden a los Hidrogeles e Hidrocoloides, respectivamente que son utilizados por los resultados positivos que ofrecen en la curación de las heridas, aunque en ocasiones la limitante es el aspecto económico. En el mercado, el precio unitario oscila entre los 20 y 90 soles, esto representa una inversión económica de 1500 soles en promedio por paciente, produciendo en algunos casos complicaciones o abandono del tratamiento cuando los recursos son escasos. Conclusiones: La demanda de pacientes con heridas crónicas de difícil resolución en las instituciones de salud públicas de Lima metropolitana es alta. Es importante promover e incentivar la investigación de nuevas alternativas terapéuticas y/o dispositivos biomédicos que favorezcan su curación.
Objective: To analyze the potential for innovation in dressings to treat chronic wounds in the City of Lima. Methods: A qualitative study was carried out by means of interviews to medical experts and purchasing managers of medical supplies for the treatment of difficult-to-resolve wounds in 8 representative public health institutions with categories 1-4 within the only 54 of Lima, Peru - 2018. Results: It was determined that an average of 17 patients is treated in public health institutions on a monthly basis (60% from hospitalization and 40% from an outpatient office). It is equivalent to say that 11,016 patients present chronic wounds of difficult resolution each year, which will require specialized treatment and an average annual demand of 110,160 dressings in stock. The dressings with the highest demand correspond to the Hydrogels and Hydrocolloids, respectively; used because of the positive results they offer in wound healing, despite economic limitations. The market price per unit ranges between 20 and 90 soles (S/.), representing an economic investment of 1500 soles on average per patient, in some cases causing complications or abandonment of treatment when resources are scarce. Conclusions: There is a high demand for patients with chronic wounds of difficult resolution in the public health institutions of Lima. It is important to promote and incentivize the investigation of new therapeutic alternatives and / or biomedical devices that favor its treatment.
ABSTRACT
Objective To detect the early diversification of the bone mineral density in skeletal fluorosis of rabbits by quantitative computed tomography (QCT),and analyze the possible relationship between bone mineral density and bone injury in rabbits with fluorosis.Methods A total of 16 rabbits,half male and half female,were randomly divided into control and experimental groups according to body weight.The two groups of rabbits were given drinking water containing NaF 0 or 300 mg/L,respectively,for 90 days.After the experiment,their bone fluoride content was determined via the fluorine ion-selective electrode method.The alkaline phosphatase (ALP) and osteocalcin (BGP) in serum were measured using enzyme-linked immunosorbent assay (ELISA).Femurl bone mineral density was detected with QCT in vivo.Histopathological changes of femur were observed under light microscope and trabecular acreage was calculated.The results were analyzed with independent-samples t test(t') and partial correlations.Results The bone fluoride content [(3 232.16 ± 927.85) mg/kg],ALP [(42.69 ± 3.28) U/L],BGP concentration [(2 504.19 ± 276.79) μg/L],bone density [(653.49 ± 167.81) g/cm3] and trabecular number [(39.02 ± 3.33)Tb.Ar] of the experimental group were higher than those of control group [(554.01 ± 376.51)mg/kg,(20.50 ± 4.90)U/L,(1 294.60 ± 191.86)μg/L,(540.40 ± 41.99)g/cm3,(8.15 ± 2.34)Tb.Ar],and the differences were statistically significant (t'=7.565,10.641,10.158,2.615,14.494,all P ＜ 0.05).The tissue sclerosis,bone sclerosis and bone texture coarsening were observed through bone mineral density imaging taken by QCT in experimental group.The number of trabeculae increased and the arrangement of tra bec ulae was disorganized.Bone mineral density was positively correlated with bone fluoride,trabeculae,BGP and ALP (r =0.702,0.627,0.614,0.567,all P ＜ 0.05).Conclusions QCT bone density measurement in skeletal fluorosis of rabbits can be used to compute the threedimensional bone density.And it has a good correlation with bone fluoride content,bone histopathological changes and index of bone metabolism in skeletal fluorosis,which suggests that QCT may provide a useful reference for application in patients with skeletal fluorosis.
ABSTRACT
Introduction: Nowadays laparoscopy is the new paradigm in many surgical treatments; however, its role in urological trauma is barely emerging. The aim of this article is to show a laparoscopic repair technique of an intraperitoneal bladder rupture secondary to a blunt abdominal trauma, its feasibility and safety. Case: We present a 28 year old man who consulted with 6 hours of hypogastric pain, absence of micturition and vesical globe, after alcoholic consumption. He presented high blood both creatini-ne and inflammatory parameters. A Foley catheter was installed, the pain increased progressively, with Blumberg sign and tachycardia. Looking back again, he told about a blow in the hypogastric region with full bladder. A non-contrasted CT of the pelvis showed the catheter's end into peritoneal cavity. A successfully three port laparoscopic repair was made using intracorporeal double layer suturing technique with poliglactin, an intraoperative cystoscopic check was performed. The patient was discharged at sixth day without complications. Discussion: Classically surgical treatment for intraperitoneal bladder rupture has been laparotomy with double layer closure of the lesion. However, there are no randomized control trials comparing this technique with other methods. Also, there is a lack of laparoscopic repair reports, probably due to most bladder ruptures are extraperitoneal (managed with non-surgical treatment) or associated with other organs injury (needing laparotomy). Although more evidence is needed, we believe that laparoscopic repair of intraperitoneal bladder rupture could be considered as an option in stable patients and without important associated injuries, achieving better cosmetic outcomes and faster recovering.
Introducción: Actualmente la laparoscopia es el nuevo paradigma en muchos tratamientos quirúrgicos, pero su rol en trauma urológico es incipiente. Nuestro objetivo es mostrar una técnica factible y segura de cistorrafia laparoscópica por ruptura vesical intraperitoneal contusa. Caso: Un hombre de 28 años consulta por 6 horas de dolor hipogástrico, retención y globo vesical, después de una transgresión alcohólica. Ingresa con creatininemia y parámetros inflamatorios elevados. A pesar de un sondeo vesical exitoso, evoluciona con más dolor, Blumberg y taquicardia. Revisando la anamnesis, refiere un golpe en hipogastrio, con vejiga llena. En pieloTAC se observa el extremo de la sonda en cavidad peritoneal. En pabellón, se realiza una reparación laparoscópica mediante tres trócares, usando sutura de poliglactina en doble capa, con revisión cistoscópica intraoperatoria. El paciente se da de alta al sexto día postoperatorio, sin complicaciones. Discusión: Clásicamente, el tratamiento quirúrgico de la ruptura vesical intraperitoneal, ha sido la laparotomía exploradora con cierre de la lesión en doble capa. Sin embargo, esta técnica no ha sido comparada en estudios randomizados con otras modalidades. Además, hay escasos reportes de la técnica laparoscópica, probablemente porque la mayoría de las lesiones son extraperitoneales (con manejo conservador) o con lesión de otros órganos (requiriendo laparotomía). Se necesita más evidencia, pero creemos que la cistorrafia laparoscópica de lesiones intraperitoneales, es una buena conducta en pacientes estables sin otros daños asociados, alcanzando mejores resultados estéticos y una recuperación más rápida.