Treatment duration of wrist-ankle acupuncture for relieving post-thyroidectomy pain: A randomized controlled trial / 中西医结合学报

BACKGROUND@#Treatment duration of wrist-ankle acupuncture (WAA) is uncertain for post-thyroidectomy pain relief.@*OBJECTIVE@#This study evaluated the effect of different WAA treatment duration on post-operative pain relief and other discomforts associated with thyroidectomy.@*DESIGN, SETTING, PARTICIPANTS AND INTERVENTION@#This randomized controlled trial was conducted at a single research site in Guangzhou, China. A total of 132 patients receiving thyroidectomy were randomly divided into the control group (sham WAA, 30 min) and three intervention groups (group 1: WAA, 30 min; group 2: WAA, 45 min; group 3: WAA, 60 min), with group allocation ratio of 1:1:1:1. Acupuncture was administered within 1 hour of leaving the operating room.@*OUTCOMES AND MEASURES@#Primary outcome was patients' pain at the surgical site assessed by visual analogue scale (VAS) at the moment after acupuncture treatment (post-intervention). Secondary outcomes included the patients' pain VAS scores at 6, 12, 24, 48 and 72 h after the thyroidectomy, the 40-item Quality of Recovery (QoR-40) score, the grade of post-operative nausea and vomiting (PONV), and the use of additional analgesic therapy.@*RESULTS@#The adjusted mean difference (AMD) in VAS scores from baseline to post-intervention in group 1 was -0.89 (95% confidence interval [CI], -1.02 to -0.76). The decrease in VAS score at post-intervention was statistically significant in group 1 compared to the control group (AMD, -0.43; 95% CI, -0.58 to -0.28; P < 0.001), and in groups 2 and 3 compared to group 1 (group 2 vs group 1: AMD, -0.65; 95% CI, -0.81 to -0.48; P < 0.001; group 3 vs group 1: AMD, -0.66; 95% CI, -0.86 to -0.47; P < 0.001). The VAS scores in the four groups converged beyond 24 h after the operation. Fewer patients in group 2 and group 3 experienced PONV in the first 24 h after operation. No statistical differences were measured in QoR-40 score and the number of patients with additional analgesic therapy.@*CONCLUSION@#Compared with the 30 min intervention, WAA treatment with longer needle retention time (45 or 60 min) had an advantage in pain relief within 6 h after surgery. WAA's analgesic effect lasted for 6-12 h post-operatively. Please cite this article as: Han XR, Yue W, Chen HC, He W, Luo JH, Chen SX, Liu N, Yang M. Treatment duration of wrist-ankle acupuncture for relieving post-thyroidectomy pain: A randomized controlled trial. J Integr Med. 2023; 21(2): 168-175.

Drotaverine to shorten the duration of labour in primigravidas: a randomised, double-blind, placebo-controlled trial

Background: Drotaverine, a spasmolytic, has been found to have potential to achieve a reduction in the duration of labor and prevent prolonged labor. Objective: To compare the effects of intravenous drotaverine hydrochloride with placebo for shortening the duration of active phase of labor in primigravida's. Methods: A double-blind, placebo-controlled randomized trial of 246 primigravida's in active phase of labor at term was conducted. They were randomly (1:1 ratio) administered intravenous 2 ml (40mg) of drotaverine hydrochloride or 2 ml of Vitamin B complex as placebo. The primary outcome measure was the duration of active phase of labor. The secondary outcome measures were cervical dilatation rate, oxytocin augmentation rate, incidence of prolonged labor, labor pain scores, mode of delivery, maternal and neonatal outcomes. Results: The mean duration of active phase of labor (hour) was significantly lower in the drotaverine group compared to the control (drotaverine; 6.22 ± 2.41 vs placebo; 8.33 ± 3.56; p <0.001). Also, the cervical dilatation rate (cm/hr) was significantly faster in the drotaverine arm (drotaverine; 1.68 ± 1.02 versus placebo; 1.06 ± 0.53, p <0.001). There was a significantly higher probability of faster delivery among women who were given drotaverine (log-rank test, p < 0.001). The oxytocin augmentation rate, incidence of prolonged labor, labor pain scores, mode of delivery, maternal and neonatal outcomes were not significantly different among the groups. Conclusions: Drotaverine hydrochloride is effective in shortening the duration of active phase of labor without adverse maternal and neonatal outcomes. However, more evidence is needed to explore its role in active phase of labor among primigravid women. Trial registration number: PACTR201810902005232

Prise en charge des patients COVID-19 à l'hôpital de dermatologie de Bamako / Care of COVID-19 patients at the dermatology hospital of Bamako

Aim: To assess the COVID-19 patients' treatment duration according to the place of treatment at the Dermatology Hospital of Bamako (DHB). Methods: This was a cross-sectional study comparing the management of COVID-19 PCR-positive patients in the hospital to that of those managed at home from March 2020 to April 2021 until two consecutive negative PCR 48 hours apart. Results: Among the 1109 patients, 369 were hospitalized, 497 followed at home. As of April 31, 2021, 81.2% (900/1109) of the patients recovered, 1.3% (14/1109) were transferred to another health structure, and 2.5% (28/1109) died. No statisticallysignificant difference was observed between the meanduration of the treatment for patients treated at home (10 days) in (95% CI, 9.69-10.3) and those managedathospital (10 days95% CI, 9.76-10.23) (Mantel-Cox test, p= 0.060). Conclusion: These results suggest that the place of treatment do not influence the time to recovery. This is particularly important given the current burden of COVID-19 management on the health workforce

Objectif: Evaluer la durée du traitement des patients COVID-19 selon le lieu de pris en charge à l'Hôpital de Dermatologie de Bamako (HDB). Méthodologie : Il s'agissait d'une étude transversale comparant la prise en charge des patients COVID-19 PCR-positifs à l'hôpital à celle à domicile de mars 2020 à avril 2021 jusqu'à l'obtention de deux tests PCR négatifs consécutifs à 48 heures d'intervalle. Résultats : Parmi les 1109 patients, 369 ont été hospitalisés, 497 suivis à domicile. Au 31 avril 2021, 81,2% (900/1109) des patients se sont rétablis, 1,3% (14/1109) ont été transférés dans une autre structure de santé et 2,5% (28/1109) sont décédés. Aucune différence statistiquement significative n'a été observée entre la durée moyenne du traitement pour les patients traités à domicile (10 jours) en (IC 95 %, 9,69-10,3) et ceux pris en charge à l'hôpital (10 jours IC 95 %, 9,76-10,23) (test de Mantel Cox, p= 0,060). Conclusion: Ces résultats suggèrent que le lieu de traitement n'influence pas le temps de récupération. Ceci est particulièrement important étant donné la charge actuelle de la gestion des COVID-19 sur le personnel de santé

Rol de enfermería en terapia de reemplazo renal continuo en una Unidad de Cuidados Intensivos Quirúrgicos / Nursing Involvement in Continuous Renal Replacement Therapy in a Surgical Intensive Care Unit

Introducción: La disfunción renal aguda es una complicación grave y frecuente en Unidades de Cuidados Intensivos, que se asocia al empleo de terapias continuas de reemplazo renal, donde la actuación de enfermería es determinante para su aplicación exitosa. Objetivo: Describir el rol de enfermería en el uso de terapias de reemplazo renal continuo en una Unidad de Cuidados Intensivos Quirúrgicos. Métodos: Estudio cuantitativo, descriptivo de corte transversal, en la Unidad de Cuidados Intensivos del Centro Nacional de Cirugía de Mínimo Acceso, La Habana, Cuba, desde 2016 hasta 2019. Universo de 10 pacientes con terapias de reemplazo renal continuo, se revisaron en historias clínicas las variables edad, sexo, duración del hemofiltro, duración de la terapia, acceso venoso, valores de creatinina y urea. Se utilizó el programa IBM SPSS para Windows para calcular distribuciones de frecuencias absolutas, porcentajes, media, mediana, desviación típica, valor mínimo y máximo. Resultados: La mediana de edad fue 73 años, el hemofiltro con duración media de 14,70 horas, tiempo medio de terapia 77 horas, valores medios de creatinina 206,9 É¥mol/l y urea 22,4 mmol/l. Se utilizó anticoagulación sistémica. Conclusiones: El rol de enfermería fue decisivo en el uso exitoso de terapias de reemplazo renal continuo en la Unidad de Cuidados Intensivos Quirúrgicos estudiada. La insuficiencia renal aguda fue la causa de inicio de las terapias, predominaron los pacientes adultos mayores sin diferencias en relación al sexo. Se mantuvo la terapia por más de 72 horas en varios pacientes, se debe lograr una mayor longevidad de los filtros(AU)

Introduction: Acute renal dysfunction is a serious and frequent complication in Intensive Care Units, associated with the use of continuous renal replacement therapies, where nursing action is decisive for successful application. Objective: To describe the involvement of nursing in the use of continuous renal replacement therapies in a Surgical Intensive Care Unit. Methods: A quantitative, descriptive, cross-sectional study of 10 patients with continuous renal replacement therapies in the Intensive Care Unit was carried out at the National Center for Minimal Invasive Surgery, Havana, Cuba, from 2016 to 2019. The medical records were reviewed for the variables age, sex, hemofilter duration, duration of therapy, venous access, creatinine and urea values. The IBM SPSS program for Windows was used to calculate absolute frequency distributions, mean, percentages, median, standard deviation, minimum and maximum value. Results: The median age was 73 years, hemofilter had a mean duration of 14.70 hours, mean therapy time 77 hours, mean creatinine values 206.9 µmol /l and urea 22.4 mmol /l. Systemic anticoagulation was used. Conclusions: The nursing involvement was decisive in the successful use of continuous renal replacement therapies in the Surgical Intensive Care Unit studied. Acute renal failure was the cause of initiation of therapies; older patients predominated with no differences in relation to sex. The therapy was kept for more than 72 hours in several patients; a greater longevity of the filters should be achieved(AU)

Esteroides y COVID-19: una revisión de la evidencia en crecimiento durante la pandemia / Steroids and COVID-19: a review of growing evidence during the pandemic

El mecanismo específico por el cual los esteroides actuarían sobre la inflamación pulmonar sostenida, así como la definición del mejor fármaco a utilizar e incluso la duración adecuada del tratamiento, siguen siendo objetivo de estudio de los ensayos clínicos en curso. Como médicos clínicos, creemos que las potentes propiedades antiinflamatorias de los esteroides sintéticos están bien definidas, y aún falta evidencia definitiva de que otras estrategias antiinflamatorias proporcionen una mejor eficacia, al menos en el COVID-19. Aunque los esteroides sintéticos comparten una marcada acción antiinflamatoria y escasos efectos mineralocorticoides, su bioequivalencia y diferentes cinéticas deben considerarse cuidadosamente, debido a la elevada variabilidad de la farmacocinética individual, uso y prescripción adecuada de estos fármacos, ya que pueden desencadenar efectos adversos diversos que podrían impactar negativamente el curso clínico del paciente con COVID-19. Además, muchos de los fármacos actualmente considerados en el manejo del paciente con esta patología pueden potenciar la vida media y la aparición de efectos adversos de los corticoesteroides, o algunos efectos adversos de estos otros fármacos pueden simular complicaciones asociadas al uso de corticoesteroides, lo que podría conllevar a una suspensión precoz e inoportuna de los mismos. Números estudios clínicos y artículos basados en revisiones narrativas han servido de guías para los médicos clínicos en medio de esta pandemia, sin embargo, sus resultados deben interpretarse con cautela. Por estas razones, hemos realizado un análisis con base en el sistema GRADE de estos estudios para contrastar la información incluida en los estudios clínicos y minimizar el error de análisis(AU)

e specific mechanism by which steroids would act on sustained lung inflammation, as well as the definition of the best drug to use and the appropriate treatment duration remain to be the objectives of ongoing clinical trials. As clinicians, we believe that the potent anti-inflammatory properties of synthetic steroids are well defined and definitive evidence that other anti-inflammatory strategies provide better efficacy is still lacking, at least in COVID-19. Although synthetic steroids share a pronounced anti-inflammatory action and few mineralocorticoid effects, their bioequivalence and different kinetics should be considered, due to the high variability of individual pharmacokinetics, the appropriate use and prescription of these drugs, given that they could trigger various effects that could negatively impact the clinical course of the patient with COVID-19. In addition, many of the drugs currently considered in the management of the patient with this disease can enhance the half-life and appearance of adverse effects of corticosteroids and some adverse effects of these other drugs can simulate complications associated with the use of corticosteroids, which could lead to an early and untimely suspension of them. Numerous clinical studies and study articles based on narrative reviews have served as guides for clinicians in the midst of this pandemic; however, the results of these should be interpreted with caution. For these reasons, we have performed an analysis based on the GRADE system of these studies to contrast the information included in the clinical studies and minimize the error of analysis(AU)

Enfermedad por arañazo de gato con compromiso hepato-esplénico en adultos inmunocompetentes / Hepatosplenic cat-scratch disease in immunocompetent adults cat scratch

La enfermedad por arañazo de gato (EAG) es una zoonosis emergente causada por Bartonella henselae. Puede presentarse de forma atípica, incluyendo meningitis, neuroretinitis, endocarditis y compromiso hepatoesplénico, lo cual es poco frecuente en adultos inmunocompetentes. Su manejo terapéutico es controvertido dada la ausencia de ensayos aleatorizados al respecto. Se describen 5 casos de EAG con compromiso hepato-esplénico, donde la correcta anamnesis epidemiológica permitió la sospecha diagnóstica, evitando la realización de procedimientos invasivos en la mayoría de los casos. La posibilidad de realización de PCR y serología para Bartonella spp. fueron de vital importancia

Cat scratch disease (CSD) is an emerging zoonosis caused by Bartonella henselae. It can occur atypically including meningitis, neuroretinitis, endocarditis and hepatosplenic involvement, a rare occurrence in immunocompetent adults. Therapeutic management is controversial, supported by case series and retrospective data published literature. Five cases of CSD with hepatosplenic involvement are described. The correct clinical and epidemiological anamnesis allow the diagnostic and avoid the performance of invasive procedures in most cases. The possibility of performing Bartonella spp PCR and serology is crucial

Prescripción de analgésicos no opioides en un Servicio de Ortopedia / Prescription of non-opioid analgesics in an Orthopedics Service

Introducción: El dolor asociado a las alteraciones del sistema musculoesquelético debe ser tratado frecuentemente por los especialistas en Ortopedia. Los analgésicos no opioides se ubican dentro de los fármacos que más se prescriben en este Servicio, aunque no siempre de modo adecuado, según los principios de la prescripción racional. Objetivo: Caracterizar el uso de analgésicos no opioides en el servicio de Ortopedia del Hospital Dr. Salvador Allende. Material y Métodos: Estudio descriptivo de utilización de medicamentos del tipo prescripción-indicación y esquema terapéutico. Se revisaron las historias clínicas de 70 pacientes ingresados en el Servicio de Ortopedia del Hospital Dr. Salvador Allende, durante el período comprendido desde septiembre de 2018 hasta enero de 2019. Resultados: Predominó el sexo femenino y la media de edad de 71,3 años en los pacientes estudiados con una desviación estándar de 22.2 años. Los analgésicos más prescritos fueron dipirona, diclofenaco y paracetamol, en indicaciones aprobadas donde destacaron las fracturas, la celulitis y la seudoartrosis. En la totalidad de los casos, las dosis empleadas fueron adecuadas, no así los intervalos de administración ni la duración del tratamiento. Conclusiones: Es alentador el predominio de la prescripción de analgésicos no opioides con buena relación beneficio-riesgo. No obstante, la presencia de prescripciones irracionales en cuanto a intervalos de administración y duración del tratamiento, indica un déficit en la práctica de la terapéutica analgésica que no debe ser ignorado(AU)

Introduction: The pain associated with alterations of the musculoskeletal system should be frequently treated by the specialist in Orthopedics. Non-opioid analgesics are the most prescribed drugs in this medical service although they are not always used appropriately according to the principles of national prescription. Objective: To characterize the use of non-opioid analgesics in the orthopedics service of the Dr. Salvador Allende Hospital. Material and Methods: A descriptive study of the use of prescription-indication medications and therapeutic scheme was conducted. Medical records of 70 patients admitted to the orthopedics service of the Dr. Salvador Allende Hospital during the period between September 2018 and January 2019 were reviewed. Results: The female sex and a mean age of 71.3 years with standard deviation of 22,2 years predominated in the study. The most frequently used analgesics, which were indicated in the treatment of fractures, cellulitis and pseudarthrosis, were dipyrone, diclofenac and paracetamol. In all cases, the doses used were adequate, but not the administration intervals or the duration of treatment. Conclusions: The predominance of the prescription of non-opioid analgesics with a good benefit-risk ratio is encouraging. However, the presence of irrational prescriptions regarding administration intervals and duration of treatment indicates a deficit in analgesic therapy that should not be ignored(AU)

Timely and conservative anticoagulation in Septic Cavernous Sinus Thrombosis: A case report

Background@#Cavernous Sinus Thrombosis (CST) is a rare and life-threatening condition with antibiotics as the mainstay of therapy for those due to infection. While controversy exists, recent retrospective reviews using anticoagulation reveal potential mortality reduction with a low risk of adverse events such as intracranial hemorrhage (ICH). The optimal timing and duration of treatment are unknown.@*The Case@#We report a 32-year-old female who presented with fever, headache, complete bilateral ophthalmoplegia, cellulitis, and a cranial MRV diagnostic of CST. She received antibiotics targeted to MRSA organisms isolated from eye and blood specimen. Further, into the course, the patient had an onset of aphasia and right-sided hemiplegia. Workup revealed multiple cranial infarcts with narrowing of the left internal carotid artery, likely representing thrombus as the source of embolism. The decision to anticoagulate was reevaluated and subsequently started. The patient was reassessed clinically after two months to have improved motor strength and speech return; thus, anticoagulation was discontinued.@*Discussion@#Although data are lacking, most recent reports favor the use of anticoagulation. Some authors recommend initiation in patients with deteriorating neurologic status despite antibiotics and hydration. The higher frequency of ICH in anticoagulated CST patients with CNS infection is a basis for some authors to withhold treatment. The treatment duration varies with different studies, generally ranging from several weeks to three months or more.@*Conclusion@#Further studies are needed to define the exact role of anticoagulation, particularly its timing and duration. Nevertheless, timely identification of the condition and constant re-evaluation are critical to early patient recovery.

Actualidad en ortodoncia: las micro-osteoperforaciones en la aceleración del tratamiento ortodóncico / An update in orthodontics: micro-osteoperforations for accelerating orthodontic treatment

La búsqueda por encontrar métodos para acortar la duración de los tratamientos de ortodoncia tiene un pasado reciente, un presente y un futuro. Las fuerzas ortodóncicas que se ejercen sobre la membrana periodontal producen movimientos dentarios por modificaciones histológicas y biomoleculares. El conocimiento de los procesos biológicos da lugar a implementar cambios para favorecer la aceleración de los procesos resortivos y neoformativos. El objetivo de esta publicación es hacer una breve síntesis de lo acontecido con este tema y exponer el procedimiento de las micro-osteoperforaciones (MOPs) como una opción complementaria al tratamiento de ortodoncia convencional. Aún no existe suficiente apoyo de ensayos clínicos en humanos para aseverar su éxito. Más aún, distintos autores publican conclusiones contradictorias. Es de esperar que, en breve, nuevas investigaciones contribuyan a respaldarlo o desestimarlo (AU)

The quest to find methods to shorten the duration of orthodontic treatments has a recent past, a present, and a future. Orthodontic forces exerted on the periodontal membrane produce tooth movements by histological and biomolecular modifications. Knowledge of biological processes results in changes to promote the acceleration of spring and neoformative processes. The objective of this publication is to make a brief synthesis of what happened with this topic and expose the micro-osteoperforations (MOPs) procedure as a complementary option to conventional orthodontic treatment. There is not yet enough support from human clinical trials to assert its success. Moreover, different authors publish conflicting conclusions. It is to be expected that, shortly, further investigations will help to support or dismiss it (AU)

Administración de radioyodo en cáncer diferenciado de tiroides bajo régimen hospitalario: a propósito de la implementación del aislamiento de radioyodoterapia en un hospital regional / Administration of radioiodine in differentiated thyroid cancer under a hospital regime: about the implementation of radioiodotherapy isolation in a regional hospital

Resumen Introducción El cáncer diferenciado de tiroides (CDT) presenta un aumento a nivel mundial. El uso selectivo de terapia con radioyodo (RAI) es un pilar de su tratamiento. Su efecto terapéutico se debe a la radiación beta, mientras que la gamma hace que sea necesaria la hospitalización para limitar la exposición de terceros. Objetivo Describir la seguridad de la administración de altas dosis de RAI en pacientes con CDT. Materiales y Método Estudio retrospectivo descriptivo. Se incluyó a todos los pacientes con diagnóstico de CDT que requirieron hospitalización para administración de RAI ≥ 30 mCi en el Hospital Regional de Talca (HRT) entre agosto-diciembre de 2018. Resultados Durante el período descrito 10 pacientes recibieron RAI bajo régimen hospitalario. La mediana de dosis de RAI administrada fue de 100 mCi (rango: 50-150 mCi). Todos los pacientes fueron manejados con asilamiento estricto. El promedio de hospitalización fue 28 horas, siendo dados de alta al reportar una tasa de dosis absorbida < 70 µSv/h a 1 metro. Se entregaron instrucciones al alta para minimizar el riesgo de irradiación o contaminación a terceras personas. Conclusiones Nuestro protocolo de administración de RAI permite tratar de manera segura a pacientes con CDT disminuyendo la exposición a radiación de terceros. Las salas de asilamiento de radioyodoterapia, podrían dar cobertura al 100% de la demanda de terapia con RAI en CDT a nivel local.

Introduction Differentiated thyroid cancer (CDT) presents an increase in global levels. The selective use of radioiodine therapy (RAI) is a pillar of its treatment. Its therapeutic effect is due to beta radiation, while gamma makes hospitalization necessary to limit exposure. Aim To describe the safety treated with RAI inpatients and the functioning of the radioactive isolation rooms of our center. Materials and Method Retrospective descriptive study. All patients diagnosed with CDT who required RAI therapy under a hospital regimen at the Regional Hospital of Talca (HRT) between August-December 2018 were included. Results During the period described, 10 patients were treated. The median dose of RAI administered was 100 mCi (range: 50-150 mCi). The average of hospitalization was 28 hours, being discharged when reporting an absorbed dose rate < 70 μSv/h at 1 meter, giving the patient instructions, so that they follow to minimize the risk of irradiation or contamination of people in their environment. Conclusions Our RAI administration protocol allows patients with CDT to be treated safely. The radioactive isolation rooms could cover 100% of the demand for RAI therapy in CDT at the local level.

Cirugía transoral en cáncer de laringe estadificado T1-T2 / Transoral surgery in T1-T2 staged laryngeal cancer

Se realizó un estudio prospectivo y descriptivo, incluyendo 103 pacientes que fueron tratados por cáncer de laringe en etapa inicial (T1-T2) con cirugía transoral. De ellos, 55 se diagnosticaron en estadio T1, 16 en estadio T1-b y 32 en estadio T2. El control local inicial (CLI) en pacientes con tumores malignos de laringe estadificados T1 fue 91%, el control local con rescate (CLR) 96%, la preservación de la función de la laringe (PFL) 93% y la sobrevida específica 96%. En T1-b, el CLI fue 81%, el CLR 94%, la PFL 94% y la sobrevida específica 94%. En T2, el CLI fue 63%, el CLR 94%, la PFL 72% y la sobrevida específica 78%. La cirugía transoral en cáncer de laringe con T inicial tiene resultados oncológicos similares a otros tratamientos (cirugía externa o radioterapia), pero consideramos que es la mejor opción por su baja morbilidad, menor duración del tratamiento, y porque deja abiertas todas las posibilidades para tratar posibles recurrencias. (AU)

A prospective and descriptive study was conducted, including 103 patients who were treated for early stage laryngeal cancer (T1-T2) with transoral surgery. Of these, 55 were diagnosed in stage T1, 16 in stage T1-b and 32 in stage T2. The initial local control (CLI) in patients with malignant T1 laryngeal tumors was: 91%, local control with rescue (CLR) 96%, preservation of larynx function (PFL) 93% and specific survival 96%. In T1-b the CLI was 81%, the CLR 94%, the PFL 94% and the specific survival 94%. In T2 the CLI was 63%, the CLR 94%, the PFL 72% and the specific survival 78%. Transoral surgery in laryngeal cancer with initial T has oncological results similar to other treatments (external surgery or radiotherapy), but we consider that it is the best option because of its low morbidity, shorter duration of treatment, and because it leaves open all the possibilities to treat possible recurrences. (AU)

Probióticos en el síndrome de intestino irritable con predominio de diarrea / Probiotics for the treatment of diarrhea predominant irritable bowel syndrome

Una mujer de 36 años, diagnosticada con síndrome de intestino irritable a predominio de diarrea (SII-D) acude a la consulta médica. Ella pregunta si el uso de probióticos sería útil para controlar los episodios de diarrea, ya que los fármacos con los que está siendo tratada no le resultan eficaces. Se realizó una búsqueda bibliográfica con el objetivo de en contrar evidencia en respuesta a su consulta, tras la cual se seleccionaron dos ensayos clínicos y una revisión sistemática. Se evidenciaron diversos resultados en cuanto al uso de probióticos en el SII-D y se discutieron los riesgos y beneficios del tratamiento, así como las implicancias en la vida de la paciente. (AU)

A 36-year-old woman diagnosed with diarrhea predominant irritable bowel syndrome (D-IBS) goes to meet the doctor. She raises whether the use of probiotics would be useful for controlling diarrhea episodes, since the drugs which she is being treated with, are not effective. A bibliographic search was conducted with the objective of finding evidence in response toher query. Two clinical trials and a systematic review were found. Variable results were found regarding the use of probioticsin D-IBS. The risks and benefits of the treatment were discussed, as well as the implications in the patient's lifestyle. (AU)

Duration of breast feeding and outcome of HIV-exposed infants seen at a tertiary health facility in Sokoto

Background: Appropriate infant feeding is still a challenge to HIV-positive mothers especially in the developing world despite their desire to breast feeding beyond the WHO recommended 12 months' duration. Objective: To determine the duration of breast feeding and correlate with outcome of HIV-exposed infants in UDUTH, Sokoto. Methods: This descriptive observational study was conducted among HIV-exposed infants attending Paediatric ART(PMTCT) clinic, UDUTH, Sokoto. The demographics, infant post-exposure prophylaxis, duration of breast feeding and results of early infant diagnosis (EID) of the infants using HIV-DNA PCR machine; and maternal highly active antiretroviral therapy (HAART) history were documented. The data were analyzed using SPSS version 24.0. A p-value of ≤0.05 was taken as significant. Results: One hundred and sixty-three HIV-positive mother-infant pairs were studied, 103(61.7%) of the HIV-positive mothers were aged 25-34 years, 105(62.9%) were of lower socio-economic class and 94(56.3%) had informal education. One hundred and fifteen (62.5%) were on TDF/3TC/EFV and 143 (85.6%) were on HAARTs prior to the index pregnancy. One hundred and sixty-three of the HIV-exposed infants studied were breast-fed and 165 (98.8%) had nevirapine as infant PEP. The mean duration of breast feeding among HIV-exposed infants was 13.2(±3.5) months with a range 6 ­ 20 months. Ninety-eight (60.1%) infants were breastfed beyond 12months. All the HIV-exposed infants were not infected at the end of breastfeeding for 12 months or more. Conclusion: Majority of the HIV-positive mother's breastfed beyond WHO recommended 12 months and their infants were uninfected. This may support the upward review of the duration of breast feeding of HIV-exposed infants in our community

Factores que Afectan la Duración de los Tratamientos de Ortodoncia en un Servicio Público de Salud / Factors that Affect the Duration of Orthodontic Treatment in Public Health Services

RESUMEN: La duración de los tratamientos de ortodoncia siempre ha sido una de las mayores preocupaciones, tanto en los pacientes como en los Ortodoncistas. El proposito de esta investigacion fue determinar la magnitud de las inasistencias a los controles por parte de los pacientes y como estas y otras variables, influyen en la duración de los tratamientos de Ortodoncia en el Centro de Salud Familiar (CESFAM) Dr. Victor Manuel Fernandez, Servicio de Salud de Concepcion, Chile. Se realizo un estudio descriptivo, de tipo transversal, retrospectivo, en el que se utilizaron las fichas clínicas de todos los pacientes que fueron dados de alta por los Ortodoncistas del CESFAM Dr. V. M. F. durante el año 2017. La tabulación se realizó en Microsoft Excel y el análisis estadístico se hizo en InfoStat 17. Se incluyeron 246 pacientes, con una edad de ingreso promedio de 13,6 años. La maloclusion predominante fue la Clase I de Angle (71 %). Estos pacientes tuvieron una duracion de tratamiento promedio de 33,9 meses. Se concluyó que a mayor cantidad de inasistencias, el tratamiento de ortodoncia tuvo una duración mayor.

ABSTRACT: The duration of orthodontic treatments has always been one of the biggest concerns, both in patients and for orthodontists. The purpose of this investigation was to determine the magnitude of the absences to the controls of the patients and how they influence the duration of the orthodontic treatments in the CESFAM Dr. Victor Manuel Fernandez, Concepcion, Chile. A descriptive, cross-sectional, retrospective study was carried out, in which the clinical records of all patients discharged by the Orthodontists of CESFAM Dr. V.M.F. during the year 2017 were analyzed. The tabulation was performed in Microsoft Excel and the statistical analysis was carried out in InfoStat 17. In total, 246 patients were included, with an average age of admission of 13.6 years. The predominant malocclusion was Class I of Angle (71 %). These patients had an average treatment duration of 33.9 months. It was further concluded that the length of orthodontic treatment, was also affected by the increased number of times patients failed to show for treatment.

Evaluation of the discrepancy between clinical diagnostic hypotheses and anatomopathological diagnoses resulting from autopsies

OBJECTIVES: An objective of clinical autopsies is to determine the final cause of death and the pathological changes that may have triggered it. Despite advances in Medicine, the level of discrepancy between clinical and autopsy diagnoses remains significant. The aim of this study was to compare the data obtained from autopsies carried out at the São Bernardo do Campo/SP Death Verification Section with clinical diagnostic hypotheses proposed during medical care. METHOD: This was a retrospective study involving the comparison of necroscopic reports issued by the São Bernardo do Campo/São Paulo Death Verification Section in 2014 and 2015 and the Cadaver Referral Guides completed by attending physicians prior to the necroscopic examination. RESULTS: A total of 465 cases were analyzed. In general, discrepancies between the clinical diagnostic hypothesis and the autopsy diagnosis occurred in 28% of the cases. A logistic regression model, with diagnostic discrepancy as a response variable and sex, age, duration of care, type of institution providing medical care and organ system as explanatory variables, was fit to the data; the results indicated that all explanatory variables with the exception of organ system are not significant (p>0.132). CONCLUSIONS: Discrepancies between clinical diagnostic hypotheses and autopsy diagnoses continue to occur, despite new developments in complementary examinations and therapies. The odds of a discrepancy when patients present with diseases of the cardiac system are greater than those when there are problems in the vascular, endocrine and neurological systems.

Análisis de usos y resistencia a antibióticos en una UCI de Montería, Colombia / Analysis of antibiotic uses and resistance in an ICU from Monteria, Colombia

Resumen Introducción: El uso de antibióticos, enfrenta grandes problemas que deben ser resueltos en pro de la calidad de vida de los pacientes buscando un equilibrio en el costo-efectividad. Los análisis farmacoeconómicos son una herramienta útil para determinar qué fármacos deben estar disponibles en guías farmacoterapéuticas. Aunque el método de selección de fármacos varía en cada institución, el principio general es que deben ser elegidos los más efectivos al menor costo. El objetivo fue establecer el costo de los tratamientos, la evaluación de susceptibilidad y resistencia a los antibióticos en una Unidad de Cuidados Intensivos de Montería. Métodos: La muestra se integró por todos los pacientes ingresados a la UCI, que recibieron tratamiento antibiótico, durante doce meses. De las historias clínicas, se identificaron y se clasificaron los tratamientos aplicados, duración del tratamiento, costo del tratamiento por paciente, consumos por paciente de los antibióticos con el fin de estimar los costos de los antibióticos utilizados en pacientes de la UCI. Resultados: Se registraron 670 ingresos, de los cuales el 48,40% recibieron terapia antimicrobiana. Las principales causas de ingreso a la UCI fueron: evento coronario agudo (16,69%), insuficiencia respiratoria aguda (13,83%), sepsis (12,48%). Los microorganismos encontrados fueron: E. coli, K. pneumoniae, S. aureus, P. aeruginosa, S. epidermidis, A. baumanni, A. haemolyticus. Conclusión: Los sistemas estandarizados de vigilancia para el uso de antibióticos es una herramienta esencial en el uso racional y en el control de la resistencia antibacteriana.

Abstract The use of antibiotics, faces major problems that must be solved to ensure high-quality care of patients, which seeking a balance in cost-effectiveness. Pharmacoeconomics analyzes are a useful tool for determining which drugs should be available for pharmacotherapy strategies. Although the method of drug selection varies in each institution, the general principle is that the most effective ones should be chosen amongst the lowest-cost. The objective was to establish the cost of treatments, susceptibility assessment and resistance to antibiotics in an Intensive Care Unit in Montería. The sample was integrated by all the patients admitted to the ICU, who received antibiotic treatment, during twelve months. From the clinical records served, the treatments applied, duration of treatment, cost of treatment per patient, consumption per patient of the antibiotics were identified and classified to estimate the costs in relation to the therapeutic effectiveness of the antibiotics used in patients in the ICU. A total of 670 patients were registered, of whom 48,40% received antimicrobial therapy. The main causes of ICU admission were: acute coronary event (16,69%), acute respiratory failure (13,83%), sepsis (12,48%). The strains were: E. coli, K. pneumoniae, S. aureus, P. aeruginosa, S. epidermidis, A. baumanni, A. haemolyticus. Standardized surveillance systems for the use of antibiotics are an essential strategic intervention for the rational use and control antimicrobial resistance.

Avaliação do tempo e do número de sessões de tratamento em pacientes com desordem temporomandibular / Assessment of time and number of treatment sessions in patients with temporomandibular disorders

O objetivo deste estudo foi avaliar a duração do tratamento e o número de sessões de controle necessárias para a remissão da dor miofacial em pacientes com Desordem Temporomandibular que fizeram uso da placa neuromiorrelaxante. Foram avaliados 300 prontuários de pacientes voluntários sem distinção de raça e gênero, com idades entre 18 e 60 anos tratados na clínica do Serviço ATM da Faculdade de Odontologia da Universidade Federal de Juiz de Fora. Estes pacientes foram diagnósticados com desordem temporomandibular baseado no eixo I do protocolo de Critérios de Diagnóstico para pesquisa das Disfunções Temporomandibulares (RDC/TMD). O exame clínico e as mensurações presentes nos prontuários foram realizados por três examinadores previamente calibrados (índice kappa = 0.71). Para análise dos resultados, utilizou-se o teste t de Student, com nível de significância de 0,05% (p-valor < 0,05). Encontrou-se que o número mínimo de sessões necessárias para a remissão da sintomatologia dolorosa foi 02 sessões, e que o número máximo foi de 13 sessões. Mais da metade dos pacientes avaliados (56%) apresentaram remissão da sintomatologia dolorosa em 05 a 07 sessões de tratamento. Já quanto ao tempo de tratamento, o tempo mínimo necessário para remissão da sintomatologia dolorosa foi de 01 mês e o tempo máximo foi de 24 meses. Cerca de 60% dos pacientes apresentaram remissão completa da sintomatologia dolorosa em 07 meses de tratamento. Concluiu-se que ocorreu uma grande variação no período de tratamento e no número de sessões para uma efetiva redução da dor miofacial nos pacientes portadores de DTM avaliados, o que impossibilitou o estabelecimento de um número exato de sessões e de meses de tratamento ideais.

Factors associated with the uptake of intermittent preventive treatment of malaria in pregnancy in the Bamenda health districts, Cameroon

Introduction: the World Health Organization (WHO) recommends that in malaria endemic areas with moderate to high transmission rates, pregnant women presenting for antenatal clinic (ANC) should receive at least three doses of intermittent preventive treatment in pregnancy (IPTp) for malaria between the 16th and 36th weeks of pregnancy at intervals of 4 weeks between doses. Several challenges remain in effective implementation of IPTp policy making the targeted coverage (80%) of the third doses of IPTp far from being achieved. The main objective of this study was to assess factors associated with the uptake of IPTp among pregnant women attending ANCs in the Bamenda Health District. Methods: to reach our objectives, we carried out a cross-sectional study following informed consent with thirty-nine (39) healthcare workers (HCW) and four hundred (400) pregnant women who were either in the third trimester of pregnancy or had recently given birth in any of thirty-six (36) health facilities (HF) within the Bamenda Health District (BHD) from May to August 2014. All sites within the BHD were included. The participants were selected by simple random sampling. The principal research instrument was a structured and pre-tested questionnaire that was designed to capture socio-demographic data and data related to stage of pregnancy and knowledge about IPTp. Data was entered using Ms Excel and analysed using SPSS v20.0. Descriptive statistics (frequencies and percentages) was used to report findings. We used Chi-Square test to compare the categorical variables (Fischer's exact test was used in cases were conditions for Chi-Square test were not met). Results: uptake for at least one dose of IPTp was 95.3% (381/400) and 54.9% (209/400) had received all three doses, 15.5% (59/400) received only one dose and 4.8% (19/400) did not receive any of the doses of IPTp. Knowledge about IPTp was associated with an increase uptake of IPTp (P<0.001). All health care providers were knowledgeable about the importance and use of IPTp. However, 35.9% reported not receiving any training on IPTp. Among the health providers, 28.2% did not know when to start IPTp and 43.59% did not know when to stop IPTp. Out of all the health care providers, 30.77% complained of medication (sulfadoxine-Pyrimethamine) stock out and 84.62% practiced the policy of direct observed therapy. Conclusion: the uptake of the third dose of IPTp is poor in the Bamenda Health District and this may be attributed to medication stock out and inadequacy of routine trainings for the health providers. The good practice observed was that of direct observed therapy by HCWs. Patient knowledge about IPTp in our study was associated with better uptake of IPTp. Encouraging education of pregnant women on the importance of IPTp, providing routine training to HCWs and promoting direct observation of therapy may improve on IPTp uptake during pregnancy