Comportamiento de la enfermedad inflamatoria pélvica aguda en la atención primaria de salud. Matanzas, 2017-2018 / Behavior of the acute inflammatory pelvic disease in the health primary care. Matanzas, 2017-2018

RESUMEN Introducción: la enfermedad inflamatoria pélvica aguda es una entidad frecuente en mujeres jóvenes en edad reproductiva, y constituye causa de infertilidad y otras complicaciones. Objetivo: caracterizar el comportamiento de la enfermedad inflamatoria pélvica aguda en pacientes atendidas en el Policlínico Docente Samuel Fernández, del municipio Matanzas, en el período de enero de 2017 a enero de 2018. Materiales y métodos: se realizó un estudio descriptivo, longitudinal y prospectivo a 76 mujeres, a las que se les hizo caracterización sociodemográfica y clínico-ecográfica, que permitió su clasificación como pacientes con enfermedad inflamatoria pélvica aguda leve-moderada, requerida de tratamiento y seguimiento en atención primaria. Se evaluó la respuesta clínico-ecográfica al tratamiento médico indicado, a partir de la disminución de la intensidad del dolor pélvico y de las modificaciones de los hallazgos ecográficos iniciales. Resultados: la enfermedad inflamatoria pélvica aguda leve-moderada representó el 87,4 % de los casos evaluados en Consulta Ginecológica de la atención primaria de salud, en el período estudiado. La media de edad fue de 31,2 años. Clínicamente predominaron los casos con dolor severo. El hallazgo ecográfico inicial más frecuente fue el de anejos engrosados. La antibioticoterapia oral combinada y el uso de antiinflamatorios fue la terapia médica empleada, con resultados clínico-ecográficos favorables en el 98,4 y el 92,2 % de los casos, respectivamente. Conclusiones: la enfermedad inflamatoria pélvica leve-moderada resultó una entidad frecuente en el Servicio de Ginecología de la atención primaria de salud en el período estudiado, con evolución satisfactoria al tratamiento médico.

ABSTRACT Introduction: acute inflammatory pelvic disease is a frequent entity in young women in reproductive age, and is cause of infertility and other complications. Objective: to characterize the behavior of the acute inflammatory pelvic disease in patients attended at the TeachingPoliclinic Samuel Fernandez, of the municipality of Matanzas, in the period from January 2017 to January 2018. Materials and methods: a descriptive, longitudinal and prospective study was carried out in 76 women, who were object of socio-demographic and clinic-echographyc characterization that allowed their classification as patients with mild-moderated acute inflammatory pelvic disease requiring treatment and follow up in primary care services. The clinic-echographyc answer to medical treatment was evaluated from the decrease of the intensity of the pelvic pain and the modification of the baseline echographyc findings. Results: mild-moderated acute inflammatory pelvic disease represented 87.4 % of the cases evaluated in the primary care Gynecological consultation in the studied period. The average age was 31.2 years. The cases with severe pain predominated clinically. The most frequent baseline echographyc finding was increased annexes. Oral combined antibiotic therapy and the use of anti-inflammatory drugs was the used medical therapy, with favorable clinic-echographyc results in 98.4 % and 92.2 % of cases respectively. Conclusions: mild-moderated inflammatory pelvic disease was a frequent entity in the Gynecology service of the primary health care in the studied period, with satisfactory evolution to medical treatment.

Cura local con apiterapia en una paciente con ántrax / Local cure with apitherapy in a patient with anthrax

Se describe el caso clínico de una paciente de 67 años de edad, quien ingresa en el en Servicio de Dermatología del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" con diagnóstico de ántrax en región posterosuperior del tórax. Se realiza necrectomía y radiografía simple de tórax que muestra un derrame pleural izquierdo de gran cuantía; por tanto, se traslada al Servicio de Neumología donde se le diagnostica neoplasia de pulmón. La infección de piel se trató con antimicrobianos de uso parenteral y curas locales con miel de abejas, así se logró la resolución total de la lesión.

The case report of a 67 years patient who was admitted in the Dermatology Service of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital with diagnosis of anthrax in postero-superior region of the thorax is described. A necrectomy and simple x-ray of thorax are carried out that which show a significant left pleural effusion; therefore, he was transferred to the Pneumology Service where he is diagnosed with lung neoplasia. The skin infection was treated with antimicrobials of parenteral use and local cures with honey, thus, the total resolution of the lesion was achieved.

Oral Antibiotics for Community–acquired Pneumonia with Chest- indrawing in Children Aged Below Five Years: A Systematic Review.

Objectives: To determine the efficacy of oral antibiotics in under-five children with pneumonia and chest indrawing. Methods: We included controlled clinical trials (randomized or quasi randomized) that compared the efficacy of oral antibiotics versus parenteral antibiotics for treatment of community- acquired pneumonia with chest-indrawing (severe pneumonia as defined by the World Health Organization’s guidelines) in children below 60 months of age. Data were extracted and managed using RevMan software. Main outcome variables were: treatment failure rate, relapse rate, death rate, need for hospitalization, and severe adverse effects. Results: We identified four randomized controlled trials involving 4400 children who were diagnosed to have severe pneumonia but were feeding well and not hypoxic. Baseline characteristics of children in the two treatment arms (oral and parenteral antibiotics) were similar. In two studies, oral antibiotics were administered on an ambulatory basis, while in two, oral antibiotics were used in hospitalized children. Failure rate in children receiving oral antibiotics was 13% (288/2208) while that in children receiving parenteral antibiotics was 13.8% (302/2183) (OR 0.93; 95% CI 0.78, 1.11). Failure rates were not affected by the type of oral antibiotic, or presence of wheeze. Relapse rates, hospitalization or serious adverse events were similar in the two groups. Conclusion: Children with tachypnea with chest-indrawing without signs/symptoms of very severe pneumonia may be treated with oral antibiotics.

Tratamiento quirúrgico ambulatorio en pacientes con hernia inguinal / Ambulatory surgycal treatment in patient with inguinal hernia

Introducción: el tratamiento quirúrgico de la hernia inguinal ha aumentado en la última década y realmente se desconoce su prevalencia. Objetivo: evaluar los resultados del tratamiento quirúrgico ambulatorio de esta entidad desde enero de 2010 hasta diciembre de 2014. Métodos: se efectuó un estudio observacional, descriptivo y prospectivo de 380 pacientes con el diagnóstico de hernia inguinal, los cuales fueron operados de manera ambulatoria en el Hospital General Docente Enrique Cabrera desde enero de 2010 hasta diciembre de 2014. Se incluyeron los pacientes operados de urgencia. Resultados: la mayor incidencia de la hernia inguinal se encontró entre las edades de 60 y 80 años. La hernia inguinal derecha indirecta apareció con mayor frecuencia. La técnica quirúrgica anatómica de Desarda fue la más aplicada en 204 (51 por ciento) de los casos y la hernioplastia de Lichtenstein con 107 (28 por ciento) le siguió en frecuencia. Hubo un total de 2 (0,5 por ciento) de recidivas. Se aplicó la anestesia local en 345 (97 por ciento) de los pacientes, de forma ambulatoria fueron el 100 por ciento. El total de complicaciones fue de 14 (3,3 por ciento). Conclusiones: el tratamiento quirúrgico de la hernia inguinal de forma ambulatoria es un proceso adecuado. Asegura la comodidad de los pacientes, disminuye el riesgo de infección hospitalaria, reduce las listas de espera y los costos hospitalarios(AU)

Introduction: the surgical treatment of inguinal hernia has increased in the last ten years and its prevalence is really unknown. Objective: the objective of this study is to evaluate the results of the ambulatory surgical treatment of this entity between January 2010 and December 2014. Methods: an observational, descriptive and prospective study was carried out with 380 patients who presented inguinal hernia and were ambulatorily operated in Dr. Enrique Cabrera General Hospital between January 2010 and December 2014. Patients urgently operated were also included. Results: the highest incidence of inguinal hernia was found at ages 60-80 years. Indirect right inguinal hernia appeared more frequently. The anatomical surgical technique Desarda was the most applied (204 cases, 51 percent), followed in frequency by Lichtenstein hernioplasty (107 cases, 28 percent). There was sheer number of 2 (0.5 percent) relapses. Local anesthesia was used in 345 (90.8 percent) of the patients. Ambulatory surgical treatment was performed in 100 percent of the cases. The total number of complications was 14 (3.3 percent). Conclusions: ambulatory surgical treatment of inguinal hernia is an appropriate process. It ensures patient comfort, decreases the risk for hospital infection, and reduces waiting lists and hospital costs(AU)

High macro rubber band ligature / Macro ligadura elástica alta

PURPOSE: The goal of a rubber band ligature is to promote fibrosis of the submucosa with subsequent fixation of the anal epithelium to the underlying sphincter. Following this principle, a new technique of ligature was developed based on two aspects: 1. macro banding: to have a better fibrosis and fixation by banding a bigger volume of mucosa and 2. higher ligature: to have this fixation at the origin of the hemorrhoidal cushion displacement. METHODS: 1634 patients with internal hemorrhoidal disease grade II or III were treated by the technique called high macro rubber band. There was no distinction as to age, gender or race. To perform this technique a new hemorrhoidal device was specially designed with a larger diameter and a bigger capacity for mucosal volume aspiration. It is recommended to utilize a longer and wider anoscope to obtain a better view of the anal canal, which will facilitate the injection of submucosa higher in the anal canal and the insertion of the rubber band device. The hemorrhoidal cushion must be banded higher in the anal canal (4 cm above the pectinate line). It is preferable to treat all the hemorrhoids in one single session (maximum of three areas banded). RESULTS: The analysis was retrospective without any comparison with conventional banding. The period of evaluation extended from one to twelve years. The analysis of the results showed perianal edema in 1.6% of the patients, immediate tenesmus in 0.8%, intense pain (need for parenteral analgesia) in 1.6 %, urinary retention in 0.1% of the patients and a symptomatic recurrence rate of 4.2%. All patients with symptomatic recurrence were treated with a new session of macro rubber banding. None of the patients developed anal or rectal sepsis. Small post-ligature bleeding was observed only in 0.8% of the patients. CONCLUSIONS: The high macro rubber banding technique represents an alternative method for the treatment of hemorrhoidal disease grades II or III, with good results at a low cost. The analysis of the observed results showed a small incidence of minor complications, with a high index of symptomatic relief. (AU)

OBJETIVO: o objetivo de uma ligadura com banda de borracha é promover a fibrose da submucosa com subsequente fixação do epitélio ao esfíncter anal subjacente. Seguindo esse princípio, uma nova técnica de ligadura foi desenvolvida baseada em dois aspectos: 1. macro bandas: para obter uma melhor fibrose e fixação ao atingir um volume maior de mucosa e 2. ligadura alta: para obter essa fixação na origem do deslocamento do coxim hemorroidal. MÉTODOS: 1634 pacientes com doença hemorroidária interna de grau II ou III foram tratados pela técnica de macro ligadura elástica alta. Não houve distinção de idade, sexo ou etnia. Para executar essa técnica, um novo dispositivo hemorroidário foi especialmente projetado com um diâmetro maior e uma maior capacidade de aspiração de volume da mucosa. Recomenda-se utilizar um anoscópio mais longo e largo para obter uma melhor vista do canal anal, o que facilitará a injeção da submucosa a nível mais alto no canal anal e a inserção do dispositivo elástico. O coxim hemorroidal deve ser ligado a um nível mais alto no canal anal (4 cm acima da linha de pectinato). É preferível o tratamento de todas as hemorróidas em uma única sessão (máximo de três zonas submetidas à ligadura). RESULTADOS: a análise foi retrospectiva, sem qualquer comparação com a ligadura convencional. O período de avaliação variou de de um a doze anos. A análise dos resultados mostrou edema perianal em 1,6% dos pacientes, tenesmo imediato em 0,8%, dor intensa (necessidade de analgesia parenteral) em 1,6%, retenção urinária em 0,1 % dos pacientes e uma taxa de recorrência sintomática de 4,2%. Todos os pacientes com recorrência sintomática foram tratados com uma nova sessão de macro ligadura elástica. Nenhum dos pacientes desenvolveu septicemia anal ou retal. Uma pequena hemorragia pós-ligadura foi observada em apenas 0,8% dos pacientes. CONCLUSÕES: a técnica de macro ligadura elástica alta representa um método alternativo para o tratamento da doença hemorroidal classe II ou III, com bons resultados a um baixo custo. A análise dos resultados observados mostrou uma pequena incidência de complicações menores, com alto índice de alívio sintomático. (AU)

Percepción institucional y comunitaria sobre comportamientos adictivos en Guayaquil / Institucional and community perceptions on addictive behaviours in Guayaquil

Introducción: en el mundo de hoy las conductas adictivas constituyen un grave problema para la humanidad. En la República de Ecuador la atención a pacientes consumidores de sustancias psicoactivas se ha desarrollado tradicionalmente desde la instancia privada pero actualmente se reconoce que ello ha devenido en un problema de salud que debe ser atendido por las políticas públicas. Objetivo: identificar la percepción sobre los comportamientos adictivos en el Centro de Docencia e Investigación para el Desarrollo Humano y el Buen Vivir y sus comunidades aledañas, en Guayaquil. Métodos: el trabajo se realizó en el 2011, con un diseño etnográfico en el que se incluyeron análisis de documentos, observación participante, entrevistas en profundidad y entrevistas grupales focalizadas. Los informantes clave se seleccionaron mediante muestreo intencional. La información obtenida fue sometida a un análisis de contenido. Resultados: se revelaron percepciones limitadas al modelo clínico en las dimensiones de gestión comunitaria, docente-asistencial e investigativa. Conclusiones: tanto en el Centro como en sus comunidades aledañas, la percepción sobre comportamientos adictivos está constreñida al modelo clínico-asistencial, lo que constituye una barrera para el posicionamiento del modelo salubrista

Introduction: In today's world, the addictive behaviors are a serious problem for the humanity. The care of patients who consume psychoactive substances in the Republic of Ecuador has mainly been given on a private basis, but at present, it is recognized that addiction is a health problem to be managed by the public policies. Objective: to identify the perception of addictive behaviours in the Center of Education and Research for the Human Development and the Good Living and neighboring communities in Guayaquil. Methods: the study was conducted in 2011 and adopted an ethnographic design in which document analysis, observation of participants, in-depth interviews and focused group interviews were included. The key informants were selected from an intentional sampling. The gathered information underwent a content analysis. Results: The study revealed perceptions limited to the clinical model in the community management, the teaching-assistance and the research dimensions. Conclusions: Both the Center and the neighboring communities have perceptions on addictive behaviors that are limited to the clinical-assistance model, which is a kind of barrier to the positioning of the public health model

Outcome of standardized treatment for patients with MDR-TB from Tamil Nadu, India.

Background & objectives Programmatic management of MDR-TB using a standardized treatment regimen (STR) is being implemented under the Revised National Tuberculosis Control Programme (RNTCP) in India. This study was undertaken to analyse the outcomes of MDR-TB patients treated at the Tuberculosis Research Centre, Chennai, with the RNTCP recommended 24 months STR, under programmatic conditions. Methods Patients failed to the category II re-treatment regimen and confirmed to have MDR-TB, were treated with the RNTCP's STR in a prospective field trial on a predominantly ambulatory basis. Thirty eight patients were enrolled to the trial from June 2006 to September 2007. Results Time to culture conversion was two months or less for 82 per cent of patients. Culture conversion rates at 3 and 6 months were 84 and 87 per cent respectively. At the end of treatment, 25 (66%) were cured, 5 defaulted, 3 died and 5 failed. At 24 months, 30 (79%) patients, including 5 defaulters, remained culture negative for more than 18 months. Twenty two (58%) patients reported adverse drug reactions (ADRs) which required dose reduction or termination of the offending drug. No patient had XDR-TB initially, but 2 failure cases emerged as XDR-TB during treatment. Interpretation & conclusions Outcomes of this small group of MDR-TB patients treated with the RNTCP's STR is encouraging in this setting. Close attention needs to be paid to ensure adherence, and to the timely recognition and treatment of ADRs.

Percepção do paciente com tuberculose sobre a internação em hospital especializado / Percepción del paciente con tuberculosis sobre el ingreso a un hospital especializado / Perception of tuberculosis' patient about the necessity of a specialized treatment center

Trata-se de uma pesquisa qualitativa cujo objetivo foi caracterizar, segundo a perspectiva dos pacientes com tuberculose (TB), os elementos que determinaram a sua internação em hospital especializado. Foram entrevistados 20 pacientes e suas opiniões analisadas quanto conhecimento sobre a doença, tratamentos anteriores e motivos da hospitalização. Avaliou-se, também, a caracterização dos mesmos quanto à idade, sexo e procedência, sendo a maioria masculina, com média de idade de 44,5 anos, não possuíam família nuclear e tinham procedência urbana. Oito pacientes estavam tratando TB pela primeira vez. Foram identificadas quatro categorias: falta de conhecimento sobre TB, medo de preconceito, abandono do tratamento ambulatorial e motivos para internação. Conclui-se que essa população em questão considera a internação como sendo uma alternativa favorßvel, tanto no que se refere ao apoio social como à continuidade terapêutica.

This is a qualitative survey whose objective was to characterize, according the perspective of tuberculosis' patient (TB), the elements that had determined which caused them to undergo in specialized hospitalization. Twenty patients were surveyed and had their opinion analyzed concerning knowledge on the illness, previous treatments and determining causes for hospitalization. These patients' characterization was also assessed, concerning age, gender and origin. Most of them were men around 44, 5 years old, without nuclear family and of urban origins. Eight patients were undergoing TB treatment for the first time. Four categories were identified: unawareness of TB, fear of prejudice, abandonment of ambulatory treatment and reasons for hospital treatment. It was concluded that these people consider hospital treatment as a favorable alternative, both for its social support and therapeutic continuity.

Investigación cualitativa cuyo objetivo fue caracterizar, según la perspectiva del paciente con tuberculosis (TBC), los elementos que determinan su ingreso en un hospital especializado. Fueron entrevistados 20 pacientes y sus opiniones analizadas según el conocimiento de la enfermedad, los tratamientos anteriores y las causas que determinaron la hospitalización. Su caracterización se realizó según edad, sexo y procedencia. La mayoría era del sexo masculino, la media de edad era de 44,5 años, sin familia nuclear y tenían procedencia urbana. Ocho pacientes se trataban la TBC por primera vez. Se identificaron cuatro categorías: falta de conocimiento sobre la TBC, miedo al prejuicio, abandono del tratamiento ambulatorio y motivos para la internación. La conclusión es que la población estudiada considera la internación como una alternativa favorable, teniendo en cuenta tanto el apoyo social como la continuidad terapéutica.

Insuficiencia ostial de la safena interna: tratamiento ambulatorio mediante ligadura con preservación de la safena in situ / Saphenous insufficiency: ambulatory treatment wiht ligadure and vein preservation

Antecedentes: durante años el tratamiento de la insuficiencia de la válvula ostial de la Safena Interna (SI) ha consistido en la resección de la vena mediante distintas técnicas. Objetivo: proponer y evaluar los resultados del tratamiento conservador mediante ligadura y sección del cayado de la SI con preservación de la vena in Situ. Diseño: estudio prospectivo, experimental y observacional. Método: entre marzo de 2005 y mayo de 2007 fueron tratados 47 pacientes con várices de Miembros Inferiores debido a una insuficiencia de la vávula ostial de la SI. en todos os casos se realizó ligadura y sección de la SI nivel del cayado con preservación de la vena in Situ en forma completamente ambulatoria. Resultados: el 93.75% de los pacientes tratados, refrió la desaparición de los síntomas subjetivos, en el 6.25% restante la mejoría fue parcial. No hubo morbilidad ni mortalidad inherente al procedimiento realizado. Conclusiones: el tratamiento ambulatorio de la insuficiencia ostial de la SI con preservación de la vena in Situ demostró, en esta experiencia inicial, ser efectivo y seguro.

BACKGROUND: During years the treatment of the insufficiency of the ostial valve of the Internal Safena (IS) it has consisted of the resection of the vein by means of different techniques. OBJECTIVE: To propose and to evaluate the results of the preservative treatment by means of tie and section of the cayado one of IF with preservation of the vein in Situ. DESIGN: Prospective, experimental and observacional study. METHOD: Between March of 2005 and May of 2007 47 patients were dealed with with varices of Inferior Members due to an insufficiency of the ostial valve IS. In all the cases it was made tie and section of IF at level of the cayado one with preservation of the vein in Situ in completely ambulatory form. RESULTS: The 93.75% of the treated patients, refered the disappearance of the subjective symptoms, in the 6.25% rest the improvement was partial. There was no morbidity nor mortality inherent to the made procedure. CONCLUSIONS: The ambulatory treatment of the ostial insufficiency of IF with preservation of the vein in Situ it demonstrated, in this initial experience, to be effective and safe.