Morbilidad y mortalidad en pacientes llevados a gastrectomía por cáncer gástrico / Morbidity and mortality in patients undergoing gastrectomy for gastric cancer

Introducción. El cáncer gástrico es la cuarta causa de muerte por cáncer a nivel mundial, con más de un millón de casos diagnosticados cada año. La cirugía con intención curativa sigue siendo el pilar del manejo para los pacientes resecables. La identificación de pacientes con mayor riesgo de morbimortalidad es importante para el proceso de toma de decisiones, sin existir hasta el momento una herramienta ideal. La revisión y el análisis de la experiencia de un centro oncológico de referencia pueden generar información útil. Métodos. Estudio observacional de cohorte histórica, en el que se incluyeron los pacientes llevados a gastrectomía por adenocarcinoma gástrico en el Instituto Nacional de Cancerología, Bogotá, D.C., Colombia, entre el 1° de enero del 2010 y el 31 de diciembre del 2017. Resultados. Se evaluaron 332 pacientes, de los cuales el 57,2 % eran hombres con edad promedio de 61 años. La mortalidad en esta serie fue del 4,5 % y la morbilidad de 34,9 %. El factor asociado con mayor riesgo de muerte fue la edad, con un HR de 1,05 (p=0,021). Se encontró un mayor riesgo en el grupo de pacientes con ASA mayor a II (p=0,009).El 17,4 % presentaron complicaciones mayores a IIIA de la clasificación de Clavien-Dindo. Conclusiones. En el presente trabajo las cifras de morbilidad y mortalidad son similares a las reportadas en la literatura. Solo la edad y la clasificación de ASA mostraron asociación con valor estadístico significativo para complicaciones postoperatorias

Introduction. Gastric cancer is the fourth leading cause of cancer death worldwide with more than one million cases diagnosed each year. Surgery with curative intent remains the mainstay of management for resectable patients. Identify patients at increased risk of morbidity and mortality is important for the decision making process, with no ideal tool available yet. Review and analysis of the experience of a referral cancer center may generate useful information. Methods. Historical cohort observational study. Patients undergoing gastrectomy for gastric adenocarcinoma at the National Cancer Institute in Bogotá, Colombia, between January 1, 2010 and December 31, 2017 were included. Results. We included 332 patients of which 57.2% were men with mean age of 61 years. Mortality in this series was 4.5% and morbidity was 34.9%. The factor associated with higher risk of death was age with a HR of 1.05 statistically significant value (p=0.021). A higher risk was found in the group of patients with ASA greater than II (p=0.009). The 17.4% presented complications greater than IIIA of the Clavien Dindo classification. Conclusions. In this study morbidity and mortality seem similar to those reported in the literature. Only age and ASA score showed an association with significant statistical value for postoperative complications

Estudio de las heridas por amoladora tratadas en el Hospital de Clínicas y Hospital Pasteur, Montevideo, Uruguay / Grinder injuries treated at the Clínicas and Pasteur Hospital of Montevideo, Uruguay / Estudo das lesões por esmerilhadeira tratadas no Hospital de Clínicas e Hospital Pasteur, Montevidéu, Uruguai

Resumen: Introducción: las heridas causadas por amoladora representan una consulta frecuente al cirujano plástico en nuestro país. Los objetivos del presente trabajo fueron conocer la epidemiología de los pacientes que consultaban con estas lesiones, conocer las circunstancias del accidente y estudiar si existía relación entre las condiciones de uso de la herramienta y la gravedad de las lesiones. Material y método: se realizó un estudio descriptivo, transversal, donde se recabaron los datos de los pacientes que consultaban por heridas por amoladora en las puertas de emergencia de Hospital Pasteur y Hospital de Clínicas en un período de 6 meses. Resultados: un total de 76 pacientes fueron incluidos en el estudio, la mayoría de sexo masculino, en edad laboral activa (39 a 58 años) dedicados a la realización de trabajos temporales o tareas de construcción, con bajo nivel de instrucción. El 84% de las heridas fueron graves. El 61% de los pacientes no utilizó los elementos de seguridad de la herramienta al momento del accidente. La mayoría de las lesiones se produjeron fuera del ambiente laboral. Conclusiones: en base a nuestro trabajo pudimos establecer el perfil epidemiológico de la población más susceptible de sufrir estas lesiones. Comprobamos que las heridas producidas por amoladora son en su mayoría graves y requieren procedimientos complejos para su resolución.

Summary: Introduction: grinder injuries represent a large number of consultations for plastic surgeons in our country. This study aims to learn about the epidemiological characteristics of patients who consulted for these lesions and the circumstances of the accidents, and to analyze whether there is a relationship between the conditions for tool use and the severity of lesions. Methodology: we conducted a retrospective, descriptive, transversal study where we collected data from the patients who consulted for grinder injuries at the emergency departments of Pasteur and Clínicas Hospital during a 6-month period. Results: seventy-six patients were included in the study, most of which were male working adults (between 39 and 58 years-old) who had temporary jobs or were performing construction works and had low levels of education. 84% of lesions were severe. 61% of patients did not respect safety regulations at the time of the accident. Most lesions occurred out of working hours. Conclusions: based on our study, we could identify the epidemiological profile of the most vulnerable population for this kind of lesions. We proved that most grinder lesions are severe and their management requires complex procedures.

Resumo: Introdução: as lesões causadas por esmerilhadeira são causa frequente de consulta ao cirurgião plástico no Uruguai. Os objetivos do presente trabalho foram conhecer as características dos pacientes que consultaram com essas lesões, conhecer as circunstâncias do acidente e analisar a possível relação entre as condições de uso da ferramenta e a gravidade das lesões. Metodologia: foi realizado um estudo descritivo, transversal, onde foram coletados dados de pacientes que consultaram por lesões de esmerilhadeira no pronto-socorro do Hospital Pasteur e Hospital de Clínicas durante um período de 6 meses. Resultados: foram incluídos no estudo 76 pacientes, a maioria do sexo masculino, em idade ativa para trabalhar (39 a 58 anos) dedicados à realização de trabalhos temporários ou trabalhos na construção civil, com baixo nível de escolaridade. 84% dos ferimentos foram graves. 61% dos pacientes não utilizaram os elementos de segurança da ferramenta no momento do acidente. A maioria das lesões ocorreu fora do ambiente de trabalho. Conclusões: com base em nosso trabalho conseguimos estabelecer o perfil da população mais suscetível a esses agravos. Constatamos que a maioria das lesões causadas por esmerilhadeiras são graves, exigindo procedimentos complexos para sua resolução.

Reacciones adversas a medicamentos utilizados para la COVID-19 en cinco países de América Latina / Adverse reactions to drugs used for COVID-19 in five Latin American countries / Reações adversas a medicamentos utilizados para a COVID-19 em cinco países da América Latina

RESUMEN Objetivo. Caracterizar y describir las notificaciones de sospechas de reacciones adversas de un grupo de medicamentos que se utilizaron en Colombia, Costa Rica, Cuba, Chile, El Salvador, México y Perú para tratar o prevenir la enfermedad por el coronavirus (COVID-19, por su sigla en inglés) entre el 1 de marzo y el 31 de agosto del 2020. Métodos. Se elaboró una lista de los 13 medicamentos utilizados para tratar o prevenir la COVID-19, según fuentes oficiales y no oficiales. Desde las bases de datos de los programas nacionales de farmacovigilancia de los países participantes, se recopilaron las notificaciones de sospechas de reacciones adversas a estos medicamentos recibidas en el período comprendido entre el 1 de marzo y 31 de agosto de año 2020. Resultados. Se recibieron 3 490 notificaciones de sospechas de reacciones adversas desde los programas de farmacovigilancia de Perú (n = 3 037), Cuba (n = 270), Colombia (n = 108), Chile (n = 72) y El Salvador (n = 3). Los medicamentos con mayor número de notificaciones de reacciones adversas fueron la azitromicina, la ivermectina y la hidroxicloroquina. La diarrea fue el evento más frecuente (15,0%). Del total de las sospechas de reacciones adversas, 11,9% fueron notificadas como graves. La más frecuente fue la prolongación del intervalo QT posterior al uso de hidroxicloroquina. De estas sospechas de reacciones adversas graves, 54,5% ocurrieron en personas mayores de 65 años. Conclusión. Si bien no es posible establecer una relación causal a partir de la evaluación de informes espontáneos, el presente estudio confirma la presencia de reacciones adversas, algunas graves, con medicamentos que se utilizaron para tratar o prevenir la COVID-19.

ABSTRACT Objective. Characterize and describe reports of suspected adverse reactions to a group of drugs used in Colombia, Costa Rica, Cuba, Chile, El Salvador, Mexico, and Peru to treat or prevent coronavirus disease (COVID-19) between 1 March and 31 August 2020. Methods. A list of the 13 drugs used to treat or prevent COVID-19 was prepared, based on official and unofficial sources. Drawing on the databases of the national pharmacovigilance programs of the participating countries, reports of suspected adverse reactions to these drugs were collected for the period from 1 March and 31 August 2020. Results. A total of 3 490 reports of suspected adverse reactions were received from the pharmacovigilance programs of Peru (n = 3 037), Cuba (n = 270), Colombia (n = 108), Chile (n = 72), and El Salvador (n = 3). The drugs with the highest number of reported adverse reactions were azithromycin, ivermectin, and hydroxychloroquine. Diarrhea was the most frequent event (15.0%). Of the total suspected adverse reactions, 11.9% were reported as serious. The most frequent was QT prolongation following use of hydroxychloroquine. Of these suspected serious adverse reactions, 54.5% occurred in people over 65 years of age. Conclusions. While it is not possible to establish a causal relationship from the evaluation of spontaneous reports, the present study confirms the presence of adverse reactions—some of them serious—involving drugs used to treat or prevent COVID-19.

RESUMO Objetivo. Caracterizar e descrever as notificações de suspeitas de reações adversas a um grupo de medicamentos utilizados na Colômbia, Costa Rica, Cuba, Chile, El Salvador, México e Peru, para tratar ou prevenir a doença do coronavírus (COVID-19), entre 1º de março e 31 de agosto de 2020. Métodos. Foi elaborada uma lista dos 13 medicamentos usados para tratar ou prevenir a COVID-19, segundo fontes oficiais e não oficiais. A partir das bases de dados dos programas nacionais de farmacovigilância dos países participantes, foram coletadas notificações de suspeitas de reações adversas a esses medicamentos, recebidas no período entre 1º de março e 31 de agosto de 2020. Resultados. Foram recebidas 3.490 notificações de suspeitas de reações adversas dos programas de farmacovigilância do Peru (n = 3.037), Cuba (n = 270), Colômbia (n = 108), Chile (n = 72) e El Salvador (n = 3). Os medicamentos com maior número de notificações de reações adversas foram azitromicina, ivermectina e hidroxicloroquina. A diarreia foi o evento mais frequente (15,0%). Do total de suspeitas de reações adversas, 11,9% foram notificadas como graves. A mais frequente foi o prolongamento do intervalo QT após o uso de hidroxicloroquina. Dessas suspeitas de reações adversas graves, 54,5% ocorreram em pessoas com mais de 65 anos. Conclusão. Embora não seja possível estabelecer uma relação causal com base na avaliação de relatos espontâneos, o presente estudo confirma a presença de reações adversas - algumas graves - a medicamentos que foram usados para tratar ou prevenir a COVID-19.

Neurología hospitalaria y COVID-19: serie de 96 pacientes evaluados en un hospital universitario / Neurology and COVID-19: Case Series of Neurological Complications in 96 patients Admitted at a University Hospital

Background: There are multisystemic consequences secondary to SARS- CoV-2 infection. Aim: To characterize neurological complications in patients admitted due to SARS-CoV-2 infection. Methods: Review of medical records of patients aged over 15 years with COVID-19 evaluated by the neurology team between April and August 2020 at a university hospital. Severity of the infection, referral reasons, neurological diagnoses and laboratory results were registered. The diagnoses were defined by consensus among the members of the hospital neurology group. Cerebrovascular and inflammatory diseases of the central and peripheral nervous system were defined as "probably associated" or "possibly associated" to COVID-19. Results: Ninety-six patients had at least 1 new neu- rological complication. 74% were admitted due to pneumonia and 20% due to a neurological disease. The most common reasons for neurological referral were impaired consciousness (39%), focal neurological deficit (24%), headache (9%) and seizures (5%). The most relevant neurological diagnoses were delirium in 48 patients, stroke in 24, critical illness polyneuropathy and myopathy in 17, seizures in 14, brachial plexopathy in 3, compressive neuropathies in 5, encephalitis in 1, possible vasculitis in 1 and Guillain-Barré syndrome in 1. Stroke and epilepsy were associated with increased length of hospital stay, but without differences in mortality. Conclusions: The spectrum of neurological complications of COVID-19 is wide. There are clinical entities typical of critically ill patients and also diseases associated directly and indirectly with the SARS-CoV2 infection.

Clasificación del nivel de riesgo por alteraciones funcionales de la deglución (CRAF) / Classification of the risk level for functional alterations of swallowing (CRAF)

El quehacer profesional en disfagia permite clasificar la severidad de la disfagia, pero no la calificación del riesgo de las distintas alteraciones funcionales durante la ingesta. A razón de ello, este escrito propone clasificar el nivel de riesgo por alteraciones funcionales de la deglución bajo un proceso metodológico de validación interna. La investigación se planteó desde una naturaleza prospectiva con relación de validez interna, a través del método Delphi, mediante la cual se postuló una lista de alteraciones funcionales de la deglución para ser validada por 6 jueces expertos en el área. Se establecieron alteraciones funcionales divididas en las fases deglutorias y los niveles de riesgo para repercutir en disfagia, según los ítems de suficiencia, relevancia, coherencia y claridad. Se obtuvo una lista de 38 errores validados, los cuales se fundamentan como riesgo, dado que al materializarse fomentan en la secuencia deglutoria una mayor probabilidad de penetración/aspiración de alimento hacia vía aérea. El consenso de la clasificación de estos errores según el riesgo, será una herramienta útil para profesionales del área. Se concluye, a través de la diferencia mínima significativa (LSD) de Fisher para medias, una lista de riesgos por alteraciones funcionales de la deglución, en orden descendente según la severidad del riesgo que representa la alteración en la ingesta.

The professional work in dysphagia allows classifying the severity of dysphagia, but not the qualification of the risk of the different functional alterations during ingestion. For this reason, this paper proposes to classify the level of risk due to functional swallowing alterations. The research was proposed from a prospective nature with a validity relationship, through the Delphi method, through which a list of functional swallowing alterations was postulated to be validated by 6 expert judges in the area. A proposal was made in a matrix, which evaluated the different functional alterations divided into the swallowing phases and the risk levels to affect dysphagia, according to the items of sufficiency, relevance, coherence and clarity. A list of 38 validated alterations was obtained, which are based on risk, since when they materialize, they promote a greater probability of penetration / aspiration of food into the airway in the deglutory sequence. The consensus on the classification of these alterations according to risk will be a useful tool for professionals in the area. A list of risks due to functional swallowing alterations is concluded through Fisher's least significant difference (LSD) for means, in descending order according to the severity of the risk represented by the alterations in intake.

Funding and performance of amateur and youth organizations in Brazil: a longitudinal analysis of a basketball league

Abstract Aim: The general aim was to analyze the profile of the teams participating in a basketball regional competition over 8 years (2012-2019). Specifically, we aimed to a) analyze the variation in the number of an organization participating, b) identify the variation in the type of funding, c) verify the existence of a relationship between the performance and the longevity of the organization, d) verify the existence of a relationship between the performance and the type of funding. Methods: The research was designed as an exploratory case study. A total of 86 organizations took part in the league during the period, with 767 different teams playing competitions between U-11 and senior. Results: Instability is the main characteristic of the league. The organizations competing are constantly changing the type of funding and unable to stay in the league for long periods. The research also showed that there is a relation between a stable source of funding and performance. Conclusion: Instability is the main problem in Brazilian youth and amateur basketball organizations. This study presents useful information for managers better understand the problems and difficulties of basketball in Brazil.

Neurofibromatosis orbitotemporal gigante / Giant orbitotemporal neurofibromatosis / Neurofibromatose órbitotemporal gigante

La neurofibromatosis orbitotemporal es una enfermedad progresiva que comienza en la infancia y puede generar importantes alteraciones morfológicas y funcionales. Presentamos el caso de un paciente adulto con diagnóstico de neurofibromatosis orbitotemporal gigante, en el cual se realizó un tratamiento mediante embolización preoperatoria y resección quirúrgica con el fin de disminuir el tamaño tumoral.

Orbitotemporal neurofibromatosis is a progressive disease that begins in childhood and may cause important morphological and functional alterations. We present the case of an adult patient with a giant orbitotemporal neurofibromatosis, which was treated by preoperative embolization and a surgical resection to reduce the size of the tumor size.

A neurofibromatose órbito-temporal é uma enfermidade progressiva que começa na infância e pode gerar importantes alterações morfológicas e funcionais. Apresentamos o caso de um paciente adulto com diagnóstico de neurofibromatose órbito-temporal gigante, que foi submetido a tratamento com embolização pré-operatória e ressecção cirúrgica para diminuir o tamanho tumoral.

As reportagens das mídias estrangeiras sobre o Brasil dos megaeventos esportivos: soft power, periferia e dependência / Foreign media reports about Brazil's mega sporting events: soft power, periphery and dependence / Los reportajes de los medios extranjeros sobre el Brasil de los megaeventos deportivos: soft power, periferia y dependencia

Neste artigo, a partir da análise de reportagens de nove jornais estrangeiros publicadas durante a Copa do Mundo e os Jogos Olímpicos realizados no Brasil, discutimos se a categoria soft power pode ser aplicada ao Brasil dos megaeventos esportivos. Consideramos que a categoria não pode ser aplicada em nações periféricas e deve ser repensada para países de economia dependente. Por isso, propomos de maneira embrionária uma redefinição da teoria de soft power. Neste contexto, surge a categoria "soft power heterodoxo". A partir de tal categoria, consideramos que os jornais analisados retrataram dois países em um mesmo território, um em 2014 e outro em 2016. Levantamos cinco hipóteses para compreender este fenômeno: organização, dimensão, características, logística, desinteresse. Ademais, este estudo evidencia que não há elementos que possam corroborar avanço no soft power do Brasil a partir das Copa do Mundo (2014) e dos Jogos Olímpicos (2016)

In this article, based on the analysis of reports from nine foreign newspapers published during the World Cup and the Olympics held in Brazil, we discuss whether the category of Soft power can be applied to the Brazil of mega sporting events. We consider that it cannot be applied to peripheral nations and must be rethought for countries with dependent economies. Therefore, we propose an initial redefinition of the soft power theory. This context gives rise to 'heterodox soft power' category based on which we consider that the newspapers analysed portray two different countries in the same territory ­ one in 2014 and another one in 2016. We point out five hypotheses to understand this phenomenon: organization, size, characteristics, logistics, lack of interest. In addition, this study shows that there are no elements to corroborate advances in Brazilian soft power after the World Cup (2014) and the Olympics (2016)

En este artículo, a partir del análisis de reportajes de nueve periódicos extranjeros publicados durante la Copa del Mundo y los Juegos Olímpicos realizados en Brasil, discutimos si la categoría soft power puede ser aplicada al Brasil de los megaeventos deportivos. Consideramos que la categoría no puede ser aplicada en naciones periféricas y debe ser repensada para países con economía dependiente. Por eso, proponemos de manera embrionaria una redefinición de la teoría de soft power. En este contexto, surge la categoría 'soft power heterodoxo'. A partir de esa categoría, consideramos que los periódicos analizados retrataron dos países en un mismo territorio, uno en 2014 y otro en 2016. Levantamos cinco hipótesis para comprender este fenómeno: organización, dimensión, características, logística, desinterés. Además, este estudio pone en evidencia que no hay elementos que puedan corroborar avance en el soft power de Brasil a partir de los megaeventos mencionados

O soft power do Brasil e a cobertura da mídia internacional da Copa do Mundo da FIFA 2014 / The soft power of Brazil and The Fifa's 2014 World Cup international midia coverage

Este artigo tem como objetivo apresentar uma reflexão sobre o impacto que a realização da Copa do Mundo da FIFA de 2014 pode ter sobre o Soft Power do Brasil em suas relações internacionais. Para tanto, desenvolveu-se a definição de Soft Power associando-a aos megaeventos esportivos. Pesquisou-se nove veículos de imprensa internacional em três idiomas diferentes (BBC, CNN, The Guardian, The New York Times, Daily Mail, Le Monde, Le Figaro, El Pais, El Mundo). Analisou-se e categorizou-se 699 reportagens em seis grandes temas geradores: infraestrutura, indicadores sociais, cultura, futebol, viabilidade da Copa, cenas do cotidiano. Conclui-se que a realização da Copa do Mundo FIFA de 2014 teve efeitos positivos nas áreas do espetáculo esportivo e da cultura brasileira voltada ao turismo, e efeitos negativos nas áreas: política (como o Estado trata os cidadãos nas manifestações políticas), sociais (saneamento básico, educação, saúde) e estruturais (brasis dos extremos).

This article aims to present a reflection on the impact that the realization of the 2014 FIFA World Cup may have on Soft Power of Brazil in its international relations. For that, the definition of Soft Power was developed associating it with the sports mega events. Nine international media outlets were searched in three different languages (BBC, CNN, The Guardian, The New York Times, Daily Mail, Le Monde, Le Figaro, El Pais, El Mundo). 699 reports were analyzed and categorized into 6 major generating themes: infrastructure, social indicators, culture, football, Copa feasibility, daily scenes. It is concluded that the 2014 FIFA World Cup had positive effects in the areas of sporting spectacle and Brazilian culture geared to tourism, and negative effects in the areas of politics (as the State treats citizens in political manifestations), social (Sanitation, education, health) and structural (extreme Brazil).

A study on the introduction and institucionalization of rugby in brazil / Um estudo sobre a introdução e institucionalização do rugby no brasil

ABSTRACT This article aims to discuss, through documentary research, the introduction and institutionalization of rugby in Brazil specifically covering the period from 1891 to 1940. The historical approach involves the systematization of documentary research, using sources such as newspapers dating from the last decades the nineteenth century until the mid-twentieth and documents of the time. In order to build a mode narrative and demonstrate that despite the narrow base of participants and only recent media interest, The modality had an interested, although limited, group of participants and practitioners in Brazil since the early twentieth century.

RESUMO Este artigo tem como objetivo discutir, por meio da pesquisa documental, a introdução e institucionalização do rugby no Brasil englobando especificamente o período de 1891 a 1940. A abordagem histórica envolve a sistematização da pesquisa documental, utilizando como fontes jornais que datam entre as últimas décadas do século XIX até meados do XX e documentos da época. Com o objetivo de construir uma narrativa da modalidade e demonstrar que, apesar da restrita base de participantes e interesse apenas recente da mídia, a modalidade gozava de um grupo engajado, apesar de restrito, de participantes e praticantes no Brasil desde o início do século XX

Recuperación cardiovascular pediátrica: relevamiento estadístico 2009 - 2012 / Pediatric cardiovascular recovery: statistical survey 2009 - 2012

INTRODUCCION: Las cardiopatías congénitas son una patología prevalente en nuestra comunidad generando una importante demanda que requiere una respuesta rápida y efectiva para lograr mejores resultados en los tratamientos. Esta necesidad ha sido cubierta en gran medida desde la implementación del Plan Nacer (Cardiopatías Congénitas), con un gran impacto en la disminución de la mortalidad infantil. En el siguiente trabajo se comunican los resultados de las cirugías cardiovasculares en cardiopatías congénitas en el Hospital de Alta Complejidad El Cruce. Dr. Néstor Carlos Kirchner. MATERIALES Y METODOS: Los datos se identificaron por medio de la revisión de la Historia Clínica Digital en el Sistema SIGHEOS. RESULTADOS: los resultados obtenidos durante el período julio 2009 - octubre 2012 se realizaron 64 cirugías cardiovasculares. Diez cirugías fueron en neonatos, treinta y seis en pacientes de 31 días a 1 año y dieciocho en mayores de 1 año. Se concluye con que el crecimiento de los Servicios de Cirugía Cardiovascular Pediátrica y Recuperación Cardiovascular Pediátrica, ha sido exponencial desde el inicio de la realización de la primera cirugía en el año 2009. Desde el inicio de las actividades del servicio de Cirugía Cardiovascular Pediátrica y de Recuperación Cardiovascular Pediátrica en UCIP (Unidad Cuidados Intensivos Pediátricos), tanto el número, como la complejidad de las patologías operadas han ido en aumento.

INTRODUCTION: Congenital heart disease is a disease prevalent in our community generating significant demand that requires a rapid and effective response to achieve better results in treatment. This need has been met largely from the implementation of the Plan nacer (congenital heart disease), with a great impact on reducing child mortality. In this paper, we report the results of cardiovascular surgery in congenital heart disease in the High Complexity Hospital El Cruce. Dr. néstor Carlos Kirchner. MATERIAL AND METHODS: review of Medical records. SIGHEOS System. RESULTS: During the period July 2009 - 64 October 2012 cardiovascular surgeries were performed. Ten surgeries were in neonates, thirty-six patients under one year and eighteen in over 1 year.

Utilización profiláctica de antibióticos en la unidad médico-quirúrgica de un hospital de la ciudad de Bogotá / Prophylactic use of antibiotics in the medical-chirurgic unit of a Bogotá hospital

Se realizó un estudio descriptivo de corte transversal para evaluar las pautas de profilaxis antimicrobiana en cirugía que se siguen en la Clínica Fundadores (cf) de la ciudad de Bogotá, institución de tercer nivel de atención. La información se obtuvo a partir de fuentes secundarias y se recopiló en un formato diseñado para tal fin. Se seleccionaron 214 procedimientos en un período de dos meses, sin diagnóstico infeccioso previo o que no se les había prescrito antibióticos con fines terapéuticos antes de la cirugía. La evaluación se desarrolló sobre la base de un algoritmo que explica si las variables indicación profiláctica, agente antimicrobiano, dosis, momento de administración y régimen posoperatorio, están de acuerdo con protocolos nacionales e internacionales previamente seleccionados. Los resultados muestran que se administran antibióticos cuando la profilaxis no estaba recomendada (29,1%) y se prolonga la profilaxis con dosis posoperatorias cuando la recomendación es dosis única (65,2%), lo que evidencia que la tendencia en la clínica consiste en la aplicación de profilaxis excesiva. En menor proporción está el momento de administración inadecuado. Como conclusiones, se puede afirmar que no existe uniformidad de criterios en cuanto a la administración de la antibioticoprofilaxis quirúrgica. Las cirugías que se realizaron con mayor frecuencia en los meses de estudio corresponden a la especialidad gastrointestinal, seguidas de las cirugías de ortopedia y traumatología. La inclinación en el uso de antibióticos profilácticos está orientada a la utilización de cefalosporinas de primera generación seguido de la combinación gentamicina + clindamicina.

A descriptive cross-sectional study was carried-out in order to evaluate patterns of antimicrobial prophylaxis in surgery that they are continued in the Clinica Fundadores (cf) of Bogota city, classified in the third level of attention. The necessary information for the development of the study was obtained starting from secondary sources and it was gathered in a format designed for such purpose. 214 procedures were selected in a period of two months without previously infectious diagnosis and/or without antibiotics prescription for therapeutic reasons before de surgery. The assessment was developed on the basis of an algorithm that explains if the variables: indication prophylaxis, antimicrobial agent, dose, administration moment and postoperative regimen, are agree with previously selected national and international protocols. The results show that in several cases antimicrobial prophylaxis was not applied according with the recommendations of the protocols. Results shows administration of antibiotics when the prevention was not recommended (29.1%) and prolonging the prevention with postoperative dose when the recommendation is unique dose (65.2%), which evidences that the tendency in the clinic consists on the application of excessive prevention. The less proportion of errors are in the administration time. As conclusion, the study can affirm there are no unified criteria about the administration of antimicrobial prophylaxis in surgical procedures. The most frequent surgeries did in such period of time belong to gastrointestinal and traumatology specialties. The prophylaxis is oriented to the utilization of first generation cephalosporines and the combination gentamicin + clindamycin.

Fontan pulsátil: oclusión transcatéter de la arteria pulmonar permeable. Seguimiento a mediano plazo / Pulsatile Fontan: transcatheter closure of patent pulmonary artery. Follow up mid-term

OBJECTIVE: We report the percutaneous closure of the pulmonary artery with residual shunt in patients with Fontan type circuit. METHOD: Patients aged 9 and 11 years, with SaO2 of 88 and 96%, respectively. One of them coursing with headaches and functional class II. Both patients with total cavopulmonary anastomosis and fenestrated extracardiac conduit and permeable pulmonary artery (pulsatile Fontan). An Amplatzer duct-occluder device was implanted in the pulmonary artery entering from the femoral vein. Follow-up by means of clinical examination, imaging, and catetherization was pursued. RESULTS: Case 1, patency fenestration, Qp/Qs: 0.7/1. Case 2, closed fenestration, Qp/Qs; 1.3/1. We obtained immediate occlusion with 6/4 and 8/6 devices, respectively; pressure recordings revealed modification of the arterial morphology to biphasic; pulmonary pressure dropped 2 mm Hg in the first patient, without alteration in the second case; no changes in SaO2 were registered. Time of fluoroscopy was 57 and 45 minutes, respectively. Follow-up was maintained for 2.8 and 2.3 years, respectively. In patient 1, headaches disappeared and the fenestration was occluded with an Amplatzer septal-occluder one year later, raising SaO2 to 96%; no complications occurred nor was recanalization of the pulmonary artery needed in either case. CONCLUSIONS: Percutaneous occlusion of patent pulmonary artery in patients with Fontan type circuit is a feasible and effective procedure, and avoids overload of the single ventricle.

Cierre de fístula coronaria con Amplatzer vascular plug en el paciente pediátrico / Closure of a Coronary Fistula with an Amplatzer Vascular Plug in a Pediatric Patient

La fístula coronaria congénita es una patología poco frecuente y en general asintomática, por lo que muchas veces se diagnostica por un hallazgo incidental. Con dependencia de la repercusión hemodinámica, algunos siguen una conducta conservadora, otros indican tratamiento quirúrgico o, más recientemente, oclusión por cateterismo. Se presenta el caso de una paciente con una gran fístula coronaria-cameral, que se trató mediante embolización percutánea con dispositivo Amplatzer vascular plug. No se presentaron complicaciones durante el procedimiento ni en el seguimiento.

Congenital coronary fistula is an infrequent condition generally asymptomatic, which is mostly diagnosed by an incidental finding. Depending on the presence of hemodynamic compromise, coronary fistulas may be treated with a conservative approach, with surgery or, recently, with transcatheter closure. We present a case report of a patient with a large coronarycameral fistula treated with percutaneous embolization with Amplatzer vascular plug. No complications developed during the procedure and follow-up.

Stent ductal en cardiopatías congénitas dependientes del ductus: seguimiento a mediano plazo / Ductal stenting in congenital heart disease with ductus dependent circulation: mid-term follow up

Objetivo: Presentar nuestra experiencia con el empleo de stent para mantener la permeabilidad ductal en cardiopatías congénitas dependientes del ductus. Método y resultados: En tres pacientes de entre 2 y 9 días de vida con atresia pulmonar se colocaron cuatro stents por cateterismo, sin complicaciones. El tiempo de seguimiento promedio fue de 411 días (123 a 721 días). Dos stents se redilataron exitosamente. Un paciente fue sometido a cirugía, uno interrumpió sus controles cuatro meses después y otro espera cirugía. La saturación promedio aumentó del 61 por ciento al 80 por ciento. Conclusiones: En pacientes con cardiopatías cuya circulación depende del ductus arterioso, el implante del stent fue factible y efectivo a corto y mediano plazos.

Estudio sobre el valor diagnóstico de la tuberculina / Study about the diagnostic value of tuberculin

Se realizó un estudio de 2 años de duración, buscando determinar el valor diagnóstico de PPD en un grupo de 174 niños menores de 15 años, para lo cual se dividieron en dos grupos, los que tenian BCG y los que no. Se observó que los que tenían BCG en el 100 por ciento fueron tuberculino negativos contra 97.24 por ciento de negatividad en los que tenían antecedente de BCG. Al aplicar a estos niños la vacuna BCG y realizar otra lectura del PPD 2 meses después el 78.26 por ciento fueron tuberculino positivos. Sin embargo al practicar otra lectura 8 meses después se encontró que el 72.97 por ciento es nuevamente tuberculino negativo. En un grupo de 33 niños menores de 15 años y con diagnóstico de TBC se observó que el 69.7 por ciento son tuberculino positivos. Se concluyó que la prueba PPD si tiene valor para la sospecha de infección por micobacteria aún en los niños con BCG siempre y cuando haya transcurrido mas de 2 años de su aplicación