The "Phase Down" of Dental Amalgam Restorations - What are the Criteria for Replacement and Indication?

ABSTRACT Objective: To guide professionals about the criteria for replacing amalgam restorations and inform them about the new guidelines regarding the use/indication of this (amalgam) material after the Minamata Convention - COP-4. Material and Methods: The articles were selected from the databases (PubMed, Scielo, Bireme), and relevant articles on the subject between the years 2003-2021 were selected. Recently, social media have been flooded with dental treatments that aim to perform restorations only with composite resins or other types of esthetic material and completely replace all dental amalgam restorations, irrespective of their time in place, size, and functionality. Results: Although improperly, it has been noted that this information reaches patients, and they are led to believe in the inaccurate data that is passed on, such as, for example, (that amalgam leads to) permanent contamination by mercury, causing systemic problems and the loss of the tooth. Conclusion: The "phase down" of amalgam in research and teaching has previously been observed in several countries worldwide; however, its use is still necessary given particular circumstances, which, theoretically, make it a material with exact indication.

Évaluation de la prescription et de l'utilisation des benzodiazépines dans la ville de Sidi Bel-Abbès / Evaluation of the prescription and use of benzodiazepines in Sidi Bel-Abbes city

Introduction :Une forte consommation des benzodiazépines (BZDs) a été remarquée en dehors parfois des règles de recommandations de prescription, ce qui rend leur consommation un problème majeur de santé publique. La présente étude a eu pour objectif d'évaluer la prescription et l'usage des BZDs dans la ville de Sidi Bel-Abbès. Méthodes-Il s'agissait d'une étude descriptive transversale réalisée du 01 Février 2018 au 30 Juin 2018 évaluant la prescription et l'usage des BZDs dans la ville de Sidi Bel-Abbès au moyen d'un questionnaire distribué aux patients de l'hôpital psychiatrique, du service de psychiatrie du CHU et aux pharmaciens d'officine.Le critère de jugement principal était l'évaluation de la prescription et de l'utilisation des BZDs dans cette ville. La saisie et l'analyse des données ont été réalisées par le logiciel SPSS. Résultats-Au total, 353 patients traités au moins par une BZD ont été inclus dont 178 hommes. Le taux de prescription des BZDs était de 1.10, des jeunes (59,77 %) et des personnes mariées (60,34%) constituaient les consommateurs privilégiés. La prescription était l'apanage des psychiatres, en monothérapie (07,42%), la molé cule la plus fréquemment prescrite était le Bromazépam (31,07%) et la prise noc turne était la plus importante (49,01%). Les BZDs étaient utilisées pour combattre l'insomnie (25,21%), l'anxiété (16,43%), pour une durée de plus d'une année (57,79 %). Conclusion-La prescription et l'utilisation des BZDs dans la ville de Sidi Bel-Abbès s'est avérée importante. L'insomnie et l'anxiété constituaient les principales raisons de leur utilisation, et le Bromazépam était la molécule la plus fréquemment utilisée .

Introduction-A high consumption of benzodiazepines (BZDs) has been noticed so metimes outside the rules of prescription recommendations, which makes their consumption a major public health problem. The present study aimed to evaluate the prescription and use of BZDs in Sidi Bel-Abbès city. Methods-: This was a descriptive cross-sectional study carried out from February 01st, 2018 to June 30th, 2018 evaluating the prescription and use of BZDs in of Sidi Bel-Abbès by means of a questionnaire distributed to patients from the psychiatric hospital, the CHU psychiatry department and community pharmacists. The primary endpoint was the assessment of the prescription and use of BZDs in this city. Data entry and analysis were performed using SPSS software. Results-A total of 353 patients treated with at least one BZD were included, including 178 men. The prescription rate of BZDs was 1.10, young people (59.77%) and married people (60.34%) were the privileged consumers. The prescription was the prerogative of psychiatrists, in monotherapy (07.42%), the molecule most frequent ly prescribed was Bromazepam (31.07%) and night intake was the most important (49.01%). BZDs were used to combat insomnia (25.21%), anxiety (16.43%), for a period of more than a year (57.79%). Conclusion-The prescription and use of BZDs in Sidi Bel-Abbès has proven to be important. Insomnia and anxiety were the main reasons for their use, and Bromazepam was the most molecule frequently used.

Effect of the COVID-19 pandemic on blood donations and transfusions in Nigeria ­ A multi-facility study of 34 tertiary hospitals

Background: The coronavirus disease 2019 (COVID-19) pandemic affected blood supplies globally. Mobile blood drive campaigns halted, and voluntary blood donations reduced, challenging available blood supplies. Furthermore, fears of virus transmission led to deferrals of elective surgeries and non-urgent clinical procedures with noticeable declines in blood donations and transfusions. Aims: We aimed to assess the effect of the COVID-19 pandemic on the number of blood donations and transfusions across the country by blood product type across various hospital departments. Materials and Methods: A retrospective descriptive study was conducted to determine the impact of the COVID-19 pandemic on blood services in 34 tertiary hospitals in Nigeria, comparing January to July 2019 (pre-COVID-19) to January to July 2020 (peri-COVID-19). Data were collected from the country's web-based software District Health Information System, Version 2 (DHIS2). Results: A 17.1% decline in numbers of blood donations was observed over the study period, especially in April 2020 (44.3%), a 21.7% decline in numbers of blood transfusions, especially in April 2020 (44.3%). The largest declines in transfusion were noted in surgery department for fresh frozen plasma (80.1%) [p = 0.012] and accident and emergency department transfusion of platelets (78.3%) [p = 0.005]. The least decline of statistical significance was observed in internal medicine transfusions of whole blood (19.6%) [p = 0.011]. Conclusions: The COVID-19 pandemic significantly affected the numbers of blood donations and transfusions in Nigeria. Strengthening blood services to provide various blood components and secure safe blood supplies during public health emergencies is therefore critical.

Socio-economic drivers and effects of contraceptive usage on breast cancer among women in Nigeria

Certain types of contraceptives might have adverse effects on women's health including the possibility of causing breast cancer (BC). Furthermore, the types of contraceptives used might depend on the socioeconomic status of women. The triangular linkage of socioeconomic factors, contraceptives, and some factors causing BC among women are scarce in the literature, especially in developing countries. Consequently, the objectives of the study are to investigate the socio-economic drivers of BC and assess effects of contraceptive on BC among women in Nigeria. Cross-sectional data were collected on a one-off participant at a particular point in time using questionnaires on 200 women with confirmed cases of BC in Southwest, Nigeria, on a continuous visitation to the hospitals over six months. Structural equation modeling (SEM) with strong evidence from path analysis was adopted to achieve the objectives. Exploratory factors analysis was adopted to identify the socio-economic factors. The study analysed certain socioeconomic pre-determinants of BC through the use of contraceptives among women in Southwest Nigeria. The study provided evidence that some tested socioeconomic factors influence women in the use of contraceptive implants (C2) and oral contraceptives (C3), at a 1% level of significance. While about 76.8% of variations in socio-economic factors cause women to adopt a contraceptive implant, 81.1% of socioeconomic factors cause women to adopt oral contraceptives. Again, the result further provided evidence that socioeconomic factors (CCT) are strong determinants of BC at a 1% level of significance. Given the women-specific peculiarities, implanted contraceptives and oral contraceptives should be carefully administered by medical scientists.

Efectos secundarios de las terapias oncológicas en pacientes con cáncer de cérvix / Side effects of cancer therapies in cervical cancer patients / Efeitos colaterais das terapias oncológicas em pacientes com câncer de colo do útero

Objetivo: Determinar los efectos secundarios de las terapias oncológicas en pacientes con cáncer de cérvix en una unidad oncológica de Neiva Huila, durante el 2017. Metodología: Estudio observacional, retrospectivo, descriptivo de corte transversal, basado en la revisión de fuentes secundarias, como son las historias clínicas de las pacientes con cáncer de cér-vix que estuvieron en tratamiento oncológico y que desarrollaron efectos secundarios a las terapias oncológicas. La muestra se conformó con 75 pacientes, la cual se obtuvo a través un muestreo no proba¬bilístico por conveniencia, previo al cumplimiento de criterios de inclusión y exclusión definidos para el estudio. Resultados: Durante el periodo de estudio, se identificaron 75 pacientes que desarrollaron efectos secundarios atribuidos a las terapias oncológicas. La edad en promedio fue de 49 años. En el grupo de 35-54 años, se presentó el mayor número de los casos con un 53,3% (IC 95%: 42,1-64,1). La radioterapia concomitante con quimioterapéuticos ocupó el primer lugar entre las terapias oncológicas con mayores efectos secundarios en el 63% (IC 95%: 51,3-72,7) de las pacientes. El sistema gastroin-testinal presentó mayores efectos secundarios en el 95% (IC 95%: 87,0-97,9) de los casos. Conclusiones: Durante las consultas de seguimiento a riesgos, se identificó que las pacientes manifestaron sensaciones molestas a nivel gastrointestinal como: náuseas, emesis y diarrea, dado que la mucosa intestinal es más susceptible a las alteraciones generadas por la radiación y los quimioterapéuticos, por el alto recambio celular presentado en estos órganos.

Objective: Determine the side effects of cancer therapies in cervical cancer patients in an oncology unit of Neiva Huila during 2017. Methodology: Observational, retrospective, descriptive cross-sectional study, based on the revision of secondary sources, such as the medical records of cervical cancer patients who were in cancer treatment and who de-veloped adverse effects on cancer therapies. The sample consisted of 75 patients, which were obtained through non-probabilistic sampling for convenience, prior to compliance with inclusion and exclusion criteria defined for the study. Results: During the study pe-riod, 75 patients who developed side effects attributed to oncology therapies were iden-tified, the age on average was 49 years. In the 35­54-year group, the highest number of cases was presented with 53.3% (95% CI: 42.1-64.1). Concomitant radiation therapy with chemotherapeutics took the first place among cancer therapies with the greatest side ef-fects in 63% (95% CI: 51.3-72.7) of patients. The gastrointestinal system had the greatest side effects in 95% (95% CI: 87.0-97.9) of cases. Conclusions: During follow-up visits to risks, patients were identified as showing bothersome sensations at the gastrointestinal level such as: nausea, emesis and diarrhea, since the intestinal mucosa is more suscepti-ble to alterations generated by radiation and chemotherapeutics, by the high cell replace-ment presented in these organs. Cancer treatments should point to greater tumor control.

Objetivo: determinar os efeitos colaterais das terapias oncológicas em pacientes com câncer do colo do útero numa unidade oncológica de Neiva-Huila, durante 2017. Materiais e méto-dos: estudo observacional, retrospectivo, descritivo, transversal, baseado na revisão de fontes secundarias como prontuários médicos das pacientes com câncer do colo do útero que esti-veram em tratamento oncológico e que desenvolveram efeitos colaterais a terapias oncológi-cas. A amostra foi de 75 mulheres, estudadas de forma não probabilística por conveniência, prévio cumprimento dos critérios de inclusão e exclusão definidos para o estudo. Resultados: foram estudadas 75 pacientes que desenvolveram efeitos colaterais em decorrência de tera-pias oncológicas. A media da idade foi de 49 anos. No grupo de 35-54 anos apresentaram-se o maior número dos casos (53,3%; IC95%: 42,1-64,1). A radioterapia conjuntamente ad-ministrada com quimioterápicos ocupou o primeiro lugar entre as terapias oncológicas com maiores efeitos colaterais nas pacientes (63%; IC 95%: 51,3-72,7). O trato gastrointestinal apresentou a maior frequência dos efeitos com sintomas e sinais como: enjoo, vômitos e diar-reia, principalmente pela mucosa intestinal ser a mais susceptível às alterações geradas pela radiação e quimioterápicos, pelo alta atividade celular desses órgãos

Tempo de permanência e motivos de retirada do cateter venoso central de pacientes renais crônicos em hemodiálise ambulatorial / Duration of use and reasons for removal of central venous catheter in patients with chronic kidney disease undergoing ambulatory hemodialysis

Introdução: A permanência prolongada de Cateter Venoso Central (CVC) em Hemodiálise (HD) está relacionado a maior risco de complicações. O objetivo deste estudo foi avaliar o tempo, em dias, de permanência e o motivo de retirada do CVC em pacientes renais crônicos submetidos à HD ambulatorial em um seguimento de 10 meses. Métodos: Estudo longitudinal, retrospectivo, realizado em unidade de HD de um hospital público no sul do Brasil, no período de janeiro a setembro/2019. A coleta de dados foi realizada pelos pesquisadores a partir de prontuário eletrônico e planilha de registros dos doentes renais crônicos em hemodiálise por CVC de curta e longa permanência no período em estudo. Projeto aprovado no Comitê de Ética em Pesquisa da instituição. Resultados: Foram avaliados 91 cateteres de 55 pacientes, com prevalência do sexo feminino 33 (60%), média de idade 55 ± 18 anos e cor branca 42 (76,3%). Quarenta e sete (52%) dos CVCs eram de curta permanência, e 70 (76,9%) inseridos em veia jugular direita. O tempo de hemodiálise com CVCs de curta permanência variou de quatro a 190 dias com mediana de 47 dias (21, 7-69, 3) e os de longa permanência de 47 a 1.486 dias, com mediana de 231 (95-676). O principal motivo de retirada dos cateteres foi a troca por outro CVC 17 (36,2%). A taxa de suspeita e/ou infecção foi de 14 (15,4%). Conclusão: O tempo de permanência dos CVC foi prolongado o que expõe os pacientes a riscos. O principal motivo para retirar o CVC não foi a confecção de Fístula Arteriovenosa (FAV), apontando para a necessidade de revisar os processos assistenciais visando modificar e priorizar essa prática. (AU)

Introduction: The prolonged permanence of Central Venous Catheter (CVC) in Hemodialysis (HD) is related to an increased risk of complications. The aim of this study was to evaluate duration of use, in days, and reasons for removal of central venous catheter (CVC) in patients with chronic kidney disease undergoing ambulatory hemodialysis in a 10-month follow-up. Methods: This longitudinal, retrospective study was conducted at the hemodialysis unit of a public hospital in southern Brazil, from January to September 2019. Data collection was performed by the researchers using electronic medical records and a spreadsheet of records of patients with chronic kidney disease undergoing hemodialysis by short- and long-term CVC in the study period. The project was approved by the institution's Research Ethics Committee. Results: Ninety-one catheters from 55 patients were evaluated. Thirty-three participants were female (60%), mean age was 55 ± 18 years, and 42 were white (76.3%). Forty-seven (52%) CVCs were short-term, and 70 (76.9%) CVCs were inserted in the right jugular vein. Hemodialysis duration with short-term CVCs ranged from four to 190 days with a median of 47 (21.7-69.3) days, and long-term CVCs ranged from 47 to 1486 days with a median of 231 (95-676) days. The main reason for removing the catheter was replacing it with another CVC, in 17 cases (36.2%). The number of cases of infection or suspected infection was 14 (15.4%). Conclusions: The duration of CVC use was prolonged, which exposes patients to risks. The main reason for removing the CVC was not related to creating an arteriovenous fistula, demonstrating the need to review the care processes aiming to modify and prioritize this practice. (AU)

Síndrome de Cushing iatrogénico secundario al mal uso de corticoïdes tópicos: Reporte de un caso pediátrico / Iatrogenic Cushing syndrome due to the misuse of topical corticosteroids: Pediatric case report

Los corticoides se utilizan en el tratamiento de muchas enfermedades dermatológicas, debido a sus efectos antiinflamatorios, inmunosupresores y antiproliferativos. Su uso indiscriminado puede ocasionar serios efectos adversos locales y sistémicos, fundamentalmente, en niños y frente a ciertos factores predisponentes. Si bien los corticoides tópicos son seguros y efectivos, se debe prestar principal atención a factores como la edad del paciente, el estado de la barrera cutánea, la localización, la potencia y el vehículo del corticoide antes de su prescripción, para disminuir la posibilidad de efectos adversos. Se presenta a una paciente de 5 meses de edad, la cual concurrió a la consulta por un hemangioma ulcerado en el glúteo izquierdo asociado a un síndrome de Cushing, debido a la aplicación local de un corticoide tópico durante más de 3 meses para tratar dicha lesión.

Corticosteroids are used in the treatment of many dermatological diseases due to their anti-inflammatory, immunosuppressive and antiproliferative effects. Its indiscriminate use can cause serious local and systemic adverse effects, mainly in children and in the presence of certain predisposing factors. While topical corticosteroids are safe and effective, it is important to pay attention to factors such as patient's age, skin barrier, clinical characteristic and localization of the lesion, potency and vehicle of the corticosteroid before its prescription to reduce the possibility of adverse effects. We present the case of a 5-month-old patient who presented an ulcerated hemangioma in the left buttock. Due to the local application of a topical corticosteroid on the hemangioma for more than 3 months, she developed Cushing's syndrome.

Disfunción sinusal transitoria secundaria a tratamiento con lacosamida / Transient sinus dysfunction secondary to lacosamide treatment

RESUMEN Se presenta el caso de una paciente de 84 años de edad, con antecedentes de hipertensión arterial, dislipemia, insuficiencia venosa crónica y osteoartrosis, que -debido a una neuralgia del trigémino- había recibido tratamiento con varios fármacos, sin lograr control del dolor neuropático, por lo que se inició tratamiento con lacosamida en monoterapia, con incremento de dosis hasta lograr el objetivo terapéutico; pero la paciente presentó manifestaciones clínicas y alteraciones electrocardiográficas compatibles con disfunción sinusal, que se resolvieron tras la reducción de la dosis del fármaco.

ABSTRACT The case of an 84-year-old female patient is presented, with a history of high blood pressure, dyslipidemia, chronic venous failure and osteoarthritis, which -due to trigeminal neuralgia- had received treatment with several drugs, without achieving neuropathic pain control; that was why the treatment with lacosamide was started in monotherapy, with an increase in dose until the therapeutic objective was achieved; but the patient presented clinical manifestations and electrocardiographic alterations compatible with sinus dysfunction, which were solved after reducing the dose of the drug.

Long Term Outcome of In-Stent Stenosis after Stent Assisted Coil Embolization for Cerebral Aneurysm

OBJECTIVE: The objective of this study was to evaluatelong-term radiologic prognosis and characteristics of in-stent stenosis (ISS) after stent assisted coiling (SAC) for cerebral aneurysm and analyze its risk factors.METHODS: Radiological records of 362 cases of SAC during 10 years were retrospectively reviewed. Patients were included in this study if they had follow-up angiogram using catheter selected angiography at least twice. All subjected were followed up from 12 months to over 30 months. Of 120 patients, 123 aneurysms were enrolled. Patient data including age, sex, aneurysm size, neck size, procedural complication, kinds of stent, ISS associated symptom, ruptured state, location of ISS, degree of ISS, radiologic prognosis of ISS, follow-up period of time, and medical comorbidities such as hypertension, diabetes mellitus (DM), dyslipidemia, and smoking were collected.Statistical comparisons of group clinical characteristics were conducted for the total population.RESULTS: Among 123 casesof aneurysm, 22 cases (17.9%) of ISS were revealed on follow-up angiography. Multiple stenting was performed in three cases and intra-procedural rupture occurred in two cases. Most cases were asymptomatic and symptomatic stenosis was identified in only one case. Sixteen cases were ruptured aneurysm. Mild stenosis was observed in 11 cases. Moderate stenosis was found in eight cases and severe stenosis was identified in three cases. Mean timing of identification of ISS was 8.90 months. The most common type was proximal type. Most cases were improved or not changed on follow-up angiography. Only one case was aggravated from mild stenosis to occlusion of parent artery. Mean follow-up period was 44.3 months. We compared risk factors and characteristic between ISS group and non-ISS group using univariate analysis. Multiple stenting was performed for three cases (13.6%) of the ISS group and four cases (4.0%) of the non-ISS group, showing no statistical difference between the two groups (p=0.108). Additionally, the proportion of patients who had more than two risk factors among four medical risk factors (hypertension, DM, dyslipidemia, and smoking) was higher in the ISS group than that in the non-ISS group, the difference between the two was not statistically significant either (31.8% vs. 12.9%, p=0.05).CONCLUSION: Clinical course and long-term prognosis of ISS might be benign. Most cases of ISS could be improved or not aggravated. Control of medical co-morbidity might be important. To the best of our knowledge, our study had more cases with longer follow-up period of time than other reports.

Long Term Outcome of In-Stent Stenosis after Stent Assisted Coil Embolization for Cerebral Aneurysm

OBJECTIVE: The objective of this study was to evaluatelong-term radiologic prognosis and characteristics of in-stent stenosis (ISS) after stent assisted coiling (SAC) for cerebral aneurysm and analyze its risk factors. METHODS: Radiological records of 362 cases of SAC during 10 years were retrospectively reviewed. Patients were included in this study if they had follow-up angiogram using catheter selected angiography at least twice. All subjected were followed up from 12 months to over 30 months. Of 120 patients, 123 aneurysms were enrolled. Patient data including age, sex, aneurysm size, neck size, procedural complication, kinds of stent, ISS associated symptom, ruptured state, location of ISS, degree of ISS, radiologic prognosis of ISS, follow-up period of time, and medical comorbidities such as hypertension, diabetes mellitus (DM), dyslipidemia, and smoking were collected.Statistical comparisons of group clinical characteristics were conducted for the total population. RESULTS: Among 123 casesof aneurysm, 22 cases (17.9%) of ISS were revealed on follow-up angiography. Multiple stenting was performed in three cases and intra-procedural rupture occurred in two cases. Most cases were asymptomatic and symptomatic stenosis was identified in only one case. Sixteen cases were ruptured aneurysm. Mild stenosis was observed in 11 cases. Moderate stenosis was found in eight cases and severe stenosis was identified in three cases. Mean timing of identification of ISS was 8.90 months. The most common type was proximal type. Most cases were improved or not changed on follow-up angiography. Only one case was aggravated from mild stenosis to occlusion of parent artery. Mean follow-up period was 44.3 months. We compared risk factors and characteristic between ISS group and non-ISS group using univariate analysis. Multiple stenting was performed for three cases (13.6%) of the ISS group and four cases (4.0%) of the non-ISS group, showing no statistical difference between the two groups (p=0.108). Additionally, the proportion of patients who had more than two risk factors among four medical risk factors (hypertension, DM, dyslipidemia, and smoking) was higher in the ISS group than that in the non-ISS group, the difference between the two was not statistically significant either (31.8% vs. 12.9%, p=0.05). CONCLUSION: Clinical course and long-term prognosis of ISS might be benign. Most cases of ISS could be improved or not aggravated. Control of medical co-morbidity might be important. To the best of our knowledge, our study had more cases with longer follow-up period of time than other reports.

"Errar es humano. Ocultar los errores es imperdonable. No aprender de ellos no tiene justificación" / "To err is human. To cover up is unforgivable. To fail to learn is inexcusable."

Es muy frecuente que cuando nos encontramos en frente de nuestros pacientes, colegas, alumnos o simplemente cuando estamos recopilando resultados de nuestras observaciones para escribir un artículo científico, al momento de tener en cuenta los efectos adversos o las complicaciones que se presentan sintamos preocupación y se generen diferentes sentimientos de frustración. A la luz de la práctica médica actual, y en especial de la Cardiología y la Cirugía Cardiovascular, foco temático de esta Revista Colombiana de Cardiología, cada día nos enfrentamos a pacientes más complejos, prematuros o ancianos, con multimorbilidades (diabetes, enfermedades mentales, pulmonares, renales, hepáticas, fragilidad, etc.), polifarmacia (diuréticos, vasodilatadores, anticoagulantes, inhibidores de bomba de protones, anti-arrítmicos, analgésicos, etc.), re-intervenidos varias veces y sometidos a intervenciones percutáneas diversas (marcapasos, desfibriladores, stents, válvulas percutáneas, implante de MitraClips, cierre de apéndice auricular izquierdo, endoprótesis de aorta, cierres percutáneos de defectos intracardiacos, etc.), cirugías de revascularización miocárdica, y muchos más, y el uso de nuevos medicamentos, dietas, productos homeopáticos que salen al mercado para el tratamiento y control de condiciones especiales, incrementando la posibilidad de eventos adversos y iatrogenia, que además ponen en riesgo la salud del paciente y su la vida, aumentando los tiempos de hospitalización y los reingresos y, finalmente, los costos al sistema de salud.

Efectividad de la anestesia espinal con morfina y bupivacaína en la cirugía de próstata / Effectiveness of spinal anesthesia with morphine and bupivacaine in prostate surgery

Introducción: El dolor posoperatorio constituye la principal causa de dolor agudo en el mundo. Brindar analgesia adecuada en el posquirúrgico garantiza la disminución del tiempo de estancia hospitalaria y tiene un impacto positivo en el resultado final de los pacientes. Objetivo: Evaluar la calidad de la analgesia posoperatoria con bupivacaína más morfina intratecal en la cirugía electiva de próstata, así como la incidencia de efectos adversos. Métodos: Se realizó una investigación cuasiexperimental, entre enero de 2014 y julio de 2017. La muestra quedó conformada de manera no probabilística por los pacientes que dieron su consentimiento informado y reunieron criterios para entrar en el estudio. Quedaron distribuidos de manera aleatoria en dos grupos denominados bupivacaína (B) y morfina-bupivacaína (MB). Para recolectar la información se emplearon las historias clínicas anestésicas y un formulario elaborado al efecto. Los datos se mostraron en tablas y gráficos, los resultados se expresaron numéricamente y en porcientos, se determinaron algunas medidas descriptivas de interés que mostraron el comportamiento de las variables que lo requirieron. Resultados: El resultado más relevante fue el efecto analgésico muy significativo en el grupo MB en las primeras 24 h del posoperatorio. La reacción adversa más frecuente fue el prurito y solo se presentó en el grupo que recibió morfina. Conclusiones: La anestesia espinal con morfina y bupivacaína es efectiva y segura, proporcionando mejor analgesia en el posoperatorio inmediato cuando se compara con bupivacaína sola(AU)

Introduction: Postoperative pain is the main cause of acute pain worldwide. Providing adequate analgesia postoperatively guarantees hospital stay reduction and positively affects patient outcome. Objective: To evaluate the quality of postoperative analgesia with bupivacaine plus intrathecal morphine in elective prostate surgery, as well as the incidence of adverse effects. Methods: A quasiexperimental research was carried out between January 2014 and July 2017. The sample was chosen in a non-probabilistic way and made up by the patients who gave their informed consent and met the inclusion criteria to enter the study. They were randomly distributed into two groups identified as bupivacaine (B) and morphine-bupivacaine (MB). To collect the information, the anesthetic medical records were used, together with a form prepared for such purpose. The data were shown in charts and graphs, the results were expressed numerically and in percentages, some descriptive measures of interest were determined that showed the behavior of the variables that required it. Results: The most relevant outcome was the very significant analgesic effect in the MB group in the first 24 hours after surgery. The most common adverse reaction was pruritus and only occurred in the group that received morphine. Conclusions: Spinal anesthesia with morphine and bupivacaine is effective and safe because it provides better analgesia in the immediate postoperative period in comparison to bupivacaine alone(AU)

Adipose-derived mesenchymal stem cells for treatment of airway injuries in a patient after long-term exposure to sulfur mustard

Objective: Sulfur mustard [SM] is a potent mutagenic agent that targets several organs, particularly lung tissue. Changes in morphological structure of the airway system are associated with chronic obstructive pulmonary deficiency following exposure to SM. Although numerous studies have demonstrated pathological effects of SM on respiratory organs, unfortunately there is no effective treatment to inhibit further respiratory injuries or induce repair in these patients. Due to the extensive progress and achievements in stem cell therapy, we have aimed to evaluate safety and potential efficacy of systemic mesenchymal stem cell [MSC] administration on a SM-exposed patient with chronic lung injuries

Materials and Methods: In this clinical trial study, our patient received 100x106 cells every 20 days for 4 injections over a 2-month period. After each injection we evaluated the safety, pulmonary function tests [PFT], chronic obstructive pulmonary disease [COPD] Assessment Test [CAT], St. George's Respiratory Questionnaire [SGRQ], Borg Scale Dyspnea Assessment [BSDA], and 6 Minute Walk Test [6MWT]. One-way ANOVA test was used in this study which was not significant [P>0.05]

Results: There were no infusion toxicities or serious adverse events caused by MSC administration. Although there was no significant difference in PFTs, we found a significant improvement for 6MWT, as well as BSDA, SGRQ, and CAT scores after each injection

Conclusion: Systemic MSC administration appears to be safe in SM-exposed patients with moderate to severe injuries and provides a basis for subsequent cell therapy investigations in other patients with this disorder

Aripiprazole-induced Tardive Dyskinesia in 13 Years Old Girl Successfully Treated with Biperiden: A Case Report

In the last years second-generation antipsychotics are increasingly prescribed in the pediatric population for the treatment of several psychiatric disorders. Among the long term adverse effects, extrapyramidal symptoms (EPS) are less reported compared to first-generation antipsychotics. Tardive dyskinesia (TD) is a iatrogenic rare syndrome characterized by persistent slow writhing and sudden involuntary movements mainly involving the oral-buccal-lingual area with masticatory movements. We report a young girl with mood disorders accompanied by mild intellectual disability and behavioral problems who had TD after treatment with Aripiprazole, which responded to Biperiden therapy.

Effects of acute kidney injury after liver resection on long-term outcomes / 대한마취과학회지

BACKGROUND: To investigate the effects of acute kidney injury (AKI) after liver resection on the long-term outcome, including mortality and renal dysfunction after hospital discharge. METHODS: We conducted a historical cohort study of patients who underwent liver resection for hepatocellular carcinoma with sevoflurane anesthesia between January 2004 and October 2011, survived the hospital stay, and were followed for at least 3 years or died within 3 years after hospital discharge. AKI was diagnosed based on the Acute Kidney Injury Network classification within 72 hours postoperatively. In addition to the data obtained during hospitalization, serum creatinine concentration data were collected and the glomerular filtration rate (GFR) was estimated after hospital discharge. RESULTS: AKI patients (63%, P = 0.002) were more likely to reach the threshold of an estimated GFR (eGFR) of 45 ml/min/1.73 m² within 3 years than non-AKI patients (31%) although there was no significant difference in mortality (33% vs. 29%). Cox proportional hazard regression analysis showed that postoperative AKI was significantly associated with the composite outcome of mortality or an eGFR of 45 ml/min/1.73 m² (95% CI of hazard ratio, 1.05–2.96, P = 0.033), but not with mortality (P = 0.699), the composite outcome of mortality or an eGFR of 60 ml/min/1.73 m² (P =0.347). CONCLUSIONS: After liver resection, AKI patients may be at higher risk of mortality or moderate renal dysfunction within 3 years. These findings suggest that even after discharge from the hospital, patients who suffered AKI after liver resection may need to be followed-up regarding renal function in the long term.

The Evaluation of Feasibility and Predictive Validity of Comprehensive Korean Frailty Instrument: Using the 2008 and 2011 Living Profiles of Older People Survey in Korea

PURPOSE: This study aimed to verify the predictive validity of Comprehensive Korean Frailty Instrument (CKFI) among older adults. METHODS: A secondary analysis of data from a prospective cohort study was conducted. Frailty was determined in older adults (N=9,188) according to the data in 2008 and the effects of frailty on adverse outcomes (such as institutionalization and death) were evaluated according to the data in 2011. The Cardiovascular Health Study (CHS) index was used to compare with the predictive validity of CKFI. RESULTS: The prevalence of frailty was 26.3%. With the CKFI, the frail group had a higher risk of negative health outcomes compared to the robust and pre-frail groups after three years. The two of the highest risks identified using the CKFI and CHS index were institutionalization (5.522 times higher) and mortality (3.210 times higher). For both instruments, the survival analysis revealed that the risk of death increased as the degree of frailty increased. CONCLUSION: The CKFI consisting of self-report items and multidimensional aspects of frailty can be used as a simple instrument for assessing the frailty of older adults residing in a local community in Korea.

Choice of bariatric and metabolic surgical procedures / 中华胃肠外科杂志

Bariatric and metabolic surgery has become the clinical hot topic of the treatment of metabolic syndromes including obesity and diabetes mellitus, but how to choose the appropriate surgical procedure remains the difficult problem in clinical practice. Clinical guidelines of American Society for Metabolic and Bariatric Surgery(ASMBS)(version 2013) introduced the procedures of bariatric and metabolic surgery mainly including biliopancreatic diversion with duodenal switch(BPD-DS), laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy(LSG). To choose the appropriate bariatric and metabolic procedure, the surgeons should firstly understand the indications and the contraindications of each procedure. Procedure choice should also consider personal condition (body mass index, comorbidities and severity of diabetes), family and socioeconomic status (postoperative follow-up attendance, understanding of potential surgical risk of gastrectomy and patient's will), family and disease history (patients with high risk of gastric cancer should avoid LRYGB; patients with gastroesophageal reflux disease should avoid LSG) and associated personal factors of surgeons. With the practice of bariatric and metabolic surgery, the defects, especially long-term complications, of different procedures were found. For example, LRYGB resulted in higher incidence of postoperative anemia and marginal ulcer, high risk of gastric cancer as well as the requirement of vitamin supplementation and regular follow-up. Though LSG has lower surgical risk, its efficacy of diabetes mellitus remission and long-term weight loss are inferior to the LRYGB. These results pose challenges to the surgeons to balance the benefits and risks of the bariatric procedures. A lot of factors can affect the choice of bariatric and metabolic procedure. Surgeons should choose the procedure according to patient's condition with the consideration of the choice of patients. The bariatric and metabolic surgery not only manages the diabetes mellitus and weight loss, but also results in the reconstruction of gastrointestinal tract and side effect. Postoperative surgical complications and nutritional deficiency should also be considered. Thereby, individualized bariatric procedure with the full consideration of each related factors is the ultimate objective of bariatric and metabolic surgery.

Prevention of surgery-related complications of D2+ lymphadenectomy for gastric cancer / 中华胃肠外科杂志

D2 lymphadenectomy is currently the worldwide standard operation for locally advanced gastric cancer and D2+ is an option for some selected patients. The D2 plus lymphadenectomy includes No.8p, No.10, No.11d, No.12b, No.12p, No.13, No.14v, No.16a2 and No.16b1. Dissection of these groups of lymph nodes may cause related complications. Postoperative complications that can cause prolonged inflammation have significant impact not only on mortality but also on overall survival of patients with gastric cancer even if the tumor is resected curatively. D2 plus lymphadenectomy is recommended only in high volume medical center by experienced surgeon. The adequate exposure of the operative field, right anatomical space, use of ultrasound scalpel and operator with enough patience are proved to be pivotal to prevent the complications.

Risk factor analysis of low anterior resection syndrome after anal sphincter preserving surgery for rectal carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the risk factors of low anterior resection syndrome (LARS) after anal sphincter preserving surgery (SPS) for rectal cancer patients.</p><p><b>METHODS</b>Clinicopathological and follow-up data of rectal cancer patients who underwent SPS from January 2010 to June 2014 in Department of Gastroenterological Surgery, Peking University People's Hospital, were retrospectively analyzed. Patients receiving permanent colostomy and local resection were excluded. Meanwhile, during October 2014 and March 2015, the enrolled patients were asked to fill out a specially designed questionnaire for LARS through face-to-face interview or telephone inquiry, according to the chronological order of operation. Based on the score of questionnaire, patients were divided into three groups: 0-20 points: non LARS; 21-29: minor LARS; 30-42: major LARS. The demographic and clinicopathologic features were compared among groups and the risk factors of major LARS were tested by logistic regression analysis.</p><p><b>RESULTS</b>A total of 100 patients (61 males, 39 females) completed the bowel function survey, with an average age of 66.2(41-86) years, 33 patients <60 years versus 67 patients ≥60 years. No significant difference was observed in age distribution (P=0.204). Interval from operation to first follow-up was more than 1 year in 70 patients, and the median follow-up was 23 months. Thirty-seven patients were non LARS, 18 were minor LARS and 45 were major LARS. No significant differences in clinicopathological data (all P>0.05) were observed among three groups except radiotherapy history (P=0.025), tumor location(P=0.000) and distance from anastomotic site to anal verge(P=0.008). After comparison of non LARS group combined with minor LARS group versus major LARS, re-analysis of risk factors showed that radiotherapy history (RR=5.608, 95%CI:1.457 to 21.584, P=0.006), distance from tumor lower margin to anal verge (RR=0.125, 95%CI:0.042 to 0.372, P=0.000), distance from anastomotic site to anal verge (RR=0.255, 95%CI:0.098 to 0.665, P=0.004) and preventive ileostomy history(RR=3.643, 95%CI:1.058 to 12.548, P=0.032) were associated with major LARS. One potential risk factor detected in combined analysis was female (RR=2.138, 95%CI: 0.944 to 4.844, P=0.078). Multivariate analysis revealed that female (RR=2.654, 95%CI: 1.005 to 7.014, P=0.049), radiotherapy history (RR=10.422, 95%CI:2.394 to 45.368, P=0.002) and distance from tumor lower margin to anal verge ≤7 cm (RR=8.935, 95%CI:2.827 to 28.243, P=0.000) were independent risk factors of major LARS.</p><p><b>CONCLUSIONS</b>LARS is a significant problem in most rectal cancer patients after SPS. The risk of major LARS increases on condition of radiotherapy, low tumor position and female. When dealing with these patients, preventive measures should be taken into consideration during SPS.</p>