Randomized trial evaluating an mHealth intervention for the early community-based detection and follow-up of cutaneous leishmaniasis in rural Colombia.

BACKGROUND: In Latin America, cutaneous leishmaniasis primarily affects dispersed rural communities, that have limited access to the public health system and medical attention. Mobile health (mHealth) strategies have shown potential to improve clinical management and epidemiological surveillance of neglected tropical diseases, particularly those of the skin. METHODS: The Guaral +ST app for Android was designed to monitor cutaneous leishmaniasis treatment and assess therapeutic response. We carried out a randomized trial in the coastal municipality of Tumaco in southwestern Colombia, with parallel arms comparing a) follow-up aided by the app to b) standard institution-based follow-up. Treatment was prescribed according to national guidelines. Follow-up of therapeutic response was scheduled at the end of treatment and at 7, 13 and 26 weeks after the start of treatment. The primary endpoint was the proportion of participants who were monitored at or around week 26, allowing outcome and effectiveness of treatment to be determined. RESULTS: Follow-up of treatment and outcome assessment was achieved in significantly more patients in the intervention arm than the controls, Of the 75 participants in the two randomized arms, 74 had information on whether or not treatment was followed and outcome determined at or around week 26. Among these, 26/49 (53.1%) were evaluated in the intervention arm, and none (0/25, 0%) in the control arm (difference = 53.1%, 95% confidence interval 39.1-67.0%, p<0.001). Of the 26 participants evaluated at or around week 26 in the intervention arm, 22 (84.6%) had cured. There were no serious adverse events, nor events of severe intensity among patients monitored by CHW using the app. CONCLUSION: This study provides proof of concept for mHealth to monitor treatment of CL in remote and complex settings, deliver improved care and to provide information to the health system on the effectiveness of treatment as it is delivered to affected populations. CLINICAL TRIAL REGISTRATION: ISRCTN54865992.

Physical and Mental Impact of Laparoscopic Sleeve Gastrectomy on the Surgeon: French vs. American Positions. A Randomized and Controlled Study.

PURPOSE: To determine the physical and mental impact on the primary surgeon, by the patient's and surgical staff's dispositions at the operating table, during laparoscopic vertical sleeve gastrectomy. MATERIALS AND METHODS: This is a randomized and controlled study that included 18 laparoscopic sleeve gastrectomy procedures performed by two surgeons in a private and academic hospital. The cases were randomized for the American or French position. After surgery, the National Aeronautics and Space Administration - Task Load Index (NASA-TLX) and the Body Part Discomfort (BPD) scales were applied to the primary surgeon. RESULTS: An increased workload and more discomfort were reported when using the French position. The NASA-TLX was 28 ± 8 vs. 57 ± 18 (p = 0.001), and the BPD was 2 vs. 8 (p = 0.001). CONCLUSIONS: The American position resulted in a lower physical and mental impact on the surgeon when performing a laparoscopic sleeve gastrectomy.

Restituciones del tránsito intestinal / Intestinal transit restitutions

La restitución de tránsito intestinal es una cirugía cotidiana en pacientes ostomizados que puede presentar complicaciones. Objetivo: Presentar la experiencia de las restituciones de tránsito intestinal del Hospital Dr. Domingo Luciani, servicio de cirugía II. Métodos: Los datos se recolectaron utilizando la base de datos del servicio de Cirugía II del Hospital Dr. Domingo Luciani en el período septiembre de 2008 - septiembre 2013. Los criterios de inclusión fueron pacientes a los que se les realizó restitución del tránsito intestinal. Los datos recolectados incluyeron: edad, sexo,comorbilidades, indicación de ostomía, tipo, duración de ostomía, dehiscencia de anastomosis. Resultados: Fueron sometidos a restituciones del tránsito intestinal un total de 40 pacientes, 7 (17.5%) sexo femenino y 33(82,5%) sexo masculino, edad media fue 33,5 años (18-72), 8(20%) padecían algún tipo de comorbilidad, 26 (65%) por causas traumáticas, la media de duración con la ostomía fue 17,3 meses(3-108). 7 (17.5%) pacientes presentaron dehiscencia de anastomosis, de los cuales 5 (71.42%) se resolvieron con tratamiento médico y 2 (28.5%) ameritaron reintervención. Conclusión:Los traumatismos son la primera causa de ostomías, los pacientes permanecen con estas un mayor tiempo de lo establecido. Las restituciones de tránsito intestinal se realizan en mayor porcentaje en pacientes masculinos y con un porcentaje bajo de complicaciones(AU)

The restitution of intestinal transit is a daily surgery in ostomized patients that can present complications. Objective: To present the experience of intestinal transit restitutions at Hospital Domingo Luciani, Surgery 2 Service. Methods: Data were collected using the database of Surgery 2 Service of Hospital Domingo Luciani in the period September 2008 - September 2013. The inclusion criteria were patients who underwent restoration of intestinal transit. The data collected included: age, gender, comorbidities, ostomy indication, type, duration of ostomy, and anastomotic dehiscence. Results: Were studied a total of 40 patients, 7 (17.5%) femaleand 33 (82.5%) sex male, mean age was 33.5 years (18-72), 8(20%) suffered from some type of comorbidity, 26 (65%) from traumatic causes, the average time with the ostomy was 17.3 months(3-108). Seven (17.5%) patients had dehiscence of anastomosis, of which 5 (71.42%) were resolved with medical treatment and 2(28.5%) by reoperation. Conclusion: Injuries are the leading cause of ostomy, patients remain a longer time with these provisions. Intestinal transit restitutions held in highest percentage in male patients and with a low rate of complications(AU)

Molecular characterization of a novel Na⁺/H⁺ antiporter cDNA from Eucalyptus globulus.

Environmental stress factors such as salt, drought and heat are known to affect plant productivity. However, high salinity is spreading throughout the world, currently affecting more than 45 millionha. One of the mechanisms that allow plants to withstand salt stress consists on vacuolar sequestration of Na(+), through a Na(+)/H(+) antiporter. We isolated a new vacuolar Na(+)/H(+) antiporter from Eucalyptus globulus from a cDNA library. The cDNA had a 1626 bp open reading frame encoding a predicted protein of 542 amino acids with a deduced molecular weight of 59.1 KDa. Phylogenetic and bioinformatic analyses indicated that EgNHX1 localized in the vacuole. To assess its role in Na(+) exchange, we performed complementation studies using the Na(+) sensitive yeast mutant strain Δnhx1. The results showed that EgNHX1 partially restored the salt sensitive phenotype of the yeast Δnhx1 strain. However, its overexpression in transgenic Arabidopsis confers tolerance in the presence of increasing NaCl concentrations while the wild type plants exhibited growth retardation. Expression profiles of Eucalyptus seedlings subjected to salt, drought, heat and ABA treatment were established. The results revealed that Egnhx1 was induced significantly only by drought. Together, these results suggest that the product of Egnhx1 from E. globulus is a functional vacuolar Na(+)/H(+) antiporter.

Guía para nutrición enteral / Guideline for enteral feeding

La forma óptima, por ser la más natural, de nutrir a los pacientes hospitalizados, aún aquellos en estado crítico, es de la vía gastrointestinal. Tal modalidad es menos costosa, más fisiológica e implica menos riesgo que la nutrición parenteral. Pero al igual que ésta, la nutrición por vía enteral requiere personal debidamente capacitado, la observación de estrictas normas de manejo y la infraestructura de un servicio de soporte metabólico y nutricional bien organizado. La presente guía pretende: fijar pautas generales para el manejo del soporte nutricional por vía enteral en el paciente hospitalizado, prevenir las complicaciones secundarias a fallas mecánicas, técnicas o metabólicas que pueden presentarse en los pacientes sometidos a regímenes de soporte nutricional por vía enteral; así como describir en forma resumida las diferentes técnicas para la administración de la alimentación enteral en el paciente hospitalizado