Bone pain management with opioid medication in a patient with Camurati-Engelmann disease: a case report / Manejo del dolor óseo con medicación opioide en una paciente con enfermedad de Camurati-Engelmann: reporte de un caso

Introduction: Camurati-Engelman Disease is a rare genetic sclerosing bone dysplasia with periosteal and endosteal thickening of the cortical of the long bones. It generates pain secondary to the reduction of the medullary canal that is usually controlled with corticosteroids and, in severe cases, with surgical decompression. Case history: We present the case of a woman with a genetic diagnosis of Camurati-Engelman Disease with poor pain control with corticosteroid management and surgical procedures throughout her childhood and early adulthood. In whom optimal pain control was achieved with pain regimen with hydrocodone analgesic management. This is the first case described in the literature for adequate pain control using an opioid drug. Discussion: CE disease is an extremely rare genetic entity with little more than 300 cases reported in the world. It is generated by an alteration in the gene for growth factor-beta 1 (TGF-B1); it has a varied clinical presentation that can begin with bone alterations accompanied by muscle weakness, joint angular alterations, headache, and nerve compressions. It has a differential diagnosis with some genetic entities that may present clinical similarity, but its morphological and radiological characteristics are distinctive. The usual management of bone pain generated by this entity is based on corticosteroids, in addition to losartan or surgical intervention aimed at reducing cortical changes. The intervention with opioid analgesics accompanied by a rehabilitation plan is not a frequent report, this being a case of success due to the refractoriness of the symptoms in a patient with chronic pain, with a positive impact on her functionality and quality of life. Conclusion: It is considered that analgesic management with opioids may be a treatment option in patients with Camurati-Engelman disease refractory to corticosteroid management and surgical interventions.(AU)

Introducción: La enfermedad de Camurati-Engelman (CE) es una displasia ósea esclerosante rara, de causa genética. Se presenta con engrosamiento perióstico y endóstico de la cortical de los huesos largos. Genera dolor secundario a la reducción del canal medular, que habitualmente se controla con corticoides y en casos severos, con descompresión quirúrgica. Historia del caso: Presentamos el caso de una mujer con diagnóstico genético de enfermedad de Camurati-Engelman, con mal control del dolor, con manejo de corticosteroides y procedimientos quirúrgicos a lo largo de su niñez y adultez temprana. Se logró un control óptimo del dolor con un régimen con manejo analgésico con hidrocodona. Este es el primer caso descrito en la literatura de un adecuado control del dolor con un medicamento opioide. Discusión: La enfermedad de CE es una entidad genética extremadamente rara, con poco más de 300 casos reportados en el mundo. Se genera por una alteración en el gen del factor de crecimiento beta 1 (TGF-B1). Tiene una presentación clínica variada que puede iniciar con las alteraciones óseas acompañado de debilidad muscular, alteraciones angulares articulares, cefalea y compresiones nerviosas. Tiene diagnóstico diferencial con algunas entidades genéticas que pueden presentar similitud clínica, pero su característica morfológica y radiológica es distintiva. El manejo usual del dolor óseo generado por esta entidad se basa en corticoesteroides, además de losartán o intervenciones quirúrgicas orientadas a disminuir los cambios corticales. La intervención con analgésicos opioides, acompañada de un plan de rehabilitación, no es un reporte frecuente, siendo este un caso de éxito ante la refractariedad de los síntomas en una paciente con dolor crónico, impactando de manera positiva en su funcionalidad y calidad de vida.(AU)

Parsonage-Turner posterior a vacunación antirrábica por mordedura de murciélago: comunicación de un caso / Parsonage-Turner after rabies vaccination due to bat bite: case report

Introducción:Paciente adulto masculino que consulta por mordedura de murciélago. Se realiza aplicación de vacuna antirrábica y toxoide tetánico, tras lo cual presenta alteraciones motoras, sensitivas y dolor de difícil manejo en el miembro superior derecho. Siendo un reto diagnóstico de manera inicial, posterior a estudios electrofisiológicos se consideró un síndrome de Parsonage-Turner. Este caso es relevante por la asociación de vacuna antirrábica no descrita en antecedentes de inmunización en revisiones previas.Caso clínico:Se le realizaron varias pruebas diagnósticas e imágenes como ecografías, resonancia magnética y estudios electrofisiológicos los cuales confirmaron el diagnóstico de neuritis braquial (síndrome de Parsonage-Turner). El paciente recibió intervenciones quirúrgicas con fascitomías y neurólisis, además de múltiples manejos farmacológicos para dolor, incluyendo opioides fuertes, neuromoduladores, antidepresivos y medicamentos por bomba intratecal, con disminución solo del 50 % de los síntomas de dolor y afectación a su calidad de vida.Conclusión:El caso nos muestra cómo el síndrome de Parsonage-Turner, una enfermedad neurológica con etiología desconocida, se puede cronificar en un síndrome doloroso al no tener un diagnóstico temprano o someter al paciente procedimientos no indicados. Este síndrome debe considerarse en la atención de urgencias y consulta externa por sus consecuencias a largo plazo y el difícil manejo de los síntomas crónicos. Hay una relación causal reportada en la literatura con el toxoide tetánico, pero este se aplicó previo a los síntomas; no hay referencias de inicio de síntomas posterior a la vacuna antirrábica, lo cual puede generar a futuro, una relación causal si se encontraran nuevos casos.(AU)

Introduction:Adult male patient who suffers a bat bite, after which rabies vaccine and tetanus toxoid are administered; later, he presents on the right upper limb severe motor, sensory and pain disorders. Initially a diagnostic challenge, after electrophysiological studies, Parsonage-Turner syndrome was considered. This case is relevant since the association between rabies vaccine and this syndrome has not been described.Clinical case:Several diagnostic tests and images were performed, including ultrasound, magnetic resonance and electrophysiological studies, which confirmed the diagnosis of brachial neuritis (Parsonage-Turner syndrome). Even though the patient received surgical interventions with fasciotomies and neurolysis as well as multiple pharmacological pain management with strong opioids, neuromodulators, antidepressants and intrathecal pump medications, there was a 50 % decrease in pain symptoms and an impairment of their quality of life.Conclusion:The case shows a Parsonage-Turner syndrome, a neurological disease with unknown etiology, with difficult diagnosis which can lead to chronic pain syndrome or unnecessary surgical procedures. This syndrome should be considered in emergency care and outpatient care due to its long-term consequences and the difficult management of chronic symptoms. There is a causal relationship reported in the literature with tetanus toxoid, but it was applied prior to symptoms; there are no reports of onset of symptoms after the rabies vaccine, which may generate a causal relationship in the future if new cases are found.(AU)

Estudio de selección de microRNA como posibles biomarcadores de aneurisma de aorta abdominal / Screening of microRNAs as possible biomarkers in abdominal aortic aneurysm

Introducción: Los microRNA (miR) son RNA de pequeño tamaño involucrados en la regulación de numerosos procesos biológicos. Debido a su estabilidad y a su capacidad para detectarse en fluidos, se han convertido en objeto de estudio como posibles biomarcadores de diferentes patologías. Objetivo: Seleccionar un número reducido de miR candidatos a ser biomarcadores de aneurisma de aorta abdominal (AAA). Material y métodos: Se determinó la expresión de 179 miR en el plasma de 7 pacientes y 7 voluntarios sanos, mediante paneles prediseñados, basados en la tecnología de RT-qPCR. Resultados: Hemos seleccionado 10 miR disregulados en pacientes como buenos candidatos para su estudio como biomarcadores debido a su implicación en diversos procesos biológicos relacionados con el desarrollo y evolución de AAA. Conclusiones: Aunque son necesarios estudios adicionales y de validación, algunos de estos miR podrían ser biomarcadores no invasivos de AAA (AU)

Introduction: MicroRNAs (miRs) are small RNA molecules that are involved in several biological processes. Due to their stability and their presence in biological fluids, several studies over the last few years have focused on the use of miRs as biomarkers of different pathologies. Objective: Selection of a group of miRs candidates to be validated as potential biomarkers of abdominal aortic aneurysm (AAA). Material and methods: A total of 179 miRs were quantified in 7 patients with AAA and in 7 healthy donors, using predesigned panels based on RT-qPCR technology. Results: A total of 10 miRs, dysregulated in patients, were selected as good candidates for studying them as biomarkers. It has been observed that most of these miRs participate in several biological processes related to the formation and development of AAAs. Conclusion: Additional, as well as validation, studies are needed, but some of these miRs could be non-invasive AAA biomarkers (AU)

Factores predictivos de recidiva de estenosis uretral tras uretrotomía endoscópica / Predictors of urethral stricture recurrence after endoscopic urethrotomy

Objetivo: El objetivo del trabajo fue analizar las variables clínico-demográficas de la serie y los factores predictores de recidiva de estenosis uretral tras uretrotomía endoscópica. Material y métodos: Se analizó retrospectivamente a 67 pacientes tratados mediante uretrotomía endoscópica tipo Sachse entre junio de 2006 y septiembre de 2014. Se excluyó a los intervenidos previamente de uretrotomía endoscópica o uretroplastia y se incluyó al resto de los pacientes que presentaban estenosis uretral. Se analizó edad, peso, hábito tabáquico, factores de riesgo cardiovascular, número, localización, longitud y etiología de la estenosis, uretrotomía previa, tiempo de sonda vesical y dilataciones posquirúrgicas. Se realizó un análisis univariado y multivariado mediante el test de chi-cuadrado o de Fisher y regresión logística para identificar las variables relacionadas con la recidiva. Resultados: El 37% recidivaron. La mayoría eran > 60 años (56,7%), obesos (74,6%), no fumadores (88%) y sin factores cardiovasculares (56,7%). La mayoría de las estenosis fueron únicas (94%), < 1 cm (82%), de uretra bulbar (64,2%), iatrogénicas (67,2%) y sin uretrotomía previa (89,6%). La mayoría llevaron sonda vesical durante < 15 días (85,1%) y no realizaron dilataciones posquirúrgicas (65,7%). Solamente la longitud de la estenosis resultó factor de riesgo independiente de recidiva (p = 0,025) con un riesgo relativo de 5,7 para un IC 95% (1,21-26,41). Conclusiones: En el tratamiento de la estenosis uretral mediante uretrotomía endoscópica, la longitud de la estenosis > 1 cm es el único factor que predice un incremento del riesgo de recidiva. No se encontró factores clínicos ni demográficos que condicionaran un incremento en la incidencia de recidiva. Del mismo modo, factores técnicos como incrementar el tiempo de sondaje vesical o las dilataciones uretrales no alteran el curso de la enfermedad, por lo que su uso rutinario es innecesario

Objective: The aim of the study was to analyse the clinical-demographic variables of the series and the predictors of urethral stricture recurrence after endoscopic urethrotomy. Material and methods: We retrospectively analysed 67 patients who underwent Sachse endoscopic urethrotomy between June 2006 and September 2014. Those patients who had previously undergone endoscopic urethrotomy or urethroplasty were excluded. The other patients who presented urethral stricture were included. We analysed age, weight, smoking habit, and cardiovascular risk factors, as well as the number, location, length and aetiology of the strictures, previous urethrotomies, vesical catheter duration and postsurgical dilatations. A univariate and multivariate analysis was conducted using the chi-squared test or Fisher's test and logistic regression to identify the variables related to recurrence. Results: Thirty-seven percent of the patients had a relapse. The majority of the patients were older than 60 years (56.7%), obese (74.6%), nonsmokers (88%) and had no cardiovascular factors (56.7%). The majority of the strictures were single (94%), < 1 cm (82%), bulbar urethral (64.2%), iatrogenic (67.2%) and with no prior urethrotomy (89.6%). The majority of the patients carried a vesical catheter for < 15 days (85.1%) and did not undergo postsurgical dilatation (65.7%). Only the length of the stricture was an independent risk factor for recurrence (P = .025; relative risk, 5.7; 95% CI 1.21-26.41). Conclusions: In the treatment of urethral strictures through endoscopic urethrotomy, a stricture length > 1 cm is the only factor that predicts an increase in the risk of recurrence. We found no clinical or demographic factors that caused an increase in the incidence of recurrence. Similarly, technical factors such as increasing the bladder catheterisation time and urethral dilatations did not change the course of the disease. Their routine use is therefore unnecessary

Cavernoplastia con injerto de mucosa oral para el tratamiento quirúrgico de la enfermedad de La Peyronie / Cavernoplasty with oral mucosa graft for the surgical treatment of Peyronie's disease

Introducción: La enfermedad de La Peyronie es un trastorno de la albugínea que condiciona incurvación peneana, y que precisa corrección quirúrgica cuando la deformidad dificulta la penetración. Material y métodos: Análisis retrospectivo de los resultados a corto plazo (longitud del pene, ángulo de incurvación y función eréctil) del tratamiento de la enfermedad de La Peyronie en 10 pacientes mediante cavernoplastia con injerto de mucosa oral. En esencia, el tratamiento incluyó la incisión de la placa fibrótica con bisturí eléctrico y el posterior recubrimiento del defecto cavernoso mediante un parche de mucosa oral. Al sexto mes medimos la longitud e incurvación peneanas, y recogimos la función eréctil mediante el cuestionario IIEF-5. Finalmente, se planteó a los pacientes la pregunta «¿volvería a repetir la misma intervención?». Resultados: La edad media fue de 53,4 años. El seguimiento promedio fue de 22,7 meses y la mediana de 24. La incurvación media preoperatoria fue de 68,5° (50-90°); la longitud media del pene de 11,2 cm (9-15) y el IIEF-5 medio de 16,1 (8-25). La longitud peneana media postoperatoria fue de 10,7 cm y el IIEF-5 medio de 18,9. Las diferencias entre los registros pre- y postoperatorios no alcanzaron significación estadística (p = ns). Un paciente desarrolló disfunción eréctil. En todos los casos la incurvación residual fue < 20°. Nueve pacientes (90%) aseguraron que repetirían la misma intervención. Conclusiones: Los resultados a corto plazo señalan que la cavernoplastia con injerto de mucosa oral puede ser una alternativa a los injertos tradicionales para la corrección quirúrgica de la enfermedad de La Peyronie

Background: Peyronie's disease is a disorder of the tunica albuginea and causes penile curvature, requiring surgical correction when the deformity impedes penetration. Material and methods: Retrospective analysis of the short-term results (penile length, angle of curvature and erectile function) of treating Peyronie's disease in 10 patients through cavernoplasty with oral mucosa graft. Essentially, the treatment included the incision of the fibrotic plaque with electrical scalpel and the subsequent coating of the cavernous defect using a patch of oral mucosa. At month 6, we measured the penile length and curvature and recorded the erectile function using the International Index of Erectile Function-5 (IIEF-5) questionnaire. Finally, the patients were asked 'Would you undergo the same operation again?'. Results: The mean age was 53.4 years. The average and median follow-up was 22.7 months and 24 months, respectively. The mean preoperative curvature was 68.5° (50°-90°), the mean penile length was 11.2 cm (9-15) and the mean IIEF-5 score was 16.1 (8-25). The mean postoperative penile length was 10.7 cm, and the mean IIEF-5 score was 18.9. The differences between the preoperative and postoperative values were not statistically significant (P=ns). One patient developed erectile dysfunction. In all cases, the residual curvature was <20°. Nine patients (90%) stated that they would undergo the same operation. Conclusions: The short-term results suggest that cavernoplasty with oral mucosa graft can be an alternative to traditional grafts for surgically correcting Peyronie's disease

Predictors of urethral stricture recurrence after endoscopic urethrotomy. / Factores predictivos de recidiva de estenosis uretral tras uretrotomía endoscópica.

OBJECTIVE: The aim of the study was to analyse the clinical-demographic variables of the series and the predictors of urethral stricture recurrence after endoscopic urethrotomy. MATERIAL AND METHODS: We retrospectively analysed 67 patients who underwent Sachse endoscopic urethrotomy between June 2006 and September 2014. Those patients who had previously undergone endoscopic urethrotomy or urethroplasty were excluded. The other patients who presented urethral stricture were included. We analysed age, weight, smoking habit, and cardiovascular risk factors, as well as the number, location, length and aetiology of the strictures, previous urethrotomies, vesical catheter duration and postsurgical dilatations. A univariate and multivariate analysis was conducted using the chi-squared test or Fisher's test and logistic regression to identify the variables related to recurrence. RESULTS: Thirty-seven percent of the patients had a relapse. The majority of the patients were older than 60 years (56.7%), obese (74.6%), nonsmokers (88%) and had no cardiovascular factors (56.7%). The majority of the strictures were single (94%), <1cm (82%), bulbar urethral (64.2%), iatrogenic (67.2%) and with no prior urethrotomy (89.6%). The majority of the patients carried a vesical catheter for <15 days (85.1%) and did not undergo postsurgical dilatation (65.7%). Only the length of the stricture was an independent risk factor for recurrence (P=.025; relative risk, 5.7; 95% CI 1.21-26.41). CONCLUSIONS: In the treatment of urethral strictures through endoscopic urethrotomy, a stricture length >1cm is the only factor that predicts an increase in the risk of recurrence. We found no clinical or demographic factors that caused an increase in the incidence of recurrence. Similarly, technical factors such as increasing the bladder catheterisation time and urethral dilatations did not change the course of the disease. Their routine use is therefore unnecessary.

Cavernoplasty with oral mucosa graft for the surgical treatment of Peyronie's disease. / Cavernoplastia con injerto de mucosa oral para el tratamiento quirúrgico de la enfermedad de La Peyronie.

BACKGROUND: Peyronie's disease is a disorder of the tunica albuginea and causes penile curvature, requiring surgical correction when the deformity impedes penetration. MATERIAL AND METHODS: Retrospective analysis of the short-term results (penile length, angle of curvature and erectile function) of treating Peyronie's disease in 10 patients through cavernoplasty with oral mucosa graft. Essentially, the treatment included the incision of the fibrotic plaque with electrical scalpel and the subsequent coating of the cavernous defect using a patch of oral mucosa. At month 6, we measured the penile length and curvature and recorded the erectile function using the International Index of Erectile Function-5 (IIEF-5) questionnaire. Finally, the patients were asked "Would you undergo the same operation again?". RESULTS: The mean age was 53.4 years. The average and median follow-up was 22.7 months and 24 months, respectively. The mean preoperative curvature was 68.5° (50°-90°), the mean penile length was 11.2cm (9-15) and the mean IIEF-5 score was 16.1 (8-25). The mean postoperative penile length was 10.7cm, and the mean IIEF-5 score was 18.9. The differences between the preoperative and postoperative values were not statistically significant (P=ns). One patient developed erectile dysfunction. In all cases, the residual curvature was <20°. Nine patients (90%) stated that they would undergo the same operation. CONCLUSIONS: The short-term results suggest that cavernoplasty with oral mucosa graft can be an alternative to traditional grafts for surgically correcting Peyronie's disease.

Úlceras por presión en diversos servicios de un hospital de segundo nivel de atención / Pressure ulcers at diverse services in a second level attention hospital / Úlceras por pressão em diversos serviços de um hospital de segundo nível de atenção

Objetivo: Describir las características epidemiológicas de las úlceras por presión, de la población que las desarrolla y estimar los costos directos del cuidado de estas lesiones en diversos servicios de un hospital de segundo nivel de atención. Metodología: Estudio descriptivo y transversal donde se valoró la población mayor de edad de los servicios de cirugía general, cirugía plástica y reconstructiva, medicina interna y unidad de cuidados intensivos de un hospital de segundo nivel de atención. Cada paciente fue valorado diariamente por 30 días consecutivos aplicando un formato de registros clínicos. Resultados Se valoraron 218 pacientes, de los cuales 61 presentaron una o más UPP, se detectaron un total de 378 lesiones. Se reportó una prevalencia cruda del 28.0% y una incidencia del 13.3%. La edad media de los pacientes afectados fue 61.4 ± 20.9. Las enfermedades más frecuentes fueron las cardiovasculares. La mayor proporción de pacientes con UPP presentaron algún tipo de incontinencia y/o sobrepeso. La puntuación media en la Escala de Braden fue 12.5 ± 2.8. La mayor proporción de UPP se localizó en los talones, el sacro y los omóplatos, con categoría I el 81.5%. Los costos directos del cuidado de UPP fueron estimados en 6,457.64 $ MXN per cápita al día. Conclusión: Las UPP continúan siendo un problema para los pacientes hospitalizados en unidades hospitalarias de segundo nivel de atención, que requieren de intervenciones a nivel asistencial, de los gestores del cuidado y autoridades sanitarias, optimizar los recursos materiales y humanos disponibles y formular políticas sanitarias enfocadas en la prevención y atención de las UPP.

Objective: To describe the epidemiologic characteristics of pressure ulcers and of the affected population and estimate the direct costs of care at diverse services in a second level of attention hospital. Methodology: Descriptive and transversal design studying the elder population of the General Surgery, Plastic and Surgery, Internal Medicine, and Intensive Care services in a second level of attention hospital. Each patient was assessed. Methodology: Descriptive and cross-sectional study, in which the entire population over 18 years old of General Surgery, Plastic and Reconstructive Surgery, Internal Medicine and Intensive Care services in second level of attention hospital. Each patient was assessed on a daily basis during 30 consecutive days through clinical registers Results: From 218 patients assessed, 61 showed one or more pressure ulcers. The total number of lesions detected was 378. A raw prevalence of 28% was reported, as well as an incidence of 13.3%. The median age of the patients was 61.4 ± 20.9 years old. The most prevalent pathologies found were cardiovascular illnesses. The majority of patients suffering from pressure ulcer showed some type of incontinence and/or overweight. The median score in the Braden scale turned out to be 12.5 ± 2.8. The majority of pressure sores were localized at the heels, sacrum, and scapula, with 81.5% being category I. The pressure ulcers direct costs were estimated at $6,457.64 MXN per person per day. Conclusion: Pressure ulcers continue being a problem for hospitalized patients in second level of attention hospital units. Therefore, it is necessary that healthcare authorities and providers offer assistance interventions, optimize available human and material resources, and develop sanitary policies focused towards both preventing and attending pressure sores.

Objetivo: Descrever características epidemiológicas das úlceras por pressão, da população que as desenvolve e calcular os custos diretos do cuidado destas lesões em diversos serviços de um hospital de segundo nível de atenção. Metodologia: Estudo descritivo e transversal onde se avaliou a população idosa dos serviços de cirurgia geral, cirurgia plástica e reconstrutiva, medicina interna e unidade de cuidados intensivos de um hospital de segundo nível de atenção. Cada paciente foi avaliado diariamente por 30 dias consecutivos aplicando um formato de registros clínicos. Resultados: Avaliaram-se 218 pacientes, dos quais 61 apresentaram uma ou mais UPP, detectando um total de 378 lesões. Reportou-se uma prevalência crua de 28.0% e uma incidência de 13.3%. A idade meia dos pacientes afetados foi de 61.4 ± 20.9. As patologias mais frequentes foram doenças cardiovasculares. A maior proporção de pacientes com UPP apresentaram algum tipo de incontinência e/ou sobrepeso. A pontuação meia na Escala de Bradem foi 12.5 ± 2.8. A maior proporção de UPP se localizou em calcanhares, sacro e omoplatas, sendo Categoria I, o 81.5%. Os custos diretos do cuidado de UPP foram calculados em 6,457.64 $ MXN per capita ao dia. Conclusão: As UPP continuam sendo um problema para os pacientes hospitalizados em unidades hospitalares do segundo nível de atenção, precisando de intervenções a nível assistencial, dos gestores de cuidado e autoridades sanitárias, melhorar os recursos materiais e humanos disponíveis e formular políticas sanitárias focalizadas na prevenção e atenção das UPP.

[Physician's adherence to medical indications for invasive procedures in the critical care unit of a university hospital]. / Adherencia médica a las indicaciones de procedimientos invasores en la unidad de pacientes críticos de un hospital universitario.

INTRODUCTION: Physicians' adherence to pre-established criteria for the indication and/or maintenance of invasive devices is a weak point in infection control programs. Fulfillment of the recommendations for preventing infections associated with invasive devices is essential to reduce their risk. OBJECTIVE: To assess the adherence of physicians to the standardized criteria for indication of central venous catheter (CVC) and permanent urinary catheter (PUC) and to the application of supervision guidelines. METHODS: During a period of 7 months, residents of the Critical Patient Unit monitored the adherence to criteria for indication of CVC and PUC recorded in patients' medical records. This information was compared with current regulations to assess compliance. RESULTS: Between April and September 2009, 2078 supervision guidelines were applied. Invasive devices were identified in 47.7%. 10.4% of CVCs and 19.2% of PUCs did not meet criteria for installation and / or maintenance at the time of monitoring. CONCLUSIONS: Adherence of our medical staff to criteria for installation and /or maintenance of CVC and CUP should be improved. Monitoring can be efficiently performed by residents and could reduce infections associated with invasive procedures.

Adherencia médica a las indicaciones de procedimientos invasores en la unidad de pacientes críticos de un hospital universitario / Physician's adherence to medical indications for invasive procedures in the critical care unit of a university hospital

Introduction: Physicians' adherence to pre-established criteria for the indication and/or maintenance of invasive devices is a weak point in infection control programs. Fulfillment of the recommendations for preventing infections associated with invasive devices is essential to reduce their risk. Objective: To assess the adherence of physicians to the standardized criteria for indication of central venous catheter (CVC) and permanent urinary catheter (PUC) and to the application of supervision guidelines. Methods: During a period of 7 months, residents of the Critical Patient Unit monitored the adherence to criteria for indication of CVC and PUC recorded in patients' medical records. This information was compared with current regulations to assess compliance. Results: Between April and September 2009, 2078 supervision guidelines were applied. Invasive devices were identified in 47.7%. 10.4% of CVCs and 19.2% of PUCs did not meet criteria for installation and / or maintenance at the time of monitoring. Conclusions: Adherence of our medical staff to criteria for installation and /or maintenance of CVC and CUP should be improved. Monitoring can be efficiently performed by residents and could reduce infections associated with invasive procedures.

Introducción: La adherencia médica a los criterios de indicación y/o mantención de procedimientos invasores es un punto débil en los programas de control de infecciones. Cumplir las recomendaciones relacionadas a prevención de infecciones asociadas a procedimientos invasores es fundamental para reducir el riesgo de infección. Objetivos: Evaluar la adherencia de médicos residentes a criterios estandarizados de indicaciones médicas de catéter venoso central (CVC) y catéter urinario permanente (CUP) y a aplicar pautas de supervisión para evaluar su cumplimiento. Método: Durante un período de siete meses, residentes de la Unidad de Paciente Crítico (UPC), monitorizaron la adherencia a los criterios de indicación de CVC y CUP registrados en las fichas clínicas de los pacientes. La información registrada se cotejó con la normativa vigente. Resultados: Entre abril y octubre de 2009 se aplicaron 2.078 pautas de supervisión, de las cuales 47,7% identificaron invasión al momento de aplicarlas. Un 10,4 y 19,2% de los CVC y CUP, respectivamente, no cumplían con criterios de instalación y/o mantención al momento de la supervisión. Conclusiones: La adherencia de nuestros médicos de UPC a los criterios de instalación y/o mantención de CVC y CUP debe mejorarse. La supervisión puede ser realizada eficientemente por los mismos residentes y podría reducir las infecciones asociadas a procedimientos invasores.