Co-delivery of HIV pre-exposure prophylaxis (PrEP) and HIV testing among publicly insured adolescents and young adults (AYA) receiving medication for opioid use disorder (MOUD).

BACKGROUND: Low rates of HIV pre-exposure prophylaxis (PrEP) prescribing contribute to the disproportionate burden of HIV in the United States. Among adolescent and young adults (AYA) with opioid use disorder, HIV testing and PrEP co-prescription rates are poorly characterized. METHODS: We performed a retrospective analysis involving deidentified data from Philadelphia's Medicaid beneficiaries ages 16-29 years who were prescribed medication for opioid use disorder (MOUD) from 2015 to 2020 and continuously Medicaid-enrolled for ≥6 months prior to that prescription. After identifying the presence of a qualifying diagnosis signifying a PrEP indication, we examined the outcome of appropriate PrEP co-prescriptions and HIV testing using generalized estimating equations (GEE) modeling. RESULTS: We identified 795 AYA Medicaid beneficiaries with 1269 qualified treatment episodes. We calculated a PrEP prescribing rate of 29.47 per 1000 person-years among AYA receiving MOUD. The HIV testing rate was 63.47 per 1000 person-years among AYA receiving MOUD. GEE modeling revealed that individuals receiving methadone were more likely (aOR=2.62, 95% CI=1.06-6.49) to receive HIV testing within 6 months after a PrEP-qualifying diagnosis compared to those receiving other MOUD medications. Those who only saw outpatient behavioral health providers were less likely (aOR=0.48, 95% CI=0.24-0.99) to have received an HIV test within 6 months after the PrEP-qualifying diagnosis compared to those receiving inpatient behavioral health services. CONCLUSIONS: Co-prescription of PrEP and HIV testing among AYA receiving MOUD was rare in this large urban publicly insured population. Interventions are needed to increase HIV prevention services for this key population of AYA at risk for HIV infection.

The role of baseline insomnia in moderating the hypnotic properties of quetiapine.

INTRODUCTION: The primary aim of this study was to investigate the effect of quetiapine on insomnia and alcohol craving (craving) in subjects with co-occurring insomnia and AUD. METHODS: Insomnia was assessed with the Insomnia Severity Index (ISI) and craving with the Penn Alcohol Craving Scale (PACS, primary) and Obsessive-Compulsive Drinking Scale (OCDS, secondary). A multivariable model adjusted for covariates (N = 123) evaluated the relationship between craving (PACS and OCDS total scores) and insomnia (ISI total score). To simultaneously assess the effects of treatment arm allocation and insomnia status, subjects (N = 115) were stratified into 4 groups, quetiapine-insomnia(N = 38), quetiapine-No insomnia(N = 19), placebo-insomnia(N = 38), and placebo-No insomnia(N = 20). Linear mixed-effects regression models adjusted for covariates compared the trajectories of ISI, PACS, and OCDS total scores across 12 weeks of treatment and at post-treatment follow-up at week 24, between the four groups. RESULTS: The ISI total score was positively associated with the PACS (p = 0.006) and OCDS (p = 0.001) total scores in the multivariable models. In the longitudinal analysis, when compared to the three other groups, subjects with insomnia treated with quetiapine showed a marked reduction in their insomnia scores with a return of insomnia after stopping treatment. There was no significant difference between the groups for the PACS and OCDS total score trajectories. DISCUSSION: Although craving is associated with insomnia, treatment with quetiapine may improve insomnia but not craving in patients with co-occurring AUD and insomnia.

Safety window for the transsphenoidal approach for pituitary tumours: a computed tomographic angiography study.

BACKGROUND: The aims are to evaluate the morphometry of the sellar region and propose a safety window on the floor of the sella turcica for the transsphenoidal approach in a Hispanic population. MATERIALS AND METHODS: We retrospectively analysed 150 computed tomographic angiography sellar region images from asymptomatic patients. The images were evaluated intraobservatory by an expert radiologist. We measured: intercarotid distance of cavernous segment; depth of sella turcica; skull base angle; anterior distance, the distance between anterior spinal nasal and floor of the sella turcica; posterior distance, the distance between anterior spinal nasal and posterior wall of the sella turcica; anterior surgical angle, formed between the floor of the nostril and superior limit of the anterior wall of the sella turcica; and posterior angle, formed between the floor of the nostril and the inferior limit of the posterior wall of the sella turcica. RESULTS: Safety window was based on two measures: the intercarotid distance and depth. The mean of the safety window is 151.13 mm² and 147.60 mm² for men and women, respectively. The intercarotid distance was 17.83 mm. The depth of the sella turcica was 8.46 mm. The skull base angle was 112.13 grades. The anterior distance was 76.34 mm. The posterior distance was 87.59 mm. The anterior surgical angle was 32.76 grades. The posterior surgical angle was 87.59 grades. CONCLUSIONS: The surgical approach space is smaller in females. It could significate a more complicated surgery in this population. Anatomical understanding could reduce complications in hospitals without a neuronavigation system.

Morphometric variants of the paranasal sinuses in a Mexican population: expected changes according to age and gender.

BACKGROUND: There are developmental variations in the paranasal sinuses. Our objective was to determine their dimensions and volume stratified by age and sex and define the expected growth pattern. MATERIALS AND METHODS: A retrospective, observational study was performed including computed tomography (CT) of patients between 1 and 20 years of age. The volumes of the frontal, sphenoid, and maxillary sinuses were obtained. RESULTS: A total of 210 CT were included with a mean age of 10 ± 6.1 years, 106 (50.5%) were female. Groups were categorised in ranges of 5 years. Spearman correlation coefficients between the right and left sides were 0.843, 0.711, 0.916 for the frontal, sphenoid and maxillary sinuses. Post-hoc for the categorical age groups demonstrated statistically significant differences with values of p < 0.01, except between age groups 11-15 against ≥ 16 years of age (p = 0.8). Gender-related differences were evident with a higher air volume in girls in the 5-10-year-old group, while boys predominated in the rest of the groups. CONCLUSIONS: Computed tomography is ideal for pre-surgical sinus assessment. The maximum volume of paranasal sinuses is reached at the age of 15. There is a clear volumetric difference between age and gender groups. There is a direct relationship between a volume and its contralateral counterpart.

Creating and sustaining effective pipeline initiatives to increase diversity in biostatistics: the ENAR Fostering Diversity in Biostatistics Workshop.

Biostatisticians with advanced degrees are highly sought after. Employment opportunities in the fields of mathematics and statistics are expected to increase dramatically by 2028. Underrepresentation of minorities in biostatistics has been a persistent problem, yielding a demographic landscape that differs substantially from the general US population. In some instances, students may have the appropriate quantitative skills, but are unaware of biostatistics and in other instances, students may not yet have the appropriate quantitative background, but are intellectually capable and willing to shore up those skills once they learn about biostatistics as a viable, exciting career option. Therefore, in order to ensure robust scientific advancement, there must be a concerted effort to increase the pipeline of intellectually talented persons available with exposure to the appropriate quantitative skills who are interested in careers in biostatistics. The overarching goal of this paper is to discuss the development, implementation, and impact of a federally funded pipeline initiative aimed at increasing the number of underrepresented minorities successful in graduate training and professional careers in biostatistics as well as establishing effective mentoring and networking relationships. Our findings provide a roadmap for the development of sustainable initiatives to promote diversity in biostatistics and STEM fields more broadly.

Effect of patient education on palliative care knowledge and acceptability of outpatient palliative care services among gynecologic oncology patients: A randomized controlled trial.

OBJECTIVES: A randomized control trial (RCT) to estimate the effect of an interventional video on improving palliative care knowledge, acceptability and attendance to outpatient services in gynecologic oncology patients. METHODS: Women receiving treatment for gynecologic malignancy recruited at an academic tertiary care center were randomized to: palliative care educational video or non-directive cancer center video. The primary outcome was referral to palliative care. Function and knowledge were assessed using the Functional Assessment of Cancer Therapy and the Palliative Care Knowledge Scale. Data analyses were performed using t-tests, Wilcoxon rank sum or Fisher's exact tests with significance level of α = 0.05. RESULTS: 111 women were enrolled. Demographic characteristics were equally distributed between groups with respect to age, race, cancer, and stage. There was no statistical difference in knowledge scores or in referral to palliative care between the patients that watched the educational versus control video (29% vs. 27%; p = .79). Secondary analysis showed a statistically significant increase in utilization of palliative care services compared to historic institutional data (8.8% to 31.5%; p ≤.001). Further, those referred had significantly worse baseline functional scores. CONCLUSIONS: Use of a palliative care educational video did not increase knowledge or acceptability of palliative services within this RCT. However, the rate of patients referred to palliative care tripled compared to historic rates. Further studies should investigate whether discussion regarding palliative care services alone may increase desire for referral, and if use of Fact-G scores may identify patients in greatest need of services.

Low bone mineral density and associated factors in patients with haemophilia in Colombia.

INTRODUCTION: Patients with haemophilia may have lower levels of bone mineral density (BMD) compared with the general population. Moreover, haemophilic patients have increased risk factors for low bone mineral density (LBMD) such as arthropathy and resulting immobility, increasing their risk for osteoporosis and fractures. AIM: To assess the prevalence of LBMD and associated risk factors among a group of Colombian haemophilic patients. METHODS: In this case-control study, 90 patients with haemophilia A and B, over the age of five, were recruited. Controls were healthy participants matched by age, gender, body mass index (BMI), socioeconomic status, and race. All participants underwent dual energy X-ray absorptiometry (DXA) and the Global Physical Activity Questionnaire. Blood tests were collected to evaluate LBMD determinants in cases. RESULTS: BMD was lower in cases than in the control group. BMD of femoral necks was 0.907 g/cm2 in cases vs. 1.020 g/cm2 in controls (P = .019), and BMD of hips 0.930 g/cm2 in cases vs. 1030 g/cm2 in controls (P = .019). The greater the severity of haemophilia, the lower BMD in spine, femoral neck, and hips. Elevated C-protein levels were found in 44.1% of patients with LBMD and 14.8% with normal BMD (P = .003). The study found an adjusted prevalence ratio of 2.11, indicating that haemophilic patients are two times more likely to have LBMD (CI95% = 1.43-3.11 P < .001). CONCLUSION: Results from the present study showed that haemophilia was associated with a higher frequency of LBMD. Severity of haemophilia, haemophilic arthropathy, and elevated C-reactive protein levels was directly associated with LBMD.

Differentiating Atypical Hemangiomas and Metastatic Vertebral Lesions: The Role of T1-Weighted Dynamic Contrast-Enhanced MRI.

BACKGROUND AND PURPOSE: Vertebral hemangiomas are benign vascular lesions that are almost always incidentally found in the spine. Their classic typical hyperintense appearance on T1- and T2-weighted MR images is diagnostic. Unfortunately, not all hemangiomas have the typical appearance, and they can mimic metastases on routine MR imaging. These are generally referred to as atypical hemangiomas and can result in misdiagnosis and ultimately additional imaging, biopsy, and unnecessary costs. Our objective was to assess the utility of dynamic contrast-enhanced MR imaging perfusion in distinguishing vertebral atypical hemangiomas and malignant vertebral metastases. We hypothesized that permeability and vascular density will be increased in metastases compared with atypical hemangiomas. MATERIALS AND METHODS: Consecutive patients from 2011 to 2015 with confirmed diagnoses of atypical hemangiomas and spinal metastases from breast and lung carcinomas with available dynamic contrast-enhanced MR imaging were analyzed. Time-intensity curves were qualitatively compared among the groups. Perfusion parameters, plasma volume, and permeability constant were quantified using an extended Tofts 2-compartment pharmacokinetic model. Statistical significance was tested using the Mann-Whitney U test. RESULTS: Qualitative inspection of dynamic contrast-enhanced MR imaging time-intensity curves demonstrated differences in signal intensity and morphology between metastases and atypical hemangiomas. Quantitative analysis of plasma volume and permeability constant perfusion parameters showed significantly higher values in metastatic lesions compared with atypical hemangiomas (P < .001). CONCLUSIONS: Our data demonstrate that plasma volume and permeability constant perfusion parameters and qualitative inspection of contrast-enhancement curves can be used to differentiate atypical hemangiomas from vertebral metastatic lesions. This work highlights the benefits of adding perfusion maps to conventional sequences to improve diagnostic accuracy.

Descripción de los pacientes mayores de 60 años ingresados al programa de hospitalización domiciliaria del complejo asistencial Dr. Sótero del Río, Santiago de Chile / Description of patients over 60 years admitted to home hospitalization program of Dr. Sótero del Rio Care Complex, Santiago de Chile

Resumen Introducción: dado el aumento de la población del adulto mayor en Chile, se han incrementado también las tasas de hospitalización. En la búsqueda por disminuir las complicaciones asociadas a esto, en el complejo asistencial dr. Sótero del Río, se ha desarrollado la unidad de hospitalización domiciliaria. Este trabajo tiene por objetivo describir las características de los pacientes mayores de 60 años ingresados en esta unidad durante el año 2014 Material y métodos: estudio descriptivo retrospectivo. Se recogieron a partir de los informes estadísticos mensuales de la unidad de hospitalización domiciliaria, datos de filiación, motivos de ingreso y estadía hospitalaria. Se excluyeron ingresos obstétricos. Se clasificaron los ingresos según su clasificación cie-10. Resultados: se ingresaron 2953 pacientes a la unidad de hospitalización domiciliaria durante el año 2014. Mil seiscientos diez y siete pacientes corresponden a mayores de 60 años (52.8%) y de éstos, 571 eran pacientes de 80 años o más (35.3%). La mediana de edad fue de 63 años. Dentro de las causas más importantes se ubican: enfermedades del sistema respiratorio n=680 (42%), enfermedades del sistema circulatorio n=324 (20%), enfermedades genitourinarias n=313 (19.4%). Discusión: La hospitalización domiciliaria podría ser un aporte al sistema de salud público chileno, dado que presenta beneficios probados en la literatura internacional a nivel clínico, satisfacción usuaria, organizativo y a nivel de costo efectividad. (Acta Med Colomb 2016; 41: 187-190).

Abstract Introduction: Given the increase of elderly population in Chile, hospitalization rates have also increased. In the Health Care Complex Dr. Sotero del Rio, a Home Hospitalization Unit has been developed searching to reduce the complications associated with this condition. This paper aims to describe the characteristics of patients older than 60 years admitted to this unit during 2014 Material and Methods: Descriptive retrospective study. Personal data, reasons for admission and hospital stay data were collected from monthly statistical reports of the Home Care Unit. Obstetric admissions were excluded. Admissions were classified according to ICD-10 classification. Results: 2953 patients were admitted to the home care unit during 2014. One thousand six hundred and seventeen patients were older than 60 years (52.8%) and of these, 571 patients were 80 years or older (35.3%). The median age was 63 years. Among the most important causes found, were: respiratory diseases n = 680 (42%), circulatory system diseases n = 324 (20%), genitourinary diseases n = 313 (19.4%). Discussion: Home hospitalization could be a contribution to the Chilean public health system, as it has proven benefits in the international literature at the clinical and organizational level, user satisfaction, and at cost-effectiveness level. (Acta Med Colomb 2016; 41: 187-190).

Intervenciones de enfermería en una persona con síndrome de Guillain-Barré tipo AMAN, bajo la teoría de Dorothea Orem / Nursing interventions framed into Dorothea Orem's theory on a patient suffering from Guillain Barre's Syndrome type AMAN

El estudio de caso que se presenta tiene como objetivo dar a conocer la importancia, así como los cuidados de alta especialidad de enfermería en este padecimiento, que a pesar de ser una enfermedad de baja incidencia, representa un gran impacto para quien la padece, debido a que la persona nunca pierde el estado de alerta y es consciente de su deterioro a lo Cuidados de largo del curso de la enfermedad, así como el hecho de que produce una discapacidad prolongada y es necesaria una atención multidisciplinaria, donde desde luego la enfermería puede hacer una gran labor con la persona y familiares. Sin embargo existe recuperación, la cual será exitosa y sin complicaciones si se brindan los cuidados especializados necesarios hacia la persona y familia, no sólo en el ambiente intrahospitalario, sino también en su domicilio, mediante la realización de un plan de alta que contempla como piedra angular el proceso de rehabilitación de la persona, basado en la educación de ésta y su cuidador primario. Los resultados obtenidos fueron satisfactorios no sólo en las cuestiones fisiológicas sino también en el aspecto emocional de la persona y su familia, el proceso de rehabilitación ha sido exitoso, y se ve reflejado en que la persona a un año y 2 meses se ha integrado a sus actividades de la vida diaria, sin secuelas de este padecimiento, otro aspecto que vale la pena mencionar es que con la información y educación adecuada se lograron disminuir riesgos de consulta o reingreso hospitalarios, tales como neumonía o infecciones de gastrostomía, las cuales son frecuentes en personas con este padecimiento y cuestiones importantes a considerar en su plan de alta.

This study case aims to highlight the importance of high specialty nursing care in Guillain Barre's Syndrome, which although has a low incidence, provokes a long and progressive health deterioration. A recovery is possible, though, if proper specialized care is provided to the patient and his family, both at the hospital and home settings. Results obtained were satisfactory, both in the physiological and the emotional aspects. The rehabilitation process was successful considering the fact that the patient, a year an 2 months from having suffered the syndrome, has been able to return to his daily activities without sequels. With proper care, education and information, hospital re-admission risks, which are common place in patients suffering from this syndrome, can be reduced.

Ecografía renal con Doppler en el diagnóstico de pielonefritis aguda en niños / Renal ultrasound with Doppler in the diagnosis of acute pyelonephritis in children

Objective: This study evaluates the diagnostic value of Renal Doppler Ultrasound (RDU) in the diagnosis of acute renal involvement among children admitted for a first febrile urinary tract infection (UTI), compared to a Renal Scintigraphy (RS). Methodology: All children admitted during 2009 for a first febrile UTI and positive urinary culture were prospectively studied. All received a RDU and RS with Tc99di-mercaptosuccinic acid during the first 72 hours of hospitalization. Image evaluation was performed blindly. RS was considered to be the gold standard to identify renal involvement. Results: The protocol was completed in 54 children (90 percent). RDU was altered in 36 (66 percent), and RS in 42 (78 percent) of children. Both exams coincided in 78 percent of the children, and in 81 percent of the kidneys. Sensitivity and specificity of RDU for these patients was 78,6 percent and 75 percent (72 percent and 89,6 percent per kidney), respectively. Negative predictive value was 50 percent. RDU detected significantly fewer defects in the left kidney, (p = 0,0026), especially if the defect was localized in the upper pole, and in absence of other associated scintigraphic abnormalities (p = 0,0001). Children with scintigraphic renal involvement showed significant more alterations during the acute phase. Conclusions: RDU is sensitive and specific to detect renal involvement in a child admitted for a febrile UTI, but has a low negative predictive value. Therefore, a negative ultrasound in a patient with inflammatory signs should be confirmed through a scintigraphy, since there are certain sites that are difficult to localize in a sonogram, such as the left superior pole.

Introducción: El objetivo del presente estudio fue evaluar las propiedades diagnósticas de la ecografía renal con Doppler (ERD) en la identificación del compromiso renal agudo, en una cohorte de niños hospitalizados con primera infección urinaria (ITU) febril y compararlas con el cintigrama renal estático (CR). Metodología: Durante el año 2009, en forma prospectiva, se estudiaron todos los niños hospitalizados con primera ITU febril y con urocultivo positivo. En todos ellos se realizó una ERD y un CR con ácido dimercapto succínico marcado con tecnecio 99, dentro de las primeras 72 horas de hospitalización. Los estudios de imágenes fueron realizados en forma ciega, por operadores independientes. El CR se consideró como gold standard para la identificación de compromiso renal. Resultados: En 54 niños (90 por ciento de los elegibles) hospitalizados por ITU febril se cumplió el protocolo de estudio imageneológico. La ERD estuvo alterada en 36 (66 por ciento) y el CR en 42 (78 por ciento) de los niños. Ambos exámenes fueron coincidentes en 78 por ciento de los niños y en 81 por ciento de los riñones estudiados. La sensibilidad y especificidad del la ERD para estos pacientes fueron de 78,6 por ciento y 75 por ciento (72 por ciento y 89,6 por ciento al analizarlo por unida renal), respectivamente, y el valor predictivo negativo de 50 por ciento. La ERD pesquisó significativamente menos defectos cuando éstos eran exclusivos del riñón izquierdo (p = 0,0026), especialmente si el defecto se localizó en el polo superior y en ausencia de otras alteraciones cintigráficas asociadas (p = 0,0001). Los niños con compromiso renal cintigráfico tenían significativamente más alterados los reactantes de fase aguda. Conclusiones: La ERD en un niño hospitalizado por una ITU febril tiene alta sensibilidad y especificidad para pesquisar el compromiso renal, pero un bajo valor predictivo negativo; por lo tanto, si la ERD es negativa y el paciente presenta parámetros inflamatorios alterados, el compromiso renal debe ser confirmado por un CR, ya que existe evidencia de ciertas localizaciones más difíciles de identificar por la ERD, como aquellas que afectan el polo superior izquierdo.

SPECT/CT preoperatorio, una nueva herramienta diagnóstica para localizar adenomas paratiroideos: presentación de 2 casos clínicos / Localization of functioning parathyroid adenomas by SPECT/CT: report of two cases

Single photon emission computed tomography and computed tomography (SPECT/CT), integrates a gamma camera and a CT scan and is effective for the location of parathyroid adenomas. We report a 55 years old male and a 80 years old female with primary hyperparathyroidism. In both cases the 99mTc-Sestamibi parathyroid scintigraphy detected a functioning nodule whose presence was confirmed with SPECT/CT.

El SPECT/CT integra una gamacámara y un escáner radiológico en un solo equipo híbrido que fusiona la imagen de la cintigrafía SPECT (tomografía computada de fotón único) con la imagen morfológica obtenida con un escáner de baja intensidad, sin movilizar al paciente, en una perfecta correspondencia anátomo-funcional, permitiendo identificar con exactitud la localización de un adenoma paratiroideo. Se describen dos pacientes con hiperparatiroidismo primario, con ecotomografía convencional negativa, donde el SPECT/CT demostró la localización exacta de adenomas de ubicación no habitual.

Emergence of Pseudomonas aeruginosa strains producing metallo-beta-lactamases of the IMP-15 and VIM-2 types in Mexico.

Eighty-six carbapenem non-susceptible Pseudomonas aeruginosa isolates collected in the National Institute of Respiratory Diseases of Mexico City were screened for the presence of metallo-beta-lactamase (MBL) activity using both E-test strips and a microbiological assay with EDTA-imipenem. Genomic comparisons and sequence analyses conducted with these isolates revealed the presence of bla(VIM-2) in two clonally related isolates, and bla(IMP-15) in a clonally unrelated isolate. Both genes were found to be carried by class 1 integrons, and bla(IMP-15) was additionally present on a broad host-range plasmid. This is the first report of co-existing P. aeruginosa strains producing different MBLs in a Mexican hospital, highlighting the necessity of appropriate surveillance to prevent dissemination of carbapenem resistance.

Aporte del SPECT-CT en la detección y localización de hiperplasia nodular focal del hígado / Usefulness of SPECT-CT in detection and location of focal nodular hyperplasia

Se presenta el caso clínico de una mujer de 39 años de edad que consulta por dolor abdominal. Los hallazgos en el Ultrasonido efectuado con Doppler y la Resonancia Magnética dinámica no lograron establecer el diagnóstico diferencial entre adenoma e hiperplasia nodular focal. Se complementó el estudio con una cintigrafía de vía biliar detectándose en controles tardíos dos focos de retención del radiofármaco. El estudio tomográfico del hígado con Tc99m-coloidal se efectuó en gamma cámara híbrida (SPECT-CT) obteniéndose imágenes fusionadas anátomo-funcionales que demostraron la existencia y la localización exacta de tres focos de hiperplasia nodular focal.

Utilidad de la cintigrafía de vía biliar en el diagnóstico diferencial de colección intrahepática: l caso clínico / Usefulness of bile duct scintigraphy in the differential diagnosis of intrahepatic collection: a clinical case

Se presenta el caso clínico de un paciente de 48 años referido por cuadro clínico de dolor abdominal y omalgia derecha de 6 meses de evolución posterior a colecistectomía y resección hepatobiliar por Cancer vesicular. El TAC abdominal demostró una gran colección quística intrahepática. El AngioTAc no mostró comunicación vascular. Frente a la sospecha de un bilioma se efectuó cintigrafía de la vía biliar con Tc99m-DISIDA. Ésta demostró un gran defecto de captación intrahepático de límites netos que reemplazaba casi todo el lóbulo derecho, un lóbulo izquierdo de contraste normal y presencia de paso enlentecido del radiofármaco hacia intestino, hallazgos cintigráficos no sugerentes de un bilioma. Se efectuó una punción percutánea de la lesión bajo TAC la cual dió salida a contenido hemático oscuro. Inmediatamente después de efectuar una evacuación parcial se realizó un nuevo AngioTAC el cual confirmó sangramiento activo subcapsular en napa desde segmento VI del hígado como complicación tardía de colecistectomía.

An hepatobiliary scintigraphy with Tc-99m diisopropyl iminodiacetic acid (DISIDA) was done in a 48-year-old man who consulted for abdominal and right shoulder pain 6 months following hepatobiliary and gallbladder resection for a gallbladder cancer. The abdominal CT showed a huge intrahepatic cystic collection. The Angio-CT showed no vascular communication. Biliary scintigraphy with DISIDA showed a large cold intrahepatic defect in the right lobe not compatible with diagnosis of bilioma. The percutaneus punction revealed an haematic collection. After partial percutaneus evacuation done under CT, a new Angio-CT showed active subcapsular hepatic bledding from segment VI of the liver as a late complication of gallbladder surgery.

Inter-rater reliability of a classification system for hospital adverse drug event reports.

Hospital pharmacovigilance systems frequently classify adverse drug event (ADE) reports on various axes such as severity and type of outcome in an attempt to better detect changes in the frequency of certain types of ADEs. The aim of this study was to measure the inter-observer reliability of an ADE classification system. Two pharmacists and two internal medicine physicians reviewed 150 pharmacist-generated ADE reports and used a structured form to classify reports on four domains: the presence or absence of process measures leading to ADE; the individual who initiated the process that potentially leads to ADE; the severity of ADE; and whether the ADE was related to dose. There was wide variation in inter-observer reliability of different elements in a classification system for ADEs. Agreement on specific processes associated with ADEs ranged from poor to moderate, which limits the ability to target accurately processes to improve drug utilization.

Definition of sizes for the design of school furniture for Bogotá schools based on anthropometric criteria.

The current paper deals with the definition of sizes for the design of school furniture for schools in Bogotá, Colombia, based on an analysis of available anthropometric data on Latin American children. State-of-the-art anthropometric, national and international standards were considered, in order to define the anthropometric variables that were to be used for defining the furniture. Matrices relating age and specific anthropometric dimensions were constructed, as a visualization method for establishing the dimensional differences between children of the same age and the ranges that should be covered by the items of furniture. Dimensional data were grouped by establishing the minimum sizes and general dimensions of furniture needed to cover the 5-95th percentile of school children between the ages of 5 and 18 years. The distribution of the furniture in the different school grades was also indicated. Apart from the need for an adequate match between child anthropometry and school furniture dimensions, this study shows the importance of a proper distribution of furniture sizes in the different school grades, as a complementary and decisive aspect to be considered in order to meet the heterogenic, anthropometrical requirements of children of the same age and school grade.

Hemorragia digestiva baja por úlceras de colon secundarias a antinflamatorios no esteroidales / Lower gastrointestinal bleeding from colonic ulcerations due to nonsteroidal antinflammatory drugs

Se presenta el caso de una mujer de 73 años, con hemorragia digestiva baja de etiología desconocida. Sus antecedentes previos confirman el uso de antinflamatorios no esteroidales por una cirugía de reemplazo total de cadera 7 días antes. Se discute la literatura disponible