Evaluation of an e-health platform for informal caregivers and health professionals: the case study of Help2Care.

The Help2Care e-Health platform was developed in order to capacitate informal caregivers with digital, multimedia training materials. Health professionals select these materials according to the needs of the homebound patients under the supervision of these caregivers. In turn, caregiver can then use their smartphones to consult and apply the care procedures illustrated by these materials. In this paper, we present the results of performed usability tests for both web and mobile software applications of the Help2Care platform. These indicate an overall positive outcome, revealing less usable aspects such as the navigation flow in the web application and some design elements in the mobile application. Important written feedback was also collected, which we took into consideration to improve the software features of the platform.

Esplenectomía parcial en pacientes con drepanocitosis / Partial splenectomy in sickle cell disease

INTRODUCCIÓN: La esplenectomía total en la drepanocitosis se relaciona con riesgo de infecciones sobreagudas y con aumento de la incidencia de otros eventos, lo que no se ha comunicado en pacientes con esplenectomía parcial. En este estudio se caracterizó a los pacientes con drepanocitosis y esplenectomía parcial, y se comparó el comportamiento clínico y de laboratorio con los pacientes no esplenectomizados. MATERIAL Y MÉTODOS: Se estudió a 54 pacientes con drepanocitosis sometidos a esplenectomía parcial durante la edad pediátrica, desde 1986 hasta el año 2011, en el Instituto de Hematología e Inmunología. Se compararon con 54 pacientes no esplenectomizados seleccionados por muestreo aleatorio con características similares. RESULTADOS: La esplenectomía parcial se realizó a una edad media de 4,1 años, con una frecuencia mayor en la anemia drepanocítica (70,4%) y su causa más común fue la crisis de secuestro esplénico recurrente. Las complicaciones posoperatorias más frecuentes fueron: fiebre de origen desconocido (14,8%) y síndrome torácico agudo (11,1%). Después de la esplenectomía, aumentaron significativamente los leucocitos, neutrófilos y plaquetas; estos 2 últimos parámetros se mantuvieron elevados de manera significativa cuando se compararon con los pacientes no esplenectomizados. No hubo diferencias en la incidencia de los eventos clínicos, excepto el secuestro hepático, que fue más frecuente en los esplenectomizados. CONCLUSIÓN: La esplenectomía parcial constituyó un proceder seguro en los pacientes con drepanocitosis. No hubo diferencias en el cuadro clínico entre los niños esplenectomizados y los no esplenectomizados, salvo la mayor frecuencia de crisis de secuestro hepático en los primeros

INTRODUCTION: Total splenectomy in sickle cell disease is related to a high risk of fulminant sepsis and increased incidence of other events, which have not been reported in patients with partial splenectomy. In this study we examined the patients with sickle cell disease and partial splenectomy and compared the clinical and laboratory results with non-splenectomized patients. MATERIAL AND METHODS: We studied 54 patients with sickle cell disease who underwent partial splenectomy in childhood from 1986 until 2011 at the Institute of Hematology and Immunology. They were compared with 54 non-splenectomized patients selected by random sampling with similar characteristics. RESULTS: Partial splenectomy was performed at a mean age of 4.1 years, with a higher frequency in homozygous hemoglobin S (70.4%), and the most common cause was recurrent splenic sequestration crisis. The most common postoperative complications were fever of unknown origin (14.8%) and acute chest syndrome (11.1%). After splenectomy there was a significant increase in leukocytes, neutrophils, and platelets, the latter two parameters remained significantly elevated when compared with non-splenectomized patients. There was no difference in the incidence of clinical events, except hepatic sequestration, which was more common in splenectomized patients. CONCLUSION: Partial splenectomy was a safe procedure in patients with sickle cell disease. There were no differences in the clinical picture in children splenectomized and non-splenectomized except the greater frequency of hepatic sequestration crisis in the first group

[Partial splenectomy in sickle cell disease]. / Esplenectomía parcial en pacientes con drepanocitosis.

INTRODUCTION: Total splenectomy in sickle cell disease is related to a high risk of fulminant sepsis and increased incidence of other events, which have not been reported in patients with partial splenectomy. In this study we examined the patients with sickle cell disease and partial splenectomy and compared the clinical and laboratory results with non-splenectomized patients. MATERIAL AND METHODS: We studied 54 patients with sickle cell disease who underwent partial splenectomy in childhood from 1986 until 2011 at the Institute of Hematology and Immunology. They were compared with 54 non-splenectomized patients selected by random sampling with similar characteristics. RESULTS: Partial splenectomy was performed at a mean age of 4.1 years, with a higher frequency in homozygous hemoglobin S (70.4%), and the most common cause was recurrent splenic sequestration crisis. The most common postoperative complications were fever of unknown origin (14.8%) and acute chest syndrome (11.1%). After splenectomy there was a significant increase in leukocytes, neutrophils, and platelets, the latter two parameters remained significantly elevated when compared with non-splenectomized patients. There was no difference in the incidence of clinical events, except hepatic sequestration, which was more common in splenectomized patients. CONCLUSION: Partial splenectomy was a safe procedure in patients with sickle cell disease. There were no differences in the clinical picture in children splenectomized and non-splenectomized except the greater frequency of hepatic sequestration crisis in the first group.

Clinical efficacy and safety of primary antifungal prophylaxis with posaconazole vs itraconazole in allogeneic blood and marrow transplantation.

Posaconazole has been recently approved for primary antifungal prophylaxis in patients with prolonged neutropenia after AML induction chemotherapy and patients with GVHD. We now present the first experience of the efficacy and safety of posaconazole during the early phase of post-allogeneic BMT (n=33; from June 2007), in comparison with itraconazole primary prophylaxis (n=16; up to May 2007). More patients receiving posaconazole were T-cell depleted (P=0.003). Groups were otherwise comparable in terms of age, sex, disease, neutrophil engraftment, incidence of GVHD, use of unrelated donors and type of conditioning. Safety data as well as the incidence of fever (84%) and persistent fever (27%) during the 100-day treatment period were comparable for both antifungal agents. Patients receiving posaconazole had a lower cumulative incidence of proven or probable invasive fungal disease, as defined by the European Organization for Research and Treatment of Cancer criteria (0 vs 12%; P=0.04), which associated with a higher probability of fungal-free survival (91 vs 56%; P=0.003) and an improved probability of OS (91 vs 63%; P=0.011) compared with patients receiving itraconazole. Our single-centre experience suggests that antifungal prophylaxis with posaconazole may lead to a better outcome than itraconazole for patients in the early high-risk neutropenic period after allogeneic BMT.

Variaciones hemodinámicas con fentanilo versus remifentanilo en anestesia general balanceada / Hemodynamic variations with fentanyl versus remifentanil in general anesthesia

Sometidos a cirugía abdominal en los quirófanos de los Hospitales Vicente Corral y José Con un diseño clínico, controlado, aleatorizado a simple ciego se incluyeron 100 pacientes Carrasco durante el año 2008. El grupo Fentanilo (n=50) recibió anestesia general balanceada con la asociación Sevoflurano + RMND + Fentanilo y el grupo Remifentanilo (n=50) recibió anestesia general balanceada con la asociación Sevoflurano + RMND + Remifentanilo. Se midieron las variaciones hemodinámicas durante la inducción, después de la laringoscopía y durante el mantenimiento anestésico así como el nivel de sedación en el despertar anestésico.Los grupos fueron comparables en: edad, sexo, ASA, escolaridad, IMC, residencia, ocupación, procedimiento quirúrgico y hemodinamia basal: presión sanguínea (PS), frecuencia cardíaca (FC) y oximetría (SpO2).Durante la inducción la PS y la FC disminuyeron significativamente en el grupo querecibió Remifentanilo (P < 0,05).A partir de los 3 min la PS y la FC disminuyeron significativamente y se mantuvieronhasta después de la laringoscopía en el grupo del Remifentanilo (P < 0,05).En el mantenimiento de la anestesia y en los análisis intergrupo e intragrupo hubovariaciones hemodinámicas con ambos fármacos aunque la disminución fue mayor enel grupo que recibió Remifentanilo (P < 0,05).En el despertar anestésico el estado de sedación fue mayor para el grupo FentaniloNuestros resultados fueron similares a los publicados. Fentanilo y Remifentanilo son los opioides de más amplio uso en la práctica clínica actual. La menor variación emodinámica y la analgesia residual del primero se compensarían con la mejor capacidad para atenuar la respuesta adrenérgica a la laringoscopía y la recuperación inmediata del sensorio, del segundo. El mejor aprovechamiento de las propiedades de cada compuesto dependerá de sus indicaciones específicas.

With a clinical design, controlled, randomized simple blind 100patients submissive abdominal surgery in operating rooms of Vicente Corral and JoséCarrasco Hospitals during year 2008. Fentanyl group (n=50) received balancedgeneral anesthesia with association Sevofluorane + RMND + Fentanyl andRemifentanilo group (n=50) received balanced general anesthesia with associationSevofluorane + RMND + Remifentanilo.The hemodynamcs variations were moderateduring induction, after laringoscopy and during the anesthetic maintenance as well asthe level of sedation in anesthetic waking up.Results. Groups were comparable in: age, sex, ASA, schooling, BMI, occupation,surgical procedure and basal hemodinamyc: blood pressure (BP), pulse frequency(FC) and oximetry (SpO2). During the induction the PS and the FC diminishedsignificantly in Remifentanilo group (P < 0,05).From 3 min PS and FC diminished significantly and they stayed after laringoscopy inRemifentanil group (P < 0,05).In maintenance of anesthesia and intergroup intragroup analyses there werehemodynamics variations with both drugs although decrease was greater inRemifentanilo group (P < 0,05).In postoperative unit up sedation state was greater for Fentanyl group but with bettercontrol of immediate postoperating pain.Our results were similar to the published ones. Fentanyl andRemifentanilo are the opioids of ampler actually present clinical use. The smallerhemodynamic variation and the residual analgesia of first would be compensated withthe best capacity to attenuate to the adrenergic answer to laringoscopy and theimmediate recovery of sensory, of the second. The best advantage of the properties ofeach compound will depend on its specific indications.

Genotypic and phenotypic analysis of Salmonella strains associated with an outbreak of equine neonatal salmonellosis.

Isolates of Salmonella choleraesuis serotype ohio (S. ohio) recovered during an outbreak of equine neonatal salmonellosis on a Thoroughbred farm were compared with isolates of the same serotype from various animal, feed and environmental sources. Biochemical profiles, antimicrobial susceptibility patterns, phage susceptibility, plasmid profiles, restriction endonuclease analysis and ribotyping were used to compare relatedness of the strains. A total of 46 outbreak and non-outbreak associated isolates of S. ohio were studied. Differences in antimicrobial susceptibility patterns, phage susceptibility and plasmid profiles were useful for differentiating outbreak isolates from other equine isolates as well as bovine, porcine and some poultry isolates. Feed and other poultry isolates, most in geographic proximity to the outbreak, were indistinguishable from outbreak isolates by any of the methods employed. Investigative studies on the farm along with results of genotypic and phenotypic analysis of isolates suggested that contaminated feed was the most likely source of Salmonella in this outbreak.

Anemia megalobástica Asociada a Diarrea crónica.Estudio prospectivo y multicéntrico en Lima / Megaloblástic anemia associated to chronic diarrhea. Prospective and multicentric study in Lima

A partir de 1986 hemos observado un incremento de Anemia Megaloblástica (AM) asociada a diarrea crónica, en 60 por ciento no se encontró ninguna relación causal. En los últimos 3 años hemos utilizado un protocolo multicéntrico prospectivo en Lima (Perú), se incluyeron adultos con AM confirmada por aspirado de médula ósea, excluyendo: ancianos, gestantes, alcohólicos, portadores de neoplasias, etc. Los pacientes fueron 45 con promedio de edad de 37.5 años. Se encontraron dosajes disminuídos de B12 + ácido fólico: 64 por ciento, B12: 20 por ciento, y ácido fólico:16 por ciento. Las biopsias gástricas demostraron atrofia: 33 por ciento (fondo), 7,6 por ciento (cuerpo) y 12 por ciento(antro). El pH gástrico menor o igual a 4.5 en 50 por ciento. El cultivo microbiológico del jugo duodenal fué positivo en 35.2 por ciento 96/17), la mayoría coliformes gram negativos. Presentaron diversas alteraciones estructurales 5/8 (62.5 por ciento) biopsias duodenales, 5/6 (83 por ciento) biopsias yeyunales y 4/4 (100 por ciento) biopsias ileales. Los estudios parasitológicos excluyeron diphillobothrium pacificum. Estos hallazgos nos llevan a sugerir que un significativo número de pacientes con AM y diarrea crónica (con o sin síndrome espruiforme) en Lima, son consecuencia del sobrecrecimiento bacteriano intestinal, lo que los configuraría como casos de Esprue Tropical

[Megaloblastic anemia and gastrointestinal manifestations in Lima. The tip of the iceberg?]. / Anemia megaloblástica y manifestaciones gastrointestinales en Lima. La punta del iceberg?

UNLABELLED: The records of the last three years from the Hematology service are reviewed and twenty patients (6.23%) fulfilling the inclusion criteria were chosen out of a total of 316. RESULTS: pallor and malaise 100%, change in bowel movements 75%, nausea, vomiting and hemorrhage 40%, jaundice 25%, nausea aroused by food 20%, infection 10%. Severe hyporegenerative anemia 100%, thrombocytopenia 75%, pancytopenia 60%. We found as associated conditions: gynecological and obstetric history 25%, enteric and peritoneal tuberculosis 15%, and without an apparent cause (primary) 40%. Levels of vitamin B12 and folic acid were measured in eleven patients and the finding were: B12 deficiency in six (54.5%), folic acid deficiency in three (27.2%) and deficiency of both in two (18.1%). With the exception of one patient who died from sepsis, all the other patients had a favorable outcome with vitamin treatment. We found folic acid deficiency associated with ferropenia mainly in those patients with obstetric history; the combined deficit in those patients with an associated pathological process, and B12 deficiency in the group without any apparent cause. From the available national information and our observations we can conclude that we are facing an outbreak of megaloblastic anemia that frequently goes on with gastrointestinal manifestations and for which the cause has not been elucidated.

Marcapaso electrónico permanente. Implantación y seguimiento / Permanenet electronic pacemaker. Implantation and follow-up

Se estudian 58 pacientes con trastornos de conducción AV, los cuales necesitaron un marcapaso electrónico como tratamiento de su afección. La edad promedio fue de 65 años, con predominio del sexo masculino (69 porciento). Prevaleció la implantación endocárdica (69 porciento): la vena más frecuentemente utilizada fue la cefálica derecha (60,7 porciento). El desplazamiento del electrodo fue visto en el 15 porciento, y el 20,4 porciento de los enfermos desarrolló insuficiencia cardiaca. El 86 porciento de los pacientes se encuentra vivo, y sólo hubo un fallecido que pudiera estar en relación directa con la implantación del marcapaso (AU)