A quality improvement intervention on surgical prophylaxis impact in antibiotic consumption and cost in selected surgical procedures.

BACKGROUND: Improper compliance with antibiotic prophylaxis (AP) in surgery is associated with an increased risk of surgical site infection (SSI), and impacts the efficiency of healthcare. OBJECTIVE: Evaluate the impact of an intervention in compliance with AP in selected surgical procedures and its effect on antibiotic consumption and cost. METHODS: A prospective interventional study was performed in a community hospital from January to December 2022. The baseline period was considered January-April 2022 and the intervention period May-December 2022. All patients who underwent cesarean section, appendectomies, hernia surgery, open reduction and internal fixation (ORIF), abdominoplasty, and cholecystectomy during the study period were selected. The intervention includes staff education, pharmacy interventions, monitoring the quality of prescriptions and feedback, and improved role of anesthesia staff, and department champions. RESULTS: The study involved 192 and 617 surgical procedures in the baseline and intervention periods respectively. The compliance with timing, selection, dose, and discontinuation achieved 100%, 99.2%, and 97.6% from baseline figures of 92.7%, 95.8%, and 81.3%, respectively. The antibiotic consumption was reduced by 55.1% during the intervention with a higher contribution of other antibiotics (94.1% reduction) in comparison with antibiotics as per policy (31.2% reduction). The cost was reduced by 47.2% (antibiotic as per policy 31.9%, other antibiotics 94.2%). CONCLUSION: The implemented strategy was effective in improving the quality of antibiotic prophylaxis with a significant impact in reducing antibiotic consumption and cost.

Tratamiento de las fracturas supracondíleas de húmero en niños con fijación interna percutánea versus reducción sin fijación interna / Treatment of supracondylar fractures of humerus in children with percutaneous internal fixation versus reduction without internal fixation

Resumen: Introducción: Las fracturas supracondíleas de húmero constituyen el segundo tipo de fracturas más frecuente en niños. Objetivo: Describir los resultados del tratamiento, los pacientes según edad, sexo, complicaciones y resultados finales. Material y métodos: Se realizó un estudio descriptivo retrospectivo, en pacientes con fracturas supracondíleas de húmero durante los años 2018-2019. Se calcularon frecuencias absolutas y porcentajes. Resultados: Las fracturas fueron más frecuentes en el sexo masculino (69.6%) y en el grupo de edad de seis a 10 años para ambos sexos. 60.8% de las fracturas se trataron con reducción más fijación interna con agujas de Kirschner, en el grupo con fijación interna predominan las tipo IV y en el grupo que no necesitó fijación interna predominó el tipo I, la complicación más frecuente fue la pérdida de la reducción en el grupo que no se fijó con agujas. Se obtuvieron mejores resultados cuando se realizó la reducción combinada con fijación interna (91.2%). Conclusiones: Las fracturas predominaron en el sexo masculino y en el grupo de edad de seis a 10 años, fue más frecuente la reducción más fijación interna con agujas de Kirschner, en el grupo con fijación interna predomina las tipo IV, predominó la pérdida de la reducción en el grupo que no se fijó con agujas. Se obtuvieron mejores resultados cuando se realizó la reducción combinada con fijación interna.

Abstract: Introduction: Supracondylar fractures of humerus are the second most frequent type of fractures in children. Objective: To describe the results of the treatment, the patients according to age, sex, complications, and final results. Material and methods: A retrospective descriptive study was conducted in patients with supracondylar fractures of humerus during the years 2018-2019. Absolute frequencies and percentages were calculated. Results: Fractures were more frequent in males (69.6%) and in the age group of six to 10 years for both sexes. 60.8% of the fractures were treated with reduction plus internal fixation with Kirschner needles, in the group with internal fixation type IV predominates and in the group that does not need internal fixation predominate type I, the most frequent complication was the loss of reduction in the group that was not fixed with needles. Better results were obtained when the reduction was performed combined with internal fixation (91.2%). Conclusions: Fractures predominated in the male sex and in the age group of six to 10 years, the reduction was more frequent more internal fixation with Kirschner needles, in the group with internal fixation predominates type IV, predominated the loss of reduction in the group that was not fixed with needles. Better results were obtained when reduction was performed combined with internal fixation.

[Treatment of supracondylar fractures of humerus in children with percutaneous internal fixation versus reduction without internal fixation]. / Tratamiento de las fracturas supracondíleas de húmero en niños con fijación interna percutánea versus reducción sin fijación interna.

INTRODUCTION: Supracondylar fractures of humerus are the second most frequent type of fractures in children. OBJECTIVE: To describe the results of the treatment, the patients according to age, sex, complications, and final results. MATERIAL AND METHODS: A retrospective descriptive study was conducted in patients with supracondylar fractures of humerus during the years 2018-2019. Absolute frequencies and percentages were calculated. RESULTS: Fractures were more frequent in males (69.6%) and in the age group of six to 10 years for both sexes. 60.8% of the fractures were treated with reduction plus internal fixation with Kirschner needles, in the group with internal fixation type IV predominates and in the group that does not need internal fixation predominate type I, the most frequent complication was the loss of reduction in the group that was not fixed with needles. Better results were obtained when the reduction was performed combined with internal fixation (91.2%). CONCLUSIONS: Fractures predominated in the male sex and in the age group of six to 10 years, the reduction was more frequent more internal fixation with Kirschner needles, in the group with internal fixation predominates type IV, predominated the loss of reduction in the group that was not fixed with needles. Better results were obtained when reduction was performed combined with internal fixation.

INTRODUCCIÓN: Las fracturas supracondíleas de húmero constituyen el segundo tipo de fracturas más frecuente en niños. OBJETIVO: Describir los resultados del tratamiento, los pacientes según edad, sexo, complicaciones y resultados finales. MATERIAL Y MÉTODOS: Se realizó un estudio descriptivo retrospectivo, en pacientes con fracturas supracondíleas de húmero durante los años 2018-2019. Se calcularon frecuencias absolutas y porcentajes. RESULTADOS: Las fracturas fueron más frecuentes en el sexo masculino (69.6%) y en el grupo de edad de seis a 10 años para ambos sexos. 60.8% de las fracturas se trataron con reducción más fijación interna con agujas de Kirschner, en el grupo con fijación interna predominan las tipo IV y en el grupo que no necesitó fijación interna predominó el tipo I, la complicación más frecuente fue la pérdida de la reducción en el grupo que no se fijó con agujas. Se obtuvieron mejores resultados cuando se realizó la reducción combinada con fijación interna (91.2%). CONCLUSIONES: Las fracturas predominaron en el sexo masculino y en el grupo de edad de seis a 10 años, fue más frecuente la reducción más fijación interna con agujas de Kirschner, en el grupo con fijación interna predomina las tipo IV, predominó la pérdida de la reducción en el grupo que no se fijó con agujas. Se obtuvieron mejores resultados cuando se realizó la reducción combinada con fijación interna.

Uso del electrobisturí para la incisión en piel durante la operación cesárea. Estudio aleatorizado, controlado y ciego / Use of electrosurgery for the skin incision during caesarean section. A randomised, controlled, blind study

Objetivo: Determinar el riesgo de infección del sitio quirúrgico y la intensidad del dolor postoperatorio comparando el uso del electrobisturí vs. bisturí convencional durante la incisión en la piel de cesáreas. Metodología: Un total de 499 pacientes intervenidas mediante cesáreas electivas y de urgencia fueron aleatorizadas en dos grupos: incisión en piel con electrobisturí (modo corte) o con bisturí convencional. El objetivo primario fue determinar el desarrollo de infección del sitio operatorio. El secundario, el nivel de dolor evaluado con una escala de dolor verbal (EDV) en su postoperatorio (24 y 72h). Resultados: No se encontró una diferencia estadísticamente significativa para el riesgo de infección de la herida quirúrgica entre los dos grupos (electrobisturí: 1,5% vs. bisturí: 0,4%; p=0,40). Tampoco se encontró diferencia en cuanto al nivel de dolor postoperatorio a las 24h [electrobisturí-puntaje EDV: 2,30(0,8) vs. bisturí-puntaje EDV: 2,43(0,8); p=0,43] ni a las 72h [electrobisturí-puntaje EDV: 1,47(0,6) vs. bisturí-puntaje EDV: 1,42(0,6); p=0,32]. Conclusiones: El uso del electrobisturí parece ser tan seguro como el del bisturí para la incisión en piel en las cesáreas. No se asocia a un riesgo elevado de infección de herida quirúrgica ni a mayor intensidad de dolor en los primeros 3 días postoperatorios

Aim: To determine the risk of surgical site infection and the intensity of pain after procedure when comparing electrosurgery vs. conventional scalpel during skin incision in caesarean sections. Methodology: A total of 499 patients selected for emergency or elective caesarean section were randomised into two groups: skin incision with electrosurgery (cut mode) or conventional scalpel. The primary outcome was the development of surgical site infection. The secondary outcome was the level of pain at 24 and 72h after surgery, evaluated with a verbal pain scale (VPS). Results: There was no statistical difference in the risk of surgical site infection between groups (Electrosurgery: 1.5% vs. Scalpel: 0.4%; P=.40). Also, no difference was found in the level of pain at 24h [Electrosurgery-VPS score: 2.30 (0.8) vs. Scalpel-VPS score: 2.43 (0.8); P=.43], or at 72h [Electrosurgery-VPS score: 1.47 (0.6) vs. Scalpel-VPS score: 1.42 (0.6); P=.32]. Conclusion: The use of electrosurgery appears to be as safe as the use of the conventional scalpel during skin incision in caesarean sections. There is no elevated risk of surgical site infection or an increased level of pain during the first three days after surgery

New insight into the environmental impact of two imidazolium ionic liquids. Effects on seed germination and soil microbial activity.

The next generation of ionic liquids must be synthetized taking into account structures that guarantee the suitable properties for a defined application as well as ecological data. Thus, searching of the right methodologies to know, quickly and efficiently, the ecological effects of these compounds is a preliminary task. The effects of two imidazolium based ionic liquids with different anions, 1-butyl-3-methylimidazolium tetrafluoroborate, [C4C1Im][BF4], and 1-propyl-3-methylimidazolium bis(trifluoromethylsulfonyl)imide, [C3C1Im][NTf2], on seedling emergence of six tree species and on the microbial behaviour of two soils were determined in this work. Results showed that the highest doses of both ionic liquids caused the total inhibition of germination for almost all the species studied and that the seeds are more sensitive to the presence of these compounds than soil microbial activity. Nevertheless, signals of stress and death are observed from the results of heat released by microorganisms after the addition of the highest doses of both ionic liquids. The novelty of this work resides in the enlargement of knowledge of toxicity of ILs on complex organisms such as arboreal species and microbial activity of soils studied for the first time through a microcalorimetric technique.

Tratamiento observacional vs. ablativo de las lesiones intraepiteliales escamosas de bajo grado. Estudio de cohorte pareado retrospectivo. Enero 2010-Enero 2014 / Observational versus ablative treatment of low-grade squamous intraepithelial lesions. A retrospective paired cohort study. January 2010 January 2014

A nivel mundial, está claramente establecido el manejo excisional de las lesiones intraepiteliales de alto grado; en cambio, existen 2 tendencias en el manejo de la lesión intraepitelial de bajo grado: seguimiento sólo con observación y esperar la remisión de la lesión, lo cual está bien documentado versus el uso de tratamiento ablativo que algunos autores proponen. El propósito de nuestro estudio fue evaluar de forma retrospectiva los resultados de la Clínica de Colposcopía de la Maternidad del Hospital Santo Tomás, comparando las pacientes manejadas de forma expectante con aquellas manejadas mediante tratamientos ablativos. Después de evaluar 242 casos que cumplían los requisitos planteados en el protocolo, se pudo observar que no había diferencias estadísticamente significativas entre ambos grupos, en cuanto a remisión, progresión o persistencia de las lesiones a los 6 meses y a los 12 meses

The indication for excisional management of high-grade intraepithelial lesions of the cervix is clearly established worldwide. However, low-grade lesions are managed in two different ways: follow-up with routine evaluation of the lesions, with expectation of complete remission, which is well documented in the literature, versus ablative treatment. The purpose of this study was to retrospectively evaluate the results of the Colposcopy Clinic of the Santo Tomás Hospital by comparing patients managed with follow-up and those receiving ablative treatment. After reviewing 242 clinical charts, we observed no statistically significant difference between the two groups in remission, progression or persistence of the lesions at 6 and 12 months

Comparison of the Carlsson-Dent and GERD-Q questionnaires for gastroesophageal reflux disease symptom detection in a general population. / Comparación de los cuestionarios Carlsson-Dent y GERD-Q para detección de síntomas de enfermedad por reflujo gastroesofágico en población general.

INTRODUCTION: Gastroesophageal reflux disease (GERD) is an extremely common pathology in the general population and one of the main reasons for consultation in gastroenterology. There are different instruments for detecting its symptoms, but few studies comparing one tool with another have been conducted in Mexico. AIMS: To compare the effectiveness of the Carlsson-Dent questionnaire (CDQ) and the GERD-Q questionnaire (GQQ) in detecting GERD symptoms in a general population. MATERIALS AND METHODS: A prospective, descriptive, cross-sectional study was conducted on 220 individuals in an open population within the time frame of May-June 2015. The subjects were evaluated through the self-assessment CDQ and GQQ. The positive scores from the CDQ (≥ 4) were compared with those of the GQQ (≥ 8), to determine which of the two instruments more easily detected patients with GERD symptoms. RESULTS: Fifty-seven percent of the patients were men and the mean patient age was 38.1 years. Fifty percent of the subjects presented with GERD symptoms with a positive score in at least one questionnaire; 45% had positive CDQ results and 23% had positive GQQ results. Fifty-seven percent of the patients with a positive CDQ score presented with overweight/obesity, as did 72% of the patients with a positive GQQ result. Finally, 20% of the individuals had positive results for reflux symptoms in both questionnaires. CONCLUSIONS: There was a prevalence of GERD symptoms in 50% of the individuals studied from a general population. The GQQ detected a greater number of GERD symptoms in patients that presented with overweight/obesity and the CDQ was considered easier for patients to understand and answer. It is striking that there was only 20% agreement between the two questionnaires, suggesting that they may be useful for identifying GERD symptoms in different populations.

Estandarización de técnicas para el diagnóstico molecular de flavivirus y alfavirus / Standarization of molecular techniques for diagnosis of flavivirus and alphavirus

Los flavivirus y alfavirus afectan la salud de los humanos. En Venezuela y de forma particular en Aragua, las comunidades se han visto afectadas por algunos de los miembros de estos géneros, como Dengue (DENV), y Chikungunya (CHIKV). DENV circula en Aragua desde 1989 causando brotes de importancia clínica, mientras que CHIKV hizo su aparición en 2014. En Aragua, el diagnóstico se había dirigido hacia la detección de DENV, sin embargo la situación con CHIKV generó la necesidad de ampliar el espectro diagnóstico hacia otros agentes virales. En el Laboratorio Regional de Diagnóstico e Investigación del Dengue y otras Enfermedades Virales se adaptaron dos protocolos de RT-PCR previamente descritos para detectar miembros de estos géneros haciendo uso de cepas controles para flavivirus (DENV y Zika) y alfavirus (CHIKV). Ambas técnicas sufrieron modificaciones en la concentración de algunos reactantes (MgCl2, dNTP´s, y cebadores) utilizados en la segunda reacción de PCR. El resto de las condiciones se mantuvieron iguales a las descritas originalmente. Las metodologías estandarizadas permitieron amplificar hasta 1 fg de ARN viral de los controles empleados (Zika y CHIKV) con posibilidad de amplificar cantidades menores a esta. En todos los casos se obtuvieron bandas nítidas e íntegras de acuerdo a los tamaños esperados haciendo uso de cepas previamente identificadas de DENV, CHIKV y Zika. La puesta en marcha de estas metodologías permitirá fortalecer el diagnóstico oportuno de miembros de estos géneros en el marco del sistema de vigilancia epidemiológica de enfermedades virales.

Flavivirus and alphavirus affect the health of humans. In Venezuela and particularly in Aragua, the communities have been affected by some members of these genus, such as dengue (DENV), and Chikungunya (CHIKV). DENV circulating in Aragua since 1989 generating outbreaks of clinical importance, while CHIKV made its appearance in 2014. In Aragua state, the diagnosis had been directed toward the detection of DENV, however the situation with CHIKV generates the need to expand the diagnosis spectrum to other viral agents. In the LARDIDEV we adapted two methodology of RT-PCR´s previously de scribed to detect members of these genus using flavivirus (DENV y Zika) and alphavirus (CHIKV) control strains. Both techniques were modified in the concentration of some reactants (MgCl2, dNTP´s, and primers) in the second reaction of PCR. The other conditions are kept equal to those originally described. Both techniques allowed amplified up to 1 fg of RNA of viral strains (Zika and CHIKV virus), but it could to amplify smaller amounts. In all cases, sharp bands according to the expected sizes using previously identified strains of DENV, CHIKV and Zika virus were obtained. The implementation of these methodologies will strengthen the timely diagnosis of members of this genus within the system of epidemiological surveillance of viral diseases.

Effect of Supplemental Corn Dried Distillers Grains with Solubles Fed to Beef Steers Grazing Native Rangeland during the Forage Dormant Season.

Two experiments were conducted to evaluate the effects of the level of corn dry distillers grains with solubles (CDDGS) supplementation on growing performance, blood metabolites, digestion characteristics and ruminal fermentation patterns in steers grazing dormant forage. In Exp. 1, of growth performance, 120 steers (204±5 kg initial body weight [BW]) were distributed randomly into 3 groups (each of 40 steers), which were provided with the following levels of CDDGS supplement: 0%, 0.25%, or 0.50% BW. All groups of steers were grazed for 30 days in each of 3 grazing periods (March, April, and May). Approximately 1,000 ha of the land was divided with electric fencing into 3 equally sized pastures (333 ha in size). Blood samples were collected monthly from 20 steers in each grazing group for analysis of glucose (G), urea-nitrogen (UN) and non-esterified fatty acids. Final BW, average daily gain (ADG) and supplement conversion (CDDGS-C) increased with increasing levels of CDDGS supplementation (p<0.05).The CDDGS supplementation also increased the plasma G and UN concentrations (p<0.05). In Exp. 2, of digestive metabolism, 9 ruminally cannulated steers (BW = 350±3 kg) were distributed, following a completely randomized design, into groups of three in each pasture. The ruminally cannulated steers were provided the same levels of CDDGS supplementation as in the growing performance study (0%, 0.25%, and 0.50% BW), and they grazed along with the other 40 steers throughout the grazing periods. The dry matter intake, crude protein intake, neutral detergent fiber intake (NDFI), apparent digestibility of dry matter (ADDM), crude protein (ADCP) and neutral detergent fiber (ADNDF) increased with increasing levels of CDDGS supplementation (p<0.05). The ruminal degradation rates of CP (kdCP), NDF (kdNDF) and passage rate (kp) also increased with increasing levels of CDDGS supplementation (p<0.05). Ruminal ammonia nitrogen (NH3-N) and propionate concentrations also increased with increasing levels of CDDGS supplementation (p<0.05). However, acetate concentrations decreased with increasing levels of CDDGS supplementation (p<0.05). Liquid dilution rate increased with increasing levels of CDDGS supplementation but ruminal liquid volume decreased (p<0.05). On the basis of these findings, we can conclude that CDDGS supplementation enhanced the productive performance of cattle grazing native rangeland without negatively affecting forage intake, glucose and urea-nitrogen blood concentrations, ruminal degradation and ruminal fermentation patterns.

Embarazo ectópico en cicatriz de cesárea previa: reporte de un caso y revisión de la literatura / Ectopic pregnancy in the scar of a previous cesarean section: Report of a case and review of the literature

Describimos un caso de embarazo ectópico localizado en la cicatriz de una cesárea previa que requirió realizar una histerectomía para control de la hemorragia asociada. Debido al incremento de la tasa de cesáreas a nivel mundial, es un cuadro que, aunque raro, irá en aumento. Se hace una revisión actualizada de la literatura mundial sobre el tema

We describe a case of ectopic pregnancy in the scar of a previous cesarean section that required a hysterectomy to control the bleeding. Although rare, this event is becoming more common because of the worldwide increase in cesarean sections. We present a review of the world literature on the subjec

[Impact of Lean methodology to improve care processes and levels of satisfaction in patient care in a clinical laboratory]. / Impacto de la metodología Lean en la mejora de procesos asistenciales y niveles de satisfacción en la atención de pacientes en un laboratorio clínico.

INTRODUCTION: The application of the Lean methodology in health institutions is an effective tool to improve the capacity and workflow, as well as to increase the level of satisfaction of patients and employees. OBJECTIVE: To optimise the time of outpatient care in a clinical laboratory, by implementing a methodology based on the organisation of operational procedures to improve user satisfaction and reduce the number of complaints for delays in care. MATERIAL AND METHODS: A quasi-experimental before and after study was conducted between October 2011 to September 2012. XBar and S charts were used to observe the mean service times and standard deviation. The user satisfaction was assessed using service questionnaires. RESULTS: A reduction of 17 minutes was observed in the time of patient care from arrival to leaving the laboratory, and a decrease of 60% in complaints of delay in care. Despite the high staff turnover and 38% increase in the number of patients seen, a culture of empowerment and continuous improvement was acquired, as well as greater efficiency and productivity in the care process, which was reflected by maintaining standards 12 months after implementation. CONCLUSION: Lean is a viable methodology for clinical laboratory procedures, improving their efficiency and effectiveness.

Distribution and feeding habitat characterization of whale sharks Rhincodon typus in a protected area in the north Caribbean Sea.

The relationship between the distribution of the whale shark Rhincodon typus and hydrobiological variables in the Caribbean Sea during 2005-2009 was analysed. Monthly trips were made to the R. typus aggregation area during the months when this species is present in the region (May to September) to record sightings and hydrological data and to collect samples to determine nutrients, chlorophyll a (Chl a) and zooplankton biomass. A total of 2104 R. typus were counted and three zones of high abundance were identified: Cabo-Catoche, Contoy (both within the Whale Shark Biosphere Reserve, WSBR) and the zone knows as Afuera. The zones of greatest R. typus density within the WSBR were characterized by high Chl a concentrations (median: 1·1 mg m-3 , interpercentile range: 0·5-1·8 mg m-3 ) and high nutrient concentrations, such as ammonium (median: 2·5 µmol l-1 , interpercentile range: 0·5-6·4 µmol l-1 ), due to the influence of local upwelling. A generalized additive model (GAM) was used to explore the relationship between R. typus distribution and the environmental variables inside WSBR. Zooplankton biomass was the most influential environmental variable, supporting the close relationship between R. typus distribution and biological productivity. Copepods were the dominant zooplankton group within the WSBR. In the Afuera zone, there were large R. typus aggregations (>80 individuals) associated with zooplankton dominated by fish eggs and significantly higher mean ± s.d. biomass (3356·1 ± 1960·8 mg m-3 ) compared with that recorded inside the WSBR (103·5 ± 57·2 mg m-3 ). The differences among zones generated changes in R. typus distribution patterns and provided opportunities to develop local management strategies for this species.

Vasectomía sin bisturí: resultados de una cohorte de 309 pacientes / No-scalpel vasectomy

Introducción: La vasectomía es una técnica segura y efectiva para el control de la fertilidad masculina. A pesar de esto, en el mundo se realizan el doble de esterilizaciones femeninas respecto a vasectomías, lo cual es más acentuado en países en vías de desarrollo. Objetivos: El objetivo de este trabajo es presentar nuestra experiencia y resultados en pacientes sometidos a una vasectomía sin bisturí. Materiales y Métodos: Se incluyó un total de 309 pacientes sometidos a una vasectomía sin bisturí entre junio de 2009 y mayo de 2010. En cada caso se evaluó la edad, tiempo operatorio, espermiograma a los 3 y 6 meses (en caso de ser necesario) y la morbilidad perioperatoria. Resultados: 281 pacientes (91 por ciento) se controlaron con al menos un espermiograma. En 189 pacientes (67 por ciento) se evidenció azoospermia en el espermiograma a los 3 meses. En 81 pacientes (29 por ciento) se evidenció un recuento con < 100.000 espermatozoides 100 por ciento inmóviles. En 9 pacientes (3,2 por ciento) se necesitó un segundo espermiograma para obtener menos de 100.000 espermatozoides 100 por ciento inmóviles. Seis pacientes (2 por ciento) consultaron por complicaciones menores: orquialgia, epididimitos o hematoma del sitio operatorio. A 2 años de seguimiento, no se registraron embarazos. Conclusiones: La vasectomía sin bisturí es un método seguro y reproducible de anticoncepción masculina, presentando tasas de efectividad superiores al resto de los métodos anticonceptivos. Un espermiograma de control debe ser realizado a los 3 meses de realizado el procedimiento. La tasa de falla temprana se estima en 0,3 por ciento de los pacientes.

Introduction: Vasectomy is a safe and effective technique of male fertility control. Despite this, in the world are carried out more than double female sterilization in comparison with vasectomies, that is more pronounced in less developed countries. Aims: To present our experience and results in patients undergoing a no-scalpel vasectomy. Methods and Material: A total of 309 patients undergoing a no-scalpel vasectomy between June 2009 and May 2010 were included. For each case was record age, operative time, sperm count at 3 months post vasectomy and peri-operative morbidity. Results: 309 vasectomies were performed, 281 patients (91%) were controlled with at least one sperm count. Azoospermia was obtained in the first sperm count at 3 months in 189 patients (67%). In 81 patients (29%) were observed ≤ 100,000 sperm 100% immobile. 9 patients (3.2%) needed a second semen analysis and 2 patients a third one for less than 100,000 sperm that were 100% immobile. 6 patients (2%) consulted by minor complications such as postoperative pain, epididymitis or hematoma with spontaneous resolution. Conclusions: Vasectomy is a safe and reproducible method of male contraception, presenting an effectiveness rates higher than others contraceptive methods. There are no absolute contraindications for performing the procedure. A sperm count should be done at 3 months of the procedure. The early failure rate in our study is 0.3%.

Ayuno vs. dieta líquida. Estudio aleatorizado controlado para evaluar la duración de la labor de parto, tasa de cesáreas y satisfacción con la labor / Oral intake versus fasting during labor. A randomized controlled trial to evaluate labor duration, cesarean section rate, and satisfaction with labor

Objetivo: Evaluar los beneficios de permitir la ingesta de líquidos claros en término de duración de la labor, tasa de cesáreas y satisfacción personal. Métodos: Estudio aleatorizado, controlado, para evaluar los efectos de una dieta de líquidos claros en una población de bajo riesgo de complicaciones. El objetivo primario fue la duración de la labor. El objetivo secundario fue la tasa de cesáreas. Una encuesta de satisfacción se aplicó durante las primeras 2 h posparto para evaluar la percepción de la labor. Resultados: Se aleatorizaron 348 pacientes. El promedio de duración de la labor en el grupo de dieta líquida fue de 257,75 min y en el grupo de ayuno fue de 288,40 min (sin significación estadística). Tampoco hubo diferencia estadísticamente significativa (análisis por protocolo y análisis por intención de tratar) en la tasa de cesáreas. No se dieron casos de síndrome de Mendelson. Finalmente, los pacientes reportaron una mayor tasa de satisfacción cuando se les permitió ingerir líquidos durante la labor que cuando estaban en ayunas. Conclusión: Demostramos que la ingesta de líquidos claros no afecta a la duración de la labor de parto o la tasa de cesáreas. Permitir la ingesta de líquidos durante la labor se asocia a una mejor percepción del proceso del parto y a un mayor grado de satisfacción

Aim: To evaluate the benefits of allowing oral intake of clear liquids in terms of labor duration, the cesarean section rate, and personal satisfaction. Methods: A randomized controlled trial was carried out to assess the effects of a clear liquid diet in a low risk population. The primary outcome was labor duration. The secondary outcome was the incidence of cesarean section. A satisfaction survey was performed within the first 2 h after delivery to evaluate the patient’s perception of labor. Results: A total of 348 patients were randomized. The mean duration of labor was 257.75 min in the liquid diet group and 288.40 min in the fasting group (p = NS). There was no statistically significant difference (per-protocol analysis and intention-to-treat analysis) in the caesarean section rate .Patients reported greater satisfaction when allowed to drink during labor than when fasting. Conclusion: A clear liquid diet during labor did not alter the duration of labor or the caesarean section rate. Allowing a liquid diet during labor was associated with a better perception of the birth process and a higher degree of satisfaction

Diagnostic validity of the Alzheimer's disease functional assessment and change scale in mild cognitive impairment and mild to moderate Alzheimer's disease.

BACKGROUND: The Alzheimer's Disease Functional Assessment and Change Scale (ADFACS) is a functional assessment instrument widely used in clinical research. AIMS: To test the diagnostic and concurrent validity of the Spanish version of this scale and to describe the functional deficit pattern for mild cognitive impairment (MCI) and Alzheimer's disease (AD) dementia. METHODS: The ADFACS, the Interview for Deterioration in Daily Living Activities in Dementia (IDDD), and the Mini Mental State Examination (MMSE) were administered to 146 control subjects (CS) and 165 patients (67 MCI and 98 AD). Nonparametric tests were used to compare the diagnostic groups. Cronbach's α and correlations with the MMSE and the IDDD were calculated. Sensitivity, specificity and predictive values were studied. RESULTS: The ADFACS had a high internal consistency (α = 0.95). Three cutoff points of 1, 4, and 17 were provided to separate CS and MCI patients, MCI and mild AD patients, and mild AD and moderate AD patients, respectively. The ADFACS strongly correlated with functional (IDDD, 0.927) and cognitive (MMSE, 0.747) measures. A similar pattern of dysfunction, but in different grades, was found for the MCI and AD groups. CONCLUSION: The ADFACS is a reliable, valid, and sensitive instrument to assess functional abilities; it is useful in dementia assessment for elderly populations.

Aloinmunización eritrocitaria severa en paciente con síndrome de Ballantyne. Reporte de un caso / Severe red blood cell alloimmunization in a patient with Ballantyne syndrome. A case report

La isoinmunización Rh(D) es una enfermedad poco frecuente hoy en día debido a la introducción de las inmunoglobulinas Rh(D) hace varias décadas. Sin embargo, cuando un feto se ve afectado por esta enfermedad, los riesgos de morbimortalidad son altos. Este riesgo es aún mayor cuando el feto desarrolla eritroblastosis fetal y, en casos extremos, esto puede tener un efecto directo sobre la madre. El síndrome de Ballantyne es una condición similar a la preeclampsia que se asocia al desarrollo de hidrops fetal y placentomegalia. Este reporte describe el manejo con transfusión intraperitoneal fetal, plasmaféresis y terapia con inmunoglobulinas en una paciente con isoinmunización Rh(D) y síndrome de Ballantyne (AU)

Rh(D) isoimmunization is rarely encountered today due to the introduction of Rh(D)immunoglobulin several decades ago. However, when a fetus is affected by this disease, there is a high risk of serious morbidity and mortality. This risk is even higher when the fetus developserythroblastosis fetalis, which, in extreme instances, can also affect the mother. Ballantynesyndrome is a preeclampsia-like condition associated with hydrops fetalis and placentomegaly. This report describes the management of this entity with intraperitoneal fetal transfusion, plasma exchange and immunoglobulin therapy in a patient with Rh(D) isoimmunization and Ballantyne syndrome (AU)

Realidad actual del screening para cáncer de próstata: ¿se llevan a cabo las recomendaciones? / Current reality of the screening for prostate cancer: are we carrying out the recommendations?

INTRODUCCIÓN: El cáncer de próstata es la segunda causa de muerte por cáncer en hombres, al igual que en países desarrollados. A pesar de la alta prevalencia y mortalidad, no existen programas de amplia cobertura para detección precoz en la población masculina. OBJETIVO: Determinar la prevalencia del tamizaje para cáncer de próstata en hombres de diversos centros de salud de Santiago de Chile. METODOLOGÍA: Encuesta dirigida a hombres mayores o igual de 40 años que consultaron a centros de salud por causas no urológicas. Se preguntó respecto a edad, realización de exámenes de detección de cáncer de próstata e inicio de controles para pesquisa. RESULTADOS: Respondieron a la encuesta 517 hombres, con una edad promedio de 59 años. Un 50,3 por ciento de los encuestados refirieron haber tenido control para detección de cáncer de próstata alguna vez en su vida. Se observó una mayor proporción de pacientes controlados en un centro de alto nivel socioeconómico de la ciudad, y de un Hospital, en comparación a otros 3 centros. La mayor parte de los controlados tenían más de 60 años, y sólo un tercio inició los controles antes de los 50 años. Finalmente, sólo un 50 por ciento de los controlados se habían realizado tanto medición de antígeno prostático específico como el examen digital rectal. CONCLUSIÓN: La cobertura del screening para cáncer de próstata es baja en la población masculina de Santiago de Chile. Además, la mayor parte de los pacientes inician los controles a edades tardías.

BACKGROUND: In Chile, prostate cancer is the second leading cause of cancer death in men, similar to developed countries. Despite the high prevalence and mortality, there are no established screening programs for early detection. AIM: To evaluate the prevalence of the prostate cancer screening method in different centers of Santiago. MATERIALS AND METHODS: A questionnaire was applied to men 40 years or older to determine age, performing some prostate screening, age at first screening, and which type of screening has been performed. RESULTS: The questionnaire was answered by 517 men, mean age 59 years. 50,3 percent reported had control for detection of prostate cancer at least one time in their life. A higher proportion of patient controlled was observed in a high socioeconomic center of the city and a hospital, compared to other 3 centers. Most of the controlled were over 60 years, and only one third of the controlled started before 50 age. Finally, only 50 percent had done prostate specific antigen plus digital rectal examination. CONCLUSION: The screening for prostate cancer is low in the male population of Santiago de Chile. Furthermore, most patients stars controls at later ages.

Embolectomía pulmonar y bypass cardiopulmonar durante el embarazo / Pulmonary embolectomy and cardiopulmonary bypass during pregnancy

La cirugía cardiaca con circulación extracorpórea en pacientes obstétricas representa un capítulo especial, debido a los cambios fisiológicos producidos por el embarazo y factores como el manejo anestésico, la monitorización y la perfusión durante el bypass cardiopulmonar que se producen sobre el binomio madre-feto, organismos en situaciones diferentes y con intereses opuestos. Describimos el manejo anestésico de una paciente de 26,2 semanas de embarazo con un tromboembolismo pulmonar y trombo auricular adherido a catéter central con comunicación interauricular.

Cardiac surgery with extracorporeal circulation in obstetric patients is a separate chapter because of the physiological changes brought about by pregnancy and factors such as anesthetic management, monitoring and perfusion during the cardiopulmonary bypass that affects both the mother and the child; both experience different circumstances and have dissimilar interests. The paper discusses the anesthetic management of a patient in her 26.2weeks of gestation with a pulmonary thromboembolism and atrial intracavitary thrombus attached to the central catheter with atrial septal defect.

Therapeutic effect of an altered peptide ligand derived from heat-shock protein 60 by suppressing of inflammatory cytokines secretion in two animal models of rheumatoid arthritis.

Rheumatoid arthritis is a systemic autoimmune disease mediated by T cells. Productive engagement of T cell receptors by major histocompatibility complex-peptide leads to proliferation, differentiation and the definition of effector functions. Altered peptide ligands (APL) generated by amino acid substitutions in the antigenic peptide have diverse effects on T cell response. We predicted a novel T cell epitope from human heat-shock protein 60, an autoantigen involved in the pathogenesis of rheumatoid arthritis. Three APLs were designed from this epitope and it was demonstrated that these peptides induce the activation of T cells through their ability to modify cell cycle phase's distribution of CD4+T cells from RA patients. Also, IL-17, TNF-α and IL-10 levels were determined in PBMC from these patients. Unlike the wild-type peptide and the other two APLs, APL2 increased the IL-10 level and suppressed IL-17 secretion in these assays. Therapeutic effect of this APL in adjuvant arthritis (AA) and collagen-induced arthritis (CIA) models was also evaluated. Clinical score, histopathology, inflammatory and regulatory cytokine concentration were monitored in the animals. APL2 efficiently inhibited the progression of AA and CIA with a significant reduction of the clinical and histopathologic score. Therapeutic effect of APL2 on CIA was similar to that obtained with MTX; the standard treatment for RA. This effect was associated with a decrease of TNF-α and IL-17 levels. These results suggest that the therapeutic effect of APL2 is mediated in part by down-regulation of inflammatory cytokines and support the potential use of APL2 as a therapeutic drug in RA patients.