ABSTRACT
Resumen Objetivo: Describir características demográficas y tratamiento quirúrgico realizado a pacientes con fractura de esternón (FE) en los últimos 5 años. Materiales y Método: Estudio descriptivo retrospectivo de pacientes operados por fractura esternal entre enero de 2015 y enero de 2020. Se analizaron edad, sexo, antecedentes mórbidos, hemodinamia de ingreso, mecanismo causal, características de lesión esternal, lesiones asociadas, indicación quirúrgica y complicaciones. Resultados: Durante el período ingresaron a nuestro hospital 9 pacientes (7 hombres) de 21 a 91 años. Todos fueron operados. La mayoría ingresó con hemodinamia estable. El mecanismo fue siempre traumático. Las indicaciones quirúrgicas fueron: dolor intratable, alteración de la mecánica ventilatoria, tórax volante, deformidad y ayuda en la rehabilitación de un trauma raquimedular. Discusión: La FE es una patología infrecuente, siendo aún más escasa su resolución quirúrgica reportada a nivel mundial. Conclusiones: Presentamos el primer reporte de una serie de casos de FE operada en Chile. La osteosíntesis esternal permite el manejo de la FE con buenos resultados funcionales con baja tasa de morbilidad. Los resultados obtenidos son comparables a los observados en la literatura internacional.
Aim: To describe demographic characteristics and surgical treatment carried out on patients with a sternal fracture (SF) in the last 5 years. Materials and Method: Retrospective descriptive study of patients operated on for SF between January 2015 and January 2020. We analyzed age, sex, morbid history, hemodynamics on admission, causal mechanism and characteristics of sternal injury, associated injuries, surgical indication and complications. Results: During the period, 9 patients were admitted to our hospital (7 men) from 21 to 91 years old. All were operated. Most were admitted with stable hemodynamics. The mechanism was always traumatic. The surgical indications were: intractable pain, alteration of ventilatory mechanics, flail chest, deformity and aid in the rehabilitation of spinal cord trauma. Discussion: SF is an infrequent pathology, its surgical resolution reported worldwide being even scarce. Conclusions: We present the first report of a series of cases of SF operated in Chile. Sternal osteosynthesis allows the management of EF with good functional results with a low morbidity rate. The results obtained are comparable to those observed in the international literature.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Sternum/surgery , Sternum/diagnostic imaging , Fractures, Bone/diagnostic imaging , Thorax/diagnostic imaging , Radiography, Thoracic , Demography , Epidemiology, Descriptive , Retrospective StudiesABSTRACT
The relationship between spirituality and medicine is present from the very origins of Medicine. Its relevance has been rediscovered during the past decades. Numerous publications report positive health results when spiritual needs of patients are addressed. Authors like Edmund Pellegrino and Christina Puchalski have gained an acknowledged leadership in this field. The purpose of the article is to study Christina Puchalkis' contributions to the field, specifically through the identification and analysis of the ethical reasons that - according to Puchalski - justify the medical duty to provide spiritual care. As a result of our investigations, we propose to systematize the ethical reasons identified in Puchalski's writings in seven categories, that presuppose a broad definition of spirituality and a conception of "whole patient care". Our analysis shows that Puchalski's arguments are ultimately grounded on an ethics of virtue and a realist anthropology, more than in mere positive effects or in patient's wishes. Indeed, Puchaslki's anthropological conception recognized human dignity as an intrinsic value that must be always acknowledged, especially in the context of disease, where questions about the meaning of life, suffering, connection and transcendence inevitable arise. We conclude that Puchalski's ethical arguments are solid and suggest the challenge of including the spiritual dimension in the formation of health care professionals.
Subject(s)
Humans , Spirituality , Medicine , Writing , Health Personnel , MoralsABSTRACT
The relationship between spirituality and medicine is present from the very origins of Medicine. Its relevance has been rediscovered during the past decades. Numerous publications report positive health results when spiritual needs of patients are addressed. Authors like Edmund Pellegrino and Christina Puchalski have gained an acknowledged leadership in this field. The purpose of the article is to study Christina Puchalkis' contributions to the field, specifically through the identification and analysis of the ethical reasons that - according to Puchalski - justify the medical duty to provide spiritual care. As a result of our investigations, we propose to systematize the ethical reasons identified in Puchalski's writings in seven categories, that presuppose a broad definition of spirituality and a conception of "whole patient care". Our analysis shows that Puchalski's arguments are ultimately grounded on an ethics of virtue and a realist anthropology, more than in mere positive effects or in patient's wishes. Indeed, Puchaslki's anthropological conception recognized human dignity as an intrinsic value that must be always acknowledged, especially in the context of disease, where questions about the meaning of life, suffering, connection and transcendence inevitable arise. We conclude that Puchalski's ethical arguments are solid and suggest the challenge of including the spiritual dimension in the formation of health care professionals.
Subject(s)
Medicine , Spirituality , Health Personnel , Humans , Morals , WritingABSTRACT
Pulmonary expansion edema is a rare complication of the management of primary spontaneous pneumothorax. We report a 20 year old male admitted with a right primary spontaneous pneumothorax. A chest tube connected to a water seal was placed, achieving lung expansion. Immediately, the patient presented hypotension and a reduction in arterial oxygen saturation to 78%. Non-invasive ventilation was started. A chest X ray showed extensive right lung edema. The patient was managed with noradrenaline and albumin infusion with good response. Pulmonary edema resolved on day 3 but air leak was persistant so, the patient required surgery to excise apical bullae in the right lung. He was discharged during the following days in good condition.
Subject(s)
Humans , Male , Young Adult , Pneumothorax/complications , Pneumothorax/therapy , Pulmonary Edema/etiology , Pulmonary Edema/therapy , Drainage/adverse effects , Pulmonary Edema/diagnostic imaging , Radiography, Thoracic , Chest Tubes/adverse effects , Risk Factors , Treatment OutcomeABSTRACT
Pulmonary expansion edema is a rare complication of the management of primary spontaneous pneumothorax. We report a 20 year old male admitted with a right primary spontaneous pneumothorax. A chest tube connected to a water seal was placed, achieving lung expansion. Immediately, the patient presented hypotension and a reduction in arterial oxygen saturation to 78%. Non-invasive ventilation was started. A chest X ray showed extensive right lung edema. The patient was managed with noradrenaline and albumin infusion with good response. Pulmonary edema resolved on day 3 but air leak was persistant so, the patient required surgery to excise apical bullae in the right lung. He was discharged during the following days in good condition.
Subject(s)
Drainage/adverse effects , Pneumothorax/complications , Pneumothorax/therapy , Pulmonary Edema/etiology , Pulmonary Edema/therapy , Chest Tubes/adverse effects , Humans , Male , Pulmonary Edema/diagnostic imaging , Radiography, Thoracic , Risk Factors , Treatment Outcome , Young AdultABSTRACT
Las diferentes patologías que se desarrollan durante el embarazo comprenden una variedad de situaciones que, sean simples o complejas en cuanto a la resolución, siempre generan al equipo de salud gran incertidumbre en el momento de abordarlas. Entre ellas, las alteraciones neurológicas, debido al espectro de enfermedades que pueden generarlas y a su impacto en la salud materno-fetal, representan un constante desafío. Esta revisión desarrolla los trastornos neurológicos más frecuentes durante el embarazo, su enfoque diagnóstico y terapéutico.(AU)
The different pathologies that develop during pregnancy include a variety of situations, whether simple or complex in their resolution that always generate great uncertainty to the health team at the time of the management. Among them, neurological disorders, due to the spectrum of diseases that can originate them and their impact on maternal and fetal health, represent a constant challenge. This review discusses the most common neurological disorders in pregnancy, their diagnosis and therapeutic approach.(AU)
Subject(s)
Humans , Female , Pregnancy , Pregnancy , Neurologic Manifestations , Thrombosis , Brain Diseases , Stroke , Postpartum PeriodABSTRACT
Background: Laparoscopic cholecystectomy (LC) is a widely used technique in the treatment of gallstone disease. Outpatient laparoscopic cholecystectomy (OLC) is a cost/effective and safe procedure in selected patients. Aim: A pilot program of OLC was conducted in a Chilean Public Hospital to evaluate the feasibility and results, including and patients' satisfaction using OLC. Patients and Methods: Patients were eligible for OLC if they were less than 60 years old, had low anesthestetic risk (ASA I-II), normal liver function tests and an abdominal ultrasound showing gallstones or gallbladder polyps with a normal common bile duct. Results: We performed OLC in 357 patients aged 36±10 years, 90% female. Intraoperative complications were observed in 4 (1.1%) patients (uncontrolled bleeding in two and minor biliary tree injuries in two, both requiring conversion to the open technique). Four other patients required conversion due to anatomic reasons (overall conversion rate: 2.2%). Ninety two percent of patients were discharged within 6 hours of the operation. Eight (2.2%) were readmitted because of a mild acute pancreatitis (n=1), biliary leakage (n=1), persistent pain (n=2), vomiting (n=2), and retained stones (n=2). Two (0.6%) patients were re-operated. There was no mortality. Ninety-four percent of 277 patients (77.6%), who answered a Satisfaction Survey, evaluated OLC procedure with a high degree of satisfaction. Conclusion: OLC is a safe and feasible procedure in selected gallstone patients. The procedure has good outcomes and a high degree of patient satisfaction. A wide use of OLC should reduce both direct and indirect costs of surgical treatment of gallstone disease.
Subject(s)
Humans , Male , Adult , Female , Cholecystectomy, Laparoscopic , Cholecystectomy, Laparoscopic , Cholelithiasis , Cholelithiasis/surgery , Chile , Ambulatory Surgical Procedures , Patient Selection , Length of StayABSTRACT
El propósito de este estudio fue estimar la carga de enfermedad de los accidentes de trabajo, utilizando como indicador los Años de Vida Ajustados por Discapacidad (AVISA). Este indicador adiciona la mortalidad con la discapacidad utilizando como unidad de medida los años. La población en estudio correspondió a 1.406843 trabajadores asegurados de la Asociación Chilena de Seguridad (ACHS) en el año 2000. Los accidentes analizados excluyen los accidentes de trayecto o aquellos que no producen ausentismo laboral. En el año en estudio se produjeron 110.073 accidentes de trabajo y 4.450 AVISA perdidos en la población en estudio. Por cada 100.000 trabajadores se perdieron 316 años de vida saludable. Los AVISA por accidentes, al igual que la mortalidad y la morbilidad son diferenciales por sexo y edad, es decir, predominan en los hombres y en los trabajadores jóvenes. La composición global de los AVISA se caracteriza por el franco predominio de los Años Perdidos por Muerte Prematura (AVPM), situación que presenta variaciones por sexo. En los hombres, más del 90 por ciento de los AVISA corresponden a AVPM, mientras que en las mujeres predominan los AVD. Las características señaladas muestran el impacto de las distintas características de los accidentes de trabajo por sexo. Las principales causas de AVISA correspondieron en orden decreciente a la Exposición a factores mecánicos, el Transporte y las Caídas. Entre las principales conclusiones del estudio destaca la necesidad de calcular en el área laboral indicadores que permitan comparar el estado de salud de los trabajadores con los del resto de la población, así como desarrollar fuentes de información de calidad. Finalmente se recomienda la realización de actividades de prevención focalizadas y de adecuado costo-efectividad
Subject(s)
Humans , Adult , Middle Aged , Accidents, Occupational , Occupational Diseases , Statistics on Sequelae and Disability , AbsenteeismABSTRACT
The utilization of Disability-Adjusted Life Years (DALYs), provides a comprehensive assessment of the health of the insured workers. We report here on the estimation of DALYs lost due to injuries in our insured population. The study population consisted of 1.406.843 insured workers of Asociación Chilena de Seguridad: 910.932 males and 495.902 females. There were 165.494 work related injuries with an overall annual incidence of 117.6 injuries per 1.00 workers. The age group that accounted for the highest injury rate in males was the 15-29 year old age group (104.2 per 1.000 workers). The main cuses of injuries in both sexes were Exposure to Inanimate Mechanical Forces (53.6 percent) and Falls (29.6 percent). 132 died in the study year from injuries sustained at work, an occupational fatal injury rate of 9.4 per 1000.000 (13.9 in males vs 1.0 in females). male workers had a workplace mortality rate 13.8 times the rate of female workers. In the year 2000, the 110.073 work-related injuries accounted by 4.450 Disability Adjusted Life years lost. This figure represents a loss of 316 DALY per 1000.000 workers: the DALY rate ratio of male to female was 8.5. There were 3.965 Years of Life Lost due to Premature Mortality in our insured population
Subject(s)
Humans , Adult , Middle Aged , Accidents, Occupational , Occupational Diseases , Statistics on Sequelae and Disability , AbsenteeismABSTRACT
Describe el trabajo de investigación realizado a través de la cuantificación durante seis meses de la generación de residuos en las instituciones de salud de Comodoro Rivadavia (Argentina). Resultando en 43 instituciones que el 94,5 de los residuos pueden devolverse al fabricante para su disposición recomendaciones de organismos internacionales esto es el 0,65 del total generado. Para evitar su disposición inadecuada se recomienda implementar sistemas de recuperación
Subject(s)
Hazardous Waste , Medical WasteABSTRACT
El documento describe el trabajo de investigación realizado a través de la cuantificación durante seis meses de la generación de residuos en la instituciones de salud de Comodoro Rivadavia (Argentina). Resultando en 43 instituciones que el 94,5 de los residuos pueden devolverse al fabricante para su disposición recomendaciones de organismos internacionales esto es el 0,65 del total generado. Para evitar su disposición inadecuada se recomienda implementar sistemas de recuperación
Subject(s)
Humans , Female , Aged , Osteomyelitis , Spine , Streptococcus pneumoniae , Low Back Pain/etiology , Osteomyelitis , Penicillins , Spine , Streptococcus pneumoniaeABSTRACT
Objetivo: determinar la prevalencia y severidad de fluorosis dental en dentadura permanente, atribuible a la ingestión de agua potable fluorada en combinación con otras vías (té y dentífricos), según nivel socioeconómico. Materiales y métodos: se efectuó un estudio transversal en individuos nacidos y con residencia permanente en Valparaíso, Chile, determinándose mediante una encuesta su nivel socioeconómico y su exposición a diferentes ingestas de flúor. Se obtuvo una muestra final de 400 individuos distribuidos aleatoriamente en 100 individuos de 7 a 8 años de nivel socioeconómico bajo y 100 de nivel socioeconómico medio, nacidos durante la fluoruración del agua potable, así como 100 individuos de 17 a 18 años de nivel socioeconómico bajo y 100 de nivel socioeconómico medio, nacidos antes de la fluoruración del agua. En ellos se detectó la prevalencia y severidad de fluorosis dental en las caras vestibulares de los incisivos superiores usando el índice de Dean y los criterios de Russell, para diferenciar las opacidades no causadas por fluoruros. Resultados: se encontró que en el grupo etario de 17 a 18 años un 10 por ciento de fluorosis dental, de los cuales el 5 por ciento presentó fluorosis muy leve, el 4 por ciento leve, el 1 por ciento moderada y un 0 por ciento en la categoría severa. En el grupo etario de 7 a 8 años se encontró un 52 por ciento de fluorosis dental, de los cuales el 35 por ciento presentó fluorosis muy leve, el 16 por ciento leve, el 1 por ciento moderada y un 0 por ciento severa. En ambos grupos etarios las diferencias fueron significativas, no así según el nivel socioeconómico. Conclusiones: el estudio reveló un aumento en la prevalencia de fluorosis dental, en el grupo etario que consumió agua potable fluorada, asociada a la ingesta sumativa de flúor por té y/o dentífricos, no existiendo diferencia significativa según nivel socioeconómico
Subject(s)
Humans , Male , Female , Adolescent , Fluorides/adverse effects , Fluorosis, Dental/epidemiology , Fluorosis, Dental/etiology , Fluoridation/adverse effects , Age Distribution , Control Groups , Cross-Sectional Studies , Dental Records , Dentifrices/adverse effects , Drinking Water , Epidemiology, Descriptive , Data Collection/methods , Simple Random Sampling , Social Class , Data Interpretation, StatisticalABSTRACT
Se presenta una serie de 32 casos de rupturas cerradas recientes del tendón de Aquiles atendidos personalmente por uno de los autores y tratados en forma incruenta con yeso en equino por ocho semanas. Los enfermos fueron controlados por un promedio de 692 días. Se produjieron cuatro casos de rerupturas, tres de los cuales fueron tratados nuevamente con yeso, obteniéndose cicatrización definitiva. El caso restante fue operado por otro cirujano. El resultado alejado de todos los enfermos fue satisfactorio, con recuperación del mismo nivel de actividades laborales y deportistas previo al accidente. Se recomienda el tratamiento incruento de las rupturas del tendón de aquiles, por ser un método de costo reducido, sencillo, y exento de complicaciones. En este caso de producirse una reruptura, no es necesario una intervención quirúrgica, ya que una nueva colocación de yeso por otras ocho semanas puede solucionar el problema
Subject(s)
Humans , Male , Adult , Middle Aged , Tendon Injuries , Immobilization , Rupture , Tendon InjuriesSubject(s)
Calcium-Transporting ATPases/antagonists & inhibitors , Calcium-Transporting ATPases/blood , Dinitrobenzenes/toxicity , Erythrocytes/enzymology , Herbicides/toxicity , Sulfanilamides , Trifluralin/toxicity , Calmodulin/blood , Erythrocyte Membrane/drug effects , Erythrocyte Membrane/enzymology , Erythrocytes/drug effects , Humans , In Vitro TechniquesABSTRACT
The effect of EGTA on Ca(2+)-ATPase activity was studied in fragmented membranes and solubilized preparations from human red cells. A dual action was found. At low concentrations (0.1-1 mM), EGTA increased Ca2+ affinity without affecting Vmax. By contrast, at high concentrations (5-10 mM), EGTA was inhibitory. Both effects were partially reversible.