Experiencia con colgajos libres en un centro médico colombiano de alta complejidad / Experience with free flaps in a highly complex Colombian medical center

Introducción y objetivo: La transferencia de tejido libre se ha convertido en una herramienta cada vez más importante en la Cirugía Plástica Re-constructiva. A pesar de las altas tasas de éxito reportadas en la literatura, el procedimiento puede fallar por variables ajenas a la técnica quirúrgica. Realizamos este estudio con el objetivo de conocer la frecuencia de complicaciones en un grupo de pacientes sometidos a transferencia de tejido libre en la Clínica Los Nogales en Bogotá, Colombia, así como determinar los factores ajenos a la técnica quirúrgica con el fin de proponer medidas que optimicen la probabilidad de éxito del procedimiento. Material y métodos: Estudio descriptivo, serie de casos, en el que analizamos retrospectivamente las historias clínicas de 40 pacientes sometidos a reconstrucción con colgajo libre durante los años 2017 a 2021. Evaluamos las variables preoperatorias, intraoperatorias y postoperatorias de cada uno de estos pacientes. Resultados: Los 40 casos de transferencia de tejido libre incluyeron 37 reconstrucciones (92.5%) secundarias a resección oncológica y 3 a trauma agudo (7.5%). El colgajo anterolateral de muslo (ALT) fue el colgajo libre realizado con mayor frecuencia (50%), seguido del colgajo de perforantes de la arteria epigástrica inferior profunda (DIEP) (22.5%), el colgajo libre de peroné (17.5%) y el colgajo radial (10%). El 15% de las reconstrucciones fueron fallidas: en el 10% de los casos por trombosis venosa y en el 5% de los casos por trombosis arterial de la anastomosis. La edad, la radioterapia y el nivel de hemoglobina preoperatoria parecen no afectar la supervivencia del colgajo. El tabaquismo fue determinante en la ocurrencia de complicaciones importantes del colgajo. Las complicaciones médicas postoperatorias ocurrieron en el 20% de los casos, predominando las cardíacas. (AU)

Background and objective: Free tissue transfer has become an increasingly important tool in Plastic Reconstructive Surgery. Despite the high success rates reported in the literature, the procedure can fail due to variables unrelated to the surgical technique. We carried out this study to know the frequency of complications in a group of patients undergoing free tissue transfer at the Clínica Los Nogales in Bogotá, Colombia, as well as determining factors unrelated to the surgical technique to propose measures that optimize the probability of success of the procedure. Methods: Descriptive case series study, in which we retrospectively analyzed the medical records of 40 patients undergoing free flap reconstruction between 2017 and 2021. We evaluated the preoperative, intraoperative, and postoperative variables of each of these patients. Results: The 40 cases of free tissue transfer included 37 reconstructions (92.5%) secondary to oncological resection and 3 to acute trauma (7.5%). The anterolateral thigh (ALT) flap was the most frequently performed free flap (50%), followed by the deep inferior epigastric artery perforator (DIEP) flap (22.5%), the fibular free flap (17.5%) and the radial flap (10%). Fifteen per cent of the reconstructions were unsuccessful: in 10% of cases due to venous thrombosis, and in 5% of cases due to arterial thrombosis of the anastomosis. Age, radiotherapy and preoperative hemoglobin level do not seem to affect flap survival. Smoking was a determining factor in the occurrence of important complications of the flap. Postoperative medical complications occurred in 20% of cases, predominantly cardiac complications. (AU)

Experiences of the COVID-19 pandemic among young parents with foster care backgrounds: A participatory action PhotoVoice study.

The COVID-19 pandemic has had a disproportionate impact on many vulnerable populations, including youth in foster care and parents of young children. In this study, we worked with nine parenting current and former foster youth to share their experiences of the COVID-19 pandemic through photography. Data were collected between January and March 2021 during a series of three virtual PhotoVoice sessions, then transcripts of PhotoVoice sessions and participant-selected captioned photographs were analyzed using thematic analysis. Themes in participants' photographs included 1) Pandemic Parenting and 2) Making the Best of It. Findings indicate the need to expand mental health services, protect essential workers, and ensure young parents receive support navigating medical and social welfare systems and the process of receiving pandemic relief-related benefits.

Potential Current and Future Distribution of the Long-Whiskered Owlet (Xenoglaux loweryi) in Amazonas and San Martin, NW Peru.

The IUCN has listed the long-whiskered owlet (Xenoglaux loweryi) as vulnerable due to the presence of few geographic records, its restricted range, and anthropogenic threats. Its natural history and ecology are largely unknown, and its distribution is widely debated; therefore, there is an urgent need for the real-time conservation of X. loweryi. In this study, 66 geo-referenced records of X. loweryi, 18 environmental variables, and the maximum entropy model (MaxEnt) have been used to predict the current and future (2050 and 2070) potential distribution of X. loweryi in the Amazonas and San Martin regions of northwestern Peru. In fact, under current conditions, areas of "high", "moderate", and "low" potential habitat suitability cover 0.16% (140.85 km2), 0.46% (416.88 km2), and 1.16% (1048.79 km2) of the study area, respectively. Moreover, under future conditions, the "high", "moderate", and "low" probability areas present profits and losses in terms of habitat suitability. Based on the environmental variables, this species mostly inhabits areas with a forest fraction with presence of trees with an emergent tree canopy of ~10-30 metres and depends on Yunga montane forest habitats with high humidity but it is not dependent on bare cover area, crops, or grasslands. Nevertheless, most of the current and future distribution areas are not part of the protected natural areas of Amazonas and San Martin. Additionally, the combination of climate change and anthropogenic activities contribute to further losses of this species habitat. Therefore, from the management point of view, corrective and preventive actions will help to preserve this species over time.

COVID-19 Vaccination Perspectives Among Young Parents with Foster Care Backgrounds.

The COVID-19 pandemic has brought unique stressors for youth in foster care and recent foster care alumni, particularly those who are also parenting young children. One way the pandemic can be mitigated is through vaccination of the general population. Yet, some young adults have been slow to choose to be vaccinated. As has been demonstrated, simple availability of the COVID-19 vaccine will not guarantee its uptake, especially among marginalized populations. In order to better understand the nuances of vaccination among youth in foster care and recent foster care alumni, we conducted in-depth, semi-structured focus groups and interviews with 23 parenting youth with foster care histories aged 18-26 years. Data regarding vaccine attitudes were analyzed using thematic analysis. Participating youth, who were majority Black, Indigenous, and people of color (BIPOC) and often lived in multigenerational households, had significant concerns about the COVID-19 vaccine. They expressed varying degrees of intention to get vaccinated. Young people, especially those who belong to marginalized populations, need opportunities to openly discuss their vaccination-related questions without judgment. Science communicators should consider these questions and address youths' concerns through diverse voices and channels to ensure youth have the information they need to make an informed decision regarding COVID-19 vaccination.

Experiences of young parents with foster care backgrounds during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has brought unique challenges to parents of young children, due to the closure of schools and childcare centers, and increased caregiver burden. These challenges may be especially pronounced for youth with foster care backgrounds, as they lack critical support and resources to rely on during emergency situations. OBJECTIVE: The purpose of the present study was to examine the experiences of these vulnerable young parents since the beginning of the pandemic. PARTICIPANTS AND SETTING: Our study included 17 young parents ages 18-26, who had recently aged out of foster care or were currently in extended care. Participants were predominantly female, and Black, Indigenous, or people of color (BIPOC). METHODS: Youth participated in virtual focus groups or individual interviews and described their experiences and challenges during the COVID-19 pandemic. A structured thematic analysis approach was employed to examine key themes in youths` accounts. RESULTS: Analysis resulted in five major themes: (a) employment disruptions and economic hardships, (b) educational challenges for parents and children, (c) parental and child mental health concerns, (d) insufficient resources and barriers to service receipt, and (e) "silver linings". CONCLUSIONS: Young parents with foster care backgrounds faced numerous challenges due to COVID-19 and struggled to access critical resources and supports. Implications for policy, practice, and research are discussed.

Diplomado para el perfeccionamiento de la formación estadística del licenciado en Sistemas de Información en Salud / Diploma for the improvement of the statistical training of the graduate in Health Information Systems

Fundamento: perfeccionar los conocimientos de estadística de los licenciados en Sistemas de Información en Salud, les permitirá responder en mayor medida con las exigencias requeridas en sus puestos laborales. Objetivo: diseñar un diplomado con contenidos de estadística aplicados a los sistemas de información en salud, para contribuir al mejor desempeño de los profesionales. Métodos: se realizó una investigación-desarrollo en la Facultad Enfermería-Tecnología de la Salud, de la Universidad de Ciencias Médicas de Santiago de Cuba, en el período 2018-2020. Se utilizaron métodos teóricos: analítico-sintético, inductivo-deductivo y sistémico-estructural; empíricos: revisión documental, entrevista a empleadores, además talleres de socialización y el criterio de especialistas para la valoración de la propuesta. Resultados: el diseño curricular del diplomado, derivado de una metodología de gestión curricular concebida, se destaca por la actualización y sistematicidad del sistema de conocimientos que posee, así como por el orden lógico en que aparecen sus cursos y entrenamientos, lo que contribuye a perfeccionar la formación estadística de los licenciados en Sistemas de Información en Salud. Los contenidos del diplomado diseñado resultan herramientas para lograr un mayor desempeño laboral, al obtener resultados mucho más confiables e importantes en el proceso de toma de decisiones. Conclusiones: Se diseño un diplomado con contenidos de estadística aplicados a los sistemas de información en salud. Fue valorado por los especialistas como pertinente, y su aplicación práctica permitirá lograr transformaciones en esta importante área del sector de la salud, de gran significación social.

Background: perfecting knowledge on statistics of the graduates in Health Information Systems will allow them to respond to a greater extent with the demands required in their jobs. Objective: to design a diploma course with statistical content applied to health information systems to contribute to the best performance of professionals. Methods: a research-development was carried out in the Faculty of Nursing-Health Technology, of Santiago de Cuba University of Medical Sciences, from 2018 to 2020. Theoretical methods were used: analytical-synthetic, inductive-deductive and systemic-structural; empirical ones: documentary review, interview with employers, in addition to socialization workshops and the criteria of specialists for the evaluation of the proposal. Results: the curricular design of the diploma course, derived from a conceived curricular management methodology, stands out for the updating and systematicity of the knowledge system it possesses, as well as for the logical order in which its courses and trainings appear, which contributes to perfect the statistical training of graduates in Health Information Systems. Conclusions: the contents of the designed diploma course were tools to achieve greater job performance, by obtaining much more reliable and important results in the decision-making process. It was valued by the specialists as pertinent to achieve transformations in this important area of ​​the health branch, of great social significance.

Giant Congenital Melanocytic Nevus in a Pediatric Patient: Case Report.

The giant congenital melanocytic nevus is a rare entity with an extremely low incidence that appears at the time of birth and generally involves the dermis but may also affect other skin layers. According to its clinical evolution, the probability of malignancy may vary, so proper follow-up is essential for potential management. There is no consensus in the literature about the greater benefit of surgical versus nonsurgical management. In this case report, we present the surgical management of a school-aged patient using dermal substitutes and skin grafts, subjectively obtaining an improvement in his quality of life.

Consumo de bebidas alcohólicas en adolescentes del área de salud América I del municipio de Contramaestre / Alcoholic drinks consumption in adolescents from America I health area in Contramaestre municipality

Se realizó un estudio descriptivo y transversal de 200 adolescentes de 10-19 años de edad, pertenecientes al área de salud América I del municipio de Contramaestre, provincia de Santiago de Cuba, desde enero hasta diciembre del 2016, a fin de caracterizar a quienes consumían bebidas alcohólicas. Resultaron bebedores 177 y el inicio de la ingestión fue más frecuente entre los 10-16 años de edad. Se evidenció un riesgo de consumo patológico en el sexo masculino. Los consumidores de riesgo, perjudiciales y dependientes alcohólicos manifestaron la necesidad de ingerir alcohol en las actividades, puesto que les producía efectos favorables; por tanto, se propuso fomentar la educación antialcohólica entre los integrantes de este grupo poblacional.

A descriptive and cross-sectional study of 200 adolescents with 10-19 years belonging to America I health area in Contramaestre municipality, Santiago de Cuba province was carried out from January to December, 2016, in order to characterize those who consumed alcoholic drinks. There were 177 drinkers and the beginning of consumption was more frequent between 10-16 years. A risk of pathological consumption was evidenced in the male sex. The harmful and alcoholic risk consumers, manifested the necessity to drink alcohol in the activities, since it produced them favorable effects; therefore, it was proposed to foment the antialcoholic education among the members of this populational group.

Metodología para la gestión curricular del posgrado en estadística para el licenciado en Sistemas de Información en Salud / Methodology for the posdegree curricular management in statistics for the Health Information System university graduate

Teniendo en cuenta la necesidad e importancia de la superación de posgrado de los licenciados en Sistema de Información en Salud, se elaboró una metodología con el objetivo de favorecer el diseño de las diversas modalidades de este tipo de superación, para perfeccionar la formación estadística de estos profesionales y potenciar su desempeño laboral. Esta tiene en cuenta los requerimientos estadísticos de sus puestos de trabajo y las insuficiencias que muestran en el empleo de métodos y técnicas afines(AU)

Taking into account the necessity and importance of the posdegree training of Health Information System university graduates, a methodology aimed at favoring the design of the diverse modalities of this type of training was elaborated, to perfect the statistical education of these professionals and promote their working performance. This methodology takes into consideration the statistical requirements of their jobs and the inadequacies that they show in the use of methods and similar techniques(AU)

Metodología para la gestión curricular del posgrado en estadística para el licenciado en Sistemas de Información en Salud / Methodology for the posdegree curricular management in statistics for the Health Information System university graduate

Teniendo en cuenta la necesidad e importancia de la superación de posgrado de los licenciados en Sistema de Información en Salud, se elaboró una metodología con el objetivo de favorecer el diseño de las diversas modalidades de este tipo de superación, para perfeccionar la formación estadística de estos profesionales y potenciar su desempeño laboral. Esta tiene en cuenta los requerimientos estadísticos de sus puestos de trabajo y las insuficiencias que muestran en el empleo de métodos y técnicas afines

Taking into account the necessity and importance of the posdegree training of Health Information System university graduates, a methodology aimed at favoring the design of the diverse modalities of this type of training was elaborated, to perfect the statistical education of these professionals and promote their working performance. This methodology takes into consideration the statistical requirements of their jobs and the inadequacies that they show in the use of methods and similar techniques

Factors Associated with Mortality in Patients with Autoimmune Diseases Admitted to the Intensive Care Unit in Bogota, Colombia.

Patients with autoimmune diseases (ADs) are a challenge for the intensivist; it is hard to differentiate among infection, disease activity, and combinations of both, leading to high mortality. This study is a retrospective analysis of 124 critically ill patients admitted to the intensive care unit (ICU) in a university hospital between 2008 and 2016. Bivariate case-control analysis was performed, using patients who died as cases; later, analysis using a logistic regression model with variables that were associated with mortality was conducted. Four variables were consistently associated with mortality in the logistic regression model and had adequate prediction value (Hosmer and Lemeshow statistic = 0.760; Nagelkerke R-squared = 0.494). The risk of death was found to be statistically associated with the following: shock at admission to ICU [odds ratio (OR): 7.56; 95% confidence interval (CI): 1.78-31.97, p = 0.006], hemoglobin level <8 g/dL (OR: 16.12; 95% CI: 3.35-77.52, p = 0.001), use of cytostatic agents prior to admission to the ICU (OR: 8.71; 95% CI: 1.23-61.5, p = 0.03), and low levels ofcomplement C3 (OR: 5.23; 95% CI: 1.28-21.35, p = 0.02). These variables can guide clinicians in the early identification of patients with AD with increased risk of death during hospitalization, leading to initial therapies seeking to improve survival. These results should be evaluated prospectively in future studies to establish their predictive power.

Descripción de los beneficios y limitaciones de la hidroterapia en los trastornos musculoesqueléticos / Description of the benefits and limitations of hydrotherapy in musculoskeletal disorders

La literatura en hidroterapia se encuentra limitada en descripciones claras sobre limitaciones y beneficios aplicados a diferentes condiciones; esta situación contribuye a que haya carencia de conocimiento verificable y comparable. Se propuso evaluar cualitativamente los beneficios y limitaciones de la hidroterapia aplicada específicamente a trastornos musculoesqueléticos; se revisaron y analizaron veinte estudios que hacen uso de esta terapia con dicho fin. Se encontró que el principal beneficio es la reducción del dolor y la técnica más eficaz es hidroterapia en piscina.

Tentativa de suicidio en la población mayor de 15 años durante el bienio 2011-2012 / Suicide attempts in the population older than 15 years during the biennium 2011-2012

Se realizó un estudio descriptivo, de corte retrospectivo y transversal, de 71 pacientes (de 15 años y más) con antecedentes de intento de suicidio, pertenecientes al área de salud del Policlínico Docente América 2 del municipio de Contramaestre en Santiago de Cuba, durante el bienio 2011-2012, con vistas a determinar el comportamiento de la tentativa de suicidio en ellos. En la casuística preponderó el sexo femenino, con más frecuencia en el 2011 del grupo etario de 15-19 años (16,5 %) y en el 2012 del grupo de 25-59 años (29,5 %); la procedencia fue mayormente urbana (53,5 %) y, como ocupación de los integrantes, predominaron los estudiantes en el 2011 (15,4 %) y los obreros en el 2012 (21,8 %). Asimismo, el método más empleado para intentar el acto fue la ingestión de psicofármacos, con superioridad en el sexo femenino (45,0 %) y el número de pacientes con intento de suicidio se incrementó en 5 en el 2012, lo cual representó 7,0 % más que el año precedente.

A descriptive, retrospective and cross-sectional study of 71 patients, (15 years and over) with a history of suicide attempt, belonging to the health area of América 2 Teaching Polyclinic from Contramaestre municipality in Santiago de Cuba was carried out during the biennium 2011-2012, aimed at determining the behavior of the suicide attempt in them. Female sex, with higher frequency in 2011 of the age group 15-19 (16.5%) prevailed in the case material, and in 2012 the age group 25-59 (29.5%); the origin was mostly urban (53.5%) and, as occupation, students prevailed in 2011 (15.4%) and workers in 2012 (21.8%). Also, the most used method for the attempt was the psychotropic drugs ingestion, predominantly in the female sex (45.0%) and the number of patients with suicide attempt increased in 5 by 2012, representing 7.0% over the previous year.

Tentativa de suicidio en la población mayor de 15 años durante el bienio 2011-2012 / Suicide attempts in the population older than 15 years during the biennium 2011-2012

Se realizó un estudio descriptivo, de corte retrospectivo y transversal, de 71 pacientes (de 15 años y más) con antecedentes de intento de suicidio, pertenecientes al área de salud del Policlínico Docente América 2 del municipio de Contramaestre en Santiago de Cuba, durante el bienio 2011-2012, con vistas a determinar el comportamiento de la tentativa de suicidio en ellos. En la casuística preponderó el sexo femenino, con más frecuencia en el 2011 del grupo etario de 15-19 años (16,5 por ciento) y en el 2012 del grupo de 25-59 años (29,5 por ciento); la procedencia fue mayormente urbana (53,5 por ciento) y, como ocupación de los integrantes, predominaron los estudiantes en el 2011 (15,4 por ciento) y los obreros en el 2012 (21,8 por ciento). Asimismo, el método más empleado para intentar el acto fue la ingestión de psicofármacos, con superioridad en el sexo femenino (45,0 por ciento) y el número de pacientes con intento de suicidio se incrementó en 5 en el 2012, lo cual representó 7,0 por ciento más que el año precedente

A descriptive, retrospective and cross-sectional study of 71 patients, (15 years and over) with a history of suicide attempt, belonging to the health area of América 2 Teaching Polyclinic from Contramaestre municipality in Santiago de Cuba was carried out during the biennium 2011-2012, aimed at determining the behavior of the suicide attempt in them. Female sex, with higher frequency in 2011 of the age group 15-19 (16.5 percent) prevailed in the case material, and in 2012 the age group 25-59 (29.5 percent); the origin was mostly urban (53.5 percent) and, as occupation, students prevailed in 2011 (15.4 percent) and workers in 2012 (21.8 percent). Also, the most used method for the attempt was the psychotropic drugs ingestion, predominantly in the female sex (45.0 percent) and the number of patients with suicide attempt increased in 5 by 2012, representing 7.0 percent over the previous year(AU)

Efectos de la complementación con heno-melaza-urea sobre parámetros productivos en cabras criollas a pastoreo / Effects of hay-molasses-urea complementation on productive parameters in grazing female native goats

Con el fin de evaluar el efecto de la complementación con heno-melaza-urea sobre la ganancia de peso, duración de lactancia y producción láctea en 31 cabras criollas, se realizó un ensayo en San José de los Ranchos, municipio Torres del estado Lara, Venezuela. Las cabras, con un peso vivo promedio de 28,87 ± 2 Kg., fueron sometidas a través de un diseño completamente aleatorizado a los siguientes tratamientos, To: Testigo (pastoreo y ramoneo de especies nativas exclusivamente); T1: To + heno (55,55%)-melaza (44,45%) y T2: To + heno (53,19%)-melaza (42,55%)-urea (4,26%), siendo complementados ambos grupos cuando los animales eran encorralados durante la noche. Se obtuvieron diferencias significativas (P<0,05), entre tratamientos, sobre la ganancia diaria de peso con medias de 91,61; 55,86 y 25,40 g para T2, T1 y To, respectivamente. La producción de leche y duración de la lactancia, no fueron estadísticamente diferentes (P>0,05), con medias de 16,30; 17,51 y 18,70 Kg./ semana y 9,00; 8,43 y 9,00 semanas para To, T1 y T2, respectivamente. Se puede concluir que la complementación con heno-melaza-urea constituye una fuente nutricional potencial para recuperar la condición corporal de cabras criollas lactantes, manejadas en condiciones extensivas similares a las descritas en este ensayo.

In order to evaluate complementation effects of hay-molasses-urea on average daily gain, lactation length and lactation yield with 31 native goats, a trial was carried out in San Jose de los Ranchos, Torres Municipality, Lara State, Venezuela. Goats with average weight of 28.87 ± 2 kg, were submitted to a completely random design to To: Control (grazing and browsing only); T1: To + hay (55.55%), molasses (44.45%) and T2: To + hay (53.19%), molasses (42.55%), urea (4.26%), being complemented both groups when animals were gathered during night time. There was significant differences (P<0.05) on average daily gain with means of 91.61, 55.86 and 25.40 g for T2, T1 and To, respectively. Milk yield and lactation length were no statistically different (P>0.05), with means of 16.30, 17.51 and 18.70 kg/week and 9.0, 8.43 and 9.0 weeks for To, T1 and T2, respectively. So, it can be pointed out that hay-molasses-urea complementation, constitutes a potential nutritional source to recuperate body condition of lactating native goats raised under extensive conditions similar to those described in this trial.

Efecto del aplazamiento de utilización sobre el contenido de nutrientes y digestibilidad de la matería orgánica de la asociación buffel-leucaena / Effect of deferment of utilization on the nutrient content and organic matter digestibility of buffel-leucaena association

En una región semiárida del Estado Zulia, Venezuela (10°32'N, 71°42'0), con 600mm de precipitación promedio anual y suelos de textura franco-arenosa, pH 5,5 con valores de Ca, Mg, Na, K y P de 0,6; 0,3; 0,1 y 0,17 mg/100 g de suelo y 6 ppm, respectivamente, se estudió el efecto de cuatro edades de utilización (42,84,126, y 168 días) sobre el contenido de proteína cruda (PC), digestibilidad in vitro de la matería orgánica (DIVMO) y minerales de una asociación buffel (Cenchrus ciliaris)-leucaena (Leucaena leucocephala). Muestras compuestas de hojas y tallos para buffel y fracción fina (pinna, pecíolos y tallos <5mm de diámetro) en leucaena se analizaron para DIVMO y contenido de PC, Ca, P, Mg, K y Na. El diseño experimental usado fue de bloques al azar con tres repeticiones. En buffel, PC (8,66 por ciento) y K (3,65 por ciento) resultaron adecuados para rumiantes a pastoreo, mientras que Ca, P, Mg, y Na fueron deficientes. En leucaena, PC, Ca, Mg, y K resultaron adecuados, mientras el P y Na estuvieron por debajo del nivel crítico de deficiencia. Solo el Na incrementó (P<0,05) con el aumento de la madurez.