Impacts of COVID-19 on clinical indicators and mortality in patients with chronic conditions in Catalonia, Spain: A retrospective population-based cohort study.

Background: The reallocation of health care services during the coronavirus disease 2019 (COVID-19) pandemic disrupted the continuity of primary care. This study examines the repercussions of the COVID-19 pandemic on clinical indicators within the Catalan population, emphasising individuals with chronic conditions. It provides insights into mortality and transfer rates considering intersectional perspectives. Methods: We designed a retrospective, observational population-based cohort study based on routinely collected data from January 2015 to June 2021 for all individuals available in the Information System for Research in Primary Care (Sistema d'Informació per al Desenvolupament de la Investigació en Atenció Primària (SIDIAP)), the largest public primary care database in Catalonia, Spain. We included 6 301 095 individuals, constituting 81.6% of Catalonia's population in 2020. To perform a repeated measurements analysis of the indicators, we focussed on individuals who had one or more indicators in both the pre-pandemic (January 2015 to March 2020) and pandemic periods (March 2020 to June 2021), and those diagnosed with type 2 diabetes mellitus (T2D), high blood pressure, and heart failure. We selected key clinical indicators for analysis, including systolic and diastolic blood pressure, body mass index (BMI), cholesterol (total, high, and low-density lipoprotein), triglycerides, glycosylated haemoglobin, the Barthel index, and cardiovascular risk (Registre Gironí del cor (REGICOR) index). Results: Mortality and transfer rates increased during the pandemic, contributing to a decline in the active population in the public health system. We also observed a reduction in pandemic period prevalence of patients with chronic conditions: -26.7% for heart failure, -15.1% for high blood pressure, and -14.6% for T2D. In both pre-pandemic and pandemic periods, 1 632 013 subjects had at least one clinical indicator record. Clinical indicators worsened in patients diagnosed with chronic conditions during the pandemic. Most indicators worsened, with differences between men and women (+9.4% vs +3.7% for the REGICOR index and -14.1% vs -16.6% for the Barthel index in men and in women, respectively), and to a similar extent (or greater in some cases) in individuals without these conditions. Conclusions: We used longitudinal data to assess the repercussions of the COVID-19 pandemic on population health while considering a wide range of clinical indicators and socioeconomic determinants. Our analysis shows a deterioration in clinical indicators during the pandemic, particularly in cardiometabolic factors, underscoring the importance of continuous primary care for individuals with chronic conditions.

O Impacto da COVID-19 no Diagnóstico de Doenças Cardíacas na América Latina Uma Subanálise do INCAPS COVID / The Impact of COVID-19 on Diagnosis of Heart Disease in Latin America an INCAPS COVID Sub-analysis

Resumo Fundamento A pandemia de COVID-19 interferiu na prestação de atendimento a doenças cardiovasculares na América Latina. No entanto, o efeito da pandemia nos volumes de procedimentos cardíacos diagnósticos ainda não foi quantificado. Objetivo Avaliar (1) o impacto de COVID-19 nos volumes de diagnóstico cardíaco na América Latina e (2) determinar sua relação com a incidência de casos de COVID-19 e as medidas de distanciamento social. Métodos A International Atomic Energy Agency realizou uma pesquisa mundial avaliando mudanças nos volumes diagnósticos cardíacos decorrentes da COVID-19. Foram obtidos os volumes diagnósticos cardíacos dos locais participantes para março e abril de 2020 e comparados com março de 2019. Foram coletados dados de distanciamento social a partir dos Relatórios de mobilidade da comunidade de Google e a incidência de COVID-19 por país a partir de Our World in Data. Resultados Foram realizadas pesquisas em 194 centros que realizam procedimentos diagnósticos cardíacos, em 19 países da América Latina. Em comparação com o mês de março de 2019, os volumes dos procedimentos diagnósticos cardíacos diminuíram 36% em março de 2020 e 82% em abril de 2020.As maiores reduções ocorreram em relação aos testes de estresse ecocardiográfico (91%), testes ergométricos de esteira (88%) e escore de cálcio por tomografia computadorizada (87%), com pequenas variações entre as sub-regiões da América Latina. As mudanças em padrões de distanciamento social (p < 0,001) estavam mais fortemente associadas com a redução do volume do que a incidência de COVID-19 (p = 0,003). Conclusões A COVID-19 foi associada a uma redução significativa de procedimentos diagnósticos cardíacos na América Latina, a qual foi mais relacionada ao distanciamento social do que ao aumento da incidência da COVID-19. São necessários melhor equilíbrio e timing de medidas de distanciamento social e planejamento para manter o acesso ao atendimento médico durante um surto pandêmico, especialmente em regiões com alta mortalidade cardiovascular.

Abstract Background The COVID-19 pandemic has disrupted the delivery of care for cardiovascular diseases in Latin America. However, the effect of the pandemic on the cardiac diagnostic procedure volumes has not been quantified. Objective To assess (1) the impact of COVID-19 on cardiac diagnostic volumes in Latin America and (2) determine its relationship with COVID-19 case incidence and social distancing measures. Methods The International Atomic Energy Agency conducted a worldwide survey assessing changes in cardiac diagnostic volumes resulting from COVID-19. Cardiac diagnostic volumes were obtained from participating sites for March and April 2020 and compared to March 2019. Social distancing data were collected from Google COVID-19 community mobility reports and COVID-19 incidence per country from the Our World in Data. Results Surveys were conducted in 194 centers performing cardiac diagnostic procedures, in 19 countries in Latin America. Procedure volumes decreased 36% from March 2019 to March 2020, and 82% from March 2019 to April 2020. The greatest decreases occurred in echocardiogram stress tests (91%), exercise treadmill tests (88%), and computed tomography calcium scores (87%), with slight variations between sub-regions of Latin America. Changes in social distancing patterns (p < 0.001) were more strongly associated with volume reduction than COVID-19 incidence (p = 0.003). Conclusions COVID-19 was associated with a significant reduction in cardiac diagnostic procedures in Latin America, which was more related to social distancing than to the COVID-19 incidence. Better balance and timing of social distancing measures and planning to maintain access to medical care is warranted during a pandemic surge, especially in regions with high cardiovascular mortality.

The Impact of COVID-19 on Diagnosis of Heart Disease in Latin America an INCAPS COVID Sub-analysis. / O Impacto da COVID-19 no Diagnóstico de Doenças Cardíacas na América Latina Uma Subanálise do INCAPS COVID.

BACKGROUND: The COVID-19 pandemic has disrupted the delivery of care for cardiovascular diseases in Latin America. However, the effect of the pandemic on the cardiac diagnostic procedure volumes has not been quantified. OBJECTIVE: To assess (1) the impact of COVID-19 on cardiac diagnostic volumes in Latin America and (2) determine its relationship with COVID-19 case incidence and social distancing measures. METHODS: The International Atomic Energy Agency conducted a worldwide survey assessing changes in cardiac diagnostic volumes resulting from COVID-19. Cardiac diagnostic volumes were obtained from participating sites for March and April 2020 and compared to March 2019. Social distancing data were collected from Google COVID-19 community mobility reports and COVID-19 incidence per country from the Our World in Data. RESULTS: Surveys were conducted in 194 centers performing cardiac diagnostic procedures, in 19 countries in Latin America. Procedure volumes decreased 36% from March 2019 to March 2020, and 82% from March 2019 to April 2020. The greatest decreases occurred in echocardiogram stress tests (91%), exercise treadmill tests (88%), and computed tomography calcium scores (87%), with slight variations between sub-regions of Latin America. Changes in social distancing patterns (p < 0.001) were more strongly associated with volume reduction than COVID-19 incidence (p = 0.003). CONCLUSIONS: COVID-19 was associated with a significant reduction in cardiac diagnostic procedures in Latin America, which was more related to social distancing than to the COVID-19 incidence. Better balance and timing of social distancing measures and planning to maintain access to medical care is warranted during a pandemic surge, especially in regions with high cardiovascular mortality.

FUNDAMENTO: A pandemia de COVID-19 interferiu na prestação de atendimento a doenças cardiovasculares na América Latina. No entanto, o efeito da pandemia nos volumes de procedimentos cardíacos diagnósticos ainda não foi quantificado. OBJETIVO: Avaliar (1) o impacto de COVID-19 nos volumes de diagnóstico cardíaco na América Latina e (2) determinar sua relação com a incidência de casos de COVID-19 e as medidas de distanciamento social. MÉTODOS: A International Atomic Energy Agency realizou uma pesquisa mundial avaliando mudanças nos volumes diagnósticos cardíacos decorrentes da COVID-19. Foram obtidos os volumes diagnósticos cardíacos dos locais participantes para março e abril de 2020 e comparados com março de 2019. Foram coletados dados de distanciamento social a partir dos Relatórios de mobilidade da comunidade de Google e a incidência de COVID-19 por país a partir de Our World in Data. RESULTADOS: Foram realizadas pesquisas em 194 centros que realizam procedimentos diagnósticos cardíacos, em 19 países da América Latina. Em comparação com o mês de março de 2019, os volumes dos procedimentos diagnósticos cardíacos diminuíram 36% em março de 2020 e 82% em abril de 2020.As maiores reduções ocorreram em relação aos testes de estresse ecocardiográfico (91%), testes ergométricos de esteira (88%) e escore de cálcio por tomografia computadorizada (87%), com pequenas variações entre as sub-regiões da América Latina. As mudanças em padrões de distanciamento social (p < 0,001) estavam mais fortemente associadas com a redução do volume do que a incidência de COVID-19 (p = 0,003). CONCLUSÕES: A COVID-19 foi associada a uma redução significativa de procedimentos diagnósticos cardíacos na América Latina, a qual foi mais relacionada ao distanciamento social do que ao aumento da incidência da COVID-19. São necessários melhor equilíbrio e timing de medidas de distanciamento social e planejamento para manter o acesso ao atendimento médico durante um surto pandêmico, especialmente em regiões com alta mortalidade cardiovascular.

Suicide: Genetics and Heritability.

Nature vs nurture is, and has been, a never stopping debate since Lamarck and Darwin exposed their corresponding theories on evolution, and even before them, such discussion already existed. Is suicide a heritable conduct? Is it learnt? Maybe the answer is both and none, at the same time. From genetic twin studies to epigenetic and environmental influence on development, this chapter aims to take a look at different points of view and most relevant theories in one of the worlds leading causes of death, specially for young individuals. We explore different studies aiming to find biomarkers for suicide, as well as other traits frequently encountered in individuals who engage in suicidal behavior, such as impulsivity, aggressivity, and hopelessness. Finally, this chapter also looks at some of the most recent approaches in treatment and prevention of suicidal behavior, in order to highlight what they have in common and try to explain (at least partially) why they could be effective.

[Disseminated tuberculosis in a patient with overlap syndrome, challenges in preventing]. / Tuberculosis diseminada en una paciente con síndrome de sobreposición, retos en la prevención.

Patients with autoimmune rheumatic diseases are at increased risk for developing infections and these are associated with increased morbidity and mortality from these diseases, especially in patients with systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis and autoimmune inflammatory myopathies. The objective of this paper is to address the challenges in detecting latent tuberculosis in immunosuppressed patients and the initiation of prophylactic treatment because currently there are no well-defined guidelines indicating what action to take for detection and treatment; so far the available scientific evidence is scarce and some methodological shortcomings.

Los pacientes con enfermedades reumáticas autoinmunes tienen un elevado riesgo para el desarrollo de infecciones, y estas se asocian al incremento de la morbimortalidad de estas enfermedades, principalmente en pacientes con lupus eritematoso sistémico, artritis reumatoide, esclerosis sistémica y con miopatías inflamatorias autoinmunes. El objetivo de este trabajo es abordar los retos en la detección de tuberculosis latente en pacientes inmunosuprimidos y el inicio del tratamiento profiláctico ya que en la actualidad no existen lineamientos bien definidos que indiquen la conducta a seguir para su detección y tratamiento; por el momento la evidencia científica disponible es escasa y con algunas deficiencias metodológicas.

Overexpression of Glutamate Decarboxylase in Mesenchymal Stem Cells Enhances Their Immunosuppressive Properties and Increases GABA and Nitric Oxide Levels.

The neurotransmitter GABA has been recently identified as a potent immunosuppressive agent that targets both innate and adaptive immune systems and prevents disease progression of several autoimmunity models. Mesenchymal stem cells (MSCs) are self-renewing progenitor cells that differentiate into various cell types under specific conditions, including neurons. In addition, MSC possess strong immunosuppressive capabilities. Upon cytokine priming, undifferentiated MSC suppress T-cell proliferation via cell-to-cell contact mechanisms and the secretion of soluble factors like nitric oxide, prostaglandin E2 and IDO. Although MSC and MSC-derived neuron-like cells express some GABAergic markers in vitro, the role for GABAergic signaling in MSC-mediated immunosuppression remains completely unexplored. Here, we demonstrate that pro-inflammatory cytokines selectively regulate GAD-67 expression in murine bone marrow-MSC. However, expression of GAD-65 is required for maximal GABA release by MSC. Gain of function experiments using GAD-67 and GAD-65 co-expression demonstrates that GAD increases immunosuppressive function in the absence of pro-inflammatory licensing. Moreover, GAD expression in MSC evokes an increase in both GABA and NO levels in the supernatants of co-cultured MSC with activated splenocytes. Notably, the increase in NO levels by GAD expression was not observed in cultures of isolated MSC expressing GAD, suggesting crosstalk between these two pathways in the setting of immunosuppression. These results indicate that GAD expression increases MSC-mediated immunosuppression via secretion of immunosuppressive agents. Our findings may help reconsider GABAergic activation in MSC for immunological disorders.

Off-pump bidirectional Glenn through right anterior thoracotomy / Glenn bidirecional sem uso de CEC via toracotomia anterior direita

AbstractThe Glenn operation involving anastomosis of the superior vena cava to the pulmonary artery has been performed for palliative operations of many cyanotic congenital heart diseases in addition to the single ventricle since the 1960s. The classic procedure is done via median sternotomy and cardiopulmonary bypass. The benefits of this procedure without the use of cardiopulmonary bypass remain mixed within reported series. Cases using this approach and off-pump technique together in Latin-America have not yet been reported in the scientific literature.

ResumoA operação de Glenn envolvendo anastomose da veia cava superior à artéria pulmonar foi realizada como procedimento paliativo de muitas doenças cardíacas congênitas cianóticas, além do ventrículo único desde os anos 1960. O procedimento clássico é feito por esternotomia mediana e circulação extracorpórea. Os benefícios deste procedimento sem o uso de circulação extracorpórea permanecem incertos dentro da série relatada. Casos utilizando conjuntamente esta abordagem e a técnica sem circulação extracorpórea na América Latina ainda não foram relatados na literatura científica.

Off-pump bidirectional Glenn through right anterior thoracotomy.

The Glenn operation involving anastomosis of the superior vena cava to the pulmonary artery has been performed for palliative operations of many cyanotic congenital heart diseases in addition to the single ventricle since the 1960s. The classic procedure is done via median sternotomy and cardiopulmonary bypass. The benefits of this procedure without the use of cardiopulmonary bypass remain mixed within reported series. Cases using this approach and off-pump technique together in Latin-America have not yet been reported in the scientific literature.

Abscesso do espaço perigoso do pescoço e complicação com mediastinite em escolar / Abscess of dangerous space of neck and complications with mediastinitis in student

É relatado um caso de escolar com abscesso de espaço perigoso de pescoço, provavelmente oriundo de uma sinusite inicial, com complicação posterior à mediastinite. Através de drenagem cirúrgica e antibioticoterapia de amplo espectro instituídas precocemente, evitou-se um desfecho fatal, apesar do índice de mortalidade nesses casos chegar até 50% dos casos em alguns serviços.

It is reported a case with school abscess neck dangerous space, probably originating from an initial sinusitis with subsequent complication to mediastinitis. By surgical drainage and antibiotics broad spectrum started early, avoided a fatal outcome, although the mortality rate in these cases reach 50% of cases in some services.

Pré-escolar grande queimado com evolução fatal por sepse pós infecção por cateter / Preschool big burned with fatal developments in sepsis after infection catheter

É apresentado relato de caso de uma pré-escolar grande queimada encaminhada a um serviço hospitalar de referência, a qual evoluiu com óbito devido à sepse subsequente à infecção de cateter, a despeito da utilização de terapia antimicrobiana guiada por antibiograma. O objetivo desse estudo é alertar a equipe pediátrica quanto às particularidades da criança grande queimada, principalmente quando em vigência de infecção, e levantar discussões quanto ao uso precoce, mas não profilático, de antibióticos.

It is presented a case report of a major burn in a preschool referred to a hospital service reference, which evolved to death due to subsequent sepsis infection catheter, despite the use of antimicrobial therapy guided by antibiogram. The aim of this study is to alert the pediatric team and the particularities of major burned kid, especially when in presence of infection, and raise discussions on the early use, but not prophylactic, antibiotics.

Perfil das mães e dos recém-nascidos e planejamento familiar / Profile of mothers and newborns and family planning

Examinar fatores relacionados ao planejamento da gestação e suas complicações em relação ao bem estar materno e fetal, comparando-se com grupo de mães que não planejaram sua gravidez. Estudo prospectivo avaliou 1001 gestantes em duas maternidades em Curitiba, sendo que uma atende gestantes pelo sistema único de saúde e a outra atente convênios e particulares, no segundo semestre de 2008. As gestantes foram separadas em 2 grupos: grupo das que planejaram a gestação e o grupo das que não planejaram a gestação e avaliado o perfil das mães e dos recém-nascidos entre os dois grupos, abrangendo: idade, condições socioeconômicas, pré-natal, peso, idade gestacional, tempo de internamento e outras intercorrências materno-fetais. Gravidez na adolescência, excesso de peso durante a gestação, número maior de prematuridade, maior desnutrição intrauterina, tempo de internamento alongado, pré-natal inadequado e falta do uso de ácido fólico foram os principais desvios observados entre os grupos de mães que não fizeram seu planejamento de sua gravidez em relação às gestantes que optaram pelo planejamento.

Examine factors related to the planning of pregnancy and its complications in relation to maternal and fetal well-being, compared to group of mothers who do not plan their pregnancy. Prospective study evaluated 1001 pregnant women at two hospitals in Curitiba, where a pregnant meets the unified health system and other private arrangements and look in the second half of 2008. Pregnant women were separated into 2 groups: the group that planned the pregnancy and that the group do not plan the pregnancy and assessed the profile of mothers and newborns between the two groups, including age, socioeconomic conditions, pre-natal care, weight, gestational age, length of hospitalization and other maternal-fetal complications. Pregnancy in adolescence, excess weight during pregnancy, higher number of prematurity, increased intrauterine malnutrition, length of stay lengthened, inadequate pre-natal care and lack of use of folic acid were the main deviations observed among groups of mothers who do not did their planning of their pregnancy in relation to women who have opted for planning.

Mycobacteria entry and trafficking into endothelial cells.

Endothelial cells are susceptible to infection by mycobacteria, but the endocytic mechanisms that mycobacteria exploit to enter host cells and their mechanisms of intracellular transport are completely unknown. Using pharmacological inhibitors, we determined that the internalization of Mycobacterium tuberculosis (MTB), Mycobacterium smegmatis (MSM), and Mycobacterium abscessus (MAB) is dependent on the cytoskeleton and is differentially inhibited by cytochalasin D, nocodazole, cycloheximide, wortmannin, and amiloride. Using confocal microscopy, we investigated their endosomal trafficking by analyzing Rab5, Rab7, LAMP-1, and cathepsin D. Our results suggest that MSM exploits macropinocytosis to enter endothelial cells and that the vacuoles containing these bacteria fuse with lysosomes. Conversely, the entry of MTB seems to depend on more than one endocytic route, and the observation that only a subset of the intracellular bacilli was associated with phagolysosomes suggests that these bacteria are able to inhibit endosomal maturation to persist intracellularly. The route of entry for MAB depends mainly on microtubules, which suggests that MAB uses a different trafficking pathway. However, MAB is also able to inhibit endosomal maturation and can replicate intracellularly. Together, these findings provide the first evidence that mycobacteria modulate proteins of host endothelial cells to enter and persist within these cells.

La sangre de cerdo y de vaca como substitutos de la sangre de oveja o de caballo en medios de cultivo para campylobacters termotolerantes / The pig's blood and cow's blood substitutes sheep or horse culture media for thermotolerant campylobacters

En la ciudad de Iquitos (ubicada en la Amazonía peruana), la sangre de oveja y de caballo, uno de los suplementos recomendados para los medios de cultivo de campylobacters termotolerantes, no son tan disponibles como la sangre de cerdo y de vaca. Por ello, se estudió la capacidad de crecimiento de 60 cepas de Campylobacter termotolerantes (37 C. jejuni y 23 C. coli), usando sangre de vaca y de cerdo como potenciales substitutos de la sangre de oveja o de caballo. Estas cepas fueron aisladas de vacas, cerdos, pollos y patos (15 cepas de cada tipo de animal). Recuentos viables fueron realizados empleando el método de Miles y Misra, modificado. Las cepas de Campylobacter mostraron mayor crecimiento en presencia de sangre de cerdo o de oveja que con sangre de vaca; por lo que se sugiere el uso de sangre de cerdo como un suplemento de los medios de cultivo para Campylobacter, cuando no existe disponibilidad de sangre de oveja o de caballo.

In Iquitos (capital city of the Peruvian Amazon), sheep and horse blood, one of the recommended supplements for thermo tolerant campylobacters in growing environments, are difficult to obtain in comparison to pig and cow blood. Therefore, the growing capacity of 60 thermo tolerant Campylobacter strains (37 C. jejuni and 23 C. coli) using cow and pig blood as potential substitutes for sheep or horse blood, was studied. The strains were isolated from cows, pigs, chickens and ducks (15 strains of each animal). Accountable measure were used applying a modified Miles and Misra method. Compylobacter strains showed better growth in presence of pig or sheep blood in comparison with cow blood, so, we suggest the use of pig blood as a supplemet in the Campylobacter growing environment, when there is no availability of sheep or horse blood.

Dentofacial features of Class II malocclusion associated with maxillary skeletal protrusion: a longitudinal study at the circumpubertal growth period.

INTRODUCTION: The purpose of this study was to describe the craniofacial growth changes of subjects with Class II malocclusion associated with maxillary skeletal protrusion at the circumpubertal growth period. METHODS: The records of 25 untreated subjects with normal Class I occlusion and 25 untreated Class II subjects (14 boys and 11 girls in each group) were selected from the longitudinal records of the University of Michigan Growth Study. All Class II subjects had maxillary protrusion. Measurements were made on lateral and posteroanterior cephalograms and on dental casts at 2 times. The first observation (T1) was during the prepubertal growth phase (vertebral stages CS1 to CS3). The second observation (T2) was during the postpubertal phase of growth (vertebral stages CS4 to CS6). The following comparisons were made: Class I vs Class II at T1, Class I vs Class II at T2, and growth changes in Class I vs Class II. RESULTS: No dentofacial feature studied showed any statistically significant difference when comparing the growth changes between the Class II and the Class I groups. CONCLUSIONS: These results suggest that dentofacial features of Class II malocclusion associated with maxillary skeletal protrusion are maintained during the circumpubertal period, and that growth changes in this type of Class II disharmony are similar to those in subjects with normal occlusion.

Avaliação da capacidade de infiltração de solos submetidos a diferentes tipos de manejo / Evaluation of the infiltration capacity of soils under ferent types of management

O manejo inadequado da vegetação e do solo leva a mudanças físicas que afetam a recarga de aquíferos. A Chapada do Araripe possui centenas de fontes que jorram na encosta; porém, há indícios de redução de vazões. Neste trabalho foi estudada a capacidade de infiltração de solos submetidos a diferentes tipos de manejo florestal na Chapada. Amostras de solos de 21 localidades foram ordenadas em quatro grupos. O Grupo 1, de áreas de vegetação preservada e os demais de áreas antropizadas. Observou-se que a umidade e capacidade de infiltração apresentaram boa correlação linear com a matéria orgânica; a umidade média do Grupo 1, no período seco, foi superior à dos demais grupos mesmo no período chuvoso; as áreas antropizadas apresentaram baixo conteúdo de matéria orgânica, umidade e baixa capacidade de infiltração, indicando modificação na estrutura do solo capaz de reduzir a recarga.

Inadequate vegetation and soil management leads to physical changes that affect aquifer recharge. The Araripe Plateau feeds an elevated number of springs on its northern slope; however, there are indications that their yield is decreasing. Through this research, it was studied the infiltration capacity of soils under different types of management. Soil samples from 21 sites were grouped into four groups. Group 1 represents areas of preserved vegetation, the others, anthropized ones. It was observed that soil moisture and infiltration capacity are linearly well correlated with organic matter; mean soil moisture during the dry season was significantly higher for Group 1 than for the other groups, even during the rainy season and anthropized areas show low organic matter contents, soil moisture, and infiltration capacity, indicating modifications in the soil's structure that reduce aquifer recharge.

Manual para implementar ambientes libres de humo de tabaco / Es

La implementación de ambientes libres de humo de tabaco es la medida más eficaz que existe para disminuir el consumo de tabaco y para prevenir sus consecuencias

Técnica de colocación de un sling sub-uretral a través de los agujeros obturatrices (TOT) / Technique of placing a sub-urethral sling through the obturator hole (TOT)

Esta es una evaluación preliminar y descripción de la curva de aprendizaje acerca de la técnica del Transobturatriz Tape (TOT) que está actualmente en boga por su simpleza y mínima presentación de complicaciones desde que en el año 2001 el Dr. Delome la describió en Francia. Esta técnica ha sido realizada por diez colegas que trabajamos en el Dpto. de Ginecología y Obstetricia del Hospital nacional Arzobispo Loayza (HNLA); la iniciamos el 19 de mayo del 2006 y hasta el mes de diciembre lo hemos realizado en 52 pacientes que aceptaron voluntariamente el procedimiento. Como sling usamos la malla de Marlex la cual la recortamos y le dimos forma según lo descrito en el desarrollo del trabajo, ésta fue colocado con la aguja de Emmet a través del agujero obturatriz. La indicación principal es la IUE, el promedio de edad fue de 58 años. El tiempo promedio del procedimiento en sí fue de 29 minutos; las complicaciones fueron: retención urinaria luego del retiro de sonda en cuatro pacientes (una de ellas se le tuvo que reinstalar dos veces hematoma en la zona obturatriz izquierda en una paciente, ITU en tres pacientes, dehiscencia de sutura de la colpo anterior en una paciente, presencia de granuloma ingenuo-perineal izquierdo por reacción a la malla en una paciente. Existieron otras complicaciones como hematoma e infección de cúpula, encefalopatía hepática, etc. Pero no eran complicaciones inherentes a la técnica. En conclusión consideramos que la técnica realmente es sencilla con el instrumental utilizado, permite que la sonsa está solo por la paciente, cura la incontinencia urinaria de esfuerzo, y el hecho de usar la malla de Marlex abarata muchísimo los costos. Las complicaciones que hemos tenido disminuirán con el uso consuetudinario del procedimiento hasta llegar a cifras mínimas.

This is a preliminary assessment and a description of the learning curve concerning the Transobturatriz Tape Technique (TOT) which is presently being used due to its simplicity and minimum presentation of complications since it was described in 2001 by Dr. Delome in France. This technique has been carried out by ten colleagues who work in the Gynecological-Obstetric Department at the Hospital Nacional Arzobispo Loayza, having started the study in May 2006. Up to December of the same year they had already operated 52 patients who voluntarily accepted the mentioned procedure. As sling, the Marlex net was used, cut and shape according to the development of the work described. The net was placed with the Emmet Needle through the obsturatriz hole. The principal indication is the true urinary incontinence, and the average age was 58 years old. The average time for the procedure was 29 minutes and the complications presented were: urinary retention in four patients, one of them has his tube reinstaller twice, hematoma in the left obsturatriz zone, urinary infection tract in three patients, suture dehiscence of the anterior vaginal wall, left granuloma inguino-perineal by Marlex reaction. There were other complications, such as hematoma and dome infection, hepatic encephalopathy, etc. However, these complications were not inherent to the technique. Finally it was concluded that the technique is simple with the surgical instrument employed and it only heed the tube to be put just for a few hours, which reduce the discomfort and post-surgical complications and heals the U.I. Besides, using the Marlex net reduced the costs and the complication presented will gradually be decreased with the use of this technique until they reach their minimum level.

Hidatidosis abdominal de localización extrahepática: características clínica y evolución de una serie de casos / Abdominal extrahepatic echinococcosis: clinical characteristics and evolution

La hidatidosis es una zoonosis endémica en nuestro país, especialmente en la IX región de Chile, donde la alta prevalencia de la enfermedad permite observar hidatidosis en localizaciones poco habituales como bazo, páncreas y peritoneo. El objetivo de este trabajo es describir las características clínicas y evolución de una serie de pacientes con hidatidosis abdominal extra-hepática atendidos en nuestro Hospital. Se desarrollo un registro y análisis de datos: edad, sexo, procedencia, antecedentes quirúrgicos, estudios de laboratorio y de imágenes, hallazgos quirúrgicos y seguimiento. La serie de pacientes se conformó por 38 pacientes, 19 hombres y 19 mujeres, con un promedio de edad de 43,9 años (20 a 80 años). El 31,6 por ciento de los pacientes tenía antecedente de cirugía previa de quiste hidatídico. El laboratorio general fue inespecífico. En el 92,1 por ciento de los casos, la ecotomografía permitió constatar quistes de patrón ecolúcido. El diámetro promedio de las lesiones fue de 14,1 cm (5-30cm). Los órganos más frecuentemente comprometidos fueron peritoneo (60,5 por ciento) y bazo (26,3 por ciento). En el 50 por ciento de los pacientes el número de quiste fue de 5 ó más. En el 81,6 por ciento de los pacientes hubo coexistencia con quiste hidatídico hepático. El 42,1 por ciento de los pacientes recibió tratamiento médico postoperatorio con albedazol. Con un seguimiento promedio de 37 meses (1 a 86 meses). La morbilidad de la serie fue de 23,7 por ciento y se verificó una recidiva de 7,9 por ciento

Evisceración, un problema siempre presente: evaluación de su prevalencia en dos años de cirugía biliar / Evisceration, an always present problem: evaluation of prevalence in 2 years of biliary surgery

La falla aguda conocida como evisceración o disrupción, tiene una incidencia que fluctúa entre el 0,24 y el 3 por ciento de todas las laparotomías. En nuestro medio, la cirugía sobre la vesícula y las vías biliares, es la operación más frecuente realizada, tanto en el Servicio de Urgencia Adultos, como en el Servicio de Cirugía. Objetivo: Describir la prevealencia de pacientes con evisceración en pacientes operados por cirugía biliar en el período 1998-1990. Material y Método: Estudio de corte transversal de pacientes intervenidos por patología biliar. En ese período, se intervinieron 1198 pacientes, de los cuales 676 (56,4 por ciento), fueron operados en el Servicio de Urgencia Adultos, y 522 (43,6 por ciento), en el Servicio de Cirugía. De los operados en el Servicio Urgencia Adultos, 432 eran mujeres (63,9 por ciento) y 244 (36,1 por ciento), hombres. Los intervenidos en el Servicio de Cirugía, fueron 444 mujeres (85,1 por ciento) y 78 hombres (14,9 por ciento). El acceso abdominal, fue por laparotomía transrectal derecha supraumbilical (LTRDSU), media supraumbilical (MSU), y laparotomía de Kocher. En ambos Servicios el cierre se hizo con Poligláctico 910 continuo. La patología coexistente más frecuente fue la obesidad (13,6 por ciento) y enfermedad cardiovascular (10,2 por ciento). Resultados: Hubo dos evisceraciones en los 676 pacientes operados en el Servicio de Urgencia (0,29 por ciento), y uno en los 522 intervenidos en el Servicio de Cirugía (0,19 por ciento). Clonclusiones: La prevalencia de evisceración encontrada, nos parece baja en relación a estudios previos

Trauma ocular penetrante laboral: seguimiento y resultados visuales / Penetrating ocular trauma at the work: surveillance and visual results

Objetivo: Conocer las características de presentación y resultados visuales de un grupo de 57 pacientes que presentaron trauma ocular penetrante de origen laboral, entre los años 1987 a 2002. Material y Método: Se revisaron las fichas clínicas de pacientes que fueron atendidos en el Instituto de Seguridad del Trabajo (Santiago de Chile) por los autores, entre los años señalados. Se analizaron las caracteríticas de ingreso, tratamientos recibidos y resultado visual final obtenido. Se realizó un análisis especial de los casos que presentaron heridas penetrantes con compromiso retinal, sin y con la presencia de cuerpo extraño intraocular (CEIO). Estos últimos casos se compararon con una cohorte antigua de los mismos autores. Resultados: Se observó que las lesiones penetrantes oculares con compromiso del polo posterior han aumentado a través de los años, tanto en frecuencia como severidad. Los resultados visuales globales fueron buenos (20/40 o mejor) en el 45.6 por ciento; aceptables (visión ambulatoria) 20/50 a 20/800 en el 21 por ciento; y malos (ausencia de percepción luminosa) en el 33 por ciento. La comparación de casos de CEIO antiguos con los actuales no demostró una mejoría del pronóstico visual, a pesar de los avances experimentados por la vitrectomía pars plana. Se concluye la prevención sigue siendo la herramienta más eficaz.