Factores prequirúrgicos asociados con dificultades técnicas de la colecistectomía laparoscópica en la colecistitis aguda / Preoperative factors associated with technical difficulties of laparoscopic cholecystectomy in acute cholecystitis

Objetivo. Identificar en pacientes con colecistitis aguda (CoA) los factores preoperatorios asociados con el tiempo quirúrgico y con la conversión de colecistectomía laparoscópica (CL) a cirugía abierta. Método. Se realizó un estudio transversal que incluyó 99 pacientes mayores de 17 años con diagnóstico definitivo de CoA tratados con CL. Se registraron variables prequirúrgicas, como datos clínicos, valores de laboratorio y hallazgos ecográficos como el grosor de la pared de la vesícula, el volumen vesicular y la presencia de: líquido perivesicular, colelitiasis múltiple o barro biliar. Se consideraron medidas indirectas de dificultad técnica de la CL, el tiempo quirúrgico empleado y la necesidad de conversión a cirugía abierta. Se utilizaron las pruebas de ji-cuadrado o U de Mann-Whitney para establecer la relación entre las variables prequirúrgicas y aquellas indicativas de dificultad técnica. Se construyeron curvas ROC (Receiver Operating Characteristic) de las variables con asociación estadística significativa (p ≤0,05 e intervalo de confianza del 95% [IC95%]) para determinar los puntos de corte de mejor rendimiento para predecir la conversión de CL a cirugía abierta. Resultados. Un grosor de la pared vesicular ≥6mm detectado por ultrasonido tiene una odds ratio de 11,71 (IC95%: 1,38-99; p = 0,008), con una sensibilidad del 87,5% y una especificidad del 62,6% para predecir la conversión a cirugía abierta. No hubo relación entre el tiempo quirúrgico y las variables prequirúrgicas evaluadas. Conclusión. El grosor de la pared de la vesícula biliar detectado por ultrasonido se asocia con la necesidad de conversión de la CL a cirugía abierta en pacientes con CoA (AU)

Objective. To identify preoperative factors associated with surgical time and conversion of the laparoscopic cholecystectomy (LC) to open surgery in subjects with acute cholecystitis (AC). Method. We developed a cross-sectional study that included 99 subjects older than 17 years with definitive diagnosis of AC who had undergone to LC. Preoperative variables such as clinical data, laboratory markers and ultrasound findings as wall thickness, the size of the major calculus and the presence of: perivesicular fluid, multiple cholelithiasis, biliary mud or microlithiasis were registered. We consider indirect measures of technical difficulties of LC the total surgical time and the need for conversion to open surgery. We used the square chi and Mann-Whitney U test to stablish the correlation between preoperative variables and the technical difficulties of LC. We build ROC curves of the variables with significant statistical association (p ≤0.05 and 95% confidence interval [95%CI]) to determine the cut-off points of better sensitivity and specificity to predict conversion of LC to open surgery. Results. A gallbladder wall thickness ≥6mm detected by ultrasound has a sensitivity of 87.5% and a specificity of 62.6% with OR 11.71 (95%CI: 1.38-99; p = 0.008) for predict conversion to open surgery. There was no relationship between surgical time and the preoperative evaluated variables. Conclusion. The gallbladder wall thickness detected by the ultrasound is associated with the need of conversion of LC to open surgery in subjects with AC, furthermore this finding could warn the surgeon on the complexity with a particular patient (AU)

Preoperative factors associated with technical difficulties of laparoscopic cholecystectomy in acute cholecystitis. / Factores prequirúrgicos asociados con dificultades técnicas de la colecistectomía laparoscópica en la colecistitis aguda.

OBJECTIVE: To identify preoperative factors associated with surgical time and conversion of the laparoscopic cholecystectomy (LC) to open surgery in subjects with acute cholecystitis (AC). METHOD: We developed a cross-sectional study that included 99 subjects older than 17 years with definitive diagnosis of AC who had undergone to LC. Preoperative variables such as clinical data, laboratory markers and ultrasound findings as wall thickness, the size of the major calculus and the presence of: perivesicular fluid, multiple cholelithiasis, biliary mud or microlithiasis were registered. We consider indirect measures of technical difficulties of LC the total surgical time and the need for conversion to open surgery. We used the square chi and Mann-Whitney U test to stablish the correlation between preoperative variables and the technical difficulties of LC. We build ROC curves of the variables with significant statistical association (p ≤0.05 and 95% confidence interval [95%CI]) to determine the cut-off points of better sensitivity and specificity to predict conversion of LC to open surgery. RESULTS: A gallbladder wall thickness ≥6mm detected by ultrasound has a sensitivity of 87.5% and a specificity of 62.6% with OR 11.71 (95%CI: 1.38-99; p = 0.008) for predict conversion to open surgery. There was no relationship between surgical time and the preoperative evaluated variables. CONCLUSION: The gallbladder wall thickness detected by the ultrasound is associated with the need of conversion of LC to open surgery in subjects with AC, furthermore this finding could warn the surgeon on the complexity with a particular patient.

Antibacterial activity of wine phenolic compounds and oenological extracts against potential respiratory pathogens.

AIMS: To investigate the effect of seven wine phenolic compounds and six oenological phenolic extracts on the growth of pathogenic bacteria associated with respiratory diseases (Pseudomonas aeruginosa, Staphylococcus aureus, Moraxella catarrhalis, Enterococcus faecalis, Streptococcus sp Group F, Streptococcus agalactiae and Streptococcus pneumoniae). METHODS AND RESULTS: Antimicrobial activity was determined using a microdilution method and quantified as IC(50) . Mor. catarrhalis was the most susceptible specie to phenolic compounds and extracts. Gallic acid and ethyl gallate were the compounds that showed the greatest antimicrobial activity. Regarding phenolic extracts, GSE (grape seed extract) and GSE-O (oligomeric-rich fraction from GSE) were the ones that displayed the strongest antimicrobial effects. CONCLUSIONS: Results highlight the antimicrobial properties of wine phenolic compounds and oenological extracts against potential respiratory pathogens. The antimicrobial activity of wine phenolic compounds was influenced by the type of phenolic compounds. Gram-negative bacteria were more susceptible than Gram-positive bacteria to the action of phenolic compounds and extracts; however, the effect was species-dependent. SIGNIFICANCE AND IMPACT OF STUDY: The ability to inhibit the growth of respiratory pathogenic bacteria as shown by several wine phenolic compounds and oenological extracts warrants further investigations to explore the use of grape and wine preparations in oral hygiene.

Outbreak of scarlet fever caused by an erythromycin-resistant Streptococcus pyogenes emm22 genotype strain in a day-care center.

We report an outbreak of scarlet fever and pharyngeal colonization with Streptococcus pyogenes in a day-care center in Mexico City. The outbreak strain was resistant to erythromycin but susceptible to clindamycin. T-type 11,12 serotype was found in eight isolates, from two patients and six carriers, which had the emm22 gene. The recognition of streptococci resistant to macrolides causing outbreaks has implications for infection control and for improving antibiotic prescribing patterns in the day-care setting.

Estudio genético multiloci en la población colombiana I. Desequilibrio de ligamento para el sistema CcEe / Genetics study

Una muestra de 11.113 individuos de la población colombiana, caracterizados para el sistema sanguíneo Rh con los sueros anti-C, anti-c, anti-E y anti-e, se distribuyeron en diez regiones de acuerdo con su lugar de nacimiento y dos generaciones, padres e hijos; se estimó el desequilibrio de ligamiento por el método del haplotipo para el sistema CcEe. Todos los valores de desequilibrio calculados fueron negativos y altos, debido a la baja asociación encontrada de la gameta CE; además, en todas las regiones y en la población total para las dos generaciones, se encontró que el valor de desequilibrio es cercano al máximo valor de desequilibrio posible

[Know well in order to do well]. / Saber bien para hacer bien.

Health care professionals should have comprehensive training, especially in the humanitarian aspects of care. This is essential to enable them to correctly resolve ethical conflicts that arise in professional practice. Starting from this premise, the article discusses some representative situations nurses encounter daily in their contacts with patients. An examination is made of the ethical aspects of the following: ordinary nursing activities; standards with regard to hospital visits by family members; administration of analgesics; schedules for feeding, drug administration, and the like; clinical research; professional secrecy; free professional practice; and death with dignity.

Know well to do good.

Health care should be entrusted to professionals who have received well-rounded training in the humanitarian as well as the technical aspects of such care. Training of this sort is essential for effective resolution of ethical conflicts that arise in professional practice. Starting from that premise, this article examines a number of ethical problems commonly encountered by nurses in the course of their daily work.