Intestinal intussusception in adult as an uncommon cause of mechanical obstruction.

A 61-year-old woman admitted for epigastric abdominal pain, three months of evolution, worsens after ingestion, associating abdominal distension and constipation. Physical examination: abdominal pain and distension in the mesogastric zone. Blood tests: slight increase in C-reactive protein; abdominal X-ray: the small bowel dilatation; computed tomography scan: small bowel obstruction due to intussusception. An exploratory laparotomy was performed, confirming a mechanical intestinal occlusion secondary to 5 centimeters jejunal intussusception (image 3); It was execute an intestinal resection with adequate margins and an anisoperistaltic mechanical side-to-side anastomosis. Correct postoperative evolution; hospital discharge on the sixth day. Pathology report: polypoid intussusception, 4.3x3.3 centimeters, superficial ulceration, edema, chronic inflammation; resection margins without alterations.

Thermal stress analysis by finite elements of a metal-ceramic dental bridge during the cooling phase of a glaze treatment.

In the present paper, a computational finite element analysis (FEA) was developed by using the COMSOL Multiphysics® software to evaluate the thermal accumulated stress on a 3-unit dental ceramic pressed over metal (POM) bridge, at different cooling rates during the glaze treatment. The cooling rates are related to the free opening of the furnace at 800 °C (extreme case) and the restricted opening when the restoration reaches 450 °C (slow case). The thermal expansion coefficients of the materials and the glass transition point of the ceramic were measured experimentally using a dilatometer test. The FEA was performed based on the ceramic temperature profile, which was determined experimentally by using thermocouples type K. When the dental ceramic reaches its transition temperature (Tg) at 510 °C, maximum principal stress at the grooves from the occlusal surface of the pontic are reported as 140 MPa for the slow and 400 MPa for the fast cooling rate. Additionally, it is demonstrated that stresses can be reduced by using low Young's modulus metals and with small differences in the material's thermal expansion coefficient (CTE).

Removal and Extraction of Carboxylic Acids and Non-ionic Compounds with Simple Hydroxides and Layered Double Hydroxides.

Carboxylic acids are an important natural component as a final product or intermediates for syntheses. They are produced in plants, animals and also as products from biotechnological processes. This review presents the use of single hydroxide particles and layered double hydroxides as alternative adsorbents to remove carboxylic acids from liquid media. The proposal to use hydroxide particles is based on its affinity to adsorb or intercalate carboxylic acids. Besides, the change in properties of the adsorbate-sorbate product evinces that this intermediate can be used as a vehicle to transport and release carboxylic acids. Additional examples will also be presented to prove that layered hydroxides are capable of removing non-ionic compounds from wine, milk and tomato. The use of layered compounds to remove active ingredients could reduce the number of separations steps, costs and reduce or eliminate solvents, thus encouraging the design of industrial processes of separation using hydroxides particles.

Factores de riesgo presentes en pacientes con lesiones intraepiteliales escamosas del cérvix en la Clínica Maternidad Rafael Calvo en la ciudad de Cartagena(Colombia): estudio descriptivo / Risk factors in patients with cervical squamous intraepithelial lesions in Clínica Maternidad Rafael Calvo in Cartagena (Colombia): descriptive study

Objetivo: describir los factores de riesgo presentes en un grupo de pacientes con lesiones intraepiteliales escamosas (LIE) de cérvix en una entidad de referencia para mujeres del régimen subsidiado en la ciudad de Cartagena entre los años 2007 y 2012. Materiales y métodos: estudio descriptivo. La población de estudio la conformaron pacientes con diagnóstico histológico de lesiones intraepiteliales escamosas, que asistieron a la Unidad de Patología Cervical y Colposcopia de la Clínica Maternidad Rafael Calvo, de Cartagena (Colombia). La muestra fueron 150 mujeres mayores de 18 años. Resultados: el promedio de edad fue 35,5 años, el62% del grupo estudio se encontró entre los 20 y 39 años. El 78% presentó LIE debajo grado y el 22% LIE de alto grado. El 74% tuvo dos o más embarazos, 44,1% su primer embarazo fue antes de los 20 años, 64% tuvieron dos o más partos, 94.66% de la población no era fumadora, 4% refirió consumir alcohol regularmente, 54% afirmó haber tenido dos o más compañeros sexuales, 62% inició su vida sexual entrelos 16-20 años, 22% usa anticonceptivos hormonales y 38% no utiliza métodos de planificación familiar. Conclusiones: la multiparidad, la cantidad de embarazos, la sexarquia temprana, el múltiple número de parejas sexuales y los métodos hormonalesde anticoncepción, fueron los factores de riesgo con mayor frecuencia encontrados en las pacientes con lesiones intraepiteliales escamosas del cerviz en Cartagena.

Introduction: the squamous intraepithelial lesions are an indispensable condition for the occurrence of cervical cancer, one of the leading causes of death from gynecological cancer. The aim of this study is to show the risk factors more frequently found inpatients with squamous intraepithelial lesions of the cervix in this population. Materials and methods: a descriptive study of patients with squamous intraepithelial lesions, who attended the unit of cervical pathology and colposcopy in Clínica Maternidad RafaelCalvo. Results: the average age was 35.5 years, 62% of the study group was between20 and 39 years. 78% had LSIL and 22% HSIL. 74% had two or more pregnancies,44,1% had their first pregnancy before age 20, 64% had two or more deliveries, 62%the age of first intercourse was between 16-20 years, 54% had two or more sexual partners, 22% use hormonal contraceptives. 94.66% of the population didn’t smokeand 78.66% deny alcohol. Conclusions: multiparity, early onset of sexual intercourse, multiple sexual partners and use hormonal contraceptives were the factors most frequently found in the population of patients with squamous intraepithelial lesions of the cervix in Cartagena.

Mechanical intestinal obstruction secondary to congenital diaphragmatic hernia in an adult. Report of a case.

We present a case of congenital diaphragmatic hernia diagnosed in an adult. It is a kind of exceptional pathology outside the pediatric age with few cases reported in the literature. Its presentation is unusual, especially in the form of mechanical intestinal obstruction, requiring surgical treatment.

Oclusión intestinal mecánica secundaria a hernia diafragmática congénita en un adulto. Presentación de un caso / Mechanical intestinal obstruction secondary to congenital diaphragmatic hernia in an adult. Report of a case

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Care Transitions in Long-term Care and Acute Care: Health Information Exchange and Readmission Rates.

Care transitions between settings are a well-known cause of medical errors. A key component of transition is information exchange, especially in long-term care (LTC). However, LTC is behind other settings in adoption of health information technologies (HIT). In this article, we provide some brief background information about care transitions in LTC and concerns related to technology. We describe a pilot project using HIT and secure messaging in LTC to facilitate electronic information exchange during care transitions. Five LTC facilities were included, all located within Oklahoma and serviced by the same regional health system. The study duration was 20 months. Both inpatient readmission and return emergency department (ED) visit rates were lower than baseline following implementation. We provide discussion of positive outcomes, lessons learned, and limitations. Finally, we offer implications for practice and research for implementation of HIT and information exchange across care settings that may contribute to reduction in readmission rates in acute care and ED settings.

Obstrucción colónica mecánica secundaria a hernia diafragmática. A propósito de un caso / Mechanical colonic obstruction due to diaphragmatic hernia. Report of a case

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Challenge-based clinical patterns of 223 Spanish patients with nonsteroidal anti-inflammatory-drug-induced-reactions.

BACKGROUND: The single-blind, placebo controlled oral challenge (SBPCOC) is the definitive way to diagnosis nonsteroidal anti-inflammatory drug (NSAID)-induced reactions. OBJECTIVE: To evaluate 223 NSAID-sensitive patients by means of SBPCOC, and to describe the main clinical patterns found. METHODS: A prospective study was carried out, including 2 patient groups with case histories consistent with NSAID-induced reactions. Of the 223 patients, 174 were diagnosed on the basis of a positive SBPCOC. The second group consisted of 49 patients who were referred because of a documented history of anaphylaxis after taking NSAIDs, and these underwent SBPCOC with potent cyclooxygenase (COX)-1/COX-2 inhibitors, except those reported as being responsible for the reaction. The type of SBPCOC reaction, the NSAID reactivity pattern, and the associated diseases were the main classification criteria. RESULTS: Two broad categories of NSAID-induced reactions were identified: the cross-reactive and selective syndromes. The 150 patients who showed cross-reactive syndromes included 3 types of diseases: type 1, patients with rhinitis and/or asthma who developed nasoocular and/or asthmatic reactions (n=40); type 2, patients with or without chronic urticaria who presented urticaria/angioedema (n=59); and type 3, atopic patients with isolated periorbital angioedema (n=51). In contrast, the selective syndromes, or type 4, included 50 patients who developed anaphylaxis, as well as 11 patients with urticaria during SBPCOC. Finally, a miscellaneous group of reactions not matching any of the above types was identified (n=1 2). CONCLUSIONS: NSAID-sensitive patients can be classified into 4 different groups of reactors, each with well-defined clinical characteristics. Thus, a clinical classification of this NSAID-induced reaction complex is proposed.

Occupational rhinoconjunctivitis and bronchial asthma due to Acalypha wilkesiana allergy.

BACKGROUND: Acalypha wilkesiana, or copperleaf, is a plant of the Euphorbiaceae family. Although it is widely known as an outdoor ornamental plant, no cases of A. wilkesiana allergy have been reported to date. OBJECTIVE: To describe a patient with occupational respiratory allergy to A. wilkesiana. METHODS: Extracts from A. wilkesiana leaves and flowers were used for skin prick testing, specific conjunctival and bronchial challenge tests, and in vitro studies. These studies range from A. wilkesiana specific IgE determination to sodium dodecyl sulfate-polyacrylamide gel electrophoresis immunodetection of A. wilkesiana protein bands in patient serum samples and immunoblot inhibition by preincubation with Salsola kali and Chenopodium album pollen extracts. RESULTS: Our patient had positive skin prick test reactions to A. wilkesiana leaf and flower extracts; negative reactions were found in a control group of 20 atopic patients. On immunodetection of A. wilkesiana extracts in patient serum samples, as many as 9 different IgE-binding proteins, with apparent molecular weights of 16 to 86 kDa, were revealed. Preincubation with S. kali and C. album pollen extracts completely inhibited IgE binding to the A. wilkesiana extract. Specific bronchial challenge resulted in a spirometric 30% decline in forced expiratory volume in 1 second with respect to baseline 1 minute after 1:100 (vol/vol) A. wilkesiana extract solution inhalation; 2 atopic controls had negative bronchial challenge test results. CONCLUSION: Acalypha wilkesiana is a new etiologic agent for IgE-mediated occupational respiratory allergy.

Genetic basis of the latex-fruit syndrome: association with HLA class II alleles in a Spanish population.

BACKGROUND: The latex-fruit syndrome is a well-defined disorder whose genetic background has not been elucidated. OBJECTIVE: To study the genetic basis of the latex-fruit syndrome. METHODS: In a case-control study, we have investigated a carefully selected group of patients allergic to latex, searching for association between latex-fruit allergy and HLA class I and II genes, HLA-DR functional groups, and markers IL4-R1 and FcepsilonRI-betaca . RESULTS: Seventy-eight patients allergic to latex without spina bifida, 33% of them also allergic to fruits, were included in our protocol. Skin prick test results with both a commercial latex extract and purified hevein were significantly greater in patients allergic to latex and fruit than in patients allergic to latex and not fruit. A cutoff point of >7 mm for commercial latex skin prick test diagnosed latex-fruit allergy with a sensitivity of 66.7% (95% CI, 41.0-86.6) and a specificity of 83.3% (95% CI, 68.6-93.0) in our series of patients. No significant differences were found regarding HLA class I, IL4-R1 , or FcepsilonRI-betaca allele distributions. However, comparison of HLA class II allelic frequencies between patients allergic to latex and fruit and patients allergic to latex and not fruit showed significant associations of latex-fruit allergy with DQB1 *0201 (corrected P value, .001; odds ratio, 7.3; 95% CI, 2.6-20.0), as well as with HLA-DR functional group E (corrected P value, .028; odds ratio, 16.0; 95% CI, 1.9-134.1). When comparing allelic distribution among different subgroups of patients allergic to latex, additional significant associations of latex-fruit allergy with DRB1 *0301 and *0901, and of latex and not fruit allergy with DQB1 *0202, DRB1 *0701 and *1101, were demonstrated. CONCLUSIONS: Latex-fruit allergy is associated with HLA-DQB1 *0201, DRB1 *0301, and *0901, as well as with HLA-DR functional group E, whereas latex-not-fruit allergy is associated with DQB1 *0202, and with both DRB1 *0701 and *1101 alleles.

Sputum eosinophilia and maximal airway narrowing in Dermatophagoides pteronyssinus allergic rhinitis patients: only rhinitis or rhinitis plus mild asthma?

STUDY OBJECTIVE: To study the existence of bronchial disease among rhinitis patients. To evaluate the laboratory test or set of tests (ie, symptoms, exposure, and sensitization to the allergen, and the provocative dose of methacholine [Mth] causing a 20% fall in FEV(1) [PD(20)] and the maximal response plateau [MRP] to Mth) that best identifies a case of mild asthma. DESIGN: Cross-sectional analysis in 52 Dermatophagoides pteronyssinus-monosensitized patients who were consulting a physician for perennial rhinitis. SETTING: Allergy Department, Hospital Doctor Negrín, Las Palmas, Grand Canary Island, Spain. INTERVENTIONS AND MEASUREMENTS: Patients filled out a standardized asthma symptom questionnaire, and underwent sputum induction and Mth challenge in which 40% falls in FEV(1) were attained. Dose-response curves were expressed in terms of both PD(20) values and the level of the MRP. D pteronyssinus allergen exposure was assessed in dust samples from patients' beds. RESULTS: No difference between patients who positively responded to the questionnaire and those who did not was observed. Mth-PD(20) values were not detected in 13% of the patients reporting bronchial symptoms, and an MRP was not identified in 59% of the subjects who did not respond positively. A higher degree of allergen sensitization (ascertained from skin test results, and total and specific serum IgE levels) and higher degree of sputum eosinophilia were detected in subjects in whom an MRP had not been identified. The presence of sputum eosinophilia provided the best differentiation between those patients who presented with an MRP and those who did not. CONCLUSION: The individual perception of bronchial symptoms is highly variable among perennial allergic rhinitis patients. The lack of a maximal airway-narrowing plateau is related to the presence of sputum eosinophilia, which might be useful in the detection of patients susceptible to anti-inflammatory therapy. Prospective studies evaluating whether these patients are more likely to develop symptomatic asthma in the future and if the early anti-inflammatory treatment prevents its development are needed.

Manual de procedimientos para la contención, conducción en intervenciones corporales de detenidos / Manual of procedures for the containment, conduction in corporal intervention of prisoners

La inclusión de este manual basa su fundamento en la necesidad de que los profesionales médicos y juristas conozcan lo concerniente a toda revisión corporal de personas privadas de libertad, ya que debe respetarse su pudor. Para estos efectos, la revisión de mujeres debe ser realizada por personal femenino, en el caso de los varones por personal masculino. Cuando el detenido asuma una posición hostil o agresiva ante el servidor que procura la revisión corporal, debe recurrirse en primera instancia al diálogo y la persuasión, y si se utilizará la fuerza que sea estrictamente la necesaria para poder realizar la diligencia, para lo cual se podrá hacer uso de los instrumentos de seguridad, como la vara policial, el dispositivo de esposas y cualquier otro autorizado por la Institución. Palabras claves: Revisión corporal, revisión de mujeres, personal femenino, vara policial, dispositivo de esposas.

Supervisión: II Curso Nacional de Planificación / Supervision: II National Course in Planning

La supervisión del modelo de administración de servicios para extensión de Cobertura, debe mantener un nivel óptimo en calidad una de sus actividades y tareas realizadas, cumplir en elmarco de las normas establecidas y procurar la aceptación del servicio en la población. Razón para fortalecer el subsistema de supervisión de Unitaria Sanitaria Oruro, operacionándola dentro el proceso de regionalización

Caumatología, proposición de un término / Caumatology: Proposal of a term

Se hace un análisis de dos palabras que de manera no oficial se han venido utilizando para nombrar la especialidad en quemados y a los que la ejercen. Se presenta un estudio sobre las características del vocabulario médico y se concluye que los términos hasta ahora empleados no son correctos. Se proponen dos nuevas voces en su lugar; caumatología y caumatólogo. Se fundamenta la proposición y se establece la posible traducción al inglés y al francés (AU)