Atención a mujeres en situación de aborto en el Hospital San José (2016-2019) / Attention to woman in abortion situation at San José Hospital (2016-2019)

Objetivo: evaluar la incorporación de elementos de calidad de atención a mujeres en situación de aborto (MSA) en la Unidad de Salud Sexual y Salud Reproductiva del Hospital San José, entre 2016 y 2019. Métodos: utilizando los datos recabados en el Sistema Informático Perinatal (SIP), se realizó un análisis descriptivo de las características sociodemográficas y se evaluó la implementación de la Unidad de Salud Sexual y Reproductiva a través de indicadores de atención de calidad. Resultados: las variables sociodemográficas que caracterizan nuestra población están definidas por una alta proporción de mujeres extranjeras (44,5%), que cuentan con un nivel educacional medio (63,8% educación secundaria y 26% universitaria), y una alta proporción de necesidades insatisfechas de métodos anticonceptivos (70,3%), representando características sociodemográficas similares a los diferentes centros de salud pública de la región. La tendencia de los indicadores de calidad de atención en las mujeres en situación de aborto del Hospital San José mejoró posterior a la implementación de la Unidad de Salud Sexual y Reproductiva y el modelo de atención postaborto (APA) al disminuir los métodos de evacuación uterina no recomendados y aumentar la cobertura en anticoncepción inmediata postaborto. Conclusión: la implementación de una unidad especializada en salud sexual y reproductiva mejora los indicadores de calidad a la MSA. (AU)

Objective: to evaluate the incorporation of elements of quality of care for women in abortion situation (WAS) in the Sexual Health and Reproductive Health Unit of the San José Hospital, between 2016 and 2019. Methods: using the data collected in the Perinatal Information System (SIP), a descriptive analysis of the sociodemographic characteristics was carried out and the implementation of the Sexual and Reproductive Health Unit was evaluated through quality care indicators. Results: the sociodemographic variables that characterize our population are defined by a high proportion of foreign women (44.5%), who have a medium educational level (63.8% secondary education and 26% university), and a high proportion of unmet needs for contraceptive methods (70.3%), representing sociodemographic characteristics similar to the different public health centers in the region. The trend of the quality of care indicators for women in abortion at the San José Hospital improved after the implementation of the Sexual and Reproductive Health Unit and the postabortion care model (PAC) by reducing non- recommended uterine evacuation methods. and increase coverage in immediate postabortion contraception. Conclusion: the implementation of a specialized unit in sexual and reproductive health improves the quality indicators of the WSA. (AU)

Reliability of pressure waveform analysis to determine correct epidural needle placement in labouring women.

Pressure waveform analysis provides a reliable confirmatory adjunct to the loss-of-resistance technique to identify the epidural space during thoracic epidural anaesthesia, but its role remains controversial in lumbar epidural analgesia during labour. We performed an observational study in 100 labouring women of the sensitivity and specificity of waveform analysis to determine the correct location of the epidural needle. After obtaining loss-of-resistance, the anaesthetist injected 5 ml saline through the epidural needle (accounting for the volume already used in the loss-of-resistance). Sterile extension tubing, connected to a pressure transducer, was attached to the needle. An investigator determined the presence or absence of a pulsatile waveform, synchronised with the heart rate, on a monitor screen that was not in the view of the anaesthetist or the parturient. A bolus of 4 ml lidocaine 2% with adrenaline 5 µg.ml-1 was administered, and the epidural block was assessed after 15 min. Three women displayed no sensory block at 15 min. The results showed: epidural block present, epidural waveform present 93; epidural block absent, epidural waveform absent 2; epidural block present, epidural waveform absent 4; epidural block absent, epidural waveform present 1. Compared with the use of a local anaesthetic bolus to ascertain the epidural space, the sensitivity, specificity, positive and negative predictive values of waveform analysis were 95.9%, 66.7%, 98.9% and 33.3%, respectively. Epidural waveform analysis provides a simple adjunct to loss-of-resistance for confirming needle placement during performance of obstetric epidurals, however, further studies are required before its routine implementation in clinical practice.

New Records Reveal the Actual Distribution of Cratomelus meritus Gorochov (Orthoptera: Anostostomatidae), a Giant Red Cricket from Chile.

The geographic distribution of the red cricket Cratomelus meritus Gorochov had remained unknown until now due to mislabeling and lack of new records. The aim of this short communication is to uncover and establish the actual distribution of the species on the basis of new records and discuss potential biogeographic hypotheses about its distribution.

Should we monitor with bispectral index in all patients at high risk for seizures in the operating room?

We report the case of a patient with a cerebral aneurysm, located in the left middle cerebral artery. During the clipping of this aneurysm, the bispectral index (BIS) increased for no apparent reason. This was then interpreted as intraoperative non-convulsive status epilepticus. This clinical condition may have negative impact in the prognosis of the patient, so it is very important to be able to detect this conditions as early as possible. Measuring the BIS while the patient is anaesthetised could be useful in this situation, considering that an increase in values greater than 60, associated with acidosis and without any other peri-anaesthetic explanation, may provide evidence of a convulsive equivalent state, allowing appropriate action to be taken (AU)

Effect of intravenous fluid therapy on postoperative vomiting in children undergoing tonsillectomy.

BACKGROUND: Postoperative vomiting (POV) is one of the most frequent complications of tonsillectomy in children. The aim of this study was to evaluate the antiemetic effect of super-hydration with lactated Ringer's solution in children undergoing elective otorhinolaryngological surgery. METHODS: One hundred ASA I-II children, aged 1-12 yr, undergoing elective tonsillectomy, with or without adenoidectomy, under general anaesthesia were studied. Induction and maintenance of anaesthesia were standardized with fentanyl, mivacurium, and sevoflurane in N(2)O/O(2). Subjects were assigned to one of the two groups: 10 ml kg(-1) h(-1) lactated Ringer's solution or 30 ml kg(-1) h(-1) lactated Ringer's solution. A multivariable logistic regression was used for assessing the effects of super-hydration on POV (defined as the presence of retching, vomiting, or both). A value of P<0.05 was considered statistically significant. RESULTS: During the first 24 h postoperative, the incidence of POV decreased from 82% to 62% (relative reduction of 24%, P=0.026). In the adjusted logistic regression model, subjects in the 10 ml kg(-1) h(-1) group had an odds ratio of POV that was 2.92 (95% confidence interval: 1.14, 7.51) for POV compared with subjects in the 30 ml kg(-1) h(-1) group. CONCLUSIONS: Intraoperative administration of 30 ml kg(-1) h(-1) lactated Ringer's solution significantly reduced the incidence of POV during the first 24 h postoperative. Our results support the use of super-hydration during tonsillectomy, as an alternative way to decrease the risk of POV in children.

Should we monitor with bispectral index in all patients at high risk for seizures in the operating room?

We report the case of a patient with a cerebral aneurysm, located in the left middle cerebral artery. During the clipping of this aneurysm, the bispectral index (BIS) increased for no apparent reason. This was then interpreted as intraoperative non-convulsive status epilepticus. This clinical condition may have negative impact in the prognosis of the patient, so it is very important to be able to detect this conditions as early as possible. Measuring the BIS while the patient is anaesthetised could be useful in this situation, considering that an increase in values greater than 60, associated with acidosis and without any other peri-anaesthetic explanation, may provide evidence of a convulsive equivalent state, allowing appropriate action to be taken.

Inmunidad humoral y trasplante renal posibilidades terapéuticas / Humoral inmunity and renal trasplant: therapeutic possibilities

El trasplante renal es el tratamiento de elección para los pacientes con falla renal terminal. Las principales causas de pérdida de injertos son la muerte del paciente con injerto funcionante, especialmente de causa cardiovascular y la nefropatía crónica del injerto, con una pérdida crónica de injertos que resulta en un problema relevante. Dentro de las causas de nefropatía crónica destaca la causa inmunológica. Una de las causas de pérdida de injertos de origen inmunológico son los rechazos agudos, los que pueden ser de origen celular y humoral. Por otra parte, y a pesar de los avances en la comprensión de los mecanismos responsables de la inmunidad celular y el desarrollo de nuevas drogas inmunosupresoras (DIS), el rechazo mediado por anticuerpos o humoral aparece hoy como un peligro para la sobrevida del injertos a corto y a largo plazo. Afortunadamente el tratamiento del rechazo agudo humoral con drogas específicas ha resultado exitoso, sin embargo no ha ocurrido lo mismo con el rechazo mediado por anticuerpos de presentación más tardía, posiblemente por su comportamiento subclínico y un diagnóstico tardío, permaneciendo como un nuevo desafío recientemente reconocido. Por otra parte y basado en el exitoso tratamiento del RAH, se ha planteado mejorar las expectativas de llegar a realizar un trasplante a los pacientes sensibilizados. Esto es posible conseguir aplicando protocolos de desensibilización que se basan en la utilización de las mismas drogas para tratar RAH, consiguiendo ampliar las posibilidades de trasplante. El éxito de éstas es relativo al tipo de protocolos y a la intensidad de la sensibilización. La sobrevida del injerto en esta situación es plausible en la gran mayoría de los casos, sin embargo existe riesgo de presentar rechazo agudo humoral, y más complejo aún es el hecho que la sobrevida a largo plazo de los injertos sigue siendo todavía desconocida.

Renal Transplantation is the therapy of choice for patients with end-stage renal failure. The main causes for graft losses are patient death with functioning graft, mainly of cardiovascular etiology and chronic allograft nephropathy. Among the causes of chronic allograft nephropathy, the immunological ones are among the most important; one of them are the acute rejection episodes, which can be of cellular or humoral etiology; in addition, and despite the understanding of the mechanisms responsible for the cell immunity and the development of new immunosuppressive drugs (DIS) the antibody mediated rejection o humoral rejection has become today a danger for the short and long term allograft survival. Fortunately, the treatment of acute humoral rejection with specific drugs has become successful, however, the situation is different with late occurring antibody mediated rejection episodes, probably due to its subclinical behavior and a late diagnosis, remaining as a new challenge recently recognized. On the other hand based on the successful treatment of the RAH, expectations of performing a transplant in sensitized patients have been improved. This is possible to achieve using desensitizing protocols base don the same drugs used to treat RAH, thus increasing transplant possibilities. The success is related to the type of protocols and the intensity of the desensitizing. Graft survival in this situation is possible in the large majority of cases, however, the risk of acute humoral rejection is present, but even more complex is the fact thatlong-term survival is still unknown.

Intento suicida en la comuna de Panguipulli / Suicidal attempt in the Panguipulli commune

A partir de la impresión clínica que la frecuencia de los intentos suicidas en el hospital de Panguipuyi era muy alta realizamos un estudio transversal descriptivo de los intentos suicidas hospitalizados en el periodo de 1 año. Obtenidos datos generales del paciente, se aplicó la escala de intención suicida de Pierce previa derivación a psiquiatra. Se analizaron 32 casos de intento suicida lo que representa una frecuencia de intentos de 1.05/1000 para la comuna. El promedio de edad, predominio de sexo femenino, estado civil soltero, sin trabajo remunerado, urbano con ingesta de fármacos fueron concordantes con la literatura. Los transtornos del ánimo, específicamente la depresión, y los transtornos de la personalidad fueron los diagnósticos psiquiátricos más frecuentes. Según la escala de Pierce, 2/3 de los pacientes presentan baja intención suicida. Al comparar el número de nuevos casos con estadísticas de otros autores, encontramos que es frecuencia relativamente baja. Si consideramos que el sistema médico comunal es cerrado y que más del 95 por ciento de los casos que consultan se hospitalizan por norma del servicio, es comprensible que haya existido la impresión clínica que el problema era más frecuente

Anticardiolipin antibodies in classic pediatric hemolytic-uremic syndrome: a possible pathogenic role.

Anticardiolipin (aCL) antibodies have been associated with thrombocytopenia, hemolytic anemia and an increased risk of thrombosis in different vascular locations, even in the absence of lupus. The classic hemolytic-uremic syndrome is a postinfectious acute renal failure characterized by hemolytic anemia, thrombocytopenia and the presence of widespread glomerular thrombosis in the kidney, with pathogenic mechanisms that remain to be identified. In order to establish the frequency of aCL antibodies in this syndrome and to identify a possible role in the pathogenesis and clinical manifestations, 17 patients were studied during the reactant phase of the disease looking for an association between the presence of aCL antibodies (isotypes IgG, IgA and IgM) and the main clinical variables of the syndrome. In 8 patients IgG aCL was present, 2 patients had IgM aCL, and 1 had IgA antibodies on the solid-phase ELISA aCL assays, but no association could be demonstrated with the clinical variables studied. Although it might correspond to an epiphenomenon related to the triggering intestinal infection, a pathogenic role cannot be discarded and additional studies should be performed.