Racial Differences in Hospice Care Outcomes in Patients With Advanced Heart Failure: Systematic Review and Meta-analysis.

There remains a paucity of investigational data about disparities in hospice services in people with non-cancer diagnoses, specifically in heart failure (HF). Black patients with advanced HF have been disproportionally affected by health care services inequities but their outcomes after hospice enrollment are not well studied. We aimed to describe race-specific outcomes in patients with advanced HF who were enrolled in hospice services. We obtained the data from PubMed, Scopus, and Embase for all investigations published until January 11, 2023. All studies that reported race-specific outcomes after hospice enrollment in patients with advanced HF were included. Of the 1,151 articles identified, 5 studies (n = 24,899) were considered for analysis involving a sample size ranging from 179 to 11,754 patients. Black patients had an increased risk of readmission (odds ratio 1.55, 95% confidence interval [CI] 1.34 to 1.79, I2 0%) and discharge (odds ratio 1.75, 95% CI 1.53 to 1.99, I2 0%) compared with White patients. Moreover, Black patients have a nonsignificant lower risk of mortality compared with White patients (relative risk 0.67, 95% CI 0.43 to 1.05, I2 90%). In conclusion, this study showed that Black patients with advanced HF receiving hospice care have a higher risk of readmission and discharge compared with White patients.

Atypical perianal and buttocks epidermal-dermal necrosis in Human Monkeypox. Histopathological study of the lesion in Peru

We report the histopathological study of a large, black, crusted lesion with symmetrical distribution in both buttocks and perineum, never described, in a man who has sex with men (MSM) and proctitis associated with Human Monkey Pox Virus (hMPXV) and HIV-AIDS infection never treated. A 39-year-old male, homosexual, HIV-AIDS without Highly Active Antiretroviral Therapy (HAART), was admitted to a hospital in Lima, Peru, with papulopustular lesions on the body and perianal area. Days later, a large, crusty, black lesion with a symmetrical distribution appeared on the buttocks and perineum. The tissue culture was negative. Wedge biopsy of the lesion showed typical MPXV cytopathogenics lesions in addition to fibrin micro thrombosis in the underlying papillary dermis. The histopathological findings of the scabby and black lesion are the classic ones described by Stagles, except for the phenomenon of fibrin micro thrombosis in the papillary dermis, a novel cytopathogenic effect of MPXV with clinical relevance (epidermal-dermal necrosis).

Reportamos el estudio histopatológico de una gran lesión costrosa, negra, de distribución simétrica en ambas nalgas y periné, nunca descrito, en un hombre que tiene sexo con hombres (HSH) y proctitis asociado a Viruela del Mono Humana (hMPXV) e infección por VIH-SIDA nunca tratado. Un varón de 39 años, homosexual, VIH-SIDA sin Terapia Antirretroviral de Gran Actividad (TARGA), ingresó en un hospital de Lima, Perú, con lesiones papulopustulosas en el cuerpo y el area perianal. Días después apareció una gran lesión negra, costrosa de distribución simétrica en las nalgas y periné. El cultivo de tejidos fue negativo. La biopsia en cuña de la lesión mostró lesiones citopatogénicas típicas de MPXV, además de microtrombosis de fibrina en la dermis papilar subyacente. Los hallazgos histopatológicos de la lesión costrosa y negra que reportamos son los clásicos descritos por Stagles, a excepción del fenómeno de microtrombosis de fibrina en la dermis papilar, un efecto citopatogénico novedoso de MPXV con relevancia clínica (necrosis epidermo-dérmico).

Sensor-based gait analyses of the six-minute walk test identify qualitative improvement in gait parameters of people with multiple sclerosis after rehabilitation.

The aim of this work was to determine whether wearable inertial measurement units (IMUs) could detect gait improvements across different disability groups of people with Multiple Sclerosis (pwMS) by the six-minute walk test (6MWT) during a rehabilitation stay in a specialized rehabilitation center. Forty-six pwMS and 20 healthy controls (HC) were included in the study. They performed the 6MWT with two inertial measurement units (IMUs) placed on the feet. Thirty-two of the pwMS were retested at the end of the stay. PwMS were divided in a mild-disability and a moderate-disability group. The 6MWT was divided in six sections of 1 min each for technical analysis, and linear mixed models were used for statistical analyses. The comparison between the two disability groups and HC highlighted significant differences for each gait parameter (all p < 0.001). The crossing effect between the test-retest and the two disability groups showed greater improvement for the moderate-disability group. Finally, the gait parameter with the higher effect size, allowing the best differentiation between the disability groups, was the foot flat ratio (R2 = 0.53). Gait analyses from wearable sensors identified different evolutions of gait patterns during the 6MWT in pwMS with different physical disability. The measured effect of a short-time rehabilitation on gait with 6MWT was higher for pwMS with higher degree of disability. Using IMUs in a clinical setting allowed to identify significant changes in inter-stride gait patterns. Wearable sensors and key parameters have the potential as useful clinical tools for focusing on gait in pwMS.

Severe type-B lactic acidosis in a patient with bilateral renal Burkitt's lymphoma.

INTRODUCTION: Lactic acidosis (LA) can be categorized as type A, which occurs in the presence of tissue hypoxia, or type B, occurring in the absence of tissue hypoxia. Hematologic malignancies are an uncommon cause of type B LA. CASE PRESENTATION: A 63-year-old man, HIV-negative, with a history of diabetes mellitus, hypothyroidism, and non-alcoholic fatty liver disease (NAFLD), presented to the ED complaining of acute-on-chronic lumbar pain, and was found to have high serum anion gap (AG) LA. The rest of chemistry and infectious workup was within normal limits. Despite bicarbonate therapy and fluid resuscitation, the patient remained with persistent AG metabolic acidosis and increasing lactic acid up to 14.5 mmol/L. An abdominal computerized tomography (CT) revealed multiple bilateral enhancing lesions in the kidneys, as well as gastric wall thickening. Upper gastrointestinal endoscopy with biopsy showed a high-grade Burkitt's lymphoma. Further staging showed bone marrow involvement and extensive abdominal adenopathy. After two cycles of inpatient chemotherapy with dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab), the patient developed multifocal pneumonia complicated by respiratory failure. Following a prolonged ICU stay, after discussion with the family members, a decision of withdrawal of life-sustaining therapy was reached. CONCLUSION: Persistent LA, without identifiable causes of tissue hypoxia, should prompt clinicians to suspect non-hypoxic etiologies, including occult high-grade malignancies. Hematological malignancies constitute an extremely rare cause of type-B LA, carrying a poor prognosis.

Painless type A aortic dissection.

Aortic dissection is an uncommon diagnosis that typically presents with acute onset of severe pain. It rarely presents with minimal to no symptoms, which carries a higher mortality risk given the delay in diagnosis. An adequate interpretation of risk factors, clinical findings and auxiliary tests constitutes a greater value for clinicians to detect this life-threatening condition. This report describes a case of type A aortic dissection in an asymptomatic patient presenting with an abnormal electrocardiogram (ECG).

Leucemia/Linfoma de células T del adulto y criptococosis sistémica: Reporte de dos casos en un hospital peruano / Adult T-cell leukemia/lymphoma and systemic cryptococcosis: report of two cases in a Peruvian hospital

La leucemia/linfoma de células T adulto (LLCTA) es una neoplasia linfoide causada por el virus linfotrópico humano de células T tipo 1 (HTLV-1), retrovirus endémico en nuestro país. Tiene una presentación heterogénea, con variedades de pobre pronóstico e infecciones oportunistas que lo ensombrecen aún más. Se presentan dos casos de pacientes con variedades agresivas de la enfermedad (aguda y linfomatosa) complicadas con criptococosis sistémica. Reforzamos la necesidad de un enfoque diagnóstico completo y un monitoreo continuo de agentes oportunistas en el paciente con LLCTA adaptado a nuestro contexto epidemiológico

Adult T-cell leukemia/lymphoma (ATLL) is a lymphoid neoplasm caused by the human T-cell lymphotropic virus type 1 (HTLV-1), an endemic retrovirus in our country. It has a heterogeneous presentation, with sub types of poor prognosis, and opportunistic infections that worsen the prognosis. We present two cases with aggressive varieties of the disease (acute and lymphomatous) complicated by systemic cryptococcosis. It is necessary to conduct a complete diagnostic approach and continuous monitoring of opportunistic agents in patients with ATL adapted to our epidemiological context.

Nódulo de la hermana Mary Joseph: una manifestación inicial poco usual de adenocarcinoma de páncreas / Sister Mary Joseph nodule: an unusual initial manifestation of pancreas adenocarcinoma

Las metástasis cutáneas representan el 10% de todas las metástasis. El nódulo de la hermana Mary Joseph es una lesión metastásica cutánea umbilical asociada a tumor intraabdominal, que con mayor frecuencia es el carcinoma gástrico. Las metástasis cutáneas de cáncer de páncreas son poco habituales y su localización más frecuente es el ombligo. La mayoría de referencias de la literatura consisten en reportes o series de caso pequeñas. Se reporta el caso de un paciente con lesión metastásica umbilical, nódulo de la hermana Mary Joseph, primaria de adenocarcinoma pancreático, debido a su inusual presentación como manifestación clínica previa al diagnóstico de la neoplasia de origen

Cutaneous metastases represent 10% of all metastatic manifestations. Sister Mary Joseph nodule is a cutaneous umbilical metastatic lesion associated to intraabdominal tumors (most frequently gastric carcinoma). Cutaneous metastases from pancreatic cancer are quite uncommon, and their most frequent location is the umbilicus. Most literature references consist in case reports or small case series. We report the case of a patient with an umbilical metastatic lesion (Sister Mary Joseph nodule) from a pancreatic adenocarcinoma, being this an unusual presentation as a clinical manifestation prior to diagnosing the original malignancy

Infección diseminada por Strongyloides stercoralis en dos receptores de trasplante renal de un único donante / Disseminated Strongyloides stercoralis infection in two persons receiving transplanted kidneys from a single donor: reported cases

La infección por Strongyloides stercoralis a partir de donantes de órganos es infrecuente, pero cuando se presenta genera diversas complicaciones. Se reportan dos casos de estrongiloidiasis diseminada derivado de un único donante cadavérico en dos receptores de trasplante renal. Ambos pacientes se presentaron con síntomas gastrointestinales y síntomas respiratorios más lesiones dermatológicas en región abdominal. El diagnóstico se basó en el hallazgo de larvas en lavado broncopulmonar, lesiones dermatológicas, y aspirado duodenal. A pesar del manejo con albendazol e ivermectina por vía oral el curso clínico fue fatal en uno de ellos. El segundo paciente recibió precozmente ivermectina por vía subcutánea y sobrevivió con falla intestinal persistente

A Strongyloides stercoralis infection acquired from the donor in a transplant receptor is not a common occurrence, but its complications have been well known. We report two cases of disseminated strongyloidiasis derived from a single cadaveric donor at two renal transplant recipients. Both patients presented gastrointestinal and respiratory symptoms plus dermatological lesions in the abdominal region. The diagnosis was based on the finding of larvae in bronchopulmonary lavage, dermatological lesions, and duodenal aspiration. Despite the oral administration of albendazole and ivermectin, the clinical course was fatal in one of them. The second patient received precociously ivermectin by subcutaneous administration and survived with persistent bowel failure

Enfermedad de Paget extramamaria: reporte de caso / Extramammary Paget's disease: case report

Se presenta el caso de una mujer de 67 años de edad, sin antecedentes de importancia, con un tiempo de enfermedad de un año. La paciente refiere una lesión tipo placa amarronada con áreas eritematosas y de bordes definidos, localizada en la región púbica izquierda, con extensión a la región inguinal, asociada a intenso prurito. Se le diagnosticó eccema y recibió tratamiento con corticoides tópicos, sin mostrar mejoría. Al momento de la evaluación, el examen físico no reveló adenopatías y los exámenes de laboratorio resultaron normales. El diagnóstico fue inmunohistopatológico, mediante el hallazgo de células de Paget y la tinción positiva para CK-7 y panqueratina, compatible con una enfermedad de Paget extramamaria, debida a diseminación intraepidérmica de un tumor primario de glándulas sudoríparas tipo adenocarcinoma in situ. La paciente fue sometida a una evaluación general para descartar una diseminación a distancia, pero no se encontró evidencia alguna. Se la trató exitosamente con cirugía escisional estándar con bordes libres y cursó favorablemente sin recurrencias cinco meses después.

A 67-year-old woman presented with a history of one year of pruriginous well defined brownish-reddish patch lesion on pubic area, which extended to inguinal area. An external diagnosis of eccema was made and the patient initiated treatment with topical corticosteroids for several months, without results. At present time, physical examination and laboratory evaluation did not reveal major alteration. A biopsy was taken and immunohistochemistry analysis was made, which revealed the presence of Paget's cells positive to CK-7 and pan Keratin. The results were compatible with extramammary Paget's disease secondary to intraepidermal dissemination of primary apocrine sweat glands adenocarcinoma. The patient underwent further evaluation to rule out distant metastases and was treated successfully with surgical excision alone with free margins. At follow-up five months later was still free of recurrences.

Asociación entre el conocimiento de las mujeres peruanas acerca del VIH y sus actitudes frente a personas infectadas / Association between knowledge of Peruvian women about HIV and their attitudes towards infected people

Objetivo: Determinar la asociación entre el conocimiento de las mujeres peruanas acerca del VIH con sus actitudes frente a las personas con VIH y sus características socio demográficas. Métodos: Análisis secundario de la Encuesta Demográfica y de Salud Familiar (ENDES) del año 2011. El conocimientos sobre VIH se evaluó mediante cinco preguntas: ¨se puede reducir el riesgo teniendo solo una pareja sexual?, ¨usando siempre condón?, ¨una persona saludable puede tener VIH?, ¨se puede contraer el VIH por besos y abrazos?, ¨por utensilios? Se consideró conocimiento adecuado si se contestó correctamente las cinco preguntas (directrices para el Desarrollo de Indicadores Básicos para el seguimiento de la Declaración Política sobre VIH/SIDA). La actitudes frente a personas infectadas se evaluaron mediante seis preguntas: si niño(a) tiene infección por VIH, ¨se le debe permitir asistir a la escuela o colegio? si un médico tiene infección por VIH, ¨se le debe permitir que siga con su trabajo en el establecimiento de salud? si una persona tiene infección por VIH y necesita operarse, ¨deben permitirle la operación?; ¨compraría vegetales de un vendedor con SIDA?; si un profesor tiene infección por VIH, ¨se le debe permitir seguir impartiendo clases en la escuela, colegio o universidad? Los análisis fueron realizados empleando el procedimiento de ponderación establecido por el INEI. Resultados: La pregunta sobre conocimiento mejor respondida fue la referida al uso del condón para disminuir el riesgo de contagio (86.5 por ciento), mientras que el 35.2 p respondió erróneamente que se puede contraer el VIH al compartir utensilios con una persona infectada...

Objective: To determine the association between the Peruvian women's knowledge about HIV and her attitudes towards the people with HIV, and the socio-demographic features. Methods: Secondary analysis of the Demographic and Family Health Survey (ENDES in espanish) 2011. The knowledge about HIV was measured with five questions: can the risk of contracting HIV be reduced by having only one sexual partner?, by using condom? A person who seems healthy, can have HIV? Can HIV be contracted by kisses and hugs?, by utensils? It was considered an adequate knowledge if the woman answered correctly the five questions (Guidelines on construction of core indicators for monitoring the political declaration of HIV/AIDS). The attitudes towards people with HIV was evaluated through six questions: if a child have HIV infection, should he or she be allowed to go to the school?; if a doctor have HIV infection, should he or she be allowed to continue working in a health center?; if a person with HIV need a surgery, should he or she be allowed to have the surgery?; would you buy vegetables from a seller with AIDS?; if a teacher have HIV infection, should he or she continue giving classes in the school, college or university? Every analysis was done using the weights established by the Statistics and Informatics National Institute (INEI). Results: The question about knowledge best answered was the one about using condom to reduce the risk of infection (86.5 percent), while 35.2 percent answered that HIV can be contracted by sharing utensils with a person infected. Only 38.9 percent answered correctly the five questions about knowledge. The best attitudes were observed in the scenario of a person with HIV who need a surgery and about the decision of firing an infected person, while the worst attitudes were observed about allowing a doctor with HIV to continue working and buying vegetables to a seller with AIDS...

Prevalencia de Anemia Nutricional en el Embarazo, en centros de salud Sarcobamba y Solomon Klein Enero 2010 - 2011 / Prevalence of Nutritional Anemia in pregnancy, in Sarcobamba and Solomon Klein healt centers 2010 - 2011

La anemia nutricional durante el embarazo es consecuencia de una dieta inadecuada y bajo contenido de hierro, el cual es un alto factor de riesgo para la salud materno infantil. Con el presente estudio se determinó la prevalencia de la anemia nutricional materna en los Centros de salud Solomon Klein y el de Sarcobamba en el periodo de enero del 2010 a enero del 2011. Es un estudio retrospectivo tipo descriptivo transversal donde se utilizó las variables de niveles de hemoglobina y grado de anemia. Se revisaron 98 Historias clínicas prenatales, en el centro de Sarcobamba , 137 en el centro Solomon Klein de mujeres embarazadas que asistieron a sus tres controles y se realizaron una prueba hematológica. La prevalencia de anemia nutricional en mujeres embarazadas fue de 40,8%, los niveles de anemia fueron 65,3% anemia leve, el 28,7% anemia moderada y el 5,9% anemia grave. Por lo tanto se concluye que la anemia nutricional en el embarazo aún sigue teniendo una alta prevalencia en los centros de primer nivel y sigue siendo uno de los retos en salud materna infantil que se debe vencer en los controles prenatales con un tratamiento oportuno y eficaz.

Nutritional anemia during pregnancy is the result of poor diet and low iron content. Which is a high risk factor for maternal and child health. The present study determined the prevalence of maternal nutritional anemia in Solomon' s Klein and Sarcobamba health centers in the period January 2010 to January 2011 .This is a retrospective descriptive cross study, where we used as variables hemoglobin and degree of anemia. We reviewed 98 Pre Natal Clinic Histories in Sarcobamba center, 137 Pre natl clinic Histories in Solomon's Klein center of pregnant women attending the three controls and a hematologic test performed. Prevalence of nutritional anemia in pregnant women was 40.8%, the levels of anemia were 65.3% with mild anemia, 28.7% moderate anemia and 5.9% severe anemia. Therefore it is concluded that nutritional anemia in pregnancy still have a high prevalence in first-class facilities and remains one of the maternal and child health challenges to be overcome in prenatal care with timely and effective treatment.

Características clínicas e inmunohistológicas del linfoma cutáneo de células T, tipo micosis fungoide Hospital Nacional Alberto Sabogal Sologúren, 2006-2010 / Clinics and immunohistological characteristics of cutaneous T-Cell type micosis fungoides Alberto Sabogal Hospital Sologuren National, 2006-2010

Los linfomas primarios cutáneos (LPC) son un grupo de desórdenes caracterizados por la proliferación de linfocitos malignos en la piel, sin evidencia de compromiso de otros órganos al momento del diagnóstico, aproximadamente dos tercios de ellos se originan en las células T, siendo el tipo más frecuente el Linfoma primario de células T tipo Micosis Fungoide (MF). La alta prevalencia, la escasa información sobre la epidemiología y características inmunohistológicas de este tipo de Linfoma en el Perú y Latinoamérica, motivaron el presente estudio. Objetivo: Conocer las características clínicas, histopatológicas e inmunohistoquímicas del Linfoma cutáneo de células T tipo micosis fungoide (MF) en el Hospital Alberto Sabogal Sologuren, durante el periodo 2006-2010. Material y métodos: Estudio de tipo retrospectivo, descriptivo, longitudinal y observacional, realizado en el Hospital Alberto Sologuren, en el periodo 2006-2010. Se revisaron las historias clínicas de los pacientes con el diagnóstico de MF, para obtener los datos clínicos y de laboratorio; además se revisaron las laminas histopatológicas de cada paciente con un médico especializado en patología cutánea del Servicio de Patología Quirúrgica del Hospital Guillermo Almenara Essalud, lugar donde se procesan regularmente las muestras para el estudio inmunohistoquímico. Resultados: se incluyeron 34 paciente, con una mediana de 65 años, siendo el mayor grupo etáreo el comprendido entre los 61 y 70 años. Sin diferencia de géneros, 50% para cada uno de ellos. Los años en que se registró un mayor diagnóstico de MF fueron el 2009 y 2010, con 11 casos en cada año (32.3%). El tiempo de enfermedad previo al diagnóstico fue de 1 a 5 años en 12 pacientes (35.3%), la forma de presentación clínica más frecuente fue el estadio de placa en 16 pacientes (47.1%) seguido de parches en 9 pacientes (26.5%). Las lesiones se localizaron con mayor frecuencia en las extremidades presentándose en el 70.6% en las inferiores...

Aim: To know the clinical, histopathological, and immune histochemical features of the mycosis fungoides (MF) variety of cutaneous T-cell lymphoma at the Alberto Sabogal Sologuren Hospital during 2006-2010. Material and methods: Retrospective, descriptive, longitudinal, observational study at the Alberto Sabogal Sologuren Hospital in the period 2006-2010. We performed a revision of the Medical records of patients with the diagnosis of MF, to obtain clinical and laboratory data, and looked through the Immuno histochemical archives of each patient at the Anatomo Pathology Department of the Alberto Sabogal Sologuren Hospital, with the assessment of a pathologist specializing in skin pathology from the department of Surgical Pathology of the Guillermo Almenara Essalud Hospital, where samples are processed regularly for inmunohistochemical study. Results: We studied 34 patients, with an average of 65 years, being the oldest group between 61 and 70 years. There was no gender difference, being 50% each one of them. The diagnosis of MF was greater between 2009 and 2010, with 11 (32.2%) of the cases in each year. The time of sickness was mainly from 1 to 5 years in 12 (35.3%) patients. The most frequent clinical presentation was the plaque in 16 (47.1%) of the patients, then the patches in 9 (26.5) of patients. This lesions were most frequently localized in the legs and arms, 70.6% in legs and 55.9% in arms 9 (26.5%) of patients. Other presentation was: in the chest 58.8%, 41.2% and abdomen 38.2%. The erythematous lesions were in the majority of patients, 76.5% of the cases. 18 cases (52.9%) had a previous diagnosis different of MF and the more prevalent were: Para-psoriasis 5 (14.7%), unspecific dermatitis in 4 (11.8%) and 2 cases of urticaria, 2 of psoriasis and 2 of lichen planus. The histopathology criteria was found in 100% of the patients, except micro abscesses in 26 patients (76.5%). All patients had positive Lymphocytes T, CD 3, CD 4, CD 5...

Late-life depression in Peru, Mexico and Venezuela: the 10/66 population-based study.

BACKGROUND: The proportion of the global population aged 60 and over is increasing, more so in Latin America than any other region. Depression is common among elderly people and an important cause of disability worldwide. AIMS: To estimate the prevalence and correlates of late-life depression, associated disability and access to treatment in five locations in Latin America. METHOD: A one-phase cross-sectional survey of 5886 people aged 65 and over from urban and rural locations in Peru and Mexico and an urban site in Venezuela. Depression was identified according to DSM-IV and ICD-10 criteria, Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) algorithm and EURO-D cut-off point. Poisson regression was used to estimate the independent associations of sociodemographic characteristics, economic circumstances and health status with ICD-10 depression. RESULTS: For DSM-IV major depression overall prevalence varied between 1.3% and 2.8% by site, for ICD-10 depressive episode between 4.5% and 5.1%, for GMS-AGECAT depression between 30.0% and 35.9% and for EURO-D depression between 26.1% and 31.2%; therefore, there was a considerable prevalence of clinically significant depression beyond that identified by ICD-10 and DSM-IV diagnostic criteria. Most older people with depression had never received treatment. Limiting physical impairments and a past history of depression were the two most consistent correlates of the ICD-10 depressive episode. CONCLUSIONS: The treatment gap poses a significant challenge for Latin American health systems, with their relatively weak primary care services and reliance on private specialists; local treatment trials could establish the cost-effectiveness of mental health investment in the government sector.

[Management of chronic subdural hematoma with twist-drill craniostomy. Report of 213 patients]. / Manejo del hematoma subdural crónico mediante minitrépano y sistema de drenaje sin succión, experiencia en 213 pacientes.

OBJECTIVES: Controversies regarding the surgical management of chronic subdural hematoma still remain. The objective of the present study was to describe our experience with twist-drill craniostomy. PATIENTS AND METHODS: Two hundred and thirteen patients were treated at the "Teodoro Maldonado Carbo" and "Alcívar" facilities between January 1992- February 2005. The surgical technique consisted of a twist-drill made under local anesthesia at the patient's bedside. We administered the Markwalder grading scale and the Glasgow outcome scale to assess treatment results. Clinical outcome, complications and relapse were measured. RESULTS: The etiology was traumatic in 65% of cases. At admission, 79% scored 2 of the Markwalder grading scale. Nine percent of the patients displayed complications. The chronic subdural hematoma persisted in 8%; they were treated again with another twist-drill craniostomy with favorable results. At six months, 97.6% reached 5 in the Glasgow outcome scale. CONCLUSIONS: Twist-drill craniostomy is a less time consuming, safe, effective, and cost-efficient method for the treatment of chronic subdural hematoma.

Manejo del hematoma subdural crónico mediante minitrépano y sistema de drenaje sin succión, experiencia en 213 pacientes / Management of chronic subdural hematoma with twist-drill craniostomy: report of 213 patients

Objetivos: Aún existen controversias respecto a la técnica en el manejo quirúrgico del hematoma subdural crónico. Este estudio tiene como objetivo describir nuestra experiencia en la craneostomía mediante el uso de minitrépano (twist drill). Pacientes y métodos: Fueron tratados 213 pacientes en los hospitales “Teodoro Maldonado Carbo” y “Alcívar” de Guayaquil, entre los meses de enero del 1992 y febrero del 2005. La técnica quirúrgica consistió en la evacuación del hematoma mediante minitrépano que se realizó en la cama del paciente y bajo anestesia local. Para evaluar los resultados utilizamos las escalas de Markwalder y la escala de evolución de Glasgow. Valoramos la evolución, las complicaciones y la recidiva. Resultados: Existió antecedente traumático en 65 % de los casos. Setenta y nueve por ciento ingresaron en grado 2 de la escala de Markwalder. Nueve por ciento presentó alguna complicación. Ocho por ciento recidivó, pero mostró curación después de un nuevo procedimiento. A los 6 meses, el 97 % evolucionó en grado 5 según la escala de evolución Glasgow. Conclusiones: La craneostomía por minitrépano es un método rápido, seguro, efectivo y menos costoso.

OBJECTIVES: Controversies regarding the surgical management of chronic subdural hematoma still remain. The objective of the present study was to describe our experience with twist-drill craniostomy. PATIENTS AND METHODS: Two hundred and thirteen patients were treated at the "Teodoro Maldonado Carbo" and "Alcívar" facilities between January 1992- February 2005. The surgical technique consisted of a twist-drill made under local anesthesia at the patient's bedside. We administered the Markwalder grading scale and the Glasgow outcome scale to assess treatment results. Clinical outcome, complications and relapse were measured. RESULTS: The etiology was traumatic in 65% of cases. At admission, 79% scored 2 of the Markwalder grading scale. Nine percent of the patients displayed complications. The chronic subdural hematoma persisted in 8%; they were treated again with another twist-drill craniostomy with favorable results. At six months, 97.6% reached 5 in the Glasgow outcome scale. CONCLUSIONS: Twist-drill craniostomy is a less time consuming, safe, effective, and cost-efficient method for the treatment of chronic subdural hematoma.

Diversidad de abejas (himenoptera; apoidea) en estados sucesionales del bosque humedo tropical / Bee Diversity (Hymenoptera: Apoidea) in a Tropical Rainforest Succession

Los objetivos principales de este trabajo fueron entender cómo la diversidad de abejas cambia durante la sucesión en un bosque húmedo neotropical, y comparar la eficiencia de los cuatro métodos de captura usados. La diversidad y riqueza de abejas fueron estudiadas al nororiente de Medellín (Antioquia, Colombia; 9001.100 m) durante seis meses en cuatro estados sucesionales (pastizal, rastrojo bajo, rastrojo alto y bosque). Las abejas fueron intensiva y sistemáticamente capturadas usando los siguientes métodos: red entomológica, Malaise, metil salicilato para abejas euglosinas (Apidae, Euglossini) y trampa Van Somer con pescado de agua dulce en descomposición. En total se capturaron 15.356 especímenes pertenecientes a cuatro familias y 287 especies de abejas. Esto corresponde al 62 por ciento del número total de especies de abejas conocidas para Colombia. Aproximadamente el 50 por ciento de todos los individuos fueron abejas sociales sin aguijón (Apidae, Meliponini). Trigona (Trigona) fulviventris fue la especie más abundante (~10 por ciento) en todo el muestreo. Augochlora y Megachile fueron los géneros con mayor número de especies. El pastizal y rastrojo alto presentaron los mayores índices de diversidad y riqueza de abejas y fueron significativamente más altos que los del bosque y rastrojo bajo. En todos los estados sucesionales, excepto por el bosque, el número de especies nuevas por muestra tendió a cero, y las curvas de acumulación de especies tendieron a normalizarse con el tiempo y aumento en el área de muestreo. La red entomológica fue el método más eficiente en todos los estados sucesionales, excepto en el bosque, donde el mayor número de especies e individuos fueron capturados con la trampa Van Somer. Sin embargo, en todos los estados sucesionales un mayor porcentaje (50 por ciento) de especies raras fueron colectadas con Malaise. El número de especies nuevas colectadas en cada muestra y las curvas de acumulación de especies sugieren que el muestreo...