Hepatic Rupture Associated With HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelets) Syndrome: A Report of Two Cases and Literature Review.

Hepatic rupture is a rare complication of severe preeclampsia. A high index of suspicion is required in the presence of abdominal pain accompanied by hemodynamic decompensation in a pregnant woman. Hepatic rupture constitutes a medical emergency that demands immediate intervention, often with the support of other medical disciplines, in a highly specialized hospital setting. Unruptured hepatic hematomas can be managed conservatively. Immediate delivery and surgical repair of the liver are necessary for maternal survival. Spontaneous liver rupture in pregnancy is often unrecognized, highly lethal, and not completely understood with few cases having been reported in the literature. Therefore, we present two cases of HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome with hepatic rupture, emphasizing their clinical presentation and therapeutic approaches.

Technological Improvements in Low- and Middle-Income Countries (LMICs): A Review of the Literature and the "Sociedad de Lucha Contra el Cáncer" (SOLCA) Institutional Experience in Neuro-Radiosurgery During the Coronavirus Disease 2019 (COVID-19) Pandemic.

OBJECTIVE: Neurosurgery is a medical field that requires specialized professionals and equipment, 2 important but scarce resources in low- and middle-income countries. Our goal was to report our experience with the replacement and implementation of linear accelerators with radiosurgery capabilities at "Sociedad de Lucha Contra el Cáncer" (SOLCA) Hospital in Quito, Ecuador, and give some recommendations for future technological replacements (TRs). METHODS: Two surveys were performed in SOLCA's radiosurgery department, one before the TR was finalized and one after, consisting of an open and multiple-choice questionnaire. Questions focused on the performance of the new equipment, perceptions regarding the training, and the influence of the pandemic on the whole process. In addition, we share our experience regarding the difficulties and benefits of TR at SOLCA. RESULTS: The most-reported limitation was lack of training (48%). By the time of the second survey, 95.2% of the staff had already treated patients or planned a radiosurgical procedure; 42.9% considered training to have been adequate, and 76.2% felt that the pandemic hindered the training process. Currently, 33 radiosurgeries have been done (26 for the central nervous system and 7 stereotactic radiation body therapies). CONCLUSIONS: The TR in SOLCA had similarities with other experiences in low- and middle-income countries, but the pandemic brought additional limitations, mainly complicating the staff training. Nevertheless, those limitations can be resolved with a structured training program and international collaboration. Overall, the benefits obtained from a TR result in exponentially better medical care and accessibility to novel treatments.

Trabajo colaborativo en el manejo de malformaciones faciales congénitas / Collaborative Work in the management of congenital facial malformations

RESUMEN El sistema de servicios de salud en el Perú es fragmentado y segmentado, en este nuevo siglo se requiere de una actitud coordinada y cooperativa entre los profesionales de la salud. Las malformaciones labio alveolo palatinas, son anomalías congénitas más frecuentes de la región bucomaxilofacial, afecta el crecimiento y desarrollo de estructuras orofaciales de las dos terceras partes de la cara, alterando reflejos orales innatos como la mordida, succión, deglución y la capacidad de la cavidad bucal para permitir acumulación de presión. Un desempeño adecuado en los servicios de salud se logra con una visión y postura compartida entre los integrantes del equipo de trabajo, sumada a una gestión eficaz, para lo cual la práctica colaborativa interprofesional requiere de cambios de paradigma, en el que se demuestre una evidencia sustancial e irrefutable de una cultura de equipo y un entorno interdisciplinario confiable, reconociendo responsabilidad compartida en los resultados.

ABSTRACT The health services system in Peru is fragmented and segmented, in this new century a coordinated and cooperative attitude is required among health professionals. Lip alveolus-palatine malformations are the most frequent congenital anomalies on the bucomaxillofacial region, affecting the growth and development of orofacial structures of two-thirds of the face, altering innate oral reflexes such as biting, sucking, swallowing and the capacity on the cavity buccal to allow pressure build-up. Adequate performance in health service is achieved with a shared vision and posture among the members of the work team, added to effective management, for which interprofessional collaborative practice requires paradigm changes, in which evidence is demonstrated substantial and irrefutable of a team culture and a reliable interdisciplinary environment, recognizing shared responsibility for results.

Estadíos de maduración ósea y su relación con la edad cronológica según el método de Hagg y Taranger / Stages of bone maturation and its relation to chronological age according to the method of Hagg and Taranger

En el presente estudio, el método que se propone para determinar la edad ósea es el de la radiografía de la falange media del tercer dedo de la mano no dominante a través de una radiografía periapical convencional N° 02. Si no se instaura el tratamiento ortodóntico u ortopédico durante el período de aceleración de crecimiento o en el pico de crecimiento puberal (estadío FG yG, respectivamente), puede llevar a fracasos o retardo en los resultados del tratamiento, ya que los mayores efectos de los aparatos de ortopedia ocurren cuando el pico de crecimiento coincide con el período de tratamiento. El objetivo del estudio fue determinar la edad cronológica promedio para cada estadío de maduración ósea según el método de Hagg y Taranger, en 62 niños desnutridos crónicos, entre 9 y 14 años de edad, que acudieron al Centro de Salud de Ocongate, del distrito del mismo nombre, entre Marzo y Abril del 2010. El pico máximo de velocidad de crecimiento puberal (estadío G) se presentó en mujeres a una edad de 13.10 años y en varones a los 13.92 años.

In this study, the method that is proposed to determine the bone age is the X– ray of the middle phalanx of the third finger of the nondominant hand through a conventional periapical X–ray Nº 02. If it is not instaured the treatment orthodontic or orthopedic during the period of accelerated growth or pubertal growth spurt (FG and G, respectively), can lead to failure or delay in treatment outcomes as the major effects of orthopedic appliances occur when the growth spurt coincides with the period of treatment. The Objective was determine the average chronological age for each stage of bone maduration, according to the method of Hagg and Taranger, in 62 chronically malnouris hed children, between 9 and 14 years old who came to the Health Center of Ocongate, in March and April of 2010. The peak of pubertal growth spurt (stage G) occurred in females at 13.10 years old and 13.92 years formales.

Noma: revisión de literatura y reporte de caso clínico / Noma: a literature review and case report

El Noma es una enfermedad rara, cuya característica es provocar destrucción de tejidos duros y blandos bucafaciales, en la presencia de esta enfermedad influyen causas predisponentes de orden sistémico como es la desnutrición crónica, además de las bacterias que habitan la cavidad bucal; las personas que la padecen requieren para su tratamiento la administración de antibióticos y la mejora de las condiciones predisponentes.

The Noma is a rare disease, whose characteristic is cause destruction of hard and soft tissues bucofaciales, in the presence of this disease influence predisposing causes systemic such as chronic malnutrition, in addition to the bacteria that live in the oral cavity; people who suffer Noma, required for treatment, the administration of antibiotic and the improvement of predisposing conditions.

Osteomielitis: revisión de la literatura y reporte de caso clínico / Osteomyelitis: a review of the literature and case report

La osteomielitis es una enfermedad inflamatoria infecciosa producida por gérmenes piógenos, fundamentalmente estafilococos y en algunas ocasiones por estreptococos, neumococos y enterobacterias. Esta enfermedad que hace años era un compromiso para la vida, actualmente gracias a la acción de los antibióticos, se ha convertido en una afección menos frecuente y con pronóstico totalmente modificado. La característica general de la inflamación ósea de los maxilares se basa en la falta de límites anatómicos en la localización del proceso inflamatorio. El tejido normal compuesto por periostio, cortical, canal medular y tejido esponjoso puede verse afectado de forma individual o conjunta, de ahí que cuando el periostio está inflamado, también lo está en mayor o menor grado el tejido óseo; la inflamación de la cavidad medular afecta invariablemente el tejido óseo adyacente. De igual modo, si el tejido óseo está inflamado, el periostio o la médula, o ambas, padecen de cierto grado de inflamación. Presentamos un caso clínico atendido en la consulta del servicio de Odontología del Hospital de Apoyo Departamental del Cusco, en el que se aplican los conocimientos teóricos presentados, para la resolución exitosa del cuadro mencionado.

Osteomyelitis is an inflammatory infectious disease produced by pyogen germs, mostly staphylococcus and sometimes streptococcus, neumococcus and enterobacterias. This disease in many years ago was a risk of life, actually thanks to antibiotics, has become into a less frequent disease and with better prognosis. The common characteristic of bone inflammation is based in the absence of anatomical limits for the location of inflammatory process. The normal tissue made up periostium, cortical, medullar channel and porous tissue may be affected individually or whole, that’s why when periostium is inflamed also is bone tissues in low or high level; the inflammation of the medullar channel affects the adjacent bone tissue. In the same way, if the bone tissue is inflamed, the periostium, medulla or both have some inflammation degree. We present a clinical case, which was attended in the service of dentistry of the Hospital de Apoyo Departamental del Cusco, in which we use the teorical knowledge presented, for the successful solution of the mentioned pathology.