RESUMO
BACKGROUND: In resource-limited countries, open appendectomy is still performed under general anesthesia (GA) or neuraxial anesthesia (NA). We sought to compare the postoperative outcomes of appendectomy under NA versus GA. METHODS: We conducted a post hoc analysis of the International Patterns of Opioid Prescribing (iPOP) multicenter study. All patients ≥ 16 years-old who underwent an open appendectomy between October 2016 and March 2017 in one of the 14 participating hospitals were included. Patients were stratified into two groups: NA-defined as spinal or epidural-and GA. All-cause morbidity, hospital length of stay (LOS), and pain severity were assessed using univariate analysis followed by multivariable logistic regression adjusting for the following preoperative characteristics: age, gender, body mass index (BMI), smoking, history of opioid use, emergency status, and country. RESULTS: A total of 655 patients were included, 353 of which were in the NA group and 302 in the GA group. The countries operating under NA were Colombia (39%), Thailand (31%), China (23%), and Brazil (7%). Overall, NA patients were younger (mean age (SD): 34.5 (14.4) vs. 40.7 (17.9), p-value < 0.001) and had a lower BMI (mean (SD): 23.5 (3.8) vs. 24.3 (5.2), p-value = 0.040) than GA patients. On multivariable analysis, NA was independently associated with less postoperative complications (OR, 95% CI: 0.30 [0.10-0.94]) and shorter hospital LOS (LOS > 3 days, OR, 95% CI: 0.47 [0.32-0.68]) compared to GA. There was no difference in postoperative pain severity between the two techniques. CONCLUSIONS: Open appendectomy performed under NA is associated with improved outcomes compared to that performed under GA. Further randomized controlled studies should examine the safety and value of NA in lower abdominal surgery.
Assuntos
Analgésicos Opioides , Apendicectomia , Adolescente , Anestesia Geral , Apendicectomia/efeitos adversos , Humanos , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia , Padrões de Prática Médica , Estudos RetrospectivosRESUMO
OBJECTIVE: The International Patterns of Opioid Prescribing study compares postoperative opioid prescribing patterns in the United States (US) versus the rest of the world. SUMMARY OF BACKGROUND DATA: The US is in the middle of an unprecedented opioid epidemic. Diversion of unused opioids contributes to the opioid epidemic. METHODS: Patients ≥16 years old undergoing appendectomy, cholecystectomy, or inguinal hernia repair in 14 hospitals from 8 countries during a 6-month period were included. Medical records were systematically reviewed to identify: (1) preoperative, intraoperative, and postoperative characteristics, (2) opioid intake within 3 months preoperatively, (3) opioid prescription upon discharge, and (4) opioid refills within 3 months postoperatively. The median/range and mean/standard deviation of number of pills and OME were compared between the US and non-US patients. RESULTS: A total of 4690 patients were included. The mean age was 49 years, 47% were female, and 4% had opioid use history. Ninety-one percent of US patients were prescribed opioids, compared to 5% of non-US patients (P < 0.001). The median number of opioid pills and OME prescribed were 20 (0-135) and 150 (0-1680) mg for US versus 0 (0-50) and 0 (0-600) mg for non-US patients, respectively (both P < 0.001). The mean number of opioid pills and OME prescribed were 23.1â±â13.9 in US and 183.5â±â133.7âmg versus 0.8â±â3.9 and 4.6â±â27.7âmg in non-US patients, respectively (both P < 0.001). Opioid refill rates were 4.7% for US and 1.0% non-US patients (P < 0.001). CONCLUSIONS: US physicians prescribe alarmingly high amounts of opioid medications postoperatively. Further efforts should focus on limiting opioid prescribing and emphasize non-opioid alternatives in the US.
Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica , Adulto , Idoso , Feminino , Saúde Global , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estados UnidosRESUMO
Prader-Willi syndrome is a genetic disorder characterized by hypotonia, obesity, short stature, mental retardation, hyperphagia, hypogonadism and low life expectancy. We describe the case of a 31-year-old female patient with Prader-Willi syndrome scheduled forbariatric surgery. Anesthetic considerations are reviewed highlighting perioperative complications associated with this syndrome.
El síndrome de Prader-Willi es un desorden genético caracterizado por hipotonía, obesidad, baja estatura, retraso mental, hiperfagia, hipogonadismo y expectativa de vida reducida. Describimos el caso de una paciente de 31 años con antecedente de síndrome de Prader -Willi, programada para realización de cirugía bariátrica. Se revisan las consideraciones anestésicas, haciendo énfasis en las complicaciones perioperatorias secundarias a este síndrome.
Assuntos
HumanosRESUMO
INTRODUCCIÓN El estudio de la enfermedad periodontal (EP) ha presentado resultados imprecisos y heterogéneos debido a diversos factores, entre ellos, los métodos usados en la medición, las diferencias en el momento de definir el grado de afectación y los valores desde los cuales se consideraría que un paciente presenta EP. Existen múltiples índices periodontales utilizados frecuentemente en estudios epidemiológicos, cada uno con sus criterios y protocolos de medición. OBJETIVO Determinar la concordancia del valor de la prevalencia de la EP dada por algunos índices periodontales utilizados. MATERIALES Y MÉTODO Se realizó un estudio observacional transversal descriptivo en una población de 58 pacientes adultos de 35-44 años pertenecientes al CESFAM Lorenzo Arenas, Concepción, en el año 2013. Los examinadores fueron calibrados. Se realizó un examen con registro de boca completa midiendo 6 sitios por diente, con exclusión de los terceros molares, para medir pérdida de inserción clínica, profundidad de sondaje y hemorragia al sondaje. Los resultados se analizaron mediante el programa estadístico EPIDAT 3.0. RESULTADOS Se determinaron unos valores de prevalencia de EP muy distintos entre los indicadores evaluados, obteniéndose una variación de incluso 31 puntos en una escala porcentual. El análisis de la concordancia de los índices periodontales con el indicador CDC/AAP mostró que tanto ICEP, como CPI y CPITN lograron un buen valor kappa. CONCLUSIÓN A pesar de la gran diversidad de los índices con respecto a su formulación, se observó cierta concordancia entre algunos de ellos.
INTRODUCTION The study of periodontal disease (PD) has shown inaccurate and heterogeneous results due to various factors, among them: most used methods to measure the illness, differences at the time of deciding the level in which it affects patients and the values from which a patient would be considered to suffer from PD. There are numerous periodontal indexes frequently used in epidemiological studies, each one with different criteria and measurement protocols. OBJECTIVE To establish the agreement in PD prevalence value given by some periodontal indexes used. MATERIALS AND METHOD A descriptive cross-sectional observational study was conducted on 58 adult patients between 35-44 years old belonging to Lorenzo Arenas Primary Health Care Center in Concepcion during the year 2013. All examiners who participated in the study were calibrated. A full mouth registration exam was carried out, measuring 6 places per tooth, not including the third molars, in order to measure the clinical attachment loss, probing depth, and bleeding on probing. The results were analyzed using EPIDAT 3.0 statistical program. RESULTS Very different PD prevalence values were obtained using the measured indicators, having a variation of up to 31 points in a percentage scale. The analysis of the agreement in periodontal indexes with the CDC/AAP indicator showed ICEP, CPI and CPITN scored a good kappa value. CONCLUSION Despite the great diversity of the indices with respect to their formulation, some correlation between them was observed.
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Humanos , Masculino , Adulto , Doenças Periodontais/epidemiologia , Índice Periodontal , Periodontite/epidemiologia , Valores de Referência , Chile , Prevalência , Estudos TransversaisRESUMO
La evaluación de los Servicios de salud para el mejoramiento de la calidad es una actividad que produce discusiones. El desarrollo de una metodología basada en la percepción de los usuarios sobre los intangibles del servicio es hoy más frecuente, cuidando la inclusión de todos los grupos como son familias con personas con discapacidad. Se estudió la población asignada a un Centro de Salud Familiar (CESFAM) mediante una encuesta validada en la metodología SERVPERF en los hogares a personas mayores de 14 años, con pacientes sin y con discapacidad atendidos bajo la modalidad pública. Se detectaron niveles de valoración con diferencias estadísticamente significativas, siendo más baja para los pacientes discapacitados. El mejoramiento pasa por un enriquecimiento del capital social, especialmente del personal de apoyo al profesional y de un fortalecimiento de elementos secundarios como son folleterías e instructivos. Hay que dar el sentido al servicio público: la satisfacción del usuario
The assessment of the health services for improvement of quality is an activity that produces discussions. The development of a new methodology based on the perception of users about intangibles of the service its today more frequent, taking care about the inclusion of all the groups like families with people with handicap members. It was studied the assigned population in a family health center through a survey validated with SERVPERF methodology in persons with more than 14 years old, with patients with disabilities and without them in the public system. It was detected levels of assessment with statistically significantly differences, the lowest rating was for patients with disabilities. The improvement involves enrichment of the social capital, especially of the back up personal to the professional and strengthening of secondary elements like educative printed material. We have to give a sense to the public service: the satisfaction of the users
Assuntos
Humanos , Assistência Odontológica para a Pessoa com Deficiência , Pesquisa sobre Serviços de Saúde , Acessibilidade aos Serviços de SaúdeRESUMO
Objetivo: revisar los aspectos más relevantes del manejo de la gestante con virus de inmunodeficiencia humana (VIH) antes, durante y después del parto. También se incluyen las medidas básicas de cuidado al recién nacido. Metodología: se realizó una revisión de las publicaciones en MEDLInE entre enero de 2000 y junio de 2009 sobre el tema. Asimismo, se abordaron las guías de manejo del Ministerio de Protección Social de Colombia y las pertenecientes a los Centros para el Control de Enfermedades de los EE.UU. de América. Resultados: la oportuna prescripción de la terapia antirretroviral de alta efectividad durante el control prenatal, la utilización de profilaxis antirretroviral anteparto, la realización de cesárea anteparto, evitar la lactancia materna y la profilaxis neonatal son las medidas que evitarán casi al 100% la transmisión madre-hijo del VIH. Conclusión: el manejo actualmente recomendado permite la prevención de la transmisión madre-hijo del VIH en la mayoría de los casos.
Objective: reviewing the most relevant aspects involved in managing pregnant females affected by human immunodeficiency virus (HIV) before, during and after giving birth. Basic measures in caring for the newborn are also included. Methodology: MEDLINE publications on the topic published from January 2000 to June 2009 were reviewed. Colombian Ministry of Social Protection guidelines were also reviewed as well as those from the US Centers for Disease Control and Prevention (CDC). Results: the opportune prescription of highly effective antiretroviral therapy during prenatal control, using pre-delivery antiretroviral prophylaxis, performing caesarean section, avoiding maternal breastfeeding and neonatal prophylaxis were found to be the measures which would lead to almost 100% mother-child HIV transmission being avoided. Conclusion: current management recommendations would lead to preventing mother-child HIV transmission in most cases.
Assuntos
Humanos , Adulto , Feminino , Gravidez , Anticoncepção , HIV , Recém-Nascido , Lactação , GravidezRESUMO
Se revisaron las hostirias clínicas de 671 pacientes quienes asistieron a la consulta externa de pediatría y presentaron como diagnóstico malaria, en un período de 36 meses comprendido entre el 1 de enero de 1993 y 31 de diciembre de 1995. El diagnóstico de malaria se llevó a cabo por parasitemia positiva en gota gruesa y/o extendido de sangre periférica mediante la coloración de Field. Se hallaron 166 pacientes quienes cursaron con malaria por Plasmodium falciparum y 505 por Plasmo-dium vivax de los cuales 9 presentaron resistencia clínica al tratamiento con cloroquina, para lo cual nos basamos en los criterios propuestos por la Organización Mundial de la Salud en 1967. Se analizó en estos 9 pacientes su distribución por sexo, edad, procedencia, tipo de resistencia y respuesta al tratamiento. Proponemos un manejo terapéutico para el Plasmodium vivax resistente a la cloroquina que nos fue efectivo en la totalidad de los casos, sin la necesidad de utilizar nuevas drogas
