Early Outcome after Sublay versus Onlay Polypropylene Mesh Repair for Ventral Midline Incisional Hernia - A Single Center Retrospective Analysis.

CONTEXT: Onlay and retromuscular sublay mesh repairs are the most frequently used procedures in open repair of midline incisional hernias. The onlay placement of the mesh is simple and fast to perform, while the sublay retromuscular repair offers a supplementary protection against infection, but it is considered a more complicated procedure with a higher risk of early postoperative complications. The personal experience of the surgeons plays an important role in choosing the technique of mesh placement. MATERIAL AND METHODS: This paper presents the results of a retrospective analysis of 220 consecutive patients operated on in the Surgical Clinic of the Mures Clinical County Hospital (Romania) between 31.01.2017 - 31.12.2019 with sublay or onlay polypropylene mesh repair for ventral midline incisional hernia. The patients were divided into two groups according to the position of the mesh. The two groups were identical in terms of age, sex distribution, incidence of comorbidities (obesity, diabetes mellitus, cardiac and respiratory diseases), number of previous operations and size of the defect (p value 0.05 for all the parameters). Results: Postoperative mortality was zero, with no statistically significant differences of the duration of the postoperative hospitalization between the two groups p 0.05. A total of 34 early reoperations were required for hematoma, skin necrosis, seroma, wound suppuration, and intestinal obstruction, with no statistically significant difference between the two groups (p 0.05 for the overall and separate incidence of each complication). The onlay placement of the mesh was associated with a later removal of the superficial drains p 0.0001 with a larger proportion of the patients who were discharged without removing the drains (group A 2/62 versus group B 141/168, p 0.0001). Conclusions: Both the onlay and the retromuscular sublay placement of polypropylene meshes may be used with good results for the treatment of midline incisional hernias. The lack of a supplementary early morbidity after the retromuscular sublay repair is an argument for a more frequent use of this technique which offers a supplementary protection against infection.

Signos de alarma en proctocolitis eosinofílica: reporte de dos casos / Warning Signs for Eosinophilic Proctocolitis: Two Case Reports

Se presentan dos pacientes con un diagnóstico de proctocolitis eosinofílica sin persistencia de la manifestación más típica, la rectorragia, aunque con perseverancia de su compromiso inflamatorio eosinofílico. A propósito de estos casos, se señala la importancia de evaluar otras manifestaciones menos relevantes como parte del seguimiento estricto de los pacientes, con el fin de decidir si necesitan colonoscopia y biopsias, así como de reorientar el manejo mediconutricional.

We present the cases of two patients diagnosed with eosinophilic proctocolitis without persistence of rectal bleeding which is the most typical manifestation but with perseverance of the eosinophilic inflammation. One purpose of presenting these cases is to emphasize the importance of assessing less relevant demonstrations as part of the strict monitoring of patients in order to decide whether they need colonoscopy and biopsies and to allow redirection of medical nutrition management.

Comparación de la evaluación tradicional del desarrollo psicomotor versus una prueba autoadministrada / Comparison of Traditional Psychomotor Development Evaluation versus a Self-Administered Test?

Introducción: El propósito del estudio fue evaluar la aplicabilidad de un cuestionario de autoreporte para el screening del desarrollo psicomotor (DSM) en atención primaria de salud (APS). Para ello se analizó el grado de acuerdo entre el cuestionario Ages and Stages (ASQ) y la Escala de Evaluación del Desarrollo Psicomotor (EEDP), que es el método empleado de rutina en APS. Además, se exploraron las percepciones y valoraciones comparativas de profesionales que participaron en la aplicación de dichos test. Metodología: Estudio cuanti-cualitativo, realizado entre noviembre 2008 y diciembre 2009. En 2 centros de Salud de la Región Metropolitana de Chile se reclutó lactantes nacidos de término, que acudieron a control sano. A los 8 y 18 meses se les solicitó a los padres o cuidadores principales completar el ASQ y un profesional de APS aplicó el EEDP. Se midió la correlación y concordancia entre ambos test. Se aplicaron entrevistas individuales y mini focus groups a los profesionales participantes en las evaluaciones. Resultados: Fueron reclutados 330 lactantes. La frecuencia de déficit del DSM fue 8,79% en EEDP y 12,73% en ASQ (p0,05). Hubo correlación entre ambas evaluaciones (r 0,5) y la concordancia en la pesquisa de déficit de DSM fue buena (kappa 0.576). En el análisis cualitativo destacó la valoración positiva del ASQ, tanto como instrumento de medición, como guía para promover el DSM. Para suplir las debilidades del ASQ, relacionadas con la modalidad de autoreporte, en grupos de mayor riesgo socio cultural o educacional, los centros de salud adoptaron diferentes estrategias. Conclusiones: El ASQ pesquisó significativamente más déficits del DSM que el EEDP, mientras que la correlación y concordancia entre ambas pruebas fueron adecuadas. Considerando las ventajas comparativas del ASQ en opinión de los profesionales, se propone que los centros de APS que deseen implementar ASQ, tomen una estrategia progresiva basada en la integración de los padres, madres y cuidadores en la observación del desarrollo de sus hijos.

Introduction: The purpose of this study is to evaluate the applicability of a self-administered questionnaire in the screening of psychomotor development (PD) in a primary care setting (PC). For that purpose, the degree of concordance between the Ages and Stages Questionnaire (ASQ) and a Psychomotor Development Evaluation Scale (Escala de Evaluación del Desarrollo Psicomotor-EEDP) currently utilized in PC was tested. In addition, perceptions and value judgment by professionals who participated in the study were explored. Methodology: This semi-quantitative study was performed between November 2008 and December 2009 in two PC centers of the Metropolitan Area of Chile on full-term newborns of the well-baby clinic. At age 8 and 18 months, parents or primary caretakers were asked to fill out the ASQ, and a PC professional completed the EEDP. Correlation and concordance between both tests was measured. Interviews and mini-focus groups were conducted with the participating professionals. Results: Three hundred and thirty newborns were recruited in the study. PD deficits were found on 8.79% of patients through the use of EEDP and in 12.73% through the use of ASQ (p = 0,05). Correlation between both evaluations was acceptable (r 0,5) as was concordance in deficit detection (kappa 0.576). The qualitative analysis showed appreciation of ASQ as a measuring tool as well as promoting awareness of PD. Staff of the PC settings utilized various strategies to overcome deficiencies of a self-administered test in populations of higher socio-educational and cultural risk. Conclusions: ASQ picked up significantly more PM deficits than EEDP, while correlation and concordance indices between both tests were adequate. Considering the subjective advantages expressed by staff in favor of ASQ, it is proposed that those PC centers that wish to implement the ASQ do so by progressively incorporating parents and caretakers into the observation of their children's development.

Comparación de la evaluación tradicional del desarrollo psicomotor versus una prueba autoadministrada / Comparison of traditional psychomotor development evaluation versus a self-administe-red test

Introduction: The purpose of this study is to evaluate the applicability of a self-administered questionnaire in the screening of psychomotor development (PD) in a primary care setting (PC). For that purpose, the degree of concordance between the Ages and Stages Questionnaire (ASQ) and a Psychomotor Development Evaluation Scale (Escala de Evaluación del Desarrollo Psicomotor-EEDP) currently utilized in PC was tested. In addition, perceptions and value judgment by professionals who participated in the study were explored. Methodology: This semi-quantitative study was performed between November 2008 and December 2009 in two PC centers of the Metropolitan Area of Chile on full-term newborns of the well-baby clinic. At age 8 and 18 months, parents or primary caretakers were asked to fill out the ASQ, and a PC professional completed the EEDP. Correlation and concordance between both tests was measured. Interviews and mini-focus groups were con-ducted with the participating professionals. Results: Three hundred and thirty newborns were recruited in the study. PD deficits were found on 8.79 percent of patients through the use of EEDP and in 12.73 percent through the use of ASQ (p = 0,05). Correlation between both evaluations was acceptable (r 0,5) as was concordance in deficit detection (kappa 0.576). The qualitative analysis showed appreciation of ASQ as a measuring tool as well as promoting awareness of PD. Staff of the PC settings utilized various strategies to overcome deficiencies of a self-administered test in populations of higher socio-educational and cultural risk. Conclusions: ASQ picked up significantly more PM deficits than EEDP, while correlation and concordance indices between both tests were adequate. Considering the subjective advantages expressed by staff in favor of ASQ, it is proposed that those PC centers that wish to implement the ASQ do so by progressively incorporating parents and caretakers into the observation of their children's development.

Introducción: El propósito del estudio fue evaluar la aplicabilidad de un cuestionario de autoreporte para el screening del desarrollo psicomotor (DSM) en atención primaria de salud (APS). Para ello se analizó el grado de acuerdo entre el cuestionario Ages and Stages (ASQ) y la Escala de Evaluación del Desarrollo Psicomotor (EEDP), que es el método empleado de rutina en APS. Además, se exploraron las percepciones y valoraciones comparativas de profesionales que participaron en la aplicación de dichos test. Metodología: Estudio cuanti-cualitativo, realizado entre noviembre 2008 y diciembre 2009. En 2 centros de Salud de la Región Metropolitana de Chile se reclutó lactantes nacidos de término, que acudieron a control sano. A los 8 y 18 meses se les solicitó a los padres o cuidadores principales completar el ASQ y un profesional de APS aplicó el EEDP. Se midió la correlación y concordancia entre ambos test. Se aplicaron entrevistas individuales y mini focus groups a los profesionales participantes en las evaluaciones. Resultados: Fueron reclutados 330 lactantes. La frecuencia de déficit del DSM fue 8,79 por ciento en EEDP y 12,73 por ciento en ASQ (p0,05). Hubo correlación entre ambas evaluaciones (r 0,5) y la concordancia en la pesquisa de déficit de DSM fue buena (kappa 0.576). En el análisis cualitativo destacó la valoración positiva del ASQ, tanto como instrumento de medición, como guía para promover el DSM. Para suplir las debilidades del ASQ, relacionadas con la modalidad de autoreporte, en grupos de mayor riesgo socio cultural o educacional, los centros de salud adoptaron diferentes estrategias. Conclusiones: El ASQ pesquisó significativamente más déficits del DSM que el EEDP, mientras que la correlación y concordancia entre ambas pruebas fueron adecuadas. Considerando las ventajas comparativas del ASQ en opinión de los profesionales, se propone que los centros de APS que deseen implementar ASQ, tomen una estrategia progresiva basada en la integración de ...

Dificultades de lenguaje en preescolares: concordancia entre el test TEPSI y la evaluación fonoaudiológica / Language difficulties in pre-scholars: concordance between TEPSI test and speech therapist evaluation

Background: Language deficits cause difficulties in the family, school and social settings, so early detection and intervention are crucial. In Primary Care, children undergo developmental screening using the TEPSI test, which includes language at 4 years-old. Objective: Establish the frequency of language delay in children at pre-school, determined by specific language tests, in order to establish their concordance with TEPSI test. Method: Children between 3 and 5 years-old, attending 2 low-income pre-school facilities from the North Metropolitan Area, were evaluated during 2006. The information was obtained in a blind and simultaneous mode through TEPSI test performed by nurses and 3 specific language tests performed by speech therapists. A performance < p10 or < 2SD in one or was more language tests was considered a deficit. The concordance and discordance between both evaluations were established. Results: From a total of 219 children, 194 (89 percent) completed the evaluation. 48 percent had a language deficit by speech evaluation and 13,9 percent by TEPSI test. The concordance between both evaluations was poor (Kappa 0,2), with a significant discordance (p < 0,0000) by Mc NemarÆs X². Conclusion: The frequency of language problems in this population is high; a poor concordance between the tests used in Primary Care and language evaluations performed by speech therapists was found. The differences could be caused by the different aspects of language being evaluated. The findings lead to reconsider the screening strategies used in Primary Care and to implement language stimulation programs directed to low-income populations at high risk for language deficits.

Introducción: Los déficit del lenguaje conllevan dificultades en el contexto familiar, escolar y social, siendo fundamental la pesquisa e intervención precoz. En la atención primaria (APS) el lenguaje se evalúa en el marco del desarrollo psicomotor (DSM), a los 4 años mediante el test de TEPSI. Objetivo: Describir la frecuencia de déficit de lenguaje en preescolares asistentes a jardín infantil según pruebas de lenguaje específicas y establecer la concordancia entre estas pruebas y el TEPSI. Metodología: Se evaluó a todos los niños entre 3 y 5 años, asistentes a dos jardines infantiles de nivel socioeconómico bajo, del área Norte de la Región Metropolitana. La información se obtuvo en forma simultánea y ciega mediante la aplicación del TEPSI por enfermeras y la evaluación del lenguaje con dos pruebas específicas aplicadas por fonoaudiólogos. Se consideró un desempeño deficitario cuando el rendimiento en una o más pruebas de lenguaje fue < p10 ó < 2DS para la edad. Se estableció la concordancia y discordancia entre ambas evaluaciones. Resultados: De un total de 219 niños, 194 (89 por ciento) completaron la evaluación con los instrumentos señalados. 48,8 por ciento presentó dificultades del lenguaje según la evaluación fonoaudiológica y 13,9 por ciento según TEPSI. La concordancia entre ambas evaluaciones fue pobre (Kappa 0,2), con una discordancia altamente significativa p < 0,0000 según X² de Mc Nemar. Conclusión: Destaca la alta frecuencia de problemas de lenguaje en la población estudiada y la pobre concordancia entre las pruebas aplicadas en APS y la evaluación fonoaudiológica. Las diferencias podrían deberse a los distintos aspectos del lenguaje considerados en las evaluaciones. Los hallazgos invitan a replantear las estrategias de pesquisa utilizadas en APS y a la implementación de programas integrales de estimulación en poblaciones desfavorecidas, consideradas de riesgo para problemas de lenguaje.

Conflicto de intereses en la práctica clínica: Análisis ético de algunas relaciones con la industria / Conflicts of interest in clinical practice: Ethical analysis of some relationships with the pharmaceutical industry

Sometimes, the prescription practice of physicians can be influenced by factors that are not related to scientific evidence due to the appearance of several conflicts of interest. These conflicts cause social concern and have prompted actions to regulate the ethics of individual and corporative activities related to healthcare. We analyzed the ethical problems involved in the physician-industry relationship. For this purpose, we considered as the main actors related to this problem, the pharmaceutical industry and their marketing strategies, medical doctors and the independence and objectivity that should guide prescriptions and, finally, patients and their right to receive prescriptions based on scientific evidence. From the point of view of the Bioethics principles, Beneficence would not be respected when gifts or other donations received from the industry affect doctor's independence. Non Maleficence principle could be jeopardized if there is an increased risk of treatment failure and finally Justice could be altered if there is a cost increase for either patients or health institutions. As a conclusion, we consider that the presence of conflicts of interest in the relationship of physicians with the pharmaceutical industry is an important ethical problem. In consequence, this group endorses the recommendations of the Chilean Association of Medical Scientific Societies and advices to include ethical guidelines on this topic in the curriculum of medical schools.

Online learning: An alternative for STD/HIV/AIDS knowledge update.

The experience of the e-learning diploma "Specialist in management for control and prevention of STD/HIV/AIDS" for Latin-American health professionals is presented. It was developed by eminent advisory Chilean experts using a web CT platform with the support of the, Global Development Learning Network (GDLN) of World Bank and certificated by the Austral University of Chile, Virtual University and REUNA. The design, development, results of learning, and the opinion of the quality of the course are described. The purpose of this research was to know the opinion of the participants about the quality of diploma on line, and to orient the decision making with respect to the optimization for future versions of this diploma. The universe and sample correspond to first cohort of the diploma during year 2005, was conformed by 33 students. The instrument of data collection used was a survey of opinion applied when finalizing of the diploma. The data were process in SPSS 13.0. The measured criteria of quality were classified like high quality when 80% or more of the participants answered that the evaluated aspect was excellent, medium quality (61 and 79%) and low quality at least of 60% thought that was excellent. The results emphasize that the quality of the contents of the diploma it considers a 95% of the participants excellent. A 100% consider the roll carried out by the tutor excellent and 91.3% excellent the roll of the academic secretary. The means of support to the student were evaluated like excellent by 58.3% of the users. The system of communication by means of internal mail of the diploma was considered excellent by 67% of the students the forums were evaluated like excellent by 84.8% of the people. In relation to the Web site 84.5% consider it excellent, the learning activities were considered as excellent by 75% and the system of evaluation of the diploma was considered adapted by 83.3% of the participants. The 100% would recommend the diploma to other professional of the health, having indicated that the diploma allowed them to extend its knowledge, those that are of much actually daily utility and to establish work networks. One concludes that the quality of the diploma is high as far as contents, roll of the professors; the pedagogical aspects; the most deficit aspects and than are due to correct is the tool as guide of study and calendar, and to optimize the tool of communication by means of the mail of the Web site. The results evidence that this methodology, is an excellent media of learning and promoting the interdisciplinary networking in relevant health issues such as STD/HIV/AIDS control and prevention, where coordinate action is crucial.

[Conflicts of interest in clinical practice. Ethical analysis of some relationships with the pharmaceutical industry]. / Conflicto de intereses en la práctica clínica. Análisis ético de algunas relaciones con la industria.

Sometimes, the prescription practice of physicians can be influenced by factors that are not related to scientific evidence due to the appearance of several conflicts of interest. These conflicts cause social concern and have prompted actions to regulate the ethics of individual and corporative activities related to healthcare. We analyzed the ethical problems involved in the physician-industry relationship. For this purpose, we considered as the main actors related to this problem, the pharmaceutical industry and their marketing strategies, medical doctors and the independence and objectivity that should guide prescriptions and, finally, patients and their right to receive prescriptions based on scientific evidence. From the point of view of the Bioethics principles, Beneficence would not be respected when gifts or other donations received from the industry affect doctor's independence. Non Maleficence principle could be jeopardized if there is an increased risk of treatment failure and finally Justice could be altered if there is a cost increase for either patients or health institutions. As a conclusion, we consider that the presence of conflicts of interest in the relationship of physicians with the pharmaceutical industry is an important ethical problem. In consequence, this group endorses the recommendations of the Chilean Association of Medical Scientific Societies and advices to include ethical guidelines on this topic in the curriculum of medical schools.

Comparacion entre la tecnica de capilaridad y la biopsia aspiracion con aguja fina (BACAF) en nodulos de tiroides / Comparison between capillary technique and fine-needle aspiration biopsy (BACAF) in thyroid nodules

La biopsia aspiración con aguja fina de tiroides es el examen de elección en los nódulos tiroideos. Se realizó un estudio en el cual se comparó la técnica de capilaridad con la biopsia por aspiración con aguja fina (BACAF) en lesiones de tiroides.Se efectuaron en total 50 biopsias de tiroides. Sc encontró que los resultados de los extendidos citológicos preparados para cada método fueron comparables en calidad, cantidad y rendimiento diagnóstico. Las dos técnicas tuvieron una adecuada eficacia diagnóstica. Se concluyó que la capilaridad es un excelente método diagnóstico y combinado con el bacaf mejora la sensibilidad diagnóstica.

The thyroid Fine-Needle Aspiration Biopsy is the test of choice for thyroid nodules. We carried out a study to compare the Capillarity technique versus Fine-Needle Aspiration Biopsy (FNAB) in thyroid lesions. We performed 50 thyroid biopsies. We found that the results of the cytology smears prepared for cach technique were comparable in qualit, amount and diagnostic reward. Both techniques had an adequate diagnostic efficacy. We concluded that capillarity, is an excellent diagnostic method and combined with FNAB improves the diagnostic sensitivity.

Diseño de un sistema de vigilancia epidemiológica por evento centinela en dermatosis ocupacional / Design of an epidemiological surveillance system in occupational dermatosis based on sentinel event

En salud ocupacional, especialmente por parte de las admnistradoras de riesgos profesionales, de las empresas y de los trabajadores, se ha buscado priorizar las acciones preventivas, mejorar el sistema de información, identificar y fortalecer la notificación de lasenfermedades relacionadas con el trabajo, así como lograr mejor comprensión de las enfermedades de origen ocupacional que afectan al trabajador.En la Administradora de Riesgos Profesionales Seguro Social, seccional Antioquia (ARP-SS), se diseñó y probó un sistema de vigilancia epidemiológica de dermatosis ocupacional por evento centinela, el cual parte de la identificación de la magnitud del problema y la valoración de las condiciones existentes para la vigilancia epidemiológica ocupacional.En este artículo se establecen los criterios teóricos y prácticos con respecto al manejo de la información y la intervención, para el funcionamiento del sistema de vigilancia epidemiológica por evento centinela, incluyendo los principales resultados de la prueba piloto.El sistema de vigilancia propuesto, promueve la articulación de las acciones de vigilancia entre los prestadores de servicios de salud y los administradores de la atención, incluyendo la adminitradora de riesgos profesionales, que facilite la detección y atención oportuna de los casos de dermatosis de origen ocupacional

Sangrado digestivo alto por antiinflamatorios no esteroidales

Se describe el caso de un paciente de 41 años que, a consecuencia de un accidente de tránsito sufre trauma abdominal y de extremidades por aplastamiento, el mismo que produjo lesiones retroperitoneales y de extremidades que fueron resueltas quirúrgicamente: laparotomía exploratoria (demostró hematoma retroperitoneal) y amputación de miembro inferior y superior derechos. Recibió antiinflamatorios no esteroidales a altas dosis; como consecuencia de estrés quirúrgico y emocional y la administración de AINES presenta hematemesis en pozo de café y melenas por tres ocasiones. Al momento del examen se encontró una TA de 120/80, FC 100 por minuto, FR 26 por minuto, pálido, diaforético, con excitación sicomotriz...

Efectos colaterales de la infiltración prostaglandina E2 en maxilares de caballos / Collateral effects of the prostaglandin E2 injected in maxillary of guinea pigs

La presente investigación se llevó a cabo con el fin de establecer la distribución sistémica y los efectos colaterales de la infiltración de PGE2 en maxilares. Se realizó una evaluación de los tejidos mediantes cortes histológicos y autorradiografía in situ y en órganos vitales como celebro, corazón,pulmón,riñon,hígado,en musculo estriado esquelético y mucosa oral adyacente al sitio de filtración. Se utilizarón 13 cabayos machos,el primer caballo se tomó con el fin de estandarizar la técnica en cuanto a tiempo y marcaje. Los doce caballos restantes se distribuyeron en cinco grupos experimentales y un caballo fue tomado como control absoluto. En el primero grupo experimental al caballo se le aplicó únicamente PGE2, al del segundo grupo solamente fluresceína sódica al 10, estos caballos fueron sacrificados a las 24 horas. Los nueve restantes, se les aplicó la mezcla de 0.1 ml Timidina 3H. Los tres grupos de caballos se sacrificaron a las 24,72 y 120 horas respectivasmente. La infiltración de la mezcla se realizó en el surco yugal distal a los incisivos superior e inferior derechos, y previa aplicación de 1 ml de Adrenalina intramuscular con el fin de evitar un shock anafiláctico.

Esquemas terapéuticos en enfermedades parasitarias / Therapeutic scheme in parasitic diseases

Expone que en el Ecuador las afecciones parasitarias son muy frecuentes por tal motivo queremos presentar una revisión actualizada de los esquemas terapéuticos de las parasitosis causadas por helmintos y protozoos. Para el tratamiento de cada una de ellas recomendaremos un máximo de tres fármacos, teniendo en cuenta que no sólo los fármacos aquí recomendados son efectivos, ya que en los últimos años se han dado importantes avances en su tratamiento, así, al momento se cuenta con antiparasitaria de dosis única, alto grado de efectividad y muy buena tolerancia.

Estudios biofarmacéuticos de productos similares de teofilina del mercado nacional / Biopharmaceutical studies of teophylline-like products at the national market

To perform in vitro release-dissolution studies of sustained release theophylline forms commercialized in Chile, 5 sustained release products were studied according to the specifications of the 7th supplement of the United States Pharmacopoeia Convention. Release and dissolution rates were compared with a rapid release aminophylline form. The identity, validation and active principle content of each product was also studied. All the studied forms complied with the quality requirements of the USP XII. The dissolution rate constants of the products at pH 6 ranged from 0.0583 to 0.2130, compared with 7.1 for the rapid release form. The dissolution of all products, except one, was pH dependent. These results underscore the need to systematically study the quality of pharmaceutical products considered similar, whose differences could have potential risks for patients

Estudio de vibrio cholerae 01 toxigenico en agus superficiales y residuales en el Departamento de Cochabamba, Bolivia

A partir de la epidemia de cólera en Bolivia se realizo un plan de control para detectar la presencia del agente etiologico. Se analizaron muestras y se llego a la conclusion que la bacteria que persiste en los ambientes acuaticos de la zona es el 01 que puede o no ser toxigenico