RESUMEN
Introducción: Las infecciones de piel y partes blandas (IPPB) son una consulta frecuente y los casos graves conllevan morbimortalidad, por lo que su identificación y manejo precoz es fundamental para mejorar el pronóstico. Objetivo: Identificar los factores de riesgo asociados a una evolución desfavorable y mortalidad en pacientes tratados por IPPB en nuestro centro. Materiales y Método: Se realizó un estudio de casos y controles de una serie consecutiva de 172 pacientes con diagnóstico de IPPB entre enero de 2018 y enero de 2019, se recolectaron variables clínicas, de laboratorio e imagenológicas. Se definió como casos aquellos que requirieron cirugía, ingresaron a una unidad de paciente crítico o fallecieron, y como controles a los pacientes con buena respuesta al tratamiento médico. Resultados: Al realizar el análisis estadístico: la leucocitosis > 12.000 cel/mm3 (OR 6,56; IC 95%; 3,21-13,42), y la PCR > 150 mg/dl (OR 7,79; IC 95%; 3,59-16,91), resultaron ser factores de riesgo para evolución desfavorable. El puntaje LRINEC elevado (25,5% vs. 15,1%, p = 0,1034) y la cirugía tardía al ingreso (31,3% vs. 16,2%, p = 0.2632) fueron más frecuente en los casos de evolución desfavorable, pero sin diferencia significativa. Discusión: El uso de parámetros clínicos, de laboratorio e imágenes es fundamental para un diagnóstico precoz y tratamiento oportuno. Conclusiones: La leucocitosis, la elevación de la PCR y la cirugía tardía son factores de mal pronóstico en IPPB. El puntaje LRINEC aún es controversial por su baja sensibilidad.
Introduction: Skin and soft tissue infections (SSTI) are a frequent consultation and severe cases carry morbidity and mortality, so their early identification and management is essential to improve prognosis. Aim: To identify the risk factors associated with an unfavorable evolution and mortality in patients treated for SSTI in our center. Materials and Method: A case-control study of a consecutive series of 172 patients diagnosed with SSTI between January 2018 and January 2019 was carried out, clinical, laboratory and imaging variables were collected. Cases were defined as those that required surgery, were admitted to a critical patient unit or died, and as controls were patients with a good response to medical treatment. Results: When performing the statistical analysis: leukocytosis > 12,000 cel/mm3 (OR 6.56; 95% CI; 3.21-13.42), and CRP > 150 mg/dl (OR 7.79; 95% CI; 3.59-16.91), turned out to be risk factors for unfavorable evolution. The high LRINEC score (25.5% vs. 15.1%, p = 0.1034) and late surgery on admission (31.3% vs. 16.2%, p = 0.2632) were more frequent in cases of evolution unfavorable but without significant difference. Discussion: The use of clinical, laboratory and imaging parameters is essential for an early diagnosis and timely treatment. Conclusions: Leukocytosis, elevated CRP, and late surgery are poor prognostic factors in SSTI. The LRINEC score is still controversial due to its low sensitivity.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Factores de Riesgo , Enfermedades Cutáneas Bacterianas/complicaciones , Infecciones de los Tejidos Blandos/complicaciones , Enfermedades Cutáneas Bacterianas/diagnóstico , Enfermedades Cutáneas Bacterianas/terapia , Infecciones de los Tejidos Blandos/diagnóstico , Infecciones de los Tejidos Blandos/terapia , Hospitalización/estadística & datos numéricosRESUMEN
Portograma aéreo o portograma de aire (PA), se define como la presencia de aire en el sistema venoso portomesentérico. Neumatosis intestinal (NI) se define como la presencia de aire en la pared intestinal, independiente de su causa o localización. La principal etiología de estas alteraciones es la isquemia intestinal aguda y en general, se consideran predictores de perforación intestinal y de mal pronóstico. Un pequeño grupo de pacientes con PA y/o NI pueden evolucionar sin complicaciones e incluso cursan sin manifestaciones clínicas. Presentamos el caso de una paciente con antecedente quirúrgico inmediato de gastrectomía total y reconstrucción en Y de Roux, que evidenció en tomografía computarizada (TC) de abdomen de control PA y NI, sin alteraciones clínicas significativas asociadas.
Hepatic portal venous gas (HPVG) is defined as the presence of air in the portal venous system. Pneumatosis intestinalis (PI) is defined as the presence of air within the bowel wall, regardless of its cause or location. Its main etiology is the intestinal ischemia and are generally considered predictors of intestinal perforation and wrong prognosis. A small group of patients with HPVG and PI may have a different clinical course, without complications and clinical manifestations. We report the case of a patient with immediate surgical history of total gastrectomy and Roux-en-Y reconstruction, which showed in computed tomography (CT) of the abdomen HPVG and PI, without associated clinically significant changes.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Neumatosis Cistoide Intestinal/diagnóstico por imagen , Vena Porta/diagnóstico por imagen , Embolia Aérea/diagnóstico por imagen , Neumatosis Cistoide Intestinal/etiología , Tomografía Computarizada por Rayos X , Hallazgos Incidentales , Embolia Aérea/etiología , Gastrectomía/efectos adversosRESUMEN
Introduction: Cultural adaptation is a process that is applied in early phases of validation. The Neuromuscular Score is an instrument that classifies the gross motor function in people with neuromuscular diseases. It was created in France and has not yet been validated in Chile. Objectives: To carry out the cross cultural adaptation of the NM Score from the original version in French to Spanish according to the International standard of translation methodology. Patients and Method: The cross cultural adaptation is a descriptive and transversal study. This study is based on the FACIT methodologic process proposed by Eremenco. Seven health professionals, who achieved inclusion requirements, participated in the translation process. The reliability of the transcultural adaptation was determined with the final version. 30 patients from 6 to 26 years old, with neuromuscular pathology, were interviewed the Teletón Santiago Institute. Results: The methodologic process of translation and adaptation suggests that the translated version does not present great semantic differences. This process has a high global reliability measurements with Cronbach alpha coefficient = 0.93. Conclusion: The translation and adaptation process for NM Score obtained a reliable score and equivalence during its application, giving a representation of the functional compromise.
Introducción: La traducción y adaptación cultural de instrumentos de medición es un proceso que se aplica en las fases iniciales dentro de las etapas de validación de ellos. La Clasificación Puntaje Neuromuscular (NM-Score), es un instrumento que clasifica la severidad de la función motora gruesa en personas con patologías neuromusculares, creada en Francia y no validada en Chile. Objetivos: Realizar la adaptación transcultural de la clasificación NM-Score, desde la versión original en francés al español, según estándares internacionales de metodología de traducción y determinar su confiabilidad. Pacientes y Método: Estudio descriptivo, transversal, basado en metodología de traducción FACIT y medición de confiabilidad propuesto por Eremenco. Siete profesionales de la salud que cumplieron requisitos de inclusión participaron del proceso de traducción. La confiabilidad de la adaptación transcultural se determinó con la versión final de la Clasificación NM Score, que puede ser aplicada a pacientes y padres. Se entrevistaron a 30 usuarios, de 6 a 26 años, con diagnóstico de patología neuromuscular del Instituto Teletón Santiago. Resultados: El proceso metodológico de traducción y adaptación sugiere que la versión traducida no presenta grandes diferencias semánticas y tiene una alta confiabilidad global medido con α de Cronbach = 0,93. Conclusión: El proceso de traducción y adaptación de la Clasificación NM Score obtuvo una versión fiable y de equivalencia al momento de aplicarla a usuarios y padres, dando una representación del compromiso funcional.
Asunto(s)
Humanos , Adolescente , Adulto , Niño , Adulto Joven , Actividad Motora/fisiología , Características Culturales , Enfermedades Neuromusculares/fisiopatología , Índice de Severidad de la Enfermedad , Traducción , Actividades Cotidianas , Estudios Transversales , Destreza Motora/clasificación , Reproducibilidad de los ResultadosRESUMEN
El diagnóstico de fase en la esquistosomiasis es complejo. Se evaluó la respuesta IgM e IgGmurina contra productos de excreción-secreción de Schistosoma mansoni machos (PESGM), hembras (PESGH) y huevos (PESH), su relación con la histopatología y expresión de IL-10 y TNF-α, mediante ELISA, en suero de ratones Balb/c con 8 y 20 semanas de infección (RI8 y RI20) y Ratones sanos(RS). En RI8, se observaron granulomas constituidos por plasmocitos, macrófagos y neutrófilos, depósitos de colágeno alrededor de los granulomas y en la zona interna del huevo. En R20SI, se observaron fibroblastos alrededor del huevo y acúmulos de macrófagos y plasmocito, aumento de los depósitos de colágeno en áreas del granuloma. IgM sérica RI8, presentó un mayor porcentaje de positividad frente PESGH (35%), mientras que IgG el mayor porcentaje de positividad fue PESGH (60%) y PESH (30%). En R20SI, IgM fue 20% positiva frente PESH e IgG 10% frente PESGM, y 25% positiva con PESGH. No se observaron diferencias en IL-10 entre los RS y RI8. TNF-α en RS vs RI8 y RS vs RI20 fue diferente y estadísticamente significativo. Los PESGH podrían detectar fase aguda y PESH fase crónica. El empleo de varios antígenos sería de utilidad en el diagnóstico de fase.
The diagnosis of schistosomiasis phase is complex. The murine IgM and IgG response against excretory-secretory products of Schistosoma mansoni males (PESGM), females (PESGH) and eggs (PESH), its relation to histopathology and expression of IL-10 and TNF-α was assessed by ELISA in serum of Balb / c mice with 8 and 20 weeks of infection (RI8 and RI20) and healthy mice, RS. In RI8, were observed granulomas consisting of plasma cells, macrophages and neutrophils, deposits of collagen around the granulomas and internal area of the egg. In R20SI, fibroblasts around the egg and accumulation of macrophages and plasmocito, increased collagen deposits in areas of granuloma were observed.RI8 serum IgM had a higher percentage of positivity PESGH (35%), while the highest percentage of IgG positivity was PESGH (60%) and PESH (30%). In R20SI, was 20% IgM positive and IgG against PESH PESGM 10% against and 25% positive with PESGH. No differences in IL-10 between the RS and RI8 were observed. TNF-α in RS vs RI8 and RS vs RI20 was different and statistically significant. The PESGH could detect phase acute while PESH chronic phase. The use of several antigens would be useful in the diagnosis phase.
RESUMEN
INTRODUCCIÓN: La combinación de embarazo y Neurofibromatosis tipo 1 (NF1) ha sido reportada con frecuencias de 1/2.500 a 1/18.500 partos. Patología con manifestaciones que van desde lesiones cutáneas, tumores o complicaciones ortopédicas. En la mujer esta enfermedad podría empeorar durante la gestación, debido a la cantidad de receptores esteroidales que tendrían los neurofibromas y la posibilidad de malignización de tumores del sistema nervioso central. PRESENTACIÓN DEL CASO: Mujer de 22 años, multípara de 1, con una perdida reproductiva a las 6 semanas de gestación, con antecedentes de NF1, un tumor cerebral tipo glioma temporal medial derecho y otro ubicado en nervio óptico izquierdo diagnosticados a los 17 años de edad, escoliosis lumbar operada a sus 13 años, controles con psiquiatra por discapacidad intelectual; además refiere que su madre y hermano presentan lesiones cutáneas compatibles con NF1, con total abandono de seguimiento hace 6 años. Inició sus controles con alto riesgo obstétrico al cursar la semana 22 de embarazo, se hospitalizó a las 37 semanas de gestación para mejorar la referencia y controles con especialistas. En el examen físico de ingreso destacó: escoliosis, estrabismo convergente de ojo derecho, lesiones hiperpigmentadas café con leche en dorso, extremidades inferiores, sin focalidad neurológica. Llegó a embarazo de término, realizándose parto vaginal a las 39semanas, con producto sexo femenino de 3360 gramos por 50 cm, adecuado para la edad gestacional, APGAR 9-10. DISCUSIÓN: Las pacientes embarazadas con NF1 contituyen un grupo de alto riesgo obstétrico, requieren de un equipo de trabajo multidisciplinario, consejería preconcepcional y de controles post parto
INTRODUCTION: The combination of pregnancy and Type 1 Neurofibromatosis (NF1) has been reported in rates of 1 in 2500 to 1 in 18500 deliveries. It's a disease with multiple manifestations such as skin damage, tumors or orthopedic complications. In women the disease may worsen during pregnancy, due to the amount of the neurofribromas' steroid receptors and the possibility of malignant transformation tumors of the central nervous system. CASE REPORT: 22 year old woman, with one previous satisfactory delivery, and a history of reproductive loss at 6 weeks gestation. She is diagnosed with NF1, showing a brain tumor, located in the right temporal medial side, glioma-type and other located in the left optic nerve diagnosed at 17 years of age, lumbar scoliosis operated at 13 years, psychiatrist controls with intellectual disabilities. Also, she relates that his mother and brother have skin lesions compatible with NF1, not keeping track six years ago. She began with high obstetrical risk unit controls at 22 weeks pregnant, then she was hospitalized at 37 weeks of gestation to improve reference and controls. In the physical first exam highlighted: scoliosis, convergent strabismus of the right eye, coffee with milk hyperpigmented lesions in the back, lower extremities without neurological deficit. She had a successful calving, performing vaginal delivery at 39 weeks, with a female of 3360 grams of weight and 50 cm height, appropriate for gestational age, APGAR 9-10. DISCUSSION: Pregnant patients with NF1 are a group of high-risk obstetrics, they require a multidisciplinary team of work, preconception counseling and birth controls after delivery
Asunto(s)
Humanos , Femenino , Embarazo , Complicaciones Neoplásicas del Embarazo/terapia , Neurofibromatosis 1/complicaciones , Neurofibromatosis 1/terapia , Resultado del Embarazo , Embarazo de Alto RiesgoRESUMEN
Sometimes, commercial products obtained from wild animals are sold as if they were from domestic animals and vice versa. At this point of the productive chain, legal control of possible wildlife products is difficult. Common in the commerce of northern Argentina, skins of two wild species, the carpincho and the collared peccary, look very similar to each other and to those of the domestic pig; it is extremely difficult to differentiate them after they have been tanned. Because there was no an adequate methodology to discriminate between leather of these three species, we developed a new methodology of DNA extraction from skin and leather. This new method involves digesting a leather sample using proteinase K, followed by precipitation of proteins with 5 M NaCl, cleaning with absolute isopropanol and DNA precipitation with 70% ethanol. DNA is hydrated in Tris-EDTA buffer. This protocol provided good-quality DNA suitable for analysis with molecular markers. This new protocol has potential for use in identifying leather products of these species using molecular markers based on RAPDs.
Asunto(s)
ADN/aislamiento & purificación , Roedores/genética , Piel/química , Sus scrofa/genética , Animales , Sitios GenéticosRESUMEN
The current method for goat brucellosis diagnosis is based on the World Organization for Animal Health (OIE) using the screening card test (CT), with antigen at 8% (CT8) or 3% (CT3) of cell concentrations, and the confirmatory complement fixation test (CFT). However, these tests do not differentiate antibodies induced by vaccination from those derived from field infections by Brucella species or other bacterial agents; in places like Mexico, where the prevalence of brucellosis and the vaccination rates are high, there is a considerable percentage of false positive reactions that causes significant unnecessary slaughter of animals. Furthermore, results of the fluorescence polarization assay (FPA) using the Brucella abortus O-polysaccharide (OPS) tracer in goats are poorer than those with cattle. The present study was undertaken to investigate a tracer prepared from the native hapten (NH) of the Rev. 1 strain of Brucella melitensis to improve FPA performance on goat brucellosis diagnosis. Evaluation of 48 positive samples and 96 negative samples showed that the NH tracer was more accurate (p<0.01) than the OPS tracer (97.2% vs. 93.8% accuracy, respectively). On the diagnostic performance evaluation, the NH tracer performed better (87.5% accuracy, 79.5% sensitivity, 84.3% specificity, and 163.8 performance index) than the OPS tracer (83.5%, 75.9%, 81.0%, and 156.9, respectively) using 1009 positive and 2039 negative Mexican field goat sera samples selected by test series approved by the OIE (card test 3% and CFT). We demonstrated a new application for the NH lipopolysaccharide on detecting antibodies against Brucella using the FPA, which may yield faster results (minutes vs. 24-72h) than the immunodiagnosis assays frequently used in bovine brucellosis. In addition, NH tracer produces similar or better performance results than the conventional OPS tracer, using the FPA in goat sera samples.
Asunto(s)
Anticuerpos Antibacterianos/sangre , Brucella melitensis/inmunología , Brucelosis/veterinaria , Inmunoensayo de Polarización Fluorescente/veterinaria , Enfermedades de las Cabras/microbiología , Haptenos/química , Animales , Anticuerpos Antibacterianos/inmunología , Brucella abortus/inmunología , Brucella melitensis/química , Brucelosis/diagnóstico , Brucelosis/inmunología , Brucelosis/microbiología , Bovinos , Fluoresceína-5-Isotiocianato/química , Inmunoensayo de Polarización Fluorescente/métodos , Colorantes Fluorescentes/química , Enfermedades de las Cabras/sangre , Enfermedades de las Cabras/diagnóstico , Enfermedades de las Cabras/inmunología , Cabras , Haptenos/inmunología , Curva ROC , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Introducción: La adición de opioides a los anestésicos locales en anestesia espinal (AE) modula algunos aspectos de la anestesia y la analgesia. Nuestro objetivo fue evaluar dos dosis de fentanilo (F) intradural sobre los requerimientos de propofol (P) en la sedación durante AE. Pacientes y Método: Estudio clínico, prospectivo, controlado de 75 pacientes, ASA I, distribuidos en 3 grupos: Grupo 1 (n=25): Bupivacaína 0,75 por ciento HB (BHB), 12,5 mg; Grupo 2 (n=25): BHB 12,5 mg + 15 µgr F; Grupo 3 (n=25): BHB 12,5 mg + 25 µgr F. Realizada AE, se instaló monitor BIS XP, registrándose valor basal. Luego, se inició sedación con propofol TCI sitio-efecto con dosis de 2,5 µgr/ml, para mantener BIS entre 60 y 75. Se registró BIS, signos vitales, dosis total utilizada (DTP), dosis promedio de infusión (DPI), el costo final del consumo de P y el tiempo de latencia del despertar. Resultados: El DPI fue de 0,084 mg*kg-1*min-1 (G 1), 0,059 mg*kg-1*min-1 (G 2) y 0,061 mg*kg-1*min-1 (G 3) (p < 0,05 G2 y G3 v/s G1). La DTP fue 344 mg*hr-1 (G 1), 227 mg*hr-1 (G 2) y de 241 mg*hr-1 (G 3). Los costos de P fueron menores en 32,8 por ciento en el Grupo 2 y 29,1 por ciento en el G 3, comparados con G 1. Conclusiones: La adición de 15 ó 25 µgr de F a la BHB reduce las dosis promedio de infusión, dosis total utilizada y los costos de P en pacientes bajo AE.
The addition of opioids to local anesthetics used in spinal anesthesia (SA) modulates some aspects of the anesthesia and analgesia. Our purpose was to evaluate two intrathecal fentanyl (F) doses over TCI Propofol requirements for sedation during SA. Methods: Prospective clinical study of 75 patients, ASA I, randomly assigned in 3 groups: Group 1 (n=25): Bupivacaine 0.75% HB (HBB), 12.5 mg; Group 2 (n=25): BHB 12.5 mg + 15 µgr F; Group 3 (n=25): BHB 12.5 mg + 25 µgr F. After SA a BIS XP monitor was installed and basal value registered. Then, sedation with Propofol TCI site-effect was started with a dose of 2.5 µgr/ml, to obtain BIS between 60 and 75. We registered total infusion dose (TID), mean infusion dose (MID), propofol costs and vital signs variations. Results: TID was 0.084 mg*kg-1min-1 (G 1), 0.059 mg*kg-1min-1 in (G 2) and 0.061 mg*kg-1*min-1 (G 3) (p < 0.05 G2 and G3 v/s G1). The MID was 344 mg*hr-1 in Group 1, 227 mg*hr-1 in Group 2 and 241 mg* hr-1 in Group 3 (p < 0.05). Propofol costs were lower in a 32.8% in Group 2 and in 29.1% in Group 3 v/s Group 1 (p < 0.05). Conclusions: The addition of 15 or 25 µgr of F to HBB reduces the total infusion doses and the mean infusion doses as well as propofol costs in patients under spinal anesthesia. Key words: Intrathecal fentanyl, sedation, spinal anesthesia, intrathecal opioids, propofol requirements.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Anestesia Raquidea/métodos , Fentanilo/administración & dosificación , Propofol/administración & dosificación , Anestésicos Combinados , Artroscopía , Analgésicos Opioides/administración & dosificación , Método Doble Ciego , Hipnóticos y Sedantes/administración & dosificación , Monitoreo Intraoperatorio , Satisfacción del Paciente , Estudios Prospectivos , Rodilla/cirugía , Encuestas y CuestionariosRESUMEN
Introduction: Tricalcium phosphate ceramics are biocompatible and biodegradable porous materials that can be formulated as bone cements or preformed as blocks, granules or powders. Material and method: The in vivo behaviour in an animal model was studied for a-tricalcium phosphate cement (CFalphaT) and for a-tricalcium phosphate ceramic (CFbetaT), materials which were compared with the fresh cancellous bone graft (AOEF). Eighteen New Zealand rabbits were used, which were implanted in cavitary defects created in the right distal femoral metaphysis, being evaluated microscopically at 12 weeks. Results: The histologic study demonstrated that the 3 implants were osteointegred and replaced by neoformed bone. The histomorphometric study determined that bone neoformation obtained at l2 weeks was equivalent, without significant statistically differences, for the 3 evaluated bone substitutes. The area of no reabsorbed biomaterial was lightly bigger for the CFbetaT, although without significant statistically differences (p < 0.05). Conclusion: Tricalcium phosphate ceramics are useful biomaterials in bone replacement, because they contribute to create an osteoconductive scaffold which is progressively replaced by neoformed bone.
Introducción: Las cerámicas de fosfato tricálcico son materiales porosos biocompatibles y biodegradables que pueden ser formuladas como cementos óseos o preformadas como bloques, gránulos o polvos. Material y Método: Se estudió el comportamiento in vivo, en un modelo animal, de un cemento de fosfato a-tricálcico (CFalfaT) y una cerámica de fosfato beta-tricálcico (CFbetaT), materiales que fueron comparados con el autoinjerto Óseo esponjoso fresco (AOEF). Se emplearon 18 conejos Nueva Zelanda los que fueron implantados en defectos cavitarios creados en la metáfisis femoral distal derecha, siendo evaluados microscópicamente a las 12 semanas. Resultados: El estudio histológico demostró que los 3 implantes se osteointegraron y fueron reemplazados por hueso neoformado. El estudio histomorfométrico determinó que la neoformación ósea obtenida a las 12 semanas fue equivalente, sin diferencias estadísticamente significativas, para los 3 sustitutivos óseos evaluados. El área de biomaterial no reabsorbido fue ligeramente mayor para la CFbetaT, aunque sin diferencias estadísticamente significativas (p < 0,(5). Conclusión: Las cerámicas de fosfino tricálcico son biomateriales útiles para rellenar defectos Óseos, dado que aportan un molde estructural osteoconductivo que en forma progresiva es reemplazado por tejido óseo neoformado.
Asunto(s)
Animales , Conejos , Sustitutos de Huesos , Fosfatos de Calcio/uso terapéutico , Materiales Biocompatibles/uso terapéutico , Prótesis e Implantes , Cerámica/uso terapéuticoRESUMEN
The diaphragm is not available in many countries, despite the recommendations of numerous authors that it has important advantages as a woman-controlled method that offers some protection against sexually transmitted diseases, and one that is safe and free of side effects. An interagency team collaborated to introduce the diaphragm in Colombia, the Philippines, and Turkey, using the same protocol to assess the acceptability, service delivery requirements and use-effectiveness of the method. Eighteen public and private sector service delivery sites were involved and a total of 550 women were enrolled in the study. Provider training aimed to improve the quality of care with which all methods were delivered and included counseling about sexuality and reproductive health risks. The cumulative 12-month pregnancy rate of 10.1 (SE 1.7) per 100 woman-years is on the low end of previous studies of the diaphragm, and the 12-month continuation rate (57.2 [SE 2.4] per 100) compares favorably with that for oral contraceptives and the intrauterine device. Focus group discussions conducted with clients and providers indicated that the method was an important alternative for some women, particularly those who had experienced health problems with other methods or were unable to negotiate condom use with their partners. Provider biases diminished as they observed the strategic niche that the diaphragm filled for their clients. While providing the diaphragm requires training and good client-provider interaction, the requirements are consistent with those called for in the Programme of Action of the International Conference on Population and Development (ICPD, 1994). With proper attention to quality of care, the diaphragm can be successfully offered in resource-poor settings.
Asunto(s)
Dispositivos Anticonceptivos Femeninos/normas , Atención a la Salud , Aceptación de la Atención de Salud , Adolescente , Adulto , Colombia , Dispositivos Anticonceptivos Femeninos/economía , Escolaridad , Empleo , Femenino , Humanos , Masculino , Filipinas , TurquíaRESUMEN
El planeamiento quirúrgico en otología se asume como el paso inicial y piedra angular de un resultado exitoso deseado. El otorrinolaringólogo y más aún el residente en formación deben contar con un laboratorio de disección que les permita un entrenamiento en la fase preparatoria del procedimiento. La conservación óptima de una pieza ósea adecuadamente fresada constituye un valioso aporte a dicho planteamiento. La conservación de huesos temporales data de finales del siglo XIX en Austria. Son escasas las colecciones de piezas quirúrgicas otomastoideas en nuestro medio debido a las restricciones en la consecución de los materiales necesarios y a los altos costos en la importación de los mismos para ejecutar algunas técnicas (v.g. plastinación). Se presenta una novedosa técnica costo-efectiva con elementos de libre compra y bajo costo, con la exposición adjunta de quince piezas con dos años de conservación a la fecha en las cuales se detallan las más frecuentes cirugías timpanomastoideas que constituyen la prueba fehaciente de la eficacia de la técnica propuesta
Asunto(s)
Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Hueso TemporalRESUMEN
El Degloving (despegamiento) mediofacial se ha constituido en uno de los más versátiles abordajes a las estructuras centrofaciales desde la base del cráneo hasta la confluencia naso-orofaríngea (1, 2). La técnica clásica (Portmann 1927) aunado a la liberación rinoplástica (Maniglia 1971) conlleva, en la mayoría de los casos, a la necesidad de reconstrucción con aplicación de injertos y/u osteosíntesis (3-5). Se presenta la modificación técnica de hemiliberación osteomusculocutánea desarrollada por la Dra. L. A. Osorio Bernal (1997), aplicada en disecciones de cadáver y reproductibilidad en pacientes con patología tumoral en el Hospital San Juan de Dios de Bogotá. Seis pacientes de sexo masculino con edad promedio de 47,6 años y con diagnósticos definitivos por histopatología del espécimen quirúrgico de papiloma nasal invertido, neurofibroma y hemangioma capilar, fueron intervenidos en la Institución en el período comprendido entre diciembre de 1997 y mayo de 1999 con la técnica aquí descrita y seguidos clínicamente por un período promedio de 8,5 meses evaluando los resultados estéticos, funcionales y de control de la enfermedad. Se presentan los resultados y se describe la técnica estandarizada quedando la propuesta de su aplicación y reproductibilidad por otros equipos quirúrgicos. Se anexa documentación video-fotográfica
Asunto(s)
Neoplasias de los Senos Paranasales , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Neoplasias de la Base del CráneoRESUMEN
EEGs from 16 patients with stroke in three different stages of evolution were recorded. EEG sources were calculated every 0.39 Hz by frequency domain VARETA. The main source was within the delta band in 2 out of 4 chronic patients, and in 67% of the patients in the acute or subacute stages when edema (cytotoxic or vasogenic) was present. Moreover, all patients showed abnormal activity in the theta band. Sources of abnormal activity in cortical or corticosubcortical infarcts were located in the cortex, surrounding the lesion. At the site of the infarct, a decrease of EEG power was observed. Sources of abnormal theta power coincided with edema and/or ischemic penumbra.
Asunto(s)
Edema Encefálico/fisiopatología , Encéfalo/fisiopatología , Infarto Cerebral/fisiopatología , Electroencefalografía , Adulto , Anciano , Encéfalo/diagnóstico por imagen , Edema Encefálico/diagnóstico por imagen , Infarto Cerebral/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
Las enfermedades granulomatosas infecciosas continúan siendo un problema de salud pública en nuestro país. El oriente del altiplano cundiboyacense es reconocido como zona endémica para la infección por Klebsiella Scleromatis. Severas lesiones del tracto aerodigestivo superior constituyen un reto para el otorrinolaringólogo desde el punto de vista infeccioso e igualmente en el intento por reducir sus secuelas, esto especialmente aplicable a la población adulta. Es reconocido en la literatura mundial que lesiones subglótico-traqueales son precedidas con evidencia infecciosa (activa o secular) en localizaciones superiores. Se presenta un caso inusual en paciente pediátrico, cuya primera manifestación fue estenosis subglótica severa (tipoIII de Cotton) de rápida instauración, la cual por evidencia histopatológica cicatricial, recibió manejo médico-quirúrgico con laringotraqueoplastia tipo Rethi (laringotraqueofisura anterior convinada con división cricoidea posterior) y doxiciclina a 5 mg/kg /día por 6 meses con resultados satisfactorios en la Fundación Hospital Universitario Pediátrico de la Misericordia en Santafé de Bogotá
Asunto(s)
Humanos , Masculino , Niño , Laringoestenosis , RinoscleromaRESUMEN
PIP: Demography, which should be the basis for planning of any program or project, has traditionally been ignored by Colombian governments. No population statistics are available for the pre-Conquest period in Colombia. Statistics during the Colonial era were based on population counts for division of lands, taxation, and similar considerations. The first census was undertaken around 1770. Colombia's most recent census was in 1993, and another is being prepared for 2000. The censuses have been useful for development purposes despite their significant limitations of completeness and accuracy. Colombia's population in 1997 was estimated at 40,300,000, making it the third most populous country of Latin America after Brazil and Mexico. Fertility has declined considerably since 1965. Colombia's crude birth rate is believed to have exceeded 50/1000 in the 18th and 19th centuries and was estimated at 45/1000 by the Latin American Demographic Center for the first half of the 20th century. The crude birth rate was 41.3/1000 in 1968, 33.1/1000 in 1973, 30/1000 in 1980, and around 26/1000 in 1990 and 1995. The total fertility rate was estimated at 7.0 in 1960-65, 6.7 in 1969, 4.5 in 1973, 3.2 in 1985, and 2.9 in 1995. Fertility declined most appreciably before 1975, but rates continue to drop in rural as well as urban areas and in all geographic zones. For Colombia as a whole the total fertility rate is 4.8 for women with less than 5 years of schooling and 2.4 for those with 8 or more years. It is 2.7 in urban and 4.4 in rural areas.^ieng
Asunto(s)
Tasa de Natalidad , Fertilidad , Américas , Colombia , Demografía , Países en Desarrollo , América Latina , Población , Dinámica Poblacional , América del SurRESUMEN
The objective of this study was to evaluate the return of fertility in women who used Cyclofem as a contraceptive method during the introductory studies conducted in Brazil, Chile, Colombia, and Peru. From these four cohorts, 101 women were eligible for the study. Thirty-one were not included in the study either because they refused to be interviewed, had initiated another contraceptive method the month after discontinuation, or were unable to be contacted. A total of 70 women were included in the study. Our results showed that the return to fertility rate after the discontinuation of Cyclofem was 1.4 per 100 women at the end of the first month and reached 82.9 at one year. More than 50% were pregnant at 6 months. Fifty-one (94.4%) pregnancies ended in a live birth, two were spontaneous first trimester abortions, and one was a hydatidiform mole. Return of fertility was not related to the woman's age at the time of discontinuation, her weight, or the number of Cyclofem injections. In conclusion, fertility is restored by 1 month following Cyclofem discontinuation. Users and potential users should be counseled regarding the rapid return of fertility after discontinuing this method of contraception.
PIP: Cyclofem, a monthly injectable contraceptive containing 5 mg estradiol cypionate and 25 mg medroxyprogesterone acetate, has been registered in several Latin American countries; however, the return to fertility after method discontinuation has not been investigated. To address this issue, 70 women were followed who had participated in introductory studies in Brazil, Chile, Colombia, and Peru during 1992-94 and who then discontinued injectable use to achieve pregnancy. The mean number of Cyclofem injections was 7.1 (range, 1-19). The fertility rate was 1.4 at the end of the first month after Cyclofem discontinuation, 52.9 after 6 months, and 82.9 at 12 months. 55 pregnancies (94.8%) ended in live-term births, with no congenital malformations; there were 2 spontaneous abortions in the first trimester. The number of months required to become pregnant was not significantly associated with maternal age, body weight, number of injections, or country site. The return to fertility for this method is comparable to that following discontinuation of copper IUDs, barrier methods, and oral contraceptives. Since information on return to fertility is essential to informed choice, these findings should be incorporated into educational and counseling materials for providers and potential acceptors of this new contraceptive method.
Asunto(s)
Anticonceptivos Femeninos/administración & dosificación , Estradiol/análogos & derivados , Fertilidad , Acetato de Medroxiprogesterona/administración & dosificación , Adulto , Estudios de Cohortes , Anticonceptivos Orales Combinados/administración & dosificación , Combinación de Medicamentos , Estradiol/administración & dosificación , Femenino , Humanos , Inyecciones , Embarazo , Factores de TiempoRESUMEN
PIP: Statistical data describing the dramatic fertility decline and increase in contraceptive usage in Colombia since 1965 are presented in this article. Colombia's estimated crude birth rate, which fluctuated around 45/1000 for the first half of the 20th century, fell from 45 in 1965 to 41.3 around 1968, 36 in 1970, 31 in 1975, 28 in 1985, and 26 in 1990. The total fertility rate declined from an estimated 7.0 in 1960-65 to 6.7 in 1969, 4.5 in the 1973 census, 3.2 in the 1985 census, and 2.9 according to the 1990 Demographic and Health Survey. The most significant fertility declines occurred before 1975, but fertility continues to decline in rural and urban zones and in all regions of Colombia. Some isolated groups of women maintain high fertility. Rural women, women in the Atlantic region, women in consensual unions, less educated women, and those not employed outside the home had higher fertility rates. Marriage age, and important proximate fertility determinant, changed significantly only between 1975-86. Age at first union was around 19 years between 1969-76 vs. 21 years for 1986-90. The median age at first marriage was estimated at 22.1 years in 1976 and 22.8 in 1985. By 1985 the median age at first marriage was 23.4 years in urban areas and 2.2 years lower in rural areas. The causes of the fertility decline have not been precisely identified, although such factors as urbanization, improved health services, increasing educational levels, and female employment are believed to be involved. Colombia's crude death rate has declined from 22/1000 in 1930-51 to 13.5 in 1964, 9 in 1973, and 6 in 1985. The decline has been attributed to improved health conditions, introduction of vaccines and antibiotics, and general development of the medical sciences. The national infant mortality rate was 27/1000 live births in 1990, but elevated levels persist in the marginal areas of large cities, in remote rural areas, and among the least educated. Colombia's fertility decline has partially compensated for the mortality decline, and the rate of natural increase has slowed significantly. Around 1964-65, the Colombian Association of Medical Faculties and the institution that developed into PROFAMILIA began offering family planning services, and in 1969 the national government began offering family planning services through its maternal-child health program. The volume of the Ministry of Health Services has fluctuated considerably over the years in response to political pressures, and the other programs have endured political attacks from diverse quarters. But much of the population has firmly accepted contraception. In 1990, 69% of urban women, 61% of rural women, and 66% of all women currently in union used a method; 14% used pills, 12% IUDs and 2% rhythm, and 5% withdrawal.^ieng
Asunto(s)
Tasa de Natalidad , Conducta Anticonceptiva , Demografía , Fertilidad , Planificación en Salud , Matrimonio , Mortalidad , Dinámica Poblacional , Américas , Colombia , Anticoncepción , Países en Desarrollo , Servicios de Planificación Familiar , América Latina , Población , Ciencias Sociales , América del SurRESUMEN
PIP: The Atlantic region contains 20% of Colombia's population, including 1.4 million women aged 15-49. 2/3 of the population is urban. Despite an increase in contraceptive usage from 39% in 1978 to 52% in 1986, the region still has the lowest prevalence of any of Colombia's major regions. PROFAMILIA has planned campaigns to increase contraceptive usage in the Atlantic region and to encourage the use of temporary methods for birth spacing. The 1st survey of the Atlantic Coast was conducted in 1988 to obtain information on contraceptive use and attitudes as the basis for a campaign to promote use of Microgynon 21 oral contraceptives (OCs) and Tahiti condoms. 59% of women in union were using a method at the time of the survey. In urban and rural areas respectively, 17.9% and 12.2% used pills, 25.8% and 23.8% used female sterilization, 4.9% and 2.8% used IUDs, and 2.5% and 2.8% used injectables. Only .9% and 1.1% used vaginal methods, and .6% and .2% used condoms. No men in rural areas and .2% in urban areas chose vasectomy. 91% of OC users reported taking a pill each day, but some users took one only when they had sexual relations or 1 each week. 70% of users waited an incorrect number of days before starting a new cycle. Over half responded correctly that if they forgot a pill they should take another immediately and follow the regular cycle. Over half of current pill users had thought of changing methods, with over half of those considering sterilization, 28% the IUD, and 12% injectables. 38% of OC users thinking of changing methods would do so because of side effects and 36% because they were tired of taking a pill each day. All users of vaginal methods reported using them correctly. Condoms are usually purchased by men, who prefer to buy them at the drug store. All urban condom users reported having considered changing methods, 3/4 to female sterilization and 1.4 to an IUD. 65% of sterilized women reported undergoing the operation because they wanted no more children, 28% on the recommendation of a physician, and 4% because of economic problems. Over 95% of sterilized women reported satisfaction with the operation.^ieng