RESUMEN
Background: The single-port (SPL) and multi-port (MPL) laparoscopic approach are the gold standard of management of acute appendicitis, due to its multiple advantages over open surgery, mainly because of its direct effects on recovery, esthetics and costs of the procedure. However, in third-world countries, the laparoscopic approach is not yet fully reproducible due to the costs of the technique. The surgical-glove port single incision laparoscopic appendectomy (SGP-SILA) has been proposed as a viable option. However, it has never been studied in Colombia. Objective: To evaluate the cost-effectiveness and reliability of SGP-SILA in the management of complicated acute appendicitis, compared to traditional MPL approach. Materials and methods: A retrospective case control study was carried out comparing patients undergoing laparoscopic appendectomy by SGP-SILA vs. MPL, evaluating operating costs associated with intraoperative and postoperative variables in two tertiary centers in Bogota, Colombia. The data were analyzed and expressed according to their nature and distribution. Results: 116 patients were included (SGP-SILA: 62 and MPL: 54). The median surgical time for SGP-SILA was 60 min vs. 39 min for MPL. SGP-SILA was shown to cause lower frequency of surgical site infection (4 vs. 8 patients; p = 0.047). It was found a significant correlation between Grade III surgical site infection and surgery time (p = 0.047) in the MPL group; also, with hospital stay (p < 0.001). Also, a lower risk of surgical site infection was found with the SGP-SILA technique (22% vs. 31%). SGP-SILA generated a reduction in both direct and indirect operating costs of approximately 10% (616 USD vs. 683 USD). Conclusion: SGP-SILA and MPL are feasible and comparable procedures in the resolution of complicated acute appendicitis. SGP-SILA turns out to be more cost-effective compared to MPL, due to the use of more easily accessible instruments. This may be a reproducible technique in low- and middle-income countries.
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The causative agents of leprosy are Mycobacterium leprae and M. lepromatosis. Mycobacterium lepromatosis was found in 2008 to cause diffuse lepromatous leprosy in Mexican patients. This study aimed to identify M. leprae and M. lepromatosis in paraffin-embedded skin samples from Caribbean patients with leprosy. A total of six skin samples were obtained from the Dominican Republic. All cases presented the multibacillary form; five were nodular lepromatous leprosy, and one was borderline lepromatous leprosy. All patients received multidrug therapy. Molecular identification was achieved using the M. leprae-specific repetitive element for M. leprae and the hemN gene for M. lepromatosis. Mycobacterium leprae was identified in two lepromatous leprosy cases, and one borderline lepromatous leprosy case; M. lepromatosis was found in one nodular lepromatous leprosy case. Both Mycobacterium species were present in two nodular lepromatous leprosy cases. This is the first report of M. lepromatosis in the Dominican Republic.
Asunto(s)
Lepra Lepromatosa , Lepra , República Dominicana , Quimioterapia Combinada , Humanos , Leprostáticos/uso terapéutico , Mycobacterium , Mycobacterium leprae/genéticaRESUMEN
Nuestro objetivo es identificar los factores que influyen en la baja captación de sintomáticos respiratorios en el centro de salud. La metodología aplicada cuantitativa, cualitativa y longitudinal. Los resultados obtenidos y las conclusiones son: escasos recursos humanos en salud, no todo el personal maneja el progarma de tuberculosis, los insumos son escasos: la población desconoce la enfermedad y su magnitud y el servicio de salud no se proyecta a la comunidad
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Atención Dirigida al Paciente , PacientesRESUMEN
Se estudiaron 36 niños en total, de los cuales 18 se trataron con fototerapia solar y 18 con terapia de óxido de zinc, la distribución al azar de los niños en grupos determina que el grupo de fototerapia solar y el grupo con terapia de pomada de óxido de zinc cuentan con los tres tipos de dermatitis del pañal, es decir, grave, moderada y leve, el porcentaje de dermatitis leve es casi igual en ambos grupos, la dermatitis moderada el porcentaje es mayor en la terapia con pomada óxido de zinc, pero el porcentaje de niños que presentaron dermatitis grave es mayor en el tratamiento con fototerapia solar