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Objetivo: Determinar la incidencia y tipo de complicaciones tras una apendicetomía en pacientes con apendicitis complicada con peritonitis en relación al tipo de intervención quirúrgica y al tiempo transcurrido desde el inicio del cuadro hasta la cirugía. Métodos: Se evaluaron 157 historias clínicas de pacientes provenientes del Servicio de Cirugía Pediátrica del HNGAI y diagnosticados de apendicitis aguda complicada con peritonitis. Los pacientes estaban entre los 2 y 14 años. Se separaron en dos grupos - 81 cirugías abiertas y 76 laparoscópicas. Se evaluaron las variables de edad, sexo, tipo de cirugía, duración de la intervención quirúrgica, tiempo de hospitalización y complicaciones postoperatorias. Se utilizó el análisis de Chi cuadrado y Mann-Whitney. Resultados: Del total de historias clínicas, sólo 157 historias clínicas cumplieron con los criterios de inclusión, de las cuales, 81 apendicetomías fueron abiertas y 76 laparoscópicas. La cirugía laparoscópica fue más prolongada. Las complicaciones fueron más frecuentes en las cirugías abiertas con una incidencia de 30.8%, así como el tiempo de hospitalización prolongado de 12.7%. Conclusión: Las cirugías laparoscópicas tienen una mayor duración en comparación con las cirugías abiertas, sin embargo, las complicaciones y hospitalización prolongada se presentaron con mayor frecuencia en las cirugías abiertas. Estos datos se podrían deber a la experiencia del operador.

Objective: To determine the incidence and type of complications after an appendectomy in patients with appendicitis complicated by peritonitis in relation to the type of surgical intervention and the time elapsed from the onset of the symptoms to surgery. Methods: 157 medical records of patients from the Pediatric Surgery Service of HNGAI and diagnosed with acute appendicitis complicated with peritonitis were evaluated. The patients were between 2 and 14 years old. They were separated into two groups - 81 open surgeries and 76 laparoscopic. The variables of age, sex, type of surgery, duration of surgery, length of hospitalization and postoperative complications were evaluated. Chi square and Mann-Whitney analysis was used. Results: From the total number of medical records, only 157 medical records met the inclusion criteria, of which 81 appendectomies were open and 76 laparoscopic. Laparoscopic surgery was longer. Complications were more frequent in open surgeries with an incidence of 30.8%, as well as prolonged hospitalization time of 12.7%. Conclusion: Laparoscopic surgeries have a longer duration compared to open surgeries, however, complications and prolonged hospitalization occurred more frequently in open surgeries. This data could be due to the experience of the operator.

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PURPOSE: AYAs with KTs experience high rates of premature allograft loss during the HCT. There is a critical need to identify protective factors associated with stable HCT. Resilience-the ability to adapt and thrive in the setting of adversity-has known positive impact on health outcomes. This study explored the novel role of resilience constructs as protective factors in securing stable HCT among AYA with KT. METHODS: We conducted semi-structured interviews of adolescents and young adults who transitioned from a single pediatric transplant center to multiple adult nephrology centers between 2010 and 2017. Interviews explored the role of key resilience constructs in participants' lives around the time of HCT. Participants were stratified into stable or unstable HCT groups based on biological markers of allograft function and clinical data from chart review. Content analyses of interview transcripts were reviewed and compared among HCT groups. RESULTS: Thirty-two participants enrolled (17 stable; 15 unstable). Key resilience constructs more salient in the stable versus unstable HCT group were confidence in and connection to one's healthcare team. Reports of healthcare self-management competencies were similar across both HCT groups. CONCLUSIONS: Confidence in and connection to one's healthcare team appear to be linked with a stable HCT among AYA with KT. This suggests that interdependence, the ability to foster connections with and elicit support from healthcare providers, as opposed to complete independence or autonomy, which is often advised in the HCT process, is a critical component of resilience linked to stable HCT.

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El 9 de julio del 2003, se informó al Ministerio de Salud, la existencia de un brote de diarrea en una empresa X, en San José. Se investigó el brote, con el objetivo de verificar su mangnitud, determinar factores de riesgo y mecanismo de transmisión, también recomendar medidas de prevención y control, a las autoridades de salud. Se revisaron 40 expedientes clínicos de pacientes atendidos por diarrea, en el consultorio de la empresa. Se definió como caso a todo funcionario, que presentó más de 2 deposiciones semilíquidas, y que consumió alimentos del comedor de la empresa, el 8 julio del 2003. Se tomaron corpocultivos, muestras de alimentos consumidos, y se enviaron a un laboratorio privado para el análisis. Se realizó un estudio de cohorte retrospectivo, y se aplicó un cuestionario. Se calcularon los riesgos relativos, RR, con intervalos de confianza del 95 por ciento, las tasas de ataque y porcentajes para los alimentos servidos. El 100 por ciento de los casos presentaron diarrea, sin fiebre. A los coprocultivos y a las muestras de alimentos, no se les buscó Clostridium perfringens. Las muestras de agua no reportaron contaminación fecal. El alimento sospechoso: cerdo con piña, presentó un RR igual 1,94; IC: 95 por ciento, 1, 26-2,96. El período de incubación y la descripción de la enfermedad coincidieron con una intoxicación por Clostridium perfringens, por lo que, se asoció el brote al alimento sospechoso. Como en la empresa X se desconocían los procedimientos a seguir ante un brote de diarrea, causado por alimentos, se recomendó a los encargados de epidemiología del Área Rectora de Salud, capacitar en el abordaje de las intoxicaciones causadas por alimentos; a las empresas bajo su responsabilidad, que cuentan con establecimientos de alimentación.

On July the 9th., 2003, an outbreak in company X was notified to the Ministry of Public Health in San José. This outbreak was investigated with thepurposes of verifying its magnitude, determining risk factors, and mechanisms of transmission as well asrecommending prevention and control measures to the Local Health authorities. Forty clinical chartsbelonging to diarrhea patients seen at the company´s infirmary, were reviewed. The case definition was anyworker with more than 2 semi-liquid bowel movements and who ate in the worker´s dining room on the 8th.of July, 2003. Stool and food cultures were taken and sent for analysis to a private lab. A retrospective cohort study was carried out and a questionnaire wasadministered to the employees. Relative Risks (with 95% confidence intervals) as well as attack rates and percentages were calculated for the foodstuffs served. All cases showed diarrhea but without fever. Clostridium perfringens was not searched in either thestool or the food cultures. Water samples didn´t report fecal contamination. The likely source of contamination, namely pineapple pork, showed a relative risk of 1.94 with a confidence interval between 1.26 and 2.96. The incubation period as well as the clinical characteristics of the illness were consistent with an intoxication dueto Clostridium perfringens. Since the employees were unaware of the procedures to be followed duringa foodborne outbreak, training was offered to the Local Health Area which in turn, educated the companies under its supervision regarding protocols to be followed during any future similar problems.

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Se realizó el estudio fitoquímico de Erythroxylum havanense jacq.(Erythroxylaceae), de donde se obtuvo el éster metílico de la anhidroecgonina como alcaloide mayoritario, el cual fue caracterizado espectroscópicamente

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