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INTRODUCTION: Five billion people worldwide do not have timely access to surgical care. Cinterandes is one of the only mobile surgical units in low- and middle-income countries. This paper examines the methodology that Cinterandes uses to deliver mobile surgery. METHODS: Founding and core staff were interviewed, four missions were participated in, and internal documents and records were analysed between 1 May and 1 July 2014. RESULTS: Cinterandes performed 7641 operations over the last 20 years (60% gastrointestinal/laparoscopic), travelling 300,000 km to remote areas of Ecuador. The mobile surgery programme was initiated by a local Ecuadorian surgeon in 1980. Funding was acquired from businesses, private hospitals, and individuals, to fund a low-cost surgical truck, simple equipment, and running costs. The mobile surgical unit is a 24-foot modified Isuzu truck containing a preparation room with general equipment storage and running water, together with an operating room including the operating table, anaesthetic and surgical equipment. Mission structure includes: patient identification by a network of local medical personnel in remote regions; pre-operative assessment at 1 week by core team via teleconsultations; four-day surgical missions; post-operative recovery in tents or a local clinic; post-operative follow-up care by local personnel and remote teleconsultations. The permanent core team includes seven members; lead surgeon, lead anaesthetist, operating-room technician, medical coordinator, driver, general coordinator, and receptionist. Additional support members include seven regular surgeons, residents, medical students, and volunteers. CONCLUSION: Surgery is a very effective way to gain the trust of the community, due to immediate results. Trust opens doors to other programmes (e.g. family medicine). Surgery can be incorporated with all other aspects of health care, which can in turn be incorporated with all other aspects of human development, education, food production and nutrition, housing, work and productivity, communication, and recreation.
Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Laparoscopia , Unidades Móveis de Saúde/organização & administração , Serviços de Saúde Rural/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Países em Desenvolvimento , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Equador , Feminino , Humanos , Lactente , Recém-Nascido , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Unidades Móveis de Saúde/estatística & dados numéricos , Consulta Remota/organização & administração , Consulta Remota/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Adulto JovemRESUMO
The histological changes of the liver in ewes with pregnancy toxemia were characterized. Ten ewes were fed on grass ad libitum, and another ten were starved from day 130 of pregnancy for up to four days. Liver puncture biopsies were performed at days 70, 100, 130, and 140 of pregnancy, and at day 45 in postpartum. Seric hydroxybutyrate (HB), non-esterified fatty acids (NEFA), aspartate aminotransferase, and alkaline phosphatase were dosed. Histological preparations revealed similar incidence and intensity of mild liver steatosis in both groups at day 130. Starved ewes become toxemic (as indicated by HB), and at day 140 exhibited more severe injury in a higher proportion (9/9 vs. 4/10; P<0.01). Almost all of them (7/9) had large amounts of small lipid droplets in almost every hepatocyte over the whole liver acinus, and higher NEFA values. At day 45 in postpartum, both groups had mild steatotic changes as initially. A positive correlation between severity of liver damage seric and only aspartate aminotransferase was observed at day 140 in starved animals (P<0.05). This enzyme could be used to assess liver damage, but not alkaline phosphatase. All samples with degeneration corresponded to the microvesicular type. A short starvation period during late pregnancy in ewes produced reversible liver degeneration.(AU)
Caraterizaram-se histologicamente as alterações do fígado de ovelhas com toxemia da prenhez. Dez ovelhas foram mantidas em pasto ad libitum, e outras 10 submetidas a jejum a partir do 130º dia de gestação, por até quatro dias. Biopsias hepáticas foram realizadas aos 70, 100, 130 e 140 dias de gestação e, aos 45 dias pós-parto. Níveis séricos de hydroxibutirato, ácidos graxos não esterificados (NEFA), aspartato aminotransferase e fosfatase alcalina foram determinados. O estudo histológico revelou extensão semelhantes de degeneração nos dois grupos no 130º dia de gestação. No 140º dia de gestação, alta proporção de animais submetidos ao jejum, apresentou intensa degeneração no fígado (9/9 vs. 4/10; P<0,01) e, desses, quase todos 7/9 tinham grande quantidade de pequenas gotas de lipídios em quase todos os hepatócitos, nas diferentes regiões do ácino, além de níveis séricos mais elevados de NEFA. Quarenta e cinco dias pós-parto, os animais dos dois grupos apresentaram degeneração discreta, como no início. No 140º dia de gestação, verificou-se correlação positiva entre a severidade das lesões histológicas e a enzima aspartato aminotransferase, nos animais submetidos a jejum (P<0.05). Todas as amostras com degeneração corresponderam ao tipo microvesicular. Um curto período de jejum, na fase final da gestação da ovelha produz degeneração hepática reversível.(AU)
Assuntos
Animais , Feminino , Fígado/anatomia & histologia , Metabolismo , Pré-Eclâmpsia/veterinária , OvinosRESUMO
The histological changes of the liver in ewes with pregnancy toxemia were characterized. Ten ewes were fed on grass ad libitum, and another ten were starved from day 130 of pregnancy for up to four days. Liver puncture biopsies were performed at days 70, 100, 130, and 140 of pregnancy, and at day 45 in postpartum. Seric hydroxybutyrate (HB), non-esterified fatty acids (NEFA), aspartate aminotransferase, and alkaline phosphatase were dosed. Histological preparations revealed similar incidence and intensity of mild liver steatosis in both groups at day 130. Starved ewes become toxemic (as indicated by HB), and at day 140 exhibited more severe injury in a higher proportion (9/9 vs. 4/10; P<0.01). Almost all of them (7/9) had large amounts of small lipid droplets in almost every hepatocyte over the whole liver acinus, and higher NEFA values. At day 45 in postpartum, both groups had mild steatotic changes as initially. A positive correlation between severity of liver damage seric and only aspartate aminotransferase was observed at day 140 in starved animals (P<0.05). This enzyme could be used to assess liver damage, but not alkaline phosphatase. All samples with degeneration corresponded to the microvesicular type. A short starvation period during late pregnancy in ewes produced reversible liver degeneration.
Caraterizaram-se histologicamente as alterações do fígado de ovelhas com toxemia da prenhez. Dez ovelhas foram mantidas em pasto ad libitum, e outras 10 submetidas a jejum a partir do 130º dia de gestação, por até quatro dias. Biopsias hepáticas foram realizadas aos 70, 100, 130 e 140 dias de gestação e, aos 45 dias pós-parto. Níveis séricos de hydroxibutirato, ácidos graxos não esterificados (NEFA), aspartato aminotransferase e fosfatase alcalina foram determinados. O estudo histológico revelou extensão semelhantes de degeneração nos dois grupos no 130º dia de gestação. No 140º dia de gestação, alta proporção de animais submetidos ao jejum, apresentou intensa degeneração no fígado (9/9 vs. 4/10; P<0,01) e, desses, quase todos 7/9 tinham grande quantidade de pequenas gotas de lipídios em quase todos os hepatócitos, nas diferentes regiões do ácino, além de níveis séricos mais elevados de NEFA. Quarenta e cinco dias pós-parto, os animais dos dois grupos apresentaram degeneração discreta, como no início. No 140º dia de gestação, verificou-se correlação positiva entre a severidade das lesões histológicas e a enzima aspartato aminotransferase, nos animais submetidos a jejum (P<0.05). Todas as amostras com degeneração corresponderam ao tipo microvesicular. Um curto período de jejum, na fase final da gestação da ovelha produz degeneração hepática reversível.
Assuntos
Animais , Feminino , Fígado/anatomia & histologia , Metabolismo , Pré-Eclâmpsia/veterinária , OvinosRESUMO
Los trabajadores de la salud (TS) tienen riesgo de desarrollar alergia al látex, lo que está respaldado por múltiples publicaciones. OBJETIVOS: Establecer prevalencia de sensibilización y alergia a látex en TS del Hospital del Trabajador Santiago (HTS) y determinar factores de riesgo asociados. MATERIALES Y MÉTODOS: Se estudiaron 157 TS con encuesta sobre atopia, tiempo y Los trabajadores de la salud (TS) tienen riesgo de desarrollar alergia al látex, lo que está respaldado por múltiples publicaciones. OBJETIVOS: Establecer prevalencia de sensibilización y alergia a látex en TS del Hospital del Trabajador Santiago (HTS) y determinar factores de riesgo asociados. MATERIALES Y MÉTODOS: Se estudiaron 157 TS con encuesta sobre atopia, tiempo y síntomas con exposición a látex. Se efectuaron prick test con aeroalergenos, látex y frutas (Leti, España), látex amoniacado, prick in prick con guantes de látex y test de parche con látex y aditivos (Trolab, Alemania). RESULTADOS: La sensibilización a látex fue de 13,4por ciento (n=21). Hubo diferencia significativa entre sensibilizados y no sensibilizados en: presencia de atopia (p<0,001), sensibilización a frutas (p<0,001) y presencia de urticaria de contacto (p<0,001). Tres TS de los 19 examinados presentaron test de parche positivo. CONCLUSIONES: La prevalencia de sensibilización a látex es menor a la encontrada en otro estudio nacional realizado por nuestro grupo. La atopia y la sensibilización a frutas tropicales parecen importantes factores para el desarrollo de alergia al látex en la población estudiada.
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Masculino , Feminino , Adulto , Humanos , Dermatite Alérgica de Contato , Pessoal de Saúde , Hipersensibilidade ao Látex/epidemiologia , Látex/toxicidade , Chile , Hospitais , Doenças Profissionais , Prevalência , Fatores de Risco , Testes de Toxicidade CrônicaRESUMO
Background: Health care workers (HCW) are a high risk group for developing natural rubber latex (NRL) hypersensitivity and allergy. Some studies showed a correlation between time and frequency of exposure to NRL gloves and hypersensitivity, but a recent meta-analysis showed no clear evidences for such assumption. Aim: To determine the prevalence of NRL hypersensitivity and allergy in a group of HCW at the University of Chile Clinical Hospital. Materials and Methods: Ninety five HCW (aged 37±10 years, 59 females) were interviewed about time of exposure, atopic diseases and latex-related allergy symptoms. Different NRL extracts and seven NRL gloves brands were tested by the prick test method. Results: Twenty four workers (25%, 95% CI = 16.9%-35.2%) were sensitized. No gender differences were found. No symptomatic cases were found in the sensitized group. In the workplace, six and two non sensitized subjects had respiratory symptoms or contact urticaria, respectively. Sensitivity to bananas, avocadoes, kiwi and chestnut was not significantly more common among latex sensitive individuals. No differences between sensitized and non sensitized subjects were observed for the presence of atopic diseases or the mean number of years at the workplace. The sensitization rate to NRL increased along with years of work, from 18.6% in patients working less than 10 years, to 28.1% in the group between 10 and 20 years and to 35% in those working more than 21 years (p=0.693). Sensitization was also related to the weekly hours of exposure: 1-10 hours, 17%; 11-20 hours, 23.5%; 21-30 hours, 50% and 31-40 hours, 28.5% (p=0.036). Conclusions: Sensitization increased proportionally to the years and weekly hours wearing NLR gloves. We did not find symptomatic patients in the sensitized group.
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Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pessoal de Saúde , Hipersensibilidade ao Látex/epidemiologia , Doenças Profissionais/epidemiologia , Salas Cirúrgicas , Anestesiologia/estatística & dados numéricos , Chile/epidemiologia , Luvas Protetoras , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Prevalência , Testes Cutâneos , Cirurgia Geral/estatística & dados numéricos , Fatores de TempoRESUMO
OBJECTIVE: To determine whether a low-bandwidth Internet connection can provide adequate image quality to support remote real-time surgical consultation. SUMMARY BACKGROUND DATA: Telemedicine has been used to support care at a distance through the use of expensive equipment and broadband communication links. In the past, the operating room has been an isolated environment that has been relatively inaccessible for real-time consultation. Recent technological advances have permitted videoconferencing over low-bandwidth, inexpensive Internet connections. If these connections are shown to provide adequate video quality for surgical applications, low-bandwidth telemedicine will open the operating room environment to remote real-time surgical consultation. METHODS: Surgeons performing a laparoscopic cholecystectomy in Ecuador or the Dominican Republic shared real-time laparoscopic images with a panel of surgeons at the parent university through a dial-up Internet account. The connection permitted video and audio teleconferencing to support real-time consultation as well as the transmission of real-time images and store-and-forward images for observation by the consultant panel. A total of six live consultations were analyzed. In addition, paired local and remote images were "grabbed" from the video feed during these laparoscopic cholecystectomies. Nine of these paired images were then placed into a Web-based tool designed to evaluate the effect of transmission on image quality. RESULTS: The authors showed for the first time the ability to identify critical anatomic structures in laparoscopy over a low-bandwidth connection via the Internet. The consultant panel of surgeons correctly remotely identified biliary and arterial anatomy during six laparoscopic cholecystectomies. Within the Web-based questionnaire, 15 surgeons could not blindly distinguish the quality of local and remote laparoscopic images. CONCLUSIONS: Low-bandwidth, Internet-based telemedicine is inexpensive, effective, and almost ubiquitous. Use of these inexpensive, portable technologies will allow sharing of surgical procedures and decisions regardless of location. Internet telemedicine consistently supported real-time intraoperative consultation in laparoscopic surgery. The implications are broad with respect to quality improvement and diffusion of knowledge as well as for basic consultation.
Assuntos
Colecistectomia Laparoscópica , Tomada de Decisões Assistida por Computador , Internet , Sistemas de Informação em Salas Cirúrgicas , Consulta Remota/instrumentação , Sistemas Computacionais , República Dominicana , Equador , Humanos , VirginiaRESUMO
The PAMI's website creation (www.pami.org.ar) has had the purpose of spreading its activities, the standards of medical care and administrative management, offering--at the same time--a honest channel of interaction with the community.
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Sistemas de Gerenciamento de Base de Dados , Internet , Assistência Médica , Programas Nacionais de Saúde , Serviço Social , Idoso , Argentina , Humanos , Controle de QualidadeRESUMO
BACKGROUND: Telemedicine is traditionally associated with the use of very expensive and bulky telecommunications equipment along with substantial bandwidth requirements (128 kilobytes per second [kbps] or greater). Telementoring is an educational technique that involves real-time guidance of a less experienced physician through a procedure in which he or she has limited experience. This technique has been especially dependent on the aforementioned requirements. Traditionally, telemedicine and telementoring have been restricted to technically sophisticated sites. The telemedicine applications through the existing telecommunication infrastructure has not been possible for underdeveloped parts of the world. STUDY DESIGN: Telemedicine and telementoring were applied using low-bandwidth mobile telemedicine applications to support a mobile surgery program in rural Ecuador run by the Cinterandes Foundation and headed by Edgar Rodas, MD. A mobile operating room traveled to a remote region of Ecuador. Using a laptop computer equipped with telemedicine software, a videoconferencing system, and a digital camera, surgical patients were evaluated and operative decisions were made over low-bandwidth telephone lines. Similarly, surgeons in the mobile unit in Ecuador were telementored by an experienced surgeon located thousands of miles away at Yale University School of Medicine. RESULTS: Five preoperative evaluations were conducted from Sucua to Cuenca, Ecuador, with excellent clinical correlation. Additionally, a laparoscopic cholecystectomy was successfully telementored from the department of surgery at Yale University School of Medicine to the mobile surgery unit in Ecuador. The telementored surgery was performed using a telephone line with a baud rate of 12 kbps. CONCLUSIONS: Mobile, low-bandwidth telemedicine applications used in the proper technical and clinical algorithms can be very effective in supporting remote health care delivery efforts. Advantages of such applications include increased cost-effectiveness by limiting travel, expanding services to patients, and increased patient quality assurance.
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Unidades Móveis de Saúde , Procedimentos Cirúrgicos Operatórios , Telemedicina/instrumentação , Equador , Humanos , Mentores , Relações Médico-Paciente , Consulta RemotaRESUMO
UNLABELLED: This paper reviews the development of the field of medical informatics in Latin America. It also describes the results of a computer-based data management system, named AGUSTINA, which is comprised of maternal and infant data on 7570 deliveries that occurred between June, 1990 and December, 1996 in a hospital in the surroundings of Buenos Aires, Argentina. These data were fundamental for the instrumentation of preventive community-oriented activities in the area. Finally, this paper describes recommendations for future actions in the area of medical informatics in Latin America. ABBREVIATIONS: PCR: perinatal clinical record; CLAP, Centro Latino-Americano de Perinato-logia; WHO, World Health Organization; PAHO, Pan-American Health Organization; E-Mail, electronic mail; WWW, world wide web; FTP, file transfer protocol.
Assuntos
Bases de Dados Factuais , Assistência Perinatal/estatística & dados numéricos , Resultado da Gravidez/epidemiologia , Adolescente , Adulto , Argentina/epidemiologia , Feminino , Humanos , Mortalidade Infantil , Recém-Nascido , Assistência Perinatal/normas , Gravidez , Gestão da Qualidade TotalRESUMO
Mobile Surgery (MS) is an innovative method of delivering high quality surgical expertise and technology to underprivileged and remote areas. This is done by means of transporting a custom-built operating room in a truck and performing the operations on-site. Patients are referred to our program by rural doctors and family physicians. A screening process is completed by our surgical team, and those patients who meet our selection criteria are offered surgical treatment. Operations are meticulously performed and patients recover under our close observation in rural health centers, school rooms, or tents with our Mobile Surgical Unit (MSU) stationed adjacent to them.
RESUMO
This paper reviews the development of the field of medical informatics in Latin America. It also describes the preliminary results of a computer-based data management system, named AGUSTINA, which is comprised of maternal and infant data on 6195 deliveries that occurred between June 1990 and December 1995 in a hospital in the surroundings of Buenos Aires, Argentina. These data were fundamental for the instrumentation of preventive community-oriented activities in the area. Finally, this paper describes recommendations for future actions in the area of medical informatics in Latin America.
Assuntos
Informática Médica/métodos , Perinatologia , Adolescente , Adulto , Argentina , Feminino , Humanos , Recém-Nascido , GravidezRESUMO
At the end of the 20th Century, the world lives in the midst of a tremendous contradiction. On one side we have great scientific and technological progress, designed for the well-being of mankind, and on the other, the everyday widening gap between a few who have more than what they need and the vast majority of people who do not have enough.
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The aim of this study was to determine the effect of diazepam on the behavior of parturient ewes towards alien lambs. There is evidence that benzodiazepines cause behavioral changes during the lactation period in rats. In two independent experiments, it was found that the ewes acceptance of alien lambs significantly increased following a single injection of the benzodiazepine, diazepam, given either 1 or 12 h after parturition. In a third experiment, in which the alien lamb was not permitted to suckle during a period of 2 h after the injection, the diazepam treatment did not provoke significant differences in maternal behavior of the ewes, although in the ewes treated with diazepam, suckling clearly tended to increase. At the dose employed (20 mg), administered 1 h after birth, diazepam caused no signs of sedation as assessed in an open-field test carried out 3 h after parturition. This doesn't eliminate the possibility of diazepam having a sedative effect in the period of 2 h immediately after its administration and before the test and, in this way, facilitating suckling which could be responsible for the maternal behavior observed after this period. As diazepam gives rise to an enhanced GABAergic activity in the brain, these observations suggest that a GABAergic mechanism could also play a role in the process whereby ewes form a selective bond with their own offspring.
Assuntos
Diazepam/farmacologia , Comportamento Materno , Agressão/efeitos dos fármacos , Animais , Feminino , Trabalho de Parto , Lactação/efeitos dos fármacos , Ocitocina/farmacologia , Gravidez , OvinosRESUMO
To study breed differences in ewes induced to parturition with dexamethasone (DXM), 15 Corriedale and 16 Polwarth ewes were injected with 15 mg of DXM four days before the expected lambing date (Days 144 and 145, respectively) in Experiment 1. Interval from treatment to parturition was twice as long for the Polwarth than for the Corriedale breed (57.9 vs 28.8 hours, P /= 0.05) and on the percentage of ewes retaining the placenta beyond 6 hours (18% vs 0%, P>/= 0.05). Birth weight of lambs was lower in the induced group (3.9 vs 4.5 kg, P
RESUMO
Time of delivery was studied in normal (N) or enucleated (E) rats. Isolated (1/cage) at mating (day 1 of gestation), they were all anaesthetized on day 8 and some of them were then blinded. After anaesthesia, they were kept either alone (N and E) or in homogeneous (NN and EE) and heterogeneous (NE) pairs either under a 12L-12D or a 2L-22D light-dark (LD) cycle. Activity, monitored throughout the rest of pregnancy in 2 homogeneous (NN and EE) and heterogeneous (NE) pairs of rats, kept a marked circadian rhythm under each light regimen. Birth distributions differed according to LD cycle in normal (N or NN) but not in enucleated (E and EE) rats. Under the 12L-12D regimen, parturitions of N and E rats were divided into 2 parts, the majority occurred on the afternoon of day 22 before 21:00 h, the remainder were observed after 6:00 h on day 23. Under the 2L-22D regimen, N rats gave birth over one period, mainly on day 23, whereas E rats had the same birth distribution as those subjected to the 12L-12D LD cycle. In heterogeneous pairs of rats (NE), birth times were affected by photoperiod; under the 2L-22D regimen it was intermediate between those of homogeneous pairs (NN and EE). These results indicate that the eyes were the first link of the nervous chain by which photoperiod influenced birth time. Social conditions may also modulate the photodependent mechanism in ways which remain to be determined.