bluuebunny/crossref_metadata_2025 huggingface dataset:
Short-term preoperative parenteral nutrition benefits malnourished patients undergoing major gastrointestinal surgery
Authors: Pendlimari Rajesh , Swamygowda Nagesh N. , Nagadas Shreedevi K. , Subramanian Kaushik
Published: April 2020

Background: Pre-operative nutritional support is of paramount in malnourished patients undergoing major gastrointestinal (GI) surgery. We aimed to investigate the outcomes of short term pre-operative parenteral nutrition in nutritionally depleted patients undergoing major GI surgeries.Methods: A retrospective study from tertiary care centre in South India, where nutritionally at risk patients undergoing major GI surgeries from 2016-2018 were identified and reviewed. Two groups –who received total or peripheral parenteral nutrition (TPN and PPN) and only enteral nutrition..Results: Of 80 patients who were nutritionally depleted underwent major GI surgery, 38 patients received pre-operative parenteral nutrition (PN) support for mean 11 days. Patients who received pre-op PN had similar outcomes (overall complication rate n=26, 68.4% vs n=32, 76.2% p=0.43), when compared to patients who received pre-op enteral nutrition conditioning. Though a small group of patients received peripheral PN supplementation, there was no difference in overall complication rate, when compared with TPN group (n=14, 58.3% vs n=12, 85.7%, p=0.08).Conclusions: Parenteral nutrition either total or supplemental is a useful adjunct pre-operatively for poorly nourished patients and should be utilized to build nutrition prior to major GI surgery. Pre-operative peripheral parenteral nutrition as supplement seems to be beneficial in patients undergoing GI surgery, pending large studies.
Clinical experience of upper limb ischemia: a retrospective study
Authors: Tolia Jitesh , Bhatt Arvind
Published: April 2020

Background: Arterial disorders of the upper extremity are much less common than those of the lower extremity, but when they result in symptoms of acute or chronic ischemia, surgical or endovascular techniques for upper extremity revascularization may be needed. This study presents a review of the epidemiology, aetiology, and clinical characteristics of upper limb ischemia.Methods: The records of 70 patients with upper limb ischemia who underwent treatment from were retrospectively reviewed.Results: A total of 44 patients were diagnosed by CT. Other diagnostic methods and tools used were conventional angiography and duplex ultrasound. Four cases were diagnosed solely on the basis of a medical history and physical examination. A total of 56 surgeries were performed. Rest of the 14 patients went under conservative therapy. The operations included embolectomy and thrombectomy using a Fogarty balloon catheter (n=32), bypass surgery using the great saphenous vein (n=10), percutaneous catheter-directed thrombolysis (n=8), and primary repair (n=4). Patients with Raynaud’s phenomenon or Burger’s disease were either treated with medication only (n=14) or with sympathectomy (n=2).Conclusions: The duration of symptoms in cases of upper limb ischemia may vary from two hours to a year, depending on the aetiology and severity of the illness. Many debates have addressed whether the time gap between the onset of symptoms and treatment predicts long-term arm function.
A prospective observational study to study and correlate the clinical and microbiological profile of bile cultures in patients with symptomatic cholelithiasis
Authors: Shankaran Ramakrishnan , Amarasekara Chaminda
Published: April 2020

Background: Biliary infection has been reported in a significant proportion of patients developing gallstones. Many studies have found biliary microflora in 20% to 46% patients with a post-operative infection rate of 7% to 20% in those who undergo cholecystectomy for symptomatic gallstone disease. Various antibiotics are also used empirically as prophylaxis against post-operative infection. The study was conducted in order to determine the bacteriology and to test its sensitivity to commonly used antibiotics of aspirated bile samples taken during laparoscopic cholecystectomy, and to correlate it with the clinical profile recorded in patients with symptomatic cholelithiasis.Methods: A total of 266 patients who underwent laparoscopic cholecystectomy were included in the study over a two year period. Intra operatively, bile was aspirated from gall bladder and sent for culture and antibiotic sensitivity testing.Results: 14.66% (39 out of 266) patients had positive growth with Escherichia coli most commonly isolated in 9.77% (26/266) patients, followed by the Klebsiella species in 4.89% (13 out of 266) patients. All the cultures were sensitive to amikacin and meropenem, 97.44% to imipenem, and only 43.39% were sensitive to ampicillin. A statistically significant correlation was observed between a positive bile culture with the duration of symptoms (p=0.01874) and gall bladder thickness (p<0.0001). No correlation was seen between bile culture and history of acute cholecystitis, number or size of calculi.Conclusions: The results of this study can help develop local guidelines and recommendations based on Indian data to ensure the rational use of prophylactic antibiotics in patients with symptomatic cholelithiasis.
The vascular armamentarium explored-the ultimate goal achieved
Authors: Ravichandran Manoj Prabakar , Rathinavelpandian Subrammaniyan , Gnanasekaran Marunraj , Balachandran Saravanan
Published: April 2020

Peripheral arterial disease is one of the commonest causes for a limb being amputated most often, we present this case of medium vessel vasculitis with chronic threatening limb ischemia to make a note of our attempt to save her limb by multiple modalities which included medical management with steroids, immunosuppressants, pulsed cyclophosphamide, interventional radiological procedure of catheter directed thrombolysis with urokinase, surgical procedures like bypass, split skin grafting and minor amputations, implemented novel modalities like hyperbaric oxygen therapy. By exploring the armamentarium available, involving a multidisciplinary team which included vascular surgeon, rheumatologist, intervention radiologist, plastic surgeon, physiotherapist and aptly using the right modality at the right time we were able to ultimately achieve our goal of limb salvage.
Extensive fournier gangrene with retroperitoneal involvement in a diabetic patient
Authors: Girieasen M. Sabari , Viswanathan Naveenkumar , Nedunchezhian S. , Ross Kannan
Published: April 2020

Fournier’s gangrene is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of the genital, perianal and perineal regions extending to the abdominal wall between the fascial planes. It is secondary to polymicrobial infection by aerobic and anaerobic bacteria with a synergistic action. A 42 year old male who is an alcoholic and diabetic on irregular treatment presented with scrotal swelling and pain for 5 days following a trauma. On examination, patient was febrile, tachypneic and had tachycardia. His scrotum was edematous and erythematous on right side with crepitus. Abdomen was warm on right side till umbilicus and had crepitus. He was in sepsis and had diabetic ketoacidosis, prerenal azotemia and mild impairment of liver function. A diagnosis of extensive Fournier gangrene with retroperitoneal involvement was made. Patient underwent scrotal exploration and aggressive debridement serially. Testis was spared. As patient improved with good wound care and glycemic control, wound was closed. Though our patient had retroperitoneal involvement without peritonitis, he was deferred laparotomy which significantly reduced the morbidity and mortality. It is one of the few reported case in the literature with retroperitoneal involvement.
Clinical profile of post coronary artery bypass graft patients undergoing percutaneous coronary intervention in native or graft vessels
Authors: Jadhav Santhosh , Setty H. S. Natraj , Prakash Bhanu , C. Yeriswamy M. , Ullegaddi Arunkumar , Reddy Babu , Raj Sathwik , Patil Rahul , Raghu T. R. , Manjunath C. N.
Published: April 2020

Background: The PCI target vessel and corresponding outcomes in prior CABG patients are poorly studied. The study aims to determine the predictors and outcomes of native coronary artery and bypass graft percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass graft surgery (CABG).Methods: The factors associated with native and bypass graft PCI were analyzed in prior CABG patients undergoing PCI between July 2011 and December 2013, at Sri Jayadeva Institute Of Cardiovascular Sciences and Research, Bengaluru. Clinical/procedural characteristics and immediate procedural outcomes were recorded and analyzed.Results: During the study period, 76 patients underwent PCI who were before CABG patients. The PCI target was a native coronary artery in 73.6% and a bypass graft in 28.9%. The majority of patients presented more than five years after the CABG (64.4%). Post PCI angina was seen in 7(9.2%), and in 6(7.8%) patients, procedural complications seen. It was found that most PCI was done in patients who presented more than five years after CABG.Conclusions: Most PCIs performed in prior CABG patients are done in native coronary artery lesions.
Thrombolytic therapy in prosthetic valve thrombosis in the second trimester of pregnancy
Authors: Jadhav Santhosh , Setty H. S. Natraj , S. Shankar , Mundru Phani Teja , C. Yeriswamy M. , Reddy Babu , Kharge Jayashree , Raj Sathwik , Ullegaddi Arunkumar , Patil Rahul , Raghu T. R. , Manjunath C. N.
Published: April 2020

Pregnancy with mechanical valves requires anticoagulation, the risk of bleeding and embryopathy associated with oral anticoagulation must be weighed against the risk of valve thrombosis. In the presence of a mechanical valve thrombosis, an appropriate treatment modality must be selected. Prosthetic valve thrombosis during pregnancy requires immediate therapy such as valve replacement, thrombolytic therapy, or surgical thrombectomy. A course of thrombolytic therapy may be considered as a first-line therapy for prosthetic heart valve thrombosis. We describe a primigravida (second trimester) with mitral valve replacement status presenting with acute prosthetic valve thrombosis and treated successfully with intravenous streptokinase.
Improving primary health care workers’ knowledge of cervical cancer and visual inspection screening techniques through competency-based training: prospects for expanding coverage in developing countries
Authors: Umuago Ibiyemi J. , Obiebi Irikefe P. , Eze Godson U. , Moeteke Nnamdi S.
Published: April 2020

Background: Health workers in resource-poor settings have not demonstrated a comprehensive knowledge of visual staining procedures for cervical cancer screening. This study adopted competency-based training (CBT) to determine if it will improve their knowledge, and potentially expand screening coverage.Methods: A quasi-experimental (pretest-posttest) design was adopted in this study conducted among primary health care workers in Ethiope-West Local Government Area of Delta State, Southern Nigeria. The participants had a competency-based training following an initial assessment of their knowledge. Data were analysed using SPSS version 22. The main outcome measures were baseline knowledge of cervical cancer, its prevention, and visual inspection screening techniques, as well as the effect of CBT on knowledge.Results: Participants demonstrated correct knowledge of cervical anatomy/physiology and cervical cancer epidemiology/symptomatology to varying degrees, although their knowledge of visual inspection with acetic acid or Lugol’s iodine (VIA/VILI) was grossly inadequate as only half had adequate knowledge. Knowledge of prevention, performance of VIA and VILI, as well as overall knowledge, improved significantly to 100% post-intervention (p=0.002, p<0.001 and p=0.003 respectively). Mean knowledge scores drastically increased among the PHWs between pre-CBT and post-CBT. The lowest mean difference was recorded for knowledge of cervical anatomy/physiology: 17.58 (CI: 8.16 - 27.00); while the highest was for knowledge of VILI/VIA technique: 41.01 (CI: 29.40 - 52.62).Conclusions: CBT significantly improved knowledge of cervical cancer prevention and visual inspection screening methods (VIA and VILI), indicating a window of opportunity for expanding screening services at primary health care level.
Perspectives of medical students on attributes of bedside teaching
Authors: Alam Nazmun N. , Haque Shammin , Khain Inn K. , Mushroor Sumaiya
Published: April 2020

Background: Bedside teaching forms an integral part of medical education which is declining recently. The aim of this study is to evaluate the perception of undergraduate medical students about the attributes of bedside teaching.Methods: This cross-sectional study was carried out among the undergraduate medical students of Dr. Sirajul Islam Medical College, Dhaka, from September to November 2016. One hundred and forty medical students were included in this study. Ethical clearance had taken and a pre-designed and pre-tested questionnaire comprising of closed ended questions was used.Results: Majority of the study group, 64.3% absolutely agree that bedside teaching is a useful method for learning medical skills and 28.6% just agree. Regarding learning correct physical examination, mostly 41.4% absolutely agree that it is helpful and 37.1% only agree. It helps in rapid improvement of medical skills within limited time as absolutely agreed and just agreed by 48.6% and 45.7%, respectively. Half (50%) absolutely agree, 40% only agree that problem-based learning is possible, while evidence-based medicine can also be learned as 51.4% participants absolutely agree than 38.6% only agree. Majority 42.9% agree and 34.3% absolutely agree that allotted time is inadequate. More than half 54.3% and 40% absolutely agree and just agree, respectively, that maximum medical knowledge can be achieved by means of bedside teaching.Conclusions: Positive opinion about bedside teaching exists among the future doctors. But unfortunately they are deprived due to time limitation. The barrier must be removed to restore this imperative element of medical education.
Needs assessment for faculty development at an Egyptian medical school: a triangulation approach
Authors: Abdelkreem Elsayed , Abo-Kresha Seham A. , Ahmed Emad A. , Ibrahim Doaa , Hemdan Shimaa B. , Abdellah Mostafa A.
Published: April 2020

Background: Faculty development (FD) is a core component of medical education, and needs assessment is central for planning effective FD programs. In the present study, we assessed the perceived development needs of medical faculty and the factors affecting these needs at an Egyptian medical school.Methods: This sequential mixed-methods research was conducted in 2019 at Faculty of Medicine, Sohag University (Egypt) using a triangulation approach for data collection: (1) web-based survey composed of 74 items about demographics and educational experiences, satisfaction with current FD programs, perceived development needs, delivery and scheduling preferences; (2) semi-structured interviews for in-depth understanding; and (3) secondary data.Results: A total of 434 out of 793 target faculty (54.7%) completed the survey. Participants in general perceived moderate to extreme need to all FD areas with the highest priorities given for discipline-specific and research domains. Awareness of teaching needs has increased among faculty in recent years. Perceived FD needs varied across career stage, and most participants preferred short interactive workshops; online methods are also desired. Compulsory participation in FD programs was a subject of high controversy. More than one-third of participants were interested in joining the newly established medical education department.Conclusions: Perceived FD needs are affected by accreditation standards, academic reward systems, and socioeconomic factors. The present study provides a transferrable model for conducting FD needs assessment, and the findings are important for planning effective and economically sound FD programs within the complex structure of today’s medical schools.
Dengue fever: a re-emerging disease
Authors: Minhas Sukhmeet , Pardal Maninder Pal Singh
Published: April 2020

Background: Dengue is a rapidly spreading mosquito borne disease. Dengue is now endemic in 100 countries worldwide.Methods: Cross sectional descriptive study design was used by the workers. We The workers obtained detailed information from each reported case. Active case finding by surveys during the period of the outbreak, besides a detailed environmental survey was also carried out. Standard statistical tools like calculating relative risk and Chi square were utilised for data analysis.Results: In all 17 cases who fulfilled the case definition criteria were admitted in the month of September 2019. Out of these 16 (94.11%) were confirmed by NS 1 Antigen ELISA, while 01 (05.88%) was probable case. The first case reported on 08 Sep 2019, followed by a sudden spurt in the number of cases. The weekly epidemic curve is depicted in (Figure 1). There were no complications or fatalities. Detailed environmental assessment of the area revealed Aedes mosquito breeding in artificial containers of water. The house index of 7.06%, while the container index was 6.06%.Conclusions: The above study thus highlights the necessity of strict environmental monitoring by all authorities concerned in the country to prevent morbidity and mortality due to Dengue fever and other mosquito borne diseases. The menace of Dengue fever will continue till we learn to manage our solid waste properly, as Dengue is after all a man-made disease due to improper solid waste disposal.
A study on prevalence of refractive error and its associated factors among school children in Tamil Nadu
Authors: Megala M. , Dhamodharan S. , Duraimurugan M. , Ganapathi K. Chellavel
Published: April 2020

Background: Refractive error is an avoidable cause of visual impairment. Children do not complain of defective vision. This warrants early detection and treatment. The study was conducted with the objective of estimating the prevalence of refractive error in school children and its associated factors.Methods: This was a cross sectional study conducted in schools of selected district in Tamil Nadu from July 2017 to January 2018. Sample size of 422 covered. A semi structured questionnaire was used to collect the details and also screened for refractive errors. Data was analysed using SPSS.Results: Among the 422 students screened, 86 (20.4%) had refractive error. The prevalence of refractive error showed significant association with age, education and occupation of parents, socio economic status, parental history of refractive error, duration of watching television and body mass index.Conclusions: Refractive errors among school children can be easily identified by regular eye screening programmes, promptly treated can be protected from future complications. Periodic screening of school children is very essential to improve the quality of eye-sight.
Prevalence of pre-hypertension and hypertension and its correlates among rural adult population in district Jhansi, Uttar Pradesh
Authors: Patel Ashok Kumar , Arya Vimal
Published: April 2020

Background: The prevalence of hypertension is on a rise in India, both in urban and rural areas. Hypertension is reported to be the fourth contributor to premature death in developed countries and the seventh in developing countries. Aims and objectives was to find out the prevalence of pre-hypertension and hypertension among persons above 18 years of age in rural area of Jhansi and to assess the association of different risk factors with pre-hypertension and hypertension.Methods: Study was conducted in the field practice area of Department of Community Medicine, MLB Medical College, Jhansi, Uttar Pradesh. Total 1100 participants were collected by house to house visit. Chi square and multivariate logistic analysis were used to assess the association.Results: Prevalence of prehypertension and hypertension was 24.2% and 19.3% respectively in our study. The factors identified as increasing the risk of developing hypertension were increasing age, family history of hypertension, inadequate physical activity, excess salt intake, tobacco consumption, alcoholism, BMI >25 kg//m2, less consumption of fruits and vegetables.Conclusions: Awareness of the hypertension status among hypertensive cases, counselling of the pre-hypertensives and hypertensives on lifestyle modification as well as regular treatment of antihypertensive medicine were key recommendations to prevent hypertension.
Assessment of antecedents for violence against doctors: a cross sectional study on health worker component
Authors: Panigrahi Sunil Kumar , Satpathy Parmeshwar , Majumdar Sagarika , Pal Anjali
Published: April 2020

Background: The occupational safety and health administration considers physicians, nurses and other healthcare providers to be vulnerable and at a high risk of workplace violence. 75% of the doctors in India have been victims of violence at workplace.Methods: This was a hospital based cross sectional study among resident doctors in a tertiary care hospital of Maharashtra.Results: Among 137 residents interviewed, 81% of them faced verbal abuse in previous 1 year. In 57.6% of the cases the perpetrators of violence were the relatives of the patients. The most common place of harassment was the indoor patient wards followed by emergency/casualty department.Conclusions: Lifestyle factors such as quality of sleep pattern, addictions have associations with events of harassment among the resident doctors. There should be a comprehensive plan aimed at reducing the lifestyle risk factors of the physicians and allow them proper rest between duty hours.
An evaluation of congenital talipes equinovarus patients treated by various methods
Authors: Goel Navneet , Goyal Ashish , Sharma Mohit
Published: April 2020

Background: Idiopathic congenital talipes equinovarus is one of the commonest congenital anomaly. Although treatment provides many options, near universal agreement exists that initial management should consist of gentle manipulation of the affected foot. In developing country like India presentation is extremely variable from soon after birth to very late childhood and irregular follow up makes treatment more difficult.

Methods: 100 cases of congenital talipes equinovarus who attended the Orthopedics OPD of our hospital (March 2013  to 2016) were taken up. In neonates with delicate skin, the passive manipulation was demonstrated to the mother which they did 5-6 times daily. The application of plaster of Paris cast and passive manipulation was done every 15th day upto 3 months of age. After the 3-month age, passive manipulation was done every 3 weeks. If no normalization, surgery was advised and done to correct the resistant component accordingly. All the analyses were performed in R-programming language (R- 3.0.0).

Results: 6 cases,10 feet were lost during follow-up. Results were assessed in 134 feet, 128 cases managed conservatively, 13 surgically. Results were assessed according to clinical, radiological criteria of Beatson and Pearson. 13 feet were operated of 144 feet,11 cases posteromedial soft tissue release (PMSTR) was done. In two Joshi’s external stabilizing system (JESS) fixator was applied.

Conclusions: Majority of cases can be treated successfully by conservative means and only in 11 cases PMSTR was done, 2 cases of relapsed feet JESS was applied.
Study of management of subtrochanteric fractures of femur with reconstruction nail
Authors: Sundaram Shivananda , Munaiah Lokesh , Mallegowda Radhakrishna A. , Siddegowda Jayaram B. , Jhamb Jai Aditya
Published: April 2020

Background: Subtrochanteric fractures of femur are the fractures occurring from the inferior aspect of the lesser trochanter to 5 cm distally. They represent a challenge for surgeons due to the deforming forces acting on the region and the high rates of complications like non-union. This study evaluates the fixation of subtrochanteric fractures of femur with reconstruction nail which is a specialized antegrade intramedullary nail for femur.

Methods: A prospective study conducted between October 2017 to May 2019 where 20 cases of subtrochanteric fractures of femur were treated with reconstruction nail and were followed up serially till 24 weeks radiologically and clinically.

Results: The average time of union for patients was 5.15±1.14 months with 3 patients whose fractures didn’t unite where one went for frank non union, one had a refracture and one patient had reverse z effect. The functional outcome was excellent in 45% patients and good in 30% patients while poor in 3 (15%) patients.

Conclusions: Reconstruction nail is a good device for subtrochanteric fractures of femur providing rigid fixation with low complication rates.
Outcome of pedicle screw fixation with transpedicular bone grafting in fracture of thoracolumbar vertebrae
Authors: Singh Harpreet , Rampurwala Aliasgar J. , Rudani Tej S. , Gandhi Malay P.
Published: April 2020

Background: Posterior short segment instrumentation for thoracolumbar fracture is known for high implant failure rate because of the lack of anterior support. Anterior body augmentation by transpedicular bone grafting has been developed as an alternative to overcome this failure. In this study, we have evaluated the outcome of the cases of the unstable thoracolumbar spine injuries managed surgically with pedicle screws and transpedicular bone grafting.

Methods: 20 patients were included in this study and were followed up for up to 6 months postoperatively. We assessed the outcome of each patient with Frankel scale and visual analog score (VAS) post-operatively clinically and radio logically by measuring Cobb’s angle and anterior vertebral body height post-operatively on follow-up at 6 weeks, 12 weeks, and 24 weeks.

Results: We found that males had higher incidence with most common mode of injury was fall from height. D12 was single most involved vertebrae. The average Cobb’s angle during preoperative stage was 12 degrees and 22.05 degrees at 6th week and this was maintained till 24th week. The mean difference of anterior vertebral body height between pre-operative and 24th post-operative week was 7.15 mm. The mean VAS pre-operatively was 9.8 which changed to 0.75 at 24 weeks follow up. These were statistically highly significant.

Conclusions: Our study established that Pedicle screw fixation with transpedicular bone grafting has a satisfactory result and can restore vertebral height, increase the stability of the injured vertebrae and leads to a significant improvement in the patient’s quality of life.
Tarlov cyst- a rare occurrence: a short series of two cases
Authors: Arora Kamal Kumar , Chaudhary Priti
Published: April 2020

Tarlov cysts were first noted and described by Tarlov in 1938. The overall incidence of these is somewhere between 08%-09% of the total population with female preponderance. Most commonly, they are in sacral region. Patients were either asymptomatic or reported in the OPD with low backache with radiculopathy CT guided micro fenestration of the cyst was done using the aspiration-injection technique in the symptomatic patient. The primary outcomes, pain and function, were assessed by using the lumbar spine outcomes questionnaire. The outcome in our cases was excellent in terms of pain intensity, personal care, lifting, walking, sitting etc., requiring no further surgical intervention.
Sytuacja społeczna kobiet na Dalekim Wschodzie utrwalona w czasopismach i wspomnieniach Polaków na przełomie XIX i XX wieku
Authors: Jaszewska Ewa
Published: April 2020

Walka z niesprawiedliwością względem kobiet toczyła się na Dalekim Wschodzie od setek lat, jednak ich położenie uległo poprawie dopiero w pierwszych dekadach XX wieku. Bodźcem do usamodzielnienia się tamtejszych kobiet stały się liczne przekłady literatury europejskiej z końca XIX wieku. Głównym postulatem stawianym przez rzesze Chinek i Japonek było przyznanie kobietom praw wyborczych, co stało się możliwe dopiero pod koniec lat czterdziestych XX wieku. Mimo wszystko kobiety Dalekiego Wschodu nie zrezygnowały ze swoich dążeń, uzyskując szereg znaczących praw, między innymi majątkowych, spadkowych, a także w dziedzinie nauki i pracy. Polacy z zaciekawieniem przyglądali się walce Chinek i Japonek o równouprawnienie, co uwidoczniło się w artykułach publikowanych zarówno w Polsce, jak i zagranicą.
Hombres, género y salud
Authors: Gomes Romeu , Couto Marcia Thereza , De Keijzer Benno
Published: April 2020

Los hombres siempre han estado presentes en las agendas de salud, basadas principalmente en enfoques clínicos y epidemiológicos. Para ampliar estos enfoques, es necesario abordar el tema desde una perspectiva que tenga en cuenta la relación entre género y salud. Además, la discusión debe tener en cuenta la interseccionalidad de género (masculinidades) con otras categorías de diferenciación social, como raza, etnicidad, clase social, generación, sexualidad. Los artículos aprobados en la convocatoria “Hombres, género y salud” de la revista Salud Colectiva ofrecen producciones teóricas y empíricas que sin duda contribuirán al debate, y aunque este conjunto de textos no agota la complejidad del problema, abre un rico debate sobre las tensiones y las brechas que aún persisten en las discusiones sobre el tema.
Plan de Acción
Authors: Gaitán Hernando
Published: April 2020

Al ser designado hace 8 años en el cargo de Director de la Revista Colombiana de Obstetricia y Ginecología (RCOG), me propuse, junto con el equipo de trabajo, colocar a la Revista en los niveles internacionales de excelencia en materia de publicaciones científicas.En este sentido se inició la revisión por pares y el envío de sugerencias amables y constructivas para mejorar la calidad de los manuscritos enviados, con insinuaciones metodológicas o de análisis cuando hubiera lugar para lograr el máximo aprovechamiento de la información, garantizando la validez de los resultados y conclusiones o con modificaciones de forma para hacer mas claros y coherentes los textos. Algunas veces estas sugerencias han sido aceptadas, otras veces han sido rechazadas con base en argumentos pertinentes de los autores.Se hizo público el nuevo proceso de evaluación de los artículos, se iniciaron una serie de cambios en la revista que llevaron a la creación del Comité Editorial y la modificación del Comité Científico. Se ha ido ampliando el número de revisores o pares que evalúan los artículos, se hace pública la fecha de recibido, revisado y aprobado de los manuscritos y se ha mantenido la periodicidad cada 3 meses. La Revista ha permanecido abierta a la comunidad de especialistas y se ampliaron los tópicos a cubrir por la publicación, incluimos los temas relacionados con la salud de la mujer, además de la obstetricia y ginecología y las subespecialidades tales como salud, género y violencia, salud pública a nivel nacional y latinoamericano.En cuanto ala calidad editorial, la revista es explícita en el proceso de selección de los artículos y del proceso de revisión por pares externos, se solicita la afirmación expresa sobre el respeto a la normas éticas y posibles conflictos de interés a los autores así como la oportuna corrección de los errores, el respeto a las opiniones diferentes a los editores. No hay ningún tipo de material publicitario que pudiera afectarla objetividad del material publicado. Por otra parte hemos ya iniciado la publicación de artículos completos en inglés y portugués.
Prevalencia de anomalías de los conductos de Müller en el Hospital General de Medellín (2000-2005)
Authors: Jara-Vélez Carlos Alberto , Rengifo-Cruz José Manuel , Arango-Martínez Adriana
Published: April 2020

Objetivos: determinar la prevalencia y características clínicas de pacientes con malformaciones Müllerianas que consultan a un hospital de tercer nivel.Métodos: se realizó un estudio de corte transversal, en pacientes con diagnóstico de malformaciones Müllerianas, en el Hospital General de Medellín entre los años 2000 y 2005.Resultados: de un total de 1.450 pacientes que consultaron por urgencias, consulta externa ginecológica o se encontraban hospitalizadas, 39 cumplieron los criterios de inclusión, hallándose una prevalencia de 2,6%. Las malformaciones más frecuentes fueron: agenesia vaginal, útero bicorne y tabique vaginal. Los síntomas más comunes: dolor pélvico (18,7%) y amenorrea (14%). La ecografía transvaginal fue la principal ayuda diagnóstica en estas pacientes (48,7%). El 38,5% de los pacientes recibió tratamiento quirúrgico: neovagina, himenoplastia, resección tabique vaginal, histeroscopía operatoria, corrección durante cesárea. La infección urinaria fue la complicación más frecuente (7,7%). El 41% requirió hasta 4 días de hospitalización.Conclusiones: la prevalencia de malformaciones Müllerianas fue de 2,6%, Las alteraciones más frecuentes fueron: útero bicorne, agenesia y tabiques vaginales. El dolor pélvico crónico y la amenorrea fueron los motivos de consulta más comunes y requirieron estudios complementarios para descartar esta patología.
Hernia diafragmática y estenosis congénita de la tráquea: reporte de un casomoléculas de adhesión y la expresión de sus unidades
Authors: Sánchez Edgar , Arenas Jaime , Rodríguez Miguel Alberto , Muñoz Esmeralda
Published: April 2020

La hernia diafragmática congénita es una malformación fetal poco frecuente. A pesar de los avances en diagnóstico prenatal, soporte neonatal intensivo y técnicas quirúrgicas, su mortalidad posnatal sigue siendo elevada. Entre los factores descritos de mal pronóstico, se mencionan las malformaciones asociadas. A continuación describimos un caso ocurrido en el Hospital Central de la Policía en Bogotá, Colombia, que cursó con estenosis congénita de la tráquea, la cual impidió el abordaje de la vía aérea al momento de nacer y el manejo planeado previamente en conjunto con el servicio de neonatología.
Utero septado, duplicación del cuello y septo vaginal: informe de una rara malformación
Authors: Badalotti Mariangela , Arent Adriana , Monteggia Vicente , Machado Julia , Petracco Rafaella , Petracco Alvaro
Published: April 2020

Objetivo: describir una rara alteración de la fusión de los canales de Müller.Diseño: presentación de casoReporte del caso: una paciente asiste a la consulta con un examen de ultrasonido en cuya descripción se plantea la sospecha de útero septado. El examen ginecológico reveló un septo vaginal longitudinal, que llegaba hasta la región del himen y la presencia de dos cuellos. La ecografía pélvica tridimensional mostró duplicación del cuello, útero septado que comprometía desde el istmo hasta la cavidad uterina pero sin división del cuerpo uterino, compatible con útero septado y cuello doble. Conclusión: este caso representa una rara malformación no incluida dentro de la clasificación habitual de las malformaciones Müllerianas y que no tiene explicación embriogénica, que se apoya en la teoría de la fusión unidireccional de los canales de Müller. La ecografía tridimensional, es un examen simple y de bajo costo y demostró ser una buena opción para el diagnóstico definitivo de esta malformación, por lo que debe ser considerada dentro del arsenal de exámenes complementarios.
Política selectiva de episiotomía y riesgo de desgarro perineal en un hospital universitario
Authors: Rubio Jorge Andrés
Published: April 2020

Objetivo: evaluar el efecto de una intervención educativa tendiente a modificar la política de realización de episiotomía medio lateral y su efecto sobre el riesgo de desgarro perineal durante la atención del parto vaginal espontáneo en un hospital universitario.Metodología: estudio de cohorte con controles no concurrentes. Lugar: Instituto Materno Infantil, Hospital Universitario de referencia para la atención materno-perinatal. Se incluyeron 3.674 partos vaginales en presentación cefálica entre 20 y 43 semanas de gestación y se excluyeron los partos instrumentados. Desenlaces: frecuencia de episiotomía y de desgarros perineales durante los años 1999-2000 y después de la intervención educativa, durante los años 2002-2003.Resultados: la política selectiva disminuyó significativamente la tasa global de episiotomía del 47,3% (IC95% 41,8-45,7) al 12,2 % (IC95% 10,2-14,6) e incrementó el Riesgo Relativo (RR) de desgarro a 1,5 (IC95% 1,34-1,67) comparado con el basal. El análisis estratificado mostró un leve aumento del riesgo de desgarro para las nulíparas, de 3,83 (IC95% 2,91-5,03) a 3,90 (IC95% 2,38-6,44) y una disminución significativa de éste, de 4,06 (IC95% 3,68-6,15) a 0,58 (IC95% 0,34-0,98) para las multíparas. La política selectiva disminuyó significativamente un 16,4% (IC95% 12,7-20,0) la necesidad de sutura perineal posparto.Conclusión: la aplicación de la política selectiva de episiotomía fue exitosa: disminuyó la frecuencia de episiotomía sin modificar significativamente el riesgo de desgarro perineal de nulíparas, disminuyó el riesgo de desgarros perineales en las multíparas durante el parto vaginal espontáneo y disminuyó la cantidad de suturas perineales posparto.
Hipertensión posparto
Authors: Velásquez Jesús Arnulfo
Published: April 2020

Muy pocos estudios han investigado acerca de la fisiopatología y los cambios puerperales que favorecen la presentación de la hipertensión posparto. No existen datos que soporten la formulación de protocolos para el manejo de la hipertensión en este período, y la poca literatura disponible al respecto, se basa en experiencia no sistematizada.Los trastornos hipertensivos del embarazo son un factor de riesgo importante para el desarrollo posterior de enfermedades cardiovasculares y de mortalidad asociada.Estos trastornos se deben considerar como el inicio o tal vez la continuación de un sinnúmero de eventos subclínicos aún ignorados. Para la preeclampsia, el parto únicamente soluciona la “crisis” temporal que produce el embarazo, mas no alivia definitivamente el trastorno. Por lo tanto es necesario establecer estrategias adecuadas de vigilancia de la salud de la mujer.
Tamizaje de eventos adversos en atención obstétrica y del puerperio en el Instituto Materno Infantil de Bogotá, Colombia. 2002 -2003.
Authors: Gaitán D. Hernando , Eslava S. Javier , Garzón O. Carmen Doris , Rubio Jorge Andrés , Forero G. Jaime , Valbuena Luis Guillermo , Vargas Aída del Pilar , Sotelo R. Darío , Páez Alberto
Published: April 2020

Introducción: en Colombia la mayoría de los partos son institucionales; sin embargo, la morbimortalidad materna y perinatal es alta. Los resultados de la atención materna están determinados en parte por la adecuada atención de las complicaciones. Dado que la morbimortalidad materna es evitable en una importante proporción de casos, es relevante determinar el impacto que tienen los eventos adversos (EA) intra-hospitalarios sobre ella. No tener datos sobre éstos, limita su análisis. El propósito del presente trabajo es describir los resultados del tamizaje de los eventos adversos en la atención materna y su relación con la morbimortalidad materna en una institución de tercer nivel y centro de referencia de la atención materno perinatal en Bogotá.Materiales y métodos: estudio prospectivo de vigilancia epidemiológica, en pacientes gestantes que ingresaron al Instituto Materno Infantil (IMI) durante el período comprendido entre noviembre del 2002 y octubre del 2003. Se incluyeron pacientes con alteraciones del embarazo o en trabajo de parto. Se excluyeron quienes tuvieron parto en otra institución. Se describen las frecuencias de los eventos adversos y los factores asociados. Se realizó un análisis univariado para establecer la asociación con variables de tipo clínico u hospitalario por medio de la prueba t de student o la prueba Ji2, con un nivel de confianza del 95%.Resultados: se incluyeron 2.530 mujeres. La incidencia de eventos adversos durante la hospitalización fue de 12,02%. Tuvieron mayor riesgo de presentar eventos adversos las pacientes con menor edad gestacional, morbilidad materna de base a su ingreso (RR 1,63 IC95% 1,06 – 2,53) y disfunción orgánica al ingreso (RR 3,2 IC95% 2,53 – 4,07). Las pacientes sometidas a cesárea tuvieron un RR de 1,81 (IC95% 1,4 – 2,41) de presentar eventos adversos, en comparación con las de parto vaginal. En el grupo de pacientes con eventos adversos la estancia fue significativamente mayor (mediana 4 días, 0 - 30versus mediana 2 días, 0 - 30).Conclusiones: los eventos adversos se encuentran asociados a la morbilidad materna y están relacionados con factores maternos y hospitalarios.
Reversión de la ligadura de trompas por microcirugía: resultados reproductivos en 115 casos
Authors: Pérez Luis Ernesto , Saavedra Diego , Pinzón Juan Alberto , Laigneleth Martha
Published: April 2020

Objetivo: describir los resultados en fertilidad de la reversión microquirúrgica de la ligadura de trompas y las causas de su solicitud. Determinar si las tasas de embarazos se relacionan con la edad de las pacientes y la longitud útil de las trompas.Diseño: cohorte descriptiva de seguimiento.Pacientes e intervención: entre enero de 1984 y enero de 2001, a 127 pacientes el mismo cirujano les practicó reversión de su ligadura de trompas, utilizando técnica microquirúrgica. Se incluyeron pacientes con edad menor de 38 años, progesterona mesoluteínica mayor de 15 ng/ml, longitud útil de trompas mayor de 5 cm a la laparoscopia diagnóstica, espermograma y prueba postcoito normales. Se excluyeron pacientes esterilizadas con fimbriectomía. Se siguieron por dos o más años. El análisis estadístico se realizó mediante el programa SPSS.Resultados: las principales indicaciones para solicitar reversión fueron nueva unión (50,4%); deseo de más hijos (35,7%); muerte de hijos (10,4%); razones psicológicas (1,7%) y motivos religiosos (1,7%). Se siguieron por más de dos años 115 pacientes (92%). La tasa global de embarazos fue del 72,17% (83/115), de las cuales el 10,4% se embarazó dos veces (12/115). Tasa acumulada de embarazos máxima a los 10,7 meses. Tasa de partos 65,2% (75/115) con 77 nacimientos. Tasa de abortos 12,2% (14/115). Y tasa de ectópicos 5,2% (6/115).Conclusiones: la reversión de la ligadura de trompas con técnica microquirúrgica es una opción para recuperar la fertilidad en pacientes menores de 38 años, con longitud final de trompas mayor de 5 cm y sin presencia de otros factores de infertilidad.
Visión actual de la terapia de sustitución hormonal en la mujer posmenopáusica
Authors: Zuleta John Jairo
Published: April 2020

Durante casi una década se esperaron los resultados del estudio WHI (Women’s Health Initiative) que se suponía, brindarían información definitiva respecto al empleo de la terapia de reemplazo hormonal en la mujer menopáusica. Para sorpresa de la mayoría, a partir de julio de 2002 han aparecido informes de este estudio, que en general son contrarios a lo que se esperaba y a las creencias que se tenían previamente con respecto a los beneficios y a los riesgos de estas terapias. Las críticas y las posibles explicaciones a estos resultados no se hicieron esperar, y hoy existe bastante confusión al respecto, no sólo para los profesionales de la salud sino especialmente para las mujeres. En el presente artículo se hace una revisión de los aspectos metodológicos más relevantes del estudio WHI y se hace un análisis de las posibles explicaciones para la resistencia a aceptar sus resultados. Se concluye que el estudio tiene validez interna, sus resultados son importantes y la posibilidad de extrapolarlos es bastante alta; también, que en el momento, la única indicación aceptable para la terapia de sustitución hormonal es el control de la sintomatología vasomotora. Es necesario esperar otros reportes antes de aceptar como terapia de reemplazo otros preparados similares.
Muerte fetal inexplicada
Authors: Sepúlveda Janer , Quintero Eliana Maribel
Published: April 2020

El porcentaje de muertes fetales inexplicadas oscila entre un 21% a 50%; se define como la muerte que ocurre en fetos con edad gestacional mayor de 20 semanas o peso superior a 500 g, en la cual ni la autopsia ni el examen histológico del cordón umbilical, placenta y membranas, se logra identificar la causa.Los factores asociados con muerte fetal inexplicada son edad materna mayor de 35 años, sobrepeso, nivel educativo menor de 10 años, cigarrillo y bajo nivel socioeconómico, entre otros.La muerte fetal se relaciona con enfermedades maternas, trombofilia, accidentes del cordón, alteraciones citogenéticas, metabólicas e infecciones congénitas, principalmente.Se realizó una revisión de muerte fetal inexplicada.
Inducción electiva ambulatoria del trabajo de parto con misoprostol en pacientes de bajo riesgo: estudio clínico controlado
Authors: Borré Arrieta Orlando , Rodríguez Yances Benjamín , Angarita Peñaranda William , Chamat Barrios Antonio , Gómez Rhenals Édgar
Published: April 2020

Introducción: la inducción electiva permite al obstetra intervenir en el embarazo a término de bajo riesgo, y tratar de disminuir potenciales efectos adversos y la ansiedad materna que puedan complicar el embarazo. El objetivo de esta investigación es determinar la seguridad y eficacia del misoprostol en la inducción electiva ambulatoria del trabajo de parto en pacientes con embarazo a término de bajo riesgo que acuden a la ESE, Clínica de Maternidad Rafael Calvo de Cartagena, Colombia.Metodología: se realizó un ensayo clínico con asignación aleatoria y controlado con placebo en pacientes embarazadas a término de bajo riesgo, que consultaron a la ESE en el período comprendido entre el 1 mayo de 2002 y el 1 de marzo de 2004; aquellas que cumplieron con los criterios de selección fueron distribuidas en tres grupos para recibir misoprostol hospitalario, ambulatorio y placebo. Los resultados se analizaron con ANOVA de dos vías para las variables continuas y Chi cuadrado en variables cualitativas.Resultados: ingresaron 20 pacientes en el grupo hospitalario, 20 en el grupo ambulatorio y seis en el grupo placebo. Hubo un menor tiempo en el inicio del trabajo de parto en el grupo de misoprostol ambulatorio. La incidencia de efectos adversos no fue relevante en los tres grupos.Conclusión: el misoprostol utilizado en la inducción electiva ambulatoria del parto es seguro y eficaz.
¿Cuándo pinzar el cordón umbilical?
Authors: Arango Gómez Fernando , Mejía Londoño Juan Carlos
Published: April 2020

El pinzamiento del cordón umbilical la mayoría de las veces se realiza en forma mecánica y casi inmediata al nacimiento, sin detenerse a pensar en las posibles implicaciones que esta conducta puede tener en el recién nacido o en la madre. En el presente artículo se revisa la evidencia disponible con respecto a los conceptos fisiológicos inherentes al pinzamiento del cordón, las razones por las que se ha recomendado el pinzamiento temprano, los posibles efectos benéficos o perjudiciales al momento del pinzamiento y las recomendaciones del Ministerio de la Protección Social.
OS DESAFIOS DO ENSINO DE LÍNGUA INGLESA EM UMA ESCOLA DE TEMPO INTEGRAL
Authors: Vieira Miliane Moreira Cardoso , Carneiro de Lima Mara , Aguiar Ataide Bruna , Da S. G. Toledo Sharon Elaine
Published: April 2020

Este artigo busca refletir sobre o ensino de Língua Inglesa em uma escola de Araguaína (TO). Em como esse desafio se perpetua em sala de aula na relação entre professor-aluno. Após experiências vividas durante o período do Programa de Residência Pedagógica, enquanto cursava o curso de Letras - Língua Inglesa e Literaturas da Universidade Federal do Tocantins, que foi realizado em uma escola de tempo integral de ensino médio. Serão destacados, por meio de relatos reflexivos, quais foram os obstáculos e desafios enfrentados durante essa vivência e quais os pontos positivos e negativos do ensino de Língua Inglesa na escola. Como embasamento teórico serão utilizados documentos que trazem orientações sobre o ensino de Língua Inglesa, como BNCC (Base Nacional Comum Curricular), OCEM (Orientações Curriculares para o Ensino Médio) e PCN (Parâmetros Curriculares Nacionais).