Estudio microbiológico clínico y epidemiológico de pacientes con pie diabético infectado, internados en tres Hospitales públicos de Managua, Febrero 2013 a Noviembre 2014

La infección y ulceración del pie diabético son uno de los principales problemas médicos y socioeconómicos causantes de morbilidad y mortalidad, especialmente en países en desarrollo como Nicaragua. Otra amenaza de salud pública es el incremento continuo de la resistencia antimicrobiana en bacterias aisladas de pies diabéticos. El objetivo de este estudio es determinar el perfil bacteriológico y los mecanismos de resistencia usados en bacterias aisladas en úlceras de pie diabético. Un estudio prospectivo se llevó a cabo en pacientes con úlceras de pie diabético para determinar el perfil microbiológico de la úlcera infectada, la resistencia a antibióticos de las bacterias y los factores de riesgos relacionados a Microorganismos Multidrogoresistentes (MDRO), así como el desenlace de estas lesiones. Se tomaron muestras de secreciones de 77 pacientes ingresados con el diagnóstico de pie diabético infectado. Los bacilos, aerobios, gram-negativos fueron testados en busca de Beta-lactamasas de Especto Extendido (ESBL) a través de métodos fenotípicos. Las especies de Staphylococcus fueron testadas en busca de susceptibilidad a la oxacilina y cefoxitin a través del método de difusión de Kirby-Bauer. Se estudiaron los factores de riesgo relacionados a la aparición de MDRO. Los aerobios gram negativos se aislaron con mayor frecuencia (91.30%), seguidos de los anaerobios gram positivos (8.70%). Cincuenta y cinco por ciento de los pacientes resultaron positivos para MDRO. La producción de ESBL y la resistencia a la meticilina se encontró en 54.35% y 7.80% de las bacterias aisladas, respectivamente. viii De todos los microorganismos anaerobios aislados de 77 pacientes, el que se encontró con mayor frecuencia fue Escherichia coli (29.35%). Once pacientes (14.30%) presentaron infecciones concomitantes con osteomielitis. Los pacientes con infecciones con MDRO tuvieron una relación directa con la neuropatía (P4 cm2 (P1 mes (44.2%) y lesiones con tamaños de >4 cm2 (68.9%), tuvieron una relación independiente con la aparición de MDRO. La prevalencia de MDRO es alarmantemente alta en pacientes con úlceras de pie diabético en Nicaragua, debido al uso indiscriminado de antibióticos. Los hallazgos del presente estudio sugieren la realización de estudios multicentricos para la creación de esquemas de tratamientos empíricos apropiados para el manejo de úlceras de pie diabético infectado

Oxigenoterapia de Alto Flujo en Insuficiencia Respiratoria Aguda en pacientes menores de 5 años ingresados en Cuidados Intensivos pediátricos en el Hospital Militar Escuela Dr. Alejandro Dávila Bolaños, 2020

Con el objetivo de analizar la eficacia de oxigenoterapia de alto flujo en pacientes menores de 5 años con insuficiencia respiratoria aguda ingresados en unidad de cuidados intensivos pediátricos en el Hospital Militar Escuela “Dr. Alejandro Dávila Bolaños” en el período de enero a noviembre 2020, se realizó un estudio observacional, descriptivo, transversal y retroprospectivo Se estudiaron a 26 pacientes menores de 5 años atendidos en cuidados intensivos pediátricos Fueron analizados los datos sobre las características sociodemográficas y antecedentes clínicos, estudios de laboratorio, con el fin de realizar un análisis univariado y bivariado, se estimaron las medidas de tendencia central además, análisis estadísticos descriptivos y se presentan en tablas y gráficos. Del análisis y discusión de los resultados obtenidos, se alcanzaron las siguientes conclusiones: la edad promedio fueron 11 meses, siendo los lactantes menores el grupo etario y sexo masculino. Las características clínicas predominaron el estado nutricional eutrófico con un 73.1%, el antecedente patológico del reflujo gastroesofágico, y el diagnostico de neumonía como causa precursora a la insuficiencia respiratoria aguda. Los datos clínicos de frecuencia cardiaca, respiratoria y saturación de oxígeno mejoraron con la oxigenoterapia de alto flujo. Disminuyó el uso de músculos accesorios, así como el aleteo nasal y el quejido respiratorio. Se estabilizaron los principales parámetros gasométricos a sus valores normales en la mayoría de pacientes. La mayoría de pacientes acudió rápidamente al hospital, tienen menos de 4 días de evolución, el 7.7% padecieron de un choque como complicación. El 19.2% necesitó de ventilación mecánica, y un 80.8% de los pacientes obtuvieron mejoría clínic

Inguinal Hernia and Airport Scanners: An Emerging Indication for Repair?

The use of advanced imaging technology at international airports is increasing in popularity as a corollary to heightened security concerns across the globe. Operators of airport scanners should be educated about common medical disorders such as inguinal herniae in order to avoid unnecessary harassment of travelers since they will encounter these with increasing frequency

Revisiting Current Strategies for Primary Prevention of Motorcycle Collisions in Jamaica

Motorcycle Road Traffic Collisions place a heavy burden on emergency medical ‎services in Jamaica. We explore the existing strategies and legislative policies that ‎may prevent or reduce the severity of these injuries in Jamaica. This is an important ‎aspect of health care as it may minimize the impact of these preventable injuries on ‎the limited resources of the health services.

Laparoscopic colectomy for colonic neoplasms in a developing country

AbstractAimTo report the outcome of patients treated for colonic neoplasms using a laparoscopic assisted technique since its introduction at the University Hospital of the West Indies, Jamaica.Subjects and MethodsAll consecutive patients undergoing laparoscopic assisted colectomy were entered into a prospective database and this data analysed. Data collected included patient demographics, pre-operative diagnosis, operative events, post-operative morbidity and outcome.ResultsOver the thirty-six months period July 1, 2005–December 31, 2005 and July 1, 2006–December 31, 2008, thirty patients each underwent laparoscopic assisted colectomy for a colonic neoplasm. Their mean age was 63 years with M: F ratio of 1:2. Seventy-four per cent of the patients had carcinomas which was located on the right and sigmoid colon in 17 and 10 patients respectively. Mean operative time was 98 min for patients with right-sided lesions and blood loss for the entire group was minimal. Two patients were converted to open resections. Median duration of hospitalization was five days. There was no mortality but three patients had complications. After median follow-up of 30 months, there was no local or systemic recurrence.ConclusionsAppropriately selected patients with colonic neoplasms can be safely subjected to a laparoscopic assisted resection and expect to enjoy the advantages of this technique even in a developing country setting.The outcome of thirty consecutive laparoscopic assisted colectomies is reported demonstrating that this technique can be safely applied to selected patients with colonic carcinomas in developing countries

Accessory renal arteries in a Caribbean population: a computed tomography based study

INTRODUCTION: The commonest variation to the classic anatomic description of renal arterial supply is the presence of accessory renal arteries. The incidence varies widely according to ethnicity. There is no data on the prevalence of these anomalies in persons of Caribbean ethnicity. METHODS: All CT scans done over two years from July 1, 2010 to June 30, 2012 were retrospectively evaluated. The anatomy of the renal arterial supply was reported from these studies and the anatomy of accessory renal arteries was documented. RESULTS: There were 302 CT scans evaluated and accessory renal arteries were present in 109/302 (36.1%) CT scans, 95% confidence interval 30.6%, 41.4%. There were 71/309 (23.5%) patients with accessory arteries on the left and 54/309 (17.9%) had them on the right (p 0.087). Of these, 16 (14.7%) patients had bilateral accessory renal arteries present. The most common origin for the accessory arteries was the abdominal aorta in 108 (99.1%) cases and in 1 case the accessory artery arose from the coeliac trunk. There were 80 left sided accessory renal arteries: 17 (21.3%) upper polar and 27 (33.8%) lower polar arteries. Of 62 right sided accessory arteries, 14 (22.6%) were upper polar and 26 (42%) were lower polar arteries. CONCLUSION: This is the first population-based report of anatomic anomalies in renal arterial supply in a Caribbean population. These are important findings that may affect vascular and urologic procedures on persons of Caribbean ethnicity

Diagnostic imaging capabilities of the Ocelot -Optical Coherence Tomography System, ex-vivo evaluation and clinical relevance

Background Optical coherence tomography (OCT) is a high-resolution sub-surface imaging modality using near-infrared light to provide accurate and high contrast intra-vascular images. This enables accurate assessment of diseased arteries before and after intravascular intervention. This study was designed to corroborate diagnostic imaging equivalence between the Ocelot and the Dragonfly OCT systems with regards to the intravascular features that are most important in clinical management of patients with atherosclerotic vascular disease. These intravascular features were then corroborated in vivo during treatment of peripheral arterial disease (PAD) pathology using the Ocelot catheter. Methods In order to compare the diagnostic information obtained by Ocelot (Avinger Inc., Redwood City, CA) and Dragonfly (St. Jude Medical, Minneapolis, MN) OCT systems, we utilized ex-vivo preparations of arterial segments. Ocelot and Dragonfly catheters were inserted into identical cadaveric femoral peripheral arteries for image acquisition and interpretation. Three independent physician interpreters assessed the images to establish accuracy and sensitivity of the diagnostic information. Histologic evaluation of the corresponding arterial segments provided the gold standard for image interpretation. In vivo clinical images were obtained during therapeutic interventions that included crossing of peripheral chronic total occlusions (CTOs) using the Ocelot catheter. Results Strong concordance was demonstrated when matching image characteristics between both OCT systems and histology. The Dragonfly and Ocelot system’s vessel features were interpreted with high sensitivity (91.1–100 %) and specificity (86.7–100 %). Inter-observer concordance was documented with excellent correlation across all vessel features. The clinical benefit that the Ocelot OCT system provided was demonstrated by comparable procedural images acquired at the point of therapy. Conclusions The study demonstrates equivalence of image acquisition and consistent physician interpretation of images acquired by the Ocelot and the Dragonfly OCT systems in-spite of distinct image processing algorithms and catheter configurations. This represents a dramatic shift away from both fluoroscopic imaging and diagnostic-only OCT imaging during peripheral arterial intervention towards therapeutic devices that incorporate real time diagnostic OCT imaging. In the clinical practice, these diagnostic capabilities have translated to best-in-class safety and efficacy for CTO crossing using the Ocelot catheter

Stump Cholecystitis: Laparoscopic Completion Cholecystectomy with Basic Laparoscopic Equipment in a Resource Poor Setting

Introduction. Stump cholecystitis is a recognised condition in which a large gallbladder remnant becomes inflamed after subtotal cholecystectomy. When this occurs, a completion cholecystectomy is indicated. Traditionally, these patients were subjected to open surgery because the laparoscopic approach was anticipated to be technically difficult. We present a case of completion cholecystectomy using basic laparoscopic equipment in a resource poor setting to demonstrate that the laparoscopic approach is feasible. Case Description. A 57-year-old woman presented with right upper quadrant pain and vomiting. She had an elective open cholecystectomy seven years before but reported remarkably similar symptoms. Abdominal ultrasound suggested calculous acute cholecystitis. MRCP confirmed the presence of a large gallbladder remnant with stones. Gastroduodenoscopy excluded other differentials. She had an uneventful laparoscopic completion cholecystectomy performed. Discussion. Although traditional dogma suggested that a completion cholecystectomy should be performed through the open approach, several small studies have demonstrated that laparoscopic completion cholecystectomy is feasible and safe. This report adds to the existing data in support of the laparoscopic approach

Hepatic surface grooves in an Afro-Caribbean population: a cadaver study

Introduction: There have been no previous reports on hepatic surface grooves in an Afro-Caribbean population. This information is important to optimize radiology and hepatobiliary surgical services in the region. Methods: Two investigators independently observed 69 cadaveric dissections performed over five years at the University of the West Indies. Variations in surface anatomy were described. Results: In this Caribbean population the majority of patients had conventional hepatic surface anatomy (88%). However, we found a greater incidence of hepatic surface grooves (12%) than reported in international literature. Conclusion: Abnormal surface anatomy is present in 12% persons in this population. Interventional radiologists and hepatobiliary surgeons practicing in the Caribbean must be cognizant of these differences in order to minimize morbidity during invasive procedures