Medición de volumen pulmonar normal por tomografía computarizada en pacientes pediátricos en el Hospital Luis Negreiros Vega en el periodo 2019 – 2021

Hoy en día existe una limitada valoración de los volúmenes normativos pulmonares en la población latinoamericana en pacientes pediátricos en relación con su edad y estatura, por lo que su escaso estudio condiciona limitaciones para la valoración de múltiples patologías en las que se requiere un conocimiento previo de la normalidad volumétrica pulmonar y en los que se puede valorar objetivamente el aumento o disminución del volumen pulmonar como parte de la valoración integral al tratamiento, como es el caso de los pacientes con escoliosis (1) o en el síndrome de insuficiencia torácica (2, 3), por lo que el estudio profundo en este ámbito podría aportar avances significativos en el tratamiento de nuestros pacientes. De forma progresiva se encuentran nuevos métodos imagenológicos para la medición de volumen y segmentación pulmonar que terminan aportando valiosos avances sobre todo en el campo de la investigación, destacando modalidades como la tomografía y la resonancia magnética (4, 5) pero sin replicas ni estudios de validación en la población latinoamericana. El estudio de volumetría pulmonar por tomografía presenta algunas ventajas respecto a otros estudios como la espirometría o la resonancia, ya que permite una valoración de otros parámetros como desarrollo pulmonar, masa pulmonar, densidad del tejido pulmonar (4), por lo que en los últimos años va ganando terreno como una modalidad de estudio cuantitativo para el estudio pulmonar. Existe una escasa investigación en la región sobre la tomografía como modalidad de estudio funcional de parámetros pulmonares, lo que representa una oportunidad interesante para futuras investigaciones al respecto con énfasis en nuestra población peruan

The influence of a new clinical motion for endodontic instruments on the incidence of postoperative pain

Previous studies showed that motor motions play an important role in determining apical extrusion of debris. Therefore a new clinical motion (MIMERACI) has been proposed. The basic idea is to progress slowly (1mm advancement), and after each 1mm, to remove the instrument from the canal, clean flutes and irrigate. The aim of the study was to prove whether the clinical use of MIMERACI technique would influence or not postoperative pain.MATERIALS AND METHODS: 100 teeth requesting endodontic treatment were selected for the study and divided into two similar groups based on anatomy, pre-operative symptoms and vitality, presence or absence of periapical lesion. All teeth were shaped, cleaned and obturated by the same operator, using the same NiTi instruments. The only difference between the two groups was the instrumentation technique: tradional (group A) vs MIMERACI (group B). Assessment of postoperative pain was performed 3 days after treatment. Presence, absence and degree of pain were recorded with a visual analogue scale (VAS), validated in previous studies. Collected data statistically analyzed using one-way ANOVA post hoc Tukey test. RESULTS: For VAS pain scores MIMERACI technique showed significantly better results than group A (p=0,031). Overall, both incidence and intensity of symptoms were significantly lower. Flare ups occurred in 3 patients, but none treated with the MIMERACI Technique. CONCLUSIONS: Since extruded debris can elicit more postoperative pain, results obtained by using MIMERACI technique are probably due to many factors: better mechanical removal and less production of debris and more efficient irrigation during instrumentation

dosimetry methods in boron neutron capture therapy

Dosimetry studies have been carried out at thermal and epithermal columns of LVR- 15 research reactor for investigating the spatial distribution of gamma dose, fast neutron dose and thermal neutron fluence. Two different dosimetry methods, both based on solid state detectors, have been studied and applied and the accuracy and consistency of the results have been inspected. One method is based on Fricke gel dosimeters that are dilute water solutions and have good tissue equivalence for neutrons and also for all the secondary radiations produced by neutron interactions in tissue or water phantoms. Fricke gel dosimeters give the possibility of separating the various dose contributions, i.e. the gamma dose, the fast neutron dose and the dose due to charged particles generated during thermal neutron reactions by isotopes having high cross section, like 10B. From this last dose, thermal neutron fluence can be obtained by means of the kerma factor. The second method is based on thermoluminescence dosimeters. In particular, the developed method draw advantage from the different heights of the peaks of the glow curve of such phosphors when irradiated with photons or with thermal neutrons. The results show that satisfactory results can be obtained with simple methods, in spite of the complexity of the subject. However, the more suitable dosimeters and principally their utilization and analysis modalities are different for the various neutron beams, mainly depending on the relative intensities of the three components of the neutron field, in particular are different for thermal and epithermal columns

Relacion entre la demora intrahospitalaria de la intervención quirúrgica y el diagnostico de apendicitis aguda complicada en el hospital regional Honorio Delgado Espinoza de Arequipa en el 2015

Los pacientes con cuadro doloroso abdominal representan entre 5 y 10% de todas las consultas en los departamentos de Emergencia en los Estados Unidos (1). De los cuales sólo el 4.3% serán diagnosticados como portadores de apendicitis aguda. A pesar de ello, la apendicitis es la causa más común de dolor abdominal que requiere de intervención quirúrgica (1), en algunas series Entre el 5-15% de la población, padece este cuadro en algún momento de su vida. La máxima incidencia tiene lugar en la segunda y tercera década de la vida (2) y ocupa un lugar entre las cinco causas más comunes de litigios exitosos de mala práctica médica por complicaciones que resultaron de la demora del tratamiento (3). La presunción que la apendicitis perforada es un fenómeno relacionado al tiempo es un concepto racional que está basado en conceptos de microbiología según Malt R. demostrándolo con estudios retrospectivos (4); sin embargo, dichos estudios no evalúan si el origen de la demora fue pre o intrahospitalario. En estudios peruanos se a demostrados que pacientes con apendicitis aguda demoran en ser operados, y este tiempo de demora influye como factor de complicación en pacientes con el diagnostico ya mencionado cuando transcurren de 29 a 36 horas entre el inicio de los síntomas y el acto operatorio (5). Se realizaron estudios locales en los cuales se evalúa las causas y consecuencias en la evolución de la apendicitis aguda complicada llegando entre muchas conclusiones, que el tiempo intrahospitalario no es un factor estadísticamente significativo para el diagnóstico de la apendicitis aguda complicada (3, 6, 7).Tesi

Use of Tachosil in splenectomy in patients with clotting and blood composition disorders

Splenectomy in patients suffering from onco-haematological conditions presents clotting-related problems which make correct haemostasis more difficult. Using operative haemostasis during splenectomy for onco-haematological conditions as a starting point, the authors report their personal clinical experience of the use of Tachosil, comparing it with other similar products and drawing some personal CONCLUSIONS: To complete their reflexions on clotting problems during splenectomy in the course of onco-haematological diseases, the comparison with its use in oncological pathologies in other parenchymas, such as the kidney and liver, which also present operative haemostatic difficulties of a technical nature, is pointed out and the soundness of the results indicated. The cases of 3 patients suffering from severe clotting disturbances and treated with splenectomy and 1 patient suffering from clear cell renal carcinoma and subjected to nephrectomy in which Tachosil was used as an aid to haemostasis are reported. In the light of these cases, it can be stated that, albeit with the persistence of difficulties related to the changed clotting capacities resulting from the basic disease, the use of Tachosil has proved effective as an aid in haemostasis and suggests the validity of its use in elective and emergency splenectomy, in these types of patien

Methods for dose measurements in small phantoms irradiated at BNCT epithermal column

Suitable dosimeter methods have been proposed and tested,to measure the different dose contributions in small phantoms exposed to epithermal/thermal neutron beams designed for BNCT. One method is based on Fricke-gel dosimeter in small tubes of 2.8 mm of ex ternal diameter, that allow determining profiles of gamma dose and of boron dose.The other method is based on the use of TLD-700 chips, from whose answer the contribution of thermal neutrons is subtracted by means of appropriate parameters of the glow curve

Introduction of SARS-CoV-2 variant of concern 20h/501Y.V2 (B.1.351) from Malawi to Italy

We report here an imported case of SARS-CoV-2 variant of concern B.1.1.351 (also known as 20H/501Y.V2 or "South African variant" or VOC 202012/02) in a 66-years old symptomatic male who returned from Malawi to Italy

The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?

BACKGROUND: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. METHODS: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. RESULTS: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. CONCLUSIONS: The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands