Small bowel obstruction secondary to intussusception due to double Meckel's diverticulum in an adult: a case report

Meckel's diverticulum (MD) is a normal variant in 2% of the population, it contains all the layers of the small intestine and is considered a true diverticulum. One of the most frequent complications in adults is obstruction secondary to intussusception of MD towards the ileum. We present the case of a 52-year-old man with severe abdominal pain, nausea, and vomiting, which did not respond to conservative management. Imaging studies compatible with small bowel obstruction, identifying the transition zone at the ileum level. An exploratory laparotomy was performed ruling an intussusception due to a diverticulum, an intestinal resection was performed. The histopathological study revealed a double MD. In adults with symptomatic MD, this represents a challenge in early diagnosis and immediate surgical treatment. Intestinal intussusception in adults secondary to MD is rare and should be considered in the differential diagnosis of those with abdominal pain and small bowel obstruction

Plasma cytokines as potential biomarkers of kidney damage in patients with systemic lupus erythematosus

Background: Systemic lupus erythematosus is a heterogeneous chronic inflammatory autoimmune disorder characterized by an exacerbated expression of cytokines and chemokines in different tissues and organs. Renal involvement is a significant contributor to the morbidity and mortality of systemic lupus erythematosus, and its diagnosis is based on renal biopsy, an invasive procedure with a high risk of complications. Therefore, the development of alternative, non-invasive diagnostic tests for kidney disease in patients with systemic lupus erythematosus is a priority. Aim: To evaluate the plasma levels of a panel of cytokines and chemokines using multiplex xMAP technology in a cohort of Colombian patients with active and inactive systemic lupus erythematosus, and to evaluate their potential as biomarkers of renal involvement. Results: Plasma from 40 systemic lupus erythematosus non-nephritis patients and 80 lupus nephritis patients with different levels of renal involvement were analyzed for 39 cytokines using Luminex xMAP technology. Lupus nephritis patients had significantly increased plasma eotaxin, TNF-a, interleukin-17-a, interleukin-10, and interleukin-15 as compared to the systemic lupus erythematosus non-nephritis group. Macrophage-derived chemokine, growth regulated oncogene alpha, and epidermal growth factor were significantly elevated in systemic lupus erythematosus non-nephritis patients when compared to lupus nephritis individuals. Plasma eotaxin levels allowed a discrimination between systemic lupus erythematosus non-nephritis and lupus nephritis patients, for which we performed a receiver operating characteristic curve to confirm. We observed a correlation of eotaxin levels with active nephritis (Systemic Lupus Erythematosus Disease Activity Index). Our data indicate that circulating cytokines and chemokines could be considered good predictors of renal involvement in individuals with systemic lupus erythematosus

Morbilidad psiquiátrica percibida por los médicos generales y prescripción de psicofármacos en la zona sur de Madrid.

Se revisan los resultados de un estudio realizado a través de cuestionarios pasados a unos de cada siete de los 19.961 pacientes que acudieron a las consultas de medicina general del lNSAL UD en dos ambulatorios y cinco consultorios de la zona sur de Madrid durante cinco días para estudiar la prevalencia de diagnósticos psiquiátricos (se utiliza la clasificación ICHPPC-2), la prescripción de psicofármacos y las derivaciones al escalón especializado en salud mental. Se obtienen resultados congruentes con los de otros estudios realizados en nuestro país, en cuanto a porcentaje de pacientes con diagnóstico de trastorno mental (5,34 %), el porcentaje es menor que el hallado en otros países. Se discute la sensibilidad y especificidad de los diagnósticos de los trastornos "menores" por los médicos generales, no se confirma la mayor predisposición de este grupo de pacientes a padecer otro tipo de trastornos, se encuentra bien representado el grupo de pacientes con patología "pesada" y se discuten las pautas de prescripción de psicofármacos

Morbilidad psiquiátrica percibida por los médicos generales y prescripción de psicofármacos en la zona sur de Madrid.

Se revisan los resultados de un estudio realizado a través de cuestionarios pasados a unos de cada siete de los 19.961 pacientes que acudieron a las consultas de medicina general del lNSAL UD en dos ambulatorios y cinco consultorios de la zona sur de Madrid durante cinco días para estudiar la prevalencia de diagnósticos psiquiátricos (se utiliza la clasificación ICHPPC-2), la prescripción de psicofármacos y las derivaciones al escalón especializado en salud mental. Se obtienen resultados congruentes con los de otros estudios realizados en nuestro país, en cuanto a porcentaje de pacientes con diagnóstico de trastorno mental (5,34 %), el porcentaje es menor que el hallado en otros países. Se discute la sensibilidad y especificidad de los diagnósticos de los trastornos "menores" por los médicos generales, no se confirma la mayor predisposición de este grupo de pacientes a padecer otro tipo de trastornos, se encuentra bien representado el grupo de pacientes con patología "pesada" y se discuten las pautas de prescripción de psicofármacos

Positive culture in allograft ACL-reconstruction: what to do?

The transmission of disease or infection from the donor to the recipient is always a risk with the use of allografts. We carried out a research study on the behavioural pattern of implanted allografts, which were initially stored in perfect conditions (all cultures being negative) but later presented positive cultures at the implantation stage. Because there is no information available on how to deal with this type of situation, our aim was to set guidelines on the course of action which would be required in such a case. We conducted a retrospective study of 181 patients who underwent an ACL reconstruction using BPTB allografts. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV were negative. An allograft sample was taken for culture in the operating theatre just before its implantation. The results of the cultures were obtained 3-5 days after the operation. We had 24 allografts with positive culture (13.25%) after the implantation with no clinical infection in any of these patients. Positive cultures could be caused by undetected contamination while harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment-other than an antibiotic protocol-would be required when facing a case of positive culture of a graft piece after its implantation

Participación comunitaria y procesos de comunicación en la implementación de programas de reasentamiento de familias dentro del contexto del desarrollo urbano en Barranquilla (Colombia)

Planning processes of development and growth of the city of Barranquilla have required the relocation of the population living in areas of intervention actions. As part of the implementation of the New Management Plan Territorial (POT), the city plans to revitalize an area around the Magdalena River with a view to improving the quality of life of citizens and to increase competitiveness of the city. The revitalization project is known as project “La Loma “. Under the current Land Use Plan of Barranquilla (POT), the urban development project “La Loma” includes, among other activities, the transfer of a large number of people currently living in this area. For this reason, this article aims to review the current POT and documents from City Council and the Mayor’s office associated with the POT and “La Loma” project, in order to identify and analyze the component of community participation and communication related to the implementation of this project. The results of the documents revealed the presence of regulatory elements associated with community participation. The results also showed potentially useful spaces for the implementation of inclusive communication processes. Therefore, this article proposes a guide for the formulation of a strategic communication plan with a focus on participatory communication and dialogue facilitator to be used during the execution of urban projects that include the relocation of families. © 2016, Universidad del Norte. All rights reserved

Frozen cancellous bone allografts: positive cultures of implanted grafts in posterior fusions of the spine

We have carried out a study on the behaviour pattern of implanted allografts initially stored in perfect conditions (aseptically processed, culture-negative and stored at -80 degrees C) but which presented positive cultures at the implantation stage. There is no information available on how to deal with this type of situation, so our aim was to set guidelines on the course of action which would be required in such a case. This was a retrospective study of 112 patients who underwent a spinal arthrodesis and in whom a total of 189 allograft pieces were used. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV (via PCR techniques) were negative. The allografts were stored by freezing them at -80 degrees C. A sample of the allograft was taken for culture in the operating theatre just before its implantation in all cases. The results of the cultures were obtained 3-5 days after the operation. There were 22 allografts with positive culture results (12%) after implantation. These allografts were implanted in 16 patients (14%). Cultures were positive for staphylococci coagulase negative (ECN) in 10 grafts (46%), Pseudomonas stutzeri in two grafts (9%), Corynebacterium jeikeium in two grafts (9%), staphylococci coagulase positive in two grafts (9%) and for each of the following organisms in one case each (4%): Corynebacterium spp., Actinomyces odontolyticus, Streptococcus mitis, Peptostreptococcus spp., Rhodococcus equi and Bacillus spp. No clinical infection was seen in any of these patients. Positive cultures could be caused by non-detected contamination at harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment different from our antibiotic protocol is required in the case of positive culture results of a graft piece after implantation

Home enteral nutrition in Spain: NADYA registry 2010

Objetivos: Describir los resultados del registro de nutrición enteral domiciliaria (NED) del grupo NADYASENPE del año 2010. Material y métodos: Se recopilaron los datos introducidos en el registro desde el 1 de enero al 31 de diciembre de 2010. Resultados: Se registraron 6.591 pacientes (51% varones) con 6.688 episodios de NED, procedentes de 32 hospitales. La edad media en los menores de 14 años (4%) fue de 1 ± 2 años (m ± DS) y de 69,9 ± 17,8 en los mayores de 14 años. El 76% de los pacientes recibieron la NED por un tiempo superior a 2 años. La patología más prevalente fue la neurológica 42%, seguida de la neoplasia 28% (en su mayoría cáncer de cabeza y cuello 18%). La información referente a la vía de acceso sólo se recogió en 626 casos (9,4%), el 51% de los pacientes utilizaron sonda nasogástrica, 27% gastrostomías, 10% vía oral y 3% yeyunostomías. Sólo 251 episodios finalizaron a lo largo del año, siendo el motivo más frecuente el fallecimiento del paciente en el 57% de los casos y el paso a la alimentación oral en el 14%. El 29% de los pacientes presentaban una actividad limitada y el 39% estaba confinado en cama/ sillón. El 68% de los adultos requerían ayuda total o parcial. El suministro del producto se realizó desde el hospital o la farmacia de referencia en el 63% y 34%, respectivamente. El suministro del material fungible se realizó desde el hospital o atención primaria en el 83% y 16%, respectivamente. Conclusiones: Los resultados obtenidos en el registro de NED del año 2010 muestran características muy similares a las recogidas en los años previos en cuanto al número y características de los pacientes registrados. Seguimos encontrando problemas en la recogida de datos relativos a la vía de acceso y finalización de los episodiosObjective: To describe the results of the home enteral nutrition (HEN) registry of the NADYA-SENPE group in 2010. Material and methods: We retrieved the data of the patients recorded from January 1st to December 31st 2010. Results: We registered 6,591 patients (51% males) with 6,688 episodes of HEN, from 32 hospitals. Mean age in those younger than 14 yr (4%) was 1 ± 2 yrs (m ± SD) and 69,9 ± 17,8 yrs in those older than 14 yr. The length of HEN was longer than 2 yrs in 76% of the patients. The most frequent underlying disease was neurological disorders 42%, followed by cancer 28% (mostly head and neck cancer 18%). We had information related to the enteral access route in only 626 cases (9,4%), 51% of them used nasogastric tubes, 27% gastrostomies, 10% oral route and 3% jejunostomies. Only 251 episodes were closed during the year, mostly due to patient death 57% and progress to oral diet 14%. The activity level was limited in 29% of the patients and 39% of them were bed- or chairridden. Total or partial help was needed by 68% of the patients. The hospitals and the private pharmacies delivered the enteral formula in 63% and 34% of the cases, respectively. The hospitals and the primary care centres delivered the disposables in 83% and16% of the cases, respectively. Conclusions: The results of the 2010 HEN registry are similar to those published in previous years regarding the number and characteristics of the patients. We continue finding problems in the entrance of data referred to the enteral access route and the closing of the episode