Giant lymphedema of the penis and scrotum: a case report

Lymphedema of the penis and scrotum is a rare entity characterized by enlargement of the skin and subcutaneous tissue of the genital region due to lymphatic drainage impairment. This clinical condition is more frequent in tropical countries due to a higher incidence of filariasis, which, in turn, is the main etiology. We describe the case of a 33-year-old man with large lymphedema of the scrotum and penis due to an acute and chronic inflammatory process, foreign body granuloma, and marked hyalinization. Four consecutive surgical interventions were necessary to remove the great part of the affected tissue, which enabled satisfactory results and improved the patient’s quality of lif

Safety and effectiveness of propranolol in severely burned patients: systematic review and meta-analysis

Background The objective of this systematic review was to determine the effectiveness and safety of propranolol compared to placebo or usual care for improving clinical relevant outcomes in severely burned patients (TBSA \u3e20%). Methods Relevant articles from randomized controlled trials were identified by a literature search in MEDLINE, EMBASE, and CENTRAL. We included trials involving patients with a severe burn (\u3e20% of total body surface area affected). Trials were eligible if they evaluated propranolol and compared to usual care or placebo. Two investigators independently assessed articles for inclusion and exclusion criteria and selected studies for the final analysis. We conducted a meta-analysis using a random-effects model. Results We included ten studies in our systematic review. These studies randomized a total of 1236 participants. There were no significant differences between propranolol and placebo with respect to mortality (RD −0.02 [95% CI −0.06 to 0.02]), sepsis (RD −0.03 [95% CI −0.09 to 0.04]), and the overall hospital stay (MD −0.37 [−4.52 to 3.78]). Propranolol-treated adults had a decrease in requirements of blood transfusions (MD −185.64 [95% CI −331.06 to −40.43]) and a decreased heart rate (MD −26.85 [95% CI −39.95 to −13.75]). Conclusions Our analysis indicates that there were no differences in mortality or sepsis in severely burned patients treated with propranolol compared with those who had usual care or placebo. However, the use of propranolol in these patients resulted in lower requirements of blood transfusion and lower values of heart rate. The evidence synthesized in this systematic review is limited to conclude that propranolol reduces the length of hospital stay among severely burned patients. Future trials should assess the impact of propranolol on clinically relevant outcomes such as mortality and adverse events

Giant lymphedema of the penis and scrotum: a case report

Lymphedema of the penis and scrotum is a rare entity characterized by enlargement of the skin and subcutaneous tissue of the genital region due to lymphatic drainage impairment. This clinical condition is more frequent in tropical countries due to a higher incidence of filariasis, which, in turn, is the main etiology. We describe the case of a 33-year-old man with large lymphedema of the scrotum and penis due to an acute and chronic inflammatory process, foreign body granuloma, and marked hyalinization. Four consecutive surgical interventions were necessary to remove the great part of the affected tissue, which enabled satisfactory results and improved the patient’s quality of lif

Clinical and demographic characteristics of sickle cell disease in colombian children

Objective: To describe the clinical and demographic characteristics of pediatric patients with sickle cell disease. Methods: We performed a descriptive observational study. We included patients under 18 years with a diagnosis of sickle cell disease, who joined the “Ruta de la Vida” Program at the Hospital Universitario del Valle (HUV) from February 2015 to October 2018. We analyzed with descriptive statistics in SPSS. Results: We reviewed 153 medical records corresponding to pediatric patients. 54.2% were male and 45.8% female. All the patients were from the Pacific Colombian Region. The median age of the patients at the time of diagnosis was 2.1 years, the median age of admission to the program was 9 years. Diagnosis by electrophoresis of hemoglobin was performed in 92.2% of the patients, the distribution of polymorphisms was: hemoglobin SS (72.3%), hemoglobin SC (19.9%), hemoglobin S + (5 , 0%) and hemoglobin So (2.8%). 76.9% of patients had crisis in the last year, the main crisis were pain and hemolysis. 6.1% of the patients had cerebrovascular disease diagnosed by cerebral MRI. Conclusion: The population studied has a sickle cell disease with characteristics of a severe phenotype, with a high frequency of crisis and chronic complications such as cerebrovascular disease. This is the first study conducted in Colombia that describes the characteristics of the pediatric population with sickle cell disease

Orthotopic kidney transplantation survival and complications: systematic review and meta-analysis

Purpose: To determine graft and patient survival and adverse events in patients who undergo orthotopic kidney transplantation. Methods: We performed a systematic review and meta-analysis. We search in Medline, Embase, and Central from inception to nowadays. We included observational studies with patients who undergo orthotopic kidney transplantation. The primary outcomes were overall patient and graft survival. We pooled the information in a frequency meta-analysis with a 95% CI. We analyzed bias with the STROBE statement. Results: Of the 106 papers initially retrieved, four met the inclusion criteria. Vascular and urinary tract complications were reported in 19% and 15%, respectively. The overall patient survival was 92% 95%CI (88% to 95%), I2 = 0%, and the overall graft survival was 88% 95 CI (83% to 91%), I2 = 0%. Conclusion: Our analysis showed a high survival rate in patients and kidney grafts after orthotopic kidney transplantation, with a similar complication rate compared to a heterotopic kidney transplant

Efetividade e segurança do uso de micronutrientes em pó no tratamento de crianças com anemia: revisão sistemática

Objective: To estimate the effectiveness of micronutrient powder use compared to other interventions for the treatment of children with anemia. Methodology: A systematic review was carried out in the following databases: Medline, EMBASE, CENTRAL, LILACS, Psycinfo, Clinicaltrials.gov, Google scholar, open gray and conference abstracts. There was no language restriction, only controlled clinical trials were considered, until January 2017. Results: A total of 14,735 articles were identified, of  which three studies met the inclusion criteria: Kounnavong, 2011, Lemaire, 2011 and Hirve, 2007. The Kounnavong study concluded that MMP supplementation had positive effects in reducing the prevalence of anemia and in improving hemoglobin concentration; in the Hirve study there was a significant increase in hemoglobin at 3 and 8 weeks at all groups with no significant differences between them. Finally, in the Lemaire study, hemoglobin was higher for subjects randomized in the group receiving MNP at 2 months. Conclusions: It is not possible to estimate the effectiveness of micronutrient powder use compared to other interventions for the treatment of children with anemia, due to the insufficiency and clinical heterogeneity of the included studies.Objetivo: Estimar la efectividad del uso de micronutrientes en polvo, comparado con otras intervenciones para tratamiento de niños con anemia. Metodología: Se realizó revisión sistemática, en las siguientes bases de datos: Medline, EMBASE, CENTRAL, LILACS, Psycinfo, Clinicaltrials.gov, Google scholar, open gray y resúmenes de congresos. No restricción de idioma, se incluyeron ensayos clínicos controlados, hasta enero de 2017. Resultados: Se identificaron 14.735 artículos; 3 estudios cumplieron con los criterios de inclusión: Kounnavong, 2011, Lemaire, 2011 y Hirve, 2007. Kounnavong concluyó que la suplementación con MMP tuvo efectos positivos en la reducción de la prevalencia de la anemia y en el mejoramiento de la concentración de hemoglobina; Hirve evidenció un aumento significativo de la Hemoglobina a las 3 y a las 8 semanas en todos los grupos sin diferencias significativas entre ellos. En el estudio de Lemaire, la hemoglobina fue mayor para los sujetos asignados al azar en el grupo que recibe MNP a 2 meses.  Conclusiones: No es posible estimar la efectividad del uso de micronutrientes en polvo, comparado con otras intervenciones para tratamiento de niños con anemia, debido a la insuficiencia y heterogeneidad clínica de los estudios incluidos.Objetivo: Estimar a eficácia do uso de micronutrientes em pó em comparação com outras intervenções no tratamento de crianças com anemia. Metodologia: Foi realizada uma revisão sistemática nos seguintes bancos de dados: Medline, EMBASE, CENTRAL, LILACS, Psycinfo, Clinicaltrials.gov, Google scholar, cinza aberto e anais de conferências. Sem restrição de idioma, foram incluídos ensaios clínicos controlados até janeiro de 2017. Resultados: foram identificados 14.735 artigos; 3 estudos preencheram os critérios de inclusão: Kounnavong, 2011, Lemaire, 2011 e Hirve, 2007. Kounnavong concluiu que a suplementação de MNP teve efeitos positivos na redução da prevalência de anemia e na melhoria da concentração de hemoglobina; Hirve mostrou um aumento significativo na hemoglobina em 3 e 8 semanas em todos os grupos, sem diferenças significativas entre eles. No estudo de Lemaire, a hemoglobina foi maior em indivíduos randomizados no grupo que recebeu MNP aos 2 meses. Conclusões: Não é possível estimar a eficácia do uso de micronutrientes em pó em comparação com outras intervenções para o tratamento de crianças com anemia, devido à insuficiência e heterogeneidade clínica dos estudos incluídos

La motivación como factor fundamental para mejorar la eficiencia en los profesionales de la salud

Recently, organizations have maximized their efforts to implement continuous improvement plans in Human Resources, recognizing that employees are the central gear for an efficient operation, labor motivation is one of the concerns, since it directly affects performance. For this reason, it is necessary to identify the factors that influence the creation of an optimal organizational climate for the efficient development of activities, considering that this influence is different depending on the sector. The results of this bibliographic review show the influence of work motivation on health care personnel and its relationship with the quality of service that the patient may perceive. The objective of this review was to describe the importance and most relevant aspects of motivation as a factor to improve efficiency in health professionals.Recientemente las organizaciones han maximizado sus esfuerzos por implementar planes de mejora continua en el área de Recursos Humanos reconociendo que los empleados son el engranaje central para un funcionamiento eficiente, la motivación laboral es una de las preocupaciones, ya que esta afecta directamente el desempeño. Por esta razón, se hace necesario identificar los factores que influyen en la creación de un clima organizacional óptimo para el desarrollo eficiente de las actividades, teniendo en cuenta que esta influencia es diferente dependiendo del sector. Los resultados de esta revisión bibliográfica dan cuenta de la influencia de la motivación laboral en el personal del área de la salud y su es relación con la calidad en el servicio que puede percibir el paciente. El objetivo de la presente revisión fue describir la importancia y aspectos más relevantes de la motivación como factor para mejorar la eficiencia en los profesionales de la salud

A meta-analysis of resuscitative endovascular balloon occlusion of the aorta (REBOA) or open aortic cross-clamping by resuscitative thoracotomy in non-compressible torso hemorrhage patients

Background The objective of this systematic review and meta-analysis was to determine the effect of REBOA, compared to resuscitative thoracotomy, on mortality and among non-compressible torso hemorrhage trauma patients. Methods Relevant articles were identified by a literature search in MEDLINE and EMBASE. We included studies involving trauma patients suffering non-compressible torso hemorrhage. Studies were eligible if they evaluated REBOA and compared it to resuscitative thoracotomy. Two investigators independently assessed articles for inclusion and exclusion criteria and selected studies for final analysis. We conducted meta-analysis using random effect models. Results We included three studies in our systematic review. These studies included a total of 1276 patients. An initial analysis found that although lower in REBOA-treated patients, the odds of mortality did not differ between the compared groups (OR 0.42; 95% CI 0.17–1.03). Sensitivity analysis showed that the risk of mortality was significantly lower among patients who underwent REBOA, compared to those who underwent resuscitative thoracotomy (RT) (RR 0.81; 95% CI 0.68–0.97). Conclusion Our meta-analysis, mainly from observational data, suggests a positive effect of REBOA on mortality among non-compressible torso hemorrhage patients. However, these results deserve further investigation