Anencefalia. Presentación de 1 caso

The anencephaly is one of the most common anomalies of the neural tube. These anomalies are congenital defects that affect the tissues that grow in the brain and the spinal cord, the objective of this investigation is to describe a case of anencephaly that is an infrequent congenital defect in the newborns in the fusion of several closing places of the neural tube. The defect in the fusion of several closing places of the neural tube occurs when the encephalic extreme or head of the neural tube does not close, generally between the 23º and the 26º day of the pregnancy, causing a congenital cerebral malformation characterized by the partial or total absence of the brain, skull, and scalp; its frequency varies between 0.5 and 2 per 1000 births. It is presented a case of a first twin who comes to the world with absence of skull, with a low apgar, and in spite of the ways to keep him alive, he died after 20 hours.La anencefalia es una de las anomalías del tubo neural más comunes. Estas anomalías son defectos congénitos que afectan el tejido que crece en el cerebro y la médula espinal, el objetivo de la presente investigación es describir un caso de anencefalia que es un defecto congénito poco frecuente en el neonato en la fusión de varios sitios de cierre del tubo neural. Defecto  en la fusión de varios sitios de cierre del tubo neural ocurre cuando el extremo encefálico o cabeza del tubo neural no logra cerrarse, generalmente entre el 23º y el 26º día del embarazo, dando como resultado una malformación cerebral congénita caracterizada por la ausencia parcial o total del cerebro, cráneo, y cuero cabelludo; su frecuencia varía entre 0.5 y 2 por cada 1 000 nacimientos. Se presenta un caso de un primer gemelar que nace con ausencia de cráneo, con puntuación de apgar bajo que a pesar de las medidas de sostén fallece a las 20 horas de edad

Carcinoma de células escamosas de la piel infiltrando hueso. Presentación de un caso

Introduction: the squamous or epidermoid cell carcinoma is the second most common ¨non- melanoma¨ tumor in the skin areas exposed to sunlight, and it is more common in older people. Its incidence is higher in men, but it can be seen in both sexes. Case presentation: a 57-year-old female patient, native, with a clinical antecedent of a "removed" lesion in her right leg about 30 years ago in a private hospital, without specifying its anatomopathological result. She went to the Emergency Service at the National Regional Hospital in Escuintla, Guatemala, because four months ago she began with a small ulcerated injure in the same leg, and as she reported, in the "same place", which was initially treated with "home remedies", without specifying which ones, but the injure did not get better, otherwise it began to grow in an exophytic way and became secondarily infected. It was decided then to hospitalize the patient in the Surgery Service of Women for the study and later treatment. It was performed a skin biopsy to obtain an accurate diagnosis, the anatomopathological diagnosis confirmed the existence of a squamous cell carcinoma, well differentiated and infiltrating of the skin. It was decided then to consult and send the case to Roosevelt Hospital in Guatemala to be consulted with a surgeon specialist in oncology.Discussion: the epidermoid carcinoma, also known as spinocellular carcinoma is the second most common "non-melanoma" skin cancer, preceded by basal cell carcinoma; it is derived from alterations in the epidermis, specifically of keratinocytes.Conclusion: the squamous (epidermoid) cell carcinoma arises from alterations in epidermal keratinocytes and it can infiltrate bone structures.Introducción: el carcinoma de células escamosas o “epidermoide” como también se le denomina, es el segundo tumor “no melanoma” más frecuente de la piel de las zonas expuestas a los rayos solares y es más común en las personas mayores. Tiene mayor incidencia en los hombres, aunque pueden ser vistos en ambos sexos.Presentación de caso: paciente de sexo femenino, 57 años de edad, raza indígena, con antecedentes de habérsele “removido” hace aproximadamente 30 años una lesión en la pierna derecha, en un Sanatorio Privado no precisando el resultado anatomopatológico de la misma. Acude a emergencias del Hospital Nacional Regional de Escuintla, (HNRE), Guatemala, porque desde hace aproximadamente 4 meses comenzó con una lesión, ulcerada, pequeña en la misma pierna y según refiere la paciente en el “mismo lugar”, que se trató inicialmente con “remedios caseros”, sin precisar cuáles, pero que no mejoró, al contrario comenzó a crecer de forma exofítica y a infectarse secundariamente. Se decide ingresar en el Servicio de Cirugía de Mujeres para estudio y posterior tratamiento. Se realiza biopsia de piel para un diagnóstico certero, el diagnóstico anatomopatológico confirma la existencia de un carcinoma de células escamosas bien diferenciado e infiltrante de piel, se toma la conducta de consultar y remitir el caso para el Hospital Roosevelt de Ciudad de Guatemala para ser interconsultado con un especialista cirujano oncólogo.Discusión: el carcinoma epidermoide o también conocido como carcinoma espinocelular, es el segundo cáncer de piel “no melanoma” más frecuente, siendo precedido por el carcinoma de células basales, el mismo se deriva de alteraciones a nivel de la epidermis específicamente de los queratinocitos.Conclusión: el carcinoma de células escamosas (epidermoide) surge por alteraciones de queratinocitos de la epidermis y es capaz de infiltrar estructuras óseas.

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely