Manifestaciones orales en pacientes con diabetes mellitus tipo 2 atendidos en el Hospital Alberto Sabogal

Objective: To determine the most frequent oral manifestations of type 2 diabetes mellitus patients at the Sabogal Hospital during 2016. Methods: Descriptive, cross-sectional study. 47 patients were evaluated with an age range of <40 years, 40-65 years and > = 65 years and in the female / male ratio was 1/1, with type 2 diabetes mellitus from the Sabogal Hospital during October, 2016. Data were collected with a chart that included socio-demographic variables of the patients and oral cavity examinations. The statistical analysis was frequency distribution and association of variables with chi-square analysis. Results: The most frequent age group was, patients over 65 years of age (48.94%). Arterial hypertension was the most frequent comorbidity with 57.45% and retinopathy as a chronic complication with 42.55%. From the sample 63.83% were insulin-dependent. The most frequent oral manifestation was partial edentulism with 85.11%, followed by caries with 82.98%, 78.72% gingivitis,Objetivo: Determinar las manifestaciones orales más frecuentes de la diabetes mellitus tipo 2 durante el año 2016 en el Hospital Alberto Sabogal. Materiales y Métodos: Estudio descriptivo, transversal. Se evaluó a 47 pacientes con un rango de edades de < 40 años, 40 – 65 años y >= 65 años y en cuanto a razón femenina/masculino fue de 1/1, con diabetes mellitus tipo 2 del Hospital Sabogal, octubre de 2016. Los datos se recolectaron con una ficha que incluía variables sociodemográficas de los pacientes y evaluación de la cavidad oral. El análisis estadístico fue de distribución de frecuencias y de asociación de variables con chi2. Resultados: El grupo etario más frecuente fue el de mayores de65 años (48,94%). La hipertensión arterial fue la comorbilidad más frecuente (57,45%) y la retinopatía como complicación crónica (42,55%). El 63,83% usaba insulina. La manifestación oral más frecuente fue edentulismo parcial (85,11%), seguido de caries (82,98%), gingivitis (78,72%), p

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe