Reconstruction of benign tracheal stenosis : Experience of a high-level complexity hospital in Colombia

Introducción. La causa más común de estenosis laringotraqueal benigna es iatrogénica, secundaria a intubación orotraqueal. El manejo quirúrgico sigue siendo la alternativa que ha mostrado mejores resultados a largo plazo. El objetivo de este estudio fue analizar la experiencia en el manejo quirúrgico de la estenosis laringotraqueal durante 15 años en un hospital de alta complejidad en Colombia.Métodos. En este estudio se revisaron las historias clínicas de todos los pacientes tratados con reconstrucción de estenosis traqueal benigna, entre los años 2005 y 2020. Para el análisis estadístico se usaron métodos de estadística descriptiva, con análisis de frecuencias y medidas de tendencia central o de dispersión.Resultados. Se identificaron 38 pacientes con estenosis laringotraqueal, con un grado variable de estenosis. La nasofibrolaringoscopia fue bien tolerada y segura para determinar el grado y la longitud de la estenosis. El uso de tomografía sirvió para determinar la extensión y las características anatómicas. Los resultados del presente estudio son similares a los de la literatura en cuanto a complicaciones, mortalidad y falla de la anastomosis. Las complicaciones más frecuentemente reportadas son reestenosis, infección del sitio operatorio, lesión nerviosa y fístula, que en general se presentan en un tercio de los pacientes. Conclusiones. La experiencia de manejo quirúrgico de estenosis laringotraqueal en este hospital permite concluir que la reconstrucción traqueal es una opción segura en nuestro medio. Las tasas de éxito y de falla del tratamiento son equiparables a las reportadas en la literatura.Introduction. The most common cause of benign laryngotracheal stenosis is iatrogenic, secondary to orotracheal intubation. Surgical management continues to be the alternative that has shown better long-term results. The objective of this study was to analyze the experience in the surgical management of laryngotracheal stenosis for 15 years in a high-level complexity hospital in Colombia.Methods. Medical records of patients treated with reconstruction of benign tracheal stenosis between 2005 and 2020 were reviewed. Descriptive statistical methods were used, with frequency analysis and measures of central tendency or dispersion.Results. Thirthy-eight patients with laryngotracheal stenosis were identified, with a variable degree of stenosis. Nasofibrolaryngoscopy was well tolerated and safe to determine the degree and length of the stenosis. The use of tomography served to determine the extension and anatomical characteristics. The results of the present study are similar to those of the literature in terms of complications, mortality and failure of the anastomosis. The most frequently reported complications are restenosis, surgical site infection, nerve injury, and fistula, which generally occur in one third of patients.Conclusions. The experience of surgical management of laryngotracheal stenosis in our hospital allows us to conclude that tracheal reconstruction is a safe option in our environment. Treatment success and failure rates are comparable to those reported in the literature.https://orcid.org/0000-0003-0960-9480https://orcid.org/0000-0002-3721-3312Revista Nacional - IndexadaN

Web-Based Asynchronous Teleconsulting for Consumers in Colombia: A Case Study

Reviewer: Edirippulige, Sisira[This item is a preserved copy and is not necessarily the most recent version. To view the current item, visit http://www.jmir.org/2007/4/e33/ ] Background: Fourteen years after the reform to Colombia’s health system, the promises of universality, improved equity, efficiency, and better quality of care have not materialized. Remote areas remain underserved and access to care very limited. Recognizing teleconsultation as an effective way to improve access to health care and health information, a noncommercial open-access Web-based application for teleconsultation called Doctor Chat was developed. Objective: The objective was to report the experience of the Center for Virtual Education and Simulation eHealth (Centro de Educación Virtual y Simulación e-Salud) with open-access Web-based asynchronous teleconsultation for consumers in Colombia. Methods: A teleconsultation service in Spanish was developed and implemented in 2006. Teleconsultation requests were classified on three axes: (1) the purpose of the query, (2) the specialty, and (3) the geographic area of the query. Content analysis was performed on the free-text queries submitted to Doctor Chat, and descriptive statistics were gathered for each of the data categories (name, email, city, country, age, and gender). Results: From September 2006 to March 2007, there were 270 asynchronous teleconsultations documented from 102 (37.8%) men and 168 (62.2%) women. On average, 1.4 requests were received per day. By age group, the largest number of requests (n = 80; 30%) were from users 24-29 years, followed by users (n = 66; 24%) 18-23 years. Requests were mainly from Colombia (n = 204; 75.6%) but also from Spain (n = 17; 6.3%), Mexico (n = 11; 4.1%), and other countries. In Colombia, 137 requests (67.2%) originated in Bogotá, the nation’s capital, 25 (12.4%) from other main cities of the country, 40 (19.7%) from intermediate cities, and 2 (0.7%) from remote areas. The purpose of the majority of requests was for information about symptoms, health-related problems, or diseases (n = 149; 55.2%) and medications/treatments (n = 70; 25.9%). By specialty, information was most requested for gynecology and obstetrics (n = 71; 26%), dermatology (n = 28; 10%), urology (n = 22; 8%), and gastroenterology (n = 18; 7%), with anesthesiology, critical care, physical medicine and rehabilitation, and pathology being the least requested (n = 0; 0%). Overall, sexual and reproductive health (n = 93; 34%) issues constituted the main query subject. The average time to deliver a response was 120 hours in 2006 and 59 hours in 2007. Only 19 out of 270 users (7%) completed a survey with comments and perceptions about the system, of which 18 out of 19 (95%) corresponded to positive perceptions and 1 out of 19 (5%) expressed dissatisfaction with the service. Conclusion: The implementation of a Web-based teleconsulting service in Colombia appeared to be an innovative way to improve access to health care and information in the community and encouraged open and explicit discussion. Extending the service to underserved areas could improve access to health services and health information and could potentially improve economic indicators such as waiting times for consultations and the rate of pregnancy among teenagers; however, cultural, infrastructural, and Internet connectivity barriers are to be solved before successful implementation can derive population-wide positive impacts

II Colombian Tromboemblism Venous Consensus

En el trombembolismo venoso (TEV), incluye la trombosis venosa profunda (TVP) y la embolia pulmonar (EP), como manifestaciones de una misma enfermedad. Constituye un fenómeno común con una incidencia de 300-600.000 casos de TVP y cerca de 50.000 muertes anuales causadas por EP, en Estados Unidos, y 10.000 muertes anuales, por la misma razón, en Francia.171-18