BISAP-O: obesity included in score BISAP to improve prediction of severity in acute pancreatitis

INTRODUCTION: Most patients with acute pancreatitis exhibits a self-limiting clinical course and relatively free of major complications. Several scores have been created with the intention of achieving adequate and early predict the severity of pancreatitis in order to reduce this mortality. BISAP score was validated in 2008 as a predictor of mortality for acute pancreatitis, obesity is an independent risk factor that increases the risk of severity in patients with acute pancreatitis. The aim of this study is to determine whether obesity BISAP added a score improves prediction of severity in patients with acute pancreatitis MATERIAL AND METHODS: This study was conducted in Daniel Alcides Carrión Hospital, Lima, Peru. The patient data were collected in the Emergency Service, it was a cross-sectional retrospective study, between January 2009 and June 2010. RESULTS: We evaluated a total of 99 patients with acute pancreatitis. Etiology of the 99 were biliary pancreatitis. Only 2 ended in death (2%). Most cases occurred in female patients 77/22 (77.8%). Sixteen of the 99 patients (16%) were considered severe acute pancreatitis. 90% (89/99) had a BISAP <3, 10% a BISAP ≥ 3, fifteen of the 99 patients had a BISAP-O> 3, of them 12 were actually considered a severe pancreatitis. Of 16 patients with severe pancreatitis, 14 patients had a BMI> 25. (P = 0.03, OR = 4.39). BISAP-O has a sensitivity, specificity, PPV and NPV of 75%, 96.4%, 80% and 95.2% respectively, with an accuracy of 92.3%. The area under the curve for BISAP-O was 0.94 (95% CI 0.89 to 0.99). There was no difference when compared with the other studied scores (p = 0.45). CONCLUSIONS: BISAP The score is a simple method that can be used to predict the severity of acute pancreatitis. Obesity associated BISAP (BISAP-O) provides higher sensitivity and diagnostic accuracy to score BISAP and can serve as a parameter to help predict severity in patients with acute pancreatitis. It was not possible to assess the BISAP-O score as a predictor of mortality for patients with acute pancreatitis, due to the low mortality rate in the present study. Further studies are required to validate the score BISAP associated with obesity in predicting severity.
Authors: Guzmán Calderon, Edson; Montes Teves, Pedro; Monge Salgado, Eduardo
Source: Rev. gastroenterol. Perú
URL: http://hdl.handle.net/10757/324690

Levels of quinolones resistance and other antimicrobial in non-pathogenic Escherichia coli strains in children from the periurban area of Lima, Peru

The main aim of this study was to establish the resistance levels to antimicrobial agents, in 222 non-pathogenic E. Coli strains of fecal origin in Peru. The proportion of resistance found to the evaluated antimicrobials was ampicillin (62.6%), cotrimoxazole (48,6%), tetracycline (43,0%) and chloramphenicol (15,8%). We emphasize the high resistance levels found for quinolones: 32% for nalidixic acid (NAL) and 12% for ciprofloxacin (CIP). These high levels of quinoloneresistance in non-pathogenic strains isolated from children in this age group highlight the extensive use and the impact of the intake of this kind of antimicrobials in the community, showing the potential risk of the loss of their utility in the area.
Authors:Pons, María J.; Mosquito, Susan; Ochoa, Theresa J.; Vargas, Martha; Molina, Margarita; Lluque, Angela; Gil, Ana I.; Ecker, Lucie; Barletta, Francesca; Lanata, Claudio F.; Del Valle, Luis J.; Ruiz, Joaquim
Source: Rev. perú. med. exp. salud publica
URL: http://hdl.handle.net/10757/324673

Surgical technique for treating bilateral assymetric cleft lip

The anatomy of bilateral cleft lip is different for each patient, and many authors have described modifications of the traditional repairing techniques in order to achieve more individualized designs and better results. The techniques described by Millard and Mulliken are probably the most commonly used all over the world for repairing bilateral cleft lip; however, there are some short-comings when trying to repair asymmetric forms of bilateral cleft lip. So, we designed this technique aiming to correct asymmetry in bilateral cleft lip. This technique is based on a double advancement and lateral rotation concept placing the scars over the natural lines between the esthetic subunits of the upper lip. Matherial and Methods: This is a retrospective and descriptive study based on a case series. We present a new technique used for surgical repair of bilateral cleft lip in 125 patients. The technique is based in the double advancement and lateral rotation concept which allows lengthening of the shortest lateral lip segment. Most of the incisions are performed on the natural lip landmarks, between the aesthetic subunits of the upper lip. Results were assessed considering the number of failures observed after following up patients for more than one year, performing physical examination and analyzing standardized postoperative pictures. Results: This technique has been used in 125 procedures for repairing cleft lip. We obtained good functional and esthetic outcomes for both nose and lips using this technique. The rate of poor results was 15/125 (12%). These latter procedures had to undergo major secondary surgical revisions. Conclusions: We describe a new technique for surgical repair of asymmetric bilateral cleft lip. This technique led to the elongation of the shortest lateral labial segment, allowing us to achieve good esthetic and functional results on upper lip and nose reconstruction in cases of bilateral asymmetric cleft lip.
Authors: Rossell Perry, Percy; Gavino Gutiérrez, Arquímedes
Source:  Acta méd. peruana
URL: http://hdl.handle.net/10757/324672

Traditional Medicine against Scientific-based Medicine ¿Are we so different in their essentials?

La medicina tradicional es el conjunto de prácticas, creencias y conocimientos sanitarios basados en el uso de recursos naturales (plantas, animales o minerales), terapias espirituales y técnicas manuales que buscan mantener la salud individual y comunitaria .

La medicina científica (también conocida como alopática u occidental) es la medicina convencional, considerada oficial en nuestro sistema de salud . ambas son prácticas aparentemente irreconciliables que se encuentran en las antípodas del ejercicio médico. Además de esa supuesta dicotomía o contradicción, se desenvuelven en una convivencia carente de horizontalidad y de respeto entre ellas. Se deja de lado y se menosprecia el valor de la práctica de la medicina tradicional por la naturaleza empírica que la caracteriza o por la dimensión mágico-religiosa en la que está parcialmente basada. El escepticismo deviene muchas veces en el desprecio y la marginación de estas prácticas.
Autor: Pereyra Elías, Reneé; Fuentes Delgado, Duilio
Fuente: Acta méd. peruana
URL: http://hdl.handle.net/10757/324671

Mastocitos y síndrome de intestino irritable, ¿falta de asociación o de potencia del estudio?

Hemos leído con mucho interés la investigación realizada por Arévalo, Aragon, Montes, Guzmán y Monge el “Incremento de Linfocitos Intraepiteliales en Pacientes con Síndrome de Intestino Irritable” y se remite esta carta con el propósito de felicitar, en primer lugar, a los autores por la iniciativa de realizar estudios sobre el tema y, del mismo modo, presentar nuestros puntos de vista con respecto a esta pesquisa médica.
Autor:Mayta Tristán, Percy
Fuente:Rev. gastroenterol. Perú
URL: http://hdl.handle.net/10757/324689