Factores asociados a tratamiento quirúrgico en pacientes con obstrucción intestinal por adherencias

El manejo de la obstrucción intestinal por adherencias es un reto para cualquier especialista en Cirugía debido a que existe controversia sobre el alcance del manejo médico y el momento adecuado para llevar el paciente a cirugía para la resolución del cuadro clínico. En el presente trabajo se pretende, identificar los factores asociados a tratamiento quirúrgico en pacientes con obstrucción intestinal por adherencias. Metodología: Se realizó un estudio de casos y controles en una relación de 1:1, con una recolección de muestra estadística de 48 pacientes en cada grupo, entre mayo 2012 y mayo 2014 en el Hospital Universitario Mayor Mederi y en Barrios Unidos. Se consideraron casos los pacientes intervenidos quirúrgicamente por obstrucción intestinal por bridas y controles los pacientes manejados con tratamiento médico. Se evaluaron factores como edad, antecedentes personales patológicos y quirúrgicos, tiempo de evolución del cuadro clínico, hallazgos en imágenes y laboratorio entre otros. Resultados: Se recolectaron un total de 158 pacientes, (78 casos, 80 controles). Ambas poblaciones fueron comparables (p=0.13). Los factores asociados a tratamiento quirúrgico estadísticamente significativos fueron género masculino, presencia de fiebre al ingreso, el hallazgo de engrosamiento de la pared intestinal y de obstrucción de asa cerrada en imágenes diagnósticas (p<0,05). Discusión: Los principales factores asociados para que un paciente con obstrucción intestinal por bridas requiera de manejo quirúrgico son consistentes con literatura. Se requiere la socialización de los resultados para disminuir la morbimortalidad de nuestros pacientes.

Percentiles de grasa corporal por bioimpedancia eléctrica en niños y adolescentes de Bogotá, Colombia: Estudio FUPRECOL

Objetivo: Recientemente, se han propuesto varios dispositivos de impedancia bioeléctrica (BIA) para la estimación rápida de la grasa corporal. Sin embargo, no han sido publicadas referencias de grasa corporal para niños y adolescentes en población Colombiana. El objetivo de este estudio fue establecer percentiles de grasa corporal por BIA en niños y adolescentes de Bogotá, Colombia de entre 9 y 17.9 años, pertenecientes al estudio FUPRECOL. Métodos: Estudio descriptivo y transversal, realizado en 2.526 niños y 3.324 adolescentes de entre 9 y 17.9 años de edad, pertenecientes a instituciones educativas oficiales de Bogotá, Colombia. El porcentaje de grasa corporal fue medido con Tanita® Analizador de Composición Corporal (Modelo BF-689), según edad y sexo. Se tomaron medidas de peso, talla, circunferencia de cintura, circunferencia de cadera y estado de maduración sexual por auto-reporte. Se calcularon los percentiles (P3, P10, P25, P50, P75, P90 y P97) y curvas centiles por el método LMS según sexo y edad y se realizó una comparación entre los valores de la CC observados con estándares internacionales. Resultados: Se presentan valores de porcentaje de grasa corporal y las curvas de percentiles. En la mayoría de los grupos etáreos la grasa corporal de las chicas fue mayor a la de los chicos. Sujetos cuyo porcentaje de grasa corporal estaba por encima del percentil 90 de la distribución estándar normal se consideró que tenían un elevado riesgo cardiovascular (chicos desde 23,4-28,3 y chicas desde 31,0-34,1). En general, nuestros porcentajes de grasa corporal fueron inferiores a los valores de Turquía, Alemania, Grecia, España y Reino Unido. Conclusiones: Se presentan percentiles del porcentaje de grasa por BIA según edad y sexo que podrán ser usados de referencia en la evaluación del estado nutricional y en la predicción del riesgo cardiovascular desde edades tempranas.

Trombosis asociada a cateter venoso central en pediatría de la Fundación Cardioinfantil julio 2013 a julio 2015

La trombosis relacionada al uso del catéter es un problema que cobra cada vez mayor importancia. Se han descrito factores de riesgo para su presentación en la población pediátrica pero aún no se han realizado estudios en nuestro medio. Objetivo: Determinar los factores de riesgo y la prevalencia de la trombosis asociada a catéter venoso central en los pacientes pediátricos de la Fundación Cardioinfantil hospitalizados durante el periodo comprendido entre Julio 2013 a Julio 2015. Metodología: Se realizó un estudio de corte transversal de asociación. Se incluyeron pacientes clasificados en 4 grupos: trombosis y catéter, trombosis sin catéter, catéter sin trombosis y sin trombosis ni catéter. Se estimaron OR como medidas de asociación utilizando el estadístico mantel haenszel. Resultados: En total se incluyeron 221 pacientes. La prevalencia de la trombosis y uso del catéter fue del 22%. La edad inferior a los 36 meses (OR 2,27 IC95% 1,16-4,44,p<0.001), profilaxis antitrombótica (OR 34,4 IC95% 4,18-282,92, p<0.01), hospitalización en la UCI (OR 3,82, IC95% 1,69-8,65, p<0.001) y el tiempo de hospitalización (OR 16,83 IC95% 7,8-36,27, p<0.001) están asociadas con un mayor riesgo de presentación de la trombosis. Conclusión: La edad, hospitalización en UCI, uso de profilaxis antitrombótica y el tiempo de hospitalización son factores de riesgo que estan relacionados con la presentación de la trombosis en pacientes con cateter.

Evaluation of the Met Office global forecast model using Geostationary Earth Radiation Budget (GERB) data

Simulations of the top-of-atmosphere radiative-energy budget from the Met Office global numerical weather-prediction model are evaluated using new data from the Geostationary Earth Radiation Budget (GERB) instrument on board the Meteosat-8 satellite. Systematic discrepancies between the model simulations and GERB measurements greater than 20 Wm-2 in outgoing long-wave radiation (OLR) and greater than 60 Wm-2 in reflected short-wave radiation (RSR) are identified over the period April-September 2006 using 12 UTC data. Convective cloud over equatorial Africa is spatially less organized and less reflective than in the GERB data. This bias depends strongly on convective-cloud cover, which is highly sensitive to changes in the model convective parametrization. Underestimates in model OLR over the Gulf of Guinea coincide with unrealistic southerly cloud outflow from convective centres to the north. Large overestimates in model RSR over the subtropical ocean, greater than 50 Wm-2 at 12 UTC, are explained by unrealistic radiative properties of low-level cloud relating to overestimation of cloud liquid water compared with independent satellite measurements. The results of this analysis contribute to the development and improvement of parametrizations in the global forecast model.

Importance of resolution and model configuration when downscaling extreme precipitation

Dynamical downscaling is frequently used to investigate the dynamical variables of extra-tropical cyclones, for example, precipitation, using very high-resolution models nested within coarser resolution models to understand the processes that lead to intense precipitation. It is also used in climate change studies, using long timeseries to investigate trends in precipitation, or to look at the small-scale dynamical processes for specific case studies. This study investigates some of the problems associated with dynamical downscaling and looks at the optimum configuration to obtain the distribution and intensity of a precipitation field to match observations. This study uses the Met Office Unified Model run in limited area mode with grid spacings of 12, 4 and 1.5 km, driven by boundary conditions provided by the ECMWF Operational Analysis to produce high-resolution simulations for the Summer of 2007 UK flooding events. The numerical weather prediction model is initiated at varying times before the peak precipitation is observed to test the importance of the initialisation and boundary conditions, and how long the simulation can be run for. The results are compared to raingauge data as verification and show that the model intensities are most similar to observations when the model is initialised 12 hours before the peak precipitation is observed. It was also shown that using non-gridded datasets makes verification more difficult, with the density of observations also affecting the intensities observed. It is concluded that the simulations are able to produce realistic precipitation intensities when driven by the coarser resolution data.

Quantifying polynya ice production in the Laptev Sea with the COSMO model

Arctic flaw polynyas are considered to be highly productive areas for the formation of sea-ice throughout the winter season. Most estimates of sea-ice production are based on the surface energy balance equation and use global reanalyses as atmospheric forcing, which are too coarse to take into account the impact of polynyas on the atmosphere. Additional errors in the estimates of polynya ice production may result from the methods of calculating atmospheric energy fluxes and the assumption of a thin-ice distribution within polynyas. The present study uses simulations using the mesoscale weather prediction model of the Consortium for Small-scale Modelling (COSMO), where polynya area is prescribed from satellite data. The polynya area is either assumed to be ice-free or to be covered with thin ice of 10 cm. Simulations have been performed for two winter periods (2007/08 and 2008/09). When using a realistic thin-ice thickness of 10 cm, sea-ice production in Laptev polynyas amount to 30 km3 and 73 km3 for the winters 2007/08 and 2008/09, respectively. The higher turbulent energy fluxes of open-water polynyas result in a 50-70% increase in sea-ice production (49 km3 in 2007/08 and 123 km3 in 2008/09). Our results suggest that previous studies have overestimated ice production in the Laptev Sea.

The conceptualisation of operational risk management models

Operational risk is evolving as a specialist field of risk management that must be practiced within all organisations, but currently has a particular relevance to banks. The Basel Committee on Banking Supervision has circulated a consultative paper which, if adopted by nation-state bank supervisors, will impose an operational risk capital charge on banks as part of a new Capital Accord. The definition of operational risk is wide-ranging and creates some unique issues related to the development of appropriate risk management models. This paper conceptualises two distinct operational risk management models; being a predictive model that will result in a known outcome upon its implementation, and a pre-emptive operational risk management model which prepares an organisation in the event that a future risk occurrence results in a disruption to critical business operations.

Suicide among psychiatric patients : a case-control study

Objective: To examine patient- and treatment-based differences between psychiatric patients who do and do not die by suicide. Method: By linking databases of deaths and psychiatric service use in Victoria, we compared 597 cases who suicided over 5 years with individually matched controls. Results: Cases and controls could not be distinguished on the majority of patient- or treatment- based characteristics. The exceptions were that cases were more likely to be male, less likely to be outside the labour force, more likely to have recent contact with inpatient and community services, and more likely to have a registration as their last contact. Conclusions: Patients who suicide 'look' similar to those who do not, suggesting prevention approaches should ensure that all psychiatric patients receive optimal care, including appropriate detection, diagnosis, assessment and treatment of mental health problems, and careful, individualised assessment of suicide risk.

The conceptualisation of operational risk management models

Operational risk is evolving as a specialist field of risk management that must be practiced within all organisations, but currently has a particular relevance to banks. The Basel Committee on Banking Supervision has circulated a consultative paper which, if adopted by nation-state bank supervisors, will impose an operational risk capital charge on banks as part of a new Capital Accord. The definition of operational risk is wide-ranging and creates some unique issues related to the development of appropriate risk management models. This paper conceptualises two distinct operational risk management models; being a predictive model that will result in a known outcome upon its implementation, and a pre-emptive operational risk management model which prepares an organisation in the event that a future risk occurrence results in a disruption to critical business operations.

The metabolic syndrome as a tool for predicting future diabetes : the AusDiab study

Objective. To compare the ability of the metabolic syndrome (MetS), a diabetes prediction model (DPM), a noninvasive risk questionnaire and individual glucose measurements to predict future diabetes.

Design. Five-year longitudinal cohort study. Tools tested included MetS definitions [World Health Organization, International Diabetes Federation, ATPIII and European Group for the study of Insulin Resistance (EGIR)], the FINnish Diabetes RIsk SCore risk questionnaire, the DPM, fasting and 2-h post load plasma glucose.

Setting. Adult Australian population.

Subjects. A total of 5842 men and women without diabetes ≥25 years. Response 58%. A total of 224 incident cases of diabetes.

Results. In receiver operating characteristic curve analysis, the MetS was not a better predictor of incident diabetes than the DPM or measurement of glucose. The risk for diabetes among those with prediabetes but not MetS was almost triple that of those with MetS but not prediabetes (9.0% vs. 3.4%). Adjusted for component parts, the MetS was not a significant predictor of incident diabetes, except for EGIR in men [OR 2.1 (95% CI 1.2–3.7)].

Conclusions. A single fasting glucose measurement may be more effective and efficient than published definitions of the MetS or other risk constructs in predicting incident diabetes. Diagnosis of the MetS did not confer increased risk for incident diabetes independent of its individual components, with an exception for EGIR in men. Given these results, debate surrounding the public health utility of a MetS diagnosis, at least for identification of incident diabetes, is required.

A social network analysis model for analysing stakeholder-associated safety risks in infrastructure projects

An important strategy in the long-term blueprint for making Australia's 18 capital and major regional cities more productive, sustainable and liveable is to develop high quality public infrastructure systems to improve civic quality of life. Because of the unique features of construction activities, such as long period, complicated processes, and dynamic organizational structures, infrastructure projects normally involve multiple stakeholders and are subject to various risks, especially safety issues. Any negligence or mismanagement of critical safety risks will have huge impact on achieving project objectives and success. Although many previous studies have identified and assessed various safety risks in construction industry, a main research gap is that these studies ignored a fact that most risks are interrelated and associated with internal and external stakeholders of the projects. The lack of a theoretical foundation and appropriate methods for analysing stakeholder-associated safety risks and their interdependencies in infrastructure projects hinders effective risk management processes and the formulations of decision strategies. This research aims at enabling higher performance in strategic safety risk management in infrastructure projects through the development of a holistic risk analysis model using Stakeholder and Social Network Theories. The outcomes can broaden project managers' awareness of emerging influential safety risks and enhance their ability to perceive, understand, assess, and mitigate safety risks in an effective and efficient way; thereby higher performance in strategic risk management could be achieved in infrastructure projects.

The influence of hip circumference on the relationship between abdominal obesity and mortality

Background Higher waist circumference and lower hip circumference are both associated with increased cardiovascular disease (CVD) risk, despite being directly correlated. The real effects of visceral obesity may therefore be underestimated when hip circumference is not fully taken into account. We hypothesized that adding waist and hip circumference to traditional risk factors would significantly improve CVD risk prediction.

Methods In a population-based survey among South Asian and African Mauritians (n = 7978), 1241 deaths occurred during 15 years of follow-up. In a model that included variables used in previous CVD risk calculations (a Framingham-type model), the association between waist circumference and mortality was examined before and after adjustment for hip circumference. The percentage with an increase in estimated 10-year cumulative mortality of >25% and a decrease of >20% after waist and hip circumference were added to the model was calculated.

Results Waist circumference was strongly related to mortality only after adjustment for hip circumference and vice versa. Adding waist and hip circumference to a Framingham-type model increased estimated 10-year cumulative CVD mortality by >25% for 23.7% of those who died and 15.7% of those censored. Cumulative mortality decreased by >20% for 4.5% of those who died and 14.8% of those censored.

Conclusions The effect of central obesity on mortality risk is seriously underestimated without adjustment for hip circumference. Adding waist and hip circumference to a Framingham-type model for CVD mortality substantially increased predictive power. Both may be important inclusions in CVD risk prediction models.

SAS macros for point and interval estimation of area under the receiver operating characteristic curve for non-proportional and proportional hazards Weibull models

Aims and objectives  For prediction of risk of cardiovascular end points using survival models the proportional hazards assumption is often not met. Thus, non-proportional hazards models are more appropriate for developing risk prediction equations in such situations. However, computer program for evaluating the prediction performance of such models has been rarely addressed. We therefore developed SAS macro programs for evaluating the discriminative ability of a non-proportional hazards Weibull model developed by Anderson (1991) and that of a proportional hazards Weibull model using the area under receiver operating characteristic (ROC) curve.

Method  Two SAS macro programs for non-proportional hazards Weibull model using Proc NLIN and Proc NLP respectively and model validation using area under ROC curve (with its confidence limits) were written with SAS IML language. A similar SAS macro for proportional hazards Weibull model was also written.

Results  The computer program was applied to data on coronary heart disease incidence for a Framingham population cohort. The five risk factors considered were current smoking, age, blood pressure, cholesterol and obesity. The predictive ability of the non-proportional hazard Weibull model was slightly higher than that of its proportional hazard counterpart. An advantage of SAS Proc NLP in terms of the example provided here is that it provides significance level for the parameter estimates whereas Proc NLIN does not.

Conclusion  The program is very useful for evaluating the predictive performance of non-proportional and proportional hazards Weibull models.

Assessing risk post intervention for an acute coronary syndrome: a review of the risk assessment tools and their development

Considerable variability in survival rate after an acute myocardial infarction exists and accurate risk stratification is of significant importance. The American College of Cardiology and the American Heart Association has recommended early risk stratification using several clinical risk scoring instruments to identify high risk patients. The aim of this paper is to identify secondary cardiovascular risk scoring instruments that could be utilized at the time of intervention for acute coronary syndromes and compare their psychometric properties as they were developed. A search using Medline, Cumulative Index to Nursing and Allied Health Literature and the Psychology and Behavioral Sciences Collection data-bases identified studies published between January 1990 and January 2010 used to measure risk after intervention for acute coronary syndrome. Four validated secondary risk prediction scoring instruments were identified for comparison.Secondary risk prediction scoring instruments for the acute coronary syndrome patient population are evidence based, valid and reliable. Use of the instruments by cardiac focused clinicians will aid in the determination of treatment strategies, and estimation of short and long term events and mortality.