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The goal of induced or spontaneous labor is childbirth by vaginal delivery. Delivery after 37 weeks is desirable and associated with favorable maternal and newborn outcomes. Delivery facilities should have suitable staff and resources on site for antenatal services and delivery care. FIGO's Prep-for-Labor triage method provides rapid diagnostic tools that help define patients as high or low risk to determine whether transfer to a higher-level center is needed. There is often a disconnect between a facility's designation and its ability to achieve safe deliveries. For preplanned labor induction, the designated clinical facility must have the right set-up and prenatal records available to achieve a successful outcome. However, this is often not the case if a patient arrives in labor or needs an induction and the facility has limited patient information and resources, thus requiring rapid management decisions. The practical guidance checklist in this article defines maternal and/or fetal risk factors and delineates approaches and safe practices for labor induction and management, including when antenatal information is limited to maximize safe delivery practices. Guidelines on using the Bishop score (>6 or <6) to manage labor are presented. Evidence supporting successful safe labor induction at 41-42 weeks of gestation in low-risk cases is described. This practice will increase the rate of spontaneous labor and delivery, minimizing intervention and thereby diverting limited clinical resources to those patients in need. In the right setting, this could lead to around 80% of women delivering spontaneously, which remains a desired goal.

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Objective: The purpose of these guidelines is to provide specific recommendations for the surgical treatment of neck metastases in patients with papillary, follicular, and medullary thyroid carcinomas. Materials and methods: Recommendations were developed based on research of scientific articles (preferentially meta-analyses) and guidelines issued by international medical specialty societies. The American College of Physicians' Guideline Grading System was used to determine the levels of evidence and grades of recommendations. The following questions were answered: A) Is elective neck dissection indicated in the treatment of papillary, follicular, and medullary thyroid carcinoma? B) When should central, lateral, and modified radical neck dissection be performed? C) Could molecular tests guide the extent of the neck dissection? Results and conclusion: Recommendation 1: Elective central neck dissection is not indicated in patients with cN0 well-differentiated thyroid carcinoma or in those with noninvasive T1 and T2 tumors but may be considered in T3-T4 tumors or in the presence of metastases in the lateral neck compartments. Recommendation 2: Elective central neck dissection is recommended in medullary thyroid carcinoma. Recommendation 3: Selective neck dissection of levels II-V should be indicated to treat neck metastases in papillary thyroid cancer, an approach that decreases the risk of recurrence and mortality. Recommendation 4: Compartmental neck dissection is indicated in the treatment of lymph node recurrence after elective or therapeutic neck dissection; "berry node picking" is not recommended. Recommendation 5: There are currently no recommendations regarding the use of molecular tests in guiding the extent of neck dissection in thyroid cancer.

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Objetivo: El objetivo de la presente investigación es evaluar nuestra experiencia inicial en la implementación de la mamografía con inyección de contraste (MCIC) y realizar una revisión de la literatura actual respecto de sus indicaciones. Los estudios se realizaron utilizando mamógrafo con capacidad de realizar MCIC, inyección de contraste iodado endovenoso y posterior toma de las imágenes mamográficas habituales (baja y alta energía). Se incluyeron 20 pacientes, invitadas a participar entre quienes concurrieron a realizar biopsias por punción histológicas. Una paciente realizó un segundo estudio al finalizar la terapia neoadyuvante. Dos de 20 (10%) pacientes tuvieron solo lesiones benignas que no realzaron y 18/20 (90%) lesiones malignas que realzaron. Se biopsiaron 27 lesiones, 4 (15%) fueron benignas y 23 (85%) malignas. La extensión del realce coincidió con la lesión visible en imágenes de baja energía en 9/18 (50%) pacientes, en 1/18 (5%) parte del realce mayor a la imagen de baja energía correspondió a una lesión benigna (falso positivo) y en 8/18 (45%) el realce mayor a la imagen de baja energía se corroboró histológicamente. En 4 (22%) pacientes se modificó la estrategia quirúrgica. En el examen post neoadyuvancia se observó respuesta imagenológica completa, reportándose en la cirugía, lesión residual invasora de 2mm. No se presentaron reacciones alérgicas ni otras complicaciones. Se realizó revisión de indicaciones en la literatura. Conclusiones: Nuestra experiencia inicial y curva de aprendizaje muestran que la MCIC es segura y con buenos resultados(AU)

Objetive The purpose of the investigation is to evaluate our initial experience with the implementation of contrast enhanced mammography (CEM) and a review of the current publications regarding its indications. The study was performed with a mammographic unit with CEM capability and iodine-based contrast medium injection. Low and high energy images (recombined image) were obtained in standard incidences. Twenty patients were invited to participate among those that came to undergo breast core biopsies. One patient had two studies, the second after neoadjuvant therapy. Two of 20 (10%) patients had only benign lesions that did not enhanced and 18/20 (90%) had malignant lesions that enhanced. Twenty-seven lesions were biopsied, 4 (15%) were benign and 23 (85%) were malignant. Enhancement was coincident with low energy images size in 9/18 (50%) patients, in 1/8 (5%) part of the enhancement, larger than the lesion in low energy images was due to a benign lesion (false positive) and 8/18 (45%) the size of the lesion that enhanced was truly larger than low energy images (histology proved). Because of this, surgery strategy was modified in 4 (22%) patients. There was radiologic complete response after neoadjuvant therapy and the surgical path report described a 2mm residual invasive carcinoma. There were no allergic reactions or other complications. A review of the published indications of the method was performed. Conclusions: Our initial experience and learning curve shows that CEM is safe with good clinical outcome (AU)

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Objetivo: Avaliar a taxa de cesáreas e suas principais indicações com base na classificação de Robson na Maternidade Municipal de São Vicente em 2020, um hospital público de risco habitual. Métodos: Trata-se de um estudo transversal observacional. Foram efetuadas revisão, correção e análise retrospectiva e documental da classificação de Robson na Maternidade Municipal de São Vicente. Foram analisados partos de janeiro a dezembro de 2020, dos quais foram coletadas e ordenadas as informações mais relevantes para a pesquisa. Resultados: Uma amostra de 1.627 partos foi encontrada. A taxa geral de cesáreas encontrada foi de 46,3%. A contribuição relativa dos grupos 1, 2 e 5 para a taxa de cesáreas foi de 16,8%, 13,3% e 46,8%, respectivamente, enquanto a contribuição relativa das indicações de cesáreas foi de 25,5% para parto cesáreo anterior e de 21,5% para sofrimento fetal agudo. Conclusão: Foi evidenciada alta taxa de cesáreas, e as principais indicações foram cesárea prévia e sofrimento fetal agudo. Os grupos 1, 2 e 5 da classificação de Robson foram os que mais contribuíram para essa taxa.

Objective: To evaluate the cesarean section rate and the cesarean indication rate based on Robson Classification during 2020 in Sã o Vicente's Municipal Maternity, a habitual-risk public hospital. Methods: This is a cross-sectional observational study. We have reviewed, corrected, analyzed retrospectively and documented Robson Classification in Sã o Vicente's Municipal Maternity. Births from January to December 2020 were analyzed, from which the main data for the research was collected and organized. Results: A sample of 1,627 births was found. The overall rate of cesarean section was 46.3%. The relative contribution of groups 1, 2 and 5 to the cesarean rate was 16.8%, 13.3% and 46.8%, respectively. While the cesarean indication relative contribution was 25.5% for previous cesarean and 21.5% for fetal distress. Conclusion: We found a high cesarean rate and the main indications were previous cesarean and fetal distress. Robson classification groups 1, 2 and 5 contributed the most to this rate.

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ABSTRACT Objective: The purpose of these guidelines is to provide specific recommendations for the surgical treatment of neck metastases in patients with papillary, follicular, and medullary thyroid carcinomas. Materials and methods: Recommendations were developed based on research of scientific articles (preferentially meta-analyses) and guidelines issued by international medical specialty societies. The American College of Physicians' Guideline Grading System was used to determine the levels of evidence and grades of recommendations. The following questions were answered: A) Is elective neck dissection indicated in the treatment of papillary, follicular, and medullary thyroid carcinoma? B) When should central, lateral, and modified radical neck dissection be performed? C) Could molecular tests guide the extent of the neck dissection? Results/conclusion: Recommendation 1: Elective central neck dissection is not indicated in patients with cN0 well-differentiated thyroid carcinoma or in those with noninvasive T1 and T2 tumors but may be considered in T3-T4 tumors or in the presence of metastases in the lateral neck compartments. Recommendation 2: Elective central neck dissection is recommended in medullary thyroid carcinoma. Recommendation 3: Selective neck dissection of levels II-V should be indicated to treat neck metastases in papillary thyroid cancer, an approach that decreases the risk of recurrence and mortality. Recommendation 4: Compartmental neck dissection is indicated in the treatment of lymph node recurrence after elective or therapeutic neck dissection; "berry node picking" is not recommended. Recommendation 5: There are currently no recommendations regarding the use of molecular tests in guiding the extent of neck dissection in thyroid cancer.

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Resumen OBJETIVO: Determinar, conforme al Índice de Robson, la tasa de cesáreas en pacientes atendidas, en un periodo de nueve meses, en el Centro de Investigación Materno-Infantil del Grupo de Estudios al Nacimiento. MATERIALES Y MÉTODOS: Estudio retrospectivo, transversal, descriptivo y monocéntrico efectuado en pacientes embarazadas atendidas en el Centro de Investigación Materno Infantil del Grupo de Estudios al Nacimiento, (CIMIGen) que finalizaron el embarazo por cesárea y en quienes se utilizó el índice de Robson para su clasificación. Parámetros de estudio: indicaciones de la cesárea, riesgo de pérdida del bienestar fetal, alta de progresión del trabajo de parto, falla en la inducción del trabajo de parto, macrosomía, periodo intergenésico corto (menos de 18 meses). RESULTADOS: Se obtuvieron 569 pacientes de las que 228 finalizaron el embarazo mediante cesárea y 341 por parto, lo que representó una tasa de cesáreas del 39.9%. Al aplicar el método de clasificación de Robson, los grupos con mayor contribución relativa a la tasa global de cesáreas fueron: grupo 1 (17.62%), grupo 2, subdividido en sus dos categorías: 2a con 19.38% y 2b 17.18%; y el grupo 5.1 (22.91%) y grupo 5.2 (3.96%). Las principales indicaciones de cesárea fueron: 1) riesgo de pérdida del bienestar fetal (18.9%), 2) falta de progresión del trabajo de parto (16.7%), 3) falla en la inducción del trabajo de parto (11.1%), 4) macrosomía (7.2%) y 5) periodo intergenésico corto (7.2%). CONCLUSIONES: El índice de Robson señaló a los grupos 1, 2 y 5 como los mayores contribuyentes a la tasa de cesáreas en CIMIGen. Esta tendencia, grupos 1 y 2 con porcentajes elevados, también se observa en otros centros de atención en México, lo que pudiera indicar una práctica de atención obstétrica que debe revisarse. Esto también se ve en otros países, aunque los porcentajes son distintos pero siguen siendo considerables en los grupos 1, 2 y 5.

Abstract OBJECTIVE: To determine, according to the Robson Index, the caesarean section rate in patients attended, over a period of nine months, at the Maternal and Infant Research Centre of the Childbirth Studies Group. MATERIALS AND METHODS: Retrospective, cross-sectional, descriptive, single-centre study carried out in pregnant patients attended at the Maternal and Infant Research Centre of the Childbirth Study Group (CIMIGen) who terminated gestation by caesarean section and in whom the Robson index was used for classification. Study parameters: indications for caesarean section, risk of loss of fetal well-being, high labour progression, failure of labour induction, macrosomia, short inter-gestational period (less than 18 months). RESULTS: We obtained 569 patients of whom 228 terminated pregnancy by caesarean section and 341 by delivery, representing a caesarean section rate of 39.9%. Applying Robson's classification method, the groups with the highest relative contribution to the overall caesarean section rate were: group 1 (17.62%), group 2, subdivided into its two categories: 2a with 19.38% and 2b 17.18%; and group 5.1 (22.91%) and group 5.2 (3.96%). The main indications for caesarean section were 1) risk of loss of fetal well-being (18.9%), 2) failure of labour to progress (16.7%), 3) failure of induction of labour (11.1%), 4) macrosomia (7.2%) and 5) short inter-gestational period (7.2%). CONCLUSIONS: Robson's index pointed to groups 1, 2 and 5 as the largest contributors to the caesarean section rate at CIMIGen. This trend, groups 1 and 2 with high percentages, is also seen in other facilities in Mexico, which may indicate an obstetric care practice that needs to be reviewed. This is also seen in other countries, although the percentages are different but still considerable in groups 1, 2 and 5.

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La estenosis aórtica severa sintomática que se presenta en pacientes de alto o mediano riesgo quirúrgico puede ser abordada de manera percutánea con reemplazos valvulares aórticos transcateter. Existe sólida evidencia de resultados favorables en estos pacientes con un perfil de seguridad adecuado. El abordaje transfemoral es el más utilizado y ha demostrado ser más seguro en comparación a los abordajes torácicos. Sin embargo, desde mitades de la década pasada el abordaje transcaval se ha convertido en una opción en los pacientes que presentan un riesgo quirúrgico alto y que presentan una vasculatura inadecuada para un abordaje transfemoral seguro. Presentamos el caso de un paciente de 65 años en quien se empleó este abordaje dado a su alto riesgo quirúrgico e inaccesibilidad para realizar un abordaje transfemoral.

Severe symptomatic aortic stenosis in patients with high surgical risk can be addressed percutaneously with transcatheter aortic valve replacement (TAVR). There is solid evidence of favorable results with an adequate safety profile in these patients. The transfemoral approach is the most widely used and has shown to be safer compared to thoracic approaches. Though, since the middle of the last decade, the transcaval approach has become an option in patients who present a high surgical risk and who have inadequate vasculature for a safe transfemoral approach. We present the case of a 65-year-old patient in whom this approach was preferred due to his high surgical risk and inaccessibility to perform a transfemoral approach.

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Introducción: La Historia Clínica es el documento principal en el sistema de información hospitalaria, imprescindible en sus vertientes asistencial y administrativa. Las nuevas tecnologías de la Informática y las comunicaciones han permitido informatizar todos los procesos del sistema de salud. Desde el punto de vista técnico, la informatización de los registros médicos, debe tener en cuenta la correcta descripción de las indicaciones médicas, más aún en los pacientes hospitalizados en las unidades de cuidados intensivos, por su estado de gravedad. Objetivo: desarrollar el prototipo de la aplicación informática que permitirá la gestión de la información del registro de las indicaciones médicas de signos vitales y ventilación de las historias clínicas en el Hospital Clínico-Quirúrgico Docente León Cuervo Rubio de la provincia de Pinar del Río. Métodos: la investigación que se describe obedeció a un estudio de desarrollo tecnológico, para su desarrollo se emplearon métodos teóricos y empíricos. Resultados: la investigación permite a los programadores desarrollar la aplicación informática para el registro de las indicaciones médicas de signos vitales y ventilación en la historia clínica tradicional, por una solución informatizada, a partir de la descripción del negocio, sus requisitos e interacciones. Conclusiones: se alcanzó un gran impacto social en nuestro sistema de salud tanto a nivel provincial como nacional, ya que no existe este sitema y beneficiaria tanto al paciente, como a los profesionales y a la misma institución al abaratar los costos.

Introduction: The Clinical History is the main document in the hospital information system, essential in its care and administrative aspects. The new information technology and communications have made it possible to computerize all the processes of the health system. From a technical point of view, the computerization of medical records must take into account the correct description of medical indications, especially in patients hospitalized in intensive care units, due to their state of seriousness. Objective: to develop the prototype of the computer application that will allow the management of the information of the registry of the medical indications of vital signs and ventilation of the medical records at the León Cuervo Rubio Teaching Clinical-Surgical Hospital in the province of Pinar del Río. Methods: the research that is described obeyed a study of technological development, for its development theoretical and empirical methods were used. Results: the research allows the programmers to develop the computer application for the registration of the medical indications of vital signs and ventilation in the traditional clinical history, by a computerized solution, based on the description of the business, its requirements and interactions. Conclusions: a great social impact was achieved in our health system both at the provincial and national level, since this system does not exist and it would benefit patient, professional and the institution itself by reducing costs.

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Abstract Continuous home oxygen therapy (CHOT) is a widely used intervention but has scant evidence regarding its indications, benefits and the clinical predictors which could affect its requirement in patients with cardiovascular disease. Objective: to describe the patients with cardiovascular disease and the need for home oxygen therapy at the Fundación Cardioinfantil throughout 2018. Methods: a descriptive observational study. Hospitalized patients at Fundación Cardioinfantil from January 1, 2018, to December 31, 2018, diagnosed with cardiovascular disease and presenting their first request for home oxygen. Sociodemographic, clinical, laboratory, and imaging variables along with inpatient days and length of stay in the ICU, were collected. Results: 192 patients were studied. The median age was 74 years (IQR: 64, 25 - 81). The BMI was 25.98 kg/m2 (IQR: 22.74 - 29.67). A total of 47.9% of the population had coronary disease; 49.5% had heart failure; 27.1% had PH, 23% had OSAH, 6.3% had PTE and 16.7% had COPD. The average BNP was 1,430 SD 1,302. The average LVEF was 35.43% SD 15.35 and the median PASP was 53 mmHg (IQR 43 - 65). Altogether, 71.9% required ICU treatment. The average hospital stay was 14.08 days SD 10.1 days. A total of 20.8% of the patients had a PaO2 less than 55 mmHg; 77.1% belonged to the contributive social security regimen. Conclusions: we found that only a minority of the study patients for whom CHOT was ordered met the usually accepted criteria. Half of the patients had heart failure, most with reduced LVEF and elevated BNP, criteria which are not currently used for prescribing CHOT. More studies should be performed on the indications for supplementary oxygen therapy in this population. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2207).

Resumen La oxigenoterapia domiciliaria continua (OCD) es una intervención altamente utilizada, pero con escasa evidencia sobre sus indicaciones, beneficios y predictores clínicos que puedan influir sobre su requerimiento en pacientes con enfermedad cardiovascular. Objetivo: caracterizar los pacientes con enfermedad cardiovascular y requerimientos de oxígeno domiciliario hospitalizados en la Fundación Cardioinfantil durante el año 2018. Métodos: estudio observacional descriptivo, hospitalizados en la Fundación Cardioinfantil del 1° de enero del 2018 a 31 de diciembre del 2018 con diagnóstico de enfermedad cardiovascular y con primera solicitud de oxígeno domiciliario. Se tomaron variables sociodemográficas, clínicas, paraclínicas, imagenológicas, días de hospitalización y estancia de UCI. Resultados: se estudiaron 192 pacientes. La mediana de edad fue 74 años (RIQ: 64, 25-81). El IMC fue 25.98 Kg/m2 (RIQ: 22.74-29.67). El 47.9% de la población tenía enfermedad coronaria. El 49.5% de los pacientes presentaban falla cardiaca. El 27.1% tenía HTP, 23% SAHOS, 6.3% TEP y 16.7% EPOC. El promedio del BNP fue de 1430 DS 1302. La FEVI promedio fue de 35.43% DS 15.35 y la mediana PSAP fue de 53 mmHg (RIQ 43-65). El 71.9% requirió manejo en UCI. El promedio de estancia hospitalaria fue de 14.08 días DS 10.1 días. El 20.8% de los pacientes tenían una PaO2 menor a 55mmHg. El 77.1% pertenecían al régimen contributivo. Conclusiones: encontramos que sólo una minoría de pacientes estudiados a los que se le indicó OCD cumplían con los criterios actualmente aceptados. La mitad de los pacientes presentaban falla cardiaca, la mayoría con FEVI reducida y BNP elevado, criterios que actualmente no son utilizados para la prescripción de OCD. Se deben realizar más estudios sobre indicaciones de la terapia con oxígeno suplementario en esta población. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2207).

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ABSTRACT BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is an important option for enteral nutrition for both children and adults. It is considered a safe, effective, and advantageous technique in comparison to other complementary feeding routes. It allows continuous feeding, the feeding of patients with swallowing disorders due to neurological causes or others, and the administration of non-palatable diets or medications, all with low rates of complications and mortality. OBJECTIVE: This study aimed to evaluate the main indications and complications of PEG in pediatric patients. In addition, the impact on the nutritional status of patients undergoing PEG was also compared with weight, body mass index (BMI), and height according to references from the World Health Organization. METHODS: This observational and retrospective study included 152 children and adolescents who underwent PEG between January/2003 and December/2018. Patients up to 18 years of age at the time of the procedure were included. Complications related to the procedure were classified as minor or major. Patients with PEG indication for nutritional supplementation were evaluated for weight gain, height, and BMI, using the Z score at the day of the procedure and six months, 1 year, and 2 years after the procedure. RESULTS: Indications for PEG were: swallowing disorder of neurological cause (67.1%), need for nutritional supplementation (25%), swallowing disorder of mechanical origin (6.6%), and indication of gastric decompression (1.3%). Minor complications occurred in 57.8% of patients and major complications in 9.8% of patients. The traction technique corresponded to 92.1% and puncture to 7.9%. The death rate was 1.3%. Thirty-eight patients had an indication for nutritional supplementation. In these patients, there was a gradual increase in both BMI and weight, reaching statistically significant differences (P=0.0340 and P= 0.0105, respectively). These differences were more evident in chronic renal disease patients. Height did not vary significantly (P=0.543). CONCLUSION: PEG proved to be an advantageous option as an auxiliary feeding method in pediatric patients. Dysphagia of neurological origin was the main indication followed by the need for nutritional supplementation. PEG has low frequency of major complications and mortality. This study also showed the importance of PEG in patients who need nutritional supplementation, as it enabled patients to move from undernutrition to normal weight ranges.

RESUMO CONTEXTO: A gastrostomia endoscópica percutânea (GEP) é uma importante opção de nutrição enteral para crianças e adultos, sendo considerada uma técnica segura, eficaz e vantajosa em comparação às outras vias de alimentação complementar. Permite a alimentação contínua, a alimentação em pacientes com distúrbios de deglutição de causa neurológica ou outros, a administração de dietas ou medicamentos não palatáveis, todos com baixos índices de complicações e mortalidade. OBJETIVO: Avaliar as principais indicações e complicações de pacientes pediátricos submetidos à GEP e o impacto no estado nutricional de pacientes submetidos à GEP para suplementação nutricional, comparando peso, índice de massa corporal (IMC) e estatura com referências da Organização Mundial de Saúde. MÉTODOS: Estudo observacional e retrospectivo de 152 crianças e adolescentes submetidos à GEP, no período de janeiro/2003 a dezembro/2018. Foram incluídos pacientes até 18 anos de idade na época do procedimento. As complicações relacionadas ao procedimento foram divididas em menores e maiores. Pacientes com indicação de GEP para suplementação nutricional foram avaliados quanto ao ganho de peso, altura e IMC, por meio do escore Z no dia do procedimento e 6 meses; 1 ano; e 2 anos após o procedimento. RESULTADOS: As indicações para GEP foram distúrbio de deglutição de causa neurológica (67,1%), necessidade de suplementação nutricional (25%), distúrbio de deglutição de origem mecânica (6,6%), e indicação de descompressão gástrica (1,3%). Complicações menores ocorreram em 57,8% dos pacientes e complicações maiores em 9,8%. A técnica de tração correspondeu a 92,1% e a punção, 7,9%. A taxa de mortalidade foi de 1,3%. Trinta e oito pacientes tinham indicação de suplementação nutricional. Nestes, houve aumento gradativo tanto do IMC quanto do peso, com variação estatisticamente significativa da mediana P=0,0340 e P=0,0105, respectivamente, mais evidente nos pacientes renais crônicos. A altura não variou significativamente (P=0,543). CONCLUSÃO: A GEP mostrou-se uma opção vantajosa como forma auxiliar de alimentação em pacientes pediátricos, tendo como principais indicações a disfagia de causa neurológica e a necessidade de suplementação nutricional, com baixa prevalência de complicações maiores e mortalidade. Este estudo também mostrou a importância da GEP em pacientes com necessidade de suplementação nutricional, possibilitando a passagem dos pacientes desnutridos para escores nutricionais de peso adequados à idade.

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