Go to Room 

Gynecology & Obstetrics

moderated by Dr Mohamad Saleh

ePosters

Prevalence of needle stick injuries and their underreporting among healthcare workers in the department of  Obstetrics and Gynecology

Dr Krishna Kumar

Introduction: Needle stick and sharp injuries (NSSIs) are hazardous and are frequently reported injuries among health care workers (HCW). Every incident is compulsory to be reported but some are underreported. This represents a missed opportunity for initiating post exposure prophylaxis, early detection of seroconversion and implementation of prevention strategies.
Objectives :
The objective of the study is to identify the prevalence of needle stick and sharps injuries (NSSIs) and the rate of underrepoting to occupational health services.
Methods: A cross-sectional study of 194 respondents involving all the healthcare workers and students (Specialists, Medical Officers, House officers, Nurses, Medical assistants, Medical students and nursing students) from Obstertrics and Gynaecology wards in two teaching hospitals who are willing to participate were included. A structured questionnaires was used as the survey instrument. By using statistical analysis, we compared the data of sociodemographics of health workers, injury information, knowledge on risk of needle stick injury and risk perception on needle stick injury.
Results: A total of 19(9.8%) respondents sustained needle stick injury. The prevalence was highest among medical student, 42.1%(n=8). Among the 19 cases, 36.8% did not report the incident due to perceived low risk of Hepatitis B/Human Immuno deficiency virus infection (42.9%), and that it was not important to report the incident (28.6%).
Conclusion: There is a fair understanding of Universal Work Precaution among the HWCs in the Department of Obstetrics and Gynaecology in both the hospitals. However, there still exist a large gap between their knowledge, attitude and practice of the universal work precaution.

Read full text article

Inducible nitric oxide synthase in the placenta of pregnant women with preeclampsia

Drs Juan Carlos Medrano Rodríguez, Christian Starlight Franco Trejo, Hilda Saray Contreras de la Fuente, Eduardo Medrano Cortés

Introduction. During pregnancy, changes in blood pressure is a major cause of maternal and fetal death worldwide, 12% of all pregnancies develop preeclampsia (PEC). The oxide nitric synthase endothelial enzyme (eNOS) generates nitric oxide continuously, producing vasodilation. The inducible isoform (iNOS) is found in macrophages, smooth muscle cells and endothelial cells, and other locations as platelets, hepatocytes, tumor cells and lymphocytes. The main objective of this work was to detect iNOS by fluorescein in placental tissue.
Methodology. Childbirth after were performed 1X1X0.5cm cuts on the surface of the cotyledons, were placed in 10% formalin were embedded in paraffin for microtome cuts and fix them on lamella. Were subsequently washed with buffer solution, oxygenated water with methanol, using also pig serum 10% (Rockland®, D305, lot # 421), solution-RabbitpAb antiiNOS (Calbioquem®482728), streptavidin-fluorescein (Calbioquem®, Cat. No.189734). Fluorescence microscope Carl Zeiss brand was used, and the Image-Pro Plus, 7.0 software.
Results. Nineteen placentas of pregnant women with PEC were collected and 19 without the pathology. It find increased uptake of fluorescein in erythrocytes in the maternal placentas no PEC, the patients who developed PEC was remarkable decreased catchment of fluorescein by state of gravity.
Conclusions. There is an obvious decrease in activity of iNOS during preeclampsia, which is a possible explanatory factor on the process of vasoconstriction during pregnancy, manifested by elevated blood pressure.

View poster
Read full text article

Can a Benign Ovarian Tumour develop a Malignant Endometrial Neoplasm? Sertoliform Ovarian Cystoadenoma getting together with a Low Malignancy Degree Endometrioid Adenocarcinoma G2

Drs Martinez-Mas J, Bueno-Crespo A, Garcia-Laencina PJ, Martinez-Cendan JP, Isaac-Montero A, Remezal-Solano M

Introduction: Sertoli cells tumours are neoplasms with a very low incidence, being sertoliform cystoadenomae extremely unusual. Its first description was made on 1982 by Young and Roth, with very few cases published after them. This is a neoplasm only described on postmenopausal women, with an average age of presentation of 68 year old, and they could suffer virilization symptoms in different degrees. Histologically, it is a well differentiated neoplasm, with a low malignancy degree, and good prognosis if it is confined to ovaries. In other way, the finding of this ovarian tumour getting together with an endometrioid adencarcinoma is an extremely rare case.
Medical Case: A 66 year old woman, who attended our office relating postmenopausal metrorrhage, is presented. The patient had a medical history of diabetes mellitus type II, arterial hypertension, dyslipidemia, liver steatosis, glaucoma and appendectomy. She got three deliveries and had her menopause at the age of 53. An outpatient hysteroscopy was carried on, finding three endometrial polyps, two of them appeared as normal, and the bigger one had a glandular appearance with atypical vascularization, taking biopsy of it that was informed as endometrioid type adenocarcinoma with mucus-secreting pattern. Ultrasoud scanning found an adnexal left 2.5 cm nodule with heterogeneous ultrasonic pattern. Magnetic Resonance found that adnexal left nodule, with heterogeneous signal pattern and significant contrast agent captation, suggestive of malignancy. Serum Ca125 detected was 5 UI/ml. An abdominal total hysterectomy with double adnexectomy, was carried on, with intraoperative biopsy, informed as a borderline tumour. Due to this finding, the operation was completed with omentectomy, lymphadenectomy and peritoneal washing. Last histological analysis identifies the ovarian tumour as sertoliform adenoma from rete ovarii, with hepatocyte multifocal metaplasia. This tumour is suspected of being estrogenic functioning one, probably was the inductor of low degree and moderatedly differentiated G2 endometrioid adenocarcinoma, that infiltrated less than 50% of myometrial wall found on Hysterectomy specimen. There was no lymphatic or omental metastases. FIGO staging IA, TNM staging T1aN0M0.
Conclusions: Sertoliform cystoadenoma is a very rare finding, with only few cases reported. It could be an estrogenic functioning tumour and due to this characteristic could induce endometrial hyperplasia, and at last, could be the reason for appearance of low malignancy degree endometrial neoplasms.

View ePoster
Read full text article


 

Pediatrics

moderated by Dr John Bennet

ePosters

Traumatic lumbar puncture diagnosis and its impact on event-free survival in pediatric patients with acute lymphoblastic leukemia

Drs Moises Gonzalez, Rosa Margarita Cruz and Jose de Jesus Perez

INTRODUCTION: iatrogenic introduction of circulating blasts to a traumatic subarachnoid space by lumbar puncture adversely affects event-free survival.
OBJETIVE: Determine whether the traumatic lumbar puncture at diagnosis is associated with a decrease in event-free survival in patients with acute lymphoblastic leukemia.
MATERIALS AND METHODS: Retrospective cohort study, between January 1, 2009 to December 31, 2013, follow-up 2-5 years of pediatric patients with acute lymphoblastic leukemia newly diagnosed who attended the service of Hematology-Oncopediatrics the Civil Hospital JIM . They were classified into two groups: lumbar puncture traumatic (PLT) and non-traumatic lumbar puncture (PLNT) in turn were classified based on the type of event (death or relapse) and as well as the variables considered risk factors to lower event-free survival.
RESULTS: Total of 228 patients, ranging in age from 0-18 years old, 113 male and 115 female patients with PLT 23, 194 and 11 PLNT SNC 3. 24 relapses were reported, 63 deaths and 141 patients were found without any event. 10% it reported PLT diagnosis.
Median survival time of 32.9 months, standard error of 4.9, CI (36.1-42.7) was calculated. In the Kaplan and Meyer calculated a log rank p = 1.62 with 0.20 and reported an event-free survival at 5 years (60 months) 62.9%.
CONCLUSIONS: It was shown that traumatic lumbar puncture (PLT) had a tendency of association with the event (death and relapse), although this did not reach significance p = 0.17 IC (0.8- 3.3) and Hazard ratio 1.63.
It was concluded that the event-free survival at 5 years (60 months) was 62.9%. The event-free survival status: hemorrhagic 66.7%, 63.6% positive blasts, PLT + 33.3%, 63.6% PLT-, pleocitosis 75%, 74.2% negative blasts.
Variables of interest include T-cell immunophenotype, age> 10 years, no remission, have statistical significance p = <0.001.

Ametropia and ambliopia in students of 42 schools of the program “Healthful Schools” in DISA II, Lima. Peru, 2009

Dr Carlos Carrión

Background: There are almost 12 million children in Peru, and no studies regarding the prevalence of ametropia or amblyopia in school children have ever been reported.
Objetives: To determine the epidemiologic characteristics and current therapy strategies for severe ametropia and amblyopia in students from limited-resource families in Southern Lima, Peru.
Material and methods: A significant sample representative of 120,000 children from 42 schools in five districts of Southern Lima was assessed. The study was performed in three stages. The first one was a cross-sectional and observational survey, assessing visual acuity and performing refraction testing in 12,364 students. The second stage consisted in follow-up assessments in students with moderate and severe ametropy, aiming to confirm their ametropy degree and its respective cyclopegic refraction. The third stage detected students with amblyopia if visual acuty could not be corrected with the best prescription for wearing eyeglasses; we looked for a relationship between severe ametropy and amblyopia, and we determined whether the children had any eyeglasses prescription as initial therapy for amblyopia. Excel 2003 software was used for calculating sample size and for analyzing results obtained.
Results: We found a high prevalence of ametropia (46,3%) (p <0,01) in the general school children population and a high prevalence of amblyiopia in those children with severe ametropy (39%). Four children out of ten with severe ametropy had developed amblyopia (p< 0,029); and of 90,25% of them did not wear eyeglasses (p< 0.045).
Conclusion: It is urgent to make prevention interventions for amblyopia before 5 years of age, since this condition may still be reversible at that age. We also postulate that infantile malnutrition may be a risk factor for the development of ametropy, as it is the case for a poor academic performance.


Gastro-enterology, Hepatology, General Surgery, Pediatric Surgery

moderated by Dr Omer Engin,  Prof Seyed Reza Mousavi, Dr Guillermo Yanowsky-Reyes and Dr Echchaoui Abdelmoughit

ePosters

Risk factors associated in patients with fatty liver ultrasound in Southeast Mexico

Dr. José de Jesús Meléndez

Background: The fatty liver is a condition closely linked to obesity, alcoholism, metabolic syndrome, drugs, viruses, hereditary metabolic diseases, parenteral nutrition or fatty liver associated with pregnancy. The identification of the risk factors associated with fatty liver will establish preventive measures.
Objective: To identify risk factors associated in patients with ultrasonographic diagnosis of fatty liver.
Methods: measures of central tendency and dispersion were used in the statistical analysis. Referred patients with ultrasonographic diagnosis of fatty liver in the service of Gastroenterology at the General Hospital of Zone 2 of the Instituto Mexicano del Seguro Social, Tuxtla Gutierrez, Chiapas included; in the period between March 17 and December 19, 2011, informed consent was obtained. Those who underwent interrogation and physical examination, liver function tests, glucose, cholesterol and triglycerides. Registration protocol R-2011-702-3
Results: 252 patients of whom 187 (74.2%) were evaluated were women and 65 (27.8%) men; history of Diabetes Mellitus 81 (32.1%), Disilipidemia 149 (59.1%), transfusion in 25 (9.9%), Consumer Complementary and Alternative Medicine 93 (36.9%) of Alcohol 21 (8.3%), drugs 44 (17.4%) , overweight 82 (32.5%) and obesity 113 (44.8%), dyslipidemia in 210 (83.3%) predominated triglycerides 123 (48.85%) Cholesterol in 87 (34.5%), Glucose 77 (30.5%), elevated aminotransferases 152 (60.3). The ultrasound reports submitted were made in medicine and familar units in the same hospital where the study was conducted.
Conclusions: The results are similar to those reported in patients in northern Mexico in relation to obesity, dyslipidemia and diabetes mellitus; the consumption of alternative and complementary medicine held an important, even bigger than alcohol percentage. While the correlation between increased echogenicity and aminotransferase was observed it is within expected parameters.

A case with groove pancreatitis

Drs Erkan Guvenc, Omer Engin, Ali Ozturk, Aykut Akseli

Introduction: Groove pancreatitis, rare form of chronic pancreatitis, is characterized by fibrous scars in the anatomic space between the head of the pancreas, the duodenum and the common bile duct. The patients usually present with postprandial abdominal pain, impaired motility and stenosis of the duodenum and postprandial vomiting. It is frequently misdiagnosed as pancreatic malignancy or autoimmune pancreatitis because of its pseudotumor formation. Most patients with groove pancreatitis are males aged 40–50 years with a history of alcohol using. The clinical symptoms are weight loss, upper abdominal pain, postprandial vomiting, and nauseation due to duodenal stenosis. The pathogenesis of groove pancreatitis is is believed to be anatomical or functional obstruction of the minor papilla.
Case report :A 40-year-old male smoker who consumed excessive amounts of alcohol presented with epigastric pain radiating to the back for nearly two months. Laboratory data showed slightly elevated serum levels of lipase (77 U/l). 3-D CT of the abdomen showed swelling of the pancreatic head with inflammatory changes, cleavage a hypodense mass of pancreaticoduodenal cleavage. Upper gastrointestinal endoscopy revealed an edematous, shiny, reddish raised mucosa having a polypoid appearance with narrowing of the second portion of the duodenum. Histological examination of the duodenal biopsy specimens showed preservation of the crypt-villus ratio, and the signs which consistent with active gastritis. These findings appeared consistent with the diagnosis of groove pancreatitis.
Conclusions :Groove pancreatitis is a rare, benign disease, and if diagnosed correctly, unnecessary surgery can be refrained . The differential diagnosis varies from anatomic variants to malignancies. Groove pancreatitis and pancreatic head cancer treatment procedure is completely different so the correct diagnosis is very important.

Case report: Rectal foreign body

Drs Aykut Akseli, Ali Öztürk Omer Engin,Erkan Güvenç, Enis Ünlütürk, Uluğ Tekin

Background: Patients with foreign rectal body may apply to emergency service in some times. This patients have mental desorders or hidden homosexuality or different accidents. This behaviors are seen in hidden homosexuality and they often repeated.
Our case is seventy years old geriatric male patient. He applied to emergency servis with abdominal pain and rectal tenesmus. At the abdominal examination, abdominal tenderness was found and pubic mass was palpated. Rectal mass was found in rectal touch. In the X-ray examination rectal foreign body was seen (Figure 1) and the foreign body was measured approximately 27 cm (Figure 2)
Rectal foreign body was forsepsed and after than extracted with manually. Rectal lasseration was no found. The case was observed for 24 hours and decharged with no any complication.
Discussion: Rectal foreign bodies are many different kinds for example they may be eggplant, cucumber, carrot, bottle, box of deodorant or may be the other hard mass. Managenet of these patients must be minimal invazive to surgical abdominal examination. Minimal invazive procedures include extraction of the foreign body from anuse. The extraction may be totally in onetimes or seperatallty in more then onetimes with breakdown of the foreign body. For example eggplants may not be evacuated in onetime but it may be evacuated more then onetime by separated into small pieces. Sometimes surgical operation may be needed in some circumstances colotomy may be performed. The habit of insert foreign bodies from anus could repeater. Psychotheraphy may be useful in these patients.

Extractioned peg tube by patient and the prevention of stoma with foley catheter; case reports

Drs Omer Engin, Erkan Guvenc, Aykut Akseli, Ali Ozturk

Background: PEG tube is inserted in some patients such as with alzheimer disease but these cases are unoriented so they may extract their PEG catheters. If they extract the catheters in early period , acut abdomen signs may be appeared. If the extraction is occured in late period, acute abdomen may not occur because of PEG stoma tunel is matured and epitelized; but if the tunnel is not recannalised by the catheter , lumen may be occluded.
Cases: We have two cases about these natures. All of two cases are alzhemir diseases. PEG were performed to them. After one month PEGs were discharged by the cases. They have applied to us for recanulation but we had not PEG catheter so we inserted to foley catheter for prevent to close of the tunels. Only after some days foley catheters were closed by enteral nutrition solutions. After than we got the PEG catheters and foleys were changed with PEG tubes.
Discussion: To pull up of the PEG tube in early period may cause to urgent abdominal operation but if the extraction is occurred in late period it may not cause acute abdomen but tunnel may be closed in a few days so we prevent the occlusion by insertion of gastrostomy tube or its like such as foley catheter. Foley catheter may be inserted if reinsertion tube is not found for prevent to occlusion in a temporary time.

Colonic atresia and diverticulum, case report and literature revision

Drs Omar Sanchez-Alvarez, Guillermo Yanowsky-Reyes

Background: PEG tube is inserted in some patients such as with alzheimer disease but these cases are unoriented so they may extract their PEG catheters. If they extract the catheters in early period , acut abdomen signs may be appeared. If the extraction is occured in late period, acute abdomen may not occur because of PEG stoma tunel is matured and epitelized; but if the tunnel is not recannalised by the catheter , lumen may be occluded.
Cases: We have two cases about these natures. All of two cases are alzhemir diseases. PEG were performed to them. After one month PEGs were discharged by the cases. They have applied to us for recanulation but we had not PEG catheter so we inserted to foley catheter for prevent to close of the tunels. Only after some days foley catheters were closed by enteral nutrition solutions. After than we got the PEG catheters and foleys were changed with PEG tubes.
Discussion: To pull up of the PEG tube in early period may cause to urgent abdominal operation but if the extraction is occurred in late period it may not cause acute abdomen but tunnel may be closed in a few days so we prevent the occlusion by insertion of gastrostomy tube or its like such as foley catheter. Foley catheter may be inserted if reinsertion tube is not found for prevent to occlusion in a temporary time.

View ePoster

Evaluation of patients with breast cancer according to histopathological types

Drs Orhan Üreyen, Enver İlhan, Abdullah Şenlikçi, Ugur Gökcelli, Demet Alay

Introduction: It is known that invasive breast carcinoma consists ductal or lobular structures. However, currently, only about%10 are classified as specific types. Some of the histopathological subtypes have characteristic features in the terms of prognosis.
Material&Methods: We evaluated non metastatic invasive breast carcinoma patients according to age, menopausal status, histopathological subtype, hormone receptor status, stage and HER 2 status.
Results: A total of 77 patients were included in the study. In the group of Invasive Ductal Carcinoma (IDC), 53 patients (%63) had a meanage of 55,2(range 35-83). Staging of these patients were Stage I, II and III 10, 28 and 15 respectively. 43 patients (%81) had positive estrogen (ER) or progesterone receptor. Nine patients with the meanage of 56,1 (range 34-76) were invasive lobuler carcinoma (ILC). Staging of these cases were Stage I, II and III 1, 5 and 3 respectively. All of ILC patients had ER or PR positive. Additionally three patients had positive and four patients were negative HER 2 status. There were seven cases (%9) with mixed type (lobular +ductal or any other of these two histologictype of tumor) of breast carcinoma. All of them had positive with ER or PR while 3 cases were HER 2 status positive.
There were eight patients (%10,3) as specific types including two noroendocrin carcinoma,two intracyctic carsinoma, two meduller carcinoma, one papillary breast cancer and one occult breast carcinoma.
Discussion: We identified consistent rates with the literature on the analysis of histopathological subtypes. Furthermore, hormone receptor positivity was also consistent with the literature as ILC was higher than IDC.

View ePoster

Strangulated omentum in the hole of silicon drainage tube, case report

Drs Omer Engin, Mehmet Yilmaz, Ulas Urganci, Enis Unluturk

Background: Drainage tube is inserted into abdominal cavity for different goals. Different kinds of fluid such as blood, serous, purulante materials are drained. So this fluid alerts the surgeon and developing complications may be recognised immediately. Sometimes it does not go well and silicon tube may cause to complication. We present to case for same tube complication.
Case: 54 years old female patient. She has applied emergency service for abdominal stab wound. She was operated. She has small intestinal full thickness incision and it was sutured with silk sutures. Pelvic silicon drainage tube was placed. After postoperative 7th day, tube drain was wanted to disharge but tube was not extracted. Plain abdominal graphy was taken, but it has not a special sign. She was reoperated. With under spinal anesthesia, incision was made vertically on the line of tube hole of the skin. Abdominal wall was opened and tha drain was followed. Omentum had entered into the lumen and some piece of the omentum had exited of the tube’s hole which was strangulated. Strangulated part was excised and tube was extracted to out of the abdomen.
Discussion: If we face with difficulty during extraction of the tube , possibility of any complication must be remembered. Radiologic imaging modalities may be helpfull. Surgical operation with mini laparotomy may be needed for tube extraction.


exhibitor label 2
moderated by Dr John Bennet
Cloud Computing for Electronic Health Records

Roberto Aguirre

New treatment options for immobilized patients using 3D printing, smartphones and wearables

Juan Monzón


Healthcare IT

moderated by David de Mena

Oral communications

How Clinical Decision Support Systems is the right tool for Physicians

Dr. George Kolostoumpis

A clinical decision support system has been defined as an “active knowledge” systems, which use two or more items of patient data to generate case-specific advice. CDSS is to assist physicians at the point of care, this means that doctors interact with CDSS to help, to analyse, and reach a diagnosis on, patient data. In early days CDSS were conceived of as being used to literally make decisions for the physicians. The users of CDSS would input the information and wait for the CDSS to output the “right” choice and the physicians would simply act on that output.
However, the modern CDSS is an assistance to the physicians interact with the CDSS, utilizing both their own knowledge and the CDSS, to make a better analysis of the patient’s data than either human or CDSS could make on their own. Typically, a CDSS makes suggestions for physicians to look through, and the physicians is to expect to pick out useful information from the presented results and discount erroneous CDSS suggestions.
We believe that CDSS delivered using information systems, ideally with the electronic medical record as the platform, will finally provide decision makers with tools making it possible to achieve large gains in performance, narrow gaps between knowledge and practice, and improve safety.

Mind Mapping, Productivity, Visualization

Jose M Guerrero

Mind mapping is superior to traditional linear text and web pages in communicating complex information. The use of mind mapping can have important consequences in the patient’s wellbeing and safety. Mind mapping is a very old technique that has often been neglected in Healthcare. The first application of mind mapping in medicine dates back to 1420. The lack of progress in the area of mind mapping automation has slowed down its use in medicine and nursing. However, in present times, we have developed consistent software solutions to increase the productivity of nurses and physicians, improve the communication between nurses, physicians and patients and improve patient safety and quality of care.
This is a mini-review of the main reasons why the mind mapping technique works and its scientific bases. Several applications in Healthcare are described.