Hernando Gaitán

International survey on variations in practice of the management of the third stage of labour.

OBJECTIVE To determine the use of the active management of the third stage of labour in 15 university-based obstetric centres in ten developing and developed countries and to determine whether evidence-based practices were being used. METHODS From March 1999 to December 1999, the Global Network for Perinatal and Reproductive Health (GNPRH) conducted an observational, cross-sectional survey to assess the use of the practice and its components. Prospective data on patient characteristics and the interventions used in the management of the third stage of labour were collected using standardized methods. Data on approximately 30 consecutive vaginal deliveries in each centre (452 in total) were included. FINDINGS Significant intracountry and intercountry variation in the practice of the active management of the third stage of labour was found (111/452 deliveries used active management), which confirmed the existence of a large gap between knowledge and practice. CONCLUSION Areas identified for improvement are the urgent implementation of the evidence-based clinical management practice defined as the active management of the third stage of labour; increased accessibility to systematic reviews in developing countries; and the conduction of clinical trials that assess the impact of this intervention in other settings.

Accuracy of five different diagnostic techniques in mild-to-moderate pelvic inflammatory disease.

OBJECTIVE: To evaluate the clinical diagnosis of pelvic inflammatory disease (PID) compared with the diagnosis of PID made by laparoscopy, endometrial biopsy, transvaginal ultrasound, and cervical and endometrial cultures. Study design: A diagnostic performance test study was carried out by cross-sectional analysis in 61 women. A group presenting PID (n = 31) was compared with a group (n = 30) presenting another cause for non-specific lower abdominal pain (NSLAP). Diagnosis provided by an evaluated method was compared with a standard diagnosis (by surgical findings, histopathology, and microbiology). The pathologist was unaware of the visual findings and presumptive diagnoses given by other methods. RESULTS: All clinical and laboratory PID criteria showed low discrimination capacity. Adnexal tenderness showed the greatest sensitivity. Clinical diagnosis had 87% sensitivity, while laparoscopy had 81% sensitivity and 100% specificity; transvaginal ultrasound had 30% sensitivity and 67% specificity; and endometrial culture had 83% sensitivity and 26% specificity. CONCLUSIONS: Clinical criteria represent the best diagnostic method for discriminating PID. Laparoscopy showed the best specificity and is thus useful in those cases having an atypical clinical course for discarding abdominal pain when caused by another factor. The other diagnostic methods might have limited use.

Laparoscopic diagnosis of acute lower abdominal pain in women of reproductive age

Objectives: To compare the accuracy of laparoscopy performed within 24 h of admission and the conventional method based on clinical observation in the etiological diagnosis of non‐specific acute lower abdominal pain (NSLAP) in women of reproductive age. Methods: A total of 110 patients who met the selection criteria and were seen from November 1997 to June 2000 at the Instituto Materno Infantil, a referral hospital for maternal and perinatal care in Bogotá, were randomly divided into two groups. The effectiveness of each method was evaluated according to number of diagnoses reached, length of in‐patient stay before diagnosis, complications, and diagnostic accuracy when compared with a standard given by microbiological and histopathological findings as well as clinical course. Results: The early laparoscopy group did not experience more accurate diagnoses (85% vs. 79%, P=0.61) or a greater number of complications (11% vs. 9%, P=0.48), although the patients’ stay was shorter (1.3 vs. 2.3 days, P=0.008) than the stay of the conventional‐diagnosis group. Sensitivity analysis showed more accurate judgements with laparoscopy in four of the five NSLAP causes, but only in two of the cases did this greater accuracy have clinical significance. Conclusions: Early laparoscopy did not show a clear benefit in women with NSLAP.

Paracervical block in incomplete abortion using manual vacuum aspiration: Randomized clinical trial

OBJECTIVE: To estimate the effectiveness of paracervical block in controlling pain among women treated with manual vacuum aspiration for an incomplete abortion METHODS: A randomized clinical trial was conducted at Nuestra Señora de Altagracia, a maternal and perinatal referral hospital in the Dominican Republic. The sample size was based on a clinical difference of 1.5 points in the level of pain measured with the visual analog scale using 90% power and a sampling error of 0.04. Women who were at 12 weeks of gestation or less with an incomplete abortion were eligible to participate. They were randomly assigned to receive either the standard treatment of care (manual vacuum aspiration for uterine evacuation with psychological support but no paracervical block) or manual vacuum aspiration treatment with psychological support and paracervical block using 1.0% lidocaine. Patients with active infections, severe illnesses, psychiatric disorders, or allergies to lidocaine were excluded. Intraoperative pain as reported by the women and as documented by an external observer was measured. RESULTS: Although the paracervical block technique used showed a slight reduction in severe pain, there were no clinically or statistically significant differences in intraoperative pain between the 2 groups (relative risk 0.73; 95% confidence interval 0.43, 1.23) with 50% of all patients registering 7 or higher score on a visual analog pain scale of 0–10. However, statistically significant differences were found in each group when comparing the level of preoperative and intraoperative pain described by the patient (P < .001). The manual vacuum aspiration technique and the paracervical block were not accompanied by complications. CONCLUSION: The paracervical block technique used in this study along with psychological support was comparable with pain control using psychological support alone; neither pain management regimen provided sufficient pain control. It is recommended that randomized comparative studies be designed to determine the effectiveness of other paracervical block techniques and the efficacy of the use of analgesics in patients suffering from incomplete abortion treated with manual vacuum aspiration. LEVEL OF EVIDENCE: I

Priestley Duality for Quasi-Stone Algebras

In this paper we describe the Priestley space of a quasi-Stone algebra and use it to show that the class of finite quasi-Stone algebras has the amalgamation property. We also describe the Priestley space of the free quasi-Stone algebra over a finite set.

A non-finitely based quasi-variety of De Morgan algebras

In this paper we exhibit a non-finitely based, finitely generated quasi-variety of De Morgan algebras and determine the bottom of the lattices of sub-quasi-varieties of Kleene and De Morgan algebras.

Subdirectly Irreducible MV-Algebras

In this note we characterize the one-generated subdirectly irreducible MV-algebras and use this characterization to prove that a quasivariety of MV-algebras has the relative congruence extension property if and only if it is a variety.

Congruences and Closure Endomorphisms of Hilbert Algebras

In this paper we describe the congruences of a finite Hilbert algebra in terms of its closure endomorphisms. We use this result to give a necessary and sufficient condition under which two finite Hilbert algebras share the same monoid of endomorphisms.

Free Algebras in Certain Varieties of Distributive Pseudocomplemented De Morgan Algebras

In this paper we characterize the join irreducible elements of the free algebras on n free generators in the subvarieties of the variety V0 of pseudocomplemented De Morgan algebras satisfying the identity xx′* = (xx′*)′*.

Validación de Índices Pronósticos e Infección del Sitio Quirúrgico en Hospitales de Colombia

Objetivo Establecer la capacidad predictiva para infeccion del sitio quirurgico (ISQ) de los indices de riesgo del National Nosocomial Infections Surveillance System (NNIS) y Study on the Efficacy of Nosocomial Infection Control (SENIC) en cinco hospitales y, evaluar la capacidad predictiva de otros factores de riesgo. Metodos Cohorte prospectiva de pacientes sometidos a cirugia entre julio de 2006 a febrero de 2007 en cinco hospitales de Colombia. Se definio ISQ segun los criterios del CDC. Se evaluaron variables como: edad, genero, coomorbilidad, tipo de cirugia, herida, especialidad, tiempo quirurgico y desenlace. Se evaluo el desempeno operativo de los indices usando el area bajo la curva operador receptor; se construyo un modelo predictivo usando un modelo de regresion logistica incondicional con las variables asociadas a infeccion en el analisis bivariado y/o aquellas conocidas por estudios previos. Resultados Fueron evaluados 7 022 procedimientos quirurgicos con una tasa de ISQ de 2,9 %. El rendimiento de los indices de riesgo NNIS y SENIC fue muy similar para predecir ISQ (area bajo la curva de 0,682 IC95 % 0,641-0,710 y 0,668 IC95 % 0.641-0.722, respectivamente). Se construyo un modelo predictivo que incluia variables del NNIS y SENIC, ademas de edad, antecedente de diabetes, transfusiones y especialidad quirurgica el cual mostro un desempeno de 0,746 (IC95 % 0,709-0,783), en ISQ superficial de 0,70 (IC95 % 0,659-0,741), en ISQ profunda de 0,712 (IC95 % 0,673-0,751) y en ISQ organo espacio de 0,719 (IC95 % 0,683-0,755). Conclusiones Los modelos de prediccion existentes para ISQ tienen una moderada capacidad discriminativa pero pueden ser mejorados con algunos factores locales.