ABSTRACT Introduction: Developmental defects are due to congenital malformations, deformations or disruptions. Lip and/or palate fissures are congenital structural deficiencies caused by lack of conjunction between developing embryonic facial processes. Objective: Evaluate the quality of cleft lip and/or palate management guidelines. Methods: A descriptive study was conducted. Evaluation was performed of six cleft lip and/or palate management guidelines published in English and Spanish from 1990 to 2012. The search was both electronic (global level) and manual (local level). The electronic search included databases such as MEDLINE, PubMed, EMBASE and SciELO, whereas for the manual search written requests for guidelines were sent to public and private organizations that manage cleft lip and/or palate patients, such as the Military Hospital, San José Hospital, Operación Sonrisa (Operation Smile) and El Bosque University. For their selection, the guidelines were filtered by title and content. Before assessing the guidelines, the evaluators standardized them. Finally, evaluation of the guidelines was performed following the instructions in the AGREE II tool. Results: The Chilean clinical guideline obtained 100 % in domains 1 and 4, whereas the guideline from Saint Thomas University in Bucaramanga obtained less than 50 % in the six domains. Conclusions: None of the management guidelines for cleft lip and/or palate evaluated met all the quality criteria in the AGREE II tool.

RESUMEN Introducción: Los defectos del desarrollo se deben a malformaciones congénitas, deformaciones o disrupciones. Las fisuras de labio y/o paladar son deficiencias estructurales congénitas debidas a la falta de unión entre procesos faciales embrionarios en formación. Objetivo: Evaluar la calidad de las guías de manejo de labio y/o paladar hendido. Métodos: Se realizó un estudio descriptivo. Se evaluaron seis guías de manejo de labio y/o paladar hendido en inglés y español desde 1990 a 2012. La búsqueda se realizó de manera electrónica (nivel global) y manual (nivel local); en la electrónica se consultaron bases de datos como MEDLINE, PubMed, EMBASE y SciELO; para la búsqueda manual se solicitaron por escrito guías a entidades públicas y privadas que manejan pacientes con labio y/o paladar hendido como Hospital Militar, Hospital San José, Operación Sonrisa, y Universidad El Bosque. Estas guías fueron filtradas según título y contenido para su selección. Previo a la evaluación de estas, se realizó una estandarización entre las evaluadoras. Finalmente se evaluó la calidad de las guías según lineamientos del instrumento Agree II. Resultados: La guía clínica de Chile en los dominios 1 y 4 obtuvo 100 % y la guía de la Universidad Santo Tomás en Bucaramanga, presentó menos del 50 % en los seis dominios. Conclusiones: De las guías para el manejo de labio y/o paladar hendido evaluadas, ninguna cumplió con todos los criterios de calidad del instrumento Agree II.

No presente estudo procura-se traçar a história do lugar do grande quarteirão onde outrora se implantou o Hospital Real de Todos-os-Santos, depois da sua transferência para o antigo Colégio Jesuíta de Santo Antão, em 1775. A subsequente demolição do edifício hospitalar original, acompanhada da supressão do contíguo Convento de São Domingos em 1834, alterou profundamente a morfologia do sítio e permitiu um remate fora de tempo do grande plano da Baixa Pombalina, que seria aproveitado para a aproximar e coser às novas áreas da cidade que a norte se desenvolveram ao longo do século XX.

The transference of the Hospital Real de Todos-os-Santos to the former Jesuit College of Santo Antão in 1775 and the suppression of the Convent of São Domingos in 1834 deeply changed the urban morphology of the site of the large block once known as the island where the Royal Hospital stands. It allowed an out of time expansion of the mid-18th century Baixa Pombalina plan that was ultimately essential to a straighter connection to the new neighborhoods developed in the northern part of the city during the 20th century.

Contrariamente a uma ideia generalizada e muitas vezes repetida, não foi o Terramoto de 1755 que condenou o Hospital Real de Todos-os-Santos, ao Rossio, a um irremediável desaparecimento. Na verdade, não só o plano de reconstrução da Baixa de Lisboa não lhe previa uma nova localização, como, nos anos subsequentes, uma campanha de obras de reconstrução chegou a ser equacionada e (parcialmente) executada. O seu destino foi traçado por uma carta régia assinada por D. José, a 26 de setembro de 1769, que decretou a passagem do hospital para o edifício do antigo Colégio jesuítico de Santo Antão e deu indicações precisas para a divisão e venda do seu terreno, ao Rossio. Mas antes (e depois disso), o local do grande quarteirão que chegou a ser conhecido como a Ilha em que estava edificado o Hospital Real de Todos os Santos¹ foi impregnado de uma riquíssima história como poucos em Lisboa.

In the late 15th century a significant part of the Convent of São Domingos’ enclosure was occupied by the new Hospital Real de Todos-os-Santos. Located in the eastern side of Rossio square, soon this large block became known as the island where the Royal Hospital stands. Although the hospital building was destroyed first by a fire in 1750 and then by a devastating earthquake in 1755, only in 1769 king José decided to transfer it to the former Jesuit College of Santo Antão. This article aims to trace the history of the final years of the Hospital Real de Todos-os-Santos building and the island where it was located.

Introduction: The Glasgow-Blatchford (GBS) scale allows us to classify the patient as a high or low risk of presenting complications. In the patients identified as "low risk", the performance of an early endoscopy could reduce the intrahospital days and the overall cost. In our environment, we do not know the usefulness of the GBS scale. Objective: To describe the utility of the Glasgow-Blatchford scale (GBS) in the stratification of risk in patients with non-variceal upper gastrointestinal bleeding (HDA) seen in the emergency department of a tertiary hospital. Materials and methods: 218 patients were prospectively included, and they were performed in the first 24-48 hr an urgent endoscopy. These were stratified, according to the GBS scale, at low risk (GBS ≤ 2), and high risk (GBS ≥ 3). We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the GBS scale in our setting based on the requirement of endoscopic, radiological treatment (arterial embolization), transfusion of blood products and / or surgery, as our gold standar to classify patients as "high risk". Results: A total of 218 patients were included, with a mean age of 56 ± 18 years, of which 121/218 (55%) were male. 156/218 required intervention for what were classified as "high risk" while 62/218 did not specify and classified as "low risk". A cut-off value of GBS ≤ 2 showed a sensitivity of 98% with a NPV of 100%. The utility of the GBS scale showed an area under the ROC curve 0.83 (95% CI 0.75-0.90). Conclusion: The GBS scale used in patients with non-variceal UGB attended in the emergency department has adequate diagnostic validity to predict the need for intervention.

Introducción: La escala de Glasgow-Blatchford (GBS) nos permite clasificar al paciente como riesgo alto o bajo de presentar complicaciones. En los pacientes identificados como "bajo riesgo", la realización de una endoscopia temprana, podría disminuir los días intrahospitalarios y en el coste global. En nuestro medio, desconocemos la utilidad de la escala de GBS. Objetivo: Describir la utilidad de la escala de Glasgow-Blatchford (GBS) en la estratificación del riesgo en los pacientes con hemorragia digestiva alta (HDA) no variceal atendidos en el servicio de urgencias en un hospital de tercer nivel. Materiales y métodos: Se incluyeron prospectivamente 218 pacientes, y se les realizó en las primeras 24-48 h endoscopia urgente. Éstos se estratificaron, según la escala de GBS, en bajo riesgo (GBS ≤ 2), y alto riesgo (GBS ≥ 3). Se calculó la sensibilidad, especificidad, valor predictivo positivo (VPP) y negativo (VPN) de la escala de GBS en nuestro medio basándonos en el requerimiento de tratamiento endoscópico, radiológico (embolización arterial), transfusión de hemoderivados y/o cirugía, como estándar de oro para clasificar a los pacientes en alto riesgo. Resultados: Se incluyó un total de 218 pacientes, con edad media de 56 ± 18 años, de los cuales 121/218 (55%) fueron varones. 156/218 precisaron intervención por lo que fueron clasificados como "alto riesgo" mientras 62/218 no precisaron y se clasificaron como "bajo riesgo". Un valor de corte de GBS ≤ 2 mostró una sensibilidad del 98% con un VPN de 100%. La utilidad de la escala de GBS mostró un área bajo la curva ROC 0,83 (IC 95% 0,75-0,90). Conclusión: La escala de GBS utilizada pacientes con HDA no variceal atendidos en el servicio de urgencias posee una validez diagnóstica adecuada para predecir la necesidad de intervención.

The objective of this study was to estimate the seroprevalence of antibodies against Anaplasma spp in students and staff of the Teaching Veterinary Clinical Hospital (HCVD) of the School of Veterinary Medicine of the University Santo Tomás (UST), Talca, Chile. Blood samples (n=58) were collected and analyzed by indirect immunofluorescence (IFI) for IgG. The exact Fischer or X2 test was used to evaluate significant differences (p<0.05) and the Kappa index to evaluate concordance between IFI and clinical signology. The results showed 25.9% of seropositivity among students and staff for Anaplasma spp. Significant differences were found in the use of biosecurity measures, extraction of ticks, and ectoparasite findings in clothing. The Kappa index was 0.13.

El estudio tuvo como objetivo estimar la seroprevalencia de anticuerpos contra Anaplasma spp en estudiantes y personal del Hospital Clínico Veterinario Docente (HCVD) de la Escuela de Medicina Veterinaria de la Universidad Santo Tomás (UST), Talca, Chile. Se analizaron 58 muestras sanguíneas humanas mediante inmunofluorescencia indirecta (IFI) para IgG. Se utilizó el test exacto de Fischer o X2 para evaluar diferencias significativas (p<0.05) y el índice de Kappa para evaluar concordancia entre IFI y signología clínica. Se obtuvo el 25.9% de seropositividad a Anaplasma spp, encontrándose diferencias significativas en uso de medidas de bioseguridad, extracción de garrapatas y hallazgos de ectoparásitos en ropa. El índice Kappa fue de 0.13.

RESUMEN Se describe el caso de un paciente canino macho entero, raza Bóxer, de ocho años de edad y 30 kg de peso vivo, que ingresó a consulta en el hospital Clínico Veterinario de la Universidad Santo Tomás, sede Santiago, por un aumento de volumen en el ojo derecho, signo clínico con un curso de dos meses de evolución que no respondió al tratamiento con prednisona oral (0,7 mg/kg, dos veces al día (BID), ni a dexametasona y tobramicina en ungüento oftálmico (1 gota, tres veces al día, TID). Al examen físico se observó una masa en el tercer párpado que desplazaba el ojo lateralmente, además de una masa que se palpaba en la base lateral del pene. Se realizó una ecografía ocular que indicó la presencia de una masa de aspecto irregular con parénquima heterogéneo y características neoplásicas en la zona medial del globo ocular derecho y una ecografía abdominal que permitió detectar una masa dorsal a la vejiga. Al realizar citología ecoguiada de las masas intraabdominal y ocular, bajo sedación, se constató una inflamación supurativa, necrosis y displasia epitelial en la masa periorbitaria sugerente de neoplasia, la cual no se pudo diagnosticar fehacientemente; por su parte, la citología de la masa intraabdominal indicó la presencia de Tumor Venéreo Transmisible (TVT). El tratamiento se inició con vincristina (ocho aplicaciones i.v. de 0,7 mg/m2 cada 7 días) lográndose remisión parcial. Ante una posible resistencia al efecto de la quimioterapia, se decidió modificar la terapia a doxorrubicina (30 mg/m2) la cual tuvo respuesta positiva alcanzando remisión completa con una aplicación única.

ABSTRACT An 8 years old, 30 kg live weight, intact male, Boxer breed, was presented at the Santo Tomas Veterinary Teaching Hospital because of a volume increase in his right eye of 2 months of duration; which didn't respond to oral prednisone (0.7 mg/kg, twice a day (BID), or dexamethasone and tobramycin in ophthalmic ointment (1 drop, three times a day, TID). On physical exam, a mass in the third eyelid and another on the base of the penis were noted. Besides that, ocular ultrasonography showed an irregular mass with neoplastic characteristics in the medial area of the eyeball and abdominal ultrasound indicated a mass dorsal to the bladder. Fine needle aspiration of the eye and abdomen masses were done under sedation; cytology of the tumor in the abdomen was compatible with transmissible venereal tumor (TVT) and in the eye the results were suppurative inflammation, necrosis and epithelial dysplasia. Neoplasia couldn't be rule out or confirmed. Initial treatment was started with vincristine (8 applications i.v of 0.7 mg/m2 every 7 days) obtaining a parcial remission; so, considering a possible resistance of the cells to this drug, doxorrubicin (30 mg/rrr2) was used. The patient had a positive response to doxorrubicin achieving complete remission with a single aplication.

Background: Major ambulatroy surgery provide to public health and efficient and high quality model. Aim: To know teh results in patient underwent Otorrinolaringologic surgery in a low complexity hospital. Material and method: Date from 815 who underwent Otorrinolaringologic surgery carried on a major ambulatory surgery basis in Hospital Santo Tomás de Limache, between 2004 and 2009 where retrospectively reviewed. Analysed date included sex, age, type of conducted surgery, type of complications and the period of time in which patients were discharged. Averages, standard deviation and proportions were used. In bivariate analysis, chi square and t-student were used. Results: 58% of enrolled patients were males with age average of 8.4 ±6.2 years. Adenotonsillectomy single or associated to other surgeries took place in 54,2% of the cases. The rate ofpostoperation side effects was 1.22%%, And half of these patient presented postoperatory bleeding. There was no mortality. There was not statistical association between the presence of complications and some variable in particular. Conclusions: Major ambulatory surgery In selected patients who need otorrinolaringologic surgery in a low complexity hospital is safe whith low rate of complication.

Introducción: La cirugía mayor ambulatoria confiere al sistema sanitario un modelo de gestión eficiente y de alta calidad. Objetivo: Conocer los resultados de la cirugía mayor ambulatoria en otorrinolaringología (ORL) en un hospital de baja complejidad. Material y método: Estudio descriptivo retrospectivo realizado en el Hospital Santo Tomás de Limache entre los años 2004 y 2009. La inclusión de pacientes sometidos a cirugía otorrinolaringológica bajo la modalidad de cirugía mayor ambulatoria. Se realizó análisis descriptivo en base a promedios, desviación estándary proporciones. En análisis bivariado, se emplearon las pruebas de chi cuadrado y t-student. Resultados: Se incorporó 815 pacientes. El 58% fue de sexo masculino, con edad promedio de 8,4 ±6,2 años. La adenoamigdalectomía sola o asociada a otras cirugías se efectuó en 54,2(0)% de los casos. La tasa de complicaciones posoperatorias fue de 1,22 %, la mitad de ella, la hemorragia. No hubo mortalidad. No se encontró asociación estadística entre la presencia de complicaciones y alguna variable en particular. Conclusiones: En pacientes de otorrinolaringología seleccionados, la cirugía mayor ambulatoria efectuada en un hospital de baja complejidad tiene buenos resultados, con una baja tasa de complicaciones.

Introduction: Major ambulatory surgery provide to public health and efficient and high quality model. Aim: To know the results in patient underwent Otorrinolaringologic surgery in a low complexity hospital. Material and methods: Retrospective descritive study. Date from 815 who underwent Otorrinolaringologic surgery carried on a major ambulatory surgery basis in Hospital Santo Tomás de Limache, between 2004 and 2009 where retrospectively reviewed. Analysed date included sex, age, type of conducted surgery, type of complications and the period of time in which patients were discharged. Averages, standard deviation and proportions were used. In bivariate analysis, chi square and t-student were used. Results: 58% of enrolled patients were males with age average of 8.4±6.2 years. Adenotonsillectomy single or associated to other surgeries took place in 54.2% of the cases. The rate of postoperation side effects was 1.22%, And half of these patient presented postoperatory bleeding. There was no mortality. There was not statistical association between the presence of complications and some variable in particular. Conclusions: Major ambulatory surgery In selected patients who need otorrinolaringologic surgery in a low complexity hospital is safe with low rate of complication.

Introducción: La cirugía mayor ambulatoria confiere al sistema sanitario un modelo de gestión eficiente y de alta calidad. Objetivo: Conocer los resultados de la cirugía mayor ambulatoria en otorrinolaringología (ORL) en un hospital de baja complejidad. Material y método: Estudio descriptivo retrospectivo realizado en el Hospital Santo Tomás de Limache entre los años 2004 y 2009. La inclusión de pacientes sometidos a cirugía otorrinolaringológica bajo la modalidad de cirugía mayor ambulatoria. Se realizó análisis descriptivo en base a promedios, desviación estándar y proporciones. En análisis bivariado, se emplearon las pruebas de chi cuadrado y t-student. Resultados: Se incorporó 815 pacientes. El 58% fue de sexo masculino, con edad promedio de 8,4±6,2 años. La adenoamigdalectomía sola o asociada a otras cirugías se efectuó en 54,2%% de los casos. La tasa de complicaciones posoperatorias fue de 1,22%%, la mitad de ella, la hemorragia. No hubo mortalidad. No se encontró asociación estadística entre la presencia de complicaciones y alguna variable en particular. Conclusiones: En pacientes de otorrinolaringología seleccionados, la cirugía mayor ambulatoria efectuada en un hospital de baja complejidad tiene buenos resultados, con una baja tasa de complicaciones.

Este trabajo se propone hacer visible la presencia de Helen Howitt en la enfermería latinoamericana. Paralelamente pretende hacer un análisis de la influencia política del Servicio Cooperativo Interamericano de Salud Pública en la enfermería de la región y la presencia de organizaciones religiosas, especialmente norteamericanas, en varios países latinoamericanos. Helen Howitt, enfermera canadiense egresada de la Universidad de Alberta, fue enviada en 1942 por la Organización Panamericana de la Salud, OPS para que asesorara en Colombia al Ministerio de Trabajo, Higiene y Previsión Social. Pasó a formar parte del proyecto de apertura y organización de la Escuela Nacional Superior de Enfermeras, y fue su primera directora. Helen Howitt fue directora de la Escuela de Enfermería del Hospital Santo Tomás de la Zona del Canal de Panamá entre 1933 y 1938, luego fundadora y primera directora de la Escuela Nacional Superior de Enfermeras de Colombia entre los años 1943 y 1951; posteriormente de la Escuela Nacional de Enfermeras de Bolivia entre 1953 y 1959, cuando fue invitada a cumplir un cargo similar en Venezuela. A todos estos países llegó primero como consultora del respectivo Ministerio de Salud, a través de convenios con el Servicio Cooperativo Interamericano de Salud Pública. La Fundación Rockefeller daba becas para todos los países latinos. En la Escuela del Hospital Santo Tomás de Panamá había estudiantes de toda la América Central, Venezuela, Colombia, hasta del Ecuador y la Argentina. La Rockefeller quería unificar la enfermería en toda Latinoamérica. Llegó primero a Venezuela; y las enfermeras que se graduaron en Panamá fueron las líderes en América Latina, donde trataron de fundar escuelas.

This work's purpose is to make more visible Hellen Howitt's presence in Latin American nursing. At the same time it pretends to make an analysis on the political influence of the Interamerican Cooperative Public Health Services in nursing in the region and the presence of religious organizations, especially North American ones in several Latin American countries. Helen Howitt, a Canadian nurse who graduated from the University of Alberta, was sent in 1942 by the PAHO (Pan American Health Organization) to advise the Colombian Ministry of Labor, Hygiene and Social Provision. She became part of the opening and organization project of the Escuela Nacional Superior de Enfermeras (National Nursing School) where she be-come their first director. Helen Howitt was director of the Nursing School of Santo Tomás Hospital in the Panamá Canal zone between 1933 and 1938, later she became the founder and first director of Colombia's National Nursing School between 1943 and 1951; afterwards of Bolivia's National Nursing School between 1953 and 1959, when she was invited to fulfill a similar position in Venezuela. She arrived to all these countries first as consultant of the respective Ministry of Health, through Agreements with the Interamerican Cooperative Public Health Services. The Rockefeller Foundation used to provide scholarships to all Latin American countries, At Santo Tomas Hospital School in Panama there used to be students from all parts in Central America, Venezuela, Colombia, Ecuador and Argentina. The Rockefeller Foundation wanted to unify nursing throughout Latin America. It first arrived in Venezuela and nurses who graduated in Panama were leaders in Latin America where they tried to open schools.

O presente trabalho pretende visibilizar a presença de Hellen Howitt na enfermagem latino-americana. Paralelamente, procura fazer uma análise sobre a influência política do Serviço Cooperativo Interamericano de Saúde Pública na enfermagem da região e sobre a presença de organizações religiosas, especialmente, estadunidenses, em vários países latinoamericanos. Helen Howitt, enfermeira canadense formada na Universidade de Alberta, foi enviada em 1942 para a OPS com a missão de assessorar o Ministério do Trabalho, Higiene e Providência Social da Colômbia. Mais tarde, participou no projeto de abertura e organização da Escola Nacional Superior de Enfermeiras, sendo a primeira Diretora dessa instituição. Helen Howitt foi diretora da Escola de Enfermagem do Hospital Santo Tomás da Zona do Canal de Panamá entre 1933 e 1938, depois foi fundadora e primeira diretora da Escola Nacional Superior de Enfermeiras da Colômbia entre os anos 1943 e 1951; posteriormente, da Escola Nacional de Enfermeiras da Bolívia entre 1953 e 1959, quando foi convidada a desempenhar um cargo similar na Venezuela. Em todos esses países trabalhou como consultora do respectivo Ministério da Saúde, através de acordos com o Serviço Cooperativo Interamericano de Saúde Pública. A Fundação Rockefeller oferece bolsas para todos os países latinos. Na Escola do Hospital Santo Tomás de Panamá tinha estudantes de toda a América Central, Venezuela, Colômbia, Equador e Argentina. A Fundação queria padronizar a enfermagem em toda América Latina. Primeiro chegou à Venezuela; e as enfermeiras formadas na Panamá guiaram esse movimento na América Latina; onde tentaram fundar escolas.

OBJECTIVES: Traditionally, chronic empyema has been treated by thoracotomy and decortication. Some recent reports have claimed similar clinical results for videothoracoscopy, but with less morbidity and mortality than open procedures. Our experience with thoracotomy and decortication is reviewed so that the results of this surgical procedure can be adequately evaluated. MATERIALS AND METHODS: From March 1992 to June 2006, 85 patients diagnosed with empyema were treated at Santo Tomás Hospital by the first author. Diagnosis of chronic empyema was based on the duration of signs and symptoms before definitive treatment and imaging findings, such as constriction of the lungs and the thoracic cage. Thirty-three patients fulfilled the criteria for chronic empyema and underwent open thoracotomy and decortication. RESULTS: Twenty-seven patients (81.8 %) were male and the average age of the study group was 34 years. The etiology was pneumonia in 26 patients (78.8%) and trauma in 7 (21.2%). The duration of symptoms and signs before definitive treatment averaged 37 days. All patients had chronic empyema, as confirmed by imaging studies and operative findings. Surgery lasted an average of 139 min. There were 3 (9%) complications with no mortality. The post-operative length of stay averaged 10 days. There were no recurrences of empyema. CONCLUSIONS: Open thoracotomy and decortication can be achieved with low morbidity and mortality. Long-term functional results are especially promising. We suggest that the validation of other surgical approaches should be based on comparative, prospective and controlled studies.