Introduction Trauma quality improvement (QI) programs have been shown to improve outcomes and decrease cost. These are high priorities in low- and middle-income countries (LMICs), where 2,000,000 deaths due to survivable injuries occur each year. We sought to define areas for improvement in trauma QI programs in four LMICs. Methods We conducted a survey among trauma care providers in four Andean middle-income countries: Bolivia, Colombia, Ecuador, and Peru. Results 336 physicians, medical students, nurses, administrators and paramedical professionals responded to the cross-sectional survey with a response rate greater than 90% in all included countries except Bolivia, where the response rate was 14%. Eighty-seven percent of respondents reported morbidity and mortality (M&M) conferences occur at their hospital. Conferences were often reported as infrequent – 45% occurred less than every three months and poorly attended – 63% had five or fewer staff physicians present. Only 23% of conferences had standardized selection criteria, most lacked documentation – notes were taken at only 35% of conferences. Importantly, only 13% of participants indicated that discussions were routinely followed-up with any sort of corrective action. Multivariable analysis revealed the presence of standardized case selection criteria (OR 3.48, 95% CI 1.16–10.46), written documentation of the M&M conferences (OR 5.73, 95% CI 1.73–19.06), and a clear plan for follow-up (OR 4.80, 95% CI 1.59–14.50) to be associated with effective M&M conferences. Twenty-two percent of respondents worked at hospitals with a trauma registry. Fifty-two percent worked at institutions where autopsies were conducted, but only 32% of those reported the autopsy results to ever be used to improve hospital practice. Conclusions M&M conferences are frequently practiced in the Andean region of Latin America but often lack methodologic rigor and thus effectiveness. Next steps in the maturation of QI programs include optimizing use of data from autopsies and registries, and systematic follow-up of M&M conferences with corrective action to ensure that these activities result in appreciable changes in clinical care.

RESUMENObjetivo: Determinar el estado nutricional y los factores asociados a malnutrición en el adulto mayor en la comunidad de Masma Chicche, Junín. Material y métodos: Estudio descriptivo transversal realizado en personas mayores de 60 años distrito de Masma Chicche, Junín, Perú. Se utilizó el Mini Nutritional Assesment (MNA) para la evaluación nutricional e instrumentos de valoración geriátrica integral para establecer la presencia de depresión (Yesavage), estado funcional (Katz), deterioro cognitivo (Pfeiffer), salud oral (GOHA) y estado social (Guijon). Se realizó estadística descriptiva, chi cuadrado y ANOVA para determinar asociación entre las variables. Se consideró un p < 0,05 como significativo. Resultados: Se encuestaron a 72 personas. La prevalencia de malnutrición fue 29,9%; 57,9% en riesgo de malnutrición. El 69,4% presentaban depresión y riesgo de la misma; 27,8% mostró deterioro cognitivo; 93,1% presentaba percepción negativa de su salud oral; 51,4% eran dependientes funcionales y el 100% poseía algún problema social. Se encontró asociación de malnutrición con las variables, sexo masculino y presencia de depresión. Conclusiones: En la comunidad de Masma Chicche, alrededor de la tercera parte de la población tiene malnutrición la que está asociada con el sexo masculino y la presencia de depresión.PALABRAS CLAVE: Desnutrición, factores de riesgo, anciano. (Fuente: DeCS BIREME) SUMMARYObjective: Determine the nutritional status and factors associated to malnutrition in the elder population of Masma Chicche, Junin. Methods: Cross-sectional study in persons above 60 years of age in the district of Masma Chicche, Junin. The nutritional evaluation was performed using the mini nutritional assessment method (MNA); depression was evaluated using an integral geriatric valoration scale (Yesavage); functional status was evaluated using the Katz´s method; cognitive deterioration was measured by the Pfeiffer´s method; oral health was evaluated by the GOHA´s method and social status by the Guijon´s method. Descriptive statistics, Chi square and ANOVA tests were used to contrast variables, a p value <0.05 was considered significant. Results: 72 elder persons were evaluated; the prevalence of malnutrition was 29.9%; 57.9% were at risk for malnutrition. Prevalence of depression was 69.4%; 27.8% had cognitive deterioration; 93.1% had negative perception of their oral health; 51.4% were functionally dependant and 100% had any kind of social problem. Malnutrition was associated with age, male gender and

Background: Obesity is a highly prevalent disease and risk factor for gastroesophageal reflux disease (GERD) which could predispose to esophageal motility disorders. Few studies exist regarding manometric and phmetric findings in patients with obesity who are candidates to bariatric surgery. The objective was to describe the preoperative profile of patients with obesity selected for bariatric surgery. Methods: Retrospective analysis of 338 patients with obesity, subjected to 24 hour-pHmetry with impedance and manometry prior to bariatric surgery between 2006 and 2021. Descriptive and analytical statistics were used for analysis. Results: The mean age and body mass index was 41.94 ± 0.70 years and 38.75 ± 0.37 kg/m2, respectively. GERD symptoms were present in 43.3% (139/321). A 24-hour pHmetry analysis showed a pathologic DeMeester index in 46.7% of patients, of which 64.3% (63/98) were symptomatic. Impedance was abnormal in 53.4%, of which 67% (73/109) were symptomatic. Manometry registered dysmotility in 22.7% (69/304) of patients, a mean lower esophageal sphincter (LES) pressure of 11.93 ± 0.43 mmHg and hypotensive LES in 38.5%. Mean gastric pressure was 9.79 ± 0.33 mmHg after deglutition and only 11.4% (34/299) presented abnormal gastroesophageal gradients. Conclusions: There is a high prevalence of dysmotility and GERD in candidates to bariatric surgery with obesity. Esophageal 24 hour-pHmetry with impedance and manometry should be considered within preoperative tests as pathologic results could guide appropriate procedure selection, at least in symptomatic patients.

Portal vein thrombosis (PVT) is a rare condition in the general population that develops serious complications if left untreated for long time. We present a case of a 29-year-old woman who developed PVT due to protein S deficiency versus neonatal funiculitis. Over time, the patient developed upper gastrointestinal bleeding due to esophageal varices and hypersplenism with splenic sequestration that caused minor bleeding episodes. Laparoscopic splenectomy and proximal splenorenal shunt with distal pancreatectomy due to aneurysmal dilatations of the splenic artery were successfully performed to avoid mayor progression of portal hypertension. Patient was discharged with indefinite anticoagulation and after surgery platelets raised 3 3 ectomy and proximal splenorenal shunt for portal hypertension due to portal vein ombosis is an adequate surgery procedure which should be applied in these medical cases.

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