The morbidity rates, particularly for intraabdominal abscesses, were less for laparoscopic appendectomy in complicated appendicitis than those reported in the literature for open appendectomy, whereas operating times and hospital stays were similar.

We conducted a telephone survey of all patients referred to a realtime telemedicine consultation at the Centre for Telehealth in Bogotá. Over a six-month period, 281 teleconsultations were conducted, and we were able to retrieve telephone numbers for 156 patients. Of these, 121 patients (78%) agreed to answer the questionnaire. Eighty percent of the respondents were satisfied or very satisfied with the teleconsultation and 63% would use telemedicine again. Sixty-five percent thought that telemedicine improved their medical care. More than 50% believed that telemedicine had a positive effect in terms of medical care improvement, time- and cost-savings. Twenty-seven percent felt that teleconsultation was not as good as a traditional face-to-face consultation. Lack of familiarity with ICT did not appear to act as a major barrier to telemedicine, and cognitive factors may be more important in acceptability to patients and their satisfaction. The results of the present study may also be relevant to the poorest countries of the world, where two-thirds of the population live in rural areas.

even in this poor region of Honduras, most chronically ill patients have access to mobile technology, and most are willing to participate in automated telephone disease management support. Given barriers to in-person care, new models of mobile healthcare should be developed for chronically ill patients in developing countries.

BackgroundSexual risk behaviors associated with poor information on sexuality have contributed to major public health problems in the area of sexual and reproductive health in teenagers and young adults in Colombia.ObjectiveTo report our experience with the use of DoctorChat Mobile to provide sexual education and information among university students in Bogota, Colombia, and knowledge about the sexual risk factors detected among them.MethodsA mobile app that allows patients to ask about sexual and reproductive health issues was developed. Sexual and reproductive risk behaviors in a sample of young adults were measured before and after the use of the app through the validated survey Family Health International (FHI) Behavioral Surveillance Survey (BSS) for Use With Adults Between 15 and 49 Years. A nonprobabilistic convenience recruitment was undertaken through the study´s webpage. After completing the first survey, participants were allowed to download and use the app for a 6-month period (intervention), followed by completion of the same survey once again. For the inferential analysis, data was divided into 3 groups (dichotomous data, discrete quantitative data, and ordinal data) to compare the results of the questions between the first and the second survey. The study was carried out with a sample of university students between 18 and 29 years with access to mobile phones. Participation in the study was voluntary and anonymous.ResultsA total of 257 subjects met the selection criteria. The preintervention survey was answered by 232 subjects, and 127 of them fully answered the postintervention survey. In total, 54.3% (69/127) of the subjects completed the survey but did not use the app, leaving an effective population of 58 subjects for analysis. Of these subjects, 53% (31/58) were women and 47% (27/58) were men. The mean age was 21 years, ranging between 18 and 29 years. The differences between the answers from both surveys were not statistically significant. The main sexual risk behaviors identified in the population were homosexual intercourse, nonuse of condoms, sexual intercourse with nonregular and commercial partners, the use of psychoactive substances, and lack of knowledge on symptoms of sexually transmitted diseases and HIV transmission.ConclusionsAlthough there were no differences between the pre- and postintervention results, the study revealed different risk behaviors among the participating subjects. These findings highlight the importance of promoting high-impact educational strategies on this matter and the importance of providing teenagers and young adults with easily accessible tools with reliable health information, regardless of their socioeconomic status.

We describe a patient with a history of asthma and remote use of steroids the development of necrotizing fascitis due to Vibrio alginolyticus after an injury from a coral reef during bathing in the Caribbean Sea off Colombia. The patient recovered with aggressive surgical debridement and antibiotics. CASE REPORTA 48-year-old female nurse suffered a blunt and penetrating trauma to the lower shin after contact with a coral reef while bathing in the Colombian coastal waters of the Caribbean Sea. A "V"-shaped wound was produced. The patient sought medical attention at the local hospital, where the wound was stitched and two doses of intramuscular clindamycin (600 mg) were prescribed, followed by three additional doses of oral dicloxacillin (500 mg). On evidence of increasing wound erythema, the patient was flown to a tertiary-care hospital, where she was examined in the emergency department. The patient's medical history included asthma diagnosed 27 years ago, for which she was taking inhaled albuterol (Salbutamol). She had received a 6-week tapering course of steroids 6 months before the current admission due to exacerbation of her asthma. On arrival, her temperature was 38°C, heart rate was 92 beats/min, respiratory rate was 16 breaths/min, and blood pressure was 120/70 mm Hg. Examination of the patient's left leg revealed a stitched "V"-shaped wound (3 by 2.5 cm) with mild cellulitis that extended from the wound toward the lateral region of the knee and with borders that were poorly defined. Moderate pain was present in cellulitic tissues, and no other wounds were present. The rest of the physical examination was unremarkable. Laboratory testing performed at admission included a peripheral white blood cell count of 12.0 cells/l with 86% segmented neutrophils, 11% lymphocyes, and 2.4% monocytes. Creatinine, blood glucose, hemoglobin, plasma sodium, and plasma potassium levels were within normal limits. Ampicillin-sulbactam (3 g four times a day intravenously) was started, the wound was debrided and left open, and samples of wound discharge were taken in the emergency department. The patient was hospitalized.During the first 2 days of hospitalization, the patient underwent several wound debridements, and culture biopsy samples of the lesion were taken. On day 3 of hospitalization, wound cultures were found positive for a gram-negative, oxidase-positive organism. Initial identification with the VITEK automated system (Biomerieux) yielded Vibrio alginolyticus. The microorganism was grown on thiosulfate-citrate-bile salts-sucrose agar, and a string test was positive. The fermentative phenotype was confirmed by inoculation in triple sugar iron medium and on Kligler iron agar. Further identification was confirmed manually with the following biochemical tests: growth at high concentrations of NaCl (up to 8%); reactions to urea, indole, lysine, arginine, ornithine, glucose, sucrose, trehalose, arabinose, gelatin, and acetate; and the VogesProskauer test. The isolate was sent to the National Reference Laboratory, where ide...