RESUMO
INTRODUCCIÓN: La bronquiolitis es la inflamación aguda de las vías aéreas de pequeño calibre, teniendo como causa principal las infecciones virales. Es altamente frecuente en menores de dos años, sobretodo en menores de 12 meses. Existe gran controversia sobre el manejo de esta patología, siendo especialmente cuestionable el uso de beta-2 agonistas de corta acción tanto en el ámbito ambulatorio como hospitalario. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud a nivel mundial, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis, y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos siete revisiones sistemáticas que en conjunto incluyen 47 estudios primarios, de los cuales 44 corresponden a ensayos aleatorizados. Concluimos que el uso de beta-2 agonistas podría no tener ningún beneficio en el manejo de la bronquiolitis, en términos de necesidad de hospitalización y/o duración de la misma. Por otra parte, podría aumentar efectos adversos como arritmias, sin embargo, la certeza de esta evidencia es baja.
Assuntos
Agonistas de Receptores Adrenérgicos beta 2/administração & dosagem , Bronquiolite/tratamento farmacológico , Agonistas de Receptores Adrenérgicos beta 2/efeitos adversos , Bronquiolite/fisiopatologia , Bases de Dados Factuais , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
INTRODUCCIÓN La bronquiolitis es la inflamación aguda de las vías aéreas de pequeño calibre, teniendo como causa principal las infecciones virales. Es altamente frecuente en menores de dos años, sobretodo en menores de 12 meses. Existe gran controversia sobre el manejo de esta patología, siendo especialmente cuestionable el uso de beta-2 agonistas de corta acción tanto en el ámbito ambulatorio como hospitalario. MÉTODOS Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud a nivel mundial, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis, y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos siete revisiones sistemáticas que en conjunto incluyen 47 estudios primarios, de los cuales 44 corresponden a ensayos aleatorizados. Concluimos que el uso de beta-2 agonistas podría no tener ningún beneficio en el manejo de la bronquiolitis, en términos de necesidad de hospitalización y/o duración de la misma. Por otra parte, podría aumentar efectos adversos como arritmias, sin embargo, la certeza de esta evidencia es baja
Assuntos
Humanos , Lactente , Bronquiolite/tratamento farmacológico , Agonistas de Receptores Adrenérgicos beta 2/administração & dosagem , Bronquiolite/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Bases de Dados Factuais , Agonistas de Receptores Adrenérgicos beta 2/efeitos adversos , Hospitalização/estatística & dados numéricosRESUMO
This is a Document from de Chilean Society of Cardiology and Cardiovascular Surgery, along with the Chilean Society of Physical Therapy of Cardiology and Cardiovascular Surgery.
Assuntos
Humanos , Doenças Cardiovasculares/prevenção & controle , Exercício Físico , Prevenção Primária , Qualidade de Vida , Doenças Cardiovasculares/epidemiologia , Medição de Risco , Consenso , Prevenção Secundária , Comportamento Sedentário , Reabilitação Cardíaca/métodosRESUMO
Abstracts: 24 hour blood pressure monitoring. Recommendations from the Chilean Society of Cardiology and Cardiovascular Surgery. The recommendations for blood pressure monitoring from the Chilean Society of Cardiology and Cardiovascular Surgery are analyzed. Emphasis is placed on indications for the procedure, according to different classes and causes of hypertension. Implications of different types of hypertension for prognosis and indications for adequate therapy are discussed.
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Humanos , Monitorização Ambulatorial da Pressão Arterial/normas , Hipertensão/diagnósticoRESUMO
INTRODUCTION: Trichomonas vaginalis, Mycoplasma hominis and Ureaplasma spp. are microorganisms responsible for genitourinary and pregnancy pathologies. Nucleic acid amplification methods have shown several advantages, but have not been widely studied for the detection of these microorganisms. AIM: To implement a conventional polymerase chain reaction (PCR) for the detection of the microorganisms and to compare its results versus the methods currently used at our laboratory. MATERIAL AND METHODS: 91 available samples were processed by PCR, culture (M. hominis y Ureaplasma spp.) and wet mount (T vaginalis). Results were compared and statistically analyzed by kappa agreement test. RESULTS: 85, 80 and 87 samples resulted in agreement for the detection of M. hominis, Ureaplasma spp. y T. vaginalis, respectively. For M. hominis and Ureaplasma spp., agreement was substantial, whereas for T. vaginalis it was moderate, however, for the latter, PCR detected more cases than wet mount. CONCLUSION: We recommend the implementation of PCR for detection of T. vaginalis whereas culture kit is still a useful method for the other microorganisms.
Assuntos
Infecções por Mycoplasma/diagnóstico , Mycoplasma hominis/genética , Tricomoníase/diagnóstico , Trichomonas vaginalis/genética , Infecções por Ureaplasma/diagnóstico , Ureaplasma/genética , Feminino , Humanos , Mycoplasma hominis/isolamento & purificação , Pacientes Ambulatoriais , Reação em Cadeia da Polimerase , Reprodutibilidade dos Testes , Ureaplasma/isolamento & purificaçãoRESUMO
Introduction: Trichomonas vaginalis, Mycoplasma hominis and Ureaplasma spp. are microorganisms responsible for genitourinary and pregnancy pathologies. Nucleic acid amplification methods have shown several advantages, but have not been widely studied for the detection of these microorganisms. Aim: To implement a conventional polymerase chain reaction (PCR) for the detection of the microorganisms and to compare its results versus the methods currently used at our laboratory. Material and Methods: 91 available samples were processed by PCR, culture (M. hominis y Ureaplasma spp.) and wet mount (T vaginalis). Results were compared and statistically analyzed by kappa agreement test. Results: 85, 80 and 87 samples resulted in agreement for the detection of M. hominis, Ureaplasma spp. y T. vaginalis, respectively. For M. hominis and Ureaplasma spp., agreement was substantial, whereas for T. vaginalis it was moderate, however, for the latter, PCR detected more cases than wet mount. Conclusion: We recommend the implementation of PCR for detection of T. vaginalis whereas culture kit is still a useful method for the other microorganisms.
Introducción: Trichomonas vaginalis, Mycoplasma hominis y Ureaplasma spp. son microorganismos causantes de patología genito-urinaria y durante el embarazo. Los métodos de amplificación de ácidos nucleicos han demostrado numerosas ventajas, pero no han sido ampliamente estudiados para la detección de estos microorganismos. Objetivo: Implementar una reacción de polimerasa en cadena convencional (RPC) para su detección y comparar sus resultados con los métodos actuales de nuestro laboratorio. Material y Métodos: Se procesaron 91 muestras mediante RPC, cultivo (M. hominis y Ureaplasma spp.) y observación microscópica al fresco (T. vaginalis). Los resultados fueron comparados y analizados estadísticamente mediante el test de concordancia kappa. Resultados: 85, 80 y 87 muestras tuvieron resultados concordantes para la detección de M. hominis, Ureaplasma spp. y T. vaginalis, respectivamente. Para M. hominis y Ureaplasma spp. el nivel de concordancia fue considerable mientras que para T. vaginalis fue moderado; sin embargo, para esta última, la RPC detectó más casos que la microscopia al fresco. Conclusión: Se recomienda la implementación de la RPC para la detección de T. vaginalis. Para M. hominis y Ureaplasma spp. el kit de cultivo continúa siendo un buen método.
Assuntos
Feminino , Humanos , Infecções por Mycoplasma/diagnóstico , Mycoplasma hominis/genética , Tricomoníase/diagnóstico , Trichomonas vaginalis/genética , Infecções por Ureaplasma/diagnóstico , Ureaplasma/genética , Mycoplasma hominis/isolamento & purificação , Pacientes Ambulatoriais , Reação em Cadeia da Polimerase , Reprodutibilidade dos Testes , Ureaplasma/isolamento & purificaçãoRESUMO
The incidence of functional connections between human temporal lobes and their latencies were investigated using intracranial EEG responses to electrical stimulation with 1 msec single pulses in 91 patients assessed for surgery for treatment of epilepsy. The areas studied were amygdala, hippocampus, parahippocampal gyrus, fusiform gyrus, inferior and mid temporal gyrus. Furthermore, we assessed whether the presence of such connections are related to seizure onset extent and postsurgical seizure control. Responses were seen in any region of the contralateral temporal lobe when stimulating temporal regions in 30 patients out of the 91 (32.96%). Bi-hippocampal or bi-amygdalar projections were seen in only 5% of temporal lobes (N = 60) and between both fusiform gyri in 7.1% (N = 126). All other bilateral connections occurred in less than 5% of hemispheres. Depending on the structures, latencies ranged between 20 and 90 msec, with an average value of 60.2 msec. There were no statistical difference in the proportion of patients showing Engel Class I between patients with and without contralateral temporal connections. No difference was found in the proportion of patients showing bilateral or unilateral seizure onset among patients with and without contralateral temporal projections. The present findings corroborate that the functionality of bilateral temporal connections in humans is limited and does not affect the surgical outcome.
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Encéfalo/cirurgia , Eletrodos Implantados , Epilepsia/epidemiologia , Epilepsia/cirurgia , Lateralidade Funcional/fisiologia , Adolescente , Adulto , Criança , Estimulação Elétrica/métodos , Eletroencefalografia/métodos , Epilepsia/fisiopatologia , Feminino , Humanos , Incidência , Masculino , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: To investigate if intracranial EEG patterns at seizure onset can predict surgical outcome. METHODS: Ictal onset patterns from intracranial EEG were analysed in 373 electro-clinical seizures and subclinical seizures from 69 patients. Seizure onset patterns were classified as: (a) Diffuse electrodecremental (DEE); (b) Focal fast activity (FA); (c) Simultaneous onset of fast activity and diffuse electrodecremental event (FA-DEE); (d) Spikes; (e) Spike-wave activity; (f) Sharp waves; (g) Alpha activity; (h) Delta activity. Presence of preceding epileptiform discharge (PED) was also studied. Engel and ILAE surgical outcome scales were used. RESULTS: The mean follow-up period was 42.1 months (SD=30.1). Fast activity was the most common seizure onset pattern seen (33%), followed by (FA-DEE) (20%), DEE (19%), spike-wave activity (12%), sharp-waves (6%), alpha activity (6%), delta activity (3%) and spikes (1%). Preceding epileptiform discharges were present in 75% of patients. FA was associated with favourable outcome (p=0.0083) whereas DEE was associated with poor outcome (p=0.0025). A widespread PED was not associated with poor outcome (p=0.9559). There was no clear association between seizure onset pattern and specific pathology, except possibly between sharp/spike waves and mesial temporal sclerosis. CONCLUSIONS: FA activity is associated with favourable outcome. DEE at onset was associated with poor surgical outcome. Widespread/bilateral PEDs were not associated with poor or good outcome. SIGNIFICANCE: FA appears to be the best marker for the epileptogenic zone. Surgery should be contemplated with caution if DEE is the first ictal change. However, a widespread/bilateral PED at onset is common and should not discourage surgery.
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Eletroencefalografia/métodos , Convulsões/diagnóstico , Convulsões/fisiopatologia , Adulto , Eletrodos Implantados , Eletroencefalografia/instrumentação , Epilepsia do Lobo Temporal/diagnóstico , Epilepsia do Lobo Temporal/fisiopatologia , Epilepsia do Lobo Temporal/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Convulsões/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: Colorectal cancer (CRC) incidence is rapidly increasing. It has been demonstrated that it can be prevented and cured when the diagnosis is made in early stages. OBJECTIVE: For this reason it is necessary to apply a screening program in asymptomatic patients. METHOD: Since 2003, we conducted a CRC screening plan called "Mes del Colon" at Clínica Alemana Santiago. A press and local diffusion campaign was designed. Open to the community CRC talks were scheduled. An ad hoc database was designed. An informed consent was available. Patients older than 50 years and high risk patients were included. Total colonoscopy and a medical interview after the procedure were included in the plan with favorable economic conditions. RESULTS: Since 2003, 1158 patients were included The 1.8% of them were excluded because of incomplete data or because they did not meet the inclusion criteria. The 54% of patients were women. Mean age was 58.4 years old and mean body mass index 25.5 kg/m2. Polipoid lesions were seen in 45% of the patients. Six (1%) of them were adenocarcinomas, 291 (57%) adenomas (98% tubular adenomas), 189 (37%) hyperplastic polyps and 25 (5%) miscellaneous lesions. In this series, the necessary number to investigate for 1 adenoma was 3.9. CONCLUSIONS: CRC prevention campaigns are needed due to the continuous increase of the incidence in our country. The detection of precursor or early lesions that are longstanding before becoming advanced cancer allows its treatment avoiding progression.
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Polipose Adenomatosa do Colo/diagnóstico , Neoplasias Colorretais/diagnóstico , Programas de Rastreamento/métodos , Lesões Pré-Cancerosas/diagnóstico , Chile , Colonoscopia , Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estadiamento de NeoplasiasRESUMO
Antecedentes: Numerosos estudios clínicos confirman los beneficios de la terapia de resincronización cardiaca (TRC) en el tratamiento de la insuficiencia cardiaca refractaria a fármacos. El Ecocardiograma (ETT) es la técnica de elección en la evaluación de esta terapia tanto en el período agudo como a largo plazo. Objetivo: Nuestro objetivo fue estudiar los beneficios a largo plazo de la TRC mediante ETT. Método y resultados: Se estudiaron 12 pacientes con ETT con más de un año de resincronización, observándose mejoría significativa en la fracción de eyección, diámetro de la aurícula izquierda y presión sistólica de arteria pulmonar, y variaciones positivas en los diámetros y volúmenes ventriculares, fracción de acortamiento, función diastólica, severidad de la insuficiencia mitral. En 8 pacientes en que se comparó la sincronía al Doppler tisular (DT) strain y tissue synchronization imaging (TSI) se observó coincidencia en 2 de 8 sugiriendo baja especificidad para el TSI. Conclusión: El ETT permite estudiar la remodelación reversa que sufre el ventrículo izquierdo con reducción de diámetros y objetivar la mejoría de parámetros de función sistólica y diastólica. El aporte del Doppler tisular para evaluar sincronía requiere de mayor estudio con un mayor número de pacientes.