RESUMO
INTRODUCTION: Temporomandibular joint internal derangement is a common disorder, which usually resolves with conservative management. However, 5% of patients require surgery and although many techniques have been described, a gold standard surgical procedure has not yet been established. OBJECTIVES: The aim of this study was to compare the clinical outcome of disc repositioning plus temporal eminectomy versus disc repositioning alone, for the treatment of temporomandibular joint internal derangement. METHODOLOGY: Matched case-control retrospective pilot study. Records of patients diagnosed with temporomandibular joint internal derangement from January 2010 to December 2015 were studied. Eleven patients treated with disc repositioning plus temporal eminectomy for the case group and 11 patients treated with disc repositioning alone for the age- and gender-matched control group. RESULTS: No difference was found in terms of pain, noise or blockage with the maximum oral opening between the groups at the first or sixth month after surgery. However, there were differences in movement restriction at the first and sixth month after surgery, in favor of the temporal eminectomy group. These differences were statistically significant only at the sixth month after surgery (P: 0.03). CONCLUSIONS: Our results suggest that disc repositioning plus temporal eminectomy could be a short-term benefit in terms of mobility and oral opening. However, larger samples and prospective trials will be necessary to corroborate the current findings.
Assuntos
Luxações Articulares , Disco da Articulação Temporomandibular , Humanos , Projetos Piloto , Estudos Prospectivos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Introducción: En la actualidad es ampliamente aceptada la metformina como manejo farmacológico inicial para el tratamiento de la diabetes mellitus tipo 2 (DMT2). Resulta, sin embargo, controversial si en algunos tipos de pacientes puede iniciarse tratamiento únicamente con cambios intensivos de estilo de vida o si existen grupos en quienes debería iniciarse desde el inicio terapia farmacológica combinada. Objetivo: Definir el impacto de estrategias de cambio intensivo en la dieta y de ejercicio, así como de la terapia farmacológica con metformina asociada a un segundo antidiabético oral como estrategias de manejo inicial en pacientes con DMT2 recién diagnosticada. Métodos: Se elaboró la guía de práctica clínica, siguiendo los lineamientos de la guía metodológica del Ministerio de Salud y Protección Social colombiano. Se revisó la evidencia disponible de forma sistemática y se formularon las recomendaciones utilizando la metodología GRADE. Conclusiones: En pacientes con DMT2 recién diagnosticada no se recomienda el manejo únicamente con cambios intensivos del estilo de vida; estos deben acompañar el manejo farmacológico con metformina, dando prelación a los componentes de la dieta mediterránea y al ejercicio aeróbico. En los pacientes con DMT2 recién diagnosticada y niveles de HbA1C > 8 % se recomienda utilizar terapia combinada desde el inicio con metformina y otro antidiabético oral, siendo de primera elección los inhibidores de DPP-4.
Introduction: Today, metformin is widely accepted as standard initial pharmacologic treatment for diabetes mellitus type 2 (DMT2). However, it is controversial if in some groups of patients, the treatment can be initiated only with life style changes, or if there are groups who should begin with combined therapy since the beginning. Aim: To define the effect of intensive strategies for change of diet or exercise, and the effect of combined therapy with metformin and a second oral antidiabetic, as initial treatment in patients with newly DMT2. Methods: A clinical practice guide has been developed following the broad outline of the methodological guide from the Colombian Ministry of Health and Social Welfare. with the aim of systematically gathering scientific evidence and formulating recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. Conclusions: In patients with recently diagnosed DMT2, initial treatment with lifestyle changes only is not recommended. However, it is recommended that lifestyles changes must begin simultaneously with metformin, including the components of a Mediterranean diet and aerobic exercise. In patients with recently diagnosed DMT2 and HbA1c levels >8%, it is recommended to administer a combined therapy from the beginning with metformin and another oral antidiabetic medication. The DPP4 inhibitor is recommended.
Assuntos
Humanos , Diabetes Mellitus Tipo 2 , Tratamento Primário , MetforminaRESUMO
In Colombia, diabetes mellitus is a public health program for those responsible for creating and implementing strategies for prevention, diagnosis, treatment, and follow-up that are applicable at all care levels, with the objective of establishing early and sustained control of diabetes. A clinical practice guide has been developed following the broad outline of the methodological guide from the Ministry of Health and Social Welfare, with the aim of systematically gathering scientific evidence and formulating recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. The current document presents in summary form the results of this process, including the recommendations and the considerations taken into account in formulating them. In general terms, what is proposed here is a screening process using the Finnish Diabetes Risk Score questionnaire adapted to the Colombian population, which enables early diagnosis of the illness, and an algorithm for determining initial treatment that can be generalized to most patients with diabetes mellitus type 2 and that is simple to apply in a primary care context. In addition, several recommendations have been made to scale up pharmacological treatment in those patients that do not achieve the objectives or fail to maintain them during initial treatment. These recommendations also take into account the evolution of weight and the individualization of glycemic control goals for special populations. Finally, recommendations have been made for opportune detection of micro- and macrovascular complications of diabetes.
En Colombia la Diabetes Mellitus es un problema de salud pública por lo que deben generarse e implementarse estrategias de prevención, diagnóstico, tratamiento y seguimiento, aplicables en todos los niveles de atención con miras a establecer el control de la diabetes en forma temprana y sostenida. Se elaboró una guía de práctica clínica siguiendo los lineamientos de la guía metodológica del Ministerio de Salud y Protección Social para recolectar de forma sistemática la evidencia científica y formular las recomendaciones utilizando la metodología GRADE. El presente documento muestra, de forma resumida, el resultado de ese proceso, incluyendo las recomendaciones y las consideraciones tenidas en cuenta para llegar a ellas. En términos generales, se propone un proceso de tamización mediante el cuestionario FINDRISC adaptado a población Colombiana que permite llegar a un diagnóstico temprano de la enfermedad y un algoritmo para el manejo inicial que es generalizable a la gran mayoría de los pacientes con diabetes mellitus tipo 2 y que es sencillo de aplicar en atención primaria. También se hacen unas recomendaciones para escalar el tratamiento farmacológico de los pacientes que no alcanzan la meta o la pierden con el manejo inicial, teniendo en cuenta principalmente la evolución del peso y la individualización de la meta de control glucémico en poblaciones especiales. Finalmente se proponen algunas recomendaciones para la detección oportuna de las complicaciones micro y macrovasculares de la diabetes.
Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Adulto , Fatores Etários , Idoso , Albuminúria/diagnóstico , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Colômbia , Diabetes Mellitus Tipo 2/prevenção & controle , Dieta para Diabéticos , Quimioterapia Combinada , Hemoglobinas Glicadas/análise , Humanos , Hipoglicemiantes/uso terapêutico , Estilo de Vida , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
In Colombia, diabetes mellitus is a public health program for those responsible for creating and implementing strategies for prevention, diagnosis, treatment, and follow-up that are applicable at all care levels, with the objective of establishing early and sustained control of diabetes. A clinical practice guide has been developed following the broad outline of the methodological guide from the Ministry of Health and Social Welfare, with the aim of systematically gathering scientific evidence and formulating recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. The current document presents in summary form the results of this process, including the recommendations and the considerations taken into account in formulating them. In general terms, what is proposed here is a screening process using the Finnish Diabetes Risk Score questionnaire adapted to the Colombian population, which enables early diagnosis of the illness, and an algorithm for determining initial treatment that can be generalized to most patients with diabetes mellitus type 2 and that is simple to apply in a primary care context. In addition, several recommendations have been made to scale up pharmacological treatment in those patients that do not achieve the objectives or fail to maintain them during initial treatment. These recommendations also take into account the evolution of weight and the individualization of glycemic control goals for special populations. Finally, recommendations have been made for opportune detection of micro- and macrovascular complications of diabetes.
En Colombia la Diabetes Mellitus es un problema de salud pública por lo que deben generarse e implementarse estrategias de prevención, diagnóstico, tratamiento y seguimiento, aplicables en todos los niveles de atención con miras a establecer el control de la diabetes en forma temprana y sostenida. Se elaboró una guía de práctica clínica siguiendo los lineamientos de la guía metodológica del Ministerio de Salud y Protección Social para recolectar de forma sistemática la evidencia científica y formular las recomendaciones utilizando la metodología GRADE. El presente documento muestra, de forma resumida, el resultado de ese proceso, incluyendo las recomendaciones y las consideraciones tenidas en cuenta para llegar a ellas. En términos generales, se propone un proceso de tamización mediante el cuestionario FINDRISC adaptado a población Colombiana que permite llegar a un diagnóstico temprano de la enfermedad y un algoritmo para el manejo inicial que es generalizable a la gran mayoría de los pacientes con diabetes mellitus tipo 2 y que es sencillo de aplicar en atención primaria. También se hacen unas recomendaciones para escalar el tratamiento farmacológico de los pacientes que no alcanzan la meta o la pierden con el manejo inicial, teniendo en cuenta principalmente la evolución del peso y la individualización de la meta de control glucémico en poblaciones especiales. Finalmente se proponen algunas recomendaciones para la detección oportuna de las complicaciones micro y macrovasculares de la diabetes.
Assuntos
Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Hemoglobinas Glicadas/análise , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Inquéritos e Questionários , Fatores Etários , Colômbia , Diabetes Mellitus Tipo 2/prevenção & controle , Dieta para Diabéticos , Albuminúria/diagnóstico , Quimioterapia Combinada , Hipoglicemiantes/uso terapêutico , Estilo de VidaRESUMO
Several studies have demonstrated that matrix metalloproteinases (MMPs) play a major role in atherosclerotic plaque disruption and lead to myocardial infarction (MI). We investigated the association between the MMP1 -1607 1G/2G (rs1799750), MMP3 -1612 5A/6A (rs3025058), and MMP9 -1562 C/T (rs3918242) polymorphisms and the risk of developing MI in a Mexican mestizo cohort. The genotype analysis was performed using the restriction fragment length polymorphism-polymerase chain reaction technique in a group of 236 patients with a history of MI and 285 healthy controls. Similar distributions of rs1799750 and rs3025058 were observed in both groups; however, the MMP9 rs3918242 T allele and the CT genotype were associated with the risk of developing MI (OR = 2.32, pC = 0.02 and OR = 2.40, pC = 0.02, respectively). Multiple logistic analysis was performed between MI patients and controls to estimate the risk, and after adjusting for identified risk factors, the CT + TT genotypes of MMP9 rs3918242 were found to be significantly associated with increased risk of developing MI than those with the CC genotype (OR = 2.88, P < 0.01). In summary, our results reveal that the rs3918242 polymorphism of the MMP9 gene plays a major role in the risk of developing MI.
Assuntos
Predisposição Genética para Doença , Metaloproteinase 9 da Matriz/genética , Infarto do Miocárdio/metabolismo , Polimorfismo de Nucleotídeo Único , Idoso , Feminino , Técnicas de Genotipagem , Humanos , Masculino , Metaloproteinase 1 da Matriz/genética , Metaloproteinase 3 da Matriz/genética , México , Pessoa de Meia-Idade , Infarto do Miocárdio/genéticaRESUMO
The determination of the origin of coffee beans by NMR fingerprinting has been shown promising and classification has been reported for samples of different countries and continents. Here we show that this technique can be extended and applied to discriminate coffee samples from one country against all others, including its closest neighbors. Very high classification rates are reported using a large number of spectra (>300) acquired over a two-year period. As original aspects it can be highlighted that this study was performed in fully automatic mode and with non-deuterated coffee extracts. This is achieved using a series of experiments to procure a robust suppression of the solvent peaks. As is, the method represents a cost effective opportunity for countries to protect their national productions.
Assuntos
Café/química , Espectroscopia de Ressonância Magnética/métodos , Colômbia , Análise de AlimentosRESUMO
The competency-based curriculum has as a reference point the desired profile defined by the University of Chile School of Medicine for its graduates. It is therefore necessary for all teachers in this school to know the new profile of graduates as well as the new curricular grid that emerges from it. This article is an attempt to reinforce this need.
Assuntos
Educação Médica , Faculdades de Medicina , ChileRESUMO
Objetivo: Valorar la capacidad diagnóstica y el seguimiento de las cardiopatías congénitas con diagnóstico prenatal realizadas en el Centro de Referencia Perinatal Oriente (CERPO). Método: Se analizan todas las cardiopatías congénitas con diagnóstico prenatal que ingresaron al CERPO entre abril 2003 y diciembre de 2011. Se realiza seguimiento postnatal, se evalúa la concordancia entre el diagnóstico pre y postnatal, y se compara el pronóstico con la experiencia previamente reportada en la literatura. Resultados: Se detectaron 568 cardiopatías congénitas, el 53 por ciento correspondían a pacientes referidas desde otras regiones del país. En relación a la edad materna y paterna el 28 por ciento y el 35 por ciento tenían 35 años o más, respectivamente. De las 568 cardiopatías congénitas controladas, el 75 por ciento fueron pesquisadas con la ecocardiografía por visión de 4 cámaras y el 25 por ciento por visión de tractos de salida. La concordancia entre la ecocardiografía prenatal y postnatal fue de 87 por ciento Los diagnósticos más frecuentes correspondieron a comunicación interventricular, síndrome de hipoplasia ventricular izquierdo, arritmias y canal aurículoventricular. Se detectaron 60 cromosomopatías, 8 síndromes genéticos y 145 malformaciones extracardiacas asociadas. Se pudo realizar seguimiento de sobrevida al año en 390 pacientes, la sobrevida global en este grupo (excluidas las aneuploidías incompatibles con la vida) alcanzó un 44 por ciento. Conclusión: Existe una alta tasa de diagnóstico prenatal de cardiopatías congénitas a nivel terciario, con un 87 por ciento de concordancia entre ecocardiografía pre y postnatal. La sobrevida global de pacientes con cardiopatías congénitas fue de 44 por ciento al año de seguimiento. Por las características territoriales de nuestro país debiera contarse con más centros de referencia perinatal, al menos en las zonas norte y sur del país.
Objective: To evaluate the diagnostic and follow-up congenital heart disease with prenatal diagnosis performed in the Centro de Referencia Perinatal Oriente (CERPO). Method: We analyzed all the congenital heart disease with prenatal diagnosis admitted to CERPO between April 2003 and December 2011. Postnatal follow-up is performed, evaluating the correlation between pre and postnatal diagnosis and prognosis compared with the experience previously reported in the literature. Results: We detected 568 congenital heart diseases of which 53 percent were patients referred from other regions of the country. In relation to maternal and paternal age, 28 percent and 35 percent were 35 years or older, respectively. From 568 controlled congenital heart diseases, 75 percent could be researched to ultrasound echocardiography 4-chamber view and 25 percent per-view outflow tracts. The correlation between prenatal and postnatal echocardiography in this series was 87 percent. The most frequent diagnosis was interventricular communication, hypoplastic left heart syndrome, arrhythmias and atrioventricular canal. In this series we detected 60 chromosomal, 8 genetic syndromes and 145 extracardiac malformations. Follow-up could be performed one year survival in 390 patients, overall survival in this group (excluding aneuploidies with life incompatibility) reached 44 percent. Conclusion: There is a high rate of prenatal diagnosis of congenital heart disease at the tertiary level, with 87 percent concordance between pre-and postnatal echocardiography. Overall survival of patients with congenital heart disease is 44 percent at one year. For the territorial characteristics of our country should be counted more perinatal referral centers, at least in the north and south.
Assuntos
Humanos , Adolescente , Adulto , Feminino , Gravidez , Pessoa de Meia-Idade , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/epidemiologia , Diagnóstico Pré-Natal , Seguimentos , PrognósticoRESUMO
Introducción: Diabetes mellitus tipo 1 (DM1) es un desorden metabólico crónico caracterizado por niveles de glicemia elevados, como consecuencia de una alteración en la secreción de la insulina. Se caracteriza por destrucción de las células beta pancreática, con un déficit absoluto de esta hormona y dependencia permanente a la insulina exógena. Presentación del caso: Lactante menor, de 11 meses 11 días, cuyos padres consultan en el Servicio de Urgencias Pediátricas del Hospital Clínico Herminda Martin (HCHM), por cuadro de un día de evolución caracterizado por irritabilidad, llanto sin lágrimas, cianosis perioral, sequedad de mucosas, con regular tolerancia a la alimentación. En los exámenes de laboratorio destaca Glicemia de 740 mg/dL, Cetonemia (+++), Glucosuria > 1000 mg/dL, pH: 7,014, HCO3: 7,5 mmol/L, y Cetonuria >150 mg/dL, diagnosticándose cetoacidosis diabética, como complicación de una DM1 de inicio precoz. Se hospitaliza en Unidad de Cuidados Intensivos Pediátricos (UCIP) del HCHM para estabilización y tratamiento. Evoluciona estable, siendo dado de alta al décimo día con glicemias adecuadas, esquema insulínico regular y educación maternal. Discusión: La DM1, es una patología que se presenta en menores de 15 años, específicamente en el grupo preescolar y prepuberal. En pacientes de edades precoces, la clínica dista a la presentación típica encontrada habitualmente en textos tradicionales, el debut de la enfermedad puede expresarse por síntomas muy variables e inespecíficos, en donde la sospecha del cuadro clínico y los exámenes de laboratorio jugarán un rol fundamental en la orientación del cuadro diagnóstico.
Introduction: Tipe 1 Diabetes mellitus (DM1) is a chronic metabolic disorder characterized by elevated levels of glycemia as a result of the alteration in insulin secretion. It is characterized by the destruction of pancreatic beta cells, which translates into an absolute deficit of this hormone and permanent dependence of exogenous insulin. Case report: Infant, 11 months 11 days old, consulted in the Pediatric Emergency room of the Hospital Clínico Herminda Martin, to present one day of irritability, crying without tears, perioral cyanosis, dry mucous, with regular feeding tolerance. In laboratory test, a Glycemia of 740 mg/dL, Ketonemia (+++), Glycosuria >1000 mg/dL, pH: 7.014. It is diagnosed with a diabetic ketoacidosis, as a complication of an early-onset DM1. It is hospitalized in the pediatric intensive care unit (PICU) of the HCHM, for stabilization and treatment. Evolve stable, so that on the 10th day of hospitalization, its discharged with appropriated glycemia, regular insulin scheme, and mothers education. Discussion: DM1 is a disease that happens mainly in children under 15 years old, specifically in the preschool and prepuberal group. In patients at early ages, the clinic frame can give it to the typical presentation usually found in books, but the debut of the disease may express highly variable and nonspecific symptoms, where the clinical suspicion and laboratory test plays a key role in the orientation and diagnosis.
Assuntos
Humanos , Masculino , Lactente , Cetoacidose Diabética/diagnóstico , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/tratamento farmacológico , Hiperglicemia , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêuticoRESUMO
Objectives: To implement an educational intervention that contributes to the prevention of malnutrition by excess among adolescents. Patients and Method: This descriptive study included a sample of 939 individuals attending school at Colegio Manuel D'Alzon, in Lota (small town), between 2007-2009. Studies included anthropometric evaluations, nutritional intake and training workshops. Parents and teachers were included in the workshops. Healthy nutrition was incorporated in the curriculum, and a site for distribution of healthy foods was implemented. Results: A 3 percent decrease in prevalence of malnutrition by excess was seen (28 percent to 25 percent), most marked among males. This decrease was attributed to reduction in obesity and increase of lower weights. This decrease appears during a period of time when boys show a growth spurt, which occurs earlier among girls. Conclusion: Collaborative interventions between health and education show positive results in this population.
Objetivo: Implementar una intervención educativa que contribuya a prevenir la malnutrición por exceso en adolescentes. Pacientes y Método: Estudio descriptivo observacional que incluyó una muestra de 939 personas pertenecientes a la comunidad educativa del Colegio Manuel D'Alzon de la Comuna de Lota, período 2007-2009. Se incluyo estudiantes a quienes se les realizó evaluaciones antropométricas, de ingesta alimentaria, y talleres educativos, se incluyó igualmente a docentes y apoderados con quienes se efectuaron talleres educativos. Se logró la incorporación de temas de alimentación saludable en las actividades curriculares, y la implementación de un kiosco saludable (tipo b). Resultados: Se observó una disminución en la prevalencia de malnutrición por exceso en 3 puntos porcentuales de un 28 por ciento inicial a un 25 por ciento final, siendo en el género masculino en donde se hace más evidente esta reducción. Atribuyéndose esto al aumento del estado de bajo peso y reducción de la obesidad, ello se sustentaría en el peak que alcanza el estirón puberal en los varones en este período de vida, lo que en las niñas ocurre a lo menos dos a tres años antes. Conclusiones: Estas intervenciones colaborativas entre el sector salud y educación logran resultados positivos en disminuir la mal nutrición por exceso en la población escolar.
Assuntos
Humanos , Masculino , Adolescente , Feminino , Educação Alimentar e Nutricional , Estado Nutricional , Estudantes/psicologia , Hipernutrição/prevenção & controle , Antropometria , Chile/epidemiologia , Desnutrição/prevenção & controle , Educação em Saúde , Fatores Sexuais , Ingestão de Energia , Necessidades Nutricionais , Obesidade/epidemiologiaRESUMO
OBJECTIVE: To evaluate chromosome damage, by means of micronucleus frequency, in dermal fibroblasts from affected and non-affected skin from systemic sclerosis (SSc) patients and from controls. METHODS: Primary fibroblast cultures were obtained by biopsy from affected and non-affected skin from SSc patients. Control fibroblasts were derived from skin remnants from plastic surgery in healthy adults. The number of micronuclei-bearing cells per 1000 binucleated cells (MN+ cells/1000 BN) was determined in cultures with and without clastogenic stimulus (bleomycin 3 µg/mL). RESULTS: Primary cultures from 10 SSc patients (affected and non-affected skin) and nine controls were analysed by two blinded examiners. In the absence of bleomycin, the frequency of MN+ cells was higher in cultures from affected (14.01 ± 11.96 MN+ cells/1000 BN; p = 0.004) and non-affected (15.41 ± 13.58 MN cells/1000 BN; p = 0.005) skin from SSc patients as compared to fibroblasts from healthy controls (4.74 ± 3.30 MN cells/1000 BN). In bleomycin-treated cultures, the frequency of MN cells was higher in SSc affected (38.03 ± 26.14 MN cells/1000 BN; p = 0.041) and non-affected skin (38.47 ± 17.88 MN cells/1000 BN; p = 0.034) as compared to healthy control fibroblasts (20.54 ± 13.09 MN cells/1000 BN). There was no difference in the frequency of MN cells in cultures from affected and non-affected skin of SSc patients. CONCLUSIONS: This is the first demonstration that dermal fibroblasts from SSc patients present an increased frequency of spontaneous and clastogen-induced micronuclei. Increased clastogenesis seems to be a widespread phenomenon in SSc because fibroblasts from clinically affected and non-affected skin presented the equivalent increased micronuclei counts.
Assuntos
Fibroblastos/patologia , Micronúcleos com Defeito Cromossômico/estatística & dados numéricos , Escleroderma Sistêmico/genética , Escleroderma Sistêmico/patologia , Pele/patologia , Adulto , Biópsia , Bleomicina/efeitos adversos , Estudos de Casos e Controles , Células Cultivadas , Feminino , Humanos , Masculino , Micronúcleos com Defeito Cromossômico/induzido quimicamente , Pessoa de Meia-Idade , Mutagênicos/efeitos adversos , Estresse Oxidativo/genética , PrevalênciaRESUMO
Se evaluó el efecto de la fortificación dela harina de trigo con ácido fólico (iniciada en 2003) sobre la ingesta de folatos en la población de mujeres en edad reproductiva y en embarazadas y los niveles séricos de folatoy vitamina B12 en los mismos grupos. Asimismo, se analizaron los cambios ocurridos en las tasas de defectosdel tubo neural antes de la fortificación y después de ella.
Assuntos
Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido , Nascido VivoRESUMO
A one-day point prevalence study to investigate the patterns of antibiotic use was undertaken in 43 latin American (LA) intensive care units. Of 510 patients admitted, 231 received antibiotic treatment on the day of the study (45%); in 125 cases (54%) due to nosocomial-acquired infections. The most frequent infection reported was nosocomial pneumonia (43%). Only in 122 patients (53%) were cultures performed before starting antibiotic treatment. 33% of the isolated microorganisms were enterobacteriaceae (40% extended-spectrum beta-lactamase-producing), 23% methicillin-resistant Staphylococcus aureus and 17% carbapenems-resistant non-fermentative Gram-negatives. The antibiotics most frequently prescribed were carbapenems (99/231, 43%); alone (60/99, 60%) or in combination with vancomycin (39/99, 40%). "Restricted" antibiotics (carbapenems, vancomycin, piperacillin-tazobactam, broad-spectrum cephalosporins, tigecycline, polymixins and linezolid) were most frequently indicated in severely ill patients (APACHE II score at admission >15, p=0.0007 and, SOFA score at the beginning of the antibiotic treatment >3, p=0.0000). Only 36% of antibiotic treatments were cultured-directed.Our findings help explain the high rates of multidrug-resistant pathogens in LA settings (i.e. ESBL-producing Gram-negatives) and the severity of the registered patients illnesses.
Assuntos
Antibacterianos/uso terapêutico , Bactérias/isolamento & purificação , Infecção Hospitalar/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Padrões de Prática Médica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bactérias/efeitos dos fármacos , Infecção Hospitalar/microbiologia , Estudos Transversais , Farmacorresistência Bacteriana , Resistência a Múltiplos Medicamentos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , América Latina , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Adulto JovemRESUMO
A database is very useful in our professional field. In neonatology, the fact of producing data that can measure our performance favour our work as physical therapist and boosts our professional role. The articles objective is to present the bases that enables the standarization of the kinesic action and registers.
Una base de datos es de gran utilidad en nuestro campo profesional. En neonatología, generar indicadores que permitan medir rendimiento facilitaría la acción en kinesiología y potenciarían nuestro rol. El objetivo de este artículo es entregar bases que permitan normalizar la acción y los registros kinésicos.
Assuntos
Humanos , Recém-Nascido , Protocolos Clínicos , Bases de Dados como Assunto , Doenças do Prematuro , Neonatologia , Especialidade de Fisioterapia , RegistrosRESUMO
Objective: Design local anthropometric growth curves for selected newborns between 24 and 42 gestational weeks, in order to compare them with other intrauterine growth charts currently used in Chile. Method: 86 575 infants born from single pregnancy and with the described gestational age were analyzed. Newborns with maternal or fetal history of delayed intrauterine growth were excluded from de analysis. The average and standard deviation 10* - 50* - 90* percentiles for weight, length and head circumference for each gestational age were calculated, distributing the obtained information in tables and graphics. Comparative statistic analysis with the main perinatal weight/length/head circumference curves currently in use was performed. Results: The obtained anthropometric growth curves of these newborns were compared with Hadlock and Pitalugga charts with statistically significant concordance, whereas there is a statiscally significant difference with Gonzalez and 10* percentile category for premature newborns in the Juez chart. Conclusion: The anthropometric chilean neonatal charts obtained have statistical and clinical advantages in comparison with other newborn local charts currently in use. We recommend these curves for perinatologic clinical use.
Objetivo: Diseñar curvas antropométricas locales para recién nacidos seleccionados, entre 24 y 42 semanas de edad gestacional, que permitan un uso clínico confiable, más representativas en comparación con otras curvas de crecimiento intrauterino de uso en Chile. Método: Se analizan 86 575 recién nacidos producto de embarazo único, con edad gestacional confiable, excluidos todos aquellos con antecedentes maternos o fetales que afecten el crecimiento intrauterino. Se calculó promedio, desviación estándar, percentiles 10, 50, y 90 para peso, talla y perímetro craneano de cada edad gestacional, tabulando y graficando la información. Se realiza análisis comparativo estadístico con las principales curvas de peso perinatal en uso. Resultados: Se obtienen curvas antropométricas de recién nacidos chilenos entre 24 y 42 semanas de población seleccionada. La comparación estadística de los pesos revela semejanza con las curvas de Hadlock y Pittaluga, y diferencias significativas con las curvas de González y percentil 10 de los recién nacidos de pretérmino de la curva de Juez. Conclusión: Se obtienen curvas antropométricas chilenas, con ventajas comparativas con respecto a otras curvas locales neonatales. Se recomienda su uso clínico perinatológico.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Antropometria , Peso ao Nascer , Desenvolvimento Fetal , Idade Gestacional , Estatura , Cefalometria , Chile/epidemiologia , Valores de ReferênciaRESUMO
A rapid DNA extraction was used for T. cruzi detection in triatomines dry fecal spots collected on filter paper and analyzed by PCR. Fifty T. infestans were fed on experimentally infected Balb/C mice with high T. cruzi parasitemia and divided into five groups of ten triatomines, and 100 triatomines were infected with lower parasitemia and divided into five groups of 20 triatomines. One dry fecal spot was analyzed per group on days 1, 2, 3, 4 and 5 post feeding. Amplification targeted T. cruzi TCZ sequence and resulted positive from day 4 after bugs feeding in the two models (high and lower parasitemial. The rapid DNA isolation and PCR proposed are suitable for detection of T. cruzi DNA in filter paper and should be considered in field research.
Assuntos
Insetos Vetores/parasitologia , Triatoma/parasitologia , Trypanosoma cruzi/isolamento & purificação , Animais , Doença de Chagas/diagnóstico , Doença de Chagas/parasitologia , DNA de Protozoário/química , DNA de Protozoário/genética , Fezes/parasitologia , Amplificação de Genes , Humanos , Parasitemia/diagnóstico , Parasitemia/parasitologia , Reação em Cadeia da Polimerase/métodos , Sensibilidade e Especificidade , Trypanosoma cruzi/genéticaAssuntos
Doença de Chagas/diagnóstico , Insetos Vetores/parasitologia , Triatoma/parasitologia , Trypanosoma cruzi/isolamento & purificação , Animais , Doença de Chagas/genética , Doença de Chagas/parasitologia , Primers do DNA/genética , DNA de Protozoário/genética , Humanos , Camundongos , Camundongos Endogâmicos BALB C , Microscopia/métodos , Reação em Cadeia da Polimerase/métodos , Sequências Repetitivas de Ácido Nucleico/genética , Trypanosoma cruzi/genéticaRESUMO
La asfixia neonatal es una causa importante de mortalidad y secuelas neurológicas. El objetivo de nuestro estudio es identificar los factores de riesgo maternos, perinatales y neonatales asociado a un Puntaje de Apgar (PA) bajo. Pacientes y Método: Se analizan los datos de 57 241 recién nacidos (RN), entre los años 1997 y 2004; los antecedentes fueron ingresados en forma prospectiva a una base de datos computacional. Se realizó un análisis multivariado con un modelo de regresión logística para identificar los factores de riesgo. Resultados: 1 167 presentaron un PA < - 3 al minuto (2,1 por ciento) y 291 presentaron además un puntaje < - 5 a los 5 minutos (0,5 por ciento). Los factores de riesgo de PA bajo estadísticamente significativos fueron: RN de muy bajo peso, malformaciones congénitas mayores, RN pequeño para la edad gestacional, RN pretérmino, embarazo de 42 semanas, expulsivo prolongado, fórceps, desprendimiento placentario y líquido amniótico con meconio. Conclusiones: En este trabajo se identifican los factores de riesgo de PA bajo en nuestra población, los cuales deben ser considerados para una adecuado manejo perinatal.
Assuntos
Masculino , Feminino , Gravidez , Recém-Nascido , Adulto , Humanos , Índice de Apgar , Asfixia Neonatal , Recém-Nascido de Baixo Peso , Análise Multivariada , Idade Gestacional , Recém-Nascido Prematuro , Modelos Logísticos , Idade Materna , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Fatores de RiscoRESUMO
Se presenta un caso de ventriculomegalia diagnosticado en un establecimiento de atención primaria, su derivación, su posterior asociación con una agenesia del cuerpo calloso y seguimiento postnatal inicial.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Adulto , Corpo Caloso/anormalidades , Corpo Caloso , Ultrassonografia Pré-Natal , Ventrículos Cerebrais/anormalidades , Ventrículos Cerebrais , Complicações na Gravidez , Dilatação Patológica , Encaminhamento e ConsultaRESUMO
The role of carabid beetles in reducing populations of phytophagous insects has been an elusive subject. A field experiment was established on a commercial wheat crop (cv. Otto) with an area of 4.5 ha in Valdivia, Chile, during the spring and summer of 1996-1997. The field had been under a prairie system for two years, before wheat sowing (fertilization and a pesticide had been applied during crop development). Samples were taken at approximately monthly intervals. Carabid beetles were sampled with a grid of pitfall traps and other insects were sampled with a vacuum insect net and soil cores. The genera of the carabids found are of neotropical origin. Exclusion by polythene barriers, together with removal of carabid beetles using traps, was an effective technique for controlling carabid populations in a commercial wheat crop. A reduction in the number of carabid beetles was associated with an increase in the number of springtails and arachnids, and a decrease of agromyzid adults. Phytophagous insects, such as homopterans and lepidopterous larvae, were not affected by carabid exclusion and removal. The action of carabid beetles on the arthropod fauna can be extremely complex, due to its predatory activity at multitrophic levels.