RESUMO
INTRODUCTION: Trauma teams (TTs) improve outcomes in trauma patients. A multidisciplinary TT was conformed in September 2015 in a tertiary level I trauma university hospital in southwestern Colombia, a middle-income war-influenced country. OBJECTIVE: To evaluate the impact of a TT in admission-tomography and admission-surgery times as well as mortality in a tertiary center university hospital in a middle-income country war-influenced country. MATERIAL AND METHODS: Retrospective analytical study. Patients older than 17 years admitted to the emergency room 15 months prior and 15 months after the TT implementation were included. Patients prior to the TT implementation were taken as controls. No exclusion criteria. Four hundred sixty-four patients were included, 220 before the TT implementation (BTT) and 244 after (ATT). Demographic data, trauma characteristics, admission-tomography, and admission-surgery time interval as well as mortality were recorded. Requirement of CT scan or surgery was based on physician decision. The analysis was made on Stata 15.1®. Categorical variables were described as quantities and proportions, and continuous variables as mean and standard deviation or median and interquartile range (IQR). Categorical variables were compared using χ2 or Fisher's test and continuous variables using Student's T test or Wilcoxon-Mann-Whitney. A multiple logistic regression model was created to evaluate the impact of being treated in the ATT group on mortality, adjusted by age, trauma severity, and physiological response upon admission. RESULTS: The admission-tomography time interval was 56 min (IQR 39-100) in the BTT group and 40 min (IQR 24-76) in the ATT group, p < 0.001. The admission-surgery time interval was 116 min (IQR 63-214) in the BTT group and 52 min (IQR 24-76) in the ATT group, p < 0.001. Mortality in the BTT group was 18.1% and 13.1% in the ATT group. Adjusted OR was 0.406 (0.215-0.789) p = 0.006 CONCLUSIONS: A trauma team conformation in a war-influenced middle-income country is feasible and reduces mortality as well as admission-surgery and admission-tomography time intervals in trauma patients.
RESUMO
A hipercapnia permissiva vem sendo utilizada como modalidade de ventilação em diversas doenças pulmonares. A hiperdistensão dos pulmões é causa de diversas lesões pulmonares, e por isso, estratégias de ventilação que diminuam essa relação de causa e efeito são propostas. Pacientes submetidos a procedimentos torácicos demandam cuidados anestésicos que propiciem um manejo clínico que reduza os efeitos da ventilação mecânica sobre o sistema respiratório e ácido-básico, diminuindo o processo inflamatório e a injúria pulmonar aguda. Nesse contexto, a hipercapnia permissiva pode ser um caminho a ser seguido com o objetivo de diminuir lesões pulmonares, contudo, sempre tendo sua boa indicação, observando a evolução do paciente.
Assuntos
Masculino , Feminino , Humanos , Anestesia , Cirurgia TorácicaRESUMO
Fundamento: la educación superior de Ecuador debe responder a las políticas educacionales en cuanto a su labor de formar a los futuros profesionales de la salud integralmente, donde las transformaciones de la ciencia y la tecnología juegan un rol fundamental. Métodos: en el estudio se ofrece una caracterización del comportamiento de la aplicación de las tecnologías de la información en la formación de talento humano en salud en el Instituto Superior Tecnológico Bolivariano de Tecnología. Se efectuó una revisión bibliográfica del tema, análisis documental y observación de las locaciones empleadas, luego se procedió a una triangulación metodológica de la información resultante. Resultados: los resultados se agrupan según sus características en este centro de altos estudios, posibilidades de empleo, infraestructura existente, y se muestran algunos ejemplos. Conclusiones: a partir de su puesta en marcha se han introducido diferentes proyectos macrocurriculares y desarrollado un proceso de enseñanza aprendizaje orientado y efectivo que propicia la formación de un profesional integral, capaz de desarrollar el pensamiento crítico que aporte al desarrollo sostenible del país.
Background: higher education in Ecuador must meet the educational policies concerning the comprehensive training of future health care professionals, where transformations of science and technology play a key role. Methods: the study provides a characterization of the behavior of the information technology implementation in the training of health care human resources at the Bolivarian Institute of Technology. A literature review of the topic was conducted, as well as a documentary analysis and an observation of the locations used. Then, a methodological triangulation of the resulting information was carried out. Results: the results were grouped according to their characteristics in this center of higher learning, possibilities of use and existing infrastructure. Some examples are shown. Conclusions: since its implementation, several macro-curricular projects have been introduced, and the development of an oriented and effective teaching-learning process that promotes the training of comprehensive professionals, who are able to develop a critical thinking that contributes to a sustainable development of the country.
Assuntos
Comunicação , Universidades , Recursos Humanos , Tecnologia da InformaçãoRESUMO
HER2 amplification can be present in ductal carcinoma in situ (DCIS). The aim of the present study was to test the feasibility of measuring soluble HER2 in the saliva of patients at risk of breast cancer towards early diagnosis and prognosis. Women with lesions classified as 4 according to BIRADS and women with spontaneous nipple discharge (NAF) were recruited for this study. Quantification of soluble HER2 in saliva was performed using the enzyme immunoassay ELISA. Median values of HER2 were quantified in saliva of the control groups and in the patient groups. The statistical test nonparametric Mann-Whitney was applied for the evaluation of median differences. Although the medians increased with the severity of the clinical status, no significant difference was found in all possibilities (p > 0.05) when comparing the medians among the patients groups. Interestingly, inter-individual HER2 quantity variations in the saliva were detected in this study in some subjects from each group. Considering possible inter-individual variations, research on saliva-based circulating HER2 has to be reinforced to ensure its correct application in diagnosis, treatment and in follow-up of breast cancer patients. Older and current issues surrounding the controversy about the appropriate methods for HER2 evaluation are discussed.
Assuntos
Neoplasias da Mama/enzimologia , Receptor ErbB-2/análise , Saliva/enzimologia , Estudos de Casos e Controles , Suscetibilidade a Doenças , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Pessoa de Meia-Idade , Estatísticas não ParamétricasRESUMO
Introducción: El trastorno por déficit de atención con hiperactividad (TDAH) es el diagnóstico Más frecuente en la consulta Psiquiátrica infantil en distintas sociedades. Clásicamente, la Triada de hiperactividad, déficit de atención e impulsividad es el núcleo y el objetivo de las Diferentes estrategias terapéuticas. Sin embargo, son múltiples los motivos de consulta que Los pacientes y sus familias establecen, debido al impacto de los síntomas en las dinámicas Escolares y de convivencia. Objetivo: Conocer cómo se expresan los motivos de consulta en un medio como el de Bogotá (Colombia). Métodos: Se analizaron 366 encuestas de padres De niños con TDAH, quienes asisten a la reunión mensual de la escuela para padres HIDEA, Especializada en TDAH, en la que relatan sus motivos de consulta y las estrategias con las Cuales tratan de mejorar estas dificultades. Resultados: Las quejas más frecuentes son La rebeldía, el desacato a la autoridad y el bajo rendimiento escolar. Para ayudar al niño, Recurren ante todo a la terapia ocupacional, de acuerdo con la recomendación del colegio. Conclusiones: Para los padres la problemática sentida no se relaciona directamente con Los rasgos clínicos principales del TDAH, sino con sus consecuencias desadaptativas en el medio escolar. Paradójicamente, también se hace evidente una relativa debilidad de las estrategias de afrontamiento que implican cambios profundos en los patrones de crianza y convivencia...
Introduction: The most frequent clinical diagnosis in psychiatric child services in different societies is attention deficit hyperactivity disorder (ADHD). Classically, the core symptoms and the main objective of different therapeutic strategies are the triad hyperactivity, attention deficit, and impulsivity. However, the chief complaints those patients and families states are diverse due to the relevant impact of the symptoms on school and social dynamics. Objective: To learn how the chief complaints are expressed in the context of Bogotá (Colombia). Methods: 366 surveys of parents of children with ADHD were analyzed. They participated in the monthly meeting of the HIDEA Parent´s School, which specializes in ADHD. Surveys summarized the complaints and confrontation strategies used to improve these inconveniences. Results: The most frequent complaints were disobedience, defying authority, and low school performance. To help the children the parents turned mainly to occupational therapy as suggested by the school. Conclusions: We observed that parents perceived the problem as linked to social annoyance consequences instead of clinical symptoms of ADHD. Paradoxically a relative weakness of confrontation approaches was also evident, involving deep changes in child rearing patterns and social interactions...
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Psiquiatria InfantilRESUMO
This paper summarizes those factors that have contributed to the degradation of the mangroves in El Salvador, and examines the implications of proposed changes in property rights to the mangroves for poor coastal communities. Current patterns of extraction and conversion in the mangrove ecosystem in El Salvador can be viewed through an entitlement lens that confers property right upon some actors, for certain uses, and denies them to others. Unfortunately, the present system of laws and regulations that governs resource use in the mangroves is contradictory and confusing. A number of laws currently are active that give entirely different directives about the use and transformation of the ecosystem. The rational and sustainable management of the mangroves cannot be secured without a redefinition of entitlement rights. This redefinition of entitlements, however, should take into account the needs of those whose livelihoods are intimately connected to the health of the ecosystem.
Assuntos
Avicennia , Conservação dos Recursos Naturais , Ecossistema , Propriedade , El Salvador , Meio Ambiente , Humanos , PobrezaRESUMO
Introducción: La insuficiencia respiratoria crónica en el recién nacido es un reto diagnóstico. Caso clínico: Se presenta el caso de una niña pretérmino que a las cuatro semanas presentó insuficiencia respiratoria con imagen radiológica de hiperaereación e infiltrado reticulonodular difuso, bilateral, con apariencia de burbujas; requirió concentraciones altas de oxígeno para mantener una oxemia satisfactoria. Hubo mejoría progresiva con desaparición de la imagen radiológica; desde los 70 días no requirió oxígeno suplementario. Conclusiones: Se estableció el diagnóstico de síndrome de Wilson-Mikity. Se hace una revisión de las características clínico-radiológicas de este síndrome y se dan las pautas de diagnóstico y tratamiento
Assuntos
Recém-Nascido , Humanos , Feminino , Insuficiência Respiratória/fisiopatologia , Enfisema/diagnóstico , Enfisema/fisiopatologia , PulmãoRESUMO
Se analiza la historia clínica de una niña de 10 años, quien presentó paraplejia flácida, pérdida del control de esfínteres y compromiso de la sensibilidad superficial en tronco y miembros inferiores con regresión del cuadro clínico. Un año después presentó un segundo episodio similar al inicial, acompañado en esta ocasión de neuritis óptica. La evolución clínica y paraclínica llevó al diagnóstico de una esclerosis múltiple en su variedad de neuromielitis óptica o enfermedad de Devic. Se discuten los criterios de diagnóstico, la evolución y el pronóstico de esta enfermedad.