RESUMO
Despite improvements in care, up to one-third of patients presenting with ST-elevation myocardial infarction (STEMI) within 12 hours of symptom onset receive no reperfusion therapy. Despite effective pre- and in-hospital reperfusion strategies becoming standard over the past two decades, time-to-admission and time-to-treatment remains prolonged. Prompt reperfusion treatment is essential to decrease mortality. The ACC/AHA guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation during percutaneous coronary intervention should be within ninety minutes of patient arrival to the ED or less and within 30 minutes for fibrinolytic therapy. However, few hospitals meet this objective. We did a retrospective analysis of patients with STEMI from January 2008 to December 2010. From an initial list of 57 patients, only 45 patients presented with confirmed STEMI. Of these, 35 had indication for reperfusion therapy. 97% received fibrinolytic therapy versus 3% who underwent percutaneous coronary intervention (PCI). The reperfusion time goal was achieved in 45% of cases treated with fibrinolytic therapy. Most of the patients presenting with STEMI undergo reperfusion therapy with fibrinolytic therapy. PCI was not performed as initial reperfusion therapy, even at regular duty hours. Reperfusion therapy was performed beyond the expected time goal in more that half of the cases. The most significant delay was related to nursing staff performance.
Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Infarto do Miocárdio/cirurgia , Reperfusão Miocárdica , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
UNLABELLED: Osteoporosis has become an issue of worldwide significance. This condition has been demonstrated in Celiac disease (CD) populations in Europe, South America and the United States. However, data from the Hispanic population is limited. METHODS: Record review containing patients with Celiac disease in a Gastroenterology Clinic to evaluate the association of decreased bone density such as Osteoporosis and Osteopenia in subjects with Celiac disease in the southern population of Puerto Rico. We compared the results of Dual-energy X-ray absorptiometry. Clinical manifestations of CD in Hispanic population are described. RESULTS: Celiac disease data was available for seven patients; of those 6 were female (86%). The average age was 46 yr Most patients were overweight with a body mass index value of 29. CD patients showed abnormalities in hemoglobin, TSH and 25-Hydroxyvitamin D. The screening markers for CD showed a high value on IgA. The data to excel is the association of IgA vs. TSH showing strength of 90%. There was significantly lower bone density in women with Celiac Disease accounting for 86% of the cases. CONCLUSION: Women with Celiac Disease were associated with lower bone density and a higher prevalence of Osteopenia but not Osteoporosis.
Assuntos
Doença Celíaca/complicações , Osteoporose/etiologia , Feminino , Hispânico ou Latino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos PilotoRESUMO
UNLABELLED: Contrast medium-induced nephropathy (CIN) is regarded as one of the most important complications after intravascular administration of radiographic contrast media and the third most common cause of hospital-acquired acute kidney injury. Contrast-induced nephropathy may develop in up to10% of patient with normal renal function but may be as high 25% in patient with risk factors. METHODS: A total of 192 medical records were obtained, in which 55 patient were eligible by our inclusion and exclusion criteria. RESULTS: A total four cases of CIN (7%) was identified and all were considered high-risk patients. In the patients that developed CIN only 50% received preventive IV hydration therapy in accordance to guidelines of the Contrast-Induced Nephropathy Consensus Panel. In 51 cases CIN was absent (93%). In the absent CIN group 22 were considered high-risk patients (43%) and 29 patients were low risk (57%). In the high-risk group with absent CIN, 77% received preventive IV hydration. CONCLUSION: Study didn't show diabetes as a direct contributory factor for CIN development, but glycemia was not properly stratified. Screening and preventive strategies were not diligently complied in our institution, so there is a great need to incorporate a protocol in our institution in accordance to published guidelines.
Assuntos
Meios de Contraste/efeitos adversos , Angiografia Coronária/efeitos adversos , Nefropatias/induzido quimicamente , Idoso , Feminino , Hispânico ou Latino , Humanos , MasculinoRESUMO
En el presente trabajo se buscó la coincidencia entre los patógenos comunes aislados del pus alrededor de los catéteres que lo presentaron y en los hemocultivos de los pacientes sépticos examinados entre junio y julio de 1989 en la Unidad de Emergencia del Hospital Vargas de Caracas, y los gérmenes aislados de las muestras de las manos de los residentes de medicina interna y cirugía general y profesionales de enfermeria de la misma unidad, encontrándose de un 30% a un 100% de coincidencia. Igualmente, la ausencia del hábito del lavado de las manos varió de un 50% a un 100%. Se encontró coincidencia de los siguientes gérmenes: Staphylococcus epidermidis, Staphyloccocus aureus, Enterobacter cloacae. Bacilos Gram negativos no fermentadores, klebsiella pneumoniae. Los gérmenes más frecuentes aislados en las muestras de las manos fueron, Gram + Staphiloccocus epidermidis, (19,7%), Staphyloccocus cobnii (16,3%), Bacillus subtilis (10,9%), y Gram - Bacilos Gram negativos no fermentadores (8,2%), Enterobacter cloacae (4,8%), Acinetobacter (3,4%). El personal de enfermería tuvo el mayor porcentaje de lavado de manos y el menor porcentaje de coincidencia de gérmenes