RESUMO
OBJETIVO: el estudio pretende caracterizar la depuración de lactato (DL) en pacientes críticamente enfermos, a gran altitud. DISEÑO: estudio prospectivo de cohorte. ÁMBITO: unidad de Cuidados Intensivos de Adultos del Hospital del Norte de la ciudad de El Alto, La Paz (Bolivia), a 4 150 metros sobre el nivel del mar, periodo 25 de abril 2016-01 de junio 2018. PACIENTES: todos los pacientes ingresados a la Unidad de Cuidados Intensivos de Adultos, nativos de gran altitud, así como residentes de la misma por lo menos los últimos 6 meses. RESULTADOS: se incluyeron 250 pacientes, con sobrevida de 68%, promedio de edad 50 años; en el grupo de 170 supervivientes, poco más de la cuarta parte del lactato de ingreso fue depurado (26%), a comparación del grupo de 80 fallecidos, en el cual incluso el valor de lactato se vio incrementado alrededor de la quinta parte del lactato de ingreso (21%), ambos con p ≤ 0.05 mediante el test de ANOVA. En pacientes críticamente enfermos a gran altitud, el riesgo relativo entre depuración de lactato ≥ 26% y sobrevida es de 2.7 con sensibilidad 0.72 y especificidad de 1. DISCUSIÓN Y CONCLUSIONES: la depuración de lactato en individuos críticamente enfermos nativos de gran altitud, se asocia a mayor sobrevida y debería ser considerado como un objetivo durante la reanimación en pacientes críticos, de forma similar a estudios realizados en otras latitudes
OBJECTIVE: to characterize the lactate clearance on critically ill patients, at high altitude. DESIGN: prospective cohort study. FIELD: critical Care Unit of "Hospital del Norte" in El Alto, La Paz (Bolivia), during the period April 25, 2016 June 01, 2018. PARTICIPANTS: critically ill patients residents of high altitude at least the last 6 months, admitted to the Adult Critical Care Unit. RESULTS: 250 patients were included, with survival of 68%, age average of 50 years; in the 170 survivors, lactate clearance average was 26%, in contrast with 80 deceased patients who presented an increased lactate level of 25%, p ≤ 0.05, both of them through ANOVA test. In high landers critically ill patients, relative risk of lactate clearance ≥ 26% and survival was 2.7 with sensitivity 0.72 and specificity 1. DISCUSSION AND CONCLUSIONS: lactate clearance in critically ill high landers dwellers, is associated with survival and it should be considered also as a reanimation objective, comparable to other studies developed in different latitudes
Assuntos
Humanos , Cuidados Críticos , Estado Terminal , Ácido Láctico/classificação , Cuidados Críticos/tendênciasRESUMO
Pregnancy-associated hypertension is a health problem in Mexico due to its high frequency of morbidity and mortality in mother and fetus as well. Research in this area has been restrained by limitations upon epidemiologic information, unknown etiology and the somewhat easy resolution provided when pregnancy is interrupted. We have reviewed contributions made in our country and up-to-date management concepts.
Assuntos
Eclampsia , Pré-Eclâmpsia , Eclampsia/etiologia , Eclampsia/prevenção & controle , Eclampsia/terapia , Feminino , Humanos , Obstetrícia/métodos , Pré-Eclâmpsia/etiologia , Pré-Eclâmpsia/prevenção & controle , Pré-Eclâmpsia/terapia , GravidezAssuntos
Flumazenil/uso terapêutico , Encefalopatia Hepática/tratamento farmacológico , Doença Aguda , Adulto , Terapia Combinada , Eletroencefalografia/efeitos dos fármacos , Feminino , Escala de Coma de Glasgow , Encefalopatia Hepática/etiologia , Humanos , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/etiologiaRESUMO
The critically ill patient, during the natural course of the disease often presents acid-base disturbances acidosis being the most common metabolic problem. Sodium bicarbonate has been used, for its correction but due to complications its use is restricted. In the present experimental study, mixed race dogs were artificially induced metabolic acidosis with in chloride acid. Arterial and venous blood gases were determined. Afterwards 0.1N sodium hydroxide was administered in the same amount statistically demonstrating modifications, in the pH values, as well as an excess of arterial and venous base which indicates the possibility of using this substance in humans to correct metabolic acidosis.
Assuntos
Acidose/tratamento farmacológico , Modelos Animais de Doenças , Hidróxido de Sódio/administração & dosagem , Acidose/induzido quimicamente , Acidose/epidemiologia , Análise de Variância , Animais , Cães , Avaliação Pré-Clínica de Medicamentos , Ácido Clorídrico , Concentração de Íons de Hidrogênio , SoluçõesRESUMO
The effect of treatment with a long acting analogue of somatostatin (SMS 201-995) administered by subcutaneous route 165 micrograms every eight hours in a patient with a external biliary fistula is reported. There was a significant reduction of the daily fistula output during treatment when compared with the basal periods (p = 0.04), with an average decrease of 270 ml/day during the first period of treatment and 357 ml/day when the drug was administered the second time (p = 0.04). There where not changes in the chemical composition of the bile neither adverse side effects were observed during treatment. These results suggest that SMS 201-995 might be useful in the treatment of external biliary fistulas.
Assuntos
Bile/metabolismo , Fístula Biliar/tratamento farmacológico , Fístula/tratamento farmacológico , Octreotida/uso terapêutico , Dermatopatias/tratamento farmacológico , Adulto , Fístula Biliar/fisiopatologia , Preparações de Ação Retardada , Fístula/fisiopatologia , Humanos , Masculino , Dermatopatias/fisiopatologiaRESUMO
The normal value of colloid-osmotic pressure (COP) was determined in male and female adults between 20 and 40 years old. Any differences of this value related to sex and age were investigated. It was found the statistical correlativeness of COP obtained with an oncometer and that calculated with Landis-Pappenheimer equation (F1) and the modified equation (F2) of the same authors. Two groups, each of 50 males and 50 females were formed. Those persons with altered routine laboratory tests that could modify COP were discarded. COP was determined with IL 186 Weil Oncometer and also calculated with both Landis-Pappenheimer equations (F1 and F2). An statistical analysis was made to see if age had any influence on COP. Results in males, measured COP was 27.22 +/- 2.51 torr, calculated COP by F1 was 26.646 +/- 2.38 torr, and calculated COP by F2 was 27.814 +/- 2.43 torr. In females, measured COP was 26.8 +/- 1.71 torr, calculated COP by F1 was 26.9476 +/- 2.005 torr, and calculated COP by F2 was 28.09 +/- 2.0984 torr. Measured COP regardless sex was 27.01 +/- 2.15. Using the variance analysis and the minimal significative differences (MSD) it was seen that measured COP and calculated COP by F1 can be used either one with 95 per cent of credibility in healthy ambulant adult. Using the aforementioned statistical procedure it was noted a lower figure between 30 and 35 years that at any other studied age.
Assuntos
Proteínas Sanguíneas/fisiologia , Adulto , Fatores Etários , Permeabilidade Capilar , Coloides , Feminino , Humanos , Masculino , México , Pressão Osmótica , Valores de Referência , Fatores SexuaisAssuntos
Injúria Renal Aguda/tratamento farmacológico , Dipiridamol/uso terapêutico , Pré-Eclâmpsia/tratamento farmacológico , Adulto , Coagulação Sanguínea/efeitos dos fármacos , Testes de Coagulação Sanguínea , Pressão Sanguínea/efeitos dos fármacos , Dipiridamol/farmacologia , Feminino , Humanos , Injeções Intraventriculares , GravidezRESUMO
Five cases of pregnancy complicated by pancreatitis are discussed. In three of the five cases there was, at the time of the pregnancy, some pathology which might have been responsable for the acute pancreatitis. Three patients were operated on. The phisiopathology and the ethiopathology of this condition are commented, as well as the principal clinical and laboratorial findings. The complications are discussed. The medical treatment represents the best management in these cases. Surgery, ideally, should only be undertaken when the pregnancy is over.