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Abstract Introduction Acquired tracheomalacia (ATM) is characterized by a loss of structural strength of the tracheal framework, resulting in airway collapse during breathing. Near half of the patients undergoing prolonged invasive mechanical ventilation will suffer tracheal lesions. Treatment for ATM includes external splinting with rib grafts, prosthetic materials, and tracheal resection. Failure in the use of prosthetic materials has made reconsidering natural origin scaffolds and tissue engineering as a suitable alternative. Objective To restore adequate airway patency in an ovine model with surgicallyinduced ATM employing a tissue-engineered extraluminal tracheal splint (TE-ETS). Methods In the present prospective pilot study, tracheal rings were partially resected to induce airway collapse in 16 Suffolk sheep (Ovis aries). The TE-ETS was developed with autologous mesenchymal-derived chondrocytes and allogenic decellularized tracheal segments and was implanted above debilitated tracheal rings. The animals were followed-up at 8, 12, and 16 weeks and at 1-year postinsertion. Flexible tracheoscopies were performed at each stage. After sacrifice, a histopathological study of the trachea and the splint were performed. Results The TE-ETS prevented airway collapse for 16 weeks and up to 1-year postinsertion. Tracheoscopies revealed a noncollapsing airway during inspiration. Histopathological analyses showed the organization of mesenchymal-derived chondrocytes in lacunae, the proliferation of blood vessels, and recovery of epithelial tissue subjacent to the splint. Splints without autologous cells did not prevent airway collapse. Conclusion It is possible to treat acquired tracheomalacia with TE-ETS without further surgical removal since it undergoes physiological degradation. The present study supports the development of tissue-engineered tracheal substitutes for airway disease.
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Introduction Acquired tracheomalacia (ATM) is characterized by a loss of structural strength of the tracheal framework, resulting in airway collapse during breathing. Near half of the patients undergoing prolonged invasive mechanical ventilation will suffer tracheal lesions. Treatment for ATM includes external splinting with rib grafts, prosthetic materials, and tracheal resection. Failure in the use of prosthetic materials has made reconsidering natural origin scaffolds and tissue engineering as a suitable alternative. Objective To restore adequate airway patency in an ovine model with surgically-induced ATM employing a tissue-engineered extraluminal tracheal splint (TE-ETS). Methods In the present prospective pilot study, tracheal rings were partially resected to induce airway collapse in 16 Suffolk sheep ( Ovis aries ). The TE-ETS was developed with autologous mesenchymal-derived chondrocytes and allogenic decellularized tracheal segments and was implanted above debilitated tracheal rings. The animals were followed-up at 8, 12, and 16 weeks and at 1-year postinsertion. Flexible tracheoscopies were performed at each stage. After sacrifice, a histopathological study of the trachea and the splint were performed. Results The TE-ETS prevented airway collapse for 16 weeks and up to 1-year postinsertion. Tracheoscopies revealed a noncollapsing airway during inspiration. Histopathological analyses showed the organization of mesenchymal-derived chondrocytes in lacunae, the proliferation of blood vessels, and recovery of epithelial tissue subjacent to the splint. Splints without autologous cells did not prevent airway collapse. Conclusion It is possible to treat acquired tracheomalacia with TE-ETS without further surgical removal since it undergoes physiological degradation. The present study supports the development of tissue-engineered tracheal substitutes for airway disease.
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BACKGROUND: Machine-learning algorithms are becoming popular techniques to predict ambient air PM2.5 concentrations at high spatial resolutions (1 × 1 km) using satellite-based aerosol optical depth (AOD). Most machine-learning models have aimed to predict 24 h-averaged PM2.5 concentrations (mean PM2.5) in high-income regions. Over Mexico, none have been developed to predict subdaily peak levels, such as the maximum daily 1-h concentration (max PM2.5). OBJECTIVE: Our goal was to develop a machine-learning model to predict mean PM2.5 and max PM2.5 concentrations in the Mexico City Metropolitan Area from 2004 through 2019. METHODS: We present a new modeling approach based on extreme gradient boosting (XGBoost) and inverse-distance weighting that uses AOD, meteorology, and land-use variables. We also investigated applications of our mean PM2.5 predictions that can aid local authorities in air-quality management and public-health surveillance, such as the co-occurrence of high PM2.5 and heat, compliance with local air-quality standards, and the relationship of PM2.5 exposure with social marginalization. RESULTS: Our models for mean and max PM2.5 exhibited good performance, with overall cross-validated mean absolute errors (MAE) of 3.68 and 9.20 µg/m3, respectively, compared to mean absolute deviations from the median (MAD) of 8.55 and 15.64 µg/m3. In 2010, everybody in the study region was exposed to unhealthy levels of PM2.5. Hotter days had greater PM2.5 concentrations. Finally, we found similar exposure to PM2.5 across levels of social marginalization. SIGNIFICANCE: Machine learning algorithms can be used to predict highly spatiotemporally resolved PM2.5 concentrations even in regions with sparse monitoring. IMPACT: Our PM2.5 predictions can aid local authorities in air-quality management and public-health surveillance, and they can advance epidemiological research in Central Mexico with state-of-the-art exposure assessment methods.
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Aprendizado de Máquina , Meteorologia , Humanos , MéxicoRESUMO
Avocado oil is a very valuable agro-industrial product which can be perishable in a short time if it is not stored in the right conditions. The encapsulation of the oils through the spray drying technique protects them from oxidation and facilitates their incorporation into different pharmaceutical products and food matrices; however, the selection of environmentally friendly emulsifiers is a great challenge. Four formulations of the following solid particles: Gum Arabic, HI-CAP®100 starch, and phosphorylated waxy maize starch, were selected to prepare avocado oil Pickering emulsions. Two of the formulations have the same composition, but one of them was emulsified by rotor-stator homogenization. The rest of the emulsions were emulsified by combining rotor-stator plus ultrasound methods. The protective effect of mixed particle emulsifiers in avocado oil encapsulated by spray drying was based on the efficiency of encapsulation. The best results were achieved when avocado oil was emulsified with a mixture of phosphorylated starch/HI-CAP®100, where it presented the highest encapsulation efficiency.
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Mixed gonadal dysgenesis is the most common chromosomal abnormality with ambiguous genitalia, defined as a 45,X/46,XY mosaicism. It can present with a normal male phenotype, ambiguous genitalia, or features of Turner syndrome. A 14-year-old patient was referred to the genetics clinic due to hypospadia, cryptorchidism, and aortic coarctation. During the physical examination, short stature, webbed neck, and Blashko lines on his back were noted. He had a previous karyotype reported as normal. However, due to an inadequate evolution and a low resolution on the previous test, a higher resolution karyotype was performed, identifying a mosaicism 45,X/46,XY. A multidisciplinary board examined the case, and follow-up with tumor markers was carried out to evaluate the presence of gonadoblastoma, one of the main complications in these patients. Treatment should be transdisciplinary and focused on the particular characteristics of each case. Other treatment alternatives include corrective surgery and hormonal therapy.
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Transtornos do Desenvolvimento Sexual , Disgenesia Gonadal Mista , Síndrome de Turner , Feminino , Disgenesia Gonadal Mista/diagnóstico , Disgenesia Gonadal Mista/genética , Disgenesia Gonadal Mista/patologia , Humanos , Masculino , Mosaicismo , Fenótipo , Síndrome de Turner/complicações , Síndrome de Turner/diagnóstico , Síndrome de Turner/genéticaRESUMO
INTRODUCTION: Improved recovery protocols were implemented in surgical specialties over the last decade, which decreased anesthetic and surgical stress and the incidence of perioperative complications. However, these recovery protocols were introduced more slowly for cardiac surgeries. The most frequent complications in cardiac surgery are related to patient clinical status and the characteristics of the surgical procedures involved, which are becoming more varied and complex every day. The first version of the enhanced recovery program for cardiac surgery was published in 2019, but its recommendations were based on only a few studies, and scant research has evaluated its implementation. Randomized and controlled clinical trials for these protocols are scarce, so research that summarizes the results of studies with other methodological designs are useful in demonstrating their benefits in cardiovascular surgery services in Cuba and in other limited-resource settings. OBJECTIVE: Estimate the effectiveness of improved recovery protocols in the perioperative evolution of patients undergoing cardiac surgery. METHODS: We performed a systematic review and meta-analysis according to the guidelines of manual 5.1.0 for reviews of the Cochrane library. We included observational and quasi-experimental studies published from January 2015 through May 2020 that compared enhanced recovery protocols with conventional treatments in patients older than 18 years, and used a quality score to evaluate them. We used the following sources: the Cochrane Library, PubMed, LILACS, SciELO, EBSCO, Google Scholar, Web of Science, Clinical Key, ResearchGate and HINARI. The following keywords were used for the database searches in English: ERAS, protocols and cardiac surgery, enhanced recovery after cardiac surgery, ERACS, clinical pathway recovery and cardiac surgery, perioperative care and cardiac surgery. We used the following search terms for databases in Spanish: protocolos de recuperación precoz and cirugía cardiaca, protocolos de recuperación mejorada and cirugía cardiaca, cuidados perioperatorios and cirugía cardiaca, programas de recuperación precoz and cirugía cardiovascular. Methodological quality of included investigations was evaluated using the surgical research methodology scale. Meta-analyses were performed for perioperative complications, intensive care unit and hospital stays, and hospital readmission within 30 days of surgery. We calculated effect sizes of the interventions and the corresponding 95% confidence intervals. We used mean differences and confidence intervals for continuous variables, and for qualitative variables we calculated relative risk (RR). Random effects analysis was used. Heterogeneity of the studies was assessed using the Q statistic and the I2 statistic. RESULTS: We selected 15 studies (a total of 5059 patients: study group, n = 1706; control group, n = 3353). The average quality score for the 15 articles included was 18.9 (out of a maximum of 36 according to the scale) and 66.6% had a score =18. With improved recovery protocols in cardiac surgery, the incidence of perioperative complications decreased (RR = 0.73; 95% CI 0.52-0.98) as did hospital readmission within 30 days after surgery (RR = 0.51; 95% CI 95% CI: 0.31-0.86). Differences in extubation time, hospital stay and length of stay in intensive care units were less marked, but always favored the group in which the enhanced protocols were implemented. CONCLUSIONS: Improved recovery protocols in cardiac surgery increase quality of care evidenced by reductions in perioperative complications and decreased incidence of hospital readmission in the month following surgery.
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Procedimentos Cirúrgicos Cardíacos , Humanos , Cuba , Unidades de Terapia Intensiva , Tempo de InternaçãoRESUMO
Resumen: La práctica de cirugía robótica es un proceso complejo que implica desarrollo y tecnología no sólo en el campo de la cirugía, sino también en el campo de la anestesiología. Implica un proceso multifactorial, ya que ha generado un cambio drástico multidisciplinario basado en tecnología de punta que pretende ofrecer mejores condiciones durante el manejo perioperatorio en cirugía robótica. La anestesia total intravenosa cumple objetivos específicos en relación a la posición del paciente, relajación cerebral, neuroprotección, hemodinamia, pérdida y recuperación de la conciencia, parálisis neuromuscular, parámetros ventilatorios, etc. Ofrece seguridad y calidad al paciente durante el procedimiento con una mínima interferencia con el monitoreo electrofisiológico y permite modular la profundidad anestésica desde una neurosedación hasta una anestesia general, de acuerdo a las diferentes etapas de la cirugía. Un factor atribuible a la anestesia moderna para el éxito de la cirugía robótica es usar diferentes agentes anestésicos que promuevan inducción, mantenimiento y emersión anestésica más rápida y suave, a fin de reducir el tiempo de recuperación del estado de conciencia, funciones básicas y psicomotoras como la anestesia general multimodal.
Abstract: The practice of robotic surgery is a complex process, involving development and technology; not only in the surgery field but also in the anesthesiology field. It implies a multifactorial process since it has generated a drastic multidisciplinary change based on state-of-the-art technology; which aims to offer better conditions during perioperative management in robotic surgery. Intravenous Total Anesthesia accomplishes specific objectives in relation to patient position, brain relaxation, neuroprotection, hemodynamics, loss and recovery of consciousness, neuromuscular paralysis, ventilatory parameters, providing safety and quality during the procedure; with minimal intervention during electrophysiological monitoring and enabling anesthetic depth to be modulated from neurosedation to general anesthesia, according to the different stages of the surgery. A factor attributable to modern anesthesia for robotic surgery success is to employ different anesthetic agents promoting induction, maintenance of general anesthesia, smother and faster anesthetic emersion, for the purpose of reducing recovery time of the state of consciousness), basic and psychomotor functions; as is the general multimodal anesthesia.
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Resumen Zapata Lamana, R., Fuentes Figueroa, V., Reyes Molina, D., Geisse Zárate, A. E. y Cigarroa, I. (2021). Características metodológicas en el estudio del compromiso hacia la práctica de actividad física y ejercicio en población general: una revisión sistemática. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 19(1), 1-23. Aunque la literatura sobre el compromiso deportivo en población deportista es extensa, se requiere profundizar sobre el compromiso hacia la práctica de actividad y ejercicio físicos en la población general. El objetivo del estudio fue sintetizar las características metodológicas de los artículos que han estudiado el compromiso hacia la práctica de actividad y ejercicio físicos en la población general. Se desarrolló una revisión sistemática siguiendo la declaración PRISMA. Se realizaron búsquedas electrónicas en las bases de datos PsycINFO y Medline desde 2009 al 2019. Un total de 14 artículos fueron elegidos, principalmente con diseños transversales. La población más estudiada fue de estudiantes universitarias mujeres, sin condición clínica. Todos los instrumentos utilizados para evaluar el compromiso hacia la actividad física y ejercicio estaban escritos en inglés, en su mayoría aplicados en Estados Unidos. Utilizaban una escala Likert con alta fiabilidad. Las principales variables asociadas a la evaluación del compromiso fueron la edad, género, origen étnico, nivel educativo y económico, nivel de actividad física, comportamiento, patologías alimentarias e índice de masa corporal y variables sociocognitivas, como autoeficacia, apoyo social, barreras y beneficios percibidos para la realización de la actividad física. Esta revisión entrega un perfil de la población en quien se evalúa el compromiso hacia la actividad física y ejercicio, los instrumentos utilizados y variables asociadas, lo que actualiza el conocimiento existente sobre el compromiso hacia la actividad física y ejercicio en la población general.
Abstract Zapata Lamana, R., Fuentes Figueroa, V., Reyes Molina, D., Geisse Zárate, A. E. & Cigarroa, I. (2021). Methodological characteristics of studying commitment to the practice of physical activity and exercise in the general population: a systematic review. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 19(1), 1-23. Although the literature on sports commitment within the sports population is extensive, in-depth studies of the commitment to the practice of physical activity and exercise in the general population are needed. The aim of this paper was to synthesize the methodological characteristics of articles that have studied the commitment to the practice of physical activity and exercise in the general population. A systematic review was developed following the PRISMA statement. Furthermore, electronic searches were conducted in the PsycINFO and Medline databases from 2009 to 2019. A total of 14 articles was selected, mainly with cross-sectional designs. The most studied population included female university students with no clinical condition. All instruments used to assess commitment to physical activity and exercise were written in English, mostly applied in the United States, and used a Likert scale with high reliability. The main variables associated with the evaluation of commitment were age, gender, ethnic origin, educational and economic level, level of physical activity, behavior, eating disorders, and body mass index, as well as sociocognitive variables such as self-efficacy, social support, and perceived barriers and benefits of physical activity. This review provides a profile of the population in which the commitment to physical activity and exercise is evaluated, the instruments used, and associated variables, which updates the existing knowledge about the commitment to physical activity and exercise in the general population.
Resumo Zapata Lamana, R., Fuentes Figueroa, V., Reyes Molina, D., Geisse Zárate, A. E. e Cigarroa, I. (2021). Características metodológicas no estudo do comprometimento com relação à prática de atividade física e exercício na população em geral: uma revisão sistemática. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 19(1), 1-23. Embora a literatura sobre o comprometimento esportivo na população esportista seja extensa, é preciso uma perscrutação sobre o comprometimento na prática de atividade e exercício físicos na população em geral. O estudo teve como objetivo sintetizar as características metodológicas dos artigos que estudaram o comprometimento na prática de atividade e exercício físicos na população em geral. Foi desenvolvida uma revisão sistemática seguindo a declaração PRISMA. Foram realizadas buscas eletrônicas nas bases de dados PsycINFO e Medline de 2009 a 2019. Um total de 14 artigos foram eleitos, principalmente com desenhos transversais. A população mais estudada foi a de estudantes universitárias mulheres, sem condição clínica. Todos os instrumentos utilizados para avaliar o comprometimento com relação à atividade física e ao exercício estavam escritos em inglês, em sua maioria aplicados nos Estados Unidos. Utilizavam uma escala Likert de alta fiabilidade. As principais variáveis associadas à avaliação do comprometimento foram a idade, o gênero, a origem étnica, o nível educativo e económico, o nível de atividade física, o comportamento, as patologias alimentarias e o índice de massa corporal e variáveis sociocognitivas, como autoeficácia, apoio social, barreiras e benefícios percebidos para a realização da atividade física. Esta revisão mostra um perfil da população na qual se avalia o comprometimento com relação à atividade física e ao exercício, os instrumentos utilizados e as variáveis associadas, o que atualiza o conhecimento existente sobre o comprometimento com relação à atividade física e ao exercício na população em geral.
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Humanos , Exercício Físico , Atividade MotoraRESUMO
In the context of smart cities, there is a general benefit from monitoring close encounters among pedestrians. For instance, for the access control to office buildings, subway, commercial malls, etc., where a high amount of users may be present simultaneously, and keeping a strict record on each individual may be challenging. GPS tracking may not be available in many indoor cases; video surveillance may require expensive deployment (mainly due to the high-quality cameras and face recognition algorithms) and can be restrictive in case of low budget applications; RFID systems can be cumbersome and limited in the detection range. This information can later be used in many different scenarios. For instance, in case of earthquakes, fires, and accidents in general, the administration of the buildings can have a clear record of the people inside for victim searching activities. However, in the pandemic derived from the COVID-19 outbreak, a tracking that allows detecting of pedestrians in close range (a few meters) can be particularly useful to control the virus propagation. Hence, we propose a mobile clustering scheme where only a selected number of pedestrians (Cluster Heads) collect the information of the people around them (Cluster Members) in their trajectory inside the area of interest. Hence, a small number of transmissions are made to a control post, effectively limiting the collision probability and increasing the successful registration of people in close contact. Our proposal shows an increased success packet transmission probability and a reduced collision and idle slot probability, effectively improving the performance of the system compared to the case of direct transmissions from each node.
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This study aimed to explore the life course identity projects of Chilean lesbian mothers who conceived their children within the context of a previous heterosexual relationship. By exploring the case of Chile, this study examined the family lives of lesbian mothers within the context of a Latino heteronormative society with a Christian (mainly Catholic) heritage. Individual interviews were conducted with eight participants aged between 27 and 40 years old (mean age of 33 years) who were recruited through snowballing and social media. A Structural Narrative Analysis of participants' stories was conducted within a Life Course Perspective theoretical framework. The study found that participants initially followed a heterosexual path to conform to their family of origin and social expectations. After building their own heterosexual family projects and having their children with a man, most participants felt pressured to continue within a heterosexual path and postponed their transition to a lesbian identity trajectory despite a growing feeling that a lesbian identity would be personally fullfilling. Although participants felt proud of their identities, they struggled to express their same-gender feelings because lesbians were often seen as inappropriate models for children within Chilean society. Crucially, lesbian mothers continued to be able to count upon support for their parenting from their own mother despite intense disapproval from their family of origin and often continued opposition from ex-husbands/partners. The findings of this study revealed the strong impact of familismo, lesbophobia and Christian religious beliefs on the life course experiences of Chilean lesbian mothers. Implications for therapy and counselling with lesbian mothers living in Latino countries are reviewed.
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In this paper, we consider amaranth starch extracted from the seeds of Amaranthus hypochondriacus L. An amphiphilic character is conferred to the starch by a chemical modification, which involves an esterification by lauroyl chloride at three modification levels. The degree of substitution (DS) after the modification ranged from 0.06 to 1.16. X-ray photoelectron spectroscopy analysis confirmed the presence of fatty acyl chains on the surface of the esterified starches. The hydrophobicity of starches was confirmed by their adsorption isotherms, which showed a decrease in the moisture adsorption of lauroylated as DS increased. X-ray diffraction analysis revealed a higher crystallinity, which was observed in the two samples subjected to the highest levels of modification. A higher crystallinity is related to a higher gelatinization enthalpy. These results are in agreement with the thermal characterization obtained by differential scanning calorimetry (DSC). An inhibition of the retrogradation properties of lauroylated amaranth starches was also observed.
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RATIONALE: Associations between urban (outdoor) airborne particulate matter (PM) exposure and TB and potential biological mechanisms are poorly explored. OBJECTIVES: To examine whether in vivo exposure to urban outdoor PM in Mexico City and in vitro exposure to urban outdoor PM2.5 (< 2.5 µm median aerodynamic diameter) alters human host immune cell responses to Mycobacterium tuberculosis. METHODS: Cellular toxicity (flow cytometry, proliferation assay (MTS assay)), M. tuberculosis and PM2.5 phagocytosis (microscopy), cytokine-producing cells (Enzyme-linked immune absorbent spot (ELISPOT)), and signalling pathway markers (western blot) were examined in bronchoalveolar cells (BAC) and peripheral blood mononuclear cells (PBMC) from healthy, non-smoking, residents of Mexico City (n=35; 13 female, 22 male). In vivo-acquired PM burden in alveolar macrophages (AM) was measured by digital image analysis. MEASUREMENTS AND MAIN RESULTS: In vitro exposure of AM to PM2.5 did not affect M. tuberculosis phagocytosis. High in vivo-acquired AM PM burden reduced constitutive, M. tuberculosis and PM-induced interleukin-1ß production in freshly isolated BAC but not in autologous PBMC while it reduced constitutive production of tumour necrosis factor-alpha in both BAC and PBMC. Further, PM burden was positively correlated with constitutive, PM, M. tuberculosis and purified protein derivative (PPD)-induced interferon gamma (IFN-γ) in BAC, and negatively correlated with PPD-induced IFN-γ in PBMC. CONCLUSIONS: Inhalation exposure to urban air pollution PM impairs important components of the protective human lung and systemic immune response against M. tuberculosis. PM load in AM is correlated with altered M. tuberculosis-induced cytokine production in the lung and systemic compartments. Chronic PM exposure with high constitutive expression of proinflammatory cytokines results in relative cellular unresponsiveness.
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Pulmão/imunologia , Mycobacterium tuberculosis/imunologia , Material Particulado/efeitos adversos , Saúde da População Urbana/estatística & dados numéricos , Adulto , Líquido da Lavagem Broncoalveolar/imunologia , Sobrevivência Celular/efeitos dos fármacos , Sobrevivência Celular/imunologia , Citocinas/biossíntese , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Feminino , Citometria de Fluxo/métodos , Interações entre Hospedeiro e Microrganismos/imunologia , Humanos , Mediadores da Inflamação/metabolismo , Masculino , México , Pessoa de Meia-Idade , Tamanho da Partícula , Material Particulado/análise , Material Particulado/farmacologia , Fagocitose/efeitos dos fármacos , Fagocitose/imunologia , Adulto JovemRESUMO
The encapsulation by spray drying of maize anthocyanins was evaluated using two types of wall materials, consisting of normal and waxy maize starch, which were esterified with octenyl succinic anhydride. The X-ray diffraction analysis revealed that SWMS possessed a completely amorphous, while SNMS had a crystalline structure. SNMS showed peaks at 2θ = 13.1°, 19.8° and 22.4°. The results revealed that SNMS and SWMS had almost the same encapsulation productivity (EP); SNMS showed the best performance because its EP was higher (95%) than in SWMS (90%). The stability of microcapsules produced with SNMS showed the highest anthocyanin retention after storage in the water activity (aw) range of 0.11-0.94 at 40 °C.
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La incidencia de la enfermedad litiásica ha aumentado globalmente en los últimos 25 años. A pesar de que la incidencia de litiasis es baja en la población pediátrica,1 ese aumento no ha sido ajeno a esa población. Se ha visto un incremento importante en su incidencia y prevalencia en los últimos años, alcanzado en países como Estados Unidos de 18,5 por cada 100.000 habitantes.2 La edad de presentación se encuentra entre los 7 y los 8 años de edad.
The incidence of lithium disease has increased globally over the past 25 years. Although the incidence of lithiasis is low in the paediatric population,1 this increase has not been alien to the paediatric population. There has been a significant increase in its incidence and prevalence in recent years, reached in countries such as the United States of 18.5 per 100,000 inhabitants.2 The age of presentation is between 7 and 8 years of age
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Humanos , Urolitíase , Dor Abdominal , Nefrolitotomia Percutânea , HematúriaRESUMO
Presentamos el caso de una mujer de 65 años de edad sin antecedentes de importancia quien luego de estrés emocional exhibe síntomas de síndrome coronario agudo (movilización de enzimas cardiacas y patrón electro cardiográfico con elevación del ST en más de dos derivaciones), se realiza Coronariografia que es normal pero presenta acinesia ventricular antero apical comprobada con eco cardiograma con gran compromiso de la función cardíaca que llegó al choque que ameritó manejo en la Unidad de Cuidados Intensivos con soporte hemodinámico y respiratorio sin causa demostrable de este compromiso presentó posterior recuperación espontanea con normalización de su función cardiaca.
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Síndrome Coronariana Aguda , Cardiomiopatias , Estresse Psicológico , Cardiomiopatia de Takotsubo , Disfunção VentricularRESUMO
Objetivos: La incisión y tubularización de la placa uretral "Snodgrass" es la técnica más utilizada en nuestro medio en la corrección de hipospadias, tiene limitantes cuando la placa uretral es pobre, estrecha o hay cicatriz de cirugías previas. Se han desarrollado técnicas nuevas como la ampliación de la placa uretral nativa con un injerto libre en el fondo de la misma y cierre primario de ésta; técnica denominada "Snodgraft" (Snodgrass + Graft/Injerto) ó Inlay. Para nuestro conocimiento en nuestro país existe poca o ninguna experiencia en el uso de injertos libres como parte integral en la corrección de hipospadias. Es este el primer trabajo realizado en Colombia. Material y Métodos: Se incluyeron todos los pacientes a quienes se les realizo corrección de hipospadias con técnica Snodgraft desde marzo 2006 hasta abril 2008 en la Clínica Infantil de Colsubsidio y Hospital Universitario San Ignacio en Bogotá Colombia. Divididos en dos grupos: A: Sin cirugía previa. B: Cirugía previa de hipospadias fallida. Se consideró éxito los que cumplieron los objetivos quirúrgicos de: Ausencia de fístulas, meato glanular, chorro anterógrado, buen resultado cosmético. Se hizo registro fotográfico pre y post quirúrgico. Análisis de Resultados: Se incluyeron 17 pacientes, edad promedio 4.2 años (rango:1.25 - 15). hipospadias del tercio medio: 75 por cien grupo A y 77por cien en el B. Se utilizo mucosa prepucial en el 100 por cien del grupo A. Mucosa oral en 78 por ciendel grupo B. Se utilizo colgajo pediculado de dartos sobre la línea de sutura de la neo uretra en todos los pacientes de ambos grupos excepto uno del B que se cubrió con túnica vaginal. 16 pacientes se derivaron con catéter uretral siliconado y uno con cistostomía. 6 complicaciones (35.3 por cien ), 2 Fístulas (11.7 por cien) que requirieron nueva cirugía, las 4 restantes: estrechez del meato (2), fístula proximal, necrosis parcial de piel, resolvieron sin intervención quirúrgica. Finalmente luego de la segunda...
Assuntos
Humanos , Complicações Pós-Operatórias/cirurgia , Hipospadia/reabilitação , Pediatria/instrumentação , Transplantes , Uretra/anormalidadesRESUMO
Introducción: La respuesta al tratamiento en diabéticos con disfunción eréctil (DE) se ha relacionado con el grado de neuropatía, tipo de diabetes mellitus (DM), hemoglobina glucosilada, etc. Determinamos la asociación entre la presencia o no de retinopatía y la respuesta al tratamiento con sildenafil. Metodología: estudio transversal retrolectivo y descriptivo en donde se incluyeron pacientes diabéticos con DE de acuerdo a las primeras 6 preguntas del cuestionario de Indice Internacional de Función Eréctil (IIEF<- 25 puntos) que tuvieran o no retinopatía. Fueron tratados con 100 mgrs de sildenafil. Se catalogó como "Respuesta al tratamiento" un puntaje >-26 puntos en el cuestionario post-tratamiento. Resultados: se incluyeron 65 pacientes con edad promedio en general de 55.5 ñ 10 años. La mayoría se encontraban con un grado moderado de DE, con un promedio de 13 ñ 4 puntos en el cuestionario pre-tratamiento. El 53 por ciento (35/65) tenía retinopatía y 46.1 por ciento (30/65) no. El 17.1 por ciento (6/35) de los pacientes con retinopatía era proliferativa. Los pacientes con y sin retinopatía tuvieron una edad promedio de 57 ñ 9 y 53 ñ 10 años (p>0.05). El 54 por ciento (19/35) y 51.4 por ciento (18/30) de los pacientes con y sin retinopatía respondieron al tratamiento (p>0.05). Sólo observamos en el grupo con retinopatía proliferativa una asociación significativa con una mala respuesta al tratamiento (p<0.00005). Conclusiones: nuestro estudio demuestra que la presencia de retinopatía diabética y DE se asocia con una baja respuesta al tratamiento con sildenafil, pero se acentúa aún más cuando la retinopatía es proliferativa. El tener retinopatía diabética aumenta 5.25 veces el riesgo de tener Disfunción Eréctil. El puntaje obtenido en el cuestionario para evaluar el grado de Disfunción Eréctil en los pacientes con retinopatía diabética tuvo correlación con el puntaje post-tratamiento en un 73 por ciento
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Diabetes Mellitus , Disfunção Erétil , Retinopatia Diabética/tratamento farmacológicoRESUMO
El estrés, la palabra introducida en 1949 por Hans Selye, se la ha catalogado como uno de los problemas de salud más frecuentes en la población actual; éste se desarrolla en tres fases: fase de alarma, resistencia y agotamiento. Está condicionado por mecanismos vegetativos, inmunológicos y hormonales regulados por la hipófisis. Ciertas etapas de vida son generadoras de estrés, en particular para la mujer, como el período menstrual, la gestación, el puerpeerio, menopausia y el climaterio, cuyos efectos pueden manifestarse en el área psicológica, física y/o laboral. El objetivo general de la presente revisión es dar a conocer los factores causantes de estrés, sus mecanismos de acción durante el embarazo. El estrés en esta etapa es debido al temor al parto inminente y a las probabilidades de peligro y daño para la gestante y sujijo durante este período y el parto, mucha de la angustia y miedo que se genera se debe a la tradición cultural, la cual puede incrementarse por la tensión que produce la práctica estomatológica, por lo cual el odontólogo debe conocer e informarse de esta respuesta cuando trate a sus pacientes gestantes, así como incorporar al modelo de atención estomatológica en la gravidez las alternativas de manejo del mismo
Assuntos
Humanos , Feminino , Gravidez , Assistência Odontológica Integral/métodos , Estresse Psicológico/diagnóstico , Estresse Psicológico/etiologia , Gravidez/psicologia , Climatério/psicologia , Acontecimentos que Mudam a Vida , Menopausa/psicologia , Parto/psicologia , Equipe de Assistência ao Paciente , Período Pós-Parto/psicologia , PsicoterapiaRESUMO
Objetivo. Conocer si la depresión y la ansiedad presente en las gestantes diabéticas está determinada por las pérdidas perinatales o por la función endocrina. Diseño de la Investigación y métodos. La muestra fue de 200 pacientes embarazadas del Instituto Nacional de Perinatología, compuesta por cien de embarazadas sin diabetes y cien con diagnóstico de la enfermedad. Se les aplicó el Inventario de Ansiedad Rasgo-Estado y la Escala de Automedición de la Depresión. Para su análisis se dividieron en tres grupos: de gestantes sanas sin antecedentes de pérdidas perinatales (grupo 1); diabéticas con pérdidas perinatales (grupo 2); diabéticas sin pérdidas perinatales (grupo 3). Análisis Estadístico: Los resultados de las pruebas se compararon por medio de la prueba "t" de student, regresión simple. Resultados. El 21 por ciento presentó depresión; en el análisis de varianza para el grupo 1 se detectaron 3 factores que explican el 58 por ciento de la varianza que son la ansiedad estado, la ansiedad rasgo y las semanas de gestación. Para el grupo 2 un factor, ansiedad rasgo que y las semanas de gestación. Para el grupo 2 un factor, ansiedad rasgo que explica el 37 por ciento y para el grupo 3, tres factores que explican el 70 por ciento de la varianza que son la ansiedad rasgo, las semanas de gestación y el número de gestas. Conclusiones. La depresión está presente como una manifestación de la enfermedad crónica más que como característica de las pérdidas perinatales