RESUMO
INTRODUCTION: The thyroid function of the pretern infant is altered by the relative immaturity of the hypothalamus-pituitary thyroid gland axis, along with other factors such as the incidence of diseases or the use of some drugs. Currently, there is controversy over normal levels of free thyroxine (FT4) in preterm infants. Our objective was to determine the distribution of FT4 and TSH values in newborn younger than 32 weeks or 1500 g of birth weight at 15 days of chronological age, in the neonatology service at Dr. Hernán Henríquez Aravena Hospital, Temuco. PATIENTS AND METHOD: Cross-sectional study; the results of FT4 and TSH from a database of 308 newborns, were analyzed, which were categorized into three gestational age ranges, 31-34, 28-30 and 23-27 weeks. It was used Pearson Chi-square for comparisons between categorical variables, and T-Test or ANOVA for categorical-variable ratios. RESULTS: Significant differences were observed between the average values of FT4 by gestatio nal age ranges (p = 0.000), these were 1.13 ng/dl for the range of 31 to 34 weeks, 1.03 ng/dl for the range of 28 to 30 weeks and 0.92 ng/dl for the range of 23 to 27 weeks; we did not observe significant differences in TSH levels by gestational age categories (p = 0.663). CONCLUSIONS: We established the distribution of FT4 and TSH levels in our population of very preterm and extremely preterm infants, finding differences with previous papers.
Assuntos
Lactente Extremamente Prematuro/sangue , Tireotropina/sangue , Tiroxina/sangue , Biomarcadores/sangue , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Valores de Referência , Estudos RetrospectivosRESUMO
INTRODUCCIÓN: La función tiroidea del prematuro se ve alterada por la relativa inmadurez del eje hipotálamo-hipófisis-tiroides, junto a otros factores como la incidencia de enfermedades o el uso de algunos fármacos. Actualmente existe controversia sobre los niveles normales de tiroxina libre (T4L) en recién nacidos prematuros. Nuestro objetivo fue determinar la distribución de los valores de hormonas T4L y TSH, en recién nacidos menores de 32 semanas o 1.500g de peso al nacer, a los 15 días de edad cronológica, en el servicio de neonatología Hospital Dr. Hernán Henríquez Aravena, Temuco. Pacientes y MÉTODO: Estudio de corte trasversal, se analizaron los resultados de T4L y TSH desde una base de datos a 308 recién nacidos, los que fueron categorizados en tres rangos de edad gestacional: 31 a 34, 28 a 30 y 23 a 27 semanas. Se utilizó Chi-cuadrado de Pearson para asociaciones entre variables categóricas, y T-Test o ANOVA para comparaciones entre variables continuas. RESULTADOS: Observamos diferencias significativas entre los valores promedio de T4L por rangos de edad gestacional (p = 0,000), estos fueron 1,13 ng/dl para el rango de 31 a 34 semanas, 1,03 ng/dl para el rango de 28 a 30 semanas y 0,92 ng/dl para el rango de 23 a 27 semanas; no observamos diferencias significativas en los niveles de TSH por categorías de edad gestacional (p = 0,663). CONCLUSIONES: Establecimos la distribución de los niveles de T4L y TSH en nuestra población de recién nacidos muy prematuros y prematuros extremos, encontrando diferencias con reportes anteriores.
INTRODUCTION: The thyroid function of the pretern infant is altered by the relative immaturity of the hypothalamus-pituitary thyroid gland axis, along with other factors such as the incidence of diseases or the use of some drugs. Currently, there is controversy over normal levels of free thyroxine (FT4) in preterm infants. Our objective was to determine the distribution of FT4 and TSH values in newborn younger than 32 weeks or 1500 g of birth weight at 15 days of chronological age, in the neonatology service at Dr. Hernán Henríquez Aravena Hospital, Temuco. PATIENTS AND METHOD: Cross-sectional study; the results of FT4 and TSH from a database of 308 newborns, were analyzed, which were categorized into three gestational age ranges, 31-34, 28-30 and 23-27 weeks. It was used Pearson Chi-square for comparisons between categorical variables, and T-Test or ANOVA for categorical-variable ratios. RESULTS: Significant differences were observed between the average values of FT4 by gestatio nal age ranges (p = 0.000), these were 1.13 ng/dl for the range of 31 to 34 weeks, 1.03 ng/dl for the range of 28 to 30 weeks and 0.92 ng/dl for the range of 23 to 27 weeks; we did not observe significant differences in TSH levels by gestational age categories (p = 0.663). CONCLUSIONS: We established the distribution of FT4 and TSH levels in our population of very preterm and extremely preterm infants, finding differences with previous papers.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Tiroxina/sangue , Tireotropina/sangue , Lactente Extremamente Prematuro/sangue , Valores de Referência , Biomarcadores/sangue , Estudos Transversais , Estudos Retrospectivos , Idade GestacionalRESUMO
Biological therapy plays an important role in the treatment of inflammatory bowel disease (IBD). However, the use of these drugs is limited due to fears about their side effects. Aim: To report the experience with the use of infliximab/adalimumab in IBD patients in a public hospital. Material and Methods: Descriptive study of a historical cohort of IBD patients treated with infliximab and adalimumab between April 2012 and July 2014. The clinical response was considered favourable when general, intestinal and extra intestinal symptoms subsided after the induction therapy. In addition, endoscopic and/or imaging response was evaluated at three and six months of treatment. Results: Fifteen out of 162 patients, aged 17 to 52 years (7 women) were included. Seven had Crohn´s Disease, 7 had ulcerative colitis and one had non-classifiable IBD. Biological therapy was indicated due to conventional refractory disease in all patients. All patients received combined treatment with immunosuppressive medications. A favorable clinical response was observed in 93 percent after induction therapy and 73 percent showed endoscopic/imagining remission after 3-6 months. Only one patient experienced side effects associated to the biological therapy, which did not result in discontinuation or treatment interruption. Conclusions: In this cohort of IBD patients treated in a public hospital, the use of infliximab/adalimumab was associated with favorable clinical and endoscopic evolution, post induction therapy with no major side effects.
La terapia biológica tiene un papel fundamental en el tratamiento de la enfermedad inflamatoria intestinal (EII). Sin embargo, el uso de estos fármacos es escaso debido a los costos y los temores sobre los efectos secundarios. Objetivo: Dar a conocer la experiencia en el uso de infliximab/adalimumab en pacientes con EII atendidos en un hospital público de nuestro país. Material y Métodos: Estudio descriptivo de una cohorte histórica de pacientes con EII tratados con infliximab y adalimumab entre abril de 2012 y julio de 2014. La respuesta clínica fue considerada favorable cuando los síntomas generales, intestinales y extra-intestinales desaparecieron después de la terapia de inducción. Además se evaluó la respuesta endoscópica/radiológica a los 3 y 6 meses de tratamiento. Resultados: De un total de 162 pacientes con EII, 15 fueron tratados con terapia biológica, con edad entre 17-52 años (7 mujeres). Siete presentaban el diagnóstico de enfermedad de Crohn, siete colitis ulcerosa y uno EII no clasificable. En todos se inició terapia biológica debido a la presencia de refractariedad a la terapia convencional. Todos recibieron terapia combinada con inmunosupresores. Se observó una respuesta clínica favorable en 93 por ciento después de la terapia de inducción y 73 por ciento tuvo una mejoría endoscópica después de 3-6 meses. Sólo un paciente presentó un evento adverso a terapia biológica, el cual no motivó la interrupción del tratamiento. Conclusiones: En esta cohorte de pacientes con EII tratados en un hospital público, el uso de infliximab/adalimumab se asoció con mejoría clínica y endoscópica post terapia de inducción, sin mayores efectos secundarios.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Feminino , Pessoa de Meia-Idade , Anti-Inflamatórios , Anticorpos Monoclonais/uso terapêutico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Anticorpos Monoclonais Humanizados/uso terapêutico , Terapia Biológica , Colite Ulcerativa/tratamento farmacológico , Epidemiologia Descritiva , Doença de Crohn/tratamento farmacológicoRESUMO
This article attempts to clarify Francisco Varela's proposal of a neurophenomenology of time consciousness in the light of distinctions based on the philosophical literature of phenomenology and recent advances of neurobiology. The analysis is carried out considering three aspects. In the first of them, we discuss the phenomenological aspect of consciousness, accessible in first-person, which describes time as a structure with three inseparable moments (past-present-future) and three levels of temporality, and not merely as the chronometric time or clock time. In the second one, we analyze the neurobiological aspect of consciousness that tends to "explain" the phenomenological time in terms of three possible levels of neuronal integration. Thus, we propose a correspondence between the levels of phenomenological time and neural integration processes. Finally, we try to analyze this "correspondence" and the issues that follow from this by considering that the notion of time in this correspondence is, in essence, the clock time and not the phenomenological time consciousness.
Assuntos
Estado de Consciência , Tempo , NeurobiologiaRESUMO
BACKGROUND: Most Chagas patients belong to the chronic indeterminate stage, in which pharmacological treatment has an inconclusive outcome. OBJECTIVE: To evaluate the efficacy of nifurtimox treatment in chronic asymptomatic Trypanosoma cruzi infection. METHODS: We performed a systematic review and meta-analysis of electronically published literature, with no language, type of study, age or gender restrictions, until September 2010. Studies of chronic asymptomatic Chagas disease patients treated exclusively with nifurtimox were included in the analysis. Treatment efficacy was evaluated using parasitological or serological parameters. RESULTS: Of 463 identified studies, 7 were finally selected: 6 observational studies and 1 randomized clinical trial; 4 of the studies were in adults, 3 in children < 14 years. In 6 studies, outcomes were defined by serological techniques. Summary estimate (log odds) was 0.37 (CI9 -1.32 - 2.07). CONCLUSIONS: The analyzed studies gave discordant results. Those might be explained by differences in the populations studied, follow-up periods, diagnostic techniques, and sample size. More studies are necessary to obtain conclusive results about treatment efficacy of nifurtimox in this clinical phase of T. cruzi infection.
Assuntos
Doença de Chagas/tratamento farmacológico , Nifurtimox/uso terapêutico , Tripanossomicidas/uso terapêutico , Adulto , Criança , Doença Crônica , Humanos , Resultado do TratamentoRESUMO
Background: Most Chagas patients belong to the chronic indeterminate stage, in which pharmacological treatment has an inconclusive outcome. Objective: To evaluate the efficacy of nifurtimox treatment in chronic asymptomatic Trypanosoma cruzi infection. Methods: We performed a systematic review and meta-analysis of electronically published literature, with no language, type of study, age or gender restrictions, until September 2010. Studies of chronic asymptomatic Chagas disease patients treated exclusively with nifurtimox were included in the analysis. Treatment efficacy was evaluated using parasitological or serological parameters. Results: Of 463 identified studies, 7 were finally selected: 6 observational studies and 1 randomized clinical trial; 4 of the studies were in adults, 3 in children < 14 years. In 6 studies, outcomes were defined by serological techniques. Summary estimate (log odds) was 0.37 (CI9 -1.32 - 2.07). Conclusions: The analyzed studies gave discordant results. Those might be explained by differences in the populations studied, follow-up periods, diagnostic techniques, and sample size. More studies are necessary to obtain conclusive results about treatment efficacy of nifurtimox in this clinical phase of T. cruzi infection.
Introducción: La mayoría de los pacientes con enfermedad de Chagas se encuentran en fase crónica indeterminada donde los resultados de tratamiento farmacológico no han sido concluyentes. Objetivo: Evaluar la evidencia que apoya la eicacia del tratamiento con nifurtimox en la infección crónica por Trypanosoma cruzi asintomática. Método: Revisión sistemática y meta-análisis de literatura publicada en forma electrónica, sin restricción de lenguaje, tipo de estudio, edad y género, hasta septiembre de 2010. Se incluyeron estudios de pacientes con enfermedad de Chagas crónica asintomáticos que recibieron tratamiento exclusivo con nifurtimox. La eicacia del tratamiento fue evaluada mediante métodos parasitológicos o serológicos. Resultados: Se identiicaron 463 estudios primarios seleccionando inalmente siete: seis observacionales y un ensayo clínico randomizado; cuatro en pacientes adultos y tres en niños bajo14 años de edad. En seis estudios los resultados se midieron mediantes técnicas serológicas. La medida resumen (log de la chance) fue de 0,37 (IC95% -1,32 -2,07). Conclusiones: Los resultados son discordantes. La incertidumbre se maniiesta por las diferencias en las poblaciones estudiadas, periodos de seguimiento, técnicas diagnósticas y tamaño de las muestras. Es necesario realizar nuevos estudios que consideren las fuentes de incertidumbre para obtener resultados concluyentes sobre la eicacia del nifurtimox en esta fase clínica de la infección por T. cruzi.
Assuntos
Adulto , Criança , Humanos , Doença de Chagas/tratamento farmacológico , Nifurtimox/uso terapêutico , Tripanossomicidas/uso terapêutico , Doença Crônica , Resultado do TratamentoRESUMO
Introducción: La obesidad y el síndrome de apnea/hipopnea del sueño (SAHOS) son factores de riesgo cardiovascular (FRCV). El principal síntoma del SAHOS es somnolencia diurna excesiva (SDE), evaluable con la Escala de Epworth (EE). Objetivos: Determinar prevalencia de SDE en población con FRCV. Establecer la asociación entre SDE y FRCV. Método: estudio transversal efectuado durante los a±os 2006 y 2007 en una población con FRCV del Hospital Gustavo Fricke. Se consideraron mediciones antropométricas y un cuestionario que incluyó Escala de Epworth (EE). Resultados: La prevalencia de SDE por EE fue 22,12 por ciento. La hipertensión arterial, dislipidemia y diabetes mellitus 2 no tuvieron diferencias respecto a EE. Se asociaron significativamente a SDE: una circunferencia de cuello y cintura (p=0,0277 y 0,0008 respectivamente), índice de masa corporal (p=0,014) y ronquidos (p=0,05), reporte de episodios apneicos (p=0,005), sensación de sueño fragmentado (p=0,006) y antecedente de IAM (p=0,026) OR=3.4 (IC95 por ciento 1,22-8,59). Discusión: La prevalencia de SDE encontrada concuerda con la literatura. Las asociaciones encontradas convierten al fenotipo característico y la EE en una evaluación fácil y económica para pesquisar SDE e iniciar el estudio de SAHOS.
Introduction: Obesity and sleep apnoea-hypopnoea syndrome (SAHOS) are risk factors for cardiovascular disease (RFCVD) The ntain symptom of SAHOS is excessive daily sleepiness (EDS), measurable through Epworth Scale (ES). Objective: To determine the association between EDS and RFCVD and to establish association between SDE and RFCVD. Methods: A cross-sectional study was done during 2006 and 2007 in a population with FRCVD at Hospital Gustavo Fricke, Viña del Mar. Anthropometrical measurements were taken and a questionnaire was applied including ES. Results: SDE prevalence measured by EE was 22.12 percent. Prevalence of hypertension, dyslipidemia and diabetes mellitus 2 had no significant differences. Variables significantly associated to SDE were neck and waist circumference (p=0,0277 and p=0,0008 respectively), body mass index (p=0,014) and snoring (p=0,05), reports of previous apnoea episodes (p=0,005), sensation of fragmented sleep (p=0,006) and previous history of myocardial infarction (p=0,026) OR=3.4 (IC95 percent 1,22-8,59). Discussion: The prevalence found at this study agrees with the literature and the associations found make evaluation and determination of characteristic phenotype an easy and cheap method in order to screen and treat SAHOS.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Distúrbios do Sono por Sonolência Excessiva , Doenças Cardiovasculares/etiologia , Obesidade/complicações , Inquéritos e Questionários , Síndromes da Apneia do Sono/complicações , Antropometria , Estudos Transversais , Chile/epidemiologia , Distúrbios do Sono por Sonolência Excessiva , /complicações , Dislipidemias/complicações , Hipertensão/complicações , Prevalência , Medição de Risco , Síndromes da Apneia do Sono/epidemiologiaRESUMO
Introducción: Estimar la prevalencia de retención urinaria aguda en el Programa de Cirugía mayor ambulatoria con anestesia espinal, e identificar los principales factores de riesgo para su desarrollo. Material y método: Estudio descriptivo de casos y controles. De 859 pacientes operados en programa de cirugía mayor ambulatoria entre abril 2003 y julio 2006, se seleccionaron 652 pacientes sometidos a cirugía con anestesia espinal. Los casos fueron 18 pacientes que desarrollaron retención urinaria aguda y 45 controles seleccionados al azar de los pacientes sin complicaciones en el postoperatorio. Se analizó estadística por pruebas estándares. Resultados: La prevalencia de retención urinaria aguda fue 2,76 por ciento. Se asociaron significativamente al desarrollo de retención urinaria aguda en postoperatorio las variables sexo masculino, p =0.026 OR =5.76 (IC 95 por ciento 1.17-28.24), edad sobre 50 años p =0.046 OR =3.14 (IC 95 por ciento 1.01-9.86) y cirugía hemiaria p =0.001 OR =7.59 (IC 95 por ciento 1.71-33.61). En todos los casos se manejó con cateterismo intermitente y la prolongación de estadía hospitalaria fue de un día en el 91 por ciento de los casos, y dos en el resto.
Background: The identified risk factors for acute urinary retention after spinal anesthesia are the dose and duration of anesthesia, old age and ano rectal surgical procedures. Aim: To assess the prevalence and risk factors of acute urinary retention in the program of ambulatory surgery with spinal anesthesia. Material and methods: Descriptive case control study. The medical records of 859 patients operated with spinal anesthesia between 2003 and 2006 were reviewed, and 18 patients aged 52 + 16 years, that had an acute urinary retention, were identified. Forty vive randomly chosen patients aged 46 + 14 years, without urinary retention were analyzed as controls. Results: The calculated prevalence of acute urinary retention was 2.8 percent. Male sex, an age over 50 years and hernia surgery were identified as risk factors for urinary retention with odds ratios of 5.8 (95 percent confidence interval (Cl) 17-28), 3.1 (95 percentCI 1.-9.9) and 7.6 (95 percentCI 1.7-33.6), respectively. All cases were managed with intermittent catheterization. Hospital stay was one day in 91 percent and two days in the rest. Conclusions: in this series, acute urinary retention occurred in 2.8 percent of patients after spinal surgery. Male sex, age over 50 years and hernia repair procedures were identified ads risk factors for the complication.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Ambulatórios , Raquianestesia/efeitos adversos , Retenção Urinária/epidemiologia , Retenção Urinária/etiologia , Doença Aguda , Fatores Etários , Estudos de Casos e Controles , Chile/epidemiologia , Complicações Pós-Operatórias/etiologia , Epidemiologia Descritiva , Prevalência , Fatores de Risco , Interpretação Estatística de DadosRESUMO
La evaluación de la calidad de vida en la enfermedad pulmonar obstructiva crónica (EPOC) mediante cuestionarios de disnea es una recomendación presente en la mayoría de las guías crónicas de manejo de la enfermedad, tanto como en el estudio de nuevas drogas. A 26 pacientes portadores de EPOC categorías 2 a 4, controlados en el policlínico de enfermedades respiratorias del Hospital Dr. Gustavo Fricke de Viña del Mar, se les realizó una espirometría basal y post-broncodilatador, el Saint George Respiratory Questionnaire (SGRQ) versión en español adaptada y una caminata de 6 minutos, de acuerdo con norma ATS (6MWT). El análisis estadístico de estas variables muestra una mejor correlación de SGRQ con 6MWT (rho=0.58) más que con VEF1 post-bd. (rho=0.511). La correlación del VEF1 post-broncodilatador con SGRQ es sólo significativa para la categoría síntomas (rho=0.63 p=0.0007), no para impacto en la calidad de vida ni en la actividad, resultados que son comparables a los descritos en la literatura.
The evaluation of the quality of life in chronic obstructive pulmonary disease (COPD) patients using questionnaires of dyspnea, is a recommendation present in most of the clinical guidelines for the management of the disease and for the study of new drugs. The study included 26 patients with COPD, categories 2 to 4, controlled in the respiratory diseases clinic at Gustavo Fricke Hospital in Viña del Mar. Studies applied to them included a pre and post-brochodilator spirometry, a saint George Respiratory Questionnaire (SGRQ) (spanish adapted version), and the six-minute walk test (6MWT) according to ATS guidelines. Statistical analysis showed a better correlation between SGRQ and 6MWT (rho = 0.58), than with FEV1 post-bronchodilator (rho = o.511). The correlation of FEV1 post-bronchodilatador with SGRQ is only significant for the category of symptoms (rho = 0.63; p = 0.0007), not for the impact in the quality of life and activity, results that are comparable to those described in literature.
Assuntos
Humanos , Qualidade de Vida/psicologia , Doença Pulmonar Obstrutiva Crônica/patologia , Doença Pulmonar Obstrutiva Crônica/psicologia , Inquéritos e Questionários , Doenças Respiratórias/diagnósticoRESUMO
Se realiza la programación para la distribución de antibióticos de primera línea (Amoxicilina y Cotrimoxazol) con destino a los 6 centros penitenciarios donde actualmente se interviene para la búsqueda de Sintomáticos Respiratorios en las cárceles e identificación de Pacientes con patología pulmonar y tuberculosis en los centros penitenciarios, manejo de Sintomáticos Respiratorios
Assuntos
Masculino , Feminino , Humanos , Adulto , Abscesso Pulmonar , Adulto , Atenção à Saúde , Saúde do Adulto , BolíviaRESUMO
Two in-series columns systems with volcanic soil were tested for wastewater pollutants adsorption capacity. The first system was tested with acidified volcanic soil and the second with a reactivated volcanic soil. The reactivated soil was obtained by washing the previous spent acidified soil system with an acid solution. The systems parameters were obtained using the Bohardt and Adams model for fixed-beds. The acidified soil parameters indicated an adsorption capacity q of 28 and 139 mg/g of phenolic compounds and color, respectively (for each column), compared to 12 and 39 mg/g for the reactivated soil system. The adsorption rate constant k ranged between 1.5x10(-6) and 2.8x10(-6) l/min mg and no significant difference was observed for each analysed column system and pollutant. Furthermore, the molecular weight distribution analysis of input and output samples of one acidified soil column indicated that the fraction >30000 Da is the most adsorbed until the breakpoint. Moreover, the CODs and tannins and lignin removal efficiencies at the breakpoint reached values between 60% and 70% in each column and each system, indicating that lower biodegradable compounds were retained effectively. The results indicate that it is possible to compare the acidified volcanic soil adsorption capacity with natural zeolites, and a preliminary costs evaluation indicates that volcanic soil could be also competitive, even when comparing with activated carbon.
Assuntos
Resíduos Industriais , Papel , Solo , Eliminação de Resíduos Líquidos/métodos , Poluentes Químicos da Água/isolamento & purificação , Adsorção , Carbono/química , Chile , Cor , Lignina/química , Lignina/isolamento & purificação , Oxigênio/análise , Fenóis/química , Fenóis/isolamento & purificação , Solo/análise , Taninos/química , Taninos/isolamento & purificação , Eliminação de Resíduos Líquidos/economiaRESUMO
La Incontinencia Urinaria (IU) es un problema que afecta significativamente la calidad de vida de laspersonas. Conocer la prevalencia de la IU es importante para planificar estrategias de salud en laspacientes y su tratamiento. El objetivo de este estudio es conocer la realidad de este problema en unaregión aislada de nuestro país con un acceso limitado al sistema de salud.Se confeccionó encuesta que incluyó preguntas en relación a la edad, presencia de IU, tipo de IU y gradode molestia, además, conocimiento del problema y consulta profesional. Ésta fue contestada anónimamentepor mujeres mayores de 30 años, que asistieron al Hospital y Centro del Adulto Mayor de Rapa Nui,durante el operativo de salud del Hospital FACH, en el mes de junio del año 2003.Doscientas treinta y seis mujeres entre 30 y 84 años contestaron la encuesta, que corresponde al 26,3 porciento de la población femenina en este rango de edad, con una edad promedio de 47,2 años. Ciento ochenta y dos(77,1 porciento) refieren episodios de IU, de éstas, 119 (50,4 porciento) manifiestan tener IU que afecta su calidad de vida. Sólo el 39 porciento sabe que este problema tiene tratamiento y 26,8 porciento de los pacientes ha consultado.Estos resultados muestran que en esta población existe una alta prevalencia de IU, que afecta a todos losgrupos etarios y que existe poca información sobre este problema...
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Incontinência Urinária/diagnóstico , Incontinência Urinária/epidemiologia , ChileRESUMO
En el presente estudio se revisa una serie de casos 12 pacientes con 13 fracturas de fémur los cuales se utilizó la técnica de osteosíntesis intra medular por vía retrógrada, una técnica relativamente rápida y poco invasiva lo que la hace útil en el manejo de pacientes con múltiples traumas. Dos de los pacientes estudiados mueren en las primeras 48 horas consecuencia de la severidad del trauma, razón por la cual fueron excluidos del estudio. Dos pacientes presentaron fracturas de fémur bilateral, pero en dichos pacientes se estudio solo una fractura dado que en uno se utilizó un clavo flexible un portal extra articular y en el otro se colocó un clavo por vía anterógrada. En vista de tales resultados finalmente se estudiaron 10 pacientes y 10 fracturas. A los que se les dio seguimiento entre 16 y 30 semanas. Se encontró que: el 90 porciento de los pacientes fueron varones; el 80 porciento mayores de 50 años; el 50 porciento de las fracturas fueron extra articulares. Al 90 porciento fueron tratadas con clavos con bloqueo dinámico. A pesar de lo antes mencionado se encontró una tasa de unión de 100 porciento. De esta el 70 porciento consolidó entre las 15 y 24 semanas; a pesar de no haber utilizado el implante adecuado. Se concluyó que la osteosíntesis intra medular por la vía retrógrada es una alternativa alentadora para su uso en el paciente politraumatizado...
Assuntos
Adulto , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas , Fraturas do Fêmur/mortalidade , Traumatologia , NicaráguaRESUMO
Washbasins and metal drums are important sources of Aedes aegypti mosquitoes in much of Latin America. When manual cleaning was found to be ineffective in eliminating mosquito larvae in a community-based control programme in El Progreso, Honduras, it was decided to develop and evaluate an improved method of removing mosquito eggs based on commonly-available materials. The method, named La Untadita ('The Little Dab', in English), consists of five steps: mixing chlorine bleach and detergent to make a paste, applying the mixture to the walls of the container, waiting 10 min, scrubbing with a brush, and finally rinsing with water. A field trial of the Untadita was conducted in 13 peri-urban neighbourhoods. At the first post-intervention survey, in spite of high levels of exposure to the community-based intervention, high levels of knowledge regarding the Untadita and high levels of its reported use, little or no impact was discernable on mosquito larvae and pupae. The method was then modified by increasing the recommended quantities of bleach and detergent and simplifying the instructions. In the second post-intervention survey, knowledge of the steps and their order increased further; the intervention neighbourhoods had significantly fewer algae on washbasin walls, an indicator of more effective cleaning; and numbers of pupae and 3rd and 4th instar larvae were significantly lower than in untreated neighbourhoods. Effective promotion of the Untadita should be able to control mosquito infestation in many washbasins, especially those in frequent use, thus reducing the need for chemical and biological larvicides that may be either more costly or less acceptable to householders.
Assuntos
Aedes , Detergentes , Utensílios Domésticos , Controle de Mosquitos , Hipoclorito de Sódio , Animais , Conhecimentos, Atitudes e Prática em Saúde , Honduras , Humanos , Larva , Óvulo , PupaRESUMO
Esta es una investigación que permite identificar algunas líneas de acción para la gestión de recurso humanos en los Ministerio de Salud de Centroamérica y República Dominicana, en el marco de la Reforma del Sector Salud. Se trata de integrar una visión de conjunto entre la administración de personal, la capacitación, la organización del trabajo y la evolución organizacional de los Servicios de Salud. Mediante estas cuatro fases se sistematiza el desarrollo de la gestión de los recursos humanos y, a partir de ellas, se tratan de deslindar los retos que se le imponen
Assuntos
América Central , República Dominicana , Mão de Obra em SaúdeRESUMO
Adult T-cell lymphoma (ATL) is a neoplastic disease associated in 80% of cases with HTLV-I (Human T Lymphotropic virus type I) infection. 1-2% of HTLV-I carriers may develop the disease during their lives. In our country, the prevalence of HTLV-I infection is about 1%. We report a 72 y.o. woman HTLV-I positive, confirmed by Western-Blot. presenting with massive adenopathies, cutaneous tumor involvement, acute course and showing Reed-Sternberg cells (RSCs) in lymph node biopsy. The response to chemotherapy was poor, with the patient dying seven months after diagnosis. ATL and Hodgkin's disease (HD) are discussed highlighting that RSCs are not pathognomonic of HD though in their absence such diagnosis can not be made. RSCs are found in other benign and malignant disorders and it is especially important to differentiate HD from the other processes in order to dispense the appropriate treatment. This is the first case of ATL with RSCs reported in Chile. Hence, in our country we suggest systematic determination of the presence of HTLV infection when histopathology is compatible with HD and Non Hodgkin Lymphoma.
Assuntos
Linfoma de Células T/patologia , Células de Reed-Sternberg/patologia , Idoso , Diagnóstico Diferencial , Feminino , Doença de Hodgkin/patologia , Vírus Linfotrópico T Tipo 1 Humano/isolamento & purificação , Humanos , Linfoma de Células T/virologia , PrognósticoRESUMO
Nine of 15 boys with severe long-standing primary hypothyroidism were found to have macroorchidism. All 15 patients had elevated thyroid-stimulating hormone levels. However, only those patients with testicular enlargement had striking elevations of serum prolactin and gonadotropin values. The response to gonadotropin-releasing hormone in our patients was blunted, in contradistinction to that of children with true precocious puberty. In spite of the elevated levels of luteinizing hormone, the serum testosterone levels were in the prepubertal range, explaining the lack of peripheral manifestations of androgenic effect. Improvement of testosterone secretion followed decreasing prolactin levels with bromocriptine administration, suggesting an inhibitory effect of prolactin on luteinizing hormone action at the Leydig cell. We conclude that testicular enlargement is the result of continuous follicle-stimulating hormone stimulation and that the term "true precocious puberty" is not appropriate in children with hypothyroidism and macroorchidism unless the hypothalamic-pituitary gonadal axis is shown to be at the pubertal stage.
Assuntos
Sistema Hipotálamo-Hipofisário/fisiopatologia , Hipotireoidismo/fisiopatologia , Sistema Hipófise-Suprarrenal/fisiopatologia , Testículo/patologia , Adolescente , Bromocriptina/uso terapêutico , Criança , Gonadotropina Coriônica , Hormônio Foliculoestimulante/sangue , Humanos , Hipotireoidismo/patologia , Hormônio Luteinizante/sangue , Masculino , Hormônios Liberadores de Hormônios Hipofisários , Prolactina/sangue , Testosterona/sangue , Tireotropina/sangue , Tiroxina/uso terapêuticoRESUMO
Sixteen prepubertal children with constitutional growth delay (10 boys and six girls, mean age 7.2 +/- 2.1 years) were administered a daily dose of clonidine (0.15 mg/m2) for a period of 1 year. Growth hormone levels, plasma somatomedin C, and linear growth rate were significantly increased at the end of the treatment. Six of the children maintained the higher growth rate even 6 months after treatment. These and other studies suggest that prolonged stimulation of the hypothalamus by clonidine may ameliorate the impairment of growth hormone release seen in some children with constitutional growth delay. Because of the low cost and the convenience of the oral route, administration of clonidine could be a mode of treatment in some children with poor growth.