RESUMO
Introducción: Las fracturas de escápula tienen una baja frecuencia, se presentan mayoritariamente en población joven tras traumatismos de alta energía. Su tratamiento historicamente ha sido conservador, sin embargo, el tratamiento quirúrgico ha demostrado mejores resultados funcionales en pacientes seleccionados, siendo la indicación quirúrgica aún controversial. La literatura sobre los pacientes tratados de forma quirúrgica es escasa. Objetico general: Caracterizar a los pacientes operados por fractura de escapula en Hospital Traumatológico de Concepción durante los años 2019-2022. Materiales y métodos: Estudio descriptivo que incluye a pacientes operados por fractura de escápula en el Hospital Traumatológico de Concepción durante los años 2019 al 2022, considerando las variables sexo, edad, lateralidad, mecanismo de lesión y lesiones asociadas. Resultados: Se estudiaron 20 pacientes de los cuales 90% fueron hombres, registrándose un promedio de edad de 41 años, sin diferencias significativas en su lateralidad. Los principales mecanismos de lesión fueron accidentes de tránsito y caídas de altura, existiendo lesiones asociadas sólo en 45% de los casos. Conclusión: Las fracturas de escápula tienen alto impacto en la funcionalidad de la extremidad afectada, por lo que su tratamiento hoy en día esta evolucionando hacia uno quirúrgico en pacientes seleccionados, con el fin de obtener mejores resultados funcionales. Los pacientes operados son mayoritariamente adultos de edad media de sexo masculino, con fracturas secundarias a traumatismos de alta energía y presencia de lesiones asociadas de baja morbimortalidad.
Introduction: Scapula fractures have a low frequency. They occur mainly in the young population after high-energy trauma. Its treatment has historically been conservative; however, surgical treatment has shown better functional results in selected patients, the surgical indication being still controversial. The literature on patients treated surgically is scarce. General Objective: Characterize the patients operated on for scapular fracture at the Hospital Traumatológico de Concepción during the years 2019-2022. Materials and methods: Descriptive study that includes patients operated on for scapula fracture at the Concepción Trauma Hospital during the years 2019 to 2022, considering the variables sex, age, laterality, mechanism of injury and associated injuries. Results: Twenty patients were studied, of whom 90% were men, recording an average age of 41 years, with right scapula fracture being slightly more frequent than left. The main mechanisms of injury were traffic accidents and falls from a height, with associated injuries only in 45% of the cases. Conclusion: Scapula fractures have a high impact on the functionality of the affected limb, so their treatment today is evolving towards surgery in selected patients, in order to obtain better functional results. The patients operated on are mostly middle-aged male adults, with fractures secondary to high-energy trauma and the presence of associated lesions with low morbidity and mortality.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Escápula/lesões , Fraturas Ósseas , Chile/epidemiologia , Epidemiologia DescritivaRESUMO
OBJECTIVES: To determine the level of readiness of the healthcare team regarding family participation in the care of the critically ill adult and their relationship with the individual characteristics of the participants in a medical-surgical intensive care unit (ICU) in Santiago de Chile. METHOD: A cross-sectional correlational study using a quantitative method and including a focus group to explore the perception of healthcare staff of family participation in the care of the critically ill patient. RESULTS: The level of readiness of the healthcare team for family participation in the care of the critically ill patient is medium, at 13.81 out of a total 20. The greater the readiness, the lower the age (râ¯=â¯-0.215; Pâ¯=â¯0.019), the higher the rating of previous experience working with families (râ¯=â¯0.304; Pâ¯=â¯0.006), and the higher the perception of being comfortable with different activities in the care of the critical patient (râ¯=â¯0.495: Pâ¯<â¯0.001). The participants also state that the work environment of the unit, the patient's condition, the relatives' characteristics, personal judgement, and the preparedness of relatives affect their readiness. CONCLUSIONS: The results contribute towards determining the healthcare team's level of readiness in a setting where the subject of the study has not been implemented. The readiness of the healthcare team is medium, and is related to individual characteristics of the healthcare staff, and to organizational and family aspects. Therefore, strategies are required to address these aspects that might increase readiness.
Assuntos
Estado Terminal , Unidades de Terapia Intensiva , Adulto , Humanos , Estudos Transversais , Estado Terminal/terapia , Grupos Focais , Equipe de Assistência ao PacienteRESUMO
The rat vas deferens has scattered sensory afferens plus a dense network of sympathetic motor efferens; these fibers are not known to interact functionally. We ascertained whether sensory fibers modulate the release of sympathetic transmitters through the release of calcitonin gene-related peptide (CGRP) and reciprocally assessed whether sympathetic transmitters modulate the overflow of ir-CGRP from sensory fibers. The tissue overflow of electrically evoked sympathetic co-transmitters (ATP/metabolites, noradrenaline (NA), and immunoreactive neuropeptide tyrosine (ir-NPY)) and the motor responses elicited were quantified following either exogenous CGRP or capsaicin application to elicit peptide release. Conversely, the outflow of ir-CGRP was examined in the presence of sympathetic transmitters. Exogenous CGRP reduced in a concentration-dependent manner the electrically evoked outflow of ATP/metabolites, NA, and ir-NPY with EC(50) values of 1.3, 0.18, and 1.9 nM, respectively. CGRP also reduced the basal NA overflow. The CGRP-evoked modulation was blocked by CGRP8-37 or H-89. Release of endogenous CGRP by capsaicin significantly reduced the basal overflow of NA, ir-NPY, and the electrically evoked sympathetic transmitter release. ADP, 2-methylthioadenosine-5'-O-diphosphate (2-MeSADP), or UTP decreased the electrically evoked ir-CGRP overflow, whereas clonidine, α,ß-methyleneadenosine 5'-triphosphate (α,ß-mATP), or adenosine (ADO) were inactive. CGRP acting postjunctionally also reduced the motor responses elicited by exogenous NA, ATP, or electrically evoked contractions. We conclude that CGRP exerts a presynaptic modulator role on sympathetic nerve endings and reciprocally ATP or related nucleotides influence the release of ir-CGRP from sensory fibers, highlighting a dynamic sympatho-sensory control between sensory fibers and sympathetic nerve ending. Postjunctional CGRP receptors further contribute to reduce the tissue sympathetic motor tone implying a pre and postjunctional role of CGRP as a sympathetic tone modulator.
Assuntos
Peptídeo Relacionado com Gene de Calcitonina/metabolismo , Junção Neuroefetora/fisiologia , Nucleotídeos/metabolismo , Células Receptoras Sensoriais/fisiologia , Sistema Nervoso Simpático/fisiologia , Trifosfato de Adenosina/metabolismo , Animais , Masculino , Ratos , Ratos Sprague-DawleyRESUMO
Chitosan is a D-glucosamine polysaccharide derived from chitin that displays an antimicrobial activity against bacteria and fungi. Objective: to evaluate the antifungal effect of high molecular weight chitosan (HMWC) in clinical strains of Candida spp. Methodology: the susceptibility of forty strains of Candida spp. to HMWC was studied (16 C albicans, 11 C glabrata, 5 C. tropicalis, 5 C krusei, 2 C parapsilosis and 2 C.famatd) by broth microdilution at pH 7.0 and pH 4.0. Results: of 40 strains, only 2 were inhibited at pH 7.0 and corresponded to ATCC control strains (C. krusei 6258 and C parapsilosis 22019). On the other hand, 37/40 strains (92.5 percent) were inhibited by concentrations lower than 1.25 mg/mL of HMWC at pH 4.0. Conclusion: these results show that HMWC, presents activity against clinical Candida spp. strains, including C glabrata, and that this activity is present at acid pH (4.0). This compound could potentially be used in vulvovaginal candidiasis since it occurs at pH 4.0-4.5.
Assuntos
Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Quitosana/farmacologia , Antifúngicos/química , Contagem de Colônia Microbiana , Candida/classificação , Quitosana/química , Peso Molecular , Testes de Sensibilidade Microbiana/métodosRESUMO
Most surveillance studies have included invasive candidiasis from hospitalized patients. However, no national study has evaluated the species distribution and susceptibility to fluconazole of Candida species isolated from hospitalized and ambulatory patients. Atotal of 166 strains were collected consecutively during a 6 month period. Strains were isolated from vaginal fluid (73.5 percent), uriñe (7.8 percent), lower respiratory tract samples (7.8 percent), blood cultures (4.2 percent), sterile fluids (2.4 percent) and wounds (1.8 percent). Most of the isolates were obtained from ambulatory patients (71.1 percent). The species found were Candida albicans (78.9 percent), C glabrata (8.4 percent), C. tropicalis (6.0 percento), C.famata (1.8 percent), C krusei (1.8 percent), C parapsilosis (1.8 percent) and C. sake (1.2 percent). Fluconazole susceptibility was: 92.3 percento for C. albicans, 85.7 percent for C glabrata (most strains being dose-dependent susceptible), 100 percent) for C parapsilosis and 80 percent) for C tropicalis. Only susceptible strains were isolated from hospitalized children, whereas more resistant strains were isolated from ambulatory adults, mainly from vaginal fluid. In order to identify probable reservoirs of less susceptible strains such as C. glabrata, it would be necessary to include ambulatory isolates in future surveillance studies.
La mayoría de los estudios de vigilancia de levaduras del género Candida se realizan en candidiasis invasora en pacientes hospitalizados; sin embargo, no existen estudios que evalúen simultáneamente la distribución global de especies y susceptibilidad a fluconazol de cepas de Candida aisladas de pacientes hospitalizados y ambulatorios. Se analizaron 166 cepas de Candida, recolectadas consecutivamente en un período de 6 meses, las cuales fueron aisladas de flujo vaginal (73,5 por ciento), orina (7,8 por ciento), muestras respiratorias bajas (7,8 por ciento), hemocultivos (4,2 por ciento), líquidos estériles (2,4 por ciento) y heridas (1,8 por ciento). Un 71,1 por ciento provenía de pacientes ambulatorios. La especies aisladas fueron Candida albicans (78,9 por ciento), C glabrata (8,4 por ciento), C tropicalis (6,0 por ciento), Cfamata (1,8 por ciento), C. krusei (1,8 por ciento), C parapsilosis (1,8 por ciento) y C. sake (1,2 por ciento). Los porcentajes de sensibilidad a fluconazol fueron: 92,3 por cientoo para C. albicans, 85,7 por cientoo para C glabrata (siendo la mayoría sensible dosis dependiente), 100 por ciento) para C parapsilosis y 80 por cientoo para C tropicalis. En los niños, todos hospitalizados, se aislaron sólo cepas sensibles, mientras que en adultos ambulatorios se aislaron más cepas resistentes, fundamentalmente de flujo vaginal. Considerar cepas ambulatorias en futuros estudios de vigilancia permitirían dar cuenta de probables reservónos de cepas más resistentes, como C. glabrata.