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BACKGROUND: Obesity has been associated with reduced dexmedetomidine clearance, suggesting impaired hepatic function or reduced hepatic blood flow. The aim of this study was to clarify the effect of obesity in dexmedetomidine metabolic clearance. METHODS: Forty patients, ASA I-III, 18-60 yr old, weighing 47-126 kg, scheduled for abdominal laparoscopic surgery, were enrolled. Anaesthetic agents (propofol, remifentanil, and dexmedetomidine) were dosed based on lean body weight measured by dual X-ray absorptiometry. Serial venous samples were drawn during and after dexmedetomidine infusion. A pharmacokinetic analysis was undertaken using non-linear mixed-effect models. In the modelling approach, the total body weight, lean body weight, and adjusted body weight were first tested as size descriptors for volumes and clearances. Hepatic blood flow, liver histopathology, liver enzymes, and gene expression of metabolic enzymes (UGT2B10 and UGT1A4) were tested as covariates of dexmedetomidine metabolic clearance. A decrease in NONMEM objective function value (ΔOFV) of 3.84 points, for an added parameter, was considered significant at the 0.05 level. RESULTS: A total of 637 dexmedetomidine serum samples were obtained. A two-compartmental model scaled to measured lean weight adequately described the dexmedetomidine pharmacokinetics. Liver blood flow was a covariate for dexmedetomidine clearance (ΔOFV=-5.878). Other factors, including fat mass, histopathological damage, and differential expression of enzymes, did not affect the dexmedetomidine clearance in the population studied (ΔOFV<3.84). CONCLUSIONS: We did not find a negative influence of obesity in dexmedetomidine clearance when doses were adjusted to lean body weight. Liver blood flow showed a significant effect on dexmedetomidine clearance. CLINICAL TRIAL REGISTRATION: NCT02557867.
Assuntos
Tecido Adiposo/metabolismo , Dexmedetomidina/farmacocinética , Hipnóticos e Sedativos/farmacocinética , Obesidade/metabolismo , Adulto , Chile , Feminino , Humanos , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
INTRODUCTION: Ritscher-Schinzel syndrome (also known as cranio-cerebello-cardiac dysplasia or 3C syndrome) is a rare genetic syndrome that is mainly characterised by the association of cardiac and craniofacial anomalies together with others affecting the posterior fossa. PATIENTS AND METHODS: We report on 26 patients with Ritscher-Schinzel syndrome at a hospital in Medellin, in the Department of Antioquia, Colombia. RESULTS: Males account for 69% of this cohort. The mean age of the cohort was 30 months, and 42% were under the age of one year at the time of diagnosis. All of them presented ocular disorders, and megalocornea was the most frequent ocular manifestation (69%), whereas low-set ears (80.7%) and septal heart defects (68.7%) were the most common facial and cardiac malformations, respectively. The most frequent malformations of the posterior fossa were megacisterna magna (31.8%) and Dandy-Walker malformation (27%). 84% of the cases had delayed neurodevelopment or intellectual disability. Skeletal manifestations were frequent: the group consisting of camptodactyly, single palmar crease, overlapping fingers, vertical talus and nail hypoplasia were found in hands and feet in 96% of the cases. CONCLUSIONS: Ritscher-Schinzel syndrome is a heterogeneous syndrome from the genetic and clinical point of view. These results suggest that the skeletal and ocular abnormalities that were observed can facilitate the phenotypic diagnosis. However, it is necessary to conduct further studies that allow us to gain a deeper knowledge of its prevalence and help identify other genes involved in this syndrome.
TITLE: Descripcion fenotipica de 26 pacientes con sindrome de Ritscher-Schinzel (displasia craneo-cerebelo-cardiaca o sindrome 3C).Introduccion. El sindrome de Ritscher-Schinzel (tambien conocido como displasia craneo-cerebelo-cardiaca o sindrome 3C) es un sindrome genetico raro que se caracteriza principalmente por la asociacion de anomalias cardiacas, craneofaciales y de la fosa posterior. Pacientes y metodos. Se describen 26 pacientes con sindrome de Ritscher-Schinzel pertenecientes a un hospital de Medellin en el departamento de Antioquia, Colombia. Resultados. La presente cohorte esta compuesta en un 69% por hombres. La mediana de edad de la cohorte fue de 30 meses y el 42% tenia menos de 1 año de edad en el momento del diagnostico. Todos presentaban afectacion ocular, y la megalocornea fue la manifestacion ocular mas frecuente (69%), mientras que las orejas de implantacion baja (80,7%) y los defectos cardiacos septales (68,7%) fueron las malformaciones faciales y cardiacas mas comunes, respectivamente. Las malformaciones de la fosa posterior mas frecuentes fueron megacisterna magna (31,8%) y malformacion de Dandy-Walker (27%). El 84% tenia retraso del neurodesarrollo o discapacidad intelectual. Las manifestaciones esqueleticas fueron frecuentes: el conjunto de camptodactilia, pliegue palmar unico, dedos sobrelapados, astragalo vertical e hipoplasia ungueal en las manos y los pies se hallo en el 96% de los casos. Conclusiones. El sindrome de Ritscher-Schinzel es heterogeneo desde el punto de vista genetico y clinico. Estos resultados sugieren que las anormalidades esqueleticas y oculares observadas pueden facilitar el diagnostico fenotipico. No obstante, es necesario realizar estudios adicionales que permitan conocer mejor su prevalencia y facilitar la identificacion de otros genes implicados en este sindrome.
Assuntos
Anormalidades Múltiplas/genética , Cerebelo/anormalidades , Fossa Craniana Posterior/anormalidades , Anormalidades Craniofaciais/genética , Síndrome de Dandy-Walker/genética , Deficiências do Desenvolvimento/genética , Anormalidades do Olho/genética , Comunicação Interatrial/genética , Deficiência Intelectual/genética , Anormalidades Múltiplas/patologia , Adolescente , Adulto , Criança , Pré-Escolar , Colômbia , Córnea/anormalidades , Anormalidades Craniofaciais/patologia , Síndrome de Dandy-Walker/patologia , Feminino , Deformidades Congênitas do Pé/genética , Deformidades Congênitas da Mão/genética , Comunicação Interatrial/patologia , Humanos , Lactente , Recém-Nascido , Masculino , Fenótipo , Estudos Retrospectivos , SíndromeRESUMO
Abstract: Introduction: Basic life support (BLS) are a group of maneuvers that constitute a fundamental tool to save lives. Therefore, knowledge about BLS has to be part of the curriculum in medical schools. Objective: Evaluate the knowledge level about BLS and evaluate its associated socio-educational factors, in medical students from nine Peruvian universities. Material and methods: We carried out a cross-sectional multicenter study in 2013 and 2014. We included undergraduate medical students from nine universities in eight regions or Peru. We measured the knowledge about BLS using a validated questionnaire, which was based in American Heart Association Guidelines (2010); adequate knowledge was defined as a minimum proportion of 50% of correct answers. We estimate adjusted prevalence ratios using generalized linear models. Results: We included 1,564 students, 13% of the students had an adequate knowledge, and average score was 6.3 ± 3.2 (range: 0-16). Adequate knowledge was associated with attending semesters that belong to academic stage of clinical sciences (p = 0.02; aPR: 1.82; CI: 95%: 1.11-2.98) and having received a previous BLS course (p < 0.01; aPR: 2.96; CI: 95%: 2.18-4.01); adjusted by age, sex, having received a previous injections and first aids courses, and to manifest the desire to be trained in practical BLS. Conclusion: A low proportion of students have an adequate knowledge level about BLS in this population.
Resumen: Introducción: Soporte vital básico (SVB) es un conjunto de maniobras que constituyen una herramienta fundamental para salvar vidas. Por lo tanto, el conocimiento sobre el SVB tiene que ser parte del plan de estudios en las escuelas de medicina. Objetivo: Evaluar el nivel de conocimiento acerca del SVB y evaluar sus factores socio-educativos asociados, en los estudiantes de medicina de nueve universidades peruanas. Material y métodos: Se realizó un estudio transversal, multicéntrico en 2013 y 2014. Se incluyeron estudiantes de medicina de nueve universidades en ocho regiones del Perú. Se midió el conocimiento acerca del SVB mediante un cuestionario validado, basado en las directrices de la Asociación Americana del Corazón (2010); el conocimiento adecuado se define como una proporción mínima del 50% de respuestas correctas. Calculamos las razones de prevalencia mediante el uso de modelos lineales generalizados. Resultados: Se incluyeron 1,564 estudiantes, el 13% de los estudiantes tenía un conocimiento adecuado, y la puntuación media fue de 6.3 ± 3.2 (rango: 0-16). El tener una nota aprobatoria estuvo asociado al cursar ciclos que pertenecen a la etapa académica de ciencias clínicas (p = 0.02; aPR: 1.82; IC 95%: 1.11-2.98) y de haber recibido un curso de SVB anterior (p < 0.01; aPR: 2.96; IC 95%: 2.18-4.01), ajustada por edad, sexo, que hayan recibido un curso de primeros auxilios e inyecciones anteriormente y de haber manifestado el deseo de ser entrenados en la práctica del SVB. Conclusión: Una baja proporción de estudiantes tiene un adecuado nivel de conocimiento acerca de SVB en esta población.
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Abstract: Introduction: Basic life support (BLS) are a group of maneuvers that constitute a fundamental tool to save lives. Therefore, knowledge of BLS has to be part of the curriculum in medical schools. Objective: Evaluate the knowledge level about BLS and evaluate its associated socio-educational factors, in medical students from nine Peruvian universities. Material and methods: A cross-sectional transversal multicenter study was conducted during 2013-2014, by surveying medical students from nine Peruvian universities in eight regions of Peru. An auto-applied validated questionnaire was used to measure the knowledge in BLS, based in 2010 in the American Heart Association (AHA) Guidelines; it was considered as adequate level by answering >50% questions correctly out of 20 possible. Adjusted prevalence rates (aPR) using generalized linear models were estimated. Results: Of all respondents (n = 1,564), 13% of the students had an adequate knowledge, the mean score was 6.3 ± 3.2 (range: 0-16). Obtaining a passing score was associated with attending semesters that belong to academic stage of clinical sciences (p = 0.02; aPR: 1.82; CI: 95%: 1.11-2.98) and having received a previous BLS course (p < 0.01; aPR: 2.96; CI: 95%: 2.18-4.01); adjusted by the age and sex of the respondent, as well as, having received a previous course of injection administration or first aids and to manifest the desire to be trained in practical BLS. Conclusion: A low proportion of students have an adequate knowledge level about BLS in the population studied. It is pertinent to evaluate the training in this subject and propose strategies for its improvement.
Resumen: Introducción: Soporte vital básico (SVB) es un grupo de maniobras que constituyen una herramienta fundamental para salvar vidas. Por lo tanto, el conocimiento de SVB tiene que ser parte de los planes de estudio en las escuelas de medicina. Objetivo: Evaluar el nivel de conocimiento acerca de SVB y evaluar sus factores socio-educativos asociados, en los estudiantes de medicina de nueve universidades peruanas. Material y métodos: Estudio transversal multicéntrico transversal, fue realizado durante 2013-2014, mediante encuestas a los estudiantes de medicina de nueve universidades peruanas en ocho regiones del Perú. Un cuestionario validado autoaplicado fue utilizado para medir el conocimiento de SVB, con base en el año 2010 en las directrices de la American Heart Association (AHA); se consideró como nivel adecuado respondiendo a 50% o más preguntas correctamente de las 20 posibles. Se estimaron las tasas de prevalencia ajustadas (TPa) utilizando modelos lineales generalizados. Resultados: De todos los encuestados (n = 1,564), el 13% de los estudiantes tenía un adecuado conocimiento, la calificación media fue de 6.3 ± 3.2 (rango: 0-16). La obtención de una calificación aprobatoria se asoció con estudiantes que asisten a semestres que pertenecen a la etapa académica de ciencias clínicas (p = 0.02; TAE: 1.82; IC del 95%: 1.11 a 2.98) y haber recibido un curso previo de SVB (p = 0.01; TAE: 2.96; IC del 95%: 2.18 a 4.1); ajustado por la edad y el sexo del encuestado, así como por haber recibido un curso previo de aplicación de inyecciones o primeros auxilios y por manifestar el deseo de ser entrenados en SVB práctico. Conclusión: Una baja proporción de los estudiantes tiene un nivel de conocimiento adecuado sobre SVB en la población estudiada. Es pertinente evaluar la formación en esta materia y proponer estrategias para su mejora.
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BACKGROUND: Post-operative cognitive dysfunction is defined as a decline in cognitive functions that occurs after surgery, but different diagnostic criteria and incidences have been reported in medical literature. Our aim was to determine incidence of post-operative cognitive dysfunction 3 months after non-cardiac surgery in adults. METHODS: A systematic review of available evidence was performed by PRISMA guidelines. A search was done in May-July 2015 on PubMed, EMBASE, CINAHL, LILACS, Scielo, Clinical Trials, and Grey Literature Reports. Inclusion criteria were prospective design studies with patients over 18 years old, surgery under general or regional anesthesia, follow-up for 3 months, and use of a neurocognitive battery for diagnosis. We excluded studies made on cardiac or brain surgery patients. Risk of bias was assessed using tools from National Heart Lung and Blood Institute. RESULTS: We selected 24 studies. Average age was 68 years. Only five studies reported incidence of cognitive decline for a non-surgical control group. Median number of tests used was 5 (range 3-13). Pooled incidence of post-operative cognitive dysfunction at 3 months was 11.7% [95% CI 10.9-12.5] but with several methodological differences between studies. Increasing age was the most consistent risk factor identified (seven studies). CONCLUSIONS: Post-operative cognitive dysfunction in patients is frequent, especially in patients over 60 years old. Limitations include methodological differences in studies. Efforts must be made to reach a consensus in definition and diagnosis for future research.
Assuntos
Disfunção Cognitiva/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Idoso , Disfunção Cognitiva/etiologia , Humanos , Incidência , Complicações Pós-Operatórias/etiologia , Fatores de RiscoRESUMO
Describir un caso de laceración de mucosa labial por incrustaci6n de anzuelo de pescar en lactante mayor, resaltando la terapéutica de remoción, que es un accidente poco frecuente Reporte de caso: Paciente lactante mayor masculino, de un año de edad, que acude a la Unidad de Odontopediatria del Hospital Universitario de Maracaibo por presentar objeto punzo-penetrante compatible con anzuelo de pescar en zona de mucosa vestibular del labio inferior. Bajo anestesia local, se realiza asepsia de la zona, se retira el objeto con técnica retrograda y sineresis de los tejidos con sutura reabsorbible. Se dieron indicaciones al representante de la terapia farmacológica a administrar. Conclusión: los traumatismos son la principal causa de urgencia en el área de odontopediatria, debemos conocer los procedimientos necesarios que incluyen la correcta anamnesis y la elaboraci6n de historia clínica correspondiente para seleccionar el tratamiento más adecuado para el tipo de accidente que se presente, considerando el uso de antibióticos y la aplicación de vacuna toxoide...
To describe a case of labial mucosa laceration by embedding fishhook in an infant, highlighting the therapeutic removal, because it is a rare accident. We present a case of a 5 year old boy, who attended the Operative Dental Service of the National Institute of Child Health, because he had a crown fracture previously treated in maxillary incisor. The treatment consisted in making an anterior telescopic maintainer to supply this deficiency. Case report: Patient male infant, of one year old, who came to the Dentistry Unit of the University Hospital of Maracaibo by daggersharp object file compatible with fishhook in area buccal mucosa of the lip. Under local anesthesia, antisepsis of the area is performed; the object with technical and syneresis retrograde tissue with absorbable suture is removed. Instructions were given to the representative of the drug therapy administered. Conclusion: Injuries are the leading cause of emergency in the area of dentistry, we must know the necessary procedures including correct history and the development of corresponding clinical history to select the must know the necessary procedures including correct history and the development of corresponding clinical history to select the most appropriate treatment for the type of accident that is present, considering the antibiotics and applying toxoid vaccine...
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Humanos , Masculino , Lactente , Ferimentos Perfurantes , Lábio , LaceraçõesRESUMO
INTRODUCCIÓN: El Carcinoma basocelular (CBC) es la neoplasia más frecuente en la población humana. Se ha observado un aumento de su incidencia en todos los países, incluyendo a Chile. CBC es un tumor heterogéneo clínica e histológicamente. Entre sus factores de riesgo, destaca la exposición a la radiación ultravioleta. En Chile, en la última década se han realizado numerosas campañas de prevención del cáncer cutáneo y de detección precoz de esta neoplasia. El propósito de este trabajo es comparar el comportamiento del CBC en relación a parámetros demográficos, clínicos e histológicos en dos periodos de tiempo, 1995-1999 y 2005-2009 en la población de cuatro hospitales públicos de Santiago de Chile...
INTRODUCTION: Basal cell carcinoma (BCC) is the most common malignancy in the human population. There has been an increased incidence in all countries, including Chile. BCC is a clinically and histologically heterogeneous tumor. The main risk factor of BCC is the ultraviolet radiation exposure. In Chile, in the last decade, there have been numerous campaigns of skin cancer prevention and early detection of this neoplasm. The purpose of this paper is to compare the behavior of BCC in relation to demographic, clinical and histological parameters in two periods, 1995-1999 and 2005-2009 in the population of four hospitals in Santiago de Chile
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Humanos , Masculino , Adolescente , Psoríase/epidemiologia , Chile , Fatores Sexuais , Epidemiologia Descritiva , Prevalência , Estudos Prospectivos , Idade de Início , Distribuição por Idade e SexoRESUMO
Introducción: Los potenciales evocados auditivos de estado estable (PEAEE) son respuestas cerebrales frente a estímulos auditivos continuos modulados en amplitud y/ o frecuencia (AM/FM). Este examen puede determinar objetivamente umbrales por frecuencia específica. Objetivo: Conocer el manejo y describir los resultados de la aplicación de los PEAEE en sujetos con distintos niveles auditivos. Material y método: Estudio exploratorio y transversal en sujetos de 10 a 30 años con audición normal o pérdida auditiva (55 oídos). El estímulo consistió en un tono puro (0,5, 1,2y4 kHz) a 46HzAM/FM. Resultados: Se obtuvo alta correlación entre la audiometría y PEAEE, tanto en el promedio (r =0,980) como en cada frecuencia evaluada. Los umbrales de PEAEE fueron superiores a los audiométricos y la diferencia promedio fue 23 dB HL en normoyentes y 13 dB HL en hipoacúsicos. Conclusiones: Los umbrales de PEAEE en sujetos hipoacúsicos fueron más cercanos a los audiométricos que en normoyentes. Dada la alta correlación entre la audiometría y PEAEE, éste podría incorporarse en la evaluación clínica, siendo un complemento en la detección y estudio de patologías auditivas.
Introduction: Auditory steady-state responses (ASSR) correspond to brain responses evoked by continuous auditory stimuli, modulated in amplitud and/or frequency (AM/FM). This test can objectively determined specific frequency thresholds. Aim: To understand the procedures and to describe the results of the ASSR test application on subjects with different auditory degrees. Material and method: Exploratory and transversal study in 10-to-30-years subjects with normal hearing or hearing loss (55 ears). The stimuli were pure tones (0.5, 1, 2y4 kHz) at 46-Hz AM/FM. Results: A high correlation coefficient was obtained between audiometry and the ASSR as well in the average (r =0.980) as in each evaluated frequency. The ASSR thresholds presented higher values than the audiometrical thresholds. The average difference were 23 dB HL in normally hearing subjects and 13 dB HL in hearing-impaired subjects. Conclusion: The ASSR threshold in the hearing-impaired group were closer to the audiometrical thresholds than in the normally hearing group. Due to the high correlation between audiometry and ASSR, it can be considered its incorporation in the clinical evaluation, bestowing a complementary value in the detection of auditory pathologies.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Audição/fisiologia , Potenciais Evocados Auditivos/fisiologia , Limiar Auditivo/fisiologia , Audiometria de Tons Puros , Estudos Transversais , Perda Auditiva/fisiopatologiaRESUMO
BACKGROUND: Methotrexate is one of the best systemic treatments for psoriasis. However it has significant adverse effects such as myelotoxicity and hepatotoxicity. AIM: To evaluate serum liver test in psoriatic patients treated with methotrexate. MATERIAL AND METHODS: Retrospective review of medical records of psoriatic patients treated with methotrexate between the years 2000 and 2005. All patients received a minimum of 7.5 mg weekly of methotrexate, for at least 4 weeks. RESULTS: Sixty three patients were included. Mean cumulative dose of methotrexate was 576 mg. Thirty two percent had alterations in liver tests, but only 9% had values that duplicated the upper limit of normal range of aminotransferases or alkaline phosphatases or a serum bilirubin over 2 mg/dl. We did not find a direct relationship between the dose of methotrexate and the magnitude of liver test alterations. Only one patient exceeded 1.5 g as cumulative dose. A liver biopsy performed to him, did not show signs of fibrosis. CONCLUSIONS: This retrospective study does not show a direct relationship between weekly doses, cumulated dose and length of treatment with methotrexate, and the degree of alteration of serum liver tests.
Assuntos
Doença Hepática Induzida por Substâncias e Drogas/etiologia , Fármacos Dermatológicos/efeitos adversos , Fígado/efeitos dos fármacos , Metotrexato/efeitos adversos , Psoríase/tratamento farmacológico , Doença Aguda , Biomarcadores/sangue , Doença Hepática Induzida por Substâncias e Drogas/patologia , Doença Hepática Crônica Induzida por Substâncias e Drogas/patologia , Fármacos Dermatológicos/administração & dosagem , Feminino , Humanos , Fígado/patologia , Cirrose Hepática/induzido quimicamente , Cirrose Hepática/patologia , Testes de Função Hepática , Masculino , Metotrexato/administração & dosagem , Psoríase/patologia , Estudos Retrospectivos , Transaminases/sangueRESUMO
Background: Methotrexate is one of the best systemic treatments for psoriasis. However it has significant adverse effects such as myelotoxicity and hepatotoxicity. Aim: To evaluate serum liver test in psoríatic patients treated with methotrexate. Material and Methods: Retrospective review of medical records of psoríatic patients treated with methotrexate between the years 2000 and 2005. All patients received a minimum of 7.5 mg weekly of methotrexate, for at íeast 4 weeks. Results: Sixty three patients were included. Mean cumulative dose of methotrexate was 576 mg. Thirty two percent had alterations in liver tests, but only 9 percent had values that duplicated the upper limit of normal range of aminotransferases or alkaline phosphatases or a serum bilirubin over 2 mg/dl. We did not find a direct relationship between the dose of methotrexate and the magnitude of liver test alterations. Only one patient exceeded 1.5 g as cumulative dose. A liver biopsy performed to him, did not show signs of fibrosis. Conclusions: This retrospective study does not show a direct relationship between weekly doses, cumulated dose and length of treatment with methotrexate, and the degree of alteration of serum liver tests.
Assuntos
Feminino , Humanos , Masculino , Doença Hepática Induzida por Substâncias e Drogas , Fármacos Dermatológicos/efeitos adversos , Fígado/efeitos dos fármacos , Metotrexato/efeitos adversos , Psoríase/tratamento farmacológico , Doença Hepática Induzida por Substâncias e Drogas , Doença Hepática Crônica Induzida por Substâncias e Drogas , Doença Aguda , Biomarcadores/sangue , Fármacos Dermatológicos/administração & dosagem , Cirrose Hepática/induzido quimicamente , Cirrose Hepática/patologia , Testes de Função Hepática , Fígado/patologia , Metotrexato/administração & dosagem , Psoríase/patologia , Estudos Retrospectivos , Transaminases/sangueRESUMO
Traumatic injuries of the diaphragm are a known consequence of severe trauma, usually of the blunt type. Its incidence is increasing due to the rise in number and severity of accidents, especially car accidents. Diagnosing a traumatic diaphragmatic rupture is still a challenge for both radiologists and surgeons, with a delayed diagnosis in more than half of cases, with the consequent development of latent hernia. This hernia may manifest with symptoms varying from unspecific to bowel strangulation. We present the case of a patient with colonic obstruction secondary to a traumatic diaphragmatic hernia, with previous history of a penetrating thoracoabdominal trauma seven years before. Radiologic methods and signs for the diagnosis of this pathology are reviewed.
Resumen: Las lesiones traumáticas del diafragma son consecuencia conocida de un trauma grave, gene-ralmente de tipo contuso. Su incidencia ha aumentado debido al crecimiento en número y severidad de los accidentes, en especial del tránsito. Su diagnóstico continúa siendo un desafío para cirujanos y radiólogos, diagnosticándose tardíamente hasta en más de la mitad de los casos, dejando una hernia diafragmática latente, que puede manifestarse con síntomas que varían desde inespecíficos hasta la estrangulación de un asa intestinal. Se presenta el caso de un paciente con obstrucción intestinal de colon secundaria a una hernia diafragmática traumática atascada, con historia de un traumatismo penetrante toracoabdominal ocurrido siete años antes. Se revisan los métodos y signos radiológicos de mayor utilidad para el diagnóstico de esta patología.
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Masculino , Humanos , Idoso , Hérnia Diafragmática Traumática/complicações , Hérnia Diafragmática Traumática , Doenças do Íleo , Obstrução Intestinal/etiologia , Obstrução Intestinal , Ferimentos Penetrantes/complicações , Resultado do TratamentoAssuntos
Masculino , Humanos , Criança , Líquen Nítido/patologia , Líquen Nítido/terapia , Pele/patologia , Biópsia , Doença CrônicaRESUMO
Describe el trabajo de investigación realizado a través de la cuantificación durante seis meses de la generación de residuos en las instituciones de salud de Comodoro Rivadavia (Argentina). Resultando en 43 instituciones que el 94,5 de los residuos pueden devolverse al fabricante para su disposición recomendaciones de organismos internacionales esto es el 0,65 del total generado. Para evitar su disposición inadecuada se recomienda implementar sistemas de recuperación
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Resíduos Perigosos , Resíduos de Serviços de SaúdeRESUMO
El documento describe el trabajo de investigación realizado a través de la cuantificación durante seis meses de la generación de residuos en la instituciones de salud de Comodoro Rivadavia (Argentina). Resultando en 43 instituciones que el 94,5 de los residuos pueden devolverse al fabricante para su disposición recomendaciones de organismos internacionales esto es el 0,65 del total generado. Para evitar su disposición inadecuada se recomienda implementar sistemas de recuperación
RESUMO
La estenosis subglótica postintubación es la causa más frecuente de estridor crónico que se observa en recién nacidos y lactantes pequeños que han recibido ventilación mecánica prolongada. En relación a dos casos clínicos se revisan las causas que determinan esta patología evitable y se discute el manejo de la extubación difícil del niño menor, de acuerdo a consideraciones clínicas y endoscópicas precisas, intentando establecer un plan de tratamiento que sea aplicable a nuestra realidad nacional. Estos dos pacientes, que son ilustrativos del amplio espectro clínico de la estenosis subglótica postintubación, fueron estudiados endoscópicamente. El primero corresponde a un prematuro tratado con ventilación mecánica que, después de varios intentos de extubación fallida, finalmente se consiguió una decanulación programada, sin necesidad de recurrir a la cirugía. El segundo se refiere a un lactante de 15 meses que, luego de una intubación necesaria para el tratamiento de un TEC severo, quedó con un estridor recurrente que requirió de la sección anterior del cricoides para superar su obstrucción. Se destaca que luego de dos fracasos en el intento de extubación programada se debe efectuar una rinofaringolaringoscopía flexible, seguida de una laringotraquescopía rígida con anestesia general, para confirmar el diagnóstico anatómico de la estenosis y efectuar el tratamiento quirúrgico si se confirma la patología
Assuntos
Humanos , Masculino , Recém-Nascido , Lactente , Feminino , Intubação Intratraqueal/efeitos adversos , Laringoestenose/etiologia , Recém-Nascido Prematuro , Laringoestenose/cirurgia , Laringoestenose/terapia , Respiração Artificial/efeitos adversos , Sons Respiratórios/etiologia , Estenose Traqueal/etiologia , TraqueostomiaRESUMO
Se presenta una revisión restrospectiva de nuestra experiencia en el manejo de la estenosis traqueal en un grupo de nueve pacientes desde marzo de 1996 a julio de 1998, describiendo el estudio y tratamiento de estos pacientes centrados principalmente en la técnica de resección traqueal. Todos los pacientes fueron reconstituidos en su vía aérea, logrando un calibre traqueal satisfactorio. Tres pacientes tuvieron complicaciones postoperatorias y no hubo mortalidad. Se concluye que esta técnica es la indicación de elección en la estenosis traqueal, siendo segura y eficiente
Assuntos
Humanos , Feminino , Masculino , Adolescente , Adulto , Pessoa de Meia-Idade , Estenose Traqueal/cirurgia , Traqueostomia , Complicações Pós-Operatórias , Estenose Traqueal/terapia , Anastomose Cirúrgica , Intubação IntratraquealRESUMO
BACKGROUND: The effect of health education provided by teachers, in three primary schools of Guerrero, Mexico, on the prevalence of head louse infestation was compared. METHODS: A cross-sectional survey and rapid appraisal methods were performed, including a child questionnaire and qualitative data from teachers and focus groups of mothers in the same schools. RESULTS: Nine hundred and forty-four students and 33 teachers were interviewed; a focus group discussion with 6-8 mothers per school was performed. In the self-diagnosis of pediculosis, the prevalence was 22% (range, 18%-33%) with a sensitivity of 68% and a specificity of 86%. In one school, 100% of the teachers applied a health program, whereas in the other two schools this percentage was only 20%. A child under 9 years of age who attended a school without information on health was 3.6 times more likely to have head louse infestation (OR = 3.6, CI 95% = 2.1-6) than a child of the same age who attended a school where information was given. In older children the effect and potential impact were lower. The difference between the two age groups is unlikely to be explained by chance (X2 het = 5.7, df = 1, p = 0.01). CONCLUSIONS: This study emphasizes the potential value of simple, but effective, health education provided by school teaching staff through liaison with patents in the amelioration of endemic disease.