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BACKGROUND: The first two studies of an artificial pancreas (AP) system carried out in Latin America took place in 2016 (phase 1) and 2017 (phase 2). They evaluated a hybrid algorithm from the University of Virginia (UVA) and the automatic regulation of glucose (ARG) algorithm in an inpatient setting using an AP platform developed by the UVA. The ARG algorithm does not require carbohydrate (CHO) counting and does not deliver meal priming insulin boluses. Here, the first outpatient trial of the ARG algorithm using an own AP platform and doubling the duration of previous phases is presented. METHOD: Phase 3 involved the evaluation of the ARG algorithm in five adult participants (n = 5) during 72 hours of closed-loop (CL) and 72 hours of open-loop (OL) control in an outpatient setting. This trial was performed with an own AP and remote monitoring platform developed from open-source resources, called InsuMate. The meals tested ranged its CHO content from 38 to 120 g and included challenging meals like pasta. Also, the participants performed mild exercise (3-5 km walks) daily. The clinical trial is registered in ClinicalTrials.gov with identifier: NCT04793165. RESULTS: The ARG algorithm showed an improvement in the time in hyperglycemia (52.2% [16.3%] OL vs 48.0% [15.4%] CL), time in range (46.9% [15.6%] OL vs 50.9% [14.4%] CL), and mean glucose (188.9 [25.5] mg/dl OL vs 186.2 [24.7] mg/dl CL) compared with the OL therapy. No severe hyperglycemia or hypoglycemia episodes occurred during the trial. The InsuMate platform achieved an average of more than 95% of the time in CL. CONCLUSION: The results obtained demonstrated the feasibility of outpatient full CL regulation of glucose levels involving the ARG algorithm and the InsuMate platform.
Assuntos
Diabetes Mellitus Tipo 1 , Hiperglicemia , Pâncreas Artificial , Adulto , Humanos , Algoritmos , Glicemia , Automonitorização da Glicemia , Diabetes Mellitus Tipo 1/tratamento farmacológico , Glucose , Hiperglicemia/tratamento farmacológico , Hipoglicemiantes , Insulina , Sistemas de Infusão de Insulina , Pacientes Ambulatoriais , América do SulRESUMO
This work is focused on the multilevel control of the population confinement in the city of Buenos Aires and its surroundings due to the pandemic generated by the COVID-19 outbreak. The model used here is known as SEIRD and two objectives are sought: a time-varying identification of the infection rate and the inclusion of a controller. A control differential equation has been added to regulate the transitions between confinement and normal life, according to five different levels. The plasma treatment from recovered patients has also been considered in the control algorithm. Using the proposed strategy the ICU occupancy is reduced, and as a consequence, the number of deaths is also decreased.
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COVID-19 , Argentina/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Cidades/epidemiologia , Humanos , Pandemias/prevenção & controleRESUMO
Los pacientes en estado crítico con COVID-19 sufren hiperglucemias sostenidas de difícil manejo. A esto se suma el desafío de minimizar la exposición al contagio. En el presente artículo analizamos la evolución metabólica de dos pacientes pediátricos con COVID-19 admitidos en unidad de cuidados intensivos (UCI) para pacientes COVID-19 del Hospital "Prof. Dr. Juan P. Garrahan" de la Ciudad Autónoma de Buenos Aires, Argentina, que requirieron tratamiento con insulina endovenosa y cuya glucemia fue monitoreada de manera remota con la plataforma InsuMate® desarrollada en la Universidad Nacional de La Plata. Los pacientes requirieron tasas de infusión de insulina en dosis marcadamente mayores que las de otros pacientes críticos que impresionaron relacionadas con los valores de marcadores de inflamación. La infusión pudo ajustarse con cuatro monitoreos diarios de glucosa y las métricas obtenidas con el monitor de glucosa. El uso del sistema de monitoreo remoto continuo de glucosa permitió disminuir la frecuencia de monitoreo glucémico durante el tratamiento.
Critically ill patients with COVID-19 suffer from sustained hyperglycemia that is difficult to manage. Added to this is the challenge of minimizing exposure to contagion. In this article we analyze the metabolic evolution of two pediatric patients with COVID-19 admitted to the intensive care unit (ICU) for COVID-19 patients at the Hospital "Prof. Dr. Juan P. Garrahan "from the Autonomous City of Buenos Aires, Argentina, who required treatment with intravenous insulin and whose blood glucose was remotely monitored with the InsuMate® platform developed at the National University of La Plata. The patients required insulin infusion rates in doses markedly higher than those of other critically ill patients, who were impressively related to the values of inflammation markers. The infusion could be adjusted with four daily glucose monitors and the metrics obtained with the glucose monitor. The use of the continuous remote glucose monitoring system made it possible to decrease the frequency of glycemic monitoring during treatment.
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COVID-19 , Pediatria , Glucose , Hiperglicemia , InsulinaAssuntos
Glicemia/metabolismo , COVID-19/terapia , Diabetes Mellitus/metabolismo , Monitorização Ambulatorial/métodos , Adolescente , Idoso , Automonitorização da Glicemia , COVID-19/complicações , COVID-19/metabolismo , Criança , Cuidados Críticos , Estado Terminal , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/etiologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/metabolismo , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Unidades de Terapia Intensiva , Unidades de Terapia Intensiva Pediátrica , Masculino , Pessoa de Meia-Idade , SARS-CoV-2RESUMO
Glyphosate is a broad-spectrum herbicide widely used worldwide. Indeed, it is the herbicide most applied to all Mexican crops. Due to the overuse and poor disposal of the waste, this herbicide can reach the aquatic environments such as groundwater and surface water. Thus, there is a clear need to implement monitoring and surveillance programs for evaluating and controlling the exposure to this herbicide in rural populations. The goal of this study was to quantify the presence of glyphosate in different water bodies (groundwater, surface and drinking water) as well as to identify the uses and managements of water resources by rural communities to evaluate the potential human exposure to glyphosate in the Tenampulco region of the Mexican state of Puebla. Measurements were performed by a rapid and cost-effective ELISA-based method in groundwater and surface water from various sampling sites of the Tenampulco region. Glyphosate was detected in all groundwater samples to be below the maximum limit for glyphosate in water in Mexico. Nevertheless, these results indicate an exposure of glyphosate in these agricultural communities and the need to establish a monitoring program.
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Exposição Ambiental/estatística & dados numéricos , Glicina/análogos & derivados , Herbicidas/análise , Poluentes Químicos da Água/análise , Ingestão de Líquidos , Glicina/análise , Hábitos , Humanos , México , População Rural , Água , GlifosatoRESUMO
BACKGROUND: Either under standard basal-bolus treatment or hybrid closed-loop control, subjects with type 1 diabetes are required to count carbohydrates (CHOs). However, CHO counting is not only burdensome but also prone to errors. Recently, an artificial pancreas algorithm that does not require premeal insulin boluses-the so-called automatic regulation of glucose (ARG)-was introduced. In its first pilot clinical study, although the exact CHO counting was not required, subjects still needed to announce the meal time and classify the meal size. METHOD: An automatic switching signal generator (SSG) is proposed in this work to remove the manual mealtime announcement from the control strategy. The SSG is based on a Kalman filter and works with continuous glucose monitoring readings only. RESULTS: The ARG algorithm with unannounced meals (ARGum) was tested in silico under the effect of different types of mixed meals and intrapatient variability, and contrasted with the ARG algorithm with announced meals (ARGam). Simulations reveal that, for slow-absorbing meals, the time in the euglycemic range, [70-180] mg/dL, increases using the unannounced strategy (ARGam: 78.1 [68.6-80.2]% (median [IQR]) and ARGum: 87.8 [84.5-90.6]%), while similar results were found with fast-absorbing meals (ARGam: 87.4 [86.0-88.9]% and ARGum: 87.6 [86.1-88.8]%). On the other hand, when intrapatient variability is considered, time in euglycemia is also comparable (ARGam: 81.4 [75.4-83.5]% and ARGum: 80.9 [77.0-85.1]%). CONCLUSION: In silico results indicate that it is feasible to perform an in vivo evaluation of the ARG algorithm with unannounced meals.
Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 1/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Refeições , Pâncreas Artificial , Algoritmos , Automonitorização da Glicemia , Simulação por Computador , Diabetes Mellitus Tipo 1/sangue , Humanos , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Período Pós-PrandialRESUMO
Field potentials (FPs) are easily reached signals that provide information about the brain's processing. However, FP should be interpreted cautiously since their biophysical bases are complex. The lateral habenula (LHb) is a brain structure involved in the encoding of aversive motivational values. Previous work indicates that the activity of the LHb is relevant for hippocampal-dependent learning. Moreover, it has been proposed that the interaction of the LHb with the hippocampal network is evidenced by the synchronization of LHb and hippocampal FPs during theta rhythm. However, the origin of the habenular FP has not been analyzed. Hence, its validity as a measurement of LHb activity has not been proven. In this work, we used electrophysiological recordings in anesthetized rats and feed-forward modeling to investigate biophysical basis of the FP recorded in the LHb. Our results indicate that the FP in the LHb during theta rhythm is a volume-conducted signal from the hippocampus. This result highlight that FPs must be thoroughly analyzed before its biological interpretation and argues against the use of the habenular FP signal as a readout of the activity of the LHb.
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BACKGROUND: Emerging therapies such as closed-loop (CL) glucose control, also known as artificial pancreas (AP) systems, have shown significant improvement in type 1 diabetes mellitus (T1DM) management. However, demanding patient intervention is still required, particularly at meal times. To reduce treatment burden, the automatic regulation of glucose (ARG) algorithm mitigates postprandial glucose excursions without feedforward insulin boluses. This work assesses feasibility of this new strategy in a clinical trial. METHODS: A 36-hour pilot study was performed on five T1DM subjects to validate the ARG algorithm. Subjects wore a subcutaneous continuous glucose monitor (CGM) and an insulin pump. Insulin delivery was solely commanded by the ARG algorithm, without premeal insulin boluses. This was the first clinical trial in Latin America to validate an AP controller. RESULTS: For the total 36-hour period, results were as follows: average time of CGM readings in range 70-250 mg/dl: 88.6%, in range 70-180 mg/dl: 74.7%, <70 mg/dl: 5.8%, and <50 mg/dl: 0.8%. Results improved analyzing the final 15-hour period of this trial. In that case, the time spent in range was 70-250 mg/dl: 94.7%, in range 70-180 mg/dl: 82.6%, <70 mg/dl: 4.1%, and <50 mg/dl: 0.2%. During the last night the time spent in range was 70-250 mg/dl: 95%, in range 70-180 mg/dl: 87.7%, <70 mg/dl: 5.0%, and <50 mg/dl: 0.0%. No severe hypoglycemia occurred. No serious adverse events were reported. CONCLUSIONS: The ARG algorithm was successfully validated in a pilot clinical trial, encouraging further tests with a larger number of patients and in outpatient settings.
Assuntos
Algoritmos , Diabetes Mellitus Tipo 1/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Pâncreas Artificial , Adulto , Automonitorização da Glicemia , Feminino , Humanos , Sistemas de Infusão de Insulina , América Latina , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Período Pós-PrandialRESUMO
OBJECTIVES: To describe the prevalence and characteristics of delirium during the initial evaluation of critically ill patients aged 5-14â¯years. METHOD/DESIGN: This is a cross-sectional descriptive study in a critical care unit. For six months, all patients were evaluated within the first 24-72â¯hours or when sedation permitted the use of the paediatric confusion assessment method for the intensive care unit (PCAM-ICU) and the Delirium Rating Scale-Revised-98 items #7 and #8 to determine motor type. We report the characteristics of PCAM-ICU delirium (at least three of the required items scored positive) and of subthreshold score cases (two positive items). RESULTS: Of 77 admissions, 15 (19.5%) had delirium, and 11 (14.2%) were subthreshold. A total of 53.3% of delirium and 45.5% of subthreshold cases were hypoactive. The prevalence of delirium and subthreshold PCAM-ICU was 83.3% and 16.7% in mechanically ventilated children. The most frequent combination of PCAM-ICU alterations in subthreshold cases was acute onset-fluctuation with altered alertness. The main nursing diagnoses were related to reduced cellular respiration. CONCLUSIONS: Delirium is common in critically ill children. It is necessary to assess whether certain nursing diagnoses imply an increase in delirium. Longitudinal studies of subthreshold PCAM-ICU cases are needed to understand their importance better.
Assuntos
Delírio/epidemiologia , Prevalência , Adolescente , Criança , Pré-Escolar , Colômbia/epidemiologia , Confusão/classificação , Confusão/epidemiologia , Estudos Transversais , Delírio/diagnóstico , Feminino , Humanos , Unidades de Terapia Intensiva Pediátrica/organização & administração , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Masculino , Psicometria/instrumentação , Psicometria/métodos , Psicometria/estatística & dados numéricosRESUMO
Resumen Objetivo: Describir el comportamiento de los parámetros hemodinámicos en un grupo de individuos sometidos al estudio de monitoreo ambulatorio de la presión arterial. Materiales y métodos: Estudio observacional descriptivo sobre el comportamiento de los parámetros hemodinámicos en el estudio de monitoreo ambulatorio de la presión arterial en un grupo de pacientes atendidos en dos instituciones de Medellín. Resultados: Se analizaron un total de 108 pacientes atendidos en el período comprendido entre septiembre de 2012 y octubre de 2013. Los promedios de la presión arterial sistólica y presión arterial diastólica en 24 horas fueron de 128.34 ± 12.79 mmHg y 75.87 ± 8.74 mm Hg, respectivamente. La media de la presión del pulso fue de 52.47 ± 11.12 mmHg. Las presiones arteriales medias diurna y nocturna fueron de 96,23 ± 9,5 mmHg y 85.19 ± 10,23 mmHg, respectivamente. La frecuencia cardiaca fue de 71.4 ± 10.03 latidos por minuto, para la carga sistólica la media fue de 39,38 ± 27,80% y para la carga diastólica fue de 26,26 ± 24,32%. Conclusiones: El monitoreo ambulatorio de la presión arterial es considerado actualmente como el método más confiable y exacto para el diagnóstico y evaluación de la hipertensión arterial. Permite no solo el diagnóstico y seguimiento del comportamiento de las cifras tensionales en los hipertensos, sino la evaluación de otras variables, como es mostrado en este estudio, con un comportamiento de los resultados muy similar a otros estudios locales.
Abstract Objetive: To describe the behavior of hemodynamic parameters in a group of individuals undergoing ambulatory blood pressure monitoring. Material and methods: Descriptive, observational study on the behavior of hemodynamic parameters in ambulatory blood pressure monitoring of a group of patients assisted in two institutions in Medellín. Results: A total of 108 patients were analysed, assisted between September 2012 and October 2013. Average 24-hour systolic and diastolic blood pressure values were 128.34 ± 12.79 mmHg and 75.87 ± 8,74 mmHg, respectively. Average pulse pressure was 52.47 ± 11.12 mmHg. Day and night blood pressure values were 96.23 ± 9.5 mmHg and 85.19 ± 10.23 mmHg, respectively. Heart rate was 71.4 ± 10.03 beats per minute, it was 39.38 ± 27.80% for the systolic load and 26.26 ± 24.32% for the diastolic load. Conclusions : Ambulatory monitoring of blood pressure is considered nowadays to be the most reliable and exact method for diagnosing and assessing arterial hypertension. Not only does it allow diagnosis and control of the behavior of blood pressure levels in hypertensive patients, but also assesses other variables, like the ones shown in this study, with results being similar to those of other local studies.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Pressão Arterial , Hipertensão , Monitorização Ambulatorial , DiagnósticoRESUMO
BACKGROUND: Time-varying dynamics is one of the main issues for achieving safe blood glucose control in type 1 diabetes mellitus (T1DM) patients. In addition, the typical disturbances considered for controller design are meals, which increase the glucose level, and physical activity (PA), which increases the subject's sensitivity to insulin. In previous works the authors have applied a linear parameter-varying (LPV) control technique to manage unannounced meals. METHODS: A switched LPV controller that switches between 3 LPV controllers, each with a different level of aggressiveness, is designed to further cope with both unannounced meals and postprandial PA. Thus, the proposed control strategy has a "standard" mode, an "aggressive" mode, and a "conservative" mode. The "standard" mode is designed to be applied most of the time, while the "aggressive" mode is designed to deal only with hyperglycemia situations. On the other hand, the "conservative" mode is focused on postprandial PA control. RESULTS: An ad hoc simulator has been developed to test the proposed controller. This simulator is based on the distribution version of the UVA/Padova model and includes the effect of PA based on Schiavon.(1) The test results obtained when using this simulator indicate that the proposed control law substantially reduces the risk of hypoglycemia with the conservative strategy, while the risk of hyperglycemia is scarcely affected. CONCLUSIONS: It is demonstrated that the announcement, or anticipation, of exercise is indispensable for letting a mono-hormonal artificial pancreas deal with the consequences of postprandial PA. In view of this the proposed controller allows switching into a conservative mode when notified of PA by the user.
Assuntos
Diabetes Mellitus Tipo 1/sangue , Exercício Físico/fisiologia , Hipoglicemia/prevenção & controle , Modelos Teóricos , Pâncreas Artificial , Glicemia/análise , Simulação por Computador , Humanos , Hipoglicemia/sangueRESUMO
A formação de apoiadores institucionais vem sendo um importante método/dispositivo da Política Nacional de Humanização (PNH) na intensificação de ações voltadas ao fortalecimento do SUS. Considerando algumas experiências no território paraense, o texto apresenta reflexões sobre este cenário, levando em conta os processos de formação que vêm sendo implementados no território, analisando alguns de seus desafios e repercussões. Partindo do referencial teórico e metodológico da PNH, mediante sua proposta de inclusão como método de intervenção nos modos de gerir e cuidar, também são levantadas algumas questões sobre a maneira como a formação de apoiadores opera no sentido de fomentar a militância pelo SUS e, consequentemente, a produção do comum por meio da mobilização e transformação dos sujeitos...
The education of institutional supporters has been an important tool of the National Humanization Policy to intensify actions targeted at empowering the Brazilian Health System. In light of some experiences in the State of Pará (Northern Brazil), the text presents some discussions on this scenario, considering the subjects education and analyzing some challenges and results. Based on the theoretical and methodological framework of the National Humanization Policy, through its proposal of inclusion as an intervention method for management and care, some questions are raised on how the education of supporters operates towards fostering militancy in the Brasilian Health Sistem and, consequently, the production of the common by means of subjects mobilization and transformation...
La formación de apoyadores institucionales ha sido un importante dispositivo de la Política Nacional de Humanización (PNH) en la intensificación de acciones destinadas a fortalecer el Sistema de Salud Brasileño. Teniendo en cuenta algunas experiencias utilizadas en Pará, el texto presenta algunas reflexiones sobre esta situación, teniendo en cuenta los procesos de formación que se han disparado en el territorio, analizando algunos de sus desafíos y repercusiones. Basado en el marco teórico y metodológico de la PNH, a través de su propuesta de inclusión como método de intervención en los modos de administrar y de cuidar, también se plantean algunas cuestiones sobre la manera como la formación de apoyadores opera en el sentido de fomentar la militancia por el Sistema de Salud Brasileño y, por lo tanto, la producción del común a través de la movilización y transformación de los sujetos...
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Humanos , Apoio ao Planejamento em Saúde/tendências , Humanização da Assistência , Sistema Único de Saúde/tendênciasRESUMO
The arbuscular mycorrhizal symbiosis is formed between arbuscular mycorrhizal fungi (AMF) and plant roots. The fungi provide the plant with inorganic phosphate (P). The symbiosis can result in increased plant growth. Although most global food crops naturally form this symbiosis, very few studies have shown that their practical application can lead to large-scale increases in food production. Application of AMF to crops in the tropics is potentially effective for improving yields. However, a main problem of using AMF on a large-scale is producing cheap inoculum in a clean sterile carrier and sufficiently concentrated to cheaply transport. Recently, mass-produced in vitro inoculum of the model mycorrhizal fungus Rhizophagus irregularis became available, potentially making its use viable in tropical agriculture. One of the most globally important food plants in the tropics is cassava. We evaluated the effect of in vitro mass-produced R. irregularis inoculum on the yield of cassava crops at two locations in Colombia. A significant effect of R. irregularis inoculation on yield occurred at both sites. At one site, yield increases were observed irrespective of P fertilization. At the other site, inoculation with AMF and 50% of the normally applied P gave the highest yield. Despite that AMF inoculation resulted in greater food production, economic analyses revealed that AMF inoculation did not give greater return on investment than with conventional cultivation. However, the amount of AMF inoculum used was double the recommended dose and was calculated with European, not Colombian, inoculum prices. R. irregularis can also be manipulated genetically in vitro, leading to improved plant growth. We conclude that application of in vitro R. irregularis is currently a way of increasing cassava yields, that there is a strong potential for it to be economically profitable and that there is enormous potential to improve this efficiency further in the future.
Assuntos
Glomeromycota/crescimento & desenvolvimento , Manihot/crescimento & desenvolvimento , Micorrizas/crescimento & desenvolvimento , Simbiose , Agricultura/economia , Agricultura/métodos , Análise de Variância , Biomassa , Colômbia , Fertilizantes/economia , Glomeromycota/fisiologia , Interações Hospedeiro-Patógeno , Manihot/microbiologia , Micorrizas/fisiologiaRESUMO
A retrospective cohort study was conducted on infants of mothers delivering at an inner-city hospital in October 2009 where postpartum maternal tetanus toxoid, reduced diptheria toxoid and acellular pertussis (Tdap) vaccination had been initiated in May 2008. We compared mothers and infants in a Tdap intervention group discharged July 2008 (n=250) with a pre-Tdap control group discharged July 2007 (n=238). Postpartum maternal Tdap impacted positively timeliness of early infant immunization.
Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Imunização/estatística & dados numéricos , Mães/estatística & dados numéricos , Adulto , Estudos de Coortes , Vacinas contra Difteria, Tétano e Coqueluche Acelular/imunologia , Feminino , Humanos , Esquemas de Imunização , Lactente , Recém-Nascido , Cuidado Pós-Natal/métodos , Período Pós-Parto , Estudos RetrospectivosRESUMO
Este artigo se insere no âmbito das políticas públicas que compõem o Sistema Único de Saúde (SUS), a fim de discutir o campo de conhecimento e práticas de saúde em curso. Discorrendo sobre a Política Nacional de Humanização da Atenção e Gestão no SUS (PNH), buscamos afirmá-la enquanto estratégia de produção coletiva das práticas em saúde, enfatizando a inseparabilidade entre clínica e gestão. Através de um percurso pela organização da PNH, destacamos seus princípios, diretrizes e método como orientações para o compartilhamento dos modos de produzir saúde, os quais sedão a partir da ação de gestores, trabalhadores, usuários e movimentos sociais.Assim, é focando na articulação entre os atores implicados com as práticas clínicas e de gestão democráticas que buscamos situar a PNH como política de saúde do SUS. (AU)
This article falls within the sphere of public policies that make up the Unified Health System (SUS) in order to discuss the field of knowledge and practice ongoing health. Discussing the National Policy on Humane Care and Management of the SUS (PNH), we seek to affirm it as a strategy of collective production of health practices, emphasizing the inseparability of clinical and management. Through a route for the organization of PNH, we highlight its principles, guidelines and methods as guidelines for the sharing of ways of producing health, which occur from the action of managers, employees, users, and social movements. Thus, focused on articulation between the actors involved with clinical practice and democratic management we seek to situate the PNH as health policy SUS. (AU)
RESUMO
Os autores tecem considerações sobre a militância no campo da saúde, em especial na defesa do Sistema Único de Saúde (SUS), enquanto uma política pública universal. Após apontar algumas estratégias desta militância, o texto discute o centralismo e o caráter identitário dessas práticas. Destacam e problematizam quatro formas de centralismo: do "bem comum" em suas representações; o procedimento como oferta de tecnologias de saúde; do usuário e as concepções sobre suas necessidades/demandas; e da proteção inadvertida da vida. Propõem, como alternativa, uma nova militância no SUS, como prática intensiva e produzida no encontro, na dimensão relacional, entre gestores, trabalhadores e usuários.
The authors make comments about militancy in the field of healthcare, especially for defending the Brazilian Unified Health System (SUS) as a universal public policy. After indicating some strategies for such militancy, the text discusses centralism and the identifying nature of these practices. It highlights and questions four forms of centralism: the "common good" in its representations; procedures as offers of health technologies; users and notions about their needs/demands; and careless protection of life. As an alternative, the authors propose a new form of militancy within SUS, as intensive practice produced at the meeting point within the dimension of the relationship between managers, workers and users.
Los autores elaboran consideraciones sobre la militanoia en el campo de la salud, especialmente en defensa del Sistema Único de Salud (SUS) como política públioa universal. Tras presentar algunas estrategias de esta miliancia, el texto discute el centralismo y el caracter de identidad de estas prácticas. Destacan el conjunto de problemas de cuatro formas de centralismo: del "bien común" en sus representaciones; el procedimiento como oferta de tecnologías de salud; del usuario y los conceptos sobre sus necesidades/demandas; el de la protección inadvertida de la vida. Proponen como alternativa una nueva militancia en el SUS como práctica intensiva y producida en el encuentro, en dimensión nacional, entre gestores, trabajadores y usuarios.
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Ética , Saúde Pública , Política de Saúde/tendências , Sistema Único de SaúdeRESUMO
Introducción: la experiencia clínica ha demostrado que el anillo de soporte de la bioprótesis valvular cardíaca (ASBVC) ejerce un importante papel en la operatividad del implante. Los resultados tras la utilización de múltiples modelos, han ampliado el estado del arte en el diseño y desarrollo de dichos anillos; aún así, no se logra un anillo que opere como el soporte natural. Dada la importancia del ASBVC, la fabricación en el ámbito nacional de bioprótesis valvular cardíaca (BVC) se ve limitada porque los fabricantes multinacionales sólo ponen a disposición el conjunto valvular bioprotésico, por lo que no se cuenta con el ASBVC aislado; además, pesa sobre éstos una patente que impide su réplica y prohibe su producción industrial. Objetivos: desarrollar un nuevo modelo de ASBVC, con mejores prestaciones, considerando los aspectos funcionales más relevantes para un soporte de alto comportamiento. Evaluar los diseños mediante técnicas computadorizadas y máquinas de pruebas especialmente construidas. Materiales y métodos: mediante técnicas de estática y dinámica, considerando variables de flexibilidad, distribución de cargas y tensión, y condiciones de operación, se hace un diseño conceptual de ASBVC. Luego se realiza un diseño geométrico dimensional teniendo en cuenta los aspectos anatómicos y el montaje del tejido biológico. Se selecciona un material que cumpla con los requerimientos de compatibilidad biológica, resistencia química y esfuerzos mecánicos a los que estará sometido el soporte de la BVC. Se evalúa la procesabilidad del material con tecnologías de fabricación rápida de prototipos, así como mediante técnicas de extrusión, maquinado o inyección de termoplásticos...
Assuntos
Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/métodos , Implante de Prótese de Valva Cardíaca/tendências , Próteses e Implantes/tendências , Valvas Cardíacas/cirurgiaRESUMO
La finalidad del presente trabajo es mostrar nuestra experiencia con el bloqueo del plexo braquial por vía paraescalénica como método anestésico para el tratamiento de la patología traumática del miembro superior en situaciones de urgencia. Entre los años 1992 y 1996 hemos utilizado esta técnica en 109 oportunidades, logrando un bloqueo efectivo en el 94,5 por ciento de los casos. La punción se realiza a nivel del borde lateral del músculo escaleno anterior, inmediatamente por encima de la arteria subclavia y a 1,5 cm por encima del borde de la clavícula y progresando la aguja en sentido anteroposterior, hasta obtener parestesias. Como reacción adversa de frecuente aparición hemos constatado el Síndrome de C. Bernard Horner (74,3 por ciento) sin repercusiones clínicas para el paciente. Los tipos de cirugía en que se ha utilizado este método corresponde a reducciones incruentas en 87 casos y cruentas en 22 casos. Se describe la técnica, sus bases anatómicas, sus ventajas con respecto a otras técnicas, sus efectos adversos y sus complicaciones. Este método de abordaje del plexo braquial, es un procedimiento seguro, de técnica sencilla, con reparos anatómicos fácilmente reconocibles, muy bajo índice de complicaciones, y las que cuando se presentan son pasajeras y sin riesgos para el paciente. Esta vía resulta de fácil realización y es segura para proveer una adecuada anestesia en toda la patología quirúrgica del miembro superior.
Assuntos
Humanos , Anestesia por Condução/métodos , Plexo Braquial , Emergências , Punções , Punções/efeitos adversos , Ombro/patologia , Ombro/cirurgia , Bupivacaína/administração & dosagem , Epinefrina/administração & dosagem , Síndrome de Horner , Lidocaína/administração & dosagemRESUMO
La finalidad del presente trabajo es mostrar nuestra experiencia con el bloqueo del plexo braquial por vía paraescalénica como método anestésico para el tratamiento de la patología traumática del miembro superior en situaciones de urgencia. Entre los años 1992 y 1996 hemos utilizado esta técnica en 109 oportunidades, logrando un bloqueo efectivo en el 94,5 por ciento de los casos. La punción se realiza a nivel del borde lateral del músculo escaleno anterior, inmediatamente por encima de la arteria subclavia y a 1,5 cm por encima del borde de la clavícula y progresando la aguja en sentido anteroposterior, hasta obtener parestesias. Como reacción adversa de frecuente aparición hemos constatado el Síndrome de C. Bernard Horner (74,3 por ciento) sin repercusiones clínicas para el paciente. Los tipos de cirugía en que se ha utilizado este método corresponde a reducciones incruentas en 87 casos y cruentas en 22 casos. Se describe la técnica, sus bases anatómicas, sus ventajas con respecto a otras técnicas, sus efectos adversos y sus complicaciones. Este método de abordaje del plexo braquial, es un procedimiento seguro, de técnica sencilla, con reparos anatómicos fácilmente reconocibles, muy bajo índice de complicaciones, y las que cuando se presentan son pasajeras y sin riesgos para el paciente. Esta vía resulta de fácil realización y es segura para proveer una adecuada anestesia en toda la patología quirúrgica del miembro superior.(AU)
Assuntos
Humanos , Anestesia por Condução/métodos , Plexo Braquial , Emergências , Punções/métodos , Punções/efeitos adversos , Ombro/cirurgia , Ombro/patologia , Síndrome de Horner , Lidocaína/administração & dosagem , Epinefrina/administração & dosagem , Bupivacaína/administração & dosagemRESUMO
Se describen dos casos, en que fue usada la técnica de intubación endotraqueal guiada por vía retrógrada, en situaciones de emergencia: uno de ellos con antecedentes de ingesta copiosa en el que no se logró visualizar la glotis durante la maniobras de intubación mediante laringoscopía directa. En el otro, con traumatismo facial y fracturas de su maxilar inferior, se optó por esta técnica en virtud de la mala apertura bucal. Se destaca la importancia del conocimiento de este procedimiento para aquellos casos en que se sospecha una intubación dificultosa o como técnica alternativa en situaciones de emergencia cuando han fracasado otras maniobras de intubación con el paciente bajo ventilación espontánea