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Introducción. La debilidad adquirida en las unidades de cuidados intensivos es una complicación frecuente de los pacientes con enfermedades críticas, que puede tener un impacto negativo en su pronóstico a corto y a largo plazo. Objetivos. Evaluar si la utilización de un protocolo multicomponente, que incluye movilidad activa temprana, manejo efectivo del dolor, reducción de la sedación, medidas no farmacológicas para prevenir el delirium, estimulación cognitiva y apoyo familiar, puede disminuir la incidencia de debilidad adquirida en las unidades de cuidados intensivos al momento del egreso del paciente. Materiales y métodos. Se trata de un ensayo clínico, no aleatorizado, en dos unidades de cuidados intensivos mixtas de un hospital de tercer nivel. Los participantes fueron pacientes mayores de 14 años con ventilación mecánica invasiva por más de 48 horas. Se aplicó como intervención un protocolo multicomponente y como control se utilizó el cuidado usual o estándar. Resultados. Ingresaron 188 pacientes al estudio, 82 al grupo de intervención y 106 al grupo control. La tasa de debilidad adquirida en las unidades de cuidados intensivos al egreso de la unidad fue significativamente menor en el grupo de intervención (41,3 % versus 78,9 %, p<0,00001). La mediana del puntaje de movilidad al momento del alta de la unidad de cuidados intensivos fue mayor en el grupo de intervención (3,5 versus 2, p<0,0138). No se encontraron diferencias estadísticamente significativas en las medianas de días libres de respiración mecánica asistida, ni de unidad de cuidados intensivos al día 28, tampoco en la tasa de mortalidad general al egreso del hospital (18 versus 15 días, p<0,49; 18,2 % versus 27,3 %, p<0,167). Conclusiones. Un protocolo multicomponente que incluía movilidad activa temprana tuvo un impacto significativo en la reducción de la debilidad adquirida en las unidades de cuidados intensivos al egreso en comparación con el cuidado estándar.
Introduction. Intensive care unit-acquired weakness is a frequent complication that affects the prognosis of critical illness during hospital stay and after hospital discharge. Objectives. To determine if a multicomponent protocol of early active mobility involving adequate pain control, non-sedation, non-pharmacologic delirium prevention, cognitive stimulation, and family support, reduces intensive care unit-acquired weakness at the moment of discharge. Materials and methods. We carried out a non-randomized clinical trial in two mixed intensive care units in a high-complexity hospital, including patients over 14 years old with invasive mechanical ventilation for more than 48 hours. We compared the intervention -the multicomponent protocol- during intensive care hospitalization versus the standard care. Results. We analyzed 82 patients in the intervention group and 106 in the control group. Muscle weakness acquired in the intensive care unit at the moment of discharge was less frequent in the intervention group (41.3% versus 78.9%, p<0.00001). The mobility score at intensive unit care discharge was better in the intervention group (median = 3.5 versus 2, p < 0.0138). There were no statistically significant differences in the invasive mechanical ventilation-free days at day 28 (18 versus 15 days, p<0.49), and neither in the mortality (18.2 versus 27.3%, p<0.167). Conclusion. A multi-component protocol of early active mobility significantly reduces intensive care unit-acquired muscle weakness at the moment of discharge.
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Unidades de Terapia Intensiva , Estado Terminal , DelírioRESUMO
Introducción. La terapia con oxigenación con membrana extracorpórea es costosa y, aunque existe existen indicios en la literatura de que puede ser una intervención costo-efectiva en los países desarrollados, hay dudas sobre su costo-efectividad en un país con un producto interno bruto per cápita bajo, como Colombia. Objetivo. Determinar el incremento de la relación costo-efectividad de la terapia con oxigenación con membrana extracorpórea en pacientes con síndrome de dificultad respiratoria aguda en Colombia. Materiales y métodos. Se eligieron pacientes adultos con diagnóstico de síndrome de dificultad respiratoria aguda para el análisis de costo-efectividad desde la perspectiva del sistema de salud. Se compararon aquellos pacientes con asistencia respiratoria mecánica con volúmenes bajos con aquellos tratados con oxigenación con membrana extracorpórea. Se determinaron los costos médicos directos de la atención y el incremento de la relación costo-efectividad a los 6 meses. Resultados. El costo esperado por paciente en asistencia respiratoria mecánica protectora fue de COP$ 17'609.909. El costo del soporte mediante terapia de oxigenación con membrana extracorpórea fue de COP$ 98'784.116. La relación de costo-efectividad promedio fue de COP$ 141'662.435 por cada vida salvada (USD$ 41.276). Conclusiones. El soporte con terapia de oxigenación con membrana extracorpórea tuvo un costo promedio de COP$ 141'662.435 por cada vida salvada, equivalente a USD$ 41.276 dólares y el incremento de la relación costo-efectividad fue de COP$ 608'783.750 (USD$ 177.384), casi diez veces superior a la regla de decisión de 3 PBI per cápita (COP$ 59'710.479).
Introduction: Extracorporeal membrane oxygenation therapy is expensive. There is evidence in the literature that it can be a cost-effective intervention in developed countries; however, in countries with low gross domestic product per capita, such as Colombia, there are still some doubts. Objective: To determine the incremental cost-effectiveness ratio of extracorporeal membrane oxygenation in patients with acute respiratory distress syndrome in Colombia. Materials and methods: Cost-effectiveness analysis in healthcare in relation to adult patients diagnosed with acute respiratory distress syndrome with mechanical ventilation with low volumes compared to extracorporeal membrane oxygenation. The direct medical costs and the incremental cost-effectiveness ratio were determined at 6 months. Results: The expected cost per patient on protective mechanical ventilation was COP$ 17,609,909. The cost of extracorporeal membrane oxygenation therapy support in surviving patients was COP$ 98,784,116. The average cost-effectiveness ratio of extracorporeal membrane oxygenation was COP$ 141,662,435 for each life saved (USD$ 41,276). Conclusions: Support with extracorporeal membrane oxygenation therapy had an average cost of COP$ 141,662,435 for each life saved equivalent to USD$ 41,276. The incremental cost-effectiveness ratio COP$ was 608,783,750 (USD$ 177,384); almost ten times higher than the decision rule of three gross domestic product per capita (COP$ 59,710,479).
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Oxigenação por Membrana Extracorpórea , Respiração Artificial , Síndrome do Desconforto Respiratório do Recém-Nascido , Análise Custo-Benefício , ColômbiaRESUMO
There is little data on the experience of managing pediatric Intestinal Failure (IF) in Latin America. This study aimed to identify and describe the current organization and practices of the IF teams in Latin America and the Caribbean. An online survey was sent to inquire about the existence of IF teams that managed children on home parenteral nutrition (HPN). Our questionnaire was based on a previously published European study with a similar goal. Twenty-four centers with pediatric IF teams in eight countries completed the survey, representing a total number of 316 children on HPN. The median number of children on parenteral nutrition (PN) at home per team was 5.5 (range 1-50). Teams consisted of the following members: pediatric gastroenterologist and a pediatric surgeon in all teams, dietician (95.8%), nurse (91.7%), social worker (79.2%), pharmacist (70.8%), oral therapist (62.5%), psychologist (58.3%), and physiotherapist (45.8%). The majority of the centers followed international standards of care on vascular access, parenteral and enteral nutrition, and IF medical and surgical management, but a significant percentage reported inability to monitor micronutrients, like vitamins A (37.5%), E (41.7%), B1 (66.7%), B2 (62.5%), B6 (62.5%), active B12 (58.3%); and trace elements-including zinc (29.2%), aluminum (75%), copper (37.5%), chromium (58.3%), selenium (58.3%), and manganese (58.3%). Conclusion: There is wide variation in how IF teams are structured in Latin America-while many countries have well-established Intestinal rehabilitation programs, a few do not follow international standards. Many countries did not report having an IF team managing pediatric patients on HPN.
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Gastroenterologia/estatística & dados numéricos , Enteropatias/terapia , Equipe de Assistência ao Paciente/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Região do Caribe , Criança , Pré-Escolar , Feminino , Gastroenterologia/métodos , Humanos , Lactente , Recém-Nascido , América Latina , Masculino , Nutrição Parenteral no Domicílio/estatística & dados numéricos , Pediatria/métodos , Inquéritos e QuestionáriosRESUMO
Abstract: The associations between morphological fruit types, fruit and seed colors, and functional plant traits: life forms, epiphytism, physiology, nutritional relationships, fruit phenology, and successional stage, were determined for 1,139 plant species from contrasting plant communities. Texture and dehiscence were closely related. Dehiscence is largely associated with dry tissues; indehiscence, however, is an attribute of both dry and fleshy fruits. The number of morphological fruit types was 28 or 55 for Gray's and Spjut's classifications, respectively. Fruits were predominantly dark in color (brown, purple-black, black or green), whilst seeds had both dark and light colors (brown, beige, or black). The most representative associations were mainly found between the more abundant fruit types and the colors most common. Asymmetries in the level of specialization, whereby less common fruit and seed colors tended to be associated with the most common fruit types, were also found. Fleshy fruits showed more variation as regards their coloration, and only drupes and berries showed a tendency towards a specific color: purple-black. The relationships among fruit type and color, seed color, and functional plant traits revealed the following trends: trees produced both fleshy and dry fruits; shrubs produced fleshy fruits; and herbaceous species, dry fruits. Woody species tended to have dark or bright colors, depending on their seed dispersal mechanisms and phylogenetic relations. Epiphytes were associated with dry-dehiscent fruits and brown seeds, and parasitic-hemiparasitic species had predominantly fleshy-indehiscent fruits. Pioneer species were more likely to have dry fruits, whereas fleshy fruits tended to be more frequent in late successional stage species. The C4 species, mostly herbs, had mainly one-seeded dry fruits, but multi-seeded fruits in succulent-CAM species showed morphologically diverse fruit types. Unripe and ripe fruits showed seasonal changes, especially during the rainy-dry transition period for the most abundant morphological fruit types, dry fruits during the dry period and fleshy fruited species was positively associated with the rainy season. All these trends are discussed with regard to their environmental significance and the relationships between fruit morphology, colors and functional groups. .
Resumen: Las asociaciones entre tipos morfológicos de frutos, colores de frutos y semillas y los grupos funcionales de las plantas: formas de vida, epifitismo, fisiología, relaciones nutricionales, fenología de frutos y estado sucesional fueron determinados para 1139 especies de plantas de comunidades contrastantes. La textura y dehiscencia estaban muy relacionadas. Dehiscencia está estrechamente asociada con tejidos secos, pero indehiscencia es un atributo de frutos secos y carnosos. El número de tipos morfológicos de frutos fue 28 y 55 para la clasificación de Gray y Spjut respectivamente. Los frutos fueron predominantemente de colores oscuros (marrón, negro-purpura, negro o verdes), mientras que las semillas tenían colores claros y oscuros (marrón, beige o negro). Las asociaciones más representativas fueron principalmente encontradas entre los tipos de frutos más abundantes y los colores más comunes. También se encontraron asimetrías en los niveles de especialización, donde los colores menos comunes de frutos y semillas estuvieron asociados con los tipos de frutos más comunes. Los frutos carnosos mostraron más variación en su coloración, y solo las drupas y bayas tendieron a colores específicos como negro-purpura. Las relaciones entre tipo de fruto y color, color semilla y rasgos funcionales de las plantas revelaron las siguientes tendencias: arboles producen frutos secos y carnosos; arbustos frutos carnosos y hierbas producen frutos secos. Las especies leñosas tendieron a tener colores oscuros y brillantes, relacionados con su mecanismo de dispersión y filogenia. Epifitas estuvieron asociadas con frutos secos dehiscentes y semillas marrones, y las especies parásitas-hemiparásitas tenían predominantemente frutos carnosos indehiscentes. Las especies pioneras tenían comúnmente frutos secos, mientras que los frutos carnosos tendieron a ser más frecuentes en especies de estados sucesionales tardíos. Las especies C4, principalmente hierbas, tenían frutos secos con una semilla, mientras que frutos polispermos en especies CAM mostraron diversos tipos de frutos. La fenología de frutos maduros e inmaduros mostro cambios estacionales para los más abundantes tipos morfológicos, especialmente durante el periodo de transición lluvia-sequia, frutos secos en el periodo seco y frutos carnosos durante el periodo lluvioso. Todas estas tendencias son discutidas con relación a las características ambientales y de acuerdo con las relaciones entre tipos morfológicos de frutos, colores y grupos funcionales.
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Breeding system, sexual system, temporal variation in sex expression and herkogamy were evaluated in seven herbaceous-shrubby communities from the Gran Sabana Plateau, Venezuela. This analysis was conducted considering the life form, substrate type, succulence, carbon metabolism, nutritional relation, successional stage, pollination system specificity and endemism of plant species. Of the 348 plant species studied, 73.8 % were hermaphrodite, 16.9 % were monoecious and 9.2 % were dioecious. Plant sexual systems such as dichogamy and herkogamy were associated with life form, nutritional relations, carbon metabolism and pollination systems. Most species were adichogamous, followed by protandrous and protogynous. Protandry was high for perennial herbs, annual herbs and trees, and protogyny was most frequent in perennial herbs. Protandrous and protogynous species were frequently anemophilous. Herkogamy was higher than non-herkogamy. Herkogamy was higher for trees, shrubs and liana; higher in monophilous and lower in anemophilous species. Most of the hermaphrodites were herkogamous and adichogamous species. In contrast, monoecy were commonly perennial herb and dichogamous species and frequently associated with anemophily. Dioecious species were trees and shrubs and with polyphilous pollination. Dioecy was the most frequent sexual system for endemic species. Hermaphrodite species were similarly distributed across plant communities. Monoecy was slightly higher for savanna and fallow than the other communities, and dioecy was higher for shrublands and secondary bushland. Most plant species were non-agamospermous, non-spontaneous self-pollinated and xenogamous. Partially self-incompatible dominated, followed by self-incompatible, partially cross-incompatible and the lowest frequency corresponded to cross-incompatible species. All these results are discussed in the context of evolutionary and ecological trends.
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Importance: The effects of recruitment maneuvers and positive end-expiratory pressure (PEEP) titration on clinical outcomes in patients with acute respiratory distress syndrome (ARDS) remain uncertain. Objective: To determine if lung recruitment associated with PEEP titration according to the best respiratory-system compliance decreases 28-day mortality of patients with moderate to severe ARDS compared with a conventional low-PEEP strategy. Design, Setting, and Participants: Multicenter, randomized trial conducted at 120 intensive care units (ICUs) from 9 countries from November 17, 2011, through April 25, 2017, enrolling adults with moderate to severe ARDS. Interventions: An experimental strategy with a lung recruitment maneuver and PEEP titration according to the best respiratory-system compliance (n = 501; experimental group) or a control strategy of low PEEP (n = 509). All patients received volume-assist control mode until weaning. Main Outcomes and Measures: The primary outcome was all-cause mortality until 28 days. Secondary outcomes were length of ICU and hospital stay; ventilator-free days through day 28; pneumothorax requiring drainage within 7 days; barotrauma within 7 days; and ICU, in-hospital, and 6-month mortality. Results: A total of 1010 patients (37.5% female; mean [SD] age, 50.9 [17.4] years) were enrolled and followed up. At 28 days, 277 of 501 patients (55.3%) in the experimental group and 251 of 509 patients (49.3%) in the control group had died (hazard ratio [HR], 1.20; 95% CI, 1.01 to 1.42; P = .041). Compared with the control group, the experimental group strategy increased 6-month mortality (65.3% vs 59.9%; HR, 1.18; 95% CI, 1.01 to 1.38; P = .04), decreased the number of mean ventilator-free days (5.3 vs 6.4; difference, -1.1; 95% CI, -2.1 to -0.1; P = .03), increased the risk of pneumothorax requiring drainage (3.2% vs 1.2%; difference, 2.0%; 95% CI, 0.0% to 4.0%; P = .03), and the risk of barotrauma (5.6% vs 1.6%; difference, 4.0%; 95% CI, 1.5% to 6.5%; P = .001). There were no significant differences in the length of ICU stay, length of hospital stay, ICU mortality, and in-hospital mortality. Conclusions and Relevance: In patients with moderate to severe ARDS, a strategy with lung recruitment and titrated PEEP compared with low PEEP increased 28-day all-cause mortality. These findings do not support the routine use of lung recruitment maneuver and PEEP titration in these patients. Trial Registration: clinicaltrials.gov Identifier: NCT01374022.
Assuntos
Respiração com Pressão Positiva/métodos , Síndrome do Desconforto Respiratório/terapia , Adulto , Idoso , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pneumotórax/etiologia , Respiração com Pressão Positiva/efeitos adversos , Síndrome do Desconforto Respiratório/mortalidade , Volume de Ventilação Pulmonar , Falha de TratamentoRESUMO
Introduction: Throughout the years, several methods have been developed to help determine injury severity and obtain accurate prognoses in trauma patients. Trauma scores that have been used for more than 40 years are extremely useful in clinical practice as well as in research. Objective: To conduct a review of the most relevant literature on trauma and to make a description of each of the scoring tools, focusing on their limitations and their application in clinical trials. Materials and methods: Narrative review conducted in different databases such as PubMed, ScienceDirect and OVID. A manual search was also conducted of articles on the subject in both English and Spanish. Results: The review articles provided an adequate description of each of the scores, the way they are calculated, the main limitations in their application, and the most relevant findings in the literature. Conclusion: There is a wide range of severity scores used in trauma patients for anticipating clinically significant outcomes with varying degrees of accuracy. Creating and validating a single, universally valid score is a huge challenge; consequently, the selection of the scoring tool is based, to a large extent, on experience, the context and the available evidence.
Introducción: a lo largo de la historia se han creado varios métodos para evaluar la gravedad de las lesiones y brindar un pronóstico exacto en pacientes con trauma. Los puntajes en trauma que se han utilizado por más de 40 años son una herramienta de gran utilidad tanto para el contexto clínico como investigativo. Objetivo: elaborar una revisión de la literatura más relevante sobre los puntajes en trauma y hacer una descripción de cada una de estas herramientas, haciendo énfasis en sus limitaciones y en la aplicación en estudios clínicos. Materiales y Métodos: revisión narrativa, se consultaron diferentes bases de datos como PubMed, ScienceDirect y OVID; además, se hizo búsqueda manual de artículos en inglés y en español sobre el tema. Resultados: los artículos revisados permitieron hacer una descripción adecuada de cada uno de los puntajes, de la forma en que se calculan, sus principales limitaciones al momento de aplicarlos y los hallazgos más notables en la literatura. Conclusión: existe una gran variedad de puntajes de gravedad para pacientes con trauma que permiten anticipar con diferente exactitud los desenlaces clínicamente significativos. La creación y validación de un único puntaje universalmente válido es todo un reto; por ello la selección de esta herramienta está basada en gran parte en la experiencia, el contexto y la evidencia disponible.
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HumanosRESUMO
BACKGROUND: Patients with lupus nephritis could progress to end-stage renal disease (10-22%); hence, kidney transplants should be considered as the treatment of choice for these patients. OBJECTIVE: To evaluate the clinical outcomes after kidney transplants in patients with chronic kidney diseases secondary to lupus nephritis, polycystic kidney disease and diabetes nephropathy at Pablo Tobon Uribe Hospital. METHODS: A descriptive and retrospective study performed at one kidney transplant center between 2005 and 2013. RESULTS: A total of 136 patients, 27 with lupus nephritis (19.9%), 31 with polycystic kidney disease (22.8%) and 78 with diabetes nephropathy (57.4%), were included in the study. The graft survivals after one, three and five years were 96.3%, 82.5% and 82.5% for lupus nephritis; 90%, 86% and 76.5% for polycystic kidney disease and 91.7%, 80.3% and 67.9% for diabetes nephropathy, respectively, with no significant differences (p= 0.488); the rate of lupus nephritis recurrence was 0.94%/person-year. The etiology of lupus vs diabetes vs polycystic disease was not a risk factor for a decreased time of graft survival (Hazard ratio: 1.43; 95% CI: 0.52-3.93). CONCLUSION: Kidney transplant patients with end stage renal disease secondary to lupus nephritis has similar graft and patient survival success rates to patients with other kidney diseases. The complication rate and risk of recurrence for lupus nephritis are low. Kidney transplants should be considered as the treatment of choice for patients with end stage renal disease secondary to lupus nephritis.
ANTECEDENTES: Pacientes con nefritis lúpica pueden progresar a enfermedad renal crónica terminal (10-22%); en estos pacientes el trasplante renal debe ser considerado como la terapia de elección. Objetivo: Evaluar los desenlaces clínicos de un grupo de pacientes con enfermedad renal crónica terminal por nefropatía lúpica, enfermedad renal poliquística y nefropatía diabética que fueron sometidos a trasplante renal en el Hospital Pablo Tobón Uribe. MÉTODOS: Estudio retrospectivo, descriptivo, realizado en un solo centro de trasplante renal, durante el período 2005-2013. RESULTADOS: Se evaluaron 136 pacientes: 27 con nefritis lúpica (19.9%), 31 con enfermedad renal poliquística (22.8%) y 78 con nefropatía diabética (57.4%). La supervivencia del injerto a uno, tres y cinco años fue de de 96.3%, 82.5% y 82.5% en nefropatía lúpica, 90%, 86% y 76.5% en enfermedad renal poliquística y 91.7%, 80.3% y 67.9% en nefropatía diabética respectivamente, sin diferencias estadísticas significativas (Long Rank test= 0.488). La tasa de recurrencia de nefritis lúpica posterior al trasplante renal fue de 0.94%/persona-año. Tener lupus vs diabetes o enfermedad renal poliquística no fue un factor de riesgo para disminución del tiempo de supervivencia del injerto (Hazard ratio= 1.43; 95% IC= 0.52-3.93). CONCLUSIONES: Los pacientes enfermedad renal crónica terminal secundaria a nefritis lúpica, que son llevados a trasplante renal tienen tasas de éxito similar en cuanto a supervivencia del injerto y del paciente, al compararlos con otras enfermedades renales. La tasa de complicaciones y el riesgo de recurrencia de la nefropatía lúpica son bajos. El trasplante renal debe ser considerado como la terapia de elección para los pacientes con enfermedad renal crónica estadio terminal secundaria a nefritis lúpica.
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Nefropatias Diabéticas/complicações , Sobrevivência de Enxerto , Falência Renal Crônica/cirurgia , Transplante de Rim , Nefrite Lúpica/complicações , Doenças Renais Policísticas/complicações , Adulto , Idoso , Feminino , Taxa de Filtração Glomerular , Rejeição de Enxerto/etiologia , Humanos , Falência Renal Crônica/etiologia , Falência Renal Crônica/mortalidade , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Análise de Regressão , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
Background: Patients with lupus nephritis could progress to endstage renal disease (10-22%); hence, kidney transplants should be considered as the treatment of choice for these patients. Objective: To evaluate the clinical outcomes after kidney transplants in patients with chronic kidney diseases secondary to lupus nephritis, polycystic kidney disease and diabetes nephropathy at Pablo Tobon Uribe Hospital. Methods: A descriptive and retrospective study performed at one kidney transplant center between 2005 and 2013. Results: A total of 136 patients, 27 with lupus nephritis (19.9%), 31 with polycystic kidney disease (22.8%) and 78 with diabetes nephropathy (57.4%), were included in the study. The graft survivals after one, three and five years were 96.3%, 82.5% and 82.5% for lupus nephritis; 90%, 86% and 76.5% for polycystic kidney disease and 91.7%, 80.3% and 67.9% for diabetes nephropathy, respectively, with no significant differences (p= 0.488); the rate of lupus nephritis recurrence was 0.94%/person-year. The etiology of lupus vs diabetes vs polycystic disease was not a risk factor for a decreased time of graft survival (Hazard ratio: 1.43; 95% CI: 0.52-3.93). Conclusion: Kidney transplant patients with end stage renal disease secondary to lupus nephritis has similar graft and patient survival success rates to patients with other kidney diseases. The complication rate and risk of recurrence for lupus nephritis are low. Kidney transplants should be considered as the treatment of choice for patients with end stage renal disease secondary to lupus nephritis.
Antecedentes: Pacientes con nefritis lúpica pueden progresar a enfermedad renal crónica terminal (10-22%); en estos pacientes el trasplante renal debe ser considerado como la terapia de elección. Objetivo: Evaluar los desenlaces clínicos de un grupo de pacientes con enfermedad renal crónica terminal por nefropatía lúpica, enfermedad renal poliquística y nefropatía diabética que fueron sometidos a trasplante renal en el Hospital Pablo Tobón Uribe. Métodos: Estudio retrospectivo, descriptivo, realizado en un solo centro de trasplante renal, durante el período 2005-2013. Resultados: Se evaluaron 136 pacientes: 27 con nefritis lúpica (19.9%), 31 con enfermedad renal poliquística (22.8%) y 78 con nefropatía diabética (57.4%). La supervivencia del injerto a uno, tres y cinco años fue de de 96.3%, 82.5% y 82.5% en nefropatía lúpica, 90%, 86% y 76.5% en enfermedad renal poliquística y 91.7%, 80.3% y 67.9% en nefropatía diabética respectivamente, sin diferencias estadísticas significativas (Long Rank test= 0.488). La tasa de recurrencia de nefritis lúpica posterior al trasplante renal fue de 0.94%/persona-año. Tener lupus vs diabetes o enfermedad renal poliquística no fue un factor de riesgo para disminución del tiempo de supervivencia del injerto (Hazard ratio= 1.43; 95% IC= 0.52-3.93). Conclusiones: Los pacientes enfermedad renal crónica terminal secundaria a nefritis lúpica, que son llevados a trasplante renal tienen tasas de éxito similar en cuanto a supervivencia del injerto y del paciente, al compararlos con otras enfermedades renales. La tasa de complicaciones y el riesgo de recurrencia de la nefropatía lúpica son bajos. El trasplante renal debe ser considerado como la terapia de elección para los pacientes con enfermedad renal crónica estadio terminal secundaria a nefritis lúpica.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrite Lúpica/complicações , Transplante de Rim , Nefropatias Diabéticas/complicações , Sobrevivência de Enxerto , Falência Renal Crônica/cirurgia , Doenças Renais Policísticas/complicações , Complicações Pós-Operatórias , Fatores de Tempo , Taxa de Sobrevida , Análise de Regressão , Estudos Retrospectivos , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , Resultado do Tratamento , Taxa de Filtração Glomerular , Rejeição de Enxerto/etiologia , Falência Renal Crônica/etiologia , Falência Renal Crônica/mortalidadeRESUMO
Objetivo general: Describir la epidemiología del Síndrome de Dificultad Respiratoria Aguda (SDRA) postraumático. Metodología: Estudio observacional descriptivo de pacientes con fractura traumática de la diáfisis femoral que requirieron manejo quirúrgico. Se analizaron variables demográficas, gravedad del trauma, métodos de tratamiento y desenlaces intrahospitalarios. Se realizó un análisis descriptivo y multivariado para explorar factores asociados al desarrollo de SDRA. Resultados: Doscientos sesenta y siete pacientes con fractura femoral, el 86% fueron hombres con edad media de 28,7 años e Índice de Severidad del Trauma (ISS) de 12,7. Se observó una prevalencia de SDRA del 8,6% en toda la población y del 20% en politraumatizados. La mortalidad fue del 7,5%. Las variables asociadas al SDRA en el análisis bivariado fueron: tiempo entre el trauma y el ingreso, ISS, contusión pulmonar, fractura asociada de tibia, requerimiento de cirugía urgente y necesidad de transfusión de glóbulos rojos. En el análisis multivariado, las variables asociadas fueron: trauma contuso de tórax, tiempo transcurrido hasta la fijación definitiva y la transfusión de glóbulos rojos en cirugía. En la cohorte hubo un incremento en la prevalencia de SDRA anual, siendo del 4,3% en 2006 comparado con el 26,1% en 2011, al igual que el politrauma que pasó del 14,5% en 2006 al 23,6% en 2011. Se evidenció también un cambio en el tratamiento, aumentando el control temprano total y el control de daño ortopédico. Conclusiones: En nuestra población, la prevalencia de SDRA en pacientes con fracturas de fémur aumenta cuando hay trauma contuso de tórax, cuando se prolonga el tiempo de fijación y la transfusión sanguínea.
Objective: To describe the epidemiology of post-traumatic acute respiratory distress syndrome. Methodology: Descriptive observational study of patients with traumatic femoral shaft fracture requiring surgical management. The variables included in the analysis were demographics, injury severity, treatment methods, and in-hospital outcomes. A descriptive multivariate analysis was performed in order to explore the factors associated with the development of Acute Respiratory Distress Syndrome (ARDS). Results: Of the 267 patients with femoral fractures, 86% were male patients with a mean age of 28.7 years and Injury Severity Score (ISS) of 12.7. The overall prevalence of ARDS was 8.6% while the prevalence among multiple trauma patients was 20%. Mortality was 7.5%. In the bivariate analysis, the variables associated with ARDS were the following: time between the trauma and hospital admission, ISS, contused lung, associated tibial fracture, urgent surgery requirement, and need for red blood cell transfusion. In the multivariate analysis, the associated variables were: blunt chest trauma, time elapsed until definitive fixation, and red blood celltrans fusion during surgery. In the cohort, there was an increase in the annual prevalence of ARDS, from 4.3% in 2006 to 26.1% in 2011, as was also the case with multiple trauma, which increased from 14.5% in 2006 to 23.6% in 2011. A change in treatment was also evidenced, with increase in early total care (ETC) and damage control orthopaedics (DCO). Conclusions: In our population, the prevalence of ARDS in patients with femoral fractures increases when associated with blunt chest trauma, delayed stabilization time, and the need for blood transfusion.
Assuntos
HumanosRESUMO
Este artículo hace una reflexión sobre la investigación ¿Qué es la bioética?1, de Gilbert Hottois2. Destaca su propuesta de bioética y su tesis central: la bioética, a diferencia de la ética, explica la vida en sociedades tecnológicas y multiculturales complejas caracterizadas por ser individualistas, pluralistas e integradas por grupos con los más diversos intereses. A partir de esa tesis de Hottois, y con fundamento en los recursos de la filosofía moral utilizados por la bioética, este artículo de reflexión hace énfasis en cuatro aspectos: 1. El principialismo, recurso contemporáneo cargado de orientaciones, para la toma de decisiones, 2. La ética kantiana, con sus imperativos categóricos que fundamentan el respeto de la dignidad humana al considerar al ser como un fin en sí mismo. 3. Los derechos humanos, como imperativo legal y moral para la supervivencia y 4. Los propósitos de la bioética.
This article reflects on the research: What is Bioethics? By Gilbert Hottois. Emphasizes his bioethical proposal and his central thesis: Bioethics, unlike Ethics, explains life in complex, multicultural and technological societies, characterized for being individualistic, pluralistic and integrated by groups with the more diverse interests. From this Hottois thesis, and based on the resources of moral philosophy used by the Bioethics, this reflection article emphasizes in four aspects: 1. The Principialism, contemporary resource loaded with guiding principles of decisions. 2. Kantian ethics, with its categorical imperatives which are the foundation of respect for human dignity, considering the being as an end in itself. 3. The Human Rights, legal and moral imperative for survival and 4.The purpose of bioethics.
Este artigo faz uma reflexão sobre a pesquisa O que é bioética?, escrita pelo belga Hottois Gilbert. Destaca sua proposta de bioética e sua tese central: a bioética, ao contrário da ética, explica a vida em sociedades tecnológicas e multiculturais complexas caraterizadas por ser individualistas, pluralistas e integradas por grupos com os mais diversos interesses. A partir desta tese do Hottois, e com base nos recursos da filosofía moral utilizados pela bioética, este artigo de reflexão enfatiza quatro aspectos: 1. O principialismo, recurso contemporâneo carregado de diretrizes para a tomada de decisões. 2. A ética kantiana, com seus imperativos categóricos que fundamentam o respeito pela dignidade humana ao considerar o ser como um fim em si mesmo. 3. Os direitos humanos como um imperativo legal e moral para a sobrevivência e 4. Os objetivos da bioética.
Assuntos
Bioética , Tomada de Decisões , Ética , Direitos Humanos , Ciência, Tecnologia e Sociedade , TecnologiaRESUMO
Este artículo es una reflexión a partir de la investigación Biología, moral y exclusión1 y la propuesta sobre un posible origen de la moral y la exclusión. Como reflexión está centrada en el aspecto considerado más atractivo: el origen de la moral, cuyas teorías están en extremos que van desde considerar la facultad moral como un revestimiento artificial, meramente formal y carente de contenidos, hasta concebirla como un producto de la evolución, innato con el cual nace dotado el ser humano, para distinguir el bien y el mal, y pasando por las posiciones intermedias de Hauser y Cadena quienes consideran que la moral es innata, pero que la educación guía la adquisición de sistemas morales particulares (Hauser) o que una moral particular no se adquiere por el razonamiento o la argumentación, sino mediante la fe (Cadena).
This article its a reflection about the research Biology, moral and exclusion and his proposal for a posible origin of the moral and exclusion. As reflection, is centered on the aspect considered more attractive: the origin of morality, whose theories are considered extremes ranging from moral faculty as an artificial coating, merely formal and devoid of content, to conceive it as a product of evolution, innate in the birth the human being, to distinguish good and evil, and through the intermediate positions of Cadena and Hauser who believe that morality is innate, but education guides the acquisition of particular moral systems (Hauser) or that a particular moral is not acquired not by reasoning or argumentation, but through faith (Cadena).
Assuntos
Altruísmo , Ética , MoralRESUMO
Introducción: el síndrome de dificultad respiratoria aguda (SDRA) es secundario a inflamación originada en una enfermedad pulmonar primaria o una afección extrínseca al pulmón. Es frecuente en cuidado intensivo y conlleva alta mortalidad. Objetivos: determinar la eficacia y seguridad de los glucocorticoides en dosis bajas en personas mayores de 18 años con SDRA, en términos de mortalidad, días libres de ventilación mecánica, incidencia de infecciones nosocomiales, neuromiopatía y sangrado digestivo. Metodología: se hizo una búsqueda sistemática de ensayos clínicos controlados que compararon glucocorticoides con placebo, en adultos con SDRA en los desenlaces descritos. También, búsqueda secundaria de ensayos clínicos referenciados en los artículos primarios. Resultados: se encontraron siete ensayos clínicos. Se demostró disminución de la mortalidad hospitalaria al día 28 (OR: 0,56 [0,38-0,81], ganancia de 3,5 días libres de ventilación mecánica, disminución en la incidencia de infecciones nosocomiales y neumonía adquirida en el hospital. No hubo diferencias en la neuromiopatía asociada con esteroides, pero sí una tendencia, no significativa, al aumento del sangrado digestivo. Conclusión: los esteroides en dosis bajas disminuyen la mortalidad al día 28 de los adultos con SDRA y aumentan los días libres de ventilación mecánica sin aumentar los efectos adversos significativos.
Background: The Acute Respiratory Distress Syndrome (ARDS) is a lung inflammation secondary to primary or extrinsic pulmonary pathology. It is a common disease in the intensive care unit and its mortality rate is high. Objectives: To determine the efficacy and safety of corticosteroids in patients with ARDS older than 18 years, in terms of mortality, mechanical ventilationfree days, and safety in regard to nosocomial infections, health-care related pneumonia, neuromiopathy, and gastrointestinal bleeding. Search methods: A systematic search of electronic and manual literature was done, without restriction of language, of controlled clinical trials involving adults with ARDS, randomized to placebo vs. steroids, and that measured the outcomes described. Results: Seven clinical trials were found showing a decrease in hospital mortality (OR 0.56 [0.38-0.81], 3.5 more days free from mechanical ventilation, a decrease in nosocomial infections and in hospitalacquired pneumonia. There were no differences in the presentation of steroid-associated neuromiopathy. There was a non-significant tendency to increase in bleeding from the digestive tract. Conclusion: Low-dose steroids seem to have a beneficial effect on mortality and ventilator-free days in adult patients with ARDS with no increase in adverse effects.
Assuntos
Humanos , Adulto , Síndrome do Desconforto Respiratório do Recém-Nascido , Glucocorticoides , Revisão , MetanáliseRESUMO
Este trabajo de reflexión trata de resolver de manera sencilla a la pregunta que hace el hombre de la calle, ¿qué es la Bioética y para qué sirve?, a partir de definiciones sencillas y de los principios orientadores clásicos, así como de otras fuentes contemporáneas que se han sumado para conformar un amplio catálogo orientador, para enfrentar los dilemas contemporáneos frente a la vida en ámbitos como los laboratorios científicos, los hogares, los centros hospitalarios y los centros de poder político.
Assuntos
Bioética , Filosofia , Ciência, Tecnologia e SociedadeRESUMO
Arrestin was identified in ciliary photoreceptors of Pecten irradians, and its role in terminating the light response was established electrophysiologically. Downstream effectors in these unusual visual cells diverge from both microvillar photoreceptors and rods and cones; the finding that key regulatory mechanisms of the early steps of visual excitation are conserved across such distant lineages of photoreceptors underscores that a common blueprint for phototransduction exists across metazoa. Arrestin was detected by Western blot analysis of retinal lysates, and localized in ciliary photoreceptors by immunostaining of whole-eye cryosections and dissociated cells. Two arrestin isoforms were molecularly identified by PCR; these present the canonical N- and C-arrestin domains, and are identical at the nucleotide level over much of their sequence. A high degree of homology to various ß-arrestins (up to 70% amino acid identity) was found. In situ hybridization localized the two transcripts within the retina, but failed to reveal finer spatial segregation, possibly because of insufficient differences between the riboprobes. Intracellular dialysis of anti arrestin antibodies into voltage-clamped ciliary photoreceptors produced a gradual slow-down of the photocurrent falling phase, leaving a tail that decayed over many seconds after light termination. The antibodies also caused spectrally neutral flashes to elicit prolonged aftercurrents in the absence of large metarhodopsin accumulation; such aftercurrents could be quenched by chromatic illumination that photoconverts metarhodopsin back to rhodopsin. These observations indicate that the antibodies depleted functionally available arrestin, and implicate this molecule in the deactivation of the photoresponse at the rhodopsin level.
Assuntos
Arrestina/metabolismo , Células Fotorreceptoras de Invertebrados/metabolismo , Rodopsina/metabolismo , Animais , Arrestina/genética , Western Blotting , Eletrofisiologia , Imuno-Histoquímica , Hibridização In Situ , Luz , Técnicas de Patch-Clamp , Pecten , Células Fotorreceptoras de Invertebrados/fisiologia , Reação em Cadeia da Polimerase , Isoformas de ProteínasRESUMO
BACKGROUND AND AIMS: Herbaceous-shrubby communities in the Gran Sabana (Great Savanna) Plateau of Venezuela grow under non-zonal conditions. We speculated that this would produce specific patterns of reproductive phenology within these different soil-climate-vegetation associations. Specifically, we tested the hypothesis that the reproductive phenology patterns of four herbaceous-shrubby communities are determined by climate, plant life-forms and soil properties. METHODOLOGY: The reproductive phenology of 233 plant species of the Gran Sabana Plateau of the Venezuelan Guayana Highlands was studied taking into account their life-forms (i.e. trees, shrubs, climbers, annual herbs, perennial herbs, epiphytes and parasites/hemiparasites) in four herbaceous-shrubby communities: (i) shrubland, (ii) secondary bush, (iii) savanna and (iv) broad-leaved meadow. Patterns of flowering, and occurrence of unripe fruit and ripe fruit were studied at two levels of intensity for 24 months within a 5-year span. Two phenological records for each month of the year and between two and four replicates for each community type were made. Randomly selected 2-3 ha plots were used. General phenological patterns were established using <25% of the plants of each species in each plot to give the total duration of each phenological phase. High-intensity phenological patterns were established using >25% of individuals in each plot to establish times of high abundance of flowers, and presence of unripe fruit and/or ripe fruit on individual plants. This generated phenological peaks for each species. PRINCIPAL RESULTS: Non-seasonality of general flowering and unripe fruiting in each of the four communities was related to non-seasonal flowering and unripe fruiting patterns in the plant life-forms studied and to low variation in precipitation throughout the year. Flowering activity in the shrubland and broad-leaved meadow peaked twice. The bush community had only one flowering peak while the savanna gave a non-seasonal flowering peak. The peak unripe fruiting pattern was not clearly related to unripe fruit phenological patterns of the most abundant life-forms. Unripe fruit patterns and precipitation were only correlated for shrubs, climbers and trees in the shrubland. Ripe fruiting patterns peaked during the short-dry season in the bush and shrubland, and were negatively correlated with precipitation in the shrubland. General and peak ripe fruiting patterns were non-seasonal in the savanna and broad-leaved meadow and related to the dominance of herbaceous species with prolonged ripe fruiting times, low climate seasonality, high plant species richness and diversity, and dispersal syndromes. CONCLUSIONS: The reproductive phenology of the herbaceous-shrubby communities is mainly influenced by the composition of the life-forms, the precipitation regime and soil type.
RESUMO
Reportamos un caso de apendicitis epiploica, así como revisión de la literatura. Se trata de un paciente masculino de 38 años, que ingresa por presentar dolor en fosa iliaca izquierda de aparición brusca , de severidad creciente , distensión y malestar, sin leucocitosis Al examen físico el abdomen esta distendido y muy doloroso a la palpación, a predominio de flanco y fosa iliaca izquierda. Trae ecosonograma abdominal que reporta esteatosis hepática y aglomeración de asas en fosa iliaca izquierda. La colonoscopía solo muestra hemorroides, el dolor abdominal persiste y hay signos de peritonismo. Es intervenido quirúrgicamente con los siguientes hallazgos apéndice epiploica gangrenosa; colon sigmoide con adherencia a pared lateral del abdomen con apéndice epiploica necrosada; realizan resección de apéndice epiploica y apendicetomía. Lo más relevante de este caso, es lo poco frecuente y en el cual sus síntomas se confunden con patologías comunes tales como la apendicitis y la diverticulitis. Sin embargo el manejo de imágenes y su característico aspecto en las misma, juega un papel determinante en el adecuado y efectivo diagnostico lo que hace de su reconocimiento un factor importante...
We report a case of epiploic appendicitis, as well as the review of the literature. This is a 38 year old male patient who was admitted due to left iliac fossa pain of sudden onset; of increasing severity, bloating and discomfort, without leukocytosis. At physical examination the abdomen is distended and very tender, with predominance in left iliac flank. He brought abdominal ultrasonography which shows hepatic steatosis and loops agglomeration in left iliac fossa. Colonoscopy shows hemorrhoids, persistent abdominal pain and there are signs of peritonitis. The patient underwent surgery with the following findings: gangrenous epiploic appendix, sigmoid colon with adherence to lateral abdominal wall with necrotic epiploic appendix; they performed the resection of the epiploic appendix and appendectomy. What is special about this case is how rare it is and that his symptoms are mistaken with common pathologies, such as appendicitis and diverticulosis. However, the imaging management and the epiploic appendix characteristic appearance in these images, play a determining role in the effective and appropriate diagnosis; which makes, its recognition an important factor...
Assuntos
Humanos , Masculino , Adulto , Apendicite/cirurgia , Apendicite/diagnóstico , Endossonografia/métodos , Peritonite/cirurgia , Peritonite/prevenção & controle , GastroenterologiaRESUMO
The Wiedemann-Rautenstrauch syndrome (WRS, OMIM: 264090) characterizes a premature aging syndrome in which several features of aging are apparent at birth. We did not find mutations in Lamin A/C (LMNA) gene in four WRS patients, and in particular, we did not find the G608G mutation (GGC > GGT transition) which is associated with most cases with Hutchinson-Gilford progeria (OMIM 176670). These findings suggest that WRS represents a distinct progeroid entity that may be caused by recessive mutations of a different gene.
Assuntos
Anormalidades Múltiplas/genética , Lamina Tipo A/genética , Mutação/genética , Adolescente , Sequência de Bases , Pré-Escolar , Análise Mutacional de DNA , Éxons/genética , Evolução Fatal , Feminino , Humanos , Lactente , Masculino , Dados de Sequência Molecular , Linhagem , Fenótipo , Gravidez , SíndromeRESUMO
El presente artículo explora el papel que desempeña el folato como conocido metabolito del ciclo de un carbono (OCM, del inglés onecarbon metabolism) en la alteración de la integridad de las células nerviosas. Aquí se discute evidencia reciente de la literatura que muestra la reparación del ADN como un proceso relacionado con la apoptosis neuronal inducida por ausencia de folato.
This essay explores the role of folate in disruption of neural cell integrity. Here, it is discussed recent evidence which shows DNA reparation as a process related to neuronal apoptosis induced by folate depletion.
RESUMO
The Wiedemann-Rautenstrauch syndrome (WRS) characterises a premature aging syndrome in which several features of human aging are apparent at birth therefore allowing their grouping as a neonatal progeroid condition. This differentiates WRS from other progeroid entities such as Hutchinson-Gilford progeria syndrome (HGPS) in which characteristics of premature aging become apparent some time after birth. The etiology of WRS remains unknown. Some studies have observed an autosomal recessive mode of inheritance. Several studies analysing telomere length and lamin A gene have not revealed any alterations. However, mutations in LMNA have been reported in several other atypical progeroid syndromes. Based on these observations, several hypothesis could be withdrawn concerning the etiology of WRS. The study of genes associated with lamin A metabolism, such as Zmpste24, and the metabolic pathways associated with insulin, such as protein kinase B or AKT, are of particular interest. We believe that WRS characteristics indicate that discovery of the gene and the metabolic pathway associated with this syndrome will most likely lead to new knowledge about the physiopathology of human aging.