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INTRODUCTION AND AIMS: Capsule endoscopy is part of the diagnostic approach to patients with suspected small bowel bleeding and data on its clinical impact are still limited in developing countries. The primary aim of the present study was to determine its impact on subsequent diagnostic and therapeutic decisions. MATERIAL AND METHODS: A retrospective study was conducted that included all the patients that underwent capsule endoscopy with the PillCam™ SB 3 Capsule system due to suspected small bowel bleeding treated at the Hospital Universitario Fundación Valle del Lili between January 2011 and December 2020. RESULTS: A total of 158 patients met the inclusion criteria. Mean patient age was 63 years (interquartile range [IQR], 52-74), 53.6% of the patients were women, and high blood pressure was the most frequent comorbidity (43.7%). The main indication was overt bleeding (58.2%). Of all the capsule endoscopies carried out, 63.9% showed lesions that were potentially responsible for bleeding. Medical or surgical treatment was indicated in 63.3% of the case total. Rebleeding at 6 months occurred in 15 patients and there were 2 deaths due to gastrointestinal bleeding at 6 months. CONCLUSIONS: Capsule endoscopy has a high impact on patients with suspected small bowel bleeding, with respect to clinical decision-making, as well as rebleeding, hospitalization, and mortality outcomes. The positivity rate of lesions potentially responsible for bleeding was similar to that reported in developed countries.
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Attentional focus instructions are verbal strategies that could maximize the effects of exercise. The objective of this review was to explore and synthesize the available evidence on the incorporation of attentional focus instruction in the exercise of people with musculoskeletal disorders. A search of 11 databases was carried out until October 2020. Of 4,227 studies identified in the searches, 15 were included. The studies showed deficiencies in the conceptualization and definition of attentional focus instructions. The available evidence indicates that external focus is effective in improving motor learning and function. However, methodological limitations, clinical heterogeneity, the small number of articles included, and new experimental studies challenge the conclusions of the systematic reviews available to date. Attentional focus instructions in musculoskeletal disorders is an emerging field and requires further research. This review is a guide for future studies.
Assuntos
Atenção , Doenças Musculoesqueléticas , Exercício Físico , Terapia por Exercício , Humanos , Doenças Musculoesqueléticas/terapiaRESUMO
La hemorragia del tracto digestivo superior (HTDS) es el sangrado originado por encima del ángulo de Treitz. A pesar del aumento en las estrategias de prevención, del incremento en los tratamientos con Inhibidor de bomba de protones (IBP) y de la intervención endoscópica temprana, esta patología sigue siendo una causa frecuente de consulta a urgencias, con una morbimortalidad no despreciable y alta carga para el sistema de salud. Esta revisión se enfoca en la HTDS de causa diferente a las varices. La principal causante de esta entidad es la enfermedad ácido-péptica, que es consecuencia del gran consumo de antiinflamatorios no esteroideos (AINES) y de la infección por Helicobacter Pylori. Otras causas son el síndrome de Mallory Weiss, la esofagitis erosiva, las malformaciones arteriovenosas y la malignidad.
Upper gastrointestinal bleeding (UGIB) refers to any bleeding originating above the angle of Treitz. Despite an increase in prevention strategies, proton pump inhibitor (PPI) therapy and early endoscopic intervention, this pathology continues to be an important cause of admission to the emergency department for gastrointestinal causes, having a pretty high morbidity and mortality in addition to a high burden on the health system. This review focuses on non-variceal UGIB. The main cause of this entity being peptic acid disease, due to great consumption of NSAIDs and Helicobacter Pylori infection. Other causes are Mallory Weiss syndrome, erosive esophagitis, arteriovenous malformations, and malignancy.
A hemorragia do trato digestivo superior (HTDS) é o sangrado originado acima do ângulo de Treitz. Apesar do aumento nas estratégias de prevenção, do incremento nos tratamentos com Inibidor da bomba de prótons (IBP) e da intervenção endoscópica precoce, esta patologia segue sendo uma causa frequente de consulta a urgências, com uma morbimortalidade não depreciável e alta carga para o sistema de saúde. Esta revisão se enfoca na HTDS de causa diferente às varizes. A principal causante desta entidade é a doença ácido-péptica, que é consequência do grande consumo de anti-inflamatórios não esteróideos (AINES) e da infecção por HelicobacterPylori. Outras causas são a síndrome de Mallory Weiss, a esofagites erosiva, as malformações arteriovenosas e a malignidade. Palavras-chave: hemorragia gastrointestinal; úlcera péptica; endoscopia gastrointestinal; inibidores da bomba de prótons; medicina geral.
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Humanos , Hemorragia Gastrointestinal , Úlcera Péptica , Anti-Inflamatórios não Esteroides , Endoscopia Gastrointestinal , Helicobacter pylori , Trato Gastrointestinal , Serviço Hospitalar de Emergência , Esofagite , Inibidores da Bomba de Prótons , Síndrome de Mallory-Weiss , NeoplasiasRESUMO
Introducción: Desde hace aproximadamente 20 años se han venido realizando varias técnicas de tiroidectomía por mínimo acceso, apoyadas en la videoendoscopia en pro de reemplazar la incisión clásica descrita por Kocher. Se han diseñado múltiples abordajes, sin embargo, ninguno ha conseguido evitar totalmente las cicatrices. En el año 2008 Witzel introdujo la técnica transoral y en el 2015, Anuwong publicó la primera serie realizada en humanos. Presentación del caso: Se trata de una paciente de 47 años a quien se ha diagnosticado por PAAF una lesión folicular en el lóbulo izquierdo de la tiroides. Discusión: La paciente fue sometida a hemitiroidectomía izquierda más estudio de congelación transoperatoria que resultó negativo. Se realizó un abordaje transoral endoscópico, con un tiempo de 280 min y sangrado de 40 ml. No se registraron complicaciones en el transoperatorio ni en el postoperatorio. Conclusión: La tiroidectomía transoral endoscópica por abordaje vestibular (TOETVA) representa, entre las cirugías de mínimo acceso, la única que potencialmente está totalmente libre de cicatrices, ofreciendo seguridad y resultados comparables con otras técnicas.
Introduction: For about 20 years we has been conducting several techniques of minimal access thyroidectomy, supported by videoendoscopy towards replacing the classic Kocher incision. Multiple approaches have been described, however none has achieved completely avoid scarring. Witzel in 2008 introduced the transoral technique and in 2015 Anuwong published the first series performed in humans. Case presentation: This is a 47 years old patient who have been diagnosed by FNAB follicular lesion in the left lobe of her thyroid. Discussion: The patient underwent a left hemithyroidectomy + intraoperative frozen study that was negative, transoral endoscopic approach was performed with a time of 280 min and 40 ml bleeding. No complications occurred intraoperatively or postoperatively. Conclusion: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) represents between the minimum access surgeries the only one that is potentially totally free of scars, offering safety and comparable results with other techniques.
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Humanos , Feminino , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Cirurgia Vídeoassistida , Procedimentos Cirúrgicos Minimamente InvasivosAssuntos
Humanos , Adulto , Pessoa de Meia-Idade , Psiquiatria , Reabilitação , Costa Rica , Qualidade da Assistência à SaúdeRESUMO
We performed a thorough neuro-otological evaluation and a radiological study of the cervical spine in 102 patients with vestibular symptoms. A group of 20 asymptomatic subjects served as control. Some degree of cervical spondylosis was found in 121 of 122 patients but also in the majority of control subjects. No relationship was observed between the degree of cervical spondylosis and vestibular abnormalities. Instead, the latter were strongly related to age. Thus, an age dependent microvascular damage may be more likely as an etiological factor for vestibular symptoms in the elderly.
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Vértebras Cervicais , Osteofitose Vertebral/complicações , Doenças Vestibulares/complicações , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Testes Calóricos , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia , Osteofitose Vertebral/diagnóstico por imagem , Vertigem/etiologia , Doenças Vestibulares/diagnósticoRESUMO
Contenido: 1.Resumen 2.Mercado.Caracteres generales de la ganaderia, la industria de la carne y los subproductos en America Latina.Poblacion nacional actual de la ganaderia.Poblacion gandera actual de Cochabamba.Series estadisticas de faeneo.Demanda de los subproductos animales.Comercializacion 3.Tamano.Tamano optimo.tamano del equipo de subproductos.Tamano minimo 4.Localizacion 5.Ingenieria.Generalidades.Usos y aplicaciones de los subproductos.Proceso de produccion faeneo.Balance de materia y rendimientos.Sangre.Decomisos y despojos.Grasa.Huesos.Pezunas y cuernos.Cerdas y pelos.Bilis.Estiercol y orina.Cueros.Balance termico.Obra civil.Mano de obra.Combustibles y lubricantes.Materiales.Energia electrica 6.Inversiones.Inversiones fijas.Capital de trabajo 7.Financiamiento.Financiamiento del capital.Amortizacion de los creditos 8.Costos e ingresos 9.Evaluacion.Flujo de fondos.Analisis de sensibilidad.Conclusiones y recomendaciones 10.Anexos.