sábado, 19 de octubre de 2013

Actualización en vacunas 2013

Estimado Pediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 23 de Octubre 2013 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Actualización en vacunas 2013” por los “Dres. Antonio Arista V; y Cesar Martínez L; Infectologos Pediatras de México DF y Monterrey N.L. La sesión inicia puntualmente las 21 hrs.
Para entrar a la Sala de Conferencia:
1.- hacer click en la siguiente liga, o cópiala y escríbela en tu buscador
http://connectpro60196372.adobeconnect.com/actualizacion_vacunas2013/
2.- “Entra como Invitado” Escribes tu nombre y apellido en el espacio en blanco
3.- Hacer click en el espacio que dice “Entrar en la Sala”
5.- A disfrutar la conferencia 6.- Recomendamos que dejes tu Nombre Completo, Correo electrónico y que participes.


Henrys


Dr. Enrique Mendoza López
Webmaster: CONAPEME
Coordinador Nacional: Seminario Ciberpeds-Conapeme
Av La clinica 2520-310
Colonia Sertoma ,Mty N.L. México
CP 64710
Tel-Fax 52 81 83482940 y 52 81 81146053
Celular 8183094806
www.conapeme.org
www.pediatramendoza.com
enrique@pediatramendoza.com
emendozal@yahoo.com.mx

“Eccema Atopico e inicio de marcha atópica en niños”

Estimado Ciberpediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 23 de Octubre 2013 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Eccema Atopico e inicio de marcha atópica en niños” por el “Dr. José Antonio Ortega Martell” Alergólogo Pediatras de la Cd de Pachuca Hgo.La sesión inicia puntualmente las 21 hrs.
Para entrar a la Sala de Conferencia:
1.- hacer click en la siguiente liga, o cópiala y escríbela en tu buscador http://connectpro60196372.adobeconnect.com/eccema_marchaatopica/
2.- “Entra como Invitado” Escribes tu nombre y apellido en el espacio en blanco
3.- Hacer click en el espacio que dice “Entrar en la Sala”
5.- A disfrutar la conferencia 6.- Recomendamos que dejes tu Nombre Completo, Correo electrónico y que participes.


Henrys


Dr. Enrique Mendoza López
Webmaster: CONAPEME
Coordinador Nacional: Seminario Ciberpeds-Conapeme
Av La clinica 2520-310
Colonia Sertoma ,Mty N.L. México
CP 64710
Tel-Fax 52 81 83482940 y 52 81 81146053
Celular 8183094806
www.conapeme.org
www.pediatramendoza.com
enrique@pediatramendoza.com
emendozal@yahoo.com.mx

La inspiradora labor del terapeuta ocupacional

http://www.listindiario.com.do/la-vida/2013/10/17/296190/La-inspiradora-labor-del-terapeuta-ocupacional

La inspiradora labor del terapeuta ocupacional
Listín Diario
... la emoción que la embargó al leer la carta de agradecimiento que le escribió Carlos Ureña a su terapeuta del programa de Medicina de Rehabilitación luego ...

La Sociedad Murciana de Rehabilitación y Medicina Física celebra ...

Búsqueda bibliográfica para clínicos: el ABC de PubMed, una síntesis en menos de mil palabras / Literature search for clinicians: the ABC of PubMed in less than a thousand words

http://www.medwave.cl/link.cgi/Medwave/Series/MBEyEpi/5817


Búsqueda bibliográfica para clínicos: el ABC de PubMed, una síntesis en menos de mil palabras

Ficha del artículo

Citación: Martínez F, Papuzinski C, Tobar C.
Literature search for clinicians: the ABC of PubMed in less than a thousand words.
Medwave 2013;13(9):e5817 doi: 10.5867/medwave.2013.09.5817


Fecha de envío: 7/10/2013
Fecha de aceptación: 8/10/2013
Fecha de publicación: 9/10/2013
Origen: solicitado
Tipo de revisión: sin revisión por pares


Citaciones asociadas

Bachelet VC. Methodological series are back!. Medwave 2013;13(9):e5818. | CrossRef |

Autores: Felipe Martínez(1,2), Cristian Papuzinski (1,3), Catalina Tobar(3)
Filiación:
(1)Centro de Investigaciones Biomédicas, Escuela de Medicina, Universidad de Valparaíso, Chile
(2)M.Sc. Programme in Evidence-Based Healthcare, University of Oxford, Inglaterra
(3)Departamento de Medicina, Escuela de Medicina, Universidad de Valparaíso, Chile
E-mail: ranoih@gmail.com
Correspondencia a: [+]





Introducción

La medicina actual se caracteriza por la gran abundancia de información disponible para guiar nuestra práctica clínica. Diversas bases de datos, como PubMed/MEDLINE y EMBASE albergan más de 23 millones de citaciones, las cuales continúan creciendo exponencialmente y fácilmente pueden sobrecoger a cualquiera buscando información para tomar las mejores decisiones para sus pacientes1-4. De hecho, diversos estudios han mostrado que de todas las preguntas realizadas por clínicos, cerca de la mitad quedan sin responder, principalmente por errores en la realización de su búsqueda5-7. Es el objetivo de este artículo exponer brevemente técnicas básicas para una búsqueda bibliográfica eficiente usando PubMed/MEDLINE como repositorio primario para detectar artículos.
Estableciendo un mapa: la pregunta clínica

Saber estructurar una pregunta clínica es crítico para una búsqueda exitosa. El objetivo es obtener términos claves que serán empleados para filtrar los artículos del buscador en base a relevancia. La medicina basada en evidencias suele reconocer dos grandes tipos de preguntas:
Las preguntas de background: preguntas amplias sobre conceptos básicos en un problema clínico particular. (¿Qué tan frecuente es la neumonía entre adultos mayores? ¿Cuál es el diagnóstico diferencial del dolor torácico en la urgencia?) y,
Las preguntas de foreground: preguntas específicas referentes a la aplicación del conocimiento científico en la práctica clínica y resultan en la obtención de evidencia científica para la toma de decisiones8. Las preguntas clínicas pertenecen habitualmente a este segundo grupo, y existen múltiples esquemas que permiten una correcta redacción de las mismas.

Una buena pregunta clínica debiera delimitar un grupo de pacientes o población (P), una intervención o exposición (I/E), una comparación relevante (C) y el desenlace deseado (Outcome, O)8,9. En ocasiones se incluye un quinto elemento correspondiente al diseño (D), con la intención de seleccionar el diseño más apropiado según su potencial de cometer errores sistemáticos10-12. De esta manera, el ensayo clínico aleatorizado representa el diseño ideal para preguntas de terapia, el estudio de corte transversal para evaluación de pruebas diagnósticas y la cohorte prospectiva para preguntas respecto al pronóstico. Este anterior elemento no debe ser visto como un reemplazante del análisis crítico de cada publicación. Todo artículo detectado debiera ser evaluado en base a su calidad metodológica, existiendo múltiples herramientas estandarizadas para estos fines13,14.
Ejecutando la búsqueda

Una vez establecida la pregunta clínica, es posible seleccionar términos de búsqueda para poder encontrar la información relevante. Considerando que MEDLINE es la base de datos del National Library of Medicine (NLM) de Estados Unidos, el uso del idioma inglés es mandatorio para garantizar los mejores resultados posibles. Esta base de datos organiza sus términos de búsqueda en un diccionario conocido como los Medical Subject Headings (MeSH), que corresponden a una nomenclatura estandarizada para referirse a determinadas condiciones médicas. De esta forma, si se deseara realizar una búsqueda sobre cáncer de mama, sería intuitivo emplear breast cancer como término para detectar literatura relevante. Sin embargo, el diccionario MeSH no utiliza este último término para la condición, empleándose breast neoplasms como sinónimo más cercano.

Clásicamente se ha considerado que toda búsqueda bibliográfica sensible debiera considerar por tanto a este sistema de nomenclatura. No obstante, los algoritmos de búsqueda en MEDLINE han avanzado considerablemente en los últimos años, permitiendo hoy que búsquedas que emplean términos no incluidos en MeSH (de indexación libre), sean complementadas con los sinónimos dentro de este repositorio, lo que permite mejorar los resultados de la búsqueda.

Con el fin de optimizar una búsqueda bibliográfica, es posible utilizar los llamados operadores booleanos para realizar combinaciones. Dos son las conjunciones más importantes a conocer: AND y OR, las cuales se especifican con mayúsculas entre los términos de búsqueda. El usar AND convertirá la búsqueda en algo específico, por cuanto instruye a PubMed/MEDLINE a seleccionar como relevante sólo a los artículos que tengan todos los términos especificados por la pregunta en su título o resumen. Por otra parte, OR hace las búsquedas más sensibles, por cuanto esta instrucción revela como importantes a todos los estudios que contengan al menos uno de los términos seleccionados. De esta forma, una búsqueda que evalúe el uso de tamoxifeno en cáncer de mama combinando ambos términos en Tamoxifen AND Breast Neoplasms, sólo detectará como relevantes a los artículos en cuyo título o resumen aparezcan ambos conceptos. La misma estrategia con un OR arrojará como relevantes a los artículos que contengan al menos uno de los anteriores, lo que puede resultar en un número de artículos inmanejable.
Restringiendo los resultados

Aún con una estrategia de búsqueda idónea es posible obtener una cantidad de artículos poco plausible de analizar. Fuera de utilizar términos adicionales de búsqueda, una opción útil para restringir los resultados es el uso de límites. Éstos son filtros prediseñados que permiten seleccionar artículos en base a alguna característica, como un diseño en particular, un rango etario, idioma o una fecha de publicación. Dentro de PubMed/MEDLINE existe una aplicación conocida como Clinical Queries en la que filtros prediseñados seleccionan artículos en base a su capacidad de responder preguntas diversas según lo discutido anteriormente. Si bien esto último podría permitir ahorrar grandes cantidades de tiempo, debe considerarse que el uso de límites no se recomienda en la ejecución de publicaciones dependientes de la detección de literatura relevante, como son las revisiones sistemáticas15-17.
Recursos adicionales

El objetivo de este artículo en proveer un breve resumen sobre cómo buscar en PubMed/MEDLINE. Para mayor información acerca de estas herramientas y cómo utilizar herramientas más avanzadas, la NLM ha dispuesto un manual en video en la dirección http://www.nlm.nih.gov/bsd/disted/pubmed.html.
Notas
Declaración de conflictos de intereses

Los autores han completado el formulario de declaración de conflictos de intereses del ICMJE traducido al castellano por Medwave, y declaran no haber recibido financiamiento para la realización del artículo; no tener relaciones financieras con organizaciones que podrían tener intereses en el artículo publicado, en los últimos tres años; y no tener otras relaciones o actividades que podrían influir sobre el artículo publicado. Los formularios pueden ser solicitados contactando al autor responsable.
Referencias
Motschall E, Falck-Ytter Y. Searching the MEDLINE literature database through PubMed: a short guide. Onkologie. 2005 Oct;28(10):517–22. | CrossRef | PubMed |
Aoki NJ, Enticott JC, Phillips LE. Searching the literature: four simple steps. Transfusion. 2013 Jan;53(1):14-7. | CrossRef | PubMed |
Tsay M-Y, Yang Y-H. Bibliometric analysis of the literature of randomized controlled trials. J Med Libr Assoc. 2005 Oct 1;93(4):450–8. | PubMed | PMC |
Manchikanti L, Benyamin RM, Helm S, Hirsch JA. Evidence-based medicine, systematic reviews, and guidelines in interventional pain management: part 3: systematic reviews and meta-analyses of randomized trials. Pain physician. 2009;12(1):35–72. | PubMed |
Ely JW, Osheroff JA, Chambliss ML, Ebell MH, Rosenbaum ME. Answering physicians' clinical questions: obstacles and potential solutions. J Am Med Inform Assoc. 2005 Mar-Apr;12(2):217-24. | CrossRef | PubMed | PMC |
Ely JW, Osheroff JA, Ebell MH, Chambliss ML, Vinson DC, Stevermer JJ, Pifer EA. Obstacles to answering doctors' questions about patient care with evidence: qualitative study. BMJ. 2002 Mar 23;324(7339):710. | CrossRef | PubMed | PMC |
Graber MA, Randles BD, Ely JW, Monnahan J. Answering clinical questions in the ED. Am J Emerg Med. 2008 Feb;26(2):144-7. | CrossRef | PubMed |
Stillwell SB, Fineout-Overholt E, Melnyk BM, Williamson KM. Evidence-based practice, step by step: asking the clinical question: a key step in evidence-based practice. Am J Nurs. 2010 Mar;110(3):58-61. | CrossRef | PubMed |
Krupski TL, Dahm P, Fesperman SF, Schardt CM. How to perform a literature search. J Urol. 2008 Apr;179(4):1264-70. | CrossRef | PubMed |
Schengrau A, Seage GR III. Overview of epidemiologic study designs. En: Essentials of epidemiology in public health. Boston, MA.: Jones and Bartlett Learning, 2003:139–40.
Glasziou P, Heneghan C. A spotter's guide to study designs. Evid Based Med. 2009 Apr;14(2):37-8. | CrossRef | PubMed |
Grimes DA, Schulz KF. An overview of clinical research: the lay of the land. Lancet. 2002 Jan 5;359(9300):57-61. | CrossRef | PubMed |
Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011 Oct 18;155(8):529-36. | CrossRef | PubMed |
Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007 Feb 15;7:10. | CrossRef | PubMed | PMC |
Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration. cochrane-handbook.org [on line] | Link |
McKibbon KA, Lokker C, Wilczynski NL, Haynes RB, Ciliska D, Dobbins M, et al. Search filters can find some but not all knowledge translation articles in MEDLINE: an analytic survey. J Clin Epidemiol. 2012 Jun;65(6):651-9. | CrossRef | PubMed |
van de Glind EM, van Munster BC, Spijker R, Scholten RJ, Hooft L. Search filters to identify geriatric medicine in Medline. J Am Med Inform Assoc. 2012 May-Jun;19(3):468-72. | CrossRef | PubMed | PMC |

Obesidad en UCI

Inquietudes en el cuidado clínico y crítico en los pacientes obesos con enfermedades graves.
Clinical and critical care concerns in severely ill obese patient.
Bajwa SJ, Sehgal V, Bajwa SK.
Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India.
Indian J Endocrinol Metab. 2012 Sep;16(5):740-8. doi: 10.4103/2230-8210.100667.
Abstract
The incidence of obesity has acquired an epidemic proportion throughout the globe. As a result, increasing number of obese patients is being presented to critical care units for various indications. The attending intensivist has to face numerous challenges during management of such patients. Almost all the organ systems are affected by the impact of obesity either directly or indirectly. The degree of obesity and its prolong duration are the main factors which determine the harmful effect of obesity on human body. The present article reviews few of the important clinical and critical careconcerns in critically ill obese patients.
KEYWORDS: Body mass index, critically ill, obesity, sleep apnea syndrome 

Efecto de la obesidad y laparotomía descompresiva sobre la mortalidad de la pancreatitis aguda que requiere admisión en UCI      
Effect of obesity and decompressive laparotomy on mortality in acute pancreatitis requiring intensive care unit admission.
Davis PJ, Eltawil KM, Abu-Wasel B, Walsh MJ, Topp T, Molinari M.
Division of General Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Room 6-302 Victoria Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.
World J Surg. 2013 Feb;37(2):318-32. doi: 10.1007/s00268-012-1821-8.
Abstract
BACKGROUND: Controversy still exists on the effect that obesity has on the morbidity and mortality in severe acute pancreatitis (SAP). The primary purpose of this study was to compare the mortality rate of obese versus nonobese patients admitted to the ICU for SAP. Secondary goals were to assess the potential risk factors for abdominal compartment syndrome (ACS) and to investigate the performance of validated scoring systems to predict ACS and in-hospital mortality. METHODS:A retrospective cohort of adults admitted to the ICU for SAP was stratified by their body mass index (BMI) as obese and nonobese. The rates of morbidity, mortality, and ACS were compared by univariate and multivariate regression analyses. Areas under the curve (AUC) were used to evaluate the discriminating performance of severity scores and other selected variables to predict mortality and the risk of ACS. RESULT: Forty-five patients satisfied the inclusion criteria and 24 (53 %) were obese with similar characteristics to nonobese patients. Among all the subjects, 11 (24 %) died and 16 (35 %) developed ACS. In-hospital mortality was significantly lower for obese patients (12.5 vs. 38 %; P = 0.046) even though they seemed to develop ACS more frequently (41 vs. 28 %; P = 0.533). At multivariable analysis, age was the most significant factor associated with in-hospital mortality (odds ratio (OR) = 1.273; 95 % confidence interval (CI) 1.052-1.541; P = 0.013) and APACHE II and Glasgow-Imrie for the development of ACS (OR = 1.143; 95 % CI 1.012-1.292; P = 0.032 and OR = 1.221; 95 % CI 1.000-1.493; P = 0.05) respectively. Good discrimination for in-hospital mortality was observed for patients' age (AUC = 0.846) and number of comorbidities (AUC = 0.801). ACS was not adequately predicted by any of the clinical severity scores (AUC = 0.548-0.661). CONCLUSIONS: Patients' age was the most significant factor associated with mortality in patients affected by SAP. Higher APACHE II and Glasgow-Imrie scores were associated with the development of ACS, but their discrimination performance was unsatisfactory.
 Respuesta respiratoria y hemodinámica a la movilización de obesos graves             
Respiratory and hemodynamic responses to mobilization of critically ill obese patients.
Genc A, Ozyurek S, Koca U, Gunerli A.
School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey.
Cardiopulm Phys Ther J. 2012 Mar;23(1):14-8.
Abstract
PURPOSE: The aim of this study was to investigate the effects of mobilization on respiratory and hemodynamic parameters in critically ill obese patients. METHODS:
Critically ill obese patients (n = 31) were included in this retrospective study. Data were collected from patients' files and physiotherapy records of mobilization sessions. Heart rate (HR), systolic/diastolic/mean blood pressure, respiratory rate (RR), and percutaneous oxygen saturation (SpO(2)) were recorded. Cardiorespiratory parameters were collected just prior to the mobilization, just after the completion of the mobilization and after 5 minutes recovery period. Respiratory reserve was calculated before and after the mobilization. RESULTS: A total of 37 mobilization sessions in 31 obese patients (mean age: 63.3 years, mean BMI: 32.2 kg/m(2)) who received physiotherapy were analyzed. Respiratory rate increased significantly after the completion of the mobilization compared to initial values (p < 0.05). SpO(2) significantly increased (p < 0.05) and all other parameters remained similar (p > 0.05) compared to initial values after the recovery period. Mobilization resulted in a significant increase in respiratory reserve (p < 0.05). CONCLUSION: Early mobilization in intensive care unit promotes respiratory reserve in obese patients. We found that mobilization can be performed safely in critically ill obese patients if cardiorespiratory parameters are continuously monitored.
KEYWORDS: critically ill patients, mobilization, obesity, physiotherapy
  
Atentamente
Dr. Juan Carlos Flores-Carrillo
Anestesiología y Medicina del Dolor

The FDA's Graphic Tobacco Warnings and the First Amendment: N Engl J Med 2013

http://www.nejm.org/doi/full/10.1056/NEJMp1304513#!


Vicente Lozada-Balderrama

The FDA's Graphic Tobacco Warnings and the First Amendment: N Engl J Med 2013
http://lnkd.in/SwHENh



Perspective
The FDA's Graphic Tobacco Warnings and the First Amendment

David Orentlicher, M.D., J.D.


N Engl J Med 2013; 369:204-206July 18, 2013DOI: 10.1056/NEJMp1304513

In the past, constitutional principle gave the government broad authority to regulate tobacco or pharmaceutical advertising. The state's power to safeguard the public health was strong, and companies' freedom to plug their products was weak.

But the Supreme Court has changed course. Whereas it once did not view “commercial” speech as the kind of speech the First Amendment protects, it now gives businesses nearly the same rights to market their goods as it does individuals to speak their minds. And as the Court has broadened corporate freedom to advertise, it has narrowed governmental power to preserve the public's health. Whereas the Court once gave the government more leeway when invoking its interests in public health than when asserting other state interests, it now tends to hold health-related rules to the same constitutional standards as other types of rules.1

As a result, government today is much more susceptible to challenge when it tries to regulate the promotional activities of the tobacco or pharmaceutical industry. In 2011, the Supreme Court rejected Vermont's effort to restrict the use of prescription data by drug companies' sales representatives.2 And last year, the U.S. Court of Appeals for the D.C. Circuit vetoed the new graphic warnings for cigarette packages that had been issued by the Food and Drug Administration (FDA).3 The Supreme Court's increasing sympathy for corporate speech and decreasing deference to public health authorities makes it more difficult for government to protect the public's health. The fate of the graphic cigarette warnings is illustrative.

Congress authorized the graphic warnings when it passed the Family Smoking Prevention and Tobacco Control Act in 2009. The Act requires the use of nine new textual warnings for cigarette packages and directs the Department of Health and Human Services to select color graphics to accompany the warnings. The images have to depict the “negative health consequences” of smoking, with text and graphic taking up the top halves of each pack's front and back panels.

In June 2011, the FDA unveiled the nine images, including some that were quite explicit. One image showed a man smoking through a tracheostomy (see image). Another showed the corpse of a man with staples in his chest on an autopsy table. Several tobacco companies promptly sued, alleging that the graphic-warning requirements violated their First Amendment rights. The companies prevailed in both the district court and the D.C. Circuit.

In one sense, the result was not surprising, given the Supreme Court's increased sympathy toward corporations and their First Amendment rights. Regulations of commercial speech often succumb to judicial scrutiny.

However, there was good reason to think that the D.C. Circuit would uphold the graphic warnings. Even as the Supreme Court has narrowed the power of government to regulate corporate speech, it has preserved an important authority to regulate. The graphic warnings seemed to fall within that authority.

The preserved authority reflects the distinction the Supreme Court makes between the regulation of corporate speech that informs and the regulation of corporate speech that misinforms. On the one hand, the Court usually objects when the government tries to block truthful speech by businesses. In the prescription-data case, the Vermont law would have restricted the free flow of information about physicians' prescribing practices. On the other hand, the Court typically approves when the government tries to prevent false or deceptive speech by businesses. For example, the government may forbid companies from saying things that are not true. It also may require companies to make disclosures that will allow consumers to make informed choices and not be misled by advertising hype. Common disclosure requirements include the corporate prospectus for stock offerings, the total interest payments for a home mortgage, nutritional information for foods, and the textual warnings for cigarettes.

The graphic cigarette warnings appeared to serve purposes similar to those of other required disclosures. The warnings would promote understanding of the risks of smoking and prevent people from being misled by cigarette marketing.

Indeed, the U.S. Court of Appeals for the Sixth Circuit had upheld Congress's authority to mandate graphic warnings.4 As that court observed, people often do not read textual warnings on cigarette packages. And even when read, the warnings may not be effective in informing consumers about the risks to their health. Adding color images can ensure that textual warnings are noticed, read, and understood. Sometimes a picture really is worth a thousand words.

Even though the Supreme Court let the Sixth Circuit's decision stand, its effect is limited. The Sixth Circuit considered only whether Congress may require some graphic warnings. The D.C. Circuit considered the constitutionality of the FDA's actual warnings.

In rejecting the warnings by a two-to-one vote, the D.C. Circuit identified two problems. First, the majority did not think the images were needed to prevent cigarette companies from misleading consumers. Other statutory provisions already prohibited many kinds of deceptive labeling or advertising. The court was not willing to defer to the FDA's judgment that the new images were necessary. Second, the warnings were not designed simply to ensure that consumers fully understand the risks to their health from cigarettes. Instead, wrote the majority, the warnings would primarily serve to convey the government's antismoking message. Indeed, each of the new images would include the phone number for the National Cancer Institute's tobacco cessation hotline, 1-800-QUIT-NOW. Whereas government may use its own resources to publicize its perspectives, it generally may not force individuals or corporations to spend their dollars to disseminate its viewpoint.

Rather than seek Supreme Court review of the D.C. Circuit's decision, the FDA opted to return to the drawing board and develop new graphic warnings. In the meantime, we are left with some important questions.

First, when do graphic warnings cross the line between trying to inform and trying to persuade? Does it depend on how “shocking” or how prominent they are? Two of the three D.C. Circuit judges thought that the images were designed to evoke an emotional response rather than to convey factual information. The dissenting judge cited the FDA's point that warnings more effectively communicate information when they elicit a strong emotional reaction. In addition, the images would provide information about risk when viewed in conjunction with their accompanying text. For example, the image of the man smoking through a tracheostomy accompanied the warning “Cigarettes are addictive” and would have illustrated the tenacity of nicotine addiction. In the dissenter's view, the images would have been acceptable without the cessation hotline number.

Second, must the warnings correct misleading impressions from the company's cigarette packaging or current advertisements, or may they also correct misimpressions from past promotional materials?

Third, if courts will not defer to the judgment of public health authorities about the need for disclosure mandates, what kind of empirical evidence must the FDA present in order to justify the use of graphic warnings?

Whatever the answers to these questions, companies today are better able to promote their products, and government is less able to promote health than was the case in the past. Ironically, early protection of commercial speech rested in large part on the need to serve consumers' welfare. In 1976, for example, the Supreme Court struck down a Virginia law that prevented pharmacists from advertising their prices for prescription drugs.5 The law especially hurt persons of limited means, who were not able to shop around and therefore might not be able to afford their medicines. Today, by contrast, courts are using the First Amendment to the detriment of consumers' welfare, by invalidating laws that would protect the public health.



Disclosure forms provided by the author are available with the full text of this article at NEJM.org.

This article was published on June 26, 2013, at NEJM.org.

SOURCE INFORMATION

From the Hall Center for Law and Health, Indiana University Robert H. McKinney School of Law, and the Indiana University School of Medicine — both in Indianapolis

jueves, 17 de octubre de 2013

Obesidad y anestesia regional

Obesidad y anestesia regional


Obesity and Regional Anesthesia
Parra, Michelle C. MD; Loftus, Randy W. MD
International Anesthesiology Clinics Summer 2013 - Volume 51 - Issue 3 - p 90-112
doi: 10.1097/AIA.0b013e31829b8f4b
http://journals.lww.com/anesthesiaclinics/Fulltext/2013/05130/Obesity_and_Regional_Anesthesia.9.aspx?utm_source=exacttarget&utm_medium=email&utm_term=Article6Button&utm_content=j01&src=Week%2042%20-%20Hot%20Topics%20-%20Anesthesiology&et_cid=251190&et_rid=vwhizar@anestesia-dolor.org




Fisiología pulmonar en el obeso mórbido y los efectos de anestesia

Pulmonary Physiology of the Morbidly Obese and the Effects of Anesthesia
Schumann, Roman MD
International Anesthesiology Clinics Summer 2013 - Volume 51 - Issue 3 - p 41-51
doi: 10.1097/AIA.0b013e3182981252

http://journals.lww.com/anesthesiaclinics/Fulltext/2013/05130/Pulmonary_Physiology_of_the_Morbidly_Obese_and_the.5.aspx



Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Las dietas ricas en polifenoles alargan la vida de los ancianos

http://www.madrimasd.org/informacionidi/noticias/noticia.asp?id=58254&origen=notiweb&dia_suplemento=miercoles

La investigación la han llevado a cabo científicos del departamento Nutrición y Bromatología de la Universidad de Barcelona y del Instituto Catalán de Oncología (ICO-IDIBELL) y expertos del Centro Nacional Italiano de Investigación sobre Envejecimiento, de la Azienda Sanitaria di Firenze (Itlia) y del Instituto Nacional sobre Envejecimiento de EE.UU.

Los polifenoles son unos compuestos de origen vegetal que se ha comprobado que pueden tener efectos beneficiosos para la salud como agentes antioxidantes, antiinflamatorios y anticancerígenos. El trabajo publicado ahora en Journal of Nutrition se basa en el seguimiento durante doce años de 807 hombres y mujeres de más de 65 años de las ciudades de Greve y Bagno, en la Toscana italiana, en el marco del proyecto InChianti.

El equipo de la UB ha estudiado el efecto del consumo de dietas ricas en compuestos fenólicos mediante el uso de un biomarcador nutricional -los polifenoles totales excretados en la orina (Total Urinary Polyphenol, TUP)- como indicador de la ingesta total de polifenoles (Total Dietary Polyphenol, TDP). La profesora Cristina Andrés Lacueva, jefa del Grupo de Investigación de Biomarcadores y Metabolómica Nutricional y de los Alimentos de la UB y coordinadora del estudio, ha explicado que "el desarrollo y el uso de biomarcadores nutricionales nos permite hacer una estimación de la ingesta más precisa, y sobre todo, más objetiva". Ello se debe a que ya que no se basa en la memoria de los participantes del estudio cuando responden los cuestionarios dietéticos, sino que considera la biodisponibilidad y las diferencias entre individuos. Según la experta, "esta metodología permite evaluar con mayor fiabilidad y menos errores las asociaciones entre la ingesta de alimentos o nutrientes y la mortalidad o riesgo de sufrir enfermedades".

El estudio muestra que la mortalidad total se redujo un 30 % en el grupo de participantes que ingirieron más de 650 miligramos por día, en comparación con el grupo con ingestas más bajas de 500 miligramos diarios. El investigador del ICO-IDIBELL, Raúl Zamora, ha resaltado que "estos resultados corroboran la evidencia científica actual que asocia dietas ricas en alimentos de origen vegetal con una mortalidad total menor y una incidencia también más baja de varias enfermedades crónicas".

Feliz Día del Anestesiólogo/Happy Anaesthesiologist Day

Desde que William Thomas Green Morton utilizó por primera ocasión anestesia general en un paciente del Hospital General de Massachusetts el 16 de Octubre de 1846, en muchos países celebramos esta fecha como el Día Internacional del Anestesiólogo, ya que este momento selló un avance de gran importancia en la lucha contra el dolor.
Empleamos la mitad de nuestra vida para alcanzar nuestra meta profesional de ser anestesiólogos. La segunda mitad de nuestro existir lo dedicamos a atender pacientes de todas las edades con patologías tan variadas que no alcanzaría una vida extra para poder estudiarlas, entenderlas y ser expertos en cada una de estas patologías. Aun así, como anestesiólogos entrenados dedicamos conocimiento, corazón y alma para dar lo mejor de nosotros a cada paciente, a cada familia que deposita su confianza en nuestro saber y experiencia.
Ser anestesiólogo hoy en día no solo es dar buenas anestesias. Hay riesgos profesionales que afrontamos diariamente; desde los incidentes no esperados, las denuncias no justificadas, los turnos con trabajo en exceso, radiaciones, ruido, contaminación de las salas de operaciones, posibilidad de suicidio, divorcio y mayor incidencia de neoplasias, fatiga profesional entre otros muchos peligros que dejamos pasar por alto en beneficio de cada uno de nuestros pacientes.
Sin duda seguiremos siendo anestesiólogos hasta nuestro último día, pero ahora que estamos activos es tiempo de pensar en nosotros mismos, hacer un análisis profundo de nuestros logros, de nuestra vida profesional y familiar, y orientar nuestras metas para ser mejores anestesiólogos, mejores seres humanos. Con el afán de colaborar en esta tarea es que los integrantes y colaboradores de Anestesiología y Medicina del dolor hemos diseñado nuestros programas educativos gratuitos utilizando las información científica disponible en el Internet. La respuesta ha sido muy satisfactoria y ya estamos en más de 120 países, lo cual nos compromete a mejorar nuestros proyectos educativos y así poder llegar a Usted, y a otros miles de colegas alrededor del mundo.
!Una vez más FELICIDADES por haber elegido a la anestesiología como su meta profesional, como parte importante de su vida y de la vida de sus pacientes!  
Since William Thomas Green Morton used for the first time general anesthesia in a patient at Massachusetts General Hospital on October 16, 1846 , many countries celebrate this day as the International Day of the Anesthesiologist , since this time sealed a major breakthrough in the fight against pain.
We spend half of our life to achieve our professional goal to become anesthesiologists. The second half of our existence is dedicated to serve patients of all ages, with medical and surgical conditions as varied that an extra life would not give us enough time to study , to understand and be expert in each of these pathologies. Still, as dedicated anesthesiologists we use our knowledge , heart and soul to give our best to every patient , every family that places its trust in our hands.
Being anesthesiologist is not as simple as to give a perfect anesthesia; there are occupational hazards that we face daily like unexpected incidents, complaints not justified , working shifts in excess, radiation, noise, pollution of the operating room, possibility of suicide, divorce, and increased incidence of neoplasm , professional fatigue among many hazards that we overlook to benefit each of our patients.
We will certainly continue to be anesthesiologists until our last day, but now that we are active it is time to think about ourselves, making a thorough analysis of our accomplishments, our work and family life, and guide our goals to be better anesthesiologists, better human beings. In an effort to assist in this task is that the members and staff of Anesthesiology and Pain Medicine have designed our free educational
programs using scientific information available on the internet. The response has been very successful and we are now in over 120 countries, which commits us to improve our educational projects so we can reach you, and other thousands of colleagues around the world .
!Again, CONGRATULATIONS for choosing Anesthesiology as your career goal and also as an important part of your life and the lives of their patients!  
Desde que William Thomas Green Morton usou pela primeira vez em um paciente sob anestesia geral no Hospital Geral de Massachusetts em 16 de outubro de 1846, muitos países comemoram este dia como o Dia Internacional do anestesiologista , pois desta vez selado um grande avanço na luta contra a dor.
Empregam metade da nossa vida para alcançar nosso objetivo profissional para ser anestesiologistas . A segunda metade de nossa existência é dedicada a servir os pacientes de todas as idades , com condições tão variadas não iria ganhar uma vida extra para ser capaz de estudar , compreender e ser especialista em cada uma dessas patologias. Ainda assim, anestesistas treinados como dedicados conhecimento , coração e alma para dar o nosso melhor para cada paciente , cada família que coloca sua confiança em nosso conhecimento e experiência.
Sendo anestesista hoje não é apenas para dar uma boa anestesia. Há riscos ocupacionais que enfrentamos diariamente , a partir de incidentes inesperados , as queixas não são justificadas , com turnos de trabalho em excesso , radiação, ruído, poluição da sala de cirurgia , possibilidade de suicídio , divórcio e aumento da incidência de neoplasias , fadiga profissional entre muitos perigos que nós negligenciamos o benefício de cada um dos nossos pacientes .
Vamos, certamente, continuar a ser anestesiologistas até o último dia , mas agora estamos ativos é hora de pensar sobre nós mesmos, fazer uma análise profunda de nossas realizações , o nosso trabalho ea vida familiar, e orientar nossas metas a serem melhores anestesiologistas , melhores seres humanos . Em um esforço para ajudar nesta tarefa é que os membros e agentes de Anestesiologia e Medicina da Dor projetamos nossos programas educacionais livres usando informação científica disponível na internet. A resposta tem sido muito bem sucedida e estamos em mais de 120 países , o que nos compromete a melhorar os nossos projetos educacionais , para que possamos alcançá-lo , e
outros milhares de colegas ao redor do mundo.
! Vez parabéns por escolher anestesiologia como seu objetivo de carreira como uma parte importante de sua vida e as vidas de seus pacientes !   
Este mes en la Historia de la Anestesia: Octubre  
This Month in Anesthesia History: October
1846 October 16: On this Friday morning, Boston dentist William Thomas Green Morton appeared in the operating theater of the Massachusetts General Hospital. Morton was running late, but surgeon John Collins Warren had not yet started the removal of a tumor from Gilbert Abbot's jaw. For about three minutes Abbot breathed ether vapor from Morton's simple apparatus-the last minute adjusting of which had been the source of his delay--and "sank into a state of insensibility," Warren noted later. The first public demonstration of ether anesthesia had begun and proved successful. 

Las primeras 24 horas después de cirugía. Como el anestesiólogo, el cirujano y la enfermera les gustaría ser tratados si fueran pacientes 
The first 24 hours after surgery: how an anesthetist, a surgeon and a nurse would like to be treated if they were patients.
Beretta L, Braga M, Casiraghi U.
Anesthesia and Neurointensive Care; Department of Surgery, Scientific Institute OSR, Milan, Italy.
HSR Proc Intensive Care Cardiovasc Anesth. 2012;4(3):149-52.
Over the last 20 years improvements in surgical and anesthesiological techniques have reduced mortality, morbidity and the length of hospital stay. Despite these considerable efforts, a great number of patients still develop perioperative complications. The ERAS (Enhanced Recovery After Surgery) concept aims to apply an evidence-based, standardized perioperative care protocol instead of traditional management based on habits.
 
Atentamente
Anestesiología y Medicina del Dolor

Curso Taller de prevencion y manejo inicial de problemas ortopedicos en el niño

 Curso Taller de prevencion y manejo inicial de problemas ortopedicos en el niño

Embarazo y obesidad/Pregnancy and obesity

Retos anestesiológicos y obstétricos en cesárea de obesas mórbidas. Estudio en el Sureste de Nigeria  
Anaesthetic and obstetric challenges of morbid obesity in caesarean deliveries--a study in South-eastern Nigeria.
Okafor UV, Efetie ER, Nwoke O, Okezie O, Umeh U.
Department of Anaesthesia, University of Nigeria, Enugu campus, Nigeria. uvkafor@yahoo.com
Afr Health Sci. 2012 Mar;12(1):54-7.
Abstract
BACKGROUND: Morbid obesity of parturient has become very important in perinatal medicine because of a worldwide obesity epidemic. Morbid obesity of parturient is reportedly associated with severely increased anaesthetic and obstetric risk. OBJECTIVE: To determine the prevalence rate, anaesthetic and obstetric complications in morbidly obese parturient that had caesarean delivery in a Nigerian tertiary care centre. METHODS: The obstetric theatre records and case files were reviewed for caesarean deliveries in the University of Nigeria Teaching Hospital, Enugu, Nigeria from May 2008 to December 2010. A sample size of 250 patients, calculated based on a prevalence rate of 19%, confidence interval of 95% , a power of 80% and a finite population of zero was used to determine the prevalence rate of morbid obesity (Body Mass Index of greater than or equal to 35 kg/m(2)). RESULTS:There were thirty-one patients with morbid obesity (12.4%). The average Body Mass Index (BMI) was 38.3 kg/m(2)(SD ± 2.99). Other findings included macrosomia (7 or 25.8%), gestational diabetes (13%) and pregnancy induced hypertension (7 or 22.5%).There were two neonatal deaths but no maternal deaths.
CONCLUSION: The prevalence rate of morbid obesity is about 10% in Nigerian women of child bearing age. This mirrors a World Health Organisation report published in the World Health Organisation Global Information Base.
KEYWORDS: anaesthetic, morbid obesity, obstetric 
Operación cesárea en parturientas con obesidad mórbida. Implicaciones prácticas y complicaciones
 
      
Cesarean section in morbidly obese parturients: practical implications and complications.
Machado LS.
Departments of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Al-Khod, Muscat, Sultanate of Oman.
N Am J Med Sci. 2012 Jan;4(1):13-8. doi: 10.4103/1947-2714.92895.
Abstract
The prevalence of obesity has reached pandemic proportions across nations. Morbid obesity has a dramatic impact on pregnancy outcome. Cesarean section in these women poses many surgical, anesthetic, and logistical challenges. In view of the increased risk of cesarean delivery in morbidly obese women, the practical implications and complications are reviewed in this article. A Medline search was conducted to review the recent relevant articles in english literature on cesarean section in morbidly obese women. The types of incisions and techniques used during cesarean delivery, intra-operative and postpartum complications, anesthetic and logistical issues, maternal morbidity and mortality were reviewed. Morbidly obese women with a body mass index (BMI >40 kg/m(2) are at increased risk of pregnancy complications and a significantly increased rate of cesarean delivery. Low transverse skin incisions and transverse uterine incisions are definitely superior and must be the first option. Closure of the subcutaneous layer is recommended, but the placement of subcutaneous drains remains controversial. Thromboprophylaxis adjusted to body weight and prophylactic antibiotics help in reducing postpartum morbidity. Morbidly obese women are at increased risk of postpartum infectious morbidity. Weight reduction in the postpartum period and thereafter must be strongly encouraged for optimal future pregnancy outcomes and well-being.
KEYWORDS: Anesthesia, Cesarean section, Morbid obesity, Postoperative complications, Postpartum morbidity, Pregnancy
  
Cambios en la distribución del tejido adiposo durante el embarazo con sobrepeso y obesidad comparada con la mujer con peso normal     
Changes in adipose tissue distribution during pregnancy in overweight and obese compared with normal weight women.
Straughen JK, Trudeau S, Misra VK.
Department of Family Medicine and Public Health Sciences, Division of Population Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA.
Nutr Diabetes. 2013 Aug 26;3:e84. doi: 10.1038/nutd.2013.25.
Abstract
OBJECTIVE: Differences in body fat distribution contribute to the metabolic abnormalities associated with overweight and obesity; however, such differences have not been adequately explored during pregnancy. Our aim was to compare longitudinal trends in maternal abdominal adipose tissue deposition during pregnancy in overweight/obese compared with normal weight women. STUDY sound  CONCLUSIONS: Adipose tissue is preferentially deposited in the more metabolically active visceral compartment as pregnancy progresses. However, this process differs in normal weight compared with overweight/obese women and may contribute to metabolic differences between these groups. Our study is a step toward a more refined description of obesity and its consequences during pregnancy.
Atentamente
Anestesiología y Medicina del Dolor

Festival Miquixtli por Día de Muertos en Chapultepec

http://www.orgullosocitadino.com/2013/10/festival-miquixtli-por-dia-de-muertos.html

Festival Miquixtli por Día de Muertos en Chapultepec



Festival Miquixtli por Día de Muertos en Chapultepec

Estamos en la época del año donde muchos espacios públicos son tomados por los citámbulos para disfrutar de las tradiciones entorno al Día de Muertos en nuestro país. Y es que en toda la República hay diferentes costumbres para recordar a los que se han adelantado, muchas de ellas con origen prehispánico y adaptadas a las creencias de la época colonial. En nuestra ciudad se mezclan muchas de esas tradiciones, por lo que los citámbulos tenemos el gusto de disfrutar de todas ellas sin salir de la ciudad.

Una de las actividades que se realizan por estas festividades, es el Festival Miquixtli, cuyo nombre significa muerte, busca fusionar todas estas tradiciones por el Día de Muertos con el Bosque de Chapultepec, incluyendo distintas disciplinas artísticas y culturales.

A partir del 31 de Octubre y hasta el 03 de noviembre, los asistentes pueden disfrutar de un ciclo de cine, recorrido en bicicleta y a pie con las leyendas dramatizadas del bosque, música y por supuesto, las ofrendas.

En el ciclo de cine, se busca resaltar las aportaciones nacionales cinematográficas como parte fundamental de las tradiciones del Día de Muertos. Tres películas son las proyectadas en este festival: Hasta el viento tiene miedo (1968) del director Enrique Taboada; Macario (1960) dirigida por Roberto Gavaldón y; Las momias de Guanajuato(1972) dirigida por Federico Curiel. Se presenta en el Altar a la Patria.

Los recorridos de leyenda como les comentamos, se realiza en bicicleta o a pie por la primera sección del Bosque de Chapultepec. Estos recorridos se realizarán diario y en él, se recrean los mitos y leyendas de los lugares emblemáticos de dicha parte del bosque como el Quijote en las nubes, los baños de Moctezuma, entre otros; y serán representados por la compañía de teatro Máquina de Espacio.

Otro gran atractivo, son las ofrendas que se instalan en la Calzada de los Poetas y en la Fuente del Quijote. Las representaciones son parte de un concurso y al cual se lanzó la convocatoria hace un par de meses, los participantes presentaron sus proyectos basados en calaveras literarias sobre distintos escritores como Manuel José Othón, Sor Juana Inés de la Cruz, Ramón López Velarde, entre otros.

Para finalizar el Festival Miquixtli, se realiza un concierto en la Fuente de Netzahualcóyotl a cargo del ensamble Mal'Akh (de quienes ya te hemos hablado aquí) quienes musicalizan en vivo cortometrajes; además, durante el concierto se anuncian a los ganadores de las ofrendas.

A continuación te dejamos toda la programación del Festival Miquixtli, que por cierto, son gratuitas:

Festival Miquixtli por Día de Muertos en Chapultepec

Uso de AINES en Ortopedia


Uso de AINES en Ortopedia

Rogelio Solano Pérez

Aquí les dejo la liga de la última plática impartida por la Dra. Myrna Rosalba Rincon Gomez, como parte de los días Académicos del Servicio de Ortopedia Mixta del Hospital de Ortopedia de Magdalena de las Salinas; en La Mixta, dónde más!

http://youtu.be/7J4c62eNF64



lunes, 14 de octubre de 2013

Lesión explosiva en cara: Una revisión ejemplificando su manejo



Lesión explosiva en cara: Una revisión ejemplificando su manejo  
Blast injury face: An exemplified review of management.
Kumar V, Singh AK, Kumar P, Shenoy YR, Verma AK, Borole AJ, Prasad V.
Natl J Maxillofac Surg [serial online] 2013 [cited 2013 Sep 7];4:33-9.

Abstract
Facial injuries are extremely common due to increased incidence of vehicular and industrial trauma and warfare injuries. But isolated injury to the face due to low voltage cells exploding is rare. In blast injury, the force can cause massive soft tissue injury, along with injury to facial fractures and damage to adnexa. Facial injury is not life threatening unless associated with other injuries of the skull and airway. The major risks to airway in facial trauma are due to anatomic alteration of patient's airway through bony and soft tissue disruption and increased chances of aspiration. The past several decades have seen a rapid growth in the range of procedures available for reconstructive purposes. However, the essential preliminary management is a must and needs to be structured. The patient, a 10-year-old boy, was joining three pencil batteries in series and twisting the wire with his teeth when one battery exploded causing severe injuries to midface and mandibular region. After stabilization, the patient was taken up for surgery. A cap splint with zygomatic suspension was done for the maxilla, and wiring of residual mandibular segments with lining and skin cover provided by a deltopectoral flap was done. Reconstructive surgeries for reconstruction of the upper lip and maintenance of oral continence were planned for the future. The present case stresses the importance of educating the masses about unsafe handling of low voltage devices, management of airway, massive soft tissue injury, along with facial fractures and damage to adnexa.
Keywords: Airway management, blast injury face, low voltage battery



  
Atentamente
Anestesiología y Medicina del Dolor