Revisiones bibliográficas. Documentación científica en Ortopedia y Traumatología, medicina deportiva, artroscopia, artroplastia y de todas las patologías del sistema Músculo-Esquelético
sábado, 11 de enero de 2014
La revista Anesthesia Analgesia January 2013 - Volume 116 - Issue 1
La revista Anesthesia Analgesia January 2013 - Volume 116 - Issue 1
se encuentra con acceso libre completo
Free articles on Anesthesia Analgesia January 2013 - Volume 116 - Issue 1
http://journals.lww.com/anesthesia-analgesia/toc/2013/01000
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
se encuentra con acceso libre completo
Free articles on Anesthesia Analgesia January 2013 - Volume 116 - Issue 1
http://journals.lww.com/anesthesia-analgesia/toc/2013/01000
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies
Sleep. 2010 May;33(5):585-92.
Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies.
Cappuccio FP, D'Elia L, Strazzullo P, Miller MA.
Author information
Abstract
BACKGROUND:
Increasing evidence suggests an association between both short and long duration of habitual sleep with adverse health outcomes.
OBJECTIVES:
To assess whether the population longitudinal evidence supports the presence of a relationship between duration of sleep and all-cause mortality, to investigate both short and long sleep duration and to obtain an estimate of the risk.
METHODS:
We performed a systematic search of publications using MEDLINE (1966-2009), EMBASE (from 1980), the Cochrane Library, and manual searches without language restrictions. We included studies if they were prospective, had follow-up >3 years, had duration of sleep at baseline, and all-cause mortality prospectively. We extracted relative risks (RR) and 95% confidence intervals (CI) and pooled them using a random effect model. We carried out sensitivity analyses and assessed heterogeneity and publication bias.
RESULTS:
Overall, the 16 studies analyzed provided 27 independent cohort samples. They included 1,382,999 male and female participants (followup range 4 to 25 years), and 112,566 deaths. Sleep duration was assessed by questionnaire and outcome through death certification. In the pooled analysis, short duration of sleep was associated with a greater risk of death (RR: 1.12; 95% CI 1.06 to 1.18; P < 0.01) with no evidence of publication bias (P = 0.74) but heterogeneity between studies (P = 0.02). Long duration of sleep was also associated with a greater risk of death (1.30; [1.22 to 1.38]; P < 0.0001) with no evidence of publication bias (P = 0.18) but significant heterogeneity between studies (P < 0.0001).
CONCLUSION:
Both short and long duration of sleep are significant predictors of death in prospective population studies.
PMID: 20469800 [PubMed - indexed for MEDLINE] PMCID: PMC2864873 Free PMC Article
http://www.ncbi.nlm.nih.gov/pubmed/20469800
Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies.
Cappuccio FP, D'Elia L, Strazzullo P, Miller MA.
Author information
Abstract
BACKGROUND:
Increasing evidence suggests an association between both short and long duration of habitual sleep with adverse health outcomes.
OBJECTIVES:
To assess whether the population longitudinal evidence supports the presence of a relationship between duration of sleep and all-cause mortality, to investigate both short and long sleep duration and to obtain an estimate of the risk.
METHODS:
We performed a systematic search of publications using MEDLINE (1966-2009), EMBASE (from 1980), the Cochrane Library, and manual searches without language restrictions. We included studies if they were prospective, had follow-up >3 years, had duration of sleep at baseline, and all-cause mortality prospectively. We extracted relative risks (RR) and 95% confidence intervals (CI) and pooled them using a random effect model. We carried out sensitivity analyses and assessed heterogeneity and publication bias.
RESULTS:
Overall, the 16 studies analyzed provided 27 independent cohort samples. They included 1,382,999 male and female participants (followup range 4 to 25 years), and 112,566 deaths. Sleep duration was assessed by questionnaire and outcome through death certification. In the pooled analysis, short duration of sleep was associated with a greater risk of death (RR: 1.12; 95% CI 1.06 to 1.18; P < 0.01) with no evidence of publication bias (P = 0.74) but heterogeneity between studies (P = 0.02). Long duration of sleep was also associated with a greater risk of death (1.30; [1.22 to 1.38]; P < 0.0001) with no evidence of publication bias (P = 0.18) but significant heterogeneity between studies (P < 0.0001).
CONCLUSION:
Both short and long duration of sleep are significant predictors of death in prospective population studies.
PMID: 20469800 [PubMed - indexed for MEDLINE] PMCID: PMC2864873 Free PMC Article
http://www.ncbi.nlm.nih.gov/pubmed/20469800
viernes, 10 de enero de 2014
Cirugía bariátrica/Bariatric surgery
Resultados a corto y mediano tiempo entre bypass gástrico en Y de Roux y manga gástrica laparoscópica para el tratamiento de obesidad mórbida
Short- and midterm results between laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy for the treatment of morbid obesity.
Albeladi B, Bourbao-Tournois C, Huten N.
J Obes. 2013;2013:934653. doi: 10.1155/2013/934653. Epub 2013 Sep 2.
Abstract
BACKGROUND:Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most widely used bariatric procedures today, and laparoscopic sleeve gastrectomy (LSG) as a single-stage procedure for the treatment of morbid obesity is becoming increasingly popular in Europe. The aim of this study was to compare short- and midterm results between LRYGB and LSG. METHODS: An observational retrospective study from a database of patients undergoing LRYGB and LSG between January 2008 and June 2011. Seventy patients (mean age 39 years) were included. Patients were followed at 6, 12, and 18 months. Operative time, length of stay, weight loss, comorbidity improvement or resolution, postoperative complications, reinterventions and mortality were evaluated. ... CONCLUSIONS: Both LRYGB and LSG are safe procedures that provide good results in weight loss and resolution of comorbidities at 18 months
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775408/pdf/JOBES2013-934653.pdf
Cirugía bariátrica versus manejo no quirúrgico para la obesidad: revisión sistemática y meta-análisis de estudios controlados randomizados
Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials.
Gloy VL, Briel M, Bhatt DL, Kashyap SR, Schauer PR, Mingrone G, Bucher HC, Nordmann AJ.
BMJ. 2013 Oct 22;347:f5934. doi: 10.1136/bmj.f5934.
Abstract
OBJECTIVE:To quantify the overall effects of bariatric surgery compared with non-surgical treatment for obesity. DESIGN:Systematic review and meta-analysis based on a random effects model. DATA SOURCES:Searches of Medline, Embase, and the Cochrane Library from their inception to December 2012 regardless of language or publication status.ELIGIBILITY CRITERIA: Eligible studies were randomised controlled trials with ≥ 6 months of follow-up that included individuals with a body mass index ≥ 30, compared current bariatric surgery techniques with non-surgical treatment, and reported on body weight, cardiovascular risk factors, quality of life, or adverse events. RESULTS:The meta-analysis included 11 studies with 796 individuals (range of mean body mass index at baseline 30-52). Individuals allocated tobariatric surgery lost more body weight (mean difference -26 kg (95% confidence interval -31 to -21)) compared with non-surgical treatment, had a higher remission rate of type 2 diabetes (relative risk 22.1 (3.2 to 154.3) in a complete case analysis; 5.3 (1.8 to 15.8) in a conservative analysis assuming diabetes remission in all non-surgically treated individuals with missing data) and metabolic syndrome (relative risk 2.4 (1.6 to 3.6) in complete case analysis; 1.5 (0.9 to 2.3) in conservative analysis), greater improvements in quality of life and reductions in medicine use (no pooled data). Plasma triglyceride concentrations decreased more (mean difference -0.7 mmol/L (-1.0 to -0.4) and high density lipoprotein cholesterol concentrations increased more (mean difference 0.21 mmol/L (0.1 to 0.3)). Changes in blood pressure and total or low density lipoprotein cholesterol concentrations were not significantly different. There were no cardiovascular events or deaths reported after bariatric surgery. The most common adverse events after bariatric surgery were iron deficiency anaemia (15% of individuals undergoing malabsorptive bariatric surgery) and reoperations (8%). CONCLUSIONS:Compared with non-surgical treatment of obesity, bariatric surgery leads to greater body weight loss and higher remission rates of type 2 diabetes and metabolic syndrome. However, results are limited to two years of follow-up and based on a small number of studies and individuals.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3806364/pdf/bmj.f5934.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Short- and midterm results between laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy for the treatment of morbid obesity.
Albeladi B, Bourbao-Tournois C, Huten N.
J Obes. 2013;2013:934653. doi: 10.1155/2013/934653. Epub 2013 Sep 2.
Abstract
BACKGROUND:Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most widely used bariatric procedures today, and laparoscopic sleeve gastrectomy (LSG) as a single-stage procedure for the treatment of morbid obesity is becoming increasingly popular in Europe. The aim of this study was to compare short- and midterm results between LRYGB and LSG. METHODS: An observational retrospective study from a database of patients undergoing LRYGB and LSG between January 2008 and June 2011. Seventy patients (mean age 39 years) were included. Patients were followed at 6, 12, and 18 months. Operative time, length of stay, weight loss, comorbidity improvement or resolution, postoperative complications, reinterventions and mortality were evaluated. ... CONCLUSIONS: Both LRYGB and LSG are safe procedures that provide good results in weight loss and resolution of comorbidities at 18 months
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775408/pdf/JOBES2013-934653.pdf
Cirugía bariátrica versus manejo no quirúrgico para la obesidad: revisión sistemática y meta-análisis de estudios controlados randomizados
Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials.
Gloy VL, Briel M, Bhatt DL, Kashyap SR, Schauer PR, Mingrone G, Bucher HC, Nordmann AJ.
BMJ. 2013 Oct 22;347:f5934. doi: 10.1136/bmj.f5934.
Abstract
OBJECTIVE:To quantify the overall effects of bariatric surgery compared with non-surgical treatment for obesity. DESIGN:Systematic review and meta-analysis based on a random effects model. DATA SOURCES:Searches of Medline, Embase, and the Cochrane Library from their inception to December 2012 regardless of language or publication status.ELIGIBILITY CRITERIA: Eligible studies were randomised controlled trials with ≥ 6 months of follow-up that included individuals with a body mass index ≥ 30, compared current bariatric surgery techniques with non-surgical treatment, and reported on body weight, cardiovascular risk factors, quality of life, or adverse events. RESULTS:The meta-analysis included 11 studies with 796 individuals (range of mean body mass index at baseline 30-52). Individuals allocated tobariatric surgery lost more body weight (mean difference -26 kg (95% confidence interval -31 to -21)) compared with non-surgical treatment, had a higher remission rate of type 2 diabetes (relative risk 22.1 (3.2 to 154.3) in a complete case analysis; 5.3 (1.8 to 15.8) in a conservative analysis assuming diabetes remission in all non-surgically treated individuals with missing data) and metabolic syndrome (relative risk 2.4 (1.6 to 3.6) in complete case analysis; 1.5 (0.9 to 2.3) in conservative analysis), greater improvements in quality of life and reductions in medicine use (no pooled data). Plasma triglyceride concentrations decreased more (mean difference -0.7 mmol/L (-1.0 to -0.4) and high density lipoprotein cholesterol concentrations increased more (mean difference 0.21 mmol/L (0.1 to 0.3)). Changes in blood pressure and total or low density lipoprotein cholesterol concentrations were not significantly different. There were no cardiovascular events or deaths reported after bariatric surgery. The most common adverse events after bariatric surgery were iron deficiency anaemia (15% of individuals undergoing malabsorptive bariatric surgery) and reoperations (8%). CONCLUSIONS:Compared with non-surgical treatment of obesity, bariatric surgery leads to greater body weight loss and higher remission rates of type 2 diabetes and metabolic syndrome. However, results are limited to two years of follow-up and based on a small number of studies and individuals.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3806364/pdf/bmj.f5934.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Sobre la necesidad de fomentar la lectura crítica de la información médica - See more at: http://medicina-general-familiar.blogspot.mx/2014/01/sobre-la-necesidad-de-fomentar-la.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:+blogspot/cRSlP+(Medicina+General+y+Familiar)#sthash.tIQHhQ4d.3FdgOCh5.dpuf
jueves, 9 de enero de 2014
Sepsis y corazón/Sepsis and cardiac dysfunction
Inflamación y disfunción cardiaca durante la sepsis, distrofia muscular y miocarditis
Inflammation and cardiac dysfunction during sepsis, muscular dystrophy, and myocarditis.
Li Y, Ge S, Peng Y, Chen X.
Burn Trauma [serial online] 2013 [cited 2013 Dec 27];1:109-21.
Abstract
Inflammation plays an important role in cardiac dysfunction under different situations. Acute systemic inflammation occurring in patients with severe burns, trauma, and inflammatory diseases causes cardiac dysfunction, which is one of the leading causes of mortality in these patients. Acute sepsis decreases cardiac contractility and impairs myocardial compliance. Chronic inflammation such as that occurring in Duchenne muscular dystropshy and myocarditis may cause adverse cardiac remodeling including myocyte hypertrophy and death, fibrosis, and altered myocyte function. However, the underlying cellular and molecular mechanisms for inflammatory cardiomyopathy are still controversial probably due to multiple factors involved. Potential mechanisms include the change in circulating blood volume; a direct inhibition of myocyte contractility by cytokines (tumor necrosis factor (TNF)-a, interleukin (IL)-1b); abnormal nitric oxide and reactive oxygen species (ROS) signaling; mitochondrial dysfunction; abnormal excitation-contraction coupling; and reduced calcium sensitivity at the myofibrillar level and blunted b-adrenergic signaling. This review will summarize recent advances in diagnostic technology, mechanisms, and potential therapeutic strategies for inflammation-induced cardiac dysfunction.
Keywords: Burn, inflammation, sepsis, Duchenne muscular dystrophy, cardiac dysfunction, contractility
http://www.burnstrauma.com/text.asp?2013/1/3/109/123072
Monitoreo e identificación de la sepsis a través de una medida compuesta de la variabilidad del ritmo cardíaco
Monitoring and identification of sepsis development through a composite measure of heart rate variability.
Bravi A, Green G, Longtin A, Seely AJ.
PLoS One. 2012;7(9):e45666. doi: 10.1371/journal.pone.0045666. Epub 2012 Sep 19.
Abstract
Tracking the physiological conditions of a patient developing infection is of utmost importance to provide optimal care at an early stage. This work presents a procedure to integrate multiple measures of heart rate variability into a unique measure for the tracking of sepsis development. An early warning system is used to illustrate its potential clinical value. The study involved 17 adults (age median 51 (interquartile range 46-62)) who experienced a period of neutropenia following chemoradiotherapy and bone marrow transplant; 14 developed sepsis, and 3 did not. A comprehensive panel (N = 92) of variability measures was calculated for 5 min-windows throughout the period of monitoring (12 ± 4 days). Variability measures underwent filtering and two steps of data reduction with the objective of enhancing the information related to the greatest degree of change. The proposed composite measure was capable of tracking the development of sepsis in 12 out of 14 patients. Simulating a real-time monitoring setting, the sum of the energy over the very low frequency range of the composite measure was used to classify the probability of developing sepsis. The composite revealed information about the onset of sepsis about 60 hours (median value) before of sepsis diagnosis. In a real monitoring setting this quicker detection time would be associated to increased efficacy in the treatment of sepsis, therefore highlighting the potential clinical utility of a composite measure of variability.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3446945/pdf/pone.0045666.pdf
Cardiomiopatía inducida por sepsis
Sepsis-induced cardiomyopathy.
Romero-Bermejo FJ, Ruiz-Bailen M, Gil-Cebrian J, Huertos-Ranchal MJ.
Curr Cardiol Rev. 2011 Aug;7(3):163-83.
Abstract
Myocardial dysfunction is one of the main predictors of poor outcome in septic patients, with mortality rates next to 70%. During the sepsis-induced myocardial dysfunction, both ventricles can dilate and diminish its ejection fraction, having less response to fluid resuscitation and catecholamines, but typically is assumed to be reversible within 7-10 days. In the last 30 years, It's being subject of substantial research; however no explanation of its etiopathogenesis or effective treatment have been proved yet. The aim of this manuscript is to review on the most relevant aspects of the sepsis-induced myocardial dysfunction, discuss its clinical presentation, pathophysiology, etiopathogenesis, diagnostic tools and therapeutic strategies proposed in recent years.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263481/pdf/CCR-7-163.pdf
Sepsis y riesgo de enfermedad cardiovascular
Dr. Pedro Villarroel González-Eliper. Pedro Villarroel González-Elipe
Médico especialista en Medicina Interna. Coordinador del Servicio de Urgencias del Hospital Clínico San Carlos, Madrid.
Profesor asociado de Medicina de la Universidad Complutense de Madrid
Introducción a la sepsis y el riesgo cardiovascular
Diferentes microbios pueden invadir el torrente circulatorio y afectar a distintos órganos, entre otros el corazón, a través de una serie de eventos tóxicos, debidos a la liberación de productos del microorganismo y del propio huésped, que interaccionan y pueden dañar la funcionalidad
del músculo cardíaco, lo que sucede en el caso de algunas situaciones tratadas en este capítulo, y que son conocidas como sepsis.
http://www.fbbva.es/TLFU/microsites/salud_cardio/fbbva_libroCorazon_Cap_20.html?gOrri=1
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Inflammation and cardiac dysfunction during sepsis, muscular dystrophy, and myocarditis.
Li Y, Ge S, Peng Y, Chen X.
Burn Trauma [serial online] 2013 [cited 2013 Dec 27];1:109-21.
Abstract
Inflammation plays an important role in cardiac dysfunction under different situations. Acute systemic inflammation occurring in patients with severe burns, trauma, and inflammatory diseases causes cardiac dysfunction, which is one of the leading causes of mortality in these patients. Acute sepsis decreases cardiac contractility and impairs myocardial compliance. Chronic inflammation such as that occurring in Duchenne muscular dystropshy and myocarditis may cause adverse cardiac remodeling including myocyte hypertrophy and death, fibrosis, and altered myocyte function. However, the underlying cellular and molecular mechanisms for inflammatory cardiomyopathy are still controversial probably due to multiple factors involved. Potential mechanisms include the change in circulating blood volume; a direct inhibition of myocyte contractility by cytokines (tumor necrosis factor (TNF)-a, interleukin (IL)-1b); abnormal nitric oxide and reactive oxygen species (ROS) signaling; mitochondrial dysfunction; abnormal excitation-contraction coupling; and reduced calcium sensitivity at the myofibrillar level and blunted b-adrenergic signaling. This review will summarize recent advances in diagnostic technology, mechanisms, and potential therapeutic strategies for inflammation-induced cardiac dysfunction.
Keywords: Burn, inflammation, sepsis, Duchenne muscular dystrophy, cardiac dysfunction, contractility
http://www.burnstrauma.com/text.asp?2013/1/3/109/123072
Monitoreo e identificación de la sepsis a través de una medida compuesta de la variabilidad del ritmo cardíaco
Monitoring and identification of sepsis development through a composite measure of heart rate variability.
Bravi A, Green G, Longtin A, Seely AJ.
PLoS One. 2012;7(9):e45666. doi: 10.1371/journal.pone.0045666. Epub 2012 Sep 19.
Abstract
Tracking the physiological conditions of a patient developing infection is of utmost importance to provide optimal care at an early stage. This work presents a procedure to integrate multiple measures of heart rate variability into a unique measure for the tracking of sepsis development. An early warning system is used to illustrate its potential clinical value. The study involved 17 adults (age median 51 (interquartile range 46-62)) who experienced a period of neutropenia following chemoradiotherapy and bone marrow transplant; 14 developed sepsis, and 3 did not. A comprehensive panel (N = 92) of variability measures was calculated for 5 min-windows throughout the period of monitoring (12 ± 4 days). Variability measures underwent filtering and two steps of data reduction with the objective of enhancing the information related to the greatest degree of change. The proposed composite measure was capable of tracking the development of sepsis in 12 out of 14 patients. Simulating a real-time monitoring setting, the sum of the energy over the very low frequency range of the composite measure was used to classify the probability of developing sepsis. The composite revealed information about the onset of sepsis about 60 hours (median value) before of sepsis diagnosis. In a real monitoring setting this quicker detection time would be associated to increased efficacy in the treatment of sepsis, therefore highlighting the potential clinical utility of a composite measure of variability.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3446945/pdf/pone.0045666.pdf
Cardiomiopatía inducida por sepsis
Sepsis-induced cardiomyopathy.
Romero-Bermejo FJ, Ruiz-Bailen M, Gil-Cebrian J, Huertos-Ranchal MJ.
Curr Cardiol Rev. 2011 Aug;7(3):163-83.
Abstract
Myocardial dysfunction is one of the main predictors of poor outcome in septic patients, with mortality rates next to 70%. During the sepsis-induced myocardial dysfunction, both ventricles can dilate and diminish its ejection fraction, having less response to fluid resuscitation and catecholamines, but typically is assumed to be reversible within 7-10 days. In the last 30 years, It's being subject of substantial research; however no explanation of its etiopathogenesis or effective treatment have been proved yet. The aim of this manuscript is to review on the most relevant aspects of the sepsis-induced myocardial dysfunction, discuss its clinical presentation, pathophysiology, etiopathogenesis, diagnostic tools and therapeutic strategies proposed in recent years.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263481/pdf/CCR-7-163.pdf
Sepsis y riesgo de enfermedad cardiovascular
Dr. Pedro Villarroel González-Eliper. Pedro Villarroel González-Elipe
Médico especialista en Medicina Interna. Coordinador del Servicio de Urgencias del Hospital Clínico San Carlos, Madrid.
Profesor asociado de Medicina de la Universidad Complutense de Madrid
Introducción a la sepsis y el riesgo cardiovascular
Diferentes microbios pueden invadir el torrente circulatorio y afectar a distintos órganos, entre otros el corazón, a través de una serie de eventos tóxicos, debidos a la liberación de productos del microorganismo y del propio huésped, que interaccionan y pueden dañar la funcionalidad
del músculo cardíaco, lo que sucede en el caso de algunas situaciones tratadas en este capítulo, y que son conocidas como sepsis.
http://www.fbbva.es/TLFU/microsites/salud_cardio/fbbva_libroCorazon_Cap_20.html?gOrri=1
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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El retorno del libro 25.12.2013 Deutsche Welle Español
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Obesidad en el anciano/Obesity in the elderly
Malnutrición en el anciano. Parte II: obesidad, la nueva pandemia
Tania García Zenón, José Antonio Villalobos Silva
Med Int Mex 2012;28(2):154-161
En las últimas décadas se ha incrementado el número de casos de obesidad en todas las edades, incluidos los ancianos. Además de su conocida asociación con: enfermedad cardiovascular, diabetes, hipertensión, dislipidemia, y diversos cánceres, la obesidad también se relaciona con incremento del riesgo de discapacidad física y cognitiva. La edad, por sí misma, no debe contraindicar el tratamiento de la obesidad, siempre y cuando se asegure que cualquier programa de reducción de peso debe minimizar la posibilidad de efectos adversos en la masa muscular, densidad ósea y otros aspecto
http://www.revistasmedicasmexicanas.com.mx/download/med%20interna/2012/Marzo-Abril/Medicina%20Interna%202.9%20Malnutricion.pdf
Obesidad en el anciano: Más complicado de lo que Usted cree
Obesity in the elderly:More complicated than you think
DERRICK C. CETIN, GAELLE NASR
CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 81 * NUMBER 1 JANUARY 2014
Abstract
The number of obese older adults is on the rise, although we lack a proper definition of obesity in this age group. The ambiguity is primarily related to sarcopenia, the progressive loss of muscle and gain in fat that come with aging. Whether to treat and how to treat obesity in the elderly is controversial because of a paucity of established guidelines, but also because of the obesity paradox-ie, the apparently protective effect of obesity in this age group.
http://www.ccjm.org/content/81/1/51.full.pdf
http://www.ccjm.org/content/81/1/51.full.pdf
La obesidad visceral no es un factor de riesgo independiente de mortalidad en sujetos mayores de 65 años
Visceral obesity is not an independent risk factor of mortality in subjects over 65 years.
Thomas F, Pannier B, Benetos A, Vischer UM.
Author information
Vasc Health Risk Manag. 2013;9:739-45. doi: 10.2147/VHRM.S49922. Epub 2013 Nov 22.
Abstract
The aim of the study was to determine the role of obesity evaluated by body mass index (BMI), waist circumference (WC), and their combined effect on all-cause mortality according to age and related risk factors. This study included 119,090 subjects (79,325 men and 39,765 women), aged from 17 years to 85 years, who had a general health checkup at the Centre d'Investigations Préventives et Cliniques, Paris, France. The mean follow-up was 5.6±2.4 years. The prevalence of obesity, defined by WC and BMI categories, was determined according to age groups (<55, 55-65, >65 years). All-cause mortality according to obesity and age was determined using Cox regression analysis, adjusted for related risk factors and previous cardiovascular events. For the entire population, WC adjusted for BMI, an index of central obesity, was strongly associated with mortality, even after adjustment for hypertension, dyslipidemia, and diabetes. The prevalence of obesity increased with age, notably when defined by WC. Nonetheless, the association between WC adjusted for BMI and mortality was not observed in subjects>65 years old (hazard ratio [HR]=1.010, P=NS) but was found in subjects<55 (HR=1.030, P<0.0001) and 55-65 years old (HR=1.023, P<0.05). By contrast, hypertension (HR=1.31, P<0.05), previous cardiovascular events (HR=1.98, P<0.05), and smoking (HR=1.33, P<0.05) remained associated with mortality even after age 65. In conclusion, WC adjusted for BMI is strongly and independently associated with all-cause mortality before 65 years of age, after taking into account the associated risk factors. This relationship disappears in subjects>65 years of age, suggesting a differential impact of visceral fat deposition according to age.
KEYWORDS: abdominal, aging, body mass index, hypertension, smoking
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3839799/pdf/vhrm-9-739.pdf
Asociación de IMC con la causa específica de muerte en ancianos chinos hipertensos
Association of body mass index with cause specific deaths in Chinese elderly hypertensive patients: Minhang community study.
Wang Y, Wang Y, Qain Y, Zhang J, Tang X, Sun J, Zhu D.
PLoS One. 2013 Aug 13;8(8):e71223. doi: 10.1371/journal.pone.0071223. eCollection 2013.
Abstract
BACKGROUND: Most studies have suggested that elevated body mass index (BMI) was associated with the risk of death from all cause and from specific causes. However, there was little evidence illustrating the effect of BMI on the mortality in elderly hypertensive patients in Chinese population. METHODS: The information of 10,957 hypertensive patients at baseline not less than 60 years were from Xinzhuang, a town in Minhang district of Shanghai, was extracted from the Electronic Health Record (EHR) system. All study participants were divided into eight categories of baseline BMI (with cut-points at 18, 20, 22, 24, 26, 28 and 30 kg/m(2)). Relative hazard ratio of death from all cause, cardiovascular and non-cardiovascular cause by baseline BMI groups were calculated, standardized for sex, age, smoking, drinking, physical activity, systolic blood pressure, history of cardiovascular disorders, serum lipid disturbance, diabetes mellitus and antihypertensive drug treatment. RESULTS: DURING FOLLOW UP (MEDIAN: 3.7 years), 561 deaths occurred. Underweight (BMI<18 kg/m(2)) was associated with significantly increased mortality from all cause mortality (OR: 2.00; 95% CI: 1.43-2.79) and non cardiovascular mortality (OR: 2.76; 95% CI: 1.87-4.07), but not with cardiovascular mortality. For the cause specific analysis, the underweight was associated significantly with neoplasms (OR: 2.15; 95% CI: 1.16-4.00) and respiratory disorders (OR: 3.41; 95% CI: 1.64-7.06). The results for total mortality and specific cause mortality were not influenced by sex, age and smoking status. CONCLUSION: Our study revealed an association between underweight and increased mortality from non-cardiovascular disorders in elderlyhypertensive patients in Chinese community. Overweight and obesity were not associated with all cause or cause specific death.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3742783/pdf/pone.0071223.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Tania García Zenón, José Antonio Villalobos Silva
Med Int Mex 2012;28(2):154-161
En las últimas décadas se ha incrementado el número de casos de obesidad en todas las edades, incluidos los ancianos. Además de su conocida asociación con: enfermedad cardiovascular, diabetes, hipertensión, dislipidemia, y diversos cánceres, la obesidad también se relaciona con incremento del riesgo de discapacidad física y cognitiva. La edad, por sí misma, no debe contraindicar el tratamiento de la obesidad, siempre y cuando se asegure que cualquier programa de reducción de peso debe minimizar la posibilidad de efectos adversos en la masa muscular, densidad ósea y otros aspecto
http://www.revistasmedicasmexicanas.com.mx/download/med%20interna/2012/Marzo-Abril/Medicina%20Interna%202.9%20Malnutricion.pdf
Obesidad en el anciano: Más complicado de lo que Usted cree
Obesity in the elderly:More complicated than you think
DERRICK C. CETIN, GAELLE NASR
CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 81 * NUMBER 1 JANUARY 2014
Abstract
The number of obese older adults is on the rise, although we lack a proper definition of obesity in this age group. The ambiguity is primarily related to sarcopenia, the progressive loss of muscle and gain in fat that come with aging. Whether to treat and how to treat obesity in the elderly is controversial because of a paucity of established guidelines, but also because of the obesity paradox-ie, the apparently protective effect of obesity in this age group.
http://www.ccjm.org/content/81/1/51.full.pdf
http://www.ccjm.org/content/81/1/51.full.pdf
La obesidad visceral no es un factor de riesgo independiente de mortalidad en sujetos mayores de 65 años
Visceral obesity is not an independent risk factor of mortality in subjects over 65 years.
Thomas F, Pannier B, Benetos A, Vischer UM.
Author information
Vasc Health Risk Manag. 2013;9:739-45. doi: 10.2147/VHRM.S49922. Epub 2013 Nov 22.
Abstract
The aim of the study was to determine the role of obesity evaluated by body mass index (BMI), waist circumference (WC), and their combined effect on all-cause mortality according to age and related risk factors. This study included 119,090 subjects (79,325 men and 39,765 women), aged from 17 years to 85 years, who had a general health checkup at the Centre d'Investigations Préventives et Cliniques, Paris, France. The mean follow-up was 5.6±2.4 years. The prevalence of obesity, defined by WC and BMI categories, was determined according to age groups (<55, 55-65, >65 years). All-cause mortality according to obesity and age was determined using Cox regression analysis, adjusted for related risk factors and previous cardiovascular events. For the entire population, WC adjusted for BMI, an index of central obesity, was strongly associated with mortality, even after adjustment for hypertension, dyslipidemia, and diabetes. The prevalence of obesity increased with age, notably when defined by WC. Nonetheless, the association between WC adjusted for BMI and mortality was not observed in subjects>65 years old (hazard ratio [HR]=1.010, P=NS) but was found in subjects<55 (HR=1.030, P<0.0001) and 55-65 years old (HR=1.023, P<0.05). By contrast, hypertension (HR=1.31, P<0.05), previous cardiovascular events (HR=1.98, P<0.05), and smoking (HR=1.33, P<0.05) remained associated with mortality even after age 65. In conclusion, WC adjusted for BMI is strongly and independently associated with all-cause mortality before 65 years of age, after taking into account the associated risk factors. This relationship disappears in subjects>65 years of age, suggesting a differential impact of visceral fat deposition according to age.
KEYWORDS: abdominal, aging, body mass index, hypertension, smoking
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3839799/pdf/vhrm-9-739.pdf
Asociación de IMC con la causa específica de muerte en ancianos chinos hipertensos
Association of body mass index with cause specific deaths in Chinese elderly hypertensive patients: Minhang community study.
Wang Y, Wang Y, Qain Y, Zhang J, Tang X, Sun J, Zhu D.
PLoS One. 2013 Aug 13;8(8):e71223. doi: 10.1371/journal.pone.0071223. eCollection 2013.
Abstract
BACKGROUND: Most studies have suggested that elevated body mass index (BMI) was associated with the risk of death from all cause and from specific causes. However, there was little evidence illustrating the effect of BMI on the mortality in elderly hypertensive patients in Chinese population. METHODS: The information of 10,957 hypertensive patients at baseline not less than 60 years were from Xinzhuang, a town in Minhang district of Shanghai, was extracted from the Electronic Health Record (EHR) system. All study participants were divided into eight categories of baseline BMI (with cut-points at 18, 20, 22, 24, 26, 28 and 30 kg/m(2)). Relative hazard ratio of death from all cause, cardiovascular and non-cardiovascular cause by baseline BMI groups were calculated, standardized for sex, age, smoking, drinking, physical activity, systolic blood pressure, history of cardiovascular disorders, serum lipid disturbance, diabetes mellitus and antihypertensive drug treatment. RESULTS: DURING FOLLOW UP (MEDIAN: 3.7 years), 561 deaths occurred. Underweight (BMI<18 kg/m(2)) was associated with significantly increased mortality from all cause mortality (OR: 2.00; 95% CI: 1.43-2.79) and non cardiovascular mortality (OR: 2.76; 95% CI: 1.87-4.07), but not with cardiovascular mortality. For the cause specific analysis, the underweight was associated significantly with neoplasms (OR: 2.15; 95% CI: 1.16-4.00) and respiratory disorders (OR: 3.41; 95% CI: 1.64-7.06). The results for total mortality and specific cause mortality were not influenced by sex, age and smoking status. CONCLUSION: Our study revealed an association between underweight and increased mortality from non-cardiovascular disorders in elderlyhypertensive patients in Chinese community. Overweight and obesity were not associated with all cause or cause specific death.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3742783/pdf/pone.0071223.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Comprendiendo a fondo la celulitis (parte I): Causas
http://blog.hsnstore.com/comprendiendo-fondo-la-celulitis-parte-i-causas/
Comprendiendo a fondo la celulitis (parte I): Causas.
Publicado por: Mario Muñoz 7 enero, 2014 en Belleza Deja un comentario
La celulitis es una afección particularmente femenina, aunque también puede darse en hombres. Se sitúa a nivel de la capa profunda de la piel, que se produce a raíz de un desequilibrio entre la acumulación (lipogénesis) y eliminación (lipólisis) de grasa.
Causas
La causa de la celulitis no puede atribuirse a un único factor, sino que influyen:
Factores genéticos: Antecedentes familiares pueden indicar probabilidad de desarrollarla.
Factores enzimáticos: Alteración en el sistema enzimático de las grasas.
Factores endocrinos: Dada la importancia de las hormonas en la vida de la mujer, así como el mayor cúmulo de grasa para la función reproductiva, la progesterona y los estrógenos provocan cambios hormonales muy significativos. En hombres con tendencia a acumular grasa (endomorfos), aumentan los niveles de aromatasa, una enzima que convierte la testosterona en estrógenos, la hormona sexual femenina más importante. Los estrógenos extra disminuyen la producción de testosterona.Y, mientras menos produzcas, más grasa corporal tendrás, sin mencionar el incremento en la cantidad de estrógenos. Es un círculo vicioso que podría hacer desarrollar celulitis en hombres.
Factores vasculares: Alteraciones en el sistema circulatorio como pueda ser la arteriosclerosis predispone a la celulitis, que está íntimamente relacionada con la microcirculación.
Factores psicosomáticos: El estrés, nerviosismo o tensión excesiva se relacionan con el resto de factores mencionados.
Factores alimentarios: Más que la cantidad de comida, importa la calidad de la misma. Una dieta deficiente de alimentos saludables, naturales y equilibrados, a favor de alimentos procesados, alcohol y con grasas trans, aumenta la formación celulítica.
¿Por qué en mujeres?
La celulitis es afectada por la grasa y la disposición de las fibras de colágeno.Estos dos factores son diferentes en los hombres y las mujeres, e incluso en distintas partes de un mismo cuerpo femenino.
Las mujeres tienden a tener una distribución vertical de las fibras de colágeno, especialmente en la parte inferior del cuerpo. Estas fibras, forman una especie de bolsa en la que los lipocitos crecen. Los hombres, por otro lado, tienen esta disposición en forma cruzada o de red, lo que enmascara más el aspecto visual.
A medida que las células grasas crecen en tamaño, se van apretando contra las fibras de colágeno, creando el arrugamiento característico y la formación de hoyuelos de la celulitis. Es como si tensamos dos cuerdas paralelas muy juntas e intentamos meter canicas entre ellas.
¿Por qué en las caderas y miembro inferior?
Las mujeres tienen 9 veces más receptores α-adrenérgicos que β-adrenérgicos en la parte inferior del cuerpo. Estos receptores se encargan de:
Receptores α: La vasoconstricción general, de la disminución de la motilidad del músculo liso y de la activación de la lipogénesis.
Receptores β: Directamente relacionados con las “hormonas quema-grasa”, las catecolaminas (adrenalina y noradrenalina).
En la parte superior del cuerpo, este ratio (α-adrenérgicos : β-adrenérgicos) es menor, por ello cuando las mujeres pierden peso, suelen perder peso más rápido de la parte superior del cuerpo que de la parte inferior.
En la parte II del post trataremos cómo intentar eliminarla, especialmente a partir del ejercicio, alimentación y unos hábitos de vida saludables.
Fuentes
Blum CL, Menzinger S, Genné D. (2013) Cellulitis: clinical manifestations and management. Rev Med Suisse.. 9(401):1812-5.
Rasmussen SG et al. (2007). Crystal structure of the human β2-adrenergic G-protein-coupled receptor. Nature 450 (7168): pp. 383–7.
Ursula Tropper, Cesar Sanchez, Diego Ferrari Tropper (2007) Todo Sobre Celulitis: Como Prevenirla, Como Curarla. Buenos Aires, Editorial Kier,
Comprendiendo a fondo la celulitis (parte I): Causas.
Publicado por: Mario Muñoz 7 enero, 2014 en Belleza Deja un comentario
La celulitis es una afección particularmente femenina, aunque también puede darse en hombres. Se sitúa a nivel de la capa profunda de la piel, que se produce a raíz de un desequilibrio entre la acumulación (lipogénesis) y eliminación (lipólisis) de grasa.
Causas
La causa de la celulitis no puede atribuirse a un único factor, sino que influyen:
Factores genéticos: Antecedentes familiares pueden indicar probabilidad de desarrollarla.
Factores enzimáticos: Alteración en el sistema enzimático de las grasas.
Factores endocrinos: Dada la importancia de las hormonas en la vida de la mujer, así como el mayor cúmulo de grasa para la función reproductiva, la progesterona y los estrógenos provocan cambios hormonales muy significativos. En hombres con tendencia a acumular grasa (endomorfos), aumentan los niveles de aromatasa, una enzima que convierte la testosterona en estrógenos, la hormona sexual femenina más importante. Los estrógenos extra disminuyen la producción de testosterona.Y, mientras menos produzcas, más grasa corporal tendrás, sin mencionar el incremento en la cantidad de estrógenos. Es un círculo vicioso que podría hacer desarrollar celulitis en hombres.
Factores vasculares: Alteraciones en el sistema circulatorio como pueda ser la arteriosclerosis predispone a la celulitis, que está íntimamente relacionada con la microcirculación.
Factores psicosomáticos: El estrés, nerviosismo o tensión excesiva se relacionan con el resto de factores mencionados.
Factores alimentarios: Más que la cantidad de comida, importa la calidad de la misma. Una dieta deficiente de alimentos saludables, naturales y equilibrados, a favor de alimentos procesados, alcohol y con grasas trans, aumenta la formación celulítica.
¿Por qué en mujeres?
La celulitis es afectada por la grasa y la disposición de las fibras de colágeno.Estos dos factores son diferentes en los hombres y las mujeres, e incluso en distintas partes de un mismo cuerpo femenino.
Las mujeres tienden a tener una distribución vertical de las fibras de colágeno, especialmente en la parte inferior del cuerpo. Estas fibras, forman una especie de bolsa en la que los lipocitos crecen. Los hombres, por otro lado, tienen esta disposición en forma cruzada o de red, lo que enmascara más el aspecto visual.
A medida que las células grasas crecen en tamaño, se van apretando contra las fibras de colágeno, creando el arrugamiento característico y la formación de hoyuelos de la celulitis. Es como si tensamos dos cuerdas paralelas muy juntas e intentamos meter canicas entre ellas.
¿Por qué en las caderas y miembro inferior?
Las mujeres tienen 9 veces más receptores α-adrenérgicos que β-adrenérgicos en la parte inferior del cuerpo. Estos receptores se encargan de:
Receptores α: La vasoconstricción general, de la disminución de la motilidad del músculo liso y de la activación de la lipogénesis.
Receptores β: Directamente relacionados con las “hormonas quema-grasa”, las catecolaminas (adrenalina y noradrenalina).
En la parte superior del cuerpo, este ratio (α-adrenérgicos : β-adrenérgicos) es menor, por ello cuando las mujeres pierden peso, suelen perder peso más rápido de la parte superior del cuerpo que de la parte inferior.
En la parte II del post trataremos cómo intentar eliminarla, especialmente a partir del ejercicio, alimentación y unos hábitos de vida saludables.
Fuentes
Blum CL, Menzinger S, Genné D. (2013) Cellulitis: clinical manifestations and management. Rev Med Suisse.. 9(401):1812-5.
Rasmussen SG et al. (2007). Crystal structure of the human β2-adrenergic G-protein-coupled receptor. Nature 450 (7168): pp. 383–7.
Ursula Tropper, Cesar Sanchez, Diego Ferrari Tropper (2007) Todo Sobre Celulitis: Como Prevenirla, Como Curarla. Buenos Aires, Editorial Kier,
México, un país con muchos obesos pero pocos nutriólogos
México, un país con muchos obesos pero pocos nutriólogos
De acuerdo con Inegi, en el país existe un promedio de 2,4 especialistas en nutrición por cada mil habitantes, un número bajo para la dimensión de la epidemia, advierten especialistas
Leer Más: http://www.animalpolitico.com/2014/01/mexico-un-pais-con-muchos-obesos-pero-pocos-nutricionistas/#ixzz2puo2VYFT
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domingo, 5 de enero de 2014
Analgesia obstétrica/Obstetric analgesia
Efecto de la analgesia epidural con ropivacaína 0.075% versus ropivacaína 0.1% sobre la temperatura materna durante la labor: Estudio randomizado controlado
Effect of epidural analgesia with 0.075% ropivacaine versus 0.1% ropivacaine on the maternal temperature during labor: a randomized controlled study.
Yue HL, Shao LJ, Li J, Wang YN, Wang L, Han RQ.
Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
Chin Med J (Engl). 2013 Nov;126(22):4301-5.
Abstract
BACKGROUND: A wealth of evidence has indicated that labor epidural analgesia is associated with an increased risk of hyperthermia and overt clinical fever. Recently, evidence is emerging that the epidural analgesia-induced fever is associated with the types of the epidural analgesia and the variations in the epidural analgesia will affect the incidence of fever. The aim of the present study was to investigate the effects of epidural analgesiawith 0.075% or 0.1% ropivacaine on the maternal temperature during labor. METHODS:Two hundred healthy term nulliparas were randomly assigned to receive epidural analgesia with either 0.1% ropivacaine or 0.075% ropivacaine. Epidural analgesia was initiated with 10 ml increment of the randomized solution and 0.5 µg/ml sufentanyl after a negative test dose of 5 ml of 1.5% lidocaine, and maintained with 7 ml bolus doses of the abovementioned mixed analgesics every 30 minutes by the patient-controlledepidural analgesia. The measurements included the maternal oral temperature, visual analog scale pain scores, labor events and neonatal outcomes. RESULTS: Epidural analgesia with 0.075% ropivacaine could significantly lower the mean maternal temperature at 4 hours after the initiation ofanalgesia and the oxytocin administration during labor compared with the one with 0.1% ropivacaine. Moreover, 0.075% ropivacaine treatment could provide satisfactory pain relief during labor and had no significant adverse effects on the labor events and neonatal outcomes. CONCLUSION:Epidural analgesia with 0.075% ropivacaine may be a good choice for the epidural analgesia during labor
http://www.cmj.org/ch/reader/view_abstract.aspx?volume=126&issue=22&start_page=4301
Una evaluación clínica de las bombas GemStar ® y de AmbIT® para analgesia epidural controlada por la paciente
A Clinical Evaluation of the GemStar® and the AmbIT® Pumps for Patient-Controlled Epidural Analgesia.
Sinha A, Paech M, Ledger R, McDonnell N, Nathan E.
Department of Anaesthesia, Queen Alexandra Hospital, Portsmouth, UK.
Anesth Pain Med. 2012 Fall;2(2):66-71. doi: 10.5812/aapm.7513. Epub 2012 Sep 13.
Abstract
BACKGROUND: Patient-controlled analgesia is used for both labor and postoperative analgesia. OBJECTIVES: This study aimed to assess user satisfaction and functionality of two ambulatory, electronic patient controlled analgesia devices, the GemStar pump Hospira Inc., Illinois, USA) and the ambIT Ambulatory Infusion Therapy pump (Sorenson Medical Products, Utah, USA). PATIENTS AND METHODS: It was a randomized clinical trial of laboring women and postoperative gynecology patients receiving patient-controlledepidural analgesia. Patients were randomized to use one of the pumps and both anesthesiologists and patients completed questionnaires about aspects of pump function, and rated their satisfaction with the equipment. Midwives and high-dependency unit nurses also evaluated the pumps in each clinical setting. RESULTS: Forty patients, 20 laboring women and 20 postoperative patients were randomized and completed the study. The pumps were compared by nine anesthesiologists. Patient and staff satisfaction with both devices was high. Patient satisfaction did not significantly differ between groups (median 10 [8, 10] for the GemStar and 10 [9, 10] for the ambIT, P = 0.525]. The median staff satisfaction score was 8 [6, 8] for the GemStar and 7 [5, 8] for the ambIT (P = 0.154). Both patient cohorts rated each pump highly for most aspects of clinical function. Staff rated the ambIT pump more favourably with respect to portability and storage at the bedside whilst the GemStar had better assessments with respect to its consumables and interactions involving the electronic interface. CONCLUSIONS: Both devices were well-rated by patients and staff, with no significant difference between them for overall satisfaction, and only minor differences with respect to their respective strengths and weaknesses.
KEYWORDS: Analgesia, Epidural, Analgesia, Obstetrical, Analgesia, Patient-Controlled, Equipment and Supplies, Infusion Pumps
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821112/pdf/aapm-02-66.pdf
Analgesia epidural durante trabajo de parto versus no analgesia. Estudio comparativo
Epidural analgesia during labor vs no analgesia: A comparative study.
Mousa WF, Al-Metwalli R, Mostafa M.
Department of Anesthesia, Dammam University, Kingdom of Saudi Arabia.
Saudi J Anaesth. 2012 Jan;6(1):36-40. doi: 10.4103/1658-354X.93055.
Abstract
BACKGROUND: Epidural analgesia is claimed to result in prolonged labor. Previous studies have assessed epidural analgesia vs systemic opioids rather than to parturients receiving no analgesia. This study aimed to evaluate the effect of epidural analgesia on labor duration compared with parturients devoid of analgesia. METHODS: One hundred sixty nulliparous women in spontaneous labor at full term with a singleton vertex presentation were assigned to the study. Parturients who request epidural analgesia were allocated in the epidural group, whereas those not enthusiastic to labor analgesia were allocated in the control group. Epidural analgesia was provided with 20 mL bolus 0.5% epidural lidocaine plus fentanyl and maintained at 10 mL for 1 h. Duration of the first and second stages of labor, number of parturients receiving oxytocin, maximal oxytocin dose required for each parturient, numbers of instrumental vaginal, vacuum-assisted, and cesarean deliveries and neonatal Apgar score were recorded. RESULTS: There was no statistical difference in the duration of the active-first and the second stages of labor, instrumental delivery, vacuum-assisted or cesarean delivery rates, the number of newborns with 1-min and 5-min Apgar scores less than 7 between both groups and number of parturients receiving oxytocin, however, the maximal oxytocin dose was significantly higher in the epidural group. CONCLUSION: Epidural analgesia by lidocaine (0.5%) and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration.
KEYWORDS: Anesthesia, epidural drug, lidocaine, obstetric technique
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299112/
http://www.saudija.org/downloadpdf.asp?issn=1658-354X;year=2012;volume=6;issue=1;spage=36;epage=40;aulast=Mousa;type=2
Atentamente
Dr. Benito Cortes-Blanco
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Effect of epidural analgesia with 0.075% ropivacaine versus 0.1% ropivacaine on the maternal temperature during labor: a randomized controlled study.
Yue HL, Shao LJ, Li J, Wang YN, Wang L, Han RQ.
Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
Chin Med J (Engl). 2013 Nov;126(22):4301-5.
Abstract
BACKGROUND: A wealth of evidence has indicated that labor epidural analgesia is associated with an increased risk of hyperthermia and overt clinical fever. Recently, evidence is emerging that the epidural analgesia-induced fever is associated with the types of the epidural analgesia and the variations in the epidural analgesia will affect the incidence of fever. The aim of the present study was to investigate the effects of epidural analgesiawith 0.075% or 0.1% ropivacaine on the maternal temperature during labor. METHODS:Two hundred healthy term nulliparas were randomly assigned to receive epidural analgesia with either 0.1% ropivacaine or 0.075% ropivacaine. Epidural analgesia was initiated with 10 ml increment of the randomized solution and 0.5 µg/ml sufentanyl after a negative test dose of 5 ml of 1.5% lidocaine, and maintained with 7 ml bolus doses of the abovementioned mixed analgesics every 30 minutes by the patient-controlledepidural analgesia. The measurements included the maternal oral temperature, visual analog scale pain scores, labor events and neonatal outcomes. RESULTS: Epidural analgesia with 0.075% ropivacaine could significantly lower the mean maternal temperature at 4 hours after the initiation ofanalgesia and the oxytocin administration during labor compared with the one with 0.1% ropivacaine. Moreover, 0.075% ropivacaine treatment could provide satisfactory pain relief during labor and had no significant adverse effects on the labor events and neonatal outcomes. CONCLUSION:Epidural analgesia with 0.075% ropivacaine may be a good choice for the epidural analgesia during labor
http://www.cmj.org/ch/reader/view_abstract.aspx?volume=126&issue=22&start_page=4301
Una evaluación clínica de las bombas GemStar ® y de AmbIT® para analgesia epidural controlada por la paciente
A Clinical Evaluation of the GemStar® and the AmbIT® Pumps for Patient-Controlled Epidural Analgesia.
Sinha A, Paech M, Ledger R, McDonnell N, Nathan E.
Department of Anaesthesia, Queen Alexandra Hospital, Portsmouth, UK.
Anesth Pain Med. 2012 Fall;2(2):66-71. doi: 10.5812/aapm.7513. Epub 2012 Sep 13.
Abstract
BACKGROUND: Patient-controlled analgesia is used for both labor and postoperative analgesia. OBJECTIVES: This study aimed to assess user satisfaction and functionality of two ambulatory, electronic patient controlled analgesia devices, the GemStar pump Hospira Inc., Illinois, USA) and the ambIT Ambulatory Infusion Therapy pump (Sorenson Medical Products, Utah, USA). PATIENTS AND METHODS: It was a randomized clinical trial of laboring women and postoperative gynecology patients receiving patient-controlledepidural analgesia. Patients were randomized to use one of the pumps and both anesthesiologists and patients completed questionnaires about aspects of pump function, and rated their satisfaction with the equipment. Midwives and high-dependency unit nurses also evaluated the pumps in each clinical setting. RESULTS: Forty patients, 20 laboring women and 20 postoperative patients were randomized and completed the study. The pumps were compared by nine anesthesiologists. Patient and staff satisfaction with both devices was high. Patient satisfaction did not significantly differ between groups (median 10 [8, 10] for the GemStar and 10 [9, 10] for the ambIT, P = 0.525]. The median staff satisfaction score was 8 [6, 8] for the GemStar and 7 [5, 8] for the ambIT (P = 0.154). Both patient cohorts rated each pump highly for most aspects of clinical function. Staff rated the ambIT pump more favourably with respect to portability and storage at the bedside whilst the GemStar had better assessments with respect to its consumables and interactions involving the electronic interface. CONCLUSIONS: Both devices were well-rated by patients and staff, with no significant difference between them for overall satisfaction, and only minor differences with respect to their respective strengths and weaknesses.
KEYWORDS: Analgesia, Epidural, Analgesia, Obstetrical, Analgesia, Patient-Controlled, Equipment and Supplies, Infusion Pumps
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821112/pdf/aapm-02-66.pdf
Analgesia epidural durante trabajo de parto versus no analgesia. Estudio comparativo
Epidural analgesia during labor vs no analgesia: A comparative study.
Mousa WF, Al-Metwalli R, Mostafa M.
Department of Anesthesia, Dammam University, Kingdom of Saudi Arabia.
Saudi J Anaesth. 2012 Jan;6(1):36-40. doi: 10.4103/1658-354X.93055.
Abstract
BACKGROUND: Epidural analgesia is claimed to result in prolonged labor. Previous studies have assessed epidural analgesia vs systemic opioids rather than to parturients receiving no analgesia. This study aimed to evaluate the effect of epidural analgesia on labor duration compared with parturients devoid of analgesia. METHODS: One hundred sixty nulliparous women in spontaneous labor at full term with a singleton vertex presentation were assigned to the study. Parturients who request epidural analgesia were allocated in the epidural group, whereas those not enthusiastic to labor analgesia were allocated in the control group. Epidural analgesia was provided with 20 mL bolus 0.5% epidural lidocaine plus fentanyl and maintained at 10 mL for 1 h. Duration of the first and second stages of labor, number of parturients receiving oxytocin, maximal oxytocin dose required for each parturient, numbers of instrumental vaginal, vacuum-assisted, and cesarean deliveries and neonatal Apgar score were recorded. RESULTS: There was no statistical difference in the duration of the active-first and the second stages of labor, instrumental delivery, vacuum-assisted or cesarean delivery rates, the number of newborns with 1-min and 5-min Apgar scores less than 7 between both groups and number of parturients receiving oxytocin, however, the maximal oxytocin dose was significantly higher in the epidural group. CONCLUSION: Epidural analgesia by lidocaine (0.5%) and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration.
KEYWORDS: Anesthesia, epidural drug, lidocaine, obstetric technique
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299112/
http://www.saudija.org/downloadpdf.asp?issn=1658-354X;year=2012;volume=6;issue=1;spage=36;epage=40;aulast=Mousa;type=2
Atentamente
Dr. Benito Cortes-Blanco
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
LA COMPETENCIA DIGITAL EN LA EDUCACIÓN SUPERIOR: INSTRUMENTOS DE EVALUACIÓN Y NUEVOS ENTORNOS
http://www.francescesteve.es/la-competencia-digital-en-la-educacion-superior-instrumentos-de-evaluacion-y-nuevos-entornos/
LA COMPETENCIA DIGITAL EN LA EDUCACIÓN SUPERIOR: INSTRUMENTOS DE EVALUACIÓN Y NUEVOS ENTORNOS
Se acaba de publicar en la revista ENL@CE el artículo titulado ”La competencia digital en la educación superior: instrumentos de evaluación y nuevos entornos“, y en el que, junto con la profesora M. Gisbert, revisamos el concepto de competencia digital, analizamos distintos instrumentos de evaluación y esbozamos un nuevo escenario para su evaluación.
Resumen
El rápido avance de la sociedad de la información y el conocimiento exige nuevas habilidades y competencias, así como sugiere nuevos escenarios y entornos de formación. La competencia digital, entendida, no sólo como las habilidades, conocimientos y actitudes hacia con las tecnologías de información y comunicación TIC, sino también por su aplicación efectiva y crítica frente a un propósito determinado configura una de las principales competencias clave del siglo XXI.
Sin embargo, los instrumentos existentes para su desarrollo y evaluación no siempre cubren todas las áreas o dimensiones de estas competencias, por lo cual resulta esencial explorar nuevos entornos y estrategias que den respuesta a esta demanda.
En el presente artículo, se parte de una definición de competencia digital que engloba diferentes alfabetizaciones para así, analizar la diversidad de instrumentos para su evaluación de las cuales, se mencionan el Inventario de Competencias TIC (INCOTIC), el Instant Digital Competence Assessment (iDCA), el International Computer Driving License (ICDL), el apartado TIC del Programa Internacional para la Evaluación de Estudiantes (PISA), y el instrumento iSkills Assessment. Finalmente, se describe una experiencia piloto llevada a cabo en una universidad española para el uso de los entornos de simulación 3D en la evaluación de la competencia digital. Una tecnología que permite simular la realidad a través de la acción y evaluar tal competencia mediante el uso y la operatividad de indicadores internacionales como los de National Educational Technology Standards (NETS) de la International Society for Technology in Education (ISTE).
Esteve, F. y Gisbert, M. (2013). La competencia digital en la educación superior: instrumentos de evaluación y nuevos entornos. Enl@ce: Revista Venezolana de Información, Tecnología y y Conocimiento, 10(3), 29-43.
Texto completo: PDF
Enlace a la revista: ENL@CE.
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Les envió Link´s interesantes:
879-Evidence-Based Neonatal Infections, 2014
http://www.mediafire.com/?qkv9sj2ikn3lg4b
880-Nutrition for the Preterm Neonate: A Clinical Perspective, 2013
http://www.mediafire.com/?uhuy4t5p1b0fooc
878-Epidemiology of Human Congenital Malformations, 2014
https://www.mediafire.com/?y7cbhp1d60asgp2
881-Gastroenterology and Nutrition: Neonatology Questions and Controversies, 2nd Edition 2012
http://www.mediafire.com/?dy585bb5769du8n
882-Paediatric Advanced Life Support: A Practical Guide for Nurses, 2nd Edition 2012
http://www.mediafire.com/?w4813b4gps5itpn
Cesárea postmortem/Postmortem C-section
Cesárea perimortem: su papel en la mortalidad materna
Perimortem cesarean delivery: its role in maternal mortality.
Katz VL.
Semin Perinatol. 2012 Feb;36(1):68-72.
doi: 10.1053/j.semperi.2011.09.013.
Abstract
Since Roman times, physicians have been instructed to perform postmortem cesarean deliveries to aid in funeral rites, baptism, and in the very slim chance that a live fetus might still be within the deceased mother's womb. This procedure was disliked by physicians being called to a dying mother's bedside. As births moved to hospitals, and modern obstetrics evolved, the causes of maternal death changed from sepsis, hemorrhage, and dehydration to a greater incidence of sudden cardiac arrest from medication errors or embolism. Thus, the likelihood of delivering a viable neonate at the time of a mother's death increased. Additionally, as cardiopulmonary resuscitation (CPR) became widespread, physicians realized that during pregnancy, with the term gravid woman lying on her back, chest compressions cannot deliver sufficient cardiac output to accomplish resuscitation. Paradoxically, after a postmortem cesarean delivery is performed, effective CPR was seen to occur. Mothers were revived. Thus, the procedure was renamed the perimortem cesarean. Because brain damage begins at 5 minutes of anoxia, the procedure should be initiated at 4 minutes (the 4-minute rule) to deliver the healthiest fetus. If a mother has a resuscitatable cause of death, then her life may be saved as well by a prompt and timelycesarean delivery during CPR. Sadly, too often, we are paralyzed by the horror of the maternal cardiac arrest, and instinctively, we try CPR for too long before turning to the perimortem delivery. The quick procedure though may actually improve the situation for the mother, and certainly will save the child.
http://download.journals.elsevierhealth.com/pdfs/journals/0146-0005/PIIS0146000511001595.pdf
Cesárea postmortem y perimortem: ¿Cuales son las indicaciones?
Postmortem and perimortem caesarean section: what are the indications?
Whitten M, Irvine LM.
J R Soc Med. 2000 Jan;93(1):6-9.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1288043/pdf/10700838.pdf
Evolución desfavorable en PTT asociada al embarazo que requiere cesárea postmortem. Informe de caso
Unfavorable course in pregnancy-associated thrombotic thrombocytopenic purpura necessitating a perimortem Cesarean section: a case report.
González-Mesa E, Narbona I, Blasco M, Cohen I.
J Med Case Rep. 2013 Apr 29;7(1):119. doi: 10.1186/1752-1947-7-119.
Abstract
INTRODUCTION: Thrombotic thrombocytopenic purpura is a type of occlusive thrombotic microangiopathy that is not specific to pregnancy but occurs with an increased frequency during it. Prognosis of thrombotic thrombocytopenic purpura greatly depends on early diagnosis and treatment. As delivery does not generally cause resolution of thrombotic thrombocytopenic purpura, pregnancy termination is not initially considered, especially under 34 weeks, although it may be required under some conditions such as preeclampsia. Plasma therapy, including plasmapheresis, and steroids are used for treatment. In the event of an unfavorable course leading to cardiopulmonary arrest, effectiveness of cardiopulmonary resuscitation measures greatly depends on an early start of such measures. In pregnant patients, not only rapid implementation of these measures is required, but a decision should also be taken about the convenience of fetal delivery through a perimortem Cesarean section. CASE PRESENTATION: We report the case of thrombotic thrombocytopenic purpura in a 30-year-old primigravida white woman in week 28 of pregnancy that had a rapidly deteriorating course leading to cardiopulmonary arrest and an emergency perimortem Cesarean section resulting in fetal survival but maternal death. The patient was asymptomatic at admission and such an unfavorable evolution was initially unexpected. Analytical findings were treated with fresh frozen plasma and methylprednisolone but they did not improve. Plasmapheresis was considered but cardiac arrest rapidly ensued.
CONCLUSIONS:Despite the low prevalence of thrombotic thrombocytopenic purpura, the finding in a pregnant woman of the triad consisting of anemia, thrombocytopenia, and neurological changes should guide clinical diagnosis, and should prompt measurement of the metalloprotease ADAMTS-13 in order to rule out or confirm diagnosis of thrombotic thrombocytopenic purpura and evaluate the best therapeutic option. If cardiopulmonary arrest occurs in a woman with a gestational age of more than 24 weeks, a perimortem Cesarean section is advised if the patient has not recovered her pulse after the first four minutes.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3656795/pdf/1752-1947-7-119.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Perimortem cesarean delivery: its role in maternal mortality.
Katz VL.
Semin Perinatol. 2012 Feb;36(1):68-72.
doi: 10.1053/j.semperi.2011.09.013.
Abstract
Since Roman times, physicians have been instructed to perform postmortem cesarean deliveries to aid in funeral rites, baptism, and in the very slim chance that a live fetus might still be within the deceased mother's womb. This procedure was disliked by physicians being called to a dying mother's bedside. As births moved to hospitals, and modern obstetrics evolved, the causes of maternal death changed from sepsis, hemorrhage, and dehydration to a greater incidence of sudden cardiac arrest from medication errors or embolism. Thus, the likelihood of delivering a viable neonate at the time of a mother's death increased. Additionally, as cardiopulmonary resuscitation (CPR) became widespread, physicians realized that during pregnancy, with the term gravid woman lying on her back, chest compressions cannot deliver sufficient cardiac output to accomplish resuscitation. Paradoxically, after a postmortem cesarean delivery is performed, effective CPR was seen to occur. Mothers were revived. Thus, the procedure was renamed the perimortem cesarean. Because brain damage begins at 5 minutes of anoxia, the procedure should be initiated at 4 minutes (the 4-minute rule) to deliver the healthiest fetus. If a mother has a resuscitatable cause of death, then her life may be saved as well by a prompt and timelycesarean delivery during CPR. Sadly, too often, we are paralyzed by the horror of the maternal cardiac arrest, and instinctively, we try CPR for too long before turning to the perimortem delivery. The quick procedure though may actually improve the situation for the mother, and certainly will save the child.
http://download.journals.elsevierhealth.com/pdfs/journals/0146-0005/PIIS0146000511001595.pdf
Cesárea postmortem y perimortem: ¿Cuales son las indicaciones?
Postmortem and perimortem caesarean section: what are the indications?
Whitten M, Irvine LM.
J R Soc Med. 2000 Jan;93(1):6-9.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1288043/pdf/10700838.pdf
Evolución desfavorable en PTT asociada al embarazo que requiere cesárea postmortem. Informe de caso
Unfavorable course in pregnancy-associated thrombotic thrombocytopenic purpura necessitating a perimortem Cesarean section: a case report.
González-Mesa E, Narbona I, Blasco M, Cohen I.
J Med Case Rep. 2013 Apr 29;7(1):119. doi: 10.1186/1752-1947-7-119.
Abstract
INTRODUCTION: Thrombotic thrombocytopenic purpura is a type of occlusive thrombotic microangiopathy that is not specific to pregnancy but occurs with an increased frequency during it. Prognosis of thrombotic thrombocytopenic purpura greatly depends on early diagnosis and treatment. As delivery does not generally cause resolution of thrombotic thrombocytopenic purpura, pregnancy termination is not initially considered, especially under 34 weeks, although it may be required under some conditions such as preeclampsia. Plasma therapy, including plasmapheresis, and steroids are used for treatment. In the event of an unfavorable course leading to cardiopulmonary arrest, effectiveness of cardiopulmonary resuscitation measures greatly depends on an early start of such measures. In pregnant patients, not only rapid implementation of these measures is required, but a decision should also be taken about the convenience of fetal delivery through a perimortem Cesarean section. CASE PRESENTATION: We report the case of thrombotic thrombocytopenic purpura in a 30-year-old primigravida white woman in week 28 of pregnancy that had a rapidly deteriorating course leading to cardiopulmonary arrest and an emergency perimortem Cesarean section resulting in fetal survival but maternal death. The patient was asymptomatic at admission and such an unfavorable evolution was initially unexpected. Analytical findings were treated with fresh frozen plasma and methylprednisolone but they did not improve. Plasmapheresis was considered but cardiac arrest rapidly ensued.
CONCLUSIONS:Despite the low prevalence of thrombotic thrombocytopenic purpura, the finding in a pregnant woman of the triad consisting of anemia, thrombocytopenia, and neurological changes should guide clinical diagnosis, and should prompt measurement of the metalloprotease ADAMTS-13 in order to rule out or confirm diagnosis of thrombotic thrombocytopenic purpura and evaluate the best therapeutic option. If cardiopulmonary arrest occurs in a woman with a gestational age of more than 24 weeks, a perimortem Cesarean section is advised if the patient has not recovered her pulse after the first four minutes.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3656795/pdf/1752-1947-7-119.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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