Revisiones bibliográficas. Documentación científica en Ortopedia y Traumatología, medicina deportiva, artroscopia, artroplastia y de todas las patologías del sistema Músculo-Esquelético
Estudio comparativo con clonidina vs. lidocaína para atenuar las respuestas hemodinámicas durante histerectomía laparoscópica
Comparative study of clonidine versus lignocaine for attenuation of hemodynamic responses during laparoscopic hysterectomy. Roy S, Chaudhuri A, Saha D, Maulik SG, Bandopadhyay AK. J Basic Clin Reprod Sci [serial online] 2014 [cited 2014 Mar 21];3:38-43. Abstract Background: Hemodynamic changes due to reflex sympathetic discharge are of great concern in laparoscopic surgeries. Aim: To compare hemodynamic changes following premedication with lignocaine or clonidine during laparoscopic hysterectomy. Subjects and Methods: This prospective cross-sectional randomized double blinded controlled trial was conducted one year in a tertiary care hospital in West Bengal. After taking institutional ethical clearance and consent of patients, hundred subjects of ASA Grade I and II undergoing elective laparoscopic hysterectomy were included in the study. Patients were allocated into two groups. Group A received clonidine and Group B received lignocaine. Baseline clinical parameters were recorded. Patients received clonidine or lignocaine as a bolus over a period of 15 minutes before induction and as continuous intravenous infusion throughout the surgical procedure. The dose of clonidine was 2.25 μg/kg bolus and 0.9 μg/kg/hr infusion while that of lignocaine was 1.5 mg/kg bolus and 0.6 mg/kg/hr infusion. Patients were given 1 μg/kg of fentanyl citrate intravenously. Following inductionwith intravenous propofol, endotracheal intubation was facilitated by atracurium. Anaesthesia was maintained by nitrous oxideIN and oxygen and along with propofol infusion. Muscle relaxation was achieved by intermittent bolus doses of atracurium. The patients were mechanically ventilated to keep EtCO 2 between 35 and 40 mm Hg. Residual neuromuscular block was reversed by an appropriate dose of neostigmine and glycopyrrolate. All patients were shifted to PACU/POCU. Ramsay Sedation Score was assessed. Data was analyzed using SPSS version 16. Results: In comparison to group B, attenuation of heart rate, Systolic blood pressure, diastolic blood pressures were significantly more in group A. There was no difference in sedation score between the two groups. Conclusion: In an attempt to attenuate both the effects of layngoscopy and insufflations with carbon dioxide in laparoscopic surgery infusions of clonidine and lignocaine were run all through the procedures in the present study and it was found that use of clonidine and lignocaine attenuated the haemodynamic responses. However clonidine being found to be more effective. Keywords: Clonidine, hemodynamic responses, hysterectomy, lignocaine
Darse Cuenta en Biblioteca Mariño Momarandu.com Darse Cuenta en Biblioteca Mariño ... abril a las 20 hs. se exhibirá en el Ciclo de Cine Debate de la Biblioteca Mariño el film nacional “Darse Cuenta” ...
Rescate de Biblioteca España sigue en análisis El Colombiano Tras mes y medio de haberse revelado el informe de la Universidad Nacional que concluyó que era necesario rehabilitar la fachada de la Biblioteca ...
InfonorteDigital
La Biblioteca Universitaria celebra el Día del Libro InfonorteDigital ... y Atención Integral y la Biblioteca Universitaria, cuya entrega estará a cargo de ... perteneciente a los distintos fondos de laBiblioteca Universitaria.
Distinción municipal a la Biblioteca de Gente de Arte Diario La Ciudad de Avellaneda Entre ellas recibió una distinción la Biblioteca «Antonio Porchia», de la Asociación Gente de Arte de Avellaneda, consistente en una medalla y un ...
carreñodenuncia.net ⋅ Moderadora Un año más la Biblioteca de Candás celebrará el Día del Libro con la entrega de premios del XI Concurso de Marcapáginas que este año ha tenido ...
CanalBiblos: blog de la Biblioteca y Archivo de la UAM ⋅ Biblioteca de Derecho Aquí se muestran los cursos de formación que ofrece la Biblioteca de Derecho en los meses de abril y mayo de 2014. Puede solicitar los cursos a ...
Priapismo. Una complicación rara después de infusión epidural continua de morfina y bupivacaína
Priapism--a rare complication following continuous epidural morphine and bupivacaine infusion. Ruan X, Couch JP, Shah RV, Liu H, Wang F, Chiravuri S. Pain Physician. 2007 Sep;10(5):707-11. Abstract BACKGROUND: Intraspinal drug delivery (IDD) therapy has been increasingly used in patients with intractable, nonmalignant pain who fail to respond to conventional treatment or can not tolerate systemic opioid therapy due to side effects. By infusing a small amount of analgesics directly into the cerebrospinal fluid (CSF) in close proximity to the receptor sites in the spinal cord, one is able to achieve the spinally mediated analgesia, sparing side effects ffrom systemic opioids. Prior to permanent intraspinal pump implantation, an intraspinal opioid screening trial is required to document the efficacy of intraspinal opioid for analgesia. Although there are a few approaches in conducting such screening trials, a patient-controlled continuous epidural morphine infusion trial, performed in an outpatient setting, is widely accepted by many interventional pain specialists. The major advantage of conducting an outpatient functional opioid infusion trial versus an inpatient trial is that it more closely mimics what the patient does in his or her usual activities of daily living, therefore minimizing the false positive rate of the inpatient screening trial. OBJECTIVE: To describe a rare complication, priapism, observed during an outpatient continuous epidural morphine and bupivacaine infusion trial. CASE REPORT: A 49-year-old male with intractable, chronic low back pain due to diffuse lumbar degenerative disc disease, lumbar spondylosis referred to our clinic for consideration of IDD therapy, after failing to respond to multi-modality pain management including medications, physical therapy with modality, transcutaneous nerve stimulation (TENS), and various interventional procedures. Following a pre-implant psychological evaluation, he was scheduled for the outpatient epidural morphine and bupivacaine infusion trial. A tunneled lumbar epidural a catheter was placed at L3-L4 with the catheter tip advanced to L1 under fluoroscopic guidance. The proximal tip of the catheter was then tunneled, subcutaneously, and connected to a Microject PCEA pump (Codman, Raynham, MA, USA) and reservoir bag containing preservative-free morphine 0.4 mg/mL and bupivacaine 0.016%. The pump was programmed to deliver a basal rate of 0.5 mL/h. The bolus dose was 0.2 mL with a 60-minute lock out interval. The patient was instructed how to use the pump properly before discharging home. Two hours following the initiation of infusion trial, the patient started to experience penile erection. It was initially painless, but became progressively painful and intensified. The unremitting priapism lasted 8 hours, finally resolving 2 to 3 hours after discontinuing the infusion. The patient recovered fully without any sequelae. CONCLUSION: Priapism may occur as a rare complication following epidural morphine administration. This report represents the third case report thus far in the literature revealing priapism induced by epidural morphine administration, yet, it is the only report, to our knowledge, describing priapism occurring in a patient undergoing an outpatient epidural morphine and bupivacaine infusion trial. We believe that epidural morphine, rather than bupivacaine, is responsible for causing priapism in this patient, through a yet to be defined spinal mechanism. http://www.painphysicianjournal.com/2007/september/2007;10;707-711.pdf
Propofol y priapismo
Propofol and priapism. Indian J Pharmacol. 2010 Aug;42(4):238-9. doi: 10.4103/0253-7613.68430. Senthilkumaran S1, Shah S, Ganapathysubramanian, Balamurgan N, Thirumalaikolundusubramanian P. Abstract Propofol-induced priapism in a 25-year-old male confirmed by rechallenge is reported for its rarity and to create awareness among practitioners, because propofol is used frequently in India for the induction and maintenance of anesthesia or sedation. The probable mechanisms are highlighted. Because propofol causes low-flow priapism, early alleviation is essential to minimize and/or avert the long-term complications. KEYWORDS:Diisopropylphenol, early recognition, low-flow priapism, mechanisms, propofol, rechallenge
Priapismo durante cirugía transuretral bajo raquianestesia. Implicaciones y revisión de las opciones de tratamiento Priapism during transurethral surgery under spinal anaesthesia: Implications and review of management options. Das J, Deuri A, Roy PM, Pant V. Indian J Anaesth. 2010 Nov;54(6):576-7. doi: 10.4103/0019-5049.72654.
La biblioteca que nunca debió cerrar Granma Internacional Durante muchos años fui asiduo usuario de la Biblioteca de Ciencias y Técnica en el Capitolio. Actualmente esa biblioteca no existe, hace unos días ...
Fisgón de bibliotecas: la biblioteca de Federico Vegas El Nacional.com Mientras echo un vistazo a uno de los muebles de la biblioteca doy con un ejemplar de Breviario del Mediterráneo del intelectual croata Pedrag ...
Diario Andino Digital de Villa La Angostura y La Patagonia ⋅ admin Miembros de la Fundación que lleva adelante la Biblioteca del Mallín agradecen al Concejo el haber llegado a un acuerdo para beneficiar a la del ...
BRIGADIER MIGUEL KRASSNOFF ⋅ krassnoff «Miguel Krassnoff: prisionero por servir a Chile», de la historiadora Gisela Silva Encina, fue agregado al catálogo de la Biblioteca Apostólica de la ...
CanalBiblos: blog de la Biblioteca y Archivo de la UAM ⋅ Biblioteca de Psicología Continuar con la línea emprendida de Apoyo al investigador, en el marco de un proyecto global del Servicio de Bibliotecas, que engloba diferentes ...
Tendiendo puentes... ⋅ CCCTE Colonia La Biblioteca del Poder Legislativo cuenta entre el material dispuesto para donación, con ejemplares de las publicaciones Charoná, El Escolar, ...
Instituto Cervantes de Tokio ⋅ Bibliteca Tokio Escrito por Bibliteca Tokio el 4/11/14 • En la Categoría Biblioteca,Noticias. Como es tradicional, el próximo 23 de abril se celebra el Día del Libro.
Marea interior ⋅ María García Esperón Ecos de Ayer en la Biblioteca de Asturias 9 de abril de 2014. Mesa (de izquierda a derecha) Joaquín de la Buelga (Dtor. de La Caravana del Verso)
Déjate llevar por tu imaginación (Biblioteca Virtual del IES Güímar) ⋅ Biblioteca IES Güímar El alumnado de 2º de Bachillerato del IES Güímar ha elaborado las características que debe tener una biblioteca.
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BIENVENIDO - Biblioteca - Universidad de Murcia um.es Formación Scopus, para la Programación de las Aplicaciones de la interfaz (API). Fecyt junto con Elsevier, ha organizado dos sesiones de formación ...
BIENVENIDO - Biblioteca - Universidad de Murcia um.es COMpetencias para el PAS (COMPAS): Proyectos de mejora. Nueva colección en DIGITUM. Dentro de la comunidad "Institucional" de Digitum, está ...
Horario de Semana Santa | Biblioteca Universitaria unileon.es Biblioteca General S. Isidoro. - Desde el 14 hasta el 21 de abril, ambos inclusive, cerrado. - Días 22 y 23 de abril el horario será el habitual de 8:00 a ...
Heparina de bajo peso molecular y mortalidad en pacientes agudos
Low-molecular-weight heparin and mortality in acutely ill medical patients. Kakkar AK, Cimminiello C, Goldhaber SZ, Parakh R, Wang C, Bergmann JF; LIFENOX Investigators. Collaborators (383) N Engl J Med. 2011 Dec 29;365(26):2463-72. doi: 10.1056/NEJMoa1111288. Abstract BACKGROUND: Although thromboprophylaxis reduces the incidence of venous thromboembolism in acutely ill medical patients, an associated reduction in the rate of death from any cause has not been shown. METHODS: We conducted a double-blind, placebo-controlled, randomized trial to assess the effect of subcutaneous enoxaparin (40 mg daily) as compared with placebo--both administered for 10±4 days in patients who were wearing elastic stockings with graduated compression--on the rate of death from any cause among hospitalized, acutely ill medical patients at participating sites in China, India, Korea, Malaysia, Mexico, the Philippines, and Tunisia. Inclusion criteria were an age of at least 40 years and hospitalization for acute decompensated heart failure, severe systemic infection with at least one risk factor for venous thromboembolism, or active cancer. The primary efficacy outcome was the rate of death from any cause at 30 days after randomization. The primary safety outcome was the rate of major bleeding during and up to 48 hours after the treatment period. RESULTS: A total of 8307 patients were randomly assigned to receive enoxaparin plus elastic stockings with graduated compression (4171 patients) or placebo plus elastic stockings with graduated compression (4136 patients) and were included in the intention-to-treat population. The rate of death from any cause at day 30 was 4.9% in the enoxaparin group as compared with 4.8% in the placebo group (risk ratio, 1.0; 95% confidence interval [CI], 0.8 to 1.2; P=0.83). The rate of major bleeding was 0.4% in the enoxaparin group and 0.3% in the placebo group (risk ratio, 1.4; 95% CI, 0.7 to 3.1; P=0.35). CONCLUSIONS:The use of enoxaparin plus elastic stockings with graduated compression, as compared with elastic stockings with graduated compression alone, was not associated with a reduction in the rate of death from any cause among hospitalized, acutely ill medical patients. (Funded by Sanofi; LIFENOX ClinicalTrials.gov number, NCT00622648.). http://www.nejm.org/doi/pdf/10.1056/NEJMoa1111288
Apixaban vs. enoxaparina para tromboprofilaxis en pacientes de tipo médico
Apixaban versus enoxaparin for thromboprophylaxis in medically ill patients. Goldhaber SZ, Leizorovicz A, Kakkar AK, Haas SK, Merli G, Knabb RM, Weitz JI; ADOPT Trial Investigators. Collaborators (371) N Engl J Med. 2011 Dec 8;365(23):2167-77. doi: 10.1056/NEJMoa1110899. Epub 2011 Nov 13Author information Abstract BACKGROUND:The efficacy and safety of prolonging prophylaxis for venous thromboembolism in medically ill patients beyond hospital discharge remain uncertain. We hypothesized that extended prophylaxis with apixaban would be safe and more effective than short-term prophylaxis with enoxaparin.METHODS:In this double-blind, double-dummy, placebo-controlled trial, we randomly assigned acutely ill patients who had congestive heart failure or respiratory failure or other medical disorders and at least one additional risk factor for venous thromboembolism and who were hospitalized with an expected stay of at least 3 days to receive apixaban, administered orally at a dose of 2.5 mg twice daily for 30 days, or enoxaparin, administered subcutaneously at a dose of 40 mg once daily for 6 to 14 days. The primary efficacy outcome was the 30-day composite of death related to venous thromboembolism, pulmonary embolism, symptomatic deep-vein thrombosis, or asymptomatic proximal-leg deep-vein thrombosis, as detected with the use of systematic bilateral compression ultrasonography on day 30. The primary safety outcome was bleeding. All efficacy and safety outcomes were independently adjudicated.RESULTS: A total of 6528 subjects underwent randomization, 4495 of whom could be evaluated for the primary efficacy outcome--2211 in the apixaban group and 2284 in the enoxaparin group. Among the patients who could be evaluated, 2.71% in the apixaban group (60 patients) and 3.06% in the enoxaparin group (70 patients) met the criteria for the primary efficacy outcome (relative risk with apixaban, 0.87; 95% confidence interval [CI], 0.62 to 1.23; P=0.44). By day 30, major bleeding had occurred in 0.47% of the patients in the apixaban group (15 of 3184 patients) and in 0.19% of the patients in the enoxaparin group (6 of 3217 patients) (relative risk, 2.58; 95% CI, 1.02 to 7.24; P=0.04). CONCLUSIONS: In medically ill patients, an extended course of thromboprophylaxis with apixaban was not superior to a shorter course with enoxaparin. Apixaban was associated with significantly more major bleeding events than was enoxaparin. (Funded by Bristol-Myers Squibb and Pfizer; ClinicalTrials.gov number, NCT00457002.).
Incidencia y prevención de tromboembolismo en chinos viejos agudos hospitalizados Incidence and prevention of venous thromboembolism in acutely ill hospitalized elderly Chinese. Li XY, Fan J, Cheng YQ, Wang Y, Yao C, Zhong NS. Chin Med J (Engl). 2011 Feb;124(3):335-40. Abstract BACKGROUND: As the third most frequent cardiovascular disease, venous thromboembolism (VTE) remains a major cause of morbidity and mortalityin hospitalized patients. The aim of this study was to determine the incidence of VTE and steps for its prevention in acutely ill hospitalized elderly Chinese patients. METHODS: A prospective multi-center study was conducted from June 2006 to November 2007. A total of 607 patients from 40 research centers in China were enrolled. Data of the patients' baseline characteristics, VTE events and prophylaxis/therapy methods were collected. RESULTS: Fifty-nine patients (9.7%) had an objectively confirmed VTE during the 90-day follow-up, of which, 59.3% occurred during the first week and 75% within 14 days. Forty-one patients died (6.6%) during the follow-up, 36.6% died within three weeks. We also found that medical disorders including respiratory failure (16.4%), acute brain infarction (15.6%), acute infectious diseases (14.3%), acute coronary artery syndrome (8.7%) and heart failure (7.6%) play a role in provoking VTE. Only 13.0% of the elderly patients with high risk of VTE used low dose unfractionated heparin, 7.1% used low molecular weight heparin, 5.4% used warfarin, 0.3% used graduated compression stockings and none of them used intermittent pneumatic compression. CONCLUSIONS: Our study showed similar results between our study and western countries in the VTE incidence by day 90 in elderly hospitalizedpatients with acute medical illness. Great caution must be applied in the care of acutely ill elderly hospitalized patients to deal with the complications of VTE. Application of safe and effective prophylaxes against embolism remains a critical challenge.
Taller sobre las bibliotecas y sus retos con las TIC El Universal - Colombia Con el objetivo de reflexionar sobre el futuro de las bibliotecas en la era de las nuevas tecnologías de la información y las comunicaciones, ...
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Hacen radiografía a las bibliotecas de Monterrey Milenio.com La organización Biblioteca Intercultural ha encontrado cerrazón por parte del Ayuntamiento de Monterrey para poder llevar a cabo el análisis de la ...
Las Bibliotecas, desde la dictadura a hoy en una obra Diario Democracia ... Rubén Marcelo Minutoli, representa el recorrido de las Bibliotecas populares desde la época de la dictadura a la actualidad con la presentación del ...
RecBib - Recursos Bibliotecarios ⋅ JulianMarquina El número de usuarios inscritos en las 93 bibliotecas públicas de la Red de Bibliotecas de Navarra se ha incrementado en 2013, con un total de ...
Santa Cruz Barillas ⋅ O. Ramos El día lunes 31 de marzo, miembros del Club Rotario de Santa Cruz Barillas, hicieron entrega de bibliotecas a 9 escuelas de este municipio a través ...
Diario Andino Digital de Villa La Angostura y La Patagonia ⋅ admin La Federación de Bibliotecas Populares y el Departamento de Filosofía y Letras de la UBA manifiestan su apoyo a la Biblioteca Popular Osvaldo ...
RecBib - Recursos Bibliotecarios ⋅ CMaite El objetivo de estas jornadas es proporcionar una visión general sobre la Web semántica y Linked open data, y su relación con los fines de las ...
RINCON DEL BIBLIOTECARIO ⋅ Ernesto Della Riva ES LA BIBLIOTECA DE ALEJANDRÍA uno más de nuestros iconos culturales, pues aun conserva el prestigio de haber sido la más importante de la ...
Comunicación Cultural ⋅ Iñaki Saldaña Bibliotecas de Barcelona El concurso #espaislecturaBCN promueve que los usuarios muestren, a través de imágenes, sus espacios de lectura ...
Ilustradores Aragoneses ⋅ Blanca Bk La red de bibliotecas municipales de Zaragoza celebrarán el martes con distintos actos, como exposiciones, sesiones de cuentacuentos o talleres el ...
Educación en Málaga ⋅ admin Los días 2 y 3 de abril de 2014 tendrá lugar el XI Encuentro Provincial de Bibliotecas Escolares bajo el título “El apoyo de las bibliotecas escolares al ...
Juárez Noticias ⋅ Redacción Por lo menos unos 40 empleados de las bibliotecas públicas administradas por el gobierno municipal no han recibido pago desde el pasado mes de ...
Un CRA para los CRA ⋅ BiblioteKaro Esto me pareció mas que interesantes, especialmente para quienes luchamos todos los dias por demostrar lo importante que es una biblioteca ...
ARCE convoca un encuentro con Google Books Asociación Revistas Culturales de España ARCE convoca un encuentro con Google Books ... a una reunión con Luis Collado, Development Manager Books, eBooks de Google en España.
Olenka recopiló sus recetas en un libro electrónico El Universal (Venezuela) ... a ocupar en sus primeras semanas en venta, el quinto lugar de favoritismo en los ebooks kindle de cocina regional e internacional de Amazon.com.
Microjuris - Puerto Rico ⋅ Ed. Microjuris.com Puerto Rico e-books El Secretario Auxiliar de la Oficina de Asuntos Monopolísticos (OAM) del Departamento de Justicia (DJ), Lcdo. Jesús M. Alvarado Rivera, ...
Comunicación Cultural ⋅ José Antonio Vázquez La idea de su plataforma es facilitar el almacenaje, clasificación, conversión de formatos y la posibilidad de prestar los ebooks de forma sencilla e ...
Prevención de tromboembolismo venoso en paciente grave hospitalizado: atención en la utilidad clínica de dosis bajas de fondaparina
Prevention of venous thromboembolism in hospitalized acutely ill medical patients: focus on the clinical utility of (low-dose) fondaparinux. Di Nisio M, Porreca E. Drug Des Devel Ther. 2013 Sep 16;7:973-80. doi: 10.2147/DDDT.S38042. eCollection 2013. Abstract Venous thromboembolism (VTE) is a frequent complication among acutely ill medical patients hospitalized for congestive heart failure, acute respiratory insufficiency, rheumatologic disorders, and acute infectious and/or inflammatory diseases. Based on robust data from randomized controlled studies and meta-analyses showing a reduced incidence of VTE by 40% to about 60% with pharmacologic thromboprophylaxis, prevention of VTE with low molecular weight heparin (LMWH), unfractionated heparin (UFH), or fondaparinux is currently recommended in all at-risk hospitalizedacutely ill medical patients. In patients who are bleeding or are at high risk for major bleeding, mechanical prophylaxis with graduated compression stockings or intermittent pneumatic compression may be suggested. Thromboprophylaxis is generally continued for 6 to 14 days or for the duration of hospitalization. Selected cases could benefit from extended thromboprophylaxis beyond this period, although the risk of major bleeding remains a concern, and additional studies are needed to identify patients who may benefit from prolonged prophylaxis. For hospitalized acutely ill medicalpatients with renal insufficiency, a low dose (1.5 mg once daily) of fondaparinux or prophylactic LMWH subcutaneously appears to have a safe profile, although proper evaluation in randomized studies is lacking. The evidence on the use of prophylaxis for VTE in this latter group of patients, as well as in those at higher risk of bleeding complications, such as patients with thrombocytopenia, remains scarce. For critically ill patients hospitalized in intensive care units with no contraindications, LMWH or UFH are recommended, with frequent and careful assessment of the risk of bleeding. In this review, we discuss the evidence for use of thromboprophylaxis for VTE in acutely ill hospitalized medical patients, with a focus on (low-dose) fondaparinux. KEYWORDS:fondaparinux, heparin, hospitalization, medical patient, venous thromboembolism http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782407/pdf/dddt-7-973.pdf
Rivaroxaban para tromboprofilaxis en el paciente grave
Rivaroxaban for thromboprophylaxis in acutely ill medical patients. Cohen AT, Spiro TE, Büller HR, Haskell L, Hu D, Hull R, Mebazaa A, Merli G, Schellong S, Spyropoulos AC, Tapson V; MAGELLAN Investigators. Collaborators (596) N Engl J Med. 2013 Feb 7;368(6):513-23. doi: 10.1056/NEJMoa1111096. Abstract BACKGROUND: The clinically appropriate duration of thromboprophylaxis in hospitalized patients with acute medical illnesses is unknown. In this multicenter, randomized, double-blind trial, we evaluated the efficacy and safety of oral rivaroxaban administered for an extended period, as compared with subcutaneous enoxaparin administered for a standard period, followed by placebo. METHODS:We randomly assigned patients 40 years of age or older who were hospitalized for an acute medical illness to receive subcutaneous enoxaparin, 40 mg once daily, for 10±4 days and oral placebo for 35±4 days or to receive subcutaneous placebo for 10±4 days and oral rivaroxaban, 10 mg once daily, for 35±4 days. The primary efficacy outcomes were the composite of asymptomatic proximal or symptomatic venous thromboembolism up to day 10 (noninferiority test) and up to day 35 (superiority test). The principal safety outcome was the composite of major or clinically relevant nonmajor bleeding. RESULTS:A total of 8101 patients underwent randomization. A primary efficacy outcome event occurred in 78 of 2938 patients (2.7%) receiving rivaroxaban and 82 of 2993 patients (2.7%) receiving enoxaparin at day 10 (relative risk with rivaroxaban, 0.97; 95% confidence interval [CI], 0.71 to 1.31; P=0.003 for noninferiority) and in 131 of 2967 patients (4.4%) who received rivaroxaban and 175 of 3057 patients (5.7%) who received enoxaparin followed by placebo at day 35 (relative risk, 0.77; 95% CI, 0.62 to 0.96; P=0.02). A principal safety outcome event occurred in 111 of 3997 patients(2.8%) in the rivaroxaban group and 49 of 4001 patients (1.2%) in the enoxaparin group at day 10 (P<0.001) and in 164 patients (4.1%) and 67patients (1.7%) in the respective groups at day 35 (P<0.001). CONCLUSIONS:In acutely ill medical patients, rivaroxaban was noninferior to enoxaparin for standard-duration thromboprophylaxis. Extended-duration rivaroxaban reduced the risk of venous thromboembolism. Rivaroxaban was associated with an increased risk of bleeding. (Funded by Bayer HealthCare Pharmaceuticals and Janssen Research and Development; MAGELLAN ClinicalTrials.gov number, NCT00571649.).
Duración extendida de tromboprofilaxis con rivaroxaban en pacientes graves: Estudio MAGELLAN Extended-duration rivaroxaban thromboprophylaxis in acutely ill medical patients: MAGELLAN study protocol. Cohen AT, Spiro TE, Büller HR, Haskell L, Hu D, Hull R, Mebazaa A, Merli G, Schellong S, Spyropoulos A, Tapson V. J Thromb Thrombolysis. 2011 May;31(4):407-16. doi: 10.1007/s11239-011-0549-x. Abstract Patients with acute medical illnesses are at increased risk of venous thromboembolism (VTE), a significant cause of morbidity and mortality. Thromboprophylaxis is recommended in these patients but questions remain regarding the optimal duration of therapy. The aim of this study is to determine whether oral rivaroxaban is non-inferior to standard-duration (approximately 10 days) subcutaneous (s.c.) enoxaparin for the prevention of VTE in acutely ill medical patients, and whether extended-duration (approximately 5 weeks) rivaroxaban is superior to standard-duration enoxaparin.Patients aged 40 years or older and hospitalized for various acute medical illnesses with risk factors for VTE randomly receive either s.c. enoxaparin 40 mg once daily (od) for 10 ± 4 days or oral rivaroxaban 10 mg od for 35 ± 4 days. The primary efficacy outcomes are the composite of asymptomatic proximal deep vein thrombosis (DVT), symptomatic DVT, symptomatic non-fatal pulmonary embolism (PE), and VTE-related death up to day 10 + 4 and up to day 35 + 4. The primary safety outcome is the composite of treatment-emergent major bleeding and clinically relevant non-major bleeding. As of July 2010, 8,101 patients from 52 countries have been randomized. These patients have a broad range of medical conditions: approximately one-third were diagnosed with acute heart failure, just under one-third were diagnosed with acute infectious disease, and just under one-quarter were diagnosed with acute respiratory insufficiency. MAGELLAN will determine the efficacy, safety, and pharmacological profile of oral rivaroxaban for the prevention of VTE in a diverse population of medically ill patients and the potential of extended-duration therapy to reduce incidence of VTE.
El Blog de la Condroprotección ha publicado un nuevo post: 'Las enfermedades reumáticas y musculoesqueléticas se incorporan a la agenda política'
Por primera vez, la atención de estas enfermedades tan prevalentes y de gran impacto socioeconómico se incorpora a la agenda política como la Estrategia Nacional de Enfermedades Reumáticas y Musculoesqueléticas (ERyME). Estas “son patologías con un amplio margen para llevar a cabo intervenciones que pueden prevenir la incapacidad, mejorar la calidad de vida de los [...]
Exposición: “La Biblioteca del Greco” La Comarca de Puertollano El Museo del Prado, la Biblioteca Nacional de España y la Fundación El Greco 2014 presentan la exposición “La biblioteca del Greco”, una muestra ...
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«Mi biblioteca es mi tesoro» El Correo Acaba de cumplir 7 años al frente de 'Pasapalabra', pero Christian Gálvez (Móstoles, Madrid, 1980) no se cansa de 'merendar' roscos cada tarde: ...
La biblioteca se queda pequeña en Soutomaior Diario Atlántico nnn Unos 600 niños, procedentes de los centros escolares de Soutomaior, se dieron cita en la biblioteca municipal Luis Seoane para celebrar el Día ...
Hacen radiografía a las bibliotecas de Monterrey Milenio.com La organización Biblioteca Intercultural ha encontrado cerrazón por parte del Ayuntamiento de Monterrey para poder llevar a cabo el análisis de la ...
El Diario de Otún
SOS por la biblioteca El Diario de Otún Durante más de 30 años en el barrio Los Pinos de la comuna El Oso, gracias a la desinteresada labor de un hombre viene funcionando la Biblioteca ...
Diario Andino Digital de Villa La Angostura y La Patagonia ⋅ admin Odette Dub reflexiona sobre el polémico proyecto del PRO y el MPN que perjudicaría la Biblioteca, y sostiene:
EN OCASIONES... LEO LIBROS ⋅ Carlota Bloom El pasado viernes 28 de marzo tuvimos el inmenso placer de recibir a Guillermo Heras en nuestra Biblioteca, en exclusiva para nuestros alumnos de ...
Riesgos iatrogénicos y la salud materna: cuestiones y resultados.
Iatrogenic risks and maternal health: Issues and outcomes. Khaskheli MN, Baloch S, Sheeba A. Pak J Med Sci. 2014 Jan;30(1):111-5. doi: 10.12669/pjms.301.4062. Abstract Objective: To observe acute maternal morbidity and mortality due to iatrogenic factors and outcomes. Methods: This observational cross sectional study was conducted at intensive care unit of Liaquat University of Medical and Health sciences Jamshoro from 1-January-2011 to 31-December-2012. In this study all the delivered or undelivered women who needed intensive care unit (ICU) admission due to management related life threatening complication referred from periphery or within this hospital were included, while those women who had pregnancy complicated by medical conditions were excluded. These women were registered on the predesigned proforma containing variables like Demographic characteristics, various iatrogenic risk factors, complications and management out comes. The data was collected and analyzed on SPSS version 20. Results: During these study period 51 women needed ICU care for different complications due to adverse effects of medical treatments. Majority of these women were between 20-40 years of age 41(80.39%), multiparous 29(56.86%), unbooked 38(74.50%), referred from periphery 39(76.47%), common iatrogenic factors were misuse of oxytocin 16(31.37%), fluid overload/cardiac failure 8(15.68%), blood reaction 7(13.72%), anesthesia related problems were delayed recovery 3(5.88%), cardiac arrest 2(3.92%), spinal shock 2(3.92%), surgical problems were bladder injury 5(9.8%), post operative internal haemorrhage 3(5.88%), 37(72.54%) women recovered and 14(27.45%) expired. Conclusion: The maternal morbidity and mortality rate with iatrogenic factors was high and majority of these factors were avoidable. KEYWORDS:Iatrogenic risk factors, Management outcome, Mortality, maternal morbidity http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955553/pdf/pjms-30-111.pdf
Riesgos iatrogénicos y la salud materna: cuestiones y resultados. Iatrogenic risks and maternal health: Issues and outcomes. Khaskheli MN, Baloch S, Sheeba A. Pak J Med Sci. 2014 Jan;30(1):111-5. doi: 10.12669/pjms.301.4062. Abstract Objective: To observe acute maternal morbidity and mortality due to iatrogenic factors and outcomes. Methods: This observational cross sectional study was conducted at intensive care unit of Liaquat University of Medical and Health sciences Jamshoro from 1-January-2011 to 31-December-2012. In this study all the delivered or undelivered women who needed intensive care unit (ICU) admission due to management related life threatening complication referred from periphery or within this hospital were included, while those women who had pregnancy complicated by medical conditions were excluded. These women were registered on the predesigned proforma containing variables like Demographic characteristics, various iatrogenic risk factors, complications and management out comes. The data was collected and analyzed on SPSS version 20. Results: During these study period 51 women needed ICU care for different complications due to adverse effects of medical treatments. Majority of these women were between 20-40 years of age 41(80.39%), multiparous 29(56.86%), unbooked 38(74.50%), referred from periphery 39(76.47%), common iatrogenic factors were misuse of oxytocin 16(31.37%), fluid overload/cardiac failure 8(15.68%), blood reaction 7(13.72%), anesthesia related problems were delayed recovery 3(5.88%), cardiac arrest 2(3.92%), spinal shock 2(3.92%), surgical problems were bladder injury 5(9.8%), post operative internal haemorrhage 3(5.88%), 37(72.54%) women recovered and 14(27.45%) expired. Conclusion: The maternal morbidity and mortality rate with iatrogenic factors was high and majority of these factors were avoidable. KEYWORDS:Iatrogenic risk factors, Management outcome, Mortality, maternal morbidity
Papel de la unidad de cuidado postanestesia en el manejo de las parturientas de alto riesgo The role of the post-anaesthesia care unit in the management of high-risk obstetric patients. Kostopanagiotou G, Kalimeris K, Pandazi A, Salamalekis G, Chrelias C, Matsota P. Arch Med Sci. 2011 Feb;7(1):123-6. doi: 10.5114/aoms.2011.20616. Epub 2011 Mar 8. Abstract INTRODUCTION: High-risk obstetric patients in the immediate postpartum period are frequently admitted to the intensive care unit, but the necessity of this practice has recently been doubted. Herein we describe the efficiency of utilizing the post-anaesthesia care unit (PACU) as an intermediate intensive care facility for those patients. MATERIAL AND METHODS: We retrospectively described the reasons for admission, duration of stay, the anaesthetic used, main interventions and outcome for all obstetric admissions in the PACU during a period of 4 years in a university hospital. RESULTS: During the 4-year period 47 women were admitted to the PACU after delivery. The frequency of admission to the PACU was 15.3 per 1000 deliveries, while obstetric cases represented 4.4 per 1000 admissions to the PACU. The majority represented caesarean sections (81%). The main reasons for admission to the PACU were haemorrhage (49%), cardiovascular problems (19%) and preeclampsia/eclampsia (17%). Mean length of stay in the PACU was 14.5 ±11.6 h, being significantly less in women having received epidural anaesthesia (8.2 ±5.6 h) compared to those who delivered with general anaesthesia (19.0 ±13.6 h, p < 0.05). General anaesthesia was used in 85% of cases in which emergency delivery was indicated, but only in 27% of cases without emergency indications for delivery (p < 0.01). No death or admission to the intensive care unit occurred during the study period. CONCLUSIONS: The PACU can offer an intermediate intensive care facility for high-risk obstetric patients, thus reducing unnecessary admissions to the intensive care unit. KEYWORDS: complications of pregnancy, maternal morbidity and mortality