http://www.madrimasd.org/informacionidi/noticias/noticia.asp?id=61256&origen=notiweb&dia_suplemento=miercoles

Los árboles pueden salvar muchas vidas en entornos urbanos

Aunque la eliminación de la contaminación de árboles equivale a una mejora promedio de la calidad del aire de menos del 1 por ciento, los impactos de esa mejora son sustanciales. Los investigadores valoraron los efectos en la salud humana de la reducción de la contaminación del aire en casi 7.000 millones de dólares cada año, en un estudio publicado recientemente en la revistaEnvironmental Pollution. El estudio es único, ya que vincula directamente la eliminación de la contaminación del aire con la mejora de los efectos en la salud humana y los valores de salud asociados. Los científicos descubrieron que la eliminación de la contaminación es mucho mayor en las zonas rurales que en las urbanas, sin embargo los efectos en la salud humana son mucho mayores en las zonas urbanas que en las rurales. "Con más de un 80 por ciento de los estadounidenses viviendo en áreas urbanas, esta investigación pone de relieve cuán verdaderamente esenciales son los bosques urbanos son para la gente en todo el país", explica Michael T. Rains, director de la Estación de Investigación del Norte del Servicio Forestal, en la nota de prensa del Departamento de Agricultura de Estados Unidos. CONTAMINANTES  El estudio tiene en cuenta cuatro contaminantes para los que los EE.UU. ha establecido normas de calidad del aire: dióxido de nitrógeno, ozono, dióxido de azufre y partículas menores a 2.5 micras (PM2.5) de diámetro aerodinámico. Los efectos sobre la salud relacionados con la contaminación del aire incluyen los impactos sobre los sistemas pulmonar, cardiaco, vascular, y neurológico. En Estados Unidos, en 2005, aproximadamente 130.000 muertes relacionadas con las PM2.5, y 4.700 muertes relacionadas con el ozono se atribuyeron a la contaminación del aire. Los beneficios de los árboles varían según la cobertura de los árboles en todo el país. La cobertura arbórea en los Estados Unidos se estima en el 34,2 por ciento, pero varía de un 2,6 por ciento en Dakota del Norte a un 88,9 por ciento en new Hampshire. "En términos de impacto en la salud humana, los árboles en las zonas urbanas son mucho más importantes que los árboles rurales debido a su proximidad a la gente", explica Nowak. "Hemos encontrado que, en general, cuanto mayor sea la cobertura de árboles, mayor será la eliminación de la contaminación, y cuanto mayor la densidad de población, mayor es el valor de los beneficios para la salud humana".

El ozono también amenaza las cosechas

http://www.madrimasd.org/informacionidi/noticias/noticia.asp?id=61266&origen=notiweb&dia_suplemento=miercoles



El ozono también amenaza las cosechas




De ello alertan investigadores del Instituto Tecnológico de Massachusetts(MIT), que publican en la revista Nature Climate Change cómo este tipo de contaminación puede, en los países en desarrollo, aumentar del 17% al 27% el porcentaje de malnutrición.




El ozono es un gas muy oxidante capaz de dañar a las especies vegetales. Muchos estudios se habían ocupado de los efectos del cambio climático en la producción agrícola, pero no se había estudiado este factor combinado con la contaminación ambiental, aseguran los autores del trabajo. El calentamiento podría reducir las cosechas globales en un 10% en 2050. Para entonces se estima que las necesidades de comida se incrementarán en un 50% debido, entre otras cosas, al crecimiento de la población, recuerdan.




Los autores estudiaron las predicciones de temperatura y contaminación, elaboraron dos posibles escenarios -uno más optimista y otro más pesimista- y sus futuros efectos en la producción de trigo, arroz, maíz y soja. "Los efectos de la contaminación por ozono dependen mucho del escenario", escriben. En el pesimista, con una contaminación por ozono es muy alta, las cosechas mundiales se reducirían un 3,6% de media.




Existen muchas diferencias en función del tipo de cosecha y la región. En el sudeste asiático, por ejemplo, donde los dos escenarios predicen más ozono, la producción de trigo podría caer un 40%. La producción de arroz y maíz en China es muy sensible al ozono. En cambio, el maíz, en zonas como Estados Unidos, Europea y Suramérica, así como la soja en Suramérica, acusan más los efectos de la temperatura. Los autores del estudio insisten en que es necesario adaptarse: reduciendo la contaminación y plantando cultivos que se adapten a temperaturas más altas.




Autor: E. G. Sevillano

Anestesia general en obstetricia/General anesthesia in obstetrics

Remifentanil para inducir la anestesia general en cesárea. Estudio clínico, doble ciego, randomizado



Remifentanil at induction of general anesthesia for cesarean section: Double blind, randomized clinical trial.
Behdad S, Ayatollahi V, Harrazi H, Nazemian N, Heiranizadeh N, Baghianimoghadam B.
Colomb Med (Cali). 2013 Jun 30;44(2):87-91. eCollection 2013.
Abstract
INTRODUCTION: Remifentanil, with its rapid activity onset and short duration of action, may be more effective than other opioids for providing hemodynamic stability during obstetric anesthesia. However, there is some evidence of adverse effects on neonatal respiratory function. We investigated maternal and fetal effects of Remifentanil during cesarean section surgery. METHODS: Eighteen women with singleton term pregnancies, and physical class status of I or II as defined by the American Society of Anesthesia(ASA), who were undergoing general anesthesia for semi-elective cesarean section were randomized into two groups (40 in each group) that received either an intravenous bolus of 0.5 µg/kg Remifentanil or the same dose of saline as a placebo. Maternal hemodynamic variables and neonatal umbilical artery pH and Apgar score at first and fifth min were evaluated in both groups. RESULTS: Systolic and diastolic blood pressure were significantly lower after tracheal intubation and skin incision in the Remifentanil group as compared with the control group (p <0.05). There were no significant differences regarding heart rate between groups at any time (p > 0.05). Apgar scores at first and fifth min were not significantly different among groups (p>0.05). No neonate required assisted ventilation or naloxane administration. CONCLUSION: Remifentanil may be a safe and effective drug for the induction of general anesthesia and surgical stimulation without subsequent neonatal depression.
KEYWORDS: Placebo; Remifentanil; caesarean
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4002026/pdf/1657-9534-cm-44-02-00087.pdf



Intubación difícil en anestesia obstétrica


Difficult and failed intubation in obstetric anaesthesia: an observational study of airway management andcomplications associated with general anaesthesia for caesarean section.
McDonnell NJ, Paech MJ, Clavisi OM, Scott KL; ANZCA Trials Group.
Collaborators (19)
Int J Obstet Anesth. 2008 Oct;17(4):292-7. doi: 10.1016/j.ijoa.2008.01.017. Epub 2008 Jul 9.
Abstract
BACKGROUND: Recent developments in anaesthesia and patient demographics have potentially changed the practice of obstetric generalanaesthesia. There are few contemporary data on Australasian practice of general anaesthesia for caesarean section, especially relating to airwaymanagement, anaesthetic techniques and complications. METHODS: Using a standardised case record form, a prospective observational study was conducted during 2005-06 in 13 maternity hospitals dealing with approximately 49 500 deliveries per annum. Patient demographics, airway management, anaesthetic techniques and major complicationswere evaluated in those given general anaesthesia. RESULTS: Data were obtained from 1095 women receiving general anaesthesia for caesarean section, 47% of which were classified as category 1 and 18% as category 4. Tracheal intubation was planned in all cases with rapid-sequence induction used in 97%. A grade 3 or 4 laryngoscopic view was obtained in 3.6 and 0.6% of cases respectively, with 3.3% considered a difficult intubation. There were four failed intubations (0.4%, 95% CI 0.01-0.9%), of which three were subsequently managed using a laryngeal mask airway. Antacid prophylaxis was used in 94% of elective cases and 64% of emergencies. Regurgitation of gastric contents was noted in eight cases (0.7%, 95% CI 0.2-1.2%), with one confirmed case of aspiration (0.1%, 95% CI 0.002-0.5%). There were no cases of serious airway-related morbidity. CONCLUSIONS: General anaesthesia is most commonly used in emergency situations. Tracheal intubation after rapid-sequence induction remains the predominant approach to airway management in Australasia. The incidence of failed intubation is consistent with previous studies. Aspiration prophylaxis is not routinely used for emergency surgery.

http://www.mc.vanderbilt.edu/documents/1anesthesiology/files/McDonnell%202008%20-%20Failed%20Intub.pdf


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

Oxígeno suplementario en operación cesárea durante anestesia regional

Oxígeno suplementario en operación cesárea durante anestesia regional


Supplemental oxygen for caesarean section during regional anaesthesia.
Chatmongkolchart S, Prathep S.
Cochrane Database Syst Rev. 2013 Jun 28;6:CD006161. doi: 10.1002/14651858.CD006161.pub2.
Abstract
BACKGROUND:Supplementary oxygen is routinely administered to low-risk pregnant women during an elective caesarean section under regional anaesthesia; however, maternal and foetal outcomes have not been well established.OBJECTIVES:The primary objective was to determine whether supplementary oxygen given to low-risk term pregnant women undergoing elective caesarean section under regional anaesthesia can prevent maternal and neonatal desaturation. The secondary objective was to compare the mean values of maternal and neonatal blood gas levels between mothers who received supplementary oxygen and those who did not (control group).SEARCH METHODS:We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2012), MEDLINE (1948 to February 2012) and EMBASE (1980 to February 2012). We did not apply language restrictions.SELECTION CRITERIA:We included randomized controlled trials of low-risk pregnant women undergoing an elective caesarean section under regional anaesthesia and compared outcomes with, and without, oxygen supplementation.DATA COLLECTION AND ANALYSIS:Two review authors independently extracted data, assessed methodological quality and performed subgroup and sensitivity analyses.MAIN RESULTS:We included 10 trials with a total of 683 participants. Supplementary oxygen administration varied widely in dose and duration between trials. No cases of maternal desaturation were reported, although none of the 10 trials focused on maternal desaturation. Significant differences were noted in maternal oxygen saturation (higher with oxygen, N = three trials; mean difference (MD) 1.6%, 95% confidence interval (CI) 0.8 to 2.3, P < 0.0001), maternal PaO2 (oxygen pressure in the blood; higher with oxygen, N = six trials; MD 141.8 mm Hg, 95% CI 109.3 to 174.3, P < 0.00001), neonatal UaPO2 (foetal umbilical arterial blood; higher with oxygen, N = eight trials; MD 3.3 mm Hg, 95% CI 1.8 to 4.9, P < 0.0001) and UvPO2 (foetal umbilical venous blood; higher with oxygen, N = 10 trials; MD 5.9 mm Hg, 95% CI 3.2 to 8.5, P < 0.0001). No significant differences were reported in neonatal UapH (N = eight trials; MD 0.00, 95% CI -0.01 to 0.00, P = 0.26) and in average Apgar scores at one minute (N = five trials; MD 0.07, 95% CI -0.20 to 0.34, P = 0.6) and at five minutes (N = five trials; MD 0.00, 95% CI -0.06 to 0.05, P = 0.91).Only two out of 10 trials had a low risk of bias in all categories. When we separated the studies into low risk and high risk for bias, we found substantial statistical heterogeneity. None of the low-risk studies showed a significant difference in neonatal UaPO2 between the two intervention groups, whereas the high-risk studies showed a benefit for the neonatal oxygen group.The level of oxygen free radicals (malondialdehyde (MDA) and 8-isoprostane) was higher in participants who received supplementary oxygen (N = two trials; MD 0.2 µmol/L, 95% CI 0.1 to 0.4, P = 0.0002; MD 64.3 pg/mL, 95% CI 51.7 to 76.8, P < 0.00001, respectively). AUTHORS' CONCLUSIONS: Current evidence suggests that supplementary oxygen given to healthy term pregnant women during elective caesarean section under regional anaesthesia is associated with higher maternal and neonatal oxygen levels (maternal SpO2, PaO2, UaPO2 and UvPO2) and higher levels of oxygen free radicals. However, the intervention was neither beneficial nor harmful to the neonate's short-term clinical outcome as assessed by Apgar scores.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006161.pub2/pdf


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

Bibliotecas. Alerta

Biblioteca
Notificaciones diarias ⋅ 29 de julio de 2014
NOTICIAS


El Universal

Biblioteca Nacional de México, el gran pendiente del siglo XXI
El Universal
La Biblioteca Nacional de México, que es el más valioso archivo bibliográfico nacional, el próximo 6 de agosto celebrará 80 años de estar bajo el ...


Biblioteca Palafoxiana será sede de la Reunión del Programa Memoria del Mundo
proceso.com.mx
La Biblioteca Palafoxiana de Puebla será sede de la XV Reunión Anual del Comité Regional para América Latina y el Caribe del Programa Memoria ...




Europa Press

Las bibliotecas de Málaga y Shanghái firman un convenio para promocionar las culturas española ...
Europa Press
Las bibliotecas de Málaga y la de Shanghái (China) han establecido un convenio de colaboración para el fomento de las culturas española y china.




Latercera

Biblioteca de Santiago celebra los 75 años de Batman con actividad gratuita
Latercera
La Biblioteca de Santiago celebrará este sábado 2 de agosto los 75 años de Batman, a través del evento gratuito Batman 75 Chile, que contará con ...




Diario Veloz

¿Biblioteca o tribunales? Pareja separada deberá leer el Principito a su hijo
Diario Veloz
También también tendrán que leerle la Convención de los Derechos del Niño y Etica para Amador. ¿Biblioteca o tribunales? Pareja separada deberá ...




EntornoInteligente

Biblioteca Nacional celebrará natalicio de Chávez con muestra fotográfica y bibliográfica
EntornoInteligente
ENTORNOINTELIGENTE.COM / La Biblioteca Nacional de Venezuela (BNV) celebrará este lunes 28 de julio, a partir de las 11 de la mañana, ...



Biblioteca de Miraflores ofrece obras literarias en Braille | El Comercio Perú
El Comercio
Dieciocho obras de literatura peruana e internacional en Braille, están ahora a disposición de los usuarios con discapacidad visual en la Biblioteca ...



La Biblioteca Central cierra hasta octubre por la reparación de la montera
Diario de Jerez
La reparación de la montera de la Biblioteca Central comenzará a ejecutarse a partir del próximo lunes 4 de agosto, una vez adjudicada la obra a la ...




Zacatecas en Línea

Bibliotecas municipales fomentan el acercamiento a la lectura en sus cursos de verano
El Sol de la Laguna - OEM
Torreón, Coahuila.- El programa "Mis Vacaciones en la Biblioteca", representa año con año una gran oportunidad para que los niños de Torreón ...




Europa Press

El Gobierno prevé un incremento "significativo" de los ingresos de laBiblioteca Nacional con el ...
Europa Press
El Gobierno prevé un "significativo" aumento de los ingresos de la Bliblioteca Nacional de España (BNE) gracias a la aprobación de la Ley ...


BLOGS

Telefónica impulsa la digitalización de los archivos de la Biblioteca Nacional con la firma de un

Think Big ⋅ Chema Amate
La Biblioteca Nacional y Telefónica continúan con su firme compromiso de que la cultura sea accesible para todo el mundo. Gracias al nuevo ...



Referencias en la Biblioteca Digital Cubana de Geociencias

Emilio Ichikawa ⋅ ei
(RC)-Una tercera versión de la Biblioteca Digital Cubana de Geociencias ya puede ser consultada en la dirección ...


WEB

San Juan de Arama: El pueblo que volvió a nacer gracias a su biblioteca pública
Biblioteca Nacional de Colombia
Luego de sufrir los rigores del conflicto armado del país, y de ver destruida su iglesia por “cilindros bomba”, esta población del Meta muestra con ...

Analgesia con ketamina en cesárea/Ketamine analgesia in C-Section

Efecto analgésico de dosis bajas de ketamina antes y después de cesárea


Analgesic effect of low dose subcutaneous ketamine administration before and after cesarean section.
Behaeen K, Soltanzadeh M, Nesioonpour S, Ebadi A, Olapour A, Aslani SM.
Iran Red Crescent Med J. 2014 Mar;16(3):e15506. doi: 10.5812/ircmj.15506. Epub 2014 Mar 5.
Abstract
BACKGROUND:Pain is considered as an importantissue after cesarean section. Multimodal approach to post cesarean pain management may not only enhance analgesia but also reduce side effects after the surgery. OBJECTIVES: This study was aimed to evaluate the clinical efficacy of subcutaneous injection of low dose ketamine at the incision site to reduce cesarean section pain. PATIENTS AND METHODS: Sixty patients, aged between 18 and 25 years old, scheduled for elective cesarean section, were enrolled to this double-blind randomized controlled trial study. Patients were divided into three groups of 20 patients each group one (k-pre) received 0.5 mg/kg ketaminebefore skin incision and normal saline after skin closure, group two (k-post) received normal saline before skin incision and 0.5 mg/kg ketamine after skin closure and group three (C) received normal saline before skin incision and after skin closure; subcutaneously at the incision site. The firstanalgesic request, the amount of analgesic and the pain intensity were evaluated for 24 hours. RESULTS: The first time analgesic requested was longer and the amount of analgesic used during the first 24 hours was significantly lower in groups K-pre and K-post compared with group C (P < 0.05). Pain intensity was significantly lower at 2, 4, 6 and 12 hours in groups K-pre and K-post compared with group C (P < 0.05). Nevertheless, pain intensity was not significantly different at 18 and 24 hours in group C (P > 0.05). The first requested time, total used amount of analgesicand pain intensity were not meaningfully different in K-pre and K-post groups (P > 0.05). CONCLUSIONS:Patients who were given ketamine before or after cesarean section subcutaneously at incision site had lower pain intensity and less analgesic consumption than patients who were given placebo.
KEYWORDS:Caesarean Section; Diclofenac; Ketamine; Pain, Postoperative
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005445/pdf/ircmj-16-15506.pdf



Evaluación del efecto analgésico de ketamina como aditivo de bupivacaína intratecal en cesárea


Evaluation of the analgesic effect of ketamine as an additive to intrathecal bupivacaine in patients undergoing cesarean section.
Khezri MB, Ghasemi J, Mohammadi N.
Acta Anaesthesiol Taiwan. 2013 Dec;51(4):155-60. doi: 10.1016/j.aat.2013.12.004. Epub 2014 Jan 21
Abstract
OBJECTIVE:Nowadays, conventional analgesic agents, which are widely used for pain relief after cesarean section, provide suboptimal analgesia with occasional serious side effects. We designed a randomized, double-blind, placebo-controlled study to evaluate the analgesic efficacy of intrathecal ketamine added to bupivacaine after cesarean section. METHODS:Sixty patients scheduled for cesarean section under spinal anesthesia were randomly allocated to one of the two groups to receive either bupivacaine 10 mg combined with 0.1 mg/kg ketamine, or bupivacaine 10 mg combined with 0.5 mL distilled water intrathecally. The time to the firstanalgesic request, analgesic requirement in the first 24 hours after surgery, onset times of sensory and motor blockades, the durations of sensory and motor blockades, and the incidences of adverse effects such as hypotension, ephedrine requirement, bradycardia, and hypoxemia, were recorded. RESULTS:Patients who received ketamine had a significantly prolonged duration of anesthesia compared with those who did not in the control group [95% confidence intervals (CI) 195-217; p = 0.001]. The mean time to the first analgesic request was also significantly longer in ketamine group (95% CI 252.5-275; p < 0.001). The total analgesic consumption in the 24 hours following surgery significantly lessened in the ketamine group compared with that of the control group (95% CI 2-2.5; p < 0.001). The two groups did not differ significantly in intraoperative and postoperative side effects. CONCLUSION:Intrathecal ketamine 0.1 mg/kg co-administered with spinal bupivacaine elongated the time to the first analgesic request and lessened the total analgesic consumption in the first 24 postoperative hours in comparison with bupivacaine alone in the control group following elective cesarean delivery.

http://www.e-aat.com/article/S1875-4597(13)00128-8/pdf

Efecto analgésico de ketamina iv durante raquia para operación cesárea

Analgesic Effects of Intravenous Ketamine during Spinal Anesthesia in Pregnant Women Undergone Caesarean Section; A Randomized Clinical Trial.
Behdad S, Hajiesmaeili MR, Abbasi HR, Ayatollahi V, Khadiv Z, Sedaghat A.
Anesth Pain Med. 2013 Sep;3(2):230-3. doi: 10.5812/aapm.7034. Epub 2013 Sep 1.
Abstract
BACKGROUND:Suitable analgesia after cesarean section helps mothers to be more comfortable and increases their mobility and ability to take better care of their infants. OBJECTIVES:Pain relief properties of ketamine prescription were assessed in women with elective cesarean section who underwent spinal anesthesia with low dose intravenous ketamine and midazolam and intravenous midazolam alone. PATIENTS AND METHODS:Sixty pregnant women scheduled for spinal anesthesia for cesarean section were randomized into two study groups.Ketamine (30 mg) + midazolam (1 mg = 2CC) or 1mg midazolam (2CC) alone, was given immediately after spinal anesthesia. Pain scores at first, second and third hours after CS operation, analgesic requirement and drug adverse effects were recorded in all patients. RESULTS: Ketamine group had significant pain relief properties in compare with control group in first hours after cesarean section (0.78 ± 1.09 vs. 1.72 ± 1.22, VAS score, P = 0.00). Total dose of meperidine consumption in women of ketamine group was significantly lower than women of control group (54.17 ± 12.86 vs. 74.44 ± 33.82 mg, P = 0.02). There were no significant drug side effects in participated patients. CONCLUSIONS: Intravenous low-dose ketamine combined with midazolam for sedation during spinal anesthesia for elective Caesarean section provides more effective and long lasting pain relief than control group.
KEYWORDS:Analgesia; Anesthesia, Spinal; Cesarean Section; Ketamine; Pain Clinics

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3833040/pdf/aapm-03-230.pdf




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

http://www.madrimasd.org/informacionidi/noticias/noticia.asp?id=61013&origen=notiweb&dia_suplemento=jueves

Nacen más hombres zurdos en ciertos meses del año

Ellas, además, según el mismo estudio, cuentan con un mayor porcentaje de diestras que de zurdas. Los hombres nacidos en noviembre, diciembre o enero, meses tradicionalmente fríos en el hemisferio norte, donde se ha llevado a cabo esta investigación, tienen mayores probabilidades de ser zurdos que los nacidos durante el resto del año. Diversas tareas manuales en la vida cotidiana requieren el uso de la mano derecha o están optimizadas para los diestros. Alrededor de 9 de cada 10 personas de la población en general son diestras, y sólo 1 de cada 10 es zurda. El estudio de Ulrich Tran, Stefan Stieger y Martin Voracek, de la Universidad de Viena en Austria, se hizo sobre la base de dos muestras grandes e independientes de casi 13.000 adultos de Austria y Alemania. En total, el 7,5 por ciento de las mujeres y el 8,8 por ciento de los hombres eran zurdos. La sorpresa para los científicos vino al comprobar que este desequilibrio era debido en buena parte a que nacían más hombres zurdos durante noviembre, diciembre y enero. Como promedio mensual, el 8,2 por ciento de los hombres zurdos nacían durante el período de febrero a octubre. Durante el periodo de noviembre a enero, este número se elevó hasta un 10,5 por ciento. Estudios anteriores sobre el tema proporcionaron pruebas incongruentes y confusas. No había una indicación clara de qué estación tenía algún efecto, o si la estacionalidad afecta a hombres, mujeres o ambos sexos de igual manera. Según los hallazgos actuales, existe un efecto, pequeño pero claro y reproducible, de estacionalidad en el nacimiento como zurdo o diestro, que afecta sólo a hombres. Los resultados son coherentes con una base hormonal para el fenómeno, lo que corrobora una vieja y controvertida teoría. Sin embargo, la forma exacta en que esto se produce deberá ser investigada en estudios futuros.

neumonía adquirida en la comunidad

Estimados Pediatras la conferencia del Dr Elias Kassisse sobre neumonía adquirida en la comunidad
la verdad excelente la disfrute mucho anoche, véanla y el Dr Kassisse solicita retroalimentación y comentarios de su conferencia

Ciberpeds: http://bit.ly/KcJV5S

Conapeme: http://bit.ly/1mNqcpS
registro a conferencias: http://bit.ly/19ApWtR



henrys

Dr. Enrique Mendoza López
Webmaster: CONAPEME
Coordinador Nacional: Seminario Ciberpeds-Conapeme
Av La Clinica 2520-310 col Sertoma
Monterrey N.L. CP 64718
Tel (81) 83482940, (81) 83485701
Cel 0448183094806
www.pediatramendoza.com
www.conapeme.org
www.ciberpeds.org

Embarazo/Pregnancy

Embarazada con tumor cerebral. Revisando evidencias para obtener guías de manejo de los meningiomas intracraneales durante el embarazo

A pregnant female with a large intracranial mass: Reviewing the evidence to obtain management guidelines for intracranial meningiomas during pregnancy.
Kasper EM, Hess PE, Silasi M, Lim KH, Gray J, Reddy H, Gilmore L, Kasper B.
Surg Neurol Int. 2010 Dec 25;1:95. doi: 10.4103/2152-7806.74242.

Abstract
INTRODUCTION:Non-obstetric surgery for intracranial meningioma is uncommon during pregnancy and poses significant risks to both the mother and the fetus. We present a case of a parturient that presented with acute mental status changes and we illustrate the decision making process that resulted in a best-possible outcome. CASE DESCRIPTION: A woman at 29-week gestation presented with acute language and speech deficits and deteriorating mental status after 2 weeks of headache. Imaging demonstrated a large intracranial mass. A multidisciplinary meeting was held to determine the best treatment plan. The decision was to proceed with caesarean delivery under epidural anesthesia to allow intraoperative monitoring of neurological function. Six hours after successful delivery, the patient had acute mental status changes and she was taken to the operating room immediately for resection of her tumor, which turned out to be a clear cell meningioma. DISCUSSION: Cerebral meningioma is usually a slow-growing tumor; however, during pregnancy, the mass may expand rapidly due to hormonal receptor expression. The presentation of this patient would have normally led to urgent resection of the mass. But the complicating factor was her 29-week pregnancy as standard intraoperative treatment during neurosurgery is known to adversely affect the fetus. A multidisciplinary meeting was critical for this patient's care, and is recommended by us when treating such patients.
KEYWORDS: Caesarean delivery; meningioma; pregnancy; resection
http://www.surgicalneurologyint.com/downloadpdf.asp?issn=2152-7806;year=2010;volume=1;issue=1;spage=95;epage=95;aulast=Kasper;type=2




Guías 2010 de la CCS para el diagnóstico y manejo de falla cardiaca: Minorias étnicas, Embarazo, manejo de la enfermedad, y mejoría de la calidad¨


The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs.
Howlett JG, McKelvie RS, Costigan J, Ducharme A, Estrella-Holder E, Ezekowitz JA, Giannetti N, Haddad H, Heckman GA, Herd AM, Isaac D, Kouz S, Leblanc K, Liu P, Mann E, Moe GW, O'Meara E, Rajda M, Siu S, Stolee P, Swiggum E, Zeiroth S; Canadian Cardiovascular Society.
Can J Cardiol. 2010 Apr;26(4):185-202.
Abstract
Since 2006, the Canadian Cardiovascular Society heart failure (HF) guidelines have published annual focused updates for cardiovascular care providers. The 2010 Canadian Cardiovascular Society HF guidelines update focuses on an increasing issue in the western world - HF in ethnic minorities - and in an uncommon but important setting - the pregnant patient. Additionally, due to increasing attention recently given to the assessment of how care is delivered and measured, two critically important topics - disease management programs in HF and quality assurance - have been included. Both of these topics were written from a clinical perspective. It is hoped that the present update will become a useful tool for health care providers and planners in the ongoing evolution of care for HF patients in Canada.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886538/



Abordar la obesidad en el embarazo: ¿Qué recomiendan los proveedores obstétricos?

Addressing obesity in pregnancy: what do obstetric providers recommend?
Herring SJ, Platek DN, Elliott P, Riley LE, Stuebe AM, Oken E.
J Womens Health (Larchmt). 2010 Jan;19(1):65-70. doi: 10.1089/jwh.2008.1343.
Abstract
OBJECTIVE: Maternal obesity is associated with adverse pregnancy outcomes. To improve outcomes, obstetric providers must effectively evaluate and manage their obese pregnant patients. We sought to determine the knowledge, attitudes, and practice patterns of obstetric providers regarding obesity in pregnancy. METHODS: In 2007-2008, we surveyed 58 practicing obstetricians, nurse practitioners, and certified nurse-midwives at a multispecialty practice in Massachusetts. We administered a 26-item questionnaire that included provider self-reported weight, sociodemographic characteristics, knowledge, attitudes, and management practices. We created an 8-point score for adherence to 8 practices recommended by the American College of Obstetricians and Gynecologists (ACOG) for the management of obese pregnant women. RESULTS: Among the respondents, 37% did not correctly report the minimum body mass index (BMI) for diagnosing obesity, and most reported advising gestational weight gains that were discordant with 1990 Institute of Medicine (IOM) guidelines, especially for obese women (71%). The majority of respondents almost always recommended a range of weight gain (74%), advised regular physical activity (74%), or discussed diet (64%) with obese mothers, but few routinely ordered glucose tolerance testing during the first trimester (26%), planned anesthesia referrals (3%), or referred patients to a nutritionist (14%). Mean guideline adherence score was 3.4 (SD 1.9, range 0-8). Provider confidence (beta = 1.0, p = 0.05) and body satisfaction (beta = 1.5, p = 0.02) were independent predictors of higher guideline adherence scores. CONCLUSIONS: Few obstetric providers were fully compliant with clinical practice recommendations, defined obesity correctly, or recommended weight gains concordant with IOM guidelines. Provider personal factors were the strongest correlates of self-reported management practices. Our findings suggest a need for more education around BMI definitions and weight gain guidelines, along with strategies to address provider personal factors, such as confidence and body satisfaction, that may be important predictors of adherence to recommendations for managing obese pregnant women.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828196/pdf/jwh.2008.1343.pdf






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

http://www.madrimasd.org/informacionidi/noticias/noticia.asp?id=61211&origen=notiweb&dia_suplemento=lunes

Estudian nuevas técnicas para la descontaminación de las aguas residuales industriales

El proyecto se encuentra actualmente en el ecuador de su desarrollo; por parte de la UPV participan el Grupo de Procesos de Oxidación Avanzada del campus de Alcoy y el Instituto de Tecnología Química (UPV-CSIC). Según destacan los investigadores, a día de hoy las principales fuentes de contaminación de las aguas son las actividades industriales. "Más de un 80% de los residuos peligrosos del mundo se producen en los países industrializados, mientras que en las naciones en vías de desarrollo un 70% de los residuos industriales se vierten al agua sin ningún tipo de tratamiento previo, contaminando así los recursos hídricos", apunta Ana Amat, investigadora del campus de Alcoy de la Universitat Politècnica de València. El proyecto Aquafotox se centra en las aguas procedentes de la industria del corcho y en los lixiviados de vertedero. El objetivo de los investigadores es ofrecer un nuevo tratamiento que permita degradar los contaminantes de ambos, en un tiempo y con un coste reducido y obtener así un efluente de mayor calidad y menor impacto ambiental. Para ello, están analizando la utilidad de nuevos tratamientos aplicando fotocatálisis solar-aprovechar la luz solar para la depuración de las aguas- u ozono. Actualmente, en el Campus de Alcoy se evalúan 30 tratamientos diferentes -15 con luz solar y otros 15 con ozono- con el objetivo de determinar cuál sería el más adecuado para la detoxificación de estas aguas y su posible aplicación industrial, en la PSA se investiga la optimización del tratamiento con aguas reales en planta piloto y en el ITQ se realizan los estudios mecanísticos de estos procesos . "Desarrollamos exhaustivos estudios biológicos de toxicidad con biomarcadores para analizar su incidencia en algas, crustáceos, bacterias, gusanos de tierra y peces. Analizamos cada muestra de agua sometida al proceso de detoxificación y, a partir de los resultados obtenidos, valoramos su idoneidad para mejorar la calidad de efluente tratado y, por tanto, reducir el impacto sobre estas y otras especies una vez se vierte. Los biomarcadores permiten prever los efectos dañinos y el estado de salud como una señal potencial de alteraciones a largo plazo, como carcinogénesis, disminución de la capacidad reproductiva, etc.", concluye Ana Amat.

Predictores de vía aérea/Airway predictors

Validation of modified Mallampati test with addition of thyromental distance and sternomental distance to predict difficult endotracheal intubation in adults. Patel B, Khandekar R, Diwan R, Shah A. Indian J Anaesth. 2014 Mar;58(2):171-5. doi: 10.4103/0019-5049.130821. Abstract BACKGROUND AND AIMS:Intubation is often a challenge for anaesthesiologists. Many parameters assist to predict difficult intubation. The present study was undertaken to assess the validity of different parameters in predicting difficult intubation for general anaesthesia (GA) in adults and effect of combining the parameters on the validity.METHODS:The anaesthesiologist assessed oropharynx of 135 adult patients. Modified Mallampati test (MMT) was used and the thyromentaldistance (TMD) and sternomental distances (SMD) for each of the patients were also measured. The Cormack and Lehane laryngoscopic grading was assessed following laryngoscopy. The validity parameters such as sensitivity, specificity, false positive and negatives values, positive and negative predictive values were calculated. The effect of combining different measurements on the validity was also studied. Univariate analysis was performed using the parametric method. RESULTS:The study group comprised of 135 patients. The sensitivity and specificity of MMT were 28.6% and 93%, respectively. The TMD (<6.5 CM) had sensitivity and specificity of 100% and 75.8%, respectively. The SMD (<12.5 CM) had sensitivity and specificity of 91% and 92.7%, respectively. Combination of MMT grading and TMD and SMD measurements increased the validity (sensitivity of 100% and specificity of 92.7%).CONCLUSION:MMT had high specificity. The validity of combination of MMT, SMD and TMD as compared to MMT alone was very high in predicting difficult intubation in adult patients. All parameters should be used in assessing an adult patient for surgery under GA. KEYWORDS:Anaesthesia; endotracheal intubation; modified Mallampatti test; validity  http://www.ijaweb.org/downloadpdf.asp?issn=0019-5049;year=2014;volume=58;issue=2;spage=171;epage=175;aulast=Patel;type=2 Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

Biblioteca. Alarma

Biblioteca
Notificaciones diarias ⋅ 20 de julio de 2014
NOTICIAS

La biblioteca de Mondariz lleva 7 años cerrada y está provisional en otro edificio
La Voz de Galicia
La biblioteca municipal de Mondariz sigue estando cerrada al público desde hace siete años y pendiente de una reforma integral para la que no hay ...



Alta satisfacción de los usuarios sobre el servicio de biblioteca
Diario Vasco
Los usuarios de la biblioteca Juan San Martin de Eibar muestran un elevado grado de satisfacción por los servicios ofrecidos y la forma de funcionar ...



Dan banderazo en Ascensión a 'Mis vacaciones en la biblioteca'
Diario Digital Juárez
Este lunes dio inicio la actividad “Mis vacaciones en la biblioteca” dando el banderazo de arranque el Presidente Municipal Sergio González Sarabia ...



La biblioteca cumple 40 años
La Opinión de Murcia
L. O. La biblioteca de San Javier está preparando su 40 aniversario y entre otras iniciativas ha puesto en marcha la recogida de historias personales ...




Aporrea.org

Ortega Díaz: Leopoldo López tiene en su celda “biblioteca, computadora, Blu-ray y una jaula con ...
Aporrea.org
Explicó que igualmente se verificó el espacio en el que permanece recluido el mencionado ciudadano, el cual “tiene una poltrona, una biblioteca, ...
Ortega Díaz: Leopoldo López tiene en su celda “biblioteca, computadora, Blu-ray y una jaula con ...- Alba Ciudad 96.3 FM
Cobertura total de la noticia



Borja Sánchez expone su muestra 'Intrínseco' en la biblioteca municipal
Sur Digital (Andalucía)
Las instalaciones de la biblioteca municipal de la Villa acogen la exposición 'Intrínseco', una introspectiva del ser humano realizada por el artista ...



Cuentacuentos estivales en la Biblioteca Pública
El Periódico Extremadura
EL PUBLICO infantil tiene una cita semanal en la biblioteca. Durante todo el verano se desarrollarán dos ciclos de cuentacuentos: Gazpacho de ...




Vanguardia Liberal

Llega la novedosa colección de libros a la Antonia Santos
Vanguardia Liberal
Un total de 678 libros fueron donados por el Ministerio de Cultura y la Biblioteca Nacional, las cuales están a disposición de la comunidad educativa, ...



Inician talleres en las bibliotecas
El Siglo de Torreón
El día de mañana lunes 21 de julio, arranca en las tres bibliotecas públicas del municipio de San Pedro, el programa Mis vacaciones en la biblioteca, ...




La Verdad de Tamaulipas

Invertirán15 mdp en remodelar plaza principal de Reynosa
Milenio.com
El alcalde de la ciudad fronteriza, José Elías Leal informó que entre otros proyectos se contempla la remodelación de la biblioteca principal y la calle ...


BLOGS

Biblioteca Nacional recibió 1.250 libros de la Gran Misión Vivienda Venezuela

Alba Ciudad 96.3 FM ⋅ Luigino Bracci
En el marco de la celebración del 181° Aniversario de la creación de la primera biblioteca pública de Caracas, el Ministerio del Poder Popular para la ...



“Mis vacaciones en la Biblioteca” en todo el estado

Noticias de Guanajuato | IGETEO Seamos uno ⋅ Igeteo Cultura
Guanajuato, Gto. 19 de julio de 2014.- El pasado viernes inició el programa “Mis vacaciones en la Biblioteca” en todas las bibliotecas de la entidad.


WEB

Homenaje a Noé Jitrik
Biblioteca Nacional | Agenda
La Asociación Argentina de Retórica rinde homenaje a la trayectoria del crítico, escritor e investigador argentino, Noé Jitrik. Reconocido ...



Registro
Gobierno de Navarra
Crónicas irreales del Reyno de Navarra / Mikel Zuza Viniegra ; [ilustraciones, José Luis Blanco Aguirre]. Editorial: Donostia : Ttarttalo, [2008].

Predictores de vía aérea/Airway predictors

La sensibilidad del signo de impresión de la palma en la predicción de laringoscopia difícil en la diabetes. Comparación con otros índices de vía aérea


Sensitivity of palm print sign in prediction of difficult laryngoscopy in diabetes: A comparison with other airway indices.
Hashim K, Thomas M.
Indian J Anaesth. 2014 May;58(3):298-302. doi: 10.4103/0019-5049.135042.
Abstract
BACKGROUND AND AIMS: Diabetic patients are prone for the limited joint mobility syndrome. The atlanto-occipital joint involvement limits adequate extension of head and neck during laryngoscopy making intubation difficult. The collagen glycosylation starts in the fourth and fifth inter-phalangeal joints. The degree of inter-phalangeal involvement can be assessed by scoring the ink impression made by the palm of the dominant hand (palm print [PP] sign) The aim of our study was to evaluate the PP sign as a screening tool for predicting difficult laryngoscopy in diabetic patients. METHODS:A total of 60 diabetic patients undergoinggeneral anaesthesia with endotracheal intubation were assessed pre-operatively for their airway indices using the modified Mallampati test, thyromental distance, degree of head extension, the PP test and the prayer sign and their corresponding Cormack-Lehane scores were noted. Statistical analysis was performed using Fischer exact test. RESULTS: Of the 60 patients, 15 had positive PP sign. Of the 13 difficult laryngoscopies encountered, 10 patients had a positive PP sign. PP sign was the most sensitive index in predicting difficult laryngoscopy. P =0.000 was obtained and considered as statistically significant. The sensitivity was 76.9%, specificity 89.4%, positive and negative predictive value 71.4% and 91.3% and accuracy 86.7%, respectively. The other signs were not significant in predicting difficult laryngoscopy.CONCLUSION:The PP test appears to be the most sensitive and specific in the prediction of difficult laryngoscopy in diabetic patients.
KEYWORDS:Diabetes; difficult intubation; limited joint mobility
http://www.ijaweb.org/downloadpdf.asp?issn=0019-5049;year=2014;volume=58;issue=3;spage=298;epage=302;aulast=Hashim;type=2



Características anatómicas del cuello como marcadores predictivos de dificultad para laringoscopia directa en los hombres y las mujeres: un estudio prospectivo.

Anatomic features of the neck as predictive markers of difficult direct laryngoscopy in men and women: A prospective study.
Chara L, Eleftherios V, Maria M, Anastasia T, Chryssoula S.
Indian J Anaesth. 2014 Mar;58(2):176-82. doi: 10.4103/0019-5049.130822.
Abstract
BACKGROUND AND AIMS: Difficult airway assessment is based on various anatomic parameters of upper airway, much of it being concentrated on oral cavity and the pharyngeal structures. The diagnostic value of tests based on neck anatomy in predicting difficult laryngoscopy was assessed in this prospective, open cohort study.
METHODS: We studied 341 adult patients scheduled to receive general anaesthesia. Thyromental distance (TMD), sternomental distance (STMD), ratio of height to thyromental distance (RHTMD) and neck circumference (NC) were measured pre-operatively. The laryngoscopic view was classified according to the Cormack-Lehane Grade (1-4). Difficult laryngoscopy was defined as Cormack-Lehane Grade 3 or 4. The optimal cut-off points for each variable were identified by using receiver operating characteristic analysis. Sensitivity, specificity and positive predictive value and negative predictive value (NPV) were calculated for each test. Multivariate analysis with logistic regression, including all variables, was used to create a predictive model. Comparisons between genders were also performed. RESULTS: Laryngoscopy was difficult in 12.6% of the patients. The cut-off values were: TMD ≤7 cm, STMD ≤15 cm, RHTMD >18.4 and NC >37.5 cm. The RHTMD had the highest sensitivity (88.4%) and NPV (95.2%), while TMD had the highest specificity (83.9%). The area under curve (AUC) for the TMD, STMD, RHTMD and NC was 0.63, 0.64, 0.62 and 0.54, respectively. The predictive model exhibited a higher and statistically significant diagnostic accuracy (AUC: 0.68, P < 0.001). Gender-specific cut-off points improved the predictive accuracy of NC in women (AUC: 0.65). CONCLUSIONS: The TMD, STMD, RHTMD and NC were found to be poor single predictors of difficult laryngoscopy, while a model including all four variables had a significant predictive accuracy. Among the studied tests, gender-specific cut-off points should be used for NC.
KEYWORDS:Height-to-thyromental distance ratio; laryngoscopy; neck circumference; sternomental distance; thyromental distance

http://www.ijaweb.org/downloadpdf.asp?issn=0019-5049;year=2014;volume=58;issue=2;spage=176;epage=182;aulast=Chara;type=2


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