sábado, 4 de octubre de 2014

Bloqueo TAP en cesárea/TAP block in C-section

Bloqueo TAP guiado con ultrasonido versus infusión continua de la herida para analgesia postcesárea. Estudio randomizado
Ultrasound-Guided Transversus Abdominis Plane Block versus Continuous Wound Infusion for Post-Caesarean Analgesia: A Randomized Trial.
Chandon M, Bonnet A, Burg Y, Barnichon C, DesMesnards-Smaja V, Sitbon B, Foiret C, Dreyfus JF, Rahmani J, Laloë PA, Fischler M, Le Guen M.
PLoS One. 2014 Aug 5;9(8):e103971. doi: 10.1371/journal.pone.0103971. eCollection 2014.

 

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

Miedo/Fear


Un equipo de neurocientíficos ha descubierto una vía neuronal que subyace a comportamientos emocionales críticos para la supervivencia. La nueva investigación ha identificado una cadena de conexiones neuronales que vincula el circuito de supervivencia central a la médula espinal, haciendo que el cuerpo se paralice al experimentar miedo.

Una importante región del cerebro, la sustancia gris periacueductal, es responsable de cómo humanos y animales responden al peligro. Esta sustancia, que rodea el acueducto cerebral en el mesencéfalo, puede desencadenar respuestas como la paralización, un alto ritmo cardíaco, el aumento de la presión arterial o el deseo de huida o de luchar. La investigación ha descubierto una vía cerebral que se extiende desde la sustancia gris periacueductal a una parte muy localizada del cerebelo, denominadapyramis, y ha demostrado que la pyramis está involucrada en la generación del comportamiento de paralización cuando las redes centrales de la supervivencia se activan, ante situaciones amenazantes innatas o aprendidas. Hay un creciente consenso en que la comprensión de los circuitos neuronales subyacentes a la conducta por miedo es un paso fundamental para el desarrollo de tratamientos eficaces para aquellos cambios de comportamiento asociados con los trastornos emocionales, como la ansiedad, el pánico o las fobias.

Los autores concluyen que el cerebelo es un objetivo prometedor de futuras estrategias terapéuticas destinadas a gestionar la desregulación de los estados emocionales propia de trastornos de pánico y fobias.

Sustratos neurales subyacentes que evocan inmovilización secundaria al miedo. El enlace de sustancia gris cerebelosa periacueductal.


Neural substrates underlying fear-evoked freezing: the periaqueductal grey-cerebellar link.
Koutsikou S, Crook JJ, Earl EV, Leith JL, Watson TC, Lumb BM, Apps R.
J Physiol. 2014 May 15;592(Pt 10):2197-213. doi: 10.1113/jphysiol.2013.268714. Epub 2014 Mar 17.Abstract
The central neural pathways involved in fear-evoked behaviour are highly conserved across mammalian species, and there is a consensus that understanding them is a fundamental step towards developing effective treatments for emotional disorders in man. The ventrolateral periaqueductal grey (vlPAG) has a well-established role in fear-evoked freezing behaviour. The neural pathways underlying autonomic and sensory consequences of vlPAG activation in fearful situations are well understood, but much less is known about the pathways that link vlPAG activity to distinct fear-evokedmotor patterns essential for survival. In adult rats, we have identified a pathway linking the vlPAG to cerebellar cortex, which terminates as climbing fibres in lateral vermal lobule VIII (pyramis). Lesion of pyramis input-output pathways disrupted innate and fear-conditioned freezing behaviour. The disruption in freezing behaviour was strongly correlated to the reduction in the vlPAG-induced facilitation of α-motoneurone excitability observed after lesions of the pyramis. The increased excitability of α-motoneurones during vlPAG activation may therefore drive the increase in muscle tone that underlies expression of freezing behaviour. By identifying the cerebellar pyramis as a critical component of the neural network subserving emotionally related freezing behaviour, the present study identifies novel neural pathways that link the PAG to fear-evoked motor responses.

http://jp.physoc.org/content/592/10/2197.full.pdf


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4027863/pdf/tjp0592-2197.pdf




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

Polineuropatía y miopatía de enfermo grave. Revisión sistemática


Polineuropatía y miopatía de enfermo grave. Revisión sistemática


Critical illness polyneuropathy and myopathy: a systematic review.
Zhou C, Wu L, Ni F, Ji W, Wu J, Zhang H.
Neural Regen Res. 2014 Jan 1;9(1):101-10. doi: 10.4103/1673-5374.125337.
Abstract
Critical illness polyneuropathy and critical illness myopathy are frequent complications of severe illness that involve sensorimotor axons and skeletal muscles, respectively. Clinically, they manifest as limb and respiratory muscle weakness. Critical illness polyneuropathy/myopathy in isolation or combination increases intensive care unit morbidity via the inability or difficulty in weaning these patients off mechanical ventilation. Many patients continue to suffer from decreased exercise capacity and compromised quality of life for months to years after the acute event. Substantial progress has been made lately in the understanding of the pathophysiology of critical illness polyneuropathy and myopathy. Clinical and ancillary test results should be carefully interpreted to differentiate critical illness polyneuropathy/myopathy from similar weaknesses in this patient population. The present review is aimed at providing the latest knowledge concerning the pathophysiology of critical illness polyneuropathy/myopathy along with relevant clinical, diagnostic, differentiating, and treatment information for this debilitating neurological disease.
KEYWORDS: Guillain-Barré syndrome; NSFC grant; critical illness myopathy; critical illness polyneuropathy; intensive care unit; multiple organ failure; nerve regeneration; neural regeneration; neurodegenerative diseases; sepsis
http://www.nrronline.org/downloadpdf.asp?issn=1673-5374;year=2014;volume=9;issue=1;spage=101;epage=110;aulast=Zhou;type=2





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

jueves, 2 de octubre de 2014

Trauma

Tendencias temporales de falla multiorgánica después de la lesión: todavía muchos recursos, morbosa, y letal.


Temporal trends of postinjury multiple-organ failure: still resource intensive, morbid, and lethal.
Sauaia A1, Moore EE, Johnson JL, Chin TL, Banerjee A, Sperry JL, Maier RV, Burlew CC.
J Trauma Acute Care Surg. 2014 Mar;76(3):582-92, discussion 592-3. doi: 10.1097/TA.0000000000000147.
Abstract
BACKGROUND:While the incidence of postinjury multiple-organ failure (MOF) has declined during the past decade, temporal trends of its morbidity, mortality, presentation patterns, and health care resources use have been inconsistent. The purpose of this study was to describe the evolvingepidemiology of postinjury MOF from 2003 to 2010 in multiple trauma centers sharing standard treatment protocols.METHODS:"Inflammation and Host Response to Injury Collaborative Program" institutions that enrolled more than 20 eligible patients per biennial during the 2003 to 2010 study period were included. The patients were aged 16 years to 90 years, sustained blunt torso trauma with hemorrhagic shock (systolic blood pressure < 90 mm Hg, base deficit ≥ 6 mEq/L, blood transfusion within the first 12 hours), but without severe head injury (motor Glasgow Coma Scale [GCS] score < 4). MOF temporal trends (Denver MOF score > 3) were adjusted for admission risk factors (age, sex, body max index, Injury Severity Score [ISS], systolic blood pressure, and base deficit) using survival analysis. RESULTS: A total of 1,643 patients from four institutions were evaluated. MOF incidence decreased over time (from 17% in 2003-2004 to 9.8% in 2009-2010). MOF-related death rate (33% in 2003-2004 to 36% in 2009-2010), intensive care unit stay, and mechanical ventilation duration did not change over the study period. Adjustment for admission risk factors confirmed the crude trends. MOF patients required much longer ventilation and intensive care unit stay, compared with non-MOF patients. Most of the MOF-related deaths occurred within 2 days of the MOF diagnosis. Lung and cardiac dysfunctions became less frequent (57.6% to 50.8%, 20.9% to 12.5%, respectively), but kidney and liver failure rates did not change (10.1% to 12.5%, 15.2% to 14.1%). CONCLUSION: Postinjury MOF remains a resource-intensive, morbid, and lethal condition. Lung injury is an enduring challenge and should be a research priority. The lack of outcome improvements suggests that reversing MOF is difficult and prevention is still the best strategy.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116088/pdf/nihms593568.pdf





Epidemiología de lesiones medulares y factores de riesgo de lesiones completas en Guangdong, China



Epidemiology of spinal cord injuries and risk factors for complete injuries in Guangdong, China: a retrospective study.

Yang R, Guo L, Wang P, Huang L, Tang Y, Wang W, Chen K, Ye J, Lu C, Wu Y, Shen H.

PLoS One. 2014 Jan 28;9(1):e84733. doi: 10.1371/journal.pone.0084733. eCollection 2014.
Abstract

BACKGROUND: Spinal cord injuries are highly disabling and deadly injuries. Currently, few studies focus on non-traumatic spinal cord injuries, and there is little information regarding the risk factors for complete injuries. This study aims to describe the demographics and the injury characteristics for both traumatic and non-traumatic spinal cord injuries and to explore the risk factors for complete spinal cord injuries. METHODS: A retrospective study was performed by reviewing the medical records of 3,832 patients with spinal cord injuries who were first admitted to the sampled hospitals in Guangdong, China. The demographics and injury characteristics of the patients were described and compared between the different groups using the chi-square test. Logistic regression was conducted to analyze the risk factors for complete spinal cord injuries. RESULTS: The proportion of patients increased from 7.0% to 14.0% from 2003 to 2011. The male-to-female ratio was 3.0 ∶ 1. The major cause of spinal cord injuries was traffic accidents (21.7%). Many of the injured were workers (36.2%), peasants (22.8%), and unemployed people (13.9%); these occupations accounted for 72.9% of the total sample. A multivariate logistic regression model revealed that the OR (95% CI) for male gender compared to female gender was 1.25 (1.07-1.89), the OR (95%CI) for having a spinal fracture was 1.56 (1.35-2.60), the OR (95%CI) for having athoracic injury was 1.23 (1.10-2.00), and the OR (95%CI) for having complications was 2.47 (1.96-3.13). CONCLUSION: The proportion of males was higher than the proportion of females. Workers, peasants and the unemployed comprised the high-risk occupational categories. Male gender, having a spinal fracture, having a thoracic injury, and having complications were the major risk factors for a complete injury. We recommend that preventive measures should focus on high-risk populations, such as young males.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3904832/pdf/pone.0084733.pdf




Manejo anestésico del traumatismo craneoencefálico

Dr. Guillermo Becerra-Escobedo
Rev Mex de Anestesiol Vol. 31. Supl. 1, Abril-Junio 2008, pp S155-S157

http://www.medigraphic.com/pdfs/rma/cma-2008/cmas081ai.pdf




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

lunes, 29 de septiembre de 2014

Bibliotecas. Alerta

Bibliotecas
Notificaciones semanales ⋅ 21 de septiembre de 2014
NOTICIAS


TICbeat


TICbeat
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La Opinión de Tenerife
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Las bibliotecas municipales de Málaga ya prestan libros electrónicos
Sur Digital (Andalucía)
La Red de Bibliotecas Públicas Municipales de Málaga ha incorporado este mes de septiembre la plataforma 'eBiblio', que permite acceder al ...




eldiario.es

Nadie apoya el canon de las bibliotecas públicas
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Te Interesa

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Entregan casi 900 libros a las bibliotecas populares
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El libro electrónico también es para las bibliotecas
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Monográfico: Mejores prácticas en bibliotecas

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WEB

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El Sistema de Bibliotecas de la U. de A., ganador de Crea Digital 2014
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Cirugía bariátrica/Bariatric surgery

STAMPEDE: La cirugía bariátrica gana más apoyo basada en evidencias


STAMPEDE: Bariatric surgery gains more evidence based support.
Al Suwaidi J.
Glob Cardiol Sci Pract. 2014 Jan 29;2014(1):45-8. doi: 10.5339/gcsp.2014.8. eCollection 2014.
Abstract
Diabetes mellitus (DM) and obesity are associated with significant morbidity and mortality. Recent large-scale trials of intensive medical management for obesity and diabetes have been disappointing. Observational studies and small-scale trials of bariatric surgery on DM patients have shown promising results. The effects of sleeve gastrectomy and gastric bypass in a larger cohort of patients with DM and obesity was tested in the STAMPEDE trial over a 3-year follow-up.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4104377/pdf/gcsp-2014-045.pdf





Comparación de la efectividad de cuatro cirugías bariátricas en obesos con DM tipo 2. Estudio retrospectivo


Comparison of the effectiveness of four bariatric surgery procedures in obese patients with type 2 diabetes: a retrospective study.
Pham S, Gancel A, Scotte M, Houivet E, Huet E, Lefebvre H, Kuhn JM, Prevost G.

J Obes. 2014;2014:638203. doi: 10.1155/2014/638203. Epub 2014 May 22.

Abstract

AIM:The aim of the present retrospective study was to evaluate the efficacy of four bariatric surgical procedures to induce diabetes remission and lower cardiovascular risk factors in diabetic obese patients. Moreover, the influence of surgery on weight evolution in the diabetic population was compared with that observed in a nondiabetic matched population. METHODS:Among 970 patients who were operated on in our center since 2001, 81 patients were identified as type 2 diabetes. Laparoscopic adjustable gastric banding (GB), intervention type Mason (MA), gastric bypass (RYGB), and sleeve gastrectomy (SG) were performed, respectively, in 25%, 17%, 28%, and 30% of this diabetic population. RESULTS:The resolution rate of diabetes one year after surgery was significantly higher after SG than GB (62.5% versus 20%, P < 0.01), but not significantly different between SG and RYGB. In terms of LDL-cholesterol reduction, RYGB was equivalent to SG and superior to CGMA or GB. Considering the other cardiovascular risk factors, there was no significant difference according to surgical procedures. The weight loss was not statistically different between diabetic and nondiabetic matched patients regardless of the surgical procedures used. CONCLUSION:Our data confirm that the efficacy of surgery to treat diabetes is variable among the diverse procedures and SG might be an interesting option in this context.

http://www.hindawi.com/journals/jobe/2014/638203/



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

Puntuación alterada de calcio en las coronarias antes de cirugía bariátrica

Puntuación alterada de calcio en las coronarias antes de cirugía bariátrica


Altered coronary artery calcium scores before bariatric surgery.
Gadelha PS1, Campos JM2, Moraes F2, da F S Leão M1, Ferraz AA2.
Springerplus. 2014 Apr 22;3:199. doi: 10.1186/2193-1801-3-199. eCollection 2014.
Abstract
INTRODUCTION:
Obesity is an important cause of cardiovascular disease, especially coronary artery disease. Severely obese patients are particularly prone to this risk. The coronary artery calcium (CAC) score is a strong predictor of coronary heart disease and provides incremental information beyond traditional risk factors. We sought to determine the prevalence of abnormally high CAC scores in the preoperative setting among patients undergoing bariatric surgery and to establish risk predictors for higher scores. METHODS: We performed an observational study of 202 patients free of known coronary artery disease who were referred for bariatric surgery. In each patient, the presence of CAC was detected with computed tomography, and coronary risk variables were either measured or determined via questionnaire. .... CONCLUSION: Obese patients in the preoperative bariatric surgery setting have a high prevalence of abnormal CAC scores. Traditional risk factors play a important role in this scenario.
KEYWORDS: Bariatric surgery; Cardiovascular risk factors; Coronary artery calcium score; Coronary artery disease; Obesity
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008727/



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

domingo, 28 de septiembre de 2014

Microbiota del Recién Nacido

Estimado Pediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 1o de Octubre 2014 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Microbiota del Recién Nacido” por el “Dr. Enrique Mendoza Lopez”, Pediatra de la Cd. de Monterrey N.L. La sesión inicia puntualmente las 21 hrs.
Para entrar a la Sala de Conferencia:
1.- hacer click en la siguiente liga, o cópiala y escríbela en tu buscador http://connectpro60196372.adobeconnect.com/microbiota_rn/
2.- “Entra como Invitado” Escribes tu nombre y apellido en el espacio en blanco
3.- Hacer click en el espacio que dice “Entrar en la Sala”
5.- A disfrutar la conferencia 6.- Recomendamos que dejes tu Nombre Completo, Correo electrónico y que participes.

Henrys



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