“Eutanasia en pediatría

Estimado Pediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 22 de Julio 2015 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Eutanasia en pediatría” por el “Dr. Jorge Chuck Sepúlveda”, Pediatra Bioeticista de la Cd. de Guadalajara, Jal. 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/eutanasia_pediatria/
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

Medwave edición de julio 2015

A continuación le informamos los artículos recientemente publicados en Medwave.


REVISIÓN CLÍNICA

Factores maternos y perinatales influyentes en la morbilidad neonatal: revisión narrativa de la literatura
Jónathan Hernández Núñez, Magel Valdés Yong, Yoanca de la Caridad Suñol Vázquez, Marelene de la Caridad López Quintana (Cuba)

Medwave 2015 Jul;15(6):e6182
http://dx.doi.org/10.5867/medwave.2015.06.6182


RESUMENES EPISTEMONIKOS

¿Sirve agregar azatioprina a los corticoides en pacientes con polimiositis?
Cristina Meneses, Gabriel Rada (Chile)

Medwave 2015 Jul;15(suppl 1):e6179
http://dx.doi.org/10.5867/medwave.2015.6179


¿Existe alguna diferencia entre los inhibidores de la enzima convertidora y los antagonistas del receptor de angiotensina para la insuficiencia cardiaca?
Carmen Rain, Gabriel Rada (Chile)

Medwave 2015 Jul;15(suppl 1):e6177
http://dx.doi.org/10.5867/medwave.2015.6177


CARTA A LA EDITORA

Diplomas adicionales y proyectos de investigación: construyendo bases académicas
Dipesh Pravin Gopal, Pieter Mackeith (Reino Unido)

Medwave 2015 Jul;15(6):e6175
http://dx.doi.org/10.5867/medwave.2015.06.6175


EDITORIAL
Queremos publicar más estudios cualitativos en salud
Vivienne C. Bachelet, Bernardita Baeza (Chile)

Medwave 2015 Jul;15(5):e6167
http://dx.doi.org/10.5867/medwave.2015.05.6167


Se encuentran abiertas las inscripciones para ciclo especial del curso Economía de la salud. Inicio 29 de julio.

Para información más detallada: http://www.medwave.cl/link.cgi/eCampus/ges02/

Y para el curso Prevención y Control de Infecciones Asociadas a la Atención de Salud

Mas información en: http://www.medwave.cl/link.cgi/eCampus/IAAS

Toda nuestra oferta de cursos y diplomados e-learning en http://www.medwave.cl/link.cgi/eCampus/Capacitacion


PORTADA MEDWAVE
www.medwave.cl

Mas de ventilación mecánica/More on mechanical ventilation

En algunos envios podrá notar que se incluye el hiperlik de los PDFs. Esto le facilita ampliar la información sobre los autores y las revistas con tan solo hacer click sobre los datos incluidos. In some e-mails you may notice that the hyperlinks are included. This makes it easy more information about the authors and journals just clicking on the data included. Em alguns e-mails que você perceber que podem os hiperlinks estão incluídos. Isto torna mais fácil obter mais informações sobre os autores e periódicos apenas clicando sobre os dados incluídos. در برخی از ایمیل شما متوجه است که ممکن است لینک گنجانده شده است. این باعث می شود آن را آسان اطلاعات بیشتر در مورد نویسندگان و مجلات تنها با کلیک کردن بر روی داده ها گنجانده شده است. Beneficios de la ventilación protectora. Viendo más allá de UCI Benefits of lung-protective ventilation: looking beyond the ICU. Gupta N, Yende S. Crit Care. 2014 Sep 25;18(5):530. doi: 10.1186/s13054-014-0530-0. PDF Avances recientes en ventilación mecánica en pacientes sin ARDS Recent advances in mechanical ventilation in patients without acute respiratory distress syndrome. Serpa Neto A, Filho RR, Rocha LL, Schultz MJ. F1000Prime Rep. 2014 Dec 1;6:115. doi: 10.12703/P6-115. eCollection 2014. Abstract While being an essential part of general anesthesia for surgery and at times even a life-saving intervention in critically ill patients, mechanical ventilation has a strong potential to cause harm. Certain ventilation strategies could prevent, at least to some extent, the injury caused by this intervention. One essential element of so-called 'lung-protective' ventilation is the use of lower tidal volumes. It is uncertain whether higher levels of positive end-expiratory pressures have lung-protective properties as well. There are indications that too high oxygen fractions of inspired air, or too high blood oxygen targets, are harmful. Circumstantial evidence further suggests that spontaneous modes of ventilation are to be preferred over controlled ventilation to prevent harm to respiratory muscle. Finally, the use of restrictive sedation strategies in critically ill patients indirectly prevents ventilation-induced injury, as daily spontaneous awakening and breathing trials and bolus instead of continuous sedation are associated with shorter duration of ventilation and shorten the exposure to the injurious effects of ventilation. PDF Enfoques para la ventilación en cuidados intensivos. Approaches to ventilation in intensive care. Spieth PM, Koch T, Gama de Abreu M. Dtsch Arztebl Int. 2014 Oct 17;111(42):714-20. doi: 10.3238/arztebl.2014.0714. Abstract BACKGROUND: Mechanical ventilation is a common and often life-saving intervention in intensive care medicine. About 35% of all patients in intensive care are mechanically ventilated; about 15% of these patients develop a ventilation-associated pneumonia. The goal of ventilation therapy is to lessen the work of respiration and pulmonary gas exchange and thereby maintain or restore an adequate oxygen supply to the body's tissues.Mechanical ventilation can be carried out in many different modes; the avoidance of ventilation-induced lung damage through protective ventilationstrategies is currently a major focus of clinical interest. METHOD: This review is based on pertinent articles retrieved by a selective literature search. RESULTS: Compared to conventional lung-protecting modes of mechanical ventilation, the modern modes of ventilation presented here are further developments that optimize lung protection while improving pulmonary function and the synchrony of the patient with the ventilator. In high-frequencyventilation, tidal volumes of 1-2 mL/kgBW (body weight) are given, at a respiratory rate of up to 12 Hz. Assisted forms of spontaneous respiration are also in use, such as proportional assist ventilation (PAV), neurally adjusted ventilatory assist (NAVA), and variable pressure-support ventilation. Computer-guided closed-loop ventilation systems enable automated ventilation; according to a recent meta-analysis, they shorten weaning times by 32% . CONCLUSION: The currently available scientific evidence with respect to clinically relevant endpoints is inadequate for all of these newer modes ofventilation. It appears, however, that they can lower both the invasiveness and the duration of mechanical ventilation, and thus improve the care of patients who need ventilation. Randomized trials with clinically relevant endpoints must be carried out before any final judgments can be made. PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Tramadol y piernas inquietas / Tramadol for restless legs syndrome

Revisión de las estrategias de manejo en el síndrome de piernas inquietas o enfermedad de Willis-Ekbon A review of current treatment strategies for restless legs syndrome (Willis-Ekbom disease). Klingelhoefer L, Cova I, Gupta S, Chaudhuri KR. Clin Med. 2014 Oct;14(5):520-4. doi: 10.7861/clinmedicine.14-5-520. Abstract Restless legs syndrome (RLS), recently renamed Willis-Ekbom disease (WED), is a common movement disorder. It is characterised by the need to move mainly the legs due to uncomfortable, sometimes painful sensations in the legs, which have a diurnal variation and a release with movement. Management is complex. First, centres should establish the severity of RLS using a simple 10-item RLS severity rating scale (IRLS). They should also exclude secondary causes, in particular ensuring normal iron levels. Mild cases can be managed by lifestyle changes, but patients with a IRLS score above 15 usually require pharmacological treatment. Dopaminergic therapies remain the mainstay of medical therapies, with recent evidence suggesting opioids may be particularly effective. This article focuses on the different treatment strategies in RLS, their associated complications and ways to manage them. KEYWORDS: RLS; Restless legs syndrome; medical treatment; side effects; therapy PDF Consenso revisado de la Fundación Willis-Ekbom Disease Foundation sobre el tratamiento del síndrome de piernas inquietas. Willis-Ekbom Disease Foundation revised consensus statement on the management of restless legs syndrome. Silber MH1, Becker PM, Earley C, Garcia-Borreguero D, Ondo WG; Medical Advisory Board of the Willis-Ekbom Disease Foundation. Collaborators (12) Mayo Clin Proc. 2013 Sep;88(9):977-86. doi: 10.1016/j.mayocp.2013.06.016. Abstract Restless legs syndrome (RLS)/Willis-Ekbom disease (WED) is a common disorder, occurring at least twice a week and causing at least moderate distress in 1.5% to 2.7% of the population. It is important for primary care physicians to be familiar with this disorder and its management. Much has changed in its management since our previous algorithm was published in 2004, including the availability of several new drugs. This revised algorithm was written by members of the Medical Advisory Board of the Willis-Ekbom Disease Syndrome Foundation based on scientific evidence and expert opinion. It considers the management of RLS/WED under intermittent RLS/WED, chronic persistent RLS/WED, and refractory RLS/WED. Nonpharmacological approaches, including mental alerting activities, avoiding substances or medications that may exacerbate RLS, and the role of iron supplementation, are outlined. Chronic persistent RLS/WED should be treated with either a nonergot dopamine agonist or a calcium channel α-2-δ ligand. We discuss the available drugs, the factors determining which to use, and their adverse effects. We define refractory RLS/WED and describe management approaches, including combination therapy and the use of high-potency opioids. KEYWORDS: MAB; Medical Advisory Board; RLS; WED; Willis-Ekbom disease; restless legs syndrome PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Farmacología clínica neonatal

Farmacología clínica neonatal Neonatal clinical pharmacology. Allegaert K, van de Velde M, van den Anker J. Paediatr Anaesth. 2014 Jan;24(1):30-8. doi: 10.1111/pan.12176. Epub 2013 Apr 26. Abstract Effective and safe drug administration in neonates should be based on integrated knowledge on the evolving physiological characteristics of the infant who will receive the drug and the pharmacokinetics (PK) and pharmacodynamics (PD) of a given drug. Consequently, clinical pharmacology in neonates is as dynamic and diverse as the neonates we admit to our units while covariates explaining the variability are at least as relevant as median estimates. The unique setting of neonatal clinical pharmacology will be highlighted based on the hazards of simple extrapolation of maturational drug clearance when only based on 'adult' metabolism (propofol, paracetamol). Second, maturational trends are not at the same pace for all maturational processes. This will be illustrated based on the differences between hepatic and renal maturation (tramadol, morphine, midazolam). Finally, pharmacogenetics should be tailored to neonates, not just mirror adult concepts. Because of this diversity, clinical research in the field of neonatal clinical pharmacology is urgently needed and facilitated through PK/PD modeling. In addition, irrespective of already available data to guide pharmacotherapy, pharmacovigilance is needed to recognize specific side effects. Consequently, pediatric anesthesiologists should consider to contribute to improved pharmacotherapy through clinical trial design and collaboration, as well as reporting on adverse effects of specific drugs. PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org