sábado, 26 de mayo de 2018

Ideas no confirmadas en UCI / ICU unconfirmed ideas.

Mayo 24, 2018. No. 3090
Siete ideas no confirmadas para mejorar la práctica futura de la UCI.
Seven unconfirmed ideas to improve future ICU practice.
Crit Care. 2017 Dec 28;21(Suppl 3):315. doi: 10.1186/s13054-017-1904-x.
Abstract
With imprecise definitions, inexact measurement tools, and flawed study execution, our clinical science often lags behind bedside experience and simply documents what appear to be the apparent faults or validity of ongoing practices. These impressions are later confirmed, modified, or overturned by the results of the next trial. On the other hand, insights that stem from the intuitions of experienced clinicians, scientists and educators-while often neglected-help place current thinking into proper perspective and occasionally point the way toward formulating novel hypotheses that direct future research. Both streams of information and opinion contribute to progress. In this paper we present a wide-ranging set of unproven 'out of the mainstream' ideas of our FCCM faculty, each with a defensible rationale and holding clear implications for altering bedside management. Each proposition was designed deliberately to be provocative so as to raise awareness, stimulate new thinking and initiate lively dialog.
KEYWORDS: Adaptive clinical trials; Melatonin; Metabolic monitoring; Microcirculation; Personalized medicine; Resuscitation; Sepsis; Shock; Ventilator-induced lung injury
Algunas de nuestras ideas favoritas sin confirmar.
A few of our favorite unconfirmed ideas.
Crit Care. 2015;19 Suppl 3:S1. doi: 10.1186/cc14719. Epub 2015 Dec 18.Abstract
Medical practice is rooted in our dependence on the best available evidence from incremental scientific experimentation and rigorous clinical trials. Progress toward determining the true worth of ongoing practice or suggested innovations can be glacially slow when we insist on following the stepwise scientific pathway, and a prevailing but imperfect paradigm often proves difficult to challenge. Yet most experienced clinicians and clinical scientists harbor strong thoughts about how care could or should be improved, even if the existing evidence base is thin or lacking. One of our Future of Critical Care Medicine conference sessions encouraged sharing of novel ideas, each presented with what the speaker considers a defensible rationale. Our intent was to stimulate insightful thinking and free interchange, and perhaps to point in new directions toward lines of innovative theory and improved care of the critically ill. In what follows, a brief background outlines the rationale for each novel and deliberately provocative unconfirmed idea endorsed by the presenter.
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X Foro Internacional de Medicina del Dolor y Paliativa
Taller de Bloqueos guiados por Ultrasonido con el Dr. Philip Peng
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Ciudad de México, 7 al 9 de junio de 2018. 
V Congreso Internacional de Vía Aérea, EVALa, México
Junio 7-9, 2018. Guadalajara. México
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Cuidado cardiovascular agudo / Acute cardiovascular care

Mayo 25, 2018. No. 3091
Los mejores artículos descargados de 2017 de la revista European Heart Journal: Acute Cardiovascular Care
Top Downloaded Papers of 2017 from European Heart Journal: Acute Cardiovascular Care
Congresos Médicos por Especialidades en todo Mundo
Medical Congresses by Specialties around the World
X Foro Internacional de Medicina del Dolor y Paliativa
Taller de Bloqueos guiados por Ultrasonido con el Dr. Philip Peng
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Ciudad de México, 7 al 9 de junio de 2018. 
V Congreso Internacional de Vía Aérea, EVALa, México
Junio 7-9, 2018. Guadalajara. México
Congreso Nacional de Residentes de Anestesiología
7 al 9 de junio, 2018. Lima, Perú 
Safe Anaesthesia Worldwide
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Trauma en obstetricia / Obstetric trauma


Mayo 26, 2018. No. 3092
Cirugía general urgente durante el embarazo
Emergency general surgery in pregnancy.
Trauma Surg Acute Care Open. 2017 Nov 2;2(1):e000125. doi: 10.1136/tsaco-2017-000125. eCollection 2017.
Abstract
It is often that the acute care surgeon will be called on to evaluate the pregnant patient with abdominal pain. Most of the diagnostic and management decisions regarding pregnant patients will follow the usual tenets of surgery; however, there are important differences in the pregnant patient to be aware of to avoid pitfalls which can lead to complications for both mother and fetus. This review hopes to describe the most common emergencies facing the surgeon caring for the pregnant patient and the latest management options.
KEYWORDS: emergency general surgery; emergency surgery; pregnancy; pregnant
PDF 
Indicadores clínicos de shock hemorrágico en el embarazo
Clinical indicators of hemorrhagic shock in pregnancy.
Trauma Surg Acute Care Open. 2017 Nov 7;2(1):e000112. doi: 10.1136/tsaco-2017-000112. eCollection 2017
Abstract
BACKGROUND: Several hemodynamic parameters have been promoted to help establish a rapid diagnosis of hemorrhagic shock, but they have not been well validated in the pregnant population. In this study, we examined the association between three measures of shock and early blood transfusion requirements among pregnant trauma patients.  We found that patients with SI>1 were significantly more likely to receive blood transfusions compared with patients with SI<1 (OR 10.35; 95% CI 1.80 to 59.62), whereas ROPE>3 was not associated with blood transfusion compared with ROPE≤3 (OR 2.92; 95% CI 0.28 to 30.42). Furthermore, comparison of area under the ROC curve for SI (0.68) and ROPE (0.54) suggested that SI was more predictive than ROPE of blood transfusion. CONCLUSION: We found that an elevated SI was more closely associated with early blood product transfusion than SBP and ROPE in injured pregnant patients.
KEYWORDS: hemorrahgic shock; pregnancy; shock management
Congresos Médicos por Especialidades en todo Mundo
Medical Congresses by Specialties around the World
Congreso Nacional de Residentes de Anestesiología
7 al 9 de junio, 2018. Lima, Perú 
V Congreso Internacional de Vía Aérea, EVALa, México
Junio 7-9, 2018. Guadalajara. México
X Foro Internacional de Medicina del Dolor y Paliativa
Taller de Bloqueos guiados por Ultrasonido con el Dr. Philip Peng
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Ciudad de México, 7 al 9 de junio de 2018. 
Safe Anaesthesia Worldwide
Delivering safe anaesthesia to the world's poorest people
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viernes, 25 de mayo de 2018

Pubertad precoz

Conferencia: Pubertad precoz, por la. Dra Erika Valencia Ramírez

Estimado Ciberpediatra
lo invitamos a unirse al seminario web Zoom.
Cuándo: may 30, 2018 9:00 PM Ciudad de México
Tema: Pubertad Precoz, por la Dra. Erika Valencia Ramírez, Endocrinologa Pediatra de Oaxaca
Haga clic en el enlace a continuación para unirse al seminario web:
https://zoom.us/j/380387703
O un toque en iPhone :
Estados Unidos: +16699006833,,380387703# or +16468769923,,380387703#
O teléfono:
Marcar:
Estados Unidos: +1 669 900 6833 or +1 646 876 9923
ID de seminario web: 380 387 703
Números internacionales disponibles: https://zoom.us/u/ggK1VN5t

Recomendamos que bajes e instales el programa Zoom en tu computadora, para poder accesar la reunión,

También que dejes tu nombre completo y correo electrónico para tomar asistencia a la conferencia

Pasaremos las preguntas al final de la presentacion y se quedaran al final de la Grabacion, por si la revisan en forma Off Line.

Puedes accesar la conferencia a través de la siguientes ligas en las paginas de Conapeme y Ciberpeds.

Ciberpeds: https://bit.ly/2s68smh

Conapeme: https://bit.ly/2tnUcnb

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martes, 22 de mayo de 2018

Más de melatonina en UCI / More on melatonina in ICU

Mayo 22, 2018. No. 3088
Los niveles sanguíneos farmacológicos de melatonina aumentan la capacidad antioxidante total en pacientes críticos.
Melatonin Pharmacological Blood Levels Increase Total Antioxidant Capacity in Critically Ill Patients.
Int J Mol Sci. 2017 Apr 3;18(4). pii: E759. doi: 10.3390/ijms18040759.
Abstract
In this study, the aim was to test the biochemical effects of melatonin supplementation in Intensive Care Unit (ICU) patients, since their blood levels are decreased. Sixty-four patients were enrolled in the study. From the evening of the 3rd ICU day, patients were randomized to receive oral melatonin (3 mg, group M) or placebo (group P) twice daily, at 20:00 and 24:00, until discharged. Blood was taken (at 00:00 and 14:00), on the 3rd ICU day to assess basal nocturnal melatonin values, and then during the treatment period on the 4th and 8th ICU days. Melatonin, total antioxidant capacity, and oxidative stress were evaluated in serum. Melatonin circadian rhythm before treatment was similar in the two groups, with a partial preservation of the cycle. Four hours from the 1st administration (4th ICU day, 00:00), melatonin levels increased to 2514 (982.3; 7148) pg·mL-1 in group M vs. 20.3 (14.7; 62.3) pg·mL-1 in group P (p < 0.001). After five treatment days (8th ICU day), melatonin absorption showed a repetitive trend in group M, while in group P nocturnal secretion (00:00) was impaired: 20 (11.5; 34.5) pg·mL-1 vs. 33.8 (25.0; 62.2) on the 3rd day (p = 0.029). Immediately from the beginning of treatment, the total antioxidant capacity was significantly higher in melatonin treated subjects at 00:00; a significant correlation was found between total antioxidant capacity and blood melatonin values (ρ = 0.328; p < 0.001). The proposed enteral administration protocol was adequate, even in the early phase, to enhance melatonin blood levels and to protect the patients from oxidative stress. The antioxidant effect of melatonin could play a meaningful role in the care and well-being of these patients.
KEYWORDS: antioxidants; critical illness; dietary supplements; melatonin; oxidative stress
Melatonina profiláctica para el delirio en cuidados intensivos (Pro-MEDIC): protocolo de estudio para un ensayo controlado aleatorizado.
Prophylactic Melatonin for Delirium in Intensive Care (Pro-MEDIC): study protocol for a randomised controlled trial.
Martinez FE1, Anstey M2,3,4, Ford A5, Roberts B6, Hardie M7, Palmer R6, Choo L7, Hillman D8,9, Hensley M10, Kelty E11, Murray K12, Singh B13,14,15, Wibrow B2,16.
Trials. 2017 Jan 6;18(1):4. doi: 10.1186/s13063-016-1751-0.
Abstract
BACKGROUND: Delirium is an acute state of brain dysfunction characterised by fluctuating inattention and cognitive disturbances, usually due to illness. It occurs commonly in the intensive care unit (ICU), and it is associated with greater morbidity and mortality. It is likely that disturbances of sleep and of the day-night cycle play a significant role. Melatonin is a naturally occurring, safe and cheap hormone that can be administered to improve sleep. The main aim of this trial will be to determine whether prophylactic melatonin administered to critically ill adults, when compared with placebo, decreases the rate of delirium. METHODS: This trial will be a multi-centre, randomised, placebo-controlled study conducted in closed ICUs in Australia. Our aim is to enrol 850 adult patients with an expected ICU length of stay (LOS) of 72 h or more. Eligible patients for whom there is consent will be randomised to receive melatonin 4 mg enterally or placebo in a 1:1 ratio according to a computer-generated randomisation list, stratified by site. The study drug will be indistinguishable from placebo. Patients, doctors, nurses, investigators and statisticians will be blinded. Melatonin or placebo will be administered once per day at 21:00 until ICU discharge or 14 days after enrolment, whichever occurs first. Trained staff will assess patients twice daily to determine the presence or absence of delirium using the Confusion Assessment Method for the ICU score. Data will also be collected on demographics, the overall prevalence of delirium, duration and severity of delirium, sleep quality, participation in physiotherapy sessions, ICU and hospital LOS, morbidity and mortality, and healthcare costs. A subgroup of 100 patients will undergo polysomnographic testing to further evaluate the quality of sleep. DISCUSSION: Delirium is a significant issue in ICU because of its frequency and associated poorer outcomes. This trial will be the largest evaluation of melatonin as a prophylactic agent to prevent delirium in the critically ill population. This study will also provide one of the largest series of polysomnographic testing done in ICU.
Agonistas del receptor de la melatonina para la prevención del delirio
Melatonin Receptor Agonists for Delirium Prevention.
Walker CK1,2, Gales MA1,3,4.
Ann Pharmacother. 2017 Jan;51(1):72-78. doi: 10.1177/1060028016665863. Epub 2016 Aug 20.
Abstract
OBJECTIVE: To review the prospective controlled trials available for the use of melatonin receptor agonists for delirium prevention. DATA SOURCES: A MEDLINE literature search (1946 to July 2016) was conducted using the search terms delirium, melatonin, ramelteon, tryptophan, and melatonin-receptor agonist. Prospective controlled clinical trials with delirium prevention as an outcome were included. The references of identified articles were reviewed to identify other relevant articles. STUDY SELECTION AND DATA EXTRACTION: Controlled clinical trials in humans, limited to the English language, were reviewed. Five randomized and 1 nonrandomized prospective controlled clinical trial exploring the use of melatonin receptor agonists for delirium preventionwere evaluated. DATA SYNTHESIS: Melatonin agonist therapy for delirium prevention has produced conflicting results in clinical trials. Delirium incidence ranged from no change to significant reductions of approximately 12% to 30%. Four trials were conducted with melatonin as the investigated agent, 1 with l-tryptophan, and 1 with ramelteon. The study setting also varied, with 4 trials being conducted in surgical patients and 2 trials in medical patients. Melatonin provided conflicting results, with 3 trials showing decreased delirium incidence and the largest randomized controlled trial showing no benefit. No benefit was found using l-tryptophan in delirium prevention. The single, small ramelteon trial showed decreased delirium incidence. Safety evaluations during trials were limited. Three trials found adverse effects similar to placebo, whereas the remaining 3 trials did not evaluate adverse effects. CONCLUSIONS: The routine use of melatonin receptor agonists for delirium prevention cannot be recommended at this time.
KEYWORDS: delirium; melatonin; melatonin-receptor agonist; ramelteon; tryptophan
Congresos Médicos por Especialidades en todo Mundo
Medical Congresses by Specialties around the World
Congreso Nacional de Residentes de Anestesiología
7 al 9 de junio, 2018. Lima, Perú 
X Foro Internacional de Medicina del Dolor y Paliativa
Taller de Bloqueos guiados por Ultrasonido con el Dr. Philip Peng
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Ciudad de México, 7 al 9 de junio de 2018. 
V Congreso Internacional de Vía Aérea, EVALa, México
Junio 7-9, 2018. Guadalajara. México
Safe Anaesthesia Worldwide
Delivering safe anaesthesia to the world's poorest people
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Anestesiología y Medicina del Dolor

52 664 6848905