jueves, 24 de julio de 2014

Miocardiopatía periparto

Miocarditis periparto
Peripartum Myocarditis
Marina Deljanin Ilic and Dejan Simonovic
Institute of Cardiology, Niska Banja, University of Nis Faculty of Medicine, Serbia
http://cdn.intechopen.com/pdfs-wm/44500.pdf


Miocardiopatía periparto
Diego Felipe Polanía Ardila, Solón Navarrete Hurtado, Edgar Mariano Acuña Osorio, Rafael Alberto Álvarez Rosero
http://www.insuficienciacardiaca.org/pdf/4_vol4_09/177-%20Miocardiopatia.pdf


Miocardiopatía periparto
http://www.medigraphic.com/pdfs/revmedcoscen/rmc-2013/rmc133m.pdf



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

Miocardiopatía y cáncer / cardiomyopathy and cancer

Tratamiento de la cardiomiopatía inducida por quimioterapia


Management of chemotherapy induced cardiomyopathy.
Saidi A, Alharethi R.
Curr Cardiol Rev. 2011 Nov;7(4):245-9.
Abstract
Chemotherapy related cardiac dysfunction (CRCD) is a serious complication of anticancer therapy. CRCD can be classified into two types. Type I CRCD is exemplified by anthracyline- induced cardiac dysfunction and type II CRCD is exemplified by trastuzumab- induced cardiac dysfunction. The mechanism of cardiac toxicity in both types is not well defined. Certain risk factors may play a role in developing the cardiac injury, most importantly, the cumulative dose when dealing with anthracycline induced cardiotoxicity. Establishing an early diagnosis and initiating early treatment may be an important step in preventing irreversible cardiac injury especially in type I CRCD. Currently there are no guidelines developed specifically for the treatment of chemotherapy induced cardiomyopathy (CIC), however a few small studies support the use of neurohormonal antagonists in the treatment and prevention of CIC. Large multi- centers trials are needed to establish guidelines for CIC. Until then, we advocate following the American College of Cardiology/ American Heart Association (ACC/AHA) and Heart Failure Society of America (HFSA) guidelines. Additionally, a close collaboration between the patient's cardiologist and oncologist is strongly recommended in order to establish a long term plan for the patient.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322442/pdf/CCR-7-245.pdf



La prevención de enfermedad cardiovascular en sobrevivientes de cáncer


The prevention of cardiovascular disease in cancer survivors.
Daher IN, Daigle TR, Bhatia N, Durand JB.
Tex Heart Inst J. 2012;39(2):190-8.
Abstract
The number of cancer survivors in the United States has exceeded 12 million and is increasing. After secondary malignancies, cardiovascular disease is the leading cause of late morbidity and death among cancer survivors. The cardiovascular needs of cancer survivors have not been described. We describe the clinical characteristics of 53 patients seen during the first year of our Cardiovascular Prevention in Cancer Survivors clinic. The mean age of the patients was 40.1 ± 13.7 years. The mean survival since cancer diagnosis was 13.9 years. A history of chemotherapy-induced cardiomyopathywas present in 21%, and 5.7% had known atherosclerotic disease. One fourth had hypertension; 32.1%, dyslipidemia; and 13%, diabetes mellitus. Three quarters had received anthracycline chemotherapy, while half had received radiation. Half had an abnormal echocardiogram (55%), and 11 of 18 had an abnormal carotid ultrasonogram. The mean Framingham risk score for patients older than 30 years (n=37) was 8.4, yielding a 10-year risk of cardiovascular disease of 7.6%. The mean vascular age was 54.3 years, and the mean chronological age was 46.3 years. The mean follow-up duration was 566 ± 213 days. There were significant improvements in serum triglycerides and high-density lipoprotein levels, as well as trends toward improved blood pressure control. Cardiovascular risk factors are prevalent in cancer survivors. There is an immediate need for the widespread availability of cardiovascular preventive services to reduce the late adverse effects of chemotherapy and radiation. Early intervention might help to improve the cardiovascular risk profile.
KEYWORDS: Anthracyclines/adverse effects; antineoplastic agents/adverse effects; atherosclerosis; calcinosis/etiology; cancer;cardiomyopathies/etiology/prevention & control; cardiotoxins; cardiovascular diseases/chemically induced/prevention & control; carotid artery diseases; disease progression; heart failure/etiology; heart/drug effects; heart/radiation effects; monitoring, physiologic; radiation injuries; risk factors; survivorship

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384047/pdf/20120400s00006p190.pdf



Cardiomiopatía inducida por quimioterapia: patogénesis, monitoreo y manejo 

Chemotherapy induced cardiomyopathy: pathogenesis, monitoring and management.
Shakir DK, Rasul KI.
J Clin Med Res. 2009 Apr;1(1):8-12. doi: 10.4021/jocmr2009.02.1225. Epub 2009 Mar 24.
Abstract
The survival rate of cancer patients has greatly increased over the last 20 years. However, to achieve this result, a considerable price has been paid in terms of the side effects associated with the intensive anticancer treatment. The most common adverse effect is cardiotoxicity which may compromise the clinical effectiveness of chemotherapy, affecting the patient's survival and quality of life independently of the oncological prognosis. There are 2 types of cardiac toxicities, type I which is more serious and result in permanent damage to the myocardium and type II which is usually reversible. Chemotherapies varies in their incidence of inducing cardiomyopathy, and the onset which may occur acutely (during or shortly after treatment), sub-acutely (within days or weeks after completion of chemotherapy) or chronically (weeks to months after drug administration). Cardiac events associated with chemotherapy may consist of mild blood pressure changes, thrombosis, Electrocardiographic (ECG) changes, arrhythmias, myocarditis, pericarditis, myocardial infarction, cardiomyopathy, cardiac failure (left ventricular failure), and congestive heart failure (CHF). The risk for such effects depends upon: cumulative dose, rate of drug administration, mediastinal radiation, advanced age, younger age, female gender, pre-existing heart disease and hypertension. Serial measurements of LVEF and fractional shortening are the most common indices monitored to assess left ventricular systolic function and cardiotoxicity. This can be achieved by 2-dimensional, M-mode and color Doppler echocardiographic examination; also Cardiac troponins as a biological marker for myocardial damage can be used for monitoring in patients received anthracyclines. Angiotensin-converting enzyme (ACE) inhibitors (ACEIs) have been shown to slow the progression of left ventricular dysfunction in several different clinical settings, including anthracycline-induced cardiomyopathy. Carvedilol and probably with anti-oxidants like Probucol and vitamin E benefits also.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3318862/pdf/jocmr-01-08.pdf




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

E-Books. Alerta


E-Books
Notificaciones semanales ⋅ 16 de julio de 2014
NOTICIAS


Diario Metro de Puerto Rico

Ebooks se asoman al mercado local
Diario Metro de Puerto Rico
Delgado aseguró que los ebooks son la “tendencia y la nueva herramienta que estará dominando el proceso de aprendizaje”. Para el experto, las ...



El Vigia.net

Presentan e-books
El Vigia.net
Dar a conocer los libros electrónicos "Navegador de historias: treinta cuentos cortos y un prólogo desesperado” y "Mudarse al ático”, del Centro de ...



Amazon corteja a los autores de Hachette ofreciendo el beneficio de e-books
ecodiario
SAN FRANCISCO (Reuters) - Amazon.com intensificó la presión sobre el grupo editorial Hachette al proponer que sus autores se queden con todo el ...




El Pais - Cali Colombia

'Pájaro de los mil cantos', el e-book que atrapará a los niños
El Pais - Cali Colombia
Este e-book infantil fue el ganador de la convocatoria Crea Digital. Cuenta con animaciones y narraciones que sumergen a los niños en el mágico ...




El Comercio

Microsoft te permite acceder a más de 250 e-books gratis | El Comercio Perú
El Comercio
La respuesta de sus lectores fue tan positiva que se descargaron más de 3,5 millones de eBookshasta junio pasado, incluyendo más de 1.000.000 ...




Todo eReaders

Blloon se dedica al juego
Todo eReaders
Esto sorprendió bastante ya que además iba a permitir leer hasta tres ebooks y su catálogo iba a tener más de un millón de ebooks disponibles casi ...




Los Andes (Argentina)

Lectura: sólo el 1% pasó del papel a los ebooks
Los Andes (Argentina)
Apenas el 1% de los argentinos ha reemplazado los libros impresos por los ebooks. Y sólo un 7% lee en ambos formatos."De todas las industrias ...




El Sol

Para publicar o descargar ebooks
El Sol
Internet ha abierto muchas puertas a artistas que de otra forma no podrían darse a conocer, son célebres los casos de algunos personajes que ...




Plano informativo

Libros digitales superan a impresos en enseñanza de la química
Plano informativo
Gracias a la interactividad, los libros electrónicos (eBooks) aventajan a los impresos en la enseñanza de química y permiten a los estudiantes ...


Pájaro de los mil cantos, e-book ganador
El Nuevo Siglo (Colombia)
El eBook, una creación de Lua Books, les enseña a los pequeños la importancia de "ser tú mismo, de tener una opinión y criterio propios. De allí ...

Bibliotecas. Alerta


Bibliotecas
Notificaciones semanales ⋅ 20 de julio de 2014
NOTICIAS


Venezolana de Televisión

Bibliotecas públicas propondrán ante la AN reforma de la Ley de Depósito Legal
Venezolana de Televisión
Esperan que el derecho de autor, que en ocasiones suele ser engorroso, sea más accesible para los funcionarios de la Biblioteca Nacional.



Bibliotecas públicas propondrán ante la AN reforma de la Ley de Depósito Legal
Agencia Venezolana de Noticias
El contenido de la Ley de Depósito Legal, que data del año 1996, fue discutido el pasado lunes por 39 trabajadores de la Biblioteca Nacional de ...



La Biblioteca General de Navarra permanecerá cerrada esta semana para realizar un inventario ...
Lainformacion.com
La Biblioteca General de Navarra permanecerá cerrada al público entre los días 21 y 25 de julio con el fin de realizar un inventario general de los ...




Quadratín

Biblioteca Virtual de la UMSNH brinda uno de los mejores servicios
Quadratín
MORELIA, Mich., 17 de julio del 2014.- La Biblioteca Virtual de la Universidad Michoacana de San Nicolás de Hidalgo (UMSNH) brinda uno de los ...



Bibliotecas y editoriales universitarias intercambiarán ebooks científicos
ecodiario
Bibliotecas y editoriales universitarias iniciarán un proyecto piloto de intercambio y préstamo de libros electrónicos científicos en las universidades ...



ADN (Argentina)

Bibliotecas Populares acordó plan de trabajo en Catriel
ADN (Argentina)
Catriel.- La Municipalidad de Catriel informa que, el pasado miércoles, la referente de BibliotecasPopulares de la Provincia, Marta Marilef, ...




NTR Zacatecas .com

Bibliotecas en localidades, a punto de colapsar
NTR Zacatecas .com
Fresnillo.- Aunque las nueve bibliotecas de comunidades tienen fallas en la infraestructura, en tres de ellas el problema es más grave y requieren de ...



Calidad en bibliotecas mantienen a la UMSNH entre las 10 mejores del país
Cambio (Michoacán)
Morelia, Michoacán.- La Universidad Michoacana de San Nicolás de Hidalgo (UMSNH) cuenta con 14 bibliotecascertificadas por su calidad, así ...



En defensa de las bibliotecas
El Nuevo Herald
Por ello merece nuestra felicitación, por su artículo publicado en el Nuevo Herald del sábado 12 de julio bajo el título Las bibliotecas: asunto urgente, ...




NTR Zacatecas .com

Decaen bibliotecas por falta de actualización y apoyo
NTR Zacatecas .com
Zacatecas.- La falta de apoyo de los ayuntamientos provoca que cada vez haya menos visitas en las bibliotecas públicas de los municipios, indicó ...


BLOGS

Biblopaz: Finalista al Premio Nacional de Bibliotecas Públicas

Biblioteca Popular del Barrio La Paz ⋅ Biblopaz
Bibliotecas Públicas “Daniel Samper Ortega”, en la cual pueden ser postuladas las Bibliotecas públicas estatales departamentales, distritales, ...



III Jornadas sobre Bibliotecas Patrimoniales

RecBib - Recursos Bibliotecarios ⋅ CMaite
La Jornada se centrará en las nuevas formas de difundir y captar patrimonio, que han de permitir, no sólo ofrecer un mejor servicio, sino que los ...


WEB

bibliotecas
Google




Taller Bibliotecas en el mundo digital en el Centro Cultural de MontevideoLa Subdirección
Ministerio de Educación, Cultura y Deporte
El taller Bibliotecas en el mundo digital es una actividad enmarcada en las acciones de la Sección de America Latina y el Caribe de IFLA.



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



La Biblioteca de Ariguaní, todo un compromiso
Biblioteca Nacional de Colombia
La segunda visita a la biblioteca de Ariguaní, Magdalena, implicó un reto para todos.



Aperturas Extraordinarias
uco.es
Bibliotecas. AGOSTO. Días. Apertura ordinaria. A. extraordinaria. RABANALES. 18-19-20-21-22-23-. 24. 09 h.-24 h. 25-26-27-28-29. 8.30 h.-19.00 h.



La CONABIP visita bibliotecas populares de todo el país
Conabip
Autoridades del organismo se acercan a las bibliotecas para relevar la situación de cada una, conocer sus actividades de promoción de la lectura, ...



Red Nacional de Bibliotecas Públicas
Biblioteca Nacional de Colombia
La Biblioteca Nacional de Colombia y la Red Nacional de Bibliotecas Públicas del Ministerio de Cultura, lanzarán los días lunes 14 y miércoles 16 de.



Vive tus vacaciones en la Biblioteca Escolar Futuro
Sistema de Bibliotecas UC
Diversas son las actividades que hemos preparado para ti para las vacaciones de invierno. ¡Vive tus vacaciones en laBiblioteca Escolar Futuro!



Parten las vacaciones de invierno en la Biblioteca Escolar Futuro
Sistema de Bibliotecas UC
vacaciones biblioteca Cuentacuentos, películas, un taller de flora nativa y mañana recreativa, son las actividades preparadas especialmente para ...



Homenaje en el Instituto de Biomedicina de Valencia al Doctor Enrique Pérez Payá
Red de Bibliotecas del CSIC
Hoy, viernes 17 de enero, a las 12:30 horas tendrá lugar en Instituto de Biomedicina de Valencia (IBV), un acto en homenaje al Dr. Enrique Pérez ...

Remimazolam: El futuro de su potencial de sedación

Remimazolam: El futuro de su potencial de sedación


Remimazolam: The future of its sedative potential.
Goudra BG, Singh PM.
Saudi J Anaesth [serial online] 2014 [cited 2014 Jul 13];8:388-91.
Remimazolam (CNS 7056) is a new drug innovation in anesthesia. It combines the properties of two unique drugs already established in anesthesia - Midazolam and remifentanil. It acts on GABA receptors like midazolam and has organ-independent metabolism like remifentanil. It is likely to be the sedative of the future, as preliminary phase II trials have shown minimal residual effects on prolonged infusions. It has potential to be used as a sedative in ICU and as a novel agent for procedural sedation. Unlike most rapidly acting intravenous sedatives available presently, the propensity to cause apnea is very low. Availability of a specific antagonist (flumazenil) adds to its safety even in cases of overdose. The present review discusses remimazolam's potential as a new drug in anesthesia along with the presently available literary evidence.
Keywords: CNS 7056, newer sedatives in anesthesia, remimazolam, soft chemistry in anesthesia
http://www.saudija.org/downloadpdf.asp?issn=1658-354X;year=2014;volume=8;issue=3;spage=388;epage=391;aulast=Goudra;type=2




http://www.saudija.org/text.asp?2014/8/3/388/136627



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

lunes, 21 de julio de 2014

Vía aérea en embarazada/Airway in pregnant women

El embarazo se asocia con disminución en la faringe pero no traqueal o laríngea del área de sección transversal: un estudio piloto utilizando el método de la reflexión acústica


Pregnancy is associated with a decrease in pharyngeal but not tracheal or laryngeal cross-sectional area: a pilot study using the acoustic reflection method.
Leboulanger N, Louvet N, Rigouzzo A, de Mesmay M, Louis B, Farrugia M, Girault L, Ramirez A, Constant I, Jouannic JM, Fauroux B.
Int J Obstet Anesth. 2014 Feb;23(1):35-9. doi: 10.1016/j.ijoa.2013.08.008. Epub 2013 Aug 22.
Abstract
BACKGROUND: The risk of difficult upper airway access is increased during pregnancy, especially in labor. Changes in upper airway calibre have been poorly studied during pregnancy. The acoustic reflection method is a non-invasive technique that allows a longitudinal assessment of the cross-sectional area of the upper airway from the mouth to carina. We used this technique to evaluate upper airway calibre during normal pregnancy. METHODS:We conducted a prospective, single centre, observational study with a clinical and upper airway acoustic reflection method evaluation of healthy women during the first, second and third trimesters of pregnancy, and up to two days and one month after delivery.RESULTS:Fifty women participated to the study. The mean pharyngeal cross-sectional area decreased between the first and third trimesters (P < 0.001) with no significant change of the minimal and mean tracheal cross-sectional areas. The Mallampati score increased during pregnancy between the first and third trimesters (P< 0.001). CONCLUSION:Using measurements with the acoustic reflection method, normal pregnancy is associated with a significant reduction in the cross-sectional area of the pharynx and a concomitant increase in the Mallampati score. No change was observed in the minimal and mean tracheal cross-sectional areas.
http://www.obstetanesthesia.com/article/S0959-289X(13)00119-2/pdf



¿Es la investigación ultrasónica de la sombra de aire del diámetro transversal traqueal razonable para la evaluación de la vía aérea difícil en mujeres embarazadas? Un estudio comparativo prospectivo.


Is ultrasonic investigation of transverse tracheal air shadow diameter reasonable for evaluation of difficult airway in pregnant women: A prospective comparative study.
Turkay Aydogmus M, Erkalp K, Nadir Sinikoglu S, Usta TA, O Ulger G, Alagol A.
Pak J Med Sci. 2014 Jan;30(1):91-5. doi: 10.12669/pjms.301.3972.
Abstract
Objective: The aim of this study was to compare clinical screening tests (modified Mallampati score, Cormack-Lehane score, thyromental distance, and sternomental distance) with ultrasonic measurements of the upper airway in predicting difficult intubation in pregnant women whose Body Mass Index (BMI) is higher and lower than 30 kg m-2. Methods: This study was designed as a prospective observational trial, and consisted of 40 pregnant women of American Society of Anesthesiologists (ASA) 1-2 groups. Patients with a BMI lower than 30 kg m-2 were included in Group 1 (n=20), and patients with a BMI higher than 30 kg m-2 were included in Group 2 (n=20). In the supine position with head in mild extension, the diameter of the transverse tracheal air shadow in the subglottic area of the front neck was measured using ultrasonography. Modified Mallampati score, Cormack-Lehane score, thyromental distance and sternomental distance measurements were recorded. Results: No statistically significant difference was detected between groups regarding mean age, mean number of pregnancy, ASA scores and comorbid disease. Mean body weight (p=0.0001) and mean pre-pregnancy weight (p=0.0001) were significantly higher in Group 2. There was no statistically significant difference between groups regarding mean modified Mallampati score, thyromental distance, sternomental distance measurements, Cormack-Lehane score, and mean ultrasonic measurements. Conclusion: It was found that BMI higher or lower than 30 kg m-2 has no effect on ultrasonic measurements and clinical airway tests. We thought that ultrasonic measurement could not give us valuable information in obese or non-obese pregnant women.
KEYWORDS: Pregnancy; airway evaluation; body mass index; diameter of transverse tracheal air shadow; obesity; ultrasonography

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955549/

ML ProSeal en la vía aérea durante cesárea después de intubación traqueal fallida


Use of a ProSeal laryngeal mask airway for airway maintenance during emergency Caesarean section after failed tracheal intubation.
Awan R, Nolan JP, Cook TM.
Br J Anaesth. 2004 Jan;92(1):144-6.
Abstract
We report the use of the ProSeal laryngeal mask airway to establish and maintain the airway during emergency Caesarean section when tracheal intubation had failed with conventional laryngoscopy and mask ventilation was difficult. The ProSeal laryngeal mask allowed controlled ventilation without gas leak and facilitated drainage of the stomach.

http://bja.oxfordjournals.org/content/92/1/144.full.pdf




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

domingo, 20 de julio de 2014

Opioides espinales en DPO/Intrathecal opioids in POP

Recomendaciones de opioides espinales en la práctica clínica en el tratamiento del dolor postoperatorio 
Recommendations for spinal opioids clinical practice in the management of postoperative pain
Mugabure BB
J Anesthesiol Clin Sci. 2013; 2:28. http://dx.doi.org/10.7243/2049-9752-2-28
Abstract
Opioids have been considered the strongest option in clinical practice for the treatment of postoperative pain. However, in this setting, the spinal administration of an opioid drug does not always guarantee selective action and segmental analgesia in the spine due to partial reuptake to blood systemic circulation reaching brain receptors. Recent evidence from experimental studies indicates that bioavailability in the spinal cord biophase is negatively correlated with liposolubility, which is higher for hydrophilic opioids, than for lipophilic ones. Clinical guidelines recommend using a mixture of local anesthetic plus a strong opioid to improve the analgesic effect, minimize adverse effects and improve the overall patient´s satisfaction. Moreover, sometimes an opioid alone, typically morphine, can be administered to provide a long period of postoperative analgesia for 24 h, or even 48 h when an extended release epidural formulation is used. In all cases a vigilance protocol must be recommended to prevent either early or delayed respiratory depression.
Keywords: Spinal analgesia, epidural opioids, intrathecal opioids, and postoperative pain


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

Dilemas Bioeticos en Hemotransfusiones y Estenosis UreteroPielica

Conferencia por el Dr Rafael Rivera Montero Dilemas Bioeticos en Hemotransfusiones
y Estenosis Uretero Pielica por el Dr Edgar Morales Juvera


las conferencias tienen una calificación de 0.25 puntos por sesión off-line


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

Cirugía de tórax/Thoracic surgery

Manejo de las complicaciones después de cirugía torácica  
Postoperative Care and Complications After Thoracic Surgery
Anand Iyer and Sumit Yadav
Principles and Practice of Cardiothoracic Surgery

Introduction
Postoperative care of thoracic surgical patients is a very important part of patient recovery and can be very challenging. Pulmonary complications are responsible for significant numbers of deaths and morbidity of patients undergoing thoracotomy. Thoracic surgery impairs postoperative respiratory function resulting in a relatively high risk of developing postoperative pulmonary complications. The incidence (19-59%) is much higher than following upper (16-17%) or lower abdominal surgery (0-5%). The overall incidence of complications following thoracic surgery varies from 15% to 37.5%, primarily due to the type of pulmonary complica-
tions studied, the clinical criteria used in the definition and the type of surgery included. The clinical and potential economic impact of these complications is marked, with significantly longer hospital and high Dependency unit stay, frequency of ICU admission and number of deaths 

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

sábado, 19 de julio de 2014

Paciente inconciente/Unconscious patient

 Evaluación de la sedación para el paciente inconsciente: ¿Estamos todavía muy lejos?
Evaluation of Sedation for the Unconscious Patient: Are We Still Far Away?
Laurenza C, Mattei A, Antonelli S, Cappiello D and Carassiti M
J Anesth Crit Care Open Access 2014, 1(2): 00007
Abstract
In our daily practice in intensive care unit, one of the "cornerstones" is to achieve adequate sedation for every patient. Intensive care unit (ICU) patients are often sedated, and a good hypnotic monitoring is important to assure an optimal level of sedation for every patient. Sedation monitoring can be achieved using subjective or objective methods. The most recent recommendations on management of sedation were published by Critical Care Medicine in January 2013. They recommend the use of subjective methods as the primary method to monitor sedation, with the use
of objective methods only in paralyzed and comatose patients, in whom subjective methods cannot be used. Unfortunately in these last recommendations, the objective methods of sedation monitoring are listed without indicating any of them as the best method actually available to assure an adequate sedation. The aim of our study is to review the characteristics of each objective method of sedation monitoring, in order to
understand which is the most appropriate in the current state. We found that several objective methods are adequate to monitor the level of sedation in paralyzed or comatose patients, although the data needs to be considered with caution, Bispectral Index (BIS) is suggested as the best method for monitoring sedation in most studies.
Keywords: Sedation; Intensive care unit; Electroencephalogram; Auditory evoked potentials  



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

A continuación le informamos los artículos recientemente publicados en Medwave

PORTADA MEDWAVE
http://www.medwave.cl


A continuación le informamos los artículos recientemente publicados en Medwave.

ESTUDIO PRIMARIO
Fiabilidad inter-jueces en evaluaciones portafolio de competencias profesionales en salud: el modelo de la Agencia de Calidad Sanitaria de Andalucía
Antonio Almuedo-Paz, Manuel Herrera-Usagre, Begoña Buiza-Camacho, José Julián-Carrión, María del Pilar Carrascosa-Salmoral, Sheila María Martín-García, Rocío Salguero-Cabalgante (España)

Medwave 2014;14(6):e5998
http://dx.doi.org/10.5867/medwave.2014.06.5998


EDITORIAL

Revisiones rápidas de la evidencia utilizando Epistemonikos: una aproximación rigurosa, amigable y actualizada a la evidencia en salud
Gabriel Rada (Chile)

Medwave 2014;14(6):e5997
http://dx.doi.org/10.5867/medwave.2014.06.5997


RESÚMENES EPISTEMONIKOS

¿Son efectivos los antagonistas de aldosterona en pacientes con insuficiencia cardiaca leve a moderada?
Gabriel Rada, José Peña (Chile)

Medwave 2014;14(6):e5999
http://dx.doi.org/10.5867/medwave.2014.06.5999


ESTUDIO PRIMARIO

Factores clínicos y socio-sanitarios relacionados a la anemia en gestantes: estudio de prevalencia en Municipio Mara, Venezuela, 2013
Ayari Guadalupe Ávila, Lenis García Soto, María Gómez, Nixon Villanueva, Betty Benítez, Belkis Fuentes (Venezuela)

Medwave 2014;14(6):e5996
http://dx.doi.org/10.5867/medwave.2014.06.5996


TEMAS Y CONTROVERSIAS EN BIOESTADÍSTICA

¿Cuántos sujetos necesito para mi estudio?
Sergio R. Muñoz Navarro (Chile)

Medwave 2014;14(6):e5995
http://dx.doi.org/10.5867/medwave.2014.06.5995


PORTADA MEDWAVE
http://www.medwave.cl

martes, 15 de julio de 2014

Fallece la Nobel Nadine Gordimer, voz literaria contra el 'apartheid'

http://www.madrimasd.org/informacionidi/noticias/noticia.asp?id=61071&origen=notiweb&dia_suplemento=martes


Fallece la Nobel Nadine Gordimer, voz literaria contra el 'apartheid'

Menuda y discreta pero dama de hierro de fuerte carácter, severa de rostro y a la vez muy coqueta con sus fulares de colores, elegante a sus 84 años cuando vino a Barcelona invitada por el Pen Club (vestigios de una belleza que lució siempre en algunas cubiertas de sus libros como si fuese una actriz), la premioNobel de literatura de 1991 Nadine Gordimer (fallecida a los 90 años en Johannesburgo) exhibía aún una vitalidad que parecía no haber menguado ni un ápice desde su combativa resistencia durante los años enrarecidos de Soweto, y seguía involucrada como el primer día en la inacabable tarea de defender la bendita libertad de expresión y el compromiso del escritor con la denuncia de cualquier censura y de cualquier connivencia con los poderes espurios o los gobiernos totalitarios.

A estos conceptos dedicó sus ensayos A writer’s freedom (1975), Relevance and commitment (1979) y el clásico The essential gesture (1984), reunidos en The Essential Gesture. Writing, Politics & Places (1988), un volumen indispensable en la bibliografía de Nadine Gordimer, el más importante de su dimensión solidaria, activista y comprometida, en el que expuso con meridiana claridad precisamente algo muy semejante a unos estatutos del compromiso literario, caballo de batalla de una obra como la suya, nacida de la sospecha de que el escritor que se construye una torre de marfil desentendiéndose de la sociedad en la que escribe pierde sin remedio buena parte de las virtudes que lo legitiman.

El enfrentamiento cultural y racial, auspiciado por el 'apartheid' que ensombreció su país desde su infancia, explica que su toma de conciencia resultara precoz, y que su idea de literatura comprometida, cuando no de novela política, recorra su obra entera, hasta el punto de sentir la imperiosa urgencia de decir, con voz alta y clara y en forma de advertencia clarividente, que "la responsabilidad es aquello que espera fuera del Edén de la creatividad. El acto creativo jamás es puro". Escribid, escribid, malditos, cread ficciones hasta reventar, pero sabed que cuando atraveséis la membrana de vuestra ficción estará aguardándoos, lo queráis o no, la responsabilidad: desde esta convicción escribió relatos y excelentes novelas escoradas sin remedio hacia el compromiso, como La hija de Burger (1979), su buque insignia, basada en conflictos políticos del activismo anti-'apartheid¡ que la dama de Johannesburgo vivió a pie de calle y no desde un confortable escritorio,Historia de mi hijo (1990) o la última de enjundia, escrita ya desde la atalaya de la senectud, Atrapa la vida (2005).

Su narrativa, enfrentada a cualquier barroquismo y obsesionada con soltar todo lastre que impida una prosa pulcra y escueta, destaca por el diseño de sus protagonistas como trasuntos de personas humanas, y más de una vez reivindicó que el lector tenía que reconocer a sus personajes por su talante, sin que el narrador tuviera que caer en la convención de anotar quienes combaten en el esgrima verbal de sus diálogos. Necesitaba penetrar en la intimidad de sus personajes, escribió antológicos monólogos, combinó la narrativa con la crónica y el ensayo político disfrazado de ficción, y alcanzó el virtuosismo en el arte de la verosimilitud: nada jamás parece falso en sus páginas, demasiada sangre caliente mezclada con la tinta negra del manuscrito. Joyce, Camus, Proust o Tolstoi arroparon su escritura.

Quiso conocer los desafueros del franquismo y el proceso de la transición española, leyó a García Lorca y a través de su poesía se asomó al drama español. A una mujer tan sensible en todo aquello que atañe a cuestiones humanitarias, a la concordia entre pueblos, le entusiasmaba cada prueba irrefutable de que el arte, o el intento de alcanzarlo, supera tarde o temprano los obstáculos que el Estado o la historia social le imponen. No soportaba la censura. Le fascinaba el surrealismo, aunque nada tenga que ver con él su obra literaria. Disparaba a bocajarro su solidaridad cada vez que surgía cualquier cuestión que atañera a las minorías, no en vano su vida entera giró alrededor de la idea de diferencia. Sonreía feliz junto a su editora, Ana Mª Moix, en la Librería La Central, cuando se veía a sí misma abrazada por su amigo Günter Grass en la foto que les hizo hace ya unos años Inge Feltrinelli. Vivió procurando que nadie seque por la fuerza la tinta de quien desee escribir para comunicar en negro sobre blanco, y valga la frase aquí en su doble sentido. Le gustaba la idea de darle la vuelta en broma a la frase de Paul Valéry: "La literatura no se hace con palabras sino con ideas".

Autor:   Javier Aparicio Maydeu (Profesor Titular de Literatura Contemporánea y Comparada en la Universitat Pompeu Fabra)

Transplante hepático/Liver transplant

Transfusión y coagulación en trasplante de hígado


Transfusion and coagulation management in liver transplantation.
Clevenger B, Mallett SV.
World J Gastroenterol. 2014 May 28;20(20):6146-58. doi: 10.3748/wjg.v20.i20.6146.
Abstract
There is wide variation in the management of coagulation and blood transfusion practice in liver transplantation. The use of blood products intraoperatively is declining and transfusion free transplantations take place ever more frequently. Allogenic blood products have been shown to increase morbidity and mortality. Primary haemostasis, coagulation and fibrinolysis are altered by liver disease. This, combined with intraoperative disturbances of coagulation, increases the risk of bleeding. Meanwhile, the rebalancing of coagulation homeostasis can put patients at risk of hypercoagulability and thrombosis. The application of the principles of patient blood management to transplantation can reduce the risk of transfusion. This includes: preoperative recognition and treatment of anaemia, reduction of perioperative blood loss and the use of restrictive haemoglobin based transfusion triggers. The use of point of care coagulation monitoring using whole blood viscoelastic testing provides a picture of the complete coagulation process by which to guide and direct coagulation management. Pharmacological methods to reduce blood loss include the use of anti-fibrinolytic drugs to reduce fibrinolysis, and rarely, the use of recombinant factor VIIa. Factor concentrates are increasingly used; fibrinogen concentrates to improve clot strength and stability, and prothrombin complex concentrates to improve thrombin generation. Non-pharmacological methods to reduce blood loss include surgical utilisation of the piggyback technique and maintenance of a low central venous pressure. The use of intraoperative cell salvage and normovolaemic haemodilution reduces allogenic blood transfusion. Further research into methods of decreasing blood loss and alternatives to blood transfusion remains necessary to continue to improve outcomes after transplantation.
KEYWORDS: Cell salvage; Coagulation; Liver disease; Patient blood management; Thromboelastography; Transfusion; Transplantation
http://www.wjgnet.com/1007-9327/pdf/v20/i20/6146.pdf




Complicaciones respiratorias tempranas después de trasplante del hígado

Early respiratory complications after liver transplantation.
Feltracco P, Carollo C, Barbieri S, Pettenuzzo T, Ori C.
World J Gastroenterol. 2013 Dec 28;19(48):9271-81. doi: 10.3748/wjg.v19.i48.9271.
Abstract
The poor clinical conditions associated with end-stage cirrhosis, pre-existing pulmonary abnormalities, and high comorbidity rates in patients with high Model for End-Stage Liver Disease scores are all well-recognized factors that increase the risk of pulmonary complications after orthotopic liver transplantation (OLT) surgery. Many intraoperative and postoperative events, such as fluid overload, massive transfusion of blood products, hemodynamic instability, unexpected coagulation abnormalities, renal dysfunction, and serious adverse effects of reperfusion syndrome, are other factors that predispose an individual to postoperative respiratory disorders. Despite advances in surgical techniques and anesthesiological management, the lung may still suffer throughout the perioperative period from various types of injury and ventilatory impairment, with different clinical outcomes. Pulmonary complications after OLT can be classified as infectious or non-infectious. Pleural effusion, atelectasis, pulmonary edema, respiratory distress syndrome, and pneumonia may contribute considerably to early morbidity and mortality in liver transplant patients. It is of paramount importance to accurately identify lung disorders because infectious pulmonary complications warrant speedy and aggressive treatment to prevent diffuse lung injury and the risk of evolution into multisystem organ failure. This review discusses the most common perioperative factors that predispose an individual to postoperative pulmonary complications and these complications' early clinical manifestations after OLT and influence on patient outcome.
KEYWORDS: Liver transplantation; Post-transplant pneumonia; Postoperative edema; Postoperative respiratory failure; Respiratory complications

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3882400/pdf/WJG-19-9271.pdf

Efecto de la ocreotida sobre el gasto urinario durante el trasplante hepático ortotópico en la función renal postoperatoria

The effect of octreotide on urine output during orthotopic liver transplantation and early postoperative renal function; a randomized, double-blind, placebo-controlled trial.
Sahmeddini MA, Amini A, Naderi N.
Hepat Mon. 2013 Sep 18;13(9):e12787. doi: 10.5812/hepatmon.12787. eCollection 2013.
Abstract
BACKGROUND:Maintenance of the adequate intraoperative renal perfusion is very important during Orthotopic Liver Transplantation (OLT) to prevent acute renal failure.OBJECTIVES:For the first time, this study was designed to survey the effects of octreotide on urine output during anesthesia for OLT and early postoperative renal function.PATIENTS AND METHODS:In this randomized double-blind placebo controlled clinical trial, 79 of 89 patients who underwent OLT and fulfilled the study requirement were randomly allocated into two groups. In the octreotide group, the patients received octreotide infusion from the start of the operation. On the other hand, the control group patients received physiologic saline infusion instead of octreotide. The Mean Arterial Pressure (MAP), heart rate, urine output, norepinephrine usage, and dosage during the three stages of OLT, and baseline and postoperative creatinine were recorded and compared between the two groups.RESULTS:No significant differences were found between the two groups regarding the demographic characteristics and graft factors (P > 0.05). However, urine output and MAP during the three stages of OLT were significantly higher in the octreotide group compared to the control group (P < 0.05). Moreover, no significant difference was observed between the two groups regarding baseline as well as postoperative creatinine (P > 0.05).CONCLUSIONS:The results demonstrated that octreotide infusion during anesthesia for OLT not only augmented the vasoconstriction effect of norepinephrine to increase MAP, but also maintained better renal perfusion and urine output during the operation.
KEYWORDS:Acute Kidney Injury; Liver Transplantation; Octreotide

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3830523/pdf/hepatmon-13-09-12787.pdf



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

Diplomado de ultrasonografía para ortopedistas



Una de las técnicas de imagen que en los últimos años ha tomado relevancia en la ecografia o ultrasonido en el sistema musculo esquelético, suma múltiples ventajas, sin embargo es preciso conocer la tecnica a fondo. El doctor Jose Carlos Cortes Sandoval del Instituto de hombro y codo en Zapopan Jalisco, les invita a pedir informes de su curso: "Ultrasonografía del sistema musculo esquelético" dirigido a médicos ortopedistas, la modalidad es semi-presencial.
En México se ofrece en el Instituto de Hombro y Codo, se imparte el diplomado de ultrasonografía para ortopedistas,en los siguientes niveles: intermedio, avanzado y master,
Un video detallando el diplomado por parte del dr José Carlos Cortes Sandoval,

http://youtu.be/jcFqsVbQyA0?list=UUiJzkftdSlIpduZ8IHepUBQ

http://mihombroycodo.blogspot.mx/

http://www.hombroycodo.com.mx/

lunes, 14 de julio de 2014

Primer curso monográfico de temas selectos de ortopedia

Primer curso monográfico de temas selectos de ortopedia, en el hospital 1° de octubre del ISSSTE en la ciudad de México, del 16 al 18 de julio del 2014, costo 300 pesos.
Transmisión en vivo vía internet, a través del canal de biblioman azteca:
http://www.livestream.com/bibliomanazteca_platicas_medicas

First monographic course of selected topics of orthopedics at the hospital October 1 ISSSTE in Mexico City from 16 to 18 July 2014, cost 300 pesos. 
Live broadcast via the Internet, through the channel of Aztec biblioman:
http://www.livestream.com/bibliomanazteca_platicas_medicas