miércoles, 12 de septiembre de 2012

IX Curso de Ortopedia Pediátrica HIM


Inteligencias múltiples, cómo reconocerlas.

La nueva responsabilidad del profesional de la información

Fuente:http://www.documentalistas.org/articulo-la-nueva-responsabilidad-del-profesional-de-la-informacion/

03/09/2012

La nueva responsabilidad del profesional de la información

Por: Enrique Fabricio Dávalos Oviedo


Toda unidad de Información, sea esta una biblioteca, un centro de documentación o un archivo debido a la muy compleja situación por la que atraviesa la sociedad actual con respecto a la pérdida de ciertos valores éticos y morales, tenemos como misión indiscutible que nuestros recursos humanos se encuentren comprometidos con sus deberes y de nuestras condiciones morales y ética profesional que poseamos.
Sin embargo no se puede evitar que la ética y la moral estén condicionadas por las diferentes formaciones socioeconómicas existentes por lo que los profesionales de la información estamos determinados por las realidades en las que nos desempeñamos.
Encarar el tema siempre será complicado, como institución social hemos sido cómplices de los poderosos y los hemos servido, pero muchas otras hemos luchado por la alfabetización y difusión del conocimiento y su libre acceso, con el fin de asegurar el derecho del usuario a la información.
Es necesario hacer aflorar nuevamente estos valores que generen prosperidad y adelanto, estableciendo la base y los cimientos de la igualdad, la libertad, la protección y la razón.
Si bien hoy la Sociedad de la Información se ha convertido en el eje en torno al cual cambia un mundo, la Sociedad actual parecería haber confundido el significado de lo moral; Y la ética se ha quedado casi sin sentido, que cada vez nos somete a nuevas formas de opresión y esclavitud.
Debemos pues los profesionales de la información guiar la reconstrucción de una realidad moral con un sentido auténtico y autocritico de carácter social, encaminado a mejorar y orientar la actitud del ser humano para aprender a vivir socialmente mejor.
Extraordinariamente todos y cada uno de los profesionales de la información gozamos de esta influencia transformadora, de emprender la tarea y comenzar a encender las chispas del cambio. Así uno de los puntos fundamentales para la práctica de la ética es necesario el reconocimiento de profesionales cualificados y calificados, con el compromiso moral de asegurar el despojo de toda cadena que nos limite y no permita que abordemos nuestra profesión con mente abierta.
Advierto y creo necesario que al conocimiento teórico se nos debería multiplicar varios principios éticos y morales en relación con nuestra responsabilidad social, aunque sea escasamente reconocida y muy pocas veces interpretada como un compromiso ético y profesional.
Actualmente los profesionales de la información debemos mantener absoluta conciencia de que debemos ser sujetos formados con y por parámetros morales e individuales desprendiéndonos de ciertos apegos, estereotipos y tradiciones
La información constituye un componente esencial para la reducción de la desigualdad imperante entre los diversos grupos sociales, el reto es entonces que los profesionales de todas las disciplinas afines a la información y en especial nosotros los bibliotecólogos debemos asumir la construcción y evolución de estas nuevas sociedades.
Lo cierto es que nuevos desafíos sociales y éticos ha generado no solo un reto moral, sino también inequidades e injusticias sociales generadas por las políticas neoliberales que han ocasionado daños a la vida digna de los pueblos posiblemente por los cambios acelerados que nos ha traído los nuevos tiempos.
Es difícil comprender, en la esfera estrictamente profesional, probablemente nos debamos unos minutos para recordarnos y tenerlo bien en claro sobre lo que representa el generar cambios sociales, el mundo vertiginoso y competitivo nos lleva probablemente a realizar grandes esfuerzos, y muy lejos estamos de acuerdos de colaboración.
Para lograr un desempeño satisfactorio ante estas determinantes, se requiere de profesionales capaces de utilizar criterios acertados y coherentes sobre todo en la línea que separa lo correcto de lo incorrecto, indudablemente en los últimos años se ha tornado algo mas que borrosa, en la gran mayoría de los casos no estamos todavía conscientes de las implicaciones de nuestro compromiso.
La interrogante es una invitación a la reflexión pues todos alguna vez nos enfrentamos a esta situación a la que no debemos la espalda, tomemos una postura pro-ciudadana, sustentándonos como fieles promotores y maestros del respeto y la información, es necesario elevar nuestro nivel de prestigio y protagonismo para la construcción de nuestros más altos valores.

Fuente:http://www.documentalistas.org/articulo-la-nueva-responsabilidad-del-profesional-de-la-informacion/

Bibliotecas. Alerta


Macri en un acto por las bibliotecas populares en la ciudad. Foto ...
Lanacion.com (Argentina)
En el marco de su plan de conectividad Wi-Fi gratis en espacios públicos, el Gobierno de la Ciudad de Buenos Aires anunció hoy la incorporación de bibliotecas públicas como puntos donde conectarse y navegar en internet de manera fácil, gratuita y ...
Ver todos los artículos sobre este tema »




Las bibliotecas populares de la provincia están de festejo
Diario C
(DIARIOC, 04/09/2012) En el marco de las actividades que se vienen desarrollando por el día de lasBibliotecas Populares, a celebrarse el 23 de septiembre, la delegación gubernamental de BibliotecasPopulares ante CONABIP, dependiente de la ...
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En el día de la Historieta, se entregarán distinciones en la Biblioteca ...
Télam
El día de la Historieta se celebrará hoy a las 17 en el auditorio Jorge Luis Borges de la BibliotecaNacional, institución que junto a la Comisión de Bibliotecas Populares incentiva a través de diversas iniciativas a los que trabajan en este espacio ...
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La Municipalidad brinda Internet gratuito a más de senta escuels y ...
LU 22 Radio Tandil
General - Locales. A través del Plan “Tandil Digital”, implementado desde mediados de 2011, el Municipio de Tandil brinda de manera gratuita acceso a internet a más de 60 escuelas y bibliotecasdel partido, además de diferentes espacios públicos.
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Obra de Pablo Neruda inspira muestra fotográfica
El Universal.mx
El director nacional de Bibliotecas y de Plan de Lectura, Manuel Velasco, señaló durante la apertura de la exhibición que el trabajo realizado por Santander detalla a través de las imágenes la belleza de lo retratado por el poeta chileno en sus odas.
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El Universal.mx






Biblioteca Comunitaria Eva Golinger, un año andando en los Cortijos
Aporrea.org
“El Diario de Bucaramanga”, donde se presenta a Simón Bolívar esplendoroso embebido de la cotidianidad doméstica; “Los Miserables“ y la “Antología Poética de Sánchez Peláez”, son algunas de las obras que conforman la modesta colección de la ...
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Aporrea.org







El París de Balzac, Hugo o Stendhal revive gracias a un mapa ...
El Universal (Venezuela)
Desde finales de agosto, el consistorio parisino, en colaboración con las bibliotecas municipales y labiblioteca electrónica Feedbooks, ha colgado en línea un mapa repleto de extractos geolocalizables de clásicos como "Los Miserables" (Hugo), "Por el ...
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Comienza ”Primer Seminario Internacional de Bibliotecas Públicas ...
Puranoticia
Entre este martes y el jueves 6 de septiembre se realizará en el Hotel Plaza San Francisco de Santiago el "Primer Seminario Internacional de Bibliotecas Públicas", instancia que contará con la presencia de destacados invitados locales y extranjeros.
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Puranoticia





Formación en línea en septiembre: Scopus y Refworks | El ...
según Bibliotecas
Los diferentes proveedores de información electrónica de la Universidad de Salamanca disponen de materiales formativos sobre las bases de datos, plataformas de revistas electrónicas, gestores bibliográficos y otros recursos similares que ...
El astronauta - Bibliotecas USAL


Auxiliares de Bibliotecas | RecBib - Recursos Bibliotecarios
según Julian_Marquina
Start: 10/09/2012 - 00:00 End: 24/03/2013 - 23:59 Descripción: Curso online para la preparación de las oposiciones de Técnicos y Auxiliares de Bibliotecas, subgrupos C1 y C2. Se trata de un cursos teórico/práctico en el que se abordará el.
RecBib - Recursos Bibliotecarios

Medicina de las alturas



Impacto de mal de montaña entre los viajeros a Cusco Perú


Acute Mountain Sickness Impact Among Travelers to Cusco, Peru
Hugo Salazar, MS, Jessica Swanson, Karen Mozo, A. Clinton White Jr., Miguel M. Cabada
School of Medicine, University of Texas Medical Branch, Galveston, TX, USA; Department of Medicine, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru; Infectious Diseases Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
DOI: 10.1111/j.1708-8305.2012.00606.x
Journal of Travel Medicine 2012; Volume 19 (Issue 4): 220-225


Background
Increasing numbers of travelers are visiting high altitude locations in the Andes. The epidemiology of acute mountain sickness (AMS) among tourists to high altitude in South America is not well understood. Methods; A cross-sectional study to evaluate the epidemiology, pre-travel preparation, and impact of AMS among travelers to Cusco, Peru (3,400 m) was performed at Cusco's International Airport during June 2010. Foreign travelers, 18 years or older, staying 15 days or less, departing Cusco were invited to participate. Demographic, itinerary, and behavioral data were collected. The Lake Louise Clinical score (LLCS) was used to assess AMS symptoms. Results. In total, 991 travelers participated, median age 32 years (interquartile range 25-49), 55.5% female, 86.7% tourists, mostly from the United States (48.2%) and England (8.1%). Most (76.7%) flew from sea level to Cusco and 30.5% visited high altitude in the previous 2 months. Only 29.1% received AMS advice from a physician, 19% recalled advice on acetazolamide. Coca leaf products (62.8%) were used more often than acetazolamide (16.6%) for prevention. AMS was reported by 48.5% and 17.1% had severe AMS. One in five travelers with AMS altered their travel plans. Travelers older than 60 years, with recent high altitude exposure, who visited lower cities in their itinerary, or used acetazolamide were less likely to have AMS. Using coca leaf products was associated with increased AMS frequency. Conclusions. AMS was common and adversely impacted plans of one in five travelers. Acetazolamide was associated with decreased AMS but was prescribed infrequently. Other preventive measures were not associated with a decrease in AMS in this population. Pre-travel preparation was suboptimal.


http://onlinelibrary.wiley.com/doi/10.1111/j.1708-8305.2012.00606.x/pdf




Síntomas de fisiológicos y psicológicos de enfermedad en la Alturas y su relación con el mal agudo de montaña: Estudio prospectivo de cohortes
Physiological and Psychological Illness Symptoms at High Altitude and Their Relationship With Acute Mountain Sickness: A Prospective Cohort Study
Samuel J. Oliver, PhD, Stephan J. Sanders, PhD, Catherine J. Williams, MBBCh,, Zoe A.
Smith, Emma Lloyd-Davies, MBBS,Ross Roberts, PhD, Calum Arthur, PhD, Lew Hardy, PhD, and Jamie H. Macdonald, PhD

Journal of Travel Medicine 2012; Volume 19 (Issue 4): 210-219

Background
The aim of this prospective observational cohort study was to investigate relationships between acute mountain sickness (AMS) and physical and mental health during a high altitude expedition.
Methods. Forty-four participants (mean age, 34 ± 13 y; body mass index, 23.6 ± 3.5 kg*m2; 57% male) completed the Dhaulagiri base camp trek in Nepal, a 19-day expedition attaining 5,372 m. Participants self-reported the following daily physical and mental health: AMS (defined by Lake Louise diagnosis and individual and total symptom scores), upper respiratory symptoms, diarrhea, and anxiety, plus physiological and behavioral factors.. Results, The rate of Lake Louise-defined AMS per 100 person days was 9.2 (95% CI: 7.2-11.7). All investigated illnesses except diarrhea increased with altitude (all p < 0.001 by analysis of variance). Total AMS symptom score was associated with a lower arterial oxygen saturation, higher resting heart rate, more upper respiratory and diarrhea symptoms, greater anxiety, and lower fluid intake (all p < 0.02 by longitudinal multiple regression analyses). However, only upper respiratory symptoms, heart rate, arterial oxygen saturation, and fluid intake predicted future AMS symptoms [eg, an increase in upper respiratory symptoms by 5 units predicted an increase in the following day's AMS total symptom score by 0.72 units (0.54-0.89)]. Conclusions: Upper respiratory symptoms and anxiety increasingly contributed to symptom burden as altitude was gained. Data were consistent with increased heart rate, decreased arterial oxygen saturation, reduced fluid intake, and upper respiratory symptoms being causally associated with AMS. Upper respiratory symptoms and fluid intake are the simplest targets for intervention to reduce AMS during high altitude exposure.
http://onlinelibrary.wiley.com/doi/10.1111/j.1708-8305.2012.00609.x/pdf

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

Dispositivos modernos para reducir la ceguera después de cirugía de columna



Dispositivos modernos para reducir la ceguera después de cirugía de columna


Current intraoperative devices to reduce visual loss after spine surgery.
Uribe AA, Baig MN, Puente EG, Viloria A, Mendel E, Bergese SD.
Departments of Anesthesiology and.
Neurosurg Focus. 2012 Aug;33(2):E14.
Abstract
Postoperative visual loss (POVL) after spine surgery performed with the patient prone is a rare but devastating postoperative complication. The incidence and the mechanisms of visual loss after surgery are difficult to determine. The 4 recognized causes of POVL are ischemic optic neuropathy (approximately 89%), central retinal artery occlusion (approximately 11%), cortical infarction, and external ocular injury. There are very limited guidelines or protocols on the perioperative practice for "prone-position" surgeries. However, new devices have been designed to prevent mechanical ocular compression during prone-position spine surgeries. The authors used PubMed to perform a literature search for devices used in prone-position spine surgeries. A total of 7 devices was found; the authors explored these devices' features, advantages, and disadvantages. The cause of POVL seems to be a multifactorial problem with unclear pathophysiological mechanisms. Therefore, ocular compression is a critical factor, and eliminating any obvious compression to the eye with these devices could possibly prevent this devastating perioperative complication.
http://thejns.org/doi/pdf/10.3171/2009.8.FOCUS09151



Isquemia óptica despues de cirugía de columna.
Ischemic optic neuropathy following spine surgery.
Ho VT, Newman NJ, Song S, Ksiazek S, Roth S.
Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA.
J Neurosurg Anesthesiol. 2005 Jan;17(1):38-44.
Abstract
Perioperative visual loss (POVL) is a devastating injury that has been reported infrequently after nonocular surgery. The most common cause of POVL is ischemic optic neuropathy (ION). Increasing numbers of cases of ION are being reported after spine surgery, but the etiology of postoperative ION remains poorly understood. After a MEDLINE search of the literature, we reviewed published case reports of ION, specifically those reported after spine surgery performed with the patient in the prone position. Most of the cases involved posterior ION (PION, n = 17), and the remainder anterior (AION, n = 5). Most patients had no or few preoperative vascular disease risk factors. All except one PION and 2 of 5 AION cases reported symptom onset within the first 24 hours after surgery. Visual loss was frequently bilateral (40% of AION, 47% of PION cases). Mean operative time exceeded 450 minutes. The lowest average intraoperative mean arterial blood pressure was 64 mm Hg and the mean lowest intraoperative hematocrit was 27%. The average blood loss was 1.7 L for AION and 5 L for PION patients. PION patients received an average of 8 L of crystalloid solution and 2.2 L of colloid intraoperatively. This compilation of case reports suggests that a combination of prolonged surgery in the prone position, decreased ocular perfusion pressure, blood loss and anemia/hemodilution, and infusion of large quantities of intravenous fluids are some of the potential factors involved in the etiology of postoperative ION. However, levels of blood pressure and anemia intraoperatively were frequently at levels considered acceptable in anesthesia practice. The etiology of postoperative ION remains incompletely understood. Potential strategies to avoid this complication are discussed.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699455/pdf/nihms-75440.pdf




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


Estudio comparativo en modelo animal con ruptura aguda de tendón calcáneo con tratamiento quirúrgico aplicando plasma rico en plaquetas

ORTOPEDIA


Hernández-Martínez JC, Vásquez-CR, Ceja-CB, Fuentes-CCE, Sesma-JF, Benítez-AG
Estudio comparativo en modelo animal con ruptura aguda de tendón calcáneo con tratamiento quirúrgico aplicando plasma rico en plaquetas
Acta Ortop Mex 2012; 26 (3)


Idioma: Español
Referencias bibliográficas: 8
Paginas: 170-173
Archivo PDF: 34.53 Kb.


[Texto completo - PDF]


RESUMEN


Objetivo: Comparar la evolución funcional e histológica entre 2 grupos de modelo animal con rupturas agudas del tendón calcáneo con el uso de plasma rico en plaquetas. Material y métodos: Se realizó ensayo clínico abierto en perros donados por el Bioterio de la Benemérita Universidad Autónoma de Puebla (BUAP), divididos en 2 grupos, un grupo control y un grupo problema, a los cuales se les realizó ruptura quirúrgica intencional del tendón calcáneo; se utilizó para reparación del tendón técnica de Krackow y se aplicó al grupo control plasma rico en plaquetas (PRP) en forma de coagulo, al otro no. Se valoraron a las 4 semanas para observar funcionalidad, utilizándose escala de valoración del grado de cojera de Farell y Schwarz. A las 5 semanas se sacrificaron, se obtuvieron los tendones y se enviaron a su estudio histopatológico.Resultados: La funcionalidad según escala de Farell y Schwarz, se encontró para el grupo problema en un grado I y II y el grupo control en un grado IV y V. Histológicamente el grupo problema mostró proliferación vascular moderada y fibroblástica abundante. El grupo testigo mostró proliferación vascular de leve a moderada y fibroblástica moderada. Conclusiones: El PRP mejora la cicatrización tendinosa y esto repercute en la recuperación funcional.

Palabras clave:

calcáneo, tendón, ruptura, plaquetas, plasma, modelo animal.

Exercícios para recuperação de uma entorse de tornozelo

Newsletter do Fa&ccedil;a Fisioterapia



Posted: 11 Sep 2012 06:53 AM PDT

O entorse do tornozelo é uma lesão muito comum na população, seja o indivíduo atleta ou não. Este tipo de lesão representa 40% das lesões esportivas, isto porque o tornozelo é uma articulação que executa funções de estabilidade e mobilidade ao mesmo tempo.

A fisioterapia conta com muitas técnicas e aparelhos para atingir objetivos como analgesia, fortalecimento muscular, manutenção ou ganho da amplitude de movimento de uma articulação, etc, e por isso, o tratamento não deve ser feito em casa e sem a supervisão de um profissional.



1 - Alongamento Com a Toalha:

Sentar sobre uma superfície firme, com a perna lesionada estendida à frente do corpo. 

Laçar o pé com uma toalha e puxá-la, suavemente, em direção ao corpo, mantendo os joelhos estendidos. 

Manter essa posição por 30 segundos e repetir 3 vezes.

Para um bom alongamento, é necessário sentir, apenas, um desconforto, não devendo permitir uma dor aguda. 

Quando esse alongamento for muito fácil, deve-se iniciar o alongamento da panturrilha em pé.



2 - Alongamento da Panturrilha em Pé:
Ficar de pé, com os braços estendidos para frente e as mãos espalmadas e apoiadas em uma parede na altura do peito.
A perna do lado lesionado deve estar, aproximadamente, 40 cm atrás da perna do lado são.
Manter o lado lesionado estendido, com o calcanhar no chão, e inclinar-se contra a parede.
Flexionar o joelho da frente até sentir o alongamento da parte de trás do músculo da panturrilha, do lado lesionado.
Manter essa posição de 30 a 60 segundos e repetir 3 vezes.




3 - Alongamento do Músculo Soleo:
Em pé, de frente para parede com as mãos na altura do peito, com os joelhos levemente dobrados e o pé lesionado para trás, gentilmente apoiar na parede até sentir alongar a parte inferior da panturrilha.
Virar o pé lesionado levemente para dentro e manter o calcanhar no chão.
Manter essa posição por 30 segundos e repetir 3 vezes.



4 - Arco do Movimento do Tornozelo:
Pode ser feito sentado ou deitado.
Com a perna esticada e o joelho apontando para o teto, movimentar o tornozelo para cima e para baixo, para dentro e para fora e em círculos.
Não dobrar o joelho enquanto estiver fazendo esse exercício.
Repetir 20 vezes para cada direção.



5 - Exercícios Com a Faixa Terapêutica:
A - Resistência a dorsiflexão:
Sentado com a perna lesionada estendida e o pé perto de uma cama, enrolar a faixa ao redor da planta do pé. Prender a outra extremidade da faixa no pé da cama.
Puxar os dedos do pé, no sentido do corpo. Lentamente, retornar à posição inicial.
Repetir 10 vezes e fazer 3 séries.

B - Resistência à flexão plantar:
Sentado com a perna lesionada estendida, laçar a planta do pé com o meio da faixa.
Segurar as pontas da faixa com ambas as mãos e, suavemente, empurrar o pé para baixo apontando os dedos do pé para frente, tencionando a faixa terapêutica (thera band), como se estivesse acelerando o pedal de um carro.

C - Inversão com resistência:
Sentar com as pernas estendidas, cruzar a perna não lesionada sobre o tornozelo lesionado.
Enrolar a faixa no pé lesionado e em seguida laçar pé bom, para que a faixa terapêutica (thera band) fique com uma ponta presa.
Segurar a outra ponta da faixa terapêutica (thera band) com a mão. Virar o pé lesionado para dentro e para cima.
Retornar à posição inicial. Fazer 3 séries de 10.

D - Eversão com resistência:
Sentado, com ambas as pernas estendidas e a faixa laçada em volta de ambos os pés.
Lentamente, virar o pé lesionado para cima e para fora.
Manter essa posição por 5 segundos. Fazer 3 séries de 10.





6 - Elevação dos Calcanhares:
Segurar em uma cadeira e suspender o corpo sobre os dedos dos pés, tirando os calcanhares do chão.
Manter esta posição por 3 segundos e, lentamente, voltar à posição inicial.
Repetir 10 vezes e fazer 5 séries.
À medida que o exercício ficar fácil, levantar, apenas, o lado lesionado.



7 - Elevação Dos Dedos do Pé:
Em pé, tirar os dedos do chão.
No início pode-se balançar para trás sobre os calcanhares, de maneira que os dedos dos pés saiam do chão, para facilitar o exercício.
Manter essa posição por 5 segundos e fazer 3 séries
de 10.



8 - Equilíbrio Sobre Uma Perna:
Ficar em pé, sem apoiar em nada e equilibrar-se sobre a perna lesionada.
Não deixar que o arco do pé aplaine-se, nem que os dedos do pé se dobrem.
Começar com os olhos abertos e, posteriormente, tentar fazer o exercício com os olhos fechados.
Manter a posição sobre uma única perna por 30 segundos.
Repetir 3 vezes.



9 - Pular Corda:
Pular corda com as duas pernas, por 1 minuto, depois apenas sobre a perna lesionada, por 1 minuto.
Se ficar fácil, aumentar o tempo.



10 - Tábua de Equilíbrio:
Esse exercício é importante para restaurar o equilíbrio e a coordenação do tornozelo.
Subir em uma tábua de oscilação e equilibrar-se apoiando sobre ambas as pernas e depois, sobre a perna lesionada.
Fazer isso por 2 a 5 minutos, 3 vezes ao dia.
Uma cadeira pode ser colocada em frente ao paciente, para ajudar a equilibrar-se.
Com a ajuda daqui

[Identidad Bibliotecaria] LOS AUTORES QUE NO AMABAN A OTROS AUTORES


El ego del escritor es legendariamente inmenso, y con los grandes talentos llegan, con frecuencia, grandes y conflictivas personalidades. Por tanto, no ha de extrañarnos que las disputas entre autores (y, por supuesto, las disputas entre autores y críticos) estén a la orden del día.

Todos recordamos aquel soneto A una nariz de Quevedo, tal vez la muestra más famosa que tenemos en la historia de la literatura española de un desencuentro entre grandes autores. Pero las broncas literarias no son exclusivas de un solo país, cultura o época. Hay odios, desprecios y rencores para elegir, como en todas las familias.

La animadversión no se limita a los coetáneos, ya que muchos autores han expresado, de manera vehemente, su aberración por escritores ya fallecidos. Algunos hasta han insistido en su deseo de desenterrar al autor detestado para aporrear su esqueleto, como le ocurría al dramaturgo George Bernard Shaw, que odiaba tanto las obras deWilliam Shakespeare que afirmaba que la intensidad de mi impaciencia con Shakespeare llega a veces hasta tal punto que sería para mí un alivio desenterrarlo para tirarle piedras, conociendo como conozco tanto su incapacidad como la de sus adoradores para entender cualquier forma menos obvia de humillación. Claro está queShaw también tenía sus detractores; de él dijo H. G. Wells (autor de La máquina del tiempo o La guerra de los mundos) que era un niño idiota gritando en un hospital. Y aquello de vejar cadáveres no se quedaba en el célebre dramaturgo irlandés; Mark Twain decía de Jane Austen, autora de grandes clásicos de la novela decimonónica comoSentido y sensibilidad que cada vez que leo Orgullo y prejuicio quiero desenterrarla y pegarle en el cráneo con su propia tibia.

Ni los más grandes y populares se libran del odio de sus colegas escritores. Y qué decir de críticos y teóricos: Harold Bloom dijo de J. K. Rowling, en el año 2000: ¿Cómo leer Harry Potter y la piedra filosofal? Bueno, con mucha prisa, para poder llegar al final. ¿Por qué leerlo? Si es imposible convencerte de que leas otra cosa mejor, imagino que Rowling tendrá que servirte. Stephen King, sin embargo, defendía a Harry Potter, aunque no puede decirse lo mismo de Crepúsculo: Tanto Rowling como Meyer le están hablando de manera directa a los jóvenes. La diferencia es que J. K. Rowling es una autora excelente y Stephenie Meyer no sabe escribir. No es muy buena.

Ni siquiera ese gran favorito de la literatura española, Cervantes, se libra del desprecio ajeno. Martin Amis dijo del Quijote en una ocasión: Leer Don Quijote podría compararse con una visita indefinida de tu pariente anciano más insoportable, con todas sus travesuras, costumbres asquerosas, relatos interminables y amigos terribles. Cuando termina la visita, y el viejo por fin se marcha (en la página 846 de una prosa apretada, sin pausas para el diálogo), llorarás, pero no lágrimas de alivio o arrepentimiento sino de orgullo. Lo conseguiste, a pesar de todo lo que Don Quijote podía hacerte.

Fuente:

http://www.lecturalia.com/blog/2012/09/12/los-autores-que-no-amaban-a-otros-autores/

A149. Aplicaciones médicas para móviles: sepsis

http://www.medicina-intensiva.com/2012/09/A149.html


MARTES, 11 DE SEPTIEMBRE DE 2012

A149. Aplicaciones médicas para móviles: sepsis

El día mundial de la sepsis se celebra el 13 de septiembre de 2012 para concienciar a los profesionales y a la población de la importancia de prevenir y tratar este síndrome [1-3]. Con dicho motivo, presentamos aquí brevemente las principales aplicaciones gratuitas sobre sepsis disponibles para dispositivos móviles.

1. Sepsis central (Quick Consult) [Enlace]


Aplicación gratuita, solo para dispositivos Android. Última actualización en abril de 2011. La página web de referencia de la aplicación (http://www.sepsiscentral.com/) no existe.

En palabras de los autores: "los pacientes con sepsis a menudo no parecen graves y sus síntomas se diagnostican erróneamente como de otros procesos. Cuando la sepsis no se reconoce y se trata precozmente, el paciente desarrolla sepsis grave. Una corta ventana de seis horas puede significar la vida o la muerte".

Los contenidos de la aplicación se basan en las guías de práctica clínica. Los temas incluidos son:

Reconocimiento y diagnóstico precoz
Puntuaciones de gravedad
Tratamiento
Biomarcadores
Referencias
2. Sepsis clinical guide [Enlace Android] [Enlace Apple]


Coincidiendo con el Día Mundial de la Sepsis, ESCAVO ofrece gratuitamente solo durante este mes de septiembre de 2012 esta aplicación, con versiones para dispositivos Apple y Android (versión 2.3 o siguientes). Dirigida a médicos y otros profesionales sanitarios que atienden pacientes críticos, la aplicación contiene información y herramientas para el diagnóstico y tratamiento de la sepsis y el shock séptico.

La aplicación pone el énfasis en ofrecer información útil a la cabecera del enfermo para el reconocimiento y tratamiento precoces de la sepsis. Los temas incluidos son los siguientes:

Epidemiología, factores de riesgo y fisiopatología
Definiciones y criterios diagnósticos
Principales infecciones que provocan sepsis
Paquetes de medidas de resucitación y tratamiento, basados en las recomendaciones de la Campaña sobrevivir a la sepsis y la American Thoracic Society.
Tratamiento antibiótico
Sepsis pediátrica y neonatal
Calculadores clínicos (APACHE-II, MODS, SAPS-II, SOFA, CPIS, etc.)
Fármacos 3. Sepsis guide [Enlace]


Aplicación solo para dispositivos Apple, gratuita, recomendada por la Campaña Sobrevivir a la Sepsis, y basada en sus guías de práctica clínica. Aunque la última versión es de mayo de 2012, sin embargo no se encuentra actualizada, ya que sigue recomendando el uso de proteína C activada, retirada del mercado hace ya casi un año.

Contenido de la aplicación:

Criterios diagnósticos
Resucitación y antibioterapia iniciales
Soporte hemodinámico
Tratamiento de soporte
Consideraciones para el paciente pediátrico
Paquetes de medidas
Referencias bibliográficas
Enlaces a sociedades científicas
4. Sepsis antibiotic guideline [Enlace]


Aplicación solo para dispositivos Android, forma parte del programa "Sepsis Kills" de la "Clinical Excellence Commission" (CEC) australiana. El contenido completo de este programa se encuentra disponible en la web [Program Sepsis Kills]. Aplicación gratuita, actualizada en septiembre de 2012.

La aplicación se centra en uno de los aspectos del programa, la administración de la primera dosis empírica de tratamiento antibiótico en adultos con sepsis; las recomendaciones de antibioterapia [PDF] se basa en las recomendaciones de antibioterapia empírica de la CEC.

Conclusión

Existen varias aplicaciones gratuitas para dispositivos móviles (con sistema operativo Android o iOS de Apple) sobre el diagnóstico y tratamiento de la sepsis. Todas ellas se basan en las guías de práctica clínica de la campaña sobrevivir a la sepsis, y ofrecen poca funcionalidad añadida aparte del acceso o la consulta rápidos a los contenidos de estas guías, más o menos desarrollados. Algunas de ellas, como la "Sepsis guide", inexplicablemente no se encuentran actualizadas en aspectos tan importantes como la retirada del mercado de la proteína C activada.

Eduardo Palencia Herrejón
Hospital Universitario Infanta Leonor, Madrid.
© REMI, http://medicina-intensiva.com. Septiembre 2012.

Enlaces:

[World Sepsis Day]
[Global Sepsis Alliance]
[Stop Sepsis, Save Lives]


Do Antibacterial Cement Spacers Help Treat Prosthetic Joint Infections?


http://www.medscape.com/viewarticle/770438

From Reuters Health Information
Do Antibacterial Cement Spacers Help Treat Prosthetic Joint Infections?


By Will Boggs, MD

NEW YORK (Reuters Health) Sep 06 - In two-stage revisions of infected prosthetic joints, does temporary placement of antibacterial cement spacers improve the outcome? In a recent literature review, researchers at the U.S. Food and Drug Administration couldn't find a conclusive answer to that question.

"Data on the role of antibacterials in spacers is limited and have not been evaluated in randomized clinical trials," coauthors Dr. Dmitri Iarikov and Dr. Sumathi Nambiar told Reuters Health by email. "In addition, the safety profile of the spacers has not been systematically evaluated, especially with regard to renal and vestibular toxicity. Case reports indicate that renal toxicity related to their use is possible."

But the lack of evidence in their favor hasn't kept antibacterial cement spacers from being widely used, the researchers say.

The two authors and their colleagues conducted a systematic review of published studies reporting results of two-stage knee and/or hip arthroplasty and compared infection eradication rates associated with spacers of different antibacterial composition.

The spacers are usually left in place for six to eight weeks. Patients also receive systemic antibiotics, as the authors noted in a report online August 23rd online in Clinical Infectious Diseases.

Ultimately, their review included 20 publications involving 824 patients with 836 infected joints. None of the studies was randomized, and all studies of knee spacers were case series without controls.

The investigators estimated infection eradication rates ranging from 46% to 100%, but the retrospective design and different levels of detail in the studies precluded a combined analysis.

There was no obvious difference overall in infection eradication rates when cements with different antibacterial loads and compositions were used.

The analysis also suggested that prosthetic joint infections could be successfully treated even when antibacterials added to spacers were not active against the infecting organisms.

Rates of renal impairment after placement of antibacterial cement spacers ranged from 0% to 10%, but the noncomparative retrospective designs did not allow for conclusions regarding the relationship between spacers and renal failure.

"The addition of antibacterials to interim spacers for the treatment of prosthetic joint infections has become standard of care with the emphasis to use at least 3.6-4 g of antibacterials per 40 g of cement," the researchers note. "However, no clinical data supporting these recommendations have been identified."

SOURCE: http://bit.ly/TmF700

Clin Infect Dis 2012.

The Choice and Doses of Antibacterial Agents for Cement Spacers in Treatment of Prosthetic Joint Infections: Review of Published Studies

D. Iarikov,
H. Demian,
D. Rubin,
J. Alexander, and
S. Nambiar

+Author Affiliations
U.S. FDA, Silver Spring, MD
Corresponding Author: D. Iarikov, MD, PhD, Division of Anti-infective products, U.S. Food and Drug Administration, Tel. 301-796-2292, E-mail: Dmitri.Iarikov@fda.hhs.gov


Alternate Corresponding Author: Sumathi Nambiar, MD, Division of Anti-infective products, U.S. Food and Drug Administration, Tel: 301-796-0772, E-mail:Sumathi.Nambiar@fda.hhs.gov

Unicompartmental Knee Arthroplasty: Simulator Explores Ways to Boost Success Rates

Bits of Mystery DNA, Far From ‘Junk,’ Play Crucial Role

http://www.nytimes.com/2012/09/06/science/far-from-junk-dna-dark-matter-proves-crucial-to-health.html?_r=1&nl=afternoonupdate&emc=edit_au_20120905


Bits of Mystery DNA, Far From ‘Junk,’ Play Crucial Role
By GINA KOLATA
Published: September 5, 2012 574 Comments


Among the many mysteries of human biology is why complex diseases like diabetes, high blood pressure and psychiatric disorders are so difficult to predict and, often, to treat. An equally perplexing puzzle is why one individual gets a disease like cancer or depression, while an identical twin remains perfectly healthy.

Béatrice de Géa for The New York Times

“It is like opening a wiring closet and seeing a hairball of wires,” Mark Gerstein of Yale University said of the DNA intricacies.

GRAPHIC: Rethinking ‘Junk’ DNA

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Now scientists have discovered a vital clue to unraveling these riddles. The human genome is packed with at least four million gene switches that reside in bits of DNA that once were dismissed as “junk” but that turn out to play critical roles in controlling how cells, organs and other tissues behave. The discovery, considered a major medical and scientific breakthrough, has enormous implications for human health because many complex diseases appear to be caused by tiny changes in hundreds of gene switches.

The findings, which are the fruit of an immense federal project involving 440 scientists from 32 laboratories around the world, will have immediate applications for understanding how alterations in the non-gene parts of DNA contribute to human diseases, which may in turn lead to new drugs. They can also help explain how the environment can affect disease risk. In the case of identical twins, small changes in environmental exposure can slightly alter gene switches, with the result that one twin gets a disease and the other does not.

As scientists delved into the “junk” — parts of the DNA that are not actual genes containing instructions for proteins — they discovered a complex system that controls genes. At least 80 percent of this DNA is active and needed. The result of the work is an annotated road map of much of this DNA, noting what it is doing and how. It includes the system of switches that, acting like dimmer switches for lights, control which genes are used in a cell and when they are used, and determine, for instance, whether a cell becomes a liver cell or a neuron.

“It’s Google Maps,” said Eric Lander, president of the Broad Institute, a joint research endeavor of Harvard and the Massachusetts Institute of Technology. In contrast, the project’s predecessor, the Human Genome Project, which determined the entire sequence of human DNA, “was like getting a picture of Earth from space,” he said. “It doesn’t tell you where the roads are, it doesn’t tell you what traffic is like at what time of the day, it doesn’t tell you where the good restaurants are, or the hospitals or the cities or the rivers.”

The new result “is a stunning resource,” said Dr. Lander, who was not involved in the research that produced it but was a leader in the Human Genome Project. “My head explodes at the amount of data.”

The discoveries were published on Wednesday in six papers in the journal Nature and in 24 papers in Genome Research and Genome Biology. In addition, The Journal of Biological Chemistry is publishing six review articles, and Science is publishing yet another article.

Human DNA is “a lot more active than we expected, and there are a lot more things happening than we expected,” said Ewan Birney of the European Molecular Biology Laboratory-European Bioinformatics Institute, a lead researcher on the project.

In one of the Nature papers, researchers link the gene switches to a range of human diseases — multiple sclerosis, lupus, rheumatoid arthritis, Crohn’s disease, celiac disease — and even to traits like height. In large studies over the past decade, scientists found that minor changes in human DNA sequences increase the risk that a person will get those diseases. But those changes were in the junk, now often referred to as the dark matter — they were not changes in genes — and their significance was not clear. The new analysis reveals that a great many of those changes alter gene switches and are highly significant.

“Most of the changes that affect disease don’t lie in the genes themselves; they lie in the switches,” said Michael Snyder, a Stanford University researcher for the project, calledEncode, for Encyclopedia of DNA Elements.

And that, said Dr. Bradley Bernstein, an Encode researcher at Massachusetts General Hospital, “is a really big deal.” He added, “I don’t think anyone predicted that would be the case.”

The discoveries also can reveal which genetic changes are important in cancer, and why. As they began determining the DNA sequences of cancer cells, researchers realized that most of the thousands of DNA changes in cancer cells were not in genes; they were in the dark matter. The challenge is to figure out which of those changes are driving the cancer’s growth.


These papers are very significant,” said Dr. Mark A. Rubin, a prostate cancer genomics researcher at Weill Cornell Medical College. Dr. Rubin, who was not part of the Encode project, added, “They will definitely have an impact on our medical research on cancer.”

In prostate cancer, for example, his group found mutations in important genes that are not readily attacked by drugs. But Encode, by showing which regions of the dark matter control those genes, gives another way to attack them: target those controlling switches.

Dr. Rubin, who also used the Google Maps analogy, explained: “Now you can follow the roads and see the traffic circulation. That’s exactly the same way we will use these data in cancer research.” Encode provides a road map with traffic patterns for alternate ways to go after cancer genes, he said.

Dr. Bernstein said, “This is a resource, like the human genome, that will drive science forward.”

The system, though, is stunningly complex, with many redundancies. Just the idea of so many switches was almost incomprehensible, Dr. Bernstein said.

There also is a sort of DNA wiring system that is almost inconceivably intricate.

“It is like opening a wiring closet and seeing a hairball of wires,” said Mark Gerstein, an Encode researcher from Yale. “We tried to unravel this hairball and make it interpretable.”

There is another sort of hairball as well: the complex three-dimensional structure of DNA. Human DNA is such a long strand — about 10 feet of DNA stuffed into a microscopic nucleus of a cell — that it fits only because it is tightly wound and coiled around itself. When they looked at the three-dimensional structure — the hairball — Encode researchers discovered that small segments of dark-matter DNA are often quite close to genes they control. In the past, when they analyzed only the uncoiled length of DNA, those controlling regions appeared to be far from the genes they affect.

The project began in 2003, as researchers began to appreciate how little they knew about human DNA. In recent years, some began to find switches in the 99 percent of human DNA that is not genes, but they could not fully characterize or explain what a vast majority of it was doing.

The thought before the start of the project, said Thomas Gingeras, an Encode researcher from Cold Spring Harbor Laboratory, was that only 5 to 10 percent of the DNA in a human being was actually being used.

The big surprise was not only that almost all of the DNA is used but also that a large proportion of it is gene switches. Before Encode, said Dr. John Stamatoyannopoulos, a University of Washington scientist who was part of the project, “if you had said half of the genome and probably more has instructions for turning genes on and off, I don’t think people would have believed you.”

By the time the National Human Genome Research Institute, part of the National Institutes of Health, embarked on Encode, major advances in DNA sequencing and computational biology had made it conceivable to try to understand the dark matter of human DNA. Even so, the analysis was daunting — the researchers generated 15 trillion bytes of raw data. Analyzing the data required the equivalent of more than 300 years of computer time.

Just organizing the researchers and coordinating the work was a huge undertaking. Dr. Gerstein, one of the project’s leaders, has produced a diagram of the authors with their connections to one another. It looks nearly as complicated as the wiring diagram for the human DNA switches. Now that part of the work is done, and the hundreds of authors have written their papers.

“There is literally a flotilla of papers,” Dr. Gerstein said. But, he added, more work has yet to be done — there are still parts of the genome that have not been figured out.

That, though, is for the next stage of Encode.


A version of this article appeared in print on September 6, 2012, on page A1 of the New York edition with the headline: Study Discovers Road Map of DNA; A Key to Biology.

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martes, 11 de septiembre de 2012

Curso de Tumores Oseos. Oaxaca 1-2/XI/2012



Participación aguda de miocárdio despues de inhalación de cocaína

Participación aguda de miocárdio despues de inhalación de cocaína

Acute myocardial involvement after heroin inhalation
Karoli R, Fatima J, Singh P, Kazmi KI.
J Pharmacol Pharmacother [serial online] 2012 [cited 2012 Aug 7];3:282-4.

Amongst the illicit drugs cocaine, amphetamines and cannabis have been studied and documented well to cause myocardial infarction by different mechanisms but there is very sparse data available on myocardial involvement after heroin abuse. We report a young man who developed acute myocardial injury after heroin inhalation and alcohol binge drinking. Heroin induced cardio toxic effect and vasospasm compounded by alcohol were suspected to be the cause of this.
Keywords: Acute myocardial infarction, binge drinking, heroin abuse, myocardial infarction in young
http://www.jpharmacol.com/text.asp?2012/3/3/282/99448


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