Revisiones bibliográficas. Documentación científica en Ortopedia y Traumatología, medicina deportiva, artroscopia, artroplastia y de todas las patologías del sistema Músculo-Esquelético
jueves, 25 de diciembre de 2014
Navidad!!!
La Navidad en la Montañas
Ignacio Manuel Altamirano
http://www.biblioteca.org.ar/libros/155394.pdf
Canción de Navidad
Charles Dickens
http://www.biblioteca.org.ar/libros/656167.pdf
A Christmas Carol
http://www.sfu.ca/~poitras/Dickens_Christmas_Carol.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Ignacio Manuel Altamirano
http://www.biblioteca.org.ar/libros/155394.pdf
Canción de Navidad
Charles Dickens
http://www.biblioteca.org.ar/libros/656167.pdf
A Christmas Carol
http://www.sfu.ca/~poitras/Dickens_Christmas_Carol.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
miércoles, 24 de diciembre de 2014
Analgesia postcesárea/Postcesarean analgesia
Efecto de la infusión pre-emptiva de sulfato de magnesio sobre el alivio del dolor postoperatorio en cesárea electiva
Effect of pre-emptive magnesium sulfate infusion on the post-operative pain relief after elective cesarean section.
Rezae M, Naghibi K, Taefnia AM.
Adv Biomed Res. 2014 Aug 19;3:164. doi: 10.4103/2277-9175.139127. eCollection 2014.
Abstract
BACKGROUND:The aim of this study was to evaluate the analgesic efficacy of pre-operative single dose of intravenous (I.V.) magnesium sulfate infusion in patients undergoing elective Cesarean section. MATERIALS AND METHODS:Seventy pregnant women who underwent elective Cesarean section were randomly divided into two groups. Before induction of anesthesia, the magnesium group (Group A) received magnesium sulfate 50 mg/kg I.V. in bolus dose. The control group (Group B) received the same volume of isotonic saline. The pain scores at rest and also upon movement were evaluated up to 24 h post-operatively and analgesic requirement was recorded during the first 24 h after operation. RESULTS: Cumulative analgesic consumption (24 h after operation was 11.2 ± 6.3 mg in group A vs. 13.9 ± 3.9 mg in group B). Post-operative pain scores (24 h after operation was 1.8 ± 2.1 in group A vs. 2.9 ± 1.2 in group B) and shivering incidents (8.57 in group A vs. 14.28 in group B) were significantly lower in Group A (P < 0.05). Mean arterial pressure just after intubation and during the immediate post-operative period was significantly lower in Group A (P < 0.05). CONCLUSION: Pre-operative intravenous magnesium sulfate infusion decrease post-operation pain and requirement of analgesia in Cesarean section. KEYWORDS:Cesarean section; magnesium sulfate; post-operative pain
http://www.advbiores.net/downloadpdf.asp?issn=2277-9175;year=2014;volume=3;issue=1;spage=164;epage=164;aulast=Rezae;type=2
Comparación de la eficiencia analgésica entre la infiltración de la herida y el bloqueo TAP guiado con ultrasonido después de cesárea con anestesia espinal
Comparison of analgesic efficiency between wound site infiltration and ultra-sound-guided transversus abdominis plane block after cesarean delivery under spinal anaesthesia.
Aydogmus M, Sinikoglu S, Naki M, Ocak N, Sanlı N, Alagol A.
Hippokratia. 2014 Jan;18(1):28-31.
Abstract
BACKGROUND: [corrected] Local anesthetic infiltration applied on the wound site or abdominal wall may be used for relieving postoperative pain after delivery by caesarean section. The aim of this study was to compare the analgesic efficiency of ultrasound (USG)-guided transversus abdominis plane (TAP) block with local anesthetic infiltration on a wound site. METHODS:This study was designed as a prospective randomized trial, and consisted of 70 pregnant women of American Society of Anesthesiologists (ASA) class I-II. Patients were randomized into Group I (wound site infiltration, n=35) and Group T (TAP block, n=35). Spinalanaesthesia was administered to all patients. In Group I, wound site infiltration was applied by the surgical team. In Group T, a USG-guided bilateral TAP block was applied. Patients' numeric pain scale (NPS) levels at 2, 6, 12 and 24(th) hours, after the operation (NPS0) and during mobilization were assessed. Postoperative complications, time to first analgesic request and patient satisfaction were recorded. RESULTS: The NPS0 values of Group T were found to higher and time to first analgesic request longer than those of Group I. The NPS values of Group I at 2, 6, 12, and 24(th) hours were found to be statistically significantly higher than those of Group T. CONCLUSIONS: According to our results, USG-guided TAP block might be superior to infiltration anaesthesia for postoperative pain management of patients who have had caesarean section and it provided longer-lasting and more efficient analgesia.
KEYWORDS: Ultrasound; cesarean section; infiltration anaesthesia; transversus abdominis plane block
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103037/pdf/hippokratia-18-28.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Effect of pre-emptive magnesium sulfate infusion on the post-operative pain relief after elective cesarean section.
Rezae M, Naghibi K, Taefnia AM.
Adv Biomed Res. 2014 Aug 19;3:164. doi: 10.4103/2277-9175.139127. eCollection 2014.
Abstract
BACKGROUND:The aim of this study was to evaluate the analgesic efficacy of pre-operative single dose of intravenous (I.V.) magnesium sulfate infusion in patients undergoing elective Cesarean section. MATERIALS AND METHODS:Seventy pregnant women who underwent elective Cesarean section were randomly divided into two groups. Before induction of anesthesia, the magnesium group (Group A) received magnesium sulfate 50 mg/kg I.V. in bolus dose. The control group (Group B) received the same volume of isotonic saline. The pain scores at rest and also upon movement were evaluated up to 24 h post-operatively and analgesic requirement was recorded during the first 24 h after operation. RESULTS: Cumulative analgesic consumption (24 h after operation was 11.2 ± 6.3 mg in group A vs. 13.9 ± 3.9 mg in group B). Post-operative pain scores (24 h after operation was 1.8 ± 2.1 in group A vs. 2.9 ± 1.2 in group B) and shivering incidents (8.57 in group A vs. 14.28 in group B) were significantly lower in Group A (P < 0.05). Mean arterial pressure just after intubation and during the immediate post-operative period was significantly lower in Group A (P < 0.05). CONCLUSION: Pre-operative intravenous magnesium sulfate infusion decrease post-operation pain and requirement of analgesia in Cesarean section. KEYWORDS:Cesarean section; magnesium sulfate; post-operative pain
http://www.advbiores.net/downloadpdf.asp?issn=2277-9175;year=2014;volume=3;issue=1;spage=164;epage=164;aulast=Rezae;type=2
Comparación de la eficiencia analgésica entre la infiltración de la herida y el bloqueo TAP guiado con ultrasonido después de cesárea con anestesia espinal
Comparison of analgesic efficiency between wound site infiltration and ultra-sound-guided transversus abdominis plane block after cesarean delivery under spinal anaesthesia.
Aydogmus M, Sinikoglu S, Naki M, Ocak N, Sanlı N, Alagol A.
Hippokratia. 2014 Jan;18(1):28-31.
Abstract
BACKGROUND: [corrected] Local anesthetic infiltration applied on the wound site or abdominal wall may be used for relieving postoperative pain after delivery by caesarean section. The aim of this study was to compare the analgesic efficiency of ultrasound (USG)-guided transversus abdominis plane (TAP) block with local anesthetic infiltration on a wound site. METHODS:This study was designed as a prospective randomized trial, and consisted of 70 pregnant women of American Society of Anesthesiologists (ASA) class I-II. Patients were randomized into Group I (wound site infiltration, n=35) and Group T (TAP block, n=35). Spinalanaesthesia was administered to all patients. In Group I, wound site infiltration was applied by the surgical team. In Group T, a USG-guided bilateral TAP block was applied. Patients' numeric pain scale (NPS) levels at 2, 6, 12 and 24(th) hours, after the operation (NPS0) and during mobilization were assessed. Postoperative complications, time to first analgesic request and patient satisfaction were recorded. RESULTS: The NPS0 values of Group T were found to higher and time to first analgesic request longer than those of Group I. The NPS values of Group I at 2, 6, 12, and 24(th) hours were found to be statistically significantly higher than those of Group T. CONCLUSIONS: According to our results, USG-guided TAP block might be superior to infiltration anaesthesia for postoperative pain management of patients who have had caesarean section and it provided longer-lasting and more efficient analgesia.
KEYWORDS: Ultrasound; cesarean section; infiltration anaesthesia; transversus abdominis plane block
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103037/pdf/hippokratia-18-28.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Libro sobre Neuroquímica
Libro sobre Neuroquímica
Book on Neurochemistry
Edited by Thomas Heinbockel, ISBN 978-953-51-1237-2, 414 pages, Publisher: InTech, Chapters published April 23, 2014 under CC BY 3.0 license
DOI: 10.5772/57074
Neurochemistry is a flourishing academic field that contributes to our understanding of molecular, cellular and medical neurobiology. As a scientific discipline, neurochemistry studies the role of chemicals that build the nervous system, it explores the function of neurons and glial cells in health and disease, it discovers aspects of cell metabolism and neurotransmission, and it reveals how degenerative processes are at work in the nervous system. Accordingly, this book contains chapters from a variety of topics that fall into the following broad sections: I. Neural Membranes and Intracellular Signaling, II. Neural Processing and Intercellular Signaling, III. Growth, Development and Differentiation, and IV. Neurodegenerative Diseases. The book presents comprehensive reviews in these different areas written by experts in their respective fields. Neurodegeneration and neuronal diseases are featured prominently and are a recurring theme throughout most chapters. This book will be a most valuable resource for neurochemists and other scientists alike. In addition, it will contribute to the training of current and future neurochemists and, hopefully, will lead us on the path to curing some of the biggest challenges in human health.
http://www.intechopen.com/books/neurochemistry
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Book on Neurochemistry
Edited by Thomas Heinbockel, ISBN 978-953-51-1237-2, 414 pages, Publisher: InTech, Chapters published April 23, 2014 under CC BY 3.0 license
DOI: 10.5772/57074
Neurochemistry is a flourishing academic field that contributes to our understanding of molecular, cellular and medical neurobiology. As a scientific discipline, neurochemistry studies the role of chemicals that build the nervous system, it explores the function of neurons and glial cells in health and disease, it discovers aspects of cell metabolism and neurotransmission, and it reveals how degenerative processes are at work in the nervous system. Accordingly, this book contains chapters from a variety of topics that fall into the following broad sections: I. Neural Membranes and Intracellular Signaling, II. Neural Processing and Intercellular Signaling, III. Growth, Development and Differentiation, and IV. Neurodegenerative Diseases. The book presents comprehensive reviews in these different areas written by experts in their respective fields. Neurodegeneration and neuronal diseases are featured prominently and are a recurring theme throughout most chapters. This book will be a most valuable resource for neurochemists and other scientists alike. In addition, it will contribute to the training of current and future neurochemists and, hopefully, will lead us on the path to curing some of the biggest challenges in human health.
http://www.intechopen.com/books/neurochemistry
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
El libro murió, pero persiste, como un zombi.
El libro murió, pero persiste, como un zombi. Nunca se editó tanto como en la
actualidad: sin contar las ediciones digitales, la cantidad de ejemplares
impresos en papel supera todo lo conocido hasta ahora. Además, nunca se leyó
tanto como en nuestra época: no sólo porque somos muchos más de lo que nunca
fuimos antes, sino porque absolutamente todo está escrito. Además, nunca
dedicamos tanto tiempo a leer.
Sin embargo, y a pesar de la masificación de la lectura y del auge de la
edición, ya no se leen más libros. El libro como objeto se masifica, a la vez
que el libro como concepto ha desaparecido (o está desapareciendo y sólo
sobrevive en los márgenes de la cultura contemporánea).
El libro surgió hace 500 años. Fue uno de los más grandes inventos de la
humanidad. Permitió un avance formidable en el campo de la comunicación. Antes
del libro, la cultura tuvo soportes y formas de leer mucho más precarias.
Antes de la imprenta, se leía y debatía en grupo, en voz alta, entre otras cosas
porque cada ejemplar costaba una fortuna. Ese tipo de lectura (que se extendió
desde Grecia hasta la Edad Media) no permitía imaginar historias en las que los
personajes tuvieran intimidad: para eso fue necesario que se masificara la
lectura silenciosa y se la realizara de manera individual. Esa experiencia hizo
posibles el Martín Fierro, Oliver Twist y el Ulises.
¿Qué implicaba un libro? Un mundo cerrado. Con un principio y un fin. Un mundo
completo entre dos tapas. Por cierto, ya en el libro había un anuncio de esa
otra forma de leer: la intertextualidad, que permitía leer entre libros,
conectar mundos diversos, sospechar que quizás el universo estaba abierto. Pero
para que la intertextualidad funcionara era necesario una mínima (no tan mínima)
erudición. No cualquiera era capaz de abrir un libro y saber conectarlo con
otros.
El libro no es un objeto: es una tecnología (que quedó obsoleta), una idea, una
forma de leer y una forma de estar en el mundo. Ahora nos queda el objeto, pero
vacío de sentido. Vivimos conectados todo el tiempo: ya no leemos mundos
cerrados (menos aún, entre dos tapas). Conectamos fragmentos. Leer, ahora, es
una sucesión de conexiones inconexas. Pasamos de un texto a un video, de un MP3
a una imagen: sin solución de continuidad.
Todas esas discusiones sobre los precios de los libros digitales y los derechos
de autor de los de papel pertenecen al pasado, aunque aun muevan un mercado de
miles de millones. Lo importante hoy es la forma en que ahora leemos: vivimos
conectando fragmentos de distinto tipo y soporte hasta cuando soñamos.
Internet y la vida digital nos hizo seres anfibios: vivimos en el mundo de los
átomos, pero mirando pantallas que nos colocan en el mundo virtual. Sin darnos
cuenta, somos distintos de los que éramos hace 20 años: somos los que ya no
podemos leer de la misma forma en como se hacía hasta fines del siglo XX.
Somos la simiente de la lectura tal como se la verá en el futuro próximo. Ese
futuro en el que vivir y leer serán la misma experiencia. Como ya sucede ahora.
El autor es crítico cultural.
Fuente: http://www.lanacion.com.ar/1754320-cuentos-de-navidad-la-esperanza-de-lo-m
"La biblioteca es el lugar del ejercicio público de la razón" Gabriel Naudé
actualidad: sin contar las ediciones digitales, la cantidad de ejemplares
impresos en papel supera todo lo conocido hasta ahora. Además, nunca se leyó
tanto como en nuestra época: no sólo porque somos muchos más de lo que nunca
fuimos antes, sino porque absolutamente todo está escrito. Además, nunca
dedicamos tanto tiempo a leer.
Sin embargo, y a pesar de la masificación de la lectura y del auge de la
edición, ya no se leen más libros. El libro como objeto se masifica, a la vez
que el libro como concepto ha desaparecido (o está desapareciendo y sólo
sobrevive en los márgenes de la cultura contemporánea).
El libro surgió hace 500 años. Fue uno de los más grandes inventos de la
humanidad. Permitió un avance formidable en el campo de la comunicación. Antes
del libro, la cultura tuvo soportes y formas de leer mucho más precarias.
Antes de la imprenta, se leía y debatía en grupo, en voz alta, entre otras cosas
porque cada ejemplar costaba una fortuna. Ese tipo de lectura (que se extendió
desde Grecia hasta la Edad Media) no permitía imaginar historias en las que los
personajes tuvieran intimidad: para eso fue necesario que se masificara la
lectura silenciosa y se la realizara de manera individual. Esa experiencia hizo
posibles el Martín Fierro, Oliver Twist y el Ulises.
¿Qué implicaba un libro? Un mundo cerrado. Con un principio y un fin. Un mundo
completo entre dos tapas. Por cierto, ya en el libro había un anuncio de esa
otra forma de leer: la intertextualidad, que permitía leer entre libros,
conectar mundos diversos, sospechar que quizás el universo estaba abierto. Pero
para que la intertextualidad funcionara era necesario una mínima (no tan mínima)
erudición. No cualquiera era capaz de abrir un libro y saber conectarlo con
otros.
El libro no es un objeto: es una tecnología (que quedó obsoleta), una idea, una
forma de leer y una forma de estar en el mundo. Ahora nos queda el objeto, pero
vacío de sentido. Vivimos conectados todo el tiempo: ya no leemos mundos
cerrados (menos aún, entre dos tapas). Conectamos fragmentos. Leer, ahora, es
una sucesión de conexiones inconexas. Pasamos de un texto a un video, de un MP3
a una imagen: sin solución de continuidad.
Todas esas discusiones sobre los precios de los libros digitales y los derechos
de autor de los de papel pertenecen al pasado, aunque aun muevan un mercado de
miles de millones. Lo importante hoy es la forma en que ahora leemos: vivimos
conectando fragmentos de distinto tipo y soporte hasta cuando soñamos.
Internet y la vida digital nos hizo seres anfibios: vivimos en el mundo de los
átomos, pero mirando pantallas que nos colocan en el mundo virtual. Sin darnos
cuenta, somos distintos de los que éramos hace 20 años: somos los que ya no
podemos leer de la misma forma en como se hacía hasta fines del siglo XX.
Somos la simiente de la lectura tal como se la verá en el futuro próximo. Ese
futuro en el que vivir y leer serán la misma experiencia. Como ya sucede ahora.
El autor es crítico cultural.
Fuente: http://www.lanacion.com.ar/1754320-cuentos-de-navidad-la-esperanza-de-lo-m
"La biblioteca es el lugar del ejercicio público de la razón" Gabriel Naudé
Enfermedades graves y embarazo / Critical illness and pregnancy
Revisión clínica. Población especial. Enfermedades graves en el embarazo
Clinical review: Special populations--critical illness and pregnancy.
Neligan PJ, Laffey JG.
Crit Care. 2011 Aug 12;15(4):227. doi: 10.1186/cc10256.
Abstract
Critical illness is an uncommon but potentially devastating complication of pregnancy. The majority of pregnancy-related critical care admissions occur postpartum. Antenatally, the pregnant patient is more likely to be admitted with diseases non-specific to pregnancy, such as pneumonia.Pregnancy-specific diseases resulting in ICU admission include obstetric hemorrhage, pre-eclampsia/eclampsia, HELLP (hemolysis, elevated liverenzymes, and low platelet count) syndrome, amniotic fluid embolus syndrome, acute fatty liver of pregnancy, and peripartum cardiomyopathy. Alternatively, critical illness may result from pregnancy-induced worsening of pre-existing diseases (for example, valvular heart disease, myasthenia gravis, and kidney disease). Pregnancy can also predispose women to diseases seen in the non-pregnant population, such as acute respiratory distress syndrome (for example, pneumonia and aspiration), sepsis (for example, chorioamnionitis and pyelonephritis) or pulmonary embolism. The pregnant patient may also develop conditions co-incidental to pregnancy such as trauma or appendicitis. Hemorrhage, particularly postpartum, and hypertensive disorders of pregnancy remain the most frequent indications for ICU admission. This review focuses on pregnancy-specific causes of critical illness. Management of the critically ill mother poses special challenges. The physiologic changes in pregnancy and the presence of a second, dependent, patient may necessitate adjustments to therapeutic and supportive strategies. The fetus is generally robust despite maternal illness, and therapeutically what is good for the mother is generally good for the fetus. For pregnancy-induced critical illnesses, delivery of the fetus helps resolve the disease process. Prognosis following pregnancy-related critical illness is generally better than for age-matched non-pregnant critically ill patients.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3387584/pdf/cc10256.pdf
Evaluación prospectiva de la morbilidad y mortalidad materna en pacientes post-cesárea admitidos en la unidad de cuidados intensivos post-anestesia.
Prospective evaluation of maternal morbidity and mortality in post-cesarean section patients admitted to postanesthesia intensive care unit.
Harde M, Dave S, Wagh S, Gujjar P, Bhadade R, Bapat A.
J Anaesthesiol Clin Pharmacol. 2014 Oct;30(4):508-513.
Abstract
BACKGROUND AND AIMS:Critical illness may complicate any pregnancy. Timely intensive care management of critically ill obstetric patients has better outcomes than expected from the initial severity of illness. The aim was to study the indications of transfer of post-cesarean section patients to post-anesthesia intensive care unit (PACU). (PACU transfer indicated that the patient required intensive care). MATERIALS AND METHODS: This was a prospective observational study carried out in the PACU of a tertiary care teaching public hospital over a period of 2 years. Sixty-one postoperative lower segment cesarean section (LSCS) females admitted consecutively in PACU were studied. The study included obstetric PACU utilization rate, intensive care unit interventions, outcome of mother, Acute Physiology and Chronic Health Evaluation (APACHE II) score, and its correlation with mortality. RESULTS: Postanesthesia intensive care unit admission rate was 2.8% and obstetric PACU utilization rate was 3.22%. Of 61 patients, four had expired. Obstetric indications (67.2%) were the most common cause of admission to PACU. Among the obstetric indications hemorrhage (36.1%) was found to be a statistically significant indication for PACU admission followed by hypertensive disorder of pregnancy (29.5%). Cardiovascular disease (16.4%) was the most common nonobstetric indication for PACU transfer and was associated with high mortality. The observed mortality was 6.557%, which was lower than predicted mortality by APACHE II Score. CONCLUSION: Obstetric hemorrhage, hypertensive disorders of pregnancy and cardiovascular diseases are the leading causes of PACU admission in post LSCS patients. Prompt provision of intensive care to critically ill obstetric patients can lead to a significant drop in maternal morbidity and mortality.
KEYWORDS: Acute Physiology and Chronic Health Evaluation II; caesarean section; postanesthesia intensive care unit.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4234787/
http://www.joacp.org/downloadpdf.asp?issn=0970-9185;year=2014;volume=30;issue=4;spage=508;epage=513;aulast=Harde;type=2
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Clinical review: Special populations--critical illness and pregnancy.
Neligan PJ, Laffey JG.
Crit Care. 2011 Aug 12;15(4):227. doi: 10.1186/cc10256.
Abstract
Critical illness is an uncommon but potentially devastating complication of pregnancy. The majority of pregnancy-related critical care admissions occur postpartum. Antenatally, the pregnant patient is more likely to be admitted with diseases non-specific to pregnancy, such as pneumonia.Pregnancy-specific diseases resulting in ICU admission include obstetric hemorrhage, pre-eclampsia/eclampsia, HELLP (hemolysis, elevated liverenzymes, and low platelet count) syndrome, amniotic fluid embolus syndrome, acute fatty liver of pregnancy, and peripartum cardiomyopathy. Alternatively, critical illness may result from pregnancy-induced worsening of pre-existing diseases (for example, valvular heart disease, myasthenia gravis, and kidney disease). Pregnancy can also predispose women to diseases seen in the non-pregnant population, such as acute respiratory distress syndrome (for example, pneumonia and aspiration), sepsis (for example, chorioamnionitis and pyelonephritis) or pulmonary embolism. The pregnant patient may also develop conditions co-incidental to pregnancy such as trauma or appendicitis. Hemorrhage, particularly postpartum, and hypertensive disorders of pregnancy remain the most frequent indications for ICU admission. This review focuses on pregnancy-specific causes of critical illness. Management of the critically ill mother poses special challenges. The physiologic changes in pregnancy and the presence of a second, dependent, patient may necessitate adjustments to therapeutic and supportive strategies. The fetus is generally robust despite maternal illness, and therapeutically what is good for the mother is generally good for the fetus. For pregnancy-induced critical illnesses, delivery of the fetus helps resolve the disease process. Prognosis following pregnancy-related critical illness is generally better than for age-matched non-pregnant critically ill patients.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3387584/pdf/cc10256.pdf
Evaluación prospectiva de la morbilidad y mortalidad materna en pacientes post-cesárea admitidos en la unidad de cuidados intensivos post-anestesia.
Prospective evaluation of maternal morbidity and mortality in post-cesarean section patients admitted to postanesthesia intensive care unit.
Harde M, Dave S, Wagh S, Gujjar P, Bhadade R, Bapat A.
J Anaesthesiol Clin Pharmacol. 2014 Oct;30(4):508-513.
Abstract
BACKGROUND AND AIMS:Critical illness may complicate any pregnancy. Timely intensive care management of critically ill obstetric patients has better outcomes than expected from the initial severity of illness. The aim was to study the indications of transfer of post-cesarean section patients to post-anesthesia intensive care unit (PACU). (PACU transfer indicated that the patient required intensive care). MATERIALS AND METHODS: This was a prospective observational study carried out in the PACU of a tertiary care teaching public hospital over a period of 2 years. Sixty-one postoperative lower segment cesarean section (LSCS) females admitted consecutively in PACU were studied. The study included obstetric PACU utilization rate, intensive care unit interventions, outcome of mother, Acute Physiology and Chronic Health Evaluation (APACHE II) score, and its correlation with mortality. RESULTS: Postanesthesia intensive care unit admission rate was 2.8% and obstetric PACU utilization rate was 3.22%. Of 61 patients, four had expired. Obstetric indications (67.2%) were the most common cause of admission to PACU. Among the obstetric indications hemorrhage (36.1%) was found to be a statistically significant indication for PACU admission followed by hypertensive disorder of pregnancy (29.5%). Cardiovascular disease (16.4%) was the most common nonobstetric indication for PACU transfer and was associated with high mortality. The observed mortality was 6.557%, which was lower than predicted mortality by APACHE II Score. CONCLUSION: Obstetric hemorrhage, hypertensive disorders of pregnancy and cardiovascular diseases are the leading causes of PACU admission in post LSCS patients. Prompt provision of intensive care to critically ill obstetric patients can lead to a significant drop in maternal morbidity and mortality.
KEYWORDS: Acute Physiology and Chronic Health Evaluation II; caesarean section; postanesthesia intensive care unit.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4234787/
http://www.joacp.org/downloadpdf.asp?issn=0970-9185;year=2014;volume=30;issue=4;spage=508;epage=513;aulast=Harde;type=2
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Bibliotecas Populares. Alerta
bibliotecas populares
Notificaciones semanales ⋅ 24 de diciembre de 2014
NOTICIAS
Agencia Fe
Michlig destacó la labor de la Biblioteca “Gaston Gori” de San Guillermo en su 60º aniversario
Agencia Fe
El senador provincial por el departamento San Cristóbal Felipe Michlig (UCR FPCyS) destacó la tarea que desarrollan las bibliotecas populares que ...
Bibliotecas sin respuestas
Diario El Argentino
Y es una pena porque habla del abandono que sufren las cuatro Bibliotecas Populares de Gualeguaychú y las 64 de toda la provincia de Entre Ríos.
Diario NORTE
Los 57 años de la biblioteca Nicolás Rojas Acosta
Diario NORTE
Fundada en 21 de diciembre de 1957, hoy la Biblioteca Popular “Profesor Nicolás Rojas Acosta” funciona de lunes a sábado para dar un espacio a ...
Córdoba y su intensa actividad literaria capítulo de la historia de América del Norte ”
LA MAÑANA de Córdoba
... Ville, Alta Gracia y La Granja), así como en la diversidad de ciclos, charlas y talleres desarrollados en bibliotecas populares y espacios culturales.
SALAMANCArtv AL DIA
Las maestras y maestros de la República (III)
SALAMANCArtv AL DIA
En cerca de trescientas Misiones se recorrieron otros tantos pueblos, se crearon más de 5.000bibliotecas populares y estas alcanzaron el número de ...
Embarazo crítico / High-risk obstetric patients
Papel de la unidad de cuidado postanestésico en el manejo de las pacientes obstétricas de alto riesgo
The role of the post-anaesthesia care unit in the management of high-risk obstetric patients.
Kostopanagiotou G, Kalimeris K, Pandazi A, Salamalekis G, Chrelias C, Matsota P.
Arch Med Sci. 2011 Feb;7(1):123-6. doi: 10.5114/aoms.2011.20616. Epub 2011 Mar 8.
Abstract
INTRODUCTION:High-risk obstetric patients in the immediate postpartum period are frequently admitted to the intensive care unit, but the necessity of this practice has recently been doubted. Herein we describe the efficiency of utilizing the post-anaesthesia care unit (PACU) as an intermediateintensive care facility for those patients. MATERIAL AND METHODS: We retrospectively described the reasons for admission, duration of stay, the anaesthetic used, main interventions and outcome for all obstetric admissions in the PACU during a period of 4 years in a university hospital. RESULTS: During the 4-year period 47 women were admitted to the PACU after delivery. The frequency of admission to the PACU was 15.3 per 1000 deliveries, while obstetric cases represented 4.4 per 1000 admissions to the PACU. The majority represented caesarean sections (81%). The main reasons for admission to the PACU were haemorrhage (49%), cardiovascular problems (19%) and preeclampsia/eclampsia (17%). Mean length of stay in the PACU was 14.5 ±11.6 h, being significantly less in women having received epidural anaesthesia (8.2 ±5.6 h) compared to those who delivered with general anaesthesia (19.0 ±13.6 h, p < 0.05). General anaesthesia was used in 85% of cases in which emergency delivery was indicated, but only in 27% of cases without emergency indications for delivery (p < 0.01). No death or admission to the intensive care unit occurred during the study period. CONCLUSIONS: The PACU can offer an intermediate intensive care facility for high-risk obstetric patients, thus reducing unnecessary admissions to the intensive care unit.
KEYWORDS:complications of pregnancy; maternal morbidity and mortality
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258694/pdf/AMS-7-1-123.pdf
Evolución fetomaterna en mujeres con preeclampsia severa que se someten a cesárea con anestesia general o espinal
Fetomaternal outcome in severe preeclamptic women undergoing emergency cesarean section under either general or spinal anesthesia.
Chattopadhyay S, Das A, Pahari S.
J Pregnancy. 2014;2014:325098. doi: 10.1155/2014/325098. Epub 2014 Apr 17.
Abstract
This prospective observational study compared the effects of general and spinal anesthesia in 173 severe preeclamptic women undergoing emergency cesarean section. 146 (84.5%) patients underwent spinal anesthesia (SA) and 27 (15.5%) patients had general anesthesia (GA). Most of the patients were primigravid and nulliparous. Intraoperatively SA group required more intravenous fluid and vasopressor support, while GA group required more preoperative labetalol injection for blood pressure control. Overall 13.3% of patients required critical care, particularly GA group (44.4% versus 7.5%; P < 0.001). Patients receiving GA had a higher mortality (25.9% versus 1.4%; P < 0.001). The length of hospital stay was comparable. Significantly more neonates of patients receiving GA were found to be preterm (77.8% versus 44.5%; P < 0.01) and required advanced resuscitation. GA group also had higher neonatal mortality (29.6% versus 11%; P < 0.05). To conclude, severe preeclamptic mothers receiving general anesthesia and their babies required more critical care support. Maternal as well as neonatal mortality was significantly higher with general anesthesia.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4016895/pdf/JP2014-325098.pdf
¿Por las pacientes obstétricas van a la UCI? Estudio de 3 años?
Why do obstetric patients go to the ICU? A 3-year-study.
Chawla S, Nakra M, Mohan S, Nambiar BC, Agarwal R, Marwaha A.
Med J Armed Forces India. 2013 Apr;69(2):134-7. doi: 10.1016/j.mjafi.2012.08.033. Epub 2012 Dec 1
Abstract
BACKGROUND: Pregnant women are at risk to develop complications due to illness related to pregnancy or due to aggravation of pre-existing disease. These patients also require critical care and ICU admissions in some cases. To determine the current spectrum of diseases in an obstetric population resulting in admission to the intensive care unit (ICU) at a tertiary care hospital. METHODS:A retrospective case series study and analysis of data from obstetric patients admitted for critical care management. RESULTS:0.26% of the total obstetric patients admitted to the hospital required ICU admissions. 46% of patients were admitted to ICU for ventilator support. Pre-eclampsia and obstetrical hemorrhage were the common diagnosis for these patients. CONCLUSION: Critically ill obstetric patients require a team approach of the obstetrician, anesthesiologist and intensive care specialist for the optimal care of these patients.
KEYWORDS:Critical care in obstetrics; Eclampsia; ICU admissions; Maternal mortality; Obstetrical hemorrhage
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3862664/pdf/main.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
The role of the post-anaesthesia care unit in the management of high-risk obstetric patients.
Kostopanagiotou G, Kalimeris K, Pandazi A, Salamalekis G, Chrelias C, Matsota P.
Arch Med Sci. 2011 Feb;7(1):123-6. doi: 10.5114/aoms.2011.20616. Epub 2011 Mar 8.
Abstract
INTRODUCTION:High-risk obstetric patients in the immediate postpartum period are frequently admitted to the intensive care unit, but the necessity of this practice has recently been doubted. Herein we describe the efficiency of utilizing the post-anaesthesia care unit (PACU) as an intermediateintensive care facility for those patients. MATERIAL AND METHODS: We retrospectively described the reasons for admission, duration of stay, the anaesthetic used, main interventions and outcome for all obstetric admissions in the PACU during a period of 4 years in a university hospital. RESULTS: During the 4-year period 47 women were admitted to the PACU after delivery. The frequency of admission to the PACU was 15.3 per 1000 deliveries, while obstetric cases represented 4.4 per 1000 admissions to the PACU. The majority represented caesarean sections (81%). The main reasons for admission to the PACU were haemorrhage (49%), cardiovascular problems (19%) and preeclampsia/eclampsia (17%). Mean length of stay in the PACU was 14.5 ±11.6 h, being significantly less in women having received epidural anaesthesia (8.2 ±5.6 h) compared to those who delivered with general anaesthesia (19.0 ±13.6 h, p < 0.05). General anaesthesia was used in 85% of cases in which emergency delivery was indicated, but only in 27% of cases without emergency indications for delivery (p < 0.01). No death or admission to the intensive care unit occurred during the study period. CONCLUSIONS: The PACU can offer an intermediate intensive care facility for high-risk obstetric patients, thus reducing unnecessary admissions to the intensive care unit.
KEYWORDS:complications of pregnancy; maternal morbidity and mortality
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258694/pdf/AMS-7-1-123.pdf
Evolución fetomaterna en mujeres con preeclampsia severa que se someten a cesárea con anestesia general o espinal
Fetomaternal outcome in severe preeclamptic women undergoing emergency cesarean section under either general or spinal anesthesia.
Chattopadhyay S, Das A, Pahari S.
J Pregnancy. 2014;2014:325098. doi: 10.1155/2014/325098. Epub 2014 Apr 17.
Abstract
This prospective observational study compared the effects of general and spinal anesthesia in 173 severe preeclamptic women undergoing emergency cesarean section. 146 (84.5%) patients underwent spinal anesthesia (SA) and 27 (15.5%) patients had general anesthesia (GA). Most of the patients were primigravid and nulliparous. Intraoperatively SA group required more intravenous fluid and vasopressor support, while GA group required more preoperative labetalol injection for blood pressure control. Overall 13.3% of patients required critical care, particularly GA group (44.4% versus 7.5%; P < 0.001). Patients receiving GA had a higher mortality (25.9% versus 1.4%; P < 0.001). The length of hospital stay was comparable. Significantly more neonates of patients receiving GA were found to be preterm (77.8% versus 44.5%; P < 0.01) and required advanced resuscitation. GA group also had higher neonatal mortality (29.6% versus 11%; P < 0.05). To conclude, severe preeclamptic mothers receiving general anesthesia and their babies required more critical care support. Maternal as well as neonatal mortality was significantly higher with general anesthesia.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4016895/pdf/JP2014-325098.pdf
¿Por las pacientes obstétricas van a la UCI? Estudio de 3 años?
Why do obstetric patients go to the ICU? A 3-year-study.
Chawla S, Nakra M, Mohan S, Nambiar BC, Agarwal R, Marwaha A.
Med J Armed Forces India. 2013 Apr;69(2):134-7. doi: 10.1016/j.mjafi.2012.08.033. Epub 2012 Dec 1
Abstract
BACKGROUND: Pregnant women are at risk to develop complications due to illness related to pregnancy or due to aggravation of pre-existing disease. These patients also require critical care and ICU admissions in some cases. To determine the current spectrum of diseases in an obstetric population resulting in admission to the intensive care unit (ICU) at a tertiary care hospital. METHODS:A retrospective case series study and analysis of data from obstetric patients admitted for critical care management. RESULTS:0.26% of the total obstetric patients admitted to the hospital required ICU admissions. 46% of patients were admitted to ICU for ventilator support. Pre-eclampsia and obstetrical hemorrhage were the common diagnosis for these patients. CONCLUSION: Critically ill obstetric patients require a team approach of the obstetrician, anesthesiologist and intensive care specialist for the optimal care of these patients.
KEYWORDS:Critical care in obstetrics; Eclampsia; ICU admissions; Maternal mortality; Obstetrical hemorrhage
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3862664/pdf/main.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
domingo, 21 de diciembre de 2014
Cardiomiopatía periparto/Peripartum cardiomyopathy
Cardiomiopatía periparto
Cardiomiopatía periparto
Peripartum cardiomyopathy .
Said H, Sobhi A.
Ain-Shams J Anaesthesiol [serial online] 2014 [cited 2014 Dec 13];7:480-4.
http://www.asja.eg.net/downloadpdf.asp?issn=1687-7934;year=2014;volume=7;issue=4;spage=480;epage=484;aulast=Said;type=2
http://www.asja.eg.net/text.asp?2014/7/4/480/145670
Cardiomiopatía periparto. Revisión y guías prácticas
Peripartum cardiomyopathy: review and practice guidelines.
Johnson-Coyle L1, Jensen L, Sobey A; American College of Cardiology Foundation; American Heart Association.
Am J Crit Care. 2012 Mar;21(2):89-98. doi: 10.4037/ajcc2012163.
http://ajcc.aacnjournals.org/content/21/2/89.full.pdf
Importancia de la ecocardiografía transesofágica en cardiopatía periparto en cesárea con anestesia regional
Importance of transesophageal echocardiography in peripartum cardiomyopathy undergoing lower section cesarean section under regional anesthesia.
Kapoor PM, Goyal S, Irpachi K, Smita B.
J Anaesthesiol Clin Pharmacol. 2014 Jul;30(3):427-9. doi: 10.4103/0970-9185.137287.
http://www.joacp.org/downloadpdf.asp?issn=0970-9185;year=2014;volume=30;issue=3;spage=427;epage=429;aulast=Kapoor;type=2
Cardiodmiopatía periparto. Programa Europeo Observacional
Peripartum cardiomyopathy: Euro Observational Research Program.
Hoes MF, van Hagen I, Russo F, Van Veldhuisen DJ, Van den Berg MP, Roos-Hesselink J, van Spaendonck-Zwarts KY, van der Meer P.
Neth Heart J. 2014 Sep;22(9):396-400. doi: 10.1007/s12471-014-0573-5.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160455/pdf/12471_2014_Article_573.pdf
La miocardiopatía periparto. Un rompecabezas más cerca de la solución
Peripartum cardiomyopathy: A puzzle closer to solution.
Fett JD.
World J Cardiol. 2014 Mar 26;6(3):87-99. doi: 10.4330/wjc.v6.i3.87.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964190/pdf/WJC-6-87.pdf
Correlación entre cardiomiopatía periparto y anticuerpos contra receptores cardiovasculares
The correlation between peripartum cardiomyopathy and autoantibodies against cardiovascular receptors.
Liu J, Wang Y, Chen M, Zhao W, Wang X, Wang H, Zhang Z, Zhang J, Xu L, Chen J, Yang X, Zhang L.
PLoS One. 2014 Jan 23;9(1):e86770. doi: 10.1371/journal.pone.0086770. eCollection 2014.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3900643/pdf/pone.0086770.pdf
Manejo anestésico de la cardiomiopatía periparto usando técnica de extensión de volumen epidural. Serie de casos
Anaesthetic management of peripartum cardiomyopathy using "epidural volume extension" technique: a case series.
Tiwari AK, Agrawal J, Tayal S, Chadha M, Singla A, Valson G, Tomar GS.
Ann Card Anaesth. 2012 Jan-Mar;15(1):44-6. doi: 10.4103/0971-9784.91481.
http://www.annals.in/downloadpdf.asp?issn=0971-9784;year=2012;volume=15;issue=1;spage=44;epage=46;aulast=Tiwari;type=2
Miocardiopatía periparto
Diego Felipe Polanía Ardila, Solón Navarrete Hurtado, Edgar Mariano Acuña Osorio, Rafael Alberto Álvarez Rosero
Rev Insuf Cardiaca 2009
http://www.insuficienciacardiaca.org/pdf/4_vol4_09/177-%20Miocardiopatia.pdf
http://www.scielo.org.ar/pdf/ic/v4n4/v4n4a06.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Cardiomiopatía periparto
Peripartum cardiomyopathy .
Said H, Sobhi A.
Ain-Shams J Anaesthesiol [serial online] 2014 [cited 2014 Dec 13];7:480-4.
http://www.asja.eg.net/downloadpdf.asp?issn=1687-7934;year=2014;volume=7;issue=4;spage=480;epage=484;aulast=Said;type=2
http://www.asja.eg.net/text.asp?2014/7/4/480/145670
Cardiomiopatía periparto. Revisión y guías prácticas
Peripartum cardiomyopathy: review and practice guidelines.
Johnson-Coyle L1, Jensen L, Sobey A; American College of Cardiology Foundation; American Heart Association.
Am J Crit Care. 2012 Mar;21(2):89-98. doi: 10.4037/ajcc2012163.
http://ajcc.aacnjournals.org/content/21/2/89.full.pdf
Importancia de la ecocardiografía transesofágica en cardiopatía periparto en cesárea con anestesia regional
Importance of transesophageal echocardiography in peripartum cardiomyopathy undergoing lower section cesarean section under regional anesthesia.
Kapoor PM, Goyal S, Irpachi K, Smita B.
J Anaesthesiol Clin Pharmacol. 2014 Jul;30(3):427-9. doi: 10.4103/0970-9185.137287.
http://www.joacp.org/downloadpdf.asp?issn=0970-9185;year=2014;volume=30;issue=3;spage=427;epage=429;aulast=Kapoor;type=2
Cardiodmiopatía periparto. Programa Europeo Observacional
Peripartum cardiomyopathy: Euro Observational Research Program.
Hoes MF, van Hagen I, Russo F, Van Veldhuisen DJ, Van den Berg MP, Roos-Hesselink J, van Spaendonck-Zwarts KY, van der Meer P.
Neth Heart J. 2014 Sep;22(9):396-400. doi: 10.1007/s12471-014-0573-5.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160455/pdf/12471_2014_Article_573.pdf
La miocardiopatía periparto. Un rompecabezas más cerca de la solución
Peripartum cardiomyopathy: A puzzle closer to solution.
Fett JD.
World J Cardiol. 2014 Mar 26;6(3):87-99. doi: 10.4330/wjc.v6.i3.87.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964190/pdf/WJC-6-87.pdf
Correlación entre cardiomiopatía periparto y anticuerpos contra receptores cardiovasculares
The correlation between peripartum cardiomyopathy and autoantibodies against cardiovascular receptors.
Liu J, Wang Y, Chen M, Zhao W, Wang X, Wang H, Zhang Z, Zhang J, Xu L, Chen J, Yang X, Zhang L.
PLoS One. 2014 Jan 23;9(1):e86770. doi: 10.1371/journal.pone.0086770. eCollection 2014.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3900643/pdf/pone.0086770.pdf
Manejo anestésico de la cardiomiopatía periparto usando técnica de extensión de volumen epidural. Serie de casos
Anaesthetic management of peripartum cardiomyopathy using "epidural volume extension" technique: a case series.
Tiwari AK, Agrawal J, Tayal S, Chadha M, Singla A, Valson G, Tomar GS.
Ann Card Anaesth. 2012 Jan-Mar;15(1):44-6. doi: 10.4103/0971-9784.91481.
http://www.annals.in/downloadpdf.asp?issn=0971-9784;year=2012;volume=15;issue=1;spage=44;epage=46;aulast=Tiwari;type=2
Miocardiopatía periparto
Diego Felipe Polanía Ardila, Solón Navarrete Hurtado, Edgar Mariano Acuña Osorio, Rafael Alberto Álvarez Rosero
Rev Insuf Cardiaca 2009
http://www.insuficienciacardiaca.org/pdf/4_vol4_09/177-%20Miocardiopatia.pdf
http://www.scielo.org.ar/pdf/ic/v4n4/v4n4a06.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
sábado, 20 de diciembre de 2014
Medwave. Diciembre 2014
A continuación le informamos los artículos recientemente publicados en Medwave.
REPORTES DE CASO
Calcificaciones en el cerebro: presentación de un caso de toxoplasmosis congénita
Mauricio J. Ávila, Andrea Rodríguez-Restrepo (Estados Unidos, Colombia)
Medwave 2014 Dic;14(11):e6056
http://dx.doi.org/10.5867/medwave.2014.11.6056
Hidatidosis hepatopulmonar: reporte de caso clínico pediátrico y revisión de literatura
Sebastián Paredes, Jorge Torres, Patricia Muena, David Schenettler (Chile)
Medwave 2014 Dic;14(11):e6053
http://dx.doi.org/10.5867/medwave.2014.11.6053
ACTUALIZACIÓN
Actualización - ¿El uso preoperatorio de bevacizumab reduce las complicaciones en pacientes con retinopatía diabética sometidos a vitrectomía?
Medwave 2014 Dic;14(11):e6054
http://dx.doi.org/10.5867/medwave.2014.11.6054
RESÚMENES EPISTEMONIKOS DE LA EVIDENCIA
¿El uso preoperatorio de bevacizumab reduce las complicaciones en pacientes con retinopatía diabética sometidos a vitrectomía?
Daniela Véliz, Gabriel Rada (Chile)
Medwave 2014 Dic;14(11):e6052
http://dx.doi.org/10.5867/medwave.2014.11.6052
ACTUALIDAD
Avances, retrocesos y ausencias en el presupuesto de salud de Chile para 2015
Matías Goyenechea (Chile)
Medwave 2014 Nov;14(10):e6045
http://dx.doi.org/10.5867/medwave.2014.10.6045
PORTADA MEDWAVE
http://www.medwave.cl
REPORTES DE CASO
Calcificaciones en el cerebro: presentación de un caso de toxoplasmosis congénita
Mauricio J. Ávila, Andrea Rodríguez-Restrepo (Estados Unidos, Colombia)
Medwave 2014 Dic;14(11):e6056
http://dx.doi.org/10.5867/medwave.2014.11.6056
Hidatidosis hepatopulmonar: reporte de caso clínico pediátrico y revisión de literatura
Sebastián Paredes, Jorge Torres, Patricia Muena, David Schenettler (Chile)
Medwave 2014 Dic;14(11):e6053
http://dx.doi.org/10.5867/medwave.2014.11.6053
ACTUALIZACIÓN
Actualización - ¿El uso preoperatorio de bevacizumab reduce las complicaciones en pacientes con retinopatía diabética sometidos a vitrectomía?
Medwave 2014 Dic;14(11):e6054
http://dx.doi.org/10.5867/medwave.2014.11.6054
RESÚMENES EPISTEMONIKOS DE LA EVIDENCIA
¿El uso preoperatorio de bevacizumab reduce las complicaciones en pacientes con retinopatía diabética sometidos a vitrectomía?
Daniela Véliz, Gabriel Rada (Chile)
Medwave 2014 Dic;14(11):e6052
http://dx.doi.org/10.5867/medwave.2014.11.6052
ACTUALIDAD
Avances, retrocesos y ausencias en el presupuesto de salud de Chile para 2015
Matías Goyenechea (Chile)
Medwave 2014 Nov;14(10):e6045
http://dx.doi.org/10.5867/medwave.2014.10.6045
PORTADA MEDWAVE
http://www.medwave.cl
Ictericia y embarazo / Jaundice and pregnancy
Evolución materna y fetal en el embarazo complicado con ictericia
Maternal and fetal outcome in jaundice complicating pregnancy
Reddy MG, Prabhakar G C, Sree V.
J NTR Univ Health Sci [serial online] 2014 [cited 2014 Dec 10];3:231-3.
http://www.jdrntruhs.org/downloadpdf.asp?issn=2277-8632;year=2014;volume=3;issue=4;spage=231;epage=233;aulast=Reddy;type=2
http://www.jdrntruhs.org/temp/JNTRUnivHealthSci34231-3526914_094749.pdf
http://www.jdrntruhs.org/text.asp?2014/3/4/231/146598
Enfermedades hepatobiliares durante el embarazo y su manejo. Actualización
Hepatobiliary diseases during pregnancy and their management: An update.
Lata I.
Int J Crit Illn Inj Sci. 2013 Jul;3(3):175-82. doi: 10.4103/2229-5151.119196.
http://www.ijciis.org/downloadpdf.asp?issn=2229-5151;year=2013;volume=3;issue=3;spage=175;epage=182;aulast=Lata;type=2
Perfil clínico, evolución maternofetal en hepatitis E y embarazo
Clinical profile, maternal and fetal outcomes of acute hepatitis E in pregnancy.
Shinde N, Patil T, Deshpande A, Gulhane R, Patil M, Bansod Y.
Ann Med Health Sci Res. 2014 Jul;4(Suppl 2):S133-9. doi: 10.4103/2141-9248.138033.
http://www.amhsr.org/downloadpdf.asp?issn=2141-9248;year=2014;volume=4;issue=8;spage=133;epage=139;aulast=Shinde;type=2
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
viernes, 19 de diciembre de 2014
Descubren fragmentos de ADN que son claves para la maduración de las neuronas
http://www.madrimasd.org/informacionidi/noticias/noticia.asp?id=62491&origen=notiweb&dia_suplemento=viernes
Descubren fragmentos de ADN que son claves para la maduración de las neuronas
El descubrimiento, que se publica en la revista científica Cell, supone un avance cualitativo importante para la comunidad científica, que desde hace años estudia estos exones 'alternativos' que, combinados, dan lugar a diferentes proteínas. Hasta ahora, los científicos conocían exones alternativos lo suficientemente grandes como para ser detectados con las técnicas computacionales disponibles. Los autores de este trabajo no sólo han sido capaces de detectar exones más pequeños, llamados microexones, sino que también han conseguido determinar sus funciones.
"Son fragmentos muy cortos, incluso los hay que codifican para sólo uno o dos aminoácidos -componentes básicos de las proteínas-, pero hemos visto que son cruciales para la maduración de las neuronas", ha explicado a Efe el investigador gallego Manuel Irimia, que inició su trabajo en la Universidad de Toronto y que ahora es jefe de grupo en el Centro de Regulación Genómica de Barcelona. "Del mismo modo que una palabra, por muy corta que sea, puede cambiar el significado de una frase, los microexones consiguen el mismo efecto y según su combinación crean proteínas con funciones distintas", ha puesto como ejemplo Irimia. "Solo hemos encontrado que los microexones se activan en el sistema nervioso y hemos visto que las posibilidades que ofrecen y las variantes proteicas que se pueden conseguir gracias a ellos son vitales para las neuronas", ha añadido. También han observado que existe una relación entre estos microexones y el autismo porque una gran parte no se expresan correctamente en personas con autismo, incluyendo varios en genes que se habían asociado ya previamente a esta patología. Según Irimia, haber identificado estos microexones y demostrado su funcionalidad añade nuevos elementos en la regulación del genoma y "ayuda a entender una capa más" de lo que se conocía hasta el momento sobre las combinaciones y empalmes ('splicing') de ADN. También les ha sorprendido observar que los microexones están muy conservados a lo largo de la evolución de vertebrados, porque hasta ahora se había constatado que los exones alternativos eran muy plásticos y generalmente no se conservaban. El hecho de que estos microexones estén tan conservados en los vertebrados y que tengan un papel importante en la maduración de las neuronas podría explicar algunas de las grandes diferencias que existen entre vertebrados e invertebrados en cuanto al sistema nervioso, según los científicos del CRG. Manuel Irimia se acaba de incorporar al Centro de Regulación Genómica de Barcelona, donde lidera el grupo Transcriptómica del Desarrollo y Evolución de Vertebrados. Irimia ha conseguido 1,5 millones de euros de una de las ayudas Starting Grants del Consejo Europeo de Investigación (ERC), destinadas a que científicos jóvenes puedan dirigir sus propios laboratorios y llevar a cabo investigaciones durante cuatro años. Irimia se formó como genetista en la Universidad Complutense de Madrid con estancias en la Universidad de Copenhague y la Universidad Massey en Nueva Zelanda. Se doctoró en genética por la Universidad de Barcelona y ha sido investigador posdoctoral en la Universidad de Stanford (EE.UU.) y en el Donnelly Centre de la Universidad de Toronto. |
'Operar' el ictus reduce las secuelas y la discapacidad de los enfermos
'Operar' el ictus reduce las secuelas y la discapacidad de los enfermos
Un estudio europeo, publicado en New England Journal of Medicine ha acabado con los recelos. Ha demostrado que la mayoría de los pacientes con ictus grave logran una mejor y más rápida recuperación si se elimina la obstrucción con rapidez haciendo una pequeña intervención. Esto es, capturar el coágulo y extraerlo con un catéter y después dejar alojada la prótesis para que no se vuelva a obstruir.
El catéter se inserta en un vaso sanguíneo a través de una pequeña abertura en la ingle y desde allí los cirujanos avanzan hacia una arteria en el cuello. Desde allí, un catéter delgado navega hacia la arteria bloqueada en el cerebro. Esta maniobra delicada la hacen neurorradiólogos y siempre acompañado de dispositivos de imagen para vigilar el avance del catéter. MENOS SECUELAS La investigación, en la que han participado 19 hospitales y 500 pacientes, entre ellos españoles, demuestra que los pacientes operados sufrirán menos daño cerebral, tendrán menos secuelas neurológicas y, por tanto, mejor calidad de vida. Las secuelas de un ictus pueden ser muy graves. Van desde problemas en el habla y el lenguaje, hasta incluso la paralización de parte del cuerpo. Sin un buen tratamiento a tiempo la discapacidad puede ser muy severa. Hasta la fecha, la práctica más utilizada es intentar disolver el trombo con medicamentos suministrados por vía intravenosa, pero este tratamiento es efectivo en tan solo 1 de cada 10 enfermos y cuando el ictus no es muy grave. DEVOLVER A LA NORMALIDAD Antonio Moreno, jefe de Neurorradiología Intervencionista del Hospital Universitario Virgen de la Arrixaca (Murcia) considera un 'hito' esta investigación. Moreno, que ha participado en el estudio europeo, cree que se muestra que "se puede tratar con esta estrategia a un mayor número de pacientes y lo que es más importante, devolverles también en un mayor número a su vida normal". Autor: N. Ramírez de Castro |
Farmacoterapia para prevenir CPPD
Farmacoterapia para prevenir CPPD
Drug therapy for preventing post-dural puncture headache.
Basurto Ona X, Uriona Tuma SM, Martínez García L, Solà I, Bonfill Cosp X.
Cochrane Database Syst Rev. 2013 Feb 28;2:CD001792. doi: 10.1002/14651858.CD001792.pub3.
Abstract
BACKGROUND: Post-dural (post-lumbar or post-spinal) puncture headache (PDPH) is one of the most common complications of diagnostic, therapeutic or inadvertent lumbar punctures. Many drug options have been used to prevent headache in clinical practice and have also been tested in some clinical studies, but there are still some uncertainties about their clinical effectiveness. OBJECTIVES: To assess the effectiveness and safety of drugs for preventing PDPH in adults and children. SEARCH METHODS: The search strategy included the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2012, Issue 5), MEDLINE (from 1950 to May 2012), EMBASE (from 1980 to May 2012) and CINAHL (from 1982 to June 2012). There was no language restriction. SELECTION CRITERIA: We considered randomised controlled trials (RCTs) that assessed the effectiveness of any drug used for preventing PDPH. DATA COLLECTION AND ANALYSIS: Review authors independently selected studies, assessed risks of bias and extracted data. We estimated risk ratios (RR) for dichotomous data and mean differences (MD) for continuous outcomes. We calculated a 95% confidence interval (CI) for each RR and MD. We did not undertake meta-analysis because participants' characteristics or assessed doses of drugs were too different in the included studies. We performed an intention-to-treat (ITT) analysis. MAIN RESULTS: We included 10 RCTs (1611 participants) in this review with a majority of women (72%), mostly parturients (women in labour) (913), after a lumbar puncture for regional anaesthesia. Drugs assessed were epidural and spinal morphine, spinal fentanyl, oral caffeine, rectal indomethacin, intravenous cosyntropin, intravenous aminophylline and intravenous dexamethasone.All the included RCTs reported data on the primary outcome, i.e. the number of participants affected by PDPH of any severity after a lumbar puncture. Epidural morphine and intravenous cosyntropin reduced the number of participants affected by PDPH of any severity after a lumbar puncture when compared to placebo. Also, intravenous aminophylline reduced the number of participants affected by PDPH of any severity after a lumbar puncture when compared to no intervention, while intravenous dexamethasone increased it. Spinal morphine increased the number of participants affected by pruritus when compared to placebo, and epidural morphine increased the number of participants affected by nausea and vomiting when compared to placebo. Oral caffeine increased the number of participants affected by insomnia when compared to placebo.The remainder of the interventions analysed did not show any relevant effect for any of the outcomes.None of the included RCTs reported the number of days that patients stayed in hospital.
AUTHORS' CONCLUSIONS:
Morphine and cosyntropin have shown effectiveness for reducing the number of participants affected by PDPH of any severity after a lumbar puncture, when compared to placebo, especially in patients with high risk of PDPH, such as obstetric patients who have had an inadvertent dural puncture. Aminophylline also reduced the number of participants affected by PDPH of any severity after a lumbar puncture when compared to no intervention in patients undergoing elective caesarean section. Dexamethasone increased the risk of PDPH, after spinal anaesthesia for caesarean section, when compared to placebo. Morphine also increased the number of participants affected by adverse events (pruritus and nausea and vomiting)There is a lack of conclusive evidence for the other drugs assessed (fentanyl, caffeine, indomethacin and dexamethasone).These conclusions should be interpreted with caution, owing to the lack of information, to allow correct appraisal of risk of bias and the small sample sizes of studies.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001792.pub3/pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Drug therapy for preventing post-dural puncture headache.
Basurto Ona X, Uriona Tuma SM, Martínez García L, Solà I, Bonfill Cosp X.
Cochrane Database Syst Rev. 2013 Feb 28;2:CD001792. doi: 10.1002/14651858.CD001792.pub3.
Abstract
BACKGROUND: Post-dural (post-lumbar or post-spinal) puncture headache (PDPH) is one of the most common complications of diagnostic, therapeutic or inadvertent lumbar punctures. Many drug options have been used to prevent headache in clinical practice and have also been tested in some clinical studies, but there are still some uncertainties about their clinical effectiveness. OBJECTIVES: To assess the effectiveness and safety of drugs for preventing PDPH in adults and children. SEARCH METHODS: The search strategy included the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2012, Issue 5), MEDLINE (from 1950 to May 2012), EMBASE (from 1980 to May 2012) and CINAHL (from 1982 to June 2012). There was no language restriction. SELECTION CRITERIA: We considered randomised controlled trials (RCTs) that assessed the effectiveness of any drug used for preventing PDPH. DATA COLLECTION AND ANALYSIS: Review authors independently selected studies, assessed risks of bias and extracted data. We estimated risk ratios (RR) for dichotomous data and mean differences (MD) for continuous outcomes. We calculated a 95% confidence interval (CI) for each RR and MD. We did not undertake meta-analysis because participants' characteristics or assessed doses of drugs were too different in the included studies. We performed an intention-to-treat (ITT) analysis. MAIN RESULTS: We included 10 RCTs (1611 participants) in this review with a majority of women (72%), mostly parturients (women in labour) (913), after a lumbar puncture for regional anaesthesia. Drugs assessed were epidural and spinal morphine, spinal fentanyl, oral caffeine, rectal indomethacin, intravenous cosyntropin, intravenous aminophylline and intravenous dexamethasone.All the included RCTs reported data on the primary outcome, i.e. the number of participants affected by PDPH of any severity after a lumbar puncture. Epidural morphine and intravenous cosyntropin reduced the number of participants affected by PDPH of any severity after a lumbar puncture when compared to placebo. Also, intravenous aminophylline reduced the number of participants affected by PDPH of any severity after a lumbar puncture when compared to no intervention, while intravenous dexamethasone increased it. Spinal morphine increased the number of participants affected by pruritus when compared to placebo, and epidural morphine increased the number of participants affected by nausea and vomiting when compared to placebo. Oral caffeine increased the number of participants affected by insomnia when compared to placebo.The remainder of the interventions analysed did not show any relevant effect for any of the outcomes.None of the included RCTs reported the number of days that patients stayed in hospital.
AUTHORS' CONCLUSIONS:
Morphine and cosyntropin have shown effectiveness for reducing the number of participants affected by PDPH of any severity after a lumbar puncture, when compared to placebo, especially in patients with high risk of PDPH, such as obstetric patients who have had an inadvertent dural puncture. Aminophylline also reduced the number of participants affected by PDPH of any severity after a lumbar puncture when compared to no intervention in patients undergoing elective caesarean section. Dexamethasone increased the risk of PDPH, after spinal anaesthesia for caesarean section, when compared to placebo. Morphine also increased the number of participants affected by adverse events (pruritus and nausea and vomiting)There is a lack of conclusive evidence for the other drugs assessed (fentanyl, caffeine, indomethacin and dexamethasone).These conclusions should be interpreted with caution, owing to the lack of information, to allow correct appraisal of risk of bias and the small sample sizes of studies.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001792.pub3/pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
miércoles, 17 de diciembre de 2014
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