Anestésicos, Pre-condicionamiento y Protección Cerebral

                      http://www.smo.edu.mx/jornada2013/

Anestésicos, Pre-condicionamiento y Protección Cerebral Rogean Rodrigues Nunes, Gastao Fernandes Duval Neto, Julio Cesar Garcia de Alencar, Suyane Benevides Franco, Nayanna Quezado de Andrade, Danielle Maia Holanda Dumaresq, Sara Lucia Cavalcante Rev Bras Anestesiol. 2013;63(1):119-138 Justificativa y objetivos: Diversos estudios han demostrado el pre-condicionamiento cerebral como un mecanismo protector frente a una situacion de estres. Estan descritos algunos factores determinantes del PC, como tambien la neuroproteccion proporcionada por los agentes anestésicos y no anestesicos. Contenido: Se hizo la revision con base en los principales articulos de la literatura que engloban la fi siopatologia de la isquemia-reperfusion y la lesion neuronal, y los factores no farmacológicos (infl amacion, glucemia y temperatura), y farmacologicos relacionados con el cambio de la respuesta a la isquemia-reperfusion, ademas de la neuroproteccion inducida por el uso de los anestesicos. Conclusiones: El cerebro tiene la capacidad de protegerse contra la isquemia cuando se le estimula. La elucidación de ese mecanismo posibilita la aplicacion de sustancias inductoras del precondicionamiento cerebral, como algunos anestesicos, otros farmacos y medidas no farmacologicas, como la hipotermia, con el fi n de inducir la tolerancia a las lesiones isquemicas. http://www.scielo.br/pdf/rba/v63n1/es_v63n1a11.pdf  Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

AINES y corazón/Nonsteroidal Anti-Inflammatory and cardiovascular risk

                                                   http://www.smo.edu.mx/jornada2013/

Diclofenaco prolonga la repolarización del músculo ventricular con daño en la repolarización de reserva  Diclofenac prolongs repolarization in ventricular muscle with impaired repolarization reserve. Kristóf A, Husti Z, Koncz I, Kohajda Z, Szél T, Juhász V, Biliczki P, Jost N, Baczkó I, Papp JG, Varró A, Virág L. Division of Cardiovascular Pharmacology, Hungarian Academy of Sciences, Szeged, Hungary. PLoS One. 2012;7(12):e53255. doi: 10.1371/journal.pone.0053255. Epub 2012 Dec 31. Abstract BACKGROUND: The aim of the present work was to characterize the electrophysiological effects of the non-steroidal anti-inflammatory drug diclofenac and to study the possible proarrhythmic potency of the drug in ventricular muscle. METHODS: Ion currents were recorded using voltage clamp technique in canine single ventricular cells and action potentials were obtained from canine ventricular preparations using microelectrodes. The proarrhythmic potency of the drug was investigated in an anaesthetized rabbit proarrhythmia model. RESULTS: Action potentials were slightly lengthened in ventricular muscle but were shortened in Purkinje fibers by diclofenac (20 µM). The maximum upstroke velocity was decreased in both preparations. Larger repolarization prolongation was observed when repolarization reserve was impaired by previous BaCl(2) application. Diclofenac (3 mg/kg) did not prolong while dofetilide (25 µg/kg) significantly lengthened the QT(c) interval in anaesthetized rabbits. The addition of diclofenac following reduction of repolarization reserve by dofetilide further prolonged QT(c). Diclofenac alone did not induce Torsades de Pointes ventricular tachycardia (TdP) while TdP incidence following dofetilide was 20%. However, the combination of diclofenac and dofetilide significantly increased TdP incidence (62%). In single ventricular cells diclofenac (30 µM) decreased the amplitude of rapid (I(Kr)) and slow (I(Ks)) delayed rectifier currents thereby attenuating repolarization reserve. L-type calcium current (I(Ca)) was slightly diminished, but the transient outward (I(to)) and inward rectifier (I(K1)) potassium currents were not influenced. CONCLUSIONS: Diclofenac at therapeutic concentrations and even at high dose does not prolong repolarization markedly and does not increase the risk of arrhythmia in normal heart. However, high dose diclofenac treatment may lengthen repolarization and enhance proarrhythmic risk in hearts with reduced repolarization reserve. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3534043/pdf/pone.0053255.pdf     Nuevas acciones de los AINES sobre los canales iónicos vasculares: La contabilización de los efectos secundarios cardiovasculares e identificación de nuevas aplicaciones terapéuticas.  Novel Actions of Nonsteroidal Anti-Inflammatory Drugs on Vascular Ion Channels: Accounting for Cardiovascular Side Effects and Identifying New Therapeutic Applications. Brueggemann LI, Mani BK, Mackie AR, Cribbs LL, Byron KL. Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Maywood, Illinois. Mol Cell Pharmacol. 2010;2(1):15-19. Abstract Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used medications for the treatment of both acute and chronic pain. Selective cyclooxygenase-2 (COX-2) inhibitors, such as celecoxib (Celebrex(®)), rofecoxib (Vioxx(®)), and diclofenac, have been among the most widely prescribed NSAIDs because they prevent the generation of prostaglandins involved in inflammation and pain, but avoid some of the gastrointestinal complications associated with less selective COX-1/COX-2 inhibitors. In 2004, rofecoxib (Vioxx(®)) was voluntarily withdrawn from the market because of adverse cardiovascular side effects. This led to an explosion of research into the cardiovascular effects of the 'coxibs', which revealed differential cardiovascular risk profiles among the members of this drug class. The differential risk profiles may relate to the tendency of some of the drugs to elevate blood pressure (BP). An important component of BP regulation is dependent on the contractile state of vascular smooth muscle cells (VSMCs), which is controlled to a large extent by the activities of KCNQ (Kv7 family) potassium channels and L-type calcium channels. Our recently published data indicate that celecoxib, but not rofecoxib or diclofenac, at therapeutically relevant concentrations, acts as a Kv7 potassium channel activator and a calcium channel blocker, causing relaxation of VSMCs and decreasing vascular tone. These vasorelaxant ion channel effects may account for the differential cardiovascular risk profiles among the different COX-2 inhibitors. We further speculate that these properties may be exploited for therapeutic benefit in the treatment of cardiovascular diseases or other medical conditions. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915785/pdf/nihms-184534.pdf  Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

Bibliotecas. Alerta

http://www.smo.edu.mx/jornada2013/


Las diez bibliotecas públicas más asombrosas del planeta
Qué.es
Las bibliotecas suelen ser lugares muy tranquilos en los que es fácil olvidarse del ruidoso mundo que nos rodea, atrapados en la lectura de sus libros. Sin embargo, algunos de estos edificios compiten en belleza y originalidad con las obras que ...
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Las bibliotecas municipales de Ourense ofrecen talleres infantiles ...
La Voz de Galicia
Las actividades, que son totalmente gratuitas, se desarrollarán el lunes 25, el martes 26, el miércoles 27 y el lunes 1 de abril entre las once de la mañana y la una de la tarde y el único requisito es ser socio de la biblioteca, que tampoco tiene ...
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BIBLIOTECAS Defienden redefinir el papel de las bibliotecas para ...
Ideal Digital
Granada, 22 mar (EFE).- Investigadores de la Universidad de Granada defienden que las bibliotecasse adapten a la era de internet y cambien su papel, de forma que ofrezcan servicios como enseñar a los usuarios a iniciar un negocio, rellenar un ...
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Presentación de “Las Bibliotecas para la Sociedad” - Granada
El próximo miércoles, 20 de marzo, a las 12,30 horas en el Salón Rojo del Hospital Real, tendrá lugar la presentación de “Las Bibliotecas para la Sociedad” , ...
canal.ugr.es/.../63832-presentación-de-“las-bibliotecas-para-la-...


AulaSurURJC: La URJC cierra todas sus bibliotecas durante las ...
Fuenlabrada | José Luis Blanco.- Las bibliotecas de los campus de la Universidad Rey Juan Carlos permanecerán cerradas desde el día 23 de marzo hasta el ...
aulasururjc.blogspot.com/.../la-urjc-cierra-todas-sus-bibliotecas...


AulaSurURJC: Encuesta | ¿Qué piensa del cierre de las bibliotecas ...
Bernal Crespo (19, Ciencias del Mar). "Si fuese en mi universidad perjudicaría a algunas personas que no pueden estudiar en casa. La biblioteca es un recurso ...
aulasururjc.blogspot.com/.../encuesta-que-piensa-del-cierre-de...


Red de Bibliotecas del Instituto Cervantes - Google+ - Español ...
Español adecuado para no insultar en Recife: 22 de marzo - La Biblioteca Carmen de Burgos celebra una nueva tertulia cuyo objetivo es minimizar la brecha…
https://plus.google.com/.../posts/MV83UwEaKs5

AINES y riesgo CV/Nonsteroidal anti-inflammatory drugs and CV risk

Riesgo cardiovascular causa-específico asociado con los AINES entre los pacientes con infarto del miocardio. Un estudio a nivel nacional  Cause-specific cardiovascular risk associated with nonsteroidal anti-inflammatory drugs among myocardial infarction patients--a nationwide study. Olsen AM, Fosbøl EL, Lindhardsen J, Andersson C, Folke F, Nielsen MB, Køber L, Hansen PR, Torp-Pedersen C, Gislason GH. Department of Cardiology, Copenhagen University Hospital, Hellerup, Denmark. amschjerning@gmail.com PLoS One. 2013;8(1):e54309. doi: 10.1371/journal.pone.0054309. Epub 2013 Jan 30. Abstract BACKGROUND: Non steroidal anti-inflammatory drugs (NSAIDs) increase mortality and morbidity after myocardial infarction (MI). We examined cause-specific mortality and morbidity associated with NSAIDs in a nationwide cohort of MI patients. METHODS AND RESULTS: By individual-level linkage of nationwide registries of hospitalization and drug dispensing from pharmacies in Denmark, patients aged >30 years admitted with first-time MI during 1997-2009 and their subsequent NSAID use were identified. The risk of three cardiovascular specific endpoints: cardiovascular death, the composite of coronary death and nonfatal MI, and the composite of fatal and nonfatal stroke, associated with NSAID use was analyzed by Cox proportional hazard analyses. Of 97,698 patients included 44.0% received NSAIDs during follow-up. Overall use of NSAIDs was associated with an increased risk of cardiovascular death (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.36-1.49). In particular use of the nonselective NSAID diclofenac and the selective cyclooxygenase-2 inhibitor rofecoxib was associated with increased risk of cardiovascular death (HR 1.96 [1.79-2.15] and HR1.66 [1.44-1.91], respectively) with a dose dependent increase in risk. Use of ibuprofen was associated with increased risk of cardiovascular death (HR 1.34[1.26-1.44]), whereas naproxen was associated with the lowest risk of (e.g., HR 1.27[1.01-1.59].CONCLUSION: Use of individual NSAIDs is associated with different cause-specific cardiovascular risk and in particular rofecoxib and diclofenac were associated with increased cardiovascular morbidity and mortality. These results support caution with use of all NSAIDs in patients with prior MI. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3559685/pdf/pone. 0054309.pdf     Riesgo cardiovascular con AINES: Revisión sistemática de estudios poblacionales observacionales controlados  Cardiovascular risk with non-steroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies. McGettigan P, Henry D. Hull York Medical School, Hull, United Kingdom. PLoS Med. 2011 Sep;8(9):e1001098. doi: 10.1371/journal.pmed.1001098. Epub 2011 Sep 27. Abstract BACKGROUND: Randomised trials have highlighted the cardiovascular risks of non-steroidal anti-inflammatory drugs (NSAIDs) in high doses and sometimes atypical settings. Here, we provide estimates of the comparative risks with individual NSAIDs at typical doses in community settings. METHODS AND FINDINGS: We performed a systematic review of community-based controlled observational studies. We conducted comprehensive literature searches, extracted adjusted relative risk (RR) estimates, and pooled the estimates for major cardiovascular events associated with use of individual NSAIDs, in different doses, and in populations with low and high background risks of cardiovascular events. We also compared individual drugs in pair-wise (within study) analyses, generating ratios of RRs (RRRs). Thirty case-control studies included 184,946 cardiovascular events, and 21 cohort studies described outcomes in >2.7 million exposed individuals. . CONCLUSIONS: This review suggests that among widely used NSAIDs, naproxen and low-dose ibuprofen are least likely to increase cardiovascular risk. Diclofenac in doses available without prescription elevates risk. The data for etoricoxib were sparse, but in pair-wise comparisons this drug had a significantly higher RR than naproxen or ibuprofen. Indomethacin is an older, rather toxic drug, and the evidence on cardiovascular risk casts doubt on its continued clinical use. Please see later in the article for the Editors' Summary. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181230/pdf/pmed.1 001098.pdf    La duración del tratamiento con medicamentos anti-inflamatorios no esteroideos y el impacto en el riesgo de muerte e infarto de miocardio recurrente en pacientes con infarto de miocardio previo: un estudio de cohorte nacional  Duration of treatment with nonsteroidal anti-inflammatory drugs and impact on risk of death and recurrent myocardial infarction in patients with prior myocardial infarction: a nationwide cohort study. Schjerning Olsen AM, Fosbøl EL, Lindhardsen J, Folke F, Charlot M, Selmer C, Lamberts M, Bjerring Olesen J, Køber L, Hansen PR, Torp-Pedersen C, Gislason GH. Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark. aols0073@geh.regionh.dk Circulation. 2011 May 24;123(20):2226-35. doi: 10.1161/CIRCULATIONAHA.110.004671. Epub 2011 May 9. Abstract BACKGROUND: Despite the fact that nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated among patients with established cardiovascular disease, many receive NSAID treatment for a short period of time. However, little is known about the association between NSAID treatment duration and risk of cardiovascular disease. We therefore studied the duration of NSAID treatment and cardiovascular risk in a nationwide cohort of patients with prior myocardial infarction (MI). METHODS AND RESULTS: Patients ≥30 years of age who were admitted with first-time MI during 1997 to 2006 and their subsequent NSAID use were identified by individual-level linkage of nationwide registries of hospitalization and drug dispensing from pharmacies in Denmark. Risk of death and recurrent MI according to duration of NSAID treatment was analyzed by multivariable time-stratified Cox proportional-hazard models and by incidence rates per 1000 person-years. Of the 83 677 patients included, 42.3% received NSAIDs during follow-up. There were 35 257 deaths/recurrent MIs. Overall, NSAID treatment was significantly associated with an increased risk of death/recurrent MI (hazard ratio, 1.45; 95% confidence interval, 1.29 to 1.62) at the beginning of the treatment, and the risk persisted throughout the treatment course (hazard ratio, 1.55; 95% confidence interval, 1.46 to 1.64 after 90 days). Analyses of individual NSAIDs showed that the traditional NSAID diclofenac was associated with the highest risk (hazard ratio, 3.26; 95% confidence interval, 2.57 to 3.86 for death/MI at day 1 to 7 of treatment). CONCLUSIONS: Even short-term treatment with most NSAIDs was associated with increased risk of death and recurrent MI in patients with prior MI. Neither short- nor long-term treatment with NSAIDs is advised in this population, and any NSAID use should be limited from a cardiovascular safety point of view. http://circ.ahajournals.org/content/123/20/2226.full.pdf  Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

Núcleo ceruleus/Locus coeruleus

                         http://www.smo.edu.mx/jornada2013/sociales.htm#DE

Las neuronas noradrenérgicas en el núcleo ceruleus contribuyen al dolor neuropático  Noradrenergic neurons in the locus coeruleus contribute to neuropathic pain. Brightwell JJ, Taylor BK. Department of Pharmacology, School of Medicine, Tulane University, New Orleans, LA 70112, USA. Neuroscience. 2009 Apr 21;160(1):174-85. doi: 10.1016/j.neuroscience.2009.02.023. Epub 2009 Feb 14. Abstract Current theories of neuropathic hypersensitivity include an imbalance of supraspinal inhibition and facilitation. Our overall hypothesis is that the locus coeruleus (LC), classically interpreted as a source of pain inhibition, may paradoxically result in facilitation after tibial and common peroneal nerve transection (spared sural nerve injury--SNI). We first tested the hypothesis that non-noxious tactile hind paw stimulation of the spared sural innervation territory increases neuronal activity in the LC in male rats. We observed a bilateral increase in the stimulus-evoked expression of transcription factors Fos and phosphorylated CREB (pCREB) in LC after SNI but not sham surgery; these markers of neuronal activity correlated with the intensity of tactile allodynia. We next tested the hypothesis that noradrenergic neurons contribute to the development of neuropathic pain. To selectively destroy these neurons, we delivered antidopamine-beta-hydroxylase saporin (anti-DbetaH-saporin) into the i.c.v. space 2 weeks before SNI. We found that anti-DbetaH-saporin, but not an IgG-saporin control, reduced behavioral signs of tactile allodynia, mechanical hyperalgesia, and cold allodynia from 3 to 28 days. after SNI. Our final experiment tested the hypothesis that the LC contributes to the maintenance of neuropathic pain. We performed SNI, waited 2 weeks for maximal allodynia and hyperalgesia to develop, and then administered the local anesthetic lidocaine (4%) directly into the LC parenchyma. Lidocaine reduced all behavioral signs of neuropathic pain in a reversible manner, suggesting that the LC contributes to pain facilitation. We conclude that, in addition to its well-known inhibition of acute and inflammatory pain, the LC facilitates the development and maintenance of neuropathic pain in the SNI model. Further studies are needed to determine the facilitatory pathways emanating from the LC. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2677992/pdf/nihms98071.pdf   Plasticidad molecular y celular inducida por opioides en las neuronas catecolaminérgicas del área tegmentaria ventral y el locus ceruleus   Opiate-induced molecular and cellular plasticity of ventral tegmental area and locus coeruleus catecholamine neurons. Mazei-Robison MS, Nestler EJ. Fishberg Department of Neuroscience and Friedman Brain Institute, Mount Sinai School of Medicine, New York, New York, USA. Cold Spring Harb Perspect Med. 2012 Jul;2(7):a012070 . doi: 10.1101/cshperspect.a012070. Abstract The study of neuronal adaptations induced by opiate drugs is particularly relevant today given their widespread prescription and nonprescription use. Although much is known about the acute actions of such drugs on the nervous system, a great deal of work remains to fully understand their chronic effects. Here, we focus on longer-lasting adaptations that occur in two catecholaminergic brain regions that mediate distinct behavioral actions of opiates: ventral tegmental area (VTA) dopaminergic neurons, important for drug reward, and locus coeruleus (LC) noradrenergic neurons, important for physical dependence and withdrawal. We focus on changes in cellular, synaptic, and structural plasticity in these brain regions that contribute to opiate dependence and addiction. Understanding the molecular determinants of this opiate-induced plasticity will be critical for the development of better treatments for opiate addiction and perhaps safer opiate drugs for medicinal use. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3385942/pdf/cshperspectmed-ADD-a012070.pdf     Núcleo Coeruleus. Neurotransmisores, Funciones y Patología.  Dr. Mauricio Valenzuela-Harrington, Dr. Vicente Negrete-Díaz, Dr. Antonio Rodríguez-Moreno Anestesia en México 2007;19:155-166. El Nucleus Coeruleus es la principal fuente de noradrenalina en el sistema nervioso central. Este complejo nuclear debido a sus aferencias y eferencias está involucrado en diversas y variadas funciones. Además está involucrado en diversas enfermedades y alteraciones del sistema nervioso central cuando su funcionamiento no es correcto. En esta revisión se describen estas funciones del nucleus coeruleus así como la forma en que participa en enfermedades del sistema nervioso tales como Enfermedad de Alzheimer, Parkinson, Depresión y estrés y su papel en procesos de drogodependencia y síndrome de abstinencia. Palabras claves: Locus Coeruleus, noradrenalina, neuromodulador, receptores a y b adrenérgicos. http://www.anestesiaenmexico.org/RAM9/RAM2007-19-3/007.pdf  Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

Casos de interés/Interesting cases

                   http://www.smo.edu.mx/jornada2013/
                     

Como médicos, y en especial como especialistas en medicina perioperatoria podemos enfrentar pacientes con patologías poco frecuentes como la miastenia gravis, la hipertermia maligna, el síndrome del corazón roto, feocromocitomas y muchas otras entidades raras. Cada mes le enviaremos una serie de informe de casos con patologías poco frecuentes que esperamos le sean de utilidad. As physicians, as well as specialists in perioperative medicine, we confront patients with rare diseases such as myasthenia gravis, malignant hyperthermia, broken heart syndrome, pheochromocytomas and many other rare entities. Each month we will send to you a series of case report articles with rare diseases, that we hope will be useful. Como especialistas em medicina perioperatória pode tratar pacientes com doenças raras, como a miastenia gravis, hipertermia maligna, síndrome do coração partido, feocromocitomas e muitas outras entidades raras. Cada mês vamos enviar uma série de relatos de casos com doenças raras, que esperamos que seja útil.  Ceguera cortical transitoria despues de cirugía de columna presentándose como signo inicial de trombofilia hereditaria  Transient cortical blindness after spinal surgery as initial presenting sign of hereditary thrombophilia. Tugcu B, Araz-Ersan B, Eren G, Selçuk H, Yigit U. Indian J Ophthalmol [serial online] 2013 [cited 2013 Mar 21];61:139-40.  Cortical blindness is a rare complication of spine surgery, and is followed by a period of recovery due to resolution of inflammation and edema around the lesion and to the re-activation of partially damaged perilesional tissue. Bilateral occipital abnormalities caused by hypotension, ischemia and infarction are associated with poor prognosis. Herein, we report complete recovery of a case with cortical blindness, despite having an ischemic infarct.  http://www.ijo.in/text.asp?2013/61/3/139/97565  Síndrome de Tapia despues de laminoplastía cervical. Reporte de un caso  Tapia's syndrome following cervical laminoplasty -A case report-. Lim KJ, Kim MH, Kang MH, Lee HM, Park EY, Kwon KJ, Lee SK, Choi H, Moon HS. Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Anyang, Korea. Korean J Anesthesiol. 2013 Feb;64(2):172-4. doi: 10.4097/kjae.2013.64.2.172. Epub 2013 Feb 15. Abstract Tapia's syndrome is the palsy of the 10th and 12th cranial nerves, resulting in ipsilateral paralysis of the vocal cord and tongue. It is a rare complication which is related to the anesthetic airway management and positioning of the patient's head during the surgery. We describe a patient with a postoperative unilateral Tapia's syndrome, after general anesthesia, with uncomplicated endotracheal intubation. The patient's symptoms improved gradually for three months. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3581789/pdf/kjae-64-172.pdf    Megaesófago: Un reto para los anestesiólogos  Megaesophagus: A challenge for anesthesiologists. Tewari P, Gupta D. Ann Card Anaesth [serial online] 2013 [cited 2013 Jan 2];16:61-2.  A fifty-nine-year male farmer presented with a history of low grade dysphagia, both for solids and liquids for twenty-five years that progressively increased in severity. He had lost weight significantly in recent years and developed spontaneous regurgitation of liquids and food content, heart burn, chest pain after eating and cough. Chest X-ray (PA-view) showed a large curvilinear, radio-opaque density lesion occupying medial 2/3 rd of right hemi thorax with Ryle's tube within the shadow suggesting a large dilated esophagus. This was not silhouetting the right cardiac border suggesting posterior mediastinal mass; moreover, there was no mediastinal shift. Barium swallow confirmed achalasia-cardia with huge, more than 10 cm in diameter, pouch of esophagus with lower constricted part. The patient did not show any cardiac compromise but lung function tests showed reduced inspiratory and forced vital capacity (60%) and borderline Peak Expiratory Flow Rate (70%). The laboratory investigations were within normal limits. He was planned for transhiatal esophagectomy (THO) with cervical esophago-gastrotomy (OG) and feeding jejunostomy (FJ). He was given one week of rigorous chest physiotherapy under guidance of professional therapists http://www.annals.in/text.asp?2013/16/1/61/105374    Síndrome de Sturge-Weber con manifestaciones oculares extremas y asociación rara con agioma de la vía aérea superior con dificultad anticipada para el manejo de la vía aérea              Sturge-Weber-Syndrome with extreme ocular manifestation and rare association of upper airway angioma with anticipated difficult airway. Wong HS, Abdul Rahman R, Choo SY, Yahya N. Universiti Kebangsaan Malaysia Medical Centre, Department of Opthalmology, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur 56000, Malaysia. whs1975@gmail.com Med J Malaysia. 2012 Aug;67(4):435-7. Abstract We report a rare case of an 18 year old girl with Sturge-Weber syndrome, she had extensive facial port wine stains, right bupthalmos and advanced glaucoma involving both eyes. She underwent right eye glaucoma drainage device surgery under general anaesthesia, and had a difficult intubation due to extensive angiomatous like soft tissue swelling at her upper airway. This report highlights the importance of being aware of the need for continuous follow-up in Sturge-Weber syndrome patients as this syndrome can lead to blindness due to advance glaucoma and the awareness of possible difficult intubation for this group of patients http://www.e-mjm.org/2012/v67n4/Sturge-Weber-Syndrome.pdf  Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

BPD para cesárea/Epidural block for C-section

http://www.smo.edu.mx/jornada2013/

Comparación de los efectos maternos y neonatales de bupivacaína más fentanil y ropivacaína más fentanil durante operación cesárea  Comparison of the maternal and neonatal effects of bupivacaine plus fentanyl and ropivacaine plus fentanyl during cesarean delivery. Canan U, Örnek D, Kilci O, Dönmez F, Gamli M, Dikmen B. Niger J Clin Pract [serial online] 2013 [cited 2013 Apr 6];16:195-200. Abstract Purpose: The aim of the present study was to compare the anesthetic efficacy, and fetal and maternal effects of 7.5 mg (1 ml) intrathecal 0.75% hyperbaric ropivacaine + 25 μg (0.5 ml) fentanyl versus 5 mg (l ml) intrathecal 0.5% hyperbaric bupivacaine + 25 μg (0.5 ml) fentanyl in elective cesarean delivery. Materials and Methods: The study included 40 ASA I-II cases scheduled for cesarean delivery that were randomized into two groups of 20 cases each. Cases in the RF group were administered 0.75% hyperbaric ropivacaine + 25 μg (0.5 ml) fentanyl and those in the BF group were administered 5 mg (l ml) hyperbaric bupivacaine + 25 μg (0.5 ml) fentanyl into the spinal space. The time until spinal anesthesia in the T4 dermatome, overall duration of analgesia, hemodynamic parameters, Apgar score of newborns at 1-5 min, fetal blood gas values (pH, PO2, PCO2, HCO3−, and BE), maternal side effects, the degree of motor block, maternal need for ephedrine, objective pain scale score, and patient satisfaction were recorded in each group. Results: There were no significant differences between the groups in terms of the parameters evaluated (P > 0.05). Conclusion: In elective cesarean delivery, the combinations of bupivacaine + fentanyl or ropivacaine + fentanyl exhibited similar anesthetic efficacy, and fetal and maternal effects. Keywords: Bupivacaine, cesarean, opioid, ropivacaine. http://www.njcponline.com/text.asp?2013/16/2/195/110154 Atentamente Dr. Benito Cortes-Blanco Anestesiología y Medicina del Dolor www.anestesia-dolor.org

PCA transdérmica en dolor agudo postoperatorio

PCA transdérmica en dolor agudo postoperatorio

Transdermal PCA in acute postoperative pain

Anesthesiology News March 2013

http://www.anesthesiologynews.com/download/SR1230_WM.pdf

Bibliotecas. Alerta

Las bibliotecas públicas celebrarán el Día Internacional del Libro
Diario de Navarra
Las bibliotecas públicas de San Francisco, Chantrea, Yamaguchi y Mendillorri celebran este martes, 23 de abril, el Día Internacional del Libro con distintas actividades, todas ellas con entrada gratuita. Así, a las cinco y media de la tarde en la ...
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Diario de Navarra



La Red de Bibliotecas Municipales y Bidebarrieta Kulturgunea ...
Europa Press
La Red de Bibliotecas Municipales de Bilbao y Bidebarrieta Kulturgunea han organizado una serie de actividades especiales con motivo de la celebración del Día Internacional del Libro, que tendrá lugar en este martes, 23 de abril. Según ha informado el ...
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IU pide mejorar la dotación presupuestaria y las suscripciones a ...
Europa Press
El concejal del grupo municipal de IU en el Ayuntamiento de Zaragoza, Raúl Ariza, ha propuesto un conjunto de iniciativas para mejorar el servicio en las bibliotecasmunicipales, que comprenden desde la mejora presupuestaria a las suscripciones a ...
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Europa Press



Las bibliotecas municipales de Gijón tuvieron 950.000 visitantes en ...
ABC.es
Las bibliotecas municipales de Gijón recibieron durante el año pasado casi 950.000 visitantes y realizaron 328.000 préstamos de sus fondos documentales y bibliográficos. El Ayuntamiento de Gijón, a través de un comunicado, hace un balance "positivo" de ...
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Bibliotecas y escuelas públicas, ejes para fomentar la lectura
Milenio.com
Para fomentar esta actividad en el país, se requiere fortalecer la formación de docentes y expertos, establecer bibliotecas en todos los planteles de educación básica y promover la imagen de estos recintos como espacios que complementan y apoyan la ...
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Visitas guiadas, tertulias y concursos, propuestas de las bibliotecas ...
20minutos.es
La red de bibliotecas públicas de Navarra ha preparado a lo largo de esta semana un "amplio" programa de actividades tanto para público adulto como infantil para celebrar el Día Internacional del Libro. En concreto, se han programado visitas guiadas, ...
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Junot Díaz, finalista en premios de Bibliotecas Americanas
El Universal
La asociación de bibliotecas anunció el lunes a los candidatos y entregará las medallas a los ganadores el 30 de junio en su conferencia anual en Chicago.Creados en el 2012, los premios Carnegie son posibles gracias a una dádiva de la Carnegie Corp.
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El Universal

Aumenta un 26 por ciento el número de usuarios de las bibliotecas ...
ABC.es
El número de usuarios de la red de Bibliotecas de Menorca, que depende del Consell insular, ha aumentado en un 26,36 por ciento durante 2012 respecto a 2011. Según el informe anual redactado por la Conselleria de Cultura y Patrimonio, difundido hoy ...
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El Gobierno premia a cinco bibliotecas de la provincia dentro del ...
leonoticias.com
El Gobierno, a través del Ministerio de Educación, Cultura y Deporte, ha premiado a 17 bibliotecaspúblicas de Castilla y León, según se recoge en el fallo de la comisión de evaluación del Concurso 'María Moliner' de 2012, para proyectos de animación a ...
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Creando un “lugar” para las bibliotecas públicas « Beyond Access
Empecemos por lo obvio: las bibliotecas públicas pueden ser (y en muchos casos son) espacios poderosos para el cambio, creación y desarrollo. Esto es, sin ...
beyondaccess.net/.../creando-un-lugar-para-las-bibliotecas-pub...


Remodelación de bibliotecas va en un 52 % - Actualidad nacional y ...
De acuerdo con María Elisa Holguín; directora ejecutiva de BiblioTEC; a la fecha en Cali ya se han remodelado diez bibliotecas.. MSN Colombia te trae noticias ...
noticias.co.msn.com/.../remodelación-de-bibliotecas-va-en-un-...




Presentación corporativa para bibliotecas // Speaker Deck
Presentación corporativa para bibliotecas. by Libranda. Published April 20, 2013 in Business. Servicios de Libranda para el préstamo digital. Plataforma de ...
https://speakerdeck.com/.../presentacion-corporativa-para-bibli...


El Gobierno premia a cinco bibliotecas de León por su fomento de ...
El Gobierno, a través del Ministerio de Educación, Cultura y Deporte, ha premiado a diecisietebibliotecas públicas de Castilla y León, cinco de las cuales son ...
www.leondirecto.com/el-gobierno-premia-a-cinco-bibliotecas-...

XXVII Jornada Nacional de Ortopedia, 58° Reunión Anual

Detección de displasia de la cadera en desarrollo en menores de un año

Bibliomanazteca

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Dolor y su computadora/Pain and your computer

                                                  http://www.smo.edu.mx/jornada2013/

Síntomas musculoesqueléticos y uso de computadoras en adolescentes Finlandeses- La intensidad del dolor y molestias de la vida cotidiana: Un estudio transversal  Musculoskeletal symptoms and computer use among Finnish adolescents--pain intensity and inconvenience to everyday life: a cross-sectional study. Hakala PT, Saarni LA, Punamäki RL, Wallenius MA, Nygård CH, Rimpelä AH. School of Health Sciences, University of Tampere, Tampere, Finland.paula.t.hakala@uta.fi BMC Musculoskelet Disord. 2012 Mar 22;13:41. doi: 10.1186/1471-2474-13-41. Abstract BACKGROUND: Musculoskeletal symptoms among adolescents are related to the time spent using a computer, but little is known about the seriousness of the symptoms or how much they affect everyday life. The purpose of the present study was to examine the intensity of musculoskeletal pain and level of inconvenience to everyday life, in relation to time spent using a computer. METHODS: In a survey, 436 school children (12 to 13 and 15 to 16 years of age), answered a questionnaire on musculoskeletal and computer-associated musculoskeletal symptoms in neck-shoulder, low back, head, eyes, hands, and fingers or wrists. Pain intensity (computer-associated symptoms) and inconvenience to everyday life (musculoskeletal symptoms) were measured using a visual analogue scale. Based on the frequency and intensity, three categories were formed to classify pain at each anatomic site: none, mild, and moderate/severe. The association with time spent using the computer was analyzed by multinomial logistic regression. RESULTS: Moderate/severe pain intensity was most often reported in the neck-shoulders (21%); head (20%); and eyes (14%); and moderate/severe inconvenience to everyday life was most often reported due to head (29%), neck-shoulders (21%), and low back (16%) pain. Compared with those using the computer less than 3.6 hours/week, computer use of ≥ 14 hours/week, was associated with moderate/severe increase in computer-associated musculoskeletal pain at all anatomic sites (odds ratio [OR] = 2.9-4.4), and moderate/severe inconvenience to everyday life due to low back (OR = 2.5) and head (OR = 2.0) pain. CONCLUSIONS: Musculoskeletal symptoms causing moderate/severe pain and inconvenience to everyday life are common among adolescent computer users. Daily computer use of 2 hours or more increases the risk for pain at most anatomic sites. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3348031/pdf/1471-2474-13-41.pdf     Tratamiento de dolor lumbar en usadores de computadoras: Un abordaje multidisciplinario  Management of low back pain in computer users: A multidisciplinary approach Shete KM, Suryawanshi P, Gandhi N. J Craniovert Jun Spine [serial online] 2012 [cited 2013 Apr 5];3:7-10. Abstract Background: Low back pain is a very common phenomenon in computer users. More than 80% people using computers for more than 4 h complain of back pain. Objective: To compare the effectiveness of multidisciplinary treatment approach and conventional treatment approach amongst computer users. Materials and Methods: A prospective interventional study was carried out at a private spine clinic amongst the computer users with the complaint of low back pain. The study participants were randomly distributed in two groups. The first group comprised the study participants treated by conventional approach and the second group was treated by multidisciplinary approach. Primary outcomes analyzed were pain intensity, sick leave availed, and quality of life. Statistical analysis was done using proportions, unpaired "t" test, and Wilcoxon signed-rank test. Results: Totally 44 study participants were randomly assigned to groups I and II, and each group had 22 study participants. Intensity of pain was reduced significantly in the group treated by multidisciplinary approach (t = 5.718; P = 0.0001). Similarly only 4 (19.19%) of the study participants of the group treated by multidisciplinary approach availed sick leave due to low back pain, while 14 (63.63%) study participants availed sick leave in the other group (P = 0.02). The quality of life amongst the study participants treated by multidisciplinary approach was significantly improved compared to the group treated by conventional approach (t = 7.037; P = 0.0001). Conclusion and Recommendation: The multidisciplinary treatment approach was better than the conventional treatment approach in low back pain cases when some factors like pain and quality of life were assessed. The multidisciplinary approach for treatment of low back pain should be promoted over conventional approach. Larger studies are required to confirm the findings in different settings. Keywords: Computer users, low back pain, multidisciplinary approach. http://www.jcvjs.com/article.asp?issn=0974-8237;year=2012;volume=3;issue=1;spage=7;epage=10;aulast=Shete     http://www.jcvjs.com/text.asp?2012/3/1/7/110117    Factores de riesgo para alteraciones del cuello y de las extremidades en usadores de ordenadores y el efecto de las intervenciones. Una visión general de revisiones sistemáticas  Risk Factors for Neck and Upper Extremity Disorders among Computers Users and the Effect of Interventions: An Overview of Systematic Reviews Johan H. Andersen, Nils Fallentin, Jane F. Thomsen, and Sigurd Mikkelsen PLoS One. 2011; 6(5): e1969. 1 Published online 2011 May 12. doi:  10.1371/journal.pone.0019691 Abstract Background. To summarize systematic reviews that 1) assessed the evidence for causal relationships between computer work and the occurrence of carpal tunnel syndrome (CTS) or upper extremity musculoskeletal disorders (UEMSDs), or 2) reported on intervention studies among computer users/or office workers. Methodology/Principal Findings PubMed, Embase, CINAHL and Web of Science were searched for reviews published between 1999 and 2010. Additional publications were provided by content area experts. The primary author extracted all data using a purpose-built form, while two of the authors evaluated the quality of the reviews using recommended standard criteria from AMSTAR; disagreements were resolved by discussion. The quality of evidence syntheses in the included reviews was assessed qualitatively for each outcome and for the interventions. Altogether, 1,349 review titles were identified, 47 reviews were retrieved for full text relevance assessment, and 17 reviews were finally included as being relevant and of sufficient quality. The degrees of focus and rigorousness of these 17 reviews were highly variable. Three reviews on risk factors for carpal tunnel syndrome were rated moderate to high quality, 8 reviews on risk factors for UEMSDs ranged from low to moderate/high quality, and 6 reviews on intervention studies were of moderate to high quality. The quality of the evidence for computer use as a risk factor for CTS was insufficient, while the evidence for computer use and UEMSDs was moderate regarding pain complaints and limited for specific musculoskeletal disorders. From the reviews on intervention studies no strong evidence based recommendations could be given. Conclusions/Significance. Computer use is associated with pain complaints, but it is still not very clear if this association is causal. The evidence for specific disorders or diseases is limited. No effective interventions have yet been documented. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093401/pdf/pone. 0019691.pdf    Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org