Cirugía cardiaca de vía rápida/Fast track cardiac surgery

Programa de estancia corta en cirugía cardiaca: Análisis de morbimortalidad en 533 casos en cinco años.


Rodríguez-Chavez, LL et al
Arch. Cardiol. Méx. [online]. 2010, vol.80, n.2, pp. 100-107. ISSN 1405-9940.
Resumen
Introducción: Para disminuir la lista de espera para la cirugía cardiaca electiva, en 1999 el Instituto Nacional de Cardiología Ignacio Chávez inició un programa de vía rápida para casos de muy bajo riesgo quirúrgico. En 2004, este programa se extendió a pacientes con riesgo intermedio.Objetivos: Estudio prospectivo, descriptivo, para evaluar las características clínicas y demográficas de los pacientes del programa de vía rápida en cirugía cardiaca electiva. También se analizaron la estancia hospitalaria, mortalidad, complicaciones y reingresos. Métodos: De marzo de 2004 a febrero de 2009 incluimos pacientes adultos con indicación de cirugía cardiaca y con riesgo quirúrgico de bajo a intermedio, con requisitos preoperatorios completos antes del internamiento. Resultados: De un total de 598 pacientes ingresados al programa, se analizaron 533, con edad de 47 ± 14 años, 62.5% mujeres. Se clasificaron en cuatro grupos: valvulares (68%), congénitos (25%), isquémicos (5%) y mixtos (2%). Los promedios de días de estancia hospitalaria fueron: preoperatoria 1.9, terapia tres, postoperatoria en piso 6.9 y total 11.9 días. Se evidenció que 17.8 % estuvieron más de 14 días por: reoperaciones, complicaciones pulmonares, arritmias, o infecciones. La mortalidad fue de 4.1% y hubo 2.8% de reingresos en los primeros tres meses posteriores a la cirugía. Conclusiones: Este programa conduce a bajos índices de mortalidad, estancia hospitalaria y reingresos.
Palabras llave : Cirugía cardiaca electiva; Vía rápida; Complicaciones de cirugía cardiaca y estancia intrahospitalaria; México.


http://www.scielo.org.mx/pdf/acm/v80n2/v80n2a7.pdf



Análisis de los factores de riesgo para la falla del protocolo de vía rápida

Risk factor analysis for fast track protocol failure.

Kiessling AH, Huneke P, Reyher C, Bingold T, Zierer A, Moritz A.

Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany. cardiac.surgeon@dr-kiessling.com

J Cardiothorac Surg. 2013 Mar 15;8:47. doi: 10.1186/1749-8090-8-47.



http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3608078/pdf/1749-8090-8-47.pdf



Tiempo de estancia en la UCI después de la cirugía cardíaca:¿Es imposible encontrar un modelo de predicción universal?

Length of intensive care unit stay following cardiac surgery: is it impossible to find a universal prediction model?
Widyastuti Y, Stenseth R, Wahba A, Pleym H, Videm V.
Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
Interact Cardiovasc Thorac Surg. 2012 Nov;15(5):825-32. doi: 10.1093/icvts/ivs302. Epub 2012 Jul 24.
Abstract
OBJECTIVES: Accurate models for prediction of a prolonged intensive care unit (ICU) stay following cardiac surgery may be developed using Cox proportional hazards regression. Our aims were to develop a preoperative and intraoperative model to predict the length of the ICU stay and to compare our models with published risk models, including the EuroSCORE II. METHODS: Models were developed using data from all patients undergoing cardiac surgery at St. Olavs Hospital, Trondheim, Norway from 2000-2007 (n = 4994). Internal validation and calibration were performed by bootstrapping. Discrimination was assessed by areas under the receiver operating characteristics curves and calibration for the published logistic regression models with the Hosmer-Lemeshow test. RESULTS: Despite a diverse risk profile, 93.7% of the patients had an ICU stay <2 days, in keeping with our fast-track regimen. Our models showed good calibration and excellent discrimination for prediction of a prolonged stay of more than 2, 5 or 7 days. Discrimination by the EuroSCORE II and other published models was good, but calibration was poor (Hosmer-Lemeshow test: P < 0.0001), probably due to the short ICU stays of almost all our patients. None of the models were useful for prediction of ICU stay in individual patients because most patients in all risk categories of all models had short ICU stays (75th percentiles: 1 day). CONCLUSIONS: A universal model for prediction of ICU stay may be difficult to develop, as the distribution of length of stay may depend on both medical factors and institutional policies governing ICU discharge.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480596/pdf/ivs302.pdf



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

X Curso de Ortopedia Pediátrica / México, 2013

Tumor de Células gigantes / ortopedia

Aquí la última plática de La Mixta por este 2013, Tumor de Células Gigantes, ponente: Dr. José Humberto Rodríguez Franco, (B Rguez Franco)

http://youtu.be/VPLTkZj5jf4

Embarazo de alto riesgo

Anestesia en una parturienta con transplante renal


Anesthesia for parturient with renal transplantation.
Parikh BK, Shah VR, Bhosale G.
Department of Anaesthesia and Critical Care, Institute of Kidney Diseases and Research Centre, Civil Hospital Campus, Ahmedabad, Gujarat, India.
J Anaesthesiol Clin Pharmacol. 2012 Oct;28(4): 524-7.
Abstract
Management of successful pregnancy after renal transplantation is a unique challenge to nephrologist, obstetrician, and anesthesiologist, as these patients have altered physiology and are immune-compromised. We present the anesthetic management of three postrenal transplant patients scheduled for cesarean section. While conducting such cases, cardiovascular status, hematological status, and function of transplanted kidney should be assessed thoroughly. Side effects of immunosuppressant drugs and their interaction with anesthetic agents should be taken into consideration. Main goal of anesthetic management is to maintain optimum perfusion pressure of renal allograft to preserve its function.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3511957/






Embarazo después de transplante de hígado: revisión de evolución y recomendaciones de manejo

Pregnancy following liver transplantation: review of outcomes and recommendations for management.
Parhar KS, Gibson PS, Coffin CS.
Division of General Internal Medicine, University of Calgary, Calgary, Alberta.
Can J Gastroenterol. 2012 Sep;26(9):621-6.
Abstract
Liver transplantation is considered to be the treatment of choice for end-stage liver disease and its success has led to an increase in the number of female liver transplant recipients who are of childbearing age. Several key issues that are noted when counselling patients who are consideringpregnancy following liver transplantation include the optimal timing of pregnancy, optimal contraception methods and the management of immunosuppression during pregnancy. The present review summarizes the most recent literature so that the clinician may address these issues with their patient and enable them to make informed decisions about pregnancy planning. The authors review recent studies examining maternal and fetal outcomes, and the rates of complications including risk of graft rejection. Subsequently, the authors provide recommendations for counselling prospective mothers and the management of the pregnant liver transplant recipient.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3441170/pdf/cjg26621.pdf


Cardiomiopatía periparto: revisión de la literatura
Peripartum cardiomyopathy: review of the literature.
Bhakta P, Biswas BK, Banerjee B.
Department of Anesthesiology, Barnes-Jewish Hospital South, Washington University School of Medicine, 660 S Euclid Avenue, St. Louis, MO, USA.
Yonsei Med J. 2007 Oct 31;48(5):731-47.
Abstract
Peripartum cardiomyopathy (PPCM) is a rare but serious form of cardiac failure affecting women in the last months of pregnancy or early puerperium. Clinical presentation of PPCM is similar to that of systolic heart failure from any cause, and it can sometimes be complicated by a high incidence of thromboembolism. Prior to the availability of echocardiography, diagnosis was based only on clinical findings. Recently, inclusion of echocardiography has made diagnosis of PPCM easier and more accurate. Its etiopathogenesis is still poorly understood, but recent evidence supports inflammation, viral infection and autoimmunity as the leading causative hypotheses. Prompt recognition with institution of intensive treatment by a multidisciplinary team is a prerequisite for improved outcome. Conventional treatment consists of diuretics, beta blockers, vasodilators, and sometimes digoxin and anticoagulants, usually in combination. In resistant cases, newer therapeutic modalities such as immunomodulation, immunoglobulin and immunosuppression may be considered. Cardiac transplantation may be necessary in patients not responding to conventional and newer therapeutic strategies. The role of the anesthesiologist is important in perioperative and intensive care management. Prognosis is highly related to reversal of ventricular dysfunction. Compared to historically higher mortality rates, recent reports describe better outcome, probably because of advances in medical care. Based on current information, future pregnancy is usually not recommended in patients who fail to recover heart function. This article aims to provide a comprehensive updated review of PPCM covering etiopathogeneses, clinical presentation and diagnosis, as well as pharmacological, perioperative and intensive care management and prognosis, while stressing areas that require further research.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628138/pdf/ymj-48-731.pdf




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

Gama globulina IV en el manejo de Inmunodeficiencia e hipersensibilidad

Estimado Ciberpediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 13 de Noviembre 2013 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Gama globulina IV en el manejo de Inmunodeficiencia e hipersensibilidad ” por “Dr. Marco Antonio Yamasaky” Inmunólogo, Pediatra de la Cd. de México DF . La sesión inicia puntualmente las 21 hrs.
Para entrar a la Sala de Conferencia:
1.- hacer click en la siguiente liga, o cópiala y escríbela en tu buscador http://connectpro60196372. adobeconnect.com/ gamaglobulina_iv/
2.- “Entra como Invitado” Escribes tu nombre y apellido en el espacio en blanco
3.- Hacer click en el espacio que dice “Entrar en la Sala”
5.- A disfrutar la conferencia 

 6.- Recomendamos que dejes tu Nombre Completo, Correo electrónico y que participes.

Henrys

Dr. Enrique Mendoza López
Webmaster: CONAPEME
Coordinador Nacional: Seminario Ciberpeds-Conapeme
Av La clinica 2520-310
Colonia Sertoma ,Mty N.L. México
CP 64710
Tel-Fax 52 81 83482940 y 52 81 81146053
Celular 8183094806
www.conapeme.org
www.pediatramendoza.com
enrique@pediatramendoza.com
emendozal@yahoo.com.mx

Sedación con dexmedetomidina/Dexmedetomidine for sedation

Dosis óptima de dexmedetomidina para sedación durante raquianestesia   Optimal dose of dexmedetomidine for sedation during spinal anesthesia. Ok HG, Baek SH, Baik SW, Kim HK, Shin SW, Kim KH. Department of Anesthesia and Pain Medicine, Pusan National University College of Medicine, Yangsan, Korea. Korean J Anesthesiol. 2013 May;64(5):426-31. doi: 10.4097/kjae.2013.64.5.426. Epub 2013  Abstract BACKGROUND:Sedation in spinal anesthesia can reduce patient's anxiety and discomfort. Dexmedetomidine has a sedative, hypnotic, analgesic, and minimal respiratory depression effect. However, use of the dexmedetomidine is associated with prolonged recovery. This study was designed to investigate the optimal dose of intravenous dexmedetomidine for proper sedation with minimal recovery time in spinal anesthesia. METHODS: One hundred twenty eight patients, aged 20-70 years (58.8 ± 0.7), were recruited. After performing the spinal anesthesia with hyperbaric bupivacaine (13 mg), a loading dose of dexmedetomidine (1 µg/kg) was administered for 10 min, followed by the maintenance infusion of the following: Group A (n = 33; normal saline), Group B (n = 35; dexmedetomidine 0.2 µg/kg/hr), and Group C (n = 39; dexmedetomidine 0.4 µg/kg/hr). Heart rate, blood pressure, and the bispectral index score (BIS) were recorded during the operation. In the recovery room, modified aldrete score (MAS) was measured. RESULTS: There were no significant differences in mean blood pressure and heart rate among the three groups. BIS was not significantly different among the three groups from baseline to 60 min after the infusion of dexmedetomidine. BIS were significantly increased in Group A after 70 and 80 min, and Group A and B after 90, 100, 110 min of dexmedetomidine infusion (P < 0.05). MAS was higher in Group A as compared to Group B and C, within 30 min after admission in the recovery room (P < 0.05). CONCLUSIONS: The loading dose (1 µg/kg/10 min) of dexmedetomidine was sufficient for surgery of less than 60 min. Dexmedetomidine infusion followed by maintenance dose (0.2 µg/kg/hr) was sufficient for surgery within 90 min. KEYWORDS: Dexmedetomidine, Sedation, Spinal anesthesia  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3668104/pdf/kjae-64-426.pdf Dexmedetomidina para sedación de pacientes de cirugía electiva bajo anestesia raquídea       Dexmedetomidine for sedation of patients undergoing elective surgery under regional anesthesia. Song J, Kim WM, Lee SH, Yoon MH. Department of Anesthesiology and Pain Medicine, Chonnam National University Hospital, Gwangju, Korea. Korean J Anesthesiol. 2013 Sep;65(3):203-8. doi: 10.4097/kjae.2013.65.3.203. Epub 2013 Sep 25. Abstract BACKGROUND:Dexmedetomidine may be useful as a sedative agent. However, it has been reported that dexmedetomidine decreases systemic blood pressure, heart rate, and cardiac output in a dose-dependent manner. The purpose of this study was to determine the appropriate dose of intravenously administered dexmedetomidine for sedation. METHODS: Forty-five American Society of Anesthesiologists physical status I-II patients under spinal anesthesia received dexmedetomidine 1 µg/kg intravenously as a loading dose. The patients were randomly allocated to one of three groups for maintenance dose: Group A (0.25 µg/kg/hr), Group B (0.50 µg/kg/hr), and Group C (0.75 µg/kg/hr). The hemodynamic variables and the Ramsay Sedation Scale (RSS) score were recorded for all patients. The numbers of patients who developed hypotension, bradycardia, or inadequate sedation necessitating further drug treatment were also recorded. RESULTS: Systolic blood pressure, heart rate, and SpO2 were decreased, and RSS score was increased significantly at both 20 min and 40 min after injection of dexmedetomidine in the three study groups compared to baseline, without significant differences between the groups. The prevalence of hypotension, but not that of bradycardia or adjunctive midazolam administration, exhibited a positive correlation with the dose of dexmedetomidine. CONCLUSIONS: Intravenous injection of dexmedetomidine 1 µg/kg followed by continuous administration at infusion rates of 0.25, 0.50, or 0.75 µg/kg/hr produced adequate levels of sedation. However, there was a tendency for the incidence of hypotension to increase as the dose increased. To minimize the risk of hemodynamic instability, a dose of 0.25 µg/kg/hr may be the most appropriate for continuous administration of dexmedetomidine. KEYWORDS: Continuous dose, Dexmedetomidine, Regional anesthesia, Sedation http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3790030/pdf/kjae-65-203.pdf Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

Cuidado prehospitalario del trauma

Fase de implementación de un sistema multicéntrico prehospitalario de apoyo a paramédicos: posibilidades y viabilidad


Implementation phase of a multicentre prehospital telemedicine system to support paramedics: feasibility and possible limitations.
Bergrath S, Czaplik M, Rossaint R, Hirsch F, Beckers SK, Valentin B, Wielpütz D, Schneiders MT, Brokmann JC.
Department of Anaesthesiology, University Hospital Aachen, Aachen, Germany. sbergrath@ukaachen.de
Scand J Trauma Resusc Emerg Med. 2013 Jul 11;21:54. doi: 10.1186/1757-7241-21-54.
Abstract
BACKGROUND: Legal regulations often limit the medical care that paramedics can provide. Telemedical solutions could overcome these limitations by remotely providing expert support. Therefore, a mobile telemedicine system to support paramedics was developed. During the implementation phase of this system in four German emergency medical services (EMS), the feasibility and possible limitations of this system were evaluated. METHODS:After obtaining ethical approval and providing a structured training program for all medical professionals, the system was implemented on three paramedic-staffed ambulances on August 1st, 2012. Two more ambulances were included subsequently during this month. The paramedics could initiate a consultation with EMS physicians at a teleconsultation centre. Telemedical functionalities included audio communication, real-time vital data transmission, 12-lead electrocardiogram, picture transmission on demand, and video streaming from a camera embedded into the ceiling of each ambulance. After each consultation, telephone-based debriefings were conducted. Data were retrieved from the documentation protocols of the teleconsultation centre and the EMS. RESULTS: During a one month period, teleconsultations were conducted during 35 (11.8%) of 296 emergency missions with a mean duration of 24.9 min (SD 12.5). Trauma, acute coronary syndromes, and circulatory emergencies represented 20 (57%) of the consultation cases. Diagnostic support was provided in 34 (97%) cases, and the administration of 50 individual medications, including opioids, was delegated by the teleconsultation centre to the paramedics in 21 (60%) missions (range: 1-7 per mission). No medical complications or negative interpersonal effects were reported. All applications functioned as expected except in one case in which the connection failed due to the lack of a viable mobile network. CONCLUSION: The feasibility of the telemedical approach was demonstrated. Teleconsultation enabled early initiation of treatments by paramedics operating under the real-time medical direction. Teleconsultation can be used to provide advanced care until the patient is under a physician's care; moreover, it can be used to support the paramedics who work alone to provide treatment in non-life-threatening cases. Non-availability of mobile networks may be a relevant limitation. A larger prospective controlled trial is needed to evaluate the rate of complications and outcome effects.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3599067/pdf/1757-7241-21-9.pdf





La adherencia a las guías y protocolos en el ámbito de la atención pre-hospitalaria y de emergencia: una revisión sistemática.

Adherence to guidelines and protocols in the prehospital and emergency care setting: a systematic review.
Ebben RH, Vloet LC, Verhofstad MH, Meijer S, Mintjes-de Groot JA, van Achterberg T.
Research group for Acute Care, Faculty of Health and Social Studies, HAN University of Applied Sciences, Verlengde Groenestraat 75, Nijmegen 6525 EJ, The Netherlands. Remco.Ebben@han.nl
Scand J Trauma Resusc Emerg Med. 2013 Feb 19;21:9. doi: 10.1186/1757-7241-21-9.
Abstract
A gap between guidelines or protocols and clinical practice often exists, which may result in patients not receiving appropriate care. Therefore, the objectives of this systematic review were (1) to give an overview of professionals' adherence to (inter)national guidelines and protocols in the emergency medical dispatch, prehospital and emergency department (ED) settings, and (2) to explore which factors influencing adherence were described in studies reporting on adherence. PubMed (including MEDLINE), CINAHL, EMBASE and the Cochrane database for systematic reviews were systematically searched. Reference lists of included studies were also searched for eligible studies. Identified articles were screened on title, abstract and year of publication (≥1990) and were included when reporting on adherence in the eligible settings. Following the initial selection, articles were screened full text and included if they concerned adherence to a (inter)national guideline or protocol, and if the time interval between data collection and publication date was <10 years. Finally, articles were assessed on reporting quality. Each step was undertaken by two independent researchers. Thirty-five articles met the criteria, none of these addressed the emergency medical dispatch setting or protocols. Median adherence ranged from 7.8-95% in the prehospital setting, and from 0-98% in the ED setting. In the prehospital setting, recommendations on monitoring came with higher median adherence percentages than treatment recommendations. For both settings, cardiology treatment recommendations came with relatively low median adherence percentages. Eight studies identified patient and organisational factors influencing adherence. The results showed that professionals' adherence to (inter)national prehospital and emergency department guidelines shows a wide variation, while adherence in the emergency medical dispatch setting is not reported. As insight in influencing factors for adherence in the emergency care settings is minimal, future research should identify such factors to allow the development of strategies to improve adherence and thus improve quality of care.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710491/pdf/1757-7241-21-54.pdf

Vía aérea prehospitalaria/Prehospital airway

Uso del tubo laríngeo en para cardiaco fuera del hospital por paramédicos noruegos  Laryngeal tube use in out-of-hospital cardiac arrest by paramedics in Norway. Sunde GA, Brattebø G, Odegården T, Kjernlie DF, Rødne E, Heltne JK. Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. geir.arne.sunde@helse-bergen.no Scand J Trauma Resusc Emerg Med. 2012 Dec 18;20:84. doi: 10.1186/1757-7241-20-84. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3547736/pdf/1757-7241-20-84.pdf Determinación prehospitalaria de la colocación del tubo traqueal en daño grave de cabeza   Prehospital determination of tracheal tube placement in severe head injury. Grmec S, Mally S. Source Emergency Medical Service, Prehospital Unit, Maribor, Slovenia. Emerg Med J. 2004 Jul;21(4):518-20. Abstract OBJECTIVES: The aim of this prospective study in the prehospital setting was to compare three different methods for immediate confirmation of tubeplacement into the trachea in patients with severe head injury: auscultation, capnometry, and capnography. METHODS: All adult patients (>18 years) with severe head injury, maxillofacial injury with need of protection of airway, or polytrauma were intubated by an emergency physician in the field. Tube position was initially evaluated by auscultation. Then, capnometry and capnography was performed (infrared method). Emergency physicians evaluated capnogram and partial pressure of end tidal carbon dioxide (EtCO(2)) in millimetres of mercury.Determination of final tube placement was performed by a second direct visualisation with laryngoscope. Data are mean (SD) and percentages. RESULTS: There were 81 patients enrolled in this study (58 with severe head injury, 6 with maxillofacial trauma, and 17 politraumatised patients). At the first attempt eight patients were intubated into the oesophagus. Afterwards endotracheal intubation was undertaken in all without complications. The initial capnometry (sensitivity 100%, specificity 100%), capnometry after sixth breath (sensitivity 100%, specificity 100%), and capnography after sixth breath (sensitivity 100%, specificity 100%) were significantly better indicators for tracheal tube placement than auscultation (sensitivity 94%, specificity 66%, p<0.01). CONCLUSION: Auscultation alone is not a reliable method to confirm endotracheal tube placement in severely traumatised patients in the prehospitalsetting. It is necessary to combine auscultation with other methods like capnometry or capnography. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1726371/pdf/v021p00518.pdf   Manejo de vía aérea en trauma maxilofacial. Estudio retrospectivo de 177 casos   Airway management in patients with maxillofacial trauma - A retrospective study of 177 cases. Raval CB, Rashiduddin M. Department of Anesthesia, Al-Nahdha Hospital, Muscat, Oman. Saudi J Anaesth. 2011 Jan;5(1):9-14. doi: 10.4103/1658-354X.76476. Abstract BACKGROUND: Airway management in maxillofacial injuries presents with a unique set of problems. Compromised airway is still a challenge to the anesthesiologist in spite of all modalities available. Maxillofacial injuries are the result of high-velocity trauma arising from road traffic accidents, sport injuries, falls and gunshot wounds. Any flaw in airway management may lead to grave morbidity and mortality in prehospital or hospital settings and as well as for reconstruction of fractures subsequently. METHODS: One hundred and seventy-seven patients of maxillofacial injuries, operated over a period of one and half years during July 2008 to December 2009 in Al-Nahdha hospital were reviewed. All patients were reviewed in depth with age related type of injury, etiology and techniques of difficult airway management. RESULTS: The major etiology of injuries were road traffic accidents (67%) followed by sport (15%) and fall (15%). Majority of patients were young in the age group of 11-30 years (71 %). Fracture mandible (53%) was the most common injury, followed by fracture maxilla (21%), fracture zygoma (19%) and pan-facial fractures (6%). Maxillofacial injuries compromise mask ventilation and difficult airway due to facial fractures, tissue edema and deranged anatomy. Shared airway with the surgeon needs special attention due to restrictions imposed during surgery. Several methods available for securing the airway, both decision-making and performance, are important in such circumstances. Airway secured by nasal intubation with direct visualization of vocal cords was the most common (57%), followed by oral intubation (17%). Other methods like tracheostomy and blind nasal intubation was avoided by fiberoptic bronchoscopic nasal intubation in 26% of patients. CONCLUSION:The results of this study indicated that surgically securing the airway by tracheostomy should be revised compared to other available methods. In the era of rigid fixation of fractures and the possibility of leaving the patient without wiring an open mouth and alternative techniques like fiberoptic bronchoscopic intubation, it is unnecessary to carry out tracheostomy for securing the airway as frequently as in the past. KEYWORDS: Difficult airway, fiberoptic bronchoscopic intubation, maxillofacial injuries, tracheostomy http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101764/ Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org

ebooks. Alerta

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El Correo de Béjar

Las bibliotecas de Sant Josep Inauguran web y sevicio de e-books Diario de Ibiza
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Mirada 21

David Beckham protagonizará primeros libros digitales en Facebook Perú.com
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(1) “Si tienes un Kindle compras hasta cuatro veces más libros” Media-Tics
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Media-Tics

El Congreso del Libro electrónico trabaja ya en su segunda edición ABC.es
En cuanto a las conclusiones del encuentro, el precio de los ebooks ha sido uno de los temas a debate, en el que los representantes de la edición tradicional ...
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Más del 80% de españoles lee en formato digital Europa Press
Es multiplataforma y lee alrededor de 10 ebooks al año, a lo que le dedica una ... Mientras tanto, el 48 por ciento no compra ebooks en la red, pero sí los lee.
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Apuestan por el libro impreso El Universal
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La situación del ebook: Un gran transatlántico varado eldiario.es
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Conozca los mejores eBooks sobre el tema. E-mail; Imprimir. Crédito: Violencia, desigualdad, crisis e inestabilidad son términos sumamente familiares para ...
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InfoBAE.com

BajaLibros.com apuesta a la cultura y educación en Estados Unidos ... Que Pasa Bulletin
MIAMI, 4 de noviembre de 2013 /PRNewswire-HISPANIC PR WIRE/ -- BajaLibros.com, la tienda más grande de eBooks en español, anunció esta semana el ...
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Bajalibros.com auspicia la presentación del nuevo libro de Thalía ... Latino
MIAMI, 5 de noviembre de 2013 /PRNewswire-HISPANIC PR WIRE/ -- Bajalibros.com, tu tienda de eBooks en español se une a Thalía en el lanzamiento de su ...
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EFE

Netflix, Spotify, Gaikai, Oyster Books y otras tarifas planas digitales ... Softonic ES
Con el auge de los e-books y las tablets lo mismo está sucediendo con nuestra forma de leer. Viendo que el formato tarifa plana funciona, ¿por qué no aplicarlo ...
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PDFfetch, buscador de archivos en PDF, libros digitales y otras ... eju.tv
... como Google Books, Issuu, Kobo, Scribd y Slideshare, para hacer posible buscar miles de archivos y documentos en PDF: ebooks, presentaciones, artículos, ...
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eju.tv

EE.UU. aprueba el uso de e−books y tabletas durante el despegue ... EntornoInteligente
ABC de España 2 / Las autoridades estadounidenses han aprobado el uso de aparatos electrónicos como tabletas durante todas las fases del vuelo en aviones ...
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Blogs 2 resultados nuevos para E-Books

PDFfetch, un potente buscador de documentos y ebooks en formato ... Juan Luis Bermúdez
PDFfetch es un buscador para todo tipo de archivos PDF (ebooks, documentos, guías, tutoriales, ...) que se sirve de diez motores de búsqueda diferentes.
- Soft & Apps

EE.UU. aprobó el uso de e−books y tabletas durante el despegue y ...
Los pasajeros podrán leer libros electrónicos, ver vídeos e incluso navegar por internet. Detalles.
La Gaceta On Line

Trombofilias y embarazo

Plaquetas en el embarazo  Platelets in pregnancy. Juan P, Stefano G, Antonella S, Albana C. Poliambulatorio di Ceprano, Ospedale SS Trinita di Sora, Ultrasound in Obstetrics and Gynecology Divisions; (FR), Italy. J Prenat Med. 2011 Oct;5(4):90-2. Abstract As stated in this review, platelets functions and their important role in coagulabity in pregnancy must be well understood, not only in thrombosis related complications in pregnancy (i.e., hypertension, diabetes, thrombophilia).Clinical findings suggest that a periodical monitoring of haematological markers such as MPV and coagulation markers may be associated to Doppler velocimetry, keeping in mind also that the incidence of complications is increased in women who have heritable platelet function disorders. KEYWORDS: coagulation, high risk pregnancies, platelets   http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399052/pdf/prenatal-5-90-92.pdf   Trombofilias y daño renal durante el embarazo Thrombophilia and damage of kidney during pregnancy. Giovanni L, Maria LG, Mauro R, Carlotta M, Federica R, Fabrizio P, Sheba J, Giuseppe DP, Alessandro B, Elio C, Herbert V. Department of Obstetrics and Gynaecology, Fatebenefratelli Isola TiberinaHospital, Rome. J Prenat Med. 2011 Oct;5(4):78-82. Abstract ABSTRACT OBJECTIVES:It's known that heritable thrombophilias are a risk factor for the development of obstetrics complications associated to inadequate uterine-placental circulation, as pre-eclampsia/eclampsia, HELLP syndrome, placental abruption and intrauterine growth restriction (IUGR), however it was never investigated the role that they could have in the renal failure associated to such conditions. The purpose of this study is to evaluate ifthrombophilia itself that predispose to a possible renal damage or if its occurrence determines a more severe involvement of the kidneys in the course of these obstetric pathologies. METHODS: In the study were enrolled 301 pregnant women, who carried a thrombophilic state, 125 of whom (B group) has had an obstetric complication. In all the women the renal function was assessed taking into consideration proteinuria, creatininaemia and hypalbuminaemia. RESULTS:Of the three parameters which have been considered as evidence of a severe renal involvement the hypalbuminaemia appears statistically significant compared to the controls. Even creatinaemia is significantly increased in pregnant women with an Anthithrombin deficiency, and increased levels are detected in women with Factor V Leiden. CONCLUSIONS: In obstetric complications associated to thrombophilic state could be a more severe involvement of the kidney. KEYWORDS: heritable thrombophilias, obstetric complications, renal damage in pregnancy http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399050/pdf/prenatal-5-78-82.pdf     Síndrome antifosfolípido durante el embarazo: estado del arte  Antiphospholipid Syndrome during pregnancy: the state of the art. Di Prima FA, Valenti O, Hyseni E, Giorgio E, Faraci M, Renda E, De Domenico R, Monte S. Policlinico Hospital, Department of Obstetrics and Gynecology, University of Catania, Italy. J Prenat Med. 2011 Apr;5(2):41-53. Abstract Obstetric complications are the hallmark of antiphospholipid syndrome. Recurrent miscarriage, early delivery, oligohydramnios, prematurity, intrauterine growth restriction, fetal distress, fetal or neonatal thrombosis, pre-eclampsia/eclampsia, HELLP syndrome, arterial or venous thrombosis and placental insufficiency are the most severe APS-related complication for pregnant women. Antiphospholipid antibodies promote activation of endothelial cells, monocytes and platelets, causing an overproduction of tissue factor and thromboxane A2. Complement activation might have a central pathogenetic role. These factors, associated with the typical changes in the hemostatic system during normal pregnancy, result in a hypercoagulable state. This is responsible of thrombosis that is presumed to provoke many of the pregnancy complications associated with APS. Obstetric care is based on combined medical-obstetric high-risk management and treatment with the association between aspirin and heparin. This review aims to deter- mine the current state of the art of APS by investigating the knowledge achievements of recent years, to provide the most appropriate diagnostic and therapeutic management for pregnant women suffering from this syndrome. KEYWORDS:Antiphospholipid, Hypercoagula- bility, Thrombophilia, Thromboprophylaxis. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279165/pdf/prenatal-05-0041.pdf Atentamente Dr. Benito Cortes-Blanco Anestesiología y Medicina del Dolor www.anestesia-dolor.org

Bibliotecas. Alerta

La biblioteca digital de centac es una de las mayores de toda ... elEconomista.es
“La biblioteca digital de medios audiovisuales de CENTAC es una de las mayores de toda Europa en materia de tecnología y accesibilidad”, según aseguró su ...
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La biblioteca, sede de la Olimpiada Solidaria de Estudio La Verdad
La XI Olimpiada Solidaria de Estudio, organizada por la ONG Coopera, se celebrará del 5 de noviembre al 5 de diciembre, en la biblioteca ´Salvador García ...
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La Biblioteca de la UCA obtiene de nuevo el Sello de Excelencia ... Diario Bahía de Cádiz
El área de Biblioteca y Archivo de la Universidad de Cádiz, que fue la primera unidad universitaria de España en recibir el Sello de Excelencia Europea 500+ ...
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Diario Bahía de Cádiz

La Junta impulsa una biblioteca digital de Santa Teresa Diario de León
La Junta de Castilla y León ha creado una Biblioteca Digital Teresiana con fondos que, en la actualidad, se están digitalizando, de cara a la conmemoración, ...
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La Biblioteca de Sanxenxo acoge una ´Noite de terror´ para ... Faro de Vigo
La Biblioteca Central Emilia Pardo Bazán, situada en la villa de Sanxenxo, acogerá mañana la tercera edición de "Noite de terror", una iniciativa destinada a los ...
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Biblioteca de El Mante se actualiza en el área digital Hoy Tamaulipas
Con el objetivo de prestar un mejor servicio a los usuarios de la Biblioteca Pública Municipal de esta Ciudad, personal de esta dependencia del Gobierno ...
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La biblioteca municipal suma 300 nuevos socios en un año El Periódico Extremadura
</b> Un usuario es atendido en el mostrador de recepción de la biblioteca ... La biblioteca municipal de Villanueva de la Serena cuenta con 300 nuevos ...
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Biblioteca móvil visita a varios pueblos Diario La Arena
La senadora María de los Angeles Higonet gestionó la visita de la Biblioteca Móvil del Congreso de la Nación a varios puntos de nuestra provincia. Estuvo ...
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La Biblioteca Teatral Municipal festeja 15 años de vida. Análisis Digital
La Biblioteca Teatral Municipal cumple 15 años y la Asociación de Amigos y el Instituto Nacional del Teatro invitan a festejarlos, en el marco de la Selección ...
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Análisis Digital

Ofrecen en Biblioteca Mauricio Magdaleno, curso de “artesanía en ... Lasnoticiasya
biblioteca Zacatecas, Zac.- Con el objetivo de despertar el ingenio y la ... personal de la biblioteca Mauricio Magdaleno ofrece el curso Artesanía en pasta ...
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Lasnoticiasya

Las películas preferidas de la biblioteca « Biblioteca del Instituto ... bibliotecaiie
Los descendientes” dirigida por Alexander Payne. “Matt King (George Clooney), casado y padre de dos niñas, se ve obligado a replantearse la vida cuando su ...
Biblioteca del Instituto Internacional

Biblioteca y Archivo y el índice Klout - CanalBiblos Servicios Centrales
En el estudio se toma como referencia el Índice Klout. En aquel momento Biblioteca y Archivo tenía un índice Klout de 14 sobre 100. A día de hoy este índice es ...
CanalBiblos: blog de la Biblioteca y Archivo de la UAM

La biblioteca UCA revalida el sello 500+ de Excelencia Europea ... Redacción
Actualmente, en España esta distinción tan solo la tienen el área de Biblioteca y Archivo de la Universidad de Cádiz, pionera en 2011, y la Biblioteca de la ...
El Baluarte de Cádiz - Periódico digital

Actividades Semana de la Ciencia 2013 en la Biblioteca de Derecho Biblioteca de Derecho
Las actividades de la Semana de la Ciencia 2013 de la Biblioteca de Derecho giran en torno al tema "El derecho al agua". Contamos con una exposición ...
CanalBiblos: blog de la Biblioteca y Archivo de la UAM

Celebrando el día de la biblioteca | Biblioteca Municipal de Aguilar ... quiquebr
El pasado 24 de octubre celebrábamos el día de la BIBLIOTECA compartiendo palabras y sonrisas con ROBERTO MEZQUITA. Nos lo pasamos genial, los ...
Biblioteca Municipal de Aguilar de Campoo

Biblioteca Nro 16 Paraje El Saltito - 25 de Mayo | "Un sueño" para ... patricia liliana Ocampo
La biblioteca se instalo en el salón de usos múltiples del paraje, ya que la escuela tiene terreno pero no edificio y los 70 alumnos que concurren a clase ...
"Un sueño" para Misiones

La gestión de la información y el conocimiento como clave de éxito del activismo social

http://www.thinkepi.net/la-gestion-de-la-informacion-y-el-conocimiento-como-clave-de-exito-del-activismo-social

La gestión de la información y el conocimiento como clave de éxito del activismo social

Posted:
Dos décadas de gestión del conocimiento Hace aproximadamente dos décadas que la gestión de la información y del conocimiento forma parte de nuestro “argot” habitual. Todos sabemos qué son, para qué...

Grupo formado por profesionales y académicos provenientes del mundo de la Información y Gestión documental. Los artículos publicados por los miembros del grupo se encuentran disponibles en nuestra sede web: http://www.thinkepi.net

Ortopedia. Alerta

El Complejo Asistencial de Ávila organiza un curso de “Ortopedia y ...Tribuna Ávila
El Complejo Asistencial de Ávila, dependiente de la Junta de Castilla y León, celebra hoy viernes 8 de noviembre la segunda edición del curso “Ortopedia y ...
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Caderas y rodillas nuevas con la operación “Walk”Crítica
El doctor Carlos Martínez, jefe de Ortopedia del HST, indicó que los pacientes pasan por una evaluación a fin de cerciorarse de que están aptos para ...
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