Más de hígado y anestesia/More on liver and anaesthesia

Papel de los anestésicos inhalados en pacientes con disfunción hepática. Una revisión. The role of inhalational anesthetic drugs in patients with hepatic dysfunction: a review article. Soleimanpour H1, Safari S2, Rahmani F3, Ameli H4, Alavian SM5. Anesth Pain Med. 2015 Jan 7;5(1):e23409. doi: 10.5812/aapm.23409. eCollection 2015Author Abstract CONTEXT: Anesthetic drugs including halogenated anesthetics have been common for many years. Consequent hepatic injury has been reported in the literature. The mechanism of injury is immunoallergic. The first generation drug was halothane; it had the most toxicity when compared to other drugs. The issue becomes more important when the patient has an underlying hepatic dysfunction. EVIDENCE ACQUISITION: In this paper, reputable internet databases from 1957-2014 were analyzed and 43 original articles, 3 case reports, and 3 books were studied. A search was performed based on the following keywords: inhalational anesthesia, hepatic dysfunction, halogenated anesthetics, general anesthesia in patients with hepatic diseases, and side effects of halogenated anesthetics from reliable databases. Reputable websites like PubMed and Cochrane were used for the searches. RESULTS: In patients with hepatic dysfunction in addition to hepatic system and dramatic hemostatic dysfunction, dysfunction of cardiovascular, renal, respiratory, gastrointestinal, and central nervous systems may occur. On the other hand, exposure to inhalational halogenated anesthetics may have a negative impact (similar to hepatitis) on all aforementioned systems in addition to direct effects on liver function as well as the effects are more pronounced in halothane. CONCLUSIONS: Despite the adverse effects of inhalational halogenated anesthetics (especially halothane) on hepatic patients when necessary. The effects on all systems must be considered and the necessary preparations must be provided. These drugs are still used, if necessary, due to the presence of positive effects and advantages mentioned in other studies as well as the adverse effects of other drugs. KEYWORDS: Halothane; Hepatitis; Inhalational Anesthetics PDF Riesgos perioperatorios en pacientes con enfermedad hepática sometidos a cirugía no hepática Perioperative risk factors in patients with liver disease undergoing non-hepatic surgery. Pandey CK1, Karna ST, Pandey VK, Tandon M, Singhal A, Mangla V. World J Gastrointest Surg. 2012 Dec 27;4(12):267-74. doi: 10.4240/wjgs.v4.i12.267. Abstract The patients with liver disease present for various surgical interventions. Surgery may lead to complications in a significant proportion of thesepatients. These complications may result in considerable morbidity and mortality. Preoperative assessment can predict survival to some extent inpatients with liver disease undergoing surgical procedures. A review of literature suggests nature and the type of surgery in these patientsdetermines the peri-operative morbidity and mortality. Optimization of premorbid factors may help to reduce perioperative mortality and morbidity. The purpose of this review is to discuss the effect of liver disease on perioperative outcome; to understand various risk scoring systems and their prognostic significance; to delineate different preoperative variables implicated in postoperative complications and morbidity; to establish the effect of nature and type of surgery on postoperative outcome in patients with liver disease and to discuss optimal anaesthesia strategy in patients withliver disease. KEYWORDS: Cirrhosis; Liver disease; Perioperative risk PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Hígado y anestesia / Liver and anaesthesia

Regímenes hipnóticos por vía intravenosa en pacientes con enfermedad hepática; un artículo de revisión. Intravenous hypnotic regimens in patients with liver disease; a review article. Soleimanpour H, Safari S, Rahmani F, Jafari Rouhi A, Alavian SM5. Anesth Pain Med. 2015 Feb 24;5(1):e23923. doi: 10.5812/aapm.23923. eCollection 2015. Abstract CONTEXT:The liver as an important organ in the body has many essential functions in physiological processes. One of the major activities of liveris drug metabolism. Hepatic dysfunction affecting hepatic physiological activities, especially drug metabolism can cause many problems duringanesthesia and administration of different drugs to patients. EVIDENCE ACQUISITION: Studies on hepatic disorders and hypnotic anesthetics prescribed in hepatic disorders were included in this review. For this purpose, reliable databases were used. RESULTS:Anesthesia should be performed with caution in patients with hepatic dysfunction and drugs with long half-life should be avoided in these patients. CONCLUSIONS: A review of the literature on the use of hypnotic drugs in patients with liver dysfunction showed that some hypnotic drugs used during anesthesia could be safely used in patients with impaired liver function. In these patients, certain drugs should be used with caution. KEYWORDS:Anesthesia; Hypnotics Drugs; Liver Disease PDF Anestesia en pacientes con enfermedad hepática Anesthesia for patients with liver disease. Rahimzadeh P, Safari S, Faiz SH, Alavian SM. Hepat Mon. 2014 Jul 1;14(7):e19881. doi: 10.5812/hepatmon.19881. eCollection 2014. Abstract CONTEXT: Liver plays an important role in metabolism and physiological homeostasis in the body. This organ is unique in its structure and physiology. So it is necessary for an anesthesiologist to be familiar with various hepatic pathophysiologic conditions and consequences of liver dysfunction. EVIDENCE ACQUISITION:WE SEARCHED MEDLINE (PUB MED, OVID, MD CONSULT), SCOPUS AND THE COCHRANE DATABASE FOR THE FOLLOWING KEYWORDS: liver disease, anesthesia and liver disease, regional anesthesia in liver disease, epidural anesthesia in liver disease and spinal anesthesia in liver disease, for the period of 1966 to 2013. RESULTS: Although different anesthetic regimens are available in modern anesthesia world, but anesthetizing the patients with liver disease is still really tough. Spinal or epidural anesthetic effects on hepatic blood flow and function is not clearly investigated, considering both the anesthetic drug-induced changes and outcomes. Regional anesthesia might be used in patients with advanced liver disease. In these cases lower drug dosages are used, considering the fact that locally administered drugs have less systemic effects. In case of general anesthesia it seems that using inhalation agents (Isoflurane, Desflurane or Sevoflurane), alone or in combination with small doses of fentanyl can be considered as a reasonable regimen. When administering drugs, anesthetist must realize and consider the substantially changed pharmacokinetics of some other anesthetic drugs. CONCLUSIONS: Despite the fact that anesthesia in chronic liver disease is a scary and pretty challenging condition for every anesthesiologist, this hazard could be diminished by meticulous attention on optimizing the patient's condition preoperatively and choosing appropriate anesthetic regimen and drugs in this setting. Although there are paucity of statistics and investigations in this specific group of patients but these little data show that with careful monitoring and considering the above mentioned rules a safe anesthesia could be achievable in these patients. KEYWORDS: Anesthesia; Epidural Anesthesia; Liver Disease; Regional Anesthesia; Spinal Anesthesia PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

http://www.madrimasd.org/informacionidi/noticias/noticia.asp?id=63217&origen=notiweb&dia_suplemento=lunes

La 'luchadora' a la que Einstein consideró una 'genio de las matemáticas'

De origen judío, Noether nació en la Baviera alemana hace 133 años -de ahí que Google lo celebre con un 'doodle'- en una familia de matemáticos. Hasta tres generaciones se habían dedicado a los números y ella no quiso ser menos. Aprendió acudiendo a las clases que impartía su padre en la universidad, ya que era una época en la que no se admitían mujeres en las aulas. Iba de simple oyente. Dada su persistencia, Emmy Noether consiguió que la dejasen matricularse en Erlangen, la universidad de su ciudad natal, donde se doctoró con un célebre trabajo sobre los invariantes. Tal fue su éxito, que el profesor David Hilbert la invitó a impartir una serie de conferencias en Gotinga, aunque no consiguió llevarlas a cabo por la oposición de parte del profesorado. Solo le permitieron acceder a un puesto no oficial de profesora asociada. Consiguió revolucionar el campo de las matemáticas con teorías sobre anillos, cuerpos y álgebras. También el de la física, con el teorema que lleva su nombre y que relaciona dos ideas básicas: la invariancia de la forma que una ley física toma con respecto a cualquier transformación y la ley de conservación de una magnitud física. Un teorema que se suele formular como "a cada simetría le corresponde una ley de conservación, y viceversa". EXILIADA EN ESTADOS UNIDOS Reconocida en su mundo, no lo era por su propia nación, que le dio la espalda tras el ascenso de Hitler al poder. Aquella Alemania no estaba hecha para genios; no si eran judíos y Emmy Noether fue un caso más de los dotados que fueron ninguneados y olvidados. Le fue imposible seguir dando clase en la Universidad de Gotinga tras la aprobación de la Ley para la Restauración del Servicio Civil Profesional, que impedía mantener su puesto a los funcionarios judíos y políticamente sospechosos. Sin poder dar clases ni conferencias bajo su nombre, Emmy Noether tuvo que exiliarse en Estados Unidos, donde continuó sus estudios y trabajos en el Instituto de Estudios Avanzados de Princeton, compaginándolos con su labor de profesora en Bryn Mawr. Allí desarrolló su labor hasta que, dos años más tarde, le descubrieron un tumor pélvico y falleció a consecuencia de la operación.

Falla hepática aguda en el embarazo. Factores etiológicos y pronósticos

Falla hepática aguda en el embarazo. Factores etiológicos y pronósticos Acute liver failure in pregnancy: Causative and prognostic factors. Sahai S, Kiran R. Saudi J Gastroenterol [serial online] 2015 [cited 2015 Feb 11];21:30-4. Abstract Background/Aims: Acute liver failure (ALF) in pregnancy is often associated with a poor prognosis. In this single-center observational study we aim to study the incidence, causes, and factors affecting mortality in pregnant women with ALF. Patients and Methods: Sixty-eight pregnant women reporting with clinical features of liver dysfunction were enrolled as "cases." Their clinical course was followed and laboratory studies were performed. The presence of ALF was defined as the appearance of encephalopathy. The results were compared with a "control" group of 16 nonpregnant women presenting with similar complaints. The cases were further subdivided into two groups of "survivors" and "nonsurvivors" and were compared to find out the factors that contribute to mortality. Results: ALF was seen in significantly more number of pregnant women than the controls (P = 0.0019). The mortality rate was also significantly higher (P = 0.0287). Hepatitis E virus (HEV) caused jaundice in a higher number of pregnant women (P < 0.001). It also caused ALF in majority (70.3%) of pregnant women, but HEV infection was comparable between the survivors and nonsurvivors (P = 0.0668), hence could not be correlated with mortality.Conclusions: Pregnant women appear to be more susceptible for HEV infection and development of ALF. The mortality of jaundiced pregnant women increased significantly with appearance of ALF, higher bilirubin, lower platelet count, higher international normalized ratio, and spontaneous delivery. Keywords: Acute liver failure, HEV infection, pregnancy PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Esteroides epidurales / Epidural steroids

Controversia-advertencia sobre esteroides epidurales en la FDA. Epidural steroid warning controversy still dogging FDA. Manchikanti L, Candido KD, Singh V, Gharibo CG, Boswell MV, Benyamin RM, Falco FJ, Grider JS, Diwan S, Hirsch JA. Pain Physician. 2014 Jul-Aug;17(4):E451-74. Abstract On April 23, 2014, the Food and Drug Administration (FDA) issued a letter of warning that injection of corticosteroids into the epidural space of the spine may result in rare, but serious adverse events, including "loss of vision, stroke, paralysis, and death." The advisory also advocated that patients should discuss the benefits and risks of epidural corticosteroid injections with their health care professionals, along with the benefits and risks associated with other possible treatments. In addition, the FDA stated that the effectiveness and safety of the corticosteroids for epidural use have not been established, and the FDA has not approved corticosteroids for such use. To raise awareness of the risks of epidural corticosteroid injections in the medical community, the FDA's Safe Use Initiative convened a panel of experts including pain management experts to help define the techniques for such injections with the aim of reducing preventable harm. The panel was unable to reach an agreement on 20 proposed items related to technical aspects of performing epidural injections. Subsequently, the FDA issued the above referenced warning and a notice that a panel will be convened in November 2014. This review assesses the inaccuracies of the warning and critically analyzes the available literature. The literature has been assessed in reference to alternate techniques and an understanding of the risk factors when performing transforaminal epidural injections in the cervical, thoracic, and lumbar regions, ultimately resulting in improved safety. The results of this review show the efficacy of epidural injections, with or without steroids, in a multitude of spinal ailments utilizing caudal, cervical, thoracic, and lumbar interlaminar approaches as well as lumbar transforaminal epidural injections . The evidence also shows the superiority of steroids in managing lumbar disc herniation utilizing caudal and lumbar interlaminar approaches without any significant difference as compared to transforaminal approaches, either with local anesthetic alone or local anesthetic and steroids combined. In conclusion, the authors request that the FDA modify the warning based on the evidence. PDF Inyección torácica epidural interlaminar en el manejo del dolor crónico del tórax. Estudio randomizado.... Thoracic interlaminar epidural injections in managing chronic thoracic pain: a randomized, double-blind, controlled trial with a 2-year follow-up. Manchikanti L, Cash KA, McManus CD, Pampati V, Benyamin RM. Pain Physician. 2014 May-Jun;17(3):E327-38 Abstract BACKGROUND: Reports of prevalence of spinal pain indicate the prevalence of thoracic pain in approximately 13% of the general population compared to 32% of the population with neck pain and 43% of the population with low back pain during the past year. Even though, thoracic pain is less common than neck or low back pain, the degree of disability resulting from thoracic pain disorders seems to be similar to other painful conditions. Interventions in managing chronic thoracic pain are also less frequent, leading to the paucity of literature about various interventions in managing chronic thoracic pain. Thoracic intervertebral discs and thoracic facet joints have been shown to be pain generators, even though thoracicradicular pain is very infrequent. Thoracic epidural injections are one of the commonly performed procedures in managing thoracic pain. The efficacy of thoracic epidural injections has not been well studied. STUDY DESIGN: A randomized, double-blind, active controlled trial. SETTING: Private interventional pain management practice and specialty referral center in the United States. OBJECTIVE: The primary objective was to assess the effectiveness of thoracic interlaminar epidural injections in providing effective pain relief and improving function in patients with chronic mid and/or upper back pain. METHODS: One hundred and ten patients were randomly assigned into 2 groups with 55 patients in each group receiving either local anesthetic alone (Group I) or local anesthetic with steroids (Group II). Randomization was performed by computer-generated random allocation sequence by simple randomization. OUTCOMES ASSESSMENT: Outcomes were assessed utilizing Numeric Rating Scale (NRS), the Oswestry Disability Index (ODI) 2.0, employment status, and opioid intake. The patients experiencing greater than 3 weeks of significant improvement with the first 2 procedures were considered as successful. Others were considered as failed participants. Significant improvement was defined as a decrease of greater than 50% NRS scores and ODI scores with measurements performed at baseline, 3, 6, 12, 18, and 24 months post treatment. RESULTS: Significant improvement was seen in 71% in Group I and 80% in Group II at the end of 2 years with all participants; however, improvement was seen in 80% and 86% when only successful patients were considered. Therapeutic procedural characteristics showed 5 to 6 procedures per 2 years with total average relief of 80 weeks in Group I and 78 weeks in Group II in the successful patient category; whereas, it was 71 and 72 weeks when all patients were considered. LIMITATIONS: Limitations of this assessment include lack of a placebo group. CONCLUSIONS: Based on the results of this trial, it is concluded that chronic thoracic pain of non-facet joint origin may be managed conservatively with thoracic interlaminar epidural injections with or without steroids. PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Mas de procalcitonina

Niveles séricos de procalcitonina son indicadores tempranos de diagnóstico de sepsis Serum procalcitonine levels as an early diagnostic indicator of sepsis. Beqja-Lika A1, Bulo-Kasneci A, Refatllari E, Heta-Alliu N, Rucaj-Barbullushi A, Mone I, Mitre A. Mater Sociomed. 2013;25(1):23-5. doi: 10.5455/msm.2013.25.23-25. Abstract INTRODUCTION: Prompt and accurate diagnosis of sepsis is of high importance for clinicians. Procalcitonine (PCT) and C-reactive protein (CRP) have been proposed as markers for this purpose. Our aim was to evaluate the levels of PCT and CRP in early sepsis and its correlation with severity of sepsis. METHODS: Levels of PCT and CRP were taken from 60 patients with sepsis criteria and 39 patients with SIRS symptoms from the University Hospital Center "Mother Teresa" in Tirana, Albania during 2010-2012. Sensitivity, specificity and predictive values for PCT and CRP were calculated. RESULTS: PCT and CRP levels increased in parallel with the severity of the clinical conditions of the patients. The mean PCT level in patients withsepsis was 11.28 ng/ml versus 0.272 ng/ml in patients with SIRS symptoms, with a sensitivity of 97.4% and a specificity of 96.6% for PCT >0.5ng/ml. The mean CRP level in septic patients was 146.58 mg/l vs. 34.4 mg/l in patients with SIRS, with a sensitivity of 98.6% for sepsis and a specificity of 75 % for CRP >11mg/l. CONCLUSION: PCT and CRP values are useful markers to determine early diagnosis and severity of an infection. In the present study, PCT was found to be a more accurate diagnostic parameter for differentiating SIRS from sepsis and may be helpful in the follow-up of critically ill patients. KEYWORDS: Albania; C-reactive protein; procalcitonine; sepsis. PDF En pacientes graves la procalcitonina sérica es más útil para diferenciar entre sepsis y SIRS que PCR, IL-6, o LPB. In Critically Ill Patients, Serum Procalcitonin Is More Useful in Differentiating between Sepsis and SIRS than CRP, Il-6, or LBP. Meynaar IA1, Droog W, Batstra M, Vreede R, Herbrink P. Crit Care Res Pract. 2011;2011:594645. doi: 10.1155/2011/594645. Epub 2011 May 15. Abstract We studied the usefulness of serum procalcitonin (PCT), interleukin-6 (IL-6), lipopolysaccharide binding protein (LBP) levels and C-reactive protein (CRP) levels, in differentiating between systemic inflammatory response syndrome (SIRS) and sepsis in critically ill patients...... Discussion. This study showed that PCT is more useful than LBP, CRP and IL-6 in differentiating sepsis from SIRS. PDF Utilidad de procalcitonina como marcador diagnóstico temprano en choque séptico Celso Montoya González, Ariadna Hernández Luna, José Antonio Villalobos Silva, Janet Aguirre Sánchez, Juvenal Franco Granillo Rev Asoc Mex Med Crit y Ter Int 2009;23(4):211-217 PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Medwave

A continuación le informamos los artículos recientemente publicados en Medwave.


EDITORIAL

Del Homo Medicus basado en la opinión al Homo Cochrane basado en la evidencia
Eva Madrid (Chile)

Medwave 2015 mar;15(2):e6102
http://dx.doi.org/10.5867/medwave.2015.02.6102


RESÚMENES EPISTEMONIKOS

¿Son efectivos los inhibidores de enzima convertidora o los antagonistas del receptor de angiotensina 2 en pacientes con insuficiencia cardiaca y fracción de eyección conservada?
Carmen Rain, Gabriel Rada (Chile)

Medwave 2015 Mar;15(2):e6101
http://dx.doi.org/10.5867/medwave.2015.02.6101


ESTUDIO PRIMARIO

Estudio retrospectivo que compara dosis bajas versus dosis estándar de bortezomib en pacientes con mieloma múltiple
Marcela Espinoza, Nicole Befferman, Mauricio Ocqueteau, Pablo Ramírez, Mauricio Galleguillos, Mauricio Sarmiento (Chile)

Medwave 2015;15(2):e6098
http://dx.doi.org/10.5867/medwave.2015.02.6098


COMENTARIOS

El elitismo del semáforo académico o la obsesión con el factor de impacto
Juan Luis Ossa Santa Cruz (Chile)

Medwave 2015 Mar;15(2):e6100
http://dx.doi.org/10.5867/medwave.2015.02.6100


PROBLEMAS DE SALUD PÚBLICA

Programa de médicos generales para la atención primaria de Chile
Germán Camilo Bass del Campo (Chile)

Medwave 2015 Mar;15(2):e6099
http://dx.doi.org/10.5867/medwave.2015.02.6099


PORTADA MEDWAVE
www.medwave.cl

Bibliometría de drogas anestésicas y sus técnicas de administración

Bibliometría de drogas anestésicas y sus técnicas de administración, 1984-2013. Scientometrics of anesthetic drugs and their techniques of administration, 1984-2013. Vlassakov KV, Kissin I. Drug Des Devel Ther. 2014 Dec 9;8:2463-73. doi: 10.2147/DDDT.S73862. eCollection 2014. Abstract The aim of this study was to assess progress in the field of anesthetic drugs over the past 30 years using scientometric indices: popularity indices (general and specific), representing the proportion of articles on a drug relative to all articles in the field of anesthetics (general index) or the subfield of a specific class of anesthetics (specific index); index of change, representing the degree of growth in publications on a topic from one period to the next; index of expectations, representing the ratio of the number of articles on a topic in the top 20 journals relative to the number of articles in all (>5,000) biomedical journals covered by PubMed; and index of ultimate success, representing a publication outcome when a new drug takes the place of a common drug previously used for the same purpose. Publications on 58 topics were assessed during six 5-year periods from 1984 to 2013. Our analysis showed that during 2009-2013, out of seven anesthetics with a high general popularity index (≥2.0), only two were introduced after 1980, ie, the inhaled anesthetic sevoflurane and the local anesthetic ropivacaine; however, only sevoflurane had a high index of expectations (12.1). Among anesthetic adjuncts, in 2009-2013, only one agent, sugammadex, had both an extremely high index of change (>100) and a high index of expectations (25.0), reflecting the novelty of its mechanism of action. The index of ultimate success was positive with three anesthetics, ie, lidocaine, isoflurane, and propofol, all of which were introduced much longer than 30 years ago. For the past 30 years, there were no new anesthetics that have produced changes in scientometric indices indicating real progress. PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Medicina de rehabilitación. Alerta

Medicina de rehabilitación
Notificaciones diarias ⋅ 5 de marzo de 2015
NOTICIAS


El Universal
Roque se culpa por tardanza de recuperación; defienderehabilitación
ESPN Deportes
"Hay que saber que el cuerpo médico siempre busca llevar al límite y estar en la vanguardia de la medicina y es la consigna que tienen todos los ...



La jornada ´De repente sin palabras´ celebra este jueves el Día de la Logopedia en la facultad de ...
20minutos.es
... Campoó impartirá en el Anfiteatro López Prieto de la Facultad de Medicina la conferencia 'El logopeda en la rehabilitación en el Daño Cerebral'.



Top 7 mujeres influyentes de México y AL en 2015
Martha Debayle
Es médico cirujano con especialidad en medicina de rehabilitación por la Universidad Nacional Autónoma de México (UNAM). 2. Nina García.

Procalcitonina

Cinética de procalcitonina como marcador pronóstico en la sepsis grave/shock séptico. Procalcitonin kinetics as a prognostic marker in severe sepsis/septic shock. Poddar B, Gurjar M, Singh S, Aggarwal A, Singh R, Azim A, Baronia A. Indian J Crit Care Med 2015;19:140-6 Abstract Background and Aims: To evaluate the prognostic value of change (fall) in serum procalcitonin level (PCT) in critically ill adults with severe sepsis/septic shock. Methods:This was a prospective observational study in a general purpose Intensive Care Unit of a teaching Institute. PCT was measured at admission (D0) and after 72-96 h (D4) by electrochemi-luminescence immunoassay (BRAHMS PCT kit) in adults (>18 years) admitted with severe sepsis or septic shock. Change in procalcitonin values from D0 to D4 was correlated with the primary outcome, that is, 28 days mortality. All results are reported as median (interquartile range). Results: A total of 171 (100 males) of 181 patients were included. The median age was 46 years (range 19-79). 137 patients were in septic shock and 34 in severe sepsis. The sequential organ failure assessment (SOFA) score in all patients was 11 (9-14).91 (53.2%) patients survived at 28 days (survivors). The baseline procalcitonin was similar in two groups (3.48 [1.04-15.85] vs. 5.27 [1.81-23.57] ng/ml in survivors and nonsurvivors [NS] respectively). The procalcitonin change was 1.58 (0.20-8.52) in survivors and 0.28 (-1.38-6.17) in NS (P = 0.01). The C-statistic of percentage change in procalcitonin from D0 to D4 to predict survival was 0.73 (95% confidence interval [CI]: 0.65-0.82) when compared to 0.78 (95% CI: 0.71-0.86) for change of SOFA score. For an absolute fall in procalcitonin of >1 ng/ml, a 70% fall predicted survival with 75% sensitivity and 64% specificity.Conclusions: In critically ill-patients with severe sepsis/septic shock, change (fall) in procalcitonin is associated with good outcome. Keywords: Biomarker, critical illness, organ dysfunction score, prognosis, septic, shock PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

http://www.madrimasd.org/blogs/medioambiente/2015/03/19/106364

La edad del rechazo a la ciencia

Cayó en mis manos, hace un par de días, el número de Marzo del National Geographical, y leí un reportaje sobre el rechazo a la ciencia de una buena parte de la ciudadanía estadounidense (y según mi modesta capacidad de detectar las opiniones de los españoles, de una buena parte de nuestra ciudadanía, incluyendo ministros, sus jefes, y altos directivos de empresas). El hecho en sí es interesante, pero lo es mucho más el análisis que hace el autor del reportaje.

Para empezar, el título del mismo: ”La edad de la falta de fé”.  La ciencia no tiene nada que ver con la fé, ni con creer o dejar de creer. Si yo veo una bola de oro, y una del mismo diámetro y pulido en su superficie, pero de madera, caer ambas desde una torre exactamente a la misma velocidad creciente, con la misma aceleración, g=9.81 m/s2, no tengo nada que “creer”: Afirmo que la gravedad es la misma para ambas sin que intervenga nada que tenga que ver con la “fé”.

En la ciencia no “creemos”, medimos.  Las personas que no miden pueden aceptar o no lo que los científicos han medido, pero no tienen que creer nada. Si repiten el experimento y ven que funciona, pueden aceptarlo, si ven que no funciona, pueden rechazarlo, pero eso no tiene nada que ver con las creencias.

El autor analiza el rechazo de muchas personas a los alimentos modificados genéticamente actuando directamente sobre los genes en vez de cruzando una y otra vez ejemplares de las especies, como hemos hecho desde hace 8000 años con las plantas y los animales, por ejemplo, perros, vacas y caballos.  El rechazo surge del miedo, pero del miedo ¿a qué?

Imaginemos una tribu de homo sapiens en la sabana africana. Cerca de ellos hay una serie de colinas que los separan de otras tierras. Unos miembros de la tribu son incapaces de subir a las montañas a ver que hay detrás: Piensan, sin razón, que detrás hay Godzillas que les van a matar mas de lo que les matan leopardos y hienas en el valle donde están.  Algunos (muy pocos) miembros de la tribu carecen de miedo, aunque tienen imaginación. Pueden imaginar godzillas, pero también otros valles llenos de riqueza y tranquilidad. Suben las colinas y ven cumplidas sus expectativas.  El miedo de unos a lo nuevo era injustificado, lo mismo que injustificado era el querer quedarse allí donde la vida era realmente peligrosa.

Las mentes humanas trabajan utilizando matrices grabadas de manera inconsciente. Por ejemplo, a un romano de la época de Escipión nunca se le hubiese ocurrido que los romanos pudiesen rendirse ante Aníbal. Sencillamente, la no rendición era una matriz fija en las mentes romanas. De la misma manera,  durante unos 4000 años nadie en el planeta podía pensar que los jefes fueran responsables ante los súbditos: la matriz mental era la del derecho divino de los jefes, y la de su responsabilidad exclusiva ante los dioses y no ante los seres humanos.

Es importante notar que hasta hoy los científicos y los eruditos no han tenido en cuenta estas matrices de manera explícita. Como mucho han aparecido en algunos libros de ciencia-ficción, como si no fueran la esencia de los problemas que experimentamos las personas de este planeta.

En el libro de la colección “Historia de Europa Oxford” correspondiente al siglo XVIII se concluye la exposición con un trabajo de T.C.W. Blanning , profesor de Historia Moderna de la Universidad de Cambridge, y en estas 7 páginas de conclusión este historiador no es capaz de señalar que le Revolución Francesa fue una autentica revolución del pensamiento humano. Se entretiene en hacer notar que la economía, el arte, el gobierno tras los años turbulentos de Napoleón, siguieron en el siglo XIX igual que en los siglos anteriores y no es capaz de darse cuenta de que había habido un cambio radical, y ese cambio era que a partir de 1789 ya ningún ”jefe”, ni siquiera en China (salvo la locura islamista) puede decir que su mandato deriva de una orden divina y que él solamente es responsable ante, realmente, nadie.

La matriz mental había cambiado. Los cambios prácticos tardaría décadas o siglos, pero la forma de pensar ya no podía volver nunca a la irresponsabilidad del gobernante.

De la misma manera, la matriz mental que asignaba a fuerzas ignotas (ángeles, demonios, dioses) los eventos de la naturaleza desapareció para siempre con los trabajos de Galileo. a partir de entonces la naturaleza no es el capricho de seres desconocidos sino que sigue reglas fijas y racionales.

La gente desconoce casi todo, y no quiere aprender. El saber no ocupa lugar, ni exige un tiempo exagerado. Se aprende en los viajes en tren, en coche, en avión, se aprende hasta en la compra, mirando los pescados, los filetes. Basta con ver todo lo que nos rodea, escuchar todo lo que nos llega a los oídos, preguntarse siempre ¿Por qué? ¿Cómo?

Ayer esta haciendo un ”examen” (Ejercicio de Grado, en lenguaje correcto) a unos alumnos de Arquitectura, que tienen que estudiar algo de física para saber la razón por la cual las casas no se caen. Una parte del ejercicio era diseñar una pared aislante al calor, y ellos debían seleccionar los espesores de los muros y de los vidrios de las ventanas.

¡ No tenían ni la más remota idea de cuanto medía un ladrillo o cual es el espesor normal de un vidrio !

De la misma manera es difícil entender cómo la gran mayoría de las personas de este mundo no tienen alguna sospecha de cómo les llega la televisión a casa o las palabras al móvil. No lo piensan siquiera, pero si algún día lo pensaran, sería para esa gran, inmensa, mayoría cosa de absoluta magia.

Y sin embargo conocer casi todo lo que ocurre y cómo ocurre en este mundo es algo relativamente sencillo que no exige mucho tiempo, o al menos no mas tiempo que el que se pierde habitualmente en actividades o ausencia de actividades a lo largo del día.  Hasta el hacer ejercicio, hasta el jugar a fútbol o al baloncesto, ir en moto o nadar nos enseña cosas sobre el mundo: El impulso de la bota al balón, el efecto Magnus de giro del balón, la necesidad de no pensar al tirar la bola al cesto, como se tiene que tumbar la moto si la queremos girar a alta velocidad o como nos impulsamos dentro de un fluido al nadar.

Pasear por las calles es aprender arquitectura, y por los campos, botánica y zoología, aprendemos que las águilas vuelen de forma distinta a las palomas o los gorriones, etc., etc.

Si uno lo hace así, inmediatamente acepta la ciencia y lo que esta le enseña.

¿Cual es la razón para el rechazo de las ideas científicas?

El ansia de ignorancia. El deseo de que haya algo que ”no podemos conocer”, el ansia de anular la acción individual y substituirla por la de entes ignotos, que por definición son irresponsables.

En definitiva: El rechazo de la responsabilidad de cada persona sobre sus actos, pensamientos y decisiones. Si conoces, eres responsable; si lo ignoras todo, la responsabilidad es de otros.  Una considerable mayoría de personas prefiere dejar la responsabilidad a imaginarios entes superiores.

El rechazo a la ciencia es el rechazo de la responsabilidad.