Muerte materna en UCI / ICU maternal death

Febrero 3, 2017. No. 2589

Rendimiento de la puntuación de la alerta temprana obstétrica en pacientes críticamente enfermos para la predicción de la muerte materna. Performance of the Obstetric Early Warning Score in critically ill patients for the prediction of maternal death. Paternina-Caicedo A1, Miranda J2, Bourjeily G3, Levinson A3, Dueñas C4, Bello-Muñoz C1, Rojas-Suarez JA5. Am J Obstet Gynecol. 2017 Jan;216(1):58.e1-58.e8. doi: 10.1016/j.ajog.2016.09.103. Epub 2016 Oct 15. Abstract BACKGROUND: Every day, about 830 women die worldwide from preventable causes related to pregnancy and childbirth. Obstetric early warning scores have been proposed as a potential tool to reduce maternal morbidity and mortality, based on the identification of predetermined abnormal values in the vital signs or laboratory parameters, to generate a rapid and effective medical response. Several early warning scores have been developed for obstetrical patients, but the majority are the result of a clinical consensus rather than statistical analyses of clinical outcome measures (ie, maternal deaths). In 2013, the Intensive Care National Audit and Research Center Case Mix Program reported the first statistically validated early warning scoring system for pregnant women. OBJECTIVE: We sought to assess the performance of the Intensive Care National Audit and Research Center Obstetric Early Warning Score in predicting death among pregnant women who required admission to the intensive care unit. STUDY DESIGN: This retrospective cohort study included pregnant women admitted to the intensive care unit at a tertiary referral center from January 2006 through December 2011 in Colombia, a developing country, with direct and indirect obstetric-related conditions. The Obstetric Early Warning Score was calculated based on data collected during the first 24 hours of intensive care unit admission. The Obstetric Early Warning Score is calculated based on values of the following variables: systolic and diastolic blood pressure, respiratory rate, heart rate, fraction of inspired oxygen (FiO2) required to maintain an oxygen saturation ≥96%, temperature, and level of consciousness. The performance of the Obstetric Early Warning Score was evaluated using the area under the receiver operator characteristic curve. Outcomes selected were: maternal death, need for mechanical ventilation, and/or vasoactive support. Statistical methods included distribution appropriate univariate analyses and multivariate logistic regression. RESULTS: During the study period, 50,897 births were recorded. There were 724 obstetric admissions to critical care, for an intensive care unit admission rate of 14.22 per 1000 deliveries. A total of 702 women were included in the study, with 29 (4.1%) maternal deaths, and a mortality ratio of 56.98 deaths per 100,000 live births. The most frequent causes of admission were direct, obstetric-related conditions (n = 534; 76.1%). The Obstetric Early Warning Score value was significantly higher in nonsurvivors than in survivors [12 (interquartile range 10-13) vs 7 (interquartile range 4-9); P < .001]. Peripartum women with normal values of Obstetric Early Warning Score had 0% mortality rate, while those with high Obstetric Early Warning Score values (>6) had a mortality rate of 6.3%. The area under the receiver operator characteristic curve of the Obstetric Early Warning Score in discrimination of maternal death was 0.84 (95% confidence interval, 0.75-0.92). The overall predictive value of the Obstetric Early Warning Score was better when the main cause of admission was directly related to pregnancy or the postpartum state. The area under the receiver operator characteristic curve of the score in conditions directly related to pregnancy and postpartum was 0.87 (95% confidence interval, 0.79-0.95), while in indirectly related conditions the area under the receiver operator characteristic curve was 0.77 (95% confidence interval, 0.58-0.96). CONCLUSION: Although there are opportunities for improvement, Obstetric Early Warning Score obtained upon admission to the intensive care unit can predict survival in conditions directly related to pregnancy and postpartum. The use of early warning scores in obstetrics may be a highly useful approach in the early identification of women at an increased risk of dying. KEYWORDS: intensive care unit; maternal death; maternal mortality; mortality prediction; pregnancy; severity scoring systems; validation PDF Factores asociados con muerte materna en UCI Factors associated with maternal death in an intensive care unit. Saintrain SV1,2, Oliveira JG1, Saintrain MV1, Bruno ZV2, Borges JL2, Daher EF3, Silva GB Jr1,4. Rev Bras Ter Intensiva. 2016 Oct-Dec;28(4):397-404. doi: 10.5935/0103-507X.20160073. Abstract OBJECTIVE:To identify factors associated with maternal death in patients admitted to an intensive care unit. METHODS:A cross-sectional study was conducted in a maternal intensive care unit. All medical records of patients admitted from January 2012 to December 2014 were reviewed. Pregnant and puerperal women were included; those with diagnoses of hydatidiform mole, ectopic pregnancy, or anembryonic pregnancy were excluded, as were patients admitted for non-obstetrical reasons. Death and hospital discharge were the outcomes subjected to comparative analysis. RESULTS:A total of 373 patients aged 13 to 45 years were included. The causes for admission to the intensive care unit were hypertensive disorders of pregnancy, followed by heart disease, respiratory failure, and sepsis; complications included acute kidney injury (24.1%), hypotension (15.5%), bleeding (10.2%), and sepsis (6.7%). A total of 28 patients died (7.5%). Causes of death were hemorrhagic shock, multiple organ failure, respiratory failure, and sepsis. The independent risk factors associated with death were acute kidney injury (odds ratio [OR] = 6.77), hypotension (OR = 15.08), and respiratory failure (OR = 3.65). CONCLUSION:The frequency of deaths was low. Acute kidney injury, hypotension, and respiratory insufficiency were independent risk factors for maternal death. PDF Diseño y validación interna de una puntuación de alerta temprana obstétrica: análisis secundario de la base de datos del Programa de Case Mix de la Intensive Care National Audit and Research Center. Design and internal validation of an obstetric early warning score: secondary analysis of the Intensive Care National Audit and Research Centre Case Mix Programme database. Carle C1, Alexander P, Columb M, Johal J. Anaesthesia. 2013 Apr;68(4):354-67. doi: 10.1111/anae.12180. Abstract We designed and internally validated an aggregate weighted early warning scoring system specific to the obstetric population that has the potential for use in the ward environment. Direct obstetric admissions from the Intensive Care National Audit and Research Centre's Case Mix Programme Database were randomly allocated to model development (n = 2240) or validation (n = 2200) sets. Physiological variables collected during the first 24 h of critical care admission were analysed. Logistic regression analysis for mortality in the model development set was initially used to create a statistically based early warning score. The statistical score was then modified to create a clinically acceptable early warning score. Important features of this clinical obstetric early warning score are that the variables are weighted according to their statistical importance, a surrogate for the FI O2 /Pa O2 relationship is included, conscious level is assessed using a simplified alert/not alert variable, and the score, trigger thresholds and response are consistent with the new non-obstetric National Early Warning Score system. The statistical and clinical early warning scores were internally validated using the validation set. The area under the receiver operating characteristic curve was 0.995 (95% CI 0.992-0.998) for the statistical score and 0.957 (95% CI 0.923-0.991) for the clinical score. Pre-existing empirically designed early warning scores were also validated in the same way for comparison. The area under the receiver operating characteristic curve was 0.955 (95% CI 0.922-0.988) for Swanton et al.'s Modified Early Obstetric Warning System, 0.937 (95% CI 0.884-0.991) for the obstetric early warning score suggested in the 2003-2005 Report on Confidential Enquiries into Maternal Deaths in the UK, and 0.973 (95% CI 0.957-0.989) for the non-obstetric National Early Warning Score. This highlights that the new clinical obstetric early warning score has an excellent ability to discriminate survivors from non-survivors in this critical care data set. Further work is needed to validate our new clinical early warning score externally in the obstetric ward environment. PDF Curso Internacional de Actualidades en Anestesiología Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Cuidad de México, Febrero 9-11, 2017 Informes  ceddem_innsz@yahoo.com  Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología. Committee for European Education in Anaesthesiology (CEEA)  y el Colegio de Anestesiólogos de León A.C. Abril 7-9, 2017, León Guanajuato, México Informes  (477) 716 06 16, kikinhedz@gmail.com Regional Anesthesiology and Acute Pain Medicine Meeting April 6-8, 2017, San Francisco, California, USA ASRA American Society of Regional Anesthesia and Pain Medicine Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Cirugía ginecológica / Gynecologic surgery

Enero 29, 2017. No. 2584

Libro sobre Cirugía Reproductiva Femenina Orientada a la Fertilidad Book on Fertility-oriented Female Reproductive Surgery Edited by Atef Darwish, ISBN 978-953-51-2878-6, Print ISBN 978-953-51-2877-9, 144 pages, Publisher: InTech, Chapters published January 18, 2017 under CC BY 3.0 license DOI: 10.5772/62748 Edited Volume In modern practice, the role of female reproductive surgery is declining apparently due to the widespread availability of assisted reproductive technology as an attractive option for infertile couples. To be more precise, prevention of female infertility should be the ultimate goal of all obstetricians and gynecologists during operating on females in the reproductive age. This book concentrates on different issues of fertility preservation both in obstetrics and gynecology. Not a matter of kindly or courtesy, but the core of obstetricians and gynecologists' work is to restore normal anatomy and to preserve fertility for all women in the reproductive age. Libro / Book El parecoxib aumenta el umbral del dolor muscular y alivia el dolor del hombro después de cirugía laparoscópica ginecológica Parecoxib increases muscle pain threshold and relieves shoulder pain after gynecologic laparoscopy: a randomized controlled trial. Zhang H1, Liu X2, Jiang H3, Liu Z4, Zhang XY1, Xie HZ3. J Pain Res. 2016 Sep 13;9:653-660. eCollection 2016. Abstract OBJECTIVES: Postlaparoscopic shoulder pain (PLSP) remains a common problem after laparoscopies. The aim of this study was to investigate the correlation between pressure pain threshold (PPT) of different muscles and PLSP after gynecologic laparoscopy, and to explore the effect of parecoxib, a cyclooxygenase-2 inhibitor, on the changes of PPT. MATERIALS AND METHODS: The patients were randomly allocated into two groups; group P and group C. In group P, parecoxib 40 mg was intravenously infused at 30 minutes before surgery and 8 and 20 hours after surgery. In group C, normal saline was infused at the corresponding time point. PPT assessment was performed 1 day before surgery and at postoperative 24 hours by using a pressure algometer at bilateral shoulder muscles (levator scapulae and supraspinatus) and forearm (flexor carpi ulnaris). Meanwhile, bilateral shoulder pain was evaluated through visual analog scale score at 24 hours after surgery. RESULTS: Preoperative PPT level of the shoulder, but not of the forearm, was significantly and negatively correlated with the intensity of ipsilateral PLSP. In group C, PPT levels of shoulder muscles, but not of forearm muscles, decreased after laparoscopy at postoperative 24 hours. The use of parecoxib significantly improved the decline of PPT levels of bilateral shoulder muscles (all P<0.01). Meanwhile, parecoxib reduced the incidence of PLSP (group P: 45% vs group C: 83.3%; odds ratio: 0.164; 95% confidence interval: 0.07-0.382; P<0.001) and the intensity of bilateral shoulder pain (both P<0.01). CONCLUSION: Preoperative PPT levels of shoulder muscles are closely associated with the severity of shoulder pain after gynecologiclaparoscopy. PPT levels of shoulder muscles, but not of forearm muscles, significantly decreased after surgery. Parecoxib improved the decrease of PPT and relieved PLSP. KEYWORDS: laparoscopic surgery; nonsteroidal anti-inflammatory drugs; pain threshold; sensitization; shoulder pain PDF Efecto del neumoperitoneo en el dolor postoperatorio en cirugía laparoscópica ginecológica: estudio randomizado, doble ciego y controlado The effect of peritoneal gas drain on postoperative pain in benign gynecologic laparoscopic surgery: a double-blinded randomized controlled trial. Tharanon C1, Khampitak K1. Int J Womens Health. 2016 Aug 10;8:373-9. doi: 10.2147/IJWH.S109568. eCollection 2016. Abstract OBJECTIVES: To compare the effect of peritoneal gas drain on postoperative pain in benign gynecologic laparoscopic surgery and the amount of postoperative analgesic dosage. METHODS: The trial included 45 females who had undergone operations during the period December 2014 to October 2015. The patients were block randomized based on operating time (<2 and ≥2 hours). The intervention group (n=23) was treated with postoperative intraperitoneal gas drain and the control group (n=22) was not. The mean difference in scores for shoulder, epigastric, suprapubic, and overall pain at 6, 24, 48 hours postoperatively were statistically evaluated using mixed-effect restricted maximum likelihood regression. The differences in the analgesic drug usage between the groups were also analyzed using a Student's t-test. The data were divided and analyzed to two subgroups based on operating time (<2 hours, n=20; and $2 hours, n=25). RESULTS: The intervention had significantly lower overall pain than the control group, with a mean difference and 95% confidence interval at 6, 24, and 48 hours of 2.59 (1.49-3.69), 2.23 (1.13-3.34), and 1.48 (0.3-2.58), respectively. Correspondingly, analgesic drug dosage was significantly lower in the intervention group (3.52±1.47 mg vs 5.72±2.43 mg, P<0.001). The three largest mean differences in patients with operating times of ≥2 hours were in overall pain, suprapubic pain at 6 hours, and shoulder pain at 24 hours at 3.27 (1.14-5.39), 3.20 (1.11-5.26), and 3.13 (1.00-5.24), respectively. These were greater than the three largest mean differences in the group with operating times of <2 hours, which were 2.81 (1.31-4.29), 2.63 (0.51-4.73), and 2.02 (0.68-3.36). The greatest analgesic drug requirement was in the control group with a longer operative time. CONCLUSION: The use of intraperitoneal gas drain was shown to reduce overall postoperative pain in benign gynecologiclaparoscopic surgery. The effects were higher in patients who had experienced longer operating times. KEYWORDS: gynecology; intraperitoneal gas drain; laparoscopic surgery; postoperative pain PDF Curso Internacional de Actualidades en Anestesiología Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Cuidad de México, Febrero 9-11, 2017 Informes  ceddem_innsz@yahoo.com  Regional Anesthesiology and Acute Pain Medicine Meeting April 6-8, 2017, San Francisco, California, USA ASRA American Society of Regional Anesthesia and Pain Medicine Información / Information California Society of Anesthesiologists Annual Meeting April 27-30, 2017 San Francisco California Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Ejercicios y consejos para mejorar la postura y aliviar el dolor de espalda

Ejercicios y consejos para mejorar la postura y aliviar el dolor de espalda



http://www.cirugiavertebral.com.mx/academia/ejercicios-y-consejos-para-mejorar-la-postura-y-aliviar-el-dolor-de-espalda/

Exercises and tips to improve posture and alleviate back pain - Bel Marra Health https://t.co/5VAiwKWK5E

— Back Pain MD (@BackPain_MD) 29 de enero de 2017

¡Restaure la base del labral en la estabilización artroscópica del hombro con una técnica doble del puente de Bankart!

¡Restaure la base del labral en la estabilización artroscópica del hombro con una técnica doble del puente de Bankart!



http://www.perezartro.com.mx/academia/restaure-la-base-del-labral-en-la-estabilizacion-artroscopica-del-hombro-con-una-tecnica-doble-del-puente-de-bankart/

Restore the labral footprint in arthroscopic shoulder stabilization with a Double Bankart Bridge Technique!https://t.co/Wipt1yJpAq pic.twitter.com/Id8ikfyoNR

— Arthroscopy Journal (@ArthroscopyJ) 29 de enero de 2017

Haga ejercicio para tener huesos sanos

Haga ejercicio para tener huesos sanos



http://www.clinicadeartroscopia.com.mx/academia/haga-ejercicio-para-tener-huesos-sanos/



Fuente
Este artículo es originalmente publicado en:

https://www.niams.nih.gov/Health_Info/Bone/espanol/Salud_hueso/bone_exercise_espanol.asp

De y Todos los derechos reservados para:

Institutos Nacionales de la Salud, Centro Nacional de Información sobre la Osteoporosis y las Enfermedades Óseas

2 AMS Circle
Bethesda,  MD 20892-3676
Teléfono: 202-223-0344
Llame gratis: 800-624-BONE (2663)
TTY: 202-466-4315
Fax: 202-293-2356
Correo electrónico: NIHBoneInfo@mail.nih.gov
Sitio web: http://www.bones.nih.gov

Hacer ejercicio a cualquier edad es vital para tener huesos sanos, y es fundamental para la prevención y el tratamiento de la osteoporosis. El ejercicio no solamente mejora la salud de los huesos, sino que también aumenta la fuerza muscular, la coordinación y el equilibrio y contribuye a mejorar la salud en general.

• ¿Por qué hay que hacer ejercicio?
• El mejor ejercicio para fortalecer los huesos
• Consejos al hacer ejercicio
• Un régimen completo para combatir la osteoporosis
• Para su información

¿Por qué hay que hacer ejercicio?

Los huesos, como los músculos, son tejidos vivos que responden al ejercicio y se fortalecen. En general, las mujeres y los hombres jóvenes que hacen ejercicio con regularidad alcanzan una mayor densidad ósea (el nivel más alto de consistencia y fuerza de los huesos) que los que no hacen ejercicio. La mayoría de las personas alcanzan el punto máximo de densidad ósea entre los 20 y los 30 años de edad. A partir de esa edad generalmente la densidad ósea empieza a disminuir. Las mujeres y los hombres mayores de 20 años pueden ayudar a prevenir la pérdida ósea hacienda ejercicio con frecuencia. El ejercicio físico nos permite mantener la fuerza muscular, la coordinación y el equilibrio, lo que a su vez ayuda a prevenir las caídas y las fracturas. Esto es especialmente importante para los adultos de edad avanzada y para las personas que han sido diagnosticadas con osteoporosis.

Lea aquí el artículo completo!!!

Sindrome compartimental de antebrazo

Sindrome compartimental de antebrazo



http://www.manoytrauma.com.mx/miembro-toracico/sindrome-compartimental-de-antebrazo/

Compartment Syndrome Of The Forearm 

Fuente
Este artículo es originalmente publicado en:

https://youtu.be/Q5Rrch-0TBA

De y Todos los derechos reservados para:

Courtesy: Prof Nabile Ebraheim, University of Toledo, Ohio, USA

Educational video describing the condition of compartment syndrome of the forearm.

Become a friend on facebook:
http://www.facebook.com/drebraheim

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https://twitter.com/#!/DrEbraheim_UTMC

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Desgarre parcial del ligamento cruzado anterior

Desgarre parcial del ligamento cruzado anterior



http://www.columnayortopedia.com.mx/academia/desgarre-parcial-del-ligamento-cruzado-anterior/

Partial tears of the anterior cruciate ligament

Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/26797008

https://www.clinicalkey.es/#!/content/playContent/1-s2.0-S1877056815003515?returnurl=http:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1877056815003515%3Fshowall%3Dtrue&referrer=https:%2F%2Fwww.ncbi.nlm.nih.gov%2F



De:

Sonnery-Cottet B¹, Colombet P².

• ¹Générale de santé, hôpital privé Jean-Mermoz, centre orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France. Electronic address: sonnerycottet@aol.com.
• ²Clinique du Sport, 2, rue Negrevergne, 33700 Merignac, France.

Orthop Traumatol Surg Res. 2016 Feb;102(1 Suppl):S59-67. doi: 10.1016/j.otsr.2015.06.032. Epub 2016 Jan 18.



Todos los derechos reservados para:

Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Abstract

Partial anterior cruciate ligament (ACL) tears were first described nearly fifty years ago but the optimal treatment for these injuries continues to be a subject of considerable debate. A question remains whether it is advantageous to preserve the ACL remnant and augment it with a graft, or to debride it and proceed with a standard ACL reconstruction unhindered by remnant fibers in the notch. Clinical outcomes of bundle preserving surgery are promising. An increasingly large body of scientific evidence suggests that augmenting the intact bundle is beneficial in terms of vascularity, proprioception and kinematics. With this knowledge, a number of surgeons have developed techniques to augment the intact bundle of the ACL in partial tears and to biologically enhance standard reconstruction techniques by preserving the ACL remnant. Correct tunnel placement is critical for achieving successful short and long-term outcomes after ACL reconstruction. However, published studies have several limitations including a limited number of patients and lack of control groups for direct comparison of outcomes. Concerns continue to exist with respect to an increased risk of impingement following augmentation, responsible of cyclops syndrome. The objective of this article was to outline the diagnostic approach, describe a reproducible and simple surgical procedure that allows correct femoral tunnel placement without the need for aggressive notch debridement and report the clinical outcome of partial ACL reconstruction.

Resumen

Los desgarres parciales del ligamento cruzado anterior (LCA) se describieron por primera vez hace casi cincuenta años, pero el tratamiento óptimo para estas lesiones sigue siendo un tema de debate considerable. Queda una cuestión de si es ventajoso preservar el remanente de ACL y aumentarlo con un injerto, o desbridarlo y proceder con una reconstrucción de ACL estándar sin impedimento por fibras remanentes en la muesca. Los resultados clínicos de la cirugía de preservación de haces son prometedores. Un cuerpo cada vez más grande de evidencia científica sugiere que el aumento del paquete intacto es beneficioso en términos de vascularidad, propiocepción y cinemática. Con este conocimiento, varios cirujanos han desarrollado técnicas para aumentar el haz intacto de la LCA en desgarres parciales y para mejorar biológicamente las técnicas de reconstrucción estándar preservando el remanente de LCA. La correcta colocación del túnel es fundamental para lograr resultados exitosos a corto y largo plazo después de la reconstrucción del LCA. Sin embargo, los estudios publicados tienen varias limitaciones, incluyendo un número limitado de pacientes y la falta de grupos de control para la comparación directa de los resultados. Siguen existiendo preocupaciones con respecto a un mayor riesgo de choque tras el aumento, responsable del síndrome de cíclope. El objetivo de este artículo fue describir el abordaje diagnóstico, describir un procedimiento quirúrgico reproducible y simple que permita la colocación correcta del túnel femoral sin la necesidad de un desbridamiento agudo de la muesca e informar el resultado clínico de la reconstrucción parcial del LCA.

Copyright © 2015 Elsevier Masson SAS. All rights reserved.

KEYWORDS:

Anterior cruciate ligament; Anteromedial bundle; Partial rupture; Posterolateral bundle; Selective bundle reconstruction

PMID: 26797008   DOI:   10.1016/j.otsr.2015.06.032

[PubMed – indexed for MEDLINE]