Revisiones_bibliográficas TyO

sábado, 16 de febrero de 2013

Cuidados paliativos en India. Progreso actual y necesidades futuras.

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

Cuidados paliativos en India. Progreso actual y necesidades futuras.

Palliative care in India: Current progress and future needs.
Khosla D, Patel FD, Sharma SC.
Indian J Palliat Care [serial online] 2012 [cited 2013 Jan 8];18:149-54.

Despite its limited coverage, palliative care has been present in India for about 20 years. Obstacles in the growth of palliative care in India are too many and not only include factors like population density, poverty, geographical diversity, restrictive policies regarding opioid prescription, workforce development at base level, but also limited national palliative care policy and lack of institutional interest in palliative care. Nonetheless we have reasons to be proud in that we have overcome several hurdles and last two decades have seen palpable changes in the mindset of health care providers and policy makers with respect to need of palliative care in India. Systematic and continuous education for medical staff is mandatory, and a major break-through for achieving this purpose would be to increase the number of courses and faculties in palliative medicine at most universities.
Keywords: Challenges, Education, Hospice, India, Palliative care, Perspectives, Research
http://www.jpalliativecare.com/text.asp?2012/18/3/149/105683

Atentamente

Anestesiología y Medicina del Dolor

www.anestesia-dolor.org

viernes, 15 de febrero de 2013

“El médico está informado o infoxicado”

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

Estimado Ciberpediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 20 de Febrero 2013 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “El médico está informado o infoxicado” por el “Dr. Ariel Melamud.” Pediatra de la Cd. de Buenos Aires Argentina. 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/informado_infoxicado/

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

Asociación Peruano Japonesa - Curso Internacional 2013

Uploaded with ImageShack.us

4º Seminario de Investigación en Ortopedia

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

4º Seminario de Investigación en Ortopedia

Estimados amigos médicos residentes de ortopedia y traumatología de primer año y los que
vayan a ingresar a los cursos propedéuticos de la especialidad y áreas a nes.
El Colegio Mexicano de Ortopedia y Traumatología A.C., en ánimo de contribuir en el desarrollo
de los médicos en formación, les invita a inscribirse y participar en el Cuarto Seminario de
Investigación en Ortopedia que habrá que realizarse en las instalaciones del Colegio el viernes
22 de febrero del 2013.
Este Seminario se ha preparado con el mayor esmero, su objetivo terminal, es que al concluir,
dispongan ustedes del conocimiento y las bases de aplicación del método cientí co en trabajos de investigación, tesis, presentaciones orales, en cartel en Congresos nacionales e internacionales y que a lo largo de su vida profesional, sea una herramienta perenne, sistemática,
metódica y de utilidad fundamental.
CMO- Cápitulo de Investigación en Ortopedia

Dr. Salvador Rivero Boschert Dr. Rubén Torres González
Presidente CMO Profesor Titular

http://www.smo.edu.mx/pdf/curso2013_4oSIO-CMO.pdf

miércoles, 13 de febrero de 2013

Colegio Mexicano de Ortopedia: XXXI Congreso Nacional 2012, en linea...

http://www.smo.edu.mx/colegiados/congreso-virtual.php

Clonidina caudal en niños/Caudal clonidine in children

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

Eficacia de clonidina como adyuvante de ropivacaína para analgesia caudal en niños con cirugía subumbilical

Efficacy of clonidine as an adjuvant to ropivacaine for caudal analgesia in children undergoing subumbilical surgery.
Manickam A, Vakamudi M, Parameswari A, Chetan C.
Department of Anesthesiology Critical Care and Pain Medicine, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India.
J Anaesthesiol Clin Pharmacol. 2012 Apr;28(2):185-9. doi: 10.4103/0970-9185.94839.
Abstract
CONTEXT: The use of clonidine as an adjuvant to ropivacaine in different concentrations through the caudal space has been shown to improve the analgesic efficacy of local anesthetics. AIMS: The purpose of our study was to compare the efficacy of ropivacaine 0.1% with clonidine 1 mcg/kg to that of plain 0.1% and 0.2% ropivacaine for caudal analgesia in children. SETTINGS AND DESIGN: Prospective, double blind, randomized controlled trial. MATERIALS AND METHODS: Sixty children in the age group of 1-6 years undergoing subumbilical surgeries were included in the study. Group A received 1 ml/kg of 0.1% ropivacaine, group B received 1 ml/kg of 0.1% ropivacaine with clonidine 1 mcg/kg, and group C received 1 ml/kg of 0.2% ropivacaine. RESULTS: The mean duration of analgesia was 243.7 ± 99.29 min in group A, 590.25 ± 83.93 min in group B, and 388.25 ± 82.35 min in group C. The duration of analgesia was significantly prolonged in group B compared to groups A and C with the P value of 0.001. At 8 h, all the 20 children in group A had received the first rescue analgesic compared to 18 children in group C and 3 children in group B. The duration of motor blockade after extubation was 30.6 ± 7.8 min and was noted only in group C. Only 1 child in group B received two rescue medications compared to 15 (75%) children in group A and 8 (40%) children in group C. None of the groups were treated for bradycardia or hypotension and no significant sedation was noted. CONCLUSIONS: Clonidine 1 mcg/kg with ropivacaine 0.1% prolongs the duration and quality of analgesia compared to plain ropivacaine 0.1% and 0.2% without any significant sedation.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3339722/

Analgesia postoperatoria en niños con clonidina o fentanil con ropivacaína caudales

Analgesia postoperatoria en niños con clonidina o fentanil con ropivacaína caudales
Postoperative analgesia in children when using clonidine or fentanyl with ropivacaine given caudally.
Shukla U, Prabhakar T, Malhotra K.
Department of Anaesthesiology and Critical Care, U.P Rural Institute of Medical Sciences and Research, Saifai, Etawah, India.
J Anaesthesiol Clin Pharmacol. 2011 Apr;27(2):205-10. doi: 10.4103/0970-9185.81842.
Abstract
BACKGROUND: The aim of the study was to compare the efficacy of clonidine and fentanyl as an additive to ropivacaine given via single shot caudal epidural in pediatric patients for postoperative pain relief. MATERIALS AND METHODS: In the present double blind study, 90 children of ASA-I-II aged 3-8 years scheduled for infraumblical surgical procedures were randomly allocated to two groups to receive either ropivacaine 0.25% 1 ml/kg + clonidine 2 μg/kg (group I) or ropivacaine 0.25% 1 μl/kg + fentanyl 1 μg/kg (group II). Caudal block was performed after the induction of general anesthesia. Postoperatively patients were observed for analgesia, sedation, hemodynamics, and side effects/complications. RESULTS: Both the groups were similar with respect to patient and various block characteristics. The analgesic properties and hemodynamics were also comparable in both groups (P > 0.05). Side effects such as respiratory depression, vomiting bradycardia were significantly less in group I than group II (P < 0.05) ensuing more patient comfort. CONCLUSIONS: The analgesic properties of clonidine and fentanyl as additives to ropivacaine in single shot caudal epidural in children are comparable but clonidine offers a more favorable side effect profile. The use of clonidine as additive to ropivacaine in caudal epidural is superior choice to fentanyl because of lack of unwanted side effects and increased patient comfort.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127300/

Atentamente

Dr. Enrique Hernández-Cortez

Anestesiología y Medicina del Dolor

www.anestesia-dolor.org

Bibliotecas. Alerta

Biblioteca Británica publicará un libro inédito de Virginia Woolf
Prensa Libre
Woolf aprovechó su espacio en The Charleston Bulletin para dejar constancia con un humor afilado, según la Biblioteca Británica, de las aventuras de miembros de la familia como Clive Bell, el servicio de su casa, como la cocinera, o de compañeros del ...
Ver todos los artículos sobre este tema »
Prensa Libre

La Biblioteca Británica digitaliza manuscritos del Beato de Liébana ...
Qué.es
«Commentarius in Apocalypsin», del Beato de Liébana; el cuaderno de notas de Leonardo da Vinci; el legendario poema «Beowulf»; los Harley Golden Gospels; el Libro de las Horas conocido como «Libro Golf», y «Petit Livre dAmour». Son los seis ...
Ver todos los artículos sobre este tema »
Qué.es

Bluebottle, la nueva biblioteca digital para empresas
Intereconomía
El proyecto consiste en una biblioteca digital para empresas, donde se pueden consultar los contenidos relevantes de las empresas, la gran venteja es que este soporte flitra la publicidad que se genera en la búsquedas online y desecha los contenidos ...
Ver todos los artículos sobre este tema »

Biblioteca Redpath - Wikipedia, la enciclopedia libre
La Biblioteca Redpath es una biblioteca que se encuentra en la Universidad McGill, Montreal, Canadá. Cuando la Biblioteca McLennan fue construida en ...
es.wikipedia.org/wiki/Biblioteca_Redpath

martes, 12 de febrero de 2013

Analgesia POP caudal en niños/PO caudal analgesia in infants.

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

Bloqueos caudales para el manejo postoperatorio del dolor en niños

The management of postoperative pain in children with caudal blocks
Hasani A, MD Soljakova M, MD Ustalar-Ozgen S, MD
South Afr J Anaesth Analg 2011;17(6):376-379
Abstract
Background: The aim of this study was to evaluate the pre-emptive analgesic effect and duration of postoperative analgesia after caudal blocks in children. Method: Forty-five children undergoing distal hypospadias surgery were assigned to group 1 (n = 23), and received caudal 0.25% bupivacaine 0.5 mg/kg and midazolam 0.05 mg/kg before the surgical incision. Group 2 (n = 22) received caudal 0.25% bupivacaine 0.5 mg/kg and midazolam 0.05 mg/kg at the end of surgery. Anaesthesia was induced with propofol and fentanyl and maintained with sevoflurane and nitrous oxide. Postoperative pain was rated on an objective paediatric pain scale. Results: The analgesic requirement was greater in the second group. Conclusion: Pre-emptive analgesia with caudal blocks may prevent the intensity and frequency of postoperative wound pain.
http://www.sajaa.co.za/index.php/sajaa/article/view/682/1017

Atentamente
Dr. Enrique Hernández-Cortez
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

Comida de la amistad. CMO. México, 2013.

lunes, 11 de febrero de 2013

Más sobre artritis juvenil idiopática/More on JIA

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

Sumario de la revisión comparativa de la efectividad de la AHRQ sobre los antireumáticos para niños que modifican la artritis idiopática juvenil

Summary of AHRQ's Comparative Effectiveness Review of Disease-Modifying Antirheumatic Drugs for Children with Juvenile Idiopathic Arthritis.
McMahan R, Balfe LM, Greene L.
1300 Amerigroup Way, Amerigroup Corporation Virginia Beach, VA 23464, USA.rmcmah1@amerigroupcorp.com.
J Manag Care Pharm. 2012 Jan-Feb;18(1 Suppl B):1-16
Abstract
BACKGROUND: A systematic review on the comparative effectiveness of disease-modifying antirheumatic drugs (DMARDs) used to treat children with juvenile idiopathic arthritis (JIA) was published by the Agency for Health Care Research and Quality (AHRQ) in September 2011. Studies from 198 articles included in the review addressed the benefits and harms of DMARDs compared with conventional treatments and other DMARDs used to treat JIA. The review also incorporated studies comparing various clinical tools used for diagnosing JIA and measuring disease activity. Clinical outcome measures were analyzed to determine the most effective methods to measure disease state. The lack of current research for the treatment of JIA motivated AHRQ to contract with researchers to synthesize the available information with the intent of enabling health professionals to make evidence-based practice decisions for their patients. The review alsohighlights gaps in the research and areas that need to be addressed in the future. OBJECTIVES: To (a) educate health care practitioners on the findings from AHRQ's 2011 comparative effectiveness review on DMARDs used to treat children with JIA, (b) apply review findings to make diagnosis and treatment decisions in clinical practice, and (c) recognize limitations and gaps n the current research relating to the comparative benefits and harms of DMARDs for treatment of JIA. SUMMARY: JIA is a chronic inflammatory disease affecting approximately 300,000 children and adolescents in the United States.1 Initially manifesting with inflammation, swelling, pain, and stiffness of the joints, the disease as no apparent or known cause. JIA is a clinical diagnosis based on several actors including the number of affected joints and the involvement of other tissues (e.g., the skin and lymphoid tissues), and JIA has 7 categories: systemic-onset arthritis, oligoarthritis, rheumatoid-factor positive polyarthritis, rheumatoid-factor negative polyarthritis, enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis.2 Complete remission and resolution of disease activity are the ultimate treatment goals; however, there is no present cure. Inhibition of inflammation, prevention of joint damage, and promotion of a high level of functioning are the immediate goals of treatment. Even with treatment, patients with JIA continue to experience disease activity, joint destruction, suboptimal function, and impaired quality of life, all of which extend into adulthood.3 JIA can be severely debilitating and places a heavy physical and psychological burden on children and families affected by the disease. Methotrexate is a nonbiologic DMARD with an unknown mechanism of action. Methotrexate has been used for so long in the treatment of JIA that it is frequently considered a part of conventional treatment; the evidence shows that methotrexate is superior to conventional treatment with NSAIDsand/or intra-articular corticosteroids. The introduction of newer biologic DMARDs has spawned optimism that treatment will increasingly lead to improved outcomes for JIA, but the evidence is insufficient to support superiority over methotrexate. There is moderate evidence to support the claim that continued treatment from 4 months to 2 years with a biologic DMARD in children who have responded to a biologic DMARD decreases the risk of a flare. However, the safety of biologic DMARDs for long-term use has not been determined and may be associated with the developmentof cancer. The association between tumor necrosis factor (TNF) alpha inhibitors and potential increased risk of lymphoma caused the U.S. Food and Drug Administration (FDA) to place boxed warning labels on biologic DMARDs including etancercept, infliximab, and adalimumab. The effectiveness of the DMARDs appears to vary among categories of JIA and the treatment history of individual patients. Except for methotrexate, there is insufficient evidence to support selection of a specific drug or drug class over another in the treatment of JIA. The AHRQ review examines the scientific literature on DMARDs used in children with JIA in an effort to synthesize what is known about the subject, and the comprehensive review identifies important research gaps in the literature that need to be addressed. Only 8 studies (in 9 publications) were rated "good quality" by the AHRQ investigators.
http://ce.effectivehealthcare.ahrq.gov/programs/CER19/AHRQ-CER19-JIA.pdf

Antirreumáticos modificadores de la enfermedad en niños con artritis juvenil idiopática

Disease-Modifying Antirheumatic Drugs (DMARDs) in Children With Juvenile Idiopathic Arthritis (JIA)
Editors
Kemper AR, Coeytaux R, Sanders GD, Van Mater H, Williams JW, Gray RN, Irvine RJ, Kendrick A.
Rockville (MD): Agency for Healthcare Research and Quality (US); 2011 Sep. Report No.: 11-EHC039-EF.
AHRQ Comparative Effectiveness Reviews.
Excerpt
OBJECTIVES: To summarize the benefits and harms of disease-modifying antirheumatic drugs (DMARDs) compared to conventional treatment (non-steroidal anti-inflammatory drugs [NSAIDs] and/or intra-articular corticosteroids) with or without methotrexate, and of the various DMARDs compared to one another, in children with juvenile idiopathic arthritis (JIA); and to describe selected tools commonly used to measure clinical outcomes associated with JIA. DATA SOURCES: MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews. Additional studies were identified from the review of reference lists. REVIEW METHODS: To evaluate efficacy, we included prospective trials that included a comparator and that lasted for at least 3 months. No comparator was required for reports of adverse events or of the clinical outcome measure tools. RESULTS: A total of 198 articles were included. There is some evidence that methotrexate is superior to conventional treatment (NSAIDs and/or intra-articular corticosteroids). Among children who have responded to a biologic DMARD, randomized discontinuation trials suggest that continued treatment decreases the risk of having a flare. Although these studies evaluated DMARDs with different mechanisms of action (abatacept, adalimumab, anakinra, etanercept, intravenous immunoglobulin, tocilizumab) and used varying comparators, followup periods, and descriptions of flare, the finding of a reduced risk of flare was precise and consistent. There are few direct comparisons of DMARDs, and insufficient evidence to determine if any specific drug or drug class has greater beneficial effects. Reported rates of adverse events are similar between DMARDs and placebo in nearly all published randomized controlled trials. This review identified 11 incident cases of cancer among several thousand children treated with one or more DMARD. The Childhood Health Assessment Questionnaire (CHAQ) was the most extensively evaluated instrument of those considered. While it demonstrated high reproducibility and internal consistency, it had only moderate correlations with indices of disease activity and quality of life, and poor to moderate responsiveness. CONCLUSIONS: Few data are available to evaluate the comparative effectiveness of either specific DMARDs or general classes of DMARDs. However, based on the overall number, quality, and consistency of studies, there is moderate strength of evidence to support that DMARDs improve symptoms associated with JIA. Limited data suggest that short-term risk of cancer is low. Future trials are needed to evaluate the effectiveness of DMARDs against both conventional therapy and other DMARDs across categories of JIA, and registries are needed to better understand the risks of these drugs.
http://www.ncbi.nlm.nih.gov/books/NBK65169/pdf/TOC.pdf

Artritis juvenil idiopática: Manejo y opciones de tratamiento

Juvenile idiopathic arthritis: management and therapeutic options.
Ruth NM, Passo MH.
Ther Adv Musculoskelet Dis. 2012 Apr;4(2):99-110.
doi: 10.1177/1759720X11413630.
Abstract
THE GOALS OF TREATMENT FOR JUVENILE IDIOPATHIC ARTHRITIS (JIA) INCLUDE: suppression of inflammation, achievement of remission, relief of pain, maintenance of function and doing so with minimal toxicity. Important discoveries over the past 10-15 years have led to more targeted treatments for children with JIA. The International League of Associations for Rheumatology (ILAR) classification system for childhood arthritides, better assessment tools for clinical response, improved definitions of remission, new imaging techniques and evidence in gene expression profiling have all contributed to the development of more targeted treatments. Nonsteroidal anti-inflammatory agents still have a role in mild disease and intra-articular steroid injections continue to be used most commonly in patients with oligoarticular JIA. Disease-modifying agents such as methotrexate have demonstrated efficacy and safety; however, in many patients, the disease remains active despite this treatment. These children now receive more targeted treatment including the tumor necrosis factor alpha (TNFα) inhibitors, interleukin-1 blockade, interleukin-6 blockade, selective costimulation modulators and selective B-cell blockade. The biologic targeted therapies have changed the strategy in which we treat our children with JIA; however, there remains much to be learned about the long-term effects and safety of these medicines
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383518/pdf/10.1177_1759720X11413630.pdf

Retos en el tratamiento de artritis juvenil idiopática con etanercept

Challenges in the management of juvenile idiopathic arthritis with etanercept.
Pain CE, McCann LJ.
Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, UK.
Biologics. 2009;3:127-39. Epub 2009 Jul 13.
Abstract
Biologic agents have been designed with the help of immunological studies to target particular areas of the immune system which are thought to play a role in the pathogenesis of disease. Etanercept is a soluble anti-tumor necrosis factor alpha (TNF-alpha) agent licensed for the treatment of active poly-articular juvenile idiopathic arthritis (JIA) in children aged 4 to 17 years who have failed to respond to methotrexate alone, or who have been intolerant of methotrexate. The safety and efficacy of etanercept in this patient group has been established by one randomized controlled trial and several longitudinal studies. This, together with the fact that until recently etanercept was the only anti-TNF licensed in JIA, has made it the most common first choice biologic for many clinicians. However, there are still many unanswered questions about etanercept, including its efficacy and safety in different subtypes of JIA, in children under 4 years of age and in those with uveitis. There are still concerns about the long term safety of TNF antagonists in the pediatric age group and unanswered questions about increased risks of malignancy and infection. Although adult studies are useful to improve understanding of these risks, they are not a substitute for good quality pediatric research and follow-up studies. Adult trials often include greater numbers of patients. However, they evaluate a different population and drug behavior may vary in children due to differences in metabolism, growth and impact on a developing immune system. In addition, rheumatoid arthritis is a different disease than JIA. Clinicians need to carefully weigh up the risk benefit ratio of anti-TNF use in children with JIA and push for robust clinical trials to address the questions that remain unanswered. This article summarizes the evidence available for use of etanercept in children with JIA and highlights aspects of treatment in need of further research.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726066/pdf/btt-3-127.pdf

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