Año global contra el dolor neuropático

Año global contra el dolor neuropático PAIN Global Year Against Neuropathic Pain Global Year Against Neuropathic Pain: Articles from 2015 on the topic of Neuropathic Pain and the top 50 most cited articles from past issues on the topic PAIN Journal of IASP Articulos/Articles

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Sepsis

Desarrollo de una fórmula predictiva de mortalidad por sepsis/sepsis severa en la UCI Development of a mortality prediction formula due to sepsis/severe sepsis in a medical intensive care unit. Mohan A, Shrestha P, Guleria R, Pandey RM, Wig N. Lung India 2015;32:313-9 Abstract Background: Although sepsis is one of the leading causes of mortality in hospitalized patients, information regarding early predictive factors for mortality and morbidity is limited. Materials and Methods: Patients fulfilling the Infectious Disease Society of America criteria of sepsis within the medical intensive care unit (ICU) were included over two years. Apart from baseline hematological, biochemical, and metabolic parameters, Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II and III (SAPS II and SAPS III), and Sequential Organ Function Assessment (SOFA) scores were calculated on day 1 of admission. Patients were followed till death or discharge from the ICU. Results: One hundred patients were enrolled over two years (54% males). The overall mortality was 53%, (69.5% in females, 38.8% in males (P < 0.01). Mortality was 65.7%, 55.7%, and 33.3% in patients with septic shock, severe sepsis, and sepsis, respectively. Patients who died were significantly older than the survivors (mean age, 57.37 ± 20.42 years and 44.29 ± 15.53 years respectively, P < 0.01). Nonsurvivors were significantly more anemic and had higher APACHE II, SAPS II, SAPS III, and SOFA scores. The presence of acute respiratory distress syndrome and renal dysfunction were associated with higher mortality (75% and 70.2%, respectively). There was no significant difference in the duration of mechanical ventilation or ICU stay between survivors and nonsurvivors. On multivariate analysis, significant predictors of mortality with odds ratio greater than 2 included the presence of anemia, SAPS II score greater than 35, SAPS III score greater than 47, and SOFA score greater than 6 at day 1 of admission. Conclusion: Several demographic and laboratory parameters as well as composite critical illness scoring systems are reliable early predictors of mortality in sepsis. A sepsis mortality prediction formula (AIIMS Sepsis Score) based on SAPS II, SAPS III, and SOFA scores and hemoglobin has greater predictive power than these scoring methods individually. Routine use of critical illness scoring systems and a composite mortality prediction formula may provide useful early prognostic information in sepsis/severe sepsis. Keywords: Mortality, scoring, sepsis PDF Métodos moleculares convencionales y moléculas biomarcadores en la detección de la septicemia. Conventional, molecular methods and biomarkers molecules in detection of septicemia. Arabestani MR, Rastiany S, Kazemi S, Mousavi SM. Adv Biomed Res 2015;4:120 Abstract Sepsis is a leading cause of morbidity and mortality in hospitalized patients worldwide and based on studies, 30-40% of all cases of severe sepsis and septic shock results from the blood stream infections (BSIs). Identifying of the disease, performing laboratory tests, and consequently treatment are factors that required for optimum management of BSIs. In addition, applying precise and immediate identification of the etiologic agent is a prerequisite for specific antibiotic therapy of pathogen and thereby decreasing mortality rates. The diagnosis of sepsis is difficult because clinical signs of sepsis often overlap with other noninfectious cases of systemic inflammation. BSIs are usually diagnosed by performing a series of techniques such as blood cultures, polymerase chain reaction-based methods, and biomarkers of sepsis. Extremely time-consuming even to take up to several days is a major limitation of conventional methods. In addition, yielding false-negative results due to fastidious and slow-growing microorganisms and also in case of antibiotic pretreated samples are other limitations. In comparison, molecular methods are capable of examining a blood sample obtained from suspicious patient with BSI and gave the all required information to prescribing antimicrobial therapy for detected bacterial or fungal infections immediately. Because of an emergency of sepsis, new methods are being developed. In this review, we discussed about the most important sepsis diagnostic methods and numbered the advantage and disadvantage of the methods in detail. Keywords: Biomarkers, blood-culture, molecular methods, sepsis PDF Valor pronóstico de la procalcitonina en adultos sépticos. Revisión sistemática y meta-análisis Prognostic Value of Procalcitonin in Adult Patients with Sepsis: A Systematic Review and Meta-Analysis. Liu D, Su L, Han G, Yan P, Xie L. PLoS One. 2015 Jun 15;10(6):e0129450. doi: 10.1371/journal.pone.0129450. eCollection 2015.Abstract Procalcitonin (PCT) has been widely investigated for its prognostic value in septic patients. However, studies have produced conflicting results. The purpose of the present meta-analysis is to explore the diagnostic accuracy of a single PCT concentration and PCT non-clearance in predicting all-cause sepsis mortality. We searched PubMed, Embase, Web of Knowledge and the Cochrane Library. Articles written in English were included. A 2 × 2 contingency table was constructed based on all-cause mortality and PCT level or PCT non-clearance in septic patients. Two authors independently evaluated study eligibility and extracted data. The diagnostic value of PCT in predicting prognosis was determined using a bivariate meta-analysis model. We used the Q-test and I2 index to test heterogeneity. Twenty-three studies with 3,994 patients were included. An elevated PCT level was associated with a higher risk of death. The pooled relative risk (RR) was 2.60 (95% confidence interval (CI), 2.05-3.30) using a random-effects model (I2 = 63.5%). The overall area under the summary receiver operator characteristic (SROC) curve was 0.77 (95% CI, 0.73-0.80), with a sensitivity and specificity of 0.76 (95% CI, 0.67-0.82) and 0.64 (95% CI, 0.52-0.74), respectively. There was significant evidence of heterogeneity for the PCT testing time (P = 0.020). Initial PCT values were of limited prognostic value in patients with sepsis. PCT non-clearance was a prognostic factor of death in patients with sepsis. The pooled RR was 3.05 (95% CI, 2.35-3.95) using a fixed-effects model (I2 = 37.9%). The overall area under the SROC curve was 0.79 (95% CI, 0.75-0.83), with a sensitivity and specificity of 0.72 (95% CI, 0.58-0.82) and 0.77 (95% CI, 0.55-0.90), respectively. Elevated PCT concentrations and PCT non-clearance are strongly associated with all-cause mortality in septic patients. Further studies are needed to define the optimal cut-off point and the optimal definition of PCT non-clearance for accurate risk assessment. PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

El funcionamiento de la anestesia continúa siendo un misterio

#anestesia

Fuente
Este artículo es originalmente publicado en:
http://www.madrimasd.org/informacionidi/noticias/noticia.asp?id=64157

El funcionamiento de la anestesia continúa siendo un misterio

El origen de la anestesia moderna tuvo lugar hace más de 150 años en un circo de Boston. Hoy, a pesar de emplearse millones de veces cada día, su mecanismo de acción permanece desconocido y las teorías generales que pretendían explicarla han caído recientemente. Los expertos reclaman mayor investigación para mejorar el cuidado de los pacientes.

FUENTE | SINC

Endocrinopatías y anestesia-Endocrinopathies and anesthesia

Endocrinopatías: Perspectivas actuales y cambiantes en la práctica de la anestesia Endocrinopathies: The current and changing perspectives in anesthesia practice. Bajwa SJ, Kaur G. Indian J Endocr Metab 2015;19:462-9 Abstract The gateways to advancements in medical fields have always been accessed through the coalition between various specialties. It is almost impossible for any specialty to make rapid strides of its own. However, the understanding of deeper perspectives of each specialty or super specialty is essential to take initiatives for the progress of the other specialty. Endocrinology and anesthesiology are two such examples which have made rapid progress in the last three decades. Somehow the interaction and relationship among these medical streams have been only scarcely studied. Diabetes and thyroid pathophysiologies have been the most researched endocrine disorders so far in anesthesia practice but even their management strategies have undergone significant metamorphosis over the last three decades. As such, anesthesia practice has been influenced vastly by these advancements in endocrinology. However, a comprehensive understanding of the relationship between these two partially related specialties is considered to be an essential cornerstone for further progress in anesthesia and surgical sciences. The current review is an attempt to imbibe the current and the changing perspectives so as to make the understanding of the relationship between these two medical streams a little simple and clearer. Keywords: Acromegaly, anesthesia for endocrinopathies, craniopharyngioma, diabetes mellitus, endocrinology, phaeochromocytoma, thyroid crisis PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Medwave, junio del 2015

Hemos completado la edición correspondiente al mes de Junio de 2015, los artículos incluidos son los siguientes:


EDITORIAL

Queremos publicar más estudios cualitativos en salud

Vivienne C. Bachelet, Bernardita Baeza (Chile)

Medwave 2015 Jun;15(5):e6167
http://dx.doi.org/10.5867/medwave.2015.05.6167


SERIE

Uso de modelos de regresión para la determinación de factores de riesgo
Sergio Muñoz Navarro, Jorge Rodríguez Tobar (Chile)

Medwave 2015 Jun;15(5):e6154
http://dx.doi.org/10.5867/medwave.2015.05.6154


ESTUDIOS PRIMARIOS

Prevalencia de especies de importancia clínica del género Vibrio en alimentos marinos de origen animal de establecimientos de la ciudad y puerto de Progreso de Castro, Yucatán, México
José Franco Monsreal, Lidia Esther Del Socorro Serralta-Peralta, José Ricardo Hernández Gómez, Florinda Sosa-Castilla, Juan Ariel Castillo-Cocom (México)

Medwave 2015 Jun;15(5):e6147
http://dx.doi.org/10.5867/medwave.2015.05.6147


Uso incorrecto de inhaladores de dosis medida en pacientes adultos de un hospital de Callao, Perú, 2014: estudio transversal
Alexandra Cayo-Quiñe, Valeria Martínez-Vargas, Rossi Bustamante-Voysest, Alejandro Piscoya, Yeny Alberca (Perú)

Medwave 2015;15(5):e6163
http://dx.doi.org/10.5867/medwave.2015.05.6163


Efectos del modafinilo en el desempeño atencional, memoria a corto plazo y funciones ejecutivas en estudiantes universitarios: un ensayo aleatorizado
Alejandro Fernández, Franco Mascayano, Walter Lips, Andrés Painel, Jonathan Norambuena, Eva Madrid (Chile)

Medwave 2015 Jun;15(5):e6166
http://dx.doi.org/10.5867/medwave.2015.05.6166


RESUMEN EPISTEMONIKOS

¿Uretroplastía con injerto de mucosa oral o piel prepucioescrotal para el tratamiento de la estrechez de uretra anterior?
Alejandro Rojas, Alvaro Saavedra (Chile)

Medwave 2015 Jun;15(5):e6148
http://dx.doi.org/10.5867/medwave.2015.05.6148

Bibliotecas. Alerta

Bibliotecas
Notificaciones semanales ⋅ 28 de junio de 2015
NOTICIAS


El Comercio

Bibliotecas a su medida y a la de su bolsillo
ElEspectador.com
Una biblioteca personal, se supone, es fruto de décadas de lectura y búsqueda individual de su dueño; pero no siempre es así.
El hombre que diseña bibliotecas para los multimillonarios - El Comercio
Bibliotecas a su medida y a la de su bolsillo - EntornoInteligente
Cobertura total de la noticia



Donan más de cuatro mil libros a bibliotecas de Benito Juárez
Sipse.com
La Coordinación de Bibliotecas del municipio de Benito Juárez informó que ante la necesidad de libros que se tenía de educación media superior y ...




Milenio.com

Bibliotecas que resguardan libros y niños solitarios
Milenio.com
Bibliotecas que resguardan libros y niños solitarios. Promotores de centros culturales de Tonalá y Tlajomulco, además de desarrollar programas de ...




El Mexicano

En el olvido bibliotecas públicas del país; en el DF, una por cada tres cantinas
El Mexicano
González Rodríguez puntualizó que tan sólo en Jalisco se han perdido 61 mil libros en la última década de las redes de bibliotecas de la Secretaría ...
Abandonadas las bibliotecas públicas; hay una por cada 3 cantinas: diputados - La Prensa (OEM)
Plantean mejorar infraestructura de bibliotecas en el país - 20minutos.com.mx
Hay en DF una biblioteca por cada 3 cantinas - entrelineas (Comunicado de prensa)
Cobertura total de la noticia




eju.tv

Sistema Municipal de Bibliotecas recibe importante lote de libros de Embajada Americana
eju.tv
El Sistema Municipal de Bibliotecas recibió un significativo aporte de la Embajada de Estados Unidos de Norteamérica para apoyar el Plan de ...




NTR Zacatecas .com

Distribuirán mil 500 libros en 9 bibliotecas de Río Grande
NTR Zacatecas .com
Se recibieron casi mil 500 libros del Consejo Nacional para la Cultura y las Artes (Conaculta), que serán distribuidos en nueve bibliotecas de Río ...




HuelvaYA

Las bibliotecas de Huelva amplían sus servicios de préstamo de cara al verano
HuelvaYA
bibliotecas 1 Las bibliotecas del Ayuntamiento de Huelva ya están preparadas para la temporada de verano con el objetivo de fomentar la lectura en ...
Las bibliotecas municipales de la capital amplían sus servicios de préstamos de cara al verano - Te Interesa
Las bibliotecas municipales amplían sus préstamos estivales - Huelva Información
Cobertura total de la noticia



Sáquele provecho a las bibliotecas TIC
La Patria.com
Las bibliotecas públicas además de abrir las puertas a la lectura y a la escritura, también son un lugar para aprender a usar las nuevas tecnologías.




La Comarca de Puertollano

Sistema de Bibliotecas UASLP prepara Jornadas de Fomento a la lectura 2015
La Razón
La Universidad Autónoma de San Luis Potosí a través del Sistema de Bibliotecas y la BibliotecaPública Universitaria invitan a la edición IX de las ...
Las bibliotecas municipales de Mérida realizan talleres de animación a la lectura para escolares ... -Región Digital
Sistema de Bibliotecas de la UASLP fomenta la lectura - Plano informativo
La bibliotecas municipales realizarán talleres de animación a la lectura en julio - EntornoInteligente
Cobertura total de la noticia



Las bibliotecas son para el verano
La Opinión de Murcia
L.O. Las bibliotecas, sol para el verano es el lema de la campaña que ha preparado la biblioteca municipal de San Javier para los meses veraniegos ...


WEB

Catálogos
Bibliotecas de Castilla y León - Junta de Castilla y León
Logotipo del Portal de Bibliotecas de Castilla y León; Ir a página principal ... Catálogo de la Red de Bibliotecas: libros, películas, música, revistas.



Fueron donados a la Biblioteca Central ocho libros facsimilares de una colección privada
Dirección General de Bibliotecas - UNAM
En su momento, el director general de Bibliotecas de la UNAM, doctor Adolfo Rodríguez Gallardo, agradeció este acto tan generoso y aseguró que ...



SpringerProtocols en pruebas para todos los centros y bibliotecas del CSIC del 20-6 al 19-9 de 2015
Red de Bibliotecas del CSIC
SpringerProtocols, con un fondo actual de más de 34.000 protocolos y con alrededor de 2.000 nuevas aportaciones anuales, ofrece instrucciones de ...



Horario bibliotecas verano 2015
Biblioteca
BIBLIOTECAS. JUNIO. JULIO. AGOSTO. SEPTIEMBRE. DESDE EL DÍA 29. VA Y P. DESDE EL DÍA 24.SORIA. DESDE EL DÍA 22. SEGOVIA.



Bibliotecas urbanas integradas
Bibliotecas de Castilla y León - Junta de Castilla y León
Bibliotecas urbanas integradas. Contactar Abre una ventana o marco nuevo · Enviar contenido Abre una ventana o marco nuevo · Imprimir contenido ...



Periodo especial de préstamo de verano en las bibliotecas de la BUZ
Biblioteca de la Universidad de Zaragoza
Desde el miercoles 24 de junio hasta el lunes 31 de agosto la duración de los préstamos de ejemplares del tipo "02" (préstamo largo) será de 15 días ...



Propuesta de compra
Bibliotecas de Castilla y León - Junta de Castilla y León
Cualquier usuario puede proponer a las Bibliotecas del Sistema, la adquisición de libros y otro tipo de materiales que puedan ser de interés, y que no ...



Directorio de personal
Bibliotecas de Castilla y León - Junta de Castilla y León
Acceso usuarios · Logotipo del Portal de Bibliotecas de Castilla y León; Ir a página principal ... Inicio · Directorio debibliotecas; Directorio de personal ...



convocatorias
Biblioteca Vasconcelos
RESUMEN. Biblioteca Vasconcelos te invita a la actividad Mirar libritos. JUEVES 25 DE JUNIO. LIBROS YBIBLIOTECAS. ¿Quiénes son los ...



Bibliometro celebra sus 19 años con lanzamiento literario
Sistema Nacional de Bibliotecas Públicas
La Biblioteca Pública más popular del país está de aniversario y lo celebrará con el lanzamiento del libro "Palestina: crónica de un asedio" de Daniel ...

Librerias. Alerta

librerias

NOTICIAS


24 Horas

Proponen cuota mínima de autores nacionales en vitrinas de librerías
24 Horas
La idea es aumentar la visibilidad de los libros de autores nacionales. La norma fue propuesta por el diputado de la UDI, Gaspar Rivas.




El Universal - Colombia

Isabel Allende se adueña de las librerías con "El amante japonés"
El Universal - Colombia
La escritora chilena Isabel Allende lo logró de nuevo: "El amante japonés", una historia de amor en San Francisco, dominó las preferencias del ...
Isabel Allende se adueña de las librerías con "El amante japonés" - El Universal (Venezuela)
Isabel Allende se adueña de las librerías con “El amante japonés” - La Nación.com.py
“El amante japonés”, dueño de las librerías - La Estrella de Panamá
Cobertura total de la noticia




El Correo

Una decena de librerías abrirán la Feria del Libro Antiguo y Viejo de Vitoria este jueves
El Correo
Este sitio web utiliza cookies propias y de terceros para optimizar tu navegación, adaptarse a tus preferencias y realizar labores analíticas.




La Nación Costa Rica

'Grey' arrasa en las librerías del Reino Unido
La Nación Costa Rica
'Grey' arrasa en las librerías del Reino Unido. POR EFE - Actualizado el 24 de junio de 2015 a: 12:04 p.m.. Ha vendido más de 640.000 copias en ...
"Grey", de la saga de "Cincuenta sombras", arrasa en las librerías - Informe21.com
'Grey' arrasa en las librerías británica - Diario de León
Cincuenta sombras de Grey: la cuarta novela aterriza en las librerías - La Verdad
Cobertura total de la noticia



Escritor Jorge Carrion finalista del Premio Anagrama con Librerias
ElTiempo.com
Quería conocer la ciudad de Borges y de librerías, de cafés y tango. Llegó sin dinero y se hospedó en una casa de huéspedes de La Boca, el barrio ...




RadioFórmula

"El placer de ser mujer" en venta en librerías de todo el país: escritora. Con Enrique Muñoz
RadioFórmula
La escritora Andrea de la Torre dijo que con su libro "El placer de ser mujer" quiere llegar a que la mujer sepa qué quiere porque "al momento que ...




Hispasonic (blog)

Tremor, una librería inspirada en la vibración y la resonancia
Hispasonic (blog)
Hace unos cinco años comenzaron a surgir librerías independientes creadas por diseñadores de sonido para diseñadores de sonido y distribuidas ...




EntornoInteligente

El masoquismo de 'Christian Grey' se pone de moda en las libreríasinglesas
EntornoInteligente
El masoquismo de 'Christian Grey' se pone de moda en las librerías inglesas / El telegrafo / Grey, el último libro de E.L. James de la saga 50 Sombras ...



Librerías se equipan para atender alta demanda en julio
El Periodiquito
Para hacer el gasto menos pesado, los padres ya empezaron a comprar los útiles del próximo año escolar. Muchos están adquiriendo la lista por ...



Caniem y FCE conjugan esfuerzos en beneficio de literatura infantil y juvenil
Milenio.com
En un esfuerzo por hacer circular los títulos dirigidos a niños y jóvenes en las librerías del Fondo de Cultura Económica, la Cámara Nacional de la ...

E-Books. Alerta

E-Books

NOTICIAS


RPP Noticias

Corte confirma fallo contra Apple por subir precio de e-books
RPP Noticias
La sentencia señala que Apple orquestó una conspiración con varias editoriales para subir el precio de los libros electrónicos. Compartir: ...
EU confirma fallo contra Apple por e-books - CNNExpansión.com
Apple conspiró para fijar precios de e-books - El Universal
Confirman fallo contra Apple por subir el precio de e-books - El Diario de Yucatán
Cobertura total de la noticia



Todo eReaders (blog)

Bookgrabbr, una innovadora empresa de promoción de ebooks
Todo eReaders (blog)
Bookgrabbr Bookgrabbr, una innovadora empresa de promoción de ebooks El número de empresas que se crean y se están creando en torno al ...




Libertad Digital

Alemania prohíbe vender 'ebooks' eróticos antes de las diez de la noche
Libertad Digital
Así, a partir de ahora los ebooks de temática adulta sólo podrán venderse entre las diez de la noche y las seis de la mañana. La medida, según ...




Todo eReaders (blog)

Apple y Smashwords ya aceptan las reservas de ebooks
Todo eReaders (blog)
Hace un año Amazon insertó una nueva modalidad en sus ventas que incluía la posibilidad de hacer lanzamientos de ebooks para que los usuarios ...




Todo eReaders (blog)

Australia se suma a la lucha contra la piratería de eBooks con una nueva ley
Todo eReaders (blog)
Con el paso del tiempo y el crecimiento del número de lectores que tienen un eReader para disfrutar de los eBooks, cada vez son más las páginas en ...




Todo eReaders (blog)

Los ventas de eBooks superan por primera vez a las de los libros de bolsillo
Todo eReaders (blog)
Los eBooks siguen creciendo y dando pasos hacia el futuro, o al menos eso se desprende del informe presentado ayer por la Federación de Gremios ...
El libro de texto empuja la primera subida de la edición en cinco años - La Voz de Galicia
El gremio de editores pide la cárcel para "algunos" piratas - eldiario.es
Cobertura total de la noticia



180.com.uy :: El libro que primero es e-book y después papel
180
El escritor uruguayo Pablo Silva Olazábal optó por lanzar su último cuento en formato digital y lo publicó en Outsider; una editorial argentina que se ...




TIME

Appeals court upholds ruling against Apple for manipulating cost of e-books
Fox News Latino
A federal court of appeals on Tuesday upheld a guilty ruling by regulators against Apple Inc. saying it had manipulated the cost of e-books in violation ...



Portal Cuba - Nuevos títulos de la Editorial CITMATEL en CD, DVD, audiolibros y ebooks
Cuba.cu
Editorial Citmatel , Productos multimedia , Audiolibros , Ebooks , Cultura , Aves de Cuba , Peces , Mamíferos , Fidel es Fidel , Citmatel , Arte , Música ...



Kindle Paperwhite (2015): análisis, características y opinión
ComputerHoy
Hoy realizamor el análisis del Kindle Paperwhite (2015), la versión mejorada del e-book más vendido de Amazon. El dispositivo no es que cuente ...


WEB

Playboy Portugal
Zinio
A PLAYBOY Portugal é uma revista que apresenta um compromisso entre um elegante modelo gráfico e um conjunto de conteúdos de excelência, ...

Eclampsia-Preeclampsia

Evolución perinatal en eclampsia Perinatal outcome in eclampsia. Khuman V, Singh RL, Singh RM, Devi UA, Kom T. J Med Soc 2015;29:12-5 Abstract Introduction: Eclampsia is a major cause for perinatal morbidity and mortality worldwide and perinatal outcome is much worse in developing countries even today. The reasons are multi-fold and may be because eclampsia is poorly managed and not up to the prescribed standards as in industrialized countries. Also prematurity usually iatrogenic one is a major cause for high perinatal morbidity and mortality in eclampsia due to non-availability and of neonatal intensive care unit (NICU) facilities. Materials and Methods: All eclampsia patients admitted to the antenatal ward in JIPMER from October 2009 to May 2011 were followedup. The pregnancy outcome was duly recorded and analyzed. Results: Majority of the patients were unbooked, young and primigravida. Majority (65%) of women required labor induction in one or more forms. In the study 20% of cases required cesarean section for delivery. Sixty percent of the cases were preterm deliveries and 44% required NICU admissions. There were 52 (17.2%) stillbirths. There were a total of 16 neonatal deaths; mostly due to prematurity (62.5%). The perinatal mortality rate is 231 per 1000 births. Hundred babies had birth weights <1.5kg; and 212 babies less than 2.5 kg. Average birth weight was 1.825kg, which is much lesser than the institutional Average birth weight. of 2.88 kg during the same period. Prematurity was the most common cause for NICU admissions as well as neonatal deaths. Conclusions: Majority (65%) of the cases required induction of labor and only 23% went into spontaneous labor. Twenty percent of eclamptic women required cesarean delivery. Major indication for caesarean section as anticipated was fetal distress. Most common cause for neonatal death was prematurity and its attendant complications. Keywords: Eclampsia, Neonatal deaths, Perinatal morbidity, Prematurity PDF Evolución materna y fetal en pre-eclampsia en un hospital de segundo nivel en el sur de India Maternal and fetal outcome in pre-eclampsia in a secondary care hospital in South India. Aabidha PM, Cherian AG, Paul E, Helan J. J Family Med Prim Care. 2015 Apr-Jun;4(2):257-60. doi: 10.4103/2249-4863.154669. Abstract BACKGROUND: Hypertensive disorders in pregnancy are one of the common causes for perinatal and maternal morbidity and mortality in developing countries. Pre-eclampsia is a condition which typically occurs after 20 weeks of gestation and has high blood pressure as the main contributing factor. The aim was to study the effects of pre-eclampsia on the mother and the fetus in rural South Indian population. MATERIALS AND METHODS: This was a descriptive study conducted in a secondary level hospital in rural South India. A total of 1900 antenatal women were screened for pre-eclampsia during the period August 2010 to July 2011 to study the effects on the mother and fetus. RESULTS: Of the 1900 women screened 93 were detected with pre-eclampsia in the study. Among these, 46.23% were primigravida, 30.1% belonged to socio-economic class 4 and 48.8% were among those with BMI 26-30. The incidence of severe pre-eclampsia was higher in the unregistered women. The most common maternal complication was antepartum hemorrhage (13.9%) and the most common neonatal complication was prematurity (23.65%). CONCLUSIONS: Treating anemia and improving socioeconomic status will improve maternal and neonatal outcome in pre-eclampsia. Antenatal care and educating women on significance of symptoms will markedly improve perinatal morbidity and mortality. Prematurity, growth restriction and low birth weight are neonatal complications to be anticipated and dealt with when the mother has pre-eclampsia. A good neonatal intensive care unit will help improve neonatal outcomes. KEYWORDS: Fetal outcome; maternal outcome; pre-eclampsia PDF

Atentamente Anestesia y Medicina del Dolor anestesia-dolor.org

Sedación/Sedation

Guías para el uso seguro de sedación y analgesia en procedimientos diagnósticos y terapéuticos en adultos: 2010 Guidelines for the safe use of procedural sedation and analgesia for diagnostic and therapeutic procedures in adults: 2010 PDF  Comparación de los efectos de ketamina, ketamina-dexmedetomidina y ketamina -midazolam en los pacientes quemados sometidos a cambios de apósitos Comparison of effects of ketamine, ketamine-dexmedetomidine and ketamine-midazolam on dressing changes of burn patients. Gunduz M, Sakalli S, Gunes Y, Kesiktas E, Ozcengiz D, Isik G. J Anaesthesiol Clin Pharmacol. 2011 Apr;27(2):220-4. doi: 10.4103/0970-9185.81823. Abstract OBJECTIVE: The aim of this randomized, controlled study was to compare the sedoanalgesic effects of ketamine-dexmedetomidine and ketamine-midazolam on dressing changes of burn patients. MATERIALS AND METHODS: Following Ethics Committee approval and informed patient consent, 90 ASA physical statuses I and II adult burn patients were included in the study. Patients were randomly divided into three groups. Ten minutes before dressing change, the dexmedetomidine group (group KD) (n = 30) received a continuous infusion of dexmedetomidine at a rate of 1 μg kg(-1), the midazolam group (group KM) (n = 30) received a continuous infusion of midazolam at a rate of 0.05 mg kg(-1) and the saline group (group KS) (n = 30) received a continuous infusion of saline intravenously. One minute before dressing change, each patient was administered 1 mg kg(-1) ketamine intravenously. Hemodynamic variables, pain and sedation scores, the number of patients requiring additional ketamine, time to dressing change and recovery time were recorded. RESULTS: Systolic blood pressure (SBP) values were significantly lower at, before and after ketamine administration; and 5, 10 and 15 minutes after the procedure in group KD in comparison with the other groups (P <0.05). There was no significant difference in pain scores among the groups during the study period. Sedation scores were significantly higher in group KD than in groups KM and KS at the end of the first hour (P <0.05). Time to dressing change and recovery time were similar in all the groups. CONCLUSION: In burn patients undergoing dressing changes, although both combinations ketamine-dexmedetomidine and ketamine-midazolam offered an effective sedoanalgesia without causing any significant side effect, the former resulted in higher sedation and lower hemodynamic discrepancy. KEYWORDS: Burn; dexmedetomidine; dressing changes; ketamine; midazolam PDF Dexmedetomidina vs sedación estándar con propofol o midazolam en UCI. Evaluación económica Dexmedetomidine versus standard care sedation with propofol or midazolam in intensive care: an economic evaluation. Turunen H1, Jakob SM2, Ruokonen E3, Kaukonen KM4,5, Sarapohja T6, Apajasalo M7, Takala J8. Crit Care. 2015 Feb 19;19:67. doi: 10.1186/s13054-015-0787-y. Abstract INTRODUCTION: Dexmedetomidine was shown in two European randomized double-blind double-dummy trials (PRODEX and MIDEX) to be non-inferior to propofol and midazolam in maintaining target sedation levels in mechanically ventilated intensive care unit (ICU) patients. Additionally, dexmedetomidine shortened the time to extubation versus both standard sedatives, suggesting that it may reduce ICU resource needs and thus lower ICU costs. Considering resource utilization data from these two trials, we performed a secondary, cost-minimization analysis assessing the economics of dexmedetomidine versus standard care sedation. METHODS: The total ICU costs associated with each study sedative were calculated on the basis of total study sedative consumption and the number of days patients remained intubated, required non-invasive ventilation, or required ICU care without mechanical ventilation. The daily unit costs for these three consecutive ICU periods were set to decline toward discharge, reflecting the observed reduction in mean daily Therapeutic Intervention Scoring System (TISS) points between the periods. A number of additional sensitivity analyses were performed, including one in which the total ICU costs were based on the cumulative sum of daily TISS points over the ICU period, and two further scenarios, with declining direct variable daily costs only. RESULTS: Based on pooled data from both trials, sedation with dexmedetomidine resulted in lower total ICU costs than using the standard sedatives, with a difference of €2,656 in the median (interquartile range) total ICU costs-€11,864 (€7,070 to €23,457) versus €14,520 (€7,871 to €26,254)-and €1,649 in the mean total ICU costs. The median (mean) total ICU costs with dexmedetomidine compared with those of propofol or midazolam were €1,292 (€747) and €3,573 (€2,536) lower, respectively. The result was robust, indicating lower costs with dexmedetomidine in all sensitivity analyses, including those in which only direct variable ICU costs were considered. The likelihood of dexmedetomidine resulting in lower total ICU costs compared with pooled standard care was 91.0% (72.4% versus propofol and 98.0% versus midazolam). CONCLUSIONS: From an economic point of view, dexmedetomidine appears to be a preferable option compared with standard sedatives for providing light to moderate ICU sedation exceeding 24 hours. The savings potential results primarily from shorter time to extubation. PDF Opciones de sedación para el paciente con obesidad mórbida en UCI. Encuesta concisa y una agenda para el desarrollo. Sedation options for the morbidly obese intensive care unit patient: a concise survey and an agenda for development. Aantaa R, Tonner P, Conti G, Longrois D, Mantz J, Mulier JP. Multidiscip Respir Med. 2015 Mar 7;10(1):8. doi: 10.1186/s40248-015-0007-2. eCollection 2015. Abstract BACKGROUND: We offer some perspectives and commentary on the sedation of obese patients in the intensive care unit (ICU). DISCUSSION: Sedation in morbidly obese patients should conform to the same broad principles now current in ICU practice. These include a general presumption against benzodiazepines as first-line agents. Opioids should be avoided in any situation where spontaneous breathing is required. Remifentanil is the preferred agent where continuous stable opioid levels using an infusion are required, because of its lack of context-sensitive accumulation. Volatile anaesthetics may be an option for the same reason but there are no substantial, controlled demonstrations of effectiveness/safety in short-term use in the ICU setting. Propofol is a valuable resource in the morbidly obese patients but the duration of continuous sedation should not exceed 6 days, in order to avoid propofol infusion syndrome. Alpha-2 agonists offer a range of theoretically positive features for the sedation of morbidly obese patients, but at present there is a lack of pharmacokinetic data and a critical mass of high-grade clinical data. Dexmedetomidine has the attraction of not causing respiratory depression or obstructive breathing during sedation and its sympatholytic effects should help deliver stable blood pressure and heart rate. Ketamine has a poor tolerability profile in adults so its use in the ICU context is largely confined to paediatrics. CONCLUSION: None of the agents currently available is ideal for every situation encountered in the management of morbidly obese patients. This article identifies additional research needed to place sedation practice of obese patients on a more systematic footing. KEYWORDS: Benzodiazepines; Clonidine; Dexmedetomidine; Intensive care; Ketamine; Obesity; Opioids; Propofol; Sedation; Volatile anaesthetics PDF

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