Revisiones bibliográficas. Documentación científica en Ortopedia y Traumatología, medicina deportiva, artroscopia, artroplastia y de todas las patologías del sistema Músculo-Esquelético
sábado, 21 de septiembre de 2013
La consulta del doctor Casado: Relatos de verano: La residencia
http://www.doctorcasado.es/2013/09/relatos-de-verano-la-residencia.html
La consulta del doctor Casado: Relatos de verano: La residencia: Foto: ' Lonely leaf left alone ' http://www.flickr.com/photos/37576773@N08/3804259707 - Doctor aquí le dejo la lista de pet...
Relatos de verano: La residencia
Foto: 'Lonely leaf left alone'
http://www.flickr.com/photos/37576773@N08/3804259707
- Doctor aquí le dejo la lista de peticiones de la residencia. La administrativa dejó la hoja en la mesa y dando media vuelta se dispuso a salir.
- ¡Cómo! otra vez 50 citados, pero si ya respondí 30 peticiones la semana pasada... gritó el doctor.
- No se azore doctor, se los he citado todos en huecos rojos, para no quitar ninguno a los que se citen hoy, ordenes de MariPili, la jefa de grupo.
- Genial, genial. Me parece genial...
Empezó a marcar los antibióticos que le pedían esa semana, veintitrés cajas. Para una residencia de 55 internos era una barbaridad, todas las semanas lo mismo. No sabía qué hacer. Había mandado cartas, hablado con la doctora a cargo, con sus compañeros, con la señora de la limpieza... Estaba hecho un lío. Decidió pedir una cita a la residencia para hacer una visita presencial, "por lo menos lo vamos a intentar".
A la semana siguiente se presentó allí al finalizar la consulta. Le recibió la directora en funciones, llevaba a penas diez días en el cargo. La residencia había atravesado un año difícil en parte debido a la complicada personalidad de la nueva dueña que tras hacerse con la empresa hacía dos años no dejaba de discutir con todo el mundo, desde la totalidad de la plantilla hasta los proveedores y demás agentes. El doctor fue invitado a pasar al despacho donde empezaron una conversación que fue interrumpida enseguida por la intromisión de una auxiliar, "señora directora una llamada urgente de doña Francisca". La directora atendió el teléfono pasándoselo al punto al galeno, "la propietaria quiere hablar con usted". En menos de un minuto el doctor tuvo que colgarla por no aguantar las formas de una señora acostumbrada a ejercer el mando de forma disciplente. Volvió a sonar el teléfono. La cara de la directora quedó hecha un poema, "si, entiendo, entiendo", colgó. "Señor doctor me temo que debo acompañarle a la puerta, lo siento mucho pero no tengo más remedio". Y así fue como terminó la visita de forma cuanto menos sorprendente. El doctor respiró hondo, le dieron ganas de montar un número con llamada al juzgado de guardia y a las fuerzas vivas pero no lo hizo. "En la vida", se dijo, "avanza más la pérdida de un peón si luego la jugada nos permite ganar una torre", y salió sonriendo por tener al menos una buena historia que contar.
La consulta del doctor Casado: Relatos de verano: La residencia: Foto: ' Lonely leaf left alone ' http://www.flickr.com/photos/37576773@N08/3804259707 - Doctor aquí le dejo la lista de pet...
Relatos de verano: La residencia
Foto: 'Lonely leaf left alone'
http://www.flickr.com/photos/37576773@N08/3804259707
- Doctor aquí le dejo la lista de peticiones de la residencia. La administrativa dejó la hoja en la mesa y dando media vuelta se dispuso a salir.
- ¡Cómo! otra vez 50 citados, pero si ya respondí 30 peticiones la semana pasada... gritó el doctor.
- No se azore doctor, se los he citado todos en huecos rojos, para no quitar ninguno a los que se citen hoy, ordenes de MariPili, la jefa de grupo.
- Genial, genial. Me parece genial...
Empezó a marcar los antibióticos que le pedían esa semana, veintitrés cajas. Para una residencia de 55 internos era una barbaridad, todas las semanas lo mismo. No sabía qué hacer. Había mandado cartas, hablado con la doctora a cargo, con sus compañeros, con la señora de la limpieza... Estaba hecho un lío. Decidió pedir una cita a la residencia para hacer una visita presencial, "por lo menos lo vamos a intentar".
A la semana siguiente se presentó allí al finalizar la consulta. Le recibió la directora en funciones, llevaba a penas diez días en el cargo. La residencia había atravesado un año difícil en parte debido a la complicada personalidad de la nueva dueña que tras hacerse con la empresa hacía dos años no dejaba de discutir con todo el mundo, desde la totalidad de la plantilla hasta los proveedores y demás agentes. El doctor fue invitado a pasar al despacho donde empezaron una conversación que fue interrumpida enseguida por la intromisión de una auxiliar, "señora directora una llamada urgente de doña Francisca". La directora atendió el teléfono pasándoselo al punto al galeno, "la propietaria quiere hablar con usted". En menos de un minuto el doctor tuvo que colgarla por no aguantar las formas de una señora acostumbrada a ejercer el mando de forma disciplente. Volvió a sonar el teléfono. La cara de la directora quedó hecha un poema, "si, entiendo, entiendo", colgó. "Señor doctor me temo que debo acompañarle a la puerta, lo siento mucho pero no tengo más remedio". Y así fue como terminó la visita de forma cuanto menos sorprendente. El doctor respiró hondo, le dieron ganas de montar un número con llamada al juzgado de guardia y a las fuerzas vivas pero no lo hizo. "En la vida", se dijo, "avanza más la pérdida de un peón si luego la jugada nos permite ganar una torre", y salió sonriendo por tener al menos una buena historia que contar.
Houston Foot Specialists: Running & Ankle Pain
Houston Foot Specialists: Running & Ankle Pain: (Photo credit: Wikipedia ) If you have a love for running, there are scores of races this fall taking place in many cities in Texas for ...
Houston Foot Specialists
Dr. Jeffrey N Bowman is the Podiatrist for Houston Foot Specialists. As a podiatric physician, Dr. Bowman is well known for his skills as a surgeon in foot and ankle surgeries and has been awarded many honors for his work in the podiatric field.
Wednesday, September 18, 2013
Running & Ankle Pain
(Photo credit: Wikipedia)
If you have a love for running, there are scores of races this fall taking place in many cities in Texas for you to choose from! The Splash-n-Dash on September 17th, 2013 and the Casa Superhero Run on September 21st, 2013 – both in Austin, TX – are favorites and are sure to put you to the test while having a ton of fun!
Nothing is more frustrating when you are a runner than having to deal with ankle pain, either in training or during the run. The ankle is made up of a lot of muscles and ligaments and provides much of the propulsion your body needs during each stride. The ankle has to endure a lot of stress during running and there are a few reasons why you may have some pain in this area.
One cause could be something called posterior tibial tendonitis. A muscle that runs down your leg, behind the inside of your ankle and into the arch of your foot can become overworked, torn and inflamed. With this condition, you may feel pain on the inside of your ankle. Running on uneven surfaces or having a foot that overpronates (rolls inward) could put you at risk for this injury. Landing the wrong way on your foot one day could also have caused a sprain that you weren’t aware of at first. This may be another reason for recurring pain, as continued running hasn’t allowed ligaments to heal properly. Overtraining could have resulted in an unseen stress fracture, which is a small hairline break in a bone that can lead to significant pain when the foot has to bear a lot of weight.
If icing and some rest from running don’t take your ankle pain away, it is time to come in and see Dr. Jeff Bowman for an accurate diagnosis of what is causing your pain and the right treatment to get rid of it. A custom orthotic might be just what you need to get rid of ankle pain by realigning your ankle and foot while you run. Take your foot health seriously and call Houston Foot Specialists today for an appointment at (713) 467-8886.
©2013 Jeff Bowman., All Rights Reserved
La consulta del doctor Casado: Unos operan con las gafas de Google, otros pasamos...
La consulta del doctor Casado: Unos operan con las gafas de Google, otros pasamos...: Hace unos días el prestigioso traumatólogo Guillén operaba una rodilla con un artroscopio sin hilos y retransmitía la cirugía por stream...
Unos operan con las gafas de Google, otros pasamos la consulta descalzos
Hace unos días el prestigioso traumatólogo Guillén operaba una rodilla con un artroscopio sin hilos y retransmitía la cirugía por streaming usando unas gafas de Google. Ese mismo día yo pasaba consulta armado con un fonendo, un otoscopio y un esfignomanómetro, en retaguardia un ordenador que me permite consultar dudas clínicas y farmacológicas sobre la marcha y poco más. Las herramientas más preciadas que manejo como generalista son lacomunicación, la información blanda (biografía, patografía, familia, comunidad...) que tengo del paciente y mirazonamiento clínico. Me alegra conocer que otros facultativos usan cirugías robóticas, gafas de realidad aumentada o tecnologías ultramodernas. Pero no puedo dejar de reflexionar en qué lugar dejamos al paciente. A esa persona que tenemos delante con un problema de salud.
Cuando constato que no puedo comunicarme por email o teléfono con otros médicos de mi hospital de referencia con los que comparto decisiones de diagnóstico y tratamiento de un paciente, o que mi agenda de pacientes supera los cuarenta me pregunto si estamos haciendo las cosas de forma adecuada.
El doctor Guillén opera en una clínica privada y me parece bien que use los aparatos que le apetezcan. En el sistema público tal vez haya llegado la hora del sentido común, aplicar tratatamientos con la suficiente evidencia científica detrás, ser prudente con las novedades y evitar aquello que no haya demostrado utilidad. Les parecerá de perogrullo pero seguimos gastando millones de euros por no seguir estas sencillas recomendaciones que un humilde médico descalzo deja escritas en su blog.
martes, 17 de septiembre de 2013
La mitad de los pacientes que utilizan un condroprotector se siente satisfecho con el tratamiento
Martes 17 de septiembre de 2013 | 10:00
La mitad de los pacientes que utilizan un condroprotector se siente satisfecho con el tratamiento
La mitad de los pacientes que utilizan un condroprotector se siente satisfecho con el tratamiento
Tabaco y anestesia/Smoking and anesthesia
Efectividad del programa de suspensión perioperatoria de fumar: estudio clínico randomizado
The effectiveness of a perioperative smoking cessation program: a randomized clinical trial.
Lee SM, Landry J, Jones PM, Buhrmann O, Morley-Forster P.
FRCPC, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Smoking Cessation Study Linda Szabo University Hospital-B3-218, 339 Windermere Rd., London, Ontario, Canada N6A 5A5. suze.lee@utoronto.c.
Anesth Analg. 2013 Sep;117(3):605-13. doi: 10.1213/ANE.0b013e318298a6b0. Epub 2013 Jul 18.
Abstract
BACKGROUND: Cigarette smoking by surgical patients is associated with increased complications, particularly perioperative respiratory problems and poor wound healing. In this study, we sought to determine whether a pragmatic perioperative smoking cessation intervention designed for a busy preadmission clinic would be successful in reducing smoking rates and intraoperative and immediate postoperative complications. METHODS: This randomized controlled trial was conducted at a university-affiliated hospital in London, Ontario, Canada. Patients seen in the preadmission clinic at least 3 weeks preoperatively were randomized to either the control group (84 patients) or the intervention group (84 patients). The control group received no specific smoking cessation intervention. The intervention group received (1) brief counseling by the preadmission nurse, (2) brochures on smoking cessation, (3) referral to the Canadian Cancer Society's Smokers' Helpline, and (4) a free 6-week supply of transdermal nicotine replacement therapy. All outcome assessors and caregivers on the operative day were blinded to group assignment. The primary outcome was the rate of smoking cessation as confirmed by exhaled carbon monoxide breath test. Secondary outcomes included perioperative complications and smoking status at 30 days postoperatively. RESULTS:
Between October 2010 and April 2012, 168 patients were recruited into the tudy. Smoking cessation occurred in 12 patients (14.3%) in the intervention group as compared with 3 patients (3.6%) in the control group (relative risk 4.0; 95% confidence interval [CI], 1.2-13.7; P = 0.03). The overall rate of combined intraoperative and immediate postoperative complications was not significantly different between intervention and control groups (13.1% and 16.7%, respectively; relative risk 0.79; 95% CI, 0.38-1.63; P = 0.67). At follow-up 30 days postoperatively, smoking cessation was reported in 22 patients (28.6%) in the intervention group compared with 8 patients (11%) in controls (relative risk 2.6; 95% CI, 1.2-5.5; P = 0.008). CONCLUSIONS: One of the objections to widespread use of smoking cessation interventions in the preadmission clinic is that it is too labor-intensive. The results of this study show that a smoking cessation intervention, designed to minimize additional use of physician or nursing time, results in decreased smoking rates on the day of surgery and promotes abstinence 30 days postoperatively.
http://www.anesthesia-analgesia.org/content/117/3/605.full.pdf
Intervenciones del tabaco y anestesia
Tobacco interventions and anaesthesia- a review.
Saha U.
Professor, Dept of Anaesthesiology, Lady Hardinge Medical College, Smt. Sucheta Kriplani & Kalawati Saran Childrens Hospital, New Delhi, 110001.
Indian J Anaesth. 2009 Oct;53(5):618-27.
Abstract
SUMMARY:
Tobacco use is the leading preventable agent of death in the world. It is manufactured on a large scale in India and has a huge international market also. Death toll from tobacco use is on the rise. Use of tobacco is also increasing esp. in developing countries, in teenagers & in women, despite government, WHO and intervention by other statutory bodies. Prolonged use of tobacco or its products, as smoke or chew, endows significant risk of developing various diseases. With advances in surgical and anaethesia techniques & prolonged life expectancy, anaesthetist will be faced with management of these patients. Tobacco consumption affects every major organ system of the body; esp. lung, heart and blood vessels. Perioperative smoking cessation can significantly reduce the risk of postoperative complications & duration of hospital stay. Anaesthetist can play an important role in motivating these patients to quit smoking preoperatively by providing brief counselling and nicotine replacement therapy in reluctant quitters. More of concern is the effect of passive smoking (second & third hand smoke) on non smokers. This is a review of tobacco & its products, their health consequences, diseases caused, anaesthetic considerations & their role in helping these patients quit smoking Preventing nicotine addiction and improving smoking cessation strategies should be the priority and despite these being only partially successful, strong measures at all levels should be continued & enforced. KEYWORDS: Anaesthetic considerations, COPD, Carcinogenesis, Diseases, Health effects, Interventions, Lung cancer, Passive smoking, Preoperative advice, Second hand smoke, Smoking, Tobacco
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900094/
Efecto de la exposición pasiva al humo del tabaco sobre la anestesia dental general en niños
Effect of passive smoke exposure on general anesthesia for pediatric dental patients.
Thikkurissy S, Crawford B, Groner J, Stewart R, Smiley MK.
The Ohio State University College of Dentistry, Columbus, OH, USA. thikkurissy.1@osu.edu
Anesth Prog. 2012 Winter;59(4):143-6. doi: 10.2344/0003-3006-59.4.143
Abstract
The purpose of this study was to test the null hypothesis that children with environmental tobacco smoke (ETS) exposure (also known as passive smoke exposure) do not demonstrate an increased likelihood of adverse respiratory events during or while recovering from general anesthesia administered for treatment of early childhood caries. Parents of children (ages 19 months-12 years) preparing to receive general anesthesia for the purpose of dental restorative procedures were interviewed regarding the child's risk for ETS. Children were observed during and after the procedure by a standardized dentist anesthesiologist and postanesthesia care unit nurse who independently recorded severity of 6 types of adverse respiratory events-coughing, laryngospasm, bronchospasm, breath holding, hypersecretion, and airway obstruction. Data from 99 children were analyzed. The children for whom ETS was reported were significantly older than their ETS-free counterparts . If the primary caregiver smoked, there was a significantly higher incidence of smoking by other members of the family (P < .0001) as well as smoking in the house (P < .0005). There were no significant differences between the adverse respiratory outcomes of the ETS (+) and ETS (-) groups. The ETS (+) children did have significantly longer recovery times (P < .0001) despite not having significantly more dental caries (P = .38) or longer procedure times. ETS is a poor indicator of post-general anesthesia respiratory morbidity in children being treated for early childhood caries.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3522491/pdf/i0003-3006-59-4-143.pdf
Atentamente
Dr. Francisco Martínez-Pelayo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
The effectiveness of a perioperative smoking cessation program: a randomized clinical trial.
Lee SM, Landry J, Jones PM, Buhrmann O, Morley-Forster P.
FRCPC, Department of Anesthesia and Perioperative Medicine, University of Western Ontario, Smoking Cessation Study Linda Szabo University Hospital-B3-218, 339 Windermere Rd., London, Ontario, Canada N6A 5A5. suze.lee@utoronto.c.
Anesth Analg. 2013 Sep;117(3):605-13. doi: 10.1213/ANE.0b013e318298a6b0. Epub 2013 Jul 18.
Abstract
BACKGROUND: Cigarette smoking by surgical patients is associated with increased complications, particularly perioperative respiratory problems and poor wound healing. In this study, we sought to determine whether a pragmatic perioperative smoking cessation intervention designed for a busy preadmission clinic would be successful in reducing smoking rates and intraoperative and immediate postoperative complications. METHODS: This randomized controlled trial was conducted at a university-affiliated hospital in London, Ontario, Canada. Patients seen in the preadmission clinic at least 3 weeks preoperatively were randomized to either the control group (84 patients) or the intervention group (84 patients). The control group received no specific smoking cessation intervention. The intervention group received (1) brief counseling by the preadmission nurse, (2) brochures on smoking cessation, (3) referral to the Canadian Cancer Society's Smokers' Helpline, and (4) a free 6-week supply of transdermal nicotine replacement therapy. All outcome assessors and caregivers on the operative day were blinded to group assignment. The primary outcome was the rate of smoking cessation as confirmed by exhaled carbon monoxide breath test. Secondary outcomes included perioperative complications and smoking status at 30 days postoperatively. RESULTS:
Between October 2010 and April 2012, 168 patients were recruited into the tudy. Smoking cessation occurred in 12 patients (14.3%) in the intervention group as compared with 3 patients (3.6%) in the control group (relative risk 4.0; 95% confidence interval [CI], 1.2-13.7; P = 0.03). The overall rate of combined intraoperative and immediate postoperative complications was not significantly different between intervention and control groups (13.1% and 16.7%, respectively; relative risk 0.79; 95% CI, 0.38-1.63; P = 0.67). At follow-up 30 days postoperatively, smoking cessation was reported in 22 patients (28.6%) in the intervention group compared with 8 patients (11%) in controls (relative risk 2.6; 95% CI, 1.2-5.5; P = 0.008). CONCLUSIONS: One of the objections to widespread use of smoking cessation interventions in the preadmission clinic is that it is too labor-intensive. The results of this study show that a smoking cessation intervention, designed to minimize additional use of physician or nursing time, results in decreased smoking rates on the day of surgery and promotes abstinence 30 days postoperatively.
http://www.anesthesia-analgesia.org/content/117/3/605.full.pdf
Intervenciones del tabaco y anestesia
Tobacco interventions and anaesthesia- a review.
Saha U.
Professor, Dept of Anaesthesiology, Lady Hardinge Medical College, Smt. Sucheta Kriplani & Kalawati Saran Childrens Hospital, New Delhi, 110001.
Indian J Anaesth. 2009 Oct;53(5):618-27.
Abstract
SUMMARY:
Tobacco use is the leading preventable agent of death in the world. It is manufactured on a large scale in India and has a huge international market also. Death toll from tobacco use is on the rise. Use of tobacco is also increasing esp. in developing countries, in teenagers & in women, despite government, WHO and intervention by other statutory bodies. Prolonged use of tobacco or its products, as smoke or chew, endows significant risk of developing various diseases. With advances in surgical and anaethesia techniques & prolonged life expectancy, anaesthetist will be faced with management of these patients. Tobacco consumption affects every major organ system of the body; esp. lung, heart and blood vessels. Perioperative smoking cessation can significantly reduce the risk of postoperative complications & duration of hospital stay. Anaesthetist can play an important role in motivating these patients to quit smoking preoperatively by providing brief counselling and nicotine replacement therapy in reluctant quitters. More of concern is the effect of passive smoking (second & third hand smoke) on non smokers. This is a review of tobacco & its products, their health consequences, diseases caused, anaesthetic considerations & their role in helping these patients quit smoking Preventing nicotine addiction and improving smoking cessation strategies should be the priority and despite these being only partially successful, strong measures at all levels should be continued & enforced. KEYWORDS: Anaesthetic considerations, COPD, Carcinogenesis, Diseases, Health effects, Interventions, Lung cancer, Passive smoking, Preoperative advice, Second hand smoke, Smoking, Tobacco
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900094/
Efecto de la exposición pasiva al humo del tabaco sobre la anestesia dental general en niños
Effect of passive smoke exposure on general anesthesia for pediatric dental patients.
Thikkurissy S, Crawford B, Groner J, Stewart R, Smiley MK.
The Ohio State University College of Dentistry, Columbus, OH, USA. thikkurissy.1@osu.edu
Anesth Prog. 2012 Winter;59(4):143-6. doi: 10.2344/0003-3006-59.4.143
Abstract
The purpose of this study was to test the null hypothesis that children with environmental tobacco smoke (ETS) exposure (also known as passive smoke exposure) do not demonstrate an increased likelihood of adverse respiratory events during or while recovering from general anesthesia administered for treatment of early childhood caries. Parents of children (ages 19 months-12 years) preparing to receive general anesthesia for the purpose of dental restorative procedures were interviewed regarding the child's risk for ETS. Children were observed during and after the procedure by a standardized dentist anesthesiologist and postanesthesia care unit nurse who independently recorded severity of 6 types of adverse respiratory events-coughing, laryngospasm, bronchospasm, breath holding, hypersecretion, and airway obstruction. Data from 99 children were analyzed. The children for whom ETS was reported were significantly older than their ETS-free counterparts . If the primary caregiver smoked, there was a significantly higher incidence of smoking by other members of the family (P < .0001) as well as smoking in the house (P < .0005). There were no significant differences between the adverse respiratory outcomes of the ETS (+) and ETS (-) groups. The ETS (+) children did have significantly longer recovery times (P < .0001) despite not having significantly more dental caries (P = .38) or longer procedure times. ETS is a poor indicator of post-general anesthesia respiratory morbidity in children being treated for early childhood caries.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3522491/pdf/i0003-3006-59-4-143.pdf
Atentamente
Dr. Francisco Martínez-Pelayo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Bibliotecas. Alerta
La biblioteca de tesoros digitales El Colombiano
El universo de los textos digitales se amplió y las bibliotecas consolidan su oferta para ... Catalina Holguín, editora digital de la Biblioteca Nacional, explica que ...Ver todos los artículos sobre este tema »
La Biblioteca Central de la UNNE cumple 54 años de compromiso ... Diario NORTE
Cuatro días después de del Día del Bibliotecario, la Biblioteca Central de la Universidad Nacional del Nordeste celebra sus 54 años. La institución formadora ...Ver todos los artículos sobre este tema »
La nueva biblioteca de La Rinconada abre sus puertas elcorreoweb.es
La nueva biblioteca de La Rinconada abre sus puertas ... a La Rinconada con la apertura de la nueva biblioteca en la zona de Acceso a Pago de Enmedio, que ...Ver todos los artículos sobre este tema »
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elcorreoweb.es
La Biblioteca Virtual será un parque interactivo El Nuevo Dia (Colombia)
La iniciativa consiste principalmente en la donación de la Biblioteca Virtual para adelantar un parque temático, que quedaría similar a Maloka, ubicado en ...Ver todos los artículos sobre este tema »
[Imágenes] BiblioTech: inauguró la primera biblioteca pública y ... Impulso Negocios
[Imágenes] BiblioTech: inauguró la primera biblioteca pública y digital, sin libros ... Library, la primera biblioteca digital pública de su estilo en Estados Unidos.Ver todos los artículos sobre este tema »
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Impulso Negocios
Presentan edición conmemorativa de los Sentimientos de la Nación ... Mi Morelia.com
... edición conmemorativa de los Sentimientos de la Nación en biblioteca de la ... se presentó en la biblioteca pública de la Universidad Michoacana de San ...Ver todos los artículos sobre este tema »
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Mi Morelia.com
Proyecto EXPLORA CONICYT Antofagasta realizó donación a ... El Nortero
Para Jorquera, cada colección donada a la biblioteca es muy importante, ya que “todas las donaciones nos permiten difundir la información en todos sus ...Ver todos los artículos sobre este tema »
Pérez Herrero, el último poeta bohemio leonés Diario de León
L a Biblioteca Pública de León, en la calle Santa Nonia, custodia desde el año pasado la librería de Francisco Pérez Herrero, cedida por su mujer, según ...Ver todos los artículos sobre este tema »
Dime qué lees Monsiváis y te diré quién eres La Jornada en linea
A casi un año de la apertura de la Biblioteca Personal del escritor, la diversidad de sus visitantes, refleja el carácter de la obra y de las lecturas del cronista y ...Ver todos los artículos sobre este tema »
"Granada ha sido el barómetro de mi éxito" Huelva Información
Miguel Ríos, en Madrid, en la puesta de largo del libro, que presentará el 7 de octubre en la Biblioteca Infanta Elena de Sevilla junto a Mercedes de Pablos.Ver todos los artículos sobre este tema »
Enfispo: actualización | La Biblioteca informa boletinbibliotecaun
ENFISPO, Base de datos de enfermería, fisioterapia y podología confeccionada por la biblioteca de la Escuela de Enfermería, Fisioterapia y Podología de la ...La Biblioteca informa
El universo de los textos digitales se amplió y las bibliotecas consolidan su oferta para ... Catalina Holguín, editora digital de la Biblioteca Nacional, explica que ...Ver todos los artículos sobre este tema »
La Biblioteca Central de la UNNE cumple 54 años de compromiso ... Diario NORTE
Cuatro días después de del Día del Bibliotecario, la Biblioteca Central de la Universidad Nacional del Nordeste celebra sus 54 años. La institución formadora ...Ver todos los artículos sobre este tema »
La nueva biblioteca de La Rinconada abre sus puertas elcorreoweb.es
La nueva biblioteca de La Rinconada abre sus puertas ... a La Rinconada con la apertura de la nueva biblioteca en la zona de Acceso a Pago de Enmedio, que ...Ver todos los artículos sobre este tema »
elcorreoweb.es
La Biblioteca Virtual será un parque interactivo El Nuevo Dia (Colombia)
La iniciativa consiste principalmente en la donación de la Biblioteca Virtual para adelantar un parque temático, que quedaría similar a Maloka, ubicado en ...Ver todos los artículos sobre este tema »
[Imágenes] BiblioTech: inauguró la primera biblioteca pública y ... Impulso Negocios
[Imágenes] BiblioTech: inauguró la primera biblioteca pública y digital, sin libros ... Library, la primera biblioteca digital pública de su estilo en Estados Unidos.Ver todos los artículos sobre este tema »
Impulso Negocios
Presentan edición conmemorativa de los Sentimientos de la Nación ... Mi Morelia.com
... edición conmemorativa de los Sentimientos de la Nación en biblioteca de la ... se presentó en la biblioteca pública de la Universidad Michoacana de San ...Ver todos los artículos sobre este tema »
Mi Morelia.com
Proyecto EXPLORA CONICYT Antofagasta realizó donación a ... El Nortero
Para Jorquera, cada colección donada a la biblioteca es muy importante, ya que “todas las donaciones nos permiten difundir la información en todos sus ...Ver todos los artículos sobre este tema »
Pérez Herrero, el último poeta bohemio leonés Diario de León
L a Biblioteca Pública de León, en la calle Santa Nonia, custodia desde el año pasado la librería de Francisco Pérez Herrero, cedida por su mujer, según ...Ver todos los artículos sobre este tema »
Dime qué lees Monsiváis y te diré quién eres La Jornada en linea
A casi un año de la apertura de la Biblioteca Personal del escritor, la diversidad de sus visitantes, refleja el carácter de la obra y de las lecturas del cronista y ...Ver todos los artículos sobre este tema »
"Granada ha sido el barómetro de mi éxito" Huelva Información
Miguel Ríos, en Madrid, en la puesta de largo del libro, que presentará el 7 de octubre en la Biblioteca Infanta Elena de Sevilla junto a Mercedes de Pablos.Ver todos los artículos sobre este tema »
Enfispo: actualización | La Biblioteca informa boletinbibliotecaun
ENFISPO, Base de datos de enfermería, fisioterapia y podología confeccionada por la biblioteca de la Escuela de Enfermería, Fisioterapia y Podología de la ...La Biblioteca informa
lunes, 16 de septiembre de 2013
Cuba expondrá sus adelantos en congreso de ortopedia
http://www.ain.cu/2013/septiembre/15ypc-congreso-cuba.htm
Cuba expondrá sus adelantos en congreso de ortopedia
Iris de Armas Padrino
La Habana, 15 sep (AIN) Los notables resultados de los fijadores externos RALCA, ideados por el Profesor Rodrigo Álvarez Cambras y que se emplean en unas 40 naciones para diferentes afecciones óseas, serán expuestos en una cita internacional que comenzará mañana en esta capital.
Álvarez Cambras, presidente del comité organizador del XXIV Congreso Internacional de Ortopedia y Traumatología, previsto hasta el 21 de septiembre, explicó a la AIN que el modelo actual denominado RALCA-4000 posee un 600 por ciento de mejores posibilidades en relación con el primero que elaboró en 1972.
Cuba expondrá sus adelantos en congreso de ortopedia
Iris de Armas Padrino
La Habana, 15 sep (AIN) Los notables resultados de los fijadores externos RALCA, ideados por el Profesor Rodrigo Álvarez Cambras y que se emplean en unas 40 naciones para diferentes afecciones óseas, serán expuestos en una cita internacional que comenzará mañana en esta capital.Álvarez Cambras, presidente del comité organizador del XXIV Congreso Internacional de Ortopedia y Traumatología, previsto hasta el 21 de septiembre, explicó a la AIN que el modelo actual denominado RALCA-4000 posee un 600 por ciento de mejores posibilidades en relación con el primero que elaboró en 1972.
Arritmias cardiacas/Cardiac arrhythmias
Tratamiento de la fibrilación auricular postoperatoria
Management of postoperative atrial fibrillation.
Omae T, Kanmura Y.
Department of Anesthesiology, Fujimoto Hayasuzu Hospital, Miyakonojo, Miyazaki, Japan. omae@za2.so-net.ne.jp
J Anesth. 2012 Jun;26(3):429-37. doi: 10.1007/s00540-012-1330-9. Epub 2012 Jan 25.
Abstract
The impact of postoperative atrial fibrillation (PAF) on patient outcomes has prompted intense investigation into the optimal methods for prevention and treatment of this complication. In the prevention of PAF, β-blockers and amiodarone are particularly effective and are recommended by guidelines. However, their use requires caution due to the possibility of drug-related adverse effects. Aside from these risks, perioperative prophylactic treatment with statins seems to be effective for preventing PAF and is associated with a low incidence of adverse effects. PAF can be treated by rhythm control, heart-rate control, and antithrombotic therapy. For the purpose of heart rate control, β-blockers, calcium-channel antagonists, and amiodarone are used. In patients with unstable hemodynamics, cardioversion may be performed for rhythm control. Antithrombotic therapy is used in addition to heart-rate maintenance therapy in cases of PAF >48-h duration or in cases with a history of cerebrovascular thromboembolism. Anticoagulation is the first choice for antithrombotic therapy, and anticoagulation management should focus on maintaining international normalized ratio (INRs) in the 2.0-3.0 range in patients <75 years of age, whereas prothrombin-time INR should be controlled to the 1.6-2.6 range in patients ≥75 years of age. In the future, dabigatran could be used for perioperative management of PAF, because it does not require regular monitoring and has a quick onset of action with short serum half-life. Preventing PAF is an important goal and requires specific perioperative management as well as other approaches. PAF is also associated with lifestyle-related diseases, which emphasizes the ongoing need for appropriate lifestyle management in individual patients
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3375013/pdf/540_2012_Article_1330.pdf
Fibrilación auricular postoperatoria en pacientes sometidos a bypass coronario o cirugía valvular: uso intraoperatorio de landiolol
Postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting or cardiac valve surgery: intraoperative use of landiolol.
Nakanishi K, Takeda S, Kim C, Kohda S, Sakamoto A.
Department of Anesthesiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. n-kazu@nms.ac.jp
J Cardiothorac Surg. 2013 Jan 24;8:19. doi: 10.1186/1749-8090-8-19.
Abstract
BACKGROUND: Landiolol hydrochloride is a new β-adrenergic blocker with a pharmacological profile that suggests it can be administered safely to patients who have sinus tachycardia or tachyarrhythmia and who require heart rate reduction. This study aimed to investigate whether intraoperative administration of landiolol could reduce the incidence of atrial fibrillation (AF) after cardiac surgery. METHODS: Of the 200 consecutive patients whose records could be retrieved between October 2006 and September 2007, we retrospectively reviewed a total of 105 patients who met the inclusion criteria: no previous permanent/persistent AF, no permanent pacemaker, no renal insufficiency requiring dialysis, and no reactive airway disease, etc. Landiolol infusion was started after surgery had commenced, at an infusion rate of 1 μg/kg/min, titrated upward in 3-5 μg/kg/min increments. The patients were divided into 2 groups: those who received intraoperative β-blocker therapy with landiolol (landiolol group) and those who did not receive any β-blockers during surgery (control group). An unpaired t test and Fisher's exact test were used to compare between-group differences in mean values and categorical data, respectively. RESULTS: Seventeen of the 105 patients (16.2%) developed postoperative atrial fibrillation: 5/57 (8.8%) in the landiolol group and 12/48 (25%) in the control group. There was a significant difference between the two groups (P=0.03). The incidence of AF after valve surgery and off-pump coronary artery bypass grafting was lower in the landiolol group, although the difference between the groups was not statistically significant. CONCLUSIONS: Our retrospective review demonstrated a marked reduction of postoperative AF in those who received landiolol intraoperatively. A prospective study of intraoperative landiolol for preventing postoperative atrial fibrillation is warranted.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3564867/pdf/1749-8090-8-19.pdf
Meta-análisis de estudios controlados randomizados sobre la adición de magnesio al betabloqueadores para prevenir arritmias auriculares después de bypass coronario
Meta-analysis of randomized controlled trials on magnesium in addition to beta-blocker for prevention of postoperative atrial arrhythmias after coronary artery bypass grafting.
Wu X, Wang C, Zhu J, Zhang C, Zhang Y, Gao Y.
Department of Cardiovascular Medicine, the Second Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China.
BMC Cardiovasc Disord. 2013 Jan 23;13:5. doi: 10.1186/1471-2261-13-5.
Abstract
BACKGROUND: Atrial arrhythmia (AA) is the most common complication after coronary artery bypass grafting (CABG). Only beta-blockers and amiodarone have been convincingly shown to decrease its incidence. The effectiveness of magnesium on this complication is still controversial. This meta-analysis was performed to evaluate the effect of magnesium as a sole or adjuvant agent in addition to beta-blocker on suppressing postoperativeAA after CABG. METHODS: We searched the PubMed, Medline, ISI Web of Knowledge, Cochrane library databases and online clinical trial database up to May 2012. We used random effects model when there was significant heterogeneity between trials and fixed effects model when heterogeneity was negligible...... CONCLUSIONS: This meta-analysis offers the more definitive evidence against the prophylactic administration of intravenous magnesium for prevention of AA after CABG when beta-blockers are routinely administered, and shows an association with more adverse events in those people who received magnesium.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3557180/pdf/1471-2261-13-5.pdf
Arritmias postoperatorias en pacientes de cirugía general
Postoperative arrhythmias in general surgical patients.
Walsh SR, Tang T, Wijewardena C, Yarham SI, Boyle JR, Gaunt ME.
Cambridge Vascular Research Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK.
Ann R Coll Surg Engl. 2007 Mar;89(2):91-5.
Abstract
INTRODUCTION: New-onset arrhythmias are a common problem in cardiothoracic surgery. They are also common following major non-cardiac surgery. This review examines the available literature to establish the incidence and significance of new-onset arrhythmias following major non-cardiothoracic surgery. MATERIALS AND METHODS: A literature search was performed using the Medline and Pubmed databases using the terms 'post-operative arrhythmia', 'peri-operative arrhythmia', 'atrial fibrillation/flutter', 'supraventricular arrhythmia/tachycardia', 'cardiac complications' and 'non-cardiothoracic surgery'. Articles were cross-referenced for additional relevant publications and reviewed for data regarding new-onset arrhythmias following major non-cardiothoracic surgery. RESULTS: There was considerable heterogeneity in the literature regarding cardiac monitoring, types of arrhythmias considered and potential associations investigated, thus hindering interpretation. The available data suggest that new-onset arrhythmias affect about 7% of patients following major non-cardiothoracic surgery. These arrhythmias are often associated with other underlying complications.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1964549/pdf/rcse8902-091.pdf
Atentamente
Dr. Juan Carlos Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Management of postoperative atrial fibrillation.
Omae T, Kanmura Y.
Department of Anesthesiology, Fujimoto Hayasuzu Hospital, Miyakonojo, Miyazaki, Japan. omae@za2.so-net.ne.jp
J Anesth. 2012 Jun;26(3):429-37. doi: 10.1007/s00540-012-1330-9. Epub 2012 Jan 25.
Abstract
The impact of postoperative atrial fibrillation (PAF) on patient outcomes has prompted intense investigation into the optimal methods for prevention and treatment of this complication. In the prevention of PAF, β-blockers and amiodarone are particularly effective and are recommended by guidelines. However, their use requires caution due to the possibility of drug-related adverse effects. Aside from these risks, perioperative prophylactic treatment with statins seems to be effective for preventing PAF and is associated with a low incidence of adverse effects. PAF can be treated by rhythm control, heart-rate control, and antithrombotic therapy. For the purpose of heart rate control, β-blockers, calcium-channel antagonists, and amiodarone are used. In patients with unstable hemodynamics, cardioversion may be performed for rhythm control. Antithrombotic therapy is used in addition to heart-rate maintenance therapy in cases of PAF >48-h duration or in cases with a history of cerebrovascular thromboembolism. Anticoagulation is the first choice for antithrombotic therapy, and anticoagulation management should focus on maintaining international normalized ratio (INRs) in the 2.0-3.0 range in patients <75 years of age, whereas prothrombin-time INR should be controlled to the 1.6-2.6 range in patients ≥75 years of age. In the future, dabigatran could be used for perioperative management of PAF, because it does not require regular monitoring and has a quick onset of action with short serum half-life. Preventing PAF is an important goal and requires specific perioperative management as well as other approaches. PAF is also associated with lifestyle-related diseases, which emphasizes the ongoing need for appropriate lifestyle management in individual patients
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3375013/pdf/540_2012_Article_1330.pdf
Fibrilación auricular postoperatoria en pacientes sometidos a bypass coronario o cirugía valvular: uso intraoperatorio de landiolol
Postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting or cardiac valve surgery: intraoperative use of landiolol.
Nakanishi K, Takeda S, Kim C, Kohda S, Sakamoto A.
Department of Anesthesiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. n-kazu@nms.ac.jp
J Cardiothorac Surg. 2013 Jan 24;8:19. doi: 10.1186/1749-8090-8-19.
Abstract
BACKGROUND: Landiolol hydrochloride is a new β-adrenergic blocker with a pharmacological profile that suggests it can be administered safely to patients who have sinus tachycardia or tachyarrhythmia and who require heart rate reduction. This study aimed to investigate whether intraoperative administration of landiolol could reduce the incidence of atrial fibrillation (AF) after cardiac surgery. METHODS: Of the 200 consecutive patients whose records could be retrieved between October 2006 and September 2007, we retrospectively reviewed a total of 105 patients who met the inclusion criteria: no previous permanent/persistent AF, no permanent pacemaker, no renal insufficiency requiring dialysis, and no reactive airway disease, etc. Landiolol infusion was started after surgery had commenced, at an infusion rate of 1 μg/kg/min, titrated upward in 3-5 μg/kg/min increments. The patients were divided into 2 groups: those who received intraoperative β-blocker therapy with landiolol (landiolol group) and those who did not receive any β-blockers during surgery (control group). An unpaired t test and Fisher's exact test were used to compare between-group differences in mean values and categorical data, respectively. RESULTS: Seventeen of the 105 patients (16.2%) developed postoperative atrial fibrillation: 5/57 (8.8%) in the landiolol group and 12/48 (25%) in the control group. There was a significant difference between the two groups (P=0.03). The incidence of AF after valve surgery and off-pump coronary artery bypass grafting was lower in the landiolol group, although the difference between the groups was not statistically significant. CONCLUSIONS: Our retrospective review demonstrated a marked reduction of postoperative AF in those who received landiolol intraoperatively. A prospective study of intraoperative landiolol for preventing postoperative atrial fibrillation is warranted.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3564867/pdf/1749-8090-8-19.pdf
Meta-análisis de estudios controlados randomizados sobre la adición de magnesio al betabloqueadores para prevenir arritmias auriculares después de bypass coronario
Meta-analysis of randomized controlled trials on magnesium in addition to beta-blocker for prevention of postoperative atrial arrhythmias after coronary artery bypass grafting.
Wu X, Wang C, Zhu J, Zhang C, Zhang Y, Gao Y.
Department of Cardiovascular Medicine, the Second Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China.
BMC Cardiovasc Disord. 2013 Jan 23;13:5. doi: 10.1186/1471-2261-13-5.
Abstract
BACKGROUND: Atrial arrhythmia (AA) is the most common complication after coronary artery bypass grafting (CABG). Only beta-blockers and amiodarone have been convincingly shown to decrease its incidence. The effectiveness of magnesium on this complication is still controversial. This meta-analysis was performed to evaluate the effect of magnesium as a sole or adjuvant agent in addition to beta-blocker on suppressing postoperativeAA after CABG. METHODS: We searched the PubMed, Medline, ISI Web of Knowledge, Cochrane library databases and online clinical trial database up to May 2012. We used random effects model when there was significant heterogeneity between trials and fixed effects model when heterogeneity was negligible...... CONCLUSIONS: This meta-analysis offers the more definitive evidence against the prophylactic administration of intravenous magnesium for prevention of AA after CABG when beta-blockers are routinely administered, and shows an association with more adverse events in those people who received magnesium.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3557180/pdf/1471-2261-13-5.pdf
Arritmias postoperatorias en pacientes de cirugía general
Postoperative arrhythmias in general surgical patients.
Walsh SR, Tang T, Wijewardena C, Yarham SI, Boyle JR, Gaunt ME.
Cambridge Vascular Research Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK.
Ann R Coll Surg Engl. 2007 Mar;89(2):91-5.
Abstract
INTRODUCTION: New-onset arrhythmias are a common problem in cardiothoracic surgery. They are also common following major non-cardiac surgery. This review examines the available literature to establish the incidence and significance of new-onset arrhythmias following major non-cardiothoracic surgery. MATERIALS AND METHODS: A literature search was performed using the Medline and Pubmed databases using the terms 'post-operative arrhythmia', 'peri-operative arrhythmia', 'atrial fibrillation/flutter', 'supraventricular arrhythmia/tachycardia', 'cardiac complications' and 'non-cardiothoracic surgery'. Articles were cross-referenced for additional relevant publications and reviewed for data regarding new-onset arrhythmias following major non-cardiothoracic surgery. RESULTS: There was considerable heterogeneity in the literature regarding cardiac monitoring, types of arrhythmias considered and potential associations investigated, thus hindering interpretation. The available data suggest that new-onset arrhythmias affect about 7% of patients following major non-cardiothoracic surgery. These arrhythmias are often associated with other underlying complications.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1964549/pdf/rcse8902-091.pdf
Atentamente
Dr. Juan Carlos Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
domingo, 15 de septiembre de 2013
La función oculta de la 'hormona del amor'
http://www.madrimasd.org/informacionidi/noticias/noticia.asp?id=57933&origen=notiweb&dia_suplemento=viernes
La función oculta de la 'hormona del amor'
La oxitocina, conocida como la 'hormona del amor, tiene más repercusiones en nuestras interacciones sociales de lo que se creía. Según un equipo de investigadores de la Universidad de Stanford (EE.UU.) la 'hormona del amor' juega un papel relevante en la formación y mantenimiento de los lazos que se crean entre una madre y un hijo, así como en los apegos sexuales. Lo que hasta ahora no estaba claro era qué rol tenía en otros aspectos de la socialización.
FUENTE | ABC Periódico Electrónico S.A. 13/09/2013
En un estudio publicado en la revista Nature, los expertos sugieren que el papel de la oxitocina en las relaciones personales pudo haber evolucionado hacia áreas relacionadas con la afinidad grupal. Los resultados de la investigación abren las puertas a posibles nuevos tratamientos para el autismo y otros trastornos neuropsiquiátricos como la esquizofrenia.
La oxitocina es el centro de un intenso estudio por su aparente papel en el establecimiento de las relaciones personales; de hecho, ya se ha administrado a niños con trastornos del espectro autista en ensayos clínicos con resultados dispares. Así, otro trabajo también publicado en Nature mostraba que la oxitocina podría jugar un papel relevante en la aparición del autismo al ser la encargada de reducir el ruido de fondo cuando se tiene una conversación con otra persona, por lo que "aumenta la intensidad de las señales deseadas". En este sentido, el estudio, explicaba que esta hormona "tiene un efecto notable sobre el paso de la información a través del cerebro", y que en las personas con autismo, se da la circunstancia contraria, ya que "se distraen fácilmente por las características extrañas de su entorno".
RECOMPENSA
Lo que este nuevo estudio explica es la forma única en la que la oxitocina altera la actividad en una parte del cerebro que es crucial para experimentar las sensaciones agradables que los neurocientíficos llaman 'recompensa'. Los resultados no sólo corroboran la validez de los ensayos con oxitocina en personas autistas, sino que también sugieren posibles nuevos tratamientos para enfermedades neuropsiquiátricas en las que la actividad social se ve deteriorada.
"Las personas con trastornos del espectro autista pueden no experimentar la recompensa normal que tenemos el resto de las personas al reunirnos con nuestros amigos", explica Robert Malenka, autor principal del estudio. "Para ellos, las interacciones sociales pueden ser muy dolorosas. Así que nos preguntamos, ¿qué hace que nuestro cerebro disfrute de pasar un rato con los amigos?".
Algunas evidencias genéticas sugieren que la incomodidad ante la interacción social, una característica de los trastornos del espectro autista, puede estar, al menos en parte, relacionada con la oxitocina.
Malenka lleva dos décadas estudiando el sistema de recompensa -una red de regiones cerebrales interconectadas responsables de nuestra sensación de placer en respuesta a una variedad de actividades, como la búsqueda o comer comida cuando tenemos hambre, dormir cuando estamos cansados, tener relaciones sexuales o la adquisición de un compañero, o bien, en un giro patológico, el consumo de drogas adictivas. El sistema de recompensas ha evolucionado para reforzar los comportamientos que promueven nuestra supervivencia, dijo.
COMBINADA CON ANTIDEPRESIVOS
En investigaciones con roedores, conocidos por ser monógamos, se había especulado que la oxitocina podía estar involucrada en este tipo de fenómeno. Pero esta hipótesis era confusa en otros mamíferos, sobre todo en el que más se usa para la investigación científica: el ratón. "En realidad no se sabía lo que intercedía para tener una recompensa social y ni siquiera era seguro que la oxitocina jugara un papel, debido a que los ratones no se casan. Los ratones no buscan una pareja y se quedan con ella de por vida, son promiscuos", explicó a BBC Malenka. "Lo que sugiere este estudio es que quizás la oxitocina, en combinación con pequeñas dosis de antidepresivos, puede funcionar bien. Esto podría ser un tratamiento rápido para problemas sociales que tienen personas con autismo o esquizofrenia".
Así que Malenka, junto con Gül Dolen, líder del estudio, y otros colegas de Stanford, se lanzaron a la tarea de desentrañar las complicaciones neuropsicológicas que respaldan el papel de la hormona del amor en las interacciones sociales. Para ellos se centraron en los acontecimientos biomecánicos que tienen lugar en una región del cerebro llamada núcleo accumbens, crucial para los sistemas de recompensa.
"Está claro que a los ratones les gusta pasar el rato con los demás, como nosotros, presumiblemente por una cuestión de supervivencia, para protegerse de depredadores o conseguir alimento con mayor facilidad. Pero también juegan, les gusta jugar -señala Malenka-. Así que la pregunta es por qué les gusta pasar un rato con los demás y por qué es gratificante". Así que hicieron un experimento de comportamiento en el que preguntaron -en sentido figurado- a los ratones si querían estar con sus amigos o solos. "Y su comportamiento nos dijo que sí querían estar con los amigos".
Los expertos descubrieron que los ratones sí tienen receptores de oxitocina en un lugar clave del núcleo accumbens y que el bloqueo de esta hormona disminuye significativamente el apetito de socialización de estos animales. "Esta era nuestra predicción: la oxitocina en el núcleo accumbens era requerida para la satisfacción social", explica Malenka.
SEROTONINA
La gran sorpresa era que no actuaba sola. "La oxitocina causa la liberación de otro químico del cerebro muy importante llamado serotonina". Esto quiere decir que, de acuerdo con el experto, es la acción combinada de la oxitocina y la serotonina lo que se necesita para la recompensa social.
La aparición de la serotonina en la ecuación fue lo que más sorprendió a los investigadores, pues este químico no sólo está implicado en los comportamientos relacionados a la recompensa sino también en aspectos como la regulación del ánimo. De hecho, los antidepresivos más populares, pertenecen a una clase de fármacos conocidos como inhibidores selectivos de la recaptación de serotonina, que aumentan las cantidades disponibles de serotonina en varias regiones del cerebro, incluyendo el núcleo accumbens.
Los hallazgos de este estudio no sólo ofrecen validez a las pruebas que ya se están haciendo con oxitocina en pacientes autistas, sino que también sugiere posibles nuevos tratamientos para este tipo de trastornos neuropsiquiátricos en que se deteriora la actividad social. "Lo que sugiere este estudio es que quizás la oxitocina, en combinación con pequeñas dosis de antidepresivos, puede funcionar bien. Esto podría ser un tratamiento rápido para problemas sociales que tienen personas con autismo o esquizofrenia".
La función oculta de la 'hormona del amor'
La oxitocina, conocida como la 'hormona del amor, tiene más repercusiones en nuestras interacciones sociales de lo que se creía. Según un equipo de investigadores de la Universidad de Stanford (EE.UU.) la 'hormona del amor' juega un papel relevante en la formación y mantenimiento de los lazos que se crean entre una madre y un hijo, así como en los apegos sexuales. Lo que hasta ahora no estaba claro era qué rol tenía en otros aspectos de la socialización.
FUENTE | ABC Periódico Electrónico S.A. 13/09/2013
En un estudio publicado en la revista Nature, los expertos sugieren que el papel de la oxitocina en las relaciones personales pudo haber evolucionado hacia áreas relacionadas con la afinidad grupal. Los resultados de la investigación abren las puertas a posibles nuevos tratamientos para el autismo y otros trastornos neuropsiquiátricos como la esquizofrenia.
La oxitocina es el centro de un intenso estudio por su aparente papel en el establecimiento de las relaciones personales; de hecho, ya se ha administrado a niños con trastornos del espectro autista en ensayos clínicos con resultados dispares. Así, otro trabajo también publicado en Nature mostraba que la oxitocina podría jugar un papel relevante en la aparición del autismo al ser la encargada de reducir el ruido de fondo cuando se tiene una conversación con otra persona, por lo que "aumenta la intensidad de las señales deseadas". En este sentido, el estudio, explicaba que esta hormona "tiene un efecto notable sobre el paso de la información a través del cerebro", y que en las personas con autismo, se da la circunstancia contraria, ya que "se distraen fácilmente por las características extrañas de su entorno".
RECOMPENSA
Lo que este nuevo estudio explica es la forma única en la que la oxitocina altera la actividad en una parte del cerebro que es crucial para experimentar las sensaciones agradables que los neurocientíficos llaman 'recompensa'. Los resultados no sólo corroboran la validez de los ensayos con oxitocina en personas autistas, sino que también sugieren posibles nuevos tratamientos para enfermedades neuropsiquiátricas en las que la actividad social se ve deteriorada.
"Las personas con trastornos del espectro autista pueden no experimentar la recompensa normal que tenemos el resto de las personas al reunirnos con nuestros amigos", explica Robert Malenka, autor principal del estudio. "Para ellos, las interacciones sociales pueden ser muy dolorosas. Así que nos preguntamos, ¿qué hace que nuestro cerebro disfrute de pasar un rato con los amigos?".
Algunas evidencias genéticas sugieren que la incomodidad ante la interacción social, una característica de los trastornos del espectro autista, puede estar, al menos en parte, relacionada con la oxitocina.
Malenka lleva dos décadas estudiando el sistema de recompensa -una red de regiones cerebrales interconectadas responsables de nuestra sensación de placer en respuesta a una variedad de actividades, como la búsqueda o comer comida cuando tenemos hambre, dormir cuando estamos cansados, tener relaciones sexuales o la adquisición de un compañero, o bien, en un giro patológico, el consumo de drogas adictivas. El sistema de recompensas ha evolucionado para reforzar los comportamientos que promueven nuestra supervivencia, dijo.
COMBINADA CON ANTIDEPRESIVOS
En investigaciones con roedores, conocidos por ser monógamos, se había especulado que la oxitocina podía estar involucrada en este tipo de fenómeno. Pero esta hipótesis era confusa en otros mamíferos, sobre todo en el que más se usa para la investigación científica: el ratón. "En realidad no se sabía lo que intercedía para tener una recompensa social y ni siquiera era seguro que la oxitocina jugara un papel, debido a que los ratones no se casan. Los ratones no buscan una pareja y se quedan con ella de por vida, son promiscuos", explicó a BBC Malenka. "Lo que sugiere este estudio es que quizás la oxitocina, en combinación con pequeñas dosis de antidepresivos, puede funcionar bien. Esto podría ser un tratamiento rápido para problemas sociales que tienen personas con autismo o esquizofrenia".
Así que Malenka, junto con Gül Dolen, líder del estudio, y otros colegas de Stanford, se lanzaron a la tarea de desentrañar las complicaciones neuropsicológicas que respaldan el papel de la hormona del amor en las interacciones sociales. Para ellos se centraron en los acontecimientos biomecánicos que tienen lugar en una región del cerebro llamada núcleo accumbens, crucial para los sistemas de recompensa.
"Está claro que a los ratones les gusta pasar el rato con los demás, como nosotros, presumiblemente por una cuestión de supervivencia, para protegerse de depredadores o conseguir alimento con mayor facilidad. Pero también juegan, les gusta jugar -señala Malenka-. Así que la pregunta es por qué les gusta pasar un rato con los demás y por qué es gratificante". Así que hicieron un experimento de comportamiento en el que preguntaron -en sentido figurado- a los ratones si querían estar con sus amigos o solos. "Y su comportamiento nos dijo que sí querían estar con los amigos".
Los expertos descubrieron que los ratones sí tienen receptores de oxitocina en un lugar clave del núcleo accumbens y que el bloqueo de esta hormona disminuye significativamente el apetito de socialización de estos animales. "Esta era nuestra predicción: la oxitocina en el núcleo accumbens era requerida para la satisfacción social", explica Malenka.
SEROTONINA
La gran sorpresa era que no actuaba sola. "La oxitocina causa la liberación de otro químico del cerebro muy importante llamado serotonina". Esto quiere decir que, de acuerdo con el experto, es la acción combinada de la oxitocina y la serotonina lo que se necesita para la recompensa social.
La aparición de la serotonina en la ecuación fue lo que más sorprendió a los investigadores, pues este químico no sólo está implicado en los comportamientos relacionados a la recompensa sino también en aspectos como la regulación del ánimo. De hecho, los antidepresivos más populares, pertenecen a una clase de fármacos conocidos como inhibidores selectivos de la recaptación de serotonina, que aumentan las cantidades disponibles de serotonina en varias regiones del cerebro, incluyendo el núcleo accumbens.
Los hallazgos de este estudio no sólo ofrecen validez a las pruebas que ya se están haciendo con oxitocina en pacientes autistas, sino que también sugiere posibles nuevos tratamientos para este tipo de trastornos neuropsiquiátricos en que se deteriora la actividad social. "Lo que sugiere este estudio es que quizás la oxitocina, en combinación con pequeñas dosis de antidepresivos, puede funcionar bien. Esto podría ser un tratamiento rápido para problemas sociales que tienen personas con autismo o esquizofrenia".
Eficacia analgésica de infusión continua de magnesio: revisión sistemática y meta-análisis
Eficacia analgésica de infusión continua de magnesio: revisión sistemática y meta-análisis
Analgesic efficacy of continuous intravenous magnesium infusion as an adjuvant to morphine for postoperativeanalgesia: a systematic review and meta-analysis.
Murphy JD, Paskaradevan J, Eisler LL, Ouanes JP, Tomas VA, Freck EA, Wu CL.
Department of Anesthesiology and Critical Care Medicine, the Johns Hopkins University and School of Medicine, Baltimore, Maryland 21287, USA.
Middle East J Anesthesiol. 2013 Feb;22(1):11-20.
Abstract
BACKGROUND: The efficacy of perioperative intravenous magnesium administration on postoperative opioid use, opioid-related side effects (e.g., nausea and vomiting) and pain are uncertain, as randomized controlled trials on this topic have reported disparate results. The objective of this systematic review is to determine if perioperative magnesium reduces opioid use, opioid-related side effects, and postoperative pain. METHODS:An electronic search was conducted using the Library of Medicine's PubMed and EMBASE databases. Included studies consisted of randomized controlled trials in an adult population with a clearly defined comparison of perioperative intravenous magnesium administration to a control with a documented assessment of opioid usage and postoperative pain. Relevant data was abstracted from included studies. Pooled estimates for weighted mean difference (WMD) with 95% confidence intervals (CI) were obtained for our primary outcome (opioid usage) using the Cochrane Collaboration's RevMan version 4.2.7 (Cochrane Collaboration; Oxford, United Kingdom). WMD and odds ratios (OR) were calculated using a random effects model. RESULTS: The literature search ultimately yielded 22 trials, enrolling 1177 (599 magnesium, 578 control) patients, who were included in the analysis. A significant decrease in morphine usage by those patients who received magnesium was noted (WMD = -7.40; 95% CI: -9.40 to -5.41, p < 0.00001). Perioperative magnesium administration was not associated with a difference in postoperative nausea or vomiting (RR = 0.76; 95% CI: 0.52 to 1.09, p = 0.14). The pooled visual analog scores for pain at 4-6 hours after surgery were significantly less in those patients who received magnesium surgery (WMD = -0.67; 95% CI: -1.12 to -0.23, p = 0.003); however, there was no difference in pain scores at 20-24 hours after surgery (WMD = -0.25; 95% CI: -0.62 to 0.71, p = 0.17). CONLUSION: Based on the results of this systematic review, perioperative intravenous magnesium may be a usefuladjuvant for the management of postoperative pain providing analgesia through a different mechanism of action than that of opioids and would make a potential addition to a multimodal anlgesic treatment plan; however, the decrease in opioid use with perioperative magnesium infusion does not appear to be associated with a decresea in opioid-related side effects.
http://www.meja.aub.edu.lb/downloads/22_1/11.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Analgesic efficacy of continuous intravenous magnesium infusion as an adjuvant to morphine for postoperativeanalgesia: a systematic review and meta-analysis.
Murphy JD, Paskaradevan J, Eisler LL, Ouanes JP, Tomas VA, Freck EA, Wu CL.
Department of Anesthesiology and Critical Care Medicine, the Johns Hopkins University and School of Medicine, Baltimore, Maryland 21287, USA.
Middle East J Anesthesiol. 2013 Feb;22(1):11-20.
Abstract
BACKGROUND: The efficacy of perioperative intravenous magnesium administration on postoperative opioid use, opioid-related side effects (e.g., nausea and vomiting) and pain are uncertain, as randomized controlled trials on this topic have reported disparate results. The objective of this systematic review is to determine if perioperative magnesium reduces opioid use, opioid-related side effects, and postoperative pain. METHODS:An electronic search was conducted using the Library of Medicine's PubMed and EMBASE databases. Included studies consisted of randomized controlled trials in an adult population with a clearly defined comparison of perioperative intravenous magnesium administration to a control with a documented assessment of opioid usage and postoperative pain. Relevant data was abstracted from included studies. Pooled estimates for weighted mean difference (WMD) with 95% confidence intervals (CI) were obtained for our primary outcome (opioid usage) using the Cochrane Collaboration's RevMan version 4.2.7 (Cochrane Collaboration; Oxford, United Kingdom). WMD and odds ratios (OR) were calculated using a random effects model. RESULTS: The literature search ultimately yielded 22 trials, enrolling 1177 (599 magnesium, 578 control) patients, who were included in the analysis. A significant decrease in morphine usage by those patients who received magnesium was noted (WMD = -7.40; 95% CI: -9.40 to -5.41, p < 0.00001). Perioperative magnesium administration was not associated with a difference in postoperative nausea or vomiting (RR = 0.76; 95% CI: 0.52 to 1.09, p = 0.14). The pooled visual analog scores for pain at 4-6 hours after surgery were significantly less in those patients who received magnesium surgery (WMD = -0.67; 95% CI: -1.12 to -0.23, p = 0.003); however, there was no difference in pain scores at 20-24 hours after surgery (WMD = -0.25; 95% CI: -0.62 to 0.71, p = 0.17). CONLUSION: Based on the results of this systematic review, perioperative intravenous magnesium may be a usefuladjuvant for the management of postoperative pain providing analgesia through a different mechanism of action than that of opioids and would make a potential addition to a multimodal anlgesic treatment plan; however, the decrease in opioid use with perioperative magnesium infusion does not appear to be associated with a decresea in opioid-related side effects.
http://www.meja.aub.edu.lb/downloads/22_1/11.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
sábado, 14 de septiembre de 2013
Incendios en cirugía/Surgical fires
Fuego quirúrgico. Un reto intraoperatorio
Surgical fires: An ongoing intra-operative challenge.
Abdulrasheed I, Lawal AM, Eneye AM.
Arch Int Surg [serial online] 2013 [cited 2013 Aug 28];3:1-5.
Abstract
Background: A surgical fire is a rare but life-threatening event. They are always unexpected and commonly occur in head and neck surgeries resulting in severe burns, disfigurement, and in some cases death. Injuries are not limited to patients alone as they may also involve health-care personnel in the operating theater. There is a resurgence in the awareness of this intra-operative challenge as well as an understanding of the need for a team approach to prevention. Materials and Methods: The surgical fire triangle is a useful paradigm that describes the three elements necessary for initiation of a surgical fire i.e., ignition source, fuel, and an oxidizer. This review will identify operating theatre contents capable of acting as ignition/oxidizer/fuel sources and highlight the management and prevention of surgical fires. Results: Surgical fires can be prevented by education across all professional boundaries in the operating theater. This will entail information on how the elements of the fire triangle interact, recognizing how standard operating room equipment can initiate a fire, and vigilance for the circumstances that increase the likelihood of a surgical fire. Conclusion: Promoting a culture of fire safety in the theater is not optional. Education on the prevention of surgical fires should be included in the curriculum of undergraduate medical students. There is an urgent need to stimulate debate within National burn associations in this context, leading to the formation of proposals to be incorporated into existing National burn prevention plans.
Keywords: Fire triangle, fuel, ignition, oxidizer, prevention, surgical fire
http://www.archintsurg.org/text.asp?2013/3/1/1/117117
Fuegos quirúrgicos. La comunicación perioperatoria es esencial para prevenir esta complicación pero devastadora
Surgical fires: perioperative communication is essential to prevent this rare but devastating complication.
Bruley ME.
Accident and Forensic Investigation, ECRI, 5200 Butler Pike, Plymouth Meeting, PA 19462, USA. mbruley@ecri.org
Qual Saf Health Care. 2004 Dec;13(6):467-71.
Abstract
A fire on or within a surgical patient is a continuing risk in modern surgery. Unfortunately, the sensitivity of surgical and anaesthesia staff to this hazard has waned over the past 25 years with cessation of the use of flammable anaesthetic agents. Prevention of surgical fires requires understanding the risks and effective communication between surgical, anaesthesia, and operating nursing staffs. Preventive measures exist but have yet to diffuse sufficiently across professional boundaries. Based on a review of relevant databases, decades of experience from field investigations, and a review of the medical literature, this paper discusses the incidence of surgical fires, the responsibility for prevention in the perioperative setting, and the procedures for surgical fire prevention and extinguishment.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1743921/pdf/v013p00467.pdf
Pensando en tres de: Cambios en las prácticas de seguridad del paciente quirúrgico en el complejo quirófano moderno.
Thinking in three's: changing surgical patient safety practices in the complex modern operating room.
Gibbs VC.
Department of Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA. verna.gibbs@va.gov
World J Gastroenterol. 2012 Dec 14;18(46):6712-9. doi: 10.3748/wjg.v18.i46.6712.
Abstract
The three surgical patient safety events, wrong site surgery, retained surgical items (RSI) and surgical fires are rare occurrences and thus their effects on the complex modern operating room (OR) are difficult to study. The likelihood of occurrence and the magnitude of risk for each of these surgicalsafety events are undefined. Many providers may never have a personal experience with one of these events and training and education on these topics are sparse. These circumstances lead to faulty thinking that a provider won't ever have an event or if one does occur the provider will intuitively know what to do. Surgeons are not preoccupied with failure and tend to usually consider good outcomes, which leads them to ignore or diminish the importance of implementing and following simple safety practices. These circumstances contribute to the persistent low level occurrence of these three events and to the difficulty in generating sufficient interest to resource solutions. Individual facilities rarely have the time or talent to understand these events and develop lasting solutions. More often than not, even the most well meaning internal review results in a new line to a policy and some rigorous enforcement mandate. This approach routinely fails and is another reason why these problems are so persistent. Vigilance actions alone have been unsuccessful so hospitals now have to take a systematic approach to implementing safer processes and providing the resources for surgeons and other stakeholders to optimize the OR environment. This article discusses standardized processes of care for mitigation of injury or outright prevention of wrong site surgery, RSI and surgical fires in an action-oriented framework illustrating the strategic elements important in each event and focusing on the responsibilities for each of the three major OR agents-anesthesiologists, surgeons and nurses. A Surgical Patient Safety Checklist is discussed that incorporates the necessary elements to bring these team members together and influence the emergence of a safer OR.
KEYWORDS:
Complex adaptive systems, Retained foreign bodies, Retained foreign objects, Retained surgical items, Safety checklist, Surgical fires, Surgical patient safety, Wrong site surgery
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520159/pdf/WJG-18-6712.pdf
Soluciones quirúrgicas a base de alcohol y el riesgo de incendio en la sala de operaciones. Informe de un caso
Alcohol based surgical prep solution and the risk of fire in the operating room: a case report.
Batra S, Gupta R.
Department of Orthopaedic Surgery, Central Institute of Orthopaedics, Vardhaman Mahavir Medical College & Safdarjung Hospital, New Delhi - 110029, India. sumitbatra104@rediffmail.com.
Patient Saf Surg. 2008 Apr 26;2:10. doi: 10.1186/1754-9493-2-10.
Abstract
A few cases of fire in the operating room are reported in the literature. The factors that may initiate these fires are many and include alcohol based surgical prep solutions, electrosurgical equipment, flammable drapes etc. We are reporting a case of fire in the operating room while operating on a patient with burst fracture C6 vertebra with quadriplegia. The cause of the fire was due to incomplete drying of the covering drapes with an alcohol based surgical prep solution. This paper discusses potential preventive measures to minimize the incidence of fire in the operating room.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2377238/pdf/1754-9493-2-10.pdf
Atentamente
Dr. Juan Carlos Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Surgical fires: An ongoing intra-operative challenge.
Abdulrasheed I, Lawal AM, Eneye AM.
Arch Int Surg [serial online] 2013 [cited 2013 Aug 28];3:1-5.
Abstract
Background: A surgical fire is a rare but life-threatening event. They are always unexpected and commonly occur in head and neck surgeries resulting in severe burns, disfigurement, and in some cases death. Injuries are not limited to patients alone as they may also involve health-care personnel in the operating theater. There is a resurgence in the awareness of this intra-operative challenge as well as an understanding of the need for a team approach to prevention. Materials and Methods: The surgical fire triangle is a useful paradigm that describes the three elements necessary for initiation of a surgical fire i.e., ignition source, fuel, and an oxidizer. This review will identify operating theatre contents capable of acting as ignition/oxidizer/fuel sources and highlight the management and prevention of surgical fires. Results: Surgical fires can be prevented by education across all professional boundaries in the operating theater. This will entail information on how the elements of the fire triangle interact, recognizing how standard operating room equipment can initiate a fire, and vigilance for the circumstances that increase the likelihood of a surgical fire. Conclusion: Promoting a culture of fire safety in the theater is not optional. Education on the prevention of surgical fires should be included in the curriculum of undergraduate medical students. There is an urgent need to stimulate debate within National burn associations in this context, leading to the formation of proposals to be incorporated into existing National burn prevention plans.
Keywords: Fire triangle, fuel, ignition, oxidizer, prevention, surgical fire
http://www.archintsurg.org/text.asp?2013/3/1/1/117117
Fuegos quirúrgicos. La comunicación perioperatoria es esencial para prevenir esta complicación pero devastadora
Surgical fires: perioperative communication is essential to prevent this rare but devastating complication.
Bruley ME.
Accident and Forensic Investigation, ECRI, 5200 Butler Pike, Plymouth Meeting, PA 19462, USA. mbruley@ecri.org
Qual Saf Health Care. 2004 Dec;13(6):467-71.
Abstract
A fire on or within a surgical patient is a continuing risk in modern surgery. Unfortunately, the sensitivity of surgical and anaesthesia staff to this hazard has waned over the past 25 years with cessation of the use of flammable anaesthetic agents. Prevention of surgical fires requires understanding the risks and effective communication between surgical, anaesthesia, and operating nursing staffs. Preventive measures exist but have yet to diffuse sufficiently across professional boundaries. Based on a review of relevant databases, decades of experience from field investigations, and a review of the medical literature, this paper discusses the incidence of surgical fires, the responsibility for prevention in the perioperative setting, and the procedures for surgical fire prevention and extinguishment.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1743921/pdf/v013p00467.pdf
Pensando en tres de: Cambios en las prácticas de seguridad del paciente quirúrgico en el complejo quirófano moderno.
Thinking in three's: changing surgical patient safety practices in the complex modern operating room.
Gibbs VC.
Department of Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA. verna.gibbs@va.gov
World J Gastroenterol. 2012 Dec 14;18(46):6712-9. doi: 10.3748/wjg.v18.i46.6712.
Abstract
The three surgical patient safety events, wrong site surgery, retained surgical items (RSI) and surgical fires are rare occurrences and thus their effects on the complex modern operating room (OR) are difficult to study. The likelihood of occurrence and the magnitude of risk for each of these surgicalsafety events are undefined. Many providers may never have a personal experience with one of these events and training and education on these topics are sparse. These circumstances lead to faulty thinking that a provider won't ever have an event or if one does occur the provider will intuitively know what to do. Surgeons are not preoccupied with failure and tend to usually consider good outcomes, which leads them to ignore or diminish the importance of implementing and following simple safety practices. These circumstances contribute to the persistent low level occurrence of these three events and to the difficulty in generating sufficient interest to resource solutions. Individual facilities rarely have the time or talent to understand these events and develop lasting solutions. More often than not, even the most well meaning internal review results in a new line to a policy and some rigorous enforcement mandate. This approach routinely fails and is another reason why these problems are so persistent. Vigilance actions alone have been unsuccessful so hospitals now have to take a systematic approach to implementing safer processes and providing the resources for surgeons and other stakeholders to optimize the OR environment. This article discusses standardized processes of care for mitigation of injury or outright prevention of wrong site surgery, RSI and surgical fires in an action-oriented framework illustrating the strategic elements important in each event and focusing on the responsibilities for each of the three major OR agents-anesthesiologists, surgeons and nurses. A Surgical Patient Safety Checklist is discussed that incorporates the necessary elements to bring these team members together and influence the emergence of a safer OR.
KEYWORDS:
Complex adaptive systems, Retained foreign bodies, Retained foreign objects, Retained surgical items, Safety checklist, Surgical fires, Surgical patient safety, Wrong site surgery
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520159/pdf/WJG-18-6712.pdf
Soluciones quirúrgicas a base de alcohol y el riesgo de incendio en la sala de operaciones. Informe de un caso
Alcohol based surgical prep solution and the risk of fire in the operating room: a case report.
Batra S, Gupta R.
Department of Orthopaedic Surgery, Central Institute of Orthopaedics, Vardhaman Mahavir Medical College & Safdarjung Hospital, New Delhi - 110029, India. sumitbatra104@rediffmail.com.
Patient Saf Surg. 2008 Apr 26;2:10. doi: 10.1186/1754-9493-2-10.
Abstract
A few cases of fire in the operating room are reported in the literature. The factors that may initiate these fires are many and include alcohol based surgical prep solutions, electrosurgical equipment, flammable drapes etc. We are reporting a case of fire in the operating room while operating on a patient with burst fracture C6 vertebra with quadriplegia. The cause of the fire was due to incomplete drying of the covering drapes with an alcohol based surgical prep solution. This paper discusses potential preventive measures to minimize the incidence of fire in the operating room.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2377238/pdf/1754-9493-2-10.pdf
Atentamente
Dr. Juan Carlos Flores-Carrillo
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
domingo, 8 de septiembre de 2013
Embarazo/Pregnancy
El ojo y el sistema visual durante el embarazo. ¿Que esperara? Una revisión profunda
The eye and visual system in pregnancy, what to expect? An in-depth review.
Samra KA.
Oman J Ophthalmol [serial online] 2013 [cited 2013 Aug 20];6:87-91.
Abstract
Pregnancy represents a real challenge to all body systems. Physiological changes can involve any of the body organs including the eye and visual system. The ocular effect of pregnancy involves a wide spectrum of physiologic and pathologic changes. The latter might be presenting for the first time during pregnancy such as corneal melting and corneal ectasia, or an already existing ocular pathologies that are modified by pregnancy such as diabetic retinopathy and glaucoma. In addition, pregnancy can affect vision through systemic disease that are either specific to the pregnant state itself such as the pre-eclampsia/eclampsia and Sheehan's syndrome, or systemic diseases that occur more frequently in relation to pregnancy such as Graves' disease, idiopathic intracranial hypertension, anti-phospholipid syndrome, and disseminated intravascular coagulation.
Keywords: Complications, eye, ocular effect, pregnancy
http://www.ojoonline.org/text.asp?2013/6/2/87/116626
Apendicitis aguda en el embarazo
Acute appendicitis in pregnancy
Sanda RB, Garba SE.
Arch Int Surg [serial online] 2013 [cited 2013 Aug 28];3:6-10.
Abstract
Background: Frequently, a general surgeon is called upon to consider the diagnosis of appendicitis in a girl or woman who is pregnant or has recently delivered. The burden of clinical decision-making and execution of treatment would rest on the general surgeon, with other specialists playing peripheral, but important supportive roles. This condition is relatively rare in pregnancy. A delay in operative intervention is often incurred in view of the risk of general anesthesia and operation on the fate of the pregnancy. Promptly diagnosed in a patient who sought medical assistance early in the evolution of the disease, acute appendicitis in pregnancy (AAP) should not pose an operative challenge to the contemporary surgeon or risk to the woman and her unborn child. It is the aim of this review to appraise AAP in the light of contemporary evidence based medicine and to demystify it with a view to encouraging general surgeons to boldly confront a potentially lethal disease and not to add to the patient's suffering by hiding behind unnecessary laboratory and imaging investigations. Materials and Methods: Many search engines are used such as MedLine, PubMed and Google scholar to search out discussions related to AAP. All the acquired information was processed to arrive at the conclusions drawn here in this essay. Results: AAP can be promptly diagnosed and treated with high index of suspicion. Awareness of this condition in pregnant patients must be high. The condition if diagnosed early and treated promptly can have a good outcome. Conclusion: Acute appendicitis is a relatively rare condition in pregnancy; surgeons must have a high index of suspicion as early diagnosis and treatment are important factors in a safe outcome of this condition.
Keywords: Acute abdomen, acute appendicitis, fetal outcome, early diagnosis, pregnancy
http://www.archintsurg.org/text.asp?2013/3/1/6/117120
Tratamiento psicológico de la diabetes durante el embarazo
Psychosocial management of diabetes in pregnancy.
Kalra B, Sridhar G R, Madhu K, Balhara YS, Sahay RK, Kalra S.
Indian J Endocr Metab [serial online] 2013 [cited 2013 Aug 29];17:815-8.
Abstract
This consensus based national guideline addresses the need for psychological, psychiatric and social assessment, as well as management, in antenatal women with diabetes. It builds upon the earlier Indian guidelines on psychological management of diabetes, and should be considered as an addendum to the parent guideline.
Keywords: Depression, gestational diabetes mellitus, stress
http://www.ijem.in/text.asp?2013/17/5/815/117216
Tratamiento anestésico de cesárea en una gestante diabética con miocardiopatía hipertrófica y disfunción diastólica restrictiva
C.M. Holgadoa, S. Covesba
Servicio de Anestesiología y Reanimación, Hospital Universitario de Tarragona Juan XXIII,
Rev Esp Anestesiol Reanim. 2012.
Resumen
Los cambios hemodinámicos que se producen durante el embarazo son máximos entre las 28.a y 34.a semanas. En una gestante con enfermedades asociadas o coincidentes, como cardiopatía hipertensiva y diabetes pregestacional estos cambios pueden dar lugar a una hipertensión pulmonar y edema agudo de pulmón de difícil control. Presentamos el caso de una gestante diabética tipo 1 de varios años de evolución, que presentó un cuadro de preeclampsia en un embarazo anterior y que desarrolló una miocardiopatía hipertensiva desde entonces. Había ingresado en la 30.a semana de gestación para control metabólico y de la presión arterial desarrollando una insuficiencia cardiaca congestiva tras la administración de betametasona para maduración pulmonar fetal. Se le realizó un ecocardiograma transtorácico que mostró un ventrículo izquierdo hipertrófico no dilatado con buena función sistólica, alteración diastólica restrictiva e hipertensión arterial pulmonar moderada. Cuando se consiguió mejorar su estado general se decidió realizar una cesárea con anestesia regional para evitar las complicaciones de la hipertensión arterial pulmonar y sistémica. Exponemos el tratamiento anestésico y la resolución de las complicaciones aparecidas tras la administración de oxitocina.
http://www.elsevier.es/sites/default/files/elsevier/eop/S0034-9356(12)00088-6.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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