Síndrome de Brugada / Brugada syndrome

Enero 21, 2016. No. 2213

Síndrome de Brugada; Aspectos clínicos, genéticos, moleculares, celulares e iónicos Brugada Syndrome: Clinical, Genetic, Molecular, Cellular, and Ionic Aspects. Antzelevitch C, Patocskai B. Curr Probl Cardiol. 2016 Jan;41(1):7-57. doi: 10.1016/j.cpcardiol.2015.06.002. Epub 2015 Jun 11. Abstract Brugada syndrome (BrS) is an inherited cardiac arrhythmia syndrome first described as a new clinical entity in 1992. Electrocardiographically characterized by distinct coved type ST segment elevation in the right-precordial leads, the syndrome is associated with a high risk for sudden cardiac death in young adults, and less frequently in infants and children. The electrocardiographic manifestations of BrS are often concealed and may be unmasked or aggravated by sodium channel blockers, a febrile state, vagotonic agents, as well as by tricyclic and tetracyclic antidepressants. An implantable cardioverter defibrillator is the most widely accepted approach to therapy. Pharmacologic therapy is designed to produce an inward shift in the balance of currents active during the early phases of the right ventricular action potential (AP) and can be used to abort electrical storms or as an adjunct or alternative to device therapy when use of an implantable cardioverter defibrillator is not possible. Isoproterenol, cilostazol, and milrinone boost calcium channel current and drugs like quinidine, bepridil, and the Chinese herb extract Wenxin Keli inhibit the transient outward current, acting to diminish the AP notch and thus to suppress the substrate and trigger for ventricular tachycardia or fibrillation. Radiofrequency ablation of the right ventricular outflow tract epicardium of patients with BrS has recently been shown to reduce arrhythmia vulnerability and the electrocardiographic manifestation of the disease, presumably by destroying the cells with more prominent AP notch. Thisreview provides an overview of the clinical, genetic, molecular, and cellular aspects of BrS as well as the approach to therapy. PDF  Síndrome de Brugada Begoña Benito, Josep Brugada, Ramón Brugada y Pedro Brugada Rev Esp Cardiol. 2009;62(11):1297-315 PDF   Síndrome de Brugada y su relevancia en el periodo perioperatorio Brugada syndrome and its relevance in the perioperative period. Sorajja D, Ramakrishna H, Poterack AK, Shen WK, Mookadam F1. Ann Card Anaesth. 2015 Jul-Sep;18(3):403-13. doi: 10.4103/0971-9784.159812. Abstract Brugada syndrome is an autosomal dominant genetic disorder associated with an increased risk of sudden cardiac death, as well as ventricular tachyarrhythmias.The defective cardiac sodium channels result in usual electrocardiographic findings of a coved-type ST elevation in precordial leads V1 to V3. The majority of patients have uncomplicated courses with anesthesia, surgery, and invasive procedures. However there is risk of worsening ST elevation and ventricular arrhythmias due to perioperative medications, surgical insult, electrolyte abnormalities, fever, autonomic nervous system tone, as well as other perturbations. Given the increasing numbers of patients with inherited conduction disorders presenting for non-cardiac surgery that are at risk of sudden cardiac death, safe anesthetic management depends upon a detailed knowledge of these conditions. PDF

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

Interpretación hematológica de la fórmula blanca

Estimado Ciberpediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 27 Enero 2016 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Interpretación hematológica de la fórmula blanca” por el “Dr. Euler Chargoy Vivaldo”, Hematologo Pediatra, de la Cd. De Houston Tx La sesión inicia puntualmente las 21 hrs.
Para entrar a la Sala de Conferencia:
1.- hacer click en la siguiente liga, o cópiala y escríbela en tu buscador http://connectpro60196372.adobeconnect.com/formula_banca/
2.- “Entra como Invitado” Escribes tu nombre y apellido en el espacio en blanco
3.- Hacer click en el espacio que dice “Entrar en la Sala”
5.- A disfrutar la conferencia
6.- Recomendamos que dejes tu Nombre Completo, Correo electrónico y que participes.


Henrys


Dr. Enrique Mendoza López Webmaster: CONAPEME Coordinador Nacional: Seminario Ciberpeds-Conapeme Av La clinica 2520-310 Colonia Sertoma ,Mty N.L. México CP 64710 Tel-Fax 52 81 83482940 y 52 81 81146053 Celular 8183094806 www.conapeme.org www.pediatramendoza.com enrique@pediatramendoza.com emendozal@yahoo.com.mx

e-books; bibliotecarios; librerias y bibliotecas. Noticias

E-Books
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Todo eReaders (blog)

Early Bird, un pequeño complemento para los ebooks eróticos
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Penguin Books and Random House Penguin Random House cambia los precios de los ebooksque se Siempre es bueno conocer los cambios en los ...



Overdrive consigue batir el récord de ebooks prestados
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El Comercio

Librerías de Hong Kong retiran libros prohibidos en China
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Las desapariciones de libreros son el motivo por el cual librerías en Hong Kong han decidido retirar de sus estantes los libros críticos con el régimen ...
Librerías de Hong Kong retiran libros prohibidos en China - Terra.com
Las librerías de Hong Kong retiran títulos prohibidos por China tras desaparecer varios editores -La Vanguardia
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EL PAÍS

En defensa de las librerías
EL PAÍS
Las cadenas de librerías no van a poder competir con Amazon. En Estados Unidos se está demostrando que sólo las librerías independientes, ...



Comercio Córdoba y Aplico señalan "situación alarmante" en las librerías ante "el impago de los ...
Lainformacion.com
La Federación Provincial de Comercio (Comercio Córdoba) y la Asociación de Comerciantes de Librerías de Córdoba (Aplico) han señalado la ...
Educación debe hasta 13.000 euros a algunos comercios por el... - El Día de Córdoba
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SDPnoticias.com

Sensuales bibliotecarios posan desnudos ¡para defender los derechos homosexuales!
TVNotas
La meta aún está lejos, pero un grupo de bibliotecarios de Brasil decidieron lanzar un calendario muy picante, ya que posan totalmente desnudos ...




Shangay.com

Bibliotecarios brasileños posan desnudos
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Un grupo de bibliotecarios y estudiantes brasileños han posado desnudos para un calendario que busca recaudar fondos para construir una ...
Bibliotecarios de Brasil posan desnudos en un calendario que busca propagar la cultura de la ... -emeequis
FOTOS: Se desnudan bibliotecarios para calendario - Hoy Estado
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Cáscara amarga

Bibliotecarios posan desnudos en un calendario benéfico
Cáscara amarga
Con el fin de recaudar fondos para la creación de la Biblioteca de la Diversidad en Brasilia, 12bibliotecarios y estudiantes de esta disciplina posaron ...


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Faro de Vigo

Las bibliotecas agotan sus ´entradas´
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Con el fin de las clases el 22 de diciembre, los estudiantes comenzaron a abarrotar las bibliotecasy, en palabras de la responsable de la situada en ...



La bibliotecas públicas extremeñas inician el año con cuentacuentos, exposiciones y talleres para ...
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Bibliotecas de Cancún esperan recuperar su esplendor
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Las bibliotecas públicas de Benito Juárez esperan “recobrar vida” a partir del lunes próximo, informó Carlos Alfredo Sosa Ávila, director de estos ...

Dexmedetomidina espinal / Spinal dexmedetomidine

Enero 16, 2016. No. 2208

Dexmedetomidina intratecal para reducir el dolor del hombro en colecistectomías laparoscópicas bajo anestesia espinal Intrathecal dextmedetomidine to reduce shoulder tip pain in laparoscopic cholecystectomies under spinalanesthesia. Bhatia T, Bhatia J, Attri JP, Singh S, Khetarpal R. Anesth Essays Res. 2015 Sep-Dec;9(3):320-5. doi: 10.4103/0259-1162.158010. Abstract BACKGROUND: General anesthesia as a technique for laparoscopic cholecystectomies has disadvantage in terms of the stress response, lack of postoperative analgesia and emesis. Regional anesthesia offers advantages over general anesthesia in terms of cost, postoperative analgesia, intact respiratory control mechanism and early ambulation. Shoulder tip pain remains the main concerns that can be alleviated by adding various adjuvants to local anesthetics. AIMS AND OBJECTIVES: To study the effect of adding intrathecal dexmedetomidine to bupivacaine to decrease shoulder tip pain, onset and duration of sensory and motor block, hemodynamic changes and side effects if any. MATERIALS AND METHODS: Totally, 60 patients were divided into two groups of 30 each. Group A received 3 ml of bupivacaine heavy and group B received 5 µg of dexmedetomidine along with 3 ml of bupivacaine diluted to total volume of 3.5 ml in each group. STATISTICAL ANALYSIS: It was done using Chi-square and Student's t-test. RESULTS AND CONCLUSIONS: Intrathecal dexmedetomidine provides stable hemodynamics, excellent sedation and analgesia and abolishes shoulder tip pain. KEYWORDS: Bupivacaine; dexmedetomidine; laparoscopic cholecystectomy; pneumoperitoneum; spinal anesthesia PDF  Comparación de los efectos de adicionar dexmedetomidina versus midazolam a bupivacaína intratecal sobre la analgesia postoperatoria Comparison of the effects of adding dexmedetomidine versus midazolam to intrathecal bupivacaine on postoperative analgesia. Samantaray A, Hemanth N, Gunnampati K, Pasupuleti H, Mukkara M, Rao MH. Pain Physician. 2015 Jan-Feb;18(1):71-7. Abstract BACKGROUND: Dexmedetomidine and midazolam both modulate spinal analgesia by different mechanisms, and yet, no human studies are available to compare them for postoperative analgesia after neuraxial administration. OBJECTIVES: We investigated the addition of dexmedetomidine or midazolam to intrathecal bupivacaine on the duration of effective analgesia and clinical safety profile. STUDY DESIGN: Prospective, randomized, double blind, placebo controlled study. SETTING: University teaching hospital. METHODS: The study cohort included a consecutive and prospective series of patients, referred for endourological procedures. The patients were randomly allocated into 3 groups (20 patients each) to receive intrathecally 3 mL of 0.5% hyperbaric bupivacaine in combination with 5 mcg of dexmedetomidine (dexmedetomidine group), 1 mg of midazolam (midazolam group) or 0.5 mL of 0.9% saline (control group). The groups were compared to the regression time of sensory block, duration of effective analgesia (defined as the time interval between administration of intrathecal drug to the time of first analgesic request or a numeric rating scale = 4.0), sedation score, and side effects in the first 24 hours. STATISTICS: One way-ANOVA, Kruskal Wallis test, and Chi-square test (χ²), significance level: P < 0.05. RESULTS: The duration of effective analgesia (time to first analgesic request) was significantly prolonged in the dexmedetomidine group (286 ± 64 minutes, P < 0.01) when compared with midazolam group (236.9 ± 64.9 minutes) and the control group (212.7 ± 70.2 minutes). Pairwise comparisons among the 3 groups with Bonferroni adjustment revealed that patients from the dexmedetomidine group were more sedated in comparison to the midazolam and control groups at the end of the first 15 minutes after intrathecal injection [χ² (2) = 7.157, P = 0.028], with a mean rank sedation score of 35.58 for dexmedetomidine, 25.00 for midazolam, and 30.93 for control. No significant differences in the side effects were observed during the study period. Midazolam did not lengthen the time of the two segment sensory regression or the time to first request analgesia. LIMITATION: The study cannot be extrapolated to muscle cutting surgeries under spinal anaesthesia. CONCLUSIONS: The addition of dexmedetomidine (5 mcg) to 3 mL of intrathecal hyperbaric bupivacaine (0.5%) significantly prolongs the duration of effective analgesia in comparison to 1 mg midazolam or placebo (0.9% normal saline) with a comparable incidences of side effects. PDF

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

Fentanil intranasal en niños / Intranasal fentanyl in children

Enero 17, 2016. No. 2209

Manejo del dolor después de miringotomía y colocación de tubos: dexmedetomidina versus fentanil intranasal Pain management following myringotomy and tube placement: intranasal dexmedetomidine versus intranasal fentanyl. Dewhirst E, Fedel G, Raman V, Rice J, Barry N, Jatana KR, Elmaraghy C, Merz M, Tobias JD. Int J Pediatr Otorhinolaryngol. 2014 Jul;78(7):1090-4. doi: 10.1016/j.ijporl.2014.04.014. Epub 2014 Apr 16 Abstract PURPOSE: Despite the brevity of the procedure, bilateral myringotomy and tympanostomy tube placement (BMT) can result in significant postoperative pain and discomfort. As the procedure is frequently performed without intravenous access, non-parenteral routes of administration are frequently used for analgesia. The current study prospectively compares the efficacy of intranasal (IN) dexmedetomidine with IN fentanyl for children undergoing BMT. METHODS: This prospective, double-blinded, randomized clinical trial included pediatric patients undergoing BMT. The patients were randomized to receive either IN dexmedetomidine (1 μg/kg) or fentanyl (2 μg/kg) after the induction of general anesthesia with sevoflurane. All patients received rectal acetaminophen (40 mg/kg) and the first 50 patients also received premedication with oral midazolam. Postoperative pain and recovery were assessed using pediatric pain and recovery scales, and any adverse effects were monitored for. RESULTS: The study cohort included 100 patients who ranged in age from 1 to 7.7 years and in weight from 8.6 to 37.4 kg. They were divided into 4 groups with 25 patients in each group: (1) midazolam premedication+IN dexmedetomidine; (2) midazolam premedication+IN fentanyl; (3) no premedication+IN dexmedetomidine; and (4) no premedication+IN fentanyl. Pain scores were comparable when comparing groups 2, 3 and 4, but were higher in group 1 (midazolam premedication with IN dexmedetomidine). There was no difference in total time in the post-anesthesia care unit (PACU) or time from arrival in the PACU until hospital discharge between the 4 groups. The heart rate (HR) was significantly lower in group 3 when compared to the other groups at several different times after arrival to the PACU. No clinically significant difference was noted in blood pressure. CONCLUSION: Following BMT, when no premedication is administered, there was no clinical advantage when comparing IN dexmedetomidine (1 μg/kg) to IN fentanyl (2 μg/kg). The addition of oral midazolam as a premedication worsened the outcome measures particularly for children receiving IN dexmedetomidine. PDF  Fentanil intranasal para el tratamiento del dolor agudo en niños Intranasal fentanyl for the management of acute pain in children. Murphy A1, O'Sullivan R, Wakai A, Grant TS, Barrett MJ, Cronin J, McCoy SC, Hom J,Kandamany N. Cochrane Database Syst Rev. 2014 Oct 10;10:CD009942. doi: 10.1002/14651858.CD009942.pub2. PDF

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