Diabetes y embarazo / Diabetes and pregnancy

Enero 8, 2018. No. 2957

Manejo de la diabetes en el embarazo: Estándares del cuidado médico en diabetes : 2018 Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes: 2018 Diabetes Care 2018;41(Suppl. 1):S137-S143 | https://doi.org/10.2337/dc18-S013 The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC. PDF Diabetes y embarazo: Manejo de la diabetes y sus complicaciones desde la preconcepción al periodo postnatal Diabetes in Pregnancy: Management of Diabetes and Its Complications from Preconception to the Postnatal Period. Editors National Collaborating Centre for Women's and Children's Health (UK). Source London: National Institute for Health and Care Excellence (UK); 2015 Feb. National Institute for Health and Care Excellence: Clinical Guidelines . Excerpt Clinical guidelines have been defined as 'systematically developed statements which assist clinicians and patients in making decisions about appropriate treatment for specific conditions'. This clinical guideline concerns the management of diabetes and its complications from preconception to the postnatal period. It has been developed with the aim of providing guidance on: preconception information; diagnosis and management of gestational diabetes; glycaemic control in the preconception, antenatal and intrapartum periods; changes to medications for diabetes and its complications before or during pregnancy; management of diabetic emergencies (for example, hypoglycaemia and ketoacidosis) and diabetic complications (such as retinopathy) during pregnancy; the timetable of antenatal appointments to be offered to women with diabetes; timing and mode of birth (including induction of labour, caesarean section, analgesia and anaesthesia, and the use of steroids for fetal lung maturation); initial care of the newborn baby; management of diabetes and its complications during the postnatal period. PDF Diabetes mellitus y el anestesiólogo, cuidados perioperatorios Elsa Elisa Jiménez Morales, Rogelio Sánchez García Revista de Investigación Médica Sur, México Vol. 15, núm. 1, Enero-Marzo 2008 Resumen La diabetes mellitus es uno de los padecimientos con mayor prevalencia, por lo que los médicos involucrados en su manejo antes, durante y después de un acto quirúrgico, deben conocer su terapéutica. Los criterios actuales de diagnóstico para diabetes son: síntomas de diabetes (poliuria, polidipsia, y pérdida de peso inexplicable) más el resultado de una muestra aleatoria mayor o igual a 200 mg/dL de glucosa, glucosa en ayuno (> 8 horas) de 126 mg/dL o mayor. Glucosa mayor o igual a 200 mg/dL 2 horas después de la administración oral de 75 g de glucosa. Los protocolos de manejo perioperatorio de pacientes diabéticos aceptados actualmente son tres y se conocen como; régimen clásico amplio, régimen estricto tipo I y escala móvil. Palabras clave: alabras clave: Diabetes mellitus, cuidados perioperatorios, anestesiología. PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information World Congress on Regional Anesthesia & Pain Medicine April 19-21, 2018, New York City, USA Informes / Information

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

Estudio observacional longitudinal de la artroplastia total reversa de hombro para la disfunción irreparable del manguito de los rotadores: resultados después de 15 años

http://www.lesionesdeportivas.com.mx/academia/estudio-observacional-longitudinal-de-la-artroplastia-total-reversa-de-hombro-para-la-disfuncion-irreparable-del-manguito-de-los-rotadores-resultados-despues-de-15-anos/

Longitudinal observational study of reverse total shoulderarthroplasty for irreparable rotator cuff dysfunction: results after 15 years


Fuente


Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/29305102
http://www.jshoulderelbow.org/article/S1058-2746(17)30697-3/fulltext

De:
Gerber C1, Canonica S1, Catanzaro S1, Ernstbrunner L2.
J Shoulder Elbow Surg. 2018 Jan 3. pii: S1058-2746(17)30697-3. doi: 10.1016/j.jse.2017.10.037. [Epub ahead of print]


Todos los derechos reservados para:




Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.









Abstract

HYPOTHESIS:


This study investigated the hypothesis that functional outcome remains significantly improved over the preoperative state beyond 15 years of reverse total shoulder arthroplasty (RTSA) for irreparable rotator cuff dysfunction.




CONCLUSIONS:


This early series of RTSA shows a substantial complication and failure rate. If, however, complications can be treated without removal of the implants, outcome is not compromised. Overall shoulder function and subjective outcome remained significantly improved and highly satisfactory during the entire study period.


KEYWORDS:


Reverse total shoulder arthroplasty; cuff tear arthropathy; irreparable rotator cuff tear; long-term; pseudoparalysis; shoulder dysfunction








Resumen




HIPÓTESIS:


Este estudio investigó la hipótesis de que el resultado funcional sigue mejorando significativamente con respecto al estado preoperatorio más allá de los 15 años de artroplastia total reversa de hombro (RTSA) para la disfunción irreparable del manguito rotador.



CONCLUSIONES:


Esta serie temprana de RTSA muestra una complicación sustancial y una tasa de fracaso. Sin embargo, si las complicaciones se pueden tratar sin quitar los implantes, el resultado no se verá comprometido. La función general del hombro y el resultado subjetivo se mantuvieron significativamente mejorados y altamente satisfactorios durante todo el período de estudio.



PALABRAS CLAVE:


Artroplastia total reversa de hombro; artropatía por desgarro del manguito; rotura irreparable del manguito rotador; a largo plazo; pseudoparalisis; disfunción del hombro






Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
PMID: 29305102 DOI: 10.1016/j.jse.2017.10.037

Resultados de la artroplastia reversa de hombro en pacientes de estatura pequeña y grande

http://www.lesionesdeportivas.com.mx/academia/resultados-de-la-artroplastia-reversa-de-hombro-en-pacientes-de-estatura-pequena-y-grande/

Outcomes of reverse shoulder arthroplasty in small- and large-stature patients

Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/29292034

http://www.jshoulderelbow.org/article/S1058-2746(17)30757-7/fulltext

De:

Matsuki K1, King JJ2, Wright TW2, Schoch BS3.

J Shoulder Elbow Surg. 2017 Dec 29. pii: S1058-2746(17)30757-7. doi: 10.1016/j.jse.2017.11.011. [Epub ahead of print]

Todos los derechos reservados para:

Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

Abstract

BACKGROUND:

As the worldwide use of reverse shoulder arthroplasty (RSA) increases, a range of implant sizes may be required to match regional and ethnic variation in patients’ stature. Size-mismatched implants may possibly result in poorer surgical outcomes. The purpose of this study was to compare the outcomes of primary RSA in patients at the extreme ends of the growth curve with those in average-stature patients in the United States.

METHODS:

A multicenter shoulder arthroplasty database was retrospectively reviewed to identify all primary RSAs using a single implant system with a minimum 2-year follow-up. Small patients were defined as the height of <155 cm, tall as >183 cm, and average as 162-178 cm. Active range of motion (ROM), visual analog scale pain score, and patient-reported outcomes (PROs) were compared among the 3 groups.

RESULTS:

The study included 552 shoulders (130 small, 384 average, and 38 tall stature). Preoperatively, the average height group had significantly less ROM than the other groups, but there were no significant differences in postoperative ROM. This resulted in poorer improvements in postoperative ROM in the small and tall groups, with the small-stature patients having significantly less ROM improvement compared with average-stature patients. However, these differences did not result in poorer PROs between groups.

DISCUSSION:

Small- and large-stature patients showed inferior improvements in ROM after RSA compared with average-stature patients. Our results suggest that current implants optimize ROM gains for average-stature patients and improve PROs independently of patient stature at a minimum 2-year follow-up.

Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

KEYWORDS:

Reverse shoulder arthroplasty; complications; implant size; outcomes; scapular notching; stature

Resumen

ANTECEDENTES:

A medida que aumenta el uso de la artroplastia reversa de hombro (RSA) en todo el mundo, es posible que se necesite una variedad de tamaños de implantes para que coincida con la variación regional y étnica en la estatura de los pacientes. Los implantes que no coinciden con el tamaño pueden dar como resultado resultados quirúrgicos más pobres. El propósito de este estudio fue comparar los resultados de RSA primaria en pacientes en los extremos de la curva de crecimiento con aquellos en pacientes de estatura promedio en los Estados Unidos.

MÉTODOS:

Se revisó retrospectivamente una base de datos de artroplastia de hombro multicéntrica para identificar todos los RSA primarios utilizando un solo sistema de implante con un mínimo de 2 años de seguimiento. Los pacientes pequeños se definieron como la altura de <155 cm, altura> 183 cm y una media de 162-178 cm. Se comparó el rango de movimiento activo (ROM), el puntaje de dolor visual en escala analógica y los resultados informados por el paciente (PRO) entre los 3 grupos.

RESULTADOS:

El estudio incluyó 552 hombros (130 pequeños, 384 de promedio y 38 de estatura alta). Preoperatoriamente, el grupo de estatura promedio tuvo significativamente menos ROM que los otros grupos, pero no hubo diferencias significativas en el ROM postoperatorio. Esto dio como resultado mejoras más pobres en el ROM postoperatorio en los grupos pequeños y altos, con los pacientes de estatura pequeña que tenían una mejora de ROM significativamente menor en comparación con los pacientes de estatura media. Sin embargo, estas diferencias no dieron como resultado PRO más pobres entre los grupos.

DISCUSIÓN:

Los pacientes de estatura pequeña y grande mostraron una mejoría inferior en la ROM después del RSA en comparación con los pacientes de estatura media. Nuestros resultados sugieren que los implantes actuales optimizan las ganancias de ROM para pacientes de estatura media y mejoran las PRO independientemente de la estatura del paciente con un mínimo de 2 años de seguimiento.

PALABRAS CLAVE:
Artroplastia reversa de hombro ; complicaciones; tamaño del implante; resultados; muescas escapulares; estatura

Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

PMID:  29292034  DOI:  10.1016/j.jse.2017.11.011

Inestabilidad de la columna cervical, radiografía de la flexión extensión

http://www.columnavertebralpediatricaygeriatrica.com.mx/academia/inestabilidad-de-la-columna-cervical-radiografia-de-la-flexion-extension/

Cervical Spine Instability, Flexion Extension X-rays

Fuente

Este artículo y/o video es originalmente publicado en:

https://medium.com/@Dr_nabil_ebraheim/cervical-spine-instability-flexion-extension-x-rays-b3a408d23b7e

https://youtu.be/HzGyMpSzosU

De y todos los derechos reservados para:

Nabil Ebraheim

Dr. Ebraheim is the Chairman of Orthopaedics and the Director of the Orthopaedic Surgery Residency Program at the University of Toledo

nabil ebraheim

SUSCRIBIRSE 188 K

Dr. Ebraheim’s educational animated video describes flexion / extension xrays of the cervical spine.

Flexion/extension views detect subtle ligamentous injuries that are not apparent on routine neutral static views. It is done to avoid missing an unstable injury in the cervical spine. It is one of the many tactics that improve understanding of the extent and personality of the neck injury.

Comparte esto:

www.columnavertebralpediatricaygeriatrica.com.mx/academia/inestabilidad-de-la-columna-cervical-radiografia-de-la-flexion-extension/

www.columnavertebralpediatricaygeriatrica.com.mx

Sepsis

Diciembre 31, 2017. No. 2949

Hoy ha llegado a su fin 2017, un año con múltiples facetas, con cambios vitales para nuestra vida que sin duda alguna nos han impactado positivamente y al reflexionar sobre los logros obtenidos estaremos reforzando nuestras metas, modificando algunos proyectos de vida, y lo más importante; continuaremos forjando nuestra felicidad al parejo de nuestros seres queridos, nuestros conocimientos para beneficio de cada uno de nuestros pacientes y la plena satisfacción personal de ser médicos en toda la extensión de la palabra. ¡Felicidades por cada uno de esos logros personales! Today, 2017 has come to an end. A year with many facets, with vital changes to our lives, that without a doubt, have positively impacted us, and reflecting on our achievements we will be reinforcing our goals, modifying some life projects, and most importantly; We will continue to forge our happiness on the same level as our loved ones, our knowledge for the benefit of each one of our patients, and the full personal satisfaction of being a doctor in every sense of the word. Congratulations on each of those personal achievements!  Hoje chegou ao fim de 2017, um ano com muitas facetas, com mudanças vitais na nossa vida que, sem dúvida, nos impactaram positivamente e refletindo sobre as conquistas, reforçaremos nossos objetivos, modificando alguns projetos de vida e, o mais importante ; Continuaremos a forjar a nossa felicidade ao mesmo nível dos nossos amados, o nosso conhecimento em benefício de cada um dos nossos pacientes e a total satisfação pessoal de ser um médico em todos os sentidos da palavra. Parabéns por cada uma dessas conquistas pessoais! Diabetes y sepsis: riesgo, recurrencia y ruina. Diabetes and Sepsis: Risk, Recurrence, and Ruination. Frydrych LM1, Fattahi F2, He K1, Ward PA2, Delano MJ1. Author information Front Endocrinol (Lausanne). 2017 Oct 30;8:271. doi: 10.3389/fendo.2017.00271. eCollection 2017. Abstract Sepsis develops when an infection surpasses local tissue containment. A series of dysregulated physiological responses are generated, leading to organ dysfunction and a 10% mortality risk. When patients with sepsis demonstrate elevated serum lactates and require vasopressor therapy to maintain adequate blood pressure in the absence of hypovolemia, they are in septic shock with an in-hospital mortality rate >40%. Traditionally, it was thought that the complex interplay between inflammatory and anti-inflammatory responses led to sepsis-induced organ dysfunction and mortality. However, a closer examination of those who die long after sepsis subsides reveals that many initial survivors succumb to recurrent, nosocomial, and secondary infections. The comorbidly challenged, physiologically frail diabetic individuals suffer the highest infection rates. Recent reports suggest that even after clinical "recovery" from sepsis, persistent alterations in innate and adaptive immune responses exists resulting in chronic inflammation, immune suppression, and bacterial persistence. As sepsis-associated immune defects are associated with increased mortality long-term, a potential exists for immune modulatory therapy to improve patient outcomes. We propose that diabetes causes a functional immune deficiency that directly reduces immune cell function. As a result, patients display diminished bactericidal clearance, increased infectious complications, and protracted sepsis mortality. Considering the substantial expansion of the elderly and obese population, global adoption of a Western diet and lifestyle, and multidrug resistant bacterial emergence and persistence, diabetic mortality from sepsis is predicted to rise dramatically over the next two decades. A better understanding of the underlying diabetic-induced immune cell defects that persist following sepsis are crucial to identify potential therapeutic targets to bolster innate and adaptive immune function, prevent infectious complications, and provide more durable diabetic survival. KEYWORDS: complications; diabetes; infections; resource utilization; sepsis; septic shock PDF Carga de líquido inicial para pacientes sépticos: ¿Se necesita algún límite de seguridad? Early fluid loading for septic patients: Any safety limit needed? Gong YC1, Liu JT1, Ma PL2. Author information Chin J Traumatol. 2017 Nov 8. pii: S1008-1275(16)30323-6. doi: 10.1016/j.cjtee.2017.06.005. [Epub ahead of print] Abstract Early adequate fluid loading was the corner stone of hemodynamic optimization for sepsis and septic shock. Meanwhile, recent recommended protocol for fluid resuscitation was increasingly debated on hemodynamic stability vs risk of overloading. In recent publications, it was found that a priority was often given to hemodynamic stability rather than organ function alternation in the early fluid resuscitation of sepsis. However, no safety limits were used at all in most of these reports. In this article, the rationality and safety of early aggressive fluid loading for septic patients were discussed. It was concluded that early aggressive fluid loading improved hemodynamics transitorily, but was probably traded off with a follow-up organ function impairment, such as worsening oxygenation by reduction of lung aeration, in a part of septic patients at least. Thus, a safeguard is needed against unnecessary excessive fluids in early aggressive fluid loading for septic patients. KEYWORDS: Fluid loading; Hemodynamic stability; Safety; Sepsis PDF Miocardiopatía inducida por sepsis: Implicaciones oxidativas en la iniciación y resolución del daño. Sepsis-Induced Cardiomyopathy: Oxidative Implications in the Initiation and Resolution of the Damage. Tsolaki V1, Makris D1, Mantzarlis K1, Zakynthinos E1. Author information Oxid Med Cell Longev. 2017;2017:7393525. doi: 10.1155/2017/7393525. Epub 2017 Sep 19.Abstract Cardiac dysfunction may complicate the course of severe sepsis and septic shock with significant implications for patient's survival. The basic pathophysiologic mechanisms leading to septic cardiomyopathy have not been fully clarified until now. Disease-specific treatment is lacking, and care is still based on supportive modalities. Septic state causes destruction of redox balance in many cell types, cardiomyocytes included. The production of reactive oxygen and nitrogen species is increased, and natural antioxidant systems fail to counterbalance the overwhelming generation of free radicals. Reactive species interfere with many basic cell functions, mainly through destruction of protein, lipid, and nucleic acid integrity, compromising enzyme function, mitochondrial structure and performance, and intracellular signaling, all leading to cardiac contractile failure. Takotsubo cardiomyopathy may result from oxidative imbalance. This review will address the multiple aspects of cardiomyocyte bioenergetic failure in sepsis and discuss potential therapeutic interventions. PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information World Congress on Regional Anesthesia & Pain Medicine April 19-21, 2018, New York City, USA Informes / Information International Anesthesia Research Society Annuals Meetings USA Informes / Information

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