XVII CONGRESO INTERNACIONAL DE Cirugía Mínima Invasiva y Endoscopía de Columna, 25-27/VII/2018

http://www.divimedic.com/academia/xvii-congreso-internacional-de-cirugia-minima-invasiva-y-endoscopia-de-columna-25-27-vii-2018/

Hiperglucemia / Hyperglycaemia

Mayo 3, 2018. No. 3070

Revisión de la hiperglucemia: Definiciones y fisiopatología. Review of hyperglycaemia: Definitions and pathophysiology. Working party approved by the French Society of Anaesthesia and Intensive Care Medicine (SFAR), the French Society for the study of Diabetes (SFD). Author information Anaesth Crit Care Pain Med. 2018 Mar 17. pii: S2352-5568(17)30293-X. doi: 10.1016/j.accpm.2018.02.019. [Epub ahead of print] Abstract Diabetes mellitus is defined by chronic elevation of blood glucose linked to insulin resistance and/or insulinopaenia. Its diagnosis is based on a fasting blood-glucose level of ≥1.26g/L or, in some countries, a blood glycated haemoglobin (HbA1c) level of >6.5%. Of the several forms of diabetes, type-2 diabetes (T2D) is the most common and is found in patients with other risk factors. In contrast, type-1 diabetes (T1D) is linked to the autoimmune destruction of β-pancreatic cells, leading to insulinopaenia. Insulin deficiency results in diabetic ketoacidosis within a few hours. 'Pancreatic' diabetes develops from certain pancreatic diseases and may culminate in insulinopaenia. Treatments for T2D include non-insulin based therapies and insulin when other therapies are no longer able to control glycaemic levels. For T1D, treatment depends on long (slow)-acting insulin and ultra-rapid analogues of insulin administered according to a 'basal-bolus' scheme or by continuous subcutaneous delivery of insulin using a pump. For patients presenting with previously undiagnosed dysglycaemia, investigations should determine whether the condition corresponds to pre-existing dysglycaemia or to stress hyperglycaemia. The latter is defined as transient hyperglycaemia in a previously non-diabetic patient that presents with an acute illness or undergoes an invasive procedure. Its severity depends on the type of surgery, the aggressiveness of the procedure and its duration. Stress hyperglycaemia may lead to peripheral insulin resistance and is an independent prognostic factor for morbidity and mortality. KEYWORDS: Basal-bolus; Diabetes; HbA1c; Ketoacidosis; Perioperative; Stress hyperglycaemia PDF Hiperglucemia de estrés en pacientes críticos y el riesgo posterior de diabetes una revisión sistemática y metaanálisis. Stress hyperglycaemia in critically ill patients and the subsequent risk of diabetes: a systematic review and meta-analysis. Ali Abdelhamid Y1,2, Kar P3,4, Finnis ME3,4, Phillips LK5,6, Plummer MP7, Shaw JE8, Horowitz M5,6, Deane AM3,4. Author information Crit Care. 2016 Sep 27;20(1):301. doi: 10.1186/s13054-016-1471-6. Abstract BACKGROUND: Hyperglycaemia occurs frequently in critically ill patients without diabetes. .....  CONCLUSIONS: Stress hyperglycaemia during ICU admission is associated with increased risk of incident diabetes. The strength of this association remains uncertain because of statistical and clinical heterogeneity among the included studies. KEYWORDS: Blood glucose; Critical care; Hyperglycaemia; Meta-analysis; Prediabetes; Type 2 diabetes mellitus PDF Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World Información / Information X Foro Internacional de Medicina del Dolor y Paliativa Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Ciudad de México, 7 al 9 de junio de 2018.  Información / Information Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

http://www.columnavertebralpediatricaygeriatrica.com.mx/academia/disco-herniado/

Disco herniado

• By admin in Academia

Fuente

Este artículo es originalmente publicado en:

http://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Herniated-Disc

De y todos los derechos reservados para:

© 2018 American Association of Neurological Surgeons. All Rights Reserved

The AANS does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific neurosurgical advice or assistance should consult his or her neurosurgeon, or locate one in your area through the AANS’ Find a Board-certified Neurosurgeon online tool.

Una hernia discal es un fragmento del núcleo del disco que es expulsado del anillo

Dogmas y Mitos, Controversias en el Niño con Asma, por el Dr. Elias. Kassisse, Neumologo Pediatra de Chile

Estimado Ciberpediatra

lo invitamos a unirse al seminario web Zoom.

Cuándo: may 2, 2018 9:00 PM Ciudad de México

Tema: Dogmas y Mitos, Controversias en el Niño con Asma, por el Dr. Elias. Kassisse, Neumologo Pediatra de Chile

Haga clic en el enlace a continuación para unirse al seminario web:

https://zoom.us/j/162502423

O un toque en iPhone :

Estados Unidos: +16699006833,,162502423# or +14086380968,,162502423#

O teléfono：

Marcar：

Estados Unidos: +1 669 900 6833 or +1 408 638 0968 or +1 646 876 9923

ID de seminario web: 162 502 423

Números internacionales disponibles: https://zoom.us/u/d4RSeHLEQ

Recomendamos que bajes e instales el programa Zoom en tu computadora, para poder accesar la reunión,

También que dejes tu nombre completo y correo electrónico para tomar asistencia a la conferencia

Pasaremos las preguntas al final de la presentacion y se quedaran al final de la Grabacion, por si la revisan en forma Off Line.

Puedes accesar la conferencia a través de la siguientes ligas en las paginas de Conapeme y Ciberpeds.

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Más sobre asma / More on asthma

Mayo 2, 2018. No. 3069

Muertes relacionadas con el asma Asthma-related deaths. D'Amato G1, Vitale C2, Molino A3, Stanziola A3, Sanduzzi A4, Vatrella A2, Mormile M3, Lanza M3, Calabrese G3, Antonicelli L5, D'Amato M3. Multidiscip Respir Med. 2016 Oct 12;11:37. eCollection 2016. Abstract Despite major advances in the treatment of asthma and the development of several asthma guidelines, people still die of asthma currently. According to WHO estimates, approximately 250,000 people die prematurely each year from asthma. Trends of asthma mortality rates vary very widely across countries, age and ethnic groups. Several risk factors have been associated with asthma mortality, including a history of near-fatal asthma requiring intubation and mechanical ventilation, hospitalization or emergency care visit for asthma in the past year, currently using or having recently stopped using oral corticosteroids (a marker of event severity), not currently using inhaled corticosteroids, a history of psychiatric disease or psychosocial problems, poor adherence with asthma medications and/or poor adherence with (or lack of) a written asthma action plan, food allergy in a patient with asthma. Preventable factors have been identified in the majority of asthma deaths. Inadequate education of patients on recognising risk and the appropriate action needed when asthma control is poor, deficiencies in the accuracy and timing of asthma diagnosis, inadequate classification of severity and treatment, seem to play a part in the majority of asthmadeaths. Improvements in management, epitomized by the use of guided self-management systems of care may be the key goals in reducing asthma mortality worldwide. KEYWORDS: Asthma mortality trends; Asthma-deaths; Inhaled corticosteroids; Near fatal asthma PDF Ketamina en estado asmático. Una revisión Ketamine in status asthmaticus: A review. Goyal S1, Agrawal A. Author information Indian J Crit Care Med. 2013 May;17(3):154-61. doi: 10.4103/0972-5229.117048. Abstract BACKGROUND AND AIMS: Status asthmaticus is a common cause of morbidity and mortality. The addition of ketamine to the standard treatment regimen of severe asthma has shown to improve outcome and alleviate the need for mechanical ventilation. The purpose of this review is to determine the pulmonary effects of ketamine and to determine whether sufficient evidence exists to support its use for refractory status asthmaticus. DATA SOURCE: MEDLINE, EMBASE, Google Scholar, and Cochrane data bases (from their inception to Jan 2012) using key words "ketamine", "asthma", "bronchospasm", "bronchodilator", and "mechanical ventilation" were searched to identify the reports on the use of ketamine as a bronchodilator in acute severe asthma or status asthmaticus, and manual review of article bibliographies was done. Relevant databases were searched for the ongoing trials on use of ketamine as a bronchodilator. Outcome measures were analyzed using following clinical questions: Indication, dose and duration of ketamine use, main effects on respiratory mechanics, adverse effects, and mortality. RESULTS: Twenty reports illustrating the use of ketamine as a bronchodilator were identified. In total, 244 patients aged 5 months to 70 years received ketamine for bronchospasm. Twelve case reports, 3 double-blind randomized placebo-controlled trials, 2 prospective observational studies, 2 clinical evaluation study, and 1 retrospective chart review were retrieved. Most of the studies showed improved outcome with use of ketamine in acute severe asthma unresponsive to conventional treatment. Patients who received ketamine improved clinically, had lower oxygen requirements, and obviated the need for invasive ventilation. Mechanically-ventilated patients for severe bronchospasm showed reduction in peak inspiratory pressures, improved gas exchange, dynamic compliance and minute ventilation, and could be weaned off successfully following introduction of ketamine. CONCLUSION: In various studies, ketamine has been found to be a potential bronchodilator in severe asthma. However, a large prospective clinical trial is warranted before laying down any definitive recommendations on its use in status asthmaticus. KEYWORDS: Bronchodilator; emergency department; intensive care unit; ketamine; status asthmaticus PDF ¿Es la ketamina un agente salvavidas en el asma infantil aguda grave? Is ketamine a lifesaving agent in childhood acute severe asthma? Hendaus MA1, Jomha FA2, Alhammadi AH1. Author information Ther Clin Risk Manag. 2016 Feb 22;12:273-9. doi: 10.2147/TCRM.S100389. eCollection 2016. Abstract Children with acute severe asthma exacerbation are at risk of developing respiratory failure. Moreover, conventional aggressive management might be futile in acute severe asthma requiring intubation and invasive ventilation. The aim of this review is to detail evidence on the use of ketamine in childhood asthma exacerbations. A search of the MEDLINE, EMBASE, and Cochrane databases was performed, using different combinations of the following terms: ketamine, asthma, use, exacerbation, and childhood. In addition, we searched the references of the identified articles for additional articles. We then reviewed titles and included studies that were relevant to the topic of interest. Finally, the search was limited to studies published in English and Spanish from 1918 to June 2015. Due to the scarcity in the literature, we included all published articles. The literature reports conflicting results of ketamine use for acute severe asthma in children. Taking into consideration the relatively good safety profile of the drug, ketamine might be a reasonable option in the management of acute severe asthma in children who fail to respond to standard therapy. Furthermore, pediatricians and pediatric emergency clinicians administering ketamine should be knowledgeable about the unique actions of this drug and its potential side effects. KEYWORDS: asthma; children; ketamine PDF Manejo anestésico en asma Anaesthetic management in asthma. Burburan SM1, Xisto DG, Rocco PR. Author information Minerva Anestesiol. 2007 Jun;73(6):357-65. Epub 2006 Nov 20. Abstract Anaesthetic management in asthmatic patients has been focused on avoiding bronchoconstriction and inducing bronchodilation. However, the definition of asthma has changed over the past decade. Asthma has been defined as a clinical syndrome characterized by an inflammatory process that extends beyond the central airways to the distal airways and lung parenchyma. With this concept in mind, and knowing that asthma is a common disorder with increasing prevalence rates and severity worldwide, a rational choice of anaesthetic agents and procedures is mandatory. Thus, we pursued an update on the pharmacologic and technical anaesthetic approach for the asthmatic patient. When feasible, regional anaesthesia should be preferred because it reduces airway irritation and postoperative complications. If general anaesthesia is unavoidable, a laryngeal mask airway is safer than endotracheal intubation. Lidocaine inhalation, alone or combined with albuterol, minimizes histamine-induced bronchoconstriction. Propofol and ketamine inhibit bronchoconstriction, decreasing the risk of bronchospasm during anaesthesia induction. Propofol yields central airway dilation and is more reliable than etomidate or thiopental. Halothane, enflurane, and isoflurane are potent bronchodilators and can be helpful even in status asthmaticus. Sevoflurane has shown controversial results in asthmatic patients. Vecuronium, rocuronium, cisatracurium, and pancuronium do not induce bronchospasm, while atracurium and mivacurium can dose-dependently release histamine and should be cautiously administered in those patients. Further knowledge about the sites of action of anaesthetic agents in the lung, allied with our understanding of asthma pathophysiology, will establish the best anaesthetic approach for people with asthma. PDF Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World Información / Information X Foro Internacional de Medicina del Dolor y Paliativa Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Ciudad de México, 7 al 9 de junio de 2018.  Información / Information Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

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

Líquido cefalorraquídeo / Cerebrospinal fluid

Abril 25, 2018. No. 3062

Circulación del líquido cefalorraquídeo: ¿Qué sabemos y cómo lo sabemos? Cerebrospinal fluid circulation: What do we know and how do we know it? Khasawneh AH, Garling RJ, Harris CA. Brain Circ 2018;4:14-8. Abstract The central nervous system's (CNS) complicated design is a double-edged sword. On the one hand, the complexity is what gives rise to higher order thinking; but on the other hand, damage to the CNS evokes its unforgiving nature. The cerebrospinal fluid (CSF) circulation system is an intricate system embedded in and around the CNS that has been the topic of debate since it was first described in the 18thcentury. It is underscored by the choroid plexus's distinct vascular network which has conventionally been seen as the most prominent structure in CSF production through a variety of active transporters and channels. Despite the ubiquity of this circulation system in vertebrates, some aspects remain understudied. Recent advances in scientific methodology and experimentation have proven to be effective tools for elucidating the mechanisms of the CSF circulation system and the pathological conditions associated with its malfunction. In this review, we capitulate the classical understanding of CSF physiology as well as a new, emerging theory on CSF production. Keywords: Absorption, circulation, CSF flow, production PDF Interacción entre la barrera hematoencefálica y el sistema glimfático en la eliminación de solutos. Interaction between blood-brain barrier and glymphatic system in solute clearance. Verheggen ICM1, Van Boxtel MPJ2, Verhey FRJ2, Jansen JFA3, Backes WH3. Author information Neurosci Biobehav Rev. 2018 Mar 30;90:26-33. doi: 10.1016/j.neubiorev.2018.03.028. [Epub ahead of print] Abstract Neurovascular pathology concurs with protein accumulation, as the brain vasculature is important for waste clearance. Interstitial solutes, such as amyloid-β, were previously thought to be primarily cleared from the brain by blood-brain barrier transport. Recently, the glymphatic system was discovered, in which cerebrospinal fluid is exchanged with interstitial fluid, facilitated by the aquaporin-4 water channels on the astroglial endfeet. Glymphatic flow can clear solutes from the interstitial space. Blood-brain barrier transport and glymphatic clearance likely serve complementary roles with partially overlapping mechanisms providing a well-conditioned neuronal environment. Disruption of these mechanisms can lead to protein accumulation and may initiate neurodegenerative disorders, for instance amyloid-β accumulation and Alzheimer's disease. Although both mechanisms seem to have a similar purpose, their interaction has not been clearly discussed previously. This review focusses on this interaction in healthy and pathological conditions. Future health initiatives improving waste clearance might delay or even prevent onset of neurodegenerative disorders. Defining glymphatic flow kinetics using imaging may become an alternative way to identify those at risk of Alzheimer's disease. KEYWORDS: Alzheimer's disease; Amyloid-β; BBB; Blood-brain barrier; Clearance; Glymphatic system; Imaging PDF El papel de las barreras cerebrales en el movimiento de fluidos en el SNC: ¿existe un sistema "glimfático"? The role of brain barriers in fluid movement in the CNS: is there a 'glymphatic' system? Abbott NJ1, Pizzo ME2,3, Preston JE4, Janigro D5,6, Thorne RG7,8,9,10,11,12. Acta Neuropathol. 2018 Mar;135(3):387-407. doi: 10.1007/s00401-018-1812-4. Epub 2018 Feb 10. Author information Abstract Brain fluids are rigidly regulated to provide stable environments for neuronal function, e.g., low K+, Ca2+, and protein to optimise signalling and minimise neurotoxicity. At the same time, neuronal and astroglial waste must be promptly removed. The interstitial fluid (ISF) of the brain tissue and the cerebrospinal fluid (CSF) bathing the CNS are integral to this homeostasis and the idea of a glia-lymph or 'glymphatic' system for waste clearance from brain has developed over the last 5 years. This links bulk (convective) flow of CSF into brain along the outside of penetrating arteries, glia-mediated convective transport of fluid and solutes through the brain extracellular space (ECS) involving the aquaporin-4 (AQP4) water channel, and finally delivery of fluid to venules for clearance along peri-venous spaces. However, recent evidence favours important amendments to the 'glymphatic' hypothesis, particularly concerning the role of glia and transfer of solutes within the ECS. This review discusses studies which question the role of AQP4 in ISF flow and the lack of evidence for its ability to transport solutes; summarizes attributes of brain ECS that strongly favour the diffusion of small and large molecules without ISF flow; discusses work on hydraulic conductivity and the nature of the extracellular matrix which may impede fluid movement; and reconsiders the roles of the perivascular space (PVS) in CSF-ISF exchange and drainage. We also consider the extent to which CSF-ISF exchange is possible and desirable, the impact of neuropathology on fluid drainage, and why using CSF as a proxy measure of brain components or drug delivery is problematic. We propose that new work and key historical studies both support the concept of a perivascular fluid system, whereby CSF enters the brain via PVS convective flow or dispersion along larger caliber arteries/arterioles, diffusion predominantly regulates CSF/ISF exchange at the level of the neurovascular unit associated with CNS microvessels, and, finally, a mixture of CSF/ISF/waste products is normally cleared along the PVS of venules/veins as well as other pathways; such a system may or may not constitute a true 'circulation', but, at the least, suggests a comprehensive re-evaluation of the previously proposed 'glymphatic' concepts in favour of a new system better taking into account basic cerebrovascular physiology and fluid transport considerations. KEYWORDS: Blood-brain barrier; Cerebrospinal fluid; Extracellular space; Glymphatic; Interstitial fluid; Perivascular space PDF Congresos Médicos por Especialidades en todo Mundo Medical Congresses by Specialties around the World Información / Information X Foro Internacional de Medicina del Dolor y Paliativa Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Ciudad de México, 7 al 9 de junio de 2018.  Información / Information Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

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