Biopsia Renal en receptores de Trasplante Renal: cuidados de enfermería y complicaciones

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Esther Sanz Izquierdo

Full Text Available Introducción: La biopsia renal percutánea es una herramienta fundamental para el manejo del paciente trasplantado renal. La prueba es primordial para detectar y/o prevenir cualquier disfunción en el injerto, siendo un procedimiento tanto diagnóstico como preconizador. Objetivo: Describir los cuidados de enfermería e identificar las complicaciones derivadas de la biopsia renal en los receptores de Trasplante Renal. Material y métodos: Estudio cuantitativo, descriptivo y transversal realizado en la Unidad de Trasplante Renal, Servicio de Nefrología, del 2008 al 2014. La población objeto de estudio son los receptores de Trasplante Renal (TR. La muestra está compuesta por 368 biopsias renales de seguimiento que ingresan para someterse a una biopsia renal. Los criterios de inclusión son ser mayores de 18 años, trasplantados y que han firmado el consentimiento informado. Se recogen datos sociodemográficos, clínico-asistenciales y complicaciones post-biopsia renal. Resultados: Desde 1980 hasta el 2014 se han llevado a cabo 1868 TR, de 2008 a 2014 se estudiaron 368 biopsias de seguimiento. Se monitoriza la Tensión Arterial y la coagulación pre biopsia. Tras el procedimiento, se controla la presencia de sangrado por micción y constantes vitales. Inicialmente el reposo absoluto era de 24 h, a partir de 2014 se reduce a 6 horas, recomendando reposo relativo al alta, las complicaciones fueron mínimas. Conclusiones: Los resultados indican que la biopsia renal es un procedimiento eficaz, con escasas complicaciones. Destacar el papel de enfermería en la detección precoz de complicaciones.

Pocos de Caldas Project

International Nuclear Information System (INIS)

1988-01-01

The first annual report of the Pocos de Caldas Project describes the results of the feasibility study established to test the objectives of the work. Boreholes have been drilled at two sites, the Osamu Utsumi uranium mine and Morro do Ferro, to assess the feasibility of using them as natural analogues of radionuclide migration processes. Detailed geochemical analysis and hydrogeological studies are described. (author)

Reparación endovascular torácica aórtica (TEVAR: un enfoque sobre complicaciones

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Ali Azizzadeh

2010-01-01

Full Text Available La reparación endovascular torácica (TEVAR se ha constituido como una alternativa válida para la reparación de los aneurismas torácicos, al ser menos agresiva. Una reciente revisión sistemática y metaanálisis de estudios comparativos confirma que TEVAR, cuando se compara con la cirugía abierta, puede reducir la muerte precoz, la paraplejía, insuficiencia renal, transfusiones, reoperación por hemorragia, complicaciones cardíacas, neumonía y estancia hospitalaria. Esta revisión se referirá a algunas de las complicaciones del procedimiento. Éstas incluyen: mortalidad, accidente cerebrovascular, isquemia medular, disección retrógrada, disfunción del dispositivo, complicaciones del acceso, endofuga y migración.

Complicaciones del tratamiento de incontinencia urinaria y prolapso de la pelvis

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Chasta Bacsu, MD

2013-03-01

Full Text Available Este artículo tiene como objetivo proporcionar una visión general de las complicaciones asociadas al tratamiento quirúrgico por incontinencia urinaria y prolapso pélvico relacionado con el uso de mallas quirúrgicas. Asimismo, otro de sus objetivos es revisar la nueva clasificación de complicaciones relacionadas con la inserción de prótesis o injertos en la cirugía de piso pélvico femenino otorgada por la Asociación Uroginecológica Internacional (IUGA, por su sigla en inglés / Sociedad de Continencia Internacional (ICS, por su sigla en inglés y por las recientes notificaciones proporcionadas por la Administración de Medicamentos y Alimentación (FDA, por su sigla en inglés.

Factores asociados a complicaciones de yeyunostomía

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H. Medina-Franco

2013-04-01

Conclusiones: La yeyunostomía se asocia a una elevada frecuencia de complicaciones, tanto médicas como quirúrgicas. Si bien se ha establecido como una mejor alternativa a nutrición parenteral, deberá tomarse en cuenta la morbilidad asociada a la misma antes de establecer su utilización rutinaria como medio de aporte nutricional, particularmente en pacientes con factores asociados al desarrollo de las mismas.

Celulitis orbitaria, celulitis frontal y empiema como complicaciones de sinusitis

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Felipa Elena García García

Full Text Available La celulitis orbitaria usualmente ocurre como complicación de infecciones de los senos para nasales, y la etiología es principalmente bacteriana. Para realizar un diagnóstico e implantar terapéutica temprana tiene gran importancia reconocer las manifestaciones clínicas de la sinusitis y las edades más afectadas, pues dada su ubicación anatómica, pueden complicarse también con infecciones del sistema nervioso central, que en la edad pediátrica tienen una connotación especial. Se presentan aquí dos pacientes de 10 y 14 años de edad respectivamente, que desarrollaron celulitis orbitaria en un caso, y celulitis frontal y empiema en el otro; así mismo, se muestran los medios diagnósticos utilizados para identificar signos tempranos de posibles complicaciones, con el objetivo que el pediatra pueda identificarlos, así como la terapéutica implantada para dar solución o evitar estas complicaciones.

Pocos de Caldas Project

International Nuclear Information System (INIS)

1989-01-01

The second annual report of the Pocos de Caldas Project describes the results of the first phase of the post-feasibility study investigations. Boreholes have been drilled at two sites, the Osamu Utsumi uranium mine and Morro do Ferro, and rock and groundwater samples analysed to provide data on natural analogues of radionuclide migration processes. These detailed geochemical analysis and hydrogeological studies are described, and related to four specific objectives concerning issues of importance in repository performance assessment. (author)

Complicaciones mecánicas del infarto agudo de miocardio: aunque infrecuentes, potencialmente letales

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Jerson Quitian Moreno

2017-09-01

Full Text Available Aunque la incidencia de complicaciones mecánicas en el infarto agudo de miocardio ha descendido después de la era de la intervención coronaria percutánea, la mortalidad sigue siendo significativa. La ruptura septal ventricular, la regurgitación mitral aguda y la ruptura de la pared libre del ventrículo izquierdo conforman el espectro de complicaciones mecánicas posteriores al infarto agudo de miocardio. La reparación quirúrgica es el pilar del tratamiento; sin embargo, como puente para la cirugía, el manejo médico permite estabilizar al paciente.

Tratamiento y complicaciones de las fracturas de seno frontal Frontal sinus fracture treatment and complications

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S. Heredero Jung

2007-06-01

Full Text Available Introducción. Las fracturas de seno frontal se producen como resultado de impactos de alta energía. Un tratamiento inadecuado puede conducir a complicaciones serias incluso muchos años después del traumatismo. Objetivos. Evaluar los datos epidemiológicos y revisar las complicaciones asociadas. Estandarizar el protocolo de tratamiento. Materiales y métodos. Se revisaron 95 pacientes diagnosticados de fracturas de seno frontal pertenecientes al servicio de Cirugía Oral y Maxilofacial del Hospital Universitario 12 de Octubre de Madrid, entre enero de 1990 y diciembre de 2004. Resultados. La edad media de los pacientes revisados es de 34 años. La mayoría son hombres (78% y la causa más frecuente del traumatismo, los accidentes de tráfico. El patrón de fractura más común es el que afecta únicamente a la pared anterior del seno frontal. Las complicaciones descritas son: deformidad estética frontal, sinusitis frontal, mucocele frontal, celulitis fronto-orbitaria, intolerancia al material de osteosíntesis, complicaciones infecciosas del SNC y persistencia de fístula de líquido cefalorraquídeo. Conclusiones. El objetivo ha de estar encaminado a prevenir las complicaciones asociadas a los pacientes con fracturas de seno frontal. Hay que individualizar el protocolo de tratamiento en cada caso. Es recomendable un seguimiento a largo plazo para identificar precozmente las posibles complicaciones.Introduction. Frontal sinus fractures are caused by high velocity impacts. Inappropriate treatment can lead to serious complications, even many years after the trauma. Objectives. To evaluate epidemiological data and associated complications. To standardize the treatment protocol. Materials and methods. the clinical records of 95 patients with frontal sinus fractures treated between January 1990 and December 2004 at the Oral and Maxillofacial Surgery Department, "12 de Octubre" Hospital (Madrid, Spain, were reviewed. Results. The average age of

Calidad de vida y complicaciones en el paciente diabético. Estudio descriptivo en farmacia comunitaria

OpenAIRE

Mateos Sánchez M

2013-01-01

INTRODUCCIÓN La investigación de la percepción de la calidad de vida en relación con las complicaciones de la diabetes permite identificar necesidades en estos pacientes. El objetivo de este trabajo es detectar cómo influyen las complicaciones crónicas de la DM2 en la calidad de vida del paciente en el medio rural. MATERIAL Y MÉTODOS Estudio observacional transversal en la zona básica de salud de Lumbrales (Salamanca). Se elaboró un cuestionario dividido en cuatro bloques: variables sociod...

Calidad de vida y complicaciones en el paciente diabético. Estudio descriptivo en farmacia comunitaria

OpenAIRE

Mateos Sánchez, Mercedes

2013-01-01

INTRODUCCIÓN La investigación de la percepción de la calidad de vida en relación con las complicaciones de la diabetes permite identificar necesidades en estos pacientes. El objetivo de este trabajo es detectar cómo influyen las complicaciones crónicas de la DM2 en la calidad de vida del paciente en el medio rural.MATERIAL Y MÉTODOS Estudio observacional transversal en la zona básica de salud de Lumbrales (Salamanca). Se elaboró un cuestionario dividido en cuatro bloques: variables sociodemog...

Complicaciones neurológicas en pacientes con leucemias y linfomas

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Gatti, Carolina; Russo, M. J.; Pazos, M.; Tizio, S.; Bunzel, S.; Borzi, A.

2010-01-01

Las leucemias y linfomas pueden afectar el sistema nervioso (SN) por invasión directa o indirecta del tumor. Se ha reportado en 5 a 29% de pacientes con linfomas y en 13% de leucemias agudas. Objetivos: Conocer las complicaciones neurológicas con el fin de implementar un diagnóstico y tratamiento adecuados, mejorar la calidad de vida y el tiempo de supervivencia.

La diabetes mellitus y las complicaciones cardiovasculares

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Olga Lidia Pereira Despaigne

2015-05-01

Full Text Available Las enfermedades cardiovasculares en las personas con diabetes mellitus son más precoces, y suelen presentarse con síntomas y signos atípicos. Igualmente, se ha demostrado que la hiperglucemia es un importante factor de riesgo para las complicaciones microangiopáticas y macroangiopáticas en la diabetes mellitus, y la hiperglucemia posprandial, con glucemia en ayunas normal, es una condición clínica frecuente y un factor de riesgo cardiovascular independiente. Así, en el presente trabajo se exponen algunas consideraciones relacionadas con el control de las dislipidemias, la hipertensión arterial y la antiagregación plaquetaria en el paciente con diabetes mellitus

Condición laboral asociada a complicaciones en el embarazo en noreste de México

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Edgar Taboada Aguirre

2014-12-01

Full Text Available Introducción: Las complicaciones clínicas en el embarazo son predictores importantes para la mortalidad materna y desenlace del embarazo dependiendo de la atención que reciban las mujeres en este periodo trascendental de la vida. Algunos de los determinantes asociados con el problema están ligados a la situación laboral y la ocupación de la madre durante el embarazo. Material y métodos: Se realizó un estudio transversal en el año 2012, en la Unidad de Medicina Familiar # 43 del Instituto Mexicano del Seguro Social. Se realizó un muestreo aleatorio de un total de 2314 se seleccionaron 318 mujeres que accedieron a participar. El objetivo principal del estudio de analizar la asociación del estatus laboral con las complicaciones durante la gestación (definidas como cualquier paciente que durante la gestación haya padecido preeclampsia, eclampsia, amenaza de aborto, amenaza de parto prematuro, infección de vías urinarias se incluyeron además variables sociodemográficas conocidas por su relación con las complicaciones prenatales. Resultados: La media de la edad fue de 26 años. La media del índice de masa corporal fue de 27. Las mujeres trabajadoras presentaron una probabilidad 64 % más alta que las no trabajadoras de presentar complicaciones en el embarazo (OR=1.64; IC95 %: 1.04-2.58. La infección de vías urinarias en las mujeres trabajadoras fue un 75 % más probable (OR=1.75; IC 95 %: 1.12-2.73, las mujeres trabajadoras tuvieron 2.72 veces más probabilidad de padecer una amenaza de aborto que las no trabajadoras (OR=2.72; IC 95 %:1.36-5.45, las trabajadoras tuvieron 2.20 veces mayor probabilidad de padecer amenaza de parto prematuro que las no trabajadoras (OR=2.20; IC 95 %: 0.91-5.29. Además las trabajadoras tuvieron una probabilidad 96 % más alta de que su embarazo terminara en cesárea (OR=1.96; IC 95 %:1.25-3.07. Conclusiones: Los resultados sugieren que la actividad laboral es un factor importante para la presentaci

Caracterización de pacientes diabéticos de tipo 2 con complicaciones vasculares y riesgo de ateroesclerosi

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Milagros Violeta Font Difour

2014-12-01

Full Text Available Se realizó un estudio observacional, descriptivo y prospectivo para caracterizar a 200 pacientes diabéticos de tipo 2, diagnosticados con complicaciones vasculares y riesgo de ateroesclerosis, los cuales fueron ingresados en el Servicio de Medicina Interna del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde junio del 2010 hasta igual mes del 2011. Entre las complicaciones más frecuentes figuraron: enfermedades cardiovasculares (29,5 %, neuropatía (21,5 % y retinopatía (19,5 %. Prevalecieron los afectados con 3 complicaciones (40,5 %, los que tenían un tiempo de evolución de la enfermedad de 11-15 años (38,0 %; además de la hiperlipidemia (35,0 %, la hipertensión arterial (32,0 % y el tabaquismo (26,5 % como factores de riesgo. Se concluye que con un enfoque multidisciplinario en el tratamiento y control de esta enfermedad se logra mejorar el pronóstico de los afectados.

Relación entre estado nutricional y complicaciones posoperatorias en cardiopatías acianóticas y flujo pulmonar aumentado

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Raquel Maciques Rodríguez

Full Text Available Introducción: los primeros trabajos que asocian desnutrición y cardiopatías se reportaron en los años 50. Los lactantes cardiópatas presentan alteraciones en el crecimiento y desarrollo, y es más severo el compromiso en aquellos que se presentan con insuficiencia cardiaca y cianosis. Se describen patrones de desnutrición de acuerdo con el tipo de cardiopatía, la que puede ser aguda o crónica. Objetivos: evaluar el impacto de la intervención nutricional, como medida que contribuye a disminuir las complicaciones posoperatorias, en lactantes con cardiopatías congénitas acianóticas y desnutridos, así como relacionar la presencia de infecciones posoperatorias con hipoalbuminemia. Métodos: estudio prospectivo que incluyó a 28 lactantes con cardiopatías congénitas acianóticas, flujo pulmonar aumentado y desnutridos, en el Cardiocentro Pediátrico "William Soler", desde septiembre de 2008 hasta agosto de 2010. Fueron divididos en 2 grupos: Grupo I, no recibieron intervención nutricional; y Grupo II, recibieron intervención nutricional. El estado nutricional se determinó por el índice peso para la talla en ambos sexos. Se analizó la asociación de complicaciones posoperatorias y estado nutricional, así como la relación entre infección e hipoalbuminemia. Se aplicaron técnicas estadísticas descriptivas, se utilizaron los porcentajes y construyeron distribuciones de frecuencias absolutas y relativas. Resultados: el 69,2 % de los niños del Grupo I se encontraron desnutridos en el momento de la cirugía, y las complicaciones infecciosas estuvieron presente en el 73,3 % de los casos. En el Grupo II las complicaciones infecciosas se presentaron en el 13,3 % de los pacientes. Conclusiones: el grupo de niños desnutridos presentó mayor número de complicaciones infecciosas, las que estuvieron relacionadas a hipoalbuminemia. La intervención nutricional preoperatoria favorece una menor incidencia de complicaciones posoperatorias.

Complicaciones mecánicas de los accesos venosos centrales

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Dr. T. Rodrigo Rivas

2011-05-01

En esta puesta al día se describen las complicaciones más frecuentes o de mayor gravedad como son: el neumotórax, la embolia aérea, mal-posición del catéter, perforación de grandes venas, punción arterial, arritmias, trombosis venosa asociada a catéter venoso central (CVC y oclusión del CVC; algunos elementos de prevención, diagnóstico y tratamiento así como el impacto que puede tener la ultrasonografía rutinaria para instalar un CVC.

Complicaciones tardías en diabetes mellitus tipo 2 en el Hospital II Essalud - Cañete

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Charlton Fernando Untiveros Mayorga

2004-04-01

Full Text Available Objetivo: Determinar las características clínicas y las complicaciones tardías en los pacientes con diabetes tipo 2 atendidos en los consultorios de medicina general y del Programa de Diabetes del Hospital II EsSALUD-Cañete. Material y Métodos: Se realizó un estudio descriptivo de serie de casos en el que se evaluaron 94 pacientes con diabetes tipo 2 elegidos aleatoriamente durante su control ambulatorio, realizándose una entrevista y evaluación clínica durante los meses de junio y julio del 2001. Resultados: La población de pacientes estudiada tuvo una edad promedio de 64.56 + 11.61. Cincuenta y tres pacientes eran mujeres (56.4%. El 68.1% de los pacientes recibían hipoglicemiantes orales y el 11.7% requerían del uso de insulina. Los transtornos lipídicos predominantes fueron la elevación del LDL-Colesterol y disminución del HDL-Colesterol. La retinopatía diabética (88.9% e hipertensión arterial (61.3% fueron las complicaciones más frecuentes. Vasculopatía periférica, neuropatía periférica y neuropatía autonómica fueron otras complicaciones crónicas frecuentes halladas en la población de estudio. Conclusiones: Las complicaciones cardiovasculares (micro y macrovasculares en la población de pacientes con diabetes tipo 2 atendidos ambulatoriamente en el Hospital II EsSALUD-Cañete fueron las más frecuentes. (Rev Med Hered 2004; 15:64-69.

Complicaciones en el uso del colgajo TRAM pediculado para reconstrucción mamaria por cáncer

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J.L. López-Robles

2013-12-01

Full Text Available Las opciones en reconstrucción mamaria tras tratamiento oncoquirúrgico incluyen el uso de técnicas con implantes, el uso de colgajos autólogos y la combinación de ambos métodos. A nivel internacional, la reconstrucción con tejidos autólogos es el estándar de oro para la reconstrucción mamaria y específicamente, la utilización del colgajo miocutáneo de recto abdominal (colgajo TRAM pediculado es una de las opciones más empleadas. El presente estudio define con qué frecuencia se presentaron complicaciones tras la cirugía con colgajo TRAM pediculado para reconstrucción mamaria por cáncer en el Servicio de Cirugía Plástica y Reconstructiva del Hospital Central Sur de Alta Especialidad (PEMEX de la Cuidad de México (México, en un periodo de estudio de 7 años. Además, se identifican los factores de riesgo que influyeron sobre la aparición de dichas complicaciones. Diseñamos un estudio descriptivo, observacional y retrospectivo, que incluyó a 71 pacientes, de las cuales el 59.15 % presentaron alguna complicación. La mayoría de dichas complicaciones fueron menores (54.9 % y tan solo 3 pacientes presentaron alguna complicación mayor (4.2 %. La complicación del sitio donante del colgajo más frecuente fue la aparición de hernia abdominal (9.86 %. La complicación más frecuente del colgajo y del sitio receptor fue la necrosis grasa parcial (23.94 %. Las únicas complicaciones sistémicas fueron atelectasia y tromboembolismo pulmonar, con 1 caso de cada. En el análisis bivariado, las pacientes fumadoras tuvieron un 40 % más riesgo de presentar una complicación del colgajo en comparación con las no fumadoras (p=0.041. Las pacientes sometidas a radioterapia tuvieron un incremento del 30 % en las complicaciones totales en comparación con las no radiadas (p=0.021. Al comparar el hecho de recibir quimioterapia o no y la presencia de necrosis grasa, el 32 % de las pacientes tuvo esta complicación en comparación con el 10

PoCos: Population Covering Locus Sets for Risk Assessment in Complex Diseases.

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Marzieh Ayati

2016-11-01

Full Text Available Susceptibility loci identified by GWAS generally account for a limited fraction of heritability. Predictive models based on identified loci also have modest success in risk assessment and therefore are of limited practical use. Many methods have been developed to overcome these limitations by incorporating prior biological knowledge. However, most of the information utilized by these methods is at the level of genes, limiting analyses to variants that are in or proximate to coding regions. We propose a new method that integrates protein protein interaction (PPI as well as expression quantitative trait loci (eQTL data to identify sets of functionally related loci that are collectively associated with a trait of interest. We call such sets of loci "population covering locus sets" (PoCos. The contributions of the proposed approach are three-fold: 1 We consider all possible genotype models for each locus, thereby enabling identification of combinatorial relationships between multiple loci. 2 We develop a framework for the integration of PPI and eQTL into a heterogenous network model, enabling efficient identification of functionally related variants that are associated with the disease. 3 We develop a novel method to integrate the genotypes of multiple loci in a PoCo into a representative genotype to be used in risk assessment. We test the proposed framework in the context of risk assessment for seven complex diseases, type 1 diabetes (T1D, type 2 diabetes (T2D, psoriasis (PS, bipolar disorder (BD, coronary artery disease (CAD, hypertension (HT, and multiple sclerosis (MS. Our results show that the proposed method significantly outperforms individual variant based risk assessment models as well as the state-of-the-art polygenic score. We also show that incorporation of eQTL data improves the performance of identified POCOs in risk assessment. We also assess the biological relevance of PoCos for three diseases that have similar biological mechanisms

Edad, aprendizaje, tiempo quirúrgico y complicaciones en la cirugía videolaparoscópica

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Luis Miguel Pita Armenteros

1999-12-01

Full Text Available El tiempo quirúrgico es un factor de riesgo menos importante en las operaciones electivas, mucho menos si existe gentileza quirúrgica y control anestésico. El método videolaparoscópico exige de mayor monitoreo en la anestesia y es de mínimo traumatismo. Sin embargo, se habla de tiempos quirúrgicos muy elevados en la fase de aprendizaje como limitante en la productividad quirúrgica con aumento del costo quirófano y de complicaciones, en particular en cirujanos mayores. Este trabajo desmitifica edad, aprendizaje, tiempo quirúrgico y complicaciones en la cirugía videolaparoscópica. La prudencia influye en el tiempo quirúrgico, pero disminuye conversión y complicaciones. Obtener la calificación básica en cirugía videolaparoscópica requiere de 40 a 50 operacionesSurgical time is not very significant risk factor in elective surgery. It is much less important when there is an adequate surgical management and anesthetic control. The videolaparoscopic method demands a greater anesthetic monitoring and produces minimun traumatism. However, reference is made to extremely elevated surgical times during training that limit surgical productivity and increase the cost of the operation and the number of complications particularly among major surgeons. This paper considers age, training, surgical time and complications in videolaparoscopic surgery. Prudence influences on the surgical time but reduces conversion and complications. To obtain the basic qualification in videolaparoscopic surgery, it is necessary to perform 40 or 50 operations

Trauma de tórax

OpenAIRE

M. Felipe Undurraga, Dr.; D. Patricio RodríGuez, Dr.; P. David Lazo, Dr.

2011-01-01

El traumatismo de tórax es una situación altamente desafiante en el manejo de urgencia. Requiere conocimientos de las complicaciones que pueden poner en riesgo vital al paciente en pocos minutos como de un adecuado manejo primario de las complicaciones que se pueden presentar en el mediano y largo plazo. De la mortalidad total del trauma, un 75% se debe a trauma torácico como causa primaria o como elemento contribuyente. Es por esto que el manejo de estas lesiones torácicas es esencial en el ...

Síndrome metabólico durante el embarazo: Complicaciones materno-fetales

OpenAIRE

Yépez, Mayel Cristina; Zeppenfel, María Eugenia; Colón, José Antonio; Zimmer, Eveline

2011-01-01

Objetivo: Determinar la asociación entre el síndrome metabólico y las complicaciones maternas, fetales y neonatales, en un grupo de embarazadas entre agosto 2008 y septiembre 2009. Ambiente: Servicio Prenatal de la Maternidad “Concepción Palacios”. Métodos: Estudio prospectivo, longitudinal, comparativo, con una muestra de 130 embarazadas, 38 cumplieron los criterios de la Federación Internacional de Diabetes para síndrome metabólico y 92 fueron el grupo control. Resultados: El promedio de ed...

222Rn determination in mineral waters from the Pocos de Caldas Plateau in Brazil

International Nuclear Information System (INIS)

Taddei, M.H.T.; Silva, N.C.; Cipriani, M.

2002-01-01

It is estimated that 50% of the radioactive effective dose equivalent to man comes from radon and its radioactivity daughters. The main 222 Rn sources are the soils, building materials and potable waters. There is an especial interest in spas waters with high natural radioactivity. It's considered that the use of these waters as drinking waters is a significant radiation exposure factor, and it is worthwhile to assess the consequent dose. Such estimation has been made for the Pocos de Caldas Plateau, which is a region of high natural radioactivity, from volcanic origin, containing several spas (Aguas da Prata, Caldas, Pocos de Caldas and Andradas). The 222 Rn content was determined in 23 spring waters in Pocos de Caldas and neighboring cities. In water sampling, modified Marinelli flasks were used. The determinations were effected with a high resolution gamma ray spectrometer. High concentration variations were observed in the collected mineral waters, the highest values having been found in Fonte Villela's waters, in Aguas da Prata town (926 Bq/l); Grande Hotel's in Caldas Town (420 Bq/l) and COLAB's in Pocos de Caldas region (289 Bq/l). The annual whole body effective dose equivalent estimate for adult due to water ingestion, using the Crowford-Brown's biokinetic model's adult dose conversion factors, was higher than 1 mSv/year in 61% of the analyzed waters. (author)

Se aprende poco : ¿Qué podemos hacer?

OpenAIRE

Quinquer, Dolors

2006-01-01

La situación en las aulas es más compleja, heterogénea y pluricultural que antes; las competencias que se han de desarrollar se han diversificado, ahora son cognitivas, éticas y sociales, mientras que los marcos organizativos siguen tan rígidos como siempre. En este contexto, comparando España con otros países, parece que los alumnos aprenden poco.¿Qué podemos hacer? 

Pocos de Caldas, Minas Gerais, Brazil: a natural analogue study

International Nuclear Information System (INIS)

Smellie, J.

1989-01-01

The Pocos de Caldas natural analogue project is an internationally funded project hosted by Brazil; the contributary organizations are SKB (Sweden), NAGRA (Switzerland), DOE (United Kingdom) and the DOE (United States). The Project is a multidisciplinary study of two mineralized areas within an alkaline igneous caldera complex located near the town of Pocos de Caldas in the state of Minas Gerais. One area, the Osamu Utsumi mine, is characterized by redox deposits of secondary remobilized pitchblende, and the other area, Morro do Ferro, comprises a highly weathered deposit of thorium and REE with subordinate uranium. The project, scheduled for three years (1986-1989), is now entering its third and final year. The pilot and feasibility studies, which characterized the first year, helped to establish the major drilling programme and the sampling protocols for both rock and groundwater studies which constituted the major part of the second year. The latest status of the investigations are briefly reported

Renal diseases in AIDS patients

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Álvarez Escobar, María del Carmen; Alfonso de León, José Alberto; Lima Gutiérrez, Héctor; Torres Álvarez, Armella; Torres Álvarez, Arling Yuliett

2009-01-01

La afectación renal en el SIDA es un tema poco abordado a pesar de su frecuencia, la misma depende de la acción directa e indirecta del virus, así como de las complicaciones y del tratamiento. La más frecuente de las complicaciones es la Insuficiencia Renal Aguda. La forma más típica de nefropatía asociada al VIH (NAVIH) se caracteriza por alto grado de proteinuria con progresión rápida a Insuficiencia Renal Terminal. En el SIDA se presentan diversas formas de glomerulopatías cuya expresión c...

Complicaciones infecciosas de la diálisis peritoneal ambulatoria en niños

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Diana Patricia Durán Casal

Full Text Available Introducción: la diálisis peritoneal es la mejor alternativa terapéutica para los niños con enfermedad renal crónica terminal, y en las modalidades de diálisis peritoneal ambulatoria ha permitido el tratamiento fuera del hospital, lo que proporciona un mejor estilo y calidad de vida. No es un método exento de riesgos. Las complicaciones infecciosas relacionadas a la diálisis peritoneal son la causa más importante de morbilidad y es la peritonitis su principal complicación. Objetivo: determinar retrospectivamente la frecuencia y las características de complicaciones infecciosas relacionadas al proceder dialítico. Métodos: nuestro hospital es referente como unidad de diálisis pediátrica del país, así que recibe la mayoría de los niños con enfermedad renal crónica terminal de Cuba. Se revisaron los expedientes clínicos de niños con enfermedad renal crónica terminal en programa de diálisis peritoneal ambulatoria en el Hospital Pediátrico de Centro Habana durante el período 2008-2011. Resultados: se estudiaron 12 pacientes con un promedio de edad de 11 años, 58 % del sexo femenino. Se documentaron 24 episodios infecciosos. Las complicaciones encontradas fueron infección del sitio de salida del catéter, con 62,5 %, peritonitis 33,3 % e infección del túnel submucoso 4,2 %. Predominaron cultivos positivos a bacterias grampositivas (66,7 %. Las bacterias más comunes fueron: Staphylococcus coagulasa positivo (48 % y Staphylococcus coagulasa negativo (22 %. Otros gérmenes identificados fueron E. coli, Enterobacter spp. y Candida spp., con 8,3 % respectivamente. Conclusiones: la infección del sitio de salida del catéter fue la complicación infecciosa más frecuente en nuestra serie. Las bacterias grampositivas son los gérmenes más comunes que causan infección del sitio de salida y peritonitis en pacientes en diálisis peritoneal ambulatoria.

Embarazo adolescente como factor de riesgo para complicaciones obstétricas y perinatales en un hospital de Lima, Perú

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Javier A. Okumura

2014-12-01

Full Text Available Objetivos: analizar el riesgo de complicaciones obstétricas y perinatales en adolescentes embarazadas en un hospital de Lima, Perú. Métodos: estudio de cohorte retrospectiva de 67.693 gestantes atendidas en el período 2000-2010. Se evaluó complicaciones obstétricas y perinatales. Las adolescentes se clasificaron en tardías (15-19 años y tempranas (< 15 años y se compararon con las adultas (20-35 años. Se calculó OR ajustados por educación, estado civil, control prenatal, gestaciones previas, paridad e IMC pregestacional. Resultados: se encontró mayor riesgo de cesárea (OR=1,28; IC95%=1,07-1,53 e infección puerperal (OR=1,72; IC95%=1,17-2,53 en las adolescentes menores de 15 años, así como mayor riesgo (OR=1,34; IC95%=1,29-1,40de episiotomía en las adolescentes tardías. Asimismo, se identificó un menor riesgo del embarazo adolescente para preeclampsia (OR=0,90; IC95%=0,85-0,97, hemorragia de la 2da mitad del embarazo (OR=0,80; IC95%=0,71-0,92, ruptura prematura de membranas (OR=0,83; IC95%=0,79-0,87, amenaza de parto pretérmino (OR=0,87; IC95%=0,80-0,94 y desgarro vaginal (OR= 0,86; IC95%=0,79-0,93. Conclusión: el embarazo se comporta como factor de riesgo para ciertas complicaciones obstétricas en la población adolescente, especialmente en las adolescentes tempranas. Existen además otros factores, que sumados a la edad materna, constituyen la necesidad de formar equipos multidis-ciplinarios para reducir complicaciones obstétricas en esta población.

Manifestaciones clínicas y complicaciones de la fase aguda de bartonelosis o Fiebre de la Oroya en pacientes atendidos en el Hospital Nacional Cayetano Heredia.

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Ciro Peregrino Maguiña Vargas

2008-07-01

Full Text Available Objetivos: Determinar las características clínicas, epidemiológicas y de laboratorio de la bartonelosis aguda, así como las complicaciones en una serie de pacientes atendidos en el Hospital Nacional Cayetano Heredia. Material y métodos: Estudio descriptivo de tipo serie de casos de pacientes mayores de 15 años con bartonelosis aguda hospitalizados en el Hospital Nacional Cayetano Heredia entre 1993 y 2006. Resultados: La edad promedio fue 27,8 años, 72,7% fueron varones, 51,5% procedía de Lima y 33,3% de Ancash. Los síntomas principales fueron: fiebre 90,9%, cefalea 87,9%, hiporexia 75,5%, baja de peso 63,6%, e ictericia 57,6%. Dos pacientes presentaron alteraciones en el fondo de ojo: retinitis exudativa y retinopatía hemorrágica. El hematocrito promedio fue 20,8% y 63,6% cursaron hematocrito £20%. Hubo desviación izquierda en 24,2%, hiperbilirrubinemia a predominio indirecto 62,5% e hipoalbuminemia (< 3mg/dl 56,5%. Se presentaron complicaciones en 84,8%, el 27,2% requirió internamiento en UCI. Las complicaciones no infecciosas ocurrieron en 84,8%, hematológicas 81,8% y gastrointestinales 78,7%. Las complicaciones infecciosas se presentaron en 12,1%. Los antibióticos más utilizados fueron ciprofloxacina 66,6% y cloranfenicol 42,4%, se administró corticoides en 9,1% y se transfundió paquete globular en 42,4%. Conclusiones: Los pacientes de UCI tuvieron más complicaciones cardiovasculares, trombocitopenia y mayor severidad de la anemia. No se registró mortalidad. (Rev. Med Hered 2008;19:87-95

Caracterización clínico-epidemiológica de las complicaciones crónicas en pacientes diabéticos, tipo 2

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Jorge Enrique Agüero Batista

2015-11-01

Full Text Available Se realizó un estudio descriptivo, prospectivo, con el objetivo de caracterizar las principales complicaciones crónicas que se presentan en pacientes diabéticos tipo 2, del policlínico “Dr. Gustavo Aldereguía Lima” del municipio Las Tunas, así como determinar el nivel de conocimientos de los mismos en aspectos relacionados con su enfermedad, en el período comprendido de enero a diciembre del 2011. Los resultados obtenidos a través de los cuestionarios elaborados fueron analizados por el método porcentual comparativo. En los 484 pacientes estudiados existió un predominio del sexo femenino y el grupo etáreo de mayor incidencia fue el de 60 a 79 años. Las complicaciones crónicas estuvieron presentes en un considerable número de pacientes, las lesiones macroangiopáticas fueron las más relevantes, dentro de ellas, la vasculopatía periférica. La neuropatía diabética fue la más frecuente de las complicaciones microangiopáticas; así como los pacientes con un inadecuado nivel de conocimientos de su enfermedad.

Factores pronósticos de complicaciones postoperatorias en el trasplante hepático Prognostic factors associated with postoperative complications in liver transplantation

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A. Rodríguez-Ariza

2008-03-01

Full Text Available Objetivo: la evolución postoperatoria de los pacientes sometidos a trasplante hepático ortotópico (THO se encuentra frecuentemente asociada a la aparición de diversas complicaciones tales como disfunción renal, rechazo agudo, infecciones y complicaciones neurológicas. Estas complicaciones constituyen las causas más significativas de morbilidad y mortalidad tempranas en pacientes que reciben un THO. El propósito del presente estudio es la identificación de factores relacionados con las distintas complicaciones postoperatorias del THO. Diseño experimental: se llevó a cabo un estudio prospectivo. Pacientes: se analizaron 78 variables en 32 pacientes consecutivos sometidos a THO. Utilizando un análisis de regresión logística se identificaron aquellos factores asociados de forma independiente con la aparición de complicaciones postoperatorias. Resultados: el análisis multivariante demostró que los niveles pretrasplante en suero de malondialdehído y creatinina estaban asociados con el desarrollo de disfunción renal. Los niveles pretrasplante de hemoglobina y las unidades de plaquetas administradas durante la cirugía fueron factores pronósticos de infecciones. El rechazo agudo fue pronosticado por los niveles séricos de γ-glutamil transpeptidasa y de bilirrubina total. Los niveles pretrasplante de sodio y glutaredoxina en suero estuvieron asociados con complicaciones neurológicas. Conclusiones: proponemos estos marcadores para la identificación de pacientes de alto riesgo, permitiendo una vigilancia y/o tratamiento anticipados que mejorarán la morbilidad y la supervivencia en pacientes sometidos a THO.Objectives: the postoperative evolution of patients submitted to orthotopic liver transplant (OLT is frequently associated with the appearance of different types of complications such as renal failure, graft rejection, infections, and neurological disorders. These complications are the most significant causes of early morbidity

Enfermedades poco comunes: una prioridad de los sistemas de salud

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RAP

2017-01-01

Las enfermedades poco comunes, incluidas las de origen genético, son aquellas enfermedades que tienen una prevalencia baja, menor de 5 casos por cada 10.000 habitantes en la comunidad, según la definición de la Unión Europea. Estas enfermedades tienen ciertas características comunes. Son, en su mayor parte, degenerativas y constituyen una prioridad de los sistemas de salud.

Detección de las complicaciones en los pacientes diabéticos que asisten a la unidad básica la libertad, durante los meses de abril y mayo del año 2006

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Elisa Katie Vergel-Arevalo

2006-12-01

Full Text Available La diabetes continua siendo uno de los mayores problemas de salud pública en el mundo, coma consecuencia de complicaciones tales como neuropatías, oftalmopatias, nefropatías, Hipertensión Arterial (HTA, alteraciones micro y macrovasculares. La presente revisión pretende exponer las complicaciones encontradas en una muestra de 14 pacientes diabéticos de la Unidad Básica la Libertad de la ciudad de Cúcuta (Colombia, con el objetivo de detectar tempranamente las complicaciones propias de la Diabetes. El principal respaldo de esta investigación se basa en los grandes estudios epidemiológicos que han demostrado que el control adecuado de la glicemia previene o retarda las complicaciones. Al valorar los pacientes diabéticos se tomaron variables sociodemográficas como sexo, edad, estrato, ocupación y nivel educativo; alteraciones en los niveles de glicemia casual en sangre, en el estado neurológico, oftalmológico, factores que puedan propiciar pie diabético, antecedentes de complicaciones agudas, valores de presión arterial y prácticas como dieta balanceada y ejercicios

Complicaciones de la apendicectomía en mayores de 65 años y su asociación con enfermedades sistémicas en el servicio de emergencia. Hospital Luis Vernaza, enero 2010 - diciembre 2012.

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Guarquila Macías, César

2015-01-01

Determinar si la presencia de una patología sistémica aumenta el riesgo de sufrir una complicación en pacientes geriátricos con diagnóstico de apendicitis aguda; enumerar las complicaciones postquirúrgicas más frecuentes de la apendicectomíaen pacientes geriátricos; relacionar las complicaciones postquirúrgicas de la apendicectomía en pacientes geriátricos con el tiempo de evolución de la enfermedad y demostrar las complicaciones post-quirúrgicas de la apendicetomí...

Complicaciones de los accesos vasculares centrales en los recién nacidos del Instituto Nacional de Perinatología

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S. Carrera Muiños

2016-10-01

Conclusión La incidencia de complicaciones relacionadas con el catéter continúa siendo un problema en todas las unidades de cuidados intensivos neonatales; la sepsis en particular es la principal complicación y la que mayor impacto tiene sobre la morbimortalidad neonatal.

Reintervenciones por complicaciones después de realizada colecistectomía laparoscópica Reinterventions in complications of the laparoscopic cholecystectomy

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Rosalba Roque González

2011-09-01

Full Text Available Durante estos años varios centros con experiencia en colecistectomía laparoscópica han publicado sus complicaciones y tratamiento a estas. El objetivo de este estudio es describir la experiencia en 23 pacientes reintervenidos por complicaciones posoperatorias de la colecistectomía laparoscópica realizadas en el Centro Nacional de Cirugía de Mínimo Acceso, según el reporte de los resultados obtenidos. Se realizó un estudio descriptivo, retrospectivo y longitudinal, en el que se revisaron las historias clínicas de los pacientes reintervenidos por sospecha de complicaciones después de la colecistectomía laparoscópica, en el período comprendido de enero de 1998 a junio de 2010. Durante el período de la investigación se realizaron 10 039 colecistectomías laparoscópicas. Fueron reintervenidos 23 pacientes (0,2 %, con una edad media de 49 años (rango 22 a 73 años, DE ± 10. La relaparoscopia fue la vía para la reintervención (70 % y solo 3 (13 % requirieron cirugía abierta. Fue la colangiopancreatografía retrógrada endoscópica un procedimiento útil para complementar la solución de algunas de estas complicaciones. El tiempo quirúrgico medio en las reintervenciones fue de 67 min (rango 30-120 min, la estadía hospitalaria tuvo una media de 4 y 5 días respectivamente. Hubo 2 pacientes (9 % que se reintervinieron tardíamente, a las 72 h de la colecistectomía, que fallecieron con cuadros de shock séptico. La laparoscopia es un procedimiento adecuado para las reintervenciones en pacientes con sospecha de complicaciones después de colecistectomía laparoscópica, con menor morbilidad y mortalidad sobre otros procederes, y su eficacia para el tratamiento de estas complicaciones está demostrada.Over past years some centers with experience in laparoscopic cholecystectomy have published the complications and treatment of this procedure. The aim of present paper is to describe the experience in 23 patients re-operated on due to

Complicaciones por rotura de aneurismas cerebrales en pacientes operados Hospital Nacional Alberto Sabogal Sologuren 2006 - 2014

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Coasaca Torres, Juan Amilcar

2016-01-01

Determinar las complicaciones que se presentan en el periodo preoperatorio, intraoperatorio y postoperatorio de los pacientes operados de aneurisma cerebral roto en el Hospital Nacional Alberto Sabogal Sologuren de 2006 a 2014. Para lo que se realizó un estudio cuantitativo, observacional, descriptivo, transversal y retrospectivo. Se revisaron las Historias Clínicas de los pacientes operados (clipaje) de aneurisma cerebral roto, que reunían los criterios de inclusión. La data obtenida fue eva...

Complicaciones pulmonares asociadas a ventilación mecánica en el paciente neonatal

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Cristabel Torres-Castro; Jaime Valle-Leal; Alba J. Martínez-Limón; Zaira Lastra-Jiménez; Lesvia Carmina Delgado-Bojórquez

2016-01-01

Introducción: Se buscó determinar la incidencia de complicaciones pulmonares asociadas a ventilación mecánica en pacientes ingresados a un servicio de cuidados intensivos neonatales (UCIN) en un hospital de 2° nivel. Metodología: Estudio analítico retrospectivo en expedientes de recién nacidos ingresados a una sala de UCIN y que recibieron ventilación mecánica en un hospital de segundo nivel de atención médica. Se recabaron datos demográficos, de la ventilación mecánica, la intubación y co...

Complicaciones neurológicas de la endocarditis infecciosa: controversias Neurological complications of infective endocarditis: controversies

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Federico A Silva

2011-07-01

Full Text Available En la endocarditis infecciosa aguda se describen complicaciones neurológicas entre 20% y 40% de los casos, lo cual representa un importante factor que predice morbimortalidad, secuelas y discapacidad. Esta entidad se caracteriza por un amplio espectro clínico debido a su compleja fisiopatología, que involucra entre otros, fenómenos inflamatorios, inmunes, infecciosos y embólicos. A pesar de la notable frecuencia de las complicaciones neurológicas en la endocarditis infecciosa, dadas especialmente por enfermedad cerebrovascular y neuroinfecciones, aun existen controversias acerca de algunos aspectos diagnósticos y terapéuticos, en parte por la poca evidencia disponible, las cuales se discuten a continuación, a partir de una serie de casos atendidos en la Fundación Cardiovascular de Colombia.Neurological complications of acute infective endocarditis are described in 20%-40% of cases, representing an important predictive factor of morbidity, mortality, sequels and disability. Acute endocarditis is characterized by a wide clinical spectrum due to its complex physiopathology that involves inflammatory, immune, infectious and embolic phenomena. Despite the remarkable frequency of neurological complications in the infective endocarditis especially by cerebrovascular disease and neuroinfections, there are still some controversies about some diagnostic and therapeutic aspects, partly because of the little evidence available. This paper describes a number of cases seen in the Fundación Cardiovascular de Colombia and discusses some aspects related with the diagnosis and treatment of the neurological complications of acute endocarditis.

Condición laboral asociada a complicaciones en el embarazo en noreste de México

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Edgar Taboada Aguirre; Eduardo Manzanera Balderas; Maria Mercedes Dávalos Torres

2014-01-01

Introducción: Las complicaciones clínicas en el embarazo son predictores importantes para la mortalidad materna y desenlace del embarazo dependiendo de la atención que reciban las mujeres en este periodo trascendental de la vida. Algunos de los determinantes asociados con el problema están ligados a la situación laboral y la ocupación de la madre durante el embarazo. Material y métodos: Se realizó un estudio transversal en el año 2012, en la Unidad de Medicina Familiar # 43 del Instituto Mexi...

Diabetes Mellitus en el servicio de urgencias: manejo de las complicaciones agudas en adultos

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Eder A. Hernández-Ruiz

2008-01-01

Full Text Available La Diabetes Mellitus (DM es una enfermedad de alta prevalencia, reconocida como un problema de salud pública, debido a sus altas tasas de morbilidad y mortalidad asociadas. Diferentes estudios han documentado que la falta de adherencia al tratamiento, constituye uno de los principales factores desencadenantes para las descompensaciones agudas en el paciente diabético. Dentro del espectro de dichas alteraciones se encuentran las crisis hiperglicémicas agudas, las cuales se han dicotomizado en dos entidades clínicas: la Cetoacidosis Diabética (CAD y el Estado Hiperglicémico Hiperosmolar (EHH, que constituyen complicaciones metabólicas potencialmente fatales en el corto plazo y de las cuales pueden encontrarse cuadros superpuestos. Se han establecido criterios diagnósticos específicos buscando realizar un diagnóstico diferencial acertado, que permita un tratamiento idóneo; sin embargo, las tasas de morbilidad y mortalidad siguen siendo considerables. Por su parte, la Hipoglicemia también constituye una emergencia médica que, de no ser tratada oportunamente, puede ocasionar daño neurológico permanente e incluso la muerte. De lo anterior se deduce la importancia de que existan guías claras de manejo de estas alteraciones en todos los centros y servicios donde se preste atención médica de urgencias. Se siguen realizando investigaciones en busca de nuevas estrategias diagnósticas y terapéuticas que permitan un manejo más integral de la DM y sus complicaciones, en aras de mejorar la calidad de vida de los pacientes.

HEMOGLOBINA GLICOSILADA COMO ELEMENTO PRONÓSTICO EN LAS COMPLICACIONES MACROVASCULARES DE LA DIABETES MELLITUS

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Agnes Fajardo Matarrita

2012-04-01

Full Text Available En este artículo se discute la información obtenida respecto del cuidado enfermero brindado a personas portadoras de Diabetes Mellitus tipo 2 relacionada con la elevación de la hemoglobina glicolisada (Hba1c como factor pronóstico para el desarrollo de complicaciones. Se realizó una búsqueda de la mejor información científica disponible para construir el estado de la cuestión. Posteriormente, se estableció una pregunta en formato PICO (pacientes, intervención, comparación, observación y se procedió a establecer estrategias de búsqueda en las diferentes bases de datos sugeridas en el Curso de Práctica Clínica de Enfermería Basada en la Evidencia impartido por CIEBE-CR, entre las que se encuentran PUBMED, EBSCO HOST, principalmente. El análisis crítico se llevó a cabo mediante las recomendaciones que brinda CASPe y se comparó con la práctica realizada en el Hospital de la Anexión. El control intensivo de la glicemia, el cual incluye agentes orales, la insulina y la intervención cardiovascular múltiple reflejada en hemoglobinas glicosilada menores a 7, indicó que existía una evidente disminución en la incidencia de eventos macrovasculares mayores tales como el infarto agudo al miocardio, el ictus no fatal y el accidente vascular cerebral. De acuerdo con la evidencia, mantener la hemoglobina glicosilada dentro de parámetros normales disminuye el riesgo de sufrir complicaciones macrovasculares de esta patología en comparación con aquellos pacientes que manejan hemoglobina glicosiladaalta.

Análisis de las complicaciones neurológicas en los pacientes diagnosticados de endocarditis infecciosa: 1985-2002

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Tomasa Centella Hernández

2007-07-01

Conclusiones: Las complicaciones neurológicas son una causa frecuente de morbimortalidad en el paciente con EI. Hemos observado un incremento de los casos en las endocarditis sobre válvula na- tiva en los últimos años, sobre todo asociado al incremento de casos producidos por S. aureus. Frecuentemente la complicación neurológica es el evento que conduce al diagnóstico de EI.

Niveles de verbalización y resolución colaborativa de problemas poco estructurados

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José D. Chávez

2015-01-01

Full Text Available Se describieron las verbalizaciones de seis estudian - tes universitarios que resolvieron colaborativamen - te un problema poco estructurado. Partiendo de que aportaban información sobre la regulación metacog - nitiva y la solución de problemas, las verbalizacio - nes fueron categorizadas en niveles. Se utilizaron matrices espacio estado para interpretar los niveles de verbalización y los procesos de resolución de problemas poco estructurados. Se evidenció el predo - minio de verbalizaciones no reguladas, la ausencia de verbalizaciones relacionadas a la elaboración de justificaciones y la superficialidad del monitoreo y la evaluación. La evidencia apoya la idea de que la interacción entre pares no mejora por sí misma la solución de problemas. Los resultados invitan al diseño de situaciones de resolución de problemas que efectivamente promuevan la regulación meta - cognitiva entre pares.

Percepciones de los hombres sobre las complicaciones asociadas a la mutilación genital femenina

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Ismael Jiménez-Ruiz

2016-07-01

Conclusiones: Los participantes procedentes de países donde se realiza la mutilación genital femenina, contrarios a mantener esta práctica, muestran un mayor conocimiento de las consecuencias negativas que los que se manifiestan a favor. El diseño de herramientas y programas de sensibilización destinados a la lucha contra la mutilación genital femenina debe visibilizar las complicaciones sobre la salud de las mujeres y las niñas, e incluir intervenciones familiares que impliquen a los hombres en el proceso de erradicación de esta práctica.

Complications of endoscopic retrograde cholangiopancreatography: A study in a small ERCP unit Complicaciones de la colangiopancreatografía retrógrada endoscópica: Estudio en una unidad pequeña de CPRE

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J García-Cano Lizcano

2004-03-01

procedimiento consolidado para el drenaje de la vía biliar y pancreática, que, sin embargo, conlleva complicaciones. El número parece ser mayor en los centros que realizan menos de 200 CPRE anuales. No obstante, en ocasiones, la distribución de los recursos sanitarios hace preciso realizar esta técnica en centros con menor número de procedimientos. Presentamos la experiencia de las complicaciones de la CPRE en una unidad pequeña. Material y métodos: estudio retrospectivo sobre unos datos recogidos de forma prospectiva durante seis años (1997-2002. En este periodo, dos endoscopistas, trabajando conjuntamente, han realizado 507 CPRE, lo que corresponde a una media aproximada de 84 procedimientos anuales. Resultados: en las 507 CPRE se produjeron 55 complicaciones (10,85% y como consecuencia de ellas, cuatro pacientes fallecieron (0,79%. Hubo 28 pancreatitis (5,5%, 8 hemorragias postesfinterotomía (1,6%, 7 perforaciones bilioduodenales (1,4%, 8 sepsis de origen biliar (1,6% y otras 4 complicaciones varias. Las CPRE con éxito diagnóstico y terapéutico -cuando se precisó- fueron 418 (82,4%, y presentaron 46 (11% complicaciones. Hubo 89 (17,6% CPRE con fallo diagnóstico o terapéutico, que presentaron 9 (10,11% complicaciones (p=0,8 entre ambos grupos. Treinta y cinco (7% CPRE fueron exclusivamente diagnósticas, presentando 6 (17% complicaciones. Las 187 CPRE realizadas para extraer coledocolitiasis, con 14 (7,4% complicaciones, fueron el grupo con menor morbilidad (p=0,04. Conclusiones: la tasa de complicaciones en nuestro centro se encuentra dentro de los rangos publicados. La extracción de coledocolitiasis fue el grupo de CPRE con menos complicaciones. Por su morbilidad, debe valorarse cuidadosamente el riesgo-beneficio de las exploraciones que se prevean exclusivamente diagnósticas.

Microorganismos patógenos y potencialmente patógenos en secreciones genitales de gestantes a término asociados a complicaciones posnatales

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Tania Castellanos Medina

2013-09-01

Full Text Available Introducción: tanto las infecciones puerperales como las neonatales precoces reflejan probablemente los microorganismos que están presentes en la vagina en el período cercano al parto. Objetivo: establecer la relación entre los microorganismos identificados en las secreciones genitales de las gestantes a término y el desarrollo de sepsis neonatal y puerperal, así como vincular dichas complicaciones con los agentes diagnosticados. Métodos: se realizó un estudio longitudinal y prospectivo en los servicios de microbiología, obstetricia, perinatología y neonatología del Hospital General Docente "Dr. "Juan Bruno Zayas Alfonso", de Santiago de Cuba, desde julio de 2009 hasta marzo de 2010. Se identificaron microorganismos en 179 muestras cervicovaginales, las cuales fueron procesadas en el laboratorio de microbiología según las normas vigentes. Resultados: los microorganismos más identificados resultaron los géneros Mycoplasmas y Chlamydias (78,2 y 69,3%, respectivamente y fueron los que con mayor frecuencia se asociaron. Un porcentaje elevado de las gestantes (67,0 %, tenía más de un agente en sus secreciones genitales. Después del parto hubo un hallazgo mayor de infecciones en el producto de la concepción (21,8 % que en las puérperas (3,9% y la mayoría de estas complicaciones se relacionaron con la presencia de 2 o más microorganismos. Conclusiones: las asociaciones de microorganismos patógenos o potencialmente patógenos en las secreciones genitales de embarazadas a término, aumentan el riesgo de complicaciones posnatales.

Sífilis una enfermedad que puede producir serias complicaciones en el organismo y producir la muerte. Puede detectarse a tiempo y tiene cura

OpenAIRE

Portilla, José Luis

2009-01-01

La sífilis es una ETS que puede causar complicaciones a largo plazo o la muerte, si no se trata de manera adecuada. Los síntomas en los adultos se dividen en fases. Estas fases son sífilis primaria, secundaria, latente y avanzada.

Immunological response in cases of complicated and uncomplicated bartonellosis during pregnancy Respuesta inmunologica en casos de bartonelosis con y sin complicaciones durante el embarazo

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Erick Huarcaya

2007-10-01

Full Text Available Bartonellosis (Carrion's Disease during pregnancy is associated with high rates of maternal and perinatal mortality. We report the immunological patterns in two cases of human bartonellosis during pregnancy. One patient had an uncomplicated course while the second patient developed life threatening anasarca and cardiac tamponade. The patient with a complicated course had a Th1 response with a higher elevation of IL-10. This elevation has been associated with poor outcome pregnancies during bacterial infections.Bartonelosis (Enfermedad de Carrión durante el embarazo esta asociado a una alta tasa de mortalidad maternal y perinatal. Reportamos el perfil inmunológico de dos casos de Bartonelosis humana en el embarazo. Una paciente tuvo un curso sin complicaciones, mientras la segunda presento complicaciones severas de anasarca y tamponamiento cardiaco. La paciente con curso complicado tuvo un patrón de repuesta Th1, con una elevación de IL-10, que se ha asociado a mal pronóstico en infecciones durante embarazo.

Factores causales en las complicaciones de estomas intestinales en cirugía de emergencia. Hospital Luis Vernaza, 2013.

OpenAIRE

Morán Mancero, María Cristina

2014-01-01

El estoma intestinal es una apertura del intestino en la superficie del abdomen. Las estadísticas según diversos autores indica que hay aproximadamente unas 32.000 personas ostomizadas, de las cuales el 75% presentan una colostomía y el 10% una ileostomía. Objetivo:Determinar los factores causales en las complicaciones tempranas y tardías de los estomas intestinales en la cirugía de emergencia.Metodología:Estudio de tipo Retrospectivo, Observacional, Transversal, de nivel Descriptivo y diseño...

Incapacidad laboral por diabetes mellitus: características epidemiológicas y complicaciones macro y microangiopáticas más frecuentes

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Raúl Jesús Regal Ramos

2014-03-01

Full Text Available La diabetes mellitus (DM es la enfermedad metabólica más frecuente y conlleva la disminución en la calidad de vida de los sujetos que la padecen, así como la pérdida de años de vida productiva a consecuencia de las complicaciones crónicas o de la mortalidad. Objetivo: Conocer las características epidemiológicas de los pacientes con invalidez permanente (IP debida a DM y conocer cuáles son las complicaciones más frecuentes que motivaron la IP y su relación con las distintas ocupaciones. Método: Se realizó un estudio descriptivo en el que se recogieron pacientes valorados en la Unidad Médica de la Dirección Provincial del INSS de Madrid entre los años 2005 a 2011 con el diagnóstico de diabetes. Se excluyeron aquellos expedientes que no fueron calificados como IP, aquellos que presentaban otras patologías no relacionadas con la diabetes subsidiarias de probable incapacidad (como procesos oncológicos, demencia, esclerosis múltiple,.. y los casos de diabetes secundarias. Se estudian las variables edad, sexo, estado civil, profesión, régimen de afiliación a la Seguridad Social, y las recogidas en el apartado diagnóstico del informe médico de síntesis (tipo de diabetes, complicaciones derivadas de la DM y factores de riesgo cardiovascular. Resultado: El total de pacientes estudiados fue de 896. Respecto a la población general ocupada de nuestro entorno observamos un 31% más de varones (p< 0,0005; Razón de prevalencia =1,56 y un 28% más de ocupaciones del grupo VII de la CNO-11 (industria y construcción (p < 0,005; Razón de prevalencia =2,3. El 48% de las profesiones científicas y el 36 % de las administrativas estaban diagnosticados de oftalmopatía. El 39% de trabajadores de industria y construcción estaban diagnosticados de algún grado de coronariopatía. Conclusión: Nuestros resultados permiten objetivar que la oftalmopatía es la complicación que más se asocia a invalidez permanente en profesiones de alta

Uranium ore from Morro do Agostinho, Pocos de Caldas, Minas Gerais, Brazil

International Nuclear Information System (INIS)

Matsuda, H.T.

1976-01-01

Three non-destrutive methods for determination of uranium from Morro do Agostinho's ore, Pocos de Caldas, Minas Gerais are presented. Comparative data between chemical analysis (volumetric method) and cited non-destructive methods are shown. Gamma spectrometry, x-rays fluorescense and delayed neutrons counting are the methods discussed. Uranium's and molibdenium's behavior related to anionic sulphuric resin system is also discussed. Comparative studies concerning retention of uranium and molibdenium in strong and weak anionic resins as well as selective elution using appropriate solvents are shown [pt

Complicaciones maternas de la cesárea en gestantes a término en periodo expulsivo en un hospital general de Lima, Perú

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Javier Puma

2015-01-01

Full Text Available Objetivo: Describir las complicaciones maternas de la cesárea en gestantes a término en periodo expulsivo en un hospital general. Material y métodos: Estudio descriptivo, observacional, retrospectivo, tipo serie de casos, realizado en el Hospital Nacional Cayetano Heredia entre el 1 de enero de 2011 hasta el 31 diciembre de 2012. Se incluyeron 67 gestantes a término operadas en periodo expulsivo. Se revisaron las historias clínicas de las pacientes, se registraron las características clínicas y las complicaciones maternas. Resultados: En el periodo de estudio se realizaron 4 218 cesáreas, siendo el 1,84% hechas en periodo expulsivo. En general, 59/ 67 (88,1% presentaron algún tipo de complicación. Se observaron 8 casos de hipotonía uterina (11,9% y 2 (2,9% de atonía. En 5 (7,4% pacientes ocurrieron desgarros de segmento adyacente a la histerotomía, siendo 2 de ellos asociados a compromiso de cuerpo uterino y vagina, y 4 (5,9% casos a laceración de arteria uterina, uno fue bilateral. No se produjeron lesiones en tracto urinario ni digestivo y tampoco hubo necesidad de reintervención quirúrgica. Cuatro pacientes presentaron hemorragia puerperal, dos asociados a hipotonía uterina post cesárea. En 56 (83,5% casos ocurrió anemia post operatoria. Hubo 1 (1,5% caso de endometritis, 3 (4,5% infecciones de herida operatoria. Conclusiones: La cesárea realizada en período expulsivo ocasiona complicaciones frecuentes, algunas muy severas.

Characterization of Rn-222 production in Campo do Cercado C/09 Pocos de Caldas, Minas Gerais State

International Nuclear Information System (INIS)

Pereira, E.B.

1977-01-01

A systematic study for correlating the Rn-222 escape with the main geochemical and mineralogical factors for understanding of some change processes from uranium deposits in Campo do Cercado C-09 in Pocos de Caldas, Minas Gerais State is described. (author)

Guia de atencion integral para la prevencion, deteccion temprana y tratamiento de las complicaciones del embarazo: Sección de Toxoplasmosis

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Jorge Alberto Cortes

Full Text Available Resumen Como parte de la Guia de atencion integral para la prevencion, deteccion temprana y tratamiento de las complicaciones del embarazo, desarrollada y financiada por el Departamento de Ciencia, Tecnologia e Innovacion, Colciencias, y el Ministerio de Salud y Proteccion Social de Colombia, se seleccionó a la infeccion por Toxoplasma para el desarrollo de recomendaciones para su prevencion, diagnostico y tratamiento. La infeccion por Toxoplasma gondii (T. gondii durante el embarazo puede resultar en graves complicaciones para el feto y dejar importantes secuelas al recien nacido. Se realizo una guia basada en la mejor evidencia disponible en la literatura cientifica, con especial pertinencia a la informacion colombiana. Un consenso de expertos en parasitologia, ginecologia, neonatologia e infectologia, tanto de adultos como pediatrica, desarrollo las recomendaciones. Se propone que las recomendaciones de esta guia de atencion integral sean utilizadas por los profesionales de salud de los programas de atencion del embarazo del pais con el fin de disminuir la morbilidad y mortalidad atribuible a esta enfermedad. Se formulan recomendaciones especificas para el diagnostico desde el primer trimestre, consejos de prevencion en las mujeres no infectadas, identificacion de la infeccion del feto o del recien nacido y recomendaciones de tratamiento en estos escenarios.

Análisis de costo de la enfermedad, del tratamiento, las complicaciones e intervenciones de la hipercolesterolemia en México en 2016.

Science.gov (United States)

Baeza-Cruz, German; Peniche-Otero, Gustavo; Alva-Esqueda, Mónica E; Naranjo-Muedano, Mariana; Soria-Suárez, Noé; Morales-Flores, Héctor J

2018-04-20

Describir los costos y el impacto económico de la atención de pacientes diagnosticados con hipercolesterolemia en México en el año 2016. METODOLOGíA: Se desarrolla una evaluación económica del tipo análisis de costo de la enfermedad donde se cuantifican los recursos médicos utilizados para el tratamiento de la hipercolesterolemia así como para sus complicaciones. Los costos de los recursos médicos utilizados son obtenidos de los costos unitarios por nivel de atención del Instituto Mexicano del Seguro Social (IMSS) así como de las licitaciones publicadas en el portal de compras del IMSS. El uso de recursos se obtiene mediante un panel de expertos y para el porcentaje de presencia de las complicaciones se efectúa una revisión de literatura. Los costos médicos directos son estimados multiplicando la frecuencia de uso por el costo unitario, agrupándolos y obteniendo así los costos individuales de cada recurso médico. Los casos de hipercolesterolemia en prevención secundaria con enfermedad coronaria y enfermedad cardiovascular representan un mayor costo promedio anual ($111,835.19, D.E. $84,276.37), seguido de la hipercolesterolemia en prevención secundaria con enfermedad coronaria sin enfermedad cardiovascular ($56,352.13, D.E. $29,004.04), los cuales no incluyen los costos generados por las complicaciones. El resto de los grupos de hipercolesterolemia representan una carga económica menor. La carga económica de la hipercolesterolemia representa en promedio por caso al año $258,761.37, esto traducido a los aproximadamente 445,075 de casos diagnosticados y tratados al año representaría un impacto económico en el sistema de salud de más de ciento quince mil millones ($115,168,331,355.11). Copyright © 2018. Published by Elsevier Inc.

Ausentismo y complicaciones de salud en usuarios de programas de hipertensión arterial de Santa Marta (Colombia

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Brigith Sánchez Serrano

2017-01-01

Full Text Available Objetivo:Identificar los factores presentes y las complicaciones de pacientes inscritos en losprogramas de hipertensión arterial de ocho centros ambulatorios de Santa Marta.Metodología:Estudio descriptivo, ambispectivo y multicéntrico; población conformada por24 programas de prevención y control de hipertensión arterial, seleccionados aleatoriamenteocho de ellos (30 %. De los 750 casos de inasistentes se calculó un tamaño muestral de 254,valor elevado a 300 para reducir el error de estimación. La información se recolectó medianteun cuestionario de identificación de condiciones de habilitación de programas, base de datos deinasistentes y aplicación de entrevista semiestructurada.Resultados:El porcentaje de incumplimiento de las condiciones de los programas de hipertensiónfue de (9 %; el récord de ausentismo de pacientes inscritos fue de 35,62 %. Mientras que losprincipales factores que motivaron el ausentismo fueron de orden institucional (32,6 %, personal(26,3 %, socioeconómicos (8.5 %, otras alternativas de tratamiento (9,4 %; las complicacionesmanifestadas sobresalientes se relacionaron con angina de pecho (34,1 %, alteraciones renales(29,2 % e infartos (9.7 %.Conclusiones:A pesar de los esfuerzos que llevan a cabo los organismos de salud para laprevención y el control de la hipertensión, aún es necesario desarrollar nuevas estrategias quereduzca el índice de ausentismo de los pacientes inscritos a dichos programas, y de esa maneracontribuir positivamente en la reducción de las tasas de complicaciones en la salud.

Radioactive ores from Agostinho field, Pocos de Caldas (MG), Brazil

International Nuclear Information System (INIS)

Fujimori, K.

1974-01-01

Aiming to characterize the radioactive minerals of Campo Agostinho, Pocos de Caldas - Brazil, the survey of all natural radiactive elements and their geochemical behaviors, decays and radioactive equilibrium was done. Several models of radioactive instability of the minerals or the radioactive samples were proposed to characterize the geochemistry and the mineralization of radioactive elements. The complete isotopic analysis of the elements was done by high resolution gamma spectrometry, using a Ge(Li) detector, at the temperature of liquid nitrogen, coupled to a multichannel analyser. The sample in radioactive equilibrium of Atomic Energy Comission of United States - A.S. n.6, NBL - New Brunswick Laboratory, was considered as standard sample. Fluorite, zircons, pirite, molibinite, rutile, anatase, niobophyllite, and in small ratio (bellow 0.1%) uranothorianite, coffinite, pyrochlore, monazite and apatite. (M.C.K.) [pt

Complicaciones de la Ventilación Mecánica. Unidad de Cuidados Intensivos Pediátricos Holguín

OpenAIRE

Carlos Alberto Córdova-Vega; Hèctor Pupo-Rodríguez; Andrés Andrés-Matos

2013-01-01

Se realizó un estudio prospectivo, descriptivo en pacientes ingresados en la Unidad de Cuidados Intensivos del Hospital Pediátrico de Holguín y que necesitaron ventilación mecánica por un tiempo mayor a las 24 horas, durante el año 2010, con el objetivo de conocer las complicaciones relacionadas con este proceder. Dentro de los resultados encontramos que las afecciones neurológicas (35,29%), las respiratorias y las malformaciones congénitas (17,64%) fueron las principales causas que llevaron ...

Celulitis orbitaria como forma de presentación de la sinusitis complicada en el niño Orbital cellulitis as a way of presentation of the complicated sinusitis in the child

OpenAIRE

Odette Pantoja Pereda; María del Carmen Luis Álvarez; Dayamí Benítez Rodríguez; Marlen Rivero González; Laura Pérez-Oliva Sánchez

2012-01-01

La sinusitis aguda es un proceso inflamatorio de la mucosa de los senos paranasales, de etiología bacteriana principalmente. Es más frecuente en las edades escolares y en las épocas de mayor circulación de los virus respiratorios. Se desarrolla cuando se afecta el drenaje normal de los senos y se retienen las secreciones mucosas. Las complicaciones más severas, como celulitis y abscesos periorbitarios, son raras. La celulitis orbitaria es una entidad poco frecuente, cuya importancia radica en...

139. Complicaciones Neurológicas Mayores en Octogenarios Tras Cirugía Cardíaca: ¿Es la Edad un Factor Limitante?

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G. Laguna

2012-04-01

Conclusiones: la incidencia de complicación neurológica mayor no es significativamente superior en nuestra población de octogenarios. Mientras en menores de 80 años la existencia de enfermedad vascular es el principal factor determinante, la inadecuada oxigenación cerebral, derivada de situaciones de anemia preoperatoria, parece influir más en la presencia de complicaciones neurológicas en los mayores de 80 años.

Complicaciones orales en pacientes sometidos a radioterapia: revisión de literatura / Oral Complications in Patients Undergoing Radiotherapy: A Review of Literature

OpenAIRE

Hurtado Redondo, Diana Carolina; Universidad Nacional de Colombia sede Bogotá; Estrada Montoya, John Harold; Universidad Nacional de Colombia sede Bogotá

2013-01-01

Objetivo: Presentar los principales conceptos de radiobiología, radioterapia en cavidadoral y complicaciones asociadas, para llevar a cabo acciones seguras de tipo preventivo yterapéutico por parte del profesional o del equipo tratante. Método: La revisión se llevó acabo en diferentes bases de datos y revistas acerca del manejo odontológico de pacientessometidos a radioterapia. Resultados: Actualmente, el tratamiento para el cáncer tiene unenfoque multidisciplinario, en el cual participan dis...

Celulitis orbitaria como forma de presentación de la sinusitis complicada en el niño

Directory of Open Access Journals (Sweden)

Odette Pantoja Pereda

2012-03-01

Full Text Available La sinusitis aguda es un proceso inflamatorio de la mucosa de los senos paranasales, de etiología bacteriana principalmente. Es más frecuente en las edades escolares y en las épocas de mayor circulación de los virus respiratorios. Se desarrolla cuando se afecta el drenaje normal de los senos y se retienen las secreciones mucosas. Las complicaciones más severas, como celulitis y abscesos periorbitarios, son raras. La celulitis orbitaria es una entidad poco frecuente, cuya importancia radica en que puede asociarse a la pérdida de la visión y otras complicaciones. Se presenta el caso de un paciente de 6 años, afectado con celulitis orbitaria, secundaria a sinusitis, y se comentan las peculiaridades del diagnóstico y el tratamiento, con el objetivo de alertar al pediatra para su diagnóstico temprano, lo que optimizaría su tratamiento.

Posibles causas de aneurisma y pseudoaneurisma de la fístula arteriovenosa en pacientes con insuficiencia renal

OpenAIRE

Franco Pérez, Neobalis; Valdés Pérez, Calixto; Savigne Gutiérrez, William Orlando; Reynaldo Concepción, Daniel

2015-01-01

El acceso vascular ideal debe proporcionar un flujo adecuado a las necesidades de la diálisis, debe ser de larga duración y tener una baja tasa de complicaciones. La realización de una fístula autóloga se considera de primera elección como acceso vascular para la hemodiálisis. Si bien se conocen las causas de los aneurismas y pseudoaneurismas de las fistulas, estos son muy pocos frecuentes y por ello es importante conocer que aparecen. Mostramos varios casos de aneurismas y pseudoaneurismas d...

262. Seudoaneurisma Sacular Aórtico y Origen Anómalo de Carótida Izquierda

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N. Arce

2012-04-01

Conclusión: aunque poco frecuentes, las anomalías en el origen de los troncos supraaórticos implican un mayor riesgo de complicaciones neurológicas para el uso de endoprótesis en procedimientos híbridos. El abordaje convencional, mediante esternotomía media con extensión cervical de la incisión, hipotermia profunda y parada circulatoria permite, en estos casos, una más adecuada preservación de la perfusión cerebral aunque no evita totalmente el daño neurológico.

Paciente con tumor de cuerpo carotideo

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Mariuska Forteza Sáez

Full Text Available Los tumores de cuerpo carotideo (paragangliomas son neoplasias altamente vascularizadas, muy poco frecuentes y generalmente benignas, originadas en los quimiorreceptores del cuerpo carotideo. Se presenta el caso de un paciente de 54 años, con aumento de volumen cervical derecho, asintomático, con estudio preoperatorio y angiografía realizados por tomografía axial computarizada, que resultan compatibles con tumor de cuerpo carotideo. Se realiza disección subadventicial, informando la biopsia paraganglioma. El tumor fue completamente resecado, sin evidencia de recurrencia y sin complicaciones.

Cavernoma de la vena porta: Descripción de casos clínicos pediátricos

OpenAIRE

Maurente, Lucía; García, Ma Lucila; Machado, Karina; López, Carola; Montano, Alicia

2012-01-01

Resumen La cavernomatosis portal es una patología poco frecuente causada por la trombosis de la vena porta. Es la principal causa de hipertensión portal en niños. La causa muchas veces no se identifica, pudiendo reconocerse factores predisponentes, entre los cuales los más frecuentes son el cateterismo de la vena umbilical y la onfalitis. Se manifiesta a través de sus complicaciones: hemorragia digestiva alta por várices esofágicas y esplenomegalia. El diagnóstico se confirma con ecografía ab...

Characterization of potassic materials of Pocos de Caldas alkaline massif, Southeastern Brazil; Caracterizacao de materiais potassicos do macico alcalino de Pocos de Caldas (MG)

Energy Technology Data Exchange (ETDEWEB)

Goncalves, P.; Navarro, F.C.; Roveri, C.D. [Universidade Federal de Alfenas (UNIFAL), MG (Brazil); Bergerman, M.G., E-mail: pattypgpatty@gmail.com [Universidade de Sao Paulo (USP), SP (Brazil)

2016-07-01

Potassium, which has featured in Brazil's agricultural sector and in the world's in the application of fertilizers, is present in magmatic rocks, such as nepheline syenite and phonolite, found in the Alkaline Massif of Pocos de Caldas (AMPC). The rare earth elements (REE), in turn, also occur in this region and have important uses in various industrial fields. The aim of this study was to investigate the potential of potassic rocks of AMPC in the fertilizer and rare earths industry. Five samples were collected and characterized. It was observed that there was no preferential concentration by granulometric range of potassium oxide, alumina, silica and iron oxide. Feldspathic mass, potash feldspar, and muscovite were found in all samples. The samples show REE with amounts greater than those found in the earth's crust, except for lutetium and scandium and possessed average content of potassium oxide from 8.70 to 14.40%. (author)

A geostatistical investigation of the spatial variation of external gamma exposure in urban area of Pocos de Caldas Plateau

International Nuclear Information System (INIS)

Silva, Nivaldo C.; Macacini, Jose F.; Taddei, Maria H.T.; Montano, Marcelo; Fontes, Aurelio T.

2008-01-01

Full text: The Pocos de Caldas Plateau has been recognized as High Level of Natural Radiation Area for a long time. It consists in an alkaline intrusion with some uranium and thorium anomalies, where the first Brazilian uranium mining and milling facilities is located. Due to these facts, the population of Pocos de Caldas city shows a great deal of concern about radiation health effects. This perception of the risks of radiation exposure leads to much confusion among the population that attributes an imaginary excess (without an scientific support) of cancer cases and deformities in newborns in the city to radiation. In order to obtain information for help radiation risks management by government and to explore the spatial variation external gamma exposure a survey in the urban area of Pocos de Caldas city was done. The measurements were performed using a Mobile Radioactivity Measurement System - Mobisys (ESM Eberline model FHT 1376). The system consists of a high-sensitivity 5-liter scintillation detector, an electronic for measurement system that is able to on-line separate natural and artificial gamma radiation (Natural Background Rejection Detector NBR), one compact Global Positioning System GPS and a computer (notebook). Data was collected at approximately 50,000 points spread over all streets of city. The obtained results ranged from 40 nSv.h -1 to 420 nSv.h -1 where the mean value was 112 nSv.h -1 . The spatial distribution of gamma exposure over the city is quite homogeneous with lowest and highest values in western and southern area, respectively. (author)

Geology and Geochemistry of the Poco de Fora region-Curaca river valley-Bahia-Brazil

International Nuclear Information System (INIS)

Figueiredo, M.C.H. de.

1976-01-01

In the Poco de Fora region level rocks of light metamorphism, from Caraiba group, corresponding to: - a meta-sedimentar sequence from Lower Pre-cambrian (Archean) - maphic-ultramaphic bodies with Fe and Cu sulphides of volcanogenic origin, and - sienitic ortho-gneiss. Geological, petrographic, geochemistry and geochronological studies were done. The sienitic-intrusion, from the upper crust, occur during the Archean-beginning of the Proterozoic. All the region was re-mobilized, and the sienitic was metamorphosed during Transamazonic Orogeny (2.200 to 1.800 m.y.). (C.D.G.) [pt

Developed methodology for the geologic control of the secondary uranium concentrations in Osamu Utsumi, Pocos de Caldas (MG)

International Nuclear Information System (INIS)

Magno Junior, L.B.

1982-01-01

It was developed a methodology for the geologic control of the mining of the secondary uranium concentrations in the Osamu Utsumi mine, Pocos de Caldas. A sequential systematization with the definitions and objectives of the operational phases of the mining explotation is shown, in addition of a scheme and flow charts of them. (A.B.) [pt

Complicaciones presentadas en pacientes mayores de 65 años ingresados por fractura de cadera en un hospital andaluz de tercer nivel

OpenAIRE

López-Hurtado, Felipe; Miñarro del Moral, Rosa María; Arroyo Ruiz, Verónica; Rodríguez Borrego, Mª Aurora

2015-01-01

Objetivo: Conocer las complicaciones que se han producido en pacientes mayores de 65 años, ingresados en un hospital andaluz de tercer nivel durante el año 2012, con diagnóstico principal de fractura de cadera. Metodología: Diseño: Se realizó un estudio descriptivo transversal. Ámbito, periodo y sujetos de estudio: Pacientes ingresados en el año 2012 mayores de 65 años con diagnóstico principal de fractura de cadera. Variables principales: Morbimortalidad recogida en el C...

“Integración de un Paradigma: Mecanismos Biomoleculares y Patogénicos, Precursores de las Complicaciones de la Diabetes”

Directory of Open Access Journals (Sweden)

Mario Sánchez Medina

2005-03-01

Inmensa cantidad de información científica y periodística hay sobre el tema del progreso de la diabetes en el mundo, particularmente en los países desarrollados, que se refleja también en los países en desarrollo con inquietante incertidumbre, por el incremento vertiginoso de la enfermedad. Uno de los problemas que más concierne a los profesionales de la salud y, desde luego, a las familias que tienen diabetes, obesidad y factores genéticos predisponentes en sus antecedentes, es el hallazgo de la presencia de complicaciones microvasculares antes de que ellos mismos sepan que están desarrollando la enfermedad...

The hydrothermal alteration in the context of geologic evolution from Pocos de Caldas Alkaline Massif, MG-SP

International Nuclear Information System (INIS)

Garda, G.M.

1990-01-01

The Pocos de Caldas Alkaline Massif covers 800 km 2 , a quarter of which is hydrothermally altered. Such proportion is uncommon, when compared to the know alkaline massifs of the world. The hydrothermal alteration is associated with Zr, U and Mo mineralizations which are predominantly located in the central-southern portion of the massif, in the central-eastern circular structure. The colour of the altered rock (and its soil) in that area is typically whitish beige to yellowish white and is regionally called potassic rock. The Osamu Utsumi Mine, also referred to as the uranium ore of Campo do Cercado, is located 25 Km to the south of Pocos de Caldas City and was explored, from 1977 to 1989, through the open pit method. A sequence of alteration minerals adapted to lowering temperatures should be expected; however, only illite and alkaline feldspar are observed in the hydrothermally altered portions of the massif, and their formation must have been controlled mainly by kinetic, other than thermal factors. The irrestrict circulation of relatively hotter hydrothermal fluids must have happened at the beginning of the process, diminishing immediately after the cooling of the brecciated areas (and the subjacent magmatic body), leading the system to kinetics levels that made subsequent hydrothermal alteration impossible. (author)

Derrame pericárdico y pericarditis purulenta por Salmonella: un caso excepcional

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Jorge Pulido-Arenas

2017-09-01

Full Text Available Las complicaciones cardiovasculares asociadas a las infecciones por la Salmonella son raras y suceden entre el 1 a 5% de los pacientes. Las enfermedades del pericardio son extremadamente inusuales con pocos casos reportados en la literatura. Presentamos el caso de un adulto mayor con síntomas de derrame pericárdico y hallazgos de pericarditis purulenta en quien la etiología corresponde a infección por la Salmonella spp. confirmada por hallazgos clínicos, de imágenes diagnósticas, microbiológicos, quirúrgicos e histopatológicos.

Envenenamiento en niños por mordedura de la araña "Latrodectus Mactans" (Viuda Negra): Características clínicas y tratamiento

OpenAIRE

Sotelo-Cruz, Norberto; Hurtado-Valenzuela, Jaime Gabriel; Gómez-Rivera, Norberto

2006-01-01

Introducción: El envenenamiento por mordedura de araña "viuda negra" es poco frecuente en edades pediátricas sin embargo no está exento de complicaciones y si no se trata a tiempo puede causar la muerte. En México se desconoce el número exacto de estos accidentes. Objetivo: Identificar los signos y síntomas característicos, evolución y tratamiento de los niños atendidos por morderua de araña en el Hospital Infantil del Estado de Sonora, con el propósito de establecer el tratamiento oportuno. ...

Neumotórax bilateral como complicación de metástasis pulmonar cavitaria de un angiosarcoma

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Lorena V. Maldonado

2014-06-01

Full Text Available Las metástasis pulmonares de angiosarcoma constituyen una complicación común de una neoplasia maligna poco frecuente. Habitualmente se presentan como nódulos solidos periféricos y derrame pleural. Presentamos el caso de un hombre de 65 años de edad con neumotórax bilateral recurrente, secundario a metástasis cavitadas de un angiosarcoma primitivo de cuero cabelludo. La videotoracoscopia permitió la inspección, la resección de las metástasis y la pleurodesis. No ocurrieron complicaciones ni recurrencia tumoral a los seis meses de seguimiento.

Cirugía de la fibrilación auricular

OpenAIRE

Hernandez-Estefania, R. (Rafael); Martin-Trenor, A. (Alejandro); Levy-Praschker, B.G. (Beltran G.); Rabago, G. (Gregorio)

2011-01-01

La cirugía de la fibrilación auricular se basa en la creación de cicatrices de aislamiento en la aurícula con el propósito de evitar los fenómenos de reentrada que inician y perpetúan la arritmia, permitiendo la reconducción del estímulo normal desde el nodo sinusal hasta el nodo auriculo-ventricular. La técnica quirúrgica inicialmente descrita (basada en incisiones y sutura), compleja y poco utilizada por el riesgo de complicaciones, potenció el desarrollo de otros procedimientos actuales, e...

iDESWEB: Ejercicio: JavaScript: Una página web con un poco de código (encuesta de valoración)

OpenAIRE

Luján Mora, Sergio

2013-01-01

Solución del ejercicio "JavaScript: Una página web con un poco de código (encuesta de valoración)" del curso MOOC iDESWEB, Introducción al desarrollo web. Página web del curso: http://idesweb.es/

Distribution of radioactive anomalies at Morro do Ferro hill in Pocos de Caldas Alkaline Complex, MG

International Nuclear Information System (INIS)

Fujimori, K.

1980-10-01

Sistematic radiation intensity measurements were alone at Morro do Ferro hill in the Pocos de Caldas Alkaline Complex, using portable Scintrex spectrometer for U, Th, K and total counting (TC). Complementary geochemical analyses were alone on selected 26 samples. It was observed that there are many radiation focii in that place and they are oriented in the E-W direction. The geochemical analyses show that Uranium has participated also in the inicial mineralization of radioactive elements. The contribution of 238 U series daugher elements is relatively strong although Uranium was 'washed' by leaching. (Author) [pt

Geoprocessing as a technical tool for radiological assessment in the urban area of Pocos de Caldas, MG

International Nuclear Information System (INIS)

Silva, Nivaldo C.; Macacini, Jose F.; Alberti, Heber L.C.

2009-01-01

The present study will introduce a methodology for spatial evaluation of external gamma dose throughout an urbanized region. As a case study, geoprocessing techniques were used to gather data, perform statistical and spatial data treatment related to natural gamma radioactivity throughout the Pocos de Caldas urban area. This information, which was initially punctual, could be correlated with the number of people exposed to natural radiation using the database from the census made available by IBGE (Brazilian Geography and Statistics Institute). The census sector is the smallest piece of territory, with identifiable physical boundaries in the field, with adequate size for research operations. All 54,237 geoprocessed external dose values, within dosimetry ranges, presented a variation from 0.33 mSv year -1 to 3.51 mSv year -1 , with an average equal to 0.95 mSv year -1 . The results obtained, when compared to worldwide dose values (0.06 mSv year -1 to 1.23 mSv year -1 with an average of 0.48 mSv year -1 ) indicated that though the average value in Pocos de Caldas - 0.95 mSv year -1 - is almost twice the world average, it is within the dosimetry range found in other countries. Nevertheless, the region has some areas with values higher than those observed elsewhere in the world, though in areas with lower population density. (author)

Characterization of potassic materials of Pocos de Caldas alkaline massif, Southeastern Brazil

International Nuclear Information System (INIS)

Goncalves, P.; Navarro, F.C.; Roveri, C.D.; Bergerman, M.G.

2016-01-01

Potassium, which has featured in Brazil's agricultural sector and in the world's in the application of fertilizers, is present in magmatic rocks, such as nepheline syenite and phonolite, found in the Alkaline Massif of Pocos de Caldas (AMPC). The rare earth elements (REE), in turn, also occur in this region and have important uses in various industrial fields. The aim of this study was to investigate the potential of potassic rocks of AMPC in the fertilizer and rare earths industry. Five samples were collected and characterized. It was observed that there was no preferential concentration by granulometric range of potassium oxide, alumina, silica and iron oxide. Feldspathic mass, potash feldspar, and muscovite were found in all samples. The samples show REE with amounts greater than those found in the earth's crust, except for lutetium and scandium and possessed average content of potassium oxide from 8.70 to 14.40%. (author)

El papel de enfermería en atención primaria para prevenir y detectar las complicaciones de los diabéticos tipo 2

OpenAIRE

Gomez Marciel, Aitor

2017-01-01

El aumento de la población, de la expectativa de vida y de los malos hábitos como el sedentarismo, la dieta inadecuada y la obesidad influyen directamente en la incidencia y prevalencia de diabetes mellitus en el mundo, caracterizándola como epidemia mundial. Según la Organización Mundial de la Salud, 422 millones de adultos tenían diabetes en 2014. El objetivo de este trabajo ha sido conocer el rol de enfermería para evitar y detectar complicaciones y comprobar si los cuidados que efectúa so...

Adolescentes estudantes: conhecimentos das complicações do aborto provocado Adolescentes estudiantes: conocimientos de las complicaciones de abortamiento Female teenager students: knowledge abortion complications

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Divanise Suruagy Correia

2011-09-01

Full Text Available O objetivo deste estudo foi identificar o conhecimento das complicações do aborto provocado e sua relação coma a idade. Estudo transversal, realizado em escolas de Maceió, Alagoas, com estudantes dos 12 aos 19 anos. A amostra foi calculada considerando-se os dados de internação de curetagem pós aborto. Usou-se o programa Epi Info versão 3.6 para análise dos dados. Das 2592 adolescentes estudadas, 65,64% não conheciam nenhuma complicação do aborto provocado e as complicações mais citadas foram morte e esterilidade. Manifestações clínicas do aborto foram incorretamente citadas como complicações. Encontrou-se significação entre o conhecimento das complicações esterilidade e hemorragia e idade. A morte foi significativa para menores de 15 anos e a esterilidade para as maiores. Conclui-se que as adolescentes não conhecem corretamente as complicações do aborto provocado, o que demonstra o risco daquelas que o provocam, verifica-se, portanto, a necessidade de maiores esclarecimentos sobre o tema bem como da educação sexual.El objetivo de este estudio fue identificar el conocimiento de las complicaciones del aborto inducido y su relación con la edad. Estudio transversal, realizado en escuelas, de Maceió, Alagoas, Brasil, con adolescentes de los 12 a los 19 años. La muestra fue calculada a partir de los datos de las internaciones para legrado después del aborto. Fue usado para analiza de los datos el Epi Info. De las 2592 adolescentes estudiadas, 65.64% no sabían de ninguna complicación del aborto inducido y las complicaciones mas citadas fueran muerte y esterilidad. Las manifestaciones clínicas del aborto también fueran citadas como complicaciones. Hube significación entre el conocimiento de la esterilidad y la hemorragia y edad. La muerte fue significativa para las menores de 15 años y la esterilidad para las más grandes. Se concluye que las adolescentes no sabían correctamente las complicaciones del aborto

Factores asociados a complicaciones de la colangiopancreatografía retrógrada endoscópica en un hospital de alta complejidad Factors associated to complications of endoscopic retrograde cholangiopancreatography in a third-level hospital

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Angel Quispe-Mauricio

2010-06-01

Full Text Available El tratamiento endoscópico de las enfermedades de la vía biliar es posible gracias a la colangiopancreatografía retrógrada endoscópica (CPRE; no obstante, no está exenta de complicaciones. Objetivos. Describir las características e indicaciones de la CPRE y determinar los factores asociados al desarrollo de complicaciones tras la realización de este procedimiento. Materiales y métodos. Se realizó un estudio observacional retrospectivo en el Departamento de Gastroenterología del Hospital Nacional Guillermo Almenara Irigoyen en Lima, Perú; desde marzo de 2002 a junio de 2005. Resultados. Se evaluaron 294 informes en 280 pacientes, la mediana de la edad fue 58 y 155 (52,7% fueron mujeres; cinco procedimientos se efectuaron en la Unidad de Cuidados Intensivos (UCI. La indicación más frecuente fue la coledocolitiasis en el 67,3% de los casos, 205 (69,7% procedimientos fueron exitosos complicándose sólo 33 de ellos. Las complicaciones más frecuentes fueron la pancreatitis aguda y la hemorragia, en 16 y 13 pacientes, respectivamente. No se reportó casos de perforación o defunción. La canulación del conducto pancreático más de una vez fue un factor asociado (OR=2,01; IC95%: 1,11 - 5,92; p=0,03. Conclusiones. El 11,2% de los casos se complicaron, siendo la pancreatitis aguda y la hemorragia leve las complicaciones más frecuentes. Sólo la canulación al conducto pancreático en más de una oportunidad es un factor asociado para tener complicaciones.Endoscopic treatment of the bile duct diseases is possible thanks to the ERCP (endoscopic retrograde cholangio pancreatography, nevertheless, it is not free of complications. Objectives. To describe the characteristics and indications of the ERCP and determine the factors associated to the development of complications after performing the procedure. Materials and methods. An observational retrospective study was done in the Gastroenterology Department of the Hospital Guillermo Almenara

Antibióticos para prevenir las complicaciones posteriores a la extracción de dientes

Directory of Open Access Journals (Sweden)

2014-05-01

Hay pruebas de que los antibióticos profilácticos reducen el riesgo de infección, alveolitis y dolor posterior a la extracción del tercer molar y dan lugar a un aumento de los efectos adversos leves y transitorios. No está claro si las pruebas de esta revisión son generalizables a los pacientes con enfermedades concomitantes o inmunodeficiencia, o a los pacientes sometidos a la extracción de dientes debido a la caries grave o a la periodontitis. Sin embargo, los pacientes en mayor riesgo de infección presentan mayor probabilidad de beneficiarse con los antibióticos profilácticos debido a que es probable que las infecciones en este grupo sean más frecuentes, se asocien con complicaciones y sean más difíciles de tratar. Debido al aumento de la prevalencia de bacterias resistentes al tratamiento con los antibióticos disponibles actualmente, los médicos deben considerar cuidadosamente la probabilidad de que el tratamiento de 12 pacientes sanos con antibióticos para prevenir una infección cause más daños que beneficios.

Distribution of uranium, thorium and potassium in the alkaline rocks of Pocos de Caldas massif

International Nuclear Information System (INIS)

Rocha, E.B.

1985-01-01

The Pocos de Caldas massif, with area about 800 Km 2 , represents the greatest complex of alkaline rocks existent in the American continent. Although values of U and Th are well Known in the mineralized areas, few has been registered with respect to the distribution of those elements outside the ore deposits. The rocks of the massif, in general, present high contents of U and Th when confronted with the surrouding country rocks. The distribution of the U and Th appoint a relevant additional data in the discussion on the hypothesis of nepheline syenites bodies formation in Pocos de Caldas by crystal fractionation processes. In this work are provided results of the U, Th and K distribution in the main petrographic facies occurring in the several studies places of the massif, yielded by gamma-ray spectrometric analysis of the samples. Those analysis disclose that khibinites present average values about 38 ppm U and 120 ppm Th; lujavrites, about 14 ppm U and more than 70 ppm Th; U-Th depleted nepheline synites, about 12 ppm U and 38 ppm Th, Th/U ratios are close to 3,0 in the nepheline syenites, about 3,7 in the phonolites, reaching values close to 4,0 in the khibinites. These values are comparable with others Th/U ratios of selected series of alkaline rocks reported in the international literature. Uranium and Th comparative data, attained by delayed neutron counting activation analysis also are given. The results obtained for the fluorimetric analysis show loss of U leaching is greater in the fine-grained rocks (phonolites) than coarse-grained ones (lujavrites, Khibinites). The autoradiographic studies reveal that radioactive elements are found concentrated in mineral phases. A new assessment of the radiogenic heat production it is also available. (Author) [pt

Síntomas y complicaciones posfunduplicatura: abordaje diagnóstico y tratamiento

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S. Sobrino-Cossío

2017-07-01

Full Text Available En la actualidad la funduplicatura laparoscópica tipo Nissen se considera el tratamiento quirúrgico de elección para la enfermedad por reflujo gastroesofágico (ERGE y su efectividad a largo plazo es mayor del 90%. Dentro de los factores predictores de buena respuesta clínica están la adecuada selección del paciente y la experiencia del cirujano. Sin embargo, la prevalencia de síntomas nuevos, persistentes y recurrentes posteriores al procedimiento antirreflujo puede ser de hasta un 30%. Las causas son múltiples pero en general se deben a una o más alteraciones en la anatomía y en la función esofagogástrica. Ante la persistencia de los síntomas posterior al procedimiento quirúrgico se debería de utilizar el término «falla». En el caso de que un paciente inicialmente manifieste control de sus síntomas y posteriormente estos reaparezcan, se pudiera emplear el término «disfunción». Por otra parte, ante el empeoramiento de los síntomas o la aparición de síntomas o situaciones clínicas que no existían antes de la cirugía, debe de considerarse una «complicación». La disfagia postoperatoria y los síntomas dispépticos son muy frecuentes y requieren un abordaje integral para poder determinar el mejor tratamiento posible. En esta revisión se detallan los aspectos fisiopatológicos, de diagnóstico y tratamiento de los síntomas y las complicaciones posteriores a la funduplicatura para el manejo de la ERGE.

Evaluation of NORM concentration in water treatment of Pocos de Caldas municipality, MG, Brazil: preliminary results; Avaliacao da presenca de NORM no tratamento de agua do municipio de Pocos de Caldas: resultados preliminares

Energy Technology Data Exchange (ETDEWEB)

Ferreira, Adriano Mota; Villegas, Raul A.S.; Fukuma, Henrique Takuji, E-mail: htfukuma@cnen.gov.br, E-mail: adrianomotaferreira@gmail.com [Comissao Nacional de Energia Nuclear (CNEN), Rio de Janeiro, RJ (Brazil)

2014-07-01

NORM is the acronym used to refer to naturally occurring radioactive materials. Besides being objects of study and monitoring such materials can be used as raw material or as by-products or waste of industrial activities. Oil and gas, mining and water treatment are examples of facilities that can handle NORM. In such cases, their concentration at significant levels from the perspective of environmental and occupational radiation protection may occur. This study aims to evaluate the presence of the natural radioactive {sup 238}U and {sup 232}Th series in the treatment of city water elements Pocos de Caldas - MG (water, materials and waste). The study can serve as an indication of the necessity of a more detailed review in the locally and in the country on this radiological issue. (author)

Ground water chemical evolution of Pocos de Caldas - Minas Gerais State -Brazil

International Nuclear Information System (INIS)

Cruz, W.B.; Peixoto, C.A.M.

1991-01-01

The chemical evolution and the origin of the groundwater, cold and thermal springs composition are analysed related to the geochemical environment of the Pocos de Caldas alkaline complex. The thermal waters origin are related to a large and deep open fracture system in three main directions: N14E, N50E and E-W. The tritium content when simultaneously analysed with the deuterium and oxygen-18 set show that thermal waters are old meteoric waters (30-40 years of age). On the other hand, the cold springs that circulate on the superficial levels are more recent, which is a characteristic of an acid oxidizing environment without sulfides and greater concentration of free CO 2 and Rn 222 . The pH increases slowly with depth and also the H C O 3 - , Na + , SO 4 2- and the Si O 2 content. High concentrations of fluoride follow this process. Reducing environment with an increase in the sulphide content and a decrease in radioactivity are trends in the system studied. (author)

Estimative of alpha radiation dose due to natural concentration of Ra-226 in waters from Pocos de Caldas

International Nuclear Information System (INIS)

Sigaud, G.M.

1979-01-01

A dosimetric model for calculating the annual dose equivalent for an individual and the annual collective dose equivalent from 226 Ra is developed. This model is applied to the measured concentrations of 226 Ra in waters of the hydro graphic basins of the Pocos de Caldas plateau, using the pathways of drinking water and ingestion of food grown in irrigated fields. A linear model for simulating potential 226 Ra contamination of the waters of the region is also applied, and the doses from these contaminations are estimated using the dosimetric model developed. (author)

19 CFR 134.14 - Articles usually combined.

Science.gov (United States)

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Articles usually combined. 134.14 Section 134.14... TREASURY COUNTRY OF ORIGIN MARKING Articles Subject to Marking § 134.14 Articles usually combined. (a) Articles combined before delivery to purchaser. When an imported article is of a kind which is usually...

Complicaciones postquirúrgicas en la población infantil de 1 a 17 años intervenidos por trauma abdominal y torácico en el servicio de cirugía pediátrica del hospital “Carlos Andrade Marín” desde el mes de junio de 2013 hasta septiembre de 2016

OpenAIRE

López Vaca, César Augusto

2017-01-01

El trauma pediátrico provoca altos índices de mortalidad y morbilidad, que generan gran coste económico y humano, por lo que requiere de métodos que permitan hacer una estimación del riesgo de aparición de complicaciones y de esta manera identificarlas y tratarlas tempranamente. Objetivo: Identificar los factores asociados a complicaciones postquirúrgicas en la población infantil de 1 a 17 años intervenidos por trauma abdominal y torácico en el servicio de Cirugía Pediátrica del Hospital “Ca...

Isotope disequilibria 4n series in the Morro do Ferro System, Pocos de Caldas (MG)

International Nuclear Information System (INIS)

Bonotto, D.M.; Fujimori, K.

1986-01-01

Thorium isotopic analyses were performed on well spoils of the main ore body at Morro do Ferro, Pocos de Caldas (MG), on groundwaters from several boreholes in the area and surface waters from a stream that originates at the base of the hill. For extraction of thorium a long chemical process was applied to samples; activities of Th-228 and Th-232 isotopes (4n series) were determined by alpha spectrometry method. The rations Th-228/Th-232 determined for well spoils did not show marked disequilibria between these isotopes. In ground and surface waters, the ratios Th-228/Th-232 showed marked isotopic fractionation between these nuclides, not related to selective leaching of Th-228 in relation to Th-232 or recoil of Th-228 nucleons. (author) [pt

Revisiting Pocos de Caldas. Application of the co-precipitation approach to establish realistic solubility limits for performance assessment

International Nuclear Information System (INIS)

Bruno, J.; Duro, L.; Jordana, S.; Cera, E.

1996-02-01

Solubility limits constitute a critical parameter for the determination of the mobility of radionuclides in the near field and the geosphere, and consequently for the performance assessment of nuclear waste repositories. Mounting evidence from natural system studies indicate that trace elements, and consequently radionuclides, are associated to the dynamic cycling of major geochemical components. We have recently developed a thermodynamic approach to take into consideration the co-precipitation and co-dissolution processes that mainly control this linkage. The approach has been tested in various natural system studies with encouraging results. The Pocos de Caldas natural analogue was one of the sites where a full testing of our predictive geochemical modelling capabilities were done during the analogue project. We have revisited the Pocos de Caldas data and expanded the trace element solubility calculations by considering the documented trace metal/major ion interactions. This has been done by using the co-precipitation/co-dissolution approach. The outcome is as follows: A satisfactory modelling of the behaviour of U, Zn and REEs is achieved by assuming co-precipitation with ferrihydrite. Strontium concentrations are apparently controlled by its co-dissolution from Sr-rich fluorites. From the performance assessment point of view, the present work indicates that calculated solubility limits using the co-precipitation approach are in close agreement with the actual trace element concentrations. Furthermore, the calculated radionuclide concentrations are 2-4 orders of magnitude lower than conservative solubility limits calculated by assuming equilibrium with individual trace element phases. 34 refs, 18 figs, 13 tabs

Revisiting Pocos de Caldas. Application of the co-precipitation approach to establish realistic solubility limits for performance assessment

Energy Technology Data Exchange (ETDEWEB)

Bruno, J.; Duro, L.; Jordana, S.; Cera, E. [QuantiSci, Barcelona (Spain)

1996-02-01

Solubility limits constitute a critical parameter for the determination of the mobility of radionuclides in the near field and the geosphere, and consequently for the performance assessment of nuclear waste repositories. Mounting evidence from natural system studies indicate that trace elements, and consequently radionuclides, are associated to the dynamic cycling of major geochemical components. We have recently developed a thermodynamic approach to take into consideration the co-precipitation and co-dissolution processes that mainly control this linkage. The approach has been tested in various natural system studies with encouraging results. The Pocos de Caldas natural analogue was one of the sites where a full testing of our predictive geochemical modelling capabilities were done during the analogue project. We have revisited the Pocos de Caldas data and expanded the trace element solubility calculations by considering the documented trace metal/major ion interactions. This has been done by using the co-precipitation/co-dissolution approach. The outcome is as follows: A satisfactory modelling of the behaviour of U, Zn and REEs is achieved by assuming co-precipitation with ferrihydrite. Strontium concentrations are apparently controlled by its co-dissolution from Sr-rich fluorites. From the performance assessment point of view, the present work indicates that calculated solubility limits using the co-precipitation approach are in close agreement with the actual trace element concentrations. Furthermore, the calculated radionuclide concentrations are 2-4 orders of magnitude lower than conservative solubility limits calculated by assuming equilibrium with individual trace element phases. 34 refs, 18 figs, 13 tabs.

The average concentrations of 226Ra and 210Pb in foodstuff cultivated in the Pocos de Caldas plateau

International Nuclear Information System (INIS)

Hollanda Vasconcellos, L.M. de.

1984-01-01

The average concentrations of 226 Ra and 210 Pb in vegetables cultivated in the Pocos de Caldas plateau, mainly potatoes, carrots, beans and corn and the estimation of the average transfer factors soil-foodstuff for both radionuclides, were performed. The total 226 Ra and 210 Pb content in the soil was determined by gamma spectrometry. The exchangeable fraction was obtained by the classical radon emanation procedure and the 210 Pb was isolated by a radiochemical procedure and determined by radiometry of its daughter 210 Bi beta emissions with a Geiger Muller Counter. (M.A.C.) [pt

Glucosilación no enzimática y complicaciones crónicas de la diabetes mellitus Non-enzymatic glycosylation and chronic complications of diabetes mellitus

Directory of Open Access Journals (Sweden)

Jeddú Cruz Hernández

2010-08-01

Full Text Available INTRODUCCIÓN: la hiperglucemia es considerada hoy como un factor patogénico fundamental del desarrollo de las complicaciones neurovasculares diabéticas y, específicamente, desempeña un papel preponderante en el fenómeno de la glucosilación no enzimática y la formación de productos finales de la glucosilación avanzada. OBJETIVOS: describir los mecanismos de la formación de los productos finales de la glucosilación avanzada y su relación con las complicaciones de la diabetes mellitus. DESARROLLO: los productos finales de la glucosilación avanzada se producen por la reacción no enzimática de la glucosa y otros derivados glucados (glioxal, metilglioxal y 3-desoxiglucosona con grupos amino de proteínas de larga vida. La glucosilación altera la estructura, las propiedades físico-químicas y la función de las proteínas intracelulares y extracelulares. En la membrana basal de los pequeños vasos se produce un engrosamiento y una distorsión de su estructura, que ocasiona pérdida de la elasticidad de la pared vascular y una permeabilidad anormal de esta a las proteínas (disfunción endotelial, así como aumento de la génesis de especies reactivas del oxígeno. La unión de productos finales de la glucosilación avanzada a sus receptores de membrana favorece la producción citoquinas y factores de crecimiento por los macrófagos y células mesangiales. Todo lo anterior favorece al desarrollo de aterosclerosis. CONCLUSIONES: los productos finales de la glucosilación avanzada desempeñan un importante papel en el desarrollo de las complicaciones microvasculares y macrovasculares en el diabético. El control metabólico estricto de la glucemia y, en la actualidad, la terapéutica farmacológica con agentes que inhiben la formación de productos finales de la glucosilación avanzada o tienen acción antioxidante, constituyen alternativas terapéuticas para la prevención y solución del problema de las complicaciones crónicas de la

Modelling of redox front and uranium movement in a uranium mine at Pocos de Caldas, Brazil

International Nuclear Information System (INIS)

Cross, J.E.; Gabriel, D.S.; Haworth, A.; Sharland, S.M.; Tweed, C.J.

1991-04-01

A study of the migration of uranium at the Pocos de Caldas uranium mine in Brazil under the influence of the infiltration of oxidising groundwaters has been performed. The modelling was carried out using the coupled chemical equilibria/transport code CHEQMATE. The work presented in this paper extends a previous study. Results give some encouraging agreements with field data, generally increasing confidence in the use of such modelling techniques in problems associated with the migration of radionuclides away from a nuclear waste repository. For particular aspects of the problem where good agreement with field data was not obtained, a number of reasons have been suggested. This study also highlights the importance of accurate thermodynamic data and choice of solubility-limiting mineral phases for modelling such systems. (author)

Fourth natural analogue working group meeting and Pocos de Caldas project final workshop

International Nuclear Information System (INIS)

Come, B.; Chapman, N.A.

1991-01-01

The fourth meeting of the CEC-sponsored natural analogue working group (NAWG) was held in Pitlochry, Scotland, from 18 to 22 June 1990, and also included the final workshop of the Pocos de Caldas (Brazil) natural analogue project, sponsored by Nagra (CH), SKB (S) UK-DOE and US-DOE. About 80 specialists attended this meeting, originating from EC Member States and also Australia, Brazil, Canada, Finland, Japan, Sweden, Switzerland and the USA. The IAEA and OCDE-NEA were also represented. This plenary meeting was the opportunity to review and discuss five years of progress and activities of natural analogues in central areas of performance assessment: waste forms and engineered barriers, geochemistry and radionuclide speciation, radionuclide migration and the overall geological context of radwaste disposal. In addition, a feedback session provided the opportunity for regulators and those individuals who had advisory roles to give their views and impressions on the significance of natural analogue research. These proceedings, divided into two sessions, contain 32 technical papers and 14 abstracts of published papers

Evaluation of NORM concentration in water treatment of Pocos de Caldas municipality, MG, Brazil: preliminary results

International Nuclear Information System (INIS)

Ferreira, Adriano Mota; Villegas, Raul A.S.; Fukuma, Henrique Takuji

2014-01-01

NORM is the acronym used to refer to naturally occurring radioactive materials. Besides being objects of study and monitoring such materials can be used as raw material or as by-products or waste of industrial activities. Oil and gas, mining and water treatment are examples of facilities that can handle NORM. In such cases, their concentration at significant levels from the perspective of environmental and occupational radiation protection may occur. This study aims to evaluate the presence of the natural radioactive 238 U and 232 Th series in the treatment of city water elements Pocos de Caldas - MG (water, materials and waste). The study can serve as an indication of the necessity of a more detailed review in the locally and in the country on this radiological issue. (author)

Ore reserve evalution, through geostatistical methods, in sector C-09, Pocos de Caldas, MG-Brazil

International Nuclear Information System (INIS)

Guerra, P.A.G.; Censi, A.C.; Marques, J.P.M.; Huijbregts, Ch.

1978-01-01

In sector C-09, Pocos de Caldas in the state of Minas Gerais, geostatistical techniques have been used to evaluate the tonnage of U 3 O 8 and associated minerals and to delimit ore from sterile areas. The calculation of reserve was based on borehole information including the results of chemical and/or radiometric analysis. Two-and three dimensional evalutions were made following the existing geological models. Initially, the evaluation was based on chemical analysis using the more classical geostatistical technique of kriging. This was followed by a second evaluation using the more recent technique of co-kriging which permited the incorporation of radiometric information in the calculations. The correlation between ore grade and radiometric was studied using the method of cross-covariance. Following restrictions imposed by mining considerations, a probabilistic selection was made of blocks of appropriate dimensions so as to evaluate the grade tonnage curve for each panel. (Author) [pt

Effluent control for the uranium mine area at Pocos de Caldas, Brazil

International Nuclear Information System (INIS)

Rochedo, E.R.R.; Vasconcellos, L.M.H.

2005-01-01

Derived levels for effluents control for the Industrial Complex of Pocos de Caldas - CIPC, Brazil were set based on the IAEA recommendation for the dose assessment of critical groups. Although the industry has stopped the uranium extraction in 1988, the installation is kept under regulatory control, as it has not yet been decommissioned. A screening procedure was set to control the effluent releases from the three main areas, the open pit mine area, the tailings dam and the waste rock piles. To each one of these areas, the dose restriction of 0,3 mSv/a was adopted, since each effluent refers to a different critical group. Monthly-composed samples are collected weekly at each outflow and sent to IRD. The radionuclides analyzed are 238 U, 226 Ra, 210 Pb, 232 Th and 228 Ra. If the activity concentration for any of these nuclides surpasses the established reference level to that particular source, a complete dose assessment for the critical group is performed using the computer program, Monitor, built based on IAEA recommendations for dose assessment to critical groups. The results show that Brazilian regulations related to public exposure are being accomplished by the installation operation. It is pointed out the relevance of maintaining the current treatment to the acid drainages and effluents from the tailings dam, until the whole area is properly decommissioned. (author)

Thorium deposit of Morro do Ferro in Pocos de Caldas, Brazil: an analogue of a radioactive waste repository

International Nuclear Information System (INIS)

Franca, E.P.; Carlos, M.T.; Sachett, I.A.; Campos, M.J.M.T. de; Lei, W.; Eisenbud, M.; New York Univ., NY

1986-01-01

A highly weathered deposit of thorium and rare earth elements located near the summit of a hill (Morro do Ferro) in Pocos de Caldas M.G., is being studied as an analogue for a radioactive waste repository that, sometime in the distant future, may be eroded to the surface or intruded by groundwater. Th - serves as an analogue for Pu 4+ and La 3+ as an analogue for Cm 3+ and Am 3+ . The mobilization rates of the analogue elements by groundwater are so slow (10 -7 to 10 -9 per year), as to suggest that essentially complete radioactive decay of transuranic actinides would occur in place, even under the unfavorable conditions that exist at a site such as this. (Author) [pt

Determination of Geogenic Radon Potential (GEORP) in Pocos de Caldas - Brazil

International Nuclear Information System (INIS)

Santos, Marcelo T.; Silva, Nivaldo C.; Guerrero, Eder T.Z.; Navarro, Fabiano C.; Oliveira, Rodrigo J.

2015-01-01

The noble gas 222 Rn is a radioactive isotope of the element radon that can be found in atmospheric air, among others gases, at broad range of concentration. This isotope decays from 238 U series, which is normally found in soil and rocks, especially in fault zones and fractures, where uranium presents greater mobility. The atmospheric high concentration of this gas is frequently related to confined environments including dwellings and other buildings with low air ventilation rate. Inhalation of this gas is acknowledged by international agencies such as WHO, as the second leading cause of lung cancer, being the first among the non-smoker population. That is the reason why, some countries have defined their regions with high radon potential where it is justified the implementation of construction techniques to reduce indoor radon concentration. This paper uses the Geogenic Radon Potential (GEORP) approach aiming to identify radon prone areas in the urban zone of Pocos de Caldas - Brazil. GEORP encompasses simultaneous measurements of the soil gas permeability and radon soil gas concentration. This investigation was accomplished using RADON-JOK permeameter, a device specially developed for in situ soil gas permeability, and ALPHAGUARD, a professional radon monitor. A large variability was observed in both radon soil concentration and soil gas permeability. Some areas have presented low gas permeability due to clayey soil characteristics thus medium GEORP. The majority of the points in this paper have been identified with high radon soil gas concentration showing values that reached 1,000 kBq.m -3 and presenting high radon index. (author)

Determination of Geogenic Radon Potential (GEORP) in Pocos de Caldas - Brazil

Energy Technology Data Exchange (ETDEWEB)

Santos, Marcelo T.; Silva, Nivaldo C.; Guerrero, Eder T.Z., E-mail: apoc@cnen.gov.br [Comissao Nacional de Energia Nuclear (LAPOC/CNEN-MG), Pocos de Caldas, MG (Brazil). Laboratorio de Pocos de Caldas; Navarro, Fabiano C.; Oliveira, Rodrigo J., E-mail: campus.pcaldas@unifal-mg.edu.br [Universidade Federal de Alfenas (UNIFAL), Pocos de Caldas, MG (Brazil). Instituto de Ciencia e Tecnologia

2015-07-01

The noble gas {sup 222}Rn is a radioactive isotope of the element radon that can be found in atmospheric air, among others gases, at broad range of concentration. This isotope decays from {sup 238}U series, which is normally found in soil and rocks, especially in fault zones and fractures, where uranium presents greater mobility. The atmospheric high concentration of this gas is frequently related to confined environments including dwellings and other buildings with low air ventilation rate. Inhalation of this gas is acknowledged by international agencies such as WHO, as the second leading cause of lung cancer, being the first among the non-smoker population. That is the reason why, some countries have defined their regions with high radon potential where it is justified the implementation of construction techniques to reduce indoor radon concentration. This paper uses the Geogenic Radon Potential (GEORP) approach aiming to identify radon prone areas in the urban zone of Pocos de Caldas - Brazil. GEORP encompasses simultaneous measurements of the soil gas permeability and radon soil gas concentration. This investigation was accomplished using RADON-JOK permeameter, a device specially developed for in situ soil gas permeability, and ALPHAGUARD, a professional radon monitor. A large variability was observed in both radon soil concentration and soil gas permeability. Some areas have presented low gas permeability due to clayey soil characteristics thus medium GEORP. The majority of the points in this paper have been identified with high radon soil gas concentration showing values that reached 1,000 kBq.m{sup -3} and presenting high radon index. (author)

Complicaciones maternas en adolescentes y adultas afiliadas al régimen subsidiado, 2012 / Maternal Complications in Adolescents and Adults Affiliated to the subsidized regime, 2012

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Lina M. Díaz B.

2015-09-01

Full Text Available RESUMEN La intervención de las complicaciones maternas y la minimización de sus efectos en la salud materno-infantil es prioridad para el cuidado en salud de esta población. La identificación de factores asociados a la complicación materna es de vital importancia para definir políticas y estrategias de intervención de esta problemática. Objetivo: determinar los factores asociados a complicaciones durante el tercer trimestre del embarazo, parto y puerperio de las maternas pertenecientes al régimen subsidiado atendidas en una institución de segundo nivel de complejidad de Medellín. Metodología: investigación de cohorte ambiespectivo, que tiene como factor de exposición la edad (expuesto: adolescentes entre 14 y 19 años, no expuesto: entre 20 y 34 años de edad y la complicación materna. Se calcularon frecuencias absolutas y relativas para las variables cualitativas y media, mediana y rango intercuartílico para las variables cuantitativas, se calculó proporción de incidencia de las complicaciones y el riesgo relativo crudo y ajustado por variables de confusión. Resultados: el principal factor de riesgo asociado a complicación materna fue la atención prenatal inadecuada (criterio de Kessner. Se encontró como factor protector la asistencia al curso psicoprofiláctico. Conclusión: no se encontraron grandes diferencias entre la población adolescente y adulta, pero sí se identificaron aspectos sociales (relaciones familiares, educacionales y de atención en salud que pueden afectar la salud materna de la población del régimen subsidiado atendida por una institución de segundo nivel de complejidad./ Abstract The intervention of maternal complications and the minimization of its impact on mother and child health is a priority for this population's health care. Identifying factors associated with maternal complications is critical to devising policies and intervention strategies against this problem. Objective: to determine the

Study of the application of non-plastic clays from Pocos de Caldas - part 1: chemical-mineralogic characterization

International Nuclear Information System (INIS)

Roveri, C.D.; Mariano, N.A.; Faustino, L.M.; Aielo, G.F.; Pinto, L.P.A.; Maestrelli, S.C.

2011-01-01

Pocos de Caldas is an important 'hidrotermomineral' center of Brazil, where can be found non-plastic clays deposits with no significant records about its characterization; this fact difficult the studies of industrial application. These nonplastic clays, not used, have been stored in sheds or open, which creates a high cost to the industry, and become an environmental liability. In the present work, the chemical-mineralogical study of six samples of non-plastic clays was realized, to expand the horizons of researches about such materials. This preliminary study showed that, overall, the samples are composed of refractory minerals such as kaolinite and gibbsite, with less significant amounts of other phases such as quartz, illite and vermiculite. The chemical analysis permitted the grouping of raw materials into two groups according to their refractories proprieties, guiding to the subsequent characterization. (author)

Lipotransferencia en piernas con o sin fasciotomía subcutánea de la aponeurosis tibial posterior

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I.R. Añorve-Borquez

2014-03-01

Full Text Available La lipotransferencia en muslos y piernas es un procedimiento muy poco empleado como complemento a la lipoescultura, siendo ésta una zona muy importante para dar más armonía y belleza al contorno corporal. Analizamos 139 procedimientos de lipotrasnferencia en muslos y piernas, ésta última complementada con o sin fasciotomía subcutánea de la aponeurosis tibial posterior o fascia profunda de la pierna. Describimos la técnica y las cantidades de grasa empleadas según zonas disminuyendo al mínimo las complicaciones y reacciones secundarias, que cuando se producen en las piernas, y si no se ha realizado la fasciotomía, puede confundir con otras patologías tales como es el síndrome compartimental y/o la trombosis venosa profunda.

Analgesia epidural para el alivio del dolor después del reemplazo de cadera o de rodilla

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2014-07-01

Conclusiones de los autores: La analgesia epidural puede ser útil para el alivio del dolor postoperatorio después de reemplazos importantes de articulaciones de los miembros inferiores. Sin embargo, los efectos beneficiosos pueden estar limitados al período postoperatorio temprano (cuatro a seis horas. Una infusión epidural de anestésico local o una mezcla de anestésico-narcótico local puede ser mejor que un narcótico epidural solo. La magnitud del alivio del dolor se debe sopesar contra la frecuencia de eventos adversos. Las pruebas actuales no son suficientes para establecer conclusiones sobre la frecuencia de complicaciones poco frecuentes de la analgesia epidural, la morbilidad o mortalidad postoperatorias, los resultados funcionales o la duración de la estancia hospitalaria.

Risk management in environmental pollution: a case study of the uranium mining and milling facilities at Pocos de Caldas, Minas Gerais, Brazil

International Nuclear Information System (INIS)

Fernandes, H.M.; Prado, V.C.S.; Veiga, L.H.S.; Amaral, E.C.S.; Freitas, P.; Bidone, E.D.

1993-01-01

Environmental risk management concept was adapted to uranium mining and milling facilities at Pocos de Caldas, Minas Gerais, Brazil. Environmental radionuclide and metal concentration in surface waters, efficiency of the effluent treatment were evaluate. The data shows that the effluent treatment was effective to reduce pollutant releases in the environment but the benefit in the dose reduction may be questioned. In addition it's stressed the necessity of a metal exposure assessment due to vegetables consumption that has never been developed in that region. (B.C.A.). 07 refs, 02 figs, 02 tabs

Ra-226 collective dosimetry for surface waters in the uranium mining region of Pocos de Caldas

International Nuclear Information System (INIS)

Paschoa, A.S.; Sigaud, G.M.; Montenegro, E.C.; Baptista, G.B.

1980-01-01

Graphs of the collective dose equivalent for the whole body, bone, gastro-intestinal tract (lower large intestine), kidneys, and liver, via the pathways of drinking water and ingestion of food grown in irrigated fields are presented as a function of the 226 Ra concentrations in the surface waters of the Pocos de Caldas region. The collective dose equivalent calculated from the 226 Ra concentrations measured in the baseline studies are compared with those collective dose equivalent estimated from the projected higher 226 Ra concentrations in the river waters. The 226 Ra concentrations in river waters of the region are expected to be enhanced due to 226 Ra releases from uranium mining and milling operations. The dose equivalent commitment for the exposed population for the referred pathways is also estimated for the contribution of the mine during its predicted time of operation. The assumptions for the dose calculations are presented and the results obtained are discussed. (H.K.)

Manejo de catéteres centrales de inserción periférica en recién nacidos

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Dora Isabel Giraldo-Montoya

2008-01-01

Conclusión: actualizar el protocolo usual y efectuar modificaciones relacionadas con la indicación de inserción y la frecuencia de la toma de rayos X, y enfatizar los cuidados de enfermería para prevenir complicaciones como infección, flebitis, obstrucción y desplazamiento.

Adnexal germ cell carcinoma with bone metastases in pregnant women: case report and review

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María Del Rosario Tenorio -Guadalupe

2016-08-01

Full Text Available Resumen El carcinoma de células germinales durante el embarazo es una entidad poco frecuente, a pesar de que su detección ha aumentado debido al posicionamiento de la ecografía de control fetal dentro del programa de control prenatal. En este artículo se reporta el caso de una gestante de 27 años de edad, diagnosticada de carcinoma anexial de células germinales a las seis semanas de gestación, cuyo abordaje inicial fue la resección local (citorreducción subóptima. Cuatro semanas después de la cirugía, la paciente debutó con neuropatía periférica grado IV en miembros inferiores, cuyo hallazgo por imagenología (resonancia magnética nuclear indicó lesión infiltrante paravertebral a nivel de D5. En junta médica se decidió que reciba tratamiento de quimioterapia a partir de la semana 19 de la gestación. El embarazo cursó sin complicaciones y la paciente fue sometida a cesárea a las 34 semanas de gestación teniendo como producto un recién nacido vivo sin complicaciones. Desafortunadamente, cuatro días luego de la cesárea, la paciente falleció a consecuencia de un shock séptico de foco respiratorio.

Comparing four methods to estimate usual intake distributions

NARCIS (Netherlands)

Souverein, O.W.; Dekkers, A.L.; Geelen, A.; Haubrock, J.; Vries, de J.H.M.; Ocke, M.C.; Harttig, U.; Boeing, H.; Veer, van 't P.

2011-01-01

Background/Objectives: The aim of this paper was to compare methods to estimate usual intake distributions of nutrients and foods. As ‘true’ usual intake distributions are not known in practice, the comparison was carried out through a simulation study, as well as empirically, by application to data

Contribution to the study of uranium migration and some trace elements in solution from Pocos de Caldas uranium mining

International Nuclear Information System (INIS)

Zenaro, R.

1989-01-01

It was studied the chemical composition of ground water from four boreholes as a contribution to the hydrogeochemical studies in the Pocos de Caldas uranium mining. Methods for water analyses were selected and optimized in order to determine the main anions, specially the ones which form stable complexes with uranium ions. Fluoride and chloride were determined by potentiometry; phosphate, nitrate and silicate by spectrophotometry. Cations were determined by atomic absorption spectrophotometry flame emission and argon plasma emission excited by continuous current arch (DCP). Uranium was determined by fluorimetry with a concentration range from 3 to 7 ppb and its distribution calculated among the different species into solution through the measures of pH, Eh, anion amounts and stability of their respective complexes. (author) [pt

Petrography, structure and geochemistry of nepheline syenites from the Pocos de Caldas alkaline massif, states of Minas Gerais and Sao Paulo, Brazil

International Nuclear Information System (INIS)

Ulbrich, H.H.

1984-01-01

The subcircular Mid-Cretaceous Pocos de Caldas alkaline massif, states of Minas Gerais and Sao Paulo, southern Brazil, covers over 800 Km 2 , and has as its main rock types phonolites and nepheline syenites, with subordinate amounts of pyroclastic rocks. Nepheline syenites consist mainly of K-feldspar, nepheline and pyroxene, varying both in texture and 'rare-metal silicates' content. A useful petrographic division is that which classifies the rocks into agpaitic and non-agpaitic (miaskitic or intermediate) types. The latter varieties, characterized by the absence of rare-metal silicates, are predominant by far; agpaitic types are easily recognized by the presence of eudialyte and other rare-metal silicates. Both petrographic and, as far as possible, structural descriptions as well are given for most of the mapped nepheline syenite bodies; many bodies show subhorizontal or moderately-dipping contacts with their country rocks. Chemically, these rocks show, on the whole, high alkaline contents (12-15%) and commonly very high K 2 O abundances. Chemical as well as additional isotopic and geochronological (Rb/Sr) data suggest that the asthenosphere is the source of parental magmas for the Pocos de Caldas nepheline syenites. The same arguments are used to reject, as unlikely, the magmatic activity interval (over 30 m.y.) given by previously published K/Ar ages. Simple structural models of the crust lithosphre in the Parana Basin area, coupled with the westward plate movement, suggest that irregularities at the asthenosphere-lithosphere decoupling surface are probable sites for melting of asthenospheric (and lithospheric) rocks induced by pressure relief. (D.J.M.) [pt

Normal tissue complications after radiation therapy Las complicaciones de la radioterapia en los tejidos sanos

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Jolyon H. Hendry

2006-09-01

desarrollo. Asimismo, se describen las bases biológicas del período de latencia que precede a la aparición de las complicaciones tisulares; la relación entre la dosis de radiación y la incidencia de complicaciones; las consecuencias de aumentar el volumen irradiado; las reacciones tisulares tempranas y tardías; los efectos de cambios en el fraccionamiento de las dosis y en las tasas de dosis; y las reacciones observadas al aplicar una combinación de quimioterapia y radioterapia. Se ofrecen ejemplos de nuevos conocimientos en el campo de la radiobiología clínica que se han adquirido mediante ensayos con nuevos protocolos. Entre las posibles modificaciones de los tratamientos figura el uso de modificadores de la respuesta biológica; en el futuro próximo, podría contarse también con modificaciones de los tratamientos para poder "predecir la respuesta". Por último, las dosis cuya eficacia biológica está demostrada y que están prescritas para tratar el cáncer cervicouterino usando una combinación de braquiterapia y teleterapia son menores en algunos centros que en otros, como se explica en este trabajo. El asunto debe examinarse más a fondo. Una gran abundancia de datos de carácter preclínico y clínico ha permitido comprender mucho mejor las bases biológicas de la radioterapia, y ello a su vez ha llevado a una serie de innovaciones en este campo, tanto en forma de estrategias físicas como biológicas. También es importante prestar atención al tratamiento de una gran variedad de cánceres en países en desarrollo, para los cuales continuamente se elaboran protocolos terapéuticos eficaces orientados a ahorrar recursos. Debería adoptarse en todas partes un único sistema de puntuación para documentar los efectos nocivos de la radioterapia. Asimismo, la toxicidad tardía debería ser un parámetro clínico de valoración obligatoria y figurar en las estadísticas de los resultados del tratamiento.

Complicaciones de las otitis medias agudas y crónicas en el niño Complications of acute and chronic otitis media in the child

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Julianis Loraine Quintero Noa

2013-03-01

Full Text Available Gracias al descubrimiento de los antibióticos, la incidencia de complicaciones en las otitis medias agudas y crónicas ha descendido significativamente, aunque continúan siendo un peligro potencial de morbilidad y mortalidad. La disminución de las complicaciones puede condicionar retrasos diagnósticos por falta de sospecha clínica, enmascaramiento por tratamientos antibióticos previos y mal pronóstico, por lo cual siguen siendo procesos graves que ponen en peligro la vida del enfermo. Se definen actualmente con igual sistema de clasificación: extracraneales e intracraneales. Las primeras se subdividen en extratemporal e intratemporal, y constituyen un problema de salud en la población pediátrica a pesar del uso extendido de antibióticos. La evaluación clínico-otomicroscópica e imaginológica se reporta como criterio diagnóstico predictivo de sospecha y de confirmación. La parálisis facial, el vértigo, los vómitos, la cefalea, el dolor irradiado a la mastoides o a la región temporoparietal, y la hipertermia, deben alertar al médico sobre la presencia de una complicación supurada.Thanks to the discovery of antiobiotics, the incidence of complications in the chronic and acute otitis media has significantly decreased, though they remain a potential mortality and morbidity risk. The reduction of complications can be conditional on some diagnostic delays, on account of lack of clinical suspicions, symptoms disguised by previous antibiotic treatments and wrong prognosis; therefore, the complications continue to be severe processes that endanger the patient's life. They are currently classified as extracranial and intracranial. The former are divided into extratemporal and intratemporal and represent a health problem for the pediatric population despite the extended use of antibiotics. The clinical, otomicroscopic and imaging assessment is reported as a diagnostic criterion predictive of suspicions and of confirmation. Facial

Las voces limpio y poco en el habla sur Andina de Nariño, Colombia

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Roberto Ramírez Bravo

2015-11-01

Full Text Available Este trabajo examina la dimensión sociolingü.stica del uso de las voces limpio y poco en el habla sur andina nariñense; describe las singularidades fonéticas, morfosintácticas, léxico-semánticas y pragmáticas de las voces en cuestión, en diferentes contextos comunicativos; explica la convencionalidad de las mismas, en estructuras lingü.sticas complejas y cotidianas. Para el logro de los propósitos, el estudio se apoya en la etnografía de la comunicación; en este sentido, la recolección de la información se lleva a efecto a través de la observación directa de conversaciones formales e informales y del diario de campo; se realizan grabaciones consentidas y anónimas en contextos de intercomunicación espontánea. Finalmente, se genera un conversatorio con los integrantes del Grupo de Investigación en Argumentación (GIA,2 con la intención de triangular los datos obtenidos y confrontar las estructuras sociolectales de los enunciados analizados.

Thorium - humic compound interaction in the water of Morro do Ferro (Pocos de Caldas, MG, Brazil)

International Nuclear Information System (INIS)

Kuechler, I.L.

1986-01-01

Experimental procedures and results are presented on the determination of thorium and organic dissolved carbon (DOC) in natural waters (bore hole and surface waters) from the Morro de Ferro, a thorium - rare earth occurrence situated in the Pocos de Caldas Plateau in Minas Gerais (Brazil). A positive correlation between Th-232 and humic compounds content was abserved. Utilizing ultrafiltration techniques with Amicon membranes (XM-300, PM-10, UM-10 and YM-2), organic compounds with molecular weights above 1000 units were separated and concentrated from waters. Percolation waters rich in organic material concentrate DOC and Th-232 in the high molecular weight fractions ( > 10.000 MW units). Humic acid was separated from a percolation water sample and characterized by elemental and infrared spectroscopic analysis. The distribution coefficient of Th-232 between water and sediment was shown to be inversely correlated to DOC concentration, as reported by other authors for different environments. These results were also confirmed by laboratory experiments, which indicated additionally that low concentrations of humic acid ( [pt

Migration of radium from the thorium ore deposit of Morro do Ferro, Pocos de Caldas, Brazil

International Nuclear Information System (INIS)

Campos, M.J.; Penna-Franca, E.; Lobao, N.; Trindade, H.; Sachett, I.

1986-01-01

A large thorium ore deposit is located in Morro de Ferro, a hill in the Pocos de Caldas Plateau, Minas Gerais, Brazil, which contains an estimated 30 000 t of Th and 100 t of U in a highly weathered matrix exposed to erosion and leaching. 228 Ra and 226 Ra were analyzed in surface waters collected at various points in the drainage basin and in groundwaters from wells drilled through and around the ore body. The concentrations in groundwater demonstrated that radium is markedly leached by rainwater percolating through the ore body. In its transit underground, radium is removed from groundwater by sorption on soil particles and this natural process greatly reduces the radium discharged to the environment. In dry weather, the concentration of dissolved 228 Ra in the main stream draining the Morro do Ferro is 7.0+-1.1 mBq litre -1 and in a control stream 1.6+-0.3 mBq litre -1 . The estimated 228 Ra mobilization rate by solubilization is of the order of 10 -7 y -1 . (author)

Una causa poco frecuente de hipertrabeculación exclusiva del ventrículo derecho: ventrículo derecho no compacto

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Juan C. Díaz, MD

2013-07-01

Full Text Available La cardiopatía por falta de compactación ventricular es una entidad infrecuente, que generalmente compromete el ventrículo izquierdo ocasionando falla cardíaca, arritmias ventriculares, embolismo periférico y muerte súbita. Hasta el momento, se han descrito muy pocos casos de ventrículo derecho no compacto, por lo cual no hay criterios diagnósticos establecidos y se desconoce como es la evolución clínica y la respuesta al tratamiento de este grupo de pacientes. Se describe el caso de un paciente con hipertrabeculación marcada del ventrículo derecho en quien se descartó un origen estructural de la misma, haciéndose diagnóstico de ventrículo derecho no compacto.

Una causa poco frecuente de hipertrabeculación exclusiva del ventrículo derecho: ventrículo derecho no compacto

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Juan C Díaz

2013-08-01

Full Text Available La cardiopatía por falta de compactación ventricular es una entidad infrecuente, que generalmente compromete el ventrículo izquierdo ocasionando falla cardíaca, arritmias ventriculares, embolismo periférico y muerte súbita. Hasta el momento, se han descrito muy pocos casos de ventrículo derecho no compacto, por lo cual no hay criterios diagnósticos establecidos y se desconoce como es la evolución clínica y la respuesta al tratamiento de este grupo de pacientes. Se describe el caso de un paciente con hipertrabeculación marcada del ventrículo derecho en quien se descartó un origen estructural de la misma, haciéndose diagnóstico de ventrículo derecho no compacto.

Analgesia peridural contínua: análise da eficácia, efeitos adversos e fatores de risco para ocorrência de complicações Analgesia peridural continua: análisis de la eficacia, efectos adversos y factores de riesgo para ocurrencia de complicaciones Continuous epidural analgesia: analysis of efficacy, side effects and risk factors

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Leonardo Teixeira Domingues Duarte

2004-06-01

. Todavia, não se pode dispensar rigorosa vigilância a fim de se obter analgesia satisfatória e diminuir as complicações.JUSTIFICATIVA Y OBJETIVOS: La analgesia promovida por la infusión peridural de anestésico local con analgésicos opioides es reconocidamente de buena calidad y con pocos efectos adversos. El objetivo de este estudio fue determinar el número, formas y gravedad de las complicaciones pós-operatorias relacionadas a la analgesia peridural y a la inserción del catéter peridural. MÉTODO: Fueron evaluados, retrospectivamente, 469 pacientes sometidos a la analgesia peridural pós-operatoria entre 18/10/1999 y 18/10/2001. La analgesia peridural fue conducida usándose solución de bupivacaína 0,1% con fentanil (1 a 5 µg.ml-1, iniciándose la infusión a 3 ml.h-1. La velocidad de infusión era ajustada de acuerdo con la queja álgica del paciente. Fueron analizadas las siguientes variables: la duración de la infusión peridural; la ocurrencia de efectos adversos y complicaciones, relacionándolos a los datos demográficos, tipo de cirugía y posición del catéter peridural; y la calidad de la analgesia obtenida con la técnica (escala analógico-visual de dolor e índice de satisfacción del paciente. RESULTADOS: Los catéteres peridurales permanecieron implantados por una media de 2,2 días, variando de 6 horas a 10 días, y el índice global de complicaciones relacionadas a la técnica fue de 46,3%, siendo que la mayoría fue de pequeña magnitud, sin repercusión clínica. De estas, 13,9% estaban relacionadas directamente al catéter peridural (desconección, exteriorización, dolor lumbar, inflamación e infección local. Otras complicaciones más comunes fueron encontradas: vómitos y retención urinaria. La analgesia pós-operatoria fue efectiva con 97,2% de los pacientes refiriendo satisfacción con la técnica. Pacientes sin dolor o con dolor leve, en el primero, segundo y tercero días de pós-operatorio, constituyeron, respectivamente, 80

Urgencia hipertensiva secundaria a enfermedad poliquística renal autosómica recesiva en lactante. Reporte de caso

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Roxana Quisbert-Cruz

2017-06-01

Full Text Available La enfermedad poliquística renal asociada a la fibrosis hepática congénita es una enfermedad hereditaria; se encuentra dentro del espectro de las enfermedades fibroquísticas hepatorrenales. Su frecuencia estimada es de 1 en 20.000 nacidos vivos para la variedad de enfermedad poliquística renal autosómica recesiva y más rara para la variedad autosómica dominante. Se presenta un reporte de caso de un paciente cuyo padecimiento se inició con crisis hipertensiva de difícil control, debido a enfermedad poliquística renal y fibrosis hepática congénita, presentación clínica poco frecuente; cabe mencionar sobre la importancia del control de la tensión arterial para prevenir complicaciones causadas por la hipertensión arterial: hipertrofia cardiaca, falla cardiaca y retinopatía crónica.

La edad materna avanzada como elemento favorecedor de complicaciones obstétricas y del nacimiento

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Jorge Manuel Balestena Sánchez

2015-10-01

Full Text Available Introducción: el aumento actual del embarazo en mujeres añosas provoca un riesgo superior para la mujer y su feto. Objetivo: evaluar la edad materna avanzada como factor de complicaciones obstétricas y del nacimiento. Material y método: se efectuó una investigación observacional, retrospectiva, transversal y analítica en el Hospital General Docente "Abel Santamaría Cuadrado" de Pinar del Río entre 2012 y 2013. El universo de estudio fueron la totalidad de gestantes que ingresaron en el período estudiado. La muestra se formó con gestantes añosas (grupo estudio 360 pacientes y un grupo control (720 pacientes con embarazadas entre 25 y 30 años; ambos se escogieron por muestreo intencionado. Se resumieron las variables cualitativas mediante frecuencias absolutas y relativas porcentuales. Se utilizaron las pruebas de ji cuadrado, Odd Ratio. El intervalo de confianza para el Odd Ratio al 95%. Resultados: hubo un predominio de la embarazada con partos anteriores (92.8%, la normopeso (68.9%, el 34.4% padecían alguna enfermedad crónica, siendo la principal la hipertensión arterial; la anemia durante el embarazo estuvo presente en el 34.4%, el 88.3% parieron a término, de modo espontáneo; además preponderó la cesárea con un (52.2%. La morbilidad intraparto se manifestó en el 13.1%, mientras la puerperal en el 26.7%. Hubo una elevada asociación del embarazo prolongado con la enfermedad hipertensiva, el oligoamnios y la anemia (p < 0,001, también con la inducción del parto (p < 0,001 y la cesárea (p < 0,001, así como con la morbilidad puerperal (p < 0,001. Conclusiones: la edad materna avanzada es un factor de riesgo a tener en cuenta durante el proceso de la gestación y el nacimiento.

Statistical modelling of usual intake. Scientific report submitted to EFSA

NARCIS (Netherlands)

Voet, van der H.; Klaveren, van J.D.; Arcella, D.; Bakker, M.; Boeing, H.; Boon, P.E.; Crépét, A.; Dekkers, A.; Boer, de W.; Dodd, K.W.; Ferrari, P.; Goedhart, P.W.; Hart, A.; Heijden, van der G.W.A.M.; Kennedy, M.; Kipnis, V.; Knüppel, S.; Merten, C.; Ocké, M.; Slob, W.

2010-01-01

Within the EFSA Article 36 project “European Tool Usual Intake” (ETUI) a workshop was organised in May 2010 where the different available models to calculate usual intake were presented and discussed. This report integrates the workshop background document, the presentations given by experts, and

Lipoma con patrón infiltrativo muscular

OpenAIRE

Vergara Pages, Julio AJ; Ferrer Lozano, Yovanny; Rodríguez Reyna, Juan C.; Medina González, Maria E

2006-01-01

Los lipomas pueden crecer hasta alcanzar un gran tamaño y se clasifican en dos tipos: cutáneo o superficial, cuando se localizan encapsulados en los tejidos blandos superficiales; y profundo o subfascial, cuando su origen es poco delimitado o difuso y presentan estructuras profundas intraóseas, intermusculares e intramusculares. Esta última es poco usual, su localización puede pasar por desapercibida y toma un patrón de crecimiento infiltrativo a través de las fibras musculares estriadas, lo ...

Science.gov (United States)

Giner, Manel; Culebras, Jesús M; Meguid, Michael M

2016-03-01

En agosto de 1976, un joven llamado LeRoy cayó desde una cornisa fracturándose el fémur. Se sospechó una hemorragia interna importante. Durante una laparotomía se comprobó que todos los órganos internos estaban intactos y los cirujanos ortopédicos arreglaron la fractura. Treintadías después, LeRoy murió. Había comido poco; diariamente, tan solo había recibido tres litros de la glucosa, el equivalente a 510 calorías, por vía intravenosa. La glucosa fue insuficiente para satisfacer sus necesidades nutricionales, perdiendo más del 20% de su peso corporaldurante su estancia en el hospital. La causa de la muerte se debió a "desnutrición médicamente inducida". Mientras tanto, un artículo científico documentó que la prevalencia de desnutrición en los hospitales de Boston era del 44% y que la desnutrición en sí era un predictor de altas tasas de complicaciones y muerte.Como resultado, los médicos sensibilizados formaron una sociedad que creó programas de formación y alentó la formación de equipos de nutrición en los hospitales. La industria comercializó fórmulas de nutrición y catéteres. Las complicaciones en enfermos hospitalizados cayeron en picado, mientras que las tasas de supervivencia aumentaron. California aprobó una legislación para regular el soporte nutricional. Aunque la industria de la atención sanitaria reconoce la importancia de la nutrición en los cuidados al paciente, el Congreso no proporcionó apoyo fiscal para los equipos de nutrición. Como resultado, los hospitales disolvieron sus equipos de nutrición de reciente creación. La educación y las habilidades en nutrición disminuyeron, y las complicaciones hospitalarias y las tasas de mortalidad aumentaron de nuevo.

Study of the feasibility of the utilization of clays from Poco Fundo (MG) for its use in bricks fabrication

International Nuclear Information System (INIS)

Gaspar Junior, L.A.; Souza, M.H.O.; Moreno, M.M.T.

2012-01-01

This work aimed to make an analysis of mineralogical (Macroscopic Description and X-Ray Diffraction), chemical (X-Ray Fluorescence and Organic Carbon Analysis) and ceramic (Particle Size Distribution, Mechanical Resistance, Water Absorption, Apparent Porosity, among others) properties of the alluvial clays collected in Poco Fundo county - Minas Gerais State, Brazil - in order to confirm the feasibility of these clays for bricks manufacturing. There were collected 4 samples from the main potteries of the county, and they were nominated PF-01, PF-02, PF-03 and MAC-01. The clays from these region display high content of quartz, kaolinite and present refractory behavior, and the alkalis content (Na 2 O and K 2 O) is low, because the studied area suffered an intense weathering process. The sample PF-03 presented the most promising ceramic results, mainly due to the lower content in silica and higher amounts of organic matter, denoting a clay coming from a swampy area. (author)

Humanistic therapies versus treatment as usual for depression

Science.gov (United States)

Davies, Philippa; Hunot, Vivien; Moore, Theresa HM; Caldwell, Deborah; Jones, Hannah; Lewis, Glyn; Churchill, Rachel

2014-01-01

This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness and acceptability of all humanistic therapies compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of different humanistic therapy models (person-centred, gestalt, process-experiential, transactional analysis, existential and non-directive therapies) compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of all humanistic therapies compared with different types of comparator (standard care, no treatment, waiting list, attention placebo) for acute depression. PMID:25408624

22 CFR 92.85 - Service of legal process usually prohibited.

Science.gov (United States)

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Service of legal process usually prohibited. 92... RELATED SERVICES Quasi-Legal Services § 92.85 Service of legal process usually prohibited. The service of process and legal papers is not normally a Foreign Service function. Except when directed by the...

The experience of Electricity Municipal Department of Pocos de Caldas, state of Minas Gerais, Brazil, in conception and construction of Antas 2 hydroelectric power plant: a hand-made power plant; A experiencia do Departamento Municipal de Eletricidade de Pocos de Caldas na concepcao e construcao da Usina Hidreletrica Antas 2: uma usina concebida e realizada na ponta do lapis

Energy Technology Data Exchange (ETDEWEB)

Moraes, Cicero Machado de [Departamento Municipal de Eletricidade de Pocos de Caldas, MG (Brazil); Nasseh, Oscar [Mecanica Pesada S.A., Taubate, SP (Brazil); Hellmuth, Harald [Siemens S.A. (Brazil)

1993-12-31

The Antas 2 hydroelectric power plant, located in Pocos de Caldas, state of Minas Gerais, Brazil, is under construction and have deadline to start operation in the beginning of 1994. Considered a high-head plant, with 165,05 m of fall, Antas 2 have three generation units of 5,7 MW and will supply a residential and industry demand of electric energy. This paper presents that the construction of an energy profit with this capacity can be performed under the mostly updated technologies with low costs, resulting in a high productivity, with reliance and asserted rentability profit 1 tab.

Usual coffee intake in Brazil: results from the National Dietary Survey 2008-9.

Science.gov (United States)

Sousa, Alessandra Gaspar; da Costa, Teresa Helena Macedo

2015-05-28

Coffee is central to the economy of many developing countries, as well as to the world economy. However, despite the widespread consumption of coffee, there are very few available data showing the usual intake of this beverage. Surveying usual coffee intake is a way of monitoring one aspect of a population's usual dietary intake. Thus, the present study aimed to characterise the usual daily coffee intake in the Brazilian population. We used data from the National Dietary Survey collected in 2008-9 from a probabilistic sample of 34,003 Brazilians aged 10 years and older. The National Cancer Institute method was applied to obtain the usual intake based on two nonconsecutive food diaries, and descriptive statistical analyses were performed by age and sex for Brazil and its regions. The estimated average usual daily coffee intake of the Brazilian population was 163 (SE 2.8) ml. The comparison by sex showed that males had a 12% greater usual coffee intake than females. In addition, the highest intake was recorded among older males. Among the five regions surveyed, the North-East had the highest usual coffee intake (175 ml). The most common method of brewing coffee was filtered/instant coffee (71%), and the main method of sweetening beverages was with sugar (87%). In Brazil, the mean usual coffee intake corresponds to 163 ml, or 1.5 cups/d. Differences in usual coffee intake according to sex and age differed among the five Brazilian regions.

As intervenções do enfermeiro e as complicações em sala de recuperação pós-anestésica Las intervenciones del enfermero y las complicaciones en la sala de recuperación postanestésica Nurse interventions and the complications in the post-anesthesia recovery room

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Débora Cristina Silva Popov

2009-12-01

Full Text Available Este estudo objetivou identificar complicações prevalentes em Sala de Recuperação Pós-Anestésica (SRPA; relacionar as complicações às intervenções de enfermagem realizadas; relacionar o esquema de jornada de trabalho dos enfermeiros às complicações. A amostra compôs-se de 400 prontuários de pacientes maiores de 18 anos, submetidos a procedimentos cirúrgicos de grande e médio porte, admitidos na unidade de SRPA, com tempo de permanência superior à uma hora. As complicações prevalentes foram: dor e hipotermia. Complicações que apresentaram relação estatisticamente significante com intervenção de enfermagem - dor: rotina, oxigenioterapia, medicação e curativo; agitação/ansiedade: rotina e oxigenioterapia; hipotensão: hidratação, exames complementares e observação; hipertensão: observação; tremor: manta térmica, transfusão sanguínea; náuseas/vômitos: rotina, medicação e sondagem vesical de alívio; sangramento: rotina, medicação e curativos; hipoxemia: rotina e oxigenioterapia; hipotermia: rotina, manta térmica e medicação. A dor, náuseas/vômitos, agitação e sangramento obtiveram relação estatisticamente significante com o enfermeiro fixo em SRPA.Este estudio objetivó identificar las complicaciones prevalentes en la Sala de Recuperación Postanestésica (SRPA; relacionar las complicaciones a las intervenciones de enfermería realizadas; relacionar el esquema de jornada de trabajo de los enfermeros con las complicaciones. La muestra estuvo compuesta de 400 fichas de pacientes mayores de 18 años, sometidos a procedimientos quirúrgicos de grande y medio porte, admitidos en la unidad de SRPA, con tiempo de permanencia superior a una hora. Las complicaciones prevalentes fueron: dolor e hipotermia. Complicaciones que presentaron relación estadísticamente significativa con la intervención de enfermería - dolor: rutina, oxigenoterapia, medicación y curativo; agitación/ansiedad: rutina y

Aqueous speciation and the importance of particulate phase in hydro-geochemistry behaviour of U,Th and REE from uranium mine and Morro do Ferro, Pocos de Caldas - Brazil

International Nuclear Information System (INIS)

Jesus, Honerio Coutinho de

1996-04-01

This work, which was realized within the Natural Analogue Project Pocos de Caldas, had as its main objective the study of the colloidal behavior of U, Th, REE and some other elements of geochemical interest, in surface and groundwaters from the Osamu Utsumi mine and the Morro do ferro in Pocos de Caldas, Minas Gerais. Ultrafiltration techniques with flat membranes of different molecular mass exclusion limits (100 K, 10 K e 1K daltons) were used for this purpose. In addition, suspended matter (>0,45 μm), retained during pre-filtering of the waters, was analysed mineralogically and chemically (U, Th, REE, isotopic composition of U and Th, etc). Studies of the chemical composition of colloidal particles (<0,45 μm) and their size distributions were performed using ESCA and SEM, respectively. In addition, speciation studies by means of the MINEQL computation program were made to obtain information about the principal complexed species of relevant elements and the formation of solid phases. All the above mentioned investigations were aimed at better understanding of the migration and sorption behavior of U, Th and REE in both environments. The data obtained in this work indicate a low importance of particulate phases (colloids or suspended particles) for the migration behavior of U, Th and REE in waters from the Osumu Utsumi uranium mine and the Morro do ferro. However, these particles, composed mainly of ferric oxyhydrates and humic compounds, play an important role in sorption and immobilization processes. (author)

Transfer of radon-222 from rocks of the Pocos de Caldas plateau to the waters

International Nuclear Information System (INIS)

Bonotto, Daniel Marcos; Lima, Jorge Luis Nepomuceno de

1997-01-01

The analytical procedures developed at the Sector of Unstable Isotopes of the Laboratory of Geochemistry, which belongs to the Department of Petrology and Metallogeny located at the Institute of Geosciences and Exact Sciences - Universidade Estadual Paulista Julio de Mesquita Filho (UNESP) to measure the release of 222 Rn from rocks to the waters is described. The methodology established was used to evaluate the emanation coefficient of 222 Rn from experiments of water-rock interaction under controlled conditions in the laboratory, which is an important parameter necessary to interpret the radioactivity related to dissolved 222 Rn content in waters. Four typical rocks from Pocos de Caldas Plateau were sampled for the experiments: phonolite, nepheline syenite, pseudoleucite tinguaite and silicified sandstone. The 226 Ra content of these rocks was evaluated by gamma-ray spectrometry using a Nal(TI) scintillation detector, a method that has been currently utilized in nuclear geophysics or isotope geochemistry to measure the equivalent uranium (e U). The 226 Ra content in the studied rocks and the 222 Rn transferred to the waters due to its generation by its 226 Ra progenitor allowed an estimation of the emanation coefficient of 222 Rn. A preliminary investigation on the influence of the mass of the rock in contact with water, of the surface area of the rock in contact with water and of the 226 Ra content in rocks on the amount of 222 Rn released to the water was also performed. (Author)

Interleucina 2 y su receptor soluble en cirugía Interleukin-2 and its soluble receptor in surgery

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Maczy González Rincón

2007-03-01

Full Text Available Desde hace más de cuatro decenios el procedimiento quirúrgico ha sido objeto de estudio para determinar su responsabilidad en la posible alteración del sistema inmunitario del individuo que se somete a una cirugía de cierta envergadura y su relación con los episodios infecciosos en el período posoperatorio. Hoy en día, se tiene un poco más claro el papel preponderante que la cirugía tiene en los cambios que sufre el sistema inmunitario después del trauma quirúrgico, y su mayor comprensión ha mejorado la incidencia de las complicaciones infecciosas en el paciente operado. En esta revisión se describen los antecedentes más relevantes que han conducido a un mejor entendimiento de los procesos involucrados en las alteraciones del sistema inmunitario luego de una intervención quirúrgica

Morbilidad y mortalidad de la apendicitis aguda en los pacientes geriátricos, 1990-1999

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Raúl A Morales González

2002-04-01

Full Text Available Se realizó un estudio descriptivo de tipo retrospectivo, que incluyó a todos los pacientes de 60 años y más, atendidos en el Hospital Provincial Clinicoquirúrgico Docente «Celia Sánchez Manduley» de Manzanillo, con el diagnóstico clínico y anatomopatológico de apendicitis aguda durante la última década. Se analizaron aspectos como: edad y sexo, características del dolor, resultados del leucograma, tiempo de evolución hasta el diagnóstico, estado anatomopatológico del apéndice y complicaciones. La enfermedad fue más frecuente en los hombres, predominó el dolor atípico y el leucograma tuvo poco valor diagnóstico; la afección se trató tardíamente y se presentó un número importante de complicacionesA descriptive and retrospective study of all the patients aged 60 and over with the clinical and anatomopathologic diagnosis of acute appendicitis that were attended at "Celia Sánchez Manduley" Provincial Clinical and Surgical Teaching Hospital, in Manzanillo, during the last decade, was conducted. Aspects such as age, sex, characteristics of pain, results of the white blood cell count, time of evolution up to the diagnosis, anatomopathologic state of the appendix and complications were analyzed. The disease was more frequent in men. The atypic pain predominated and the white blood cell count had a poor diagnostic value. The disease was treated late and an important number of complications were observed

Complicaciones obstétricas y médicas en el Trastorno de Déficit Atencional/Hiperactividad (TDAH: ¿hay diferencias entre los subtipos?

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Connie Capdevila-Brophy

2007-01-01

Full Text Available El debate actual sobre los subtipos de Trastorno de Déficit Atencional/ Hiperactividad (TDAH se centra en determinar si las similitudes y diferencias halladas en la sintomatología asociada aportan evidencia para conceptualizar los subtipos como manifestaciones de distinto trastorno. El objetivo de este estudio retrospectivo ex post facto es investigar las diferencias entre los subtipos de TDAH con predominio de inatención (TDAH-I (n = 20 y TDAH combinado (TDAH-C (n = 39 en su historia prenatal, perinatal, del primer año y los problemas médicos posteriores. Los resultados indican que ambos subtipos presentan índices elevados de complicaciones obstétricas y problemas médicos. El subtipo TDAH-I se asocia con hemorragias prenatales, infecciones de oído y alergias, y el TDAH-C con cólicos del lactante y lesiones con sutura. La principal conclusión sugiere que las noxas de curso más continuo o dilatadas en el tiempo estarían más presentes en el grupo TDAH-I mientras que algunas características en el primer año y las lesiones que requieren suturas estarían más asociadas al subtipo TDAH-C.

Fibroadenoma with "immature-like" type of usual ductal hyperplasia.

Science.gov (United States)

Bezić, Joško; Karaman, Ivana; Kunac, Nenad

2016-01-01

We herein report a case of the breast fibroadenoma with foci of so-called immature variant of the conventional ductal hyperplasia. This type of usual ductal hyperplasia is histologically characterised by encircling intraductal proliferation of large cells with pale to amphophilic cytoplasm and large nuclei which vary in shape and in staining quality of the chromatin. We showed here, using the cytokeratin immunohistochemistry, that the proliferating cells were not of immature but rather mature immunohistochemical phenotype. Because of the presented discordance between immature histology and mature immunohistological profile we suggest that this rare type of usual ductal hyperplasia should be called "immature-like".

Acid rock drainage in the uranium mining and milling site of Pocos de Caldas, Brazil -- duration assessment, pollutant generation modelling and remediation strategies

International Nuclear Information System (INIS)

Fernandes, H.M.; Franklin, M.R.

2002-01-01

This geochemical modeling work was carried out to simulate the acid drainage generation from one of the waste-rock piles at the Pocos de Caldas uranium mining site. The mathematical code STEADQYL was used. The estimated results were in good agreement for sulphate and uranium concentrations and the duration of the acid water generation was estimated to be about 500 years. The effect of covering the dump with a material that minimized oxygen diffusion was assessed. Projections indicated that covering the dump with a 1.0 m thickness of a material (like clay), which had an oxygen diffusion coefficient of 10 9 m 2 ·s 1 , would reduce the pollutant concentrations to acceptable values. The estimated cost, when using this strategy, would be about US $10 million. (author)

Análisis de los factores que influyen en la aparición de complicaciones y supervivencia de los catéteres venosos centrales para hemodiálisis

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Gabriel Eduardo Rajoy Fernández

2014-03-01

Full Text Available Una de las principales actividades de enfermería nefrológica en las unidades de hemodiálisis, es el cuidado de catéteres venosos centrales mediante el cumplimiento de un protocolo que hace especial hincapié en las medidas universales de asepsia durante su manipulación. Además existen otras variables que pueden influir en la aparición de complicaciones del catéter limitando su supervivencia. Objetivo: Los objetivos de este estudio fueron analizar los factores que pudieran influir en la aparición de complicaciones del catéter venoso central para hemodiálisis, y valorar las tasas de infección en nuestro centro. Material y método: Se realizó un estudio descriptivo de una cohorte, en la Unidad de Diálisis del Hospital Meixoeiro, entre enero de 1991 y octubre de 2012, con una muestra formada por 1231 catéteres. Resultados: Fueron implantados 1231 catéteres (1187 temporales y 44 tunelizados tipo Hikman. Los temporales, 78% en femoral, 18% en yugular, y 4 % en subclavia. Los Hikman, 40 en lado derecho y 4 en lado izquierdo. La duración media de los catéteres implantados fue de 17,7 ± 30,8 días (mediana 8 días. 88% no presentaron incidencias durante su colocación. Las principales causas de colocación fueron la IRA (56% y el fallo de acceso vascular previo (30%. La principal complicación dentro de las causas de retirada fue la obstrucción del catéter (15%, siendo la más grave la infección (6%. De los 1231 catéteres, 70 presentaron un episodio de infección a los 19,1±33,0 días de media, (mediana 1 días. Tasa de infección (2010-2012 de 0,75/1000 días de catéter. Conclusión: Concluimos que la aplicación de cuidados continuos y estandarizados mediante un protocolo que hace especial hincapié en la asepsia durante la conexión y desconexión del CVC da como resultado un bajo índice de infecciones en esta unidad.

Radium-226 and head-210 in agriculture products produced on the environs of the uranium mine and mill at the Pocos de Caldas plateau in Minas Gerais

International Nuclear Information System (INIS)

Vasconcellos, L.M.H.; Amaral, E.C.S.; Vianna, M.E.C.M.; Franca, E.P.

1986-01-01

Radium-226 and Lead-210 in agriculture products produced on the environs of the uranium mine and mill at the Pocos de Caldas Plateau in Minas Gerais. As a complement to the pre-operational environmental monitoring program of the Brazilian first uranium mine and mill, a survey of 226 Ra and 210 Pb in agriculture products, and in the corresponding soils, were carried out in the Pocos de Caldas Plateu. The survey intended to determine site specific transfer factors, in order to better estimate radiation doses on the population, resulting from the plant operation. In local soils, 226 Ra and 210 Pb have similar concentrations. The average contents are comparable to the values found in areas of normal radioactivity, but the maximum values are higher by one order of magnitude. In the vegetables analyzed (beans, carrot, corn and potato), 226 Ra concentrations are slightly higher than those of 210 Pb, and the maximum values are also one order of magnitude greater than in normal regions. For both radionuclides, the average soil-to-plant transfer factors are of the order of 10 -3 and 10 -2 when related to total and to exchangeable content soil, respectively. These results led to the conclusion that 226 Ra and 210 Pb have similar importance, concerning the population exposure via the foodstuff ingestion pathway. Therefore, it was recommended to carry on routine monitoring program for both radionuclides in the main agriculture crops. However, the naturally elevated radionuclide concentrations, in some local vegetables, will decrease the sensivity for detecting for detecting small increments resulting from the plant operation. (Author) [pt

The International intraval project. Phase 1, case 7. The Pocos de Caldas natural analogue: studies of redox front movement

International Nuclear Information System (INIS)

Chapman, N.

1992-01-01

The study of natural analogues is an important means of validating models of the geochemical processes affecting radionuclide behaviour. This test case, which is one aspect taken from the much broader geochemical studies carried out in the Pocos de Caldas Project, concerns the nature and behaviour of redox fronts, such as might be generated in the near-field of a spent-fuel repository. A redox front is potentially important in terms of the movements and speciation of certain radionuclides close to the waste package. The natural redox fronts in Osamu Utsumi uranium mine display many of the features which may occur in a repository, and influence the movement of natural series radionuclides, and other elements, through the rock/groundwater system. This report, describes the geological, hydrogeological and geochemical nature of the site, and of the redox fronts. Emphasis is placed on the mineralogy of the fronts, and the concentration profiles of various elements across them. The project involved a number of different modelling approaches which attempted to describe the generation and movement of the fronts through the rock. These included mass balance, reaction-diffusion models, fissure flow models, thermodynamic models, and kinetic models. 21 refs., 36 figs., 1 tab

Behavior of 226Ra in the aquatic environment of the uranium mine region of Pocos de Caldas, MG, Brazil

International Nuclear Information System (INIS)

Silva Amaral, E.C. da.

1979-08-01

A sampling and analytical program for 238 U, 226 Ra and 210 Pb was started, at first, in the uranium mine region, at Pocos de Caldas, MG, Brazil. Afterwards, the interaction was studied between 226 Ra and local river sediments and waters. Peliminary studies were also done on the mobility of 226 Ra retained on solid matter or soil, induced by local waters. Above normal concentrations of 238 U, 226 Ra and 210 Pb were found in local waters, sediments and plants collected on the imediate vicinity of the mine. 226 Ra distribution coefficients are on the order of 10 3 for the different samples assayed. It was concluded that, in the future, 226 Ra discharged into liquid environment should be only temporarily retained by sediments. Its transport by surface waters should be predominantly in the soluble form. 226 Ra should become the critical radionuclide in terms of internal radiation dose on the local population, due to its ingestion with water. 226 Ra retained on solid supports is mobilized by local waters and its solubilization is dependent on the volume of water passed through. (M.A.) [pt

Conocimientos de los médicos sobre enfermedad periodontal y su relación con complicaciones en el embarazo

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Martha Juliana Rodríguez

2013-12-01

Full Text Available Introducción: Estudios recientes han vinculado a las enfermedades bucales con condiciones sistémicas. Específicamente, la enfermedad periodontal se ha relacionado con parto pretérmino, bajo peso al nacer y preclampsia. Objetivo: Evaluar los conocimientos y las prácticas de los médicos generales y ginecobstetras sobre la enfermedad periodontal y su relación con complicaciones del embarazo. Metodología: Se realizó un estudio de corte transversal en una muestra de 139 médicos generales y 24 ginecobstetras. Se aplicó un cuestionario de autoreporte, se calcularon frecuencias y proporciones para las variables cualitativas, promedios y desviaciones estándar para las cuantitativas. Para establecer las diferencias entre los grupos se realizó la prueba de Chi cuadrado, el test exacto de Fisher, la prueba t de Student y la U. de Mann Whitney según la naturaleza y distribución de las variables. Resultados: El 66,9% (93 de los médicos generales y el 75,0% (18 de los ginecobstetras consideraron que la enfermedad periodontal podría ser un factor de riesgo para la salud de la madre y su hijo. Así mismo, el 30,7% (42 de los médicos generales y el 45,8% (11 de los ginecobstetras relacionaron a la enfermedad periodontal con el parto pretérmino, bajo peso al nacer y preclampsia. A pesar de estos hallazgos, sólo el 77,4% (106 de los médicos y el 54,2% (13 de los ginecobstetras "siempre" remitían a la gestante a consulta odontológica. Conclusión: Aunque los participantes tenían conocimientos sobre los tópicos evaluados, hace falta una mayor aplicación de los mismos para asegurar el bienestar del binomio madre e hijo.

Complicaciones multiorgánicas de origen tardío secundarias a lesiones por descarga eléctrica, reporte de un caso

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Gary Caballero García

2013-11-01

Full Text Available Title: Late complications of origin multiorgan secondary injuries electric shock, report of a case.ResumenTeniendo en cuenta el gran número de lesiones y muertes ocasionadas por energía eléctrica, se revisarán las secuelas que pueden acontecer posteriores a dicho suceso, dado que la electricidad daña los tejidos al transformarse en energía térmica mediante la destrucción de la integridad de la membrana celular. El caso clínico trata de un paciente de 31 años de edad quien hace siete años recibió una descarga eléctrica de 440 voltios, y en su evolución ha presentado diversas complicaciones multiorgánicas: Neuropatía periférica tipo dolor neuropático, alteración estructural de la vía aferente sensorial visual, entre otras. (DUAZARY 2013 No. 1, 51 - 55AbstractGiven the large number of injuries and deaths caused by electricity, a review of the consequences that can happen after that event, given that electricity damages tissue by transforming into heat energy by destroying the integrity of the cell membrane. The clinical case is a 31 years old pacient who seven years ago received an electric shock of 440 volts, and their evolution has presented various multiorgan complications: Neuropathic pain Peripheral neuropathy type, structural alteration of the visual sensory afferent pathway, among others.Keywords: Burns; Electric; Chronic Pain; Complications; Rehabilitation. Source: Medical Subjet Headings (MeSH.

Hipertiroidismo congénito, Reporte de dos casos

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Víctor Clemente Mendoza Rojas

2014-04-01

Full Text Available Introducción: El hipertiroidismo es una patología tiroidea poco frecuente en neonatos, relacionada con el antecedente materno de enfermedad de Graves, y por lo tanto con el paso transplacentario de inmunoglobulinas estimulantes del receptor de TSH. Presentación de casos: Reportamos dos casos de sexo femenino, que se presentaron en el Hospital Universitario de Santander. El primero de los casos se manifestó en la primera semana; el segundo caso se presentó tardíamente después del primer mes de vida. Los síntomas que presentaron en común fueron taquicardia persistente e hiperactividad. En uno de los casos la presentación clínica fue confundida con una infección bacteriana, debido a la presencia de fiebre. Se confirma el diagnóstico con los niveles de TSH muy suprimidos y T4 libre elevada, al menos al doble del límite superior. Los dos casos observaron medicamentos antitiroideos y propanolol con buena evolución clínica y de laboratorios; no se observamos complicaciones a corto o largo plazo como arritmias o craneosinostosis. Discusión: El hipertiroidismo congénito es una patología poco frecuente y siempre debe ser sospechado en recién nacidos de madres con antecedente de enfermedad de Graves, sus manifestaciones pueden presentarse prenatalmente o postnatalmente, y su diagnóstico y tratamiento deben ser oportunos para evitar secuelas a largo plazo o incluso la muerte

Hydrogeochemical utilization of natural isotopes from U(4n+2) and Th(4n) series at Morro do Ferro, Pocos de Caldas (MG)

International Nuclear Information System (INIS)

Bonotto, D.M.

1991-01-01

Uranium and thorium isotopic analysis were performed on well spoils of the main ore body at Morro do Ferro, Pocos de Caldas (MG), using groundwater from several boreholes in the area and surface water from a steam that originates at the base of the hill. For extraction of uranium and thorium a long chemical process was applied to samples; activities of 228Th and 232 Th isotopes (4n series) and also of 238U, 234U and 230Th isotopes (4n+2 series)were determined by the alpha spectrometry method. The ratios 234U?238U determined for well spoils did not show marked disequilibria between these isotopes. However, the ratios 228Th/232Th and 230Th/234U obtained in some samples showed a high disequilibrium between these isotopes, associated with the presence of possible zones of removal of uranium and precipitation of radium.(author)

Acid drainages of the pyritic sterile from the Pocos de Caldas uranium mine: environmental interpretation and implications; Drenagens acidas do esteril piritoso da mina de uranio de Pocos de Caldas: interpretacao e implicacoes ambientais

Energy Technology Data Exchange (ETDEWEB)

Souza, Vicente Paulo de

1995-12-01

Considering the planned closure of the first uranium mine and milling plant operating in Brazil, located in the Pocos de Caldas Plateau, in the State of Minas Gerais, in the next two years, there is the need to obtain basic information for its decommissioning. Special attention has been directed to the following critical areas: open pit, tailing, dam and waste rock piles, because these are the main sources of acid drainage generation. These waters cannot be allowed to flow in the external environment because in addition to sulphuric acid, there is a number of elements in concentration above those allowed by regulations. Among the waste piles (bota-foras BF) two of them BF-4 and BF-8, are in a process of acid generation, thus requiring more attention. The objective of this work was to simulate at the laboratory scale the oxidation and the reduction zones of BF-4. The experiments were conducted in acrylic columns, where the waste sample was kept under aerated and saturated conditions, in different columns. The control of the chemical (solubilized chemical species), physico-chemical (redox potential, pH, conductivity) and biological (bacterial activity) parameters has been carried out on the acid solutions generated by the chemical and biological reactions that occur at the waste. Although the results refer to a four month period, some relevant points can be highlighted, which will serve as a basis for further research. The mineralogical characterization identified the existence of other sulphides associated to pyrite with lower oxidation potential than the latter. The results obtained with the biological characterization for the two conditions studied revealed that the bacterial activity is more intense in the region in contact with air, than in saturated region. (author) 30 refs., 29 figs., 8 tabs.

Complicações respiratórias em pacientes com paralisia cerebral submetidos à anestesia geral Complicaciones respiratorias en pacientes con parálisis cerebral sometidos a la anestesia general Respiratory complications in patients with cerebral palsy undergoing general anesthesia

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Sérgio Silva de Mello

2007-10-01

álisis cerebral (PC puede representar un desafío para el anestesiólogo. Este estudio prospectivo tuvo como objetivo determinar la prevalencia y el riesgo de complicaciones respiratorias en niños con PC sometidos a anestesia general inhalatoria para tomografía computadorizada. MÉTODO: Participaron del estudio pacientes con edades entre 1 y 17 años, estado físico ASA I a III, sometidos a AGI con sevoflurano y máscara laríngea para TC en el período de junio/2002 a junio/ 2003, divididos en 3 grupos: PC tetraplégicos (PCT, Otros tipos de PC (PCO, y paciente sin PC (NPC. Los padres o responsables respondieron a un cuestionario con preguntas sobre el historial médico de los pacientes, infección de vías aéreas superiores (IVAS, asma, convulsión, no coordinación oro faríngea, reflujo gastroesofágico, etc. Datos sobre la incidencia y la gravedad de las complicaciones respiratorias fueron recolectados proscpectivamente (tos, bronco espasmo, laringo espasmo, hipoxemia, aspiración. La muestra fue calculada para una incidencia esperada de 5% en el grupo NPC, con una diferencia de 15% entre los grupos (alfa = 0,05 y beta = 0,1, utilizando los tests del Chi-cuadrado, exacto de Fisher y t de Student. RESULTADOS: Conformaron la muestra 290 pacientes divididos en los grupos de la siguiente forma: PCT - 100, PCO - 79 y NPC- 111. No hubo diferencia en la prevalencia de complicaciones respiratorias entre los grupos PCT (4%, PCO (8,9% y NPC (7,3%. Hubo una asociación entre la presencia de IVAS y la incidencia de complicaciones (riesgo relativo 10,71. CONCLUSIONES: Niños con parálisis cerebral tipo tetraplegia espástica no parecen correr riesgo aumentado de complicaciones respiratorias durante la anestesia general inhalatoria con sevoflurano y máscara laríngea. El estudio confirma IVAS como factor de riesgo para la incidencia de esas complicaciones.BACKGROUND AND OBJETIVES: Anesthesia in patients with cerebral palsy (CP poses a challenge for the anesthesiologist. The objective

Supportive psychodynamic psychotherapy versus treatment as usual for first-episode psychosis

DEFF Research Database (Denmark)

Rosenbaum, Bent; Harder, Susanne; Knudsen, Per

2012-01-01

manualized individual supportive psychodynamic psychotherapy (SPP) in addition to treatment as usual or with treatment as usual alone (TaU). Symptoms and functional outcomes were measured using the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning scale (GAF). The study.......000) and GAF(symptom) (p = 0.010) significantly favored SPP in combination with TaU over TaU alone. In spite of limitations, this study speaks in favor of including supportive psychodynamic psychotherapy in the treatment for patients with schizophrenic first-episode psychoses....

Adherencia terapéutica y flexibilidad en el uso de las insulinas basales

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José E Costa Gil

2014-08-01

Full Text Available Desde 1921, los beneficios alcanzados por las investigaciones sobre insulinoterapia han sido constantes. Sin embargo, el temor a las hipoglucemias y la rigidez horaria para administrar la insulina aún interfieren sobre la adherencia al tratamiento, que es esencial para lograr un buen control de la glucemia y minimizar las complicaciones en los pacientes con diabetes. En este contexto, se analiza la posibilidad de utilizar un análogo de insulina ultra-lento (degludec que posee un perfil farmacocinético prolongado y predecible por más de 24 horas. En ensayos clínicos demostró que, al administrarlo en un esquema de dosis flexible mantiene un buen control de la glucemia, sin que aumente el riesgo de hipoglucemias. Si bien en la práctica clínica es aconsejable seguir un plan establecido, la posibilidad de flexibilizar el horario en la aplicación diaria del análogo ultra-lento en caso de ser necesario, podría mejorar la adherencia en pacientes con una vida social y laboral activa y poco previsible.

Cistitis hemorrágica relacionada al trasplante de médula ósea: primer reporte de casos en el país

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Juan Nunura

2004-06-01

Full Text Available Objetivo: Determinar la incidencia, características clínicas y complicaciones de la cistitis hemorrágica (CH. Material y Métodos: Estudio descriptivo sobre pacientes transplantados de médula ósea en la Unidad de Trasplante de Médula Ósea del Hospital Nacional Edgardo Rebagliati Martins, desde noviembre 1994 hasta octubre 2003, y que desarrollaron cistitis hemorrágica. Resultados: En 9 años fueron transplantados 170 pacientes, desarrollando cistitis hemorrágica 8 de ellos (incidencia acumulada 4,7%. El cuadro clínico se caracterizó por disuria más hematuria macroscópica o microscópica. La presentación tardía fue la más frecuente. En 4 pacientes, la cistitis hemorrágica fue severa. Dos de los tres pacientes que desarrollaron el cuadro de cistitis hemorrágica en dos oportunidades, fallecieron. Conclusiones: La mitad de los pocos pacientes que desarrollan CH en la Unidad, lo hacen bajo la forma severa y, si presentan la CH por segunda vez, su pronóstico se complica.

Endoftalmitis poscirugía de catarata por Sphingomonas paucimobilis

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Omar Mauri Garrido

Full Text Available Se presenta la caracterización y manejo terapéutico de un caso de endoftalmitis bacteriana posoperatoria causada por el germen Sphingomonas paucimobilis. La endoftalmitis es la inflamación de los tejidos intraoculares, considerada como la más devastadora de las complicaciones posoperatorias; posee pronóstico visual muy reservado y un elevado riesgo de secuela. Las Sphingomonas paucimobilis son bacterias gramnegativas con forma de bacilo, quimioheterótrofa y estrictamente aerobias que causan enfermedades en los seres humanos, principalmente infecciones hospitalarias que típicamente son tratadas fácilmente con antibióticos. Por sus capacidades biodegradantes y biosintéticas, son pocos los reportes hallados de infección intraocular por este germen. El pronóstico visual es favorable con un diagnóstico precoz y la aplicación del tratamiento adecuado. En este artículo se presentan un caso de endoftalmitis poscirugía de catarata por Sphingomonas paucimobilis reportado en Cuba en el mes de septiembre de 2009.

Churg-Strauss syndrome: a case with unusual manifestations; Sindrome de Churg-Strauss: a proposito de un caso con manifestaciones poco usuales

Energy Technology Data Exchange (ETDEWEB)

Restrepo, Mauricio; Gonzalez, Luis Alonso; Vasquez, Gloria

2008-07-01

Churg-Strauss syndrome, a necrotizing systemic vasculitis which involves the small and (more rarely) the medium-sized vessels, is a primary vasculitis strongly associated with anti neutrophil cytoplasm antibodies (ANCA). It is characterized by the presence of asthma, eosinophilia and extravascular eosinophilic granulomas. Herein, we report a 36-year-old woman with a history of late onset asthma and allergic rhinitis who developed central nervous system involvement, peripheral neuropathy, leucocytoclastic vasculitis and eosinophilia. Interestingly, unusual clinical manifestations of Churg-Strauss syndrome such as mesenteric micro aneurysms and jaw claudication were present in this particular patient. A brief review of the literature of Churg-Strauss syndrome is presented.

Accumulation of sup 210 Po in foodstuffs cultivated in farms around the Brazilian mining and milling facilities on Pocos de Caldas plateau

Energy Technology Data Exchange (ETDEWEB)

Santos, P L; Gouvea, R C; Dutra, I R [Universidade Federal, Rio de Janeiro, RJ (Brazil). Inst. de Biologia; Gouvea, V A [Brazilian Energy Commission, Rio de Janeiro (Brazil). Int. of Radioprotection and Dosimetry

1990-01-01

Several sample types from the environment of the uranium mining and milling facilities of Pocos de Caldas plateau (CIPC) in Minas Gerais state, Brazil have been assayed for their concentrations of uranium and its daughters. This paper presents the data for {sup 210}Po in food, soils and fertilizers in the CIPC region and, for comparison, the corresponding results from a vegetable garden in a control region in Joinville, in the state of Santa Catarina. The results show that vegetables from two gardens near the CIPC region have no significance differences in Po content, despite the closeness of one of the sites to a uranium mine. For some species of vegetables, however, nearsite values were twice those in the control region. Superphosphate fertilizers influence the accumulation of {sup 210}Po by plants, as well as the concentrations in soils, and their contribution is more evident than the local deposition. The major concentration in the leaf and stem suggests that the accumulation of {sup 210}Po in vegetables is due chiefly to its deposition on and absorption by their leaves. (author).

Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use.

Science.gov (United States)

Jones, Audrey L; Cochran, Susan D; Leibowitz, Arleen; Wells, Kenneth B; Kominski, Gerald; Mays, Vickie M

2015-12-01

The benefits of the patient-centered medical home (PCMH) over and above that of a usual source of medical care have yet to be determined, particularly for adults with mental health disorders. To examine qualities of a usual provider that align with PCMH goals of access, comprehensiveness, and patient-centered care, and to determine whether PCMH qualities in a usual provider are associated with the use of mental health services (MHS). Using national data from the Medical Expenditure Panel Survey, we conducted a lagged cross-sectional study of MHS use subsequent to participant reports of psychological distress and usual provider and practice characteristics. A total of 2,358 adults, aged 18-64 years, met the criteria for serious psychological distress and reported on their usual provider and practice characteristics. We defined "usual provider" as a primary care provider/practice, and "PCMH provider" as a usual provider that delivered accessible, comprehensive, patient-centered care as determined by patient self-reporting. The dependent variable, MHS, included self-reported mental health visits to a primary care provider or mental health specialist, counseling, and psychiatric medication treatment over a period of 1 year. Participants with a usual provider were significantly more likely than those with no usual provider to have experienced a primary care mental health visit (marginal effect [ME] = 8.5, 95 % CI = 3.2-13.8) and to have received psychiatric medication (ME = 15.5, 95 % CI = 9.4-21.5). Participants with a PCMH were additionally more likely than those with no usual provider to visit a mental health specialist (ME = 7.6, 95 % CI = 0.7-14.4) and receive mental health counseling (ME = 8.5, 95 % CI = 1.5-15.6). Among those who reported having had any type of mental health visit, participants with a PCMH were more likely to have received mental health counseling than those with only a usual provider (ME = 10.0, 95 % CI�

Study of radon and thoron gas behaviour in the air at the commercial centers in Rio de Janeiro and Pocos de Caldas city; Estudo do comportamento dos gases radonio e toronio presentes no ar em centro comercial do Rio de Janeiro e Pocos de Caldas

Energy Technology Data Exchange (ETDEWEB)

Castro, Carlos A.C. [Minas Gerais Univ., Belo Horizonte, MG (Brazil). Dept. de Engenharia Mecanica. Lab. de Robotica, Soldagem e Simulacao; Morales, Rudnei K; Santos, Victor C. dos . [Instituto Militar de Engenharia (IME), Rio de Janeiro, RJ (Brazil); br, victorcs@ime eb; Cardoso, Domingos D [Comissao Nacional de Energia Nuclear (CNEN), Rio de Janeiro, RJ (Brazil)

2005-07-01

The radon is a radioactive gas. It occurs naturally in the atmosphere coming from the decay of radium, with emission of alpha particles. There are three radon isotopes more known, of which the most important under the environmental point of view is the Rn-222, whose half life is 3.82 days. The radon and their descendants are responsible by more than 40 % of the natural radioactive dose received for the human beings inside the building. In doses above 4 pCi/l, given as occupational dose, can cause among other diseases, the lung cancer. The main source of radon inside the building is the soil. The incidence of radon inside the building varies according to the soil composition, the materials employed in its construction, the inside air temperature and humidity, time during the day, season and the ventilation process designed. The work was realized at the commercial centers in Rio de Janeiro and Pocos de Caldas, for methodology confirmation. It was utilized the passive (track detectors) and active (two filters technique. Kusnetz technique, Tsivoglou technique and alpha spectrometry technique) methods. The objective of this work was to analyze the radon and thoron concentrations levels in order to supply parameters upon the quality of the air in those commercial centers. (author)

Marlboro and Other Usual Brand Choices by Youth Smokers in Middle Eastern Countries

Science.gov (United States)

Page, Randy M.

2012-01-01

This study analyzed data from 118,743 adolescents completing 30 different Global Youth Tobacco Surveys conducted in 15 different Middle Eastern countries between 1999 and 2007 to determine the proportion of young smokers who usually smoked Marlboro, other cigarette brands, or no usual brand smoked in these countries. Marlboro was the most…

Effectiveness of Mindfulness-Based Group Therapy Compared to the Usual Opioid Dependence Treatment.

Science.gov (United States)

Imani, Saeed; Atef Vahid, Mohammad Kazem; Gharraee, Banafsheh; Noroozi, Alireza; Habibi, Mojtaba; Bowen, Sarah

2015-06-01

This study investigated the effectiveness of mindfulness-based group therapy (MBGT) compared to the usual opioid dependence treatment (TAU).Thirty outpatients meeting the DSM-IV-TR criteria for opioid dependence from Iranian National Center for Addiction Studies (INCAS) were randomly assigned into experimental (Mindfulness-Based Group Therapy) and control groups (the Usual Treatment).The experimental group undertook eight weeks of intervention, but the control group received the usual treatment according to the INCAS program. The Five Factor Mindfulness Questionnaire (FFMQ) and the Addiction Sevier Index (ASI) were administered at pre-treatment and post-treatment assessment periods. Thirteen patients from the experimental group and 15 from the control group completed post-test assessments. The results of MANCOVA revealed an increase in mean scores in observing, describing, acting with awareness, non-judging, non-reacting, and decrease in mean scores of alcohol and opium in MBGT patient group. The effectiveness of MBGT, compared to the usual treatment, was discussed in this paper as a selective protocol in the health care setting for substance use disorders.

Effectiveness of Mindfulness-Based Group Therapy Compared to the Usual Opioid Dependence Treatment

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Saeed Imani

2015-11-01

Full Text Available  Objective: This study investigated the effectiveness of mindfulness-based group therapy (MBGT compared to the usual opioid dependence treatment (TAU.Thirty outpatients meeting the DSM-IV-TR criteria for opioid dependence from Iranian National Center for Addiction Studies (INCAS were randomly assigned into experimental (Mindfulness-Based Group Therapy and control groups (the Usual Treatment.The experimental group undertook eight weeks of intervention, but the control group received the usual treatment according to the INCAS program.  Methods:The Five Factor Mindfulness Questionnaire (FFMQ and the Addiction Sevier Index (ASI were administered at pre-treatment and post-treatment assessment periods. Thirteen patients from the experimental group and 15 from the control group completed post-test assessments. Results:The results of MANCOVA revealed an increase in mean scores in observing, describing, acting with awareness, non-judging, non-reacting, and decrease in mean scores of alcohol and opium in MBGT patient group. Conclusion:The effectiveness of MBGT, compared to the usual treatment, was discussed in this paper as a selective protocol in the health care setting for substance use disorders.

Gliosarcoma: un tumor cerebral poco común (Gliosarcoma, a rare brain tumor

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Edison Vega

2014-08-01

Full Text Available Resumen (español El Gliosarcoma (GS es una neoplasia primaria agresiva y poco frecuente del Sistema Nervioso Central (SNC, compuesta de elementos astrocíticos anaplásicos y mesenquimales claramente malignos. El cuadro clínico se caracteriza por cefalea y convulsiones, que se presentan como parte de los síntomas iniciales en el 30% de los pacientes y cuyo porcentaje aumenta conforme avanza la enfermedad. Dentro de las manifestaciones secundarias, se describen cambios como alteración de la concentración y la personalidad; de manera particular las lesiones que afectan al lóbulo parietal se asocian a déficit motor o sensitivo. En cuanto al diagnóstico imagenológico por RMN, los gliomas malignos se observan bien circunscritos con edema focal y captan el contraste en la periferia con un centro hipointenso. Se reporta el caso de paciente Masculino de 45 años de edad, cuyos hallazgos clínico-imagenológicos concuerdan con los previamente descritos por lo que se plantea el diagnóstico de glioma parietooccipital derecho. Al realizar exeresis del tumor, se practicó estudio histopatológico, el cual fue reportado como un glioblastoma multiforme, y posterior al análisis inmunohistoquímico, se concluyó definitivamente como un gliosarcoma. La baja frecuencia de esta entidad patológica y la repercusión en la morbimortalidad de los pacientes que la padecen motivaron a la presentación de este caso. Abstract (english The Gliosarcoma (GS is an aggressive primary neoplasm and rare in central nervous system (CNS, composed of anaplastic astrocytic and mesenchymal elements clearly malignant. The clinical picture is characterized by headaches and seizures, presented as part of the initial symptoms in 30% of patients whose percentage increases as the disease progresses. Among the secondary manifestations, described changes as impaired concentration and personality of lesions particularly affecting the parietal lobe is associated with motor or sensory

Hydrogeochemical applications of natural isotope of the U (4n+2) and Th(4n) series in Morro do Ferro, Pocos de Caldas (MG), Brazil

International Nuclear Information System (INIS)

Bonotto, D.M.

1987-01-01

Uranium and thorium isotopic analysis were performed on well spoils of the ore body at Morro do Ferro, Pocos de Caldas (MG), Brazil, using groundwater from several boreholes in the area and surface water from a stream and that originates at the base of the hill. For uranium and thorium extraction, a chemical process was applied to samples; activites of 228 Th and 232 Th radioisotopes (4n+2 series) were determined by alpha spectrometry. The uranium concentration and 234 U/ 238 U isotope ratio in groundwater were applied to developed models for deducing proportions of water in a mixture and for characterizing uranium accumulation. The correlation between variability in concentration of uranium dissolved in groundwater and alteration of the level of the water table due to infiltration of rainfall was observed. Chemical analysis of the major and minor compounds for groundwater of the ore body zone were done. (Author) [pt

Novel loci associated with usual sleep duration: The CHARGE Consortium Genome-Wide Association Study

NARCIS (Netherlands)

D.J. Gottlieb (Daniel J); K. Hek (Karin); T.-H. Chen; N.F. Watson; G. Eiriksdottir (Gudny); E.M. Byrne; M. Cornelis (Marilyn); S.C. Warby; S. Bandinelli; L. Cherkas (Lynn); D.S. Evans (Daniel); H.J. Grabe (Hans Jörgen); J. Lahti (Jari); M. Li (Man); T. Lehtimäki (Terho); T. Lumley (Thomas); K. Marciante (Kristin); L. Perusse (Louis); B.M. Psaty (Bruce); J. Robbins; G.J. Tranah (Gregory); J.M. Vink; J.B. Wilk; J.M. Stafford; C. Bellis (Claire); R. Biffar; C. Bouchard (Claude); B. Cade; G.C. Curhan (Gary); J. Eriksson; R. Ewert; L. Ferrucci (Luigi); T. Fülöp; P.R. Gehrman (Philip); R. Goodloe (Robert); T.B. Harris (Tamara); A.C. Heath (Andrew C.); D.G. Hernandez (Dena); A. Hofman (Albert); J.J. Hottenga (Jouke Jan); D. Hunter (David); M.K. Jensen (Majken K.); A.D. Johnson (Andrew); M. Kähönen (Mika); W.H.L. Kao (Wen); P. Kraft (Peter); E.K. Larkin; D.S. Lauderdale; A.I. Luik (Annemarie I); M. Medici; G.W. Montgomery (Grant W.); A. Palotie; S.R. Patel (Sanjay); G. Pistis (Giorgio); E. Porcu; L. Quaye (Lydia); O. Raitakari (Olli); S. Redline (Susan); E.B. Rimm (Eric B.); J.I. Rotter; A.V. Smith; T.D. Spector (Timothy); A. Teumer (Alexander); A.G. Uitterlinden (André); M.-C. Vohl (Marie-Claude); E. Widen; G.A.H.M. Willemsen (Gonneke); T.L. Young (Terri L.); X. Zhang; Y. Liu; J. Blangero (John); D.I. Boomsma (Dorret); V. Gudnason (Vilmundur); F. Hu; M. Mangino; N.G. Martin (Nicholas); G.T. O'Connor (George); K.L. Stone (Katie L); T. Tanaka; J. Viikari (Jorma); S.A. Gharib (Sina); N.M. Punjabi (Naresh); K. Räikkönen (Katri); H. Völzke (Henry); E. Mignot; H.W. Tiemeier (Henning)

2015-01-01

textabstractUsual sleep duration is a heritable trait correlated with psychiatric morbidity, cardiometabolic disease and mortality, although little is known about the genetic variants influencing this trait. A genome-wide association study (GWAS) of usual sleep duration was conducted using 18

It's not business as usual anymore

International Nuclear Information System (INIS)

Brown, C.W. Jr.

1992-01-01

In 20 years, a complex body of environmental laws, regulations, and decisions has been established in the U.S. Basic knowledge of environmental laws, regulations, and management techniques is now necessary for design, construction, and operation of oil field facilities. Environmental permits are on the critical path and could significantly affect project viability or the cost of doing business. In California and many other states, resource development projects face complex and voluminous environmental regulations. Because of these permitting obstacles and the competition for the available permits, early environmental planning is necessary if a project is to be successful and if costs and future liabilities are to be minimized. This paper reviews eight federal environmental laws, significant events that affect our daily business, and the reasons why environmental management must be integrated in our business as usual work decisions to minimize future (hidden) liabilities

La paradoja de la transición epidemiológicaThe paradox of epidemiological transition

Directory of Open Access Journals (Sweden)

José Manuel Arriaga López

2014-10-01

Full Text Available En el año dos mil se celebró en la ciudad de Nueva York la Cumbre del Milenio, en donde se aprobó la Declaración del milenio. En esta, tomando como base la problemática existente a nivel global, se establecieron los Objetivos del Milenio. Estos constituyen un plan convenido entre todas las naciones del mundo y las instituciones de desarrollo más importantes a nivel mundial, y en los cuales se proponen: (1 Erradicar la pobreza extrema y el hambre. (2 Lograr la enseñanza primaria universal. (3 Promover la igualdad entre los géneros y la autonomía de la mujer; (4 reducir la mortalidad infantil. (5 Mejorar la salud materna. (6 Combatir el VIH/SIDA, el paludismo y otras enfermedades. (7 Garantizar la sostenibilidad del medio ambiente. (8 Fomentar una asociación mundial para el desarrollo. De estos objetivos, al menos cuatro involucran de manera directa al sector salud y de ellos todos incluyen al perfil epidemiológico clásico de nuestro país. Sin embargo, hacia el 2010, cuando se presenta el Tercer informe de avances en el cumplimiento de los objetivos de desarrollo del milenio, se evidenció que aún se está lejos de cumplir alguno de los objetivos. Además, mientras no es posible resolver los temas prioritarios para el sistema de salud, empieza a ser evidente el aumento de casos de enfermedades como diabetes mellitus, hipertensión arterial, dislipidemias y otras, que tienen como consecuencia complicaciones como infartos de miocardio, falla cardíaca, eventos cerebrovasculares y otras complicaciones que saturan los servicios de salud, dando como resultado objetivos prioritarios no cumplidos y el surgimiento de problemas de salud que eran considerados poco prevalentes en Guatemala.

Celulitis orbitaria como forma de presentación de la sinusitis complicada en el niño Orbital cellulitis as a way of presentation of the complicated sinusitis in the child

Directory of Open Access Journals (Sweden)

Odette Pantoja Pereda

2012-03-01

Full Text Available La sinusitis aguda es un proceso inflamatorio de la mucosa de los senos paranasales, de etiología bacteriana principalmente. Es más frecuente en las edades escolares y en las épocas de mayor circulación de los virus respiratorios. Se desarrolla cuando se afecta el drenaje normal de los senos y se retienen las secreciones mucosas. Las complicaciones más severas, como celulitis y abscesos periorbitarios, son raras. La celulitis orbitaria es una entidad poco frecuente, cuya importancia radica en que puede asociarse a la pérdida de la visión y otras complicaciones. Se presenta el caso de un paciente de 6 años, afectado con celulitis orbitaria, secundaria a sinusitis, y se comentan las peculiaridades del diagnóstico y el tratamiento, con el objetivo de alertar al pediatra para su diagnóstico temprano, lo que optimizaría su tratamiento.The acute sinusitis is a inflammatory process of the mucosa of paranasal sinuses, the more important bacterial etiology. It is more frequent in the school ages and in the periods of more circulation of the respiratory viruses, which develops when the normal drainage of the sinuses is involved and there is retention of the mucosa secretions. The more severe complications including cellulitis and periorbital abscesses are rare. The orbital cellulitis is an entity not much frequent, whose significance lie in it may be associated to loss of vision and other complications. Authors present the case of a patient aged 6 presenting with orbital cellulitis, secondary to sinusitis and the particular feature of diagnosis and treatment to alert pediatrician for its early diagnosis, optimizing its treatment.

Etiología del colesteatoma ótico

Directory of Open Access Journals (Sweden)

Julianis Loraine Quintero Noa

2011-12-01

Full Text Available El colesteatoma es una estructura quística caracterizada por la presencia de epitelio escamoso productor de queratina, que sustituye o recubre la mucosa normal en la hendidura del oído medio y ápex petroso, y puede ser causa de hipoacusia irreversible, destrucción ósea y graves complicaciones por su crecimiento expansivo. Clásicamente se describen los colesteatomas en congénitos y adquiridos. La etiología de su formación es multifactorial y continúa siendo poco claro y controversial. Se reportan diferentes teorías que han tratado de explicar el colesteatoma congénito, la transición de un bolsillo de retracción hasta la aparición del colesteatoma adquirido primario, y otras en la génesis del colesteatoma adquirido secundario. Se describe la presencia de algunas citoquinas dentro del colesteatoma que inducen la hiperproliferación e invasión incoordinada de los queratinocitos de la piel del conducto auditivo externo y la pars fláccida, más agresiva en el colesteatoma adquirido pediátrico, y que desempeñan un papel fundamental en la proliferación y en la apoptosis del queratinocito. En cultivo in vitro de una muestra de tejido colesteatomatoso, se ha identificado recientemente que el TNF-a estimula la producción de la IL-8. Se considera de interés ofrecer esta revisión sobre la etiología del colesteatoma, que aún se mantiene en el campo de la investigación y continúa siendo un reto para los otocirujanos por su alta incidencia de recidivas y posibles complicaciones.

Importancia de la evaluación clínico-imaginológica en el diagnóstico del colesteatoma: Presentación de dos casos Importance of the clinico-imaging evaluation in the diagnosis of cholesteatoma: Report of two cases

Directory of Open Access Journals (Sweden)

María del Carmen Hernández Cordero

2008-03-01

Full Text Available Entre de las afecciones infecciosas crónicas del oído medio, la otitis media colesteatomatosa es la patología inflamatoria que causa un mayor número de complicaciones, tanto en el adulto como en el niño. Se presentan dos pacientes tratados quirúrgicamente en el servicio de otorrinolaringología del Hospital Pediátrico Docente «William Soler» en los años 2004 y 2005, a causa de complicaciones poco frecuentes de esta enfermedad (absceso de Bezold, tromboflebitis del seno lateral, absceso epidural, fistula laberíntica y parálisis facial. Se destaca la importancia de la sospecha clínica de colesteatoma y el impacto científico de la tomografía computarizada del hueso temporal y de cráneo, simple y contrastada, para el diagnóstico preoperatorio del colesteatoma complicado en la infancia, lo cual contribuye con la primera prioridad de la cirugía otológica: un oído seguro y sin recidivas.Among the chronic infectious affections of the middle ear, the cholesteatomatous otitis media is the inflammatory pathology causing a higher number of complications, both in the adult and the child. Two patients that were surgically treated at the otorrhynolaryngology service of "William Soler" Pediatric Hospital from 2004 to 2005 because of rare complications of this disease (Bezold's abscess, thrombophlebitis of the lateral sinus, epidural abscess, labyrinthic fístula and facial paralysis were presented. It was stressed the importance of clinical suspicion of cholesteatoma and the scientific impact of the simple and contrast computerized tomography of the temporal bone cranius for the preoperative diagnosis of complicated cholesteatoma in children, which contributes with the first priority of otological surgery: a safe ear without relapses.

Novel loci associated with usual sleep duration: the CHARGE Consortium Genome-Wide Association Study

NARCIS (Netherlands)

Gottlieb, D.J.; Hek, K.; Chen, T.H.; Watson, N.F.; Eiriksdottir, G.; Byrne, E.M.; Cornelis, M.; Warby, S.C.; Bandinelli, S.; Cherkas, L.; Evans, D.S.; Grabe, H.J.; Lahti, J.; Li, M.; Lehtimäki, T.; Lumley, T.; Marciante, K.; Pérusse, L.; Psaty, B.M.; Robbins, J.; Tranah, G.; Vink, J.M.; Wilk, J.B.; Stafford, J.M.; Bellis, M.; Biffar, R.; Bouchard, C.; Cade, B.; Curhan, G.C.; Eriksson, J.G.; Ewert, R.; Ferrucci, L.; Fülöp, T.; Gehrman, P.R.; Goodloe, R.; Harris, T.B.; Heath, A.C.; Hernandez, D.; Hofman, A.; Hottenga, J.J.; Hunter, D.J.; Jensen, M.K.; Johnson, A.D.; Kähönen, M.; Kao, L.; Kraft, P.; Larkin, E.K.; Lauderdale, D.S.; Luik, A.I.; Medici, M.; Montgomery, G.W.; Palotie, A.; Patel, S.R.; Pistis, G.; Porcu, E.; Quaye, L.; Raitakari, O.; Redline, S.; Rimm, E.B.; Rotter, J.I.; Smith, A.V.; Spector, T.D.; Teumer, A.; Uitterlinden, A.G.; Vohl, M.-C.; Widén, E.; Willemsen, G.; Young, T.; Zhang, X.; Liu, Y.; Blanger, J.; Boomsma, D.I.; Gudnason, V.; Hu, F.; Mangino, M.; Martin, N.G.; O'Connor, G.T.; Stone, K.L.; Tanaka, T.; Viikari, J.; Gharib, S.A.; Punjabi, N.M.; Räikkönen, K.; Völzke, H.; Mignot, E.; Tiemeier, H.

2015-01-01

Usual sleep duration is a heritable trait correlated with psychiatric morbidity, cardiometabolic disease and mortality, although little is known about the genetic variants influencing this trait. A genome-wide association study (GWAS) of usual sleep duration was conducted using 18 population-based

Usual Vitamin Intakes by Mexican Populations.

Science.gov (United States)

Pedroza-Tobías, Andrea; Hernández-Barrera, Lucía; López-Olmedo, Nancy; García-Guerra, Armando; Rodríguez-Ramírez, Sonia; Ramírez-Silva, Ivonne; Villalpando, Salvador; Carriquiry, Alicia; Rivera, Juan A

2016-09-01

In the past several years, the consumption of high-energy, nutrient-poor foods has increased globally. Dietary intake data collected by the National Health and Nutrition Survey (ENSANUT) 2012 provide information to assess the quality of the Mexican diet and to guide food and nutrition policy. The aim was to describe the usual intake and the prevalence of inadequate intakes of vitamins for the overall Mexican population and by subgroups defined by sex, age, region, urban or rural areas, and socioeconomic status (SES). ENSANUT 2012 is a cross-sectional probabilistic survey representative of the Mexican population. Dietary information was collected by using the 24-h recall automated multiple-pass method (n = 10,096) with a repeated measurement on a subsample (n = 889) to permit adjustment for intraindividual variability with the use of the Iowa State University method. Mean usual intakes and the prevalence of inadequate intakes of thiamin, riboflavin, niacin, folate, and vitamins A, D, E, C, B-6, and B-12 were calculated for children aged 1-4 y (CH1-4y), children aged 5-11 y (CH5-11y), adolescents aged 12-19 y, and adults aged ≥20 y. In all of the age groups, prevalences of inadequate intakes of vitamins D and E were the highest (77-99% of adults and adolescents and 53-95% of CH5-11y and CH1-4y) and those of folate and vitamin A were intermediate (47-70% of adults and adolescents, 15-23% of CH5-11y and 8-13% of CH1-4y), whereas those of thiamin, riboflavin, niacin, and vitamins B-6, B-12, and C were the lowest (0-37% of adults, 1-27% of adolescents, and 0-2.4% of CH5-11y and CH1-4y). With few exceptions, the highest prevalences of inadequate intakes for vitamins were observed in the poorest populations (rural South region and the lowest tertile of SES). The intake of vitamins among Mexicans is inadequate overall. Information collected by ENSANUT can help target food assistance programs and develop strategies to prevent vitamin deficiencies. © 2016 American Society

It's not business as usual - anymore

International Nuclear Information System (INIS)

Brown, C.W.

1991-01-01

In a short period of 20 years, a complex body of environmental laws, regulations, and decisions has been established in the United States. Basic knowledge of environmental laws, regulations, and environmental management are now necessary for design, construction, and operation of our oil field facilities. environmental permits are on the critical path and could have the potential to significantly affect project viability or the cost of doing business. In California and many other States, resource development projects faced complex and voluminous environmental regulations. These permitting obstacles along with competition for the available permits require early project environmental planning if a project is to be successful and if costs and future liability are to be minimized. This paper will review eight Federal environmental laws, significant events that affect our daily business, and why environmental management must be integrated in our business as usual work decisions to minimize future (hidden) liabilities

Association of usual intake of added sugars with nutrient adequacy

Science.gov (United States)

Recommendations for intakes of added sugars have varied considerably and the scientific basis supporting these recommendations has been inconsistent. The goal of this study was to examine the association of usual intake (UI) of added sugars and nutrient adequacy in those participating in NHANES 2009...

Recirculation usually precedes malignant edema in middle cerebral artery infarcts

DEFF Research Database (Denmark)

Nielsen, T H; Ståhl, N; Schalén, W

2012-01-01

In patients with large middle cerebral artery (MCA) infarcts, maximum brain swelling leading to cerebral herniation and death usually occurs 2-5 days after onset of stroke. The study aimed at exploring the pattern of compounds related to cerebral energy metabolism in infarcted brain tissue....

Therapy recommendation "act as usual" in patients with whiplash injuries QTF I°.

Science.gov (United States)

Dehner, Christoph; Kraus, Michael; Schöll, Hendrik; Schneider, Florian; Richter, Peter; Kramer, Michael

2012-08-20

Up to now no therapy study has used the classification system of the Quebec Task Force (QTF) to differentiate between patients with (QTF II°) and without functional disorders (QTF I°). This differentiation seems meaningful, as this difference may be relevant for the correct treatment planning. In this context the effect of the therapy recommendation "act as usual" has been evaluated in a homogeneous patient collective with whiplash injuries QTF I°. 470 patients with acute whiplash injuries had been catched in this study and classified according to the QTF. 359 patients (76.4%) with QTF I° injuries could be identified. Out of that 162 patients were enrolled to the study and received the therapy recommendation "act as usual" and the adapted pain treatment with non-steroidal anti-inflammatory drugs (NSAID). After six months the outcome was evaluated by phone. After injury the median pain score assessed by a visual analogue scale (VAS) was 5.4 (min = 3.3; max = 8.5). After six months 5 of the 162 patients complained intermittent pain symptoms (VAS values < 2). This is consistent with a chronification rate of 3.1%. After injury, the median pain disability index (PDI) was 3.9 (min = 1.9; max = 7.7). After six months 3 of the 162 patients stated persisting disability during sporting and physical activities (VAS values < 1). The therapy recommendation "act as usual" in combination with an adapted pain treatment is sufficient. Usually patients with whiplash injuries QTF I° do not need physical therapy. An escalation of therapy measures should be reserved to patients with complicated healing processes.

Business as usual and nuclear power

International Nuclear Information System (INIS)

2000-01-01

Energy and nuclear policy makers face many challenges as they evaluate options to ensure an adequate supply of electricity while pursuing environmental, economic and energy security goals. Many analysts suggest that nuclear's share of global energy supply could decrease in coming decades. If energy markets and national energy policies continue along 'business as usual' lines, what are the issues that arise? what are the consequences for the long-term availability of nuclear technology and expertise? This book identifies the issues in a series of papers presented at a recent meeting jointly organised by the International Energy Agency and the OECD Nuclear Energy Agency. Senior energy policy makers and industry executives from OECD Member countries contributed these analyses. They offer a realistic assessment of nuclear's potential contribution, and the major challenges awaiting nuclear energy and energy supply in general. For those seeking a review of the current issues facing nuclear power within the broad context of energy policy, this is an essential report. (authors)

Microbiological analysis at the Osamu Utsumi mine and Morro do Ferro analogue study sites, Pocos de Caldas, Brazil

International Nuclear Information System (INIS)

West, J.M.; Vialta, A.; McKinley, I.G.

1990-01-01

The Pocos de Caldas project is a wide-ranging natural analogue study focussed on a number of areas of concern in the performance assessment of the disposal of radioactive waste. Part of the work has involved characterising microbial populations and their influence in various processes. Core material and groundwaters have been sampled for microbiological content at various depths form boreholes at the Osamu Utsumi open pit uranium mine and Morro do Ferro Th/REE ore body. Microbes were found in all samples but numbers do not appear to be related to depth. Analyses of groundwaters gave higher numbers than with solid material and demonstrated the presence of sulphur cycle bacteria. These observations have been compared with predictions of a model used in performance assessment to calculate the maximum biomass/microbial activity based on constraints set by available nutrients and energy. The main conclusions of this analysis are: 1. Low microbial activities can be supported by the energy and nutrients supplied by alteration processes at or around the redox front. The maximum annual production of approximately equal to 0.01 - 0.1 g biomass (dry)/m 2 of redox front is in reasonable agreement with observed standing populations. 2. The presence of high concentrations of sulphate reducing bacteria around the redox front indicate a complex sulphur geochemistry which may be predominantly microbially catalysed and could explain the nodular form of pitchblende concretions and the presence of secondary pyrite. 3. There is little trace element mobilisation by organic byproducts and the main role of microbes in this system is to catalyse specific redox reactions. (au)

[Not Available].

Science.gov (United States)

Baena González, Marta; Molina Recio, Guillermo

2016-06-30

Introducción: la disfagia es un síntoma que se refiere a la dificultad para mover el bolo alimentario desde la boca al estómago. A pesar de su relevancia y de la gravedad de sus posibles complicaciones, es poco conocida y estudiada. La prevalencia de la disfagia orofaríngea en enfermosde alzhéimer es de un 84% y puede originar complicaciones de gran trascendencia clínica como consecuencia de las alteraciones en la eficacia de la deglución, y en la seguridad de la misma.Objetivo: conocer el estado actual del conocimiento en relación al abordaje de la disfagia en enfermos de alzhéimer, localizando aquellos factores que permitan un diagnóstico precoz que facilite la prevención de complicaciones y la elección de la pauta de actuación más adecuada.Metodología: revisión sistemática. Estudios publicados entre 2005 y 2014 en inglés y castellano. Bases de datos: PubMed, Cochrane, Scopus, Elsevier, Scielo y Dialnet. Términos MeSH empleados: disfagia, dysphagia, alzheimer, modified y texture food.Resultados: el diagnóstico en los pacientes de alzhéimer se realiza mediante métodos clínicos y exploraciones complementarias como la videofluoroscopia, considerada como el estándar para el estudio de la disfagia orofaríngea, ya que permite identificar entre 1/3 y 1/4 de los pacientes que presentan aspiraciones silentes no diagnosticables clínicamente. Existen estrategias terapéuticas que incluyen cambios en el volumen y viscosidad del bolo, cambios posturales, maniobras deglutorias, procedimientos de rehabilitación y técnicas de incremento sensorial que han demostrado su eficacia, pero se trata de una labor compleja que exige un abordaje multidisciplinar para un correctodiagnóstico y tratamiento.Conclusiones: existe una escasa evidencia científica en el abordaje de la disfagia y un gran desconocimiento en cuanto a la alimentación de los enfermos de alzhéimer. Esta patología necesita una intervención multidisciplinar en la cual las medidas

Future reef decalcification under a business-as-usual CO2 emission scenario.

Science.gov (United States)

Dove, Sophie G; Kline, David I; Pantos, Olga; Angly, Florent E; Tyson, Gene W; Hoegh-Guldberg, Ove

2013-09-17

Increasing atmospheric partial pressure of CO2 (pCO2) is a major threat to coral reefs, but some argue that the threat is mitigated by factors such as the variability in the response of coral calcification to acidification, differences in bleaching susceptibility, and the potential for rapid adaptation to anthropogenic warming. However the evidence for these mitigating factors tends to involve experimental studies on corals, as opposed to coral reefs, and rarely includes the influence of multiple variables (e.g., temperature and acidification) within regimes that include diurnal and seasonal variability. Here, we demonstrate that the inclusion of all these factors results in the decalcification of patch-reefs under business-as-usual scenarios and reduced, although positive, calcification under reduced-emission scenarios. Primary productivity was found to remain constant across all scenarios, despite significant bleaching and coral mortality under both future scenarios. Daylight calcification decreased and nocturnal decalcification increased sharply from the preindustrial and control conditions to the future scenarios of low (reduced emissions) and high (business-as-usual) increases in pCO2. These changes coincided with deeply negative carbonate budgets, a shift toward smaller carbonate sediments, and an increase in the abundance of sediment microbes under the business-as-usual emission scenario. Experimental coral reefs demonstrated highest net calcification rates and lowest rates of coral mortality under preindustrial conditions, suggesting that reef processes may not have been able to keep pace with the relatively minor environmental changes that have occurred during the last century. Taken together, our results have serious implications for the future of coral reefs under business-as-usual environmental changes projected for the coming decades and century.

Compared With Usual Sodium Intake, Low- and Excessive-Sodium Diets Are Associated With Increased Mortality

DEFF Research Database (Denmark)

Graudal, Niels; Jürgens, Gesche; Baslund, Bo

2014-01-01

BACKGROUND: The effect of sodium intake on population health remains controversial. The objective was to investigate the incidence of all-cause mortality (ACM) and cardiovascular disease events (CVDEs) in populations exposed to dietary intakes of low sodium (<115 mmol), usual sodium (low usual so...

Acid drainages of the pyritic sterile from the Pocos de Caldas uranium mine: environmental interpretation and implications

International Nuclear Information System (INIS)

Souza, Vicente Paulo de

1995-12-01

Considering the planned closure of the first uranium mine and milling plant operating in Brazil, located in the Pocos de Caldas Plateau, in the State of Minas Gerais, in the next two years, there is the need to obtain basic information for its decommissioning. Special attention has been directed to the following critical areas: open pit, tailing, dam and waste rock piles, because these are the main sources of acid drainage generation. These waters cannot be allowed to flow in the external environment because in addition to sulphuric acid, there is a number of elements in concentration above those allowed by regulations. Among the waste piles (bota-foras BF) two of them BF-4 and BF-8, are in a process of acid generation, thus requiring more attention. The objective of this work was to simulate at the laboratory scale the oxidation and the reduction zones of BF-4. The experiments were conducted in acrylic columns, where the waste sample was kept under aerated and saturated conditions, in different columns. The control of the chemical (solubilized chemical species), physico-chemical (redox potential, pH, conductivity) and biological (bacterial activity) parameters has been carried out on the acid solutions generated by the chemical and biological reactions that occur at the waste. Although the results refer to a four month period, some relevant points can be highlighted, which will serve as a basis for further research. The mineralogical characterization identified the existence of other sulphides associated to pyrite with lower oxidation potential than the latter. The results obtained with the biological characterization for the two conditions studied revealed that the bacterial activity is more intense in the region in contact with air, than in saturated region. (author)

El coste de la diabetes tipo 2 en España: El estudio CODE-2

Directory of Open Access Journals (Sweden)

Mata M.

2002-01-01

Full Text Available Objetivo: Estimar el coste de la atención sanitaria al paciente diabético tipo 2, diferenciando el gasto derivado del control de la enfermedad, de la atención de sus complicaciones y de otros costes directos asociados. Métodos: Recogida retrospectiva del consumo de recursos a partir de la historia clínica y la entrevista personal en 29 centros de atención primaria de todo el territorio nacional de una muestra de pacientes seleccionados de forma aleatoria a partir del registro de diabéticos de cada centro. Resultados: Se evaluó a 1.004 pacientes (561 mujeres con una media de edad de 67,42 años y una media de evolución de la enfermedad de 10,07 años. El 50,9% no presentaba complicaciones, el 17,7% sólo macrovasculares, el 19,5% sólo microvasculares y el 11,9% ambas. El coste anual sanitario por paciente fue de 1.305,15 euros. De este coste el 28,6% (373,27 euros estaba relacionado directamente con el control de la diabetes, el 30,51% (398,20 euros con sus complicaciones y el 40,89% (533,68 euros no estaba relacionado. El coste medio de un paciente sin complicaciones fue de 883 euros frente a 1.403 de un paciente con complicaciones microvasculares, 2.022 cuando existían complicaciones macrovasculares y 2.133 cuando coexistían ambos tipos de complicaciones. Conclusiones: El elevado coste del tratamiento de la diabetes tipo 2 y sus complicaciones, sugiere la posibilidad de que la mejora del control de la enfermedad pueda no sólo mejorar la supervivencia y la calidad de vida, sino reducir los costes asociados con las complicaciones crónicas.

Incidence of vascular complications in patients submitted to percutaneous transluminal coronary angioplasty by transradial and transfemoral arterial approach Incidencia de complicaciones vasculares en pacientes sometidos a angioplastía coronaria transluminal percutánea por vía arterial transradial y transfemoral Incidência de complicações vasculares em pacientes submetidos a angioplastia coronariana transluminal percutânea por via arterial transradial e transfemoral

Directory of Open Access Journals (Sweden)

Marinez Kellermann Armendaris

2008-03-01

Full Text Available OBJECTIVE: To describe the vascular complications of transradial and transfemoral artery punctures in patients submitted to percutaneous transluminal coronary angioplasty (PTCA. METHODS: Prospective cohort study including patients submitted to PTCA. An interview was performed and an instrument applied to collect risk factors/predictors of complications. After the procedure, a physical examination was performed, vital signs were measured and the puncture site was assessed. RESULTS: 199 patients were included, age 64±10 years. Complications found for the radial and femoral approach were respectively: ecchymosis (18.29%, (17.14%; bruising (17.66%, (14.27%; urinary retention (2.43%, (25.71%; loss of vessel permeability (8.53%, (0%. CONCLUSION: The complications found were considered minor or secondary, depending on the classification found in literature. A higher rate of vascular complications related to transradial artery punctures compared to the interventions performed by transfemoral approach.OBJETIVO: Describir complicaciones vasculares relacionadas a punciones arteriales transradial y transfemoral en pacientes sometidos a angioplastía coronaria transluminal percutánea (ACTP. MÉTODOS: Se trata de un estudio de cohorte prospectivo realizado con pacientes sometidos a ACTP. Se llevó a cabo una entrevista y aplicó un instrumento para obtener factores de riesgo/predictores. Fue realizado un examen físico, medición de signos vitales y se evaluó el lugar de punción. RESULTADOS: Fueron incluidos 199 pacientes, edad 64±10 años. Las complicaciones encontradas para vía radial y femoral respectivamente, fueron: esquimosis (18,29%, (17,14%; hematoma (17,66%, (14,27%; retención urinaria (2,43%, (25,71%; pérdida de permeabilidad de vaso (8,53%, (0%. CONCLUSIÓN: Las complicaciones fueron consideradas menores o secundarias conforme clasificación literaria. Existe una mayor incidencia de complicaciones vasculares relacionadas a punciones

Intervenções de enfermagem nas complicações mais freqüentes durante a sessão de hemodiálise: revisão da literatura Intervenciones de enfermería en las complicaciones más frecuentes durante la sesión de hemodialisis: revisión de la literatura Nursing interventions for the most frequent complications during hemodialysis procedure: literature review

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Cristiano Dias Nascimento

2005-12-01

Full Text Available O procedimento hemodialítico tem complicações potenciais e o enfermeiro deve estar apto a intervir em tais complicações. Considerando este contexto, este artigo tem como objetivo descrever as complicações mais freqüentes relacionadas à hemodiálise e as intervenções de enfermagem a elas relacionadas. Esta revisão de literatura consiste em pesquisa as Bases de Dados, LILACS, BEDENF E MEDLINE, utilizando descritores pertinentes. Os resultados demonstraram que as complicações que ocorrem com maior freqüência são: hipotensão, hipertensão, cãibras musculares, náusea e vômito, cefaléia, dor torácica e lombar, prurido, febre e calafrios. Concluiu-se que o papel do enfermeiro é essencial para a monitorização, detecção e intervenção em tais complicações e que este é um diferencial para a obtenção de segurança e qualidade no procedimento hemodialítico. No entanto, existe a necessidade de realização de mais pesquisas na área de enfermagem para melhor definir a atuação do enfermeiro.Lo procedimiento de hemodialisis tiene complicaciones potenciales y los enfermeros deben estar aptos a intervenir en ellos. Al considerar esto contexto, lo artículo objectiva describir las complicaciones más frecuentes relacionadas a la hemodialisis así como las intervenciones de enfermería. Esta revisión bibliografica ha consistido de busqueda a las basis de datos LILACS, DBENF y MEDLINE usandose descriptores pertinentes. Resultados han demonstrado que las mayores complicaciones son: hipotensión, hipertensión, distres musculares, nausea, vomitos, cefalea, dolor toracica y lumbar, prurido, fiebre y calafrios. Se ha concluido que el papel del enfermero es esencial para la monitorización, identificación y intervención en estas complicaciones y que esto papel tanbien es uno diferencial para obterse la calidad en lo procedimiento hemodialitico. Entremientes, hay una necessidad de realizarse más pesquisas en la area de enfermer

Dancing for Parkinson Disease: A Randomized Trial of Irish Set Dancing Compared With Usual Care.

Science.gov (United States)

Shanahan, Joanne; Morris, Meg E; Bhriain, Orfhlaith Ni; Volpe, Daniele; Lynch, Tim; Clifford, Amanda M

2017-09-01

To examine the feasibility of a randomized controlled study design and to explore the benefits of a set dancing intervention compared with usual care. Randomized controlled design, with participants randomized to Irish set dance classes or a usual care group. Community based. Individuals with idiopathic Parkinson disease (PD) (N=90). The dance group attended a 1.5-hour dancing class each week for 10 weeks and undertook a home dance program for 20 minutes, 3 times per week. The usual care group continued with their usual care and daily activities. The primary outcome was feasibility, determined by recruitment rates, success of randomization and allocation procedures, attrition, adherence, safety, willingness of participants to be randomized, resource availability, and cost. Secondary outcomes were motor function (motor section of the Unified Parkinson's Disease Rating Scale), quality of life (Parkinson's Disease Questionnaire-39), functional endurance (6-min walk test), and balance (mini-BESTest). Ninety participants were randomized (45 per group). There were no adverse effects or resource constraints. Although adherence to the dancing program was 93.5%, there was >40% attrition in each group. Postintervention, the dance group had greater nonsignificant gains in quality of life than the usual care group. There was a meaningful deterioration in endurance in the usual care group. There were no meaningful changes in other outcomes. The exit questionnaire showed participants enjoyed the classes and would like to continue participation. For people with mild to moderately severe PD, set dancing is feasible and enjoyable and may improve quality of life. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Abordaje transparotídeo para la reducción abierta de las fracturas subcondíleas: Técnica quirúrgica y análisis de sus complicaciones Transparotid approach for the open reduction of subcondylar fractures: Surgical technique and analysis of complications

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J. Rodríguez Flores

2011-03-01

Full Text Available Introducción: Existen varias opciones para el tratamiento de las fracturas subcondíleas. El abordaje transparotídeo anterior es una de las posibilidades terapéuticas para su reducción abierta y su fijación interna. El objetivo de este artículo es realizar una descripción de la técnica quirúrgica y analizar las complicaciones asociadas. Material y métodos: Se realizó una revisión clínica sobre un total de 31 pacientes con 34 fracturas subcondíleas, todas ellas tratadas quirúrgicamente con un abordaje transparotídeo anterior, usando placas y tornillos de osteosíntesis. Resultados: No se registraron complicaciones de ningún tipo en 22 de los 31 pacientes (70,97%, con buena oclusión posquirúrgica en 28 de ellos (90,32%. Las complicaciones relacionadas con el abordaje en nuestra serie de casos fueron las siguientes: 2 casos de paresia facial (5,88%, que en ambos fue leve y transitoria; 6 casos de fístula salival (17,65%, siendo en todos ellos autolimitadas, y 3 infecciones de la herida quirúrgica (8,82%: 2 resueltas con antibióticos y una que requirió también drenaje quirúrgico. Como complicación no relacionada con el tipo de abordaje sino con el tipo de osteosíntesis, hubo 2 casos de fractura de placa de osteosíntesis (5,88%. Conclusiones: El abordaje transparotídeo anterior es seguro, con un bajo riesgo lesivo para el nervio facial. Esta técnica proporciona un adecuado campo quirúrgico que permite la colocación y la fácil fijación de una segunda placa de osteosíntesis en la parte anterior de la fractura. La cicatriz resultante es estética.Introduction: Several options exist for the treatment of subcondylar jaw fractures. The anterior transparotid approach is one of the therapeutic options for open reduction and internal fixation. The aim of this communication was to describe the surgical technique and analyze the related complications. Patients and methods: A clinical review was made of 31 patients with 34

Cisticercosis diseminada: reporte de un caso en Perú

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Julio Maquera-Afaray

Full Text Available La cisticercosis es una enfermedad desatendida y endémica en el Perú que afecta comúnmente al sistema nervioso central (SNC, causando la neurocisticercosis (NCC. Sin embargo, son pocos los reportes de cisticercosis diseminada (CCD en el mundo. Se reporta el caso de un paciente varón de 82 años, natural del departamento de Junín, que presenta pérdida brusca del nivel de conciencia asociada a convulsiones tónico-clónicas generalizadas. La tomografía axial computarizada y la resonancia magnética nuclear cerebral mostraron múltiples lesiones de aspecto quístico con presencia de escólex en su interior y compatibles con NCC masiva; la resonancia magnética nuclear torácica, abdominal y pélvica permitieron evidenciar la diseminación multiorgánica de cisticercos. Aunque es poca la casuística y experiencia terapéutica en los casos de CCD, el paciente recibió tratamiento antiparasitario con albendazol y corticoides, logrando una evolución clínica favorable y sin complicaciones durante la hospitalización

Síndrome de inmunodeficiencia común variable a propósito de un caso

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Teresa Mendoza Altuna

2013-12-01

Full Text Available La inmunodeficiencia común variable (IDCV es la inmunodeficiencia primaria que con más frecuencia encontramos en la práctica clínica. Clínicamente se define como la presencia de infecciones recurrentes y una reducción en suero de IgG (al menos 2 desviaciones estándar por debajo de los valores de referencia para su edad y al menos otra de las Ig (IgA o IgM y una reducción o ausencia de producción de anticuerpos La clínica que presentan estos pacientes son múltiples infecciones pulmonares, infecciones bacterianas sistémicas y complicaciones gastrointestinales, siendo las infecciones la manifestación clínica más frecuente. Se conoce muy poco acerca de los mecanismos etiopatogénicos que conducen a esta anormalidad inmunológica. Presentamos un caso de IDCV en una trabajadora sanitaria pretendiendo revisar los síntomas del cuadro clínico así como hacer una reflexión sobre los efectos de la prevención de riesgos para el trabajador.

Mandometer Treatment Not Superior to Treatment as Usual for Anorexia Nervosa

NARCIS (Netherlands)

van Elburg, Annemarie A.; Hillebrand, Jacquelien J. G.; Huyser, Chaim; Snoek, Maartje; Kas, Martien; Hoek, Hans W.; Adan, Roger A. H.

Objective: A comparison of the efficacy of a novel treatment method for anorexia nervosa (AN), the Mandometer treatment (MT), with treatment as usual (TAU). Method: During treatment data were collected to determine weight recovery and outcome as assessed by the Morgan Russell Outcome Assessment

<報文>レアメタル資源に関する研究(I) : ジルコニウム資源としてのPocos de Caldas, Brasil産カルダサイト

OpenAIRE

佐藤, 修彰; 伊藤, 良雅; 南條, 道夫

1986-01-01

The zirconium deposit of the Pocos de Caldas Plateau is north of Sa^^?o Paulo, Brasil, on the boundary between the States of Minas Gerais and Sa^^?o Paulo. The zirconium ore was formed as a mixture of baddeleyite (ZrO_2) and zircon (ZrSiO_4) which was identified as caldasite from the microscopic, X-ray and electron microprobe studies. This ore also contained a high content of uranium and thorium oxides, enough for nuclear fuel resources from the γ-ray spectrometry. The ore shows stable behavi...

Control and chronic complications of diabetes mellitus in an outpatient atention center in Medellín, Colombia, 1998-2001 Control y complicaciones crónicas de la diabetes mellitus en el Centro de Atención Ambulatorio central, Instituto de Seguro Social 1998-2001

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Catalina Bedoya Gómez

2004-01-01

were: cardiovascular 48,4%, eyerelated 57.4%, renal 31,5%, neuropathy 28,6% and diabetic foot 24%. Less than 50% of the patients had reached goals in controlling glycemia, HbA1c, total cholesterol, HDL cholesterol and systolic blood pressure. In the control of triglycerides and diastolic blood pressure, 62% and 76.3%, respectively had reached the goals of control. When association tests among different variables were performed, we only found association between the type of diabetes and the presence of hypertension and cardiovascular disease (p <0.000 for both. Conclusions: in diabetic patients attending the outpatient diabetes control program of the iss sectional Antioquia, diabetes is associated to other metabolic syndrome components in high proportion; these patients have a high incidence of chronic complications which varies from 24 to 58%, thus enhancing their morbility and mortality and they represent an important burden to the health system. We emphasize on the need of early detection in order to do a proper control and to carry out therapeutic and educational strategies to prevent or slow down the appearance of complications. El control de la diabetes mellitus requiere la evaluación continua y estricta de un gran número de factores que lo afectan, no solo desde el punto de vista de la glucemia sino de otros participantes en el trastorno metabólico por ella producida, de otras enfermedades asociadas a ella y de hábitos de salud que influyen en su control y en la aparición de diferentes complicaciones. Para identificar esta situación en el programa de diabetes del Centro de Atención Ambulatoria (CAA central del Instituto del Seguro Social (ISS, seccional Antioquia se evaluaron el control de la diabetes, la presencia de enfermedades asociadas, los hábitos de salud, las complicaciones crónicas presentadas y el grado de control de los diferentes parámetros. Metodología: entre enero de 1998 y diciembre de 2001, mediante un muestreo aleatorio simple con

Study of radon and thoron gas behaviour in the air at the commercial centers in Rio de Janeiro and Pocos de Caldas city

International Nuclear Information System (INIS)

Castro, Carlos A.C.; Cardoso, Domingos D.

2005-01-01

The radon is a radioactive gas. It occurs naturally in the atmosphere coming from the decay of radium, with emission of alpha particles. There are three radon isotopes more known, of which the most important under the environmental point of view is the Rn-222, whose half life is 3.82 days. The radon and their descendants are responsible by more than 40 % of the natural radioactive dose received for the human beings inside the building. In doses above 4 pCi/l, given as occupational dose, can cause among other diseases, the lung cancer. The main source of radon inside the building is the soil. The incidence of radon inside the building varies according to the soil composition, the materials employed in its construction, the inside air temperature and humidity, time during the day, season and the ventilation process designed. The work was realized at the commercial centers in Rio de Janeiro and Pocos de Caldas, for methodology confirmation. It was utilized the passive (track detectors) and active (two filters technique. Kusnetz technique, Tsivoglou technique and alpha spectrometry technique) methods. The objective of this work was to analyze the radon and thoron concentrations levels in order to supply parameters upon the quality of the air in those commercial centers. (author)

Complicaciones asociadas al catéter percutáneo en recién nacidos pretérmino y a término.

Science.gov (United States)

Higareda-Almaraz, Martha Alicia; Gutiérrez-Monraz, Paz Alejandra; Castillo-Sánchez, Ruth Alejandrina; León, Juan Carlos Barrera-de; Zavalza-Gómez, Ana Bertha; Higareda-Almaraz, Enrique

2018-01-01

Identificar las complicaciones asociadas al catéter percutáneo en recién nacidos pretérmino y a término. Estudio transversal comparativo. Se incluyeron recién nacidos que tenían insertado un catéter percutáneo, con resultados de cultivo de sangre y segmento distal del catéter. Se formaron dos grupos: pretérmino y a término. Se calcularon la razón de momios (RM) y el intervalo de confianza del 95% (IC 95%). Se analizaron datos de 50 recién nacidos por grupo. En los pretérmino y a término se encontró un valor de la media de edad gestacional de 30 ± 3 y 40 ± 2, respectivamente (p = 0.01), y unos porcentajes de sepsis por catéter del 36 y el 18% (p = 0.02; RM: 2.56; IC 95%: 1.02-7.17), de catéter infectado del 50 y el 22% (p = 0.01; RM: 5.92; IC 95%: 1.66-23.12), de catéter colonizado del 24 y el 14% (p = 0.01; RM: 3.58; IC 95%: 1.32-9.90), de infección local del 14 y el 8% (p = 0.03; RM: 1.87; IC 95%: 1.45-8.29), de infiltración del 18 y el 4% (p = 0.02; RM: 5.27; IC 95%: 1.17-59), de retiro accidental del 6 y el 22% (p = 0.02; RM: 0.23; IC 95%: 0.05-0.87) y de rotura del catéter del 10 y el 28% (p = 0.02; RM: 0.29; IC 95%: 0.08-0.98). Se encontró mayor asociación de infecciones e infiltraciones por catéter percutáneo en los pretérmino, y de retiro accidental y rotura del catéter en los nacidos a término. Copyright: © 2018 SecretarÍa de Salud

How the psychosocial context of clinical trials differs from usual care: A qualitative study of acupuncture patients

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White Peter

2011-05-01

Full Text Available Abstract Background Qualitative studies of participants' experiences in randomised clinical trials (RCTs suggest that the psychosocial context of treatment in RCTs may be quite different to the psychosocial context of treatment in usual practice. This is important, as the psychosocial context of treatment is known to influence patient outcomes in chronic illness. Few studies have directly compared the psychosocial context of treatment across RCTs and usual practice. In this study, we explored differences in psychosocial context between RCT and usual practice settings, using acupuncture as our model. Methods We undertook a secondary analysis of existing qualitative interviews with 54 patients. 27 were drawn from a study of western and traditional acupuncture in usual practice (for a range of painful conditions. 27 were drawn from a qualitative study nested in an RCT of western acupuncture for osteoarthritis of the hip or knee. We used qualitative analysis software to facilitate an inductive thematic analysis in which we identified three main themes. Results In usual practice, starting acupuncture was more likely to be embedded in an active and ongoing search for pain relief, whereas in the RCT starting acupuncture was opportunistic. Usual practice patients reported few uncertainties and these had minimal consequences for them. In the RCT, patients experienced considerable uncertainties about their treatment and its effectiveness, and were particularly concerned about whether they were receiving real (or fake acupuncture. Patients stopped acupuncture only at the end of the fixed course of treatment in the RCT, which was similar to those receiving acupuncture in the public sector National Health Service (NHS. In comparison, private sector patients re-evaluated and re-negotiated treatments particularly when starting to use acupuncture. Conclusions Differences in psychosocial context between RCTs and usual practice could reduce the impact of

Unusual behaviour of usual materials in shock waves

International Nuclear Information System (INIS)

Kanel, G I

2014-01-01

Exotic results of investigations of inelastic deformation and fracture under shock wave loading are presented and briefly discussed. Temperature effects on the flow stress at high strain rate may differ even in sign from those we observe at low and moderate strain rates. Investigations of the temperature-rate dependence of the yield stress at shock compression demonstrate intense multiplication of dislocations. At the highest strain rates, so-called ideal (ultimate) shear and tensile strength is reached in experiments with picosecond durations of shock loading. Although grain boundaries, in general, reduce resistance to fracture as compared to single crystals, the spall strength of ultra-fine-grained metals usually slightly exceeds that of coarse-grain samples. Failure wave phenomena have been observed in shock-compressed glasses.

Cocaína: complicaciones obstétricas, médicas y perinatales. Características clínicas y tratamiento a estas pacientes Cocaine: obstetric, medical and perinatal complications. Clinical characteristics and treatment of these patients

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Miguel Lugones Botell

2005-08-01

Full Text Available Se realizó una revisión sobre los efectos generales de la cocaína, y en particular, sobre el embarazo y el recién nacido, en la que se enfatiza en los efectos deletéreos que tiene esta droga sobre la gestación, entre los que se destacan el bajo peso al nacer, el hematoma retroplacentario, la hipertensión arterial y la muerte fetal, entre otras complicaciones, así como también las consecuencias negativas que provoca sobre el producto de la concepción. Se hacen consideraciones acerca del manejo integral que hay que tener sobre estas pacientes.A review on the general effects of cocaine and, in particular, on its effects on pregnancy and the newborn infant, was made. Low birth weight, retroplacental hematoma, arterial hypertension and fetal death, are some of the deleterious effects of this drug on gestation that were emphazised, among other complications, as well as its negative consequences for the product of conception. Considerations are made on the comprehensive management of these patients.

Revisión histórica del sexismo en el cine español. El extraño caso de la película 'Amanece que no es poco'

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Pedro Vázquez Miraz

2017-04-01

Full Text Available Se presenta en esta investigación una revisión sistémica de artículos científicos relacionados con películas españolas que abordan situaciones de violencia hacia las mujeres y/o que tratan a éstas bajo el prisma tradicional de los roles sexuales, permitiendo que esos actos agresivos se enmarquen, de forma exclusiva, en el ámbito doméstico. De forma sorprendente, en todos los artículos y revisiones de películas que se centran en el papel de la mujer y/o de la violencia que ésta sufre, la célebre película de José Luis Cuerda Amanece, que no es poco, ni siquiera es nombrada como simple ejemplo de película española donde la violencia de género es evidente.

Secondary prevention after minor stroke and TIA - usual care and development of a support program.

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Stefanie Leistner

Full Text Available Effective methods of secondary prevention after stroke or TIA are available but adherence to recommended evidence-based treatments is often poor. The study aimed to determine the quality of secondary prevention in usual care and to develop a stepwise modeled support program.Two consecutive cohorts of patients with acute minor stroke or TIA undergoing usual outpatient care versus a secondary prevention program were compared. Risk factor control and medication adherence were assessed in 6-month follow-ups (6M-FU. Usual care consisted of detailed information concerning vascular risk factor targets given at discharge and regular outpatient care by primary care physicians. The stepwise modeled support program additionally employed up to four outpatient appointments. A combination of educational and behavioral strategies was employed.168 patients in the observational cohort who stated their openness to participate in a prevention program (mean age 64.7 y, admission blood pressure (BP: 155/84 mmHg and 173 patients participating in the support program (mean age 67.6 y, BP: 161/84 mmHg were assessed at 6 months. Proportions of patients with BP according to guidelines were 50% in usual-care and 77% in the support program (p<0.01. LDL<100 mg/dl was measured in 62 versus 71% (p = 0.12. Proportions of patients who stopped smoking were 50 versus 79% (p<0.01. 72 versus 89% of patients with atrial fibrillation were on oral anticoagulation (p = 0.09.Risk factor control remains unsatisfactory in usual care. Targets of secondary prevention were met more often within the supported cohort. Effects on (cerebro-vascular recurrence rates are going to be assessed in a multicenter randomized trial.

Near-field high-temperature transport: Evidence from the genesis of the Osamu Utsumi uranium mine, Pocos de Caldas alkaline complex, Brazil

International Nuclear Information System (INIS)

Cathles, L.M.; Shea, M.E.

1990-01-01

The chemical, isotopic and mineralogical alteration which occurred during primary uranium ore deposition at the breccia pipe-hosted Osamu Utsumi mine, Pocos de Caldas, Brazil, was studied as a natural analogue for near-field radionuclide migration. Chemical and isotopic alteration models were combined with finite difference models of the convective cooling of caldera intrusives. Application of the chemical models successfully used to interpret mineralization and alteration at the Osamu Utsumi mine to the hypothetical waste repository shows that even in a worst case scenario (waste emplaced in a permeable host rock with no measures taken to inhibit flow through the repository), the amount of hydrothermal alteration in the hypothetical repository will be about 0.1% of that in the breccia pipe at the Osamu Utsumi mine. Assuming no barriers to uranium mobility, uranium precipitation above the hypothetical repository would be 0.05 ppm (rather than 50 ppm), hydrothermal alteration 0.03 wt.% (rather than 30 wt.%), etc. The analysis indicates that mineralogical alteration is extremely sensitive to thermodynamic data. Prediction of mineralogical alteration (which may be necessary to predict the migration of radionuclides other than uranium, for example) probably cannot be based directly on even very carefully collected laboratory thermodynamic data. Mineralogical complexities of the system, as well as database uncertainties, will require calibration of the thermodynamic framework against mineralogical alteration observed in the laboratory or field by procedures briefly described. (au)

End-of-Life Transitions and Hospice Utilization for Adolescents: Does Having a Usual Source of Care Matter?

Science.gov (United States)

Keim-Malpass, Jessica; Lindley, Lisa C

2017-08-01

Adolescents with life-limiting illnesses have intensive end-of-life trajectories and could benefit from initiation of hospice services. The medical home model, which includes having a usual source of primary care, may help facilitate quality outcomes at the end-of-life for adolescents. The purpose of this study was to determine the relationship between having a usual source of primary care on hospice utilization and end-of-life transitions among adolescents between 15-20 years with a life-limiting illness. A retrospective cohort design used 2007-2010 California Medicaid claims data (n=585). Our dependent variables were hospice utilization (i.e., hospice enrollment, hospice length of stay) and the independent variable was usual source of primary care. Multivariate regression techniques including least squares regression, multivariate logistic regression, and negative binomial regression were used in the analysis of the relationship between usual source of primary care and hospice utilization and end-of-life transitions. Ten percent of our sample utilized hospice services. Having a usual source of primary care was associated with an increase in hospice enrollment, hospice length of stay, and end-of-life transitions. Adolescents with a cancer diagnosis were more likely to enroll in hospice services. For adolescents at the end of life, having a usual source of primary care had a significant impact on hospice enrollment and length of stay. This study is among the first to demonstrate a relationship between primary care and hospice use among this vulnerable population.

Factors associated with different cigarette access behaviours among underage smoking youth who usually smoke contraband (native) cigarettes.

Science.gov (United States)

Leatherdale, Scott T; Ahmed, Rashid; Vu, Mary

2011-01-01

Given that little is known about how youth access contraband cigarettes, the current study seeks to examine factors associated with how underage smoking youth report usually accessing contraband cigarettes. This study used nationally representative data collected from 41,886 students (grades 9 to 12) as part of the 2006-07 Canadian Youth Smoking Survey (YSS). Using data from current smokers who report that their usual brand of cigarettes is contraband, three logistic regression models were used to examine factors associated with buying cigarettes from a store, getting cigarettes from a family member, or getting cigarettes from friends or strangers. In 2006, 7.9% (n = 1 3,300) of Canadian youth who were current smokers reported that their usual brand of cigarettes was contraband. Among these youth, the majority reported that they usually get their cigarettes from a friend or stranger (54.8%), whereas 26.4% report usually getting them from a family member and 18.8% usually buying their own from a store. Boys were more likely to buy contraband cigarettes from a store, whereas youth with a parent who smokes contraband cigarettes were substantially more likely to get contraband cigarettes from a family member and youth with friends who smoke contraband cigarettes were substantially more likely to get contraband cigarettes from a friend or stranger. Ongoing surveillance of contraband cigarette use among youth and how youth access contraband cigarettes is required for guiding future tobacco control policy and programming activities.

Motivational, reduction and usual care interventions for smokers who are not ready to quit: a randomized controlled trial.

Science.gov (United States)

Klemperer, Elias M; Hughes, John R; Solomon, Laura J; Callas, Peter W; Fingar, James R

2017-01-01

To test whether, in comparison to usual care, brief motivational or reduction interventions increase quit attempts (QA) or abstinence among smokers who are not ready to quit. A parallel-group randomized controlled trial of brief motivational (n = 185), reduction (n = 186) or usual care (n = 189) telephone interventions delivered over the course of 4 weeks. Outcomes were assessed at 6- and 12-month follow-ups. No medication was provided. United States. A total of 560 adult smokers of ≥ 10 cigarettes per day who were not ready to quit in the next 30 days. The primary outcomes were whether participants made a QA that lasted ≥ 24 hours and whether they made a QA of any length between baseline and 6 months. Secondary outcomes included 7-day point-prevalence abstinence at 6 and 12 months. The 12-month follow-up was added after the study began. A priori-defined comparisons were between motivational versus usual care and reduction versus usual care conditions. The probability of making a QA that lasted ≥ 24 hours was not significantly different between the motivational (38%) or the reduction (31%) conditions and the usual care (34%) condition [motivational versus usual care odds ratio (OR) = 1.19, 95% confidence interval (CI) = 0.78-1.82; reduction versus usual care OR = 0.89, 95% CI = 0.57-1.36]. Bayes factors ranged from 0.13 to 0.18. Findings regarding a QA of any length were similar. At 6 months, the motivational condition had marginally more abstinence than usual care (11 versus 5%, OR = 2.17, 95% CI = 0.99-4.77), but the reduction condition was not significantly different from usual care (8 versus 5%, OR = 1.57, 95% CI = 0.69-3.59). At 12 months, the motivational condition had significantly more abstinence than usual care (10 versus 4%, OR = 2.80, 95% CI = 1.14-6.88) and the reduction condition had marginally more abstinence than usual care (9 versus 4%, OR = 2.45, 95% CI = 0.98-6.09). Among adult smokers who are not ready

The Stock Market's Reaction to Unemployment News: Why Bad News is Usually Good for Stocks

OpenAIRE

John H. Boyd; Ravi Jagannathan; Jian Hu

2001-01-01

We find that on average an announcement of rising unemployment is 'good news' for stocks during economic expansions and 'bad news' during economic contractions. Thus stock prices usually increase on news of rising unemployment, since the economy is usually in an expansion phase. We provide an explanation for this phenomenon. Unemployment news bundles two primitive types of information relevant for valuing stocks: information about future interest rates and future corporate earnings and divide...

Auscultation of Velcro Crackles is Associated With Usual Interstitial Pneumonia.

Science.gov (United States)

Sellarés, Jacobo; Hernández-González, Fernanda; Lucena, Carmen M; Paradela, Marina; Brito-Zerón, Pilar; Prieto-González, Sergio; Benegas, Mariana; Cuerpo, Sandra; Espinosa, Gerard; Ramírez, José; Sánchez, Marcelo; Xaubet, Antoni

2016-02-01

Auscultation of Velcro crackles has been proposed as a key finding in physical lung examination in patients with interstitial lung diseases (ILDs), especially in idiopathic pulmonary fibrosis (IPF). However, no studies have been carried out to assess the association of Velcro crackles with other clinical variables.We evaluated a cohort of 132 patients, prospectively and consecutively included in our ILD diagnostic program at a tertiary referral center. All patients were auscultated during the physical examination. The patients were divided into 2 groups: "presence" or "nonpresence" of bilateral Velcro crackles.Of all patients assessed, 83 (63%) presented Velcro crackles in the respiratory auscultation. Patients with Velcro crackles usually had more frequently cough and dyspnea at the moment of diagnosis. Forced vital capacity (P = 0.002) and lung diffusion capacity for carbon monoxide (P = 0.04) was lower in these patients. The ILD-GAP index was higher in the group with Velcro crackles (P = 0.01). All patients with usual interstitial pneumonia (UIP) in high-resolution computed tomography and all patients with final IPF diagnosis presented Velcro crackles. In multivariate analysis, the presence of Velcro crackles was independently associated with an UIP pattern.In patients suspected of having ILD, the auscultation of Velcro crackles was associated with UIP, a possibility which must be taken into consideration in early ILD detection in primary care.

Cardiac rehabilitation versus usual care for patients treated with catheter ablation for atrial fibrillation

DEFF Research Database (Denmark)

Risom, Signe S; Zwisler, Ann-Dorthe; Rasmussen, Trine Bernholdt

2016-01-01

) versus 20.7mL kg(-1) min(-1), p of main effect=0.003, p of interaction between time and intervention=0.020). No significant difference between groups on Short Form-36 was found (53.8 versus 51.9 points, P=.20). Two serious adverse events (atrial fibrillation in relation to physical exercise and death...... unrelated to rehabilitation) occurred in the cardiac rehabilitation group versus one in the usual care group (death unrelated to intervention) (P=.56). In the cardiac rehabilitation group 16 patients versus 7 in the usual care group reported non-serious adverse events (P=.047). CONCLUSION: Comprehensive...

Association of point-of-purchase tobacco advertising and promotions with choice of usual brand among teenage smokers.

Science.gov (United States)

Wakefield, Melanie A; Ruel, Erin E; Chaloupka, Frank J; Slater, Sandy J; Kaufman, Nancy J

2002-01-01

The objective is to determine the relationship between brand-specific advertising and promotions in convenience stores for Marlboro and Camel cigarettes and choice of usual brand among school students. A cross-sectional survey was designed that merged records of store tobacco advertising and promotions. The survey was administered to 3,890 U.S. high school smokers with a usual brand, matched to 196 convenience stores. Choice of Marlboro as a usual brand was associated with presence of a Marlboro gift with purchase (p purchase promotions (p > .05) and negatively associated with a greater share of exterior advertising voice for Camel (p < .001). The results are consistent with the notion that Marlboro-specific advertising and promotions may influence choice of Marlboro as a usual brand to smoke among teens, but resultsfor Camel are mixed and inconclusive. Further research is required to confirm and extend these findings.

Consolidity: Moving opposite to built-as-usual systems practices

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Hassen Taher Dorrah

2013-06-01

Full Text Available With the recent uncovering of the mystery of consolidity as an inner property of systems, it is demonstrated that this notion is an indispensable pillar of systems modeling, analysis, design and building. Based on the opposite mathematical relation between consolidity versus stability and controllability, a new conceptual life cycle (change pathway graph for natural and man-made built-as-usual systems is presented and thoroughly discussed. For the conceptual cycle development progress, it is logically conceived that system behavior changes rate has not accidentally happened, but is relatively influenced at the point of progress by the associated direct system consolidity index corresponding to the acting on-the-spot varying environments or effects. Such conceptual graph represents a real research advancement indicating that we have to move opposite to current systems building practices for solving many real life enigmatic problems. It is illustrated using stabilization of inverted pendulum problem that it is amenable by cleverly manipulating systems structure and parameters to attain new designed systems with aggregates of superiority of consolidity, stability and controllability principle. It is recommended that we have to seek new generation of innovative non-conventional systems structures moving opposite to conventional built-as-usual system practices that can enable providing directly such three aggregates of superiority requirements as their built-in self property. This will open the door towards solving many real life challenging dilemmas in various sciences and disciplines, such as engineering, space sciences, medicine, pharmacology, biology, ecology, life sciences, economy, operations research, humanities and social sciences that are believed to be attributed due to their systems inferior consolidity.

Life changes among homeless persons with mental illness: a longitudinal study of housing first and usual treatment.

Science.gov (United States)

Nelson, Geoffrey; Patterson, Michelle; Kirst, Maritt; Macnaughton, Eric; Isaak, Corinne A; Nolin, Danielle; McAll, Christopher; Stergiopoulos, Vicky; Townley, Greg; MacLeod, Timothy; Piat, Myra; Goering, Paula N

2015-06-01

This study compared the life changes of homeless people with mental illness participating in Housing First or treatment as usual and examined factors related to various changes. Semistructured narrative interviews were conducted with 219 participants in five Canadian cities at baseline; 197 were interviewed again at 18 months after random assignment to Housing First (N=119) or treatment as usual (N=78). Interviews were coded across 13 life domains, and each participant was categorized as reporting positive, mixed-neutral, or negative changes. Housing First and treatment as usual participants were compared with respect to change patterns. Thematic analysis was used to examine factors related to various changes. The percentage of participants in Housing First reporting positive changes was more than double that for participants in treatment as usual, and treatment as usual participants were four times more likely than Housing First participants to report negative changes. Factors related to positive changes included having stable good-quality housing, increased control over substance use, positive relationships and social support, and valued social roles. Factors related to negative changes included precarious housing, negative social contacts, isolation, heavy substance use, and hopelessness. Factors related to mixed-neutral changes were similar to those for participants reporting negative changes but were less intense. Housing First with intensive support was related to more positive changes among homeless adults with mental illness across five Canadian cities. Those with poor housing or support, more common in treatment as usual, continued to struggle. These findings are relevant for services and social change to benefit this population.

Experiencia en Cuba del tratamiento de la litiasis renoureteral con litotricia extracorpórea por ondas de choque en niños

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María Victoria Labrada Rodríguez

2012-06-01

Full Text Available Introducción: la litiasis urinaria en el niño resulta una enfermedad poco frecuente si se compara con su incidencia en el adulto. Objetivos: describir el resultado del tratamiento en Cuba de la litiasis del aparato urinario en niños, mediante la litotricia extracorpórea por ondas de choque, así como validar la eficacia del método. Métodos: la muestra corresponde a 227 niños, tratados en el Centro de Tratamiento de la Litiasis Urinaria del Hospital Clinicoquirúrgico "Hermanos Ameijeiras'' de La Habana, entre abril de 1986 y octubre de 2011, utilizando 3 tipos de litotritores: el HM3 (Dornier, Lithostar Plus (Siemens y Medical Modulith® SLX (Storz. Resultados: las edades límites fueron 2 y 18 años. De manera general resultó similar el total de pacientes tratados del sexo femenino que el masculino (51 %/49 %. El síntoma predominante fue el cólico nefrítico con cálculos renales (81,9 %, y en el uréter (18,1 %. La superficie media fue de 1,20 cm². Se utilizó anestesia general orotraqueal (34,4 % y general intravenosa (65,6 %. Los retratamientos fueron necesarios en 8 casos (3,52 %. Las complicaciones fueron la infección urinaria aguda (3,08 % y el hematoma subcapsular renal (0,88 %. Resultó libre de material litiásico el 96,04 %. Conclusiones: la terapéutica mediante la litotricia extracorpórea por ondas de choque resulta efectiva, con baja tasa de morbilidad y de complicaciones graves, por lo que creemos debe defenderse científicamente como la primera opción terapéutica en la resolución de la litiasis urinaria en estas edades. Debe recordarse que eliminar el cálculo no es suficiente, hay que identificar la enfermedad, su tratamiento de fondo, y evitar las recidivas.

Rotura del Bíceps Distal. Evaluación de resultados con técnica de doble fijación. [Distal biceps rupture: evaluation of results with double fixation technique

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Miguel Ángel Capomassi

2013-11-01

Full Text Available In­tro­duc­ción La rotura del bíceps distal es una lesión poco frecuente producida por la aplicación de una fuerza excéntrica sobre el codo flexionado. El objetivo de este trabajo es analizar los resultados obtenidos para la reinserción del bíceps distal mediante técnica de doble fijación con botón de anclaje cortical y tornillo interferencial de biotenodesis a través de una incisión anterior única. Materiales­ y­ Métodos Entre agosto de 2008 y febrero de 2013, registramos 19 casos de rotura del bíceps distal tratados quirúrgicamente por vía anterior limitada. Los 17 últimos casos consecutivos fueron tratados con doble fijación utilizando botón extracortical y tornillo de biotenodesis, y forman parte del estudio. Todos eran hombres, con una mediana de la edad de 41 años (rango 27-59. Los pacientes fueron evaluados con el Cuestionario DASH y el Puntaje Subjetivo/Objetivo de Andrews y Carson, y la fuerza de flexión y supinación se controló con la escala del British Medical Research Council modificada por Mackinnon y Dellon (M0-M5. Resultados El cuestionario DASH arrojó un valor mediano de 1,7 (0-5,83 y el de Andrews y Carson, de 195 (170-200 para el total; con 15 resultados excelentes y 2 buenos. Todos consiguieron una fuerza M5 para flexión y supinación de antebrazo. El seguimiento tuvo una mediana de 12 meses (4-32. En dos pacientes, se registraron complicaciones, ambas con recuperación ad íntegrum. Conclusión La técnica descrita ha demostrado ser confiable y eficaz, y permitió lograr resultados satisfactorios y una baja tasa de complicaciones.

Association Between Parental Barriers to Accessing a Usual Source of Care and Children's Receipt of Preventive Services.

Science.gov (United States)

Bellettiere, John; Chuang, Emmeline; Hughes, Suzanne C; Quintanilla, Isaac; Hofstetter, C Richard; Hovell, Melbourne F

Preventive health services are important for child development, and parents play a key role in facilitating access to services. This study examined how parents' reasons for not having a usual source of care were associated with their children's receipt of preventive services. We used pooled data from the 2011-2014 National Health Interview Survey (n = 34 843 participants). Parents' reasons for not having a usual source of care were framed within the Penchansky and Thomas model of access and measured through 3 dichotomous indicators: financial barriers (affordability), attitudes and beliefs about health care (acceptability), and all other nonfinancial barriers (accessibility, accommodation, and availability). We used multivariable logistic regression models to test associations between parental barriers and children's receipt of past-year well-child care visits and influenza vaccinations, controlling for other child, family, and contextual factors. In 2014, 14.3% (weighted percentage) of children had at least 1 parent without a usual source of care. Children of parents without a usual source of care because they "don't need a doctor and/or haven't had any problems" or they "don't like, trust, or believe in doctors" had 35% lower odds of receiving well-child care (adjusted odds ratio = 0.65; 95% CI, 0.56-0.74) and 23% lower odds of receiving influenza vaccination (adjusted odds ratio = 0.77; 95% CI, 0.69-0.86) than children of parents without those attitudes and beliefs about health care. Financial and other nonfinancial parental barriers were not associated with children's receipt of preventive services. Results were independent of several factors relevant to children's access to preventive health care, including whether the child had a usual source of care. Parents' attitudes and beliefs about having a usual source of care were strongly associated with their children's receipt of recommended preventive health services. Rates of receipt of child preventive

Increasing the amount of usual rehabilitation improves activity after stroke: a systematic review

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Emma J Schneider

2016-10-01

Full Text Available Questions: In people receiving rehabilitation aimed at reducing activity limitations of the lower and/or upper limb after stroke, does adding extra rehabilitation (of the same content as the usual rehabilitation improve activity? What is the amount of extra rehabilitation that needs to be provided to achieve a beneficial effect? Design: Systematic review with meta-analysis of randomised trials. Participants: Adults aged 18 years or older that had a diagnosis of stroke. Intervention: Extra rehabilitation with the same content as usual rehabilitation aimed at reducing activity limitations of the lower and/or upper limb. Outcome measures: Activity measured as lower or upper limb ability. Results: A total of 14 studies, comprising 15 comparisons, met the inclusion criteria. Pooling data from all the included studies showed that extra rehabilitation improved activity immediately after the intervention period (SMD = 0.39, 95% CI 0.07 to 0.71, I2 = 66%. When only studies with a large increase in rehabilitation (> 100% were included, the effect was greater (SMD 0.59, 95% CI 0.23 to 0.94, I2 = 44%. There was a trend towards a positive relationship (r = 0.53, p = 0.09 between extra rehabilitation and improved activity. The turning point on the ROC curve of false versus true benefit (AUC = 0.88, p = 0.04 indicated that at least an extra 240% of rehabilitation was needed for significant likelihood that extra rehabilitation would improve activity. Conclusion: Increasing the amount of usual rehabilitation aimed at reducing activity limitations improves activity in people after stroke. The amount of extra rehabilitation that needs to be provided to achieve a beneficial effect is large. Trial registration: PROSPERO CRD42012003221. [Schneider EJ, Lannin NA, Ada L, Schmidt J (2016 Increasing the amount of usual rehabilitation improves activity after stroke: a systematic review. Journal of Physiotherapy 62: 182–187

Evaluación del optimismo disposicional en pacientes en hemodiálisis y su relación con las complicaciones

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Isabel Luque Cantarero

2014-12-01

Full Text Available Introducción: El optimismo parece tener una influencia sobre la resistencia a la enfermedad y de la mejora de la salud en pacientes con problemas cardíacos, respiratorios y oncológicos. Sin embargo, son escasos los estudios en pacientes en con enfermedad crónica renal en hemodiálisis; de ahí el interés de nuestro estudio. Objetivo: El objetivo de este estudio fue analizar la relación entre el grado de optimismo disposicional con las complicaciones y la calidad de vida percibida en un grupo de pacientes de hemodiálisis. Pacientes y Métodos: Se estudiaron 78 pacientes en HD, del servicio de Nefrología de Córdoba. Se realizó un estudio observacional analítico. Se evaluaron variables demográficas, tiempo en diálisis, índice de comorbilidad de Charlson, centro de diálisis, acceso vascular, optimismo disposicional mediante el LOT-R (a mas puntuación más optimismo, calidad de vida relacionada con la salud mediante láminas COOP-WONCA (a mas puntuación peor calidad de vida percibida y número de ingresos en el año anterior. Resultados: La edad media fue 64.8±17.1 años. El 38.5% eran mujeres y el 61.5% hombres. La mediana del número de ingresos en el último año fue de 1 (rango: 0-10. La mediana del índice de comorbilidad fue 7 (rango 0-12. La media del LOT-R fue 20.76±4.8 y la mediana 21 (rango: 8-29. Se estableció la mediana del LOT-R, como punto de corte para clasificar a los pacientes como optimistas (>21 de mediana y pesimistas (<21. Al comparar ambos grupos (optimistas frente a pesimistas se encontraron diferencias significativas para el COOP-WONCA (19.8±5.6 frente a 24.5±6.6, p<0.002. Sin embargo no se encontraron diferencias para el número de ingresos, ni para el índice de comorbilidad, entre ambos grupos. Conclusiones: No se encontró relación entre optimismo disposicional y número de ingresos, ni comorbilidad asociada. Sin embargo, los más optimistas tienen mayor de calidad de vida percibida relacionada con

Geomorphological and hydrogeological features of the Pocos de Caldas caldera and the Osamu Utsumi mine and Morro do Ferro analogue study sites, Brazil

International Nuclear Information System (INIS)

Holmes, D.S.; Noy, D.J.; Pitty, A.E.

1990-01-01

The Osamu Utsumi mine and Morro do Ferro study sites lie within the Pocos de Caldas plateau which is roughly circular in outline with a diameter of 35 km and an area of approximately 800 km 2 . Its general altitude lies between 1300 and 1600 m. The plateau is the eroded form of a caldera which initially intruded some 80 million years ago. Geomorphologically, both sites occupy watershed areas adjacent to small streams in the centre of the plateau. The climate of the area has a marked wet season from November to April and is dry the rest of the year. The streams are ephemeral in their upper reaches, tending to dry up in the dry season as they are fed by a declining base flow. In the wet season they exhibit flash floods fed by high-intensity rainfall causing overland flow. The wet season also provides recharge to the groundwater. Natural slopes are steep and the original vegetaion was thin forest cover which is now restricted to the valley bottoms; usable slopes have poor quality grass cover used for cattle grazing. The plateau is a stable feature and its surface has been eroding at an average rate of 12 m per million years over a period of 50 million years. (author) 21 figs., 47 refs

Costs of terminal patients who receive palliative care or usual care in different hospital wards.

Science.gov (United States)

Simoens, Steven; Kutten, Betty; Keirse, Emmanuel; Berghe, Paul Vanden; Beguin, Claire; Desmedt, Marianne; Deveugele, Myriam; Léonard, Christian; Paulus, Dominique; Menten, Johan

2010-11-01

In addition to the effectiveness of hospital care models for terminal patients, policy makers and health care payers are concerned about their costs. This study aims to measure the hospital costs of treating terminal patients in Belgium from the health care payer perspective. Also, this study compares the costs of palliative and usual care in different types of hospital wards. A multicenter, retrospective cohort study compared costs of palliative care with usual care in acute hospital wards and with care in palliative care units. The study enrolled terminal patients from a representative sample of hospitals. Health care costs included fixed hospital costs and charges relating to medical fees, pharmacy and other charges. Data sources consisted of hospital accountancy data and invoice data. Six hospitals participated in the study, generating a total of 146 patients. The findings showed that palliative care in a palliative care unit was more expensive than palliative care in an acute ward due to higher staffing levels in palliative care units. Palliative care in an acute ward is cheaper than usual care in an acute ward. This study suggests that palliative care models in acute wards need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients. This finding emphasizes the importance of the timely recognition of the need for palliative care in terminal patients treated in acute wards.

Concentrations of 226Ra and 210Pb in agricultural products surrounding the first brazilian mine and mill in Pocos de Caldas, MG

International Nuclear Information System (INIS)

Vasconcellos, L.M.H.; Amaral, E.C.S.; Vianna, E.C.M.

1989-01-01

As a complement to the pre-operational environmental monitoring program of the Brazilian first uranium mine and mill, a survey of 226 Ra and 210 Pb in agriculture products, and in the corresponding soils, were carried out in the Pocos de Caldas Plateau. The survey intended to determine site specific transfer factors, in order to better estimate radiation doses on the population. Resulting from the plant operation. In local soils, 226 Ra and 210 Pb have similar concentrations. The average contents are comparable to the values found in areas of normal radioactivity, but the maximum values are higher by one order of magnitude. In the vegetables analyzed (beans, carrot, corn and potato), 226 Ra concentrations are slightly higher than those of 210 Pb, and the maximum values are also one order of magnitude greater than in normal regions. For both radionuclides, the average soil-to-plant transfer factors are of the order of 10 -3 and 10 -2 , when related to total and to exchangeable contents in soils, respectively. These results led to the conclusion that 226 Ra and 210 Pb have similar importance, concerning the population exposure via the foodstuff ingestion pathway. Therefore, it was recommended to carry on routine monitoring program for both radionuclides in the main agriculture crops. However, the naturally elevated radionuclide concentrations, in some local vegetables, will decrease the sensitivity for detecting small increments resulting from the plant operation. (author) [pt

The added value of food frequency questionnaire (FFQ) information to estimate the usual food intake based on repeated 24-hour recalls.

Science.gov (United States)

Ost, Cloë; De Ridder, Karin A A; Tafforeau, Jean; Van Oyen, Herman

2017-01-01

Statistical methods to model the usual dietary intake of foods in a population generally ignore the additional information on the never-consumers. The objective of this study is to determine the added value of Food Frequency Questionnaire (FFQ) data allowing distinguishing the never-consumers from the non-consumers while modeling the usual intake distribution. Three food items with a different proportion of never-consumers were selected from the database of the Belgian food consumption survey of 2004 ( N  = 3200). The usual intake distribution for these food items was modeled with the Statistical Program for Analysis of Dietary Exposure (SPADE) and modeling parameters were extracted. These parameters were used to simulate (a) a new database with two 24-h recalls per respondent and (b) a "true" usual intake distribution. The usual intake distribution from the new database was obtained by modeling the 24-h recalls with SPADE, once without and once with the inclusion of the FFQ data on the never-consumers. Ratios were calculated for the different percentiles of the usual intake distribution: the modeled usual intake (g/day) (for both SPADE with and without the inclusion of FFQ data on never-consumers) was divided by the corresponding percentile of the simulated "true" usual intake (g/day). The closer the ratio is to one, the better the model fits the data. Inclusion of the FFQ information to identify the never-consumers did not improve the estimation of the higher percentiles of the usual intake distribution. However, taking into account this FFQ information improved the estimation of the lower percentiles of the usual intake distribution even when the proportion of never-consumers was low. The inclusion of FFQ information to identify the never-consumers is beneficial when interested in the whole usual intake distribution or in the lower percentiles only, no matter how low the proportion of never-consumers for that food item may be. However, when interest is only in

Usual Dietary Intakes: SAS Macros for Estimating Ratios of Two Dietary Components that are Consumed Nearly Every Day

Science.gov (United States)

The following SAS macros can be used to create a bivariate distribution of usual intake of two dietary components that are consumed nearly every day and to calculate percentiles of the population distribution of the ratio of usual intakes.

Transplante cardíaco: complicações apresentadas por pacientes durante a internação Trasplante de corazón: complicaciones que presentan los pacientes durante la hospitalización Heart Transplantation: complications presented by patients during the hospitalization

Directory of Open Access Journals (Sweden)

Elaine Araújo da Silva

2012-12-01

Full Text Available Com o avanço da ciência, a insuficiência cardíaca tem como possibilidade de intervenção o transplante cardíaco. Este trabalho teve como objetivos traçar o perfil demográfico dos pacientes submetidos ao transplante cardíaco e identificar as complicações apresentadas durante a internação. Trata-se de um estudo descritivo, quantitativo, realizado com 44 prontuários de pacientes submetidos a transplante de junho/2006 a julho/2009 em um Hospital Universitário de Belo Horizonte, Minas Gerais, Brasil. O projeto atendeu às recomendações da Resolução 196/96. Pelos resultados, a maioria dos pacientes era do sexo masculino, casada, escolaridade de nível fundamental e idade média de 45,2 anos. A miocardiopatia chagásica foi a principal causa de insuficiência cardíaca. As complicações predominantes foram alteração da glicemia, insuficiência renal e infecções. A taxa de mortalidade na internação foi de 20,4%. Além das complicações biológicas só foram registradas ansiedade e depressão. São necessárias pesquisas sobre o tema nos âmbitos psicossociais e espirituais, contribuindo para o desenvolvimento científico.Hoy día, con los avances de la medicina y de la tecnología para el tratamiento de la insuficiencia cardiaca irreversible, se ha utilizado como última intervención el trasplante cardíaco. Este trabajo se desarrolló con los objetivos de delinear el perfil demográfico de los pacientes sometidos a trasplante cardíaco e identificar las complicaciones presentadas por ellos después del trasplante de corazón. Estudio descriptivo y cuantitativo, realizado en conjunto con los registros de 44 pacientes sometidos a trasplante de corazón desde Jun/2006 hasta Jul/2009, en un Hospital Universitario de Belo Horizonte, Minas Gerais, Brasil. El proyecto cumplió con las recomendaciones de la Resolución 196/96. Los resultados mostraron que la mayoría de los pacientes eran del sexo masculino, casados, con educaci

Medical teleconferencing with high-definition video presentation on the 'usual' Internet.

Science.gov (United States)

Obuchi, Toshiro; Shima, Hiroji; Iwasaki, Akinori

2013-06-01

Although medical teleconferences on advanced academic networks have been common (Telemed J E Health 15:112-117, 1; Asian J Endosc Surg 3:185-188, 2; Surg Today 41:1579-1581, 3; Telemedicine development center of Asia. http://www.aqua.med.kyushu-u.ac.jp/eg/index.html . Accessed 6 March 2013, 4), reports regarding 'usual' Internet teleconferences or tele-lectures employing a telecommunication system for business use are very rare. Medical teleconferences and tele-lectures on the Internet were held three times between our institutions and other institutions, using the 'HD Com' made by Panasonic (HD Com. http://panasonic.biz/com/visual/ . Accessed 6 March 2013, 5), which is a high-definition telecommunication system for business tele-meeting. All of our medical telecommunications were successfully completed without any troubles. This system allows for all kinds of presentations using personal computers to be made from each station, so that discussions with high-definition surgical video presentation, which has recently been developed, could be effortlessly established despite the distance between institutions. Unlike telecommunication using advanced academic networks, this system can run without any need for specific engineering support, on the usual Internet. Medical telecommunication employing this system is likely to become common among ordinary hospitals in the near future.

020. Coexistence of lung adenocarcinoma and usual interstitial pneumonia: a case report

Science.gov (United States)

Baliaka, Aggeliki; Papaemmanouil, Styliani; Spyratos, Dionysis; Zarogoulidis, Paul; Sakkas, Leonidas

2015-01-01

Background Usual interstitial pneumonia (UIP)/idiopathic pulmonary fibrosis (IPF) is a chronic fibrosing interstitial pneumonia of unknown cause. The most common symptoms are progressively increased shortness of breath and dry cough. Some studies suggest an association between usual interstitial pneumonia and lung cancer through different pathogenetic mechanisms. Objective The case presentation of a patient with lung adenocarcinoma and UIP. Methods A 66-year-old male presented with persistent dry cough, hemoptysis and dyspnea. The chest radiographs revealed a mass in the lower lobe of the left lung, measuring 3 cm, as well as diffuse interstitial changes in the same lobe. Two partial lobectomies were performed. Results Histological examination of the mass showed moderately differentiated adenocarcinoma, focally with bronchoalveolar pattern (Immunohistochemical detection of EGFR: positive). The rest lung parenchyma presented histological appearance of UIP. Conclusions According to clinicopathological studies, the prevalence of lung cancer among patients with UIP/IPF varies between 4% and 9%. The overall median survival of IPF-Ca patients is seven months in comparison with IPF only patients (14 months).

Asociación de infección por Chlamydia trachomatis con el diagnóstico de cervicitis aguda

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Angélica Lorena Castillo Gutiérrez

2017-03-01

Full Text Available Sra. Editora: Las infecciones de transmisión sexual se consideran un problema de salud pública en el mundo debido a su creciente incidencia y elevada morbimortalidad. Las infecciones por Chlamydia trachomatis son las más comunes y costosas de las enfermedades de transmisión sexual bacterianas. En los estudios llevados a cabo en diferentes países se han encontrado prevalencias de C. trachomatis entre 1.7% y 25%, siendo más alta en la población menor de 25 años. La infección por clamidia genital causa cervicitis y salpingitis en mujeres, y uretritis y conjuntivitis tanto en hombres como en mujeres. Sin embargo, las infecciones por clamidia suelen producir pocos o ningún síntoma (en aproximadamente el 70% de las mujeres y el 50% de los hombres y pueden permanecer sin ser detectadas y sin tratamiento. Si no se trata, esta infección de transmisión sexual puede progresar y causar complicaciones con graves consecuencias sobre la salud reproductiva de las mujeres, incluida la enfermedad inflamatoria pélvica (EPI que puede conducir al embarazo ectópico y a la infertilidad de las trompas.

Ritidectomía frontal bicoronal subaponeurótica

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Julio César Gálvez Chávez

2002-12-01

Full Text Available Para el tratamiento del envejecimiento del tercio superior de la cara se han empleado diversas técnicas quirúrgicas. El abordaje bicoronal ha sido el más utilizado, pero a su vez el que más variantes y modificaciones ha tenido. Con este trabajo los autores se proponen evaluar los resultados de la ritidectomía frontal bicoronal siguiendo un mismo procedimiento dado por la disección subaponeurótica hasta los rebordes orbitarios, sección horizontal múltiple del músculo frontal y prócer, así como disección y sección de los músculos corrugadores. Solo se modificó la localización de la incisión frontal en dependencia de la longitud de la frente. Fueron operados 31 pacientes y se evaluaron los resultados a los 6 meses de la operación. Con la técnica empleada se modificaron las arrugas frontoglabelares hacia el borramiento o la desaparición, la ptosis de las cejas se corrigió de forma armoniosa y las complicaciones fueron escasas y poco relevantes. No se produjo afectación de la mímica frontoglabelar

Usual Dietary Energy Density Distribution Is Positively Associated with Excess Body Weight in Mexican Children.

Science.gov (United States)

Aburto, Tania C; Cantoral, Alejandra; Hernández-Barrera, Lucia; Carriquiry, Alicia L; Rivera, Juan A

2015-07-01

Studies suggest a positive association between dietary energy density (DED) and body weight in adults, but evidence in children is inconclusive. The objective of this study was to compare usual DED distributions of nonoverweight vs. overweight or obese (OW/O) Mexican children. The study used 24-h recall (24HR) data from 2367 children aged 5-11 y from the 2012 Mexican National Health and Nutrition Survey (ENSANUT 2012). Repeated 24HR measures were obtained in a random sample (∼10%) to estimate usual intake distributions by using the Iowa State University (PC-Side) method. Implausible dietary reports were identified. Multivariate linear regression models were used to evaluate the relation between DED and body mass index status and to compare results with and without PC-Side adjustment and restriction to plausible reporters. A total of 35.1% of the children in the sample were OW/O. The usual DED mean was ∼175 kcal/100 g in both the complete sample and the plausible reporters subsample. Regression models adjusted by PC-Side and for potential confounders showed higher DED in OW/O relative to nonoverweight children for both plausible reporters (9.7 kcal/100 g; n = 1452, P 0.10). A positive association between usual DED and OW/O was found in Mexican children. The association was stronger when only plausible reporters were considered. This suggests that there is a need for strategies to reduce energy density in the diet of Mexican children. © 2015 American Society for Nutrition.

Disseminated dendriform pulmonary ossification associated with usual interstitial pneumonia: incidence and thin-section CT-pathologic correlation

Energy Technology Data Exchange (ETDEWEB)

Kim, Tae Sung; Chung, Myung Jin [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Seoul (Korea); Han, Joungho [Sungkyunkwan University School of Medicine, Department of Pathology, Seoul (Korea); Chung, Man Pyo [Sungkyunkwan University School of Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Seoul (Korea); Choi, Yong Soo [Sungkyunkwan University School of Medicine, Division of Thoracic Surgery, Seoul (Korea)

2005-08-01

The aim of this work was to assess the incidence of disseminated pulmonary dendriform ossification in usual interstitial pneumonia and nonspecific interstitial pneumonia, and to correlate thin-section computed tomography (CT) and histopathologic findings. We retrospectively reviewed thin-section CT and pathologic specimens of biopsy-proven usual interstitial pneumonia (75 patients, 57 men and 18 women, mean age 60 years, range 29-83 years) and nonspecific interstitial pneumonia (44 patients, 9 men and 35 women, mean age 55 years, range 20-73 years). On review of CT and histopathologic specimens, diffuse dendriform ossification was identified in five (four men and one woman, age range 41-68 years, mean 58 years) of 75 patients (6.7%) with usual interstitial pneumonia. It was not seen in any of 44 patients with nonspecific interstitial pneumonia. With thin-section CT (osteoporosis window; window width 818, level 273), disseminated dendriform pulmonary ossification was detected as multiple tiny calcifications in bibasilar subpleural lungs (100% sensitive and 100% specific when compared with histopathologic findings as the gold standard). The thin-section CT finding of multiple tiny calcifications in bibasilar subpleural lungs might be of some help in the differential diagnosis between usual interstitial pneumonia and nonspecific interstitial pneumonia, considering they were not seen in any patients with nonspecific interstitial pneumonia (0%, 0/44) in our series. (orig.)

Disseminated dendriform pulmonary ossification associated with usual interstitial pneumonia: incidence and thin-section CT-pathologic correlation

International Nuclear Information System (INIS)

Kim, Tae Sung; Chung, Myung Jin; Han, Joungho; Chung, Man Pyo; Choi, Yong Soo

2005-01-01

The aim of this work was to assess the incidence of disseminated pulmonary dendriform ossification in usual interstitial pneumonia and nonspecific interstitial pneumonia, and to correlate thin-section computed tomography (CT) and histopathologic findings. We retrospectively reviewed thin-section CT and pathologic specimens of biopsy-proven usual interstitial pneumonia (75 patients, 57 men and 18 women, mean age 60 years, range 29-83 years) and nonspecific interstitial pneumonia (44 patients, 9 men and 35 women, mean age 55 years, range 20-73 years). On review of CT and histopathologic specimens, diffuse dendriform ossification was identified in five (four men and one woman, age range 41-68 years, mean 58 years) of 75 patients (6.7%) with usual interstitial pneumonia. It was not seen in any of 44 patients with nonspecific interstitial pneumonia. With thin-section CT (osteoporosis window; window width 818, level 273), disseminated dendriform pulmonary ossification was detected as multiple tiny calcifications in bibasilar subpleural lungs (100% sensitive and 100% specific when compared with histopathologic findings as the gold standard). The thin-section CT finding of multiple tiny calcifications in bibasilar subpleural lungs might be of some help in the differential diagnosis between usual interstitial pneumonia and nonspecific interstitial pneumonia, considering they were not seen in any patients with nonspecific interstitial pneumonia (0%, 0/44) in our series. (orig.)

Acupuncture, Counseling, and Usual care for Depression (ACUDep: study protocol for a randomized controlled trial

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MacPherson Hugh

2012-11-01

Full Text Available Abstract Background The evidence on the effect of acupuncture or counseling for depression is not conclusive yet is sufficient to warrant further research. Our aim is to conduct a full-scale RCT to determine the clinical and cost effectiveness of acupuncture and counseling compared to usual care alone. We will explore the experiences and perspectives of patients and practitioners. Methods/Design Randomized controlled trial with three parallel arms: acupuncture plus usual care, counseling plus usual care, and usual care alone, in conjunction with a nested qualitative study using in-depth interviews with purposive samples of trial participants. Participants: Patients aged over 18 years diagnosed with depression or mood disorder by their GP and with a score of 20 or above on the Beck Depression Inventory (BDI-II. Randomization: Computer randomization by York Trials Unit to acupuncture, counseling, and usual care alone in proportions of 2:2:1, respectively, with secure allocation concealment. Interventions: Patients allocated to acupuncture and counseling groups receive the offer of up to 12 weekly sessions. Both interventions allow flexibility to address patient variation, yet are constrained within defined protocols. Acupuncture is based on traditional Chinese medicine and counseling is non-directive within the humanistic tradition. Outcome: The PHQ-9 is the primary outcome measure, collected at baseline, 3, 6, 9, and 12 months. Also measured is BDI-II, SF-36 Bodily pain subscale, and EQ-5D. Texted mood scores are collected weekly over the first 15 weeks. Health-related resource use is collected over 12 months. Analysis: The sample size target was for 640 participants, calculated for an effect size of 0.32 on the PHQ-9 when comparing acupuncture with counseling given 90% power, 5% significance, and 20% loss to follow-up. Analysis of covariance will be used on an intention-to-treat basis. Thematic analysis will be used for qualitative data. We will

Treatment-as-usual (TAU) is anything but usual: a meta-analysis of CBT versus TAU for anxiety and depression.

Science.gov (United States)

Watts, Sarah E; Turnell, Adrienne; Kladnitski, Natalie; Newby, Jill M; Andrews, Gavin

2015-04-01

There were three aims of this study, the first was to examine the efficacy of CBT versus treatment-as-usual (TAU) in the treatment of anxiety and depressive disorders, the second was to examine how TAU is defined in TAU control groups for those disorders, and the third was to explore whether the type of TAU condition influences the estimate of effects of CBT. A systematic search of Cochrane Central Register of Controlled Trials, PsycINFO, and CINAHL was conducted. 48 studies of CBT for depressive or anxiety disorders (n=6926) that specified that their control group received TAU were identified. Most (n=45/48) provided an explanation of the TAU group however there was significant heterogeneity amongst TAU conditions. The meta-analysis showed medium effects favoring CBT over TAU for both anxiety (g=0.69, 95% CI 0.47-0.92, pCBT is superior to TAU and the size of the effect of CBT compared to TAU depends on the nature of the TAU condition. The term TAU is used in different ways and should be more precisely described. The four key details to be reported can be thought of as "who, what, how many, and any additional treatments?" Copyright © 2014 Elsevier B.V. All rights reserved.

Un poco de Matemagia

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José Mª Navas

2012-10-01

Full Text Available Junto a los clásicos juegos de manipulación, para los que se necesita una considerable habilidad manual, hay otra rama del ilusionismo que se basa en procedimientos más sutiles, entre los que están cogiendo auge en los últimos años los que parten de conceptos matemáticos, algunos enormemente simples, otros de cierta complejidad. Así nació lo que ha dado en llamarse Matemagia.

Do you really know precise radiologic–pathologic correlation of usual interstitial pneumonia?

Energy Technology Data Exchange (ETDEWEB)

Johkoh, Takeshi, E-mail: johkoht@aol.com [Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami (Japan); Sumikawa, Hiromotsu [Department of Radiology, Osaka University Graduate School of Medicine, Suita (Japan); Fukuoka, Junya; Tanaka, Tomonori [Department of Pathology, Nagasaki University Graduate School of Medicine, Toyama (Japan); Fujimoto, Kiminori [Department of Radiology and Center for Diagnostic Imaging, Kurume University School of Medicine, Kurume (Japan); Takahashi, Masashi [Department of Radiology, Shiga Medical University, Otsu (Japan); Tomiyama, Noriyuki [Department of Radiology, Osaka University Graduate School of Medicine, Suita (Japan); Kondo, Yasuhiro; Taniguchi, Hiroyuki [Department of Respiratory and Allergic Medicine, Tosei General Hospital, Seto (Japan)

2014-01-15

Although usual interstitial pneumonia (UIP) is the most common chronic interstitial pneumonia, understanding of pathologic backgrounds of CT findings has still not been enough. Since honeycombing on either scanning microgram or CT is essential for diagnosis of UIP in 2010 ATS-ERS-JRS-ALAT guide line, the role of radiologists has become much more important. We will summarize common and uncommon CT findings with radiologic–pathological correlation.

Do you really know precise radiologic–pathologic correlation of usual interstitial pneumonia?

International Nuclear Information System (INIS)

Johkoh, Takeshi; Sumikawa, Hiromotsu; Fukuoka, Junya; Tanaka, Tomonori; Fujimoto, Kiminori; Takahashi, Masashi; Tomiyama, Noriyuki; Kondo, Yasuhiro; Taniguchi, Hiroyuki

2014-01-01

Although usual interstitial pneumonia (UIP) is the most common chronic interstitial pneumonia, understanding of pathologic backgrounds of CT findings has still not been enough. Since honeycombing on either scanning microgram or CT is essential for diagnosis of UIP in 2010 ATS-ERS-JRS-ALAT guide line, the role of radiologists has become much more important. We will summarize common and uncommon CT findings with radiologic–pathological correlation.

Levonorgestrel-releasing intrauterine system vs. usual medical treatment for menorrhagia: an economic evaluation alongside a randomised controlled trial.

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Sabina Sanghera

Full Text Available OBJECTIVE: To undertake an economic evaluation alongside the largest randomised controlled trial comparing Levonorgestrel-releasing intrauterine device ('LNG-IUS' and usual medical treatment for women with menorrhagia in primary care; and compare the cost-effectiveness findings using two alternative measures of quality of life. METHODS: 571 women with menorrhagia from 63 UK centres were randomised between February 2005 and July 2009. Women were randomised to having a LNG-IUS fitted, or usual medical treatment, after discussing with their general practitioner their contraceptive needs or desire to avoid hormonal treatment. The treatment was specified prior to randomisation. For the economic evaluation we developed a state transition (Markov model with a 24 month follow-up. The model structure was informed by the trial women's pathway and clinical experts. The economic evaluation adopted a UK National Health Service perspective and was based on an outcome of incremental cost per Quality Adjusted Life Year (QALY estimated using both EQ-5D and SF-6D. RESULTS: Using EQ-5D, LNG-IUS was the most cost-effective treatment for menorrhagia. LNG-IUS costs £100 more than usual medical treatment but generated 0.07 more QALYs. The incremental cost-effectiveness ratio for LNG-IUS compared to usual medical treatment was £1600 per additional QALY. Using SF-6D, usual medical treatment was the most cost-effective treatment. Usual medical treatment was both less costly (£100 and generated 0.002 more QALYs. CONCLUSION: Impact on quality of life is the primary indicator of treatment success in menorrhagia. However, the most cost-effective treatment differs depending on the quality of life measure used to estimate the QALY. Under UK guidelines LNG-IUS would be the recommended treatment for menorrhagia. This study demonstrates that the appropriate valuation of outcomes in menorrhagia is crucial.

Water quality and toxicity of river water downstream of the uranium mining facility at Pocos de Caldas, MG, Brazil

International Nuclear Information System (INIS)

Lauria, Dejanira C.; Vascocnellos, Luisa M.H.; Simoes, Francisco F. Lamego; Clain, Almir F.; Scassiotti, Walter F.; Antunes, Ivan; Ferreira, Ana M.; Nascimento, Marcos R.L.

2009-01-01

The uranium mining site of Pocos de Caldas consists of open mine pit, tailings, waste rock dumps and an acid rock drainage problem, which has the potential to impact upon freshwater of the Ribeirao das Antas catchment. The high level of manganese (value of 1.8 mg/L) contained in the discharge water (DW) is an important factor affecting the water quality of the river (water quality criterion for aquatic life for Mn is 0.1 mg/L). Water quality criteria (WQC) are used for regulatory purpose and intended to define concentrations of chemicals in water that are protective of aquatic life and human health. WQC is a standard, although it is recognized that in some instances these criteria may be overprotective as metal bioavailability and hence toxicity is dependent on water chemistry. The toxicity assessment of WD was performed by bioassays with Daphnia similis and Ceriodaphnia dubia as bioindicators. As DW showed no toxicity to the organisms and the chemical analysis and dose assessments pointed U and Mn as the most important metals for water toxicity, the U and Mn toxicities were evaluated in the DW spiked with U and Mn. Acute uranium toxicity (48 h immobilisation test) for Daphnia similis was determined as a LC50 value (concentration that is toxic to 50% of test organisms) around 0.05-0.06 mg/L, value close to the one found for effects on reproduction, a 7 day LOEC (lowest observed effect concentration) of 0.062 mg/L for Ceriodaphnia dubia. The value of NOEC (no-observed effect concentration) for U was 0.03 mg U/L, which is higher than the concentration corresponded to the authorized dose limit for 238 U (0.004 mg/L) and higher than the uranium WQC (0.02 mg U/L). The manganese concentration in the DW is lower than the found value of LC50 (11.5 mg/L), LOEC (10 mg/L) and NOEC (5 mg Mn/L). (author)

COMPLICACIONES PSIQUIÁTRICAS DEL ABORTO

OpenAIRE

Manuel Gurpegui; Dolores Jurado

2009-01-01

Introducción: Las consecuencias psiquiátricas del aborto inducido siguen siendo objeto de controversia. Las reacciones de cualquier mujer al descubrir que ha concebido pueden ser muy variables. El embarazo, inicialmente intencionado o no deseado, puede provocar estrés; y el aborto espontáneo puede acarrear sentimientos de pérdida y reacciones de duelo, por lo que no es de extrañar que el aborto inducido, con las implicaciones emocionales añadidas (sentimientos de alivio, vergüenza y culpa), s...

Evaluación posoperatoria de pacientes operados mediante otoplastias Postoperative evaluation of patients operated on by otoplasties

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Juan Carlos Quintana Díaz

2008-12-01

Full Text Available INTRODUCCIÓN. Las orejas prominentes son una deformidad no poco frecuente, que se caracteriza en la mayoría de los casos por la ausencia o subdesarrollo del antihélix, combinado con una concha profunda y una marcada separación de la oreja respecto del cráneo. El objetivo de este trabajo fue evaluar el comportamiento posoperatorio de un grupo de pacientes operados mediante otoplastia, y medir el grado de satisfacción estética de cada paciente. MÉTODOS. El universo de trabajo estuvo constituido por 93 pacientes operados mediante otoplastia, según los pasos descritos por Psillakis y con alguna variante específica para cada caso, entre el 1994 y el 2004. Los pacientes fueron citados para seguimiento a las 72 h, a los 7 días para retirar la sutura, al mes, a los 6 meses, al año y a los 18 meses. RESULTADOS. Se constató que el número de complicaciones fue poco significativo y que la mayoría de ellas se debieron al incumplimiento de las medidas posoperatorias indicadas. Solo se presentaron 2 casos con recidivas y el 96,8 % de los pacientes estuvieron conformes con el resultado estético obtenido. CONCLUSIONES. Nuestros resultados en cuanto a complicaciones fueron similares y un tanto menores a los documentados por otros autores. Los pacientes y sus familiares quedaron muy complacidos con este tipo de tratamiento y confirmaron haber logrado mejorar su autoimagen, tras lo cual la incorporación a la sociedad es más plena, con una vida social y económica más productiva.INTRODUCTION. Prominent ears are a common deformity characterized in most of the cases by the absence or underdevelopment of the antihelix combined with a deep concha and a marked separation of the ear from the cranium. This paper was aimed at evaluating the postoperative behavior of a group of patients that underwent surgery by otoplasty, and at measuring the aesthetic satisfaction degree of every patient. METHODS. The universe of work was composed of 93 patients operated

Adequacy of Usual Vitamin and Mineral Intake in Spanish Children and Adolescents: ENALIA Study

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Ana M. López-Sobaler

2017-02-01

Full Text Available Background: The National Dietary Survey on the Child and Adolescent Population in Spain (ENALIA provides data to assess the usual micronutrient intake among Spanish infants, children, and adolescents. Methods: Cross-sectional survey (November 2012–July 2014 of a representative sample of Spanish children and adolescents (six months–17 years (n = 1862. Dietary information was collected using two non-consecutive one-day food diaries (six months–10 years old or two 24 h dietary recalls (11 years and older separated by at least 14 days. Estimates were calculated using the Iowa State University method and PC-SIDE software (version 1.0, department of statistics, center for agricultural and rural development, Ames, IA, USA to account for within- and between-person variation. Results: Usual intake of vitamin D was insufficient in practically all individuals. Vitamin E, folate, and calcium were insufficient, especially from nine years of age, and magnesium and iodine from 14 years of age. The percentage of subjects with insufficient intakes was higher among females. Sodium intake was excessive in a considerable percentage of the population, especially in males, and it increased with age. Finally, over half of children under four years of age had zinc usual intakes that exceeded the Tolerable Upper Level. Conclusion: Vitamin and mineral intake in Spain should be improved, especially in late childhood and adolescence. Nutritional intervention and educational strategies are needed to promote healthy eating habits and correct micronutrient inadequacies in Spanish children and adolescents.

Circulação extracorpórea e complicações no período pós-operatório imediato de cirurgias cardíacas Circulación extracorpórea y complicaciones en el período post-operatorio inmediato de cirugías cardíacas Extracorporeal circulation and complications during the immediate postoperative period for cardiac surgery

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Fernanda Gaspar Torrati

2012-01-01

Full Text Available OBJETIVO: Comparar a frequência de complicações apresentadas pelos pacientes, durante o pós-operatório imediato (POI, de cirurgias cardíacas de acordo com o tempo de circulação extra-corpórea (CEC. MÉTODOS: Estudo de natureza quantitativa, descritivo e correlacional com 83 pacientes adultos divididos em dois grupos de acordo com o tempo de CEC. RESULTADOS: Do total de pacientes, 44 (53% tiveram o tempo de duração da CEC de até 85 minutos e 39 (47 % tiveram o tempo acima de 85 minutos. As complicações foram comuns para ambos os grupos, sendo as mais frequentes dor e oligúria. No entanto, hemotórax, pneumotórax e infarto agudo do miocárdio ocorreram apenas no grupo com maior tempo de CEC. CONCLUSÃO: A maioria das complicações ocorridas no POI apresentou frequencia semelhante para os pacientes, independente do tempo de CEC.OBJETIVO: Comparar la frecuencia de complicaciones presentadas por los pacientes, durante el post-operatorio inmediato (POI, de cirugías cardíacas de acuerdo con el tiempo de circulación extra-corpórea (CEC. MÉTODOS: Estudio de naturaleza cuantitativa, descriptiva y correlacional realizado con 83 pacientes adultos divididos en dos grupos de acuerdo con el tiempo de CEC. RESULTADOS: Del total de pacientes, 44 (53% tuvieron el tiempo de duración de la CEC de hasta 85 minutos y 39 (47 % tuvieron el tempo encima de 85 minutos. Las complicaciones fueron comunes para ambos grupos, siendo las más frecuentes dolor y oliguria. Entre tanto, hemotórax, pneumotórax e infarto agudo del miocardio ocurrieron en el grupo con mayor tiempo de CEC. CONCLUSIÓN: La mayoría de las complicaciones ocurridas en el POI presentó frecuencia semejante para los pacientes, independiente del tiempo de CEC.OBJECTIVE: To compare the frequency of complications presented by patients during the immediate postoperative period (IPP for cardiac surgery, based on the time of extracorporeal circulation (ECC. METHODS: A quantitative

Amyloidogenic determinants are usually not buried

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Karletidi Carolina-Maria

2009-07-01

Full Text Available Abstract Background Amyloidoses are a group of usually fatal diseases, probably caused by protein misfolding and subsequent aggregation into amyloid fibrillar deposits. The mechanisms involved in amyloid fibril formation are largely unknown and are the subject of current, intensive research. In an attempt to identify possible amyloidogenic regions in proteins for further experimental investigation, we have developed and present here a publicly available online tool that utilizes five different and independently published methods, to form a consensus prediction of amyloidogenic regions in proteins, using only protein primary structure data. Results It appears that the consensus prediction tool is slightly more objective than individual prediction methods alone and suggests several previously not identified amino acid stretches as potential amyloidogenic determinants, which (although several of them may be overpredictions require further experimental studies. The tool is available at: http://biophysics.biol.uoa.gr/AMYLPRED. Utilizing molecular graphics programs, like O and PyMOL, as well as the algorithm DSSP, it was found that nearly all experimentally verified amyloidogenic determinants (short peptide stretches favouring aggregation and subsequent amyloid formation, and several predicted, with the aid of the tool AMYLPRED, but not experimentally verified amyloidogenic determinants, are located on the surface of the relevant amyloidogenic proteins. This finding may be important in efforts directed towards inhibiting amyloid fibril formation. Conclusion The most significant result of this work is the observation that virtually all, to date, experimentally determined amyloidogenic determinants and the majority of predicted, but not yet experimentally verified short amyloidogenic stretches, lie 'exposed' on the surface of the relevant amyloidogenic proteins, and also several of them have the ability to act as conformational 'switches'. Experiments

The Kramers-Kronig relations for usual and anomalous Poisson-Nernst-Planck models

OpenAIRE

Evangelista, Luiz Roberto; Lenzi, Ervin Kaminski; Barbero, Giovanni

2013-01-01

The consistency of the frequency response predicted by a class of electrochemical impedance expressions is analytically checked by invoking the Kramers-Kronig (KK) relations. These expressions are obtained in the context of Poisson-Nernst-Planck usual (PNP) or anomalous (PNPA) diffusional models that satisfy Poisson's equation in a finite-length situation. The theoretical results, besides being successful in interpreting experimental data, are also shown to obey the KK relations when these re...

The Kramers–Kronig relations for usual and anomalous Poisson–Nernst–Planck models

International Nuclear Information System (INIS)

Evangelista, Luiz Roberto; Lenzi, Ervin Kaminski; Barbero, Giovanni

2013-01-01

The consistency of the frequency response predicted by a class of electrochemical impedance expressions is analytically checked by invoking the Kramers–Kronig (KK) relations. These expressions are obtained in the context of Poisson–Nernst–Planck usual or anomalous diffusional models that satisfy Poisson’s equation in a finite length situation. The theoretical results, besides being successful in interpreting experimental data, are also shown to obey the KK relations when these relations are modified accordingly. (paper)

The Kramers-Kronig relations for usual and anomalous Poisson-Nernst-Planck models.

Science.gov (United States)

Evangelista, Luiz Roberto; Lenzi, Ervin Kaminski; Barbero, Giovanni

2013-11-20

The consistency of the frequency response predicted by a class of electrochemical impedance expressions is analytically checked by invoking the Kramers-Kronig (KK) relations. These expressions are obtained in the context of Poisson-Nernst-Planck usual or anomalous diffusional models that satisfy Poisson's equation in a finite length situation. The theoretical results, besides being successful in interpreting experimental data, are also shown to obey the KK relations when these relations are modified accordingly.

The effects of cognitive therapy versus 'treatment as usual' in patients with major depressive disorder

DEFF Research Database (Denmark)

Jakobsen, Janus Christian; Lindschou Hansen, Jane; Storebø, Ole Jakob

2011-01-01

BACKGROUND: Major depressive disorder afflicts an estimated 17% of individuals during their lifetimes at tremendous suffering and costs. Cognitive therapy may be an effective treatment option for major depressive disorder, but the effects have only had limited assessment in systematic reviews....... METHODS/PRINCIPAL FINDINGS: Cochrane systematic review methodology, with meta-analyses and trial sequential analyses of randomized trials, are comparing the effects of cognitive therapy versus 'treatment as usual' for major depressive disorder. To be included the participants had to be older than 17 years....... Meta-analysis on the data from the Hamilton Rating Scale for Depression showed that cognitive therapy compared with 'treatment as usual' significantly reduced depressive symptoms (mean difference -2.15 (95% confidence interval -3.70 to -0.60; P

Evolución de las complicaciones neurológicas en la cirugía de deformidades vertebrales en la infancia. [Outcome of neurological complications in spinal deformity in children

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Miguel A. Godoy

2015-01-01

Full Text Available Introducción: Se llevó a cabo un estudio retrospectivo descriptivo con el propósito de evaluar cómo evolucionaron los pacientes que sufrieron trastornos neurológicos a causa de una cirugía de las cifoescoliosis en la infancia. Materiales y Métodos: Se evaluó a 9 pacientes sin alteraciones neurológicas previas, que presentaron complicaciones neurológicas luego de un procedimiento quirúrgico por escoliosis o cifosis, operados en nuestra institución, durante un período de 10 años. Resultados: las etiologías de las deformidades fueron: 4 escoliosis idiopáticas, 2 escoliosis congénitas, una secundaria a neurofibromatosis de tipo 1, una cifosis idiopática y una poslaminectomía por miofibrosarcomatosis. Cinco pacientes tuvieron episodios neurofisiológicos intraquirúrgicos. Todos requirieron, al menos, una segunda intervención quirúrgica para solucionar su patología de base. La lesión neurológica fue: lesión radicular (un caso y lesión del cordón medular (8 casos; 6 sufrieron una lesión medular completa (75% que se manifestó como una paresia bilateral y 2 (25%, una lesión medular incompleta con monoparesia, sólo 2 quedaron con vejiga neurogénica. Conclusión: la detección temprana de una complicación neurológica, su diagnóstico etiológico y la resolución quirúrgica mejoran la evolución neurológica del paciente, y evitan la secuela o disminuyen su gravedad.

Effects of circuit training as alternative to usual physiotherapy after stroke: randomised controlled trial

NARCIS (Netherlands)

van de Port, I.G.L.; Wevers, L.E.G.; Lindeman, E.; Kwakkel, G.

2012-01-01

Objective: To analyse the effect of task oriented circuit training compared with usual physiotherapy in terms of self reported walking competency for patients with stroke discharged from a rehabilitation centre to their own home. Design: Randomised controlled trial with follow-up to 24 weeks.

Depressed mood, usual activity level, and continued employment after starting dialysis.

Science.gov (United States)

Kutner, Nancy G; Zhang, Rebecca; Huang, Yijian; Johansen, Kirsten L

2010-11-01

When patients start dialysis, their employment rate declines and disability benefits are an option. With patient sociodemographic and clinical characteristics including disability income status controlled, we investigated the significance of depressed mood and usual activity level as predictors of patients' continued employment after dialysis start. Incident patients from 296 randomly selected dialysis clinics were surveyed in the Comprehensive Dialysis Study (CDS). Participants provided information about employment status, disability income status, education, depressive symptoms measured by the Patient Health Questionnaire-2 (PHQ-2), and usual activity level/energy expenditure measured by the Human Activity Profile. Age, gender, race, insurance, diabetes, inability to ambulate or transfer, chronic obstructive pulmonary disease, cardiovascular conditions, and hemoglobin and serum albumin values at treatment start were obtained from US Renal Data System files. Dialysis modality was defined at time of interview. Among 585 CDS participants who worked in the previous year, 191 (32.6%) continued working after dialysis start. On the basis of the PHQ-2 cutoff score ≥3, 12.1% of patients who remained employed had possible or probable depression, compared with 32.8% of patients who were no longer employed. In adjusted analyses, higher Human Activity Profile scores were associated with increased likelihood of continued employment, and there was a borderline association between lower PHQ-2 scores and continued employment. Screening and management of depressive symptoms and support for increased activity level may facilitate patients' opportunity for continued employment after dialysis start, along with generally improving their overall quality of life.

Not the usual suspects: addressing layers of vulnerability.

Science.gov (United States)

Luna, Florencia; Vanderpoel, Sheryl

2013-07-01

This paper challenges the traditional account of vulnerability in healthcare which conceptualizes vulnerability as a list of identifiable subpopulations. This list of 'usual suspects', focusing on groups from lower resource settings, is a narrow account of vulnerability. In this article we argue that in certain circumstances middle-class individuals can be also rendered vulnerable. We propose a relational and layered account of vulnerability and explore this concept using the case study of cord blood (CB) banking. In the first section, two different approaches to 'vulnerability' are contrasted: categorical versus layered. In the second section, we describe CB banking and present a case study of CB banking in Argentina. We examine the types of pressure that middle-class pregnant women feel when considering CB collection and storage. In section three, we use the CB banking case study to critique the categorical approach to vulnerability: this model is unable to account for the ways in which these women are vulnerable. A layered account of vulnerability identifies several ways in which middle-class women are vulnerable. Finally, by utilizing the layered approach, this paper suggests how public health policies could be designed to overcome vulnerabilities. © 2013 John Wiley & Sons Ltd.

Effect of reversal of neuromuscular blockade with sugammadex versus usual care on bleeding risk in a randomized study of surgical patients.

Science.gov (United States)

Rahe-Meyer, Niels; Fennema, Hein; Schulman, Sam; Klimscha, Walter; Przemeck, Michael; Blobner, Manfred; Wulf, Hinnerk; Speek, Marcel; McCrary Sisk, Christine; Williams-Herman, Debora; Woo, Tiffany; Szegedi, Armin

2014-11-01

Previous studies show a prolongation of activated partial thromboplastin time and prothrombin time in healthy volunteers after treatment with sugammadex. The authors investigated the effect of sugammadex on postsurgical bleeding and coagulation variables. This randomized, double-blind trial enrolled patients receiving thromboprophylaxis and undergoing hip or knee joint replacement or hip fracture surgery. Patients received sugammadex 4 mg/kg or usual care (neostigmine or spontaneous recovery) for reversal of rocuronium- or vecuronium-induced neuromuscular blockade. The Cochran-Mantel-Haenszel method, stratified by thromboprophylaxis and renal status, was used to estimate relative risk and 95% confidence interval (CI) of bleeding events with sugammadex versus usual care. Safety was further evaluated by prespecified endpoints and adverse event reporting. Of 1,198 patients randomized, 1,184 were treated (sugammadex n = 596, usual care n = 588). Bleeding events within 24 h (classified by an independent, blinded Adjudication Committee) were reported in 17 (2.9%) sugammadex and 24 (4.1%) usual care patients (relative risk [95% CI], 0.70 [0.38 to 1.29]). Compared with usual care, increases of 5.5% in activated partial thromboplastin time (P sugammadex occurred 10 min after administration and resolved within 60 min. There were no significant differences between sugammadex and usual care for other blood loss measures (transfusion, 24-h drain volume, drop in hemoglobin, and anemia), or risk of venous thromboembolism, and no cases of anaphylaxis. Sugammadex produced limited, transient (<1 h) increases in activated partial thromboplastin time and prothrombin time but was not associated with increased risk of bleeding versus usual care.

Outcomes of usual chiropractic, harm & efficacy, the ouch study: study protocol for a randomized controlled trial

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Walker Bruce F

2011-10-01

Full Text Available Abstract Background Previous studies have demonstrated that adverse events occur during chiropractic treatment. However, because of these studies design we do not know the frequency and extent of these events when compared to sham treatment. The principal aims of this study are to establish the frequency and severity of adverse effects from short term usual chiropractic treatment of the spine when compared to a sham treatment group. The secondary aim of this study is to establish the efficacy of usual short term chiropractic care for spinal pain when compared to a sham intervention. Methods One hundred and eighty participants will be randomly allocated to either usual chiropractic care or a sham intervention group. To be considered for inclusion the participants must have experienced non-specific spinal pain for at least one week. The study will be conducted at the clinics of registered chiropractors in Western Australia. Participants in each group will receive two treatments at intervals no less than one week. For the usual chiropractic care group, the selection of therapeutic techniques will be left to the chiropractors' discretion. For the sham intervention group, de-tuned ultrasound and de-tuned activator treatment will be applied by the chiropractors to the regions where spinal pain is experienced. Adverse events will be assessed two days after each appointment using a questionnaire developed for this study. The efficacy of short term chiropractic care for spinal pain will be examined at two week follow-up by assessing pain, physical function, minimum acceptable outcome, and satisfaction with care, with the use of the following outcome measures: Numerical Rating Scale, Functional Rating Index, Neck Disability Index, Minimum Acceptable Outcome Questionnaire, Oswestry Disability Index, and a global measure of treatment satisfaction. The statistician, outcome assessor, and participants will be blinded to treatment allocation. Trial

Autoconocimiento, monitorización y complicaciones de la diabetes en la jornada No más ciegos por diabetes en Antioquia, 2005 Self-knowledge, control and complications of diabetes at no more blind by diabetes session in Antioquia, 2005

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Guillermo Latorre Sierra

2007-03-01

Full Text Available INTRODUCCIÓN: una sólida educación a los pacientes en temas relacionados con la diabetes y la monitorización de la glucosa, se han asociado con mejor control metabólico, mayor entendimiento de la enfermedad, auto confianza y mejor cuidado clínico. MATERIALES Y MÉTODOS: estudio de corte transversal, en la jornada No más ciegos por diabetes en Antioquia 2005. Se diligenció un cuestionario indagando acerca de la monitorización, tipo de diabetes, tratamiento y complicaciones; se midieron la glucometría, el peso, la talla y el perímetro abdominal. RESULTADOS: se incluyeron 210 pacientes, de los cuales 36,6% no saben que tipo de diabetes tienen, 59,7% no saben que es la hemoglobina glicosilada y 25,8% saben que este examen debe realizarse cada 3 a 4 meses, sin embargo, solo se le había realizado a siete pacientes (3,3% con la frecuencia ideal. El 36,4% tienen glucómetro y 60,6% de los pacientes saben que se deben realizarse una evaluación oftalmológica anual. En los pacientes con Diabetes Mellitus tipo 2 el 26,2% tuvo glucometrías postprandial menores de 140 mg/dl. Las complicaciones informadas con mayor frecuencia fueron el compromiso renal y descompensación aguda en los Diabéticos tipo 1, la dislipidemia y la neuropatía periférica en los diabéticos tipo 2. INTRODUCTION: A better knowledge about diabetes by patients has been associated with better understanding of the disease, self esteem and improved clinical care and metabolic control. MATERIAL AND METHODS: It is a cohort study, made during the “No more blind by Diabetes” session, 2005. The study population fills out the form with questions about the blood glucose control, type of diabetes and treatment. Also a measure of blood glucose, height, weight, and abdominal circumference was made. RESULTS: 210 patients were included, 36.6% did not know which type of diabetes they have, 59.7% did not know what glycosylated hemoglobin is, 25.8% know that the frequency to evaluated

Parámetros funcionales y su relación con la velocidad de marcha en adultos mayores chilenos residentes en la comunidad

OpenAIRE

Christopher Rybertt; Silvia Cuevas; Ximena Winkler; Pamela Lavados; Sergio Martínez

2015-01-01

Introducción. La velocidad de marcha es una prueba para medir la capacidad funcional en adultos mayores. Sin embargo, los factores que influyen en esta variable han sido poco descritos en la población sudamericana. Objetivo. Determinar la relación existente entre la velocidad de marcha usual y máxima, y los parámetros de funcionalidad en chilenos adultos mayores de la comunidad. Material y métodos. Este estudio cuantitativo, observacional y descriptivo, de corte transversal, incluyó 6...

USO DE PRESSÃO POSITIVA CONTÍNUA DAS VIAS AÉREAS EM RECÉM-NASCIDOS: CONHECIMENTO DA EQUIPE DE ENFERMAGEM

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Daniela Mota da Silva

2010-01-01

Full Text Available El objetivo del estudio fue evaluar el conocimiento del equipo de enfermería acerca del uso de presión positiva continua de las vías aéreas (CPAP en recién nacidos (RN, las complicaciones provenidas de ese uso y las intervenciones realizadas. Investigación descriptiva desarrollada en Juazeiro do Norte-CE, en mayo/ 2010, en la unidad de cuidados intensivos y de cuidados intermediarios neonatal de un hospital de referencia. La muestra se formó con 12 enfermeros y 18 técnicos de enfermería. Los datos fueron recolectados a través de un cuestionario sobre las principales complicaciones del uso de la CPAP y de las intervenciones de enfermería relacionadas. Las complicaciones ocasionadas en los RN citadas con mayor frecuencia fueron: necrosis del tabique nasal o septum, irritación y malestar. Entre las intervenciones realizadas se mencionaron: aspiración de las vías respiratorias y posicionamiento adecuado del recién nacido. Se concluyó que el conocimiento del personal de enfermería con respecto a las complicaciones del uso de la CPAP se limitaba a los efectos más predominantes en la práctica asistencial, aunque los técnicos han señalado una mayor diversidad de complicaciones.

Comparación de la atención del parto normal en los sistemas hospitalario y tradicional

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Méndez-González Rosa María

2002-01-01

Full Text Available Objetivo. Comparar la atención del parto por vía vaginal entre los sistemas hospitalario y tradicional, para identificar recursos y procedimientos utilizados, y la aparición de complicaciones maternas y neonatales derivadas del tipo de atención. Material y métodos. Estudio transversal realizado en tres hospitales de la ciudad de Mérida y cuatro municipios del estado de Yucatán, México, entre 1989 y 1990. La muestra estuvo constituida por 205 mujeres que tuvieron parto por vía vaginal. Se observó la atención del parto y, a los 15 días posparto, se les entrevistó para detectar complicaciones maternas y neonatales. Se calcularon proporciones y se aplicó ji cuadrada para compararlas. Resultados. Se presentaron complicaciones en ambos sistemas. Sin embargo, en el hospitalario predominaron las maternas y en el tradicional, las neonatales. El número total de complicaciones fue similar. Conclusiones. La calidad de la atención fue similar en ambos servicios. Las complicaciones observadas pueden atribuirse a los recursos y acciones utilizados en cada sistema. Se requieren más estudios de este tipo para contar con evaluaciones objetivas de las ventajas y desventajas de ambos sistemas y contribuir a mejorar la calidad de la atención materno-infantil.

Geochemical modelling of water-rock interactions at the Osamu Utsumi mine and Morro do Ferro analogue study sites, Pocos de Caldas, Brazil

International Nuclear Information System (INIS)

Nordstrom, D.K.; Puigdomenech, I.; McNutt, R.H.

1990-01-01

Geochemical processes involving water-rock interactions have been modelled using groundwater composition, mineralogical data, ion plots and computations of speciation, non-thermodynamic mass balance and thermodynamic mass transfer for two natural analogue sites near Pocos de Caldas, Brazil: the Osamu Utsumi mine and Morro do Ferro. The main rock type is an alkaline igneous complex composed of volcanic and sub-volcanic phonolites that have been hydrothermally altered and highly weathered. This altered rock mass grades from a laterite at the surface to a saprolite and finally to unweathered, hydrothermally altered bedrock at depth. The mine site contains high concentrations of uranium and Morro do Ferro contains high concentrations of thorium and rare-earths. The reaction models can reproduce the water chemistry and mineral occurences and they were validated by predicting the masses of minerals precipitated and the pH of the final water. The model computations can also reproduce the pH and iron concentrations of the water samples during CO 2 degassing and iron(II) oxidation from exposure to air. The results from the geochemical reaction models reveal that the dominant processes are production of CO 2 in the soil zone through aerobic decay of organic matter, dissolution of fluorite, calcite, K-feldspar, albite and manganese oxides, oxidation of pyrite and sphalerite and precipitation of ferric oxides, silica and kaolinite. Recharge waters are undersaturated with respect to barite and discharging waters and deeper groundwaters are saturated to supersaturated with respect to barite, demonstrating a strong equilibrium solubility control. Strontium isotope data demonstrate that sources other than calcium-bearing minerals are required to account for the dissolved strontium in the ground. These may include K-feldspar, smectite-chlorite mixed-layer clays and goyazite. (author) 24 figs., 4 tabs., 18 refs

Transfusão sangüínea no intra-operatório, complicações e prognóstico Transfusión sanguínea en el intraoperatorio, complicaciones y pronóstico Complications and prognosis of intraoperative blood transfusion

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João Manoel Silva Junior

2008-10-01

mortalidade. Os escores APACHE II, POSSUM e maior número de transfusões foram fatores de riscos independentes de pior prognóstico no pós-operatório.JUSTIFICATIVA Y OBJETIVOS: Transfusiones sanguíneas en el intraoperatorio están asociadas al aumento de complicaciones en el postoperatorio y costes hospitalarios. Por tanto, este estudio evaluó las características, complicaciones y los posibles factores de riesgos para muerte en pacientes quirúrgicos que necesitaron transfusiones sanguíneas en el intraoperatorio. MÉTODO: Categoría prospectiva, durante el período de un año, en el centro quirúrgico de hospital terciario. Se incluyeron pacientes con edad por encima de los 18 años que necesitaron transfusiones sanguíneas en el intraoperatorio. Testigos de Jeová, pacientes que recibieron transfusiones previas, fracaso coronario y lesión encefálica aguda quedaron excluidos del estudio. RESULTADOS: El estudio involucró a 80 pacientes, con una edad promedio entre los 68,4 ± 14,1 años. Los pacientes ASA II eran prevalecientes con 69,6% de los casos, las puntuaciones APACHE II y POSSUM fueron, como promedio respectivamente de 13,6 ± 4,4 y 37,5 ± 11,4. La hemoglobina promedio al momento de la transfusión era de 8,2 ± 1,8 g.dL-1 y un 19% de los pacientes tuvieron hemoglobina por encima de 10 g.dL-1. Los pacientes recibieron como promedio 2,2 ± 0,9 UI de concentrados de hematíes. La mortalidad hospitalaria fue de un 26,3%. Las complicaciones postransfusiones totalizaron un 57,5% de los casos en el postoperatorio y la más frecuente fue la infección. Fueron factores independientes de muerte en la regresión logística las puntuaciones APACHE II (OR = 1,34; IC 95% 1,102-1,622, POSSUM (OR = 1,08; IC 95% 1,008 - 1,150 y número de unidades de concentrados de hematíes recibidos (OR = 2,22; IC 95% 1,100 - 4,463. Mientras mayor es el número de transfusiones sanguíneas, mayores son las incidencias de las complicaciones y de la mortalidad. CONCLUSIONES: El valor de la

Linfoma primario del sistema nervioso central en una paciente con lupus eritematoso sistémico

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C. N. Pisoni

2003-06-01

Full Text Available Se presenta una paciente de 36 años con diagnóstico de lupus eritematoso sistémico tratada con prednisona y ciclofosfamida que se internó por cefalea, hemiparesia y hemianestesia braquiocrural derecha de dos semanas de evolución. Se realizó una tomografía computada y una resonancia magnética nuclear de cerebro que mostraron una lesión nodular frontal izquierda. Se efectuó una biopsia a cielo abierto de la lesión cerebral cuyo diagnóstico histopatológico fue linfoma B de celulas grandes, difuso. Se inició radioterapia, no completó el tratamiento por complicaciones y falleció. Son muy pocos los casos publicados de linfoma primario del sistema nervioso central asociado a lupus eritematoso sistémico.A 36 year-old woman with systemic lupus erythematosus was admitted to our hospital with headache, brachiocrural hemiparesis and hemianesthesia. She had been treated with prednisone and cyclophosphamide. CT scan and MRI revealed a 15 mm nodular mass enhanced with gadolinium in left frontal convexity. CNS biopsy was performed and a diffuse large B-cell lymphoma was diagnosed. She was treated with radiation therapy without response and died. There are few reports of erythematosus systemic lupus associated with primary central nervous system lymphoma.

Ansiedade, depressão e estresse em pacientes com síndrome metabólica

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Martha Wallig Brusius Ludwig

2012-01-01

Full Text Available El Síndrome Metabólico (SM es un conjunto de factores de riesgo para enfermedades cardiovasculares relacionadas con un estilo de vida poco saludable. Algunos estudios indican la presencia de complicaciones psicológicas como la depresión, la ansiedad y el estrés en estos pacientes. La evaluación de las mismas es fundamental para un tratamiento individualizado visando la mejora y la adhesión del paciente a las directrices. El estudio pretende presentar la descripción socio demográfica de ansiedad, depresión y de estrés de los participantes del programa de Modificación de estilo de vida y el riesgo cardiovascular, desarrollado en la ciudad de Porto Alegre, RS. De los 38 participantes, la mayoría era del género femenino (78,9%, con educación superior completa (42,1%. En cuanto a otros aspectos evaluados, el 31,6% tenían síntomas moderados de depresión, el 55,3% se encontraban en la etapa de la resistencia de estrés, el 47,4% tenían síntomas mínimos de ansiedad y el 86,8% presenta alta probabilidad de desarrollo de enfermedades relacionadas con el estrés.

Bocio intratorácico

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Gladys Iglesias Díaz

2014-12-01

Full Text Available Introducción: el bocio constituye la afección de la glándula tiroides que más es tratado en los servicios quirúrgicos, sin embargo, su posición anómala no es frecuente. Presentación de caso: paciente de 51 años de edad, con antecedentes de asma bronquial. Hace 3 años presentó un aumento de volumen de la región lateral izquierda del cuello y presencia de decaimiento, palpitaciones y disfagia ocasional, para lo cual llevó el tratamiento con levotiropsina sódica. Se indicaron estudios de la función tiroidea, radiografías de tórax (vista anteroposterior, ecografía de la tiroides y biopsia por aspiración con aguja fina. A través de la vía cervical se le realizó la tiroidectomía total corroborando que más del 50% de la glándula estaba en posición intratorácica, nódulos en ambos lóbulos y sin complicaciones; resultó ser un bocio coloide multinodular. Conclusiones: el bocio intratorácico responde poco al tratamiento médico, de preferencia se utiliza la tiroidectomía total por vía cervical ante síntomas de compresión siempre que sea posible.

En el sellado del catéter venoso central en hemodiálisis, ¿presenta el uso de citrato respecto al uso de heparina menos complicaciones de infección? Una revisión de la literatura

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Mateu Nadal Servera

Full Text Available Resumen Introducción: La heparina es el fármaco anticoagulante de elección y de uso habitual en los servicios de hemodiálisis, en el procedimiento de permeabilización de los catéteres venosos centrales, aunque su uso no está exento de riesgos como la hemorragia. La infección asociada al catéter, bien por colonización del catéter o por bacteriemia, es el evento más importante y la segunda causa de mortalidad tras la enfermedad cardiovascular en el paciente en hemodiálisis. En este sentido, el uso del citrato se está presentando como una alternativa para el sellado de los catéteres venosos centrales, dado que tiene propiedades tanto anticoagulantes locales como antimicrobianas y podría ser más eficiente en la prevención o la reducción de la infección asociada al catéter. Objetivos: Identificar qué anticoagulante de uso en el sellado del catéter venoso central, la heparina o el citrato, presenta menos complicaciones de bacteriemia asociada al catéter y de colonización del catéter; Material y Método: se realizó una búsqueda bibliográfica a través del metabuscador EBSCOhost (Academic Search Premier, CINAHL y las bases de datos PubMed, IME, Ibecs, LILACS, CUIDEN, Scopus y Cochrane Library, con la selección final de 15 documentos tras la aplicación de los límites de búsqueda, la eliminación de duplicados y la aplicación de los criterios de inclusión/exclusión. Los resultados más relevantes y actuales disponibles en la literatura científica presentaron cierta variabilidad, tanto en las concentraciones de anticoagulante como en la incidencia de infección. Resultados y Discusión: La numerosa evidencia sobre la bacteriemia asociada al catéter, tanto en relación con la concentración como en la combinación del anticoagulante de sellado, indica que el citrato 4% podría reducir la incidencia de bacteriemia, aunque el citrato asociado a antimicrobianos es más efectivo en la prevención de ésta respecto a la

Predicting therapy success for treatment as usual and blended treatment in the domain of depression.

Science.gov (United States)

van Breda, Ward; Bremer, Vincent; Becker, Dennis; Hoogendoorn, Mark; Funk, Burkhardt; Ruwaard, Jeroen; Riper, Heleen

2018-06-01

In this paper, we explore the potential of predicting therapy success for patients in mental health care. Such predictions can eventually improve the process of matching effective therapy types to individuals. In the EU project E-COMPARED, a variety of information is gathered about patients suffering from depression. We use this data, where 276 patients received treatment as usual and 227 received blended treatment, to investigate to what extent we are able to predict therapy success. We utilize different encoding strategies for preprocessing, varying feature selection techniques, and different statistical procedures for this purpose. Significant predictive power is found with average AUC values up to 0.7628 for treatment as usual and 0.7765 for blended treatment. Adding daily assessment data for blended treatment does currently not add predictive accuracy. Cost effectiveness analysis is needed to determine the added potential for real-world applications.

Self-managed loaded exercise versus usual physiotherapy treatment for rotator cuff tendinopathy: a pilot randomised controlled trial.

Science.gov (United States)

Littlewood, Chris; Malliaras, Peter; Mawson, Sue; May, Stephen; Walters, Stephen J

2014-03-01

Rotator cuff tendinopathy is a common source of shoulder pain characterised by persistent and/or recurrent problems for a proportion of sufferers. The aim of this study was to pilot the methods proposed to conduct a substantive study to evaluate the effectiveness of a self-managed loaded exercise programme versus usual physiotherapy treatment for rotator cuff tendinopathy. A single-centre pragmatic unblinded parallel group pilot randomised controlled trial. One private physiotherapy clinic, northern England. Twenty-four participants with rotator cuff tendinopathy. The intervention was a programme of self-managed loaded exercise. The control group received usual physiotherapy treatment. Baseline assessment comprised the Shoulder Pain and Disability Index (SPADI) and the Short-Form 36, repeated three months post randomisation. The recruitment target was met and the majority of participants (98%) were willing to be randomised. 100% retention was attained with all participants completing the SPADI at three months. Exercise adherence rates were excellent (90%). The mean change in SPADI score was -23.7 (95% CI -14.4 to -33.3) points for the self-managed exercise group and -19.0 (95% CI -6.0 to -31.9) points for the usual physiotherapy treatment group. The difference in three month SPADI scores was 0.1 (95% CI -16.6 to 16.9) points in favour of the usual physiotherapy treatment group. In keeping with previous research which indicates the need for further evaluation of self-managed loaded exercise for rotator cuff tendinopathy, these methods and the preliminary evaluation of outcome offer a foundation and stimulus to conduct a substantive study. Copyright © 2013 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Manejo endoscópico del síndrome de túnel del carpo, una experiencia de 5 años

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Álvaro Antonio Kafury Goeta

2016-06-01

Full Text Available Introducción: El síndrome de túnel del carpo afecta el 1% de la población, siendo la neuropatía por compresión más frecuente, la liberación endoscópica es una técnica que presenta buenos resultados, aunque no está exenta de complicaciones. Objetivo: El objetivo del estudio es determinar la prevalencia de complicaciones asociadas en una experiencia de 5 años. Metodología: Estudio de corte transversal en pacientes con diagnóstico del túnel del carpo sometidos a liberación endoscópica en un periodo de 5 años, donde se documentó todas las complicaciones neurológicas, vasculares e infección. Resultados: Se incluyeron 175 manos en 139 pacientes con un promedio de edad de 52 años de edad; el 89.2% de los casos se presentaron en mujeres. Las comorbilidades encontradas fueron: hipertensión arterial 31.6%, hipotiroidismo 29.5%, diabetes 5%, y consumo de cigarrillo 11%. La prevalencia de complicaciones fue del 5.7% (10 casos, de las cuales la lesión neurológica fue del 0.6% clasificada como neuropraxia del nervio cubital, 1.7% presentaron hematomas que resolvieron sin cirugía y 3.4% presentaron infección que resolvieron con manejo antibiótico y curaciones. Todas las complicaciones presentaron una recuperación satisfactoria. El 99% de los pacientes presentaron resolución de los síntomas. Conclusiones: La técnica de liberación endoscópica del túnel del carpo es una técnica segura, en donde se encontró un porcentaje bajo de complicaciones siendo comparables a otras series.

Enfermedad por reflujo gastroesofágico en niños Disease due to gastroesophageal reflux in children

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Leonor Adriana Castiblanco Galvis

1997-03-01

Full Text Available En niños normales el reflujo gastroesofágico (RGE es usualmente autolimitado. La enfermedad por RGE (ERGE causa severos problemas respiratorios, gastrointestinales y de alimentación. La ERGE es causa frecuente de morbilidad en niños. El propósito del presente artículo es describir la fisiopatología, las manifestaciones clínicas, el diagnóstico, el manejo y las complicaciones de la ERGE en niños. In normal infants gastroesophageal reflux (GER is usually self-limited but GER disease (GERD is a frequent cause of morbidity in childhood, causing severe respiratory, gastrointestinal and feeding problems. This review describes the pathophysiology, clinical aspects,diagnosis, treatment and complications of GERD in children.

Tratamiento quirúrgico de las complicaciones del shock meningocóccico grave Surgical treatment of the severe meningococcal septic shock complications

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P. Casteleiro Roca

2010-06-01

Full Text Available El shock meningocóccico es una entidad relativamente frecuente y de pronóstico muy grave, que provoca fallo multiorgánico con una alta mortalidad y que precisa ingreso en Unidad de Cuidados Intensivos. En los casos grandes puede provocar necrosis de tejidos mediante una fisiopatología poco clara. En los últimos años la supervivencia de estos pacientes ha aumentado debido al diagnóstico precoz y a medidas de reanimación más agresivas. Como consecuencia encontramos un aumento del número de pacientes con necrosis extensas de tejidos que precisan tratamiento. Lo fundamental ante el diagnóstico de un shock meningocóccico es establecer el tratamiento médico precoz con medidas de reanimación agresivas y antibioterapia. Sugerimos que la necrosis extensa de tejidos que sufren estos pacientes debe tratarse como si se tratase de un paciente quemado, realizando curas diarias con sulfadiacina argéntica y cirugías seriadas (desbridamiento - amputación - cobertura tan pronto como la situación clínica del paciente lo permita. Es necesario un seguimiento muy cercano de estos pacientes, dada la necesidad de cirugías secundarias que van a precisar a lo largo de su vida, así como la realización de pruebas de imagen para descartar la presencia de osteomielitis secundarias.Meningococcal shock is a relatively frequent disease with a serious prognosis, that causes a multiorganic failure with high mortality and Intensive Care Unit admission. Serious meningococcal shock causes tissue necrosis by uncertain physiopathology. In the last years, there is an increase of the survival, as a result of early diagnosis and aggressive resuscitation. So, there is an increase of patient's tissue necrosis that needs surgery. The most important aspect in front of meningococcal shock is to establish early medical treatment with aggressive resuscitation and antibiotics. Tissue necrosis should be treated like burn patient: argentic sulfadiazine daily cure and serial

PRECISE - pregabalin in addition to usual care for sciatica: study protocol for a randomised controlled trial.

Science.gov (United States)

Mathieson, Stephanie; Maher, Christopher G; McLachlan, Andrew J; Latimer, Jane; Koes, Bart W; Hancock, Mark J; Harris, Ian; Day, Richard O; Pik, Justin; Jan, Stephen; Billot, Laurent; Lin, Chung-Wei Christine

2013-07-11

Sciatica is a type of neuropathic pain that is characterised by pain radiating into the leg. It is often accompanied by low back pain and neurological deficits in the lower limb. While this condition may cause significant suffering for the individual, the lack of evidence supporting effective treatments for sciatica makes clinical management difficult. Our objectives are to determine the efficacy of pregabalin on reducing leg pain intensity and its cost-effectiveness in patients with sciatica. PRECISE is a prospectively registered, double-blind, randomised placebo-controlled trial of pregabalin compared to placebo, in addition to usual care. Inclusion criteria include moderate to severe leg pain below the knee with evidence of nerve root/spinal nerve involvement. Participants will be randomised to receive either pregabalin with usual care (n = 102) or placebo with usual care (n = 102) for 8 weeks. The medicine dosage will be titrated up to the participant's optimal dose, to a maximum 600 mg per day. Follow up consultations will monitor individual progress, tolerability and adverse events. Usual care, if deemed appropriate by the study doctor, may include a referral for physical or manual therapy and/or prescription of analgesic medication. Participants, doctors and researchers collecting participant data will be blinded to treatment allocation. Participants will be assessed at baseline and at weeks 2, 4, 8, 12, 26 and 52. The primary outcome will determine the efficacy of pregabalin in reducing leg pain intensity. Secondary outcomes will include back pain intensity, disability and quality of life. Data analysis will be blinded and by intention-to-treat. A parallel economic evaluation will be conducted from health sector and societal perspectives. This study will establish the efficacy of pregabalin in reducing leg pain intensity in patients with sciatica and provide important information regarding the effect of pregabalin treatment on disability and quality of life

A relação entre polifarmácia, complicações crônicas e depressão em portadores de Diabetes Mellitus Tipo 2 Relación entre polifarmacia, complicaciones crónicas y depresión en portadores de Diabetes Mellitus Tipo 2 The relationship between polipharmacy, chronic complications and depression in individuals with Type 2 Diabetes Mellitus

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Alexandra Bulgarelli do Nascimento

2010-03-01

Full Text Available Os objetivos deste estudo foram: caracterizar a polifarmácia entre portadores de Diabetes Mellitus tipo2(DM2; e correlacionar polifarmácia e número de complicações do DM2 com indicadores de depressão (Inventário de Depressão de Beck[IDB] e cortisol urinário[CORT]. A amostra foi composta por 40 pacientes da Liga de Diabetes do HCFM-USP, avaliados quanto aos indicadores de depressão (CORT e IDB e quanto à prática de polifarmácia e número de complicações do DM2. Os resultados mostraram que os medicamentos utilizados foram: antidiabéticos orais, insulinas, anti-hipertensivos, diuréticos, anti-lipêmicos e trombolíticos. No grupo estudado, 75% fizeram uso diário de 5 a 8 medicamentos, e 12,5% de 8 medicamentos/dia ou mais; todos fizeram no mínimo 3 tomadas diárias, 60% tinham entre 1 e 3 complicações do DM2, e 22,5% tinham 3 ou mais. A correlação entre os indicadores de depressão(IDB e CORT, o número de medicamentos e o número de complicações do DM2 não foi estatisticamente significante. No entanto, houve correlação positiva entre CORT e número de tomadas diárias de medicamentos (Spearman,r=0.319, p=0.019.Fueron objetivos de este estudio: caracterizar a la polifarmacia entre portadores de Diabetes Mellitus tipo 2 (DM2 y correlacionar la polifarmacia y el número de complicaciones de la DM2 con indicadores de depresión (Inventario de Depresión de Beck [IDB] y cortisol urinario [CORT]. La muestra fue integrada por 40 pacientes de la Liga de Diabetes del HCFM-USP evaluados respecto de los indicadores de depresión (CORT e IDB y también en cuanto a la práctica de polifarmacia y número de complicaciones de la DM2. Los resultados mostraron que los medicamentos utilizados fueron: antidiabéticos orales, insulinas, antihipertensivos, diuréticos, antilipemiantes y trombolíticos. Dentro del grupo estudiado, 75% de los pacientes utilizaban diariamente entre 5 y 8 medicamentos, un 12,5% de la muestra hacía uso de 8

Effects of business-as-usual anthropogenic emissions on air quality

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A. Pozzer

2012-08-01

Full Text Available The atmospheric chemistry general circulation model EMAC has been used to estimate the impact of anthropogenic emission changes on global and regional air quality in recent and future years (2005, 2010, 2025 and 2050. The emission scenario assumes that population and economic growth largely determine energy and food consumption and consequent pollution sources with the current technologies ("business as usual". This scenario is chosen to show the effects of not implementing legislation to prevent additional climate change and growing air pollution, other than what is in place for the base year 2005, representing a pessimistic (but plausible future.

By comparing with recent observations, it is shown that the model reproduces the main features of regional air pollution distributions though with some imprecisions inherent to the coarse horizontal resolution (~100 km and simplified bottom-up emission input.

To identify possible future hot spots of poor air quality, a multi pollutant index (MPI, suited for global model output, has been applied. It appears that East and South Asia and the Middle East represent such hotspots due to very high pollutant concentrations, while a general increase of MPIs is observed in all populated regions in the Northern Hemisphere. In East Asia a range of pollutant gases and fine particulate matter (PM_2.5 is projected to reach very high levels from 2005 onward, while in South Asia air pollution, including ozone, will grow rapidly towards the middle of the century. Around the Persian Gulf, where natural PM_2.5 concentrations are already high (desert dust, ozone levels are expected to increase strongly.

The population weighted MPI (PW-MPI, which combines demographic and pollutant concentration projections, shows that a rapidly increasing number of people worldwide will experience reduced air quality during the first half of the 21st century. Following this business as usual

Electronic Health Record for Intensive Care based on Usual Windows Based Software.

Science.gov (United States)

Reper, Arnaud; Reper, Pascal

2015-08-01

In Intensive Care Units, the amount of data to be processed for patients care, the turn over of the patients, the necessity for reliability and for review processes indicate the use of Patient Data Management Systems (PDMS) and electronic health records (EHR). To respond to the needs of an Intensive Care Unit and not to be locked with proprietary software, we developed an EHR based on usual software and components. The software was designed as a client-server architecture running on the Windows operating system and powered by the access data base system. The client software was developed using Visual Basic interface library. The application offers to the users the following functions: medical notes captures, observations and treatments, nursing charts with administration of medications, scoring systems for classification, and possibilities to encode medical activities for billing processes. Since his deployment in September 2004, the EHR was used to care more than five thousands patients with the expected software reliability and facilitated data management and review processes. Communications with other medical software were not developed from the start, and are realized by the use of basic functionalities communication engine. Further upgrade of the system will include multi-platform support, use of typed language with static analysis, and configurable interface. The developed system based on usual software components was able to respond to the medical needs of the local ICU environment. The use of Windows for development allowed us to customize the software to the preexisting organization and contributed to the acceptability of the whole system.

Sarcoma granulocítico hepático: una presentación inusual

OpenAIRE

Alama Zaragoza, Mª A.; Robles Iniesta, A.; Roca Adelantado, I.; Sales Maicas, M.A.; Ferrández Izquierdo, A.; Román Sánchez, P.

2003-01-01

El sarcoma granulocítico es un tumor extramedular, poco frecuente, constituido por precursores inmaduros mieloides. Puede aparecer en ausencia de enfermedad hematológica o con anterioridad a la misma, aunque lo más usual es que se asocie a una leucemia mieloide aguda o a otro proceso mieloproliferativo, o bien que se manifieste en el curso de un síndrome mielodisplásico. Nuestro paciente, varón de 81 años de edad, presentaba un cuadro de ictericia mucocutánea franca, aguda, con un patrón anal...

Ecuador : ¿planificación democrática y consensuada de su política exterior?

OpenAIRE

Carrión Mena, Francisco

2007-01-01

En un ejercicio poco usual, Ecuador fijó en noviembre de 2006 un Plan Nacional de Política Exterior de largo plazo (hasta el 2020) después de un proceso democrático de diálogo y consultas con los más diversos sectores políticos, sociales y locales para identificar sus aspiraciones e intereses y proyectarlos al mundo competitivo y desafiante en que vivimos. El proceso que contempló talleres, seminarios y conferencias se desarrolló durante diez meses fijó en un documento gu...

Graphene and electric transport properties in graphene-superconductor interfaces

OpenAIRE

Manjarrés, Diego; Gómez, Shirley; Herrera, William

2012-01-01

El grafeno es una estructura bidimensional de carbono que tiene propiedades electrónicas que no son usuales y  donde los electrones son descritos por la ecuación de Dirac. Este material permite establecer una analogía entre la física de partículas y la materia condensada. La obtención del grafeno hace pocos años ha incentivado una gran cantidad de trabajos experimentales y teóricos con el propósito de poder entender y manipular sus propiedades. Actualmente se han investigado diferentes juntur...

Coffee Drinking Is Widespread in the United States, but Usual Intake Varies by Key Demographic and Lifestyle Factors123

Science.gov (United States)

Loftfield, Erikka; Freedman, Neal D; Dodd, Kevin W; Vogtmann, Emily; Xiao, Qian; Sinha, Rashmi; Graubard, Barry I

2016-01-01

Background: Despite widespread popularity and possible health effects, the prevalence and distribution of coffee consumption in US adults are poorly characterized. Objective: We sought to estimate usual daily coffee intakes from all coffee-containing beverages, including decaffeinated and regular coffee, among US adults according to demographic, socioeconomic, and health-related factors. Methods: Dietary intake data from ≤2 nonconsecutive 24-h dietary recalls and a food-frequency questionnaire administered during the NHANES 2003–2006 were used to estimate the person-specific probability of consuming coffee on a particular day and the usual amount consumed on consumption days. Trends in population mean coffee consumption over time were evaluated by using multiple linear regression and 1-d 24-h recall data from NHANES 2003–2012. Analyses were weighted to be representative of the US adult population aged ≥20 y. Results: An estimated 154 million adults, or 75% of the US population, aged ≥20 y reported drinking coffee; 49% reported drinking coffee daily. Prevalence did not vary by sex, education, income, or self-reported general health (all P ≥ 0.05) but did vary by age, race/ethnicity, smoking status, and alcohol drinking (all P coffee drinkers, the mean ± SE usual intake was 14.1 ± 0.5 fluid ounces/d (417 ± 15 mL/d). Mean usual intakes were higher in men than women, in older age groups than in those aged 20 to coffee consumption was stable from 2003 to 2012 (P-trend = 0.09). Conclusions: Coffee is widely consumed in the United States, with usual intakes varying by lifestyle and demographic factors, most notably by age. Longitudinal studies are needed to determine whether observed differences by age reflect birth cohort effects or changes in drinking patterns over the lifetime. PMID:27489008

Usual Intake of Added Sugars and Saturated Fats Is High while Dietary Fiber Is Low in the Mexican Population.

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López-Olmedo, Nancy; Carriquiry, Alicia L; Rodríguez-Ramírez, Sonia; Ramírez-Silva, Ivonne; Espinosa-Montero, Juan; Hernández-Barrera, Lucia; Campirano, Fabricio; Martínez-Tapia, Brenda; Rivera, Juan A

2016-09-01

The Mexican National Health and Nutrition Survey (ENSANUT) was carried out in 2012. Information from the survey is used to design and evaluate food and nutrition policies in Mexico. The objective of this study was to estimate the usual intake of energy and macronutrients in the Mexican population by using the ENSANUT 2012. Twenty-four-hour recall interviews were administered to a nationally representative subsample of 10,096 individuals aged ≥1 y from the ENSANUT 2012. Usual intake distributions and the prevalence of inadequate intakes were estimated by using the Iowa State University method. Student's t tests and tests on the equality of proportions were used to compare usual intakes and prevalence of inadequacy across socioeconomic status, area (rural or urban), and region of residence (North, Center, or South). Energy and macronutrient intakes and indicators of dietary adequacy are presented for children (ages 1-4 y and 5-11 y), adolescents (12-19 y), and adults (≥20 y). At the national level, the estimated mean fiber intake was below the Adequate Intake for all population subgroups, suggesting inadequacies. The estimated proportion with a usual added sugars intake of >10% of total energy intake was >64% in all age groups. The proportion with a usual saturated fat intake of >10% of total energy intake was estimated to be >78% in children, >66% in adolescents, and >50% in adults. Overall, fiber intake was lower and intakes of saturated fat and added sugars were higher in urban compared with rural areas, in the North compared with South regions, and among those with high compared with low socioeconomic status (P 50% of the Mexican population aged ≥1 y. These results highlight the importance of improving the diets of the overall population to reduce the risk of noncommunicable chronic diseases. © 2016 American Society for Nutrition.

Usual Choline Intakes Are Associated with Egg and Protein Food Consumption in the United States

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Taylor C. Wallace

2017-08-01

Full Text Available Choline is an essential nutrient with critical roles in several biological processes including neuronal development, cell signaling, nerve impulse transmission, and lipid transport and metabolism. The National Cancer Institute method was used to assess usual intakes of choline from foods according to data for participants enrolled in the National Health and Nutrition Examination Survey 2009–2014 datasets and pregnant women in the 2005–2014 datasets. Suboptimal intakes of choline are present across many gender and life-stage subpopulations, as well as pregnant women in the U.S. Only 8.03 ± 0.56% of adults and 8.51 ± 2.89% pregnant women meet the AI for choline. Children 2–3 years were the most likely to meet their gender and life-stage specific AI, followed by children 4–8 years. Adults 19+ years who consume eggs were more likely to meet their gender and life-stage AI as compared to non-consumers (57.3 ± 1.45% and 2.43 ± 0.28%. Consumers of eggs had almost double the usual intake of choline as compared to non-consumers (525 ± 5.17 mg/d and 294 ± 1.98; p < 0.0001. Protein food (meat, poultry and seafood consumption also increased usual choline intakes compared to non-consumers (345 ± 2.21 mg/day and 235 ± 8.81; p < 0.0001 to a lesser degree, but did not result in substantial increases in the percent of individuals meeting the AI. No subpopulation exceeded the UL for choline. This research illustrates that it is extremely difficult to achieve the AI for choline without consuming eggs or taking a dietary supplement.

Geoengineering, Climate Harm, and Business as Usual

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Jankunis, F. J.; Peacock, K.

2014-12-01

We define geoengineering (GE) as the intentional use of technology to change the planet's climate. Many people believe GE is different in kind rather than degree from any other organized activity in human history. In fact, humans caused changes in the planet's climate long before the industrial age, and all organisms engineer their environments directly or indirectly. The relevant difference between this cumulative and generally inadvertent activity and GE is the presence of intention. Now that science has revealed the extent to which humans can change the climate, however, even the continuance of Business as Usual (BAU) is, in effect, a form of intentional GE, albeit one that will cause significant climate harm, defined as effects such as sea level rise that will impact human well-being. But as with all forms of engineering, the devil is in the details: what forms of GE should be tried first? Some methods, such as large-scale afforestation, are low risk but have long-term payoffs; others, such as aerosol injection into the stratosphere, could help buy time in a warming crisis but have unknown side-effects and little long-term future. Climate change is a world-wide, inter-generational tragedy of the commons. Rational choice theory, the spatial and temporal extension of the problem, poorly fitted moral frameworks, and political maneuvering are all factors that inhibit solutions to the climate tragedy of the commons. The longer that such factors are allowed to dominate decision-making (or the lack thereof) the more likely it is that humanity will be forced to resort to riskier and more drastic forms of GE. We argue that this fact brings an additional measure of urgency to the search for ways to engineer the climate differently so as to avoid climate harm in the most lasting and least risky way.

Assessing usual dietary intake in complex sample design surveys: the National Dietary Survey Evaluación del consumo alimentario usual en investigaciones con muestras complejas: pesquisa nacional de alimentación Avaliação do consumo alimentar usual em pesquisas com amostras complexas: Inquérito Nacional de Alimentação

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Washington Leite Junger

2013-02-01

Full Text Available The National Cancer Institute (NCI method allows the distributions of usual intake of nutrients and foods to be estimated. This method can be used in complex surveys. However, the user must perform additional calculations, such as balanced repeated replication (BRR, in order to obtain standard errors and confidence intervals for the percentiles and mean from the distribution of usual intake. The objective is to highlight adaptations of the NCI method using data from the National Dietary Survey. The application of the NCI method was exemplified analyzing the total energy (kcal and fruit (g intake, comparing estimations of mean and standard deviation that were based on the complex design of the Brazilian survey with those assuming simple random sample. Although means point estimates were similar, estimates of standard error using the complex design increased by up to 60% compared to simple random sample. Thus, for valid estimates of food and energy intake for the population, all of the sampling characteristics of the surveys should be taken into account because when these characteristics are neglected, statistical analysis may produce underestimated standard errors that would compromise the results and the conclusions of the survey.El objetivo del estudio fue indicar una adaptación del método del Instituto Nacional del Cáncer (NCI, utilizándose datos de la pesquisa nacional de alimentación. Ese método estima la distribución del consumo usual de nutrientes y alimentos y puede ser aplicado en estudios con muestra compleja. Mientras, son necesarios cálculos adicionales, tales como la replicación repetida balanceada, a fin de obtener los errores estándar e intervalos de confianza para los percentiles y el promedio de la distribución de consumo usual. La aplicación de este método fue ejemplificado analizando el total de energía (Kcal y frutas (gr, comparando las estimaciones de los promedios y sus respectivos errores estándar obtenidos

Letalidade e complicações da cirurgia de revascularização miocárdica no Rio de Janeiro, de 1999 a 2003 Letalidad y complicaciones de la cirugía de revascularización miocárdica en el Rio de Janeiro, de 1999 a 2003 Mortality and complications of coronary artery bypass grafting in Rio de Janeiro, from 1999 to 2003

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Thaís Mendonça Lips de Oliveira

2010-09-01

sobreviventes as complicações foram mais frequentes do que o esperado.FUNDAMENTO: La cirugía de revascularización del miocardio (RVM es un procedimiento consolidado en el tratamiento de las enfermedades isquémicas del corazón (EIC, requiriendo constante evaluación. OBJETIVO: Evaluar la calidad en la RVM, a través de las características clínicas de los pacientes, tasas de letalidad hasta un año tras el alta hospitalaria, causas básicas de muerte y complicaciones posoperatorias, en cuatro hospitales públicos del Municipio del Rio de Janeiro, de 1999 a 2003. MÉTODOS: Se seleccionaron aleatoriamente prontuarios de pacientes sometidos a RVM. Informaciones sobre características clínicas, complicaciones y óbitos se recolectaron retrospectivamente de los prontuarios y de las declaraciones de defunción. Las tasas de letalidad se estimaron en los períodos intrahospitalarios y hasta un año posalta. RESULTADOS: Las prevalencias de las características preoperatorias fueron: mujer: Un 31,9%, hipertensión arterial: un 90,7%, dislipidemia: un 67,4%, diabetes: un 37,2%, aquismo: un 22,9%, obesidad: un 18,3%, enfermedad pulmonar obstructiva crónica: un 8,2%, accidente vascular encefálico previo: un 5,8%, arteriopatía extracardíaca: un 12,7%, elevación de la creatinina: un 4,1%, estado crítico preoperatorio: un 3,7%, infarto agudo de miocardio reciente: un 23,5%, angina inestable: un 40,8%, síndrome coronario agudo: el 50%, RVM previa: un 2,4%, disfunción ventricular izquierda: un 27,3%, lesión de tronco da coronaria izquierda: un 3,9% y asociada con lesión en otro sistema: un 19,8%. Las tasas de letalidad en los hospitales variaron del 7% a un 14,3% en el período intrahospitalario y de un 8,5% a un 20,2% hasta un año pos la dada de alta. Las EIC representaron las causas de más del 80% de los óbitos. El grupo de complicaciones posoperatorias más frecuente fue de hemorragia o bajo débito posprocedimiento. Sesenta por ciento de las muertes presentaron cinco o m

Cost-effectiveness of a specialized atrial fibrillation clinic vs. usual care in patients with atrial fibrillation

NARCIS (Netherlands)

Hendriks, Jeroen; Tomini, Florian; van Asselt, Thea; Crijns, Harry; Vrijhoef, Hubertus

AIMS: A recent randomized controlled trial demonstrated significant reductions in cardiovascular hospitalizations and deaths with a nurse-led integrated chronic care approach in patients with atrial fibrillation (AF) compared with usual care. The aim of the present study is to assess

Cost-effectiveness of a specialized atrial fibrillation clinic vs. usual care in patients with atrial fibrillation

NARCIS (Netherlands)

Hendriks, J.M.L.; Tomini, F.; van Asselt, A.D.I.; Crijns, H.J.G.M.; Vrijhoef, H.J.M.

2013-01-01

Aims A recent randomized controlled trial demonstrated significant reductions in cardiovascular hospitalizations and deaths with a nurse-led integrated chronic care approach in patients with atrial fibrillation (AF) compared with usual care. The aim of the present study is to assess

Incidência de complicações pulmonares na cirurgia de revascularização do miocárdio Incidencia de complicaciones pulmonares en la cirugía de revascularización del miocardio Incidence of pulmonary complications in myocardial revascularization

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Leila D. N Ortiz

2010-10-01

tanto, las complicaciones pulmonares después del abordaje quirúrgico aun son frecuentes, predisponiendo al paciente a un mayor tiempo de internación o al óbito. OBJETIVO: Describir la incidencia de complicaciones pulmonares y identificar su asociación con tiempos de circulación extracorporal (CEC; cirugía e isquemia; número de injertos; localización y tiempo de drenajes después de cirugía de revascularización del miocardio (CRM. MÉTODOS: En esta cohorte contemporánea, fueron estudiados 202 pacientes en hospital universitario de referencia para cardiología en el sur del Brasil, sometidos a la CRM electiva con puente safena y arteria mamaria interna con CEC, en el período de abril/2006 a noviembre/2007. Los desenlaces considerados fueron: tiempo de ventilación mecánica; surgimiento de neumonía; atelectasia; derrame pleural; hora de la retirada y localización de los drenajes; y tiempo de internación. RESULTADOS: Se observó algún tipo de complicación pulmonar en 90 de los 202 pacientes. La frecuencia de derrame pleural fue de 84% y la de atelectasia fue de 65%. Presentaron asociación con complicaciones pulmonares los tiempos de CEC (p = 0,003, quirúrgico (p = 0,040e isquemia (p = 0,001; el tiempo de permanencia de drenajes (p = 0,050 y la localización pleural de los drenajes (p = 0,033, además de edad (p = 0,001, fracción de eyección (p = 0,010, diagnóstico de asma (p = 0,047 y examen radiológico de tórax pre-operatorio anormal (p = 0,029. CONCLUSIÓN: Variables relacionadas a la complejidad del acto quirúrgico y comorbilidades pre-existentes están asociadas a una alta incidencia de complicaciones pulmonares en el post-operatorio. Esos datos refuerzan la importancia de la evaluación clínica peri-operatoria para detección precoz de complicación respiratoria después de CRM.BACKGROUND: Despite the increasingly careful attempts to reduce perioperative risks, pulmonary complications following surgery are still very common, leading to

Estimating usual intakes mainly affects the micronutrient distribution among infants, toddlers and pre-schoolers from the 2012 Mexican National Health and Nutrition Survey.

Science.gov (United States)

Piernas, Carmen; Miles, Donna R; Deming, Denise M; Reidy, Kathleen C; Popkin, Barry M

2016-04-01

To compare estimates from one day with usual intake estimates to evaluate how the adjustment for within-person variability affected nutrient intake and adequacy in Mexican children. In order to obtain usual nutrient intakes, the National Cancer Institute's method was used to correct the first 24 h dietary recall collected in the entire sample (n 2045) with a second 24 h recall collected in a sub-sample (n 178). We computed estimates of one-day and usual intakes of total energy, fat, Fe, Zn and Na. 2012 Mexican National Health and Nutrition Survey. A total of 2045 children were included: 0-5·9 months old (n 182), 6-11·9 months old (n 228), 12-23·9 months old (n 537) and 24-47·9 months old (n 1098). From these, 178 provided an additional dietary recall. Although we found small or no differences in energy intake (kJ/d and kcal/d) between one-day v. usual intake means, the prevalence of inadequate and excessive energy intake decreased somewhat when using measures of usual intake relative to one day. Mean fat intake (g/d) was not different between one-day and usual intake among children >6 months old, but the prevalence of inadequate and excessive fat intake was overestimated among toddlers and pre-schoolers when using one-day intake (P6 months. There was overall low variability in energy and fat intakes but higher for micronutrients. Because the usual intake distributions are narrower, the prevalence of inadequate/excessive intakes may be biased when estimating nutrient adequacy if one day of data is used.

Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension.

Science.gov (United States)

Rothwell, Peter M

2010-03-13

Although hypertension is the most prevalent treatable vascular risk factor, how it causes end-organ damage and vascular events is poorly understood. Yet, a widespread belief exists that underlying usual blood pressure can alone account for all blood-pressure-related risk of vascular events and for the benefits of antihypertensive drugs, and this notion has come to underpin all major clinical guidelines on diagnosis and treatment of hypertension. Other potentially informative measures, such as variability in clinic blood pressure or maximum blood pressure reached, have been neglected, and effects of antihypertensive drugs on such measures are largely unknown. Clinical guidelines recommend that episodic hypertension is not treated, and the potential risks of residual variability in blood pressure in treated hypertensive patients have been ignored. This Review discusses shortcomings of the usual blood-pressure hypothesis, provides background to accompanying reports on the importance of blood-pressure variability in prediction of risk of vascular events and in accounting for benefits of antihypertensive drugs, and draws attention to clinical implications and directions for future research. Copyright 2010 Elsevier Ltd. All rights reserved.

Avoidance of Vitamin K-Rich Foods Is Common among Warfarin Users and Translates into Lower Usual Vitamin K Intakes.

Science.gov (United States)

Leblanc, Cristina; Dubé, Marie-Pierre; Presse, Nancy; Dumas, Stéphanie; Nguyen, Mimosa; Rouleau-Mailloux, Étienne; Perreault, Sylvie; Ferland, Guylaine

2016-06-01

Warfarin users should aim for stable daily vitamin K intakes. However, some studies report that patients are often advised to avoid eating green vegetables. Whether this advice impacts vitamin K intakes is unknown. Our aim was to describe the nature and sources of vitamin K-related dietary recommendations that patients received at the initiation of warfarin therapy, assess their adherence to these recommendations, and examine whether usual vitamin K intakes vary according to these recommendations. We conducted a retrospective cohort study with patients enrolled in the Québec Warfarin Cohort Study. Patients were asked to report dietary recommendations they had received at warfarin initiation and their adherence to these recommendations. Usual vitamin K intakes were assessed using a validated semi-quantitative food frequency questionnaire. Three hundred seventeen patients aged 36 to 97 years who initiated warfarin between 2011 and 2012 and were treated for 12 months or longer with a target international normalized ratio range of 2.0 to 3.0 or 2.5 to 3.5. Patients were classified according to vitamin K-related recommendations reported: limit or avoid vitamin K-rich foods; aim for stable consumption of vitamin K-rich foods; or no vitamin K-related advice. A one-way analysis of covariance was used to compare mean usual vitamin K intakes between patients after adjustment for covariates. Most patients (68%) reported being advised to limit or avoid vitamin K-rich foods, particularly green vegetables, 10% reported being advised to aim for stable consumption of vitamin K-rich foods, and 22% did not recall receiving any vitamin K-related recommendation. Mean usual vitamin K intakes of patients adhering to the recommendation to limit or avoid vitamin K-rich foods was 35% to 46% lower than those of other patients (Pvitamin K-rich foods, which translated into lower usual vitamin K intakes. Copyright © 2016 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All

Interrupciones de embarazo en adolescentes. Problemática social y humanística Abortion in adolescence, a social and humanistic problem

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Alejandro Fonseca León

2009-08-01

Full Text Available Se realizó un estudio observacional, analítico y transversal para evaluar el comportamiento del aborto en adolescentes y su significado como problema social y humanístico en el Hospital Materno Infantil Ana Betancourt de Mora de la ciudad de Camagüey desde el 2001 al 2008. De un universo constituido por 31 876 interrupciones de embarazos, 9 952 fueron en adolescentes las cuales representan el 31,2 por ciento constituyendo la muestra del estudio. La edad de la primera relación sexual fue entre los 14 y 17 años. El factor de riesgo más frecuente fue la infección vaginal en 6 478 casos. El olvido y el exceso de confianza los motivos para no usar métodos anticonceptivos en 5 639 jóvenes. Las complicaciones más usuales fueron la endometritis y los restos ovulares con 265 y 73 respectivamente. Las fuentes de educación sexual suelen ser los padres, amigos y los programas escolares. La prevención del aborto en la adolescencia constituye un pilar importante en la disminución de sus complicaciones como problema social y biológico.We carried out a cross-sectional, analytic, observational study to assess abortion behavior in adolescents and its significance as a social and humanistic problem at Camagüey’s Ana Betancourt de Mora Maternal Hospital from 2001 to 2008. Out of a universe comprised by 31 876 abortions, we selected a sample of 9 952 cases of adolescents having firstly experienced sex at ages 14 to 17, representing 31, 2 percent. Vaginitis was the most frequent risk factor with 6 478 cases. Oversight and overconfidence motivated lack of contraception use in 5 639 cases. Endometritis and ovular remnants were the most common complications with 265 and 73, respectively. Usually, parents, friends, and school programs are the sources of sex education. Prevention is an important pillar to reduce social and biological complications.

Manual acupuncture plus usual care versus usual care alone in the treatment of endometriosis-related chronic pelvic pain: study protocol for a randomised controlled feasibility study.

Science.gov (United States)

Armour, Mike; Smith, Caroline A; Schabrun, Siobhan; Steiner, Genevieve Z; Zhu, Xiaoshu; Lawson, Kenny; Song, Jing

2018-01-01

Endometriosis is the most common cause of chronic pelvic pain worldwide. Non-surgical treatments are effective for only 30-50% of women and have a significant side effect burden that leads to high discontinuation rates. Surgery can be effective but is expensive and invasive, and symptoms tend to recur within 5 years. There is early evidence that acupuncture may be effective in treating endometriosis-related chronic pelvic pain, showing clinically significant analgesia. Both levels of inflammation and pain processing have been shown to be altered in women with chronic pelvic pain. Acupuncture has been shown to reduce inflammation and change central pain processing in other conditions, but research on women with endometriosis is currently lacking. The aim of this feasibility study is to provide data on recruitment rates, retention, appropriateness of outcome measures, minimal clinically important difference in numeric rated scales for pain and the potential effect of acupuncture on pain processing and markers of inflammation in endometriosis-related CPP. We will include women aged 18-45 years with a diagnosis of endometriosis via laparoscopy in the past 5 years. A total of 30 participants will be recruited and randomly allocated in a 1:1 ratio to receive acupuncture or usual care. Women in the acupuncture group will receive two 45-min treatment sessions per week for 8 weeks (total of 16 sessions). Women in the usual care group will continue with their current treatment regimen. The primary feasibility outcomes are recruitment rates, retention rates and the safety and acceptability of the intervention; secondary patient-centred outcomes include a change in 0-10 daily pelvic pain ratings, the Endometriosis Health Profile 30 (EHP-30) and changes in conditioned pain modulation, resting and task-related EEG activity and inflammatory markers. Analyses will be performed blind to group allocation. This is a two-armed, assessor blind, randomised controlled feasibility

Early rehabilitation after total knee replacement surgery: a multicenter, noninferiority, randomized clinical trial comparing a home exercise program with usual outpatient care.

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Han, Annie S Y; Nairn, Lillias; Harmer, Alison R; Crosbie, Jack; March, Lyn; Parker, David; Crawford, Ross; Fransen, Marlene

2015-02-01

To determine, at 6 weeks postsurgery, if a monitored home exercise program (HEP) is not inferior to usual care rehabilitation for patients undergoing primary unilateral total knee replacement (TKR) surgery for osteoarthritis. We conducted a multicenter, randomized clinical trial. Patients ages 45-75 years were allocated at the time of hospital discharge to usual care rehabilitation (n = 196) or the HEP (n = 194). Outcomes assessed 6 weeks after surgery included the Western Ontario and McMaster Universities Osteoarthritis Index pain and physical function subscales, knee range of motion, and the 50-foot walk time. The upper bound of the 95% confidence interval (95% CI) mean difference favoring usual care was used to determine noninferiority. At 6 weeks after surgery there were no significant differences between usual care and HEP, respectively, for pain (7.4 and 7.2; 95% CI mean difference [MD] -0.7, 0.9), physical function (22.5 and 22.4; 95% CI MD -2.5, 2.6), knee flexion (96° and 97°; 95% CI MD -4°, 2°), knee extension (-7° and -6°; 95% CI MD -2°, 1°), or the 50-foot walk time (12.9 and 12.9 seconds; 95% CI MD -0.8, 0.7 seconds). At 6 weeks, 18 patients (9%) allocated to usual care and 11 (6%) to the HEP did not achieve 80° knee flexion. There was no difference between the treatment allocations in the number of hospital readmissions. The HEP was not inferior to usual care as an early rehabilitation protocol after primary TKR. Copyright © 2015 by the American College of Rheumatology.

Postnatal medical complications and behavioral inhibition in the offspring

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Eva Moehler

2007-01-01

Full Text Available Se ha sugerido que la inhibición conductual representa un indicador temperamental importante en la predicción del desarrollo emocional del niño, del adolescente e incluso del adulto. En consonancia, el objetivo de este estudio experimental fue investigar el impacto de las complicaciones pre-, peri-, y postnatales sobre la inhibición conductual. Se midió la inhibición conductual de niños que empiezan a andar mediante un procedimiento estandarizado de laboratorio en 101 niños con 14 meses de edad postnatal. Las complicaciones médicas fueron evaluadas a través de las Rutter Scales, tomadas por el examinador de registros médicos de las pacientes internadas, y de documentaciones sobre el embarazo en el caso de las no hospitalizadas. Los criterios de inclusión fueron un peso al nacer por encima de 2500g, 37 semanas o más de gestación y puntuaciones APGAR por encima de 7. Las complicaciones postnatales evaluadas abarcaron ictericia fisiológica, trastornos de adaptación, enfermedades contagiosas, entre otras. Las complicaciones médicas en el periodo postnatal pero no en el pre- o perinatal resultaron aumentar significativamente la inhibición conductual a los 14 meses de edad postnatal. Los esfuerzos preventivos orientados al preescolar y al desarrollo emocional del niño deberían tomar en consideración que los niños con complicaciones neonatal parecen tener un mayor riesgo de presentar trastornos de internalización en su vida posteriormente.

Complicaciones posoperatorias y mortalidad en pacientes operados por endocarditis infecciosa Postoperative complications and mortality observed in patients operated on from infective endocarditis

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Joaquín Gómez Armando Gonga

2013-03-01

Full Text Available Objetivo: describir las causas de morbilidad y mortalidad perioperatorias en los pacientes afectos de endocarditis infecciosa activa y significar cómo pueden ser disminuidas. Métodos: se realizó un estudio retrospectivo de las complicaciones posoperatorias y mortalidad en 139 pacientes operados por presentar endocarditis infecciosa en un período de 16 años. Se efectuaron 147 operaciones a los 139 pacientes de las cuales 83 (57,1 % fueron electivas y 64 (42,9 % fueron de urgencia. El 24 % de los pacientes fueron remitidos de otros centros en los que habían sido sometidos a tratamiento médico no exitoso por más de 4 semanas. Resultados: las operaciones efectuadas fueron: Sustituciones valvulares aórticas,mitrales y tricuspídeas 75 (41,1 %, extracción de electrodos de marcapasos o desfibriladores automáticos implantables del ventrículo derecho 57 (41 % , otras operaciones en número de 7 (4,9 %y 8 reintervenciones. La complicación más frecuente fue la sepsis generalizada (10,07 % pObjective: To describe the causes of perioperative morbidity and mortality of patients suffering active infectious endocarditis and to explain how both aspects can be reduced. Methods: A retrospective study of postoperative complications and mortality observed in 139 patients operated on from infectious endocarditis in 16 years. One hundred forty seven surgeries were performed, of which 83 (57.1 % were elective and 64 (42.9 % were emergency surgeries. In this group, 24 % had been referred from other medical centers where they had been unsuccessfully treated for 4 weeks. Results: The performed surgeries comprised 15 aortic, mitral and tricuspid valve replacements, 57 (41 % removals of pacemaker electrodes or of implanted automatic defibrillators in the right ventricle, seven other types of surgeries and 8 reoperations. The most frequent complication was generalized sepsis ((10.07 % p< 0.01, followed by the low heart output and postoperative bleeding. The

Steam injections wells: topics to consider in casing design of steam injection wells; Revestimento para pocos de vapor

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Conceicao, Antonio Carlos Farias [PETROBRAS, Recife, PE (Brazil). Gerencia de Perfuracao do Nordeste. Div. de Operacoes

1994-07-01

Steam injection is one of the processes used to increase production from very viscous oil reservoirs. A well is completed at a temperature of about 110 deg F and during steam injection that temperature varies around 600 deg F. Strain or breakdowns may occur to the casing, due to the critical conditions generated by the change of temperature. The usual casing design methods, do not take into account special environmental conditions, such as those which exist for steam injection. From the results of this study we come up to the conclusion that casing grade K-55, heavy weight with premium connections, without pre-stressing and adequately heated, is the best option for steam injection well completion for most of the fields in Brazil. (author)

PROBLEMÁTICAS POCO EXPLORADAS DE LOS JÓVENES EN EL PROCESO DE LA TRANSICIÓN DEMOGRÁFICA. EL CASO DE LA FRONTERA NORTE DE MÉXICO

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Humberto González Galbán

2012-12-01

Full Text Available A pesar de los importantes cuestionamientos que han sido realizados a la “Teoría” de la Transición Demográfica, ésta continúa representando el marco interpretativo más usualmente utilizado por los investigadores de la temática poblacional, los cuales tratan de enriquecerla con lo “observado” en diferentes contextos, buscando las regularidades de las problemáticas poblacionales manifestadas en los mismos con lo acontecido en otras regiones, generalmente de países desarrollados. En tal sentido en el presente artículo se analizan aspectos demográficos o sociales poco explorados, en el marco de dicha teoría, que no obstante, pueden haber tenido un peso importante en la explicación de los cambios poblacionales tales como la  sexualidad y la nupcialidad y asociado a ello el comportamiento reproductivo de las mujeres así como las relaciones de violencia en el marco de la familia y la afectación de todo ello a grupos vulnerables como son los jóvenes. El interés de análisis se centra en los aspectos referidos, considerando como  contexto espacial a los estados limítrofes con los Estados Unidos, en los que los indicadores sociodemográficos sugieren un relativamente avanzado proceso de transición demográfica, lo que pudiera estar vinculado a la influencia norteamericana, escenario que es complejizado por una intensa corriente migratoria desde otras partes del país hacia la región del norte de México.

A self-managed single exercise programme versus usual physiotherapy treatment for rotator cuff tendinopathy: a randomised controlled trial (the SELF study).

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Littlewood, Chris; Bateman, Marcus; Brown, Kim; Bury, Julie; Mawson, Sue; May, Stephen; Walters, Stephen J

2016-07-01

To evaluate the clinical effectiveness of a self-managed single exercise programme versus usual physiotherapy treatment for rotator cuff tendinopathy. Multi-centre pragmatic unblinded parallel group randomised controlled trial. UK National Health Service. Patients with a clinical diagnosis of rotator cuff tendinopathy. The intervention was a programme of self-managed exercise prescribed by a physiotherapist in relation to the most symptomatic shoulder movement. The control group received usual physiotherapy treatment. The primary outcome measure was the Shoulder Pain & Disability Index (SPADI) at three months. Secondary outcomes included the SPADI at six and twelve months. A total of 86 patients (self-managed loaded exercise n=42; usual physiotherapy n=44) were randomised. Twenty-six patients were excluded from the analysis because of lack of primary outcome data at the 3 months follow-up, leaving 60 (n=27; n=33) patients for intention to treat analysis. For the primary outcome, the mean SPADI score at three months was 32.4 (SD 20.2) for the self-managed group, and 30.7 (SD 19.7) for the usual physiotherapy treatment group; mean difference adjusted for baseline score: 3.2 (95% Confidence interval -6.0 to +12.4 P = 0.49).By six and twelve months there remained no significant difference between the groups. This study does not provide sufficient evidence of superiority of one intervention over the other in the short-, mid- or long-term and hence a self-management programme based around a single exercise appears comparable to usual physiotherapy treatment. © The Author(s) 2015.

Comparison of group-based outpatient physiotherapy with usual care after total knee replacement: a feasibility study for a randomized controlled trial.

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Artz, Neil; Dixon, Samantha; Wylde, Vikki; Marques, Elsa; Beswick, Andrew D; Lenguerrand, Erik; Blom, Ashley W; Gooberman-Hill, Rachael

2017-04-01

To evaluate the feasibility of conducting a randomized controlled trial comparing group-based outpatient physiotherapy with usual care in patients following total knee replacement. A feasibility study for a randomized controlled trial. One secondary-care hospital orthopaedic centre, Bristol, UK. A total of 46 participants undergoing primary total knee replacement. The intervention group were offered six group-based exercise sessions after surgery. The usual care group received standard postoperative care. Participants were not blinded to group allocation. Feasibility was assessed by recruitment, reasons for non-participation, attendance, and completion rates of study questionnaires that included the Lower Extremity Functional Scale and Knee Injury and Osteoarthritis Outcome Score. Recruitment rate was 37%. Five patients withdrew or were no longer eligible to participate. Intervention attendance was high (73%) and 84% of group participants reported they were 'very satisfied' with the exercises. Return of study questionnaires at six months was lower in the usual care (75%) than in the intervention group (100%). Mean (standard deviation) Lower Extremity Functional Scale scores at six months were 45.0 (20.8) in the usual care and 57.8 (15.2) in the intervention groups. Recruitment and retention of participants in this feasibility study was good. Group-based physiotherapy was acceptable to participants. Questionnaire return rates were lower in the usual care group, but might be enhanced by telephone follow-up. The Lower Extremity Functional Scale had high responsiveness and completion rates. Using this outcome measure, 256 participants would be required in a full-scale randomized controlled trial.

Evolución y letalidad por endocarditis infecciosa en pacientes atendidos en el Hospital Nacional Dos de Mayo

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Evelyn Sánchez

2006-06-01

Full Text Available Objetivo: Evaluar la evolución y letalidad de los pacientes portadores de endocarditis infecciosa, así como la presencia de complicaciones y la influencia de estas sobre la mortalidad. Diseño: Estudio longitudinal no concurrente. Lugar: Servicio de cardiología del Hospital 2 de Mayo, hospital universitario. Pacientes: Pacientes con diagnóstico de endocarditis infecciosa. Intervenciones: Se revisó las historias clínicas de los pacientes con diagnóstico de endocarditis infecciosa atendidos entre junio de 1999 y junio de 2005. Se evaluó los criterios clínicos, de laboratorio y ecocardiográficos (criterios de Duke empleados en el diagnóstico. Para el análisis estadístico, se realizó el análisis descriptivo y comparativo con el empleo de las pruebas de Fisher y t de Student y la comparación de las curvas de Kaplan Meier, para evaluar la supervivencia a través de la prueba de rango logarítmico. Principales medidas de resultados: Evaluación de supervivencia: Complicaciones y mortalidad en pacientes en endocarditis infecciosa. Resultados: Se estudió 75 pacientes, la edad promedio fue 42,1±20,4 años, 66,7% del sexo masculino. El 93,3% tenía cardiopatía de base. La presentación clínica incluyó insuficiencia cardiaca congestiva (73,3%, encefalopatía (17,3% y fenómenos embólicos (50,6%. Se evaluó la evolución de los parámetros de laboratorio, evidenciándose deterioro de la función renal. El ecocardiograma evidenció presencia de vegetaciones en 97,3% y complicaciones, como rotura valvar (8%, abscesos valvares (4%. Durante la evolución, se sometió a cirugía a 14,7%. La letalidad general fue 14,7%, la cual estuvo influenciada por el número de complicaciones, en particular las complicaciones sépticas y renales, que impactaron de igual manera en la probabilidad de supervivencia de estos pacientes. Conclusiones: Se registró una letalidad general de 14,7%. La probabilidad de supervivencia se vio afectada

Conocimientos usuales de los pacientes diabéticos en los estudiantes de medicina del occidente de México Usual knowledge of medical students form Western Mexico on diabetic patients

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Rafael Bustos Saldaña

2007-12-01

Full Text Available Objetivo: Identificar el conocimiento que presentan los estudiantes de Medicina acerca de los conceptos usuales de los pacientes diabéticos sobre su enfermedad. Material y métodos: Estudio descriptivo en 275 estudiantes de Medicina del Centro Universitario del Sur de la Universidad de Guadalajara. Se seleccionó la muestra en forma aleatoria a los alumnos inscritos en el calendario 2006 A, para aplicarles el instrumento Diabetes Knowledge Questionnaire (24. Se utilizó el programa de estadística EPI INFO 2000, se tomó una significancia estadística Objective: To identify the knowledge that presents Medicine students about the usual concepts of the diabetic patients on their disease. Material and Methods: Cross sectional study in 275 Medicine alumni of the University Center of the South of the University of Guadalajara. Sample was selected in randomized form in the students enrolled in calendar 2006 A, in order to apply them instrument Diabetes Knowledge Questionnaire (24. The statistic program was used EPI INFO 2000, a statistical significance was taken <0.05. Results: Students age: 20.03±1.9 years. The total average of guessed right answers was: 17.56± 3.24, students of 7º and 8º. cycle presented 19.53 ±2.15 and 19.75±1.92 right answers. As far as Basic knowledge of the disease 75,82% answered the reagents suitably, in glycemic control 70.7% and prevention measures and complications 71.9%. Conclusions: knowledge in Medicine students as far as the concepts that must have the diabetic patients on their disease increases in significant form as soon as it increases the semesters of study, the first scholastic cycles have the tendency to be similar to the population in regional diabetic patients.

El control de la diabetes mellitus y sus complicaciones en Medellín, Colombia, 2001-2003 Controlling diabetes mellitus and its complications in Medellín, Colombia, 2001-2003

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Alberto Villegas Perrasse

2006-12-01

Full Text Available OBJETIVOS: Identificar las principales características sociodemográficas, clínicas y conductuales de los pacientes que participaban en los programas de atención al diabético en Medellín, Colombia, y evaluar el cumplimiento de las metas de control metabólico y de los estándares de control en el diabético. MÉTODOS: Se realizó un estudio descriptivo transversal mediante el análisis de las historias clínicas de todos los pacientes que asistían a los programas de atención al diabético desde al menos 6 meses en nueve instituciones de salud entre enero de 2001 y diciembre de 2003. Se tomaron datos sociodemográficos (edad y sexo, clínicos (tiempo de evolución de la enfermedad, tipo y tratamiento de la diabetes y enfermedades concurrentes y su tratamiento, sobre los hábitos de vida (práctica de ejercicios físicos, hábito de fumar y consumo de azúcar y grasas y sobre las complicaciones crónicas y los resultados de las pruebas de laboratorio del último año. Todos los datos confusos o faltantes se registraron como ausentes. RESULTADOS: De las 3 583 historias clínicas evaluadas, se logró conocer el tipo de diabetes que padecían 3 554 pacientes, de ellos 95,1% correspondieron a pacientes con diabetes tipo 2. En general, 56,9% (intervalo de confianza de 95% [IC95%]: 55,2 a 58,6% de los pacientes realizaban ejercicios periódicos; 15,1% (IC95%: 13,9 a 16,3% aún fumaba en el momento del corte, 17,7% (IC95%: 16,4 a 19,0% había dejado de fumar y 67,2% (IC95%: 65,6 a 68,8% nunca había fumado. En total, 21,0% (IC95%: 19,6 a 22,5% de los pacientes consumía azúcar regularmente, mientras 24,8% (IC95%: 23,3 a 26,3% consumía grasas y solo 19,5% (IC95%: 17,8 a 21,3% realizaba automonitoreo de la glucemia con una frecuencia semanal o mayor. La prevalencia general de hipertensión arterial fue de 68,8% y de 98,2% de dislipidemia en los diabéticos tipo 2. El promedio general del índice de masa corporal fue de 28,0 kg/m² (IC95%: 27,8 a

El coste de la diabetes tipo 2 en España: El estudio CODE-2 The cost of type 2 diabetes in Spain: the CODE-2 study

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M. Mata

2002-12-01

Full Text Available Objetivo: Estimar el coste de la atención sanitaria al paciente diabético tipo 2, diferenciando el gasto derivado del control de la enfermedad, de la atención de sus complicaciones y de otros costes directos asociados. Métodos: Recogida retrospectiva del consumo de recursos a partir de la historia clínica y la entrevista personal en 29 centros de atención primaria de todo el territorio nacional de una muestra de pacientes seleccionados de forma aleatoria a partir del registro de diabéticos de cada centro. Resultados: Se evaluó a 1.004 pacientes (561 mujeres con una media de edad de 67,42 años y una media de evolución de la enfermedad de 10,07 años. El 50,9% no presentaba complicaciones, el 17,7% sólo macrovasculares, el 19,5% sólo microvasculares y el 11,9% ambas. El coste anual sanitario por paciente fue de 1.305,15 euros. De este coste el 28,6% (373,27 euros estaba relacionado directamente con el control de la diabetes, el 30,51% (398,20 euros con sus complicaciones y el 40,89% (533,68 euros no estaba relacionado. El coste medio de un paciente sin complicaciones fue de 883 euros frente a 1.403 de un paciente con complicaciones microvasculares, 2.022 cuando existían complicaciones macrovasculares y 2.133 cuando coexistían ambos tipos de complicaciones. Conclusiones: El elevado coste del tratamiento de la diabetes tipo 2 y sus complicaciones, sugiere la posibilidad de que la mejora del control de la enfermedad pueda no sólo mejorar la supervivencia y la calidad de vida, sino reducir los costes asociados con las complicaciones crónicas.Objective: To estimate the cost of providing health care to patients with type 2 diabetes, by differentiating costs of the disease, costs of complications, and other unrelated health costs. Methods: Data on resource use were retrospectively collected from medical records and personal interviews in 29 primary health care centers in Spain. Patients were randomly selected from each center's diabetes

Effects of Structured Versus Usual Care on Renal Endpoint in Type 2 Diabetes: The SURE Study

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Chan, Juliana C.; So, Wing-Yee; Yeung, Chun-Yip; Ko, Gary T.; Lau, Ip-Tim; Tsang, Man-Wo; Lau, Kam-Piu; Siu, Sing-Chung; Li, June K.; Yeung, Vincent T.; Leung, Wilson Y.; Tong, Peter C.

2009-01-01

OBJECTIVE Multifaceted care has been shown to reduce mortality and complications in type 2 diabetes. We hypothesized that structured care would reduce renal complications in type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 205 Chinese type 2 diabetic patients from nine public hospitals who had plasma creatinine levels of 150–350 μmol/l were randomly assigned to receive structured care (n = 104) or usual care (n = 101) for 2 years. The structured care group was managed according to a prespecified protocol with the following treatment goals: blood pressure triglyceride 500 μmol/l or dialysis). RESULTS Of these 205 patients (mean ± SD age 65 ± 7.2 years; disease duration 14 ± 7.9 years), the structured care group achieved better control than the usual care group (diastolic blood pressure 68 ± 12 vs. 71 ± 12 mmHg, respectively, P = 0.02; A1C 7.3 ± 1.3 vs. 8.0 ± 1.6%, P structured care (23.1%, n = 24) and usual care (23.8%, n = 24; NS) groups had similar end points, but more patients in the structured care group attained ≥3 treatment goals (61%, n = 63, vs. 28%, n = 28; P < 0.001). Patients who attained ≥3 treatment targets (n = 91) had reduced risk of the primary end point (14 vs. 34; relative risk 0.43 [95% CI 0.21–0.86] compared with that of those who attained ≤2 targets (n = 114). CONCLUSIONS Attainment of multiple treatment targets reduced the renal end point and death in type 2 diabetes. In addition to protocol, audits and feedback are needed to improve outcomes. PMID:19460913

Effect of Endobronchial Coils vs Usual Care on Exercise Tolerance in Patients With Severe Emphysema: The RENEW Randomized Clinical Trial.

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Sciurba, Frank C; Criner, Gerard J; Strange, Charlie; Shah, Pallav L; Michaud, Gaetane; Connolly, Timothy A; Deslée, Gaëtan; Tillis, William P; Delage, Antoine; Marquette, Charles-Hugo; Krishna, Ganesh; Kalhan, Ravi; Ferguson, J Scott; Jantz, Michael; Maldonado, Fabien; McKenna, Robert; Majid, Adnan; Rai, Navdeep; Gay, Steven; Dransfield, Mark T; Angel, Luis; Maxfield, Roger; Herth, Felix J F; Wahidi, Momen M; Mehta, Atul; Slebos, Dirk-Jan

Preliminary clinical trials have demonstrated that endobronchial coils compress emphysematous lung tissue and may improve lung function, exercise tolerance, and symptoms in patients with emphysema and severe lung hyperinflation. To determine the effectiveness and safety of endobronchial coil treatment. Randomized clinical trial conducted among 315 patients with emphysema and severe air trapping recruited from 21 North American and 5 European sites from December 2012 through November 2015. Participants were randomly assigned to continue usual care alone (guideline based, including pulmonary rehabilitation and bronchodilators; n = 157) vs usual care plus bilateral coil treatment (n = 158) involving 2 sequential procedures 4 months apart in which 10 to 14 coils were bronchoscopically placed in a single lobe of each lung. The primary effectiveness outcome was difference in absolute change in 6-minute-walk distance between baseline and 12 months (minimal clinically important difference [MCID], 25 m). Secondary end points included the difference between groups in 6-minute walk distance responder rate, absolute change in quality of life using the St George's Respiratory Questionnaire (MCID, 4) and change in forced expiratory volume in the first second (FEV1; MCID, 10%). The primary safety analysis compared the proportion of participants experiencing at least 1 of 7 prespecified major complications. Among 315 participants (mean age, 64 years; 52% women), 90% completed the 12-month follow-up. Median change in 6-minute walk distance at 12 months was 10.3 m with coil treatment vs -7.6 m with usual care, with a between-group difference of 14.6 m (Hodges-Lehmann 97.5% CI, 0.4 m to ∞; 1-sided P = .02). Improvement of at least 25 m occurred in 40.0% of patients in the coil group vs 26.9% with usual care (odds ratio, 1.8 [97.5% CI, 1.1 to ∞]; unadjusted between-group difference, 11.8% [97.5% CI, 1.0% to ∞]; 1-sided P = .01). The between-group difference in

Survey of Usual Practice: Dysphagia Therapy in Head & Neck Cancer Patients

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Krisciunas, Gintas P.; Sokoloff, William; Stepas, Katherine; Langmore, Susan E.

2012-01-01

There is no standardized dysphagia therapy for head and neck cancer patients and scant evidence to support any particular protocol, leaving institutions and individual speech language pathologists (SLPs) to determine their own protocols based on “typical” practices or anecdotal evidence. To gain an understanding of current usual practices, a national internet-based survey was developed and disseminated to SLPs who treat HNC patients. From a random sample of 4,000 ASHA SID 13 members, 1,931 fit the inclusion criteria, and 759 complete responses were recorded for a 39.3% response rate. Results were analyzed by institution type as well as by individual clinical experience. While some interesting trends emerged from the data, a lack of uniformity and consensus regarding best practices was apparent. This is undoubtedly due to a paucity of research adequately addressing the efficacy of any one therapy for dysphagia in the HNC population. PMID:22456699

Well test: production analysis and allocation measurement; Teste de poco: analise da producao e medicao de apropriacao

Energy Technology Data Exchange (ETDEWEB)

Geron, Luis Carlos [Smar Equipamentos Industriais Ltda., Sertaozinho, SP (Brazil). Dept. de Engenharia Aplicacoes; Tateishi, Sergio Hideki [Smar Equipamentos Industriais Ltda, Sertaozinho, SP (Brazil). Dept. de Pesquisa e Desenvolvimento

2008-07-01

The well test is an instrument frequently used to evaluate the production capacity of wells and it usually has specific requirements in the flow measurement, that are not necessary in the flow measurement system for custody transfer applications. Starting with the requirement to measure the injected product in the well when it is in the recuperation phase and it also includes compliance to specific standards for allocation measurement, because these hydrocarbon products are not treated as well as that ones in the production streams. Other important issue associated to the well test is the employment of new technologies, that helps to reduce the uncertainty of measurement as digital communication between the field devices and the flow computer through an open protocol as the Foundation Field bus. Another indication of technology evolution in the flow measurement focusing a lower uncertainty is the new version of API MPMS 11.1:2004, that requires calculation with double precision floating point, as well the correction factors with 5 decimal digits. (author)

Porfirias poco frecuentes: Casos detectados en la población argentina Non frequent porphyrias in the argentinean population

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V A Melito

2006-12-01

Full Text Available Las porfirias son consecuencia de fallas en el metabolismo del hemo. Se clasifican según el tipo de sintomatología clínica prevalente o el órgano donde se expresa preferencialmente la falla metabólica. En general la deficiencia enzimática está asociada a mutaciones en los genes que codifican para cada una de las enzimas. Están descritos 7 tipos de porfiria diferentes. Se transmiten por carácter autosómico dominante a excepción de la PCE, la PHE y la NPA que son recesivas. Sin embargo, están reportadas variantes homocigotas para el resto de las porfirias de pronóstico y evolución mucho más grave que la forma heterocigota. La descripción de estos casos poco frecuentes, sus tratamientos y evolución, facilitarían tanto el diagnóstico diferencial de la porfiria como el conocimiento de las posibilidades terapéuticas en cada caso. Asimismo para las porfirias heterocigotas con manifestación infantil, su identificación temprana y tratamiento aseguraría una mejor evolución minimizando los riesgos asociados. Se han diagnosticado 5 casos de porfirias agudas en niñas: 2 de PAI, 2 de PV y 1 de CPH. Entre las porfirias cutáneas se presentan 25 casos de PCT infantil, el primer caso de PHE en Argentina, 4 casos de PCE infantil y 1 en un adulto y 2 casos de PPE con compromiso hepatobiliar.The Porphyrias are a group of diseases resulting from partial deficiencies in one of the heme biosynthetic enzymes. These disorders can be classified on the basis of their clinical manifestations or according the organ where the metabolic deficiency is mainly expressed. In general this enzyme deficiency is associated with mutations in the genes which codify each enzyme. There are 7 types of Porphyrias. They are autosomal dominant disorders with the exception of PCE, PHE and NPA which are recessive. However, some rare and severe cases with recessive inheritance have also been reported. The description of these infrequent cases and their treatments and

Arteriopatía periférica crónica inducida por cocaína

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Sonia Pankl

2012-02-01

Full Text Available La trombosis periférica aguda inducida por cocaína ha sido descripta en la literatura, siendo una complicación poco común. Si bien existen comunicaciones que reflejan los efectos crónicos de la cocaína sobre el sistema arterial periférico, no hay casos publicados de tal complicación en ausencia de otros factores de riesgo. Se presenta el caso de una mujer de 22 años de edad con antecedentes de consumo de cocaína intranasal de 3 gramos por semana durante un año, que consultó por claudicación intermitente a los 200 metros asociada a dolor y parestesias en miembro inferior izquierdo de 2 meses de evolución. El ecodoppler arterial evidenció una estenosis mayor del 70% en la arteria femoral superficial izquierda. Se realizaron estudios complementarios descartando otras etiologías probables. Se inició tratamiento con ácido acetilsalicílico, cilostazol y ejercicio reglado, asociado a terapia de apoyo para mantenimiento del cese del consumo de cocaína, con buena respuesta. Se destaca la importancia de la difusión de información a los pacientes, dado que la mayoría de la población desconoce las complicaciones cardiovasculares de dicha adicción. Es indispensable indagar sobre el consumo de cocaína en pacientes jóvenes con arteriopatía sin factores de riesgo aparentes.

No more 'business as usual' with audit and feedback interventions: towards an agenda for a reinvigorated intervention.

Science.gov (United States)

Ivers, Noah M; Sales, Anne; Colquhoun, Heather; Michie, Susan; Foy, Robbie; Francis, Jill J; Grimshaw, Jeremy M

2014-01-17

Audit and feedback interventions in healthcare have been found to be effective, but there has been little progress with respect to understanding their mechanisms of action or identifying their key 'active ingredients.' Given the increasing use of audit and feedback to improve quality of care, it is imperative to focus further research on understanding how and when it works best. In this paper, we argue that continuing the 'business as usual' approach to evaluating two-arm trials of audit and feedback interventions against usual care for common problems and settings is unlikely to contribute new generalizable findings. Future audit and feedback trials should incorporate evidence- and theory-based best practices, and address known gaps in the literature. We offer an agenda for high-priority research topics for implementation researchers that focuses on reviewing best practices for designing audit and feedback interventions to optimize effectiveness.

Evolución de los embarazos de mujeres infectadas por el virus de la inmunodeficiencia humana

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Figueroa-Damián Ricardo

1999-01-01

Full Text Available OBJETIVO: Identificar las complicaciones médicas de las embarazadas infectadas por el virus de la inmunodeficiencia humana (VIH y asintomáticas, y determinar el riesgo que el virus representa para el desarrollo de las mismas. MATERIAL Y MÉTODOS: Se comparó la evolución del embarazo y el resultado perinatal de 44 embarazadas seropositivas al VIH, asintomáticas y que presentaron más de 200 linfocitos CD4/mm³, con embarazadas control no infectadas; las pacientes se parearon por edad y nivel socioeconómico. RESULTADOS: En 42 (95.4% pacientes la vía de contagio fue sexual; 35 (79.5% tenían menos de un año de saber que estaban infectadas y 15 (34% recibieron tratamiento antiviral durante la gestación. Las mujeres infectadas por el VIH presentaron un riesgo mayor de complicaciones infecciosas (RR3.1, IC95% 1.9-52, cervicovaginitis (RR2.2, IC95% 1- 48 y enfermedades de transmisión sexual (RR18, IC95% 2.3-137. El promedio de peso y talla de los recién nacidos y el número de complicaciones neonatales fueron similares entre los grupos comparados. El análisis estratificado mostró que la ausencia de tratamiento antirretroviral y el antecedente de tres o más parejas sexuales incrementaron el riesgo de complicaciones infecciosas. CONCLUSIONES: Las embarazadas seropositivas al VIH y asintomáticas no tuvieron un riesgo mayor de complicaciones médicas del embarazo, con excepción de problemas infecciosos.

Usual intake of added sugars and lipid profiles among the U.S. adolescents: National Health and Nutrition Examination Survey, 2005-2010.

Science.gov (United States)

Zhang, Zefeng; Gillespie, Cathleen; Welsh, Jean A; Hu, Frank B; Yang, Quanhe

2015-03-01

Although studies suggest that higher consumption of added sugars is associated with cardiovascular risk factors in adolescents, none have adjusted for measurement errors or examined its association with the risk of dyslipidemia. We analyzed data of 4,047 adolescents aged 12-19 years from the 2005-2010 National Health and Nutrition Examination Survey, a nationally representative, cross-sectional survey. We estimated the usual percentage of calories (%kcal) from added sugars using up to two 24-hour dietary recalls and the National Cancer Institute method to account for measurement error. The average usual %kcal from added sugars was 16.0%. Most adolescents (88.0%) had usual intake of ≥10% of total energy, and 5.5% had usual intake of ≥25% of total energy. After adjustment for potential confounders, usual %kcal from added sugars was inversely associated with high-density lipoprotein (HDL) and positively associated with triglycerides (TGs), TG-to-HDL ratio, and total cholesterol (TC) to HDL ratio. Comparing the lowest and highest quintiles of intake, HDLs were 49.5 (95% confidence interval [CI], 47.4-51.6) and 46.4 mg/dL (95% CI, 45.2-47.6; p = .009), TGs were 85.6 (95% CI, 75.5-95.6) and 101.2 mg/dL (95% CI, 88.7-113.8; p = .037), TG to HDL ratios were 2.28 (95% CI, 1.84-2.70) and 2.73 (95% CI, 2.11-3.32; p = .017), and TC to HDL ratios were 3.41 (95% CI, 3.03-3.79) and 3.70 (95% CI, 3.24-4.15; p = .028), respectively. Comparing the highest and lowest quintiles of intake, adjusted odds ratio of dyslipidemia was 1.41 (95% CI, 1.01-1.95). The patterns were consistent across sex, race/ethnicity, and body mass index subgroups. No association was found for TC, low-density lipoprotein, and non-HDL cholesterol. Most U.S. adolescents consumed more added sugars than recommended for heart health. Usual intake of added sugars was significantly associated with several measures of lipid profiles. Published by Elsevier Inc.

Joint recovery programme versus usual care - An economic evaluation of a clinical pathway for joint replacement surgery

NARCIS (Netherlands)

Brunenberg, DE; van Steyn, MJ; Sluimer, JC; Bekebrede, LL; Bulstra, SK; Joore, MA

2005-01-01

Objective: The objective of the present study was to determine the incremental cost-effectiveness of a clinical pathway for patients undergoing joint replacement, the Joint Recovery Programme (JRP), as compared with usual care. The existing care process was revised to contain costs and shorten

Geomorphological and hydrogeological features of the Pocos de Caldas caldera and the Osamu Utsumi mine and Morro do Ferro analogue study sites, Brazil

International Nuclear Information System (INIS)

Holmes, D.C.; Pitty, A.E.; Noy, D.J.

1990-01-01

The Osamu Utsumi mine and Morro do Ferro study sites lie within the Pocos de Caldas plateau which is roughly circular in outline with a diameter of 35 km and an area of approximately 800 km 2 . Its general altitude lies between 1300 and 1600 m. The plateau is the eroded form of a caldera which was initially intruded some 80 million years ago. Geomorphologically, both sites occupy watershed areas adjacent to small streams in the centre of the plateau. The climate of the area has a market wet season from November to April and is dry the rest of the year. The streams are ephemeral in their upper reaches, tending to dry up in the dry season as they are fed by a declining base flow. In the wet season they exhibit flash flood fed by high-intensity rainfall causing overland flow. The wet season also provides recharge to the groundwater. Natural slopes are steep and the original vegetation was thin forest cover which is now restricted to the valley bottoms; usable slopes have poor quality grass cover used for cattle grazing. The plateau is a stable feature and its surface has been eroding at an average rate of 12 m per million years over a period of 50 million years. The mine geology is dominantly volcanic to subvolcanic phonolites that have been hydrothermally altered. Fracturing of the rock is extensive. Downward diffusion of oxygen in groundwaters during deep weathering has produced a distinct redox zone seen as a colour change from green/grey to brown/yellow. Morro do Ferro has a more weathered version (laterite/clay) of the same geology penetrated by magnetite breccia dykes. Whilst the area surrounding Morro do Ferro remains untouched, that around the mine has been seriously disturbed by mining activity which has penetrated the water-table. The existing mine has modified groundwater flow patterns and disturbed the movement of oxidising and reducing waters. (au) (47 refs.)

Business as usual in spite of the CO2 trade of the EU

International Nuclear Information System (INIS)

Wellander, Dag

2004-01-01

The trade system that is going to be launched by the EU at the turn of the year (2004/2005) has some serious shortcomings as it was originally formulated. It is limited to the EU. It is only partial; it applies only to emission sources in the energy sector and some energy-intensive sectors. Both limitations raise the costs of cutting down on the emissions, which would have hit the EU unilaterally. According to the author, work is now in progress to make the trade system as inefficient as possible, aiming at ''business as usual''. The climate problems cannot be solved without global cooperation, which is not in sight

From Sustainability-as-usual to Sustainability Excellence in Local Bioenergy Business

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Heli Kasurinen

2017-06-01

Full Text Available Bioenergy business operators can significantly contribute to the sustainability of bioenergy systems. While research has addressed the maturity of corporate responsibility for sustainability, the maturity levels of bioenergy business have not been determined. The objectives of this research were to characterise the maturity levels of bioenergy corporate responsibility for sustainability and outline an approach by which companies can operate at the most mature sustainability excellence level. Literature, three workshops attended by bioenergy experts and a case study on biobutanol production in Brazil were used to develop the maturity model and approach. The results characterise the profitability, acceptability, and sustainability orientation maturity levels through sustainability questions and methods, and list the components of a systemic, holistic approach. Although the shift of business mindset from sustainability-as-usual to sustainability excellence is challenging, a systemic approach is necessary to broadly identify sustainability questions and a multitude of methods by which they can be answered.

Randomized clinical trial of an intravenous hydromorphone titration protocol versus usual care for management of acute pain in older emergency department patients.

Science.gov (United States)

Chang, Andrew K; Bijur, Polly E; Davitt, Michelle; Gallagher, E John

2013-09-01

Opioid titration is an effective strategy for treating pain; however, titration is generally impractical in the busy emergency department (ED) setting. Our objective was to test a rapid, two-step, hydromorphone titration protocol against usual care in older patients presenting to the ED with acute severe pain. This was a prospective, randomized clinical trial of patients 65 years of age and older presenting to an adult, urban, academic ED with acute severe pain. The study was registered at http://www.clinicaltrials.gov (NCT01429285). Patients randomized to the hydromorphone titration protocol initially received 0.5 mg intravenous hydromorphone. Patients randomized to usual care received any dose of any intravenous opioid. At 15 min, patients in both groups were asked, 'Do you want more pain medication?' Patients in the hydromorphone titration group who answered 'yes' received a second dose of 0.5 mg intravenous hydromorphone. Patients in the usual care group who answered 'yes' had their ED attending physician notified, who then could administer any (or no) additional medication. The primary efficacy outcome was satisfactory analgesia defined a priori as the patient declining additional analgesia at least once when asked at 15 or 60 min after administration of the initial opioid. Dose was calculated in morphine equivalent units (MEU: 1 mg hydromorphone = 7 mg morphine). The need for naloxone to reverse adverse opioid effects was the primary safety outcome. 83.0 % of 153 patients in the hydromorphone titration group achieved satisfactory analgesia compared with 82.5 % of 166 patients in the usual care group (p = 0.91). Patients in the hydromorphone titration group received lower mean initial doses of opioids at baseline than patients in the usual care group (3.5 MEU vs. 4.7 MEU, respectively; p ≤ 0.001) and lower total opioids through 60 min (5.3 MEU vs. 6.0 MEU; p = 0.03). No patient needed naloxone. Low-dose titration of intravenous hydromorphone in increments of

Giant solitary fibrous tumour of the pleura: a rare but usually benign intrathoracic neoplasm

DEFF Research Database (Denmark)

Bodtger, Uffe; Pedersen, Jesper Holst; Skov, Birgit Guldhammer

2009-01-01

BACKGROUND: Low forced expiratory volume (FEV(1)) and low performance status usually preclude surgical treatment of lung neoplasms. Earlier case reports have suggested that curative, safe surgery is possible in extrapulmonal intrathoracic neoplasms. METHODS: A case report of an 83-year-old women...... with progressing dyspnoea secondary to a huge left-side neoplasm. RESULTS: Work-up reveal an FEV(1) of 0.4 L, and a giant solitary fibrous tumor of the pleura. The tumor was surgically removed in toto without complications: weighting approximately 3 kg, and benign histology. The patient was without dyspnoea...

Enfermedad tromboembólica venosa y cirrosis hepática Venous thromboembolism and liver cirrhosis

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M. J. García-Fuster

2008-05-01

Full Text Available Objetivos: la enfermedad tromboembólica venosa (ETV es poco frecuente en la cirrosis hepática, no estando su tratamiento contemplado en las guías del American College of Chest Physicians. El objetivo del presente trabajo es aportar la experiencia de pacientes cirróticos con ETV hospitalizados en nuestro centro en los últimos 15 años. Material y método: de enero de 1992 a diciembre de 2007 fueron hospitalizados en nuestro centro 2.074 pacientes con cirrosis hepática. Presentaron una ETV no esplácnica 17, siendo ellos la población a estudio. Se recogen datos epidemiológicos y analíticos: hemograma, VSG, química hemática, coagulación, trombofilia congénita, anticuerpos antifosfolípidos (AAFL y homocisteinemia. Se valoran factores de riesgo adquiridos, características de la trombosis, el tratamiento y las complicaciones. Resultados y conclusiones: la ETV no esplácnica se observa en el 0,8% de pacientes cirróticos. En ellos es frecuente observar hipoalbuminemia, disminución de factores anticoagulantes (ATIII, PC, y PS, presencia de AAFL e hiperhomocisteinemia, así como la presencia de factores de riesgo adquiridos: intervenciones quirúrgicas, insuficiencia venosa, inmovilización e infecciones. Tras la anticoagulación, se observan complicaciones hemorrágicas mayores en el 35% de los pacientes.Objective: despite the endogenous coagulopathy of cirrhosis, some patients do experience thrombophilic states. The American College of Chest Physicians failed to address the prevention and treatment of venous thromboembolism (VTE occurring among these patients. This study aims to describe the characteristics of cirrhotics patients hospitalized in the last 15 years, and to use the experience gained. Material and method: we retrospectively reviewed all admissions for cirrhosis in our hospital from 1992 to 2007. A total of 17 patients had non-portal venous thromboembolic disease. We recorded risk factors, epidemiological and laboratory data

Facility-based care for delivery and management of complications related to pregnancy and childbirth in Mexico

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Bernardo Hernández

2012-10-01

Full Text Available OBJECTIVE: To describe the incidence and management of severe maternal and newborn complications in selected health facilities in Mexico. MATERIALS AND METHODS: As part of the WHO Multicountry Survey on Maternal and Newborn health, information was collected from medical records of women with deliveries and/or severe maternal complications during pregnancy or puerperium in 14 hospitals in Mexico City and the state of Guanajuato, Mexico. RESULTS: Of 13 311 women, 157 (12 per 1 000 live births had severe maternal complications including 4 maternal deaths. The most frequent complications were preeclampsia, postpartum hemorrhage, and chronic hypertension. Adverse perinatal outcomes were more frequent among women with severe maternal complications. A high use of uterotonics and parenteral antibiotics was found. A small proportion of women with eclampsia received magnesium sulfate. CONCLUSION: This study provides indicators on the incidence and management of maternal and neonatal complications in Mexico, which may be useful in studying and evaluating the performance of obstetric services.OBJETIVO: Describir la incidencia y manejo de complicaciones maternas y neonatales severas en hospitales seleccionados de México. MATERIAL Y MÉTODOS: En el marco de la Encuesta Multipaís de la OMS sobre Salud Materna y Neonatal, se recolectó información de los expedientes médicos de las mujeres que tuvieron su parto o experimentaron complicaciones maternas severas durante el embarazo o puerperio en 14 hospitales de la Ciudad de México y el estado de Guanajuato, México. RESULTADOS: De 13 311 mujeres, 157 (12/1 000 nacidos vivos tuvieron complicaciones maternas severas, incluyendo 4 muertes maternas. Las complicaciones más frecuentes fueron preeclampsia, hemorragia postparto e hipertensión crónica. Los resultados perinatales adversos fueron más frecuentes en las mujeres con complicaciones severas. Hubo un uso amplio de uterotónicos y antibi

The third Symptom Management Research Trial in Oncology (SMaRT Oncology-3: a randomised trial to determine the efficacy of adding a complex intervention for major depressive disorder (Depression Care for People with Lung Cancer to usual care, compared to usual care alone in patients with lung cancer

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Sharpe Michael

2009-09-01

Full Text Available Abstract Background Depression Care for People with Lung Cancer is a complex intervention delivered by specially trained cancer nurses, under the supervision of a psychiatrist. It is given as a supplement to the usual care for depression, which patients receive from their general practitioner and cancer service. The third Symptom Management Research Trial in Oncology (SMaRT Oncology-3 Trial will test its efficacy when compared to usual care alone. Design A two arm parallel group multi-centre randomised controlled trial. 200 patients will be recruited through established systematic Symptom Monitoring Services, which screen patients for depression. Patients will have: a diagnosis of lung cancer; an estimated life expectancy of three months or more and a diagnosis of Major Depressive Disorder. Patients will be randomised to usual care or usual care plus Depression Care for People with Lung Cancer. Randomisation will be carried out by telephoning a secure computerised central randomisation system or by using a secure web interface. The primary outcome measure is average depression severity. This will be assessed using scores on the 20-item Symptom Hopkins Checklist (SCL-20D, collected every four weeks over 32 weeks. Secondary outcomes include severity of anxiety, pain and fatigue; self-rated improvement of depression; quality of life and satisfaction with depression care. Trial Registration Current controlled trials ISRCTN75905964

Evidencia neurofisiológica del estado neurocognitivo en pacientes con acromegalia tratada farmacológicamente

OpenAIRE

Caballero Martínez, Manuel

2016-01-01

Introducción: La acromegalia es un trastorno hormonal producido por la secreción aberrante de hormona del crecimiento (GH) y el consecuente incremento del factor de crecimiento similar a la insulina 1 (IGF-I) generalmente debido a la acción de un adenoma hipofisario, y que produce complicaciones sistémicas, incluyendo complicaciones neurocognitivas. Además, también se han descrito alteraciones neurofisiológicas en el análisis espectral...

Influencia de la diabetes mellitus sobre la evolución del paciente con enfermedad cerebrovascular y nutrición enteral por sonda

OpenAIRE

Coto García, Cristina

2017-01-01

La Diabetes Mellitus juega un importante papel tanto en la patogenia como en el pronóstico de la enfermedad cerebrovascular. El ictus y las complicaciones que este conlleva conforman una entidad de elevada morbimortalidad. El soporte nutricional constituye un pilar importante a la hora tratar a los pacientes que han sufrido un ictus. Valorar si existe diferencia en estancia media hospitalaria, éxitus y complicaciones relacionadas con la nutrición entre aquellos pacientes con diabetes melli...

A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain

Science.gov (United States)

Cherkin, Daniel C.; Sherman, Karen J.; Avins, Andrew L.; Erro, Janet H.; Ichikawa, Laura; Barlow, William E.; Delaney, Kristin; Hawkes, Rene; Hamilton, Luisa; Pressman, Alice; Khalsa, Partap S.; Deyo, Richard A.

2009-01-01

Background Acupuncture is a popular complementary and alternative treatment for chronic back pain. Recent European trials suggest similar short-term benefits from real and sham acupuncture needling. This trial addresses the importance of needle placement and skin penetration in eliciting acupuncture effects for patients with chronic low back pain. Methods 638 adults with chronic mechanical low back pain were randomized to: individualized acupuncture, standardized acupuncture, simulated acupuncture, or usual care. Ten treatments were provided over 7 weeks by experienced acupuncturists. The primary outcomes were back-related dysfunction (Roland Disability score, range: 0 to 23) and symptom bothersomeness (0 to 10 scale). Outcomes were assessed at baseline and after 8, 26 and 52 weeks. Results At 8 weeks, mean dysfunction scores for the individualized, standardized, and simulated acupuncture groups improved by 4.4, 4.5, and 4.4 points, respectively, compared with 2.1 points for those receiving usual care (P0.05). Conclusions Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits. These findings raise questions about acupuncture’s purported mechanisms of action. It remains unclear whether acupuncture, or our simulated method of acupuncture, provide physiologically important stimulation or represent placebo or non-specific effects. PMID:19433697

Usual Intake of Added Sugars and Lipid Profiles Among the U.S. Adolescents: National Health and Nutrition Examination Survey, 2005–2010

Science.gov (United States)

Zhang, Zefeng; Gillespie, Cathleen; Welsh, Jean A.; Hu, Frank B.; Yang, Quanhe

2015-01-01

Purpose Although studies suggest that higher consumption of added sugars is associated with cardiovascular risk factors in adolescents, none have adjusted for measurement errors or examined its association with the risk of dyslipidemia. Methods We analyzed data of 4,047 adolescents aged 12–19 years from the 2005–2010 National Health and Nutrition Examination Survey, a nationally representative, cross-sectional survey. We estimated the usual percentage of calories (%kcal) from added sugars using up to two 24-hour dietary recalls and the National Cancer Institute method to account for measurement error. Results The average usual %kcal from added sugars was 16.0%. Most adolescents (88.0%) had usual intake of ≥10% of total energy, and 5.5% had usual intake of ≥25% of total energy. After adjustment for potential confounders, usual %kcal from added sugars was inversely associated with high-density lipoprotein (HDL) and positively associated with triglycerides (TGs), TG-to-HDL ratio, and total cholesterol (TC) to HDL ratio. Comparing the lowest and highest quintiles of intake, HDLs were 49.5 (95% confidence interval [CI], 47.4–51.6) and 46.4 mg/dL(95% CI, 45.2–47.6; p = .009), TGs were 85.6 (95% CI, 75.5–95.6) and 101.2 mg/dL(95% CI, 88.7–113.8; p = .037), TG to HDL ratios were 2.28 (95% CI, 1.84–2.70) and 2.73 (95% CI, 2.11–3.32; p = .017), and TC to HDL ratios were 3.41 (95% CI, 3.03–3.79) and 3.70 (95% CI, 3.24–4.15; p = .028), respectively. Comparing the highest and lowest quintiles of intake, adjusted odds ratio of dyslipidemia was 1.41 (95% CI, 1.01–1.95). The patterns were consistent across sex, race/ethnicity, and body mass index subgroups. No association was found for TC, low-density lipoprotein, and non-HDL cholesterol. Conclusions Most U.S. adolescents consumed more added sugars than recommended for heart health. Usual intake of added sugars was significantly associated with several measures of lipid profiles. PMID:25703323

The potential of telehealth for 'business as usual' in outpatient clinics.

Science.gov (United States)

Day, Karen; Kerr, Patricia

2012-04-01

A six-month pilot study was conducted to ascertain the value of using high-definition videoconferencing equipment in an outpatients' setting. The videoconferencing equipment, which included digital biometric equipment, was installed in the outpatient clinics of a remote health service in New Zealand. Use of the equipment was evaluated using action research techniques. Clinicians were interviewed about their assessment of the equipment's usefulness. Patients and their carers completed questionnaires about their clinic experience. During the pilot trial, 109 patients were seen in 25 clinics of six different specialities. Questionnaire results showed that patients and their companions had a good user experience, similar to a face-to-face appointment. Clinicians found that the large screen, sense of proximity, video clarity and definition, and lack of sound/picture lag worked well for certain types of outpatients' clinics, e.g. methadone maintenance clinics. The need for process changes made it difficult to turn telehealth into business as usual in an environment built for face-to-face appointments. We conclude that videoconference equipment has potential to become integral to outpatients' clinics.

The Impact of Automation on Employment: Just the Usual Structural Change?

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Ben Vermeulen

2018-05-01

Full Text Available We study the projected impact of automation on employment in the forthcoming decade, both at the macro-level and in actual (types of sectors. Hereto, we unite an evolutionary economic model of multisectoral structural change with labor economic theory. We thus get a comprehensive framework of how displacement of labor in sectors of application is compensated by intra- and intersectoral countervailing effects and notably mopped up by newly created, labor-intensive sectors. We use several reputable datasets with expert projections on employment in occupations affected by automation (and notably by the introduction of robotics and AI to pinpoint which and how sectors and occupations face employment shifts. This reveals how potential job loss due to automation in “applying” sectors is counterbalanced by job creation in “making” sectors as well in complementary and quaternary, spillover sectors. Finally, we study several macro-level scenarios on employment and find that mankind is facing “the usual structural change” rather than the “end of work”. We provide recommendations on policy instruments that enhance the dynamic efficiency of structural change.

Osteomielitis tuberculosa de la bóveda craneal Tubercular osteomielitis of the skull

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Isael Olazábal Armas

2013-03-01

Full Text Available Introducción: la osteomielitis tuberculosa del cráneo es una entidad rara y sólo ocurre en el 0,01 % de los pacientes con infección por Mycobacterium Tuberculosis, aunque esta frecuencia de presentación se incrementa notablemente en las personas portadoras de algún grado de inmunodeficiencia. El cuadro clínico suele ser de inicio insidioso y caracterizarse por la presencia de dolor local de intensidad progresiva. Objetivo: presentar un caso clínico poco frecuente con osteomielitis crónica de la bóveda craneal, secundaria a infección por Mycobacterium Tuberculoso. Presentación del caso: paciente de 5 años de edad con historia de dolor y aumento de volumen de la región interparietal del cráneo. Al examen físico se constató aumento de volumen con fluctuación de dicha región y defecto óseo irregular. Se realizó Rayos x de cráneo donde se pudo observar una lesión osteolítica de la bóveda craneal. Se practicó exéresis del hueso. En la recuperación post operatoria, se utilizaron durante las 2 primeras semanas la vancomicina y el ceftriaxone. La evolución clínica no fue satisfactoria, hasta que se obtuvo un cultivo positivo de Mycobacterium Tuberculoso, momento en que se comenzó tratamiento específico antituberculoso. El paciente evolucionó favorablemente después de cinco semanas del diagnóstico inicial. Conclusiones: la osteomielitis tuberculosa de la bóveda craneal aunque es poco frecuente puede verse, sobre todo, en países con una alta prevalencia de la enfermedad. Su diagnóstico y tratamiento oportuno pueden evitar complicaciones intracraneales.Background: tubercular osteomielitis of the skull is a rare entity that only occurs in the 0.01 % of patients infected by Mycobacterium Tuberculosis, although this frequency of presentation increases significantly in people who are carriers of some degree of immunodeficiency. The clinical picture is usually insidious at the onset of the disease and is characterized by the

Development of a Systematic Approach to Post-Operation Clean Out at Sellafield

International Nuclear Information System (INIS)

Macpherson, Ian; Dunlop, Alister

2016-01-01

Post Operational Clean Out (POCO) relates to the activities undertaken directly after commercial operations cease to remove residual activity and facilitate decommissioning of a nuclear facility. Historically the transition of Sellafield facilities has proved sub-optimal resulting in loss of critical plant knowledge, additional cost and protracted delivery timelines. The move from reprocessing in Magnox and Thorp to POCO is a significant transition facing the site, with a large number of diverse facilities scheduled to cease operations over the next 15 years. In order to ensure that the facilities are dealt with in a consistent manner, that supports both Site and Nuclear Decommissioning Authority (NDA) strategies, the POCO programme has been established across the Sellafield Operations Division. Primary aims of the POCO programme are: - Risk and Hazard Reduction; - Enabling redeployment of resource and capability; - Life-cycle cost reduction; - Enhanced Reputation. Transition preparations will cover process, organisation, technology and information. Knowledge is a key output of POCO: the creation of records of the plant configuration and status to enable and support the safe and effective eventual decommissioning of the plant. The consistent approach that has been developed will: - Ensure the smooth transition from operations into POCO, and then into surveillance and maintenance. - Maximise the potential of facilities to support other site activities prior to POCO. - Optimise the facility schedules within the overall POCO programme, to ensure timely decoupling. - Define and manage the resource demands and capabilities prior to and during POCO. - Provide a baseline configuration for each facility at the end of the POCO phase. - Encourage and enable knowledge management to ensure that subsequent decommissioning activities are informed and supported. - Look for opportunities to progress housekeeping and co-processing activities so as to reduce inventory and make best

A 'business-as-usual' energy scenario for France at the 2020 vista

International Nuclear Information System (INIS)

Giraud, P.N.

2000-01-01

A 'business-as-usual' energy scenario is the most probable scenario where the energy demand follows the trends of the past and where no new energy policy is implemented. This work is a complement to the three contrasted energy scenarios built in 1998 by the 'Energy 2010-2020' prospective group of the French general commission of national development. The scenario built in this study is only a reference which allows the measure the efforts made to reach political goals. The main conclusion of this scenario is the increase of the CO 2 emissions under the double effect of the economic growth and of the cessation of the nuclear program which becomes non-competitive with respect to the gas prices and actualization rates retained in the scenario. The main constraint of the energy future is incontestably the necessary fight against the greenhouse effect. (J.S.)

Abordaje biauricular transeptal superior en el tratamiento quirúrgico del mixoma auricular izquierdo de gran tamaño

Directory of Open Access Journals (Sweden)

Salvador Torregrosa

2009-01-01

Full Text Available Evitar la fragmentación del tejido mixoide durante el acto quirúrgico y resecar todo el espesor del septo interauricular con implantación tumoral son las dos claves para evitar las graves complicaciones de embolia peroperatoria y recidiva postoperatoria en el tratamiento quirúrgico del mixoma auricular izquierdo. La vía transeptal superior nos ha permitido, en tres pacientes, la extirpación en bloque de mixomas de gran tamaño con facilidad y sin complicaciones.

Efectividad y seguridad de la laparotomía vs laparoscopía en abdomen agudo de origen gineco-obstétrico causado por embarazo ectópico roto y quiste de ovario roto.

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Luna Aveiga, Cristhian

2014-01-01

Comparar efectividad, tiempo y sangrado operatorio, estadía y complicaciones entre laparotomía y laparoscopía en abdomen agudo (AA) por embarazo ectópico roto (EER) y quiste de ovario roto (QOR). Métodos: Estudio retrospectivo en el Hospital de Santa Elena y Clínica Granados de Enero 2010-Diciembre 2011. Se obtuvieron las causas, procedimientos, edad, hemoglobina, edad gestacional, antecedentes personales y complicaciones. Tiempo, sangrado operatorio y estadía fueron comparadas por T de stud...

Complicaciones tardías en siete gastrectomizados

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Jaime Campos

1972-01-01

Full Text Available Seven patients with complications due to gastrectomy performed several years back are described. Their main symptons were: weight loss in 6, diarrhea in 5, anemia in 5, blind loop syndrome in 5 and dumping syndrome in 5. Some of the patients developed mild absorption disturbances such us steatorrhea in 3, abnormal d-xylosa excretion in 1 and significant atrophy of the intestinal mucosa in 2. In three patients we found pulmonar T.B.C

Enfermedad de Hirschsprung y apendicitis. Una asociación rara

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C Baeza-Herrera

2016-05-01

Full Text Available La enfermedad de Hirschsprung asociada con apendicitis es una condición poco usual; suman 15 los reportados en la literatura, ya incluido este caso. Se informa el caso de un lactante de 12 meses de edad que ingresó con fiebre, anorexia, distensión abdominal, vómito, evacuaciones hemáticas y antecedente de estreñimiento. Se realizó laparotomía exploradora que reportó apendicitis y megacolon congénito o enfermedad de Hirschsprung. El reporte histopatológico reveló periapendicitis, huevecillos de áscaris lumbricoides, con ausencia de células ganglionares.

Gaussian Quadrature is an efficient method for the back-transformation in estimating the usual intake distribution when assessing dietary exposure.

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Dekkers, A L M; Slob, W

2012-10-01

In dietary exposure assessment, statistical methods exist for estimating the usual intake distribution from daily intake data. These methods transform the dietary intake data to normal observations, eliminate the within-person variance, and then back-transform the data to the original scale. We propose Gaussian Quadrature (GQ), a numerical integration method, as an efficient way of back-transformation. We compare GQ with six published methods. One method uses a log-transformation, while the other methods, including GQ, use a Box-Cox transformation. This study shows that, for various parameter choices, the methods with a Box-Cox transformation estimate the theoretical usual intake distributions quite well, although one method, a Taylor approximation, is less accurate. Two applications--on folate intake and fruit consumption--confirmed these results. In one extreme case, some methods, including GQ, could not be applied for low percentiles. We solved this problem by modifying GQ. One method is based on the assumption that the daily intakes are log-normally distributed. Even if this condition is not fulfilled, the log-transformation performs well as long as the within-individual variance is small compared to the mean. We conclude that the modified GQ is an efficient, fast and accurate method for estimating the usual intake distribution. Copyright © 2012 Elsevier Ltd. All rights reserved.

Response of the Pre-oriented Goal-directed Attention to Usual and Unusual Distractors: A Preliminary Study

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Golnaz Baghdadi

2017-03-01

Full Text Available Introduction: In this study, we investigated the distraction power of the unusual and usual images on the attention of 20 healthy primary school children. Methods: Our study was different from previous ones in that the participants were asked to fix the initial position of their attention on a pre-defined location after being presented with unusual images as distractors. The goals were presented in locations, which were far from the attraction basin of distractors. Our expectation was that the pre-orienting of the attention to the position of targets can reduce the attractive effect of unusual images compared to the usual ones. The percentage of correct responses and the reaction time have been measured as behavioral indicators of attention performance. Results: Results showed that using the goal-directed attention, subjects ignored both kinds of distractors nearly the same way. Conclusion: With regard to previous reports about the more attraction towards the unusual images, it is suggested that the dynamics of the visual attention system be sensitive to the initial condition. That is, changing the initial position of the attention can lead to the decrement of the unusual images’ effects. However, several other possibilities such as a probable delay in processing unusual features could explain this observation, too. 

Cost-effectiveness Analysis of an Aftercare Service vs Treatment-As-Usual for Patients with Severe Mental Disorders.

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Barfar, Eshagh; Sharifi, Vandad; Amini, Homayoun; Mottaghipour, Yasaman; Yunesian, Masud; Tehranidoost, Mehdi; Sobhebidari, Payam; Rashidian, Arash

2017-09-01

There have been claims that community mental health principles leads to the maintenance of better health and functioning in patients and can be more economical for patients with severe and chronic mental disorders. Economic evaluation studies have been used to assess the cost-effectiveness of national health programs, or to propose efficient strategies for health care delivery. The current study is intended to test the cost-effectiveness of an Aftercare Service when compared with Treatment-As-Usual for patients with severe mental disorders in Iran. This study was a parallel group randomized controlled trial. A total of 160 post-discharge eligible patients were randomized into two equal patient groups, Aftercare Service (that includes either Home Visiting Care, or Telephone Follow-up for outpatient treatment) vs Treatment-As-Usual, using stratified balanced block randomization method. All patients were followed for 12 months after discharge. The perspective of the present study was the societal perspective. The outcome measures were the rate of readmission at the hospitals after discharge, psychotic symptoms, manic symptoms, depressive symptoms, illness severity, global functioning, quality of life, and patients' satisfaction with the services. The costs included the intervention costs and the patient and family costs in the evaluation period. There was no significant difference in effectiveness measures between the two groups. The Aftercare Service arm was about 66,000 US$ cheaper than Treatment-As-Usual arm. The average total cost per patient in the Treatment-As-Usual group was about 4651 USD, while it was reduced to 3823 US$ in the Aftercare Service group; equivalent to a cost reduction of about 800 USD per patient per year. Given that there was no significant difference in effectiveness measures between the two groups (slightly in favor of the intervention), the Aftercare Service was cost-effective. The most important limitation of the study was the relatively

Caracterización de pacientes peruanos operados de catarata traumática

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Rebeca Pérez Sánchez

2014-04-01

Full Text Available Se realizó un estudio descriptivo y transversal de 75 pacientes operados de catarata traumática, atendidos en el Centro Oftalmológico de Copacabana, Bolivia, desde enero hasta diciembre de 2007, a fin de determinar los resultados de la cirugía en los afectados. Entre las variables analizadas figuraron: edad, sexo, tipo de trauma, alteraciones oculares asociadas, agudeza visual mejor corregida, conducta quirúrgica y complicaciones. Predominaron las cataratas por trauma contuso en el sexo masculino y el grupo etario de 36-55 años, así como la ruptura de cápsula posterior y la deformidad pupilar como las complicaciones más frecuentes. La mayoría de los pacientes lograron una visión mayor de 0,5, a los cuales se le implantó lente intraocular, lo que garantizó el buen pronóstico visual de los mismos; con ello se redujo el número de complicaciones y secuelas invalidantes

ANÁLISE DAS COMPLICAÇÕES DO USO DA VENTILAÇÃO MECÂNICA EM CRIANÇAS DE UMA UNIDADE DE TERAPIA INTENSIVA PEDIÁTRICA

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DENIZIELLE DE JESUS

2008-01-01

Full Text Available La insuficiencia respiratoria aguda es una de las situaciones que puede provocar la entubación traqueal del niño. Se objetivó analizar las complicaciones de la ventilación mecánica en niños de una Unidad de Terapia Intensiva Pediátrica. Estudio transversal, cuantitativo, con muestra de 72 niños en soporte de ventilación. Los datos se recogieron a través de un formulario de septiembre a diciembre de 2006, presentados en tablas y gráficos. En los resultados, las complicaciones más frecuentes fueron la entubación accidental y la entubación selectiva. El promedio de ventilación mecánica (VM fue de 21 días y 4 horas. Concluimos que la asistencia a la VM aún representa un gran reto para los profesionales que precisan buscar alternativas para minimizar las complicaciones relacionadas al cuidado dado al niño en estado grave.

H eat transfer betw een tw o surfaces usually in- creases w h en th e ...

Indian Academy of Sciences (India)

Srimath

H eat transfer betw een tw o surfaces usually in- creases w h en th e tem p eratu re d i® eren ce b etw een the tw o surfaces increases. H ere w e highlight an unusual situation in radiation heat transfer w herein the heat transfer decreases w hen the tem perature di®erence increases. In tro d u ctio n. In 1701,N ew ton ...

The effect of interpersonal psychotherapy and other psychodynamic therapies versus 'treatment as usual' in patients with major depressive disorder.

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Janus Christian Jakobsen

Full Text Available BACKGROUND: Major depressive disorder afflicts an estimated 17% of individuals during their lifetimes at tremendous suffering and costs. Interpersonal psychotherapy and other psychodynamic therapies may be effective interventions for major depressive disorder, but the effects have only had limited assessment in systematic reviews. METHODS/PRINCIPAL FINDINGS: Cochrane systematic review methodology with meta-analysis and trial sequential analysis of randomized trials comparing the effect of psychodynamic therapies versus 'treatment as usual' for major depressive disorder. To be included the participants had to be older than 17 years with a primary diagnosis of major depressive disorder. Altogether, we included six trials randomizing a total of 648 participants. Five trials assessed 'interpersonal psychotherapy' and only one trial assessed 'psychodynamic psychotherapy'. All six trials had high risk of bias. Meta-analysis on all six trials showed that the psychodynamic interventions significantly reduced depressive symptoms on the 17-item Hamilton Rating Scale for Depression (mean difference -3.12 (95% confidence interval -4.39 to -1.86;P<0.00001, no heterogeneity compared with 'treatment as usual'. Trial sequential analysis confirmed this result. DISCUSSION: We did not find convincing evidence supporting or refuting the effect of interpersonal psychotherapy or psychodynamic therapy compared with 'treatment as usual' for patients with major depressive disorder. The potential beneficial effect seems small and effects on major outcomes are unknown. Randomized trials with low risk of systematic errors and low risk of random errors are needed.

Comparative Effectiveness of Usual Source of Care Approaches to Improve End-of-Life Outcomes for Children With Intellectual Disability.

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Lindley, Lisa C; Cozad, Melanie J

2017-09-01

Children with intellectual disability (ID) are at risk for adverse end-of-life outcomes including high emergency room utilization and hospital readmissions, along with low hospice enrollment. The objective of this study was to compare the effectiveness of usual source of care approaches to improve end-of-life outcomes for children with ID. We used longitudinal California Medicaid claims data. Children were included who were 21 years with fee-for-service Medicaid claims, died between January 1, 2007, and December 31, 2010, and had a moderate-to-profound ID diagnosis. End-of-life outcomes (i.e., hospice enrollment, emergency room utilization, hospital readmissions) were measured via claims data. Our treatments were usual source of care (USC) only vs. usual source of care plus targeted case management (USC plus TCM). Using instrumental variable analysis, we compared the effectiveness of treatments on end-of-life outcomes. Ten percent of children with ID enrolled in hospice, 73% used the emergency room, and 20% had three or more hospital admissions in their last year of life. USC plus TCM relative to USC only had no effect on hospice enrollment; however, it significantly reduced the probability of emergency room utilization (B = -1.29, P life outcomes for children with ID. Further study of the extent of UCS and TCM involvement in reducing emergency room utilization and hospital readmissions at end of life is needed. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Brief Strategic Family Therapy versus Treatment as Usual: Results of a Multisite Randomized Trial for Substance Using Adolescents

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Robbins, Michael S.; Feaster, Daniel J.; Horigian, Viviana E.; Rohrbaugh, Michael; Shoham, Varda; Bachrach, Ken; Miller, Michael; Burlew, Kathleen A.; Hodgkins, Candy; Carrion, Ibis; Vandermark, Nancy; Schindler, Eric; Werstlein, Robert; Szapocznik, Jose

2011-01-01

Objective: To determine the effectiveness of brief strategic family therapy (BSFT; an evidence-based family therapy) compared to treatment as usual (TAU) as provided in community-based adolescent outpatient drug abuse programs. Method: A randomized effectiveness trial in the National Drug Abuse Treatment Clinical Trials Network compared BSFT to…

Análise semiquantitativa de biópsias cirúrgicas de diferentes lobos pulmonares de pacientes com pneumonia intersticial usual/fibrose pulmonar idiopática Semiquantitative analysis of surgical biopsies of distinct lung lobes of patients with usual interstitial pneumonia/idiopathic pulmonary fibrosis

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José Júlio Saraiva Gonçalves

2009-07-01

Full Text Available OBJETIVO: Avaliar as diferenças histológicas da pneumonia intersticial usual entre biópsias cirúrgicas de lobos pulmonares distintos, utilizando um escore semiquantitativo. MÉTODOS: Foram selecionados todos os pacientes com o diagnóstico de fibrose pulmonar idiopática e submetidos à biópsia cirúrgica em dois lobos distintos no Hospital São Paulo e em hospitais afiliados da Universidade Federal de São Paulo, no período entre 1995 e 2005. Foi utilizado um método semiquantitativo na avaliação histológica dos espécimes, com base em estudos prévios, aplicando-se um escore para cada local submetido à biópsia. RESULTADOS: Nenhuma diferença estatisticamente significante foi encontrada nesta amostra de pacientes que viesse alterar o estágio da doença, com base no escore utilizado. Este achado foi independente do local da biópsia (lobo médio ou segmento lingular. CONCLUSÕES: Não foram observadas diferenças histológicas significantes entre os lobos pulmonares estudados. O diagnóstico histológico definitivo de pneumonia intersticial usual não alterou o estágio da doença.OBJECTIVE: To evaluate the differences between surgical biopsies of distinct lung lobes in terms of the histopathological features of usual interstitial pneumonia, using a semiquantitative score. METHODS: We selected all of the patients diagnosed with idiopathic pulmonary fibrosis and submitted to surgical biopsy in two distinct lobes between 1995 and 2005 at the Hospital São Paulo and other hospitals operated by the Federal University of São Paulo. In the histological evaluation of the specimens, we used a semiquantitative method based on previous studies, assigning a score to each of the biopsied sites. RESULTS: In this sample of patients, we found no statistically significant differences that would alter the stage of the disease, based on the score used. This finding was independent of the biopsy site (middle lobe or lingular segment. CONCLUSIONS: No

Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial.

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Zipfel, Stephan; Wild, Beate; Groß, Gaby; Friederich, Hans-Christoph; Teufel, Martin; Schellberg, Dieter; Giel, Katrin E; de Zwaan, Martina; Dinkel, Andreas; Herpertz, Stephan; Burgmer, Markus; Löwe, Bernd; Tagay, Sefik; von Wietersheim, Jörn; Zeeck, Almut; Schade-Brittinger, Carmen; Schauenburg, Henning; Herzog, Wolfgang

2014-01-11

Psychotherapy is the treatment of choice for patients with anorexia nervosa, although evidence of efficacy is weak. The Anorexia Nervosa Treatment of OutPatients (ANTOP) study aimed to assess the efficacy and safety of two manual-based outpatient treatments for anorexia nervosa--focal psychodynamic therapy and enhanced cognitive behaviour therapy--versus optimised treatment as usual. The ANTOP study is a multicentre, randomised controlled efficacy trial in adults with anorexia nervosa. We recruited patients from ten university hospitals in Germany. Participants were randomly allocated to 10 months of treatment with either focal psychodynamic therapy, enhanced cognitive behaviour therapy, or optimised treatment as usual (including outpatient psychotherapy and structured care from a family doctor). The primary outcome was weight gain, measured as increased body-mass index (BMI) at the end of treatment. A key secondary outcome was rate of recovery (based on a combination of weight gain and eating disorder-specific psychopathology). Analysis was by intention to treat. This trial is registered at http://isrctn.org, number ISRCTN72809357. Of 727 adults screened for inclusion, 242 underwent randomisation: 80 to focal psychodynamic therapy, 80 to enhanced cognitive behaviour therapy, and 82 to optimised treatment as usual. At the end of treatment, 54 patients (22%) were lost to follow-up, and at 12-month follow-up a total of 73 (30%) had dropped out. At the end of treatment, BMI had increased in all study groups (focal psychodynamic therapy 0·73 kg/m(2), enhanced cognitive behaviour therapy 0·93 kg/m(2), optimised treatment as usual 0·69 kg/m(2)); no differences were noted between groups (mean difference between focal psychodynamic therapy and enhanced cognitive behaviour therapy -0·45, 95% CI -0·96 to 0·07; focal psychodynamic therapy vs optimised treatment as usual -0·14, -0·68 to 0·39; enhanced cognitive behaviour therapy vs optimised treatment as usual -0·30

Integrating a Smartphone-Based Self-Management System into Usual Care of Advanced CKD.

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Ong, Stephanie W; Jassal, Sarbjit V; Miller, Judith A; Porter, Eveline C; Cafazzo, Joseph A; Seto, Emily; Thorpe, Kevin E; Logan, Alexander G

2016-06-06

Patient self-management has been shown to improve health outcomes. We developed a smartphone-based system to boost self-care by patients with CKD and integrated its use into usual CKD care. We determined its acceptability and examined changes in several clinical parameters. We recruited patients with stage 4 or 5 CKD attending outpatient renal clinics who responded to a general information newsletter about this 6-month proof-of-principle study. The smartphone application targeted four behavioral elements: monitoring BP, medication management, symptom assessment, and tracking laboratory results. Prebuilt customizable algorithms provided real-time personalized patient feedback and alerts to providers when predefined treatment thresholds were crossed or critical changes occurred. Those who died or started RRT within the first 2 months were replaced. Only participants followed for 6 months after recruitment were included in assessing changes in clinical measures. In total, 47 patients (26 men; mean age =59 years old; 33% were ≥65 years old) were enrolled; 60% had never used a smartphone. User adherence was high (>80% performed ≥80% of recommended assessments) and sustained. The mean reductions in home BP readings between baseline and exit were statistically significant (systolic BP, -3.4 mmHg; 95% confidence interval, -5.0 to -1.8 and diastolic BP, -2.1 mmHg; 95% confidence interval, -2.9 to -1.2); 27% with normal clinic BP readings had newly identified masked hypertension. One hundred twenty-seven medication discrepancies were identified; 59% were medication errors that required an intervention to prevent harm. In exit interviews, patients indicated feeling more confident and in control of their condition; clinicians perceived patients to be better informed and more engaged. Integrating a smartphone-based self-management system into usual care of patients with advanced CKD proved feasible and acceptable, and it appeared to be clinically useful. The results provide

INFLUENCE OF USUAL AND DUAL WHEELS ON SOIL PENETRATION RESISTANCE: THE GIS-APPROACH

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Zhukov A. V.

2015-12-01

Full Text Available GIS-APPROACH application has allowed establishing that usual wheels of machine-tractor units carry out considerable influence on soil which exceeds visible borders of a track of wheels on the dimensions. This influence shows in augmentation of soil penetration resistance at 100-155 % in comparison with the control on depth of 0-10 cm and on 20-30 % on depth of 45-50 %. It is impossible to exclude that influence of wheels proceeds more deeply, than tests have been conducted. Critical for cultivated plants value of soil penetration resistance in 3 MPa under the influence of usual wheels of agricultural machinery comes nearer practically to a surface. Character of profile changes of hardness in various regions influences of wheels allows assuming the long season of a relaxation of soil for achievement of background values of soil penetration resistance. The further researches are necessary for an establishment of concrete indicators of dynamics. Negative influence of an overstocking does not confine only deterioration of conditions of growth of assemblages of rootlets of plants. Infringement of processes of moving of moisture in the soil, the accelerated evaporation and the slowed down processes of a filtration and an infiltration, destruction of modular frame, activization of erosive processes is possible. The understanding of these processes will give the chance volume understanding of real influence of running systems of machine-tractor devices on bedrock. Region intensive influence of dual wheels is circumscribed by the top soil layers (0-15 cm. The major feature of influence of dual wheels is absence of an overstocking above critical levels. It is impossible to exclude possible positive influence of moderate inspissations of soil under the influence of dual wheels for growth of agricultural crops and moisture conservation in soil. The cumulative negative effect on soil crossed vehicles traces is probable. The long season of a relaxation of

Práctica 7. Fisioterapia en la insuficiencia venosa de miembros inferiores

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Cebrià Iranzo, M. Àngels

2011-01-01

La fisioterapia en la insuficiencia venosa y sus complicaciones (trombosis venosa), sustenta su aplicación en la estimulación de los mecanismos favorecedores del retorno venoso. Entre las medidas favorecedoras del retorno venoso encontramos: el postural en declive, la respiración abdomino-diafragmática y torácica, el masaje deplectivo, la presoterapia neumática, las medidas de contención-compresión y la cinesiterapia. La fisioteràpia en la insuficiència venosa i les seues complicacions (tr...

Envejecimiento fisiológico y predisposición al trauma craneoencefálico

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Mosquera Betancourt, Gretel

2011-01-01

Fundamento: el trauma craneoencefálico es la enfermedad neuroquirúrgica más frecuente en todos los grupos de edades y en el adulto mayor es la principal causa de morbilidad y de mortalidad neuroquirúrgica. El envejecimiento fisiológico predispone a la ocurrencia de esta variedad de traumas y a sus complicaciones. Objetivo: actualizar los conocimientos sobre los efectos del envejecimiento fisiológico, su predisposición al trauma craneoencefálico y a sus complicaciones en el adulto mayor. Desar...

Evaluation of Ahmed valve in the glaucoma of poor surgical prognosis

OpenAIRE

García González, Francisco; Novoa Sánchez, Ester; San Martín Geisse, Raúl

2001-01-01

Se intervinieron 8 pacientes con glaucoma de mal pronóstico quirúrgico a los que se les implantaron una válvula de Ahmed con la técnica quirúrgica convencional. Se logró controlar la presión intraocular (PIO). Las complicaciones fueron: hipotonía (75 %), desprendimiento coroideo (37,5 %), hifema (25,0 %), contacto tubo iridiano (25, 0 %), hipotalamia (12,5 %) y congestión en el área del implante (12,5 %). No hubo complicaciones intraoperatorias. Se obtuvieron resultados satisfactorios a media...

Study protocol: Cost-effectiveness of transmural nutritional support in malnourished elderly patients in comparison with usual care

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van Bokhorst-de van der Schueren Marian AE

2010-02-01

Full Text Available Abstract Background Malnutrition is a common consequence of disease in older patients. Both in hospital setting and in community setting oral nutritional support has proven to be effective. However, cost-effectiveness studies are scarce. Therefore, the aim of our study is to investigate the effectiveness and cost-effectiveness of transmural nutritional support in malnourished elderly patients, starting at hospital admission until three months after discharge. Methods This study is a randomized controlled trial. Patients are included at hospital admission and followed until three months after discharge. Patients are eligible to be included when they are ≥ 60 years old and malnourished according to the following objective standards: Body Mass Index (BMI in kg/m2 Conclusion In this randomized controlled trial we will evaluate the effect of transmural nutritional support in malnourished elderly patients after hospital discharge, compared to usual care. Primary endpoints of the study are changes in activities of daily living, body weight, body composition, quality of life, and muscle strength. An economic evaluation will be performed to evaluate the cost-effectiveness of the intervention in comparison with usual care. Trial registration Netherlands Trial Register (ISRCTN29617677, registered 14-Sep-2005

Distribución y caracterización morfológica de Hycleus duodecimmaculatus (Olivier, 1811 (Coleoptera, Meloidae, una especie poco conocida del oeste de Marruecos

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Ruiz, José L.

2014-06-01

Full Text Available Hycleus duodecimmaculatus (Coleoptera, Meloidae, Mylabrini is a poorly known species endemic to Morocco. Its geographic range extends along the coastal-subcoastal fringe of the Atlantic Coast, between Larache and Tiznit region (Arbaa Ait Ahmed. In this paper we study more than a hundred specimens, mostly preserved in the collection of the Museo Nacional de Ciencias Naturales (MNCN-CSIC, Spain. We provide new geographic records, including the Western Rif and confirm its presence in Marrakech (northwestern slopes of the High Atlas. Because of the scarcity of information, disperse and sometimes erroneous, we synthesize information available on chorology and phenology, and characterize the typology of the species’ habitat. From a taxonomic point of view, we redefine the species’ diagnostic characters and illustrate various aspects of the intra- and interpopulational morphological variability.Hycleus duodecimmaculatus (Coleoptera, Meloidae, Mylabrini es un endemismo de Marruecos muy poco conocido, cuya distribución se extiende por la franja costera-subcostera del Marruecos atlántico, entre Larache y la región de Tiznit (Arbaa Ait Ahmed. En este trabajo, realizado principalmente a partir del estudio de más de un centenar de ejemplares conservados en su mayor parte en la colección del Museo Nacional de Ciencias Naturales (MNCN-CSIC, España, se aportan nuevas citas geográficas incluyendo el Rif occidental, y se confirma su presencia en Marrakech (falda noroccidental del Alto Atlas. A la vista de la escasez de información existente para esta especie, dispersa y a veces errónea, se sintetiza la información corológica disponible, y se ofrecen datos sobre fenología de los adultos y tipología general de los hábitats que ocupa. Desde el punto de vista taxonómico, se redefinen los caracteres diagnósticos de la especie y se ilustran diversos aspectos de la variabilidad morfológica intra e interpoblacional.

Economic evaluation of a multifactorial, interdisciplinary intervention versus usual care to reduce frailty in frail older people.

Science.gov (United States)

Fairhall, Nicola; Sherrington, Catherine; Kurrle, Susan E; Lord, Stephen R; Lockwood, Keri; Howard, Kirsten; Hayes, Alison; Monaghan, Noeline; Langron, Colleen; Aggar, Christina; Cameron, Ian D

2015-01-01

To compare the costs and cost-effectiveness of a multifactorial interdisciplinary intervention versus usual care for older people who are frail. Cost-effectiveness study embedded within a randomized controlled trial. Community-based intervention in Sydney, Australia. A total of 241 community-dwelling people 70 years or older who met the Cardiovascular Health Study criteria for frailty. A 12-month multifactorial, interdisciplinary intervention targeting identified frailty characteristics versus usual care. Health and social service use, frailty, and health-related quality of life (EQ-5D) were measured over the 12-month intervention period. The difference between the mean cost per person for 12 months in the intervention and control groups (incremental cost) and the ratio between incremental cost and effectiveness were calculated. A total of 216 participants (90%) completed the study. The prevalence of frailty was 14.7% lower in the intervention group compared with the control group at 12 months (95% CI 2.4%-27.0%; P = .02). There was no significant between-group difference in EQ-5D utility scores. The cost for 1 extra person to transition out of frailty was $A15,955 (at 2011 prices). In the "very frail" subgroup (participants met >3 Cardiovascular Health Study frailty criteria), the intervention was both more effective and less costly than the control. A cost-effectiveness acceptability curve shows that the intervention would be cost-effective with 80% certainty if decision makers were willing to pay $A50,000 per extra person transitioning from frailty. In the very frail subpopulation, this reduced to $25,000. For frail older people residing in the community, a 12-month multifactorial intervention provided better value for money than usual care, particularly for the very frail, in whom it has a high probability of being cost saving, as well as effective. Trial registration: ACTRN12608000250336. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care

Usual alcohol consumption and suicide mortality among the Korean elderly in rural communities: Kangwha Cohort Study.

Science.gov (United States)

Yi, Sang-Wook; Jung, Myoungjee; Kimm, Heejin; Sull, Jae-Woong; Lee, Eunsook; Lee, Kwang Ok; Ohrr, Heechoul

2016-08-01

The evidence from prospective studies on whether greater usual alcohol consumption is associated with a higher risk of death by suicide in the general population is inconclusive. 6163 participants (2635 men; 3528 women) in a 1985 survey among rural residents in Korea aged 55 years and above were followed until 2008. A Cox model was used to calculate HRs of suicide death after adjustment for demographic, socioeconomic and health-related confounders. 37 men and 24 women died by suicide. Elderly persons who consumed alcohol daily, 70 g alcohol (5 drinks) or more per drinking day, or 210 g alcohol (15 drinks) or more per week had higher suicide mortality (prisk of suicide death, respectively. Women had a higher relative risk of suicide death associated with alcohol consumption, compared with men. A greater frequency and amount of usual alcohol consumption was linearly associated with higher suicide death. Given the same amount of alcohol consumption, women might have a higher relative risk of suicide than men. Our findings support 'the lower the better' for alcohol intake, no protective effect of moderate alcohol consumption, and a sex-specific guideline (lower alcohol threshold for women) as actions to prevent suicide death. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Bacterias causantes de enfermedades transmitidas por alimentos: una mirada en colombia

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Zamira Soto Varela

2016-01-01

Full Text Available Objetivo: Las enfermedades de transmisión alimentaria constituyen un grave problema de salud pública a nivel mundial; entre sus causas más frecuentes se encuentran los patógenos bacterianos, los cuales generan desde síntomas gastrointestinales hasta complicaciones que pueden conducir a la muerte. En esta revisión se describen estudios sobre detección de patógenos bacterianos en diferentes alimentos en Colombia publicados entre 2010 y 2013, y se presenta información acerca de las características y prevalencia de los microorganismos encontrados, alimentos implicados y caracterización de los aislados. La búsqueda en bases de datos arrojó un total de 16 artículos enfocados directamente a la detección de cinco patógenos: Salmonella spp., Listeria monocytogenes, Escherichia coli, Aeromonas spp. y Vibrio spp. La mayor parte de los estudios correspondió al género Salmonella. No se hallaron investigaciones relacionadas con otras bacterias causantes de enfermedades de transmisión alimentaria. Los productos analizados fueron principalmente de origen animal, desde alimentos crudos, como pescado y carnes, hasta alimentos listos para el consumo. Esta revisión evidencia que a pesar de la importancia a nivel de salud pública de detectar y caracterizar bacterias patógenas trasmitidas por alimentos existen muy pocos estudios publicados relacionados con esta temática en el periodo revisado. Asimismo, los trabajos se encaminaron primordialmente a la búsqueda del microorganismo en el producto final y no a lo largo de la cadena productiva.

Trastorno neurocognitivo asociado al virus de inmunodeficiencia humana

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Erik Guevara-Silva

2014-04-01

Full Text Available El trastorno neurocognitivo asociado a VIH (TNAV es una complicación poco conocida pero de elevada prevalencia e impacto en los pacientes con VIH. El término TNAV agrupa un espectro de complicaciones progresivas del sistema nervioso central (SNC, desde un compromiso neurocognitivo asintomático y un trastorno neurocognitivo leve hasta una demencia asociada a VIH (DAV. Mientras que la incidencia de DAV ha disminuido significativamente con el tratamiento antirretroviral de gran actividad (TARGA, las formas más leves de TNAV se han incrementado. En esta revisión, describimos la nomenclatura actualizada y definiciones de caso para orientar el diagnóstico del TNAV. También, resumimos las manifestaciones clínicas, diagnóstico y recomendaciones para el tratamiento. Finalmente, mientras que el deterioro cognitivo es típicamente diagnosticado con una evaluación neuropsicológica completa, la interpretación de los resultados se basa en la comparación entre el rendimiento del paciente con valores normalizados en poblaciones ajustados culturalmente y según edad; así, los resultados de estas pruebas son válidos solo si existen datos representativos normalizados adecuadamente para un paciente. Por lo tanto, proponemos un grupo de pruebas neuropsicológicas breves validadas en nuestra población peruana, que pueden ser utilizadas para la detección temprana del TNAV no solo por los neurólogos sino también por el médico tratante del paciente con VIH o en centros de escasos recursos.

Evaluación del estado nutricional según compartimentos somático, graso y proteico-visceral al ingreso en una unidad de cuidados intensivos

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María Esther Rodríguez Delgado

2014-12-01

Full Text Available La alta prevalencia de malnutrición en el ámbito hospitalario continúa siendo un problema de especial relevancia en España en la actualidad debido al impacto negativo sobre la evolución clínica del paciente hospitalizado. Numerosos estudios evidencian tasas de desnutrición hospitalaria cercanas a un 33-50% de la población hospitalizada. Este impacto es mucho más importante y de mayor trascendencia cuando hablamos de pacientes críticos dentro de la unidad de Cuidados Intensivos. Estados nutricionales y metabólicos deficitarios tienen una repercusión directa sobre el enfermo, entorpeciendo la evolución clínica del enfermo e incrementando las tasas de morbimortalidad y de complicaciones hospitalarias así como los costes sanitarios derivados de ello. Desarrollar un adecuado abordaje nutricional mediante soportes nutricionales es un objetivo fundamental y un pilar básico para un óptimo manejo del paciente críticamente enfermo, pudiéndose ver obstaculizado en numerosas ocasiones, especialmente en pacientes que cursan con hipercatabolismo e hipermetabolismo con un consumo energético importante secundario al proceso patológico que motivó el ingreso. A todo ello hay que sumar la gran dificultad que supone una valoración integral y completa de su estado nutricional donde muchos de estos parámetros, encuestas nutricionales y pruebas funcionales puede resultar complicadas de realizar, poco fidedignos, o pueden aportan datos incorrectos, incompletos o con imposibilidad de su realización.

Abdominal actinomycosis: a report of three cases of this uncommon infection; Actinomicos abdominal: una infeccion poco frecuente. A proposito de tres casos

Energy Technology Data Exchange (ETDEWEB)

Ostiz, S.; Sanchez, C.; Jimenez, G.; Caballero, P.; Cordero, J. L.; Montes, M. [Hospital Virgen del Camino. Pamplona (Spain)

1999-07-01

Abdominal actinomycosis is a rare infection caused by Actinomyces, a grampositive bacterium that generally exists as a saprophyte in the oral cavity and colon. The diagnosis is usually difficult due to its low incidence and nonspecific clinical and radiological findings. We present three new cases of abdominal actinomycosis. The first involved several pelvic structures and abdominal wall. The second was detected in left hepatic lobe. In the third case, the infection was located in descending colon. We stress the wide range of presenting signs, describing the findings that, when taken together, suggest the correct diagnosis. (Author) 13 refs.

Effect of lifestyle coaching versus care coordination versus treatment as usual in people with severe mental illness and overweight

DEFF Research Database (Denmark)

Jakobsen, Ane Storch; Speyer, Helene; Nørgaard, Hans Christian Brix

2017-01-01

as usual group (P = 0.24). Also, there were no intervention effects for any secondary or exploratory outcomes, including cardiorespiratory fitness, weight, physical activity, diet and smoking. No reported adverse events could be ascribed to the intervention. We conclude that there was neither any direct...

Angioleiomioma lingual: A propósito de un caso Lingual angioleiomyoma: A case report

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I. Peña González

2008-04-01

Full Text Available Introducción. Los leiomiomas orales son tumores del músculo liso poco frecuentes debido a la escasez de este tejido en la boca. La forma más frecuente es el angioleiomioma. Son tumoraciones generalmente asintomáticas, que pueden malignizar, por lo que está indicada su extirpación. Su diagnóstico es anatomopatológico siendo importante diferenciarlas de su forma maligna. El tratamiento es quirúrgico y la recidiva inusual. Material y método. Se presenta un caso de angileiomioma lingual y sus características anatomopatológicas, relacionando los hallazgos con la literatura existente Discusión. Los angioleiomiomas linguales son tumoraciones poco frecuentes, generalmente asintomáticas y de fácil acceso quirúrgico. Los hallazgos anatomopatológicos consisten en una proliferación vascular rodeada de un estroma positivo a la actina músculo liso específica. Ha de tenerse en cuenta en el diagnóstico diferencial de masas linguales tales como abscesos, neuromas y tumores de glándulas salivales menores. El tratamiento de elección es quirúrgico y la recidiva inusual. Conclusiones. Los angioleiomiomas linguales son tumores benignos poco frecuentes pero que deben ser tenidos en cuenta en el diagnóstico diferencial de masas linguales. Es importante diferenciarlos de su forma maligna a través de su estudio anatomopatológico.Introduction. Oral leiomyomas are uncommon smooth muscle tumors due to the scant presence of this tissue in the oral cavity. The most common type is angioleiomyoma. Angioleiomyomas usually are asymptomatic tumors that can become malignant, so surgery is necessary. These tumors have a histopathologic diagnosis and the differential diagnosis from their malignant counterparts is important. Surgery is the treatment of choice and recurrence is rare. Material and method. We report a case of lingual angioleiomyoma, its histopathologic findings, and our literature review. Discussion. Lingual angioleiomyomas are tumors that are

Aspectos Psicológicos en la depresión postparto

OpenAIRE

Asensio Alonso, Cintia

2017-01-01

Estudios realizados por La Organización Mundial de la Salud (OMS) establecen que 20 millones de los 136 millones de partos que se producen cada año presentan complicaciones diversas. (1) Dentro del ámbito psicológico, las principales complicaciones son tres: Disforia postparto, Psicosis postparto y Depresión postparto. Esta última presenta una prevalencia del 12-13% de los casos, pudiéndose reducir este número con una detección precoz y un tratamiento adecuado. Por ello, el fin de este tra...

Coneixements, actituds i percepció versus la infecció per Virus del Papil·loma Humà en els professionals d'infermeria : tendències en salut pública

OpenAIRE

Figueras Besalú, Marina

2013-01-01

Actualment, s’evidencia una dificultat en el seguiment estricte de les infeccions de transmissió sexual (ITS). A nivell mundial, aquestes causen un problema de Salut Pública (SP) en termes de morbiditat i mortalitat per complicacions i seqüeles que es poden originar si no es diagnostiquen i no es tracten adequadament. Entre les ITS més comunes trobem la provocada pel Virus del Papil·loma Humà (VPH), la principal causant del càncer de cèrvix, entre altres complicacions La família de VPH compta...

Anticoncepción de emergencia

OpenAIRE

García Mirás, Ramón; Lay Rodríguez, Adalberto; Riverón Cobo, Ana María

2002-01-01

Se realizó una revisión bibliográfica sobre el tema, con el objetivo de lograr que nuestra población conozca y sea capaz de utilizar la anticoncepción de emergencia para disminuir los embarazos involuntarios con su consecuente interrupción y complicaciones. Es un método hormonal que se puede realizar con los preparados anticonceptivos con que contamos, es eficaz y con escasas complicaciones.A bibliographic review on emergency contraception was made so that our population knows and be able to ...

Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease.

Science.gov (United States)

Lenferink, Anke; Brusse-Keizer, Marjolein; van der Valk, Paul Dlpm; Frith, Peter A; Zwerink, Marlies; Monninkhof, Evelyn M; van der Palen, Job; Effing, Tanja W

2017-08-04

Chronic Obstructive Pulmonary Disease (COPD) self-management interventions should be structured but personalised and often multi-component, with goals of motivating, engaging and supporting the patients to positively adapt their behaviour(s) and develop skills to better manage disease. Exacerbation action plans are considered to be a key component of COPD self-management interventions. Studies assessing these interventions show contradictory results. In this Cochrane Review, we compared the effectiveness of COPD self-management interventions that include action plans for acute exacerbations of COPD (AECOPD) with usual care. To evaluate the efficacy of COPD-specific self-management interventions that include an action plan for exacerbations of COPD compared with usual care in terms of health-related quality of life, respiratory-related hospital admissions and other health outcomes. We searched the Cochrane Airways Group Specialised Register of trials, trials registries, and the reference lists of included studies to May 2016. We included randomised controlled trials evaluating a self-management intervention for people with COPD published since 1995. To be eligible for inclusion, the self-management intervention included a written action plan for AECOPD and an iterative process between participant and healthcare provider(s) in which feedback was provided. We excluded disease management programmes classified as pulmonary rehabilitation or exercise classes offered in a hospital, at a rehabilitation centre, or in a community-based setting to avoid overlap with pulmonary rehabilitation as much as possible. Two review authors independently assessed trial quality and extracted data. We resolved disagreements by reaching consensus or by involving a third review author. Study authors were contacted to obtain additional information and missing outcome data where possible. When appropriate, study results were pooled using a random-effects modelling meta-analysis. The primary

Skin care education and individual counselling versus treatment as usual in healthcare workers with hand eczema

DEFF Research Database (Denmark)

Ibler, K.S.; Jemec, G.B.E.; Thomsen, S.F.

2012-01-01

Objective: To evaluate the effect of a secondary prevention programme with education on skin care and individual counselling versus treatment as usual in healthcare workers with hand eczema. Design: Randomised, observer blinded parallel group superiority clinical trial. Setting: Three hospitals...... in Denmark. Participants: 255 healthcare workers with self reported hand eczema within the past year randomised centrally and stratified by profession, severity of eczema, and hospital. 123 were allocated to the intervention group and 132 to the control group. Interventions: Education in skin care...

Having a usual source of care and its associated factors in Korean adults: a cross-sectional study of the 2012 Korea Health Panel Survey.

Science.gov (United States)

An, Ah Reum; Kim, Kyoungwoo; Lee, Jae-Ho; Sung, Nak-Jin; Lee, Sang-Il; Hyun, Min Kyung

2016-11-29

Usual source of care (USC) is one of the hallmarks of primary care. We aimed to examine the status of having a USC and its patient-related sociodemographic factors among Korean adults. Data were obtained from the 2012 Korea Health Panel survey. Panel participants were selected for the study who were aged 18 years or older and who replied to questionnaire items on having a USC (n = 11,935). Of the participants, 21.5% had a usual place and 13.9% had a usual physician. Reasons for not having a USC were seldom being ill (66.1%), the preference to visit multiple medical institutions (27.9%), and others. The private community clinic was the most common type of usual place (57.0%). In patient-reported attributes of care provided by a usual physician, the percentages of positive responses for comprehensiveness and coordination were 67.2% and 34.5%, respectively. By institution type, primary care clinics showed the lowest percentage (32.8%) of positive responses for coordination. Adjusted odds ratios of having a usual physician were 3.77 (95% confidence interval, CI: 3.75-3.79) for those aged 65 years or older (vs. aged 18-34 years), 1.31 (CI: 1.30-1.31) for females (vs. males), 0.72 (CI: 0.72-0.73) for unmarried people (vs. married), 1.16 (CI: 1.16-1.16) for college graduates or higher (vs. elementary school graduate or less), 0.64 for the fifth quintile (vs. the first quintile) by household income, 1.53 (CI: 1.52-1.54) for Medical Aid (vs. employee health insurance) for type of health insurance, and 4.09 (CI: 4.08-4.10) for presence (vs. absence) of a chronic diseases. The proportion of Korean adults who have a USC is extremely low, the most influential factor of having a USC is having a chronic disease or not, and Korean patients experience much poorer health care coordination than do patients in other industrialized countries. The findings of this study will give insight to researchers and policy makers regarding the potential facilitators of and barriers to

Remission and rheumatoid arthritis: Data on patients receiving usual care in twenty-four countries

DEFF Research Database (Denmark)

Sokka, Tuulikki; Hetland, Merete Lund; Mäkinen, Heidi

2008-01-01

and lowest remission rates was >/=15% in 10 countries, 5-14% in 7 countries, and definition of remission, male sex, higher education, shorter disease duration, smaller number of comorbidities, and regular......OBJECTIVE: To compare the performance of different definitions of remission in a large multinational cross-sectional cohort of patients with rheumatoid arthritis (RA). METHODS: The Questionnaires in Standard Monitoring of Patients with RA (QUEST-RA) database, which (as of January 2008) included 5......,848 patients receiving usual care at 67 sites in 24 countries, was used for this study. Patients were clinically assessed by rheumatologists and completed a 4-page self-report questionnaire. The database was analyzed according to the following definitions of remission: American College of Rheumatology (ACR...

Remission and rheumatoid arthritis: Data on patients receiving usual care in twenty-four countries

DEFF Research Database (Denmark)

Sokka, Tuulikki; Hetland, Merete Lund; Mäkinen, Heidi

2008-01-01

and lowest remission rates was >/=15% in 10 countries, 5-14% in 7 countries, and generally low remission rates [definition of remission, male sex, higher education, shorter disease duration, smaller number of comorbidities, and regular......OBJECTIVE: To compare the performance of different definitions of remission in a large multinational cross-sectional cohort of patients with rheumatoid arthritis (RA). METHODS: The Questionnaires in Standard Monitoring of Patients with RA (QUEST-RA) database, which (as of January 2008) included 5......,848 patients receiving usual care at 67 sites in 24 countries, was used for this study. Patients were clinically assessed by rheumatologists and completed a 4-page self-report questionnaire. The database was analyzed according to the following definitions of remission: American College of Rheumatology (ACR...

Effectiveness of Standardized Physical Therapy Exercises for Patients With Difficulty Returning to Usual Activities After Decompression Surgery for Subacromial Impingement Syndrome: Randomized Controlled Trial.

Science.gov (United States)

Christiansen, David Høyrup; Frost, Poul; Falla, Deborah; Haahr, Jens Peder; Frich, Lars Henrik; Andrea, Linda Christie; Svendsen, Susanne Wulff

2016-06-01

Little is known about the effectiveness of exercise programs after decompression surgery for subacromial impingement syndrome. For patients with difficulty returning to usual activities, special efforts may be needed to improve shoulder function. The purpose of this study was to evaluate the effectiveness at 3 and 12 months of a standardized physical therapy exercise intervention compared with usual care in patients with difficulty returning to usual activities after subacromial decompression surgery. A multicenter randomized controlled trial was conducted. The study was conducted in 6 public departments of orthopedic surgery, 2 departments of occupational medicine, and 2 physical therapy training centers in Central Denmark Region. One hundred twenty-six patients reporting difficulty returning to usual activities at the postoperative clinical follow-up 8 to 12 weeks after subacromial decompression surgery participated. A standardized exercise program consisting of physical therapist-supervised individual training sessions and home training was used. The primary outcome measure was the Oxford Shoulder Score. Secondary outcome measures were the Constant Score and the Fear-Avoidance Beliefs Questionnaire. At 3 and 12 months, follow-up data were obtained for 92% and 83% of the patients, respectively. Intention-to-treat analyses suggested a between-group difference on the Oxford Shoulder Score favoring the exercise group at 3 months, with an adjusted mean difference of 2.0 (95% confidence interval=-0.5, 4.6), and at 12 months, with an adjusted mean difference of 5.8 (95% confidence interval=2.8, 8.9). Significantly larger improvements for the exercise group were observed for most secondary and supplementary outcome measures. The nature of the exercise intervention did not allow blinding of patients and care providers. The standardized physical therapy exercise intervention resulted in statistically significant and clinically relevant improvement in shoulder pain and

Mindfulness based cognitive therapy versus treatment as usual in adults with attention deficit hyperactivity disorder (ADHD).

Science.gov (United States)

Janssen, Lotte; Kan, Cornelis C; Carpentier, Pieter J; Sizoo, Bram; Hepark, Sevket; Grutters, Janneke; Donders, Rogier; Buitelaar, Jan K; Speckens, Anne E M

2015-09-15

Adults with attention deficit hyperactivity disorder (ADHD) often present with a lifelong pattern of core symptoms that is associated with impairments of functioning in daily life. This has a substantial personal and economic impact. In clinical practice there is a high need for additional or alternative interventions for existing treatments, usually consisting of pharmacotherapy and/or psycho-education. Although previous studies show preliminary evidence for the effectiveness of mindfulness-based interventions in reducing ADHD symptoms and improving executive functioning, these studies have methodological limitations. This study will take account of these limitations and will examine the effectiveness of Mindfulness Based Cognitive Therapy (MBCT) in further detail. A multi-centre, parallel-group, randomised controlled trial will be conducted in N = 120 adults with ADHD. Patients will be randomised to MBCT in addition to treatment as usual (TAU) or TAU alone. Assessments will take place at baseline and at three, six and nine months after baseline. Primary outcome measure will be severity of ADHD symptoms rated by a blinded clinician. Secondary outcome measures will be self-reported ADHD symptoms, executive functioning, mindfulness skills, self-compassion, positive mental health and general functioning. In addition, a cost-effectiveness analysis will be conducted. This trial will offer valuable information about the clinical and cost-effectiveness of MBCT in addition to TAU compared to TAU alone in adults swith ADHD. ClinicalTrials.gov NCT02463396. Registered 8 June 2015.

Complicaciones maternas y mortalidad perinatal en el Síndrome de Hellp: Registro multicéntrtico en unidades de cuidados intensivos del área Buenos Aires Maternal morbidity and perinatal mortality in HELLP syndrome. Multicentric studies in intensive care units in Buenos Aires area

Directory of Open Access Journals (Sweden)

Eduardo Malvino

2005-03-01

Full Text Available Se analizaron en forma retrospectiva las características clínicas, complicaciones, gravedad, y sobrevivencia materna y fetal, en un grupo de gestantes con síndrome HELLP ( Hemolysis , Elevated Liver enzyme levels, Low Platelet count que requirieron admisión en cuatro unidades de cuidados intensivos del área metropolitana Buenos Aires, Argentina. Durante el período comprendido entre marzo de 1997 y marzo de 2003 se evaluaron 62 pacientes en la segunda mitad del embarazo o el puerperio inmediato que cumplían criterios diagnósticos de hipertensión inducida por el embarazo, asociado a plaquetopenia 70 UI/l, láctico deshidrogenasa >600 UI/l, bilirrubina total >1.2 mg / dl , y/o frotis de sangre periférica con signos de hemólisis. La edad promedio fue 28 ± 8 años; número de gestas promedio 2.7 ± 2.3; edad gestacional media 33 ± 4 semanas. Según el grado de plaquetopenia, 23 casos pertenecieron a la clase 1, 29 a la clase 2 y el resto a la clase 3 de la clasificación de Martin . Hubo 16 formas eclámpticas. El recuento plaquetario promedio fue 67 604 ± 31 535/ mm3 ; TGO 271 ± 297 UI/l; TGP 209 ± 178 UI/l; LDH 1 444 ± 1 295 UI/l; creatininemia 1.1 ± 0.8 mg / dl. Cuarenta y una pacientes cursaron con diverso grado de deterioro del filtrado glomerular, con requerimiento de tratamiento hemodialítico y plasmaféresis en un caso. Se presentó insuficiencia respiratoria vinculada a síndrome de distrés respiratorio del adulto en cuatro enfermas. Todas las puérperas sobrevivieron y se comprobaron cuatro muertes perinatales. En la población estudiada, se observó baja prevalencia de complicaciones graves, óptima sobrevivencia materna y baja mortalidad perinatal.We analized the clinical characteristics, complications, severity, and maternal and fetal survival of patients suffering from HELLP syndrome ( Hemolysis , Elevated Liver enzymes level, Low Platelet count requiring admission to the intensive care unit in four hospitals from

Effectiveness of Standardized Physiotherapy Exercises for Patients With Difficulty Returning to Usual Activities After Decompression Surgery for Subacromial Impingement Syndrome

DEFF Research Database (Denmark)

Christiansen, David Høyrup; Frost, Poul; Falla, Deborah

2016-01-01

BACKGROUND: Little is known about the effectiveness of exercise programs after decompression surgery for subacromial impingement syndrome. For patients with difficulty returning to usual activities, special efforts may be needed to improve shoulder function. OBJECTIVE: The purpose of this study w...

The Glycoprofile Patterns of Endothelial Cells in Usual Interstitial Pneumonia

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A Barkhordari

2014-09-01

Full Text Available [THIS ARTICLE HAS BEEN RETRACTED FOR DUPLICATE PUBLICATION] Background: The pathological classification of cryptogenic fibrosing alveolitis has been a matter of debate and controversy for histopathologists. Objective: To identify and specify the glycotypes of capillary endothelial cells in usual interstitial pneumonia (UIP compared to those found in normal tissue. Methods: Sections of formalin-fixed, paraffin-embedded blocks from 16 cases of UIP were studied by lectin histochemistry with a panel of 27 biotinylated lectins and an avidin-peroxidase revealing system. Results: High expression of several classes of glycan was seen de novo in capillary endothelial cells from patients with UIP including small complex and bi/tri-antennary bisected complex N-linked sequences bolund by Concanavalin A and erythro-phytohemagglutinin, respectively, GalNAca1 residues bound by Helix pomatia and Maclura pomifera agglutinins, and L-fucosylated derivatives of type II glycan chains recognized by Ulex europaeus agglutinin-I. Glycans bound by agglutinins from Lycopersicon esculentum (β1,4GlcNAc and Wisteria floribunda (GalNAc as well as GlcNAc oligomers bound by Phytolacca americana and succinylated Wheat Germ agglutinin were also seen in the capillary endothelial cells of UIP. In contrast, L-fucosylated derivatives of type I glycan chains were absent in cells from cases of UIP when Anguilla anguilla agglutinin was applied, unlike the situation in normal tissue. Conclusion: These results may indicate existence of two distinct populations of endothelial cell in UIP with markedly different patterns of glycosylation, reflecting a pattern of differentiation and angiogenesis, which is not detectable morphologically.

Comparative experimental and numerical studies of usual insulation materials and PCMs in buildings at Casablanca

Science.gov (United States)

Mourid, Amina; El Alami, Mustapha

2018-05-01

In this paper, we present a comparative thermal study of the usual insulation materials used in the building as well as the innovate one like phase change materials (PCMs). Both experimental study and numerical approach were applied in this work for summer season. In the experimental study the PCM was installed on the outer surface on the ceiling of one of two full-scale rooms located at FSAC, Casablanca. A simulation model was performed with TRNSYS’17 software. We have established as a criterion of comparison the internal temperatures. An economic study also has been carried out. Based on this latter, that the PCM is most efficient.

Cost-effectiveness of cognitive-behavioral therapy versus treatment as usual for anxiety disorders in children with autism spectrum disorder

NARCIS (Netherlands)

van Steensel, F.J.A.; Dirksen, C.D.; Bögels, S.M.

2014-01-01

The study's aim was to evaluate the cost-effectiveness of CBT compared to treatment as usual (TAU). In total, 49 children aged 8-18 years with ASD and comorbid anxiety disorders, and their parents, participated; 24 were assigned to CBT and 25 were assigned to TAU. Outcome measures were the

The feasibility of a pragmatic randomised controlled trial to compare usual care with usual care plus individualised homeopathy, in children requiring secondary care for asthma.

Science.gov (United States)

Thompson, E A; Shaw, A; Nichol, J; Hollinghurst, S; Henderson, A J; Thompson, T; Sharp, D

2011-07-01

To test the feasibility of a pragmatic trial design with economic evaluation and nested qualitative study, comparing usual care (UC) with UC plus individualised homeopathy, in children requiring secondary care for asthma. This included recruitment and retention, acceptability of outcome measures patients' and health professionals' views and experiences and a power calculation for a definitive trial. In a pragmatic parallel group randomised controlled trial (RCT) design, children on step 2 or above of the British Thoracic Society Asthma Guidelines (BTG) were randomly allocated to UC or UC plus a five visit package of homeopathic care (HC). Outcome measures included the Juniper Asthma Control Questionnaire, Quality of Life Questionnaire and a resource use questionnaire. Qualitative interviews were used to gain families' and health professionals' views and experiences. 226 children were identified from hospital clinics and related patient databases. 67 showed an interest in participating, 39 children were randomised, 18 to HC and 21 to UC. Evidence in favour of adjunctive homeopathic treatment was lacking. Economic evaluation suggests that the cost of additional consultations was not offset by the reduced cost of homeopathic remedies and the lower use of primary care by children in the homeopathic group. Qualitative data gave insights into the differing perspectives of families and health care professionals within the research process. A future study using this design is not feasible, further investigation of a potential role for homeopathy in asthma management might be better conducted in primary care with children with less severe asthma. Copyright © 2011 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

The 'carry-over' effects of patient self-testing: positive effects on usual care management by an anticoagulation management service.

LENUS (Irish Health Repository)

Ryan, Fiona

2010-11-01

Patient self-testing (PST) of the international normalised ratio (INR) has a positive effect on anticoagulation control. This study investigated whether the benefits of PST (other than increased frequency of testing, e.g. patient education, empowerment, compliance etc.) could be \\'carried-over\\' into usual care management after a period of home-testing has ceased.

Economic evaluation of an intensive group training protocol compared with usual care physiotherapy in patients with chronic low back pain

NARCIS (Netherlands)

van der Roer, N.; van Tulder, M.; van Mechelen, W.; de Vet, H.C.W.

2008-01-01

STUDY DESIGN. Economic evaluation from a societal perspective conducted alongside a randomized controlled trial with a follow-up of 52 weeks. OBJECTIVE. To evaluate the cost effectiveness and cost utility of an intensive group training protocol compared with usual care physiotherapy in patients with

Usual water-related behaviour and 'near-drowning' incidents in young adults.

Science.gov (United States)

Gulliver, Pauline; Begg, Dorothy

2005-06-01

To describe usual water-related behaviour and 'near-drowning' incidents in a cohort of young New Zealand adults. This was a cross-sectional study based on data collected as part of the Dunedin Multidisciplinary Health and Development Study, which is the study of a cohort (n = 1,037) born between 1 April 1972 and 31 March 1973 in Dunedin, New Zealand. The data analysed were collected at age 21 (1993/94). Each study member was given a face-to-face interview using a structured questionnaire. Males reported a higher level of water confidence, exposure to risk behaviours, and exposure to unsafe locations, and more 'near-drowning' incidents, than the females, but protective behaviour did not differ. Males and females who were 'confident' in the water were more likely to be exposed to unsafe water locations, and water-confident males were more likely to drink alcohol before water activities, but not boating. A total of 169 'near-drowning' incidents were reported by 141 study members (63% males). 'Near-drowning' incidents were associated with unsafe swimming environments for males (p near-drowning' incidents among a high-risk age group. Larger case-control studies are required to further investigate risk factors for 'near-drowning'. IMPLICATIONS FOR PRACTITIONERS: Further investigation is required to determine the effectiveness of providing water skills acquisition in both safe and unsafe environments on 'near-drowning' experience.

Complicações microvasculares e disfunção autonômica cardíaca em pacientes com diabete melito tipo 1 Complicaciones microvasculares y disfunción autonómica cardíaca en pacientes con diabetes mellittus tipo 1 Microvascular complications and cardiac autonomic dysfunction in patients with diabetes mellitus type 1

Directory of Open Access Journals (Sweden)

Fernando K Almeida

2011-06-01

Full Text Available FUNDAMENTO: A presença de neuropatia autonômica cardíaca (NAC em pacientes com diabete melito (DM está associada a aumento da mortalidade e a complicações crônicas microvasculares do diabete. OBJETIVO: Investigar uma possível associação entre achados sugestivos de NAC durante a realização do teste ergométrico (TE e nefropatia e retinopatia em pacientes com DM tipo 1. MÉTODOS: Realizamos um estudo transversal com 84 pacientes com DM tipo 1. Todos os pacientes foram submetidos à avaliação clínica e laboratorial e realizaram TE, sendo que aqueles que apresentaram achados sugestivos de isquemia miocárdica foram excluídos da análise dos dados (n = 3. A avaliação de complicações microvasculares (retinopatia e nefropatia foi realizada na amostra. RESULTADOS: Os pacientes com nefropatia e aqueles com retinopatia atingiram uma frequência cardíaca (FC durante o pico de exercício (FC máxima menor e apresentaram aumento menor da FC em relação ao repouso (ΔFC pico quando comparados com aqueles sem estas complicações. Esses pacientes também apresentaram menor redução da FC no segundo e 4º minutos após o final do teste (ΔFC recuperação dois e 4 minutos. Após realização de análise multivariada com controle para os possíveis fatores de confusão, os ΔFC recuperação em dois e 4 minutos, FC máxima e o ΔFC pico permaneceram significativamente associados à retinopatia; e os ΔFC recuperação no segundo e 4º minutos permaneceram associados à presença de nefropatia. CONCLUSÃO: O TE pode ser considerado um instrumento adicional para a detecção precoce de NAC e para identificar pacientes em maior risco para complicações microvasculares do diabete.BACKGROUND: LA presencia de neuropatía autonómica cardíaca (NAC en pacientes con diabetes mellittus (DM está asociada a aumento de la mortalidad y a complicaciones crónicas microvasculares de diabetes. OBJECTIVE: Investigar una posible asociación entre

Disease progression in usual interstitial pneumonia compared with desquamative interstitial pneumonia. Assessment with serial CT

International Nuclear Information System (INIS)

Hartman, T.E.; Primack, S.L.; Kang, E.Y.

1997-01-01

Objective. To determine the outcome of areas of ground-glass attenuation and assess disease progression on serial high-resolution CT (HRCT) scans of patients with biopsy specimen-proved usual interstitial pneumonia (UIP) and desquamative interstitial pneumonia (DIP). Materials and methods. Twelve patients with biopsy specimen-proved UIP and 11 patients with biopsy specimen-proved DIP who had initial and follow-up HRCT scans (median interval, 10 months) were reviewed. Eleven patients with UIP and 11 with DIP received treatment between the initial and follow-up CT scans. The scans were evaluated for the presence and extent of ground-glass attenuation, irregular linear opacities and honeycombing, and overall extent of parenchymal involvement. Results. On initial CT scans, all 12 patients with UIP had areas of ground-glass attenuation (mean±SD extent, 30±16%) and irregular lines (mean±SD extent, 17±7%) and 10 patients had honeycombing (mean±SD extent, 10±6%). All 11 patients with DIP had areas of ground-glass attenuation on initial HRCT scans (mean±SD extent, 51±26%), 5 patients had irregular linear opacities (mean±SD extent, 5±5%), and 1 patient had honeycombing. Nine of the 12 patients with UIP showed increase in the extent of ground-glass attenuation (n=6) or progression to irregular lines (n=2) or honeycombing (n=4) on follow-up as compared with only 2 patients with DIP who showed progression to irregular lines (n=1) or honeycombing (n=1) (p 2 test). Conclusion. In patients with UIP, areas of ground-glass attenuation usually increase in extent or progress to fibrosis despite treatment. Areas of ground-glass attenuation in most patients with DIP remain stable or improve with treatment. (authors)

Diabetes y Enfermedad Coronaria

Directory of Open Access Journals (Sweden)

Alfredo Jácome Roca

1997-06-01

Full Text Available

La Diabetes Mellitus es un síndrome con etiología multifactorial y con variadas expresiones en la clínica y en las complicaciones. Las formas más comunes son la diabetes tipo 11 o diabetes no insulino dependiente (DMNID y la tipo 1 (antigua juvenil o insulino-dependiente (DMID. Las más notables diferencias entre la frecuencia e intensidad de sus manifestaciones clínicas y complicaciones así como de su etiología son muy conocidas pero las anotaremos a manera de repaso.

En la DMID o tipo 1 (la menos frecuente al menos dos genes localizados en el sistema HLA, región de antígenos de histocompatibilidad en el brazo corto del cromosoma 6, aumentan el riesgo. Se observa la presencia en el haplotipo de los antígenos B8/BWI5 y DW3/DW4. Posteriormente un virus (paperas, sarampión, mononucleosis, Cocksakie B desencadenarían una destrucción autoinmune de islotes!.

En la DMNID o tipo II influyen la herencia y la obesidad como factores más notorios. Como en la DMID la producción de insulina es cerca a cero o cero, hay mayor tendencia a hiperglicemias marcadas, coma diabético y complicaciones microvasculares (nefropatía, retinopatía y neuropatía, pero también pueden haber complicaciones “macrovasculares” o aterogénicas, como enfermedad coronaria y arterioesclerosis periférica. La DMNID o tipo 11 presenta mayor incidencia de la última clase de complicaciones y menos de las primeras y generalmente hay “hiperinsulinemia” y obesidad asociadas. Los tipo 1generalmente mueren de falla renal y ciegos mientras los de tipo 11 mueren de infarto

Como noticias recientes en diabetes, se ha comprobado que el control estricto de la hiperglicemia (manifestado por normalización de la hemoglobina glicosilada Al en la diabetes tipo 1previene o retarda la presencia de complicaciones microvasculares; esto se logra con un manejo intensivo, que incluye también uso intensivo de regímenes de insulina.

Pero ¿qué pasa con la

Antioxidantes y diabetes mellitus: revisión de la evidencia Antioxidants and diabetes mellitus: review of the evidence

OpenAIRE

C. Cuerda; L. M. Luengo; M. A. Valero; A. Vidal; R. Burgos; F. L. Calvo; C. Martínez

2011-01-01

Introducción: En la diabetes mellitus existe un aumento del estrés oxidativo y una disminución de los sistemas de defensa antioxidante, que se han implicado en la etiopatogenia de la enfermedad y en la aparición de complicaciones crónicas. Metodología: Realizamos una revisión no sistemática con el objetivo de evaluar la relación entre el estrés oxidativo y la diabetes, y los posibles efectos de los antioxidantes en la prevención y tratamiento de la diabetes y sus complicaciones. Resultados: L...

Enfermería: Prevención y Cuidados del Pie Diabético Revisión Bibliográfica

OpenAIRE

Sevillano Gamarra, Laura

2017-01-01

La diabetes mellitus es una de las enfermedades crónicas más prevalentes e incidentes en el mundo. Una de sus complicaciones más vigentes y que más costos socio-sanitarios acarrea, es el pie diabético que afecta al 15-25% de los pacientes diabéticos; siendo la primera causa de hospitalización, la amputación no traumática del miembro inferior. El objetivo de este trabajo es identificar los factores de riesgo relacionados con las complicaciones de la diabetes mellitus y conocer la función ed...

Oxidative stress in a model for experimental diabetic retinopathy: treatment with antioxidants

OpenAIRE

Miranda, M; Muriach, M; Johnsen, S; Bosch-Morell, F; Araiz, J; Romá, J; Romero, FJ

2004-01-01

Propósito: La retinopatía diabética es la primera causa de ceguera en países desarrollados, aunque lo mejor para prevenir las complicaciones es un adecuado control glucémico, este no siempre se puede conseguir. Por tanto, es necesario el uso de terapias coadyuvantes que ayuden a prevenir o retrasar la aparición de complicaciones propias de la diabetes. Se han estudiado los cambios bioquímicos y funcionales que ocurren en la retina de ratones diabéticos, y la capacidad del ebselen y la luteína...

Hallazgos cuantitativos y cualitativos en la OCTA en pacientes con y sin retinopatía diabética en el servicio de oftalmología del área este de Valladolid

OpenAIRE

Radoslaw Szewc, Marcin

2017-01-01

La retinopatía diabética (RD) es una de las complicaciones microvasculares más frecuentes de la diabetes mellitus (DM). La detección precoz de la RD permite evitar en numerosas ocasiones la aparición de complicaciones graves y ceguera. El diagnóstico es clínico y apoya en pruebas de imagen complementarías, entre ellas la angiofluoresceingrafía (AFG) y la tomografía de coherencia óptica (OCT) y un nuevo método de diagnóstico OCT Angiografía (OCTA) que permite visualizar las estr...

Treating Anxiety Disorders in Inner City Schools: Results from a Pilot Randomized Controlled Trial Comparing CBT and Usual Care

Science.gov (United States)

Ginsburg, Golda S.; Becker, Kimberly D.; Drazdowski, Tess K.; Tein, Jenn-Yun

2012-01-01

Background: The effectiveness of cognitive-behavioral treatment (CBT) in inner city schools, when delivered by novice CBT clinicians, and compared to usual care (UC), is unknown. Objective: This pilot study addressed this issue by comparing a modular CBT for anxiety disorders to UC in a sample of 32 volunteer youth (mean age 10.28 years, 63%…

Estimating the population distribution of usual 24-hour sodium excretion from timed urine void specimens using a statistical approach accounting for correlated measurement errors.

Science.gov (United States)

Wang, Chia-Yih; Carriquiry, Alicia L; Chen, Te-Ching; Loria, Catherine M; Pfeiffer, Christine M; Liu, Kiang; Sempos, Christopher T; Perrine, Cria G; Cogswell, Mary E

2015-05-01

High US sodium intake and national reduction efforts necessitate developing a feasible and valid monitoring method across the distribution of low-to-high sodium intake. We examined a statistical approach using timed urine voids to estimate the population distribution of usual 24-h sodium excretion. A sample of 407 adults, aged 18-39 y (54% female, 48% black), collected each void in a separate container for 24 h; 133 repeated the procedure 4-11 d later. Four timed voids (morning, afternoon, evening, overnight) were selected from each 24-h collection. We developed gender-specific equations to calibrate total sodium excreted in each of the one-void (e.g., morning) and combined two-void (e.g., morning + afternoon) urines to 24-h sodium excretion. The calibrated sodium excretions were used to estimate the population distribution of usual 24-h sodium excretion. Participants were then randomly assigned to modeling (n = 160) or validation (n = 247) groups to examine the bias in estimated population percentiles. Median bias in predicting selected percentiles (5th, 25th, 50th, 75th, 95th) of usual 24-h sodium excretion with one-void urines ranged from -367 to 284 mg (-7.7 to 12.2% of the observed usual excretions) for men and -604 to 486 mg (-14.6 to 23.7%) for women, and with two-void urines from -338 to 263 mg (-6.9 to 10.4%) and -166 to 153 mg (-4.1 to 8.1%), respectively. Four of the 6 two-void urine combinations produced no significant bias in predicting selected percentiles. Our approach to estimate the population usual 24-h sodium excretion, which uses calibrated timed-void sodium to account for day-to-day variation and covariance between measurement errors, produced percentile estimates with relatively low biases across low-to-high sodium excretions. This may provide a low-burden, low-cost alternative to 24-h collections in monitoring population sodium intake among healthy young adults and merits further investigation in other population subgroups. © 2015 American

El reto de las transferencias de colgajos libres en pacientes quemados: ¿cuál es el momento para la cirugía?

Directory of Open Access Journals (Sweden)

M.E. Villaverde-Doménech

Full Text Available La transferencia de colgajos libres es una herramienta fundamental dentro del arsenal reconstructivo para el tratamiento quirúrgico del gran quemado. Durante años ha existido controversia sobre la influencia del momento de la cirugía sobre la tasa de complicaciones, así como el alto riesgo de complicaciones al realizar reconstrucciones con colgajos libres en pacientes quemados. Diseñamos un estudio retrospectivo de las reconstrucciones quirúrgicas mediante colgajos libres realizadas en nuestra Unidad de Quemados del Hospital Universitari y Politecnic La Fe, de Valencia (España en el periodo comprendido entre 2001 y 2013, recogiendo todos los datos relativos al paciente, a la lesión, al procedimiento reconstructivo, a los resultados y relacionando todo ello con el momento en el cual se realizó la cirugía. Para el análisis de los datos y asociaciones entre distintas variables usamos tablas de contingencia y aplicamos el test de independencia de Chi-cuadrado. Exponemos además 2 casos clínicos representativos de la cirugía reconstructiva practicada en pacientes quemados. Recogimos en total datos de 21 procedimientos de reconstrucción mediante colgajo libre en pacientes quemados. En ninguno se realizó reconstrucción primaria inmediata (en los primeros 5 días, mientras que la reconstrucción primaria temprana (entre el día 5 y el 21 se realizó en el 28,57 % de los casos, la primaria intermedia (entre el día 21 y las 6 semanas en el 28,57 %, la secundaria (más de 6 semanas en el 9,5 %, y la cirugía de secuelas en el 33,33 % de los casos. Las tasas de complicaciones mayores y menores fueron respectivamente 19,05 % y 9,5 % . El 50 % de complicaciones mayores ocurrieron en el periodo de reconstrucción primaria temprana, mientras que no registramos ninguna en el periodo primario intermedio. El resto de complicaciones se repartió a partes iguales entre el periodo secundario y la cirugía de secuelas (ambas con el 25 %. No

Effect of usual lead apron in decreasing dose rate in nuclear medicine department

Energy Technology Data Exchange (ETDEWEB)

Momennezhad, M.; Ghazikhanloo, K.; Zakavi, S.R. [Mashhad Univ. of Medical Sciences (Iran, Islamic Republic of)

2006-07-01

Full text of publication follows: Introduction: In a busy nuclear medicine department personnel exposure to radiation is inevitable during patient positioning and radiotracer preparation. There is controversy regarding usage of usual lead aprons with respect to penetrating gamma rays used in nuclear medicine departments as well as production of characteristic lead x-ray from aprons.This study tries to evaluate the effect of 0.5 mm lead apron on dose reduction. Methods and materials: We used three point sources usual radioisotopes used in nuclear medicine departments (99 mTc, 201 Tl and 131 I) and a single head L.F.O.V. gamma camera (S.M.V., D.S.X.) was used for counting purposes. The count rate for each source was about 20 K count/sec in air and in a brain water phantom. All point sources were placed at a distance of 3 meters, parallel to the center of the detector. The collimator was removed and imaging was performed for 1 min with and without lead apron on the detector. Lead apron covered all field of view of the detector. Each imaging was repeated 3 times and mean count was obtained for each radioisotope. The measurements were accomplished from full spectrum and specific region of spectrum such as characteristic lead x rays region (88 keV 20%) with and without apron. Result and Discussion: The measurement and comparison of count rates (count/min) for each source in different conditions (with and without apron source in air and in water phantom) showed that count rates were reduced in air about 77.3%, 84.2% and 40.8% for 99 mTc, 201 Tl and 131 I respectively. The reduction in count rates when sources placed in brain water phantom were 83.5%, 87% and 53.7% for the same isotope respectively. As the main source of radiation for personnel is from scattered photon and with respect to about 83% of count rate reduction using lead aprons for 99 mTc, it is expected that wearing lead apron significantly decrease dose rate. Conclusion: Our study showed that lead aprons

Effect of usual lead apron in decreasing dose rate in nuclear medicine department

International Nuclear Information System (INIS)

Momennezhad, M.; Ghazikhanloo, K.; Zakavi, S.R.

2006-01-01

Full text of publication follows: Introduction: In a busy nuclear medicine department personnel exposure to radiation is inevitable during patient positioning and radiotracer preparation. There is controversy regarding usage of usual lead aprons with respect to penetrating gamma rays used in nuclear medicine departments as well as production of characteristic lead x-ray from aprons.This study tries to evaluate the effect of 0.5 mm lead apron on dose reduction. Methods and materials: We used three point sources usual radioisotopes used in nuclear medicine departments (99 mTc, 201 Tl and 131 I) and a single head L.F.O.V. gamma camera (S.M.V., D.S.X.) was used for counting purposes. The count rate for each source was about 20 K count/sec in air and in a brain water phantom. All point sources were placed at a distance of 3 meters, parallel to the center of the detector. The collimator was removed and imaging was performed for 1 min with and without lead apron on the detector. Lead apron covered all field of view of the detector. Each imaging was repeated 3 times and mean count was obtained for each radioisotope. The measurements were accomplished from full spectrum and specific region of spectrum such as characteristic lead x rays region (88 keV 20%) with and without apron. Result and Discussion: The measurement and comparison of count rates (count/min) for each source in different conditions (with and without apron source in air and in water phantom) showed that count rates were reduced in air about 77.3%, 84.2% and 40.8% for 99 mTc, 201 Tl and 131 I respectively. The reduction in count rates when sources placed in brain water phantom were 83.5%, 87% and 53.7% for the same isotope respectively. As the main source of radiation for personnel is from scattered photon and with respect to about 83% of count rate reduction using lead aprons for 99 mTc, it is expected that wearing lead apron significantly decrease dose rate. Conclusion: Our study showed that lead aprons

Supervised progressive cross-continuum strength training compared with usual care in older medical patients

DEFF Research Database (Denmark)

Pedersen, Mette Merete; Petersen, Janne; Beyer, Nina

2016-01-01

Background: Hospitalization in older adults is characterized by physical inactivity and a risk of losing function and independence. Systematic strength training can improve muscle strength and functional performance in older adults. Few studies have examined the effect of a program initiated during...... hospitalization and continued after discharge. We conducted a feasibility study prior to this trial and found a progression model for loaded sit-to-stands feasible in older medical patients. This study aims to determine whether a simple supervised strength training program for the lower extremities (based...... on the model), combined with post-training protein supplementation initiated during hospitalization and continued at home for 4 weeks, is superior to usual care on change in mobility 4 weeks after discharge in older medical patients. Methods: Eighty older medical patients (65 years or older) acutely admitted...

How to distinguish between 'business as usual' and 'significant business disruptions' and plan accordingly.

Science.gov (United States)

Halliwell, Peter

2008-01-01

This paper seeks to provide an insight into Air New Zealand and how business continuity is managed in an industry with inherent disruptions. The differences between 'business as usual' and 'significant business disruptions' are outlined along with their associated criteria, response and escalation processes. The paper describes why the company incorporates the four 'R's of the Civil Defence Emergency Management Act within its BCM framework and how this aids resilience. A case study is provided that details a 'significant disruption' that occurred in November 2006. This event resulted in the total loss of a sales office and cargo shed after unrest in the Kingdom of Tonga escalated to widespread rioting, looting and destruction of their central business district. The lessons from this event have been captured and provide some essential mitigation measures that will assist in future events.

Mud-Bath Therapy in Addition to Usual Care in Bilateral Knee Osteoarthritis: An Economic Evaluation Alongside a Randomized Controlled Trial.

Science.gov (United States)

Ciani, Oriana; Pascarelli, Nicola Antonio; Giannitti, Chiara; Galeazzi, Mauro; Meregaglia, Michela; Fattore, Giovanni; Fioravanti, Antonella

2017-07-01

To perform a cost-effectiveness analysis of mud-bath therapy (MBT) in addition to usual treatment compared to usual treatment alone in patients with bilateral knee osteoarthritis (OA). An economic evaluation alongside a randomized controlled trial was conducted. Patients were randomly assigned to receive either a 2-week cycle of MBT in addition to their usual treatment or to continue routine care alone. The EuroQol 5-domain questionnaire was administered at baseline, 2 weeks, and at 3, 6, 9, and 12 months. Direct health care resource consumption data up until 12 months were derived from a daily diary given to patients and returned at prescheduled followup visits. A total of 103 patients were included (n = 53 for MBT patients; n = 50 for controls). Overall, patients in the MBT group accrued mean ± SD 0.835 ± 0.10 quality-adjusted life years (QALYs) compared to 0.753 ± 0.11 in the control group (P < 0.001). Average direct costs per patient (€303 versus €975; P < 0.001) were higher in the control group, primarily because of hospitalization for total knee replacement and use of intraarticular hyaluronic acid. Bootstrapping replications of costs and QALY sample distributions consistently indicated that the MBT therapy combined with standard therapy represents a dominant strategy as compared with standard therapy alone. The probability of MBT being cost-effective at standard cost-effectiveness thresholds (e.g., €20,000/QALY) is 100%. The results of this cost-effectiveness analysis support the use of MBT as midterm complementary therapy in the management of knee OA. © 2016, American College of Rheumatology.

Tratamento cirúrgico da escoliose em pacientes com amiotrofia espinhal com parafusos pediculares (instrumental de 3ª geração e complicações precoces Tratamiento quirúrgico de la escoliosis en pacientes con amiotrofia espinal con tornillos pediculares (instrumental de 3ª generación y complicaciones precoces Surgical treatment of scoliosis in spinal muscular atrophy with pedicle screws (third generation instrumentation and early complications

Directory of Open Access Journals (Sweden)

Daniel Cantarelli dos Santos

2010-06-01

Full Text Available OBJETIVO: avaliar a utilização de artrodese via posterior com parafusos pediculares para correção da escoliose em pacientes com amiotrofia espinhal. MÉTODOS: realizou-se um estudo retrospectivo de 16 pacientes com amiotrofia espinhal submetidos à artrodese via posterior exclusiva, com parafusos pediculares. Foi avaliado o perfil geral dos pacientes e o potencial de correção do ângulo de Cobb e da obliquidade pélvica, além das complicações precoces. RESULTADOS: o ângulo de Cobb pré-operatório foi em média de 94,6º (65 a 132º, no pós-operatório de 40,4º (2 a 70º, percentual de correção de 57,2%. A obliquidade pélvica pré-operatória foi em média 34,7º (25 a 56º, no pós-operatório foi para 11,3º (0 a 20º, com percentual de correção de 67,4%. Cinco pacientes tiveram complicações precoces (31,2% com boa resolução. CONCLUSÕES: o tratamento cirúrgico da escoliose em pacientes com amiotrofia espinhal por meio de artrodese via posterior utilizando parafusos pediculares tem grande potencial de correção da deformidade coronal e da obliquidade pélvica, sem grandes complicações no pós-operatório precoce.OBJETIVO: evaluar la utilización de la artrodesis vía posterior con tornillos pediculares para la corrección de la escoliosis en pacientes con amiotrofia espinal. MÉTODOS: fue realizado un estudio retrospectivo de 16 pacientes con amiotrofia espinal sometidos a la artrodesis vía posterior exclusiva, con tornillos pediculares. Fue evaluado el perfil general de los pacientes, y el potencial de corrección del ángulo de Cobb y de la oblicuidad pélvica, además de las complicaciones precoces. RESULTADOS: el ángulo de Cobb preoperatorio fue en promedio 94.6º (65 a 132º, en el postoperatorio 40.4º (2 a 70, porcentual de corrección de 57.2%. La oblicuidad pélvica preoperatoria fue en media 34.7º (25 a 56º, en el postoperatorio fue para 11.3º (0 a 20º, porcentual de corrección de 67.4%. Cinco

Nutrient intakes among children and adolescents eating usual pizza products in school lunch compared with pizza meeting HealthierUS School Challenge criteria.

Science.gov (United States)

Hur, In Young; Marquart, Len; Reicks, Marla

2014-05-01

Pizza is a popular food that can contribute to high intakes of saturated fat and sodium among children and adolescents. The objective of this study was to compare daily nutrient intakes when a pizza product meeting the US Department of Agriculture's criteria for competitive food entrées under the HealthierUS School Challenge (HUSSC) was substituted for usual pizza products consumed during foodservice-prepared school lunch. The study used National Health and Nutrition Examination Survey (2005-2008) dietary recall data from a cross-sectional sample of US children and adolescents (age 5 to 18 years, n=337) who ate pizza during school lunch on 1 day of dietary recall. Daily nutrient intakes based on the consumption of usual pizza products for school lunch (pre-modeled) were compared with intakes modeled by substituting nutrient values from an HUSSC whole-grain pizza product (post-modeled). Paired t tests were used to make the comparison. Post-modeled intakes were lower in daily energy, carbohydrate, total fat, saturated fat, cholesterol, and sodium compared with pre-modeled intakes among children and adolescents (Ppizza product for usual pizza products may significantly improve dietary quality of children and adolescents eating pizza for school lunch, indicating that it could be an effective approach to improve the nutritional quality of school lunch programs. Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Efficacy of an adjunctive brief psychodynamic psychotherapy to usual inpatient treatment of depression: rationale and design of a randomized controlled trial

Science.gov (United States)

2012-01-01

Background A few recent studies have found indications of the effectiveness of inpatient psychotherapy for depression, usually of an extended duration. However, there is a lack of controlled studies in this area and to date no study of adequate quality on brief psychodynamic psychotherapy for depression during short inpatient stay exists. The present article describes the protocol of a study that will examine the relative efficacy, the cost-effectiveness and the cost-utility of adding an Inpatient Brief Psychodynamic Psychotherapy to pharmacotherapy and treatment-as-usual for inpatients with unipolar depression. Methods/Design The study is a one-month randomized controlled trial with a two parallel group design and a 12-month naturalistic follow-up. A sample of 130 consecutive adult inpatients with unipolar depression and Montgomery-Asberg Depression Rating Scale score over 18 will be recruited. The study is carried out in the university hospital section for mood disorders in Lausanne, Switzerland. Patients are assessed upon admission, and at 1-, 3- and 12- month follow-ups. Inpatient therapy is a manualized brief intervention, combining the virtues of inpatient setting and of time-limited dynamic therapies (focal orientation, fixed duration, resource-oriented interventions). Treatment-as-usual represents the best level of practice for a minimal treatment condition usually proposed to inpatients. Final analyses will follow an intention–to-treat strategy. Depressive symptomatology is the primary outcome and secondary outcome includes measures of psychiatric symptomatology, psychosocial role functioning, and psychodynamic-emotional functioning. The mediating role of the therapeutic alliance is also examined. Allocation to treatment groups uses a stratified block randomization method with permuted block. To guarantee allocation concealment, randomization is done by an independent researcher. Discussion Despite the large number of studies on treatment of depression

[Combined pulmonary fibrosis and emphysema (CPFE)--limitation of usual lung function test and challenge at practice].

Science.gov (United States)

Takai, Daiya

2014-12-01

Spirometry and the flow-volume curve test are commonly performed lung function tests. However, a unique clinical entity occasionally shows almost normal data in these tests, and is therefore missed on screening tests. The clinical entity of combined pulmonary emphysema and pulmdoary fibrosis was recognized and documented in the 90's in Japan, the USA, and Europe. Typical emphysema shows obstructive disorders, and pulmonary fibrosis shows restrictive disorders. Thus, the combination of both should lead to a combined disorder pattern in lung function tests, but this is not the case. In 2005, Cottin reported and redefined this combination of emphysema and fibrosis of the lung as "Combined Pulmonary Fibrosis and Emphysema" (CPFE). The patients are typically heavily smoking males who show an almost normal lung function. The upper lobe of these patients usually shows severe emphysema, which contributes to a static volume and a late phase in the forced volume test. On the other hand their lower lobe shows fibrotic change. The fibrotic portion contributes to early phase flow in the flow-volume curve. These mechanisms are a reason for the normal pattern appearance in lung function tests in CPFE patients. As a matter of course, these patients have damaged upper and lower lobes: their diffusing capacity of the lung shows a low performance, their saturation of blood hemoglobin decreases soon after light exercise, and their KL-6 (a blood marker of pulmonary fibrosis) usually shows a high value. They are considered a high risk group regarding complications of post-surgical treatment. Thus, when medical technologists identify suspicious cases, they should advise doctors to add diffusing capacity and KL-6 tests. (Review).

Mastocitosis: Unaafección poco común

OpenAIRE

Coronel Carbajal, Carlos

2001-01-01

La mastocitosis es la proliferación anormal de mastocitos que puede afectar 1 o varios órganos. Esta célula almacena importantes sustancias farmacológicamente activas. Sus manifestaciones más frecuentes son las cutáneas, pero pueden aparecer otras a causa de afectación de órganos como la médula ósea, hígado, bazo, huesos, ganglios linfáticos y tubo digestivo. Existen varios métodos diagnósticos, pero la histología es fundamental. El tratamiento incluye medidas generales y específicas; actualm...

Mastocitosis: Unaafección poco común

Directory of Open Access Journals (Sweden)

Carlos Coronel Carbajal

2001-06-01

Full Text Available La mastocitosis es la proliferación anormal de mastocitos que puede afectar 1 o varios órganos. Esta célula almacena importantes sustancias farmacológicamente activas. Sus manifestaciones más frecuentes son las cutáneas, pero pueden aparecer otras a causa de afectación de órganos como la médula ósea, hígado, bazo, huesos, ganglios linfáticos y tubo digestivo. Existen varios métodos diagnósticos, pero la histología es fundamental. El tratamiento incluye medidas generales y específicas; actualmente el uso del interferón ha cobrado interés.Mastocytosis is the abnormal proliferation of mastocytes that may affect one or various organs. This cell stores important pharmacologically active substances. Its most frequent manifestations are the cutaneous ones, but other manifestations may appear as a result of the affectation of some organs as the bone marow, the liver, the spleen, the bones, the lymphatic ganglia and the digestive tube. There are different diagnostic methods, but histology is essential. The treatment includes general and specific measures. Interest in using interferon has increased nowadays.

Effects of structured versus usual care on renal endpoint in type 2 diabetes: the SURE study: a randomized multicenter translational study.

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Chan, Juliana C; So, Wing-Yee; Yeung, Chun-Yip; Ko, Gary T; Lau, Ip-Tim; Tsang, Man-Wo; Lau, Kam-Piu; Siu, Sing-Chung; Li, June K; Yeung, Vincent T; Leung, Wilson Y; Tong, Peter C

2009-06-01

Multifaceted care has been shown to reduce mortality and complications in type 2 diabetes. We hypothesized that structured care would reduce renal complications in type 2 diabetes. A total of 205 Chinese type 2 diabetic patients from nine public hospitals who had plasma creatinine levels of 150-350 micromol/l were randomly assigned to receive structured care (n = 104) or usual care (n = 101) for 2 years. The structured care group was managed according to a prespecified protocol with the following treatment goals: blood pressure triglyceride 500 micromol/l or dialysis). Of these 205 patients (mean +/- SD age 65 +/- 7.2 years; disease duration 14 +/- 7.9 years), the structured care group achieved better control than the usual care group (diastolic blood pressure 68 +/- 12 vs. 71 +/- 12 mmHg, respectively, P = 0.02; A1C 7.3 +/- 1.3 vs. 8.0 +/- 1.6%, P structured care (23.1%, n = 24) and usual care (23.8%, n = 24; NS) groups had similar end points, but more patients in the structured care group attained >or=3 treatment goals (61%, n = 63, vs. 28%, n = 28; P or=3 treatment targets (n = 91) had reduced risk of the primary end point (14 vs. 34; relative risk 0.43 [95% CI 0.21-0.86] compared with that of those who attained

Las complicaciones macrovasculares y su relación con algunas variables clínicas y bioquímicas en diabéticos tipo 2 The macrovascular complications and its relation to some clinical and biochemical variables in type 2 diabetes patients

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Eduardo Valdés Ramos

2010-12-01

Full Text Available OBJETIVO: determinar la frecuencia de macroangiopatía diabética, así como su relación con algunas variables clínicas y bioquímicas en diabéticos tipo 2 (DM 2. MÉTODOS: se realizó un estudio transversal y descriptivo con 438 pacientes DM 2 ingresados en el Centro de Atención al Diabético de Bayamo, Granma, en el período comprendido desde octubre de 2007 a diciembre de 2008. Las variables utilizadas fueron: edad, sexo, color de la piel, consumo de tabaco y alcohol, tiempo de evolución de la diabetes, peso, talla, circunferencia de la cintura, tensión arterial, niveles séricos de colesterol y triglicéridos, así como la presencia de complicaciones macrovasculares de la diabetes. Los sujetos se dividieron en 2 grupos: con macroangiopatía y sin macroangiopatía. RESULTADOS: de los 438 pacientes DM 2 estudiados, 107 (24,4 % tenían algún tipo de macroangiopatía. Predominó la insuficiencia arterial periférica en 67 casos (15,3 %, seguido de la cardiopatía isquémica con 52 (11,8 % y el ictus con 4 (0,9 %. En 16 casos se presentó más de una complicación. Resultó significativa la asociación entre la edad (p=0,0000, el tiempo de evolución de la diabetes (p=0,0000, la hipertensión arterial sistólica (p=0,0361, el colesterol (p=0,0000 y los triglicéridos (p=0,0000, con el desarrollo de macroangiopatía. Los pacientes DM 2 con síndrome metabólico presentaron 4,31 veces más probabilidades de desarrollar cardiopatía isquémica, que aquellos que no lo tenían (p=0,0388. CONCLUSIONES: la frecuencia de complicaciones cardiovasculares en los pacientes con DM 2 en nuestro medio es elevada y se asocia a la edad, el tiempo de evolución de la diabetes, la hipertensión arterial y con los altos niveles de colesterol y triglicéridos. El síndrome metabólico incrementa el riesgo de cardiopatía isquémica en los pacientes con DM 2.OBJETIVE: to determine the diabetic macroangiopathy frequency, as well as its relation to some clinical

Dissemination of the nurse-administered Tobacco Tactics intervention versus usual care in six Trinity community hospitals: study protocol for a comparative effectiveness trial

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Duffy Sonia A

2012-08-01

Full Text Available Abstract Background The objectives of this smoking cessation study among hospitalized smokers are to: 1 determine provider and patient receptivity, barriers, and facilitators to implementing the nurse-administered, inpatient Tobacco Tactics intervention versus usual care using face-to-face feedback and surveys; 2 compare the effectiveness of the nurse-administered, inpatient Tobacco Tactics intervention versus usual care across hospitals, units, and patient characteristics using thirty-day point prevalence abstinence at thirty days and six months (primary outcome post-recruitment; and 3 determine the cost-effectiveness of the nurse-administered, inpatient Tobacco Tactics intervention relative to usual care including cost per quitter, cost per life-year saved, and cost per quality-adjusted life-year saved. Methods/Design This effectiveness study will be a quasi-experimental design of six Michigan community hospitals of which three will get the nurse-administered Tobacco Tactics intervention and three will provide their usual care. In both the intervention and usual care sites, research assistants will collect data from patients on their smoking habits and related variables while in the hospital and at thirty days and six months post-recruitment. The intervention will be integrated into the experimental sites by a research nurse who will train Master Trainers at each intervention site. The Master Trainers, in turn, will teach the intervention to all staff nurses. Research nurses will also conduct formative evaluation with nurses to identify barriers and facilitators to dissemination. Descriptive statistics will be used to summarize the results of surveys administered to nurses, nurses’ participation rates, smokers’ receipt of specific cessation services, and satisfaction with services. General estimating equation analyses will be used to determine differences between intervention groups on satisfaction and quit rates, respectively, with

Effectiveness of a multifaceted implementation strategy compared to usual care on low back pain guideline adherence among general practitioners.

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Suman, Arnela; Schaafsma, Frederieke G; van de Ven, Peter M; Slottje, Pauline; Buchbinder, Rachelle; van Tulder, Maurits W; Anema, Johannes R

2018-05-11

To improve patient care, and to reduce unnecessary referrals for diagnostic imaging and medical specialist care for low back pain, an evidence-based guideline for low back pain was developed in the Netherlands in 2010. The current study evaluated the effect of a multifaceted implementation strategy on guideline adherence among Dutch general practitioners. The implementation strategy included a multidisciplinary training, provision of educational material and an interactive website for healthcare professionals, supported by a multimedia eHealth intervention for patients with low back pain. Adherence was measured using performance indicators based on 3 months data extracted from the contacts with patients with low back pain recorded in the electronic medical records of participating general practitioners. Performance indicators were compared between two groups: a usual care group and an implementation group. Performance indicators were referrals to consultations with medical specialists, to diagnostic imaging, and to psychosocial and/or occupational physician consultations, and inquiries about psychosocial and occupational risk factors. The electronic medical records of 5130 patient contacts for LBP were analysed; 2453 patient contacts in the usual care group and 2677 patient contacts in the implementation group. Overall, rates of referral and of recorded inquiries regarding psychosocial and occupational risk factors remained low in both groups over time. The only statistically significant difference found was a reduction in the number of referrals to neurologists in the implementation group (from 100 (7%) to 50 (4%)) compared to the usual care group (from 48 (4%) to 50 (4%), (p strategy did not result in improved guideline adherence among general practitioners, and it is not recommended for widespread use. However, baseline referral rates in participating practices were already low, possibly leaving only little room for improvement. Inquiries for psychosocial and

Cognitive-Behavioral Therapy versus Usual Clinical Care for Youth Depression: An Initial Test of Transportability to Community Clinics and Clinicians

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Weisz, John R.; Southam-Gerow, Michael A.; Gordis, Elana B.; Connor-Smith, Jennifer K.; Chu, Brian C.; Langer, David A.; McLeod, Bryce D.; Jensen-Doss, Amanda; Updegraff, Alanna; Weiss, Bahr

2009-01-01

Community clinic therapists were randomized to (a) brief training and supervision in cognitive-behavioral therapy (CBT) for youth depression or (b) usual care (UC). The therapists treated 57 youths (56% girls), ages 8-15, of whom 33% were Caucasian, 26% were African American, and 26% were Latino/Latina. Most youths were from low-income families…

Acciones educativas de prevención del pie diabético Educational actions to prevent diabetic foot complications

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Pedro Vejerano García

2009-08-01

Full Text Available La Diabetes Mellitus y sus complicaciones son causas de hospitalización, invalidez y afectación económica. Este trabajo hace referencia a la experiencia camagüeyana en prevención, seguimiento y control del pie diabético. Dicha experiencia demostró que la pobre educación para prevenir las complicaciones del pie diabético, se convierte en un factor de riesgo sociocultural modificable. Una consulta de mayor alcance como la Clínica del Pie Diabético, pone al territorio en condiciones ventajosas para atender la transición epidemiológica de la diabetes y sus complicaciones.Diabetes Mellitus and its complications are causes of hospitalization, disability, and financial problems. This paper deals with the experience in prevention, monitoring, and control of diabetic foot in the province of Camagüey. This experience proved that a poor education in the prevention of diabetic foot complications is a modifiable sociocultural risk factor. As an example of more comprehensive consultation, the Diabetic Foot Clinic has benefitted the territory in the assistance of Diabetes Mellitus and its complications.

muito baixo peso

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Débora Cristina de Arruda

2007-01-01

Full Text Available El presente artículo es un estudio descriptivo de naturaleza cualitativa que utilizó los principios de la etnografía y del análisis de contenido para develar cómo ha sido para la familia en expansión, convivir con Interocurrencias durante la gestación y el parto del bebé nacido prematuro y con bajo peso. Los informantes del estudio han sido ocho madres de niños y que han pasado por hospitalización en Unidad de Terapia Intensiva Neonatal del Hospital Universitario de Maringa, de 1998 a 2000. Los datos fueron recolectados en el periodo de diciembre del 2005 hasta junio del 2006, a través de entrevistas parcialmente elaboradas, grabadas y realizadas en el domicilio de las familias. Los resultados obtenidos han revelado que tanto los embarazos como sus complicaciones surgieron de manera inusitada, cambiando la estructura y la dinámica familiar. Las vivencias relatadas han permitido la identificación de tres categorías: el embarazo cambiando la vida de la mujer/familia; siendo sorprendidos por las complicaciones del embarazo; las complicaciones desencadenando el trabajo de parto prematuro.

Lipodistrofia parcial familiar tipo 1: ¿Un síndrome subdiagnosticado o raro?

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Jimena Soutelo

2015-02-01

Full Text Available La lipodistrofia parcial familiar de tipo1 (LPF 1 es un síndrome caracterizado por la pérdida parcial de grasa subcutánea en extremidades con distribución incrementada de la misma en rostro, cuello y tronco. Es una identidad familiar aunque hay casos espontáneos. Hasta ahora no se conoce mutación responsable. Se debe realizar diagnóstico diferencial con el síndrome de Cushing. Es un síndrome poco frecuente y en oportunidades se llega al diagnóstico cuando los pacientes presentan complicaciones cardiovasculares o afectación pancreática como consecuencia de una grave alteración metabólica. Se presenta el caso de una paciente de 45 años con diabetes mellitus desde los 20 años de edad, mal control glucémico (HbA1c: 11.7% e hipertrigliceridemia (TG: 3000 mg/dl, índice de masa corporal (IMC: 38, extremidades adelgazadas, pérdida de grasa subcutánea en glúteos, sobreelevación de pliegue por encima de los mismos, venas prominentes en miembros inferiores, cara de luna llena y marcada acantosis nigricans, hipertensión (TA: 150/100 mm Hg y medidas de pliegues subcutáneos disminuidos. El dosaje de leptina fue 16.8 mg/ml. El estudio genético para gen LMNA fue negativo. Se instauraron medidas de cambio de estilo de vida, tratamiento con fenofibrato, insulina premezcla 50/50 y enalapril, obteniéndose una franca mejoría clínica, de la HbA1c (7.8% y de los TG (243 mg/dl.

Parotiditis crónicas recidivantes: Nuestra experiencia

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Manuel Estrada Sarmiento

1998-08-01

Full Text Available Se realizó una investigación observacional, prospectiva y descriptiva de 27 pacientes con el diagnóstico clínico e histopatológico de parotiditis crónica, con el objetivo de conocer su comportamiento en nuestro medio durante el período 1994-1995. De los 27 pacientes, 19 eran femeninos (70,4 % y 8 masculinos. En el 3,7 % se observó una edad inferior a los 10 años; la parótida izquierda fue la más afectada. La técnica quirúrgica de Blair se empleó en 19 pacientes (70,4 % y la mortalidad operativa fue nula. Cuatro pacientes (14,8 % presentaron complicaciones. Esta entidad es frecuente en niños, su cuadro clínico oscila entre meses y años, por lo cual no es poco frecuente después de las primeras décadas de la vida.An observational prospective and descriptive study of 27 patients clinically and histopathologically diagnosed with chronic parotitis was performed with the objective of finding out the behaviour of such disease in our context from 1994- to 1995. 19 were females (70.4 % and 8 were males. 3.7 % were under 10 years and the laft parotid gland was the most affected. Blair’s surgical technique was successfully used in 19 patients (70.4 % and none of them died. Complications occured in 4 patients (14.8 %. This disease is common in children, its clinical pattern ranges from months to years, so, it is not an uncommon disease after the first decades of life.

Changes in executive functions and self-efficacy are independently associated with improved usual gait speed in older women

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Hsu Chun

2010-05-01

Full Text Available Abstract Background Improved usual gait speed predicts substantial reduction in mortality. A better understanding of the modifiable factors that are independently associated with improved gait speed would ensure that intervention strategies are developed based on a valid theoretical framework. Thus, we examined the independent association of change in executive functions and change in falls-related self-efficacy with improved gait speed among community-dwelling senior women. Methods A secondary analysis of the 135 senior women aged 65 to 75 years old who completed a 12-month randomized controlled trial of resistance training. Usual gait speed was assessed using a 4-meter walk. Three executive processes were assessed by standard neuropsychological tests: 1 set shifting; 2 working memory; and 3 selective attention and response inhibition. A linear regression model was constructed to determine the independent association of change in executive functions and falls-related self-efficacy with change in gait speed. Results Improved selective attention and conflict resolution, and falls-related self-efficacy, were independently associated with improved gait speed after accounting for age, global cognition, baseline gait speed, and change in quadriceps strength. The total variance explained was 24%. Conclusions Interventions that target executive functions and falls-related self-efficacy, in addition to physical functions, to improve gait speed may be more efficacious than those that do not. Trial Registration ClinicalTrials.gov Identifier: NCT00426881

Recuperación de plusvalías: reflexiones sobre su posible aplicación en las ciudades chilenas

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Gonzalo Cáceres Quiero

2002-08-01

Full Text Available Es usual que la posibilidad de recuperar plusvalías urbanas genere un amplio debate. Si observamos la trayectoria de las ciudades chilenas (Cáceres y Sabatini, 2001, se advierten tres momentos en que suele discutirse dicha posibilidad: (a Cuando se viven tiempos de disciplina fiscal y el Estado cuenta con pocos recursos; (b cuando existe un aumento de las desigualdades sociales, situación que dota a la recuperación de plusvalías de una implicancia distributiva;4 y (c cuando enfrentamos importantes desafíos de renovación urbana, como el que nos plantea hoy el Bicentenario de la República.

Factores de riesgo para complicaciones en el periodo de recuperación post anestésica en el paciente anciano Fatores de risco para complicações no período de recuperação pós anestésica no paciente idoso Risk factors for complications in the post anesthesia period in elderly patients

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Isabel Yovana Quispe Mendoza

2010-11-01

Full Text Available Objetivos. Identificar los factores de riesgo para complicaciones en el periodo de recuperación post anestésica en el paciente anciano. Metodología. Estudio descriptivo retrospectivo. Los datos fueron recolectados de las historias clínicas de pacientes ancianos. Resultados. Se estudiaron 110 pacientes que tuvieron este perfil: sexo masculino (56.4%, hipertensos (32.7% y fueron clasificados en ASA II (60.0%. En cuanto al intraoperatorio: fueron sometidos a cirugía abdominal (53.6%, les administraron anestesia general (50.9%, estuvieron durante la cirugía posición de decúbito dorsal (81.8% y el período intraoperatorio fue inferior a tres horas (62.7%. Las complicaciones más frecuentes fueron: hipotermia (55.5%, dolor (43.6% y aumento de la presión arterial (36.4%. Conclusión. Se evidenció la importancia de la visita preoperatoria con la finalidad de evaluar los factores de riesgo que puedan influenciar en el procedimiento quirúrgico.Objetivos. Identificar os fatores de risco para complicações no período de recuperação pós anestésica no paciente idoso. Metodologia. Estudo descritivo retrospectivo. Os dados foram coletados das histórias clínicas de pacientes idosos. Resultados. Estudaram-se 110 pacientes que tiveram este perfil: sexo masculino (56.4%, hipertensos (32.7% e foram classificados em ASA II (60.0%. Quanto ao intra-operatório: foram submetidos a cirurgia abdominal (53.6%, administraram-lhes anestesia geral (50.9%, estiveram durante a cirurgia posição de decúbito dorsal (81.8% e o período intra-operatório foi inferior a três horas (62.7%. As complicações mais freqüentes foram: hipotermia (55.5%, dor (43.6% e aumento da pressão arterial (36.4%. Conclusão. Evidenciou-se a importância da visita pré-operatória com a finalidade de avaliar os fatores de risco que possam influenciar no procedimento cirúrgico.Objective. To identify the risk for complications in the post anesthesia recovery period in elderly

Young Adult and Usual Adult Body Mass Index and Multiple Myeloma Risk: A Pooled Analysis in the International Multiple Myeloma Consortium (IMMC).

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Birmann, Brenda M; Andreotti, Gabriella; De Roos, Anneclaire J; Camp, Nicola J; Chiu, Brian C H; Spinelli, John J; Becker, Nikolaus; Benhaim-Luzon, Véronique; Bhatti, Parveen; Boffetta, Paolo; Brennan, Paul; Brown, Elizabeth E; Cocco, Pierluigi; Costas, Laura; Cozen, Wendy; de Sanjosé, Silvia; Foretová, Lenka; Giles, Graham G; Maynadié, Marc; Moysich, Kirsten; Nieters, Alexandra; Staines, Anthony; Tricot, Guido; Weisenburger, Dennis; Zhang, Yawei; Baris, Dalsu; Purdue, Mark P

2017-06-01

Background: Multiple myeloma risk increases with higher adult body mass index (BMI). Emerging evidence also supports an association of young adult BMI with multiple myeloma. We undertook a pooled analysis of eight case-control studies to further evaluate anthropometric multiple myeloma risk factors, including young adult BMI. Methods: We conducted multivariable logistic regression analysis of usual adult anthropometric measures of 2,318 multiple myeloma cases and 9,609 controls, and of young adult BMI (age 25 or 30 years) for 1,164 cases and 3,629 controls. Results: In the pooled sample, multiple myeloma risk was positively associated with usual adult BMI; risk increased 9% per 5-kg/m 2 increase in BMI [OR, 1.09; 95% confidence interval (CI), 1.04-1.14; P = 0.007]. We observed significant heterogeneity by study design ( P = 0.04), noting the BMI-multiple myeloma association only for population-based studies ( P trend = 0.0003). Young adult BMI was also positively associated with multiple myeloma (per 5-kg/m 2 ; OR, 1.2; 95% CI, 1.1-1.3; P = 0.0002). Furthermore, we observed strong evidence of interaction between younger and usual adult BMI ( P interaction adult BMI may increase multiple myeloma risk and suggest that healthy BMI maintenance throughout life may confer an added benefit of multiple myeloma prevention. Cancer Epidemiol Biomarkers Prev; 26(6); 876-85. ©2017 AACR . ©2017 American Association for Cancer Research.

Enterovirus 71-related encephalomyelitis: usual and unusual magnetic resonance imaging findings

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Jang, Seonah; Suh, Sang-Il; Ha, Su Min; Seol, Hae-Young; Byeon, Jung Hye; Eun, Baik-Lin; Lee, Young Hen; Seo, Hyung Suk; Eun, So-Hee

2012-01-01

Most enterovirus (EV) 71 infections manifest as mild cases of hand-foot-mouth disease (HFMD)/herpangina with seasonal variations, having peak incidence during the summer. Meanwhile, EV 71 may involve the central nervous system (CNS), causing severe neurologic disease. In many cases, enteroviral encephalomyelitis involves the central midbrain, posterior portion of the medulla oblongata and pons, bilateral dentate nuclei of the cerebellum, and the ventral roots of the cervical spinal cord, and the lesions show hyperintensity on T2-weighted and fluid-attenuation inversion recovery (FLAIR) images. Our goal was to review usual and unusual magnetic resonance (MR) findings in CNS involvement of enteroviral infection. Among consecutive patients who had HFMD and clinically suspected encephalitis or myelitis and who underwent brain or spinal MR imaging, five patients revealed abnormal MR findings. Diffusion-weighted and conventional MR and follow-up MR images were obtained. From cerebrospinal fluid, stool, or nasopharyngeal swabs, EV 71 was confirmed in all patients. MR imaging studies of two patients showed hyperintensity in the posterior portion of the brainstem on T2-weighted and FLAIR images, which is the well-known MR finding of EV 71 encephalitis. The remaining three cases revealed unusual manifestations: leptomeningeal enhancement, abnormal enhancement along the ventral roots at the conus medullaris level without brain involvement, and hyperintensity in the left hippocampus on T2/FLAIR images. EV 71 encephalomyelitis shows relatively characteristic MR findings; therefore, imaging can be helpful in radiologic diagnosis. However, physicians should also be aware of unusual radiologic manifestations of EV 71. (orig.)

Enterovirus 71-related encephalomyelitis: usual and unusual magnetic resonance imaging findings

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Jang, Seonah; Suh, Sang-Il; Ha, Su Min; Seol, Hae-Young [Korea University Guro Hospital, Korea University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Byeon, Jung Hye; Eun, Baik-Lin [Korea University Guro Hospital, Korea University College of Medicine, Department of Pediatrics, Seoul (Korea, Republic of); Lee, Young Hen; Seo, Hyung Suk [Korea University Ansan Hospital, Korea University College of Medicine, Department of Radiology, Ansan (Korea, Republic of); Eun, So-Hee [Korea University Ansan Hospital, Korea University College of Medicine, Department of Pediatrics, Ansan (Korea, Republic of)

2012-03-15

Most enterovirus (EV) 71 infections manifest as mild cases of hand-foot-mouth disease (HFMD)/herpangina with seasonal variations, having peak incidence during the summer. Meanwhile, EV 71 may involve the central nervous system (CNS), causing severe neurologic disease. In many cases, enteroviral encephalomyelitis involves the central midbrain, posterior portion of the medulla oblongata and pons, bilateral dentate nuclei of the cerebellum, and the ventral roots of the cervical spinal cord, and the lesions show hyperintensity on T2-weighted and fluid-attenuation inversion recovery (FLAIR) images. Our goal was to review usual and unusual magnetic resonance (MR) findings in CNS involvement of enteroviral infection. Among consecutive patients who had HFMD and clinically suspected encephalitis or myelitis and who underwent brain or spinal MR imaging, five patients revealed abnormal MR findings. Diffusion-weighted and conventional MR and follow-up MR images were obtained. From cerebrospinal fluid, stool, or nasopharyngeal swabs, EV 71 was confirmed in all patients. MR imaging studies of two patients showed hyperintensity in the posterior portion of the brainstem on T2-weighted and FLAIR images, which is the well-known MR finding of EV 71 encephalitis. The remaining three cases revealed unusual manifestations: leptomeningeal enhancement, abnormal enhancement along the ventral roots at the conus medullaris level without brain involvement, and hyperintensity in the left hippocampus on T2/FLAIR images. EV 71 encephalomyelitis shows relatively characteristic MR findings; therefore, imaging can be helpful in radiologic diagnosis. However, physicians should also be aware of unusual radiologic manifestations of EV 71. (orig.)

Fatty Acid and Cholesterol Concentrations in Usually Consumed Fish in Brazil

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Carlos Scherr

2015-02-01

Full Text Available Background: Several studies have demonstrated clinical benefits of fish consumption for the cardiovascular system. These effects are attributed to the increased amounts of polyunsaturated fatty acids in these foods. However, the concentrations of fatty acids may vary according to region. Objective: The goal of this study was to determine the amount of,cholesterol and fatty acids in 10 Brazilian fishes and in a non-native farmed salmon usually consumed in Brazil. Methods: The concentrations of cholesterol and fatty acids, especially omega-3, were determined in grilled fishes. Each fish sample was divided in 3 sub-samples (chops and each one was extracted from the fish to minimize possible differences in muscle and fat contents. Results: The largest cholesterol amount was found in white grouper (107.6 mg/100 g of fish and the smallest in badejo (70 mg/100 g. Omega-3 amount varied from 0.01 g/100 g in badejo to 0.900 g/100 g in weakfish. Saturated fat varied from 0.687 g/100 g in seabass to 4.530 g/100 g in filhote. The salmon had the greatest concentration of polyunsaturated fats (3.29 g/100 g and the highest content of monounsaturated was found in pescadinha (5.98 g/100 g. Whiting and boyfriend had the best omega-6/omega 3 ratios respectively 2.22 and 1.19, however these species showed very little amounts of omega-3. Conclusion: All studied Brazilian fishes and imported salmon have low amounts of saturated fat and most of them also have low amounts of omega-3.

Complicações e seqüelas neurológicas da anestesia regional realizada em crianças sob anestesia geral: um problema real ou casos esporádicos? Complicaciones y secuelas neurológicas de la anestesia regional realizada en niños bajo anestesia general: ¿ Un problema real o casos esporádicos? Neurological complications and damage of regional block in children under general anesthesia: a real problem or sporadic cases?

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Verônica Vieira da Costa

2006-12-01

mayoría de las veces se realiza después de la anestesia general, sea realmente segura. Existe el riesgo potencial de una lesión neurológica permanente o temporal cuando el paciente no puede informar la eventual parestesia o dolor, durante la realización de la anestesia regional, lo que genera inseguridad por parte de los anestesiólogos. El objetivo de este estudio fue el de evaluar la prevalencia de complicaciones y de secuelas neurológicas de la anestesia regional en niños bajo anestesia general. MÉTODO: En un análisis prospectivo se estudiaron niños sometidos a intervenciones quirúrgicas ortopédica y plástica reparadora bajo anestesia regional asociada a la anestesia general. La inducción y el mantenimiento de la anestesia fueron por vía venosa o por inhalación. Después de la anestesia general se realizaba anestesia regional y se evaluaba la existencia de complicaciones inmediatas, el número de punciones realizadas, complicaciones de medio plazo y la presencia de secuelas neurológicas. RESULTADOS: En un período de 13 meses se estudiaron 499 niños de los dos sexos, con edad promedio entre 6 y 7 años. La mayoría de los pacientes se sometió a la anestesia general asociada a la peridural lumbar o caudal. La prevalencia de complicación inmediata fue de un 3,6%, siendo la más frecuente el sangramiento al momento de la punción. La prevalencia de complicaciones en medio plazo fue de un 1,1%, siendo la más frecuente la hipoestesia y no hubo secuela neurológica a largo plazo. CONCLUSIONES: Los resultados del presente estudio están a tono con los de otros autores con relación a la baja prevalencia de complicaciones de la anestesia regional en niños bajo anestesia general, sin dejar secuelas neurológicas. Eso puede ser atribuido al uso de material adecuado y a la experiencia del equipo de anestesia.BACKGROUND AND METHODS: It has been questioned whether regional block in children, which most of the time is done under general anesthesia, is really

The effect of interpersonal psychotherapy and other psychodynamic therapies versus 'treatment as usual' in patients with major depressive disorder.

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Jakobsen, Janus Christian; Hansen, Jane Lindschou; Simonsen, Erik; Gluud, Christian

2011-04-27

Major depressive disorder afflicts an estimated 17% of individuals during their lifetimes at tremendous suffering and costs. Interpersonal psychotherapy and other psychodynamic therapies may be effective interventions for major depressive disorder, but the effects have only had limited assessment in systematic reviews. Cochrane systematic review methodology with meta-analysis and trial sequential analysis of randomized trials comparing the effect of psychodynamic therapies versus 'treatment as usual' for major depressive disorder. To be included the participants had to be older than 17 years with a primary diagnosis of major depressive disorder. Altogether, we included six trials randomizing a total of 648 participants. Five trials assessed 'interpersonal psychotherapy' and only one trial assessed 'psychodynamic psychotherapy'. All six trials had high risk of bias. Meta-analysis on all six trials showed that the psychodynamic interventions significantly reduced depressive symptoms on the 17-item Hamilton Rating Scale for Depression (mean difference -3.12 (95% confidence interval -4.39 to -1.86;Pinterpersonal psychotherapy or psychodynamic therapy compared with 'treatment as usual' for patients with major depressive disorder. The potential beneficial effect seems small and effects on major outcomes are unknown. Randomized trials with low risk of systematic errors and low risk of random errors are needed.

Influence of usual zinc intake and zinc in a meal on 65Zn retention and turnover in the rat

International Nuclear Information System (INIS)

Hunt, J.R.; Johnson, P.E.; Swan, P.B.

1987-01-01

The influences of zinc in a meal and usual zinc intake on zinc retention and turnover were investigated in 7-wk-old male rats fed diets containing 12-151 mg Zn/kg for 3 wk before and after consuming a 65 Zn-labeled meal containing ZnCl 2 . Retention corrected to zero time and turnover rate were determined by whole-body counting. Percent zinc retention was inversely proportional to the natural logarithm of the meal zinc, between 0.09 and 26 mumol. In comparison to lower doses, higher doses resulted in lower percent retention but greater amounts of zinc retained. Although the latter relationship was slightly curvilinear, there was no indication of a limited capacity for zinc retention with high doses. However, doses above 4 mumol resulted in higher turnover rates in rats accustomed to lower zinc intakes. Percent retention and the reciprocal of the turnover rate were proportional to the reciprocal of the dietary zinc concentration. The greatest differences in retention and turnover occurred between 12 and 26 mg Zn/kg diet. The zinc dose in a meal and the usual dietary zinc separately influenced percent zinc retention. These factors also interacted, such that greater dose effects were observed at lower zinc intakes and greater dietary zinc effects were observed at lower doses

European Gas in the Next Century. Fundamental Changes or Business as Usual?

International Nuclear Information System (INIS)

Norvik, Harald

1999-01-01

The oil price development is surprising. As soon as a consensus has been formed, it moves in some direction opposite of what was expected. Producers should be prepared to meet a future with declining rather than increasing prices in real terms. In this presentation, the President and Chief Executive Officer of Statoil focuses on some aspects he believes to be important for the evolution of current and future natural gas trade: Demand, supply and prices, Innovation, Geopolitical environment. The European gas industry is moving into the next century after a remarkable development with extensive infrastructure and solid trade patterns established. The future will bring new challenges. The market will be more transparent and more competitive. Cost efficiency and capacity utilization of existing infrastructure will be key factors in order to exploit production at competitive costs. Big reserves are available, although at more remote locations which call for strong commercial players and strong relations between the producers and the distributors if new big supply projects shall be lifted. Norway has gained a competitive position, but new measures will be needed in order to ensure a competitive position for the commercial companies also in the future. The shape of the gas business has developed continuously and market changes will keep it doing so. Therefore, Business as usual will never be a winning strategy in a world of change

European Gas in the Next Century. Fundamental Changes or Business as Usual?

Energy Technology Data Exchange (ETDEWEB)

Norvik, Harald [Statoil, Stavanger (Norway)

1999-07-01

The oil price development is surprising. As soon as a consensus has been formed, it moves in some direction opposite of what was expected. Producers should be prepared to meet a future with declining rather than increasing prices in real terms. In this presentation, the President and Chief Executive Officer of Statoil focuses on some aspects he believes to be important for the evolution of current and future natural gas trade: Demand, supply and prices, Innovation, Geopolitical environment. The European gas industry is moving into the next century after a remarkable development with extensive infrastructure and solid trade patterns established. The future will bring new challenges. The market will be more transparent and more competitive. Cost efficiency and capacity utilization of existing infrastructure will be key factors in order to exploit production at competitive costs. Big reserves are available, although at more remote locations which call for strong commercial players and strong relations between the producers and the distributors if new big supply projects shall be lifted. Norway has gained a competitive position, but new measures will be needed in order to ensure a competitive position for the commercial companies also in the future. The shape of the gas business has developed continuously and market changes will keep it doing so. Therefore, Business as usual will never be a winning strategy in a world of change.

HIV and pregnancy: Maternal and neonatal evolution HIV y embarazo: Evolución materna y neonatal

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Diego Cecchini

2011-10-01

Full Text Available Data regarding epidemiological aspects, antiretroviral drug safety, and outcomes of HIV-infected pregnant women and their newborns are limited in Argentina. We underwent a retrospective analysis of registries of HIV-infected pregnant women assisted at Helios Salud, Buenos Aires, Argentina (1997-2006. Variables associated with preterm delivery and neonatal complications were analyzed by univariate and logistic regression analyses. A total of 204 mother-child binomium were included. Maternal age (median: 29 years; 32.5% without prior diagnosis of HIV-infection. Baseline median CD4 T-cell count: 417 cell/μl; 98% received antiretroviral drugs during pregnancy [2 nucleoside analogs plus either nevirapine (55% or a protease inhibitor (32%]. Overall incidence of toxicity was 12.5%: rash (8%, anemia (3.5% and hepatotoxicity (1%. Rash was associated with exposure to nevirapine. Eighty one percent and 50% reached HIV-viral loads La información sobre aspectos epidemiológicos, seguridad de drogas antirretrovirales y evolución de mujeres embarazadas HIV positivas y sus hijos es limitada en la Argentina. Realizamos un análisis retrospectivo de registros de embarazadas HIV positivas asistidas en Helios Salud, Buenos Aires, Argentina (1997-2006. Las variables asociadas con parto prematuro y complicaciones neonatales se estudiaron mediante análisis univariado y regresión logística. Estudiamos 204 binomios madre-hijo. Edad materna (mediana: 29 años, 32.5% sin diagnóstico previo de HIV. Recuento de linfocitos T CD4+ (mediana: 417 células/μl. El 98% recibió tratamiento antirretroviral durante el embarazo [dos análogos de nucleósidos más nevirapina (55% o un inhibidor de proteasa (32%]. La incidencia global de toxicidad fue 12.5%: erupción cutánea (8%, anemia (3.5% y hepatotoxicidad (1%. La exposición a nevirapina se asoció con rash. El 81% y 50% alcanzaron cargas virales <1000 y <50 copias/ml preparto, respectivamente. Cesárea programada: 68

Mindfulness-based stress reduction added to care as usual for lung cancer patients and/or their partners: A multicentre randomized controlled trial

NARCIS (Netherlands)

Schellekens, M.P.J.; Hurk, D.G.M. van den; Prins, J.B.; Donders, A.R.T.; Molema, J.; Dekhuijzen, R.; Drift, M.A. van der; Speckens, A.E.M.

2017-01-01

OBJECTIVE: Lung cancer patients report among the highest distress rates of all cancer patients. Partners report similar distress rates. The present study examined the effectiveness of additional mindfulness-based stress reduction (care as usual [CAU] + MBSR) versus solely CAU to reduce psychological

Implementation of the Tobacco Tactics intervention versus usual care in Trinity Health community hospitals

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Sonia A. Duffy

2016-11-01

Full Text Available Abstract Background Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM implementation framework, a National Institutes of Health-sponsored study compared the nurse-administered Tobacco Tactics intervention to usual care. A prior paper describes the effectiveness of the Tobacco Tactics intervention. This subsequent paper provides data describing the remaining constructs of the RE-AIM framework. Methods This pragmatic study used a mixed methods, quasi-experimental design in five Michigan community hospitals of which three received the nurse-administered Tobacco Tactics intervention and two received usual care. Nurses and patients were surveyed pre- and post-intervention. Measures included reach (patient participation rates, characteristics, and receipt of services, adoption (nurse participation rates and characteristics, implementation (pre-to post-training changes in nurses' attitudes, delivery of services, barriers to implementation, opinions about training, documentation of services, and numbers of volunteer follow-up phone calls, and maintenance (continuation of the intervention once the study ended. Results Reach: Patient participation rates were 71.5 %. Compared to no change in the control sites, there were significant pre- to post-intervention increases in self-reported receipt of print materials in the intervention hospitals (n = 1370, p < 0.001. Adoption: In the intervention hospitals, all targeted units and several non-targeted units participated; 76.0 % (n = 1028 of targeted nurses and 317 additional staff participated in the training, and 92.4 % were extremely or somewhat satisfied with the training. Implementation: Nurses in the intervention hospitals reported increases in providing advice to quit, counseling, medications, handouts, and DVD (all p < 0.05 and reported decreased barriers to implementing smoking cessation services (p < 0.001. Qualitative comments were very

Incidência de complicações relacionadas à massagem do seio carotídeo em 502 pacientes ambulatoriais Incidencia de complicaciones relacionadas al masaje del seno carotídeo en 502 pacientes ambulatorios Complications related to carotid sinus massage in 502 ambulatory patients

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Gustavo de Castro Lacerda

2009-02-01

aterosclerótica y cardiopatía. MÉTODOS: Estudio transversal. Criterios de inclusión: pacientes ambulatorios con edad >50 años, orientados a realizar el electrocardiograma (ECG. Criterios de exclusión: individuos que no aceptaron participar de un estudio sobre la prevalencia de la respuesta cardioinhibitoria al MSC; pacientes con demencia; portadores de marcapaso; individuos con soplo carotídeo o historia de ACV o IAM en los últimos 3 meses. Se realizó el MSC en posición supina durante 10 segundos. Se consideraron complicaciones del MSC: la ocurrencia de arritmias sostenidas y el aparecimiento de déficit neurológico, ya sea durante el MSC, ya sea en las 24 horas subsecuentes a su término. RESULTADOS: Se seleccionaron, de modo aleatorio, a 562 pacientes, de un total de 1.686 individuos con los criterios de inclusión. El total de 60 individuos presentaron criterios de exclusión. Los 502 pacientes restantes (el 52% varones, edad promedio de 65 años, el 69% cardiópatas y el 50% con enfermedad aterosclerótica se sometieron a 1.053 MSC. La cantidad de dos pacientes presentaron complicaciones (0,4%; IC95%:0%-0,9%. Un varón de 71 años presentó monoparesia del brazo izquierdo con regresión completa en 30 minutos. Otro varón, de 56 años, presentó hemianopsia homónima izquierda, que retrocedió en 7 días. CONCLUSIÓN: La incidencia de complicaciones relacionadas al MSC resultó pequeña, particularmente cuando se consideró que la población sometida a la maniobra era anciana y con alta prevalencia tanto de cardiopatía estructural como de enfermedad aterosclerótica.BACKGROUND: The carotid sinus massage (CSM is a simple and low-cost technique with many indications. OBJECTIVE: To determine the safety of CSM in outpatients with high prevalence of atherosclerotic disease and cardiopathy. METHODS: A transversal study. Inclusion criteria: Outpatients aged >50 years, referred for ECG. Exclusion criteria: Individuals that refused to participate in a study on the

Characterization of the geochemical processes present in the radionuclides and metals mobilization in the tailing dam at the Uranium Mining and Milling Facilities - Pocos de Caldas, MG, Brazil; Caracterizacao dos processos geoquimicos atuantes na mobilizacao de radionuclideos e metais na bacia de rejeitos do complexo minero-industrial de Pocos de Caldas, MG, Brazil

Energy Technology Data Exchange (ETDEWEB)

Pinto, Patricia Freitas

1995-08-01

In Brazil, the first step of nuclear fuel cycle - the mining and milling of the uranium ore - is developed at the Uranium Mining and Milling Facilities of Pocos de Caldas, Minas Gerais state. The wastes management is a very important aspect of the process. The understanding of the geochemical processes that occur in the tailings dam is a key question to define a plan of action concerning the decommissioning strategy of the facility. The objective of the present work was to give some issues to help in the adoption of the remedial actions concerning the decommissioning of the facility. It focused on the characterization of the most important geochemical processes regulating the mobilization of radionuclides and heavy metals in the tailings dam. Two cores from the tailings dam (uncovered area) were collected. Seepage and drainage waters were sampled, the same being true for the tailings dam lake. Groundwater form an aquifer bellow the tailings dam and superficial waters from a river that receives the effluents of the dam (Soberbo River) were also sampled. Data from the mining company were used to calculate the inventory of radionuclides and heavy metals deposited in the waste dam.The obtained results showed that pyrite oxidation is the key process in the mobilization of radionuclides and heavy metals from the wastes. Pyrite oxidation is a process regulated by oxygen diffusion and water. In the studied scenario it could be shown that the process was limited to a one meter deep layer in the uncovered part of the waste dam. Because of this, Fe, Al, Mn, Zn, Th and {sup 238} U showed higher concentrations in the bottom layers of the cores in relation to the upper ones. {sup 226} Ra and {sup 210} Pb showed opposite patterns. The coprecipitation with Ca SO{sub 4} was the most relevant mechanism in both radionuclides immobilization in the wastes. Sulfate was the only chemical species that could be assigned as a contaminant in aquifer bellow the waste dam. As a conclusion, the

A review and analysis of renewable energy curtailment schemes and Principles of Access: Transitioning towards business as usual

International Nuclear Information System (INIS)

Kane, Laura; Ault, Graham

2014-01-01

In the last decade, the EU has driven forward the development and connection of renewable power sources across Europe. This has changed the way in which distribution networks operate, moving from a passive system, to a more active system where generation and demand are located closer together with system states being more complex and variable. Increased penetration of renewable generation into distribution networks is presenting a number of challenges to Distribution Network Operators (DNOs) including the provision of network access in capacity constrained networks. The introduction of Active Network Management (ANM) is enabling an increase in renewable generation connections through enhanced network access in otherwise ‘full’ networks. This paper presents a way in which DNOs might move towards Business as Usual (BAU) arrangements for ANM schemes. It is necessary to determine the curtailment arrangements, or Principles of Access (PoA), and from this estimate generation access under ANM and the flow of services and money for different scenarios. In this paper, a comprehensive literature review, detailed case study evaluation on early ANM schemes, quantitative curtailment assessment for different PoA and a qualitative analysis of business models for different ANM PoA is presented in turn with conclusions drawn from these three approaches. - Highlights: • Literature review of Principles of Access. • Detailed case study analysis of Principles of Access in ANM projects. • Quantitative analysis of different Principles of Access. • Proposed business models for ANM as business as usual

Complicações obstétricas em gestações com feto portador de anomalia incompatível com a sobrevida neonatal Complicaciones obstétricas en gestaciones con feto portador de anomalía incompatible con la sobrevivencia neonatal Obstetric complications in pregnancies with fetal anomalies incompatible with neonatal survival

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Danila Cristina Paquier Sala

2010-10-01

Full Text Available OBJETIVO: Descrever as complicações obstétricas mais comuns encontradas nos períodos gestacional, parto e puerpério imediato de gestantes com fetos portadores de anomalias incompatíveis com a vida. MÉTODOS: Estudo descritivo, onde avaliou-se 78 prontuários de pacientes atendidas no pré-natal da Disciplina de Medicina Fetal da Universidade Federal de São Paulo que tiveram partos nessa mesma instituição, entre 2000 e 2006. RESULTADOS: As principais complicações obstétricas identificadas foram:variação do volume de líquido amniótico em 68%; abortamento, parto pré-termo e a gravidez prolongada estiveram presentes em 6,4%, 55,1% e 3,8% das gestações, respectivamente; óbito fetal intra-uterino em 17,9%; descolamento prematuro da placenta ocorreu em 6,4% e histerectomia em 2,6%. CONCLUSÃO: Estes resultados sugerem aumento de risco materno em gestações com fetos portadores de anomalias graves, fato que demonstra necessidade de avaliação especializada caso a caso.OBJETIVO: Describir las complicaciones obstétricas más comunes encontradas en los períodos de gestación, parto y puerperio inmediato de embarazadas con fetos portadores de anomalías incompatibles con la vida. MÉTODOS: Se trata de un estudio descriptivo, que evaluó 78 fichas médicas de pacientes atendidos en el prenatal de la Disciplina de Medicina Fetal de la Universidad Federal de Sao Paulo que tuvieron partos en esa misma institución, entre 2000 y 2006. RESULTADOS: Las principales complicaciones obstétricas identificadas fueron: variación del volumen de líquido amniótico en 68%; abortamiento, parto pre-término y embarazo prolongado estuvieron presentes en 6,4%, 55,1% y 3,8% de las gestaciones, respectivamente; muerte fetal intra-uterina en 17,9%; desprendimiento prematuro de la placenta ocurrió en 6,4% e histerectomía en 2,6%. CONCLUSIÓN: Éstos resultados sugieren un aumento del riesgo materno en gestaciones con fetos portadores de anomal

Associations between usual school lunch attendance and eating habits and sedentary behaviour in French children and adolescents.

Science.gov (United States)

Dubuisson, C; Lioret, S; Dufour, A; Volatier, J L; Lafay, L; Turck, D

2012-12-01

Our objective was to investigate whether school lunch attendance was associated with overall eating habits and sedentary behaviour in a French sample of children and adolescents. Data for the study were taken from the second French cross-sectional dietary survey (INCA2-2006-07). In total, 1413 school children aged 3-17 years old were classified according to their school type and their usual school lunch attendance. Eating habits included meal regularity, dietary diversity, purchase in vending machine, snacking habits and frequency of eating in fast-foods. Two composite indices of eating habits were derived from multiple correspondence analyses. Sedentary behaviour was assessed by the average daily screen times for TV and computer. The association between school lunch attendance and each variable was tested. Multivariate association between school lunch attendance and the composite indices of eating habits and sedentary behaviours was studied. In all, 69.0% (CI(95%): 64.2-73.9) of secondary school children and 63.0% (CI(95%): 58.5-67.5) of pre- and elementary school children usually attended school lunch at least once a week. Pre- and elementary school children attending school lunches showed a higher dietary diversity score (P=0.02) and ate morning snacks more frequently (P=0.02). In secondary school children, attending school canteen was related to a lower rate of skipping breakfast (P=0.04) and main meals (P=0.01). In all school children, school lunch attendance was simultaneously associated with healthier overall eating habits and less sedentary behaviour. In France, children attending school canteens seem to have healthier eating habits and display less sedentary behaviour, independently of their socio-economic and demographic background.

Bartonelosis aguda en niños: Estudio de 32 casos en el Instituto Especializado de Salud del Niño y el Hospital Nacional Cayetano Heredia (Período 1993-2003.

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Judith Patricia BREÑA CHÁVEZ

2006-07-01

Full Text Available Objetivos: Determinar las características epidemiológicas, clínicas, datos de laboratorio y tratamiento de la Bartonelosis aguda en niños. Materiales y métodos: Se revisaron las historias clínicas de 32 niños con Bartonelosis aguda, internados en el Hospital Nacional Cayetano Heredia y en el Instituto Especializado de Salud del Niño entre 1993 y 2003. Resultados: La edad promedio fue 9,8 años, 72% fueron varones, los lugares de exposición probable fueron principalmente las zonas endémicas de los valles interandinos de Perú, pero hubieron pacientes procedentes de zonas no endémicas de la selva alta; fueron nativos de éstas zonas el 72%. Los síntomas principales fueron fiebre (97%, hiporexia (91%, síntomas gastrointestinales (66% y malestar general (53%; los signos principales fueron palidez (97%, hepatomegalia (78%, taquicardia (75% y linfadenomegalia (72%. El promedio de hematocrito fue 18,8 %, 63% cursaron con anemia severa, leucocitosis 63%, hiperbilirrubinemia a predominio indirecto 45% de casos e hipoalbuminemia el 68%. Las complicaciones fueron frecuentes (78%, siendo las infecciosas 25%, no infecciosas 22%, infecciosas y no infecciosas 31%. De las infecciosas destacan las respiratorias (25%, fiebre tifoidea / salmonelosis (19%, un caso de endocarditis infecciosa y otro de probable púrpura fulminans. De las complicaciones no infecciosas desatacan las complicaciones cardiovasculares (34% y la neurobartonelosis (34%; hubo un caso de anemia hemolítica autoinmune. El 72% recibió transfusiones sanguíneas; el 97% recibió antibiótico, utilizando cloranfenicol (56% y ciprofloxacino (34%. La letalidad fue de 6%. Conclusiones: La Bartonelosis aguda en esta serie tuvo gran morbilidad, siendo frecuentes las complicaciones cardiovasculares, neurológicas y respiratorias. (Rev Med Hered 2006;17:122-131.

Características sociodemográficas y clínicas de pacientes con diabetes tipo 2 y microangiopatías

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Teresa Mendizábal

2010-03-01

Full Text Available Objetivo: Determinar las características sociodemográficas y clínicas de pacientes con diabetes tipo 2 y microangiopatías. Diseño: Estudio descriptivo, de serie de casos. Institución: Hospital Nacional Daniel Alcides Carrión del Callao, hospital docente. Participantes: Pacientes adultos con diabetes mellitus. Intervenciones: Se realizó un estudio de 48 pacientes adultos con diabetes mellitus 2 con y sin microangiopatías. Se determinó edad, sexo, tiempo de enfermedad, glicemia, y características posibles de relacionarse con la ausencia de complicaciones microvasculares, susceptibles o no de modificación: nivel educativo, nivel socioeconómico, atención mínima (endocrinólogo, atención estándar (endocrinólogo y nutricionista, atención integral (profesionales anteriores más otro especialista, percepción de apoyo familiar, asistencia al control médico, adherencia a dieta sin azúcares simples y actividad física regular. Principales medidas de resultados: Presentación de microangiopatías y otras complicaciones. Resultados: La edad promedio fue 55,6 años y 52% de los pacientes presentó microangiopatía. Los pacientes sin complicaciones tuvieron menor edad, tiempo de enfermedad y antecedentes familiares de diabetes; mayor nivel educativo y socioeconómico; mejor estado nutricional y menor nivel de glicemia. La ausencia de microangiopatías se asoció a una atención estándar (endocrinólogo y nutricionista (p=0,013. Conclusiones: La microangiopatía se presentó en 52% de pacientes del estudio. Los pacientes sin complicaciones tuvieron menor edad, menor tiempo de enfermedad y antecedentes familiares de diabetes; mayor nivel educativo y socioeconómico; mejor estado nutricional y menor nivel de glicemia.

Cirugía bariátrica previo a embarazo y su impacto en el resultado perinatal

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Fernando Andres Ferrer Márquez

2016-12-01

Full Text Available La obesidad en mujeres embarazadas se asocia a mal resultado materno y perinatal. El tratamiento de la obesidad, especialmente obesidad mórbida es complejo, muchas veces requiere del apoyo de técnicas quirúrgicas. La cirugía bariátrica es una solución eficiente para la obesidad al lograr pérdida de peso sostenida en el tiempo, lo que podría ayudar a disminuir las complicaciones asociadas a la obesidad durante el embarazo. En este trabajo presentamos realizar una revisión narrativa de la literatura científica respecto a los efectos de la cirugía bariátrica en los resultados maternos y perinatales. La evidencia actual muestra que la cirugía bariátrica disminuye significativamente complicaciones como: diabetes pregestacional, diabetes gestacional, síndrome hipertensivo del embarazo, preeclampsia y macrosomía fetal, sin producir cambios en la mortalidad perinatal. Sin embargo, la cirugía bariátrica se asocia a mayor frecuencia de recién nacidos pequeños para edad gestacional, parto prematuro y complicaciones quirúrgicas no obstétricas de la cirugía bariátrica. No se ha demostrado un efecto benéfico de la cirugía bariátrica en reducir la tasa de malformaciones congénitas y la frecuencia de operación cesárea. Concluimos que la cirugía bariátrica es recomendable en mujeres en edad reproductiva que desean embarazo, pues reduce las complicaciones asociadas a la obesidad mórbida durante el embarazo, reconociendo que la calidad de la evidencia es baja al sustentarse principalmente en estudios retrospectivos o reportes de casos.

Resultados del tratamiento con implantes dentales osteointegrados en la fase quirúrgica

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Oviedo Pérez Pérez

Full Text Available Objetivo: evaluar los resultados del tratamiento con implantes dentales osteointegrados en la fase quirúrgica. Métodos: se realizó un estudio longitudinal y prospectivo en 802 pacientes en quienes se colocaron 2 165 implantes, en la Clínica Estomatológica Provincial Docente de Santiago de Cuba y la Facultad de Estomatología de La Habana en el decenio 20002009. Se evaluaron las variables: técnica quirúrgica, longitud y diámetro de los implantes, complicaciones intraoperatorias y complicaciones postoperatorias, los resultados del tratamiento se evaluaron en supervivencia y fracaso. Resultados: se logró la supervivencia de los implantes en 705 pacientes para el 87,9 % y se produjo el fracaso en 97 pacientes para el 12,1 %. Se colocaron 2 165 implantes, se logró efectividad de 2 055 para el 94,9 % y fracasaron 110 que representan el 5,08 %. No existen diferencias significativas de los resultados de acuerdo a la técnica quirúrgica empleada. Los implantes que más fracasaron fueron los de 10 mm, para el 34,9 % y 8 mm con el 13,1 %. La efectividad se incrementa a medida que aumenta el diámetro. En las complicaciones intraoperatorias el fracaso fue mayor en relación con la perforación de la tabla ósea con el 92,9 %, inestabilidad con el 86 % y la dehiscencia ósea con el 57,4 %. En el postoperatorio fue notable que en el 100 % de los casos con dolor existió fracaso de los implantes. Conclusiones: en la etapa quirúrgica existe una fuerte asociación de los resultados con la longitud, diámetro de los implantes y la presencia de complicaciones intraoperatorias y postoperatorias.

Erradicación de diabetes en Guatemala: Un sueño posible

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José Antonio Cornejo Guerra

2015-07-01

Full Text Available La diabetes mellitus es un problema de salud con alcances económicos y sociales. La prevalencia mundial está aumentando: se estima que para 1985 había 30 millones de personas con diabetes, 177 millones en el año 2000 y se estima que para el año 2030 habrá 438 millones de diabéticos. En Guatemala el 8% de la población tiene diabetes y se desconoce el porcentaje no diagnosticado y en pre-diabetes; además el país tiene índices de obesidad, sobrepeso y sedentarismo altos, situación que predispone a la aparición de la enfermedad. En el mundo cada 6 segundos muere alguien a causa de complicaciones relacionadas con diabetes y en Guatemala ocupa la tercera causa de mortalidad general. Existen varios tipos de diabetes, sin embargo, el ensayo se enfoca en la diabetes tipo 2 debido a que representa el 90% de los casos pero sobre todo por que es prevenible. Para el autor existen tres momentos importantes de los pacientes diabéticos: (1 paciente sano y con riesgo qué enfermará de diabetes, (2 paciente diabético que tendrá complicaciones y (3 pacientes con complicaciones que morirán. En los tres momentos se puede intervenir directamente, sin embargo, existen deficiencias como la ausencia de programas de prevención y la ineficiencia del sistema asistencial público. El autor propone posibles soluciones en base a evidencia científica para detener el aumento de casos de diabetes mellitus, disminuir las complicaciones micro y macro vasculares en los pacientes y principalmente, generar una cultura preventiva en Guatemala.

Importancia clínica del sangrado en pacientes con intervencionismo coronario percutáneo por vía radial en el CIMEQ

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Myder Hernández Navas

2015-10-01

Full Text Available Introducción: Las complicaciones por sangrado después de una intervención coronaria percutánea se asocian con un mayor riesgo de morbilidad y mortalidad. El acceso radial ha demostrado consistentemente la reducción de estos riesgos. A pesar de su uso en nuestro país, aun es escasa la evidencia sobre su repercusión con relación a la disminución del sangrado y sus complicaciones.Objetivo: Determinar la importancia clínica del sangrado en los pacientes con intervencionismo coronario percutáneo por vía radial en el CIMEQ.Método: Se realizó un estudio observacional, descriptivo con 217 pacientes, a quienes se les realizó una intervención coronaria percutánea por acceso radial en el laboratorio de hemodinámica del Cardiocentro CIMEQ, entre el 2009 y el 2013. Se determinó y clasificó el sangrado, así como el tipo de lesión tratada, se exploraron los antecedentes patológicos personales y la presencia de complicaciones.Resultados: Predominó el sexo masculino (78,3 % y la media de edad fue de 62,2 años. Hubo mayor incidencia de fumadores (62,7 % e hipertensos (54,4 % y solo 6 casos (2,8 % de sangrado leve en forma de hematoma en el sitio de acceso. La mitad de los pacientes con hematoma presentaba lesiones tipo C, sin existir asociación significativa entre estas dos variables (p=0.203. El sangrado solo se asoció significativamente con la pérdida del pulso radial (p<0.001.Conclusiones: Los pacientes intervenidos por vía radial en el CIMEQ presentaron una baja incidencia de sangrado, sin complicaciones asociadas de gravedad.

Aneurisma del seno de Valsalva disecando hacia el septo interventricular en una paciente embarazada

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Edison Muñoz O.

2015-11-01

Full Text Available El aneurisma del seno de Valsalva es una entidad rara en la población general, con una incidencia de 0,14 al 3,5% en cirugías de corazón abierto; con un espectro clínico amplio y complicaciones cardiacas mecánicas o eléctricas que pueden ser fatales. En mujeres embarazadas también ha sido reportada esta entidad en unos cuantos casos en la literatura médica publicada. Se presenta un caso de una paciente gestante con aneurisma de seno de Valsalva, sus complicaciones y las medidas terapéuticas que se llevaron a cabo, además de una revisión del tema.

Allocation of energy resources for power generation in India: Business as usual and energy efficiency

International Nuclear Information System (INIS)

Mallah, Subhash; Bansal, N.K.

2010-01-01

This paper deals with MARKAL allocations for various energy sources, in India, for Business As Usual (BAU) scenario and for the case of exploitation of energy saving potential in various sectors of economy. In the BAU scenario, the electrical energy requirement will raise up to 5000 bKwh units per year or 752 GW of installed capacity with major consumers being in the industry, domestic and service sectors. This demand can be met by a mix of coal, hydro, nuclear and wind technologies. Other reneawbles i.e. solar and biomass will start contributing from the year 2040 onwards. By full exploitation of energy saving potential, the annual electrical energy demand gets reduced to 3061 bKwh (or 458 GW), a reduction of 38.9%.The green house gas emissions reduce correspondingly. In this scenario, market allocations for coal, gas and large hydro become stagnant after the year 2015.

Biomarker-based evaluation of two 24-h recalls for comparing usual fish, fruit and vegetable intakes across European centers in the EFCOVAL Study

NARCIS (Netherlands)

Vries, de J.H.M.; Crispim, S.P.; Souverein, O.W.; Hulshof, P.J.M.; Ruprich, J.; Dofkova, M.; Huybrechts, I.; Keyzer, de W.; Lillegaard, I.T.L.; Lafay, L.; Rousseau, A.S.; Ocke, M.C.; Slimani, N.; Veer, van 't P.

2011-01-01

Background/Objectives: A standardized methodology is important to enable consistent monitoring of dietary intake across European countries. For this reason, we evaluated the comparability of the assessment of usual food intake collected with two non-consecutive computerized 24-h dietary recalls

South Africa's greenhouse gas emissions under business-as-usual: The technical basis of 'Growth without Constraints' in the Long-Term Mitigation Scenarios

International Nuclear Information System (INIS)

Winkler, Harald; Hughes, Alison; Marquard, Andrew; Haw, Mary; Merven, Bruno

2011-01-01

This article describes the methodology for projecting business-as-usual GHG trajectory developed in technical work for South Africa's Long-Term Mitigation Scenarios (LTMSs), in particular the 'Growth without Constraints' (GWCs) scenario. Technically rigorous projections are important as developing countries define their commitment to act on mitigation relative to business-as-usual (BAU). The key drivers for the GWC scenario include GDP (both growth rate and composition), population, discount rate and technological change. GDP emerged as an important driver in the research for LTMS and further analysis. If South Africa's economy grows without constraints over the next few decades, GHG emissions will continue to escalate, multiplying more than four-fold by mid-century. There is little gain in energy efficiency, and emissions continue to be dominated by energy use and supply, the latter remaining coal-based in GWC. We analyse the projections (not predictions) in relation to various measures. The LTMS GWC scenario is compared to other projections, nationally and internationally. A broadly comparable projection is being used at national level, for electricity planning. When compared to projections from international models, we find that the assumptions about GDP growth rates are a key factor, and suggest that comparisons of global data-sets against national analyses is important. - Highlights: → Specifies business-as-usual GHG trajectory for South Africa's Long-Term Mitigation Scenarios. → Provides details on methodology, drivers of emissions and key parameters. → In a scenario of Growth without Constraints, emissions would quadruple by 2050. → Analysis of resulting emission projection, not a prediction. → Compares projections from other national and international models.

Simple quantum systems in the momentum representation; Sistema de cuantica simple en la representacion de un momneto

Energy Technology Data Exchange (ETDEWEB)

Guillaumin-Espana, E; Salas Brito, A. L [Universidad Autonoma Metropolitana-Azcapotzalco, Mexico, D.F (Mexico); Martinez y Romero, R. P. [Universidad Nacional Autonoma de Mexico, Mexico, D.F (Mexico); Nunez-Yepez, H. N. [Universidad Autonoma-Iztapalapa, Mexico, D.F (Mexico)

2001-02-01

The momentum representation is little used in quantum mechanics courses. Some students are hence surprised by the change in viewpoint when, in doing advanced work, they have to use the momentum rather than the coordinate representation. In this work, we give an introduction to quantum mechanics in momentum space. To this end we discuss standard elementary problems, namely, the free particle, the quantum motion under a constant potential function, a particle interacting with a potential step function, and the motion of a particle under a oscillatory potential function. What is not standard is that they are all conceived from momentum space and hence they, with the exception of the free particle, are not equivalent to the coordinate space ones with the same names. We solve for the bound eigenstates of the problems working within the momentum representation trying not to make explicit reference to the systems they correspond to in the coordinate representation. [Spanish] La representacion de los impetus es muy poco empleada en los cursos de mecanica cuantica. Ello es causa de que muchos estudiantes queden un tanto confundidos, por el cambio de representacion cuando tienen que usar aquella, en vez de la mas usual de las coordenadas, al comenzar trabajos mas avanzados. Esta contribucion ofrece una introduccion a la mecanica cuantica en el espacio de los impetus. Con este fin analizamos sistemas elementales tipicos, a saber, la particula libre, el movimiento cuantico bajo una funcion de potencial constante, la interaccion con una funcion de potencial de tipo escalon y el movimiento en una funcion oscilante de potencial. Lo que es poco usual es que los sistemas se conciben desde la representacion de los impetus y, por lo tanto, con la excepcion de la particula libre, no pueden considerarse equivalentes a aquellos con el mismo nombre pero en la representacion de las coordenadas. Encontramos los eigenestados ligados de los problemas trabajando en la representacion de los

Neuronal and microglial regulators of cortical wiring: usual and novel guideposts

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Paola eSquarzoni

2015-07-01

Full Text Available Neocortex functioning relies on the formation of complex networks that begins to be assembled during embryogenesis by highly stereotyped processes of cell migration and axonal navigation. The guidance of cells and axons is driven by extracellular cues, released along by final targets or intermediate targets located along specific pathways. In particular, guidepost cells, originally described in the grasshopper, are considered discrete, specialized cell populations located at crucial decision points along axonal trajectories that regulate tract formation. These cells are usually early-born, transient and act at short-range or via cell-cell contact. The vast majority of guidepost cells initially identified were glial cells, which play a role in the formation of important axonal tracts in the forebrain, such as the corpus callosum, anterior and post-optic commissures as well as optic chiasm. In the last decades, tangential migrating neurons have also been found to participate in the guidance of principal axonal tracts in the forebrain. This is the case for several examples such as guideposts for the lateral olfactory tract (LOT, corridor cells, which open an internal path for thalamo-cortical axons and Cajal-Retzius cells that have been involved in the formation of the entorhino-hippocampal connections. More recently, microglia, the resident macrophages of the brain, were specifically observed at the crossroads of important neuronal migratory routes and axonal tract pathways during forebrain development. We furthermore found that microglia participate to the shaping of prenatal forebrain circuits, thereby opening novel perspectives on forebrain development and wiring. Here we will review the last findings on already known guidepost cells populations and will discuss the role of microglia as a potentially new class of atypical guidepost cells.

[Spanish collaborative study: Description of usual clinical practice in infant obesity].

Science.gov (United States)

Lechuga Sancho, Alfonso; Palomo Atance, Enrique; Rivero Martin, María José; Gil-Campos, Mercedes; Leis Trabazo, Rosaura; Bahíllo Curieses, María Pilar; Bueno Lozano, Gloria

2018-06-01

Childhood obesity is a high prevalence health problem. Although there are clinical guidelines for its management, there is variability in its clinical approach. The aim of this study is to describe the usual clinical practice in Paediatric Endocrinology Units in Spain and to evaluate if it resembles the recommended guidelines. An observational, cross-sectional and descriptive study was carried out by means of a questionnaire sent to paediatric endocrinologists of the Spanish Society of Paediatric Endocrinology. The questions were formulated based on the recommendations of "Clinical Practice Guidelines on the Prevention and Treatment of Childhood Obesity" issued by the Spanish Ministry of Health. A total of 125 completed questionnaires were obtained from all Autonomous Communities. Variability was observed both in the number of patients attended and in the frequency of the visits. The majority (70%) of the paediatricians who responded did not have a dietitian, psychologist or psychiatrist, in their centre to share the treatment for obese children. As regards treatment, dietary advice is the most used, and 69% have never prescribed weight-loss drugs. Of those who have prescribed them, 52.6% did not use informed consent as a prior step to them being used. There are few centres that comply with the recommendations of the clinical practice guidelines on prevention and treatment of childhood obesity as an established quality plan. Clinical practice differs widely among the paediatric endocrinologists surveyed. There are no uniform protocols of action, and in general there is limited availability of resources for the multidisciplinary treatment required by this condition. Copyright © 2017 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Effectiveness of app-based self-acupressure for women with menstrual pain compared to usual care: a randomized pragmatic trial.

Science.gov (United States)

Blödt, Susanne; Pach, Daniel; Eisenhart-Rothe, Sanna von; Lotz, Fabian; Roll, Stephanie; Icke, Katja; Witt, Claudia M

2018-02-01

Primary dysmenorrhea is common among women of reproductive age. Nonsteroidal anti-inflammatory drugs and oral contraceptives are effective treatments, although the failure rate is around 20% to 25%. Therefore additional evidence-based treatments are needed. In recent years, the use of smartphone applications (apps) has increased rapidly and may support individuals in self-management strategies. We aimed to investigate the effectiveness of app-based self-acupressure in women with menstrual pain. A 2-armed, randomized, pragmatic trial was conducted from December 2012 to April 2015 with recruitment until August 2014 in Berlin, Germany, among women aged 18 to 34 years with self-reported cramping pain of 6 or more on a numeric rating scale (NRS) for the worst pain intensity during the previous menstruation. After randomization, women performed either app-based self-acupressure (n = 111) or followed usual care only (n = 110) for 6 consecutive menstruation cycles. The primary outcome was the mean pain intensity (NRS 0-10) on the days with pain during the third menstruation. Secondary outcomes included worst pain intensity during menstruation, duration of pain, 50% responder rates (reduction of mean pain by at least 50%), medication intake, sick leave days, and body efficacy expectation assessed at the first, second, third, and sixth menstruation cycles. We included 221 women (mean age, 24.0 years; standard deviation [SD], 3.6 years). The mean pain intensity difference during the third menstruation was statistically significant in favor of acupressure (acupressure: 4.4; 95% confidence interval [CI], 4.0-4.7; usual care 5.0; 95% CI, 4.6-5.3; mean difference -0.6; 95% CI, - 1.2 to -0.1; P = .026). At the sixth cycle, the mean difference between the groups (-1.4; 95% CI, -2.0 to -0.8; P 0.5; 95% CI, 0.3-0.9] and 0.3 (95% CI, 0.2-0.5) were lower in the acupressure group. At the third cycle, hormonal contraceptive use was more common in the usual care group than in

Disasters as Usual

DEFF Research Database (Denmark)

Albris, Kristoffer

In this thesis, I explore how citizens and public institutions have adjusted to recent recurring floods in Dresden. As a riverine city, Dresden regularly experienced damaging floods throughout its history, right up until the start of the Second World War. Then something strange happened. Although...... the future as being fraught with uncertainty. This has implications both for how people understand themselves as members of society as well as for the relationship between the state and civil society. In other words, floods in Dresden have a social, political and public life. Rather than seeing disasters...

Semi-Individualized Homeopathy Add-On Versus Usual Care Only for Premenstrual Disorders: A Randomized, Controlled Feasibility Study.

Science.gov (United States)

Klein-Laansma, Christien T; Jong, Mats; von Hagens, Cornelia; Jansen, Jean Pierre C H; van Wietmarschen, Herman; Jong, Miek C

2018-03-22

Premenstrual syndrome and premenstrual dysphoric disorder (PMS/PMDD) bother a substantial number of women. Homeopathy seems a promising treatment, but it needs investigation using reliable study designs. The feasibility of organizing an international randomized pragmatic trial on a homeopathic add-on treatment (usual care [UC] + HT) compared with UC alone was evaluated. A multicenter, randomized, controlled pragmatic trial with parallel groups. The study was organized in general and private homeopathic practices in the Netherlands and Sweden and in an outpatient university clinic in Germany. Women diagnosed as having PMS/PMDD, based on prospective daily rating by the daily record of severity of problems (DRSP) during a period of 2 months, were included and randomized. Women were to receive UC + HT or UC for 4 months. Homeopathic medicine selection was according to a previously tested prognostic questionnaire and electronic algorithm. Usual care was as provided by the women's general practitioner according to their preferences. Before and after treatment, the women completed diaries (DRSP), the measure yourself concerns and well-being, and other questionnaires. Intention-to-treat (ITT) and per protocol (PP) analyses were performed. In Germany, the study could not proceed because of legal limitations. In Sweden, recruitment proved extremely difficult. In the Netherlands and Sweden, 60 women were randomized (UC + HT: 28; UC: 32), data of 47/46 women were analyzed (ITT/PP). After 4 months, relative mean change of DRSP scores in the UC + HT group was significantly better than in the UC group (p = 0.03). With respect to recruitment and different legal status, it does not seem feasible to perform a larger, international, pragmatic randomized trial on (semi-)individualized homeopathy for PMS/PMDD. Since the added value of HT compared with UC was demonstrated by significant differences in symptom score changes, further studies are warranted.

The Effect of Cognitive-Behavioral Therapy versus Treatment as Usual for Anxiety in Children with Autism Spectrum Disorders: A Randomized, Controlled Trial

Science.gov (United States)

Storch, Eric A.; Arnold, Elysse B.; Lewin, Adam B.; Nadeau, Josh M.; Jones, Anna M.; De Nadai, Alessandro S.; Mutch, P. Jane; Selles, Robert R.; Ung, Danielle; Murphy, Tanya K.

2013-01-01

Objective: To examine the efficacy of a modular cognitive-behavioral therapy (CBT) protocol relative to treatment as usual (TAU) among children with high-functioning autism spectrum disorders (ASD) and clinically significant anxiety. Method: A total of 45 children (7-11 years of age) with high-functioning ASD and clinically significant anxiety…

Behavioural graded activity results in better exercise adherence and more physical activity than usual care in people with osteoarthritis: a cluster-randomised trial

NARCIS (Netherlands)

Pisters, M.F.; Veenhof, C.; de Bakker, D.H.; Schellevis, F.G.; Dekker, J.

2010-01-01

Question: Does behavioural graded activity result in better exercise adherence and more physical activity than usual care in people with osteoarthritis of the hip or knee? Design: Analysis of secondary outcomes of a cluster-randomised trial with concealed allocation, assessor blinding, and

The effects of immunotherapy with intravenous immunoglobulins versus no intervention, placebo, or usual care in patients with recurrent miscarriages

DEFF Research Database (Denmark)

Egerup, Pia; Lindschou, Jane; Gluud, Christian

2014-01-01

, and publication status investigating infusions with immunoglobulins in relation to pregnancy compared to placebo, no intervention, or treatment as usual for assessments of benefits and harms. The relevant published literature will be searched using the following databases: Cochrane Central Register of Controlled...... Trials, Medline, Embase, WHO International Clinical Trials Registry Platform, and Ovid Medline In-Process and Other Non-Indexed Citations databases. Two review authors will independently extract data and assess risk of bias. We will undertake meta-analyses according to the recommendations stated...

Transporte intra-hospitalar de pacientes adultos em estado crítico: complicações relacionadas à equipe, equipamentos e fatores fisiológicos Transporte intrahospitalario de pacientes adultos en estado crítico: complicaciones relacionadas al equipo, equipamientos y factores fisiológicos Intra-hospital transport of critically ill adult patients: complications related to staff, equipment and physiological factors

Directory of Open Access Journals (Sweden)

Ana Carolina Goulardins de Almeida

2012-01-01

Full Text Available OBJETIVO: Identificar na literatura as complicações relacionadas às alterações fisiológicas do paciente, à equipe multidisciplinar e ao uso de equipamentos durante o transporte intra-hospitalar de pacientes críticos. MÉTODOS: Revisão integrativa da literatura, com busca nas bases de dados PUBMED, MEDLINE, e LILACS. RESULTADOS: Foram encontrados 20 artigos, todos escritos na língua inglesa. Os estudos mostraram que as alterações na pressão arterial e na frequência cardíaca são as mais comuns durante o transporte. Dos eventos adversos relacionados a problemas com a equipe, destacaram-se, a falta de conhecimento do profissional e a falha de comunicação, além dos provenientes dos equipamentos utilizados. CONCLUSÃO: Transportar o paciente crítico de maneira segura significa melhorar a comunicação entre as equipes, padronizar as ações e equipamentos utilizados por meio de protocolos e identificar intercorrências para obter excelência no atendimento durante o transporte.OBJETIVO: Identificar en la literatura las complicaciones relacionadas a las alteraciones fisiológicas del paciente, al equipo multidisciplinario y al uso de equipamientos durante el transporte intrahospitalario de pacientes críticos. MÉTODOS: Revisión integrativa de la literatura, con búsqueda en las bases de datos PUBMED, MEDLINE, y LILACS. RESULTADOS: Fueron encontrados 20 artículos, todos escritos en el idioma inglés. Los estudios mostraron que las alteraciones en la presión arterial y en la frecuencia cardíaca son las más comunes durante el transporte. De los eventos adversos relacionados a problemas con el equipo, se destacaron, la falta de conocimiento del profesional y la falla en la comunicación, además de los provenientes de los equipamientos utilizados. CONCLUSIÓN: Transportar al paciente crítico de manera segura significa mejorar la comunicación entre los equipos, patronizar las acciones y equipamientos utilizados por medio de

Polyethylene glycol intestinal lavage in addition to usual antibiotic treatment for severe Clostridium difficile colitis: a randomised controlled pilot study.

Science.gov (United States)

McCreery, Greig; Jones, Philip M; Kidane, Biniam; DeMelo, Vanessa; Mele, Tina

2017-07-31

Clostridium difficile infections (CDI) are common, costly and potentially life threatening. Most CDI will respond to antibiotic therapy, but 3%-10% of all patients with CDI will progress to a severe, life-threatening course. Complete removal of the large bowel is indicated for severe CDI. However, the 30-day mortality following surgical intervention for severe CDI ranges from 20% to 70%. A less invasive approach using surgical faecal diversion and direct colonic lavage with polyethylene glycol (PEG) and vancomycin has demonstrated a relative mortality reduction of approximately 50%. As an alternative to these operative approaches, we propose to treat patients with bedside intestinal lavage with PEG and vancomycin instillation via nasojejunal tube, in addition to usual antibiotic management. Preliminary data collected by our research group are encouraging. We will conduct a 1-year, single-centre, pilot randomised controlled trial to study this new treatment strategy for patients with severe CDI and additional risk factors for fulminant or complicated infection. After informed consent, patients with severe-complicated CDI without immediate indication for surgery will be randomised to either usual antibiotic treatment or usual antibiotic treatment with the addition of 8 L of PEG lavage via nasojejunal tube. This pilot trial will evaluate our eligibility and enrolment rate, protocol compliance and adverse event rates and provide further data to inform a more robust sample size calculation and protocol modifications for a definitive multicentre trial design. Based on historical data, we anticipate enrolling approximately 24 patients during the 1-year pilot study period.As a pilot study, data will be reported in aggregate. Between-group differences will be assessed in a blinded fashion for evidence of harm, and to further refine our sample size calculation. This study protocol has been reviewed and approved by our local institutional review board. Results of the pilot

Economic evaluation of Internet-based problem-solving guided self-help treatment in comparison with enhanced usual care for depressed outpatients waiting for face-to-face treatment: A randomized controlled trial.

Science.gov (United States)

Kolovos, Spyros; Kenter, Robin M F; Bosmans, Judith E; Beekman, Aartjan T F; Cuijpers, Pim; Kok, Robin N; van Straten, Annemieke

2016-08-01

Previous studies have demonstrated the effectiveness of Internet-based interventions for depression in comparison with usual care. However, evidence on the cost-effectiveness of these interventions when delivered in outpatient clinics is lacking. The aim of this study was to estimate the cost-effectiveness of an Internet-based problem-solving guided self-help intervention in comparison with enhanced usual care for outpatients on a waiting list for face-to-face treatment for major depression. After the waiting list period, participants from both groups received the same treatment at outpatient clinics. An economic evaluation was performed alongside a randomized controlled trial with 12 months follow-up. Outcomes were improvement in depressive symptom severity (measured by CES-D), response to treatment and Quality-Adjusted Life-Years (QALYs). Statistical uncertainty around cost differences and incremental cost-effectiveness ratios were estimated using bootstrapping. Mean societal costs for the intervention group were €1579 higher than in usual care, but this was not statistically significant (95% CI - 1395 to 4382). Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective in comparison with usual care was 0.57 at a ceiling ratio of €15,000/additional point of improvement in CES-D, and 0.25 and 0.30 for an additional response to treatment and an extra QALY respectively, at a ceiling ratio of €30,000. Sensitivity analysis showed that from a mental healthcare provider perspective the probability of the intervention being cost-effective was 0.68 for a ceiling ratio of 0 €/additional unit of effect for the CES-D score, response to treatment and QALYs. As the ceiling ratio increased this probability decreased, because the mean costs in the intervention group were lower than the mean costs in the usual care group. The patients in the intervention group showed low adherence to the Internet-based treatment

Neck collar, "act-as-usual" or active mobilization for whiplash injury? A randomized parallel-group trial

DEFF Research Database (Denmark)

Kongsted, Alice; Montvilas, Erisela Qerama; Kasch, Helge

2007-01-01

practitioners within 10 days after a whiplash injury and randomized to: 1) immobilization of the cervical spine in a rigid collar followed by active mobilization, 2) advice to "act-as-usual," or 3) an active mobilization program (Mechanical Diagnosis and Therapy). Follow-up was carried out after 3, 6, and 12......-extension trauma to the cervical spine. It is unclear whether this, in some cases disabling, condition can be prevented by early intervention. Active interventions have been recommended but have not been compared with information only. Methods. Participants were recruited from emergency units and general......Study Design. Randomized, parallel-group trial. Objective. To compare the effect of 3 early intervention strategies following whiplash injury. Summary of Background Data. Long-lasting pain and disability, known as chronic whiplash-associated disorder (WAD), may develop after a forced flexion...

Neck collar, "act-as-usual" or active mobilization for whiplash injury? A randomized parallel-group trial

DEFF Research Database (Denmark)

Kongsted, Alice; Montvilas, Erisela Qerama; Kasch, Helge

2007-01-01

Study Design. Randomized, parallel-group trial. Objective. To compare the effect of 3 early intervention strategies following whiplash injury. Summary of Background Data. Long-lasting pain and disability, known as chronic whiplash-associated disorder (WAD), may develop after a forced flexion......-extension trauma to the cervical spine. It is unclear whether this, in some cases disabling, condition can be prevented by early intervention. Active interventions have been recommended but have not been compared with information only. Methods. Participants were recruited from emergency units and general...... practitioners within 10 days after a whiplash injury and randomized to: 1) immobilization of the cervical spine in a rigid collar followed by active mobilization, 2) advice to "act-as-usual," or 3) an active mobilization program (Mechanical Diagnosis and Therapy). Follow-up was carried out after 3, 6, and 12...

Sharp Lines Due to Cr³⁺ and Mn²⁺ Impurities in Insulators: Going Beyond the Usual Tanabe−Sugano Approach

DEFF Research Database (Denmark)

García Lastra, Juan Maria; García-Fernández, P.; Barriuso, M. T.

2014-01-01

energies of MF6 complexes through the ten Coulomb and exchange integrals consistent with the cubic symmetry and not considered in the usual Tanabe-Sugano approach. It is shown that E((6)A1 → (4)A1) depends on exchange integrals K(3z(2) - r(2), xy) and K(x(2) - y(2), xy), while E((2)E → (4)A2) depends on K......This work is aimed at understanding the different behavior of optical sharp lines (corresponding to 10Dq-independent transitions) of Mn(2+) and Cr(3+) in normal and inverted perovskites that cannot be explained within the usual Tanabe-Sugano approach. In particular, we want to clarify why...... on passing from KMgF3:M to LiBaF3:M (M = Mn(2+), Cr(3+)) the energy, E((6)A1 → (4)A1), for Mn(2+) decreases by Δ = 1100 cm(-1), while Δ difference in these model systems is clarified by writing the transition...

Human performance breakdowns are rarely accidents: they are usually very poor choices with disastrous results

International Nuclear Information System (INIS)

Besco, Robert O.

2004-01-01

When human error is involved in the error chain of accidents in complex systems, the causes of the errors are very seldom the result of: - a random slip,; - one inadvertent oversight,; - a single unintended action,; - one mis-perceived event,; - simple mal-performance of a complex action, or; - a poor training program for the human operators. Invariably, the cause of the break down is in a very poor conscious choice by someone from the operator back through system designer, the supervision, management and leadership through the entire organization. Usually the operator bears the burden of the blame and is either rebuked, retrained or replaced. In systems such as commercial aviation, complex manufacturing systems, power plants, process control systems, information-processing systems and communications networks, the replacement or retraining of individuals or even classes of individuals usually does not result in any long-term improvement of the safety or effectiveness of the system. What is needed is a system that identifies the reasons why the operators made the errors. Further a system is needed that can recommend what can be done to improve the future performance within the system. The professional performance analysis system (PPAS) has been developed and applied to more than 50 major aircraft accidents in the past 30 years. The PPAS is a direct outgrowth of the human performance analysis system developed by Robert Mager over 45 years ago. The PPAS system is applied after a complete and unbiased definition and description of the events of the accident or incident has been developed by the teams of accident investigation and accident reconstruction professionals. The PPAS then uses a systematic protocol and algorithm to determine the reasons as to why the humans committed the errors or why they performed at subnormal performance levels. This process is based on quantitative behavioral science principles and findings that have been demonstrated valid for many

Esporotricosis cutánea diseminada con compromiso articular en una mujer con diabetes tipo 2

Directory of Open Access Journals (Sweden)

Sendy Solorzano

Full Text Available La esporotricosis diseminada es una presentación infrecuente de esta micosis. Aunque ha sido descrita en sujetos inmunocompetentes, con frecuencia existe compromiso de la inmunidad mediada por células T. Reportamos el caso de una mujer con diabetes tipo 2 no controlada que desarrolló esporotricosis cutánea diseminada. El curso de la enfermedad presentó varias complicaciones que incluyeron hepatitis secundaria a itraconazol y artritis de la rodilla con cultivo positivo para Sporothrix schenckii durante el tratamiento con solución saturada de ioduro de potasio. La discusión del caso incluye aspectos de la patogénesis de la esporotricosis diseminada y el manejo de la infección y sus complicaciones.

Anticoncepción de emergencia

Directory of Open Access Journals (Sweden)

Ramón García Mirás

2002-08-01

Full Text Available Se realizó una revisión bibliográfica sobre el tema, con el objetivo de lograr que nuestra población conozca y sea capaz de utilizar la anticoncepción de emergencia para disminuir los embarazos involuntarios con su consecuente interrupción y complicaciones. Es un método hormonal que se puede realizar con los preparados anticonceptivos con que contamos, es eficaz y con escasas complicaciones.A bibliographic review on emergency contraception was made so that our population knows and be able to use emergency contraception to reduce undesired pregnancies with their subsequent interruption and complications. This hormonal method may be applied with the contraceptive preparations we have. It is efficient and has a few complications.

A randomized controlled trial on early physiotherapy intervention versus usual care in acute care unit for elderly: potential benefits in light of dietary intakes.

NARCIS (Netherlands)

Blanc-Bisson, C.; Dechamps, A.A.; Gouspillou, G.; Dehail, P.; Bourdel-Marchasson, I.

2008-01-01

OBJECTIVE: To evaluate effects of early intensive physiotherapy during acute illness on post hospitalization activity daily living autonomy (ADL). DESIGN: Prospective randomized controlled trial of intensive physiotherapy rehabilitation on day 1 to 2 after admission until clinical stability or usual

Cirugía para la obesidad: efectos generales, beneficios y riesgos

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V. Karin Papapietro, Dra.

2012-03-01

Full Text Available El paciente obeso es difícil de tratar. La cirugía para la obesidad en pocos meses logra disminuir más del 20% del peso corporal. Las técnicas quirúrgicas actúan restringiendo la capacidad gástrica y/o produciendo malabsorción parcial de los alimentos. Todas han demostrado ser eficaces para el tratamiento de la obesidad y mejorar sus comorbilidades asociadas, destacando el alto porcentaje de remisión de la diabetes tipo 2, especialmente con las técnicas malabsortivas. El banding gástrico tienen la menor tasa de remisión de diabetes tipo2. La mayoría de los beneficios de la cirugía persisten más de 10 años, lo que ha permitido observar disminución del riesgo de aparición de enfermedades del ámbito metabólico, reducción del riesgo cardiovascular y de la mortalidad general de obesos mórbidos operados. Actualmente, las técnicas quirúrgicas más frecuentes son el bypass gástrico y la gastrectomía vertical (manga gástrica. La cirugía bariátrica tiene baja tasa de morbimortalidad en centros quirúrgicos expertos, sin embargo se pueden producir complicaciones nutricionales que se deben prevenir o tratar precozmente. La participación de un equipo multidisciplinario con expertos en nutrición, salud mental y actividad física aumenta las posibilidades de lograr una mejor reducción y mantención del peso, ya que con todas las técnicas se puede producir reganancia de peso en el largo plazo.

Distracción osteogénica alveolar como método de aumento del reborde alveolar

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Denia Morales Navarro

2011-03-01

Full Text Available La distracción osteogénica alveolar, como proceso biológico de neoformación de hueso alveolar, nos motivó a la realización de la presente revisión bibliográfica, con el objetivo enfatizar en el análisis de las variables: antecedentes históricos en Cuba, clasificación de los distractores, fases de la distracción (latencia, distracción y consolidación, indicaciones, contraindicaciones, ventajas, desventajas y complicaciones. Se realizó una revisión bibliográfica mediante la consulta de bases de datos de los sistemas referativos, como MEDLINE y PubMed con la utilización de descriptores "alveolar distraction" y "osteogenic distraction". Se consultaron las fuentes bibliográficas publicadas fundamentalmente en los últimos 5 años, lo que reveló que esta técnica es una excelente alternativa para la formación de huesos y tejidos blandos en zonas de atrofia alveolar, que consta de tres etapas: latencia, distracción y consolidación; un método previsible y con bajas tasas de reabsorción ósea en comparación con otras técnicas de aumento del reborde alveolar. Tiene su principal indicación en la terapia de implantes al proveer volumen óseo. Debemos individualizar cada caso y usar el método más adecuado según las características clínicas y personales del paciente. Una adecuada selección de los casos y una mejor comprensión de la técnica son los puntales para lograr exitosos resultados mediante la distracción osteogénica alveolar. En Cuba se ha aplicado poco la distracción alveolar, por lo que ha sido necesario ampliar los estudios sobre esta temática.

Obesidad: epidemia del nuevo milenio

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Guido Lastra Lastra

2005-07-01

Full Text Available La obesidad es una de las enfermedades más antiguas del mundo, sin embargo hasta hace relativamente poco se ha reconocido como tal, debido a su gran incidencia en la salud pública por sus características epidémicas y por las funestas asociaciones que la acompañan. Aún cuando es sus comienzos esta acumulación de energía permitió la supervivencia en épocas de hambruna, la evolución hormonal que implica este fenómeno la ha convertido en una afección epidémica, propiciada por el sedentarismo y la sobre alimentación. El sueño de nuestros ancestros de comida disponible con menor esfuerzo ha llegado a ser una pesadilla. Un gran número de factores hormonales producidos en diversos tejidos por más de 450 genes se encargan de mantener una homeostasis energética cuya alteración puede promover la obesidad; a su vez los adipocitos hipertróficos producen adipocinas que alteran el metabolismo de la glucosa, predisponiendo a diabetes mellitus y a la lesión del endotelio vascular generando enfermedad cardiovascular. La obesidad se constituye así en un estado proinflamatorio crónico de bajo grado. Las diferentes estrategias de tratamiento de esta enfermedad multifactorial implican una disminución en el aporte y un aumento del gasto energéticos. El tratamiento definitivo a muy largo plazo posiblemente resulte del desarrollo de la biología molecular, sin embargo en el momento actual ese horizonte está tan lejano que el conocimiento de las graves complicaciones de la obesidad, los esfuerzos educativos, los cambios en el medio ambiente y en el estilo de vida son críticos para enfrentar el desafío.

Conocimientos de hipertensión en una población hipertensa colombiana

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Luis Fernando Barraza Araiza

2014-07-01

Full Text Available Antecedentes: El conocimiento de hipertensión que tiene el paciente es un factor que influye en el control de su enfermedad. Poco se ha estudiado este conocimiento en la población hipertensa colombiana, y es necesario evaluarlo para poder realizar intervenciones que ayuden a mejorar el control hipertensivo. Objetivo: Evaluar los conocimientos de hipertensión en una población hipertensa colombiana. Material y métodos: Se elaboró un cuestionario cuyo contenido fue validado por expertos de la Universidad Nacional de Colombia y el Comité de Investigaciones de Virrey Solís IPS. El cuestionario fue aplicado a 150 pacientes hipertensos mediante una entrevista presencial al momento de estos acudir a su consulta. Resultados: El 70% de la población encuestada sabe que la hipertensión es una enfermedad prevenible, aunque apenas el 48% sabe que no es curable. Solamente el 23% sabe que la hipertensión no causa dolor de cabeza en la mayoría de los casos y el 44% desconoce que no debe suspender la medicación para la hipertensión cuando no tiene síntomas. Tanto el conocimiento sobre las modificaciones al estilo de vida, como el de las complicaciones de la hipertensión fueron altos, mientras que el riesgo de una complicación oftalmológica fue el menos conocido. El conocimiento fue menor en pacientes con baja escolaridad y de reciente diagnóstico. Conclusiones: Existen severas deficiencias en el conocimiento de hipertensión de la población encuestada. El médico y el equipo de salud deben tomar un rol más activo en la educación del paciente para mejorar su conocimiento de la enfermedad.

Manifestaciones cardiacas del dengue: Reporte de una serie de casos durante la epidemia colombiana de 2010

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Clara Saldarriaga G.

2013-12-01

Full Text Available INTRODUCCIÓN: el dengue es la enfermedad viral transmitida por vectores de diseminación más frecuente en el mundo. Su espectro clínico incluye las manifestaciones atípicas, entre ellas el compromiso cardiaco, del cual sólo se han reportado pocas series de casos en la literatura. OBJETIVO: reportar las características clínicas de los pacientes atendidos por casos confirmados por serología de dengue con manifestaciones cardiovasculares en un centro de referencia cardiovascular colombiano durante la epidemia de 2010. METODOLOGÍA: estudio observacional, descriptivo, prospectivo, en el que se incluyeron los pacientes que consultaron al servicio de urgencias, a quienes se les realizó un diagnóstico confirmado de dengue y tuvieron manifestaciones cardiovasculares de la enfermedad. RESULTADOS: se encontraron 7 pacientes; el 50% no tenía antecedentes previos de enfermedad cardiovascular. Los trastornos del ritmo fueron la manifestación cardiaca más frecuente (42,8%, entre ellos la fibrilación auricular de novo (14,2%, el bloqueo auriculoventricular completo y transitorio (14,2%, la bradicardia sinusal concomitante con derrame pericárdico (14,2% y la disfunción ventricular leve (28,5%; un paciente presentó un síndrome coronario agudo con elevación de ST durante la infección y dos descompensación aguda de insuficiencia cardiaca. No se reportaron muertes. CONCLUSIÓN: la incidencia de las complicaciones cardiacas asociadas a la infección por dengue varía de una serie a otra y su fisiopatología no se conoce por completo. Durante la epidemia que se desató en Colombia en 2010 se encontraron pocos casos de manifestaciones cardiovasculares pero con una morbilidad importante que debe alertar respecto a su identificación temprana.

Variation in Hospital Length of Stay : Do Physicians Adapt Their Length of Stay Decisions to What Is Usual in the Hospital Where They Work?

NARCIS (Netherlands)

Jong, Judith D. de; Westert, Gert P.; Lagoe, Ronald; Groenewegen, Peter P.

2006-01-01

Objective. To test the hypothesis that physicianswho work in different hospitals adapt their length of stay decisions to what is usual in the hospital under consideration. Data Sources. Secondary data were used, originating from the Statewide Planning and ResearchCooperative System (SPARCS). SPARCS

Variation in hospital length of stay: do physicians adapt their length of stay decisions to what is usual in the hospital where they work?

NARCIS (Netherlands)

Jong, J.D. de; Westert, G.P.; Lagoe, R.; Groenewegen, P.P.

2006-01-01

OBJECTIVE: To test the hypothesis that physicians who work in different hospitals adapt their length of stay decisions to what is usual in the hospital under consideration. DATA SOURCES: Secondary data were used, originating from the Statewide Planning and Research Cooperative System (SPARCS).

southern Brazil

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João A.N. Batista

2005-01-01

Full Text Available Se describen e ilustran Cyrtopodium klenii y C. brandoniamum subsp. lageanum (Orchidaceae, Cymbidieae, Cyrtopodiinae de la región sur de Brasil. C klenii se asemeja a un grupo de especies caracterizado por los pseudobulbos pequeños, enterrados en el suelo, y por las flores pequeñas; pero se distingue por el color de las flores, los lóbulos laterales del labelo poco o nada falcados, aproximadamente tan largos como anchos, por el lóbulo mediano del labelo con base poco o nada constricta y por la distribución geográfica. C. brandoniamum subsp. lageanum es similar a la variedad tipo en cuanto al patrón general de coloración, pero se distingue por florecer más tempranamente, por las hojas poco desarrolladas en la antesis, y por la forma y coloración del labelo. Ambos son taxones poco frecuentes, sólo conocidos para el sur de Brasil.

Factores de riesgo y complicaciones crónicas en el diagnóstico reciente de la diabetes tipo 2 Risk factors and chronic complications in the newly diagnosis of type 2 diabetes

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Isaac Salama Benarroch

2001-08-01

Full Text Available Se pesquisó la frecuencia de complicaciones crónicas en pacientes con diabetes tipo 2 en el momento del diagnóstico y se evaluó la asociación con factores de riesgo como enfermedad cardiovascular, hipertensión arterial, obesidad, dislipidemia y factores bioquímicos asociados. Se estudiaron durante 3 meses, 24 casos con edades entre 30 y 70 años en los servicios de Diabetología y Nutrición, Cardiología y Retina del Hospital Municipal de Oftalmología "Dr. Pedro Lagleyze" de Buenos Aires. Se estudió perfil metabólico, microalbuminuria, fondo de ojo, vascular periférico, neurológico, tensión arterial y obesidad. Se comprobó que la edad promedio fue 50 años. Hallazgos: neuropatía: 5 (25 %: nefropatía: 3 (12,5 %; retinopatía: 6 (25 %; cardiopatía y enfermedad vascular periférica: 13 (54 %; hipertensión arterial: 13 (54 %; obesidad: 3 (12,5 %; hipercolesterolemia: 14 (58 %; LDLc elevado: 12 (50 %; HDLc bajo: 10 (41,6 %; hiperviscosidad sanguínea: 6 (25 %; hemoglobina glucosilada elevada 18 (75 %; hipertrigliceridemia: 7 (29, 7 %. Se halló que el 100 % de los pacientes tenían factores de riesgo asociados a la diabetes. Se consideró necesario promover la educación pública sobre diabetes, pesquisar los factores asociados y tratar de forma agresiva y precoz la hiperglucemia y los factores bioquímicos agregadosThe frequency of chronic complications in patients with type 2 diabetes at the time of diagnosis was screened and their association with risk factors such as cardiovascular disease, blood hypertension, obesity, dislipidemia and related biochemical factors were evaluated. During three months, 24 cases aged 30-70 years were studied by the Diabetology and Nutrition Service, Cardiology and Retina Services of "Dr Pedro Lagleyze" Municipal Ophthalmology Hospital in Buenos Aires. Metabolic, peripheral vascular and neurologic profiles, microalbuminuria, fundus oculi, blood pressure and obesity were studied. It was proved that

Decisiones compartidas en la enfermedad avanzada

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Mª Aránzazu García Martínez

2013-12-01

Full Text Available Tomar decisiones es una práctica diaria de todo ser humano. Hay decisiones sencillas, con pocos valores en juego, con con secuencias poco importantes y en las que solo una persona está implicada y otras más complejas y con consecuencias irreversibles.

The behaviour of trace elements and radionuclides in must of grapes during fermentation and usual wine technology

International Nuclear Information System (INIS)

Hellmuth, K.H.; Fischer, E.

1985-01-01

The elements Co(II), Sr(II), Cs(I), Tl(I) and Am(III) were added as their radionuclides to the must of white grapes of one vintage and from that wine was prepared using usual wine technology. The elimination of the elements during the fermentation and as a consequence of the subsequent treatments has been determined. The decrease of the metal contents with time follows approximately an exponential function in the cases of Co, Cs, Tl and Am, whereas the Sr-content remains nearly constant. In the total balance, the following residual values were found in the final wine: Co 8.6+-0.6%, Sr 41+-4%, Cs 0.13+-0.07 resp. 0.031+-0.008%, Tl 1.3+-0.2% and Am 1.0+-0.2% of the initial value. (orig./PW) [de

A d-statistic for single-case designs that is equivalent to the usual between-groups d-statistic.

Science.gov (United States)

Shadish, William R; Hedges, Larry V; Pustejovsky, James E; Boyajian, Jonathan G; Sullivan, Kristynn J; Andrade, Alma; Barrientos, Jeannette L

2014-01-01

We describe a standardised mean difference statistic (d) for single-case designs that is equivalent to the usual d in between-groups experiments. We show how it can be used to summarise treatment effects over cases within a study, to do power analyses in planning new studies and grant proposals, and to meta-analyse effects across studies of the same question. We discuss limitations of this d-statistic, and possible remedies to them. Even so, this d-statistic is better founded statistically than other effect size measures for single-case design, and unlike many general linear model approaches such as multilevel modelling or generalised additive models, it produces a standardised effect size that can be integrated over studies with different outcome measures. SPSS macros for both effect size computation and power analysis are available.

Diabetes mellitus. Urgencias metabólicas

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Alfredo Darío Espinosa Brito

2010-12-01

Full Text Available En este artículo se realiza una revisión profunda sobra las características fundamentales de las complicaciones metabólicas que se pueden presentar en el paciente diabético. El propósito de dicha revisión es contribuir a una mejor identificación diagnóstica y establecer las pautas generales de tratamiento de las principales complicaciones metabólicas agudas de los diabéticos. Entre ellas, se consideran: la cetoacidosis diabética, el coma hiperglicémico hiperosmolar no cetósico, la acidosis láctica y la hipoglicemia. En ese sentido, se revisan los aspectos clínicos más importantes, los cambios metabólicos que ocurren en el organismo y las bases fundamentales para el tratamiento de estas complicaciones.An extensive review on the fundamental characteristics of the main metabolic complications that may occur in diabetic patients is presented in this article. Its purpose is to contribute to a better diagnosis and to establish general guidelines for the treatment of major acute metabolic complications in diabetic patients. Among those complications we have considered: diabetic ketoacidosis, hyperosmolar coma, nonketotic hyperglycemia, lactic acidosis and hypoglycemia. In that sense, an extensive review on the major clinical aspects, metabolic changes in the organism and fundamental basis for the treatment of such serious complications is presented.

Repercusión de las lesiones medulares traumáticas en la dinámica vesical: perspectivas de seguimiento

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Héctor Alfonso Solano Moreno

2013-01-01

Full Text Available Las lesiones en la médula espinal representan un porcentaje importante como causa de discapacidad en México y en el mundo, siendo la tercera causa con un porcentaje superior a 25%. Este tipo de pacientes sufre múltiples complicaciones y una de ellas es la que corresponde al sistema urológico al que muchas veces no se le da un seguimiento de manera regular. Dentro de las lesiones de las vías neurológicas, que inervan a la vejiga, pueden afectar a uno o varios aspectos de la fisiología, ya sea su fase de llenado, de almacenamiento o de vaciamiento, lo anterior según el área nerviosa alcanzada y la naturaleza de la lesión; estas lesiones deben ser manejadas por el mismo urólogo que debe seleccionar la opción terapéutica adecuada en su ámbito de competencia, tomando en cuenta los pros y contras de cada una de ellas, ya que esto tendrá una repercusión en la calidad de vida del paciente, así como continuar un programa de seguimiento para la detección de complicaciones de manera oportuna. Particularmente el cateterismo urinario es pilar fundamental para el manejo de las lesiones medulares postraumáticas, ya que puede contribuir a la disminución de las complicaciones.

P63 marker Expression in Usual Skin Cancers Compared With Non Tumoral Skin Lesions

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Abdolhamid Esmaili

2017-07-01

Full Text Available Background: Non-melanoma skin cancers including basal cell carcinoma and squamous cell carcinoma are the most common cancers in human. The aim of this study was to determine the expression of P63 marker in usual skin cancers compared with non-tomoral skin lesions. Materials and Methods: In this cross-sectional study, sampling was performed from archival blocks of Shahid Mohammadi hospital patients during 2010-2011. 60 samples (including 30 samples of non tumoral skin lesions and 30 samples of basal cell carcinoma and squamous cell carcinoma were studied and evaluation of p63 gene expression was done with Immunohistochemistry method. T-test and Chi-square were used for analysis of data. Results: P63 gene were expressed in 4 cases (13.33 % of non tumoral lesions and all tumoral lesions (100 %. In tumoral lesions, 5 cases (16.66 % showed 1+ severity experssion, 11 cases (36.66% 2 + severity experssion and 14 cases (46.66 % 3+severity experssion. All 4 non tumoral lesions shoed 1+ severity experssion of P63gene. Conclusion: The results of this study indicated that the incidence and severity of gene expression of P63 can be use for differentiation between basal cell carcinoma and squamous cell carcinoma as well as non-tumoral skin lesions. 

Managing Nature–Business as Usual: Resource Extraction Companies and Their Representations of Natural Landscapes

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Mark Brown

2015-11-01

Full Text Available This article contributes to knowledge of how one category of business organization, very large, British-based, natural resource extraction corporations, has begun to manage its operations for sustainability. The object of study is a large volume of texts that make representations of the managing-for-sustainability practices of these multinational corporations (MNCs. The macro-level textual analysis identifies patterns in the wording of the representations of practice. Hajer’s understanding of discourse, in which ideas are contextualized within social processes of practice, provides the theoretical approach for discourse analysis that gives an insight into how they understand and practice sustainability. Through this large-scale discourse analysis, illustrated in the article with specific textual examples, one can see that these natural resource MNCs are developing a vocabulary and a “grammar” which enables them to manage natural spaces in the same way that they are able to manage their own far-flung business operations. They make simplified representations of the much more complex natural landscapes in which their operations are sited and these models of nature can then be incorporated into the corporations’ operational management processes. Their journey towards sustainability delivers, in practice, the management of nature as business continues as usual.

EPIDEMIOLOGÍA DE LA DIABETES MELLITUS EN CHILE

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Jorge Sapunar Z., MD, MSC, FACP

2016-03-01

Finalmente, la frecuencia, morbilidad y mortalidad de la diabetes mellitus, se suman para explicar que el manejo de la enfermedad y sus complicaciones consuma el 10,2% del presupuesto en salud de Chile.

Expectations about recovery from acute non-specific low back pain predict absence from usual work due to chronic low back pain : a systematic review

NARCIS (Netherlands)

Hallegraeff, J.M.; Krijnen, W.P.; van der Schans, C.P.; de Greef, M.H.G.

2012-01-01

Question: Do negative expectations in patients after the onset of acute low back pain increase the odds of absence from usual work due to progression to chronic low back pain? Design: Systematic review with meta-analysis of prospective inception cohort studies. Participants: Adults with acute or

Evaluation of the Relative Validity of the Short Diet Questionnaire for Assessing Usual Consumption Frequencies of Selected Nutrients and Foods

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Bryna Shatenstein

2015-08-01

Full Text Available A 36-item Short Diet Questionnaire (SDQ was developed to assess usual consumption frequencies of foods providing fats, fibre, calcium, vitamin D, in addition to fruits and vegetables. It was pretested among 30 community-dwelling participants from the Québec Longitudinal Study on Nutrition and Successful Aging, “NuAge” (n = 1793, 52.4% women, recruited in three age groups (70 ± 2 years; 75 ± 2 years; 80 ± 2 years. Following revision, the SDQ was administered to 527 NuAge participants (55% female, distributed among the three age groups, both sexes and languages (French, English prior to the second of three non-consecutive 24 h diet recalls (24HR and validated relative to the mean of three 24HR. Full data were available for 396 participants. Most SDQ nutrients and fruit and vegetable servings were lower than 24HR estimates (p < 0.05 except calcium, vitamin D, and saturated and trans fats. Spearman correlations between the SDQ and 24HR were modest and significant (p < 0.01, ranging from 0.19 (cholesterol to 0.45 (fruits and vegetables. Cross-classification into quartiles showed 33% of items were jointly classified into identical quartiles of the distribution, 73% into identical and contiguous quartiles, and only 7% were frankly misclassified. The SDQ is a reasonably accurate, rapid approach for ranking usual frequencies of selected nutrients and foods. Further testing is needed in a broader age range.

Early motion and directed exercise (EMADE) versus usual care post ankle fracture fixation: study protocol for a pragmatic randomised controlled trial.

Science.gov (United States)

Matthews, Paul A; Scammell, Brigitte E; Ali, Arfan; Coughlin, Timothy; Nightingale, Jessica; Khan, Tanvir; Ollivere, Ben J

2018-05-31

Following surgical fixation of ankle fractures, the traditional management has included immobilisation for 6 weeks in a below-knee cast. However, this can lead to disuse atrophy of the affected leg and joint stiffness. While early rehabilitation from 2 weeks post surgery is viewed as safe, controversy remains regarding its benefits. We will compare the effectiveness of early motion and directed exercise (EMADE) ankle rehabilitation, against usual care, i.e. 6 weeks' immobilisation in a below-knee cast. We have designed a pragmatic randomised controlled trial (p-RCT) to compare the EMADE intervention against usual care. We will recruit 144 independently living adult participants, absent of tissue-healing comorbidities, who have undergone surgical stabilisation of isolated Weber B ankle fractures. The EMADE intervention consists of a non-weight-bearing progressive home exercise programme, complemented with manual therapy and education. Usual care consists of immobilisation in a non-weight-bearing below-knee cast. The intervention period is between week 2 and week 6 post surgery. The primary outcome is the Olerud and Molander Ankle Score (OMAS) patient-reported outcome measure (PROM) at 12 weeks post surgery. Secondary PROMs include the EQ-5D-5 L questionnaire, return to work and return to driving, with objective outcomes including ankle range of motion. Analysis will be on an intention-to-treat basis. An economic evaluation will be included. The EMADE intervention is a package of care designed to address the detrimental effects of disuse atrophy and joint stiffness. An advantage of the OMAS is the potential of meta-analysis with other designs. Within the economic evaluation, the cost-utility analysis, may be used by commissioners, while the use of patient-relevant outcomes, such as return to work and driving, will ensure that the study remains pertinent to patients and their families. As it is being conducted in the clinical environment, this p-RCT has high external

Estudio multivariado sobre determinación de factores sociodemográficos relacionados con el éxito o fracaso en la cirugía de prótesis de rodilla

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Fabiola Arévalo Vilchis

Full Text Available Introducción: la artrosis de rodilla es una alteración de la superficie de uno o más de los tres componentes de la articulación femorotibial interno, externo y rotuliano. Existen factores de riesgo como la obesidad, tensiones o inestabilidad de la articulación, factores genéticos, alteraciones anatómicas, el ejercicio de contacto, traumatismos, entre otros, que predisponen a la enfermedad. Objetivo: determinar los factores sociodemográficos relacionados con el éxito o fracaso de la cirugía de prótesis de rodilla. Material y Métodos: se realizó un estudio descriptivo, retrospectivo y transversal durante el periodo de enero de 2009 a diciembre de 2010, en el Hospital Regional "Lic. Adolfo López Mateos" del ISSSTE en México. Se estudiaron los expedientes de 240 pacientes intervenidos de cirugía de prótesis de rodilla, de los cuales sólo 155 cumplieron con los criterios de inclusión. Se captó la información en programa Excel y SPSS 20, procediendo a realizar análisis de frecuencias, de variabilidad, de correlación y técnica multivariada de análisis discriminante. Resultados: de los 155 pacientes estudiados 30 (19,3 % presentaron complicaciones. De las nueve variables, sólo dos presentaron significancia estadística: la edad con 48 (31 %, con p< -0,001 y Gamma -0,702, indicando una correlación buena, a mayor edad menos complicaciones. La ocupación con 53 activos (34,2 %, con p< 0,001 y Eta 0,301, indicó correlación baja, a mayor actividad más complicaciones. El índice de masa corporal arrojó un resultado no contundente. Conclusiones: los pacientes jóvenes y activos presentan mayores complicaciones. La obesidad tiene una influencia relativa.

Effect of guided self-determination youth intervention integrated into outpatient visits versus treatment as usual on glycemic control and life skills

DEFF Research Database (Denmark)

Husted, Gitte R; Thorsteinsson, Birger; Esbensen, Bente Appel

2014-01-01

the amotivation for diabetes self-management after adjusting for the baseline value (P = 0.001). Compared with the control group, the trial completion was prolonged in the GSD-Y group (P ... of the adolescents' visits (P = 0.05) compared with control parents. CONCLUSIONS: Compared with treatment-as-usual, GSD-Y did not improve HbA1c levels, but it did decrease adolescents' amotivation for diabetes self-management.Trial registration: ISRCTN 54243636, registered on 10 January 2010. Life skills...

Encounter Decision Aid vs. Clinical Decision Support or Usual Care to Support Patient-Centered Treatment Decisions in Osteoporosis: The Osteoporosis Choice Randomized Trial II.

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Annie LeBlanc

Full Text Available Osteoporosis Choice, an encounter decision aid, can engage patients and clinicians in shared decision making about osteoporosis treatment. Its effectiveness compared to the routine provision to clinicians of the patient's estimated risk of fracture using the FRAX calculator is unknown.Patient-level, randomized, three-arm trial enrolling women over 50 with osteopenia or osteoporosis eligible for treatment with bisphosphonates, where the use of Osteoporosis Choice was compared to FRAX only and to usual care to determine impact on patient knowledge, decisional conflict, involvement in the decision-making process, decision to start and adherence to bisphosphonates.We enrolled 79 women in the three arms. Because FRAX estimation alone and usual care produced similar results, we grouped them for analysis. Compared to these, use of Osteoporosis Choice increased patient knowledge (median score 6 vs. 4, p = .01, improved understanding of fracture risk and risk reduction with bisphosphonates (p = .01 and p<.0001, respectively, had no effect on decision conflict, and increased patient engagement in the decision making process (OPTION scores 57% vs. 43%, p = .001. Encounters with the decision aid were 0.8 minutes longer (range: 33 minutes shorter to 3.0 minutes longer. There were twice as many patients receiving and filling prescriptions in the decision aid arm (83% vs. 40%, p = .07; medication adherence at 6 months was no different across arms.Supporting both patients and clinicians during the clinical encounter with the Osteoporosis Choice decision aid efficiently improves treatment decision making when compared to usual care with or without clinical decision support with FRAX results.clinical trials.gov NCT00949611.

Comparación de la atención del parto normal en los sistemas hospitalario y tradicional A comparison of vaginal delivery care between hospital and traditional systems

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Rosa María Méndez-González

2002-04-01

Full Text Available Objetivo. Comparar la atención del parto por vía vaginal entre los sistemas hospitalario y tradicional, para identificar recursos y procedimientos utilizados, y la aparición de complicaciones maternas y neonatales derivadas del tipo de atención. Material y métodos. Estudio transversal realizado en tres hospitales de la ciudad de Mérida y cuatro municipios del estado de Yucatán, México, entre 1989 y 1990. La muestra estuvo constituida por 205 mujeres que tuvieron parto por vía vaginal. Se observó la atención del parto y, a los 15 días posparto, se les entrevistó para detectar complicaciones maternas y neonatales. Se calcularon proporciones y se aplicó ji cuadrada para compararlas. Resultados. Se presentaron complicaciones en ambos sistemas. Sin embargo, en el hospitalario predominaron las maternas y en el tradicional, las neonatales. El número total de complicaciones fue similar. Conclusiones. La calidad de la atención fue similar en ambos servicios. Las complicaciones observadas pueden atribuirse a los recursos y acciones utilizados en cada sistema. Se requieren más estudios de este tipo para contar con evaluaciones objetivas de las ventajas y desventajas de ambos sistemas y contribuir a mejorar la calidad de la atención materno-infantil.Objective. To compare vaginal delivery hospital and traditional care systems to identify resources and practices, as well as maternal and neonatal complications related to each system. Material and Methods. Between 1989 and 1990, a cross-sectional study was conducted in three hospitals of Merida City and four municipalities of the state of Yucatan. The study sample consisted of 205 women who had a normal vaginal delivery. Delivery procedures were observed and a questionnaire to identify complications was applied 15 days after childbirth. Data analysis consisted in comparison of proportions with the chi-squared test. Results. Maternal and neonatal complications were identified in both systems

Theoretical study of excitonic complexes in semiconductors quantum wells; Estudo teorico de complexos excitonicos em pocos quanticos de semicondutores

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Dacal, Luis Carlos Ogando

2001-08-01

A physical system where indistinguishable particles interact with each other creates the possibility of studying correlation and exchange effect. The simplest system is that one with only two indistinguishable particles. In condensed matter physics, these complexes are represented by charged excitons, donors and acceptors. In quantum wells, the valence band is not parabolic, therefore, the negatively charged excitons and donors are theoretically described in a simpler way. Despite the fact that the stability of charged excitons (trions) is known since the late 50s, the first experimental observation occurred only at the early 90s in quantum well samples, where their binding energies are one order of magnitude larger due to the one dimensional carriers confinement. After this, these complexes became the subject of an intense research because the intrinsic screening of electrical interactions in semiconductor materials allows that magnetic fields that are usual in laboratories have strong effects on the trion binding energy. Another rich possibility is the study of trions as an intermediate state between the neutral exciton and the Fermi edge singularity when the excess of doping carriers is increased. In this thesis, we present a theoretical study of charged excitons and negatively charged donors in GaAs/Al{sub 0.3}Ga{sub 0.7}As quantum wells considering the effects of external electric and magnetic fields. We use a simple, accurate and physically clear method to describe these systems in contrast with the few and complex treatments s available in the literature. Our results show that the QW interface defects have an important role in the trion dynamics. This is in agreement with some experimental works, but it disagrees with other ones. (author)

Absence of the predisposing factors and signs and symptoms usually associated with overreaching and overtraining in physical fitness centers

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Carolina Ackel-D'Elia

2010-01-01

Full Text Available OBJECTIVE: The aim of this study was to evaluate the occurrence of the well-known predisposing factors and signs and symptoms usually associated with either overreaching or overtraining syndrome in physical fitness centers in São Paulo City, Brazil. METHOD: A questionnaire consisting of 13 question groups pertaining to either predisposing factors (1-7 or signs and symptoms (8-13 was given to 413 subjects. The general training schedule of the volunteers was characterized by workout sessions of 2.18 ± 0.04 h for a total of 11.0 ± 0.3 h/week for 33 ± 2 months independent of the type of exercise performed (walking, running, spinning, bodybuilding and stretching. A mean score was calculated ranging from 1 (completely absent to 5 (severe for each question group. A low occurrence was considered to be a question group score lower than 4, which was observed in all 13 question groups. RESULTS: The psychological evaluation by POMS Mood State Questionnaire indicated a normal non-inverted iceberg. The hematological parameters, creatine kinase activity, cortisol, total testosterone and free testosterone concentrations were within the normal ranges for the majority of the volunteers selected for this analysis (n = 60. CONCLUSION: According to the questionnaire score analysis, no predisposing factors or signs and symptoms usually associated with either overreaching or overtraining were detected among the members of physical fitness centers in São Paulo City, Brazil. This observation was corroborated by the absence of any significant hematological or stress hormone level alterations in blood analyses of the majority of the selected volunteers (n = 60.