Seguimiento a largo plazo de pacientes traqueostomizados post injuria cerebral adquirida grave / Long-term follow-up of tracheostomized patients post severe acquired brain injury

Resumen Introducción: Alrededor del 50% de los pacientes hos pitalizados por injuria cerebral adquirida grave requie ren traqueostomía y cuidados a largo plazo. El objetivo principal de este estudio fue describir la evolución de enfermos con injuria cerebral adquirida grave (ICAg) traqueostomizados que ingresaron a rehabilitación. Se cundariamente se estudió el fracaso de la decanulación y la supervivencia a los 12 meses del alta. Métodos: estudio cuantitativo observacional prospec tivo de centro único. Se incorporó al estudio, de forma prospectiva y consecutiva, usuarios mayores de 18 años, traqueostomizados posterior a ICAg ingresados a un cen tro de rehabilitación entre abril de 2018 y marzo de 2020. Resultados: se incluyeron para el análisis 50 pacien tes. La estancia en el centro fue de 203 (RIQ 93-320) días. Al alta de la institución, 32 (64%) pacientes pudieron ser decanulados exitosamente. El tiempo transcurrido desde el ingreso al centro hasta la decanulación fue de 49 (12-172) días. No se observó fracaso de la decanula ción. La mortalidad a los 12 meses de seguimiento fue de 32%, cinco (16%) de los 32 pacientes que pudieron ser decanulados y 11 (61%) de los 18 que no lograron la decanulación fallecieron dentro de los 12 meses de seguimiento. La relación entre la decanulación y la mortalidad a los 12 meses de seguimiento resultó esta dísticamente significativa (p = 0.002). Discusión: La supervivencia global fue relativamente elevada, el proceso de decanulación resulta relevante ya que puede tener impacto en la supervivencia a largo plazo.

Abstract Introduction: About 50% of patients hospitalized for severe acquired brain injury require tracheostomy, and many of them need long-term care. The main objective of this study was to describe the evolution of patients with severe acquired brain injury (sABI) tracheotomized who entered rehabilitation. Secondarily, mortality re lated to the success or failure of decannulation and survival at 12 months of discharge were studied. Methods: A single-center prospective observational quantitative study. Users over 18 years of age were recruited prospectively and consecutively, tracheosto mized after sABI, and admitted to a rehabilitation center between April 2018 and March 2020. Results: Fifty patients were included for analysis. The stay in the center was 203 (RIQ 93-320) days. At discharge to the institution, 32 (64%) patients managed to be successfully decannulated. The median number of days from admission to the center to decannulation was 49 (12-172). No decannulation failure was observed. Mortality at 12 months follow-up was 32%, five (16%) of the 32 patients who managed to be decannulated, and 11 (61%) of 18 who failed to achieve decannulation died within 12 months of follow-up. The relationship between decannulation success and mortality at 12 months of follow-up was statistically significant (p= 0.002). Discussion: Addressing the decannulation process early and properly guided is relevant as it may impact long-term survival.

Comparación entre la primera y segunda ola de pacientes con COVID-19 que requirieron ventilación mecánica invasiva en una unidad de cuidados intensivos de Argentina / Comparison between the first and second COVID-19 wave of patients who required invasive mechanical ventilation in an intensive care unit in Argentina

Resumen Introducción: la información sobre características y resultados ventilatorios que comparen la primera (O1) y segunda (O2) ola de COVID-19 en Argentina son limitados. El objetivo principal de este estudio fue describir las características generales y variables ventilatorias en pacientes COVID-19 que requirieron ventilación mecánica invasiva (VMI) y comparar las diferencias entre olas. Secundariamente se es tudiaron factores asociados con mortalidad en la unidad de cuidados intensivos (UCI). Métodos: Realizamos un estudio observacional analítico de cohorte prospectiva que incluyó pacientes mayores de 18 años infectados por SARS-CoV-2 ingresados de forma consecutiva a la unidad de cuidados intensivos, con requerimiento de VMI, entre el 1 de agosto de 2020 y el 30 de junio de 2021. Se incluyeron 412 pacientes. Resultados: Encontramos diferencias estadísticamente significativas (p < 0.001) en: la edad [O1 64 (55-72) años versus O2 59 (50-66) años]; presencia de EPOC [O1 n = 41 (19.8%) versus O2 n = 13 (6.3%)]; Presión meseta [O1 27 (25-30) cmH2O versus O224 (22-27) cmH2O],presión de conducción (ΔP) [O1 15 (13-17) cmH2O versus O2 12 (11-14) cmH2O]; complacencia [O1 40 mL/cmH2O (32-46) versus O2 33 mL/cmH2O (27-40)]; reintubación [O1 30.4% (n=63/207) versus O2 13.7% (n=28/205)]. Se identificaron como factores independientes asociados a mortalidad las siguientes variables: edad [(OR 1.07 (IC 95% 1.05-1.09)], el ΔP en las primeras 24 h [(OR 1.19 (IC 95% 1.10-1.28)] y O2 [OR 1.81 (IC 95% 1.12-2.93); p = 0.015]. Discusión: Durante O2, los pacientes eran más jóvenes. Fue posible lograr una mecánica ventilatoria más ajustada a una estrategia de ventilación protectora. Como conclusión, en los pacientes estudiados la edad y ΔP fueron predictores independientes de mortalidad.

Abstract Introduction: the information regarding characteristics and ventilatory results comparing the first (W1) and the second wave (W2) in Argentina are limited. The main objective of this study was to describe general charac teristics and ventilatory variables in COVID-19 patients who required invasive mechanical ventilation (IMV) and compare differences between waves. Secondarily, factors associated with mortality in intensive care unit (ICU) were studied. Methods: We conducted a prospective observational cohort study that included patients older than 18 years infected with SARS-CoV-2 consecutively admitted to ICU with IMV between August 1, 2020, and June 30, 2021. We included 412 patients. Results: We found statistically significant differences (p < 0.001) in age [W1 64(55-72) vs W2 59 (50-66) years], presence of COPD [W1 n = 42 (19.8%) vs. W2 n = 13(6.3%)], plateau pressure [W1 27(25-30) cm H2O vsW2 24 (22-27) cmH2O], driving pressure (ΔP) [W1 15 (13-17) cmH2O vs. W2 12 (11-14) cm H2O] compliance [W1 40 mL/cmH2O (32-46) vs. W2 = 33 mL/cm H2O (27-40)]; reintubation [W1 30.4% (n = 63/207) vs. W2 13.7% (n = 28/205)]. We identified as independent factors associated with mortality the following variables: age [OR 1.07(95% CI 1.05-1.09)], the ΔP in the first 24 hours [OR 1.19(95% CI 1.10- 1.28)] and W2 [OR 1.81 (95% IC1.12-2.93); p = 0.015. Discussion: During W2 the patients were younger. It was possible to achieve ventilatory mechanics more adjusted to a protective ventilation strategy. In conclusion, in the patients studied, age and ΔP were independent predictors of mortality.

Sensitivity comparison for the Leishmania spp. detection in different canine tissues using PCR-HRM

ABSTRACT Background: Leishmaniasis is a vector-borne disease caused by a parasite protozoon from the genus Leishmania. Among the molecular techniques applied for detecting these parasites, real-time PCR with High Resolution Melting (PCR-HRM) proved advantageous since it simultaneously determines both the presence and species of the pathogen in one step, through amplification and later analysis of curves generated by melting temperature. Methods: Based on this molecular technique, the goal of this study was to estimate the PCR-HRM sensitivity for Leishmania spp. detection in different canine tissues by evaluating biological samples obtained from popliteal, submandibular, and pre-scapular lymph nodes, from bone marrow and ear pinnae of 28 stray dogs captured in the metropolitan area of Asunción (Paraguay). Results: The rk39 immunochromatographic test showed that 25/28 tested dogs (89%) presented antibodies against L. infantum. In 20/25 dogs that tested positive for rk39 (80%), it was possible to detect Leishmania spp. by PCR-HRM and determine that the species corresponded entirely to L. infantum. Regarding the analysis of different tissues, the parasite was detected in all popliteal lymph node samples, followed by high detection in submandibular (at 95%) and pre-scapular lymph nodes (at 90%), bone marrow (at 85%), and ear pinnae (at 85%). Conclusions: This study demonstrated that the use of real-time PCR-HRM using the molecular marker hsp70 was a highly sensitive method for simultaneously detecting and identifying Leishmania species in different tissues taken from infected dogs. In addition, the usefulness of ear pinnae as easily accessible tissue for molecular diagnosis was emphasized.

Antiprotozoal action of synthetic cinnamic acid analogs

Abstract INTRODUCTION Leishmaniasis, Chagas disease, and malaria cause morbidity globally. The drugs currently used for treatment have limitations. Activity of cinnamic acid analogs against Leishmania spp., Trypanosoma cruzi, and Plasmodium falciparum was evaluated in the interest of identifying new antiprotozoal compounds. METHODS In vitro effects of analogs against L. braziliensis, L. infantum chagasi, T. cruzi, and P. falciparum, and hemolytic and cytotoxic activities on NCTC 929 were determined. RESULTS Three analogs showed leishmanicidal and tripanocidal activity. No antiplasmodial, hemolytic, or cytotoxic activity was observed. CONCLUSIONS Antiprotozoal activity of analogs against L. infantum braziliensis, L. infantum chagasi, and T. cruzi was demonstrated.

Avaliação da atividade anti-Leishmania e anti-Trypanosoma do extrato etanólico das folhas de Annona squamosa L / Evaluation of the anti-leishmania and anti-trypanosoma activity of ethanolic extract from the leaves of Annona squamosa L

As doenças parasitárias, também chamadas de “doenças negligenciadas”, continuam sendo uma grande dificuldade para o desenvolvimento social e econômico dos países mais pobres. Podemos citar como exemplo dessas doenças, a leishmaniose e a doença de Chagas. A leishmaniose é causada por parasitas do gênero Leishmania e afeta cerca de 12 milhões de pessoas. A doença de Chagas, causada pelo protozoário Trypanosoma cruzi, causa aproximadamente 50.000 mortes por ano. Os fármacos disponíveis para o tratamento dessas doenças são altamente tóxicos, sendo este um dos motivos que leva à busca por drogas eficazes e seguras para seus tratamentos. As folhas da Annona squamosa, espécie da família Annonaceae, já foram descritas na literatura por suas atividades hepatoprotetora, antiparasitária, pesticida e antimicrobiana. Nesse estudo avaliamos a atividade anti-leishmania e tripanocida do extrato etanólico das folhas de Annona squamosa L. (EEAS) em formas promastigota do parasita Leishmania braziliensis e Leishmania infantum e epimastigota de Trypanosoma cruzi, além de avaliar a atividade citotóxica em fibroblasto. Os resultados demonstram que o extrato apresentou uma melhor atividade contra Leishmania infantum e Leishmania brasiliensis quando comparados com Trypanosoma cruzi; e que apresentou uma maior toxicidade nas concentrações de 500 e 1000 μg/ml, com mortalidade dos fibroblastos de aproximadamente 85% e 100%, respectivamente. Esse estudo aponta para uma perspectiva terapêutica alternativa que se mostrou eficaz frente aos parasitas aqui estudados, exceto a forma epimastigota de Trypanosoma cruzi. Com relação aos testes de citotoxicidade fazem-se necessários novos testes, uma vez que apresentou um alto nível de toxicidade, viabilizando assim futuros ensaios in vivo.

The parasitic diseases, also calls by “neglected diseases”, continue being a major difficulty for the social and economic development of the poorest countries. We can cite as an example of these diseases, the leishmaniasis and the Chagas disease. Leishmaniasis is caused by parasites of the genus Leishmania and affects about 12 million people. The Chagas disease, caused by the protozoan Trypanosoma cruzi, causes approximately 50,000 deaths per year. The drugs available for the treatment of these diseases are highly toxic, being this one of the reasons that leads to the search for effective and safe drugs for their treatments. The leaves of the Annona squamosa, species of the family Annonaceae, have already been described in the literature by their hepatoprotective activities, antiparasitic, pesticide and antimicrobial. In this study we assessed the activity tripanocidal and antileishmania of ethanolic extract from the leaves of Annona squamosa L. (EEAS) in promastigota forms of the parasite Leishmania braziliensis and Leishmania infantum and epimastigota of Trypanosoma cruzi, in addition to evaluating the cytotoxic activity in fibroblasts. The results demonstrate that the extract presented a better activity against Leishmania infantum and Leishmania brasiliensis when compared with Trypanosoma cruzi; and which presented a greater toxicity at concentrations of 500 and 1000 μg/ml, with mortality of fibroblasts of approximately 85% and 100%, respectively. This study points to an alternative therapeutic perspective that showed effective against the parasites here studied, except the epimastigota form of Trypanosoma cruzi. With relation to cytotoxicity tests are required new tests, once presented a high level of toxicity, thus enabling future in vivo assays.

A citotoxicidade e a avaliação da atividade antiprotozoária de Melissa officcinalis L (CIDRO-MELISA) / Actividad citotóxica y evaluación antiparasitaria de Melissa officcinalis L. (CIDRO-MELISA) / The cytotoxicity activity and evaluation of antiprotozoa Melissa officcinalis L (CIDRO-MELISA)

Introdução: as Leishmanioses correspondem a um complexo de doenças tropicais causada por mais de vinte diferentes espécies de protozoários intracelulares pertencentes ao gênero Leishmania. A Doença de Chagas é uma doença que representa um dos principais problemas de saúde pública em vários países, afetando sobretudo a população carente e rural. Melissa officinalis L., é uma erva perene, uma planta exótica, cuja família é Lamiaceae, que tem sido amplamente utilizada na medicina popular com finalidades terapêuticas. O seu óleo essencial tem sido usado como antioxidante, antimicótica, antifúngica, sedativa e antivirótica. Objetivo: avaliar a citotoxicidade, composição química e atividade antiparasitária do óleo essencial da espécie M. officinalis. Métodos: M. officcinalis foi coletada no município do Crato, CE, Brasil, e foi depositada no herbário da Universidade Regional do Cariri URCA. A análise da composição química do óleo essencial de M. officcinalis, foi realizada através de Cromatografia Gasosa acoplada à Espectrometria de Massas. No estudo da atividade leishmanicida in vitro, utilizou-se formas promastigotas de L. braziliensis e epimastigotas de Trypanosoma cruzi. Para a atividade citotóxica utilizou-se a linhagem de fibroblastos de mamífero NCTC clone 929. Resultados: a través da análise do óleo essencial de M. officcinalis feita por CG/EM, foi possível identificar 12 constituintes que totalizavam 99,83 por cento, dentre os quais alguns foram majoritários: Geranial, Z Citral, 1- Limonene e Carvone. Foi verificado baixa toxicidade contra os fibroblastos. M. officcinalis exibiu maior capacidade para impedir a replicação contra a forma promastigota do protozoário, nas concentrações testadas. Conclusão: a espécie pode ser uma fonte importante na busca de agentes novos e seletivos para o tratamento de doenças tropicais causadas por protozoários, cujas propriedades necessitam ser investigadas quanto aso seus mecanismos(AU)

Introducción: Leishmaniasis corresponde a un complejo de enfermedades tropicales causadas por más de veinte especies diferentes de protozoos intracelulares que pertenece al género Leishmania. La enfermedad de Chagas es una enfermedad que es uno de los principales problemas de salud pública en muchos países, que afectan especialmente a la población pobre y rural. Melissa officinalis L., es una hierba perenne, una planta exótica, cuya familia Lamiaceae, ha sido ampliamente utilizado en la medicina popular para fines terapéuticos. Su aceite esencial se ha usado como un antioxidante, antimicótico, antifúngica, antiviral y sedante. Objetivo: evaluar la citotoxicidad, la composición química y la actividad antiparasitaria del aceite esencial de la especie M. officinalis. Métodos: M. officinalis se recogió en el municipio de Crato, CE, Brasil, y fue depositado en el herbario de la Universidad Regional del Cariri URCA. El análisis de la composición química del aceite esencial de M. officcinalis se realizó por espectrometría de masa de cromatografía de gas. En el estudio de la actividad invitro leishmanicida se utilizó promastigotes L. braziliensis y Trypanosoma cruzi. Para la actividad citotóxica se utilizó la cepa de fibroblastos de mamífero NCTC clon 929. Resultados: a través de análisis de aceite esencial de M. officinalis hizo por GC/ EM se identificó un total de 12 constituyentes 99,83 por ciento, entre los cuales algunos eran mayoría: geranial, Z citral, limoneno y carvona 1. Se comprobó una baja toxicidad contra fibroblastos. M. officcinalis exhibió mayor capacidad para evitar la replicación contra la forma promastigote de parásito, a las concentraciones ensayadas. Conclusión: la especie puede ser una fuente importante en la búsqueda de nuevos agentes y selectivos para el tratamiento de enfermedades tropicales causadas por protozoos, cuyas propiedades deben ser investigados con respecto a sus mecanismos(AU)

Introduction: Leishmaniasis is a complex of tropical diseases caused by more than twenty different species of intracellular protozoa from the genus Leishmania. Chagas disease is one of the main public health problems in many countries. It mostly affects the poor, rural population. Melissa officinalis L. is a perennial herb, an exotic plant from the family Lamiaceae which has been widely used in folk medicine for therapeutic purposes. Its essential oil has been used as antioxidant, antifungal, antiviral and sedative. Objective: Evaluate the cytotoxicity, chemical composition and antiparasitic activity of essential oil of the species M. officinalis. Methods: M. officinalis specimens were collected from the municipality of Crato, CE, Brazil, and deposited in the herbarium at the Regional University of Cariri (URCA). Analysis of the chemical composition of essential oil of M. officinalis was performed by gas chromatography / mass spectrometry. L. braziliensis and Trypanosoma cruzi promastigotes were used for the study of in vitro leishmanicidal activity. Mammalian fibroblast strain NCTC clone 929 was used to evaluate cytotoxic activity. Results: Analysis of essential oil from M. officinalis by GC / MS led to identification of a total 12 constituents 99.83 percent, among which some were a majority: geranial, Z citral, limonene and 1-carvone. Toxicity against fibroblasts was found to be low. M. officinalis displayed greater capacity to avoid replication against the promastigote form of the parasite at the concentrations assayed. Conclusion: The species may be an important source of new agents and selective media for the treatment of tropical diseases caused by protozoa, whose properties should be studied with respect to their mechanisms(AU)

El sentido de vida de las madres de niños prematuros internados en Unidad de Cuidados Intensivos Neonatales (UCIN) / The meaning of life of the mothers of premature babies who are hospitalized in the Neonatal Intensive Care Unit (NICU)

La prematuridad es una problemática que se encuentra en aumento a nivel mundial. En Argentina 8 de cada 100 bebés nacen antes de tiempo, de ahí la importancia de sensibilizar a la población sobre este tema. Para la logoterapia la motivación básica y propia del ser humano es su orientación fundamental hacia el sentido, es decir, el encontrar y descubrir un porqué y para qué. Tener en cuenta la dimensión existencial de la persona es una forma de acercarnos al problema. Por tal motivo el objetivo del trabajo que se informa fue relacionar el sentido de vida develado por las madres de niños que se encuentran internados en Unidad de Cuidados Intensivos Neonatales (UCIN) debido a su nacimiento prematuro con dos factores; por un lado con la capacidad que ellas mismas refieren para informarse adecuadamente acerca de la situación de su hijo y por el otro, con su vinculación con situaciones límite vividas durante el embarazo. Se realizó un estudio experimental con 30 madres de niños prematuros que han pasado por una internación en UCIN en tres instituciones hospitalarias. Se construyó un instrumento con formato de entrevista semidirigida llamado Vivencia de Madres de Niños Nacidos Prematuramente. Los resultados demuestran que las madres con mayor capacidad para solicitar información sobre la situación de sus hijos son las que pudieron dar respuestas acerca de la pregunta sobre el sentido que esta situación les permitía descubrir. En un porcentaje menor pudieron relacionarse las respuestas con situaciones límites vividas con anterioridad.

Prematurity is a problem which is getting bigger worldwide. In eight out of one hundred babies are born before their due time, that is why it is necessary to make the population conscious of this issue. In relation to this figure it is necessary to work on raising public awareness about prematurity and integrate thus subject to the public health agenda. For Logotherapy the basic human motivation is its fundamental orientation meaning the same psychological school posits the existence of the tragic triad. Others have called extreme situations; these are death, guilt and suffering. These situations which by their nature are permanent, you cannot work to change them, they are imposed situations that leave no alternative but to live them, to suffer, to experience, even if you want to run. They are fighting ability, the potential and the true self. It is in these extreme situations that person forgets the surface world and struggle for existence. None of them can be avoided by humans. Taking into account the existential sphere of the person is a way of approaching the problem, therefore, the aim of this project is to relate the meaning of life shown by the mothers of those children who are hospitalized in the Neonatal Intensive Care Unit (NICU) owing to their premature birth, with two factors. On the one hand, with the capability they themselves refer to of getting information properly about their child‘s situation and, on the other hand, with their connection with extreme situations experienced during their pregnancy. Our search is based on an experimental study of 30 premature babies’ mothers that have undergone a hospitalization in the NICU. Knowing this dimension of the person, is a contribution to the awareness of health personnel working with families that this type of situation is passing , it is also a starting point for a possible psychological treatment and a tool to strengthen the link between mother and infant. A tool was built, in the shape of a semi - addressed interview call ed premature babies mothers’ personal experiences with the aim of approaching the study properly. This model is based on five areas, beginning with formal details, then it enquires about the pregnancy, the labor, the hospitalization and the conclusions. It includes questions related to the meaning of life displayed in the hospitalization situation, the capability the person has to get informed properly about her baby’s situation, the relationship with doctors and nurses, contradictory feelings, among other items. Results show that the mothers with greater capability to ask for information about their children’s situation are the ones who could answer about the meaning this experience give them. The highest percentage of coincidence belongs to the group of moderate premature babies, decreasing progressively to the extreme premature ones. In a lower percentage we could relate the answers of meaning with extreme situations lived before. In some cases meaning, information and previous extreme situations are co-related. There are five areas in the mothers’ answers according to the meaning they get from the situation they lived. They are: learning, valuation, personal growth and acceptance of the situation they lived, beliefs and religion and general responses. The meaning of life allows us to open the doors for future studies in which we may be able to elaborate strategies of work with mothers and their children hospitalized in the NICU, considering the existential aspect of the person, above all supporting them in extreme situations and in the handling of information as a way of facing them.

Guía para padres de bebés nacidos prematuros: La internación / Guide for parents of babies born prematurely: Hospitalization

Cada año nacen a nivel mundial alrededor de 15 millones de niños anticipadamente y dicha tasa de nacimientos prematuros sigue en aumento. De estos infantes, un millón muere a causa de secuelas relacionadas con su temprana llegada al mundo. A partir de la experiencia en Psicología Perinatal en tres hospitales de la Ciudad Autónoma de Buenos Aires y el Gran Buenos Aires, se observaron ciertos cuestionamientos de los padres de niños que se encuentran internados debido a su prematuridad en servicios de Unidad de Cuidados Intensivos Neonatales (UCIN). Por este motivo el objetivo del trabajo realizado fue elaborar una Guía para padres de bebés nacidos prematuros que permita una correcta y rápida comprensión del ámbito de internación además de las situaciones por las que podría atravesar un niño nacido prematuro. Se utilizaron para este fin textos y cuadros. A su vez se trabajó acerca de los equipos empleados, el personal de salud que lo atenderá, el contacto con el niño, la lactancia, las experiencias de otros padres, páginas y redes sociales relacionadas con la temática y los derechos del niño prematuro según UNICEF. Se incluyen también, algunas sugerencias y fuentes bibliográficas. Esta guía pretende colaborar en el empoderamiento de los padres con niños internados en UCIN. En futuros estudios se podría evaluar el impacto de la misma en los padres y en los servicios de salud.

Each year are born prematurely 15 million babies worldwide and premature birth rates continue to rise. One million children die from complications from his prematurity and many survivors face a life with sequels. Prematurity is the leading cause of neonatal death and the second cause of deaths in children under five. In a report by March of Dimes is a need to addres surgent measures to deal with the millions of children born premature each year and ensure that all professionals can have an important role to make these measures. So working in the written information provided to relatives of patients admitted in NICU can be one of many possible ways to work on this goal. It is understood by premature baby, every infant born before 37 weeks gestational age. There are classifications of children born prematurely, Unicef puts based on gestational age: Between 36 and 31 weeks referred to Moderate Prematurity, between 30 and 28 weeks, Prematurity Extreme and when the birth occurs before 28 weeks, It is considered very extreme. Through experience in Perinatal Psychology in different institutions with hospitalization in Neonatal Intensive Care Unit (NICU) of the Ciudad Autónoma de Buenos Aires and Gran Buenos Aires, we have noted certain issues and characteristics particular to the parents of children hospitalized in NICU due to their premature birth. The aim of this work was to create a guide for parents experiencing the hospitalization of their children in NICU that permits rapid and comprehensive consultation for those un familiar with psychological-medical terminology. Comprehension is enriched by the addition of images and tables allowing cross-reference. This guide is intended to assist in empowering parents with children in NICU. This paper tries to give an idea that allows to remove the stigma of prematurity and take the child as a person who exceeds its prematurity. The issues dealt with in the guide are generally expressed through questions and corresponding answers: What does it mean that my baby has been born prematurely? What situations can my child experience during his/her hospitalization for premature birth and how is he/she assisted? What role do I play as mother or father in the neonatal unit? What care can I give as mother or father to my baby during his / her hospitalization? What signs does my baby present when they feel un comfortable or in pain? How can I comfort my baby? What is the experience of breastfeeding for a baby born prematurely? Can other family members visit my baby while he / she is hospitalized in the NICU? Is there a parents' group? What examinations will my child need after being discharged? Other informative items are added to help parents realize they are not the only ones, such as UNICEF's Rights of the Premature Child, experiences and feelings of mothers and fathers of babies born pre maturely, the sense of personal experience, recommendations, sites of interest on the internet (web and social networks) and bibliographical references. We stress the use of the phrase child / baby born prematurely and not just premature, to highlight that this child is a person who goes beyond the circumstance of having been born prematurely. This helps the parents to think of the situation as related to an experience in the life of their child and in their lives, rather than a constant in time, thus aiming to avoid future stigmatization, anxiety and over -protection. In future studies could evaluate the impact of this guide on parents and health services.

Estudio observacional de procedimientos médicos dolorosos realizados a infantes nacidos prematuros internados en unidad de cuidados intensivos neonatales (UCIN) / Observational study of painful medical procedures performed on preterm infants Admitted to the neonatal intensive care unit (NICU)

El dolor impacta en el infante, sobre todo en el nacido prematuro, dejando huellas más profundas de las que podría vivenciar un adulto. Este sufrimiento empaña a todo el ser, obligando a los profesionales de la salud a realizar una mirada abarcadora de esta temática, comprendiendo las esferas bio-psico-socio-axioculturales de la persona. Los autores que se han encargado de estudiar el dolor aseguran que el niño nacido prematuro no solo siente dolor sino que, producto de su inmadurez, se le presentaría con mayor intensidad y de manera difusa. Con motivo de analizar indicadores que correspondan a sensaciones de dolor en estos niños, se ha realizado un estudio observacional en la Unidad de Cuidados Intensivos Neonatales (UCIN) de un hospital privado de niños de la Ciudad Autónoma de Buenos Aires (CABA) - Argentina. La muestra fue de 14 niños pre-término, de los cuales 7 fueron prematuros muy extremos, 3 prematuros extremos y otros 4 prematuros moderados, correspondiendo esta clasificación a la sugerida por UNICEF (2010). Los indicadores tanto fisiológicos como conductuales observados fueron frecuencia cardiaca (FC), saturación de oxígeno (SO), tiempos de recuperación (TR) y comportamiento. Hallamos como resultados que los indicadores varían según edad gestacional. En prematuros muy extremos, la frecuencia cardiaca (FC) tiende a disminuir y no se presentan signos conductuales ante el procedimiento doloroso. A medida que aumenta la edad gestacional, estos valores van modificando su comportamiento, asemejándose cada vez más a las respuestas manifestadas por los bebés recién nacidos a término. La saturación de oxígeno en prácticamente la totalidad de la muestra presentó disminución de sus valores y los tiempos de recuperación fueron variables. Por lo tanto, siguiendo los indicadores presentados por las escalas de dolor, los bebés prematuros reaccionan de manera diferente ante el dolor que los niños recién nacidos de término...

Pain impacts in the infant, especially in the newborn, leaving deeper footprints that in the adult. This suffering tarnishes the whole being, forcing health professionals to perform a comprehensive view of this subject, comprising the bio-psycho-socio-cultural and axiological spheres of the individual. Authors who have been commissioned to study the pain ensure that the child who born premature not only feels pain, but like a product of his immaturity this would present more intensely and diffusely. Due to analyze indicators corresponding to sensations of pain in these children, was performed an observational study in Neonatal Intensive Care Unit (NICU) of a private children’s hospital of Buenos Aires (CABA) - Argentina. The sample included 14 preterm children of which 7 were premature very extreme, 3 premature extreme and 4 premature moderate, corresponding to the classification suggested by UNICEF (2010). Both physiological and behavioral indicators observed were heart rate (HR), oxygen saturation (OS), recovery time (RT) and behavior. We find as results that the indicators vary by gestational age. In very extreme premature heart rate (HR) tends to decrease and no behavioral signs are present in the painful procedure. As gestational age increases these values are changing their behavior, increasingly resembling the responses expressed by in term newborn. Oxygen saturation in most of the sample had decreased its values and recovery times were variable. Therefore, following signs presented by pain scales, premature babies react to pain different way that term newborns...

Detección de la deleción F508 del gen CFTR por la técnica de mutagénesis dirigida mediante PCR en pacientes con enfermedad fibroquística / Detection of F508 Deletion in the CFTR Gene by PCR Directed Mutagenesis in Patients with fibrocystic Ddsease

La Fibrosis quística es la enfermedad autosómica recesiva más común en la población blanca y se caracteriza por la obstrucción de conductos, principalmente en pulmón, páncreas y tracto genital. Se presenta en uno de cada 2000 a 2500 nacidos vivos y tiene una frecuencia de portadores de uno cada 20 a 25 nacidos vivos. La enfermedad es causada por diferentes mutaciones en el gen regulador de la conductancia transmembrana de la fibrosis quística (CFTR). La mutación más frecuente en el gen CFTR es la deleción de tres pares de bases (CTT) denominada F508. Este trabajo se realizó con el fin de estandarizar la técnica de mutagénesis dirigida mediante PCR (PSM) para la detección de.la mutación F508 en pacientes con fibrosis quística. El método utilizado fue validado mediante secuenciación del DNA del exón 10 en todos los individuos. Mediante este análisis genético se detectaron seis individuos con las mutaciones F508 e I507. El método implementado en nuestro laboratorio podría servir para realizar un sondeo poblacional de portadores de mutaciones para la FQ.