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Resumen: El síndrome de encefalopatía posterior reversible (PRES) se caracteriza por manifestaciones neurológicas asociadas a edema cerebral posterior hemisférico transitorio y se relaciona con el síndrome de preeclampsia-eclampsia. Objetivo: Identificar la incidencia del síndrome PRES en pacientes con eclampsia ingresadas a la Unidad de Cuidados Intensivos de Adultos (UCIA) del Hospital Regional de Alta Especialidad de la Mujer (HRAEM) y comparar los factores de riesgo asociados. Material y métodos: Observacional, retrospectivo, analítico, transversal y de cohorte de pacientes ingresadas con diagnóstico de eclampsia a la UCIA del HRAEM en el periodo de enero de 2010 a diciembre de 2015. Resultados: La incidencia obtenida fue de 57%. Las variables maternas significativas: edad (p = 0.034), número de crisis convulsivas (p = 0.001), edad media de 20.4 ± 6.5 años. La cefalea se observó en 91.5%. En 85% se detectó eclampsia anteparto. La vía de interrupción fue 77% por vía abdominal. La topografía de la lesión se manifestó como multifocal y bilateral en el lóbulo parietal y occipital. Conclusiones: La incidencia fue de 57%. Se estableció un perfil de alto riesgo de PRES en pacientes con eclampsia anteparto, primigestas, menores de 21 años, con presión arterial media mayor de 120 mmHg y con más de dos crisis convulsivas.
Abstract: The syndrome of reversible posterior encephalopathy (PRES) presents neurological manifestations associated to transient hemispheric posterior cerebral edema, is related to the syndrome of preeclampsia-eclampsia. Objective: To identify the incidence of PRES in patients with Eclampsia admitted to the ICU of the High Specialty Women's Hospital and to compare the associated risk factors. Material and methods: Observational, retrospective, analytical, cross-sectional and cohort study of patients admitted to the ICU with the diagnosis of Eclampsia of the Regional High Specialty Hospital from January 2010 to December 2015. Results: The incidence was 57%. Significant maternal variables: age (p = 0.034) and number of seizures (p = 0.001), with a mean age of 20.4 ± 6.5 years. The headache was present in 91.5%. Eighty-five percent had antepartum eclampsia. The route of interruption was 77% by the abdominal route. The topography of the lesion was multifocal and bilateral, in the parietal and occipital lobe. Conclusions: The incidence was 57%. A high-risk profile for PRES in patients with antepartum eclampsia, primigravidae, younger than 21 years, with a mean arterial pressure greater than 120 mmHg, and who have presented more than two seizures were established.
Resumo: A síndrome de encefalopatia posterior reversível (PRES), na eclâmpsia, apresenta manifestações neurológicas associadas ao edema cerebral transitório. Objetivo: Identificar a incidência da PRES em pacientes com eclâmpsia internadas na UTI e comparar os fatores de risco associados. Material e Métodos: Foram 311 pacientes internadas na UTI em um período de 5 anos com diagnóstico de eclâmpsia, divididos en 2 grupo: PRES (n = 176) e sem PRES (n = 135). Estudo observacional, retrospectivo, analítico, transversal e coorte. Resultados: A incidência encontrada foi de 57%. No grupo da PRES a idade foi de 20 ± 6,5 vs 21 ± 5.7 anos, no grupo sem PRES (p = 0.034). Número de crises convulsivas 2 ± 2 vs 1.8 ± 1.8 eventos (p = 0.001), proteinúria 1355 ± 175 vs 930 ± 92 miligramos em 24 horas (p = 0.000) e PAM 120 ± 20 vs 115 ± 15 mmHg (p = 0.011), respectivamente. Mortalidade perinatal foi de 8.6% vs 3.5% (p = 0.05). 85% apresentou eclâmpsia antepartum. A interrupção da gestação foi de 77% pela via abdominal. A topografia da lesão cerebral foi multifocal e bilateral. O odds ratio para associarse a PRES foram: proteinúria, eclâmpsia antepartum, cesárea, PAM > 110mmHg com OR 3, 2.9, 2.5 e 2.3 respectivamente (p ≤ 0.05). Conclusões: A incidência da PRES foi de 57%. Se estabeleceu um perfil de alto risco para PRES em pacientes com eclâmpsia antepartum, menores de 21 anos, PAM 120 mmHg e a presença de duas crisis convulsivas. A mortalidade perinatal se associou a PRES.
ABSTRACT
Objetivo. Estimar la elasticidad precio de la demanda de cigarros en México con base en fuentes de información y metodología distintas a las utilizadas en estudios previos sobre el tema. Material y métodos. Se utilizaron series trimestrales de consumo, ingreso y precio para el periodo de 1994 a 2005. Se estimó un modelo de demanda de largo plazo mediante mínimos cuadrados ordinarios (MCO) y se investigó la existencia de una relación de cointegración. Además, se estimó un modelo mediante mínimos cuadrados ordinarios dinámicos (MCOD) para corregir posibles problemas de endogeneidad de las variables independientes y autocorrelación de los residuales. Resultados. Las estimaciones mediante MCOD mostraron que un incremento del precio de los cigarros de 10 por ciento podría reducir el consumo en 2.5 por ciento (p<0.05) y aumentar la recaudación fiscal en 16.11 por ciento. Conclusiones. Los resultados confirmaron la efectividad de los impuestos como herramienta para el control del tabaco en México. El incremento de los impuestos puede utilizarse para aumentar el precio de los cigarros, y por consiguiente, para reducir el consumo y aumentar la recaudación fiscal.
Objective. To estimate the price elasticity of the demand for cigarettes in Mexico based on data sources and a methodology different from the ones used in previous studies on the topic. Material and Methods. Quarterly time series of consumption, income and price for the time period 1994 to 2005 were used. A long-run demand model was estimated using Ordinary Least Squares (OLS) and the existence of a cointegration relationship was investigated. Also, a model using Dinamic Ordinary Least Squares (DOLS) was estimated to correct for potential endogeneity of independent variables and autocorrelation of the residuals. Results. DOLS estimates showed that a 10 percent increase in cigarette prices could reduce consumption in 2.5 percent (p<0.05) and increase government revenue in 16.11 percent. Conclusions. The results confirmed the effectiveness of taxes as an instrument for tobacco control in Mexico. An increase in taxes can be used to increase cigarette prices and therefore to reduce consumption and increase government revenue.
Subject(s)
Humans , Commerce , Smoking/trends , Nicotiana , Data Interpretation, Statistical , MexicoABSTRACT
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Summary Delusions are unreal beliefs out of the boundaries of logic which are not shared by the members of a given culture (APA). Henri Ey classified them into two general groups: acute delusions and chronic delusions. This paper is focused on chronic delusions, which are divided according to different phenomenological features into paranoid, fantastic, and schizophrenic. Paranoid delusions are mainly characterized by high systematization, persecutory theme, and absence of disintegration of the cognitive and personality functions. Fantastic delusions are mainly composed by a great imaginative content that contrasts with the maintenance of objective reality, preservation of cognitive functions, and absence of personality disintegration. Finally, schizophrenic delusions are shaped by incoherence, level of personality disintegration, and cognitive worsening. When delusions are orally expressed, their narrative structure can be analyzed. Siegel defined narrative as a description that joins internal and external experiences; it contrasts histories that give coherence and understanding to an individual living in the world and in time. Ramos stated that narrative is comprised by several elements: theme, order, structure, and an identifiable narrative voice. We suggest that when narrating their experiences, the delusional patients try to give coherence to their internal and external worlds, which have been transformed to the extent that other human beings see these as unreal. We also afirm that in their reconstruction of the world, the individual uses his or her creativity, and that creativity is influenced by the psychotic process or the very own creative qualities of the individual. Chavez defined creativity as the process of generating something, transforming or transcending the existing. This process comprises three overlapping phases: (A) Association-integration: the subject makes associations between elements of the external world and the own subjectivity. During this phase occurs a perceptual, sensorial, cognitive and affective integration. Different levels of consciousness are involved in this phase. (B) Elaboration: the person works with the association building a product, using her or his particular talents and abilities. This phase is conscious and involves volition. (C) Communication: by sharing the work the associations are transmitted and reproduced in others, as well as the sensorial and emotional experience. Communication ends the process at the time that it begins a new creative processes in others. Reality is in consequence understood from a new perspective. The purpose of this study is to describe the narrative structure of different kinds of delusions, and to describe the performance of patients with different kinds of chronic delusions in the Torrance Test for Creative Thinking (TTCT) Figural form. Material and method A descriptive investigation was developed to analyze the narrative structure of each one of the delusions previously mentioned, using a frequency table of linguistic transformations (LT), and the elements to evaluate thought content and cognitive-oral disorders from the Positive and Negative Schizophrenic Symptoms scale (PANSS). Creative thought was measured in each delusional patient with the figural TTCT. Three patients from the Instituto Nacional de Psiquiatría Ramón de la Fuente were evaluated, each one with a different kind of chronic delusion according to Ey's criterion. Results There is a shorter number of TL in paranoid delusion, and higher severity scores for delusion and suspicion in PANSS. Regarding the figural TTCT, elaboration has a score above percentil 85, and title expressiveness and synthesis are notorious while fluency and originality have scores below percentile 25. In the fantastic delusion some linguistic transformations were found: 5 metaphors and 3 neologisms. Greater severity was found in PANSS for delusion, suspicion, and unusual content items. In the figural TTCT a score above percentile 85 was found in elaboration and abstraction, it also stood out the context articulation and the limits extension. The patient with this delusion got the highest overall score in the figural TTCT. Most of the TL were found in the schizophrenic delusion: this derailment got to the point of incoherence and association by assonance. Grater score of conceptual disorganization was found in severity of PANSS areas. Some dimensions below percentile 25 were found in the figural TTCT: fluency, originality, elaboration, and resistance to premature closing. The patient with this delusion got the lowest global score in the figural TTCT. Different characteristics were present in narrative of the three kinds of delusions -as shown in frequency tables of TL, in cognitive-oral disorders, and in thought content on PANSS. Among these patients there were interesting variations within creative thought in the figural TTCT. Discussion In fantastic and paranoid delusions we found similarities in suspicion and systematization, and also in the elaboration dimension evaluated with the figural TTCT. Elaboration refers to the detail in developing an idea. This may be related to the subject's ability in explaining the how, when, and why of the story present in the delusion. However this is more obvious in the paranoid delusion, where the synthesis dimension is high. Synthesis refers to the ability to connect, combine, and summarize ways of associating things. This same delusion stands out because of its low scoring in originality and fluency in the figural TTCT; the first one tends to appear diminished when elaboration develops in a higher degree. The loss on fluency in creative thought could match personality tightness observed in this kind of patients. Unusual content and limits extension predominate in the fantastic delusion, this has to do with going out of established routes and breaking defined problem limits, which may be related to the unusualness of the narrative theme in this reconstruction of the world implicit in the delusion; that represents a space where even the patient has the need to invent new words. It is interesting to notice the high score in abstraction; understood as the synthesis and organization ability for thought processes it coincides with the use of metaphors. In this delusion the high score in the context articulation, which refers to the clear an powerful communication of the history, could be related to the delusion demarcation that gives the patient the opportunity to function properly in some degree. In the case of schizophrenic delusion it was observed that there is a severe alteration of the cognitive and personality functioning, and also oral incoherence was found as well as an important loss of the dimensions evaluated with the test of creative thinking. Narrative is a phenomenon that integrates different cognitive processes which are transformed by the psychotic condition, where the internal and external worlds of the patient are rebuilt. Creative thinking intervenes in several ways in this reconstruction. Thus, and based on the results from this study, we hypothesize that some characteristics of the narrative of delusions could be related with certain dimensions of creative thinking. Some of these dimensions were affected, others seemed to be more developed than in general population. However, another possibility could be that the creative potential previous to the outcome of the disease could affect the clinical course. This could have implications in the rehabilitation process of these patients. Nevertheless, this has to be tested in future research.
ABSTRACT
Las condiciones en que se realiza la combustión del tabaco durante el acto de fumar favorecen el arrastre de diferentes componentes del cigarrillo, incluyéndose los que se generan en la ignición y que llegan al aparato respiratorio del sujeto que aspira el humo del tabaco. En el extremo de la combustión del cagarrillo la temperatura alcanza 600ºC pero en el punto opuesto, que se pone en contacto con los labios del fumador, la temperatura es menor; por lo anterior se considera que en el cigarrillo se forma un gradiente de temperatura que puede ser capaz de transportar los productos del tabaco. Para demostrar que sí es posible encontrar componentes inmunorreactivos en el humo del tabaco se diseñó un modelo en el cual se usaron dos series de cigarrillos. La serie experimental de cigarrillos fue inyectada con distintas concentraciones de una solución de albúmina sérica bovina (albúmina sérica bovina) y la control recibió salina-fosfato (SSF) sin ninguna proteína. Ambos grupos de cigarrillos permanecieron a 20ºC durante 48 horas para permitir su secado. Posteriormente, se procedió a la combustión de cada serie por separado y el condensado del humo del tabaco producido se dejó en solución salina-fosfato. Los condensados de humo del tabaco derivados de los cigarrillos con mayor concentración de albúmina sérica bovina presentaron más proteína total que los cigarrillos controles. La identificación de la albúmina sérica bovina, que previamente se había colocado en los cigarrillos, se realizó con técnicas inmunoserológicas en las cuales se demostró una banda correspondiente a la albumina sérica bovina, la cual fue revelada con los anticuerpos policlonales anti-albúmina sérica bovina. Los condensados de humo del tabaco producidos con cigarrillos sin albúmina sérica bovina no reaccionaron con los anticuerpos anti-albúmina sérica bovina. La cuantificación de la albvúmina sérica bovina en cada conjunto de cigarrillos mostró de 15 a 601 mcg por cada cigarrillo, de acuerdo con la dosis de albúmina sérica bovina aplicada inicialmente. Se concluye que una fracción de la proteína puesta a los cigarrillos conserva su inmunorreactividad en el condensado del humo del tabaco; por lo cual es posible que los sujetos fumadores al aspirar el humo se pongan en contacto con estructuras del tabaco que desencadenan una respuesta inmunitaria anti-tabaco
Subject(s)
Humans , Animals , Cattle , Serum Albumin, Bovine/immunology , Antibodies/immunology , Cattle , Hot Temperature , Immunologic Techniques , Plant Proteins/analysis , Plant Proteins/immunology , Respiratory Hypersensitivity/etiology , Smoke/analysis , Nicotiana/chemistryABSTRACT
Entre los meses de agosto y setiembre de 1995 se entrevistaron 400 puérperas consecutivas que concurrieron al Hospital Regional Honorio Delgado y Hospital Goyeneche de Arequipa. El diseño fue de tipo pseudolongitudinal. Se identificaron factores asociados con la concurrencia de las gestantes a sus controles prenatales y se estudió su importancia relativa mediante el análisis de regresión múltiple. Los más importantes fueron la edad gestacional, grado de instrucción, estado civil, número de gestaciones previas, y edad materna. Un resultado importante fue encontrar que el ingreso familiar, lugar de residencia y ocupación son variables que no se asocian con el número de controles prenatales. Se logró asignar un coeficiente a cada variable asociada y de ésta manera poder construir un indice predictivo.
Subject(s)
Humans , Pregnancy , Prenatal Care , ObstetricsABSTRACT
Se reportan 32 casos de pacientes con antecedentes de protesis valvular cardíaca, que se han embarazado en 56 ocasiones. Treinta y dos de estas gestaciones fueron atendidas en el InPer. En dos casos, se han conrolado dos embarazos consecutivos. Se comenta la experiencia obstétrica derivada del manejo y se discuten los criterios y repercusiones maternas, fetales y neonatales de los coagulantes administrados