ABSTRACT
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Introduction: The development of recommendations for the treatment of rheumatoid arthritis (RA) in the Cuban context may be one of the ways to achieve better control of this disease. Objective: To reach a consensus and update relevant aspects of conventional and biological RA modifier therapy in Cuba. Methods: 18 specialists from 8 Cuban provinces, experts in RA care, were summoned, according to the years of dedication to the specialty, the conferences on this topic and their publications. The first meeting took place in March 2016 in the provincial hospital of Villa Clara, Cuba, with the participation of all the experts. A review of the literature on conventional and biological therapy previously collected by the participants was developed, and two teams were formed: the first would address everything related to conventional therapy in RA (HRCT) and the other, biological therapy in RA (TBAR). Three questionnaires related to the use of corticosteroids, HRCT and TBAR, were prepared, answered by the participants via email. In a second meeting, held in October 2016 in Havana, the analysis of all the responses provided was carried out. Questions with a response of 90% or more votes were considered as recommendations. Results: The questionnaires were answered by 95% of the participants. 9 recommendations and 1 algorithm were established. The recommendations are as follows: methotrexate is the drug of choice in the treatment of RA after diagnosis; The administration of another conventional drug (DMARDc) (azathioprine, salazosulfapyridine, antimalarials and leflunomide) is recommended in patients with a diagnosis of active RA in whom methotrexate is contraindicated or there is a failure in response - consider the administration of low doses of prednisone or equivalent (<7.5 mg/d) associated with DMARDc in patients with active moderate to severe RA, for the shortest possible time; perform serological control including tests for hepatitis B and C viruses and screening for HIV in all patients diagnosed with RA before starting treatment with DMARDc and biologics; in patients in remission or, at least, with a DAS-28 below 3.2, consideration should be given to withdrawing one of the DMARDs or reducing, to the minimum possible expression, the dose of both disease modifiers; if methotrexate fails, tocilizumab in combination with methotrexate or as monotherapy will be indicated. Conclusions: Aspects related to conventional therapy with methotrexate, azathioprine, salazosulfapyridine, antimalarials and leflunomide were agreed. The value of early diagnosis and immediate initiation of DMARDc therapy and the use of glucocorticoids was analyzed. Treatment with tocilizumab, the only biological available in Cuba against RA, will be administered when there is a failure in the response to conventional therapy and combinations between these drugs. It is recommended to hold educational conferences through the mass media aimed at patientshttp(AU)
Subject(s)
Humans , Arthritis, Rheumatoid/drug therapy , Biological Therapy/methods , Antimalarials/therapeutic use , Arthritis, Rheumatoid/therapyABSTRACT
La vestibulopatía bilateral es poco frecuente, se caracteriza principalmente por inestabilidad al caminar o al estar de pie, visión borrosa inducida por el movimiento u oscilopsia al caminar o al realizar movimientos rápidos de la cabeza o del cuerpo, empeoramiento de la estabilidad en la oscuridad o terrenos irregulares, reducción de los síntomas al estar en condiciones estáticas, ganancia del reflejo vestíbulo-ocular angular reducida de forma bilateral, entre otros. Existen múltiples causas. Dentro de las causas identificables, se describen principalmente medicamentos ototóxicos, meningitis y enfermedad de Ménière. Se presenta el caso de una paciente de 64 años diagnosticada con vestibulopatía bilateral posterior a tratamiento intramuscular con gentamicina por sobreinfección bacteriana cutánea de las manos. La evaluación vestibular complementada con videonistagmografía y prueba de impulso cefálico asistida por video confirman el diagnóstico y se inicia tratamiento con rehabilitación vestibular enfocada en promover la compensación central a través de estrategias de sustitución principalmente; además de habituación y adaptación vestibular, favoreciendo la estabilización de la mirada, mantención del equilibrio, control postural, marcha y reducción de los síntomas.
Bilateral vestibulopathy is infrequent, and it is characterized mostly by unstable walking or when standing, blurred vision induced by movement, or oscillopsia when walking or performing fast movements; worsening of the stability in darkness or uneven ground, but with lack of symptoms in static conditions. Other symptoms may include bilateral reduction of the oculo-vestibular reflex. Among the identifiable causes, there is the use of ototoxic medication, meningitis, Ménière's disease, although it can be idiopathic or have a neurological cause. We hereby describe the case of a 64-year-old woman, diagnosed with bilateral vestibulopathy secondary to intramuscular treatment with gentamicin due to a bacterial hand infection. Vestibular assessment was complemented with video-nystagmography and video head impulse test which confirmed the diagnosis, and therapy was started with vestibular rehabilitation focused on promoting central compensation mainly, through substitution strategies. Also, habituation exercise and vestibular adaptation strategies were used, thus promoting sight stabilization, balance maintenance, postural control, walking, and reduction of the symptoms.
Subject(s)
Humans , Female , Middle Aged , Gentamicins/adverse effects , Bilateral Vestibulopathy/chemically induced , Bilateral Vestibulopathy/rehabilitation , Anti-Bacterial Agents/adverse effects , Audiometry , Superinfection , Electronystagmography , Head Impulse Test , Bilateral Vestibulopathy/diagnosis , Bilateral Vestibulopathy/physiopathologyABSTRACT
INTRODUCCIÓN: El uso de cannabinoides en diversas condiciones clínicas es hoy un tema de debate. Se ha planteado su uso para el control del glaucoma. Sin embargo, existe controversia sobre su real efectividad y seguridad. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cinco revisiones sistemáticas que en conjunto incluyen 3 estudios primarios, todos correspondientes a ensayos aleatorizados. Concluimos que, si bien los cannabinoides podrían disminuir la presión intraocular, lo hacen de forma transitoria y se asocian a efectos adversos frecuentes.
INTRODUCTION: The use of cannabinoids in diverse clinical conditions is today a subject of debate. Its use has been proposed for the control of glaucoma. However, there is controversy about its real effectiveness and safety. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified five systematic reviews including three studies overall, all of them randomized controlled trials. We concluded that although cannabinoids could decrease intraocular pressure, the effect would be transient and associated with frequent adverse effects.
Subject(s)
Humans , Cannabinoids/administration & dosage , Glaucoma/drug therapy , Intraocular Pressure/drug effects , Cannabinoids/adverse effects , Randomized Controlled Trials as Topic , Databases, Factual , Treatment OutcomeABSTRACT
Various methods are available for preservation of vascular grafts for pulmonary artery (PA) replacement. Lyophilization and cryopreservation reduce antigenicity and prevent thrombosis and calcification in vascular grafts, so both methods can be used to obtain vascular bioprostheses. We evaluated the hemodynamic, gasometric, imaging, and macroscopic and microscopic findings produced by PA reconstruction with lyophilized (LyoPA) grafts and cryopreserved (CryoPA) grafts in dogs. Eighteen healthy crossbred adult dogs of both sexes weighing between 18 and 20 kg were used and divided into three groups of six: group I, PA section and reanastomosis; group II, PA resection and reconstruction with LyoPA allograft; group III, PA resection and reconstruction with CryoPA allograft. Dogs were evaluated 4 weeks after surgery, and the status of the graft and vascular anastomosis were examined macroscopically and microscopically. No clinical, radiologic, or blood-gas abnormalities were observed during the study. The mean pulmonary artery pressure (MPAP) in group III increased significantly at the end of the study compared with baseline (P=0.02) and final [P=0.007, two-way repeat-measures analysis of variance (RM ANOVA)] values. Pulmonary vascular resistance of groups II and III increased immediately after reperfusion and also at the end of the study compared to baseline. The increase shown by group III vs group I was significant only if compared with after surgery and study end (P=0.016 and P=0.005, respectively, two-way RM ANOVA). Microscopically, permeability was reduced by ≤75% in group III. In conclusion, substitution of PAs with LyoPA grafts is technically feasible and clinically promising.
Subject(s)
Animals , Dogs , Female , Male , Allografts/physiology , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/methods , Cryoprotective Agents , Cryopreservation/methods , Freeze Drying/methods , Glutaral , Pulmonary Artery , Analysis of Variance , Allografts/anatomy & histology , Allografts/surgery , Blood Pressure , Blood Vessel Prosthesis/adverse effects , Pulmonary Circulation , Pulmonary Artery/pathology , Pulmonary Artery/physiology , Transplantation, Homologous , Vascular ResistanceABSTRACT
De todo el conjunto de problemas que se desarrollan en la infancia, no cabe duda que la escoliosis ocupa un puesto importante debido a sus repercusiones en la edad temprana y adulta. El objetivo del estudio fue evaluar la relación existente entre el sexo, escoliosis y lateralidad manual. La muestra estuvo formada por 2822 participantes, con edad comprendida entre 6 y 12 años, pertenecientes a la provincia de Almería. Se utilizaron dos instrumentos de medida, es decir, inventario de lateralidad manual de Edinburgh y la prueba de Adams, para analizar las variables seleccionadas. No se encontraron diferencias estadísticamente significativas entre las variables lateralidad y sexo (p=0,106) ni entre lateralidad y escoliosis (p=0,673); pero sí entre escoliosis y sexo (p<0,001). Como principales conclusiones debemos señalar la importancia en el desarrollo de adecuados programas de intervención teniendo en cuenta el número obtenido de niños con escoliosis, sobre todo en niñas.
Based on the number of problems that develop during childhood, it is clear that scoliosis has an important place because of its impact and in early adulthood. The main objective of the study was to evaluate the relationship between sex, scoliosis and handedness. The sample consisted of 2822 participants, aged between 8 and 12 years, from the province of Almería. Two instruments were used to measure, Inventary Laterality of Edinburgh and Test de Adams, to analyze the selected variables. No statistically significant differences were found between the variables laterality and sex (p=0.106) or between laterality and scoliosis (p=0.673); significant differences however, were found between scoliosis and sex (p<0.001). Principal conclusions are the importance in the development of appropriate intervention programs bearing in mind the number of children with scoliosis, especially in girls.
Subject(s)
Humans , Male , Female , Functional Laterality , Hand , Scoliosis/epidemiology , Prevalence , Scoliosis/diagnosis , Sex Factors , SpainABSTRACT
La atención sanitaria basada en la evidencia y su aplicación a través de las herramientas disminuye la variabilidad de la práctica clínica. Una de estas herramientas son los procedimientos, las cuales contienen las normas de calidad de proceso que definen las responsabilidades y las acciones que se deben llevar a cabo en una situación dada, orientan hacia la consecución de objetivos que garanticen la satisfacción del paciente como receptor de los cuidados y proporcionan al profesional seguridad y confianza para desarrollar sus actuaciones. Éstas constituyen un instrumento de trabajo preciso para conocer, controlar y mejorar el producto que generamos en forma de servicio y un respaldo institucional, legal y científico. El estudio electrofisiológico cardíaco y la ablación exigen una adecuada preparación protocolizada. Se presenta el procedimiento de actuación de enfermería en el Laboratorio de Electrofisiología del Hospital Universitario Virgen del Rocío.
Evidence based health care and its application by using different tools in order to reduce variability in clinical practice is essential nowadays. One of these tools are procedures. They contain process quality regulations which define responsibilities and actions to be taken, aim at the achievement of objectives to ensure the satisfaction of the patient as recipient of care, and give the professionals safety and confidence for carrying out their interventions. Such procedures are a necessary working tool to know, monitor, and improve the outcomes that we produce as a service and institutional, legal and scientific support. Cardiac electrophysiologic studies and radiofrequency catheter ablation demands an adequate protocolized preparation. Now, it is presented the nursing actuation procedure on Electrophysiologic Studies and Radiofrequency Ablation, in the Electrophysiology and Arrhytmia Unit (Virgen del Rocio University Hospital Seville).
Subject(s)
Humans , Electrophysiologic Techniques, Cardiac/nursing , Electrophysiologic Techniques, Cardiac , Patient Care , NursingABSTRACT
Se evaluó la eficacia de la técnica de estimulación vibratoria del pene (EVP) para obtener semen en quince especímenes de S. leucopus bajo condiciones de cautiverio, en cuatro diferentes sitios en Colombia. Adicionalmente, se estandarizó la técnica EVP y se determinaron algunas características seminales (color, viscosidad, volumen, pH, motilidad, morfología, viabilidad, concentración y morfometría espermática). Se empleó clorhidrato de ketamina a dosis entre 5 y 10 mg/kg I.M. para la sedación previa al muestreo a fin de disminuir el estrés de la captura y del procedimiento, ya que los especímenes no estaban acostumbrados o entrenados para procesos de obtención de muestras biológicas. En el uso de la técnica se logró un 52,6% de éxito en la combinación de 90 Hz de vibración y 1 mm de amplitud; el tiempo de eyaculación promedio fue de 12:35±6:42 minutos; el pH, 7,5±0,26; el volumen, 24±18,82 µl; la motilidad masal fue de 3,7/5,0±0,5; la motilidad individual progresiva, 97,1±45,4%; la concentración espermática fue de 87.617±21.327 x 10(4) spz/µl; la normalidad fue del 69,3±11,06% y la viabilidad del 93,7±4,9%. Las características seminales fueron similares a las reportadas en otras especies de callitríchidos y obtenidas por la misma técnica. Se empleó satisfactoriamente el diluyente Talp-Hepes y el cual no afectó las características antes descritas. La EVP es un método innovador, replicable, viable y seguro para la obtención de semen en S. leucopus y a otros callitríchidos bajo sedación con ketamina en condiciones de cautiverio.
The efficacy of the penile vibratory stimulation (PVS) for semen collection was evaluated in fifteen (15) specimens of white-footed tamarin (S. leucopus), held in captivity, at four different locations. Additionally the technique was standardized for semen collection in this species and seminal characteristics, color, viscosity, volume, pH, motility, morphology, viability, sperm concentration and morphometry were also evaluated. Ketamine hydrochloride was used at a dose between 5 to 10 mg/Kg for sedation and semen sampling. The technique was successful in 52.6% of the animals using the combination of 90 Hertz of vibration and 1 mm of amplitude; time of ejaculation was 12:3 ±6:42 minutes. Seminal characteristics were: pH of 7.5±0.26; volume of 24±18.82 µl; masal motility of 3.7/5.0±0.5; progressive motility of 97.1±45.4%; sperm concentration of 87,617±21,327 x 10(4)spz/µl; normal morphology 69.3±11.06% and viability of 93.7±4.9%. Talp-Hepes extender was satisfactorily used and it did not appear to affect seminal characteristics. The PVS is an innovating, replicable, viable and safe method for obtain semen in S. leucopus and perhaps in other callitrichids under ketamine sedation and in captivity.
ABSTRACT
Background: Parkinson disease (PD) is the second more common neurodegene-rative disorder and determines a loss in quality oflife, caregiver burden and increased mortality in those affected. Aim: To determine the rates of mortality due to Parkinson disease in Chile. Material andMethods: Data were collected from death certificates between 1997 and 2008. Mortality rates were calculated and the mortality trend was established along the study period, and analyzed by age, sex and geographic región of Chile. Results: There was a steady increase in mortality over the years, particularly since2001 (r²= 0.85, p < 0.01). The increase in mortality rates was 0.25per 100.000 habitants/year (r²: 0.89, p < 0.01). Mortality was always higher in men and in those older than 80years. The highest rate (per 100,000 habitants) in Chile was observed in the región of Valparaíso (2.4) while the lowest was in Antofagasta (0.8) (t = 3.72, p < 0.05). Conclusions: Mortality associated with PD has increased progressively, consistent with the expected increase in prevalence ofthe disease in the population.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Parkinson Disease/mortality , Chile/epidemiology , Death Certificates , Prevalence , Sex DistributionABSTRACT
El Síndrome de la Rubéola Congénita (SRC), se caracteriza por presentar secuelas tempranas y tardías que afectan el sistema ocular, cardíaco y auditivo de manera simultánea acompañada de diferentes manifestaciones bucales. El objetivo de este reporte es dar a conocer las características bucales asociadas al Síndrome, como puede afectar al paciente desde temprana edad y guiar al odontólogo a identificar dicha entidad. Se presenta el caso de escolar de género femenino que acude al servicio de ortodoncia interceptiva del Postgrado de Odontología Infantil de la U.C.V., con el diagnóstico de S.R.C. se realizó el consentimiento informado y se cumplieron los protocolos de profilaxis antibiótica. Al examen clínico intraoral y extraoral y al análisis cefalométrico se diagnosticó Maloclusión dentaria Clase I tipo 3, Maloclusión esquelética Clase III, oligodoncias, microdoncias, además de ciertas características no reportadas asociadas al SRC como la queilitis descamativa y lesiones fibrosas. El SRC posee diferentes manifestaciones bucales que incluyen alteraciones en el desarrollo dental, maloclusiones. El tratamiento odontológico adecuado para estos pacientes debe realizarse en conjunto con un equipo multidisciplinario tomando en cuenta el estado sistémico del paciente
The Congenital Rubella Syndrome (CRS) is characterized by early and late sequelae that affect the eye, heart and ear simultaneously accompanied by various oral manifestations. The purpose of this report is to present oral characteristics associated with Syndrome, how it can affect the patient from an early age and guide the dentist to identify the syndrome. We report the case of a female pacient who attended school at the time in which she was treated at the Graduate interceptive orthodontic Pediatric Dentistry UCV, with the diagnosis of CRS. Informed consent was performed and antibiotic prophylaxis protocols were fulfilled. When intraoral and extraoral clinical examination and cephalometric analysis were diagnosed dental malocclusion Class I Type 3, Class III skeletal, oligodontics , microdontics, plus some unreported characteristics associated with the SRC as desquamative cheilitis and fibrous lesions. SRC has various oral manifestations that include disturbances in dental development, malocclusion. Appropriate dental treatment for these patients should be performed in conjunction with a multidisciplinary team taking into account the patient's clinical state
Subject(s)
Female , Child, Preschool , Child , Anodontia/therapy , Child , Mouth Diseases/therapy , Fibroma , Informed Consent , Malocclusion/therapy , Antibiotic Prophylaxis , Rubella Syndrome, Congenital/complications , DentistryABSTRACT
Pharmaceuticals and personal care products have become an environmental problem in recent years. Their physicochemical properties and persistence in the environment have allowed the distribution of degradates and parent compounds in water, soil, air and food. The widespread use of pharmaceuticals and personal care products in hospitals, domestic residences, agricultural and industrial facilities has increased their discharge into the water bodies, and its toxicity has started to manifest in different biological components of ecosystems. The development of methods for sample treatment and instrumental analysis techniques has enabled the separation, identification and quantification of active ingredients and degradates with higher environmental impact, at concentrations of parts per billion or even parts per trillion. In addition, in vitro and in vivo assays have demonstrated their ecotoxicity in water, driving them to the classification of emerging organic pollutants, whose waste is indeterminate. Although their adverse effects are still unknown, they could have strong implications for global public health. This review presents the dynamics and the development of research over the past ten years about the presence of non-steroidal anti-inflammatory analgesics, antihypertensives, antibiotics and other drugs in water bodies. Similarly, it described the impact of pharmaceutical activity, hospital services and domestic effluents on water quality.
Subject(s)
Cosmetics , ToxicityABSTRACT
Con el objetivo de estimar parámetros reproductivos de referencia en yeguas criollas colombianas (CC), se emplearon 30 yeguas a las que se les realizó seguimiento de dos ciclos estrales (CE). La duración del CE fue 21,5 ± 1,8 días (promedio ± DE), la cual fue similar en el 40% de las yeguas en los dos CE, en el 60% restante la duración entre los dos CE tuvo una diferencia entre 1 a 7 días. La tasa de crecimiento diario del folículo dominante (FD) fue de 1,62 ± 0,4 mm y la del folículo subordinado (FS) de 0,65 ± 0,4 mm. La desviación folicular se presentó el día 17,2 ± 3,0 del CE. El tamaño máximo del FD fue 44,3 ± 4,8 mm. En el 63% de los CE el FD se ubicó en el ovario derecho y en el 37% en el izquierdo. En el 85% de los CE ocurrió primero el edema uterino y después los signos de celo. El grado de edema disminuyó antes de la ovulación en 86,6% de los CE. La duración del estro fue 5,9 ± 1,8 días. Hasta 48 horas posovulación se presentaron signos de celo en el 73,3% de los CE y en el 26,6% ningún signo de celo. Según los valores obtenidos, aunque los parámetros reproductivos son similares a los descritos para otras razas de equinos en países diferentes a Colombia, hay algunas diferencias que deben tenerse en cuenta en las prácticas clínicas de rutina en la reproducción de las yeguas CC.
This study aims to contribute in the generation of reference values in Colombian Criollo (CC) mares, 30 animals were used to characterize their estrous cycles (EC). EC duration was 21.5 ± 1.8 days (mean ± SD). 40% of mares had the same duration in days for the two cycles observed and in the remaining 60% the difference in EC duration ranged from 1 to 7 days. The daily growth rate of the dominant follicle (DF) was 1.62 ± 0.4 mm and for the subordinate follicle (SF) was 0.65 ± 0.4 mm. Follicular deviation occurred on day 17.2 ± 3.0. The maximum size of DF was 44.3 ± 4.8 mm. In 63% of the observed EC, the DF was located in the right ovary and 37% in the left. In 85% of the studied EC, uterine edema preceded heat signs. The degree of edema decreased before ovulation in 86.6% of the studied EC. The average estrus duration was 5.9 ± 1.8 days. Most mares (73.3%) maintained heat signs up to 48 hours after ovulation. The values obtained showed that the reproductive parameters in CC mares are somewhat different from those described for different genotypes in other countries; these differences should be taken into account on routine clinical practices in the reproduction of the CC mares.
ABSTRACT
El interferón alfa se utiliza para tratar y controlar la evolución de diversas enfermedades, destacando como terapia de elección de la hepatitis crónica por virus hepatitis C. Dentro de sus efectos secundarios ha sido asociado a la producción de síntomas depresivos llegando incluso a ser una contraindicación para su uso el hecho de estar cursando con un episodio depresivo en el presente. Se describe un caso de un síndrome depresivo activo en un paciente con hepatitis crónica por virus hepatitis C, con indicación de tratamiento con interferón alfa
Interferon alpha is used to treat and control several diseases nowadays being a primary component of treatment for chronic hepatitis C. It has been associated to the development of side effects, in particular the occurrence of depressive symptoms, which could be a contraindication for its administration if the patient is experiencing depression in the present. We present the case of a patient with chronic hepatitis C and depressive syndrome, with indication for interferon alpha therapy
Subject(s)
Humans , Male , Middle Aged , Depression , Hepatitis C , Hepatitis, Chronic , Interferon-alpha , Psychiatric Department, HospitalABSTRACT
La criopreservación de embriones se ha venido desarrollando en los últimos años con el propósito de conservar embriones obtenidos de vacas superovuladas. Las investigaciones han continuado su desarrollo y se han dirigido hacia la criopreservación de oocitos y embriones in vitro, los cuales necesitan diferentes metodologías para lograr una supervivencia aceptable. Por consiguiente, los métodos tradicionales de criopreservación se han tenido que modificar para obtener mejores tasas de supervivencia poscriopreservación que serán discutidas en esta revisión.
Embryo cryopreservation techniques have developed in order to preserve embryos obtained from superovulated cows. Research has followed trying to cryopreserve embryos and oocytes manipulated under in vitro conditions due to the low survival rates obtained with traditional cryopreservation methods. The different methodologies are discussed in the present review.
ABSTRACT
Rectal perforation rarely occurs spontaneously. We report a 44 years old male consulting for abdominal pain lasting 12 hours. Abdominal muscular resistance was observed on physical examination. A plain abdominal X ray film showed a pneumoperitoneum. The patient was operated finding a perforation in the lower rectum, with omentum sliding through it and exiting through the anus. The omentum was sectioned and ligated and a derivative colostomy was performed. The cause of the rectal perforation was not ascertained.
La perforación de recto se produce como resultado de una complicación bajo condiciones patológicas que comprometen la pared rectal. Rara vez ocurre espontáneamente. En casi todos los casos reportados de lesión rectal asociada a evisceración intestinal, el intestino delgado es el órgano involucrado. Las técnicas de reparación son variables, desde una rafia primaria en lesiones poco extensas, hasta resección de segmento lesionado y colostomía para los casos más graves. La decisión de la técnica a utilizar dependerá de la extensión y otras características de la lesión, del compromiso de estructuras vecinas, del tiempo de evolución y del grado de contaminación. El cirujano general debe estar preparado para el manejo de estas lesiones ya que son de resolución en los servicios de urgencias. Presentamos un caso, poco frecuente, de evisceración del epiplón mayor, transanal, posterior a lesión rectal de dudosa etiología.
Subject(s)
Humans , Male , Adult , Omentum/surgery , Omentum/injuries , Intestinal Perforation/complications , Rupture, Spontaneous , Rectum/injuries , Abdomen, Acute/etiology , Colostomy , Rectal Prolapse , Rectum/surgeryABSTRACT
El objetivo del presente trabajo fue evaluar la respuesta de la aplicación doble o triple de prostaglandina sobre la regresión de CL, ovulación y retorno al celo después de un tratamiento superovulatorio en vacas donantes de embriones. Para este experimento se tomaron 44 vacas asignadas al azar a dos grupos de tratamiento. Al primero (n = 23; CLO 0 & 7) se le aplicó una dosis de 500 μg de cloprostenol los días 0 (denominado día de la colecta) y 7; al segundo grupo (n = 21; CLO 0, 1 & 7) se le aplicó una inyección adicional el día 1. Los animales fueron examinados por ultrasonografía los días 0, 4, 7, 10 y 13 para evaluar la regresión de cuerpos lúteos y la ovulación. Se realizó observación del celo dos veces al día (mañana y tarde). El 60,8 y 52,3% de los grupos CLO 0 & 7 y CLO 0, 1 & 7, respectivamente, presentaron signos de celo. No se presentaron diferencias en el día del celo entre los grupos (7,2 ± 0,3, 7,3 ± 0,5 días). Tampoco hubo diferencia para la variable ovulación (8,5 ± 0,9 y 9,8± 0,9 días). Todas las vacas tratadas regresaron los cuerpos lúteos antes de finalizar el experimento. Cuando se analizó el tiempo de ovulación, se encontró que las vacas con 4 o menos cuerpos lúteos ovulan en un tiempo menor (P < 0,01) que las vacas con 5 o más cuerpos lúteos. Se concluye que no hay diferencia entre la doble o triple aplicación de cloprostenol para las variables. Sería innecesaria una aplicación adicional de cloprostenol el día 7.
The purpose of the present study was to evaluate the effect of prostaglandin (PG) treatment schedule on luteal regression and return to estrus in superovulated cows. A group of 44 donor cows were randomly assigned to two groups on the day of ova/ embryo collection (day 0). The first group (n = 23; CLO 0 & 7) was treated with 500 μg of cloprostenol on days 0 and 7 after embryo recovery; the second group (n = 21; CLO 0, 1 & 7) received an additional treatment with cloprostenol on day 1. All animals were scanned by transrectal ultrasonography on days 0 (embryo recovery), 4, 7, 10 and 13 to evaluate CL regression and subsequent ovulation. Estrus detection was done twice daily (am/pm) starting on day 4. There were no significant differences between groups in the percentage of animals returning to estrus (60.8% and 52.3%, respectively), or the intervals from the first PG treatment to estrus (7.2 ± 0.3 vs 7.3 ± 0.5 days), or ovulation (8.5 ± 0.9 vs 9.8± 0.9 days). All cows had luteolysis before the end of the experiment. Animals that had 4 CL or less ovulated earlier than cows that had 5 or more CL (P<0.01). In summary, there was no difference in luteal regression and the return to estrus and ovulation in donor cows treated with cloprostenol twice or three times after superovulation. It would not appear to be necessary to treat donors with PG 7 days later, since all cows had luteal regression after the first PG treatment.
ABSTRACT
Introducción: Un porcentaje significativo de personas que adquieren una lesión cerebral necesita programas de rehabilitación ambulatoria. En Chile predomina aún un modelo biomédico de rehabilitación, no obstante, las nuevas guías clínicas recomiendan un abordaje interdisciplinario que considere las necesidades del paciente y su familia. Actualmente existe un vacío respecto a cómo operacionalizar intervenciones eficaces que respondan a este paradigma. Objetivo: Encontrar evidencia que permita el desarrollo y evaluación de enfoques en neurorehabilitación ambulatoria de personas con lesión cerebral adquirida y las posibles metodologías de operacionalización de estos. Metodología: Revisión inductiva y conceptual de la literatura. Resultados: En la literatura chilena no existe evidencia empírica ni desarrollos sistemáticos sobre los fundamentos y la efectividad de los programas de rehabilitación ambulatoria para estas personas. En la literatura internacional se destacan tres enfoques: el enfoque holista, el centrado en el cliente y el basado en la planificación de metas. Si bien tales enfoques permiten guiar las acciones de los equipos, la evidencia de su efectividad, en base al criterio de expertos y pequeños estudios longitudinales y de caso único, es aun limitada. Conclusiones: Esencial a la construcción de identidad de un equipo de rehabilitación es determinar los principios y enfoques que sustente su labor. La complejidad y diversidad de los pacientes en la fase ambulatoria requiere que los equipos posean claros fundamentos para guiar la constante toma de decisiones. Es necesaria la evaluación de la eficacia de los programas de rehabilitación ambulatoria en Chile, desarrollando metodologías acordes a la naturaleza multifactorial del fenómeno.
Introduction: A significant percentage of people who acquire a Brain Injury need outpatient rehabilitation programs. In Chile the rehabilitation field is in a transitional stage. Even though the biomedical model is predominant in rehabilitation, the clinical guidelines have begun to recommend an interdisciplinary approach that considers patients needs and their families. Now-a-days, there is a gap on how to operationalize effective interventions responding to this paradigm. Objectives: To find evidence that sustains the development and assessment of outpatient neurorehabilitation approaches of people with brain injury and, to describe the possible operationalization methodologies of these. Methodology: Inductive and conceptual review of literature. Results: In Chilean Literature does not exist empirical evidence nor systematic developments on the foundations and effectiveness of outpatient rehabilitation programs for people with brain injury. International Literature describes three approaches: holistic, client centered, and goal-based. While such approaches can guide the team actions, the evidence of their effectiveness, based on expert criteria and small longitudinal studies and single case studies is still limited. Conclusions: For the development of a rehabilitation team identity, it is essential to determine the principles and approaches that support their work. Due to complexity and diversity of patients in the ambulatory phase, it is crucial that teams have clear foundations to guide the constant decision making. The evaluation of the effectiveness of ambulatory programs in Chile is a necessity; also it is to develop methodologies according to the nature of the phenomenon.
Subject(s)
Humans , Ambulatory Care , Patient Care Team , Rehabilitation/methods , Brain Injuries, Traumatic/rehabilitation , Models, TheoreticalABSTRACT
Desde mediados de los años setenta, la tecnología de transferencia de embriones (TE)se usó comercialmente para multiplicar rápidamente animales de genética valiosa. Posteriormente,con la congelación de embriones, se crea la posibilidad de movilizar animales entre países con barreras sanitarias. En la última década, con el uso comercial deembriones producidos in vitro (PIV) se dinamizó la producción de los mismos; en la práctica, son múltiples los factores que pueden influir en los resultados de los programas de TE, estos tienen orígenes muy diversos: factores del embrión (estado de desarrollo, calidad, componente genético, etc.), factores de la receptora (condición corporal, cuerpo lúteo) y factores externos (época del año, factores de manejo de los animales).Este documento abordará los temas asociados a los factores que podrían afectar las tasasde preñez en programas de TE.
Since mid 70´s, the Embryo Transfer (ET) technology was commercially used to quickly reproduce animals of valuable genetics; with the development of embryo freezing,the possibility of mobilizing animals between countries with sanitary barriers became areality. In the last decade with the commercial use of in vitro produced embryos (IVPE)the production increased, there are multiple factors that can influence in the results of the ET programs, these factors has very diverse origins: embryo (stage of development, quality, genetic component etc), recipient factors (body score, corpus luteum) external factors (season, animal management). This document will approach the topics associated with the factors that could affect pregnancy rates in ET programs of IVPE.
Subject(s)
Animals , Cattle , Embryonic StructuresABSTRACT
La transferencia de embriones tiene su origen en los años cincuenta, pero solo hasta los setenta se consideró como una alternativa comercial. A pesar de llevar más de 30 años, las tasas de superovulación y de preñez no se han mejorado sustancialmente. El número de ovulaciones varía entre 0 y 40 y, además, un 30% de las vacas superovuladas no responden al tratamiento o producen muy pocos embriones de mala calidad. Los investigadores del área han tratado de disminuir esta variabilidad sin mucho éxito. Por otra parte, se ha mejorado mucho en el conocimiento del ciclo estral, lo cual ha permitido que los esquemas se lleven a cabo en menos tiempo y se logren manejar los protocolos en tiempo fijo. El propósito de esta revisión es discutir los factores que afectan las tasas de superovulación en las vacas donadoras de embriones, y las posibles estrategias para mejorarlas.
Embryo transfer in cattle started to be explored in the 50´s but only in the 70´s was considered as a commercial alternative. Even though the technology has been around for more than 30 years, the superovulatory response and the pregnancy rate after transfer of the embryos have not improved substantially. The number of ovulations varies between 0 y 40 and additionally about 40% of the superovulated cows do not respond to treatment or produce very few embryos or bad quality embryos. Research in this area has been done to reduce this variability without much success. On the other hand, the studies have helped in the understanding of the bovine estrous cycle, allowing the improvement and implementation of better and shorter protocols to obtain embryos as well as to program fixed time embryo recoveries. The purpose of this review is to discuss the factors that can affect the superovulatory response of embryo donor cows and the different strategies available to improve this response.
Subject(s)
Animals , Cattle/embryology , Estrous Cycle , Pregnancy, Animal , SuperovulationABSTRACT
Poland Syndrome is a rare congenital alteration. It is characterized by hypoplasia or absence of the pectoral muscle, hypoplasia or aplasia of the mammary gland, nipple, ribs or cartilages, and hand malformations. A case is reported of a girl showing these malformations, and neuronal migration abnormalities. Emphasis is made upon the need for a multidisciplinary team for management and rehabilitation. A literature review is presented, including pathogenesis, clinical manifestations and treatment.
El Síndrome de Poland es una alteración congénita de baja frecuencia y de carácter esporádico. Se caracteriza por ausencia o hipoplasia del músculo pectoral; hipoplasia o aplasia de glándula mamaria, pezón, costillas o cartílagos, y malformaciones de la mano. Se reporta el caso de una recién nacida con Secuencia de Poland con trastorno de migración neuronal. Se hace énfasis en la necesidad de un equipo multidisciplinario en su manejo y rehabilitación. Se presenta una revisión de la literatura con especial énfasis en la patogenia, manifestaciones clínicas y tratamiento.
Subject(s)
Humans , Female , Infant, Newborn , Poland Syndrome/diagnosis , Poland Syndrome/etiology , Poland Syndrome/therapy , Cell Movement , EctromeliaABSTRACT
Ante un brote de una enfermedad infecto-contagiosa, el estudio de contactos limita la transmisión de esta. El objetivo de este trabajo fue identificar a los contactos de los posibles casos de influenza en trabajadores de la UNAM para establecer una comunicación y proporcionar educación para la salud sobre medidas higiénicas. Material y métodos: Se elaboró un cuestionario, se estableció contacto con los casos por vía telefónica y se llevó a cabo una visita domiciliaria. Se llevó a cabo un análisis descriptivo de los datos y una descripción de las experiencias y percepciones durante las visitas. Resultados: Se identificó que la mayoría de los contactos eran familiares directos de los casos, que no contaban con un esquema de vacunación completo, ni contra la influenza y la frecuencia de síntomas varió de 1 hasta 4. Comentarios finales: Ante una situación de este tipo (la Pandemia del Virus de la Influenza Humana A (H1N1)) el papel de la enfermera en salud pública es de suma importancia no solo en la búsqueda de los casos y sus contactos, sino también en la orientación y educación de la población en relación a las medidas preventivas.
In the view of an infectious and contagious disease epidemic, the identification of the contacts limits its transmission. The objective of this work was to identify the contacts of the possible cases of UNAM workers in order to establish communication and provide health education about hygiene measures. Material and methods: A questionnaire was prepared, telephone contact was established with the cases, and a home visit was arranged. A descriptive analysis of the data was carried out, as well as, a description of the experiences and perception during the home visit. Results: Most identified contacts were relatives of the cases, which did not have a complete vaccine scheme, no even against influenza, and the frequency of symptoms varied between 1 a 4. Final comments: In a situation like this (A(H1N1) human influenza virus pandemic) the public health nurse roll is of great importance, not just in the identification of the cases and its contacts, but also in the orientation and education of the population in relation to preventive measures.