ABSTRACT
Introducción: El COVID-19 ha generado retos por la alta demanda de servicios, haciendo necesario buscar alternativas de soporte ventilatorio que permitan responder a las necesidades de la población. Es importante disponer de herramientas que permitan detectar precozmente el fracaso de estrategias ventilatorias no invasivas e identificar tempranamente la necesidad de intubación. Objetivo: identificar las variables asociadas a fracaso en el tratamiento con cánula de alto flujo (CNAF) en pacientes con COVID-19. Materiales y Métodos: estudio observacional analítico, corte transversal con 68 pacientes de la unidad de cuidados intensivos con COVID-19, que recibieron tratamiento con CNAF. Las variables de estudio se evaluaron en tres momentos, a las 24, 48 y 72 horas, llevando a cabo un análisis bivariado y multivariado entre los que fracasaron y los que tuvieron éxito. Resultados: en el análisis bivariado las variables que presentaron una relación estadísticamente significativa a las 24h fueron el no presentar un aumento del trabajo respiratorio (Wresp) (p=0.000) y saturación de oxígeno (SatO2) normal (p=0.006). A las 48h: no aumento en Wresp (p=0.014), SatO2 normal (p=0.005), presión arterial de oxígeno/fracción inspirada de oxígeno (PAFI) leve o moderado (p=0.039). A las 72h fracasaron: PAFI severa (p=0.000), aumento de Wresp (p=0.001) y el índice de ROX menor a 4.88 (p=0.023). De acuerdo con el análisis multivariado las variables predictoras de fracaso a las 24h fueron: FIO2, SatO2, Wresp y a las 48h FIO2 y SatO2. Conclusiones: el aumento de FIO2>70 %, presentar incremento del Wresp y SpO2 menor de 88 % son variables asociadas a fracaso de la CNAF y facilitan tomar decisiones clínicas sobre avanzar o no hacia un soporte ventilatorio invasivo.
Introduction: COVID-19 has generated challenges due to the high demand for health care services, making it necessary to seek ventilatory support alternatives that allow us to fulfill the needs of the population. It is important to have tools that allow to detect the failure of non-invasive ventilatory strategies early and to identify the need for intubation on time. Objective: Identify the variables associated with failure of high-flow nasal cannula treatment (HFNC) on COVID-19 patients. Materials and Methods: Analytical observational, cross-sectional study of 68 patients in the intensive care unit with COVID-19, who received treatment with HFNC. The variables of the study were evaluated at three time points, at 24, 48 and 72 hours. A bivariate and multivariate analysis was performed between those who failed and those who were successful. Results: In the bivariate analysis, the variables that presented a statistically significant relationship at 24h were: No increase in work of breathing (WOB) (p=0.000), normal oxygen saturation (SatO2) (p=0.006). At 48h: No increase in WOB (p=0.014), normal SatO2 (p=0.005), mild to moderate partial pressure arterial oxygen/fraction inspired oxygen ratio (P/F ratio) (p=0.039). At 72h failed: severe P/F ratio (p=0.000), Increased WOB (p=0.001) and ROX index less than 4.88 (p=0.023). According to multivariate analysis the predictive variables for the therapeutic failure at 24h were: FIO2, SatO2, WOB; at 48h: FIO2 and SatO2. Conclusions: Increased FIO2>70%, increased WOB and SpO2 less than 88% are variables associated with failure of HFNC, and facilitate clinical decisions on whether or not to progress with invasive ventilatory support.
Subject(s)
Humans , Work of Breathing , Cannula , Pulmonary Medicine , Critical Care , COVID-19 , Oxygen SaturationABSTRACT
Introducción. Los pacientes con Covid-19 tienen el riesgo de presentar síndrome de dificultad respiratoria aguda, por lo que pueden requerir ventilación mecánica y traqueostomía. De este modo, la decanulación es un proceso importante que está a cargo del equipo rehabilitador. Objetivos. Describir y caracterizar el proceso de decanulación en pacientes traqueostomizados con COVID-19 para identificar posibles factores que influyen en su realización exitosa. Métodos. Estudio descriptivo transversal realizado en los pacientes que fueron sometidos a traqueostomía entre junio de 2020 y julio del 2021 en la Clínica de Alta Complejidad Santa Bárbara de Palmira, Colombia. Las variables categóricas se presentaron con porcentajes y para las cuantitativas se contrastó la hipótesis de normalidad a través de la prueba de Kolmogorov-Smirnov. Resultados. Los pacientes, al momento de ingreso, tenían características de severidad, con un promedio de PaO2/FiO2 de 99,7 mmhg y bloqueo neuromuscular hasta por 20 días; el tiempo promedio de ventilación mecánica fue 17,3 días. A todos los pacientes el equipo de rehabilitación les realizó intervención; de los 15 pacientes incluidos, tres no fueron decanulados. Se realizó un análisis descriptivo de los objetivos y de la interven- ción realizada por cada disciplina; para los tres pacientes no decanulados se analizaron las principales barreras y los predictores del fracaso de una decanulación. Conclusión. Gracias a la instauración de un plan constante y activo de rehabilitación multidisciplinario en el que los pacientes reciben intervención desde su ingreso hasta su egreso se logró decanular de manera exitosa al 80% de los pacientes traqueostomizados.
Introduction. Patients with Covid-19 are at risk of presenting acute respiratory distress syndrome and may require mechanical ventilation and tracheostomy. Thus, decannulation is an important process that is in charge of the rehabilitation team. Objectives. To describe and characterize the decannulation process in tracheostomized patients with COVID-19 in order to identify possible factors that influence its successful performance. Methods. Cross-sectional descriptive study conducted in patients who underwent tracheostomy between June 2020 and July 2021 at the Clínica de Alta Complejidad Santa Bárbara de Palmira, Colombia. Categorical variables were presented with percentages and for quantitative variables the hypothesis of normality was contrasted through the Kolmogorov-Smirnov test. Results. The patients, at the time of admission, had severe characteristics, with an average PaO2/FiO2 of 99.7 mmhg and neuromuscular block for up to 20 days; the average time on mechanical ventilation was 17.3 days. All patients underwent intervention by the rehabilitation team; of the 15 patients included, three were not decannulated. A descriptive analysis was made of the objectives and the intervention performed by each discipline; for the three patients who were not decannulated, the main barriers and predictors of decannulation failure were analyzed. Conclusion. Thanks to the implementation of a constant and active multidisciplinary rehabilitation plan in which patients receive intervention from admission to discharge, 80% of the tracheostomized patients were successfully decannulated.
Subject(s)
Humans , Middle AgedABSTRACT
ABSTRACT: This article presents some findings derived from the doctoral thesis entitled Subject Topos. The problem of space in psychoanalysis. The aim is to show how Lacan used the logic of ancient stoicism to solve the Freudian problems related to space, which posed difficulties both in locating the unconscious spatially, and in clearly establishing a conception of the body, thus solving the advantages derived from the limits imposed by Aristotelian logic and Newtonian mechanics.
Resumo: Este artigo apresenta alguns achados derivados da tese doutoral intitulada Topos do Sujeito. O problema do espaço em psicanálise. O propósito é mostrar como Lacan se serviu da lógica do estoicismo antigo para solucionar os problemas freudianos relativos ao espaço, os quais colocavam dificuldades tanto para localizar espacialmente o inconsciente, como para estabelecer claramente uma concepção de corpo, resolvendo assim as aporias derivadas dos limites impostos pela lógica aristotélica e a mecânica newtoniana.
Subject(s)
Philosophy , Psychoanalysis , Spatio-Temporal AnalysisABSTRACT
Objective: To report the percentage of non-vaccine pneumococcal serotypes and theirantibiotic susceptibility pattern in children with invasive peumococcal disease. Methods:Invasive pneumococcal isolates of children <5 years during January 2007 to December2016 were serotyped by a co-agglutination reaction and sequential multiplex polymerasechain reaction. Results: Among the total 170 S. pneumoniae invasiveisolates, 54 (31.8%)and 44 (25.9 %) were the serotypes, which are not included in current 10-valent or 13-valent vaccines, respectively. Very low resistance was observed against penicillin (4.5%)and all isolates were susceptible to cefotaxime. Conclusions: One-fourth to one-third ofthe S. pneumoniae serotypes in under-five children with invasive pneumococcal diseaseare not covered by existing pneumococcal vaccines in India.
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Objective: To assess the knowledge, perception and use of Health Information Technology (HIT) among private dental practitioners in Chennai, Tamil Nadu, India. Material and Methods: The sample population consisted of private dental practitioners in Chennai District of Tamil Nadu who were individually approached to participate in the cross-sectional survey. A structured, self-reported, close-ended questionnaire, which contained queries on the knowledge, usage and concerns about HIT in their practice, was designed. Descriptive statistics such as frequency distribution and percentages were analyzed using SPSS version 24. Results: Of the 483 dental clinics that were approached, 352 dental practitioners completed the questionnaire survey. A significant proportion of dental practitioners (65 percent) reported positive attitude towards use of HIT systems and believed that HIT systems could help make their work easier and efficient. However, it is unfortunate to note that almost half (47 percent) the dental practitioners were not interested in implementing HIT systems in their practice due to various monetary concerns such as installation and maintenance costs. Conclusion: The widespread adoption of HIT provides system connectivity and information exchange among providers of the same organisation, providers at different organisations and, ultimately, providers practising regionally and nationally.
Subject(s)
Humans , Health Knowledge, Attitudes, Practice , Dentists , Information Technology , Health Information Systems , India/ethnology , Medical Informatics/methods , Cross-Sectional Studies/methods , Surveys and Questionnaires , Data Interpretation, StatisticalABSTRACT
Objective: To compare and evaluate the relationship between anemia and periodontitis by estimation of peripheral blood between healthy patients and chronic periodontitis patients. Material and Methods: Of the total of 230 outpatients approached to participate in the study, 100 eligible patients were selected as per the selection criteria. After written consent, these patients were divided into two groups according to the clinical parameters as healthy and disease (chronic periodontitis) groups. Under aseptic conditions, venous blood samples were obtained by vein-puncture in the ante-cubital fossa without excessive venous stasis and the mean value of erythrocytes (EC), hemoglobin concentration (HGB), mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) were measured. Paired t-test was employed to find the significance of study parameters on continuous scale within the group analysis and unpaired t-test (two tailed, dependent) was used to find the significance of study parameters on continuous scale in the inter group analysis. Results: Generally, the healthy group reported higher levels of EC, HGB, MCV and MCH than the periodontitis group. The mean hemoglobin level was significantly higher (p-value<0.05) in healthy patients (12.66 ±1.41 gm/dl) whereas a slightly lower level of 11.32±1.85 gm/dl was observed in patients with chronic periodontitis. Similarly, the range of erythrocyte count of healthy patients was significantly higher (3.69-5.29 million/µl) than chronic periodontitis patients (3.33-5.97 million/µl). Whilst MCV was higher in healthy patients but non-significant, higher mean MCH of 27.75 ± 3.25 pg/cell was reported in healthy patients compared to mean of 25.73 ± 3.22 pg/cell in patients with chronic periodontitis. Conclusion: Significant hematological differences in EC, HGB, MCV and MCH between healthy periodontium and chronic periodontitis subjects were seen indicating mild anemia.
Subject(s)
Humans , Male , Female , Adult , Hemoglobins , Chronic Periodontitis/diagnosis , Anemia , Brazil , Erythrocyte Count/methods , Hematologic Tests/methodsABSTRACT
Background: The brown widow spider (Latrodectus geometricus Koch, 1841) has colonised many parts of the world from its continent of origin, Africa. By at least 1841, the species had successfully established populations in South America and has more recently expanded its range to the southern states of North America. This highly adaptable spider has been far more successful in finding its niche around the world than its famous cousins, the black widow, Latrodectus mactans, found in the south-eastern states of North America, and the red-back, Latrodectus hasselti, found mostly in Australia, New Zealand and Japan. Methods: We performed an extensive web search of brown widow sightings and mapped the location of each sighting using ArcGIS. Specimens reputedly of the species L. geometricus were collected at three localities in Peninsular Malaysia. The spiders were identified and documented based on an examination of morphological characteristics and DNA barcoding. Results: The spiders found in Peninsular Malaysia were confirmed to be Latrodectus geometricus based on their morphological characteristics and DNA barcodes. We recorded 354 sightings of the brown widow in 58 countries, including Peninsular Malaysia. Conclusion: Reports from the Americas and the Far East suggest a global-wide invasion of the brown widow spider. Herein we report the arrival of the brown widow spider in Peninsular Malaysia and provide notes on the identification of the species and its recently expanded range.
Subject(s)
Animals , Spiders , Animal Distribution , MalaysiaABSTRACT
Background:The brown widow spider (Latrodectus geometricus Koch, 1841) has colonised many parts of the world from its continent of origin, Africa. By at least 1841, the species had successfully established populations in South America and has more recently expanded its range to the southern states of North America. This highly adaptable spider has been far more successful in finding its niche around the world than its famous cousins, the black widow, Latrodectus mactans, found in the south-eastern states of North America, and the red-back, Latrodectus hasselti, found mostly in Australia, New Zealand and Japan.Methods:We performed an extensive web search of brown widow sightings and mapped the location of each sighting using ArcGIS. Specimens reputedly of the species L. geometricus were collected at three localities in Peninsular Malaysia. The spiders were identified and documented based on an examination of morphological characteristics and DNA barcoding.Results:The spiders found in Peninsular Malaysia were confirmed to be Latrodectus geometricus based on their morphological characteristics and DNA barcodes. We recorded 354 sightings of the brown widow in 58 countries, including Peninsular Malaysia.Conclusion:Reports from the Americas and the Far East suggest a global-wide invasion of the brown widow spider. Herein we report the arrival of the brown widow spider in Peninsular Malaysia and provide notes on the identification of the species and its recently expanded range.(AU)
Subject(s)
Animals , Black Widow Spider/anatomy & histology , Latrodectus hasselti , Research ReportABSTRACT
Purpose: Many virulence factors are involved in the pathomechanism of infection caused by Helicobacter pylori. Toxins such as vacuolating cytotoxin, encoded by the vacA gene and the immunogenic protein cagA, encoded by the cagA gene (cytotoxin-associated gene) are major factors conferring the property of virulence. The current study is aimed at isolation of H. pylori and separation of its toxin from antral biopsies of patients. Materials and Methods: The following cell lines were used to demonstrate the cytopathic effect (CPE) of the separated toxin: African green monkey kidney (Vero), baby hamster kidney, human lung carcinoma (LLC-MK2), and human epithelial. Results: H. pylori was isolated from 27 out of 45 patients (60%) selected for the study. CPE of H. pylori toxin was highly signifi cant on Vero cells than other cell lines used as it reached a high dilution titer of toxin (1/16) in 13 isolated strains (48.15%). No signifi cant difference in CPE of toxin in different dilutions was detected among other cell lines used in different groups. H. pylori toxin could be detected by sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis as a distinct band with a molecular weight ranging between 66 and 97 kDa and closely related to 87 kDa. Conclusion: H. pylori vacuolating cytotoxin plays a vital role in the pathogenesis of gastroduodenal diseases (gastritis, gastric ulcer, duodenal ulcer, and gastric cancer). The Vero cell lines were found to be the most suitable form of tissue culture when compared with other cell lines used in our study for demonstrating the activity of H. pylori toxin.
ABSTRACT
Este artículo presenta algunas conjeturas derivadas del análisis de entrevistas realizadas con sujeto que han padecido enfermedades cardiovasculares, específicamente infarto. Se ponen aquí en evidencia algunas modalidades en las respuestas del sujeto ante la angustia y el encuentro con lo que Freud denominó sentimiento inconsciente de culpa, particularmente por la vía del masoquismo moral.
This article presents some conjectures derived from the analysis of interviews conducted with subjects who have suffered from cardiovascular diseases, specifically heart attack. Some modalities in the responses of the subject to anxiety and the encounter with what Freud called the unconscious feeling of guilt are brought out here, particularly by way of moral masochism.
Subject(s)
Humans , Infarction/psychology , Anxiety/psychology , Cardiovascular Diseases/psychology , Guilt , Masochism/psychologyABSTRACT
Este artículo se basa en la consideración de algunas cuestiones preliminares al estudio de la salud mentalcon comunidades tradiciona-les. Y para ello toma como punto de partida la dificultad que se presenta al ingresar en el estudio de categorías que no son propias de un marco de referencia cultural, como en el caso de la salud mental. Así, es ineludible la referencia a la antropología médica y la metodología etnográfica, cuando se trata de profundizar en el estudio de culturas basadas en cosmovisiones complejas que explican la nfermedad a partir de visiones integracionistas del sujeto y el universo. Al mismo tiempo valora la situación actual en la que se encuentran las comunidades tradicionales y algunos nuevos problemas sociales que pueden derivar en problemáticas de investigación.