Niveles de vitamina D en médicos: ¿son los anestesiólogos el único grupo de riesgo? / Vitamin D levels among anesthesiologists and other physicians

Background Sun exposure is the main source of 25-hydroxy-vitamin D. Since anesthesiologists work inside operating rooms, they are identified as a deficiency risk group. As medical activity in general occurs indoors, added to the work excess and sedentary lifestyle, physicians in general have low sun exposure. Aim To investigate the determinants of vitamin D levels in physicians. Material and Methods Anesthesiologists and physicians not working in operating rooms were included. A survey that comprised working hours, diet, skin color, sunscreen use and outdoor activities was also applied. Measurements of vitamin D and parathormone levels in blood were performed. Results We analyzed samples from 81 volunteers. Median vitamin D values of the whole sample were in the range of insufficiency (25.3 [interquartile range 12.4] ng/ml). Multiple linear regression analysis detected no differences between anesthesiologists and non-anesthesiologists. A higher body mass index was a risk factor for vitamin D deficiency, (p = 0.025). The only protective factor was the intake of a vitamin D supplement (p < 0.01). Conclusions Anesthesiologists and other specialists were both at risk for vitamin D deficiency. Obesity was a risk factor and the use of a vitamin D supplement was the only protective factor.

Confiabilidade de dois aparelhos localizadores apicais / Accuracy of two apex locators

O objetivo deste trabalho foi avaliar in vitro a eficácia dos localizadores apicais Root ZX II e NovAPEX em canais mesiovestibulares de molares inferiores nas medidas 0,5mm e 1mm aquém do forame apical. Vinte molares foram acessados coronalmente e a porção cervical dos canais foi alargada com brocas Gates Glidden e irrigados com hipoclorito de sódio 5,25%. Foram feitas 120 medições divididas em 6 grupos. As medidas reais dos canais foram tomadas com a introdução de uma lima tipo K#15 até que a ponta da lima atingisse o forame apical. Dessa medida foram subtraídos 1mm e 0,5mm e os valores registrados. Grupo 1 (n=20) medida real a 1mm aquém do ápice, Grupo 2 (n=20) medida real a 0,5mm aquém, Grupo 3 (n=20) localizador Root ZX II a 1mm aquém, Grupo 4 (n=20) localizador Root ZX II a 0,5mm aquém, Grupo 5 (n=20) localizador NovAPEX a 1mm aquém, Grupo 6 (n=20) localizado NovAPEX a 0,5mm aquém, localizadores apicais foram programados de acordo com as instruções dos fabricantes para a medição dos canais a 0,5mm e 1mm aquém do ápice, sendo que as medidas obtidas foram registradas e comparadas com as medidas reais. O teste estatístico T Student foi aplicado aos resultados e observou-se que não houve diferença estatisticamente significativa (p>0.05) entre ambos os localizadores apicais, e que os dois foram eficazes para se medir o comprimento de trabalho de canais radiculares. As porcentagens de confiabilidade dos aparelhos foram 96% para o localizador apical Root ZX II a 1mm, 98,4% a 0,5mm e 96% para o localizador apical NovAPEX a 1mm e 91,2% a 0,5mm.

The objective of the current study was to evaluate in vitro the accuracy of Root ZX II and NovAPEX apex locators in mesical buccal root canals of mandibular molars in measures 0.5 mm and 1 mm from the apical foramen. Twenty molars were coronally accessed and cervical portion of the root canals was enlarged with Gates Glidden drills and irrigated with sodium hypochlorite 5.25%. It was done 120 measurements divided into six groups. Reals measurements of the canals were taken with the introduction of a K file # 15 until the file tip reached the apical foramen. This measure were subtracted 1 mm and 0.5 mm and the values recorded. Group 1 (n = 20) the real measure 1 mm from the apex, Group 2 (n = 20) measured 0.5 mm below the real, Group 3 (n = 20) locator Root ZX II to 1mm below, Group 4 (n = 20) locator Root ZX II to 0.5 mm below, Group 5 (n = 20) locator NovAPEX to 1mm below, Group 6 (n = 20) locator NovAPEX to 0.5 mm below, apex locators were programmed according to manufacturers’ instructions for measuring cannals to 0.5 mm and 1 mm from the apex, and the measurements were recorded and compared with actual measurements. The statistical T test was applied and the results showed that there was no statistically significant difference (p> 0.05) between the two apex locators, and that both were effective for measuring the working length of root canals. The percentages of reliability of the devices were 96% for the apex locator Root ZX II to 1 mm, 98.4% to 0.5 mm and 96% for the apical NovAPEX 1 mm and 91.2% to 0.5mm.

Trasplante de células hematopoyéticas / Hematopoietic stem cells transplant

El trasplante de células hematopoyéticas (TCH) es la infusión de células progenitoras a fin de restablecer la función medular e inmune en pacientes con enfermedades hematológicas malignas y no malignas adquiridas y genéticas. El impacto del TCH se refleja en las alternativas de tratamiento, mayor difusión de la técnica y mejores opciones al paciente.El procedimiento consiste en la obtención de progenitores hematopoyéticos periféricos, mediante las células CD34+ (2- 2.5 x 106/Kg peso); es un excelente predictor de prendimiento del injerto. El trasplante de donante no relacionado, permite tratamiento a pacientes que carecen de donantes familiares histo-idénticos. Otra variante de TCH es el mini-trasplante, utilizando dosis bajas de quimioterapia e inmunosupresores, produciendo menos complicaciones, pero jerarquizando el efecto “injerto sobre tumor”, que permite la remisión de enfermedades neoplásicas hematológicas y no hematológicas, siendo una alternativa en países en vías de desarrollo, por la posibilidad de disminuir costos y complicaciones.

Transplant of Hematopoietic Stem Cells (HSCT) is the infusion of hematopoietic progenitor cells in patients with hematologic malignant, non malignant, acquired and genetic disorders of the bone marrow to reestablish inmune and marrow function. The impact of the HSCT reflects on the choices of treatment, the wide diffusion of the technique and better options to the patient.This procedure consist to obtain the peripheral hematopoietic progenitors; through the CD34+ cells (2–2.5 x 106/Kg) is an excellent predictor of the successful of the engraftment. Transplant from not-related donors allow treatment to patients who lack of haploidentical family donors. Other variable of HSCT is mini-transplant, using low-doses of chemotherapy and inmunosupressors, it produces less complications, and enhances the effect “graft vs tumor”. This allows the remission of the malignant hematologic and non-hematologic diseases. It is becoming a good choice for treatment in developing countries, because decrease costs and complications.

Anestesia neonatal / Neonatal anesthesia

El periodo neonatal comprende las cuatro primeras semanas de vida. Durante este aparente corto periodo se presentan cambios anatómicos y fisiológicos que le permiten al neonato adaptarse a la vida extrauterina. Se hace énfasis en las diferencias que deben estar siempre presentes en la mente del médico para un manejo anestésico exitoso en los pacientes. Asimismo, se hace una revisión de las patologías congénitas que en muchas ocaciones son incompatibles con la vida y se discute el manejo anestésico de cada una de ellas

Anestesia total endovenosa propofol-fentanyl en pediatría usando parámetros farmacocinéticos de volumen de distribución del compartimiento central / Total intravenous anesthesia with propofol-fentanyl with the use of pharmacokinetical parameters of distribution volume and central compartment

Se realizó un estudio clínico descriptivo y prospectivo, con 25 pacientes ASA I, II, y III, con edades entre 1 y 15 años (edad media de 8.46 años, SD 4.07), programados para cirugía electiva de diferentes especialidades. Se administró anestesia general intravenosa con propofol y fentanyl, utilizando el modelo farmacocinético de 2 compartimientos calculando las dosis de carga con el volumen de distribución del compartimiento central y las dosis de infusión se modificaron con el tiempo de una manera gradual y progresiva, de acuerdo a la respuesta clínica del paciente. Las velocidades de infusión se recalcularon con concentraciones plasmáticas cada vez menores con periodos fijos de tiempo y si había signos de respuesta al estímulo nocivo se regresaba a los niveles plasmáticos previos En todos los casos se encontró un adecuado nivel de anestesia, de analgesia y sedación postoperatoria. Los cambios hemodinámicos carecieron de importancia clínica y de significancia estadística. No se encontró en ningún caso signos de actividad del sistema nervioso autónomo y no hubo complicaciones relacionadas con la técnica anestésica, ni necesidad de ventilación mecánica o de antagonismo. El tiempo medio de despertar luego de suspender la infusión de fentanyl de 27 ñ 7.91 minutos y del 16.8 ñ 9.23, para el propofol y se correlacionaron con la dosis total administrada de fentanyl, pero no con la de propofol. La dosis promedio de carga fue de 6.49 ñ 1.65 µg/kg para el fentanyl y de 2.75 ñ 0.1 mg/kg para el propofol. Las dosis promedio de infusión fue de 5.68 ñ 0.5 µg/kg/hora para el fentanyl de 9.5 ñ 2.42 mg/kg/hora para el propofol. La dosis promedio total fue de 9.22 ñ 2.04 µg/kg/hora para el fentanyl y de 10.35 ñ 1.46 mg/kg/hora para el propofol. La edad no modificó los requerimientos de los fármacos