¿Existe correlación metabólica hipoglucémica y el síndrome de Percheron? Reporte de caso / Is there a metabolic correlation between hypoglycemia and Percheron syndrome? Case report

Introducción: El síndrome de Percheron es causa de lesiones isquémicas talamicas bilaterales ocasionando una serie de anomalías clínicas como: alteración del estado de conciencia, oftalmoplejias, y alteraciones de la memoria. Caso clínico: Presentamos el caso de una mujer de 49 años con diabetes mellitus, mal control metabólico, episodios hipoglucémicos e hiperglucemicos repetitivos, quien cursa con sintomatologia inespecífica, se realizan estudios imagenológicos no invasivos documentado lesiones talamica bilaterales. Conclusiones: Los cuadros subagudos e isquémicos parciales que involucran la región paramediana del Talamo bilateral podrían tener alguna relación con episodios hipoglucémicos e hiperglucemicos repetitivos, que pueden llegar a cursar con sintomatología leve e inespecífica, lo cual lo convierte un reto diagnóstico para este síndrome.

Introduction: Percheron syndrome is the cause of bilateral thalamic ischemic lesions, causing a series of clinical abnormalities such as an altered state of consciousness, ophthalmoplegia, and memory alterations. Clinical case: We present the case of 49-year-old woman with diabetes mellitus, poor metabolic control, and repetitive hypoglycemic and hyperglycemic episodes with nonspecific symptoms, non-invasive imaging studies were performed, which documented bilateral thalamic lesions. Conclusions: Subacute and partial ischemic symptoms that involve the paramedian region of the bilateral thalamus could have some relationship with repetitive hypoglycemic and hyperglycemic episodes, and can lead to mild and nonspecific symptoms, which makes it a diagnostic challenge for this syndrome.

Efectos de la Nueva Gestión Pública en el desempeño: análisis de los hospitales públicos chilenos / Effects of the New Public Management System on performance: An analysis of Chilean public hospitals

RESUMEN Objetivo Evaluar los efectos de la implementación de una reforma de Nueva Gestión Pública (NGP) que profesionaliza los cargos de dirección, sobre el desempeño de los hospitales públicos chilenos. Métodos Se construyó una base de datos para 181 hospitales públicos chilenos con información pública del año 2015. Se determinó el efecto generado por la permanencia en el cargo de dirección de un hospital público de quien fue seleccionado a través del Sistema de Alta Dirección Pública (SADP), mediante la estimación de cuatro modelos de regresión multivariada. Resultados La permanencia en el cargo de la persona seleccionada vía SADP se asocia positivamente con variables como el número de altas, la rotación de pacientes y la tasa de ocupación, denotando una mejora en la rentabilidad de los recursos disponibles. No se encuentra una relación significativa entre dicha variable y la disminución de la letalidad. Conclusiones Este trabajo proporciona evidencias acerca de los efectos sobre el desempeño de una reforma inspirada en la NGP, en particular, se muestra que la incorporación de profesionales con capacidad de gestión en cargos de alta dirección en hospitales públicos chilenos mejora su desempeño, relevándose la importancia del perfil profesional de quienes dirigen este tipo de organizaciones y recomendando ampliar el periodo de nombramiento de estos cargos.(AU)

ABSTRACT Objective To evaluate the effects of the implementation of a New Public Management system -which professionalizes management positions- on the performance of Chilean public hospitals. Materials and Methods A database was constructed for 181 Chilean public hospitals using public information issued in 2015. The effect generated by the tenure of a person selected through the Public Senior Management System (SADP by its acronym in Spanish) for a senior management position in a public hospital was determined by estimating four multivariate regression models. Results The tenure of a person selected via SADP is positively associated with variables such as the number of discharges, rotation of patients and occupation rate, thus demonstrating an improvement in the profitability of the available resources. No significant relationship was found between the tenure of a person selected via SADP and the decrease in case fatality. Conclusions This article provides evidence about the effects on the performance of a reform based on the New Public Management system. Specifically, it demonstrates that the incorporation of professionals with management skills in senior management positions in Chilean public hospitals improves hospital performance, revealing the importance of the profession of those who direct this type of organizations. Thus, the recommendation is to extend the period of appointment people in these positions.(AU)

EFFECT OF DIFFERENT SUBSTRATES AND AUXINS ON ROOTING OF Leucadendron sp. (PROTEACEAE) / EFECTO DE DIFERENTES SUSTRATOS Y AUXINAS EN EL ENRAIZAMIENTO DE Leucadendron sp. (PROTEACEAE)

ABSTRACT Colombian flower growers are faced with economic and social problems, so they are looking for alternatives, which include Proteas, ornamentals that require research that ensures an appropriate, local technical management. One of the Proteas most likely to be involved in this search is the genus Leucadendron. Therefore, this study aimed to establish the best basis for rooting its cuttings. The experimental design was a split plot design with a factorial arrangement. Four substrates were evaluated in combination with two auxins, naphthaleneacetic acid (NAA) and indolebutiric acid (IBA), three doses each, plus a commercial control. Each treatment was repeated three times and the experimental unit consisted of 30 stakes at the first locality and 25 at the second one. The most relevant results showed that vermiculite was the best substrate for rooting cuttings of Leucadendron at both localities. Also, it was identified that IBA is the growth regulator which improved the rooting percentage, the root volume, the stem decreased the percentage of losses.

RESUMEN Los cultivadores colombianos de flores tradicionales están confrontados con problemas, tanto económicos como sociales, por lo que están buscando alternativas, que incluyen a las Proteas, ornamentales que requieren investigación, que asegura un manejo técnico. Una de las Proteas con más posibilidad de estar involucrado en este desarrollo es el género Leucadendron. El diseño experimental empleado fue un diseño de parcelas, divididas con arreglo factorial. Así, que el objetivo de este estudio fue establecer la base para el enraizamiento de las estacas. En combinación con dos auxinas, ácido 1-naftalenacético (ANA) y ácido indolbutírico (AIB), tres dosis de cada una y el control comercial, se evaluaron cuatro sustratos. Cada tratamiento, se repitió tres veces y cada unidad experimental consistió en 30 estacas, para la primera localidad y de 25, para la segunda. Los resultados más relevantes mostraron que el mejor sustrato para el enraizamiento de estacas de Leucadendron fue la vermiculita, en ambas localidades. También, se identificó que AIB es el regulador de crecimiento que mejoró el porcentaje de enraizamiento, el volumen de raíces, la longitud del tallo disminuyó el porcentaje de pérdidas.

CURVAS DE ABSORCIÓN DE MACRONUTRIENTES EN TRES VARIEDADES DE CAÑA DE AZÚCAR (Saccharum officinarum L.) PARA PANELA, EN LA HOYA DEL RÍO SUÁREZ / MACRONUTRIENT ABSORPTION CURVES IN THREE VARIETIES OF SUGARCANE (Saccharum officinarum L.) FOR PANELA IN THE HOYA DEL RÍO SUÁREZ

RESUMEN La caña de azúcar (Saccharum officinarum L.) es una fuente importante de carbohidratos para la panela. En Colombia, la principal región panelera está ubicada en la Hoya del Río Suarez; sin embargo, falta aún consolidar una producción suficientemente rentable, competitiva y amigable con el ambiente. Uno de los aspectos más determinante en la producción de panela es la nutrición mineral, debido a que, actualmente, se hace de forma convencional, desconociendo los niveles de extracción de los materiales genéticos utilizados. El objetivo fue determinar el requerimiento nutricional, producción de biomasa y productividad en segundo corte, en el municipio de Suaita (Santander). El diseño empleado fue bloques al azar (BCA), con 3 tratamientos (las variedades CC 93-7711, CC 93-7510 y RD 75-11) y 5 repeticiones. Se realizaron 4 muestreos, a los 118, 252, 335 y 392 días después de corte (ddc). Se observó que la mayor absorción de N, Ca y Mg ocurrió a los 335 ddc, mientras que para P y K, aconteció a los 392. Los nutrientes se acumularon, especialmente, en los tallos; la CC 93-7711 superó a las otras variedades, con una absorción total en kilogramos por hectárea, de 448 N, 296 K, 85 Ca, 43 P y 40 Mg, seguida por RD 75-11, que presentó, aproximadamente, 16% menos en N-K-Ca-P-Mg. El patrón de absorción de los nutrientes fue N>K>Ca>P>Mg y, referente a la productividad, se destacó RD 75-11, luego CC 93-7711 y CC 93-7510, con 172,6, 171,1 y 159,9 toneladas de caña por hectárea, respetivamente.

ABSTRACT Sugarcane (Saccharum officinarum L.) is a primary carbohydrates source for panela; in Colombia the main panela region is located in the Hoya del Rio Suarez, however, it has not been consolidated a production sufficiently profitable, competitive and environmentally friendly production. One of the most decisive aspects in the production of panela is mineral nutrition, due to the fact that it is currently done in a conventional way without knowing the levels of extraction of the genetic materials used. The objective was to determine the nutritional requirement, production of biomass and productivity in second cut in the municipality of Suaita (Santander), the design used was blocks at random, with 3 treatments (the varieties CC 93-7711, CC 93-7510 and RD 75-11) and 5 repetitions, 4 samplings were made at 118, 252, 335 and 392 days after cutting (ddc). It was observed that the highest absorption of N, Ca and Mg occurred at 335 ddc, while for P and K, occurred at 392 ddc; nutrients accumulated especially in the stems; CC 93-7711 outperformed the other varieties with a total absorption in kilograms per hectare of 448 N, 296 K, 85 Ca, 43 P and 40 Mg, followed by RD 75-11 that presented approximately 16% less in N-K-Ca-P-Mg, the nutrient absorption pattern was N>K>Ca>P>Mg and as for productivity, RD 75-11 stood out, then CC 93-7711 and CC 93-7510 with 172.6, 171,1 and 159.9 tons of cane per hectare, respectively.

A robust fully automatic lumen segmentation method for in vivo intracoronary optical coherence tomography

Abstract Introduction: Intravascular optical coherence tomography (IVOCT) is an in-vivo imaging modality based on the introduction of a catheter in a blood vessel for viewing its inner wall using electromagnetic radiation. One of the most developed automatic applications for this modality is the lumen area segmentation, however on the evaluation of these methods, the slices inside bifurcation regions, or with the presence of complex atherosclerotic plaques and dissections are usually discarded. This paper describes a fully-automatic method for computing the lumen area in IVOCT images where the set of slices includes complex atherosclerotic plaques and dissections. Methods The proposed lumen segmentation method is divided into two steps: preprocessing, including the removal of artifacts and the second step comprises a lumen detection using morphological operations. In addition, it is proposed an approach to delimit the lumen area for slices inside bifurcation region, considering only the main branch. Results Evaluation of the automatic lumen segmentation used manual segmentations as a reference, it was performed on 1328 human IVOCT images, presenting a mean difference in lumen area and Dice metrics of 0.19 mm2 and 97% for slices outside the bifurcation, 1.2 mm2 and 88% in the regions with bifurcation without automatic contour correction and 0.52 mm2 and 90% inside bifurcation region with automatic contour correction. Conclusion This present study shows a robust lumen segmentation method for vessel cross-sections with dissections and complex plaque and bifurcation avoiding the exclusion of such regions from the dataset analysis.

Integração com monitores de beira de leito utilizando health level 7 / Integration with bedside monitors using health level 7 / Integración de monitores de cabecera utilizando health level 7

OBJETIVOS: desenvolver solução para integração de monitores de beira de leito ao Sistema de Informações Hospitalares (SIH). MÉTODOS: Desenvolvimento e implementação de troca de mensagens no padrão Health Level 7, Admit Discharge Transfer (ADT) e Observation (OBX), utilizando a biblioteca HAPI, para cadastro do paciente e coletados parâmetros de monitoramento. Criação de base de dados para seleção e armazenamento dos parâmetros desejados. RESULTADOS: cadastro integrado com o SIH e captura em banco de dados dos parâmetros dos monitores de beira de leito além de interface de teste para visualização dos dados. CONCLUSÃO: Desenvolvido e implementado um sistema para a integração com monitores beira de leito, permitindo uma visão mais abrangente dos dados dos pacientes.

OBJECTIVES: develop solution for integration of bedside monitors to the Hospital Information System (HIS). METHODS: Development and implementation of the exchange of messages using the standard Health Level 7, Admit Discharge Transfer (ADT) and Observation (OBX), using the HAPI library in order to register the patient and to collect parameters from the monitors. It was also created a database in order to support the selection and storage of the desired parameters. RESULTS: registration integrated with HIS and saving of bedside monitors' parameters in database plus test interface for data visualization. CONCLUSION: Developed and implemented a system to integrate with bedside monitors, allowing a more comprehensive view of patient data.

Sistematização do registro eletrônico de atendimento da parada cardiorrespiratória / Systematization of the electronic record of attendance of cardiac arrest / Sistematización del registro electrónico de asistencia de un parada cardiorrespiratoria

Objetivo: Descrever o desenvolvimento e a implantação do sistema informatizado padronizado no Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo para o registro de atendimento da parada cardiorrespiratória (PCR). Método: O registro eletrônico de atendimento da PCR foi baseado no Protocolo de Utstein e desenvolvido pelo Serviço de Informática da instituição, tendo a participação de um grupo de especialistas. Utilizou-se o Sistema Integrado de Informações InCor (SI3), com acesso seguro baseado nos perfis de acesso e comunicação segura por meio do protocolo Security Socket Layer. Após o desenvolvimento, o registro eletrônico foi disponibilizado para todas as unidades da instituição por meio do SI3. Resultados: O módulo de registro de ressuscitação é constituído de uma tela de identificação do paciente e cinco telas que contemplam informações do Protocolo de Utstein. À partir da implantação do sistema, foi possível coletar dados sobre o atendimento da PCR, como o tempo despendido e número de profissionais envolvidos para o atendimento. Conclusão: O desenvolvimento do módulo de registro de ressuscitação é útil para facilitar a obtenção de registros completos e adequados. Contudo, faz-se necessário à realização de novos estudos, com o intuito de avaliar o sistema informatizado.

Objective: To describe the development and implantation of computerized system standardized in Heart Institute, Medical School, University of São Paulo to the records of attendance of heart arrest (HA).Method: The electronic record of attendance of HA was based on the Utstein protocol and developed by the Informatics Department of the institution, with the participation of a experts group. We used the InCor Integrated Information System (SI3), with secure access based on access profiles, and secure communication through the Security Socket Layer. After the development, the electronic record was available for all units of the institution through the SI3. Results: The resuscitation record module consists of a patient identification screen and five screens that include information of Utstein Protocol. With the system implantation, was possible to collect data about attendance of HA, as the time spent and number of professionals involved in this attendance. Conclusion: The development of resuscitation record module is useful to facilitate the obtaining of the adequate and complete records. However, it is necessary to conduct other studies that evaluating the computerized system.

Objetivo: Describir el desarrollo y la implantación del sistema informatizado estandarizado en el Instituto del Corazón del Hospital de las Clínicas de la Facultad de Medicina de la Universidad de Sao Paulo para el registro del tratamiento del paro cardiorrespiratorio (PRC). Método: El registro electrónico del tratamiento del PCR fue desarrollado por el Servicio de Informática de la institución, teniendo la participación de un grupo de especialistas. Fue utilizado el Sistema Integrado de Informações InCor (SI3), con acceso seguro y basado en los perfiles de acceso y comunicación segura por medio del protocolo Security Socket Layer. Después del desarrollo, el registro electrónico fue disponible para todas las unidades de la institución por medio del SI3. Resultados: El módulo del registro de la resucitación se compone de una pantalla para identificar el paciente y otras cinco pantallas, que incluyen las informaciones del protocolo Utstein. A partir de la implantación del sistema, fue posible recoger datos sobre el tratamiento del PCR, como el tiempo empleado y el número de profesionales implicados en el tratamiento. Conclusión: La creación del módulo de registro de la resucitación es útil para facilitar la obtención de los registros completos y adecuados. Sin embargo, es necesario realizar nuevos estudios, con el fin de evaluar el sistema computarizado.

MedCast - sistema colaborativo para discussão de casos clínicos / MedCast - Sistema Colaborativo para la Discussión de casos clínicos / MedCast - Colaborative System for the Discussion of clinical cases

Neste artigo é apresentada uma arquitetura para a integração do Sistema de Informação hospitalar (SIH) com uma ferramenta colaborativa. Também se descreve o desenvolvimento de seu protótipo, denominado MedCast, realizado em parceria entre o CPqD e o Instituto do Coração (InCor) - HCFMUSP. O MedCast, em sua versão atual, permite a inclusão de casos clínicos por meio de Web services e a discussão de casos com utilização de ferramentas multimídia. O protótipo demonstra que a utilização cuidadosa dessas informações permite o enriquecimento da discussão.

This article presents an architecture for the integration of the Hospital Information System (HIS) with a collaborative tool. It is also described the development of its prototype, called MedCast, as result of a partnership between CPqD and Heart Institute (InCor) - FMUSP. The MedCast, in its current version, allows the inclusion of clinical cases by means of Web services and the discussion of cases with use of multimedia tools. The prototype demonstrates that the careful use of this information is useful to enrich the discussion.

Este artículo presenta una arquitectura para la integración del Sistema de Información Hospitalario (SIH) con una herramienta de colaboración. También se describe el desarrollo de su prototipo, llamado MedCast, hecho en colaboración entre CPqD y el Instituto del Corazón (InCor) - FMUSP. El MedCast, en su versión actual, permite la inclusión de casos clínicos por medio de servicios Web y la discusión de casos con el uso de herramientas multimedia. El prototipo demuestra que el uso cuidadoso de esta información permite enriquecer el debate.

Minersus: ambiente computacional para extração de informações para a gestão da saúde pública por meio da mineração dos dados do SUS / Minersus: a computational framework for extracting analytical information through data mining of Brazilian public health databases

O objetivo deste trabalho é apresentar a definição, implementação e validação de um ambiente computacional, denominado MINERSUS, para a produção de informação analítica por meio da mineração das bases de dados dos sistemas de informações do Sistema Único de Saúde (SUS). A partir de uma revisão bibliográfica e de um projeto desenvolvido na Secretaria Estadual de Saúde (SES-SP) (Santos et al., 2004 e 2006), levantou-se uma lista de desafios para implantar uma ferramenta analítica na área da saúde. Mediante esta lista foram formuladas premissas que direcionaram a configuração arquitetônica do MINERSUS, e que exigiram a definição e implementação de alguns mecanismos especiais, como o versionamento de tabelas, o controle de mudanças estruturais nos arquivos e os mecanismos específicos incluídos nas atividades de mineração de dados. A utilidade do MINERSUS foi avaliada a partir da operacionalização desse ambiente para responder a questões pertinentes à saúde pública, e a sua usabilidade foi apreciada por meio de uma pesquisa de campo que permitiu a interação do usuário com o ambiente. A avaliação da utilidade confirmou a coerência da informação produzida pelo MINERSUS, comprovando a sua capacidade de extrair informações úteis à gestão da saúde pública. Os resultados da avaliação da usabilidade também foram positivos, comprovando a premissa da facilidade para o usuário realizar a mineração nas bases do SUS. O objetivo principal do trabalho foi alcançado: o ambiente computacional para extração de informação a partir da mineração das bases de dados da saúde pública foi definido, implantado e avaliado.

This paper demonstrates the definition, implementation and validation of a computational framework, called MINERSUS, for the extraction of analytical information through data mining of the Brazilian public health databases. The first point was to define main challenges in order to implement an analytical solution in public health organizations. The process to define main challenges included a bibliographic review and a trial project developed in São Paulo Health Department. These challenges were used to define basic premises which drove the design of MINERSUS, such as special features to table versioning, files structural changes and new mechanism into data mining tasks. MINERSUS was evaluated against two different criteria: utility and usability. We performed the utility evaluation by analyzing the information produced by the framework when answering selected questions from public health management and the usability evaluation has been concluded according to a field survey which evaluated the interaction between users and the framework. The utility evaluation demonstrated the coherency of the information produced by MINERSUS and confirmed its capacity to produce useful information for public health management. The results from the usability evaluation were also positive, and indicated that the framework provides a simple form for users mining data from public health databases. The general objective was achieved: a computational framework to extract information through data mining of public health databases was defined, implemented and evaluated. The contributions are the methodology to build the framework and an implanted framework ready to use.

Presión media de la vía aérea con la aplicación de presión positiva al final de la espiración estática vs. dinámica / Mean airway pressure during pressure-controlled ventilation with static vs. dynamic positive end-expiratory pressure

Introducción: la presión positiva al final de la espiración (PEEP) incrementa la presión media de la vía aérea (Paw) en pacientes con ventilación mecánica. Con el objetivo de comparar la presión media de la vía aérea que se obtiene en un mismo paciente con ventilación mecánica controlada por presión al aplicar presión positiva al final de la espiración estática (PEEPe) y al aplicar presión positiva al final de la espiración dinámica (PEEPd), se realizó un estudio prospectivo, longitudinal, experimental, comparativo y de grupos relacionados. Material y métodos: se incluyeron pacientes con ventilación mecánica controlada por presión con SaO2 > 90 % y FiO2 < 50%, con PEEPe de 4 cm de H2O y relación inspiraciónespiración de 1:2. Después de 15 minutos se midió la presión media de la vía aérea (fase 1). Posteriormente se modificó la relación inspiración-espiración a 2:1 por 15 minutos, con el fin de generar PEEPd (fase 2). Una vez registrada la presión media de la vía aérea, en la fase 3 se regresó de nuevo a la relación inspiración-espiración 1:2, sustituyendo la PEEPd obtenida en la fase 2 por PEEPe para mantener la misma presión positiva al final de la espiración total (PEEPt) de la fase 2 (PEEPt = PEEPe + PEEPd). Concluidos los 15 minutos de estabilización, se registró de nuevo la presión media de la vía aérea y la PEEPt. Se utilizaron las pruebas de Friedman y Wilcoxon, considerando una p < 0.05 como estadísticamente significativa. Resultados: se estudiaron 38 pacientes. La PEEPt fue de 4, 8 y 8 cm de H2O, y las medianas de la presión media de la vía aérea fueron de 8.7, 13.8 y 11.4 cm de H2O en las fases 1, 2 y 3 respectivamente (p < 0.05). Conclusiones: en un mismo paciente con ventilación mecánica controlada por presión y con los mismos niveles de PEEPt, la presión media de la vía aérea es mayor al utilizar PEEPd que PEEPe.

BACKGROUND: Positive end-expiratory pressure increases mean airway pressure (Paw) in patients with mechanical ventilation. We undertook this study to compare mean airway pressure (Paw) generated with static PEEP (sPEEP) vs. dynamic PEEP (dPEEP) at the same level of total PEEP (tPEEP) in the same patient with pressure-controlled mechanical ventilation (PC). METHODS: We conducted a prospective clinical trial at the Intensive Care Unit of a university-affiliated hospital. Consecutive patients in PC with SaO2>90%; FiO2<50%; sPEEP of 4 cm H2O and inspiration-expiration ratio (I:E ratio) 1:2 were included in the study. After a basal period of time of 15 min, Paw was registered (phase one of the study protocol). In phase 2 with the ventilator settings constant, only the I:E ratio was switched to 2:1 to generate dPEEP, and after 15 min Paw and total PEEP (tPEEP) were registered (tPEEP=sPEEP+dPEEP). In phase 3, the I:E ratio was switched back to 1:2 substituting the dPEEP generated in the second phase of the study by sPEEP to maintain the same level of tPEEP of phase 2. After 15 min, Paw was again registered. Friedman and Wilcoxon's test were used, p value<0.05 was considered statistically significant. RESULTS: Thirty eight patients were admitted to the study protocol, tPEEP was 4, 8 and 8 cm H2O and median of the Paw 8.7, 13.8, and 11.4 cm H2O, respectively, with a p value<0.05 in the first, second and third phases of the study. CONCLUSIONS: During pressure control ventilation, mean airway pressure is affected by the level of total PEEP and its composition. Paw is higher when dynamic PEEP participates in the composition of total PEEP.

A Comparison of Sap Flow Measurements and Potometry in Two Tropical Lowland Tree Species with Contrasting Wood Properties

We evaluated the performance of the Heat Dissipation Technique (HDT) to measure sap flow in whole trees by comparison with potometric water uptake. Two tropical lowland species, Ochroma lagopus (balsa), a pioneer species with light wood and Hyeronima alchorneoides (pilón), a late-successional species with hard wood were examined. Diurnal courses of sap flow measured with the HDT showed good agreement with potometry. At the low sap flow rates (below 1 Kg h-1) occurring during nocturnal recharge HDT consistently underestimated sap flow rates. This resulted in the failure of the current version of the HDT to measure nocturnal water uptake, an important component of the water budget of at least one of the two species examined.

Efecto de diferentes niveles de presión positiva al final de la espiración sobre el gasto energético en reposo medido por calorimetría indirecta en pacientes con ventilación en presión control / Effects of Different Positive End Expiratory Pressure Levels on Resting Energy Expenditure Measured by Indirect Calorimeter in Patients with Pressure-Controlled Ventilation

Objetivo: determinar la variación del gasto energético en reposo (GER), consumo de oxígeno (VO2) y producción de CO2 (VCO2 por calorimetría indirecta (CI) al aplicar tres diferentes niveles de presión positiva al final de la espiración (PEEP) en pacientes con ventilación mecánica controlada por presión. Diseño: estudio prospectivo, longitudinal, experimental y comparativo. Material y método: se incluyeron nueve pacientes con ventilación mecánica controlada por presión internados en la unidad de cuidados intensivos. Se efectuó CIcon el propósito de medir el GER, VO2 y VCO2 así como el volumen minuto (VE) en tres diferentes niveles de PEEP. Para el análisis estadístico se utilizó la prueba de la t pareada y Wilcoxon se calcularon los coeficientes de variación de las variables en estudio. Resultados: se observó con el incremento de la PEEP disminución en el GER, VO2 y VCO2 que guarda relación con la disminución del VE y cuyo coeficiente de variación se mantiene alrededor del 6 %. En los tres casos en los que se mantuvo constante el VE durante la CI el coeficiente de variación fue menor de 6%. Conclusiones: la medición del GER por CI es confiable y útil cuando se incrementa la PEEP siempre que se mantenga el VE. El cálculo del cociente respiratorio (QR) en estas circunstancias no es confiable.

Objective: To identify variations during measurements of resting energy expenditure (REE), oxygen consumption (VO2 and CO production (VCO2 by indirect calorimetry (IC) in patients with pressure-controlled ventilation and different levels of positive end expiratory pressure (PEEP). Design: Prospective and comparative study. Setting: Intensive care unit (ICU) of a university-affiliated hospital. Measurements and Main Results: REE, VO2, and VCO2 were measured by IC in nine patients with pressure- controlled ventilation and different levels of PEEP. Paired t Wilcoxon and coeficient of variation tests for all measurements were carried out. Decrease in REE, VCO2, and VO2 was observed with increments in PEEP, these changes related with a concomitant reduction in VE. Coefficient of variation during IC was above 6%, and was lower in three patients who maintained the same VE throughout the study. Conclusions: Measurement of REE by Ids reliable atvarious levels of PEEP, and it improves if VE remains constant throughout measurement. Respiratory quotient (RQ) in this setting is not accurate.

Aplicações de telemedicina em redes de alta velocidade / Telemedicine applications in high speed networks

A distribuição dos serviços de saúde e o compartilhamento de informações clínicas, utilizando sistemas de telecomunicação, envolvem um conjunto diverso e complexo de tecnologias. Além disso, se a informação a ser compartilhada contém imagens, um problema especial em cardiologia é como distribuir imagens dinâmicas obtidas em estudos de ecocardiografia e de angiografia com qualidade de serviço. As imagens individuais são facilmente transmitidas, mas o volume total, considerando todas as imagens em uma seqüência, é enorme, podendo chegar facilmente à ordem de gigabytes por paciente. Os avanços em tecnologias de comunicações e em informática facilitam a médicos e especialistas localizados em um centro de referência a troca de informações com médicos e profissionais de saúde em local distante, em outro centro ou mesmo com o próprio paciente. Embora em especialidades como cardiologia, radiologia e patologia as informações relevantes sobre o paciente sejam inerentemente digitais, a necessidade de alta qualidade associada ao volume de dados impõe limitações à prática de ações de Medicina a distância por intermédio dos meios de comunicação convencionais.

Plasmaféresis en el síndrome de Guillain-Barré / Plasmapheresis in Guillain-Barre syndrome

OBJECTIVE: To evaluate the efficacy of early therapeutic plasmapheresis in severely affected patients with Guillain-BarrÚ syndrome (GBS). PATIENTS AND METHOD: Patients between 16 to 70 years of age, with GBS according to NINCDS criteria, in stage > or = 3 of Huges severity score and with less than 7 days of onset of symptoms were admitted for therapeutic plasmapheresis. All patients completed a total of five sessions of plasma exchange every other day using 25 albumin and saline in a 1:1 proportion. Follow-up was performed for 6 months. Friedman and Wilcoxon tests were done to establish differences within groups. RESULTS: A total of 34 patients were admitted to the study. The time span between onset of symptoms and admission to the study was 4 days (median). Fourteen (41) required mechanical ventilation. Clinical progression of the syndrome was observed during the first two sessions of plasma-pheresis. Improvement in motor function by Huges score was observed only after fourth session of plasma exchange (p < 0.05). Two patients did not improve, and one died. CONCLUSIONS: Clinical improvement in GBS during early therapeutic plasmapheresis occurs only after the fourth session of plasma exchange.