Muerte materna incidental en un accidente por relámpago: Reporte de caso / Incidental maternal death due to lightning injury: a case report

Resumen Los relámpagos se presentan con una frecuencia mayor a 50 veces por segundo a nivel mundial; sin embargo, las descargas directas suceden rara vez y son responsables del 5% de los eventos fatales. El mecanismo de lesión inicial es la parálisis de los centros vitales, lo que ocasiona apnea, fibrilación auricular o paro cardíaco. En mujeres embarazadas, el accidente por rayo puede producir complicaciones graves, dependiendo del punto de entrada en el cuerpo y su efecto indirecto sobre el feto, produciendo trastornos de la conducción en el sistema cardíaco y daño a nivel del sistema nervioso central. En la literatura mundial, solo catorce casos de embarazo y traumatismo por relámpago han sido reportados, sobreviviendo en todos la madre, con un único reporte de muerte fetal. Se presenta un caso de accidente por relámpago en una mujer embarazada en la semana 23 de gestación, cuyo tipo de lesión fue por contacto directo en el abdomen, y quien ingresó con compromiso neurológico, taquicardia materna y bradicardia fetal. El deceso materno ocurrió por infarto agudo extenso del miocardio y la formación de un émbolo intracavitario en el ventrículo izquierdo, con la consecuente muerte del binomio. Se describe su frecuencia, el mecanismo de lesión, las manifestaciones clínicas y el manejo actual. MÉD.UIS.2019;32(1):21-6

Abstract Lightning occurs with a frequency rate of more than 50 times per second worldwide. Nevertheless, direct lightning strikes are not common, and they are responsible for about 5% of all lightning injury fatalities. The initial mechanism of injury is the paralysis of the vital centers, which causes apnea, atrial fibrillation and cardiac arrest. In pregnant women, lightning can produce severe complications which depend on the point of entrance and its indirect effect on the fetus, affecting the cardiac conduction system and the central nervous system. We report a case of a lightning accident by direct strike on a 23-week pregnant woman, who's type of injury was by direct contact on the abdomen. She arrives to the emergency room with neurologic symptoms, maternal tachycardia and fetal bradycardia. The mother died due to myocardial infarction and the presence of an intracavitary embolus in the left ventricle, with the consequent maternal-fetal death. The incidence and injury mechanisms, as well as the clinical features and clinical management are described. MÉD.UIS.2019;32(1):21-6.

Management of Critical Burn Injuries: Recent Developments / 대한구급학회지

BACKGROUND: Burn injury and its subsequent multisystem effects are commonly encountered by acute care practitioners. Resuscitation is the major component of initial burn care and must be managed to restore and preserve vital organ function. Later complications of burn injury are dominated by infection. Burn centers are often called to manage problems related to thermal injury, including lightning and electrical injuries. METHODS: A selected review is provided of key management concepts as well as of recent reports published by the American Burn Association. RESULTS: The burn-injured patient is easily and frequently over resuscitated, with ensuing complications that include delayed wound healing and respiratory compromise. A feedback protocol designed to limit the occurrence of excessive resuscitation has been proposed, but no new “gold standard” for resuscitation has replaced the venerated Parkland formula. While new medical therapies have been proposed for patients sustaining inhalation injury, a paradigm-shifting standard of medical therapy has not emerged. Renal failure as a specific contributor to adverse outcome in burns has been reinforced by recent data. Of special problems addressed in burn centers, electrical injuries pose multisystem physiologic challenges and do not fit typical scoring systems. CONCLUSION: Recent reports emphasize the dangers of over resuscitation in the setting of burn injury. No new medical therapy for inhalation injury has been generally adopted, but new standards for description of burn-related infections have been presented. The value of the burn center in care of the problems of electrical exposure, both manmade and natural, is demonstrated in recent reports.

Management of Critical Burn Injuries: Recent Developments / 대한중환자의학회지

BACKGROUND: Burn injury and its subsequent multisystem effects are commonly encountered by acute care practitioners. Resuscitation is the major component of initial burn care and must be managed to restore and preserve vital organ function. Later complications of burn injury are dominated by infection. Burn centers are often called to manage problems related to thermal injury, including lightning and electrical injuries. METHODS: A selected review is provided of key management concepts as well as of recent reports published by the American Burn Association. RESULTS: The burn-injured patient is easily and frequently over resuscitated, with ensuing complications that include delayed wound healing and respiratory compromise. A feedback protocol designed to limit the occurrence of excessive resuscitation has been proposed, but no new “gold standard” for resuscitation has replaced the venerated Parkland formula. While new medical therapies have been proposed for patients sustaining inhalation injury, a paradigm-shifting standard of medical therapy has not emerged. Renal failure as a specific contributor to adverse outcome in burns has been reinforced by recent data. Of special problems addressed in burn centers, electrical injuries pose multisystem physiologic challenges and do not fit typical scoring systems. CONCLUSION: Recent reports emphasize the dangers of over resuscitation in the setting of burn injury. No new medical therapy for inhalation injury has been generally adopted, but new standards for description of burn-related infections have been presented. The value of the burn center in care of the problems of electrical exposure, both manmade and natural, is demonstrated in recent reports.

A Follow-Up Study of a Large Group of Children Struck by Lightning

Background. On 11 November 1994; 26 preadolescent girls; 2 adult supervisors and 7 dogs were sleeping in a tent in rural South Africa when the tent was struck by lightning. Four of the girls and 4 of the dogs were killed. The 2 adults were unharmed; but all but 3 of the children suffered significant injuries. An article in 2002 detailed the event and examined the medical and psychological changes in the surviving girls. Objective. To understand the medical and psychological changes secondary to lightning strike years after injury. Methods. An online questionnaire was prepared that included a checklist of physical and psychological symptoms. Participants were asked to report on both initial and current symptoms. Eleven of the 22 survivors were contacted; and 10 completed the survey. Results. Participants reported that initial physical symptoms generally resolved over time; with ~10 - 20% continuing to experience physical symptoms. Vision problems persisted in 50% of respondents. Psychological symptoms; overall; had a later onset and were more likely to be chronic or currently experienced. Depression and anxiety; specifically; were higher among the survivors than the reported incidence in South Africa. Conclusions.Initial and current/chronic physical and psychological symptoms following lightning strike are reported; adding to the body of literature on the long-term after-effects of lightning strike on survivors. A brief discussion on post-traumatic stress disorder symptomatology and post-lightning shock syndrome is provided

Quantitative analysis of iris parameters in keratoconus patients using optical coherence tomography / Uso de tomografia de coerência óptica na análise quantitativa dos parâmetros irianos em pacientes com ceratocone

ABSTRACTPurpose:To investigate the relationship between quantitative iris parameters and the presence of keratoconus.Methods:Cross-sectional observational study that included 15 affected eyes of 15 patients with keratoconus and 26 eyes of 26 normal age- and sex-matched controls. Iris parameters (area, thickness, and pupil diameter) of affected and unaffected eyes were measured under standardized light and dark conditions using anterior segment optical coherence tomography (AS-OCT). To identify optimal iris thickness cutoff points to maximize the sensitivity and specificity when discriminating keratoconus eyes from normal eyes, the analysis included the use of receiver operating characteristic (ROC) curves.Results:Iris thickness and area were lower in keratoconus eyes than in normal eyes. The mean thickness at the pupillary margin under both light and dark conditions was found to be the best parameter for discriminating normal patients from keratoconus patients. Diagnostic performance was assessed by the area under the ROC curve (AROC), which had a value of 0.8256 with 80.0% sensitivity and 84.6% specificity, using a cutoff of 0.4125 mm. The sensitivity increased to 86.7% when a cutoff of 0.4700 mm was used.Conclusions:In our sample, iris thickness was lower in keratoconus eyes than in normal eyes. These results suggest that tomographic parameters may provide novel adjunct approaches for keratoconus screening.

RESUMOObjetivo:Investigar a relação entre os parâmetros quantitativos irianos e a presença de ceratocone.Métodos:Estudo observacional transversal com quinze olhos de 15 pacientes com ceratocone e 26 olhos de 26 indivíduos normais, pareados por idade e gênero. Parâmetros da íris (área, espessura e diâmetro da pupila) de olhos com ceratocone e olhos sem ceratocone foram medidos usando tomografia de coerência óptica do segmento anterior (AS-OCT), em condições padronizadas de alta luminosidade e ambiente escuro. Com o objetivo de maximizar a sensibilidade, especificidade e identificar o melhor ponto de corte na diferenciação entre ceratocone e indivíduos normais, foi realizada a análise quantitativa da curva característica operacional do receptor (ROC) dos parâmetros de espessura da íris.Resultados:A área e espessura da íris estavam reduzidas nos olhos de pacientes com ceratocone. Observamos que o melhor parâmetro para discriminar indivíduos normais de pacientes com ceratocone foi a espessura média na margem pupilar, tanto em condições de alta luminosidade quanto em ambiente escuro. O desempenho diagnóstico deste parâmetro foi avaliado pela análise quantitativa da área sob a curva ROC (AROC), mostrando AROC de 0,8256, com sensibilidade de 80,0% e especificidade de 84,6% usando um ponto de corte de 0,4125 milímetros de espessura da íris. A sensibilidade aumentou para 86,7%, com um corte de 0,4700 milímetros de espessura da íris.Conclusões:Na amostra deste estudo, a espessura da íris demostrou-se reduzida nos olhos com ceratocone. Estes resultados sugerem que os parâmetros tomográficos podem proporcionar novas informações no auxilio da triagem de pacientes com ceratocone.

A Patient of Lightning Injury Combined with Reversible Neurologic Deficits: A Case Report

Lightning injury can cause systemic deterioration, including neurologic deficits. We present a case of lightning injury with reversible neurologic deficits in a 49-year-old man. Clinical manifestations of neurologic deficits due to lightning injury vary from lightheadedness to paralysis. In order to achieve a favorable outcome, immediate respiratory support and careful neurologic examinations are key elements during initial resuscitation. If secondary injuries due to any type of trauma following lightning were suspected, emergency physicians should make a decision regarding use of advanced diagnostic and therapeutic modalities.

Impacto de la luz artificial sobre la anidación de la tortuga marina Dermochelys coriacea (Testudines: Dermochelyidae), en playa Cipara, Venezuela

Impact of artificial light on nesting in the leatherback turtle Dermochelys coriacea (Testudines: Dermochelyidae) at Cipara beach, Venezuela. The number of Leatherback turtle nests and their spatial distribution was compared between years with and without artificial light, and between dark and lighted beach segments, in Cipara Beach, Paria Peninsula, Venezuela. Residents were interviewed to identify their perceptions about the impact of artificial light on sea turtles. Mean volume of sand per meter of beach was larger at La Peña, Cipara and La Remate and smaller at Varadero (p<0.001), increasing from April to June and later decreasing until August (p<0.05). Mean percentage of gravel was higher at Varadero and La Peña, and lower at La Remate and Cipara. Most interviewed people said that artificial light does not affect sea turtles. Between 2000 and 2005, 1 217 leatherback landings and 1 056 nests were observed. Successful nests increased with the years (p=0.035) as well as total nest number (p=0.015). From 2000 through 2003 there were 743 landings, 661 nests and 374 clutches. During the two years with electric light (2004-2005), there were 474 landings, 395 nests and 232 clutches. Proportion of landings with nest building decreased significantly during the years with electric light (p= 0.005), but nesting success did not vary (p= 0.402). No significant difference was found between landings per beach meter in dark and lighted sectors (p=0.244), between nests built (p=0.379) and in the rate of successful nesting (p=0.516). Dark and lighted sectors did not differ in the proportion of landings with nest building (p=0.067) and success rate (p=0.833). Rev. Biol. Trop. 57 (3): 515-528. Epub 2009 September 30.

En Playa Cipara, Península de Paria, Venezuela, se evaluó el impacto de la luz artificial sobre la anidación de la tortuga cardón. Se estimó el número de anidaciones y su distribución espacial a lo largo de la playa entre los años sin y con iluminación artificial y entre segmentos de playa iluminada y oscura. Se hicieron entrevistas a los residentes para conocer su percepción sobre el impacto de la luz artificial hacia las tortugas marinas. Entre el 2000 y 2005 se registraron 1 217 salidas de tortuga cardón; con 1 056 nidos. El número de nidos con huevos dependió significativamente del año (p=0.035) al igual que el número de nidos totales (p=0.015). En los años previos a la electricidad (2000-2003) se observaron 743 salidas, de las cuales 661 con nido y 374 nidadas confirmadas. En los dos años (2004-2005) con iluminación artificial, se contaron 474 salidas con 395 nidos y 232 nidadas. La proporción de salidas con construcción de nido disminuyó significativamente (p=0.005) en los años con luz eléctrica, pero no varió el éxito de desove (p=0.402). No se encontró diferencia significativa entre el número de salidas por metro de playa en los sectores oscuros y los iluminados (p=0.244), ni entre el número de nidos construidos (p=0.379), ni entre las anidaciones con desove (p=0.516). Tampoco en la proporción de las salidas totales que constituyeron anidaciones (p=0.067) entre los sectores iluminados y oscuros, ni en la proporción de nidos exitosos (p=0.833). El volumen medio de arena por metro de playa fue mayor en La Peña, Cipara y La Remate y menor en Varadero (p<0.001), aumentando de abril a junio y posteriormente disminuyó un poco hasta agosto (p<0.05). El porcentaje medio de gravas fue mayor en Varadero y La Peña y menor en La Remate y Cipara. La mayoría de los entrevistados consideraron que la luz artificial no afecta a las tortugas marinas.

Fenología de árbol Sideroxylon capiri (Sapoteceae) en el Bosque Seco Tropical de Costa Rica / Phenology of the tree Sideroxylon capiri (Sapotaceae) at the tropical dry forest in Costa Rica

From March 1996 until February 2000, an study about the phenology of the Tempisque tree [Sideroxylon capiri (A.DC.) Pittier ] was made in the Tropical Dry Forest of the Barra Honda National Park (Costa Rica).Ten trees were choosen at random and their phenology was evaluated monthly during the first two years and every two months afterwards. Climatological data were also collected in situ .Trees change their foliage each year during the rainy season or at the beginning of the dry season. In contrast with other native species in forest, soil water deficit is not responsible for foliage change in S.capiri. Some elements that affect the process are photoperiod and herbivores. Unknown physiological mechanisms allow the tree to maintain foliage during the driest months (March and April). Flowering and fruiting may occur every year and in any season,but mostly in the dry season, with variability both among seasons and among individuals

Se estudió la fenología del árbol de tempisque Sideroxylon capiri (A.DC.) Pittier en el Bosque Seco Tropical del Parque Nacional Barra Honda (Costa Rica), desde marzo de 1996 hasta febrero de 2000. Para ello se tomaron diez árboles escogidos al azar, a los cuales se les evaluó la fenología, una vez al mes durante los dos primeros años y posteriormente cada dos meses. Además, se tomaron datos climatológicos in situ para establecer relaciones con el comportamiento fenológico. Se encontró que los árboles renuevan el follaje cada año, pero la caída ocurre durante el período lluvioso o a inicios del seco, por lo que, contrario a lo que sucede en otras especies nativas de este tipo de bosque, el déficit hídrico del suelo no es el responsable de la caída del follaje, sino que deben haber otros factores ambientales responsables de ello. Entre estos podrían estar el fotoperíodo y la presencia de herbívoros. Durante los meses más secos (marzo y abril)todos los árboles mantienen su follaje al máximo y para que esto ocurra deben existir también mecanismos fisiológicos particulares. Respecto a los procesos de floración y fructificación, estos se presentan todos los años, especialmente en el período de sequía, pero es posible que ocurran en cualquier otra época del año. Existen diferencias en la magnitud de la floración y fructificación, dependiendo de la época y del individuo. Se discuten las posibles causas de este comportamiento fenológico, así como las ventajas ecológicas que podría tener

La semilla de Campsiandra angustifolia (Fabaceae: Caesalpiniodeae)como un reflejo de las presiones selectivas sobre su dispersión y establecimiento / The seeds of Campsiandra angustifolia (Fabaceae: Caesalpiniodeae) as a reflex of selective pressures on dispersal and establishment

We indirectly evaluated the selective pressures on dispersal and establishment of Campsiandra angustifolia, a common water-dispersed tree from the Peruvian Amazon, analyzing the variation in the relationship between the volume occupied by dispersal and establishment structures in a total of 535 seeds from 13 trees located at three different habitats. The seeds differed one order of magnitude in their total volume. However, independently of their size and the location of the maternal tree, the relationship between the volume occupied by dispersal and establishment structures was relatively constant (~1) and showed a normal distribution with low skewness, indicating stabilizing selection. These results suggest that, in the habitats studied, dispersal and establishment processes may have similar importance to C.angustifolia. In species with seeds confined in pods, and therefore strongly space-limited, the relative volume of their seeds occupied by dispersal and establishment structures could be a better measure of the trade-off between these two processes than the variation in seed size

Evaluamos indirectamente las presiones selectivas sobre la dispersión y el establecimiento en Campsiandra angustifolia, un árbol de la Amazonía Peruana dispersado por agua, analizando variaciones de la relación entre el volumen ocupado por las estructuras de dispersión y de establecimiento en sus semillas. Medimos un total de 535 semillas de 13 árboles ubicados en tres hábitats diferentes, las cuales presentaron una gran variación en su volumen total. Independientemente del tamaño de la semilla y de la ubicación del árbol de origen, la relación entre el volumen asignado a estructuras de establecimiento y a estructuras de dispersión fue relativamente constante (~1) y presentó una distribución normal con baja asimetría, indicando selección estabilizante. Este resultado sugiere que los procesos de dispersión y establecimiento poseen una importancia relativa similar para C.angustifolia en los hábitats estudiados. En especies con semillas empaquetadas, el volumen relativo ocupado por estructuras relacionadas con la dispersión o el establecimiento podría ser una medida más adecuada de la solución de compromiso entre estos dos procesos que la variación del tamaño de la semilla

Responses to climatic factors by foragers of Plebeia pugnax Moure (in litt.) (Apidae, Meliponinae)

Flight activity of Plebeia pugnax Moure (in litt.) was studied in six colonies coming from Cunha, SP, from July to October 1994. Twice a week, from 8:00 a.m. to 6:00 p.m., for 5 minutes every half-hour, all the bees entering and leaving the hives were counted. Six hundred counts were made and the materials that foragers carried were recorded. Data were analysed in relation to temperature, relative humidity, light intensity and day time. Foragers' flight activity was relatively constant in a wide range of temperature, from 22 C to 34 C. The minimum temperature for the beginning of flight activity was 14 C. Effective flight activity (when foragers of all colonies were leaving the hives) occurred at 15 C. These bees also flew within a wide range of relative humidity, from 30 percent to 100 percent, decreasing slowly after 50 percent. Flight activity increased as light intensity rose and it has also increased as the hours passed by, reaching a peak around midday and decreasing gradually afterwards. Pollen was collected all day long, while resin collection was relatively constant and debris transportation was slightly higher after 10:00 h. From all known Plebeia species, this one flew on the lowest temperature ever registered for this genus

A Case of Lightning Burn with Flame Burn / 대한피부과학회지

Lightning injury is uncommon, as evidenced by the fact that most physicians never see or treat such a victim. To our knowledge, there were no reports of lightning burn with flame burn. We report a case of lightning burn with flame burn. On a rainy day, a 64-year-old woman with an umbrella in her left hand was walking along a road. When lightning struck the tip of her umbrella, her clothes were flamed. She threw herself into the water in a nearby field. The fire was extinguished. Then she lost consciousness, but she regained consciousness immediately. She was transported to our hospital. On arrival at our emergency center, her physical examination was remarkable. The patient had an entrance wound of the left palm and an exit wound of the left foot as well as 25 % total body surface burns, which were present in the flexor surface of the left hand, left arm, left leg and left flank. Histopathology showed epidermal and dermal necrosis. Three months later the burns were healed spontaneously, with some remaining scars.

Pineal serotonin N - acetyltransferase and hydroxyindole - 0 - methyltransferase activities in vizcacha (Lagostomus maximus maximus) maintained under various photoperiods

Este trabajo tiene como propósito estudiar las actividades de las enzimas NAT y HIOMT en glándula pineal de vizcacha, bajo distintos regímenes de iluminación. La actividad de NAT presentó marcada variación diaria en los animales mantenidos en condiciones de LD 12:12, permaneciendo descendida durante las horas de iluminación y siendo máxima en oscuridad. En oscuridad permanente aumenta significativamente y se anulan las variaciones diarias de NAT. La actividad de HIOMT en pineal de vizcachas mantenidas en LD 12:12 no presentó ritmos diarios; en iluminación la actividad desciende, no recuperándose en la etapa de oscuridad. En el lote de oscuridad permanente se observó un marcado aumento, mientras que en iluminación permanente descendió a 1/7 de los valores encontrados en oscuridad. En iluminación natural día-noche la HIOMT recuperó su actividad en las horas de oscuridad. Concluimos que en este roedor la actividad de las enzimas estudiadas es afectada por la luz, siendo la HIOMT la más sensible