Experiencia de trombolisis sistematizada en infarto cerebral agudo en un hospital público de Chile / Thrombolysis for acute ischemic stroke with recombinant tissue plasminogen activator in a Chilean public hospital

Background: The only accepted treatment for acute ischemic stroke is thrombolysis with recombinant tissue plasminogen activator (t-PA). It was implemented in Chile in 1996, although its use was mainly restricted in Chile to private clinics. Recently, at year 2009, we have implemented this treatment in a public hospital. Aim: To describe the results of treatment of acute ischemic stroke with t-PA in a public hospital in Chile. Material and Methods: Prospective analysis of all eligible patients with acute ischemic stroke that were admitted within 4 hours of its onset and had no contraindications for thrombolysis. Results: In an eight months period, a total of 19 intravenous thrombolyses were performed in 12 males and seven females aged 28 to 79 years old. The mean lapse between onset of symptoms and onset of thrombolysis was 190 ± 57 min. Results were favorable, according to Rankin and National Institute of Health Stroke scales. Ninety days after treatment, 63 percent of patients had minimal or absent disability, 26 percent had moderate disability and only one (5 percent) had severe disability. One patient had a clinically not significant intracranial hemorrhage and one patient died six days after thrombolysis. Conclusions: These results indicate that thrombolysis can be successfully implemented in Chilean public hospitals. The limitations for its use in this setting are mostly administrative.

Diagnósticos de enfermería prevalentes en los pacientes que presentan impregnación neuroléptica / Nursing diagnosis prevalence in patients presenting impregnation neuroleptic

La impregnación neuroléptica es un trastorno causado por los efectos adversos del tratamiento terapéutico con neurolépticos, que provocan en ciertos pacientes una variedad de efectos secundarios, que al ser identificados obligan a reducir las dosis o emplear otros medicamentos para controlarlos, pero, si no son hallados a tiempo sus síntomas se acentúan hasta llegar a ser un síndrome neuroléptico maligno, el cual es altamente mortal. La presente investigación está enfocada a plantear los diagnósticos e intervenciones en el correcto manejo de este trastorno, observando que el personal de enfermería del hospital mental no dispone de un plan de cuidados que incluya la valoración diagnóstica de enfermería y por tal motivo no se lleva a cabo un tratamiento terapéutico apropiado. Con los resultados obtenidos, se encontró que es más frecuente en el género masculino, ya que es la patología en la que más se presenta como es el trastorno psicótico agudo. Los neurolépticos más utilizados en los pacientes con impregnación neuroléptica son el haloperidol y el sinogan; y los efectos adversos se presentan con mayor frecuencia después de 0-13 días de tener instaurado un tratamiento farmacológico con neurolépticos. Las actividades realizadas por el personal de enfermería del Hospital Mental Rudesindo Soto con los pacientes que presentan impregnación neuroléptica, son en la mayoría de los casos la administración del medicamento antagonista y con menor frecuencia la suspensión del neuroléptico, administración de dieta liquida y blanda. Los signos y síntomas más frecuentes son la rigidez muscular, confusión y disfagia. Se encontraron dieciséis diagnósticos de enfermería prevalentes de los cuales se eligieron seis prioritarios para intervenir.

The impregnation neuroléptica is a disorder caused by the adverse effects of the therapeutic treatment with neuroleptics, which provoke in certain patients a variety of side effects, which on having been identified force to reduce the doses or to use other medicines to control them, but if his(her, your) symptoms are not found in time they accent up to managing to be a syndrome malignant Narcoleptic, which is highly mortal. The present this investigation focused to raising the diagnoses and interventions for the correct managing of this disorder, observing that the personnel of infirmary of the mental hospital does not order a plan of taken care that it includes the valuation diagnoses of infirmary and for such a motive there is not carried out a therapeutic appropriate treatment. With the obtained results, one thought that it is more frequent in masculine kind (genre); the pathology in the one that more appears is in the psychotic sharp disorder; the neuroleptics most used in the patients with impregnation neuroléptica are the haloperidol and the sinogan; the adverse effects appear with major frequency after 0-13 days of having a pharmacological treatment eslablished with neuroleptics. The activities realized by the personnel of infirmary of the Mental Hospital Rudesindo Soto with the patients who present impregnation neuroléptica, are in most cases the administration of the medicine antagonist and with minor frequency the suspension of the neuroleptic, administration of diet liquidates and swing. The signs and the most frequent symptoms are the muscular inflexibility, Confusion and disfagia. They found sixteen diagnoses of infirmary prevalent of which they were elected six priority ones to intervene.

Metabolismo del glutatión y desarrollo posnatal del pulmón de la rata / Glutathione metabolism during postnatal development of the rat lung

Background: Significant changes in lung antioxidants occur in preparation for birth. Little is known about physiological regulation of antioxidants in the postnatal period. Aim: To study the glutathione system in the lungs during postnatal development. Material and methods: In the lungs of 7, 15, 21, 50 and 70 days old Sprague-Dawley rats we measured total and oxidized glutathione content as well as the activity of the limiting enzyme in glutathione synthesis (y-GCS) and of the enzymes glutathione peroxidase (GPx) and glutathione reducíase (GRd). Results: Between 7 and 15 days the activities of GPx and GRd increase 32 percent and 26 percent, respectively (p <0.001). Whereas GPx activity remains high throughout the rest of the study period, GRd activity decreases progressively reaching adulthood values at 7 days. y-GCS activity shows a gradual increase that reaches significance at 50 days when it doubles values observed at 7 days (p <0.05). A significant correlation was found between GPx and GRd activities over the entire period (r =0.62, p <0.0001). Strength of the correlation is age dependent due to the differences in time course of the enzyme changes. Whereas total GSH does not change, oxidized glutathione decreases from 7 percent at 7 and 15 days to 4 percent later on (p <0.01). Conclusions: The activity of several enzymes involved in glutathione metabolism increases during postnatal development of the rat lung. Interpretation of lung responses to injurious agents needs to be done taking into consideration the physiological regulation of antioxidants during postnatal development.