Sulfohemoglobinemia secundaria a zopiclona. Casos clínicos / Sulfhemoglobinemia secondary to the use of zopiclone. Report of two cases

Sulfhemoglobin (SulfHb) is formed by hemoglobin (Hb) oxidation by sulfur compounds. Sulfhemoglobinemia is mainly associated with drugs or intestinal bacterial overgrowth. Patients present with central cyanosis, an abnormal pulse oximetry and normal arterial oxygen partial pressure. These features are shared with methemoglobinemia (MetHb) whose diagnosis requires an arterial co-oximetry. Depending on the device used, SulfHb may produce interference with this technique. We report two females aged 31 and 43 years, consulting at the emergency room with cyanosis. Both had a history of acute and chronic, high dose zopiclone ingestion. Pulse oximetry showed desaturation but with normal arterial oxygen partial pressure. Cardiac and pulmonary diseases were ruled out. Co-oximetry in two different analyzers showed interference or normal MetHb percentages. No other complications ensued, and cyanosis decreased over days. Since MetHb was discarded among other causes of cyanosis in a compatible clinical context, the diagnosis of sulfhemoglobinemia was made. The confirmatory method is not available in Chile. The presence of SulfHb is difficult to diagnose, confirmatory tests are not readily available, and it frequently interferes with arterial co-oximetry. This is attributed to a similar absorbance peak of both pigments in arterial blood. Venous co-oximetry can be useful in this context. SulfHb is a self-limited condition in most cases, however it must be differentiated from methemoglobinemia to avoid inappropriate treatments like methylene blue.

Protocolo con recomendaciones para aplicar el WHOQOL-BREF en población con cáncer de mama / Protocol and recommendations for applying the WHOQOL-BREF in population with breast cancer

Resumen Objetivo: Determinar la validez de contenido de un protocolo con recomendaciones para la aplicación del instrumento WHOQOL-BREF, en la evaluación de la calidad de vida en mujeres con cáncer de mama. Materiales y métodos: Estudio descriptivo, observacional, tipo validación de instrumentos. El proceso se desarrolló en 3 fases, incluyendo validación de contenido con la participación de expertos en las áreas de oncología, psicología, trabajo social, y enfermería; valorando la claridad, coherencia, pertinencia, y suficiencia del protocolo. Se determinó el grado de acuerdo entre los evaluadores con el índice RwG. Resultados: El protocolo obtuvo puntajes promedios superiores a 9,0 en todos los ítems, la mayoría con índices RwG mayor a 0,5. Por su parte, los evaluadores adicionaron recomendaciones claves como acompañamiento permanente durante la aplicación de la encuesta e incluir pausas activas, por la extensión del instrumento. Conclusiones: Se presenta un protocolo para mejorar la aplicación del instrumento WHOQOL-BREF en población con cáncer de mama.

Abstract Objective: To determine content validity of a protocol with the recommendations for the application of the WHOQOL-BREF instrument to assess the quality of life of women with breast cancer. Materials and methods: This is a descriptive, observational, and type validation of instruments study. The process was developed in 3 phases, including content validation with the participation of experts in the oncology, psychology, social work, and nursing fields that assessed the clarity, coherence, relevance, and sufficiency of the protocol. The degree of agreement between the evaluators was determined using the rWG index. Results: The protocol obtained mean scores higher than 9.0 in all items, the majority with rWG indices greater than 0.5. The evaluators added key recommendations such as permanent accompany during the application of the survey and active pauses inclusion due to the instrument extension. Conclusions: A protocol is presented to improve the application of the WHOQOL-BREF instrument in populations that suffer from breast cancer.

Capacidad estructural, recursos humanos tecnológicos y requerimientos de ventilación mecánica en 58 unidades de cuidados intensivos en argentina durante la pandemia por SARS-CoV-2. Estudio SATICOVID-19 / Structural capacity, technological human resources and mechanical ventilation requirements in 58 intensive care units in Argentina during the SARS-CoV-2 pandemic. A SATICOVID-19 Study

Resumen Durante la pandemia por SARS-CoV-2 hubo un marcado requerimiento de camas de cuidados críticos, insumos y profesionales entrenados para asistir a pacientes con insuficiencia respiratoria grave. La Sociedad Argentina de Terapia Intensiva (SATI) diseñó un estudio para caracterizar estos aspectos en las Unidades de Cuidados Intensivos (UCIs). Estudio multicéntrico, de cohorte prospectiva; las UCIs participantes completaron un formulario al final del estudio (31/10/2020) sobre características hospitalarias, número de camas de áreas críticas pre- e intra-pandemia, incorporación de profesionales, insumos y recursos tecnológicos, y carga de trabajo. Participaron 58 UCIs; 28(48%) de Provincia de Buenos Aires, 22(38%) de Ciudad Autónoma de Bue nos Aires, 10(17%) de otras; 31(53%) UCIs pertenecían al sector público; 23(47%) al privado-seguridad social. En 35/58(60%) hospitales las camas de cuidados críticos aumentaron de 902 a 1575(75%); 37% en UCI y 63% principalmente en Unidad Coronaria y Emergencias-shock room. En 41/55(75%) UCIs se incorporó personal: 27(49%) médicos/as (70% intensivistas), 36(65%) enfermeros/as, 28(51%) kinesiólogos/as, 20(36%) personal de limpieza, y 1(2%) otros/as; 96% de las UCIS reportaron disponer de respiradores suficientes, y 95%, insumos y EPP suficientes. De todos los pacientes en ventilación mecánica invasiva, 55% [43-64] presentaron COVID-19. Se requirió oxigenoterapia como soporte no invasivo en 14% [8-24] de los ingresos por COVID-19. Se registró una importante expansión de las áreas críticas operativas, secundariamente al aumento de camas, personal, y adecuada disponibilidad de respiradores e insumos esenciales. La carga de la enfermedad crítica por COVID-19 fue intensa, constituyendo más de la mitad de los pacientes en ventilación mecánica.

Abstract During the SARS-CoV-2 pandemic, there was a marked requirement for critical care beds, supplies and trained professionals to assist patients with severe respiratory failure. The Argentine Society of Intensive Care (SATI) designed a study to characterize these aspects in intensive care units (ICUs). Multicenter, prospective cohort study; the participating ICUs completed a form at the end of the study (31/10/2020) on hospital characteristics, number of beds in pre- and intra-pandemic critical areas, incorporation of professionals, technological resources, and workload. Fifty-eight ICUs participated; 28(48%) were located in Buenos Aires Province, 22(38%) in Buenos Aires Autonomous City and 10 (17%) in other provinces; 31 (53%) of UCIs belonged to the public sector; 23 (47%) to the private-social security. In 35/58 (60%) of the hospitals critical care beds increased from 902 to 1575 (75%), 37% in ICU and 63% mainly in Coronary Care Unit and Emergency-shock room. In 41/55 (75%) UCIs, staff were incorporated: 27(49%) physicians (70% intensivists), 36 (65%) nurses, 28 (51%) respiratory therapists, 20(36%) cleaning staff, and 1(2%) others. A 96% of the ICUS reported having sufficient ventilators and 95% enough sup plies and PPE. Of all patients on invasive mechanical ventilation, 55% [43-64] had COVID-19. Oxygen therapy was required as noninvasive support in 14% [8-24] of COVID-19 admissions. There was a significant expansion of critical operational areas, secondary to the increase in beds, staff, and adequate availability of ventilators and essential supplies. The burden of critical illness from COVID-19 was intense, with more than half of patients on mechanical ventilation.

Impacto de alvos de saturação liberais versus conservadores sobre os índices de troca gasosa na síndrome do desconforto respiratório agudo relacionada à COVID-19: um estudo fisiológico / Impact of liberal versus conservative saturation targets on gas exchange indices in COVID-19 related acute respiratory distress syndrome: a physiological study

RESUMO Objetivo: Comparar o comportamento dos índices de troca gasosa conforme o uso de alvos de oxigenação liberais em comparação a conservadores em pacientes com síndrome do desconforto respiratório agudo moderada a grave secundária à COVID-19 e em uso de ventilação mecânica; avaliar a influência da FiO2 elevada na mecânica do sistema respiratório. Métodos: Foram incluídos prospectivamente pacientes consecutivos com idades acima de 18 anos, diagnóstico de COVID-19 e síndrome do desconforto respiratório agudo moderada e grave. Para cada paciente, aplicou-se aleatoriamente dois protocolos de FiO2 para obter SpO2 de 88% a 92% ou 96%. Avaliaram-se os índices de oxigenação e a mecânica do sistema respiratório. Resultados: Foram incluídos 15 pacientes. Todos seus índices foram significantemente afetados pela estratégia de FiO2 (p < 0,05). A proporção PaO2/FiO2 deteriorou, o PA-aO2 aumentou e o Pa/AO2 diminuiu significantemente com a utilização de FiO2 para obter SpO2 96%. Opostamente, a fração de shunt funcional foi reduzida. A mecânica respiratória não foi afetada pela estratégia de FiO2. Conclusão: Uma estratégia com alvos liberais de oxigenação deteriorou significantemente os índices de troca gasosa, com exceção do shunt funcional, em pacientes com síndrome do desconforto respiratório agudo relacionada à COVID-19. A mecânica do sistema respiratório não foi alterada pela estratégia de FiO2. Registro Clinical Trials: NCT04486729.

ABSTRACT Objective: To compare gas exchange indices behavior by using liberal versus conservative oxygenation targets in patients with moderate to severe acute respiratory distress syndrome secondary to COVID-19 under invasive mechanical ventilation. We also assessed the influence of high FiO2 on respiratory system mechanics. Methods: We prospectively included consecutive patients aged over 18 years old with a diagnosis of COVID-19 and moderate-severe acute respiratory distress syndrome. For each patient, we randomly applied two FiO2 protocols to achieve SpO2 88% - 92% or 96%. We assessed oxygenation indices and respiratory system mechanics. Results: We enrolled 15 patients. All the oxygenation indices were significantly affected by the FiO2 strategy (p < 0.05) selected. The PaO2/FiO2 deteriorated, PA-aO2 increased and Pa/AO2 decreased significantly when using FiO2 to achieve SpO2 96%. Conversely, the functional shunt fraction was reduced. Respiratory mechanics were not affected by the FiO2 strategy. Conclusion: A strategy aimed at liberal oxygenation targets significantly deteriorated gas exchange indices, except for functional shunt, in COVID-19-related acute respiratory distress syndrome. The respiratory system mechanics were not altered by the FiO2 strategy. Clinical Trials Register: NCT04486729.

Test de desarrollo motor aplicados en Chile entre el período 2014-2018: una revisión sistemática / Motor development tests applied in Chile between the period 2014-2018: a systematic review

El desarrollo motor es un proceso continuo y multidimensional del ciclo vital del ser humano. Para el profesor de educación física se hace esencial buscar instrumentos que permitan medir el desarrollo motor para una intervención intencionada que permita alcanzar un desarrollo apropiado a la edad de cada estudiante. El objetivo de este estudio es identificar los test de desarrollo motor aplicados en Chile entre 2014-2018. Se realizó una revisión sistemática de artículos científicos que aplicaron test de desarrollo motor, entre los años 2014-2018. La búsqueda de artículos se realizó en las bases de datos "Ebsco", "Dialnet" y "Scielo". Las palabras claves en la búsqueda fueron, desarrollo motor y test desarrollo motor, en los idiomas español, inglés y portugués. Se obtuvo un total de 9 artículos que cumplieron los criterios de inclusión. Los resultados mostraron que se han utilizado 4 test de desarrollo motor en el periodo declarado. En conclusión, el test más utilizado en Chile es el TGMD-2 el cual es ampliamente recomendado y validado en el contexto chileno; y cuyo propósito se basa en la identificación de los niveles de ejecución (bajo o superior) del desarrollo motor grueso en los niños según la edad cronológica

Motor development is a continuous and multidimensional process of the human being life cycle. For the physical education teacher it is essential to look for instruments that allow measuring the motor development for an intentional intervention that allows achieving an appropriate development at the age of each student. The objective of this study is to identify the motor development test applied in Chile between 2014-2018. A systematic review of scientific articles that applied motor development tests was carried out between 2014-2018. The search for articles was carried out in the "Ebsco", "Dialnet" and "Scielo" databases. The keywords in the search were; motor development and motor development test, in the Spanish, English and Portuguese languages. Nine articles were obtained that met the inclusion criteria. The results showed that four motor development tests have been used in the declared period. In conclusion, the most used test in Chile is TGMD-2 which is widely recommended and validated in the Chilean context; and whose purpose is based on the identification of the performance levels (lower or higher) of gross motor development in children according to chronological age

TOPOGRAPHICAL AND STRUCTURAL EVALUATION OF DIATHERMY PENCILS EMPLOYED ON AESTHETIC SURGERY SUBJECTED TO FOUR REPROCESSING CYCLES USING THE EIA/CES "QUALY" APPROACH / EVALUACIÓN TOPOGRÁFICA Y ESTRUCTURAL DE LÁPICES DE DIATERMIA EMPLEADAS EN CIRUGÍA ESTÉTICA, SOMETIDOS A CUATRO CICLOS DE REPROCESADO UTILIZANDO EL ENFOQUE DE EIA/CES "QUALY" / AVALIAÇÃO TOPOGRÁFICA E ESTRUTURAL DE LÁPIS DE DIATERMIA USADOS EM CIRURGIA COSMÉTICA SOFRIDO QUATRO CICLOS DE REPROCESSAMENTO USANDO A ABORDAGEM DE EIA/CES "QUALY"

Diathermy pencils are one of the most employed medical devices around the world, this condition increases its probability to be reprocessing in patients; diathermy pencil has different parts (cord, tip, handgrip, current cables), which are composed of different kind of materials. In order to identify the medical device behavior is necessary to characterize all of those materials in the instrument. An exploration to determinate topographic surface defects and structural movements in each material was performed, with the intention of evaluated the reuse cycles effects on the medical device. The experiment was performing using the EIA/CES "QUALY" approach [1]. The study concludes that four reprocessing cycles induce some changes that are not statistically representative. Surface defects were detected in the cord; also an aggressive superficial waste after four reprocessing cycles in the tip was observed. We do not observe structural changes in the polymeric chain of the cord.

Los lápices diatermia son uno de los dispositivos médicos más empleados en todo el mundo, condición que aumenta su probabilidad de ser reprocesados con pacientes. El lápiz diatermia tiene diferentes partes (cable, punta, empuñadura, cables de corriente), que están compuestas de diferentes tipos de materiales. Con el fin de identificar el comportamiento de dispositivos médicos es necesario caracterizar todos esos materiales en el instrumento. Se efectuó una exploración de los defectos en la superficie topográfica y determinados movimientos estructurales en cada material, con el propósito de evaluar los efectos de los ciclos de reutilización sobre el dispositivo médico. El experimento se realizó mediante el enfoque "QUALY" EIA/CES [1]. El estudio concluye que cuatro ciclos de reprocesado implican algunos cambios que no son estadísticamente representativos. Se detectaron defectos en la superficie del cable; igualmente, se observó un residuo superficial agresivo después de cuatro ciclos de reprocesamiento en la punta. No se observaron cambios estructurales en la cadena polimérica de la cuerda.

Os lápis de diatermia são um dos dispositivos mais utilizados em todo o mundo médico, uma condição que aumenta a sua chance de ser reprocessados com os pacientes. O lápis de diatermia tem diferentes partes (cabo, ponta, aderência, linhas de energia), que são compostas de materiais diferentes. A fim de identificar o comportamento de dispositivos médicos é necessário caracterizar todos tais materiais no instrumento. Uma varredura de defeitos foi realizado na superfície topográfica e certos movimentos estruturais em cada material, com o objetivo de avaliar os efeitos dos ciclos de reutilização no dispositivo médico. O experimento foi realizado utilizando o EIA/CES [1] abordagem "QUALY". O estudo conclui que quatro ciclos de reprocessamento envolvem algumas mudanças que não são estatisticamente representativa. Os defeitos foram detectados na superfície do cabo; do mesmo modo, um resíduo de superfície agressivo foi observada após quatro ciclos na ponta reprocessamento. Não foram observadas alterações estruturais na cadeia do polímero da corda.

Determinación de la estatura a partir del arco y radio-cuerda maxilar / Stature determination from maxillary arch and radio-cord

La estatura aproximada es un dato muy importante cuando se pretende realizar la identificación a partir de restos esqueletizados incompletos o fragmentados. El propósito de este estudio fue desarrollar un método para la estimación de la estatura a partir de las dimensiones del arco y radio-cuerda maxilar unilateral. Evaluamos 145 pacientes de entre 18 y 44 años, en ellos determinamos la estatura real, el arco y cuerda maxilar del lado derecho, con estos datos realizamos una regresión lineal multivariada. la ecuación construida permitió determinar correctamente la estatura en un 54 por ciento de los casos, por lo que el método permite realizar una aproximación a la estatura, debiendo ser complementado con otros métodos.

The approximate stature is very important when we are trying to make the identification from incomplete and fragmented skeletonized remains. The purpose of this study was to develop a method for estimation of stature from the dimensions of the arch and radio-cord bow in unilateral maxillary. We evaluated 145 patients between 18 and 44 years old, we determined the actual stature, the arch and radio-cord maxillary on the right side, and with these data we constructed a multivariate linear regression. Equation constructed was allowed to determine the stature is 54 percent of cases, so the method allows an approximation that must be complemented with other methods.