Sistema de presión negativa en loxoscelismo cutáneo-visceral. Reporte de un caso

Introducción: Las mordeduras por araña parda pueden manifestarse desde una simple lesión dérmica en el área de la mordedura, hasta formas graves, con falla orgánica múltiple. Caso Clínico: presentamos el caso de una paciente con mordedura por araña parda, quien presenta inicialmente lesiones dérmicas sin necrosis, evolucionando con áreas de necrosis y el desarrollo de síndrome compartimental de extremidad, sepsis, choque séptico y falla renal. Mejora tras manejo intensivo, anti veneno y colocación de terapia de presión negativa (TPN) en herida, conservando la extremidad afectada integra y recuperando la función renal. Discusion: Este caso en particular presenta los tres tipos de manifestaciones que se generan en el loxoscelismo, las cuales son una forma de presentación poco frecuente. El tratamiento con TPN se ha introducido como una terapia poderosa, no farmacológica para ayudar a acelerar el proceso de cicatrización de heridas y puede ser de utilidad en pacientes con mordedura de araña (loxoscelismo).

Introduction: The brown spider bites have the peculiarity of manifesting from a simple skin lesion in the area of the bite, to severe forms, with multiple organic failure. Clinical Case: We present the case of a patient with a brown spider bite, initially presenting dermal lesions without necrosis, evolving with areas of necrosis and the development of compartment syndrome of extremities, sepsis, septic shock and renal failure. Improvement after intensive management and installation in negative pressure therapy wound (NPT), keeping the affected limb integrated and recovering renal function. Discussion: This case in particular presents the three types of manifestations that are generated in loxoscelism, which are a rare form of presentation. The NPT treatment has been introduced as a powerful, non-pharmacological and physical therapy to help accelerate the wound healing process and may be useful in patients with spider bites.

Applicability of three nutritional screening tools in patients with liver cirrhosis under the Global Leadership Initiative on Malnutrition criteria / 临床肝胆病杂志

Objective To investigate whether Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT) is more suitable than Nutritional Risk Screening 2002 (NRS-2002) in nutritional risk screening for patients with liver cirrhosis, as well as the applicability of subjective global assessment (SGA) in the nutritional assessment of patients with liver cirrhosis. Methods A total of 113 patients with liver cirrhosis who were hospitalized in Renmin Hospital of Wuhan University from August 2020 to June 2021 were enrolled. RFH-NPT and NRS-2002 were used for nutritional risk screening, and SGA was used for nutritional assessment. The results of these tools were compared with the Global Leadership Initiative on Malnutrition (GLIM) criteria, and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the three tools. The receiver operating characteristic (ROC) curve was plotted and the area under the ROC curve (AUC) was calculated for each screening tool, and the association between nutritional status and short-term prognosis was analyzed. The independent samples t -test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The Spearman correlation analysis was used to analyze the correlation of GLIM criteria with NRS2002, RFH-NPT and SGA. Results According to the GLIM criteria, 69.9% of the patients were diagnosed with malnutrition, and RFH-NPT and NRS2002 screened out that 72.6% and 51.3%, respectively, of the patients had nutritional risk, while SGA assessment showed that 57.5% of the patients had malnutrition. Compared with NRS2002, RFH-NPT had a higher degree of correlation with the GLIM criteria ( r =0.764, P < 0.001), higher sensitivity (94.9%) and NPV (87.1%), and a better predictive value (AUC=0.872, 95% confidence interval [ CI ]: 0.786-0.957). Under the GLIM criteria, SGA had good specificity (88.2%) in the diagnosis of malnutrition in patients with liver cirrhosis, with fair sensitivity (77.2%), good correlation ( r =0.607, P < 0.001), and good predictive value (AUC=0.827, 95% CI : 0.744-0.911). Based on the GLIM criteria, SGA assessment, and RFH-NPT assessment, the patients with nutritional risk or malnutrition tended to have a longer length of hospital stay ( Z= -3.301, -2.812, and -3.813, all P < 0.05) and a higher rehospitalization rate ( χ 2 =3.957, 6.922, and 6.766, all P < 0.05). Based on the GLIM criteria and NRS2002 assessment, the patients with nutritional risk or malnutrition had a significant increase in mortality rate within 3 months ( χ 2 =4.511 and 0.776, both P < 0.05). Conclusion Under the GLIM criteria, RFH-NPT is more suitable than NRS2002 for nutritional risk screening of patients with liver cirrhosis, and SGA also has good applicability in nutritional assessment of patients with liver cirrhosis. In addition, GLIM criteria, SGA, and RFH-NPT are associated with the clinical outcome of patients.

Registro de la utilización de nutrición parenteral en el Hospital de Pediatría Juan P. Garrahan / Registry of the use of parenteral nutrition at the Pediatric Hospital Juan P. Garrahan

La nutrición parenteral (NPT) en pediatría es un recurso que permite mantener el sostén clínico de aquellos pacientes que por la complejidad de la patología que presentan no pueden utilizar la vía enteral. El objetivos es analizar el registro de utilización de NPT en el Hospital de Pediatría Juan P. Garrahan. Estudio retrospectivo descriptivo. Se analizaron 95 solicitudes de NPT durante el período julio-agosto 2011. Se accedió a las historias clínicas, donde se constataron las variables principales: edad (meses), sexo, área de internación, patología asociada a su uso, duración promedio (días), tipo de NPT (Standard o personalizada) y evidencia de complicaciones. Se definió colestasis a valores de Bilirrubina directa mayor a 2 mg%. Sobre un total 114 indicaciones médicas de NPT, se accedió a 95 historias clínicas. Perfil de uso: Neonatología 34,5%, Cuidados Intensivos 35,7% y Cuidados Intermedios y moderados 29,8%. La media de edad 39 meses (0-192). Las patologías más frecuentes son quirúrgicas 52,6%, hematológicas y oncológicas 28,4%. La duración total de la indicación fue en promedio 16,5 días (0-187). Las soluciones personalizadas (a la carta) 83%. Las soluciones con lípidos sumaron un total de 73 (76%). Como complicaciones se observaron 13 casos de colestasis (13,68%) los cuales se asociaron a soluciones con lípidos. La mayoría de los pacientes que requirieron uso de NPT presentaron patologías que requerían cuidados críticos neonatales o pediátricos. Las soluciones personalizadas o "a la carta" fueron las más utilizadas. El tiempo de administración fue muy variable, la presencia de colestasis se relacionó con los usos más prolongados; superior a los 71 días promedio (AU)

In pediatrics, total parenteral nutrition (TPN) is a resource that allows to clinically support those patients who, due to the severity of their disease, do not tolerate the enteral route. The aim of this study was to analyze the registry of TPN use at the Pediatric Hospital Dr. Juan P. Garrahan. A retrospective descriptive study was conducted. Ninety-five requests for TPN made in July and August 2011 were analyzed. Clinical charts of the patients were assessed recording the main variables: Age (months), sex, area the child was admitted to, pathology associated with TPN use, duration of TPN (days), type of TPN (standard or personalized), and evidence of complications. Cholestasis was defined as direct bilirubin greater than 2 mg%. For a total of 114 medical indications for PN, access to 95 clinical charts was obtained. User's profile: Neonatology 34.5%, intensive care 35.7%, intermediate and moderate care 29.8%. Mean age of the patients was 39 months (0-192). The most common pathologies were surgical in 52.6% and hematological and oncological in 28.4%. Mean duration of TPN was 16.5 days (0-187). Personalized formulations ("a la carte") were used in 83%. Overall, 73 (76%) formulations with lipids were used. Complications observed were 13 cases of cholestasis (13.68%) that were associated with the use of lipid formulations. Most patients that needed TPN had pathologies requiring neonatal or pediatric critical care. Personalized or "a la carte" formulations were most often used. The duration of TPN administration was variable. Cholestasis was related with longer TPN use, with a mean of 71 days (AU)

Effect of Rehabilitation of Traditional Chinese Medicine or Neurophysiological Therapy on Recovering Stroke Patients / 中国康复理论与实践

@#Objective To explore the effect of the rehabilitation of Traditional Chinese Medicine(TCM)and neurophysiological therapy(NPT)on motor function in patients with stroke.Methods62 patients with ischemic or hemorrhagic stroke at the recovery stage were divided into two groups.They were given the routine medical treatment and rehabilitation.The patients in the TCM group were given rehabilitation of TCM,while the patients in the control group were given rehabilitation of NPT.They were evaluated with Fugl-Meyer Assessment(FMA)and the Barthel Index(BI)at the beginning and the end of the treatment.ResultsAfter the treatments,the scores of FMA and BI improved obviously in both groups.The BI of the TCM group improved more than that of the control group after the treatments(P=0.015).But the improvement of the FMA between these two groups was not significant.ConclusionBoth the rehabilitation of TCM and NPT can significantly improve the function of stroke patients during the convalescent stage,and TCM is more effective on activity of daily living.

Effects of training in an emulated battlefield on serum immunosuppressive acidic protein and neopterin of involved soldiers / 解放军医学杂志

0.05) after the training,while for the students of control group,the levels of IAP and Npt increased significantly after the training(P

Problems with interpretation of primary diagnostic tests for impotence / 대한비뇨기과학회지

We analyzed the practical problems and factors which affect making the correct differential diagnosis in the interpretation or test results from the nocturnal penile tumescence (NPT) test and erotic stimulation test (EST). This was done to provide better information for higher diagnostic accuracy in the clinical application of these tests. The followings are the results of NPT tests and EST identifying the factors affecting correct differential diagnosis by comparison the other differential diagnostic methods. The overall sensitivity of NPT test (Number: 114 total patients) was 82%. 21 cases (18%) could not be diagnosed correctly due to traction of the sensor (12 cases, 10%) and sleep disturbance (9 cases, 8%). The overall sensitivity of EST (Number: 174 total patients) without considering the degree of patient`s sexual drive to erotic stimulation was 77%. 40 cases (23%) could not be diagnosed correctly due to tolerance to pornographic film (17 cases, 10 %), discomfort by the body attachments (14 cases, 8%) and traction of the sensor (9 cases, 5%). However, higher sensitivity (90%) and lower rate of incorrect diagnosis (10% ) were observed in 119 patients who showed Grade II or III (moderate to good) sexual drive to erotic stimulation. The results suggest that undesirable factors in the primary screening methods, traction of sensor, sleep disturbance in NPT test, and tolerance to pornographic film, discomfort by the body attachments, traction of sensor in EST must be taken into consideration when interpretation of test results is being performed.

Sleep-Related Penile Tumescence with Aging in Korean Adults / 대한비뇨기과학회지

Studies on nocturnal penile tumescence characteristics in normal men have advantages of further investigations of erection physiology and of impotence research. We conducted a study of nocturnal penile tumescence in 30 Korean healthy males aged 21 to 68 (divided into 5 groups, from 20s to 60s) by means of polysomnographic monitoring to provide normative data on how it is related to man`s sexual function with aging and its range of characteristics for the management of impotence. Analyses of 60 sleep data showed that with aging from 20s to 60s, there was steady decrease in mean values of total tumescence time, total tumescence time/total sleep period time, total tumescence time/total REM period time, amount of maximum REM-related tumescence episodes, frequency of REM-related tumescence, frequency of maximum REM-related tumescence episode, as well as of penile circumferential change and penile rigidity in maximum tumescence episode. These results indicate that there is steady decrease in the quality of nocturnal penile tumescence including frequency, duration, amount and degree with aging from 20s to 60s, which reflects changes of sexual capacity and function in psychosexul aspect. We suppose these normative data will contribute to further clinical investigations of nocturnal penile tumescence and male sexual dysfunction.

Nocturnal Penile Tumescences in Normal Korean Adult Males with Relation of Age / 대한비뇨기과학회지

Nocturnal penile tumescence (NPT) evaluation is the single most important step and widely used technique for the differential diagnosis between psychogenic and organic impotence. It is based on findings that male subjects have erection in association with rapid eye movement sleep. A normal pattern of NPT indicates that neural supply, vascular supply and penile structures are intact. Nocturnal penile tumescence minitoring (NPTM) in the abscence of rigidity evaluation in the assessment of the impotent male is of questionable value, but we conducted a study of NPT in 41 healthy male subjects aged 20 to 69 by means of portable tumistore NPT monitor to provide normative data for clinical utility in diagnosis and prognosis of impotence. The results indicate that NPT occurs consistently in a healthy male population and its expression is significantly affected by age.

The Comparison of Nocturnal Erection and Audiovisual Stimulating Erection / 대한비뇨기과학회지

This study is to compare the diagnostic usefulness and relationships between AVS penogram. Snap gauge test, and NPT monitoring in impotent patients confirmed using multidisciplinary diagnostic approach at the Department of Urology, Yonsei University College of Medicine from December 1986 to June 1987. Following results were obtained. 1. Among 24 cases of Group I(AVS penogram) 20 cases(83.3%) were psychogenic impotence, where 15 cases(75%) revealed sufficient penile rigidity on the Snap gauge test. 4 cases(16.7%) of group I were organic impotence, which revealed incomplete penile rigidity on the Snap gauge test. Among 45 cases of Group II-B(AVS Penogram) 34 cases(75.6%) were psychogenic impotence, where 28 cases(82.4%) showed sufficient penile rigidity on the Snap gauge test. 10 cases(24.4%) of Group II-B were organic impotence, which showed incomplete penile rigidity on the Snap gauge test. Among 17 cases of Group II-A and II-C 5 cases were psychogenic impotence, all of which revealed sufficient penile rigidity on the Snap gauge test. >From above results, the AVS Penogram is not a confirmative method, but using AVS Penogram and the Snap gauge test simultaneously will give useful information differentiating organic impotence and psychogenic impotence. 2. In comparison of AVS penogram and NPT monitoring, among 20 cases 7 cases of erectile curve showed similar shape, but the precise mechanism of each penile erection is not yet certain, more study is needed in the near future.