[Effectiveness of nursing interventions in the control of type 2 diabetes mellitus].

BACKGROUND: To analyze whether nursing interventions classified according to NIC taxonomy and applied to patients with type 2 diabetes mellitus (T2DM), showing the NANDA diagnoses "Willingness to improve your own health management", are related to better achievement of T2DM control. METHODS: Cross-sectional study conducted on 721 patients in Primary Care whose data were obtained from their electronic clinical record. The control of parameters such as hemoglobin-glycosylated (HbA1c), LDL-cholesterol and body mass index (BMI) was related to NIC interventions performed, particularly to those recommended for management of T2DM. RESULTS: One hundred and thirty-seven NIC interventions were performed on 2,401 occasions, 1,714 of which (71.4%) were interventions recommended for management of T2DM. Of these, 41.2% belonged to Behavioral domain, while Surveillance was the most frequent intervention (25.4%). Control of both HbA1c and LDL-cholesterol was achieved in more than 50% of cases, but BMI only was achieved in 13.6%. NIC interventions were more frequently performed on patients with controlled parameters, especially on nine of them; two interventions were negatively related to control of BMI. CONCLUSION: We have observed that with a higher incidence in the application of the NIC included in the recommendations of the clinical practice guidelines for T2DM, better health results are obtained.

Enfermeras comunitarias, cuidamos personas, gestionamos cuidados / Community nurses, we care people, we manage care

Este artículo reflexiona sobre la Gestión de Cuidados y la atención a las personas que realizan las enfermeras comunitarias; su aportación y valor, tanto para la profesión como para la sociedad. A lo largo de los casi 40 años de la Atención Primaria, las enfermeras comunitarias han logrado un gran desarrollo de la profesión y de sus competencias (nivel universitario, especialización, prescripción). Sin embargo, todavía quedan pendientes cuestiones como regular las competencias enfermeras, el reconocimiento social del trabajo que se realiza, así como ocupar una posición visible y de manera continuada en la política de los sistemas de salud. En esa dirección se debe trabajar ahora para intentar dar respuesta a las necesidades actuales de la población que nada tienen que ver con las de hace unas décadas.comienza un tiempo de cambio para la Atención Primaria y las enfermeras comunitarias debemos liderarlo

This article reflects on the Care Management and the attention to the people who carry out the community nurses, their contribution and value both for the profession and for society. Throughout the almost 40 years of Primary Care, community nurses have achieved a great development of the profession and its competences (university level, specialization, prescription). However, there are still outstanding issues such as regulating nursing competencies, social recognition of the work being done as well as occupying a visible and continuous position in the health systems policy. In that direction we must work now to try to respond to the current needs of the population, that have nothing to do with those of a few decades ago. A time of change for Primary Care begins and community nurses must be leading it

Malaria congénita: A propósito de un caso / Congenital malaria: Case report

La malaria congénita es una patología relativamente rara en el contexto de las patologías neonatales. El presente caso se trata de un recién nacido masculino de 24 días de vida con malaria congénita por Plasmodium vivax y falciparum cuyo diagnóstico se observó a través del estudio de la gota gruesa. El recién nacido es procedente de una zona poco endémica, pero la madre viajó por compromiso laborales en varias ocasiones a una zona endémica en el Estado Bolívar. La madre presentó malaria gestacional a partir del I trimestre de gestación con tratamiento irregular. Las manifestaciones clínicas del recién nacido fueron fiebre de 40°c y el tratamiento antimalárico fue con Artesunate 60 mg con adecuada respuesta clínica, confirmada mediante la negativización de la gota gruesa al finalizar el tratamiento. Es importante considerar el diagnóstico diferencial con el de sepsis neonatal sobre todo en pacientes procedentes de zonas de riesgo y endémicas. La malaria congénita es real y por lo tanto se recomienda que los recién nacidos de madres con malaria deben ser examinados inmediatamente.

Congenital malaria is a relatively rare disease in the context of neonatal pathologies. We present a case of a 24 day old newborn male with congenital malaria by Plasmodium vivax and falciparum whose diagnosis was performed through the study of thick film. The newborn comes from a non- endemic area were as the mother because of worktravelled to an endemic area of our country in Bolivar state. The mother had a maternal history of seasonal malaria during the I trimester of gestation with irregular treatment. The clinical manifestation of the newborn was fever 40 °c and the antimalarial treatment was performed with Artesunate at 60 mg with adequate clinical response, confirmed by the thick film negativization at the end of the treatment. It is important to consider the differential diagnosis with neonatal sepsis especially in patients from endemic areas and risk. Congenital malaria is real and therefore it is recommended that newborns of mothers with malaria should be examined immediately.

Omalizumab beyond asthma

Introduction: Omalizumab has been demonstrated to be a successful therapy in the management of asthma through reduction of patient's symptoms and use of inhaled corticosteroids. The effect of omalizumab is achieved by immunoglobulin E (IgE) blockage and other secondary mechanisms resulting from this blockage. Because other diseases have an important IgE mediation in their physiopathology, the question arises as to if omalizumab would be useful in the treatment of other IgE-mediated diseases. Objective: We present an overview of the experimental studies and clinical reports evaluating the use of omalizumab in diseases different to asthma including atopic dermatitis, urticaria, eosinophilic gastrointestinal disorders, idiopathic anaphylaxis, latex allergy, hymenoptera venom allergy, and other IgE diseases. Methods: We reviewed the literature using PUBMED, EMBASE, and LILACS for publications which used omalizumab in the treatment of patients with allergic diseases or any other diseases. Complete articles published in English, Spanish or Portuguese were included. Conclusion: There is not enough evidence to support the regular use of omalizumab in IgE diseases other than asthma. However, some experimental and clinical investigations indicate that omalizumab could be a therapeutic option in several allergic diseases like atopic dermatitis, urticaria, and eosinophilic gastrointestinal disorders. More control studies are needed in each IgE disease to evaluate the efficacy and safety of omalizumab in IgE mediated diseases(AU)

No disponible

Omalizumab beyond asthma.

INTRODUCTION: Omalizumab has been demonstrated to be a successful therapy in the management of asthma through reduction of patient's symptoms and use of inhaled corticosteroids. The effect of omalizumab is achieved by immunoglobulin E (IgE) blockage and other secondary mechanisms resulting from this blockage. Because other diseases have an important IgE mediation in their physiopathology, the question arises as to if omalizumab would be useful in the treatment of other IgE-mediated diseases. OBJECTIVE: We present an overview of the experimental studies and clinical reports evaluating the use of omalizumab in diseases different to asthma including atopic dermatitis, urticaria, eosinophilic gastrointestinal disorders, idiopathic anaphylaxis, latex allergy, hymenoptera venom allergy, and other IgE diseases. METHODS: We reviewed the literature using PUBMED, EMBASE, and LILACS for publications which used omalizumab in the treatment of patients with allergic diseases or any other diseases. Complete articles published in English, Spanish or Portuguese were included. CONCLUSION: There is not enough evidence to support the regular use of omalizumab in IgE diseases other than asthma. However, some experimental and clinical investigations indicate that omalizumab could be a therapeutic option in several allergic diseases like atopic dermatitis, urticaria, and eosinophilic gastrointestinal disorders. More control studies are needed in each IgE disease to evaluate the efficacy and safety of omalizumab in IgE mediated diseases.

Ultrasound guidance in accessing the afferent limb of a modified Roux-en-Y choledochojejunostomy for percutaneous dilation of biliary strictures.

Percutaneous retrograde biliary dilation via the afferent limb of a modified Roux-en-Y choledochojejunostomy is used in the management of chronic biliary strictures. Access to the afferent loop may be challenging in the absence of surgically placed radiopaque markers. Ultrasound (US) guidance was used to access the loop in 10 patients with subcutaneous afferent loops and three patients with subfascial afferent loops. Successful puncture was made in all 10 patients with subcutaneous loops and in one patient with a subfascial loop. Initial fluoroscopically guided attempts failed in five loops, which were then successfully accessed with use of US guidance. US is useful in accessing subcutaneous afferent loops.

Percutaneous catheter-directed debridement of infected pancreatic necrosis: results in 20 patients.

PURPOSE: To evaluate the usefulness of transcatheter debridement of infected pancreatic necrosis. MATERIALS AND METHODS: Transcatheter debridement was performed on 20 patients who ranged in age from 20 to 78 years during the 8-year study period. All patients had infected pancreatic necrosis and were hemodynamically stable. Necrosis was defined as nonenhancing pancreatic tissue, as seen on contrast-enhanced computed tomography (CT). Infection was suspected clinically and documented by cultures of the pancreatic fluid at its initial drainage. Debridement was performed in multiple sessions in close succession (duration, 30-120 minutes; mean, 60 minutes) via large-bore catheters with enlarged side holes. Debris was removed with use of suction catheters, stone baskets, and copious amounts of lavage fluid. RESULTS: All patients underwent successful catheter debridement. Success was determined by clinical course, as well as lesion appearance, at fluoroscopy and CT. Patients underwent 7-32 (average, 17) episodes of debridement and stayed 0-36 days (average, 9 days) in the intensive care unit, 13-118 days (average, 42 days) on the regular floor, and spent 0-98 days (average, 32 days) with the catheters as an outpatient. No deaths occurred. CONCLUSION: Percutaneous catheter-directed debridement is a safe and effective treatment and it can be used as the primary means of treatment for the hemodynamically stable patient with infected pancreatic necrosis.

Successful management of calyceal fistula following simultaneous pancreas-kidney transplantation.

Calyceal fistula is an unusual complication of renal transplantation. We report a case of calyceal fistula after simultaneous pancreas-kidney transplant that developed after thrombosis of a lower pole artery. Surgical correction was successfully achieved with a lower pole nephrectomy, closure of the involved calyces, and placement of a ureteral stent and a pedicle of greater omentum graft over the affected parenchyma.

Recognition and treatment of reactions to contrast media: a model for resident and faculty education employing lectures and case scenario workshops.

RATIONALE AND OBJECTIVES: The effectiveness of an interactive course on the recognition and treatment of contrast media reactions was studied. METHODS: An instructional course on contrast media reactions was organized for the radiology staff, residents, and nurses. Before the beginning of the 3-day course, a 25-point pretest was administered to determine the ability of each participant to recognize and treat contrast material reactions. An identical posttest was administered after the course, and the pre- and posttest results were compared. RESULTS: There was a statistically significant improvement on the posttest scores for all subjects tested (P < .05). There was also a substantial improvement in the participants' confidence levels in dealing with contrast media reactions. CONCLUSIONS: A short course on contrast material reactions is a worthwhile learning aid that is simple to conduct and educates and instills confidence in both residents and staff.

Stab wounds to the back and flank in the hemodynamically stable patient: a decision algorithm based on contrast-enhanced computed tomography with colonic opacification.

PURPOSE: The authors wanted to determine whether contrast-enhanced computed tomography (CE-CT) with colonic opacification is an accurate tool to triage hemodynamically stable victims of stab wounds to the flank and back. PATIENTS AND METHODS: One hundred forty-five consecutive patients were categorized as low-risk ( penetration superficial to the deep fascia) or high-risk (penetration beyond the deep fascia) based on CE-CT findings. RESULTS: There were no significant differences in admission vital signs, Glasgow Coma Scale, or complete blood counts between low- and high-risk groups. None of the 92 low-risk patients required surgery or had sequelae. Six of the 53 high-risk patients underwent surgery, 2 based on initial CE-CT, 4 due to evolving clinical signs. The CE-CT correctly predicted surgical findings in all cases. CONCLUSIONS: Hemodynamically stable patients with stab wounds to the back and/or flank can be successfully triaged based on CE-CT findings. Low-risk patients may be discharged immediately. High-risk patients may have a discharge decision implemented at 24 hours.