Subject(s)
Humans , Female , Pregnancy , Placenta Accreta/surgery , Placenta Accreta/psychology , Stress Disorders, Post-TraumaticABSTRACT
ABSTRACT Objective Placenta accreta spectrum (PAS) is a cause of massive obstetric hemorrhage and maternal mortality. The application of family-centered delivery techniques (FCDTs) during surgery to treat this disease is infrequent. We evaluate the implementation of FCDTs during PAS surgeries. Methods This was a prospective, descriptive study that included PAS patients undergoing surgical management over a 12-month period. The patients were divided according to whether FCDTs were applied (group 1) or not (group 2), and the clinical outcomes were measured. In addition, hospital anesthesiologists were surveyed to evaluate their opinions regarding the implementation of FCDTs during the surgical management of PAS. Results Thirteen patients with PAS were included. The implementation of FCDTs during birth was possible in 53.8% of the patients. The presence of a companion during surgery and skin-to-skin contact did not hinder interdisciplinary management in any case. Conclusion Implementation of FCDTs during PAS care is possible in selected patients at centers with experience in managing this disease.
Resumo Objetivo O espectro da placenta acreta (do inglês placenta accreta spectrum - PAS) é causa de hemorragia obstétrica maciça e mortalidade materna. A aplicação de técnicas de parto centrado na família (do inglês family-centered delivery techniques - FCDTs) durante a cirurgia para tratar esta doença é pouco frequente. Avaliamos a implementação das FCDTs durante as cirurgias do PAS. Métodos Estudo prospectivo e descritivo que incluiu pacientes com PAS submetidos a tratamento cirúrgico durante um período de 12 meses. Os pacientes foram divididos de acordo com a aplicação de FCDTs (grupo 1) ou não (grupo 2), e os resultados clínicos foram medidos. Além disso, anestesiologistas hospitalares foram entrevistados para avaliar suas opiniões sobre a implementação das FCDTs durante o manejo cirúrgico do PAS. Resultados Foram incluídos 13 pacientes com PAS. A implementação de FCDTs durante o parto foi possível em 53,8% das pacientes. A presença do acompanhante durante a cirurgia e o contato pele a pele não prejudicou o manejo interdisciplinar em nenhum caso. Conclusão A implementação de FCDTs durante o atendimento do PAS é possível em pacientes selecionados em centros com experiência no manejo dessa doença.
Subject(s)
Humans , Female , Pregnancy , Placenta Accreta , Birthing Centers , Patient-Centered Care , Humanization of AssistanceABSTRACT
OBJECTIVE: Placenta accreta spectrum (PAS) is a cause of massive obstetric hemorrhage and maternal mortality. The application of family-centered delivery techniques (FCDTs) during surgery to treat this disease is infrequent. We evaluate the implementation of FCDTs during PAS surgeries. METHODS: This was a prospective, descriptive study that included PAS patients undergoing surgical management over a 12-month period. The patients were divided according to whether FCDTs were applied (group 1) or not (group 2), and the clinical outcomes were measured. In addition, hospital anesthesiologists were surveyed to evaluate their opinions regarding the implementation of FCDTs during the surgical management of PAS. RESULTS: Thirteen patients with PAS were included. The implementation of FCDTs during birth was possible in 53.8% of the patients. The presence of a companion during surgery and skin-to-skin contact did not hinder interdisciplinary management in any case. CONCLUSION: Implementation of FCDTs during PAS care is possible in selected patients at centers with experience in managing this disease.
OBJETIVO: O espectro da placenta acreta (do inglês placenta accreta spectrum - PAS) é causa de hemorragia obstétrica maciça e mortalidade materna. A aplicação de técnicas de parto centrado na família (do inglês family-centered delivery techniques - FCDTs) durante a cirurgia para tratar esta doença é pouco frequente. Avaliamos a implementação das FCDTs durante as cirurgias do PAS. MéTODOS: Estudo prospectivo e descritivo que incluiu pacientes com PAS submetidos a tratamento cirúrgico durante um período de 12 meses. Os pacientes foram divididos de acordo com a aplicação de FCDTs (grupo 1) ou não (grupo 2), e os resultados clínicos foram medidos. Além disso, anestesiologistas hospitalares foram entrevistados para avaliar suas opiniões sobre a implementação das FCDTs durante o manejo cirúrgico do PAS. RESULTADOS: Foram incluídos 13 pacientes com PAS. A implementação de FCDTs durante o parto foi possível em 53,8% das pacientes. A presença do acompanhante durante a cirurgia e o contato pele a pele não prejudicou o manejo interdisciplinar em nenhum caso. CONCLUSãO: A implementação de FCDTs durante o atendimento do PAS é possível em pacientes selecionados em centros com experiência no manejo dessa doença.
Subject(s)
Placenta Accreta , Pregnancy , Female , Humans , Placenta Accreta/surgery , Prospective Studies , Hysterectomy/methods , Cesarean Section/methods , Maternal Mortality , Retrospective Studies , PlacentaABSTRACT
ElsíndromedeDownpredisponeatrastornosmieloproliferativos. Se estima que del 5 % al 30 % de los neonatos con esta condición desarrollarán mielopoyesis anormal transitoria. El tratamiento no está estandarizado; la exanguinotransfusión y la citarabina podrían ser efectivos. Se describen dos casos de pacientes con síndrome de Down, quienes durante el período neonatal presentaron leucemia mieloide aguda y mielopoyesis anormal transitoria, los tratamientos utilizados y sus desenlaces. Se considera que la sospecha y el diagnóstico temprano de esta entidad son factores determinantes en el pronóstico.
Down syndrome predisposes to haematological disorders. It is estimated that 5-30% of neonates with this condition will develop transient abnormal myelopoiesis. Treatment is not standardized; exchange transfusion and the use of cytarabine could be effective. We present two clinical cases of patients with Down syndrome, who during the neonatal period showed acute myeloid leukemia and transient abnormal myelopoiesis, the treatments used and their outcomes. Suspicion and early diagnosis of this entity are considered determining factors in prognosis.
Subject(s)
Humans , Male , Female , Infant, Newborn , Leukemia, Myeloid, Acute/complications , Leukemia, Myeloid, Acute/diagnosis , Down Syndrome/complications , Down Syndrome/diagnosis , Leukemoid Reaction/diagnosis , Leukemoid Reaction/etiology , Leukemoid Reaction/therapy , Myeloproliferative Disorders/complications , Myeloproliferative Disorders/diagnosisABSTRACT
Down syndrome predisposes to haematological disorders. It is estimated that 5-30% of neonates with this condition will develop transient abnormal myelopoiesis. Treatment is not standardized; exchange transfusion and the use of cytarabine could be effective. We present two clinical cases of patients with Down syndrome, who during the neonatal period showed acute myeloid leukemia and transient abnormal myelopoiesis, the treatments used and their outcomes. Suspicion and early diagnosis of this entity are considered determining factors in prognosis.
El síndrome de Down predispone a trastornos mieloproliferativos. Se estima que del 5 % al 30 % de los neonatos con esta condición desarrollarán mielopoyesis anormal transitoria. El tratamiento no está estandarizado; la exanguinotransfusión y la citarabina podrían ser efectivos. Se describen dos casos de pacientes con síndrome de Down, quienes durante el período neonatal presentaron leucemia mieloide aguda y mielopoyesis anormal transitoria, los tratamientos utilizados y sus desenlaces. Se considera que la sospecha y el diagnóstico temprano de esta entidad son factores determinantes en el pronóstico.
Subject(s)
Down Syndrome , Leukemia, Myeloid, Acute , Leukemoid Reaction , Myeloproliferative Disorders , Down Syndrome/complications , Down Syndrome/diagnosis , Humans , Infant, Newborn , Leukemia, Myeloid, Acute/complications , Leukemia, Myeloid, Acute/diagnosis , Leukemoid Reaction/diagnosis , Leukemoid Reaction/etiology , Leukemoid Reaction/therapy , Myeloproliferative Disorders/complications , Myeloproliferative Disorders/diagnosisABSTRACT
Los teratomas cervicales son tumoraciones infrecuentes y su ubicación a este nivel solo se presenta en el 6 % de todos los tumores de este tipo. Su pronóstico depende del tamaño, localización, tasa de crecimiento, compromiso en la vía aérea, y el manejo adecuado de la lesión. En la literatura se encuentran pocos reportes de casos, dado que dicha enfermedad es poco común. En la Fundación Valle del Lili, en el año anterior, se recibieron varios recién nacidos con masas en el cuello de los cuales dos correspondieron a teratomas congénitos. En el presente reporte se describen dos recién nacidos con grandes masas en cuello, sin diagnóstico prenatal, una de ellas con compromiso hasta región del lóbulo temporal, y en ambos casos con marcado compromiso de la vía aérea y lesiones de rápido crecimiento. El manejo inicial fue la resección quirúrgica con participación del grupo interdisciplinario de la Unidad de Neonatología. El estudio anatomopatológico reportó un teratoma benigno en el primer caso y en el segundo un teratoma inmaduro. Se resalta el manejo interdisciplinario y se incluyen los estudios de imágenes, resultados histopatológicos y se realiza revisión amplia de la literatura existente.
Cervical teratomas are rare tumors in newborns, usually represent close 6% of all of them. Pronostic depend of extension, localization of the mass, optim treatment, rate of growth and level of airway compromise. There are few reports of cases because of low frecuency of presentation. Last year in the Valle del Lili Foundation we admited some newborns with cervical tumors, two of them with congenital teratomas. We present two neonates patients with giant neck masses present at birth, without prenatal diagnosis, one with compromise until temporal lobe and both with severe airway compromise. Initial management was surgical excision with pediatric surgeon, neurosurgeon and interdisciplinary group of specialists of the neonatal intensive care unit. Histopathology study of the lesion reported benign teratoma in the first case and immature teratoma in the second one. We recognize interdisciplinary management and included imagenology histopathology studies and literature review is done.
Subject(s)
Humans , Infant, Newborn , Teratoma/diagnosis , Teratoma/pathology , Teratoma/therapy , DiagnosisABSTRACT
BACKGROUND: Chronic lung disease is one of the most frequent and serious complications of premature birth. Because mechanical ventilation is a major risk factor for chronic lung disease, the early application of nasal continuous positive airway pressure has been used as a strategy for avoiding mechanical ventilation in premature infants. Surfactant therapy improves the short-term respiratory status of premature infants, but its use is traditionally limited to infants being mechanically ventilated. Administration of very early surfactant during a brief period of intubation to infants treated with nasal continuous positive airway pressure may improve their outcome and further decrease the need for mechanical ventilation. OBJECTIVE: Our goal was to determine if very early surfactant therapy without mandatory ventilation improves outcome and decreases the need for mechanical ventilation when used in very premature infants treated with nasal continuous positive airway pressure soon after birth. DESIGN/METHODS: Eight centers in Colombia participated in this randomized, controlled trial. Infants born between 27 and 31 weeks' gestation with evidence of respiratory distress and treated with supplemental oxygen in the delivery room were randomly assigned within the first hour of life to intubation, very early surfactant, extubation, and nasal continuous positive airway pressure (treatment group) or nasal continuous airway pressure alone (control group). The primary outcome was the need for subsequent mechanical ventilation using predefined criteria. RESULTS: From January 1, 2004, to December 31, 2006, 279 infants were randomly assigned, 141 to the treatment group and 138 to the control group. The need for mechanical ventilation was lower in the treatment group (26%) compared with the control group (39%). Air-leak syndrome occurred less frequently in the treatment group (2%) compared with the control group (9%). The percentage of patients receiving surfactant after the first hour of life was also significantly less in the treatment group (12%) compared with the control group (26%). The incidence of chronic lung disease (oxygen treatment at 36 weeks' postmenstrual age) was 49% in the treatment group compared with 59% in the control group. All other outcomes, including mortality, intraventricular hemorrhage, and periventricular leukomalacia were similar between the groups. CONCLUSIONS: In premature infants treated with nasal continuous positive airway pressure early after birth, the addition of very early surfactant therapy without mandatory ventilation decreased the need for subsequent mechanical ventilation, decreased the incidence of air-leak syndrome, and seemed to be safe. Reduction in the need for mechanical ventilation is an important outcome when medical resources are limited and may result in less chronic lung disease in both developed and developing countries.
Subject(s)
Continuous Positive Airway Pressure/methods , Infant, Premature, Diseases/therapy , Pulmonary Surfactants/administration & dosage , Respiration, Artificial/methods , Continuous Positive Airway Pressure/adverse effects , Female , Humans , Infant, Newborn , Infant, Premature/physiology , Infant, Premature, Diseases/physiopathology , Infant, Premature, Diseases/prevention & control , Lung Diseases/physiopathology , Lung Diseases/prevention & control , Lung Diseases/therapy , Male , Respiration, Artificial/adverse effects , Surface-Active Agents/administration & dosage , Time Factors , Treatment OutcomeABSTRACT
El objetivo de la presente investigación fue evaluar la relación de los autoesquemasy las habilidades sociales de 49 adolescentes de ambos géneros con diagnósticode labio y paladar hendido, de la ciudad de Medellín, Colombia. El diseño delestudio fue exploratorio-descriptivo-transversal-correlacional. Se utilizaroncomo instrumentos el Cuestionario de Esquemas, CIE y la Escala de HabilidadesSociales, EHS. Los resultados no evidenciaron niveles clínicamente significativosen las variables del estudio, a nivel general los puntajes de los autoesquemas y lashabilidades sociales, reportados por los adolescentes con labio y paladar hendido,fueron buenos. Por último, todo el estudio tuvo un Alfa de Cronbach superior a.70.
The purpose of this research was to evaluate the relationship of the self-schemesand social skills of 49 adolescents of both genres with a diagnosis of cleft lip and palate in the city of Medellin, Colombia. The design of the study was exploratorydescriptive-transversal-correlational. The Schemes Questionnaire (CIE) and theScale of Social Skills EHS were used as instruments. The outcomes did notdemonstrate clinically significant levels in the variables of the study; the scoresof the self-schemes and the social skills reported by the adolescents with cleft lipand palate were generally good. Finally, the whole study had a Cronbach Alfaabove .70.
O objetivo da presente investigação foi avaliar a relação dos autoesquemas eas habilidades sociais de 49 adolescentes de ambos gêneros com diagnósticode Lábio e Paladar Fendido da cidade de Medellín, Colômbia. O desenho doestudo foi exploratório-descritivo-transversal-correlacional. Se utilizaram comoinstrumentos o Questionário de Esquemas CIE e a Escala de Habilidades SociaisEHS. Os resultados não evidenciaram níveis clinicamente significativos nasvariáveis do estudo, em nível geral os puntajes dos autoesquemas e as habilidadessociais reportados pelos adolescentes com Lábio e Paladar Fendido foram bons.Por último, todo o estudo teve um alfa de cronbach superior a .70.
Subject(s)
Adolescent , Cleft Lip , Cleft PalateABSTRACT
Las hemoglobinopatías son alteraciones cualitativas o cuantitativas de las cadenas de hemoglobina, estimándose que anualmente nacen en todo el mundo 200 millones de personas portadoras de esta alteración (heterocigotos) y 200 a 300 mil personas que padecen la enfermedad (homocigotos) Clínicamente las más importantes de todas las hemoglobinopatías son: la anemia de células falciformes (ACF) y las alfa y beta talasemias; siendo de mayor incidencia que otras enfermedades congénitas frecuentes y graves como el hipotiroidismo congénito y la fenilcetonuria. La ACF es un defecto heredado en forma recesiva, que afecta a uno de cada 400.900 recién nacidos en poblaciones de riesgo que son: las de raza negra (africanos, quienes pueden alcanzar una prevalencia del 40 por ciento o negros inmigrantes en América con una prevalencia del 8 por ciento); o aquéllas con una alta frecuencia de mezclas raciales, como son la de América Central y del Sur, donde pueden tener una prevalencia del 6 por ciento. En Colombia se han realizado algunos estudios aislados, especialmente en la región de la Costa Pacífica, encontrando una prevalencia aproximada del 10 por ciento al 18 por ciento. Esta patología presenta una alta tasa de morbimortalidad, especialmente en los tres primeros años de vida, cuando no se realiza un diagnóstico y tratamiento rápido y adecuado de las principales complicaciones (infecciones por gérmenes encapsulados; crisis vaso-oclusivas con lesión orgánica a largo plazo; crisis de secuestro esplénico o hemolíticas y crisis aplásticas); o una adecuada profilaxis de estas mismas especialmente la educación sobre los signos y síntomas de alerta que ameritan consulta inmediata y un seguimiento clínico multidisciplinario. Esta alta morbimortalidad puede reducirse sustancialmente al realizarse un diagnóstico temprano. El diagnóstico precoz puede hacerse en forma prenatal, implicando procedimientos que no están exentos de riesgo para la madre y el feto, que requieren instituciones de tercer nivel y mayores costos (amniocentesis, biopsia de vellosidades coriónicas); o postnatal, utilizando muestras de sangre de cordón o capilares de fácil recolección y sin complicaciones. El análisis de laboratorio puede realizarse por diversos métodos, de los cuales la prueba de elección sigue siendo la electroforesis en acetato de celulosa. El diagnóstico temprano permite además el estudio de la familia (para identificación de portadores), consejería genética y educación.
Subject(s)
Humans , Infant, Newborn , Anemia, Sickle Cell/classification , Anemia, Sickle Cell/diagnosis , Anemia, Sickle Cell/nursing , Anemia, Sickle Cell/etiology , Anemia, Sickle Cell/genetics , Anemia, Sickle Cell/drug therapyABSTRACT
Introducción. El síndrome de Wolf-Hirschhorn (SWH) es una cromosopatía poco frecuente, debido a la delección en la banda del brazo 4p16.3 que se manifiesta con una amplia variedad clínica, incluyendo malformaciones craneofaciales importantes. Caso clínico. Paciente de 3 mmeses de edad que acudió por presentar paladar hendido y que inició su manejo en el servicio de cirugía maxilofacial. Con el antecedente materno de haber presentado cuadro exantemático diagnósticado como rubéola durante el primer trimestre del embarazo. Se detectaron múltiples malformaciones congénitas agregadas (cardiovasculares, oftalmológicas y ortopédicas). Conclusiones. De acuerdo a los hallazgos fenotípicos se realizó el diagnóstico de SWH asociado a síndrome de rubéola congénita. Es éste el primer reporte en que se documenta la asociación de ambos síndromes
Subject(s)
Humans , Male , Infant , Chromosome Aberrations/etiology , Chromosome Aberrations/genetics , Chromosomes, Human, Pair 4/genetics , Chromosomes, Human, Pair 4/ultrastructure , Rubella Syndrome, Congenital/diagnosis , Rubella Syndrome, Congenital/genetics , Rubella Syndrome, Congenital/epidemiology , SyndromeABSTRACT
La hemorragia intraventricular en el recién nacido a término es un evento raro en la práctica pediátrica y en estudios post mortem de neonatos fallecidos en el período neonatal, solo un pequeño número corresponde a hemorragia intraventricular: Se presenta el caso de un recien nacido a término con hemorragia intraventricular en los plexos coroides, sin factores de riesgo
Subject(s)
Humans , Infant, Newborn , Cerebral Hemorrhage/diagnosis , Infant, Newborn , TomographyABSTRACT
Se presenta el caso de un lactante, con crísis clónicas inicialmente y luego tónicoclónicas que lo llevan finalmente a status epiléptico, secundarias a déficit de piridoxina. El caso debe alertar sobre la posibilidad de procesos infrecuentes, como el de este ejemplo, como causa de cuadros convulsivos de difícil manejo.
Subject(s)
Humans , Infant , Seizures/classification , Seizures/diagnosis , Seizures/drug therapy , Seizures/etiology , Seizures/nursing , Pyridoxine/administration & dosage , Pyridoxine/adverse effects , Pyridoxine/classification , Pyridoxine/metabolism , Pyridoxine/pharmacokinetics , Pyridoxine/therapeutic useABSTRACT
Se informa de un caso de un recién nacido con hemorragia intraventricular, a quien se le confirmó con estudios neuroradiológicos, hemorragia de los plexos coroides, sin que se pudiera demostrar factores de riesgo asociados a este evento.
