Analysis of hypothermia through the acute phase in major burns patients: Nursing care. / Análisis de la hipotermia durante la fase aguda del paciente gran quemado: cuidados enfermeros.

Major burns patients usually present hypothermia after suffering a thermal burn, due to exposure during the accident, cooling of the burn and transfer. There are methods of reheating to avoid this heat loss, where nursing care is key. OBJECTIVE: To analyse the constant temperature presented by large burns patients on admission to the Burns Unit and their progression over the first 72hours. METHOD: Retrospective cross-sectional descriptive observational study of patients with thermal burns affecting more than 15% of body surface area, from December 2010 to May 2018. By reviewing databases and clinical records, demographic data, qualitative variables (origin of burn, previous pathologies, mechanical ventilation and ABSI and BOBI scales) and quantitative variables (burn depth and extension, temperature at admission and taken every 8hours for 72hours). Absolute, relative frequencies and the statistics of the quantitative variables were analysed. The study was verified by statistical tests according to the variables and contingency tables. A logistic regression model was developed expressed in a ROC curve. RESULTS: Of the 57 patients included, 79.2% developed hypothermia on admission. They presented burns over 34.56%±16.64 of their body surface, with 28.04%±17.49 being deep burns. Mortality during the stay was 29.8%. The presence of hypothermia during the acute phase was statistically related to death during stay in the unit (p=.033). It was observed that hypothermia is directly related to the extent of the burn (p=.003). CONCLUSIONS: Due to the presence of hypothermia on admission, and to the fact that the average temperature does not exceed 36°C until at least 16hours after the burn, nurses must know and promptly administer adequate reheating measures to improve chances of survival in major burns.

[Regulation of cardiac output;an approximation at 3 levels: organic, cellular, and protein]. / Regulación del rendimiento cardíaco; una aproximación a tres niveles: órgano, células, proteínas.

The heart is the central point for adaptation of the organism to physical exercise because it is the center of the energy support system. Its activity is regulated at three levels; organ, cells and molecular and genetic components. During the development of the heart, the organ adapts in response to chronic and acute overloads by instantaneous functional and chronic changes, leading to a variable degree of cardiac growth. Physical exercise (acute and chronic) is the main example of physiologic overload. The acute response of the heart means a mechanical-hemodynamical and energetic modulation, driving to a final point where oxygen supply fits the increased need. Training, as response to chronic exercise, promotes an increase in energetic capacity (heart rate and stroke volume), structurally reflected in the physiological cardiac hypertrophy. Global functional and structural changes express what is happening at the cellular level. Different stimuli signal through specific receptors and second messengers to the nucleus, regulating gene expression and conditioning structural (size) and functional (contractile) changes. Changes in cellular size explain, by Starling mechanism, the increase in individual contractile strength and in reduction of the ventricular cavity in the systolic period. Other structural changes refer to the interstitium, myocardial vasculature and vascular reactivity. Changes in contractility affect the composition of the contractile elements (isoforms of heavy myosin, light myosin and/or modulatory proteins) and sarcoplasmic Ca2+ regulation, through the increase in Ca2+ flow. Many of the adaptations to chronic exercise studied in vivo in intact heart, isolated heart (Langendorf) or papillary muscle (multicellular preparation), are retained in the cardiomyocyte. Isolated cardiomyocytes can be precisely through the medium, temperature, ionic composition, active substances, etc. Shortening speed without load (Vmax), considered an inotropic index (Sonnenblick) can be measured independently of the initial length. Myocytes shorten against an internal load (restoration force) with viscous and elastic components, although they cannot be loaded externally (stretching is difficult). Cardiomyocyte isolation and maintenance requires strict and controlled conditions. This model offers many possibilities for studying dimensions, contraction-relaxation mechanics, Ca2+ and pH dynamics, beta-adrenergic receptors, electrophysiology, pharmacology, genetics, etc. This kind of studies can deal with normal myocytes or myocytes from trained animals, cardiomyopathies, etc.

Seismicity remotely triggered by the magnitude 7.3 landers, california, earthquake.

The magnitude 7.3 Landers earthquake of 28 June 1992 triggered a remarkably sudden and widespread increase in earthquake activity across much of the western United States. The triggered earthquakes, which occurred at distances up to 1250 kilometers (17 source dimensions) from the Landers mainshock, were confined to areas of persistent seismicity and strike-slip to normal faulting. Many of the triggered areas also are sites of geothermal and recent volcanic activity. Static stress changes calculated for elastic models of the earthquake appear to be too small to have caused the triggering. The most promising explanations involve nonlinear interactions between large dynamic strains accompanying seismic waves from the mainshock and crustal fluids (perhaps including crustal magma).

Fenitoina sodica (difenilhidantoinato de sodio) para el tratamiento de epilepsias con crisis generalizadas en adolescentes y adultos. / Sodium phenytoin (sodium diphenylhydantoinate) in the treatment of epilepsies with generalized crises in adolescents and adults

Se refiere la experiencia del tratamiento con fenitoina sodica en 20 pacientes adolescentes y adultos con epilepsia generalizada, tipo "gran mal". Se hace enfasis en la utilidad del control de la terapia mediante la determinacion de niveles sericos por el metodo de inmunoensayo mediante enzimas, comparando los resultados obtenidos con los informados en la literatura internacional. El control por EEG corrobora los resultados clinicos y refleja el mantenimiento de niveles sericos utiles.Se analizan los efectos colaterales de acuerdo a su severidad y su relacion con la concentracion serica del medicamento, confirmandose ampliamente las observaciones de otros autores. El estudio con TAC proporciona datos similares a otros recientemente encontrados, pero senala una situacion propia a la patologia cerebral de Mexico

[Immunoelectrophoretic and functional evidence in various infants of a transient variant of the fibrinogen (fetal fibrinogen?)]. / Evidencia inmunoelectroforética y funcional, en algunos recién nacidos, de una variante transitoria del fibrinógeno (fibrinógeno fetal?).

In 21 out of 466 full term newborn babies (4.5%) and in 5 out of 50 prematures (10%) a transient fibrinogen electrophoretic abnormality, anodic and cathodic, was found. The observation that the thrombin time in full term newborn babies is prolonged, compared with the adult levels, was confirmed (p less than 0.0005). The difference between the thrombin time in full term newborn babies without fibrinogen electrophoretic abnormalities and those who had them, was statistically significant (p = 0.005) suggesting that the abnormality is associated with the protein function. The normal electrophoretic component could be the "adult" equivalent of the protein and the cathodic variant, the "fetal" type of fibrinogen. This hypothesis could explained why the thrombin time of plasma in newborn normal babies is enriched with the "fetal" fibrinogen in variable proportion, and is delayed compared with that of the adults.