Profilaxis para sangrado gastrointestinal en pacientes del servicio de medicina interna de un hospital universitario / Gastrointestinal bleeding prophylaxis in internal medicine patients of a univeristy hospital

Introducción: Los medicamentos antiulcerosos son utilizados frecuentemente en pacientes hospitalizados, sin embargo, a menudo este uso no está indicado. Objetivo: Describir la frecuencia de prescripción e indicación de medicamentos para prevenir el sangrado gastrointestinal en pacientes hospitalizados. Materiales y métodos: Estudio de corte trasversal, descriptivo, prospectivo del servicio de Medicina Interna de la Sociedad de Cirugía de Bogotá- Hospital de San José de Bogotá, Colombia. Se excluyeron pacientes con diagnóstico de sangrado gastrointestinal o antecedente de alergia a los medicamentos antiulcerosos. Se recolectaron datos demográficos, así como fármacos prescritos. Se determinó si la indicación del fármaco era adecuada y se identificó el tipo de error de prescripción. Resultados: Se incluyeron 179 pacientes, 102 (57%) mujeres. Promedio de edad de 61,3 años (±20,2). El principal diagnóstico de ingreso fue enfermedad infecciosa 76 (42,4%). Del total de pacientes, 165 (92,17%) recibieron medicamento para prevención del sangrado gastrointestinal. La indicación fue adecuada en 75 pacientes (41,89%). El error más frecuente fue el uso en pacientes de bajo riesgo de sangrado, 101 (97,1%). Conclusión: Un alto porcentaje de los pacientes recibió medicación para la prevención del sangrado gastrointestinal. En aproximadamente la mitad de estos no estaba indicada.

Introduction: Anti-ulcer medications are frequently used in hospitalized patients, yet their use is not usually indicated. Objective: To describe the frequency of prescription and indication of medications to prevent gastrointestinal bleeding in hospitalized patients. Materials and methods: A cross-sectional, descriptive, prospective study was carried out in the Internal Medicine service of the Surgery Society of Bogota-San Jose Hospital of Bogota (Colombia). Excluded patients were those with either a gastrointestinal bleeding diagnosis or a history of allergy to anti-ulcer medications. Demographic data and information regarding prescribed medications were collected. It was determined whether the medicine indication was adequate and the type of prescription error was identified. Results: 179 patients were included in the study, 57% (102) of which were women. The average age was 61.3 (±20.2) years old. Infectious disease was the main admission diagnosis (76; 42.4%). A 92.17% (165) of the total number of patients received medications to prevent gastrointestinal bleeding. This indication was adequate for 75 (41.89%) patients. The most frequent error was their use in bleeding low-risk patients (101; 97.1%). Conclusion: A high percentage of patients received medication to prevent gastrointestinal bleeding. However, in about half of these patients it was not indicated.

Pasteurella multocida Bacteremia Due to Obstructive Pneumonia in an Immunocompromised Patient.

Background: Pasteurella multocida is a gram-negative pathogen commonly associated with soft tissue infections caused by bites or scratches from household animals. However, P. multocida infections have been reported without prior zoonotic exposure or associated soft tissue or skin infection in immunocompromised individuals. Case: A 73-year-old patient with history significant for multiple malignancies including lung cancer presented to the emergency department with a fever, chills, and rigor. Patient denied any zoonotic exposure and did not have any soft tissue or skin structure infection. Laboratory testing and imaging revealed sepsis secondary to pneumonia and further lower respiratory cultures grew Pasteurella. Subsequent laboratory cultures indicated P. multocida bacteremia. Conclusion: This case aims to advance awareness of the possibility of P. multocida infection in patients who do not have any known zoonotic exposure or identifiable skin or soft tissue infection. Nasopharyngeal colonization in immunocompromised individuals could be a source for invasive infection. Patients who have a pre-existing lung disease are susceptible for developing Pasteurella pneumonia, which can serve as the source of bacteremia.

Preoperative Statin Use is Associated With Lower Incidence of Limb Loss After Lower Extremity Endovascular Interventions.

BACKGROUND: Statin therapy is the primary lipid-lowering agent used in peripheral artery disease (PAD) patients. Although the benefits of statins have been described in the literature, most studies have focused on postoperative statin use and outcomes in major upper body vasculature. Our study aimed to assess the impact of statin therapy on postoperative outcomes of lower extremity endovascular interventions including mortality and amputation rates. METHODS: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2012 to 2019 was utilized for this study. Patients were divided into 2 groups: those on preoperative statins (Group I) and those not on statins (Group II). Univariate and multivariate analyses were performed to assess statin's effect on postoperative outcomes. RESULTS: A total of 12,217 patients (72.7%) were in Group I and 4599 patients (27.3%) were in Group II. The distribution of primary outcomes was as follows: Amputation (Group I: 3% vs Group II: 3.9%, P <.05) and Mortality (Group I: 1.6% vs Group II: 1.9%, P = .086). Statin use was associated with decreased amputation rates. Patients with tissue loss were 5 times more likely to undergo amputations (AOR: 5.58 [CI 2.29-13.63] P < .01) within 30-days postoperatively as compared to those whose presenting symptoms were claudication. CONCLUSION: Statin therapy was associated with a decreased limb loss within 30-days after intervention at the time of lower extremity endovascular intervention. Patients presenting with rest pain and tissue loss had a higher incidence of limb loss than claudicants.

Manejo con dispositivo Watchman en un paciente con fibrilación auricular y en terapia de diálisis. Reporte de caso y revisión narrativa / Management with the Watchman device in a patient with atrial fibrillation and on dialysis therapy. Case report and narrative review

Resumen La anticoagulación es la terapia de elección para la mayoría de pacientes con fibrilación auricular no valvular; sin embargo, en pacientes con enfermedad renal crónica con alto riesgo de sangrado se deben considerar terapias antitrombóticas locales como el cierre percutáneo de la orejuela izquierda con dispositivo Watchman. A continuación, se reporta el primer caso de implante de este dispositivo llevado a cabo en el Hospital de San José de Bogotá, Colombia, y se hace una revisión narrativa sobre este tema. El uso del dispositivo Watchman se asocia con menos accidentes cerebrovasculares hemorrágicos (0,15 vs. 0,96 eventos / 100 pacientes-año HR=0,22; p=0,004), menos muertes cardiovasculares o inexplicadas (1,1 vs. 2,3 eventos / 100 paciente-año; HR=0,48; p=0,006) y menos casos de sangrado no asociado al procedimiento (6,0 % vs. 11,3 %; HR=0,51; p=0,006) en comparación con la warfarina.

Resumen Anticoagulation remains the therapy of choice for the majority of patients with non-valvular atrial fibrillation, however, in patients with chronic kidney disease at high risk of bleeding, local antithrombotic therapies such as the left atrial closure with Watchman device should be considered. We report the first case of implant of this type device in the Hospital de San José at the City of Bogotá, Colombia, and a narrative review of the literature is made. Watchman's use is associated with fewer hemorrhagic strokes (0.15 versus 0.96 events / 100 patients-year HR: 0.22; p = 0.004), cardiovascular death / unexplained death (1.1 vs. 2.3 events / 100 patient-year; HR: 0.48; p = 0.006), and bleeding not associated with the procedure (6.0 % vs. 11.3 %; HR: 0.51; p = 0.006) compared to warfarin.

The complete mitogenome of the invasive Japanese mud snail Batillaria attramentaria (Gastropoda: Batillariidae) from Elkhorn Slough, California, USA.

Genomic analysis of the invasive marine snail Batillaria attramentaria from Elkhorn Slough, Moss Landing, California, USA using 150 bp paired-end Illumina sequences resulted in the assembly of its complete mitogenome. The mitogenome is 16,095 bp in length and contains 2 rRNA, 13 protein-coding, and 22 tRNA genes (GenBank Accession MN557850). Gene content and organization of B. attramentaria are identical to the Turritellidae and Pachychilidae. The phylogenetic analysis of B. attramentaria resolves it in a fully supported clade with these same two families in the superfamily Cerithioidea. Nucleotide BLAST searches of the Elkhorn Slough cox1 gene of B. attramentaria yielded identical sequences from invasive populations from California and British Columbia, and native populations from northeastern and central Japan. These data show that mitogenome sequencing is a useful tool for studying the classification and phylogenetic history Cerithioidea.

Visual Processing during Short-Term Memory Binding in Mild Alzheimer's Disease.

Patients with Alzheimer's disease (AD) typically present with attentional and oculomotor abnormalities that can have an impact on visual processing and associated cognitive functions. Over the last few years, we have witnessed a shift toward the analyses of eye movement behaviors as a means to further our understanding of the pathophysiology of common disorders such as AD. However, little work has been done to unveil the link between eye moment abnormalities and poor performance on cognitive tasks known to be markers for AD patients, such as the short-term memory-binding task. We analyzed eye movement fixation behaviors of thirteen healthy older adults (Controls) and thirteen patients with probable mild AD while they performed the visual short-term memory binding task. The short-term memory binding task asks participants to detect changes across two consecutive arrays of two bicolored object whose features (i.e., colors) have to be remembered separately (i.e., Unbound Colors), or combined within integrated objects (i.e., Bound Colors). Patients with mild AD showed the well-known pattern of selective memory binding impairments. This was accompanied by significant impairments in their eye movements only when they processed Bound Colors. Patients with mild AD remarkably decreased their mean gaze duration during the encoding of color-color bindings. These findings open new windows of research into the pathophysiological mechanisms of memory deficits in AD patients and the link between its phenotypic expressions (i.e., oculomotor and cognitive disorders). We discuss these findings considering current trends regarding clinical assessment, neural correlates, and potential avenues for robust biomarkers.

Procesamiento de las expresiones faciales en personas con esquizofrenia: análisis dinámico de la información visual / Processing of Facial Expressions in People with Schizophrenia: Dynamic Analysis of Visual Information

INTRODUCCIÓN: Las personas con esquizofrenia presentan deficiencias en su desempeño social. El procesamiento emocional explica los aspectos relacionados con percibir y utilizar emociones faciales para un adecuado manejo social. Los movimientos oculares son un indicador del estatus cognitivo de un sujeto. OBJETIVOS: Evaluar los movimientos oculares que realiza una persona con esquizofrenia cuando procesa una emoción facial, teniendo en cuenta su funcionamiento social. MÉTODOS: Se realizó un estudio de tipo analítico, observacional y cuantitativo. Incluyó entrevistas semiestructuradas y tests validados en Argentina, y luego el seguimiento de movimientos oculares a 38 personas (19 con diagnóstico de esquizofrenia y 19 sujetos sanos). Se analizaron todos los datos con sistema estadístico R. RESULTADOS: El análisis de la duración total de fijaciones por sujeto por región de interés mostró las dificultades que presentan las personas con esquizofrenia para utilizar los lugares de la cara e interpretar la emoción. En la evaluación de la identificación de emociones, las personas con esquizofrenia tuvieron mayor cantidad de errores y de consignas sin respuestas. CONCLUSIONES: En comparación con controles, las personas con esquizofrenia utilizan una estrategia diferente y deficiente de la recogida de la información visual para identificar la expresión emocional, que puede ser medida y posiblemente estandarizada, como método de evaluación cognitiva.

INTRODUCTION: People with schizophrenia have deficits in their social performance. Emotional processing explains aspects related to the perception and use of facial emotions for a proper social performance. Ocular movements are an indicator of the cognitive status of a person. OBJECTIVES: To evaluate the ocular movements made by a person with schizophrenia when processing a facial emotion, taking into account the social functioning. METHODS: An observational, quantitative and analytical study was conducted, including semi-structured interviews and tests validated in Argentina, as well as eyetracking to 38 people (19 diagnosed with schizophrenia and 19 healthy subjects). All data were analyzed through R statistical program. RESULTS: The analysis of the total duration of fixations per subject and region of interest showed the difficulties people with schizophrenia have to use the places of the face and to interpret emotion. In the assessment of the identification of emotions, people with schizophrenia had the highest number of errors and unanswered items. CONCLUSIONS: When compared to controls, people with schizophrenia use a different and poor strategy of collecting visual information to identify emotional expression, that can be measured and possibly standardized as a method of cognitive assessment.

Actividad física y salud en docentes. Una revisión / Physical activity and health in teachers. A review

Los docentes de las universidades en la mayoría de los casos tienen estilos de vida sedentarios producto de su propio trabajo. Por tanto, se realizó un estudio de revisión documental y bibliográfica de artículos científicos publicados entre enero de 1999 y febrero de 2016 con el objetivo de actualizar los conocimientos existentes sobre la actividad física relacionada con la salud de docentes a nivel internacional. Las bases de datos consultadas fueron Medline, Scopus y Scielo. La búsqueda se realizó mediante PubMed y fue clasificada por 2 objetivos de búsqueda. Se usaron las siguientes palabras claves: actividad física, ejercicio físico, docentes; en idioma español e inglés (physical activity, physical exercise, teachers). Se seleccionaron aquellos estudios de aplicación de la actividad física en docentes de cualquier tipo de enseñanza, a nivel internacional. Se encontraron 8 estudios, todos de aplicación, en los diferentes niveles de experimentación (pre-, cuasi- y experimental) en los que se demostró los beneficios de la actividad física en poblaciones de docentes y futuros docentes (AU)

Most university teachers have sedentary lifestyles, a product of the job itself. Scientific articles published between January 1999 and February 2016 were reviewed in terms of bibliography and documentary evidence, with a view to updating existing knowledge of physical activity and its effect on the health of teachers, internationally. The databases searched were Medline, Scopus and Scielo. The search was run using PubMed, and classified by two search objectives. The following keywords were used in English and Spanish: physical activity, physical exercise and teachers (actividad física, ejercicio físico, docentes). Studies on the physical activity of any kind of teacher, internationally, was selected. Eight studies were found, all applied at different levels of experimentation (pre, quasi, and experimental), which demonstrated the benefits of physical activity in populations of current and future teachers (AU)

Alimentación saludable en docentes / A healthy diet in professors

Introducción: en la actualidad, los docentes tienen estilos de vida sedentarios producto a su propio trabajo y esto les provoca en muchos casos enfermedades asociadas. Objetivo: actualizar los conocimientos existentes sobre la alimentación saludable de docentes a nivel internacional. Métodos: revisión documental y bibliográfica de artículos científicos publicados hasta abril de 2016. Las bases de datos consultadas fueron Medline, Scopus y Scielo. Las búsquedas que se han realizado mediante PubMed y clasificadas por dos objetivos de búsqueda. Se usaron las siguientes palabras claves: alimentación, docentes, salud; en idioma español e inglés. Se seleccionaron aquellos estudios de donde se reflejara programas, intervenciones y revisiones sobre la alimentación saludable en docentes o futuros docentes de cualquier tipo de enseñanza a nivel internacional. Conclusiones: la aplicación correcta de programas de alimentación saludable es beneficiosa de forma general en los docentes y futuros docentes(AU)

Introduction: Nowadays, teachers have sedentary lifestyles due to their own work, which causes them, in many cases, associated diseases. Objective: To update the existing knowledge on healthy diets of teachers at the international level. Methods: Document and bibliography review of scientific articles published until April 2016. The databases consulted were Medline, Scopus and Scielo. The searches used PubMed and were classified by two search goals. The following key words were used: food, teachers, health, both in Spanish and English. These studies were selected to reflect programs, interventions and reviews on healthy diet in teachers or future teachers of any kind of schooling at an international level. Conclusions: The correct application of healthy diet programs is generally beneficial for teachers and future teachers(AU)

Alimentación saludable en docentes / A healthy diet in professors

Introducción: en la actualidad, los docentes tienen estilos de vida sedentarios producto a su propio trabajo y esto les provoca en muchos casos enfermedades asociadas. Objetivo: actualizar los conocimientos existentes sobre la alimentación saludable de docentes a nivel internacional. Métodos: revisión documental y bibliográfica de artículos científicos publicados hasta abril de 2016. Las bases de datos consultadas fueron Medline, Scopus y Scielo. Las búsquedas que se han realizado mediante PubMed y clasificadas por dos objetivos de búsqueda. Se usaron las siguientes palabras claves: alimentación, docentes, salud; en idioma español e inglés. Se seleccionaron aquellos estudios de donde se reflejara programas, intervenciones y revisiones sobre la alimentación saludable en docentes o futuros docentes de cualquier tipo de enseñanza a nivel internacional. Conclusiones: la aplicación correcta de programas de alimentación saludable es beneficiosa de forma general en los docentes y futuros docentes(AU)

Introduction: Nowadays, teachers have sedentary lifestyles due to their own work, which causes them, in many cases, associated diseases. Objective: To update the existing knowledge on healthy diets of teachers at the international level. Methods: Document and bibliography review of scientific articles published until April 2016. The databases consulted were Medline, Scopus and Scielo. The searches used PubMed and were classified by two search goals. The following key words were used: food, teachers, health, both in Spanish and English. These studies were selected to reflect programs, interventions and reviews on healthy diet in teachers or future teachers of any kind of schooling at an international level. Conclusions: The correct application of healthy diet programs is generally beneficial for teachers and future teachers(AU)

Nutrición adecuada aplicada a los docentes. Una revisión / Adequate nutrition applied to teachers. A review

Fundamentos: En la actualidad los docentes tienen estilos de vida sedentarios producto de su propio trabajo y esto les provoca, en muchos casos, enfermedades asociadas. Esta revisión pretende actualizar los conocimientos existentes sobre la nutrición adecuada de los docentes a nivel internacional. Métodos: se realizó una revisión documental y bibliográfica de artículos científicos publicados hasta abril de 2016. Para ello se consultaron las bases de datos Scopus y Scielo. Se usaron las siguientes palabras claves: nutrición, docentes, salud; en idioma español e inglés. Se seleccionaron aquellos estudios de donde se reflejaban programas, intervenciones y revisiones sobre la nutrición adecuada y saludable en docentes o futuros docentes de cualquier tipo de enseñanza, a nivel internacional. Resultados: se encontraron diez estudios de aplicación en diferentes niveles de experimentación, donde se demostraban los beneficios de distintos programas de nutrición saludable en poblaciones de docentes y futuros docentes. Conclusiones: la aplicación correcta de programas de nutrición aplicados a los docentes y futuros docentes resulta beneficioso de forma general

Background: Nowadays, teachers have sedentary lifestyles as a result of their own work and this causes them, in many cases, associated diseases. This review intends to update existing knowledge on the adequate nutrition of teachers at the international level. Methods: a documentary and bibliographical review of scientific articles published until April 2016 was carried out. For this, the Scopus and Scielo databases were consulted. The following keywords were used: nutrition, teachers, health; In Spanish and English. Those studies which reflected programs, interventions and reviews on adequate and healthy nutrition in teachers or future teachers of any type of education, at the international level, were selected. Results: ten application studies were found at different levels of experimentation, showing the benefits of healthy nutrition programs in teachers and future teachers. Conclusions: the correct application of nutrition programs applied to teachers and future teachers is generally beneficial

Word processing during reading sentences in patients with schizophrenia: evidences from the eyetracking technique.

PURPOSE: The current study analyze the effect of word properties (i.e., word length, word frequency and word predictability) on the eye movement behavior of patients with schizophrenia (SZ) compared to age-matched controls. METHOD: 18 SZ patients and 40 age matched controls participated in the study. Eye movements were recorded during reading regular sentences by using the eyetracking technique. Eye movement analyses were performed using linear mixed models. FINDINGS: Analysis of eye movements revealed that patients with SZ decreased the amount of single fixations, increased their total number of second pass fixations compared with healthy individuals (Controls). In addition, SZ patients showed an increase in gaze duration, compared to Controls. Interestingly, the effects of current word frequency and current word length processing were similar in Controls and SZ patients. The high rate of second pass fixations and its low rate in single fixation might reveal impairments in working memory when integrating neighbor words. In contrast, word frequency and length processing might require less complex mechanisms, which were functioning in SZ patients. CONCLUSION: To the best of our knowledge, this is the first study measuring how patients with SZ process dynamically well-defined words embedded in regular sentences. The findings suggest that evaluation of the resulting changes in eye movement behavior may supplement current symptom-based diagnosis.

Contextual predictability enhances reading performance in patients with schizophrenia.

In the present work we analyzed fixation duration in 40 healthy individuals and 18 patients with chronic, stable SZ during reading of regular sentences and proverbs. While they read, their eye movements were recorded. We used lineal mixed models to analyze fixation durations. The predictability of words N-1, N, and N+1 exerted a strong influence on controls and SZ patients. The influence of the predictabilities of preceding, current, and upcoming words on SZ was clearly reduced for proverbs in comparison to regular sentences. Both controls and SZ readers were able to use highly predictable fixated words for an easier reading. Our results suggest that SZ readers might compensate attentional and working memory deficiencies by using stored information of familiar texts for enhancing their reading performance. The predictabilities of words in proverbs serve as task-appropriate cues that are used by SZ readers. To the best of our knowledge, this is the first study using eyetracking for measuring how patients with SZ process well-defined words embedded in regular sentences and proverbs. Evaluation of the resulting changes in fixation durations might provide a useful tool for understanding how SZ patients could enhance their reading performance.

Patients with Mild Alzheimer's Disease Fail When Using Their Working Memory: Evidence from the Eye Tracking Technique.

Patients with Alzheimer's disease (AD) develop progressive language, visuoperceptual, attentional, and oculomotor changes that can have an impact on their reading comprehension. However, few studies have examined reading behavior in AD, and none have examined the contribution of predictive cueing in reading performance. For this purpose we analyzed the eye movement behavior of 35 healthy readers (Controls) and 35 patients with probable AD during reading of regular and high-predictable sentences. The cloze predictability of words N - 1, and N + 1 exerted an influence on the reader's gaze duration. The predictabilities of preceding words in high-predictable sentences served as task-appropriate cues that were used by Control readers. In contrast, these effects were not present in AD patients. In Controls, changes in predictability significantly affected fixation duration along the sentence; noteworthy, these changes did not affect fixation durations in AD patients. Hence, only in healthy readers did predictability of upcoming words influence fixation durations via memory retrieval. Our results suggest that Controls used stored information of familiar texts for enhancing their reading performance and imply that contextual-word predictability, whose processing is proposed to require memory retrieval, only affected reading behavior in healthy subjects. In AD patients, this loss reveals impairments in brain areas such as those corresponding to working memory and memory retrieval. These findings might be relevant for expanding the options for the early detection and monitoring in the early stages of AD. Furthermore, evaluation of eye movements during reading could provide a new tool for measuring drug impact on patients' behavior.

Patients with mild Alzheimer's disease produced shorter outgoing saccades when reading sentences.

In the present work we analyzed forward saccades of thirty five elderly subjects (Controls) and of thirty five mild Alzheimer's disease (AD) during reading regular and high-predictable sentences. While they read, their eye movements were recorded. The pattern of forward saccade amplitudes as a function of word predictability was clearly longer in Controls. Our results suggest that Controls might use stored information of words for enhancing their reading performance. Further, cloze predictability increased outgoing saccades amplitudes, as this increase stronger in high-predictable sentences. Quite the contrary, patients with mild AD evidenced reduced forward saccades even at early stages of the disease. This reduction might reveal impairments in brain areas such as those corresponding to working memory, memory retrieval, and semantic memory functions that are already present at early stages of AD. Our findings might be relevant for expanding the options for the early detection and monitoring of in the early stages of AD. Furthermore, eye movements during reading could provide a new tool for measuring a drug's impact on patient's behavior.

Prevalence of bucco-dental pathologies in patients with psychiatric disorders.

INTRODUCTION: Oral diseases in psychiatric patients are usually a result of bad oral hygiene and psychopharmaceutical side-effects. OBJECTIVE: The aim of this study was to detect the most prevalent oral lesions in patients hospitalized in a psychiatric institution in Caracas, Venezuela with the confirmed diagnosis of psychiatric illness. MATERIAL AND METHODS: A transversal study consisted of 65 hospitalized patients with psychiatric disorders out of whom 50 were males and 15 females. Patients were aged from 19 to 80 years, mean age 50.2 years. Data on oral lesions were obtained within history and clinical examination of the oral cavity. Other medical data were collected from medical documentation. Statistical analysis was performed by SPSS version 17.0. RESULTS: 56.92% of patients had caries in at least one tooth, 29.23% presented gingivitis and 56.92% periodontal disease. In relation to Temporomandibular joint, 36.92% presented articular sounds and 10.76% muscular pain. Between the most prevalent parafunctional habits were found cigarette habit, bruxism, onychophagia and cheek bite. CONCLUSION: Results imply that psychiatric patients are more frequently involved with oral lesions than healthy persons. It is necessary to organize specific preventive and educational oral health programmes with these patients, in a multidisciplinary group. Key words:Phychiatric patients, schizophrenia, medication, periodontal diseases.

Sangrado gastrointestinal en pacientes hospitalizados / Gastrointestinal bleeding in hospitalized patients

El sangrado gastrointestinal es una complicación potencial del paciente que se hospitaliza. Como las descripciones iniciales en cuidados intensivos relacionaban el sangrado por úlceras de estrés con alta mortalidad, la investigación fue creciente en los pacientes críticos. No sucedió lo mismo con los hospitalizados y los trabajos disponibles son escasos. Los principales factores de riesgo se han descrito en los críticos (ventilación mecánica más de 48 horas y coagulopatía). La eficacia de la terapia no se ha demostrado en aquellos en la sala general. La evidencia indirecta muestra utilidad marginal de estos medicamentos en la prevención del sangrado gastrointestinal. En los casos críticos hay abundante información pero la interpretación es confusa. Se ha documentado una tasa alta de formulación para prevenir el sangrado en los hospitalizados, la mayoría sin indicación clara, lo cual puede exponer al paciente a eventos adversos innecesarios y gastos adicionales al sistema de salud. Se recomiendan estrategias para implementación de guías para el uso racional de estos fármacos...

Gastrointestinal bleeding is a potential inpatient complication. Research has extensively focused in critically ill patients due to initial descriptions of high mortality related to bleeding due to stress ulceration. On the other hand, research evaluating GI bleeding in inpatients is scarce with few available reports. The main risk factors have been described in critically ill patients (requiring mechanical ventilation for more than 48 hours and coagulopathy). Treatment efficacy has not been demonstrated in patients hospitalized in the general ward. Indirect evidence show marginal usefulness of these medications in gastrointestinal bleeding prevention. There is plentiful data on critically ill patients but with confusing interpretation. It has been documented that preventive medicines are often prescribed to avoid bleeding in inpatients, with no clear indication in most cases, exposing the patient to unnecessary adverse events and additional costs for the healthcare system. Implementation guidelines are recommended for the rational use of these medicines...

Variabilidad clínica del vecuronio. Experiencia en una institución en Colombia / Clinical variability of vecuronium. Experience at an Institution in Colombia

Objetivo: Determinar la variabilidad del vecuronio (lag time, duración de latencia, duración clínica y recuperación completa), molécula original, en un grupo de pacientes que reciben este fármaco para ser intervenidos quirúrgicamente bajo anestesia general, con intubación endotraqueal. Materiales y métodos: Estudio observacional prospectivo hecho con 20 pacientes adultos, clasificados ASA I o II, seleccionados por conveniencia, quienes recibieron anestesia general y vecuronio usado como relajante neuromuscular. La inducción fue hecha usando remifentanilo y propofol. La actividad neuromuscular fue cuantificada mediante un estimulador TOF-WATCH SX® determinando lag-time, duración de latencia, duración clínica y recuperación completa. El análisis de datos se efectuó en STATA 10. Resultados: Los datos referenciados desde lag time hasta recuperación completa están dados en medianas; lag time: 32,5 s; tiempo de latencia: 240 s; duración clínica 25: 43,5 min; duración clínica 50: 57,5 min; duración clínica 75: 58,5 min; duración clínica 100: 55 min. Recuperación completa: 87 min. Necesidad de reversión: 55%. Efectos adversos: ninguno. Conclusiones: Los resultados obtenidos sugieren una gran variabilidad del tiempo entre la administración del vecuronio, su efecto clínico y la duración de acción, observándose superiores a los registrados en la literatura; esto lo hace ver más como un fármaco de larga acción y destacada imprevisibilidad, por lo que sugerimos el uso de monitorización de la función neuromuscular como elemento indispensable, preferiblemente de tipo cuantitativo.

Objective: To establish the variability of vecuronium (lag-time, latency duration, clinical duration and complete recovery), original molecule, in a group of patients that received the agent prior to surgery under general anesthesia with endotracheal intubation. Materials and methods: Observational, prospective study including 20 adult patients - ASA I or II classification - selected on the basis of suitability, who received general anesthesia and vencuronium as neuromuscular relaxant. Remifentanyl and propofol were the induction agents. The neuromuscular activity was quantified using a TOF-WATCH SX® stimulator, establishing lag-time, duration of latency, clinical duration and complete recovery. The data were analyzed using STATA 10. Results: The data on lag-time to complete recovery, are given as medians: lag-time: 32.5 seconds; latency time: 240 seconds; clinical length 25: 43.5 min; clinical length 50: 57.5 min; clinical length 75: 58.5 min; clinical length 100: 55 min. Complete recovery: 87 min. Need for reversion: 55%. Adverse effects: none. Conclusions: The results obtained suggest a broad variability between the time of administration of vecuronium, its clinical effect and duration of action, all of which were above the levels recorded in the literature. This suggests that the agent is long-acting and highly unpredictable. We recommend neuromuscular function monitoring as an indispensable routine and preferably quantitative.

Giant right coronary artery aneurysm with unusual physiology: role of intraoperative transesophageal echocardiography.

A 65-year-old woman presented with a history of dyspnea and atypical chest pain. She was diagnosed with a non-ST-segment elevation myocardial infarction due to a giant right coronary artery aneurysm. After a failed percutaneous embolization, she was scheduled for right coronary artery aneurysm resection, posterior descending artery revascularization and mitral valve repair. During the induction of anesthesia and institution of mechanical ventilation, the patient suffered cardiovascular collapse. The transesophageal echocardiographic examination revealed tamponade physiology owing to compression of the cardiac chambers by the unruptured aneurysm, which resolved with the sternotomy. The surgery was carried out uneventfully.