ABSTRACT
OBJECTIVE: Describes the economic effects on bio-psychosocial homeostasis from a three-dimensional analysis of the joint interaction of biological, psychological and economic-social comorbidities, in order to know the probabilities of occurrence of these conditions simultaneously. METHOD: It is a cross-sectional study and random quota sampling. 353 men and women over 20 years of age participated, and answered a 27 questions application (bio-psycho-economic-social), the data was analyzed three-dimensionally in order to know the probability of occurrence of the variables studied and their possible location in the probabilistic unit cube. RESULTS: Based on the unit cube proposal, it can be observed that in the block of people with incomes from 2200 to 6600 pesos in the group of men there is a probability of 12.9 per 1000 inhabitants of presenting debt problems, overweight and severe depression, while in the case of women, the probability is 2.08 per 1000 inhabitants. CONCLUSIONS: There is a priority axis that determines the change of the remaining variables, in this case it is the economic axis the one that determines the biological and psychological conditions.
OBJETIVO: Describir los efectos económicos en la homeostasis biopsicosocial a partir de un análisis tridimensional de la interacción conjunta de la comorbilidad biológica, psicológica y económico-social, con la finalidad de conocer las probabilidades de ocurrencia a partir de estas condiciones de forma simultánea. MÉTODO: Estudio transversal y muestreo aleatorio por cuotas. Participaron 353 hombres y mujeres mayores de 20 años que contestaron un cuestionario con 27 preguntas (biopsicosociales-económicas). Se analizaron los datos tridimensionalmente con la finalidad de conocer la probabilidad de ocurrencia de las variables estudiadas y su posible localización en el cubo unitario probabilístico. RESULTADOS: Con base en la propuesta del cubo unitario se obtiene que, en las personas con ingresos de 2200 a 6600 pesos, en los hombres existe una probabilidad de 12.9 por cada 1000 habitantes de presentar deudas, sobrepeso y depresión grave; en las mujeres, la probabilidad es de 2.08 por cada 1000 habitantes. CONCLUSIONES: Existe un eje prioritario que determina el cambio de las variables restantes, en este caso el eje económico que determina las condiciones biológicas y psicológicas.
Subject(s)
Cross-Sectional Studies , Adult , Female , Homeostasis , Humans , Male , ProbabilityABSTRACT
The severe acute respiratory syndrome (SARS-Cov-2) is a clinical entity generated by this new virus a Coronavirus (COVID-19). Disease called COVID-19 (CoronaVIrus Disease 2019) by the World Health Organization. Its presentation is acute respiratory failure characterized by hyperinflation of the lung that leads to an increase in capillaries and epithelial permeability, with loss of ventilation of lung tissue and increases lung stiffness. These disturbances lead to imbalances between ventilation and perfusion ratio, which ultimately result in hypoxemia and impaired carbon dioxide clearance. For this review, a search of PubMed and Trip Database was performed. Due to the scarcity of publications, a specific search algorithm was not used. The objective is to review, the evidence and the recommendations of national and international experts, of the hemodynamic and ventilatory management of these patients.
El coronavirus del síndrome respiratorio agudo grave 2 (SARS-CoV-2, conocido previamente como nCoV-2019) es el agente causal de una nueva enfermedad denominada COVID-19 (COronaVIrus Disease 2019) por la Organización Mundial de la Salud. Su presentación es la insuficiencia respiratoria aguda caracterizada por una hiperinflación del pulmón que conduce a un incremento de los capilares y permeabilidad epitelial, con pérdida de la aireación de tejido pulmonar e incremento de la rigidez pulmonar. Estas alteraciones conducen a desequilibrios entre la ventilación y la relación de perfusión, que finalmente resultan en hipoxemia y deterioro de la depuración de dióxido de carbono. Para la presente revisión se realizó una búsqueda en PubMed y Trip Database. Debido a la escasez de publicaciones no se utilizó un algoritmo de búsqueda específico. El objetivo es dar a conocer, de acuerdo con la evidencia y las recomendaciones de expertos nacionales e internacionales, el manejo hemodinámico y ventilatorio de estos pacientes.
Subject(s)
COVID-19/therapy , Hemodynamics , Respiration , SARS-CoV-2 , COVID-19/blood , COVID-19/complications , COVID-19/physiopathology , Extracorporeal Membrane Oxygenation , Humans , Hypoxia/etiology , Lung/pathology , Phenotype , Positive-Pressure Respiration, Intrinsic , Prone Position/physiology , Respiration, Artificial/methods , Respiratory Distress Syndrome/etiology , Severity of Illness Index , Supine Position/physiology , Time Factors , Ultrasonography , Ventilator Weaning , Ventricular Dysfunction, Left/diagnosisABSTRACT
The disease caused by a new coronavirus, which started in 2019, was named COVID-19 and declared a pandemic on March 11, 2020 by the World Health Organization. Although it is true that the first reports emphasized the respiratory manifestations of this disease as an initial clinical presentation, little by little cases with different initial manifestations began to appear, involving other systems. In cases where central nervous system involvement was identified, the most frequent findings were dizziness, headache, and alteration of alertness. Regarding the cardiovascular system, elevation of cardiac biomarkers and myocarditis are one of the most frequent findings. The main gastrointestinal symptoms described so far are: anorexia, nausea, vomiting, diarrhea, abdominal pain and/or discomfort. Venous thromboembolism is a frequent complication and a public health problem. Skin manifestations remain a field of investigation. Maculopapular rashes, reticular livedo, acral gangrene, among others, have been identified. Health personnel must be updated on new clinical findings and the forms of presentation of this partially known disease, which will make it possible to make more accurate and timely diagnoses, thus impacting the prognosis of these patients.
La enfermedad causada por un nuevo coronavirus, que inició en 2019, fue denominada COVID-19 y declarada pandemia el 11 de marzo de 2020 por la Organización Mundial de la Salud. Si bien es cierto que los primeros reportes enfatizaron las manifestaciones respiratorias de esta enfermedad como presentación clínica inicial, poco a poco empezaron a aparecer casos con manifestaciones iniciales distintas, involucrando otros sistemas. En los casos en los que se identificó afectación del sistema nervioso central, los hallazgos más frecuentes fueron mareo, cefalea y alteración del estado de alerta. Respecto al sistema cardiovascular, la elevación de biomarcadores cardiacos y la miocarditis son unos de los hallazgos más frecuentes. Los principales síntomas gastrointestinales descritos hasta el momento son anorexia, náuseas, vómitos, diarrea y dolor o disconfort abdominal. La tromboembolia venosa es una complicación frecuente y un problema de salud pública. Las manifestaciones cutáneas siguen siendo un campo de investigación. Se han identificado exantemas maculopapulares, livedo reticular y gangrena acral, entre otros. El personal sanitario debe estar actualizado sobre los nuevos hallazgos clínicos y las formas de presentación de esta enfermedad solo parcialmente conocida, lo que permitirá hacer diagnósticos más precisos y oportunos, y así impactar en el pronóstico de estos enfermos.
Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Pandemics , Pneumonia, Viral/complications , COVID-19 , Cardiovascular Diseases/etiology , Central Nervous System Diseases/etiology , Cytokine Release Syndrome/etiology , Gastrointestinal Diseases/etiology , Humans , Kidney Diseases/etiology , SARS-CoV-2 , Skin Diseases/etiologyABSTRACT
The World Health Organization (WHO) has declared coronavirus disease 2019 (COVID-19), the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a pandemic. Global health care now faces unprecedented challenges with widespread and rapid human-to-human transmission of SARS-CoV-2 and high morbidity and mortality with COVID-19 worldwide. Across the world, medical care is hampered by a critical shortage of not only hand sanitizers, personal protective equipment, ventilators, and hospital beds, but also impediments to the blood supply. Blood donation centers in many areas around the globe have mostly closed. Donors, practicing social distancing, some either with illness or undergoing self-quarantine, are quickly diminishing. Drastic public health initiatives have focused on containment and "flattening the curve" while invaluable resources are being depleted. In some countries, the point has been reached at which the demand for such resources, including donor blood, outstrips the supply. Questions as to the safety of blood persist. Although it does not appear very likely that the virus can be transmitted through allogeneic blood transfusion, this still remains to be fully determined. As options dwindle, we must enact regional and national shortage plans worldwide and more vitally disseminate the knowledge of and immediately implement patient blood management (PBM). PBM is an evidence-based bundle of care to optimize medical and surgical patient outcomes by clinically managing and preserving a patient's own blood. This multinational and diverse group of authors issue this "Call to Action" underscoring "The Essential Role of Patient Blood Management in the Management of Pandemics" and urging all stakeholders and providers to implement the practical and commonsense principles of PBM and its multiprofessional and multimodality approaches.
Subject(s)
Blood Banks/organization & administration , Blood Transfusion , Coronavirus Infections , Pandemics , Pneumonia, Viral , Blood Donors , COVID-19 , Coronavirus Infections/therapy , Coronavirus Infections/transmission , Evidence-Based Medicine , Humans , Pneumonia, Viral/therapy , Pneumonia, Viral/transmissionABSTRACT
INTRODUCTION: Thromboelastometry evaluates viscoelastic changes in the coagulation process. It offers a graphic representation of the formation of the coagulum, its stability and the presence of lysis. OBJECTIVE: This first case of transfusion management guided by thromboelastography in Mexico and we conducted a review of the literature. METHOD: A metasearch search was performed (PubMed, Scielo, Medigraphic) with the words thromboelastometry, coagulopathy, transfusion medicine and the most influential works were included. CONCLUSIONS: The rotational thromboelastometry is a diagnostic tool that graphs the functionality of the clot, for a directed and individualized management of the coagulopathy associated with bleeding.
INTRODUCCIÓN: La tromboelastometría evalúa los cambios viscoelásticos en el proceso de coagulación. Ofrece una representación gráfica de la formación del coágulo, su estabilidad y la presencia de lisis. OBJETIVO: Se notifica el primer caso de manejo transfusional guiado por tromboelastografía en México con revisión de la bibliografía. MÉTODO: Se realizó una búsqueda en metabuscadores (PubMed, Scielo, Medigraphic) con las palabras tromboelastometría, coagulopatía y medicina transfusional y se incluyeron los trabajos más influyentes. CONCLUSIONES: La tromboelastometría rotacional es una herramienta diagnóstica que grafica la funcionalidad del coágulo para un manejo dirigido e individualizado de la coagulopatía relacionada con hemorragia.
Subject(s)
Blood Component Transfusion/methods , Shock/therapy , Thrombelastography/methods , Whole Blood Coagulation Time/methods , Adolescent , Afibrinogenemia/drug therapy , Afibrinogenemia/etiology , Blood Platelets/physiology , Craniocerebral Trauma/complications , Craniocerebral Trauma/surgery , Crystalloid Solutions/administration & dosage , Emergencies , Erythrocyte Transfusion/methods , Fatal Outcome , Female , Fibrinogen/therapeutic use , Humans , Mexico , Plasma , Shock/etiology , Wounds, Gunshot/complications , Wounds, Gunshot/surgeryABSTRACT
Monitoring of the neurocritical in the perioperatory is in constant evolution. There are essentially two ultrasonographic application of neuromonitoring: the diameter of the sheath of the optic nerve and transcranial Doppler. Ultrasound-guided neuromonitoring can detect stenosis or occlusion of intracranial arteries, monitor the evolution of patients with vasospasm after subarachnoid hemorrhage, detect cerebral embolism, evaluate the cerebral collateral system, determine brain death, calculate indirectly Intracranial pressure and cerebral perfusion and helps in clinical decisions and early therapeutic interventions in neurocritical care. The purpose of this review is to present the applications of ultrasonography to the head of the patient in neuromonitoring.
El monitoreo del paciente neurocrítico en el perioperatorio se encuentra en constante evolución. Existen fundamentalmente dos evaluaciones ultrasonográficas de neuromonitoreo: el diámetro de la vaina del nervio óptico y el Doppler transcraneal. En la actualidad, el neuromonitoreo guiado por ultrasonido permite detectar estenosis u oclusión de arterias intracraneales, monitorizar la evolución de los enfermos que presentan vasoespasmo tras una hemorragia subaracnoidea, detectar embolias cerebrales, evaluar el sistema colateral cerebral, determinar la muerte cerebral, calcular de manera indirecta la presión intracraneana y la perfusión cerebral, entre otras, y de esta manera poder tomar decisiones terapéuticas tempranas en el manejo del paciente neurocrítico. El motivo de esta revisión es dar a conocer las aplicaciones de la ultrasonografía a la cabecera del enfermo en neuromonitoreo.
Subject(s)
Cerebrovascular Disorders/diagnostic imaging , Intraoperative Neurophysiological Monitoring/methods , Neuroimaging/methods , Optic Nerve/diagnostic imaging , Perioperative Care/methods , Ultrasonography, Doppler, Transcranial , Brain Death/diagnostic imaging , Brain Injuries, Traumatic/diagnostic imaging , Cerebrovascular Circulation/drug effects , Clinical Decision-Making , Humans , Intracranial Pressure , Orbit/diagnostic imaging , Pulsatile Flow , Subarachnoid Hemorrhage/diagnostic imaging , Vasoconstrictor Agents/pharmacology , Vasospasm, Intracranial/diagnostic imagingABSTRACT
ANTECEDENTES: La reanimación hídrica intravenosa es esencial en el manejo de los pacientes hospitalizados, en especial en aquellos con enfermedad aguda o crítica. En la actualidad se proponen cuatro premisas con cuatro indicaciones, cuatro preguntas y cuatro fases para la reanimación hídrica intravenosa. OBJETIVO: El objetivo de esta revisión es dar a conocer esta propuesta de manejo en la reanimación hídrica intravenosa. CONCLUSIONES: Estas premisas de reanimación hídrica intravenosa coexisten de manera continua y con una variabilidad observada en el balance hídrico que se da a entender como un proceso dinámico, sin un patrón fijo temporal ni una escala de tiempo, el cual debe ser individualizado según el contexto clínico del paciente. BACKGROUND: Intravenous fluid therapy is essential in the management of hospitalized patients, especially in those with acute or critical illness. It has been proposed four premises, four indications, four questions, and four phases for guidance of this fluid therapy. OBJECTIVE: The objective of this manuscript is to review these new concepts of intravenous fluid therapy. CONCLUSION: These phases of intravenous fluid resuscitation coexist continuously and with a variability observed on fluid balance, is meant as a dynamic process, not as a temporary fixed pattern or a time scale and which must be individualized to the clinical context of patient.
