Electroencephalographic Patterns During Common Nursing Interventions in Neurointensive Care: A Descriptive Pilot Study.

BACKGROUND: Many patients with neurological insults requiring neurointensive care have an increased risk of acute symptomatic seizures. Various nursing interventions performed when caring for these patients may elicit pathological cerebral electrical activity including seizures and stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs). The aim was to explore changes in electroencephalogram (EEG) due to neurointensive care nursing interventions. METHODS: A convenience sample was recruited between November 2015 and April 2016, consisting of 12 adult patients with impaired consciousness due to a neurosurgical condition. Continuous EEG and simultaneous video recordings of nursing interventions were collected 48 continuous hours for each patient. Two analysts categorized the video recordings for common nursing interventions, and a neurophysiologist analyzed the EEGs. RESULTS: In total, 976 nursing interventions were observed. Epileptiform activity was observed in 4 patients (33%), during 1 nursing intervention episode each (0.4%). The 4 observed episodes of epileptiform activity occurred during multiple simultaneous nursing interventions (n = 3) and hygienic interventions (n = 1). Stimulus-induced rhythmic, periodic, or ictal discharges were observed in 1 patient (8%), in 1 single nursing intervention (0.1%). The observed SIRPIDs occurred during repositioning of the patient. All patients had muscle artifacts, during 353 nursing interventions (36.3%). The duration of nursing interventions was longer for those with simultaneous muscle artifacts (median, 116 seconds) than those without muscle artifacts, epileptiform activity, or SIRPIDs (median, 89.0 seconds). With regard to epileptiform activity and SIRPIDs, the median durations of the nursing interventions were 1158 and 289 seconds, respectively. CONCLUSION: The results of this pilot study indicate that muscle artifacts seem prevalent during nursing interventions and may be a sign of stress. Nurses should be aware of the risk of inducing stress by performing regular nursing interventions in daily practice, consider shorter or fewer interventions at a time in sensitive patients, and administer sedation accordingly. Considering that this was a pilot study, more research that investigates correlations between EEG patterns and nursing interventions in larger samples is needed.

Redes integradas de servicios de salud: gestión de tres programas sanitarios en red. Resultados y alcances en la red sudeste, área programática Hospital El Cruce, región sanitaria VI, provincia de Buenos Aires / Integrated networks of health services: management of three network health programs. Results and scope in the southeast network, Hospital El Cruce programmatic area, health region VI, province of Buenos Aires

OBJETIVO Se abordará el análisis de las capacidades técnico-asistenciales y de gestión para el desarrollo de tres Programas sanitarios estratégicos en la red de servicios de salud de la Subregión Sudeste, Área programática del Hospital El Cruce, Región Sanitaria VI, Provincia de Buenos Aires. Se seleccionaron tres Programas, que por su relevancia sanitaria en términos de impacto en salud y por los procesos de interacción entre servicios que implican, ponen de manifiesto el grado de consolidación de la red, alcances y obstáculos a revertir. Estos Programas son; Programa de Cardiopatías Congénitas, Programa de Procuración y Trasplante y Programa Cirugías de Corta Estancia. Los dos primeros representan Programas de alta complejidad y el tercero corresponde a intervenciones de baja complejidad asistencial. METODOLOGÍA El diseño metodológico será cuantitativo y cualitativo, incluyendo variables de estructura, procesos y resultados de los Programas en el contexto de la red. Por su temporalidad y procesos aplicados para la recolección de datos se trata de un estudio transversal retroprospectivo, que triangula información secundaria con fuentes primaria aplicando entrevista a actores claves. RESULTADOS El estudio contribuirá a la identificación de barreras y oportunidades para la consolidación de redes, particularmente referidas a la accesibilidad y cobertura efectiva de los Programas estudiados; posibilitará sistematizar capacidades técnico asistenciales y de gestión que aporten base a la planificación de procesos de atención en red y de recursos asistenciales; y aportará evidencias para el desarrollo de herramientas de medición de brechas asistenciales y de cobertura en los Programas seleccionados y en la red en general

Total and biologically active CD154 in patients with SLE.

CD154, a member of the tumor necrosis factor receptor family, is involved in several biological responses. In the sera of systemic lupus erythematosus (SLE) patients, the levels of sCD154 have been shown to be increased, however, few reports have dealt with the biologically active tetramer. Here, we assessed the biological activity of the serum CD154 tetramer using bioassays for BC activation and production nitrite or peroxide. The patients showed a markedly increased total sCD154 serum concentration (12.5 +/- 8.2 vs. 3.9 +/- 1.2 ng/ml; p < 0.001). ba-sCD154 was significantly increased in non-treated patients (7.4 +/- 3.4 ng/ml, n = 22; p < 0.001) and patients with the highest SLE disease activity index (SLEDAI) scores (5.3 +/- 2.9 ng/ml, n = 8), but not in stable patients (1.3 +/- 1.2 ng/ml, n = 30) whose values were similar to normal healthy donors (NHD; 0.8 +/- 0.2 ng/ml). Patients with SLEDAI above 8 that recovered after successful treatment displayed significantly decreased levels of ba-sCD154. We conclude that the bioassay is a useful tool discriminating active and stable SLE, as well as non-treated patients.

Decreased transcription, expression and function of low-density lipoprotein receptor in leukocytes from patients with systemic lupus erythematosus.

The low-density lipoprotein receptor (LDLR) is directly involved in the metabolism of low-density lipoprotein (LDL) and its impairment causes accumulation of plasmatic LDL leading to atherosclerosis, a prevalent disease in patients with systemic lupus erythematosus (SLE). We studied LDLR transcription, expression and function in leukocytes patients with SLE and normal healthy donors (NHD). The ratio LDLR/glyceraldehyde-3-phosphate dehydrogenase (GADPH) mRNAs the expression of LDLR and the uptake of LDL-DiI were significantly lower (p < 0.001) in the patients with SLE. On the contrary, patients with SLE had significantly higher (p < 0.0001) levels of total cholesterol, LDL cholesterol and anti-oxLDL autoantibodies (AAb) as compared to NHD. No correlation between LDLR transcription, expression and function with the SLE disease activity index or with treatment was found. The decreased function of LDLR was independent of treatment. It seems dependent on the sterol regulatory binding protein and may be responsible for the increase of plasma LDL cholesterol and oxLDL AAb further increasing the risk of vascular diseases.

Serum adipokine levels in patients with systemic lupus erythematosus.

In patients with systemic lupus erythematosus (SLE) metabolic alterations are often observed, which may be due to either the disease, the genetic background or the treatment. We studied the serum levels of the adipokines leptin, adiponectin, resistin, visfatin and ghrelin in patients with SLE and controls. Leptin levels were lower and adiponectin, ghrelin and visfatin levels were higher in the patients. No significant differences were encountered for resistin. The values of adipokines were independent of treatment, even after correction for body mass index. Inverse correlations were found among leptin and adiponectin, ghrelin and visfatin. We conclude that adipokines are involved in the metabolic imbalance of patients with SLE.

La relevancia de la intervención psicosocial en pacientes con cáncer de mama / Relevance of psychosocial intervention in breast cancer patient

Cancer diagnosis and disease progression induce high levels of stress than in some people go along with depression and anxiety. Objectives: To analyze the incidence of psychological alterations in breast cancer patients and possible modifications by a cognitive-behavioral treatment, that included relaxation and guided-imagery as well as stress management. Methods: Depression, anxiety and alexithymia were diagnosed by the use of Beck2 Depression Inventory, Spielberger´State/Trait Anxie3ty Inventory and Toronto Alexithymia Scale in 26 breast cancer patients and 18 controls without cancer with mean age 48 ± 11 years. Eight patients attended for 5 days to a psychosocial intervention program. Depression, anxiety, alexithymia and perceived physical well-being were measured before and one week after program attendance. Results: Higher frequency of depression, state and trait anxiety was detected in patients in opposition to controls who showed higher frequency of alexithymia. Patients showed increased severity of depression and alexithymia. Furthermore, a higher percentage of patients showed simultaneous expression of depression and state/trait anxiety. Lower levels of state anxiety levels (p<0.02) and trait anxiety were detected after support program attendance. Patients with previous depression diagnosis did not showed depression indicators after intervention. Conclusion: Breast cancer patients showed higher incidence of psychological alterations than persons without cancer. Psychological Interventions can increase the quality of life in breast cancer patients by de3creasing the anxiety and depression they present (AU)

El diagnóstico de cáncer y su progresión, genera altos niveles de estrés que se acompañan en algunos casos con alteraciones psicológicas. Objetivos: Analizar la incidencia de alteraciones psicológicas en pacientes con cáncer de mama y su posible modificación mediante un tratamiento cognitivo-conductual, que aplica relajación, imaginación guiada y otras técnicas de control de estrés. Método: Se evaluó la presencia de depresión, ansiedad y alexitimia mediante el Inventario de Depresión de Beck, el Inventario de Ansiedad Estado/Rasgo de Spielberger y la Escala de Alexitimia de Toronto, en 26 pacientes con cáncer de mama y 18 controles sin cáncer, con edad promedio de 48 ±11 años. Ocho pacientes participaron durante 5 días en un programa de intervención psicosocial y se midió depresión, ansiedad, alexitimia y bienestar físico percibido, antes y una semana después de participar en el programa. Resultados: Las pacientes presentaron mayor frecuencia de depresión, ansiedad estado y rasgo; las mujeres del grupo control presentaron mayor frecuencia de alexitimia. Se observó mayor severidad de depresión y alexitimia en las pacientes. UN mayor porcentaje de pacientes presentó simultáneamente depresión y ansiedad estado/rasgo. La participación en el programa de apoyo psicosocial determinó disminución en los niveles de ansiedad estado (p<0.02) y ansiedad rasgo. Pacientes con diagnóstico previo de depresión no presentaron indicadores de la misma después de la intervención. Conclusiones: Las pacientes con cáncer de mama presentan más alteraciones psicológicas que las personas sin cáncer. La intervención psicosocial puede mejorar la calidad de vida del paciente con cáncer de mama al disminuir la ansiedad y la depresión que frecuentemente acompañan a la enfermedad (AU)

Inducción del trabajo de partos con misoprostol intravaginal: experiencia de 5 años / Labor induction with intravaginal misoprostol: experience of 5 years

Los comprimidos para empleo oral de misoprostol se están usando en nuestro país como en otros para la inducción del trabajo de parto en que la experiencia acumulada ha mostrado ser una alternativa segura y eficiente. Es necesario precisar las exactas indicaciones del medicamento y se presenta la experiencia del Hospital de Castro. Se destaca que los malos resultados perinatales ocurren en el grupo en que fracasa la inducción con misoprostol como en aquellos en que se sospecha una insuficiencia placentaria (síndrome hipertensivo, oligoamnios y retardo del crecimiento intrauterino)