[Recommendations on organization, design, characteristics and operation of neonatology services]. / Recomendaciones de organización, diseño, características y funcionamiento de servicios o unidades de neonatología.

Neonatal care has undergone important advances involving the technology for treatment and mo nitoring, the design of care spaces, the incorporation of support professionals, and, especially, the strengthening of an organizational model in networks with centers of different levels of care. Neona tal units should be located in centers with maternity services and, ideally, with pediatric ones of an equivalent level of care. This document defines the admission and transfer criteria according to the level of care and among the different levels, respectively. The evidence recommends an individual room design due to the associated benefits such as decreased occurrence and better control of health care-associated infections, improved breastfeeding, and better interaction with parents. The sugges ted room sizes favor the implementation of the family-centered care model. These recommendations establish the possibility of performing emergency surgical procedures in the neonatal unit and define the safety criteria of the physical plant. In addition, they define the human resources according to the level of care, recognizing the time dedicated to non-direct patient care activities, , and the re quirements of non-medical professionals such as psychologists, physical and respiratory therapists, occupational therapists, speech therapists, pharmacists, dietitians, and social workers. Neonatal care should be led by the neonatologist allowing the participation of general pediatricians with training and demonstrated experience in neonatal care. Midwives and neonatal nurses should have accredited formation in such area. The purpose of this document is to update the "Recommendations on the Organization, Characteristics and Operation of Neonatology Services or Units" to serve as an orien tation and guide for the design and management of neonatal care in public and private health care centers in the country.

Within Our Skin.

From "beauty is only skin deep" to "it takes a thick skin," there are a countless number of skin-related aphorisms that serve as social commentaries on the beauty and resilience of skin. The skin as an interface to society may have diverse psychological implications, but its physiological importance to health is undeniable. As the largest organ in the body, the skin presents a formidable barrier that serves to protect our internal physiology from potentially harmful stimuli of the external environment.

Rehabilitation of medically complex ectodermal dysplasia with novel surgical and prosthodontic protocols.

The functional and aesthetic needs of a 17-year-old patient afflicted with ectodermal dysplasia, chronic long-term immunosuppression, cleft palate, velopharyngeal insufficiency, hypernasality, maxillary hypoplasia, and oligodontia were met with a multidisciplinary team approach. Predictable functional and aesthetic outcomes were obtained with a combination of injection augmentation of the soft palate and nasopharynx and rigid fixation maxillary external distraction with immediate placement and immediate load protocols. No biological or prosthetic complications were noted after definitive rehabilitation with a mandibular implant-retained fixed prosthesis and a maxillary implant-retained detachable prosthesis.

Intoxicación neonatal por sulfato de magnesio: caso clínico / Magnesium neonatal intoxication: a case review

Magnesium Sulfate is currently the treatment of choice for severe preeclampsia and eclampsia. Since it crosses the placenta, magnesium can reach high levels in fetal plasma, occasionally reaching levels higher than maternal plasma. Objective: To analyze a 35 weeks gestational age newborn, who presented hypermagnesemia due to maternal treatment with magnesium sulfate (in routine dosage) indicated for severe preeclampsia. Clinical Case: The mother was infused with MgS04 for 17 hours until pregnancy was interrupted because of fetal monitoring. The baby weighed 2,620 grams, was depressed, hypotonic, cyanotic and without respiratory effort and only partially responded to initial resuscitation with positive pressure ventilation. The infant was admitted to the Neonatal Intensive Care Unit for monitoring, support and management. High levels of plasma MgS04 were found (4.7 mg/dl), compatible with the diagnosis of hypermagnesemia. Symptoms and signs slowly disappeared, and the child was discharged after 10 days of hospitalization. Conclusion: We present the clinical case of a newborn with a history of maternal use of magnesium sulfate, who presented hypermagnesemia characterized by neonatal depression, hypotonia, central apnea with oxygen requirement and who progressively normalized in a 10 day period.

El Sulfato de Magnesio es actualmente el medicamento de elección para el tratamiento de la embarazada con preeclampsia severa y eclampsia. Dado que atraviesa la placenta, alcanza elevados niveles en el plasma fetal, pudiendo en ocasiones superar la concentración plasmática materna. Objetivo: Analizar la evolución de un neonato de 36 semanas de edad gestacional que cursó con cuadro de hipermagnesemia secundario a tratamiento materno con sulfato de magnesio en dosis habituales, indicado como terapia de una preeclampsia severa. Caso clínico: Madre recibe infusión de MgS04 por un total de 17 hrs antes de decidirse la interrupción del embarazo por vía alta debido a un registro sospechoso. Se obtuvo recién nacido de 2 620 gramos, deprimido, sin esfuerzo respiratorio, hipotónico y cianótico, que respondió parcialmente a la reanimación inicial con ventilación a presión positiva. Se decidió ingreso a Cuidados Intensivos de la Unidad de Neonatología para monitorización, soporte y manejo. Se detectaron niveles plasmáticos elevados de MgS04 de 4,7 mg/dL compatibles con el diagnóstico de Hipermagnesemia. La signología fue disminuyendo progresivamente, decidiéndose el alta luego de 10 días de hospitalización. Conclusión: Se presenta caso clínico de un recién nacido, con antecedente de sulfato de magnesio administrado a la madre y que evoluciona con un cuadro de hipermagnesemia caracterizado por depresión neonatal, apneas centrales, requerimientos de oxígeno e hipotonía, los cuales van normalizándose progresivamente en el curso de 10 días.

Histerectomía laparoscópica y medicina basada en la evidencia / Laparoscopic hysterectomy and evidence-based medicine

Objetivo: Se analiza el grado de evaluación de la histerectomía laparoscópica mediante estudios prospectivos aleatorizados. Material y método: Artículos prospectivos aleatorizados y metaanálisis sobre histerectomía laparoscópica recogidos en la base de datos médicos PubMed y en la Colaboración Cochrane, en el período comprendido entre enero de 1989 y octubre de 2004. Se analizan los metaanálisis y los estudios prospectivos aleatorizados que comparan la histerectomía laparoscópica con la histerectomía abierta (abdominal o vaginal). Resultados: Se encontraron 1.255 documentos, de los que 53 (4,22%) son estudios prospectivos aleatorizados y, de ellos, 27 (50,94%) comparan la histerectomía laparoscópica con el abordaje tradicional de la histerectomía (abdominal o vaginal). No se encontró ninguna revisión sistemática en la Colaboración Cochrane acerca de la histerectomía laparoscópica. Conclusiones: Los estudios controlados aleatorizados no se han utilizado ampliamente en el análisis de la histerectomía laparoscópica. Las razones son múltiples y están relacionadas fundamentalmente con las dificultades para realizar este tipo de estudios, tanto por parte de los profesionales como de los pacientes

Objective: To evaluate the extent to which laparoscopic hysterectomy has been evaluated through randomized controlled trials. Material and method: Studies on laparoscopic hysterectomy published between January 1989 and October 2004 were retrieved from PubMed and the Cochrane Library. Metaanalyses and randomized controlled trials comparing laparoscopic hysterectomy with open hysterectomy (abdominal or vaginal) were analyzed. Results: Of 1255 documents retrieved, 4.22% (53) were randomized controlled trials; of these, 27 (50.94%) compared laparoscopic hysterectomy with open hysterectomy. No systematic reviews were found in the Cochrane Library. Conclusions: Randomized controlled trials are not widely used in the evaluation of endoscopic surgery. The reasons for this are multiple and are usually related to the technical difficulties of carrying out this type of study for both gynecologists and patients

Situaciones y conductas de riesgo en el trayecto escolar de un grupo adolescente de la región metropolitana. 2001 / Risk situations and behavior involving a group of a teen-agers in their journey to and from school in the metropolitan region. 2001

Para conocer algunas de las características de los accidentes, violencia y conductas de riesgo que enfrentan los estudiantes durante el trayecto desde y hacia su hogar, se encuestaron durante el año 2001 un total de 551 adolescentes varones estudiantes de un colegio de Santiago centro. El objetivo de la investigación fue precisar la frecuencia; tipo de accidente; lugar y horario de ocurrencia así como el impacto físico y emocional de los eventos detectados. El promedio de edad de los estudiantes fue de 14,6 años; el tiempo promedio de viaje fue de 53 minutos. De los que se movilizaban en locomoción pública, el 42,9 porciento lo hacía "siempre o casi siempre" acompañado por un amigo; el 16,9 porciento acompañado por sus padres y el 21,2 porciento lo hacía "solo o raramente acompañado". El 60 porciento de los estudiantes reconocieron algunas conductas positivas en los choferes de la locomocíon colectiva pero asignándoles, a la vez, conductas negativas de entre 36,8 a 68,8 porciento. por otra parte, los estudiantes reconocieron conductas negativas "siempre o casi siempre" en un 26,3 porciento y 52,1 porciento y solo autocalificaron con baja frecuencia conductas positivas. el 11 porciento de los estudiantes dieron el antecedente de haber sido asaltados, cerca del colegio o de sus domicilios (42,6 porciento) o en los autobuses (23 porciento). El 81,4 porciento de los asaltos ocurrieron en el viaje de retorno a casa y generaron "inseguridad y miedo" (34 porciento) "odio o rabia" (33,9 porciento). Un 11,2 porciento señalaron haber sufrido algún accidente de tránsito durante sus despalazamientos (especialmente al bajar del autobús siendo los más comunes los esguinces de tobillo y rodilla (37,9 porciento). El tren metropolitano fue considerado como el medio de movilización más seguro (62,9 porciento) en tanto que la calle y los paraderos de autobuses como los lugares más inseguros.

A randomized double-blind clinical trial of the effect of chondroitin sulfate and glucosamine hydrochloride on temporomandibular joint disorders: a pilot study.

Previous studies have shown chondroitin sulfate and glucosamine hydrochloride have beneficial effects on symptoms of osteoarthritis of the knee. Our aim was to study the effect of a daily dose of 1500 mg of glucosamine hydrochloride (GH) and 1200 mg of chondroitin sulfate (CS) taken for twelve weeks on subjects diagnosed with capsulitis, disk displacement, disk dislocation, or painful osteoarthritis of the temporomandibular joint (TMJ). Forty-five subjects were enrolled in the study and were randomly assigned to either an active medication group or a placebo group. Eleven subjects were lost from the study for various reasons, resulting in fourteen subjects remaining in the active medication group and twenty subjects remaining in the placebo group. Subjects taking CS-GH had improvements in their pain as measured by one index of the McGill Pain Questionnaire, in TMJ tenderness, in TMJ sounds, and in the number of daily over-the-counter medications needed. Subjects taking the placebo medication had improvements in their pains as measured by the visual analog scale and by four indices of the McGill Pain Questionnaire. Additional studies are required to evaluate the clinical effectiveness of CS-GH and to determine the exact mechanism by which CS-GH affects the articular cartilage of synovial joints.

Trompa de falopio accesoria / Accessory Fallopian tube

No disponible

A combined direct dowel and indirect core technique.

The dowel-and-core restoration is indicated when inadequate tooth structure remains to retain an extracoronal restoration. A modified technique for fabricating the dowel and core combines the direct technique of forming the dowel in the actual channel with the indirect technique of creating an ideal core contour in the laboratory. This technique allows the operator to create an accurate and passive fit of the dowel pattern in the canal preparation. The technique also introduces the option of retrieving the dowel portion by utilizing a polyvinyl siloxane cast or liner. Further advantages of the technique are reduced chairside time and the ability to capitalize on the preparation of multiple teeth. The technique focuses efforts on achieving an accurate and passive fit of the dowel clinically while delegating the formation of the core to the laboratory.

Managing malrelated arches and limited vertical space for implant-supported overdentures: a case report.

Advancements in implant therapy have expanded the prosthetic options available to treat edentulous patients. The dental professional must be able to accurately diagnose the status of the intraoral environmental in order to provide the patient with appropriate treatment and a suitable restorative result. Skeletal relationships, arch malalignment, implant angulation, and ridge morphology must be evaluated during initial treatment planning and incorporated into the definitive prosthetic result. This case report demonstrates the application of an implant-supported prosthesis to address the various complications presented in the treatment of edentulous patients.