ABSTRACT
Resumen: La diabetes mellitus se ha convertido en un problema de salud pública en el mundo, ya que su incidencia y prevalencia se ha incrementado de manera exponencial en las últimas décadas, lo que ha traído consigo un aumento en las complicaciones agudas y crónicas asociadas a su diagnóstico tardío y poco apego a su tratamiento. Los pacientes con diabetes mellitus tienen una mayor probabilidad de requerir una cirugía en comparación con la población general, quienes podrían llegar a presentar complicaciones graves asociadas al evento quirúrgico como hipertensión, cardiopatía isquémica, nefropatía y neuropatía autonómica, las cuales se deben a un incremento de la resistencia a la insulina y a la hiperglucemia. Por lo anterior, el control metabólico es pieza clave en la conducta perioperatoria del paciente con diabetes mellitus donde la participación de un equipo multidisciplinario (médico internista, cirujano y anestesiólogo) definan de manera conjunta las mejores estrategias quirúrgicas y anestésicas para un mejor desenlace previo, durante y posterior a la cirugía.
Abstract. Diabetes mellitus has become a public health problem worldwide, its incidence and prevalence have exponentially increased in recent decades, bringing with it an increase in acute and chronic complications associated with late diagnosis and failure of adherence to treatment. Patients with diabetes mellitus are more likely to require surgery compared to the general population, they may have serious complications associated with the surgical event such as hypertension, ischemic heart disease, nephropathy and autonomic neuropathy, due to an increase in insulin resistance and hyperglycemia. Therefore, metabolic control is a key element in the perioperative behavior of patients with diabetes mellitus where the joint collaboration of a multidisciplinary team (internist, surgeon and anesthesiologist) to define the best surgical and anesthetic strategies for a better outcome before, during and after surgery.
ABSTRACT
Resumen La osteoartritis es una enfermedad articular crónica degenerativa, es la afección articular observada con más frecuencia en la población adulta y una de las principales causas de discapacidad en todo el mundo, por lo que es de importancia el diagnóstico y tratamiento en las fases tempranas de la enfermedad. En la actualidad los nuevos tratamientos, además de aliviar el dolor, pueden disminuir la limitación funcional y modificar el curso de la enfermedad. El objetivo de este artículo es actualizar la evidencia acerca del diagnóstico y de las nuevas formas de tratamiento de la osteoartritis, así como evaluar los cambios en la evidencia que ha habido en relación con la guía anterior. Para la elaboración de la guía motivo de esta reunión, se contó con la participación de especialistas en Medicina Interna, Reumatología, Ortopedia y Rehabilitación física, un bibliotecario y un experto en metodología; se realizó una búsqueda extensa en PubMed y en otros sitios web especializados. Se estableció una serie de recomendaciones y niveles de evidencia basados en la bibliografía consultada. Se concluye que la osteoartritis es una enfermead compleja que implica múltiples factores de riesgo, por lo que es importante tomar en cuenta que el tratamiento es multidisciplinario y consta de un enfoque no farmacológico y uno farmacológico; sin embargo, es necesario crear una cultura preventiva de la osteoartritis en los médicos tratantes, en la que se eduque y se dé información al paciente para evitar que la enfermedad progrese.
Abstract Osteoarthritis, a chronic degenerative joint disease, is the joint condition most frequently observed in the adult population; is one of the leading causes of disability worldwide. Therefore, it is important the diagnosis and treatment in the early stages of the disease. Currently new therapies, in addition to relieving pain, can reduce functional limitation and modify the course of the disease. The objective of this article is to update the evidence on diagnosis and new forms of osteoarthritis treatment, as well as to evaluate the changes in the evidence that has been in relation to the previous guide. For the elaboration of the guide, there was participation of specialists (Internal Medicine, Rheumatology, Orthopedics and Physical Rehabilitation), a librarian and an expert in methodology; an extensive search was carried out in PubMed and other specialized websites. A series of recommendations and levels of evidence were established based on the bibliography consulted. Concluding that osteoarthritis is a complex pathology involving multiple risk factors, it is important to consider that the treatment is multidisciplinary and consists of a non-pharmacological approach and a pharmacological treatment; however, it is necessary to create a preventive culture on osteoarthritis in treating doctors, in which the patient is educated and given information to prevent the disease from progressing.
ABSTRACT
INTRODUCTION: Craniosynostosis is a congenital anomaly resulting from the premature fusion of the cranial sutures changing growth patterns of the skull. METHODOLOGY: Focus, scope, target population and clinical questions to be solved were defined. A systematic search for evidence in different databases (Medline, Embase, KoreaMed, Cochrane Library and the website of the World Health Organization) in stages was performed: clinical practice guidelines; systematic reviews, and clinical trials and observational studies; using MeSH, Decs and corresponding free terms, unrestricted language or temporality. Risk of bias was evaluated using appropriate tools (AMSTAR, Risk of Bias or STROBE). The quality of evidence was graduated using the GRADE system. Modified Delphi Panel technique was used to assign the recommendation's strength and direction, as well as the degree of agreement with it, taking into account the quality of evidence, balance between risks and benefits of interventions, values and preferences of patients and availability of resources. RESULTS: There were 3,712 documents obtained by search algorithms; selecting 29 documents for inclusion in the qualitative synthesis. Due to heterogeneity between studies, it was not possible to perform meta-analysis. CONCLUSIONS: We issued 7 recommendations and 8 good practice points, which will serve as support for decision-making in the comprehensive care of patients with craniosynostosis.
Subject(s)
Craniosynostoses , Practice Guidelines as Topic , Clinical Trials as Topic , Craniosynostoses/diagnosis , Craniosynostoses/rehabilitation , Craniosynostoses/surgery , Delphi Technique , Evidence-Based Medicine , Female , Humans , Infant , Infant, Newborn , Male , Observational Studies as Topic , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND: Clinical practice guidelines are tools that have been able to streamline decisions made in health issues and to decrease the gap between clinical action and scientific evidence. OBJECTIVE: The objective of the study is to share the experience in the development and to update the guidelines by the National Health System of Mexico. MATERIAL AND METHODS: The methodology in the development of the guidelines consists of 5 phases: prioritisation, establishment of work groups, development by adoption of international guidelines of de novo, validation and integration in the Master catalogue of clinical practice guidelines for its dissemination. RESULTS: The Master catalogue of clinical practice guidelines contains 664 guidelines, distributed in 42% Internal Medicine, 22% Surgery, 24% Pediatrics and 12% Gynecology. From the total of guidelines coverage is granted at an 85% of the Universal catalogue of health services, an 84% of the Catastrophic expenses protection fund and a 61% of the XXI Century Medical Insurance of the National Commission of Social Protection in Health. DISCUSSION: The result is the sum of a great effort of coordination and cooperation between the institutions of the National Health System, political wills and a commitment of 3,477 health professionals that participate in guidelines' development and update. CONCLUSION: Master catalogue guidelines' integration, diffusion and implantation improve quality of attention and security of the users of the National Health System.
Subject(s)
Delivery of Health Care , Practice Guidelines as Topic , Humans , Mexico , Practice Guidelines as Topic/standardsABSTRACT
BACKGROUND: the intra-abdominal hypertension is defined as an increase in intra-abdominal pressure more or equal as ≥ 12 mmHg and it is called as abdominal compartment syndrome when associates with any organ dysfunction. Its development in the patient with multiple trauma is the result of the mechanism of injury, aggressive resuscitation and/or surgical treatment. The goal of this investigation is to describe the monitoring and all decisions made based on the measurement of intra-abdominal pressure in a patient with multiple injuries that developed abdominal compartment syndrome. CLINICAL CASE: 21 years old male with multiple trauma who underwent damage control surgery with splenectomy, repair of liver injury and packaging. Intra-abdominal pressure monitoring showed progressive increase that was associated with cardiopulmonary dysfunction resistant to medical treatment so we decided to unpack, which reduced the intra-abdominal pressure and improved cardiopulmonary fitness. CONCLUSIONS: intra-abdominal hypertension / abdominal compartment syndrome significantly increases morbidity and mortality therefore the measurement of intra-abdominal pressure is a fundamental tool for early detection and timely management of this condition and its complications.
Subject(s)
Fluid Therapy/adverse effects , Hemorrhage/therapy , Hemostatic Techniques/adverse effects , Intra-Abdominal Hypertension/etiology , Multiple Trauma/complications , Postoperative Complications/etiology , Accidents, Traffic , Capillary Permeability , Cytokines/metabolism , Edema/etiology , Edema/physiopathology , Female , Hemodynamics , Hemorrhage/etiology , Humans , Intra-Abdominal Hypertension/physiopathology , Intra-Abdominal Hypertension/therapy , Liver/injuries , Liver/surgery , Manometry , Multiple Trauma/surgery , Oxidative Stress , Postoperative Complications/physiopathology , Postoperative Complications/therapy , Shock/etiology , Shock/physiopathology , Shock/therapy , Splenectomy , Splenic Rupture/etiology , Splenic Rupture/surgery , Sympathetic Nervous System/physiopathology , Young AdultABSTRACT
BACKGROUND: At the beginning of the second trimester of 2009 there was an influenza A (H1N1) outbreak. The aim of this study is to describe the clinical presentation and mortality of the severe form of pneumonia in patients with human influenza A H1N1. METHODS: We conducted a retrospective review of all files of confirmed and suspected patients with severe human influenza A (H1N1) pneumonia. RESULTS: We studied 26 patients admitted to the ICU from April 1 to December 31, 2009, among which 16 were males (61.54%) and 10 females (38.46%) with an average age of 52.26 ± 15.48 years. The time of onset of symptoms to admission to the ICU was 6.3 ± 3.19 days. The most frequent symptoms and signs were salmonated sputum (47%), chills (45%), dry cough (44%) and myalgia (42%). The mortality rate was 19.23%. The treatment was based on antiviral therapy, modulating inflammation and ventilatory techniques to optimize oxygenation. There was an association between combined therapy based on methylprednisolone, activated protein C and statins with a better survival (p = 0.05). CONCLUSIONS: Pneumonia virus of human influenza A (H1N1) is associated with high morbidity and mortality. According to our results, it is recommended to make an early diagnosis and to initiate a treatment regimen based on treatment bundles designed to optimize oxygenation, reduce viral load and modulate inflammation.
Subject(s)
Critical Care/methods , Disease Outbreaks , Influenza A Virus, H1N1 Subtype , Influenza, Human/therapy , Intensive Care Units/statistics & numerical data , Pneumonia, Viral/therapy , Adult , Aged , Anti-Inflammatory Agents/therapeutic use , Antiviral Agents/therapeutic use , Biomarkers , Blood Proteins/analysis , Combined Modality Therapy , Comorbidity , Disease Management , Female , Humans , Influenza, Human/blood , Influenza, Human/drug therapy , Influenza, Human/epidemiology , Male , Mexico/epidemiology , Middle Aged , Oxygen Inhalation Therapy , Pneumonia, Viral/blood , Pneumonia, Viral/drug therapy , Pneumonia, Viral/epidemiology , Pravastatin/therapeutic use , Protein C/therapeutic use , Respiration, Artificial , Retrospective StudiesABSTRACT
Introducción: El quilotórax es la presencia de quilo en el espacio pleural secundaria a lesión u obstrucción del conducto torácico. Su etiología puede ser traumática o no traumática. El aspecto lechoso del líquido pleural y su alto contenido de triglicéridos orientan el diagnóstico. El objetivo de este trabajo es presentar un caso de quilotórax secundario a herida por proyectil de arma de fuego y revisar los conceptos actuales y opciones terapéuticas. Caso clínico: Paciente de 33 años que presentó quilotórax secundario a herida por proyectil de arma de fuego. Se manejó a base de ayuno, alimentación parenteral y drenaje pleural. Su evolución fue satisfactoria. Conclusiones: El quilotórax es una entidad asociada a elevada morbilidad y mortalidad. Su diagnóstico temprano y oportuno, como en el paciente descrito, es fundamental para asegurar la evolución satisfactoria.
BACKGROUND: Chylothorax is the occurrence of chyle in the pleural space due to damage or obstruction of the thoracic duct. Its etiology can be traumatic or nontraumatic. Traumatic lesion of the thoracic duct occurs after accidents or cardiothoracic surgery. Non-Hodgkin's lymphoma is the most frequent nontraumatic etiology. Milky aspect and high content of triglycerides in pleural fluid confirm the diagnosis. The objective of this paper is to present a case of chylothorax secondary to shotgun lesion as well as to review current concepts about chylothorax and its treatment. CLINICAL CASE: We present the case of a 33-year-old male patient with chylothorax secondary to gunshot lesion. Management was based on fasting, parenteral nutrition and pleural drainage. Patient's evolution was satisfactory. CONCLUSIONS: Chylothorax is an entity associated with high morbidity and mortality. Early diagnosis and appropriate treatment are essential.
Subject(s)
Humans , Male , Adult , Wounds, Gunshot/complications , Chylothorax/etiologyABSTRACT
BACKGROUND: Chylothorax is the occurrence of chyle in the pleural space due to damage or obstruction of the thoracic duct. Its etiology can be traumatic or nontraumatic. Traumatic lesion of the thoracic duct occurs after accidents or cardiothoracic surgery. Non-Hodgkin's lymphoma is the most frequent nontraumatic etiology. Milky aspect and high content of triglycerides in pleural fluid confirm the diagnosis. The objective of this paper is to present a case of chylothorax secondary to shotgun lesion as well as to review current concepts about chylothorax and its treatment. CLINICAL CASE: We present the case of a 33-year-old male patient with chylothorax secondary to gunshot lesion. Management was based on fasting, parenteral nutrition and pleural drainage. Patient's evolution was satisfactory. CONCLUSIONS: Chylothorax is an entity associated with high morbidity and mortality. Early diagnosis and appropriate treatment are essential.
