The family in preventing delirium in the intensive care unit: Scoping review.

INTRODUCTION: Delirium is cognitive impairment related to negative inpatient outcomes in the Intensive Care Unit (ICU), family interventions have been shown to be effective in reducing the incidence of this condition. OBJECTIVE: To identify strategies that include the family in the prevention of delirium in the adult intensive care unit that can be integrated into ABCDEF. INCLUSION CRITERIA: Studies describing actions and interventions involving caregivers and family members in the ICU for the prevention of delirium, conducted in the last five years, available in full text, in English and Spanish, Portuguese and in adults. METHODS: A scope review was conducted using the keywords "Critical Care, Delirium, Family, Primary Prevention" in 11 databases (PubMed, Virtual Health Library, Cochrane Library, TRIP Data base, EBSCO, Ovid Nursing, Springer, Scopus, Dialnet, Scielo, Lilacs) and other sources (Open Gray, Google Scholar), between August - October 2019; 8 studies were considered relevant and were analysed. RESULTS: The results were described in 3 categories: flexibility vs. restriction of visits in the ICU, Reorientation as a prevention strategy and post-ICU syndrome in the family. CONCLUSION: Extended visits, development of family-mediated activities, and redirection are non-pharmacological strategies that reduce the incidence of delirium in the ICU and offer multiple benefits to the patient and family/caregiver.

La familia en la prevención del delirium en la unidad de cuidados intensivos: scoping review / The family in preventing delirium in the intensive care unit: Scoping review

Introducción: El delirium es una alteración cognitiva relacionada con resultados negativos en el paciente interno en la unidad de cuidados intensivos (UCI), las intervenciones familiares han demostrado ser efectivas para reducir la incidencia de esta condición.Objetivo: Identificar las estrategias que incluyen a la familia en la prevención del delirium en la UCI del adulto que pueden ser integradas al ABCDEF. Criterios de inclusión: Estudios que describieran acciones e intervenciones que incluyan a cuidadores y familiares en la UCI para la prevención del delirium en adultos, realizados en los últimos 5 años, disponibles en texto completo, en español, portugués e inglés.Métodos: Se realizó una revisión de alcance utilizando las palabras clave «Critical Care, Delirium, Family, Primary Prevention» en 11 bases de datos (PubMed, Biblioteca Virtual de Salud, Cochrane Library, TRIP Data base, EBSCO, Ovid Nursing, Springer, Scopus, Dialnet, Scielo, Lilacs) y otras fuentes (Open Gray, Google Scholar), entre los meses de agosto-octubre de 2019; 8 estudios se consideraron relevantes y fueron analizados.Resultados: Los resultados fueron descritos en 3 categorías: flexibilidad vs. restricción de visitas en la UCI, reorientación como estrategia de prevención y síndrome post-UCI en la familia.Conclusión: Las visitas extendidas, el desarrollo de actividades mediadas por la familia y la reorientación son estrategias no farmacológicas que reducen la incidencia del delirium en la UCI y ofrecen múltiples beneficios para el paciente y su familiar/cuidador.

Introduction: Delirium is cognitive impairment related to negative inpatient outcomes in the Intensive Care Unit (ICU), family interventions have been shown to be effective in reducing the incidence of this condition.Objective: To identify strategies that include the family in the prevention of delirium in the adult intensive care unit that can be integrated into ABCDEF. Inclusion criteria: Studies describing actions and interventions involving caregivers and family members in the ICU for the prevention of delirium, conducted in the last five years, available in full text, in English and Spanish, Portuguese and in adults.Methods: A scope review was conducted using the keywords “Critical Care, Delirium, Family, Primary Prevention” in 11 databases (PubMed, Virtual Health Library, Cochrane Library, TRIP Data base, EBSCO, Ovid Nursing, Springer, Scopus, Dialnet, Scielo, Lilacs) and other sources (Open Gray, Google Scholar), between August - October 2019; 8 studies were considered relevant and were analysed.Results: The results were described in 3 categories: flexibility vs. restriction of visits in the ICU, Reorientation as a prevention strategy and post-ICU syndrome in the family.Conclusion: Extended visits, development of family-mediated activities, and redirection are non-pharmacological strategies that reduce the incidence of delirium in the ICU and offer multiple benefits to the patient and family/caregiver.

The family in preventing delirium in the intensive care unit: Scoping review. / La familia en la prevención del delirium en la unidad de cuidados intensivos: scoping review.

INTRODUCTION: Delirium is cognitive impairment related to negative inpatient outcomes in the Intensive Care Unit (ICU), family interventions have been shown to be effective in reducing the incidence of this condition. OBJECTIVE: To identify strategies that include the family in the prevention of delirium in the adult intensive care unit that can be integrated into ABCDEF. INCLUSION CRITERIA: Studies describing actions and interventions involving caregivers and family members in the ICU for the prevention of delirium, conducted in the last five years, available in full text, in English and Spanish, Portuguese and in adults. METHODS: A scope review was conducted using the keywords "Critical Care, Delirium, Family, Primary Prevention" in 11 databases (PubMed, Virtual Health Library, Cochrane Library, TRIP Data base, EBSCO, Ovid Nursing, Springer, Scopus, Dialnet, Scielo, Lilacs) and other sources (Open Gray, Google Scholar), between August - October 2019; 8 studies were considered relevant and were analysed. RESULTS: The results were described in 3 categories: flexibility vs. restriction of visits in the ICU, Reorientation as a prevention strategy and post-ICU syndrome in the family. CONCLUSION: Extended visits, development of family-mediated activities, and redirection are non-pharmacological strategies that reduce the incidence of delirium in the ICU and offer multiple benefits to the patient and family/caregiver.

A scoping review of the detection, epidemiology and control of Cyclospora cayetanensis with an emphasis on produce, water and soil.

Cyclospora cayetanensis is a parasite causing cyclosporiasis (an illness in humans). Produce (fruits, vegetables, herbs), water and soil contaminated with C. cayetanensis have been implicated in human infection. The objective was to conduct a scoping review of primary research in English on the detection, epidemiology and control of C. cayetanensis with an emphasis on produce, water and soil. MEDLINE® (Web of ScienceTM), Agricola (ProQuest), CABI Global Health, and Food Science and Technology Abstracts (EBSCOhost) were searched from 1979 to February 2020. Of the 349 relevant primary research studies identified, there were 75 detection-method studies, 40 molecular characterisation studies, 38 studies of Cyclospora in the environment (33 prevalence studies, 10 studies of factors associated with environmental contamination), 246 human infection studies (212 prevalence/incidence studies, 32 outbreak studies, 60 studies of environmental factors associated with non-outbreak human infection) and eight control studies. There appears to be sufficient literature for a systematic review of prevalence and factors associated with human infection with C. cayetanensis. There is a dearth of publicly available detection-method studies in soil (n = 0) and water (n = 2), prevalence studies on soil (n = 1) and studies of the control of Cyclospora (particularly on produce prior to retail (n = 0)).

A bacterial metabolite induces glutathione-tractable proteostatic damage, proteasomal disturbances, and PINK1-dependent autophagy in C. elegans.

Gene-by-environment interactions are thought to underlie the majority of idiopathic cases of neurodegenerative disease. Recently, we reported that an environmental metabolite extracted from Streptomyces venezuelae increases ROS and damages mitochondria, leading to eventual neurodegeneration of C. elegans dopaminergic neurons. Here we link those data to idiopathic disease models that predict loss of protein handling as a component of disorder progression. We demonstrate that the bacterial metabolite leads to proteostatic disruption in multiple protein-misfolding models and has the potential to synergistically enhance the toxicity of aggregate-prone proteins. Genetically, this metabolite is epistatically regulated by loss-of-function to pink-1, the C. elegans PARK6 homolog responsible for mitochondrial maintenance and autophagy in other animal systems. In addition, the metabolite works through a genetic pathway analogous to loss-of-function in the ubiquitin proteasome system (UPS), which we find is also epistatically regulated by loss of PINK-1 homeostasis. To determine remitting counter agents, we investigated several established antioxidants and found that glutathione (GSH) can significantly protect against metabolite-induced proteostasis disruption. In addition, GSH protects against the toxicity of MG132 and can compensate for the combined loss of both pink-1 and the E3 ligase pdr-1, a Parkin homolog. In assessing the impact of this metabolite on mitochondrial maintenance, we observe that it causes fragmentation of mitochondria that is attenuated by GSH and an initial surge in PINK-1-dependent autophagy. These studies mechanistically advance our understanding of a putative environmental contributor to neurodegeneration and factors influencing in vivo neurotoxicity.

Mitochondrial dysfunction, oxidative stress, and neurodegeneration elicited by a bacterial metabolite in a C. elegans Parkinson's model.

Genetic and idiopathic forms of Parkinson's disease (PD) are characterized by loss of dopamine (DA) neurons and typically the formation of protein inclusions containing the alpha-synuclein (α-syn) protein. Environmental contributors to PD remain largely unresolved but toxins, such as paraquat or rotenone, represent well-studied enhancers of susceptibility. Previously, we reported that a bacterial metabolite produced by Streptomyces venezuelae caused age- and dose-dependent DA neurodegeneration in Caenorhabditis elegans and human SH-SY5Y neurons. We hypothesized that this metabolite from a common soil bacterium could enhance neurodegeneration in combination with PD susceptibility gene mutations or toxicants. Here, we report that exposure to the metabolite in C. elegans DA neurons expressing human α-syn or LRRK2 G2019S exacerbates neurodegeneration. Using the PD toxin models 6-hydroxydopamine and rotenone, we demonstrate that exposure to more than one environmental risk factor has an additive effect in eliciting DA neurodegeneration. Evidence suggests that PD-related toxicants cause mitochondrial dysfunction, thus we examined the impact of the metabolite on mitochondrial activity and oxidative stress. An ex vivo assay of C. elegans extracts revealed that this metabolite causes excessive production of reactive oxygen species. Likewise, enhanced expression of a superoxide dismutase reporter was observed in vivo. The anti-oxidant probucol fully rescued metabolite-induced DA neurodegeneration, as well. Interestingly, the stress-responsive FOXO transcription factor DAF-16 was activated following exposure to the metabolite. Through further mechanistic analysis, we discerned the mitochondrial defects associated with metabolite exposure included adenosine triphosphate impairment and upregulation of the mitochondrial unfolded protein response. Metabolite-induced toxicity in DA neurons was rescued by complex I activators. RNA interference (RNAi) knockdown of mitochondrial complex I subunits resulted in rescue of metabolite-induced toxicity in DA neurons. Taken together, our characterization of cellular responses to the S. venezuelae metabolite indicates that this putative environmental trigger of neurotoxicity may cause cell death, in part, through mitochondrial dysfunction and oxidative stress.

Criterio de selección en diagnóstico por imágenes / Selection criteria in imaging diagnosis

Las radiografías odontológicas son herramientas esenciales para el diagnóstico bucomaxilofacial: panorámica (PAN), periapical (PER) y bite-wing (BW), las cuales se pueden utilizar en forma individual o combinadas entre sí (American Dental Assoc. Council on Scientific Affairs, JADA, 2006). Aunque las dosis de radiación utilizadas por los odontólogos no son altas, la cantidad de exposiciones a que son sometidos los pacientes pueden ser excesivas. En USA y en la UE se han publicado guías sobre portección radiológica dental (BOE, Reegulations on Ionizing Radiation Protection in State Oficial Bulletin, 2001; Brown, 1980; Oficial Journal of the European Communities, 1996; European Guidelines on Radiation Protection in Dental Radiology, 2004), estableciendo el uso de las radiografías para evitar irradiaciones rutinarias innecesarias.

Toxina botulínica y Fisioterapia en la parálisis cerebral infantil / Botulin toxin and Physiotherapy in cerebral palsy in children

Este artículo pretende explicar el modo de acción de la toxina botulínica en niños con parálisis cerebral infantil (PCI). Este potente neurotóxico induce a una parálisis parcial por bloqueo presináptico que nos ayuda en el manejo de la espasticidad asociada a la PCI. La toxina puede reducir la espasticidad de los músculos de los miembros inferiores como obstáculo para la habilidad de caminar, correr y diferentes trabajos activos. Este articulo proporciona información sobre diversos aspectos de indicación, uso, efectos secundarios y la relación con la Fisioterapia (AU)

Free flaps for head and neck reconstruction in non-oncological patients: experience of 200 cases.

Two hundred free flaps for reconstructing the head and neck regions in 192 patients with non-oncological pathology were studied. Pathological entities included Romberg's disease, hemifacial microsomia, acquired facial palsy, trauma, and burn sequelae. Indications for selecting a specific free flap for reconstructing each case, details of anastomoses, reexploration, flap success, operative time, length of hospitalization, and complications were studied. The long-term results of cosmetic and function were also obtained. Patient age ranged from 6 to 40 years. The most common diagnosis was Romberg's disease 39% (n = 75), followed by hemifacial microsomia 20% (n = 40). The free flap most frequently used was the scapular 32% (n = 64), followed by the groin free flap 21% (n = 42). A total of 190 flaps (95%) were successful, whereas only 10 (5%) were lost. The mean operative time was 5:30 h and the average hospital stay was only 6 days. There were no major complications and no deaths in the study group. The patients were followed for at least 1 year in all cases. It is concluded that free flaps are safe and reliable procedures for reconstructing complex head and neck non-oncological defects.

[Preoperative assessment in adults]. / La valoración preoperatoria en el adulto.

UNLABELLED: The scope of this work is to analyze the usefulness and indications of preoperative evaluation. PATIENTS AND METHODS: 791 consecutive patients candidate for surgical treatment, were studied prospectively under the next inclusion criteria: 40 years old or less than 40 years old. Blood count cell, glucose, urea, creatinine, sodium, potassium, prothrombin time, partial thromboplastin time, platelets count, liver function tests, chest x-ray and electrocardiograph made before entry. In the the post liver, lung, bleeding, infectious or metabolic complications was done, while visiting the patients every day until discharge. Relative risk (RR) was calculated for every variable, analyzing differences with X2 and Fisher's Test. Those variables with statistical significance value were analyzed with logistic regression. Only 751 patients were studied, there were 335 male (44%) and 416 female (56%), with mean age of 63.9 years. Metabolic disorders (16.9%) and postoperative infections (7.0%) were the more frequent complications. Hemorrhage during of after surgery occurred in 2.2% of the patients. There were seventeen deaths (2.2%) related directly with surgery, with systemic illness or with postoperative complications. Selection of auxiliary tests for preoperative evaluation must be agree with clinical evaluation. The major objective of clinical evaluation is to estimate risk factors for surgery.

Thyroid function and abdominal surgery. A longitudinal study.

Surgical trauma produces complex metabolic changes and may be an excellent model for studying the effects of an acute insult on the circulating thyroid hormone concentrations. Abnormalities in thyroid function tests in patients with nonthyroidal illness can be divided into a low T3 syndrome, low T3 and T4 syndrome in more severe cases and elevated T4 syndrome. In this study 30 patients undergoing elective or urgent abdominal surgery were longitudinally evaluated with pre- and postoperative thyroid function tests. Comparing with preoperative values, a significant reduction in total T3 serum values in the immediate postoperative period was seen (p < 0.005). The rest of the variables did not show significant statistical differences between the three periods. Over half of the patients undergoing urgent surgery had a low T3 syndrome, whereas only a sixth of the patients scheduled for elective surgery suffered from this syndrome. In the late postoperative period half the patients submitted to urgent surgery persisted with alterations in thyroid function tests, whereas most of the patients scheduled for elective surgery showed an improvement in their thyroid hormone level in the same period of time. Abnormalities in thyroid hormone metabolism were more frequent in patients admitted for urgent surgery, reflecting the severity of their illness and favoring the concept that these syndromes can be used as prognostic markers.