Particle aerosolization with energy devices: A comparative study.

OBJECTIVE: To compare the degree of particle aerosolization with the use of several energy devices used in tonsillectomy and other common upper airway procedures. METHODS: Three different energy devices were measured. These included (a) monopolar electrocautery, (b) bipolar electrocautery, and (c) thermal welding device (TWD). Each device was applied to fresh cadaveric cow tongue and porcine nose. Aerosolized particles produced by these devices were measured using a calibrated electronic particle counter. Measurements were recorded over the course of 3 minutes. Particle sizes were measured at 0.3, 0.5, 1.0, 5, and 10 µm. RESULTS: In comparing types of tissues and particle sizes, TWD had the lowest aerosolizing burden among the three devices. By analyzing the highest particle value of TWD against both monopolar and bipolar, monopolar electrocautery proved to have the highest aerosolization exposure with statistical significance at 0.5 and 10 µm. No statistical significance was found when comparing TWD against monopolar electrocautery. DISCUSSION: Our study demonstrates there is a difference in aerosolization burden dependent on the type of device utilized. TWD proved to have the lowest burden whereas monopolar electrocautery had the highest. CONCLUSION: TWD produces less aerosolization than conventional monopolar electrocautery when cauterizing or ablating tissue in an experimental setting. The degree of aerosolization was comparable to bipolar electrocautery. LEVEL OF EVIDENCE: 2.

[Prognostic value of the absolute decrease of the N-terminal portion of B-type natriuretic propeptide in decompensated heart failure: secondary analysis of the CLUSTER-HF study]. / Valor pronóstico del descenso absoluto de la porción N-terminal del propéptido natriurético tipo B en insuficiencia cardiaca descompensada: análisis secundario del estudio CLUSTER-HF.

Objective: The purpose of this study is to determine the prognostic value of the absolute decrease in the N-terminal portion of pro-B-type natriuretic peptide (NT-proBNP) to prevent fewer clinical events, in the population of CLUSTER-HF (efficacy of ultrasound lung to guide therapy and prevent readmissions in heart failure). Materials and methods: This study was conducted in a subgroup of ninety-four patients with available NT-proBNP information at hospital discharge and prior to randomization in the CLUSTER-HF study. The primary objective of the study was to determine the prognostic value of absolute NT-proBNP decline below which fewer events of all-cause death, emergency room visits, and rehospitalization for heart failure at 180 days. Results: The absolute decrease in NT-proBNP below 3,350 pg/mL has a moderate discriminative capacity with AUC= 0.602, with a prognostic value in the combined event at 180 days (log-rank test, p=0.01). Also, according to the multivariable analysis, it is an independent marker of clinical events at 180 days OR 0.319 (0.102-0.995, p=0.04) above other clinical variables. Conclusions: An absolute decrease to 3,350 pg/mL of NT-proBNP or less at discharge from the hospitalization due to heart failure, was associated with fewer clinical events at 180 days.

Effect of Fodder Tree Species with Condensed Tannin Contents on In vitro Methane Production.

The objective was to evaluate the effect of fodder tree species (FTS) with condensed tannin contents: Cordia elaeagnoides, Platymiscium lasiocarpum, Vitex mollis, and Haematoxylon brasiletto, on in vitro methane (CH4) production at 24 h post incubation. The analysis was performed using the in vitro gas production technique, with three levels of inclusion/species: 600, 800, and 1,000 mg and with 4 replicates/species/level of inclusion. The substrate was incubated at 39°C, and the gas and CH4 production were recorded at 4, 8, 12, and 24 h post incubation. The data collected was analyzed through Pearson correlation, polinomial regression and fixed effects models. There were negative correlations between FTS-total gas volume (r = -0.40; p<0.001); FTS-volume of CH4 produced (r = -0.40; p<0.001) and between the inclusion level-volume of CH4 produced (r = -0.20; p<0.001). As well as a positive correlation between hours post incubation-total gas volume (r = 0.42; p<0.001) and between hours post incubation-volume of CH4 produced (r = 0.48; p<0.001). The FTS: C. elaeagnoides, V. mollis, and H. brasiletto have potential, in the three inclusion levels analyzed, to reduce CH4 emission on in vitro trials (>32.7%), taking into account the total CH4 production at 24 h of the forage used as reference (Avena sativa). It's suggested that C. elaeagnoides-according to its crude protein, neutral detergent fiber, and condensed tannins content- is the best alternative within the FTS analyzed, for feeding ruminants and for the control of CH4 emissions during the dry season.

Preprueba para la adaptación cultural de la versión española del instrumento de calidad de vida dermatológico Skindex-29, en Colombia / Pre-test for the cross cultural adaptation of the Spanish version of the quality of life instrument Skindex-29 in Colombia

Antecedentes. La investigación clínica, y en especial los ensayos clínicos, debe involucrar la evaluación de la calidad de vida relacionada con la salud como una de las maneras de medir los desenlaces subjetivos de las intervenciones sobre las personas. Objetivo. Evaluar la comprensión e interpretación de la versión española del Skindex-29 entre colombianos. Pacientes y métodos. El cuestionario fue administrado a adultos colombianos que consultaron por cualquier enfermedad dermatológica a la consulta externa de la Institución Prestadora de Salud (IPS) Universitaria de la Universidad de Antioquia o a un consultorio dermatológico particular, y a individuos sanos que no presentaban ningún trastorno cutáneo. Cada uno de los sujetos manifestaba la comprensión o no de cada pregunta y sugería la posibilidad de cambiar su redacción. Resultados. Se encuestaron 21 individuos: 9 sanos y 12 con algún problema dermatológico. La edad promedio fue de 41,7 años y 66,7% eran mujeres. De los 29 ítems, cuatro requirieron traducción y “retrotraducción”. Entre estos, en el ítem 25 se continuaron presentando dificultades en la comprensión, por lo que se requirió utilizar otra versión traducida y “retrotraducida” del ítem, con lo cual se logró su comprensión completa en una nueva prueba en 20 individuos. Conclusión. Se obtuvo una versión colombiana preliminar del Skindex-29. Se requirió la traducción y “retrotraducción” de cuatro ítems antes de aplicar dicho cuestionario a una población colombiana. En un paso siguiente, se evaluarán las propiedades sicométricas del cuestionario final y la determinación de su validez de constructo, su fiabilidad y su sensibilidad al cambio.

Determination of the antioxidant status of plasma from type 2 diabetic patients.

An increase in oxidizing response above a certain threshold produces, in the absence of a concomitant rise in antioxidant/reducing response, oxidative stress that is associated with complications in diabetes. A simple technique involving reduction of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) dye has been developed in order to determine quantitatively the antioxidant status of plasma. MTT (50microL; 5.0mg/mL in PBS) was incubated with plasma (100microL) in PBS for 30, 60 or 120min at 37 degrees C, the reaction terminated by addition of 1.0mL of 0.04M hydrochloric acid in isopropanol and the absorbance measured at 570nm. The modulation by plasma of the generation of reactive oxygen species (ROS) in 12,13-phorbol dibutyrate (PDB)-stimulated granulocytes was evaluated using a chemiluminescence luminol-dependent assay. Plasma from healthy subjects (n=15) showed significantly higher antioxidant status (p<0.05) over all time periods studied compared with plasma from diabetic patients (n=27). MTT was directly reduced by plasma although platelets were not involved. Moreover, the reduction of MTT by bovine serum albumin at levels equivalent to the concentration of human serum albumin in plasma was much lower. The antioxidant status of plasma, as evaluated by MTT dye reduction, may reflect an antioxidant response since ROS generation in PDB-stimulated granulocytes was rapidly down-regulated by the presence of plasma (3.3-fold in diabetic patients and 5.8-fold in healthy subjects) confirming the lower antioxidant activity of plasma from diabetic patients. The results demonstrate that extracellular reduction of MTT by plasma may occur via enzymatic and non-enzymatic processes.

Oxidizing and reducing responses of granulocytes from type 2 diabetic patients.

Oxidizing/reducing response by granulocytes and a potential correlation between reactive oxygen species generation and triglyceride, total cholesterol, low-density lipoprotein, high-density lipoprotein, body mass index, fasting plasma glucose, glycemic control (hemoglobin A(1c)), or duration of diabetes were examined in type 2 diabetic patients and in healthy subjects. An increase in both oxidizing and reducing responses was observed in cells from diabetic patients relative to normoglycemic individuals. The increase in oxidizing response was nearly 2-fold higher, whereas the antioxidant response increased by 50%. Although reactive oxygen species generation from healthy subjects was correlated with levels of low-density lipoprotein (positive correlation), high-density lipoprotein (negative correlation), and body mass index (positive correlation), no such associations were observed in diabetic subjects, suggesting either an intrinsic perturbation in the oxidant/antioxidant response or possibly due to the effect of the various medications being taken by these patients. These issues need further study.

Errors in medical interpretation and their potential clinical consequences in pediatric encounters.

BACKGROUND: About 19 million people in the United States are limited in English proficiency, but little is known about the frequency and potential clinical consequences of errors in medical interpretation. OBJECTIVES: To determine the frequency, categories, and potential clinical consequences of errors in medical interpretation. METHODS: During a 7-month period, we audiotaped and transcribed pediatric encounters in a hospital outpatient clinic in which a Spanish interpreter was used. For each transcript, we categorized each error in medical interpretation and determined whether errors had a potential clinical consequence. RESULTS: Thirteen encounters yielded 474 pages of transcripts. Professional hospital interpreters were present for 6 encounters; ad hoc interpreters included nurses, social workers, and an 11-year-old sibling. Three hundred ninety-six interpreter errors were noted, with a mean of 31 per encounter. The most common error type was omission (52%), followed by false fluency (16%), substitution (13%), editorialization (10%), and addition (8%). Sixty-three percent of all errors had potential clinical consequences, with a mean of 19 per encounter. Errors committed by ad hoc interpreters were significantly more likely to be errors of potential clinical consequence than those committed by hospital interpreters (77% vs 53%). Errors of clinical consequence included: 1) omitting questions about drug allergies; 2) omitting instructions on the dose, frequency, and duration of antibiotics and rehydration fluids; 3) adding that hydrocortisone cream must be applied to the entire body, instead of only to facial rash; 4) instructing a mother not to answer personal questions; 5) omitting that a child was already swabbed for a stool culture; and 6) instructing a mother to put amoxicillin in both ears for treatment of otitis media. CONCLUSIONS: Errors in medical interpretation are common, averaging 31 per clinical encounter, and omissions are the most frequent type. Most errors have potential clinical consequences, and those committed by ad hoc interpreters are significantly more likely to have potential clinical consequences than those committed by hospital interpreters. Because errors by ad hoc interpreters are more likely to have potential clinical consequences, third-party reimbursement for trained interpreter services should be considered for patients with limited English proficiency.

Prevalencia de tuberculosis pulmonar en el Hospital Nstra. Señora de Regla; Baní, R. D., 1988-1992 / Prevalence of pulmonary tuberculosis in Hospital Nuestra Señora de Regla ; Bani, R. D. 1988-1992

Se realizó un estudio retrospectivo y longitudinal para determinar la frecuencia de tuberculosis pulmonar en el hospital Nuestra Señora de Regla de Baní, República Dominicana, durante el período 1988-1992, de un total de 284 casos estudiados el 17.6 por ciento osciló entre las edades de 19 y 28 años. El 58 por ciento de ellos fueron masculinos. Al 54.9 por ciento se le realizó baciloscopía como medio diagnóstico, y radiografía a un 33.3 por ciento . Un 37.7 por ciento abandonó el tratamiento. Al esquema de 7 meses correspondió un 88.7 por ciento y que fue eficaz para un 57.8 por ciento ; el 2.4 por ciento falleció

Accidentes laborales: Prevención / Occupational accidents: Prevention

Se revisaron 167 casos de accidentes laborales en obreros y empleados, entre los 17 y 64 años de edad, pertenecientes a diferentes empresas de nuestra región, textiles y de construcción, en un lapso comprendido entre 1988 y 1992, con el objeto de analizar las características de los mismos y llegar así a tomar medidas preventivas

Síndrome de Bandas Amnióticas / Ammiotic Band Syndrome

El Síndrome de Bandas Amnióticas, es una entidad caracterizada por una variedad de anomalías congénitas asimétricas tan amplia, que ningún caso es exactamente igual a otro. Reportamos un caso de un infante de 2 años de edad, con bandas constrictivas en los dedos de la mano, las cuales son suficientes para hacer el diagnóstico. Además, discutimos las teorías etiopatogénicas más aceptadas, basándonos en la revisión de la literatura publicada más recientemente