Cesárea perimortem por trauma penetrante por proyectil de arma de fuego con supervivencia fetal. Reporte de un caso / Perimortem C-Section after gunshot penetrating trauma with infant survival. Case report

Resumen Introducción: El trauma en el embarazo es un escenario complejo, y pocas publicaciones estudian los problemas secundarios a éste en el tercer trimestre, como es el caso de las indicaciones y resultados de las cesáreas de emergencia. La cesárea perimortem es un acontecimiento inusual; cuando se realiza, es el único recurso para obtener un recién nacido vivo. Si existe paro cardiorrespiratorio, la cesárea perimortem está indicada después de 4 a 5 minutos de inicio del paro en la madre. Caso: Mujer de 19 años, con antecedente de herida por proyectil de arma de fuego, que ingresó al cubículo de choque en paro y con maniobras de reanimación cardiopulmonar y embarazo de aproximadamente 36 semanas de gestación. Se realizaron 4 ciclos de reanimación sin reversión a circulación espontánea; por lo cual se decidió realizar cesárea de emergencia perimortem por un cirujano general en el área de choque. Se obtuvo un producto único vivo, y se reportó la defunción de la madre minutos después. Se trasladó el producto a la Unidad de Cuidados Intensivos Neonatales (UCIN), y 5 días después del procedimiento se reportó sin secuelas neurológicas. Conclusión: La primera razón para realizar de una cesárea perimortem es la supervivencia de la madre. Como se trata de una emergencia, no es necesario invertir tiempo en verificar la viabilidad fetal. En casos especiales, en los que debido a su patología la posibilidad de supervivenciade la madre es nula, la cesárea perimortem podrá realizarse para salvar la vida del producto. Realizar este procedimiento requiere tomar una decisión muy importante y de manera muy rápida, hay que resaltar la importancia del lugar donde se realizó, ya que era un centro de trauma, donde se cuenta con salas de choque especializadas para realizar procedimientos de emergencia con mayor rapidez, y personal capacitado sin necesidad de trasladarse a un quirófano para realizarlo, para obtener resultados satisfactorios.

Abstract Introduction: Trauma in pregnancy is a complex scenario, few publications study the issues after trauma in the 3rd trimester, including indications and outcomes in emergency C-Section. Perimorten Cesarean Section, is an unusual event, when it's performed it is the only resource for infant survival. When there is cardiac arrest, Perimortem Cesarean Section is indicated 4 to 5 minutes after cardiac arrest. Case: 19 year old female, with recent history of gunshot injury to the chest, arrives in cardiac arrest and with CPR and a 36 week pregnancy. 4 cycles of Cardiopulmonary resuscitation where performed without reversion to spontaneous circulation, then we decide to perform a Perimortem Cesarean Section by General Surgeon in the trauma room. Infant alive t is obtained, death of the mother is reported minutes later. The infant is transferred to NICU, 5 days after the procedure, it is reported without neurological sequelae. Conclusion: The first reason to perform a perimortem cesarean section is the survival of the mother, because it's an emergency, it's not necessary to lose time in verifying the infant's vitals. In special cases, in which there are few possibilities of mother survival, the perimortem cesarean section is performed for infant survival. Performing this procedure requires a very important decision making and in a quick way, it's very important to remark that this procedure was performed in a Trauma Center, which has the facilities as a trauma room, where we can do emergency procedures faster, and with the trained medical staff to do it, with no need to move to an operating room to perform it, obtaining successful outcomes.

Análisis del discurso didáctico usando una tarea de igualación de la muestra de segundo orden / Analysis of didactic discourse using a second-order matching-to-sample task / Análise do discurso didático empregando uma tarefa de igualação da amostra da segunda ordem

Aprender a enseñar parece ser resultado de un aprendizaje vivencial y directo. Por ello, en el presente estudio, se utilizó una tarea de igualación de la muestra de segundo orden para evaluar la construcción de un discurso didáctico a partir del propio aprendizaje. El diseño experimental consideró dos momentos, uno de aprendizaje y otro de enseñanza. En el primero, se entrenó la tarea de igualación con un procedimiento de complejidad creciente. En el segundo, cada participante entrenado tuvo que enseñar a otros dos cómo contestar tareas similares a las que se sometieron. Los resultados se analizaron en términos del dominio de la tarea por los participantes expuestos al entrenamiento de aprendizaje, las posibilidades de transferencia de lo aprendido, los procesos implicados en la elaboración de un discurso didáctico, y los efectos del acto de enseñar sobre los aprendices. Todos los sujetos aprendieron la igualación, ya sea por entrenamiento directo o mediante la exposición al discurso didáctico. Sin embargo, hubo diferencias en el desempeño durante las pruebas de transferencia debido a las distintas formas de verbalizar los criterios de ejecución correcta implicados en el discurso didáctico.

Learning to teach seems to be a product of direct experiential learning. Therefore, in this study, a second-order matching-to-sample task was used to evaluate the didactic discourse that a person can elaborate from his own learning. The research design involved two different phases, learning and teaching. During the learning phase, the participants were trained in the matching task with a procedure that gradually increased its complexity .During the teaching phase, each trained participant had to teach another two participants on how to perform effectively in similar tasks. Results were analyzed in terms of the trained participants’ performance on the task, transference of learning, processes involved in the elaboration of didactic discourse, and the effects of teaching on he apprentices. Data suggest that all participants learned the matching task, either by direct training or by being exposed to didactic discourse. However, differences on performance during transfer tests were found among participants due to the different ways of verbalizing task criteria and effective performance involved in didactic discourse.

Aprender a ensinar parece o resultado de uma aprendizagem vivencial e direito. Portanto, neste estudo, utilizou-se uma tarefa de igualação da amostra de segunda ordem para avaliar a construção de um discurso didático a partir da aprendizagem própria. O desenho experimental considerou dois momentos. No primeiro, treinou-se a tarefa de igualação com um procedimento de complexidade crescente. No segundo, cada participante treinado tive que ensinar a outros dois como responder a tarefas semelhantes às que foram submetidos. Os resultados se analisaram em relação ao domínio da tarefa pelos participantes expostos ao treinamento de aprendizagem, as possibilidades de transferência do aprendido, os processos envolvidos na elaboração de um discurso didático e os efeitos que ato de ensinar produze nos aprendizes. Todos os sujeitos aprenderam a igualação, bem seja por treinamento direito ou através da exposição ao discurso didático. No entanto, apresentaram-se diferenças no desempenho durante as provas de transferência, devido as diferentes formas de verbalizar os critérios de execução correta envolvidos no discurso didático.

24-Week study on the use of collagen hydrolysate as a dietary supplement in athletes with activity-related joint pain.

BACKGROUND: Collagen hydrolysate is a nutritional supplement that has been shown to exert an anabolic effect on cartilage tissue. Its administration appears beneficial in patients with osteoarthritis. OBJECTIVE: To investigate the effect of collagen hydrolysate on activity-related joint pain in athletes who are physically active and have no evidence of joint disease. DESIGN AND SETTING: A prospective, randomized, placebo-controlled, double-blind study was conducted at Penn State University in University Park, Pennsylvania. Parameters including joint pain, mobility, and inflammation were evaluated with the use of a visual analogue scale during a 24-week study phase. STUDY PARTICIPANTS: Between September 2005 and June 2006, 147 subjects who competed on a varsity team or a club sport were recruited. Data from 97 of 147 subjects could be statistically evaluated. INTERVENTION: One hundred and forty-seven subjects (72 male, 75 female) were randomly assigned to two groups: a group (n = 73) receiving 25 mL of a liquid formulation that contained 10 g of collagen hydrolysate (CH-Alpha) and a group (n = 74) receiving a placebo, which consisted of 25 mL of liquid that contained xanthan. MAIN OUTCOME MEASURES: The primary efficacy parameter was the change in the visual analogue scales from baseline during the study phase in relation to the parameters referring to pain, mobility, and inflammation. RESULTS: When data from all subjects (n = 97) were evaluated, six parameters showed statistically significant changes with the dietary supplement collagen hydrolysate (CH) compared with placebo: joint pain at rest, assessed by the physician (CH vs. placebo (-1.37 +/- 1.78 vs. -0.90 +/- 1.74 (p = 0.025)) and five parameters assessed by study participants: joint pain when walking (-1.11 +/- 1.98 vs. -0.46 +/- 1.63, p = 0.007), joint pain when standing (-0.97 +/- 1.92 vs. -0.43 +/- 1.74, p = 0.011), joint pain at rest (-0.81 +/- 1.77 vs. -0.39 +/- 1.56, p = 0.039), joint pain when carrying objects (-1.45 +/- 2.11 vs. -0.83 +/- 1.71, p = 0.014) and joint pain when lifting (-1.79 +/- 2.11 vs. -1.26 +/- 2.09, p = 0.018). When a subgroup analysis of subjects with knee arthralgia (n = 63) was performed, the difference between the effect of collagen hydrolysate vs. placebo was more pronounced. The parameter joint pain at rest, assessed by the physician, had a statistical significance level of p = 0.001 (-1.67 +/- 1.89 vs. -0.86 +/- 1.77), while the other five parameters based on the participants' assessments were also statistically significant: joint pain when walking (p = 0.003 (-1.38 +/- 2.12 vs. -0.54 +/- 1.65)), joint pain when standing (p = 0.015 (-1.17 +/- 2.06 vs. -0.50 +/- 1.68)), joint pain at rest with (p = 0.021 (-1.01 +/-1.92 vs. -0.47 +/- 1.63)), joint pain when running a straight line (p = 0.027 (-1.50 +/- 1.97 vs. -0.80 +/- 1.66)) and joint pain when changing direction (p = 0.026 (-1.87 +/- 2.18 vs. -1.20 +/- 2.10)). CONCLUSION: This was the first clinical trial of 24-weeks duration to show improvement of joint pain in athletes who were treated with the dietary supplement collagen hydrolysate. The results of this study have implications for the use of collagen hydrolysate to support joint health and possibly reduce the risk of joint deterioration in a high-risk group. Despite the study's size and limitations, the results suggest that athletes consuming collagen hydrolysate can reduce parameters (such as pain) that have a negative impact on athletic performance. Future studies are needed to support these findings.