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Resumen: De acuerdo a la información disponible, los pacientes pediátricos con COVID-19 tendrían una me nor frecuencia, se presentarían en su mayoría con un cuadro clínico de leve a moderado, y con una baja tasa de morbimortalidad asociada5. Sin embargo, es incierto el comportamiento real que tendrá el SARS-CoV-2 en Chile, así como tampoco sabemos el impacto que tendrá su interacción con otros virus respiratorios en el desenlace clínico. Asumiendo que los pacientes pediátricos que requieran hospitalización por sospecha o confirmación de COVID-19 necesitarán de diferentes niveles de so porte respiratorio, hemos elaborado recomendaciones transversales fundamentadas en el óptimo manejo del apoyo respiratorio pediátrico, basados en los principios de calidad y eficiencia en la en trega del soporte, en parámetros de bioseguridad y en el uso apropiado de recursos6. Estos elementos que se encuentran relacionados al armado y filtrado de los aerosoles producidos por algunos equipos de soporte ventilatorio, son recomendados en esta guía con el fin de unificar criterios técnicos que permitan entregar un apoyo óptimo al paciente pediátrico, manteniendo la mayor bioseguridad po sible para el paciente y el equipo de salud.
Abstract: According to the available information, pediatric cases of COVID-19 would present less frequently, most of them with mild to moderate clinical picture, and low associated morbidity and mortality5. However, we do not know the actual behavior that SARS-CoV-2 will have in Chile, nor the impact that its interaction with other respiratory viruses will have on the clinical outcome. On the assump tion that pediatric patients requiring hospitalization due to suspicion or confirmation of COVID-19 will need different levels of respiratory support, we have developed wide-range recommendations based on the optimal management of pediatric respiratory support according to the principles of quality and efficiency in the delivery of support, biosafety parameters, and appropriate use of resou rces6. These elements, which are related to assembling and filtering the aerosols produced by some respiratory support equipment, are recommended in this guide in order to unify technical criteria that allow optimal support for the pediatric patient while maintaining the highest possible biosafety for the patient and the health team.
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INTRODUCTION: Raynaud's phenomenon (RP) is a common condition and causes pain, paraesthesia, ulceration and gangrene. Botulinum toxin A (Btx-A) is effective when injected via a digital palmar approach, in the treatment of severe RP. However, hand weakness resulting from lumbrical malfunction is a recognized complication. This study aimed to determine the effect of Btx-A injected via a dorsal approach. METHOD: Forty patients received 100 units of Btx-A, injected across both hands via a dorsal approach. Each patient had a baseline, 6- and 12-week hand assessment and thermographic image (FLIR E60bx) performed for the study. RESULTS: Eighty-eight percent of patients reported an improvement in symptoms including reduction in pain, improved colour change with reduced swelling and edema at 6 weeks. Of these patients, 80% reported an improvement in cold intolerance with a reduction in the frequency and severity of Raynaud's attacks. There was a significant improvement in both the DASH score (p = 0.001), Kapandji score (p = 0.001) and hand strength (p < 0.05). No patients reported weakness. Improvements in hand function and symptoms of RP were still evident at 12 weeks. CONCLUSIONS: Btx-A injected via a dorsal approach improves symptoms and reduces the number of RP. We have shown an effective non-surgical approach technique to treat RP.Key Points⢠Raynaud's phenomenon is a common vasospastic disorder of the digital vessels, which can cause severe pain, restrictions to hand function and ulceration.⢠Dorsal botulinum toxin type A injections can improve the symptoms of secondary Raynaud's phenomenon and hand function for approximately 3 months.
Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Fármacos Neuromusculares/administração & dosagem , Doença de Raynaud/tratamento farmacológico , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Doença de Raynaud/diagnóstico por imagem , TermografiaRESUMO
Una de las principales causas de la falla de los ciclos de fecundación in vitro es la aneuploídia embrionaria. OBJETVO: determinar si las pruebas de tamizaje genético pre-implantacional favorece la posibilidad de embarazos MÉTODOS: Se realizó un revisión sistemática y meta-análisis. Buscamos en las bases PUBMED y EMBAS, estudios publicados entre 2006-2016, que compararan el número de embarazos en fecundación in vitro con y sin tamizeje genético preimplantaicon RESULTADOS: De los 115 artículos analizados, 4 cumplieron los criterios de selección. Evaluamos un total de 221 ciclos con tamizje y 592 sin. No encontramos diferencias en la posibilidad de embarazo (RR 0.88; IC95% 0.71-1.10; p=0.28). Al hacer análisis por subgrupo de técnica de tamizaje, encontramos que el uso de hibridación fluosrescente in situ se asoció a una disminución en la posibilidad de embarazo (3 estudios, RR 0.53; IC95% 0.36-0.77; p=0.0009); mientras que el uso de hibidración genómica comparativa se asoció a un aumeto (1 estudio, RR 1.58; IC 95% 1.24-2.00; p<0.001). CONCLUSION: La eficacia de las pruebas de tamizaje genñeticos son dependientes de la técnica, por lo que se deberia favorecer el uso de hibidración genómica comparativa.
Probably, the main cause in IVF failure is the transfer of aneuploid embryos. OBJECT: To determine if the use of preimplantational genetic screening improves the pregnancy rate in IVF cycles, compared to regular IVF. METHODS: We performed a systematic review and meta-analysis, searching in PUBMED and EMBASE databases studies published between 2006-2016, comparing the pregnancy rates in women undergoing IVF with PGS with that of women undergoing IVF only. RESULTS: Of the 115 articles found, 4 met the selection criteria, with a total of 734 women between 33 and 41 years: 221 with PGS and 592 controls. We found no association between the use of PGS and pregnancy (RR 0.88, 95% CI 0.71-1.10, p = 0.28). However, we performed a subgroup analysis by technique of PGS, and found that fluorescent in situ hybridization was associated with a diminished risk of pregnancy (3 studies;(RR 0.53; 95% CI 0.36-0.77; p = 0.0009), whereas comparative genomic hybridization was associated with an increase (1 study, RR 1.58, CI95% 1,24-2.00, p<0.001). CONCLUSION: The effectivity of PGS is determined by the technique for PGS; therefore, only comparative genomic hybridization should be offered.
