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OBJECTIVE: Neonates with moderate-to-severe perinatal asphyxia often develop acute kidney injury (AKI). Additionally, therapeutic hypothermia (TH) can affect renal blood flow. This study aimed to evaluate the association between renal regional oxygen saturation (rSrO2) during TH and AKI in neonates with moderate and severe perinatal asphyxia. STUDY DESIGN: This retrospective longitudinal study included neonates with moderate-to-severe asphyxia who required TH. The primary outcome was the occurrence of AKI, classified as a rate of decrease in creatinine levels of <33% at 72 hours of TH. rSrO2 was continuously monitored by near-infrared spectroscopy during the hypothermia and rewarming phases. Data analysis involved dividing the average rSrO2 levels into 12-hour periods. We analyzed the association between AKI and rSrO2 levels using univariate and multivariate logistic regression models. Furthermore, we assessed the predictive capacity of rSrO2 for AKI by analyzing the area under the receiver operating characteristic curve. RESULTS: Ninety-one patients were included in the study. On average, patients with AKI exhibit lower rSrO2 levels during TH. Specifically, rSrO2 levels within the first 12 hours and between 25 and 72 hours of TH demonstrated the highest predictive capability for AKI. Multivariate logistic regression analysis revealed that rSrO2 levels within the initial 12 hours (adjusted odds ratio [aOR] = 1.11, 95% confidence interval [CI]: 1.01-1.21) and between 61 and 72 hours (aOR = 0.85, 95% CI: 0.78-0.92) were significantly associated with AKI. CONCLUSION: An increase in rSrO2 during the first 12 hours of TH and lower rSrO2 levels between 61 and 72 hours of treatment were associated with the development of AKI in asphyxiated neonates undergoing TH. KEY POINTS: · Neonates with asphyxia often develop AKI.. · Renal saturations are affected by hypothermia and asphyxia. · Patients with AKI initially show higher rSrO2, then lower rSrO2.. · Monitoring rSrO2 identifies early AKI..
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BACKGROUND: The number of individuals diagnosed with Alzheimer's disease (AD) has increased, and it is estimated to continue rising in the coming years. The diagnosis of this disease is challenging due to variations in onset and course, its diverse clinical manifestations, and the indications for measuring deposit biomarkers. Hence, there is a need to develop more precise and less invasive diagnostic tools. Multiple studies have considered using electroencephalography (EEG) entropy measures as an indicator of the onset and course of AD. Entropy is deemed suitable as a potential indicator based on the discovery that variations in its complexity can be associated with specific pathologies such as AD. METHODOLOGY: Following PRISMA guidelines, a literature search was conducted in 4 scientific databases, and 40 articles were analyzed after discarding and filtering. RESULTS: There is a diversity in entropy measures; however, Sample Entropy (SampEn) and Multiscale Entropy (MSE) are the most widely used (21/40). In general, it is found that when comparing patients with controls, patients exhibit lower entropy (20/40) in various areas. Findings of correlation with the level of cognitive decline are less consistent, and with neuropsychiatric symptoms (2/40) or treatment response less explored (2/40), although most studies show lower entropy with greater severity. Machine learning-based studies show good discrimination capacity. CONCLUSIONS: There is significant difficulty in comparing multiple studies due to their heterogeneity; however, changes in Multiscale Entropy (MSE) scales or a decrease in entropy levels are considered useful for determining the presence of AD and measuring its severity.
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Doença de Alzheimer , Eletroencefalografia , Entropia , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/fisiopatologia , Humanos , Eletroencefalografia/métodosRESUMO
INTRODUCTION: Perinatal asphyxia, a leading cause of neonatal mortality and neurological sequelae, necessitates early detection of pathophysiological neurologic changes during hypoxic-ischaemic encephalopathy (HIE). This study aimed to review published data on rScO2 monitoring during hypothermia treatment in neonates with perinatal asphyxia to predict short- and long-term neurological injury. METHODS: A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Study identification was performed through a search between November and December 2021 in the electronic databases PubMed, Embase, Lilacs, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL). The main outcome was short-term (Changes in brain magnetic resonating imaging) and long-term (In neurodevelopment) neurological injury. The study protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews) with CRD42023395438. RESULTS: 380 articles were collected from databases in the initial search. Finally, 15 articles were selected for extraction and analysis of the information. An increase in rScO2 measured by NIRS (Near-infrared spectroscopy) at different moments of treatment predicts neurological injury. However, there exists a wide variability in the methods and outcomes of the studies. CONCLUSION: High rScO2 values were found to predict negative outcomes, with substantial discord among studies. NIRS is proposed as a real-time bedside tool for predicting brain injury in neonates with moderate to severe HIE.
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Asfixia Neonatal , Hipotermia Induzida , Hipóxia-Isquemia Encefálica , Recém-Nascido , Humanos , Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Hipóxia-Isquemia Encefálica/terapia , Espectroscopia de Luz Próxima ao Infravermelho , Asfixia/complicações , Asfixia/terapia , Encéfalo/diagnóstico por imagem , Hipotermia Induzida/efeitos adversos , Hipotermia Induzida/métodos , Asfixia Neonatal/complicações , Asfixia Neonatal/terapia , Asfixia Neonatal/diagnósticoRESUMO
INTRODUCTION: Choric obstructive pulmonary disease (COPD) is the third mortality cause in the world, and the development of useful diagnostic tools is necessary to improve timely diagnostic rates in primary care settings. OBJECTIVE: To develop a web application displaying spirometric and clinical information - including respiratory symptoms and risk factors- to facilitate a COPD diagnosis. MATERIALS AND METHODS: In this cross-sectional study, an expert consensus was carried out with three specialists using the Delphi method to choose the relevant variables for COPD diagnosis. We developed a Python-based web application to diagnose COPD, displaying the clinical variables deemed relevant by the experts along the spirometric curve. RESULTS: Twenty-six clinical variables were included in the web application for the diagnosis of COPD. A fourth expert used the web application to classify a cohort of 695 patients who had undergone spirometry in a third-level centre and had answered at least one of five questionnaires for COPD screening. Out of the 695 subjects, 34% had COPD, according to the expert that diagnosed them using the web application. Only 42% of the patients in the COPD group had received a previous COPD diagnosis and 19% of the patients in the no COPD group had been misdiagnosed with the disease. CONCLUSION: We developed a web application that displays demographic and clinical information, as well as spirometric data, to facilitate the process of diagnosing COPD in primary care settings.
Introducción. La enfermedad pulmonar obstructiva crónica (EPOC) es la tercera causa de mortalidad en el mundo y es necesario el desarrollo de herramientas diagnósticas útiles para mejorar las tasas de diagnóstico oportuno en los entornos de atención primaria. Objetivo. Desarrollar una aplicación web que muestre la información clínica y de la espirometría incluyendo síntomas respiratorios y factores de riesgo para facilitar el diagnóstico de la EPOC. Materiales y métodos. En este estudio transversal se realizó un consenso de expertos con tres especialistas usando el método Delphi para elegir las variables relevantes para el diagnóstico de EPOC. Se desarrolló una aplicación web basada en Python que muestra la información clínica relevante según los expertos, junto con la curva y los datos de la espirometría para el diagnóstico de la EPOC. Resultados. Se incluyeron 26 variables clínicas para el diagnóstico de la EPOC. Un cuarto experto utilizó la aplicación web para clasificar una cohorte de 695 pacientes a los que se les había realizado una espirometría en un centro de tercer nivel y que habían contestado al menos uno de los cinco cuestionarios para la detección de la EPOC. De los 695 sujetos, el 34 % tenían EPOC según el experto que les diagnosticó usando la aplicación web. Sólo el 42 % de los pacientes del grupo con EPOC había recibido un diagnóstico previo de la enfermedad y el 19 % de los pacientes del grupo sin EPOC había sido diagnosticado erróneamente con la enfermedad. Conclusión. Se desarrolló una aplicación web que muestra información demográfica y clínica, así como datos espirométricos, para facilitar el proceso de diagnóstico de la EPOC en entornos de atención primaria.
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Internet , Atenção Primária à Saúde , Doença Pulmonar Obstrutiva Crônica , Espirometria , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Humanos , Estudos Transversais , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Técnica DelphiRESUMO
Background: Development of new tools in artificial intelligence has an outstanding performance in the recognition of multidimensional patterns, which is why they have proven to be useful in the diagnosis of Chronic Obstructive Pulmonary Disease (COPD). Methods: This was an observational analytical single-centre study in patients with spirometry performed in outpatient medical care. The segment that goes from the peak expiratory flow to the forced vital capacity was modelled with quadratic polynomials, the coefficients obtained were used to train and test neural networks in the task of classifying patients with COPD. Results: A total of 695 patient records were included in the analysis. The COPD group was significantly older than the No COPD group. The pre-bronchodilator (Pre BD) and post-bronchodilator (Post BD) spirometric curves were modelled with a quadratic polynomial, and the coefficients obtained were used to feed three neural networks (Pre BD, Post BD and all coefficients). The best neural network was the one that used the post-bronchodilator coefficients, which has an input layer of 3 neurons and three hidden layers with sigmoid activation function and two neurons in the output layer with softmax activation function. This system had an accuracy of 92.9% accuracy, a sensitivity of 88.2% and a specificity of 94.3% when assessed using expert judgment as the reference test. It also showed better performance than the current gold standard, especially in specificity and negative predictive value. Conclusion: Artificial Neural Networks fed with coefficients obtained from quadratic and cubic polynomials have interesting potential of emulating the clinical diagnostic process and can become an important aid in primary care to help diagnose COPD in an early stage.
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Pulmão , Aprendizado de Máquina , Redes Neurais de Computação , Valor Preditivo dos Testes , Doença Pulmonar Obstrutiva Crônica , Espirometria , Humanos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Masculino , Idoso , Feminino , Pessoa de Meia-Idade , Capacidade Vital , Pulmão/fisiopatologia , Reprodutibilidade dos Testes , Diagnóstico por Computador , Broncodilatadores , Pico do Fluxo ExpiratórioRESUMO
La composición corporal en población militar es indispensable en la caracterización del estado nutricional, lo cual representa la acumulación de grasa, huesos, agua y músculo total en el cuerpo. Objetivo: Describir y analizar variables de la composición corporal en datos recolectados de una muestra de oficiales del Ejército Nacional de Colombia. Metodología: Estudio descriptivo entre oficiales con la finalidad determinar la composición corporal y bioimpedancia con el estado nutricional como un indicador de riesgos sobre la salud, utilizando un tallímetro, báscula con precisión de 100 gramos, cinta antropométrica flexible, compás de pequeños diámetros y de pliegues cutáneos. Se consideró un valor de p estadísticamente significativo <0,05. Resultados: La muestra de oficiales recolectada está compuesta por un total de 96 sujetos, con una división de rangos militares de la siguiente manera: teniente (n= 28), capitán (n=23), mayor (n=15), teniente coronel (n=10), subteniente (n=4) y coronel (n=1). La diferencia de edad y peso entre el grupo de oficiales superiores y subalternos fue de 11,33 años (p=0,089) y 1,42 kilogramos (p=0,235), respectivamente. El valor esperado de la flexibilidad fue diferente entre grupos, siendo mayor en el grupo de oficiales subalternos (p=0,016). Conclusión: Las variables de composición corporal no presentaron diferencias estadísticamente significativas entre los grupos oficiales superiores y subalternos.
Background: Body composition in the military population is essential in the characterization of nutritional status, representing the accumulation of fat, bone, water, and total muscle in the body. Objective: Describe and analyze variables of the CP data collected from a sample of officers of the Colombian National Army. Methodology: Descriptive study among officers in order to determine body composition and bioimpedance with nutritional status as an indicator of health risks, using a height rod, a scale with a precision of 100 grams, a flexible anthropometric tape, a small diameter compass and skinfold compass. A statistically significant p value of <0.05 is considered. Results: The sample of officers collected is composed of a total of 96 subjects with a division of military ranks as follows: lieutenant (n= 28), captain (n=23), major (n=15), lieutenant colonel ( n=10), second lieutenant (n=4) and colonel (n=1). The difference in age and weight between the group of senior and junior officers was 11.33 years (p=0.089) and 1.42 kilograms (p=0.235), respectively. The expected value of flexibility is different between groups, being higher in the group of junior officers (p=0.016). Conclusion: The body composition variables did not present statistically significant differences between the superior and subordinate official groups.
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Introducción: La musicoterapia puede ser utilizada para influenciar en el estado físico y emocional de pacientes diagnosticados con la COVID-19. Se realiza una revisión sistemática exploratoria que incluye estudios observacionales y ensayos clínicos; Pubmed y Scopus fueron las bases de datos empleadas para la realización de la búsqueda. Además, se incluyen registros de ensayos clínicos de la Plataforma de Registros Internacionales de Ensayos Clínicos de la Organización Mundial de la Salud. Objetivo: Explorar la literatura médica disponible, sobre el impacto clínico de la musicoterapia en pacientes diagnosticados con la COVID-19. Desarrollo: De 39 documentos encontrados se incluyen 2 artículos: un ensayo clínico y un reporte de caso, con una población total de 41 pacientes. Se encuentra evidencia médica que respalda el impacto clínico favorable sobre la saturación de oxígeno, rehabilitación física y síntomas asociados al estrés en pacientes con diagnóstico de la COVID-19 con y sin requerimiento de soporte ventilatorio. Conclusiones: La musicoterapia es una herramienta útil en el tratamiento y rehabilitación no farmacológica de pacientes con la COVID-19; sin embargo, son necesarios nuevos estudios clínicos con mayor número de poblaciones muestrales y mayor tiempo de seguimiento.
Background: Music therapy can be used to influence the physical and emotional state of patients diagnosed with COVID-19. An exploratory systematic review was carried out including observational studies and clinical trials, Pubmed and Scopus were the databases used to carry out the literature search. In addition, clinical trial registries from the World Health Organization International Clinical Trials Registry Platform are included. Objective: To explore the available medical literature on the clinical impact of music therapy in patients diagnosed with COVID-19. Development: Of 39 documents found in the search, two articles are included: a clinical trial and a case report, with a total population of 41 patients. Medical evidence is found to support the favorable clinical impact on oxygen saturation, physical rehabilitation and symptoms associated with stress in patients diagnosed with COVID-19 with and without the need for ventilatory support. Conclusions: Music therapy is a useful tool in the non-pharmacological treatment and rehabilitation of patients with COVID-19. However, new clinical studies with a larger number of sample populations and follow-up times using music therapy in this disease are necessary.
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Objetivo: Describir el comportamiento de la glucosa y la insulina durante las etapas del ejercicio en atletas acondicionados en ejercicio aeróbico y anaeróbico. Materiales y métodos: En un estudio cuasiexperimental de corte transversal se compararon la glucosa e insulina de 6 atletas anaeróbicos y 10 aeróbicos durante el reposo, ejercicio de moderada - alta intensidad y la recuperación. Se eligió un valor p de <0.05, se encontró distribución no-normal y se utilizaron pruebas no paramétricas y modelos de regresión linear. Resultados: El ejercicio moderado llevó a hipoinsulinemia, y el intenso a hiperinsulinemia e hiperglicemia. No encontramos diferencias entre los dos tipos de atletas. Conclusiones: El comportamiento del sistema nervioso autónomo afectaría el balance glucoenergético corporal durante el ejercicio aún más que la insulina, con variaciones dependiendo del tipo de entrenamiento, pero es necesario realizar estudios adicionales para evaluar esta relación.
Objective: Describe glucose and insulin behavior at the different phases of exercise in aerobic and anaerobic athletes. Materials and methods: Glucose and insulin from 6 anaerobic and 10 aerobic athletes were compared during rest, moderate-high intensity exercise, and recovery. Statistical analysis was performed to evaluate insulin and glucose behavior, and differences between aerobic aerobic and anaeribic-trained individuals. A p value of <0.05 was set. A non-normal distribution was found, non-parametric tests and multivariate analysis were performed. Results: Moderate exercise led to hypoinsulinemia, whereas intense exercise caused hyper-insulinemia and hyperglycemia. No differences were found between the 2 groups. Conclusions: Autonomic nervous system behavior may play a role in the glucoenergetic balance that could overcome insulin effect, and it could vary depeding on the type of exercise régimen but further evaluation is necessary to confirm these findings
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Resumen: Las complicaciones neurológicas perioperatorias secundarias a hipoxia durante procedimientos de sedación y anestesia general son frecuentes en cirugía cardiovascular y en pacientes con comorbilidades. Sin embargo, hasta el momento no existe un consenso para el diagnóstico de estas posibles complicaciones. En pacientes con trauma encefálico severo y/o hemorragia subaracnoidea el lactato cerebral no fue útil para predicción de hipoxia cerebral; pese a ello, la relación de lactato/piruvato podría ser una herramienta para diagnóstico intraoperatorio de hipoxia cerebral aguda. Los estudios sugieren que éste debe asociarse a otros marcadores y/o a monitoreo multimodal. Es necesario realizar estudios que evalúen su valor predictivo para hipoxia cerebral.
Abstract: Perioperative neurological complications secondary to hypoxia during sedation and general anesthesia procedures are frequent in cardiovascular surgery, and in patients with comorbidities. However, so far there is no consensus for the diagnosis of these possible complications. In patients with head trauma severe and/or subarachnoid hemorrhage cerebral lactate was not useful for predicting cerebral hypoxia, however the lactate/pyruvate ratio could be a tool for intraoperative diagnosis of acute cerebral hypoxia. Studies suggest that it must be associated with other markers or multimodal monitoring. Further studies are needed to evaluate lactate predictive value for the diagnosis of cerebral hypoxia.
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Abstract Background: Currently, there are a few studies on the clinical characteristics of the pediatric population with COVID-19 and pneumonia. This study aimed to analyze data associated with the development of pneumonia in children and adolescents with SARS-CoV-2 infection throughout Mexico. Methods: We conducted a secondary analysis of the database of the Dirección General de Epidemiología of the Mexican Government. We included children under the age of 19 who were confirmed with SARS-CoV-2 infection by reverse transcription-polymerase chain reaction (RT-PCR) test. The dependent variable was the diagnosis of pneumonia. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. Multiple logistic regression models were performed to adjust factors associated with pneumonia. Results: A total of 1443 children with a COVID-19 diagnosis were included. The median age of the participants was 12 years (interquartile range 25, 75: 5, 16). Pneumonia occurred in 141 children (9.8%). The main risk factors were age < 3 years (OR, 3.5; 95%CI, 2.45-5.03); diabetes or obesity (OR, 12.6; 95%CI, 4.62-34.91); and immunocompromise (OR, 7.03; 95%CI, 3.97-13.61). Conclusions: Children < 3 years with COVID-19 and comorbidities, especially diabetes or obesity, and immunocompromised patients have a higher risk of developing pneumonia.
Resumen Introducción: Hasta ahora existen pocos estudios sobre las características clínicas de la población pediátrica con neumonía por COVID-19. El objetivo de este estudio fue analizar los datos que se asocian con el desarrollo de neumonía en niños y adolescentes con infección por SARS-CoV-2 en México. Métodos: Se llevó a cabo un análisis secundario de la base de datos de la Dirección General de Epidemiología del Gobierno Mexicano. Se incluyeron menores de 19 años con infección por SARS-CoV-2 confirmada mediante la prueba de retrotranscripción acoplada a la reacción en cadena de la polimerasa (RT-PCR). La variable dependiente fue el diagnóstico de neumonía. Se calcularon las razones de momios (RM) y los intervalos de confianza del 95% (IC95%). Se realizaron modelos de regresión logística múltiple para ajustar los factores asociados a neumonía. Resultados: Se incluyeron 1443 niños con diagnóstico de COVID-19. La mediana de edad de los participantes fue de 12 años (rango intercuartilar 25-75: 5-16). La neumonía se presentó en 141 niños (9.8%). Los principales factores de riesgo fueron edad < 3 años (RM: 3.5; IC95%: 2.45-5.03), diabetes u obesidad (RM: 12.6; IC95%: 4.62-34.91) e inmunocompromiso (RM: 7.03; IC95%: 3.97-13.61). Conclusiones: Los niños con COVID-19 menores de 3 años y con comorbilidad, especialmente diabetes u obesidad, y los inmunocomprometidos presentan mayor riesgo de desarrollar neumonía.
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Abstract Introduction: Total intravenous anesthesia (TIVA) and balanced anesthesia (BA) are the most commonly used anesthetic techniques. The differences are the variability of the depth of anesthesia between these techniques that might predict which one is safer for patients and presents a lower risk of intraoperative awakening. Objective: To determine whether a difference exists in the variability of depth of anesthesia obtained by response entropy (RE). Methods: A crossover clinical trial was conducted on 20 healthy patients receiving upper or lower limb ambulatory orthopedic surgery. Patients were randomly assigned to (a) target-controlled infusion of propofol using the Schnider model at a target concentration of 2.5 µg/mL for 15 minutes and a 10-minute washout, followed by sevoflurane administration at 0.8 minimal alveolar concentration (MAC) for the reminder of the surgery, or (b) the reverse sequence. Differences in the variability of the depth of anesthesia using RE were evaluated using paired t-test. Results: The treatment effect showed no significant difference in the average values of RE, during TIVA = 97.23 vs BA 97.04 (P = 0.39). Carry Over (-4.98 vs 4.08) and Period (100.3 vs 94.68) effects were not significantly different. Conclusion: The present study suggests that both anesthetic techniques are equivalent in terms of the stability of the depth of anesthesia. It is important to keep testing the determinants of the efficacy of different populations because the individual behaviors of patients might ultimately tip the scale.
Resumen Introducción: La anestesia total intravenosa (TIVA, por sus siglas en inglés) y la anestesia balanceada (AB) son las técnicas anestésicas más comúnmente utilizadas. La diferencia está en la variabilidad de la profundidad de la anestesia entre estas dos técnicas, lo cual pudiera predecir cuál es más segura para los pacientes y representar un menor riesgo de despertar intraoperatorio. Objetivo: Determinar si existe alguna diferencia en la variabilidad de la profundidad de la anestesia obtenida según los índices de entropía de respuesta (ER). Métodos: Se llevó a cabo un estudio clínico cruzado en 20 pacientes sanos que se sometieron a cirugía ortopédica ambulatoria de miembros superiores o inferiores. Los pacientes se asignaron aleatoriamente así: a) infusión controlada por objetivo (TCI, por sus siglas en inglés) de propofol, utilizando el modelo Schnider a una concentración objetivo de 2,5 µg/mL durante 15 min y un período de lavado de 10 minutos, seguido de la administración de sevoflurano a 0,8 de concentración alveolar mínima (CAM) durante el tiempo restante de la cirugía; o b) la secuencia inversa. Las diferencias en la variabilidad de la profundidad de la anestesia utilizando entropía de respuesta se evaluaron utilizando la prueba t pareada. Resultados: El efecto del tratamiento no mostró ninguna diferencia significativa en los valores promedio de entropía de respuesta (ER) durante TIVA = 97,23 vs. AB 97,04 (P = 0,39). Los efectos de arrastre (-4,98 vs. 4,08) y período (100,3 vs. 94,68) no fueron significativamente diferentes. Conclusiones: El presente estudio sugiere que ambas técnicas anestésicas son equivalentes en términos de estabilidad de la profundidad de la anestesia. Es importante continuar probando los factores determinantes de eficacia en las distintas poblaciones, ya que el comportamiento individual de cada paciente pudiera finalmente inclinar la balanza.
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Humanos , Masculino , Feminino , Adulto , Entropia , Consciência no Peroperatório , Anestesia Balanceada , Anestesia Intravenosa , Propofol , Métodos Epidemiológicos , SevofluranoRESUMO
Abstract Many decisions must be made under stress; therefore, stress and decision-making are intrinsically related not only at the behavioral level but also at the neural level. Additionally, virtual reality tools have been proposed as a method to induce stress in the laboratory. This review focuses on answering the following research question: Does stress assessed by physiological variables of a subject under virtual reality stimuli increase the chances of error in decision-making? The reviewed studies were consulted in the following databases: PubMed, IEEE Xplore, and Science Direct. The analysis of the consulted literature indicates that the stress induced in the laboratory using virtual reality tools and the physiological response of the central and autonomous nervous system are complementary subjects and allow the design of training and support systems for the decision-making process.
Resumen Muchas decisiones deben tomarse bajo estrés, por lo tanto, el estrés y la toma de decisiones están intrínsecamente relacionados, no solo a nivel conductual sino también a nivel neural. Además, las herramientas de realidad virtual se han propuesto como un método para inducir estrés en el laboratorio. El presente trabajo de revisión temática se centra en responder la siguiente pregunta de investigación: ¿El estrés evaluado mediante variables fisiológicas de un sujeto bajo estímulos de realidad virtual aumenta las posibilidades de error en la toma de decisiones? Los estudios revisados fueron consultados en las siguientes bases de datos: PubMed, IEEE Xplore y Science Direct. El análisis de la literatura consultada indica que el estrés inducido en el laboratorio, por medio de herramientas de realidad virtual, y la respuesta fisiológica del sistema nervioso central y autónomo son temas que se complementan y permiten el diseño de sistemas de soporte y entrenamiento para el proceso de toma de decisiones.
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Resumen La intoxicación por acetaminofén es una intoxicación frecuente en Colombia y en su tratamiento es fundamental la administración de un antídoto. El manejo convencional con N acetil cisteína presenta potenciales eventos adversos. El objetivo de este reporte de caso es evidenciar la utilidad de un nuevo esquema de tratamiento en un paciente masculino de 19 años quien ingirió 16,5 gramos de acetaminofén y luego de seis horas inició con dolor abdominal y episodios de emésis, para lo cual se inició manejo con N acetil cisteína en la forma tradicionalmente recomendada con la cual desarrolló reacción de hipersensibilidad. Ante la necesidad de continuar con este medicamente se inició un esquema diferente del antídoto con un resultado exitoso y sin nuevas reacciones de hipersensibilidad.
Abstract Toxicity due to Acetaminophen is a very common type of intoxication in Colombia, and in its treatment is essential the administration of an antidote. Conventional management with N acetyl cysteine presents potential adverse events. The objective of this case report is to demonstrate the usefulness of a new treatment scheme in a 19-year-old male patient who ingested 16.5 grams of acetaminophen and after six hours started with abdominal pain and episodes of emesis, for which management was started with N acetyl cysteine in the recommended form and then developed a hypersensitivity reaction. Given the need to continue with this medication, a different antidote scheme was started with a successful result and without new hypersensitivity reactions.
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Abstract: Background: Ambulatory therapy in low-risk patients with cancer, fever, and neutropenia seems to be a secure and effective alternative. This study aimed to compare the effectiveness and safety of the antimicrobial treatment in early discharge vs. in-hospital treatment in children with cancer and febrile neutropenia (FN) with low risk of invasive bacterial infection (IBI). Methods: Quasi-experimental design with a historical cohort control group. Children with cancer during an episode of FN and low risk of IBI were included. The control group were inpatient children that received intravenous piperacillin/tazobactam. The experimental group was early discharge patients, who received 48 h of IV treatment and were switched to oral treatment. Outcomes: fever resolution, readmissions, and mortality. Results: Eighty low-risk FN episodes were included; the median age was 6 years old (2.6-11 years), and 43 (54%) were female. Main diagnoses were solid tumors (52 patients) and leukemia or lymphoma (28 patients). Forty-three patients received in-hospital treatment, and 37 were selected for early discharge (31 patients received ciprofloxacin and six received amoxicillin/clavulanate). Two patients were readmitted, one due to a relapse of fever with tumor progression and the other due to epistaxis. Adverse effects occurred in 21.6% of the early discharge group and 12% of the inpatient treatment group (p = 0.04). Conclusions: Early discharge in pediatric patients with cancer, fever, and neutropenia is an acceptable and safe alternative for low-risk patients.
Resumen: Introducción: El tratamiento ambulatorio en pacientes con cáncer, fiebre y neutropenia de bajo riesgo parece ser una alternativa segura y efectiva. El objetivo de este trabajo fue comparar la efectividad y la seguridad del tratamiento antimicrobiano en la modalidad de egreso temprano vs. el tratamiento intrahospitalario en niños con cáncer y neutropenia febril (NF), con bajo riesgo de infección bacteriana invasiva (IBI). Métodos: Diseño cuasi-experimental con un grupo control histórico. Se incluyeron niños con cáncer durante un episodio de NF con bajo riesgo de IBI. El grupo control fue constituido por pacientes que recibieron tratamiento hospitalario con piperacilina-tazobactam intravenosa. Los pacientes en el grupo de egreso temprano recibieron 48 horas de tratamiento intravenoso y egresaron con antimicrobianos por vía oral. Desenlaces: resolución de la fiebre, reingreso al hospital y muerte. Resultados: Se incluyeron 80 pacientes con NF de bajo riesgo; la mediana de edad fue de 6 años; 43 pacientes (54%) eran de sexo femenino. Los diagnósticos principales fueron tumores sólidos (52) y leucemia o linfoma (28). Cuarenta y tres pacientes recibieron tratamiento hospitalario y 37 fueron seleccionados para egreso temprano. En el grupo de egreso temprano, 31 pacientes recibieron ciprofloxacino y 6 recibieron amoxicilina-clavulanato. Dos pacientes reingresaron, uno por fiebre secundaria a progresión tumoral y otro por epistaxis. Los efectos adversos se presentaron en el 21.6% de los pacientes en el grupo de egreso temprano y en el 12% del grupo de tratamiento hospitalario (p = 0.04). Conclusiones: El egreso temprano para niños con cáncer y NF de bajo riesgo es una alternativa aceptable y segura.
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Criança , Pré-Escolar , Feminino , Humanos , Masculino , Alta do Paciente , Infecções Bacterianas/tratamento farmacológico , Neutropenia Febril Induzida por Quimioterapia/tratamento farmacológico , Antibacterianos/administração & dosagem , Neoplasias/tratamento farmacológico , Estudos de Casos e Controles , Risco , Centros de Atenção Terciária , Assistência Ambulatorial , Combinação Piperacilina e Tazobactam/administração & dosagem , Hospitalização , Hospitais Pediátricos , MéxicoRESUMO
ABSTRACT Introduction: The maximum oxygen consumption (VO2max) is the gold standard in the cardiorespiratory endurance assessment. Objective: This study aimed to develop a mathematical model that contains variables to determine the VO2max of sedentary people. Methods: Twenty participants (10 men and 10 women) with a mean age of 19.8±1.77 years were included. For each participant, body composition (percentage of fat and muscle), heart rate variability (HRV) at rest (supine and standing), and VO2max were evaluated through an indirect test on a cycloergometer. A multivariate linear regression model was developed from the data obtained, and the model assumptions were verified. Results: Using the data obtained, including percentage of fat (F), percentage of muscle (M), percentage of power at very low frequency (VLF), α-value of the detrended fluctuation analysis (DFAα1), heart rate (HR) in the resting standing position, and age of the participants, a model was established for men, which was expressed as VO2max = 4.216 + (Age*0.153) + (F*0.110) - (M*0.053) - (VLF*0.649) - (DFAα1*2.441) - (HR*0.014), with R2 = 0.965 and standard error = 0.146 L/min. For women, the model was expressed as VO2max = 1.947 - (Age*0.047) + (F*0.024) + (M*0.054) + (VLF*1.949) - (DFAα1*0.424) - (HR*0.019), with R2 = 0.987 and standard error = 0.077 L/min. Conclusion: The obtained model demonstrated the influence exerted by body composition, the autonomic nervous system, and age in the prediction of VO2max.
RESUMO Introdução: O consumo máximo de oxigênio (VO2máx) é o padrão-ouro na avaliação da resistência cardiorrespiratória. Objetivo: Este estudo visou desenvolver um modelo matemático com as variáveis usadas na determinação do VO2máx em indivíduos sedentários. Método: Vinte indivíduos (10 homens e 10 mulheres) com média de idade 19,8±1,77 anos foram incluídos. Para cada participante, foram avaliados composição corporal (percentual de gordura e de músculo), variabilidade da frequência cardíaca (VFC) em repouso (em decúbito dorsal e em pé) e o VO2máx, empregando-se o protocolo em cicloergômetro, método indireto. A partir dos dados obtidos, desenvolveu-se um modelo de regressão linear multivariado e os pressupostos do modelo foram verificados. Resultados: Usando os dados obtidos, incluindo percentual de gordura (G), porcentagem de músculos (M), porcentagem de energia em frequência muito baixa (FMB), valor de α da análise de flutuação sem tendências (DFAα1), frequência cardíaca (FC) em repouso na posição em pé e a idade dos participantes, estabeleceu-se um modelo para homens, expresso como: VO2máx = 4,216 + (Idade*0,153) + (G*0,110) - (M*0,053) - (FMB0,649*) - (DFAα1*2,441) - (FC*0,014) com R2 = 0,965 e erro padrão = 0,146 L/min. Para as mulheres, o modelo foi expresso como: VO2máx = 1,947 - (Idade*0,047) + (G*0,024) + (M*0,054) + (FMB*1,949) - (DFAα1*0,424) - (FC*0,019) com R2 = 0,987 e erro padrão de 0,077 L/min. Conclusão: O modelo desenvolvido demonstrou a influência exercida pela composição corporal, pelo sistema nervoso autônomo e pela idade na predição do VO2máx.
RESUMEN Introducción: El consumo máximo de oxígeno (VO2max) es el patrón áureo en la evaluación de la resistencia cardiorrespiratoria. Objetivo: Este estudio tuvo como objetivo desarrollar un modelo matemático con las variables que participan en la determinación del VO2max en individuos sedentarios. Método: Veinte sujetos (10 hombres y 10 mujeres) con edad promedio de 19,8 ± 1,77 años se han incluido. Para cada participante, se evaluó la composición corporal (porcentaje de grasa y músculo), variabilidad de la frecuencia cardiaca (VFC) en reposo (decúbito supino y en pie) y VO2max mediante un test indirecto en cicloergómetro. A partir de los datos obtenidos se desarrolló un modelo de regresión lineal multivariado y se comprobaron los supuestos del modelo. Resultados: Usando los datos obtenidos, incluyendo porcentaje de grasa (G), porcentaje de músculos (M), porcentaje de energía en frecuencia muy baja (FMB), valor de α del análisis de fluctuación sin tendencias (DFAα1), frecuencia cardiaca (FC) en reposo en la posición en pie y la edad de los participantes, se estableció un modelo para hombres que se expresa como VO2max = 4,216 + (Edad*0,153) + (G*0,110) - (M*0,053) - (FMB*0,649) - (DFAα1*2,441) - (FC*0,014) con R2 = 0,965 y error típico = 0,146 L/min. Para las mujeres el modelo se expresó como VO2max = 1,947 - (Edad*0,047) + (G*0,024) + (M*0,054) + (FMB*1,949) - (DFAα1*0,424) - (FC*0,019) con R2 = 0,987 y error típico de 0,077 L/min. Conclusión: El modelo desarrollado demostró la influencia ejercida por la composición corporal, el sistema nervioso autónomo y la edad en la predicción del VO2max.
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Resumen: Introducción: La tuberculosis (TB) continúa siendo un reto ya que las formas graves se presentan con mayor frecuencia en los menores de 5 años y el diagnóstico es complejo. El objetivo del presente trabajo fue describir las formas de presentación clínica, frecuencia, métodos de diagnóstico empleados y respuesta al tratamiento en niños con TB atendidos en un hospital de tercer nivel. Métodos: Se diseñó un estudio retrospectivo, descriptivo, de una cohorte de casos consecutivos atendidos desde enero de 2010 hasta diciembre de 2013. Se revisaron 93 expedientes clínicos de niños con diagnóstico de TB de acuerdo con la definición de la NOM-006-SSA2-2013. Se utilizó estadística descriptiva para el análisis. Resultados: El 58% de 93 niños fueron pacientes de sexo masculino con una media de edad de 7 años. El 97% contaba con antecedente de vacunación BCG; el 6% tuvo contacto con algún caso de TB. Las formas clínicas más frecuentes fueron la TB pulmonar (30.1%), ganglionar (24.7%), miliar/diseminada (16.1%), meníngea (13%) y ósea (7.5%). Los síntomas más comunes fueron fiebre y pérdida de peso (50% y 40%, respectivamente). El BAAR y el cultivo fueron positivos en el 26% y el 7% de todos los casos, respectivamente. El estudio histopatológico fue concluyente en el 90%. El tratamiento fue exitoso en el 94.6%, sin mortalidad asociada. Conclusiones: La asociación del cuadro clínico con las alteraciones en la radiografía de tórax y PPD positivo son útiles para establecer el diagnóstico presuntivo e iniciar el manejo oportuno.
Abstract: Background: Tuberculosis (TB) remains a challenge because severe forms occur most frequently in children under 5 years of age and the diagnosis is complex. The objective of this paper was to describe the clinical presentation, frequency, diagnostic methods used and response to treatment in children with TB treated at a tertiary level hospital. Methods: The study was retrospective and descriptive of a cohort of consecutive cases treated from January 2010 to December 2013. Ninety-three medical records of children diagnosed with TB according to the definition of the NOM-006-SSA2-2013 were reviewed. Descriptive statistics were used for the analysis. Results: From 93 children, 58% were male (mean age of 7 years), 97% with a history of BCG vaccination, and 6% had contact with a TB case. The most frequent clinical forms were pulmonary (30.1%), lymph node (24.7%), miliary/disseminated (16.1%), meningeal (13%), and osteal TB (7.5%). The most common symptoms were fever and weight loss (50% and 40%, respectively). BAAR and culture were positive in 26% and 7% of all cases, respectively. The histopathological study was conclusive in 90% of the cases. The treatment was successful in 94.6%, with not associated mortality. Conclusions: The association of clinical symptoms with alterations in chest radiography and positive PPD are useful in establishing the presumptive diagnosis and an early and appropriate treatment.
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Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Tuberculose/epidemiologia , Vacina BCG/administração & dosagem , Redução de Peso , Febre/epidemiologia , Tuberculose/diagnóstico , Tuberculose/terapia , Estudos Retrospectivos , Estudos de Coortes , Resultado do Tratamento , Febre/microbiologia , Centros de Atenção TerciáriaRESUMO
Introduction: There are two different pharmacokinetic models (Marsh and Schnider) for the administration of total intravenous anesthesia with propofol, the parameter differences could have some impact over the depth of anesthesia. Objective: To determine if there is a significant difference in the variability of depth of anesthesia suggesting that one model is superior in achieving a more stable and predictable depth of anesthesia during surgery. Methods: A cross-over clinical trial was conducted on 16 healthy patients programmed for upper or lower limb ambulatory orthopedic surgery. Patients were randomly assigned to (i) effect site target controlled infusion of propofol with Marsh model at a target concentration of 2.5 μg/ml for 20 min, a 20 min washout, then propofol was administered with Schnider model at the same effect site target for the reminder of the surgery, or (ii) the reverse sequence. Differences in variability of depth of anesthesia, were assessed by comparing records of spectral entropy indices during surgery through an unpaired t-test. Results: There was no evidence of significant difference in the mean variances of either spectral entropy indices between the two models (p-value: 0.57 for State Entropy, p-value: 0.51 for Response Entropy). Conclusion: The study suggests that both pharmacokinetic models are equivalent in terms of stability of depth of anesthesia. It is important to keep testing determinants of the efficacy of the models in different types of population because their behavior according to individual characteristics of patients or variables such as cost-effectiveness could end up tilting the scale.
Introducción: Hay dos modelos farmacocinéticos diferentes para la administración de la anestesia total intravenosa con propofol (Marsh y Schnider), las diferencias entre los parámetros podrían tener algún impacto sobre la profundidad anestésica. Objetivo: Comparar la variabilidad de la profundidad anestésica durante administración de infusión de propofol con los modelos de Marsh y Schnider para determinar si hay diferencias significativas que sugieran que uno de los modelos es superior en lograr una profundidad anestésica más estable y predecible. Métodos: Estudio clínico cruzado, controlado y aleatorizado llevado a cabo en 16 pacientes programados para cirugía ambulatoria de ortopedia. Los pacientes fueron asignados aleatoriamente a i) infusión controlada por objetivo de propofol con el modelo de Marsh a una concentración objetivo en sitio de efecto de 2.5μg/ml durante 20 minutos, 20 minutos de periodo de lavado, seguido de infusión de propofol con modelo de Schnider a la misma concentración objetivo; o ii) la secuencia inversa. La diferencia en variabilidad de profundidad anestésica fue evaluada mediante la comparación de registros de índices de entropía con una prueba t no pareada. Resultados: No se encontró evidencia de diferencias significativas de la varianza media en los índices de entropía espectral asociada a los modelos (valor-p: 0.57 para entropía de estado, valor-p: 0.51 para entropía de respuesta). Conclusión: El estudio sugiere que ambos modelos son equivalentes en términos de estabilidad de profundidad anestésica. Es importante continuar estudiando la eficacia de los modelos en diferentes tipos de población, dado que su comportamiento según características individuales de los pacientes o variables cómo costo-efectividad podrían inclinar la balanza.
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HumanosRESUMO
El síndrome de Wiskott-Aldrich es una inmunodeficiencia primaria; con una incidencia de 3,5 a 5,2 por cada millón de recién nacidos masculinos. Se caracteriza por tener un patrón de herencia recesiva ligada al cromosoma X. En estos pacientes; se ha descrito la tríada clásica de inmunodeficiencia; microtrombocitopenia y eczema. Presentamos un paciente de 5 años de edad; hispánico; con antecedentes de numerosas infecciones desde el primer año de vida. Actualmente; presenta desnutrición crónica; talla baja secundaria y retraso en el desarrollo del lenguaje. Se diagnosticó una mutación poco frecuente del gen asociado al síndrome de Wiskott-Aldrich.
The Wiskott-Aldrich syndrome is a rare X-linked recessive immunodeficiency, with an estimated incidence of 3.5 to 5.2 cases per million males. It is characterizedby immunodeficiency, microthrombocytopenia and eczema. We present a 5-year-old Hispanic male, with a medical history of numerous infectious diseases, compromised health, chronic malnutrition, language delay and failure to thrive. An infrequent mutation in the Wiskott-Aldrich syndrome gene was found.