RESUMEN
Cystic fibrosis liver disease (CFLD) affects a large proportion of cystic fibrosis (CF) patients; however encephalopathy is a rare complication. While classical hepatic encephalopathy can be a feature of end-stage liver disease, "hyperammonemic encephalopathy" can be precipitated in previously stable CFLD by various triggers including systemic corticosteroids. We describe one such case and review the relevant literature.
Asunto(s)
Encefalopatías Metabólicas/metabolismo , Fibrosis Quística/metabolismo , Hiperamonemia/metabolismo , Cirrosis Hepática/metabolismo , Adolescente , Encefalopatías Metabólicas/etiología , Encefalopatías Metabólicas/fisiopatología , Confusión/etiología , Confusión/fisiopatología , Trastornos de la Conciencia/etiología , Trastornos de la Conciencia/fisiopatología , Fibrosis Quística/complicaciones , Estado de Descerebración/etiología , Estado de Descerebración/fisiopatología , Encefalopatía Hepática/metabolismo , Encefalopatía Hepática/fisiopatología , Humanos , Hiperamonemia/etiología , Cirrosis Hepática/etiología , MasculinoRESUMEN
OBJECTIVE: to evaluate the opinions of UK perinatal health care professionals on home birthing. DESIGN: cross-sectional survey. SETTING: four hospitals and three Primary Care Trusts in the East of England. POPULATION: hospital and community midwives, GPs, consultant obstetricians and gynaecologists, consultant paediatricians and neonatologists. METHODS: postal questionnaire between December 2010 and June 2011 using Likert scales (range 0-10) and freetext questions. Data were analysed using the Kruskal-Wallis test and qualitative methods. MAIN OUTCOME MEASURES: opinions, support and enthusiasm for home birthing. FINDINGS: 432/831 (52%) professionals responded: 224/418 (54%) midwives, 148/321 (46%) GPs, 32/52 (62%) obstetricians/gynaecologists and 28/41 (68%) paediatricians/neonatologists. Midwives were more enthusiastic about home birthing than any other professionals (median Likert scale rating: 9 [IQR 8-10], p<0.0001) and more supportive of the UK government's plan to increase home birth rates (median 8.5 [IQR 7-10], p<0.0001). GPs and obstetricians/gynaecologists tended to hold neutral opinions about home birthing (median of GPs 5 [IQR 3-7.5] and of obstetrician/gynaecologists 5 [IQR 2-7]) and regarding support for the government's plan (GP median 5 [IQR 2-6]; obstetrician/gynaecologists median 5 [IQR 2-5]). Paediatricians/neonatologists were generally negative about home birthing (median 4 [IQR 3-5]) and opposed to the government's plan (median 3 [IQR 2-5]). CONCLUSIONS: significant differences of opinion exist between UK perinatal health care professional groups about home birthing. Negative and neutral opinions should be further explored and addressed as they may impact on the uptake of home birth by women.