Pain on injection from propofol may be avoided by changing its formulation.

BACKGROUND: After using propofol for a decade, pain on injection had been considered routine by patients and medical personnel. When given propofol from a different manufacturer, patients did not complain. Two preparations of propofol were compared. METHODS: A comparative, double-blind, randomized study was conducted in 22 adult patients undergoing pain relief procedures; they received sedation by an intravenous injection of 1.7 mg/kg of propofol and then were treated with paravertebral injections. Pain on injection was assessed by verbal complaint, movement of the extremity, of the whole body and recollection of pain at induction, when discharged. Propofol from Baxter Laboratories, mixed with either 5 ml of 2% lidocaine or 5 ml of NaCl 0.9%, was compared with propofol Laboratorios Gray, which was similarly mixed. Injections were randomly administered four times, blindly, to each of 22 patients. Statistical analysis was conducted using the analysis of variance method. RESULTS: A total of 352 propofol injections were given. Each of the four propofol solutions was administered 88 times; of patients receiving Baxter propofol+saline, 74 (84%) had pain; when mixed with 2% lidocaine 45 (50.2%) complained. After propofol Gray with NaCl 0.9% was given, two patients (2.2%) experienced pain. Propofol Gray with 2% lidocaine produced no pain. None of the latter group remembered having pain, whereas, those given propofol Baxter 54 (61.3%) and 26 (29.5%) remembered experiencing pain at injection. Pain on injection was prevented and statistically reduced (<0.01) with the propofol from Laboratorios Gray. CONCLUSIONS: By changing the formulation (size of molecules and their dispersion) of propofol, pain on injection was avoided.

Chronic blockade of the AT2 receptor with PD123319 impairs insulin signaling in C57BL/6 mice.

The renin-angiotensin system modulates insulin action. Angiotensin type 1 receptor exerts a deleterious effects while the angiotensin type 2 receptor (AT2R) appears to have beneficial effects providing protection against insulin resistance and type 2 diabetes. Although recent reports indicate that agonism of AT2R ameliorates diabetes and insulin resistance, the phenotype of AT2R-knockout mice seems to be controversial relating this aspect. Thus, in this study we have explored the role of AT2R in the control of insulin action. To that end, C57Bl/6 mice were administered the synthetic AT2R antagonist PD123319 for 21days (10mg/kg/day ip); vehicle treated animals were used as control. Glucose tolerance, metabolic parameters, in vivo insulin signaling in main insulin-target tissues as well as levels of adiponectin, TNF-α, MCP-1 and IL-6 in adipose tissue were assessed. AT2R blockade with PD123319 induced a marginal effect on glucose homeostasis but an important reduction in the insulin-induced phosphorylation of the insulin receptor and Akt in both liver and adipose tissue. Insulin signaling in skeletal muscle remained unaltered after treatment with PD123319, which could explain the minimal effect on glucose homeostasis induced by PD123319. Our current results reinforce the notion that the AT2R has a physiological role in the conservation of insulin action.

[Breast-feeding during the first month of life in Cordoba city, Argentina]. / Comportamiento de la lactancia en el primer mes de vida en la ciudad de Córdoba, Argentina.

In the foregoing investigation breast-feeding during the first 30 days of life was studied in a representative sample of 620 babies born and settled down in the city of Cordoba Argentina. To analyse this information, the classification of breastfeeding suggested by the WHO/UNICEF was used. The results reveal that being a month old, 26% of the babies had complete breastfeeding 60% had partial breastfeeding and the remaining 14% did not have it at all. Among the children with complete breast-feeding, 21% was exclusive and 5% was prevailing. 18% of the babies were exposed to breastfeeding before an hour and a half after they were born, the average number of nursings a day was 7.3 (D.S. 1.9) taking less than 15 minutes to reach the 57%; and with a free-demanding timetable in 44%. The children with partial breast-feeding were classified into low, medium, and high being 20%, 54%, 22% respectively. The average age in which another milk was introduced was 3.7 days, and the main reasons were "insufficient mother milk", and "the child's hunger". Among the children with artificial lactation, 87% were once exposed to breastfeeding, the weaning took place during the 4 days in average (D.S. 5.6) and in an abrupt way in 55% of them. The Health personnel helped supporting the introduction of lacteal formula in 68% of the children with partial lactation and in 42% of the cases of complete abandon of natural breastfeeding.

Paso de guardia en enfermería: Una revisión sistemática / Nursing shift handover: A systematic review / Passagem de plantão em enfermagem: Uma revisão sistemática

Resumen El paso de guardia en enfermería es una actividad fundamental para dar continuidad al cuidado de los pacientes, se realiza como cumplimiento obligatorio de una tarea en el quehacer laboral. Objetivo Describir la producción científica publicada entre 2007-2017, referente a la temática de paso de guardia de enfermería en los servicios de urgencias. Metodología Se desarrolló una revisión sistemática en seis bases de datos, se incluyeron estudios en idiomas inglés, español y portugués que estuvieran publicados en revistas indexadas con acceso a texto completo. Se realizó un análisis crítico de cada uno de los artículos con las Herramientas CASPe y STROBE, los resultados se ordenaron en una matriz que facilitó la obtención de información y categorías. Resultados De un total de 430 artículos, se incluyeron a la investigación únicamente 19, de los cuales 17 están escritos en idioma inglés y dos en español. Después del análisis de los artículos seleccionados se estructuraron dos categorías: Características del paso de guardia y Estandarización del proceso. Conclusiones Las brechas en la comunicación se perfilan como uno de los principales aspectos a tener en cuenta, para mejorar el paso de guardia. El lugar más recomendable para que se lleve a cabo el proceso debe ser en la habitación del paciente y verificado por los dos equipos de enfermería. En la actualidad es necesario realizar investigaciones para mejorar el nivel de evidencia de los estudios.

Abstract Nursing shift handover is an obligatory and a fundamental activity to ensure continuity in the process of patient care. Objective To describe the scientific production published between 2007-2017 regarding nursing shift handover within medical emergency services. Methodology A systematic review was conducted on six databases. Articles with full texts written in English, Spanish, and Portuguese, and published in indexed journals were included. A critical analysis on each article was conducted using the Critical Appraisal Skills Programme spanish, and the Strengthening the Reporting of Observational Studies in Epidemiology tools. Articles were clustered in a matrix of categories. Results From a total of 430 possible articles, 19 were included for this study - 17 written in English and 2 written in Spanish. From the corresponding analysis, two categories were structured: Nursing Shift Handover Characteristics, and Process Standardization. Conclusions Communication gaps seem to be one of the main issues to address while improving the nursing shift handover process. The patient room should be the place for the shift handover, and this process must be acknowledged by both nursing teams.

Resumo A passagem de plantão em enfermagem é uma atividade fundamental para dar continuidade ao cuidado dos pacientes, realiza-se como cumprimento obrigatório de uma tarefa no trabalho laboral. Objetivo Descrever a produção científica publicada entre 2007-2017, referente à temática de passagem de plantão de enfermagem nos serviços de urgências. Metodologia Desenvolveu-se uma revisão sistemática em seis bases de dados, incluíram-se estudos em idiomas inglês, espanhol e português que estiveram publicados em revistas indexadas com acesso a texto completo. Realizou-se uma análise crítica de cada um dos artigos com as Ferramentas CASPe e STROBE, os resultados ordenaram-se em uma matriz que facilitou a obtenção de informação e categorias. Resultados De um total de 430 artigos, incluíram-se à pesquisa unicamente 19, dos quais 17 estão escritos em idioma inglês e dois em espanhol. Depois da análise dos artigos selecionados estruturaram-se duas categorias: Caraterísticas da passagem de plantão e Padronização do processo. Conclusões Os abismos na comunicação perfilam-se como um dos principais aspectos a ter em conta, para melhorar a passagem de plantão. O lugar mais recomendável para se efetuar o processo deve ser no quarto do paciente e verificado pelas duas equipes de enfermagem. Na atualidade é necessário realizar pesquisas para melhorar o nível de evidência dos estudos.

Características y seguimiento de 38 casos de bronquiolitis obliterante post-infecciosa en Bogotá­Colombia / Characteristics and follow up of 38 Post-Infectious Bronchiolitis Obliterans cases in Bogota­Colombia

Post-infectious bronchiolitis obliterans (PIBO) is a chronic obstructive bronchial disease that develops after a viral respiratory infection, acquired before 2 years of age. In Bogotá, Colombia our group published in 2017 the description and follow-up of 21 cases of this pathology. The purpose of this publication is to describe the evolution of 38 children with PIBO living in Bogotá, Colombia at 2640 m above sea level, with an average of 6.5 years of follow-up. The estimated prevalence of PIBO in the population group in the group studied here was at least 1 case per 10,526 children under 15 years of age. The highest frequency of oxygen dependence and pulmonary hypertension are highlighted in this group of children living at high altitude…

La bronquiolitis obliterante post-infecciosa (BOPI) es una enfermedad bronquial obstructiva crónica, que se desarrolla luego de una infección respiratoria viral, adquirida antes de los 2 años de vida. En Bogotá, Colombia nuestro grupo hizo en al año 2017 la descripción y seguimiento de 21 casos de esta patología. La presente publicación tiene como objetivo describir la evolución de 38 niños con BOPI que viven en la ciudad de Bogotá a 2640 m sobre el nivel del mar, con un segumiento de 6.5 años en promedio. Se calcula que la prevalencia de la enfermedad en el grupo poblacional de donde se refieren estos casos, es de al menos 1 caso por 10.526 menores de 15 años. Se destacan la mayor frecuencia de oxigeno dependencia e hipertensión pulmonar en este grupo de niños que viven a gran altura.

Plasma thrombin-activatable fibrinolytic inhibitor (TAFI) among healthy subjects and patients with vascular diseases: a validation study.

Thrombin activable fibrinolysis inhibitor antigen levels (TAFI Ag ) exhibit a great inter-individual variability in healthy populations. Our aim is to determine whether variability is due to physiologic variations depending on genetic control or due to validation of the method,in order to allow a better interpretation of the results inpatients with vascular diseases. With this purpose, we performed a strategy validation of specific ELISA method, Zymutest TAFI Ag Hyphen Biomed, base don a commercial monoclonal antibody. After methodology validation we have recently determined plasma TAFI Ag levels in several groups of diseases such as septic patients, menopause and cerebrovascular diseases. TAFI was finally determined in acute ischemic stroke to know its relationship with stroke evolution and response to thrombolytic treatments.

Feeding in the first month of life, by social strata, in Córdoba, Argentina.

A study was made of the feeding history from birth to 1 month of age in a cohort of children born and residing in the city of Córdoba, Argentina, in 1993. The sample was divided into six social strata, in accordance with the occupation of the individual primarily responsible for family support. A total of 620 mothers were surveyed 1 month (mean = 31 days; SD = 1.2 days) following delivery in order to obtain information on the occupational, housing, and demographic characteristics of the family. In addition, information was collected on the first food given to infants following birth as well as on the type of food received at 1 month of age, the latter being based on 24-hour recall. The living conditions and demographic characteristics of the families were associated with their social strata. Families in Stratum I (high) and strata II and III (intermediate) tended to have higher standards of living and to have parents who were older when the children were born than did families in the lowest strata (V and VI), while families in Stratum IV tended to approach the average values found for the entire sample. With regard to feeding practices, it was found that 98% of the children had begun breast-feeding during the first week of life. A statistical association was observed between first food and social strata, with breast-feeding being more prevalent among the very low strata (V and VI) and use of bottle feeding being more prevalent in strata I and III. At 1 month of age, 26% of the sample was receiving complete natural breast-feeding, 60% was receiving partial natural breast-feeding, and 14% was being entirely bottle-fed. A significant association (P < 0.05) was observed between type of breast-feeding and social strata, with a figure of 38% complete natural breast-feeding recorded for Stratum I as compared to 16% for Stratum IV and 17% for Stratum V. Other findings of this study that stood out were that a high percentage of children in all the strata were initially breast-fed; a high percentage of the children were given breast-milk substitutes during the first month of life; and a low prevalence of complete natural breast-feeding was observed at 1 month of age.

Biomodelo para la docencia de grado y postgrado en pediatría / Biomodel for teaching undergraduate and graduate in pediatrics

Introducción: La incorporación de la Clínica y la Imagenología permiten una mejor comprensión de la Anatomía. El objetivo de este trabajo es desarrollar un prototipo rápido en material sintético que replique detalles anatómicos para ser utilizado en la docencia de grado y postgrado en Pediatría. Material y Método: Caso 1: Niña de 1 año de edad con síndrome de dificultad respiratoria a causa de una malformación vascular. Caso 2: recién nacido con malformación torácica. Con la finalidad de analizar una conducta adecuada, se solicitó la confección de un prototipo rápido a escala 1:1 que simulara una condición idéntica a la topografía torácica del paciente, utilizando imágenes virtuales 3D almacenadas en formato DICOM.Técnica de generación de prototipo rápido: Se obtuvouna malla digital tridimensional y se generó el código “g”que se utilizó para controlar el hardware de producción. Se efectuó simulación digital y producción en material plástico (ABS) con técnica de deposición y fusión (MDF).Se validó el prototipo comparándo lo con las mediciones testigos del modelo virtual en 3 D.Resultados y Discusión: El modelo replicó exactamente los defectos hallados en la tomografía y endoscopía, confirmando la presencia de la malformación vascular y su repercusión sobre el aparato respiratorio. El prototipo rápido muestra las estructuras internas y externas del cuerpo humano con máxima precisión permitiendo una visión topográfica de situaciones “normales o patológicas” que facilitaría la docencia y el entrenamiento del equipo quirúrgico para proponer un plan de tratamiento adecuado. Hay numerosas áreas de la medicina que sebeneficiarían con este modelo que podría ser construído con diversos tipos de materiales de diferente flexibilidad y consistencia. Conclusiones: El prototipo rápido le da estado físico a las imágenes virtuales 3D, permitiendo la docencia y entrenamiento del equipo quirúrgico.

Introduction: The incorporation of the clinic and the imaging allow a better understanding of anatomy. Theaim of this work is to develop a rapid prototype in synthetic material that replicates anatomical details to be used inteaching and surgical training in Pediatrics. Material and method: Case 1: one year old female with respiratory distress syndrome because of vascular malformation. Case 2: newborn patient with thoracic malformation. In order to discuss appropriate conduct, the making of rapid prototyping in scale 1:1 was requested to simulate an identical condition of the thoracic topography of the patients, using virtual 3D images stored in the DICOM format. Rapid prototype technique: code "g" was generated, which was used to control the hardware of production and a three-dimensional digital grid was obtained. Digital simulation and production in plastic (ABS) with deposition and fusion technique (MDF) was performed. The prototype was validated by comparing measurements with witnesses of the virtual model in 3 D. Results and discussion: the model replied exactly the defects found in the scan and endoscopy, confirming the presence of vascular malformation and its impact on the respiratory system. Rapid prototype shows the internal and external structures of the human body with maximum precision allowing a topographic view of "normal or pathological" situations that would facilitate the teaching and training of the surgical team to propose an appropriate treatment plan. There are many areas of medicine that would benefit from this model that couldbe built with different types of materials with different flexibility and consistency. Conclusions: Rapid prototype gives form to virtual 3D images, allowing teaching and training of the surgical team.

Percepción materna de la calidad en la atención a niños hospitalizados / Maternal perception of care's quality to their children during hospitalization

A fin de evaluar la percepción que tienen las madres sobre la calidad de atención a los niños hospitalizados se realizó una encuesta especialmente diseñada. Se aplicó en 100 madres, en forma aleatoria, al egreso de los niños. La atención fue encontrada excelente o buena en 96%, regular o mala en 4%; 74%de las madres vio a alguien del personal, en su mayoría auxiliares de enfermería, actuar cariñosamente con sus hijos. Sólo el 2%afirmó que su hijo fue alguna vez retado o castigado. Al mismo tiempo, se detectaron diversos déficit materiales, de recursos humanos y de la atención y el trato. Se concluye que la atención fue percibida de modo satisfactorio. Se estima necesario continuar este tipo de estudios para perfeccionar la atención en salud

Características de las familias de pacientes reumáticos con y sin corea de Sydenham y de controles sanos / Family characteristics of rheumatic patients with and whithout Sydenham's chorea and a control group

Con el propósito de aportar información sobre la relación de la estructura familiar con la enfermedad reumática con o sin corea de Sydenham, se diseñó un estudio de muestras equivalentes pareadas de familias de pacientes con corea, de pacientes reumáticos sin corea y de familias controles sin antecedentes de enfermedades crónicas entre sus miembros. Todos los padres, madres y hermanos de los casos índice de cada familia fueron encuestados por separado mediante un cuestionario especialmente preparado. La gráfica familiar de Fuhrmann-Armengol se aplicó a todos los componentes de cada familia simultáneamente. Los resultados indican una atmósfera psicológica de mayor inestabilidad en los dos grupos de pacientes que en el grupo control, pues, la previsibilidad del sistema familiar, cuando es alta (28,8; 30,5 y 35,6%) o mediana (51,3; 40,0 y 54,0%) -respectivamente en corea, reumáticos y controles- es siempre mayor en los últimos. Se observan características estructurales de las familias con pacientes reumáticos sin corea, especialmente con cardiopatía, que sugieren una respuesta protectora adaptativa de este sistema familiar, pues, la cercanía afectiva de los hijos ante el sufrimiento de otro integrante es del orden de 93% en contraste con 83,9% en las familias de pacientes con corea y 83,3% en controles, como también en la cercanía ante la tristeza y la alegría donde las correspondientes proporciones fueron 30,5 y 52,9% respectivamente, en reumáticos, versus 25 y 30,3% en familias con corea, así como 14 y 29,4% en controles. Se concluye que la estructura familiar, no sólo se relaciona con la enfermedad psicosomática, sino que también con enfermedades orgánicas como la enfermedad reumática con y sin corea de Sydenham. Es necesario hacer más investigación para comprender mejor estas asociaciones

Peritonitis apendicular. / Appendicular peritonitis

En la experiencia que se presenta, la frecuencia de la peritonitis apendicular fue del 9,70%. Se observo un retardo notable en el diagnostico y tratamientos de los cuadros apendiculares agudos y en un elevado porcentaje de casos la falla fue medica