A Prospective Evaluation of Transverse Tracheal Sonography During Emergent Intubation by Emergency Medicine Resident Physicians.

OBJECTIVES: Establishing a definitive airway is often the first step in emergency department treatment of critically ill patients. Currently, there is no agreed upon consensus as to the most efficacious method of airway confirmation. Our objective was to determine the diagnostic accuracy of real-time sonography performed by resident physicians to confirm placement of the endotracheal tube during emergent intubation. METHODS: We performed a prospective cohort study of adult patients in the emergency department undergoing emergent endotracheal intubation. Thirty emergency medicine residents, who were blinded to end-tidal carbon dioxide detection results, performed real-time transverse tracheal sonography during intubation to evaluate correct endotracheal tube placement. RESULTS: Seventy-two patients were enrolled in the study. Sixty-eight instances (94.4%) were interpreted as correct placement in the trachea; 4 (5.6%) were interpreted as esophageal, of which 1 was a false-negative finding, therefore conferring sensitivity of 98.5% (95% confidence interval, 92.1%-99.9%) and specificity of 75.0% (95% confidence interval, 19.4%-99.4%) for correct placement. There was no significant difference in accuracy among resident sonographers with different levels of residency training. CONCLUSIONS: A simple transverse tracheal sonographic examination performed by emergency medicine resident physicians can be used as an adjunct to help confirm correct endotracheal tube placement during intubation. In our cohort, the level of training did not appear to affect the ability of residents to correctly identify the endotracheal tube position.

Aerobic exercise but not resistance exercise reduces intrahepatic lipid content and visceral fat and improves insulin sensitivity in obese adolescent girls: a randomized controlled trial.

It is unclear whether regular exercise alone (no caloric restriction) is a useful strategy to reduce adiposity and obesity-related metabolic risk factors in obese girls. We examined the effects of aerobic (AE) vs. resistance exercise (RE) alone on visceral adipose tissue (VAT), intrahepatic lipid, and insulin sensitivity in obese girls. Forty-four obese adolescent girls (BMI ≥95th percentile, 12-18 yr) with abdominal obesity (waist circumference 106.5 ± 11.1 cm) were randomized to 3 mo of 180 min/wk AE (n = 16) or RE (n = 16) or a nonexercising control group (n = 12). Total fat and VAT were assessed by MRI and intrahepatic lipid by proton magnetic resonance spectroscopy. Intermuscular AT (IMAT) was measured by CT. Insulin sensitivity was evaluated by a 3-h hyperinsulinemic (80 mU·m(2)·min(-1)) euglycemic clamp. Compared with controls (0.13 ± 1.10 kg), body weight did not change (P > 0.1) in the AE (-1.31 ± 1.43 kg) and RE (-0.31 ± 1.38 kg) groups. Despite the absence of weight loss, total body fat (%) and IMAT decreased (P < 0.05) in both exercise groups compared with control. Compared with control, significant (P < 0.05) reductions in VAT (Δ-15.68 ± 7.64 cm(2)) and intrahepatic lipid (Δ-1.70 ± 0.74%) and improvement in insulin sensitivity (Δ0.92 ± 0.27 mg·kg(-1)·min(-1) per µU/ml) were observed in the AE group but not the RE group. Improvements in insulin sensitivity in the AE group were associated with the reductions in total AT mass (r = -0.65, P = 0.02). In obese adolescent girls, AE but not RE is effective in reducing liver fat and visceral adiposity and improving insulin sensitivity independent of weight loss or calorie restriction.

Tensiones culturales en adolescentes migrantes residentes en Chile / Cultural tensions in migrant adolescents living in Chile / Tensões culturais em adolescentes migrantes residentes no Chile

Resumen (analítico) Las migraciones contemporáneas han desafiado significativamente el desarrollo de las parentalidades en el núcleo de la familia transnacional. Resulta de interés acercarnos a las tensiones culturales que afrontan adolescentes migrantes desde sus significados, deconstruyendo lógicas adultocéntricas que los han invisibilizado como sujetos protagónicos. Este estudio contó con la participación de adolescentes migrantes provenientes de Colombia, Haití y Venezuela, cuyas familias residen en Chile. A partir de entrevistas en profundidad, se realizó un análisis desde un enfoque constructivista de los principales resultados respecto a tensiones culturales vivenciadas por los y las adolescentes en el ámbito individual y familiar, destacando en este último los estilos educativos y la apertura cultural, desplegándose distintos mecanismos de resolución o afrontamiento, tales como la integración, resistencia y exclusión.

Abstract (analytical) Contemporary migration patterns have significantly challenged the role of parenting in transnational families. Faced with this scenario, this study enquires about the cultural tensions faced by migrant adolescents through their meanings, deconstructing adultcentered logics that have made them invisible as subjects. This study included the participation of migrant adolescents from Colombia, Haití and Venezuela whose families are living in Chile. Following the indepth interviews, an analysis was carried out using a constructivist approach. The main results highlighted the cultural tensions experienced by adolescents in both individual and family spheres of life. Within their families, they high-lighted cultural differences in terms of educational styles and cultural openness. The adolescents deploy different resolution and/or coping mechanisms, such as integration, resistance and exclusion.

Resumo (analítico) As migrações contemporâneas têm desafiado significativamente o desenvolvimento das relações parentais no seio da família transnacional. Diante desse cenário, interessa abordar as tensões culturais enfrentadas pelos adolescentes migrantes a partir de seus significados, desconstruindo lógicas adultocêntricas que os têm invisibilizado como sujeitos protagonistas. Este estudo contou com a participação de adolescentes migrantes da Colômbia, Haiti e Venezuela, cujas famílias residem no Chile. Partindo das entrevistas em profundidade, procedeu-se uma análise desde um enfoque construtivista dos principais resultados relativos às tensões culturais vivenciadas pelas e pelos adolescentes no âmbito individual e familiar, destaca-se neste último, os estilos educacionais e a abertura cultural, implantando distintos mecanismos de resolução e/ou enfrentamento, tais como a integração, resistência e exclusão.

Manejo quirúrgico de ependimomas en médula cervical: A propósito de un caso clínico / Surgical management of ependymomas in the cervical spine: Apropos of a clinical case

Introducción: los ependimomas son tumores cerebrales que surgen de células ependimarias, células de soporte en el cerebro y la médula espinal. Representan entre el 2 y el 3% de todos los tumores cerebrales primarios. Son el cuarto tumor cerebral más común en los niños, donde el 90% de los mismos se localizan en la fosa posterior. En adultos, el 60% de estos tumores se encuentran en la médula espinal pudiendo presentarse a cualquier nivel de ésta; el caso a continuación reporta un ependimoma cervical. Objetivo: reportar un caso de ependimoma medular de ubicación poco frecuente, con resección total, sin recidiva porterior a 2 años de seguimiento.Descripción del caso: se reporta el caso de un paciente adulto, 44 años, masculino, con un síndrome medular cervical completo, progresivo, provocado por un ependimoma cervical. Intervención: se realizó laminectomía de dos espacios [C7 a T1], apertura dural, mielotomía posterior logrando exéresis total de la lesión con durorrafia a sello de agua y posterior cierre por planos sin complicaciones, con seguimiento de 2 años de sobrevida. Conclusiones: la resección total macroscópica de este tipo de tumores es muy importante para poder evitar residiva. El ependimoma cervical puede recidivar, sobre todo cuando existen residuales de la lesión. El manejo oportuno depende de gran manera de que los pacientes acudan tempranamente a valoración especializada; la resección guiada con monitorización neurofisiológica transoperatoria provee mayor oportunidad a los pacientes a no presentar secuelas permanentes y permite asimismo, mejores resultados de la rehabilitación neurológica postoperatoria

Introduction: ependymomas are brain tumors that arise from ependymal cells, supporting cells in the brain and spinal cord. They represent between 2 and 3% of all primary brain tumors. They are the fourth most common brain tumor in children, where 90% of them are located in the posterior fossa. In adults, 60% of these tumors are found in the spinal cord and can occur at any level of the spinal cord; the case below reports a cervical ependymoma. Objective: to report a case of medullary ependymoma of rare location, with total resection, without recurrence after 2 years of follow-up. Case description: a 44-year-old male adult patient with a progressive, complete cervical spinal cord syndrome, caused by a cervical ependymoma, is reported.Intervention: two-space laminectomy [C7 to T1], dural opening and posterior myelotomy were performed, achieving total excision of the lesion with water-seal durorrhaphy and subsequent closure by planes without complications, with a 2-year survival follow-up. Conclusions: macroscopic total resection of this type of tumor is very important to avoid residual. Cervical ependymoma can recur, especially when there is residual lesion. Timely management depends to a great extent on the patients attending early for a specialized evaluation; guided resection with intraoperative neurophysiological monitoring provides a greater opportunity for patients to not present permanent sequelae and also allows better results of postoperative neurological rehabilitation.

Relación entre Problemas de Conducta en Adolescentes y Conflicto Interparental en Familias Intactas y Monoparentales / Relationship between Teen Behavior Problems and Interparental Conflict in Intact and Single-Parent Families / Relação entre Problemas de Comportamento em Adolescentes e Conflito Interparental em Famílias Intactas e Monoparentais

El propósito del estudio fue analizar la influencia del conflicto interparental en la aparición de problemas de conducta en adolescentes de familias intactas y monoparentales. Se utilizó un diseño explicativo que consideró prueba de medias y análisis multivariado de varianza. La muestra estuvo compuesta de 466 adolescentes de 12 a 16 años. Para la medición de las variables se utilizaron las escalas Children's Perception of Interparental Conflict (cpic) y Youth Self Report (YSR). Los resultados confirman la asociación entre conflicto interparental y problemas de conducta en los hijos, y muestran que, cuando hay conflicto en las familias intactas, se produce una mayor frecuencia de conductas externalizantes que en familias monoparentales.

The purpose of the study was to analyze the influence of interparental conflict in the emergence of behavior problems in teenagers of intact and single-parent families. An explicative design using mean difference test and MANOVA was used. The sample was comprised of 466 teens from 12 to 16 years old. The variables were measured using the Children's Perception of Interparental Conflict (CPIC) and Youth Self Report (YSR) scales. The results confirmed the association between interparental conflict and behavior problems in their children, and also reveal that, when there is conflict in intact families, a higher frequency of externalizing conduct is produced in these than in single-parent families.

O propósito deste artigo foi analisar a influência do conflito interparental no surgimento de problemas de comportamento em adolescentes de famílias intactas e monoparentais. Utilizou-se um desenho explicativo que considerou prova de médias e análise multivariada de variação. A amostra foi composta por 466 adolescentes de 12 a 16 anos. Para a medição das variáveis, foram utilizadas as escalas Children's Perception of Interparental Conflict (CPIC) e Youth Self Report (YSR). Os resultados confirmam a associação entre conflito interparental e problemas de comportamento nos filhos e mostram que, quando há conflito nas famílias intactas, se produz uma maior frequência de comportamentos externalizantes do que em famílias monoparentais.