Limitaciones para investigar: perspectivas de los estudiantes de la Escuela de Medicina de la Universidad Católica Santo Toribio de Mogrovejo / No disponible

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An evaluation of extubation failure predictors in mechanically ventilated infants and children.

OBJECTIVE: To assess the accuracy of traditional weaning indices in predicting extubation failure, and to compare their accuracy when indices are measured at the onset of a breathing trial (SBT) and at the end of the SBT before extubation. DESIGN: Prospective study. SETTING: Medical-surgical intensive care unit at a tertiary care hospital. PATIENTS: Four hundred eighteen consecutive infants and children who received mechanical ventilation for at least 48 h and were deemed ready to undergo a SBT by their primary physician. INTERVENTIONS: Respiratory frequency (RR), tidal volume (V(T)), maximal inspiratory pressure (P(imax)) and frequency-to-tidal volume ratio (f/V(T)) were obtained within the first 5 min of breathing through a T-piece. The primary physicians were unaware of those measurements and the decision to extubate a patient was made by them. RR, V(T), f/V(T) were remeasured before extubation by the respiratory therapists. Extubation failure was defined as needing re intubation within 48 h after extubation. The area under the receiver operating characteristic (ROC) curve was calculated for each index as a measure of the accuracy in predicting extubation outcome. MEASUREMENTS AND MAIN RESULTS: Three hundred twenty-three patients successfully underwent the SBT and were extubated, but 48 of them (14%) required re-intubation. The ROC curve for V(T), RR, P(imax) and f/V(T) measured within the first 5 min of breathing were 0.54, 0.56, 0.57 and 0.57, respectively. The ROC curve did not increase significantly when the above indices were remeasured before extubation. CONCLUSIONS: In a population which had passed SBT, the ability of the traditional weaning indices to discriminate between children successfully extubated and children re-intubated is very poor.

[Modification of the conjuntival flora with cleaning palpebral solutions]. / Modificación de la flora conjuntival por el empleo de soluciones de higiene palpebral.

OBJECTIVE: The aim of the present study is to evaluate the effectiveness of a solution of palpebral hygiene during the preoperative stage of cataract surgery. MATERIALS AND METHODS: We studied 286 patients divided in 5 groups. One control group that did not use the product, and the remaining 4, that used the product during 3, 4, 5 and 6 days. The design of the study was prospective, randomize and masked. We took a sample of the conjunctival fundus in the morning of the day of the surgery, before commencing treatment with eye drops. This sample was sown according to microbiological techniques and analyzed by the microbiology department. RESULTS: The best time for using palpebral hygiene solutions prior to cataract surgery is four to five days. If it is used at less than three days, it does not decrease the rate of positive cultures and if the solution is applied more than six days, microorganisms that are not part of the common conjunctival flora may appear. CONCLUSIONS: Palpebral hygiene products should not be used more than five consecutive days previous to surgery.

Prevalencia de patología cardíaca en la enfermedad de Chagas: años 2004-2012. Programa y Red de Chagas de CABA / Prevalence of cardiac pathology in Chagas disease: 2004 -2012. Program and Chagas CABA network

El Instituto Universitario de Ciencias de las Salud ha mostrado un particular compromiso con la formación de sus estudiantes en la estrategia de Atención Primaria de la Salud, con las prácticas asistenciales dedicadas al 1er nivel de atención ambulatoria y a las patologías prevalentes en ese ámbito. Del mismo modo se han desenvuelto las actividades de formación en investigación. Como exponente de esa orientación, la revista Ciencias de la Salud publicó en el Vol. 2, N°1, 2011:4-9, el artículo “Prevalencia de la Enfermedad de Chagas” de Érica G. Morais, que había obtenido el premio “Futuros Líderes”, otorgado por el Curso Anual Internacional de Investigación en Ciencias de la Salud (IUCS-AMA, Prof. Carlos Álvarez Bermúdez). Aquella investigación formaba parte de un proyecto más amplio realizado en el Hospital Teodoro Álvarez entre 2004 y 2012, en el que participaron un conjunto de investigadores, que compartieron la autoría de la actual publicación. El Dr. Jorge Mitelman, Prosecretario de Ciencia y Técnica del IUCS e integrante de ese equipo, preparó además una reseña sobre la jornada del INCOSUR, realizada en abril del presente año, describiendo asimismo el proceso de desarrollo de la Ciudad de Buenos Aires, como área no endémica, para encarar las consecuencias de la enfermedad de Chagas

Modificación de la flora conjuntival por el empleo de soluciones de higiene palpebral / Modification of the conjuntival flora with cleaning papebral solutions

Objetivo: El objetivo del presente trabajo consiste en valorar la efectividad de una solución de higiene palpebral en el preoperatorio de cirugía de cataratas así como las modificaciones en la flora conjuntival. Material y métodos: Estudiamos 286 pacientes divididos en 5 grupos. Un grupo control que no utilizó el producto y los 4 restantes que emplearon el producto durante 3, 4, 5 y 6 días respectivamente. El diseño del estudio fue prospectivo, randomizado y enmascarado. Se tomó una muestra de fondo de saco conjuntival en la mañana del día de la cirugía, previa a la instilación de colirios. Las muestras fueron sembradas y analizadas según las técnicas microbiológicas. Resultados: El tiempo óptimo de utilización de las soluciones de higiene palpebral en el preoperatorio de cirugía de cataratas es de 4 a 5 días. Si se usan menos de tres días no se reduce la tasa de cultivos positivos y si se aplican más de seis se aíslan microorganismos que no forman parte de la flora conjuntival habitual. Conclusión: En caso de utilizar productos de higiene palpebral no deben prolongarse más de cinco días consecutivos previo a la cirugía de cataratas(AU)

Objective: The aim of the present study is to evaluate the effectiveness of a solution of palpebral hygiene during the preoperative stageof cataract surgery. Materials and methods: We studied 286 patients divided in 5 groups. One control group that did not use the product, and the remaining 4, that used the product during 3, 4, 5 and 6 days. The design of the study was prospective, randomize and masked. We took a sample of the conjunctival fundus in the morning of the day of the surgery, before commencing treatment with eye drops. This sample was sown according to microbiological techniques and analyzed by the microbiology department. Results: The best time for using palpebral hygiene solutions prior to cataract surgery is four to five days. If it is used at less than three days, it does not decrease the rate of positive cultures and if the solution is applied more than six days, microorganisms that are not part of the common conjunctival flora may appear. Conclusions: Palpebral hygiene products should not be used more than five consecutive days previous to surgery(AU)