Complicaciones relacionadas con el cateterismo cardíaco pediátrico y cardiopatías congénitas. / Complications associated to pediatric cardiac catheterization and congenital heart diseases

INTRODUCTION: Congenital heart diseases are the most common congenital abnormalities in newborns with a prevalence of 1%. Therapeutic and diagnostic cardiac catheterization has revolutionized the treatment of these diseases; however, it can be associated with complications. OBJECTIVE: To describe the incidence and type of complications associated with pediatric cardiac catheterization in a reference center for congenital heart defects. METHODOLOGY: Retrospective observational study, with analytical intention based on records of cardiac catheterization performed on patients with congenital and acquired heart disease. RESULTS: 2,688 records were included for nine consecutive years. 53.9% were men, 21.3% with ages between 2 and 5 years and 20.3% between 6 months and 2 years. 63.5% of the procedures were elective. The prevalence of complications in the first 24 hours after catheterization was 6.7% (4.2% minor and 2.4% major). Early death occurred in 0.8% of the procedures. Factors associated with complications were age at catheterization <28 days (OR 2.18, 95% CI [1.28-3.70]), precatheter oxygen saturation <79% (OR 2.15, 95% CI [1.02-4.53]), use of pre-catheter inotropics (OR 3.00, 95% CI [1.68-5.33]). The variables included in the model explain 38% of the variance of post-cardiac catheterization complications in patients younger than 18 years. DISCUSSION: Cardiac catheterization is associated with major and minor complications including death. The associated factors were less than 28 days, lower oxygen saturation and use of pre-catheter inotropics.

INTRODUCCIÓN: Las cardiopatías congénitas son las anomalías congénitas más comunes en recién nacidos con una prevalencia de 1%. El cateterismo cardíaco diagnóstico y terapéutico ha revolucionado el tratamiento de estas enfermedades, aunque puede acompañarse de complicaciones. OBJETIVO: Describir la incidencia y el tipo de complicaciones vinculadas con el cateterismo cardíaco pediátrico en un centro de referencia para cardiopatías congénitas. MÉTODO: Estudio observacional retrospectivo, con intención analítica a partir de registros de cateterismos cardíacos realizados a pacientes con cardiopatías congénitas y adquiridas. RESULTADOS: Se incluyeron 2,688 registros durante nueve años consecutivos. El 53.9% correspondió a hombres, 21.3% con edades de dos a cinco años y 20.3% de seis meses a dos años. El 63.5% de los procedimientos fue electivo. La prevalencia de complicaciones en las primeras 24 horas posteriores al cateterismo fue de 6.7% (4.2% menores y 2.4% mayores). En el 0.8% de los procedimientos sobrevino la muerte temprana. Los factores relacionados con las complicaciones fueron: edad al momento del cateterismo <28 días (OR, 2.18; IC 95%, 1.28-3.70), saturación de oxígeno antes del cateterismo <79% (OR, 2.15; IC 95%, 1.02-4.53), uso de inotrópicos antes del cateterismo (OR, 3.00; IC 95%, 1.68-5.33). Las variables incluidas en el modelo explican el 38% de la varianza de las complicaciones posteriores al cateterismo cardíaco en pacientes menores de 18 años. CONCLUSIONES: En este estudio, el cateterismo cardíaco se vinculó con complicaciones mayores y menores, incluida la muerte. Los factores adjuntos fueron edad menor de 28 días, menor saturación de oxígeno y uso de inotrópicos antes del cateterismo.

Conocimiento científico y medios de comunicación: desafíos del periodismo científico en colombia

La noticia debe informar al lector y permitirle construir una opinión sobre el tema leído, sin embargo, los medios de comunicación colombianos no reflejan adecuadamente el papel preponderante que algunas secciones deben tener, debido a la preferencia de los medios de comunicación por noticias blandas y sin mucho contenido. El periodismo científico colombiano atraviesa dos problemas: la falta de especialización de los periodistas y el poco apoyo de los investigadores, sin embargo, en los últimos años se ha incrementado la capacitación de los comunicadores en esta área, cuyo trabajo consiste en convertir el resultado de la investigación a un lenguaje más sencillo para que así sea entendido con mayor facilidad por las audiencias. El objetivo de este artículo de reflexión es describir algunas deficiencias y desafíos que presenta el periodismo científico en Colombia.

The news should inform and allow the reader to build an opinion on the topic read, however, Colombian media do not adequately show the relevant role that some sections should have, due to the media prefers soft and with lack of content news. Colombian scientific journalism faces two issues: Journalists have not enough expertise, and the lack of support of researcher, however, in recent years the training of journalists in this field has increased, whose job is to convert the findings of the research to a simpler language, so that the audience understand more easily. The objective of this article of reflection is to describe some deficiencies and challenges currently faced by scientific journalism in Colombia.

As notícias devem informar o leitor e permitir que ele construa uma opinião sobre o tópico lido, no entanto, a mídia colombiana não reflete adequadamente o papel preponderante que algumas seções devem ter, devido à preferência da mídia por soft news e sem muito conteúdo. O jornalismo científico colombiano tem dois problemas: a falta de especialização dos jornalistas e o pouco apoio dos pesquisadores, no entanto, nos últimos anos tem aumentado o treinamento de comunicadores nessa área, cujo trabalho é converter o resultado da investigação a uma linguagem mais simples para que seja compreendido mais facilmente pelo público. O objetivo deste artigo de reflexão é descrever algumas deficiências e desafios que o jornalismo científico apresenta na Colômbia.

Inverse psoriasis involving genital skin folds: successful therapy with dapsone.

INTRODUCTION: Inverse psoriasis is a rare form of psoriasis that affects between 3% and 7% of the patients with psoriasis. It can comprise genital skin folds as part of genital psoriasis, and it is one of the most commonly seen dermatoses of this area. There are few evidence-based studies about the treatment of intertriginous psoriasis involving genital skin folds. CASE PRESENTATION: The authors present a 42-year-old female patient with erythematous plaques in the vulva, groin, and perianal region. The patient had previously received a broad range of topical and systemic therapies that had to be discontinued due to ineffectiveness or side effects. She was treated with 100 mg dapsone daily for 10 months, showing a significant improvement of her cutaneous and mucous lesions. Complete clearance of psoriatic lesions was observed after 4 weeks of treatment. She has remained in remission for up to 2 years, using only topical therapy with tacrolimus 0.1% and calcipotriol. DISCUSSION: Genital psoriasis is a skin disease that causes great discomfort. It is important to include examination of the genital region and to adopt this conduct in daily clinical practice. Research in this field is still poor, making no discrimination between flexural and genital psoriasis, and is based on case series and expert opinion; therefore, empirical recommendations for the treatment of genital psoriasis remain. Dapsone has been shown to be an effective and convenient alternative for the treatment of inverse psoriasis in genital skin folds, which can provide effective control of the disease. Further studies are required to determine the efficacy and safety of current therapies, and to decide whether dapsone therapy should be considered in the management of this form of psoriasis when topical and other systemic agents are not effective.

DEVELOPMENT OF AN ELECTRO-MECHANICALLY CONTROLLED HAND ORTHOSIS FOR ASSISTING FINGER EXTENSION IN STROKE SURVIVORS

Stroke is the leading cause of long-term disability in the world. It causes chronic deficits, such as hemiparesis, especially prevalent in the distal upper extremities. An electro-mechanically driven hand orthosis has been developed to assess the potential therapeutic use of such devices in rehabilitating hand function. A small Direct Current (DC) brushed motor is used as the main actuator, and a cable-driven glove connected to the motor shaft is the central component of the device. The orthosis control is achieved through a force feedback loop using a miniature load cell attached in series to the cable and control module. The later, generates Pulse Width Modulated (PWM) and direction signals required to drive the motor. The speed is determined by the duty cycle of the PWM signal while the direction by the status of a flag bit modified by a user-operated switch. A portable design was achieved by using a 6 V battery pack as the power supply. The device is ready for use in clinical trials with stroke survivor subjects as it has already been tested on healthy individuals with satisfactory performance.

Los accidentes cerebro-vasculares son una de las causas más comunes de discapacidad permanente en los Estados Unidos y el mundo. Esta condición causa déficits crónicos, como la hemiparesis, que es especialmente prevalente en las extremidades distales superiores. Se ha desarrollado una órtesis de mano controlada electromecánicamente para determinar el potencial uso terapéutico de este tipo de dispositivos en la rehabilitación funcional de la mano. Un pequeño motor de corriente directa es utilizado como el actuador principal, y un guante operado mecánicamente por el usuario por medio de un cable es el componte central del dispositivo. El control de la órtesis se logra por medio de un sistema automatizado utilizando un sensor de fuerza conectado al cable del guante. Adicionalmente se usa un microcontrolador para generar la señal de ancho de pulso modulada (PWM) y las señales de dirección requeridas para operar el motor, a una velocidad determinada por el ciclo de trabajo de la señal de PWM y en la dirección determinada por el estado de un bit bandera que es modificado por un interruptor que opera el usuario. El diseño es portátil y el dispositivo está listo para pruebas clínicas, ya que mostró un desempeño aceptable en pruebas iniciales con individuos sanos.