RESUMEN
La deshidratación es una de las principales causas de mortalidad en la población pediátrica en países en vía de desarrollo. Por ello, se han estudiado alternativas de manejo para la rehidratación oral, intravenosa e intraósea, de fácil aplicación y bajo costo. La hipodermoclisis es la técnica para la administración subcutánea de líquidos con el fin de prevenir o tratar la deshidratación leve o moderada; olvidada por muchos años debido a la falta de experiencia y protocolos bien estructurados. Recientemente resurge el interés en investigar e implementar esta técnica gracias a sus beneficios y menores riesgos frente a las otras opciones, entre las que se encuentran facilidad de aplicación, mantenimiento de la vía, comodidad del paciente y disminución de complicaciones por daño endotelial, demostrados en diferentes estudios como es el caso del Infuse Peds 1 y 2. Para favorecer la absorción subcutánea se puede implementar la hialuronidasa recombinante humana, enzima encargada de disolver el ácido hialurónico para alterar, temporalmente, la permeabilidad del tejido, que es el objeto de análisis dentro de estos estudios. En Colombia esta técnica aún no ha sido completamente difundida para aplicarla en la población pediátrica. Es imperativo divulgar opciones de manejo que sean efectivas y de bajo costo para la atención de las enfermedades más prevalentes. La hipodermoclisis cumple con estos objetivos y cuenta, además, con beneficios como la satisfacción de los padres y mejora índices de morbimortalidad infantil.
Dehydration is one of the main causes of mortality in pediatric population in developing countries. Thus, we have studied alternative measures that are low-cost and easy to administer for oral, intravenous, and intraosseuos rehydration. Hypodermoclysis is the technique for subcutaneous administration of liquids in order to prevent or treat mild or moderate dehydration. This method has been forgotten for many years due to the lack of experience and well-structured protocols. Recently, there has been increasing interest in researching and implementing this technique due to the benefits and lower risks compared to other options, including easy administration, pathway maintenance, patient comfort, and reduced complications due to endothelial damage, demonstrated in different studies, such as INFUSE-Peds I and II. Human recombinant hyaluronidase can be implemented in order to favor subcutaneous absorption; this enzyme is in charge of dissolving hyaluronic acid to temporarily alter the permeability of the tissue, which is the object of analysis of these studies. This technique has not been completely disseminated in Colombia to administer in pediatric population. It is imperative to divulge treatment options that are effective and low-cost to treat the most prevalent diseases. Hypodermoclysis meets these objectives and also has benefits such as parent satisfaction and improves indexes of infant morbidity and mortality.
A desidratação é uma das principais causas de mortalidade na população pediátrica em países em via de desenvolvimento. Por isso, se estudaram alternativas de manejo para a reidratação oral, intravenosa e intraóssea, de fácil aplicação e baixo custo. A hipodermóclise é a técnica para a administração subcutânea de líquidos com o fim de prevenir ou tratar a desidratação leve ou moderada; esquecida por muitos anos devido à falta de experiência e protocolos bem estruturados. Recentemente ressurge o interesse em investigar e implementar esta técnica graças a seus benefícios e menores riscos frente às outras opções, entre as que se encontram facilidade de aplicação, manutenção da via, comodidade do paciente e diminuição de complicações por dano endotelial, demostrados em diferentes estudos como é o caso do Infuse Peds 1 e 2. Para favorecer a absorção subcutânea se pode implementar a hialuronidase recombinante humana, enzima encargada de dissolver o ácido hialurônico para alterar, temporalmente, a permeabilidade do tecido, que é o objeto de análise dentro destes estudos. Na Colômbia esta técnica ainda não há sido completamente difundida para aplicá-la na população pediátrica. É imperativo divulgar opções de manejo que sejam efetivas e de baixo custo para a atenção das doenças mais prevalentes. A hipodermóclise cumpre com estes objetivos e conta, ademais, com benefícios como a satisfação dos pais e melhora índices de morbimortalidade infantil.
Asunto(s)
Humanos , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Hipodermoclisis , Soluciones para Rehidratación , Deshidratación , Países en Desarrollo , FluidoterapiaRESUMEN
The evolutionary relationships of five Atlantic Aeglidae species (Aegla neuquensis affinis, A. humahuaca, A. jujuyana, A. platensis, and A. uruguayana) were studied by (i) satellite DNA analysis using a restriction enzyme digestion and hybridization pattern approach and (ii) genome screening by using randomly amplified polymorphic DNA (RAPD) typing. The identical restriction patterns and intense interspecific hybridization patterns obtained in this study strongly suggest a recent cladogenetic event for the Aeglidae. The species-specific amplification products which were detected using RAPD markers allowed species characterization. A total of 49 amplification products were used to construct trees by cluster analysis. The new scheme agrees in part with previous proposals based on biogeography and morphology. We considered that the subdivision northwestern-platensis species was probably due to the rising of the Andes, which started in the Middle Miocene. Divergence due to altitude is suggested by the different altitudinal distribution of three northwestern species along the same river. The possible role of selection by ecological factor/s was observed at the population level in A. jujuyana, which has a wider altitudinal range distribution. RAPD markers revealed a high level of intraspecific diversity and important genetic flow among populations. However, a few markers showed significant differences in frequency or H between the lowermost population and the other populations, located in a different biogeographical region. The differences were not in relation to geographical distance, and we interpreted them as being due to selection. Repetitive sequences constitute an important reservoir of genetic variation, and these results show their usefulness in testing and proposing evolutionary hypothesis in crabs. These sequences seem to have played an important role in aeglid evolution. Ecological factors related to altitude have probably influenced macro- and microevolutionary processes, at least in northwestern species.