Pain prevalence in infants and preschool children in a Colombian hospital / Prevalencia de dolor en lactantes y preescolares en un hospital colombiano

Abstract Introduction The pain prevalence in hospitalized infants and preschool children has not been accurately identified in high-income countries, and in low and medium-income countries it has not been extensively studied. The assessment instruments are limited. Objective To describe the prevalence and management of pain in infants and preschool children during the first 24 hours of hospitalization in a third level institution in Colombia, using the LLANTO scale. Methods An observational study was conducted during the first 24 hours of hospitalization. Demographic information was recorded, pain was assessed at admission, after 4, and 24 hours using the LLANTO scale. Pharmacological therapy was also documented. Results 250 children between one month and 5 years old were studied. The pain prevalence at admission was 12 %. The pain prevalence per subgroups was higher among the surgical patients, as compared to the clinical patients (35.9 % vs. 7.6 %). The pharmacological analysis revealed that 70.8 % of patients received treatment; the most widely used medications were oral acetaminophen and intravenous dipyrone. Conclusions: Pain prevalence was lower than the levels described for the general pediatric population. This result may be due to the sensitivity of the LLANTO instrument, or to a particular pain behavior. Further studies are needed to identify the sensitivity of the assessment instruments in early life and to accurately investigate any associated phenomena.

Resumen Introducción La prevalencia de dolor en lactantes y preescolares hospitalizados no se conoce con exactitud en países de altos ingresos. Mientras que en países con bajos y medianos ingresos se ha estudiado poco. Los instrumentos de evaluación son limitados. Objetivo Describir la prevalencia y manejo del dolor en lactantes y preescolares durante las primeras 24 horas de hospitalización en un centro de tercer nivel en Colombia, mediante la escala LLANTO. Métodos Se realizó un estudio observacional durante las primeras 24 horas de hospitalización. Se registró la información demográfica, se evaluó el dolor al ingreso, 4 y 24 horas, mediante la escala LLANTO. Adicionalmente se documentó el tratamiento farmacológico. Resultados Se estudiaron 250 niños (entre un mes y 5 años). La prevalencia de dolor encontrada al ingreso fue del 12 %. La prevalencia de dolor por subgrupos fue mayor en los pacientes quirúrgicos comparado con los clínicos (35,9 % vs. 7,6 %). Al analizar el manejo farmacológico, 70,8 % de los pacientes recibió tratamiento. Los medicamentos más empleados fueron acetaminofén oral y dipirona endovenosa. Conclusiones La prevalencia de dolor fue menor a la descrita en la población pediátrica general. El resultado puede deberse a la sensibilidad del instrumento LLANTO o a un comportamiento particular del dolor. Se necesitan más estudios para conocer la sensibilidad de los instrumentos de evaluación en las primeras etapas de la vida y poder investigar los fenómenos relacionados acertadamente.

Cheese Whey Milk Adulteration Determination Using Casein Glycomacropeptide as an Indicator by HPLC.

Raw milk adulteration with cheese whey is a major problem that affects the dairy industry. The objective of this work was to evaluate the adulteration of raw milk with the cheese whey obtained from the coagulation process, with chymosin enzyme using casein glycomacropeptide (cGMP) as an HPLC marker. Milk proteins were precipitated with 24% TCA; with the supernatant obtained, a calibration curve was established by mixing raw milk and whey in different percentages, which were passed through a KW-802.5 Shodex molecular exclusion column. A reference signal, with a retention time of 10.8 min, was obtained for each of the different percentages of cheese whey; the higher the concentration, the higher the peak. Data analysis was adjusted to a linear regression model, with an R2 of 0.9984 and equation to predict dependent variable (cheese whey percentage in milk) values. The chromatography sample was collected and analyzed by three tests: a cGMP standard HPLC analysis, MALDI-TOF spectrometry, and immunochromatography assay. The results of these three tests confirmed the presence of the cGMP monomer in adulterated samples with whey, which was obtained from chymosin enzymatic coagulation. As a contribution to food safety, the molecular exclusion chromatography technique presented is reliable, easy to implement in a laboratory, and inexpensive, compared with other methodologies, such as electrophoresis, immunochromatography, and HPLC-MS, thus allowing for the routine quality control of milk, an important product in human nutrition.

Characterization by HPLC-ESI-MS2 of native and oxidized procyanidins from litchi (Litchi chinensis) pericarp.

Procyanidins (PCs) are polyphenols highly accumulated in litchi fruit (Litchi chinensis). Despite their bioactivity, the molecular composition of native and oxidized procyanidins is little understood. In this paper, polyphenols from litchi pericarp were extracted using two solvents (methanol and acetone). The mean degree of polymerization (mDP) of native and identification of oxidized PCs were carried out by phloroglucinolysis- and thioglycolysis-HPLC-ESI-MS/MS, respectively. About 60% of extracted polyphenols corresponded to procyanidins from litchi pericarp. Native PCs were mainly oligomeric procyanidins (mDP 4). Only (-)-epicatechin was detected as terminal and extension units in PCs. Thioglycolysis-HPLC-ESI-MS identified five oxidation markers of PCs with [M-H]-m/z 575, 593, 609, 679 and 863. Intra- and intermolecular modifications of A and B-type procyanidins were identified. The method used for the characterization of PCs from litchi pericarp allowed understanding of the structural composition of its native and oxidized tannins.

Manual de diálisis y trasplantes de órganos / Manual of Dialysis and Organ Transplants

Por tal motivo, surge la necesidad de crear este Manual que nos enseña, ilustra y sirve de guía rápida para entender qué es la enfermedad renal crónica, cuáles son sus tratamientos y sus complicaciones. El acceso vascular en este tipo de pacientes es indispensable y lo más importante del manejo integral junto a enfermería. Finalmente, el Manual nos lleva a entender todo lo relacionado con la donación y el trasplante, siempre de la mano de los reglamentos de la Ley 329-98 de nuestra Constitución.

Paternal Risk Factors for Oral Clefts in Northern Africans, Southeast Asians, and Central Americans.

While several studies have investigated maternal exposures as risk factors for oral clefts, few have examined paternal factors. We conducted an international multi-centered case-control study to better understand paternal risk exposures for oral clefts (cases = 392 and controls = 234). Participants were recruited from local hospitals and oral cleft repair surgical missions in Vietnam, the Philippines, Honduras, and Morocco. Questionnaires were administered to fathers and mothers separately to elicit risk factor and family history data. Associations between paternal exposures and risk of clefts were assessed using logistic regression adjusting for potential confounders. A father's personal/family history of clefts was associated with significantly increased risk (adjusted OR: 4.77; 95% CI: 2.41-9.45). No other significant associations were identified for other suspected risk factors, including education (none/primary school v. university adjusted OR: 1.29; 95% CI: 0.74-2.24), advanced paternal age (5-year adjusted OR: 0.98; 95% CI: 0.84-1.16), or pre-pregnancy tobacco use (adjusted OR: 0.96; 95% CI: 0.67-1.37). Although sample size was limited, significantly decreased risks were observed for fathers with selected occupations. Further research is needed to investigate paternal environmental exposures as cleft risk factors.

Comparative in vitro study of the antimicrobial activities of different commercial antibiotic products for intravenous administration.

BACKGROUND: The antimicrobial resistance is a global problem, probably due to the indiscriminate and irrational use of antibiotics, prescriptions for incorrect medicines or incorrect determinations of dose, route and/or duration. Another consideration is the uncertainty of patients receiving antibiotics about whether the quality of a generic medicine is equal to, greater than or less than its equivalent brand-name drug. The antibiotics behaviors must be evaluated in vitro and in vivo in order to confirm their suitability for therapeutic use. METHODS: The antimicrobial activities of Meropenem and Piperacillin/Tazobactam were studied by microbiological assays to determine their potencies (content), minimal inhibitory concentrations (MICs), critical concentrations and capacity to produce spontaneous drug-resistant mutants. RESULTS: With respect to potency (content) all the products fulfill USP requirements, so they should all be considered pharmaceutical equivalents. The MIC values of the samples evaluated (trade marks and generics) were the same for each strain tested, indicating that all products behaved similarly. The critical concentration values were very similar for all samples, and the ratios between the critical concentration of the standard and those of each sample were similar to the ratios of their specific antibiotic contents. Overall, therefore, the results showed no significant differences among samples. Finally, the production of spontaneous mutants did not differ significantly among the samples evaluated. CONCLUSIONS: All the samples are pharmaceutical equivalents and the products can be used in antimicrobial therapy.

Intubación orotraqueal sin relajante muscular: propofol o etomidato en combinación con remifentanilo / Orotracheal Intubation without the use of muscle relaxant: propofol or etomidate in combination with remifentanil

Introducción. El remifentanilo en combinación con propofol provee adecuadas condiciones para la intubación orotraqueal sin relajante neuromuscular. Otros agentes inductores no han sido adecuadamente evaluados. El propósito del estudio fue evaluar las condiciones de intubación y los cambios hemodinámicos tras la inducción anestésica con remifentanilo-propofol o remifentanilo- etomidato. Métodos. En este estudio prospectivo, doble ciego y aleatorio, participaron 90 pacientes con clasificación ASA I/II. Recibieron 0,03 mg/kg de midazolam y 7 ml/kg de lactato de Ringer, y posteriormente, 3 mg/kg de remifentanilo seguidos de 1 mg/kg de lidocaína. A continuación, se distribuyeron en forma aleatoria en los siguientes grupos de pacientes: los que recibieron 2 mg/kg de propofol (grupo propofol, n=29), 0,3 mg/ kg de etomidato (grupo etomidato 3, n=31) o 0,4 mg/kg de etomidato (grupo etomidato 4, n=30). Después se realizó laringoscopia e intubación orotraqueal. Las condiciones para la intubación se evaluaron utilizando un sistema cualitativo de puntaje. Se registraron la presión arterial media y la frecuencia cardiaca previa a la inducción, posterior a la inducción, inmediatamente después de la intubación y cada minuto hasta 5 minutos después de la intubación. Resultados. Tres pacientes del grupo etomidato 3 y dos del grupo etomidato 4 no pudieron ser intubados en el primer intento. Se alcanzaron condiciones clínicamente aceptables de intubación en 100%, 74% y 80%, en los grupo propofol, etomidato 3 y etomidato 4, respectivamente (p=0,016). El descenso en la presión arterial media fue significativamente mayor en el grupo propofol comparado con el grupo etomidato 3. Conclusiones. Para la intubación orotraqueal sin relajante neuromuscular, el uso de remifentanilo-propofol es superior al de remifentanilo-etomidato, 0,3 mg/kg o 0,4 mg/kg. Con 0,3 mg/kg de etomidato se obtiene un mejor perfil hemodinámico.

Introduction: Remifentanil followed by propofol provides adequate conditions for tracheal intubation without using muscle relaxants. Other hypnotic drugs have not been thoroughly evaluated in this regard. The purpose of this study was to assess intubating conditions and cardiovascular changes after induction of anesthesia with remifentanil-propofol or. Methods: 90 ASA I/II patients were enrolled in this random, prospective, double-blind study. Subjects received 0.03 mg/kg of midazolam followed by a 7 ml/kg infusion of RingerLs lactate. After that, 3 ƒÊg/kg of remifentanil were injected followed by lydocaine, 1 mg/kg. Then, patients received either propofol (2 mg/ kg) (Propofol Group, n= 29), or etomidate (0.3 mg/kg) (Etomidate 3 Group, n=31) or etomidate (0.4 mg/kg) (Etomidate 4 Group, n=30). Subsequent laryngoscope and intubation were performed. Intubating conditions were assessed using a quality scoring system. Mean arterial pressure and heart rates pre-induction, post-induction were recorded immediately after intubation and every 1 to 5 minutes after intubation. Results: Three patients in the etomidate 3 Group and two patients in the etomidate 4 Group were not able to beintubated in the first attempt. Clinically acceptable intubating conditions were observed in 100%, 74%, 80% in the Propofol, Etomidate 3 and etomodate 4 groups, respectively (p=0.01 6). The decrease in mean arterial pressure was significantly higher in the propofol group as compared to the etomidate 3 group (p<0.05). Conclusions: The use of lydocaine-remifentanil-propofol for tracheal intubation without muscle relaxants is superior to 0.3 or 0.4 mg/kg lydocaine-remifentanil plus etomidate. However, etomidate 0.3 mg/kg produces a better hemodynamic profile when compared to propofol.

Nursing care for adaptation.

The Roy adaptation model has been adopted as the frame of reference for the nursing curriculum at the Universidad de La Sabana School of Nursing in Colombia. The purpose of this paper is to discuss, through an example, the application process of the Roy model, the reflection that has been developed to study in great depth its central concepts and scientific and philosophic principles, and to explain the concept of nursing care for adaptation as a fundamental aspect for its application. Likewise, the process generated from the model's application in teaching and practice are presented.

Anestesiología y sedación paliativa: pertinencia, aspectos éticos y clínicos / Anestesiology and paliativa sedación: ethical and clinical pertinencia, aspects

La atención médica al final de la vida es una situación a la que se enfrentan, cada vez con más frecuencia, los anestesiólogos. En esas circunstancias es esencial un enfoque médico y ético apropiado, con el fin de garantizar una calidad de muerte adecuada para el paciente y su familia. Se describe un caso de un paciente de 42 años, con cáncer de colon metastático, a quien se le inició sedación paliativa en presencia de síntomas refractarios, tanto físicos como existenciales. La práctica de la sedación como una opción terapéutica válida dentro de un contexto de atención paliativa eficiente, debe llevarse a cabo teniendo en cuenta los principios éticos y médicos relevantes. Así mismo, hay que reconocer las características propias de la formación del anestesiólogo, para que no se limite este tipo de atención en los pacientes al final de su vida. La atención médica al final de la vida es una situación que, cada vez con más frecuencia, enfrentamos los anestesiólogos. La sedación paliativa se establece como una opción terapéutica, basada en importantes criterios éticos y clínicos. En el momento de iniciarla hay que asegurarse del cumplimiento de dichos criterios, que deben evidenciarse frente al paciente, la familia y el grupo de salud...

La familia como unidad de supervivencia, de sentido y de cambio en las intervenciones psicosociales: intenciones y realidades / The family as a survival, meaning and change unit in psychosocial interventions: intentions and realities

Este ensayo invita a la reflexión sobre las consecuencias de tomar a la familia como unidad de cambio en las diversas instancias sociales que la atienden. La familia es una unidad ecosistémica, que crea solidaridades de destino en el tiempo y en el espacio. Opera a través de rituales, mitos y epistemes que se organizan en el interjuego de procesos filogenéticos, ontogenéticos y culturogenéticos. Se observa que a pesar de las intenciones de trabajar con la familia, predominan las intervenciones individuales en los campos de la salud, la educación y la intervención psico-socio-jurídica. En vez de situar los problemas en la interacción, los sitúan en las personas portadoras de la dificultad, a quienes les asignan roles específicos. En el sector salud, el de enfermo. En educación, los niños y niñas son inadaptados al medio escolar. En la atención psicojurídica, son víctimas y victimarios. Se desconoce que el cambio que surge de la atención individual y secuencial de los miembros de la familia no es equivalente al que se genera por el efecto sinérgico del sistema. Se sugiere entonces revisar las prácticas profesionales e institucionales para implementar la intervención con la familia como unidad de supervivencia, de evolución y de cambio. Sólo así podrán confluir la responsabilidad social y ecosistémica con la liberación individual.