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1.
Indian Heart J ; 74(1): 34-39, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-34919965

RESUMEN

BACKGROUND: Short term outcomes of patients with pulmonary hypertension are not available from low and middle-income countries including India. METHODS: We conducted a prospective study of 2003 patients with pulmonary hypertension, from 50 centres (PROKERALA) in Kerala, who were followed up for one year. Pulmonary hypertension (PH) was mainly diagnosed on the basis of Doppler echocardiography. The primary outcome was a composite end-point of all-cause death and hospital admission for heart failure. All cause hospitalisation events constituted the secondary outcome. RESULTS: Mean age of study population was 56 ± 16 years. Group 1 and Group 2 PH categories constituted 21.2% and 59% of the study population, respectively. Nearly two-thirds (65%) of the study participants had functional class II symptoms. 31% of Group 1 PH patients were on specific vasodilator drugs.In total, 83 patients (4.1%) died during the one-year follow-up period. Further, 1235 re-hospitalisation events (61.7%) were reported. In the multivariate model, baseline NYHA class III/IV (OR 1.87, 95% C.I. 1.35-2.56), use of calcium channel blockers (OR 0.18, 95% C.I. 0.04-0.77), vasodilator therapy (OR 0.5, 95% C.I. 0.28-0.87) and antiplatelet agents (OR 1.80, 95% C.I. 1.29-2.51) were associated with primary composite outcome at one-year (p < 0.05). CONCLUSION: In the PROKERALA registry, annual mortality rate was 4%. More than half of the patients reported re-hospitalisation events on follow up. Uptake of guideline directed therapies were suboptimal in the study population. Quality improvement programmes to improve guideline directed therapy may improve clinical outcomes of PH patients in India.


Asunto(s)
Insuficiencia Cardíaca , Hipertensión Pulmonar , Adulto , Anciano , Ecocardiografía Doppler , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/tratamiento farmacológico , Hipertensión Pulmonar/epidemiología , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros
2.
Glob Heart ; 16(1): 71, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34900562

RESUMEN

Background: Congenital heart disease (CHD) has emerged as a leading contributor to infant mortality in many low-and middle-income countries (LMICs). We report early results of a population health program for CHD, implemented in the state of Kerala, India. Objective: Report on early results of a population-based program implementation in a LMIC to reduce mortality from CHD. Methods: We retrospectively analyzed the results of an innovative population-based program to address CHD. We devised, implemented and evaluated measures in the care continuum to address deficiencies in CHD care in Kerala, India, through structured capacity building initiatives that enabled early detection, prompt stabilization and expedited referral to a tertiary center. A comprehensive web-based application enabled real-time case registration, prioritization of treatment referrals, and tracking every child registered with CHD. Advanced pediatric heart care was delivered through a public-private partnership. Results: Early identification, referral, and treatment of infants with CHD were improved. The web-based application, 'Hridyam,' registered 502 cases in 2017 (Aug-Dec), 2190 in 2018 and 3259 in 2019; infants < 1 year of age constituted 56, 62 and 63% in these years, respectively. The number of heart operations managed through Hridyam rose from 208 to 624 and 1227 in the same years, with overall 30-day mortality of 2.4%. Overall- and CHD-related infant mortality in Kerala fell by 21.1% and 41.0%, respectively, over the same interval. Unmet challenges include lack of universal catchment and a 5% preoperative mortality rate. Conclusion: We demonstrate successful implementation of a population-based and real-time approach to reduce CHD mortality. We speculate that Hridyam has contributed to the observed decline in Kerala's IMR from 12 to 7 between 2016 and 2019. This model has potential applications for other conditions, and in other jurisdictions, especially LMICs considering building CHD capacity.


Asunto(s)
Cardiopatías Congénitas , Salud Poblacional , Niño , Promoción de la Salud , Cardiopatías Congénitas/epidemiología , Cardiopatías Congénitas/terapia , Humanos , India/epidemiología , Lactante , Mortalidad Infantil , Estudios Retrospectivos
3.
Nat Commun ; 12(1): 6392, 2021 Nov 04.
Artículo en Inglés | MEDLINE | ID: mdl-34737289

RESUMEN

Oscillatory magnetoresistance measurements on graphene have revealed a wealth of novel physics. These phenomena are typically studied at low currents. At high currents, electrons are driven far from equilibrium with the atomic lattice vibrations so that their kinetic energy can exceed the thermal energy of the phonons. Here, we report three non-equilibrium phenomena in monolayer graphene at high currents: (i) a "Doppler-like" shift and splitting of the frequencies of the transverse acoustic (TA) phonons emitted when the electrons undergo inter-Landau level (LL) transitions; (ii) an intra-LL Mach effect with the emission of TA phonons when the electrons approach supersonic speed, and (iii) the onset of elastic inter-LL transitions at a critical carrier drift velocity, analogous to the superfluid Landau velocity. All three quantum phenomena can be unified in a single resonance equation. They offer avenues for research on out-of-equilibrium phenomena in other two-dimensional fermion systems.

4.
Ophthalmic Epidemiol ; 28(4): 349-358, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-33969793

RESUMEN

Purpose: To define the prevalence of visual impairment, refractive errors and other ocular problems among school children from the public schools of South India between 2011 and 2015.Methods: This was a cross-sectional study covering 296 schools in the three districts of Tamil Nadu. The school eye screening included visual acuity assessment, external eye examination, objective and subjective refraction, and direct ophthalmoscopy. Vision impairment was defined as logMAR visual acuity of less than 0.2 (Snellen equivalent of 6/9).Results: A total of 91545 children were included with a mean age of 12.9 ± 3.0 years. The prevalence of vision impairment was found to be 5.67% (95%CI 5.53-5.83) and spherical equivalent refractive error was 4.42% (95%CI 4.29-4.56). The prevalence of myopia, hyperopia, and 'other refractive errors' was found to be 3.57% (95%CI 4.01-4.27), 0.03% (95%CI 0.02-0.04), and 0.82% (95%CI 0.76-0.88) respectively. Strabismus, retina and neuro-ophthalmology-related abnormalities, ptosis, and corneal scars were the common ocular problems. In the rural region the prevalence of the refractive errors and the ocular problems were 2.92% and 2.32%, respectively.Conclusion: The study reports a lower prevalence of refractive errors and myopia in this population, much lesser compared to other reported studies from India. Rural regions exhibit an equal need for both refractive services and management of other ocular problems.


Asunto(s)
Errores de Refracción , Adolescente , Niño , Estudios Transversales , Humanos , India/epidemiología , Prevalencia , Refracción Ocular , Errores de Refracción/diagnóstico , Errores de Refracción/epidemiología , Instituciones Académicas , Agudeza Visual
5.
Indian J Ophthalmol ; 69(3): 543-547, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33595468

RESUMEN

Purpose: Global trends show a high prevalence of refractive errors among children. The prevalence of vision impairment due to uncorrected refractive errors among school children is increasing and the need for management of other ocular conditions is also reported. This study presents the status of eye health and pattern of daily activities among the school children of a tribal location in Tamil Nadu, South India. Methods: A cross-sectional study was conducted in 13 schools of Karumandurai cluster, Salem district in Tamil Nadu, India. A three-phased comprehensive school screening protocol was conducted to understand the prevalence of vision impairment, refractive error, and other ocular conditions along with a survey about the daily activities of the children at school and home. Results: Among the 3655 children screened, the prevalence of vision impairment was found to be 0.62% (n = 23, 95% confidence interval [CI] 0.42-0.94) and prevalence of refractive error was 0.30% (n = 11, 95%CI 0.17-0.54), among which 0.11% (n = 4) were already wearing spectacles. A total of 44 children (1.20%; 95%CI 0.90-1.61) were found to have other ocular problems and among them, 14 (0.38%) had visual acuity less than 20/30 (6/9). Almost 84% of children required surgical or specialty eye care services. Vision impairment was more in children with other ocular conditions compared to refractive errors (P < 0.001). Conclusion: The prevalence of vision impairment and refractive errors in this tribal area was less. Ocular conditions were more prevalent than refractive errors in this tribal region with the majority of children needing specialty or surgical eye care services. This implies the need for access to secondary or tertiary eye care centers.


Asunto(s)
Errores de Refracción , Niño , Estudios Transversales , Humanos , India/epidemiología , Prevalencia , Errores de Refracción/epidemiología , Instituciones Académicas , Agudeza Visual
6.
Catheter Cardiovasc Interv ; 97(1): 127-134, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-32294315

RESUMEN

OBJECTIVES: To describe the development of a quality collaborative for congenital cardiac catheterization centers in low and middle-income countries (LMICs) including pilot study data and a novel procedural efficacy measure. BACKGROUND: Absence of congenital cardiac catheterization registries in LMICs led to the development of the International Quality Improvement Collaborative Congenital Heart Disease Catheterization Registry (IQIC-CHDCR). As a foundation for this initiative, the IQIC is a collaboration of pediatric cardiac surgical programs from LMICs. Participation in IQIC has been associated with improved patient outcomes. METHODS: A web-based registry was designed through a collaborative process. A pilot study was conducted from October through December 2017 at seven existing IQIC sites. Demographic, hemodynamic, and adverse event data were obtained and a novel tool to assess procedural efficacy was applied to five specific procedures. Procedural efficacy was categorized using ideal, adequate, and inadequate. RESULTS: A total of 429 cases were entered. Twenty-five adverse events were reported. The five procedures for which procedural efficacy was measured represented 48% of cases (n = 208) and 71% had complete data for analysis (n = 146). Procedure efficacy was ideal most frequently in patent ductus arteriosus (95%) and atrial septal defect (90%) device closure, and inadequate most frequently in coarctation procedures (100%), and aortic and pulmonary valvuloplasties (50%). CONCLUSIONS: The IQIC-CHDCR has designed a feasible collaborative to capture catheterization data in LMICs. The novel tool for procedural efficacy will provide valuable means to identify areas for quality improvement. This pilot study and lessons learned culminated in the full launch of the IQIC-CHDCR.


Asunto(s)
Cardiopatías Congénitas , Mejoramiento de la Calidad , Cateterismo Cardíaco/efectos adversos , Niño , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/terapia , Humanos , Proyectos Piloto , Sistema de Registros , Resultado del Tratamiento
7.
Nat Commun ; 11(1): 3054, 2020 Jun 11.
Artículo en Inglés | MEDLINE | ID: mdl-32528007

RESUMEN

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

8.
Sci Adv ; 6(16): eaay7838, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32494602

RESUMEN

Magnetic fields force ballistic electrons injected from a narrow contact to move along skipping orbits and form caustics. This leads to pronounced resistance peaks at nearby voltage probes as electrons are effectively focused inside them, a phenomenon known as magnetic focusing. This can be used not only for the demonstration of ballistic transport but also to study the electronic structure of metals. Here, we use magnetic focusing to probe narrowbands in graphene bilayers twisted at ~2°. Their minibands are found to support long-range ballistic transport limited at low temperatures by intrinsic electron-electron scattering. A voltage bias between the layers causes strong minivalley splitting and allows selective focusing for different minivalleys, which is of interest for using this degree of freedom in frequently discussed valleytronics.

9.
J Am Coll Cardiol ; 75(19): 2463-2477, 2020 05 19.
Artículo en Inglés | MEDLINE | ID: mdl-32408981

RESUMEN

Challenges and special aspects related to the management and prognosis of pulmonary hypertension (PH) in middle- to low-income regions (MLIRs) range from late presentation to comorbidities, lack of resources and expertise, cost, and rare options of lung transplantation. Expert consensus recommendations addressing the specific challenges for prevention and therapy of PH in MLIRs with limited resources have been lacking. To date, 6 MLIR-PH registries containing mostly adult patients with PH exist. Importantly, the global prevalence of PH is much higher in MLIRs compared with high-income regions: group 2 PH (left heart disease), pulmonary arterial hypertension associated with unrepaired congenital heart disease, human immunodeficiency virus, or schistosomiasis are highly prevalent. This consensus statement provides selective, tailored modifications to the current PH guidelines to address the specific challenges faced in MLIRs, resulting in the first pragmatic and cost-effective consensus recommendations for PH care providers, patients, and their families.


Asunto(s)
Hipertensión Pulmonar/economía , Hipertensión Pulmonar/terapia , Pobreza/economía , Pobreza/tendencias , Cardiología/economía , Cardiología/tendencias , Cardiopatías Congénitas/economía , Cardiopatías Congénitas/epidemiología , Cardiopatías Congénitas/terapia , Humanos , Hipertensión Pulmonar/epidemiología , Trasplante de Pulmón/economía , Trasplante de Pulmón/tendencias , Sistema de Registros , Literatura de Revisión como Asunto
10.
World J Nucl Med ; 19(1): 36-40, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32190020

RESUMEN

With the increasing use of 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) scans in oncology, the finding of thyroid incidentalomas, also popularly described as PET-associated incidental neoplasms (PAINs) of the thyroid gland is not unusual. The 18F-FDG PET-CT scans of all patients who underwent imaging for indications other than thyroid malignancy at our tertiary care center between January 1 and December 31, 2017, were retrospectively reviewed for PAINs of the thyroid. A total of 1737 18F-FDG PET-CT scans were done at our center in the year 2017. 288 thyroid incidentalomas were detected in the said period; the rate of PET-CT-detected thyroid incidentalomas being 16.58%, focal incidentalomas among them being 11.7%. Only 29 out of 204 patients (14.21%) with focal thyroid incidentalomas in our cohort underwent an aspiration cytology and/or ultrasound. The rate of malignancy among the PET detected focal thyroid incidentalomas in the cohort of patients with a proven diagnosis was 10.34%. Our study highlights the challenges in the evaluation and management of PAIN in a tertiary care oncology setting. None of the factors studied including nodule size and standardized uptake value predicted the risk of malignancy. Clinicians specializing in the management of thyroid nodules need to understand the clinical significance of the PAIN, and we hope that our unique experience adds to the limited clinical information available in this regard.

12.
Heliyon ; 5(11): e02841, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31768439

RESUMEN

Background: Limited information exists on trends of common inflammatory markers after infant heart surgery and their role in identifying post-operative sepsis. Methods: 275 consecutive infants undergoing cardiac surgery (231 with and 44 without Cardiopulmonary Bypass) were studied prospectively. Daily trends (0-4 day post-operative) of leucocyte counts, platelet counts and C-reactive protein were recorded. Association of these trends with early post-operative bloodstream sepsis, Cardiopulmonary Bypass and surgical outcomes were studied. Observations: Trends of these inflammatory markers were noted. While off-Cardiopulmonary Bypass Surgery, and sepsis were associated with a statisticaly insignificant rise in total leucocyte count peaking on first post-operative day, Cardiopulmonary Bypass exposure was associated with significant decline (p = 0.002), more pronounced with Cardiopulmonary Bypass-exposure exceeding 150 min. Percentage of neutrophils showed a rise (maximum on first post-operative day) but no significant association with sepsis or Cardiopulmonary Bypass.Platelet counts significantly declined after surgery, with nadir on 2nd POD (p < 0.001), the drop being more marked in patients operated on Cardiopulmonary Bypass (p < 0.005). Counts were significantly lower in patients exposed to >150 min Cardiopulmonary Bypass compared to those with shorter Cardiopulmonary Bypass. Septic patients had significantly lower platelet counts than uninfected patients, decline >2 SD from mean pre-operative level strongly associated with sepsis (p < 0.001).C-Reactive Protein levels rose markedly after surgery, peaking on 2nd POD; levels were significantly higher if operated on Cardiopulmonary Bypass. Cardiopulmonary Bypass >150 min was associated with lower mean C-Reactive Protein on first post-operative day, but significantly higher values on third and fourth post-operative days, as compared to Cardiopulmonary Bypass <150 min. Comparison of infected versus non-infected patients showed significantly higher mean C-Reactive Protein in the former group. Conclusion: While leucocyte count, platelet count and C-Reactive Protein emerged as useful markers of post-operative inflammatory response and reaction to Cardiopulmonary Bypass, they proved unsatisfactory predictors of early post-operative sepsis.

13.
Ann Pediatr Cardiol ; 12(3): 254-286, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31516283

RESUMEN

A number of guidelines are available for the management of congenital heart diseases (CHD) from infancy to adult life. However, these guidelines are for patients living in high-income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for CHD, as often these patients present late in the course of the disease and may have coexisting morbidities and malnutrition. Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on August 10 and 11, 2018, at the All India Institute of Medical Sciences. The meeting was supported by Children's HeartLink, a nongovernmental organization based in Minnesota, USA. The aim of the study was to frame evidence-based guidelines for (i) indications and optimal timing of intervention in common CHD; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for CHD; and (iii) indications for use of pacemakers in children. Evidence-based recommendations are provided for indications and timing of intervention in common CHD, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus, and others), obstructive lesions (pulmonary stenosis, aortic stenosis, and coarctation of aorta), and cyanotic CHD (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebstein's anomaly, and others). In addition, protocols for follow-up of postsurgical patients are also described, disease wise. Guidelines are also given on indications for implantation of permanent pacemakers in children.

14.
J Heart Lung Transplant ; 38(9): 879-901, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31495407

RESUMEN

The European Pediatric Pulmonary Vascular Disease Network is a registered, non-profit organization that strives to define and develop effective, innovative diagnostic methods and treatment options in all forms of pediatric pulmonary hypertensive vascular disease, including pulmonary hypertension (PH) associated with bronchopulmonary dysplasia, PH associated with congenital heart disease (CHD), persistent PH of the newborn, and related cardiac dysfunction. The executive writing group members conducted searches of the PubMed/MEDLINE bibliographic database (1990-2018) and held face-to-face and web-based meetings. Ten section task forces voted on the updated recommendations, based on the 2016 executive summary. Clinical trials, meta-analyses, guidelines, and other articles that include pediatric data were searched using the term "pulmonary hypertension" and other keywords. Class of recommendation (COR) and level of evidence (LOE) were assigned based on European Society of Cardiology/American Heart Association definitions and on pediatric data only, or on adult studies that included >10% children or studies that enrolled adults with CHD. New definitions by the World Symposium on Pulmonary Hypertension 2018 were included. We generated 10 tables with graded recommendations (COR/LOE). The topics include diagnosis/monitoring, genetics/biomarkers, cardiac catheterization, echocardiography, cardiac magnetic resonance/chest computed tomography, associated forms of PH, intensive care unit/lung transplantation, and treatment of pediatric PH. For the first time, a set of specific recommendations on the management of PH in middle- and low-income regions was developed. Taken together, these executive, up-to-date guidelines provide a specific, comprehensive, detailed but practical framework for the optimal clinical care of children and young adults with PH.


Asunto(s)
Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/terapia , Algoritmos , Niño , Humanos
16.
Indian J Cancer ; 55(1): 105-110, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30147104

RESUMEN

Background: Papillary carcinoma of thyroid (PTC) is a rare disease in children and adolescents and contributes to about 1.5%-3% of all pediatric malignancies. To date, no randomized trial has ever been performed in the pediatric population and management of these patients has been extrapolated from adult practice. Materials and Methods: Retrospective analysis of the patients treated for PTC in the age <21 years, between the years 1998-2013 at a tertiary cancer center from India. Results: Sixty-seven patients were treated in the above said period with a male:female ratio of 1:1.6 and a median age of 18 years. Fifty-two (77.6%) patients clinically presented as a thyroid swelling with or without nodal swelling while 13 (19.4%) presented with isolated nodal swelling. Surgery was performed in 30 patients at a nononcological hospital and was subsequently referred to our center; more than half of them needed a completion surgery at our center. Pathologically, multifocal tumors were found in close to a quarter of the patients. Among the pathological variants, classical, follicular, and tall cell variants comprised 65.7%, 28.4%, and 5.9% of the cases, respectively. Nodal positivity was noted 71.6% of the cases of which 14.5% were N1a disease and the vast majority (85.5%) harboring N1b disease. The median follow-up period of the study cohort was 104 months during which there were 3 local, 6 nodal, and 2 systemic recurrences. The 5- and 10-year disease-free survival were found to be 85.9% and 81.4%, respectively. Univariate and multivariate analysis has shown no significant clinical and pathological feature defining the disease outcomes except for the T-stage. Logistic regression revealed extrathyroidal invasion and the age ≤ 15 years correlated with nodal positivity. Conclusion: Being a rare malignancy, pediatric and adolescent PTCs tend to behave differently from adult PTC with a seemingly aggressive clinical presentation; however, they are associated with excellent survival outcomes.


Asunto(s)
Adenocarcinoma Folicular/cirugía , Carcinoma Papilar/cirugía , Recurrencia Local de Neoplasia/cirugía , Glándula Tiroides/cirugía , Neoplasias de la Tiroides/cirugía , Adenocarcinoma Folicular/epidemiología , Adenocarcinoma Folicular/patología , Adolescente , Carcinoma Papilar/epidemiología , Carcinoma Papilar/patología , Niño , Manejo de la Enfermedad , Supervivencia sin Enfermedad , Femenino , Humanos , India/epidemiología , Metástasis Linfática , Masculino , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/patología , Estudios Retrospectivos , Cáncer Papilar Tiroideo , Glándula Tiroides/patología , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/patología , Resultado del Tratamiento , Adulto Joven
17.
Contemp Clin Dent ; 9(Suppl 1): S58-S63, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29962765

RESUMEN

Aim: This study aimed to quantitatively compare the remineralization potential of casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP) and Novamin on artificially induced enamel subsurface lesions using scanning electron microscope-energy dispersive X-ray (SEM-EDX). Materials and Methods: Enamel specimens were prepared from seventy caries-free premolars and were kept for demineralization for 4 days. Following demineralization, enamel specimens were assigned to three groups: (1) Control group, (2) Group with CPP-ACFP-containing toothpaste, and (3) Group with Novamin-containing toothpaste. Further, both the experimental groups (CPP-ACFP group and Novamin) were then divided into three subgroups based on the duration of re-mineralization as follows: (a) 7 days, (b) 14 days, and (c) 21 days. Enamel specimens of experimental groups were then subjected to SEM-EDX to evaluate mineral content after treating with CPP-ACFP and Novamin. Results: Both the experimental groups showed very high significant differences between Ca/P ratios of remineralized samples. Conclusion: Even though both CPP-ACFP and Novamin showed remineralization potential, remineralization was found to be higher in the samples treated with CPP-ACFP.

18.
Cardiol Young ; 27(S6): S9-S13, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-29198257

RESUMEN

This manuscript provides a global perspective on physician and nursing education and training in paediatric cardiac critical care, including available resources and delivery of care models with representatives from several regions of the world including Africa, Israel, Asia, Australasia, Europe, South America, and the United States of America.


Asunto(s)
Cardiología/educación , Cuidados Críticos , Pediatría/educación , Cuidados Críticos/organización & administración , Salud Global , Cardiopatías/diagnóstico , Cardiopatías/terapia , Humanos , Enfermeras y Enfermeros/normas , Médicos/normas , Recursos Humanos
19.
Cardiol Young ; 27(S6): S22-S30, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-29198259

RESUMEN

Poor growth with underweight for age, decreased length/height for age, and underweight-for-height are all relatively common in children with CHD. The underlying causes of this failure to thrive may be multifactorial, including innate growth potential, severity of cardiac disease, increased energy requirements, decreased nutritional intake, malabsorption, and poor utilisation of absorbed nutrition. These factors are particularly common and severe in low- and middle-income countries. Although nutrition should be carefully assessed in all patients, failure of growth is not a contraindication to surgical repair, and patients should receive surgical repair where indicated as soon as possible. Close attention should be paid to nutritional support - primarily enteral feeding, with particular use of breast milk in infancy - in the perioperative period and in the paediatric ICU. This nutritional support requires specific attention and allocation of resources, including appropriately skilled personnel. Thereafter, it is essential to monitor growth and development and to identify causes for failure to catch-up or grow appropriately.


Asunto(s)
Insuficiencia de Crecimiento/etiología , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/fisiopatología , Desnutrición/complicaciones , Apoyo Nutricional/métodos , Niño , Cuidados Críticos/organización & administración , Países en Desarrollo , Ingestión de Energía , Nutrición Enteral , Insuficiencia de Crecimiento/fisiopatología , Cardiopatías Congénitas/cirugía , Humanos , Tiempo de Internación
20.
J Pharm Bioallied Sci ; 9(Suppl 1): S166-S172, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-29284958

RESUMEN

Background: Many patients consider removal of caries to be a very unpleasant experience. Removal of caries with conventional drill is considered traumatic mainly due to fear and anxiety of children and their parents. Minimally invasive dentistry adopts a philosophy that integrates prevention, remineralization, and minimal intervention for the placement and replacement of restorations, thus reaching the treatment objective using the least invasive surgical approach, with the removal of the minimal amount of healthy tissues. Chemomechanical caries removal (CMCR) is a method for minimally invasive, gentle dentin caries removal based on biological principles which is an effective alternative to the traditional method. The present study was done to compare the microhardness of sound dentin before and after carious removal using a chemomechanical method and a conventional method. Materials and Methods: The present in vitro study was done on 28 proximal surfaces of fourteen extracted primary molars (with active caries on one proximal surface and sound side as control). The study was done to assess the Knoop microhardness of remaining dentinal surface after caries removal using a slow speed conventional bur and a chemomechanical method (Carie-Care™). Results and. Conclusion: The rotary instrument group showed a consistent microhardness value with not much difference according to depth. The chemomechanical group showed a lesser microhardness value closer to the cavity floor than away from it. The microhardness values at all depths were significantly different for each treatment group with an increased value seen in the rotary group. The mean microhardness values of residual dentin in treated side were found to be insignificant when compared among each interval in each group. The microhardness of sound dentin had high significant difference from that of residual dentin in both the rotary group and the chemomechanical group.

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