Lista de verificación: tomografía computarizada de cuello en urgencias no traumáticas / Checklist: Neck computed tomography in non-traumatic emergencies

A los pacientes que acuden a urgencias con síntomas inflamatorio/infecciosos a nivel cervical o con masas que pueden comprometer el tracto aerodigestivo o las estructuras vasculares, es necesario hacerles una tomografía computarizada (TC) de cuello con contraste. Su interpretación radiológica se ve dificultada por la complejidad anatómica y la interrelación fisiopatológica entre los diferentes sistemas que lo componen, en un área de estudio relativamente pequeña. Estudios recientes proponen realizar una evaluación sistemática de las estructuras cervicales, utilizando para ello un listado de verificación de 7 elementos, para identificar correctamente la patología, y detectar los hallazgos incidentales que pueden interferir en el manejo del paciente. El objetivo de este trabajo es revisar los hallazgos de la TC en la patología no traumática del cuello en urgencias siguiendo una lectura sistemática, tras la cual se pueda realizar un informe radiológico estructurado, completo y conciso.(AU)

Patients attending the emergency department (ED) with cervical inflammatory/infectious symptoms or presenting masses that may involve the aerodigestive tract or vascular structures require a contrast-enhanced computed tomography (CT) scan of the neck. Its radiological interpretation is hampered by the anatomical complexity and pathophysiological interrelationship between the different component systems in a relatively small area. Recent studies propose a systematic evaluation of the cervical structures, using a 7-item checklist, to correctly identify the pathology and detect incidental findings that may interfere with patient management. As a conclusion, the aim of this paper is to review CT findings in non-traumatic pathology of the neck in the ED, highlighting the importance of a systematic approach in its interpretation and synthesis of a structured, complete, and concise radiological report.(AU)

Checklist: Neck computed tomography in non-traumatic emergencies.

Patients attending the emergency department (ED) with cervical inflammatory/infectious symptoms or presenting masses that may involve the aerodigestive tract or vascular structures require a contrast-enhanced computed tomography (CT) scan of the neck. Its radiological interpretation is hampered by the anatomical complexity and pathophysiological interrelationship between the different component systems in a relatively small area. Recent studies propose a systematic evaluation of the cervical structures, using a 7-item checklist, to correctly identify the pathology and detect incidental findings that may interfere with patient management. As a conclusion, the aim of this paper is to review CT findings in non-traumatic pathology of the neck in the ED, highlighting the importance of a systematic approach in its interpretation and synthesis of a structured, complete, and concise radiological report.

Evaluación del dolor crónico postoperatorio en hernioplastia TAPP versus Lichtenstein por Residentes / Evaluation of chronic postoperative pain in hernioplasty Tapp versus Lichtenstein by residents

La incidencia de la hernia inguinal a lo largo de la vida es variable, pero con una mayor prevalencia en los hombres. Hoy en día no existe una técnica superior en términos de reducir el dolor postoperatorio crónico, que es la mayor morbilidad que afecta a los pacientes. Es por eso que realizamos un breve análisis comparativo, donde evaluamos la incidencia de dolor crónico entre el ensayo convencional versus laparoscópico de la patología de la hernia

The incidence of inguinal hernia throughout life is variable, but with a higher prevalence in males. Today there is no superior technique in terms of reducing chronic postoperative pain, which is the greatest morbidity that afflicts patients. That is why we carried out a brief comparative analysis, where we evaluated the incidence of chronic pain between conventional versus laparoscopic rehearsal of hernia pathology

Cervical spine trauma.

Cervical spine trauma encompasses a wide of injuries, ranging from stable, minor lesions to unstable, complex lesions that can lead to neurologic sequelae or vascular involvement. The Canadian C-Spine Rule and the NEXUS criteria aim to identify individuals with a low risk of cervical spine trauma who can safely forgo imaging tests. In high-risk patients, an imaging test is indicated. In adult patients the imaging test of choice is multidetector computed tomography. Complementary imaging tests such as CT angiography of the supra-aortic vessels and/or magnetic resonance imaging are occasionally necessary. It can be challenging for radiologists to diagnose and classify these lesions, because some of them can be subtle and difficult to detect. This paper aims to describe the most important imaging findings and the most widely used classification systems.

Hyperspectral Nanoimaging of van der Waals Polaritonic Crystals.

Phonon polaritons (PhPs) in van der Waals (vdW) crystal slabs enable nanoscale infrared light manipulation. Specifically, periodically structured vdW slabs behave as polaritonic crystals (vdW-PCs), where the polaritons form Bloch modes. Because the polariton wavelengths are smaller than that of light, conventional far-field spectroscopy does not allow for a complete characterization of vdW-PCs or for revealing their band structure. Here, we perform hyperspectral infrared nanoimaging and analysis of PhPs in a vdW-PC slab made of h-BN. We demonstrate that infrared spectra recorded at individual spatial positions within the unit cell of the vdW-PC can be associated with its band structure and local density of photonic states (LDOS). We thus introduce hyperspectral infrared nanoimaging as a tool for the comprehensive analysis of polaritonic crystals, which could find applications in the reconstruction of complex polaritonic dispersion surfaces in momentum-frequency space or for exploring exotic electromagnetic modes in topological photonic structures.

Radiologic diagnosis of patients with COVID-19. / Diagnóstico radiológico del paciente con COVID-19.

The pandemia caused by the SARS-CoV-2 virus has triggered an unprecedented health and economic crisis. Although the diagnosis of infection with SARS-CoV-2 is microbiological, imaging techniques play an important role in supporting the diagnosis, grading the severity of disease, guiding treatment, detecting complications, and evaluating the response to treatment. The lungs are the main organ involved, and chest X-rays, whether obtained in conventional X-ray suites or with portable units, are the first-line imaging test because they are widely available and economical. Chest CT is more sensitive than plain chest X-rays, and CT studies make it possible to identify complications in addition to pulmonary involvement, as well as to suggestive alternative diagnoses. The most common radiologic findings in COVID-19 are airspace opacities (consolidations and/or ground-glass opacities), which are typically bilateral, peripheral, and located primarily in the lower fields.

Diagnóstico radiológico del paciente con COVID-19 / Radiologic diagnosis of patients with COVID-19

La pandemia por el virus SARS-CoV-2ha desencadenado una crisis económica y sanitaria sin precedentes. Aunque el diagnóstico es microbiológico, las técnicas de imagen tienen un papel importante para apoyar el diagnóstico, graduar la gravedad de la enfermedad, guiar el tratamiento, detectar posibles complicaciones y valorar la respuesta terapéutica. La afectación es principalmente pulmonar. La radiografía de tórax en sala convencional o portátil es el primer método de imagen por su amplia disponibilidad y bajo coste. La tomografía computarizada torácica tiene una mayor sensibilidad que la radiografía de tórax y permite valorar tanto la afectación pulmonar como posibles complicaciones, además de proporcionar diagnósticos alternativos. Los hallazgos radiológicos más frecuentes son las opacidades del espacio aéreo en forma de consolidaciones y/u opacidades en vidrio deslustrado, con distribución típicamente bilateral, periférica y de predominio en los campos inferiores

The pandemia caused by the SARS-CoV-2 virus has triggered an unprecedented health and economic crisis. Although the diagnosis of infection with SARS-CoV-2 is microbiological, imaging techniques play an important role in supporting the diagnosis, grading the severity of disease, guiding treatment, detecting complications, and evaluating the response to treatment. The lungs are the main organ involved, and chest X-rays, whether obtained in conventional X-ray suites or with portable units, are the first-line imaging test because they are widely available and economical. Chest CT is more sensitive than plain chest X-rays, and CT studies make it possible to identify complications in addition to pulmonary involvement, as well as to suggestive alternative diagnoses. The most common radiologic findings in COVID-19 are airspace opacities (consolidations and/or ground-glass opacities), which are typically bilateral, peripheral, and located primarily in the lower fields

Empalamiento precordial por arma blanca: extracción bajo visión videotorcoscópica / PRECORDIAL REMOVAL OF AN IMPALED KNIFE UNDER THORACOSCOPIC VISION

Background: It is widely established that the extraction of impaled objects should be carried out under direct vision. In the case of stable patients, endoscopic vision can be used as an alternative. Clinical Case: A 70-year-old male is admitted for a 5-hour impaled precordial stab wound. Evolution valued according to ATLS standards. Clinically and hemodynamically compensated patient. On physical examination: left pulmonary hypoventilation, subcutaneous emphysema, no jugular engorgement. Control of vital signs: TA: 110 / 70mmHg, FC: 70min, FR: 20min, Sat02: 97%. Complementary studies: ECO FAST: no pericardial fluid. Rx thorax: mild left pneumothorax heme. Chest CT: Puncture object of 18 cm in the left lung of AP and medial to the lateral path, hematoma of the angle, and hemopneumothorax grade I. Surgery: Patient in dorsal recumbency, under ARM with selective intubation. An incision in 5th left intercostal space, middle axillary line. 10mm trocar placement, 30 ° optics introduction. After discarding the commitment of the pericardium, active bleeding, and observing that the end of the weapon was going through the end of the angle, the weapon is removed under endoscopic vision. Clot washing/aspiration. Verification of hemostasis, absence of air leakage and pulmonary expansion. Drainage with 28 French tubes. Evolution: Derived from UTI extubated. CT scan thorax 72 h post: small intraparenchymal hematoma left, expanded lung. Minimum serohematic debit. Pleural tube and definitive discharge are removed on the 4th post-surgical day. Discussion: The literature suggests in the urgency, the removal of impaled objects under direct vision of the compromised structures. However, in stable patients, the previous study with CT should be unavoidable. Video-thoracoscopy in these wounded can avoid open surgery, but the procedure must be performed in trauma reference centers, with the appropriate means and by a trained surgical team willing to perform an emergency thoracotomy

Launching of hyperbolic phonon-polaritons in h-BN slabs by resonant metal plasmonic antennas.

Launching and manipulation of polaritons in van der Waals materials offers novel opportunities for field-enhanced molecular spectroscopy and photodetection, among other applications. Particularly, the highly confined hyperbolic phonon polaritons (HPhPs) in h-BN slabs attract growing interest for their capability of guiding light at the nanoscale. An efficient coupling between free space photons and HPhPs is, however, hampered by their large momentum mismatch. Here, we show -by far-field infrared spectroscopy, infrared nanoimaging and numerical simulations- that resonant metallic antennas can efficiently launch HPhPs in thin h-BN slabs. Despite the strong hybridization of HPhPs in the h-BN slab and Fabry-Pérot plasmonic resonances in the metal antenna, the efficiency of launching propagating HPhPs in h-BN by resonant antennas exceeds significantly that of the non-resonant ones. Our results provide fundamental insights into the launching of HPhPs in thin polar slabs by resonant plasmonic antennas, which will be crucial for phonon-polariton based nanophotonic devices.

Deeply subwavelength phonon-polaritonic crystal made of a van der Waals material.

Photonic crystals (PCs) are periodically patterned dielectrics providing opportunities to shape and slow down the light for processing of optical signals, lasing and spontaneous emission control. Unit cells of conventional PCs are comparable to the wavelength of light and are not suitable for subwavelength scale applications. We engineer a nanoscale hole array in a van der Waals material (h-BN) supporting ultra-confined phonon polaritons (PhPs)-atomic lattice vibrations coupled to electromagnetic fields. Such a hole array represents a polaritonic crystal for mid-infrared frequencies having a unit cell volume of [Formula: see text] (with λ0 being the free-space wavelength), where PhPs form ultra-confined Bloch modes with a remarkably flat dispersion band. The latter leads to both angle- and polarization-independent sharp Bragg resonances, as verified by far-field spectroscopy and near-field optical microscopy. Our findings could lead to novel miniaturized angle- and polarization-independent infrared narrow-band couplers, absorbers and thermal emitters based on van der Waals materials and other thin polar materials.

Identification of differences in the formation of plasma glycated proteins between dogs and humans under diabetes-like glucose concentration conditions.

Dogs have been proposed as a translational model and used for studying aging, diabetes, and diabetes-related complications in humans. However, no studies have ever compared the glycation of plasma proteins between dogs and humans under similar experimental conditions. Thus, the aim of this study was to fill this gap by comparing the plasma protein glycation patterns of dogs and humans in an ex-vivo system. Canine and human plasma samples were incubated with glucose at concentrations comparable to those observed in diabetic patients. The final glucose plasma concentration resulted in similar glucose:albumin ratios in both species. Glycated proteins were evaluated by measuring the content of fructosamine, protein carbonyls, and the formation of advanced glycation end-products (AGEs). The concentrations of fructosamine and protein carbonyls in canine and human plasma increased in a glucose concentration-dependent manner (P < 0.0001). Of note, the relative increment of fructosamine and protein carbonyl content and AGE formation was always higher in human than in dog plasma. Our results reveal that the plasma glycation processes in dogs and humans are not similar. These novel findings could contribute to improve our understating about canine and human diabetes as well as other condition associated in the glycation of proteins.

Choque séptico fulminante neonatal por Clostridium perfringens / Neonatal fulminant septic shock by Clostridium perfringens

Resumen Clostridium spp. es un bacilo grampositivos, anaerobio, formador de esporas y ampliamente distribuido en el ambiente. Las infecciones por Clostridium perfringens en neonatos son en extremo raras. La sepsis grave por anaerobios, incluyendo el choque séptico, es un evento clínico inusual en este grupo de pacientes. Se reportan dos casos de bacteriemia por C. perfringens asociados a choque séptico fulminante en recién nacidos con enterocolitis necrosante grave.

Abstract Clostridium species are anaerobic, spore, forming gram-positive bacteria that are widely spread in the environment. Clostridium perfringens infections in neonates are extremely rare. Severe anaerobic sepsis, including septic shock, is an unusual clinical event in this group of patients. We highlight two cases of C. perfringens bacteremia associated with fulminant septic shock in neonates with severe necrotizing enterocolitis.

The role of laryngectomy in locally advanced thyroid carcinoma. Review of 16 cases.

SUMMARY: Locally advanced disease with larynx invasion is a challenge to the surgeon, but laryngectomy is almost never necessary in thyroid carcinoma. The aim of this study was to review the clinical outcomes of patients with locally advanced thyroid carcinoma invading the larynx who underwent laryngectomy. A case series of patients treated in a tertiary care hospital was reviewed. Data about the type of operation, method of reconstruction, complications and overall survival of 16 patients operated on between 2002 and 2015 with larynx invasion is presented. There were 10 females. The mean age was 63 ± 8.8 years. Besides total thyroidectomy and neck dissection, four patients underwent total pharyngolaryngectomy, 11 total laryngectomy and one hemi-laryngectomy. Reconstruction was made with regional flaps in 10 patients (7 pectoral/Bakamjian flaps and 3 gastric pull-through procedures) and a jejunum free flap in one patient. Two patients needed carotid artery reconstruction. Five tumours were classic (conventional) papillary carcinoma variants, while the others were aggressive histological varieties (insular, tall cell, sclerosing). The mean tumour size was 4.3 ± 1.6 cm. All tumours had lymphovascular invasion and 12 had positive lymph nodes. Concomitantly, oesophageal/hypopharyngeal invasion was present in 7 cases and invasion of carotid vessels in 2 cases. There were two postoperative deaths and two anastomotic leaks that were treated conservatively. The mean overall survival was 31 ± 33 months (median 27.6 months, range 0-120). Laryngectomy is an alternative surgical procedure to control selected cases of advanced thyroid carcinoma that offers good local control and long term survival.

Ex vivo binding of the immunosuppressant mycophenolic acid to dog and cat plasma proteins and the effect of co-incubated dexamethasone and prednisolone.

Mycophenolic acid (MPA) has been shown to be promising for the treatment of autoimmune diseases in dogs and cats. In humans, MPA is highly bound to plasma proteins (~97%). It has been recommended to monitor free drug plasma concentrations because the free MPA correlates with its immunosuppressive effect. However, it is unknown if MPA is highly bound to plasma proteins in dogs and cats. The objectives of this study were to determine the extent of plasma protein binding of MPA and evaluate the effect of prednisolone and dexamethasone on the extent of protein binding of MPA in dogs and cats. The extent of plasma protein binding of MPA was determined in plasma collected from clinically healthy adult cats (n = 13) and dogs (n = 14) by combining high-throughput dialysis and ultra-high-liquid chromatography. This study reveals that MPA is highly bound to plasma proteins (>90%) in dogs and cats, mean extent of binding of MPA at 15 µg/ml to plasma proteins being 96% (range, 95%-97%) and 92% (range, 90%-93%) for dogs and cats, respectively. In dog plasma, MPA is primarily bound to albumin. In vitro, prednisolone increased the unbound MPA in dogs (p < .01) but not in cats (p = .07) while dexamethasone had no effect on MPA plasma binding in either species (p > .05). Results of this study provide valuable information for designing future pharmacokinetic and pharmacodynamic studies and also therapeutic monitoring programs for dogs and cats.

Primary Sjögren's syndrome: Extraglandular manifestations and hydroxychloroquine therapy.

The use of hydroxychloroquine (HCQ) in Primary Sjögren's Syndrome (pSS) has been assessed in different studies over the last years, with conflicting results regarding its efficacy in sicca syndrome and extraglandular manifestations (EGM). The goal of this study was to compare the incidence rate of EGM in pSS patients with and without HCQ therapy.We performed a multicenter retrospective study, including patients with pSS (European classification criteria) with at least 1 year of follow-up. Subjects with concomitant fibromyalgia, autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis were excluded. Demographics and pSS characteristics were recorded. The EGM were defined by EULAR-SS disease activity index (ESSDAI). Patients were divided into two groups according to their use or not of HCQ therapy. We evaluated the use of HCQ and its relationship to EGM. HCQ therapy was defined as the continuous use of the drug for at least 3 months. A descriptive analysis of demographics and pSS characteristics was performed. We compared the incidence of EGM between groups defined by HCQ therapy using chi2 test or Fisher's exact test. A total of 221 patients were included (97.3% women), mean age, 55.7 years (SD 14). Mean age at diagnosis, 48.8 years (SD 15); median disease duration, 60 months (IQR 35-84). One hundred and seventy patients (77%) received HCQ. About half of the patients had at least one EGM during the course of the disease, 20% of them developed an EGM before the onset of the sicca syndrome and 26% simultaneously with dryness symptom. Overall, EGM were less frequent in those on HCQ therapy (36.5% vs 63.5%, p < 0.001). Considering each EGM individually, the following manifestations were more frequent in the non-treated group: arthritis (p < 0.001), fatigue (p < 0.001), purpura (p = 0.01), Raynaud phenomenon (p = 0.003), and hypergammaglobulinemia (p = 0.006). Immunosuppressive treatment was indicated on 28 patients (12.7%), 13 of which were receiving also HCQ. The first reason for those treatments was the presence of arthritis in 12/28 patients (42.8%), and the drug used in all the cases was methotrexate. Only three patients required immunosuppressive therapy with cyclophosphamide, due to the presence of glomerulonephritis, vasculitis, and interstitial lung disease. None of the patients received biologic therapy. The lower incidence of EGM was observed in patients on HCQ therapy supports its efficacy in pSS. However, further large scale prospective studies are needed to confirm these findings.

Nanoimaging of resonating hyperbolic polaritons in linear boron nitride antennas.

Polaritons in layered materials-including van der Waals materials-exhibit hyperbolic dispersion and strong field confinement, which makes them highly attractive for applications including optical nanofocusing, sensing and control of spontaneous emission. Here we report a near-field study of polaritonic Fabry-Perot resonances in linear antennas made of a hyperbolic material. Specifically, we study hyperbolic phonon-polaritons in rectangular waveguide antennas made of hexagonal boron nitride (h-BN, a prototypical van der Waals crystal). Infrared nanospectroscopy and nanoimaging experiments reveal sharp resonances with large quality factors around 100, exhibiting atypical modal near-field patterns that have no analogue in conventional linear antennas. By performing a detailed mode analysis, we can assign the antenna resonances to a single waveguide mode originating from the hybridization of hyperbolic surface phonon-polaritons (Dyakonov polaritons) that propagate along the edges of the h-BN waveguide. Our work establishes the basis for the understanding and design of linear waveguides, resonators, sensors and metasurface elements based on hyperbolic materials and metamaterials.

Optical Nanoimaging of Hyperbolic Surface Polaritons at the Edges of van der Waals Materials.

Hyperbolic polaritons in van der Waals (vdW) materials recently attract a lot of attention, owing to their strong electromagnetic field confinement, ultraslow group velocities, and long lifetimes. Typically, volume-confined hyperbolic polaritons (HPs) are studied. Here we show the first near-field optical images of hyperbolic surface polaritons (HSPs), which are confined and guided at the edges of thin flakes of a vdW material. To that end, we applied scattering-type scanning near-field optical microscopy (s-SNOM) for launching and real-space nanoimaging of hyperbolic surface phonon polariton modes on a hexagonal boron nitride (h-BN) flake. Our imaging data reveal that the fundamental HSP mode exhibits a stronger field confinement (shorter wavelength), smaller group velocities, and nearly identical lifetimes, as compared to the fundamental HP mode of the same h-BN flake. Our experimental data, corroborated by theory, establish a solid basis for future studies and applications of HPs and HSPs in vdW materials.

Uso de las tecnologías de información y comunicación para el cuidado del binomio materno-fetal: revisión de tema / Use of information and communications technology to care for the maternal-fetal binomial: Topic review / Uso das tecnologias de informação e comunicação para o cuidado do binômio materno-fetal: revisão do assunto

La existencia de foros clínicos y redes sociales de pacientes que intercambian información sobre su enfermedad y tratamiento, sitios web con información especializada en patologías y en lenguaje accesible al público en general, entre otros cambios, han modificado la asimetría de información que hace que la gente consulte los servicios de salud. Si se tienen en cuenta estas nuevas posibilidades virtuales, la escasez del personal de salud y los demás factores contemplados, la telesalud tiene todas las posibilidades en el futuro inmediato. El propósito de esta revisión es identificar el uso de la telesalud como estrategia para superar barreras de acceso, disponibilidad y oportunidad de servicio para el binomio materno fetal. Para establecer conceptos se retoman definiciones de informática biomédica, e-salud, telesalud, telemedicina y teleeducación. Es preciso evaluar los modelos de telesalud para el cuidado del binomio materno fetal con el fin de identificar las lecciones aprendidas y factores de éxito necesarios para nuevas implementaciones de modelos. Dentro de las tecnologías aplicadas se encuentran medios masivos de comunicación, teléfono convencional, celular, mensajes de texto, internet, videoconferencias, correo electrónico, ultrasonido y ecocardiografía fetal. Después de evaluar las experiencias se encuentran ventajas como: adherencia a tratamientos, aumento de la cobertura y en la capacidad de detección temprana de acontecimientos, entre otras. Dentro de las desventajas: problemática de cobertura de internet y de señal de celular, y resistencia al uso de tecnologías de información y comunicación (TIC). En cuanto a los aspectos económicos, no hay pruebas concluyentes de que la telemedicina y la teleasistencia son rentables en comparación con la atención tradicional de la salud. Sin embargo, la evidencia sugiere que la telesalud en el hogar tiene el potencial de reducir costos, pero su impacto, desde una perspectiva social, es incierto mientras no se disponga de estudios de mayor calidad. El uso de las tecnologías de telemedicina a través del tiempo (monitoreo remoto fetal, ultrasonido, y teleconsultas) ha dado lugar a una marcada reducción en la mortalidad perinatal en comparación con un grupo equivalente de pacientes obstétricas con estrategias tradicionales.

The existence of clinical forums, social networks where patients exchange information about their disease and treatment, web sites specializing in diseases and accessible to the general public language, among many other changes have modified, at least in part, information asymmetry that makes people visit health services. Taking into account these new virtual possibilities, the shortage of health personnel, and other factors referred to, telehealth has every chance in the near future. The purpose of this review is to identify the use of telehealth as a strategy to overcome some of the barriers to access, availability, and timeliness of service for the maternal-fetal binomial. To establish concepts, definitions are taken from biomedical informatics, e-health, telehealth, telemedicine, and tele-education. It is important to evaluate the different models of telehealth care of the maternal-fetal binomial in order to identify lessons learned and success factors necessary for new implementations of models. The technologies applied include mass media, conventional phone, cell phone, text messaging, internet, video conferencing, e-mail, ultrasound, and fetal echocardiography. After evaluating the experiences, advantages included adherence to treatment, increased coverage, and increased capacity for early detection of events, among others. The disadvantages identified involved problems with internet coverage and poor cell phone signal, and resistance to the use of Information and Communications Technology (ICT). With regard to costs, there is no conclusive evidence that telemedicine interventions and telecare are cost-effective compared to traditional health care. However, current evidence suggests that home telehealth has the potential to reduce costs, but its impact from a social perspective remains uncertain pending the availability of higher quality studies. The general use of telemedicine technologies over time (remote fetal monitoring, ultrasound, and teleconsultation) has resulted in a marked reduction in perinatal mortality when compared to an equivalent group of obstetric patients receiving traditional treatment.

A existência de foros clínicos e redes sociais de pacientes que intercambiam informação sobre sua doença e tratamento, páginas web com informação especializada em patologias e em linguagem acessível ao público em geral, entre outras mudanças, hão modificado a assimetria de informação que faz que as pessoas consulte os serviços de saúde. Se se tem em conta estas novas possibilidades virtuais, a escassez de pessoal de saúde e os demais fatores contemplados, a tele-saúde têm todas as possibilidades no futuro imediato. O propósito desta revisão é identificar o uso da tele-saúde como estratégia para superar barreiras de acesso, disponibilidade e oportunidade de serviço para o binômio materno fetal. Para estabelecer conceitos se retomam definições de informática biomédica, e-saúde, tele-saúde, tele-medicina tele-educação. É necessário avaliar os modelos de tele-saúde para o cuidado do binômio materno fetal com o fim de identificar as lições aprendidas e fatores de sucesso necessários para novas implementações de modelos. Dentro das tecnologias aplicadas se encontram meios massivos de comunicação, telefone convencional, celular, mensagens de texto, internet, videoconferências, correio electrônico, ultrassom e ecocardiografia fetal. Depois de avaliar as experiências se encontra vantagens como: aderência a tratamentos, aumento da cobertura e na capacidade de detecção precoce de acontecimentos, entre outras. Dentro das desvantagens: problemática de cobertura de internet e de sinal de celular, e resistência ao uso de tecnologias de informação e comunicação (TIC). Enquanto aos aspectos económicos, não há provas concluintes de que a tele-medicina e a teleassistência são rentáveis em comparação com a atenção tradicional da saúde. Mas, a evidência sugere que a tele-saúde no lar tem o potencial de reduzir custos, mas seu impacto, desde uma perspectiva social, é incerto enquanto não se disponha de estudos de maior qualidade. O uso das tecnologias de tele-medicina através do tempo (monitoração remoto fetal, ultrassom, e tele-consultas) há dado lugar a uma marcada redução na mortalidade perinatal em comparação com um grupo equivalente de pacientes obstétricas com estratégias tradicionais.

Controlling graphene plasmons with resonant metal antennas and spatial conductivity patterns.

Graphene plasmons promise unique possibilities for controlling light in nanoscale devices and for merging optics with electronics. We developed a versatile platform technology based on resonant optical antennas and conductivity patterns for launching and control of propagating graphene plasmons, an essential step for the development of graphene plasmonic circuits. We launched and focused infrared graphene plasmons with geometrically tailored antennas and observed how they refracted when passing through a two-dimensional conductivity pattern, here a prism-shaped bilayer. To that end, we directly mapped the graphene plasmon wavefronts by means of an imaging method that will be useful in testing future design concepts for nanoscale graphene plasmonic circuits and devices.

Onset of a propagating self-sustained spin reversal front in a magnetic system.

The energy released in a magnetic material by reversing spins as they relax toward equilibrium can lead to a dynamical instability that ignites self-sustained rapid relaxation along a deflagration front that propagates at a constant subsonic speed. Using a trigger heat pulse and transverse and longitudinal magnetic fields, we investigate and control the crossover between thermally driven magnetic relaxation and magnetic deflagration in single crystals of Mn(12)-acetate.