RESUMO
OBJECTIVES: The European Alliance of Associations for Rheumatology (EULAR) supports the use of nailfold videocapillaroscopy (NVC) to identify disease patterns (DPs) associated with systemic sclerosis (SSc) and Raynaud's phenomenon (RP). Recently, EULAR proposed an easy-to-manage procedure, a so-called Fast Track algorithm, to differentiate SSc from non-SSc patterns in NVC specimens. However, subjectivity among capillaroscopists remains a limitation. Our aim was to perform a software-based analysis of NVC peculiarities in a cohort of samples from SSc and RP patients and, subsequently, build a Fast Track-inspired algorithm to identify DPs without the constraint of interobserver variability. METHODS: NVCs were examined by 9 capillaroscopists. Those NVCs whose DPs were consensually agreed (≥2 out of 3 interobservers) were subsequently analysed with an in-house developed software. Each variable's results were grouped according to the consensually agreed DPs in order to identify useful hallmarks to categorise them. RESULTS: Eight-hundred and fifty-one NVCs (21 957 images) whose DPs had been consensually agreed were software-analysed. Appropriate cut-offs set in capillary density and percentage of abnormal and giant capillaries, tortuosities and hemorrhages allowed DP categorization and the development of the CAPI-Score algorithm. This consisted of 4 rules: Rule 1, SSc vs non-SSc, accuracy 0.88; Rules 2 and 3, SSc-early vs SSc-active vs SSc-late, accuracy 0.82; Rule 4, non-SSc normal vs non-SSc non-specific, accuracy 0.73. Accuracy improved when the analysis was limited to NVCs whose DPs had achieved full consensus among interobservers. CONCLUSIONS: The CAPI-Score algorithm may become a useful tool to assign DPs by overcoming the limitations of subjectivity.
RESUMO
Purpose of review: Systemic sclerosis (SSc) and myositis are two different entities that may coexist as an overlap syndrome. Immunological biomarkers such as anti-PM/Scl or anti-Ku reinforce the syndrome. This review is focused on the treatment of different and characteristic manifestations of this syndrome. Recent findings: Among the different phenotypes of muscle involvement in patients with SSc, the fibrotic pattern and the sporadic inclusion body myositis must be identified early to avoid a futile immunosuppressive treatment. Other forms such as dermatomyositis, non-specific myositis and immune-mediated necrotizing myopathy need to receive conventional immunosuppressive therapy considering that high dose of glucocorticoids may induce a scleroderma renal crisis in patients with SSc. Physicians must be aware of the existence of a "double trouble" association of hereditary myopathy with an autoimmune phenomenon. Several autoantibodies, mainly anti-PM/Scl and anti-Ku may help to define specific phenotypes with characteristic clinical manifestations that need a more specific therapy. Vasculopathy is one of the underlying mechanisms that link SSc and myositis. Recent advances in this topic are reviewed. Summary: Current treatment of SSc associated myopathy must be tailored to specific organs involved. Identifying the specific clinical, pathological, and immunological phenotypes may help to take the correct therapeutic decisions.
RESUMO
Objetivo: Determinar la incidencia y los factores asociados con delírium en pacientes de la Unidad de Cuidados Intensivos. Métodos: Se condujo un estudio de cohortes en 134 pacientes de la unidad de cuidados intensivos en una clínica de Bucaramanga, Colombia. Quienes fueron reclutados en las primeras 24 h de ingreso y se les aplicaron las escalas de sedación y agitación de Richmond (RASS), PRE-DELIRIC versión en español y Confusion Assessment Method for Intensive Care Unit (CAM-ICU); el desenlace se evaluó a través de seguimiento diario con CAM-ICU. Resultados: La incidencia de delírium fue del 20,2%, predominando el de tipo hipoactivo 66,7%, seguido del hiperactivo 7,4% y mixto 25,9%. El 52% de los pacientes con delírium fallecieron. En el análisis bivariado, se identificaron como factores de riesgo para delírium, el uso de sedantes (riesgo relativo [RR] 2,4, intervalo de confianza del 95% [IC del 95%] = 1,2-4,5), infección (RR = 2,8, IC del 95% = 1,3-5,9), acidosis metabólica (RR = 4,3, IC del 95% = 2,3-8), ventilación mecánica (RR = 4,6, IC del 95% = 2-10,6), edad mayor a 60 años (RR = 2,3, IC del 95% = 1,09-5,3) y puntaje APACHE mayor a 14 (RR = 3, IC del 95% = 1,1-8,2). En el análisis multivariado, solo se encontró relación con la infección (RR = 3,8, IC del 95% = 1,6-9,1) y la edad mayor a 60 años (RR = 3,2, IC del 95% = 1,2-8,3). Conclusiones: El delírium es frecuente en los pacientes de la Unidad de Cuidado Intensivo, en especial el hipoactivo. La mitad de los pacientes con delírium fallecieron. Los principales factores de riesgo para delírium son infección y la edad mayor a 60 años, por lo tanto, las actividades de prevención de delírium deben ser enfocadas a estos pacientes críticos
Objective: To determine the incidence and the factors associated with delirium in intensive care unit patients. Methods: A cohort study conducted on 134 patients in the intensive care unit at a clinic in Bucaramanga, Colombia., who were recruited in the first 24 hours following admission and on whom the Richmond Agitation-Sedation Scale (RASS), PRE-DELIRIC version in Spanish, and Confusion Assessment method for Intensive Care Unit (CAM-ICU) were applied; the outcome was evaluated through daily monitoring with CAM-ICU. Results: The incidence of delirium was 20.2%, the predominating type was hypoactive at 66.7%, followed by the hyperactive type at 7.4% and mixed at 25.9%. Fifty-two percent of the patients with delirium died. In the bivariate analysis, the use of sedatives (Relative Risk(RR) 2.4, 95% confidence interval (95% CI) = 1.2-4.5), infection (RR = 2. 8, 95% CI=1.3-5.9), metabolic acidosis (RR = 4 3, 95% CI=2.3-8.0), mechanical ventilation (RR = 4 6, 95% CI=2.0-10.6), aged over 60 years (RR = 2 3, 95% CI=1.09-5.3) and APACHE score greater than 14 (RR = 3. 0) (95% CI=1.1-8.2) were identified as risk factors for delirium. The multivariate analysis only found a relationship with infection (RR = 3 8, 95% CI=1.6-9.1) and being aged over 60 years (RR = 3 2, 95% CI 1.2-8.3). Conclusions: delirium is frequent in patients in the intensive care unit, especially the hypoactive type. Half of the patients with delirium died. The main risk factors for delirium are infection and being over 60 years age, therefore, delirium prevention activities should focus on these critical patients
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Delírio/prevenção & controle , Cuidados Críticos , Delírio/epidemiologia , Colômbia/epidemiologia , Fatores de Risco , Estudos de Coortes , Sedação Consciente , APACHE , Unidades de Terapia Intensiva , Infecções/complicaçõesRESUMO
Objetivos: entre el 70 y el 85 % de la población adulta sufre de dolor de espalda alguna vez en su vida. El síndrome de dolor miofascial (SDM) ha sido descrito recientemente definiéndose como dolor musculoesquelético no inflamatorio, localizado, desarrollado sin causa aparente, refractario a tratamientos farmacológicos y físicos, y se acompaña de la presencia de puntos gatillos y de bandas tensas palpables en el músculo. Su prevalencia se estima que varía entre un 30 y un 85 %. Los músculos psoas, cuadrado lumbar y piramidal son los más frecuentemente implicados en el SDM de cintura pélvica. Una de las principales alternativas para tratar el SDM es la toxina botulínica tipo A (TB), que actúa en la membrana sináptica en la placa neuromuscular, inhibiendo la liberación de acetilcolina, produciendo relajación muscular y alivio del dolor, aunque, en muchas ocasiones, su efecto no se hace evidente hasta transcurridos varios días. La lidocaína es un anestésico local (AL) tipo amida con duración de acción intermedia que actúa impidiendo la propagación del impulso nervioso disminuyendo la permeabilidad de los canales de sodio. El objetivo de este estudio era comprobar si al añadir AL a ladosis de TB, conseguíamos un acortamiento en el tiempo dela reducción de la EVA y mejoría de la calidad de vida. Material y métodos: el diseño del estudio fue prospectivo, controlado, longitudinal y aleatorizado en el que se ha valorado la evolución de 20 pacientes divididos en dos grupos. Al primer grupo se les administró TB tipo A (grupo T). Al segundo grupo se les trató con TB tipo A y dosis adicional de lidocaína al 2% (grupo TL). Previamente, ambos grupos, habían respondido de forma positiva a un test con infiltración del músculo afecto con lidocaína al 2 %. El seguimiento de los pacientes se hizo secuencialmente a los 3, 7, 15 y 90 días de iniciado el tratamiento. Para el análisis estadístico se utilizó un análisis de la varianza, ANOVA, complementada por la prueba de Mauchly para comprobación de la esfericidad y la prueba de Greenhouse-Geisser, con un intervalo de confianza del 95 %, considerando una p<0,05 para establecer diferencias estadísticas. Resultados: hubo diferencia estadísticamente significativa entre la EVA del grupo TL Y TB en la valoración a los tres días, del mismo modo en la evaluación del índice de Lattinen. No hubo diferencias significativas en el resto de valoraciones. En ambos grupos hubo diferencia significativa en la reducción del EVA y mejoría del índice de Lattinen, al principio y final del estudio. Conclusiones: la TXB-A presenta una alternativa al tratamiento de este cuadro cuando la terapia conservadora ha fracasado. Los anestésicos locales producen una relajación previsible, breve y reversible de la musculatura provocada por el bloqueo de la conducción nerviosa en las terminaciones nerviosas, mientras que la TXB actúa en las terminaciones neuronales de la placa motora, impidiendo la liberación de la acetil colina. Su acción la ejercen en lugares distintos y con características diferentes. La acción de los anestésicos locales es casi instantánea y breve, la de la TXB es diferida y duradera en el tiempo, por lo que pueden ser complementarias y agonistas en su efecto final
Objectives: between 70 and 85 % of the adult population suffers from back pain sometime in their life. Myofascial pain syndrome (MPS) has been described recently and defined as a localized non-inflammatory musculoskeletal pain, developed without apparent cause, being refractory to pharmacological and physical treatments, and is accompanied by the presence of trigger points and palpable taut bands in the muscle. Its prevalence is estimated to vary between 30 and 85 %. The psoas, quadratus lumborum and pyramidal muscles are the most frequently involved in the pelvic girdle MPS. One of the main alternatives to treat MPS is botulinum toxin type A (BT), which acts in the synaptic membrane at the neuromuscular junction, inhibiting the release of acetylcholine, producing muscle relaxation and pain relief, although in many cases its effect is not evident until several days have passed. Lidocaine is an amide type local anesthetic with an intermediate duration of action, which act by preventing the propagation of nerve impulses by decreasing the permeability of sodium channels. The objective of this study was to test whether adding LA to the BT dose, we got a shortening in the time of the reduction of EVA and improvement in quality of life. Material and methods: the study design was prospective, controlled, longitudinal and randomized in which we have evaluated the evolution of 20 patients randomly divided into two groups. The first group were given BT A type (group T). The second group was treated with BT A type and an additional dose of 2 % lidocaine (group TL). Previously, both groups had responded positively to a test with lidocaine 2 % infiltration of the affected muscle. Monitoring patients was sequentially to 3, 7, 15 and 90 days of treatment performed. For statistical analysis we used an analysis of variance, ANOVA, complemented by Mauchly test for sphericity check and by Greenhouse-Geisser test, with a confidence interval of 95 %, considering p < 0.05 to establish statistical differences. Results: there was statistically significant difference between group EVA TL and TB in the assessment on the third day, just as in the evaluation of Lattinen Index. No significant differences in the other reviews. In both groups there was significant difference in EVA reduction and Lattinen Index improvement at the beginning and end of the study. Conclusions: BT-A presents an alternative to the management of this condition when conservative therapy has failed. Local anesthetics cause a predictable, short and reversible muscle relaxation caused by blocking nerve conduction in nerve endings, while BT acts on the neuronal endings of the motor plate, preventing the release of acetylcholine. Its action is exercised in different places and with different characteristics. The action of local anesthetics is almost instantaneous and short, the TXB action is delayed and long lasting, so both can be complementary and agonists in their final effect
Assuntos
Humanos , Masculino , Feminino , Adulto , Síndromes da Dor Miofascial/classificação , Síndromes da Dor Miofascial/complicações , Síndromes da Dor Miofascial/diagnóstico , Dor da Cintura Pélvica/complicações , Dor da Cintura Pélvica/diagnóstico , Dor da Cintura Pélvica/terapia , Antitoxina Botulínica/metabolismo , Antitoxina Botulínica/uso terapêutico , Toxinas Botulínicas Tipo A/uso terapêutico , Lidocaína/uso terapêutico , Síndromes da Dor Miofascial/tratamento farmacológico , Síndromes da Dor Miofascial/fisiopatologia , Dor da Cintura Pélvica/tratamento farmacológico , Dor da Cintura Pélvica/fisiopatologia , Músculos Psoas , Músculos Psoas/fisiopatologiaRESUMO
El marco legal del anestesiólogo en Cirugía Mayor Ambulatoria está cobrando relativa importancia en los últimos años. Cada vez más los profesionales vamos tomando conciencia de las implicaciones legales en las que podemos incurrir al realizar nuestro trabajo diario. El análisis de sentencias judiciales en España demuestra que es una especialidad con altas cuantías indemnizatorias. Es muy importante que los anestesiólogos conozcamos todo lo relativo a las normas de los servicios y centros donde desarrollamos nuestra labor asistencial, de igual manera debemos conocer las normas de los colegios profesionales y de las sociedades científicas, y las leyes de ámbito regional y estatal que afectan a nuestro trabajo (AU)
The legal framework anesthesiologist at Ambulatory Surgery, is gaining on importance in recent years, more and more professionals will become aware of the legal implications you may incur while performing our daily work. Analysis of court decisions in Spain shows that anesthesiology is a specialty with high compensatory amounts. It is very important that anesthesiologists know everything about standards of services and facilities where we do care work, just as we must know the rules of professional associations and scientific societies, and the laws of regional and state level that affect our work (AU)
Assuntos
Humanos , Anestesiologia/legislação & jurisprudência , Procedimentos Cirúrgicos Ambulatórios/métodos , Legislação Médica/tendências , Segurança do Paciente/legislação & jurisprudência , Responsabilidade LegalRESUMO
OBJECTIVE: To compare the glycemic level patients with type 2 diabetes (T2DM) with and without Metabolic syndrome (MS). METHODOLOGY: cross sectional study. Included patients randomly DM2 corroborated in your clinical record. The SM was identified in patients with at least 3 of 5 criteria of ATP III (Adult Treatment Panel III). A questionnaire was structured. Hemoglobin was determined (HbA1c), HDL-cholesterol, triglycerides, hypertension (HBP), body mass index (BMI), waist circumference (WC) and hip (NCC). RESULTS: 283 patients were included. Mean age was 59.8 ± 10.6. The predominant sex was female (73.6
). SM Criteria were : low HDL: 62.9
; hypertriglyceridemia: 56.3
; obesity abdominal (OA) 90.1
, hypertension (HBP): 62.5
. The prevalence of MS was 86.6
(95
CI 83
to 89
). There was significant difference in mean HbA1c level in patients with and without MS, HAS, OR, and low HDL. In contrast, subjects with hypertriglyceridemia had an HbA1c level significantly higher than those without hypertriglyceridemia (8.9
2.3 vs 8.5
2.1, respectively, P = 0.01). HbA1c is positively correlated with triglycerides (r = 0.24, p = 0.001), and negatively with weight (r = -0.19, p = 0.001), BMI (r = -0172, p = 0.004), CCI (r = -0.12, P = 0.004) and CCA (r = -0.14, p = 0.02). In adjusted multivariate analysis, only the duration of diabetes was associated with glycemic level (OR = 1.014, 95
in 1.010 to 1.016). CONCLUSIONS: We not found differences significant glycemic level in patients with and without MS.
Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 2/sangue , Síndrome Metabólica/sangue , Idoso , Análise de Variância , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Masculino , Síndrome Metabólica/complicações , México , Pessoa de Meia-Idade , Prevalência , Fatores Sexuais , Circunferência da Cintura/fisiologiaRESUMO
OBJECTIVE: To compare the glycemic level patients with type 2 diabetes (T2DM) with and without Metabolic syndrome (MS). METHODOLOGY: cross sectional study. Included patients randomly DM2 corroborated in your clinical record. The SM was identified in patients with at least 3 of 5 criteria of ATP III (Adult Treatment Panel III). A questionnaire was structured. Hemoglobin was determined (HbA1c), HDL-cholesterol, triglycerides, hypertension (HBP), body mass index (BMI), waist circumference (WC) and hip (NCC). RESULTS: 283 patients were included. Mean age was 59.8 ± 10.6. The predominant sex was female (73.6
. The prevalence of MS was 86.6
). There was significant difference in mean HbA1c level in patients with and without MS, HAS, OR, and low HDL. In contrast, subjects with hypertriglyceridemia had an HbA1c level significantly higher than those without hypertriglyceridemia (8.9
2.1, respectively, P = 0.01). HbA1c is positively correlated with triglycerides (r = 0.24, p = 0.001), and negatively with weight (r = -0.19, p = 0.001), BMI (r = -0172, p = 0.004), CCI (r = -0.12, P = 0.004) and CCA (r = -0.14, p = 0.02). In adjusted multivariate analysis, only the duration of diabetes was associated with glycemic level (OR = 1.014, 95
in 1.010 to 1.016). CONCLUSIONS: We not found differences significant glycemic level in patients with and without MS.
Assuntos
/sangue , Glicemia/análise , Síndrome Metabólica/sangue , Análise de Variância , Circunferência da Cintura/fisiologia , /complicações , Estudos Transversais , Fatores Sexuais , Feminino , Humanos , Idoso , Masculino , México , Pessoa de Meia-Idade , Prevalência , Síndrome Metabólica/complicaçõesAssuntos
Humanos , Masculino , Pessoa de Meia-Idade , Anestesia Geral/instrumentação , Esclerose Múltipla/complicações , Esclerose Múltipla/diagnóstico , Fraturas do Fêmur/complicações , Fraturas do Fêmur/diagnóstico , Fixação de Fratura/métodos , Oximetria/instrumentação , Oximetria/tendências , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla , Midazolam/uso terapêutico , Fentanila/uso terapêutico , Propofol/uso terapêutico , Capnografia/métodos , Tramadol/uso terapêuticoRESUMO
La incontinencia urinaria es un problema universal, que tiene una repercusión importante en la percepción de salud de las mujeres quela padecen. Realizamos un estudio de calidad de vida en mujeres con incontinencia urinaria en un periodo de 9 meses con dos encuestas: ICIQ-SFy EQ-5D. Los resultados obtenidos mostraron una media de 15 en el ICIQ-SF y 0.67 en el EQ-5D, con una menor afectación en la calidad de vida de la incontinencia de esfuerzo respecto a la mixta y a la de urgencia. Como conclusión creemos que la enfermería juega un papel decisivo en la implantación de las encuestas auto administradas, como una herramienta más en la evaluación de estas pacientes (AU)
Urinary incontinence is a universal problem, which has an important repercussion on the perception of health of the women who suffer it. We carry out a study about quality of life in women with urinary incontinence in a period of 9 months with two surveys: ICIQ-SF and EQ-5D. The obtained results showed an average of 15 in the ICIQ-SF and 0.67 in the EQ-5D, with a smaller affectation in the quality of life of the incontinence of effort with regard to the mixed one and to that of urgency. As a conclusion, we think that nursing stakes a decisive role in the introduction of the self administered surveys, as one common tool in the evaluation of these patients (AU)
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Incontinência Urinária/epidemiologia , Psicometria/instrumentação , Incontinência Urinária/psicologia , Qualidade de Vida , Distribuição por IdadeRESUMO
No disponible
Assuntos
Humanos , Cuidados Paliativos , Psicologia , Atitude Frente a Morte , Assistência Terminal/psicologia , Doente Terminal/psicologiaAssuntos
Humanos , Dor Pós-Operatória/tratamento farmacológico , Buprenorfina/farmacologia , Buprenorfina/administração & dosagem , Buprenorfina/efeitos adversos , Colecistectomia , Dipirona/farmacologia , Estudos Prospectivos , Metadona/farmacologia , Administração Sublingual , Frequência Cardíaca , Pressão Sanguínea , RespiraçãoRESUMO
Se revisaron los expedientes de 82 pacientes operados por hiperparatiroidismo primario (HPTB) en el I.N.N.S.Z. Esto de una frecuencia de un caso de HPTB por cada 1487 pacientes atendidos en el Instituto y de uno en 745 si solo tomamos en cuenta los últimos 15 años. La enfermedad fue más frecuente en el sexo femenino en una proporción de 3.5 a 1, y en la quinta y sexta décadas de la vida. La manifestación clínica más frecuente fue urolitiasis, presente en el 49% de los enfermos; otras manifestaciones fueron netrocalcinosis en el 16%, fracturas en el 11%, úlcera péptica en el 18% y pancreatitis en el 11%. Por laboratorio la enfermedad se manifestó con hipercalcemia mayor a 11 mg en el 91% y fósforo bajo en el 81%. Como hallazgo poco común encontramos que en el 74% de los pacientes en quienes se determinó magnesio sérico, éste se encontró disminuido. De acuerdo a la impresión del cirujano se encontraron adenomas únicos o múltiples en el 74% e hiperplasia de las paratiroides en el 20%; los informes del patólogo reportan adenomas en sólo el 46% e hiperplasia en el 37%, quedando otros casos no clasificados y reportándose uno como carcinoma. Los casos considerados como adenoma fueron tratados en su mayoría con resección de la glándula afectada y de otra macroscópicamente normal; los considerados como hiperplasia se trataron con paratiroidectomía de tres a tres y media glándulas. A largo plazo, 11 pacientes desarrollan hipocalcemia, siendo ésta sintomática y tributaria de tratamiento médico en cinco. Diez pacientes continuaron hipercalcémicos; cinco de éstos se reintervinieron en el Instituto, lográndose resolución del problema en solo dos
Assuntos
Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Hiperparatireoidismo/cirurgia , Idoso de 80 Anos ou mais , Osso e Ossos , Cálcio/metabolismo , Hiperparatireoidismo/diagnóstico , México , Estudos RetrospectivosRESUMO
Se presenta un estudio de casos, retrospectivos sobre la mortalidad materna en Bolivia. La informaciòn recolectada en instituciones hospitalarias y registros civiles de 8 de las 11 Unidades Sanitarias del paìs, aparece sòlo en cuadros de frecuencia. Se analiza diferentes variables relacionadas con la muerte de mujeres en el embarazo, parto y puerperio, asi como la influencia del aborto. Finalmente, se presenta cuadros sobre las causas directas de muerte materna. Investigaciòn realizada en 1982, sobre la base de informaciòn estadìstica en 1980. Mèdico Gineco-Obstetra. Divisiòn Materno Infantil Ministerio de Previsiòn Social y Salud Pùblica. Sociòlogo Divisiòn Materno Infantil, Ministerio de Previsiòn Social y Salud Pùblica