Incidence of post-anesthetic respiratory complications in pediatrics. Observational, single-center study in Medellin, Colombia / Incidencia de complicaciones respiratorias postanestésicas en pacientes pediátricos. Estudio observacional en un hospital en Medellín, Colombia

Abstract Introduction: Post-anesthetic complications, particularly respiratory complications, continue to be a source of concern due to their high frequency, particularly in pediatrics. Objective: To describe the incidence of respiratory complications in the post-anesthesia care unit of an intermediate complexity center during a six-month period, and to explore the variables associated with major respiratory complications. Materials and Methods: Retrospective cohort study based on clinical record reviews. The records of the post-anesthesia care unit of an intermediate complexity pediatric institution located in Medellin, Colombia, were reviewed. This center uses a nursing-based care model that includes patient extubation in the post-anesthesia care unit. Results: The records of 1181 patients were analyzed. The cumulative incidences of major complications were bronchospasm 1.44%, laryngospasm 0.68% and respiratory depression 0.59%. There were no cases of cardiac arrest or acute pulmonary edema. A history of respiratory infection less than 15 days before the procedure, rhinitis and female sex were associated with major respiratory complications. Conclusions: A low frequency of respiratory complications was found during care provided by nursing staff trained in anesthesia recovery and pediatric airway in the post-anesthesia care unit.

Resumen Introducción: Las complicaciones postanestésicas, especialmente las respiratorias, siguen siendo causa de preocupación por su alta frecuencia, en particular, en la población pediátrica. Objetivo: Describir la incidencia de complicaciones respiratorias en la unidad de cuidados postanestésicos de una institución de mediana complejidad, en un período de seis meses y explorar las variables relacionadas con las complicaciones respiratorias mayores. Materiales y métodos: Estudio de cohorte retrospectivo, basado en la valoración de historias clínicas. Se revisaron los registros de la unidad de cuidados postanestésicos de una institución pediátrica de mediana complejidad ubicada en Medellín. Esta institución utiliza un modelo de atención -basado en enfermería- que incluye la extubación del paciente en la unidad de cuidados postanestésicos. Resultados: Se analizaron los registros de 1181 pacientes. La incidencia acumulada de complicaciones mayores fue: broncoespasmo 1,44 %, laringoespasmo 0,68 % y depresión respiratoria 0,59 %. No se presentaron casos de paro cardiaco ni de edema agudo de pulmón. El antecedente de infección respiratoria menor a 15 días, rinitis y sexo femenino se asociaron con complicaciones respiratorias mayores. Conclusiones: Durante la atención en la unidad de cuidados postanestésicos por parte del personal de enfermería entrenado en la recuperación de la anestesia y de la vía aérea de los pacientes pediátricos, se encontró una baja frecuencia de complicaciones respiratorias.

Towards the elimination of hepatitis C: implementation of reflex testing in Andalusia

BACKGROUND AND AIM: undiagnosed hepatitis C virus (HCV) infection and/or inadequate access to care are barriers to the elimination of HCV. Reflex testing has proven to facilitate referral to care, treatment and viral elimination. In this study, a reflex testing program was implemented in Andalusia and its impact on access to care was evaluated. PATIENTS AND METHODS: an observational, retrospective and prospective study was performed across diagnostic laboratories responsible for HCV diagnosis in southern Spain. After surveying the barriers to performing reflex testing, the number of patients that were not referred for care in 2016 was retrospectively studied (pre-reflex cohort). Subsequently, several measures were proposed to overcome the identified barriers. Finally, reflex testing was implemented and its impact evaluated. RESULTS: the pre-reflex cohort included information from 1,053 patients. Slightly more than half of the patients (n = 580; 55%) visited a specialist for treatment evaluation during a median period of 71 days (interquartile range = 35-134) since the date of diagnosis. The post-reflex cohort (September 2017 to March 2018) included 623 patients. Only 17% (n = 106) of the patients had not been referred for care or evaluated for treatment in a median period of 52 days (interquartile range = 28-86). CONCLUSIONS: in 2016, nearly half of new HCV diagnoses in southern Spain were not referred for care. Barriers to the implementation of reflex testing were overcome in our study. Moreover, this strategy was effectively implemented in 2017. Reflex testing contributed to improving referral for care. This program will contribute to the micro-elimination of hepatitis C in Spain

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El actor y el espectador: De Freud a Lacan / The actor and the audience: from Freud to Lacan / L’acteur et le spectateur. de Freud à Lacan

Teniendo en cuenta los aportes de Freud y Lacan, en este texto se trata, por una parte, de mirar cuál es la función del actor en la representación teatral o parafraseando al segundo de estos autores ¿Qué añade el actor a la obra escrita? de otro lado, profundizar en los mecanismos que en el espectador ponen en juego para conectarse con la obra y el actor, suscitando las vivencias y emociones propias de la experiencia teatral...

Taking in account Freud and Lacan works, this paper questions about what is the actor function in a theatrical performance; paraphrasing Lacan: What does the actor add to the written work? On the other hand, deeping into the mechanisms that the member of the audience uses to put in contact with the play and the actor, arousing his/her own life experiences and emotions through the theatrical experience...

En prenant compte des apports de Freud et de Lacan, ce texte essaie de voir quel est le rôle de l’acteur dans la représentation théâtrale, ou – si l’on reprend les mots du deuxième de ces auteurs: Qu’est ce qui l’acteur apporte à l’œuvre écrite ? D’autre part, il essaie d’aller plus loin dans les mécanismes mis en jeu par le spectateur afin de se connecter avec l’œuvre et avec l’acteur, suscitant ainsi les expériences vécues et les émotions propres de l’expérience théâtrale...

El arte como tramitador de lo real en lo social. A propósito de una obra de Alfredo Jaar / Art as a manager of the real in the social. About a work by Alfredo Jaar

El arte es una de las mas primigenias manifestaciones de la cultura. Desde el psicoanálisis y tomando como referencia la obra del artista contemporáneo, Alfredo Jaar, intentaremos acercarnos a la función que en el campo social, tiene una de las vertientes del arte actual en tanto que por medio de él se vehiculiza lo innombrable del devenir humano.

Art is one of the most primal manifestations of culture. From the psychoanalysis and taking as reference the work of the contemporary artist, Alfredo Jaar, we will try to approach the function that in the social field, has one of the slopes of the current art while through it the unnameable of the human becoming is conveyed.