Reflexiones sobre la investigación de Enfermería en México / Reflections on nursing research in Mexico

Con relación a las prioridades de la investigación en enfermería, organismos como el Consejo Internacional de Enfermeras centra la atención en el desarrollo del conocimiento sobre la enfermería y su ejercicio, incluida la atención y la comprensión de los mecanismos fundamentales que afectan a la capacidad de las personas y a sus familias. Ubica la investigación como una forma reflexiva, crítica y realista de la práctica, lo que permite a los profesionales ver los problemas desde un punto de vista diferente. De esa misma manera, la generación de nuevos conocimientos impulsa a la disciplina de enfermería a asumir nuevos liderazgos en la gestión del cuidado, lo que significa planificar, organizar y controlar la provisión de cuidados continuados, oportunos, seguros e integrales, sustentados en el juicio profesional, y en las políticas y lineamientos estratégicos de la institución. Y para que estos juicios sean aceptables, deben, de igual forma, estar sustentados en la mejor evidencia disponible, resultado de la investigación.

Actitudes de los profesionales sanitarios de un área de salud ante el tabaquismo y el paciente fumador / No disponible

Introducción: La actitud de los profesionales sanitariospuede condicionar el manejo del tabaquismo en la poblacióna la que asisten.Pacientes y método: Se realizó un estudio transversal descriptivoy analítico, en los profesionales sanitarios que trabajabanen centros sanitarios del área de salud de Talavera dela Reina, Toledo, mediante cuestionario anónimo estructuradoy autoadministrado.Resultados: Contestaron 634 profesionales, de ellos 450atienden directamente pacientes. El 81,6% aconsejaba a suspacientes el abandono del tabaco. El 78,2% consideraba elconsumo de tabaco como una adicción, en menor medidacuando el profesional era fumador (66%).Al 94,3% les preocupaban “mucho o bastante” las consecuenciasdel consumo de tabaco, pero signifi cativamentemenos a los fumadores. La mayor parte (95%) considera elhumo ambiental de tabaco cómo un problema de salud pública“bastante o muy importante”, pero fumadores y hombreslo consideran signifi cativamente menos importante.Sólo el 32,1% de los profesionales fumadores está muy deacuerdo con el papel de modelo social de los profesionalessanitarios, frente a un 47,6% de los profesionales nofumadores. El 71% de los profesionales fumadores estámuy de acuerdo con que “nunca deberían fumar delantede sus pacientes”, frente a un 83% de los no fumadores.Conclusiones: Existen diferencias en las actitudes anteel tabaquismo de los profesionales fumadores respecto alos no fumadores. Los fumadores tienen menor percepciónde riesgo y valoran menos su papel ejemplarizante,siendo su posición frente al consumo de tabaco menosrestrictiva(AU)

Introduction: The attitude of the sanitary professionalscan determine the managing of the smoking in the populationwhom they attend.Patients and methods: There was realized a transversedescriptive and analytical study, in the sanitary professionalswho were employed at sanitary centers of the area of healthof Talavera de la Reina, Toledo, by means of anonymousconstructed and self-administered questionnaire.Results: 634 professionals answered, of them 450 attenddirectly patient. 81,6% was advising the abandon of the tobaccohis patients. 78,2% was considering the consumptionof tobacco to be an addiction, in minor measure when professionalwas smoker (66%).They were worrying 94,3% “very much or enough” theconsequences of the consumption of tobacco, but significantly less to the smokers. Most (95%) considers to be theenvironmental smoke of tobacco how a problem of publichealth “enough or very importantly”, but smokers and menconsider it to be signifi cantly less important.Only 32,1% of the smoking professionals agrees very with therole of social model of the sanitary professionals, opposite to47,6% of the not smoking professionals. 71% of the smokingprofessionals agrees very with that “should never smoke infront of his patients”, opposite to 83% of not smokers.Conclusions: Smokers have differences in the attitudes tothe smoking of the smoking professionals with regard tonot. The smokers have minor perception of risk and valueless his exemplary role, being his position opposite to theconsumption of tobacco less restrictive(AU)

Urea as new stabilizing agent for imipenem determination: electrochemical study and determination of imipenem and its primary metabolite in human urine.

Imipenem shows a fast chemical conversion to a more stable imin form (identical to that of biochemical dehydropeptidase degradation) in aqueous solutions and stabilizing agents used avoid its electrochemical study and determination. The aim of this work is the proposal of urea as stabilizing agent which allows the electrochemical study of imipenem and the proposal of electrochemical methods for the determination of imipenem and its primary metabolite (M1) in human urine samples. Electrochemical studies were realized in phosphate buffer solutions over pH range 1.5-8.0 using differential-pulse polarography, DC-tast polarography, cyclic voltammetry and adsorptive stripping voltammetry. In acidic media, a non-reversible diffusion-controlled reduction involving a two steps mechanism which involves one electron and one proton in the first step and two electrons and two protons in the second step occurs and the mechanism for the reduction was suggested. A differential-pulse polarographic method for the determination of imipenem in the concentration range 3.2x10(-6) to 2x10(-5)M (0.95-3.4 mg/L) and its primary metabolite in the concentration range 1.4x10(-6) to 10(-4)M (0.43-26.1 mg/L) with detection limits of 9.6x10(-7)M (0.28 microg/L imipenem) and 4.3x10(-7)M (0.14 microg/L M1) was proposed. Also, a method based on controlled adsorptive pre-concentration of imipenem on the hanging mercury drop electrode followed by voltammetric measure, allows imipenem determination in the concentration range 1.8x10(-8) to 1.2x10(-6)M (5.42-347 microg/L) with a detection limit of 5.4x10(-9)M (1.63 microg/L). The proposed methods have been used for the direct determination of the analytes in a pharmaceutical formulation and human urine.

[Acute myocardial infarction in pregnancy of 39 week treated with fibrinolysis]. / Infarto agudo de miocardio en gestante a término de 39 semanas tratado con fibrinolisis.

We report a 39-year-old woman in her 39th week of pregnancy who presented acute myocardial infarction with clinical and electrocardiography criteria and was treated with systemic fibrinolysis. After this, she was transported to the hemodynamic service of a referral hospital where heart catheterization was done that confirmed the coronary lession. 24 hours after, she had a newborn without sequellae.

Determination of imipenem and rifampicin in mouse plasma by high performance liquid chromatography-diode array detection.

A high performance liquid chromatographic (HPLC) method for the determination of imipenem and rifampicin was developed and validated. The method involves plasma deproteinisation with methanol, gradient elution on a RP-18 column and diode array detection. Separation was carried out in 8 min using a mobile phase composed of methanol and 0.2M borate buffer (pH 7.2). Imipenem and rifampicin were detected at 300 nm and 255 nm, respectively. A linear response was observed at plasma levels ranged between 0.3 and 30 microgmL(-1) for imipenem and 1.5 and 20 microgmL(-1) for rifampicin. The detection limits were 0.07 microgmL(-1) and 0.47 microgmL(-1) for imipenem and rifampicin, respectively. The method was applied to the determination of both compounds in mouse plasma samples.

Infarto agudo de miocardio en gestante a término de 39 semanas tratado con fibrinolisis / Acute miocardial infarction in pregnancy of 39 week treated with fibrinolysis

Exponemos el caso de una paciente de 39 años de edad con gestación a término de 39 semanas que sufre un cuadro de infarto agudo de miocardio con criterios clínicos y electrocardiográficos y que fue tratada con fibrinolisis sistémica. Posteriormente fue trasladada al servicio de hemodinámica del Hospital de referencia donde se realizó cateterismo confirmando la lesión coronaria. A las 24 horas de éste episodio dio a luz un recién nacido a término sin complicaciones mediante parto vaginal

We report a 39 years old woman at ehr 39th week of pregancy who presented acute miocardial infarction with clinics and electrocardiography criteria and was trated with systemic fibrynolisis. After this was traslated to hemodynamic service of referency hospital were was done cateterism thas confirmed the coronary lession. 24 hours after she had an newborn without secuels

[Study of the use of atypical antipsychotic drugs in Málaga Prison]. / Utilización de Neurolépticos atípicos en el Centro Penitenciario de Málaga.

AIM: we studied the use of psychotropic drugs belonging to the group of atypical neuroleptics in Malaga State Prison (Centro Penitenciario de Málaga) from 2003 to 2004. We also compared the results of this study with references taken from the Primary Health Care District of Guadalhorce. MATERIALS AND METHODS: A retrospective study was carried out on the use of antipsychotic drugs from 2003 to 2004 in Malaga State Prison. A comparison was then made with the use of this type of medication in the Primary Health Care District of Guadalhorce. Data on medication consumption was taken from medical orders received at the prison during this study. The ATC (Anatomical Therapeutic and Chemical Classifying System) was used for classifying the active principles. The prison´s own data base (SANIT) was used for calculating the number of containers. For calculating the DDD, the ratio DDD/1000 inmates/day was utilised. RESULTS: The use of atypical antipsychotic medication in the prison increased. There is an increasing trend towards the use of quetiapine in small doses. The use of risperidone went down during the period of this study, although it is still the most commonly used drug in DDD and in consumed containers. The Primary Health care results indicate a trend in the opposite direction. CONCLUSION: The use of the group of drugs in this study has decreased in the Primary Health Care area, possibly because of special medical control measures such as the control stamp. In Malaga Prison use of these drugs has increased. The reasons for this difference are as yet unknown.

Utilización de Neurolépticos atípicos en el Centro Penitenciario de Málaga / Study of the use of atypical antipsychotic drugs in Málaga prison

Objetivo: Hacer un estudio de la utilización de psicofármacos del grupo de antipsicóticos atípicos dentro del Centro Penitenciario de Málaga durante los años 2003/2004 y compararlo con el Distrito de Atención Primaria de referencia (Distrito Guadalhorce). Material y Métodos: Se ha realizado un estudio retrospectivo sobre la utilización de antipsicóticos atípicos en el Centro penitenciario de Málaga durante los años 2003/04 y se ha comparado con la utilización que de estos fármacos se hace en el Distrito de Atención Primaria (A.P.) de referencia. La información sobre consumo de medicación se obtuvo a partir de las ordenes médicas recibidas en el centro durante los años de estudio. Para la clasificación de principios activos se usó la clasificación ATC (Anatomical Therapeutic and Chemical Classifying System) y para el cálculo de envases, la base de datos propia del centro (SANIT 3.0). Para el cálculo de DDD se utilizó la DDD/1000 habitantes día. Resultados: Se ha incrementado la utilización de antipsicóticos atípicos a nivel del C.P. Existe una tendencia hacia la mayor utilización de quetiapina a dosis bajas mientras que ha disminuido la utilización de risperidona en el año 2004 respecto a 2003, aunque continúa siendo el de mayor utilización tanto en DDD como en envases consumidos. La situación en Atención Primaria es exactamente la contraria. Conclusión: El uso de este grupo de medicamentos en estudio ha disminuido a nivel de Atención Primaria (A.P.), posiblemente debido a medidas especiales de control médico (visado). En nuestro Centro Penitenciario se ha incrementado el uso, aunque se desconocen los motivos de dichas diferencias

Aim: we studied the use of psychotropic drugs belonging to the group of atypical neuroleptics in Malaga State Prison (Centro Penitenciario de Málaga) from 2003 to 2004. We also compared the results of this study with references taken from the Primary Health Care District of Guadalhorce. Materials and Methods: A retrospective study was carried out on the use of antipsychotic drugs from 2003 to 2004 in Malaga State Prison. A comparison was then made with the use of this type of medication in the Primary Health Care District of Guadalhorce. Data on medication consumption was taken from medical orders received at the prison during this study. The ATC (Anatomical Therapeutic and Chemical Classifying System) was used for classifying the active principles. The prison’s own data base (SANIT) was used for calculating the number of containers. For calculating the DDD, the ratio DDD/1000 inmates/day was utilised. Results: The use of atypical antipsychotic medication in the prison increased. There is an increasing trend towards the use of quetiapine in small doses. The use of risperidone went down during the period of this study, although it is still the most commonly used drug in DDD and in consumed containers. The Primary Health care results indicate a trend in the opposite direction. Conclusion: The use of the group of drugs in this study has decreased in the Primary Health Care area, possibly because of special medical control measures such as the control stamp. In Malaga Prison use of these drugs has increased. The reasons for this difference are as yet unknown

Síndrome de distrés respiratorio del adulto secundario a inhalación de cocaína / Adult respiratory distress syndrome secondary to cocaine inhalation

Presentamos un caso de síndrome de distrés respiratorio del adulto tras inhalación de cocaína de gran pureza. El paciente sufrió un rápido deterioro de su función respiratoria. Hubo de instaurarse ventilación mecánica durante 15 días. Se descartó la existencia de neumonía y de patología cardíaca que justificase el cuadro. Finalmente el enfermo mejoró y fue dado de alta sin secuelas (AU)

Recomendaciones para mejorar la atención en enfermería / Recommendations to improve attention in nursing

El personal de enfermería desempeña una actividad fundamental en los servicios de salud, con fuerte apego a principios científicos y éticos; sus intervenciones permiten fortalecer la calidad en los servicios de salud, através de acciones interdisciplinarias. Se analizaron las inconformidades relacionadas con atención de enfermería que recibió la Comisión Nacional de Arbitraje Médico (CONAMED) de junio de 1996 a diciembre de 2001. Con base en el análisis se elaboraron recomendaciones dirigidas a prevenir el conflicto, mejorar la práctica de enfermería y propiciar la adecuada comunicación con el paciente, familiares y equipo interprofesional de salud. Se integró un grupo representativo de las instituciones educativas y gremiales de enfermería más prestigiadas y reconocidas, para su validación externa. De esta manera, la CONAMED y el grupo de validación externa, proponen al personal de enfermería atender las siguientes recomendaciones: 1) Mantener una comunicación efectiva con las personas a las que proporciona atención; 2) Reconocer en la persona su concepción holística; 3) Proporcionar cuidados que garanticen la atención libre de riesgos y daños innecesarios; 4) Establecer una coordinación efectiva con el equipo interprofesional de salud; 5) Actuar con base en los principios éticos que rigen la práctica profesional de enfermería.

Nurse personnel performs a fundamental activity in t health services, with strong attach at scientific and ethical principles, whose interventions can fortify the services of health quality, through interdisciplinary actions. We analyzed the compliants related to nursing attention that were received in CONAMED since June 1996 to December 2001. Wedevised recommendations directed to prevent patient-health care professionals conflicts, improve the practice of nursing and favor adequate communication with the patient, family and interprofessional health care team. Those recommendations were presented to the more prestigious and recognized educational and professional groups of nursing, for their external validation. In this manner, CONAMED and the external group of validation, propose to nurses to attend the following recommendations: 1) Maintain an effective communication with the patients that provides attention; 2) Recognize the holistic concept in the person; 3) Provide cares that guarantee tree-risk attention and prevent unnecessary damages; 4) Establish an effective coordination with the health care interprofessional team and 5) Act based on ethical principles that govern the professional practice of nursing.

Electrochemical behaviour and determination of acrivastine in pharmaceuticals and human urine.

The differential pulse polarography, DC-tast polarography and cyclic voltammetry behaviour of acrivastine was studied in Britton-Robinson buffer solutions (pH 2-11.7). In acidic media, a non-reversible diffusion controlled reduction process involving four electrons takes place. Two reduction waves appear at a E(1/2)=-0.6 and -0.99 V. The reduction mechanism is discussed. The linear relationship between peak current height and acrivastine concentration allowed the differential pulse polarographic determination of acrivastine over a wide concentration range, from 0.35 to 26.1 mg l(-1)at pH 2.5. The procedure was applied to determination of the drug in pharmaceutical formulations and human urine samples.

Heavy metal extractable forms in sludge from wastewater treatment plants.

The analysis of heavy metals is a very important task to assess the potential environmental and health risk associated with the sludge coming from wastewater treatment plants (WWTPs). However, it is widely accepted that the determination of total elements does not give an accurate estimation of the potential environmental impact. So, it is necessary to apply sequential extraction techniques to obtain a suitable information about their bioavailability or toxicity. In this paper, a sequential extraction scheme according to the BCR's guidelines was applied to sludge samples collected from each sludge treatment step of five municipal activated sludge plants. Al. Cd, Co, Cu, Cr, Fe, Mn, Hg, Mo, Ni, Pb, Ti and Zn were determined in the sludge extracts by inductively coupled plasma atomic emission spectrometry. In relation to current international legislation for the use of sludge for agricultural purposes none of metal concentrations exceeded maximum permitted levels. In most of the metal elements under considerations, results showed a clear rise along the sludge treatment in the proportion of two less-available fractions (oxidizable metal and residual metal).

[Evaluation of the efficacy of the endoscopic treatment in volvulus of the colon]. / Evaluación de la eficacia del tratamiento endoscópico en el vólvulo de colon.

Volvulus of the colon mainly affects the elderly and early surgery, with high morbidity and mortality, is often required. The efficacy of endoscopic devolvulization as an alternative is evaluated herein. From January 1993 to April 1999, 25 patients diagnosed with volvulus of the colon were retrospectively reviewed. Endoscopic devolvulization was not performed in one patient who showed signs of necrosis but was carried out in the remaining 24. The mean follow-up was 35.3 months. In all patients the procedure was initially effective. After the first attempt, 9 of the 24 patients (37%) relapsed, 4 out of 7 (57%) after a second attempt and 2 out of 2 (100%) after a third attempt. No morbidity or mortality was associated with the endoscopy. Six patients underwent surgery. Of these, none relapsed but two presented complications associated with the surgery. Mean hospital stay of the patients undergoing surgery was 30.8 days and that of those undergoing endoscopic devolvulization was 9.1 days. We conclude that endoscopic devolvulizatio is an effective therapeutic option when the mucosa is viable, with a high percentage of initial success, few complications inherent to the technique and with the possibility of carrying out a maximum of two attempts in cases of relapse. In the majority of patients, this technique is a valid alternative to urgent surgery, which has higher morbidity and mortality and longer mean hospital stay.

[Reversible hypertransaminasemia after diet therapy]. / Hipertransaminasemia reversible tras tratamiento dietético.

An increase in transaminases may be due to multiple causes. We present a case of reversible hypertransaminasemia following specific dietary therapy. The various potential aetiopathogenies are reviewed to explain the raising of transaminase levels and the improvement in analytical results after the institution of this dietary treatment.

[Poisoning by organophosphates and paraquat: apropos 14 cases]. / Intoxicación por organofosforados y paraquat: a propósito de catorce casos.

We present the clinical aspects and the evolution of 14 patients brought in the last 5 years in an ICU polyvalent with diagnostic of intoxication by organophosphate (OF) 10 and paraquat 4. The intoxicated by OF were subjugated at the same treatment record book with atropine, gastric washing, coal activated and pralidoxime. At the intoxicated by paraquat used precocious hemoperfusion. The mortality in intoxicated by OF went 20%, and 100% in paraquat intoxications. We analyzed to them the complications during their stay in ICU, as soon as diverse clinical aspects of this intoxications and equal form varied aspects about treatment.

Differential-pulse polarographic determination of iron in acids, waters, fruit juices and wines.

A method for the determination of iron by differential-pulse polarography, based on the formation of a 5,5-dimethylcyclohexane-1,2,3-trione 1,2-dioxime 3-thiosemicarbazone-iron(II) complex, is proposed. The method was applied to the determination of iron in acids, waters, wines and fruit juices.

[Transient diabetes insipidus following removal of a medullary thyroid carcinoma (author's transl)]. / Diabetes insípida transitoria tras la extirpación de carcinoma medular de tiroides.

Medullary thyroid carcinoma (MTC) is a known apudoma producing calcitonin, prostaglandins and serotonin. It can present itself as a familial or sporadic form or as part of a multiple endocrine adenomatosis. We present here the case of a patient admitted with a four-year history of diarrhea, enlargement of the thyroid and palpable lymph nodes in the right side of the neck. There was no uptake of 131I in the right lobe of the thyroid and the serum calcitonin levels were very high. With the diagnosis of MTC a total thyroidectomy mas performed developping within hours of the surgical procedure a picture of diabetes insipidus with 31 liters of urine output in the first 48 hours. It responded to vasopressin and disappeared spontaneously in two weeks. We have considered the different mechanisms that could explain the development of diabetes insipidus, and after failing to find one, we especulate at prostaglandins could play an important role in the synthesis and/or release of ADH. The sudden depletion of prostaglandins after removal of the neoplasm that produced them could account for the diabetes insipidus in our patient. We have not found any similar case described in the literature. We call attention to the need for a close postoperative observation of patients operated for MTC for the possible onset of diabetes insipidus.