Analytical Determination of Serotonin Exocytosis in Human Platelets with BDD-on-Quartz MEA Devices.

Amperometry is arguably the most widely used technique for studying the exocytosis of biological amines. However, the scarcity of human tissues, particularly in the context of neurological diseases, poses a challenge for exocytosis research. Human platelets, which accumulate 90% of blood serotonin, release it through exocytosis. Nevertheless, single-cell amperometry with encapsulated carbon fibers is impractical due to the small size of platelets and the limited number of secretory granules on each platelet. The recent technological improvements in amperometric multi-electrode array (MEA) devices allow simultaneous recordings from several high-performance electrodes. In this paper, we present a comparison of three MEA boron-doped diamond (BDD) devices for studying serotonin exocytosis in human platelets: (i) the BDD-on-glass MEA, (ii) the BDD-on-silicon MEA, and (iii) the BDD on amorphous quartz MEA (BDD-on-quartz MEA). Transparent electrodes offer several advantages for observing living cells, and in the case of platelets, they control activation/aggregation. BDD-on-quartz offers the advantage over previous materials of combining excellent electrochemical properties with transparency for microscopic observation. These devices are opening exciting perspectives for clinical applications.

Strategies and Adaptations to an Integrated Substance Use and Infant Mental Health Treatment Program During COVID-19.

The COVID-19 pandemic resulted in increased parenting stress and substance use. At the same time that mental health and social service needs increased, access to services, including among those receiving treatment, decreased due to stay-at-home orders. Few programs were equipped or prepared to translate their interventions to a virtual format at the start of the pandemic. There is a critical need to identify effective adaptations to substance use and family-focused treatment during the COVID-19 pandemic. Effective program adaptations have continued relevance for the expansion of access to family-focused addiction services beyond the pandemic itself, particularly for rural or other hard to reach populations. Seventy-three semi-structured interviews were conducted with the five agencies participating in the implementation of the In-Home Recovery Program (IHRP), an in-home, substance use disorder (SUD) treatment program. Using a rapid analysis approach two coders analyzed interviews for recurring concepts and themes. Facilitators for adapting services included: (1) the introduction of virtual toxicology screens, (2) helping parents access technology, (3) assisting parents with non-identified children to decrease their stress, and (4) anticipating reoccurrences of substances during the pandemic. Barriers to adapting services included: (1) engaging young children in virtual treatment, (2) privacy, and (3) engaging in telehealth with parents experiencing domestic violence or reoccurrence of substances. Findings reveal virtual substance use treatment is possible. Facilitators to adaptation such as providing access to technology and virtual toxicology screens demonstrate the feasibility and acceptability of utilizing telehealth interventions for substance use. Barriers to adaptations were primarily related to the infant mental health component. Telehealth is likely not appropriate for children below the age of five. Individual sessions focusing on caregiving, rather than dyadic treatment may be more suitable to virtual formats.

A Relational Workforce Capacity Approach to Trauma-Informed Care Implementation: Staff Rejection Sensitivity as a Potential Barrier to Organizational Attachment.

This study explores the relationship between staff rejection sensitivity (a psychological concept grounded in histories of loss and trauma) and organizational attachment among mental health agencies transitioning to Trauma-Informed Care (TIC), which is currently outside the focus of most research. Specifically, this study examines: (1) whether staff rejection sensitivity predicts organizational attachment; (2) whether staff turnover intentions account for the association between rejection sensitivity and organizational attachment; and (3) whether those associations hold once taking into account staff demographic factors (gender, race and ethnicity, education, and income)? Around 180 frontline workers in three Northeastern U.S. mental health agencies responded to surveys collected between 2016 and 2019 using the organizational attachment, rejection sensitivity and turnover intention measures, and their previous TIC training experience. Rejection sensitivity was significantly associated with organizational attachment (ß = -0.39, p < 0.001), accounting for 6% of its variance in organizational attachment. The relationship between these variables retained significance, and staff education significantly predicted organizational attachment, with higher education predicting lower levels of organizational attachment (ß = -0.15, p < 0.05), accounting for 22% of its variance. This study concludes that TIC transitioning mental health agencies' staff with a higher rejection sensitivity are more likely to express lower organizational attachment and higher intent-to-turnover.

Expanding the Trauma-Informed Care Measurement Toolkit: An Evaluation of the Attitudes Related to Trauma-Informed Care (ARTIC-45) Scale with SUD Workers in PIMH.

Human service organizations (HSO) have increasingly recognized the value of employing trauma-informed care (TIC) in a variety of practice settings. Evidence suggests that effectively adopting TIC has shown client improvements. Organizational barriers to TIC implementation, however, exist. To improve TIC practice, the attitudes related to trauma-informed care (ARTIC) scale was developed to measure staff attitudes and beliefs towards TIC. The ARTIC has been widely adopted by researchers without evaluating its psychometric performance in diverse practice settings. The purpose of this study was to independently validate the ARTIC scale drawn from a sample of staff (n = 373) who provide services to substance-using parents. Psychometric tests were conducted to evaluate how the ARTIC performs with our HSO population. Results from a confirmatory factor analysis showed poor fit (X2 = 2761.62, df = 2.96; RMSEA = 0.07 [0.07, 0.08]; CFI = 0.72). An exploratory factor analysis was conducted to analyze how the data fit with our specific population, yielding 10 factors. Finally, a qualitative inter-item analysis of these factors was conducted, resulting in nine factors. Our findings suggest that measuring TIC attitudes and beliefs may vary according to field of practice and ethno-racially diverse workers. Further refinement of the ARTIC may be necessary for various services domains.

Multielectrode Arrays as a Means to Study Exocytosis in Human Platelets.

Platelets are probably the most accessible human cells to study exocytosis by amperometry. These cell fragments accumulate biological amines, serotonin in particular, using similar if not the same mechanisms as those employed by sympathetic, serotoninergic, and histaminergic neurons. Thus, platelets have been widely recognized as a model system to study certain neurological and psychiatric diseases. Platelets release serotonin by exocytosis, a process that entails the fusion of a secretory vesicle to the plasma membrane and that can be monitored directly by classic single cell amperometry using carbon fiber electrodes. However, this is a tedious technique because any given platelet releases only 4-8 secretory δ-granules. Here, we introduce and validate a diamond-based multielectrode array (MEA) device for the high-throughput study of exocytosis by human platelets. This is probably the first reported study of human tissue using an MEA, demonstrating that they are very interesting laboratory tools to assess alterations to exocytosis in neuropsychiatric diseases. Moreover, these devices constitute a valuable platform for the rapid testing of novel drugs that act on secretory pathways in human tissues.

The Complexity of Psychotropic Medication Prescription and Treating Trauma Among Youth in Foster Care: Perspectives from the Lived Experience.

Youth in the US foster care system are disproportionately prescribed antipsychotic and psychotropic medication compared to youth not involved with foster care. Research on the relationship between experiences of trauma, mental health symptoms, evidence-based treatment, and safe psychotropic prescribing practices for youth in foster care is limited. We explored stakeholders' perspectives of the relationship between psychotropic medications and trauma informed care (TIC) for youth in foster care. We conducted semi-structured individual and group interviews with foster caregivers, caseworkers, prescribing clinicians, and alumni of the foster care system. Data were recorded and transcribed verbatim, and analyzed using a directed content analysis approach. Five themes emerged across and within stakeholder groups: (1) acknowledging trauma; (2) role of psychotropic medication; (3) psychosocial resources; (4) additional supports; and, (5) training and education. Stakeholders identified TIC as an important component of mental health services for youth in foster care. There was not consensus around the role of psychotropic medication in treating trauma; however, most stakeholders felt that it was overused. Respondents suggested including additional supportive team members to help guide youth through the mental health treatment system, and emphasized the importance of support from individuals with common lived experiences. Results demonstrate the need for a system that emphasizes trauma-sensitive clinical interactions and psychosocial supports. Improving training and education for stakeholders, and providing additional sources of support for youth in foster care, could help better identify and treat the effects of trauma and the safe pharmacotherapy for youth in foster care.

Caída del paciente adulto mayor hospitalizado

Resumen Las caídas en pacientes adultos mayores durante su estadía hospitalaria, son un hecho real que constituye un problema de salud, por su repercusión tanto a nivel personal como en costos institucionales, siendo la convergencia de distintos factores que las favorecen. El reconocer una caída es fundamental para poder instaurar oportunamente medidas destinadas a prevenirlas, así como para disminuir el daño secundario que pudiera alterar la rehabilitación del paciente. Objetivo. Proponer un protocolo de atención de enfermería para contribuir a prevenir la caída del adulto mayor durante su estadía hospitalaria. Materiales y Métodos: Se aplicaron las técnicas de la encuesta, entrevista y revisión de historiales clínicos, con la finalidad de conocer factores de riesgo que causan la caída y la percepsión sobre la atención resivida por el profesional al paciente durante su estadía hospitalaria. Resultados. La revisión de historiales clínicos evidenció el 10% de caídas, la encuesta aplicada reveló el 40% de factores extrínsecos, el 60% factores intrinsecos presentes y latentes en el hospital que ocacionan la caída, a la entrevista a pacientes adultos mayores manifiestan que por la sobrecarga de actividades y demanda de pacientes el profesional de enfermería no coadyuva con las necesidades de salud que ellos requieren, se sientes solos y abandonados. Conclusiones: Los resultados obtenidos de la investigación, fueron el camino para plantear una propuesta, sustentada en un modelo teórico que fundamenta e idealiza al proceso de atención de enfermería con sus componentes, para luego concretizar en un protocolo como documento normativo sustentado en la premisa del cuidado con calidad.

Abstract Falls in elderly patients during their hospital stay are a real fact that constitutes a health problem, due to their repercussion both at a personal level and in institutional costs, being the convergence of different factors that favor them. Recognizing a fall is fundamental to be able to establish timely measures aimed at preventing them, as well as to reduce the secondary damage that could alter the patient's rehabilitation. Objective . To propose a nursing care protocol to help prevent falls in the elderly during their hospital stay. Materials and Methods . Survey, interview and clinical history review techniques were applied in order to determine the risk factors that cause falls and the perception of the care received by the professional during the patient's hospital stay. Results . The review of clinical histories evidenced 10% of falls, the survey applied revealed 40% of extrinsic factors, 60% intrinsic factors present and latent in the hospital that cause the fall, to the interview to elderly patients manifest that due to the overload of activities and demand of patients the nursing professional does not assist with the health needs they require, they feel alone and abandoned. Conclusions . The results obtained from the research, were the way to raise a proposal, based on a theoretical model that supports and idealizes the nursing care process with its components, and then materialize in a protocol as a normative document based on the premise of quality care.

Resumo As quedas em pacientes adultos mais velhos durante sua internação hospitalar são um fato real que constitui um problema de saúde, devido a suas repercussões tanto em nível pessoal quanto em termos de custos institucionais, sendo a convergência de diferentes fatores que os favorecem. Reconhecer uma queda é fundamental para poder implementar medidas destinadas a preveni-la em tempo hábil, assim como para reduzir os danos secundários que poderiam alterar a reabilitação do paciente. Objetivo . Propor um protocolo de cuidados de enfermagem para ajudar a prevenir quedas em idosos durante sua estadia hospitalar. Materiais e Métodos . Foram aplicadas técnicas de pesquisa, entrevista e revisão do histórico clínico para determinar os fatores de risco que causam as quedas e a percepção dos cuidados recebidos pelo profissional durante a permanência do paciente no hospital. Resultados . A revisão das histórias clínicas evidenciou 10% das quedas, a pesquisa aplicada revelou 40% de fatores extrínsecos, 60% de fatores intrínsecos presentes e latentes no hospital que causam a queda, na entrevista com pacientes adultos mais velhos eles afirmam que devido à sobrecarga de atividades e demanda dos pacientes o profissional de enfermagem não ajuda nas necessidades de saúde que eles necessitam, eles se sentem sozinhos e abandonados. Conclusões . Os resultados obtidos com a pesquisa, foram a forma de propor uma proposta, baseada em um modelo teórico que apóia e idealiza o processo de cuidados de enfermagem com seus componentes, para então se materializar em um protocolo como um documento normativo baseado na premissa de cuidados de qualidade.

Negotiating child protection mandates in Housing First for families.

BACKGROUND: Housing First (HF) is an evidence-based service model that combines permanent housing and supportive case management premised on harm reduction and consumer self-determination to end homelessness for high-need individuals. Originally developed for use with single adults, this model is now being employed with families. Yet there is little empirical work on how HF is implemented with this particular population. OBJECTIVE: The aim of this study is to examine how frontline providers adapt and apply HF to formerly homeless or at-risk, families involved in child welfare. PARTICIPANTS AND SETTING: Frontline providers working in family HF programs (N = 59) were recruited from two states, across 11 organizations, and 16 program sites. The theoretical sample (n = 26) includes 13 participants working in programs that encouraged direct collaboration with Child Protective Services (CPS) in the program model and 13 participants from three non-CPS-aligned sites in a second state. METHODS: A grounded theory approach was used to analyze semi-structured, qualitative interviews. RESULTS: Frontline providers exercised street-level bureaucratic discretion when interpreting child protection reporting mandates and they found ways to adapt the HF model to this population. In doing so, they worked to juggle both their mandates to child protection and to principles of HF to create a "child safety-modified" form of HF. CONCLUSIONS: While our study shows that providers are modifying HF to address the needs of families involved in child welfare, it also raises questions as to the degree to which HF can be done with high fidelity when used with this population.

Comportamiento de neumonía asociada a ventilación mecánica en cuidados intensivos de adultos / Behavior of mechanic ventilator-associated pneumonia in adult at intensive care

Introducción: las neumonías asociadas a la ventilación causan grandes inquietudes a los médicos que plantean serias dificultades diagnósticas las que a su vez motivan a menudo la toma de decisiones terapéuticas desproporcionadas que favorecen la génesis de la resistencia antimicrobiana. Objetivo: valorar el comportamiento de la neumonía asociada a la ventilación mecánica como indicador de calidad asistencial en la Unidad de Terapia Intensiva de Adultos del Hospital General Docente Octavio de la Concepción y de la Pedraja de Baracoa entre enero-diciembre de 2015. Método: se realizó un estudio descriptivo transversal. De un universo de 67 pacientes se tomó una muestra de 27 pacientes por el método aleatorio simple, que desarrollaron esta enfermedad asociada a la ventilación según grupos de edades, sexo, afecciones que propiciaron usarla, tiempo de aparición de los síntomas y resultados microbiológicos. Resultados: las enfermedades de base que más incidieron fueron las enfermedades cerebrovasculares seguidas por distrés respiratorio y sepsis severa. En los primeros nueve días fue que aparecieron los síntomas. Se obtuvo mayor aislamiento de gérmenes Gram negativo. Conclusiones: el comportamiento de las neumonías asociadas a la ventilación estuvo dado en el sexo masculino, mayores de 60 años, se asociaron con mayor frecuencia a las enfermedades cerebrovasculares, en su mayoría los síntomas aparecieron entre 4 y 6 días; el Staphylococcus epidermidis y la Klebsiellap neumoniae fueron los gérmenes que con mayor frecuencia se aislaron en estos pacientes(AU)

Introduction: pneumonias associated with ventilation cause great concern to physicians who pose serious diagnostic difficulties which in turn often motivate the making of disproportionate therapeutic decisions that favor the genesis of antimicrobial resistance. Objective: assess the behavior of pneumonia associated with mechanical ventilation as an indicator of quality of care in the Unit of Intensive Adult Therapy of the General Teaching Hospital Octavio de la Concepción y de la Pedraja of Baracoa between January-December 2015. Method: a cross-sectional descriptive study was carried out. From a universe of 67 patients, a sample of 27 patients was taken by the simple random method, which developed this disease associated with ventilation according to age groups, sex, conditions that led to its use, time of onset of symptoms and microbiological results. Results: the underlying diseases that most affected were cerebrovascular diseases followed by respiratory distress and severe sepsis. In the first nine days, the symptoms appeared. Greater isolation of Gram negative germs was obtained. Conclusions: the behavior of the pneumonias associated to ventilation was given in the male sex, older than 60 years, they were associated with a greater frequency to the cerebrovascular diseases, in the majority the symptoms appeared between 4 and 6 days; Staphylococcus epidermidis and Klebsiellap pneumoniae were the germs that were most frequently isolated in these patients(AU)

Introdução: as pneumonias associadas à ventilação são motivo de grande preocupação para os médicos que apresentam sérias dificuldades diagnósticas, que por sua vez, muitas vezes motivam a tomada de decisões terapêuticas desproporcionais que favorecem a gênese da resistência antimicrobiana. Objetivo: avaliar o comportamento da pneumonia associada à ventilação mecânica como um indicador de qualidade de atendimento na Unidade de Terapia Intensiva de Adultos do Hospital Geral de Ensino Octavio de la Concepción y de la Pedraja de Baracoa entre janeiro-dezembro de 2015. Método: foi realizado um estudo descritivo transversal. De um universo de 67 pacientes, uma amostra de 27 pacientes foi tomada pelo método aleatório simples, que desenvolveu essa doença associada à ventilação de acordo com as faixas etárias, sexo, condições que levaram ao seu uso, tempo de início dos sintomas e resultados microbiológicos. Resultados: as doenças de base que mais afetaram foram as doenças cerebrovasculares, seguidas de desconforto respiratório e sepse grave. Nos primeiros nove dias, os sintomas apareceram. Maior isolamento de germes Gram negativos foi obtido. Conclusões: o comportamento das pneumonias associadas à ventilação foi dado no sexo masculino, com idade superior a 60 anos, foram associadas com maior frequência às doenças cerebrovasculares, na maioria os sintomas apareceram entre 4 e 6 dias; Staphylococcus epidermidis e Klebsiellap pneumoniae foram os germes mais freqüentemente isolados nesses pacientes(AU)

Comportamiento de neumonía asociada a ventilación mecánica en cuidados intensivos de adultos / Comportamento de pneumonia associado à ventilação mecãnica em terapia intensiva de adultos / Behavior of mechanic ventilator-associated pneumonia in adult at intensive care

Introducción: las neumonías asociadas a la ventilación causan grandes inquietudes a los médicos que plantean serias dificultades diagnósticas las que a su vez motivan a menudo la toma de decisiones terapéuticas desproporcionadas que favorecen la génesis de la resistencia antimicrobiana. Objetivo: valorar el comportamiento de la neumonía asociada a la ventilación mecánica como indicador de calidad asistencial en la Unidad de Terapia Intensiva de Adultos del Hospital General Docente Octavio de la Concepción y de la Pedraja de Baracoa entre enero-diciembre de 2015. Método: se realizó un estudio descriptivo transversal. De un universo de 67 pacientes se tomó una muestra de 27 pacientes por el método aleatorio simple, que desarrollaron esta enfermedad asociada a la ventilación según grupos de edades, sexo, afecciones que propiciaron usarla, tiempo de aparición de los síntomas y resultados microbiológicos. Resultados: las enfermedades de base que más incidieron fueron las enfermedades cerebrovasculares seguidas por distrés respiratorio y sepsis severa. En los primeros nueve días fue que aparecieron los síntomas. Se obtuvo mayor aislamiento de gérmenes Gram negativo. Conclusiones: el comportamiento de las neumonías asociadas a la ventilación estuvo dado en el sexo masculino, mayores de 60 años, se asociaron con mayor frecuencia a las enfermedades cerebrovasculares, en su mayoría los síntomas aparecieron entre 4 y 6 días; el Staphylococcus epidermidis y la Klebsiellap neumoniae fueron los gérmenes que con mayor frecuencia se aislaron en estos pacientes(AU)

Introduction: pneumonias associated with ventilation cause great concern to physicians who pose serious diagnostic difficulties which in turn often motivate the making of disproportionate therapeutic decisions that favor the genesis of antimicrobial resistance. Objective: assess the behavior of pneumonia associated with mechanical ventilation as an indicator of quality of care in the Unit of Intensive Adult Therapy of the General Teaching Hospital "Octavio de la Concepción y de la Pedraja" of Baracoa between January-December 2015. Method: a cross-sectional descriptive study was carried out. From a universe of 67 patients, a sample of 27 patients was taken by the simple random method, which developed this disease associated with ventilation according to age groups, sex, conditions that led to its use, time of onset of symptoms and microbiological results. Results: the underlying diseases that most affected were cerebrovascular diseases followed by respiratory distress and severe sepsis. In the first nine days, the symptoms appeared. Greater isolation of Gram negative germs was obtained. Conclusions: the behavior of the pneumonias associated to ventilation was given in the male sex, older than 60 years, they were associated with a greater frequency to the cerebrovascular diseases, in the majority the symptoms appeared between 4 and 6 days; Staphylococcus epidermidis and Klebsiellap pneumoniae were the germs that were most frequently isolated in these patients(AU)

Introdução: as pneumonias associadas à ventilação são motivo de grande preocupação para os médicos que apresentam sérias dificuldades diagnósticas, que por sua vez, muitas vezes motivam a tomada de decisões terapêuticas desproporcionais que favorecem a gênese da resistência antimicrobiana. Objetivo: avaliar o comportamento da pneumonia associada à ventilação mecânica como um indicador de qualidade de atendimento na Unidade de Terapia Intensiva de Adultos do Hospital Geral de Ensino "Octavio de la Concepción y de la Pedraja" de Baracoa entre janeiro-dezembro de 2015. Método: foi realizado um estudo descritivo transversal. De um universo de 67 pacientes, uma amostra de 27 pacientes foi tomada pelo método aleatório simples, que desenvolveu essa doença associada à ventilação de acordo com as faixas etárias, sexo, condições que levaram ao seu uso, tempo de início dos sintomas e resultados microbiológicos. Resultados: as doenças de base que mais afetaram foram as doenças cerebrovasculares, seguidas de desconforto respiratório e sepse grave. Nos primeiros nove dias, os sintomas apareceram. Maior isolamento de germes Gram negativos foi obtido. Conclusões: o comportamento das pneumonias associadas à ventilação foi dado no sexo masculino, com idade superior a 60 anos, foram associadas com maior frequência às doenças cerebrovasculares, na maioria os sintomas apareceram entre 4 e 6 dias; Staphylococcus epidermidis e Klebsiellap pneumoniae foram os germes mais freqüentemente isolados nesses pacientes(AU)

Comportamiento de neumonía asociada a ventilación mecánica en cuidados intensivos de adultos / Behavior of mechanic ventilator-associated pneumonia in adult at intensive care

Se realizó un estudio descriptivo transversal con el objetivo de valorar el comportamiento de la neumonía asociada a la ventilación mecánica (NAV) en la Unidad de Terapia Intensiva de Adultos del Hospital General Docente Octavio de la Concepción y de la Pedraja de Baracoa entre enero-diciembre de 2015. De un universo de 67 pacientes se tomó una muestra de 27 pacientes por el método aleatorio simple, que desarrollaron esta enfermedad asociada a la ventilación según grupos de edades, sexo, afecciones que propiciaron usarla, tiempo de aparición de los síntomas y resultados microbiológicos. El comportamiento de las neumonías asociadas a la ventilación estuvo dado en el sexo masculino, mayores de 60 años, se asociaron con mayor frecuencia a las enfermedades cerebrovasculares, en su mayoría los síntomas aparecieron entre 4 y 6 días; el Staphylococcusepidermidis y la Klebsiellapneumoniae fueron los gérmenes que con mayor frecuencia se aislaron en estos pacientes(AU)

A descriptive cross-sectional study was carried out to evaluate the behavior of ventilator-associated pneumonia (VAP) in the Adult Intensive Care Unit of the General Teaching Hospital Octavio de la Concepción and de la Pedraja in Baracoa between January -December 2015. From a universe of 67 patients, a sample of 27 patients was taken by the simple random method, which developed this disease associated with ventilation according to age, groups, sex, conditions that led to its use, time of onset of symptoms and microbiological results. The behavior of mechanic ventilator-associated pneumonias in males, older than 60 years, were more frequently associated with cerebrovascular diseases, most of the symptoms appeared between 4 and 6 days; Staphylococcus epidermidis and Klebsiellappneumoniae were the most frequently isolated germs in these patients(AU)

Factores de riesgo en el fracaso de la miringoplastía / Risk factors associated with failure in myringoplasty

Objetivo: Identificar factores de riesgo asociados a fracaso en miringoplastía.Material y métodos: Se revisaron 290 expedientes en el período de julio de 1997 a marzo de 1999, realizándose un análisis de casos y controles.Resultados: Se analizaron los resultados de 290 miringoplastías; el período mínimo de seguimiento fue de 6 meses; las cirugías exitosas se estimaron en 82.1 por ciento y 17.9 por ciento se consideraron como falla. No encontramos como factores de riesgo estadísticamente significativo a las variables: edad, sexo, escolaridad, ocupación, tabaquismo, alcoholismo y enfermedades asociadas, antecedente de cirugía nasal u otológica previa, así como tampoco la causa de la perforación, el tiempo de evolución, o si fue médico residente el que realizó la cirugía. Estos resultados no son definitivos ya que los intervalos de confianza fueron amplios en la mayoría de las variables, lo cual puede atribuirse al tamaño de la muestra. Las variables de riesgo significativo encontrados fueron: tamaño de la perforación mayor al 40 por ciento, localización marginal de la perforación; placas de timpanoesclerosis, bridas y epitelio escamoso en la caja timpánica.Conclusiones: Los factores de riesgo para fracaso son similares a otros reportes. Las variables de alto riesgo deben de ser consideradas técnicamente para evitar fallas en la cirugía.

Actividad de la enzima convertidora de angiotensina en la hipertensión inducida por el embarazo / Activity the converting enzime of angiotensin in the pregnancy induced hypertensión

Con el fin de establecer las características bioquímicas del sistema-renina angiotensina aldosterona en preeclampsia, en el presente estudio se cuantificó la actividad plasmática de la enzima convertidora de angiotensina y la concentración de aldosterona plasmática en 32 mujeres embarazadas con presión arterial normal o con hipertensión inducida por el embarazo (HIE). Las pacientes con HIE presentaron un incremento significativo en la presión arterial media cuando se compara con las embarazadas normotensas. Por otra parte, se observó una reducción significativa tanto de la actividad de ECA como de la concentración de aldosterona plasmática en las pacientes con HIE al compararlas con su contraparte normotensas. Aún más, se observó una correlación negativa y significativa entre los niveles de ECA/aldosterona y las presiones arteriales en todas las mujeres embarazadas, sugiriendo que la alteración en estos parámetros se correlaciona con la alteración de la presión arterial. Nuestros resultados indican que el sistema renina angiotensina aldosterona se encuentra suprimido en la hipertensión inducida en el ambarazo

Sistema renina-angiotensina-aldosterona en hipertensión inducida por el embarazo / Renin-angiotensin-aldosterone system in induced hypertensión by the pregnancy

Se incluyeron 32 pacientes en tercer trimestre de embarazo, 17 HIE y 15 normotensas, con edades que oscilaban entre 19 y 35 años. Ninguna de ellas tenía antecedentes de LES, nefropatía, Hepatopatía, hipertensión arterial crónica, púrpuras, diabetes mellitus, enfermedades pulmonares o enfermedades tromboembólicas. Se tomaron 12 cc de sangre venosa y se realizó amniocentesis. Se analizó la concentración plasmática de aldosterona, mediante el método de radioinmunoensayo, y la actividad de ECA tanto en plasma como en el LA por método radiométrico. Resultados: no se observó diferencia significativa en la edad y EG entre ambos grupos. La actividad de ECA plasmática en el grupo de embarazadas con HIE fue de 483 ñ 67 mientras que para las embarazadas normotensas fue de 219 ñ 31 (p<0.0001). La concentración de aldosterona plasmática fue de 223 ñ 60 mientras que en pacientes con HIE fue de 82 ñ 25 (p<0,03). La actividad de ECA en LA fue de 8.34 ñ 1.9 y de 14.05 ñ 1.4 con p<0.027, para el grupo de embarazadas con HIE y para el grupo de pacientes normotensas respectivamente. Todos los parámetros bioquímicos mostraron correlación con la PAM estadísticamente significativa. Los parámetros clínicos: edema, proteinuria e IG no presentaron correlación estadísticamente significativa. Los parámetros clínicos: edema, proteinuria e IG no presentaron correlación estadísticamente significativa con ninguno de los parámetros bioquímicos