RESUMO
RESUMEN INTRODUCCIÓN: Tener claras las competencias profesionales permite dirigir adecuadamente los esfuerzos académicos, económicos y sociales para cumplir la vocación como neurólogos; hasta ahora, la bibliografía al respecto es escasa. OBJETIVO: Describir las competencias profesionales que debe tener un neurólogo clínico en Colombia. MÉTODOS Y MATERIALES: Es un estudio cualitativo exploratorio descriptivo, realizado según la teoría fundamentada, mediante una entrevista semiestructurada a 23 líderes de la especialidad en Colombia. RESULTADOS Y DISCUSIÓN: A partir de las entrevistas, se redactan según el modelo del Ministerio de Salud, competencias transversales y específicas que complementan las 8 planteadas previamente por ASCOFAME, para un total de 34 competencias divididas en cinco dominios. CONCLUSIONES: luego de conocer las competencias profesionales, deben diseñarse criterios de desempeño para medir el logro de esas habilidades. Dado que las competencias dependen de las condiciones de la sociedad, las cuales son cambiantes, su reevaluación debe ser continua.
SUMMARY INTRODUCTION: Having a clear idea of professional competencies allows to direct properly the academic economic and social efforts to accomplish the neurologist's vocation; neverthless, the literature is scarce. OBJECTIVE: Describe the professional competencies of clinical neurologists in Colombia. METHODS AND MATERIALS: It is a descriptive exploratory qualitative study, carried out according to grounded theory, through a semi-structured interview with 23 leaders of the specialty in Colombia. RESULTS AND DISCUSSION: From the interviews, transversal and specific competences are drawn up according to the model of the Ministry of Health, complementing the 8 previously proposed by ASCOFAME, for a total of 34 competencies divided into five domains. CONCLUSIONS: After knowing the neurologist's competencies, it's mandatory to design perfomance criteria to measure the achievement of those abilities. Since competencies depend on the conditions of society which are in constant change, their reassessment must be continuous.
Assuntos
Mobilidade UrbanaRESUMO
ABSTRACT Introduction: Spontaneous pneumomediastinum (SPM) is defined as the presence of air in the mediastinum. It is a rare entity considered benign and self-limiting, which mostly affects young adults. Its diagnosis is confirmed through clinical and radiological studies. Case description: 21-year-old male patient with cough and greenish expectoration for four days, associated with dyspnea, chest pain, fever and bilateral supraclavicular subcutaneous emphysema. Chest X-ray suggested pneumomediastinum, which was confirmed by tomography. The patient was hospitalized for observation and treatment. After a positive evolution, he was discharged on the sixth day. Discussion: SPM is a differential diagnosis in patients with chest pain and dyspnea. Its prevalence is lower than 0.01% and its mortality rate is low. It should be suspected in patients with chest pain and subcutaneous emphysema on physical examination. Between 70 and 90% of the cases can be identified by chest X-ray, while confirmation can be obtained through chest tomography. In most cases it does not require additional studies. Conclusion: SPM is a little known cause of acute chest pain, and rarely considered as a differential diagnosis; it is self-limited and has a good prognosis.
Assuntos
Humanos , Enfisema , Enfisema SubcutâneoRESUMO
ABSTRACT Introduction: Pulmonary infarction occurs in 29% to 32% of patients with pulmonary thromboembolism (PTE). The infection of a pulmonary infarction is a complication in approximately 2 to 7% of the cases, which makes it a rare entity. Case Presentation: 49-year-old woman with pleuritic pain in the left hemithorax that irradiated to the dorsal region, associated with dyspnea and painful edema in the left lower limb of two days of evolution. Two weeks prior to admission, the patient suffered from a left knee trauma that required surgical intervention; however, due to unknown reasons, she did not receive antithrombotic prophylaxis. Physical examination showed tachycardia, tachypnea and painful edema with erythema in the left leg. After suspecting a pulmonary thromboembolism, anticoagulation medication was administered and a chest angiotomography was requested to confirm the diagnosis. The patient experienced signs of systemic inflammatory response, and respiratory deterioration. A control tomography was performed, suggesting infected pulmonary infarction. Antibiotic treatment was initiated, obtaining progressive improvement; the patient was subsequently discharged, and continued with anticoagulation medication and follow-up on an outpatient basis. Conclusions: Pulmonary infarction is a frequent complication in patients with PTE. Therefore, infected pulmonary infarction should be suspected in patients with clinical deterioration and systemic inflammatory response. The radiological difference between pulmonary infarction and pneumonia is not easily identified, thus the diagnostic approach is clinical, and anticoagulant and antimicrobial treatment should be initiated in a timely manner.
RESUMEN Introducción El infarto pulmonar ocurre entre un 29 y un 32% de pacientes con tromboembolismo pulmonar (TEP). Por su parte, la infección de un infarto pulmonar complica aproximadamente del 2 al 7% de los casos, lo que hace que el infarto pulmonar infectado sea una entidad poco frecuente. Descripción del caso Mujer de 49 años con dolor pleurítico en hemitórax izquierdo, irradiado a región dorsal, asociado a disnea y edema doloroso de miembro inferior izquierdo de dos días de evolución. Dos semanas antes de su ingreso la paciente sufrió trauma de rodilla izquierda, el cual que requirió intervención quirúrgica; sin embargo, por motivos desconocidos, no recibió profilaxis anti trombótica. En el examen físico se encontró taquicardia, taquipnea y edema doloroso con eritema en pierna izquierda. Al existir alta sospecha de tromboembolia pulmonar se inició anticoagulación y se solicitó angiotomografía de tórax, con la cual fue posible confirmar el diagnóstico. Durante su evolución, la paciente experimentó signos de respuesta inflamatoria sistémica, deterioro respiratorio. Se realizó tomografía de control sugestiva de infarto pulmonar infectado. Se inició antibiótico y la paciente mejoró de forma progresiva; después de esta mejora, fue dada de alta para continuar anticoagulación y seguimiento ambulatorios. Conclusiones El infarto pulmonar es una complicación frecuente en pacientes con TEP. Por lo tanto, debe sospecharse infarto pulmonar infectado en pacientes con deterioro clínico y respuesta inflamatoria sistémica. La diferencia radiológica entre infarto pulmonar y neumonía no es fácil de identificar, su enfoque diagnóstico es clínico y el tratamiento anticoagulante y antimicrobiano debe iniciarse de manera oportuna.
