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1.
Trop Med Infect Dis ; 7(10)2022 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-36288063

RESUMO

Dengue fever is a serious and growing public health problem in Latin America and elsewhere, intensified by climate change and human mobility. This paper reviews the approaches to the epidemiological prediction of dengue fever using the One Health perspective, including an analysis of how Machine Learning techniques have been applied to it and focuses on the risk factors for dengue in Latin America to put the broader environmental considerations into a detailed understanding of the small-scale processes as they affect disease incidence. Determining that many factors can act as predictors for dengue outbreaks, a large-scale comparison of different predictors over larger geographic areas than those currently studied is lacking to determine which predictors are the most effective. In addition, it provides insight into techniques of Machine Learning used for future predictive models, as well as general workflow for Machine Learning projects of dengue fever.

2.
J Burn Care Res ; 41(6): 1260-1266, 2020 11 30.
Artigo em Inglês | MEDLINE | ID: mdl-32511725

RESUMO

Certain parameters of complete blood count (CBC) such as red cell distribution width (RDW) and mean platelet volume, as well as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and RDW-to-platelet ratio (RPR) have been associated with inflammatory status and outcome in diverse medical conditions. The aim of this study was to describe the evolution pattern of these parameters in adult burned patients. Adult burned patients admitted to the National Burn Center in Uruguay between May 2017 and February 2018 (discovery cohort) and between March 2018 and August 2019 (validation cohort) were included. Patients' characteristics and outcomes were recorded, as well as CBC parameters on days 1, 3, 5, and 7 after thermal injury. Eighty-eight patients were included in the discovery cohort. Total body surface area burned was 14 [7-23]% and mortality was 15%. Nonsurvivors presented higher RDW and mean platelet volume (P < .01). NLR decreased after admission in all patients (P < .01), but was higher in nonsurvivors (P < .01). Deceased patients also presented higher RPR on days 3, 5, and 7 (P < .001). On the contrary, PLR was reduced in nonsurvivors (P < .05). There was a significant correlation between NLR on admission and burn extension and severity. Kaplan-Meier analysis revealed that NLR, PLR, and RPR could identify patients with increased mortality. These findings were confirmed in the validation cohort (n = 95). Basic CBC parameters and derived indices could be useful as biomarkers to determine prognosis in adults with thermal injuries.


Assuntos
Contagem de Células Sanguíneas , Queimaduras/sangue , Adulto , Idoso , Queimaduras/mortalidade , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Uruguai
3.
Rev Bras Ter Intensiva ; 32(1): 43-48, 2020 Mar.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32401983

RESUMO

OBJECTIVE: To determine the independent risk factors associated with mortality in adult burn patients. METHODS: This was a retrospective, observational study performed at the Centro Nacional de Queimados do Uruguai. All patients with skin burns admitted to the unit since its opening on July 1, 1995 through December 31, 2018 were included. The demographic data, burn profiles, length of stay, mechanical ventilation duration and hospital mortality were studied. A multivariate logistic regression was used to identify the risk factors for mortality. The standardized mortality ratio was calculated by dividing the number of observed deaths by the number of expected deaths (according to the Abbreviated Burn Severity Index). RESULTS: During the study period, 3,132 patients were included. The median total body surface area burned was 10% (3%-22%). The Abbreviated Burn Severity Index was 6 (4 - 7). Invasive mechanical ventilation was required in 60% of the patients for a median duration of 6 (3 - 16) days. The median length of stay in the unit was 17 (7 - 32) days. The global mortality was 19.9%. Crude mortality and standardized mortality ratio decreased from 1995 through 2018. The global standardized mortality ratio was 0.99. A need for mechanical ventilation (OR 8.80; 95%CI 5.68 - 13.62), older age (OR 1.07 per year; 95%CI 1.06 - 1.09), total body surface area burned (OR 1.05 per 1%; 95%CI 1.03 - 1.08) and extension of third-degree burns (OR 1.05 per 1%; 95%CI 1.03 - 1.07) were independent risk factors for mortality. CONCLUSION: The need for mechanical ventilation, older age and burn extension were independent risk factors for mortality in the burned adult Uruguayan population.


Assuntos
Queimaduras/mortalidade , Adulto , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Uruguai/epidemiologia
4.
In. Verga, Federico; Burghi, Gastón. Encares de paciente crítico. Montevideo, Oficina del Libro FEFMUR, 2020. p.269-281.
Monografia em Espanhol | LILACS, BNUY, UY-BNMED | ID: biblio-1342656
5.
J Surg Case Rep ; 2019(4): rjz121, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31044063

RESUMO

Irretrievable rectal foreign bodies can cause significant distress and generally require emergency medical attention. While smaller objects can often be removed trans-anally, larger objects typically require more invasive intervention. Here, we report the case of a 57-year-old man who had previously presented to the emergency department with a baseball lodged in the rectosigmoid that required a laparotomy. One year later, he represented with a significantly larger object also affixed in the rectosigmoid. Exploratory laparotomy revealed an edematous, inflamed bowel with extensive adhesions from the pervious surgery. Given the degree of tissue damage and large size of the object, the decision was made to perform a Hartmann's procedure. The object, an 11 × 10 cm rubber chew toy, was successfully removed and the patient was referred to the appropriate mental health professionals during follow-up.

6.
Rev. méd. Urug ; 35(1): 14-19, mar. 2019. graf
Artigo em Espanhol | LILACS | ID: biblio-981356

RESUMO

Introducción: la mortalidad de los pacientes con injuria térmica ha descendido a nivel mundial. Este hecho se ha relacionado en parte con la creación de centros especializados en el tratamiento de esta patología. En nuestro medio no existen estudios recientes que evalúen la evolución de la mortalidad en este tipo de centros. Objetivo: describir las características de la población asistida y la evolución de la mortalidad en el Centro Nacional de Quemados. Material y método: estudio transversal, observacional, descriptivo. Se incluyeron todos los pacientes ingresados con diagnóstico de quemadura cutánea o de injuria inhalatoria desde la inauguración del centro en 1995 hasta el 31 de diciembre de 2017. Resultados: ingresaron en el período de estudio 3.050 pacientes quemados, 25% presentaron una superficie corporal quemada superior o igual a 20%. Existió un predominio de pacientes jóvenes (más de 60% menores de 50 años) y de sexo masculino (62%). El agente causal más frecuente fue el fuego directo (71%), seguido por líquidos calientes (9%) y electricidad (5%). El 43% de los pacientes requirió asistencia ventilatoria mecánica, y la estadía media en el centro fue de 17 días. La mortalidad global fue de 19,7%, similar a la esperada de acuerdo a scores de severidad específicos. La mortalidad de los pacientes más graves ha descendido desde la apertura del centro. Conclusiones: nuestro centro asiste predominantemente a pacientes jóvenes, con siniestros que involucran al fuego como el principal agente causal. La mortalidad es acorde a la esperada de acuerdo a los scores de severidad, destacándose un descenso continuo de la misma a lo largo de los años. (AU)


Introduction: burned patients mortality has decreased because of a better understanding of initial shock pathophysiology, early surgical interventions, antibiotic therapy optimization and appropriate nutritional support. Mortality reduction has also been related to the creation of specialized burn centers. There are no recent reports of burn injury patients in our country. Objective: to describe characteristics and evolution of patients assisted at the national burned center (Centro Nacional de Quemados, Uruguay). Methods: transversal, observational, descriptive study. All patients admitted in the center with diagnosis of skin burns or inhalation injury, from the center's opening in 1995 through December 31, 2017. Results: during the study period 3,050-burned patients were admitted, 25% of which had a total body surface area burnt of at least 20%. There was a predominance of male sex (62%) and young patients (more than 60% had less than 50 years old). The most frequent responsible agent was direct fire (71%), followed by hot liquids (9%) and electricity (5%). Mechanical ventilation was needed in 43% of the patients, and mean length of stay in the center was 17 days. Overall mortality rate was 19.7%, accordingly to that predicted by specific severity scores. In the sub-group of more severe patients, mortality has progressively decreased since the center opening. Conclusions: our center assists young patients with burn injuries mostly caused by direct fire. Overall mortality is in line with the expected according to severity scores, having decreased progressively since the center inauguration.


Introduction: burned patients mortality has decreased because of a better understanding of initial shock pathophysiology, early surgical interventions, antibiotic therapy optimization and appropriate nutritional support. Mortality reduction has also been related to the creation of specialized burn centers. There are no recent reports of burn injury patients in our country. Objective: to describe characteristics and evolution of patients assisted at the national burned center (Centro Nacional de Quemados, Uruguay). Methods: transversal, observational, descriptive study. All patients admitted in the center with diagnosis of skin burns or inhalation injury, from the center's opening in 1995 through December 31, 2017. Results: during the study period 3,050-burned patients were admitted, 25% of which had a total body surface area burnt of at least 20%. There was a predominance of male sex (62%) and young patients (more than 60% had less than 50 years old). The most frequent responsible agent was direct fire (71%), followed by hot liquids (9%) and electricity (5%). Mechanical ventilation was needed in 43% of the patients, and mean length of stay in the center was 17 days. Overall mortality rate was 19.7%, accordingly to that predicted by specific severity scores. In the sub-group of more severe patients, mortality has progressively decreased since the center opening. Conclusions: our center assists young patients with burn injuries mostly caused by direct fire. Overall mortality is in line with the expected according to severity scores, having decreased progressively since the center inauguration.


Assuntos
Unidades de Queimados , Queimaduras/mortalidade
7.
Rev. bioét. (Impr.) ; 26(4): 484-493, out.-dez. 2018.
Artigo em Português | LILACS | ID: biblio-1041957

RESUMO

Resumo A bioética recorre à filosofia ao examinar conceitos e valores, problemas e ferramentas metodológicas e ao tratar de problemas específicos da vida humana no mundo moderno. Contudo, tanto na bioética quanto na filosofia, a compreensão existencial do que significa nascer é poucas vezes articulada, enquanto a dimensão existencial da morte e do morrer tem recebido mais atenção. Neste artigo, propomos reconsiderar a condição humana como pano de fundo de uma ética para a vida em seus múltiplos extratos e modulações, e a partir da qual se pode elaborar perspectiva filosófica que pense o nascimento como horizonte mais amplo para tratar problemas bioéticos específicos. Destacamos, neste artigo, algumas contribuições de Hannah Arendt e María Zambrano, duas pensadoras que se ocuparam da condição humana, entre o nascimento e a morte.


Abstract Bioethics uses philosophy in its practice of analysis of concepts and values, problems and methodological tools in order to deal with specific problems of human life in the modern world. We propose a reconsideration of the human condition as a background from which an ethic for life is constructed - in its multiple extracts and modulations - as a philosophical perspective to the thinking about birth in Bioethics, and as broader horizon for approaching more specific bioethical problems. We highlight in this article some contributions by Hannah Arendt and Maria Zambrano, two thinkers who addressed the human condition between birth and death. The existential understanding of what it means to be born is rarely articulated dimension from a philosophical and bioethical viewpoint, whereas the existential dimension of death and dying has received better attention in these areas.


Resumen La bioética recurre a la filosofía en su práctica de examen conceptual y de valores, sus problemas y herramientas metodológicas, para tratar problemas específicos de la vida humana en el mundo moderno. Proponemos una reconsideración de la condición humana, como un trasfondo a partir del cual se elabora una ética para la vida - en sus múltiples dimensiones y modulaciones - como una perspectiva filosófica para pensar el nacimiento en la bioética, y como un horizonte más amplio para el tratamiento de problemas bioéticos específicos. Destacamos, en este artículo, algunas contribuciones de Hannah Arendt y de María Zambrano, dos pensadoras que se ocuparon de la condición humana, entre nacimiento y muerte. La comprensión existencial de lo que significa nacer es una dimensión raramente articulada, en filosofía y bioética, mientras que la consideración existencial de la muerte, y del morir, han recibido mayor atención en estas áreas.


Assuntos
Filosofia , Bioética , Temas Bioéticos , Parto , Nascido Vivo
8.
Int J Surg Pathol ; 25(7): 648-651, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28573901

RESUMO

Parvovirus B19 infection is undiagnosed in recipients undergoing solid organ transplantation. It is usually responsible for unexplained acute and chronic red blood cell aplasia that does not respond to erythropoietin therapy. Cases of parvovirus B19 infection associated with pancytopenia, solid organ dysfunction, and allograft rejection have been described in the literature. The deterioration of the immune system as a result of severe immunotherapy favors the reactivation of a previous infection or the acquisition of a new one. We present a case of a 32-year-old woman with a 1-year history of renal allograft transplant and previous cytomegalovirus (CMV) infection who presented with chest pain, polyarthritis, pancytopenia, and renal dysfunction. A serum sample using polymerase chain reaction showed a parvovirus titer of 13.8 trillion IU/mL and a CMV titer of 800 IU/mL. The renal biopsy revealed nucleomegaly with focal viral inclusions, along with changes associated with immunotherapy toxicity. Electron microscopy demonstrated capillary and tubular epithelial cells with "viral factories," thereby confirming the diagnosis. Thus, screening for parvovirus B19 is advised in high-risk patients who present with refractory anemia to avoid the complications of a chronic infection associated with the fatal rejection of the transplanted organ.


Assuntos
Artrite/patologia , Dor no Peito/patologia , Eritema Infeccioso/sangue , Eritema Infeccioso/patologia , Transplante de Rim/efeitos adversos , Pancitopenia/patologia , Parvovirus B19 Humano/isolamento & purificação , Adulto , Aloenxertos/patologia , Aloenxertos/ultraestrutura , Aloenxertos/virologia , Artrite/tratamento farmacológico , Artrite/virologia , Biópsia por Agulha , Inibidores de Calcineurina/uso terapêutico , Dor no Peito/tratamento farmacológico , Dor no Peito/virologia , Citomegalovirus/isolamento & purificação , DNA Viral/isolamento & purificação , Eritema Infeccioso/tratamento farmacológico , Eritema Infeccioso/virologia , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Imunossupressores/uso terapêutico , Rim/patologia , Rim/ultraestrutura , Rim/virologia , Microscopia Eletrônica , Pancitopenia/tratamento farmacológico , Pancitopenia/virologia , Parvovirus B19 Humano/genética , Reação em Cadeia da Polimerase
9.
In. Tejera, Darwin; Soto Otero, Juan Pablo; Taranto Díaz, Eliseo Roque; Manzanares Castro, William. Bioética en el paciente grave. Montevideo, Cuadrado, 2017. p.231-237, tab.
Monografia em Espanhol | LILACS, BNUY, UY-BNMED | ID: biblio-1380950
10.
FEM (Ed. impr.) ; 19(4): 175-185, jul.-ago. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-155070

RESUMO

Sujetos y métodos: Este estudio prospectivo correlacional-descriptivo tuvo como objetivos determinar la correlación bivariada entre las puntuaciones del examen teórico, la práctica clínica, el aprendizaje virtual y el examen clínico objetivo estructurado (ECOE) de la serie total con el portafolio; la ecuación de regresión para predecir la puntuación del portafolio a partir del examen teórico y ECOE de Cirugía Oncológica; la correlación entre el aprendizaje autorreflexivo del portafolio con la nota final del curso; las puntuaciones del portafolio con el test Inventory y la fiabilidad interevaluador de la estructura del portafolio y de su nota global. Resultados: Hubo correlación significativa entre el portafolio con el examen teórico (r = 0,410; p = 0,0001), la práctica clínica (r = 0,258; p = 0,003), el caso clínico virtual (r = 0,260; p = 0,003) y el ECOE (r = 0,204; p = 0,020). El análisis de regresión lineal múltiple determinó la ecuación de regresión para predecir la puntuación del portafolio y su relación con el examen teórico (p = 0,001) y el ECOE de Cirugía Oncológica (p = 0,010). Hubo correlación significativa entre el aprendizaje autorreflexivo (r = 0,305; p = 0,0001) con la nota teórica final del curso. La fiabilidad interevaluador del portafolio fue significativa en: caso clínico real (α = 0,486; p = 0,006), incidente crítico (α = 0,702; p = 0,0001), aprendizaje autorreflexivo (α = 0,664; p = 0,0001) y estructura del lenguaje (α = 0,431; p = 0,017). Hubo acuerdo aceptable entre los dos evaluadores con respecto a la nota del portafolio (α = 0,67; p = 0,0001) y con el test Inventory (α = 0,632; p = 0,001). Conclusiones: El portafolio se puede utilizar en el pregrado porque es fiable y tiene validez predictiva y concurrente, de manera que permite que el estudiante reflexione sobre sus necesidades de aprendizaje


Subjects and methods: This prospective correlational and descriptive study aimed to determine: the bivariate correlation among test scores of theoretical exam, clinical practice, virtual learning and objective structured clinical examination (OSCE) of the total series with portfolio; the regression equation to predict the score of portfolio from the theoretical and OSCE of chapter of surgical oncology; the correlation between self-reflective learning of portfolio with the final grade and portfolio scores with Inventory; and inter-rater reliability of the structure and its overall portfolio note. Results: There was significant correlation between portfolio and theoretical examination (r = 0.410; p = 0.0001), clinical practice (r = 0.258; p = 0.003), virtual clinical case (r = 0.260; p = 0.003) and OSCE (r = 0.204; p = 0.020). The multiple linear regression analysis determined the regression equation to predict the score of portfolio and its relation to the theory test (p = 0.001) and the OSCE of Surgical Oncology chapter (p = 0.010). There was significant correlation between self-reflective learning (r = 0.305; p = 0.0001) with the final theoretical note of the course. The rater reliability of portfolio was significant in: real clinical case (α = 0.486; p = 0.006), critical incident (α = 0.702; p = 0.0001), self-reflective learning (α = 0.664; p = 0.0001) and language structure (α = 0.431; p = 0.017). There was a correlation between the two raters with respect to the note of portfolio (α = 0.67; p = 0.0001) and the test Inventory (α = 0.632; p = 0.001). Conclusions: The portfolio can be used in undergraduate because it is a reliable instrument and has predictive and concurrent validity, allowing students to reflect on their learning needs


Assuntos
Humanos , Oncologia/educação , Cirurgia Geral/educação , Educação Médica/organização & administração , Avaliação Educacional/métodos , Estágio Clínico/organização & administração , Reprodutibilidade dos Testes
12.
Nutr Hosp ; 32(5): 2062-70, 2015 Nov 01.
Artigo em Espanhol | MEDLINE | ID: mdl-26545661

RESUMO

INTRODUCTION: during the first days of life the mother is the main source of nutrients for the newborn. However, breastfeeding difficulties are common and may generate excessive neonatal weight loss. OBJECTIVE: estimate the magnitude and association between breastfeeding problems and excessive neonatal weight loss beyond the physiological norm in the neonatology ward in a social security hospital in Lima, Peru. METHODS: we conducted a cross sectional analysis of the recorded neonatal weight in a routine evaluation (between 24 and 72 hours of life) and compared it against birth weight. Excessive weight loss was defined as a difference greater than or equal to 7 %. Breastfeeding problems (defined as problems with breastfeeding initiation, mouth position, breastfeeding duration, breastfeeding frequency, too much clothing, nipple pain and C form) were investigated using a survey and visual verification. The association between excessive weight loss and breastfeeding problems, adjusted by other factors, was quantified using a multiple generalized linear model. RESULTS: excessive weight loss was present in 18.8% (74/393) of the newborns. Improper positioning of the mouth on the nipple was present in 53.7% (211/393) of neonates while nipple pain was reported by 44.0% (173/393) of mothers. In the adjusted analysis, nipple pain [PR = 1.50 (95% CI: 1.02 to 2.22)] and improper positioning of the mouth [PR = 1.67 (95% CI: 1.09- 2.57)] were associated with an increased occurrence of excessive neonatal weight loss. CONCLUSIONS: breastfeeding problems are common. These difficulties are significantly associated with an increased occurrence of excessive neonatal weight loss. Improvements in breastfeeding practices, for example through educational programs, may decrease the occurrence of excessive neonatal weight loss.


Introducción: durante los primeros días de vida la madre es la principal fuente de alimento para el recién nacido. Sin embargo, es común que la madre presente trastornos de la lactancia y se genere una pérdida de peso neonatal superior a la fisiológica. Objetivo: estimar la magnitud y asociación entre los trastornos de la lactancia y la pérdida de peso neonatal superior a la fisiológica en neonatos en el área de alojamiento conjunto de un servicio de neonatología en un hospital de la Seguridad Social en Lima, Perú. Métodos: estudio de tipo transversal analítico. Registramos el peso neonatal en una evaluación de rutina (entre las 24 y 72 horas de vida) y lo comparamos con el peso al nacer. La pérdida de peso excesiva fue definida como una diferencia igual o mayor al 7%. Mediante una encuesta y una verificación visual investigamos los trastornos de la lactancia materna (retraso en el inicio, posición de la boca, duración de la lactancia, frecuencia de la lactancia, sobreabrigo, dolor en el pezón y forma de la C). La asociación entre la pérdida de peso excesiva y los trastornos, ajustada por otros factores, fue cuantificada mediante un modelo lineal generalizado múltiple. Resultados: en 18,8% (74/393) de los neonatos, la pérdida de peso excesiva fue igual o superior al 7% del peso al nacer. La posición inadecuada de la boca en el pezón estuvo presente en el 53,7% (211/393) de los neonatos, mientras que el dolor en el pezón fue reportado en el 44,0% (173/393) de las madres. En el análisis ajustado, el dolor en el pezón [RP = 1,50 (IC95%:1,02-2,22)] y la posición inadecuada de la boca [RP = 1,67 (IC95%:1,09- 2,57)] estuvieron asociados a una mayor pérdida de peso excesiva. Conclusiones: los trastornos de la lactancia son comunes. Estos factores están directa y positivamente asociados a una mayor pérdida de peso excesiva. La introducción de mejoras en las prácticas de lactancia, por ejemplo mediante programas educativos, podría disminuir la pérdida de peso neonatal excesiva.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Redução de Peso , Adolescente , Adulto , Aleitamento Materno/efeitos adversos , Estudos Transversais , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Recém-Nascido , Masculino , Mães , Peru/epidemiologia , Inquéritos e Questionários , Adulto Jovem
13.
Nutr. hosp ; 32(5): 2062-2070, nov. 2015. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-145532

RESUMO

Introducción: durante los primeros días de vida la madre es la principal fuente de alimento para el recién nacido. Sin embargo, es común que la madre presente trastornos de la lactancia y se genere una pérdida de peso neonatal superior a la fisiológica. Objetivo: estimar la magnitud y asociación entre los trastornos de la lactancia y la pérdida de peso neonatal superior a la fisiológica en neonatos en el área de alojamiento conjunto de un servicio de neonatología en un hospital de la Seguridad Social en Lima, Perú. Métodos: estudio de tipo transversal analítico. Registramos el peso neonatal en una evaluación de rutina (entre las 24 y 72 horas de vida) y lo comparamos con el peso al nacer. La pérdida de peso excesiva fue definida como una diferencia igual o mayor al 7%. Mediante una encuesta y una verificación visual investigamos los trastornos de la lactancia materna (retraso en el inicio, posición de la boca, duración de la lactancia, frecuencia de la lactancia, sobreabrigo, dolor en el pezón y forma de la C). La asociación entre la pérdida de peso excesiva y los trastornos, ajustada por otros factores, fue cuantificada mediante un modelo lineal generalizado múltiple. Resultados: en 18,8% (74/393) de los neonatos, la pérdida de peso excesiva fue igual o superior al 7% del peso al nacer. La posición inadecuada de la boca en el pezón estuvo presente en el 53,7% (211/393) de los neonatos, mientras que el dolor en el pezón fue reportado en el 44,0% (173/393) de las madres. En el análisis ajustado, el dolor en el pezón [RP = 1,50 (IC95%:1,02-2,22)] y la posición inadecuada de la boca [RP = 1,67 (IC95%:1,09- 2,57)] estuvieron asociados a una mayor pérdida de peso excesiva. Conclusiones: los trastornos de la lactancia son comunes. Estos factores están directa y positivamente asociados a una mayor pérdida de peso excesiva. La introducción de mejoras en las prácticas de lactancia, por ejemplo mediante programas educativos, podría disminuir la pérdida de peso neonatal excesiva (AU)


Introduction: during the first days of life the mother is the main source of nutrients for the newborn. However, breastfeeding difficulties are common and may generate excessive neonatal weight loss. Objective: estimate the magnitude and association between breastfeeding problems and excessive neonatal weight loss beyond the physiological norm in the neonatology ward in a social security hospital in Lima, Peru. Methods: we conducted a cross sectional analysis of the recorded neonatal weight in a routine evaluation (between 24 and 72 hours of life) and compared it against birth weight. Excessive weight loss was defined as a difference greater than or equal to 7 %. Breastfeeding problems (defined as problems with breastfeeding initiation, mouth position, breastfeeding duration, breastfeeding frequency, too much clothing, nipple pain and C form) were investigated using a survey and visual verification. The association between excessive weight loss and breastfeeding problems, adjusted by other factors, was quantified using a multiple generalized linear model. Results: excessive weight loss was present in 18.8% (74/393) of the newborns. Improper positioning of the mouth on the nipple was present in 53.7% (211/393) of neonates while nipple pain was reported by 44.0% (173/393) of mothers. In the adjusted analysis, nipple pain [PR = 1.50 (95% CI: 1.02 to 2.22)] and improper positioning of the mouth [PR = 1.67 (95% CI: 1.09- 2.57)] were associated with an increased occurrence of excessive neonatal weight loss. Conclusions: breastfeeding problems are common. These difficulties are significantly associated with an increased occurrence of excessive neonatal weight loss. Improvements in breastfeeding practices, for example through educational programs, may decrease the occurrence of excessive neonatal weight loss (AU)


Assuntos
Humanos , Recém-Nascido , Redução de Peso , Transtornos da Lactação , Triagem Neonatal/métodos , Aleitamento Materno/estatística & dados numéricos , Fatores de Risco , Recém-Nascido de Baixo Peso
14.
Clin Nephrol ; 84(4): 236-40, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26308079

RESUMO

Amyloidosis results from the pathologic deposition of beta pleated sheet fibrils within various organs including the kidney. Most often, the deposition is composed of the well-known monoclonal immunoglobulin light chains (AL) or serum amyloid A protein (AA). Recently, a new type of amyloidogenic protein was discovered, leukocyte chemotactic factor 2 (LECT2). This type of amyloid tends to have an affinity to kidney and liver and is recognized as a distinct clinico-pathologic type of amyloidosis, presenting with varying degrees of impaired kidney function and proteinuria. Herein, a case of this uncommon novel amyloidosis is presented with a brief review of the literature.


Assuntos
Amiloidose/patologia , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Nefropatias/patologia , Rim/metabolismo , Idoso , Amiloidose/metabolismo , Feminino , Humanos , Nefropatias/metabolismo
15.
BMJ Case Rep ; 20152015 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-26160551

RESUMO

Pompe disease, or glycogen storage disease type II (GSD2), an autosomal recessive disease first described by Joannes Cassianus Pompe (1901-1945), causes deficient activity of acid α-glucosidase (GAA) enzyme. GAA catalyses α 1,4 and α 1,6 glucosidic linkages in lysosomes; destruction of these linkages permits glycogen to be separated into glucose and later used for energy. Without proper function of this enzyme, glycogen accumulates in lysosome, causing muscle hypotonia. We report a previously undescribed association of c.1437G>A intron 9 substitution on the GAA gene with severe infantile-onset Pompe disease in a deceased proband and carrier status in four of five surviving family members. Previous authors have found late-onset or moderate severity infantile-onset Pompe disease associated with this allelic variation. Our proband's family's village was suspicious for locally endemic disease. While our proband developed all features of classic infantile onset GSD2, socioeconomic and geographic factors initially suggested an infectious aetiology.


Assuntos
Genótipo , Doença de Depósito de Glicogênio Tipo II/genética , Glicogênio/metabolismo , Íntrons , Fenótipo , Mutação Puntual , alfa-Glucosidases/genética , Alelos , Família , Triagem de Portadores Genéticos , Humanos , Lactente , Lisossomos/metabolismo , Masculino , Hipotonia Muscular/genética , Polimorfismo de Nucleotídeo Único
16.
ACG Case Rep J ; 2(4): 239-41, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26203451

RESUMO

Eosinophilic pancreatitis (EP) is a rare clinical entity, and few cases have been reported. It usually presents on imaging as a pancreatic mass leading to common bile duct obstruction and jaundice. Since it can mimic a malignancy, eosinophilic pancreatitis is often diagnosed after "false positive" pancreatic resections. To our knowledge, we report the only known case of EP in which the diagnosis was made by fine needle aspiration and core biopsy of the pancreas during EUS, sparing the patient a surgical resection. After a steroid course, there was improvement of clinical symptoms.

17.
Aesthethika (Ciudad Autón. B. Aires) ; 11(1): 45-53, abr.2015.
Artigo em Espanhol | LILACS | ID: lil-777926

RESUMO

Este artículo integra la introducción del libro de Julio Cabrera, Margens das Filosofias da Linguagem, cuya edición en español se encuentra en preparación. Se trata de una obra imprescindible tanto por la discusión que introduce como por el método con el que se la aborda. Desde los cronopios y las famas de Julio Cortázar hasta una discusión con los pensadores más relevantes de las disciplinas involucradas, el abordaje reúne rigurosidad y poesía...


Assuntos
Humanos , Idioma , Filosofia , Formação de Conceito , Métodos
18.
Rev. latinoam. bioét ; 14(2): 118-127, jul.-dic. 2014. ilus, tab
Artigo em Português | LILACS | ID: lil-724985

RESUMO

Dentro do atual panorama de crise global, tenta-se colocar em discussão a proposta do filósofo Martin Heidegger, que pode modificar a formulação de uma boa parte das questões bioéticas. O filósofo alemão apresenta uma nova noção do humano, não mais como "pessoa" ou "agente racional", mas como Dasein, como existente, mostrando seu confronto contra o paradigma baconiano-cartesiano, que tem norteado a atual visão tecnológica e capitalista do mundo. Heidegger sustenta que o perigo inicia-se desde uma visão do mundo como objeto de exploração, norteada pela metafísica como constante esquecimento da finitude, criando estruturas fixas de pensar. Segundo ele, a Modernidade foi construída em torno a três ideias: o sujeito como centro e fundamento, a ciência como critério único de verdade e o progresso e sua consequente tecnificação do mundo; haveria que liberar um espaço para outro tipo de criação que não exclua a técnica, mas que também não a enobreça a um ponto que o resto desapareça. Num plano mais próximo da Bioética, Heidegger pode ser extremamente instigante na questão da distinção saúde-doença e problemas como a medicalização, na tentativa de obter uma noção existencial destes conceitos, superando a sua visão metafísica tradicional. A saúde deixa de ser um acontecimento objetivo para transformar-se em projeto existencial.


Dentro del actual panorama de crisis global, se intenta poner en discusión la propuesta del filósofo Martin Heidegger, que puede modificar la formulación de una buena parte de las cuestiones bioéticas. El filósofo presenta una nueva noción de lo humano, no solo como "persona" o "agente racional". Según el concepto del Dasein, la modernidad fue construida en torno a tres ideas: el sujeto como centro y fundamento, la ciencia como criterio único de verdad en el progreso y su consecuente tecnificación del mundo; habría que liberar un espacio para otro tipo de creación que no excluya la técnica, pero que tampoco la exalte hasta el punto de que lo demás desaparezca. Heidegger puede ser extremadamente instigante en cuanto a la distinción salud-enfermedad y problemas como la medicalización, en el intento de obtener una noción existencial de estos conceptos, superando su visión metafísica tradicional. La salud entonces deja de ser un acontecimiento objetivo para transformarse en un proyecto existencial.


Within the present global crisis, we discuss some proposals of the philosopher Martin Heidegger concerning the human being that could sensibly modify the formulation of a good portion of bioethical questions. He introduces a new concept of human, not as a person or rational agent. According to Dasein modernity was built around three main ideas: the subject as a center, science as the sole criterion of truth and progress and the consequent technification of the world. There would have to liberate a place for another kind of creation that doesn't excludes the technical and neither stands out it to the point to make everything else disappear. Heidegger can be extremely useful on the issue of health-illness distinction and medicalization, in an attempt to obtain an existential notion of these concepts surpassing the traditional metaphysical view. Health is no longer a fact, but an existential project.


Assuntos
Humanos , Bioética , Filosofia , Temas Bioéticos , Medicalização
19.
Behav Res Methods ; 44(3): 753-64, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22090261

RESUMO

To control order effects in questionnaires containing paired comparisons, Ross (1934) described an optimal ordering of the pairings. The pairs can also be balanced so that every stimulus appears equal numbers of times as the first and the second member of a pair. First, we describe and illustrate the optimally spaced, balanced ordering of pairings. Then we show how the optimally spaced, balanced order can be used to implement a matrix-sampling design or a fully incomplete design when the number of stimuli n is so large that respondents cannot reasonably be expected to judge all n(n - 1)/2 pairs. The algorithm for balancing and optimally spacing the list of pairs is described.


Assuntos
Algoritmos , Comportamento de Escolha , Julgamento , Aprendizagem por Associação de Pares , Inquéritos e Questionários , Aprendizagem por Discriminação , Humanos , Modelos Estatísticos
20.
Medisur ; 9(1)2011.
Artigo em Espanhol | CUMED | ID: cum-48536

RESUMO

El comportamiento clínico y epidemiológico del asma bronquial en los adultos mayores, resulta un tópico casi desconocido en las investigaciones realizadas en el medio, porque los estudios de la población adulta incorporan a los asmáticos a partir del grupo de edad de 15 años y más. El asma bronquial está considerada como un problema de salud dada su alta prevalencia: alrededor del 10 por ciento de la población en Cuba la padece. En el anciano es una enfermedad subdiagnosticada y subtratada y por lo general confundida con la enfermedad pulmonar obstructiva crónica, por lo que reviste gran importancia su conocimiento para poder evaluar las peculiaridades presentes en los ancianos y de esta manera combatir esta afección de manera eficaz, y así favorecer la calidad de vida del asmático de la tercera edad(AU)


Clinical and epidemiological behaviour of bronchial asthma in elderlies is almost an unknown topic in the investigations carried out in the field, because studies conducted in adult population approach a single age group from 15 years old on. Bronchial asthma is considered a health problem given its high prevalence: about 10 percent of the Cuban population suffers from it. In elderlies it is an underdiagnosed and undertreated disease often confused with chronic lung disease, so it is very important to able to evaluate the specific characteristics it presents in elderlies in order to attack the disease effectively, and promote the life quality of asthmatic elderlies(AU)


Assuntos
Humanos , Idoso , Asma/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Cuba
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