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1.
Rev. colomb. anestesiol ; 47(3): 142-153, July-Sept. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-1013883

RESUMO

Abstract Introduction: Patients undergoing cardiac surgery frequently develop low cardiac output syndrome (LCOS). Multiple interventions including levosimendan have been used in the prevention and treatment of LCOS. Preliminary studies reported lower mortality respect to placebo or other inotropes, however, recently, 3 clinical trials found no benefit against this outcome. Objective: Our objective was to evaluate the evidence of levosimendan on mortality and secondary outcomes in patients undergoing cardiac surgery, and to determine the sources of heterogeneity. Methods: We conducted a systematic review and meta-analysis of the clinical trials that evaluated the efficacy of levosimendan in patients undergoing cardiac surgery. We obtained the odds ratio (OR) of mortality and other outcomes such as kidney injury with dialysis requirement and LCOS, using fixed and random effects models. The risk of bias was assessed and the sources of heterogeneity were explored. Results: Of 47 studies identified, 14 studies were selected (n=2752). Regarding the mortality outcome and use of levosimendan, only a decrease was found in the studies of low quality (OR 0,30; CI 95%, 0,18 to 0,51). While high-quality studies, there was no protective effect (OR 0.99,95% CI 0.70-1.40) with an I2 = 0%. The quality of the studies and ejection fraction were the main sources of heterogeneity. Conclusion: In high-quality studies, the use of levosimendan in patients undergoing cardiovascular surgery has no effect on 30-day mortality. There was a protective effect on postoperative renal failure with dialysis.


Resumen Introducción: Los pacientes llevados a cirugía cardiaca tienen riesgo de desarrollar síndrome de bajo gasto cardiaco posoperatorio (SBGC). Estudios previos han encontrado una menor mortalidad con levosimendán respecto a placebo u otros inotrópicos; sin embargo, tres experimentos clínicos no encontraron beneficio frente a este desenlace. Objetivo: Evaluar la evidencia del levosimendán sobre la mortalidad y los desenlaces secundarios en pacientes sometidos a cirugía cardiaca, y determinar las fuentes de heterogeneidad. Métodos: Mediante una revisión sistemática y metaanálisis de los experimentos clínicos que evaluaron la eficacia del levosimendán en los pacientes llevados a cirugía cardiaca, se evaluó la eficacia en la mortalidad y en otros desenlaces, como lesión renal y SBGC, utilizando los modelos de efectos fijos y aleatorios. Resultados: De 47 estudios identificados, fueron seleccionados 14 (n = 2752). Respecto al desenlace de mortalidad y el uso de levosimendán solo se encontró una disminución en los estudios de baja calidad (OR 0.30; IC 95%, 0.18-0.51), mientras que para los de alta calidad no hubo efecto protector (OR 0.99; IC 95%, 0.70-1.40) con un I2=0%. La calidad de los estudios y la fracción de eyección fueron las principales fuentes de heterogeneidad. Conclusión: el uso del levosimendán en los pacientes llevados a cirugía cardiovascular no tiene efectos sobre la mortalidad a 30 días en los estudios de alta calidad. Hubo efecto protector sobre la falla renal postoperatoria con necesidad de diálisis.

2.
Eur J Clin Nutr ; 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31383976

RESUMO

BACKGROUND/OBJECTIVES: We sought to determine the associations of n-3 and n-6 polyunsaturated fatty acids (PUFA) in middle childhood with externalizing and internalizing behavior problems in adolescence. SUBJECTS/METHODS: Using gas-liquid chromatography, we quantified n-3 and n-6 PUFA in serum samples of 444 Colombian schoolchildren aged 5-12 years at the time of enrollment into a cohort study. After a median 6 years, adolescent externalizing and internalizing behavior problems were determined with the Youth Self Report (YSR) questionnaire. We estimated adjusted mean behavior problem score differences with 95% confidence intervals (CIs) between quartiles of each PUFA using multivariable linear regression. We also considered as exposures the Δ6-desaturase (D6D) and Δ5-desaturase (D5D) enzyme activity indices. RESULTS: Docosahexaenoic acid (DHA) was positively associated with externalizing problems; every standard deviation (SD) of DHA concentration was associated with an adjusted one unit higher externalizing problem score (95% CI: 0.1, 1.9). The D5D enzyme activity index was inversely related to externalizing problem scores. Alpha-linolenic acid concentration was positively associated with internalizing problem scores, whereas adrenic acid was inversely related to this outcome. CONCLUSIONS: Serum PUFA in middle childhood were related to behavior problems in adolescence. Some of these associations might reflect the role of D5D enzyme activity.

3.
J Nutr ; 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429909

RESUMO

BACKGROUND: Vitamin D deficiency (VDD) is associated with depression and schizophrenia in adults. The effect of VDD in childhood on behavioral development is unknown. OBJECTIVES: We aimed to study the associations of VDD and vitamin D binding protein (DBP) in middle childhood with behavior problems in adolescence. METHODS: We quantified plasma total 25-hydroxyvitamin D [25(OH)D] and DBP in 273 schoolchildren aged 5-12 y at recruitment into a cohort study in Bogota, Colombia. Externalizing and internalizing behavior problems were assessed after a median 6-y follow-up by parental report [Child Behavior Checklist (CBCL)] and self-report [Youth Self-Report (YSR)]. We estimated mean problem score differences with 95% CIs between exposure categories using multivariable linear regression. We also compared the prevalence of clinical behavior problems (score >63) between exposure groups. We assessed whether the associations between DBP and behavior problems were mediated through VDD. RESULTS: Mean ± SD CBCL and YSR externalizing problems scores were 56.5 ± 9.3 and 53.2 ± 9.5, respectively. Internalizing problems scores averaged 57.1 ± 9.8 and 53.7 ± 9.8, respectively. VDD [25(OH)D <50 nmol/L] prevalence was 10.3%. VDD was associated with an adjusted 6.0 (95% CI: 3.0, 9.0) and 3.4 (95% CI: 0.1, 6.6) units higher CBCL and YSR externalizing problems scores, respectively, and an adjusted 3.6 (95% CI: 0.3, 6.9) units higher CBCL internalizing problems scores. The prevalence of clinical total externalizing problems was 1.8 (95% CI: 1.1, 3.1) times higher in children with VDD than that in children without VDD. DBP concentration below the population median was related to higher YSR aggressive behavior and anxious/depressed subscale scores and to higher prevalence of clinical total externalizing problems. The associations between DBP and behavior problems were not mediated through VDD. CONCLUSIONS: VDD and low DBP in middle childhood are related to behavior problems in adolescence.

4.
J Nutr ; 2018 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-29897579

RESUMO

Background: Iron deficiency (ID) in infancy is related to subsequent behavior problems. The effects of micronutrient status in middle childhood are uncertain. Objective: The aim of the study was to examine the associations of micronutrient status biomarkers in middle childhood with externalizing and internalizing behavior problems in adolescence. Methods: We assessed whether ID (ferritin <15 µg/L), anemia (hemoglobin <12.7 g/dL), or blood concentrations of zinc, vitamins A and B-12, and folate at ages 5-12 y were associated with externalizing or internalizing behavior problems in adolescence in 1042 schoolchildren from Bogotá, Colombia. Behavior problems were assessed with the Youth Self-Report questionnaire after a median 6.2 y of follow-up. Mean problem score differences with 95% CIs were estimated between categories of micronutrient status biomarkers with the use of multivariable linear regression. Results: Mean ± SD externalizing and internalizing problems scores were 52.6 ± 9.6 and 53.8 ± 9.9, respectively. Among boys, middle-childhood ID, anemia, and low plasma vitamin B-12 were associated with 5.9 (95% CI: 1.0, 10.7), 6.6 (95% CI: 1.9, 11.3), and 2.7 (95% CI: 0.4, 4.9) units higher mean externalizing problems scores in adolescence, respectively-after adjustment for baseline age, time spent watching television or playing video games, mother's height, and socioeconomic status. Also in boys, ID was related to an adjusted 6.4 (95% CI: 1.2, 11.6) units higher mean internalizing problems score. There were no associations among girls. Other micronutrient status biomarkers were not associated with behavior problems. Conclusions: ID, anemia, and low vitamin B-12 in middle childhood are related to behavior problems in adolescent boys. This study was registered at clinicaltrials.gov as NCT03297970.

5.
Rev. colomb. anestesiol ; 46(2): 177-177, Apr.-June 2018.
Artigo em Inglês | LILACS, COLNAL | ID: biblio-959799

RESUMO

Reply to Letter to the Editor


Assuntos
Humanos
6.
Br J Nutr ; 118(12): 1097-1105, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29199923

RESUMO

Childhood intake of animal foods is associated with age at first menstrual period (menarche). It is unknown whether the micronutrients present in these foods could explain this association. Our objective was to investigate the associations of micronutrient status biomarkers in middle childhood with age at menarche. We quantified circulating Hb, ferritin, mean corpuscular volume, Zn, vitamin B12, erythrocyte folate and retinol in 1464 pre-menarcheal girls aged 5-12 years in Bogotá, Colombia, and followed them for a median 5·7 years for the occurrence and date of menarche. We estimated median age at menarche and hazard ratios (HR) with 95 % CI by levels of each biomarker with use of Kaplan-Meier survival probabilities and Cox regression, respectively. Median age at menarche was 12·4 years. Middle childhood Hb was inversely related to age at menarche whereas plasma ferritin was positively associated with this outcome in a linear manner. HR of menarche for every 1 sd of Hb (11 g/l) and ferritin (23·2 µg/l) were 1·11 (95 % CI 1·04, 1·18; P=0·001) and 0·94 (95 % CI 0·88, 0·99; P=0·02), respectively, after adjustment for baseline age, C-reactive protein concentration, maternal age at menarche and parity and socioeconomic status. The association with ferritin was stronger in girls aged 9-10 years at baseline. Additional adjustment for baseline height- and BMI-for-age did not change the results. We conclude that higher Fe status in middle childhood is related to later age at menarche whereas Hb concentrations are inversely associated with age at onset of menses.


Assuntos
Menarca/sangue , Micronutrientes/sangue , Biomarcadores/sangue , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Criança , Colômbia/epidemiologia , Eritrócitos/metabolismo , Feminino , Ferritinas/sangue , Ácido Fólico/sangue , Seguimentos , Hemoglobinas/metabolismo , Humanos , Estudos Longitudinais , Micronutrientes/deficiência , Estado Nutricional , Modelos de Riscos Proporcionais , Fatores Socioeconômicos , Vitamina A/sangue , Vitamina B 12/sangue , Zinco/sangue
7.
Rev. colomb. anestesiol ; 45(1): 80-80, Jan.-June 2017.
Artigo em Inglês | LILACS, COLNAL | ID: biblio-900336

RESUMO

Letter to the Editor


Assuntos
Humanos
8.
Rev. colomb. anestesiol ; 45(1): 80-80, Jan.-June 2017.
Artigo em Inglês | LILACS, COLNAL | ID: biblio-959766

RESUMO

Letter to the Editor


Assuntos
Humanos
9.
Rev. costarric. cardiol ; 18(1/2): 5-11, ene.-dic. 2016. tab, ilus
Artigo em Espanhol | LILACS-Express | ID: biblio-960254

RESUMO

ResumenIntroducción:La dinámica cardíaca ha sido caracterizada a partir de la teoría de los sistemas dinámicos y la geometría fractal, permitiendo generar metodologías de aplicación clínica.Objetivo:desde los sistemas dinámicos, se desarrollará una metodología de evaluación de los pH y presiones de dióxido de carbono arteriales y venosos para pacientes de la Unidad de Cuidados Intensivos.Materiales y Métodos:se escogieron 10 pacientes con diversas patologías de la Unidad de Cuidados Intensivos Postqui rúrgicos del Hospital Militar Central, registrando pH y presiones de dióxido de carbono arteriales y venosas durante su tiempo de estancia; posteriormente se construyeron atractores, determinando su tipo de trayectoria y estableciendo los valores máximos y mínimos de estas variables en el mapa de retardo.Resultados:se encontró un comportamiento caótico de las variables evaluadas, hallando valores mínimos y máximos de 7,01 y 7,59 para pH arterial, 6,97 y 7,53 para pH venoso, 14,40 y 73,70 para presión arterial de dióxido de carbono, y 19,20 y 97,90 para presión venosa de dióxido de carbono.Conclusiones:La evaluación de los valores máximos y mínimos del atractor en el mapa de retardo constituye un nuevo método, objetivo y reproducible, para la evaluación matemática de cada una de las variables estudiadas, de utilidad para el seguimiento de pacientes en UCI.


SummaryIntroduction:Cardiac dynamics has been characterized from the theory of dynamical systems and fractal geometry, allowing to generate methodologies with clinical application. Objective: from dynamic systems, a methodology for evaluating the arterial and venous pH and dioxide of carbon pressures for patient in Intensive Care Unit will be developed.Materials and Methods:10 patients with various pathologies were selected from Post-surgical Intensive Care Unit of the Central Military Hospital, recording arterial and venous pH and dioxide of carbon pressures of during its stay; attractors were built subsequently, determining the type of path and setting the maximum and minimum values of these variables on the delay map.Results:chaotic behavior of the variables evaluated was found, finding maximum and minimum values of 7,01 and 7,59 for arterial pH values, 6,97 and 7,53 for venous pH, 14,40 and 73,70 for arterial dioxide of carbon pressure, and 19,20 and 97,90 for venous dioxide of carbon pressure.Conclusions:The evaluation of the maximum and minimum values of the attractor on the delay map is a new method, objective and reproducible for the mathematical evaluation of each of the variables studied, useful for monitoring patients in Intensive Care Unit.

10.
Rev. colomb. anestesiol ; 44(4): 299-304, Oct.-Dec. 2016. ilus, tab
Artigo em Inglês | LILACS, COLNAL | ID: biblio-830269

RESUMO

Introduction: The use of guidelines for goal-oriented resuscitation in patients with severe sepsis and septic shock has a positive impact on multiple organ failure and mortality outcomes. However, in patients over 65, adherence to the guidelines may be less stringent because of considerations of lower functional, cardiac, pulmonary and renal reserve. This study compares adherence to the guidelines and compliance with resuscitation goals by the healthcare staff in populations over and under 65 years of age. Objective: To determine adherence to the guidelines by the healthcare staff in the treatment of severe sepsis and septic shock in the group over 65 years of age, compared with patients under 65. Materials and methods: Observational, analytical, cross-sectional study of patients under and over 65 years of age admitted to the Intensive Care Unit (ICU) after having been diagnosed with severe sepsis and septic shock. Frequency of adherence to the guidelines was determined and a comparison of the different resuscitation goals in relation to adherence to the guidelines was made. Results: Except for adherence to early initiation of antibiotic therapy, there was better adherence to the other goals in the patients under 65 when compared to patients over 65. Adherence to the guidelines declined progressively as the number of goals increased. Conclusions: There was a lower adherence to resuscitation guidelines in the group of patients over 65 with severe sepsis and septic shock when compared with the group of patients under 65.


Introducción: El uso de guías de reanimación por metas en los pacientes con sepsis severa y choque séptico, genera un impacto benéfico en los desenlaces de disfunción orgánica múltiple y de la mortalidad, sin embargo en los pacientes mayores de 65 años, la adherencia a las guías puede ser menor, por la menor reserva funcional, cardíaca, pulmonar y renal. En el presente estudio comparamos la adherencia a la guía y el cumplimiento de las metas de reanimación por parte del personal de salud en la población mayor y menor de 65 años. Objetivo: Determinar la adherencia a las guías para el tratamiento de la sepsis severa y choque séptico por parte del personal de salud en el grupo mayor de 65 años comparado con el grupo de pacientes menores de 65 años.. Materiales y métodos: Estudio observacional analítico de corte transversal de los pacientes menores y mayores de 65 años ingresados a la Unidad de Cuidados Intensivos (UCI), con diagnóstico de sepsis severa y choque séptico, se determinó la frecuencia de adherencia a la guía para cada grupo de edades y se compararon las diferentes metas de reanimación en relación a la adherencia. Resultados: Excepto por la adherencia del inicio temprano de la antibiótico terapia, las demás metas presentaron una mejor adherencia, en el grupo de pacientes menores de 65 años cuando se compararon con los pacientes mayores de 65 años, la adherencia para ambos grupos disminuyo progresivamente a medida que se consideraron mayor número de metas. Conclusiones: Existe una menor adherencia a las guías de reanimación, en el grupo de grupo de pacientes mayores de 65 años con sepsis severa y choque séptico cuando se compara con el grupo de pacientes menores de 65 años.


Assuntos
Humanos
11.
Acta méd. colomb ; 41(3): 169-175, jul.-set. 2016. tab, graf
Artigo em Espanhol | LILACS-Express | ID: biblio-949509

RESUMO

Resumen Antecedentes: los valores de la diferencia alveolo arterial de oxígeno D(A-a)O2 y de la relación presión alveolar de oxígeno y fracción inspirada de oxígeno (PaO2/FiO2), son pobremente conocidos a gran altitud para predecir ventilación mecánica (VM) en pacientes con neumonía adquirida en comunidad (NAC) mayores de 65 años. Objetivo: conocer los valores de D(A-a)O2 y PaO2/FiO2 en pacientes con NAC que requirieron soporte ventilatorio. Métodos: estudio de cohorte prospectivo donde se obtuvo la D(A-a)O2 y PaO2/FiO2 de los gases arteriales de ingreso a urgencias, con cálculo de sensibilidad (S), especificidad (E), valor predictivo positivo (VPP), valor predictivo negativo VPN) y área bajo la curva ROC para el requerimiento de VM en las primeras 72 horas. Resultados: se siguieron 247 pacientes, 37 (15%) requirieron VM, no se encontraron diferencias en edad, género, y comorbilidades entre los grupos de VM y no VM. El área bajo la curva ROC para D(A-a) O2 como predictor de VM fue de 0.84 (IC95%:0.77-0.92), para la PaO2/FiO2 de 0.85 (IC 5%: 0.78-0.92) (p<0.0001). Para una D(A-a)O2 en 55 se obtuvo una sensibilidad para predecir VM en 70.27%, especificidad 86.19%, VPP: 47%, VPN: 94%, razón de verosimilitud positiva (LR+): 5.1, razón de verosimilitud negativa (LR-): 0.3. Una PaO2/FiO2 de 180 tiene una sensibilidad para predecir VM de: 86.65%, especificidad: 70.27%, VPP: 34%, VPN: 97%, LR+: 2.9, LR-: 0.2. La mortalidad global fue 3.2%. Conclusión: los valores de D(A-a)O2 y PaO2/FiO2 se relacionan con el requerimiento de VM en pacientes mayores de 65 años con NAC. (Acta Med Colomb 2016; 41: 169-175).


Abstract Background: the values of the difference of alveolar arterial oxygen D(A-a)O2 and ratio of the alveolar oxygen pressure and fraction of inspired oxygen (PaO2/FiO2) are poorly known at high altitude to predict mechanical ventilation (MV) in patients over 65 years with community-acquired pneumonia (CAP). Objective: to know the values of D(A-a)O2 and PaO2/FiO2 in CAP patients requiring ventilatory support. Methods: prospective cohort study where D(A-a)O2 y PaO2/FiO2 were obtained from arterial blood gases at entrance to the emergency room, with calculation of sensitivity (S), specificity (E), positive predictive value (PPV), negative predictive value (NPP) and area under the ROC curve for MV requirement within the first 72 hours. Results: 247 patients were followed; 37 (15%) required MV. No differences were found in age, gender and comorbidities between the groups of MV and no MV. The area under the ROC curve for D(A-a) O2 as a predictor of MV was 0.84 (95% CI: 0.77 to 0.92), for the la PaO2/FiO2 of 0.85 (95% CI: 0.78 to 0.92) (p <0.0001). For a D(A-a)O2 in 55 patients was obtained a sensibility to predict MV in 70.27%, specificity 86.19%, PPV 47%, NPV 94%, positive likelihood ratio (LR +): 5.1, negative likelihood ratio (LR -): 0.3. A PaO2/FiO2 of 180 has a sensitivity to predict MV of 86.65%, specificity: 70.27%, PPV 34%, NPV 97%, LR +: 2.9, LR: 0.2. Overall mortality was 3.2%. Conclusion: the values of D(A-a)O2 and PaO2/FiO2 relate to the requirement of MV in patients older than 65 with CAP. (Acta Med Colomb 2016; 41: 169-175).

12.
Rev. colomb. anestesiol ; 44(3): 193-200, July-Sep. 2016. ilus, tab
Artigo em Inglês | LILACS, COLNAL | ID: lil-791215

RESUMO

Introduction: There are two different pharmacokinetic models (Marsh and Schnider) for the administration of total intravenous anesthesia with propofol, the parameter differences could have some impact over the depth of anesthesia. Objective: To determine if there is a significant difference in the variability of depth of anesthesia suggesting that one model is superior in achieving a more stable and predictable depth of anesthesia during surgery. Methods: A cross-over clinical trial was conducted on 16 healthy patients programmed for upper or lower limb ambulatory orthopedic surgery. Patients were randomly assigned to (i) effect site target controlled infusion of propofol with Marsh model at a target concentration of 2.5 μg/ml for 20 min, a 20 min washout, then propofol was administered with Schnider model at the same effect site target for the reminder of the surgery, or (ii) the reverse sequence. Differences in variability of depth of anesthesia, were assessed by comparing records of spectral entropy indices during surgery through an unpaired t-test. Results: There was no evidence of significant difference in the mean variances of either spectral entropy indices between the two models (p-value: 0.57 for State Entropy, p-value: 0.51 for Response Entropy). Conclusion: The study suggests that both pharmacokinetic models are equivalent in terms of stability of depth of anesthesia. It is important to keep testing determinants of the efficacy of the models in different types of population because their behavior according to individual characteristics of patients or variables such as cost-effectiveness could end up tilting the scale.


Introducción: Hay dos modelos farmacocinéticos diferentes para la administración de la anestesia total intravenosa con propofol (Marsh y Schnider), las diferencias entre los parámetros podrían tener algún impacto sobre la profundidad anestésica. Objetivo: Comparar la variabilidad de la profundidad anestésica durante administración de infusión de propofol con los modelos de Marsh y Schnider para determinar si hay diferencias significativas que sugieran que uno de los modelos es superior en lograr una profundidad anestésica más estable y predecible. Métodos: Estudio clínico cruzado, controlado y aleatorizado llevado a cabo en 16 pacientes programados para cirugía ambulatoria de ortopedia. Los pacientes fueron asignados aleatoriamente a i) infusión controlada por objetivo de propofol con el modelo de Marsh a una concentración objetivo en sitio de efecto de 2.5μg/ml durante 20 minutos, 20 minutos de periodo de lavado, seguido de infusión de propofol con modelo de Schnider a la misma concentración objetivo; o ii) la secuencia inversa. La diferencia en variabilidad de profundidad anestésica fue evaluada mediante la comparación de registros de índices de entropía con una prueba t no pareada. Resultados: No se encontró evidencia de diferencias significativas de la varianza media en los índices de entropía espectral asociada a los modelos (valor-p: 0.57 para entropía de estado, valor-p: 0.51 para entropía de respuesta). Conclusión: El estudio sugiere que ambos modelos son equivalentes en términos de estabilidad de profundidad anestésica. Es importante continuar estudiando la eficacia de los modelos en diferentes tipos de población, dado que su comportamiento según características individuales de los pacientes o variables cómo costo-efectividad podrían inclinar la balanza.


Assuntos
Humanos
13.
Rev. MED ; 24(1): 46-58, ene.-jun. 2016. ilus, tab
Artigo em Espanhol | LILACS-Express | ID: biblio-957282

RESUMO

Objetivo: Evaluar la eficacia a 6 meses del trasplante autólogo de células madre CD34+ de médula ósea "potenciado", mediante pre-condicionamiento isquémico en pacientes con angina refractaria. Métodos: Estudio piloto con 14 pacientes con angina refractaria, clase funcional clínica mayor o igual a III (NYHA y CCS), del Servicio de Cardiología del Hospital Militar Central. Fueron seleccionados por conveniencia 14 pacientes los cuales se asignaron aleatoriamente a 2 grupos, el primero (intervención) con trasplante autólogo de células madre CD34+ de médula ósea potenciado mediante pre-condicionamiento isquémico por vía intravenosa más tratamiento médico convencional, y el segundo (control) con tratamiento médico convencional. Se realizaron mediciones basales a 6 meses del umbral de angina/isquemia medido en mets y clase funcional. Resultados: Al comparar las medianas, el cambio en el valor umbral de angina/isquemia 6 meses después, para el grupo intervenido fue de 3.5 mets vs 0.9 mets, para el grupo control P= 0.013. No se registraron complicaciones inherentes al tratamiento. Conclusiones: En esta investigación, los pacientes con angina refractaria intervenidos con trasplante autólogo de células madre de médula ósea CD34+ potenciado mediante pre-condicionamiento isquémico mostraron mejoría del umbral de angina y clase funcional a 6 meses.


Objective: To evaluate the efficacy of 6 months of autologous CD34+ stem cells in bone marrow "enhanced" by ischemic preconditioning in patients with refractory angina. Methods: A pilot study with 14 patients with refractory angina, with a functional class greater than or equal to III clinical (NYHA and CCS), of the Department of Cardiology of the Central Military Hospital. They were selected by convenience 14 patients who were randomly assigned to two groups, the first (intervention) with autologous stem cells CD34+ bone marrow powered by ischemic preconditioning, intravenously more conventional medical treatment, and the second (control) with conventional medical treatment. Baseline measurements were performed and six months' threshold angina/ischemia measured in mets and functional class. Results: Comparing the medians, the change in threshold value angina/ischemia six months later for the intervention group was 3.5 mets vs 0.9 mets for the control group P = 0.013. No inherent complications to treatment were recorded. Conclusions: In this study patients with refractory angina who underwent autologous stem cell transplant of bone marrow CD34+ powered by ischemic preconditioning, showed an improvement in threshold angina and functional class of 6 months.


Objetivo: Avaliar a eficácia de 6 meses de células-tronco autólogas CD34+ na medula óssea "aumentada" pelo pré-condicionamento isquêmico em pacientes com angina refratária. Métodos: Um estudo piloto com 14 pacientes com angina refratária, com classe funcional maior ou igual a III clínica (NYHA e CCS), Do Departamento de Cardiologia do Hospital Militar Central. Eles foram selecionados por conveniência 14 pacientes que foram aleatoriamente designados para dois grupos, a primeira (intervenção) com células- tronco autólogas CD34+ medula óssea alimentado por pré-condicionamento isquêmico, tratamento intravenoso mais convencional, e o segundo (controle) com tratamento médico convencional. Medidas de linha de base foram realizadas e seis meses de angina limiar /isquemia medido em mets e classe funcional. Resultados: Comparando as mediana, a alteração do valor limiar angina / isquemia seis meses depois para o grupo de intervenção foi de 3,5 mets vs 0,9 mets para o grupo de controlo P = 0,013. Não foram registadas complicações inerentes ao tratamento. Conclusões: Neste estudo, pacientes com angina refratária submetidos a transplante de células-tronco autólogas de medula óssea CD34+ alimentado por pré-condicionamento isquêmico, apresentaram melhora da angina limiar e classe funcional de 6 meses.

14.
Rev. colomb. anestesiol ; 43(2): 160-162, Apr.-June 2015.
Artigo em Inglês | LILACS, COLNAL | ID: lil-749501

RESUMO

The mechanism of barotrauma and volutrauma has been described since the 70s in patients with acute lung injury and acute respiratory distress syndrome receiving high tidal volume ventilation (10-15 ml/kg ideal body weight). This led to the development of controlled clinical trials in an attempt to determine the ideal tidal volume. Different forms of mechanical ventilation were proposed in the 90s using tidal volumes ranging between 3-12 ml/kg of the estimated weight. However, it was only in 2000 when the ARMA study published by the ARDS Network provided recommendations for low-volume mechanical ventilation (6 ml/kg) and airway plateau pressures under 30 cm H2O, leading to a significant reduction in mortality, from 40% down to 31% in patients with ARDS. Since then, the protective ventilation strategy has been broadened to include other types of patients, including those taken to elective surgery, although not taking into consideration the large difference in the pathophysiology of ventilation between diseased and healthy lungs, or the different consequences. Despite this, some clinical trials have found the benefit of low tidal volume ventilation in terms of pulmonary infection and, mortality outcomes. However, other studies like ours have shown an increase in 30-day mortality.


Assuntos
Humanos
15.
Acta neurol. colomb ; 30(3): 149-155, jul.-sep. 2014. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-731687

RESUMO

Los factores epidemiológicos y las características clínicas de la Enfermedad Cerebrovascular(ECV) varían de acuerdo a factores ambientales, raciales, de género y socioculturales; por tal razón, el conocimientode dichos factores epidemiológicos de riesgo para ECV en nuestra población tiene gran importanciay aporta elementos claves en términos de salud pública.Objetivos. Determinar la frecuencia de los factores de riesgo para el desarrollo de ECV y su tiempo de evolución,así como el número de pacientes que reciben tratamiento para dichos factores de riesgo, la adherenciaal mismo y el seguimiento de recomendaciones de dieta y actividad física.Materiales y métodos. Se realizó un estudio observacional, tipo serie de casos, en pacientes mayores de 18años que consultaron por ECV isquémico en el periodo comprendido entre enero de 2009 hasta septiembrede 2013. Los pacientes se identificaron a través de los códigos CIE-10 contenidos en la base de datos de lainstitución para obtener los registros que incluyeran un diagnóstico principal o relacionado de EnfermedadCerebrovascular Isquémica.Resultados. El promedio de edad fue de 72.7 (SD 12.7) años. Hubo predominio del sexo masculino (50.4%).Conclusiones. La frecuencia de factores de riesgo para ECV parece haber aumentado respecto a publicacionesprevias, posiblemente por modificaciones no saludables en el estilo de vida de la población. El presente estudio brinda información respecto al tratamiento y adherencia farmacológica, ya que realizar un diagnóstico correctode factores de riesgo es muy importante; así mismo, es fundamental instaurar un tratamiento adecuado y, sobre todo, que los pacientes sean adherentes con la terapia para obtener los resultados esperados...


to environmental racial, gender and cultural factors, for this reason, knowledge of the epidemiology of CVDrisk factors in our population is very important and provides key elements in terms of public health.Objective. To determine the frequency of risk factors for the development of CVD and its development time,as well and the number of patients receiving treatment for these risk factors, their adherence to it, in terms offollowing recommendations of diet and physical activity.Materials and Methods. We performed an observational, case series, in patients over 18 years old whoconsulted for ischemic CVD in the period between January 2009 and September 2013. Patients were identifiedby ICD-10 codes in the database for those records or associated with a diagnosis of Ischemic CerebrovascularDisease. Thus, 220 patients met the inclusion criteria. For data collection, a questionnaire was designed to beapplied to each of the records. The information collected was entered in a database in Excel. Descriptive analysiswas performed using STATA statistical software version 12.0. Measures of central tendency and dispersionfor continuous variables and frequencies and proportions for nominal and ordinal variables were estimated...


Assuntos
Humanos , Ataque Isquêmico Transitório , Neurologia , Fatores de Risco
16.
Am J Trop Med Hyg ; 91(1): 50-3, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24799373

RESUMO

Risk factors for progression from acute malaria to multiple organ dysfunction syndrome (MODS) are poorly understood. The MODS is commonly diagnosed with the sequential organ failure assessment (SOFA) scale, but this scale has been understudied in patients with severe malaria. We conducted a cohort study among 426 adult males admitted to hospital with malaria in Bogotá, Colombia. We estimated SOFA scores and relative risks (RRs) for MODS during hospitalization according to patients' characteristics on admission. Risk of MODS was 7.3% over a median 6.0 days in hospital. Baseline hemoglobin was strongly, inversely associated with MODS (adjusted RR for hemoglobin ≤ 8.5 g/dL versus hemoglobin > 11 g/dL = 9.5, 95% confidence interval [CI]: 3.6, 25.3). Plasmodium falciparum malaria and parasitemia were positively associated with MODS. There was a strong interaction between baseline parasitemia and hemoglobin on MODS risk. In conclusion, the use of parasitemia and hemoglobin on admission to identify high-risk patients deserves consideration.


Assuntos
Hemoglobinas/metabolismo , Malária Falciparum/parasitologia , Insuficiência de Múltiplos Órgãos/parasitologia , Parasitemia/parasitologia , Doença Aguda , Adolescente , Adulto , Estudos de Coortes , Colômbia , Hospitalização/estatística & dados numéricos , Humanos , Malária Falciparum/sangue , Malária Falciparum/complicações , Masculino , Insuficiência de Múltiplos Órgãos/sangue , Insuficiência de Múltiplos Órgãos/etiologia , Parasitemia/sangue , Parasitemia/complicações , Plasmodium falciparum/fisiologia , Risco
17.
Rev. colomb. anestesiol ; 40(3): 173-174, jul.-oct. 2012.
Artigo em Espanhol | LILACS, COLNAL | ID: lil-663755

RESUMO

La evaluación de los trastornos de la coagulación que presentan los pacientes críticos tradicionalmente se realiza basándose en el tiempo parcial de tromboplastina (PTT) activada y en el tiempo de protrombina (PT) normalizado utilizando el índice internacional normalizado (INR), que nos dan una información del tiempo de formación del coágulo después de la adición de reactivos exógenos. El PTT fue diseñado para determinar deficiencias en los factores VII, IX y XI, mientras que el PT, por su parte, lo fue para detectar deficiencias en los factores II, V, VII y X, y desde el punto de vista clínico se utiliza para el seguimiento de los pacientes que están siendo tratados con warfarina


Assuntos
Humanos
18.
Matern Child Health J ; 16(4): 753-9, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-21516299

RESUMO

Low birthweight and preterm birth are associated with adverse health outcomes later in life, but acquisition of accurate birthweight information is not always feasible in large epidemiological studies. We examined the validity of child birthweight and gestational age recall by mothers, and the extent to which recall bias affects associations between birthweight and childhood obesity in children from Bogotá, Colombia. We surveyed mothers of 3,202 schoolchildren aged 5-12 years about child's weight and gestational age at birth, and sociodemographic characteristics. In a subsample of 279 children, we obtained hospital birth records and extracted birthweight, gestational age, and other perinatal information. Mean birthweight (SD) was 3,106 (739) grams according to maternal recall and 2,977 (462) grams according to hospital records (difference 129 g; 95% CI = 55, 203). Thirty-three percent of mothers recalled their children's birthweights exactly as they appeared in hospital records. Mother's age and fewer years of education were each significantly associated with greater birthweight recall bias. Specificity of low birthweight (<2,500 g) and preterm birth (<37 weeks gestation) from maternal recall was 0.95 and 0.86, respectively; however, sensitivity was lower (0.66 and 0.67, respectively). Associations between recalled birthweight and BMI-for-age or overweight during school age were weaker than those with hospital record birthweight. Maternal birthweight recall 5-12 years after birth differs from hospital record birthweight by a clinically meaningful amount. Birthweight recall should be used with caution in epidemiological studies conducted in this and comparable settings. Associations between birthweight and obesity may be stronger than they appear when using recalled birthweight.


Assuntos
Peso ao Nascer , Idade Gestacional , Rememoração Mental , Mães/psicologia , Adulto , Criança , Pré-Escolar , Colômbia , Escolaridade , Feminino , Inquéritos Epidemiológicos , Registros Hospitalares , Humanos , Modelos Logísticos , Masculino , Idade Materna , Obesidade/etiologia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Adulto Jovem
19.
J Crit Care ; 27(1): 104.e9-17, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21703811

RESUMO

OBJECTIVE: The aim of this study was to determine the differences in the efficacy and efficiency in providing critical care to hospitalized patients in teaching vs nonteaching intensive care units (ICUs) in Colombia. METHODS: A prospective cohort observational study was conducted. LOCATION: This study was conducted in 11 teaching and 8 nonteaching ICUs. From June 1 until December 31, 2005, data on 826 patients admitted consecutively to teaching ICUs and 825 patients admitted to nonteaching ICUs were analyzed. MEASUREMENTS: Acute Physiology and Chronic Health Evaluation II, Simplified Therapeutic Intervention Scoring System, ICU discharge status (dead or alive) and ICU length of stay, and standardized mortality ratios were considered in this study. A logistic regression and robust linear regression were performed. RESULTS: There were no differences in mortality (P = .25). Standardized mortality was less than 1 for both types of units. The teaching ICUs length of stay was 1 day longer (P < .01). Resource use is 25% higher in teaching units (P = .01). When the Simplified Therapeutic Intervention Scoring System score on the last day was from 21 to 35, a higher ratio of patients from the nonteaching ICUs was observed going floor or home when discharged from the ICU (P < .01). CONCLUSIONS: Nonteaching ICUs discharge patients earlier than do teaching ICUs, but the effect of it remains to be clarified with further studies addressing questions as what happens after ICU discharge.


Assuntos
Cuidados Críticos/organização & administração , Hospitais de Ensino/organização & administração , Unidades de Terapia Intensiva/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Colômbia , Cuidados Críticos/estatística & dados numéricos , Eficiência Organizacional , Feminino , Mortalidade Hospitalar , Hospitais de Ensino/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
20.
Cleft Palate Craniofac J ; 48(2): 145-9, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20500068

RESUMO

OBJECTIVE: The aim of this study is to compare patients treated with pharyngoplasty and those treated with palatoplasty for velopharyngeal insufficiency to establish what surgical procedure poses the highest risk for developing sleep apnea. The hypothesis tested in this study is that the incidence of obstructive sleep apnea syndrome associated with pharyngoplasty is greater than that associated with palatoplasty for velopharyngeal insufficiency. SUBJECTS: Twenty patients were taken from the Institution FISULAB. DESIGN: Observational cohort analytic study. MAIN OUTCOME MEASURES: An overnight polysomnographic study was used to determine the incidence and severity of obstructive sleep apnea syndrome. RESULTS: The incidence of obstructive sleep apnea syndrome following pharyngoplasty was shown to be significantly higher than after palatoplasty. The apnea-hypopnea index, also called the respiratory disturbance index, was 12.7 in the pharyngoplasty group and 1.35 in the palatoplasty group (p < .001). When obstructive sleep apnea syndrome was stratified into different levels of severity according to the values of respiratory disturbance index, there were noticeable differences between these two groups. In the palatoplasty group, one patient had mild obstructive sleep apnea syndrome. In the pharyngoplasty group, two patients had mild obstructive sleep apnea syndrome, one patient had moderate obstructive sleep apnea syndrome, and two patients had severe obstructive sleep apnea syndrome. CONCLUSIONS: When comparing the apnea-hypopnea index (i.e., respiratory disturbance index) of patients treated for velopharyngeal insufficiency with palatoplasty versus pharyngoplasty, we observed an important difference between the groups, with the highest indices in the pharyngoplasty group.


Assuntos
Palato/cirurgia , Faringe/cirurgia , Apneia Obstrutiva do Sono/prevenção & controle , Insuficiência Velofaríngea/cirurgia , Adolescente , Adulto , Feminino , Humanos , Palato/fisiopatologia , Faringe/fisiopatologia , Polissonografia , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/fisiopatologia , Resultado do Tratamento , Insuficiência Velofaríngea/fisiopatologia
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