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1.
MMWR Morb Mortal Wkly Rep ; 69(1): 1-5, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31917782

RESUMO

In May 2018, a study of birth defects in infants born to women with diagnosed human immunodeficiency virus (HIV) infection in Botswana reported an eightfold increased risk for neural tube defects (NTDs) among births with periconceptional exposure to antiretroviral therapy (ART) that included the integrase inhibitor dolutegravir (DTG) compared with other ART regimens (1). The World Health Organization* (WHO) and the U.S. Department of Health and Human Services† (HHS) promptly issued interim guidance limiting the initiation of DTG during early pregnancy and in women of childbearing age with HIV who desire pregnancy or are sexually active and not using effective contraception. On the basis of additional data, WHO now recommends DTG as a preferred treatment option for all populations, including women of childbearing age and pregnant women. Similarly, the U.S. recommendations currently state that DTG is a preferred antiretroviral drug throughout pregnancy (with provider-patient counseling) and as an alternative antiretroviral drug in women who are trying to conceive.§ Since 1981 and 1994, CDC has supported separate surveillance programs for HIV/acquired immunodeficiency syndrome (AIDS) (2) and birth defects (3) in state health departments. These two surveillance programs can inform public health programs and policy, linkage to care, and research activities. Because birth defects surveillance programs do not collect HIV status, and HIV surveillance programs do not routinely collect data on occurrence of birth defects, the related data have not been used by CDC to characterize birth defects in births to women with HIV. Data from these two programs were linked to estimate overall prevalence of NTDs and prevalence of NTDs in HIV-exposed pregnancies during 2013-2017 for 15 participating jurisdictions. Prevalence of NTDs in pregnancies among women with diagnosed HIV infection was 7.0 per 10,000 live births, similar to that among the general population in these 15 jurisdictions, and the U.S. estimate based on data from 24 states. Successful linking of data from birth defects and HIV/AIDS surveillance programs for pregnancies among women with diagnosed HIV infection suggests that similar data linkages might be used to characterize possible associations between maternal diseases or maternal use of medications, such as integrase strand transfer inhibitors used to manage HIV, and pregnancy outcomes. Although no difference in NTD prevalence in HIV-exposed pregnancies was found, data on the use of integrase strand transfer inhibitors in pregnancy are needed to understand the safety and risks of these drugs during pregnancy.


Assuntos
Infecções por HIV/diagnóstico , Defeitos do Tubo Neural/epidemiologia , Complicações Infecciosas na Gravidez/diagnóstico , Adolescente , Adulto , Antirretrovirais/efeitos adversos , Antirretrovirais/uso terapêutico , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Estados Unidos/epidemiologia , Adulto Jovem
2.
AIDS ; 33(9): 1537-1539, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31259770
3.
AIDS ; 32(13): 1821-1828, 2018 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-29894382

RESUMO

OBJECTIVE: The aim of this study was to evaluate the transition process from paediatric to adult care among persons with perinatal HIV infection in New York City (NYC). DESIGN: A retrospective prepost study and a matched exposed/unexposed nested cohort study. METHODS: Using data from the NYC HIV registry, a retrospective prepost study was performed among persons who transitioned from paediatric to adult care to assess pre and posttransition retention in care (≥1 CD4 cell count/viral load in a 12-month period), CD4 cell count and viral suppression (≤200 copies/ml). A 1 : 3 matched exposed/unexposed nested cohort study was conducted to assess pre and posttransition 1-year mortality by matching persons who transitioned to adult care and persons who remained in paediatric care on calendar year (±1 year) and age at transition (±1 year). RESULTS: A total of 735 persons with perinatal HIV infection transitioned to adult care in NYC during 2006-2015, of whom 53.9% were women, 57.7% black and 37.1% Hispanic. Pretransition (Year 0), and posttransition Year 1, Year 2 and Year 3 proportions of persons with CD4 cell count at least 500 cells/µl were 35.2, 38.3, 38.9 and 39.0%, respectively, and viral suppression were 45.9, 48.6, 51.1 and 51.8%, respectively. One-year mortality rates before and after transition were 2.3/1000 and 55.8/1000, respectively. CONCLUSION: Persons with perinatal HIV infection in NYC who transitioned from paediatric to adult care saw improvements in CD4 cell count and viral suppression after transition. The increase in mortality after transition was likely caused by the conditions before or leading to the transition.


Assuntos
Continuidade da Assistência ao Paciente , Gerenciamento Clínico , Infecções por HIV/terapia , Pesquisa sobre Serviços de Saúde , Adolescente , Adulto , Contagem de Linfócito CD4 , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Cidade de Nova Iorque , Estudos Retrospectivos , Análise de Sobrevida , Carga Viral , Adulto Jovem
4.
Paediatr Anaesth ; 28(3): 287-290, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29285839

RESUMO

BACKGROUND: Children that have had a meningomyelocele repair often present for hip and bilateral lower limb surgeries. Due to vertebral, epidural, and nerve root abnormalities, placement of epidural catheter is difficult. AIMS: We aim to describe the potential role of ultrasound in delineating the most appropriate intervertebral space for central neuroaxial blocks in these patients. METHODS: Twelve children with previous meningomyelocele repair, in the age group of 6-12 years posted for hip or bilateral lower limb surgeries were included. After induction of anesthesia, an ultrasound scan was done with the patient in the left lateral position. The central neuroaxial block was performed in the most appropriate intervertebral space seen on transverse scan of spine. These patients were studied with regard to visibility of the osseous framework of the spine, the anterior and posterior dural complexes, ease of insertion of catheter, evidence of dural puncture, and possibility of identification of the extent of peri-incisional fibrosis. RESULTS: One case required 2 attempts. There was no evidence of dural puncture. We could confirm the soft tissue shadow, the osseous framework, and the anterior and posterior dural complexes in all 12 patients. Ultrasonography guided in selecting the most appropriate space for epidural catheter placement. CONCLUSION: Ultrasound guidance aids in identification of normal intervertebral space and explicitly shows the abnormal space. It can be used as an aid to differentiate between normal and abnormal space in post-meningomyelocele repair.


Assuntos
Anestesia Epidural/métodos , Extremidade Inferior/cirurgia , Meningomielocele/cirurgia , Ultrassonografia de Intervenção/métodos , Criança , Pré-Escolar , Espaço Epidural/diagnóstico por imagem , Feminino , Pé/cirurgia , Quadril/cirurgia , Humanos , Masculino , Procedimentos Ortopédicos/métodos , Coluna Vertebral/diagnóstico por imagem
5.
Anesth Essays Res ; 11(3): 751-757, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28928582

RESUMO

BACKGROUND: In this meta-analysis, we explore the role of repetitive transcranial magnetic stimulation (rTMS), a noninvasive neuromodulation technique in the treatment of chronic pain. METHODS: Studies comparing rTMS and conventional treatment for chronic pain were searched. The comparison was made for decrease in the pain scores with and without (sham) the use of rTMS after a follow-up interval of 4-8 weeks. All reported pain scores were converted into a common scale ranging from "0" (no pain) to "10" (worst pain). RESULTS: Nine trials with 183 patients in each of the groups were included in the analysis. The decrease in pain scores with rTMS was 1.12 (95% confidence interval [CI] being 1.46-0.78) (fixed effects, I2 = 0%, P < 0.001) and in sham-rTMS was 0.28 (95% CI being 0.49-0.07) (Fixed effects, I2 = 0, P = 0.01). The pooled mean drop in pain scores with rTMS therapy was higher by 0.79 (95% CI being 0.26-1.33) (fixed effects, I2 = 0, P < 0.01). The duration and frequency of rTMS were highly variable across trials. Publication bias was unlikely (Egger's test, X-intercept = 0.13, P = 0.75). CONCLUSIONS: Use of rTMS improves the efficacy of conventional medical treatment in chronic pain patients. This treatment is not associated with any direct adverse effects. However, the duration and frequency of rTMS therapy is presently highly variable and needs standardization.

6.
Public Health Rep ; 131(4): 566-73, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27453601

RESUMO

OBJECTIVE: The HIV care continuum outlines the steps from HIV infection to diagnosis, linkage to care, and viral suppression among people living with HIV. We examined data for steps along the HIV care continuum among people living with perinatally acquired infection in New York City using surveillance data. METHODS: This study included data for people who acquired HIV infection perinatally and lived in New York City as of December 31, 2014. We defined "in care" as having ≥1 CD4 or viral load test in 2014, "in continuous care" as having ≥2 CD4 or viral load tests ≥3 months apart in 2014, and "virally suppressed" as having a viral load of #200 copies per milliliter in the most recent test in 2014. We estimated factors associated with viral suppression from a weighted log-binomial regression model that included sex, race/ethnicity, age, and country of birth as independent variables. RESULTS: As of December 31, 2014, an estimated 1,596 people were living with perinatally acquired HIV infection in New York City. All were diagnosed, 96% were in care, 80% were in continuous care, and 61% were virally suppressed. The multivariable analysis showed significant differences in viral suppression by race/ethnicity and age. Black patients (59%, 534/907) were the least likely of all racial/ethnic groups examined to have a suppressed viral load. By age, compared with 73% (80/109) of children aged 0-12 years who were virally suppressed, 58% (568/987) of adults aged 20-29 years and 56% (54/96) of adults aged 30-39 years were virally suppressed; the adjusted prevalence ratio was 0.80 (95% confidence interval [CI] 0.69, 0.92) for those aged 20-29 years and 0.79 (95% CI 0.63, 0.99) for those aged 30-39 years. CONCLUSION: The low level of viral suppression among people living with perinatally acquired infection found in this study warrants further exploration to identify the best management strategies to improve viral suppression in this population, especially those transitioning from pediatric to adult health care.


Assuntos
Continuidade da Assistência ao Paciente , Infecções por HIV/epidemiologia , Vigilância da População , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Lactente , Masculino , Cidade de Nova Iorque/epidemiologia , Prevalência , Adulto Jovem
7.
Lung ; 194(2): 201-17, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26896040

RESUMO

INTRODUCTION: Prophylactic continuous positive airway pressure (CPAP) can prevent pulmonary adverse events following upper abdominal surgeries. The present meta-regression evaluates and quantifies the effect of degree/duration of (CPAP) on the incidence of postoperative pulmonary events. METHODS: Medical databases were searched for randomized controlled trials involving adult patients, comparing the outcome in those receiving prophylactic postoperative CPAP versus no CPAP, undergoing high-risk abdominal surgeries. Our meta-analysis evaluated the relationship between the postoperative pulmonary complications and the use of CPAP. Furthermore, meta-regression was used to quantify the effect of cumulative duration and degree of CPAP on the measured outcomes. RESULTS: Seventy-three potentially relevant studies were identified, of which 11 had appropriate data, allowing us to compare a total of 362 and 363 patients in CPAP and control groups, respectively. Qualitatively, Odds ratio for CPAP showed protective effect for pneumonia [0.39 (0.19-0.78)], atelectasis [0.51 (0.32-0.80)] and pulmonary complications [0.37 (0.24-0.56)] with zero heterogeneity. For prevention of pulmonary complications, odds ratio was better for continuous than intermittent CPAP. Meta-regression demonstrated a positive correlation between the degree of CPAP and the incidence of pneumonia with a regression coefficient of +0.61 (95 % CI 0.02-1.21, P = 0.048, τ (2) = 0.078, r (2) = 7.87 %). Overall, adverse effects were similar with or without the use of CPAP. CONCLUSIONS: Prophylactic postoperative use of continuous CPAP significantly reduces the incidence of postoperative pneumonia, atelectasis and pulmonary complications in patients undergoing high-risk abdominal surgeries. Quantitatively, increasing the CPAP levels does not necessarily enhance the protective effect against pneumonia. Instead, protective effect diminishes with increasing degree of CPAP.


Assuntos
Abdome/cirurgia , Pressão Positiva Contínua nas Vias Aéreas , Pneumopatias/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Anestesia Geral/efeitos adversos , Humanos , Incidência , Pneumopatias/epidemiologia , Razão de Chances , Pneumonia/epidemiologia , Pneumonia/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Atelectasia Pulmonar/epidemiologia , Atelectasia Pulmonar/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Resultado do Tratamento
8.
J Anaesthesiol Clin Pharmacol ; 31(3): 354-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26330715

RESUMO

BACKGROUND AND AIMS: The role of clonidine as an adjuvant to regional blocks to hasten the onset of the local anesthetics or prolong their duration of action is proven. The efficacy of dexamethasone compared to clonidine as an adjuvant is not known. We aimed to compare the efficacy of dexamethasone versus clonidine as an adjuvant to 1.5% lignocaine with adrenaline in infraclavicular brachial plexus block for upper limb surgeries. MATERIAL AND METHODS: Fifty three American Society of Anaesthesiologists-I and II patients aged 18-60 years scheduled for upper limb surgery were randomized to three groups to receive 1.5% lignocaine with 1:200,000 adrenaline and the study drugs. Group S (n = 13) received normal saline, group D (n = 20) received dexamethasone and group C (n = 20) received clonidine. The time to onset and peak effect, duration of the block (sensory and motor) and postoperative analgesia requirement were recorded. Chi-square and ANOVA test were used for categorical and continuous variables respectively and Bonferroni or post-hoc test for multiple comparisons. P < 0.05 was considered significant. RESULTS: The three groups were comparable in terms of time to onset and peak action of motor and sensory block, postoperative analgesic requirements and pain scores. 90% of the blocks were successful in group C compared to only 60% in group D (P = 0.028). The duration of sensory and motor block in group S, D and C were 217.73 ± 61.41 min, 335.83 ± 97.18 min and 304.72 ± 139.79 min and 205.91 ± 70.1 min, 289.58 ± 78.37 min and 232.5 ± 74.2 min respectively. There was significant prolongation of sensory and motor block in group D as compared to group S (P < 0.5). Time to first analgesic requirement was significantly more in groups C and D as compared with group S (P < 0.5). Clinically significant complications were absent. CONCLUSIONS: We conclude that clonidine is more efficacious than dexamethasone as an adjuvant to 1.5% lignocaine in brachial plexus blocks.

9.
Am J Public Health ; 105(2): 351-7, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25521890

RESUMO

OBJECTIVES: We sought to assess 6-month outcomes for HIV-infected people released from New York City jails with a transitional care plan. METHODS: Jail detainees in New York City living with HIV who accepted a transitional care plan during incarceration were asked to participate in a multi-site evaluation aimed at improving linkages to community-based care. The evaluation included a 6-month follow-up; HIV surveillance data were used to assess outcomes for those considered lost to follow-up. RESULTS: Participants (n=434) completed baseline surveys during incarceration in a jail in New York City. Of those seen at 6 months (n=243), a greater number were taking antiretroviral medications (92.6% vs 55.6%), had improved antiretroviral therapy adherence (93.2% vs 80.7%), and reported significant reductions in emergency department visits (0.20 vs 0.60 visits), unstable housing (4.15% vs 22.4%), and food insecurity (1.67% vs 20.7%) compared with baseline. CONCLUSIONS: Transitional care coordination services facilitate continuity of care and improved health outcomes for HIV-positive people released from jail.


Assuntos
Continuidade da Assistência ao Paciente , Infecções por HIV/terapia , Prisioneiros , Adulto , Fármacos Anti-HIV/uso terapêutico , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Cidade de Nova Iorque , Avaliação de Resultados da Assistência ao Paciente , Prisioneiros/estatística & dados numéricos , Prisões/organização & administração
10.
Paediatr Anaesth ; 25(3): 253-7, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25331111

RESUMO

BACKGROUND: The needle tip placed at the level of posterior cord under ultrasound guidance is described as the most effective way to obtain single shot successful block in adults, for forearm and hand surgeries. OBJECTIVE: The aim of this research was to study the spread of dye (depicting the local anesthetic) through catheters placed along the posterior cord. This was performed with continuous infraclavicular blocks placed under ultrasound guidance in children. METHODS: Twenty-four ASA 1 and 2 children, aged 7 months to 8 years old, scheduled for upper limb orthopedic surgeries were included in this prospective descriptive study. They received continuous infraclavicular block under ultrasound guidance. Skin markings were obtained from catheters that were placed below the posterior cord inserted 2-3 cm beyond the tip of the Tuohy needle. A radio-opaque dye was injected into the catheters and 5 min later, the dye spread was evaluated fluoroscopically. Postoperatively, all patients received a continuous infusion of 0.125% bupivacaine for pain relief. RESULTS: All 24 cases showed the presence of the dye along the neurovascular bundle in the infraclavicular region suggesting successful blocks. The mean ± standard deviation of the skin marking for the catheter was 5.61 ± 1.77 cm. Postoperatively, all patients had adequate pain relief with the catheters. One patient had break through pain on day 1 and four catheters were accidentally dislodged on day 2. CONCLUSION: We conclude that continuous infraclavicular catheters can be accurately and effectively placed along the posterior cord exclusively under ultrasound guidance in infants and small children.


Assuntos
Anestésicos Locais/farmacocinética , Anestésicos Locais/uso terapêutico , Cateterismo/métodos , Dor Pós-Operatória/tratamento farmacológico , Prega Vocal/diagnóstico por imagem , Bupivacaína/farmacocinética , Bupivacaína/uso terapêutico , Criança , Pré-Escolar , Meios de Contraste , Feminino , Fluoroscopia , Humanos , Lactente , Masculino , Agulhas , Bloqueio Nervoso , Procedimentos Ortopédicos , Estudos Prospectivos , Ultrassonografia de Intervenção , Extremidade Superior/cirurgia
11.
Nurs Manag (Harrow) ; 21(6): 18-23, 2014 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-25253330

RESUMO

A peri-operative bay was created to treat all patients with proximal femoral fractures admitted to one trauma ward at the Queen's Medical Centre, Nottingham. All patients had urinary catheterisation and their fluid intake and output was recorded; patients had daily blood tests and were cared for on pressure-relieving mattresses. In addition, a study day was provided for all nursing staff on the management of patients with proximal femoral fractures. These measures resulted in a significant decrease in the incidence of acute kidney injury, reduced the length of hospital stay for patients on this ward and reduced the numbers of falls and pressure-related injuries for these patients.

12.
Paediatr Anaesth ; 23(1): 74-8, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23004225

RESUMO

BACKGROUND AND OBJECTIVES: Arthrogryposis multiplex congenital is hallmarked with immobile joints and muscle fibrosis. The main objective of this study was to compare the success rate of ultrasound-guided sciatic and femoral nerve blocks with nerve stimulations in children diagnosed with distal arthrogryposis multiplex congenita. METHOD: Sixty children aged 8 months to 2 years posted for foot surgery were randomly assigned to group NS and group US of 30 each. Under general anesthesia, femoro-sciatic block was performed with nerve stimulator guidance in group NS and ultrasound guidance in group US. RESULTS: Group NS: 23 of 30 (76.7%) children showed ankle movement with sciatic neurostimulation. In 7 (23.6%), distal motor response could not be elicited and the block was abandoned. Out of 23 children who could be given femoral block, in 12 (52%) patients quadriceps contractions were not elicited and fascia iliaca block was given. All 23 blocks were successful. CHIPPS score at 1, 4, 6, 8, and 10 h was 1.05 ± 0.90, 1.82 ± 1.18, 3.36 ± 1.65, 2.23 ± 2.02, and 1.18 ± 1.14, respectively. Group US: In 29 of 30 patients (96.6%), sciatic nerve was visualized with ultrasonography. All 29 children received femoral block, and they were successful. The odds of success in group US were 8.9 (95% confidence interval [1.0, 77.9]) as compared with NS group. The difference in success rate was statistically significant (P = 0.026). The analgesic duration difference in the US and NS groups was a mean 7.62 ± 0.57 h in group NS and 8.60 ± 0.66 h in group US (statistically significant [P < 0.001]). CHIPPS score at 1, 4, 6, 8, and 10 h was 0.79 ± 0.96, 1.61 ± 0.92, 2.96 ± 1.04, 2.36 ± 2.54, and 1.14 ± 1.01, respectively. The difference between the CHIPPS score was not statistically significant. CONCLUSION: Ultrasonography significantly increases the success rate of sciatic and femoral block in arthrogryposis.


Assuntos
Artrogripose/cirurgia , Nervo Femoral/diagnóstico por imagem , Bloqueio Nervoso/métodos , Nervo Isquiático/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Anestesia Geral , Pré-Escolar , Estimulação Elétrica/métodos , Feminino , Nervo Femoral/efeitos dos fármacos , Nervo Femoral/fisiologia , Pé/cirurgia , Humanos , Lactente , Masculino , Estudos Prospectivos , Nervo Isquiático/efeitos dos fármacos , Nervo Isquiático/fisiologia , Fatores de Tempo
13.
J Anaesthesiol Clin Pharmacol ; 28(4): 510-3, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23225936

RESUMO

Intraoperative myocardial ischemia is attributed to decreased myocardial oxygen supply. We present an unusual case of recurrent, symptomless inferior wall ischemia in an apparently healthy male with no history of coronary artery disease after a spinal block. The recurring episodes were linked to tachycardia and presented with significant ST depression in Lead II with reciprocal elevation in lead aVL. The episodes responded to phenylephrine and subsided without residual sequelae.

15.
Saudi J Anaesth ; 6(4): 423-5, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23493244

RESUMO

Neonatal upper limb ischemia due to accidental arterial damage remains a major concern, which can lead to devastating complications if untreated. The primary objective of this case report is to emphasize the role of continuous infraclavicular brachial plexus block, the issues related with block performance in an ischemic hand, and the importance of ultrasound guidance in this particular case scenario. A 1.1 kg infant suffered from distal forearm ischemia due to accidental arterial damage, which was treated with brachial plexus block. An ultrasound-guided single shot block with 0.5 mL/kg of 0.25% bupivacaine was followed by ultrasound-guided catheter placement in the target area. A continuous infusion of 0.03% of bupivacaine at the rate of 0.5 mL/kg/hr (approx. 0.15 mg/kg/h of bupivacaine) was administered for 36 h. This treatment resulted in reversal of ischemia. Permanent ischemic damage was eventually confined to the tips of 4 fingers. We conclude that ultrasound-guided continuous infraclavicular block has a therapeutic role to play in the treatment of hand ischemia due to arterial damage and subsequent arterial spasm in neonates with added benefits.

16.
Paediatr Anaesth ; 21(4): 406-10, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21324045

RESUMO

BACKGROUND: Placement of sciatic catheters with ultrasound and stimulating catheters is known. Literature regarding catheter placements with only ultrasound is limited. We aimed to investigate the feasibility of performing continuous sciatic nerve block exclusively with ultrasound guidance and minimal equipment. METHOD: Forty ASA 1 and 2 patients aged 8 months-10 years posted for congenital talipoequinovarus surgery were included in the study. Continuous sciatic catheters were placed under ultrasound guidance with 18- gauge Tuohy needle at the infragluteal fold. Then, 0.25% of bupivacaine 0.5 ml·kg(-1) bolus was injected followed by continuous infusion later. Half the volume of the drug was injected prior to catheter insertion to improve visibility. The sciatic nerve, needle tip and shaft, catheter tip and the drug spread were visualized. The efficacy of the block intraoperatively and postoperatively was evaluated. RESULTS: The sciatic nerve, needle shaft, and tip were well visualized in all 40 patients. The catheter tip was seen in 72.5% of patients. The effect of block was complete intraoperatively and postoperatively. Clinically significant complications were absent. CONCLUSION: We conclude that in children, continuous sciatic catheters can be accurately and efficaciously placed with minimal equipment with ultrasound alone.


Assuntos
Cateterismo/métodos , Bloqueio Nervoso/métodos , Nervo Isquiático/diagnóstico por imagem , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Anestésicos Intravenosos/administração & dosagem , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Nervo Femoral/diagnóstico por imagem , Fentanila/administração & dosagem , Humanos , Lactente , Masculino , Procedimentos Ortopédicos , Dor Pós-Operatória/tratamento farmacológico , Estudos Prospectivos , Tálus/cirurgia , Tramadol/administração & dosagem , Tramadol/uso terapêutico , Ultrassonografia
17.
Sex Transm Dis ; 35(10): 869-76, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18641535

RESUMO

BACKGROUND: Partner notification (PN) is an effective strategy to identify undiagnosed human immunodeficiency virus (HIV) infections and to likely reduce HIV transmission. Whereas published literature has documented the benefits of provider referral for HIV PN, determination of the optimal provider--health department staff or community clinician--has not been previously studied. This study examined whether PN conducted by New York City (NYC) Disease Intervention Specialists (DIS) is more successful than PN conducted by community clinicians. METHODS: PN results overall and by index case-patient characteristics were compared for new HIV cases diagnosed in public sexually transmitted disease (STD) clinics versus those diagnosed in non-STD facilities. RESULTS: In NYC in 2004, 206 new HIV cases were diagnosed in STD clinics and 3460 in non-STD facilities. STD DIS personnel elicited 4 times as many partners per case diagnosed (0.87 vs. 0.22, P <0.01). Index case-patient characteristics differed between STD clinics and non-STD facilities, but STD DIS elicited more partners within all demographic and risk subgroups. Excluding partners previously HIV+, the proportion of partners notified was 70.9% for partners elicited by STD DIS and 48.3% for partners elicited by community clinicians (P <0.01). Among tested partners with previously unknown or negative status, the proportion of new HIV diagnoses was similar between those elicited by DIS and community clinicians (27.0% vs. 22.2%, P = 0.56). CONCLUSIONS: NYC STD DIS appear to be more effective than community clinicians at both partner elicitation and notification. NYC has stationed DIS at large healthcare facilities to assist community clinicians with the PN process.


Assuntos
Busca de Comunicante , Infecções por HIV/diagnóstico , Saúde Pública/métodos , Encaminhamento e Consulta , Parceiros Sexuais , Adolescente , Adulto , Centros Comunitários de Saúde/organização & administração , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Médicos
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