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Pediatr Blood Cancer ; : e28552, 2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32881326


BACKGROUND: The impact of pediatric hematopoietic stem cell transplant (HCT) on family functioning varies, but little is known about how the timing of HCT in children's treatment course contributes to this variability. This study examines how preexisting child, sibling, and family problems, the length of time between diagnosis to HCT, and children's age at HCT are associated with family and caregiver functioning. PROCEDURE: Caregivers (n = 140) of children (≤18 years old) scheduled to undergo their first HCT completed the Psychological Assessment Tool-HCT and the Impact on Family Scale. Treatment information was extracted from electronic medical records. A bootstrapped multivariate path analysis was used to test the hypotheses. RESULTS: More preexisting family problems related to greater caregiver perceived negative impact of their child's HCT across family and caregiver functioning domains. Less time between diagnosis and HCT was associated with greater caregiver personal strain, particularly for those with younger children undergoing HCT. Younger child age at HCT was also associated with a larger negative impact on family social functioning. CONCLUSIONS: Families with preexisting problems are the most at-risk for experiencing negative impacts related to their child's HCT. The timing of a child's HCT within their treatment course and the child's age during HCT may impact families' social functioning and caregiver adjustment. Screening families for preexisting family problems, particularly for families with young children or who are abruptly learning of their child's need for an HCT, may assist providers in identifying families who would benefit from earlier or more intensive psychosocial support.

Artigo em Inglês | MEDLINE | ID: mdl-32765899


Background: To report a case of morning glory disc anomaly (MGDA) in a pediatric patient with prenatal Zika virus (ZIKV) exposure. Case presentation: A 3-year-old male with prenatal exposure to ZIKV, confirmed by real-time polymerase chain reaction testing during the second trimester of pregnancy, was evaluated due to visual loss. Physical examination was remarkable for unilateral MGDA. Neuroimaging showed a base of skull encephalocele through the floor of the sella and callosal dysgenesis. Conclusions: This is the first report to suggest an association between prenatal ZIKV exposure and MGDA. Prenatal ZIKV exposure may be associated to a wider pathologic spectrum than previously reported.

J Pediatr Psychol ; 45(5): 530-539, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32196090


OBJECTIVE: Psychosocial intervention studies with parents often have difficulty with regard to participant recruitment, retention, and engagement. Prior to conducting a pilot test of the Electronic Surviving Cancer Competently Intervention Program (eSCCIP), a psychosocial eHealth intervention for parents of children with cancer, a qualitative study was designed to preemptively generate strategies to address potential difficulties in these domains. METHODS: Two focus groups and three semi-structured interviews were conducted with parents of children with cancer. Qualitative data were analyzed using the principles of thematic and content analysis. Themes were generated to describe results and inform the development of concrete recruitment, retention, and engagement strategies to be utilized in future intervention trials. RESULTS: Five themes emerged specific to recruitment, and three themes emerged related to retention and engagement. Parents highlighted a number of important potential recruitment, retention, and engagement strategies, including the importance of flexibility, ease of access and use, intervention timing, and pathways to follow-up care. Themes were linked to actionable recruitment, retention, and engagement strategies which can be utilized in future studies. CONCLUSION: Results from the current study will be utilized when designing future eSCCIP intervention trials and will also be of use to the broader field of psychosocial eHealth intervention research in pediatric psychology. This study also underscores the importance of working with parent stakeholders at all phases of study design and implementation.

Pediatr Blood Cancer ; 67(2): e28051, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31724814


PURPOSE: Family psychosocial risk in pediatric oncology can be assessed using the Psychosocial Assessment Tool (PAT), a brief parent report screener based on the Pediatric Psychosocial Preventative Health Model (PPPHM; universal, targeted, and clinical). However, little is known about risk over the course of treatment and its association with medical and psychosocial healthcare utilization. METHODS: Primary caregivers of children with cancer participated in this prospective multisite investigation, completing the PAT at diagnosis (T1; n = 396) and 6 months later (T2; n = 304). Healthcare utilization data were extracted from electronic health records. RESULTS: The distribution of PPPHM risk levels at T1 and T2 was highly consistent for the samples. Two-thirds of families remained at the same level of risk, 18% decreased and 16% increased risk level. Risk was not related to sociodemographic or treatment variables. The PAT risk score correlated with psychosocial contacts over the 6-month period. CONCLUSIONS: Although the majority of families reported universal (low) risk on the PAT and were stable in their risk level over 6 months, reassessing risk is helpful in identifying those families who report higher level of risk during treatment than at diagnosis. PAT scores were related to psychosocial services that are provided to most but not all families and could be tailored more specifically to match risk and delivery of evidence-based care.

Cuidadores/psicologia , Família/psicologia , Neoplasias/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Psicometria/estatística & dados numéricos , Estresse Psicológico , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Prospectivos , Inquéritos e Questionários , Adulto Jovem
Rev. Finlay ; 9(3): 161-171, jul.-set. 2019. tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1092108


RESUMEN Fundamento: las enfermedades cerebrovasculares constituyen la tercera causa de muerte en el mundo y una de las principales responsables de discapacidad y minusvalía en el adulto. Objetivo: describir las principales características clínicas en fallecidos por enfermedad cerebrovascular en el Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos. Métodos: se realizó un estudio descriptivo, transversal. El universo estuvo conformado por 517 pacientes fallecidos con diagnóstico de enfermedad cerebrovascular en el período comprendido entre el 1 de enero 2014 y el 31 de diciembre 2016 en Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos. Se consideraron como variables: edad, sexo, tipo y forma de presentación de la enfermedad cerebrovascular focal, estadía hospitalaria, patologías asociadas y año de defunción. Se obtuvieron los resultados en frecuencias absolutas y porcientos. Resultados: el 31,1 % de los fallecidos se halló entre los 80-89 años. Predominó el sexo masculino en un 55,3 %. El ictus de tipo isquémico representó el 62,5 %, fue la forma aterotrombótica la más frecuente con un 31,9 %. El 2015 fue el año con mayor número de defunciones con 186. El 75,2 % de las muertes se registró en los primeros 7 días de estadía hospitalaria. La principal patología asociada fue la hipertensión arterial (34,6 %). Conclusiones: la mortalidad por enfermedad cerebrovascular se presentó principalmente en pacientes de edades avanzadas, varones e hipertensos. Predominó la etiología isquémica. La mayoría de los pacientes que fallecieron lo hicieron en la primera semana de estadía hospitalaria.

ABSTRACT Foundation: cerebrovascular diseases are the third cause of death in the world and one of the main causes of disability in the adult. Objective: to describe the main clinical characteristics of deceased patients due to cerebrovascular disease at the Dr. Gustavo Aldereguía Lima General Hospital in Cienfuegos. Methods: a descriptive, cross-sectional study was conducted between January 1, 2014 and December 31, 2016 in the General University Hospital Gustavo Aldereguía Lima de Cienfuegos. The universe consisted of 517 deceased patients with a diagnosis of cerebrovascular disease in the period and the variables considered were: age, sex, type and form of presentation of focal cerebrovascular disease, hospital stay, associated pathologies and year of death. The results were obtained in absolute and percent frequencies. Results: from the deceased 31.1 % of were between 80-89 years old. Male sex predominated in 55.3 %. Stroke of the ischemic type represented 62.5 %, the athero-thrombotic form was the most frequent with 31.9 %. The year 2015 had the highest number of deaths with 186. The first 7 days of hospital stay recorded 75.2 % of deaths. The main associated pathology was hypertension (34.6 %). Conclusions: mortality from cerebrovascular disease. Most patients who died did so in the first week of hospital stay.

Pediatr Blood Cancer ; 66(10): e27889, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31276304


OBJECTIVE: Currently, no evidence-based psychosocial clinical care pathways (PCCP) exist to triage psychosocial risk levels and guide delivery of psychosocial care to youth receiving a hematopoietic stem cell transplantation (HCT) and their families. The purpose of this paper is to describe the use of qualitative research methodologies to develop PCCP in pediatric HCT consistent with the Standards for Psychosocial Care developed for children with cancer. METHODS: We previously used qualitative methodologies to interview parents to identify four principles to inform the development of PCCPs. Then in this study a focus group with parents and multidisciplinary clinicians was conducted to assess the acceptability of the PCCP, suggest modifications, and provide input on its use. RESULTS: The PCCP is six-step pathway, starting with a standardized screening assessment with the Psychosocial Assessment Tool (PAT-HCT) that identifies the family's specific care needs. The focus group data support overall assessment with the PAT-HCT and the care principles underlying this approach. CONCLUSIONS: This PCCP is a systemic multidisciplinary model for providing psychosocial care that is ready for the next stage of development and evaluation in clinical care.

Procedimentos Clínicos , Transplante de Células-Tronco Hematopoéticas/psicologia , Neoplasias/terapia , Psico-Oncologia/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Grupos Focais , Humanos , Lactente , Masculino , Neoplasias/psicologia , Psicometria/métodos , Adulto Jovem
Biol Blood Marrow Transplant ; 25(7): 1374-1381, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30878608


Family psychosocial risk screening is an important initial step in delivering evidence-based care in hematopoietic stem cell transplantation (HCT). Establishing an evidence-based screening approach that is acceptable, reliable, and valid is an essential step in psychosocial care delivery. This is a 3-institution multimethod study. In part 1, caregivers of children about to undergo HCT (n = 140) completed the Psychosocial Assessment Tool-Hematopoietic Cell Transplantation (PAT-HCT), a brief parent report screener adapted for HCT, and validating questionnaires. Families received feedback on their risks identified on the PAT-HCT. In part 2, 12 caregivers completed a semistructured interview about their perceptions of the PAT and the feedback process. The reliability and validity of the PAT-HCT total and subscale scores were tested using Kuder-Richardson-20 (KR-20) and Pearson correlations. Thematic content analysis was used to analyze the qualitative interview data. Internal consistency for the total score (KR-20 = .88) and the Child Problems, Sibling Problems, Family Problems, and Stress Reactions subscales were strong (KR-20 >.70). Family Structure, Social Support, and Family Beliefs subscales were adequate (KR-20 = .55 to .63). Moderate to strong correlations with the criteria measures provided validation for the total and subscale scores. Feedback was provided to 97.14% of the families who completed the PAT-HCT, and the mean rating of acceptability was >4.00 (on a 5-point scale). The qualitative data indicate that families appreciate the effort to provide screening and feedback. The PAT-HCT is a psychometrically sound screener for use in HCT. Feedback can be given to families. Both the screener and the feedback process are acceptable to caregivers.

J Pediatr Psychol ; 43(10): 1104-1113, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-29982606


Objective: Family psychosocial risk screening is an important initial step in delivering evidence-based care and in addressing health disparities. There is currently no validated measure of family psychosocial risk in Spanish. The Psychosocial Assessment Tool (PAT) is a brief parent report screener based on the trilevel Pediatric Preventative Psychosocial Risk Model (PPPHM; Universal, Targeted, and Clinical). The current article validates a Spanish version of the PAT (Version 3.0) in pediatric oncology. Method: Spanish-speaking Hispanic primary caregivers of 79 children newly diagnosed with cancer participated in this 4-institution multisite investigation, completing Spanish versions of the PAT and validation measures using REDCap. Results: Over 60% of the sample had a high school or lower level of education and they primarily identified as Hispanic in terms of acculturation. Internal consistency for the total score (KR20 = 0.76) and the Social Support, Child Problems, Sibling Problems, and Family Problems subscales was strong (KR20 = 0.69-0.79). Stress Reactions, Family Structure, and Family Beliefs subscales were lower (KR20 = 0.43-0.55). Moderate to strong correlations with the criteria measures provided validation for the total and subscale scores. Nearly two-thirds of the sample scored in the Targeted or Clinical range of the PPPHM. The PAT was successful in identifying clinical cases. Conclusions: The Spanish version of the PAT can be used with families of children newly diagnosed with cancer. Elevated psychosocial risks were found and warrant particular attention in providing psychosocial care attentive to the needs of Spanish-speaking families.

Cuidadores/psicologia , Família/psicologia , Hispano-Americanos/psicologia , Neoplasias/psicologia , Inquéritos e Questionários/normas , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Idioma , Masculino , Estudos Prospectivos , Psicometria , Reprodutibilidade dos Testes , Medição de Risco/métodos , Apoio Social , Tradução , Estados Unidos , Adulto Jovem
Neuroimaging Clin N Am ; 28(3): 453-470, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30007755


This article summarizes common neurologic emergencies presenting in pediatric patients. Imaging techniques and appearances of specific conditions are detailed, including pearls and pitfalls for each presentation. Specific attention is given to differential diagnoses that can serve as mimickers of pediatric neurologic emergencies.

Encefalopatias/diagnóstico por imagem , Traumatismos Craniocerebrais/diagnóstico por imagem , Acidentes , Adolescente , Encefalopatias/etiologia , Criança , Pré-Escolar , Traumatismos Craniocerebrais/etiologia , Emergências , Humanos , Lactente , Recém-Nascido , Imagem por Ressonância Magnética , Neuroimagem , Tomografia Computadorizada por Raios X
Medisur ; 16(2): 322-334, mar.-abr. 2018.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-894824


En los últimos años Acinetobacter baumannii se ha convertido en uno de los gérmenes de mayor relevancia clínica, lo cual le convierte en un verdadero paradigma de las infecciones nosocomiales multirresistentes. El presente trabajo tuvo como objetivo describir los mecanismos de resistencia de Acinetobacter baumannii frente a múltiples fármacos, así como explicar las estrategias terapéuticas actuales en cepas multirresistentes; para ello fueron consultadas 37 fuentes bibliográficas. Los mecanismos implicados en la resistencia del microorganismo comprenden la inhibición del antibiótico por β-lactamasas, disminución de la permeabilidad de los antibióticos por pérdida de porinas, presencia de bombas de expulsión y la alteración del sitio de acción del fármaco. Se recomienda que el tratamiento de elección en cepas multirresistentes sea la colistina y la tigeciclina, aunque se pueden utilizar otros fármacos y combinaciones entre estos.

In the last years Acinetobacter baumannii has become one of the germs of higher clinical relevance, which really turns it into a paradigm in the nosocomial multi-drug resistant infections. The present work had the objective of describing the resistance mechanisms of Acinetobacter baumannii to multiple drugs, so as to explain current therapeutic strategies in multidrug-resistant strains; for that 37 bibliographic resources were consulted. The mechanisms involved in the micro-organism resistance include inhibition to the antibiotic by β-lactamases, decreasing of antibiotic permeability due to porin loses, presence of efflux pumps and drug action site disturbances. It is recommended that the treatment of choice in multi-drug resistant strains is colistin and tigecycline, though other drugs may be used so as their combination.

Rev. Finlay ; 8(1): 46-58, ene.-mar. 2018.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1092046


La hipertensión intra-abdominal y el síndrome compartimental abdominal son entidades frecuentes en los pacientes graves, las cuales cursan con una alta mortalidad. El presente trabajo tuvo como objetivo explicar la etiopatogenia del síndrome compartimental abdominal, así como describir los mecanismos fisiopatológicos involucrados en dicha patología. Para ello se consultó un total de 25 fuentes bibliográficas, entre ellas artículos de revistas, libros y otras, accedidas por medio de los principales gestores de la información. Se concluyó que el síndrome compartimental abdominal es propiciado por la disminución de la distensibilidad de la pared abdominal, el aumento del volumen intra-abdominal o una combinación de ambas, y que además se produce compresión directa de los órganos por la hipertensión intra-abdominal, el edema, isquemia secundaria al descenso del flujo sanguíneo, alteración de la función y composición de la microbiota intestinal, llegando a causar tardíamente el síndrome de disfunción múltiple orgánica.

Intra-abdominal hypertension and compartment syndrome are frequent entities in severely ill patients and result in a high mortality. This work is aimed at explaining the ethiopathogenesis of compartment abdominal syndrome, so as describing pathophysilogical mechanisms involved in this pathology. For that, a total of 25 bibliographic resources were reviewed, among them journals, books and others, consulted through the main information agents. It was concluded that the compartment syndrome is caused by the decrease of the abdominal wall distensibility and the increase of intraabdominal volumen or a combination of both. In addition it is produced by the direct organ compression by intra-abdominal hypertension, edema, ischemia secundary to blood flow decreasing, disturbances of the function and composition of the intestinal microbiota, all which later causes a multiple organ disfunction.

Neuroradiol J ; 28(2): 140-4, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25963156


Granular cell tumor is a rare soft tissue neoplasm that commonly affects the head and neck regions. We describe a case of a granular cell tumor of the orbit including its clinical presentation, histopathology, and magnetic resonance imaging findings.

Tumor de Células Granulares/patologia , Imagem por Ressonância Magnética/métodos , Neoplasias Orbitárias/patologia , Adulto , Tumor de Células Granulares/cirurgia , Humanos , Masculino , Neoplasias Orbitárias/cirurgia , Resultado do Tratamento
Rev. enferm. Inst. Mex. Seguro Soc ; 22(3): 123-129, Septiembre.-Dic. 2014. graf
Artigo em Espanhol | LILACS, BDENF - Enfermagem | ID: biblio-1031227



Introducción: los cuidados proporcionados por personas ajenas al equipo de salud suelen pasar desapercibidos; sin embargo, no se puede negar que su ayuda es muchas veces insustituible y sus actividades van más allá de proporcionar afecto al enfermo hospitalizado.

Objetivo: determinar el perfil del cuidador principal y su relación con el cuidado que el personal de enfermería ofrece a pacientes hospitalizados de un hospital general de Manzanillo, Colima. Metodología: se realizó un estudio correlacional, prospectivo y transversal. La muestra estuvo constituida por 117 sujetos. Se utilizó una adaptación validada del instrumento de Aurora Quero Rufián, el cual se aplicó mediante entrevista al cuidador principal, teniendo previamente identificadas las 15 necesidades de cuidado del paciente hospitalizado.

Resultados: el promedio de edad del cuidador fue de 39.08 años (DE ± 13.22 años); 86.3 % eran mujeres. En cuanto a la escolaridad, prevaleció la educación primaria y secundaria con 70.9 %. En el 67.5 % de los casos, el cuidador vivía con el paciente, y 30.8 % era esposo(a) o pareja. Respecto al paciente, 53.8 % eran hombres y 50.4 % se encontraba hospitalizado en Medicina Interna; en la evaluación de 15 necesidades de cuidado, los cuidadores (65 %) consideraron que las tareas propias del cuidado debían ser realizadas por ellos; el resto refirió que debían efectuarlas el personal de enfermería. Conclusiones: se aprecia el deslinde de responsabilidad de enfermería hacia el cuidador, quien deberá ser entrenado al alta del paciente para evitar recaídas o complicaciones; no se debe olvidar que el responsable de otorgar los cuidados durante la estancia hospitalaria debe ser el equipo de enfermería.


Introduction: The care provided by persons not belonging to the health team goes unnoticed; however, it cannot be denied that help given by these people is often irreplaceable and their activities go beyond providing endearment to the hospitalized patient.

Objective: To determine the primary caregiver's profile and its relationship with the care provided by nurses to the inpatients of a general hospital in Manzanillo, Colima, México. Methodology: A correlational, prospective and cross-sectional study was performed. The sample consisted of 117 subjects. We validated and used an adapted instrument, based on the proposed by Aurora Quero Rufián. This instrument was applied through direct interview to the primary caregiver. In order to do this, we previously identified 15 care needs of the inpatient. Results: The average age was 39.08 years (SD ± 13.22 years); 86.3 % were females. About schooling, primary and secondary education prevailed with 70.9 %. In 67.5 % of the cases, the caregiver lived with the patient, and 30.8 % was spouse or partner. Regarding the patient, 53.8 % were men and 50.4 % were inpatients in Internal Medicine service. When the assessment of the 15 care needs was done, 65 % of the caregivers considered that the tasks had to be carried out by them; the remaining 35 % referred that those tasks should be made by the nursing staff.

Conclusions: The boundaries of responsibility between the nursing staff and the caregiver are clearly set out, despite the caregivers should be trained to the inpatient discharge in order to prevent relapse or complications. We must not forget that the responsible to provide cares during hospitalization should be the nursing staff.

Atitude , Cuidadores , Cuidados de Enfermagem , Recursos Humanos de Enfermagem , México , Humanos
Radiographics ; 33(6): 1717-36, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24108559


Certain tumors of the head and neck use peripheral nerves as a direct conduit for tumor growth away from the primary site by a process known as perineural spread. Perineural spread is associated with decreased survival and a higher risk of local recurrence and metastasis. Radiologists play an important role in the assessment and management of head and neck cancer, and positron emission tomography/computed tomography (PET/CT) with 2-[fluorine 18]fluoro-2-deoxy-d-glucose (FDG) is part of the work-up and follow-up of many affected patients. Awareness of abnormal FDG uptake patterns within the head and neck is fundamental for diagnosing perineural spread. The cranial nerves most commonly affected by perineural spread are the trigeminal and facial nerves. Risk of perineural spread increases with a midface location of the tumor, male gender, increasing tumor size, recurrence after treatment, and poor histologic differentiation. Focal or linear increased FDG uptake along the V2 division of the trigeminal nerve or along the medial surface of the mandible, or asymmetric activity in the masticator space, foramen ovale, or Meckel cave should raise suspicion for perineural spread. If FDG PET/CT findings suggest perineural spread, the radiologist should look at available results of other imaging studies, especially magnetic resonance imaging, to confirm the diagnosis. Knowledge of common FDG PET/CT patterns of neoplastic involvement along the cranial nerves and potential diagnostic pitfalls is of the utmost importance for adequate staging and treatment planning.

Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Imagem Multimodal , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Fluordesoxiglucose F18 , Humanos , Planejamento de Assistência ao Paciente , Neoplasias do Sistema Nervoso Periférico/secundário , Compostos Radiofarmacêuticos
Rev. argent. cir ; 104(1): 1-5, mar. 2013.
Artigo em Espanhol | LILACS | ID: lil-700381


Antecedentes: El colgajo libre anterolateral de muslo está poco difundido en Occidente dado lo complejo de su anatomía y las características morfológicas de nuestra población. No obstante, cuando las condiciones son propicias, representa una alternativa eficaz en la reconstrucción de cirugías de cabeza y cuello ya que puede proveer una cantidad suficiente de piel, músculo y eventualmente fascia con relativamente poca morbilidad en el sitio dador.Objetivo: Evaluar resultados en la utilización del colgajo libre anterolateral de muslo en patología de cabeza y cuello.Material y Método: Estudio retrospectivo y descriptivo de pacientes tratados entre 2004-2011. Se analizaron datos poblacionales y del tumor, resección, tamaño del colgajo, número y tipo de perforantes, complicaciones del colgajo y lecho dador, morbimortalidad.Resultados: Se trataron 20 pacientes, 15 (75%) hombres, edad promedio 55,5 años (rango: 22-77). Doce pacientes presentaban tumores de cavidad oral y 8 de piel. Todas fueron reconstrucciones primarias, siendo 3 cirugías de rescate. Quince fueron colgajos fasciocutáneos y 5 fasciomiocutáneos. By-pass venoso: 1 caso. Promedio de perforantes por colgajo: 2, la mayoría miocutáneas (23/31). Superficie promedio de isla de piel: 118 cm2 (rango: 24-319 cm2). Complicaciones del colgajo: 1 caso (5%). Cierre primario del lecho dador: 17 pacientes, 2 requirieron injerto y un cierre por segunda. La mortalidad fue de 5%.Conclusiones: El colgajo libre anterolateral de muslo representa una alternativa válida para reconstrucción quirúrgica en tumores de cabeza y cuello, dada su versatilidad y la posibilidad de cubrir defectos de diferentes tamaños, poco defecto en lecho dador y morbimortalidad aceptable.

Background: Because of its complex anatomy and the morphology of our population the anterolateral thigh flap has not been widely spread in Occident. Nevertheless, in selected situations, it represents a useful alternative for recon-struction in surgery of head and neck because it may provide enough amounts of skin, muscle and eventually fascia with little donor site morbidity Objective: To evalúate the results in the utilization of anterolateral thigh free flap in head and neck pathology Materials and Method: Retrospective and descriptive study of patients treated between 2004 and 2011. Population and tumor data, type of resection, flap size, quantity and type of perforators, flap and donor site complica-tions, morbidity and mortality was evaluated. Results: Twenty patients was treated, 15 (75%) males, average age was 55,5 (range: 22-77). Twelve patients had oral cavity tumors and 8 skin tumors. All the reconstructions were primary, with 3 rescuers surgeries. There were 15 fas-ciocutaneous flaps and 5 fasciomyocutaneous. Venous by-pass: 1 case. Average flap's perforators: 2, the majority myocutaneous (23/31). Average skin paddle surface: 118 cm2 (range: 24-319 cm2). Flap complications: 1 case (5%). Primary cióse of donor site: 17 patients, 2 with skin graft and 1 secondary cióse. Mortality rate 5%. Conclusions: Anterolateral thigh flap represents a useful alternative for reconstructive surgery in head and neck tumors, due its versatility and possibility of resolve defectsof variables sizes, little donor site defect and acceptable morbidity and mortality.

Humanos , Cirurgia Geral , Retalho Miocutâneo , Pescoço , China , Japão , Língua
Rev. obstet. ginecol. Venezuela ; 71(2): 88-97, jun. 2011. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-659241


Determinar la prevalencia de la violencia de género en un grupo de mujeres tomadas al azar entre febrero - octubre de 2009. Hospital General del Oeste “Dr. José Gregorio Hernández” de Caracas. Se realizó un estudio descriptivo, prospectivo y transversal con 400 mujeres elegidas al azar, incluidas previa firma del consentimiento voluntario informado, aplicándose como instrumento una encuesta. Los datos fueron analizados aplicando procedimientos estadísticos descriptivos. 266 mujeres (66,5 por ciento del total) había sufrido algún tipo de violencia, más de uno en algunos casos, predominando la violencia psicológica (66,25 por ciento), seguida por la violencia física (38,25 por ciento), siendo el grupo etario de la segunda década el más afectado para todos los tipos de violencia. El agresor más frecuente fue la pareja actual de las afectadas por violencia psicológica, física y sexual. En el grupo de embarazadas hubo 61,06 por ciento casos de violencia. Alrededor de la mitad de las encuestadas (52,25 por ciento) conocen los mecanismos de denuncia en caso de ser víctimas de violencia, aunque solo 20,3 por ciento de las agredidas han denunciado alguna situación de violencia. La violencia de género es un problema de salud pública a nivel mundial, y Venezuela no escapa de esta realidad, determinando mediante esta investigación que la mayoría de las mujeres sufren algún maltrato a lo largo de su vida, recordando que 3 de cada 5 mujeres han sido víctimas de algún tipo de violencia

To determine the prevalence of gender´s violence in a group of women take at random in the General Hospital of the West during February - October of 2009. Hospital General del Oeste “Dr. José Gregorio Hernández” de Caracas. A descriptive, prospective and transversal study was done with 400 women chosen at random, they were included with previous sign of the voluntary consent inform, applying a survey as instrument. The data´s analysis was done applying descriptive procedures. 266 women (66.5 percent of the total) had suffer any kind of violence, more of one in some cases, predominating the psychological violence (66.25 percent), follow by the physic violence (38.25 percent), being women in second decade of age the most affected for all the types of violence. The most frequent aggressor was the present couple of the inquiry women by physic, psychological and sexual violence. In the group of pregnant women there were 61.06 percent cases of violence. Around the half of women surveyed (52.25 percent) know the mechanisms for accuse in case of be a violence victim, although only 20.3 percent of the affected were accused any violence situation. Violence of gender is a public sanitary problem at world-wide level, and Venezuela don’t escape of this fact, being determinate by this investigation that mostly of the women has been battered at the long of their life’s, remembered that 3 of every 5 women has been victim of some kind of violence

Feminino , Violência contra a Mulher , Violência/psicologia , Violência/tendências
Value Health ; 13(8): 903-14, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21091827


OBJECTIVE: Maraviroc is the first approved drug in a new class of antiretrovirals, the CCR5 antagonists. The objective of this study was to predict the long-term clinical impact and cost-effectiveness of maraviroc in treatment-experienced adults with HIV/AIDS in Mexico. METHODS: The AntiRetroviral Analysis by Monte Carlo Individual Simulation (ARAMIS) model was adapted to the Mexican context to predict clinical and economic outcomes of treating with optimized background therapy (OBT) versus testing for viral tropism status and treating with OBT ± maraviroc accordingly in treatment-experienced adults in Mexico. Baseline characteristics and efficacy were from the MOTIVATE trials' screening cohort. Costs and population mortality data were specific to Mexico. Results were reported from the perspective of health care payers in 2008 Mexican pesos (converted to 2008 US$ in parentheses). RESULTS: Compared to treatment with OBT alone, treatment with OBT ± maraviroc contingent on tropism test result increased projected undiscounted life expectancy and discounted quality-adjusted life expectancy from 7.54 to 8.71 years and 4.42 to 4.92 quality-adjusted life years (QALYs), respectively, at an incremental cost of $228,215 (US$21,329). The resultant incremental cost-effectiveness ratio (ICER) was $453,978 (US$42,429) per QALY gained. The ICER was somewhat lower when maraviroc was modeled in individuals susceptible to ≤ 2 components of OBT ($407,329; US$38,069), while the ICER was higher in individuals susceptible to ≥3 OBT components ($718,718; US$67,171). CONCLUSION: In treatment-experienced individuals with HIV/AIDS in Mexico, maraviroc may be cost-effective, particularly in individuals with limited options for active antiretroviral therapy (ART).

Cicloexanos/economia , Inibidores da Fusão de HIV/economia , Infecções por HIV/economia , Triazóis/economia , Simulação por Computador , Análise Custo-Benefício , Cicloexanos/uso terapêutico , Feminino , Inibidores da Fusão de HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Maraviroc , México , Pessoa de Meia-Idade , Modelos Biológicos , Anos de Vida Ajustados por Qualidade de Vida , Triazóis/uso terapêutico
Rev. argent. cir ; 92(5/6): 232-240, mayo-jun. 2007. ilus
Artigo em Espanhol | LILACS | ID: lil-502601


Antecedentes: Desde que comenzaron los tratamientos transfistulares (Kehr) en la década del 60, se presenataron casos de hidatidosis manejados por esta vía. Paulatinamente se agregaron y mejoraron los tratamientos médicos y los procedimientos transparietohepáticos y endoscópicos que actualmente son aplicados en escala cada vez mayor. Objetivo: Comunicar la experiencia con los tratamientos mininvasivos, percutáneos y endoscós, de quistes hidatídicos simples y complicados. Lugar de aplicación: Hospital público y centros privados. Diseño: Descriptivo retrospectivo. Material y método: Fueron tratados 26 pacientes (15 mujeres y 11 varones), edad 20 a 68 años. Se utilizó anestesia local, complementada con opiáceos o sedantes. Por vía percutánea exclusiva se realizaron 6 punción aspiración, inyección de escolicidas y reaspiración, en 10 se agregó drenaje prolongado. En 8 casos se realizó tratamiento complementario percutáneo postcirugía a traveés de los trayectos fistulosos (Kehr) y en 2 tratamiento combinado endoscópico y percutáneo. Resultados: Se resolvieron favorablemente los 26 casos. La morbilidad fue cuadros febriles en 6,1 crisis hipertensiva que se trató médicamente y una hemorragia que se cohibió con cambio de drenaje. No hubo mortalidad. Conclusiones: Los procedimientos minivasivos percutáneos y endoscópicos tuvieron aplicación, ya sea como tratamiento único o asociado a la cirugía, en pacientes de alto riesgo y en quistes simples, de 7 a 17 cm, de acceso quirúrgico difícil o peligroso. Se resolvieron eficazmente los 26 casos con complicaciones menores y sin mortalidad.

Adulto , Equinococose Hepática/cirurgia , Endoscopia do Sistema Digestório , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Retrospectivos
Washington, D.C; Banco Interamericano de Desarrollo (BID). Unidad de Programa de la Mujer en el Desarrollo; dic. 1999. 18 p. (Serie de Informes Técnicos del Departamento de Desarrollo Sostenible).
Monografia em Espanhol | Desastres | ID: des-12957
Washington, D.C; Inter-American Development Bank. Sustainable Development Department; 1999. 15 p. (Technical Paper Series, SOC-115).
Monografia em Inglês | Desastres | ID: des-12623


This report examines evidence from post-Mitch Central America and disasters in other parts of the world to identify the way disasters affect women and to highlight womenïs participation in prevention, relief, rehabilitation, and reconstruction efforts. It attempts to fill a void in the knowledge regarding peopleïs responses to disasters in the region, by exploring the gender dimension and providing general guideliness for integrating a gender perspective in effective disaster management. The report was prepared for and presented at the meeting of the Consultative Group for the Reconstruction and Transformation of Central America which took place in Stockholm, Sweden, May 25-27,1999. It is based on a technical meeting attended by international and government agencies and NGOs which was held in Tegucigalpa, Honduras, May 6-7, 1999 ("Hurricane Mitch: Effects on Women and their Participation in the Reconstruction and Transformation of Central America"), Shubh Dumar-Range (consultant), and Jane Mocellin (World Health Organization)

Mulheres , Administração de Desastres , Tempestades Ciclônicas , Saúde da Mulher , Mulheres Maltratadas , Mulheres Trabalhadoras , América Central