Trombos en cavidades cardiacas derechas en pacientes con tromboembolia pulmonar aguda sintomática. Pronóstico y tratamiento

La evidencia respecto a la prevalencia y al significado pronóstico de la coexistencia de trombos en cavidades cardiacas derechas (TCD) en pacientes con tromboembolia de pulmón (TEP) aguda sintomática es desconocida y el manejo terapéutico de estos pacientes sigue siendo controvertido. En un primer estudio, en el que se incluyeron 12.441 pacientes con TEP aguda sintomática del Registro Informatizado de la Enfermedad TromboEmbólica (RIETE), observamos que la presencia de TCD es infrecuente y que los pacientes con TEP y TCD tienen peor pronóstico que aquellos pacientes con TEP sin TCD. Realizamos además un metanálisis que incluyó 6 estudios prospectivos y retrospectivos, y observamos que en pacientes diagnosticados de TEP aguda sintomática, la presencia de TCD se asocia a un riesgo aumentado de muerte por cualquier causa y por la propia TEP en los primeros 30 días después del diagnóstico. Un tercer estudio nos permitió demostrar que, en pacientes con TEP y TCD, no hubo diferencias significativas en las tasas de mortalidad y sangrado entre el tratamiento de reperfusión y el tratamiento anticoagulante

Formación docente como herramienta pedagógica en estudiantes con trastorno de déficit de atención e hiperactividad (TDAH) en el colegio del Sagrado Corazón.

El objetivo principal del estudio es desarrollar competencias pedagógicas de formación docente que faciliten el proceso de Enseñanza Aprendizaje, en estudiantes con Trastorno de Déficit de Atención e Hiperactividad (TDAH) en el Colegio del Sagrado Corazón. La investigación se sustenta en la recopilación de los fundamentos de diversos autores tales como Vaillant (2009), Ministerio Educación Nacional (MEN) (2002), Imbernón, (2008), además de la población en estudio y de los propios investigadores. Desde el análisis de un paradigma socio-crítico; se desarrolló bajo una modalidad de investigación – acción. La información fue recabada mediante las técnicas observación por encuesta y entrevista en profundidad. En cuanto al análisis del contenido y estructurar la información, la investigación se sustentará en Bardín & Suárez (2002) quienes toman como referencia tres fases; el pre análisis, aprovechamiento del material y el tratamiento de los resultados.The main objective of the study is to develop pedagogical competencies of teacher training that facilitate the Teaching-Learning process, in students with Attention Deficit Hyperactivity Disorder (ADHD) at the Colegio del Sagrado Corazón. The research is based on the compilation of the foundations of various authors such as Vaillant (2009), Ministry of National Education (MEN) (2002), Imbernón, (2008), in addition to the study population and the researcher herself. From the analysis of a socio-critical paradigm; it was developed under a research - action modality. The information was collected through the techniques observation by survey and in-depth interview. Regarding content analysis and structuring information, the research will be based on Bardín & Suárez (2002) who take three phases as a reference; the pre-analysis, use of the material and the treatment of the results.Magíster en EducaciónMaestrí

Intermediate-high risk pulmonary embolism

Limited information exists about the prevalence, management, and outcomes of intermediate-high risk patients with acute pulmonary embolism (PE). In a prospective cohort study, we evaluated consecutive patients with intermediate-high risk PE at a large, tertiary, academic medical center between January 1, 2015 and March 31, 2019. Adjudicated outcomes included PE-related mortality and a complicated course through 30 days after initiation of PE treatment. Repeat systolic blood pressure (SBP), heart rate (HR), brain natriuretic peptide (BNP), and cardiac troponin I (cTnI) measurements, and echocardiography were performed within 48 hours after diagnosis. Among 1,015 normotensive patients with acute PE, 97 (9.6%) had intermediate-high risk PE. A 30-day complicated course and 30-day PE-related mortality occurred in 23 (24%) and 7 patients (7.2%) with intermediate-high risk PE. Seventeen (18%) intermediate-high risk patients received reperfusion therapy. Within 48 hours after initiation of anticoagulation, normalization of SBP, HR, cTnI, BNP, and echocardiography occurred in 82, 86, 78, 72, and 33% of survivors with intermediate-high risk PE who did not receive immediate thrombolysis. A complicated course between day 2 and day 30 after PE diagnosis for the patients who normalized SBP, HR, cTnI, BNP, and echocardiography measured at 48 hours occurred in 2.9, 1.4, 4.5, 3.3, and 14.3%, respectively. Intermediate-high risk PE occurs in approximately one-tenth of patients with acute symptomatic PE, and is associated with high morbidity and mortality. Normalization of HR 48 hours after diagnosis might identify a group of patients with a very low risk of deterioration during the first month of follow-up

Diclofenac for reversal of right ventricular dysfunction in acute normotensive pulmonary embolism: A pilot study

Background The inflammatory response associated with acute pulmonary embolism (PE) contributes to the development of right ventricular (RV) dysfunction. Nonsteroidal anti-inflammatory drugs (NSAIDs) may facilitate the reversal of PE-associated RV dysfunction. Methods We randomly assigned normotensive patients who had acute PE associated with echocardiographic RV dysfunction and normal systemic blood pressure to receive intravenous (IV) diclofenac (two doses of 75 mg in the first 24 h after diagnosis) or IV placebo. All patients received standard anticoagulation with subcutaneous low-molecular-weight heparin (LMWH) and an oral vitamin K antagonist. RV dysfunction was defined by the presence of, at least, two of the following criteria: i) RV diastolic diameter > 30 mm in the parasternal window; ii) RV diameter > left ventricle diameter in the apical or subcostal space; iii) RV free wall hypokinesis; and iv) estimated pulmonary artery systolic pressure > 30 mm Hg. Persistence of RV dysfunction at 48 h and 7 days after randomization were the primary and secondary efficacy outcomes, respectively. The primary safety outcome was major bleeding within 7 days after randomization. Results Of the 34 patients randomly assigned to diclofenac or placebo, the intention-to-treat analysis showed persistent RV dysfunction at 48 h in 59% (95% confidence interval [CI], 33–82%) of the diclofenac group and in 76% (95% CI, 50–93%) of the placebo group (difference in risk [diclofenac minus standard anticoagulation], − 17 percentage points; 95% CI, − 47 to 17). Similar proportions (35%) of patients in the diclofenac and placebo groups had persistent RV dysfunction at 7 days. Major bleeding occurred in none of patients in the diclofenac group and in 5.9% (95% CI, 0.2–29%) of patient in the placebo group. Conclusions Due to slow recruitment, our study is inconclusive as to a potential benefit of diclofenac over placebo to reverse RV dysfunction in normotensive patients with acute PE

Effect of a Pulmonary Embolism Diagnostic Strategy on Clinical Outcomes in Patients Hospitalized for COPD Exacerbation. A Randomized Clinical Trial

SLICE Trial Group.[Importance] Active search for pulmonary embolism (PE) may improve outcomes in patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD).[Objective] To compare usual care plus an active strategy for diagnosing PE with usual care alone in patients hospitalized for COPD exacerbation.[Design, Setting, and Participants] Randomized clinical trial conducted across 18 hospitals in Spain. A total of 746 patients were randomized from September 2014 to July 2020 (final follow-up was November 2020).[Interventions] Usual care plus an active strategy for diagnosing PE (D-dimer testing and, if positive, computed tomography pulmonary angiogram) (n = 370) vs usual care (n = 367).[Main Outcomes and Measures] The primary outcome was a composite of nonfatal symptomatic venous thromboembolism (VTE), readmission for COPD, or death within 90 days after randomization. There were 4 secondary outcomes, including nonfatal new or recurrent VTE, readmission for COPD, and death from any cause within 90 days. Adverse events were also collected.[Results] Among the 746 patients who were randomized, 737 (98.8%) completed the trial (mean age, 70 years; 195 [26%] women). The primary outcome occurred in 110 patients (29.7%) in the intervention group and 107 patients (29.2%) in the control group (absolute risk difference, 0.5% [95% CI, −6.2% to 7.3%]; relative risk, 1.02 [95% CI, 0.82-1.28]; P = .86). Nonfatal new or recurrent VTE was not significantly different in the 2 groups (0.5% vs 2.5%; risk difference, −2.0% [95% CI, −4.3% to 0.1%]). By day 90, a total of 94 patients (25.4%) in the intervention group and 84 (22.9%) in the control group had been readmitted for exacerbation of COPD (risk difference, 2.5% [95% CI, −3.9% to 8.9%]). Death from any cause occurred in 23 patients (6.2%) in the intervention group and 29 (7.9%) in the control group (risk difference, −1.7% [95% CI, −5.7% to 2.3%]). Major bleeding occurred in 3 patients (0.8%) in the intervention group and 3 patients (0.8%) in the control group (risk difference, 0% [95% CI, −1.9% to 1.8%]; P = .99).[Conclusions and Relevance] Among patients hospitalized for an exacerbation of COPD, the addition of an active strategy for the diagnosis of PE to usual care, compared with usual care alone, did not significantly improve a composite health outcome. The study may not have had adequate power to assess individual components of the composite outcome.[Trial Registration] ClinicalTrials.gov Identifier: NCT02238639.Peer reviewe

Randomised controlled trial of a prognostic assessment and management pathway to reduce the length of hospital stay in normotensive patients with acute pulmonary embolism

[Background] The length of hospital stay (LOS) for acute pulmonary embolism (PE) varies considerably. Whether the upfront use of a PE prognostic assessment and management pathway is effective in reducing the LOS remains unknown.[Methods] We conducted a randomised controlled trial of adults hospitalised for acute PE: patients were assigned either to a prognostic assessment and management pathway involving risk stratification followed by predefined criteria for mobilisation and discharge (intervention group) or to usual care (control group). The primary end-point was LOS. The secondary end-points were the cost of prognostic tests and of hospitalisation, and 30-day clinical outcomes.[Results] Of 500 patients who underwent randomisation, 498 were included in the modified intention-to-treat analysis. The median LOS was 4.0 days (interquartile range (IQR) 3.7–4.2 days) in the intervention group and 6.1 days (IQR 5.7–6.5 days) in the control group (p<0.001). The mean total cost of prognostic tests was EUR 174.76 in the intervention group, compared with EUR 233.12 in the control group (mean difference EUR −58.37, 95% CI EUR −84.34­ to −32.40). The mean total hospitalisation cost per patient was EUR 2085.66 in the intervention group, compared with EUR 3232.97 in the control group (mean difference EUR −1147.31, 95% CI EUR −1414.97­ to −879.65). No significant differences were observed in 30-day readmission (4.0% versus 4.8%), all-cause mortality (2.4% versus 2.0%) or PE-related mortality (0.8% versus 1.2%) rates.[Conclusions] The use of a prognostic assessment and management pathway was effective in reducing the LOS for acute PE.Peer reviewe

ANOREXIA EN LAS MODELO DE LA CIUDAD DE CÚCUTA

El objetivo del presente trabajo de investigación es analizar el impacto de la anorexia en las jóvenesentre 14 y 25 años de la ciudad de Cúcuta, la cual es una enfermedad que está aquejando a los jóvenesy en especial a las modelos, que por seguir una imagen, modelo, actriz o cualquier personaje del mundode la farándula se introducen en ese mundo de inestabilidad emocional. Los requisitos de las agenciasde modelos y de las academias llevan a los jóvenes hacer dietas extremas y ejercicios rigurosos quelos conllevan a una serie de enfermedades y padecimientos que finalmente terminan con la vida de lasjóvenes. La técnica de investigación utilizada para la recolección de la información es la encuesta quese aplicaron en las principales agencias de modelos y academias de la ciudad; como resultado de laaplicación del cuestionario se muestra que no solo el motivo de ser flaco para conseguir una figura sinoque también un alto porcentaje se debe a problemas familiares o sentimentales.Palabras clave: anorexia, delgadez, enfermedad, problema.ABSTRACTThe objective of this research is to analyze the impact of anorexia in young women between 14 and 25years of the city of Cucuta, which is a disease that is afflicting the young and especially the models thatfollow a image, model, actress or any character from the world of showbiz are introduced into the worldof emotional instability. Requirements modeling agencies and schools takes young extreme dieting andrigorous exercises that involve a number of diseases and conditions that ultimately end up with the livesof young people. The research technique used for collecting data is the survey that were applied in the topmodeling agencies and schools of the city; as a result of the questionnaire shows that not only the reasonto be skinny to get a figure but also a high percentage is due to family or emotional problems.Keywords: anorexia, disease, problem, thinness

Relación entre la capacidad de agencia de autocuidado y la adherencia al tratamiento farmacológico y no farmacológico en personas con hipertensión arterial. Montería, 2010

El presente estudio tuvo como objetivo determinar la relación existente entre la capacidad de agencia de autocuidado y la adherencia al tratamiento farmacológico y no farmacológico en personas inscritas y asistentes al Programa de control de hipertensión arterial de una E.S.E. de baja complejidad de atención de Montería, 2010. Se utilizó un diseño correlacional, del total de la población se tomó una muestra de 50 personas en control de la hipertensión arterial, con más de un año de permanencia en el programa y un grupo testigo conformado por 30 personas recién inscrita al programa. La información se obtuvo aplicando la Escala Apreciación de la Agencia de Autocuidado de Isemberg y Evers, validada en Colombiana y del Instrumento Factores que influyen en la adherencia a tratamientos farmacológicos y no farmacológicos en pacientes con factores de riesgo de enfermedad cardiovascular de Bonilla y De Reales. Los resultados revelaron que existe relación entre la capacidad de agencia de autocuidado y la adherencia al tratamiento farmacológico y no farmacológico para el control de la hipertensión arterial en la muestra de estudio y en el grupo testigo arrojando un coeficiente de correlación de 0.85 y de 0.66 respectivamente, lo cual demuestra una relación fuerte con tendencia positiva entre las dos variables de estudio en ambos grupos, siendo más fuerte cuando se realiza una intervención de cuidado de enfermería. Se espera que los resultados contribuyan al desarrollo de estrategias que promuevan el autocuidado con el fin de lograr la adherencia al tratamiento en este grupo poblacional. /Abstract This study aimed to determine the relationship between self-care agency ability and adherence to drug treatment and non-pharmacological in people registered and attended the Program control of hypertension in an ESE low complexity care of Monteria, 2010. Correlational design was used, the population sample consisted of 50 persons in control of hypertension, with more than a year spent in the program and control group consisted of 30 new registrants to the program. The information was obtained using the Scale Assessment of Self-Care Agency of Isemberg and Evers, validate in Colombia and Instrument Factors influencing adherence to pharmacological and non pharmacological treatments in patients with risk factors for cardiovascular disease of Bonilla and De Reales. The results revealed a relation between the capacity of self-care agency and adherence to drug treatment and non-pharmacological control of hypertension in the study sample and in the control group yielding a correlation coefficient of 0.85 and 0.66 respectively , which shows a strong relationship with positive trend between the two variables of study in both groups, being strongest when performing a nursing care intervention. Results are expected to contribute to the development of strategies that promote self-care in order to achieve adherence to treatment in this population.Maestrí

Diseño y construcción de un prototipo de bastón sensorial para invidentes mediante la utilización de ultrasonido

Tesis (Ingeniero de Sistemas).-- Universidad de San Buenaventura, Facultad de Arquitectura, Ingenierías, Arte y Diseño, Programa de Ingeniería de Sistemas, 2015La movilidad en las vías de Cartagena para las personas con discapacidad ha sido una problemática de muchos años, debido a que las calles de las ciudades no son aptas para el tránsito de cualquier persona con algún tipo de discapacidad en especial los invidentes; queriendo dar solución al problema que los aqueja, surgió este proyecto de investigación, el cual consiste en un sensor de ultrasonido que detecta a cierta distancia objetos, personas, animales, entre otros, que se le crucen a la persona, adaptando este sistema al bastón que ellos usan convencionalmente, dándole así más seguridad a la hora de transitar en las calles de cualquier ciudad del país. Se ensamblo un dispositivo o circuito, el cual contiene un microcontrolador ARDUINO Sparfunk pro micro, que es una pequeña placa que posee una memoria que se programa mediante código java y c++; un sensor de ultrasonido que hace el proceso de detección de los objetos, personas, etc., un motor el cual le dará una señal de alerta al acercarse a los dichos objetos, personas, entre otros, y un interruptor que le permitirá mantenerlo apagado cuando no la persona invidente no lo esté usando. Este proyecto se presenta como prototipo debido a que las necesidades de los invidentes son distintas y no se puede definir un sistema de alerta que funcione y que cumpla con las necesidades de ellos, también porque pueden realizarse mejoras añadiéndole otras funciones que pueden ser de beneficio para los ciego