Symptomatic and Asymptomatic Neurological Complications of Infective Endocarditis: Impact on Surgical Management and Prognosis

International audienceObjectives:Symptomatic neurological complications (NC) are a major cause of mortality in infective endocarditis (IE) but the impact of asymptomatic complications is unknown. We aimed to assess the impact of asymptomatic NC (AsNC) on the management and prognosis of IE.Methods: From the database of cases collected for a population-based study on IE, we selected 283 patients with definite left-sided IE who had undergone at least one neuroimaging procedure (cerebral CT scan and/or MRI) performed as part of initial evaluation.Results Among those 283 patients, 100 had symptomatic neurological complications (SNC) prior to the investigation, 35 had an asymptomatic neurological complications (AsNC), and 148 had a normal cerebral imaging (NoNC). The rate of valve surgery was 43% in the 100 patients with SNC, 77% in the 35 with AsNC, and 54% in the 148 with NoNC (p<0.001). In-hospital mortality was 42% in patients with SNC, 8.6% in patients with AsNC, and 16.9% in patients with NoNC (p<0.001). Among the 135 patients with NC, 95 had an indication for valve surgery (71%), which was performed in 70 of them (mortality 20%) and not performed in 25 (mortality 68%). In a multivariate adjusted analysis of the 135 patients with NC, age, renal failure, septic shock, and IE caused by S. aureus were independently associated with in-hospital and 1-year mortality. In addition SNC was an independent predictor of 1-year mortality.Conclusions The presence of NC was associated with a poorer prognosis when symptomatic. Patients with AsNC had the highest rate of valve surgery and the lowest mortality rate, which suggests a protective role of surgery guided by systematic neuroimaging results

Eficacia del uso de foam roller en la flexibilidad de la cadena posterior en adultos de grupofisio, Arequipa 2021

El presente estudio tuvo enfoque cuantitativo porque utilizó la recolección y análisis de datos, el tipo de investigación fue aplicada, ya que tuvo que resolver un problema, el nivel fue correlacional, ya que hubo experimento alguno, solo se midieron las variables, el método fue científico observacional, permitiendo contrastar la hipótesis, el diseño fue prospectivo, ya que la información se recolectó de acuerdo a los criterios del investigador; y longitudinal porque las variables se midieron en varias ocasiones. El objetivo fue determinar la eficacia del uso del Foam Roller en la flexibilidad de la cadena posterior en personas adultas de GrupoFisio de la ciudad de Arequipa en el 2021. Los resultados hallados en la intervención del uso del Foam Roller y la elasticidad muscular en la cadena posterior, se encontró un grado de significancia de 0,000 (p < 0,005), observándose que antes de realizar la intervención para el rango articular en las articulaciones del miembro inferior era incompleta, luego de realizar la intervención se nota una mejora, logrando completar el rango articular. Podemos concluir que existe significancia estadística referente a la eficacia del uso del Foam Roller y la elasticidad de la cadena posterior porque el p-valor hallado fue menor al nivel de significancia planteado

Representación y exploración sobre el concepto del dolor. Cuerpo, mente e identidad

El presente trabajo tiene como objetivo la exploración del concepto del dolor. Tomando como base la propia experiencia, me sumerjo en una búsqueda cuyo fin es reescribir mi concepción sobre dicho sentimiento. Por medio de escritos, dibujos, instalaciones y pinturas, revalúo mi relación con esta sensación y pongo a prueba toda percepción sobre la misma que he tenido hasta ahora. Así mismo, testo sus límites a fin de mostrar la relevancia y presencia que tiene realmente en nuestra construcción como individuos. Hemos limitado el dolor al sufrimiento, desvirtuando siempre todo aquello que concebimos como doloroso y negando o reprimiendo cualquiera de sus otras dimensiones. En estas páginas plasmo mi recorrido por esta búsqueda y me presento a mí misma y a mi cuerpo como objeto de estudio. El resultado final no es una obra cerrada, sino un conjunto de piezas en las que me posiciono como una transcriptora de las realidades que he ido descubriendo.The actual work has as objective the exploration of the concept of pain. Taking my own experience as a base, I get immersed in a search which purpose is rewrite my conception about said feeling. By means of writings, drawings, installations and paintings, I reappraise my relationship with this sensation and test any perception I have had about it until now. Likewise, I challenge its limits with the aim to show the relevance and presence that it actually has in our construction as individuals. We have limited the pain to the suffering, always detracting everything that we conceive as painful and denying or suppressing any other of its dimensions. In these pages I show my path through this search and I present myself and my body as the object of study. The final result is not a closed piece, but a collection of them in which I position myself as a transcriber of the realities that I have been founding.Moya Cabrera, MY. (2019). Representación y exploración sobre el concepto del dolor. Cuerpo, mente e identidad. http://hdl.handle.net/10251/125919TFG

A randomized trial of planned cesarean or vaginal delivery for twin pregnancy

Background: Twin birth is associated with a higher risk of adverse perinatal outcomes than singleton birth. It is unclear whether planned cesarean section results in a lower risk of adverse outcomes than planned vaginal delivery in twin pregnancy.\ud \ud Methods: We randomly assigned women between 32 weeks 0 days and 38 weeks 6 days of gestation with twin pregnancy and with the first twin in the cephalic presentation to planned cesarean section or planned vaginal delivery with cesarean only if indicated. Elective delivery was planned between 37 weeks 5 days and 38 weeks 6 days of gestation. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity, with the fetus or infant as the unit of analysis for the statistical comparison.\ud \ud Results: A total of 1398 women (2795 fetuses) were randomly assigned to planned cesarean delivery and 1406 women (2812 fetuses) to planned vaginal delivery. The rate of cesarean delivery was 90.7% in the planned-cesarean-delivery group and 43.8% in the planned-vaginal-delivery group. Women in the planned-cesarean-delivery group delivered earlier than did those in the planned-vaginal-delivery group (mean number of days from randomization to delivery, 12.4 vs. 13.3; P = 0.04). There was no significant difference in the composite primary outcome between the planned-cesarean-delivery group and the planned-vaginal-delivery group (2.2% and 1.9%, respectively; odds ratio with planned cesarean delivery, 1.16; 95% confidence interval, 0.77 to 1.74; P = 0.49).\ud \ud Conclusion: In twin pregnancy between 32 weeks 0 days and 38 weeks 6 days of gestation, with the first twin in the cephalic presentation, planned cesarean delivery did not significantly decrease or increase the risk of fetal or neonatal death or serious neonatal morbidity, as compared with planned vaginal delivery