A randomised controlled trial comparing the effect of adjuvant intrathecal 2 mg midazolam to 20 micrograms fentanyl on postoperative pain for patients undergoing lower limb orthopaedic surgery under spinal anaesthesia

Background: Intrathecal adjuvants are added to local anaesthetics to improve the quality of neuraxial blockade and prolong the duration of analgesia during spinal anaesthesia. Used intrathecally, fentanyl improves the quality of spinal blockade as compared to plain bupivacaine and confers a short duration of post operative analgesia. Intrathecal midazolam as an adjuvant has been used and shown to improve the quality of spinal anaesthesia and prolong the duration of post-operative analgesia. No studies have been done comparing intrathecal fentanyl with bupivacaine and intrathecal 2 mg midazolam with bupivacaine.Objective: To compare the effect of intrathecal 2mg midazolam to intrathecal 20 micrograms fentanyl when added to 2.6 ml of 0.5% hyperbaric bupivacaine, on post-operative pain, in patients undergoing lower limb orthopaedic surgery under spinal anaesthesia.Methods: A total of 40 patients undergoing lower limb orthopaedic surgery under spinal anaesthesia were randomized to two groups. Group 1: 2.6mls 0.5% hyperbaric bupivacaine with 0.4mls (20micrograms) fentanyl Group 2: 2.6mls of 0.5% hyperbaric bupivacaine with 0.4mls (2mg) midazolamResults: The duration of effective analgesia was longer in the midazolam group (384.05 minutes) as compared to the fentanyl group (342.6 minutes). There was no significant difference (P 0.4047). The time to onset was significantly longer in midazolam group 17.1 minutes as compared to the fentanyl group 13.2 minutes (P 0.023). The visual analogue score at rescue was significantly lower in the midazolam group (5.55) as compared to the fentanyl group 6.35 (P - 0.043).Conclusion: On the basis of the results of this study, there was no significant difference in the duration of effective analgesia between adjuvant intrathecal 2 mg midazolam as compared to intrathecal 20 micrograms fentanyl for patients undergoing lower limb orthopaedic surgery.Keywords: Midazolam fentanyl, lower limb, orthopaedic surgery, spinal anaesthesi

A randomised controlled trial comparing the effect of adjuvant intrathecal 2 mg midazolam to 20 micrograms fentanyl on postoperative pain for patients undergoing lower limb orthopaedic surgery under spinal anaesthesia

Background: Intrathecal adjuvants are added to local anaesthetics to improve the quality of neuraxial blockade and prolong the duration of analgesia during spinal anaesthesia. Used intrathecally, fentanyl improves the quality of spinal blockade as compared to plain bupivacaine and confers a short duration of post-operative analgesia. Intrathecal midazolam as an adjuvant has been used and shown to improve the quality of spinal anaesthesia and prolong the duration of post-operative analgesia. No studies have been done comparing intrathecal fentanyl with bupivacaine and intrathecal 2 mg midazolam with bupivacaine. Objective: To compare the effect of intrathecal 2mg midazolam to intrathecal 20 micrograms fentanyl when added to 2.6 ml of 0.5% hyperbaric bupivacaine, on post-operative pain, in patients undergoing lower limb orthopaedic surgery under spinal anaesthesia. Methods: A total of 40 patients undergoing lower limb orthopaedic surgery under spinal anaesthesia were randomized to two groups. Group 1: 2.6mls 0.5% hyperbaric bupivacaine with 0.4mls (20micrograms) fentanyl Group 2: 2.6mls of 0.5% hyperbaric bupivacaine with 0.4mls (2mg) midazolam Results: The duration of effective analgesia was longer in the midazolam group (384.05 minutes) as compared to the fentanyl group (342.6 minutes). There was no significant difference (P 0.4047). The time to onset was significantly longer in midazolam group 17.1 minutes as compared to the fentanyl group 13.2 minutes (P 0.023). The visual analogue score at rescue was significantly lower in the midazolam group (5.55) as compared to the fentanyl group 6.35 (P - 0.043). Conclusion: On the basis of the results of this study, there was no significant difference in the duration of effective analgesia between adjuvant intrathecal 2 mg midazolam as compared to intrathecal 20 micrograms fentanyl for patients undergoing lower limb orthopaedic surgery

Hallazgos identificados en tomografías de oído, realizadas en pacientes atendidos en el Hospital Dr. Fernando Vélez Paiz, enero 2018 - diciembre 2019

Título: Hallazgos identificados en tomografías de oído, realizadas en pacientes atendidos en el hospital Dr. Fernando Vélez Paiz, enero 2018 - diciembre 2019. Objetivo: identificar los hallazgos tomográficos de la anatomía del oído externo, medio e interno, en pacientes, atendidos en el Hospital Dr. Fernando Vélez Paiz, enero 2018 - diciembre 2019. Tipo de estudio: observacional, transversal, retrospectivo y descriptivo. Material y método: se incluyeron pacientes enviados al servicio de imagenología, entre el 01 de enero de 2018 al 31 de diciembre de 2019, remitidos por el departamento de ORL del hospital Dr. Fernando Vélez Paiz, donde se les realizó TC de Oído. La información se capturó mediante las fichas de recolección de datos e interpretación de imágenes. Se empleó estadística descriptiva mediante frecuencias, porcentajes, medidas de tendencia central y desviaciones estándar, en SPSS v. 25. Resultados: del total de pacientes, (43.3 %) femeninos y (56.7 %) masculinos, el mayor porcentaje procedía del área urbana (93.3%). El grupo etáreo en el que se realizó mayor cantidad de estudios fue 1-15 años. Las principales indicaciones médicas de las TC de oído fueron los procesos infecciosos crónicos del oído (porcentaje acumulado 43 %) y los defectos congénitos (porcentaje acumulado 26.7%), el 80% de los estudios fueron patológicos, las principales alteraciones corresponden a: mastoides alterada (46.6%) principalmente por esclerosis y secreciones, oído medio ocupado por secreciones (16.6%), engrosamiento de la membrana timpánica, pabellón auricular con microtia grado 1 y 3 (10%), Conclusión: la mayor parte de estudios tomográficos se dio en la edad de 1-15 años, el 80% de estudios resultaron patológicos, las indicaciones médicas de dichos estudios concuerdan en porcentajes similares con las conclusiones diagnósticas por imagen, 23.3% acumulado para procesos infecciosos crónicos, principalmente del mastoides, y 19.8 % acumulado para defectos congénitos como microtia y agenesia del CAE. Palabras clave: TC de oídos, defectos congénitos, otiti

A randomised controlled trial comparing the effect of adjuvant intrathecal 2 mg midazolam to 20 micrograms fentanyl on postoperative pain for patients undergoing lower limb orthopaedic surgery under spinal anaesthesia.

Background: Intrathecal adjuvants are added to local anaesthetics to improve the quality of neuraxial blockade and prolong the duration of analgesia during spinal anaesthesia. Used intrathecally, fentanyl improves the quality of spinal blockade as compared to plain bupivacaine and confers a short duration of post-operative analgesia. Intrathecal midazolam as an adjuvant has been used and shown to improve the quality of spinal anaesthesia and prolong the duration of post-operative analgesia. No studies have been done comparing intrathecal fentanyl with bupivacaine and intrathecal 2 mg midazolam with bupivacaine. Objective: To compare the effect of intrathecal 2 mg midazolam to intrathecal 20 micrograms fentanyl when added to 2.6 ml of 0.5% hyperbaric bupivacaine, on post-operative pain, in patients undergoing lower limb orthopaedic surgery under spinal anaesthesia. Methods: A total of 40 patients undergoing lower limb orthopaedic surgery under spinal anaesthesia were randomized to two groups. Group 1: 2.6mls 0.5% hyperbaric bupivacaine with 0.4mls (20micrograms) fentanyl Group 2: 2.6mls of 0.5% hyperbaric bupivacaine with 0.4mls (2mg) midazolam Results: The duration of effective analgesia was longer in the midazolam group (384.05 minutes) as compared to the fentanyl group (342.6 minutes). There was no significant difference (P 0.4047). The time to onset was significantly longer in midazolam group 17.1 minutes as compared to the fentanyl group 13.2 minutes (P 0.023). The visual analogue score at rescue was significantly lower in the midazolam group (5.55) as compared to the fentanyl group 6.35 (P - 0.043). Conclusion: On the basis of the results of this study, there was no significant difference in the duration of effective analgesia between adjuvant intrathecal 2 mg midazolam as compared to intrathecal 20 micrograms fentanyl for patients undergoing lower limb orthopaedic surgery

El Servicio de Asistencia Técnica a la Escuela: Aproximaciones a su configuración en México.

This article aims to analyze first drafts of a coaching service to schools (SATE, for its acronym in Spanish) in the context of current educational reform in Mexico. To this end all legal documents and various program documents that have been released throughout 2013 and 2014 relating to basic education were analyzed. The paper is organized in three sections. The history of this type of service in Mexico is presented first; the second section includes information on the SATE as included in the legal documents of the current educational policy. In a third section some comments on what have to be taken into account for the proper implementation of a service of this nature are made

El Servicio de Asistencia Técnica a la Escuela: Aproximaciones a su configuración en México.

This article aims to analyze first drafts of a coaching service to schools (SATE, for its acronym in Spanish) in the context of current educational reform in Mexico. To this end all legal documents and various program documents that have been released throughout 2013 and 2014 relating to basic education were analyzed. The paper is organized in three sections. The history of this type of service in Mexico is presented first; the second section includes information on the SATE as included in the legal documents of the current educational policy. In a third section some comments on what have to be taken into account for the proper implementation of a service of this nature are made

Should patients with hip joint prosthesis receive antibiotic prophylaxis before dental treatment?

The safety committee of the American Academy of Orthopedic Surgeons (AAOS) recommended in 2009 that clinicians should consider antibiotic prophylaxis for all patients with total joint replacement before any invasive procedure that may cause bacteremia. This has aroused confusion and anger among dentists asking for the evidence. The present review deals with different aspects of the rationale for this recommendation giving attention to views both in favor of and against it

A randomised controlled trial comparing the effect of adjuvant intrathecal 2MG midazolam to 20-micrograms fentanyl on post-operative pain for patients undergoing lower limb orthopaedic surgery under spinal anaesthesia

Background: Intrathecal adjuvants are added to local anaesthetics to improve the quality of neuraxial blockade and prolong the duration of analgesia during spinal anaesthesia. As an intrathecal adjuvant, fentanyl improves the onset and quality of spinal blockade as compared to plain bupivacaine and confers a short duration of postoperative analgesia. However, its use is associated with several adverse effects that range from pruritus to life threatening respiratory depression. Intrathecal midazolam as an adjuvant has been used and shown to improve the quality of spinal anaesthesia and prolong the duration of postoperative analgesia. No studies have been done comparing intrathecal fentanyl with bupivacaine and intrathecal 2mg midazolam with bupivacaine. Objective: To compare the effect of intrathecal 2mg midazolam to intrathecal 20 micrograms fentanyl when added to 2.6 ml of 0.5% hyperbaric bupivacaine, on post-operative pain, in patients undergoing lower limb orthopaedic surgery under spinal anaesthesia. Study design: Single blinded Randomized Controlled Trial Methods: A total of 40 patients undergoing lower limb orthopaedic surgery under spinal anaesthesia were randomized to two groups Group 1; 2.6mls 0.5% hyperbaric bupivacaine with 0.4mls (20micrograms) fentanyl Group 2; 2.6mls of 0.5% hyperbaric bupivacaine with 0.4mls (2mg) midazolam Results: The duration of effective analgesia was longer in the midazolam group 384.05min as compared to the fentanyl group 342.6min. There was no significant difference (‘P’ 0.4047). The time to onset was significantly longer in midazolam group 17.1min as compared to the fentanyl group 13.2min (‘P 0.023’). The visual analogue score at rescue was significantly lower in the midazolam group 5.55 as compared to the fentanyl group 6.35 (‘P - 0.043’). Conclusion: On the basis of the results of this study, there was no significant difference in the duration of effective analgesia between adjuvant intrathecal 2mg midazolam as compared to intrathecal 20micrograms fentanyl for patients undergoing lower limb orthopaedic surgery

B / Ilustre Colegio Oficial de Doctores y Licenciados en Filosofía y Letras y en Ciencias

Se relata la biografía de José Saramago, premio Nobel de Literatura en lengua portuguesa en el año 1998. Se desglosa su obra literaria hasta su muerte en Lanzarote el 18 de junio de 2010 a los 87 años. Entre sus obras más importantes están: Ensayo sobre la ceguera, Todos los nombres, La caverna, El hombre duplicado y Las pequeñas memorias. Se erigió en uno de los más acérrimos defensores de una Iberia unida, en la que España y Portugal fueran un sólo país.MadridCRIF Las Acacias. Dirección General de Mejora de la Calidad de la Enseñanza. Comunidad de Madrid; Calle General Ricardos, 179; 28025 Madrid; Tel. +34915250893; Fax +34915255888; [email protected]