Pre-anesthesia evaluation in patients with chronic renal disease (emphasis on cardiovascular risk)

Chronic renal disease is a public health problem worldwide. Several times these patients will undergo surgical procedures related to dialysis or surgeries related to their co-morbidities. The purpose of the pre-anesthesia evaluation is to assess the risk of cardiovascular events and initiate interventions that may influence morbidity and mortality. This article describes the relevant epidemiological data of chronic kidney disease and its cardiovascular risk and provides a guide on clinical assessment, diagnostic tools and strategies to reduce surgical risk. This narrative literature review is based on articles written in both English and Spanish limited to the last 10 years, information from basic textbooks and primary databases (i.e., PUBMED - EMBASE - LILACS), supported by articles referenced in the above-mentioned search.La enfermedad renal crónica es un problema de salud pública mundial. En varias ocasiones los pacientes son llevados a cirugías relacionadas con su diálisis con operaciones propias de sus comorbilidades. El propósito de la valoración preanestésica es asesorar el riesgo de eventos cardiovasculares e iniciar las intervenciones que puedan influir en su morbimortalidad El presente artículo describe datos epidemiológicos relevantes de la enfermedad renal crónica, así como su riesgo cardiovascular, y nos orienta en su valoración clínica, ayudas diagnósticas y estrategias para reducir el riesgo quirúrgico. La presente revisión narrativa de la literatura fue desarrollada con artículos escritos en inglés y español, limitados a los últimos 10 años, información referenciada en textos guía y bases de datos primaria

Knowledge and Practice of Health Professionals in the Management of Dysphagia

Background: Dysphagia is associated with poor outcome in stroke patients. Studies investigating the association of dysphagia and early dysphagia screening (EDS) with outcomes in patients with acute ischemic stroke (AIS) are rare. The aims of our study are to investigate the association of dysphagia and EDS within 24 h with stroke-related pneumonia and outcomes. Methods: Over a 4.5-year period (starting November 2007), all consecutive AIS patients from 15 hospitals in Schleswig-Holstein, Germany, were prospectively evaluated. The primary outcomes were stroke-related pneumonia during hospitalization, mortality, and disability measured on the modified Rankin Scale >= 2-5, in which 2 indicates an independence/slight disability to 5 severe disability. Results: Of 12,276 patients (mean age 73 +/- 13; 49% women), 9,164 patients (74%) underwent dysphagia screening; of these patients, 55, 39, 4.7, and 1.5% of patients had been screened for dysphagia within 3, 3 to 72 h following admission. Patients who underwent dysphagia screening were likely to be older, more affected on the National Institutes of Health Stroke Scale score, and to have higher rates of neurological symptoms and risk factors than patients who were not screened. A total of 3,083 patients (25.1%; 95% CI 24.4-25.8) had dysphagia. The frequency of dysphagia was higher in patients who had undergone dysphagia screening than in those who had not (30 vs. 11.1%; p < 0.001). During hospitalization (mean 9 days), 1,271 patients (10.2%; 95% CI 9.7-10.8) suffered from stroke-related pneumonia. Patients with dysphagia had a higher rate of pneumonia than those without dysphagia (29.7 vs. 3.7%; p < 0.001). Logistic regression revealed that dysphagia was associated with increased risk of stroke-related pneumonia (OR 3.4; 95% CI 2.8-4.2; p < 0.001), case fatality during hospitalization (OR 2.8; 95% CI 2.1-3.7; p < 0.001) and disability at discharge (OR 2.0; 95% CI 1.6-2.3; p < 0.001). EDS within 24 h of admission appeared to be associated with decreased risk of stroke-related pneumonia (OR 0.68; 95% CI 0.52-0.89; p = 0.006) and disability at discharge (OR 0.60; 95% CI 0.46-0.77; p < 0.001). Furthermore, dysphagia was independently correlated with an increase in mortality (OR 3.2; 95% CI 2.4-4.2; p < 0.001) and disability (OR 2.3; 95% CI 1.8-3.0; p < 0.001) at 3 months after stroke. The rate of 3-month disability was lower in patients who had received EDS (52 vs. 40.7%; p = 0.003), albeit an association in the logistic regression was not found (OR 0.78; 95% CI 0.51-1.2; p = 0.2). Conclusions: Dysphagia exposes stroke patients to a higher risk of pneumonia, disability, and death, whereas an EDS seems to be associated with reduced risk of stroke-related pneumonia and disability. (C) 2016 S. Karger AG, Base

Nurse and Nursing Students' Opinions and Perceptions of Enteral Nutrition by Nasogastric Tube in Palliative Care

It is widely accepted that nursing staff play a key role in palliative care (PC). The use of Nasogastric tubes (NG tubes) for Enteral Nutrition (EN) administration is still controversial in patients who receive PC. The aim of this study was to describe nurses' and nursing students ' opinions and perceptions about EN using NG tubes in adult patients in palliative care. To achieve this goal, a cross-sectional descriptive study was carried out. A self-administered, semi-structured questionnaire intended for nurses and nursing students was used. Data was descriptively and inferentially analyzed using a chi-square test to determine the differential frequency of responses. In addition, a multivariate logistic regression model was also conducted. A total of 511 participants completed the questionnaire. Among them, nursing staff represented 74.9% (n = 383) whereas nursing students were 25.1% (n = 128). When life expectancy was above six months, 90.0% (n = 460) reported that EN using NG should be implemented. In contrast, when life expectancy is less than a month, 57.5% (n = 294) discouraged it. Significant differences within groups were found when life expectancy was <1 month (p = 0.044). It was also found that 491 participants (96.1%) reported that patient ' s autonomy must be carefully respected for deciding whether continuing EN by NG tube or not. Finally, it was concluded for both nurses and nursing students that life expectancy should be the mean reason for implementing and withdrawing EN by NG tube. Major differences were found regarding when it should be ceased, suggesting perceptions may change as nurses graduate and move into their professional roles

The circumnuclear environment of the peculiar galaxy NGC 3310

Gas and star velocity dispersions have been derived for eight circumnuclear star-forming regions (CNSFRs) and the nucleus of the spiral galaxy NGC3310 using high resolution spectroscopy in the blue and far red. Stellar velocity dispersions have been obtained from the CaII triplet in the near-IR, using cross-correlation techniques, while gas velocity dispersions have been measured by Gaussian fits to the Hb 4861A and [OIII]5007A emission lines. The CNSFRs stellar velocity dispersions range from 31 to 73 km/s. These values, together with the sizes measured on archival HST images, yield upper limits to the dynamical masses for the individual star clusters between 1.8 and 7.1 x 10$^6$ M$_\odot$, for the whole CNSFR between 2 x 10$^7$ and 1.4 x 10$^8$ M$_\odot$, and 5.3 x 10$^7$ M$_\odot$ for the nucleus inside the inner 14.2 pc. The masses of the ionizing stellar population responsible for the HII region gaseous emission have been derived from their published Ha luminosities and are found to be between 8.7 x 10$^5$ and 2.1 x 10$^6$ M$_\odot$ for the star-forming regions, and 2.1 x 10$^5$ M$_\odot$ for the galaxy nucleus; they therefore constitute between 1 and 7 per cent of the total dynamical mass. The ionized gas kinematics is complex; two different kinematical components seem to be present as evidenced by different line widths and Doppler shifts.Comment: 24 pages, accepted by MNRA

Coping Strategies in Elderly Colorectal Cancer Patients

The author(s) disclose the receipt of the following financial support for the research, authorship and/or publication of this article: this study was supported by a grant from the Education Ministry (Program FPU16/01437), Madrid, Spanish Government.In Spain, 34,331 new cases of colorectal cancer were diagnosed in 2018 and 15,923 individuals died from this disease in the same year. The highest incidence of colorectal cancer is among individuals aged 65–75 years and the physiological consequences of aging, alongside the effects of the disease and its treatment, can exacerbate their physical deterioration and cognitive impairment and reduce their social relationships. The learning of coping strategies may help to improve the quality of life of patients after cancer diagnosis. To test the hypothesis that the utilization of coping strategies can improve the quality of life of elderly patients with colorectal cancer, PubMed and EBSCO databases were searched, up to 2021, using the following terms: “coping strategies and colorectal cancer” with “anxiety”, “quality of life”, “depression”, “unmet needs”, “optimism”, “intimacy”, “distress”, “self-efficacy” and “self-esteem” with Boolean operators “AND”, “OR”. The literature search retrieved 641 titles/abstracts written in English. After an exhaustive analysis, only 7 studies met the inclusion criteria. Randomized evidence was scant and was reported only in 3/7 of the studies analyzed. Data from available randomized evidence support that patients improved on their depression and quality of life and felt more prepared to deal with their cancer. Coping strategies in patients with colorectal cancer were effective in improving patient adaptation to their new situation. Healthcare professionals working with these patients should receive training in this complementary treatment, to be able to conduct comprehensive care in order to improve the quality of life of these patients.Education Ministry, Madrid, Spanish Government FPU16/0143

Cultural adaptation, validity and reliability of the Maternal Role Adoption Scale in Colombia

Background: At present, an instrument with a disciplinary, valid, reliable and culturally adapted theoretical support is required to measure the process of becoming a first-time mother. Methods: Adaptation scale and validation scale study. Experts of Colombia participated in the facial validity and the content validity, for cultural adaptation. The content validity index and factor analysis were performed. A total of 282 first-time mothers participated in the survey to establish construct validity and reliability. Reliability was estimated using Cronbach's alpha coefficient. Results:he cultural adaptation was achieved. Facial validity for mothers was found as follows: high comprehension (97%). For experts: high comprehension (95.50%), high clarity (94.38%) and high precision (93.58%). In relevance, the content validity index was 0.97 (highly relevant) and in pertinence, the content validity index was 0.96 (highly pertinent). In the factor validation, ten factors that accounted for 66% of the variance were identified. Cronbach's alpha value of the scale was found to be 0.96 CI95% (0.95-0.97). Conclusion: The scale of Adoption of the Maternal Role culturally adapted in Colombia is valid and reliable for first-time mothers with full-term babies. This scale makes possible to identify the level: low, medium or high, of the process of becoming a mother and can be used to evaluate interventions focused on favoring the process of becoming a mother

Estudios históricos 7 : arquitectura y diseño

1 archivo PDF (160 páginas)Compilación de doce conferencias de excelencia académica presentadas en el Seminario de Historia de la Arquitectura y del Diseño en el siglo XX, UAM-UNAM. Éstas se organizan, en una primera parte, como investigaciones referidas a la historia de la Arquitectura y del diseño en México y a la globalización ... y, en segunda, al resto del mundo: Reino Unido, Bilbao, Berlín, Barcelona, Alemania

Kinematics of gas and stars in the circumnuclear starforming ring of NGC 3351

We have measured gas and stellar velocity dispersions in 5 circumnuclear starforming regions (CNSFRs) and the nucleus of the barred spiral galaxy NGC 3351. The stellar dispersions have been obtained from high resolution spectra of the CaT lines at $\lambda\lambda$ 8494, 8542, 8662 \AA, while the gas velocity dispersions have been measured by Gaussian fits to the H$\beta$ $\lambda$ 4861 \AA line on high dispersion spectra. The CNSFRs, with sizes of about 100 to 150 pc in diameter, are seen to be composed of several individual star clusters with sizes between 1.7 and 4.9 pc on an HST image. Using the stellar velocity dispersions, we have derived dynamical masses for the entire starforming complexes and for the individual star clusters. Values of the stellar velocity dispersions are between 39 and 67 km s$^{-1}$. Dynamical masses for the whole CNSFRs are between 4.9 $\times$ 10$^6$ and 4.3 $\times$ 10$^7$ M$_\odot$ and between 1.8 and 8.7 $\times$ 10$^6$ M$_\odot$ for the individual star clusters. Stellar and gas velocity dispersions are found to differ by about 20 km s$^{-1}$ with the H$\beta$ lines being narrower than both the stellar lines and the [O{\sc iii}] $\lambda$ 5007 \AA lines. We have found indications for the presence of two different kinematical components in the ionised gas of the regions. The radial velocity curve shows deviation from circular motions for the ionised hydrogen consistent with its infall towards the central regions of the galaxy at a velocity of about 25 km s$^{-1}$. To disentangle the origin of these two components it will be necessary to map these regions with high spectral and spatial resolution and much better S/N in particular for the O$^{2+}$ lines.Comment: 17 pages, 13 figures, 7 tables - Accepted by MNRA

Clinical Presentation of American Tegumentary Leishmaniasis in a Leishmania (Viannia) braziliensis Endemic Hotspot: A 35-Year History

American tegumentary leishmaniasis (ATL) is a neglected tropical disease affecting the skin and mucosa. American tegumentary leishmaniasis due to Leishmania (Viannia) braziliensis is endemic in Argentina, where the Department of Oran is a hyperendemic focus. All cases of ATL with laboratory confirmation evaluated at a referral center in Oran city between 1985 and 2019 were analyzed retrospectively. Information from cases included clinical form, lesion size and number, time of evolution, and anatomical location; sex, age, and geographic origin were also studied. The temporal distribution of cases was analyzed. A total of 3,573 cases were included in the analysis. The ratio of males to females was 3:1 and the median age was 33 years old. Eighty-seven percent of cases were from Oran city and its surroundings, highlighting the hyperendemic nature of the area. Regarding clinical forms, 92.5% of cases were cutaneous and 7.5% were mucosal, with a median evolution time until clinical evaluation of 30 days and 7 months, respectively. Single cutaneous lesions were more frequent, localized mainly on the exposed areas in the upper and lower limbs. Secondary events were observed and described in 140 (4%) cases, with a median interval of 3.8 years for the appearance of recurrent mucosal disease in previously cutaneous forms. This is the largest case series of ATL due to L. (V.) braziliensis. The most classic presentation is of adult males with single cutaneous ulcers in exposed body areas, with, 10% of cases with mucosal complications. This comprehensive clinical characterization serves as a basis for future studies of the care and control of this neglected tropical disease.Fil: Almazán, María Cristina. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Cajal, Silvana Pamela. Universidad Nacional de Salta. Facultad de Ciencias Naturales. Escuela de Biología. Cátedra de Química Biológica; Argentina. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; ArgentinaFil: Díaz Fernández, Melisa Evangelina. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; ArgentinaFil: Juárez, Marisa. Universidad Nacional de Salta. Facultad de Ciencias Naturales. Escuela de Biología. Cátedra de Química Biológica; ArgentinaFil: Quipildor, Marcelo Omar. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; ArgentinaFil: Portal, Guillermo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; Argentina. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; ArgentinaFil: Tejerina, Valeria. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; ArgentinaFil: Vargas, Carlos. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; ArgentinaFil: Copa, Griselda Noemí. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; Argentina. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; ArgentinaFil: Gil, José Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; Argentina. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; ArgentinaFil: Cimino, Rubén Oscar. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; Argentina. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; ArgentinaFil: Krolewiecki, Alejandro Javier. Universidad Nacional de Salta. Sede Regional Orán. Instituto de Investigación de Enfermedades Tropicales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; Argentin

Analyzing derived metallicities and ionization parameters from model-based determinations in ionized gaseous nebulae

We analyze the reliability of oxygen abundances and ionization parameters obtained from different diagnostic diagrams. For this, we compiled from the literature observational emission line intensities and oxygen abundance of 446 star-forming regions whose O/H abundance was determined by direct estimation of electron temperature. The abundances compiled were compared with the values calculated in this work using different diagnostic diagrams in combination with results from a grid of photoionization models. We found that the [\ion{O}{iii}]/[\ion{O}{ii}] vs. [\ion{N}{ii}]/[\ion{O}{ii}], [\ion{O}{iii}]/H$\beta$ vs. [\ion{N}{ii}]/[\ion{O}{ii}], and ([\ion{O}{iii}]/H$\beta$)/([\ion{N}{ii}]/H$\alpha$) vs. [\ion{S}{ii}]/[\ion{S}{iii}] diagnostic diagrams give O/H values close to the $T_{\rm e}$-method, with differences of about 0.04 dex and dispersion of about 0.3 dex. Similar results were obtained by detailed models but with a dispersion of 0.08 dex. The origin of the dispersion found in the use of diagnostic diagrams is probably due to differences between the real N/O-O/H relation of the sample and the one assumed in the models. This is confirmed by the use of detailed models that do not have a fixed N/O-O/H relation. We found no correlation between ionization parameter and the metallicity for the objects of our sample. We conclude that the combination of two line ratio predicted by photoionization models, one sensitive to the metallicity and another sensitive to the ionization parameter, which takes into account the physical conditions of star-forming regions, gives O/H estimates close to the values derived using direct detections of electron temperatures.Comment: 12 pages, 9 figures, accepted by MNRA