Escorpionismo en una instituci?n de tercer nivel del municipio de Ibagu? Tolima durante los a?os 2010-2017

84 p. Recurso Electr?nicoIntroducci?n: El escorpionismo se conoce como la inoculaci?n del veneno del escorpi?n en el cuerpo humano generando manifestaciones desde leves a severas con afectaci?n multisistemica. Objetivo: Describir el comportamiento epidemiol?gico y estad?stico del escorpionismo en una instituci?n de tercer nivel de atenci?n en el municipio de Ibagu? Tolima durante los a?os 2010-2017. Materiales y m?todos: Se realiz? un estudio epidemiol?gico observacional descriptivo transversal con informaci?n retrospectiva, en pacientes que presentaron escorpionismo, ingresados a una instituci?n de tercer nivel de atenci?n en el municipio de Ibagu? Tolima durante los a?os 2010-2017. Resultados: El promedio de la edad de presentaci?n de escorpionismo fue de 35 a?os. Cerca del 96% de pacientes permanecieron en el ?rea de urgencias y observaci?n. Un 98.6% de pacientes manifest? la presencia de dolor en el sitio de la picada. Solo al 30.6% del total de los pacientes se les aplic? el suero antiescorpi?nico. El rango de edad que m?s frecuencia tuvo casos fue entre 21 y 40 a?os con 46 personas, 6 ni?os estuvieron en Unidad de cuidados intensivos (UCI), 5 de ellos menores de 1 a?o y uno de 6 a 10 a?os. Conclusi?n: La poblaci?n afectada por el escorpionismo no tiene en consideraci?n la edad ni el g?nero, generalmente las medidas de prevenci?n deben ser uno de los pilares para contrarrestar las picaduras por estos artr?podos. Destacar la importancia que tiene la clasificaci?n de severidad en los ni?os menores a 1 a?o, pues la mayor?a terminaron en UCIP (unidad de cuidados intensivos pedi?tricos). Palabras Claves: Escorpionismo, escorpi?n, antiveneno, epidemiolog?a.Introduction: Scorpionism is known as the inoculation of the scorpion venom in the human body generating manifestations from mild to severe with multisystemic affectation. Objective: To describe the epidemiological and statistical behavior of scorpionism in a third-level care institution in the municipality of Ibagu? Tolima during the years 2010-2017. Materials and methods: An observational, cross-sectional observational epidemiological study was conducted with retrospective information, in patients who presented scorpionism, admitted to a third-level care institution in the municipality of Ibagu? Tolima during the years 2010-2017. Results: The average age of presentation of scorpionism was 35 years. About 96% of patients remained in the emergency and observation area. A 98.6% of patients reported the presence of pain at the site of the bite. Only 30.6% of the total patients were treated with antiscorpionic serum. The age range that most often had cases was between 21 and 40 years with 46 people, 6 children were in intensive care unit (ICU), 5 of them under 1 year and one of 6 to 10 years. Conclusion: The population affected by the scorpionism does not take into account the age or the gender, generally the preventive measures must be one of the pillars to counteract the stings by these arthropods. Highlight the importance of the classification of severity in children under 1 year, since most ended up in PICU (pediatric intensive care unit). Keywords: scorpionism, escorpions, antivenom, epidemiology

THE EFFECT OF A PERIPHERAL NOREPINEPHRINE PROTOCOL ON CENTRAL LINE UTILIZATION IN A SURGICAL ICU

INTRODUCTION: Central venous catheters (CVC) are associated with various complications. In several studies, the use of vasopressors through peripheral venous catheters (PVC) obviated the need for CVC insertion in 34-87% of patients. Although evidence indicates that the peripheral administration of vasopressors is safe, most health systems currently use protocols that favor the use of CVC over PVC. We proposed a quality improvement study evaluating the use of a protocol for the peripheral administration of a dilute norepinephrine solution (16 mcg/ml) in the surgical intensive care unit (SICU). METHODS: This was a retrospective quality improvement study conducted at Henry Ford Hospital in Detroit, MI. We included 100 patients that were admitted to the SICU between June and December 2021 and received dilute norepinephrine for any cause through a PVC under our prespecified protocol. Guidelines for CVC insertion were present in the protocol to assist clinicians. An extravasation protocol was instituted which included application of 2% nitroglycerin ointment. The primary endpoint evaluated was the number of patients in which a CVC was placed, regardless of the cause, within 24 hours of discontinuation of norepinephrine through the PVC. Secondary endpoints included the indication for central line placement, dose of norepinephrine infused, duration of norepinephrine infusions, gauge and location of the PVC, frequency of extravasation events, and tissue injury. RESULTS: Out of the 100 included in the study 51 patients (51%) did not receive a CVC, and 60 patients (60%) did not receive a CVC within the first 24 hours of discontinuation of peripheral norepinephrine. Norepinephrine extravasation was noted in 6 patients (6%). These incidents were successfully managed with nitroglycerin (2%) ointment. CONCLUSIONS: We demonstrated that administration of diluted norepinephrine through a PVC following a protocol in the SICU was associated with a reduction in CVC placement. The incidence of extravasation of norepinephrine was rare. Careful assessment of the PVC allowed for early treatment with topical nitroglycerine and no harm was identified to any patient

A Phase II, Randomized, Double-Blind, Placebo Controlled, Dose-Response Trial of the Melatonin Effect on the Pain Threshold of Healthy Subjects

Background: Previous studies have suggested that melatonin may produce antinociception through peripheral and central mechanisms. Based on the preliminary encouraging results of studies of the effects of melatonin on pain modulation, the important question has been raised of whether there is a dose relationship in humans of melatonin on pain modulation. Objective: The objective was to evaluate the analgesic dose response of the effects of melatonin on pressure and heat pain threshold and tolerance and the sedative effects. Methods: Sixty-one healthy subjects aged 19 to 47 y were randomized into one of four groups: placebo, 0.05 mg/kg sublingual melatonin, 0.15 mg/kg sublingual melatonin or 0.25 mg/kg sublingual melatonin. We determine the pressure pain threshold (PPT) and the pressure pain tolerance (PPTo). Quantitative sensory testing (QST) was used to measure the heat pain threshold (HPT) and the heat pain tolerance (HPTo). Sedation was assessed with a visual analogue scale and bispectral analysis. Results: Serum plasma melatonin levels were directly proportional to the melatonin doses given to each subject. We observed a significant effect associated with dose group. Post hoc analysis indicated significant differences between the placebo vs. the intermediate (0.15 mg/kg) and the highest (0.25 mg/kg) melatonin doses for all pain threshold and sedation level tests. A linear regression model indicated a significant association between the serum melatonin concentrations and changes in pain threshold and pain tolerance (R2 = 0.492 for HPT, R2 = 0.538 for PPT, R2 = 0.558 for HPTo and R2 = 0.584 for PPTo). Conclusions: The present data indicate that sublingual melatonin exerts well-defined dose-dependent antinociceptive activity. There is a correlation between the plasma melatonin drug concentration and acute changes in the pain threshold. These results provide additional support for the investigation of melatonin as an analgesic agent. Brazilian Clinical Trials Registry (ReBec): (U1111-1123-5109). IRB: Research Ethics Committee at the Hospital de Clínicas de Porto Alegre

Thrombosed great saphenous vein aneurysm accompanied by venous thrombosis

Superficial venous aneurysms of the lower extremities are considered rare and their clinical significance is poorly defined. The purpose of this article is to report a case of a 72- year-old woman with a thrombosed great saphenous vein aneurysm along with deep venous thrombosis and review its clinical presentation, diagnosis and treatment

Effect of Intubation Timing on the Outcome of Patients With Severe Respiratory Distress Secondary to COVID-19 Pneumonia.

Background: The optimal timing of intubation for critically ill patients with severe respiratory illness remains controversial among healthcare providers. The coronavirus disease 2019 (COVID-19) pandemic has raised even more questions about when to implement this life-saving therapy. While one group of providers prefers early intubation for patients with respiratory distress because these patients may deteriorate rapidly without it, other providers believe that intubation should be delayed or avoided because of its associated risks including worse outcomes. Research question: Our objective was to assess whether the timing of intubation in patients with severe COVID-19 pneumonia was associated with differences in mortality or other outcomes. Study design and methods: This was a single-center retrospective observational cohort study. We analyzed outcomes of patients who were intubated secondary to COVID-19 pneumonia between March 13, 2020, and December 12, 2020, at Henry Ford Hospital in Detroit, Michigan. Patients were categorized into two groups: early intubated (intubated within 24 hours of the onset of severe respiratory distress) and late intubated (intubated after 24 hours of the onset of severe respiratory distress). Demographics, comorbidities, respiratory rate oxygenation (ROX) index, sequential organ failure assessment (SOFA) score, and treatment received were compared between groups. The primary outcome was mortality. Secondary outcomes were ventilation time, intensive care unit stay, hospital length of stay, and discharge disposition. Post hoc and Kaplan-Meier survival analyses were performed. Results: A total of 110 patients were included: 55 early intubated and 55 late intubated. We did not observe a significant difference in overall mortality between the early intubated (43%) and the late intubated groups (53%) (p = 0.34). There was no statistically significant difference in patients\u27 baseline characteristics including SOFA scores (the early intubation group had a mean score of 7.5 compared to 6.7 in the late intubation group). Based on the ROX index, the early intubation group had significantly more patients with a reduced risk of intubation (45%) than the late group (27%) (p = 0.029). The early intubation group was treated with a high-flow nasal cannula at a significantly lower rate (47%) than the late intubation group (83%) (p \u3c 0.001). Significant differences in patient baseline characteristics, treatment received, and other outcomes were not observed. Post hoc analysis adjusting for SOFA score between 0 and 9 revealed significantly higher mortality in the late intubation group (49%) than in the early intubation group (26%) (p = 0.03). Patients in the 0 to 9 SOFA group who were intubated later had 2.7 times the odds of dying during hospital admission compared to patients who were intubated early (CI, 1.09-6.67). Interpretation: The timing of intubation for patients with severe COVID-19 pneumonia was not significantly associated with overall mortality or other patient outcomes. However, within the subgroup of patients with SOFA scores of 9 or lower at the time of intubation, patients intubated after 24 hours of the onset of respiratory distress had a higher risk of death than those who were intubated within 24 hours of respiratory distress. Thus, patients with COVID-19 pneumonia who are not at a high level of organ dysfunction may benefit from early mechanical ventilation

Criterios para la instrumentación de un magnetómetro hall en corriente continua.

En este trabajo se presentan los criterios de diseño para la implementación de un medidor de intensidad de campo magnético, mediante un sensor Hall, es decir un magnetómetro Hall, teniendo en cuenta criterios instrumentales y metrológicos. En el proceso de medición de campo magnético se presenta incertidumbre tipo B, debida a la transducción, amplificación, filtrado y conversión A/D. Se incorporan consideraciones que el instrumentador debe tener en cuenta para reducir el índice de incertidumbre, haciendo el proceso de medición más eficiente. Se realizó la instrumentación del magnetómetro Hall y se redujo el índice de incertidumbre en un 5%, correspondiente a uno de los factores de error

Neurobiological Effects of Transcranial Direct Current Stimulation: A Review

Transcranial Direct Current Stimulation (tDCS) is a non-invasive brain stimulation technique that is affordable and easy to operate compared to other neuromodulation techniques. Anodal stimulation increases cortical excitability, while the cathodal stimulation decreases it. Although tDCS is a promising treatment approach for chronic pain as well as for neuropsychiatric diseases and other neurological disorders, several complex neurobiological mechanisms that are not well understood are involved in its effect. The purpose of this systematic review is to summarize the current knowledge regarding the neurobiological mechanisms involved in the effects of tDCS. The initial search resulted in 171 articles. After applying inclusion and exclusion criteria, we screened 32 full-text articles to extract findings about the neurobiology of tDCS effects including investigation of cortical excitability parameters. Overall, these findings show that tDCS involves a cascade of events at the cellular and molecular levels. Moreover, tDCS is associated with glutamatergic, GABAergic, dopaminergic, serotonergic, and cholinergic activity modulation. Though these studies provide important advancements toward the understanding of mechanisms underlying tDCS effects, further studies are needed to integrate these mechanisms as to optimize clinical development of tDCS

Bulk viscosity and energy-momentum correlations in high energy hadron collisions

We show how the measurement of appropriately constructed particle-energy/momentum correlations allows access to the bulk viscosity of strongly interacting hadron matter in heavy ion collisions. This measurement can be performed by the LHC and RHIC experiments in events with high-particle multiplicity, following up on existing estimates of the shear viscosity based on elliptic flow.Comment: 7 pages, no figure