29 research outputs found

    Mixoma auricular y disfunción cardiaca. A propósito de un caso

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    Se presenta el caso de una paciente de 57 años de la raza blanca que hace aproximadamente un mes antes de su ingreso comenzó a presentar falta de aire a los esfuerzos habituales. Luego fueron aumentando pero mejoraban con el reposo y acompañado también de palpitaciones al examen fisico se observó: ruidos cardiacos taquicardicos primer ruido normal segundo ruido desdoblado, no soplo hepatomegalia congestiva de 3 a 4 cm, tejido celular subcutaneo infiltrado en ambos miembros inferiores, reflujo hepato yugular. Se realizó ecocardiograma que demostró una masa tumoral que protruye en diástole hacia su ventrículo izquierdo a través del orificio de la válvula mirtral. Se envía al Instituto de Cardiología donde se realizó excerisis del mixoma

    Tratamiento farmacológico de la emergencia Hipertensiva

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    Se presenta la emergencia hipertensiva desde varios puntos de vista. Se define la entidad, se abordaron las diferentes formas de presentación así como las causas que la producen. Se exponeel tratamiento de elección para cada complicación, con dosis, vía de administración y efectos adversos

    Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

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    BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

    Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

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    Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

    Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

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    Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

    Mixoma auricular y disfunción cardiaca. A propósito de un caso

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    Se presenta el caso de una paciente de 57 años de la raza blanca que hace aproximadamente un mes antes de su ingreso comenzó a presentar falta de aire a los esfuerzos habituales. Luego fueron aumentando pero mejoraban con el reposo y acompañado también de palpitaciones al examen fisico se observó: ruidos cardiacos taquicardicos primer ruido normal segundo ruido desdoblado, no soplo hepatomegalia congestiva de 3 a 4 cm, tejido celular subcutaneo infiltrado en ambos miembros inferiores, reflujo hepato yugular. Se realizó ecocardiograma que demostró una masa tumoral que protruye en diástole hacia su ventrículo izquierdo a través del orificio de la válvula mirtral. Se envía al Instituto de Cardiología donde se realizó excerisis del mixoma

    Tratamiento inicial de la hipertensión arterial

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    Se plantea la clasificación de los medicamentos hipotensores, asi como las características que debe de tener un antihipertensivo ideal. Se exponen algunas acciones metabólicas de estos medicamentos. Se considera el tratamiento inicial con antihipertensivo cuando coexisten otrasalteraciones en el paciente. Se revisa las indicaciones y contraindicaciones de los diferentes agentes hipotensores arteriales. Se expresan las dosis de los medicamentos más utilizados en nuestro medio. Se pone de manifiesto la monoterapia en el tratamiento de la hipertensión, siendolos diuréticos, beta bloqueadores, anticálcicos, alfa bloqueadores e inhibidores de la enzima convertasa, los medicamentos que se utilizan actualmente para el inicio del tratamiento antihipertensivo siguiendo las características del paciente

    Tratamiento farmacológico de la emergencia Hipertensiva

    Get PDF
    Se presenta la emergencia hipertensiva desde varios puntos de vista. Se define la entidad, se abordaron las diferentes formas de presentación así como las causas que la producen. Se exponeel tratamiento de elección para cada complicación, con dosis, vía de administración y efectos adversos

    Tratamiento inicial de la hipertensión arterial

    No full text
    Se plantea la clasificación de los medicamentos hipotensores, asi como las características que debe de tener un antihipertensivo ideal. Se exponen algunas acciones metabólicas de estos medicamentos. Se considera el tratamiento inicial con antihipertensivo cuando coexisten otrasalteraciones en el paciente. Se revisa las indicaciones y contraindicaciones de los diferentes agentes hipotensores arteriales. Se expresan las dosis de los medicamentos más utilizados en nuestro medio. Se pone de manifiesto la monoterapia en el tratamiento de la hipertensión, siendolos diuréticos, beta bloqueadores, anticálcicos, alfa bloqueadores e inhibidores de la enzima convertasa, los medicamentos que se utilizan actualmente para el inicio del tratamiento antihipertensivo siguiendo las características del paciente

    Hemobilia secundaria a pseudoaneurisma de la arteria hepática

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    a hemobilia es la presencia de sangre en el árbol biliar ca-racterizada por la tríada: ictericia, dolor en hipocondrio de-recho (HD) y hemorragia digestiva alta (HDA). Las causas etiológicas son varias y se destacan en orden de frecuencia: las traumáticas (trauma hepático accidental y/o iatrogénico), las inflamatorias (colecistitis aguda y crónica), las infecciosas (colangitis, abscesos hepáticos, infecciones parasitarias) y las vasculares (aneurismas, vasculitis, malformaciones arteriove-nosas). Para el diagnóstico se dispone de múltiples exámenes complementarios tales como: imágenes (ecografía abdominal, tomografía computada, angio TC, resonancia magnética), endoscopía y la angiografía, no sólo como herramienta diag-nóstica sino también como modalidad terapéutica de elección. Se presenta el caso clínico de un paciente de sexo masculino, de 52 años de edad, con hemobilia secundaria a un pseudoa-neurisma de la arteria hepática y revisión de la literatura.Palabras claves
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