6 research outputs found
Experiencia clínica en el tratamiento con aféresis terapéutica en el Hospital Militar Escuela «Dr. Alejandro Dávila Bolaños»
Doctora en Ciencias de Salud Pública, Docente Investigadora, Facultad de Ciencias Médicas «Coronel Dr. Juan Ignacio Gutiérrez Sacasa», Managua, Nicaragua. [email protected]
ORCID: https://orcid.org/0000-0001-8860-2193
Doctor en Epidemiología, Profesor Investigador en el Instituto Regional de Investigación
en Salud Pública, Centro
Universitario de Ciencias de la Salud-Universidad de Guadalajara, México. [email protected]
ORCID https://orcid.org/0000-0002-2827-8093.
Internista, nefrólogo, Jefe de Unidad de hemodiálisis del HMEADB. [email protected]
ORCID: https://orcid.org/0000-0003-0797-9306.
Médico General. Dirección de atención primaria CMM. [email protected]
ORCID: https://orcid.org/0000-0003-3001-1336.
Médico General Dirección de atención primaria CMM. [email protected].
ORCID: https://orcid.org/0000-0001-6057-3984.La plasmaféresis terapéutica es un procedimiento con enormes beneficios terapéuticos cuando se utiliza en patologías con demostrada eficacia. Es una técnica de tratamiento dirigido, principalmente, a enfermedades autoinmunes. Ha cobrado gran importancia en el manejo de enfermedades renales, reumatológicas, neurológicas, infecciosas y metabólicas. Actualmente se ha posicionado como el tratamiento de primera línea. Este tipo de patologías no son tan frecuentes en nuestro medio, la incidencia en la población nicaragüense ha aumentado progresivamente. La prevalencia de la esclerosis múltiple del 2012 con respecto al año 2013 se incrementó de 1.8 a 2 por cada 100,000 habitantes en nuestro país. Se describe la experiencia clínica en el tratamiento con aféresis terapéutica en pacientes atendidos en el Servicio de Medicina Interna del Hospital Militar Escuela «Dr. Alejandro Dávila Bolaños». La metodología Se realizó estudio observacional descriptivo, retrospectivo en el Hospital Militar Escuela «Dr. Alejandro Dávila Bolaños», durante 2017-2019 con el objetivo de describir la experiencia clínica de los pacientes tratados con aféresis terapéutica. En el hospital fuerontudio. Los resultados muestran que 92 % de pacientes seleccionados tenían enfermedades neurológicas y 8 % enfermedades renales. El 80 % de los pacientes tuvieron una respuesta adecuada. La indicación más frecuente para la plasmaféresis fue el diagnóstico de miastenia gravis (32 %), seguida de síndrome de Guillain-Barré (28 %) y esclerosis múltiple (12 %). El 76 % de los pacientes no presentó complicaciones durante el procedimiento mientras que el 24 % experimentaron hipotensión arterial transitoria resuelta en los primeros 20 minutos del procedimiento
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Isovolemic hemodilution in experimental focal cerebral ischemia Part 2: Effects on regional cerebral blood flow and size of infarction
✓ Seventy-six splenectomized dogs were entered in a study of the value and effects of isovolemic hemodilution. Of these, seven were not included in the analysis because of technical errors. Of the remaining 69 dogs, 35 were treated with hemodilution; 28 were subjected to a 6-hour period of temporary occlusion of the distal internal carotid artery and the proximal middle cerebral artery, and seven underwent a sham operation only, with arterial manipulation but no occlusion. The other 34 dogs were not subjected to hemodilution; 26 of these underwent temporary arterial occlusion and eight had a sham operation only. In each group the animals were about equally divided into 1) an acute protocol with regional cerebral blood flow measurements by a radioactive microsphere technique and sacrifice at the end of the acute experiment, and 2) a chronic protocol with survival for 1 week to permit daily neurological assessment and final histopathological examination but without blood flow measurements. The general experimental protocol, the hemodynamic and rheological measurements, and the changes in intracranial pressure are described in Part 1 of this report. In the animals with arterial occlusion, blood flow decreased significantly in the territory of the ischemic middle cerebral artery. This decrease was partially reversed by hemodilution in the animals so treated. When the changes in blood flow before and after hemodilution in treated animals are compared with the changes at equivalent times in animals without hemodilution, the increases in flow in the gray matter of the ischemic hemisphere brought about by hemodilution are statistically significant. The neurological condition of the animals in the chronic protocol (sacrificed 1 week after occlusion) with hemodilution, as evaluated by daily neurological assessment, was significantly better than that of the control animals. In the animals sacrificed acutely (8 hours after arterial occlusion), the volume of infarction as estimated by the tetrazolium chloride histochemical method was 7.36% of the total hemispheric volume in the control animals and 1.09% in the hemodiluted animals, showing a statistically significant difference (p < 0.005). In the chronic animals these values were 9.84% and 1.26%, respectively (p < 0.005), as calculated by fluorescein staining. By histopathological examination the volume of infarction in the chronic animals was calculated as 10.92% in the control animals and 1.20% in the hemodiluted animals (p < 0.005). There was good correlation between the size of infarction and the decrease in hematocrit and viscosity, and excellent correlation between the size of infarction estimated by fluorescein and that determined by histopathological examination in each animal in the chronic group