Etiología de la pancreatitis aguda en el servicio de Medicina Interna del Hospital General, 2021

Se estudió un total de 101 pacientes con pancreatitis aguda idiopática como causa principal con 66.2% seguida de la etiología alcohólica con 18.8%. En relación al sexo, la causa idiopática es la principal causa en el sexo femenino con 87.5% y en el sexo masculino la causa idiopática con la alcohólica tienen una relación 1:1 con 40%. Con respecto a los factores predisponentes, en la pancreatitis aguda idiopática, la obesidad es el principal factor predisponente con 28.7%, en la pancreatitis alcohólica se encontró solo el 6.9% con un factor predisponente diferente al alcoholismo y solo 2% y 1% tenían autoinmunidad o inmunosupresión respectivamente. Conclusiones: La pancreatitis idiopática constituye la principal causa de ingreso en pacientes con pancreatitis aguda no biliar, según este estudio en el sexo femenino la causa principal es idiopática y en el sexo masculino predominan causa idiopática y alcohólica por igual; la obesidad es el principal factor predisponente de la pancreatitis idiopática. La principal recomendación es descartar todas las causas posibles de pancreatitis aguda antes de ser clasificada como idiopática

Percepción de autoeficacia para brindar cuidados humanizados por parte de estudiantes de enfermería

Objetivo: Evaluar la percepción de autoeficacia para brindar cuidados humanizados por parte de estudiantes de enfermería de una institución de carácter confesional adventista de la provincia de Entre Ríos, Argentina. Material y métodos: Estudio descriptivo, transversal y cuantitativo. Participaron 90 estudiantes de la Licenciatura en Enfermería, quienes diligenciaron el instrumento Caring Efficacy Scale de Coates. Resultados: La mediana de autoeficacia para brindar cuidados humanizados y relacionarse con los pacientes fue de 145,00 (RIQ: 30). Las dimensiones con los puntajes más altos y bajos fueron relación interpersonal y empatía, respectivamente. Conclusión: Se identifica una percepción positiva de autoeficacia para brindar cuidados humanizados en los estudiantes de la Licenciatura en Enfermería y esta se halló vinculada a la formación previa en el tema y con el estado civil

221st ENMC International Workshop : Foot Surgery in Charcot-Marie-Tooth disease June 10th-12th, 2016 Naarden, The Netherlands

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The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Steal syndrome of the hand with a strong palpable radial pulse at the wrist after creation of a basilic-vein-transposition fistula in the arm above the elbow

Steal syndrome is a major complication after creation of an arteriovenous fistula (AVF) and may lead to ischemic symptoms in the hand. A strong palpable radial pulse at the wrist typically excludes the diagnosis of steal syndrome in patients with brachial-artery-based AVF. We present a patient with steal syndrome and a palpable radial pulse after creation of an above-the-elbow AVF using the basilic vein transposition approach. The patient had a brachial artery with high bifurcation and the vein was mistakenly anastomosed to the dominant aberrant ulnar artery. The steal syndrome was treated by proximalization of arterial flow to the proximal brachial artery

An atypical case of hemodialysis access stent migration

Endovascular stent fractures are commonly seen in arteries but are rare events in the venous system. Stents deployed in hemodialysis vascular accesses can fracture and migrate to proximal locations. Complications associated with stent fracture include in-stent stenosis and central vein stenosis. In this report, we present a unique case of a hemodialysis access stent fracture that migrated to the left ventricle and manifested with chest pain