Indicaciones terapéuticas para concentrado de plaquetas en pacientes hospitalizados en las salas de neurocirugía, nefrología, infectologia, unidad de cuidados intensivos, urología y medicina interna del hospital escuela Dr. Antonio Lenin Fonseca Martínez durante el período de julio de 2018 - febrero del 2019

Con el objetivo de analizar indicaciones terapéuticas para concentrado de plaquetas en pacientes hospitalizados en las salas de Neurocirugía, Nefrología, Infectología, Unidad de Cuidados Intensivos, Urología y Medicina interna del Hospital Escuela Dr. Antonio Lenin Fonseca Martínez durante el período de julio de 2018 - febrero del 2019, se realizó un estudio descriptivo, de corte transversal. Donde fueron analizados los datos sobre las edades, sexo, grupo sanguíneo y Rh, y diagnósticos de los pacientes con el fin de identificar la prevalencia de cada uno de ellos. Los análisis estadísticos efectuados fueron: descriptivos, de acuerdo a la naturaleza de cada una de las variables (cuantitativas o cualitativas) y guiados por el compromiso definido en cada uno de los objetivos específicos, se realizaron los análisis descriptivos correspondientes a las variables nominales y/o numéricas, entre ellos: (a) El análisis de frecuencia, (b) las estadísticas descriptivas según cada caso. Además, se realizaron gráficos del tipo: barras y secciones de manera univariadas de acuerdo a cada dato, del análisis y discusión de los resultados obtenidos, se alcanzaron las siguientes conclusiones: las edades más frecuente estuvieron entre los 46 – 60 años con el 44.6%, El sexo masculino fue el de mayor predominio con un 55.4%, el diagnostico que más requirió de transfusión de concentrado de plaquetas fue la Enfermedad renal crónica con el 24.3%, la sala que más solicito plaquetas fue Nefrología con el 36%, el grupo sanguíneo que más prevaleció fue el grupo O con el 56.6% y el factor Rh positivo destacándose con el 99.1%; cabe señalar que se logró destacar la importancia del uso de concentrado de plaquetas, así mismo se explicaron los criterios clínicos para el uso del mismo

DESARROLLO HISTÓRICO DE LA DOCENCIA MÉDICA EN VILLA CLARA EN SUS PRIMEROS 50 AÑOS

The medical studies in Villa Clara began due to the need to increase the number of health professionals with better distribution, political awareness and public dedication, which compensated quantitatively and qualitatively for the mass exodus that occurred in the first years of the Cuban Revolution. This review work aims to show the historical development of medical teaching in the province in its first 50 years. For the elaboration of the same, 6 bibliographical references were used. It was concluded that medical education in Villa Clara has responded to the historical, social and academic changes of the country; In all its stages its progress is perceived, concretized in the progressive number of graduates, their achievements and the adjustment to the transformations emanated from their university processes

Neumonía necrotizante

A male patient of 44 years old with a personal pathological history of arterial hypertension. He was admitted for extrahospital pneumonia of right base, it was indicated antibiotic treatment and the evolution was favorable. After 15 days he was re-admitted because he had worsened, it was performed a computerized axial tomography of high-resolution of the thorax that reported, at the level of the lung bases, several bilateral and peripheral hyperdense images that took on nodular shape, in intimate contact with the pleura, with central cavitation. A tumor etiology was considered and a thoracotomy was performed; samples of the pleura and lung were taken for biopsy. At the autopsy, necrotizing pneumonia was found in resolution phase and a bilateral pulmonary thromboembolism of thick branches.Se trata de un paciente masculino de 44 años con antecedentes patológicos personales de hipertensión arterial. Fue ingresado por neumonía extrahospitalaria de base derecha, se indicó tratamiento antibiótico y la evolución fue favorable. A los 15 días fue reingresado porque empeoró, se le realizó una tomografía axial computadorizada de alta resolución de tórax que informó, a nivel de las bases pulmonares, varias imágenes hiperdensas bilaterales y periféricas que adoptaban forma nodular, en íntimo contacto con la pleura, con cavitación central. Se pensó en una etiología tumoral y se le realizó una toracotomía; se tomaron muestras de la pleura y el pulmón para biopsia. En la autopsia se evidenció neumonía necrotizante en fase de resolución y un tromboembolismo pulmonar bilateral de ramas gruesas

Cuestionamientos al modelo extractivista neoliberal desde el Sur

Este libro se enmarca en la voluntad de alimentar un diálogo inter-disciplinar entre múltiples esferas sociales, culturales y territoriales en relation al extractivismo, su estudio y vivencia. El libro se constituye en un instrumento que expresa un entrelazamiento entre actores, redes y realidades territoriales que dan forma a la riqueza y a la diversidad de los territorios amenazados actualmente por el extractivismo. Permitiendo una réflexión sobre el présente y el futuro del modelo de desarrollo actual, la présente publicación integra diverso

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease

Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI) : a phase 3, placebo-controlled, randomised trial

Background: Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. Methods: The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). Findings: Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8–3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74–0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, p interaction=0·16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3·1%] with ticagrelor vs 183 (3·3%) with placebo; HR 0·96 [95% CI 0·78–1·18], p=0·68), as well as all-cause death (282 [5·1%] vs 323 [5·8%]; 0·88 [0·75–1·03], p=0·11). TIMI major bleeding occurred in 111 (2·0%) of 5536 patients receiving ticagrelor and 62 (1·1%) of 5564 patients receiving placebo (HR 2·03 [95% CI 1·48–2·76], p<0·0001), and fatal bleeding in 6 (0·1%) of 5536 patients with ticagrelor and 6 (0·1%) of 5564 with placebo (1·13 [0·36–3·50], p=0·83). Intracranial haemorrhage occurred in 33 (0·6%) and 31 (0·6%) patients (1·21 [0·74–1·97], p=0·45). Ticagrelor improved net clinical benefit: 519/5558 (9·3%) versus 617/5596 (11·0%), HR=0·85, 95% CI 0·75–0·95, p=0·005, in contrast to patients without PCI where it did not, p interaction=0·012. Benefit was present irrespective of time from most recent PCI. Interpretation: In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk