Factores asociados a la aparición de insuficiencia renal crónica en pacientes sometidos a hemodiálisis, Complejo Hospitalario Metropolitano Dr. Arnulfo Arias Madrid, diciembre 2008 a marzo 2009

El daño a las nefronas debido a diversos factores causa una INSUFICIENCIA RENAL CRÓNICA. En este estudio cuali-cuantitativo, descriptivo, transversal, correlacional, se analizan los factores asociados a la aparición de la insuficiencia renal crónica en pacientes sometidos a hemodiálisis en el Complejo Hospitalario Metropolitano de la Caja de Seguro Social, a fin de comprobar si la prevención, la detección temprana y el tratamiento ayudan a evitar que la insuficiencia renal aparezca o empeore. Se utilizó la población de 202 pacientes, escogiendo a personas que cumplían con el atributo de haber sido diagnosticadas con insuficiencia renal crónica, sometidos a hemodiálisis. Se realizaron observaciones en la Sala de Hemodiálisis en los cuatro turnos, durante dos días consecutivos, aplicando el instrumento validado de manera individual a cada paciente, los expedientes clínicos fueron revisados con el propósito de identificar los factores mencionados en el marco teórico Los resultados muestran que factores como la hipertensión (64 4%) y el grado de consanguinidad con el familiar que ha sufrido de los riñones (16 8%) y si éste ha tenido problemas renales (23 3%), demostró una correlación positiva y estadísticamente significativa. Otros factores como la diabetes mellitus (31 2%), las dislipidemias (29 2%), la etnia (15 8%), se consideran como factores de progresión de la Insuficiencia renal crónica en pacientes sometidos a hemodiálisis, no como factores de aparición de la enfermedad. Se recomienda divulgar los resultados y enfatizar en campañas de promoción de estilos de vida saludable

Comorbidade entre abuso/dependência de drogas e o sofrimento psíquico em sete países da América Latina e um do Caribe

Fue realizado estudio multicéntrico en pacientes bajo tratamento por dependencia de alcohol y substancias ilícitas, en ocho países (Brasil, Chile, Guatemala, Jamaica, Nicaragua, Panamá, Paraguay, Uruguay). El objetivo fue investigar la frecuencia de distrés psicológico, diagnóstico actual de comorbilidades, y disfuncionalidad familiar percibida. Fueron incluídos 1.073 voluntarios adultos, que diligenciaron un cuestionario o fueron entrevistados. El distrés psicológico y la disfuncionalidad familiar fueron evaluados por escalas (Kessler K-10 y APGAR-family). Hombres predominaron en todos los lugares (edades entre 18 y 86). En la mayoría de los sitios, el diagnóstico actual de ansiedad varió entre 30% y 40% y el de depresión entre 20% y 35%. Niveles altos u muy altos de distrés psícológico fueron reportados por más de 70% en Uruguay, Nicaragua, Guatemala y Brasil. La disfuncionalidad familiar severa fue mayor en Panamá 34.7% seguida de los sitios de Nicaragua 20-25%. La prevalencia de distrés psicológico sugiere niveles altos de comorbilidad. __________________________________________________________________________________________________________________ ABSTRACTA multicenter study among patients in treatment for alcohol and illicit drugs abuse were conducted in eight countries (Brazil, Chile, Guatemala, Jamaica, Nicaragua, Panama, Paraguay, Uruguay). Our objective was to ascertain the frequency of psychological distress, current diagnosis of comorbidities and perceived familiar dysfunction. It was recruited 1,073 adult volunteers and they filled out a questionnaire or were interviewed. Psychological distress was evaluated through the Kessler's K-10 scale and family dysfunction by the APGAR-family scale. Male individuals predominated at all study sites (age range: 18-86). Current diagnosis of anxiety ranged from 30.0% to 40.0% in most sites. Current diagnosis of depression ranged from 20% to 35% in most sites. High and very high levels of psychological stress were higher than 70% in Uruguay, Nicaragua, Guatemala, and Brazil. Severe family dysfunction was higher in Panamá 34.7% followed by Nicaraguan cities 20-25%. The prevalence of psychological distress suggests higher rates of comorbidity. __________________________________________________________________________________________________________________ RESUMOFoi realizado um estudo multicéntrico em pacientes sob tratamento para dependência de álcool e substâncias ilícitas em oito países (Brasil, Chile, Guatemala, Jamaica, Nicarágua, Panamá, Paraguai, Uruguai). O objetivo foi averiguar a frequência de sofrimento psíquico, diagnóstico atual de comorbidades, e disfuncionalidade familiar percebida. Foram incluídos 1.073 voluntários adultos, que preencheram um questionário ou foram entrevistados. O sofrimento psíquico e a disfuncionalidade familiar foram avaliados por escalas (Kessler K-10 e APGAR-family). Os homens predominaram em todos os locais (idades entre 18 e 86). Na maioria dos locais, o diagnóstico atual de ansiedade variou de 30% a 40% e o de depressão, de 20% a 35%. Níveis altos e muito altos de sofrimento psíquico foram relatados por mais de 70% em Uruguai, Nicarágua, Guatemala e Brasil. Disfuncionalidade familiar severa foi maior no Panamá 34,7%, seguida da Nicarágua 20-25%. A prevalencia de sofrimento psíquico sugere níveis mais altos de comorbidade

Search for lepton-flavour-violating decays of the Higgs and Z bosons with the ATLAS detector

Direct searches for lepton flavour violation in decays of the Higgs and Z bosons with the ATLAS detector at the LHC are presented. The following three decays are considered: H→eτ, H→μτ, and Z→μτ. The searches are based on the data sample of proton–proton collisions collected by the ATLAS detector corresponding to an integrated luminosity of 20.3 fb−1 at a centre-of-mass energy of s√=8 TeV. No significant excess is observed, and upper limits on the lepton-flavour-violating branching ratios are set at the 95 % confidence level: Br (H→eτ)<1.04%, Br (H→μτ)<1.43%, and Br (Z→μτ)<1.69×10−5

Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012

OBJECTIVE: To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008. DESIGN: A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict of interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. A stand-alone meeting was held for all subgroup heads, co- and vice-chairs, and selected individuals. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. METHODS: The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations as strong (1) or weak (2). The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Recommendations were classified into three groups: (1) those directly targeting severe sepsis; (2) those targeting general care of the critically ill patient and considered high priority in severe sepsis; and (3) pediatric considerations. RESULTS: Key recommendations and suggestions, listed by category, include: early quantitative resuscitation of the septic patient during the first 6 h after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm a potential source of infection (UG); administration of broad-spectrum antimicrobials therapy within 1 h of the recognition of septic shock (1B) and severe sepsis without septic shock (1C) as the goal of therapy; reassessment of antimicrobial therapy daily for de-escalation, when appropriate (1B); infection source control with attention to the balance of risks and benefits of the chosen method within 12 h of diagnosis (1C); initial fluid resuscitation with crystalloid (1B) and consideration of the addition of albumin in patients who continue to require substantial amounts of crystalloid to maintain adequate mean arterial pressure (2C) and the avoidance of hetastarch formulations (1B); initial fluid challenge in patients with sepsis-induced tissue hypoperfusion and suspicion of hypovolemia to achieve a minimum of 30 mL/kg of crystalloids (more rapid administration and greater amounts of fluid may be needed in some patients (1C); fluid challenge technique continued as long as hemodynamic improvement is based on either dynamic or static variables (UG); norepinephrine as the first-choice vasopressor to maintain mean arterial pressure ≥65 mmHg (1B); epinephrine when an additional agent is needed to maintain adequate blood pressure (2B); vasopressin (0.03 U/min) can be added to norepinephrine to either raise mean arterial pressure to target or to decrease norepinephrine dose but should not be used as the initial vasopressor (UG); dopamine is not recommended except in highly selected circumstances (2C); dobutamine infusion administered or added to vasopressor in the presence of (a) myocardial dysfunction as suggested by elevated cardiac filling pressures and low cardiac output, or (b) ongoing signs of hypoperfusion despite achieving adequate intravascular volume and adequate mean arterial pressure (1C); avoiding use of intravenous hydrocortisone in adult septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability (2C); hemoglobin target of 7-9 g/dL in the absence of tissue hypoperfusion, ischemic coronary artery disease, or acute hemorrhage (1B); low tidal volume (1A) and limitation of inspiratory plateau pressure (1B) for acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure (PEEP) in ARDS (1B); higher rather than lower level of PEEP for patients with sepsis-induced moderate or severe ARDS (2C); recruitment maneuvers in sepsis patients with severe refractory hypoxemia due to ARDS (2C); prone positioning in sepsis-induced ARDS patients with a PaO (2)/FiO (2) ratio of ≤100 mm Hg in facilities that have experience with such practices (2C); head-of-bed elevation in mechanically ventilated patients unless contraindicated (1B); a conservative fluid strategy for patients with established ARDS who do not have evidence of tissue hypoperfusion (1C); protocols for weaning and sedation (1A); minimizing use of either intermittent bolus sedation or continuous infusion sedation targeting specific titration endpoints (1B); avoidance of neuromuscular blockers if possible in the septic patient without ARDS (1C); a short course of neuromuscular blocker (no longer than 48 h) for patients with early ARDS and a PaO (2)/FI O (2) 180 mg/dL, targeting an upper blood glucose ≤180 mg/dL (1A); equivalency of continuous veno-venous hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1B); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding in patients with bleeding risk factors (1B); oral or enteral (if necessary) feedings, as tolerated, rather than either complete fasting or provision of only intravenous glucose within the first 48 h after a diagnosis of severe sepsis/septic shock (2C); and addressing goals of care, including treatment plans and end-of-life planning (as appropriate) (1B), as early as feasible, but within 72 h of intensive care unit admission (2C). Recommendations specific to pediatric severe sepsis include: therapy with face mask oxygen, high flow nasal cannula oxygen, or nasopharyngeal continuous PEEP in the presence of respiratory distress and hypoxemia (2C), use of physical examination therapeutic endpoints such as capillary refill (2C); for septic shock associated with hypovolemia, the use of crystalloids or albumin to deliver a bolus of 20 mL/kg of crystalloids (or albumin equivalent) over 5-10 min (2C); more common use of inotropes and vasodilators for low cardiac output septic shock associated with elevated systemic vascular resistance (2C); and use of hydrocortisone only in children with suspected or proven "absolute"' adrenal insufficiency (2C). CONCLUSIONS: Strong agreement existed among a large cohort of international experts regarding many level 1 recommendations for the best care of patients with severe sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for this important group of critically ill patients

Electron performance measurements with the ATLAS detector using the 2010 LHC proton-proton collision data

Detailed measurements of the electron performance of the ATLAS detector at the LHC are reported, using decays of the Z, W and J/psi particles. Data collected in 2010 at sqrt(s)=7 TeV are used, corresponding to an integrated luminosity of almost 40 pb^-1. The inter-alignment of the inner detector and the electromagnetic calorimeter, the determination of the electron energy scale and resolution, and the performance in terms of response uniformity and linearity are discussed. The electron identification, reconstruction and trigger efficiencies, as well as the charge misidentification probability, are also presented.Comment: 34 pages plus author list (46 pages total), 24 figures, 12 tables, matches published version in EPJ

Measurement of event shapes at large momentum transfer with the ATLAS detector in pppp collisions at s\sqrt{s}= 7 TeV

A measurement of event shape variables is presented for large momentum transfer proton-proton collisions using the ATLAS detector at the Large Hadron Collider. Six event shape variables calculated using hadronic jets are studied in inclusive multi-jet events in 35 pb^-1 of integrated luminosity at a center-of-mass energy of sqrt(s) = 7 TeV. These measurements are compared to predictions by three Monte Carlo event generators containing leading-logarithmic parton showers matched to leading order matrix elements for 2 to 2 and 2 to n (n=2,...6) scattering. Measurements of the third-jet resolution parameter, aplanarity, thrust, sphericity, and transverse sphericity are generally well described. The mean value of each event shape variable is evaluated as a function of the average momentum of the two leading jets pT1 and pT2, with a mean pT approaching 1 TeV.Comment: 11 pages plus author list (25 pages total), 3 figures, submitted to European Physical Journal