Evaluación de las indicaciones de endoscopía digestiva en la Unidad de Endoscopía del Hospital Militar Escuela Dr. Alejandro Dávila Bolaños durante el periodo Enero 2012 a Diciembre 2013

Evaluar las indicaciones de endoscopía digestiva en la Unidad de Endoscopía del Hospital Militar Escuela Dr. Alejandro Dávila Bolaños. Estudio retrospectivo de corte transversal, realizado enero 2012 a diciembre 2013 en la Unidad de Endoscopía del Hospital Militar Escuela Dr Alejandro Dávila Bolaños. Población: todos los pacientes a quienes se les solicito estudio de endoscopía y colonoscopía en el período de estudio. 2852 pacientes. Endoscopía Alta digestiva alta (EDA): Edad media 45 años, predominó el género femenino en un 63.3% y la procedencia Consulta externa en un 97.2% de los además la Categoría INSS fue la mayormente referida con 60.5%. La mayor proporción de EDA fue indicada por los Gastroenterólogos en un 36.1%, seguido por los médicos Cirujanos en un 22.8%. Los diagnósticos de envío más frecuente fueron: Enfermedad ácido péptica 45%, Neoplasia 20.5% y Enfermedad por reflujo gastroesofágico (ERGE) 15.4%. Las EDA fueron anormales en un 67% y normales en 33% de los casos. Colonoscopia: La edad media fue 52 años, predominando el género femenino en un 63.3%, procedencia de consulta externa en un 97% y la Categoría INSS en un 52%. Los Gastroenterólogos enviaron este procedimiento en una 40% de los casos, seguido de los Cirujanos en 29%. Los diagnósticos de envío más frecuente fueron: Síndrome de Intestino Irritable (SII) 57%, Sangrado 23%, Neoplasia 11% y del total de Colonoscopías 68% fueron normales. Rectoscopias: La edad media de envío fue de 46 años, predominando el género femenino en un 56.5%, procedencia de Consulta externa en un 97% y la Categoría INSS en un 67%. La mayor proporción de Rectoscopias fue indicada por médicos Cirujanos en un 51%, seguidos por Gastroenterólogos en un 19%. Los diagnósticos más frecuentes de envío fueron: Dolor Anal 64%, Sangrado 31% y Neoplasia 4.5%. Se observaron hallazgos anormales en 68% de los casos, siendo el principal diagnóstico enfermedad hemorroidal en el 54.2%. Las endoscopias digestivas altas se enviaron a edades más tempranas que las bajas. En los tres grupos predominó el género femenino

Muerte fetal intermedia y tardía en Estelí (2007-2008) : frecuencia, caracterización, causas y factores de riesgo

Tesis (Dr. Médico y Cirujano)-Universidad Nacional Autónoma de Nicaragua, León.UNAN-Leó

Renal and brain failure predict mortality of patients with acute-on-chronic liver failure admitted to the intensive care unit

Introduction and Objectives: Acute on Chronic Liver Failure (ACLF) is characterized by organ failure and high 28-day mortality. Identifying clinical predictors associated with early mortality could have implications for the treatment of patients with ACLF. Patients and methods: Patients diagnosed with chronic liver failure that developed ACLF based on the EASL-CLIF Consortium definition admitted to the Intensive care unit of a tertiary hospital between 2012–2018 were included. Bivariate and multivariate Cox regression analyses were performed to identify factors associated with mortality. Results: 148 patients (55% female) were diagnosed with ACLF of which 55% (n = 82) had ACLF grade 3, 28% (n = 41) grade 2 and 17% (n = 25) grade 1. The median age was 54 years (41-63). Hepatitis C virus (HCV) was the most frequent etiology in 29.8% (n = 44) of the patients with bacterial infection being the most predominant precipitant factor in 58.1% (n = 86). Ninety-day global cumulative survival was only 18%. When divided by grade, mortality reached to 10% in ACLF 3. Moreover, in the multivariate Cox regression analysis, renal failure (HR 3.26, 95% CI (2.13–4.99), brain failure (HR 1.37, 95% CI 1.09–2.04) and male sex (HR 1.62, 95% CI 1.10–2.40) were independent predictors of 28- and 90-day mortality. Conclusions: ACLF is a frequent syndrome among chronic liver disease patients. Brain and renal failure are significantly associated with higher mortality and are independent predictors of 28 and 90-day mortality

Virtual Reality Game for Physical and Emotional Rehabilitation of Landmine Victims

Landmine victims require an engaging and immersive rehabilitation process to maintain motivation and therapeutic adherence, such as virtual reality games. This paper proposes a virtual reality exercise game called Exogames, which works with Nukawa, a lower limb rehabilitation robot (LLRR). Together, they constitute the general Kina system. The design and development process of Exogames is reported, as well as the evaluation of its potential for physical and emotional rehabilitation. In an initial survey designed ad-hoc, 13 health professionals evaluated compliance with various requirements. They agreed that Exogames would help the user focus on rehabilitation by providing motivation; 92.3% said that the user will feel safe in the virtual world, 66.7% of them agreed or totally agreed that it presents characteristics that may enhance the physical rehabilitation of lower limbs for amputees, 83.3% stated that it would promote the welfare of landmine victims, and 76.9% responded that the graphical interface and data report are useful for real-time assessment, and would be helpful for four interventional areas in all rehabilitation stages. In a second evaluation, using standardized surveys, five physical therapists and one lower limb amputee tried the Kina system as users. They filled out the System Usability Scale (SUS), the Physical Activity Enjoyment Scale (PACES), and the Game Experience Questionnaire (GEQ). The usability of the Kina system overall score was 69 (66, 79) out of 100, suggesting an acceptable though improvable usability. The overall PACES score of 110 (108, 112) out of 126 suggests that users enjoyed the game well. Finally, users indicated a positive effect with a good sense of immersion and smooth of gameplay during the tests, as indicated by the GEQ results. In summary, the evaluations showed that Exogames has the potential to be used as a virtual reality game for the physical and emotional rehabilitation of landmine victims

Immunotolerance in liver transplantation: a primer for the clinician

The use of immunosuppressive medications for solid organ transplantation is associated with cardiovascular, metabolic, and oncologic complications. On the other hand, the development of graft rejection is associated with increased mortality and graft dysfunction. Liver transplant recipients can withdraw from immunosuppression without developing graft injury while preserving an adequate antimicrobial response - a characteristic known as immunotolerance. Immunotolerance can be spontaneously or pharmacologically achieved. Contrary to the classic dogma, clinical studies have elucidated low rates of true spontaneous immunotolerance (no serologic or histological markers of immune injury) among liver transplant recipients. However, clinical, serologic, and tissue biomarkers can aid in selecting patients in whom immunosuppression can be safely withdrawn. For those who failed an immunosuppression withdrawal trial or are at high risk of rejection, pharmacological interventions for immunotolerance induction are under development.In this review, we provide an overview of the mechanisms of immunotolerance, the clinical studies investigating predictors and biomarkers of spontaneous immunotolerance, as well as the potential pharmacological interventions for inducing it

Position statement on the use of albumin in liver cirrhosis

Cirrhosis is characterized by a prolonged asymptomatic period in which the inflammation persists, increasing as the disease progresses. Proinflammatory cytokines and pro-oxidant molecules are key in the development of organ dysfunction. Cirrhosis progression and worsening of portal hypertension bring about bacterial translocation and systemic dissemination via portal circulation of bacterial products, and molecular patterns associated with damage, which exacerbate the systemic Inflammation. Albumin is a molecule that undergoes structural and functional changes as liver damage progresses, affecting its antioxidant, immunomodulatory, oncotic, and endothelial stabilizing properties. Our knowledge of the properties of albumin reveals a molecule with multiple treatment options, capable of targeting several physiopathological aspects of cirrhosis. For the elaboration of the present manuscript on the uses of albumin in liver cirrhosis, several experts in the field of hepatology in Mexico were divided into 5 working groups to summarise and formulate, when appropriate, position statements: 1)pathophysiology of cirrhosis and properties of albumin; 2)proven uses of albumin [large-volume paracentesis, spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS)]; 3)controversial/emerging uses of albumin (long-term use, acute decompensation, liver transplant, non-HRS kidney injury, muscle cramps, non-SBP infections, hyponatremia, encephalopathy); 4)use of albumin in acute-on-chronic liver failure, immunomodulation, and systemic Inflammation; 5)pharmacoeconomics