Aire. Apoyo Integral Respiratorio en Emergencias

El desarrollo de la formación académica en vía aérea difícil concluyó en el texto que se presenta ahora bajo el nombre de AIRE, Apoyo Integral Respiratorio en Emergencias. Este proyecto se inició hace 5 años con el objetivo de desarrollar un curso adquirieran las aptitudes y los conocimientos necesarios para el manejo básico y avanzado de la vía aérea del paciente urgente. Así mismo, respondió a la necesidad creciente de entrenamiento para el manejo avanzado de la vía aérea en el entorno de los servicios de urgencias intra y extra hospitalarias por parte de los médicos generales, especialistas en Medicina de Emergencias, Anestesia, Cirugía General, Medicina Interna, y de todo el personal relacionado con el cuidado del paciente crítico. Fue así como un grupo de conformado por dos emergeciólogos, cuatro residentes de Medicina de Emergencias y una terapeuta respiratoria comenzamos a convertirnos en facilitadores para el aprendizaje de este difícil tema

Complicaciones del uso del angioseal vs compresión manual en cateterismo cardíaco mediante punción femoral

Objetivo: Comparar las complicaciones del uso de Angioseal® versus compresión manual en los pacientes llevados a cateterismo cardíaco en el Servicio de Hemodinamia de la Fundación Santa Fe de Bogotá, del 1º de enero de 2005 al 31 de diciembre de 2010, mediante punción arterial femoral percutánea. Metodología: Se realizó un Estudio Observacional, Analítico, de tipo Cohorte Retrospectiva. Partiendo de dos grupos de personas con indicación de cateterismo cardíaco por cualquier causa, uno expuesto al procedimiento con Angioseal® y el otro con compresión manual. Resultados: Con el uso de Angioseal® versus compresión manual la aparición de complicaciones fue 7,3% vs 4,1%, estas diferencias no fueron significativas (OR 1,81 IC95 0,96-3,40; RR 1,75 IC95 0,96-3,18) . La enfermedad coronaria (OR 2,27 IC95 1,07-4,79; RR 2,18 IC95 1,06-4,46) y a la colocación de stent (OR 3,49 IC95 1,82-6,69; RR 3,25 IC95 1,75-6,02 si se relacionaron significativamente con la aparición de complicaciones menores. Conclusión: No encontramos soporte para aprobar o desaprobar el uso de Angioseal® o compresión manual como manejo de la hemostasia, con respecto a las complicaciones. Sin embargo, se encontró que la colocación de stents está fuertemente relacionada con el desarrollo de complicaciones menores, lo cual hace que estos pacientes deban ser objeto de monitorización estrecha.Objective: To compare the complications of using Angioseal ® versus manual compression in patients undergoing cardiac catheterization at the Service Hemodynamics of the Fundación Santa Fe de Bogotá, from 1 January 2005 to 31 December 2010, by femoral artery puncture percutaneously. Methodology: An observational, analytical, retrospective cohort study. Based on two groups of people with cardiac catheterization indication for any reason, one exposed to Angioseal ® procedure and the other with manual compression. Results: With the use of manual compression Angioseal ® versus the occurrence of complications was 7.3% vs 4.1%, these differences were not significant (OR 1.81 CI95 0.96 to 3.40, RR 1.75 CI95 0.96 to 3.18). Coronary heart disease (OR 2.27 CI95 1.07 to 4.79, RR 2.18 CI95 1.06 to 4.46) and stent placement (OR 3.49 CI95 1.82 to 6.69, RR CI95 3.25 1.75 to 6.02 were significantly associated with occurrence of minor complications. CONCLUSION: We found no support to approve or disapprove the use of Angioseal ® or manual compression as hemostasis management, respect to complications . However, we found that the stent is strongly related to the development of minor complications, which makes that these patients must be closely monitored

Relationship between testosterone and penile spicules in Guinea pigs (Cavia porcellus)

7 Pág.Understanding the physiology of penile spicules in guinea pigs (Cavia porcellus) may improve their management in large-scale production guinea systems. Here we examined whether penis spicule development depends on testosterone and whether exogenous testosterone can reverse penile spicule atrophy in castrated guinea pigs. The relationship between total testosterone (TT) and the development of penile spicules (DPS) in guinea pigs was explored in two experiments. The first experiment described the TT and DPS curves in non-castrated guinea pigs (E1-G1) and guinea pigs castrated on day 35 (E1-G2). In the second experiment, the dose-dependent effect of the administration of exogenous testosterone (ET) was evaluated during DPS in Group 1 (E2-G1; castrated guinea pigs + 125 μg ET on days 65 and 80 of age), Group 2 (E2-G2; castrated guinea pigs + 250 μg ET on days 65 and 80 of age), Group 3 (E2-G3; non-castrated guinea pigs), and Group 4 (E2-G4; castrated guinea pigs without ET). Analysis of variance using a General Linear Model (GLM) was performed. TT increased from day 20 to day 35 in both groups in the first experiment (P > 0.05). This increase in TT was maintained in E1-G1 on days 50, 65, and 80; however, TT fell to basal values in E1-G2 after castration. DPS guinea was directly related to TT level. In Experiment 2, guinea E2-G1 and E2-G2 animals that received ET showed an increase in TT, significantly differing from E2-G4 (P < 0.05). Nevertheless, ET administration in E2-G1 and E2-G2 was not sufficient to reach the TT levels in E2-G3. DPS was closely related to TT levels, such that when testicles were removed, the spicules began to atrophy without disappearing. Our results suggest that TT in guinea pigs increases steadily until puberty completes, after which it decreases and stabilizes and shows an association with DPS. Furthermore, 12-35% of TT produced by guinea pigs is testicle-independent. Finally, ET administration can stop and reverse the spicule atrophy process in castrated males. These results will help to manage guinea pigs in a more sustainable way in countries where this species is of utmost relevance to provide the population with the meat of high quality.This work was supported by the Research Directorate of the University of Cuenca, ECUADOR (DIUC_XVI_2018_38_ROSALES_CORNELIO).Peer reviewe

Patrón tromboelastográfico en pacientes anticoagulados con rivaroxabán por fibrilación auricular

Introducción: La fibrilación auricular es la arritmia más frecuente y se asocia con mayor riesgo de eventos tromboembólicos, que requieren tratamiento anticoagulante. En la actualidad no existe un examen que permita monitorizar el rango terapéutico cuando se usan nuevos anticoagulantes. Objetivo: Describir los patrones tromboelastográficos en los pacientes con fibrilación auricular que reciben terapia de anticoagulación con rivaroxabán del servicio de Cardiología del Hospital Universitario Fundación Santa Fe de Bogotá. Materiales y métodos: En este estudio de corte transversal se recolectaron los datos correspondientes a 30 pacientes con fibrilación auricular que recibieron tratamiento anticoagulante con rivaroxabán a partir del 10 de julio de 2013 hasta el 06 de enero de 2015. Se describieron las características generales de la muestra, así como de los parámetros obtenidos por medio del tromboelastograma, y se compararon los patrones de tromboelastografía de acuerdo con la dosis del anticoagulante. Resultados: La edad promedio fue 75,8 años y la principal indicación de anticoagulación fue la fibrilación auricular paroxística (56,67%). En más del 60% de los pacientes se obtuvo un tiempo de reacción prolongado y un índice de coagulación bajo. El resto de parámetros del tromboelastograma se encontraban dentro del rango normal en la mayoría de los casos. No hubo diferencias estadísticamente significativas en los parámetros del tromboelastograma al comparar la dosis de rivaroxabán de 15 mg versus 20 mg. Conclusión: El patrón tromboelastográfico obtenido en la mayoría de pacientes del estudio se caracterizó por un tiempo de reacción alto y un índice de coagulación bajo, posiblemente debido al efecto del inhibidor del factor Xa

Relationship between testosterone and penile spicules in Guinea pigs (Cavia porcellus)

Understanding the physiology of penile spicules in guinea pigs (Cavia porcellus) may improve their management in large-scale production guinea systems. Here we examined whether penis spicule development depends on testosterone and whether exogenous testosterone can reverse penile spicule atrophy in castrated guinea pigs. The relationship between total testosterone (TT) and the development of penile spicules (DPS) in guinea pigs was explored in two experiments. The first experiment described the TT and DPS curves in non-castrated guinea pigs (E1-G1) and guinea pigs castrated on day 35 (E1-G2). In the second experiment, the dose-dependent effect of the administration of exogenous testosterone (ET) was evaluated during DPS in Group 1 (E2-G1; castrated guinea pigs + 125 μg ET on days 65 and 80 of age), Group 2 (E2-G2; castrated guinea pigs + 250 μg ET on days 65 and 80 of age), Group 3 (E2-G3; non-castrated guinea pigs), and Group 4 (E2-G4; castrated guinea pigs without ET). Analysis of variance using a General Linear Model (GLM) was performed. TT increased from day 20 to day 35 in both groups in the first experiment (P > 0.05). This increase in TT was maintained in E1-G1 on days 50, 65, and 80; however, TT fell to basal values in E1-G2 after castration. DPS guinea was directly related to TT level. In Experiment 2, guinea E2-G1 and E2-G2 animals that received ET showed an increase in TT, significantly differing from E2-G4 (P < 0.05). Nevertheless, ET administration in E2-G1 and E2-G2 was not sufficient to reach the TT levels in E2-G3. DPS was closely related to TT levels, such that when testicles were removed, the spicules began to atrophy without disappearing. Our results suggest that TT in guinea pigs increases steadily until puberty completes, after which it decreases and stabilizes and shows an association with DPS. Furthermore, 12–35% of TT produced by guinea pigs is testicle-independent. Finally, ET administration can stop and reverse the spicule atrophy process in castrated males. These results will help to manage guinea pigs in a more sustainable way in countries where this species is of utmost relevance to provide the population with the meat of high quality

Aire. Apoyo Integral Respiratorio en Emergencias

El desarrollo de la formación académica en vía aérea difícil concluyó en el texto que se presenta ahora bajo el nombre de AIRE, Apoyo Integral Respiratorio en Emergencias. Este proyecto se inició hace 5 años con el objetivo de desarrollar un curso adquirieran las aptitudes y los conocimientos necesarios para el manejo básico y avanzado de la vía aérea del paciente urgente. Así mismo, respondió a la necesidad creciente de entrenamiento para el manejo avanzado de la vía aérea en el entorno de los servicios de urgencias intra y extra hospitalarias por parte de los médicos generales, especialistas en Medicina de Emergencias, Anestesia, Cirugía General, Medicina Interna, y de todo el personal relacionado con el cuidado del paciente crítico. Fue así como un grupo de conformado por dos emergeciólogos, cuatro residentes de Medicina de Emergencias y una terapeuta respiratoria comenzamos a convertirnos en facilitadores para el aprendizaje de este difícil tema

Clinical and genetic characteristics of late-onset Huntington's disease

Background: The frequency of late-onset Huntington's disease (&gt;59 years) is assumed to be low and the clinical course milder. However, previous literature on late-onset disease is scarce and inconclusive. Objective: Our aim is to study clinical characteristics of late-onset compared to common-onset HD patients in a large cohort of HD patients from the Registry database. Methods: Participants with late- and common-onset (30–50 years)were compared for first clinical symptoms, disease progression, CAG repeat size and family history. Participants with a missing CAG repeat size, a repeat size of ≤35 or a UHDRS motor score of ≤5 were excluded. Results: Of 6007 eligible participants, 687 had late-onset (11.4%) and 3216 (53.5%) common-onset HD. Late-onset (n = 577) had significantly more gait and balance problems as first symptom compared to common-onset (n = 2408) (P &lt;.001). Overall motor and cognitive performance (P &lt;.001) were worse, however only disease motor progression was slower (coefficient, −0.58; SE 0.16; P &lt;.001) compared to the common-onset group. Repeat size was significantly lower in the late-onset (n = 40.8; SD 1.6) compared to common-onset (n = 44.4; SD 2.8) (P &lt;.001). Fewer late-onset patients (n = 451) had a positive family history compared to common-onset (n = 2940) (P &lt;.001). Conclusions: Late-onset patients present more frequently with gait and balance problems as first symptom, and disease progression is not milder compared to common-onset HD patients apart from motor progression. The family history is likely to be negative, which might make diagnosing HD more difficult in this population. However, the balance and gait problems might be helpful in diagnosing HD in elderly patients

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially