Comparación de 3 pautas de sedación para pacientes sometidos a anestesia subaracnoidea. Ensayo clínico aleatorizado, simple ciego

ResumenIntroducciónLa sedación es un conjunto de acciones dirigidas a lograr que un paciente se encuentre tranquilo, cómodo, libre de dolor o de malos recuerdos mientras se realiza un procedimiento diagnóstico o terapéutico. Dado que las técnicas anestésicas regionales empleadas en la práctica clínica habitual son procedimientos relativamente traumáticos y dolorosos, se han asociado a sedación, para hacer este tipo de intervenciones más confortables para el paciente y hacer más fácil la colaboración del mismo.ObjetivoDeterminar la eficacia de 3 pautas de sedación en pacientes que van a ser sometidos a anestesia subaracnoidea.MetodologíaEstudio experimental, ensayo clínico, aleatorizado, prospectivo, simple ciego, en el cual se compararon 3 pautas para sedación en pacientes sometidos a anestesia subaracnoidea.ResultadosTodos los pacientes del estudio tuvieron ansiolisis, colaboraron a la punción y refirieron que volverían a recibir una anestesia subaracnoidea sin temor; además, no se reportaron complicaciones tales como depresión respiratoria, náuseas, vómitos u otra, con las pautas de sedación utilizadas, siendo alta la satisfacción por parte de los pacientes. El reflejo de retirada (p=0,0003) y el dolor a la punción (p=0,0069) se presentaron en mayor proporción en el grupo que usó como pauta solo midazolam intravenoso. En este mismo grupo hubo menor satisfacción con la sedación; sin embargo, las 3 pautas mostraron una buena eficacia.ConclusionesLas 3 pautas de sedación propuestas fueron eficaces para su uso en anestesia subaracnoidea, con mejores resultados cuando se usó midazolam más fentanilo o midazolam más ketamina.p-2011-1682 Colciencias. Registro # NCT0213664 (clinicaltrials.gov,prospectivo).AbstractIntroductionSedation is defined as the set of actions aimed at having a quiet, comfortable, pain-free patient during a diagnostic or therapeutic procedure without any bad memories. Since the standard regional anesthesia techniques used in clinical practice are relatively traumatic and painful procedures, sedation has been introduced to make these interventions more comfortable for the patient and to facilitate the patient's cooperation.ObjectiveTo establish the efficacy of three sedation guidelines in patients undergoing subarachnoid anesthesia.MethodologyExperimental, randomized, prospective, single blind clinical trial comparing three guidelines for the sedation of patients undergoing subarachnoid anesthesia.ResultsAll of the patients in the trial received anxiolysis, collaborated with the puncture and said that they would not be afraid to receive subarachnoid anesthesia in the future. There were no complications including respiratory depression, nausea, vomiting or any other complications reported with the use of the sedation guidelines. Patient satisfaction was high. Withdrawal reflex (P=0.0003) and puncture related pain (P=0.0069) were more common in the group using the intravenous midazolam-only guideline and patient satisfaction with sedation was also lower in this group; however, the three guidelines showed good efficacy.ConclusionsThe three sedation guidelines presented were effectively used in subarachnoid anesthesia; the results were more favorable with the use of midazolam + fentanyl or midazolam + ketamine.p-2011-1682 Colciencias. Registro # NCT0213664 (clinicaltrials.gov,prospectivo)

Comunicación, desarrollo y política

Comunicación, política y desarrollo aborda una variedad de objetos de estudio, enfoques y metodologías utilizadas en el campo de los estudios de la comunicación en nuestra región. Las propuestas pretenden incorporar nuevos enfoques provenientes de múltiples disciplinas asociados a la comunicación desde una perspectiva crítica. A la vez, este compilado busca entender la comunicación no de manera instrumental, sino como un proceso complejo de significación social e interacción, con implicaciones políticas, tecnológicas, sociales y culturales. En este sentido, la Serie Estudios de la Comunicación, de la cual este libro es parte, busca fomentar la discusión, el debate y la producción científica desde diferentes ángulos o perspectivas, que conlleven a la resolución de problemas a través de la investigación aplicada o el desarrollo de ensayos teóricos que fortalezcan investigaciones de comunicación desde perspectivas transdisciplinarias

Body-fat sensor triggers ribosome maturation in the steroidogenic gland to initiate sexual maturation in Drosophila

Fat stores are critical for reproductive success and may govern maturation initiation. Here, we report that signaling and sensing fat sufficiency for sexual maturation commitment requires the lipid carrier apolipophorin in fat cells and Sema1a in the neuroendocrine prothoracic gland (PG). Larvae lacking apolpp or Sema1a fail to initiate maturation despite accruing sufficient fat stores, and they continue gaining weight until death. Mechanistically, sensing peripheral body-fat levels via the apolipophorin/Sema1a axis regulates endocytosis, endoplasmic reticulum remodeling, and ribosomal maturation for the acquisition of the PG cells' high biosynthetic and secretory capacity. Downstream of apolipophorin/Sema1a, leptin-like upd2 triggers the cessation of feeding and initiates sexual maturation. Human Leptin in the insect PG substitutes for upd2, preventing obesity and triggering maturation downstream of Sema1a. These data show how peripheral fat levels regulate the control of the maturation decision-making process via remodeling of endomembranes and ribosomal biogenesis in gland cells

Natural History of MYH7-Related Dilated Cardiomyopathy

BACKGROUND Variants in myosin heavy chain 7 (MYH7) are responsible for disease in 1% to 5% of patients with dilated cardiomyopathy (DCM); however, the clinical characteristics and natural history of MYH7-related DCM are poorly described. OBJECTIVES We sought to determine the phenotype and prognosis of MYH7-related DCM. We also evaluated the influence of variant location on phenotypic expression. METHODS We studied clinical data from 147 individuals with DCM-causing MYH7 variants (47.6% female; 35.6 +/- 19.2 years) recruited from 29 international centers. RESULTS At initial evaluation, 106 (72.1%) patients had DCM (left ventricular ejection fraction: 34.5% +/- 11.7%). Median follow-up was 4.5 years (IQR: 1.7-8.0 years), and 23.7% of carriers who were initially phenotype-negative developed DCM. Phenotypic expression by 40 and 60 years was 46% and 88%, respectively, with 18 patients (16%) first diagnosed at <18 years of age. Thirty-six percent of patients with DCM met imaging criteria for LV noncompaction. During follow-up, 28% showed left ventricular reverse remodeling. Incidence of adverse cardiac events among patients with DCM at 5 years was 11.6%, with 5 (4.6%) deaths caused by end-stage heart failure (ESHF) and 5 patients (4.6%) requiring heart transplantation. The major ventricular arrhythmia rate was low (1.0% and 2.1% at 5 years in patients with DCM and in those with LVEF of <= 35%, respectively). ESHF and major ventricular arrhythmia were significantly lower compared with LMNA-related DCM and similar to DCM caused by TTN truncating variants. CONCLUSIONS MYH7-related DCM is characterized by early age of onset, high phenotypic expression, low left ventricular reverse remodeling, and frequent progression to ESHF. Heart failure complications predominate over ventricular arrhythmias, which are rare. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Complicaciones y su correlación con el antihipertensivo en pacientes hipertensos arteriales, sometidos a cirugías electivas bajo anestesia general

Revista Ciencias Biomédicas Vol.3 Num.2 (2012) Pág. 226 – 233El presente estudio tiene por objetivo estimar asociación entre la ingesta de medicamentos antihipertensivos preoperatorios y las complicaciones intraoperatorias, en pacientes sometidos a anestesia general

Evaluación del efecto de la aminofilina en recuperación de conciencia y disminución de agitación postoperatoria

Revista Ciencias Biomédicas Vol.4 Num.2 (2013) Pág. 256 – 261El presente estudio tiene por objetivo comparar la eficacia del uso de la aminofilina versus solución salina en la disminución del tiempo de recuperación de la consciencia en el paciente sometido a procedimientos quirúrgicos bajo anestesia general

Evaluación del efecto de la aminofilina en recuperación de conciencia y disminución de agitación postoperatoria

Revista Ciencias Biomédicas Vol.4 Num.2 (2013) Pág. 256 – 261El presente estudio tiene por objetivo comparar la eficacia del uso de la aminofilina versus solución salina en la disminución del tiempo de recuperación de la consciencia en el paciente sometido a procedimientos quirúrgicos bajo anestesia general