Introducción a las matemáticas básicas de paz. Para comprender la paz….(o la guerra)

Introducción a las matemáticas básicas de paz. Para comprender la paz….(o la guerra

Guía retenida y anudada extravascular durante un cateterismo venoso

RESUMENEl cateterismo venoso central (CVC) es un procedimiento común en la práctica médica de especialistas en salas de emergencia, cuidado intensivo y salas de cirugía. Su uso no está libre de complicaciones estas pueden ser de tipo mecánica, infecciosa y trombóticas. Dentro de las complicaciones mecánicas las asociadas con la guía tipo atrapamiento vascular es la más común, pero el anudamiento y el atrapamiento extravascular son muy infrecuentes. Presentamos el caso de una mujer con atrapamiento extravascular de la guía y neumotórax como complicaciones de un CVC subclavio.Palabras clave: Cateterismo venoso central, complicaciones, cuerpo extraño, efectos adversos. Retained and extravascular knotting of the guidewire during central venous catheterization: a case reportABSTRACTCentral venous catheterization is a common procedure in the medical practice of specialists of emergency rooms, critical care and surgery rooms. The use of central venous catheters is associated with mechanical infectious and thrombotic complications. Within the mechanical complications, those associated with the guidewire, especially extravascular entrapments are very infrequent. This work presents a case of a female patient with extravascular entrapment of the guidewire and pneumothorax as complications of right subclavian venous catheterization.Keywords: Catheterization, Central Venous, Complications, Foreign bodies, adverse effects. Forma de citar: Corzo RJ, Parra R, Meléndez HJ. Guía retenida y anudada extravascular durante un cateterismo venoso central: reporte de un caso. rev.univ.ind.santander.salud 2014; 46 (1): 61-6

Guía retenida y anudada extravascular durante un cateterismo venoso

RESUMENEl cateterismo venoso central (CVC) es un procedimiento común en la práctica médica de especialistas en salas de emergencia, cuidado intensivo y salas de cirugía. Su uso no está libre de complicaciones estas pueden ser de tipo mecánica, infecciosa y trombóticas. Dentro de las complicaciones mecánicas las asociadas con la guía tipo atrapamiento vascular es la más común, pero el anudamiento y el atrapamiento extravascular son muy infrecuentes. Presentamos el caso de una mujer con atrapamiento extravascular de la guía y neumotórax como complicaciones de un CVC subclavio.Palabras clave: Cateterismo venoso central, complicaciones, cuerpo extraño, efectos adversos. Retained and extravascular knotting of the guidewire during central venous catheterization: a case reportABSTRACTCentral venous catheterization is a common procedure in the medical practice of specialists of emergency rooms, critical care and surgery rooms. The use of central venous catheters is associated with mechanical infectious and thrombotic complications. Within the mechanical complications, those associated with the guidewire, especially extravascular entrapments are very infrequent. This work presents a case of a female patient with extravascular entrapment of the guidewire and pneumothorax as complications of right subclavian venous catheterization.Keywords: Catheterization, Central Venous, Complications, Foreign bodies, adverse effects. Forma de citar: Corzo RJ, Parra R, Meléndez HJ. Guía retenida y anudada extravascular durante un cateterismo venoso central: reporte de un caso. rev.univ.ind.santander.salud 2014; 46 (1): 61-6

Relación del intervalo QT corregido con la escala GRACE en pacientes con infarto de miocardio sin elevación del segmento ST

Background. The Global Registry of Acute Coronary Events (GRACE) prediction model stratifies patients with non-ST-segment elevation myocardial infarction (NSTEMI). Corrected QT interval (QTc) is not considered in this model. Objective. To evaluate the relationship between the QTc interval and the GRACE score in patients with NSTEMI. Materials and methods. An observational, retrospective study was carried between 2016 and 2019. We included patients with diagnosis of NSTEMI, QTc intervals were calculated with Bazett’s formula, and they were classified into 2 groups: a normal QTc interval (<440 ms) and prolonged (≥440 ms). According to the GRACE score they were classified in three ranges: low risk (≤109 points), intermedium (110 - 139 points) and high (≥140 points), we determined if there were a correlation between QTc interval and the GRACE score. Results. A total of 940 patients with a diagnosis of NSTEMI were admitted in our institution, 634 met the inclusion criteria, there were 390 patients with normal QTc interval and 244 with a prolonged QTc interval. Patients with prolonged QTc were older (65.5 vs 61, p=0.001) with a lower proportion of males (71.7% vs 82.8%, p=0.001). An association was found between the GRACE score and the QTC interval, subjects with a normal QTc had a greater proportion of low and intermediate risk than those with a prolonged QTc (p=0.001). Conclusions. In NSTEMI patients, a normal QTc interval (<440 ms) is associated with a GRACE risk score of low or intermediate risk.Antecedentes. El modelo de predicción del registro global de eventos coronarios agudos (GRACE por sus siglas en inglés) es usado para estratificar el riesgo en pacientes con infarto de miocardio sin elevación del segmento ST (IAMSEST). El intervalo QT corregido (QTc) no se considera en este modelo. Objetivo. Evaluar la relación entre el intervalo QTc con la escala GRACE en pacientes con IAMSEST. Materiales y métodos. Se realizó un estudio observacional retrospectivo entre 2016 y 2019. Se incluyeron pacientes con diagnóstico de IAMSEST, los intervalos QTc se calcularon con la fórmula de Bazett y se clasificaron en dos grupos: intervalo QTc normal (<440 ms) y prolongado (≥440 ms). Según el puntaje GRACE fueron clasificados en tres rangos: riesgo bajo (≤109 puntos), intermedio (110-139 puntos) y alto (≥140 puntos), se determinó si existía relación entre el intervalo QTc y la puntuación GRACE. Resultados. Durante el período mencionado ingresaron en nuestro centro 940 pacientes con diagnóstico de IAMSEST, 634 cumplieron con los criterios de inclusión; hubo 390 pacientes con intervalo QTc normal y 244 con intervalo QTc prolongado. Los pacientes con QTc prolongado eran mayores (65,5 vs. 61, p=0,001) con menor proporción de hombres (71,7% vs. 82,8%, p=0,001). Se encontró asociación entre la escala GRACE y el intervalo QTC, los sujetos con un QTc normal tenían una mayor proporción de riesgo bajo e intermedio que aquellos con un QTc prolongado (p=0,001). Conclusiones. En pacientes con IAMSEST un intervalo QTc normal (<440 ms) se relaciona con una escala de riesgo GRACE de riesgo bajo o intermedio

Distribución del coral arrecifal Pocillopora inflata (Scleractinia) en el Pacífico Mexicano y comentarios sobre su situación taxonómica

Background. The geographic distribution of reef corals in the eastern Pacific is well documented. However, field surveys still produce new geographic records of the taxa. Goals. The objective of this paper is to present a detailed compilation of the areas of occurrence of the Pocillopora inflata in Mexico, provide observations on its distribution range and comment on the taxonomic validity of the records of this species in the country. Methods. Data regarding distribution of the species in the Eastern Pacific and Mexican Pacific were gathered from published sources and field logs. Results. The distribution of P. inflata ranges from the southern Gulf of California (including new records for four locations of Baja California Sur, along the 24°N parallel), Nayarit, Colima, Guerrero and Oaxaca (to Huatulco Bays; 15°N). This new data call for a modification of the distribution map for the taxon in the Red List of the International Union for Conservation of Nature. Conclusions. Repeated observations in the Gulf of California revealed that, due to the remarkable phenotypic plasticity of another species (P. damicornis), confusion may arise with the identification of P. inflata in the field, since the general form of this species, is quite similar to the branches of P. damicornis affected by storms.Antecedentes. La distribución de los corales del Pacífico Oriental está bien caracterizada, sin embargo prospecciones de campo siguen arrojando nuevos registros geográficos de los taxa. Objetivos. Presentar una recopilación detallada de las zonas de presencia del coral Pocillopora inflata, en México, aportar observaciones que extienden su ámbito de distribución y discutir algunos aspectos sobre la validez taxonómica de los registros de la especie en el país. Métodos. Se compilaron datos de distribución de la especie en el Pacífico Oriental y datos de campo del taxón en el Pacífico mexicano. Resultados. Los resultados indican que la distribución de P. inflata comprende el sur del Golfo de California (incluyendo nuevos registros en cuatro localidades de Baja California Sur, dentro del paralelo 24°N), Nayarit, Colima, Guerrero y Oaxaca (hasta Bahías de Huatulco; 15°N). Los nuevos datos modifican el mapa de distribución reconocido para el taxón en la Lista Roja de la Unión Internacional para la Conservación de la Naturaleza. Conclusiones. Observaciones llevadas a cabo repetidamente en el Golfo de California evidencian que debido a la gran plasticidad fenotípica de otra morfoespecie (P. damicornis), puede haber confusiones al identificar P. inflata en el campo, ya que la forma general de esta especie y la de las ramas de P. damicornis afectadas por tormentas, llega a ser muy similar

First Sagittarius A* Event Horizon Telescope results. II. EHT and multiwavelength observations, data processing, and calibration

We present Event Horizon Telescope (EHT) 1.3 mm measurements of the radio source located at the position of the supermassive black hole Sagittarius A* (Sgr A*), collected during the 2017 April 5–11 campaign. The observations were carried out with eight facilities at six locations across the globe. Novel calibration methods are employed to account for Sgr A*'s flux variability. The majority of the 1.3 mm emission arises from horizon scales, where intrinsic structural source variability is detected on timescales of minutes to hours. The effects of interstellar scattering on the image and its variability are found to be subdominant to intrinsic source structure. The calibrated visibility amplitudes, particularly the locations of the visibility minima, are broadly consistent with a blurred ring with a diameter of ∼50 μas, as determined in later works in this series. Contemporaneous multiwavelength monitoring of Sgr A* was performed at 22, 43, and 86 GHz and at near-infrared and X-ray wavelengths. Several X-ray flares from Sgr A* are detected by Chandra, one at low significance jointly with Swift on 2017 April 7 and the other at higher significance jointly with NuSTAR on 2017 April 11. The brighter April 11 flare is not observed simultaneously by the EHT but is followed by a significant increase in millimeter flux variability immediately after the X-ray outburst, indicating a likely connection in the emission physics near the event horizon. We compare Sgr A*'s broadband flux during the EHT campaign to its historical spectral energy distribution and find that both the quiescent emission and flare emission are consistent with its long-term behavior.http://iopscience.iop.org/2041-8205Physic

First Sagittarius A* Event Horizon Telescope Results. II. EHT and Multiwavelength Observations, Data Processing, and Calibration

We present Event Horizon Telescope (EHT) 1.3 mm measurements of the radio source located at the position of the supermassive black hole Sagittarius A* (Sgr A*), collected during the 2017 April 5–11 campaign. The observations were carried out with eight facilities at six locations across the globe. Novel calibration methods are employed to account for Sgr A*'s flux variability. The majority of the 1.3 mm emission arises from horizon scales, where intrinsic structural source variability is detected on timescales of minutes to hours. The effects of interstellar scattering on the image and its variability are found to be subdominant to intrinsic source structure. The calibrated visibility amplitudes, particularly the locations of the visibility minima, are broadly consistent with a blurred ring with a diameter of ∼50 μas, as determined in later works in this series. Contemporaneous multiwavelength monitoring of Sgr A* was performed at 22, 43, and 86 GHz and at near-infrared and X-ray wavelengths. Several X-ray flares from Sgr A* are detected by Chandra, one at low significance jointly with Swift on 2017 April 7 and the other at higher significance jointly with NuSTAR on 2017 April 11. The brighter April 11 flare is not observed simultaneously by the EHT but is followed by a significant increase in millimeter flux variability immediately after the X-ray outburst, indicating a likely connection in the emission physics near the event horizon. We compare Sgr A*’s broadband flux during the EHT campaign to its historical spectral energy distribution and find that both the quiescent emission and flare emission are consistent with its long-term behavior

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Eficacia profiláctica de ondansetrón y dexametasona en náusea y vómito posterior a cesárea con opioides neuroaxiales como coadyuvantes. Ensayo clínico controlado

Background: Subarachnoid anesthesia is the most common technique for cesarean section and coadjuvant opioids such as morphineand fentanyl have adverse events, predominantly nausea and vomit. A randomized, placebo-controlled trial was performed to evaluatethe prophylactic effect of ondansetron and dexamethasone on these events. Objective: To establish the efficacy of ondansetron anddexamethasone in nausea and vomit prophylaxis in patients undergoing cesarean section. Method: A sample of 300 pregnant womenwas randomized in 3 groups: dexamethasone 4 mg, ondansetron 4 mg, and placebo. Standardized dose of 9 mg of bupivacaine at 0,5%100 mcg of morphine and 25 mcg of intratechal fentanyl were administered to all patients. Both dexamethasone and ondansetron werecompared against placebo. Emergency cesarean section, ASA III and allergic patients to any study drugs were excluded. Nausea andvomiting were evaluated intraoperative, 2, 6 and 24 hours after anesthesia, with a significance level α of 0,05. Results: On dexamethasonegroup the RR for vomit was 0,46 (CI 95% 0,28 to 0,76) and 0,79 (CI 95% 0, 64-0,96) for nausea. On the ondansetron group, it was 0.41 (CI95% 0,24- 0,69) for vomit and 0,75 (CI 95% 0,67 a 0,84) for nausea. The severity of nausea was statistically lower on the ondansetron groupIntroducción: la anestesia subaracnoidea es la técnica más empleada para realización de cesáreas usando opioides neuroaxiales, cuyosprincipales eventos adversos son náusea y vómito. Objetivo: establecer la eficacia de ondansetrón y dexametasona en la profilaxis denáuseas y vómitos en pacientes sometidos a cesárea. Materiales y métodos: una muestra de 300 embarazadas llevadas a cesárea noemergente bajo anestesia subaracnoidea fueron asignadas aleatoriamente en tres grupos: DEX (dexametasona 4 mg), OND (ondansetrón4 mg), PLB (placebo 5 mL de solución salina normal). La técnica anestésica se estandarizó con 9 mg de bupivacaína al 0.5%, 100 mcg demorfina y 25 mcg de fentanilo Intratecal. Se evaluó el resultado de interés durante el intraoperatorio, a las 2, 6 y 24 horas post-anestesia,con un nivel de significancia α de 0,05. Resultados: el RR en el grupo DEX para vómito fue 0,46 (IC95%: 0,28-0,76), y para náusea fue 0,79(IC95%: 0,64-0,96). En el grupo OND el RR para vómito fue 0,41 (IC95%: 0,24-0,69) y para náusea 0,75 (IC95%: 0,67-0,84). La severidad dela náusea fue menor y significativa en el grupo OND durante todo el tiempo evaluado (p<0.001). Conclusiones: la dexametasona 4 mg y elondansetrón 4 mg mostraron eficacia para disminuir el riesgo de náusea y vómito postoperatorio en pacientes sometidas a cesárea bajoanestesia subaracnoidea cuando se usan opioides neuroaxiales. Trial registration: (ISRCTN 57227250). MÉD.UIS. 2018;31(1):31-8

Guía retenida y anudada extravascular durante un cateterismo venoso central: reporte de un caso

El cateterismo venoso central (CVC) es un procedimiento común en la práctica médica de especialistas en salas de emergencia, cuidado intensivo y salas de cirugía. Su uso no está libre de complicaciones estas pueden ser de tipo mecánica, infecciosa y trombóticas. Dentro de las complicaciones mecánicas las asociadas con la guía tipo atrapamiento vascular es la más común, pero el anudamiento y el atrapamiento extravascular son muy infrecuentes. Presentamos el caso de una mujer con atrapamiento extravascular de la guía y neumotórax como complicaciones de un CVC subclavi