Presentación, diagnóstico y tratamiento del tromboembolismo venoso

Venous thromboembolism makes reference to a group of thromboembolic pathologies which include deep vein thrombosis, pulmonary thromboembolism and superficial thrombophlebitis. The relevance of this pathology relies on the fact that it is the third most important cardiovascular disease because of its high morbidity and mortality. The diagnosis might be suspected because of the clinical presentation of the patient, nevertheless, it is stablished by assessing pretest probability, laboratory tests and image studies. Anticoagulants, either parenteral or oral direct anticoagulants, are the main treatment for this pathology. Accurate treatment decreases the probability of complications which means improving the patient’s quality of life.El tromboembolismo venoso hace referencia a un grupo de enfermedades tromboembólicas las cuales abarcan la trombosis venosa profunda, el tromboembolismo pulmonar y la tromboflebitis superficial. La relevancia de esta patología se debe a que es la tercera enfermedad cardiovascular más importante por su alta tasa de morbilidad y mortalidad. Se puede sospechar su diagnóstico por la presentación clínica del paciente, sin embargo, el diagnóstico final se establece mediante valoración de riesgo pretest, laboratorios y estudios de imágenes. El uso de anticoagulantes ya sean parenterales o anticoagulantes orales directos, es la base del tratamiento para esta patología. Un tratamiento certero y a tiempo disminuye la probabilidad de complicaciones lo que implica mejorar la calidad de vida en estos pacientes

Actualización en el manejo de labor de parto pre-término

Preterm labor is one of the main causes of neonatal morbimortality and one of the most frequent causes of hospitalization during pregnancy. The diagnosis is based on the presence of regular uterine contractions accompanied by cervical changes before 37 weeks of gestation. Recently, objective measures, such as the measurement of cervical length by transvaginal ultrasound and fetal fibronectin, are used for diagnosis, as this is key to the success of the management. The purpose of the treatment of preterm labor is to delay delivery for at least 48 hours, to be able to supply corticosteroids, which are the only medications that have been shown to improve fetal survival, and transfer the patient to a specialized medical center. Tocolytic treatment is reserved for women in whom the delay in childbirth will benefit the newborn and the choice is basedLa labor de parto pre-término es una de las principales causas de morbimortalidad neonatal y una de las causas más frecuentes de hospitalización durante el embarazo. Su diagnóstico se basa en la presencia de contracciones uterinas regulares acompañados de cambios cervicales antes de las 37 semanas de gestación. Recientemente se utilizan medidas objetivas, como la medición de longitud cervical por ultrasonido transvaginal y la fibronectina fetal, para su diagnóstico, ya que este es clave para el éxito del manejo. El propósito del tratamiento de la labor de parto pre-término es retrasar el parto durante al menos 48 horas, para poder suministrar corticosteroides, que son los únicos medicamentos que han demostrado mejorar la supervivencia fetal, y trasladar a la paciente a un centro médico especializado. El tratamiento tocolítico se reserva para mujeres en quienes el retraso en el parto va a beneficiar al neonato y la escogencia de este se basa en las contraindicaciones fetales, maternas y los efectos secundarios de cada uno de los agentes.  &nbsp

Diagnóstico, evaluación y tratamiento de la apendicitis aguda en el servicio de emergencias

Appendicitis is defined as the inflammation of the vermiform appendix, with obstruction of the lumen by a fecalith as the most common cause in adult patients. The diagnosis is mainly clinical, based on anamnesis and findings at physical examination and in some cases it may be necessary to rely on imaging studies. Because acute appendicitis is a pathology that presents with acute abdominal pain as the main symptom, it has a wide variety of differential diagnosis and the clinical assessment is very important in order to achieve the definite diagnosis. First line treatment is laparoscopic appendectomy. Studies have suggested a non-surgical approach to simple appendicitis; however, this requires further investigation.Apendicitis se define como la inflamación del apéndice cecal, siendo la obstrucción del lumen por un fecalito la causa más común en pacientes adultos. El diagnóstico es principalmente clínico, basándose en la anamnesis y los hallazgos al examen físico y en algunos casos puede ser necesario acudir a estudios de imagen. Al ser una patología que se presenta con dolor abdominal agudo como el síntoma principal, la apendicitis aguda tiene una gran cantidad de diagnósticos diferenciales y la valoración clínica es muy importante para realizar el diagnóstico definitivo. El tratamiento de elección es la apendicectomía laparoscópica. También se ha estudiado el abordaje no quirúrgico con terapia antibiótica para apendicitis simple, sin embargo, este requiere mayor investigación

Intrauterine contraception and their use in adolescents

La población de mujeres adolescentes se ha convertido en un grupo vulnerable en cuanto a embarazos no deseados. En esto radica la importancia del uso de anticonceptivos en este grupo poblacional. Se ha estudiado ampliamente el uso de anticonceptivos reversibles de larga duración para esta población, entre ellos, los dispositivos uterinos. Durante muchos años los médicos se han abstenido de recomendar este método anticonceptivo basándose en mitos y falta de conocimiento de estos métodos. Sin embargo, se ha visto que los dispositivos intrauterinos son altamente confiables y seguros y son recomendados por la Academia Americana de Pediatría y el Colegio Americano de Obstetras y Ginecólogos como métodos anticonceptivos de primera línea en las adolescentes, por lo que es necesario educar a las pacientes y entrenar al personal de salud para beneficio de este grupo de mujeres.for this population, including uterine devices, has been widely studied. For many years, doctors have refrained from recommending this method of contraception based on myths and lack of knowledge of these methods. However, IUDs have been found to be highly reliable and safe and are recommended by the American The population of adolescent women has become a vulnerable group in terms of unwanted pregnancies. Herein lies the importance of contraceptive use in this population group. The use of long-term reversible contraceptives Academy of Pediatrics and the American College of Obstetricians and Gynecologists as first-line contraceptive methods for adolescents, making it necessary to educate patients and train health workers for the benefit of this group of women

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

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

Diagnóstico, evaluación y tratamiento de la apendicitis aguda en el servicio de emergencias

Appendicitis is defined as the inflammation of the vermiform appendix, with obstruction of the lumen by a fecalith as the most common cause in adult patients. The diagnosis is mainly clinical, based on anamnesis and findings at physical examination and in some cases it may be necessary to rely on imaging studies. Because acute appendicitis is a pathology that presents with acute abdominal pain as the main symptom, it has a wide variety of differential diagnosis and the clinical assessment is very important in order to achieve the definite diagnosis. First line treatment is laparoscopic appendectomy. Studies have suggested a non-surgical approach to simple appendicitis; however, this requires further investigation.Apendicitis se define como la inflamación del apéndice cecal, siendo la obstrucción del lumen por un fecalito la causa más común en pacientes adultos. El diagnóstico es principalmente clínico, basándose en la anamnesis y los hallazgos al examen físico y en algunos casos puede ser necesario acudir a estudios de imagen. Al ser una patología que se presenta con dolor abdominal agudo como el síntoma principal, la apendicitis aguda tiene una gran cantidad de diagnósticos diferenciales y la valoración clínica es muy importante para realizar el diagnóstico definitivo. El tratamiento de elección es la apendicectomía laparoscópica. También se ha estudiado el abordaje no quirúrgico con terapia antibiótica para apendicitis simple, sin embargo, este requiere mayor investigación

Presentación, diagnóstico y tratamiento del tromboembolismo venoso

Venous thromboembolism makes reference to a group of thromboembolic pathologies which include deep vein thrombosis, pulmonary thromboembolism and superficial thrombophlebitis. The relevance of this pathology relies on the fact that it is the third most important cardiovascular disease because of its high morbidity and mortality. The diagnosis might be suspected because of the clinical presentation of the patient, nevertheless, it is stablished by assessing pretest probability, laboratory tests and image studies. Anticoagulants, either parenteral or oral direct anticoagulants, are the main treatment for this pathology. Accurate treatment decreases the probability of complications which means improving the patient’s quality of life.El tromboembolismo venoso hace referencia a un grupo de enfermedades tromboembólicas las cuales abarcan la trombosis venosa profunda, el tromboembolismo pulmonar y la tromboflebitis superficial. La relevancia de esta patología se debe a que es la tercera enfermedad cardiovascular más importante por su alta tasa de morbilidad y mortalidad. Se puede sospechar su diagnóstico por la presentación clínica del paciente, sin embargo, el diagnóstico final se establece mediante valoración de riesgo pretest, laboratorios y estudios de imágenes. El uso de anticoagulantes ya sean parenterales o anticoagulantes orales directos, es la base del tratamiento para esta patología. Un tratamiento certero y a tiempo disminuye la probabilidad de complicaciones lo que implica mejorar la calidad de vida en estos pacientes

Actualización en el manejo de labor de parto pre-término

Preterm labor is one of the main causes of neonatal morbimortality and one of the most frequent causes of hospitalization during pregnancy. The diagnosis is based on the presence of regular uterine contractions accompanied by cervical changes before 37 weeks of gestation. Recently, objective measures, such as the measurement of cervical length by transvaginal ultrasound and fetal fibronectin, are used for diagnosis, as this is key to the success of the management. The purpose of the treatment of preterm labor is to delay delivery for at least 48 hours, to be able to supply corticosteroids, which are the only medications that have been shown to improve fetal survival, and transfer the patient to a specialized medical center. Tocolytic treatment is reserved for women in whom the delay in childbirth will benefit the newborn and the choice is basedLa labor de parto pre-término es una de las principales causas de morbimortalidad neonatal y una de las causas más frecuentes de hospitalización durante el embarazo. Su diagnóstico se basa en la presencia de contracciones uterinas regulares acompañados de cambios cervicales antes de las 37 semanas de gestación. Recientemente se utilizan medidas objetivas, como la medición de longitud cervical por ultrasonido transvaginal y la fibronectina fetal, para su diagnóstico, ya que este es clave para el éxito del manejo. El propósito del tratamiento de la labor de parto pre-término es retrasar el parto durante al menos 48 horas, para poder suministrar corticosteroides, que son los únicos medicamentos que han demostrado mejorar la supervivencia fetal, y trasladar a la paciente a un centro médico especializado. El tratamiento tocolítico se reserva para mujeres en quienes el retraso en el parto va a beneficiar al neonato y la escogencia de este se basa en las contraindicaciones fetales, maternas y los efectos secundarios de cada uno de los agentes.