Hipotensión en anestesia regional y velocidad de inyección

SUMMARYIntroductionTo present some thoughts on the article "Regional subarachnoid anesthesia for C-section and post-partum Pomeroy procedure. Application of a local anesthetic at a rate lower or greater than 60 seconds" in order to provide readers with a different perspective regarding the results reported.MethodsThe paper was read critically in order to assess the quality of the methodology, the potential sources of bias and error, the confounding variables, and also to review the results from a fresh perspective.ResultsHypotension occurs frequently when subarachnoid anesthesia is applied, and the rate of injection may explain it in part. The case series analyzed has a limited sample size, creating the possibility of information bias and confounding factors, not to mention that the potential interaction between the rate of infusion and the mix of anesthetics was not considered.ConclusionA cohort study with a larger sample size must be undertaken in order to control confusion by means of standardized procedures, an analysis stratified by subgroups, and mathematical modeling designed to identify the strength of association between the injection rate and the onset of hypotension, as potential sources of confusion and interaction

Recomendaciones internacionales para el tratamiento médico de la hemorragia posparto

La hemorragia posparto es la principal causa de mortalidad y morbilidad obstétrica extrema a nivel mundial; de una oportuna identificación y un manejo adecuado depende la disminución de eventos adversos derivados de esta patología. Esta revisión expone las medidas de manejo médico no quirúrgico indicadas por distintas organizaciones internacionales y nacionales basadas en evidencia.Se realizó una búsqueda en tres bases de datos de literatura científica —Pubmed, Lilacs y Embase— y se seleccionaron artículos correspondientes con guías de práctica clínica basadas en evidencia, revisiones sistemáticas y artículos que compararan las recomendaciones de distintas guías. Como resultado se seleccionaron siete guías de práctica clínica, una revisión sistemática y dos ensayos clínicos. Las recomendaciones para el tratamiento médico presentadas están basadas en estos artículos.Postpartum hemorrhage is the leading cause of maternal extreme morbidity and mortality worldwide. Decreasing adverse events derived from this pathology depends on a timely identification and an adequate treatment. This review focuses on evidence-based recommendations for non-surgical medical treatment provided by different national and international organizations. A search for scientific literature in three databases —Pubmed, Lilacs and Embase— was performed. Articles on evidence-based clinical practice guidelines, systematic reviews and comparison of recommendations given by different guidelines were selected. As a result seven clinical practice guidelines, one systematic review and two clinical trials were selected. The recommendations for the medical treatment of postpartum hemorrhage presented in this work are based on those articles

Tratamiento de la sífilis gestacional y prevención de la sífilis congénita en un hospital público en bogotá, 2010

Antecedentes.Objetivo. Evaluar el cumplimiento de las recomendaciones del Centro de Control de Enfermedades (CDC) para el tratamiento de casos intrahospitalarios de sífilis gestacional y congénita.Material y métodos. Estudio retrospectivo basado en registros de notificación e historias clínicas de gestantes y neonatos de un hospital público de Bogotá entre enero 1 y octubre 31 de 2010. ResultadosSe identificaron 40 casos de sífilis gestacional: 12,5% con diagnóstico de aborto sin control prenatal, 12,5% en gestaciones en curso (una término en aborto), 72,5% durante el parto y 2,5% en puerperio. Sólo 45% estaban afiliadas a la seguridad social, la tasa de analfabetismo fue 12%. El 100% de los casos encontrados latentes y 58% de los compañeros no recibió tratamiento. Se identificaron 25 casos de sífilis congénita. Hubo 2 (8,3%) casos confirmados de neurosífilis congénita. Todos los neonatos recibieron tratamiento para sífilis congénita como escenarios 1 y 2 del CDC independiente del tratamiento materno recibidido. Conclusión.La sífilis gestacional y congénita afecta grupos vulnerables. Se debe tratar integralmente a la gestante y su hijo, ubicar el escenario terapéutico del neonato y realizar el manejo clínico adecuado para curar la enfermedad

Prevalence of high-risk human papilloma virus infection and abnormal cytology of the anal transformation zone in women with cervical dysplasia. Bogotá, Colombia, 2017-2019

Objetivo: establecer la prevalencia de infección anal por virus de papiloma humano de alto riesgo (VPH- AR) y citología anal anormal en mujeres con displasia cervical confirmada. Materiales y métodos: estudio de corte transversal que incluyó pacientes entre 30 y 65 años con diagnóstico nuevo de displasia cervical por histopatología, en dos unidades de colposcopia y patología del tracto genital inferior (una de carácter público y otra privada) entre diciembre de 2017 y abril de 2019. Se excluyeron mujeres con infección por virus de inmunodeficiencia humana (VIH), inmuno-compromiso (uso de esteroides, trasplante, quimioterapia), en embarazo o con malformaciones anorrectales. Muestreo consecutivo. Se evaluaron variables sociodemográficas, tipo de relaciones sexuales, el grado de displasia cervical, resultado positivo de prueba de reacción en cadena de la polimerasa para VPH de alto riesgo en canal anal y tipo de VPH-AR identificado (16-18 u otro). Se utilizó estadística descriptiva. Resultados: de 188 candidatas a ingresar se incluyeron 100 pacientes en el análisis, se encontró una prevalencia de 32 % de infección por VPH de alto riesgo y de 2,8 % de citología anal anormal (ASCUS) en el canal anal. El 68,8 % de las infecciones por VPH-AR en el canal anal correspondió a genotipos de VPH-AR diferentes a 16 o 18. Conclusiones: la prevalencia de infección anal por VPH-AR en mujeres con displasia cervical fue del 32 %. Es importante determinar la utilidad del tamizaje del compromiso de la mucosa anal por virus VPH de alto riesgo de cáncer en mujeres con displasia cervical. Se requieren estudios sobre el pronóstico de la infección anal por VPH-AR en las mujeres con displasia cervical.Objective: To determine the prevalence of anal infection caused by high-risk human papilloma virus (HR-HPV) and of abnormal anal cytology in women with confirmed cervical dysplasia. Materials and methods: Cross-sectional study that included patients between 30 and 65 years of age with a new diagnosis of cervical dysplasia by histopathology attended in two lower genital tract colposcopy and pathology units (one public and one private institution), conducted between December 2017 and April 2019. Women with human immunodeficiency virus (HIV) infection, immune compromise (use of steroids, transplant, chemotherapy), pregnancy or anorectal malformations were excluded. Consecutive sampling. Sociodemographic variables, intercourse type, degree of cervical dysplasia, positive results of HR HPV Polymerase Chain Reaction test in anal canal and HR – HPV type indentified (16-18 or others) were evaluated. Descriptive statistics were used. Results: Of 188 candidates, 100 were included in the analysis. A 32 % prevalence of high-risk HPV infection and a 2.8 % prevalence of abnormal cytology in the anal canal (ASCUS) were found. Of the HR-HPV infections in the anal canal, 68.8 % corresponded to HR-HPV genotypes different from 16 or 18. Conclusions: Prevalence of HR HPV infection in women with lower genital tract dysplasia was 32%. It is important to determine the usefulness of screening for anal mucosa compromise by HPV virus associated with a high risk of cancer in women with cervical dysplasia. Studies are needed on the prognosis of anal HR-HPV infection in women with cervical dysplasia

Clinical practice guidelines for early detection of abnormalities during labor, care for normal and dystocic delivery

Objetivo: realizar recomendaciones para detección temprana de las anomalías durante el trabajo de parto, atención del parto normal y distócico. Materiales y métodos: el grupo desarrollador de la Guía (GDG) elaboró esta GPC durante 2011-2012 acorde con la Guía Metodológica para la elaboración de Guías de Atención Integral en el Sistema General de Seguridad Social en Salud colombiano, basándose en la evidencia científica disponible y sumando la participación activa de grupos de pacientes, sociedades científicas y grupos de interés. En particular, la evidencia de esta Guía fue adaptada de la “Guía de práctica clínica sobre la atención del parto normal” (País Vasco - 2010) y actualizada por procedimientos sistemáticos, tanto para la búsqueda y valoración de la evidencia como para la generación de recomendaciones. El nivel de evidencia y la fuerza de las recomendaciones fueron expresados por medio del sistema del Scottish Intercollegiate Guidelines Network (SIGN). Esta guía y sus secciones hacen parte de un grupo de 25 GAI basadas en la evidencia que incorporan consideraciones económicas y de implementabilidad en el contexto del Sistema General de Seguridad Social en Salud colombiano, y que se desarrollaron por iniciativa del Ministerio de Salud y Protección Social y el Departamento de Ciencia, Tecnología e Innovación (Colciencias) en temas prioritarios y de alta prevalencia en el país mediante contrato otorgado a la Universidad Nacional de Colombia en el año 2010. Resultados: se presentan las recomendaciones para la asistencia del trabajo de parto y el parto asociadas con mayor probabilidad de obtener un resultado materno fetal exitoso durante la atención del parto. Conclusiones: se espera que las recomendaciones de esta GPC sean utilizadas por los profesionales de la salud de los programas de atención de la gestación con el fin de disminuir la morbilidad y mortalidad atribuibles a complicaciones del trabajo de parto y el parto.objective: To make recommendations for early detection of abnormalities during labor, and care of normal and dystocic delivery. materials and methods: The Guideline Developer Group (GDG) prepared this CPG during 2011-2012 in accordance with the Methodology Guideline for the development of Comprehensive Care Guidelines of the Colombian General System of Social Security, on the basis of the available scientific evidence, and with the active participation of patient groups, scientific societies and stakeholders. In particular, the evidence for this section was adapted from the “Clinical practice guideline for normal delivery care” (País Vasco – 2010) and adapted through systematic procedures for the search and assessment of the evidence as well as for the generation of recommendations. The level of evidence and the power of the recommendations were expressed using the Scottish Intercollegiate Guidelines Network (SIGN) system. results: We present the recommendations for labor and delivery care associated with the highest probability of a successful outcome for the mother and the baby. conclusions: It is expected that the recommendations contained in this CPG will be used by practitioners in pregnancy care programs in order to reduce morbidity and mortality attributable to labor and delivery complications

Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Withdrawal Is Associated with Higher Mortality in Hospitalized Patients with COVID-19

Our main aim was to describe the effect on the severity of ACEI (angiotensin-converting enzyme inhibitor) and ARB (angiotensin II receptor blocker) during COVID-19 hospitalization. A retrospective, observational, multicenter study evaluating hospitalized patients with COVID-19 treated with ACEI/ARB. The primary endpoint was the incidence of the composite outcome of prognosis (IMV (invasive mechanical ventilation), NIMV (non-invasive mechanical ventilation), ICU admission (intensive care unit), and/or all-cause mortality). We evaluated both outcomes in patients whose treatment with ACEI/ARB was continued or withdrawn. Between February and June 2020, 11,205 patients were included, mean age 67 years (SD = 16.3) and 43.1% female; 2162 patients received ACEI/ARB treatment. ACEI/ARB treatment showed lower all-cause mortality (p < 0.0001). Hypertensive patients in the ACEI/ARB group had better results in IMV, ICU admission, and the composite outcome of prognosis (p < 0.0001 for all). No differences were found in the incidence of major adverse cardiovascular events. Patients previously treated with ACEI/ARB continuing treatment during hospitalization had a lower incidence of the composite outcome of prognosis than those whose treatment was withdrawn (RR 0.67, 95%CI 0.63-0.76). ARB was associated with better survival than ACEI (HR 0.77, 95%CI 0.62-0.96). ACEI/ARB treatment during COVID-19 hospitalization was associated with protection on mortality. The benefits were greater in hypertensive, those who continue

Obstetricia integral siglo XXI. Tomo II

El libro Obstetricia Integral siglo XXI, Tomo II, es una publicación virtual de la Facultad de Medicina, se trata de la continuación sobre el análisis detallado de los principales tópicos en el área de la obstetricia, realizada por un grupo interdisciplinario de investigadores comprometidos con el mejoramiento de la calidad en el cuidado de la salud de la mujer gestante. Se ha procurado un balance entre los aspectos básicos de fisiopatología y las guías de atención clínica soportadas en evidencias científicas, con el ánimo de brindarle al lector un equilibrio entre las bases biopsico-sociales de la salud y la enfermedad y los aspectos prácticos de la atención clínica.Vargas Fiesco, Diana Carolina and Rubio Romero, Jorge Andrés and Ruiz Parra, Ariel Iván and Rodríguez, Luis Martín and Aragón, Miguel Eduardo and Arteaga Díaz, Clara Eugenia and Riaño, Jorge Enrique and Arenas Gamboa, Jaime and Ramírez Martínez, Javier Andrés and Amaya Guío, Jairo and Gaitán , Magda Alexandry and Gallego Arbeláez, Jaime and Cortés Díaz, Daniel Otálvaro and Ángel Müller, Edith and Bracho Ch., Alcides C. and Bautista Charry, Alejandro and Rodríguez Ramos, Marcela and Navarro Milanés, Alfonso and Díaz Cruz, Luz Amparo and Mercado Pedroza, Manuel Esteban and Gaitán Duarte, Hernando and Gómez Sánchez, Pio Iván and Peña, Diana Marcela and Calvo Gómez, José Manuel and Parra Pineda, Mario Orlando and Cárdenas Muñoz, María Luisa (2010) Obstetricia integral siglo XXI. Tomo II. Facultad de Medicina, Universidad Nacional de Colombia, Bogotá. ISBN 978958447618

El conflicto entre cristianos y musulmanes en las relaciones de sucesos : la liberación de Buda

Este trabajo propone el análisis de una selección de textos escritos en romance sobre la derrota turca y la toma de la ciudad de Buda en 1686, que denuncian la exultante acogida popular de la noticia de las gestas cristianas en Centroeuropa, la percepción del eterno conflicto entre Oriente y Occidente y la proyección del imaginario colectivo del siglo xvii acerca de la lucha contra los infieles.This paper offers the analysis of a selection of texts, written in Romance languages, about the Turkish defeat and the conquest of the city of Buda in 1686, which provide evidence of the popular exultation at the news of the Christian achievements in Central Europe, the perception of the eternal conflict between East and West, and the projection of the seventeenth-century collective imagination regarding the struggle against the infidel

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio