INCIDENCIA DE SIGNOS APENDICULARES FRECUENTES Y NO FRECUENTES EN LA APENDICITIS AGUDA

La apendicitis aguda es el padecimiento quirúrgico abdominal más frecuente en el mundo y la principal causa de abdomen agudo, el diagnóstico es principalmente clínico; aunque la mortalidad es inferior al 0.1%, se requiere un diagnóstico oportuno para evitar las posibles complicaciones secundarias al retraso del mismo. Existe numerosa literatura acerca de los signos apendiculares explorados comúnmente, sin embargo existen muy pocas referencias sobre la frecuencia de aparición de otros signos apendiculares en el campo clínicos

A randomized clinical trial of unfractioned heparin for treatment of sepsis (the HETRASE study): design and rationale [NCT00100308]

INTRODUCTION: Infection promotes coagulation via a large number of molecular and cellular mechanisms, and this procoagulant activity has boosted basic and clinical research using anticoagulant molecules as therapeutic tools in sepsis. Heparin, which is a naturally occurring proteoglycan that acts by reducing thrombin generation and fibrin formation, has not been rigorously tested in a randomized clinical trial. METHODS: Randomized, double-masked, placebo-controlled, single-center clinical trial. Patients are recruited through the emergency room at Hospital Universitario San Vicente de Paul. This is a 650-bed University Hospital in Medellín, Colombia and is a referral center for a region with approximately 3 million habitants. The recruitment process started on July 2005 and will finish on June 2007. Patients aged 18 years or older, males or females, hospitalized with clinically or microbiological confirmed sepsis, have been included. The interventions are unfractioned heparin in low dose continuous infusion (500 units per hour for 7 days) or placebo, additionally to the standard of care for sepsis patients in Colombia. RESULTS: Our primary aims are to estimate the effects of heparin on hospital length of stay and change from baseline Multiple Organ Dysfunction (MOD) score. Secondary objectives are to estimate the effects of heparin on 28-day all-cause mortality, and to estimate the possible effect modification on 28-day all-cause mortality, in subgroups defined by source and site of infection, and baseline values of APACHE II score, MOD score and D-dimer. CONCLUSION: The available literature in animal and human research, and the understanding of the molecular biology regarding inflammation and coagulation, supports a randomized clinical trial for the use of heparin in sepsis. Our study will provide appropriate power to detect differences in valid surrogate outcomes, and it will explore important preliminary data for efficacy regarding the clinical end-point of mortality

Nivel de conocimiento sobre el uso e higiene en pacientes portadores de las prótesis dentales atendidos en el centro de salud Pachacútec Cajamarca, 2022

En la actualidad el uso de prótesis dentales ha ido incrementando, por lo que la presente investigación tuvo el propósito: Determinar el nivel de conocimiento sobre el uso e higiene en pacientes portadores de prótesis dental atendidos en el centro de salud Pachacútec Cajamarca-2022, El diseño de investigación no fue de prueba, explicación y método cuantitativo y variado. La muestra estuvo conformada por 63 pacientes con implantes dentales a quienes se les entregó una lista de 15 preguntas sobre información sobre el uso e higiene de los implantes dentales. Como resultado se encontró: El 76,2% tenía un nivel de conocimiento sobre el uso e higiene de las prótesis dentales regular, el 22,2% deficiente y 1,6% bueno, respecto al nivel de conocimientos según el género, se obtuvo que el 79,4% fueron del sexo femenino, de ellos el 58,7% tuvieron nivel de conocimiento regular, el 20,6% fueron del sexo masculino, de los cuales el 17,5% tuvo nivel de conocimiento regular, la prótesis más utilizada fue la Prótesis Parcial Removible con 50,8% y el 74,6% usan su prótesis dental removible por más de 8 años, de ellos el 47,6% se encuentra en buena condición, 17,5% usan su prótesis entre 5 a 8 años, de ellos el 6,3% se encuentra en buena condición y 1,6% en mala condición y 7,9% usan menos de 5 años su prótesis, de ellos el 15,9% se encuentra en buena condición, el 93,7% recibieron instrucciones sobre la higiene de su prótesis dental y el 6,3% NO fueron instruidos. Concluyendo que su conocimiento sobre uso e higiene de los implantes dentales en pacientes del C.S. Pachacútec de Cajamarca fue regular.TesisCiencias de la vida y cuidado de la salud human

Characterization of thermal and hydric conditions of nesting sites of female Aspidoscelis costatus costatus (Squamata: Teiidae)

Ambiente térmico e hídrico de incubaciónReproductive success in oviparous squamates requires the selection of an appropriate nest site for oviposition. The resulting environmental conditions directly influence different biological traits of offspring. We studied thermal and hydric conditions of nesting sites before, during, and after the egg-laying season of Aspidoscelis costatus costatus (Balsas Basin Whiptail) in central Mexico to assess their respective relationships with the female reproductive cycle. We placed electronic thermometers directly into nests and measured soil humidity using a modification of the McGehee method. We measured and classified 45 nests of this subspecies, all located under volcanic rocks, as either active (i.e., with developing turgid, white-shelled eggs or shell remnants) or inactive (i.e., those from previous reproductive seasons as indicated by brown eggshells). We located active nests between June and September, whereas the inactive nests were found throughout the year. The average temperature and humidity in nests were 24.6° C and 19.5%, respectively, during the nesting season; however, neither temperature or humidity was optimal for clutch development in the months before and after the observed nesting season. Our study suggests that gravid female A. c. costatus respond to environmental seasonal cues for oviposition (obtained from nesting sites) that coincidentally influence completion of embryonic development. This is the first study of nesting sites in Aspidoscelis that could be monitored without destruction of the nest. Knowledge of the location of nesting sites for this species has major implications for its conservation, especially in patches of suitable habitat in a crowded urban landscape.Apoyo del proyecto número 2620/200

The relationship between performance in a theory of mind task and intrinsic functional connectivity in youth with early onset psychosis

Psychotic disorders are characterized by theory of mind (ToM) impairment. Although ToM undergoes maturational changes throughout adolescence, there is a lack of studies examining ToM performance and its brain functional correlates in individuals with an early onset of psychosis (EOP; onset prior to age 18), and its relationship with age. Twenty-seven individuals with EOP were compared with 41 healthy volunteers using the "Reading-the-Mind-in-the-Eyes" Test, as a measure of ToM performance. A resting-state functional MRI scan was also acquired, in which the default mode network was used to identify areas relevant to ToM processing employing independent component analysis. Group effects revealed worse ToM performance and less intrinsic functional connectivity in the medial prefrontal cortex in EOP relative to healthy volunteers. Group by age interaction revealed age-positive associations in ToM task performance and in intrinsic connectivity in the medial prefrontal cortex in healthy volunteers, which were not present in EOP. Differences in ToM performance were partially mediated by intrinsic functional connectivity in the medial prefrontal cortex. Poorer ToM performance in EOP, coupled with less medial prefrontal cortex connectivity, could be associated with the impact of psychosis during a critical period of development of the social brain, limiting normative age-related maturation

Epidemiología de la sepsis en unidades de cuidado intensivo en Colombia

Introduction: Currently, there is not enough data available concerning sepsis in developing countries, especially in Latin America.Objective: We developed a study aimed at determining the frequency, clinical and epidemiological characteristics, and the consequences of sepsis in patients requiring admission to intensive care units in Colombia.Materials and methods: This was a secondary analysis of a prospective cohort study carried out over a six-month period, from September 1, 2007, to February 28, 2008, in ten medical/surgical intensive care units in four Colombian cities. Patients were considered eligible if they had a probable or confirmed diagnosis of infection according to medical records. We recorded demographic characteristics, first admission diagnosis and co-morbidities, clinical status, and sepsis, severe sepsis or septic shock.Results: During the study period, 826 patients were admitted to the intensive care units. From these patients, 421 (51%) developed sepsis in the community, 361 (44%) in the ICU, and 44 (5%) during hospitalization in the general ward. Two hundred and fifty three patients (30.6%) had involvement of one organ system: 20% had respiratory involvement, followed by kidney and central nervous system involvement with 3.4% and 2.7%, respectively.Conclusions: In our cohort of septic patients, the prevalence of sepsis treated in ICU is similar to that reported in other studies, as well as the overall mortality.Introducción. Actualmente no se cuenta con muchos datos disponibles sobre la sepsis en los países en desarrollo y especialmente en América Latina.Objetivo. Este estudio tuvo como objetivo determinar la frecuencia, las características clínicas y epidemiológicas y las consecuencias de la sepsis en una población de pacientes que requirieron ingreso en algunas unidades colombianas de cuidados intensivos.Materiales y métodos. Este fue un análisis secundario de un estudio prospectivo realizado en un período de seis meses contados a partir del 1° de septiembre de 2007 hasta el 28 de febrero del 2008 en diez unidades médico-quirúrgicas de cuidados intensivos de cuatro ciudades de Colombia. Los pacientes se consideraron elegibles si tenían un diagnóstico probable o confirmado de infección según los registros médicos. Se registraron las características demográficas, los diagnósticos de primer ingreso y las enfermedades concomitantes, el estado clínico y la sepsis, sepsis grave o choque séptico.Resultados. Durante el período de estudio, 826 pacientes fueron ingresados en las unidades de cuidados intensivos seleccionadas para el estudio. De estos pacientes, 421 (51 %) desarrollaron sepsis en la comunidad, 361 (44 %) en la unidad de cuidados intensivos y 44 (5 %) durante la hospitalización en la sala general; 253 pacientes (30,6 %) presentaron afectación de un órgano del sistema: 20 % tuvo problemas respiratorios, seguido por problemas en los riñones y el sistema nervioso central con 3,4 % y 2,7 %, respectivamente.Conclusiones. En la muestra de pacientes sépticos, la prevalencia de la sepsis, así como de la mortalidad global, en los pacientes tratados en la unidad de cuidados intensivos fue similar a la reportada en otros estudios

Brain structural trajectories in youth at familial risk for schizophrenia or bipolar disorder according to development of psychosis spectrum symptoms

Background: The evaluation of child and adolescent offspring of patients with schizophrenia (SzO) or bipolar disorder (BpO) may help understand changes taking place in the brain in individuals at heightened risk for disease during a key developmental period. Methods: One hundred twenty-eight individuals (33 SzO and 46 BpO, considered jointly as 'Familial High Risk' (FHR), and 49 controls) aged 6-17 years underwent clinical, cognitive and neuroimaging assessment at baseline, 2- and 4-year follow-up. Twenty FHR participants (11 SzO and 9 BpO) developed psychotic spectrum symptoms during follow-up, while 59 FHR participants did not. Magnetic resonance imaging was performed on a 3Tesla scanner; cortical surface reconstruction was applied to measure cortical thickness, surface area and grey matter volume. Results: FHR participants who developed psychotic spectrum symptoms over time showed greater time-related mean cortical thinning than those who did not and than controls. By subgroups, this effect was present in both BpO and SzO in the occipital cortex. At baseline, FHR participants who developed psychotic spectrum symptoms over time had smaller total surface area and grey matter volume than those who did not and than controls. Over time, all FHR participants showed less longitudinal decrease in surface area than controls. In those who developed psychotic spectrum symptoms over time, this effect was driven by BpO, while in those who did not, this was due to SzO, who also showed less grey matter volume reduction. Conclusion: The emergence of psychotic spectrum symptoms in FHR was indexed by smaller cross-sectional surface area and progressive cortical thinning. Relative preservation of surface area over time may signal different processes according to familial risk. These findings lay the foundation for future studies aimed at stratification of FHR youth

The epidemiology of sepsis in Colombia : a prospective multicenter cohort study in ten university hospitals

Q1Q11675-1682OBJECTIVE: Our aim was to determine the frequency and the clinical and epidemiologic characteristics of sepsis in a hospital-based population in Colombia. DESIGN: Prospective cohort. SETTING: Ten general hospitals in the four main cities of Colombia. PATIENTS: Consecutive patients admitted in emergency rooms, intensive care units, and general wards from September 1, 2007, to February 29, 2008, with confirmation of infection according to the Centers for Disease Control and Prevention definitions. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The following information was recorded: demographic, clinical, and microbiologic characteristics; Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores; requirement for intensive care unit; length of stay; and 28-day all-cause mortality. During a period of 6 months, 2,681 patients were recruited: 69% and 31% with community-acquired and hospital-acquired infections, respectively. The mean age was 55 yrs (SD = 21), 51% were female, and the median length of stay was 10 days (interquartile range, 5-19). The mean Acute Physiology and Chronic Health Evaluation score was 11.5 (SD = 7) and the mean Sequential Organ Failure Assessment score was 3.8 (SD = 3). A total of 422 patients with community-acquired infections (16%) were admitted to the intensive care unit as a consequence of their infection and the median length of stay was 4.5 days in the intensive care unit. At admission, 2516 patients (94%) met at least one sepsis criterion and 1,658 (62%) met at least one criterion for severe sepsis. Overall, the 28-day mortality rates of patients with infection without sepsis, sepsis without organ dysfunction, severe sepsis without shock, and septic shock were 3%, 7.3%, 21.9%, and 45.6%, respectively. In community-acquired infections, the most frequent diagnosis was urinary tract infection in 28.6% followed by pneumonia in 22.8% and soft tissue infections in 21.8%. Within hospital-acquired infections, pneumonia was the most frequent diagnosis in 26.6% followed by urinary tract infection in 20.4% and soft tissue infections in 17.4%. CONCLUSIONS: In a general inpatient population of Colombia, the rates of severe sepsis and septic shock are higher than those reported in the literature. The observed mortality is higher than the predicted by the Acute Physiology and Chronic Health Evaluation II score

Factores de riesgo de los trastornos hipertensivos inducidos por el embarazo en mujeres atendidas en una entidad de salud de Santa Marta

The Hypertensive disorders of pregnancy are a public health problem, is the first cause of maternal death in the developed countries and the third in developing countries. Objective: To identify the riskfactors those determine the occurrence of the hypertensive disorders in pregnant women attending in a health institution of Santa Marta, Colombia, in the months of January 2011 to January 2012. Materials and Methods: descriptive study, quantitative retrospective, executed in a group of 51 pregnant patients who had hypertensive disorders. The collection techniques of information used were based on the documentary review (medical history) and the application of an inquest previously validated by experts. Through these methods found variables which allowed identifying the risk factors in the hypertensive disorders of pregnant women. Results: The age distribution was ubicated in the range 26-34 years old / 54.8%), risk factors present were: underweight (45.0%), not attending antenatal care (11.8%), multiparous (56.9%), socioeconomic status medium high (45.1), family history related hypertensive disorder of the mother (39.2%), medical history of urinary tract infections (83.3%) and alcohol consumption (58.8%). Conclusions: The risk factors of medical history of urinary tract infections occurred in a high percentage (83.3%), alcohol consumption, and family history multiparity, occupied an important place, while the significant level of assistance to prenatal care not prevent the appearance of hypertensive disorder.Los trastornos hipertensivos del embarazo, son un problema de salud pública, la primera causa de muerte materna en países desarrollados y la tercera en países en desarrollo. Objetivo: Identificar los factores de riesgos que determinan la aparición de los trastornos hipertensivos, en mujeres embarazadas atendidas en una entidad de salud de Santa Marta, Colombia, en los meses de enero de 2011 a enero 2012. Materiales y métodos: estudio descriptivo, cuantitativo retrospectivo, realizado a un grupo de 51 pacientes gestantes que presentaron trastornos hipertensivos. Las técnicas de recolección de información se basaron en la revisión documental (historias clínicas) y la aplicación de una encuesta previamente validada por expertos. A través de estos métodos se consignaron variables que permitieron identificar los factores en los trastornos hipertensivos de las gestantes. Resultados: la distribución por edad se ubicó en el rango 26 a 34 años (54.8%), los factores de riesgos presentes fueron: bajo peso (45.0%), no asistencia a controles prenatales (11,8%), multiparidad (56.9%), nivel socioeconómico medio-alto (45.1), antecedentes familiares relacionados con alteración hipertensiva de la madre (39.2%), antecedentes personales patológicos de infecciones urinarias (83.3%) y consumo de alcohol (58.8%). Conclusiones: los factores de riesgo de antecedentes personales patológicos de infecciones urinarias se presentaron en un alto porcentaje (83,3%), el consumo de alcohol, multiparidad y antecedentes familiares, ocuparon un lugar importante; mientras que el nivel significativo de asistencia a controles prenatales, no evitó la aparición del trastorno hipertensivo. (DUAZARY 2013 No. 2, 119 - 126

Cognitive reserve and its correlates in child and adolescent offspring of patients diagnosed with schizophrenia or bipolar disorder

Aim: To analyze cognitive reserve (CR) in child and adolescent offspring of patients diagnosed with schizophrenia (SZ-off) or bipolar disorder (BD-off) and compare them with a group of community controls (CC-off). We also aimed to investigate whether there was an association between CR and clinical and neuropsychological variables according to group. Methods: The study included 46 SZ-off, 105 BD-off and 102 CC-off. All participants completed assessments regarding CR and clinical, neuropsychological and psychosocial functioning. CR was measured with a proxy based on premorbid intelligence, parental occupational level, educational attainment, developmental milestones and sociability. The clinical assessment included the Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime, the Semi-structured Interview for Prodromal Syndromes, and the Global Assessment Functioning scale. The neuropsychological assessment included measures of executive functioning, attention, verbal memory, working memory and processing speed. Results: SZ-off showed a lower level of CR compared to BD-off and CC-off, while BD-off showed an intermediate level of CR between SZ-off and CC-off. Moreover, an association between higher CR and less lifetime psychopathology, fewer prodromal psychotic symptoms, higher psychosocial functioning, and a higher working memory score was observed in all groups, but it was stronger in SZ-off. Conclusions: CR seemed to be associated with psychopathology, clinical symptoms, psychosocial functioning, and some cognitive functions. SZ-off appeared to benefit more from a higher CR, therefore it could be considered a protective factor against the development of clinical symptomatology and cognitive impairment