RESUMO
Resumen: En los últimos años, el mundo entero se vio enfrentado al manejo de pacientes con una patología totalmente nueva y desafiante en términos de su entendimiento fisiopatológico y estrategias de manejo, mientras que su tasa de contagio se incrementaba de manera importante. Se trata de la enfermedad COVID-19, originada por el virus SARS-CoV-2 y que puso en alerta a toda la humanidad. Por lo tanto, se presentaron grandes problemas de salud pública, incluyendo el desabastecimiento de medicamentos y recursos de primera línea para el control de la enfermedad, y en los pacientes críticos se afectó el manejo de soporte óptimo a medida que se superaba la compleja respuesta inmunológica, que terminaba afectando en sus primeros estadios el parénquima pulmonar, y según el estado fisiológico, mórbido y genético del huésped, generando una disfunción orgánica múltiple. En el presente documento se establecen las mejores alternativas para enfrentar un desabastecimiento de medicamentos asociados al abordaje integral de la analgosedación, prevención y manejo de delirium y abstinencia, así como la necesidad de relajación neuromuscular en cada una de las fases por las que atraviesa el paciente crítico hospitalizado en Unidades de Cuidado Intensivo con soporte respiratorio invasivo o no invasivo.
Abstract: In recent years, the entire world has been faced with the management of patients with a totally new and challenging pathology in terms of its pathophysiological understanding and management strategies, while its rate of infection was increased significantly. It is the COVID-19 disease, caused by the SARS-CoV-2 virus, and that put all of humanity on alert. Therefore, major public health problems arose, including shortages of medicines and first-line resources for disease control, and in critical patients, optimal support management was affected as the complex immune response was overcome, which ended up affecting the lung parenchymal in its early stages, and depending on the physiological, morbid and genetic state of the host, generating multiple organ dysfunction. This document establishes the best alternatives to face a shortage of medications associated with the comprehensive approach to analgesia and sedation, prevention and management of delirium and withdrawal, and the need for neuromuscular relaxation in each of the phases that critically hospitalized patients go through in Intensive Care Units with invasive or non-invasive respiratory support.
Resumo: Nos últimos anos, o mundo inteiro se deparou com o manejo de pacientes com uma patologia totalmente nova e desafiadora em termos de compreensão fisiopatológica e estratégias de manejo, enquanto sua taxa de contágio aumentava significativamente. Trata-se da doença COVID-19, causada pelo vírus SARS-CoV-2 que colocou toda a humanidade em alerta. Surgiram, assim, grandes problemas de saúde pública, incluindo a escassez de medicamentos e recursos de primeira linha para o controle da doença, em pacientes em estado crítico afetou-se o manejo do suporte ideal à medida que superavase a complexa resposta imune, que terminava afetando o parênquima pulmonar em seu estágio inicial, e dependendo do estado fisiológico, mórbido e genético do hospedeiro, gerando múltiplas disfunções orgânicas. Este documento estabelece as melhores alternativas para enfrentar a escassez de medicamentos associada à abordagem integral da analgesedação, prevenção e manejo do delirium e abstinência, e a necessidade de relaxamento muscular em cada uma das fases que atravessa o paciente em estado crítico internado na UTI com suporte respiratório invasivo ou não invasivo.
RESUMO
Gastric cancer is one of the most frequent neoplasias in the digestive tract and is the result of premalignant lesion progression in the majority of cases. Opportune detection of those lesions is relevant, given that timely treatment offers the possibility of cure. There is no consensus in Mexico on the early detection of gastric cancer, and therefore, the Asociación Mexicana de Gastroenterología brought together a group of experts and produced the "Mexican consensus on the detection and treatment of early gastric cancer" to establish useful recommendations for the medical community. The Delphi methodology was employed, and 38 recommendations related to early gastric cancer were formulated. The consensus defines early gastric cancer as that which at diagnosis is limited to the mucosa and submucosa, irrespective of lymph node metástasis. In Mexico, as in other parts of the world, factors associated with early gastric cancer include Helicobacter pylori infection, a family history of the disease, smoking, and diet. Chromoendoscopy, magnification endoscopy, and equipment-based image-enhanced endoscopy are recommended for making the diagnosis, and accurate histopathologic diagnosis is invaluable for making therapeutic decisions. The endoscopic treatment of early gastric cancer, whether dissection or resection of the mucosa, should be preferred to surgical management, when similar oncologic cure results can be obtained. Endoscopic surveillance should be individualized.
Assuntos
Adenocarcinoma/diagnóstico , Adenocarcinoma/terapia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/terapia , Adenocarcinoma/epidemiologia , Adenocarcinoma/patologia , Terapia Combinada , Técnica Delphi , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Ressecção Endoscópica de Mucosa/métodos , Ressecção Endoscópica de Mucosa/normas , Gastroscopia/métodos , Gastroscopia/normas , Humanos , México/epidemiologia , Estadiamento de Neoplasias , Fatores de Risco , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/patologiaRESUMO
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 subclavio.
Central 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.
RESUMO
Reportamos el caso de una paciente de 27 años de edad, G2P1, a quien se le diagnostica en la semana 20 de gestación un tumor supratentorial frontal izquierdo tipo glioblastoma multiforme, el cual se manifestó con una crisis de ausencia. La conducta tomada fue quirúrgica y la paciente fue sometida en la semana 28 a craneotomía bajo anestesia general, con monitoreo fetal, con resultados exitosos para la madre y el feto. Dado lo infrecuente de esta asociación, creemos importante su reporte.
This is a case report of a 27-year-old female patient, G2P1, diagnosed at 20 weeks of gestation with a left frontal supratentorial tumor of a glioblastoma multiforme type, which manifested in the form of ictal absence. The patient was taken to surgery on week 28 and underwent a craniotomy under general anesthesia and fetal monitoring, with a successful outcome for both the mother and the fetus. We consider it important to report this case given this rare association.
Assuntos
HumanosRESUMO
Existe gran controversia sobre el momento de intervenir la fractura de cadera, la mayoría de estudios propugnan por un manejo precoz (48-72 h) para prevenir y evitar deterioro en sus procesos concomitantes. Casi todos enfocan su objetivo en evaluar la morbilidad y mortalidad, pero el análisis de estos factores y, adicionalmente, los de tipo administrativo, no han sido tenidos en cuenta. Materiales y métodos: con el objetivo de evaluar los factores relacionados con la oportunidad en cirugía de cadera y los resultados finales, realizamos un estudio de corte transversal del que se excluyeron pacientes en los cuales no se pudo recolectar toda la información requerida. La muestra incluyó 95 pacientes, para el análisis se dividieron en dos grupos según manejo oportuno o no, de acuerdo con la definición adoptada. Se realizó análisis univariado, bivariado y, posteriormente, regresión binomial con el fin de evaluar posibles factores relacionados con el retardo de la oportunidad. Resultados: el manejo adicional fue la única variable influyente, con una probabilidad 8,62 veces mayor de producir retardo en la oportunidad (OR=8,62 IC 95% 1,07-69), y con un índice de complicaciones del 12,2%. Se requieren estudios prospectivos que pueden dar conclusiones extrapolables, y es necesaria una coordinación más ágil en el manejo multidisciplinario de los pacientes con patologías asociadas para una optimización más oportuna de los mismos.
Assuntos
Artroplastia , Diagnóstico Precoce , Fixação Interna de Fraturas , Fraturas do Quadril/cirurgia , Fraturas do QuadrilRESUMO
Prior to its total synthesis, a new vanadium coordination compound, called TSAG0101, was computationally designed to inhibit the enzyme protein tyrosine phosphatase 1B (PTP1B). The PTP1B acts as a negative regulator of insulin signaling by blocking the active site where phosphate hydrolysis of the insulin receptor takes place. TSAG001, [V(V)O(2)(OH)(picolinamide)], was characterized by infrared (IR) and nuclear magnetic resonance (NMR) spectroscopy; IR: ν/cm(-1) 3,570 (NH), 1,627 (C=O, coordinated), 1,417 (C-N), 970/842 (O=V=O), 727 δ̣ (pyridine ring); (13)C NMR: 5 bands between 122 and 151 ppm and carbonyl C shifted to 180 ppm; and (1)H NMR: 4 broad bands from 7.6 to 8.2 ppm and NH(2) shifted to 8.8 ppm. In aqueous solution, in presence or absence of sodium citrate as a biologically relevant and ubiquitous chelator, TSAG0101 undergoes neither ligand exchange nor reduction of its central vanadium atom during 24 hours. TSAG0101 shows blood glucose lowering effects in rats but it produced no alteration of basal- or glucose-induced insulin secretion on ß cells during in vitro tests, all of which excludes a direct mechanism evidencing the extrapancreatic nature of its activity. The lethal dose (LD(50)) of TSAG0101 was determined in Wistar mice yielding a value of 412 mg/kg. This value is one of the highest among vanadium compounds and classifies it as a mild toxicity agent when compared with literature data. Due to its nonsubstituted, small-sized scaffold design, its remarkable complex stability, and low toxicity; TSAG0101 should be considered as an innovative insulin-mimetic principle with promising properties and, therefore, could become a new lead compound for potential nonpeptide PTP1B inhibitors in antidiabetic drug research. In view of the present work, the inhibitory concentration (IC(50)) and extended solution stability will be tested.
Assuntos
Glicemia/efeitos dos fármacos , Complexos de Coordenação/farmacologia , Inibidores Enzimáticos/farmacologia , Ácidos Picolínicos/farmacologia , Proteína Tirosina Fosfatase não Receptora Tipo 1/antagonistas & inibidores , Animais , Biologia Computacional , Complexos de Coordenação/síntese química , Complexos de Coordenação/toxicidade , Inibidores Enzimáticos/síntese química , Inibidores Enzimáticos/toxicidade , Feminino , Insulina/metabolismo , Secreção de Insulina , Células Secretoras de Insulina/efeitos dos fármacos , Células Secretoras de Insulina/metabolismo , Dose Letal Mediana , Espectroscopia de Ressonância Magnética , Camundongos , Ácidos Picolínicos/síntese química , Ácidos Picolínicos/toxicidade , Ratos , Ratos Endogâmicos LewRESUMO
El hotdog es una de las comidas rápidas mas populares y de alto consumo por la población de Santiago de Chile, los cuales, hoy en día, son consumidas generalmente junto a papas fritas, en lo que se conoce popularmente como ®combo¼. Esta investigación realizó una encuesta a 204 personas para determinar la preferencia por comidas rápidas y cadenas de comercialización. En base a esto, se seleccionó a cuatro tipos de combos de hotdog, a los cuales se les determinó el análisis proximal y perfil de ácidos grasos. Las muestras fueron seleccionadas de las cadenas de mayor preferencia y se escogieron 5 locales al azar, las que estaban compuestas por 5 réplicas de combos y todos los análisis fueron realizados en duplicado. Todos los combos analizados presentaron diferencias significativas (p<0.05) en los contenidos de grasa y proteínas, con valores de 13 a 16 g/100g y de 5 a 7 g/100g respectivamente. El aporte calórico de estos combos fluctuó entre 220 a 252 kcal por ciento. Para el perfil de ácidos grasos, no se observaron diferencias significativas y se obtuvo en las muestras valores de las razones AGPI/AGS y C18:2/C18:3 cercanas a 1 y 10 respectivamente. Estos productos presentan un alto aporte en grasa, cubriendo más de 50 por ciento de los requerimientos diarios de grasa.
Assuntos
Restaurantes , Ingestão de Energia , Fenômenos Químicos , Ácidos Graxos , Fast Foods , Valor Nutritivo , ChileRESUMO
Evaluation of desinsectation programs carried out in the two Health Services from the V Region, was undertaken by comparing serologic prevalences of T. cruzi infection age groups exposed to the risk of infection in rural areas during the antivectorial campaign activities (1982 vs 1995). Thus, were studied 2,193 blood samples from children under 10 years of age, proceeding from six chagasic endemic provinces in which antitriatomic domiciliary insecticide sprayings had been performed. Indirect hemagglutination and ELISA tests were carried out to each of the blood samples. A total de 42 (1.9%) children resulted positive. As in five counties no positive cases were detected in the last five years it is possible to assume that vector transmission of T. cruzi should have been interrupted in them. When comparing prevalences existing in 1982 with the present ones, it is possible to observe a 63.5% of reduction of transmission in the V Region, been this reduction higher in the Aconcagua Health Service with 79.6% and lower in the Viña del Mar--Quillota Health Service with 55.6%. According to these results, comparison of prevalence of T. cruzi infection in children less than 10-year-old in diverse periods, allows evaluate the vectorial control of Triatoma infestans programs.
Assuntos
Anticorpos Antiprotozoários/sangue , Doença de Chagas/epidemiologia , Trypanosoma cruzi/imunologia , Animais , Doença de Chagas/sangue , Doença de Chagas/diagnóstico , Criança , Pré-Escolar , Chile/epidemiologia , Humanos , Lactente , Recém-Nascido , Prevalência , Fatores de Risco , População Rural , Estudos SoroepidemiológicosRESUMO
Intoxication produced by Karwinskia humboldtiana presents a neurological picture similar to that of poliomyelitis, Guillain-Barré syndrome or other polyradiculoneuritis with which it is frequently confused. The purpose of this paper is to report the frequency of this intoxication, by means of the antecedent of ingestion of the fruit and the detection of toxins in blood using a thin layer chromatography method. One hundred fifty four samples of cases with acute flaccid paralysis from 18 states of the country were received. The antecedent of ingestion in 56 of them was corroborated and the detection was positive in 50 of these. In 98 patients there was not antecedent of ingestion and detection was negative in 95 of them. We estimated that the sensibility and specificity of detection method are 89% and 96.9% respectively.
Assuntos
Intoxicação por Plantas/epidemiologia , Plantas Medicinais , Plantas Tóxicas , Rhamnus , Adolescente , Idoso , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Incidência , Lactente , Masculino , México/epidemiologia , Hipotonia Muscular/diagnóstico , Hipotonia Muscular/epidemiologia , Hipotonia Muscular/etiologia , Paralisia/diagnóstico , Paralisia/epidemiologia , Paralisia/etiologia , Intoxicação por Plantas/complicações , Intoxicação por Plantas/diagnóstico , Polirradiculoneuropatia/diagnósticoRESUMO
The ingestion of ripe fruit of the Karwinskia humboldtiana, a shrub commonly known as tullidora or coyotillo, produces an intoxication described in the literature as a symmetric flaccid paralysis of the hind limbs, progressive and ascendent, that in severe cases may cause bulbar paralysis and death. The cause of an acute accidental intoxication of an entire family is presented here, wherein ten out of thirteen members ingested the ripe fruit of the tullidora. Three died, the father and two daughters. For the first time the toxins determination in blood by thin layer chromatography method is described. This method supports the diagnosis with other polyradiculoneuritis such as poliomyelitis and the Guillain Barre's syndrome.