RESUMO
La pandemia de COVID-19 producida por SARS-CoV-2 actualmente en curso anticipa una gran demanda por ventiladores mecánicos (VM), ya que un porcentaje relevante de los contagiados cae rápidamente en insuficiencia respiratoria y requiere de cuidados intensivos. Anticipándose a ese exceso de demanda y considerando que es muy probable que el número actual de ventiladores mecánicos en las unidades de cuidados intensivos (UCI) sean insuficientes, se ha solicitado a la SACH un informe técnico en relación al uso de las máquinas de anestesia como VM.
Assuntos
Pneumonia Viral/terapia , Pneumonia Viral/epidemiologia , Ventiladores Mecânicos/provisão & distribuição , Infecções por Coronavirus/terapia , Infecções por Coronavirus/epidemiologia , Pandemias , Betacoronavirus , Anestesia/métodos , Chile/epidemiologiaRESUMO
En diciembre de 2019, una serie de casos de neumonía de causa desconocida surgieron en Wuhan, Hubei, China, con presentaciones clínicas muy parecidas a la neumonía viral. El análisis de secuenciación profunda de muestras del tracto respiratorio inferior indicó un nuevo coronavirus, que se denominó nuevo coronavirus 2019 (2019-nCoV o SARS-CoV2) [15]. La propagación del virus ha sido extremadamente rápida, tanto así que el 11 de marzo de 2020 y luego de más de 118.000 infectados en 114 países con 4.300 fallecidos a esa fecha, la organización mundial de la salud declaró a la enfermedad COVID-19, causada por 2019-nCoV, como una pandemia.
Assuntos
Pneumonia Viral/prevenção & controle , Desinfecção das Mãos , Infecções por Coronavirus/diagnóstico , Assistência Perioperatória/enfermagem , Período Perioperatório/enfermagem , Extubação/instrumentação , BetacoronavirusRESUMO
Body image is a cognitive construction, the precursor of identity, based on the experience with a mirror. The mother and the child use this external device in a complex representational game prior to language. objective: To describe and analyze the mirror-child interaction and mother-child-mirror game to identify the construction of realities and representations in preverbal children by comparing two different populations of the Chilean culture. subjects and Methods: qualitative and quantitative, non-experimental, descriptive and comparative study where categories of interaction between mother and child in the mirror are created and their association with sociodemographic variables are evaluated. 49 Mapuche rural and urban mother-child interaction videos in the presence of a mirror at eating and feeding times are assessed, interactional categories emerged which become the observation instrument used. results: Different ways to play from the child perspective and the mother-child dyad are reported in different degrees of cognitive and relational complexity, significant differences between both populations are observed. Urban children developed integrated games (p 0.0013) and games of four players (p 0.001), while the Mapuche play mostly by themselves (p 0.0014). Infants older than 13 months make more complex games (p 0.026). The parallel (not looking at the mirror) and the dyadic game correlate positively with the rural unmarried Mapuche mother, and if there is a history of alcoholism and depression, they are prompt to play in groups of four. Conclusions: Qbservation categories and stages of relational complexity in front of the mirror emerged, which reflect the cognitive and relational development of children. Differences were observed in the study populations, possibly due to cultural differences. It is suggested to use this study as development diagnosis and monitoring.
La imagen corporal es una construcción cognitiva, precursora de la identidad, basada en la experiencia del espejo. La madre y el niño usan este dispositivo externo en un juego representacional complejo anterior al lenguaje. objetivo: Describir y analizar la interacción niño-espejo, y el juego madre-hijo-espejo, para identificar la construcción de realidades y representaciones en niños pre-verbales comparando dos poblaciones chilenas de diferente cultura. Pacientes y Método: Estudio cualicuantitativo, no experimental, descriptivo y comparativo donde se crean categorías de interacción entre la madre y el niño ante el espejo y se evalúa su asociación con variables sociodemográficas. Se evalúan 49 vídeos de interacciones madre-hijo urbanos y rural-mapuches en presencia de un espejo durante el comer y dar de comer, emergen categorías interaccionales que a su vez constituyen el instrumento de observación utilizado. resultados: Se reconocen formas de juego desde la perspectiva del niño y la diada madre-hijo en distintos grados de complejidad cognitiva y relacional, observándose diferencias significativas entre ambas poblaciones. Los niños urbanos hacen juego integrado (p 0,0013) y juego de a cuatro (p 0,001), mientras los mapuche juegan más solos (p 0,0014). Los > 13 meses hacen juegos más complejos (p 0,026). El juego paralelo (no mirar el espejo) y juego diádico, se correlacionan positivamente con la madre rural mapuche conviviente y si hay antecedentes de alcoholismo y depresión, hacen más juego de a cuatro. Conclusiones: se aportan categorías de observación y estadios de complejidad relacional delante del espejo que dan cuenta del desarrollo cognitivo y relacional del niño. se evidencian diferencias en las poblaciones estudiadas posiblemente por diferencias culturales. se sugiere utilizarlo como diagnóstico y seguimiento del desarrollo.
Assuntos
Humanos , Masculino , Adulto , Feminino , Criança , Desenvolvimento Infantil , Comparação Transcultural , Indígenas Sul-Americanos , Relações Mãe-Filho , Chile , Características Culturais , Zona Rural , Fatores Socioeconômicos , Área UrbanaRESUMO
Great genome size (GS) variations described in desert-specialist octodontid rodents include diploid species ( Octomys mimax and Octodontomys gliroides ) and putative tetraploid species ( Tympanoctomys barrerae and Pipanacoctomys aureus ). Because of its high DNA content, elevated chromosome number, and gigas effect, the genome of T. barrerae is claimed to have resulted from tetraploidy. Alternatively, the origin of its GS has been attributed to the accumulation of repetitive sequences. To better characterize the extent and origin of these repetitive DNA, self-genomic in situ hybridization (self-GISH), whole-comparative genomic hybridization (W-CGH), and conventional GISH were conducted in mitotic and meiotic chromosomes. Self-GISH on T. barrerae mitotic plates together with comparative self-GISH (using its closest relatives) discriminate a pericentromeric and a telomeric DNA fraction. As most of the repetitive sequences are pericentromeric, it seems that the large GS of T. barrerae is not due to highly repeated sequences accumulated along chromosomes arms. W-CGH using red-labeled P. aureus DNA and green-labeled O. mimax DNA simultaneously on chromosomes of T. barrerae revealed a yellow-orange fluorescence over a repetitive fraction of the karyotype. However, distinctive red-only fluorescent signals were also detected at some centromeres and telomeres, indicating closer homology with the DNA sequences of P. aureus. Conventional GISH using an excess of blocking DNA from either P. aureus or O. mimax labeled only a fraction of the T. barrerae genome, indicating its double genome composition. These data point to a hybrid nature of the T. barrerae karyotype, suggesting a hybridization event in the origin of this species.
Assuntos
Evolução Biológica , Tamanho do Genoma/genética , Hibridização Genética , Sequências Repetitivas de Ácido Nucleico/genética , Roedores/genética , Animais , Hibridização Genômica Comparativa , Análise Citogenética , Hibridização In Situ , Especificidade da EspécieRESUMO
For the past 60 years intraarticular infiltrations have been performed with variable results. However, they have improved with time as a result of the innovations seen in the techniques and the glucocorticoids used, according to reports by several authors. We report the experience and results obtained in 10 years in 793 patients applying 5 mg of betamethasone dipropionate and 2 mg of betamethasone sodium phosphate (Diprospan). This was a retrospective, therapeutic and cross-sectional study. Betamethasone was combined with 1 ml of 2% plain lidocaine and 1 ml of bupivacaine or ropivacaine. Infiltrations were used to treat intraarticular conditions, post-traumatic acute inflammatory conditions and degenerative intraarticular conditions of the knee and shoulder. In the soft tissues they were used to treat bursitis, entrapment syndromes, epicondylitis, plantar fasciitis and sprains. Ninety-two percent had an improved clinical picture; it was possible to avoid surgery for several conditions. The conclusion is that infiltrations with betamethasone, both intraarticular and in periarticular structures, are fully justified in orthopedics. If applied properly, they are safe and effective.
Assuntos
Artrite/tratamento farmacológico , Betametasona/análogos & derivados , Glucocorticoides/administração & dosagem , Articulação do Joelho , Articulação do Ombro , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betametasona/administração & dosagem , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
La apendicectomía es la intervención quirúrgica abdominal, más comunmente practicada, actualmente la apendicectomía laparoscópica constituye la modalidad terapéutica ideal, en la búsqueda de técnicas quirúrgicas menos invasivas, se propone la realización de apendicectomía por orificios naturales, siendo la vía transvaginal el acceso para el desarrollo del procedimiento. En la presente investigación se expone y describe la técnica quirúrgica NOTES: apendicectomía hibrida transvaginal con instrumentos laparoscópicos convencionales. El acceso transvaginal parece ser factible y seguro con instrumental laparoscópico convencional, para la realización de apendicectomías en cuadros clínicos no complicados. Es indispensable el entrenamiento en cirugía laparoscópica convencional. La triangulación laparoscópica desaparece, lo que dificulta la maniobrabilidad. No es necesario el uso de trócares para acceder a la cavidad abdominal.
The apendicectomy is the most common surgical procedure practice. Laparoscopic apendicectomy it is the gold standard. Searching for less invasive procedure it is propose the transvaginal apendicectomy for selected cases. The investigation describes the technique of NOTES: hybrid transvaginal apendicectomy, using regular laparoscopics instruments. The transvaginal access it is feasible way to perform the apendicectomy. It is essential to be trained on advance laparoscopic technique. The triangulation trough transvaginal way is lost. It is not necessary to use throcars to access trough transvaginal way.
Assuntos
Humanos , Adulto , Feminino , Pessoa de Meia-Idade , Apendicectomia/métodos , Colpotomia/métodos , Laparoscopia/métodos , Traumatismos Abdominais/cirurgia , Traumatismos Abdominais/terapia , Colecistectomia Laparoscópica/métodos , Métodos , Vagina/cirurgiaRESUMO
1. Baroreceptors regulate moment-to-moment blood pressure (BP) variations, but their long-term effect on the cardiovascular system remains unclear. Baroreceptor deficit accompanying hypertension contributes to increased BP variability (BPV) and sympathetic activity, whereas exercise training has been associated with an improvement in these baroreflex-mediated changes. The aim of the present study was to evaluate the autonomic, haemodynamic and cardiac morphofunctional effects of long-term sinoaortic baroreceptor denervation (SAD) in trained and sedentary spontaneously hypertensive rats (SHR). 2. Rats were subjected to SAD or sham surgery and were then further divided into sedentary and trained groups. Exercise training was performed on a treadmill (five times per week, 50-70% maximal running speed). All groups were studied after 10 weeks. 3. Sinoaortic baroreceptor denervation in SHR had no effect on basal heart rate (HR) or BP, but did augment BPV, impairing the cardiac function associated with increased cardiac hypertrophy and collagen deposition. Exercise training reduced BP and HR, re-established baroreflex sensitivity and improved both HR variability and BPV. However, SAD in trained SHR blunted all these improvements. Moreover, the systolic and diastolic hypertensive dysfunction, reduced left ventricular chamber diameter and increased cardiac collagen deposition seen in SHR were improved after the training protocol. These benefits were attenuated in trained SAD SHR. 4. In conclusion, the present study has demonstrated that the arterial baroreflex mediates cardiac disturbances associated with hypertension and is crucial for the beneficial cardiovascular morphofunctional and autonomic adaptations induced by chronic exercise in hypertension.
Assuntos
Adaptação Fisiológica/fisiologia , Denervação Autônoma , Barorreflexo/fisiologia , Hipertensão/terapia , Condicionamento Físico Animal , Pressorreceptores/fisiologia , Animais , Frequência Cardíaca/fisiologia , Hipertensão/fisiopatologia , Masculino , Contração Miocárdica , Condicionamento Físico Animal/métodos , Pressorreceptores/cirurgia , Ratos , Ratos Endogâmicos SHRRESUMO
BACKGROUND AND OBJECTIVE: Target-controlled infusions (TCIs) of remifentanil and fentanyl in conscious sedation regimes for extra-corporeal shock-wave lithotripsy have not been reported. We estimated the effect site concentrations of remifentanil and fentanyl needed to obtain adequate analgesia in 50% of patients (EC50) and compared both drugs in terms of intra- and post-procedure complications. METHODS: Forty-four adult patients were randomly distributed into two groups: Group R received remifentanil and Group F received fentanyl TCI with initial effect site concentrations of 1.5 and 2 ng mL(-1), respectively. Pain was assessed using a 10-point verbal analogue scale and <3 was considered adequate analgesia. Increments or decrements of 0.5 ng mL(-1) were then introduced for subsequent patients according to Dixon's up and down method. During the rest of the procedure, TCI was adjusted to maintain verbal analogue scale <3. RESULTS: Remifentanil and fentanyl EC50 were 2.8 ng mL(-1) (95% confidence interval (CI): 1.8-3.7 ng mL(-1)) and 2.9 ng mL(-1) (95% CI: 1.7-4.1 ng mL(-1)), respectively (n.s.). At EC50, the probability of having a respiratory rate <10 was 4% (95% CI: 0-57%) for remifentanil and 56% (95% CI: 13-92%) for fentanyl. Hypoxaemia, vomiting and sedation were more frequent in Group F during and after the procedure (P < 0.05). CONCLUSIONS: A similar EC50 but more respiratory depression, sedation and PONV were found with fentanyl TCI than with remifentanil TCI.