La fascitis necrotizante es una enfermedad infecciosa grave y poco frecuente de piel y partes blandas, asociada a una alta mortalidad. Generalmente es de etiología polimicrobiana, su manejo es ...difícil y representa un desafío para todo el personal de salud implicado en el tratamiento. Se presenta un paciente con ese diagnóstico atendido en el servicio de Cirugía General del Hospital General Docente "Leopoldito Martínez", de San José de las Lajas, provincia Mayabeque, El mismo se presentó con un absceso perianal que evolucionó hacia una fascitis necrotizante afectando al escroto derecho, la región inguinal y toda la pared anterolateral del abdomen, evolucionando al shock séptico. En el paciente que se presenta, el diagnóstico fue clínico, la conducta terapéutica estuvo sustentada en el tratamiento quirúrgico, el uso de antimicrobianos sistémicos y del oleozón tópico. La evolución fue satisfactoria.
La fascitis necrotizante es una enfermedad infecciosa grave y poco frecuente de piel y partes blandas, asociada a una alta mortalidad. Generalmente es de etiología polimicrobiana, su manejo es ...difícil y representa un desafío para todo el personal de salud implicado en el tratamiento. Se presenta un paciente con ese diagnóstico atendido en el servicio de Cirugía General del Hospital General Docente "Leopoldito Martínez", de San José de las Lajas, provincia Mayabeque, El mismo se presentó con un absceso perianal que evolucionó hacia una fascitis necrotizante afectando al escroto derecho, la región inguinal y toda la pared anterolateral del abdomen, evolucionando al shock séptico. En el paciente que se presenta, el diagnóstico fue clínico, la conducta terapéutica estuvo sustentada en el tratamiento quirúrgico, el uso de antimicrobianos sistémicos y del oleozón tópico. La evolución fue satisfactoria.
Preoperative use of flurbiprofen axetil (FA) is extensively adopted to modulate the effects of analgesia. However, the relationship between FA and sedation agents remains unclear. In this study, we ...aimed to investigate the effects of different doses of FA on the median Effective Concentration (EC50) of propofol.
Ninety-six patients (ASA I or II, aged 18–65 years) were randomly assigned into one of four groups in a 1:1:1:1 ratio. Group A (control group) received 10mL of Intralipid, and groups B, C and D received 0.5mg.kg−1, 0.75mg.kg−1 and 1mg.kg−1 of FA, respectively, 10minutes before induction. The depth of anesthesia was measured by the Bispectral Index (BIS). The “up-and-down” method was used to calculate the EC50 of propofol. During the equilibration period, if BIS≤50 (or BIS>50), the next patient would receive a 0.5μg.mL−1-lower (or -higher) propofol Target-Controlled Infusion (TCI) concentration. The hemodynamic data were recorded at baseline, 10minutes after FA administration, after induction, after intubation and 15minutes after intubation.
The EC50 of propofol was lower in Group C (2.32μg.mL−1, 95% Confidence Interval 95% CI 1.85–2.75) and D (2.39μg.mL−1, 95% CI 1.91–2.67) than in Group A (2.96μg.mL−1, 95% CI 2.55–3.33) (p=0.023, p=0.048, respectively). There were no significant differences in the EC50 between Group B (2.53μg.mL−1, 95% CI 2.33–2.71) and Group A (p>0.05). There were no significant differences in Heart Rate (HR) among groups A, B and C. The HR was significantly lower in Group D than in Group A after intubation (66±6 vs. 80±10bpm, p<0.01) and 15minutes after intubation (61±4 vs. 70±8bpm, p<0.01). There were no significant differences among the four groups in Mean Arterial Pressure (MAP) at any time point. The MAP of the four groups was significantly lower after induction, after intubation, and 15minutes after intubation than at baseline (p<0.05).
High-dose FA (0.75mg.kg−1 or 1mg.kg−1) reduces the EC50 of propofol, and 1mg.kg−1 FA reduces the HR for adequate anesthesia in unstimulated patients. Although this result should be investigated in cases of surgical stimulation, we suggest that FA pre-administration may reduce the propofol requirement when the depth of anesthesia is measured by BIS.
A administração pré-operatória de Flurbiprofeno Axetil (FA) é amplamente usada para a modulação da analgesia. No entanto, a relação entre FA e fármacos sedativos permanece obscura. Neste estudo, nosso objetivo foi investigar os efeitos de diferentes doses de FA na Concentração Efetiva mediana (CE50) do propofol.
Noventa e seis pacientes (ASA I ou II, com idades de 18–65 anos) foram alocados aleatoriamente em quatro grupos na proporção de 1:1:1:1. Dez minutos antes da indução, o Grupo A (grupo controle) recebeu 10mL de Intralipid, enquanto os grupos B, C e D receberam FA na dose de 0,5mg.kg−1; 0,75mg.kg−1 e 1mg.kg−1, respectivamente. A profundidade da anestesia foi medida pelo Índice Bispectral (BIS). O método up-and-down foi usado para calcular a CE50 do propofol. Durante o período de equilíbrio, se o valor do BIS fosse ≤50 ou BIS>50, o próximo paciente tinha a infusão de propofol ajustada para uma concentração alvo-controlada 0,5μg.mL−1 inferior ou superior, respectivamente. Os dados hemodinâmicos foram registrados no início do estudo, 10 minutos após a administração de FA, após a indução, após a intubação e 15 minutos após a intubação.
A CE50 do propofol foi menor no Grupo C (2,32μg.mL−1, Intervalo de Confiança de 95% 95% IC 1,85–2,75) e D (2,39μg.mL−1, 95% IC 1,91–2,67) do que no Grupo A (2,96μg.mL−1; 95% IC 2,55–3,33) (p=0,023, p=0,048, respectivamente). Não houve diferenças significantes na CE50 entre o Grupo B (2,53μg.mL−1, 95% IC 2,33–2,71) e o Grupo A (p>0,05). Não houve diferenças significantes na Frequência Cardíaca (FC) entre os grupos A, B e C. A FC foi significantemente menor no grupo D do que no grupo A após a intubação (66±6 vs. 80±10 bpm, p<0,01) e 15 minutos após a intubação (61±4 vs. 70±8 bpm, p<0,01). Não houve diferenças significantes entre os quatro grupos na Pressão Arterial Média (PAM) em qualquer momento. A PAM dos quatro grupos foi significantemente menor após a indução, após a intubação e 15 minutos após a intubação do que na linha de base (p<0,05).
FA em altas doses (0,75mg.kg−1 ou 1mg.kg−1) reduz a CE50 do propofol, e 1mg.kg−1 de FA reduz a FC durante níveis adequados de anestesia em pacientes não estimulados. Embora esse resultado deva ser investigado na presença de estimulação cirúrgica, sugerimos que a pré-administração de FA pode reduzir a necessidade de propofol durante anestesia cuja profundidade seja monitorada pelo BIS.
El cacao, es uno de los cultivos de mayor importancia en Ecuador, destinado a la exportación para ser utilizado en la elaboración de chocolate en otros países. El objetivo de este trabajo fue ...analizar el desempeño ambiental y las potencialidades de aplicación de mecanismos de producciones más limpias (PML) en la Asociación de productores de cacao fino de aroma “Tsatsayaku”. Las herramientas de PML utilizadas fueron la revisión ambiental inicial, ecomapas, y análisis del proceso. Los resultados muestran que la generación de mucilago y cascarilla son los principales problemas ambientales del proceso. Se propusieron y evaluaron 2 opciones de mejora para controlar y disminuir la contaminación del proceso. El análisis muestra una relación B/C de 1.38 y el Valor Actual Neto es de $ 36,001.37 con una Tasa Interna de Retorno de 249.29%. Finalmente, la aplicación de prácticas y tecnologías enmarcadas en sistemas de PML puede optimizar la utilización de materias primas y reducir los contaminantes sólidos y líquidos generados.
Introduction: The diagnostic and therapeutic management of patients with systemic lupus erythematosus who develop a neuropsychiatric involvement represents one of the biggest challenges due to the ...heterogeneity of the ways in which it can occur and the absence of diagnostic criteria.Objective: To recognize the clinical forms of presentation of neurophthalmological syndromes that express pontine involvement.Case presentation: Seventy-one-year-old man with history of systemic lupus erythematosus with neuropsychiatric involvement who acutely develops an emetic episode in the course of a hypertensive emergency followed by a paralysis of the horizontal gaze to the left, a right-sided posterior internuclear ophthalmoplegia and a left facial palsy. In the neuroimaging, a multifocal involvement with marked pontine damage is observed.Conclusions: Recognizing the clinical forms of presentation of these rare neurophthalmological disorders that generally occur in an acute or subacute form allows the neurologist to perform the topographic diagnosis of the lesion at a protuberancial level with high precision from the time when the patient attends the Emergency Department and reduces the possible differential diagnoses to a vascular, demyelinating or occupational etiology of space.
Introducción: El manejo diagnóstico y terapéutico en los pacientes con lupus eritematoso sistémico que desarrollan una afectación neuropsiquiátrica representa un reto, debido a la heterogeneidad de las formas en que puede presentarse y la ausencia de criterios diagnósticos.Objetivo: Reconocer las formas clínicas de presentación de los síndromes neuroftalmológicos que traducen afectación pontina.Presentación del caso: Hombre de 71 años con antecedente de lupus eritematoso sistémico con afectación neuopsiquiátrica, que de forma aguda desarrolla un cuadro emético en el curso de una emergencia hipertensiva seguido de una parálisis de la mirada horizontal hacia la izquierda, una oftalmoplejía internuclear posterior derecha y una parálisis facial izquierda. En la neuroimagen se constata una afectación multifocal con marcado daño pontino.Conclusiones: Reconocer las formas clínicas de presentación de estos trastornos neuroftalmológicos raros que generalmente se presentan de forma aguda/subaguda permite al neurólogo realizar el diagnóstico topográfico de la lesión a nivel protuberancial con elevada precisión desde la Sala de Urgencias, así como reducir los posibles diagnósticos diferenciales a una etiología vascular, desmielinizante u ocupativa de espacio.
In this paper, monuments dedicated to Telesfor, discovered in the territory of today's Serbia were mentioned. With the cult of Telesfor four findings may be connected originating from three ...localities. Monuments undoubtedly dedicated to Telesfor were to be found at sculptural group from Mediana, epigraphic monument from Pećka Banja and relief-epigraph monument from Prizren. This short list may be added by fragments of sculptural group from Mediana as well. Out of the mentioned sculptural group, fragmented sculpture Asklepia and the base of group with the traces of feet of two deities were preserved. The cult of God-boy of Telesfor, the sun of Asclepius, had undoubtedly iatric character. Telesfor had taken care of the health and progress of children until their maturity, and during the recovering and cure of all diseased. Future research, field and theoretic ones, will have brought new findings and interpretations connected to numerous issues being raised by the study of this cult.
•A method to estimate θs, α, n and Ks from an upward infiltration is presented.•The influence of θs, θr and hi, on the α, n and Ks optimization was studied.•It was applied to 50 mm high undisturbed ...cores under different soil management.•θs and hi affected α, n and Ks, and hi should be located the dθdh≈0 region.•It was sensible to different texture and structure due to the soil management.
Estimation of the α and n van Genuchten (1980) parameters and the saturated hydraulic conductivity, Ks, of undisturbed soil samples is critical for realistic water flow simulations in the vadose zone. Given the Latorre and Moret-Fernández (2019) method, which allows estimating Ks, α and n from the inverse analysis of a single upward infiltration, the objective of this work is to advance on the theoretical understanding of this method and to apply it on undisturbed soil cores. To this end, the influence of the saturated, θs, and residual, θr, water content and initial soil tension, hi, on the α, n and Ks optimization was first studied on synthetic soils. A procedure to simultaneously estimate θs, α, n and Ks, which consisted on optimizing α, n and Ks for a range of θs values, was proposed. To this end, α, n and Ks were optimized leaving each θs as a fixed value. The method was next applied to experimental curves measured from sieved and undisturbed soil cores of 50 mm high and diameter, sampled the last ones from three fields with different management: bare vs. under plant soil; agricultural soil under conservation vs. conventional tillage; and overburden soil from mine vs. topsoil formed by the original soil. Results showed that θs had an important effect on α, n and Ks optimization, where the minimum error within the selected θs interval corresponded to the theoretical θs. An important effect of hi on the optimization was also observed. However, this influence was omitted by using a hi value located in the θr region, where dθdh≈0. Under this assumption, θr only affected the θs optimization, which value varied with θr. A robust relationship (R2 = 0.99; p < 0.0001) was found between theoretical and optimized θs, Ks and α and n calculated for the synthetic soils. Thus, the method allowed estimating four of the five van Genuchten (1980) parameters. An absolute minimum was also observed when the method was applied on experimental infiltration curves. The θs measured gravimetrically on the undisturbed samples was, on average, 8.1% higher than the optimized one. Overall, the method allowed detecting significant differences (p < 0.05) in hydraulic properties between bare and under plant soils and among tillage treatments. The large variability found in the mine’s soils prevented to find significant differences within this scenario.
Objetivou-se propor faixas específicas de classificação dos coeficientes de variação (CVs) na experimentação com coelhos no Brasil. Coletaram-se os CVs nos artigos publicados em periódicos ...brasileiros entre 2000 e 2010 para as variáveis consumo de ração, peso vivo, ganho de peso, conversão alimentar, peso e rendimento da carcaça, além dos coeficientes de digestibilidade aparente do/a: matéria seca, proteína bruta, energia bruta, matéria orgânica, fibra em detergente ácido, fibra em detergente neutro, amido e extrato etéreo. Para cada variável, os CVs foram classificados utilizando-se uma relação entre a mediana (MD) e o pseudo-sigma (PS) da seguinte maneira: baixo (CV ? MD – PS), médio (MD – PS < CV ? MD + PS), alto (MD + PS < CV ? MD + 2PS) e muito alto (CV > MD + 2PS). Os CVs observados variaram de 0,01 a 29,83% dependendo da variável analisada. Os resultados encontrados permitem concluir que para cada variável utilizada em experimentação na cunicultura existe faixa de classificação específica de valores de coeficiente de variação que podem ser utilizadas como referência para determinar a precisão experimental. As faixas de classificação encontradas para cunicultura são diferentes das para outras espécies animais e das utilizadas em experimentação agronômica. Palavras-chave: cunicultura; mediana; precisão experimental; pseudo-sigma.
The aim of this study is to propose specific classification range of the coefficients of variation (CVs) in experiments with rabbits in Brazil. The CVs were collected in articles published in ...Brazilian journals between 2000 and 2010 for feed intake, live weight, body weight gain, feed conversion, carcass weight, and carcass yield, besides the apparent digestibility coefficients of dry matter, crude protein, gross energy, organic matter, acid detergent fiber, neutral detergent fiber, starch, and lipids. For each variable, the CVs were ranked using a relation between the median (MD) and pseudo-sigma (PS) as follows: low (CV > MD – PS), medium (MD – PS < MD +PS ≤ CV), high (MD + PS < CV ≤ MD + 2PS), and very high (CV > MD + 2PS). The CVs observed ranged from 0.01 to 29.83% depending on the variable analyzed. We concluded that for each variable used in experimentation with rabbits there is a specific classification range for the coefficient of variation values that can be used as reference to determine the experimental precision. Classification range found for rabbits differ from other animal species and from agronomic experimentation. Keywords: cuniculture; experimental precision; median; pseudo-sigma.
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