Although the indications for β-blockers in the management of patients with congestive heart failure and myocardial infarction are well established, the use of β-blockers in the perioperative setting ...remains controversial.
Since 2008 PeriOperative ISchemic Evaluation Trial, there have been numerous studies suggesting that perioperative β-blockers are associated with adverse events such as hypotension, bradycardia, increased mortality, and stroke.
In this article, we review the most recent evidence to suggest an approach to perioperative β-blocker use tailored to patient and surgical risk factors. We also review recent studies on off-label uses for perioperative β-blockers.
Las primeras referencias y caracterizaciones sobre los Ychsma fueron en base a fuentes etnohistóricas que suscitaron el interés de arqueólogos e investigadores por querer saber más sobre esta ...sociedad, asentada entre los valles de Rímac y Lurín, en la actual capital del Perú, antes de la llegada del Inca a estos valles. En esta ocasión, el contexto y el análisis óseo del Fardo 14 proporcionará información acerca de este individuo y de su sociedad. Se iniciará con la recontextualización de toda la evidencia que se ha conservado desde su hallazgo y se analizarán los restos óseos del individuo denominado como Fardo 14, hallado intrusivamente en la plataforma superior del Monumento de Huallamarca y que corresponde al periodo Intermedio Tardío (1000 d.C.-1476 d.C.) Cabe mencionar que el Fardo 14 proviene de una serie de contextos funerarios que fueron hallados en el Corte 5 durante la temporada de excavación llevada a cabo entre los años 1991 y 1992 por la Lic. Clide Valladolid. El material y la información proveniente de este corte está siendo analizado y recontextualizado por la arqueóloga a cargo y el equipo de conservación del Museo de Sitio Huallamarca, para próximas publicaciones y exposiciones.
The electrophysiology laboratory facilitates complex procedures on patients, many of whom have advanced disease processes and extensive comorbidities. Historically, nurses administered sedation as ...required, but in recent years a shift to anesthesiologist-led sedation has been promoted for patient safety and advanced therapeutic considerations. Uncertainty remains, however, regarding whether the electrophysiology laboratory is best staffed with general or cardiothoracic anesthesiologists. In this article, the authors discuss the anesthetic considerations of some commonly performed electrophysiology and structural cardiac procedures and the pros and cons of staffing with general or cardiothoracic anesthesiologists.
Background The COVID-19 pandemic led to a national lockdown and the interruption of all cancer preventive services, including cervical cancer screening. We aimed to assess the COVID-19 pandemic ...impact on opportunistic screening participation, abnormal cytology (ASCUS+) prevalence and screening interval in 2020 and 2021 within the Public Health System of Catalonia, Spain. Methods Individual data on cytology and HPV testing of women aged 25–65 from 2014 to 2021 were retrieved from the Information System for Primary Care Services (SISAP). Time-series regression models were used to estimate expected screening participation and abnormal cytology prevalence in 2020 and 2021. The impact was determined by comparing observed and expected values (ratios). Additionally, changes in screening interval trends between 2014 and 2021 were assessed by fitting a Piecewise linear regression model. Results Cervical cancer screening participation decreased by 38.8% and 2.2% in 2020 and 2021, respectively, with the most significant impact on participation (-96.1%) occurring in April 2020. Among older women, participation was lower, and it took longer to recover. Abnormal cytology prevalence was 1.4 times higher than expected in 2020 and 2021, with variations by age (range=1.1–1.5). From June 2020 onwards, the screening interval trend significantly changed from an increase of 0.59 to 3.57 months per year, resulting in a median time of 48 months by December 2021. Conclusions During the pandemic, fewer women have participated in cervical cancer screening, abnormal cytology prevalence has increased, and the screening interval is more prolonged than before. The potential cervical cancer lifetime risk implications highlight the need for organized HPV-based screening.
El presente artículo aborda el modo en que el Estado Nacional Argentino concibe y modula territorialidades específicas en el marco de la política asistencial durante la última década, ...específicamente, entre los años 2008 y 2015. A partir de un abordaje cualitativo, que combina el análisis documental y entrevistas en profundidad, se indagó sobre la naturaleza de las intervenciones del Estado Argentino en el territorio que tuvieron lugar en el marco del programa nacional denominado "Plan Ahí". La investigación sostiene que el "Plan Ahí" es una intervención de gobierno (Foucault, 2006) que opera como un modelo ordenador de las prácticas estatales, orientadas a transformar la dirección y el sentido de las intervenciones de abordaje territorial, así como, a revertir los efectos de una ausencia estatal supuesta.
Tuberculosis (TB) is an opportunistic infection 20 to 74 times more frequent in immunocompromised patients compared to the general population. The prevalence with renal transplant had a 0.5% to 15% ...incidence. The infection could be pulmonary or extrapulmonary (EPTB). The EPTB accounts for almost 20% of TB cases in immunocompetent people and 50% in positive human immunodeficiency virus cases. In this case report, we present a patient who attended the emergency room because of chronic diarrhea, abdominal pain, loss of weight, nocturne diaphoresis, and intermittent fever. A computed tomography scan showed retroperitoneal ganglionic conglomeration. He got into an exploratory laparotomy for histopathology specimens and paraganglionic fluid culture to a Gene Xpert MTB-RIF Assay G4, positive for rifampicin resistance tuberculosis. After an individualized treatment, trying to protect the graft’s remaining function, the patient returned with acute abdominal pain and pancreatic enzymes elevation; the antibiotic management had to be suspended until the return of renal function.
•Tuberculosis remains a worldwide public health problem.•In low- and middle-income countries, tuberculosis infections can enhance mortality in immunocompromised patients by a high incidence in latent infection.•Protocols for latent infection tuberculosis should be established in every transplantation center.•Physicians in low- or middle-income countries must suspect a tuberculosis infection in every fever of unknown origin.
Diet is a modifiable risk factor for several neoplasms but evidence for chronic lymphocytic leukemia (CLL) is sparse. Previous studies examining the association between single-food items and CLL risk ...have yielded mixed results, while few studies have been conducted on overall diet, reporting inconclusive findings. This study aimed to evaluate the association between adherence to three dietary patterns and CLL in the multicase-control study (MCC-Spain) study. Anthropometric, sociodemographic, medical and dietary information was collected for 369 CLL cases and 1605 controls. Three validated dietary patterns, Western, Prudent and Mediterranean, were reconstructed in the MCC-Spain data. The association between adherence to each dietary pattern and CLL was assessed, overall and by Rai stage, using mixed logistic regression models adjusted for potential confounders. High adherence to a Western dietary pattern (i.e. high intake of high-fat dairy products, processed meat, refined grains, sweets, caloric drinks, and convenience food) was associated with CLL ORQ4
Q1=1.63 (95%CI 1.11; 2.39);
-trend=0.02; OR 1-SD increase=1.19 (95%CI: 1.03; 1.37), independently of Rai stages. No differences in the association were observed according to sex, Body Mass Index, energy intake, tobacco, physical activity, working on a farm, or family history of hematologic malignancies. No associations were observed for Mediterranean and Prudent dietary patterns and CLL. This study provides the first evidence for an association between a Western dietary pattern and CLL, suggesting that a proportion of CLL cases could be prevented by modifying dietary habits. Further research, especially with a prospective design, is warranted to confirm these findings.
Introduction. Pregnancy, being a situation of vulnerability and with its inherent changes, places women at a great risk of depression. In Mexico, the prevalence of probable depression in pregnant ...women treated at the Instituto Nacional de Perinatologia, was 17.8%, assessed using the Edinburgh Perinatal Depression Scale (EPDS). To date, there are no data regarding this issue in Sonora. Objective. To determine the prevalence of depressive symptoms in pregnant women treated at the Hospital Infantil del Estado de Sonora (Mexico). Method. An observational, descriptive, transversal, and prospective study was conducted in 2021, applying the EPDS in 168 2nd/3rd trimester pregnant women, selected by non-probabilistic sampling by consecutive cases. Sociodemo-graphic variables, pathological/non-pathological, gynecological, and obstetrical personal history were explored. The analysis was performed using measures of central tendency and dispersion for quantitative variables; for qualitative variables, frequency and percentage; chi square test to assess differences in distribution of depressive symptomatology by age and the rest of variables. Results. Aglobal prevalence of "probable depression" of 14.3% was determined. The majority, within 20-29 age group, with a partner and a planned/desired pregnancy. High school educational level, 50%. History of intimate partner violence, 54.2%. Almost 40%, primigravida. Substance use, denied. Overweight/obesity, in 70%. Discussion and conclusion. There is a high prevalence of depressive symptoms during pregnancy, going unnoticed for reasons such as insufficient knowledge (patient/health care providers), since there is no routine screening. It is imperative to work on prevention, detection and treatment, since it entails multiple consequences at a binomial, family, and social level. Keywords: Depression, pregnancy, screening, Edinburgh, Sonora. Introducción. El embarazo, al ser una situación de vulnerabilidad y los cambios que conlleva, ubica a las mujeres en mayor riesgo de padecer depresión. En México, la prevalencia de probable depresión en embarazadas en el Instituto Nacional de Perinatología, fue del 17.8%, mediante la Escala de Depresión Perinatal de Edimburgo (EPDS). Hasta hoy, no se cuenta con datos en Sonora sobre este problema. Objetivo. Determinar la prevalencia de sintomatología depresiva en embarazadas atendidas en el Hospital Infantil del Estado de Sonora (México). Método. Se realizó un estudio observacional, descriptivo, transversal y prospectivo en 2021, utilizando la EPDS en 168 embarazadas cursando 2/3er trimestre, seleccionadas por muestreo no probabilístico por casos consecutivos. Se exploraron variables sociodemográficas, antecedentes patológicos/no patológicos y ginecoobstétricos. El análisis se realizó mediante medidas de tendencia central y dispersión para variables cuantitativas; para cualitativas, frecuencia y porcentaje; prueba de ji al cuadrado para evaluar diferencias en distribución de sintomatología depresiva por edad y resto de variables. Resultados. Se determinó prevalencia global de "probable depresión" de 14.3%. La mayoría, grupo etario 20-29 años, con pareja y embarazo planeado/deseado. Escolaridad preparatoria, 50%. Antecedente de violencia de pareja, 54.2%. Casi 40%, primigestas. Consumo de sustancias, negado. Sobrepeso/obesidad, en 70%. Discusión y conclusión. Existe una alta prevalencia de sintomatología depresiva durante el embarazo, pasando desapercibida por motivos como conocimiento insuficiente (paciente y proveedores de salud), pues no se cuenta con un tamizaje rutinario. Es apremiante trabajar en prevención, detección y tratamiento, ya que conlleva múltiples consecuencias a nivel binomio, familiar y social. Palabras clave: Depresión, embarazo, tamizaje, Edimburgo, Sonora.
Myxoid endometriosis, a rare entity, is part of the histological changes that can occur in endometriosis. Pathologists must know the histological guidelines for the morphological recognition of this ...entity, as well as the histochemical and immunohistochemical techniques that support diagnosis, and define the morphological characteristics of myxoid endometriosis. In the present work, we propose diagnostic guidelines and primary differential diagnoses using special histochemical techniques and immunohistochemical reactions to recognize this entity.
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