Reimplantes de punta de dedo. Fundación Santafé de Bogotá 2003 – 2011. Serie de Casos

Introducción: El objetivo de este trabajo es caracterizar los pacientes con amputaciones de punta de dedo en zonas I & II de Ishikawa & Tamai y describir los casos exitosos y de fallas en estos niveles tan distales de reimplantación. Materiales y Métodos: serie de casos retrospectiva de reimplantes de punta de dedo. Se registraron variables pre, intra y postoperatorias y de seguimiento. Resultados preliminares: 8 casos fueron reimplantes en las zonas I y II. Tiempo promedio de isquemia: 5,1 hs, promedio de edad 39,5. Se reimplantaron: 2 pulgares, 2 índices, 2 medios y 2 anulares, 6 dedos del lado derecho y 2 dedos del lado izquierdo. 5 reimplantes en zona II y 3 en zona I. El mecanismo de trauma más frecuente fue avulsión, seguido de aplastamiento. En todos los casos se logro hacer una anastomosis arterial. En cinco pacientes no se logro hacer una anastomosis venosa. No se observó estandarización el esquema antitrombótico ni en la estrategia para manejar la congestión venosa. Cinco reimplantes fueron exitosos. Todos los pacientes durante el primer año fueron tratados con fisioterapia. A pesar de que los pacientes reportan perdida de la movilidad comparativa con el dedo contralateral, ninguno reportó molestias a causa de este déficit o alteraciones en la sensibilidad que impactaran negativamente su calidad de vida. Discusión: se requieren estudios prospectivos para evaluar los resultados objetivamente y estandarizar el protocolo de reimplantes en la FSFB.

Uso del test de cuantificación sensitiva para el estudio de la neuropatía de fibra pequeña

Introducción La mutación genética Val30Met de la proteína transtiretina (TTR) es causante de la polineuropatía amiloidótica familiar, comprometiendo en fases iniciales las fibras nerviosas pequeñas (mielinizadas Aδ y amielínicas tipo C), involucradas en funciones autonómicas, nocicepción, percepción térmica y sudoración. Los métodos neurofisiológicos convencionales, no logran detectar dichas anormalidades, retardando el inicio de tratamientos específicos para la enfermedad. Metodología El objetivo principal fue evaluar el test de cuantificación sensitiva (QST) como método de detección temprana de anormalidades de fibra pequeña, en individuos Val30Met, seguidos en el Hospital Universitario Santa María, Lisboa. Se clasificaron los pacientes en 3 grupos, según sintomatología y examen neurológico. Se analizaron los umbrales para percepción de frío, dolor con el calor y vibración en los grupos, en correlación con controles sanos. Resultados 18 registros de controles sanos y 33 de individuos con la mutación, divididos en asintomáticos (24,2%), sintomáticos con examen neurológico normal (42,4%) y sintomáticos con examen neurológico anormal (33,3%). No se encontraron diferencias entre los pacientes asintomáticos y los controles. Los umbrales para frío (p=0,042) y en el dolor intermedio con el calor (HP 5) (p=0,007) se encuentran elevados en individuos Val30Met sintomáticos con examen normal. En los pacientes sintomáticos con alteraciones al examen, también se presentaron alteraciones en el intervalo entre el inicio y el dolor intermedio con el calor (HP 5-0,5) (p=0,009). Discusión Los umbrales de frío y de percepción de dolor con el calor, permiten detectar anormalidades en personas con la mutación TTR Val30Met, sintomáticos, incluyendo aquellos sin cambios objetivos al examen neurológico.

Family Characterization of Young Experimental Consumers of Psychoactive Substances Seen in the Toxicology Department at Colsubsidio

This investigation characterized families of adolescents experimenting with psychoactive substances (PAS) consumption. Materials and methods: For this purpose, a qualitative study with a hermeneutical emphasis was conducted among a population of adolescents between the ages of 12 and 17 who have experimented with PAS. Semi-structured interviews were conducted with patients and their families employing a flexible protocol of 14 categories. Results: The findings showed low levels of family cohesion and sense of family identity, inconsistency between educational patterns followed by the parents, as well as deficient parental support. Similarly, the findings indicate significant peer influence during the first stages of consumption of illegal substances. In this regard, the findings suggest that more than providing physical satisfaction, consumption represents a form of acquiring prestige and social position while granting a sensation of psychological, emotional and social well-being. Conclusions: Parental influence was also found considerable in regarding the consumption of legal PAS, like alcohol and tobacco. The study identified as a high-priority need to promote and incorporate communication and conflict resolution skills within the family dynamics by means of prevention and monitoring programs. Those skills and programs would be aimed at providing parents of adolescents experimenting with PAS consumption with new educational tools to orientate new raising guidelines so as to respond appropriately to the problems identified in this study.

Transcutaneous electrical nerve stimulation and primary dysmenorrhea: a case report

Primary dysmenorrhea is pelvic pain during the menstrual cycle. The A delta and C fibers aresensitized by the increased release of prostaglandins and leukotrienes, thus causing pain. TransElectric Nerve Stimulation (TENS) is a physiotherapeutic strategy that mitigatespain sensation. Objective: The aim of this paper is to present six cases of women in childbearingage who were diagnosed with primary dysmenorrhea and received transcutaneous electricnerve stimulation. Materials and methods: A type of study, case report, was conducted with sixwomen between 15 and 25 years of age with medical diagnosis of primary dysmenorrhea. Weassessed pain intensity utilizing the visual analogue pain scale and located the pain by usinga pain test map. Results: Pain intensity decreased in all treated women. Conclusion: Transcutaneouselectric nerve stimulation (TENS) is a physiotherapeutic strategy that mitigates painsensation. We conclude that high frequency TENSis a safe noninvasive modality to achievereduction of pain in primary dysmenorrhea.

La experiencia de los receptores en el trasplante de órganos y tejidos

El trasplante de órganos y/o tejidos es considerado como una opción terapéutica viable para el tratamiento tanto de enfermedades crónicas o en estadios terminales, como de afectaciones no vitales, pero que generen una disminución en la calidad de vida percibida por el paciente. Este procedimiento, de carácter multidimensional, está compuesto por 3 actores principales: el donante, el órgano/tejido, y el receptor. Si bien un porcentaje significativo de investigaciones y planes de intervención han girado en torno a la dimensión biológica del trasplante, y a la promoción de la donación; el interés por la experiencia psicosocial y la calidad de vida de los receptores en este proceso ha aumentado durante la última década. En relación con esto, la presente monografía se plantea como objetivo general la exploración de la experiencia y los significados construidos por los pacientes trasplantados, a través de una revisión sistemática de la literatura sobre esta temática. Para ello, se plantearon unos objetivos específicos derivados del general, se seleccionaron términos o palabras claves por cada uno de estos, y se realizó una búsqueda en 5 bases de datos para revistas indexadas: Ebsco Host (Academic Search; y Psychology and Behavioral Sciences Collection); Proquest; Pubmed; y Science Direct. A partir de los resultados, se establece que si bien la vivencia de los receptores ha comenzado a ser investigada, aún es necesaria una mayor exploración sobre la experiencia de estos pacientes; exploración que carecería de objetivo si no se hiciera a través de las narrativas o testimonios de los mismos receptores

Jardins Verticais : um contributo para os espaços verdes urbanos e oportunidade na reabilitação do edificado

O Homem tem privilegiado a vida no meio urbano, em detrimento do rural, por mais oportunidade de emprego e melhores condições de vida. As cidades cresceram de forma acelerada, sobretudo depois da Revolução Industrial do século XVIII, crescimento sem controlo, repercutindo-se num desajustado planeamento urbano, ambiental, humano, social e económico. De uma forma, as paisagens verdes e naturais, foram substituídas por densas manchas cinzentas de construção, criando afastamento crescente do Homem com a Natureza. Os Jardins Verticais poderão ter um papel fundamental revestindo de forma verde e natural as fachadas dos edifícios, numa tentativa de colmatar o afastamento entre ambos. Para além destes aspectos, os Jardins Verticais proporcionam inúmeras vantagens para o edifício, de que se destacam a eficiência energética e acústica, a protecção da estrutura do edificado ou a melhoria da qualidade do ar interior. Estes também importantes para a envolvente, como na redução do efeito ilha de calor, no aumento da biodiversidade, na melhoria da qualidade do ar exterior, mas sobretudo porque proporcionam ao Homem uma sensação de saúde e conforto, exclusivo da Natureza. Tendo em conta o estado de degradação do edificado nas grandes cidades, e tomando como exemplo particular a cidade do Porto, o recurso aos Jardins Verticais poderá ser uma solução viável para a reabilitação urbana, mudando a imagem de degradação, propondo uma imagem mais “verde” e contribuindo para o nível de sustentabilidade. Partindo deste pressuposto, propõe-se como aplicação do conhecimento adquirido no estudo desenvolvido e aqui apresentado, o recurso a Jardins Verticais como estratégia de reabilitação de edifícios da cidade do Porto. Inspirado na técnica e mestria de Patrick Blanc, resultou um “pormenor-tipo”, como base para a aplicação de Jardins Verticais no edificado social da cidade, experimentado em 10 estudos práticos, tirando-se partido das vantagens supra-mencionadas.

Crise de Identidade docente

Esta pesquisa versa sobre a crise de identidade docente e tem como objetivos averiguar de que maneira o professor do ensino fundamental, na rede pública de ensino, vem ressignificando sua atuação docente, frente a um contexto de profundas mudanças, nos padrões de autoridade estabelecidos pela sociedade; investigar o contexto social da pósmodernidade, relacionando-o à educação e compreender as razões do desprestígio profissional que os professores sofrem na atual conjuntura. Essa temática se insere no debate sobre as identidades presente nas produções nacionais e estrangeiras inseridas nas obras de Nóvoa (1999), Lopes (1999); Sacristán (1999) Dubar (2005, 2006), Hall (1999) entre outros. Para seu desenvolvimento estabelecemos como percurso metodológico a abordagem qualitativa, como técnica de análise de dados a análise do conteúdo, apresentada por Bardin (2011), que oferece seu trabalho como um guia ao pesquisador. Trabalhamos com questionário de identificação dos professores e entrevista, aplicada a oito docentes de duas escolas de cidades e redes de ensino diferentes. Como resultados encontramos, nos depoimentos dos professores, incertezas em relação ao exercício do seu trabalho, angústias nos relacionamentos com os discentes, sentimentos contraditórios em relação à profissão, questionamentos associados à formação docente, dificuldade em transpor as teorias adquiridas nas formações à prática, sensação de impotência perante a atual reputação profissional docente.

A comunicação da equipe de enfermagem com o paciente em cuidados paliativos

The article consists of a contextualized reflection on the communication in palliative care with the purpose of explaining strategies used for effective communication among the nursing, terminally ill and his family. In that sense, it was observed that for the nurse to assist the terminally ill is a difficult task, which raises sensation of sadness, frustration, impotence and even failure in the rendered attendance. This way, many professionals use denial, escaping, and the apparent coldness as defense mechanisms to cope with situation. Throughout this discussion are exposed some aspects that enable developing empathic communication skills, perceived as a task that requires nursing staff a shift in focus and attitude. Apart from careful listening, truthfulness, good humor and therapeutic touch, forming strategies for effective communication in the terminally ill life.

Risky attitudes towards road use in pre-drivers

Motor vehicle accidents are one of the principal causes of adolescent disability or mortality and male drivers are more likely to be involved in road accidents than female drivers. In part such associations between driver age and sex have been linked to differences in risky behaviour (e.g. speed, violations) and individual characteristics (e.g. sensation seeking, deviant behaviour). The aim of this research is to determine whether associations between risky road user behaviour and individual characteristics are a function of driver behaviour or whether they are intrinsic and measurable in individuals too young to drive. Five hundred and sixty-seven pre-driver students aged 11-16 from three secondary schools completed questionnaires measuring enthusiasm for speed, sensation seeking, deviant behaviour and attitudes towards driver violations. Boys reported more risky attitudes than girls for all measures. Associations between sensation seeking, deviant behaviour and attitudes towards risky road use were present from early adolescence and were strongest around age 14, before individuals learn to drive. Risky attitudes towards road use are associated with individual characteristics and are observed in adolescents long before they learn to drive. Safe attitudes towards road use and driver behaviour should be promoted from childhood in order to be effective. (C) 2007 Elsevier Ltd. All rights reserved.

A behavioral comparison between motorcyclists and a matched group of non-motorcycling car drivers: factors influencing accident risk

Motorcyclists and a matched group of non-motorcycling car drivers were assessed on behavioral measures known to relate to accident involvement. Using a range of laboratory measures, we found that motorcyclists chose faster speeds than the car drivers, overtook more, and pulled into smaller gaps in traffic, though they did not travel any closer to the vehicle in front. The speed and following distance findings were replicated by two further studies involving unobtrusive roadside observation. We suggest that the increased risk-taking behavior of motorcyclists was only likely to account for a small proportion of the difference in accident risk between motorcyclists and car drivers. A second group of motorcyclists was asked to complete the simulator tests as if driving a car. They did not differ from the non-motorcycling car drivers on the risk-taking measures but were better at hazard perception. There were also no differences for sensation seeking, mild social deviance, and attitudes to riding/driving, indicating that the risk-taking tendencies of motorcyclists did not transfer beyond motorcycling, while their hazard perception skill did. (C) 2002 Elsevier Science Ltd. All rights reserved.

Invasive neural prosthesis for neural signal detection and nerve stimulation

This paper specifically examines the implantation of a microelectrode array into the median nerve of the left arm of a healthy male volunteer. The objective was to establish a bi-directional link between the human nervous system and a computer, via a unique interface module. This is the first time that such a device has been used with a healthy human. The aim of the study was to assess the efficacy, compatibility, and long term operability of the neural implant in allowing the subject to perceive feedback stimulation and for neural activity to be detected and processed such that the subject could interact with remote technologies. A case study demonstrating real-time control of an instrumented prosthetic hand by means of the bi-directional link is given. The implantation did not result in infection, and scanning electron microscope images of the implant post extraction have not indicated significant rejection of the implant by the body. No perceivable loss of hand sensation or motion control was experienced by the subject while the implant was in place, and further testing of the subject following the removal of the implant has not indicated any measurable long term defects. The implant was extracted after 96 days. Copyright © 2004 John Wiley & Sons, Ltd.

The application of implant technology for cybernetic systems

Objective: To assess the usefulness, compatibility, and long-term operability of a microelectrode array into the median nerve of the left arm of a healthy volunteer, including perception of feedback stimulation and operation of an instrumented prosthetic hand. Setting: The study was carried out from March 14 through June 18, 2002, in England and the United States. Results: The blindfolded subject received feedback information, obtained from force and slip sensors on the prosthetic hand, and subsequently used the implanted device to control the hand by applying an appropriate force to g rip an unseen object. Operability was also demonstrated remotely via the Internet, with the subject in New York, NY, and the prosthetic hand in Reading, England. Finally, the subject was able to control an electric wheelchair, via decoded signals from the implant device, to select the direction of travel by opening and closing his hand. The implantation did not result in infection or any perceivable loss of hand sensation or motion control. The implant was finally extracted because of mechanical fatigue of the percutaneous connection. Further testing after extraction has not indicated any measurable long-term defects in the subject. Conclusions: This implant may allow recipients to have abilities they would otherwise not possess. The response to stimulation improved considerably during the trial, suggesting that the subject learned to process the incoming information more effectively.

Issues impairing the success of neural implant technology

By monitoring signals from the central nervous system, humans can be provided with a novel extra channel of communication that can, for example, be used for the voluntary control of peripheral devices. Meanwhile, stimulation of neural tissue can bring about sensation such as touch, can facilitate feedback from external, potentially remote devices and even opens up the possibility of new sensory input for the individual to experience. The concept of successfully harnessing and stimulating nervous system activity is though something that can only be achieved through an appropriate interface. However, interfacing the nervous system by means of implant technology carries with it many problems and dangers. Further, results achieved may not be as expected or as they at first appear. This paper describes a comparative study investigating different implant types and procedures. It is aimed at highlighting potential problem areas and is intended to provide a useful reference explaining important tolerances and limits.

Occupants' adaptive responses and perception of thermal environment in naturally conditioned university classrooms

A year-long field study of the thermal environment in university classrooms was conducted from March 2005 to May 2006 in Chongqing, China. This paper presents the occupants’ thermal sensation votes and discusses the occupants’ adaptive response and perception of the thermal environment in a naturally conditioned space. Comparisons between the Actual Mean Vote (AMV) and Predicted Mean Vote (PMV) have been made as well as between the Actual Percentage of Dissatisfied (APD) and Predicted Percentage of Dissatisfied (PPD). The adaptive thermal comfort zone for the naturally conditioned space for Chongqing, which has hot summer and cold winter climatic characteristics, has been proposed based on the field study results. The Chongqing adaptive comfort range is broader than that of the ASHRAE Standard 55-2004 in general, but in the extreme cold and hot months, it is narrower. The thermal conditions in classrooms in Chongqing in summer and winter are severe. Behavioural adaptation such as changing clothing, adjusting indoor air velocity, taking hot/cold drinks, etc., as well as psychological adaptation, has played a role in adapting to the thermal environment.

Thermal comfort assessment in a non-uniform thermal environment

This paper presents results for thermal comfort assessment in non-uniform thermal environments. Three types of displacement ventilation (DV) units that created stratified condition in an environmental test chamber have been selected to carry out the thermal comfort assessment: a flat diffuser (DV1), semi-circular diffuser (DV2), and floor swirl diffuser (DV3). The CBE (Center for the Built Environment at Berkeley) comfort model was implemented in this study to assess the occupant’s thermal comfort for the three DV types. The CBE model predicted the occupant’s mean skin as well as local skin temperatures very well when compared with measurements found in the literature, while it underestimated the occupant’s core temperature. The predicted occupant’s thermal sensation and thermal comfort for the case of (DV2) were the best. Therefore, the semi-circular diffuser (DV2) provided better thermal comfort for the occupant in comparison with the other two DV types.