991 resultados para Escala de Coma de Glasgow
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Se realiza la validación de la escala de madurez gonadal macroscópica de la cabrilla Paralabrax humeralis. Se analizaron 197 ovarios y 188 testículos provenientes del seguimiento de la pesquería demersal y cruceros de investigación de recursos demersales en el 2005 (Enero-febrero y mayo-junio). Sobre la base del análisis histológico se asignó a cada individuo un estadio de madurez macroscópico. Se realizó la descripción de los estadios de madurez que van desde el estadio 0 (virginal) hasta el 5 (recuperación en hembras, post expulsante en machos). Se realizó una comparación con escalas anteriormente realizadas, discutiendo además los beneficios de su uso.
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Se presenta la escala de madurez gonadal del lenguado Paralichthys adspersus, elaborada en base al análisis y procesamiento histológico de 96 ovarios y 66 testículos de ejemplares capturados en la costa central del Perú y mantenidos en cautiverio. Los ovarios fueron clasificados micro y macroscópicamente, teniendo en cuenta el desarrollo de gametos y gonadas en: virginal, reposo, en maduración, maduro, desovante y recuperación; y a los testículos en virginal, reposo, en maduración, maduro, expulsante y post expulsante. La comparación de las características macro y microscópicas de las gónadas de peces en cautiverio no mostraron ninguna diferencia con respecto a las gónadas de los peces en su ambiente natural.
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En este trabajo se realiza la validación de la escala de madurez gonadal macroscópica de cachema Cynoscion analis. Se analizaron 242 muestras de gónadas provenientes del Seguimiento de la Pesquería Artesanal y los Cruceros de Evaluación de Recursos Demersales del 2005. A cada individuo se le asignó un estadio de madurez macroscópica. Posteriormente, se analizó el desarrollo ovocitario y espermatogénico en cortes histológicos de gónadas. Se describieron seis estadios de maduración que van desde el estadio 0 (virginal) hasta el 5 (recuperación en hembras, post expulsante en machos). Se compara la descripción de esta escala con trabajos anteriormente realizados.
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El lenguado de ojo grande Hippoglossina macrops es un recurso potencial poco estudiado. Tiene una amplia distribución latitudinal (3°S-8°S) y batimétrica (90-380 m de profundidad). Para determinar la escala de madurez gonadal, se analizaron 570 ovarios colectados en los Cruceros de Evaluación de Recursos Demersales de los años 2003 al 2007. Se determinó seis estadios de madurez gonadal: 0 (virginal), I (reposo), II (en maduración), III (maduro), IV (desovante), V (recuperación), los que permiten conocer con mayor certeza, la condición reproductiva de las hembras de esta especie y su principal periodo de reproducción.
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Vinciguerria lucetia es uno de los recursos mesopelágicos más abundantes e inexplotados. En el presente trabajo, mediante el análisis de 774 gónadas (597 ovarios y 177 testículos) colectados en el BIC José Olaya durante los Cruceros de Investigación de agosto 2010 y diciembre 2011, se establece una escala histológica de madurez gonadal para hembras, que ha permitido validar una escala macroscópica de 5 estadios. En el caso de los machos, se identificaron 4 estadios de madurez gonadal tanto microscópicamente como macroscópicamente. Esta escala permite facilitar la obtención de datos reproductivos en diversas circunstancias como prospecciones de campo y muestreo a bordo.
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Los problemas críticos de la pesquería de arrastre de menor escala, son las capturas de ejemplares juveniles, alta presencia de descartes, pesca incidental o accesoria y conflictos con los pescadores artesanales que usan redes de enmalle cortineras. En toda la zona de estudio, los índices de captura por unidad de esfuerzo (CPUE) fue 142,4 kg/h y 477,5 kg/lance, bycatch por unidad de esfuerzo (BPUE) fue 27,2 kg/h y 91,1 kg/lance. Los mayores CPUE fueron en la zona sur dentro de las 5 mn con 199,0 kg/h y 617,8 kg/lance. La composición de la captura relativa al peso estuvo dominada por el falso volador (Prionotus stephanophrys, 24,6%) y carajito (Diplectrum conceptione, 21,4%). Las especies incidentales más importantes fueron espejo (Selene peruviana, 9,8%), bereche (Larimus pacificus, 9,3%), cachema (Cynoscion analis, 4,0%), chiri (Peprilus medius, 2,9%), lenguado de boca chica (Etropus ectenes, 2,5%), doncella (Hemanthias peruanus, 2,1%). El descarte fue 19,1% de la captura, los principales recursos fueron merluza (Merluccius gayi peruanus, 39,1%), lengüeta (Symphurus sechurae, 10,9%), morena (Muraena clepsidra, 4,9%), pez hojita (Chloroscombrus orqueta, 4,8%), otras especies 31,5% (incluyendo restos de peces y equinodermos). El índice de impacto al ecosistema marino fue de 3,7 (1: no favorable al 10: favorable). Por lo que es un arte de pesca no amigable con el ecosistema marino que no debe usarse dentro del área costera
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En este trabajo investigó la consistencia interna y la estructura factorial, comparando tres modelos de medición, de una versión en español de 12 ítems de la Escala de Identidad Étnica Multigrupo de Phinney, en una muestra de 631 estudiantes mexicanos (301 indígenas y 330 mestizos) entre 17 y 40 años de edad. Los resultados apoyan la consistencia interna de la medida y apuntan a una estructura de dos factores de la identidad étnica: la afirmación o identificación étnica y la exploración étnica. Así mismo, se encontraron diferencias estadísticamente significativas en los grupos estudiados, siendo los indígenas quienes puntúan más alto en identidad étnica y sus componentes. Sugerimos que se necesitan más investigaciones para evaluar la identidad étnica y validar la medida y los factores de la identidad étnica a través de diversos grupos étnicos con otras muestras de adolescentes y adultos de habla hispana
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Introduction: Low brain tissue oxygen pressure (PbtO2) is associated with worse outcome in patients with severe traumatic brain injury (TBI). However, it is unclear whether brain tissue hypoxia is merely a marker of injury severity or a predictor of prognosis, independent from intracranial pressure (ICP) and injury severity. Hypothesis: We hypothesized that brain tissue hypoxia was an independent predictor of outcome in patients wih severe TBI, irrespective of elevated ICP and of the severity of cerebral and systemic injury. Methods: This observational study was conducted at the Neurological ICU, Hospital of the University of Pennsylvania, an academic level I trauma center. Patients admitted with severe TBI who had PbtO2 and ICP monitoring were included in the study. PbtO2, ICP, mean arterial pressure (MAP) and cerebral perfusion pressure (CPP = MAP-ICP) were monitored continuously and recorded prospectively every 30 min. Using linear interpolation, duration and cumulative dose (area under the curve, AUC) of brain tissue hypoxia (PbtO2 < 15 mm Hg), elevated ICP >20 mm Hg and low CPP <60 mm Hg were calculated, and the association with outcome at hospital discharge, dichotomized as good (Glasgow Outcome Score [GOS] 4-5) vs. poor (GOS 1-3), was analyzed. Results: A total of 103 consecutive patients, monitored for an average of 5 days, was studied. Brain tissue hypoxia was observed in 66 (64%) patients despite ICP was < 20 mm Hg and CPP > 60 mm Hg (72 +/- 39% and 49 +/- 41% of brain hypoxic time, respectively). Compared with patients with good outcome, those with poor outcome had a longer duration of brain hypoxia (1.7 +/- 3.7 vs. 8.3 +/- 15.9 hrs, P<0.01), as well as a longer duration (11.5 +/- 16.5 vs. 21.6 +/- 29.6 hrs, P=0.03) and a greater cumulative dose (56 +/- 93 vs. 143 +/- 218 mm Hg*hrs, P<0.01) of elevated ICP. By multivariable logistic regression, admission Glasgow Coma Scale (OR, 0.83, 95% CI: 0.70-0.99, P=0.04), Marshall CT score (OR 2.42, 95% CI: 1.42-4.11, P<0.01), APACHE II (OR 1.20, 95% CI: 1.03-1.43, P=0.03), and the duration of brain tissue hypoxia (OR 1.13; 95% CI: 1.01-1.27; P=0.04) were all significantly associated with poor outcome. No independent association was found between the AUC for elevated ICP and outcome (OR 1.01, 95% CI 0.97-1.02, P=0.11) in our prospective cohort. Conclusions: In patients with severe TBI, brain tissue hypoxia is frequent, despite normal ICP and CPP, and is associated with poor outcome, independent of intracranial hypertension and the severity of cerebral and systemic injury. Our findings indicate that PbtO2 is a strong physiologic prognostic marker after TBI. Further study is warranted to examine whether PbtO2-directed therapy improves outcome in severely head-injured patients .
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PURPOSE: To investigate the relationship between hemoglobin (Hgb) and brain tissue oxygen tension (PbtO(2)) after severe traumatic brain injury (TBI) and to examine its impact on outcome. METHODS: This was a retrospective analysis of a prospective cohort of severe TBI patients whose PbtO(2) was monitored. The relationship between Hgb-categorized into four quartiles (≤9; 9-10; 10.1-11; >11 g/dl)-and PbtO(2) was analyzed using mixed-effects models. Anemia with compromised PbtO(2) was defined as episodes of Hgb ≤ 9 g/dl with simultaneous PbtO(2) < 20 mmHg. Outcome was assessed at 30 days using the Glasgow outcome score (GOS), dichotomized as favorable (GOS 4-5) vs. unfavorable (GOS 1-3). RESULTS: We analyzed 474 simultaneous Hgb and PbtO(2) samples from 80 patients (mean age 44 ± 20 years, median GCS 4 (3-7)). Using Hgb > 11 g/dl as the reference level, and controlling for important physiologic covariates (CPP, PaO(2), PaCO(2)), Hgb ≤ 9 g/dl was the only Hgb level that was associated with lower PbtO(2) (coefficient -6.53 (95 % CI -9.13; -3.94), p < 0.001). Anemia with simultaneous PbtO(2) < 20 mmHg, but not anemia alone, increased the risk of unfavorable outcome (odds ratio 6.24 (95 % CI 1.61; 24.22), p = 0.008), controlling for age, GCS, Marshall CT grade, and APACHE II score. CONCLUSIONS: In this cohort of severe TBI patients whose PbtO(2) was monitored, a Hgb level no greater than 9 g/dl was associated with compromised PbtO(2). Anemia with simultaneous compromised PbtO(2), but not anemia alone, was a risk factor for unfavorable outcome, irrespective of injury severity.
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A variabilidade espacial das características do solo torna a estimativa da infiltração de água altamente dependente da escala de análise. Muitos trabalhos necessitam de informações da dinâmica da infiltração para descrever o mecanismo de outros processos associados à água, aos sedimentos ou aos solutos. O objetivo deste trabalho foi utilizar duas estratégias metodológicas para a estimativa da infiltração na escala de bacia. Os parâmetros de dois modelos de infiltração foram ajustados a um conjunto de dados coletados durante dois anos de monitoramento, em 77 eventos de chuva-vazão ocorridos sob diferentes condições de uso e manejo do solo numa bacia hidrográfica rural de 1,2 km². Os resultados dos ajustes para os dois modelos de infiltração na escala de bacia foram comparados com aqueles obtidos para dois métodos pontuais de estimativa da infiltração. Com o conjunto de dados do monitoramento, foi possível definir um modelo de infiltração para a bacia monitorada. Além disso, os resultados indicaram que a comparação realizada entre os valores dos modelos com os pontuais são fortemente dependentes da escala de análise; isto é, as medidas pontuais revelaram valores médios de taxa de infiltração alta para a bacia em estudo. Todavia, observações no campo indicaram baixa infiltração, principalmente nas áreas saturadas onde condicionam o escoamento superficial nessa bacia, ao contrário dos resultados pelos modelos de estimativa, que apresentaram menor ordem de magnitude dos valores estimados de infiltração, em razão, entre outros, da maior incorporação dos fatores controladores do processo em seu método.
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Introduction: Non-operative management (NOM) of blunt splenic injuries in hemodynamically stable patients is nowadays considered the standard treatment. Material and Methods: The aim was to clarify the criteria used for primary operative management (OM) and planned NOM. Furthermore, the study aimed to identify risk factors for failure of NOM. All adult patients with blunt splenic injuries treated from 2000-2008 were reviewed and a logistic regression analysis employed. Results: There were 206 patients (146 men, 70.9%). Mean age was 38.2 ± 19.1 years. The mean Injury Severity Score (ISS) was 30.9 ± 11.6. The American Association for the Surgery of Trauma (AAST) classification of the splenic injury was: grade I, n = 43 (20.9%); grade II, n = 52 (25.2%); grade III, n = 60 (29.1%), grade IV, n = 42 (20.4%) and grade V, n = 9 (4.4%). 47 patients (22.8%) required immediate surgery (OM). More than 5 units of red cell transfusions (odds ratio [OR] 13.72, P < 0.001), a Glasgow Coma Scale < 11 (OR 9.88, P = 0.009) and age ? 55 years (OR 3.29, P = 0.038) were associated with primary OM. 159 patients (77.2%) qualified for a non-surgical approach (NOM), which was successful in 89.9% (143/159). The overall splenic salvage rate amounted to 69.4% (143/206). Multiple logistic regression analysis found age ? 40 years to be the only factor significantly and independently related to the failure of NOM (OR 13.58, P = 0.001). Conclusion: Advanced age is associated with an increased failure rate of NOM in patients with blunt splenic injuries.
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Introduction: Continuous EEG (cEEG) is increasingly used to monitor brain function in neuro-ICU patients. However, its value in patients with coma after cardiac arrest (CA), particularly in the setting of therapeutic hypothermia (TH), is only beginning to be elucidated. The aim of this study was to examine whether cEEG performed during TH may predict outcome. Methods: From April 2009 to April 2010, we prospectively studied 34 consecutive comatose patients treated with TH after CA who were monitored with cEEG, initiated during hypothermia and maintained after rewarming. EEG background reactivity to painful stimulation was tested. We analyzed the association between cEEG findings and neurologic outcome, assessed at 2 months with the Glasgow-Pittsburgh Cerebral Performance Categories (CPC). Results: Continuous EEG recording was started 12 ± 6 hours after CA and lasted 30 ± 11 hours. Nonreactive cEEG background (12 of 15 (75%) among nonsurvivors versus none of 19 (0) survivors; P < 0.001) and prolonged discontinuous "burst-suppression" activity (11 of 15 (73%) versus none of 19; P < 0.001) were significantly associated with mortality. EEG seizures with absent background reactivity also differed significantly (seven of 15 (47%) versus none of 12 (0); P = 0.001). In patients with nonreactive background or seizures/epileptiform discharges on cEEG, no improvement was seen after TH. Nonreactive cEEG background during TH had a positive predictive value of 100% (95% confidence interval (CI), 74 to 100%) and a false-positive rate of 0 (95% CI, 0 to 18%) for mortality. All survivors had cEEG background reactivity, and the majority of them (14 (74%) of 19) had a favorable outcome (CPC 1 or 2). Conclusions: Continuous EEG monitoring showing a nonreactive or discontinuous background during TH is strongly associated with unfavorable outcome in patients with coma after CA. These data warrant larger studies to confirm the value of continuous EEG monitoring in predicting prognosis after CA and TH.
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En el marc d'una investigació més àmplia sobre transicions escolars i el paper de les xarxes socials et demanem que contestis les preguntes següents sobre les teves relacions personals. Et preguem que llegeixis amb atenció les preguntes i contestes amb sinceritat. Agraïm molt la teva col·laboració.