Uretero-uretero anastomosis: una alternativa para pacientes con patología asociada a doble sistema colector

Introducción El doble sistema colector es la alteración renal más frecuente y presenta una incidencia 1/500 individuos. Hay varias opciones de tratamiento para el uréter con reflujo o severamente dilatado cuando se asocia a un sistema duplicado, entre ellas la uretero-uretero anastomosis. El objetivo es dar a conocer nuestra experiencia en la realización de este procedimiento para pacientes pediátricos. Materiales y métodos: Se presenta una serie de casos entre Enero 2010 y Abril 2014, se revisaron 214 historias clínicas de pacientes con doble sistema colector y patologías asociadas; 10 fueron sometidos a uretero-uretero anastomosis. El Seguimiento posopertorio fue de 12 meses promedio. Resultados: Se incluyeron 10 pacientes. El 70% fueron género femenino, la edad promedio al momento de la cirugía fue 5 años . Todos cursaban con infección urinaria y 10% presentaban incontinencia urinaria. En el postoperatorio, en 40% se encontró uréter ectópico, 30% ureterocele intravesical y 30% reflujo vesicoureteral al sistema inferior. Se realizaron siete anastomosis del sistema superior al inferior y tres del inferior al superior, todos por una incisión de 2cm a nivel inguinal y fueron derivados con catéter doble J sin complicaciones postoperatorias. Al tiempo de seguimiento la totalidad de los pacientes se encontraron sin profilaxis antibiótica, con dilatación resuelta, sin infecciones urinarias ni incontinencia. Conclusión: La uretero-uretero anastomosis es una alternativa fiable, segura y con mínima morbilidad para el tratamiento de pacientes con patología asociada a doble sistema colector. Estudios adicionales, con mayor número de pacientes y seguimiento serán necesarios para ver evolución a largo plazo.

Comparación de parámetros de atención en una escala de triage de 5 niveles con los parámetros estándar

Introducción: La escala de severidad en emergencias es una herramienta que ofrece seguridad a pacientes en servicios de urgencias. Este trabajo evalúa la aplicación de la escala ESI 4.0 en términos de oportunidad de atención y consumo de recursos en la Fundación Santa Fé de Bogotá, para comparar los resultados con parámetros estándar. Metodología Estudio observacional analítico de corte transversal. Se incluyeron 385 pacientes aleatorizados por nivel de atención. Se tomaron datos demográficos y variables como consumo de recursos y destino del paciente para su descripción y análisis. Resultados: El promedio de edad fue 44.9 años IC95%42.9–46.9, el 54.5% fueron mujeres. Se encontró un tiempo promedio de espera para nivel 1 de 1.39 min, para el nivel 2 de 22.9 min 2, para el nivel 3 de 41.9 min, para el nivel 4 de 56.9 min y para el nivel 5 de 52.1 min. El tiempo promedio de estancia en urgencias fue 5.9 horas y el 78.9% consumió recursos. Al comparar los tiempos con estándares mundiales en el nivel 1, 2 y 3 son significativamente mayores (P<0,05), en el nivel 4 es similar (p0,51) y en el nivel 5 es significativamente menor (p=0,00) Discusión: La escala ESI 4.0 es una herramienta segura, con un comportamiento similar en oportunidad de atención y consumo de recursos con respecto a los estándares de cuidado en los servicios de urgencias.

Una aproximación al financiamiento de un sistema de protección social en Colombia

El documento hace una revisión de las principales fuentes de protección social que hay en Colombia y las características de los sistemas de protección de otros países. Se encuentra que gran parte de lo que se conoce como gasto social se destina al tema pensional y que los resultados de los fondos de solidaridad son muy pequeños frente a la autoprotección de los hogares. Se propone tener en cuenta los esfuerzos individuales y privados que hay en Colombia al diseñar un sistema de protección social, pues de lo contrario se estarían desincentivando estos esfuerzos.

Comparación del efecto de mera exposición y el condicionamiento clásico en la formación de preferencias

El objetivo de este estudio fue comparar la eficacia del condicionamiento clásico (CC) y el efecto de mera exposición (ME), en condiciones supraliminales (2000 milisegundos –ms-), sobre la formación de preferencias hacia marcas publicitarias. Se realizó un experimento con diseño intrasujeto, donde se manipuló la variable tratamiento afectivo representada por los dos procedimientos a comparar y se midió la variable dependiente –preferencia hacia las marcas- a través de una tarea de elección forzosa y un diferencial semántico. En el experimento participaron 70 hombres, estudiantes de medicina de la Universidad del Rosario con edades entre 18 y 22 años. El CC se realizó a través de un procedimiento simultáneo y en ambas condiciones la variable independiente se expuso el estímulo 8 veces con una duración de 2000 ms. Los resultados mostraron que los dos procedimientos generaron preferencias en los sujetos, pero no diferencias significativas entre la efectividad de los procedimientos.

Anestesia regional y periférica guiada por ultrasonido en el paciente critico

El presente trabajo es un capítulo de libro titulado “Anestesia Regional y Periférica Guiada por Ultrasonido en el Paciente Crítico” que será incluido en la última edición del libro “Manual de Ultrasonido en Terapia Intensiva y Emergencias” cuyo editor es el Doctor José de Jesús Rincón Salas y que será publicado por la Editorial Prado de México para distribución latinoamericana desde dicho país. Por solicitud del editor y teniendo en cuenta el enfoque del libro, el presente trabajo está dirigido a estudiantes de formación, médicos graduados y especialistas en las áreas de cuidado intensivo, anestesiología, dolor, medicina interna y medicina de urgencias. Tiene como propósito empapar de conocimientos necesarios y prácticos en anestesia regional a personas que usualmente no han tenido contacto con la anestesia regional, pues desafortunadamente sólo en los últimos años ha sido posible que la anestesia regional haya comenzado a salir de las salas de cirugía, ámbito donde ha estado confinada tradicionalmente. El lenguaje utilizado es sencillo y el capítulo ha sido escrito para que sea fácil de leer y consultar, dejando así mensajes muy claros sobre la utilidad, viabilidad e implicaciones que tiene el uso de anestesia regional guiada por ultrasonido en cuidado intensivo. Los autores esperamos que de esta manera, el presente capítulo permita continuar superando los obstáculos que se interponen entre los invaluables beneficios de la anestesia regional y los pacientes de cuidado intensivo que necesitan de ella.

What kind of competence teachers need in the year 2020?

Resumen basado en el de la publicaci??n

Are there hazardous auditory effects of high-frequency turbines and ultrasonic dental scalers on dental professionals?

The purpose of this pilot study was to survey dentists in the St. Louis area to assess their subjective opinion of commonly used dental handpieces as well as history of noise exposure and use of hearing protection. Selected handpieces were then chosen to measure their output levels and determine if emissions are hazardous to the auditory system.

Piping Plover response to coastal storms occurring during the nonbreeding season

The increase in coastal storm frequency and intensity expected under most climate change scenarios is likely to substantially modify beach configuration and associated habitats. This study aimed to analyze the impact of coastal storms on a nesting population of the endangered Piping Plover (Charadrius melodus melodus) in southeastern New Brunswick, Canada. Previous studies have shown that numbers of nesting Piping Plovers may increase following storms that create new nesting habitat at individual beaches. However, to our knowledge, no test of this pattern has been conducted over a regional scale. We hypothesized that Piping Plover abundance would increase after large coastal storms occurring during the nonbreeding season. However, we expected a delay in the colonization of newly created habitat owing to low-density populations, combined with high site fidelity of adults and high variability in survival rate of subadults. We tested this hypothesis using a 27-year (1986-2012) data set of Piping Plover abundance and productivity (nesting pairs and fledged young) collected at five sites in eastern New Brunswick. We identified 11 major storms that could potentially have modified Piping Plover habitat over the study period. The number of fledged young increased three years after a major storm, but the relationship was much weaker for the number of nesting pairs. These findings are consistent with the hypothesized increase in suitable habitat after coastal storms. Including storm occurrence with other factors influencing habitat quality will enhance Piping Plover conservation strategies.

The diabatic contour advective semi-Lagrangian model

This article describes a novel algorithmic development extending the contour advective semi-Lagrangian model to include nonconservative effects. The Lagrangian contour representation of finescale tracer fields, such as potential vorticity, allows for conservative, nondiffusive treatment of sharp gradients allowing very high numerical Reynolds numbers. It has been widely employed in accurate geostrophic turbulence and tracer advection simulations. In the present, diabatic version of the model the constraint of conservative dynamics is overcome by including a parallel Eulerian field that absorbs the nonconservative ( diabatic) tendencies. The diabatic buildup in this Eulerian field is limited through regular, controlled transfers of this field to the contour representation. This transfer is done with a fast newly developed contouring algorithm. This model has been implemented for several idealized geometries. In this paper a single-layer doubly periodic geometry is used to demonstrate the validity of the model. The present model converges faster than the analogous semi-Lagrangian models at increased resolutions. At the same nominal spatial resolution the new model is 40 times faster than the analogous semi-Lagrangian model. Results of an orographically forced idealized storm track show nontrivial dependency of storm-track statistics on resolution and on the numerical model employed. If this result is more generally applicable, this may have important consequences for future high-resolution climate modeling.

Serial clustering of extratropical cyclones

The clustering in time (seriality) of extratropical cyclones is responsible for large cumulative insured losses in western Europe, though surprisingly little scientific attention has been given to this important property. This study investigates and quantifies the seriality of extratropical cyclones in the Northern Hemisphere using a point-process approach. A possible mechanism for serial clustering is the time-varying effect of the large-scale flow on individual cyclone tracks. Another mechanism is the generation by one parent cyclone of one or more offspring through secondary cyclogenesis. A long cyclone-track database was constructed for extended October March winters from 1950 to 2003 using 6-h analyses of 850-mb relative vorticity derived from the NCEP NCAR reanalysis. A dispersion statistic based on the varianceto- mean ratio of monthly cyclone counts was used as a measure of clustering. It reveals extensive regions of statistically significant clustering in the European exit region of the North Atlantic storm track and over the central North Pacific. Monthly cyclone counts were regressed on time-varying teleconnection indices with a log-linear Poisson model. Five independent teleconnection patterns were found to be significant factors over Europe: the North Atlantic Oscillation (NAO), the east Atlantic pattern, the Scandinavian pattern, the east Atlantic western Russian pattern, and the polar Eurasian pattern. The NAO alone is not sufficient for explaining the variability of cyclone counts in the North Atlantic region and western Europe. Rate dependence on time-varying teleconnection indices accounts for the variability in monthly cyclone counts, and a cluster process did not need to be invoked.

Global observations and forecast skill

The impact of selected observing systems on forecast skill is explored using the European Centre for Medium-Range Weather Forecasts (ECMWF) 40-yr reanalysis (ERA-40) system. Analyses have been produced for a surface-based observing system typical of the period prior to 1945/1950, a terrestrial-based observing system typical of the period 1950-1979 and a satellite-based observing system consisting of surface pressure and satellite observations. Global prediction experiments have been undertaken using these analyses as initial states, and which are available every 6 h, for the boreal winters of 1990/1991 and 2000/2001 and the summer of 2000, using a more recent version of the ECMWF model. The results show that for 500-hPa geopotential height, as a representative field, the terrestrial system in the Northern Hemisphere extratropics is only slightly inferior to the control system, which makes use of all observations for the analysis, and is also more accurate than the satellite system. There are indications that the skill of the terrestrial system worsens slightly and the satellite system improves somewhat between 1990/1991 and 2000/2001. The forecast skill in the Southern Hemisphere is dominated by the satellite information and this dominance is larger in the latter period. The overall skill is only slightly worse than that of the Northern Hemisphere. In the tropics (20 degrees S-20 degrees N), using the wind at 850 and 250 hPa as representative fields, the information content in the terrestrial and satellite systems is almost equal and complementary. The surface-based system has very limited skill restricted to the lower troposphere of the Northern Hemisphere. Predictability calculations show a potential for a further increase in predictive skill of 1-2 d in the extratropics of both hemispheres, but a potential for a major improvement of many days in the tropics. As well as the Eulerian perspective of predictability, the storm tracks have been calculated from all experiments and validated for the extratropics to provide a Lagrangian perspective.

African easterly wave variability and its relationship to Atlantic tropical cyclone activity

Automatic tracking of vorticity centers in European Centre for Medium-Range Weather Forecasts analyses has been used to develop a 20-yr climatology of African easterly wave activity. The tracking statistics at 600 and 850 mb confirm the complicated easterly wave structures present over the African continent. The rainy zone equatorward of 15 degreesN is dominated by 600-mb activity, and the much drier Saharan region poleward of 15 degreesN is more dominated by 850-mb activity. Over the Atlantic Ocean there is just one storm track with the 600- and 850-mb wave activity collocated. Based on growth/decay and genesis statistics, it appears that the 850-mb waves poleward of 15 degreesN over land generally do not get involved with the equatorward storm track over the ocean. Instead, there appears to be significant development of 850-mb activity at the West African coast in the rainy zone around (10 degreesN, 10 degreesW), which, it is proposed, is associated with latent heat release. Based on the tracking statistics, it has been shown that there is marked interannual variability in African easterly wave (AEW) activity. It is especially marked at the 850-mb level at the West African coast between about 10 degrees and 15 degreesN, where the coefficient of variation is 0.29. For the period between 1985 and 1998, a notable positive correlation is seen between this AEW activity and Atlantic tropical cyclone activity. This correlation is particularly strong for the postreanalysis period between 1994 and 1998. This result suggests that Atlantic tropical cyclone activity may be influenced by the number of AEWs leaving the West African coast, which have significant low-level amplitudes, and not simply by the total number of AEWs.

How may tropical cyclones change in a warmer climate?

Tropical Cyclones (TC) under different climate conditions in the Northern Hemisphere have been investigated with the Max Planck Institute (MPI) coupled (ECHAM5/MPIOM) and atmosphere (ECHAM5) climate models. The intensity and size of the TC depend crucially on resolution with higher wind speed and smaller scales at the higher resolutions. The typical size of the TC is reduced by a factor of 2.3 from T63 to T319 using the distance of the maximum wind speed from the centre of the storm as a measure. The full three dimensional structure of the storms becomes increasingly more realistic as the resolution is increased. For the T63 resolution, three ensemble runs are explored for the period 1860 until 2100 using the IPCC SRES scenario A1B and evaluated for three 30 year periods at the end of the 19th, 20th and 21st century, respectively. While there is no significant change between the 19th and the 20th century, there is a considerable reduction in the number of the TC by some 20% in the 21st century, but no change in the number of the more intense storms. Reduction in the number of storms occurs in all regions. A single additional experiment at T213 resolution was run for the two latter 30-year periods. The T213 is an atmospheric only experiment using the transient Sea Surface Temperatures (SST) of the T63 resolution experiment. Also in this case, there is a reduction by some 10% in the number of simulated TC in the 21st century compared to the 20th century but a marked increase in the number of intense storms. The number of storms with maximum wind speeds greater than 50ms-1 increases by a third. Most of the intensification takes place in 2 the Eastern Pacific and in the Atlantic where also the number of storms more or less stays the same. We identify two competing processes effecting TC in a warmer climate. First, the increase in the static stability and the reduced vertical circulation is suggested to contribute to the reduction in the number of storms. Second, the increase in temperature and water vapor provide more energy for the storms so that when favorable conditions occur, the higher SST and higher specific humidity will contribute to more intense storms. As the maximum intensity depends crucially on resolution, this will require higher resolution to have its full effect. The distribution of storms between different regions does not, at first approximation, depend on the temperature itself but on the distribution of the SST anomalies and their influence on the atmospheric circulation. Two additional transient experiments at T319 resolution where run for 20 years at the end of the 20th and 21st century, respectively using the same conditions as in the T213 experiments. The results are consistent with the T213 study. The total number of tropical cyclones were similar to the T213 experiment but were generally more intense. The change from the 20th to the 21st century was also similar with fewer TC in total but with more intense cyclones.

Relationships between lightning and properties of convective cloud clusters

Satellite observations of convective system properties and lightning flash rate are used to investigate the ability of potential lightning parameterizations to capture both the dominant land-ocean contrast in lightning occurrence and regional differences between Africa, the Amazon and the islands of the maritime continent. As found in previous studies, the radar storm height is tightly correlated with the lightning flash rate. A roughly second order power-law fit to the mean radar echo top height above the 0C isotherm is shown to capture both regional and land-ocean contrasts in lightning occurrence and flash rate using a single set of parameters. Recent developments should soon make it possible to implement a parameterization of this kind in global models. Parameterizations based on cloud top height, convective rain rate and convective rain fraction all require the use of separate fits over land and ocean and fail to capture observed differences between continental regions.