Curva de aprendizaje para ventana ecográfica de la vena cava inferior, en residentes de medicina de emergencias

INTRODUCCIÓN. El ultrasonido es fundamental en la medicina de emergencias, no se conoce cual debería ser la curva de aprendizaje para obtener las competencias técnicas y operativas; ACEP recomienda por cada ventana ecográfica realizar 25 repeticiones. No existe una curva de aprendizaje para ventana de VCI en la población de residentes colombianos. OBJETIVO: Determinar la curva de aprendizaje necesaria para obtener una proporción mayor al 80% de éxitos en la toma de la ventana ecográfica de la VCI, usando la escala de calificación para el aseguramiento de la calidad sugerida por ACEP, en residentes de I a III año de medicina de emergencias. METODOLOGÍA: Estudio experimental no comparativo, que evaluó la proporción de éxito en función del las tomas repetidas de la VCI por ultrasonido, mediciones que se tomaron luego de participar en una capacitación teórica y demostrativa de la técnica propuesta; se calificaron los videos según la escala publicada por ACEP. El análisis estadístico se realizó con un modelo logístico multinivel para la proporción del éxito, agrupado por repetición y agrupado por sujeto. RESULTADOS: Se obtuvo información de 8 residentes, cada uno realizo 25 repeticiones a 3 modelos sanos con asignación aleatoria. Se realizó la curva de aprendizaje obteniendo en 11 repeticiones una proporción de 0.80 (rango 0.54 a 0.92) y en 21 repeticiones una proporción de 0.9 (rango 0.75 a 0.96), datos ajustados por numero de repetición y residente. CONCLUSIÓN: La curva de aprendizaje para la ventana ecográfica de la VCI es de 11 y 21 repeticiones para obtener el 80% y 90% de éxito en residentes de medicina de emergencias de I a III año de la universidad del rosario.

Asociación entre degeneración macular relacionada con la edad y la hipertensión arterial Bogotá 2014

Estudio Casos y Controles 1:1 que busca la relación entre la DMRE e HTA. Se estudian otras variables. Muestra de 400 pacientes, edad promedio 66,9 años +/-9,2 años. HTA y DM OR 2,315 y OR 4,626. Oclusión vascular OR 13,549 (IC 95% 3,023-60,724).

Caracterización de las variantes anatómicas de las venas pulmonares en pacientes candidatos a aislamiento de venas pulmonares en Colombia

Introducción y objetivos: El conocimiento de la anatomía de las venas pulmonares y de la aurícula izquierda es fundamental para la planeación y prevención de posibles complicaciones durante la ablación de las venas pulmonares, procedimiento realizado para el manejo de la fibrilación auricular. Este estudio pretende caracterizar la anatomía (tamaño y forma) de las venas pulmonares y determinar las variantes anatómicas más comunes de las mismas. Métodos: Se analizaron 277 estudios de angioresonancia tridimensional y tomografía computarizada realizados previo al procedimiento de aislamiento de venas pulmonares. Se evaluaron los diámetros de la aurícula izquierda, de los ostia de las venas pulmonares y se determinaron la presencia de venas pulmonares comunes, accesorias y ramificaciones tempranas. Resultados: 75% de nuestros pacientes presentaron la anatomía normal de dos venas pulmonares derechas y dos izquierdas. En un 10,1% de los casos se encontraron venas supernumerarias y en un 11,2% se encontró un tronco común. En un 61% de los pacientes se encontraron ramas ostiales, las cuales en un 39,4% de los casos se presentaron en la vena pulmonar inferior derecha. Conclusiones: La evaluación de la morfología de la aurícula derecha y las venas pulmonares por medio de angioresonancia o tomografía computarizada, es necesaria para la realización de ablación por radiofrecuencia dada la alta frecuencia de variantes anatómicas y presencia de ramas ostiales.

Seasonal variations of the physical and optical characteristics of Saharan Dust: results from the Dust outflow and Deposition to the Ocean (DODO) experiment

North African dust is important for climate through its direct radiative effect on solar and terrestrial radiation and its role in the biogeochemical system. The Dust Outflow and Deposition to the Ocean project (DODO) aimed to characterize the physical and optical properties of airborne North African dust in two seasons and to use these observations to constrain model simulations, with the ultimate aim of being able to quantify the deposition of iron to the North Atlantic Ocean. The in situ properties of dust from airborne campaigns measured during February and August 2006, based at Dakar, Senegal, are presented here. Average values of the single scattering albedo (0.99, 0.98), mass specific extinction (0.85 m^2 g^-1 , 1.14 m^2 g^-1 ), asymmetry parameter (0.68, 0.68), and refractive index (1.53--0.0005i,1.53--0.0014i) for the accumulation mode were found to differ by varying degrees between the dry and wet season, respectively. It is hypothesized that these differences are due to different source regions and transport processes which also differ between the DODO campaigns. Elemental ratios of Ca/Al were found to differ between the dry and wet season (1.1 and 0.5, respectively). Differences in vertical profiles are found between seasons and between land and ocean locations and reflect the different dynamics of the seasons. Using measurements of the coarse mode size distribution and illustrative Mie calculations, the optical properties are found to be very sensitive to the presence and amount of coarse mode of mineral dust, and the importance of accurate measurements of the coarse mode of dust is highlighted.

Contemporary social variations in household water use, management strategies and awareness under conditions of 'water stress': the case of Greater Amman Jordan

One of the distinctive characteristics of the water supply system of Greater Amman, the capital of Jordan, is that it has been based on a regime of rationing since 1987, with households receiving water once a week for various durations. This reflects the fact that while Amman's recent growth has been phenomenal, Jordan is one of the ten most water-scarce nations on earth. Amman is highly polarised socio-economically, and by means of household surveys conducted in both high- and low-income divisions of the city, the aim has been to provide detailed empirical evidence concerning the storage and use if water, the strategies used by households to manage water and overall satisfactions with water supply issues, looking specifically at issues of social equity. The analysis demonstrates the social costs of water rationing and consequent household management to be high, as well as emphasising that issues of water quality are of central importance to all consumers.

Genotypic variations in the accumulation of Cd, Cu, Pb and Zn exhibited by six commonly grown vegetables

Metal contaminants in garden and allotment soils could possibly affect human health through a variety of pathways. This study focused on the potential pathway of consumption of vegetables grown on contaminated soil. Five cultivars each of six common vegetables were grown in a control and in a soil spiked with Cd, Cu, Pb and Zn. Highly significant differences in metal content were evident between cultivars of a number of vegetables for several of the contaminants. Carrot and pea cultivars exhibited significant differences in accumulated concentrations of Cd and Cu with carrot cultivars also exhibiting significant differences in Zn. Distinctive differences were also identified when comparing one vegetable to another, legumes (Leguminosae) tending to be low accumulators, root vegetables (Umbelliferae and Liliaceae) tending to be moderate accumulators and leafy vegetables (Compositae and Chenopodiaceae) being high accumulators. (c) 2006 Elsevier Ltd. All rights reserved.

Hydrochemical variations and contaminant load in the Rio Tinto (Spain) during flood events

The aim of this work is to study the hydrochemical variations during flood events in the Rio Tinto, SW Spain. Three separate rainfall/flood events were monitored in October 2004 following the dry season. In general, concentrations markedly increased following the first event (Fe from 99 to 1130 mg/L; Q(max) = 0.78 m(3)/s) while dissolved loads peaked in the second event (Fe = 7.5 kg/s, Cu = 0.83 kg/s, Zn = 0.82 kg/s; Q(max) = 77 m(3)/s) and discharge in the third event (Q(max) = 127 m(3)/s). This pattern reflects a progressive depletion of metals and sulphate stored in the dry summer as soluble evaporitic salt minerals and concentrated pore fluids, with dilution by freshwater becoming increasingly dominant as the month progressed. Variations in relative concentrations were attributed to oxyhydroxysulphate Fe precipitation, to relative changes in the sources of acid mine drainage (e.g. salt minerals, mine tunnels, spoil heaps etc.) and to differences in the rainfall distributions along the catchment. The contaminant load carried by the river during October 2004 was enormous, totalling some 770 t of Fe, 420 t of Al, 100 t of Cu, 100 t of Zn and 71 t of Mn. This represents the largest recorded example of this flush-out process in an acid mine drainage setting. Approximately 1000 times more water and 1408 200 times more dissolved elements were carried by the river during October 2004 than during the dry, low-flow conditions of September 2004, highlighting the key role of flood Events in the annual pollutant transport budget of semi-arid and and systems and the need to monitor these events in detail in order to accurately quantify pollutant transport. (c) 2007 Elsevier B.V. All rights reserved.