Pulsioximetría de pacientes en hemodiálisis, de la unidad de terapia renal – fundación cardioinfantil, análisis para establecer recomendaciones

Introducción. En Colombia, el 80% de los pacientes con enfermedad renal crónica en hemodiálisis tienen fístula arteriovenosa periférica (FAV) que asegura el flujo de sangre durante la hemodiálisis (1), la variabilidad en el flujo de sangre en el brazo de la FAV hacia la parte distal, puede afectar la lectura de la oximetría de pulso (SpO2) (2), llevando a la toma de decisiones equivocadas por el personal de salud. El objetivo de este estudio es aclarar si existe diferencia entre la SpO2 del brazo de la FAV y el brazo contralateral. Materiales y métodos. Se realizó un estudio de correlación entre los valores de SpO2 del brazo con FAV contra el brazo sin FAV, de 40 pacientes que asistieron a hemodiálisis. La recolección de los datos se llevó a cabo, con un formato que incluyó el resultado de la pulsioximetria y variables asociadas, antes, durante y después de la hemodiálisis. Se comparó la mediana de los deltas de las diferencias con pruebas estadísticas T Student – Mann Whitney, aceptando un valor significativo de p < 0,05. Resultados. No se encontraron diferencias estadísticamente significativas de la SpO2 entre el brazo con FAV y el brazo sin FAV, antes, durante y después de la diálisis, sin embargo si se apreció una correlación positiva estadísticamente significativa. Conclusiones. Se encontró correlación positiva estadísticamente significativa, donde no hubo diferencias en el resultado la pulsioximetría entre el brazo con FAV y brazo sin FAV, por lo tanto es válido tomar la pulsioximetría en cualquiera de los brazos.

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.

Understanding mathematics for young children : a guide for Foundation Stage and Lower Primary Teachers.

Guía para tener una comprensión más clara de las matemáticas y de los materiales que se utilizan en el aula con niños de tres a ocho años. Muestra cómo ayudarlos en el desarrollo y la comprensión de las matemáticas por sí mismos, en lugar de aprender recetas y rutinas. Al final de cada capítulo se incluyen algunos ejemplos de actividades que pueden ser utilizadas en las distintas edades. Contiene estrategias para el cálculo mental.

The Influence of Body Condition on the Stopover Ecology of Least Sandpipers in the Lower Mississippi Alluvial Valley during Fall Migration

Many shorebirds are long-distance migrants and depend on the energy gained at stopover sites to complete migration. Competing hypotheses have described strategies used by migrating birds; the energy-selection hypothesis predicts that shorebirds attempt to maximize energy gained at stopover sites, whereas the time-selection hypothesis predicts that shorebirds attempt to minimize time spent at stopover sites. The energy- and time-selection hypotheses both predict that birds in better condition will depart sites sooner. However, numerous studies of stopover duration have found little support for this prediction, leading to the suggestion that migrating birds operate under energy and time constraints for only a small portion of the migratory season. During fall migration 2002, we tested the prediction that birds in better condition depart stopover sites sooner by examining the relationship between stopover duration and body condition for migrating Least Sandpipers (Calidris minutilla) at three stopover sites in the Lower Mississippi Alluvial Valley. We also tested the assumption made by the Lower Mississippi Alluvial Valley Migratory Bird Science Team that shorebirds stay in the Mississippi Valley for 10 d. The assumption of 10 d was used to estimate the amount of habitat required by shorebirds in the Mississippi Valley during fall migration; a period longer than 10 d would increase the estimate of the amount habitat required. We used multiple-day constancy models of apparent survival and program MARK to estimate stopover duration for 293 individually color-marked and resighted Least Sandpipers. We found that a four-day constancy interval and a site x quadratic time trend interaction term best modeled apparent survival. We found only weak support for body condition as a factor explaining length of stopover duration, which is consistent with findings from similar work. Stopover duration estimates were 4.1 d (95% CI = 2.8–6.1) for adult Least Sandpipers at Bald Knob National Wildlife Refuge, Arkansas, 6.5 d (95% CI = 4.9–8.7) for adult and 6.1 d (95% CI =4.2–9.1) for juvenile Least Sandpipers at Yazoo National Wildlife Refuge, Mississippi, and 6.9 d (95% CI = 5.5–8.7) for juvenile Least Sandpipers at Morgan Brake National Wildlife Refuge, Mississippi. Based on our estimates of stopover duration and the assumption made by the Lower Mississippi Alluvial Valley Migratory Bird Science Team, there is sufficient habitat in the lower Mississippi Valley to support shorebirds during fall migration.

The response of tropospheric circulation to perturbations in lower-stratospheric temperature

A multiple regression analysis of the NCEP-NCAR reanalysis dataset shows a response to increased solar activity of a weakening and poleward shift of the subtropical jets. This signal is separable from other influences, such as those of El Nino-Southern Oscillation (ENSO) and the North Atlantic Oscillation (NAO), and is very similar to that seen in previous studies using global circulation models (GCMs) of the effects of an increase in solar spectral irradiance. The response to increased stratospheric (volcanic) aerosol is found in the data to be a weakening and equatorward shift of the jets. The GCM studies of the solar influence also showed an impact on tropospheric mean meridional circulation with a weakening and expansion of the tropical Hadley cells and a poleward shift of the Ferrel cells. To understand the mechanisms whereby the changes in solar irradiance affect tropospheric winds and circulation, experiments have been carried out with a simplified global circulation model. The results show that generic heating of the lower stratosphere tends to weaken the subtropical jets and the tropospheric mean meridional circulations. The positions of the jets, and the extent of the Hadley cells, respond to the distribution of the stratospheric heating, with low-latitude heating forcing them to move poleward, and high-latitude or latitudinally uniform heating forcing them equatorward. The patterns of response are similar to those that are found to be a result of the solar or volcanic influences, respectively, in the data analysis. This demonstrates that perturbations to the heat balance of the lower stratosphere, such as those brought about by solar or volcanic activity, can produce changes in the mean tropospheric circulation, even without any direct forcing below the tropopause.

Is Antarctic climate most sensitive to ozone depletion in the middle or lower stratosphere?

Antarctic stratospheric ozone depletion has been associated with an observed downward trend in tropospheric geopotential height and temperature. Stratospheric ozone depletion peaks in October–November, whereas tropospheric trends are largest in December–January, concurrent with maximum ozone changes close to the tropopause. Surface temperatures are most sensitive to ozone loss near the tropopause, therefore it has been suggested that the observed tropospheric response is forced mainly by ozone depletion in the lower stratosphere. In this study the climate response to ozone depletion exclusively below 164 hPa is simulated using HadSM3-L64, and compared with simulations in which ozone depletion is prescribed exclusively above 164 hPa. Results indicate that the tropospheric response is dominated by ozone changes above 164 hPa, with ozone changes in the lowermost stratosphere playing an insignificant role. A tropospheric response is also seen in fall/winter which agrees well with observations and has not been found in modeling studies previously.