Guía de manejo cuidado critico post-transplante hepático en niños fundación cardio-infantil

El transplante de órganos constituye uno de los avances más espectaculares en la historia de la Medicina. Representa un ejemplo de cómo la medicina moderna ha progresado de manera extraordinaria gracias a la importancia del trabajo en equipo, la super-especialización así como su carácter multi e interdisciplinario. El desarrollo del transplante se ha logrado gracias a la conjunción de numerosos factores, el desarrollo de diversas ramas de las ciencias médicas y básicas, así como la tecnología moderna que han permitido que lo que era un sueño en la década del 60 hoy en día se considere una práctica rutinaria. A continuación queremos compartir el Resumen Ejecutivo del manejo postquirúrgico en Cuidados Intensivos en niños con transplante de hígado que realizamos en la Fundación Cardio-Infantil IC.

Mediastinitis post revascularización miocárdica: impacto del cambio de profilaxis antibiótica en la fundación Cardioinfantil 2012 - 2013

INTRODUCCIÓN. La mediastinitis posterior a cirugía de revascularización miocárdica es una infección infrecuente, pero potencialmente fatal. En la Fundación Cardioinfantil se ha observado una tendencia al incremento de la misma en los últimos años, obligando a un cambio en las medidas de profilaxis antimicrobiana, pasando de cefalosporinas a vancomicina – gentamicina, sin embargo no se conoce aún el impacto de estas medidas. OBJETIVO: Determinar si el cambio de la profilaxis antibiótica en pacientes sometidos a revascularización miocárdica influye en una disminución de la incidencia de mediastinitis durante los años 2012 – 2013. METODOLOGÍA: Estudio de cohortes retrospectivo, evaluando la incidencia de mediastinitis post revascularización miocárdica, en pacientes expuestos a 2 diferentes tipos de profilaxis antimicrobiana (cefalosporinas vs vancomicina-gentamicina). Se describieron los patrones de susceptibilidad y resistencia de los patógenos encontrados en mediastinitis y la mortalidad de esta patología. RESULTADOS: Los patógenos más frecuentemente aislados en la mediastinitis fueron Staphylococcus aureus y Klebsiella pneumoniae, en la mayoría monomicrobiano. Se encontraron patógenos con perfiles de resistencia como betalactamasas de espectro extendido en Gram negativos y resistencia a la meticilina en cocos Gram positivos. El RR de mediastinitis del grupo expuesto a vancomicina-gentamicina respecto al grupo de cefalosporinas fue de 0,9 con IC 95% 0,28 – 3,28. CONCLUSIÓN: la epidemiologia microbiana de la mediastinitis no difiere de la reportada en otras series. La profilaxis antimicrobiana con vancomicina - gentamicina en pacientes sometidos a revascularización miocárdica, no redujo la incidencia de mediastinitis. Se propone regresar a la terapia de profilaxis con cefalosporinas.

Educational participation post-16: a longitudinal analysis of intentions and outcomes

The issue of levels of participation in post-compulsory education has been emphasised by the current policy initiatives to increase the age to which some form of participation is compulsory. One of the acknowledged weaknesses of research in the field of children's intentions with regard to participation is the lack of longitudinal data. This paper offers a longitudinal analysis using the Youth Survey from the British Household Panel Survey. The results show that most children can express intentions with regard to future participation very early in their secondary school careers and that these intentions are good predictors of actual behaviour five years later. Intentions to stay on are more consistent than intentions to leave and most children who finally leave at 16 have at some point said they want to remain in education post-16. The strongest association with participation levels is attainment at GCSE. However, there are also influences of gender and parental background and these remain, even after attainment is held constant. The results show the value of focusing on intentions for participation at a very early stage of children's school careers and also the importance of current attempts to reform curriculum and assessment for the 14-19 age group.

Modelling oil absorption during post-frying cooling - I: model development

Several studies have highlighted the importance of the cooling period in oil absorption in deep-fat fried products. Specifically, it has been established that the largest proportion of oil which ends up into the food, is sucked into the porous crust region after the fried product is removed from the oil bath, stressing the importance of this time interval. The main objective of this paper was to develop a predictive mechanistic model that can be used to understand the principles behind post-frying cooling oil absorption kinetics, which can also help identifying the key parameters that affect the final oil intake by the fried product. The model was developed for two different geometries, an infinite slab and an infinite cylinder, and was divided into two main sub-models, one describing the immersion frying period itself and the other describing the post-frying cooling period. The immersion frying period was described by a transient moving-front model that considered the movement of the crust/core interface, whereas post-frying cooling oil absorption was considered to be a pressure driven flow mediated by capillary forces. A key element in the model was the hypothesis that oil suction would only begin once a positive pressure driving force had developed. The mechanistic model was based on measurable physical and thermal properties, and process parameters with no need of empirical data fitting, and can be used to study oil absorption in any deep-fat fried product that satisfies the assumptions made.

Modelling oil absorption during post-frying cooling - II: solution of the mathematical model, model testing and simulations

The mathematical models that describe the immersion-frying period and the post-frying cooling period of an infinite slab or an infinite cylinder were solved and tested. Results were successfully compared with those found in the literature or obtained experimentally, and were discussed in terms of the hypotheses and simplifications made. The models were used as the basis of a sensitivity analysis. Simulations showed that a decrease in slab thickness and core heat capacity resulted in faster crust development. On the other hand, an increase in oil temperature and boiling heat transfer coefficient between the oil and the surface of the food accelerated crust formation. The model for oil absorption during cooling was analysed using the tested post-frying cooling equation to determine the moment in which a positive pressure driving force, allowing oil suction within the pore, originated. It was found that as crust layer thickness, pore radius and ambient temperature decreased so did the time needed to start the absorption. On the other hand, as the effective convective heat transfer coefficient between the air and the surface of the slab increased the required cooling time decreased. In addition, it was found that the time needed to allow oil absorption during cooling was extremely sensitive to pore radius, indicating the importance of an accurate pore size determination in future studies.

Building a left coast: the legacy of the California Popular Front and the challenge to Cold War liberalism in the post-world war two era

The Cold War in the late 1940s blunted attempts by the Truman administration to extend the scope of government in areas such as health care and civil rights. In California, the combined weakness of the Democratic Party in electoral politics and the importance of fellow travelers and communists in state liberal politics made the problem of how to advance the left at a time of heightened Cold War tensions particularly acute. Yet by the early 1960s a new generation of liberal politicians had gained political power in the Golden State and was constructing a greatly expanded welfare system as a way of cementing their hold on power. In this article I argue that the New Politics of the 1970s, shaped nationally by Vietnam and by the social upheavals of the 1960s over questions of race, gender, sexuality, and economic rights, possessed particular power in California because many activists drew on the longer-term experiences of a liberal politics receptive to earlier anti-Cold War struggles. A desire to use political involvement as a form of social networking had given California a strong Popular Front, and in some respects the power of new liberalism was an offspring of those earlier battles.

From services to civilian: the geographies of veterans’ post-military lives

This paper explores the spatiality of (post)military identities, demonstrating the continuing impact of having been part of the military community despite the passage of time. Our tri-service respondents highlighted the challenges faced even by those deemed to have ‘successfully’ transitioned to ‘Civvy Street’, articulating discourses of loss and separation. While some had achieved closure with their past military selves, others struggled and became stuck in a liminal space between civilian and military lives that perpetuated feelings of isolation. Our work contributes to understandings of military geographies and highlights the importance of conceptualising post-institutional transitions as a process in order to understand how individuals negotiate their identities in changing spatial circumstances.

Calcium intake and its relationship with adiposity and insulin resistance in post-pubertal adolescents

Background Dietary calcium intake has been described as being a negative contributor to adiposity. In adolescents, this relationship is not well established. The objectives of the present study were to compare the calcium intake of normal-weight and obese adolescents and to evaluate its relationship with adiposity and insulin resistance. Methods A cross-sectional analysis of 96 post-pubertal adolescents; 47 normal weight and 49 obese, mean age 16.6 (SD +/- 1.3) years. Body composition was assessed by dual-energy X-ray absorptiometry. Dietary intake was evaluated using a 3-day dietary record. The biochemical evaluation comprised the measurements of serum lipids, lipoproteins, glucose and insulin. Insulin resistance was calculated using the Homeostasis Model Assessment of Insulin resistance (HOMA-IR). Results The mean calcium intake, adjusted for energy, was lower in obese adolescents, 585.2 (+/- 249.9) mg, than in normal weight adolescents, 692.1 (+/- 199.5) mg. Only 4% of adolescents had an adequate intake of calcium. Calcium intake was inversely associated with body trunk fat, insulin and HOMA-IR in the obese group. The quartile analysis of calcium intake provided evidence that girls in the highest quartile had decreased adiposity and insulin resistance. Conclusions This study showed a negative relationship between calcium intake and body fat and insulin resistance, mainly in obese girls, and demonstrates the importance of an increased dietary calcium intake.

Retrospective analysis of post-exposure to human anti-rabies treatment in Botucatu, São Paulo State, Brazil

This analysis aimed to identify characteristics of accidents that would, probably, provoke rabies infection. A total of 14,409 survey questionnaires for surveillance of human rabies from the Brazilian Information System for Disease Notification (SINAN), from 2000 to 2005, were analyzed. Regarding demographics, it was observed that 7,377 (51.5%) of the victims were white, 4,458 (30.93%) were children and 8,008 (55.58%) were males. Urban cases were prevalent (88.10%) while dogs were the animals most frequently involved in accidents, in 11,700 cases (81.19%). Bites (84.35%) and scratches (19.15%) were the most prevalent exposure types, and occurred predominantly on victims' extremities (38.79%). The prophylactic measure taken in 6,179 cases comprised anti-rabies vaccine; of these victims, 421 (2.92%) showed systemic reactions while 693 (4.80%) reported no response. The importance of developing awareness in professionals that should correctly report post-exposure immunoprophylaxis cases is emphasized given the high number of individuals who receive this type of treatment annually.

The importance of endogenous nutrition of chicks from divergent strains for growing tested by deutectomy

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

EVALUATION OF THE PERCEPTION TOWARDS RESEARCH INVOLVING HUMAN BEINGS IN BRASILEAN POST DEGREE STUDENTS

In Brazil, research involving human beings must obey to ethical norms foresaw by the 196/96 National Health Council Resolution of the Ministry of Health. This paper gives account of a knowledge evaluation about some concepts and rules established by the resolution by Dental post degree students. It is concluded that in spite of the spreading and importance of the resolution most students do not know about it. In the same situation are those who work in research.

Spatial variation in post-dispersal seed removal in an Atlantic forest: Effects of habitat, location and guilds of seed predators

Studies of post-dispersal seed removal in the Neotropics have rarely examined the magnitude of seed removal by different types of granivores. The relative impact of invertebrates, small rodents, and birds on seed removal was investigated in a 2,178 ha Atlantic forest fragment in southeastern Brazil. We used popcorn kernels (Zea mays-Poaceae) to investigate seed removal in a series of selective exclosure treatments in a replicated, paired design experiment that included forest understory, gaps, and forest edge sites. We recorded the vegetation around the experimental seed stations in detail in order to evaluate the influence of microhabitat traits on seed removal. Vertebrate granivores (rodents and birds) were surveyed to determine whether granivore abundance was correlated with seed removal levels. Seed removal varied spatially and in unpredictable ways at the study site. Seed encounter and seed use varied with treatments, but not with habitat type. However, seed removal by invertebrates was negatively correlated with gap-related traits, which suggested an avoidance of large gaps by granivorous ants. The abundance of small mammals was remarkably low, but granivorous birds (tinamous and doves) were abundant at the study site. Birds were the main seed consumers in open treatments, but there was no correlation between local granivorous bird abundance and seed removal. These results emphasize the stochastic spatial pattern of seed removal, and, contrary to previous studies, highlight the importance of birds as seed predators in forest habitats. (c) 2007 Elsevier Masson SAS. All rights reserved.

Granivorous birds as potentially important post-dispersal seed predators in a Brazilian forest fragment

In tropical forests, rodents exert a prominent role as post-dispersal seed predators, while other vertebrates apparently have a minor effect on seed predation. In some forest fragments in southeast Brazil, however, the density of rodents is unusually low, whereas terrestrial granivorous birds are abundant. In this study, we used seeds of a second-growth tree (Croton priscus, Euphorbiaceae) to investigate experimentally the relative importance of rodents and birds as seed predators in a forest fragment. We also estimated the density of terrestrial granivorous birds and trapped small mammals. Results indicate that, as a consequence of decreased rodent population and increased bird abundance, the latter are at least as important as the former as the main post-dispersal seed predators of C priscus. We interpret such apparent imbalance in the interaction between C priscus and their seed predators as a possible consequence of forest fragmentation.

Modelling post-release survival of reintroduced Red-billed Curassows Crax blumenbachii

Modelling post-release survival probabilities of reintroduced birds can help inform 'soft-release' strategies for avian reintroductions that use captive-bred individuals. We used post-release radiotelemetry data to estimate the survival probabilities of reintroduced captive-bred Red-billed Curassow Crax blumenbachii, a globally threatened Cracid endemic to the Brazilian Atlantic Rainforest. Between August 2006 and December 2008, 46 radiotagged Curassows from the Crax Brazil breeding centre were reintroduced to the Guapiacu Ecological Reserve (REGUA), Rio de Janeiro state, Brazil, in seven different cohorts. Reintroduced birds were most vulnerable during the first 12 months post-release from natural predation, domestic dogs and hunting. Annual post-release survival probability was high (75%) compared with published estimates for other Galliform species. However, when considering survival in all birds transported to REGUA (some birds died before release or were retained in captivity) and not only post-release survival, phi in this study was closer to estimates for other species (60%). The duration of the pre-release acclimatization period within the soft-release enclosure and the size of the released cohorts both positively influenced post-release survival of reintroduced Curassows. Our results are relevant to future Cracid reintroductions and highlight the importance of utilizing post-release monitoring data for evidence-based improvements to soft-release strategies that can significantly enhance the post-release survival of captive-bred birds.

Phylogeography of endemic toads and post-Pliocene persistence of the Brazilian Atlantic Forest

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)