Comportamiento de la patología biliar aguda y su manejo en el servicio de trauma y emergencia del Hospital "Vicente Corral Moscoso" Cuenca. Enero a junio de 2014

La patología biliar afecta a un gran porcentaje de la población adulta, motivo por el cual su tratamiento en la actualidad ha cambiado hacia un nuevo paradigma de cuidado bajo el concepto de “Acute Care Surgery” (ACS) 1 el cual se caracteriza por priorizar la valoración integral del paciente e intervención precoz de la patología. En el Hospital Vicente Corral Moscoso (HVCM) bajo este modelo ACS, y mediante la utilización de protocolos estandarizados se ha logrado dar un giro importante en el tratamiento oportuno de la patología biliar mediante la utilización de herramientas habituales como pruebas de laboratorio, imagenología y si es el caso, la resolución quirúrgica mediante técnica mínimamente invasiva o por vía convencional. OBJETIVO: Describir el comportamiento de la patología biliar y su manejo en el servicio de Trauma y Emergencias del Hospital “Vicente Corral Moscoso”, durante el período de enero a junio de 2014, bajo el modelo ACS. MÉTODOS: Estudio descriptivo transversal, que analizó los casos de colecistitis aguda litiásica (CAL), coledocolitiasis, pancreatitis aguda biliar (PAB) y su manejo, registrado en la base de datos digital del servicio de Emergencias del Hospital Vicente Corral Moscoso, bajo criterios clínicos, de laboratorio e imagenológicos, durante el periodo de enero a junio del 2014. RESULTADOS: El estudio contó con un total de 240 pacientes atendidos en el servicio de Trauma y Emergencia del HVCM, durante el periodo de enero a junio de 2014. La patología en orden de frecuencia fue: en un 47%, la Coledocolitiasis; 35% colecistitis aguda y, pancreatitis aguda biliar 18%. La prevalencia fue mayor en el sexo femenino en un 85%, 67%, y 81% respectivamente y el tratamiento se adaptó a cada patología. 1 Acute Care Surgery” (ACS): si bien no existe una definición literal hace referencia a una disciplina tripartita que engloba la cirugía de trauma, general en emergencias y cuidados críticos quirúrgicos, y que prioriza la identificación y manejo de las patologías potencialmente letales y de alta morbilidad. En nuestro medio lo más próximo a la definición seria Cirugía de Trauma y Emergencias. El manejo de la pancreatitis aguda biliar (PAB) bajo el concepto de cuidado agudo de pacientes quirúrgicos o “Acute Care Surgery” hace indispensable una intervención oportuna y temprana, utilizando todos los recursos disponibles para un manejo integral. CONCLUSIONES: La implementación del modelo de Cirugía de Trauma y Emergencias en nuestra institución ha logrado un manejo integral de colecistitis aguda litiásica, pancreatitis aguda biliar y coledocolitiasis, disminuyendo las complicaciones asociadas y evitando las recidivas de cuadros de mayor gravedad.

Analysis of personality traits as a risk factor in crash related trauma.

Background: Due to increasing stress, individual personality traits are becoming a significant contributor to CRT (Crash Related Trauma). In the present study, we hypothesized that there will be no difference in personality characteristics of CRT patients and control subjects and there will be no association between trauma and personality characteristics of CRT patients. Method: A total of 119 cases and 112 controls of age >18 years were selected as per criteria decided. After obtaining ethical clearance, patients presenting to the emergency orthopedic unit were included in the study. After primary management all enrolled subjects were assessed by ICD 10 module screening questionnaire and analyzed for nine personality traits, subject to written informed consent. Results: Of all the cases enrolled 82.35% were males. Impulsive personality trait is found in 84.78% (39/46) cases. There were 46 motorcyclists out of 119 cases enrolled. Most of the personality traits showed a statistical significant association (p < 0.0003) with CRT. Conclusion: Majority of CRT victims attending orthopedic emergency unit at trauma center had impulsive and histrionic personality characteristics which accounted for 84.78% and 82.61% cases respectively. These traits showed a statistical significant association with CRT.

The Influence of Pre-Migration Factors and Post-Migration Climate of the Receiving Community on the Psychological Distress of Latino Immigrants

Over forty million foreign-born residents currently live in the United States. Latinos make up the largest population of immigrants living in the U.S. Previous research suggests that Latino immigrants often experience pre-migration stressors, such as traumatic experiences, political upheaval, and unplanned migration. These stressors may have a negative impact on immigrants’ post-migration mental health. Research also suggests that the post-migration climate of the receiving community may inform the connection between pre-migration experiences and post-migration mental health. The current study examined the relationship between Latino immigrants’ reasons for migration, migration planning, and pre-migration experience of political and/or interpersonal violence, and post-migration symptoms of psychological distress. In addition to examining the effect of these pre-migration factors, the current study also examined the community “climate” experienced by Latino immigrants post-migration by assessing the influence of three post-migration factors: 1) community support and engagement, 2) discrimination, and 3) employment. The study was a secondary analysis of data collected for the National Latino and Asian American Study, which focused on the mental health and service utilization of Latinos and Asian Americans. Participants included 1,629 Latino immigrants from across the United States. Results indicated that pre-migration experience of political and/or interpersonal trauma, post-migration experience of discrimination, and female sex were positively associated with psychological distress. Post-migration employment was negatively associated with psychological distress. In addition, discrimination modified the association between unplanned migration and psychological distress; the relationship between unplanned migration and psychological distress decreased for participants who reported more discrimination. Furthermore, employment modified the association between political and/or interpersonal trauma and psychological distress; the connection between trauma and psychological distress increased among those who reported having less employment. Recommendations for further research were presented. Policy and clinical practice implications were discussed, particularly given the current climate of high anti-immigrant sentiment and hostility in the U.S.

The interaction between Sertoli cells and luekemia inhibitory factor on the propagation and differentiation of spermatogonial stem cells in vitro

Background: Sertoli cells play a pivotal role in creating microenvironments essential for spermatogonial stem cells (SSCs) self-renewal and commitment to differentiation. Maintenance of SSCs and or induction of in vitro spermiogenesis may provide a therapeutic strategy to treat male infertility. Objective: This study investigated the role of luekemia inhibitory factor (LIF) on the propagation of SSCs and both functions of Sertoli cells on the proliferation and differentiation of these cells. Materials and Methods: SSCs were sorted from the testes of adult male mice by magnetic activated cell sorting and thymus cell antigen 1 antibody. On the other hand, isolated Sertoli cells were enriched using lectin coated plates. SSCs were cultured on Sertoli cells for 7 days in the absence or presence of LIF. The effects of these conditions were evaluated by microscopy and expression of meiotic and post meiotic transcripts by reverse transcriptase polymerase chain reaction. Results: Our data showed that SSCs co-cultured with Sertoli cells in the presence of LIF formed colonies on top of the Sertoli cells. These colonies had alkaline phosphatesase activity and expressed SSCs specific genes. SSCs were enjoyed limited development after the mere removal of LIF, and exhibiting expression of meiotic and postmeiotic transcript and loss of SSCs specific gene expression (p< 0.05). Conclusion: Our findings represent co-culture of SSCs with Sertoli cells provides conditions that may allow efficient proliferation and differentiation of SSCs for male infertility treatment.

Direct Write Fabrication of Waveguides and Interconnects for Optical Printed Wiring Boards

Current copper based circuit technology is becoming a limiting factor in high speed data transfer applications as processors are improving at a faster rate than are developments to increase on board data transfer. One solution is to utilize optical waveguide technology to overcome these bandwidth and loss restrictions. The use of this technology virtually eliminates the heat and cross-talk loss seen in copper circuitry, while also operating at a higher bandwidth. Transitioning current fabrication techniques from small scale laboratory environments to large scale manufacturing presents significant challenges. Optical-to-electrical connections and out-of-plane coupling are significant hurdles in the advancement of optical interconnects. The main goals of this research are the development of direct write material deposition and patterning tools for the fabrication of waveguide systems on large substrates, and the development of out-of-plane coupler components compatible with standard fiber optic cabling. Combining these elements with standard printed circuit boards allows for the fabrication of fully functional optical-electrical-printed-wiring-boards (OEPWBs). A direct dispense tool was designed, assembled, and characterized for the repeatable dispensing of blanket waveguide layers over a range of thicknesses (25-225 µm), eliminating waste material and affording the ability to utilize large substrates. This tool was used to directly dispense multimode waveguide cores which required no UV definition or development. These cores had circular cross sections and were comparable in optical performance to lithographically fabricated square waveguides. Laser direct writing is a non-contact process that allows for the dynamic UV patterning of waveguide material on large substrates, eliminating the need for high resolution masks. A laser direct write tool was designed, assembled, and characterized for direct write patterning waveguides that were comparable in quality to those produced using standard lithographic practices (0.047 dB/cm loss for laser written waveguides compared to 0.043 dB/cm for lithographic waveguides). Straight waveguides, and waveguide turns were patterned at multimode and single mode sizes, and the process was characterized and documented. Support structures such as angled reflectors and vertical posts were produced, showing the versatility of the laser direct write tool. Commercially available components were implanted into the optical layer for out-of-plane routing of the optical signals. These devices featured spherical lenses on the input and output sides of a total internal reflection (TIR) mirror, as well as alignment pins compatible with standard MT design. Fully functional OEPWBs were fabricated featuring input and output out-of-plane optical signal routing with total optical losses not exceeding 10 dB. These prototypes survived thermal cycling (-40°C to 85°C) and humidity exposure (95±4% humidity), showing minimal degradation in optical performance. Operational failure occurred after environmental aging life testing at 110°C for 216 hours.

Mechanisms of Chloroperoxidase-catalyzed Enantioselective Reactions as Probed by Site-directed Mutagenesis and Isotopic Labeling

Chloroperoxidase (CPO) is a heme-containing glycoprotein secreted by the marine fungus Caldariomyces fumago. Chloroperoxidase contains one ferriprotoporphyrin IX prosthetic group per molecule and catalyzes a variety of reactions, such as halogenation, peroxidation and epoxidation. The versatile catalytic activities of CPO coupled with the increasing demands for chiral synthesis have attracted an escalating interest in understanding the mechanistic and structural properties of this enzyme. In order to better understand the mechanisms of CPO-catalyzed enantioselective reactions and to fine-tune the catalytic properties of chloroperoxidase, asparagine 74 (N74) located in the narrow substrate access channel of CPO was replaced by a bulky, nonpolar valine and a polar glutamine using site-directed mutagenesis. The CPO N74 mutants displayed significantly enhanced activity toward nonpolar substrates compared to wild-type CPO as a result of changes in space and polarity of the heme distal environment. More interestingly, N74 mutants showed dramatically decreased chlorination and catalase activity but significantly enhanced epoxidation activity as a consequence of improved kinetic perfection introduced by the mutation as reflected by the favorable changes in kcat and kcat/KM of these reactions. It is also noted that the N74V mutant is capable of decomposing cyanide, the most notorious poison for many hemoproteins, as judged by the unique binding behavior of N74V with potassium cyanide. Histidine 105 (H105) was replaced by a nonpolar amino acid alanine using site-directed mutagenesis. The CPO H105 mutant (H105A) displayed dramatically decreased chlorination and catalase activity possibly because of the decreased polarity in the heme distal environment and loss of the hydrogen bonds between histidine 105 and glutamic acid 183. However, significantly increased enantioselectivity was observed for the epoxidation of bulky styrene derivatives. Furthermore, my study provides strong evidence for the proposed histidine/cysteine ligand switch in chloroperoxidase, providing experimental support for the structure of the 420-nm absorption maximum for a number of carbon monoxide complexes of heme-thiolate proteins. For the NMR study, [dCPO(heme)] was produced using 90% deuterated growth medium with excess heme precursors and [dCPO(Phe)] was grown in the same highly deuterated medium that had been supplemented with excess natural phenylalanine. To make complete heme proton assignments, NMR spectroscopy has been performed for high-resolution structural characterization of [dCPO(heme)] and [dCPO(Phe)] to achieve unambiguous and complete heme proton assignments, which also allows important amino acids close to the heme active center to be determined.

Choques al hogar, trabajo Infantil y acumulación de capital humano : evidencia para Colombia

En este trabajo se estima el efecto que tienen distintos choques a los hogares sobre el logro académico de los niños. Mediante un modelo de regresión lineal, se encuentra un efecto adverso de la presencia de choques sobre el puntaje de la prueba Saber 11. Además, los resultados sugieren que el trabajo infantil es un mecanismo por el cual los choques afectan negativamente la acumulación de capital humano. Al explorar efectos heterogéneos por sexo y edad, las estimaciones indican que el efecto de los choques es guiado por los hombres y los adolescentes mayores a 14 años.

FAST-E en Pacientes con Trauma Abdominal Cerrado Estable, en un Departamento de Urgencias en Colombia

El impacto que ha generado el trauma en Colombia a lo largo de la historia, nos ha obligado a mejorar y adaptar diferentes tipos de sistemas de atención en trauma, basados en los lineamientos internacionales, los cuales buscan evitar el significativo aumento en las tasas de mortalidad y discapacidad que se obtienen de este, especialmente en los servicios de Emergencias en los cuales se reciben el 100% de estos pacientes con traumatismo múltiple o politraumatismo. Dentro de este grupo de pacientes hay un subgrupo que son las pacientes con trauma de abdomen que cursan con estabilidad hemodinámica y además son clasificados de bajo riesgo, ya sea por índices de trauma o por otros métodos como la medición sérica de lactato, los cuales tienen un papel poco despreciable al momento de ver mortalidad y discapacidad por trauma, ya sea penetrante o cerrado; en este trabajo específicamente nos centramos en las personas que consultan al servicio de Emergencias con trauma cerrado de abdomen los cuales son considerados de bajo riesgo, siendo este subgrupo de pacientes uno de los más difíciles de abordar y enfocar al momento de la valoración inicial, ya que se debe tener la seguridad de que no hay lesiones que comprometen la vida y por consiguiente estos pacientes puedan ser dados de alta.

Resiliencia y desempeño organizacional

El cambio hoy se reconoce como el principal reto que enfrentan las empresas. Desde diversas ciencias como la biología, la psicología y la dirección se vienen estudiando las diferentes variables que tienen relación con los procesos de ajuste y adaptación que los individuos y las organizaciones desarrollan cuando disrupciones de diverso tipo se materializan en el entorno. En las últimas décadas se ha contemplado el estudio de la resiliencia como una característica que pueden desarrollar las organizaciones. Por ello, es un tema de estudio interesante, tanto desde los individuos como desde las organizaciones. Se revisan en este artículo los conceptos de resiliencia, resiliencia individual y organizacional, así como las relaciones que surgen entre dichos conceptos para explicar el desempeño organizacional.

El concepto de duelo en los familiares de los desaparecidos : una revisión de la literatura

Este trabajo de grado tiene por objetivo realizar una revisión de literatura que dé cuenta de las características conceptuales del duelo que viven los familiares de los desaparecidos, en un contexto de desaparición forzada de personas como ilícito internacional de los derechos humanos. Para ello se exploraron libros de consulta reconocidos en el tema, artículos de revistas indexadas de los últimos diez años, y jurisprudencia de la Corte Interamericana de Derechos Humanos de casos de desapariciones forzada. Se presenta la definición de la desaparición forzada como ilícito internacional en DDHH, una categorización de víctimas, el desarrollo del concepto de duelo general y para estos casos y su aplicabilidad a los casos de la Corte IDH. Se encontró que los hallazgos dados por la teoría son aplicados en los dictámenes de esta corte, con un discurso de reivindicación de derechos y reparación integral. Se recomiendan futuras investigaciones en propuestas terapéuticas.

Ravines in Angola. Causes and restraint methods

The Earth we know today was not always so. Over millions of years have undergone significant ch an g e s brought about by numerous geological phenomena aimed at your balance, some internal order, creating new geological formations and other external order smoothing formations previously created. From t h e tectonic standpoint, Angola is located in a relatively stable area which gives it a certain p ri v i l e g e w h e n compared with some Asian countries or even Americans where quite often occur earthquakes and volcanic eruptions. However, the same cannot be said in relation to the occurrence of an external geodynamics phenomena, such as the ravines, which in recent years has taken shape in many provinces, especially due to anthropogenic activity, giving rise to geological hazards, increasing the risk of damage in buildings and others infrastructures, losses direct or indirect in economic activities and loss of human lives. We understand that the reducing of these risks starts, in particular, by their identification, for later take preventive measures. This work is the result of some research work carried out by the authors through erosion courses of s o i l and stabilization of soils subject to erosion phenomena, carried out by Engineering Laboratory of Angola (LEA). For the realization of this work, we resorted to cartographic data query, literature, listening to s o m e o f the provincial representatives and local residents, as well as the observation in lo co o f s o m e af f e ct ed areas. The results allow us to infer that the main provinces affected by ravine phenomenon are located in Central and Northern highlands, as well as in the eastern region, and more recently in Cuando-Cub an go province. Not ruling out, however, other regions, such as in Luanda and Cabinda [1]. Relatively the causes, we can say that the ravines in Angola are primarily due to the combination of three natural factors: climate, topography and type of soil [2]. When we add the anthropogenic activit y , namely the execution of construction works, the drainage system obstructio n, exploration of m i n e ral s, agriculture and fires, it is verified an increasing of the phenomenon, often requiring immedi at e act i o n . These interventions can be done through structural or engineering measures and by the stabilization measures on the degraded soil cover [3]. We present an example of stabilization measures throu g h t h e deployment of a local vegetation called Pennisetum purpureum. It is expected that the results may contribute to a better understanding of the causes of the ravine phenomenon in Angola and that the adopted stabilization method can be adapted in other affected provinces in order to prevent and making the contention of the ravines.

The effect of mechanochemical activation upon the intercalation of a high-defect kaolinite with formamide

The effect of mechanochemical activation upon the intercalation of formamide into a high-defect kaolinite has been studied using a combination of X-ray diffraction, thermal analysis, and DRIFT spectroscopy. X-ray diffraction shows that the intensity of the d(001) spacing decreases with grinding time and that the intercalated high-defect kaolinite expands to 10.2 A. The intensity of the peak of the expanded phase of the formamide-intercalated kaolinite decreases with grinding time. Thermal analysis reveals that the evolution temperature of the adsorbed formamide and loss of the inserting molecule increases with increased grinding time. The temperature of the dehydroxylation of the formamide-intercalated high-defect kaolinite decreases from 495 to 470oC with mechanochemical activation. Changes in the surface structure of the mechanochemically activated formamide-intercalated high-defect kaolinite were followed by DRIFT spectroscopy. Fundamentally the intensity of the high-defect kaolinite hydroxyl stretching bands decreases exponentially with grinding time and simultaneously the intensity of the bands attributed to the OH stretching vibrations of water increased. It is proposed that the mechanochemical activation of the high-defect kaolinite caused the conversion of the hydroxyls to water which coordinates the kaolinite surface. Significant changes in the infrared bands assigned to the hydroxyl deformation and amide stretching and bending modes were observed. The intensity decrease of these bands was exponentially related to the grinding time. The position of the amide C&unknown;O vibrational mode was found to be sensitive to grinding time. The effect of mechanochemical activation of the high-defect kaolinite reduces the capacity of the kaolinite to be intercalated with formamide.

The measurement of applied forces during anterior single rod correction of adolescent idiopathic scoliosis

Adolescent idiopathic scoliosis (AIS) is the most common form of spinal deformity in paediatrics, prevalent in approximately 2-4% of the general population. While it is a complex three-dimensional deformity, it is clinically characterised by an abnormal lateral curvature of the spine. The treatment for severe deformity is surgical correction with the use of structural implants. Anterior single rod correction employs a solid rod connected to the anterior spine via vertebral body screws. Correction is achieved by applying compression between adjacent vertebral body screws, before locking each screw onto the rod. Biomechanical complication rates have been reported as high as 20.8%, and include rod breakage, screw pull-out and loss of correction. Currently, the corrective forces applied to the spine are unknown. These forces are important variables to consider in understanding the biomechanics of scoliosis correction. The purpose of this study was to measure these forces intra-operatively during anterior single rod AIS correction.

Using resilience to reconceptualise child protection workforce capacity

Current approaches to managing and supporting staff and addressing turnover in child protection predominantly rely on deficit-based models that focus on limitations, shortcomings, and psychopathology. This article explores an alternative approach, drawing on models of resilience, which is an emerging field linked to trauma and adversity. To date, the concept of resilience has seen limited application to staff and employment issues. In child protection, staff typically face a range of adverse and traumatic experiences that have flow-on implications, creating difficulties for staff recruitment and retention and reduced service quality. This article commences with discussion of the multifactorial influences of the troubled state of contemporary child protection systems on staffing problems. Links between these and difficulties with the predominant deficit models are then considered. The article concludes with a discussion of the relevance and utility of resilience models in developing alternative approaches to child protection staffing issues.

Class language

How social class factors into linguistic practices and use, language change and loss has been a major theme in postwar sociolinguistics and ethnography of communication, language planning and sociology of language. Key foci of linguistic and sociological research include the study of social class in everyday language use, media and institutional texts. A further concern is to understand the relationship between social class stratification, intergenerational social reproduction, and language variation. Bourdieu’s model of linguistic habitus and cultural capital offers a broad theoretical template for examining these relations, even as they are complicated by forces of economic and cultural globalization, new media and identity formations.