Clínica, evolución y sobrevida de los pacientes que desarrollaron síndrome de intestino corto posterior a resección quirúrgica por enterocolitis necrotizante grado III en el HNNBB en el período enero 2006-diciembre 2010.

La enterocolitis necrotizante es de las enfermedades más frecuentes en la etapa neonatal con alta morbi mortalidad, requiriendo en muchos casos resección quirúrgica, predisponiendo de manera directa al desarrollo del síndrome de intestino corto. El síndrome de intestino corto conlleva a una serie de complicaciones nutricionales, infecciosas y metabólicas importantes no identificadas en nuestro medio y que están asociadas a factores directos e indirectos que aún no se han descrito. Las características clínicas dependerán del segmento resecado, extensión, compromiso de la válvula ileocecal, grado de adaptación intestinal y complicaciones posquirúrgicas. Su manejo es principalmente nutricional y requiere un equipo multidisciplinario para complementar las necesidades principales del tratamiento y mejorar el pronóstico. Objetivos: En este estudio de graduación para optar al título de especialista en medicina pediátrica se describirán las características epidemiológicas, clínicas, el manejo quirúrgico y de soporte en niños que se someten a resección intestinal por enterocolitis necrotizante grado III y desarrollan síndrome de intestino corto, así como su prevalencia y complicaciones frecuentes observadas en el período entre enero 2006 a diciembre 2010. Material y Métodos: El estudio se realizó a través de una revisión sistemática de expedientes clínicos de pacientes con diagnóstico de enterocolitis necrotizante. La recolección de éstos datos se realizó utilizando la base de datos del departamento de estadística del HNNBB en un periodo de 5 años. Se registraron 216 casos de enterocolitis necrotizante y de éstos se depuraron según los criterios de inclusión y exclusión hasta extraer solamente a aquellos a los cuales se les realizó cirugía intestinal y se identificaron los que cumplían con la definición de síndrome de intestino corto, siendo 17 y 6 respectivamente. Resultados: Posterior a esta recolección se aporta información actual y real a las diferentes disciplinas involucradas en el manejo del niño con SIC secundario a resección quirúrgica por ECN. Se describen los factores epidemiológicos y clínicos que mantienen relación directa o indirecta con el desarrollo de síndrome de intestino corto y también el tratamiento médico y quirúrgico que influyeron en el mismo.

Síndrome del nervio interóseo posterior: presentación de 3 casos.

La neuropatía compresiva del nervio interóseo posterior es poco frecuente. Clínicamente se expresa por una paresia (o plejia) de los músculos extensores del puño, los dedos y abductores del pulgar. El estudio eléctrico es fundamental para determinar la topografía de la lesión, y la ecografía o imagen por resonancia magnética ayudan a descartar causas secundarias de compresión, pero el diagnóstico sigue reposando en un correcto examen clínico. En los casos que no mejoran o que tienen un déficit severo, se debe indicar el tratamiento quirúrgico dado que tiene hasta un 95% de buenos resultados cuando se acompaña de una buena rehabilitación posterior. Se presentan tres casos de parálisis del nervio interóseo posterior por compresión en su recorrido por debajo del músculo supinador corto. De los mismos, uno tuvo mejoría espontánea y dos requirieron cirugía descompresiva.

O efeito do tratamento da atapulgita no desenvolvimento de compósito com o polietileno reciclado

The study aimed at the treatment of attapulgite for the development and characterization of composite recycled low density polyethylene - PEBD_rec embedded with natural attapulgite - ATP_NAT, sifted - ATP_PN and attapulgite treated with sulfuric acid - ATP_TR in different compositions (1, 3 and 5%) and compared with the PEBD_rec. The atapulgitas, natural, screened and treated, were characterized by X-ray diffraction (XRD), X-ray fluorescence (XRF), particle size analysis, scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS) and determining the area specific surface (BET). The composites were characterized by thermogravimetry (TG), differential scanning calorimetry (DSC), Xray diffraction (XRD), torque rheometry, scanning electron microscopy (SEM) and traction. The composite PEBD_rec / ATP (natural, sieved and treated) were produced by mixing in the molten state in a single screw extruder matrix wire with subsequent reprocessing matrix tape. It was found that the screening of attapulgite not reduce the quantity of quartz and the acid treatment completely extracted dolomite aggregate impurities of the channels attapulgite, and increase their surface area. The addition of attapulgite in PEBD_rec acts as a catalyst, reducing the thermal stability of the polymer. The increased concentration of attapulgite, increases resistance and reduces the elongation at break and modulus of elasticity of the composite PEBD_rec / attapulgite

Use of posterior predictive assessments to evaluate model fit in multilevel logistic regression

Assessing the fit of a model is an important final step in any statistical analysis, but this is not straightforward when complex discrete response models are used. Cross validation and posterior predictions have been suggested as methods to aid model criticism. In this paper a comparison is made between four methods of model predictive assessment in the context of a three level logistic regression model for clinical mastitis in dairy cattle; cross validation, a prediction using the full posterior predictive distribution and two “mixed” predictive methods that incorporate higher level random effects simulated from the underlying model distribution. Cross validation is considered a gold standard method but is computationally intensive and thus a comparison is made between posterior predictive assessments and cross validation. The analyses revealed that mixed prediction methods produced results close to cross validation whilst the full posterior predictive assessment gave predictions that were over-optimistic (closer to the observed disease rates) compared with cross validation. A mixed prediction method that simulated random effects from both higher levels was best at identifying the outlying level two (farm-year) units of interest. It is concluded that this mixed prediction method, simulating random effects from both higher levels, is straightforward and may be of value in model criticism of multilevel logistic regression, a technique commonly used for animal health data with a hierarchical structure.

Citrato de fentanyl a diferentes dosis en su capacidad protectora ante los cambios hemodinámicos posterior a la intubación orotraqueal en pacientes de cirugía abdominal, en Hospital Nacional de Santiago de María, año 2015

La presente investigación surge como respuesta a la necesidad de comparar diferentes dosis de citrato de fentanyl en su capacidad protectora de los cambios en la presión arterial sistólica, diastólica, media, frecuencia cardíaca y saturación de oxígeno posterior a la intubación orotraqueal. Esto insistió a formular el Tema: Citrato de fentanyl a diferentes dosis en su capacidad protectora ante los cambios hemodinámicos posterior a la intubación orotraqueal en pacientes de cirugía abdominal, en hospital nacional de Santiago de María, año 2015. Por ello se elaboró el Objetivo: Comparar citrato de fentanyl a diferentes dosis en su capacidad protectora ante los cambios hemodinámicos posterior a la intubación orotraqueal. Se construyó la Metodología base de estudio: La investigación es de tipo ensayo clínico controlado, ya que evaluamos experimentalmente el fentanil a diferentes dosis y se controlaron las variables. La selección de los pacientes se realizó mediante la determinación de criterios de inclusión. Los instrumentos que se utilizaron para la obtención de la información son la guía de observación, en la cual se llevó un control y monitoreo continuo de los signos vitales de los pacientes que formaron parte de la investigación. Asimismo se obtuvieron los Resultados que fueron procesados por medio del sistema SPSS versión 19, determinando si tenían una distribución normal mediante Shapiro-Wilk dependiendo de esto se le aplicaron pruebas estadísticas de T-Student, U de Mann Whitney, determinando que el fentanyl a dosis de 4 mcg/kg proporciona una mayor estabilidad en los cambios hemodinámicos que se dan posterior a la intubación orotraqueal.

Discrepância posterior e sua relação com o padrão de crescimento facial hiperdivergente

Poster apresentado na XXVII Reunião Científica Anual da SPODF. Figueira da Foz, 23-25 Abril 2015

Clinical characteristics and selection of treatment modality for patients with vitreomacular traction:real-world implementation of NICE guidance (TA297)

Aim: To investigate the qualitative aspects in patient selection and the quantitative impact of disease burden in real world treatment of vitreomacular traction (VMT) and implementation of the National Institute for Health and Care Excellence (NICE) guidance (TA297). Methods: A monocentric, retrospective review of consecutive patients undergoing optical coherence tomography (OCT) imaging over a 3 month period. Patients with VMT in at least one eye were identified for further data collection on laterality, visual acuity, symptoms, presence of epiretinal membrane, macular hole and treatment selection. Results: A total of 3472 patients underwent OCT imaging with a total of 6878 eyes scanned. Out of 87 patients, 74 patients had unilateral VMT (38 right, 36 left) and 13 patients had bilateral VMT. Eighteen patients with unilateral VMT satisfied NICE criteria of severe sight problems in the affected eye. Eight were managed for a coexisting pathology, one refused treatment, one patient did not attend, two closed spontaneously, and one received ocriplasmin prior to the study start date. Only two patients with unilateral VMT received ocriplasmin and three underwent vitrectomy. Those failing to meet NICE criteria for unilateral VMT were predominantly asymptomatic (n=49) or had coexisting ERM (n=5) or both (n=2). Conclusion: Ocriplasmin provides an alternative treatment for patients with symptomatic VMT. Our data shows that the majority of patients with VMT do not meet NICE TA297 primarily due to lack of symptoms. Those meeting NICE criteria, but not treated, tended to have coexisting macular pathology. Variation in patient selection due to subjective factors not outlined in NICE guidance suggests that real world outcomes of ocriplasmin therapy should be interpreted with caution.

Efeito de diferentes tempos de alongamento na flexibilidade da musculatura posterior da coxa

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Fisioterapia

Resolución 218 del 04 de noviembre de 2009: ¿Puede una ley posterior configurar situaciones jurídicas constituidas bajo una ley anterior?

Servicios registrales

Luxación esternoclavicular posterior

Paciente masculino de 24 años, ingresa a urgencias por trauma contundente en clavícula derecha durante accidente de tránsito. Presenta dolor en articulación esternoclavicular que se exacerba con la movilización del hombro y disfagia. Al examen físico, leve depresión del extremo medial de la clavícula y limitación de los arcos de movimiento del hombro. Las imágenes confirmaron el diagnostico de LEC posterior. El paciente fue llevado a cirugía para reducción y cerclaje, sin complicaciones.

Functional heterogeneity of medial posterior parietal cortex of macaque monkey

The posterior parietal cortex (PPC) of primates represents a remarkable platform that has evolved over time to solve some of the computational challenges that we face in the everyday life, such as sensorimotor integration, spatial attention, and motor planning. With the aim of further investigating the multifaceted functional characteristics of medial PPC, we conducted three studies to explore the visuomotor, somatic, visual, and attention-related properties of two PPC areas: V6A, a visuomotor area part of the dorsomedial visual stream, and PE, an area strongly dominated by somatomotor input, residing mainly on the exposed surface of the superior parietal lobule. In the first study, we tested the impact of visual feedback on V6A grasp-related activity during arm movements towards objects of different shapes. Our results demonstrate that V6A is modulated by both grip type and visual information during grasping preparation and execution, with a predominance of cells influenced by grip type. In the second study, we explored the influence of depth and direction information on reach-related activity of neurons in the so far largely neglected medial part of area PE. We observed a remarkable trend in medial PPC, going from the joint coding of depth and direction signals caudally, in area V6A, to a largely segregated processing of the two signals rostrally, in area PE. In the third study, we used a combined fMRI-electrophysiology experiment to investigate the neuronal mechanisms underlying covert shift of attention processes in area V6A. Our preliminary results reveal that half of the cells showed shift-selective activity when the monkey covertly shifted its attention towards the receptive field. All together these findings highlight the role of the medial PPC in integrating information coming from different sources (vision, somatosensory and motor) and emphasize the involvement of action-related regions of the dorsomedial visual stream in higher level cognitive functions.

Lifetime Modeling of SiC Power Modules in Automotive Traction Inverters

This thesis presents a model-based software implementation for the estimation of the damage of a power module inside and automotive traction inverter with few hardware test setup performed to support the simulation with real-life data.

Analysis of human posterior EEG alpha frequency as a function of implicit learning of probabilistic lateralized stimuli in a visual detection task

Alpha oscillatory activity has long been associated with perceptual and cognitive processes related to attention control. The aim of this study is to explore the task-dependent role of alpha frequency in a lateralized visuo-spatial detection task. Specifically, the thesis focuses on consolidating the scientific literature's knowledge about the role of alpha frequency in perceptual accuracy, and deepening the understanding of what determines trial-by-trial fluctuations of alpha parameters and how these fluctuations influence overall task performance. The hypotheses, confirmed empirically, were that different implicit strategies are put in place based on the task context, in order to maximize performance with optimal resource distribution (namely alpha frequency, associated positively with performance): “Lateralization” of the attentive resources towards one hemifield should be associated with higher alpha frequency difference between contralateral and ipsilateral hemisphere; “Distribution” of the attentive resources across hemifields should be associated with lower alpha frequency difference between hemispheres; These strategies, used by the participants according to their brain capabilities, have proven themselves adaptive or maladaptive depending on the different tasks to which they have been set: "Distribution" of the attentive resources seemed to be the best strategy when the distribution probability between hemifields was balanced: i.e. the neutral condition task. "Lateralization" of the attentive resources seemed to be more effective when the distribution probability between hemifields was biased towards one hemifield: i.e., the biased condition task.

Mordida Cruzada posterior em crianças: como previnir futuras maloclusões

A saúde bucal, como parte integrante e inseparável da saúde geral do indivíduo, precisa oferecer condições para que a criança cresça e se desenvolva da melhor forma possível. O presente trabalho teve como objetivo abordar o tema "Mordida cruzada posterior em crianças" como prevenir futuras "Maloclusões" e obter conhecimento suficiente para orientar os pais sobre a importância da amamentação como prevenção de maloclusões na dentição decídua, ressaltando a importância do diagnóstico e da intervenção precoce para evitar maloclusões graves na dentição permanente. O aleitamento materno exclusivo até o sexto mês e parcial até um ano de idade é fundamental para o crescimento e desenvolvimento da criança e tem um papel importante na prevenção de problemas ortodônticos. A duração insuficiente do aleitamento natural está associada à presença de hábitos de sucção e influencia o desenvolvimento de mordidas cruzadas posteriores. Realizou-se uma revisão de literatura com buscas de artigos relacionados ao tema na língua portuguesa e inglesa nas bases virtuais de dados da Scielo, BBO, Bireme e Lilacs, sendo utilizadas as palavras-chave "mordida cruzada posterior", "saúde bucal", "odontopediatria", "maloclusões", "saúde bucal infantil", que tiveram publicações entre 1988 e 2010. A persistência dos hábitos de chupeta e/ou dedo entre cinco e seis anos revelaram oito vezes mais chances para o desenvolvimento de Mordida Cruzada Posterior (MCP), em relação às crianças que nunca possuíram tais hábitos. A MCP dificilmente se corrige espontaneamente com a idade e o diagnóstico precoce em portadores de MCP é de extrema importância, haja vista que as modificações oclusais, musculares, ósseas e até mesmo articulares poderão originar-se durante o estabelecimento da oclusão dos dentes decíduos. Concluiu-se, portanto, que existe a necessidade de implantação de programas de prevenção e controle de maloclusões em crianças na rede pública de saúde, pois embora relativamente simples, a atenção dada nessa fase, é extremamente importante para permitir o desenvolvimento normal da dentição e o estabelecimento de uma adequada oclusão. Quanto mais precocemente forem descobertas essas alterações, maiores serão as possibilidades de reabilitação, devolvendo a harmonia fisiológica ao indivíduo.

The Influence Of Altered Occlusion On Pro-inflammatory Cytokine Levels In The Tmj Synovial Tissues Of Rats.

The aim of this study was to evaluate whether altered occlusion affects both the condylar cartilage thickness and the cytokine levels of the TMJs of rats. Thirty adult-male rats (n=30) were randomly assigned to three experimental conditions: a control group that underwent sham operations with unaltered occlusion; an FPDM group that underwent functional posterior displacement of the mandible that was induced by an incisor guiding appliance; and an iOVD group in which the increased occlusal vertical dimension was induced in the molars. The rats were subjected to the FPDM or iOVD model for 14 days and then killed. Both the right and left TMJs were removed and randomly assigned to examination with staining or immunoassay techniques. Toluidine blue staining was used to measure the thicknesses of the four layers of the articular cartilage (i.e., the fibrous, proliferating, mature, and hypertrophic layers). ELISA assays were used to assess the concentrations of the pro-inflammatory cytokines IL-1α, IL-1β, IL-6, and tumour necrosis factor (TNF-α). The measurements of the articular cartilage layers and cytokine concentrations were analyzed with ANOVA and Tukey's tests and Kruskal-Wallis and Dunn tests, respectively (α=5%). The thickness of articular cartilage in the FPDM group (0.3±0.03mm) was significantly greater than those of the control (0.2±0.01mm) and iOVD (0.25±0.03mm) groups. No significant difference was observed between the control and iOVD groups. The four articular cartilage layers were thicker in the FPDM group than in the control and iOVD groups, and the latter two groups did not differ one from each other. Both the FPDM and iOVD groups exhibited higher cytokine levels than did the control (p<0.05) group. Compared to the FPDM group, the iOVD group exhibited significantly higher levels of IL-1β and TNF-α. Both models induced inflammation in the TMJ and caused significant structural changes in the TMJ and surrounding tissues.