Curva de aprendizaje para ecografía cardiaca en residentes de primer y segundo año de medicina crítica de la universidad del rosario en el año 2016

La ecografía básica cardiaca (ECB) es una herramienta útil en la Unidad de Cuidados intensivos al facilitar la realización de ciertas intervenciones. No se ha definido el número de repeticiones necesarias para obtener un nivel de competencia adecuado. La evidencia encontrada indica un número mínimo de cincuenta repeticiones, para alcanzar cierto grado de habilidad.

Tratamiento quirúrgico del síndrome de apnea hipopnea obstructiva del sueño en la Clínica Rivas, Bogotá – Colombia

Introducción: El Síndrome de Apnea Hipopnea Obstructiva del Sueño es un trastorno respiratorio del sueño mayor ampliamente conocido, con importantes implicaciones para los pacientes y cuya incidencia ha venido en aumento durante los últimos años; comprende diversas manifestaciones clínicas que varían desde el ronquido hasta consecuencias cardiovasculares importantes. Objetivo: Describir la experiencia de los procedimientos quirúrgicos más utilizados para el tratamiento de pacientes con Trastornos Respiratorios del Sueño en la Clínica Rivas. Diseño: Estudio observacional descriptivo. Métodos: Revisión de 366 historias clínicas de pacientes con diagnóstico clínico y Polisomnográfico de SAHOS intervenidos quirúrgicamente debido al Trastorno Respiratorio del Sueño por rechazo de terapia de presión positiva en 3 años de observación. Resultados: Se evaluaron diferencias en medianas de los cambios del IAH, índice de Saturación de oxigeno basal y mínima, y el índice de microdespertares nocturnos tanto prequirúrgica como postquirúrgicamente. Como medida de evaluación secundaria se evaluaron las complicaciones quirúrgicas. Conclusión: En nuestra institución, como centro de referencia en apnea del sueño, la cirugía ha demostrado que disminuye de forma significativa gravedad del SAHOS y disminuye el riesgo de los pacientes con trastornos respiratorios del sueño que han rechazado el dispositivo de presión positiva.

Descripción de la prevalencia del boarding en la fundación santa fe de bogotá.

Introducción: El boarding es el fenómeno que ocurre cuando existen pacientes hospitalizados en urgencias sin una cama de hospitalización a la cual trasladarse, en la literatura mundial se ha identificado como un factor que repercute en la calidad y seguridad de la atención en urgencias. Este trabajo busca describir la prevalencia de dicho fenómeno en el servicio de urgencias de la Fundación Santa fe de Bogotá Metodología: Estudio observacional de prevalencia. Se incluyeron pacientes del mes de octubre de 2015 atendidos por especialistas en medicina de emergencias de la Fundación Santa fe de Bogotá. Se tomaron datos del turno realizado (mañana, tarde y noche), y datos del servicio de urgencias para su descripción. Resultados: La mediana de ocupación por boarding en urgencias fue del 68% con un rango intercuartil de 54-75%; en términos de tiempo en minutos, la mediana fue de 1054 minutos, con un rango intercuartil de 621-1490. Existen diferencias numéricas del tiempo en minutos de acuerdo el turno (mañana: 992,77 DE 519, tarde:1584,13 DE 1000,27 noche:1304,13 DE 2126,43). Discusión: El tiempo de boarding reportado para urgencias de la Fundación Santa fe de Bogotá es comparativamente mayor al descrito en la literatura mundial, se deben explorar en estudios analíticos posteriores los factores o variables que se asocien a la presencia de este fenómeno.

Las empresas energéticas y la gran estrategia estadounidense hacia Irak : una reflexión sobre el rol de Exxon Mobil y Chevron como grupos económicos y de presión (2001- 2011)

La monografía pretende explicar el rol desempeñado por Exxon Mobil y Chevron en la formulación de la Gran Estrategia del gobierno Bush hacia Irak. Especialmente, se sostiene que las dos compañías multinacionales mencionadas lograron que la intervención militar en Irak, fuera pensada como un objetivo fundamental de la política energética del gobierno Bush. Para lograr este objetivo, Chevron y Exxon aprovecharon principalmente su posición en la economía nacional estadounidense. De hecho, lograron celebrar contratos a largo plazo para la extracción del crudo y de gas en Irak. Fundamentándose en un análisis documental, estas compañías son analizadas como grupos de presión empresarial y grupos económicos, cuyos beneficios derivados de la invasión en Irak pueden encontrarse incluso durante el gobierno Obama.

La seguridad energética de Estados Unidos a inicios del siglo XXI: ¿securitización o politización del acceso a recursos energéticos?

Tradicionalmente, la consolidación de la seguridad energética en Estados Unidos se ha mostrado como un asunto de seguridad nacional. En especial, la escasez de recursos energéticos ha sido vista como un problema existencial que requiere de medidas de emergencia en el marco de un proceso de securitización. Sin embargo, esta investigación surgiere que el tema ha sido mayoritariamente politizado a inicios del siglo XXI. Quizá este proceso de securitización tan solo fue implícitamente planteado con ocasión de la invasión a Irak en 2003, en la medida en que dicha intervención pudo haberse inspirado por la necesidad de derrocar a un régimen que había impedido el acceso estadounidense a recursos petroleros iraquíes. En este orden de ideas, la investigación analiza las políticas de seguridad energética de los gobiernos de George W. Bush y Barack H. Obama con el propósito de entender el grado en el que estas estuvieron vinculadas a sus respectivas agendas de seguridad nacional.

Veterinary allergy diagnosis: past, present and future perspectives

Fleas, several aeroallergens as well as many food allergens are the most common allergenic sources for animals and frequent cause of allergic reactions with different target organs such as skin, eyes, and respiratory or digestive systems. Allergy diagnosis needs to follow well-established guidelines under clinical and laboratory approaches. Since 1980 with the Hanifin & Rajka’s criteria for the diagnosis of atopic dermatitis (AD) in humans, successive proposals have been developed to identify atopic dermatitis in dogs. A consensual plan was first proposed by Willemse in 1986 undergoing several modifications in 1994. Prélaud and colleagues made important changes to the plan in 1998 and it was further adjusted by Favrot in 2009. In 2010, this plan was approved by the International Task Force on Canine Atopic Dermatitis (CAD). It was subjected in 2015 to minor updates with regard to therapeutic options. To improve diagnostic accuracy by integrating the basic knowledge on sensitization development and allergen nature and diversity, allergen sources and implicated molecular allergens for animals should be clearly identified. As well as in human medicine, this molecular epidemiology concept is essential for the veterinary allergy diagnosis in the near future, standing as the basis of a component-resolved diagnosis (CRD). Besides current pharma- cotherapy, it will be highly relevant to increase the efficiency of the avoidance measures and specific immunotherapy. Clinical guidelines will lead to at least 80 % of positive diagnosis of atopy, but newer laboratory methods in veterinary medicine aiming to a more precise diagnosis and a better integration of the clinical/laboratory diagnostic course are needed. Allergoms identification for animals, from different allergen sources proteoms should become a priority in veterinary allergology, in order to allow the intended CRD, which is essential to understand the cross-reaction phenomena, allowing a more precise and possibly effective component-resolved immunotherapy (CRIT). Further research has been carried out for a better understanding of the interaction between allergic clinical condition and immune pathophysiology. As well as in human medicine, a deeper knowledge of the molecular immunological mechanisms in veterinary allergy — with their specific allergen triggers — will also provide the veterinary allergist with the necessary information to act more efficiently in the future.

Effect of bandwidth knowledge of results on the learning of a grip force control task

An experiment was conducted to investigate the persistence of the effect of ""bandwidth knowledge of results (KR)"" manipulated during the learning phase of performing a manual force-control task. The experiment consisted of two phases, an acquisition phase with the goal of maintaining 60% maximum force in 30 trials, and a second phase with the objective of maintaining 40% of maximum force in 20 further trials. There were four bandwidths of KR: when performance error exceeded 5, 10, or 15% of the target, and a control group (0% bandwidth). Analysis showed that 5, 10, and 15% bandwidth led to better performance than 0% bandwidth KR at the beginning of the second phase and persisted during the extended trials.

Soldiers in a stingless bee: work rate and task repertoire suggest they are an elite force

The differentiation of workers into morphological subcastes (e.g., soldiers) represents an important evolutionary transition and is thought to improve division of labor in social insects. Soldiers occur in many ant and termite species, where they make up a small proportion of the workforce. A common assumption of worker caste evolution is that soldiers are behavioral specialists. Here, we report the first test of the "rare specialist" hypothesis in a eusocial bee. Colonies of the stingless bee Tetragonisca angustula are defended by a small group of morphologically differentiated soldiers. Contrary to the rare specialist hypothesis, we found that soldiers worked more (+34%-41%) and performed a greater variety of tasks (+23%-34%) than other workers, particularly early in life. Our results suggest a "rare elite" function of soldiers in T. angustula, that is, that they perform a disproportionately large amount of the work. Division of labor was based on a combination of temporal and physical castes, but soldiers transitioned faster from one task to the next. We discuss why the rare specialist assumption might not hold in species with a moderate degree of worker differentiation.

Grip and load force coordination in cyclical isometric manipulation task is not affected by the feedback type

Background: The relationship between normal and tangential force components (grip force - GF and load force - LF, respectively) acting on the digits-object interface during object manipulation reveals neural mechanisms involved in movement control. Here, we examined whether the feedback type provided to the participants during exertion of LF would influence GF-LF coordination and task performance. Methods. Sixteen young (24.7 ±3.8 years-old) volunteers isometrically exerted continuously sinusoidal FZ (vertical component of LF) by pulling a fixed instrumented handle up and relaxing under two feedback conditions: targeting and tracking. In targeting condition, FZ exertion range was determined by horizontal lines representing the upper (10 N) and lower (1 N) targets, with frequency (0.77 or 1.53 Hz) dictated by a metronome. In tracking condition, a sinusoidal template set at similar frequencies and range was presented and should be superposed by the participants' exerted FZ. Task performance was assessed by absolute errors at peaks (AEPeak) and valleys (AEValley) and GF-LF coordination by GF-LF ratios, maximum cross-correlation coefficients (r max), and time lags. Results: The results revealed no effect of feedback and no feedback by frequency interaction on any variable. AE Peak and GF-LF ratio were higher and rmax lower at 1.53 Hz than at 0.77 Hz. Conclusion: These findings indicate that the type of feedback does not influence task performance and GF-LF coordination. Therefore, we recommend the use of tracking tasks when assessing GF-LF coordination during isometric LF exertion in externally fixed instrumented handles because they are easier to understand and provide additional indices (e.g., RMSE) of voluntary force control. © 2013 Pedão et al.; licensee BioMed Central Ltd.

Visuomotor processing and hand force coordination in dyslexic children during a visually guided manipulation task

Developmental Dyslexia negatively affects children's reading and writing ability and, in most cases, performance in sensorimotor tasks. These deficits have been associated with structural and functional alterations in the cerebellum and the posterior parietal cortex (PPC). Both neural structures are active during visually guided force control and in the coordination of load force (LF) and grip force (GF) during manipulation tasks. Surprisingly, both phenomena have not been investigated in dyslexic children. Therefore, the aim of this study was to compare dyslexic and non-dyslexic children regarding their visuomotor processing ability and GF-LF coordination during a static manipulation task. Thirteen dyslexic (8-14YO) and 13 age- and sex-matched non-dyslexic (control) children participated in the study. They were asked to grasp a fixed instrumented handle using the tip of all digits and pull the handle upward exerting isometric force to match a ramp-and-hold force profile displayed in a computer monitor. Task performance (i.e., visuomotor coordination) was assessed by RMSE calculated in both ramp and hold phases. GF-LF coordination was assessed by the ratio between GF and LF (GF/LF) calculated at both phases and the maximum value of a cross-correlation function (r(max)) and its respective time lag calculated at ramp phase. The results revealed that the RMSE at both phases was larger in dyslexic than in control children. However, we found that GF/LF, rmax, and time lags were similar between groups. Those findings indicate that dyslexic children have a mild deficit in visuomotor processing but preserved GF-LF coordination. Altogether, these findings suggested that dyslexic children could present mild structural and functional alterations in specific PPC or cerebellum areas that are directly related to visuomotor processing. (C) 2014 Elsevier Ltd. All rights reserved.

Do synergies improve accuracy? A study of speed-accuracy trade-offs during finger force production

We explored possible effects of negative covariation among finger forces in multifinger accurate force production tasks on the classical Fitts's speed-accuracy trade-off. Healthy subjects performed cyclic force changes between pairs of targets ""as quickly and accurately as possible."" Tasks with two force amplitudes and six ratics of force amplitude to target size were performed by each of the four fingers of the right hand and four finger combinations. There was a close to linear relation between movement time and the log-transformed ratio of target amplitude to target size across all finger combinations. There was a close to linear relation between standard deviation of force amplitude and movement time. There were no differences between the performance of either of the two ""radial"" fingers (index and middle) and the multifinger tasks. The ""ulnar"" fingers (little and ring) showed higher indices of variability and longer movement times as compared with both ""radial"" fingers and multifinger combinations. We conclude that potential effects of the negative covariation and also of the task-sharing across a set of fingers are counterbalanced by an increase in individual finger force variability in multifinger tasks as compared with single-finger tasks. The results speak in favor of a feed-forward model of multifinger synergies. They corroborate a hypothesis that multifinger synergies are created not to improve overall accuracy, but to allow the system larger flexibility, for example to deal with unexpected perturbations and concomitant tasks.

Impairments of movement kinematics in patients with Huntington's disease: A comparison with and without a concurrent task

This study aimed to quantify the efficiency and smoothness of voluntary movement in Huntington's disease (HD) by the use of a graphics tablet that permits analysis of movement profiles. In particular, we aimed to ascertain whether a concurrent task (digit span) would affect the kinematics of goal-directed movements. Twelve patients with HD and their matched controls performed 12 vertical zig-zag movements, with both left and right hands (with and without the concurrent task), to large or small circular targets over long or short extents. The concurrent task was associated with shorter movement times and reduced right-hand superiority. Patients with HD were overall slower, especially with long strokes, and had similar peak velocities for both small and large targets, so that controls could better accommodate differences in target size. Patients with HD spent more time decelerating, especially with small targets, whereas controls allocated more nearly equal proportions of time to the acceleration and deceleration phases of movement, especially with large targets. Short strokes were generally less force inefficient than were long strokes, especially so for either hand in either group in the absence of the concurrent task, and for the right hand in its presence. With the concurrent task, however, the left hand's behavior changed differentially for the two groups; for patients with HD, it became more force efficient with short strokes and even less efficient with long strokes, whereas for controls, it became more efficient with long strokes. Controls may be able to divert attention away from the inferior left hand, increasing its automaticity, whereas patients with HD, because of disease, may be forced to engage even further online visual control under the demands of a concurrent task. Patients with HD may perhaps become increasingly reliant on terminal visual guidance, which indicates an impairment in constructing and refining an internal representation of the movement necessary for its. effective execution. Basal ganglia dysfunction may impair the ability to use internally generated cues to guide movement.

Influence of dual-task on sit-to-stand-to-sit postural control in Parkinson's disease

Postural control deficits are the most disabling aspects of Parkinson's disease (PD), resulting in decreased mobility and functional independence. The aim of this study was to assess the postural control stability, revealed by variables based on the centre of pressure (CoP), in individuals with PD while performing a sit-to-stand-to-sit sequence under single- and dual-task conditions. An observational, analytical and cross-sectional study was performed. The sample consisted of 9 individuals with PD and 9 healthy controls. A force platform was used to measure the CoP displacement and velocity during the sit-to-stand-to-sit sequence. The results were statistically analysed. Individuals with PD required greater durations for the sit-to-stand-to-sit sequence than the controls (p < 0.05). The anteroposterior and mediolateral CoP displacement were higher in the individuals with PD (p < 0.05). However, only the anteroposterior CoP velocity in the stand-to-sit phase (p = 0.006) was lower in the same individuals. Comparing the single- and dual-task conditions in both groups, the duration, the anteroposterior CoP displacement and velocity were higher in the dual-task condition (p < 0.05). The individuals with PD presented reduced postural control stability during the sit-to-stand-to-sit sequence, especially when under the dual-task condition. These individuals have deficits not only in motor performance, but also in cognitive performance when performing the sit-to-stand-to-sit sequence in their daily life tasks. Moreover, both deficits tend to be intensified when two tasks are performed simultaneously.

Linee guida della consensus conference dell'ANGP per il monitoraggio plasmatico dei farmaci (TDM) in psichiatria. Aggiornamento 2011 =AGNP consensus guidelines for therapeutic drug monitoring in psychiatry: update 2011

Therapeutic drug monitoring (TDM), i.e., the quantification of serum or plasma concentrations of medications for dose optimization, has proven a valuable tool for the patient-matched psychopharmacotherapy. Uncertain drug adherence, suboptimal tolerability, non-response at therapeutic doses, or pharmacokinetic drug-drug interactions are typical situations when measurement of medication concentrations is helpful. Patient populations that may predominantly benefit from TDM in psychiatry are children, pregnant women, elderly patients, individuals with intelligence disabilities, forensic patients, patients with known or suspected genetically determined pharmacokinetic abnormalities or individuals with pharmacokinetically relevant comorbidities. However, the potential benefits of TDM for optimization of pharmacotherapy can only be obtained if the method is adequately integrated into the clinical treatment process. To promote an appropriate use of TDM, the TDM expert group of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) issued guidelines for TDM in psychiatry in 2004. Since then, knowledge has advanced significantly, and new psychopharmacologic agents have been introduced that are also candidates for TDM. Therefore the TDM consensus guidelines were updated and extended to 128 neuropsychiatric drugs. 4 levels of recommendation for using TDM were defined ranging from "strongly recommended" to "potentially useful". Evidence-based "therapeutic reference ranges" and "dose related reference ranges" were elaborated after an extensive literature search and a structured internal review process. A "laboratory alert level" was introduced, i.e., a plasma level at or above which the laboratory should immediately inform the treating physician. Supportive information such as cytochrome P450 substrateand inhibitor properties of medications, normal ranges of ratios of concentrations of drug metabolite to parent drug and recommendations for the interpretative services are given. Recommendations when to combine TDM with pharmacogenetic tests are also provided. Following the guidelines will help to improve the outcomes of psychopharmacotherapy of many patients especially in case of pharmacokinetic problems. Thereby, one should never forget that TDM is an interdisciplinary task that sometimes requires the respectful discussion of apparently discrepant data so that, ultimately, the patient can profit from such a joint effort.