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Pantaleon F. G.,Hospital Clinico Quirurgico Hermanos Ameijeiras | Juvier R. T.,Institute Neurologia Y Neurocirugia Prof Rafael Estrada
Revista Chilena de Pediatria | Year: 2015

Rett syndrome (RS) is a neurodevelopmental disorder that exclusively affects girls, and occurs along with autism. It is very uncommon, and has five distinct forms, one classic and the others atypical, which generally compromise manual skills, language, and mobility, and widely associated with the appearance of stereotypy and early epilepsy. With the aim of updating the information about RS, a search was performed in the computer data bases of PubMed, Hinari, SCIELO and Medline, as well as consulting other web sites including OMIM, ORPHANET, GeneMap, Genetests, Proteins and Gene, using the descriptors “Síndrome de Rett”, “genes y Síndrome de Rett”, “Rett Syndrome gene”, “Rett Syndrome”, “Rett Syndrome gene therapy”, and “Rett Syndrome review”. Of the 1,348 articles found, 42 articles were selected, which reported 3 genes causing the syndrome: MECP2, CDKL5 and FOXG. The MECP2 gene is mutated in 80% of patients with classic RS, as well as in 40% of those affected by any of its atypical forms. RS with early epilepsy and the congenital variant are mainly due to variations in the CDKL5 and FOXG1 genes, respectively. Conclusions: The diagnosis of RS is based on clinical criteria. However, the advances in molecular biology and genetics have opened a wide range of possibilities for diagnosing the different clinical forms that could not be classified before. Molecular analysis can help confirm the clinical criteria and provided information as regards the prognosis of the patient. © 2015 Publicado por Elsevier España. Source

Every medical surgical action implies costs. Costs of medical provisions should be translated into tangible, and thus, measurable, benefits for the health status of the patient. Nutritional support therapies might increase the costs of medical provisions, but it is expected their implementation to result in lower morbidity and mortality rates as well as shortening of hospital stay, all of them leading to important savings. It is then required the assimilation of tools for costs analysis for a better management of nutritional support therapies. A proposal for the design of a hospital system (regarded anywhere in this text as SHACOST) for the analysis of the costs of interventions conducted in a patient in accordance with the guidelines included in the Metabolic, Nutrient and Food Intervention Program (referred everywhere for its Spanish acronym PRINUMA) is presented in this article. Hence, strategies are described to estimate the costs of a specified intervention. In addition, a primer on cost-effectiveness (ACE) and incremental cost-effectiveness (ACEI) analyses is shown relying on examples taken from the authors’s experience in the provision of nutritional care to patients electively operated for a colorectal cancer. Finally, costs of surgical treatment of a mandibular tumor are described, followed by a discussion on how a better impact of the adopted surgical action could be achieved without considerable increases in total costs should a perioperatory nutritional support program be included. Implementation of SHACOST can provide the medical care teams with accounting tools required to assess the effectiveness of hospital nutritional support schemes, decide whether to acquire and introduce new technologies, and measure the impact of the performance of hospital forms for provision of nutritional care upon health management and perceived quality of life of the patient and their relatives. © 2015, Grupo Aula Medica S.A. All rights reserved. Source

Duran Arrieta G.,Hospital Clinico Quirurgico Hermanos Ameijeiras
Revista Cubana de Educacion Medica Superior | Year: 2013

Professional guidance in nursing postgraduate studies is mainly aimed at consolidating knowledge with an efficient and responsible character in the search of solution to problems in the professional practice. Taking into account the present need for the perspectives on development of human resources in the nursing personnel in the National Health System, what demands their professional strength as well as the need to be at the level of Scientific and Technical Revolution what will redound to the improvement in the quality of the attention to the patient, the family and the community, it has been important to carry out a work for professional guidance directed to professional nurses who are involved in postgraduate studies (Masters Degrees, nursing specialties and diploma Courses) in different modalities in hospitalization centres in Centro Havana Municipality. For this work, a universe of 60 professional nurses was used and a sample of 25 was taken representing a 41.6%. The method used was the descriptive, explanatory one. Courses on professional guidance were given. A control was made at the beginning of the postgraduate studies as well as halfway through them to know if they knew the importance of applying the knowledge of professional guidance; besides, surveys and interviews to experts in Nursing Studies were made. At the beginning of the introductory course, it was realized that they didn't know the importance of the application of the material studied; later, achievements in obtaining knowledge about professional guidance and the connotation it has in the course of their professional competence were observed. © 2013 2002, Editorial Ciencias Médicas. Source

An education research was conducted to identify the satisfaction of residents and professors of the specialty of Physical Medicine and Rehabilitation with the course on Physical Agents given in the Diploma Course on Rehabilitation in Primary Health Attention and evaluate retention of the contents studied as well as the need to deal with these contents again, because of their importance, in the course design of the specialty. To measure the level of satisfaction, inquiries were applied to the 23 second year residents of the specialty and 16 professors who gave lessons in the course. A theory exam was applied to all residents to evaluate retention of the above contents. For information analysis, all data were processed by means of frequencies and percentages, they were shown in tables and, to emphasize their importance, a triangulation of data with theoretical elements was presented. The results showed low satisfaction with the contents on physical agents given in the Diploma Course which are not sufficient; they are not updated and present difficulties in their depth and application what means that they should be undertaken again in depth in the course design of the specialty. Residents showed not to have enough knowledge of the contents received. © 2013 2002, Editorial Ciencias Médicas. Source

Cordero Escobar I.,Hospital Clinico Quirurgico Hermanos Ameijeiras
Revista española de anestesiología y reanimación | Year: 2011

We report the use of sugammadex to reverse a rocuronium block in a man who had received a kidney transplant 4 years earlier. The patient was admitted for gastric non-Hodgkins lymphoma and bleeding that required surgery. Arterial hypertension, tachycardia, and frequent ventricular extrasystoles were detected. Anesthetic induction was accomplished with propofol, fentanyl, and rocuronium; intubation was uneventful. We monitored pulse oximetry, capnography, heart rate, electrocardiography, arterial pressure (invasive), cardiac output, end-systolic volume, bispectral index, temperature, and neuromuscular function. Anesthesia was maintained with an infusion of propofol, fentanyl, and rocuronium guided by train-of-four (TOF) ratio. Total diuresis was 1100 mL. The operation lasted 4.5 hours. Recovery of neuromuscular response was spontaneous until the second TOF twitch, after which we injected 2 mg/kg of sugammadex. A TOF ratio of 0.94 was recorded 158 seconds after injection of the reversal agent. The patient was extubated without complications. Sugammadex can be used in patients with a transplanted kidney, provided the glomerular filtration rate has recovered sufficiently to allow full excretion of the sugammadex-rocuronium complex. Source

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