Hospital Militar Dr Carlos Arvelo

Carlos, Venezuela

Hospital Militar Dr Carlos Arvelo

Carlos, Venezuela

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Contreras F.,Medico Internista | Gutierrez R.,Hospital Militar Dr Carlos Arvelo | Velasco Y.M.,Farmacologo clinico
Revista Latinoamericana de Hipertension | Year: 2011

Leptin is secreted primarily by white adipose tissue and secondarily inoutrown fat. It participates as a satiety signal in the regulation of food intake. It promotes insulin resistance as well as nitric oxide-mediated vasodilation increasing the activity of the sympathetic system. Leptin stimulates insulin secretion out of adipose tissue too. This work was carried out to study how leptin affects the maintenance of hypertension and Diabetes mellitus type 2. Objective: to describe the interaction between leptin, diabetes and hypertension on healthy patients, the hypertensive diabetics type 2 as well as the relationship between leptin, non invasive hemodynamical variables and metabolic diseases. Methods: A crossed-comparative observational design research was done with 75 subjects who were selected and divided into three groups of 25 participants: Healthy, diabetics type 2 and hypertense. Patients were measured: anthropometric parameters, systolic blood pressure (SBP), diastolic blood pressure (DBP), and medial blood pressure (MBP). Biochemical variables as: insulin, glocose, HbA1c, HOMA-IR and leptin data were statistically analysed and described. Similarly, SBP, DBP and MAP were in the three groups (P>0.05). Conclusions: Leptin showed high levels in diabetic and hypertensive patients when compared with control group. The SBP, DBP.and MBP were altered in both diabetic and hypertense subjects resulting from the sympathetic system activation throughout leptin activity. In short, Diabetes type 2, which is an insulin resistance state, may be influenced by leptin levels as well as its relation with Diabetes Mellitus type 2 (DM2), and High blood pressure, (HBP).


Rosenthal V.D.,International Nosocomial Infection Control Consortium | Maki D.G.,University of Wisconsin - Medical School | Jamulitrat S.,Songklanagarind Hospital | Medeiros E.A.,Hospital Sao Paulo | And 22 more authors.
American Journal of Infection Control | Year: 2010

We report the results of the International Infection Control Consortium (INICC) surveillance study from January 2003 through December 2008 in 173 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study, using Centers for Disease Control and Prevention (CDC) US National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infection, we collected prospective data from 155,358 patients hospitalized in the consortium's hospital ICUs for an aggregate of 923,624 days. Although device utilization in the developing countries' ICUs was remarkably similar to that reported from US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were markedly higher in the ICUs of the INICC hospitals: the pooled rate of central venous catheter (CVC)-associated bloodstream infections (BSI) in the INICC ICUs, 7.6 per 1000 CVC-days, is nearly 3-fold higher than the 2.0 per 1000 CVC-days reported from comparable US ICUs, and the overall rate of ventilator-associated pneumonia (VAP) was also far higher, 13.6 versus 3.3 per 1000 ventilator-days, respectively, as was the rate of catheter-associated urinary tract infection (CAUTI), 6.3 versus 3.3 per 1000 catheter-days, respectively. Most strikingly, the frequencies of resistance of Staphylococcus aureus isolates to methicillin (MRSA) (84.1% vs 56.8%, respectively), Klebsiella pneumoniae to ceftazidime or ceftriaxone (76.1% vs 27.1%, respectively), Acinetobacter baumannii to imipenem (46.3% vs 29.2%, respectively), and Pseudomonas aeruginosa to piperacillin (78.0% vs 20.2%, respectively) were also far higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 23.6% (CVC-associated bloodstream infections) to 29.3% (VAP). © 2010 Association for Professionals in Infection Control and Epidemiology, Inc.


PubMed | Centro Dermatologico Dr Ladislao Of La Pascua, Hospital Italiano, Hospital Militar Dr Carlos Arvelo, Santiago Medical Institute and 2 more.
Type: Journal Article | Journal: Photodermatology, photoimmunology & photomedicine | Year: 2016

Although conventional photodynamic therapy (c-PDT) using methyl aminolevulinate cream (MAL) is effective for the treatment of grade I-II facial and scalp actinic keratosis (AK), it is associated with treatment-related pain for some patients. Daylight-mediated PDT (DL-PDT) has shown similar efficacy to c-PDT, was nearly painless, and was well tolerated. Overall, DL-PDT effectively treats AK and offers a simpler and better tolerated treatment option than c-PDT. This consensus panel provided recommendations on the use of DL-PDT in Latin America (LATAM) for the treatment of actinic damage associated with few or multiple AKs. The panel was comprised of eight dermatologists from different LATAM countries who have experience using PDT for the treatment of actinic damage. The panel reviewed the relevant literature and provided personal expertise with regard to using DL-PDT for the treatment of photodamage with or without AK. The recommendations formulated by the expert panel provide evidence-based guidelines on all aspects of DL-PDT for the treatment of actinic damage associated with AK in different regions of LATAM. These recommendations provide guidance for dermatologists to ensure maintenance of efficacy and safety of DL-PDT when treating actinic damage, associated with few or multiple AKs in sun-exposed skin.


PubMed | International Nosocomial Infection Control Consortium INICC, Hospital Militar Dr Carlos Arvelo and Hospital Of Clinicas Caracas
Type: Journal Article | Journal: International health | Year: 2017

Device-associated healthcare-acquired infections (DA-HAI) pose a threat to patient safety in the intensive care unit (ICU).A DA-HAI surveillance study was conducted by the International Nosocomial Infection Control Consortium (INICC) in two adult medical/surgical ICUs at two hospitals in Caracas, Venezuela, in different periods from March 2008 to April 2015, using the US Centers for Disease Control and Preventions National Healthcare Safety Network (CDC/NHSN) definitions and criteria, and INICC methods.We followed 1041 ICU patients for 4632 bed days. Central line-associated bloodstream infection (CLABSI) rate was 5.1 per 1000 central line days, ventilator-associated pneumonia (VAP) rate was 7.2 per 1000 mechanical ventilator days, and catheter-associated urinary tract infection (CAUTI) rate was 3.9 per 1000 urinary catheter days, all similar to or lower than INICC rates (4.9 [CLABSI]; 16.5 [VAP]; 5.3 [CAUTI]), and higher than CDC/NHSN rates (0.8 [CLABSI]; 1.1 [VAP]; and 1.3 [CAUTI]). Device utilization ratios were higher than INICC and CDC/NHSN rates, except for urinary catheter, which was similar to INICC. Extra length of stay was 8 days for patients with CLABSI, 9.6 for VAP and 5.7 days for CAUTI. Additional crude mortality was 3.0% for CLABSI, 4.4% for VAP, and 16.9% for CAUTI.DA-HAI rates in our ICUs are higher than CDC/NSHNs and similar to or lower than INICC international rates.


Lares M.,Hospital Militar Dr Carlos Arvelo | Lares M.,Central University of Venezuela | Velazco Y.,Central University of Venezuela | Brito S.,Hospital Militar Dr Carlos Arvelo | And 2 more authors.
Revista Latinoamericana de Hipertension | Year: 2011

Objective: To validate a nutritional assessment methodology to detect cardiovascular disease predisposing factors. Methods: It was applied a nutritional assessment, including the anthropometric indicators, and quantitative and qualitative measurement of food consumption. 50 volunteers, among 18 and 75 years, patient of the Endocrinology department database of the Hospital Militar "Dr. Carlos Arvelo" were evaluated. Results: According to anthropometric indicators, 66% of the patients show a BMI>25; 80% of them was above the reference values for waist circumference; 78% have a abdominal obesity for waist-hip ratio, and 60% with a body fat percentage higher to those normal values. When evaluating the food consumption, it was found: low-calorie diet (76%), high protein (52%), and high fat with a predominance of animal fat consumption (44%), hipoglucidic (80%) and low in dietary fiber (68%), all of these data is in according to reference values for the INN. These results are allowing the identification of cardiovascular risk factors, anthropometrical and diet. Conclusion: It can be concluded that the nutritional status through anthropometric and dietary indicators can be a useful tool in identifying risk factors for cardiovascular disease. It is imperative that the measurement and evaluation of the indicators should be performed in a larger sample of subjects in order to verify the consistency of the results.


PubMed | Central University of Venezuela, Instituto Medico La Floresta, Hospital Militar Dr Carlos Arvelo and Hospital Militar Dr Carlos Arvel
Type: | Journal: Acta otorrinolaringologica espanola | Year: 2016

To evaluate the clinical presentation, treatment outcome and follow-up of all patients managed with sinonasal papillomas (SP), at a tertiary private otorhinolaryngology centre in Caracas (Venezuela).We reviewed 94 patients with SP that were treated at our otolaryngology center, from July 1st 1993 to June 31st 2015. The demographic data, clinical features, radiological findings, anatomical origin, disease extension into the adjacent structures, surgical approaches performed, histopathology outcomes, recurrent risk, malignant transformation rate and coadjuvant therapies were assessed.Sixty-five patients (69.1%) were male and 29 (30.9%) female with an average age of 44.5 years (range 9-80 years). All patients underwent endoscopic sinus surgery. The most commont histologic subtypes of SP were inverted papilloma (58 patients; 61.7%), fungiform papilloma (35 patients; 37.2%) and oncocytic papilloma (one patient; 1.1%). SP was associated in 2 patients with undifferentiated squamous cell carcinoma. Twelve patients (12.8%) had disease with extension beyond the sinus without associated malignancy. All these patients received adjuvant treatment with advanced techniques of radiotherapy. The mean duration of the follow-up period was 9 years and 2 months. Eighteen patients (19.1%) had recurrent disease during the entire course of follow-up.Complete endoscopic surgical removal of SP is the treatment of choice. In less endoscopically accessible tumours, with peripheral extension or incompletely resected, Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy may be indicated. Timely post-operative endoscopic follow-up with biopsy of suspected lesions is important for early detection of recurrences and associated malignancy.


PubMed | Medicentro del Parque, c 3 Medico Otorrinolaringologo Neurootologo, g 7 Neurologia, Hospital Militar Dr Carlos Arvelo and 3 more.
Type: Journal Article | Journal: Acta oto-laryngologica | Year: 2015

Clinical studies and meta-analyses demonstrated that betahistine is effective and safe in the treatment of Mnires disease, BPPV (benign paroxysmal positional vertigo), vestibular neuronitis, and other types of peripheral vertigo.The goal of this paper is to review the pharmacological profile of betahistine and the evidence for its effectiveness and safety in the treatment of peripheral vertigo.Selection criteria for the publications on betahistine included randomized clinical trials that evaluated the effectiveness and safety of betahistine vs placebo or active control in the treatment of peripheral vertigo. Recent meta-analyses were also included. Databases searched included PubMed, the Cochrane Ear, Nose and Throat Disorders Group Trials Register, and ICTRP. The review also presents an update on the mechanisms of action, pharmacodynamics, and pharmacokinetics of betahistine.Efficacy and safety of betahistine has been demonstrated in numerous clinical trials. The precise mechanism of action of betahistine is still not completely understood, but the clinical experience demonstrated the benefit of betahistine in different types of peripheral vertigo. In more than 40 years of clinical use, betahistine has shown an excellent safety profile with the usual dose range from 8-48 mg daily. According to clinical studies, betahistine 48 mg daily during 3 months is an effective and safe option for the treatment of peripheral vertigo.


Inverted papilloma (IP) is a relatively rare neoplasm of the nasal cavity and paranasal sinuses. Although it is considered a benign tumor, its biological behavior is not so benign because of local aggressive growth, high recurrence rate, and risk of malignant transformation with associated carcinoma. Therefore, it requires complete surgical removal and long term postoperative follow-up. Bilateral IP is unusual and even more so when associated with simultaneous intra-orbital and intra-cranial extensions. These extremely aggressive behaviors have been separately reported in the literature, especially in recurrent cases. Report of cases with bilateral and multifocal involvement without malignancy has been exceptional. Surgical management in these cases includes an endonasal endoscopic approach combined with external approaches, either conventional or endoscopic minitrepanation. Intensity modulated radiation therapy can be useful in patients with incompletely resected disease. A case of this rare disease is reported. © 2016, Universidad de Antioquia. All rights reserved.

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