viernes, 18 de junio de 2010

Resultados Estudio CRASH-2: Una simple inyección podri la vida de miles de gestantes [Archivos adjuntos 2]



---------- Mensaje reenviado ----------
De: Victor Zamora <victor@victorzamora.com>
Fecha: 18 de junio de 2010 08:57
Asunto: [SANFERNANDOPERU] Resultados Estudio CRASH-2: Una simple inyección podri la vida de miles de gestantes [Archivos adjuntos 2]
Para: Victor Zamora <victor@victorzamora.com>


 
[Más abajo se incluyen archivos adjuntos de Victor Zamora]

Excelentes noticias las que nos envía nuestro colega Jaime Miranda. Primero, porque los estudios demuestran la efectividad de esta medida en victimas de accidentes de transito; y, segundo, por sus potenciales efectos positivos en materia de reducir la mortalidad materna, en donde la hemorragia es una de las principales causas de mortalidad materna. Felicitaciones Jaime!

 


De: mirandajj@gmail.com [mailto:mirandajj@gmail.com] En nombre de Jaime Miranda [UPCH]
Enviado el: Thursday, June 17, 2010 11:13 AM
Para: Victor Zamora; Victor Zamora; Victor Zamora
CC: CRASH-2 Peru
Asunto: Resultados Estudio CRASH-2: Una simple inyección puede salvar la vida de miles de víctimas de accidentes en todo el mundo

 

Hola Cumpa,

Salieron los resultados del CRASH-2.
Tenias razon, ahoras se usara para reducir mortalidad materna. Ver: http://www.womantrial.lshtm.ac.uk/

Jaime

======

Estimados amigos y colegas,


Adjunto la publicacion en Ingles (junto con un editorial) y una nota de prensa sobre los resultados del estudio CRASH-2.

Les solicitaria, agradeciendo de antemano, su apoyo con una amplia difusion de estos resultados, que sin duda, tendran un impacto positivo en reducir muertes en nuestro medio.

Un saludo cordial,
Jaime

**********************************************************
Dr. Jaime Miranda, MD MSc PhD
Coordinador Nacional Perú
Estudio CRASH-2, www.crash2.lshtm.ac.uk
Estudio WOMAN, www.womantrial.lshtm.ac.uk
M: +51 1 990 041 045   //   #344175 (RPM)
**********************************************************
PD. Tildes omitidas en texto en Castellano

 

 

 

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Archivos adjuntos de Victor Zamora

Archivo 2 de 2

lunes, 14 de junio de 2010

Hypertension in Childhood

 



Edwin Villacorta V.
MEDICO PEDIATRA
 
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BEBÈ SANO
- La mejor web para padres primerizos (machuca en el link)
 
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--- El lun, 6/14/10, William Arellano Santillan <williamarellanos@gmail.com> escribió:
Hypertension in Childhood

Description

There is no current standard UK definition of hypertension in children. However, the issue has been researched in some detail in America were a working group in 2004 defined the condition as an average systolic and/or diastolic blood pressure ≥95th percentile for gender, age and height on 3 or more separate occasions.1 The working group also introduced the concept of 'pre-hypertension' which it defines as a blood pressure level ≥90th percentile but <95th percentile.

As with adults, blood pressure is a variable parameter in children. It varies between individuals and within individuals from day to day and at various times of the day. Attention must be paid to correct technique in measuring blood pressure and with small patients this includes the use of a small cuff. The traditional method of auscultation of 1st and 5th Korotkoff sounds, using a mercury sphygmomanometer, gives an accuracy that is second only to direct cannulation of the artery. Nowadays mercury and aneroid instruments are being replaced by electronic or Doppler devices.

White coat hypertension and masked hypertension may be particularly relevant in this patient group. One study found that ambulatory blood pressure measurement correlated quite well with home monitoring2and the latter is becoming a validated method.3 Whatever method is used, the instrument must be regularly checked for accuracy and serviced and used correctly.

Epidemiology

A Department of Health Survey for England in 1996 showed that the mean systolic blood pressure for both boys and girls aged 5 to 15 was 111 mmHg.4 Mean diastolic pressure was 57 mmHg in boys and 58 mmHg in girls. Mean pulse pressure was 58 mmHg in both boys and girls aged 5 to 15. 

An approximate rule of thumb is 80 + (2 x age) for 50th centile, and 100 + (2 x age) for 95th centile.

Blood pressure increases with age in childhood and children who are either heavier or taller or both have higher blood pressure than smaller children of the same age.5 The relationship between body mass and blood pressure in children is stronger than in adults and children who have high blood pressure and are taller and heavier than their peers are more likely to become hypertensive as adults.6

Hypertension is on the increase due to the rise in obesity in children. One study found that organ damage, such as left ventricular hypertrophy, thickening of the carotid vessel wall, retinal vascular changes and even subtle cognitive changes, were detectable in children and adolescents with high blood pressure and the authors of this study considered that hypertension was a common long-term health problem in this age group.7

Risk factors

In the absence of overt disease that will cause hypertension, there are a number of factors known to affect blood pressure in children and young adults. These are:

  • Salt intake - this is very important and targets to reduce our intake may not go far enough.8Processed and convenience foods tend to be very high in salt.
  • Obesity - childhood obesity increases the risk of childhood hypertension. The Bogalusa Heart Study derived figures from several national studies and found that the odds ratios in obese children were 2.4 for raised diastolic blood pressure and 4.5 for raised systolic blood pressure.9
  • Low birth weight - this seems to be a particular risk factor in patients who subsequently have a high BMI.10,11
Presentation12

History

The condition is usually asymptomatic but may be revealed fortuitously during examination in patients with suspected underlying conditions such as kidney disease or coarctation of the aorta.

There are a few presenting features that should raise the possibility of hypertension:

In neonates:

In older children

If the condition is found, enquiry should be made for certain features in the child's history:

Examination

  • Examination of the child starts with looking at the general state of nutrition and apparent state of health. Check height and weight against centile charts.
  • Examination of the pulse precedes measurement of blood pressure. The child should be seated and relaxed or supine if a baby. The cuff is on the right arm at the level of the heart. The rubber blade inside the cloth cover should be long enough to encircle the arm and wide enough to cover approximately ¾ of the distance from shoulder to elbow. Examine the rest of the cardiovascular system. Check for displacement of the apex beat and signs of left ventricular hypertrophy. Heart murmurs in children may be very relevant. Also feel the pulses in the lower limbs. If the amplitude of the pulse is poor this suggests coarctation of the aorta.
  • Look for stigmata of specific diseases:
    • Café au lait spots may suggest pheochromocytoma.
    • Examination of the abdomen will reveal a mass in Wilms' tumour and abdominal bruit may suggest coarctation or other vascular abnormalities including in the renal system.
    • Virilisation will point to congenital adrenal hyperplasia.
Causes

In general, the younger the child and the higher the blood pressure the greater the chance of identifying the cause. 80% are due to renal parenchymal abnormality. The table gives the order of frequency of the various causes of hypertension in 4 age groups:12

Causes of Childhood Hypertension According to Age Group

Age

Causes

1 to 6 years Renal parenchymal disease; renal vascular disease; endocrine causes; coarctation of the aorta; essential hypertension
6 to 12 years Renal parenchymal disease; essential hypertension; renal vascular disease; endocrine causes; coarctation of the aorta; iatrogenic illness
12 to 18 years Essential hypertension; iatrogenic illness; renal parenchymal disease; renal vascular disease; endocrine causes; coarctation of the aorta
Investigations12

Most adults are deemed to have essential hypertension and little or no further investigation is undertaken but in children a cause for the hypertension should be sought. Basic screening tests to detect underlying pathology should be carried out together with investigations to assess co-morbidity and end organ damage. Further testing may be required, depending on individual and family histories, the presence of risk factors and the results of the screening tests.

To identify the cause

  • Urine - check for albumin and blood
  • Urea, electrolytes and creatinine - to assess renal function; low potassium may suggest elevated aldosterone
  • Full blood count - may reveal anaemia consistent with renal disease
  • Renal ultrasound - to exclude abnormalities of renal morphology

To identify co-morbidities

  • Drug screen - this may be relevant in adolescents to exclude ingestion of recreational drugs
  • Fasting lipids and glucose - to rule out hyperlipidaemia, metabolic syndrome, diabetes
  • Polysomnography - to establish the existence of a sleep disorder, which may be linked to hypertension

To identify end-organ damage

  • ECG - may show left ventricular hypertrophy or strain
  • Echocardiography - can show hypertrophy and abnormal function
  • Retinal examination - may identify retinal vascular changes

Additional tests as clinically indicated

  • 24-hour urine for protein and creatinine, creatinine clearance - to exclude chronic renal disease
  • Advanced imaging - magnetic resonance angiogram, duplex Doppler flow studies; 3-dimensional computed tomography; arteriography (classic or digital subtraction) , may be required to exclude renovascular abnormalities
  • Ambulatory blood pressure monitoring - may be needed to exclude white coat hypertension
  • Thyroid function tests - to rule out thyrotoxicosis
  • Plasma aldosterone - a high concentration is diagnostic of hyperaldosteronism
  • Plasma catecholamines or urine catecholamines and catecholamine metabolites - high levels are diagnostic of pheochromocytoma or neuroblastoma
  • Plasma renin levels
    • High plasma renin activity indicates renal vascular hypertension, including coarctation of the aorta.
    • Very low plasma renin activity suggests glucocorticoid remediable aldosteronism or apparent mineralocorticoid excess.
Management1

There are no consensus UK guidelines on the management of hypertension in children. American guidelines suggest that lifestyle modifications should be applied to all hypertensive paediatric patients and that drugs are indicated in patients who fail to respond to lifestyle measures or have secondary hypertension, symptomatic hypertension, co-morbidity or end-organ damage.

Lifestyle modification1,12

This includes weight control, encouragement of exercise, reduction in dietary sodium and fat and, where appropriate, cessation of smoking and alcohol.

Drugs

American guidelines suggest starting with one drug and increasing the dose until a therapeutic effect is achieved or side-effects develop, at which point a second drug should be added. There is little experience in using combination drugs in children. There is little comparative evidence so the choice of drug depends on the physician's preference plus any secondary causes or comorbidities.

  • Thiazides and beta blockers - these have the best track record in terms of safety and efficacy.
  • ACE inhibitors and calcium channel blockers - these are gradually gaining preference as first-line drugs in view of their low side-effect profile. Caution may need to be exerted when using ACE inhibitors in patients with renal disease but they can be helpful in some cases.
  • Angiotensin receptor antagonists - their role is currently being evaluated.14 One study found that the blood pressure reduction of angiotensin- converting enzyme inhibitors, angiotensin II receptor antagonists and calcium-channel blockers was almost identical. In children with pathological proteinuria, angiotensin- converting enzyme inhibitors or angiotensin II antagonists were superior to calcium-channel blockers.15

Management of a hypertensive crisis

An acute hypertensive crisis may be the result of an acute illness, such as glomerulonephritis oracute renal failure, drugs or psychogenic substances, or exacerbation of moderate hypertension. A hypertensive crisis can present with features of cerebral oedema, seizures, heart failure, pulmonary oedema, or renal failure. The accurate assessment of blood pressure is essential when a patient has a seizure, particularly when no epileptic disorder is known. Anticonvulsant drugs are ineffective to treatconvulsions in a hypertensive crisis. Suitable drugs include nifedipine, labetalol and sodiumnitroprusside. Newer rapid-acting drugs such as clevidipine have been developed.16 The aim is to decrease blood pressure to normal within several hours. Close supervision is required to avoid an excessively rapid decrease in blood pressure that may result in underperfusion.17 A Cochrane review concluded that further research was needed to determine which drugs were best for the treatment of hypertensive crisis and their effect on morbidity and mortality.18

Prognosis

This is dependent upon the underlying cause. Experience from adults shows that poorly controlled blood pressure is a risk factor for CHD and is the major risk factor for stroke. There is no definitive data to link childhood blood pressure with cardiovascular risk but extrapolation of other data would suggest that, if hypertension is poorly controlled from an early age, morbidity or mortality will also strike early.12,19


      WILLIAM ARELLANO
               Pediatra
facebook.com/ William.Virgo.
          RPM: #893353
         Cel: 964 713855

mononuleosis infeciosa en pediatria [Archivo adjunto 1]




 
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Protocolo DX diferencial del síndrome mononucleósico
pulse sobre visualizar documento
Protocolo diagnóstico diferencial del paciente febril con adenopatías
pulse sobre visualizar documento
Mononucleosis infecciosa. Revisión y actualización
va como adjunto

ojala te sirva estos tres aportes

Atte.
MÁXIMO CUADROS
UNYK: 245 HRP

De: lester raymundo dominguez huarcaya <lesterdominguezhuarcaya@yahoo.es>
Para: interno_residente_medico_PERU@yahoogroups.com
Enviado: vie,11 junio, 2010 17:01
Asunto: [interno_residente_medico_PERU] Necesito articulos de revison de mononuleosis infeciosa en pediatria
 

Estimados amigos ,
necesito articulos de revison sobre mononucleosis infecciosa en niños, fueran tan amables de ayuadrme a conseguirlas por favor, sea en español o inglés,gracias de antemano.
Saludos,
lester


__._,_.___

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domingo, 13 de junio de 2010

HTA [Archivo adjunto 1]



 
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Detección temprana y gestión del riesgo
de pacientes con presión arterial elevada

JANO 17 DE ABRIL DE 2009. N.º 1.734 - www.jano.es
http://www.jano.es/ficheros/sumarios/1/0/1735/19/00190022_LR.pdf
va también como adjunto


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PAGINA DE NATICIAS SOBRE LA CIENCIA.


 

Encontré esta pagina sobre noticias de la ciencia y tiene versión en Español.
Un saludo/ Lancelot.

http://www.sciencefriday.com/cienciacierta/

miércoles, 9 de junio de 2010

ULTIMAS PUBLICACIONES CORTESIA CARVEDIL (PUBLICIDAD)







De nuestra estimación:

Sírvase encontrar a continuación las últimas direcciones electrónicas de interés para su especialidad accesibles con un solo clicK de su mouse.

CARDIOLOGIA

DOES VITAMIN D DEFICIENCY PLAY A ROLE IN THE PATHOGENESIS OF CHRONIC HEART FAILURE? DO SUPPLEMENTS IMPROVE SURVIVAL?

LA DEFICIENCIA DE VITAMINA D JUEGA UN ROL EN LA PATOGÉNESIS DE INSUFICIENCIA CARDIACA? LOS SUPLEMENTOS MEJORAN LA SOBREVIDA?

La deficiencia de vitamina D puede jugar un rol en la patogénesis de ICC, pero lo que no está claro es si el suplemento vitamínico para elevar los niveles de vitamina D a rangos normales pueda mejorar la sobrevida.

Cleveland Clinic Journal of Medicine Volume 77 • Number 5 may 2010


Para ver hacer click aquí


¡Ah! y recuerde doctor, CARVEDIL es el betabloqueador y vasodilatador que protege al paciente en forma integral.



Cordialmente,


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--
Claudio Guido Mori Gonzales
DNI 07963726
CMP 18700

domingo, 6 de junio de 2010

McGraw-Hill's I.V. Drug Handbook by Patricia Dwyer Schull



 

Administer I.V. medications knowledgeably, safely and confidently
Because there's no room for error, turn to McGraw-Hill's I.V. Drug Handbook. Featuring a strong focus on patient safety, administering and monitoring I.V. drugs, the Handbook delivers concise, practical guidance to help you carry out one of the most difficult tasks you face. Written by and for practicing nurses and pharmacists, the Handbook is reliable, comprehensive, and easy-to-use.

verything you need for safe, successful I.V. drug administration:

* All-inclusive coverage of over 350 parenteral drugs with the latest warnings from the FDA
* Includes antibiotics, insulin, pain medications, emergency drugs -- and more coverage of chemotherapeutic agents with more supportive therapies than you'll find in any other text
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* Each drug monograph includes administration guidelines, covering preparation, dilution & compatibility, infusion rates, admixtures, supportive therapies and monitoring.
* Features a 32 page full-color patient safety insert describing measures for ensuring safe drug administration, including 6 pagea on inserting an I.V. catheter
* Uses distinctive icons to call your attention to "clinical alerts," "life-threatening reactions," "high-alert", "hazardous" drugs, and more

http://www.megaupload.com/?d=40RPI8LV

http://depositfiles.com/es/files/gsqtxw4xs

 

LOS MITOS DE LA HOJA DE COCA

ultimo numero de Anales San Fernando


 

Anales de la Facultad de Medicina
©  UNMSM. Facultad de Medicina
ISSN versión electrónica : 1609-9419

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Vol. 71, Nº 1,  2010
 


EDITORIAL   
  
    Texto completo PDF
 

TRABAJOS ORIGINALES

Características sociodemográficas y clínicas de pacientes con diabetes tipo 2 y microangiopatías./ Sociodemographic and clinical characteristics of type 2 diabetes mellitus patients with microangiopathies
Teresa Mendizábal, Narda Navarro, Alfonso Ramírez, María Cervera, Enriqueta Estrada, Irasema Ruiz

Texto completo PDF
 
Resistencia a insulina en adolescentes obesos. / Insulin resistance in obese adolescents
 Maria Isabel Rojas-Gabulli, Oswaldo Núñez, Carlos Del Águila, Mariel Briceño, Nelly Valenzuela

Texto completo PDF
 
Validez de la prueba de adenosina deaminasa y del recuento diferencial de leucocitos para el diagnóstico de tuberculosis pleural. / Validity of both adenosine deaminase test and differential cell count for pleural tuberculosis diagnosis
Jhonatan Boris Quiñones-Silva, César Héctor Gonzalo Ramírez-Yépez, Américo Peña-Oscuvilca, Efraín Estrada-Choque

Texto completo PDF
 
Sintomatología depresiva en pacientes con fibromialgia. / Depressive symptoms in fibromyalgia.
Vanessa Moreno, Fernando Namuche, Adrián Eduardo Noriega, Maritza Vidal, Carlos Rueda, Jorge Pizarro, Luis Vidal

Texto completo PDF
 
Aspectos entomológicos de la enfermedad de Chagas en Huallaga y Picota, San Martín, Perú. / Entomological aspects of Chagas disease in Huallaga and Picota, San Martin, Peru
Abraham G. Cáceres, Silvia Vega, Jenny Ancca, Jesús Pinto, Gregorio Vela, Videla Cárdenas, Juan Ruiz, Patricia Del Pilar Alva, Javier Ruiz, Arcadio Alvarado, Heriberto Arévalo, Francisco Cruzado, Felipe Vela, César Náquira

Texto completo PDF
 
Accidentes biológicos en estudiantes de medicina de una universidad peruana:
prevalencia, mecanismos y factores de riesgo. / Biological accidents in a Peruvian university medical students: prevalence, mechanisms and risk factors
Elizabeth Inga, Gregory López, Carlos Kamiya

Texto completo PDF
 CASOS CLÍNICOS
 Síndrome de costillas cortas y polidactilia: displasia esquelética fetal incompatible con la vida. / Short rib polydactyly syndrome: lethal skeletal dysplasia.
Erasmo Huertas, Jaime Íngar, Guiselle Gutiérrez, Eva María Quiñones

Texto completo PDF
 
Hipersexualidad asociada a pramipexol, en el tratamiento de síntomas parkinsonianos: revisión de la literatura, a propósito de 3 casos. / Hypersexuality associated to pramipexole in the treatment of parkinsonian symptoms: presentation of 3 cases and review of the literature
Nilton Custodio, Rosa Montesinos, David Lira, Hernando Torres

Texto completo PDF
 
Trastorno dismórfico corporal con desenlace fatal: reporte de un caso. / Body dysmorphic disorder with fatal outcome: a case report
Lizardo Cruzado, Édgar Vásquez, Jorge Huavil

Texto completo PDF
  REVISIÓN
  Toxicidad del cianuro. Investigación bibliográfica de sus efectos en animales y en el hombre. / Cyanide toxicity. Bibliography research of its effects in animals and man
Augusto V. Ramírez

Texto completo PDF
  CARTAS AL EDITOR
  Los ensayos clínicos y el cumplimiento de las guías CONSORT en el Perú

Texto completo PDF
 
La familia en la prevención de la adicción de sustancias psicoactivas

Texto completo PDF

 
   

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Anales de la Facultad de Medicina Vol 71. 2010. (nuevo número)

Última publicación

Anales de la Facultad de Medicina
©  UNMSM. Facultad de Medicina
ISSN versión electrónica : 1609-9419

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Tabla de contenido

Vol. 71, Nº 1,  2010
 

 


EDITORIAL   
  

    Texto completo PDF
 


TRABAJOS ORIGINALES


  • Características sociodemográficas y clínicas de pacientes con diabetes tipo 2 y microangiopatías./ Sociodemographic and clinical characteristics of type 2 diabetes mellitus patients with microangiopathies
    Teresa Mendizábal, Narda Navarro, Alfonso Ramírez, María Cervera, Enriqueta Estrada, Irasema Ruiz

    Texto completo PDF
     

  • Resistencia a insulina en adolescentes obesos. / Insulin resistance in obese adolescents
     Maria Isabel Rojas-Gabulli, Oswaldo Núñez, Carlos Del Águila, Mariel Briceño, Nelly Valenzuela


    Texto completo PDF
     

  • Validez de la prueba de adenosina deaminasa y del recuento diferencial de leucocitos para el diagnóstico de tuberculosis pleural. / Validity of both adenosine deaminase test and differential cell count for pleural tuberculosis diagnosis
    Jhonatan Boris Quiñones-Silva, César Héctor Gonzalo Ramírez-Yépez, Américo Peña-Oscuvilca, Efraín Estrada-Choque

    Texto completo PDF
     

  • Sintomatología depresiva en pacientes con fibromialgia. / Depressive symptoms in fibromyalgia.
    Vanessa Moreno, Fernando Namuche, Adrián Eduardo Noriega, Maritza Vidal, Carlos Rueda, Jorge Pizarro, Luis Vidal


    Texto completo PDF
     

  • Aspectos entomológicos de la enfermedad de Chagas en Huallaga y Picota, San Martín, Perú. / Entomological aspects of Chagas disease in Huallaga and Picota, San Martin, Peru
    Abraham G. Cáceres, Silvia Vega, Jenny Ancca, Jesús Pinto, Gregorio Vela, Videla Cárdenas, Juan Ruiz, Patricia Del Pilar Alva, Javier Ruiz, Arcadio Alvarado, Heriberto Arévalo, Francisco Cruzado, Felipe Vela, César Náquira

    Texto completo PDF
     

  • Accidentes biológicos en estudiantes de medicina de una universidad peruana:
    prevalencia, mecanismos y factores de riesgo. /
    Biological accidents in a Peruvian university medical students: prevalence, mechanisms and risk factors
    Elizabeth Inga, Gregory López, Carlos Kamiya

    Texto completo PDF

  CASOS CLÍNICOS
 
  • Síndrome de costillas cortas y polidactilia: displasia esquelética fetal incompatible con la vida. / Short rib polydactyly syndrome: lethal skeletal dysplasia.
    Erasmo Huertas, Jaime Íngar, Guiselle Gutiérrez, Eva María Quiñones


    Texto completo PDF
     

  • Hipersexualidad asociada a pramipexol, en el tratamiento de síntomas parkinsonianos: revisión de la literatura, a propósito de 3 casos. / Hypersexuality associated to pramipexole in the treatment of parkinsonian symptoms: presentation of 3 cases and review of the literature
    Nilton Custodio, Rosa Montesinos, David Lira, Hernando Torres

    Texto completo PDF
     

  • Trastorno dismórfico corporal con desenlace fatal: reporte de un caso. / Body dysmorphic disorder with fatal outcome: a case report
    Lizardo Cruzado, Édgar Vásquez, Jorge Huavil

    Texto completo PDF

  REVISIÓN
 
  • Toxicidad del cianuro. Investigación bibliográfica de sus efectos en animales y en el hombre. / Cyanide toxicity. Bibliography research of its effects in animals and man
    Augusto V. Ramírez


    Texto completo PDF

  CARTAS AL EDITOR
 
  • Los ensayos clínicos y el cumplimiento de las guías CONSORT en el Perú

    Texto completo PDF
     

  • La familia en la prevención de la adicción de sustancias psicoactivas

    Texto completo PDF


 

   

Volúmenes anteriores | Listado por Títulos




domingo, 30 de mayo de 2010

lunes, 3 de mayo de 2010

Atrial Fibrillation: Does Real World Care Match Trial Results?