Revista Medica del Uruguay最新文献

{"title":"Nefritis lúpica Experiencia con dosis reducidas de glucocorticoides en una unidad de enfermedades autoinmunes sistémicas","authors":"Adriana Carlomagno, G. Silveira, Ã. Danza, Ana Carina Pizzarossa, Martín Yandián, Federico Yandián, M. Rebella","doi":"10.29193/rmu.37.4.6","DOIUrl":"https://doi.org/10.29193/rmu.37.4.6","url":null,"abstract":"Introduction: current recommendations to treat lupus nephritis (LN) point to low-dose glucocorticoids to control the disease and avoid cumulativedamage. Objective: to learn about and compare the response of patients with proliferative LN who are treated following two prednisone therapy guidelines: reduced initial doses <30 mg/d and standard initial doses >30 mg/d during the induction stage. Method: clinical, analytical and therapeutic guidelines of patients with proliferative LN were compared and classified into two groups according to the standard or low-dose initial prednisone dose. Results: 21 patients with proliferative LN were studied (n=12 low-dose initial prednisonevs. n=9 standard initial prednisone). No significant differences were found between clinical and analytical variables, although a significantly different statistic difference was observed in the number of methylprednisone pulses (5 ± 2.95 initial prednisone <30 mg/d vs 2.33 ± 2.91 initial prednisone >30 mg/d, p = 0.041) and in the prednisone dose accumulated in 6 months (12.8 mg ± 4.9 initial prednisone <30 mg/d vs 30.0 ± 13.1 mg initial prednisone >30 mg/d, p =0.008). Rev Méd Urug 2021; 37(4): e37407","PeriodicalId":51931,"journal":{"name":"Revista Medica del Uruguay","volume":"4 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83543052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coagulopatía asociada al trauma en la Unidad de Cuidados Intensivos","authors":"P. Grille, Andrea Herrerín, Federico Verga","doi":"10.29193/rmu.37.4.5","DOIUrl":"https://doi.org/10.29193/rmu.37.4.5","url":null,"abstract":"Resumen Introducción: la enfermedad traumática es un problema de salud mundial. La coagulopatía asociada al trauma (CAT) cons tituye una complicación grave, multifactorial y de diagnóstico controversial. Objetivos: valorar la incidencia de CAT, los factores asociados a su desarrollo y su asociación con el pronóstico, en una serie de pacientes traumatizados ingresados a la Unidad de Cuidados Intensivos de nuestro hospital. Pacientes y métodos: estudio prospectivo de todos los pacientes ingresados con diagnóstico de trauma grave a la UCI. Se definió CAT en base a los parámetros clásicos de laboratorio, por la presencia de al menos uno de: INR mayor a 1,3, plaque-topenia menor a 100.000/mm 3 , y/o aPTT mayor a 38 segundos. Las variables continuas se expresaron como la media ± desvío estándar. Se realizó análisis de chi cuadrado, test exacto de Fisher y regresión logística binaria para estudiar la asociación entre las variables. Se consideró significativo un valor p < 0,05. Resultados: se analizaron 103 pacientes, con media de edad de 33 años y predominio de sexo masculino. Se encontró CAT en 42 pacientes (40,8%), presentándose al ingreso hospitalario en la mayoría de los casos. Los factores de riesgo asociados a CAT fueron: gravedad al ingreso, shock, hipoperfusión, acidosis, transfusión masiva, sangrado significativo","PeriodicalId":51931,"journal":{"name":"Revista Medica del Uruguay","volume":"28 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79832658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Características de las consultas de los recién nacidos en un servicio de emergencia pediátrica","authors":"Mariana Más, A. Casuriaga, G. Giachetto, Carina Giacoia, Lucía Centena, M. López, Yelenna Ramírez","doi":"10.29193/rmu.37.4.7","DOIUrl":"https://doi.org/10.29193/rmu.37.4.7","url":null,"abstract":"Introduction: the are by signifi-cant Objective: to describe the characteristics of newborn presentations to the pedriatric emergency department of a comprehensive health care provider between January 1 and December 31, 2018. Method: descriptive study by analysing medical re-cords and telephone interviews to mothers. Newborn, maternal and consultation variables were analysed. Results: 237 presentations were recorded, 209 of which corresponded to newborns, male neonates 53%, average age was 16 days. Diagnostics upon discharge were three categories:1) consultations childcare physiological processes Hospitalizationrate hospitalized:","PeriodicalId":51931,"journal":{"name":"Revista Medica del Uruguay","volume":"142 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85345071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caracterización de pacientes con microcarcinoma papilar de tiroides en el Hospital de Clínicas (UDELAR) en los últimos 10 años","authors":"","doi":"10.29193/rmu.37.4.4","DOIUrl":"https://doi.org/10.29193/rmu.37.4.4","url":null,"abstract":"","PeriodicalId":51931,"journal":{"name":"Revista Medica del Uruguay","volume":"31 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88482624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Homicidios intencionales en la salud. Un tema huérfano de la seguridad asistencial.","authors":"Carlos Vivas, H. Bagnulo","doi":"10.29193/rmu.37.3.9","DOIUrl":"https://doi.org/10.29193/rmu.37.3.9","url":null,"abstract":"Intentional homicides committed by health workers in the course of their duties are very rare events. Its importance resides in the fact that the structural and functional weaknesses of health systems are exposed through its analysis. Moreover, their harmful effects are not limited to the victims and their families, since the reliability of the health system as a whole is damaged. This article summarizes the characteristics of these attacks, emphasizing the strategies of healthcare security that can intercept offenders.","PeriodicalId":51931,"journal":{"name":"Revista Medica del Uruguay","volume":"2 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75337195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influencia de la incorporación de la tomosíntesis en un centro de diagnóstico mamario.","authors":"G. Febles, Cristina Balbiani, Graciela Vázquez","doi":"10.29193/rmu.37.3.5","DOIUrl":"https://doi.org/10.29193/rmu.37.3.5","url":null,"abstract":"Introduction: significant technological progress has been made in the history of mammography. Recently, direct digital mammography plus tomosynthesis arrived and improved breast cancer screening.Objective: to evaluate the effects of new technology in the performance of mammography, at the Breast Diagnostic Service of the British Hospital.Method: mammography performance during 2019- 2020 was compared to that between 2010 and 2018.In 2019 the previous tehcnology was substituted by a direct digital mammogram with tomosynthesis, Hologic, Selenia Dimensions model.Results: 10.725 mammographies were done in 2019-2020. Cancer was detected in 84 cases and the cancer detection rate was 8 per 1000 persons. PPV was 35%. 45.438 mammographies were done in 2010-2018. Cancer was detected in 229 cases and the cancer detection rate was 5 per 1.000 persons. PPV was 40%. As to images, it is worth pointing out an increase in microcalcifications between 2019 and 2020, when they grew from 7% of cases to 19% of cases and distortions increased from 11% to 13%.DCIS was 4 times greater in 2019-2020 when compare to the previous period of time (17% of all detected cases).Conclusions: the integration of tomosynthesis increased 60% the cancer detection rate and the DCIS was 4 times greater.","PeriodicalId":51931,"journal":{"name":"Revista Medica del Uruguay","volume":"20 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77334169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morbimortalidad asociada al Departamento de Neurocirugía del Hospital de Clínicas. Estudio longitudinal retrospectivo durante el período Abril 2017-2019.","authors":"Gonzalo Bertullo, Rodrigo Moragues, Laura Lanning, V. Reyes, Agustín Oliveira, Cristian Cardozo, Rodrigo Veiga, Patricia Álvarez","doi":"10.29193/rmu.37.3.4","DOIUrl":"https://doi.org/10.29193/rmu.37.3.4","url":null,"abstract":"Introduction: morbidity and mortality rates allow for the evaluation of the quality of care and outcome and they also make it possible to compare different healthcare centers. This is the first morbidity and mortality study in neurosurgery carried out in Uruguay.Objective: to determine the global and specific morbidity and mortality rates in the Neurosurgery Department at the Clinicas University Hospital, and to determine if mortality and morbidity are associated to surgical complications.Method: retrospective, longitudinal, observational and descriptive analysis of all patients  >15 years old that underwent a neurosurgical procedure between April 2017 and 2019. Data were obtained from patient medical records. The following variables were analyzed: age, sex, comorbidity, clinical data, diagnosis, opportunity of surgical procedure, complications, type of complication, mortality, cause of mortality, outcome and surgical time.Results: 477 patients underwent neurosurgical procedure, 72 of which were complicated surgeries. Overall mortality was 5.5% (26/477) and morbidity 15% (72/477). 36% of complicated patients died (26/72). Vascular pathology was the specific morbidity that complicated patients the most 20% (14/69). Infection was the most frequent type of complication 46% (39/84). The evolution of the disease itself and the terrain caused the death of 90% of complicated patients undergoing emergency surgery (19/21), being the latter an independent risk factor for death (p = 0.018).As to coordinated surgeries, the cause of death was associated to the surgical act (80%). Association was found between vascular pathology and morbidity and mortality (p = 0.015) and between ischemic complication and morbidity and mortality (p = 0.024). The presence of intracranial hypertension (IH) was associated with a bad outcome (p= 0.003).Conclusions: the results show a good quality of care compared to other centers. There are still aspects to correct to reduce morbidity and mortality rates.","PeriodicalId":51931,"journal":{"name":"Revista Medica del Uruguay","volume":"12 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87570208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tratamiento con toxina botulínica en niños con parálisis cerebral espástica.","authors":"A. Cerisola, Maite Borderre, Facundo Carranza, Camilo Cuadro, Sofía Cures, Lucía Quintela, M. Vázquez, E. Suarez, Ligia Bacchetta","doi":"10.29193/rmu.37.3.2","DOIUrl":"https://doi.org/10.29193/rmu.37.3.2","url":null,"abstract":"Introduction: cerebral palsy (CP) is the most common source of motor disability in children and adolescents. In 85% of cases, the prevailing motor manifestation is spasticity. Botulinum toxin Type A injections (TB-A) have been used to reduce spasticity in children with cerebral palsy (CP). There are no studies at the national level that show whether the results are comparable to those reported in literature. Objective: to determine the effect of TB-A therapy in the triceps surae along with the physical rehabilitation in children with spastic cerebral palsy (CP) during 2017-2018 at the Teleton Children ́s Rehabilitation Center, Uruguay. Method: retrospective, descriptive study of a single cohort with a longitudinal follow-up was conducted, through the review of medical records belonging to patients with CP with independent or assisted gait, who received TB-A therapy to treat sural triceps spasticity during 2017-2018. Results: 40 TB-A injection procedures were analysed. A good response was observed one month and three months after being treated with TB-A, evidencing improvement in the dorsiflexion angle between the foot and the knee in flexion and extension, improvement on the modified Ashworth spasticity scale score and, in 95% of procedures, the subjective perception of parents. The effect was observed to decrease towards 6 months after the procedure. Conclusion: application of TB-A at the Teletón Center shows positive results, comparable to those reported by international blibliography.","PeriodicalId":51931,"journal":{"name":"Revista Medica del Uruguay","volume":"57 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76465717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ESPLENECTOMÍA LAPAROSCÓPICA EN ESPLENOMAGALIA MASIVA POR LINFOMA NO HODGKIN DE ZONA MARGINAL.","authors":"","doi":"10.29193/rmu.37.3.12","DOIUrl":"https://doi.org/10.29193/rmu.37.3.12","url":null,"abstract":"","PeriodicalId":51931,"journal":{"name":"Revista Medica del Uruguay","volume":"12 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79322951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Luxación traumática aguda de rodilla. Indicaciones del uso del fijador externo en la urgencia","authors":"M. Pamparato, Juan M Del Castillo, L. Francescoli","doi":"10.29193/rmu.37.3.7","DOIUrl":"https://doi.org/10.29193/rmu.37.3.7","url":null,"abstract":"Introduction: traumatic dislocation of the knee constitutes an unusual lesion in orthopedic pathology, the diagnosis of which is often missed. This is because it occurs in the context of multiple trauma patients, and failure to diagnose it may result in a potentially fatal outcome for the life-threatening compromise of the injured limb.Objective: to perform a literature review of literature on indications for the use of the external fixator in the acute knee dislocation at the emergency room that has been available in the last twenty years.Method: we conducted a systematized search by means of electronic search engines Cochrane, Lilacs, Scielo, Pubmed, Science direct and the Timbo portal. The search included 6495 articles and according to the criteria of inclusion and exclusion 14 studies were selected.Results: the review highlights that most articles found are level of evidence IV. The use of the external fixator in the emergency room as part of the temporary stabilization and initial handling of the condition would be indicated in the following clinical scenarios: multiple trauma patients, vascular lesion, exposed dislocation, joint instability, recurrent dislocation, fracture dislocation, lesions of the extensor apparatus, morbid obesity, splint or orthosis intolerance.Conclusion: systematization and the observation of protocols when it comes to the making of decisions enables the decrease of most complications associated to trauma pathologies. Actions must be geared to stabilizing patients first and to stabilize the knee joint. The external fixator is indicated for specific clinical scenarios. However, some of these indications are still a matter of debate.","PeriodicalId":51931,"journal":{"name":"Revista Medica del Uruguay","volume":"2 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86618240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}