De Manejo Research Articles

The ketogenic diet is effective for refractory epilepsy associated with acquired structural epileptic encephalopathy.

Ketogenic diet therapies have proven efficacy for refractory epilepsy. There are many reports of their use in the genetic developmental and epileptic encephalopathies; however, little attention has been paid as to whether the diet is also effective in individuals with an acquired structural aetiology. We observed remarkable efficacy of the diet in two patients with hypoxic-ischaemic encephalopathy. We then analysed our cases with refractory structural epilepsies of acquired origin to characterize their response to the ketogenic diet. The classical ketogenic diet was implemented with dietary ratios of 3:1 to 4.4:1. Seizure frequency at 1month, 3months, 6months, 1year, and 2years was ascertained. A responder was defined as greater than 50% seizure reduction compared to baseline. Seven of the nine patients were responders at 3months. Somewhat surprisingly we found that the ketogenic diet was effective in patients with a developmental and epileptic encephalopathy due to an acquired structural aetiology. This cohort may not be routinely considered for the ketogenic diet because of their structural and acquired, rather than genetic, basis. The ketogenic diet should be considered early in the management of patients with acquired structural encephalopathies as it can improve seizure control with the potential to improve developmental outcome. The ketogenic diet was effective in children with epilepsy associated with an acquired structural aetiology.

MANEJO DE LAS HERIDAS QUIRÚRGICAS, DESDE EL TIPO, TÉCNICA E INSUMOS UTILIZADOS EN UNA IPS”. ARMENIA, QUINDÍO, 2014

Este artículo surge de la investigación “Manejo de las heridas quirúrgicas, desde el tipo, técnica e insumos utilizados en una ips. Armenia, Quindío, 2014, financiado por la Vicerrectoría de Investigaciones de la Universidad del Quindío. La investigación describe los métodos que son manejados para el cuidado de las heridas por parte del personal de enfermería que realiza dicho procedimiento, con el fin de conocer con detalle la técnica, o técnicas, y los procesos utilizados en el procedimiento, materiales, pasos, asepsia, entre otros; contrasta lo observado con los avances científicos-tecnológicos en este campo y determina el cuidado de enfermería brindado a los pacientes adultos hospitalizados con heridas de diferente etiología. La investigación fue de tipo Descriptiva-Transversal, con enfoque cuantitativo. La muestra se obtuvo a través de un muestreo intencional, para este caso, pacientes con herida quirúrgica hospitalizados en los servicios quirúrgicos, que ingresaron durante un trimestre por cirugía programada, complicaciones quirúrgicas o por cirugía de urgencia, en una IPS de tercer nivel de atención de Armenia, y quien es eligieron voluntariamente su participación. La técnica para la recolección de la información fue a través de la filmación del procedimiento. Posteriormente, se diligenciaron los instrumentos diseñados para los fines de la investigación; los datos fueron ingresados a Bases de Datos construidas y procesadas en SPSS.

Validation of Family Management Measure for the Brazilian culture.

To validate the Family Management Measure (FaMM) for Brazilian culture. Quantitative research excerpt, following the recommendations for validation studies. The data presented refer to the last stage of the process. The internal consistency of the items was analyzed through Cronbach's alpha of the six domains: Child's Daily Life (0.78); Condition Management Effort (0.51); Condition Management Ability (0.55); Family Life Difficulty (0.86); View of Condition Impact (0.56); and Parental Mutuality (0.80). Exploratory factorial analysis of the instrument was carried out, obtaining an acceptable adjustment, according to validation standards. The FaMM presents evidence of validation and can be used in the Brazilian culture under the name of Instrumento de Medida de Manejo Familiar, which was adjusted in eight domains, providing varied aspects of family management and a good evaluation of the fundamental aspects of family life in the context of childhood chronic conditions.

Guías, algoritmos y recomendaciones durante el manejo de la vía aérea difícil en el paciente sometido a cirugía torácica: ¿están respaldados por la evidencia cientifica?

Guías, algoritmos y recomendaciones durante el manejo de la vía aérea difícil en el paciente sometido a cirugía torácica: ¿están respaldados por la evidencia cientifica?

Manejo de la osteoporosis inducida por corticoides: enfoque práctico para el dermatólogo

Manejo de la osteoporosis inducida por corticoides: enfoque práctico para el dermatólogo

Assessing the sensitivity of matching algorithms: The case of a natural resource management programme in Honduras

A fundamental challenge in impact evaluations that rely on a quasi-experimental design is to define a control group that accurately refl ects the counterfactual situation. Our aim is to evaluate empirically the performance of a range of approaches that are widely used in economic research. In particular, we compared three diff erent types of matching algorithms (optimal, greedy and nonparametric). These techniques were applied in the evaluation of the impact of the MARENA programme (Manejo de Recursos Naturales en Cuencas Prioritarias), a natural resource management programme implemented in Honduras between 2004 and 2008. The key findings are: (a) optimal matching did not produce better-balanced matches than greedy matching; and (b) programme impact calculated from nonparametric matching regressions, such as kernel or local linear regressions, yielded more consistent outcomes. Our impact results are similar to those previously reported in the literature, and we can conclude that the MARENA programme had a significant, positive impact on beneficiaries.

Manejo de la vía aérea a través de faringostoma cervical por radionecrosis

Manejo de la vía aérea a través de faringostoma cervical por radionecrosis

Craniectomía descompresiva secundaria para el manejo de la hipertensión endocraneanal refractaria en el traumatismo craneoencefálico grave. Luces y sombras de los estudios recientes

Craniectomía descompresiva secundaria para el manejo de la hipertensión endocraneanal refractaria en el traumatismo craneoencefálico grave. Luces y sombras de los estudios recientes

Qualidade Física do Solo Sob Manejo Silvipastoril e Floresta Secundária

RESUMO Objetivou-se analisar a qualidade física em uma área de floresta em regeneração (FS) há 20 anos quando comparada à área que, neste período, permaneceu sendo manejada com sistema silvipastoril, com espécies arbóreas nativas em espaçamento aleatório (SSP). Foram realizadas coletas até 60 cm de profundidade para obtenção das curvas de retenção de água no solo, a densidade, a porosidade total, a macro e a microporosidade, a resistência mecânica à penetração (RMP) e sua respectiva umidade do solo, no momento da coleta. Houve similaridade entre os sistemas de manejo para as variáveis: densidade do solo, resistência mecânica à penetração e porosidade total. A microporosidade foi maior na FS em relação ao SSP, fazendo com que o sistema silvipastoril apresentasse menor capacidade de armazenamento de água. O isolamento do sistema silvipastoril no período de 20 anos apresentou capacidade de alterar o armazenamento de água no solo devido à modificação na porosidade, tornando-a similar à floresta natural.

Dujardinascaris helicina (Nematoda: Ascarididae) parásito de Crocodylus acutus (Reptilia: Crocodylidae) en Puerto Vallarta, Jalisco, México

The river crocodile (Crocodylus acutus, Cuvier, 1807) is a protected species in Mexico. In this work the stomach contents obtained through gastric lavage of 53 C. acutus from the estuarine systems “El Salado”, “Boca Negra-Boca de Tomates” and from the “UMA (Unidad de Manejo y Conservación de Vida Silvestre” for its meaning in Spanish) Reptilario Cipactli” located in Puerto Vallarta, Jalisco, Mexico were collected to study the helminth fauna of the species. Only Dujardinascaris helicina (Molin, 1860) was identified. The highest prevalence occurred in “Boca Negra-Boca de Tomates” with 74% and an abundance of 3.17, and the lowest in “UMA Reptilario Cipactli” with 12% and an abundance of 0.76. The dissimilarity is assumed to be caused primarily by the different feeding habits between wildlife and captivity raised crocodiles. During this investigation D. helicina is registered for the first time as a parasite for C. acutus in the region.

Eugenol como anestésico para el manejo de juveniles de Pavón (Cichla orinocensis)

Con el objeto de establecer una concentración anestésica de eugenol óptima para una adecuada manipulación de juveniles de Pavón (Cichla orinocensis), 24 juveniles (57,65 ± 43 g y 16.44 ± 1,17 cm de longitud estándar) provenientes de la estación Piscícola Experimental Casa Piedra de la Fundación Orinoquia de Puerto Carreño, Vichada, Colombia, fueron sometidos a diferentes concentraciones de eugenol (30, 40 y 50 mg/L) y un grupo control. Se presentaron diferencias estadísticamente significativas entre los tratamientos tanto para los tiempos de inducción como de recuperación con las concentraciones de 20, 30 y 50 mg/L (p<0,05), siendo el tratamiento de 20 mg/L el que presento el mayor tiempo de inducción (133±63,21 segundos) y el tratamiento de 50 mg/L presento el menor tiempo de inducción (46±17,51 segundos), los tiempos de recuperación del experimento aumentaron conforme aumentaban las concentraciones anestésicas empleadas, se observaron diferencias significativas (p<0,05) entre los tiempos de recuperación de cada tratamiento. La concentración anestésica de eugenol recomendada para juveniles de pavón (C. orinocensis) obtenida en este trabajo es de 35 mg/L.

Tropheryma whipplei endocarditis in Spain: Case reports of 17 prospective cases.

Tropheryma whipplei endocarditis is an uncommon condition with very few series and <90 cases reported in the literature. The aim of the study was to analyze the epidemiological, clinical, and outcome characteristics of 17 cases of T. whipplei endocarditis recruited in our country from a multicentric cohort from 25 Spanish hospitals from the Spanish Collaboration on Endocarditis—Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España.From a total of 3165 cases included in the cohort, 14.2% were diagnosed of blood culture negative endocarditis (BCNE) and 3.5% of these had T. whipplei endocarditis. This condition was more frequent in men. The average age was 60.3 years. Previous cardiac condition was present in 35.3% of the cases. The main clinical manifestation was cardiac failure (76.5%) while fever was only present in the 35.3%. Ecocardiography showed vegetations in 64.7% of patients. Surgery was performed in all but 1 cases and it allowed the diagnosis when molecular assays were performed. A broad range rRNA 16S polymerase chain reaction was used for first instance in all laboratories and different specific targets for T. whipplei were employed for confirmation. A concomitant Whipple disease was diagnosed in 11.9% of patients. All patients received specific antimicrobial treatment for at least 1 year, with no relapse and complete recovery.T. whipplei endocarditis is an uncommon condition with an atypical presentation that must be considered in the diagnosis of BCNE. The prognosis is very good when an appropriate surgical management and antimicrobial-specific treatment is given.

Ecuaciones alométricas de biomasa aérea para la estimación de los contenidos de carbono en manglares del Caribe Colombiano

The distribution of carbon in “Blue Carbon” ecosystems such as mangroves is little known, when compared with the highly known terrestrial forests, despite its particular and recognized high productivity and carbon storage capacity. The objective of this study was to analyze the above ground biomass (AGB) of the species Rhizophora mangle and Avicennia germinans from the Marine Protected Area of Distrito de Manejo Integrado (DMI), Cispatá-Tinajones-La Balsa, Caribbean Colombian coast. With official authorization, we harvested and studied 30 individuals of each species, and built allometric models in order to estimate AGB. Our AGB results indicated that the studied mangrove forests of the DMI Colombian Caribbean was of 129.69 ± 20.24 Mg/ha, equivalent to 64.85 ± 10.12 MgC/ha. The DMI has an area of 8 570.9 ha in mangrove forests, and we estimated that the total carbon potential stored was about 555 795.93 Mg C. The equations generated in this study can be considered as an alternative for the assessment of carbon stocks in AGB of mangrove forests in Colombia; as other available AGB allometric models do not discriminate mangrove forests, despite being particular ecosystems. They can be used for analysis at a more detailed scale and are considered useful to determine the carbon storage potential of mangrove forests, as a country alternative to support forest conservation and emission reduction strategies. In general, the potential of carbon storage from Colombian Caribbean mangrove forests is important and could promote the country leadership of the “blue carbon” stored.

The need for clinical guidelines for the comprehensive management of patients with cleft lip and palate

Objective To identify clinical guidelines for the treatment of cleft lip and / or palate in children under one year of age, published in Colombia and internationally. Method A search was conducted in three databases: PubMed, Lilacs and Scielo with the terms "guideline cleft lip and palate", "protocols cleft lip and palate", "guía clínica labio paladar fisurado", "guía de manejo labio paladar fisurado" and "guía labio paladar hendido". In addition to this, we consulted the websites of all pediatric hospitals in Colombia. Results 190 papers were found, of which 96 were not related to the population or focused on treatment, 84 were disciplinary, 8 interdisciplinary and only two were clinical guidelines. Conclusions There are few published guidelines and there is a lack of unified criteria. This gives rise to numerous forms of intervention and the creation of interdisciplinary teams. Therefore, there is a need to reach a consensus regarding the therapeutic approach in order to create treatment protocols based on evidence with quality standards.

Guía de práctica clínica sobre tromboprofilaxis y manejo de los fármacos anticoagulantes y antiagregantes en pacientes neuroquirúrgicos y neurocríticos

Guía de práctica clínica sobre tromboprofilaxis y manejo de los fármacos anticoagulantes y antiagregantes en pacientes neuroquirúrgicos y neurocríticos

Preliminary study of habitat preferences of red brocket deer (Mazama temama) in a mountainous region of central Mexico

Introduction: Red brocket deer ( Mazama temama ) is a cervid distributed along Mexico and Central America, and an important element for subsistence hunters. However, the availability of information of this species is very limited, especially in the mountainous ranges of its geographical distribution. The aim of this study was analyzing the habitat preferences of the red brocket deer in the highlands located in the Mexican states of Puebla, Oaxaca, and Veracruz. Methods: We evaluated the habitat use-availability of the brocket deer in relation to four habitat variables (vegetation type, vegetation cover, plant species richness, and slope). We considered the presence of deer signs and tracks as an indicator of use, while the availability was evaluated by random points. We use chi-squared tests in combination with Bonferroni confidence intervals to determine if the red brocket deer preferred or avoided the selected habitat variables. Results: Results showed that brocket deer selected coffee agroecosystems and avoided areas covered by secondary growth vegetation. Likewise, we observed that the species selects high vegetation cover sites and intermediate plant species richness. Discussion and conclusions: It has been reported that this species are commonly found in areas with slight human influence, our results suggest that the red brocket deer can also use sites with low-level disturbance, such as coffee agroecosystems. However, the use of these sites is associated with the proximity of patches of vegetation in good condition. In Mexico, the red brocket deer is an important species for management and conservation of Management Units for Wildlife Conservation (Unidades de Manejo y Aprovechamiento Sustentable de Vida Silvestre; UMAs for their Spanish initials), so our study results help to understand how the species respond to the habitat characteristics of their environment. This information will help to develop the relevant conservation and management measures that help to maintain healthy populations of the species.

Translation, adaptation and validation the contents of the Diabetes Medical Management Plan for the Brazilian context.

ABSTRACTObjective: to translate, adapt and validate the contents of the Diabetes Medical Management Plan for the Brazilian context. This protocol was developed by the American Diabetes Association and guides the procedure of educators for the care of children and adolescents with diabetes in schools. Method: this methodological study was conducted in four stages: initial translation, synthesis of initial translation, back translation and content validation by an expert committee, composed of 94 specialists (29 applied linguists and 65 health professionals), for evaluation of the translated version through an online questionnaire. The concordance level of the judges was calculated based on the Content Validity Index. Data were exported into the R program for statistical analysis: Results: the evaluation of the instrument showed good concordance between the judges of the Health and Applied Linguistics areas, with a mean content validity index of 0.9 and 0.89, respectively, and slight variability of the index between groups (difference of less than 0.01). The items in the translated version, evaluated as unsatisfactory by the judges, were reformulated based on the considerations of the professionals of each group. Conclusion: a Brazilian version of Diabetes Medical Management Plan was constructed, called the Plano de Manejo do Diabetes na Escola.

Performance and Muscular Development of Nile Tilapia Larvae (&amp;lt;i&amp;gt;Oreochromis niloticus&amp;lt;/i&amp;gt;) Fed Increasing Concentrations of Phenylalanine

Even though tilapia is of great economic interest, data on the nutritional requirements of amino acids during commercial breeding stages are scarce. So, the aim of this study was to analyse the performance and muscular growth of Nile tilapia larvae (Oreochromis niloticus) fed diets containing increasing concentrations of phenylalanine. The experiment took place at the Laboratory of Aquaculture of the Grupo de Estudos de Manejo na Aquicultura (GEMAq) of the Universidade Estadual do Oeste do Parana (Unioeste), Toledo, PR, Brazil, for 30 days. A total of 450 larvae, with mean initial length of 1.5 ± 0.14 cm and mean initial weight of 0.04 ± 0.004 g, were randomly distributed into 6 treatment groups with 5 repetitions (30 tanks). Each experimental unit consisted of a 30 L tank containing 15 larvae. Six diets were formulated with increasing concentrations of phenylalanine (1.09, 1.24, 1.39, 1.54, 1.69 and 1.84%) and offered four times a day until apparent satiation. By the end of the experimental period, the following productivity indexes were analysed: length, weight, survival, weight gain, uniformity, feed conversion, specific growth rate and protein efficiency ratio. Three fish from each tank were collected for muscular growth analysis and the frequency of small ( 0.05) was observed in the productive performance parameters between the treatment groups. Thus, it can be concluded that the levels of phenylalanine contained in the experimental diets did not influence the performance of Nile tilapia larvae. However, there was more hyperplasia when we put 1.39% of phenylalanine in the diet.

Quality of antenatal and childbirth care in rural health facilities in Burkina Faso, Ghana and Tanzania: an intervention study

To assess the impact of an intervention consisting of a computer-assisted clinical decision support system and performance-based incentives, aiming at improving quality of antenatal and childbirth care. Intervention study in rural primary healthcare (PHC) facilities in Burkina Faso, Ghana and Tanzania. In each country, six intervention and six non-intervention PHC facilities, located in one intervention and one non-intervention rural districts, were selected. Quality was assessed in each facility by health facility surveys, direct observation of antenatal and childbirth care, exit interviews, and reviews of patient records and maternal and child health registers. Findings of pre- and post-intervention and of intervention and non-intervention health facility quality assessments were analysed and assessed for significant (P < 0.05) quality of care differences. Post-intervention quality scores do not show a clear difference to pre-intervention scores and scores at non-intervention facilities. Only a few variables had a statistically significant better post-intervention quality score and when this is the case this is mostly observed in only one study-arm, being pre-/post-intervention or intervention/non-intervention. Post-intervention care shows similar deficiencies in quality of antenatal and childbirth care and in detection, prevention, and management of obstetric complications as at baseline and non-intervention study facilities. Our intervention study did not show a significant improvement in quality of care during the study period. However, the use of new technology seems acceptable and feasible in rural PHC facilities in resource-constrained settings, creating the opportunity to use this technology to improve quality of care.

La armonización territorial: su incorporación en la planificación y gestión administrativa mediante la gestión del riesgo

A lo largo del artículo emergen varios elementos con los cuales se puede establecer la incidencia de las políticas públicas en las tomas de decisión en el territorio, sobre todo en la utilización de tres instrumentos de planificación y de gestión territorial como el Plan de Desarrollo (PD), el Plan de Ordenamiento Territorial (POT) y los Planes de Manejo Integral de Cuencas Hidrográficas (Pomca), estructurados por medio de las Unidades de Planificación y de Gestión Territorial (UPGT). Estos permiten articular el desarrollo de programas y proyectos en un territorio asociado en municipios y departamentos, con el motivo de invertir y localizar infraestructuras que reduzcan la vulnerabilidad y amenaza en áreas que han sido objeto de deslizamientos e inundaciones e intervenidas por el Gobierno nacional mediante la Ley 1523 de 2012 de Gestión del Riesgo y complementadas por otras normas que fortalecen la dimensión ambiental, social, económica y administrativa que coadyuvan a un ordenamiento territorial más integral. La participación de actores y sectores públicos y privados y la sociedad civil son coordinados con la puesta en marcha de los Comités de Integración Territorial (CIT), que jalonan los procesos administrativos alrededor del riesgo y de los desastres naturales asociados, en muchos casos, con las actividades humanas