bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of supracondylar fractures of the humerus in children
Authors: Vaquero-Picado Alfonso , González-Morán Gaspar , Moraleda Luis
Published: October 2018

Supracondylar fractures of the humerus are the most frequent fractures of the paediatric elbow, with a peak incidence at the ages of five to eight years. Extension-type fractures represent 97% to 99% of cases. Posteromedial displacement of the distal fragment is the most frequent; however, the radial and median nerves are equally affected. Flexion-type fractures are more commonly associated with ulnar nerve injuries. Concomitant upper-limb fractures should always be excluded. To manage the vascular status, distal pulse and hand perfusion should be monitored. Compartment syndrome should always be borne in mind, especially when skin puckering, severe ecchymosis/swelling, vascular alterations or concomitant forearm fractures are present. Gartland’s classification shows high intra- and inter-observer reliability. Type I is treated with casting. Surgical treatment is the standard for almost all displaced fractures. Type IV fractures can only be diagnosed intra-operatively. Closed reduction and percutaneous pinning is the gold standard surgical treatment. Open reduction via the anterior approach is indicated for open fractures, absence of the distal vascular flow for > 10 to 15 minutes after closed reduction, and failed closed reduction. Lateral entry pins provide stable fixation, avoiding the risk of iatrogenic ulnar nerve injury. About 10% to 20% of displaced supracondylar fractures present with alterations in vascular status. In most cases, fracture reduction restores perfusion. Neural injuries occur in 6.5% to 19% of cases involving displaced fractures. Most of them are neurapraxias and it is not routinely indicated to explore the nerve surgically.

Cite this article: EFORT Open Rev 2018;3:526-540. DOI: 10.1302/2058-5241.3.170049
“We Had to Keep Pushing”: Caregivers' Perspectives on Autism Screening and Referral Practices of Black Children in Primary Care
Authors: Dababnah Sarah , Shaia Wendy E. , Campion Karen , Nichols Helen M.
Published: October 2018

Black children with autism spectrum disorder (ASD) are diagnosed later than their White peers, are more likely to be misdiagnosed, and are less likely to receive early intervention services or a developmental evaluation by three years old. Using a grounded theory approach, we solicited the perspectives of parents and other primary caregivers of Black children with ASD on barriers and facilitators to ASD screening and referrals in primary care. A socioeconomically diverse sample of 22 female caregivers participated. Four themes emerged. First, while some caregivers noted their child's primary healthcare providers facilitated a timely ASD diagnosis, other participants reported these providers ignored early concerns about child developmental delays. Second, many participants felt racial bias negatively impacted caregiver-primary healthcare provider interactions. Third, legal/custodial issues slowed caregivers' abilities to follow up on referrals from their primary healthcare providers. Finally, caregivers described denial, shame, and stigma relating to ASD in the Black community as possible factors for delayed follow up to referrals. Differences based on socioeconomic status are discussed. Efforts to improve family-centered, culturally relevant care for all Black caregivers raising children with or at-risk for ASD are needed, particularly for those families experiencing the multiple effects of poverty.
EDUCAÇÃO PARA A EMANCIPAÇÃO: IMPLICAÇÕES PEDAGÓGICAS NO CONTEXTO DA SOCIEDADE ATUAL
Authors: Santos Adriana Regina de Jesus , Oliveira Marta Regina Furlan de
Published: October 2018

Este artigo tem como objetivo refletir sobre a possibilidade de educação para a emancipação e suas implicações pedagógicas no contexto da sociedade atual. Como referenciais teóricos, partimos de algumas obras de Imannuel Kant, principalmente com o ensaio sobre Resposta à pergunta: O que é esclarecimento (Aufklãrung)? entre outras obras e, ainda as reflexões de Theodor Adorno e Horkheimer, principalmente, com a obra Dialética do Esclarecimento (1985), no sentido de pensar acerca do processo de educação. Kant, considerado um dos maiores filósofos alemães a partir do século XIX e mesmo do mundo, tomou para si a tarefa de pensar sobre os limites e as possibilidades do conhecimento; no sentido de que, por meio da filosofia, a humanidade pode ser compreendida e educada. Acredita o filósofo que, na e pela educação, o homem tem condições de conquistar sua maioridade e autonomia, ou seja, sua emancipação. Na mesma lógica do pensamento, Adorno nos convida ao processo de reflexão sobre a educação, no sentido de que os homens abandonem seu estado de auto inculpável menoridade em favor do projeto de emancipação humana. As contribuições desses filósofos alemães potencializam-nos a pensar e problematizar a educação, tecendo novos direcionamentos em favor da emancipação do ser humano.
A FILOSOFIA EM MEIO À EDUCAÇÃO PROFISSIONAL TÉCNICA NOS INSTITUTOS FEDERAIS DO BRASIL
Authors: Amaral Filho Fausto Dos Santos , Juk Joelson
Published: October 2018

O texto investiga a educação profissional técnica nos Institutos Federais do Brasil em uma perspectiva de crítica filosófica. Parte-se do surgimento dos Institutos Federais em um contexto liberal positivista, para se pensar a tecnocracia e a especialização na constituição do modelo social e pedagógico presente nessas instituições de ensino. Por conseguinte, a reflexão recai sobre o papel que pode ser desempenhado pelo ensino da Filosofia na defesa da educação profissional técnica integral em contraponto com a educação profissionalizante de caráter liberal positivista. Busca, assim, contribuir para o fortalecimento de um projeto de educação profissional técnica integral.
A EDUCAÇÃO INTEGRAL E A GESTÃO ESCOLAR: (CONTRA)TEMPOS
Authors: Fernandes Renata Sieiro , Consentino Modolo Esteves Baptista Flávia Fernanda
Published: October 2018

OO artigo trata do Programa Ensino Integral do Estado de São Paulo e da gestão educacional. São apresentados os fundamentos básicos da educação de tempo integral e analisadas as implicações do modelo de gestão empresarial. O objetivo é apresentar as concepções e as práticas das propostas de ampliação do tempo escolar e buscar entender as problemáticas que envolvem a sua implantação, as influências no cotidiano da escola e as demandas dirigidas às escolas e, especialmente, aos gestores para que o Programa Ensino Integral seja posto em prática. Vale-se de pesquisa bibliográfica, documental e de episódios cotidianos da gestão financeira, dos recursos físicos, humanos e do tempo. Os documentos norteadores do Programa preconizam uma educação humanizada e o modelo de gestão empresarial cobra resultados, metas, sem oferecer condições e sem levar em conta a realidade da escola, podendo causar sofrimento psíquico, doença e possível afastamento ou abandono da profissão por parte de gestores e professores.
O ‘APAGÃO’ DOCENTE: LICENCIATURAS EM FOCO
Authors: Esquinsani Rosimar Serena Siqueira , Esquinsani Valdocir Antonio
Published: October 2018

Avizinha-se o risco de ‘apagão’ docente na Educação Básica brasileira. Tal risco assenta-se, sobretudo, em duas constatações: a parca opção por cursos de licenciatura e a defasagem quantitativa entre o número de jovens professores e o número de docentes na etapa final de suas carreiras.  Para fazer o enfrentamento desta situação, são necessárias soluções estruturais que passariam por dois movimentos: a) o investimento na atratividade e a permanência na carreira docente, e b) o fortalecimento dos cursos de licenciatura. Na esteira desse debate, o artigo objetiva discutir circunstancialmente o ensino nos cursos de licenciatura e a sua potencial contribuição para a superação do deficit crescente de professores. Para essa discussão, o artigo foi pautado em base bibliográfica, conduzida por metodologia analítico-reconstrutiva, edificada a partir da análise de conteúdo sobre dois procedimentos de coleta de informações: dados de contexto e utilização de grupo focal.  Como conclusão, o texto confirma as licenciaturas como apoio para a solução estrutural do ‘apagão’ docente.  Já no que concerne ao debate específico sobre o ensino nos cursos de licenciatura, há duas perspectivas: a) a necessidade de cursos específicos para a formação docente – visto que a atividade docente não pode ser descolada de uma preparação específica; e b) a convivência curricular de dois grandes núcleos: os conhecimentos disciplinares e os conhecimentos pedagógicos ou didáticos, ambos tomados como elementos centrais na formação de professores.
A life in training
Authors: Fletcher J. D.
Published: October 2018

Select Quotes: Good luck happens, don’t ignore it. Recognize it for what it is and, if it fits, take advantage of it–a road of travel I should have followed more carefully.Those of us working with research discovery or advancement need to be better prepared to answer the “so what” question about its monetary (does it save money?) and operational (does it increase missions success?) return on investment. This preparation is often neglected and/or ignored in research circles. The world may not be our oyster, but the need to understand and apply emerging instructional capabilities and technologies to, and across, education and training activities continues to escalate and never ends. In an applied world, even more than in the ethereal world of academic theory, anything that works or might work goes.. . . there is substantial value in communicating and collaborating with colleagues in related and/or relevant disciplines such as computer science, engineering in general, human factors, economics, statistics (of course), cultural anthropology, linguistics, and so forth. This value seems especially evident in practical applications where the issue of what works is paramount, and it may be better accepted outside of university departments where relevance and dedication to a particular discipline may be of more value for advancement than cooperation across discipline boundaries.
The Design and Testing of 3DmoveR: an Experimental Tool for Usability Studies of Interactive 3D Maps
Authors: Herman Lukáš , Řezník Tomáš , Stachoň Zdeněk , Russnák Jan
Published: October 2018

Various widely available applications such as Google Earth have made interactive 3D visualizations of spatial data popular. While several studies have focused on how users perform when interacting with these with 3D visualizations, it has not been common to record their virtual movements in 3D environments or interactions with 3D maps. We therefore created and tested a new web-based research tool: a 3D Movement and Interaction Recorder (3DmoveR). Its design incorporates findings from the latest 3D visualization research, and is built upon an iterative requirements analysis. It is implemented using open web technologies such as PHP, JavaScript, and the X3DOM library. The main goal of the tool is to record camera position and orientation during a user’s movement within a virtual 3D scene, together with other aspects of their interaction. After building the tool, we performed an experiment to demonstrate its capabilities. This experiment revealed differences between laypersons and experts (cartographers) when working with interactive 3D maps. For example, experts achieved higher numbers of correct answers in some tasks, had shorter response times, followed shorter virtual trajectories, and moved through the environment more smoothly. Interaction-based clustering as well as other ways of visualizing and qualitatively analyzing user interaction were explored.
Direct shoot regeneration from male immature flower buds of Musa paradisiaca Linn. cv. Poovan (AAB)
Authors: Nair Anjana R G , Ravichandran P , Bejoy Mathew
Published: October 2018

A tissue culture system has been developed to multiply Musa paradisiaca cv. Poovan using male immature flower bud and to establish it in ex vitro condition. Size of explants has been found an influencing factor for culture initiation. Immature male flower bud segments of 3 cm size were ideal for better survival and subsequent shoot regeneration. Direct shoot regeneration was achieved from male immature flower buds on Murashige and Skoog (MS) medium supplemented with varying concentrations of plant growth regulators. Initially, actively dividing meristematic region developed at the basal region of flower buds near the bract axil, which later grew into green shoot buds in most of the PGR treatments. Single use of benzyl adenine were found beneficial than kinetin or addition of indole-3-acetic acid. Maximum production of 31.0 ± 0.65 shoots was achieved on MS + 3% sucrose + 6 mg/L benzyl adenine in 15 weeks. Isolated healthy shoots were rooted in half-strength MS medium with 150 mg/L activated charcoal + 30 g/L sucrose + 1 mg/L indole-3-butyric acid within 15 days and they established successfully in greenhouse conditions with 85 % survival.
Pesticides: Le Talon d’Achille des politiques alimentaires canadiennes et québécoises
Authors: Bacon Marie-Hélène , Vandelac Louise , Petrie Sébastien
Published: October 2018

Comment expliquer que le projet de politique alimentaire du Canada ignore le dossier des pesticides alors que la récente politique bioalimentaire du Québec évoque vaguement la question, mais sans engagements significatifs? Pourquoi évacuer ainsi l’analyse des enjeux et des effets sanitaires et environnementaux préoccupants des pesticides et notamment du glyphosate, premier pesticide au monde, en croissance exponentielle, qui, déclaré cancérogène probable par le Centre international de recherche sur le cancer (CIRC) de l’Organisation mondiale de la santé (OMS) (IARC, 2015), constitue au Canada 56 pour cent des pesticides agricoles et 44 pour cent de ceux du Québec (Santé Canada, 2017a; MDDELCC, 2017)? Presqu’omniprésent dans les champs, les cours d’eau agricoles et dans 30 pour cent des aliments au Canada, le glyphosate est l’objet de vives controverses scientifiques et citoyennes dans le monde entier (Robin, 2008, 2018). En Europe, sa ré-autorisation, suite à deux ans de vives controverses a été limitée à 5 ans. Aux États-Unis, 3,500 victimes d’un lymphome non-hodgkinien attribué au Roundup, premier herbicide à base de glyphosate (HBG) en importance au monde, poursuivent en justice son principal fabricant Monsanto (Gonzague & Michel, 2017) alors qu’en France et en Argentine, des poursuites pour malformations congénitales s’amorcent également contre Monsanto (Foucart, 2018). Cet article examine, dans une approche interdisciplinaire et intersectorielle, les facteurs de la montée en puissance des HBG, leurs principaux effets sur l’environnement et la santé, et les lacunes d’évaluation et d’encadrement des pesticides, contribuant à leur diffusion massive et à leurs effets. Il met aussi en évidence que les projets et politiques alimentaires canadiennes et québécoises, centrés sur le développement de modèles agro-industriels intensifs et technicisés d’exportation soumis à une conception de croissance économique, sont peu compatibles avec les exigences de protection de la biodiversité, de la santé et de la sécurité alimentaire. Or, dans un contexte de globalisation des marchés et d’accords de libre-échange avec l’Europe, plus soucieuse du Principe de Précaution et de droits des consommateurs, la négligence de ces enjeux écologiques et sanitaires risque d’en constituer le talon d’Achille.
Settler colonialism and the (im)possibilities of a national food policy
Authors: Rotz Sarah , Kepkiewicz Lauren Wood
Published: October 2018

In this perspectives piece we ask: is it possible for a national food policy to form the foundation for sustainable and equitable food systems in Canada? First, we argue that under the current settler government, such a policy does not provide this foundation. Second, we consider what is possible to achieve within the scope of a national food policy, recognizing our responsibility as settlers to hold our government accountable so policies do not exacerbate food system inequities. To mitigate some of the harmful effects of current food-related policy, we make three suggestions: 1) restrict land access based on capital, number of properties owned, acreage, and interest in food provisioning; 2) support relevant and culturally appropriate markets by divesting from industrial scale food chains, and re-invest in marginalized food provisioners; and 3) direct funding to diverse non-consumptive food networks rather than export-oriented agro-food industries. To be clear, these suggestions will not decolonize a national food policy; rather, we argue they present short-term actions within the current settler state to address some of the ways the Canadian government inhibits Indigenous food systems.
Tackling household food insecurity: An essential goal of a national food policy
Authors: Dachner Naomi , Tarasuk Valerie
Published: October 2018

Eradicating household food insecurity is essential to the articulated vision of a national food policy that aims to promote healthy living and safe food for families across the country. Household food insecurity refers to the insecure or inadequate access to food due to financial constraints. Despite federal commitments to improve the situation, food insecurity in Canada increased between 2007-08 and 2011-12. It currently affects more than four million Canadians, and is particularly grave in Indigenous communities. Food insecurity takes a toll on individuals’ health and well-being, and it is a burden on our healthcare system. The social epidemiology of household food insecurity shows it to be inextricably linked to the social and economic circumstances of households. Federal and provincial policy interventions that improve the financial circumstances of very low income households have yielded reductions of up to 50 percent in household food insecurity prevalence and severity. Yet, prevalence rates remain high. A national food policy represents an invaluable opportunity to address food insecurity in Canada. To do so, this policy must transcend the conventional boundaries of agriculture and agri-food. Addressing food insecurity requires the integration of policy actions across the three levels of government. In addition, performance targets must be established, and ongoing monitoring and evaluation mechanisms implemented, to ensure that policies and programs meant to address food insecurity actually have a meaningful impact.
Governance recommendations from forty years of national food strategy development in Canada and beyond
Authors: Andrée Peter , Coulas Mary , Ballamingie Patricia
Published: October 2018

This paper contributes to Canada’s current national food policy discussion by introducing lessons gleaned from the development of two earlier Canadian government food policy efforts, A Food Strategy for Canada (1977) and Canada’s Action Plan for Food Security (1998), as well as lessons drawn from national food strategy development in seven other countries. By examining the strengths and weaknesses of these previous policy-making processes, we show how today’s food policy conversation builds on the legacy of 1998's Action Plan. We then offer food policy governance recommendations designed to avoid the mistakes of the previous efforts. This paper explores international precedents for governance mechanisms designed to be inclusive of key food systems’ stakeholders, and to meaningfully include multiple levels of government in food governance. Drawing on both our domestic and international research, we conclude by recommending the establishment of a multi-sectoral and inter-governmental National Food Policy Council. We show how such a Council, operating in close cooperation with other key mechanisms, could help govern the pan-Canadian food strategy we advocate.
Parameters of Nanosecond Overvoltage Discharge Plasma in a Narrow Air Gap between the Electrodes Containing Electrode Material Vapor
Authors: Shuaibov O. K. , Minya O. Y. , Chuchman M. P. , Malinina A. O. , Malinin O. M. , Danilo V. V. , Gomoki Z. T.
Published: October 2018

Parameters of the nanosecond overvoltage discharge plasma in an air gap of (1÷5) × 10−3 m between the electrodes, which contains the vapor of an electrode material (Zn, Cu, Fe) injected into plasma due to the ectonic mechanism, have been studied. The dependences of those parameters on the ratio E/N between the electric field strength E and the particle concentration N in the discharge are calculated for the “air–copper vapor” system, by using the numerical simulation method.
SPR in Cesium Halide Thin Films Due to Embedded Elliptic Cesium Metal Nano-Particles
Authors: Kumar Kuldeep , Arun P.
Published: October 2018

Cesium nanorods embedded in cesium halides (CsCl, CsBr, and CsI) show surface plasmon resonance (SPR) absorption peaks. The size and shape of these cesium nanorods in the cesium halide matrix evolve with time, which gives some uncontrollable data for comparing with the theory. The theory used here was developed by R. Gans. It leads to the good match between experiment and theory for Cs–Cs halide nanocomposites.
Immediate Complications of Elective Newborn Circumcision
Authors: Heras Andrea , Vallejo Victoria , Pineda Marcela I. , Jacobs Allan J. , Cohen Lourdes
Published: October 2018

OBJECTIVES:

To determine the incidence of immediate complications of elective newborn circumcision in 2 community teaching hospitals.

METHODS:

We performed a retrospective chart review of all term neonates who had circumcision performed between August 2011 and December 2014 at 2 community hospitals in New York. Neonatal hospital records and subsequent inpatient and outpatient records were reviewed. We classified complications as minor, intermediate, and major.

RESULTS:

Out of a total of 1115 circumcisions, 1064 met inclusion criteria. There were 41 complications (3.9%), all involving hemorrhage. Sutures were used to control hemorrhage in 3 patients (0.3%). Local pressure or application of hemostatic chemical agents controlled bleeding in the remainder of patients. Bleeding was more common with the use of the Gomco clamp than with the Mogen clamp. Circumcisions performed with Gomco clamp represented 73.2% of the total complications compared with 26.8% with the Mogen clamp. There were no injuries to structures outside the prepuce or problems requiring medical treatment after discharge from the neonatal hospitalization.

CONCLUSIONS:

The most common immediate complication encountered during an elective neonatal circumcision was bleeding that required only pressure or topical thrombin to achieve hemostasis. Bleeding was more common with the use of the Gomco versus the Mogen clamp. To conclude, our data support the theory that elective infant circumcision can be performed safely in a hospital setting.
Gomco Versus Mogen? No Effect on Circumcision Revision Rates
Authors: Chan Priscella S. , Penna Frank J. , Holmes Alison Volpe
Published: October 2018

OBJECTIVES:

Elective newborn circumcision, one of the most common surgical procedures in the world, is often performed with either the Gomco clamp or the Mogen clamp. Our aims were to determine differential circumcision revision and complication rates due to surgical technique and differences in outcomes when residents versus attending physicians performed the procedure.

METHODS:

We conducted a retrospective chart review of newborns who underwent elective circumcision at our children’s hospital from January 2013 to June 2017 using Current Procedural Terminology codes for newborn circumcision and repair of an incomplete circumcision. We excluded patients who were initially circumcised by a physician other than a pediatrician and procedures that were performed after 31 days of age. The primary outcome was the rate of circumcision revisions. The secondary outcome was the incidence of minor and major complications. We used independent sample t tests, analysis of variance, Fisher’s exact test, and logistic regression models in the analysis.

RESULTS:

We analyzed 979 Gomco and 718 Mogen procedures. Both groups had similar complication (26 of 1697 or 1.53%) and revision rates (8 of 1697 or 0.47%). Attending physicians and residents had similar revision rates overall, but residents using the Gomco clamp had a higher rate of revision (2 of 249 or 0.80%) than attending physicians (2 of 730 or 0.27%; P = .003). Older age at primary procedure was significantly associated with revision (P = .03).

CONCLUSIONS:

Elective newborn circumcision is associated with similar complication and revision rates after the use of either Gomco or Mogen clamps. There were no differences in outcomes when the procedure was performed by pediatric residents or attending pediatricians.
A New Mobile Application to Reduce Anxiety in Pediatric Patients Before Bone Marrow Aspiration Procedures
Authors: Wantanakorn Pornchanok , Harintajinda Supamas , Chuthapisith Jariya , Anurathapan Usanarat , Rattanatamrong Prapaporn
Published: October 2018

OBJECTIVES:

Insufficient preparation for children who are undergoing bone marrow aspiration can cause anxiety and negative outcomes. Nonpharmacological therapies have been proven to reduce fear in children who are undergoing painful procedures. We have therefore developed a mobile application to help reduce these patients’ anxiety by providing them with procedural information and coping skills.

METHODS:

This single-blinded, randomized controlled trial included 60 patients age 5 to 12 years old who were undergoing bone marrow aspiration procedures in Thailand that were conducted between May 2015 and May 2016. Sixty participants were randomly assigned to the intervention group (mobile application added to usual care) or the control group (usual care only). Preprocedural anxiety levels were evaluated by visual analog scales (child anxiety visual analog scale); this was repeated in the intervention group immediately after patients used the mobile application. On the day of the procedure, the patients’ cooperation levels were assessed by using the modified Yale Preoperative Anxiety Scale. The total amount of sedative drugs that were used was also recorded. The paired t test and the Wilcoxon signed rank test were used to analyze within-person change, whereas the t test and the Wilcoxon rank sum test were used for group comparisons.

RESULTS:

The child anxiety visual analog scale score of patients in the intervention group decreased significantly after they used the mobile application (P < .0012). The modified Yale Preoperative Anxiety Scale score of patients in the intervention group was significantly lower than that in the control group (P < .01). There was no difference in sedative use between the 2 groups.

CONCLUSIONS:

This mobile application possibly had effectiveness in routine use for reducing anxiety and increasing patients’ cooperation in bone marrow aspiration procedures.
A Pragmatic Method for Identification of Long-Stay Patients in the PICU
Authors: Woodger Owen , Menon Kusum , Yazbeck Myra , Acharya Anand
Published: October 2018

OBJECTIVES:

To develop a pragmatic method of identifying long-stay patients (LSPs) in the PICU.

METHODS:

We surveyed 40 expert stakeholders in 14 Canadian PICUs between February 2015 and March 2015 to identify key factors to use for defining LSPs in the PICU. We then describe a pragmatic method using these factors to analyze 523 admissions to an academic, tertiary-care PICU from February 1, 2015, to January 31, 2016.

RESULTS:

The overall response rate was 70% (28 of 40). Of respondents, 75% (21of 28) stated that it was important to define LSPs and identified present and future resource consumption (18 of 21 [86%] and 16 of 21 [76%], respectively) as the key reasons for defining LSPs. Respondents valued a definition that was consistent and ranked a percentile cutoff as the preferred analytic method for defining LSPs. Of respondents, 86% (24 of 28) though the LSP definition should include factors other than length of stay. We developed a surrogate marker for LSPs using mechanical ventilation and presence of a central venous catheter in our sample population to compare to varying percentile cutoffs. We identified 108 patients at the 80th percentile as LSPs who used 67% of total bed days and had a median length of stay of 11.3 days.

CONCLUSIONS:

We present a pragmatic method for the retrospective identification of LSPs in the PICU that incorporates unit- and/or patient-specific characteristics. The next steps would be to validate this method using other patient and/or unit characteristics in different PICUs and over time.
Educational Perspectives: Advanced Technology and High Sensibility in Providing Safe Neonatal Care in Intensive Care Units
Authors: Martínez Jorge César
Published: October 2018

Possibly no other field of medicine has undergone such dramatic progress in reducing mortality and morbidity as the care of preterm newborns. In recent years, remarkable advances in the care of pregnant women and their children have led to an increase in infant survival. However, advances in neonatal care need to be accompanied by mechanisms that help us deliver care safely to this most vulnerable population.
An Introduction to the Duchenne Muscular Dystrophy Care Considerations
Authors: Ward Leanne M. , Birnkrant David J.
Published: October 2018

Building on the 2018 DMD Care Considerations, in this article, we introduce companion articles that provide detailed guidance on managing patients with DMD.
Bone Health and Osteoporosis Management of the Patient With Duchenne Muscular Dystrophy
Authors: Ward Leanne M. , Hadjiyannakis Stasia , McMillan Hugh J. , Noritz Garey , Weber David R.
Published: October 2018

Duchenne muscular dystrophy is associated with an increased risk of bone fragility due to the adverse effects of prolonged glucocorticoid therapy and progressive muscle weakness on bone strength. Osteoporosis manifests clinically as low-trauma long-bone and vertebral fractures (VFs), with VFs frequent, particularly in those treated with glucocorticoid therapy. It is increasingly recognized that bone pain, medical complications of osteoporosis (such as fat embolism syndrome), and the potential for permanent, fracture-induced loss of ambulation can be mitigated with timely bone health surveillance and management. This includes periodic spine radiographs for VF detection because VFs can be asymptomatic in their early phases and thereby go undetected in the absence of monitoring. With this article, we provide a comprehensive review of the following 4 phases of bone health management: (1) bone health monitoring, which is used to identify early signs of compromised bone health; (2) osteoporosis stabilization, which is aimed to mitigate back pain and interrupt the fracture–refracture cycle through bone-targeted therapy; (3) bone health maintenance, which has the goal to preserve the clinical gains realized during the stabilization phase through ongoing bone-targeted therapy; and (4) osteoporosis therapy discontinuation, which places those who are eligible for discontinuation of osteoporosis treatment back on a health monitoring program. In the course of reviewing these 4 phases of management, we will discuss the criteria for diagnosing osteoporosis, along with detailed recommendations for osteoporosis intervention including specific drugs, dose, length of therapy, contraindications, and monitoring of treatment efficacy and safety.
Primary Care and Emergency Department Management of the Patient With Duchenne Muscular Dystrophy
Authors: Noritz Garey , Naprawa James , Apkon Susan D. , Kinnett Kathi , Racca Fabrizio , Vroom Elizabeth , Birnkrant David J.
Published: October 2018

Primary care providers (PCPs) are usually the first point of contact with the health care system for patients with Duchenne muscular dystrophy (DMD), and patients often present to emergency departments in which providers have little experience in dealing with this condition. With this article, we give primary care and emergency medicine providers a background in the common issues that affect people with DMD. By acquiring some specialized knowledge about the multisystem medical complications of DMD and by applying general principles of primary care, such as timely immunization, anticipatory safety counseling, behavioral screening, and routine nutritional and developmental assessments, the PCP can be a valued and effective medical provider to patients with DMD. The PCP can provide access to and effective coordination among the patient’s specialty caregivers. Moreover, the PCP can become a trusted advisor to the patient and his family about important medical decisions, as well as issues in the psychosocial, behavioral, and educational domains. This article also contains a “pocket guide” used to assess and manage common urgent medical problems that cause patients with DMD to seek care in the emergency department. With the background information discussed in this article, both PCPs and emergency medicine physicians can skillfully care for patients with DMD in their respective settings, optimizing patient outcomes.
Psychosocial Management of the Patient With Duchenne Muscular Dystrophy
Authors: Colvin Mary K. , Poysky James , Kinnett Kathi , Damiani Mario , Gibbons Melissa , Hoskin Janet , Moreland Scott , Trout Christina J. , Weidner Norbert
Published: October 2018

In this article, we outline a comprehensive plan for the psychosocial management of patients with Duchenne muscular dystrophy (DMD) across the life span. In 2010, the Centers for Disease Control and Prevention sponsored the development of multidisciplinary management guidance for DMD, and in 2018, that guidance was updated. In the intervening years, a new emphasis was placed on studying and addressing the psychosocial issues that affect patients with DMD, driven in part by improved patient survival. Once viewed as ancillary to managing the significant medical needs of patients with DMD, it is now standard practice to integrate psychosocial management into the multidisciplinary management of the disease. It is also increasingly recognized that neurodevelopmental disorders in DMD occur at a higher rate than what was previously understood and that these disorders warrant early and intensive intervention. In this article, we expand on the content found in the 2018 DMD Care Considerations.
Human and Animal Bites
Authors: Bula-Rudas Fernando J. , Olcott Jessica L.
Published: October 2018

In the United States, nearly 56% of households owned a pet in 2011 according to the 2012 U.S. Pet Ownership & Demographics Sourcebook by the American Veterinary Medical Association. The survey also reports that approximately 70 million dogs and 74 million cats lived in households in the United States during the same year. (1)

Human and animal bites are a frequent cause of primary care and emergency department visits for children. It is estimated that 250,000 human bites, 400,000 cat bites, and 4.5 million dog bites occur in the United States each year in both adults and children. (2) In the United States, approximately 10% of all human bites will become infected in a child with a bite wound. The infection rate of dog bites in children is 20%. Cat bite infection rates in children vary but can be up to 50%. Each type of bite wound has a predisposition for sex and/or age. Infected bite wounds manifest with swelling, erythema, and tenderness with or without drainage of the affected site and can lead to serious complications. Most animal bite wounds are polymicrobial in nature. Pasteurella species (spp.) is the most common organism isolated from both cat and dog bites. The microbiology of human bites consists of both aerobic and anaerobic bacteria.

Basic medical management of bite wounds includes thorough cleansing and debridement. Irrigation, closure, and need to obtain culture depend on the type of bite wound, the appearance of the wound, the and timing of medical evaluation after the initial injury. Amoxicillin-clavulanate is the antibiotic of choice for prophylaxis and empirical therapy for children who are not allergic to penicillin. With most animal bites being preventable injuries, healthcare providers caring for children have an important role discussing pet safety with the child and the family.
Percepción de usuarios de Cali-Colombia acerca de medicamentos genéricos
Authors: Torres Serna Camilo , Salcedo David Altman , Fernández Rodríguez Luisa María , Orozco Idrobo Luis , Rosero Alayón Rodrigo A.
Published: October 2018

En la población en general existe gran controversia alrededor del uso de medicamentosinnovadores y de sus copias llamadas medicamentos genéricos. El objetivo de esteestudio es cuantificar la aceptación de los pacientes, del Sistema General de SeguridadSocial en Salud de Colombia (SGSSS) a la prescripción de medicamentos genéricos.Se realizó un estudio de tipo descriptivo con un diseño transversal en 63 hombres y57 mujeres, todos adultos pacientes que asistieron a consulta externa de los sitios depráctica de una Facultad de Medicina de Cali-Colombia.Se concluye que si se usan medicamentos genéricos, se requiere que los médicos y losusuarios tengan confianza en él. Los resultados del presente estudio muestran que,aunque no en forma mayoritaria, todavía un porcentaje importante de los consumidoresentrevistados dudan de la calidad y de los resultados terapéuticos de los genéricos.De manera preocupante, casi una cuarta parte de los participantes en el estudiopiensa que los medicamentos genéricos son productos fraudulentos.
Agentes dopaminérgicos centrales análogos N-aralquil metoxilados del 2-aminoindano
Authors: Suárez Bozo Geraldine , Sanguino Díaz María , Lucena Gerardo , Ocampo Hernández Miriam , Rodríguez Villasmil Lucía , Balza Jiménez Katherin , Vera Sosa Mariagracia , Ángel Migliore Ligia , Migliore de Ángel Biagina , Charris Charris Jaime , Israel Anita , López D’ Sola Simón , Izquierdo Rodolfo , Caldera Luzardo José , Ortega Fernández José , Ramírez Morán María , Ángel Guio Jorge
Published: October 2018

La neurotransmisión dopaminérgica interviene en los mecanismos que involucran los procesos motores, cognoscitivos, conductuales y neurocrinos y su mal funcionamiento la involucra en los trastornos neurodegenerativos que afectan al sistema nervioso central (SNC), tales como en la enfermedad de Parkinson y la enfermedad de Huntington, entre otras. Con el propósito de encontrar una solución terapéutica a estas patologías, en publicaciones anteriores hemos reportado la síntesis, la evaluación farmacológica y el estudio teórico computacional de los compuestos análogos mono y dihidroxilados (sobre el anillo indano) del N-aralquil-2-aminoindano 4-8, análogos 4,7-dimetoxi-2-aminoindano-N-aralquil, bajo sus formas metoxiladas sobre el anillo bencénico del fragmento aralquil 9 y el derivado fenólico 10, así como también los análogos diclorados del N-aralquil-2-aminoindano 11 con actividades dopaminérgicas centrales. En el presente trabajo se sintetizaron los clorhidratos del 2-aminoindano-N-[2-(mono o dimetoxi)-fenil)-1-metil-etil] 12-15 y su evaluación farmacológica mostraron respuestas agonísticas como potenciales agentes antihuntington y antipárkinson.
Prevención en diabetes mellitus y riesgo cardiovascular: enfoque médico y nutricional
Authors: Pinilla-Roa Análida Elizabeth , Barrera-Perdomo María Del Pilar
Published: October 2018

Introducción. La epidemia de diabetes mellitus tipo 2 (DM2) incrementa la enfermedad cardiovascular y la morbimortalidad; por tanto, es importante prevenir, tratar integralmente y valorar complicaciones y comorbilidades asociadas.Objetivo. Presentar una revisión sobre prevención de DM2 y riesgo cardiovascular con enfoque médico y nutricional.Materiales y métodos. Se hizo una revisión en las bases de datos Embase, PubMed, Bireme (LILACS, SciELO) y Cochrane Library con términos específicos. La búsqueda se hizo en inglés y español sobre publicaciones entre 2001 y 2016.Resultados. Se encontraron 811 publicaciones y, después de aplicar los criterios de inclusión y exclusión, se seleccionaron 71 documentos clasificados así: 24 artículos de investigación, 14 artículos de revisión, 18 guías clínicas, 8 consensos y 7 de otras categorías (informes, capítulos de libro, normatividad y un libro)Conclusión. La educación es una herramienta fundamental para prevenir y tratar factores de riesgo. Se debe incentivar el trabajo en equipo con el paciente y la familia para reducir el desarrollo de comorbilidades asociadas a DM2.
Respuesta a la farmacoterapia en pacientes con glomerulonefritis membranoproliferativa en una clínica de Barranquilla, Colombia. 2007-2014
Authors: Aroca-Martínez Gustavo , González-Torres Henry Joseth , Domínguez-Vargas Alex , Fontalvo-Pastorizo Jossie , Silva-Díaz Diana , Cadena-Bonfanti Andrés
Published: October 2018

Introducción. La glomerulonefritis membranoproliferativa (GnMP) es un patrón de lesión glomerular hipercelular mesangial con adelgazamiento de la membrana basal glomerular y proliferación endocapilar que está mediado por las inmunoglobulinas o el sistema del complemento en el mesangio y endotelio capilar.Objetivo. Evaluar la respuesta a la farmacoterapia en pacientes diagnosticados con GnMP en una clínica de Barranquilla entre los años 2007 y 2014.Materiales y métodos. Estudio de cohorte retrospectivo en el que se evaluaron 58 pacientes con diagnóstico de GnMP por biopsia renal, quienes se clasificaron como respondedores y no respondedores. Se realizó una evaluación de tratamiento estándar según tipo de GnMP: mediado por complemento y mediado por inmunocomplejos e inmunofluorescencia negativa a los 6 y 12 meses de tratamiento.Resultados. La edad promedio de los participantes fue de 35±13 años. De 58 pacientes, 52% eran mujeres, 63% desarrolló enfermedad renal crónica (ERC) al año de evaluación, 25.8% logró remisión (22.4% completa y 3.4% parcial) y 74.2% no logró entrar en remisión.Conclusión. La GnMP es una causa importante de ERC entre la población estudiada. La respuesta al tratamiento inmunosupresor no demostró beneficios estadísticamente significativos, independiente del tipo de GnMP.
Caracterización clínica y molecular en hipercolesterolemia familiar homocigota
Authors: Rincón Erika Andrea , Gómez Mesa Juan Esteban , Pachajoa Harry Mauricio
Published: October 2018

Introducción. La hipercolesterolemia familiar homocigota es un desorden genético raro que se caracteriza por niveles muy elevados de colesterol y por una pobre respuesta al tratamiento farmacológico convencional (estatinas, ezetimibe). El estudio molecular es un recurso importante que puede impactar de forma positiva en el tratamiento y pronóstico de estos pacientes; sin embargo, este tipo de estudio no siempre está disponible en todos los centros de atención. El resultado de estas pruebas genéticas permite identificar pacientes que se pueden beneficiar de nuevas opciones terapéuticas asociadas a mayor disminución de colesterol total y LDL.Presentación de casos. Se presentan los casos de dos hermanas con hipercolesterolemia severa y pobre respuesta al tratamiento farmacológico convencional, en quienes el diagnóstico molecular confirmó una mutación en homocigosis del gen del receptor de la lipoproteína de baja densidad. Con base en estos resultados, en ambos casos se adicionó un inhibidor selectivo de proteína microsomal de transferencia de triglicéridos al manejo hipolipemiante convencional, con lo que se logró una reducción de más del 49% en los niveles séricos de colesterol total y LDL.Conclusión. Las pruebas moleculares son una herramienta importante para definir el diagnóstico, pronóstico y tratamiento de los pacientes con hipercolesterolemia familiar homocigota.
Función pulmonar, capacidad funcional y calidad de vida en pacientes con fibrosis pulmonar idiopática. Revisión de la literatura
Authors: Villarroel-Bustamante Karin , Jérez-Mayorga Daniel , Campos-Jara Christian , Delgado-Floody Pedro , Guzmán-Guzmán Iris Paola
Published: October 2018

Introducción. La fibrosis pulmonar idiopática (FPI) es un tipo de enfermedad intersticial, crónica y progresiva que suele manifestarse con disnea y deterioro progresivo de la tolerancia al ejercicio y a las actividades de la vida diaria, llegando a comprometer el nivel psicológico y la interacción social.Objetivos. Seleccionar y sintetizar información acerca de la respuesta de la capacidad funcional, la función pulmonar y la calidad de vida relacionada con la salud en pacientes con FPI luego de ser sometidos a un programa de rehabilitación pulmonar.Materiales y métodos. Revisión de la literatura desde 2000 a 2016, utilizando las bases de datos PubMed y ScienceDirect.Resultados. Se seleccionaron 10 ensayos clínicos randomizados. Se observó tendencia al aumento significativo en la distancia recorrida en test de marcha de 6 minutos. Respecto a la función pulmonar, los resultados variaron entre las poblaciones estudiadas. En la calidad de vida relacionada con la salud se observó mejora en los pacientes sometidos a rehabilitación, pero los niveles de disnea mostraron resultados discordantes.Conclusión. Se evidenciaron beneficios en términos de capacidad funcional y calidad de vida relacionada con la salud, pero los estudios siguen siendo escasos y con poblaciones pequeñas; los efectos de los programas de rehabilitación no se mantienen a los 6 meses de evaluación post-entrenamiento.
Una mirada global y actualizada del cáncer de próstata
Authors: García-Perdomo Herney Andrés , Zapata-Copete James Alejandro , Sánchez Adalberto
Published: October 2018

Introducción. El cáncer de próstata es una patología importante en la salud pública y tiene alto impacto mundial. El conocimiento y manejo de esta enfermedad debe ser del dominio de todo médico general y especialista que tenga a cargo pacientes que la padezcan.Objetivo. Obtener una visión actualizada de la epidemiología, los factores de riesgo, la clasificación, el diagnóstico y el tratamiento del cáncer de próstata.Materiales y métodos. Se realizó una búsqueda en las bases de datos Embase y MEDLINE desde enero del 2000 hasta marzo del 2017 mediante la cual se hizo un recorrido a través de las condiciones de riesgo, tamizaje, diagnóstico, nuevos biomarcadores y tratamiento del cáncer de próstata.Resultados. Factores genéticos y medioambientales son foco de estudio en la actualidad. La sospecha diagnóstica del cáncer de próstata sigue siendo con el antígeno específico prostático y el tacto rectal y su diagnóstico se debe hacer con la biopsia de próstata. Se han hecho cambios importantes en cuanto a la clasificación y tratamiento de los pacientes con esta enfermedad.Conclusión. Existe mucha investigación en curso y por venir sobre la prevención, el diagnóstico y el tratamiento de esta condición tan importante, relevante y pertinente para los hombres alrededor del mundo.