Objective To assess the pulse oximetry as a method for screening critical congenital heart disease (CHD) in newborns. Study design This is an observational, transversal, descriptive simple study. The pre-ductal and postductal saturation were taken in term newborns that fulfilled the criteria of inclusion and exclusion in the Hospital Gineco-Obstetrico Isidro Ayora (HGOIA) in Quito. These measurements were performed between the 24 and 48 h after birth. Those newborns that saturated less than 90% on initial pulse oxìmetry underwent 3 successive measurements at 1-h intervals. Those who saturate less than 90% after 3 measurements or have a difference higher than 3% in preductal saturation and postductal saturation (positive screening) underwent transthoracic echocardiography evaluate for CHD. Results Pulse oximetry from 963 newborns was evaluated. In Quito, at an altitude of 2820 meters above sea level (9252 feet), the mean preductal saturation was 92.76% (SD ± 3) and the postductal saturation, 93.76% (SD ± 4.7). Pulse oximetry in 53 patients (5.5%) was classified as a positive screening. No critical congenital heart diseases were found. Atrial septal defect (ASD) was the most common finding in a 46.94% (n = 23), followed by the association of patent ductus arteriosus (PDA) and ASD with a 12.24% (n = 6). Conclusion In this cohort of patients who underwent screening pulse oximetry, no critical congenital heart diseases (CHD) were observed. However, identifying those with oxygen saturation less than 90% after 3 successive measurements or a pre- and postductal oxygen difference of > 3% resulted in successful identification of ASD and PDA. It is necessary to implement new cutoff points in saturation values to identify critical cardiac anomalies in cities placed at a high altitude. The use of pulse oximetry should be recommended in all the newborns.
La ensenanza universitaria se configura como un proceso de busqueda y de construccion cientifica y critica del conocimiento. En este sentido, la propia complejidad de la ensenanza, la mutabilidad de las condiciones educativas, la heterogeneidad del alumnado, la disparidad de intereses e intenciones y expectativas de aprendizaje requieren la comprension interpretativa de lo que sucede en las practicas de ensenanza universitaria. Entre ellas las practicas universitarias de evaluacion, como fenomeno complejo, obligan a dar cuenta de los multiples entrecruzamientos que las determinan, no solo en un aqui y ahora, sino atendiendo fundamentalmente al proceso historico a partir del cual se construye una practica educativa. Por ello el proposito de la presente comunicacion es compartir el acercamiento problematico a los procesos de evaluacion de la ensenanza y aprendizaje en el contexto universitario de formacion docente. Las dimensiones de analisis fueron las representaciones de los docentes y alumnos acerca de la evaluacion y las situaciones de examenes finales. Partiendo de la idea de realidad como construccion social que es percibida y aprehendida de manera diferente por los protagonistas de las practicas universitarias de evaluacion, hemos reconocido -en una primera aproximacion interpretativa- las siguientes problematicas en cuanto a criterios y procesos de evaluacion: A. Complejidad de los contenidos de aprendizaje y su valoracion. B. Ausencia de criterios evaluativos, de su explicitacion, y negociacion con los alumnos. C. Priorizacion de la evaluacion sumativa, atendiendo al producto o resultado del aprendizaje. D. Utilizacion del interrogatorio como unico instrumento evaluativo y el tipo de aprendizaje que se requiere a traves del mismo. E. Movilizacion socioafectiva promovida como dinamica de la practica evaluativa y expresada en reacciones emocionales, representaciones simbolicas, interacciones comunicativas, significaciones discursivas, entre otras. El aporte de este trabajo esta centrado en la evaluacion universitaria como campo multidimensional de significados y a su percepcion por parte de los protagonistas, quienes paradojicamente se implican en la construccion de un discurso pedagogico acerca de la evaluacion que no siempre se refleja en las propias practicas
Este material va dirigido sobre todo a los médicos jóvenes o estudiantes en etapa de formación con el afán de recordar y adquirir conocimientos básicos sobre Generalidades sobre fracturas que serán aplicados durante su vida en residencia. Teniendo en cuenta la gran importancia que significa manejar este tema, por la alta incidencia según la epidemiologia reportada en nuestro país y de forma mundial. Este texto y la información contenido en el mismo no pretenden reemplazar el consejo de un profesional sobretodo en una situación de emergencia. Recomendando al lector o profesional que curse estudios de especialización profundizar o complementar cada tema con literatura médica más específica para cada tema tomando en cuenta la gran cantidad de texto científico que se genera día a día en el campo de la Medicina.
Background The aim of this study was to assess the technical success and procedural safety of the new Silk Vista device (SV) by evaluating the intraprocedural and periprocedural complication rate after its use in several institutions worldwide. Methods The study involved a retrospective review of multicenter data regarding a consecutive series of patients with intracranial aneurysms, treated with the SV between September 2020 and January 2021. Clinical, intra/periprocedural and angiographic data, including approach, materials used, aneurysm size and location, device/s, technical details and initial angiographic aneurysm occlusion, were analyzed. Results 60 aneurysms were treated with SV in 57 procedures. 66 devices were used, 3 removed and 63 implanted. The devices opened instantaneously in 60 out of 66 (91%) cases and complete wall apposition was achieved in 58 out of 63 (92%) devices implanted. In 4 out of 66 (6%) devices a partial opening of the distal end occurred, and in 5 (8%) devices incomplete apposition was reported. There were 3 (5%) intraprocedural thromboembolic events managed successfully with no permanent neurological morbidity, and 4 (7%) postprocedural events. There was no mortality in this study. The initial occlusion rates in the 60 aneurysms were as follows: O’Kelly–Marotta (OKM) A in 34 (57%) cases, OKM B in 15 (25%) cases, OKM C in 6 (10%) cases, and OKM D in 5 (8%) cases. Conclusions Our study demonstrated that the use of the new flow diverter Silk Vista for the treatment of intracranial aneurysms is feasible and technically safe.
A comprehensive review of the technical literature was conducted regarding the impact of environmental conditions on hyman performance applicable to nuclear power plant workers. The environmental conditions considered were vibration, noise, heat, cold, and light. Research staff identified potential human performance deficits (e.g., decreased dexterity, impaired vision, hearing loss, memory deficiency) along a continuum of increasing occupational exposure, ranging from exposures that result in no deficit to exposures that resulted in significant performance problems. Specific deficits were included in the report if there was sound scientific evidence that environmental exposure resulted in those performance deficits. The levels associated with each deficit were then compared to the protection afforded by existing occupational exposure standards. Volume 1 is a handbook for use by NRC inspectors to help them determine the impact of specific environmental conditions on licensee personnel performance.