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Vital signs like the fever usually are frustrating for the binomial doctor-patient; as such it is indispensable to have in mind a series of steps that direct us to the etiologic diagnosis of this pathological modality. We cannot face this disturbance by following protocols recommended by authors of the first world, as many times we remain halfway, constituting a loss of time and frustration. That is why we need to reorganize an established affluent protocol. In this paper, the English diagnosis protocol is reorganized in order to deduce the etiologic factor in Fever of unknown origin (FOD). Most of the authors expert on the subject recommend four divided diagnosis phases according to the tools (technological and scientific) of diagnosis. The intention of this paper is to regroup the diagnosis modality in benefit of hospital units of Latin America and other developing countries. We presen...
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From January 1995 to February 1996 in the Department of Surgery at Guillermo Almenara Irigoyen Hospital (General Surgery Service N° 5) we resolved to prepare a protocol of assessment and/or nutritional support in patients who are awaiting for surgery or who recently has undergone surgery. Our porponse is to decrease the morbimortality rate. After several work meetings, we resolved to offer this protocol for its aplication, as well as evaluation and follow up of the patients.
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OBJETIVE: To evaluate the performance of ultrasound clinical trial proposed by the CLAP. MATERIALS AND METHODS: A descriptive study that evaluates the likelihood of association of small for gestational age (SGA) with factore risk and ultrasound findings. RESULTS: Correlation between risk factors and the cranial circumference (CC) and abdominal (CA) lower 5th percentile dle with PEG was found. CONCLUSIONS: A significant association between risk factors and the presence of small for gestational age fetus. The high specificity and negative predictive value DC and AC make this biometrics useful for the assessment of fetal growth.
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OBJETIVE: To evaluate the performance of ultrasound clinical trial proposed by the CLAP. MATERIALS AND METHODS: A descriptive study that evaluates the likelihood of association of small for gestational age (SGA) with factore risk and ultrasound findings. RESULTS: Correlation between risk factors and the cranial circumference (CC) and abdominal (CA) lower 5th percentile dle with PEG was found. CONCLUSIONS: A significant association between risk factors and the presence of small for gestational age fetus. The high specificity and negative predictive value DC and AC make this biometrics useful for the assessment of fetal growth.
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Introduction: Making fair coverage decisions by allocating limited resources implies prioritization. Given the pandemic, this is even more difficult, given the economic recession and the need to cope with new demands for health technologies, in addition to the rest of the needs of the health system. Health Technology Assessment and the regulation of drug prices are two strategies recommended by WHO-PAHO to increase the efficiency and equity of health systems. We analize the budget impact and opportunity cost of spinraza, a high-cost drug that would be effective in increasing the survival of patients with a rare disease named Type I Spinal Muscular Atrophy. In Argentina, it is covered without price regulation, paying three times more expensive than in Brazil, although a National Health Technology Assessment did not recommend this. Methods: The opportunity cost of spinraza for Spinal Muscu...
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Objectives: to measure the prevalence and intensity of acute pain in hospitalized patients in the Neurosurgery Service of a Tertiary Hospital, using a numerical verbal scale, the Visual Analogue Scale (VAS) for its evaluation. Material and methods: observational, cross-sectional study to evaluate acute pain. All patients admitted to the ward during November 2019 are included and those with limitations to understand or evaluate pain according to VAS are excluded. Results: of the total of 120 patients admitted to the ward during the study period, 40 were excluded because they did not meet the inclusion criteria. Eighty patients with a high prevalence of pain (76.61%) were analyzed, with a mean score of 3.47 ± 0.78. Of those who report pain, 20% is mild, 40% moderate and 40% intense. For pathologies, the highest values ​​correspond to post-intervention. Hospital analgesic protocols wer...
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El objetivo de este estudio fue caracterizar las principales situaciones de indicación, contraindicación y accionar profiláctico para la exodoncia de terceros molares, según la literatura. Se utilizaron las bases de datos PubMed, Scopus y Web of Science, con un total de 3 llaves de búsqueda, y se incluyeron publicaciones de máximo 5 años de antigüedad, en inglés o español, con disponibilidad de texto completo. Fueron seleccionados 18 artículos, en los que se determinó que la indicación más frecuente en la exodoncia de terceros molares fue el diagnóstico de pericoronaritis, seguido de caries cervical distal en segundo molar inferior, reabsorción radicular en dientes adyacentes y quistes. A su vez, puede estar indicada para facilitar otros tipos de tratamientos dentales, como ortodoncia, cirugía ortognática y rehabilitación. En cuanto a las contraindicaciones, predominó...
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Congenital diaphragmatic hernia is a rare but potentially fatal condition in which abdominal organs herniate into the thoracic cavity, leading to pulmonary hypoplasia and respiratory distress. Interinstitutional variability exists for disease management, and in this study, we present evidence-based recommendations regarding delivery room management, respiratory, hemodynamic, and nutritional support, sedation, and vascular access. Adequate preoperative management is essential for stabilizing these neonates before surgical correction, aiming to improve pulmonary function and overall neonatal well-being. In the present manuscript, we detail the preoperative approach employed by Texas Children's Hospital to manage congenital diaphragmatic hernia.
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BACKGROUND AND OBJECTIVES: Traumatic brain injury (TBI) is a major global public health problem. It is a leading cause of death and disability in children and adolescents worldwide. Although increased intracranial pressure (ICP) is common and associated with death and poor outcome after pediatric TBI, the efficacy of current ICP-based management remains controversial. We intend to provide Class I evidence testing the efficacy of a protocol based on current ICP monitor-based management vs care based on imaging and clinical examination without ICP monitoring in pediatric severe TBI. METHODS: A phase III, multicenter, parallel-group, randomized superiority trial performed in intensive care units in Central and South America to determine the impact on 6-month outcome of children aged 1-12 years with severe TBI (age-Appropriate Glasgow Coma Scale score ?8) randomized to ICP-based or non-ICP-b...
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Objetivo: determinar el grado de adherencia al protocolo de curación de catéter venoso central (CVC) del profesional de enfermería del servicio de emergencia del hospital Hermilio Valdizan Huánuco, 2025. Materiales y métodos: estudio cuantitativo, descriptivo, de diseño no experimental y corte transversal. La población estará conformada por 50 licenciados en enfermería, para la muestra se utilizará el muestreo censal con criterios de inclusión y exclusión. La recolección de datos se realizará mediante un cheklist de observación con 24 ítems dicotómicos, validados mediante juicio de expertos y el grado de confiabilidad se determinará mediante le alfa de Cronbach. Los resultados se esperan identificar el grado de adherencia al protocolo de curación de CVC. Conclusión: implementar un programa de capacitación continúa focalizado y establecer un sistema de auditoria clí...
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The Therapeutic Abortion Protocol (PAT), in force since 2014, regulates the procedure for the execution of therapeutic abortions nationwide. Establishes an open list of clinical entities for access, under the Informed Consent of the pregnant woman and not including the rights of her child. This rule generates in the medical professional the obligation to perform abortions, which may contradict the precepts of his conscience about the indiscriminate respect of all human life, restricting his constitutional right to freedom of conscience. In this article, we analyze the content of said freedom and the right to Conscientious Objection, as well as the coherence between the PAT and Article 119 of the Criminal Code (CP), to determine if with this rule the Objection of Awareness (OC) of the medical professional to the execution of said abortion, for colliding with his deep conviction to respect...
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Ivermectin is one of the most widely used antiparasitic drugs in veterinary medicine. Moreover, it is used for treating many parasitosis in human medicine. However, its uncontrolled massive use is being associated to the appearance of parasitic resistance. The emergence of SARS-CoV-2, causing agent of COVID-19, has challenged health systems worldwide, forcing them to urgently work in the development of proper therapeutic protocols against such disease. In Peru, the Ministry of Health approved the addition of ivermectin within the treatment protocol for COVID-19. Aiming to collect scientific evidence that supported such decision, a systematic search was performed within scientific journals´ digital repositories and clinical trials´ databases focused on therapy against COVID-19. Until the date of submission of this article, no scientific evidence was found to support the efficacy or safe...
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En la Obra material del Presente se implementó el Plan anual de Seguridad y Salud donde se identificó los peligros, prevenimos riesgos de accidentes y garantizamos las medidas de control de bioseguridad necesarios. Desde el momento de ingreso se cumplió con todos los protocolos de bioseguridad como lavado de manos, desinfección con alcohol, toma de temperatura con termómetro infrarrojo y pulsioxímetro, sobre todo llevando constantemente charlas de 30 minutos para la concientización del personal formando una cultura de seguridad y salud en el trabajo. Tomando como referencia y poniendo en ejecución toda las Normas, OIT, Matriz IPER, entre otros se logró la meta de Cero Incidentes y Cero Accidentes durante la ejecución de la construcción de la Obra y se detectó un caso de COVID-19 el cual se tuvo seguimiento y un informe clínico para el retorno de las actividades.
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The work aimed to evaluate the effect of two doses of eCG on the superovulatory response, embryonic recovery rate and reproductive disorders. Thirty-two clinically healthy adult llamas were used, divided into two groups: Group I (700 IU eCG; n = 15) and Group II (500 IU eCG; n = 21). The superovulation protocol included: day 1, induction of ovulation (GnRH); day 4, application of eCG according to the dose established for each group; day 8, application of luteolytic (PGF2α); day 11, ultrasound to verify the number of follicles and application of GnRH analog; days 11 and 12, natural mating to induce ovulation; day 19, uterine lavage and embryo recovery (it was considered as cervical torsion when the Foley catheter was difficult to pass to the uterus); day 26: ultrasound evaluation to determine the presence of reproductive disorders. The number of follicles per female for groups I and II w...
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The study aimed to determine changes in respiratory and heart rate, pulse, saturation of oxygen, temperature and blood pressure caused by the combination of tramadol, diazepam, xylazine and ketamine during canine ovariohysterectomy for possible use in sterilization campaigns. Ten bitches between 10 months and 6 years of age of different breeds and sizes, clinically healthy, with hemogram and leucogram normal and classified as ASA I and II, were subjected to elective surgery ovariohysterectomy using the same anesthetic protocol. Physiological data was recorded during the six stages of the anesthetic-surgical procedure. Heart rate and pulse were within normal levels. Three patients presented tachypnea during maintenance. Episodes of mild hypoxia were observed. Body temperature showed a gradual decline. All patients presented hypertension during maintenance and the end of the surgery. There...
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The study aimed to determine changes in respiratory and heart rate, pulse, saturation of oxygen, temperature and blood pressure caused by the combination of tramadol, diazepam, xylazine and ketamine during canine ovariohysterectomy for possible use in sterilization campaigns. Ten bitches between 10 months and 6 years of age of different breeds and sizes, clinically healthy, with hemogram and leucogram normal and classified as ASA I and II, were subjected to elective surgery ovariohysterectomy using the same anesthetic protocol. Physiological data was recorded during the six stages of the anesthetic-surgical procedure. Heart rate and pulse were within normal levels. Three patients presented tachypnea during maintenance. Episodes of mild hypoxia were observed. Body temperature showed a gradual decline. All patients presented hypertension during maintenance and the end of the surgery. There...
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Introduction: Systemic loxoscelism is the most severe complication of loxoscelism. The management of the cadre by health personnel presents a high variability due to factors that are currently unknown. There is no standard of reference or a clinical prediction model that can guide our decisions when approaching a spider bite patient. Objective: Develop and validate a clinical prediction rule for systemic loxoscelism. Methods: An observational study of derivation and validation of a clinical prediction model was carried out with diagnostic test validation based on a historical single-arm cohort in patients treated at Vitarte Hospital between 2007 and 2016 and international clinical reports published. Results: Systemic loxoscelism occurred only in 32.9% (n = 24) of cases. For the bivariate analysis, the variables that showed a statistically significant association (P <0.05) were sex...
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Adult T-cell leukemia/lymphoma (ATLL) is a post timic T-cell neoplasia of poor prognosis and difficult management. It has been etiologically associated with Human T-lymphotropic virus 1 (HTLV-1), a retrovirus that has been identified in endemic regions such as Japan, Western Africa, the Caribbean islands and South America. In Perú, it is estimated that 1-2% of the population carries the virus. The lifetime risk for an HTLV-1 carrier to develop ATLL is 5%. Given the endemicity of this infection in our setting and the poor overall prognosis of ATLL, there is a need for novel therapeutic strategies and preventive interventions. In this review, we explore the clinical and epidemiological characteristics of ATLL and its therapeutic options.
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Adult T-cell leukemia/lymphoma (ATLL) is a post timic T-cell neoplasia of poor prognosis and difficult management. It has been etiologically associated with Human T-lymphotropic virus 1 (HTLV-1), a retrovirus that has been identified in endemic regions such as Japan, Western Africa, the Caribbean islands and South America. In Perú, it is estimated that 1-2% of the population carries the virus. The lifetime risk for an HTLV-1 carrier to develop ATLL is 5%. Given the endemicity of this infection in our setting and the poor overall prognosis of ATLL, there is a need for novel therapeutic strategies and preventive interventions. In this review, we explore the clinical and epidemiological characteristics of ATLL and its therapeutic options.
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<br class="Apple-interchange-newline"><div></div>   2797/5000   Mr. Editor Clinical trials are characterized by having one of the highest levels of scientific evidence1. A properly designed, executed and reported clinical trial constitutes the gold standard in the evaluation of medical interventions. Therefore, timely dissemination is essential to ensure that the clinical decisions made by physicians and patients reflect the best available evidence2. However, the literature reports that in the last decade only half of clinical trials carried out worldwide have been published3. A study conducted in the United States described that less than 30% of clinical trials were published within 2 years of completion in that country4. In the case of Latin America, only 15% of published clinical trials are reported5. In Peru, information regar...