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Administración de la alimentación enteral en salas generales de internación
Bertona,MV; Vestilleiro,ME;
Diaeta , 2009,
Abstract: discontinuation of enteral nutrition leads to an inadequate caloric intake, a circumstance that is aggravated by the patient's catabolic state, which in turn contributes to an impaired nutritional status. protein-energy malnutrition is associated with more complications, increased duration of hospital stay, and greater associated costs. the objective of this study is to establish the rate of inadequate delivery of prescribed enteral feedings by nasogastric tube and the reasons for inadequate delivery in hospitalized patients. a descriptive observational cross-sectional prospective study was performed from july 2008 through february 2009. the study included 43 patients hospitalized at argerich hospital in the clinical medicine, general surgery and neurosurgery wards, who were receiving enteral nutrition by nasogastric tube as the only route of feeding. overall delivery of enteral nutrition by nasogastric tube was found inadequate in 79.10% of cases (ci 95%: 64-90%). nursing staffand patient-related causes were the most common reasons for discontinuing enteral feeding (35.85% and 30.19%, respectively). patient-related causes included gastrointestinal intolerance and nasogastric tube removal. according to the results of this research, we conclude that the implementation of specific protocols should be promoted in every ward since they are a simple and effective approach and their use is clearly associated with an improvement in enteral nutrition delivery in hospitalized patients.
Administración de la alimentación enteral en salas generales de internación Nutrition delivery in general wards
MV Bertona,ME Vestilleiro
Diaeta , 2009,
Abstract: La interrupción de la alimentación enteral conduce a un aporte calórico inadecuado, circunstancia que se agrava debido al estado catabólico que presentan los pacientes, contribuyendo ambos al deterioro de su estado nutricional. La malnutrición calóricoproteica se asocia a mayor número de complicaciones, aumento de la estancia hospitalaria, y por lo tanto mayores costos. Los objetivos del presente trabajo fueron establecer en qué porcentaje se administran inadecuadamente las alimentaciones enterales por sonda nasogástrica prescriptas y cuales son las causas de administración inadecuada en los pacientes internados. Se realizó un estudio descriptivo, observacional, transversal y prospectivo entre julio de 2008 y febrero de 2009. Se estudiaron 43 pacientes internados en el Hospital Argerich en las salas de Clínica Médica, Cirugía General y Neurocirugía que recibieron alimentación enteral por sonda nasogástrica como vía de alimentación exclusiva. La administración global de la alimentación enteral por sonda nasogástrica tuvo una inadecuación del 79.10% (IC 95%: 64-90%). Las causas más comunes de interrupción de la alimentación enteral fueron las relacionadas con el personal de enfermería (35.85%) y con el paciente (30.19%). Estas últimas incluyeron intolerancia gastrointestinal y extracción de la sonda nasogástrica. De acuerdo a los resultados obtenidos a través de la presente investigación se considera que se debería promover la implementación de protocolos específicos en cada sala de internación ya que la utilización de los mismos está claramente asociada con una mejoría en la administración de alimentación enteral en los pacientes internados y son un método simple y efectivo. Discontinuation of enteral nutrition leads to an inadequate caloric intake, a circumstance that is aggravated by the patient's catabolic state, which in turn contributes to an impaired nutritional status. Protein-energy malnutrition is associated with more complications, increased duration of hospital stay, and greater associated costs. The objective of this study is to establish the rate of inadequate delivery of prescribed enteral feedings by nasogastric tube and the reasons for inadequate delivery in hospitalized patients. A descriptive observational cross-sectional prospective study was performed from July 2008 through February 2009. The study included 43 patients hospitalized at Argerich Hospital in the Clinical Medicine, General Surgery and Neurosurgery wards, who were receiving enteral nutrition by nasogastric tube as the only route of feeding. Overall delivery of enteral nutr
Variantes anatómicas de la segmentación bronquial, prevalencia y diagnóstico mediante TC multidetector 64 canales Bronchial segmentation: Anatomical variants, prevalence, and diagnosis by 64-channel multidetector CT
Mariana Robledo M,Carlos Bertona T,Juan Bertona T,Cecilia Giordanengo M
Revista Chilena de Radiología , 2012,
Abstract: Propósito. Conocer tipos y prevalencia de las variantes anatómicas de la segmentación bronquial, en pacientes a quienes se les realizó TC de Tórax Multidetector 64 (TCMD 64). Evaluar la capacidad de este método para el diagnóstico de las mismas. Material y métodos. Se estudiaron en forma retrospectiva los estudios tomográficos que incluyeron el tórax, en 156 pacientes adultos, con tomógrafo Toshiba Aquilion 64, con adquisiciones volumétricas del tórax, cortes de 0.5 mm, obteniendo imágenes que permitieron reconstrucciones MPR, 3D y visualización endoscópica virtual traqueobronquial, en el período entre mayo de 2007 y mayo de 2011, independientemente del motivo por el cual fueron solicitados. Resultados. De los 156 estudios examinados, 89 (57%) fueron de sexo masculino y 67 (43%) femenino. En su análisis se encontraron 52 variantes, en 47 pacientes, ya que en cinco de ellos se observaron dos variantes. Entre las más frecuentes fueron: de número (28 variantes-53%), de las cuales: 15 (28%) con bronquio sub-superior; 6 (11%) bronquio accesorio en lóbulo inferior izquierdo; 5 (10%) isomerismo de lóbulos inferiores; y 2 (4%) bronquio accesorio en lóbulo superior derecho. Entre las variantes de origen (24 variantes-47%) encontramos 17 variantes (33%) con bifurcación del lóbulo superior derecho; 6 (12%) trifurcación del bronquio del lóbulo superior izquierdo; y 1 (2%) bronquio traqueal accesorio. Conclusión.Las variantes anatómicas en el árbol traqueobronquial presentaron una prevalencia en nuestra población de estudio del 33%, hallándose 52 en 47 pacientes, siendo las más frecuentes la bifurcación del lóbulo superior derecho y el bronquio subsuperior. Su estudio y el de la anatomía total del árbol traqueo-bronquial mediante TCMD 64, independientemente del protocolo de estudio empleado, puede aportar información de utilidad previo a la realización de procedimientos más invasivos como la broncoscopía convencional. Purpose. A) To determine types and prevalence of anatomical variants of bronchial segmentation in patients who underwent 64-section Multidetector CT (MDCT) of the chest. B) To evaluate the ability of this method as a diagnostic tool. Material and methods. We conducted a retrospective review of chest computed tomography studies of 156 adult patients, performed with Toshiba, Aquilion 64 CFX, CT Scanner Equipment, with chest volumetric acquisitions, and cuts of 0.5 mm. Images obtained allowed MPR and 3D reconstructions, along with virtual endoscopic visualization of the tracheobronchial tree, in the study period from may 2007 to may 2011, irrespective of r
Estudio del oído con TC Multidetector de 64 canales 64 - Detector CT findings in the study of the ear
María Lourdes Mallo,Cecilia C. Giordanengo,Carlos A. Bertona,Juan José Bertona
Revista Argentina de Radiología , 2010,
Abstract: El oído es una estructura anatómica compleja. Su estudio y comprensión resultan un reto diario para el radiólogo, siendo la tomografía computada una herramienta esencial para su estudio. La tomografía computada convencional con cortes finos en planos axiales y coronales permite una buena visualización de las diferentes estructuras. Sin embargo, se necesitan tiempos prolongados para su realización y posicionamientos incómodos o intolerables para muchos pacientes. Además la visualización de algunas de sus estructuras es limitada. La tomografía axial computada multidetector de 64 canales a nuestro medio permite optimizar el estudio de la compleja y peque a anatomía del oído. La realización de adquisiciones volumétricas con cortes de 0,5 mm, con reconstrucciones multiplanares en los tres planos básicos, en planos curvos y reconstrucciones tridimensionales, hacen posible la visualización detallada de las estructuras en escasos segundos y en condiciones cómodas para el paciente. Nuestro propósito en este artículo es demostrar la utilidad de las reconstrucciones, particularmente en planos oblicuos, para identificar y analizar los diferentes reparos anatómicos del oído y alcanzar la visualización óptima de la anatomía relevante del hueso temporal. The ear is a complex anatomic structure. Its study and understanding represent a constant challenge for the radiologist. As a consequence the computed tomography becomes an essential tool for its examination. Conventional tomographic examination with both axial and coronal reconstruction of the image allows a satisfactory visualization of the different structures. However, the study requires long periods of time for its acquisition and uncomfortable or intolerable positions for the patients. Moreover, the characterization of some structures of the ear becomes limited. Sixty-four slice multidetector computed tomography allows the optimal study of the small and complex ear anatomy. Volumetric acquisitions with 0.5 mm slices, with multiplanar reconstructions in the three basic plans, in tri-dimensional reconstructions and curved plans, allow detailed visualization of structures in a few seconds, thuf avoiding patient discomfort. Our purpose in this article is to demonstrate the utility of reconstructions particularly in oblique planes, and reaching an optimal visualization of the temporal bone.
Anti-inflammatory effects of a topical preparation containing nicotinamide, retinol, and 7-dehydrocholesterol in patients with acne: a gene expression study
Emanuele E, Bertona M, Altabas K, Altabas V, Alessandrini G
Clinical, Cosmetic and Investigational Dermatology , 2012, DOI: http://dx.doi.org/10.2147/CCID.S29537
Abstract: nti-inflammatory effects of a topical preparation containing nicotinamide, retinol, and 7-dehydrocholesterol in patients with acne: a gene expression study Original Research (12071) Total Article Views Authors: Emanuele E, Bertona M, Altabas K, Altabas V, Alessandrini G Published Date February 2012 Volume 2012:5 Pages 33 - 37 DOI: http://dx.doi.org/10.2147/CCID.S29537 Received: 28 December 2011 Accepted: 18 January 2012 Published: 27 February 2012 Enzo Emanuele1, Marco Bertona1, Karmela Altabas2, Velimir Altabas2, Giuseppe Alessandrini3 1Department of Health Sciences, University of Pavia, Pavia, Italy; 2Clinical Hospital "Sestre Milosrdnice", Zagreb, Croatia; 3Dermatology Clinics, Ugento, Italy Purpose: Acne vulgaris is a skin disorder of the sebaceous follicles, involving hyperkeratinization and perifollicular inflammation. Aberrant extracellular matrix remodeling due to matrix metalloproteinases (MMPs) has been associated with the presence of acne conditions. Given the complex pathophysiology of acne, novel topical therapies should include combination products that target multiple pathogenetic mechanisms. In this pilot study we investigated the changes in gene expression of extracellular MMPs, the tissue inhibitors of metalloproteinases, and proinflammatory molecules after 45 days of topical application of a combination product containing nicotinamide, retinol, and 7-dehydrocholesterol in 16 patients with inflammatory acne on their back. Materials and methods: Skin biopsies were obtained before and after treatment for gene expression studies. Results: Quantitative real-time polymerase chain reaction revealed a significant downregulation of MMP-1, MMP-2, MMP-9, MMP-14, interleukin-6, monocyte chemoattractant protein-1, and macrophage migration inhibitory factor. In contrast, the tissue inhibitors of metalloproteinases and transforming growth factor- 1 were significantly upregulated. The gene expression findings correlated well with the clinical treatment response. Conclusions: The combination of nicotinamide, retinol, and 7-dehydrocholesterol appears to be effective for acne treatment from both clinical and molecular standpoints.
Caracterización fenotípica y genotípica de la resistencia enzimática a las cefalosporinas de tercera generación en Enterobacter spp. Phenotypic and genotypic characterization of resistance to third-generation cephalosporins in Enterobacter spp.
E. Bertona,M. Radice,C. H. Rodríguez,C. Barberis
Revista argentina de microbiolog?-a , 2005,
Abstract: Enterobacter spp. es un patógeno intrahospitalario que presenta múltiples mecanismos de resistencia a los antibióticos b-lactámicos. Se caracterizaron fenotípica y genotípicamente las diferentes b-lactamasas presentes en 27 aislamientos consecutivos e ininterrumpidos de Enterobacter spp. (25 Enterobacter cloacae y 2 Enterobacter aerogenes). También se evaluó la habilidad de diferentes métodos fenotípicos para detectar b-lactamasas de espectro extendido (BLEE) en estos microorganismos. En 15/27 aislamientos (63%) se observó resistencia a las cefalosporinas de tercera generación. En 12 de los aislamientos resistentes se detectó un alto nivel de producción de cefalosporinasa cromosómica, siendo 6 de ellos también productores de PER-2. Dicha resistencia en los 3 aislamientos restantes se debió exclusivamente a la presencia de BLEE, PER-2 en 2 de ellos y CTX-M-2 en un caso. Sólo CTX-M-2 se detectó con todas las cefalosporinas probadas en los ensayos de sinergia, utilizando el método de difusión, mientras que cefepima mejoró la detección de PER-2 en 7/8 aislamientos productores de esta BLEE, 4/8 utilizando la prueba de doble disco y 7/8 comparando discos de cefepima con y sin el agregado de ácido clavulánico. El método de dilución empleado solo detectó 1/9 BLEE al comparar las cefalosporinas con y sin el agregado de inhibidor. Enterobacter spp. are becoming increasingly frequent nosocomial pathogens with multiple resistance mechanism to b-lactam antibiotics. We carried out the phenotypic and genotypic characterization of beta-lactamases in 27 Enterobacter spp. (25 Enterobacter cloacae y 2 Enterobacter aerogenes), as well as the ability of different extended spectrum b-lactamase (ESBL) screening methods. Resistance to third generation cephalosporins was observed in 15/27 (63%) isolates. Twelve resistant isolates produced high level chromosomal encoded AmpC b-lactamase; 6 of them were also producers of PER-2. Resistance to third generation cephalosporins in the remaining 3 isolates was due to the presence of ESBLs, PER-2 in 2 cases, and CTX-M-2 in the other. Only CTX-M-2 production was detected with all tested cephalosporins using difusion synergy tests, while cefepime improved ESBLs detection in 7/8 PER-2 producers, 4/8 in the inhibitor aproximation test and 7/8 with double disk test using cefepime containing disk with and without clavulanic acid. Dilution method, including cephalosporins with and without the inhibitor detected 1/9 ESBLs producers.
Uso del hábitat por Boa constrictor occidentalis (Serpentes: Boidae) durante la estación seca en Córdoba, Argentina
Attademo, Andrés,Bertona, Miguel,Kozykariski, Mónica,Chiaraviglio, Margarita
Cuadernos de Herpetología , 2004,
Abstract: El análisis sobre el uso del hábitat es una herramienta fundamental para la conservación y el manejo de las poblaciones silvestres. Cuantificar los cambios en el uso de recursos asociados con la reproducción puede ofrecer una idea de las fuerzas selectivas que actúan sobre los organismos durante esta fase crítica de su historia de vida. Se ha observado en distintas especies de ofidios que hembras grávidas frecuentan hábitats distintos de los que utilizan hembras no grávidas y machos, por lo que la selección de un ambiente en particular podría estar influenciado por el comportamiento reproductivo. En el presente trabajo evaluamos el uso del hábitat en Boa constrictor occidentalis mediante radiorastreo a nivel de microhábitat durante la estación seca en la localidad de El Quemado, Departamento Pocho, Córdoba. Se marcaron mediante radiotransmisores 14 individuos adultos: 5 hembras reproductivas, 4 hembras no reproductivas y 5 machos reproductivos. Las diferencias en el uso del hábitat observadas en las lampalaguas en función de la condición reproductiva durante la estación seca, reflejarían diferencias en los requerimientos para la termorregulación. El uso que las hembras reproductivas hacen del hábitat les permitiría seleccionar sitios que brinden buenos lugares para asolearse permitiendo obtener temperaturas mayores y óptimas para el desarrollo de los embriones. Habitat use analysis is a basic tool for the conservation and management of wild populations. Quantifying the changes in the use of resources associated with reproduction can offer an insight into the selective forces acting on organisms in this critical phase of life history. Reproduction condition often has obvious effects on habitat use. Reproductive individual females have been observed in habitats different from those frequented by males and non reproductive females. In this study, we evaluate the differential use of habitats in Boa constrictor occidentalis through radio-tracking. Habitat use was evaluated at a microhabitat level during dry season at El Quemado, in the department of Pocho, Córdoba. Fourteen adult individuals were implanted with radio transmitters: 5 reproductive females, 4 non-reproductive females and 5 reproductive males. There were differences in the use of the habitat among these conditions. The differences observed in relation to reproductive functions during the dry season should reveal different thermoregulation requirements in lampalagua. In reptiles, these requirements are among the most influential causes in the selection of a particular habitat. The habitat choice
Anti-inflammatory effects of a topical preparation containing nicotinamide, retinol, and 7-dehydrocholesterol in patients with acne: a gene expression study
Emanuele E,Bertona M,Altabas K,Altabas V
Clinical, Cosmetic and Investigational Dermatology , 2012,
Abstract: Enzo Emanuele1, Marco Bertona1, Karmela Altabas2, Velimir Altabas2, Giuseppe Alessandrini31Department of Health Sciences, University of Pavia, Pavia, Italy; 2Clinical Hospital "Sestre Milosrdnice", Zagreb, Croatia; 3Dermatology Clinics, Ugento, ItalyPurpose: Acne vulgaris is a skin disorder of the sebaceous follicles, involving hyperkeratinization and perifollicular inflammation. Aberrant extracellular matrix remodeling due to matrix metalloproteinases (MMPs) has been associated with the presence of acne conditions. Given the complex pathophysiology of acne, novel topical therapies should include combination products that target multiple pathogenetic mechanisms. In this pilot study we investigated the changes in gene expression of extracellular MMPs, the tissue inhibitors of metalloproteinases, and proinflammatory molecules after 45 days of topical application of a combination product containing nicotinamide, retinol, and 7-dehydrocholesterol in 16 patients with inflammatory acne on their back.Materials and methods: Skin biopsies were obtained before and after treatment for gene expression studies.Results: Quantitative real-time polymerase chain reaction revealed a significant downregulation of MMP-1, MMP-2, MMP-9, MMP-14, interleukin-6, monocyte chemoattractant protein-1, and macrophage migration inhibitory factor. In contrast, the tissue inhibitors of metalloproteinases and transforming growth factor- 1 were significantly upregulated. The gene expression findings correlated well with the clinical treatment response.Conclusions: The combination of nicotinamide, retinol, and 7-dehydrocholesterol appears to be effective for acne treatment from both clinical and molecular standpoints.Keywords: acne, gene expression, topical treatment, matrix metalloproteinases, inflammation
Takotsubo Cardiomyopathy as an Early Complication of Drug-Induced Suicide Attempt
Massimo Romanò,Federica Zorzoli,Roberta Bertona,Rosvaldo Villani
Case Reports in Medicine , 2013, DOI: 10.1155/2013/946378
Abstract: Takotsubo cardiomyopathy typically presents in menopausal women following episodes of intense physical or mental stress. To our knowledge, the literature contains only two documented cases of Takotsubo cardiomyopathy arising following a suicide attempt, neither of which involved pharmaceutical poisoning. Here, however, we document the case of a young male patient with borderline personality disorder and a clinical and angiographic presentation compatible with Takotsubo cardiomyopathy arising following a suicide attempt by voluntary drug intoxication (risperidone, barbiturates, and benzodiazepine). The potential pathophysiological mechanisms behind this unusual clinical picture are discussed. 1. Introduction Takotsubo syndrome, or stress-induced cardiomyopathy, manifests as a transitory dysfunction of the left ventricle, whose characteristic angiographic appearance is known as apical ballooning. It mimics the symptoms and electrocardiographic appearance of acute myocardial infarction, generally with ST segment elevation but without any significant signs of coronary lesions under angiography. Its pathogenesis is probably secondary to a damage to the myocytes mediated by the catecholamines and microvascular dysfunction [1]. Over recent years, increasing numbers of cases, arising in various circumstances of physical or mental stress, have been described in the literature. Nonetheless, only two reported cases brought on following a suicide attempt have been documented, one following the consumption of herbicide [2] and the other by hanging [3]. To our knowledge, this is the first reported case of Takotsubo cardiomyopathy arising following a suicide attempt by ingestion of psychotropic drugs. 2. Case Report A 40-year-old male with type 2 diabetes mellitus and obesity (110?kg, 172?cm, and BMI 37.2) who underwent a biliodigestive bypass in 2011 was brought in a comatose state to our accident and emergency department by the emergency services. This followed a suicide attempt, attested to by a note addressed to family members, by ingestion of phenobarbital, risperidone, lorazepam, clotiazepam, and bisoprolol. The patient was already known to the mental health services as a sufferer of borderline personality disorder and was being treated with 5?mg/day olanzapine. Tests conducted on the patient in accident and emergency confirmed the comatose state, Glasgow Coma Scale 5, and revealed an arterial pressure of 110/80?mmHg, heart rate 80?bpm, and oxygen saturation at 94%, with an oxygen mask set at 6?L/min. Arterial blood gas analysis showed respiratory acidosis, and
Estudio del oído con TC Multidetector de 64 canales
Mallo,María Lourdes; Giordanengo,Cecilia C.; Bertona,Carlos A.; Bertona,Juan José; Gigena,Cecilia; Florez,María Paula;
Revista argentina de radiolog?-a , 2010,
Abstract: the ear is a complex anatomic structure. its study and understanding represent a constant challenge for the radiologist. as a consequence the computed tomography becomes an essential tool for its examination. conventional tomographic examination with both axial and coronal reconstruction of the image allows a satisfactory visualization of the different structures. however, the study requires long periods of time for its acquisition and uncomfortable or intolerable positions for the patients. moreover, the characterization of some structures of the ear becomes limited. sixty-four slice multidetector computed tomography allows the optimal study of the small and complex ear anatomy. volumetric acquisitions with 0.5 mm slices, with multiplanar reconstructions in the three basic plans, in tri-dimensional reconstructions and curved plans, allow detailed visualization of structures in a few seconds, thuf avoiding patient discomfort. our purpose in this article is to demonstrate the utility of reconstructions particularly in oblique planes, and reaching an optimal visualization of the temporal bone.
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