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OALib Journal期刊

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Choque séptico por ehrliquiosis
Hernández-de Mezerville,Viviana; Padilla-Cuadra,Juan I;
Acta Médica Costarricense , 2007,
Abstract: human ehrlichiosis is a tick-borne infectious disease caused by anaplasma sp and ehrlichia sp. the presentation can range from a flu-like syndrome with fever, malaise, myalgia and headache to a septic shock state with multiorganic dysfunction. half the patients require in- hospital care and the mortality rate is 5% as a result of opportunistic infections or hemorrhage. the diagnosis can be made by the visualization of intracytoplasmatic morulae in the blood smear, serology, cultives or polymerase chain reaction. the treatment of choice is doxycicline and generally carries a good response. we report a case of human ehrlichiosis associated with septic shock and multiorganic dysfunction successfully treated at the calderon guardia hospital.
Vasculitis por Propiltiouracilo: reporte de un caso
Salas-Segura,Donato A.; Padilla-Cuadra,Juan I.; Salas-Segura,Juliana;
Acta Médica Costarricense , 2002,
Abstract: we report a case of 43-year-old woman who developed two complications associated with the use of propylthiouracil: vasculitis and agranulocytosis. vasculitis associated with antithyroid therapy is a rare well-documented clinical entity with a pathogenic mechanism not clear yet. there a few published reports of an association between treatment with propylthiouracil, and the occurrence of anca positivity and anca-associated vasculitis. this is probably one more.
Decisión de estudiar medicina: Factores determinantes y elección de la especialidad
Padilla-Cuadra,Juan Ignacio; Vindas-Sánchez,Leonel; Villalobos-Pérez,Alfonso;
Acta Médica Costarricense , 2012,
Abstract: introduction: the decision to study medicine as a career depends on many factors, including intrinsic (personal) and extrinsic ones to the individual. to be aware of these factors could be useful for curriculum development and student counseling. therefore, the study was proposed to identify the key factors taken into account to make this decision, intention of specialization and the main areas chosen. materials and methods: this is a descriptive research based on a survey applied to a sample of 84 active medical students of a private university (universidad de iberoamerica, unibe). results: the survey was applied to 84 students, 28.6 % were male and 71.4 % were female. 39.5 % reported to have physicians as relatives. the main reason to study medicine was self-conviction without outside influence and motivation due to humanitarian issues. most of them chose to study this career between 16 and 20 years old. 91.6% of the subjects surveyed has the intention to follow a specialty. the main choices for specialization were internal medicine and its specialties; followed by surgery and its related branches. conclusion: the study determined an important predominance of females. the main motives to study medicine and follow a specialization are humanitarian and altruistic ones. the areas with the highest demand are internal medicine and surgery. this information might be useful for decision making on undergraduate curriculum management and for planning postgraduate specialization programs.
Taponamiento pericárdico
Sánchez-Suen,Kwok Ho; Padilla-Cuadra,Juan Ignacio;
Acta Médica Costarricense , 2001,
Abstract: the incidence of cardiac tamponade is increasing. this is mainly due to cardiothoracic trauma and invasive procedures. from the pathophysiological point of view, it is characterized by a restriction to the expansion of the cardiac chambers as a consequence of increased intrapericardial pressure and volume. this state can change lo a obstructive shock which is potentially lethal if not promptly diagnosed and treated.
Fístula carotídea-yugular secundaria a colocación de vía central
Hernández-Matamoros,Harol; Padilla-Cuadra,Juan Ignacio; Hernández de Mezerville,Viviana;
Revista Costarricense de Cardiología , 2007,
Abstract: carotid-jugular fistula secondary to central vein catheterization the internal jugular vein access to central venous catheterization is not free of complications. one rare complication due to arterial puncture is the formation of an arteriovenous fistula, between the jugular vein and the carotid artery. the diagnosis must be suspected in a patient who develops local thrill after the procedure and the treatment can be either surgical or endovascular. there are some measures to avoid simultaneous venous and arterial puncture and prevent this complication such as the use of ultrasound as a guide. we report a case of carotid jugular fistula after right jugular catheterization.
Fístula carotídea-yugular secundaria a colocación de vía central
Harol Hernández-Matamoros,Juan Ignacio Padilla-Cuadra,Viviana Hernández de Mezerville
Revista Costarricense de Cardiología , 2007,
Abstract: La colocación de una vía central yugular interna no está exenta de complicaciones. Una infrecuente es la formación de una fístula arterio-venosa entre la vena yugular y la arteria carótida. Este diagnóstico debe sospecharse en pacientes que después del procedimiento desarrollan un frémito en el sitio de la punción y el tratamiento puede ser quirúrgico o endovascular. Existen medidas de prevención para evitar la punción simultánea de la arteria y la vena durante el procedimiento, tales como es el uso de la ecografía para guiar la canalización de la vena. Se reporta el caso de un paciente que desarrolló una fístula carotídea-yugular luego de la colocación de una vía yugular interna. Carotid-jugular fistula secondary to central vein catheterization The internal jugular vein access to central venous catheterization is not free of complications. One rare complication due to arterial puncture is the formation of an arteriovenous fistula, between the jugular vein and the carotid artery. The diagnosis must be suspected in a patient who develops local thrill after the procedure and the treatment can be either surgical or endovascular. There are some measures to avoid simultaneous venous and arterial puncture and prevent this complication such as the use of ultrasound as a guide. We report a case of carotid jugular fistula after right jugular catheterization.
Taponamiento pericárdico
Kwok Ho Sánchez-Suen,Juan Ignacio Padilla-Cuadra
Acta Médica Costarricense , 2001,
Abstract: El taponamiento pericárdico es una entidad de creciente incidencia, debido principalmente al incremento en los traumatismos cardiotorácicos y procedimientos invasivos. Fisiopatológicamente, se caracteriza por ser una condición en la que se limita la expansión de las cámaras cardíacas, como consecuencia de la compresión aguda de ellas por aumento del volumen y de la presión del líquido pericárdico. Este estado puede evolucionar hacia un shock obstructivo potencialmente letal si no es diagnosticado y tratado oportunamente. The incidence of cardiac tamponade is increasing. This is mainly due to cardiothoracic trauma and invasive procedures. From the pathophysiological point of view, it is characterized by a restriction to the expansion of the cardiac chambers as a consequence of increased intrapericardial pressure and volume. This state can change lo a obstructive shock which is potentially lethal if not promptly diagnosed and treated.
Choque séptico por ehrliquiosis
Viviana Hernández-de Mezerville,Juan I Padilla-Cuadra
Acta Médica Costarricense , 2007,
Abstract: La ehrliquiosis humana es una infección zoonótica transmitida por "garrapatas duras" causada por Anaplasma sp y Ehrlichia sp. Puede presentarse como un cuadro pseudogripal con fiebre, malestar general, mialgias y cefalea o hasta un choque séptico con falla multiorgánica y muerte. La mitad de los pacientes requieren atención hospitalaria en algún momento y se reporta una mortalidad de hasta el 5% secundaria a enfermedades oportunistas o a hemorragias. El diagnóstico se puede sospechar visualizando las mórulas intracitoplasmáticas en las células afectadas en frotis de sangre periférica, y se confirma con serología, con cultivos o con detección molecular. El tratamiento de elección es la doxiciclina con buena respuesta clínica. Se reporta un caso probable de ehrliquiosis humana asociado a choque séptico y falla multiorgánica tratado exitosamente en el Hospital Dr. Rafael Angel Calderón Guardia. Human ehrlichiosis is a tick-borne infectious disease caused by Anaplasma sp and Ehrlichia sp. The presentation can range from a flu-like syndrome with fever, malaise, myalgia and headache to a septic shock state with multiorganic dysfunction. Half the patients require in- hospital care and the mortality rate is 5% as a result of opportunistic infections or hemorrhage. The diagnosis can be made by the visualization of intracytoplasmatic morulae in the blood smear, serology, cultives or polymerase chain reaction. The treatment of choice is doxycicline and generally carries a good response. We report a case of human ehrlichiosis associated with septic shock and multiorganic dysfunction successfully treated at the Calderon Guardia Hospital.
Vasculitis por Propiltiouracilo: reporte de un caso
Donato A. Salas-Segura,Juan I. Padilla-Cuadra,Juliana Salas-Segura
Acta Médica Costarricense , 2002,
Abstract: Se reporta el caso clínico de una paciente femenina de 43 a os que presentó dos complicaciones secundarias al uso de propiltiouracilo: vasculitis y agranulocitosis.La vasculitis asociada con el tratamiento antitiroideo es una entidad clínica bien documentada, pero rara, y de un mecanismo patogénico no claro aún. Hay pocos casos reportados de asociación entre la ingesta de propiltiouracilo, la aparición de anticuerpos anticitoplasmáticos antineutrófilos y vasculitis ANCA positiva. Este es probablemente uno de ellos. We report a case of 43-year-old woman who developed two complications associated with the use of propylthiouracil: vasculitis and agranulocytosis. Vasculitis associated with antithyroid therapy is a rare well-documented clinical entity with a pathogenic mechanism not clear yet. There a few published reports of an association between treatment with propylthiouracil, and the occurrence of ANCA positivity and ANCA-associated vasculitis. This is probably one more.
Decisión de estudiar medicina: Factores determinantes y elección de la especialidad Decision to Study Medicine: Determinants and Specialty Choice
Juan Ignacio Padilla-Cuadra,Leonel Vindas-Sánchez,Alfonso Villalobos-Pérez
Acta Médica Costarricense , 2012,
Abstract: Introducción: La decisión de estudiar medicina depende de múltiples factores incluyendo aspectos internos (personales) y otros externos al individuo. Conocer estos factores puede ser útil para la administración del plan de estudios de la carrera y para la orientación estudiantil. Por tal motivo se propuso un estudio para identificar los factores determinantes para tomar esta decisión, intención de especialización y conocer las principales escogencias para especialidad. Materiales y métodos: Se realizó investigación descriptiva basada en una encuesta aplicada a una muestra de 84 estudiantes activos de la carrera de medicina de una universidad privada (Universidad de Iberoamérica, UNIBE). Resultados: Fueron encuestados 84 estudiantes, 71.4 % del sexo femenino. La relación con familiares médicos fue afirmativa en 39.5 % de los casos. Los principales motivos para estudiar medicina fueron por convicción propia sin influencia externa con motivación especialmente humanitaria y de realización personal. La mayoría escogió esta carrera entre los 16 y 20 a os. Un 91.6 % de los encuestados tiene intenciones de seguir una especialidad. Como opción de especialidad predomina la medicina interna y sus especialidades, seguida por la cirugía y sus respectivas ramas. Conclusión: Se determinó un importante predominio del género femenino. Los motivos para estudiar medicina y seguir una especialidad son de predominio humanitario y altruista. Las especialidades de mayor demanda son en el área de la medicina interna y la cirugía. Esta información puede ser útil para la gestión académica a nivel de pregrado y para la orientación de los programas de posgrado en especialidades médicas. Introduction: The decision to study Medicine as a career depends on many factors, including intrinsic (personal) and extrinsic ones to the individual. To be aware of these factors could be useful for curriculum development and student counseling. Therefore, the study was proposed to identify the key factors taken into account to make this decision, intention of specialization and the main areas chosen. Materials and Methods: This is a descriptive research based on a survey applied to a sample of 84 active medical students of a private university (Universidad de Iberoamerica, UNIBE). Results: The survey was applied to 84 students, 28.6 % were male and 71.4 % were female. 39.5 % reported to have physicians as relatives. The main reason to study Medicine was self-conviction without outside influence and motivation due to humanitarian issues. Most of them chose to study this career between 16 and 20 ye
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