domingo, 18 de abril de 2010

Manual para padres de ninos autistas

Manual avanzado para padres de niños autistas
De la aceptación a la vida útil

ÍNDICE
PRÓLOGO
I. INTRODUCCIÓN AL AUTISMO
Características del autista
Hechos comprobados
La etiqueta del autismo
Autismo y Síndrome de Asperger
Tratamientos para el autismo
Cuidado con los farsantes
II. COMPRENDIENDO AL AUTISTA
"Pensando en imágenes"
Discriminación auditiva selectiva
Prosopagnosia
Ceguera mental
Auto estimulación
¿Los autistas tienen sentimientos?
¿Qué me diría un autista?

III. PATERNIDAD: CALIDAD DE VIDA
¿Aceptar o elegir?
Los miserables
Juegos extraños
¿Porqué son tan tiernos nuestros hijos?
Decidido a ser feliz
IV. INTRODUCCIÓN A LA TERAPIA CONDUCTUAL
Condiciones para la aplicación
Métodos generales de manejo
V. SISTEMA CONDUCTUAL
Tipos de reforzadores
Principios de reforzamiento
Procedimientos para el aprendizaje
VI. TÉCNICAS PARA LA MODIFICACIÓN DE LA CONDUCTA
Técnicas para decrementar conductas
Corrección verbal
Corrección física
Interrupción de respuesta
Extinción
Tiempo fuera
Saciedad o sobrecorrección
Reforzamiento de conductas incompatibles
Desensibilización
Costo de respuesta
Recomendaciones al aplicar estas técnicas
Técnicas para incrementar una conducta
Modelamiento o Imitación
Moldeamiento
Contrato de Contingencias
Economía de Fichas

VII. HABILIDADES BÁSICAS DEL TERAPEUTA
Control de sentimientos y emociones
Manejo de expresión facial, tono y volumen de voz
Dar instrucciones
Presentación y manejo de material
Registro de programas y conductas
Graficación de programas y conductas
Manejo de apoyos
Elaboración de programas
VIII. PLANEACIÓN DE LA TERAPIA
Registro anecdótico
Definición de las conductas
Línea base o preevaluación
Evaluación de las conductas
Escala de reforzadores
Control de las conductas inadecuadas
Habilidades preparatorias
Valoración
Programación por áreas
IX. BIBLIOGRAFÍA

X. APÉNDICE
Ejemplo de ficha de programación
Ejemplo del registro de programas
Ejemplo de escala de reforzadores

XI. NUESTROS ARTISTAS
XI. CARTA A MI HIJO
ARTÍCULO ! TENGO UN HIJO AUTISTA

PSICOM EDITORES

Manual avanzado para padres de niños autistas
De la aceptación a la vida útil
 

solucion hipertonica para bronquiolitis


Existen trabajos que hablan de la efectividad de la solución salina hipertonica al 3% nebulizada
en la mejoria de pacientes con bronquiolitis aguda.
En este trabajo pretenden demostrar que la combinación solución salina hipertonica al 3%
y salbutamol es un tratamiento seguro para los niños con Bronquiolitis aguda.
Artículo bueno para discusión entre pediatras, neumonologos y alergologos. Que tal?

 http://xa.yimg.com/kq/groups/17358357/1932471568/name/Nebulized%20hypertonic%20saline%20salbutamol%20%20in%20bronchiolitis.pd

       Dr. Douglas Umbría
          Médico Pediatra
    Emergencia de Pediatría
      Hospital Chiquinquirá
               Maracaibo
               Venezuela

sábado, 3 de abril de 2010

GASTOS POR DIABETES


 
Buenos días
 
¿Sabías que la Diabetes Mellitus (DM) sin manejo es un problema mayor no solo para los pacientes sino también para los profesionales de la salud y las aseguradoras?
 
La DM es una enfermedad crónica y mayormente silente cuya incidencia esta creciendo e impacta negativamente en los tejidos corporales cuando los niveles de glucosa en sangre no están normalizados.
 
Más información en el siguiente enlace:
 
http://redsaf.org/blog/?p=128

 
Saludos cordiales
 
Q.F. Aldo Alvarez Risco
Red Sudamericana de Atención Farmacéutica
www.redsaf.org
Síguenos en Twitter  http://twitter.com/redsaf

viernes, 2 de abril de 2010

Se cuecen habas

En todas partes se cuecen  habas pero los motivos son diferentes y no se puede comparar sociedades que tienen instituciones que funcionan con sociedades que nos las tienen.
El 90 % DE LAS TABLETAS de nitroglicerina que se expenden en USA  no han sido aprobadas por la FDA por un vacio legal acerca de drogas que se venden desde antes de la fundacion de la FDA en 1938. No se sabe si son seguras o efectivas. El presidente de la ACC Ralf Brindis cardiologo  de la Universidad de California San Francisco ha quedado sorprendido. Y como estaremos por aca en general?. TENEMOS que reconocer por otro lado que el nuevo petitorio nacional de farmacos del Minsa ESTA BASTANTE completo y ha acogido casi todas las sustentaciones presentadas en la ultima reunion del comite nacional. Figuran entre otros  alteplase  enoxiparina  dalteparina sevorane, etc. Algo que tendria que haberse hecho hace mucho tiempo. Y estos farmacos se pueden usar en el SIS.
 
 

polidocanol para varices pequenas


March 31, 2010 — The US Food and Drug Administration (FDA) has approved polidocanol injection (Asclera, Chemische Fabrik Kreussler & Co) for the treatment of small varicose veins.

Specifically, polidocanol is approved to close spider veins (<1 mm in diameter) and reticular veins (1 - 3 mm in diameter), according to the FDA press release issued on Monday.

"Asclera is indicated for the treatment of small types of varicose veins when the aim of treatment is to improve appearance," noted Norman Stockbridge, MD, PhD, from the Center for Drug Evaluation and Research at the FDA, in the written release.

Polidocanol creates fibrosis within the cell lining of blood vessels, causing them to collapse; the vein is then eventually replaced by other types of tissue.

Adverse reactions to polidocanol include leakage, hematoma, bruising, irritation, discoloration, and pain at the injection site.

hipertermia maligna

----- Mensaje reenviado ----

De: Victor Whizar-Lugo <vwhizar@anestesia-dolor.org>
Para: maximocuadros@yahoo.es
Enviado: vie,2 abril, 2010 11:53
Asunto: Hipertermia maligna

 


Anestesiología y Medicina del Dolor

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Anestesiología y Medicina del Dolor

No:09001 Abril 2010

Estimad@ Maximo Jesus Cuadros Chavez:

 

Hipertermia maligna
Malignant Hyperthermia
Denborough, Michael A. M.D., M.B., Ch.B., D.Phil., D.Sc., F.R.A.C.P., F.R.C.P., F.N.Z.C.A.
Anesthesiology 2008;108:156-157.  doi: 10.1097/01.anes.0000296107.23210.dd
Additional material related to this article can be found on the Anesthesiology Web site. Go to http://www.anesthesiology.org, click on Enhancements Index, and then scroll down to find the appropriate article and link. Supplementary material can also be accessed on the Web by clicking on the ArticlePlus link either in the Table of Contents or at the top of the Abstract or HTML version of the article.

 
Abstract
A local family is described in which there have been ten deaths attributable to general anesthesia. The pattern of inheritance of the abnormality is compatible with that due to an incompletely penetrant dominant gene or genes. Spinal anesthesia produced no ill effects when used in the one member of the family who survived a reaction following a general anesthetic.

 
Articulo en PDF
Estado actual sobre hipertermia maligna y tratamiento con Dantrium i.v.
Current State of Malignant Hyperthermia And the Use of Dantrium IV as Treatment.
Rosenberg H.
Anesthesiology News 2010:36:3
Malignant hyperthermia (MH) is an autosomally inherited disorder characterized by an increase in heart rate, respiratory rate, body temperature, and muscle rigidity when the patient is exposed to potent volatile anesthetic gases and succinylcholine. The prevalence and incidence of MH are difficult to determine because patients display no characteristic signs until anesthetized with one of the triggering agents, and even then do not always develop the disorder. This article discusses the clinical presentation of MH, treatment using Dantrium® IV, and provides information on educational resources such as the Malignant Hyperthermia Association of the United States.
Articulo en PDF
Tendencias y evolución de hipertermia maligna en Estados Unidos de Norteamérica, 2000 a 2005.
Trends and outcomes of malignant hyperthermia in the United States, 2000 to 2005.
Rosero EB, Adesanya AO, Timaran CH, Joshi GP.
Department of Surgery, Division of Vascular Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9157, USA. eric.rosero@utsouthwestern.edu
Anesthesiology. 2009 Jan;110(1):89-94.
 

BACKGROUND: Malignant hyperthermia (MH) is a potentially fatal pharmacogenetic disorder with an estimated mortality of less than 5%. The purpose of this study was to evaluate the current incidence of MH and the predictors associated with in-hospital mortality in the United States. METHODS: The Nationwide Inpatient Sample, which is the largest all-payer inpatient database in the United States, was used to identify patients discharged with a diagnosis of MH during the years 2000-2005. The weighted exact Cochrane-Armitage test and multivariate logistic regression analyses were used to assess trends in the incidence and risk-adjusted mortality from MH, taking into account the complex survey design. RESULTS: From 2000 to 2005, the number of cases of MH increased from 372 to 521 per year. The occurrence of MH increased from 10.2 to 13.3 patients per million hospital discharges (P = 0.001). Mortality rates from MH ranged from 6.5% in 2005 to 16.9% in 2001 (P < 0.0001). The median age of patients with MH was 39 (interquartile range, 23-54 yr). Only 17.8% of the patients were children, who had lower mortality than adults (0.7% vs. 14.1%, P < 0.0001). Logistic regression analyses revealed that risk-adjusted in-hospital mortality was associated with increasing age, female sex, comorbidity burden, source of admission to hospital, and geographic region of the United States. CONCLUSIONS: The incidence of MH in the United States has increased in recent years. The in-hospital mortality from MH remains elevated and higher than previously reported. The results of this study should enable the identification of areas requiring increased focus in MH-related education.

 
Articulo en PDF
Papel del CACNA 1S en la predisposición para hipertermia maligna

The role of CACNA1S in predisposition to malignant hyperthermia.
Carpenter D, Ringrose C, Leo V, Morris A, Robinson RL, Halsall PJ, Hopkins PM, Shaw MA.
MH Investigation Unit, Academic Unit of Anaesthesia, St James's University Hospital, Leeds, LS9 7TF, UK. danielle.carpenter@nottingham.ac.uk
BMC Med Genet. 2009 Oct 13;10:104.
BACKGROUND: Malignant hyperthermia (MH) is an inherited pharmacogenetic disorder of skeletal muscle, characterised by an elevated calcium release from the skeletal muscle sarcoplasmic reticulum. The dihydropyridine receptor (DHPR) plays an essential role in excitation-contraction coupling and calcium homeostasis in skeletal muscle. This study focuses on the gene CACNA1S which encodes the alpha1 subunit of the DHPR, in order to establish whether CACNA1S plays a major role in MH susceptibility in the UK. METHODS: We investigate the CACNA1S locus in detail in 50 independent MH patients, the largest study to date, to identify novel variants that may predispose to disease and also to characterise the haplotype structure across CACNA1S. RESULTS: We present CACNA1S cDNA sequencing data from 50 MH patients in whom RYR1 mutations have been excluded, and subsequent mutation screening analysis. Furthermore we present haplotype analysis of unphased CACNA1S SNPs to (1) assess CACNA1S haplotype frequency differences between susceptible MH cases and a European control group and (2) analyse population-based association via clustering of CACNA1S haplotypes based on disease risk. CONCLUSION: The study identified a single potentially pathogenic change in CACNA1S (p.Arg174Trp), and highlights that the haplotype structure across CACNA1S is diverse, with a high degree of variability

 
Articulo en PDF
Hipertermia maligna postoperatoria: un análisis de casos del Registro Norteamericano de hipertermia maligna.
Postoperative malignant hyperthermia: an analysis of cases from the North American Malignant Hyperthermia Registry.
Litman RS, Flood CD, Kaplan RF, Kim YL, Tobin JR.
Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Anesthesiology. 2008 Nov;109(5):825-9.
BACKGROUND: The initial presentation of malignant hyperthermia (MH) may begin in the postoperative period. However, the maximal latency period between the end of anesthesia care and the onset of postoperative MH is unknown. The authors hypothesized that this latency period is short and is not manifested by hyperthermia as the initial presenting sign. The authors sought to test this hypothesis and to describe the clinical characteristics of postoperative MH by analysis of suspected cases in the North American Malignant Hyperthermia Registry. METHODS: Of 528 possible or suspected cases of MH in the North American Malignant Hyperthermia Registry, the authors identified 64 possible reports of postoperative MH. The records were reviewed in detail by the authors, each of whom assigned a qualitative score of "likely," "not likely," "not enough information available," or "not applicable" (where MH was not the final definitive diagnosis). Postoperative MH was confirmed after a consensus meeting of the three senior authors who reviewed in detail all possible "likely" cases. RESULTS: The authors identified postoperative MH in 10 subjects. All received volatile agents and 5 also received succinylcholine. All demonstrated signs characteristic of acute MH, including generalized rigidity, hypercapnia and/or tachypnea, tachycardia, and hyperthermia. No subject demonstrated hyperthermia as the presenting sign. The latency period between the anesthesia finish time and the onset of a sign indicative of acute MH ranged from 0 to 40 min. CONCLUSIONS: Postoperative MH is uncommon, occurring in 10 of 528 suspected MH cases (1.9%) reported to the North American Malignant Hyperthermia Registry. Postoperative MH began shortly after completion of the anesthetic care. Hyperthermia was not a presenting sign of MH.

 Articulo en PDF
Hipertermia maligna

Malignant hyperthermia.
Rosenberg H, Davis M, James D, Pollock N, Stowell K.
Department of Medical Education and Clinical Research, Saint Barnabas Medical Center, Livingston, NJ 07039, USA.
Orphanet J Rare Dis. 2007 Apr 24;2:21.
Malignant hyperthermia (MH) is a pharmacogenetic disorder of skeletal muscle that presents as a hypermetabolic response to potent volatile anesthetic gases such as halothane, sevoflurane, desflurane and the depolarizing muscle relaxant succinylcholine, and rarely, in humans, to stresses such as vigorous exercise and heat. The incidence of MH reactions ranges from 1:5,000 to 1:50,000-100,000 anesthesias. However, the prevalence of the genetic abnormalities may be as great as one in 3,000 individuals. MH affects humans, certain pig breeds, dogs, horses, and probably other animals. The classic signs of MH include hyperthermia to marked degree, tachycardia, tachypnea, increased carbon dioxide production, increased oxygen consumption, acidosis, muscle rigidity, and rhabdomyolysis, all related to a hypermetabolic response. The syndrome is likely to be fatal if untreated. Early recognition of the signs of MH, specifically elevation of end-expired carbon dioxide, provides the clinical diagnostic clues. In humans the syndrome is inherited in autosomal dominant pattern, while in pigs in autosomal recessive. The pathophysiologic changes of MH are due to uncontrolled rise of myoplasmic calcium, which activates biochemical processes related to muscle activation. Due to ATP depletion, the muscle membrane integrity is compromised leading to hyperkalemia and rhabdomyolysis. In most cases, the syndrome is caused by a defect in the ryanodine receptor. Over 90 mutations have been identified in the RYR-1 gene located on chromosome 19q13.1, and at least 25 are causal for MH. Diagnostic testing relies on assessing the in vitro contracture response of biopsied muscle to halothane, caffeine, and other drugs. Elucidation of the genetic changes has led to the introduction, on a limited basis so far, of genetic testing for susceptibility to MH. As the sensitivity of genetic testing increases, molecular genetics will be used for identifying those at risk with greater frequency. Dantrolene sodium is a specific antagonist of the pathophysiologic changes of MH and should be available wherever general anesthesia is administered. Thanks to the dramatic progress in understanding the clinical manifestation and pathophysiology of the syndrome, the mortality from MH has dropped from over 80% thirty years ago to less than 5%.

 
Articulo en PDF
Alteraciones mitocondriales y anestesia general: una serie de casos y revisión
Mitochondrial disorders and general anaesthesia: a case series and review.
Footitt EJ, Sinha MD, Raiman JA, Dhawan A, Moganasundram S, Champion MP.
Department of Paediatric Metabolic Medicine, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Lambeth Palace Road, London SE1 7EH, UK.
Br J Anaesth. 2008 Apr;100(4):436-41.
Patients with mitochondrial disease are at risk of metabolic decompensation and often require general anaesthesia (GA) as part of their diagnostic work up and subsequent management. However, the evidence base for the use of GA is limited and inconclusive. We have documented the practice and outcome in the use of GA in paediatric patients with mitochondrial disease using a retrospective case review study of 38 mitochondrial patients who had undergone 58 anaesthetics within the regional metabolic service for the period 1989-2005. A variety of anaesthetic agents were used and the pattern of use reflects that seen in standard paediatric practice. There were no episodes of malignant hyperthermia and no documented intraoperative events attributable to the GA. Three postoperative adverse events were noted; one episode of hypovolaemia, one episode of acute on chronic renal failure, and one episode of metabolic decompensation 12 h post-muscle biopsy. Despite theoretical concern about this group of patients, adverse events after GA are rare and in most cases unrelated to the anaesthesia. Further prospective studies of GA in mitochondrial disease are required to create evidence-based clinical guidelines for safe practice
Articulo en PDF


Atentamente
 
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

--

alzheimer

----- Mensaje reenviado ----
De: PABLO ALBAN SILVA <albansilvamedico@hotmail.com>
Para: ASOCIACIÓN PSIQUIATRICA PERUANA <listaapp@yahoogrupos.com.mx>
Enviado: vie,2 abril, 2010 12:10
Asunto: ALZHEIMER
Alzheimer


Introducción
Glosario de términos
Antecedentes históricos del mal de Alzheimer
Enfermedad de Alzheimer
¿Qué sucede en el cerebro con la enfermedad de Alzhaimer?
Causas de la enfermedad de Alzheimer, incidencias y factores de riesgo
¿Cuáles son los síntomas de la enfermedad de Alzheimer?
Fases de la enfermedad de Alzheimer
Diagnosis de la enfermedad de Alzheimer
Tratamiento
Manejo de la enfermedad de Alzheimer
Cuidados de enfermería para un enfermo con Alzheimer
Conclusión
Bibliografía
Anexos
 
LA HISTORIA: OBJETIVIDAD Y SENTIMIENTOS EN ...
MÚSICOTERAPIA
 
su amigo
Dr. Pablo Albán

] Desempenho acadêmico superior está relacionado a um aumento do risco de transtorno bipolar . Leia esta e outras notícias.



---------- Forwarded message ----------
From: CLEVER HUMBERTO LEIVA HERRADA <clever_leiva@yahoo.com>
Date: 2010/4/2
Subject: [SALUD_LORETO] Desempenho acadêmico superior está relacionado a um aumento do risco de transtorno bipolar . Leia esta e outras notícias.
To: SALUD LORETO <salud_loreto@yahoogroups.com>


 








 

Date: Thu, 1 Apr 2010 16:45:17 -0400
From: brsac@medcenter.com
Subject: Desempenho acadêmico superior está relacionado a um aumento do risco de transtorno bipolar . Leia esta e outras notícias.

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] Recordatorio de semiología [Archivos adjuntos 2]


 
[Más abajo se incluyen archivos adjuntos de =?utf-8?B?TcOheGltbyBDdWFkcm9z?=]

Delirio: recuerdo semiológico

Eduardo Palencia Herrejón

a y Beatriz Sánchez Artolab

a

Servicio de Medicina Intensiva. Hospital Infanta Leonor. Madrid.

b

Servicio de Medicina Interna. Hospital Infanta Leonor. Madrid.

febrero 2010 |

www.jano.es

 

Semiología de la esquizofrenia

David Fraguas Herráez y Juan Antonio Palacios Castaño

Servicio de Psiquiatría. Hospital Infanta Sofía. San Sebastián de los Reyes. Madrid. España

JANO 11 DE DICIEMBRE DE 2009. N.º 1.755

www.jano.es 
Atte.
MÁXIMO CUADROS
UNYK: 245 HRP

__._,_.___

Archivos adjuntos de =?utf-8?B?TcOheGltbyBDdWFkcm9z?=

Archivo 2 de 2

 

SIRVE el Swan Ganz



---------- Mensaje reenviado ----------
De: Máximo Cuadros <maximocuadros@yahoo.es>
Fecha: 2 de abril de 2010 03:40
Asunto: {emergencias_y_desastres} Medicina Intensiva
Para: interno_residente_medico_PERU@yahoogroups.com


 

Revision

El papel del catéter de Swan-Ganz en la actualidad

A. Carrillo López, M. Fiol Sala, A. Rodríguez Salgado

Med Intensiva.2010; 34 :203-14

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