En algunas ocasiones, los pacientes con enfermedades neuromusculares infantojuveniles, pueden requerir internación en unidades de cuidados intensivos pediátricos. La principal causa de ingreso hospitalario es la insuficiencia respiratoria aguda, desencadenada por atelectasias y neumonías que, en la mayoría de los casos, tienen su inicio en infecciones del tracto respiratorio superior. Independientemente de su forma de presentación, las enfermedades neuromusculares en periodo infantojuvenil, pueden comprometer en grados distintos a los 3 grupos musculares vinculados a la ventilación pulmonar y protección glótica. Es posible dar asistencia a los músculos inspiratorios y espiratorios con soporte ventilatorio no invasivo y asistencia mecánica de la tos respectivamente. Esta estrategia combinada permite el manejo no invasivo de este tipo de pacientes, logrando extubar o decanular a aquellos considerados potencialmente no destetables con las estrategias clásicas utilizadas en unidades de cuidados intensivos en pediatría. El objetivo de esta revisión es sugerir recomendaciones en cuidados respiratorios no invasivos para pacientes con enfermedades neuromusculares ingresados en unidades de paciente crítico pediátrico. Se presentan 2 casos clínicos ilustrativos, en los cuales estas estrategias fueron utilizadas en forma exitosa.
Tuberculosis remains a very important issue of global health. The extrapulmonary tuberculosis forms (TBE) can be observed in less than 30% of all patients suffering from this disease. Pleural tuberculosis has a nonspecific presentation, which may delay the diagnosis. The polymerase chain reaction (PCR) applied for the identification of mycobacterial DNA facilitates a quick diagnosis in pleural tuberculosis. However, when the result is negative, and the patient is co-infected with other pathogens, the diagnosis may be delayed. We present a case of an immunocompetent patient with pleural tuberculosis and concomitant Flavimonas oryzihabitans bacteriemia, who was successfully treated with anti-tuberculosis treatment and antibiotic.
Objective: To determine the efficacy of using a narrative-based intervention to reduce HIV stigma among members of the general public in a rural community in Ecuador. Design: This cross-sectional intervention study involved a convenience sample of 133 participants from Cariamanga, Ecuador. We used a post-test only comparison group design. Setting: The number of adults living with HIV in Ecuador is increasing. Stigma and discrimination are among the greatest barriers to HIV prevention, access to treatment, care and support. Stigma is also associated with negative health outcomes. The study took place in the rural community of Cariamanga, Loja, Ecuador. Method: The intervention included (1) a fact-based presentation, (2) video stories from two individuals living with HIV and (3) a structured group discussion. Data were collected using an HIV Stigma Scale and an HIV Knowledge Assessment. Data were analysed using independent t-test and multivariate analysis of variance (MANOVA). Results: Participants who received the intervention had higher HIV knowledge scores ( p < .001; d = 2.06) and lower stigma scores (0.59) subsequent to the intervention than the comparison group (1.02, p < .001; d = 1.05). Conclusion: This narrative-based educational intervention was effective in reducing HIV-related stigma. Public health practitioners should consider including narratives as a component of future health education interventions aimed at reducing HIV-related stigma.
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