RESUMENEl neumomediastino espontáneo (definido por la presencia de aire libre en el mediastino) es una entidad infrecuente que se presenta en ausencia de enfermedades o factores precipitantes. Generalmente afecta a varones jóvenes y sanos. El dolor torácico, la disnea o ambos son los síntomas más frecuentes. Otros síntomas y signos son el enfisema subcutáneo y el signo de Hamman. La radiografía simple de tórax establece el diagnóstico en un alto porcentaje de pacientes. El tratamiento conservador está indicado en estos pacientes y tiene un pronóstico favorable. Las recidivas son infrecuentes.Palabras clave. Neumomediastino espontáneo. Dolor torácico. Diagnóstico. Tratamiento. ABSTRACTSpontaneous pneumomediastinum (defined by the presence of free air in the mediastinum) is an infrequent entity that is presented in the absence of diseases or precipitating factors. It generally affects young and healthy males. Thoracic pain, dyspnea, or both, are the most frequent symptoms. Other signs and symptoms are subcutaneous emphysema and Hamman's sign. Simple radiography of the thorax allows for the diagnosis in a high percentage of patients. Conservative treatment is indicated in these patients and has a favourable prognosis. Relapses are infrequent.
Background: In patients with acute decompensated heart failure (ADHF), both natriuretic peptides and renal impairment predict adverse outcomes. Our aim was to evaluate the complementary prognosis role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the newly developed Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations based on cystatin C (CysC) for glomerular filtration rate (GFR) estimation in ADHF patients. Hypothesis: Renal impairment assessed by CysC-based CKD-EPI equations and natriuretic peptides have complementary prognostic value in ADHF patients. Methods: The study included 613 consecutive patients presenting with ADHF. At admission, plasma levels of NT-proBNP and CysC were determined. The GFR was estimated using CysC-based CKD-EPI equations. The primary endpoint was death from any cause and heart failure readmission. Results: During the median follow-up of 365 days (interquartile range, 227-441 days), 323 patients (0.65 %patient-year) died or were readmitted for heart failure. After multivariate adjustment, estimated GFR <60 mL/min/1.73 m 2 and NT-proBNP >3251 pg/mL were independent predictors of adverse outcomes (P < 0.01). The combination of GFR <60 mL/min/1.73 m 2 and NT-proBNP >3251 pg/mL was associated with the highest risk of adverse outcomes. Furthermore, reclassification analyses demonstrated that use of both NTproBNP and CysC-based CKD-EPI equations resulted in improving the accuracy for adverse outcomes prediction. Conclusions: In patients with ADHF, the combination of NT-proBNP with estimated GFR using CysC-based CKD-EPI equations better predicts outcomes than either parameter alone and adds valuable complementary prognosis information to other established risk factors.
Fundamento. El objetivo del presente trabajo es conocer las características epidemiológicas, el manejo diagnóstico y terapéutico, su seguimiento y la incidencia de diagnósticos alternativos en una muestra de pacientes diagnosticados de cólico renal en el Servicio de Urgencias de un Hospital de tercer nivel.Material y métodos. Estudio descriptivo retrospectivo de 182 pacientes seleccionados aleatoriamente que consultan por clínica compatible con cólico renal en un hospital de tercer nivel, valorando su manejo inicial, seguimiento al alta y diagnósticos alternativos.resultados. El 55,4% fueron varones, la edad media fue de 47,7 años y el 40% de los casos se produjeron en primavera. En todos los pacientes se realizó analítica urinaria (62,7% tira reactiva y 72% sedimento) apareciendo alteraciones en más del 70%. La función renal se deterioró en el 26,4 % de los casos, siempre de forma transitoria. La prueba de imagen realizada con más frecuencia fue la radiografía de abdomen (81,9%) seguida de la ecografía (25,8%). El tratamiento incluyó fluidoterapia en el 31,3% y el analgésico más usado fue el metamizol (61%) seguido del ketorolaco (44,5%). El 46,2% de los pacientes necesitó más de un analgésico. Un total de 24 pacientes precisaron ingreso hospitalario y 5 de ellos cirugía urgente. El 24,1% presentó recaídas en los seis meses posteriores. El 41,6% fue remitido al Servicio de Urología al alta. El 18,1% presentaron diagnósticos alternativos, siendo la pielonefritis aguda el más frecuente de ellos (55%).conclusiones. Hemos detectado una importante variación en el manejo diagnóstico y terapéutico de estos pacientes. El uso de guías clínicas debe permitirnos unificar el manejo del paciente con cólico renal tanto en urgencias como posteriormente. El alto porcentaje de diagnósticos alternativos nos obliga a descartar sistemáticamente patologías más graves.Palabras clave. Cólico renal. Urgencias. Diagnóstico. Tratamiento. Seguimiento. Diagnóstico diferencial. aBstractBackground. To evaluate the diagnostic and therapeutic management of patients with nephritic colic in a referral hospital, their monitoring and the incidence of alternative diagnoses.Methods. This is a retrospective review of 182 randomly selected patients who presented a clinical diagnosis compatible with nephritic colic in a referral hospital. In these cases initial treatment, monitoring and alternative diagnoses have been evaluated. results. Fifty-five point four percent of the patients were male, the mean age was 47.7 years and 40% of the cases were in spring. Urinalysis was carried out in every patient (62.7% dipstick and 72% urinary sediment); they were pathological in over 70%. In 26.4% of cases renal function deteriorated, always transiently. Abdominal radiography (81.9%) was the most frequently diagnostic test performed, followed by ultrasound (25.8%). Treatment included a serum therapy in 31.3%; metamizol (61%) was the most commonly used analgesic followed by ketorolac (44.5%). More than one non-steroidal anti-inflammatory was used by 46.2%. Hospit...
Assistive and rehabilitation robotics have gained momentum over the past decade and are expected to progress significantly in the coming years. Although relevant and promising research advances have contributed to these fields, challenges regarding intentional physical contact with humans remain. Despite being a fundamental component of assistive and rehabilitation tasks, there is an evident lack of work related to robotic manipulators that intentionally manipulate human body parts. Moreover, existing solutions involving end-effector robots are not based on accurate knowledge of human limb dimensions and their current configuration. This knowledge, which is essential for safe human-limb manipulation, depends on the grasping location and human kinematic parameters. This paper addresses the upper-limb manipulation challenge and proposes a pose estimation method using a compliant robotic manipulator. To the best of our knowledge, this is the first attempt to address this challenge. A kinesthetic-based approach enables estimation of the kinematic parameters of the human arm without integrating external sensors. The estimation method relies only on proprioceptive data obtained from a collaborative robot with a Cartesian impedance-based controller to follow a compliant trajectory that depends on human arm kinodynamics. The human arm model is a 2-degree of freedom (DoF) kinematic chain. Thus, prior knowledge of the arm's behavior and an estimation method enables estimation of the kinematic parameters. Two estimation methods are implemented and compared: i) Hough transform (HT); ii) least squares (LS). Furthermore, a resizable, sensorized dummy arm is designed for experimental validation of the proposed approach. Outcomes from six experiments with different arm lengths demonstrate the repeatability and effectiveness of the proposed methodology, which can be used in several rehabilitation robotic applications.
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