banco essalud 2001
TRANSCRIPT
• Inmadurez cervical
• - Sedación profunda
• - Causas idiopáticas
• - Incoordinación uterina
OBSTETRICIA [email protected] www.qxmedic.com
HEMORRAGIA UTERINA ANORMAL: 30% consulta. Embarazo, organico, anovulacion,
hemostasia, neoplasia.
SANGRADO NORMAL:24-35d / 2-7d / 80ml maximo (30-40ml).
Variabilidad maxima: 2 a 7postmenarquia y 10ª antes menopausia.
OVULACIONEdema mamario, discomfort pelvico, cambios
humor, descarga vaginal a medio ciclo.>10d puede ser anovulatorio.
• Tratar sexualmente activos. Niños opcional.
• Primera linea: crioterapia, curetaje y cantaridin, podofilotoxina 0.5%.
ANTIANGINAL THERAPY — There are three classes of antiischemic drugs commonly used in the management of angina pectoris: nitrates, beta blockers, and calcium channel blockers [1]. Often a combination of these agents is used for control of symptoms.
IRA PRERENAL• Urinalysis• Response to fluid repletion• Fractional excretion of sodium (FENa) and urea
(FEUrea) <1% PRE• BUN/plasma creatinine ratio >20/1 PRE• Rate of rise of plasma creatinine concentration: mas
lento PRE• Urine sodium concentration: <20meq/L PRE• Urine osmolality: >500mOSM/L PRE• Urine volume: oliguria PRE• Urine-to-plasma creatinine concentration: >40 PRE
MENINGO TBC
ANEMIA MEGALOBLA
STICA
Mechanism of action — Rifampin isthought to inhibit bacterial DNA-dependent RNA polymerase, which isnot a mechanism of action sharedwith other antibiotics. This effect onRNA polymerase appears to resultfrom drug binding in the polymerasesubunit deep within the DNA/RNAchannel where direct blocking of theelongating RNA can occur [2].
MECHANISM OF ACTION — The mode of action of INH is complex. The best-defined mechanism is inhibition of mycolic acid biosynthesis. However, INH also disrupts DNA, lipid, carbohydrate, and NAD synthesis and/or metabolism.
CLINICAL FEATURES — Febrile seizures occur in children between the ages of six months and six years, with the majority occurring in children between 12 to 18 months of age. Febrile seizures have been reported in children over six years of age, but in older children, febrile seizures should be considered a diagnosis of exclusion, as they are more likely than younger children with febrile seizures to have subsequent afebrile seizures [46].
Simple febrile seizures are the most common type encountered in children. Generalized seizures are mainly clonic, but other forms include atonic and tonic spells. The facial and respiratory muscles are commonly involved.
Complex febrile seizures (focal features, longer than 15 minutes or multiple episodes within 24 hours) are unusual; prolonged convulsions occur in fewer than 10 percent and focal features in fewer than 5 percent of children with febrile seizures.
The majority of children have their febrile seizures on the first day of illness and, in some cases, it is the first manifestation that the child is ill. The degree of fever associated with febrile convulsions is variable, and approximately 25 percent of events occur when the temperature is between 38ºC and 39ºC. They are often seen as the temperature is increasing rapidly but may develop as the fever is declining. Recurrent febrile seizures do not necessarily occur with the same degree of fever as the first episode and do not occur every time the child has a fever.
Recurrent febrile seizures — Children with febrile seizures are at risk for developing recurrent febrile seizures. The overall recurrence rate is approximately 30 to 35 percent [61,62]. However, the values vary with age from as high as 50 to 65 percent in children who are younger than one year of age at the time of the first seizure to as low as 20 percent in older children [63]. A major factor influencing the recurrence rate is the age of the infant at the time of the first seizure.
A prospective cohort study of 428 children with a first febrile seizure defined other features and factors influencing recurrences [61]. Approximately one-third of the children had at least one recurrence, 17 percent had one recurrence, 9 percent had two recurrences, and approximately 6 percent had three or more recurrences. The majority of recurrences (50 to 75 percent) took place within one year of the initial seizure and almost all occurred within two years [64]. Four factors in the prospective cohort study increased the recurrence risk [61]:
Young age at onsetHistory of febrile seizures in a first-degree relativeLow degree of fever while in the emergency departmentBrief duration between the onset of fever and the initial seizure
Children who had all four factors were much more likely to have a recurrent febrile seizure than were those with none (≥70 versus ≤20 percent). Complex features were not associated with the risk of recurrence. These findings were confirmed in another prospective study [65].
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