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  1. An evening at "La Clinica del Pueblo".

    PubMed

    Shefsky, M L

    1986-01-01

    This article describes a typical evening at the Clinica del Pueblo in the Hispanic neighborhood of Adams-Morgan in Washington, D.c. The Clinical del Pueblo began operating in 1983 in response to the urgen medical needs of Central American refugees arriving in the Washington D.c. area. The refugees bring with them severe trauma, fear, and health problems caused by the civil was and exacerbated by inadequate or non-existant health services. Approximately 80,000 Salvadoran refugees live in the area. They do not receive adequate health care for 3 reasons. 1) Because the US goverment is unwilling to recognize them as true refugees, they live with the constant threat of deportatin back to the violence from which they have fled. 2) Refugees lack the ability to pay for private care. 3) Langauage and culture create frightening barriers to health care for the refugees. For those who do seek care, these barriers can lead to the inadequate or incomplete diagnoses and poor compliance and follow-up. Plenty International and the Central American Refugee Center responded to these problems by organizing a free clinic to provide not only medical care but also a training course for volunteers. The director of the clinic organizes the course, the classes are taught by a variety of people including the clinic's volunteer physicians, nurses, and public health educators as well as graduates of previus training courses and people from the wider community. The services of the clinic reach only a small portion of the population in need. However, the fact that free medical services are now available to some Central American refugees make the Clinica del Pueblo an important program.

  2. Automated Transformation of CDISC ODM to OpenClinica.

    PubMed

    Gessner, Sophia; Storck, Michael; Hegselmann, Stefan; Dugas, Martin; Soto-Rey, Iñaki

    2017-01-01

    Due to the increasing use of electronic data capture systems for clinical research, the interest in saving resources by automatically generating and reusing case report forms in clinical studies is growing. OpenClinica, an open-source electronic data capture system enables the reuse of metadata in its own Excel import template, hampering the reuse of metadata defined in other standard formats. One of these standard formats is the Operational Data Model for metadata, administrative and clinical data in clinical studies. This work suggests a mapping from Operational Data Model to OpenClinica and describes the implementation of a converter to automatically generate OpenClinica conform case report forms based upon metadata in the Operational Data Model.

  3. The first century of the "clinica del lavoro" in Milan.

    PubMed

    Bertazzi, Pier Alberto; Foà, Vito

    2005-01-01

    The Clinica del Lavoro was created in Milan at the beginning of the 20th century by Luigi Devotto, who deemed it essential for physicians and health researchers to get involved in the life and health problems of working populations. The main roles of the Clinica del Lavoro were to educate medical students and train physicians; study actual workplaces, examine health and safety hazards and their noxious effects; and create initiatives and services to protect and promote workers' health. Important scientific contributions were made in several fields, including chemical carcinogenesis, effects of mineral and biologicalfibers, mechanism of action of silica dust, methods for the detection and measurements of toxic substances in both the work environment and workers' biological media.

  4. [Analysis of utilization of information in the journal Medicina Clinica].

    PubMed

    Aleixandre, R; Giménez Sánchez, J V; Terrada, M L; López Piñero, J M

    1994-09-10

    Scientific communication knowledge is specifically based in the analysis of the bibliographic references inside the publications. Pattern and laws determining the information consumption in the items of the journal Medicina Clinica are investigated in the present study as its own aim. An analysis was performed on the 13,286 references downloaded from 618 papers published by the journal in 1990. With dBASE IV was generated a database for the management of the information; data was distributed in several tables through criteria of age, documentary types, countries, journals and Bradford zones. The analysed references belong to 1,241 different journals, 110 from Spain. Being two thirds of the total sum, the publications from United States and United Kingdom have received more citations than those from Spain. The publications from european countries, like France, Germany and Italy, are scarcely present. Bradford core is constituted by the journals Medicina Clinica and The Lancet. The analysis of the bibliographic references available from the articles in this journal is able to produce knowledge on the information consumption by the practitioners; its usefulness as a complementary utility to the Indice de Citas e Indicadores Bibliométricos de Revistas Españolas de Medicina Interna y sus especialidades 1990 must be considered.

  5. Acta Clinica Croatica: progress of a journal step by step.

    PubMed

    Ramljak, Gordana

    2014-03-01

    The journal Acta Clinica Croatica (ACC) was founded in 1962 under the title Anali Bolnice Dr. M. Stojanović. In 1995, the title of the journal was changed into its present form and ever since all papers have been published in English. In 2000, the electronic (online) edition of the ACC was released in addition to the print version. The paper presents development of the journal from 1962 to 2012 based on the analysis of the following SCOPUS citation index parameters: type and number of documents published in the journal; number of citations; and number of domestic and foreign authors. The studied period was analyzed in three time segments: the period from 1995 to 1999, the period from 2000 to 2006 and the period from 2007 to 2012. The same parameters were analyzed in the Web of Science/SCI-Expanded bibliographic and citation index for the 2007-2012 period. The increasing number of documents, authors (both domestic and foreign) and citations demonstrates gradual rise in the quality, visibility and impact of the journal. The fifty years of experience show that a goal, at first very distant and almost unachievable, may be reached by progressing step by step.

  6. [The role of the "Clinica del Lavoro Luigi Devoto" in international research].

    PubMed

    Bertazzi, P A; Forni, Alessandra M

    2003-01-01

    During its long history, the Clinica del Lavoro Luigi Devoto has produced numerous internationally recognized scientific contributions in the specific field of occupational medicine and health, and in other broader areas as, for example, immunology, toxicology, cytogenetics. Pivotal in this activity was the figure of Enrico C. Vigliani, director of the Clinica for over 35 years. We mention here, in particular, the results of the study of "early" markers of lead intoxication; the research on the carcinogenicity of benzene and aromatic amines; the study of the pathogenesis of silicosis and byssinosis; the study of cytogenetic damage after exposure to industrial toxic chemicals; the technical research for dust abatement in mines. Such research also played a major role in the development of pulmonary medicine, toxicology and immunology in Italy, and conferred scientific dignity on the newborn "industrial hygiene" discipline thanks to the work of Nicola Zurlo. Today, the Clinica's research is maintained at international standards especially by the work of thematic Research Centers recently established within the Clinica, covering fields such as occupational and environmental toxicology, occupational oncology, ergonomics, respiratory disease and allergy, psycho-social risk factors. These Centers are also devoted to the development of innovative methods in epidemiology, toxicology, psychology, molecular biology, and ergonomic measurement for the identification and evaluation of health risks at work.

  7. OC ToGo: bed site image integration into OpenClinica with mobile devices

    NASA Astrophysics Data System (ADS)

    Haak, Daniel; Gehlen, Johan; Jonas, Stephan; Deserno, Thomas M.

    2014-03-01

    Imaging and image-based measurements nowadays play an essential role in controlled clinical trials, but electronic data capture (EDC) systems insufficiently support integration of captured images by mobile devices (e.g. smartphones and tablets). The web application OpenClinica has established as one of the world's leading EDC systems and is used to collect, manage and store data of clinical trials in electronic case report forms (eCRFs). In this paper, we present a mobile application for instantaneous integration of images into OpenClinica directly during examination on patient's bed site. The communication between the Android application and OpenClinica is based on the simple object access protocol (SOAP) and representational state transfer (REST) web services for metadata, and secure file transfer protocol (SFTP) for image transfer, respectively. OpenClinica's web services are used to query context information (e.g. existing studies, events and subjects) and to import data into the eCRF, as well as export of eCRF metadata and structural information. A stable image transfer is ensured and progress information (e.g. remaining time) visualized to the user. The workflow is demonstrated for a European multi-center registry, where patients with calciphylaxis disease are included. Our approach improves the EDC workflow, saves time, and reduces costs. Furthermore, data privacy is enhanced, since storage of private health data on the imaging devices becomes obsolete.

  8. [Extracorporeal circulation in no-cardiac surgery: experience at the Clinica Universidad de Navarra].

    PubMed

    Mastrobuoni, Stefano; Algarra, S Martin; Dell'Aquila, A M; Herreros, J

    2009-01-01

    Analyse the use of the Extra-Corporeal Circulation (ECC) in no-cardiac operations at the Clinica Universidad de Navarra. Between 1985 and 2009, the ECC has been involved in 28 operations for retroperitoneal tumour with inferior vena cava thrombus, in 43 isolated hyperthermic perfusion of a limb for locally advanced cancer and in 8 cases of chest mass with invasion of the pulmonary veins or bronchial carina. The intraoperative mortality for renal cancer has been of 7% while the 28% of patients showed a major complication. None patient died for the isolated hyperthermic perfusion and the 81% showed no toxicity. 1 patient out of 8 for chest mass died during the surgery for impossibility of weaning from the ECC. The ECC has been utilised in our experience mostly in cases of advanced cancer. It is an aggressive technique with a certain rate of complications. Nevertheless mid- and long-term results are encouraging. The ECC is the only technique in some advanced cancer in order to safely perform the mass removal. The precise co-ordination of the team is necessary to reduce the complication rate.

  9. Automated Import of Clinical Data from HL7 Messages into OpenClinica and tranSMART Using Mirth Connect.

    PubMed

    Camacho Rodriguez, Juan Carlos; Stäubert, Sebastian; Löbe, Matthias

    2016-01-01

    Electronic data capture (EDC) tools are designed to simplify data acquisition, improving data quality and managing clinical data electronically. Some data are collected from the laboratory information management system (LIMS), which is an important data source for a study. OpenClinica is an open source clinical data management system (CDMS) for web-based electronic data capture (EDC), which is used widely in academic clinical research. TranSMART is also an open source web-based platform used for the management and analysis of different data types common in clinical and translational research. Many LIMS use the Health Level 7 standard - Version 2.x (HL7) as a message exchange protocol. In this paper, we implement Mirth Connect as a Communication Server (CS) to convert these HL7 messages either to Operational Data Model (ODM) data for the automatic import in OpenClinica or tabular-delimited text format files, whose data is uploaded in tranSMART using the tMDataLoader tool.

  10. [Mobbing and its effects on health. the experience of the "Clinica del Lavoro Luigi Devoto" in Milan].

    PubMed

    Punzi, Silvia; Cassitto, Maria Grazia; Castellini, Giovanna; Costa, G; Gilioli, R

    2007-01-01

    There is increasing interest in research, prevention and management of mobbing in the field of occupational psychosocial risks. To describe mobbing and its health effects by analysis of the cases examined from 1997 to 2003 at the Department of Occupational Health "Clinica del Lavoro Luigi Devoto" in Milan. A total of 226 clinical records of patients who reported a mobbing situation when undergoing medical examination were selected out of 2455 patients examined for stress-related disorders. The percentage of women was higher (53.1%) than in men (46.9%) with a prevalent age range of 35-54 years. There was a great variety of jobs, especially white-collars and workers in large service companies. In one third of the cases, mobbing occurred within 4 years from beginning of employment and mostly after company reorganization and management changes. The most frequent negative acts included social isolation and demotion. The most frequent symptoms were exhaustion, sleep, mood and sexual disorders. The number of symptoms was not related to the duration of mobbing but to the number and frequency of negative actions. 61.1% of the subjects took psychotropic drugs. Occupational health physicians play an essential role in primary prevention (information on occupational risks) and in early diagnosis and rehabilitation and could act as mediators between workers and enterprises.

  11. Virtual-reality-based attention assessment of ADHD: ClinicaVR: Classroom-CPT versus a traditional continuous performance test.

    PubMed

    Neguț, Alexandra; Jurma, Anda Maria; David, Daniel

    2017-08-01

    Virtual-reality-based assessment may be a good alternative to classical or computerized neuropsychological assessment due to increased ecological validity. ClinicaVR: Classroom-CPT (VC) is a neuropsychological test embedded in virtual reality that is designed to assess attention deficits in children with attention deficit hyperactivity disorder (ADHD) or other conditions associated with impaired attention. The present study aimed to (1) investigate the diagnostic validity of VC in comparison to a traditional continuous performance test (CPT), (2) explore the task difficulty of VC, (3) address the effect of distractors on the performance of ADHD participants and typically-developing (TD) controls, and (4) compare the two measures on cognitive absorption. A total of 33 children diagnosed with ADHD and 42 TD children, aged between 7 and 13 years, participated in the study and were tested with a traditional CPT or with VC, along with several cognitive measures and an adapted version of the Cognitive Absorption Scale. A mixed multivariate analysis of covariance (MANCOVA) revealed that the children with ADHD performed worse on correct responses had more commissions and omissions errors than the TD children, as well as slower target reaction times . The results showed significant differences between performance in the virtual environment and the traditional computerized one, with longer reaction times in virtual reality. The data analysis highlighted the negative influence of auditory distractors on attention performance in the case of the children with ADHD, but not for the TD children. Finally, the two measures did not differ on the cognitive absorption perceived by the children.

  12. [Maternal mortality in the Hospital das Clinicas, Faculdade de Medicina de Ribeirao Preto (USP) from 1957 to 1977. Pt. 1: Incidence (Author's transl)].

    PubMed

    Parente, J V; Martinez, A R; Franco Jg; De Carvalho, R L; Carravazzo, N C; Meirelles, R S

    1979-08-01

    A study was carried out from 1957-1977 which investigated the incidence of maternal mortality in the Hospital das Clinicas, Faculdade de Medicina de Ribeirao Preto. The yearly distribution of these deaths related to the resolution of pregnancy always showed predominance of the abortion group over the others (pregnant patients, normal delivery, and surgical delivery), with increased evidence starting at the beginning of the 1970's. When the deaths were distributed by relating pregnancy resolution to marital status, absolute predominance of married over single patients was observed, including the abortion group. When the site of the 21st obstetrical aid was considered, it was observed that in 17 of 68 cases studied, the patients were directed to another hospital or delivered at home assisted by a midwife. The mortality rate for the entire period studied was 22.04%. When the cases receiving 1st obstetrical aid outside the Hospital das Clinicas are subtracted, the rate drops to 16.53% and to 8.1% when the abortion group is also excluded. On the basis of these data, it was concluded that abortion is the greatest medical-social problem detected in this study.

  13. [The scientific progress of the "Clinica del Lavoro Luigi Devoto" as seen through the contents of the journal "La Medicina del Lavoro". ].

    PubMed

    Foà, V; Camerino, Donatella

    2003-01-01

    On occasion of the Centenary of the "Clinica del Lavoro Luigi Devoto", its researchers suggested that awareness of its historical identity and scientific development should constitute the basis for the future of the Institution. The directors of the Institute who have succeeded one to the other over the years have left a vivid report of the vast amount of work developed in several research fields and also of the original results achieved with significant impact on the scientific community and on society. Content analysis of "La Medicina del Lavoro" allowed us to shed light on strong bonds existing between manufacturing techniques, work organization and health, in the different political and social periods in which they developed. Many actions have been defined and several research subjects have been renewed (according to current demands and new methodological possibilities) between the past and the present, nevertheless many new approaches need to be taken in the fields of epidemiology, indoor air quality, ergophthalmology, muskuloskeletal disorders, environmental and molecular toxicology, and further research will be undertaken thanks to the potential of this discipline for the future. The aim of this report is also to express our thanks to all the medical and non-medical staff who have made their contribution over 100 years of engagement.

  14. [The centenary of the founding of the "Clinica del Lavoro Luigi Devoto" in Milan (1902-2002). The oldest health organization in the world for the study, treatment, and prevention of occupational diseases].

    PubMed

    Grieco, A

    2003-01-01

    The foundation of the Clinica del Lavoro by Luigi Devoto cannot be dated back to the specific date of an event or, worse, to the official inauguration as has happened so far. It can rather be considered as a process started on November 20, 1902 (date of the first resolution by the Milan Municipality Council), continuing with the national law n. 365 of July 9, 1905, then with the laying of the first stone on December 11, 1907 bearing the motto of the Milanese School "In aliis vivimus, movemur et sumus" and finally the official inauguration on March 20, 1910. The Founder Luigi Devoto was born in 1864 at Borzonasca (Genoa) and took a degree of medicine and surgery at the Genoa University in 1888. After a period in Prague and then in Genoa, he was appointed temporary teacher of medical pathology in Pavia. He published several scientific contributions in different fields of occupational health (lead intoxication, ankylostomiasis, strain cardiopathy, etc.) and in other branches (tuberculosis, pellagra, etc.) that he considered as indirectly work-related diseases. He died in Milan in 1936. Three issues characterize the ingenious intuition of Luigi Devoto and his thirty-year direction of the Clinica del Lavoro: 1. Full respect for the principles of discipline and scientific method suggested by Bernardino Ramazzini; 2. The extremely broad conception of the diseases that had to be considered as "workers' diseases"; 3. The constant social attention towards the application of scientific knowledge also through workers' information and updating of regulations to improve working conditions. Many of the conflicts and events associated with the foundation of the Clinica del Lavoro can be summarized in the name chosen by the Founder. Actually to those asking why "Clinic of Work" and not "Clinic of Workers", Devoto used to reply that it was work that was ill and therefore it was necessary to treat the work to prevent workers' illnesses.

  15. Development of ClickClinica: a novel smartphone application to generate real-time global disease surveillance and clinical practice data

    PubMed Central

    2013-01-01

    -producing bodies, clinical governance and public health institutions and also for patient recruitment into ongoing studies. Conclusions Further parallel studies are needed to assess the clinical and epidemiological utility of novel disease surveillance applications, such as this, with direct comparisons made to data collected through routine surveillance routes. Nevertheless, current disease surveillance mechanisms do not always comprehensively and accurately reflect disease distribution for many conditions. Smartphone applications, such as ClickClinica, are a novel approach with the potential to generate real-time disease surveillance data that may augment current methods. PMID:23816161

  16. "La Clinica Day"

    DTIC Science & Technology

    2002-12-01

    modeled after what immigrants from Mexico encountered in their native country when seeking health care. The health fairs provided health screenings...Illinois University School of Nursing nurse-managed rural health clinic. The health fairs were modeled after what immigrants from Mexico encountered...community that is consistent with the health care system of rural Mexico from which local community members have immigrated. 2. Investigate the impact of La

  17. [The preparation and characterization of fine dusts carried out in the Clinica del Lavoro di Milano in support of experimental studies].

    PubMed

    Occella, E; Maddalon, G; Peruzzo, G F; Foà, V

    1999-01-01

    This paper aims to illustrate the conditions selected at the Clinica del Lavoro of the University of Milan to prepare and analyze a large number of fine dust samples produced over a period of about 50 years, that were initially used for studies within the Clinic performed in its own facilities, and since 1956 were sent to other Italian and overseas laboratories (Luxembourg, UK, Germany, Norway, Sweden, South Korea, USA). The total quantity of material distributed (with maximum size 7-10 microns) was about 2 kg and consisted of the following mineral and artificial compounds: quartz, HF-treated quartz, tridymite, HF-treated tridymite, cristobalite, chromite, anthracite, quartz sand for foundry moulds, sand from the Lybian desert, vitreous silica, pumice, cement, as well small quantities of metallic oxides, organic resins, chrysotile, crocidolite, fibres (vitreous, cotton and polyamidic). About half of the entire quantity of dusts produced consisted of partially HF-treated tridymite. Initially, research on the etiology of silicosis used quartz dust samples, simply sieved or ventilated (consisting of classes finer than 0.04 mm, containing a 15-20% respirable fraction). From 1956 to 1960 the dusts were produced by manual grinding in an agate mortar, below about 10 microns, starting from quartz from Quincinetto (near Ivrea, Province of Turin), containing about 99.5% quartz: particle size and composition were checked using an optical-petrographic technique, with identification of the free and total silica content. Subsequently, the dusts used for biological research were obtained by grinding coarse material with a cast iron pestle and planetary mills, agate and corundum jars. The grinding products were sized by means of centrifugal classification, using the selector developed by N. Zurlo, ensuring control of dust size both optically and by means of wet levigators and hydraulic classifiers (in cooperation with the Institute of Mines of Turin Polytechnic School). After 1990

  18. Clinica use of platelet additive solutions.

    PubMed

    van Rhenen, Dick J

    2007-12-01

    Randomised clinical trial (RCT) to study the clinical efficacy and safety of new platelet products using platelet additive solutions are scarce. In this paper a number of recent RCT's is discussed. It can be the start of a development where new transfusion products enter a RCT before the product is applied in clinical practice.

  19. [One autism, several autisms. Phenotypical variability in autism spectrum disorders].

    PubMed

    Hervas, A

    2016-01-01

    Introduccion. Los trastornos del espectro autista comprenden un grupo heterogeneo de trastornos que se inician en los primeros meses de la vida y que siguen una evolucion cronica. Su origen es biologico, con factores etiologicos complejos que implican diferentes mecanismos geneticos, epigeneticos y ambientales, que interactuan. Objetivo. Revisar los principales factores que varian la presentacion del autismo considerando la evidencia cientifica actual. Desarrollo. Aspectos relacionados con el desarrollo de sintomas, el sexo, la comorbilidad, la edad y la etiologia determinan la variabilidad en la presentacion clinica de los trastornos del espectro autista. Conclusiones. El autismo es altamente heterogeneo y se relaciona fenotipicamente, en parte, con una gran heterogeneidad etiologica, que comienza a descifrarse, pero que todavia permanece desconocida en gran parte. La investigacion etiologica, especialmente en el area de la genetica, permitira identificar diferentes subgrupos homogeneos con sus correspondientes fenotipos y abrir la posibilidad de alternativas terapeuticas futuras.

  20. The Crystallization Clinic-A TA Orientation Exercise

    NASA Astrophysics Data System (ADS)

    Kandel, Marjorie

    1999-01-01

    Our orientation exercise for TAs in the organic laboratories is a Crystallization Clinic, and the main feature is a contest. Each TA has a different unknown solid to recrystallize. The products are judged by the students in the organic lab courses. Beauty of the crystals is the single criterion. The contest serves to refresh the TAs' technique and to give them empathy with the beginning students.

  1. [Etiology, clinical presentation and outcome of severe viral acute childhood encephalitis (ECOVE study)].

    PubMed

    Flores-Gonzalez, José C; Jordan-Garcia, Iolanda; Turon-Vinas, Eulàlia; Montero-Valladares, Cristina; Tellez-Gonzalez, Cinta; Fernandez-Carrion, Francisco; Garcia-Iniguez, Juan P; Onate-Vergara, Eider; Rodriguez-Nunez, Antonio

    2015-07-01

    Introduccion. Las encefalitis viricas son procesos raros y potencialmente graves, con etiologia diversa y no siempre identificable. El objetivo es describir las caracteristicas etiologicas, la presentacion clinica y la evolucion neurologica de las encefalitis viricas que ingresaron en las unidades de cuidados intensivos pediatricos (UCIP) en España. Pacientes y metodos. Estudio prospectivo multicentrico observacional. Se incluyeron los niños ingresados en 14 UCIP con diagnostico de encefalitis virica durante un periodo de tres años (2010-2013). Para el diagnostico etiologico se utilizo reaccion en cadena de la polimerasa y serologia a virus neurotropos en la sangre y el liquido cefalorraquideo. Se registraron los antecedentes personales, la presentacion clinica, la evolucion y la situacion neurologica en el momento del alta. Resultados. Se incluyeron 80 pacientes con edad media de 5 años; el 70%, varones. Los sintomas clinicos mas relevantes fueron disminucion de conciencia (86%), fiebre (82,4%), convulsiones (67%), vomitos (42%), cefalea (27%), agitacion (25%) y desorientacion (23%). Se llego al diagnostico etiologico en un 35%, y los mas frecuentes fueron virus herpes simple y enterovirus. La evolucion fue curacion sin secuelas en 55 pacientes (69%, sobre todo enterovirus, rotavirus y virus respiratorios), secuelas leves-moderadas en 19 (23,5%) y graves en seis (7,5%). Dos pacientes fallecieron. Conclusiones. En las UCIP españolas solo se realizo el diagnostico etiologico en un tercio de los niños con sospecha de encefalitis virica grave. A pesar de la gravedad clinica, hemos observado una tasa de mortalidad y morbilidad baja. La amplia mayoria son dados de alta de la UCIP con ninguna o escasa secuela neurologica.

  2. [Magnetic resonance imaging with gadolinium in the acute phase of relapses in multiple sclerosis].

    PubMed

    Ortiz, P; Bareno, J; Cabrera, L; Rueda, K; Rovira, A

    2017-03-16

    Objetivo. Describir los factores que estan relacionados con el realce de gadolinio en la resonancia magnetica (RM) en pacientes con esclerosis multiple (EM) con sintomas de recaida. Pacientes y metodos. Estudio observacional de corte transversal, retrospectivo, de pacientes mayores de 18 años con diagnostico de EM remitente recurrente o progresiva, que presentaron actividad clinica y a quienes se les realizo resonancia cerebral y medular con contraste durante la fase aguda de los sintomas. Resultados. De los 93 pacientes incluidos, el 70% fueron mujeres, con una edad media de 37 ± 9,6 años. El 90% presentaba un diagnostico de EM remitente recurrente y el 50% tenia una duracion de la enfermedad de al menos cinco años. El 56% presento actividad clinica de origen medular, y las alteraciones sensitivas fueron las mas frecuentes (44%). La mediana de duracion de los sintomas fue de seis dias (rango: 1-89 dias). El 93% requirio tratamiento con metilprednisolona intravenosa durante 3-5 dias, que se administro despues de realizar los estudios de RM. La presencia de lesiones que realzaran con contraste durante la fase de recaida en los estudios de RM no mostro relacion significativa con ninguna de las variables clinicas analizadas y solo se observo una tendencia con los sintomas asociados (p = 0,07). Conclusiones. La definicion de recaida en la EM es clinica. Una RM en la fase de recaida podria ser util para confirmar la actividad de la enfermedad, pero el realce de gadolinio durante la recaida no se encontro que fuera determinado por la presentacion clinica, la localizacion anatomica o la duracion del sintoma.

  3. [Frontal variant of Alzheimer's disease. Two pathologically confirmed cases and a literature review].

    PubMed

    Herrero-San Martín, Alejandro; Villarejo-Galende, Alberto; Rábano-Gutiérrez, Alberto; Guerrero-Márquez, Carmen; Porta-Etessam, Jesús; Bermejo-Pareja, Félix

    2013-12-16

    Introduccion. La enfermedad de Alzheimer (EA) es la causa mas frecuente de demencia en nuestro medio. En la mayoria de los pacientes, las manifestaciones iniciales consisten en una afectacion selectiva y progresiva de la memoria. Sin embargo, no se trata de un proceso homogeneo y, en algunos casos, el modo de presentacion puede ser atipico. La presentacion de la EA en forma de alteracion precoz de la personalidad, el comportamiento y las funciones ejecutivas se ha denominado variante frontal de la EA. En nuestro caso, su diagnostico definitivo solo fue posible mediante el estudio histologico, pues los criterios clinicos vigentes resultaron entonces insuficientes para el diagnostico de esta forma atipica de la EA. Casos clinicos. Dos pacientes, una mujer y un hombre de 60 y 52 años respectivamente, presentaron un cuadro progresivo de deterioro cognitivo con afectacion inicial de las funciones ejecutivas y cambio de personalidad, junto con alteraciones del estado de animo, por lo que se realizo el diagnostico inicial de probable demencia frontotemporal. No obstante, en ambos casos, la autopsia revelo datos compatibles con el diagnostico de EA, con una distribucion de la patologia que afectaba fundamentalmente a los lobulos frontales. Conclusiones. La EA tiene una forma heterogenea de presentacion, lo que puede originar errores en su diagnostico inicial, dado que los criterios clinicos actuales no recogen de modo suficiente esta variabilidad clinica. Por ello, consideramos importante prestar atencion a las formas atipicas de la EA con el objeto de desarrollar nuevos metodos diagnosticos que permitan diferenciar la EA del resto de procesos degenerativos.

  4. [Neurofibromatosis type 2 in childhood: a clinical characterization].

    PubMed

    Hinojosa-Mateo, C M; Reche-Sainz, J A; Hernandez-Nunez, A; Ramos-Lopez, M; Arpa-Fernandez, A; Natera-de Benito, D

    2017-02-01

    Introduccion. La neurofibromatosis de tipo 2 (NF2) es un trastorno neuroectodermico con patron de herencia autosomico dominante que condiciona una predisposicion para desarrollar tumores de varios tipos en el sistema nervioso central y periferico. Se asocia tambien con alteraciones oculares y cutaneas. Caso clinico. Varon de 12 años con diagnostico de NF2 de acuerdo con los criterios de Baser et al e inicio en la infancia. Se realiza una revision bibliografica sobre la evolucion de los criterios diagnosticos en los niños. Conclusiones. El modo de presentacion de la NF2 en la infancia difiere de la presentacion en los adultos. Las manifestaciones iniciales de NF2 en los niños son las alteraciones oculares y cutaneas, no las auditivas. La clinica de inicio mas frecuente en la edad pediatrica es la triada de cataratas subcapsulares posteriores, lesiones intracutaneas en forma de placa o tumores nodulares subcutaneos, y sintomas neurologicos secundarios a la afectacion de pares craneales distintos al VIII par, tronco encefalico o medula espinal. Debido a que los criterios diagnosticos de NF2 son menos sensibles en los pacientes pediatricos, los niños con cataratas congenitas o de aparicion precoz y manifestaciones cutaneas tipicas de NF2 deben ser seguidos estrechamente.

  5. [Clinical features and diagnosis of Pelizaeus-Merzbacher disease: five case reports].

    PubMed

    Espinosa, E; Mera-Solarte, P R; Cote-Orozco, J E

    2016-05-01

    Introduccion. La enfermedad de Pelizaeus-Merzbacher es un trastorno hipomielinizante raro debido a alteraciones en el gen PLP1, que lleva a un fallo de la mielinizacion axonal de los oligodendrocitos en el sistema nervioso central. Existen dos formas descritas segun la gravedad de su presentacion: connatal y clasica. Se caracteriza por hipotonia neonatal, retraso del desarrollo psicomotor, espasticidad progresiva de predominio en los miembros inferiores y nistagmo, con signos y sintomas piramidales y extrapiramidales, y la forma connatal es mucho mas grave. La resonancia magnetica muestra leucoencefalopatia hipomielinizante difusa, los potenciales evocados usualmente se alteran y la confirmacion se realiza mediante estudio molecular del gen PLP1. Casos clinicos. Se presentan cinco pacientes pediatricos afectados, cuatro con la forma clasica y uno con la forma connatal; se describen las caracteristicas clinicas, los estudios complementarios y se realiza una revision concisa de la bibliografia. Conclusion. Esta enfermedad tiene una evolucion progresiva y casi invariable, lo cual es la clave clinica para diferenciarla de otras entidades como la paralisis cerebral infantil, neuropatias perifericas, esclerosis multiple, entre otras, ademas de los hallazgos caracteristicos en las neuroimagenes. Es necesario sospechar este diagnostico y confirmar alteraciones en el gen PLP1 con el fin de obtener una incidencia real de esta entidad, probablemente subestimada, como otras leucodistrofias.

  6. [Alarming signs and symptoms in the early diagnostics of late onset Pompe disease: super omnia clinica].

    PubMed

    Nikitin, S S; Kurbatov, S A; Bredelev, V A; Kovalchuk, M O

    2015-01-01

    Pompe disease (PD) is a rare autosomal recessive muscle lysosomal glycogenosis caused by a deficiency of acid-α-glucosidase. There are two main forms of the disease: aggressive infantile PD started within the first year of life with a severe enzyme deficiency and multiorgan involvement, and late onset PD (LOPD) with progressive signs and symptoms including predominant proximal, axial muscle weakness and respiratory insufficiency started at any time from 1 till 75 years and older. Usually due to physician's unawareness, most adults with PD are diagnosed with great delay. The typical features and early nonspecific signs in four patients, aged between 35 and 72 years, with confirmed LOPD are delineated and discussed in correspondence with the age of first signs, age development of muscle weakness, distribution and age of final diagnosis. The disorders for differential diagnosis and spectrum of conditions that expanded the possibility of PB are listed. The fluorometrically analyzed level of acid α-glucosidase from dried blood spots is considered to be the first choice diagnostic method for clinically suspected cases of LOPD.

  7. Hepatitis C Virus-related Mixed Cryoglobulinemia: Pathogenesis, Clinica Manifestations, and New Therapies.

    PubMed

    Schamberg, Neal J; Lake-Bakaar, Gerond V

    2007-09-01

    Within the past decade, it has been recognized that a majority of patients with essential mixed cryoglobulinemia (MC) are chronically infected with hepatitis C virus (HCV). Although the underlying mechanisms have not been fully elucidated, cryoglobulin formation is clearly linked to the attempt of the host to clear the significant quantities of virions generated daily by the chronic infection. This review summarizes the current understanding of the relationship between chronic HCV infection and the development of MC, and discusses the interaction between the immune system and HCV and how this interaction can lead to the development of lymphoproliferative disorders.

  8. [Food status peculiarities, anthropometric, clinica and biochemical indices at professional sportsmen].

    PubMed

    Gapparova, K M; Nikitiuk, D B; Zaĭnudinov, Z M; Tserekh, A A; Chekhonina, Iu G; Golubeva, A A; Sil'vestrova, G A; Rusakova, D S; Grigor'ian, O N

    2011-01-01

    Under steady state conditions in 66 athletes involved in weightlifting, bodybuilding, judo and taekwondo have studied features of the metabolic status. Data on matter-of-fact nutrition, body weight content within the inter-competition period, energy exchange, clinical and biochemical indices and physical acceptability indices were analyzed. As a result, the decrease indexes of metabolism at all the sportsmen and high-level caloric value at sportsmen who are engaged in weightlifting, which corresponds their energy expenditures, was revealed.

  9. Clinica Tibas: an experimental response to health system challenges in Costa Rica.

    PubMed

    Pezza, P E; Barquero Bolaños, J F

    1994-10-01

    Several experiments in health services delivery featuring contractual arrangements between government and the private sector have been initiated in Costa Rica. This report describes a public-private partnership serving a community of 50,000. A 'cooperative' of providers stands to gain financially if it succeeds in providing clinic services in an efficacious and efficient manner. This experimental approach retains elements of the existing public system for health promotion and disease prevention while introducing innovations for increased organizational efficiency and client satisfaction. The clinic provides easier access to better care, including ambulatory surgery, pharmacy service, and home visits, and at a lower cost to government than that budgeted under pre-existing arrangements. Inappropriate usage of area hospitals has been reduced; and a commitment to community participation and organized programming permit greater responsiveness to community needs. Those served by the clinic report satisfaction. Personnel also report satisfaction and enthusiasm for their work. Issues concerning extension of this model are considered.

  10. Parent Participation Reading Clinic--A Research-Demonstration Project. Final Report.

    ERIC Educational Resources Information Center

    Wise, James H.

    The general purpose of this study was to explore the possibility of developing a Parent Participation Reading Clinic home-based instructional model for assisting in the teaching of reading to economically disadvantaged elementary school children. Working within a community-based child health care agency in Washington, D.C., the Parent…

  11. [Tropical spastic paraparesis in a non tropical region].

    PubMed

    Pias-Peleteiro, L; Pias-Peleteiro, J M; Arias, M

    2015-10-16

    Introduccion. El virus linfotropo humano de celulas T tipo 1 (HTLV-1) es el agente causal de la paraparesia espastica tropical. Su prevalencia, elevada en determinadas areas tropicales, es baja en Europa y Norteamerica. Casos clinicos. Se describen dos casos de paraparesia espastica tropical en varones naturales y residentes en Galicia. Se realizaron estudios analiticos en la sangre y el liquido cefalorraquideo (LCR), examenes neurofisiologicos y resonancia magnetica craneal y medular. En ambos pacientes, la presentacion clinica fue la de una mielopatia cronica, con cuadro torpido y progresivo que evoluciono a paraparesia espastica. Un paciente desarrollo uveitis antes de la clinica neurologica. En los dos casos, el estudio del LCR demostro leve pleocitosis linfoide, ligera hiperproteinorraquia, bandas oligoclonales negativas y anticuerpos anti-HTLV-1 positivos. La reaccion en cadena de la polimerasa para HTLV-1 resulto positiva en ambos casos. La resonancia magnetica raquidea resulto normal en un paciente y mostro en el otro hiperseñal medular dorsal, que desaparecio tras el tratamiento. No se demostraron datos de polineuropatia periferica. Recibieron corticoides e interferon alfa, con leve mejoria y estabilizacion del cuadro clinico. La anamnesis dirigida revelo antecedentes de contactos sexuales de riesgo en regiones endemicas de HTLV-1. Conclusiones. La uveitis asociada a HTLV-1 podria ser predictora de paraparesia espastica tropical. Esta es probablemente una entidad infradiagnosticada (alto porcentaje de portadores asintomaticos, clinica insidiosa y bajo indice de sospecha en areas no endemicas). Debe considerarse su diagnostico en zonas no tropicales que reciben inmigrantes de areas endemicas y tambien en regiones con una tradicional emigracion a regiones tropicales.

  12. Presentaciones poco comunes y peligros de la sífilis secundaria: periosteitis, tenosinovitis y anomalías hepáticas.

    PubMed

    Rosa-Gonçalves, Diana; Bernardes, Miguel; Costa, Lúcia

    2017-06-02

    We herein describe two cases of secondary syphilis in patients with human immunodeficiency virus (HIV) infection with an unusual presentation, a diffuse polyostotic periosteitis. Patients referred mainly intense bone pain. Other relevant aspects of the clinical pictures were flexor tenosynovitis and hepatic abnormalities. Given the persistence of symptoms, the treatment duration performed was different from most described in literature. However, although more slowly than expected, both obtained a favorable clinical response after treatment with benzathine penicillin G. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  13. [Electrical status epilepticus during sleep: a retrospective multi-centre study of 29 cases].

    PubMed

    Lorenzo-Ruiz, María; Miguel-Martin, Beatriz; García-Pérez, Asunción; Martínez-Granero, Miguel A; Aguilera-Albesa, Sergio; Yoldi-Petri, M Eugenia; Sánchez-Ruiz de Gordoa, Javier; Castro-De Castro, Pedro; Sánchez-Carpintero, Rocío

    2015-02-01

    Introduccion. El estado epileptico electrico durante el sueño (ESES) es un sindrome epileptico caracterizado por la presencia de descargas epilepticas tipo punta-onda lenta de manera muy persistente durante el sueño no REM. En la actualidad, el manejo de esta patologia es heterogeneo y no hay estudios controlados con los tratamientos utilizados, ni se ha comprobado si estos mejoran la evolucion cognitiva de los pacientes. Pacientes y metodos. Se revisan los pacientes diagnosticados de ESES durante 15 años en cuatro centros hospitalarios, se recoge la presentacion clinica, el manejo terapeutico y la evolucion clinica, y se compara con la bibliografia. Resultados. Se seleccionaron 29 pacientes con ESES, 20 de ellos idiopatico y 26 de ellos generalizado. Los farmacos con los que se consiguio mayor control de la actividad electrica fueron los corticoides/hormona adrenocorticotropa (ACTH), el clobazam y el levetiracetam. La mediana de duracion del ESES en los casos primarios fue de seis meses, y en los secundarios, el doble. El 45% de los pacientes mantuvo un cociente intelectual normal y un 40% presento en la evolucion discapacidad cognitiva de diferente grado. Conclusiones. El pronostico neuropsicologico evolutivo suele ser desfavorable y la evolucion cognitiva parece estar en relacion con la duracion del ESES y el area donde este concentrada la actividad epileptica, lo que sugiere que el mal pronostico, si se trata precozmente, se puede evitar. Los antiepilepticos mas frecuentemente utilizados son el acido valproico, la etosuximida y el levetiracetam, y en nuestra muestra tambien se utilizaron con frecuencia el clobazam y la lamotrigina. Los farmacos mas eficaces para el control del ESES fueron los corticoides/ACTH, el clobazam y el levetiracetam.

  14. [Supratentorial cavernous malformations in an Argentinian institution: experience with surgical treatment].

    PubMed

    Vergara, G E; Cervio, A; Farez, M; Mormandi, R; Condomi-Alcorta, S; Salvat, J

    2017-04-01

    Introduccion. Las malformaciones cavernosas son lesiones vasculares del sistema nervioso central constituidas por endotelio sinusoidal que forma capilares agrupados o cavernas que carecen de los elementos tipicos de una pared arterial madura y ausencia de tejido neural interpuesto. El endotelio esta rodeado por una densa capa de fibras colagenas que dejan pequeñas hendiduras por las que se extravasa hemosiderina. Se comunican con el sistema vascular a muy baja presion y su tratamiento puede ser por microcirugia o radiocirugia. Objetivos. Analizar las malformaciones cavernosas supratentoriales tratadas quirurgicamente en nuestra institucion (FLENI), determinar la epidemiologia y las caracteristicas intrinsecas, estudiar la clinica de presentacion, determinar las indicaciones quirurgicas y complicaciones, y establecer el pronostico. Pacientes y metodos. Estudio retrospectivo analitico de historias clinicas e imagenes de pacientes operados de malformaciones cavernosas supratentoriales en la FLENI desde enero de 1996 hasta diciembre de 2013. Resultados. Evaluamos a 51 pacientes, de 34 años de media, seguidos durante una media de 30 meses. El 1,96% de los pacientes presento diagnostico incidental y el resto mostro sintomas. El 23,52% presento hemorragia en el momento del diagnostico. En todas las cirugias se logro una exeresis total de las malformaciones cavernosas supratentoriales. Se observo un caso de meningitis postoperatoria. Conclusiones. La tasa de sangrado de las malformaciones cavernosas supratentoriales en nuestro medio es del 1,38% por paciente por año. El tratamiento quirurgico es eficaz para erradicar o disminuir los sintomas y para evitar un posible resangrado. Presenta una tasa muy baja de complicaciones y un pronostico neurologico favorable.

  15. [Sex differences in the integrated stroke management in a rural healthcare area in Asturias].

    PubMed

    Lopez-Martinez, T; Bernardo-Cofino, J; Garcia-Prieto, E; Feito-Alvarez, M; de Dios-Del Valle, R; Calleja-Puerta, S

    2016-08-16

    Introduccion. Las diferencias de sexo y el caracter (rural o urbano) de las poblaciones determinan en gran medida el abordaje integral de patologias dependientes del tiempo, como el ictus, principal causa de hospitalizacion y mortalidad femenina en nuestro medio. Objetivo. Determinar si en un area sanitaria rural del Principado de Asturias se ponen de manifiesto las caracteristicas diferenciales entre mujeres y hombres con ictus. Pacientes y metodos. Estudio descriptivo retrospectivo realizado en el Hospital de Jarrio. Se revisaron variables a traves de las historias clinicas informatizadas de los pacientes que sufrieron ictus en 2013. Resultados. Se produjeron 126 altas totales, el 53,2% en las mujeres, que sufrieron la enfermedad con un retraso de cinco años (p < 0,008) en relacion con los varones, los cuales fueron mas fumadores y consumidores perjudiciales de alcohol (p < 0,000). La demora prehospitalaria no arrojo diferencias de sexo significativas. El trastorno del lenguaje fue el sintoma principal en el grupo femenino (p < 0,008), que registro una puntuacion superior en la National Institute of Health Stroke Scale (p < 0,046). Los estudios complementarios, como el Holter (p < 0,04) y la ecografia de troncos supraaorticos (p < 0,02), se realizaron menos en las mujeres, que recibieron un tratamiento principalmente conservador con mayor hidratacion parenteral (p < 0,017) y reposo. El grupo femenino sufrio mas complicaciones, discapacidad al alta (p < 0,001) y a los tres meses (p < 0,004), y registro porcentajes mas elevados de institucionalizacion posterior (p < 0,005). Conclusiones. Existen diferencias de sexo demograficas, en el perfil de riesgo cerebrovascular, la presentacion clinica, el manejo hospitalario y la comorbilidad del ictus en esta poblacion rural, que sugieren areas de mejora.

  16. Las experiencias clinicas de los estudiantes de enfermeria: Estudio de caso hacia la integracion de la mentoria

    NASA Astrophysics Data System (ADS)

    Rivera Rodriguez, Ivelisse

    Clinical experiences are an essential part of the training of future nursing professionals. The period of clinical experience aims to develop in the student the necessary skills to practice as a nursing professional, when the academic program ends. This case study aimed to understand the opinion and explore the perception of faculty, clinical instructors, and nursing students on the meaning, contributions and challenges presented during clinical experiences. Among the themes explored in the focus groups were the meaning and importance to learning about the profession of clinical experiences, teaching strategies used during the practice scenarios, didactic relationships developed among students, clinical instructors, and teachers. The goal was to learn from all participants about what they do, their expectations, and the challenges presented during the clinical experiences. A qualitative, descriptive and contextual research design was followed, which required conducting six focus groups to collect the information from the perspective of all the participants. Faculty, clinical instructors, and nursing students participated each in two focus groups. Collected data were transcribed, coded and analyzed in order to organize it under themes related to the research framework. The qualitative analysis of the focus groups revealed that nursing faculty and clinical instructors perceived clinical experiences as a very important element in the training of nursing students, but that coordination between the academy and practice scenarios is disconnected and needs improvement. They also expressed that they use various learning strategies during the clinical experiences, however, they recognize it needs more structure and suggested mentoring as a strategy to consider. They affirmed that mentoring could contribute positively to enhance the teaching-learning process. Clinical instructors understand they perform mentoring roles, but they would like to have a more defined role and structured process. Nursing students, also, recognized the importance of clinical experiences in their professional training. They expressed the need to improve the communication between the academy and the practice scenarios in order to reduce the levels of anxiety they experience when entering the clinical experiences. Nursing students also expressed the need to consider the use of different teaching strategies, such as mentoring, to improve clinical experiences.

  17. Effectiveness of the Healthy Skin Clinic--a randomized clinical trial of nurse-led patient counselling in hand eczema.

    PubMed

    Mollerup, Annette; Veien, Niels K; Johansen, Jeanne D

    2014-10-01

    Hand eczema is a common disease, and continuous preventive skin protection and skin care must be adopted to prevent a chronic course. Hand eczema is not a uniform disease, and counselling must therefore be individually tailored. To evaluate the effectiveness of a nurse-led counselling programme, the Healthy Skin Clinic, emphasizing the patient's self-management, resources, and risks. Patients (n = 306) referred for diagnostic work-up and treatment of hand eczema were randomized and allocated either to the programme or to usual care. The primary outcome was clinical disease severity at follow-up. Secondary outcomes were quality of life, burden of disease, skin protective behaviours, and self-reported medication adherence. Patients in the intervention group had greater reductions in clinical severity and reported more beneficial behavioural changes at follow-up than those in the usual-care group. This was especially true of patients who were treated solely with topical corticosteroids and who had a primarily exogenous aetiology of hand eczema. However, the effect was very dependent on baseline disease severity. No differences in quality of life or burden of disease were found between the two groups. A tailored nurse-led programme of skin protection counselling may be recommended as an essential part of hand eczema treatment. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. [Instituto de Investigaciones Clinicas "Dr. Américo Negrette": 55 years of excellent research versus global economic recession].

    PubMed

    Valero Cedeño, Nereida Josefina

    2014-12-01

    The Instituto de Investigaciones Clínicas "Dr. Américo Negrette" belongs to the Faculty of Medicine at University of Zulia in Maracaibo, Zulia State, Venezuela. It was created on December 4, 1959 by Dr. Américo Negrette. Today, with 55 years of existence, the Institute seeks to fulfill the mission that characterizes it, based on the values instilled by its founder and maintained by subsequent generations, whose research projects are implemented through seven research sections: Biochemistry, Hematologic Research, Neuropharmacology and Neuroscience, Immunology and Cell Biology, Clinical Neurochemistry, Parasitology and Virology. The research originated in these laboratories have become national and international points of reference, despite the current economic situation with budget deficits that put at risk the quality and originality of their projects with negative consequences on the productivity and applications for health population, reasons of biomedical research.

  19. [The ECCIS study: the epidemiology and clinical picture of silent ischemic cardiopathy. Epidemiologia e Clinica della Cardiopatia Ischemica Silente].

    PubMed

    Fazzini, P F; Prati, P L; Rovelli, F; Antoniucci, D; Menghini, F; Seccareccia, F; Menotti, A

    1994-12-01

    The ECCIS project (Epidemiology and Clinic of Silent Ischemic Heart Disease) is an italian epidemiological study based on a population sample of 4,842 totally asymptomatic men aged 40-59 whose primary aim is the evaluation of the prevalence of totally silent myocardial ischemia and silent myocardial infarction. The systemic search for markers of silent ischemia and infarction was pursued along 3 screening stages: the 1st stage included resting electrocardiogram, hyperventilation test, exercise electrocardiogram and 24-hour Holter electrocardiogram; the 2nd stage included echocardiogram, thallium-201 scintigraphy in conjunction with exercise test or dypiridamole test, exercise radionuclide ventriculography and ergometrine test; the 3rd stage included coronary angiography. After the completion of the 1st stage procedures 439 men (9.1%) with abnormal results and low probability of disease were invited to the 2nd stage and 387 accepted to undergo the diagnostic procedures. After the completion of the 2nd stage, 104 men with moderate or high suspicion of silent myocardial ischemia or infarction were invited to perform coronary angiography but only 62 men accepted to undergo the 3rd stage procedures (participation rate 59.6%). The final diagnosis of totally silent myocardial ischemia or infarction on the basis of predefined criteria was established in 25 patients. The prevalence of silent ischemic heart disease on the overall original 4,842 men was 0.52% (95% CL, 0.32 and 0.72%), while the final estimate after adjusting for participation rates at 2nd and 3rd stages was 0.89% (95% CL, 0.6 and 1.1%). The results of the ECCIS study show that the prevalence of silent myocardial ischemia is definitely lower than that revealed by prior epidemiological studies in Norway and in USA.

  20. [An unusual presentation of painful tic convulsive].

    PubMed

    Romano-Feinholz, S; Medina, M P; Nares-Lopez, F E; Soto-Hernandez, J L; Revuelta-Gutierrez, R

    2017-03-16

    Introduccion. La presentacion clinica de un espasmo hemifacial asociado a neuralgia trigeminal ipsilateral se conoce como tic convulsivo doloroso. La causa mas comun de esta patologia es la compresion vascular de los nervios craneales V y complejo VII-VIII en la zona de entrada y salida de las raices en el tronco del encefalo, pero existen informes de diversas etiologias. Su tratamiento, aunque aun esta en discusion, se basa en la descompresion microvascular quirurgica. Caso clinico. Mujer de 63 años, con un cuadro de evolucion de 14 años de neuralgia trigeminal, con predominio en distribucion de la rama maxilar (V2) izquierda, asociado durante mas de 10 años a espasmo hemifacial ipsilateral. Tras fallar el tratamiento medico, se sometio a cirugia por abordaje microasterional, y en un primer momento se realizo una diseccion de adherencias aracnoideas firmes rodeando complejos nerviosos. En un segundo tiempo quirurgico se insertaron fragmentos de teflon en los sitios de entrada de los nervios V y complejo VII-VIII, y se logro una resolucion completa de la sintomatologia durante mas de un año. Conclusion. La etiologia del tic convulsivo doloroso en esta paciente fue aracnoiditis basal, lo cual la convierte en el unico caso comunicado hasta el momento con dicha etiologia.

  1. [Acute optic neuropathy: differential diagnoses].

    PubMed

    Buompadre, María Celeste

    2013-09-06

    Introduccion. La alteracion funcional del nervio optico se caracteriza por un deficit en la agudeza visual, en la vision cromatica y en el campo visual, defecto pupilar aferente y, en algunos casos, edema del nervio o atrofia y palidez. Objetivo. Describir el espectro de neuropatias opticas agudas, su clinica, diagnostico y tratamiento, con mayor interes en aquellas de presentacion en la edad pediatrica. Desarrollo. La neuritis optica puede ser monofasica, recurrente o el componente de un cuadro desmielinizante polisintomatico. El objetivo del tratamiento es reducir el numero y la gravedad de los ataques y prevenir discapacidad. La infecciosa es secundaria a diferentes microorganismos (bacterias, virus, hongos y protozoos). El tratamiento depende de la etiologia. La isquemica anterior no arteritica o idiopatica es la forma mas frecuente y es secundaria a enfermedad de pequeños vasos (ciliares posteriores). La neuropatia optica hereditaria o de Leber representa una causa importante de afectacion visual cronica y se caracteriza por la afectacion selectiva de las celulas ganglionares de la retina. Hasta el momento, la terapia solo es de apoyo. En el papiledema asociado a hipertension endocraneal, la agudeza visual generalmente se conserva pero existe aumento de la mancha ciega. El tratamiento se basa en disminuir la hipertension y el factor etiologico si existe. Conclusiones. Las neuropatias opticas agudas constituyen un amplio grupo de entidades, de etiologia diversa y con un pronostico visual variable. La presencia de signos del examen neurologico, fondo de ojo y neuroimagenes pueden orientar hacia el diagnostico y tratamiento oportuno.

  2. [Emotional dysregulation and autism spectrum disorders].

    PubMed

    Hervas, A

    2017-02-24

    Introduccion. Los trastornos del espectro autista (TEA) son trastornos del neurodesarrollo que afectan la comunicacion social y presentan conductas estereotipadas. Muestran una gran variabilidad fenotipica relacionada con la capacidad expresiva del lenguaje, habilidades cognitivas y comorbilidades psiquiatricas, entre otras. La comorbilidad psiquiatrica resulta muy frecuente en TEA y en muchos casos es multiple. La desregulacion emocional se relaciona con TEA y con otros trastornos psiquiatricos y del neurodesarrollo. La comorbilidad multiple asociada a TEA es el grupo que presenta gran incapacidad funcional, multiple farmacologia e ingresos hospitalarios. La desregulacion emocional podria ser la base de la comorbilidad multiple existente en TEA y requerira consideraciones propias en la valoracion diagnostica y tratamiento. Objetivo. Revisar la desregulacion emocional, el concepto actual y su relacion con TEA. Desarrollo. Se exponen las diferentes definiciones de desregulacion emocional, los mecanismos cognitivos y neurobiologicos asociados, la presentacion clinica cuando se asocia a TEA, su papel en la comorbilidad psiquiatrica y consideraciones en las intervenciones psicologicas y farmacologicas. Conclusiones. La desregulacion emocional podria asociarse a la comorbilidad multiple presente en personas con TEA, relacionandose con alta morbilidad, ingresos hospitalarios y uso de psicofarmacos. La falta de identificacion y diagnostico de la desregulacion emocional podria relacionarse con poca efectividad y un elevado numero de efectos secundarios cuando se trata la comorbilidad asociada a TEA.

  3. Our Roots Feed Our Future: 30th Anniversary Conference of the Cornell Migrant Program. Presentations (May 22, 2002) = Nuestras raices nutren nuestro futuro: Conferencia del 30mo aniversario del Programa para Emigrantes de Cornell. Presentaciones (22 mayo 2002).

    ERIC Educational Resources Information Center

    State Univ. of New York, Ithaca. Coll. of Human Ecology at Cornell Univ.

    Presented in English and Spanish, this publication compiles 13 presentations at a conference celebrating the 30th anniversary of the Cornell Migrant Program. The entries examine experiences of migrant workers and children related to immigrating, finding work, enduring discrimination and police harassment, switching schools frequently, suffering…

  4. Ingestion Reiterada de Cuerpos Extranos. Forma Inusual de Presentacion del Sindrome de Munchausen por Poderes (Reiterated Ingestion of Foreign Bodies. Unusual Form of Presentation of Munchausen Syndrome by Proxy).

    ERIC Educational Resources Information Center

    Terreros, I. Gomez de; And Others

    1996-01-01

    An unusual case of Munchausen syndrome by proxy is reported. A mother with a psychiatric record of behavior disorders and family dysfunction perpetrated the ingestion of foreign bodies (for example, earrings, a screw, sewing needles) on a 10-month-old infant with a history of prematurity, repeated visits to emergency rooms, and nonjustified…

  5. Ingestion Reiterada de Cuerpos Extranos. Forma Inusual de Presentacion del Sindrome de Munchausen por Poderes (Reiterated Ingestion of Foreign Bodies. Unusual Form of Presentation of Munchausen Syndrome by Proxy).

    ERIC Educational Resources Information Center

    Terreros, I. Gomez de; And Others

    1996-01-01

    An unusual case of Munchausen syndrome by proxy is reported. A mother with a psychiatric record of behavior disorders and family dysfunction perpetrated the ingestion of foreign bodies (for example, earrings, a screw, sewing needles) on a 10-month-old infant with a history of prematurity, repeated visits to emergency rooms, and nonjustified…

  6. Presentaciones escolares. Serie de programas para conmemorar acontecimientos de valor cultural para el mexico americano (School Assembly Presentations. Series of Programs to Commemorate Events of Cultural Value to the Mexican American).

    ERIC Educational Resources Information Center

    Villarreal, Abelardo; And Others

    This material consists of a series of cultural presentations designed for elementary school assemblies or special programs. The activities are intended to strengthen Mexican-American children's awareness of their cultural heritage. Program scripts, poems, songs, historical narratives and skits are included to illustrate and celebrate Mexican and…

  7. Alienacion de la Madre, Psicopatoligia y la Practica Clinica en Mexico. (Alienation of the Mother, Psychopathology, and the Practice Clinic in Mexico).

    ERIC Educational Resources Information Center

    Diaz-Guerrero, Rogelio; And Others

    1979-01-01

    The study related the role of the maternal figure to the affective behavior of the Mexican. Two hundred adolescents judged the concept of "Insult to the Mother" in relation to other similarly charged affective concepts, e.g., "death", "suicide", "drunkenness", etc. Results showed that "Insult to the…

  8. Evolution of sensitivity to fosfomycin in bacteria isolated in 1973, 1974 and 1975 in the Servicio de Microbiologia y Epidemiologia of the 'Clinica Puerta de Hierro', Madrid.

    PubMed

    Dámaso, D; Moreno-López, M; Martínez-Beltrán, J

    1977-01-01

    The bacteriostatic activity of fosfomycin was studied in vitro against 1,243 clinical isolations of gram-positive cocci and 4,086 isolations of gram-negative bacilli that were obtained in 1973, 1974 and in the period from January to May of 1975. MIC was determined by the agar diffusion method, quantifying it by means of the standard curve that was worked out with the strain of E. coli NCTC 10,418. A slight increase in resistance was observed in the gram-positive cocci: 64 mug/ml were inhibitory for 63% of the 249 isolations obtained in 1973, 59.1% of the 716 isolations obtained in 1974, and 57.5% of the 278 isolations from 1975. A slight loss of sensitivity was also observed in the gram-negative bacilli: the aforementioned concentration of fosfomycin inhibited 36% of the 742 isolations from 1973, 33.6% of the 2,387 isolations from 1974 and 32.6% of the 957 isolations from 1975. 933 g of this antibiotic were consumed in our hospital in 1973, 4,203 g in 1974 and 957 g in 1975. The consumption rate per patient per year was 0.15, 0.72 and 0.20 g, respectively. In conclusion, although no change was observed in the sensitivity of some bacterial strains to fosfomycin, the overall study indicates a slight decrease in the sensitivity, although it does not apparently have any relationship to the consumption of fosfomycin in our hospital.

  9. Use of a registry-generated audit, feedback, and patient reminder intervention in an internal medicine resident clinic--a randomized trial.

    PubMed

    Thomas, Kris G; Thomas, Matthew R; Stroebel, Robert J; McDonald, Furman S; Hanson, Gregory J; Naessens, James M; Huschka, Todd R; Kolars, Joseph C

    2007-12-01

    Disease registries, audit and feedback, and clinical reminders have been reported to improve care processes. To assess the effects of a registry-generated audit, feedback, and patient reminder intervention on diabetes care. Randomized controlled trial conducted in a resident continuity clinic during the 2003-2004 academic year. Seventy-eight categorical Internal Medicine residents caring for 483 diabetic patients participated. Residents randomized to the intervention (n = 39) received instruction on diabetes registry use; quarterly performance audit, feedback, and written reports identifying patients needing care; and had letters sent quarterly to patients needing hemoglobin A1c or cholesterol testing. Residents randomized to the control group (n = 39) received usual clinic education. Hemoglobin A1c and lipid monitoring, and the achievement of intermediate clinical outcomes (hemoglobin A1c <7.0%, LDL cholesterol <100 mg/dL, and blood pressure <130/85 mmHg) were assessed. Patients cared for by residents in the intervention group had higher adherence to guideline recommendations for hemoglobin A1c testing (61.5% vs 48.1%, p = .01) and LDL testing (75.8% vs 64.1%, p = .02). Intermediate clinical outcomes were not different between groups. Use of a registry-generated audit, feedback, and patient reminder intervention in a resident continuity clinic modestly improved diabetes care processes, but did not influence intermediate clinical outcomes.

  10. [Costs and quality of the timely detection of cervix uteri cancer at a public clinica and at a non-government organization].

    PubMed

    Gómez-Jauregui, J

    2001-01-01

    To compare the costs and quality of cervical cancer screening between a non-governmental organization (NGO) and a Ministry of Health clinic. A quantitative and qualitative cross-sectional study was conducted between April and July 1999, in two healthcare clinics in Cuernavaca, Morelos, Mexico. Cervical cancer screening production processes were compared along four components: a) Pap smear collection; b) its transportation to the cytology center; c) analysis and interpretation; and d) notification of results. The framework developed by Bruce was used for assessing the quality of care. The framework includes users' perceptions on information received and waiting times, as well as providers' perceptions of space and equipment availability. The unitary cost of the production process in the public clinic ($144 pesos or US$15.5) was 26% higher than in the NGO ($114 pesos or US$12.3). Women attending NGO services reported a higher satisfaction with the quality of care than those who attended the public clinic. The waiting time prior to screening and the time each woman has to wait to receive test results were the main sources of insatisfaction. Analysis of costs and quality of care results suggest that NGOs should be considered as an alternative in the provision of cervical cancer screening. The English version of this paper is available at: http://www.insp.mx/salud/index.html

  11. THE FIRST GRADE CLINIC--A MEDIUM FOR EARLY IDENTIFICATION OF PHYSICAL, SOCIAL, EMOTIONAL, AND MENTAL DEVELOPMENT FACTOR THAT MAY TEND TO BLOCK OR IMPEDE SCHOOL PROGRESS.

    ERIC Educational Resources Information Center

    MCGAHAN, F.E.

    DURING A 5-YEAR PERIOD, A FIRST GRADE CLINIC IDENTIFIED, AT THE START OF EACH SCHOOL YEAR, CHILDREN WITH DEVIATIONS IN BEHAVIOR, SOCIAL AND EMOTIONAL ADJUSTMENT, AND MENTAL MATURATION THAT MIGHT BLOCK OR RETARD SUCCESS IN SCHOOL. THESE CHILDREN WERE REFERRED FOR FURTHER DIAGNOSTIC EVALUATIONS. THE PROGRAM WAS FIRST TRIED IN ONE CLASSROOM. A 3-YEAR…

  12. Gallbladder carcinoma in the "Hospital de Clinicas" of Uruguay: 1998-2002. A clinicopathologic study of five cases in 802 cholecystectomies.

    PubMed

    Barcia, Juan José; Rodríguez, Ana; Siri, Leonardo; Masllorens, Ana; Szwebel, Patricia; Acosta, Gisĕle

    2004-02-01

    Five cases of primary carcinoma of the gallbladder are presented. The cases were identified after a study of 802 cholecystectomies in a period of 5 years. The patients are three women and two men between the ages of 43 and 60 years (mean, 55.8 years). In three cases the clinical diagnosis was that of carcinoma, while in two other patients the clinical diagnosis was that of acute cholecystitis. Grossly, all cases were characterized by a gray-white diffuse or focal plaque-like thickening of the gallbladder wall, with loss of the normal velvety mucosal surface and fibrosis of the organ. Histologically, four cases belong to moderately to poorly differentiated adenocarcinoma and were characterized by infiltrative, irregularly shaped and sized glands, islands, nests, and cords. The cells showed pleomorphic nuclei with clumped chromatin and frequent single nucleoli. One case was a mucinous adenocarcinoma characterized by large pools of mucoid material with neoplastic glands and cells "floating" within. Pathologic staging was pT3 in three cases; pT2 in one case; and pT2N1 in one other case. The present study highlights the importance of careful gross and histopathologic evaluation of gallbladders otherwise removed with the history of chronic or acute cholecystitis. In addition, it highlights the incidence of gallbladder carcinoma in a particular institution.

  13. THE FIRST GRADE CLINIC--A MEDIUM FOR EARLY IDENTIFICATION OF PHYSICAL, SOCIAL, EMOTIONAL, AND MENTAL DEVELOPMENT FACTOR THAT MAY TEND TO BLOCK OR IMPEDE SCHOOL PROGRESS.

    ERIC Educational Resources Information Center

    MCGAHAN, F.E.

    DURING A 5-YEAR PERIOD, A FIRST GRADE CLINIC IDENTIFIED, AT THE START OF EACH SCHOOL YEAR, CHILDREN WITH DEVIATIONS IN BEHAVIOR, SOCIAL AND EMOTIONAL ADJUSTMENT, AND MENTAL MATURATION THAT MIGHT BLOCK OR RETARD SUCCESS IN SCHOOL. THESE CHILDREN WERE REFERRED FOR FURTHER DIAGNOSTIC EVALUATIONS. THE PROGRAM WAS FIRST TRIED IN ONE CLASSROOM. A 3-YEAR…

  14. Alienacion de la Madre, Psicopatoligia y la Practica Clinica en Mexico. (Alienation of the Mother, Psychopathology, and the Practice Clinic in Mexico).

    ERIC Educational Resources Information Center

    Diaz-Guerrero, Rogelio; And Others

    1979-01-01

    The study related the role of the maternal figure to the affective behavior of the Mexican. Two hundred adolescents judged the concept of "Insult to the Mother" in relation to other similarly charged affective concepts, e.g., "death", "suicide", "drunkenness", etc. Results showed that "Insult to the…

  15. Normal behaviour of circulatory parameters during exercise. Reference values for heart rate and systemic blood pressure. The ECCIS Project data. Epidemiologia e Clinica della Cardiopatia Ischemica Silente.

    PubMed

    Menghini, F; Dally, L; Fazzini, P F; Menotti, A; Prati, P L; Rovelli, F; Antoniucci, D; Seccareccia, F

    1995-08-01

    The study of simultaneous variations in heart rate (HR) and systemic blood pressure is of great interest in ergometric practice complementing the analysis of the ST segment by ECG. This paper examines data proceeding from 500 consecutive, normal, exercise stress tests with the aim of offering reference values on the step-by-step behaviour of HR, systolic and diastolic blood pressure (SBP, DBP) during exercise in a normal population. The sample comes from a large epidemiological study (ECCIS Project) conducted on 4842 healthy, working men, aged 40-59, which proposes to identify, by a 3 stage procedure, subjects with totally asymptomatic coronary artery disease (type I silent ischemia). A further aim of our paper is to examine the influence of some physiological variables (age, height, weight, body mass index, resting HR, SBP and DBP) on the response to effort of HR, SBP and DBP; reciprocal HR/SBP adjustment during exercise; maximal attained workload and recovery time. Due to a preliminary observation that the rate of step-by-step increase in HR and SBP is inversely related to total duration, the population was split into 4 groups according to exercise tolerance (defined by maximal attained workload) to elaborate reference values. Furthermore our data demonstrate that: 1) SBP increases more rapidly with respect to HR for older and heavier subjects; 2) Exercise tolerance is inversely related to age, baseline HR and SBP, and directly related to weight and height; 3) return to baseline conditions, during recovery, is quicker for subjects with better exercise tolerance and lower baseline HR, SBP and weight.

  16. [MCT8-specific thyroid hormone cell transporter deficiency: a case report and review of the literature].

    PubMed

    López-Marín, Laura; Martín-Belinchón, Mónica; Gutiérrez-Solana, Luis G; Morte-Molina, Beatriz; Duat-Rodríguez, Anna; Bernal, Juan

    2013-06-16

    Introduccion. El MCT8 es un transportador especifico para las hormonas tiroideas T4 y T3, que permite su entrada en el cerebro y otros organos. La deficiencia de MCT8, o sindrome de Allan-Herndon-Dudley, es un trastorno ligado a X que, generalmente, se presenta como un cuadro neurologico grave de inicio precoz, con un perfil tiroideo caracteristico (aumento de T3 y disminucion de T4 y rT3). Objetivo. Se presenta el primer caso diagnosticado en España con este sindrome y se revisa la bibliografia publicada, las distintas formas de presentacion clinica, los avances geneticos, el diagnostico diferencial y las perspectivas terapeuticas, y se propone un algoritmo diagnostico. Caso clinico. Varon de 5 años con un cuadro clinico compatible con una enfermedad de Pelizaeus-Merzbacher. La secuenciacion del gen PLP1 no mostro alteraciones. Todos los estudios metabolicos y geneticos realizados fueron normales. Finalmente, un estudio completo del perfil tiroideo revelo alteraciones compatibles con una deficiencia del transportador MCT8. La secuenciacion del gen SLC16A2 (MCT8) mostro una mutacion en el exon 3 y el estudio celular confirmo que esta mutacion cambia las propiedades de la proteina. Conclusiones. En los ultimos años se han multiplicado las publicaciones sobre este sindrome, con la identificacion de mas de 50 familias en el mundo. Es importante conocer este sindrome y sospecharlo, porque el diagnostico es facil, economico y accesible (perfil tiroideo), y, aunque no tiene tratamiento especifico, el diagnostico precoz evita pruebas innecesarias y permite ofrecer consejo genetico a las familias afectadas.

  17. WITHDRAWN: Corrigendum to "High-sensitive cardiac troponin I (hs-cTnl) values in patients with stable cardiovascular disease: An initial foray" [Clinica Chimica Acta 411 (2010) 812--817].

    PubMed

    Schulz, Olaf; Reinicke, Markus; Berghoefer, Gunnar H; Bensch, Ricarda; Kraemer, Jochen; Schimke, Ingolf; Jaffe, Allan S

    2010-05-18

    This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

  18. State of the art of aldosterone immunoassays. A multicenter collaborative study on the behalf of the Cardiovascular Biomarkers Study Group of the Italian Section of European Society of Ligand Assay (ELAS) and Società Italiana di Biochimica Clinica (SIBIOC).

    PubMed

    Fortunato, Antonio; Prontera, Concetta; Masotti, Silvia; Franzini, Maria; Marchetti, Cristina; Giovannini, Stefania; Zucchelli, Gian Carlo; Emdin, Michele; Passino, Claudio; Clerico, Aldo

    2015-04-15

    Two new immunoassay methods for aldosterone assay using automated platforms recently became available into market. The main aim of the present study is to evaluate the analytical performance of these automated direct immunoassay methods, and also to compare their analytical characteristics to those of the most popular RIA and EIA methods used in an Italian External Quality Assessment (EQA) study. In this study analytical performances of two aldosterone immunoassays using the IDS iSYS and DiaSorin LIAISON fully automated platforms, were evaluated. Results obtained with the two platforms in EDTA plasma samples of healthy subjects and patients were compared with those obtained by RIA and EIA methods used in the Italian EQA scheme, named Immunocheck study. The two automated methods showed similar analytical performances: LoD 83.9 vs 92.2 pmol/L, LoQ 104.4 vs 111.1 pmol/L, respectively; moreover, the within-run and total imprecision values showed CV% between 8.1 and 14.1 for samples with 180.8 and 387.2 pmol/L concentration for both methods. There was a close linear regression between methods, however we found a significant proportional bias between LIAISON and iSYS methods. The EQA samples results obtained with these two methods were highly correlated to the consensus mean values. Our data indicate that aldosterone values measured with the two automated methods actually show better reproducibility, shorter laboratory Turn Around Time (TAT) and require less "hands on labor" compared to RIA and EIA immunoassays. However, in our study significant bias was observed in result comparison, this means that translating aldosterone concentration in clinical information an appropriate definition of reference ranges for each method is mandatory. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. Cooperation-Induced Topological Complexity: A Promising Road to Fault Tolerance and Hebbian Learning

    DTIC Science & Technology

    2012-03-16

    Information Science Directorate, United States Army Research Office, Durham, NC, USA 4 Istituto di Fisiologia Clinica del Consiglio Nazionale delle...Vadim Uritsky, Catholic University of America at NASA Goddard Space Flight Center, USA *Correspondence: Paolo Allegrini , Istituto di Fisiologia Clinica

  20. Dual Utilization of Medical Services by Low Income Latino Families: An Exploratory Investigation.

    ERIC Educational Resources Information Center

    Coe, Merilyn

    1985-01-01

    Interviews with 50 low income family members who used two health care providers--Kaiser Health Maintenance Organization and La Clinica de La Raza--were used to study how cost, need, access, services, and culture affected choice of provider. Cultural affinity seemed to influence decisions to use and pay for La Clinica's services. (JHZ)

  1. [Hand-foot-mouth disease: its course in the city of Milan (1980-86). Epidemiologic study gathered from the records of the community and scholastic ambulatory services of the Istituto di Clinica Dermatologic I and Dermatologia Pediatrica of the University].

    PubMed

    Sala, F; Mansi, M; Greppi, F; Ferrari, L; Perotta, E; Andreani, B

    1989-03-01

    Hand-foot-mouth disease: the Authors describe the epidemiological observations in a period of seven years made in a big urban area of Milan. They point out the periodic course of hand-foot and mouth disease, which is present in particular during May and November and particularly in children under six years. The Authors point out the difference between males and females and they try to correlate their dates with those gathered from the study of the literature.

  2. [The role of biochemical markers of myocardial damage in clinical practice: the diagnosis of infarct and risk stratification. The Intersociety Interdisciplinary Study Group of the ANMCO-SIBioC-SIMeL, Markers of Muocardial Lesions. L'Associazione Nazionale Medici Cardiologi Ospedalieri-Società Italiana di Biochimica Clinica-Società Italiana di Medicina di Laboratorio].

    PubMed

    Ottani, F; Galvani, M; Panteghini, M; Dolci, A; Plebani, M; Tubaro, M; Zaninotto, M

    2000-01-01

    For many years creatine kinase (CK) and CK-MB isoenzymes were used together with the ECG to confirm the presence of myocardial infarction. During the last decade newer cardiac markers have been introduced and immunological test systems developed for their quantification. Among these new markers, a prominent role has emerged for cardiac troponins (T or I). These technological advanced assays have shown greater sensitivity compared to "conventional cardiac enzymes;, thereby identifying patients with small--at times, microscopic--infarcts who would not have met defining criteria for myocardial infarction in an earlier era. Another major advantage shown by both cardiac troponins with respect to "conventional cardiac enzymes" is their ability to predict clinical outcome over a short- or long-term follow-up in patients with acute coronary syndromes, and this appears to be particularly relevant in patients with micronecrosis, who constitute a high-risk subgroup of unstable angina patients. Recently, myoglobin has also been widely applied as a marker. Although lacking in myocardial specificity, it is the earliest marker to show an increase after coronary occlusion. Thus, the combined use of myoglobin and a cardiospecific structural protein such as troponin T or I may prove an attractive strategy for biochemical testing in chest pain patients. With the routine use of these novel cardiac markers, fascinating opportunities are now open in the field of diagnostic classification (making the World Health Organization definition of myocardial infarction obsolete) and risk stratification in chest pain patients; opportunities that were unforeseen in the era of cardiac enzymes. However, the use of these markers has also posed some important questions on: a) the best and most cost-effective diagnostic strategy in chest pain patients; b) the remaining role of cardiac enzymes; c) the therapeutic consequences of a positive test result.

  3. Military Suicide Research Consortium

    DTIC Science & Technology

    2013-10-01

    Abramson, L. Y., Joiner, Jr., T. E., Alloy, L. B., & Metalsky, G. I. (1998). The hopelessness theory of depression: A review. Revista de...Blalock, J. (1996). Revista de una modelo de depresíon, ansiedad, y emocíon negativa. Revista de Psicopatologia y Psicologia Clinica, 1, 27-34. 46...Behavior, appointed 2003. Revista de Psicopatologia y Psicologia Clinica (Review of Psychopathology & Clinical Psychology), Spain, appointed 1995

  4. [Compliance of the guidelines of the Spanish Neurology Society in the treatment of patients with multiple sclerosis].

    PubMed

    Oreja-Guevara, Celia; Río, Jordi; Gobartt, Ana L

    2015-08-16

    Introduccion. El tratamiento de la esclerosis multiple se basa en la administracion de farmacos modificadores de la enfermedad (FAME), utilizados para frenar el curso natural de la enfermedad. Objetivo. Evaluar el grado de cumplimiento de las guias terapeuticas de la Sociedad Española de Neurologia (SEN) de 2010 por parte de los neurologos. Pacientes y metodos. Estudio observacional, retrospectivo y multicentrico de 218 pacientes adultos con esclerosis multiple de al menos cinco años de evolucion y en tratamiento con FAME. Los datos se obtuvieron de la historia clinica y se compararon con las recomendaciones de la SEN. Resultados. Segun las guias de la SEN de 2010, el 82% de los pacientes presentaba respuesta clinica adecuada, y el 18%, respuesta clinica inadecuada al FAME actual; el 94% y 92%, respectivamente, mantuvieron ese tratamiento. Los pacientes en los que la respuesta clinica inadecuada no origino un cambio del FAME actual llevaban en tratamiento mas tiempo y experimentaron con mayor frecuencia progresion de su discapacidad e incremento del numero de brotes. El 48% de los pacientes inicio tratamiento de primera linea con interferon beta-1a, administrado por via subcutanea (29%) o intramuscular (19%), seguido de interferon beta-1b y acetato de glatiramero. Algunos pacientes recibieron tratamientos de segunda linea como segunda/tercera opcion (15% y 28%, respectivamente), pero el uso de estos tratamientos (especialmente natalizumab) solo se generalizo a partir de la cuarta linea de tratamiento. Conclusiones. De acuerdo con las guias de la SEN de 2010, la mayoria de los pacientes tuvo una respuesta clinica adecuada. Un elevado porcentaje de pacientes con respuesta clinica inadecuada continuo con el tratamiento actual.

  5. Knowledge and Beliefs of Breast Cancer Among Elderly Puerto Rican Women.

    DTIC Science & Technology

    1995-10-01

    ideas y las opiniones de los entrevistados sobre diversos temas (Basch 1987). Como rn6todo de investigaci6n es rnenos costoso que las entrevistas ...autoexamen, examen clinica , * mamografia)? C. Informaci6n sabre el cancer 5. EQu6 informacifn sabre el cincer de mama y las pruebas de del sena y las...le ha llevadas a caba par el m~dica. hecha a le ha recamendada su m~dica (autaexamen, examen clinica , mamagrafia)? E. Casta y accesibilidad para 7

  6. [Castleman's disease with abdominal localization. Report of an unusual case].

    PubMed

    Russo, R; Vertemati, G; Carzaniga, P L; Ballerini, A; Rossi, G; Zuccoli, E

    1995-10-01

    Castleman's disease is an unusual condition characterized by uncontrolled growth of lymphoid tissue. The first case was recorded by Castleman in 1956. In this paper a case of the above-mentioned disease is reported with regard to its unusual clinica-histologic aspect (localized form of plasmacellular type) and surgical therapeutic strategies.

  7. [The physiotherapic aspect of omeral epicondilitis (author's transl)].

    PubMed

    Marenghi, P; Tella, G C

    1976-01-01

    The Authors describe history, etiopatogenesis, clinic, therapy of omeral epicondilitis, very frequent affection. Physiotherapic aspects are studied by different methods. The indications are different compared to clinical aspect, pain modality, relapse eventuality. They conclude with personal considerations based on what observed in Orthopedic Clinica of Parma University.

  8. Psychophysiological Assessment Methods (Including a Register of Psychophysiologists - on Microfiches) (Methodes d’Evaluation Psychophysiologique (Liste de Psychophysiologues Incluse sur Microfiches)

    DTIC Science & Technology

    1994-05-01

    Allee 45 60123 Bologna 14195 Berlin Clinica Neurologica Universtb di 305 Roma Tor Vergata Via 0. Raimondo 8 00173 Roma J-33 Instiuto do Fisiologia ...Policlimoo DASRS-Diviono Aeree Stud’ 268.,326 37134 Verona Ricercho.a Spermontazioni Reparto Medicine Aeronautic& e Spazialo Instiltuto di Fisiologia umana

  9. From Self-Organized to Extended Criticality

    DTIC Science & Technology

    2012-04-26

    Texas, Denton, TX, USA 2 Centro EXTREME, Scuola Superiore Sant’Anna, Pisa, Italy 3 Istituto di Fisiologia Clinica-CNR, Pisa, Italy 4 Department of Physics...Netherlands Klaus Linkenkaer-Hansen, Center for Neurogenomics and Cognitive Research, Netherlands *Correspondence: Paolo Allegrini , Istituto di Fisiologia

  10. Source Hierarchy List. Volume 1. A through D

    DTIC Science & Technology

    1994-07-01

    DEPARTAMENTO DE FISICA 01 CHILE UNIV SANTIAGO OEPARTAMENTO DE FISIOLOGIA Y BIOFISICA 01 CHILE UNIV SANTIAGO OEPARTAMENTO OE VIROLOGIA 1259 401858 401398...EDAFOLOGIA Y BIOLOGIA VEGETAL 01 CONSEJO SUPERIOR DE INVESTIGACIONES CIENTIFICAS MADRID (SPAIN) INSTITUTO DE EDAFOLOGIA Y FISIOLOGIA VEGETAL 01...NAZIONALE DELLE RICERCHE PISA (ITALY) IST DI FISIOLOGIA CLINICA* 01 CONSIGLIO NAZIDNALE OELLE RICERCHE PISA (ITALY) IST DI NEURDFISIDLDGIA 01

  11. Influence of Progressive Central Hypovolemia on Multifractal Dimension of Cardiac Interbeat Intervals

    DTIC Science & Technology

    2010-05-07

    and 5 Istituto Fisiologia Clinica, CNR-Area Ricerca San Cataldo, Via Moruzzi 1, 56124-Pisa (Dated: May 7, 2010) Abstract We analyzed the heartbeat time...the research group of prof. B Ghe- larducci, Dipartimento di Fisiologia e Biochimica, Universitá di Pisa, and Dr. M. Varanini, Institute of Clinical

  12. Rapid Diagnosis of Arbovirus and Arenavirus Infections by Immunofluorescence.

    DTIC Science & Technology

    1981-01-01

    and Barrera Oro, J.G. 1975. Serologia do a fiebre hemorragica Argentina. II. Comparacion de Is prueba indirecta de anticuerpos fluorescentes con Is... prueba de fijacion de complemento. Acts - - lioquimica Clinica Latinoamericana, 9: 141-146. Hotchin, J., and Kinch, W. 1975. Microplaque reduction: New

  13. Spanish Navy Up to Date Data in DCS

    DTIC Science & Technology

    2001-06-01

    therapeutic measures. Final results are similar to another world navies diving centres Bibliography: 1.- Pujante, A.; Inoriza, J; Viqueira, A. Estudio de 121... casos de enfermedad descompresiva Medicina Clinica, vol . 94, n` 7, 1990 2.- Rivera, J.C. Decompression sickness among divers: An analysis of 935

  14. Analysis of Activity Patterns and Performance in Polio Survivors

    DTIC Science & Technology

    2006-10-01

    subjective estimate of their activity level over the past week using the Physical Activity Scale for the Elderly (PASE).3 This instrument dealt with...May 2004. Talaty M. Models for Gait Analysis. 5th SIAMOC (Societa Italiana Di Analisi Del Movimento in Clinica) Congress, Loano, Italy November

  15. (Short overview of the Mexican Society of Clinical Chemistry meetings)

    SciTech Connect

    Burtis, C.

    1991-01-01

    Organized and chaired session on instrument evaluation at the XIV Congreso Nacional De Quimica Clinica which is the National Meeting of the Mexican Society of Clinical Chemistry. In addition, I presented a paper on calibration at a Congress workshop and spoke on the impact of technology in a symposium on quality control.

  16. Estudio de la estructura logica utilizada en la ensenanza y el aprendizaje de los conceptos sobre el comportamiento de gases en el curso introductorio de quimica a nivel universitario

    NASA Astrophysics Data System (ADS)

    Costa Diaz, Agnes

    El estudio que se presenta es de caracter cualitativo, un estudio multicasos donde se estudia la estructura logica utilizada por cuatro (4) profesores universitarios que ensenan el curso introductorio de quimica, en la planificacion, presentacion y evaluacion del tema sobre el comportamiento de los gases. Se utilizaron varias fuentes de informacion como: cuestionarios de profesores y estudiantes, entrevistas, grabaciones videomagnetofonicas, materiales didacticos y una prueba conceptual, entre otros. La informacion recopilada fue analizada de acuerdo al orden logico del contenido presentado, el estilo de ensenanza del profesor, las tecnicas y estrategias utilizadas para el desarrollo de destrezas de pensamiento, el ambiente fisico en el salon de clase y los instrumentos de evaluacion y avaluo. El estudio demuestra que lo que los profesores piensan y planifican para hacer sus presentaciones no necesariamente es lo que ocurre en el salon de clases. El desarrollo de destrezas de pensamiento, que constituye una prioridad de los profesores, no se elaboran efectivamente. El uso de las estrategias de resolucion de problemas numericos predomino. La participacion del estudiante en el salon de clases fue limitada y no se logro demostrar el desarrollo de las destrezas de pensamiento deseadas. Aunque los profesores tienen su propio estilo de ensenanza, el orden logico del contenido presentado en clase fue el mismo o siguio muy de cerca el orden establecido por el libro de texto. Los profesores utilizaron preferentemente la tiza y la pizarra para sus presentaciones y la dinamica en el salon de clases fue esencialmente tradicional. Los profesores hicieron su presentacion y los estudiantes copiaron pasivamente la informacion. Las evaluaciones de los estudiantes fueron esencialmente, pruebas escritas de seleccion multiple de acuerdo con el estilo en que se les enseno. El avaluo fue casi inexistente. La prueba conceptual administrada revela un aprendizaje pobre en los conceptos mas

  17. Age group, menarche and regularity of menstrual cycles as efficiency predictors in the treatment of overweight.

    PubMed

    Kuzmar, Isaac; Cortés, Ernesto; Rizo, Mercedes

    2014-10-30

    Objetivo: Evaluar si existe una relacion entre los grupos de edad, la menarquia, ciclos menstruales y embarazos previos con el exito en la perdida de peso en pacientes obesos en una clinica de nutricion. Métodos: Se ha llevado a cabo un estudio entre pacientes con sobrepeso y obesidad que acudieron a una clinica de nutricion en la ciudad de Barranquilla (Colombia) con el fin de recibir un tratamiento nutricional. A todos los pacientes se les realizo un tratamiento nutricional semanal personalizado por 16 semanas continuas en los que se registraron los patrones de consumo de alimentos, medidas antropometricas, la imagen corporal y la auto-percepcion. Resultados: Se evaluaron un total de 135 pacientes. 41 (30,4%) de los cuales no completaron el estudio. 69,6% perdieron peso y 83,7% perdieron cintura. Estas perdidas son menores en edades mas avanzadas (95,5%

  18. Los damnificados: El Paso medical team aids in Mexican earthquake disaster.

    PubMed

    Villescas, J

    1986-05-01

    The aftermath of the catastrophic earthquakes in Mexico City compromised health care in many parts of the capital. Teams of American medical volunteers from throughout the nation placed personal lives and careers on hold and headed south of the border. Under the auspices of the Salvation Army, "Clinica Esperanza" was founded in the poorest colonia of the city. The El Paso team was one of several who responded to the call. These volunteers combined their expertise with novel uses of existing space and material to help create a viable, efficient clinic. The journal distillation that follows provides a broad overview of events transpiring both in and out of Clinica Esperanza. May pharmacists come forward in number in this team concept in the event of a future cataclysm.

  19. European Conference on Visual Perception (6th).

    DTIC Science & Technology

    1983-11-30

    Institut fuer Verhaltenswissenschaft, ETH- Zentrum, 8092 Zuerich - Switzerland W. GERBINO: Istituto di Psicologia , Universitk di Padova, Piazza Capitaniato...fuer medizinische Psychologie, Schillerstrasse 42 - 8000 Muenchen 2, West Germany L. JANEZ ESCALADA: Psicologia Matem&tica, Facultad de Psicologla...Norway P. MANCINI: Istituto di Fisiologia clinica del C.N.R., Via Bonanno Pisano - 56100 Pisa, Italy C.A. MARZI: Istituto di Psicologia . Universit

  20. [Neurosyphilis in the 21st century: a descriptive study in a tertiary hospital in Madrid].

    PubMed

    Villar-Quiles, R N; Porta-Etessam, J

    2016-11-01

    Introduccion. La neurosifilis puede ocurrir en cualquier momento tras la infeccion por Treponema pallidum y su incidencia esta aumentando en los ultimos años. El patron epidemiologico y clinico ha experimentado un cambio sustancial en la era postantibiotica. Objetivo. Describir y analizar la poblacion de pacientes con diagnostico de neurosifilis de un hospital terciario de Madrid desde enero de 2008 a mayo 2015. Pacientes y metodos. Se analizaron retrospectivamente datos demograficos, clinicos, pruebas complementarias –serologia, liquido cefalorraquideo (LCR), neuroimagen– y evolucion de 28 pacientes diagnosticados entre 2008 y 2015. Resultados. La mayoria fueron varones (89,3%), españoles (60,7%), con una edad media de 53 ± 16,4 años. Lo mas frecuente fueron las formas asintomaticas (39,3%), seguidas de sifilis ocular (21%), formas no clasicas (14,3%), deterioro cognitivo y alteraciones neuropsiquiatricas (11%). El 50% presentaba infeccion concomitante por virus de la inmunodeficiencia humana, la mayoria asintomaticos, con una correlacion significativa entre linfocitos T CD4+ y neurosifilis asintomatica. Unicamente el 50% presento VDRL+ en el LCR, basandose el diagnostico en la clinica, la serologia y las alteraciones en el LCR (citobioquimicas o serologicas). La neuroimagen fue inespecifica en la mayoria de los casos. Las formas tempranas y las formas oculares se asociaron a una mejor evolucion clinica. Conclusiones. Respecto a la era preantibiotica, se observa un descenso muy importante en las formas tardias, asi como la aparicion de formas no clasicas que pueden simular otras entidades, como encefalitis viricas. El diagnostico es complejo y se basa en la clinica, la serologia y el estudio del LCR, a menudo con una interpretacion compleja, por lo que la sospecha clinica es fundamental en el diagnostico.

  1. Control of Chaos: New Perspectives in Experimental and Theoretical Science. International Journal of Bifurcation and Chaos in Applied Sciences and Engineering. Theme Issue. Part 2, Volume 8, Number 9, September 1998.

    DTIC Science & Technology

    1998-09-01

    behavior of neuron groups at multiple locations and it has been animals [Eckhorn et al., 1988; Singer, 1993; Fujii suggested [Eckhorn et al., 1988; Singer...the brain of some animals [Gray et al., 1989; problem. Engel et al., 1990; Bressler et al., 1993; Whit- So some coordination or synchronization of...GARBO*, R. BALOCCHIt and S. CHILLEMI* *Istituto di Biofisica CNR, Via S. Lorenzo 26, 56127 Pisa, Italy tIstituto di Fisiologia Clinica CNR, Via

  2. ["Investigación Clínica": 50 years disseminating biomedical research].

    PubMed

    Ryder, Elena

    2010-06-01

    INVESTIGACION CLINICA was founded by the initiative of Américo Negrette, who became its first editor, and it has been published uninterruptedly since July 1960, with a quarterly frequency. The first issues consisted mainly of a collection of reviews of seminars held at the now called Instituto de Investigaciones Clínicas "Dr. Américo Negrette", Facultad de Medicina, Universidad del Zulia, its publisher. Very soon, original research results from this institution were included in the novel journal. In the 60's, papers on results obtained during the outbreaks of Venezuelan Equine Encephalitis present in the area, were prominent. Originally, the journal published 3-4 papers, but due to the increased number of contributions, in 2001, its format changed from 1/16 to 1/8, and now each number includes 11 original articles. Currently, INVESTIGACION CLINICA publishes 44 papers a year, in Spanish or English on different biomedical topics, from contributors all around the world. Progressively it has been included in different renowned indexes, such as PubMed/MEDLINE, Science Citation Index Expanded, Excerpta Medica, Tropical Diseases Bulletin, Copernicus, Scopus, Periodica, and several others. Besides, it can be found in open access through www.Scielo.org.ve, www.freemedicaljournals.com and in our new Web page: https://sites. google.com/site/revistainvestigacionesclinicas/home. Most papers published in INVESTIGACION CLINICA have been cited in the regional or foreign literature accumulating more than 1200 citations by now. For this particular issue, to celebrate the 50th anniversary of INVESTIGACION CLINICA, we have invited some of our more recent referees or authors to contribute with Reviews in their respective areas of expertise.

  3. Endogenous 6-Hydroxymelatonin Excretion and Subsequent Risk of Breast Cancer: A Prospective Study

    DTIC Science & Technology

    2005-03-01

    Epidemiologia e Prevenzione 46:359-363; 1991. Bojkowski CJ. Arendt J. Shih MC. Markey SP. Melatonin secretion in humans assessed by measuring its...urinary 6-hydroxymelatonin excretion. Clinica Chimica Acta. 150(3):221-5, 1985. Mawson AR. Breast cancer in female flight attendants. Lancet. 352(9128...expected cases in a dynamic cohort. Epidemiologia e Prevenzione. 18(60): 164-9; 1994. Muti P, Celentano E, Panico S, Berrino F. Measurement of cutaneous

  4. Global health opportunities in surgery: a guide for medical students and faculty.

    PubMed

    Guzman, Pablo; Schecter, William P

    2008-01-01

    A four-week surgical rotation at the Clinica Universitaria Teleton in Chia, Colombia, was arranged for a U.S. student at the completion of the first year of medical school. The rotation resulted in a supervised intense early clinical exposure to surgery resulting in advancement in five of the six clinical competencies. International medical experiences can provide great benefit to U. S. medical students.

  5. [Diagnostic-therapeutic approach for retroperitoneal tumors].

    PubMed

    Cariati, A

    1993-12-01

    After a careful review of the Literature, diagnostic and therapeutic strategies for Primary Retroperitoneal Tumours (PRT) are reported. The Author analyzes the experience of the Institute of Clinica Chirurgica "R" (Chief: Prof. E. Tosatti) as well as that of Anatomia Chirurgica (Chief: Prof. E. Cariati),--University of Genoa--in the management of PRT, stressing the importance of preoperative staging for a correct surgical approach.

  6. Breast Cancer Epidemiology in Puerto Rico

    DTIC Science & Technology

    2010-06-01

    saliva es simple y el riesgo a su salud es minimo. Una enfermera adiestrada del Centro de Investigaciones Clinicas del Recinto de Ciencias Medicas...daremos una merienda y la entrevistadora le hara las preguntas del cuestionario. La entrevista dura aproximadamente 30 minutos y las preguntas estan...hijos que ha tenido, al igual que algunas preguntas sobre diagnostico y tratarniento de cancer. Una vez que terminemos la entrevista , usted habra

  7. Breast Cancer Epidemiology in Puerto Rico

    DTIC Science & Technology

    2012-06-01

    Investigacion Clinica y Traslacional del Recinto de Ciencias Medicas (PRCTRC) tomara estas muestras. La enfermera tambien le tomara las medidas...cuestionario. La entrevista dura aproximadamente 30 minutos y las preguntas estan relacionadas a Ia dieta, Ia actividad fisica, el historial de peso, los...del sujeto/paciente: -.,........,,.,.........,...,..,,...,. Protocolo #0750 I 08 Pagina 3 de 8 Una vez que terminemos Ia entrevista , usted habra

  8. Breast Cancer Epidemiology in Puerto Rico

    DTIC Science & Technology

    2013-06-30

    minimo. Una enfermera adiestrada del Consorcio de Investigacion Clinica y Traslacional del Recinto de Ciencias Medicas (PRCTRC) tomara estas muestras...y la entrevistadora Ie hara las preguntas del cuestionario. La entrevista dura aproximadamente 30 minutos y las preguntas estan relacionadas a la... entrevista , usted habra completado su participaci6n en el estudio. EI procedimiento completo no debe tardar mas de una (1) hora. Para este estudio usaremos

  9. [Fingolimod: effectiveness and safety in routine clinical practice. An observational, retrospective, multi-centre study in the province of Alicante].

    PubMed

    Mallada, J; Perez-Carmona, N; Berenguer-Ruiz, L; Sanchez-Perez, R; Martin-Gonzalez, R; Sola-Martinez, D; Mola, S; Lopez-Arlandis, J M; Vela-Yebra, R; Gabaldon-Torres, L; Freire-Alvarez, E; Garcia-Escriva, A; Sempere, A P

    2016-09-05

    Introduccion. Los estudios postautorizacion son importantes para confirmar si los resultados de los ensayos clinicos se reproducen en la practica clinica habitual. Objetivo. Evaluar la efectividad y seguridad del fingolimod en la practica clinica en la provincia de Alicante. Pacientes y metodos. Estudio multicentrico retrospectivo de pacientes con esclerosis multiple remitente tratados con fingolimod. Se recogen las caracteristicas demograficas, clinicas y farmacologicas. Se describe la efectividad del farmaco –tasa anualizada de brotes (TAB) y porcentaje de pacientes libres de brotes– al año y a los dos años de tratamiento en relacion con el año previo y datos de efectos secundarios. Resultados. Se incluyo a 89 pacientes. El tratamiento previo fue inmunomodulador (interferon beta o acetato de glatiramero) en 54 pacientes y natalizumab en 32. Cincuenta pacientes cambiaron por fracaso con el inmunomodulador y 31 por serologia positiva del virus JC (VJC+). La TAB global disminuyo el 67,3% el primer año (p < 0,0001) y el 84,1% el segundo (p = 0,0078). Disminuyo en los pacientes con fracaso del inmunomodulador (el 85,6% el primer año, p < 0,0001; el 88,9% el segundo año, p = 0,0039) y aumento de forma no significativa en los pacientes VJC+ en el primer año. El porcentaje de pacientes libres de brotes en la poblacion global aumento del 32,6 al 68,1% en el primer año (p < 0,0019) y al 82,6% en el segundo (p = 0,0215). Este aumento no se observo en los pacientes VJC+. Trece pacientes tuvieron efectos secundarios, que obligaron a la retirada del farmaco en dos de ellos. Conclusion. En la practica clinica de la provincia de Alicante, el fingolimod mostro una efectividad y una seguridad ligeramente superiores a las de los ensayos clinicos.

  10. Practical aspects of the use of intrathecal chemotherapy.

    PubMed

    Olmos-Jiménez, Raquel; Espuny-Miró, Alberto; Cárceles Rodríguez, Carlos; Díaz-Carrasco, María Sacramento

    2017-01-01

    Introducción: La quimioterapia intratecal es utilizada frecuentemente, en la practica clinica, para el tratamiento y prevencion de la meningitis neoplasica. A pesar de su uso extendido, existe poca informacion acerca de aspectos practicos tales como el volumen de farmaco a administrar o la forma de preparacion y administracion. Objetivo: Realizar una revision de la literatura acerca de aspectos practicos de la utilizacion de la quimioterapia intratecal.

  11. [Hand fine motor skills and use of both hand and arm in subjects after a stroke: a systematic review].

    PubMed

    Ostolaza, M; Abudarham, J; Dilascio, S; Drault-Boedo, E; Gallo, S; Garcete, A; Kramer, M; Maiaru, M; Mendelevich, A; Modica, M; Peralta, F; Sanchez-Correa, C

    2017-04-01

    Introduccion. En la practica clinica resulta importante poder evaluar la funcion de la extremidad superior paretica del paciente que ha sufrido un ictus. No hay una revision sistematica que identifique herramientas de evaluacion del 'uso fino de la mano' o el 'uso de la mano y el brazo'. Objetivos. Como objetivo primario, identificar las herramientas observacionales que evaluan el uso fino de la mano o el uso de la mano y el brazo en pacientes con secuela de ictus. Secundariamente, analizar el riesgo de sesgo de los articulos incluidos, describir y categorizar la validez, fiabilidad y utilidad clinica. Pacientes y metodos. Se realizo una busqueda en Medline, LILACS, SciELO y Open Grey hasta octubre de 2015. Se incluyeron estudios de validacion de herramientas de evaluacion del miembro superior en sujetos con secuela de ictus, que evaluen el uso fino de la mano o el uso de la mano y el brazo. Resultados. Se han seleccionado 11 herramientas que evaluan el uso fino de la mano y el uso de la mano y el brazo. Conclusiones. Si bien se comunicaron la fiabilidad, la validez y la utilidad clinica, esta ultima fue menos evaluada. Los estudios que investigaron estas herramientas presentaron alto riesgo de sesgo, en particular en la eleccion de la prueba de referencia. La herramienta ARAT-19 fue la que presento un menor riesgo de sesgo, pero cuando se evaluo la aplicabilidad, esta presento una preocupacion alta para la prueba de referencia.

  12. [Asymptomatic skull base metastases: clinical course and therapeutic alternatives].

    PubMed

    Vargas, A; Paulazo, C; Oleaga, L; Verger, E

    2017-03-01

    Introduccion. Las metastasis sintomaticas de la base craneal (MBC) son una progresion infrecuente, tardia y de mal pronostico en pacientes con tumores solidos. Sus manifestaciones clinicas pueden agruparse en cinco sindromes caracteristicos, y su tratamiento mas frecuente es la radioterapia. Gracias a los progresos tecnologicos en las pruebas de imagen y al seguimiento estrecho de los pacientes con cancer, las MBC pueden diagnosticarse incidentalmente. En este subgrupo no se conoce la evolucion clinica ni se ha establecido la mejor modalidad de tratamiento. Objetivo. Analizar las caracteristicas clinicas y la evolucion de los pacientes diagnosticados incidentalmente de MBC. Pacientes y metodos. Entre enero de 2012 y diciembre de 2015, 31 pacientes con una neoplasia solida diagnosticados de MBC fueron valorados por nuestro servicio. Resultados. Las MBC se diagnosticaron por la presencia de un sindrome de base craneal (n = 24) o incidentalmente (n = 7). Los pacientes sintomaticos fueron tratados con radioterapia. Todos los pacientes diagnosticados incidentalmente permanecieron sin sintomas relacionados con la afectacion de la base craneal hasta la fecha del fallecimiento, aunque frecuentemente presentaron de forma concomitante otros tipos de progresion intracraneal de mal pronostico. Se observo una diferencia estadisticamente significativa en la supervivencia a favor de los pacientes sintomaticos (p = 0,001). Conclusiones. Las MBC diagnosticadas incidentalmente se asociaron frecuentemente a otros tipos de progresion intracraneal, limitando las opciones terapeuticas.

  13. [Central nervous system in IgG4-related disease: case report and literature review].

    PubMed

    Vanegas-Garcia, A L; Calle-Lopez, Y; Zapata, C H; Alvarez-Espinal, D M; Saavedra-Gonzalez, Y A; Arango-Viana, J C

    2016-08-01

    Introduccion. La enfermedad relacionada con IgG4 es una entidad clinica multisistemica recientemente descrita y que se presenta con diferentes manifestaciones clinicas. Los organos que estan afectados con mayor frecuencia son el pancreas, la via biliar y las glandulas salivales, y es menos frecuente la afeccion del sistema nervioso central. Caso clinico. Mujer de 33 años con alteraciones cognitivas, alucinaciones, cefalea, sindrome convulsivo, sinusitis maxilar con afeccion osea y evidencia de paquimeningitis y panhipopituitarismo, con biopsia meningea que confirmo una enfermedad relacionada con IgG4, tras haberse descartado causas secundarias. Se inicio tratamiento con glucocorticoides y azatioprina, sin recaidas despues de 12 meses de seguimiento. Conclusiones. Se debe considerar el diagnostico de enfermedad relacionada con IgG4 en casos de paquimeningitis hipertrofica e hipofisitis, incluso sin que se acompañen de otras manifestaciones sistemicas, siempre que se hayan descartado otras causas mas frecuentes. El tratamiento de eleccion son los glucocorticoides, y puede ser necesario añadir otro inmunosupresor como ahorrador de esteroides y para evitar las recaidas. Se necesitan estudios prospectivos para evaluar las diferentes manifestaciones clinicas y paraclinicas y establecer los resultados del tratamiento a largo plazo.

  14. [Reviewing the past and looking to the future].

    PubMed

    Ryder, Elena

    2005-06-01

    The first issue of "Investigación Clinica" was published in July, 1960; by the initiative of Dr. Américo Negrette. The journal had a small format (1/16) and was very sober in its presentation. It consisted of about 45 pages, with four articles, that were mainly the product of conferences and seminars. As time went by, 45 years of existence, our journal has evolved following the continuous changes on international regulations; such as the 1/8 format, the impression on acid-free paper and its bibliography in compliance with the Vancouver rules. Currently, Investigaci6n Clinica appears in the best international biomedical indexes and publishes eight original articles on average, in about 100 pages per number. It gets to 106 libraries and health centers in Venezuela and 102 abroad. International peer-review of research articles represents 50% of the current scientific reviews solicited. It is opportune to thank all of those that have collaborated, in such disinterested way, with the journal over the years, and to extend our gratitude to the Editorial and Advisory Boards, the financial supporters, the publishing companies that have worked in its final printing and, of course, to all the researchers that have confided in the responsibility, seriousness and punctuality of Investigaci6n Clinica.

  15. [Prefrontal clinical symptoms in daily living: screening assessment by means of the short Prefrontal Symptoms Inventory (PSI-20)].

    PubMed

    Pedrero-Pérez, Eduardo J; Ruiz-Sánchez de León, José M; Morales-Alonso, Sara; Pedrero-Aguilar, Jara; Fernández-Méndez, Laura M

    2015-05-01

    Introduccion. La estimacion de sintomas cotidianos de disfuncion frontal se considera imprescindible para aportar validez ecologica a las evaluaciones neuropsicologicas. Los cuestionarios disponibles se construyeron para estimar problemas ejecutivos en la vida diaria en poblaciones con daño neurologico. Se requieren instrumentos enfocados a medir estos comportamientos en la poblacion general o en poblaciones clinicas con fallos leves o moderados. Objetivo. Estudiar la validez factorial y encontrar indicios de validez concurrente de la version abreviada del inventario de sintomas prefrontales. Sujetos y metodos. Se obtuvieron tres muestras: la primera, a traves de Internet (n = 504); la segunda, en poblacion no clinica mediante lapiz y papel (n = 1.257), y la tercera, de pacientes en tratamiento por adiccion a sustancias (n = 602). Se utilizo un metodo de analisis factorial sin restricciones sobre la primera muestra y los resultados se sometieron a analisis factorial confirmatorio sobre las otras dos muestras. Resultados. La estructura de tres factores encontrada se confirmo con excelentes indicadores de ajuste en las otras dos muestras. Se hallaron indicios de validez concurrente con pruebas de calidad de vida y salud mental. Conclusiones. Se propone un cuestionario breve para la deteccion de fallos de origen prefrontal en la vida diaria, que mejora las cualidades psicometricas de tests similares, pero orientados a patologias neurologicas graves. La estabilidad estructural de la prueba garantiza la utilidad en la poblacion general, para la deteccion precoz del deterioro cognitivo, y en poblaciones clinicas con deterioro leve o moderado. Se proponen baremos para la interpretacion de resultados.

  16. [Inferior vertical nystagmus: is magnetic resonance imaging mandatory?].

    PubMed

    Esteban-Sánchez, Jonathan; Rueda-Marcos, Almudena; Sanz-Fernández, Ricardo; Martín-Sanz, Eduardo

    2016-02-01

    Introduccion. La aparicion de un nistagmo vertical inferior clasicamente obliga a descartar una patologia vascular o de la union craneocervical mediante resonancia magnetica (RM). Estudios recientes demuestran una baja rentabilidad de esta prueba, ya que sugieren que este signo oculomotor puede tener una causa vestibular periferica, sobre todo cuando el paciente presenta un vertigo posicional paroxistico benigno (VPPB) del canal semicircular superior. Objetivo. Comprobar la rentabilidad de la RM en una poblacion de pacientes con nistagmo de posicion vertical inferior. Pacientes y metodos. Estudio retrospectivo de 42 pacientes consecutivos a los que se les realizo una historia clinica, exploracion fisica, y pruebas vestibulares caloricas y rotatorias. A todos ellos se les practico una RM craneal y cervical. Resultados. El 52% de los pacientes con nistagmo de posicion vertical inferior presentaba una clinica y exploracion fisica compatibles con VPPB del canal semicircular superior. La RM fue normal en un 67%, un 26% mostraba datos de espondilopatia y un 5% de microangiopatia cerebral no relacionados con la clinica del paciente. La prevalencia de malformacion de Arnold-Chiari de tipo I fue de un 9% en la poblacion estudiada, sin que nadie tuviera un antecedente reciente de VPPB. Los resultados obtenidos en las pruebas complementarias vestibulares no aportaron informacion adicional para llegar a un diagnostico etiologico. Conclusion. En los pacientes con un VPPB, la RM craneal y las pruebas vestibulares tienen una baja rentabilidad diagnostica, y se debe evaluar la necesidad real de esta prueba con el contexto clinico.

  17. [Psychosis as debut of antiphospholipid syndrome].

    PubMed

    del Rio-Casanova, Lucía; Paz-Silva, Eduardo; Requena-Caballero, Ignacio; Diaz-Llenderrozas, Francisco; Gomez-Trigo Baldominos, Jesús; de la Cruz-Davila, Alberto; Paramo-Fernandez, Mario

    2014-06-01

    Introduccion. El sindrome antifosfolipido (SAF) es un trastorno autoinmune que determina un estado de hipercoagulabilidad caracterizado por eventos tromboticos, abortos de repeticion y la presencia de anticuerpos antifosfolipido. Puede presentarse de manera aislada (SAF primario) o asociado a lupus eritematoso sistemico u otras enfermedades autoinmunes (SAF secundario). Las manifestaciones neuropsiquiatricas del SAF incluyen jaqueca, epilepsia, corea, demencia y psicosis. Se realiza una revision bibliografica de la sintomatologia neuropsiquiatrica en general y psicotica en particular de los pacientes afectos de SAF. Caso clinico. Mujer de 23 años afecta de un SAF primario que comenzo con manifestaciones clinicas unicamente neuropsiquiatricas consistentes en sintomatologia psicotica (dos episodios de clinica delirante) y movimientos anormales coreiformes y hemibalisticos que inicialmente se interpretaron como clinica conversiva. Conclusiones. Se discute la patogenesis de la sintomatologia motora y psicotica. La etiologia de los sintomas neuropsiquiatricos todavia no se conoce con claridad, pero la trombosis de pequeños vasos en el cerebro podria explicar parte de los sintomas. Asimismo, se revisa el papel que la medicacion antipsicotica y antitrombotica tiene para estos pacientes. En la actualidad, nuestra paciente se mantiene asintomatica sin necesidad de terapia antipsicotica y recibe tratamiento unicamente con un agente antiagregante y otro antipaludico.

  18. [Alternating hemiplegia of childhood. The first clinical case reported in El Salvador].

    PubMed

    Ramírez-Zamora, Mauricio; Ortez-González, Carlos Ignacio

    2013-09-01

    Introduccion. La hemiplejia alternante de la infancia (HAI) es una enfermedad rara, caracterizada por episodios repetidos de hemiplejia que afectan alternativamente a un hemicuerpo, son de inicio preferente antes de los 18 meses, duran de minutos a varios dias, e incluso pueden dejar tetraplejico durante un tiempo al lactante, si antes de que se acabe un episodio comienza otro o si estos ocurren de manera simultanea. La descripcion clinica incluye, ademas de estos ataques plejicos, otras manifestaciones paroxisticas presentes practicamente en todos los niños diagnosticados de este trastorno y que son, ademas, de aparicion mas precoz. Consisten en ataques tonicos, ataques distonicos, movimientos oculares anormales y trastornos autonomicos. El hecho de que estos sintomas precedan a la clinica tipica provoca en bastantes ocasiones un retraso en el diagnostico definitivo. Caso clinico. Varon de un año y nueve meses que inicia clinica de crisis tonicas a las dos semanas de vida, posteriormente episodios de hemiplejia que se manifiestan de forma alternante a los 11 meses de vida, y ademas presenta retraso psicomotor global. Al principio de los sintomas se diagnostico epilepsia, no respondio a multiples farmacos antiepilepticos, y el electroencefalograma, la neuroimagen y las pruebas complementarias en sangre y orina fueron normales/negativos. Presento respuesta favorable a la flunaricina. Conclusion. Es el primer paciente descrito de HAI en El Salvador. El diagnostico precoz y acertado de HAI es fundamental para iniciar farmacoterapia y mejorar el pronostico y calidad de vida de los pacientes y sus familias.

  19. [IgG4- and MPO-ANCA-associated hypertrophic pachymeningitis].

    PubMed

    Aragonès, Josep M; Arias-Rivero, Montserrat; García-Barrionuevo, Joan M; Lucchetti, Gianni

    2015-11-16

    Introduccion. La paquimeningitis hipertrofica idiopatica es una enfermedad fibroinflamatoria de la duramadre. Su diagnostico requiere la exclusion de enfermedades infecciosas, tumorales y otras enfermedades inflamatorias. En los ultimos años se han descrito nuevas entidades que pueden presentarse con paquimeningitis hipertrofica: la enfermedad relacionada con IgG4 y la paquimeningitis MPO-ANCA+ como forma de vasculitis limitada al sistema nervioso central. Caso clinico. Varon de 64 años con cefalea y cervicalgia de predominio nocturno y clinica de compresion medular. Tras el diagnostico de paquimeningitis hipertrofica craneocervical facilitado por el estudio de resonancia magnetica, se realizo un estudio etiologico. Se descartaron enfermedades infecciosas y tumorales. La clinica no mostraba afectacion sistemica y en la analitica presentaba IgG4 elevada y MPO-ANCA+. Tras tratamiento con corticoides presento una rapida mejoria de la clinica. Conclusiones. La enfermedad relacionada con IgG4 y la vasculitis asociada a MPO-ANCA limitada al sistema nervioso central pueden representar un alto porcentaje de las paquimeningitis hipertroficas que se consideraban idiopaticas, y su diagnostico requiere biopsia y estudio histologico.

  20. [Healthcare management of an epilepsy clinic: factors involved in the demand for health care and clinical situation of patients].

    PubMed

    García-Martín, Guillermina; Martín-Reyes, Guillermina; Dawid-Milner, Marc Stefan; Chamorro-Muñoz, M Isabel; Pérez-Errazquin, Francisco; Romero-Acebal, Manuel

    2013-05-16

    Introduccion. La epilepsia es una enfermedad cronica que implica un seguimiento periodico del paciente a largo plazo, lo que supone un aumento del numero de pacientes visitados con el tiempo y, por tanto, un coste al sistema sanitario. Objetivo. Determinar los factores implicados en el tiempo para la siguiente visita de un paciente epileptico. Pacientes y metodos. Seleccion de pacientes durante un ano que acuden consecutivamente a consulta de epilepsia de nuestro hospital. Se analiza su situacion clinica y relacion con el consejo medico dado, y los factores implicados en el tiempo transcurrido hasta la siguiente visita mediante modelos econometricos predictivos. Resultados. Existe una clara asociacion entre la situacion clinica del paciente y la modificacion del tratamiento propuesta por el neurologo en la visita anterior. Los factores implicados en el tiempo hasta la siguiente visita fueron frecuencia de crisis, efectos adversos medicamentosos, sobre todo los que afectan a la cognicion, y consejo medico al paciente. No resultaron significativos la politerapia, los trastornos psicoafectivos ni la situacion social del paciente. Conclusiones. El seguimiento en una consulta especifica de epilepsia mejora la situacion del paciente. Se trata del primer analisis de demanda asistencial en pacientes con epilepsia realizado mediante metodos econometricos y desde una perspectiva mixta medico-paciente. Dado que los factores que determinan el tiempo para la siguiente visita son modificables, podria disminuir el numero de visitas al ano, mejorando la situacion clinica de los pacientes. Proponemos una mayor duracion por visita para poder incidir en ello y reducir costes a largo plazo.

  1. [The neuroanatomy of attention deficit hyperactivity disorder: neuropsychological and clinical correlates].

    PubMed

    Albert, J; Fernandez-Jaen, A; Martin Fernandez-Mayoralas, D; Lopez-Martin, S; Fernandez-Perrone, A L; Calleja-Perez, B; Jimenez-De la Pena, M; Recio-Rodriguez, M

    2016-07-16

    Introduccion. El desarrollo de la resonancia magnetica estructural y de nuevos metodos de analisis ha permitido examinar, como nunca antes, las bases neuroanatomicas del trastorno por deficit de atencion/hiperactividad (TDAH). No obstante, poco se sabe todavia sobre la relacion de los sintomas clinicos y las disfunciones neuropsicologicas caracteristicas del TDAH con las alteraciones neuroanatomicas observadas. Objetivo. Explorar la relacion entre neuroanatomia, clinica y neuropsicologia en el TDAH. Desarrollo. A nivel de grupo, existen diferencias marcadas entre el cerebro de niños adolescentes y adultos con TDAH y el cerebro de personas con desarrollo tipico. Estas diferencias se observan transversal y longitudinalmente en todas las medidas, tanto de la sustancia gris como de la sustancia blanca. Aunque todavia escasa, cada vez existe mayor evidencia que señala que estas diferencias se relacionan con los sintomas nucleares del trastorno y con el grado de disfuncion clinica. Tambien parecen asociarse con el funcionamiento cognitivo (principalmente, atencion y control inhibitorio). Conclusiones. La relacion entre los distintos niveles de analisis de estudio del TDAH acerca la investigacion a la clinica y permite comprender y tratar mejor el trastorno. Aunque el avance en este campo es innegable, todavia son muchas las cuestiones que hay que explorar y profundizar en mayor detalle. Se requiere comprender mejor la asociacion entre las medidas neuroanatomicas y cada dimension sintomatologica, y la relacion con otros procesos neuropsicologicos tambien implicados en el trastorno.

  2. [Syringomyelias in paediatrics: a retrospective study of 25 cases].

    PubMed

    Martinez-Albaladejo, I; Prochazkova, M; Perez-Sebastian, I; Bernardino-Cuesta, B; Martinez-Ferrandez, C; Suarez-Traba, O M; Budke, M; Garcia-Penas, J J

    2016-09-01

    Introduccion. Se define siringomielia como una cavidad que contiene liquido cefalorraquideo dispuesta en el interior de la medula espinal. Objetivo. Describir las caracteristicas clinicas de una serie de pacientes con siringomielia, su diagnostico y tratamiento. Pacientes y metodos. Estudio descriptivo retrospectivo realizado mediante la revision de historias clinicas en nuestro centro. Resultados. Se revisaron 25 pacientes diagnosticados de siringomielia. En cinco el diagnostico fue casual y ocho presentaban una patologia grave previa (tumoral, osea o vascular). Dos pacientes comenzaron con hidrocefalia y clinica de hipertension intracraneal y unicamente dos destacaban cefalea como unico sintoma. Cuatro presentaron escoliosis progresiva, dos de ellos como queja inicial, y precisaron cirugia con artrodesis y uso de corse, respectivamente. Destaca la precocidad del diagnostico. La mayoria presentaba unicamente perdida de fuerza leve, con potenciales somatosensoriales y electromiograma normales. En todos se hicieron controles con resonancia magnetica. Ocho pacientes precisaron craniectomia descompresiva con laminectomia posterior C1-C2, con drenaje de la cavidad siringomielica en cuatro. Nueve requirieron valvula de derivacion y dos precisaron, ademas, ventriculostomia. Conclusiones. La presencia de siringomielia en pediatria es rara, y se asocia generalmente a malformaciones en la fosa posterior y antecedentes de disrafismo espinal. Destaca la escoliosis progresiva como posible manifestacion aislada. Un abordaje multidisciplinar con controles radiologicos seriados y la valoracion por servicios de neurologia y neurocirugia pediatricos son mandatorios para su seguimiento.

  3. [Oliver Sacks and literary neurology].

    PubMed

    Guardiola, Elena; Banos, Josep E

    2014-03-16

    Introduccion. La literatura medica de divulgacion intenta poner al alcance del publico general temas medicos en un lenguaje desprovisto, en lo posible, de jerga medica para hacerlo mas inteligible. En el ambito de la neurologia, su complejidad hace dificil que los relatos de esta especialidad sean faciles de comprender para el publico sin formacion medica. Objetivo. El presente articulo revisa la obra de Oliver Sacks en el ambito de la neurologia dirigida al publico general; se presentan las principales caracteristicas y las situaciones clinicas que describe. Desarrollo. Se incluyen unas notas biograficas sobre Oliver Sacks y se analizan los 11 libros publicados a lo largo de los ultimos 40 años. Para cada uno de ellos, se realiza una contextualizacion historica y se comentan los aspectos mas destacados que justifican el interes de su lectura. En la mayoria de los casos, se explica la genesis de la obra, asi como sus caracteristicas mas relevantes. Conclusiones. La obra de Sacks contiene un amplio abanico de situaciones clinicas de gran interes que se explican, generalmente, con un lenguaje accesible para el publico general. A los neurologos les permite, ademas, una vision holistica de diversas situaciones clinicas con una discusion de sus componentes biograficos, historicos y evolutivos.

  4. [Arteriovenous malformations of the brain: personal experience with 121 patients treated with microsurgery].

    PubMed

    Vilalta, Jordi

    2015-12-01

    Introduccion. Las malformaciones arteriovenosas (MAV) se pueden encontrar en el 0,1% de la poblacion, y la forma de presentacion mas frecuente es la hemorragia intracraneal. Objetivo. Analisis descriptivo de una serie de MAV operadas por un neurocirujano. Pacientes y metodos. De un registro hospitalario se han seleccionado los casos de MAV cerebrales operados por el autor en el periodo 1990-mayo 2014, revisando los aspectos clinicos, demograficos y angiograficos, y los resultados clinicorradiologicos seis meses despues de la cirugia. Resultados. De los 400 pacientes tratados en el mismo periodo, 121 fueron intervenidos por el autor, con una media de edad de 34,3 años (rango: 5-75 años). El 61,7% de los pacientes se diagnostico por una hemorragia cerebral, y la segunda forma de presentacion mas frecuente, el 19,8%, por crisis epilepticas. La localizacion superficial supratentorial, en 97 casos (80,2%), fue la mas frecuente. Mas de la mitad de los enfermos presentaba una MAV de grados bajos, I-II, segun la escala de Spetzler y Martin. Doce pacientes (10%) tenian aneurismas no intranidales asociados. En la mayoria de los casos, 109 (90,1%), se realizo cirugia electiva. La reseccion completa de la MAV despues del ultimo examen angiografico se obtuvo en 118 pacientes (97,5%). Los resultados clinicos fueron buenos (buena recuperacion y moderada incapacidad) en 114 casos (95%), y malos (gran incapacidad y muerte), en seis (5%). Conclusiones. La cirugia para las MAV cerebrales, con un criterio de seleccion apropiado, es la mejor opcion terapeutica para muchos pacientes.

  5. [Pharmacological management of attention deficit hyperactivity disorder with methylphenidate and atomoxetine within a context of epilepsy].

    PubMed

    Mulas, Fernando; Roca, Patricia; Ros-Cervera, Gonzalo; Gandía-Benetó, Rubén; Ortiz-Sánchez, Pedro

    2014-02-24

    Introduccion. La prevalencia del trastorno por deficit de atencion/hiperactividad (TDAH) en pacientes con epilepsia se situa en torno al 30-40%, especialmente del subtipo inatento, mientras que, a su vez, distintos estudios sobre niños diagnosticados de TDAH muestran cifras variables del 6,1-30% que presentan alteraciones en el electroencefalograma y problemas de epilepsia. Aunque las guias de practica clinica no desaconsejan el tratamiento con psicoestimulantes en el TDAH comorbido con epilepsia, en especial si esta no se considera activa, algunos investigadores y clinicos recomiendan ser cautos en el inicio de esta terapia farmacologica, mientras que el uso de no psicoestimulantes esta menos estudiado. Objetivo. Revisar las historias clinicas de niños con epilepsia y TDAH que recibieron tratamiento farmacologico con psicoestimulantes y no psicoestimulantes para el trastorno de atencion. Pacientes y metodos. Muestra de 23 pacientes de 5-16 años. Se analizo el tipo de epilepsia y la evolucion clinica y electroencefalografica al año y a los dos años tras el inicio del tratamiento farmacologico del TDAH. Resultados. A los dos años, un paciente presento una crisis y dos pacientes continuaban mostrando actividad paroxistica en el electroencefalograma. Conclusion. Los datos presentados muestran que el tratamiento farmacologico del TDAH no empeora la epilepsia en pacientes bien controlados, aunque se recomienda tener en cuenta factores como el tipo de farmaco antiepileptico, el tipo de farmaco para el TDAH, asi como el perfil cognitivo, para favorecer un desarrollo adecuado. En los niños epilepticos con dificultades del aprendizaje, deben valorarse los mecanismos de los procesos atencionales que puedan estar alterados y que precisen un tratamiento especifico.

  6. Hypoglycemic treatment of diabetic patients in the Emergency Department.

    PubMed

    Caballero Requejo, Carmen; Urbieta Sanz, Elena; Trujillano Ruiz, Abel; García-Molina Sáez, Celia; Onteniente Candela, María; Piñera Salmerón, Pascual

    2016-05-01

    Objetivo: Analizar la adecuacion del tratamiento hipoglucemiante prescrito en el Servicio de Urgencias a las recomendaciones de consenso disponibles, asi como evaluar su repercusion clinica. Método: Estudio observacional descriptivo. Se incluyeron pacientes que se encontraban en la sala de observacion del Servicio de Urgencias pendientes de ingreso hospitalario, con diagnostico previo de diabetes mellitus y en tratamiento domiciliario con farmacos hipoglucemiantes. Se evaluo el manejo del tratamiento antidiabetico y su repercusion clinica. Resultados: Se incluyeron 78 pacientes. Al ingreso en el Servicio de Urgencias se modifico el tratamiento en el 91% de los pacientes, y se omitio en el 9%, siendo el tratamiento mas pautado los rescates con insulina rapida (68%). Los tratamientos prescritos se ajustaron en un 16,7% a las recomendaciones de la Sociedad Espanola de Medicina de Urgencias y Emergencias. Tras la intervencion del farmaceutico, la omision descendio al 1,3% y la adecuacion a las recomendaciones aumento al 20,5%. Comparando los pacientes cuyo tratamiento se ajusto a las recomendaciones y los que no, la repercusion clinica fue, respectivamente: media de glucemia a las 24 horas 138,3 } 49,5 mg/dL versus 182,7 } 97,1 mg/dL (p = 0,688); media de rescates con insulina lispro 1 } 1,6 versus 1,5 } 1,8 (p = 0,293); media de unidades de insulina lispro administradas 4,6 } 12,7 UI frente a 6,6 } 11,3 UI (p = 0,155). Conclusiones: Encontramos una baja adecuacion de las prescripciones de antidiabeticos a las recomendaciones de consenso. Estos resultados van en linea con otros estudios, objetivandose un abuso de las pautas de rescate con insulina rapida como unico tratamiento hipoglucemiante.

  7. [Fingolimod: effectiveness and safety in routine clinical practice. An observational, retrospective, multi-centre study in Galicia].

    PubMed

    Pato-Pato, A; Midaglia, L; Costa-Arpin, E; Rodriguez-Regal, A; Puy-Nunez, A; Rodriguez-Rodriguez, M; Lopez-Real, A; Llaneza-Gonzalez, M A; Garcia-Estevez, D A; Moreno-Carretero, M J; Escriche-Jaime, D; Aguado-Valcarcel, M L; Munoz, D; Prieto, J M; Lorenzo-Gonzalez, J R; Amigo-Jorrin, M C

    2016-09-05

    Introduccion. La efectividad y seguridad del fingolimod en pacientes con esclerosis multiple remitente recurrente (EMRR) se demostro en ensayos clinicos. Sin embargo, por las limitaciones de estos, es importante saber como se comporta en condiciones de practica clinica habitual. Asi, el objetivo de este estudio es evaluar la efectividad y seguridad del fingolimod despues de 12 meses de uso en la practica clinica en Galicia. Pacientes y metodos. Estudio retrospectivo y multicentrico (n = 8) de pacientes con EMRR y tratados con una o mas dosis de fingolimod, 0,5 mg/dia. Se evaluo la efectividad –tasa anualizada de brotes (TAB), cambio en la puntuacion de la escala expandida del estado de discapacidad (EDSS), porcentaje de pacientes libres de brotes, libres de progresion de discapacidad y libres de actividad en resonancia– para el total de pacientes y segun tratamiento previo. Se evaluo la seguridad a partir del porcentaje de pacientes que discontinuaron y que presentaron efectos adversos. Resultados. Despues de 12 meses de uso, el fingolimod redujo un 87% la TAB (de 1,7 a 0,23; p < 0,0001) y, en consecuencia, un 81% de pacientes estuvo libre de brotes. La puntuacion de la EDSS disminuyo un 9%. Un 91% de pacientes estuvo libre de progresion de discapacidad y un 72%, libre de actividad en resonancia. En el 43% de los pacientes no se evidenciaron signos de la actividad de la enfermedad. La mayoria de los beneficios del fingolimod difirieron segun el tratamiento previo. Alrededor de un tercio de los pacientes comunicaron efectos adversos, pero solo el 2% discontinuo debido a ellos. Conclusiones. La mayoria de los resultados de efectividad de los ensayos clinicos del fingolimod se observa durante los 12 primeros meses de tratamiento en la practica clinica. Se observo un mejor perfil de seguridad al comunicado en los ensayos clinicos.

  8. [Brainstem dysgenesis: functional prognosis and rehabilitative treatment. A series of nine cases].

    PubMed

    Alberdi-Otazu, Ainara; Vives-Ortega, Juan C; Castelló-Verdú, Teresa; Toro-Tamargo, Esther; Meléndez-Plumed, Mar

    2014-05-01

    Introduccion. La disgenesia del tronco encefalico es una entidad clinica heterogenea, de baja incidencia y alta variabilidad clinica, que afecta a estructuras del tronco del encefalo. La combinacion de sintomatologia, neuroimagen y estudios neurofisiologicos es la base diagnostica. Objetivo. Conocer las caracteristicas clinicas comunes, pronostico funcional y necesidades de tratamiento rehabilitador en un grupo de niños con disgenesia del tronco encefalico. Pacientes y metodos. Estudio retrospectivo observacional de nueve pacientes diagnosticados de disgenesia del tronco encefalico controlados en consultas externas. Resultados. La edad media de los pacientes era de 5,5 años. Cinco presentaron alteraciones en la neuroimagen y, en los cinco con estudio neurofisiologico, este estaba alterado. Seis presentaron hipotonia muscular; ocho, amimia/hipomimia; seis, hipoacusia central, y cinco, gastrostomia. Un tercio presento un episodio de parada cardiorrespiratoria. En todos se detecto retraso psicomotor. Actualmente cinco realizan marcha autonoma por interiores y cuatro de ellos por exteriores. Un porcentaje elevado (77,7%) comprende ordenes simples y es capaz de comunicarse (66,6%). Conclusiones. Las alteraciones de los pares craneales, del tono muscular y la disfagia son las manifestaciones mas comunes en nuestra poblacion. El riesgo de broncoaspiracion y parada cardiorrespiratoria supone una amenaza vital para estos pacientes. Todos los niños presentan retraso psicomotor y la mitad de ellos alcanza marcha autonoma. Dada la diversidad de discapacidad que presentan estos pacientes, consideramos necesario un tratamiento de rehabilitacion integral e individualizado para conseguir un nivel funcional optimo. Necesitamos estudios con muestras mas amplias para obtener grupos homogeneos y establecer el pronostico funcional y las necesidades de tratamiento rehabilitador.

  9. Prevalence of dermatoses in dermatologic evaluation requests from patients admitted to a tertiary hospital for 10 years*

    PubMed Central

    Dantas, Lia Dias Pinheiro; Bakos, Lucio; Balbinot, Gabriela; Drechsler, Carine Elisabete Rost; Eidt, Letícia Maria

    2015-01-01

    Skin diseases are common in hospitalized patients. However, there is a lack of data concerning their frequency. The objective of this study is to evaluate the prevalence of dermatological diagnoses in hospitalized patients after consultation requested by nondermatologist physicians to the Department of Dermatology, Hospital de Clinicas de Porto Alegre period of 10 years. A total of 5685 patients were evaluated, representing an average of 48.2 patients per month. The five most frequent groups were infectious dermatoses(33.25%), eczematous dermatoses (11.49%), drug reactions (11.43%), vascular dermatoses (6.81%) and group of pruritus, prurigo nodularis and urticaria (hives) (4.71%). PMID:26560228

  10. Molecular Characterization of Attenuated Junin Virus Variants.

    DTIC Science & Technology

    1992-07-14

    No. DAMD17-89-Z-9024 Area de Quimica Biologica y Biologia Molecular Facultad de Ciencias Exactas Universidad Nacional de La Plata Calles 47 y 115, 1900...MONITORING ORGANIZATION Area de Quimica Biologica (If applicable) y Biologia Molecular I 6c. ADDRESS (City, State, and ZIPCode) 7b. ADDRESS (City, State...etc. 3. "Detecci6n temprana de virus Junin en muestras clinicas por amplificaci6n de ,cidos nucleicos" M.E. Lozano, P.D. Ghiringhelli, V. Romanowski

  11. Building market share in the Latino Community.

    PubMed

    Stevenson, Paul B; Elzey, Thomas J; Romagoza, Juan

    2002-05-01

    Within the next few years, the Latino community will become the largest cultural segment in the United States. Hospitals face many barriers in addressing the needs of the Latino community, including language, cultural influences, and perception of health care. Economics, demographics, and regulations dictate the need to take action, but concerns over costs, lack of skills, and negative attitudes create barriers to success. A unique partnership in Washington, D.C., between La Clinica de Pueblo, a grassroots clinic serving the Latino community, and Howard University Hospital offers insight into an effective strategy that hospitals can adopt to meet the needs of this community appropriately.

  12. A partnership approach for Electronic Data Capture in small-scale clinical trials.

    PubMed

    Franklin, Joshua D; Guidry, Alicia; Brinkley, James F

    2011-12-01

    Amid researchers' growing need for study data management, the CTSA-funded Institute for Translational Health Sciences developed an approach to combine technical and scientific resources with small-scale clinical trials researchers in order to make Electronic Data Capture more efficient. In a 2-year qualitative evaluation we found that the importance of ease of use and training materials outweighed number of features and functionality. EDC systems we evaluated were Catalyst Web Tools, OpenClinica and REDCap. We also found that two other systems, Caisis and LabKey, did not meet the specific user needs of the study group.

  13. Translation, adaptation, and validation of the Stanford Hypnotic Clinical Scale in Puerto Rico.

    PubMed

    Deynes-Exclusa, Yazmin; Sayers-Montalvo, Sean K; Martinez-Taboas, Alfonso

    2011-04-01

    The only hypnotizability scale that has been translated and validated for the Puerto Rican population is the Barber Suggestibility Scale (BSS). In this article, the Stanford Hypnotic Clinical Scale (SHCS) was translated and validated for this population. The translated SHCS ("Escala Stanford de Hipnosis Clinica" [ESHC]) was administered individually to 100 Puerto Rican college students. There were no significant differences found between the norms of the original SHCS samples and the Spanish version of the SHCS. Both samples showed similar distributions. The Spanish version's internal reliability as well as the item discrimination index were adequate. The authors conclude that the ESHC is an adequate instrument to measure hypnotizability in the Puerto Rican population.

  14. [The women's contribution to occupational health at the end of the nineteenth century].

    PubMed

    Salerno, Silvana

    2011-01-01

    In the late nineteenth century Italian working class was mainly represented by women. An extraordinary women movement (Laura Solera Mantegazza, Gualberta Adelaide Beccari, Anna Maria Mozzoni, Ersilia Majno Bronzini, Nina Rignano Sullam, Giuseppina Poggiolini among others) including the first Italian women physicians (Anna Kuliscioff, Maria Montessori, Gina Lombroso, Linita Beretta and the very close to become physician Anna Fraentzel Celli) build up associations, journals, books, schools, researches, and petitions. The first law on women and child labour (1902), the First Congress on Occupational illnesses (1906), the birth of the Clinica del Lavoro (1910) represent only part of this contribution which has been almost forgotten and should be enlightened.

  15. Intramural esophagic hematoma secondary to coumarinic anticoagulation: a case report

    PubMed Central

    2009-01-01

    Esophagic Intramural Hematoma is an uncommon clinical condition, with a prognosis which is essentially benign. On most cases, a predisposing or precipitating factor may be seen, with the most common ones being the history of esophagic instrumentation, food impactations and thrombocytopenia. In the following manuscript, the authors present the case of a 54-years-old male with history of valve replacement surgery, who was treated at the Clinica Cardiovascular (Medellin, Colombia), with a clinical case of Intramural Esophagic Hematoma that was later confirmed to be due to a Coumarinic overanticoagulation. On this case, it is evidenced that Intramural Esophagic Hematoma is an unrecognized complication of Courmarinic anticoagulation therapy. PMID:20069068

  16. A DXA Whole Body Composition Cross-Calibration Experience: Evaluation With Humans, Spine, and Whole Body Phantoms.

    PubMed

    Krueger, Diane; Libber, Jessie; Sanfilippo, Jennifer; Yu, Hui Jing; Horvath, Blaine; Miller, Colin G; Binkley, Neil

    2016-01-01

    New densitometer installation requires cross-calibration for accurate longitudinal assessment. When replacing a unit with the same model, the International Society for Clinical Densitometry recommends cross-calibrating by scanning phantoms 10 times on each instrument and states that spine bone mineral density (BMD) should be within 1%, whereas total body lean, fat, and %fat mass should be within 2% of the prior instrument. However, there is limited validation that these recommendations provide adequate total body cross-calibration. Here, we report a total body cross-calibration experience with phantoms and humans. Cross-calibration between an existing and new Lunar iDXA was performed using 3 encapsulated spine phantoms (GE [GE Lunar, Madison, WI], BioClinica [BioClinica Inc, Princeton, NJ], and Hologic [Hologic Inc, Bedford, MA]), 1 total body composition phantom (BioClinica), and 30 human volunteers. Thirty scans of each phantom and a total body scan of human volunteers were obtained on each instrument. All spine phantom BMD means were similar (within 1%; <-0.010 g/cm2 bias) between the existing and new dual-energy X-ray absorptiometry unit. The BioClinica body composition phantom (BBCP) BMD and bone mineral content (BMC) values were within 2% with biases of 0.005 g/cm2 and -3.4 g. However, lean and fat mass and %fat differed by 4.6%-7.7% with biases of +463 g, -496 g, and -2.8%, respectively. In vivo comparison supported BBCP data; BMD and BMC were within ∼2%, but lean and fat mass and %fat differed from 1.6% to 4.9% with biases of +833 g, -860 g, and -1.1%. As all body composition comparisons exceeded the recommended 2%, the new densitometer was recalibrated. After recalibration, in vivo bias was lower (<0.05%) for lean and fat; -23 and -5 g, respectively. Similarly, BBCP lean and fat agreement improved. In conclusion, the BBCP behaves similarly, but not identical, to human in vivo measurements for densitometer cross-calibration. Spine phantoms, despite good

  17. [Medicine and its museums].

    PubMed

    Acerbi Cremades, N

    1998-11-01

    There are described in this article the historical patrimonies belonging to five museums of Cordoba city, Argentina: the Museo de anatomia, which was named after Pedro Ara, notable Spanish Anatomist; the Museo de Anatomia Patologica; the Museo de Historia de la Medicina, created by Prof. Enrique P. Aznarez; the Museo "Obispo Salguero" of the Hospital San Roque; and the Museo Historico del Hospital Nacional de Clinicas, declared national historic monument. All these museums have a rich historic hoard, reflecting one of the important cultural aspects of this province.

  18. An investigation on some of the tumor treatment cases using x-rays and electron beams

    NASA Astrophysics Data System (ADS)

    Ucar, Burcu; Yigitoglu, Ibrahim; Arslan Kabalay, Ipek; Altiparmak, Duygu; Kilicaslan, Sinem

    2015-07-01

    In this work, we discussed some of the applications which X-rays and electron beam used in radiotherapy for tumor treatments. This study has been performed at Radiation Oncology Department, Medicine Faculty in Gaziosmanpasa University by using the VARIAN CLINICA DHX linear accelerator which is operated in the range of 6 MeV - 15 MeV. Processes for the treatments that X-rays used for pancreas, bladder and prostate tumors and the processes that the electron beam used for some of the derm tumors are studied. Effects of X-rays and electron beams to treatments process are examined and the obtained results are presented comparatively.

  19. Infraspinatus strength assessment and ultrasound evaluation of posterior capsulotenodesis after arthroscopic hill-sachs remplissage in traumatic anterior glenohumeral instability: a retrospective controlled study protocol.

    PubMed

    Merolla, Giovanni; Porcellini, Giuseppe

    2014-04-01

    Giovanni Merolla Co-investigator: Giuseppe Porcellini Investigation performed at the Biomechanics Laboratory "Marco Simoncelli", D. Cervesi Hospital, Cattolica - Italy PLAN OF CLINICAL INVESTIGATION (PCI): Version 1.0 of June 12, 2012 Approved by AV/IRST Ethical Committee (Comitato Etico Area Vasta Romagna) and authorized by AUSL RN ("Determina AUSL Rimini numero 326 del 29/03/2013: Remplissage U.O Chirurgia della Spalla - Valutazione clinica ed ultrasonografica dell'infraspinato dopo capsulo-tenodesi artroscopica (remplissage) nell'instabilità anteriore traumatica di spalla con lesione di Bankart e difetto omerale di Hill-Sachs").

  20. [The dispute and prospect of sedation and analgesia treatments in outpatient dental procedures].

    PubMed

    Cong, Yu

    2015-12-01

    The topic of eliminating the fear or pain of patients during dental therapy is gaining increasing attention from dentists across the country. The field of painless dental therapeutics involves a wide range of subjects, including stomatology, anesthesiology, and hospital management. We summarized the characteristics of sedation and analgesia technology in outpatient oral therapy, reviewed the common sedative and analgesic treatments, and discussed the disputes on the use of sedation and analgesia in dental procedures. We also reviewed the trends and breakthroughs in this area on the basis of our own clinica experiences.

  1. Military Suicide Research Consortium

    DTIC Science & Technology

    2014-10-01

    theory of depression: A review. Revista de Psicopatología y Psicología Clínica, 2, 211-222. 2. Joiner, T., Brown, D., Felthous, A., Barratt, E...another. Prevention and Treatment, 2, 0006c. 48. Joiner, T., Catanzaro, S., Laurent, J., Sandín, B., & Blalock, J. (1996). Revista de una modelo de...depresíon, ansiedad, y emocíon negativa. Revista de Psicopatologia y Psicologia Clinica, 1, 27-34. 49. Metalsky, G. I., Laird, R., Heck, P., & Joiner

  2. Military Suicide Research Consortium

    DTIC Science & Technology

    2015-10-01

    Metalsky, G. I. (1998). The hopelessness theory of depression: A review. Revista de Psicopatología y Psicología Clínica, 2, 211-222. 2. Joiner, T...Treatment, 2, 0006c. 48. Joiner, T., Catanzaro, S., Laurent, J., Sandín, B., & Blalock, J. (1996). Revista de una modelo de depresíon, ansiedad, y emocíon...negativa. Revista de Psicopatologia y Psicologia Clinica, 1, 27-34. 49. Metalsky, G. I., Laird, R., Heck, P., & Joiner, Jr., T. E. (1995

  3. Evaluation of Automated Yeast Identification System

    NASA Technical Reports Server (NTRS)

    McGinnis, M. R.

    1996-01-01

    One hundred and nine teleomorphic and anamorphic yeast isolates representing approximately 30 taxa were used to evaluate the accuracy of the Biolog yeast identification system. Isolates derived from nomenclatural types, environmental, and clinica isolates of known identity were tested in the Biolog system. Of the isolates tested, 81 were in the Biolog database. The system correctly identified 40, incorrectly identified 29, and was unable to identify 12. Of the 28 isolates not in the database, 18 were given names, whereas 10 were not. The Biolog yeast identification system is inadequate for the identification of yeasts originating from the environment during space program activities.

  4. [Auditing as a tool for ongoing improvement in the Stroke Care Plan of the Region of Aragon].

    PubMed

    Gimenez-Munoz, A; Palacin-Larroy, M; Bestue, M; Marta-Moreno, J

    2016-07-16

    Introduccion. El Plan de Atencion al Ictus de Aragon (PAIA) se creo en 2008 en el marco de la Estrategia Nacional en Ictus del Sistema Nacional de Salud. La monitorizacion de la atencion hospitalaria al ictus mediante auditorias periodicas se definio como una de sus lineas de trabajo. Objetivo. Determinar la calidad del proceso asistencial hospitalario prestado al paciente con ictus en Aragon mediante el uso de indicadores de calidad. Materiales y metodos. Se realizaron tres audits (en los años 2008, 2010 y 2012) siguiendo la misma metodologia, basada en la revision retrospectiva de una muestra representativa de ingresos por ictus en cada uno de los hospitales generales del Servicio Aragones de Salud. Se recogio informacion sobre 48 indicadores seleccionados segun su evidencia cientifica o relevancia clinica. Resultados. Se estudiaron 1.011 casos (331 en el primer audit, y 340 en el segundo y en el tercero). Treinta y un indicadores presentaron una mejoria significativa (entre ellos destacan los indicadores de calidad de la historia clinica, de evaluacion neurologica, las medidas preventivas iniciales y, con especial relevancia, la realizacion de test de deglucion), dos sufrieron empeoramiento (relacionados con el tratamiento rehabilitador) y 15 no registraron variaciones significativas. Conclusiones. La implantacion del PAIA ha supuesto una mejoria notable en la mayoria de los indicadores de calidad evaluados, reflejo de una mejora continua en la atencion hospitalaria del ictus. La generalizacion progresiva de la atencion especializada y la creacion de las areas de ictus son algunos de los factores determinantes.

  5. [Forced medical treatment: existent law and its limitations in a general hospital].

    PubMed

    Nitzan, Uri; Lev-Ran, Shaul; Phenig, Shmuel

    2011-04-01

    The conditions in which we can provide medical treatment without informed consent are detailed in the Israeli Law for Treating the Mentally Ill [1991), and the Law of Patient Rights (1996). Our clinicaL experience in a general hospital indicates that the law does not provide a satisfactory solution in cases where the patient is actively resisting emergency treatment. This may be the case for patients suffering from dementia, personality disorders or substance abuse disorders. Not infrequently, the physician finds himself perplexed in face of a genuine ethical/juridical dilemma, without being able to use the law efficiently or, at times, even implement it pragmatically. in this article, we review the array of laws by which Israeli physicians in general, and psychiatrists in particular, operate upon when deciding to treat a patient against his will in a general hospital. We describe and discuss a clinicaL case that raises fundamental questions concerning the existing law. We also discuss other complex cases, such as anorexia, debating the possibility of coercing medical treatment on someone who is not mentally ill--psychotic according to Israeli juridical system. Finally, we raise a few ideas as to how the present condition can be improved.

  6. [Metabolism of N-acetyl-L-aspartate: its diagnostic and prognostic value].

    PubMed

    Martinez, Manuel A; Florenzano, Néstor V; Macchia, Esteban A

    2016-04-16

    Objetivos. Analizar la implicacion clinica del aminoacido N-acetil-L-aspartato (NAA) y el peptido N-acetil-aspartil-glutamato (NAAG) en relacion con su valoracion diagnostica y pronostica mediante espectroscopia de resonancia magnetica. Realizar una revision del metabolismo del NAA y del NAAG, considerando su estructura quimica y fisiologia, en relacion con las variaciones de su concentracion y en correlacion con la clinica. Desarrollo. La revision se divide en dos partes: en una se comprobo que el unico sitio de sintesis del NAA es la mitocondria neuronal, y del NAAG, el citoplasma neuronal; la segunda parte aborda las tecnicas de resonancia magnetica y, particularmente, la espectroscopia. Se analizan diversas patologias en busca de criterios que posibiliten obtener pautas diagnosticas y pronosticas. Conclusiones. El estudio del aminoacido mas abundante del sistema nervioso central (NAA) junto con un producto de su metabolismo, el NAAG, permite en patologias de diversos origenes su diagnostico y seguimiento y facilita la obtencion de datos de densidad de la poblacion celular y vitalidad de esta, de manera que se accede, ademas, al estado funcional de las sinapsis.

  7. [Scientific productivity, collaboration and research areas in Enfermedades Infecciosas y Microbiología Clínica (2003-2007)].

    PubMed

    González-Alcaide, Gregorio; Valderrama-Zurián, Juan Carlos; Ramos-Rincón, José Manuel

    2010-10-01

    Collaboration is essential for biomedical research. The Carlos III Health Institute (the Spanish national public organization responsible for promoting biomedical research) has encouraged scientific collaboration by promoting Thematic Networks and Cooperative Research Centres. Scientific collaboration in Enfermedades Infecciosas y Microbiología Clinica journal is investigated. Papers published in Enfermedades Infecciosas y Microbiología Clinica in the period 2002-2007 have been identified. Bibliometrics and Social Network Analysis methods have been carried out in order to quantify and characterise scientific collaboration and research areas. A total of 805 papers generated by 2,289 authors and 326 institutions have been analysed. There were 36 research groups involving 138 authors identified. The Collaboration Index for articles was 5.5. Institutional collaboration was determined in 75% of articles. The collaboration between departments or units of the same institution prevails (43%), followed by intra-regional domestic collaboration (41%) and inter-regional domestic collaboration (14%). Hospital centres were the main institutional sector responsible of research (88% of papers), with 68% of articles cited. Sida/VIH (AIDS/HIV) is the main research area (n=114), followed by Staphylococcal Infections (n=33). Notable collaboration and citation rates have been observed. Research is focused on diseases with the highest mortality rates caused by infectious diseases in Spain. Copyright © 2009 Elsevier España, S.L. All rights reserved.

  8. [Evolution of epidemiological methods in clinical research in Spain (1975-1994)].

    PubMed

    Aibar Remón, C; Rabanaque, M J; Alvarez-Dardet, C; Nolasco, A; Moncho, J; Gascón, E

    1999-01-01

    Previous studies have shown a sparing utilization of analytical and experimental designs in Spanish clinical research journals. The study aims are to compare among countries, the use of epidemiologic method in articles published in scientific journals, and to determine the extent to which this research has direct funding. Cross-sectional study including all original papers published during 1994 in Medicina Clinica [(Med Clin (Barc)], Revista Clinica Española (Rev Clin Esp), The Lancet (Lancet) and New England Journal of Medicine (N Engl J Med). They were classified according to epidemiological design and we verified the financial support mention. 594 papers were included. Epidemiological studies without control group prevailed in Spanish journals. The most common designs were descriptive studies in Med Clin (Barc), with 45.5%, and clinical series in Rev Clin Esp, with 41.7%. The 33.6% of original papers published in Lancet and 28.4% of N England J Med were randomized trials. We found information about financial support in 73.7% of papers published in Lancet, in 77.4% of N Engl J Med, in 23.1% of Med Clin (Barc) papers and not one in the Rev Clin Esp studies. In Spanish clinical journals the use of epidemiological methods with control group is limited and direct financial support unusual. Wherefore these studies have a limited applicability.

  9. [The dementia of King Ferdinand VI and the year with no king].

    PubMed

    Fernandez-Menendez, S; Gonzalez-Gonzalez, J M; Alvarez-Antuna, V; Bobes, J

    2016-06-01

    Introduccion. Fernando VI fue rey de España entre 1746 y 1759. Su ultimo año de reinado se conoce como el año sin rey. Durante ese año, el monarca sufrio un rapido empeoramiento de sus condiciones mentales. La enfermedad generalmente ha sido atribuida a una condicion psiquiatrica primaria, generalmente por un trastorno bipolar. Desarrollo. Se realiza un estudio de investigacion en los archivos documentales españoles y bibliotecas en busca de informacion clinica sobre la enfermedad de Fernando VI. Se realiza una evaluacion y discusion clinica de la enfermedad del rey sobre la base de la informacion obtenida. Conclusiones. El inicio del empeoramiento clinico del ultimo año de Fernando VI empezo tras la muerte de su amada esposa. Los sintomas iniciales descritos pueden ser similares a los de un episodio depresivo mayor, sin embargo, el monarca sufrio un empeoramiento rapidamente progresivo con alteraciones de la personalidad, conductuales, encamamiento, perdida de control de esfinteres y crisis epilepticas. Los ultimos meses de su vida estuvo en un estado de postracion con un estado cognitivo compatible con una demencia grave. Por todo ello, aunque es posible que Fernando VI pudiera padecer previamente algun tipo de trastorno psiquiatrico, la enfermedad que le llevo a su muerte precoz seria compatible con lo que hoy conocemos como una demencia rapidamente progresiva.

  10. [RIT1: a novel gene associated with Noonan syndrome].

    PubMed

    Arroyo-Carrera, I; Solo de Zaldivar-Tristancho, M; Martin-Fernandez, R; Vera-Torres, M; Gonzalez de Buitrago-Amigo, J F; Botet-Rodriguez, J

    2016-10-16

    Introduccion. El sindrome de Noonan es el mas frecuente del grupo de los sindromes malformativos congenitos originados por mutaciones germinales en genes de la via RAS/MAPK, denominados genericamente RAS-opatias, uno de los grupos mas comunes de alteraciones geneticas congenitas en la practica clinica. Recientemente se han descrito mutaciones en el gen RIT1 en pacientes con sindrome de Noonan. Caso clinico. Nina de 7 anos con diagnostico clinico de sindrome de Noonan, que entre sus manifestaciones clinicas incluye miocardiopatia hipertrofica, en la que se ha identificado una mutacion de novo en heterocigosis, en RIT1, c.295T>C (p.Phe99Leu), no descrita previamente, probablemente causal. Conclusiones. RIT1 comparte homologia con otras proteinas RAS y la expresion de alelos mutantes origina un efecto de ganancia de funcion que apoya su papel causal en el sindrome de Noonan. Podemos estimar actualmente que es responsable de un 3-5% de los casos del sindrome. Estos casos con sindrome de Noonan, respecto a los que presentan mutaciones en otros genes, se caracterizan por una mayor frecuencia de alteraciones prenatales, alta frecuencia de miocardiopatia hipertrofica y menor frecuencia de talla baja y deformidad toracica. Destaca la importancia de incorporar los nuevos genes identificados en los paneles diagnosticos.

  11. [Familial microepidemic of food-borne botulism in the Region of Madrid].

    PubMed

    Jalda, D; Junco, A; Alvarez-Moreno, M; Rodero, I; Carneado-Ruiz, J

    2016-07-01

    Introduccion. El botulismo es un sindrome causado por la toxina del bacilo Clostridium botulinum. La toxina actua bloqueando las terminaciones colinergicas presinapticas de la placa motora y del sistema nervioso parasimpatico, y ocasiona una paralisis flacida y un fallo parasimpatico. El modo mas habitual de adquisicion de la enfermedad es por ingesta de toxina preformada presente en las conservas caseras mal esterilizadas, aunque otros mecanismos son posibles. Su incidencia actual en Espana es muy baja. Casos clinicos. Se describen tres miembros convivientes de una familia que presentaron un cuadro de botulismo alimentario. Las manifestaciones clinicas iniciales mostraron predileccion por la paresia ocular y por sintomatologia disautonomica de escasa especificidad, y la agregacion familiar fue el indicio fundamental que sugirio el diagnostico. Posteriormente, los pacientes empeoraron y dos de ellos presentaron afectacion de la funcion respiratoria y precisaron ingreso prolongado en la unidad de cuidados intensivos. Los tres pacientes convalecieron y se recuperaron sin secuelas. Se consiguio detectar la toxina botulinica por bioensayo en los restos de alimentos, lo que confiere al caso la categoria diagnostica de confirmado. Conclusiones. La microepidemia familiar presentada constituye un caso de afectacion inicial predominantemente ocular y disautonomica. Asimismo, ilustra varios aspectos tipicos de la enfermedad: la sospecha diagnostica ante pacientes convivientes que acuden simultaneamente por clinica similar, las complicaciones caracteristicas del proceso y su tratamiento, el diagnostico de laboratorio y su historia natural hacia la resolucion.

  12. [Optic neuritis in childhood. A pediatric series, literature review and treatment approach].

    PubMed

    Lopez-Martin, D; Martinez-Anton, J

    2016-08-01

    Introduccion. En la edad pediatrica, la forma mas frecuente de neuritis optica se presenta generalmente despues de un cuadro infeccioso, con edema de papila, que suele ser bilateral y tiene buen pronostico. La conversion a esclerosis multiple es infrecuente. Objetivo. Presentar las caracteristicas clinicas y de laboratorio de una serie pediatrica de neuritis optica. Pacientes y metodos. Se analiza una serie de 17 casos de neuritis optica en niños y jovenes de 4 a 14 años, referidos entre los años 2000 y 2015. Resultados. La edad mediana de la serie fue de 11 años. Predominaron los pacientes de sexo femenino y el antecedente infeccioso fue poco frecuente; en cinco pacientes, la afectacion fue bilateral, y cuatro casos se presentaron como neuritis optica retrobulbar. La resonancia magnetica mostro hiperintensidad en T2 en los nervios opticos afectados en cinco pacientes. El estudio del liquido cefalorraquideo y bandas oligoclonales fue normal en todos los casos. Los pacientes, tratados con metilprednisolona intravenosa, tuvieron buena recuperacion. Solo en tres casos se comprobo una evolucion posterior a esclerosis multiple. Conclusiones. En esta serie, los casos que evolucionaron a esclerosis multiple no mostraron diferencias clinicas, aunque si presentaron mayor cantidad de lesiones hiperintensas en la resonancia magnetica. Este hecho, descrito en trabajos previos, apoya nuestro esquema diagnostico y terapeutico en un intento por acercarnos al manejo optimo de esta patologia.

  13. [Clinical usefulness and psychometric properties of the Cambridge Behavioural Inventory].

    PubMed

    Fernandez-Martinez, R; Kokoulina, E; Carballido-Araujo, E; Garcia-Fuertes, I; Gutierrez-Martinez, O; Santiago-Lopez, F; Vazquez-Batan, P

    2016-11-16

    Introduccion. Un area importante de la evaluacion neuropsicologica son los sintomas psicologicos y conductuales. El inventario conductual de Cambridge –Cambridge Behavioural Inventory (CBI)– es una medida de autoinforme dirigida a allegados que recoge una amplia variedad de sintomas conductuales que pueden darse en el curso de las enfermedades neurologicas. El principal objetivo del estudio es comprobar la utilidad clinica de su adaptacion al castellano. Sujetos y metodos. El CBI fue cumplimentado por 215 allegados de pacientes remitidos desde los servicios de neurologia y psiquiatria. Se compararon los perfiles del CBI de cuatro grupos de pacientes formados sobre la base de sus principales caracteristicas clinicas, datos psicometricos, pruebas de imagen y juicio clinico del profesional solicitante del estudio neuropsicologico. Resultados. La mayoria de las escalas (10 de 13) del CBI tuvo valores de consistencia interna aceptables, y las escalas de memoria y atencion/orientacion, correlaciones elevadas con medidas objetivas de memoria y orientacion temporal. Los perfiles del CBI de los grupos de pacientes con distintas condiciones (trastorno organico de la memoria, trastorno funcional de la memoria, variante conductual de demencia frontotemporal y enfermedad de Alzheimer) fueron consistentes con sus principales caracteristicas. Conclusiones. El CBI es un instrumento psicometricamente fiable y con adecuada validez convergente y discriminante que puede ser util en el proceso de evaluacion neuropsicologica, aportando informacion relevante no solo sobre el funcionamiento cognitivo y las capacidades funcionales, sino tambien sobre los sintomas conductuales y psicologicos de los pacientes con trastornos cognitivos.

  14. [Cognitive performance and quality of life in multiple sclerosis in Gipuzkoa].

    PubMed

    Sistiaga, Andone; Castillo-Triviño, Tamara; Aliri, Jone; Gaztañaga, Mirari; Acha, Joana; Arruti, Maialen; Otaegui, David; Olascoaga, Javier

    2014-04-16

    Introduccion. El deterioro cognitivo y la presencia de sintomas depresivos, comunes en los pacientes con esclerosis multiple, inciden en la calidad de vida de los pacientes. Objetivo. Describir la calidad de vida, la afectacion cognitiva y los niveles de depresion, en relacion con otras variables clinicas, en los pacientes con esclerosis multiple de la provincia de Gipuzkoa. Pacientes y metodos. Se evaluo neuropsicologicamente a 114 pacientes. Se incluyeron el MSQoL-54 y el inventario de depresion de Beck para evaluar la calidad de vida y los niveles de depresion. Se emprendieron tres analisis principales: comparacion del rendimiento cognitivo entre subtipos, analisis de correlacion entre variables clinicas, neuropsicologicas y de calidad de vida, y analisis sobre los efectos del genero en el rendimiento cognitivo. Resultados. Se halla en la esclerosis multiple un patron neuropsicologico caracterizado por enlentecimiento en el procesamiento de la informacion y dificultades atencionales. La calidad de vida se relaciona con sintomas depresivos y con el rendimiento cognitivo global pero no con factores clinicos como la tasa de brote o la duracion de la enfermedad. Los datos confirman un peor rendimiento cognitivo en los hombres, sobre todo en la memoria auditiva verbal. Conclusiones. El genero se presenta como un factor modulador en el impacto de la enfermedad sobre el rendimiento cognitivo, que refuerza el interes de estudios que clarifiquen el origen de dichas diferencias. Ademas, la calidad de vida muestra una mayor relacion con la adaptacion a la enfermedad que con sus sintomas.

  15. [Structural congenital myopathies].

    PubMed

    Erazo-Torricelli, Ricardo

    2013-09-06

    Introduccion. Las miopatias congenitas son un grupo heterogeneo de enfermedades que comparten clinica de inicio precoz y alteraciones histopatologicas musculares especificas. El estudio genetico permite determinar la mutacion causal en la mayoria de los casos. Existe heterogeneidad fenotipica y genotipica, lo que se ilustra al observar que un genotipo puede expresarse en mas de una forma clinicopatologica y un fenotipo puede estar causado por diferentes mutaciones geneticas. Desarrollo. En esta revision, se detallan las caracteristicas de las principales miopatias congenitas que permiten su identificacion clinica, patologica y genetica. Se describen los hallazgos de la biopsia muscular que constituyen el principal pilar diagnostico. Se enfatiza y se detalla la importancia del diagnostico diferencial, descartando otras patologias que se presentan con hipotonia en la lactancia o el periodo neonatal. Se destacan las formas neonatales graves (nemalinica, miotubular ligada al X) que se deben identificar precozmente para establecer el pronostico y brindar un consejo genetico adecuado. Se subrayan las mutaciones del gen rianodina (RYR1) por su asociacion a la hipertermia maligna y las mutaciones de la selenoproteina 1 (SEPN1) y la miopatia nemalinica por su asociacion a hipoventilacion nocturna. Conclusiones. El conocimiento profundo de las miopatias estructurales congenitas facilita la confirmacion diagnostica de la miopatia congenita, lo que permite la aplicacion oportuna de medidas relacionadas con la respiracion y la alimentacion de los casos mas graves y con la optimizacion de la funcion motora en todos los pacientes con miopatia congenita.

  16. [Increasing difficulties for scientific publication in Venezuela].

    PubMed

    Ryder, Elena

    2014-03-01

    A very important increase in the costs of the edition of scientific journals has taken place in Venezuela, due to difficulties in obtaining imported free acid paper and other materials used for handling documents. Like other journals, Investigaci6n Clinica has been considering switching completely to a digital publication format; however there are several reasons that prevent us to doing it at this time: the journal is distributed in printed form to many national institutions, which do not have immediate access to digital information. In addition, there exists a commitment of shipment of printed issues for some international indices and in exchange with other national and foreign journals, whose printed format we receive. Another important aspect is that our University maintains a weak technological platform that makes difficult the immediacy required for the interchange with authors and consulted referees of received papers; and there is a latent danger of limitations in the use of digital technologies, due to current national politic problems. Consequently, we need to continue with the printed format, but must reduce the amount of printed issues, so as not to limit the number of papers published in each edition. Nevertheless, there is an ever increasing number of contributions from foreign researches and Investigaci6n Clinica has been recently included in two new international indices, the SEIIC from Argentina and the Infobase Index from India, reasons that obligate us to maintain our levels of excellence and commitment to our authors and readers.

  17. [Spanish validation of the Iowa Rating Scale for Personality Change (IRSPC) for the appraisal of changes in personality in patients with acquired brain injury].

    PubMed

    Guallart-Balet, María; Jiménez-Cortés, Marta P; Tuquet-Calvo, Helena; Pelegrín-Valero, Carmelo; Olivera-Pueyo, Javier; Benabarre-Ciria, Sergio; Tirapu-Ustárroz, Javier

    2015-01-01

    Introduccion. La Iowa Rating Scale for Personality Change (IRSPC) presenta una serie de caracteristicas (enfasis en las funciones motivacionales y emocionales, evaluacion de las funciones ejecutivas 'cognitivas' en la vida cotidiana, estimacion de la personalidad premorbida, valoracion de la fiabilidad del informador) que hacen muy interesante su utilizacion tanto en la clinica como en la investigacion. Objetivo. Validar en castellano la IRSPC para la evaluacion de los 'cambios de personalidad' secundarios a las lesiones cerebrales de la corteza prefrontal en general y del area ventromedial en particular. Pacientes y metodos. Tras el proceso de traduccion y adaptacion de la guia de la escala al castellano, se realizo un estudio de validacion con 31 pacientes con daño cerebral traumatico y se obtuvieron unos resultados de fiabilidad muy adecuados. Resultados. Los resultados obtenidos al medir la consistencia interna de la IRSPC y los coeficientes de fiabilidad interobservadores y test-retest apoyan dicha afirmacion. La validez del instrumento es confirmada por la validez concurrente (comparandolo con el inventario neuropsiquiatrico) y la validez de constructo (comparando las puntuaciones de los pacientes antes y despues del traumatismo). Conclusiones. La IRSPC es un instrumento fiable y valido para la exploracion clinica, en el contexto de una evaluacion integral de los sintomas derivados de las enfermedades neurologicas en general, y en particular de aquellas en las que se encuentra involucrada la corteza prefrontal ventromedial.

  18. [Prefrontal Symptoms Inventory (PSI): ecological validity and convergence with neuropsychological measures].

    PubMed

    Pedrero-Perez, E J; Ruiz-Sanchez de Leon, J M; Rojo-Mota, G; Morales-Alonso, S; Pedrero-Aguilar, J; Lorenzo, I; Gonzalez, A

    2016-09-16

    Introduccion. El inventario de sintomas prefrontales (ISP) es un cuestionario autoinformado creado en España que interroga sobre alteraciones cognitivas, emocionales y comportamentales en las actividades de la vida diaria y que resulta aplicable tanto en poblacion general como en multiples poblaciones clinicas. Existe una version abreviada de 20 items (ISP-20) con excelentes propiedades psicometricas para el cribado. Objetivo. Estudiar la validez convergente y divergente del ISP e ISP-20, analizando como sus escalas reflejan las consecuencias cotidianas de deficits reales hallados en evaluacion neuropsicologica mediante pruebas de ejecucion. Pacientes y metodos. Se estudiaron 52 personas con adiccion a sustancias en tratamiento (31 varones y 21 mujeres) a las que se administro el ISP junto con una bateria de exploracion neuropsicologica abreviada centrada en describir procesos atencionales, mnemicos y ejecutivos. Resultados. Ambas versiones del ISP presentan optimas propiedades psicometricas (0,78 > alfa > 0,94 para la version completa de 46 items y 0,7 > alfa > 0,89 para la version abreviada de 20 items). Los resultados confirman las hipotesis sobre su validez: la escala de problemas en la ejecucion se relaciona con la capacidad para resolver tests que presumiblemente valoran funciones ejecutivas de origen prefrontal (validez convergente), mientras que las escalas de problemas en el control emocional y problemas en la conducta social no se relacionan con dichas capacidades cognitivas (validez discriminante). Conclusiones. El ISP es una prueba clinicamente util, psicometricamente valida y aplicable en multiples poblaciones clinicas.

  19. [The difficult start of nephrology in Rome].

    PubMed

    Cagli, V; Cinotti, G A

    2009-01-01

    Nephrology in Rome began in the 1960s with the arrival of Ernico Fiaschi in the wake of Cataldo Cassano at the Institute of Medical Pathology (later on Clinica Medica II). A group of doctors interested in nephrology was set up, with among them Giulio A. Cinotti, who was to become full professor of nephrology at the University of Rome ''La Sapienza'' in 1980. By the end of the 1960s, the renal transplant activity had become an important asset at the Institute of Surgical Pathology (later on Clinica Chirurgica II) thanks to Paride Stefanini. A chair of surgical nephrology was instituted at the Urology Clinics of Ulrico Bracci; the chair was first held by Nicola Cerulli, who developed an intensive hemodialysis program. Around the same time, the Center for the Research and Treatment of Arterial Hypertension and Kidney Diseases became operational at the hospitals of Rome (under the responsibility of Vito Cagli at the Policlinico Umberto I), while a nephrology and dialysis unit, directed by Giancarlo Ruggieri, was set up at the San Giacomo Hospital. Many nephrology-related ''cultural'' activities started to be undertaken thanks to the ''Gruppo Laziale di Nefrologia Medica e Chirurgica'' founded by Drs Cagli, Cerulli, and Cinotti. Two national congresses were organized by Giulio Cinotti in 1979 (Fiuggi) and 1992 (Rome).

  20. Simplifying electronic data capture in clinical trials: workflow embedded image and biosignal file integration and analysis via web services.

    PubMed

    Haak, Daniel; Samsel, Christian; Gehlen, Johan; Jonas, Stephan; Deserno, Thomas M

    2014-10-01

    To improve data quality and save cost, clinical trials are nowadays performed using electronic data capture systems (EDCS) providing electronic case report forms (eCRF) instead of paper-based CRFs. However, such EDCS are insufficiently integrated into the medical workflow and lack in interfacing with other study-related systems. In addition, most EDCS are unable to handle image and biosignal data, although electrocardiography (EGC, as example for one-dimensional (1D) data), ultrasound (2D data), or magnetic resonance imaging (3D data) have been established as surrogate endpoints in clinical trials. In this paper, an integrated workflow based on OpenClinica, one of the world's largest EDCS, is presented. Our approach consists of three components for (i) sharing of study metadata, (ii) integration of large volume data into eCRFs, and (iii) automatic image and biosignal analysis. In all components, metadata is transferred between systems using web services and JavaScript, and binary large objects (BLOBs) are sent via the secure file transfer protocol and hypertext transfer protocol. We applied the close-looped workflow in a multicenter study, where long term (7 days/24 h) Holter ECG monitoring is acquired on subjects with diabetes. Study metadata is automatically transferred into OpenClinica, the 4 GB BLOBs are seamlessly integrated into the eCRF, automatically processed, and the results of signal analysis are written back into the eCRF immediately.

  1. [Peripheral nervous system and speech disorders].

    PubMed

    Ferri, Lluís

    2014-02-24

    Introduccion. Las afectaciones de la neurona motora inferior en la infancia, de etiologia congenita o adquirida, provocan dificultades en la respuesta motriz del habla en un periodo especialmente critico para el desarrollo del lenguaje. El interes por esta patologia radica en su baja incidencia, en su comorbilidad con otras afectaciones cerebrales y en su pronostico incierto. Objetivo. Hacer una revision de las alteraciones motoras del habla, de la valoracion funcional y de la intervencion logopedica en la disartria flacida. Desarrollo. Se plantea la caracterizacion clinica de las alteraciones en la produccion verbal de origen periferico, concretamente de la disartria flacida y sus manifestaciones respiratorias, fonatorias, de resonancia, de articulacion y de prosodia. Seguidamente, se esboza la valoracion funcional y se plantean las lineas de intervencion para su tratamiento. Conclusiones. Las manifestaciones clinicas de la disartria flacida son muy heterogeneas y van desde leves dificultades articulatorias a graves trastornos que limitan gravemente la capacidad para la expresion verbal. En la mayoria de los casos, la exploracion funcional proporciona hallazgos valiosos para su identificacion y tipificacion, para determinar la necesidad de valoraciones complementarias y para establecer el programa idoneo de intervencion logopedica. La participacion guiada de la familia y el abordaje interdisciplinar son factores que contribuyen decisivamente a mejorar estos procesos.

  2. [The language area of the brain: a functional reassessment].

    PubMed

    Ardila, Alfredo; Bernal, Byron; Rosselli, Monica

    2016-02-01

    Introduccion. Hacia finales del siglo XIX y comienzos del siglo XX, y basandose en observaciones clinicas, se propuso que existe un 'area del lenguaje' en el cerebro que corresponde, en general, a la region perisilviana del hemisferio izquierdo. Tal idea ha continuado existiendo desde entonces. Objetivo. Partiendo de los estudios contemporaneos de imagenes cerebrales, reanalizar la localizacion y extension del area del lenguaje con relacion a las diferentes areas de Brodmann. Materiales y metodos. Utilizando la metodologia conocida como metaanalytic connectivity modeling, se revisan varios estudios metaanaliticos en los cuales se analizan las imagenes de resonancia magnetica funcional durante la realizacion de tareas linguisticas. Resultados. Se encontro que existen dos sistemas linguisticos diferentes en el cerebro: un sistema lexico/semantico, relacionado con el area de Wernicke, y que incluye un area de Wernicke central (reconocimiento de palabras) y un area de Wernicke extendida (asociaciones linguisticas); y un sistema gramatical, dependiente del complejo de Broca (produccion del lenguaje y gramatica), en el lobulo frontal, y que se extiende subcorticalmente. Se propone tambien que la insula desempeña un papel de coordinacion de estos dos sistemas linguisticos cerebrales. Conclusion. Los estudios contemporaneos de neuroimagen sugieren que el area del lenguaje en el cerebro es notoriamente mas amplia de lo que se supuso hace un siglo basandose en observaciones clinicas. Tal como se consideraba durante el siglo XIX, la insula parece desempeñar un papel critico en el lenguaje.

  3. [Quantitative gait analysis in patients with advanced Parkinson's disease].

    PubMed

    Villadoniga, M; San Millan, A; Cabanes-Martinez, L; Aviles-Olmos, I; Del Alamo-De Pedro, M; Regidor, I

    2016-08-01

    Objetivo. Describir las alteraciones de la marcha e inestabilidad postural en un grupo de pacientes con enfermedad de Parkinson (EP) avanzada. Pacientes y metodos. Se analizo la marcha de pacientes con EP en estadio avanzado on medicacion. Por medio de un sistema de analisis computarizado del movimiento, se estudiaron las variables cinematicas: cadencia, numero de ciclos con apoyo correcto (ciclos HFPS), numero de ciclos totales, duracion de las fases del ciclo, electromiografia, y goniometria de rodilla y tobillo. La valoracion clinica del equilibrio y la inestabilidad postural se completo con los tests Tinetti y Timed Up and Go. Resultados. El analisis mostro alteraciones en los parametros espaciotemporales con respecto a los rangos de normalidad: disminucion de los ciclos HFPS, aumento del numero total de ciclos y alteracion de la cadencia en muchos pacientes, y conservacion de la cadencia media dentro de los limites de la normalidad, aumento de la duracion de la fase de apoyo, disminucion del apoyo monopodal y alteracion del rango articular de la rodilla y el tobillo. Asimismo, se observo una alteracion en las puntuaciones obtenidas en las escalas clinicas, que mostraban un aumento del factor de riesgo de caidas y dependencia leve. Conclusion. La cuantificacion mediante analisis objetivo de las variables cineticas y cinematicas en los pacientes con EP puede emplearse como herramienta para establecer la influencia de las distintas alternativas terapeuticas en el trastorno de la marcha.

  4. [Pharmacogenetics and antiepileptic drug metabolism: implication of genetic variants in cytochromes P450].

    PubMed

    Saldaña-Cruz, Ana Miriam; Sánchez-Corona, José; Márquez de Santiago, Daniel Alejandro; García-Zapién, Alejandra Guadalupe; Flores-Martínez, Silvia Esperanza

    2013-05-01

    Introduccion. Los farmacos antiepilepticos (FAE) son la base para el control de las crisis en pacientes con epilepsia; sin embargo, se conoce que el 20-30% de los pacientes son farmacorresistentes. Son diversos los factores que contribuyen a la variabilidad de la respuesta a los FAE, y esta variabilidad puede atribuirse, al menos en parte, a la presencia de polimorfismos (variaciones de la secuencia) en genes que codifican para enzimas involucradas en el metabolismo de los FAE. Objetivo. Describir las variaciones de la secuencia en genes que codifican para proteinas implicadas en el metabolismo de algunos de los principales FAE, con enfasis en las enzimas citocromo P450 (CYP450). Desarrollo. Existen algunos polimorfismos en genes que codifican para proteinas involucradas en el metabolismo de farmacos, particularmente enzimas de la superfamilia CYP450, que se consideran ya de utilidad clinica en el manejo terapeutico. La presencia de estas variantes geneticas contribuye a la variabilidad de la actividad de enzimas metabolizadoras, lo que, a su vez, influye en la pobre o inadecuada respuesta terapeutica, e incluso en la aparicion de efectos adversos. Conclusiones. La identificacion de la variabilidad interindividual en la respuesta a los diversos FAE puede permitir la individualizacion del tratamiento con la intencion de maximizar su eficacia y minimizar el riesgo, independientemente de que la variabilidad clinica y los efectos adversos se presenten en una minoria de pacientes.

  5. [Integrated management of childhood illness (IMCI) for iron deficiency in children].

    PubMed

    López, Diana F; Benjumea, María V

    2011-02-01

    Evaluating implementing the integrated management of childhood illness (IMCI) strategy in the prevention, detection and treatment of iron deficiency in children aged less than 5 who were treated at ASSBASALUD's Clinica La Asunción in Manizales, Colombia, during 2007. This was a cross-sectional study of 310 children aged 6 to 71 months who attended the first-level Clinica La Asunción in Manizales. Iron deficiency prevalence was evaluated in the children, as was IMCI implementation for prevention, diagnosis and treatment by health professionals responsible for child-care at that centre. Most children were aged less than 24 months, came within category 2 in the Identification and Classification System for Potential Beneficiaries for Social Programmes (SISBEN) and had been treated by Growth and Development section nurses. Children suffering from iron deficiency without anaemia accounted for most of those affected by iron deficiency. In half the population suffering anaemia this was due to iron deficiency; anaemia prevalence was higher than other types of infection-associated anaemia. For every child suffering iron deficiency-related anaemia, almost three had iron deficiency. Only six people accompanying the children being studied said that they had received indications for the dietary prevention of anaemia and this was wrong in half of the cases. These results showed that when caring for children aged less than five, prevention, diagnosis and treatment of iron deficiency anaemia did not follow the guidelines provided by the IMCI strategy.

  6. Experience of using an open source clinical trials data management software system in Kenya.

    PubMed

    Ngari, Moses M; Waithira, Naomi; Chilengi, Roma; Njuguna, Patricia; Lang, Trudie; Fegan, Greg

    2014-11-26

    Clinical trials data management (CTDM) remains one of the many challenges in running state of the art trials in resource-poor settings since most trials do not allocate, or have available, sufficient resources for CTDM and because of poor internet connectivity. Open-source software like OpenClinica could be a solution in such scenarios. In 2007, the KEMRI-Wellcome Trust Research Programme (KWTRP) adopted OpenClinica (OC) community edition, an open-source software system and we share our experience and lessons learnt since its adoption. We have used OC in three different modes; direct remote data entry from sites through Global System for Mobile Communications (GSM) modems, a centralized data centre approach where all data from paper records were entered at a central location and an off-line approach where data entry was done from a copy of database hosted on a field-site server laptop, then data uploaded to a centralized server later. We have used OC in eleven trials/studies with a cumulative number of participants in excess of 6000. These include large and complex trials, with multiple sites recruiting in different regions of East Africa. In the process, we have developed substantial local capacity through hands-on training and mentorship, which we have now begun to share with other institutions in the region. Our experience demonstrates that an open source data management system to manage trials' data can be utilized to international industry standards in resource-poor countries.

  7. Electronic Patient Reported Outcomes in Paediatric Oncology - Applying Mobile and Near Field Communication Technology.

    PubMed

    Duregger, Katharina; Hayn, Dieter; Nitzlnader, Michael; Kropf, Martin; Falgenhauer, Markus; Ladenstein, Ruth; Schreier, Günter

    2016-01-01

    Electronic Patient Reported Outcomes (ePRO) gathered using telemonitoring solutions might be a valuable source of information in rare cancer research. The objective of this paper was to develop a concept and implement a prototype for introducing ePRO into the existing neuroblastoma research network by applying Near Field Communication and mobile technology. For physicians, an application was developed for registering patients within the research network and providing patients with an ID card and a PIN for authentication when transmitting telemonitoring data to the Electronic Data Capture system OpenClinica. For patients, a previously developed telemonitoring system was extended by a Simple Object Access Protocol (SOAP) interface for transmitting nine different health parameters and toxicities. The concept was fully implemented on the front-end side. The developed application for physicians was prototypically implemented and the mobile application of the telemonitoring system was successfully connected to OpenClinica. Future work will focus on the implementation of the back-end features.

  8. [Attention deficit hyperactivity disorder: from a neurodevelopmental perspective].

    PubMed

    Fernandez-Jaen, A; Lopez-Martin, S; Albert, J; Martin Fernandez-Mayoralas, D; Fernandez-Perrone, A L; Calleja-Perez, B; Lopez-Arribas, S

    2017-02-24

    Introduccion. Los trastornos del neurodesarrollo engloban a un grupo heterogeneo de trastornos como la discapacidad intelectual, el trastorno del espectro autista o los trastornos especificos del aprendizaje, entre otros. La reciente inclusion en las clasificaciones internacionales del trastorno por deficit de atencion/hiperactividad (TDAH) dentro de los trastornos del neurodesarrollo parece claramente justificada atendiendo a variables neurobiologicas y clinicas. Desarrollo. El caracter dimensional y la distribucion de diferentes sintomas en la poblacion caracterizan a la mayoria de los trastornos del neurodesarrollo. Se revisan estos aspectos, particularmente desde la sintomatologia y neuropsicologia en el TDAH. El caracter sintomatico dimensional del TDAH contrasta con los criterios diagnosticos de este trastorno de acuerdo a diferentes clasificaciones o guias clinicas. Contrasta igualmente con los datos recogidos a traves de diferentes exploraciones complementarias (escalas, tests...). Conclusiones. El entendimiento del continuo clinico dentro de cada trastorno del neurodesarrollo (incluido el TDAH), entre los diferentes trastornos del neurodesarrollo, y entre los trastornos del neurodesarrollo y la normalidad, es esencial para la investigacion, el diagnostico y el abordaje de todos ellos. El desarrollo de instrumentos que avalen este componente dimensional es igualmente trascendental.

  9. [Language disorders in acute cerebellitis: beyond dysarthria].

    PubMed

    Barragan-Martinez, D; Nunez-Enamorado, N; Berenguer-Potenciano, M; Villora-Morcillo, N; Martinez de Aragon, A; Camacho-Salas, A

    2017-01-01

    Introduccion. La cerebelitis aguda es una de las principales causas de sindrome cerebeloso en la infancia. Entre un amplio elenco de manifestaciones, en el que predominan la cefalea y la ataxia, podemos encontrar otras menos habituales, aunque interesantes, como las alteraciones del lenguaje, mas alla de la bien conocida disartria cerebelosa. Las diferentes combinaciones en que pueden aparecer los sintomas, especialmente cuando no se acompañan de ataxia, hacen de este cuadro un verdadero reto para el clinico. Casos clinicos. Se presentan dos pacientes, de 2 y 4 años, con clinica, pruebas de laboratorio y neuroimagen compatibles con cerebelitis aguda parainfecciosa, que asociaron una llamativa alteracion del lenguaje, uno en forma de mutismo cerebeloso y otro en forma de hipofluencia y agramatismo, y este ultimo cursaba ademas en ausencia de ataxia. La evolucion de ambos casos fue buena, y persistieron leves alteraciones del habla en el seguimiento posterior. Conclusiones. Casos como estos amplian el espectro de manifestaciones clinicas de la cerebelitis aguda. Cada vez cobra mayor importancia la participacion del cerebelo en procesos neurocognitivos como el lenguaje y, aunque muchos aspectos son aun especulativos, alcanzar a definir su verdadero papel tendra una repercusion en el diagnostico, el tratamiento y el pronostico a largo plazo de estos pacientes.

  10. [Sensitivity, precision and resolution of the optical microscope in the study of environmental pollution by asbestos fibers].

    PubMed

    Maddalon, G; Patroni, M; Trimarchi, R; Clerici, C; Occella, E

    1991-01-01

    The authors comment on the methods and equipment used in two Italian laboratories for sampling and microscopic phase contrast analysis of asbestos and other respirable fibres in the air of the general environment, i.e., the Dust Analysis Laboratory, Industrial Hygiene and Toxicology Department of the Institute of Occupational Health (Clinica del Lavoro), University of Milan and the Technical Microscopy Laboratory, Ground Resources and Land Control (Georisorse e Territorio) Department of Turin Polytechnic, which use identical methods. Airborne dust samples are taken with personal samplers, 1 l/min air flow (sample duration 4-8 h), filtering air on 25 mm diameter, 0.8 micropore cellulose filters (about 300 mm total net surface of dust deposit). The following equipment is used for counting and analysis of fibres: a) Clinica del Lavoro, Milan: Polyvar Reichert-Jung microscope, 500 magnitudes, Zernike positive phase contrast; numerical counting on 100 whole ocular fields, equal to 6.38% of the total net surface of dust deposit on the membrane; b) Turin Polytechnic: Leitz Ortholux microscope, 500 magnitudes, Heine and Zernike phase contrast with mean standard contrast; numerical counting on square grid, with explored surface total equal to 1.68% of the total net surface of dust deposit on the membrane. Measurements performed: Clinica del Lavoro, Milan: 2,980 since 1960; Turin Polytechnic: 875 since 1965. The sensitivity of the methods for counting airborne fibres is discussed, concluding that the methods used by the two laboratories have a sensitivity between 0.05 and 1.6 fibre/litre of air, according to the overall dustiness of the environment under study. Analysis of the accuracy of the optic determinations, based on the repeated counts, shows a repeatability of 0.4 (40%) within 95% confidence limits. A resolution power of 0.35 microns is reported; however, the possibility exists (and is normally achieved in analytical practice in both laboratories) of identifying and

  11. Planetary Sciences practical experiences at the Master level with small telescopes

    NASA Astrophysics Data System (ADS)

    Sanchez-Lavega, A.; Perez-Hoyos, S.; del Rio-Gaztelurrutia, T.; Hueso, R.; Ordonez Etxeberria, I.; Rojas, J. F.

    2016-12-01

    The Master in Space Science and Technology of the Basque Country University UPV/EHU in Bilbao (Spain) has been taught during 7 years (A. Sanchez-Lavega et al., Eur. J. of Eng. Education. 2014). Along the different courses, a series of practical observations and studies of planetary sciences have been conducted with Master students, using telescopes with diameters in the range 28-50 cm pertaining to the Aula EspaZio Gela Observatory (http://www.ehu.eus/aula-espazio/presentacion.html). Simple instrumentation (cameras and a spectrograph) have been employed to study planetary atmospheres (dynamics and cloud structure) and orbital mechanics using the Galilean satellites. Here we present a sample of these studies, which have lead to publications in refereed journals and have been presented at different meetings with the coauthoring of the students. Plans for the future include involving the master students in high-resolution observations of Solar System planets using a remote controlled 36 cm telescope at the Calar Alto observatory in Southern Spain (separated 1000 km from the teaching facilities in Bilbao).

  12. [Lung eosinophilic syndrome: clinical presentation and cases report].

    PubMed

    Egea, N; Merlo, A; Esponda, L; Cazaux, A; Cambursano, V H; Cortés, J R

    2014-01-01

    Introducción: El síndrome de eosinofilia pulmonar se caracteriza por un grupo de patologías que presentan afección clínico – radiológica pulmonar con eosinofilia periférica o en parénquima pulmonar en su evolución. Materiales y métodos: Se describen las características de presentaciones clínico-radiológicas y evolutivas de pacientes atendidos entre 2007 y 2010 en Hospital Rawson. Resultados: Sobre 8 casos, se observó mayor número de casos en mujeres. Los signos y síntomas principales fueron tos, disnea, fiebre y sibilancias. Los hallazgos radiológicos más prevalentes fueron patrón alveolar y alveolointersticial. En la TAC el más frecuente fue el patrón en vidrio esmerilado. La eosinofilia periférica presentó valores entre 550 y 10.000 cel/mm3. Los pacientes fueron abdordados inicialmente como neumonía adquirida en la comunidad en el 62% de los casos. Los diagnósticos principales realizados fueron neumonía eosinofílica aguda y crónica, ambas con respuesta a esteroides. Conclusiones: El síndrome de eosinofilias pulmonares comparte características clínico-radiológicas comunes con entidades de mayor prevalencia, particularmente NAC.

  13. [Posterior reversible encephalopathy in a case of late-onset eclampsia].

    PubMed

    Castrillo-Sanz, Ana; Mendoza, Amelia; Gutiérrez-Ríos, Raúl; Zamora, M Isabel; Morollón, Noemí; Rodríguez-Sanz, M Fernanda; Duarte, Jacinto

    2013-08-01

    Introduccion. El sindrome de encefalopatia posterior reversible (SEPR) es un sindrome clinico-radiologico de presentacion aguda o subaguda que se caracteriza por la presencia de cefalea, vomitos, crisis epilepticas, trastornos visuales y alteracion del nivel de conciencia asociado a lesiones localizadas fundamentalmente en la sustancia blanca de regiones posteriores cerebrales. Caso clinico. Mujer de 32 años que desarrollo un SEPR en el periodo posparto secundario a eclampsia tardia. La paciente presento 10 dias despues del parto un cuadro clinico consistente en cefalea, crisis epilepticas, ceguera y deterioro del nivel de conciencia. El estudio de imagen con resonancia magnetica confirmo la afectacion de la sustancia blanca de predominio posterior. Conclusiones. Aunque la eclampsia es una entidad tipica del embarazo y puerperio inmediato, es necesario recordar que tambien puede producirse de forma tardia tras el parto y que puede ser la causa de otros sindromes, como el SEPR. Aunque en estos casos el pronostico suele ser favorable, el tratamiento debe ser precoz, efectuando un rapido control de la tension arterial y las convulsiones con el fin de evitar un daño cerebral permanente. Es necesario considerar siempre este sindrome en mujeres con crisis epilepticas u otros sintomas neurologicos durante el posparto.

  14. [Supra-on state freezing of gait: two case reports].

    PubMed

    Gallardo-Alcaniz, M José; Cabello-De la Rosa, Juan P; Bravo-Gomez, José J; Diaz-Gomez, Samuel; Vaamonde-Gamo, Julia

    2016-04-16

    Introduccion. Durante los ultimos años se han descrito diversos tipos de congelacion de la marcha (CDM), definidos fundamentalmente por su respuesta o no al tratamiento con levodopa. El fenomeno de la CDM en la enfermedad de Parkinson es de presentacion muy variable de unos pacientes a otros, con sustrato fisiopatologico diverso. En algunos pacientes, el aumento del estimulo dopaminergico no solo no mejora, sino que puede empeorar este problema. Casos clinicos. Se presentan dos pacientes con enfermedad de Parkinson que fueron evaluados en situacion off, on y supra-on. Para la evaluacion motora se utilizo la Unified Parkinson's Disease Rating Scale III (bilateral) y el tapping test en las extremidades inferiores, y se cuantificaron los episodios de CDM que presentaban los pacientes en las tres situaciones. Ambos pacientes sufrian episodios de CDM en situacion off que no mejoraban significativamente durante el on. Al aumentar el estimulo dopaminergico, en un intento de mejorar la respuesta motora, empeoraron significativamente los episodios de CDM, hasta el punto de imposibilitar la marcha por graves bloqueos. Conclusiones. Los episodios de CDM no siempre son una mera consecuencia de la acinesia o la rigidez. En la fisiopatologia de la CDM podrian intervenir estructuras que desbordan la sustancia negra y el deficit dopaminergico, lo cual podria explicar la falta de respuesta adecuada al tratamiento e incluso el empeoramiento por desequilibrio de los neurotransmisores, en relacion con la sobreestimulacion dopaminergica, en otros nucleos implicados en el control postural y de la marcha.

  15. [Detection of vascular risk factors and unknown atrial fibrillation in patients hospitalised in the stroke unit].

    PubMed

    Jiménez-Caballero, Pedro E; López-Espuela, Fidel; Portilla-Cuenca, Juan C; Jiménez-Gracia, M Antonia; Casado-Naranjo, Ignacio

    2013-05-01

    Introduccion. Existe una serie de factores de riesgo cerebrovascular modificables, como son la hipertension arterial, la diabetes mellitus, dislipidemias y la fibrilacion auricular, cuyo reconocimiento y control es fundamental para disminuir la aparicion de enfermedades cerebrovasculares. En ocasiones, el ictus puede ser el sintoma de presentacion de estos factores de riesgo. Pacientes y metodos. Estudio observacional prospectivo de los pacientes que ingresan en la unidad de ictus de nuestro hospital por enfermedad cerebrovascular aguda –accidente isquemico transitorio e ictus isquemico– para conocer el porcentaje de pacientes con hipertension arterial, diabetes mellitus, dislipidemias y fibrilacion auricular no diagnosticadas previamente. Resultados. Se selecciono a 186 pacientes, de los que 24 presentaban hipertension arterial no conocida (12,9%); 11, diabetes mellitus no conocida (5,9%); 49, hipercolesterolemia no conocida (26,3%); 15, hipertrigliceridemia no conocida (8,1%), y 22 tenian fibrilacion auricular no conocida (11,8%). En total, 96 pacientes (51,6%) tenian alguno de estos factores de riesgo cerebrovascular. La existencia de un factor de riesgo no diagnosticado previamente era mayor en el medio rural, en los sujetos que no habian fallecido a los seis meses y en los ataques isquemicos transitorios respecto a los ictus isquemicos. Conclusiones. Mas de la mitad de los sujetos que sufren un evento cerebrovascular tienen un factor de riesgo que no se ha diagnosticado previamente. Se deben realizar campanas para implementar la deteccion de estos factores, asi como incidir en el control de estos para disminuir la aparicion y recidiva de patologia vascular.

  16. [The whole world in a cup of coffee. Case reports].

    PubMed

    De Fiore, Luca

    2009-01-01

    There is a rising interest for clinical cases in medicine. Actually, they don't necessarily conflict with the evidence-based medicine approach; rather, as several authors made clear, EBM-oriented case reports and clinical trials could be complementary. Cases and case series could even represent the first line of evidence and they are extremely valuable in discovering new pathologies and monitoring unexpected drug effects. They also play a relevant role in continuing medical education. The new section of Recenti Progressi in Medicina is edited by a prominent Italian research Institute (Istituto di Fisiologia Clinica, CNR). It focuses on a single case, guiding the physicians' decision-making from differential diagnosis to the treatment options.

  17. Use of total reflection X-ray fluorescence (TXRF) for the evaluation of heavy metal poisoning due to the improper use of a traditional ayurvedic drug.

    PubMed

    Borgese, L; Zacco, A; Bontempi, E; Pellegatta, M; Vigna, L; Patrini, L; Riboldi, L; Rubino, F M; Depero, L E

    2010-09-05

    An Indian patient referred to Clinica del Lavoro 'L.Devoto' of Milano showed clinical signs of heavy metal poisoning, possibly related to a sustained 6-month use of approx. 3 g/day of a traditional preparation (a whitish powder with a 'mineral' appearance) to treat urological problems. To confirm the causal relationship between the disease and the use of such product, metal testing was performed on the patient's hair and the ayurvedic remedy samples by total reflection X-ray fluorescence (TXRF). For TXRF analysis 1-cm cut of the patient's hair was directly deposited onto the quartz glass sample carrier, then 10 microl of nitric acid 65% were added and dried in air. TXRF showed high versatility, rapid and simultaneous element detection, and short analysis time, thus supporting a wider use in emergency medicine and in forensic analyses. 2010 Elsevier B.V. All rights reserved.

  18. [Haemorrhagic pineal cysts: two clinical cases successfully treated by means of microsurgery].

    PubMed

    Arevalo, A; Pulido-Rivas, P; Gilo-Arrojo, F; Sola, R G

    2016-09-01

    Introduccion. Los quistes pineales son un hallazgo incidental relativamente frecuente en las pruebas de imagen; sin embargo, la apoplejia pineal se considera rara y se asocia a sintomas graves. Casos clinicos. Varon de 25 a˜os y mujer de 15 a˜os, que acudieron a urgencias con clinica de hipertension intracraneal; mediante pruebas de imagen se confirmo la existencia de una hemorragia pineal. Se les trato con exito mediante microcirugia. Conclusion. En nuestra experiencia, y avalado por la bibliografia, creemos que el mejor tratamiento de esta infrecuente patologia es el abordaje microquirurgico. Sin embargo, no se excluye la posibilidad de que, en un futuro, las tecnicas endoscopicas puedan tener un lugar importante en el tratamiento de la apoplejia pineal.

  19. The trabecular bypass stent in a pseudophakic glaucoma patient: A 1-year follow-up

    PubMed Central

    Fea, Antonio M; Dogliani, Monica; Machetta, Federica; Lale-Lacroix, Gabriella; Brogliatti, Beatrice; Grignolo, Federico M

    2008-01-01

    Purpose To describe the 1-year success of a trabecular stent implant in a pseudophakic glaucoma patient. The stent is implanted through a small corneal incision under gonioscopic control. Intraocular pressure control was reported in cultured human anterior segment. Design Observational case report. Methods We report the case of a patient who was implanted and followed-up for 1 year at the Dipartimento di Fisiopatologia Clinica. The main outcome measures were intraocular pressure and visual field. Results The patient’s intraocular pressure was controlled with topical beta-blockers for 6 months and without therapy for 6 months. Two diurnal curves demonstrated achievement of target pressure during the day. The 1-year visual field was unchanged. Conclusions We are not aware of previous reports of trabecular stent implantation in pseudophakic patients. The trabecular stent had minimal peri-operative morbidity. Identification of the implantation site is challenging and reduction of efficacy over time may occur. PMID:19668446

  20. Particulate matter (PM10) exposure, birth and fetal-placental weight and umbilical arterial pH: results from a prospective study.

    PubMed

    Giovannini, Niccolò; Schwartz, Lianne; Cipriani, Sonia; Parazzini, Fabio; Baini, Ilaria; Signorelli, Valentina; Cetin, Irene

    2017-04-10

    This prospective study aims to analyze the relation between particulate matter (PM10) exposure during pregnancy and birth weight (BW), placental weight (PW) and umbilical artery PH (UAPH). Population included 3614 women born in Italy, living in Lombardia Region, consecutively admitted to the Clinica Mangiagalli for an elective cesarean section from January 2004 through December 2006. Outdoor air quality data were provided by the Department of the Regional Environmental Protection Agency and obtained by a network of fixed monitoring stations representatively distributed in eight geographical areas. Birth weight was negatively associated with exposure to PM10 concentration during the first trimester of pregnancy (mean change -22.2 g, 95%CI -8.7 to -35.7, p = 0.0013). Placental weight and umbilical artery PH were not associated with exposure to PM10 concentration. Fetal weight was negatively associated with exposure to PM10 concentration during the first trimester of pregnancy.

  1. [Molecular characterisation and phenotypic description of two patients with reciprocal chromosomal aberrations in the region of the 3q29 microdeletion/microduplication syndromes].

    PubMed

    Quintela, I; Barros-Angueira, F; Perez-Gay, L; Dacruz, D; Castro-Gago, M; Carracedo, A; Eiris-Punal, J

    2015-09-16

    Introduccion. Los sindromes de microdelecion y microduplicacion 3q29 se caracterizan por una marcada heterogeneidad fenotipica, y el retraso del desarrollo y la discapacidad intelectual de grado leve-moderado son las manifestaciones clinicas mas frecuentes. Casos clinicos. Dos pacientes con aberraciones cromosomicas reciprocas en la region 3q29. La paciente con la microdelecion 3q29 presenta dificultades de aprendizaje, microcefalia limite, dismorfismo facial leve, deficit atencional e impulsividad, y rasgos ansiosos y obsesivos. El paciente con la microduplicacion 3q29 reciproca presenta dificultades de aprendizaje, dismorfismo facial leve y un perfil conductual disruptivo no asociado previamente con esta duplicacion. Conclusion. Se comparan los fenotipos de estos pacientes y se revisa la bibliografia de pacientes pediatricos con microdeleciones y microduplicaciones 3q29.

  2. [Bilateral cerebellopontine arachnoid cyst].

    PubMed

    Gelabert-Gonzalez, M; Aran-Echabe, E; Pita-Buezas, L

    2016-06-16

    Introduccion. Los quistes aracnoideos bilaterales del angulo pontocerebeloso son excepcionales, y unicamente existen tres casos publicados en la bibliografia. Caso clinico. Niña de 14 años, previamente sana, que acude a consultas por presentar cefalea bifrontal de seis semanas de evolucion. La exploracion clinica era normal y la resonancia magnetica craneal mostraba dos lesiones extraaxiales localizadas en ambos angulos pontocerebelosos, siendo ligeramente mayor la izquierda. Las lesiones se comportaban como homogeneamente intensas en T1 e hiperintensas en T2, no captaban contraste y no existia restriccion en las secuencias de difusion. No se indico tratamiento quirurgico. Conclusiones. Los quistes aracnoideos bilaterales situados en el angulo pontocerebeloso son excepcionales. La principal indicacion para el tratamiento quirurgico es la presencia de sintomas o signos neurologicos coincidentes con la localizacion de los quistes.

  3. From the mind to the brain: an unusual pathway.

    PubMed

    Liberini, P; Spano, P

    2000-04-01

    One of the most unrecognized aspects of Golgi's life was his deep interest in neuropsychiatry. From 1865 to 1868 he attended the Clinica per le Malattie Nervose e Mentali in Pavia directed by Cesare Lombroso, the founder of modern criminology. Golgi was involved in research on the etiology of psychiatric ailments. During this short period of time he produced significant theoretic advances in clinical psychiatry. However, very soon he started to criticize the conceptual approach as well as the nosological system proposed by his academic mentor. In July 1868 he left Lombroso's school in search for a more rational method of studying brain functions and diseases. In spite of his anatomical approach to the central nervous system, he always maintained curiosity in the phenomenology of functional and organic mental disorders. This predisposition is witnessed by his capability to relate clinical observations to neuropathological findings.

  4. [Microbiological diagnosis of HIV infection].

    PubMed

    López-Bernaldo de Quirós, Juan Carlos; Delgado, Rafael; García, Federico; Eiros, José M; Ortiz de Lejarazu, Raúl

    2007-12-01

    Currently, there are around 150,000 HIV-infected patients in Spain. This number, together with the fact that this disease is now a chronic condition since the introduction of antiretroviral therapy, has generated an increasing demand on the clinical microbiology laboratories in our hospitals. This increase has occurred not only in the diagnosis and treatment of opportunistic diseases, but also in tests related to the diagnosis and therapeutic management of HIV infection. To meet this demand, the Sociedad de Enfermedades Infecciosas y Microbiología Clinica (Spanish Society of Infectious Diseases and Clinical Microbiology) has updated its standard Procedure for the microbiological diagnosis of HIV infection. The main advances related to serological diagnosis, plasma viral load, and detection of resistance to antiretroviral drugs are reviewed in this version of the Procedure.

  5. The prescribing clinical health psychologist: a hybrid skill set in the new era of integrated healthcare.

    PubMed

    McGuinness, Kevin M

    2012-12-01

    The prescribing clinical health psychologist brings together in one individual a combination of skills to create a hybrid profession that can add value to any healthcare organization. This article addresses the high demand for mental health services and the inequitable distribution of mental health practitioners across the nation. The close link between physical and mental health and evidence that individuals in psychological distress often enter the mental health system via primary care medical clinics is offered as background to a discussion of the author's work as a commissioned officer of the U.S. Public Health Service assigned to the Chaparral Medical Center of La Clinica de Familia, Inc. near the U.S.-Mexico border. The prescribing clinical health psychologist in primary care medical settings is described as a valuable asset to the future of professional psychology.

  6. External auditory canal atresia of probable congenital origin in a dog.

    PubMed

    Schmidt, K; Piaia, T; Bertolini, G; De Lorenzi, D

    2007-04-01

    A nine-month-old Labrador retriever was referred to the Clinica Veterinaria Privata San Marco because of frequent headshaking and downward turning of the right ear. Clinical examination revealed that there was no external acoustic meatus in the right ear. Computed tomography confirmed that the vertical part of the right auditory canal ended blindly, providing a diagnosis of external auditory canal atresia. Cytological examination and culture of fluid from the canal and the bulla revealed only aseptic cerumen; for this reason, it was assumed that the dog was probably affected by a congenital developmental deformity of the external auditory canal. Reconstructive surgery was performed using a "pull-through" technique. Four months after surgery the cosmetic and functional results were satisfactory.

  7. The trabecular bypass stent in a pseudophakic glaucoma patient: A 1-year follow-up.

    PubMed

    Fea, Antonio M; Dogliani, Monica; Machetta, Federica; Lale-Lacroix, Gabriella; Brogliatti, Beatrice; Grignolo, Federico M

    2008-12-01

    To describe the 1-year success of a trabecular stent implant in a pseudophakic glaucoma patient. The stent is implanted through a small corneal incision under gonioscopic control. Intraocular pressure control was reported in cultured human anterior segment. Observational case report. We report the case of a patient who was implanted and followed-up for 1 year at the Dipartimento di Fisiopatologia Clinica. The main outcome measures were intraocular pressure and visual field. The patient's intraocular pressure was controlled with topical beta-blockers for 6 months and without therapy for 6 months. Two diurnal curves demonstrated achievement of target pressure during the day. The 1-year visual field was unchanged. We are not aware of previous reports of trabecular stent implantation in pseudophakic patients. The trabecular stent had minimal peri-operative morbidity. Identification of the implantation site is challenging and reduction of efficacy over time may occur.

  8. Neutron spectrometry in a PET cyclotron with a Bonner sphere system.

    PubMed

    Fernández, F; Amgarou, K; Domingo, C; García, M J; Quincoces, G; Martí-Climent, J M; Méndez, R; Barquero, R

    2007-01-01

    Positron emission tomography (PET) is a non-invasive medical imaging technique normally used for diagnostic purposes to determine the location and concentration of physiologically active compounds in a human body. An unshielded cyclotron is used for PET at the Clinica Universitaria de Navarra to produce short-lived positron emitting radionuclides ((15)O, (13)N, (11)C and (18)F) by bombarding appropriate target material with proton or deuteron beams with energies up to 18 and 9 MeV, respectively. Subsequent nuclear reactions may generate undesirable neutrons that should be evaluated and controlled. In this study, the neutron measurements performed with an active and a passive Bonner sphere systems at different locations outside and inside the cyclotron vault during operation have been presented. The neutron spectrum at each location was determined with an unfolding code developed by the authors.

  9. Electroencephalography in congenital malformations of the central nervous system.

    PubMed

    Campos, P; Cruz, G; Lizarraga, R; Bancalari, E; Guillen, D; Castañeda, C

    1994-12-01

    We studied clinical and EEG features of 36 cases with congenital malformations of the CNS. Patients were followed at the outpatient clinic of Hospital Cayetano Heredia and of Hogar Clinica San Juan de Dios in Lima-Peru, from January 1984 to June 1992. Eighty percent of the patients had convulsive syndromes and mental retardation. The most frequent malformation was agenesis of corpus callosum, and it was not possible to find a "typical" EEG pattern. The second were porencephalic cysts, with a good clinical-EEG correlation. There were two typical cases of schizencephaly, one of hemimegalencephaly with good prognosis, and one of holoprosencephaly. The results are compared to those obtained for a series we previously reported. Data discussed take into account reports on the subject registered in the literature. It is concluded that EEG is an useful method to evaluate possible CNS malformations in developing countries.

  10. [Association of Chlamydia trachomatis and human papilloma virus as predisposing factors in cervical intraepithelial neoplasia].

    PubMed

    González Sánchez, J L; Flores Avilés, Y; Gómez Campos, G; Montero Ramírez, A

    1995-10-01

    Human papilloma virus (HPV) has a predisposing association as cofactor in etiopathology of cervicouterine cancer; it is known also that viral infection is not enough, and there are other agents, as Chlamydia trachomatis. The objective of this study was to investigate the association of these cofactors as predisposal for intraepithelial cervical neoplasia (NIC). Prospectively, at Clinica de Colposcopia, Hospital de Ginecología y Obstetricia "Luis Castelazo Ayala", IMSS, 37 patients with cytologic, colposcopic and histological diagnosis of CIN pure or associated to HPV, underwent endocervical cytologies, and by immunofluorescence method, using monoclonal antibodies of conjugated fluoresceine, it was tried to demonstrate Chlamydia trachomatis, presence. From all patients, 12(32,4) were positive for Chlamydia trachomatis, significant percentually, and with Xi square of 0.32, non significant for this group of population. It is concluded that there is an important association of Chlamydia trachomatis and HPV, which should be taken into consideration in diagnosis and treatment of intraepithelial cervical neoplasia.

  11. [Delirio condiviso: approfondimento storico e un case report sulla folie à deux].

    PubMed

    Balducci, Pierfrancesco Maria; Gobbicchi, Chiara; Moretti, Patrizia; Tortorella, Alfonso

    2017-01-01

    RIASSUNTO. La folie à deux (FAD) è una condizione clinica osservata per la prima volta nella storia da Lasègue e Falret nel XIX secolo. Descrissero una rara circostanza nella quale due o più persone si ritrovarono a condividere idee deliranti gli uni dagli altri. Oggigiorno tracce di questa diagnosi del passato e del suo substrato psicopatologico si ritrovano nell'ICD-10, in cui la FAD viene codificata come "Disturbo Psicotico Condiviso". Considerando la scarsa letteratura in merito e la mancanza di una ben precisa definizione sintomatologica, risulta difficile circoscrivere i confini clinici della FAD. Inoltre, la presenza di comorbilità può portare a un'errata diagnosi. In questo articolo riportiamo un caso peculiare di FAD e un approfondimento storico, nel tentativo di fornire un punto di vista più ampio e degli strumenti atti a riconoscere questa diagnosi psichiatrica "non convenzionale".

  12. Clinical biochemistry education in Spain.

    PubMed

    Queraltó, J M

    1994-12-31

    Clinical biochemistry in Spain was first established in 1978 as an independent specialty. It is one of several clinical laboratory sciences specialties, together with haematology, microbiology, immunology and general laboratory (Clinical analysis, análisis clinicos). Graduates in Medicine, Pharmacy, Chemistry and Biological Sciences can enter post-graduate training in Clinical Chemistry after a nation-wide examination. Training in an accredited Clinical Chemistry department is 4 years. A national committee for medical and pharmacist specialties advises the government on the number of trainees, program and educational units accreditation criteria. Technical staff includes nurses and specifically trained technologists. Accreditation of laboratories is developed at different regional levels. The Spanish Society for Clinical Biochemistry and Molecular Pathology (SECQ), the national representative in the IFCC, has 1600 members, currently publishes a scientific journal (Química Clinica) and a newsletter. It organizes a continuous education program, a quality control program and an annual Congress.

  13. Sexual function in women from infertile couples and in women seeking surgical sterilization.

    PubMed

    Hentschel, Heitor; Alberton, Daniele Lima; Sawdy, Robert John; Capp, Edison; Goldim, José Roberto; Passos, Eduardo Pandolfi

    2008-01-01

    The purpose of this study was to compare sexual function between women of infertile couples (AR) and women seeking tubal ligation (TL). Women who attended Setor de Infertilidade do Serviço de Ginecologia e Obstetrícia do Hospital de Clinicas de Porto Alegre (HCPA) or the Serviço de Orientação e Planejamento Familiar (SERPLAN) completed the Female Sexual Function Index, a questionnaire about sexual activity in the last 4 weeks. Scored data were collected on six different domains: desire, arousal, lubrication, orgasm, satisfaction, and discomfort/pain. The greatest positive correlation in the TL group was between orgasm and sexual satisfaction (0.798), and in group AR between desire and arousal (0.627). Infertile women and fertile women who want to undergo surgical sterilization have similar sexual satisfaction scores.

  14. [Multifactorial analysis of the blood levels of LH, FSH and estradiol in relation to ovular harvesting rates, fertilization and segmentation in patients undergoing assisted reproduction (GIFT-FIVTE)].

    PubMed

    Di Castro Stringher, P; Espinosa de los Monteros Mena, A; Hernández Vazquez, J; Parra Covarrubias, A; Kably Ambe, A; Alvarado Duran, A

    1992-04-01

    This study shows that there is certain tendency to asssign more value to the observation of follicular growth by ultrasound than to hormonal levels "per se". However, the appreciation of growth is only part of the phenomenon of development and ovarian maturity, for that, surveillance with hormonal monitor of ovarian response keeps with a most important role in Assisted Reproduction Clinica. The basal levels, mainly of FSH and in a less degree LH, inversely correlate with the amount of retrieved ovocytes. Estradiol values should be interpreted with a fixed point of reference, as the day of HCG administration, and a direct relation is seen between estradiol levels and captured ovocytes; however, is of highest usefulness to value the conduct of estradiol level, with the knowledge that the prognosis for good capture rates improves with ascending values and above 700 pg in the day of HCG administration.

  15. Thoracic ultrasonography: A new method for the work-up of patients with dyspnea().

    PubMed

    Vitturi, N; Soattin, M; Allemand, E; Simoni, F; Realdi, G

    2011-09-01

    SommarioLa diagnosi differenziale di dispnea è fondamentale per la gestione dell’insufficienza respiratoria in cui, ai parametri routinari, può essere ora affiancata l’ecografia toracica. L’obiettivo di questo studio è stato valutare la validità e l’accuratezza di questa metodica anche in un reparto di medicina interna. MATERIALI E METODI: 152 pazienti ricoverati conseguentemente con diagnosi di dispnea sono stati esaminati dopo valutazione clinica, radiografia del torace, dosaggi bioumorali (NT-proBNP) e terapia d’emergenza. L’esame ecografico polmonare è stato considerato positivo qualora il numero totale di linee B fosse superiore ad 8. L’esame ecografico e il dosaggio dell’NT-proBNP sono stati ripetuti dopo 48 ore. Il gold standard di riferimento è stato la diagnosi clinica di scompenso cardiaco fatta da medici esperti secondo le linee guida dell’AHA. RISULTATI: Il gruppo di pazienti che mostrava un esame ecografico positivo riceveva in percentuale maggiore la diagnosi finale di insufficienza cardiaca (X 92.5; p < 0.005) e valori significativamente più elevati di NT-proBNP (10,384 ng/l vs 3889 ng/l; p < 0.05). Inoltre la diminuzione delle linee B a 48 ore era significativamente maggiore (p < 0.005) nel gruppo di pazienti trattati per scompenso cardiaco mentre non vi erano cambiamenti significativi nei valori di NT-proBNP (p = 0.37). DISCUSSIONE: In conclusione abbiamo dimostrato che anche in un reparto di medicina interna l’ecografia polmonare è uno strumento diagnostico utile per le gestione dell’insufficienza respiratoria e il suo monitoraggio durante la terapia.

  16. Integration of a clinical trial database with a PACS

    NASA Astrophysics Data System (ADS)

    van Herk, M.

    2014-03-01

    Many clinical trials use Electronic Case Report Forms (ECRF), e.g., from OpenClinica. Trial data is augmented if DICOM scans, dose cubes, etc. from the Picture Archiving and Communication System (PACS) are included for data mining. Unfortunately, there is as yet no structured way to collect DICOM objects in trial databases. In this paper, we obtain a tight integration of ECRF and PACS using open source software. Methods: DICOM identifiers for selected images/series/studies are stored in associated ECRF events (e.g., baseline) as follows: 1) JavaScript added to OpenClinica communicates using HTML with a gateway server inside the hospitals firewall; 2) On this gateway, an open source DICOM server runs scripts to query and select the data, returning anonymized identifiers; 3) The scripts then collects, anonymizes, zips and transmits selected data to a central trial server; 4) Here data is stored in a DICOM archive which allows authorized ECRF users to view and download the anonymous images associated with each event. Results: All integration scripts are open source. The PACS administrator configures the anonymization script and decides to use the gateway in passive (receiving) mode or in an active mode going out to the PACS to gather data. Our ECRF centric approach supports automatic data mining by iterating over the cases in the ECRF database, providing the identifiers to load images and the clinical data to correlate with image analysis results. Conclusions: Using open source software and web technology, a tight integration has been achieved between PACS and ECRF.

  17. [Therapeutic possibilities in refractory epilepsy in tuberous sclerosis complex].

    PubMed

    Puertas-Martin, Verónica; Carreras-Saez, Inmaculada; Marana, Ana; Ruiz-Falco Rojas, M Luz; Cantarin-Extremera, Verónica; Calleja-Gero, M Lourdes

    2014-06-16

    Introduccion. El complejo esclerosis tuberosa (CET) cursa frecuentemente con epilepsia de dificil control, lo que condiciona la calidad de vida y el nivel cognitivo de estos pacientes. Objetivo. Describir las caracteristicas epidemiologicas, clinicas y el tratamiento de los pacientes afectos de CET con epilepsia. Pacientes y metodos. Se han revisado retrospectivamente las historias clinicas de 30 pacientes menores de 18 años, diagnosticados de CET y epilepsia registrados en nuestra base de datos. Resultados. La edad de inicio de la epilepsia en los pacientes con CET en nuestra serie esta comprendida entre el primer mes de vida y los 4 años. Todos comenzaron con crisis parciales. Dos presentaron sindrome de West y cuatro, espasmos infantiles sin hipsarritmia. En 19 de los pacientes, la epilepsia se comporto como farmacorresistente. Respecto al tratamiento con farmacos antiepilepticos, 11 estan en monoterapia, 10 en biterapia, siete en triterapia y uno con cuatro farmacos. Dos recibieron ACTH, dos tienen implantado un estimulador del nervio vago, cuatro reciben tratamiento con everolimus y ocho han sido sometidos a cirugia. Conclusiones. La epilepsia es un problema muy frecuente y de inicio en los primeros años de vida en el CET. Las opciones terapeuticas actuales son muchas, sin embargo el 63,3% de los pacientes tiene una epilepsia no controlada y la mayoria de ellos presenta crisis diarias. El mal control de las crisis se correlaciona con retraso mental y trastorno del espectro autista. Señalar la respuesta positiva obtenida con otras posibilidades terapeuticas: inhibidores de la via mTOR, cirugia y el estimulador del nervio vago.

  18. [Subjective memory complaints, personality and prefrontal symptomatology in young adults].

    PubMed

    Pedrero-Pérez, Eduardo J; Ruiz-Sánchez de León, José M

    2013-10-01

    Introduccion. El presente trabajo explora dos cuestiones relacionadas con la aparicion de quejas subjetivas de memoria en adultos jovenes: la posibilidad de que dichas quejas sean resultado de deficits atencionales y ejecutivos, y, por otro lado, si determinadas caracteristicas de la personalidad propician y modulan la expresion clinica de las quejas. Sujetos y metodos. Se administro el Memory Everyday Failures, version española, el inventario de sintomas prefrontales y el inventario del temperamento y el caracter-revisado a una muestra de 1.132 participantes (900 de poblacion general y 232 en tratamiento por adiccion a drogas). Se exploro la correlacion entre variables de las quejas de memoria, del funcionamiento prefrontal en la vida diaria y de las dimensiones de la personalidad propuestas por Cloninger. Se estudiaron relaciones de causalidad entre las variables mediante metodos estructurales. Resultados. Se observa una fuerte correlacion entre las quejas cognitivas y la sintomatologia prefrontal, lo que sugiere que las quejas son, en realidad, resultado de una inadecuada gestion atencional y ejecutiva que propicia los errores cotidianos. Se aprecia tambien una relacion con gran tamaño del efecto entre las quejas cognitivas y la baja autodireccion. Esta dimension de la personalidad presenta una importante capacidad predictiva sobre la aparicion y la intensidad de las quejas, bien directamente, bien modulada por otras dimensiones, especialmente la evitacion del daño. Conclusiones. Los datos apoyan la idea de que las quejas de memoria son producto de la autopercepcion de fallos y errores cotidianos provocados a nivel atencional y ejecutivo –aunque son tenidos por olvidos mnesicos–, y que la expresion clinica de dichas quejas esta modulada por un perfil de la personalidad.

  19. [Autisms that 'cure themselves'].

    PubMed

    Artigas-Pallares, J; Paula-Perez, I

    2016-01-01

    Introduccion. La investigacion sobre el autismo, basada principalmente en el modelo categorico del Manual diagnostico y estadistico de los trastornos mentales, se ha centrado de forma preferente en la epidemiologia, las manifestaciones clinicas, los mecanismos cognitivos y los determinantes biologicos y ambientales; sin embargo, se ha prestado escaso interes a las trayectorias evolutivas, las cuales son decisivas de cara al pronostico a medio y largo plazo. Objetivo. Revisar el curso evolutivo de niños diagnosticados de autismo que, aun conservando a medio o largo plazo rasgos conductuales acordes con el perfil inicial, alcanzan una adaptacion social y laboral satisfactorias, y ademas dejan de cumplir los criterios que dieron lugar al diagnostico inicial. Desarrollo. Se ha revisado la bibliografia sobre el autismo centrada en el analisis de la evolucion de las manifestaciones clinicas y de su repercusion desde las primeras edades hasta la edad adulta. Asimismo, se han tomado en consideracion aspectos conceptuales sobre el autismo que facilitan la comprension y el significado de los patrones evolutivos. Conclusiones. Alrededor del 20% de los niños diagnosticados dejan de cumplir los criterios en los que se baso el diagnostico y, ademas, alcanzan un ajuste social y laboral satisfactorio. Como factores favorecedores se identifica: inteligencia normal, buen nivel de lenguaje y baja incidencia de 'comorbilidades'; por el contrario, en las series notificadas no se señalan como factores determinantes las intervenciones terapeuticas precoces e intensivas. Por ultimo, se menciona el concepto de neurodiversidad, donde la recuperacion se centra en el desarrollo optimo de las capacidades de cada individuo en un entorno facilitador.

  20. Integrated clinical-ultrasonographic diagnosis in acute appendicitis.

    PubMed

    Summa, M; Perrone, F; Priora, F; Testa, S; Quarati, R; Spinoglio, G

    2007-12-01

    Sommario SCOPO: L'appendicite acuta è una delle urgenze chirurgiche addominali più comuni. Se non trattata, può rapidamente progredire verso complicanze severe, quali la perforazione e la peritonite. Spesso i chirurghi optano per un intervento chirurgico precoce anche in caso di diagnosi solo probabile, con il rischio di eseguire una quota importante di appendicectomie inutili. Lo scopo dello studio è di analizzare la nostra esperienza con la diagnosi integrata clinico-ultrasonografica dell'appendicite acuta. MATERIALI E METODI: Durante il periodo gennaio 1999-dicembre 2006 1447 pazienti sono stati sottoposti a valutazione clinica, a conta leucocitaria, dosaggio della proteina C reattiva ed ecografia addominale. È stata utilizzata la tecnica ecografia di compressione graduale, con sonda ad alta frequenza. RISULTATI: È stata formulata diagnosi ecografica di appendicite acuta in 368 pazienti (25%). Ulteriori 8 pazienti sono stati operati sulla base del solo giudizio clinico. Abbiamo osservato 7 casi di falsi positivi ecografici. In 1079 (75% del totale) pazienti è stato espresso un giudizio diagnostico negativo per appendicite acuta: in 173 di essi (12%) è stata formulata una diagnosi diversa. I restanti 906 pazienti sono stati sottoposti a controllo clinico fino alla risoluzione della sintomatologia, senza alcuna complicanza. I nostri risultati hanno dimostrato una sensibilità dell'ecografia del 98%, una specificità del 99%, un valore predittivo positivo del 98% e un valore predittivo negativo del 99%. L'accuratezza diagnostica globale è stata del 99%. CONCLUSIONI: La diagnosi integrata (clinica, di laboratorio ed ecografica) dell'appendicite acuta consente una diagnosi sicura, con risparmio di risorse evitando il ricorso ad appendicectomie inutili.

  1. [Predictive factors of the response to treatment with onabotulinumtoxinA in refractory migraine].

    PubMed

    Pagola, Inmaculada; Esteve-Belloch, Patricia; Palma, José Alberto; Luquin, M Rosario; Riverol, Mario; Martinez-Vila, Eduardo; Irimia, Pablo

    2014-03-16

    Objetivo. Identificar las caracteristicas clinicas que predicen una respuesta favorable al tratamiento con onabotulinumtoxina A (OnabotA) en pacientes con migraña refractaria. Pacientes y metodos. Estudio retrospectivo de pacientes con migraña refractaria que recibieron al menos dos infiltraciones de OnabotA entre los años 2008 y 2012. Los pacientes fueron divididos en respondedores y no respondedores a OnabotA y se compararon entre ambos grupos, y de forma retrospectiva, una serie de caracteristicas clinicas consideradas predictoras de respuesta en estudios previos: localizacion unilateral de la cefalea, presencia de tension muscular pericraneal, tipo de dolor (implosivo, explosivo u ocular), tiempo de evolucion de la migraña (menor o mayor de 10 años) y abuso de medicacion analgesica. Resultados. Se incluyeron 39 pacientes (35 mujeres) con una edad media de 46 años. En 18 pacientes (46,2%) se observo una reduccion mayor del 50% en el numero de dias de cefalea/mes (pacientes respondedores). Al analizar las diferentes caracteristicas de la migraña, se observo que todas ellas fueron igualmente prevalentes en los pacientes respondedores y en los no respondedores (p > 0,05): localizacion unilateral (66,7% frente a 66,6%, respectivamente), dolor implosivo (27,8% frente a 38,1%), presencia de tension muscular pericraneal (33,3% frente a 38,1%), tiempo de evolucion de la migraña mayor de 10 años (77,8% frente a 69,2%) y presencia de abuso de medicacion analgesica (50% frente a 81%). Conclusion. En esta serie de pacientes no se ha identificado ningun rasgo clinico que permita predecir en pacientes con migraña refractaria una respuesta favorable al tratamiento con OnabotA.

  2. [Detection of the PMP22 gene duplication in peripheral neuropathy patients: a study in Mexican population].

    PubMed

    Cortés, Hernán; Hernández-Hernández, Óscar; Bautista-Tirado, Teresa; Escobar-Cedillo, Rosa Elena; Magaña, Jonathan J; Leyva-García, Norberto

    2014-08-01

    Introduccion. La enfermedad de Charcot-Marie-Tooth (CMT) es una neuropatia que afecta los nervios motores y sensitivos, y la CMT1A es el subtipo mas frecuente en el mundo. La CMT1A se produce por una duplicacion de 1,5 Mb en el locus 17p11.2-p12, donde se localiza el gen PMP22. Para el diagnostico de CMT1A es importante contar con tecnicas moleculares especificas para la determinacion de esta mutacion. Objetivos. Establecer un metodo de uso rutinario para detectar la duplicacion de PMP22 en la poblacion mexicana y estimar su frecuencia en pacientes con caracteristicas clinicas para la CMT. Pacientes y metodos. Se analizaron 157 pacientes mexicanos no relacionados entre si, diagnosticados de CMT por valoracion clinica. La determinacion de la duplicacion de PMP22 se realizo a traves de reaccion en cadena de la polimerasa en tiempo real mediante el metodo comparativo 2–ΔΔCT. Resultados. El metodo 2–ΔΔCT para detectar la duplicacion del gen PMP22 mostro ser sensible y fiable. Los resultados fueron consistentes con los obtenidos mediante la tecnica de hibridacion in situ fluorescente. Se detecto la duplicacion de PMP22 en 79 pacientes (50,3%), con un comportamiento similar a lo comunicado en Estados Unidos, Australia, Finlandia, Suecia y España. Sin embargo, se observo que existen diferencias con otras poblaciones. Conclusiones. La tecnica de reaccion en cadena de la polimerasa cuantitativa se implemento como un diagnostico molecular de CMT1A eficaz y de bajo coste, por lo que puede utilizarse rutinariamente en Mexico. Esto es esencial para el asesoramiento genetico y el tratamiento oportuno de los pacientes con CMT. La frecuencia de la duplicacion del gen PMP22 varia entre regiones geograficas, por lo que es importante estimarla en diferentes poblaciones.

  3. [Autosomal recessive GTPCH 1 deficiency: the importance of the analysis of neurotransmitters in cerebrospinal fluid].

    PubMed

    Moreno-Medinilla, E E; Mora-Ramirez, M D; Calvo-Medina, R; Martinez-Anton, J

    2016-06-01

    Introduccion. El deficit de la enzima trifosfato de guanosina ciclohidrolasa 1 (GTPCH 1) origina una disminucion de la sintesis de la tetrahidrobiopterina (BH4), cofactor indispensable en la sintesis de la tirosina, la dopamina y la serotonina. Es una enfermedad poco frecuente que produce un retraso o regresion psicomotora y trastornos del movimiento, y en la que el tratamiento puede mejorar o incluso corregir la clinica. Caso clinico. Niña afecta de deficit de GTPCH con herencia autosomica recesiva, diagnosticada a los 14 meses con estudio del liquido cefalorraquideo con deficit de pterinas, HVA y 5-HIAA, test de sobrecarga de fenilalanina y estudio genetico positivos. La clinica comenzo a los 5 meses con temblor cefalico y de las extremidades superiores, en reposo e intencional, intermitente, que desaparecio en un mes. El desarrollo psicomotor era normal, destacaba una hipotonia axial leve en la exploracion y las pruebas complementarias realizadas fueron normales. Posteriormente presento regresion psicomotora con perdida del sosten cefalico, disminucion de los movimientos activos, dificultad para la manipulacion bimanual, hipomimia e hipotonia global grave, lo que motivo el estudio de una encefalopatia progresiva. Tras el diagnostico de deficit de GTPCH, inicio tratamiento sustitutivo con levodopa/carbidopa, OH triptofano y BH4, con muy buena evolucion tanto motora como cognitiva. Actualmente, la paciente tiene 5 años, presenta un desarrollo psicomotor adecuado a su edad, cursa tercer curso de educacion infantil y ha alcanzado el nivel de su clase. Conclusion. Hay que destacar en este caso la mejoria tan satisfactoria, tanto motora como cognitiva, tras iniciar el tratamiento sustitutivo, ya que el nivel cognitivo suele quedar afectado en muchos casos.

  4. [Wolf-Hirschhorn syndrome. A series of 27 patients: their epidemiological and clinical characteristics. The current situation of the patients and the opinions of their caregivers regarding the diagnostic process].

    PubMed

    Blanco-Lago, Raquel; Málaga, Ignacio; García-Peñas, Juan José; García-Ron, Adrián

    2013-07-16

    Introduccion. El sindrome de Wolf-Hirschhorn (SWH) es una cromosomopatia producida por una delecion en la region distal del brazo corto del cromosoma 4. Se caracteriza por la presencia de un fenotipo peculiar, retraso en el crecimiento, retraso del desarrollo psicomotor y epilepsia. Objetivos. Describir las caracteristicas de una serie de niños con SWH, incluido el tiempo medio empleado para el diagnostico, y valorar la opinion de las familias sobre el proceso diagnostico. Pacientes y metodos. Se contacto con la Asociacion Nacional de SWH y, a traves de ella, con 29 familias afectadas. Se recogio informacion sobre la clinica del niño y la opinion sobre el proceso diagnostico, y se solicitaron informes medicos que confirmaran la informacion facilitada. Constituida una base de datos de pacientes, se procedio a su analisis estadistico. Resultados. Se obtuvo informacion de 27 familias. Los pacientes presentan una edad media actual de 6,94 ± 6,37 años. La edad media de diagnostico fue de 14,34 meses. Existe retraso del crecimiento intrauterino en el 92,6% de los embarazos. Un 92,6% de los pacientes presenta epilepsia, el 44,4% de ellos en monoterapia. Existe retraso del desarrollo psicomotor/cognitivo en todos los pacientes. Camina sin ayuda el 33%. Los padres califican con una nota media de 7,25 ± 2,17 el trato ofrecido por los facultativos y de 6,29 ± 2,11 la informacion recibida. Conclusiones. No se han encontrado referencias a la edad media de diagnostico para el SWH. En nuestra muestra, existen variaciones importantes en este aspecto, posiblemente condicionadas por el fenotipo del caso y la experiencia del medico. Las caracteristicas clinicas son similares a las esperadas. El grado de dependencia estimado es alto y la calidad de la informacion recibida por la familia, baja.

  5. For men only.

    PubMed

    1993-01-01

    In 1985 the Colombian Family Planning Association PROFAMILIA realized that men did not want to come to its family planning centers simply because they felt intimidated by the feminine atmosphere there. Nor did they dare disclose their problems and sexual questions even to a female professional. The solution was to establish a family planning center, La Clinica del Hombre (Men's Clinic), providing services exclusively for men and staffed with men to provide the necessary privacy. Latin American men's attitudes are changing. In 1985 in Bogota, the majority of men were convinced that a vasectomy was equivalent to castration. In 1993, 300 vasectomies were performed in the clinic each month. The Colombian Family Planning Association is not only providing contraception, but also information on sexual and reproductive education to avoid misunderstanding of the available methods. PROFAMILIA has incorporated a sexuality consultation into its services, so they can deal with husbands and wives separately, without spoiling the couple's relationship. PROFAMILIA now has 7 family planning clinics for men and 48 for women, thanks to the contribution of international donors. The Challenge Grant for Men's Programs, given by an anonymous donor from the United States, helped with the fund-raising to open 3 clinics in the Atlantic Coast Region where needs were vital. The Clinica del Hombre will incorporate a program to treat infertility, in addition to the department of urology, general medicine, ambulatory surgery, and treatment of sexually transmitted diseases. In January, 1994, they will begin offering dental and plastic surgery services because, owing to the violence that exists in the country, there are many men whose faces are disfigured and who need to have corrective plastic surgery.

  6. The pedagogic evolution in Surgery: the University at the centre of a training which becomes territorialized The model of the region Marche.

    PubMed

    Patrizi, Andrea; Tranà, Cristian; Baldoni, Andrea; Coletta, Pietro; Marmorale, Cristina

    2014-01-01

    La formazione in Chirurgia è un tema di grande interesse in un’epoca di crisi, ma anche di grandi cambiamenti mossi dalla spinta della Comunità Europea di uniformare i Percorsi Formativi di tutti i suoi Stati Membri. I punti principali delle riforme attuate per uniformarci al contesto Comunitario, vertevano sulla riduzione dei tempi e sulla implementazione della multidisciplinarietà della formazione specialistica, con il rischio di adombrare quelli che sono i punti di forza del nostro Sistema Sanitario, tra cui l’alto livello assistenziale dei nostri ospedali territoriali. La Scuola di Specializzazione di Chirurgia Generale dell’UNIVPM da alcuni anni punta su un progetto che vede la Clinica Universitaria al Centro di una Formazione Specialistica che si sviluppa sempre più sul territorio, avvicinando il mondo Ospedaliero a quello Universitario. Questo nuovo modello organizzativo prevede una prima fase all’interno della Clinica Universitaria ed una seconda nella Rete Formativa, nella quale rientrano Centri a differente impatto specialistico, all’interno di Strutture Ospedaliere Italiane ed Estere, e la possibilità di poter collaborare con l’Organizzazione di Emergency. Per testare questa nuova organizzazione del Corso Specialistico, abbiamo preso in analisi l’attività chirurgica svolta dagli specializzandi del nostro Ateneo, che hanno terminato il loro percorso formativo in Chirurgia Generale a Marzo 2014, essendo loro i primi ad aver beneficiato di questo modello. L’attività operatoria è stata, per ciascuno, mediamente di 400 interventi da primo operatore (237-476) distribuiti in chirurgia maggiore 44 (13-80), media 172 (129-268) e minore 209 (70-378), rapportando i loro risultati con gli standard complessivi di addestramento professionalizzante previsti dallo Statuto Nazionale si osserva il buon rendimento di questo sistema, che vede i suoi punti di forza nell’EQUITA dell’offerta, in quanto standardizzabile; nel concetto di RETE

  7. [Automatic application of clinical guidelines - from theory to practice].

    PubMed

    Shalom, Erez; Shahar, Yuval; Lunenfeld, Eitan

    2013-05-01

    ClinicaL guidelines (GLs) have been shown to be a powerful tool for enhancing the uniformity and quality of care, reducing its costs. However, since they are typically represented in free text, this leads to low rates of compliance. Therefore, physicians might benefit from GL automated decision support. It should be noted that not many studies evaluate the effect of providing support for the application of GLs over significant stretches of time on the quality of medical decisions. In this paper, we will describe the general architecture of medical decision support systems, review several known GL application frameworks, and focus on the research performed in the medicaL informatics research center at Ben-Gurion University [BGU] of the Negev which developed the Digital ELectronic Guideline Library, called DeGeL. In particular, we will describe a new GL application framework called PICARD that is intended for GL application over time, while ensuring that the GLs recommendations were followed. We will briefly introduce a technical evaluation of PICARD in the cardiology domain to manage patients according to a Coumadin [Warfarin] protocoL, and a functional evaluation in a complex pre-eclampsia/ eclampsia GL in the OB/GYN domain, which we performed with 36 physicians. The results showed that the PICARD creates independence in the quality of the decisions from any particular physician, level of expertise, clinicaL scenario, or decision type within the scenarios. CurrentLy, PICARD is a core component in the EU Mobiguide project, which focuses on remote monitoring and care of chronic patients, using mobile devices to send alerts and recommendations.

  8. [Desvenlafaxine and neuropathic pain: additional clinical benefits of a second generation serotonin-noradrenaline reuptake inhibitor].

    PubMed

    Alcantara-Montero, A

    2017-03-01

    Introduccion. La desvenlafaxina es el tercer antidepresivo incluido entre los inhibidores de la recaptacion de serotonina y noradrenalina. Las ultimas guias de practica clinica consultadas coinciden en señalar que los antidepresivos triciclicos, los duales (venlafaxina/duloxetina) y los antiepilepticos gabapentina y pregabalina constituyen los farmacos de primera linea en el tratamiento del dolor neuropatico. El tramadol, los apositos de lidocaina al 5% y los parches de capsaicina al 8% son los farmacos de segunda linea, mientras que los opioides potentes constituirian una tercera linea de tratamiento. La interaccion entre el binomio dolor y depresion es muy habitual y representa la complicacion psicologica mas frecuente en los pacientes con dolor cronico. Desarrollo. Tras una busqueda bibliografica, en este articulo se resumen los datos farmacologicos mas relevantes de la desvenlafaxina y su utilidad en la practica clinica, asi como la bibliografia especifica de este farmaco en el dolor neuropatico y el dolor cronico. Conclusiones. Aunque la evidencia de la desvenlafaxina en el dolor neuropatico es escasa, presenta unas caracteristicas farmacocineticas interesantes, como son no ser sustrato ni actuar sobre la glicoproteina P y tener un metabolismo que practicamente no depende del sistema del citocromo P450, lo que limita el riesgo de interacciones farmacocineticas y los potenciales problemas de tolerabilidad asociados cuando se administra con farmacos que sean inhibidores moderados o potentes del CYP2D6 o con otros sustratos de esta isoenzima. Estas caracteristicas hacen de la desvenlafaxina un antidepresivo distinto y especialmente util en algunos subgrupos de pacientes con dolor cronico (como polimedicados y pacientes con insuficiencia hepatica), donde la depresion comorbida es frecuente.

  9. [The importance of sleep deprivation as a mechanism for activating interictal epileptiform paroxysms].

    PubMed

    Navas, Patricia; Rodríguez-Santos, Lucía; Bauzano-Poley, Enrique; Lara, José Pablo; Barbancho, Miguel Ángel

    2016-04-01

    Introduccion. Aunque la privacion de sueño se ha utilizado durante años en electroencefalografia (EEG) como metodo de activacion de descargas epileptiformes intercriticas (DEI) en pacientes con alta sospecha de epilepsia, su sensibilidad y especificidad estan aun en discusion. Pacientes y metodos. Estudio descriptivo y retrospectivo de pacientes pediatricos derivados a neurofisiologia clinica para valoracion de epilepsia. Se han comparado los resultados de los EEG de privacion de sueño (EEG-PS) con los EEG de vigilia (EEG-V) en cada paciente para describir su rendimiento como mecanismo activador de DEI. Resultados. Se han analizado 500 pacientes (830 EEG-PS y 1.018 EEG-V). En los EEG-V se detectaron DEI en el 44%. El EEG-PS aumento en un 35% la capacidad del test para detectar las DEI. En los EEG-PS en los que se alcanzo sueño espontaneo se observaron DEI (no detectadas en el EEG-V) en un 25,1%. En el grupo de epilepsias focales se constato que el EEG-V detecto DEI en el 60,1% frente al 79,12% demostradas con el EEG-PS. En las epilepsias generalizadas esta diferencia fue mas marcada (27,2% y 77,2%, respectivamente). En los pacientes en los que tras un EEG-PS no se detectaron DEI (23,7%) y la sospecha clinica de epilepsia seguia siendo alta, se realizo polisomnografia nocturna y se llego a objetivar actividad epileptiforme intercritica en un 13,6%. Conclusiones. El EEG-PS aumenta la posibilidad de recoger DEI en un 35% con respecto al EEG-V. La privacion de sueño es un metodo activador de paroxismos epileptiformes, independientemente de si hay sueño o no durante la realizacion del EEG, aunque este efecto es mas marcado en los pacientes que alcanzan sueño.

  10. [Fingolimod: effectiveness and safety in routine clinical practice. An observational, retrospective, multi-centre study in Asturias and Cantabria].

    PubMed

    Oterino, A; Uria, D F; Pena, J; Solar, D; Villafani, J; Oliva-Nacarino, P; Suarez-Moro, R; Quintanilla, V G

    2016-09-05

    Objetivo. Evaluar la efectividad y seguridad del fingolimod en la practica clinica habitual en la region de Asturias y Cantabria (España). Pacientes y metodos. Estudio retrospectivo y multicentrico de pacientes con esclerosis multiple recurrente remitente tratados con fingolimod, segun la ficha tecnica. La efectividad se evaluo en los pacientes con al menos un año de tratamiento. Se calculo la tasa anualizada de brotes (TAB), el porcentaje de pacientes libres de brotes y libres de lesiones captantes de gadolinio, y los que mejoraron/mantuvieron la puntuacion en la escala expandida del estado de discapacidad (EDSS). Se analizo la poblacion total y segun el tratamiento previo: inmunomodulador (interferon beta-1 o acetato de glatiramero) o natalizumab. Resultados. Un total de 138 pacientes iniciaron tratamiento con fingolimod; el 60% recibio previamente inmunomodulador; el 28%, natalizumab; y el 9%, ningun tratamiento. Noventa y nueve pacientes estuvieron al menos un año en tratamiento con fingolimod. Despues de un año de tratamiento, el fingolimod disminuyo la TAB en un 67% (1,26 a 0,42; p < 0,0001), aumento el porcentaje de pacientes libres de brotes de un 24% a un 69% (p < 0,0001), y el porcentaje de pacientes libres de lesiones captantes de gadolinio de un 70% a un 85% (p < 0,0106). El 77% de los pacientes mejoro/mantuvo la puntuacion en la EDSS. Resultados similares se observaron en pacientes tratados previamente con inmunomodulador. La efectividad de los pacientes tratados previamente con natalizumab se mantuvo tras el tratamiento con fingolimod. Conclusiones. La practica clinica habitual en las regiones de Asturias y Cantabria muestra que el fingolimod tiene resultados similares a los observados en los ensayos clinicos, al comparar las variables clinicorradiologicas utilizadas en estos ultimos.

  11. Phacoemulsification versus phacoemulsification with micro-bypass stent implantation in primary open-angle glaucoma: randomized double-masked clinical trial.

    PubMed

    Fea, Antonio M

    2010-03-01

    To compare phacoemulsification alone and phacoemulsification with micro-bypass stent implantation in eyes with primary open-angle glaucoma. Instituto di Fisiopatologia Clinica, Clinica Oculistica, Universita' di Torino, Torino, Italy. In this prospective double-masked randomized clinical trial, patients had phacoemulsification alone (control group) or phacoemulsification with iStent implantation (combined group). Primary outcomes were intraocular pressure (IOP) and reduction in medication use over 15 months and IOP after a 1-month washout of ocular hypotensive agents (ie, 16 months postoperatively). The baseline IOP was similar between groups (combined group: 17.9 mm Hg +/- 2.6 [SD]; control group: 17.3 +/- 3.0 mm Hg) (P = .512). Three patients in the control group were lost to follow-up. The mean IOP was 14.8 +/- 1.2 mm Hg in the combined group and 15.7 +/- 1.1 mm Hg in the control group at 15 months and 16.6 +/- 3.1 mm Hg and 19.2 +/- 3.5 mm Hg, respectively, after washout; the IOP was statistically significantly lower in the combined group than in the control group at both time points (P = .031 and P = .042, respectively). At 15 months, the mean number of medications was lower in the combined group than in the control group (0.4 +/- 0.7 and 1.3 +/- 1.0, respectively; P = .007), as was the proportion of patients on ocular hypotensive medication (33% and 76%, respectively). Phacoemulsification with stent implantation was more effective in controlling IOP than phacoemulsification alone; the safety profiles were similar. Copyright 2010 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  12. [Encephalopathy and neuromyelitis optica: the importance of recognising atypical symptoms].

    PubMed

    Hervás-García, José V; Grau-López, Laia; Doménech-Puigcerver, Sira; Ramo-Tello, Cristina

    2014-01-01

    Introduccion. La neuromielitis optica (NMO) o enfermedad de Devic es un trastorno autoinmune, inflamatorio y desmielinizante del sistema nervioso central, que afecta principal y caracteristicamente al nervio optico y a la medula espinal. Los anticuerpos antiacuaporina-4 (AQ-4) son un biomarcador especifico de esta entidad y, desde su descubrimiento, se ha ampliado el numero de sintomas y datos radiologicos de la enfermedad y se ha definido el concepto de espectro clinico de NMO. Caso clinico. Mujer de 66 años diagnosticada de NMO por haber sufrido brotes de neuritis optica y mielitis de repeticion junto con anticuerpos AQ-4 positivos. Presento un cuadro de disminucion del nivel de conciencia, con resonancia magnetica cerebral que mostro multiples lesiones en la sustancia blanca, sin realce de contraste, que se resolvio sin tratamiento. Un mes despues, sufrio empeoramiento del estado general, sindrome confusional y ceguera. En la resonancia magnetica cerebral se observaron nuevas lesiones en la sustancia blanca y aumento del tamaño de otras ya existentes. Se emitio el diagnostico de encefalopatia en el contexto de NMO y se trato a la paciente con corticoides e inmunoglobulinas intravenosas, con lo que se produjo mejoria clinica y radiologica. Conclusiones. Desde el descubrimiento de los anticuerpos AQ-4, ha aumentado el numero de manifestaciones clinicas y radiologicas de la NMO mas alla de la afectacion del nervio optico y de la medula espinal, entre ellas las manifestaciones cerebrales. Reconocerlas es muy importante para hacer un diagnostico precoz, evitar pruebas complementarias no necesarias e instaurar el tratamiento adecuado.

  13. [Lacosamide and neuropathic pain, a review].

    PubMed

    Alcántara-Montero, Antonio; Sánchez-Carnerero, Clara I

    2016-03-01

    Introduccion. La mayor parte de las guias de practica clinica consultadas coinciden en señalar que los antidepresivos triciclicos, duales (venlafaxina/duloxetina), antiepilepticos gabapentina/pregabalina, apositos de lidocaina al 5% y parches de capsaicina al 8% constituyen los farmacos de primera linea en el tratamiento del dolor neuropatico periferico, y el tramadol y algunos opioides potentes (morfina, oxicodona y tapentadol) son farmacos de segunda linea. Por otra parte, la prevalencia de dolor neuropatico refractario al tratamiento se acerca al 1,5% de la poblacion, de forma que se calcula que un 50% de los pacientes no responde al tratamiento prescrito. Existen otros antiepilepticos que no tienen indicacion en el dolor neuropatico por las agencias reguladoras, como la lamotrigina, el topiramato o la oxcarbacepina, pero se utilizan en la practica clinica habitual fuera de indicacion. Desarrollo. Tras una busqueda bibliografica, se realizo una revision sobre el empleo de la lacosamida en el dolor neuropatico, tanto en distintos modelos animales como en diferentes estudios en humanos. Conclusiones. El tratamiento con lacosamida en el dolor neuropatico de diferentes etiologias podria considerarse como una alternativa efectiva para los pacientes que no respondan o no toleren los tratamientos estandares. Sin embargo, la mayor parte de la evidencia disponible, a excepcion de los ensayos clinicos en fase II/III realizados en el dolor neuropatico diabetico, corresponde a estudios abiertos y observacionales, sin grupo control y con bajo numero de pacientes, pero los resultados favorables obtenidos invitan a seguir investigando la utilidad de la lacosamida en el dolor neuropatico.

  14. [Medical students' views on the use of virtual patients for teaching and assessment of clinical knowledge and reasoning].

    PubMed

    Oliven, Arie; Nave, Rachel; Hasson-Gilad, Dalia R; Baruch, Adam

    2013-05-01

    Computerized cLinical cases ["virtual patient" (VP)] provide a useful teaching and assessment tool for clinicaL knowledge and skiLLs. However, the attitude of medical students toward this new modality needs to be evaluated. We examined students' acceptance of a web-based VP system that was deveLoped in the Technion Faculty of Medicine for teaching and assessment purposes. The VP system enables free conversation (in writing) for history taking and listing of disease symptoms. It aLso depicts images and audio-videos of heart and lung sounds, and enables users to order Laboratory and imaging tests. The system was designed to be learnt without instructors and to provide feedback online. Therefore, the process of Learning and practicing with the VP system was performed by the students at home, during their free time. At the end of the clinical introductory course to internal medicine, students (n=91) were asked to complete questionnaires and rate multiple aspects of the VP system. Student acceptance of this web-based modality was high: over 95% fully or partially accepted that the VP practice system facilitates Learning the approach to diseases they were not exposed to during the course, practicing differential diagnosis, and improving their knowledge, clinicaL skills and reasoning. A similar percentage of the students agreed that the VP exam assessed their clinical knowledge and comprehension adequately, correctly and objectively. These results document high acceptance of web-based instruction and assessment by medical students. However, many students expect that a clinical course should also include bed-side assessment.

  15. [Prevalence of multiple sclerosis in the Region of Murcia].

    PubMed

    Carreon-Guarnizo, E; Andreu-Reinon, E; Cerdan-Sanchez, M; Carrasco-Torres, R; Hernandez-Clares, R; Prieto-Valiente, L; Garcia-Escriba, C; Sola-Roca, A; Martinez-Andreu, M E; Miralles Gonzalez-Conde, M A; Martin-Fernandez, J J; Meca-Lallana, J E

    2016-05-01

    Introduccion. La esclerosis multiple (EM) es una enfermedad inflamatoria desmielinizante del sistema nervioso central con patogenia inmunomediada. Recientes estudios indican un aumento de su prevalencia, y numerosos trabajos relacionan el virus de Epstein-Barr (VEB) con su etiologia. Objetivo. Analisis de prevalencia de la EM en la Region de Murcia, incluyendo la descripcion de las caracteristicas clinicas en el momento del inicio de la enfermedad, y del estado serologico del VEB de los pacientes con EM. Pacientes y metodos. Estudio epidemiologico retrospectivo, tomando como muestra la poblacion residente en el area sanitaria centro-oeste de la Region de Murcia (257.865 habitantes). Se analizan datos clinicos y serologicos extraidos de diferentes fuentes. Resultados. Prevalencia de la EM en la poblacion estudiada: 88 casos/100.000 habitantes. Prevalencia de la EM junto con el sindrome desmielinizante aislado: 98,4 casos/100.000 habitantes. Incidencia media de la EM: 5,8 casos/100.000 habitantes/año. En el inicio de la EM, el 67,8% eran mujeres, el 81,9% presentaba un curso recurrente-remitente, la edad media era de 31,4 años, el sistema funcional mas frecuentemente afectado era el sensitivo (45,1%), el inicio fue monofocal en el 55,4% y el grado de discapacidad en la Expanded Disability Status Scale era de 2,1 puntos. La seroprevalencia del VEB fue del 99,3%. La reactivacion de la infeccion por VEB se relaciono con actividad clinica de EM en 10 pacientes (45,4%). Conclusiones. Actualmente, la prevalencia de la EM en la Region de Murcia es similar a la estimada en otras comunidades autonomas españolas. El estudio confirma la tendencia de incremento de prevalencia observada en las ultimas decadas.

  16. [Patient safety: prescription of drugs that prolong the QT interval].

    PubMed

    Hernández-Arroyo, María Jesús; Díaz-Madero, Alfonso; Menacho-Miguel, David

    2015-09-01

    Objetivo: conocer la prescripcion de farmacos con riesgo conocido de prolongar el intervalo QT en un area de salud, informar a los medicos responsables de los factores de riesgo asociados a su aparicion y mejorar la seguridad del paciente. Métodos: estudio descriptivo transversal y observacional de prevalencia. Se incluyeron 4.964 pacientes de un area de salud en tratamiento con farmacos con riesgo conocido en un mes. Se identificaron farmacos de riesgo, interacciones y factores predisponentes. Se proporciono a cada medico los pacientes con farmacos con riesgo conocido, las recomendaciones y la encuesta para conocer mas factores de riesgo, su utilidad y su actitud clinica. Se realizo un analisis estadistico descriptivo. Resultados: el 3,2% de los pacientes del area estaban tratados con farmacos con riesgo conocido. El 64,0% eran mujeres, 57,5% mayores de 65 anos, y el 39,6% presentaban interacciones. El numero medio de factores de riesgo por paciente fue 1,78. Los farmacos con riesgo conocido mas frecuentes fueron antidepresivos (41,2%) y antibioticos (40,4%). El 25,4% de los medicos devolvio la encuesta informando de la actitud clinica en 1.073 pacientes: se retiro el farmaco con riesgo conocido en 289, se redujo la dosis en 113 y se realizo electrocardiograma en 398. Los medicos identificaron otros factores de riesgo: problema cardiaco (17,9%) e hiper/hipotiroidismo (8,8%). Conclusiones: la prevalencia detectada en la prescripcion de farmacos que prolongan el intervalo QT es relevante teniendo en cuenta que los pacientes tenian ademas otros factores de riesgo. Su identificacion permite mejorar la calidad de la atencion y la seguridad del paciente.

  17. [Usefulness of electronic drug registers: Spanish register of patients treated with fingolimod (Gilenya ®)].

    PubMed

    Fernández, Óscar; Rodríguez-Antigüedad, Alfredo; Oreja-Guevara, Celia; Garcia-Garcia, Margarida; Montalban, Xavier

    2014-01-16

    Introduccion. Se describe el diseño de un registro electronico de los pacientes con esclerosis multiple que inician tratamiento con fingolimod en España, que se plantea como una herramienta para monitorizar su manejo en la practica clinica habitual que permita optimizar su uso. Objetivos. Conocer el perfil de los pacientes con esclerosis multiple en tratamiento con fingolimod y determinar la efectividad y seguridad de este tratamiento en la practica clinica habitual. Desarrollo. Se establece un registro observacional, retrospectivo y prospectivo, multicentrico, que estara activo durante cinco años. Participaran 40 neurologos de España. Se incluiran pacientes tratados con fingolimod que cumplan los criterios de seleccion. Las variables de efectividad que se evaluaran son: la discapacidad medida mediante la escala ampliada del estado de discapacidad, la tasa de brotes, las lesiones captantes de gadolinio en secuencia T1 y las lesiones nuevas en secuencia T2, y el porcentaje de pacientes libres de actividad y aquellos que requieran tratamientos concomitantes. Las variables de seguridad que se evaluaran son: la tasa de pacientes que presenten acontecimientos y reacciones adversas, respectivamente, analizandose separadamente aquellos que se presenten tras la primera dosis o relacionados con el plan de manejo del riesgo de fingolimod, y la tasa de abandonos del tratamiento. Conclusiones. Los nuevos farmacos de reciente comercializacion requieren mayor informacion acerca de su efectividad y seguridad, mas alla del entorno controlado de un ensayo clinico. Las iniciativas de registros electronicos como el registro Gilenya son la solucion para dar respuesta a dicha necesidad, proporcionando informacion en el menor tiempo posible acerca del manejo mas adecuado para conseguir su uso mas optimo y eficiente posible.

  18. [Variability in the clinical presentation of Pompe disease in infancy: two case reports and response to treatment with human recombinant enzyme].

    PubMed

    Moreno-Medinilla, Esther; Berzosa-López, Raquel; Mora-Ramírez, M Dolores; Blasco-Alonso, Javier; Martínez-Antón, Jacinto

    2014-12-01

    Introduccion. La enfermedad de Pompe o glucogenosis tipo II es un error innato del metabolismo, de herencia autosomica recesiva, causado por un deficit de la enzima lisosomal alfa-glucosidasa acida (GAA), que ocasiona un acumulo multisistemico de glucogeno. Describimos dos casos de inicio temprano (infantil) con diferentes formas de presentacion. Casos clinicos. El primer caso se trata de un neonato que presento una bradicardia mantenida desde el nacimiento, lo que motivo el estudio cardiologico, en el que se evidencio una hipertrofia biventricular grave. El segundo caso se trata de un niño de 14 meses con retraso motor e hipotonia con arreflexia. En la analitica destacaban una creatincinasa, lactato deshidrogenasa, transaminasa glutamico oxalacetica y transaminasa glutamico piruvica elevadas. El electromiograma mostro signos de afectacion miopatica, y la biopsia muscular, una miopatia vacuolar con deposito de glucogeno. En ambos, la actividad de la GAA estaba disminuida y el analisis genetico del gen GAA evidencio que eran portadores heterocigotos de mutaciones descritas en la enfermedad de Pompe. Iniciaron tratamiento con enzima recombinante humana al mes y a los 18 meses de vida, respectivamente, con mejoria evidente de la miocardiopatia hipertrofica, aunque mas limitada a nivel motor. En la actualidad tienen, respectivamente, 9 meses y 5 años, y este ultimo presenta un nivel III de la escala GMFM (Gross Motor Function Measure). Conclusion. La GAA recombinante humana es la unica opcion terapeutica autorizada para estos pacientes. Los efectos que hemos observado son similares a los descritos en otros casos, con una excelente evolucion de la miocardiopatia hipertrofica y un efecto variable sobre la musculatura esqueletica.

  19. [Clinico-radiological profile of acute disseminated encephalomyelitis in the childhood population. A retrospective analysis of a series of 20 patients in a tertiary hospital].

    PubMed

    Tomás-Vila, Miguel; Menor, Francisco; Otero-Reigada, M Carmen; Pérez-Tamarit, Amparo; Téllez de Meneses, Montserrat; Pitarch-Castellanos, Inmaculada

    2014-01-01

    Introduccion. La encefalomielitis aguda diseminada (EAD) es un trastorno inflamatorio del sistema nervioso central mediado inmunologicamente y de patogenia desconocida. Puede presentarse en cualquier edad, pero es mucho mas frecuente en niños. La EAD no tiene marcador biologico especifico y el diagnostico se basa en hallazgos clinicos y neurorradiologicos. Objetivo. Mejorar el conocimiento del perfil clinicorradiologico de esta enfermedad. Pacientes y metodos. Estudio retrospectivo con inclusion de pacientes menores de 14 años ingresados en un hospital terciario en los ultimos 15 años con el diagnostico de EAD. Se revisaron antecedentes, signos clinicos de presentacion, datos analiticos en sangre/liquido cefalorraquideo y la semiologia radiologica. En 16 casos se realizo un seguimiento medio de 25 meses. Resultados. Se revisaron 20 pacientes, un 70% niños, con una edad media de 4,4 años. El 40% tuvo un episodio febril previo. El 85% presento fiebre o vomitos, y el 70%, afectacion del estado de consciencia. Predominaron los deficits motores (45%), las convulsiones (35%) y la afectacion de pares craneales (30%). Tres niños presentaron una evolucion recidivante, y otros tres, secuelas motoras. Los estudios de resonancia magnetica mostraron lesiones hiperintensas en secuencias T2, con patron de realce escaso o nulo, que predominaron en los talamos (70%), la medula (67%) y la sustancia blanca subcortical (50%). En dos pacientes se diagnostico EAD hemorragica. Conclusiones. La EAD representa una entidad con importante afectacion general y repercusion neurologica, que muestra un potencial secuelar considerable. Los datos clinicoanaliticos y la resonancia magnetica cerebral y medular son relevantes para el diagnostico inicial y seguimiento de pacientes con EAD.

  20. The efficacy and safety of natalizumab for the treatment of multiple sclerosis in Portugal: a retrospective study.

    PubMed

    Sousa, L; de Sa, J; Sa, M J; Cerqueira, J J; Martins-Silva, A

    2014-11-01

    Introduccion. Los estudios han demostrado que el natalizumab constituye un tratamiento eficaz contra la esclerosis multiple remitente recurrente (EMRR). Hasta la fecha, no habia datos de pacientes portugueses. Objetivo. Determinar la eficacia y la seguridad del natalizumab en pacientes con EMRR atendidos en la practica clinica ordinaria en Portugal. Pacientes y metodos. Los datos clinicos de adultos con EMRR tratados con natalizumab en centros especializados de neurologia en Portugal se introdujeron de forma retrospectiva en una base de datos para llevar a cabo un analisis entre octubre de 2010 y febrero de 2012. Se analizo el cambio en la tasa anualizada de brotes (TAB), en las puntuaciones de la escala ampliada de discapacidad (EDSS) y en el estado de discapacidad. Resultados. Se admitio un total de 383 pacientes atendidos en 20 centros. Antes de iniciar el tratamiento con natalizumab, la mediana inicial de la EDSS era de 4,0 y la TAB media, de 1,64. La mayor parte de los pacientes ya habia recibido tratamiento contra la esclerosis multiple (93,0%). La duracion media del tratamiento con natalizumab era de 12 meses. El tratamiento propicio reducciones significativas (p < 0,001) de los valores iniciales de la TAB media y de las puntuaciones EDSS en los tratados con el anticuerpo durante >= 12 meses (n = 288) y durante >= 24 meses (n = 160). El natalizumab resulto mas eficaz en los pacientes que presentaban un menor grado de discapacidad (EDSS < 3,0) y en los que no habian recibido ningun tratamiento modificador de la enfermedad. Se notificaron dos casos de leucoencefalopatia multifocal progresiva. No hubo efectos adversos inesperados. Conclusion. El natalizumab presenta una tolerabilidad satisfactoria y se muestra eficaz en la reduccion de las recidivas y la estabilizacion de la EMRR en el marco de la practica clinica ordinaria en Portugal. Conserva su eficacia con el tratamiento continuado y podria ser eficaz especialmente en los pacientes con menos discapacidad y

  1. Risk stratification systems for surgically treated localized primary Gastrointestinal Stromal Tumors (GIST). Review of literature and comparison of the three prognostic criteria: MSKCC Nomogramm, NIH-Fletcher and AFIP-Miettinen.

    PubMed

    Belfiori, Giulio; Sartelli, Massimo; Cardinali, Luca; Tranà, Cristian; Bracci, Raffaella; Gesuita, Rosaria; Marmorale, Cristina

    2015-01-01

    L’avvento dell’Imatinib mesilato (glivec) ha rivoluzionato la terapia dei GIST, apportando un aumento della sopravvivenza libera da malattia dopo resezione chirurgica completa di un GIST a localizzazione primitiva (RFS: Recurrence Free Survival). La definizione di un sistema prognostico accurato è fondamentale per decidere quali pazienti sottoporre a tale trattamento. In letteratura, esistono attualmente vari sistemi prognostici di riferimento in grado di predire la probabilità di recidiva, tra cui: NIH-FLETCHER, AFIP-MIETTINEN standard e modificato. A questi che sono i più diffusamente utilizzati, di recente si sono aggiunti altri metodi che utilizzano modelli matematici o no, come il Nomogramma del MSKCC, Nomogramma di Rossi ed il Joensuu high hotline Degjun. Nonostante tutti questi tentativi la storia naturale dei GIST rimane ancora non completamente nota e controversa e non è ancora possibile predire le recidive con una accuratezza assoluta. Lo scopo del nostro studio è stato quello di trovare quale sistema è più accurato e pratico per essere utilizzato nella nostra pratica clinica. Particolare attenzione è stata posta al Nomogamma del MSKCC, che è stato pertanto confrontato con i NIH-Fletcher ed AFIPMiettinen. Sono stati analizzati retrospettivamente i dati riguardanti 37 GIST operati presso il nostro istituto dal 2002 al 2012 e da questi sono stati selezionati 27 GIST a localizzazione primitiva, completamente resecati c non trattati con l’imatinib ne prima ne dopo l’intervento, sui quali è stato eseguito il confronto. Le conclusioni sono state che il nomogramma MSKCC è un metodo prognostico pratico, sicuro e valido, probabilmente più del NIH e AFIP e può essere utilizzato nella pratica clinica per predire il rischio di recidiva, specialmente nella pianificazione della strategia terapeutica, anche se non è un metodo ottimale per calcolare il tempo di sopravvivenza libera da recidiva. Il limite del Nomogramma del MSKCC sta nel valutare il

  2. [Description of a series of hospital patients with a spinal fistula].

    PubMed

    Garcia-Cabo, C; Morales-Deza, E S; Martinez-Rodriguez, L; Murias-Quintana, E; Perez-Alvarez, A; Martinez-Ramos, J; Vega-Valdes, P; Suarez-Santos, P; Garcia-Rua, A; Moris, G

    2016-10-01

    Introduccion. Aunque las fistulas espinales suponen el 70% de las malformaciones arteriovenosas espinales, son una entidad infradiagnosticada. El shunt arteriovenoso produce una congestion vascular que da lugar a una mielopatia progresiva, en ocasiones irreversible si no se trata de forma precoz. Objetivo. Describir las caracteristicas clinicorradiologicas de una serie de pacientes con fistula espinal. Pacientes y metodos. Se realizo una busqueda retrospectiva de pacientes con diagnostico de fistula espinal ingresados en el area de neurociencias de un hospital de tercer nivel asistencial. Resultados. Se identificaron 19 pacientes (7 mujeres y 12 varones) con una edad media de 56 años. La fistula espinal fue de tipo I en un 79% de los pacientes y la localizacion dorsal fue la mas frecuente. La mayoria de los casos presento un curso progresivo (90%). Un 74% de los pacientes se diagnostico mediante resonancia magnetica. En cuatro casos fue necesaria la realizacion de una angiografia para llegar al diagnostico, y en uno de ellos se preciso una biopsia intraoperatoria. Se realizaron tres punciones lumbares, en dos de las cuales se objetivo pleocitosis linfocitaria e hiperproteinorraquia. El retraso diagnostico medio fue de nueve meses. Se trato a un 79% de los pacientes, y de ellos solo mejoro el 10%. Conclusiones. Ante una clinica sugestiva de fistula espinal, debe realizarse una angiografia espinal diagnostica aunque el paciente estudiado pueda presentar caracteristicas licuorales atipicas y normalidad en la resonancia magnetica medular.

  3. HPV detection and genotyping in males from the city of Córdoba, Argentina.

    PubMed

    Venezuela, F; Kremer, L E; Kiguen, X; Cuffini, C

    2010-01-01

    A wide range of human papillomavirus (HPV) types can infect the anogenital region of males. Although there is a vast knowledge on HPV infections in women as well as on their association with cervical cancer, the study of HPV infections in males is scarce and controversial. The aim of the present work was to detect and typify HPV infections of the anogenital region in males and analyze the associated risk factors in the population studied. Anogenital samples from 37 patients (30 of whom were HIV carriers) attending the Infectology Service at the Hospital Nacional de Clinicas in C6rdoba, Argentina, were studied. Nine of these patients tested HPV-positive and five out of these nine were found to have mixed infections, being 18 and 61 the most frequent genotypes. There was a significant correlation between the HPV-positive patients and those having an HPV-compatible lesion or AIDS. The present work is the first study in the city of Cordoba which contributes relevant results to the knowledge of HPV infection and to the possible implementation of measures for its prevention.

  4. [A novel neurocutaneous syndrome: Legius syndrome. A case report].

    PubMed

    Cemeli-Cano, Mercedes; Peña-Segura, José Luis; Fernando-Martínez, Ruth; Izquierdo-Álvarez, Silvia; Monge-Galindo, Lorena; López-Pisón, Javier

    2014-09-01

    Introduccion. El sindrome de Legius es un trastorno autosomico dominante resultante de la mutacion del gen SPRED1, que implica perdida de funcion de una de las proteinas implicada en la via patogenica RAS-MAPK, similar a la neurofibromina y por ello muestra similitudes clinicas con la neurofibromatosis tipo 1 (NF1), pero con menor gravedad. Estos pacientes presentan multiples manchas cafe con leche y pueden asociar efelides, rasgos dismorficos, lipomas y trastornos del aprendizaje sin relacionarse con la aparicion de neurofibromas, gliomas opticos, nodulos de Lisch o predisposicion tumoral. Caso clinico. Niño de 10 meses, sin antecedentes personales de interes, que consulta por hipotonia de extremidades, manchas cafe con leche y leve retraso psicomotor. En los antecedentes familiares destaca una hermana de la madre y el abuelo materno con manchas cafe con leche. En nuestro paciente, el estudio genetico fue negativo para NF1, pero se hallo una mutacion en el gen SPRED1, compatible con el sindrome de Legius. La madre asintomatica presenta la misma mutacion en el gen SPRED1. Conclusion. Es de destacar la importancia del diagnostico diferencial de NF1, con las numerosas complicaciones que puede conllevar, con una entidad recientemente descrita de mejor pronostico como es el sindrome de Legius.

  5. [A descriptive study of the neuropsychological and psychopathological profile in patients with type 1 myotonic dystrophy].

    PubMed

    Seijas-Gomez, Raquel; Basterra-Jimenez, Izaskun; Luna-Lario, Pilar; Tirapu-Ustarroz, Javier; Cabada-Giadas, Teresa; Iridoy-Zulet, Marina; Jerico-Pascual, Ivonne; Gargallo-Vaamonde, Álvaro; Lopez-Goni, José Javier

    2015-12-16

    Introduccion. La distrofia miotonica tipo 1 (DM-1) o enfermedad de Steinert es un trastorno multisistemico y progresivo. Se han encontrado deficits cognitivos, clinica depresiva y alta incidencia de rasgos de personalidad ansiosos con afectacion tanto en la funcionalidad como en la calidad de vida de estos pacientes. Objetivo. Describir el perfil cognitivo y psicopatologico de una muestra de pacientes con la variante adulta de DM-1. Pacientes y metodos. Se selecciono una muestra de 27 pacientes con diagnostico de DM-1 en seguimiento en el Servicio de Neurologia del Complejo Hospitalario de Navarra. Los criterios de inclusion fueron tener menos de 50 anos y descartar cualquier otra patologia o condicion fisica que impidiese realizar la evaluacion psicologica. Se utilizo una bateria de evaluacion neuropsicologica especificamente disenada para este tipo de patologia, ademas de medidas de psicopatologia y funcionalidad. Resultados. La evaluacion neuropsicologica reflejo, principalmente, deficits en habilidades visuoconstructivas, visuoespaciales, atencion alternante y en sintomatologia disejecutiva heteroinformada. El grupo de pacientes no presento sintomatologia depresiva ni ansiosa clinicamente significativa, pero si puntuaciones elevadas en obsesion-compulsion, sensibilidad interpersonal, ideacion paranoide y psicoticismo. Los resultados orientaron hacia un deterioro en la funcionalidad. Conclusiones. En el abordaje integral de la DM-1, la caracterizacion y el seguimiento evolutivo del perfil cognitivo, psicopatologico y de personalidad, asi como del nivel de funcionalidad, contribuyen a la mejora de la calidad de vida de estos pacientes.

  6. The Integrated Oncology Program of the Italian Ministry of Health. Analytical and clinical validation of new biomarkers for early diagnosis: network, resources, methodology, quality control, and data analysis.

    PubMed

    Paradiso, Angelo; Mangia, Anita; Orlando, Claudio; Verderio, Paolo; Belfiglio, Maurizio; Marchetti, Antonio; Bertario, Lucio; Chiappetta, Gennaro; Gion, Massimo; Tonini, Gian Paolo; Podo, Franca; Vocaturo, Amina; Silvestrini, Rosella; Romani, Massimo; Belloni, Elena; Cavallo, Delia; Ulivi, Paola; Tommasi, Stefania; Steffan, Agostino; Russo, Antonio; Alessio, Massimo; Calistri, Daniele; Zancan, Matelda; Parrela, Paola; Broggini, Massimo; Giuseppe, Antonio; Buttitta, Fiamma; Finocchiaro, Gaetano; Mazzocco, Katia; Veronesi, Giulia; Landuzzi, Lorena; Benevolo, Maria; Mariani, Luciano; De Marco, Federico; Venuti, Aldo; Giannelli, Gianluigi; Quaranta, Michele; Trojano, Vito

    2009-01-01

    In 2007, an Italian cancer research group proposed a specific concerted action aimed at the "analytical and clinica validation of new biomarkers for early diagnosis: Network, resources, methodology, quality control, and data analysis." The proposal united 37 national operative units involved in different biomarker studies and it created a strong coordinative body with the necessary expertise in methodologies, statistical analysis, quality control, and biological resources to perform ad hoc validation studies for new biomarkers of early cancer diagnosis. The action, financed by the Italian Ministry of Health within the Integrated Oncology Program (PIO) coordinated by NCI-Istituto Tumori Bari, started in 2007 and activated 7 projects, each of which focused on disease-specific biomarker studies. Overall, the 37 participating units proposed studies on 50 biomarkers, including analytical and clinical validation procedures. Clusters of units were specifically involved in research of early-detection biomarkers for cancers of the lung, digestive tract, prostate/bladder, and nervous system, as well as female cancers. Furthermore, a cluster involved in biomarkers for bioimaging and infection-related cancers was created. The first investigators' meeting, "Analytical and clinical validation of new biomarkers for early diagnosis," was held on 9 September 2008 in Bari. During this meeting, methodological aspects, scientific programs and preliminary results were presented and discussed.

  7. [Acute posterior multifocal placoid pigment epitheliopathy. A rare cause of ischaemic stroke].

    PubMed

    del Saz-Saucedo, Pablo; Alfaya-Muñoz, Laura Blanca; Recio-Bermejo, Marta; Lara-Medina, Francisco Javier; García-Chiclano, Amalia; Ortega-León, Teresa; Rueda-Medina, Ignacio; Domínguez-Fernández, María José; Madrid-Muñiz, Carmen; Franco-Huerta, María

    2013-06-01

    Introduccion. La epiteliopatia pigmentaria placoide multifocal posterior aguda (EPPMPA) es una enfermedad inflamatoria rara, generalmente de etiologia indeterminada, de la coriocapilar, el epitelio pigmentario y la retina externa. Afecta predominantemente a pacientes jovenes y en algunos casos puede involucrar al sistema nervioso central en forma de ictus o de meningoencefalitis. Presentamos el caso clinico de una mujer joven con EPPMPA complicada con ictus e hipertension intracraneal. Caso clinico. Mujer de 16 anos que comienza con cefalea intensa sugestiva de hipertension intracraneal, asi como con un deficit agudo hemisferico izquierdo. La resonancia magnetica craneal ponia de manifiesto lesiones embolicas o vasculiticas en diferentes territorios. No se evidenciaron datos de meningoencefalitis en el estudio del liquido cefalorraquideo, pero si de hipertension intracraneal asociada. La presencia de lesiones muy especificas en el polo ocular posterior permitio el diagnostico de EPPMPA complicada con ictus isquemico, probablemente por mecanismo vasculitico. Un amplio estudio etiologico fue negativo para identificar un factor desencadenante claro del proceso. Se inicio tratamiento corticoideo con buena evolucion clinica y radiologica. Conclusiones. La EPPMPA es una entidad rara que generalmente entrana buen pronostico; sin embargo, en algunos casos puede complicarse con afectacion del sistema nervioso central, y el ictus isquemico secundario a vasculitis es la complicacion mas grave. Ante un paciente joven con ictus que presente sintomatologia visual y lesiones coriorretinianas, debe considerarse la EPPMPA en su diagnostico etiologico.

  8. [Neuropsychological study in patients with Parkinson's disease: the effects of deep brain stimulation].

    PubMed

    de la Peña, Cristina; Fernández-Medina, Juliana M; Parra-Bolaños, Nicolás; Martínez-Restrepo, Óscar A

    2016-02-16

    Introduccion. La enfermedad de Parkinson (EP) es un trastorno cuyas manifestaciones clinicas se observan en el ambito motor y neuropsicologico e influyen en la calidad de vida del paciente. Diversos estudios cientificos muestran la eficacia de la estimulacion cerebral profunda como tratamiento sobre los sintomas motores, pero faltan estudios sobre los sintomas neuropsicologicos. Objetivo. Analizar la existencia de diferencias significativas en procesos neuropsicologicos, como la atencion, la memoria, el lenguaje, la visuopercepcion y la funcion ejecutiva en los pacientes con EP antes y despues de la estimulacion cerebral profunda. Pacientes y metodos. La muestra estuvo formada por 20 pacientes parkinsonianos de 50-70 años de ambos sexos, pertenecientes a entidades prestadoras de servicios de salud de Medellin, a los que se les administraron el Continuous Performance Test y el Trail Making Test para valorar la atencion, la figura compleja de Rey y la prueba de memoria de Ardila para evaluar la memoria, el test de Boston y fluidez verbal para valorar el lenguaje, la figura compleja de Rey copia para la visuopercepcion, y el test de clasificacion de cartas de Wisconsin para valorar la funcion ejecutiva. Resultados. Existen diferencias significativas entre las puntuaciones antes y despues de la estimulacion cerebral profunda en los pacientes con EP en la atencion y la memoria. Conclusiones. El conocimiento de estos hallazgos es relevante para la terapia neuropsicologica de los pacientes con EP.

  9. [Prevalence and associated factors of anger post stroke: a systematic review].

    PubMed

    Ramos-Perdigués, Sònia; Mané-Santacana, Anna; Pintor-Pérez, Luis

    2015-06-01

    Introduccion. El ictus es una de las primeras causas de muerte e incapacidad, y supone un elevado coste economico. La ira tras un ictus es frecuente, y empeora la funcionalidad y la calidad de vida, aunque todavia es poco comprendida. Objetivo. Conocer la evidencia actual sobre la prevalencia y factores asociados a la ira tras un ictus. Materiales y metodos. Revision sistematica en Medline de todos los articulos originales que estudian la prevalencia o factores asociados a la ira tras un ictus. Resultados. La prevalencia de la ira tras un ictus es elevada (15-57,2%). La mayoria de los estudios no encuentra asociacion entre la ira y el sexo, edad, naturaleza, tamaño, lateralidad, gravedad del ictus y funcionalidad. Ocasionalmente, la ira se ha asociado a localizaciones anteriores y afasia. Los datos de su asociacion con deficits motores y deterioro cognitivo son poco concluyentes. Sin embargo, la asociacion con antecedentes psiquiatricos, clinica depresiva e incontinencia emocional comorbida se ha replicado ampliamente. Los factores ambientales, dificiles de estudiar, podrian tener relevancia. Conclusion. La prevalencia de la ira tras un ictus es elevada. Se ha asociado a patologia psiquiatrica, y otras asociaciones son poco concluyentes. Para un mejor conocimiento de la ira y los factores asociados tras un ictus, seria necesario mejorar sus definiciones e instrumentos de medida.

  10. [Mental illness, personality traits and quality of life in epilepsy: control study of patients with juvenile myoclonic epilepsy and other epilepsies].

    PubMed

    Martínez-Domínguez, Sara; Labrada-Abella, Jacob; Pedrós-Roselló, Alfonso; López-Gomáriz, Elena; Tenías-Burillo, José M

    2013-06-16

    Introduccion. La asociacion de epilepsia con enfermedad mental esta descrita desde hace años. En la actualidad, se intenta relacionar ciertas epilepsias, como la epilepsia mioclonica juvenil (EMJ), con determinados rasgos de personalidad marcados por la inestabilidad afectiva. Sujetos y metodos. Se estudia un grupo de pacientes con EMJ y su estado mental, con especial interes sobre los rasgos de personalidad, la presencia de clinica de ansiedad o depresion, y la calidad de vida, junto con otros pacientes diagnosticados de otras epilepsias, asi como frente a un grupo control. Resultados. Los pacientes con epilepsia presentan rasgos de personalidad mas marcados, asi como sintomas de ansiedad y depresion, y realizan una valoracion mas negativa de su calidad de vida respecto al grupo control. Los pacientes con otras epilepsias presentan una mayor alteracion de la personalidad y una peor percepcion de su calidad de vida que los pacientes con EMJ. Conclusiones. Se obtienen diferencias entre los pacientes con epilepsia y el grupo control en todas las variables analizadas (personalidad, ansiedad, depresion y calidad de vida). Los pacientes con EMJ presentan mejores puntuaciones en personalidad y calidad de vida que los pertenecientes al grupo de otras epilepsias.

  11. Hepatitis C risk factor for patients submitted to dialysis.

    PubMed

    Baldessar, Maria Zélia; Bettiol, Jane; Foppa, Fabrício; Oliveira, Lúcia Helena das Chagas

    2007-02-01

    This article reports the results of the research which has evaluated the prevalence and factors associated to the presence of Hepatitis C in patients submitted to dialysis at the Clinica de Doenças Renais (Clinic of Renal Diseases) in Tubarao city (CRDT), Santa Catarina State, Brazil, in the period between January 1st, 2004 to December 31st in the same year. The prevalence of 16.8% of Hepatitis C in the studied population and the time-length of dialysis as significative risk factor have become evident. The non-correlation of seropositivity of the followings factors is also indicated: age, gender, base diseases, infrastructures, the type of clinic machines, the type of dialyser, used membranes, the machine sterilisation and substances for this process as well as the number of times of the dialyser reutilization. The data represented in this project suggest that the Hepatitis C presents high prevalence in patients in dialysis and the time-length of the treatment is a risky factor to acquire the infection.

  12. [First case described of isolated, complete and fluctuating cranial nerve III palsy heralding multiple myeloma].

    PubMed

    León-Ruiz, Moisés; Benito-León, Julián; Sierra-Hidalgo, Fernando; García-Soldevilla, Miguel Ángel; Izquierdo-Esteban, Laura; Tejeiro-Martínez, José; Cabrera-Valdivia, Francisco; García-Albea Ristol, Esteban

    2015-02-01

    Introduccion. El mieloma multiple es la neoplasia de celulas plasmaticas mas frecuente. Al ser incurable, el tratamiento persigue obtener el mayor tiempo de supervivencia libre de clinica. Constituye una causa extremadamente rara de afectacion de los nervios craneales y es producido habitualmente por un plasmocitoma intracraneal. Presentamos un caso de mieloma multiple, que asociaba un plasmocitoma intracraneal y que comenzo clinicamente con paralisis aislada, completa y fluctuante del III nervio craneal. Caso clinico. Mujer de 63 años que acudio a urgencias por presentar un cuadro clinico oscilante, consistente en diplopia binocular horizontal y, posteriormente, cefalea. La exploracion neurooftalmologica revelo una paralisis completa del III nervio craneal derecho. Se solicito una tomografia axial computarizada craneal urgente, que revelo multiples lesiones osteoliticas diploicas, asociando una de ellas componente de partes blandas en la hendidura esfenoidal derecha. La paciente fue ingresada, y se le diagnostico posteriormente un mieloma multiple IgA-kappa. Tras recibir induccion quimioterapica y ser sometida a un trasplante autologo de progenitores hematopoyeticos, alcanzo la remision completa. Conclusiones. El mieloma multiple es un trastorno raro de los nervios craneales, una causa muy infrecuente de paralisis aislada y completa del III nervio craneal y menos aun fluctuante, y no se ha encontrado ningun caso publicado con este inicio clinico. Tener en cuenta las posibles manifestaciones neurooftalmologicas del mieloma multiple puede contribuir a un diagnostico precoz y a una incidencia positiva sobre el curso de esta enfermedad.

  13. State-of-the-art phacoemulsification performed by residents in Buenos Aires, Argentina.

    PubMed

    Badoza, D A; Jure, T; Zunino, L A; Argento, C J

    1999-12-01

    To analyze the learning curve for state-of-the-art phacoemulsification performed by residents. Department of Ophthalmology, Hospital de Clinicas José de San Martin, University of Buenos Aires, Buenos Aires, Argentina. The records of patients having phacoemulsification performed by residents from June 1996 to January 1998 were reviewed for preoperative and postoperative best corrected visual acuities and the occurrence of complications. The phacoemulsification technique used for the first 35 surgeries of each resident was compared with that of their last 35 surgeries. The records showed 249 cases of phacoemulsification by residents. Mean preoperative best corrected visual acuity was 0.19 +/- 0.19 (SD). One month postoperatively, it was 0.86 +/- 0.2. Nuclear fracture was performed in a mean of 28.33 +/- 5.0 of the first 35 surgeries by each resident, whereas chopping techniques were used in a mean of 23.33 +/- 1.5 of the last 35 cases. Vitreous loss occurred in 2.8% of cases. Residents learned cracking and chopping phacoemulsification techniques safely with satisfactory outcomes.

  14. [Adherence to oral antineoplastic therapy].

    PubMed

    Olivera-Fernandez, R; Fernandez-Ribeiro, F; Piñeiro-Corrales, G; Crespo-Diz, C

    2014-11-03

    Introducción: Los tratamientos antineoplasicos orales presentan ventajas en cuanto a coste, comodidad y mejora potencial en la calidad de vida respecto al tratamiento endovenoso, pero es mas dificil controlar la adherencia y monitorizar los efectos adversos. El objetivo de este estudio fue conocer la adherencia real en pacientes con antineoplasicos orales en nuestro centro, analizar la influencia de las caracteristicas del paciente y del tratamiento, identificar motivos de no adherencia, oportunidades de mejora en la atencion farmaceutica y evaluar la posible relacion adherencia y respuesta al tratamiento. Método: estudio prospectivo observacional de cuatro meses de duracion, en los pacientes con tratamiento antineoplasico oral dispensado desde la consulta de farmacia oncologica. Para la recogida de datos se utilizaron: orden medica, historia clinica y visita con entrevistas al paciente. Resultados: Se evaluaron un total de 141 pacientes. Un 72% se considero totalmente adherente, mientras que en un 28% se detecto algun tipo de no adherencia. El tiempo desde el diagnostico y la presencia de efectos adversos fueron las variables que afectaron a la adherencia. No se pudo demostrar relacion entre adherencia y respuesta al tratamiento. Conclusiones: La adherencia al tratamiento antineoplasico oral en nuestro centro fue del 72%, identificando oportunidades de mejora en la atencion farmaceutica dirigidas a prevenir los efectos adversos y a potenciar la adherencia de nuestros pacientes.

  15. Study Design of the Microcirculatory Shock Occurrence in Acutely Ill Patients (microSOAP): an International Multicenter Observational Study of Sublingual Microcirculatory Alterations in Intensive Care Patients

    PubMed Central

    Vellinga, Namkje A. R.; Boerma, E. Christiaan; Koopmans, Matty; Donati, Abele; Dubin, Arnaldo; Shapiro, Nathan I.; Pearse, Rupert M.; Bakker, Jan; Ince, Can

    2012-01-01

    Objective. Sublingual microcirculatory alterations are associated with an adverse prognosis in several critical illness subgroups. Up to now, single-center studies have reported on sublingual microcirculatory alterations in ICU patient subgroups, but an extensive evaluation of the prevalence of these alterations is lacking. We present the study design of an international multicenter observational study to investigate the prevalence of microcirculatory alterations in critically ill: the Microcirculatory Shock Occurrence in Acutely ill Patients (microSOAP). Methods. 36 ICU's worldwide have participated in this study aiming for inclusion of over 500 evaluable patients. To enable communication and data collection, a website, an Open Clinica 3.0 database, and image uploading software have been designed. A one-session assessment of the sublingual microcirculation using Sidestream Dark Field imaging and data collection on patient characteristics has been performed in every ICU patient >18 years, regardless of underlying disease. Statistical analysis will provide insight in the prevalence and severity of sublingual alterations, its relation to systemic hemodynamic variables, disease, therapy, and outcome. Conclusion. This study will be the largest microcirculation study ever performed. It is expected that this study will also establish a basis for future studies related to the microcirculation in critically ill. PMID:22666566

  16. Heparin in pregnant women with previous placenta-mediated pregnancy complications: a prospective, randomized, multicenter, controlled clinical trial.

    PubMed

    Martinelli, Ida; Ruggenenti, Piero; Cetin, Irene; Pardi, Giorgio; Perna, Annalisa; Vergani, Patrizia; Acaia, Barbara; Facchinetti, Fabio; La Sala, Giovanni Battista; Bozzo, Maddalena; Rampello, Stefania; Marozio, Luca; Diadei, Olimpia; Gherardi, Giulia; Carminati, Sergio; Remuzzi, Giuseppe; Mannucci, Pier Mannuccio

    2012-04-05

    To assess whether antithrombotic prophylaxis with low-molecular-weight heparin effectively prevents recurrence of late pregnancy complications, 135 women with previous history of preeclampsia, hemolytic anemia, elevated liver enzymes and low platelet count syndrome, intrauterine fetal death, fetal growth restriction, or placental abruption who had been referred within the 12th gestational week were randomized to medical surveillance alone (n = 68) or combined to open-label nadroparin (3800 IU daily subcutaneous injections) treatment (n = 67) in the setting of a randomized, parallel-group, superiority trial, run in Italy from April 2007 to April 2010. Primary outcome was a composite end point of late-pregnancy complications. Analysis was by intention to treat. The study was stopped for futility at the time of the first planned interim analysis. Among the 128 women eventually available for final analyses, 13 of the 63 (21%) randomized to nadroparin compared with 12 of the 65 (18%) on medical surveillance alone progressed to the primary end point. The absolute event risk difference between treatment arms (2.2; -1.6 to 16.0) was not statistically significant (P = .76). Thus, nadroparin did not prevent late-pregnancy complications in women at risk of recurrence. This finding challenges the role of antithrombotic prophylaxis with low-molecular-weight heparin in the prevention of recurrent late pregnancy complications The trial was registered at http://ricerca-clinica.agenziafarmaco.it as EudraCT 2006-004205-26.

  17. A novel method of placing right ventricular leads in patients with persistent left superior vena cava using a conventional j stylet.

    PubMed

    Mora, Guillermo

    2014-03-01

    Locating pacemaker electrodes can become complicated by congenital abnormalities such as persistent left superior vena cava (LSVC). To evaluate a technique for the implanting of ventricular electrode in patients with persistent LSVC. The study was carried out from June 2001 to June 2010 involving all patients who were admitted to the Hospital Universitario Mayor, Instituto de Corazon de Bogota and Hospital Universitario Clinica San Rafael (Bogota-Colombia) for implanting pacemakers or cardiac defibrillators. LSVC was diagnosed by fluoroscopic observation (anterior-posterior view) of the course of the stylet. Four steps were followed: 1) Move the electrode with a straight stylet to the right atrium. 2) Change the straight stylet by a conventional J stylet and push the electrode to the lateral or anterolateral wall of the right atrium. 3) Remove the guide 3-5 cm and 4) Push the electrode which crosses the tricuspid valve into the right ventricle and finally deploy the active fixation mechanism. A total of 1198 patients were admitted for pacemaker or cardiac defibrillator implant during the 9-year study period, 1114 received a left subclavian venous approach. There were 573 males and 541 females. Persistent LSVC was found in five patients (0.45%) Fluoroscopy time for implanting the ventricular electrode ranged from 60 to 250 seconds, 40 to 92 minutes being taken to complete the whole procedure. We present a simple and rapid technique for electrode placement in patients with LSVC using usual J guide and active fixation electrodes with high success.

  18. [A proposal for a model to replace carbamazepine or oxcarbazepine by eslicarbazepine acetate in clinical practice].

    PubMed

    Poza-Aldea, J J

    2016-09-01

    Introduccion. Durante muchos a˜os, la carbamacepina (CBZ) ha sido el farmaco de referencia para el tratamiento de las crisis epilepticas parciales. Sin embargo, los problemas asociados de su farmacocinetica y tolerabilidad han llevado al desarrollo de otros derivados, como la oxcarbacepina (OXC) y, mas recientemente, el acetato de eslicarbacepina (ESL), que obvien estos inconvenientes. Desarrollo. En la practica clinica, se presenta con relativa frecuencia la posibilidad de sustituir la CBZ o la OXC por ESL, buscando mantener la eficacia de los predecesores y ganar las ventajas en el ambito de farmacocinetica y tolerabilidad que ofrece este ultimo derivado. Para ello es indispensable disponer de una equivalencia aproximada de dosis y un protocolo de intercambio. La presente revision ofrece un modelo practico y razonado para realizar el cambio. Conclusiones. El paso de OXC a ESL se puede realizar de un dia para otro con una equivalencia de dosis de 1-1,5 a 1. La sustitucion de CBZ por ESL debe ser mas progresiva, y la equivalencia de dosis se establece en 1-1,3 a 1.

  19. A comparative analysis between laparoscopy and open colectomy: assessment of perioperative and oncological outcomes.

    PubMed

    Farinetti, Alberto; Bonetti, Luca Reggiani; Migaldi, Mario; Mattioli, Anna Vittoria; Pennella, Sonia; Muratori, Simone; Rossi, Aldo

    2015-01-01

    Il presente studio raffronta due gruppi di pazienti affetti da adenocarcinoma dolo-rettale, sottoposti rispettivamente a colectomia con tecnica open e a videolaparoscopia, mettendone in luce benefici e svantaggi. Si tratta di un’analisi retrospettiva: dal gennaio 2003 e il dicembre 2006 sono stati reclutati 54 pazienti; di questi 26 operati in laparotomia e 28 in laparoscopia. Per la chirurgia laparotomica la durata media dell’intervento è stata di 177.9 minuti (tempo chirurgico) e di 280.4 minuti (tempo di sala operatoria con un minimo di 110 ed un massimo di 360 minuti, con significative differenze in rapporto al tipo di chirurgia effettuata e la storia clinica del paziente. Per la chirurgia laparoscopica la durata media è stata di 293 minuti (range 135-520), con significative differenze dipendenti dalla porzione di intestino asportata. Il raffronto delle due tecniche chirurgiche, laparotomica versus lapsroscopica, ha rivelato alcune differenze. La durata della resezione è stata maggiore per la laparoscopia se confrontata con la tecnica tradizionale. Entrambi gli approcci rappresentano tecniche convenienti, sicure ed oncologicamente corrette. La laparoscopia mostra maggiori vantaggi in termini di controllo del dolore, assenza di estese cicatrici, riscontro di laparoceli e di degenza post operatoria comparata con la tecnica laparotomica.

  20. [Hysteroscopy findings in patients with postmenopausal genital bleeding].

    PubMed

    Alanis Fuentes, José; Martínez Gutiérrez, Martel; Mata, Miranda Pilar

    2007-05-01

    To describe morphological and histological findings in postmenopausal patients with abnormal uterine bleeding. An open, descriptive, observational, retrospective and cross sectional study was done at Clinica de Histeroscopia at Hospital Dr. Manuel Gea Gonzalez, in Mexico City. There were included 372 patients with postmenopausal abnormal uterine bleeding diagnosis without hormone replacement therapy. Hysteroscopy study was made with a 5 mm surgical hysteroscope using warm saline solution (280C) as a medium of distension, and a trans-hysteroscopy endometrial biopsy was taken for histopathological correlation. Statistic analysis was obtained using SPSS program version 10 for windows with a kappa test. In order to analyze more than two samples, we used the chi-square test. Endometrial atrophy was the most frequent hysteroscopic diagnosis (202 patients, 54.3%), followed by polyps (93 patients, 25%), cancer (14 patients, 4%) and hyperplasia (11 patients, 2.95%). Correlated results between hysteroscopic findings and hystopathological biopsy diagnosis obtained were: atrophy (157 cases, 63.3%), polyps (76 cases, 77.55%), endometrial cancer (14 cases, 93.05%), endometrial hyperplasia (10 cases, 90.63%) and miomatosis (three cases, 16.20%). It can be stated that there is a high level of concordance between findings of hysteroscopic studies and the directed endometrial biopsy. So, we recommend initially the use of hysteroscopy for diagnosis and treatment of endometrial cavity malignant and benign pathology.

  1. Evaluation of an HIV adherence counseling program in La Romana, Dominican Republic.

    PubMed

    Winter, Meredith C; Halpern, Mina; Brozovich, Ava; Neu, Natalie

    2014-01-01

    Research has demonstrated that adherence to antiretroviral therapy (ART) results in lower rates of morbidity and mortality associated with HIV infection, yet adherence remains a challenge in resource-limited settings like the Dominican Republic. Clinica de Familia La Romana addressed this problem with an education-based adherence program for adult patients new to ART, and this retrospective cohort study aimed to evaluate the impact of this intervention. Appointment adherence and biological markers were assessed in cases and controls through 12 months. A total of 101 participants were included, with 61 controls and 40 cases. The baseline CD4 count was 162 and 157 cells/mm3 in controls and cases, respectively. Cases showed a 15-fold increase in CD4 count compared with a 2.5-fold increase in controls. Cases were more likelyto adhere to appointments with adherence rates of 86% versus 76% in controls. There was no difference between the rates of treatment abandonment, transfer of care, or death.

  2. [Occupational epidemiology: from analysis of the apparent to investigation of the unknown].

    PubMed

    Zocchetti, C; Pesatori, Angela; Consonni, D

    2003-01-01

    This paper, as a contribution for the centenary celebration of the establishment of the "Clinica del Lavoro Luigi Devoto" in Milan (Italy), presents a brief 30 year history of the activities of its Department of Occupational Epidemiology. Studies and methodological contributions that characterized the first decade of activity are presented and grouped under the heading of analysis of known health effects. The second decade was dominated by the studies and activities that originated from the Seveso accident (dioxin), with an initial interest towards molecular epidemiology, which became increasingly relevant during the third decade when we addressed topics like melanoma, lung cancer, and benzene, in addition to dioxin. More traditional occupational approaches were not dismissed and cohort mortality studies are currently under way (textile dyeing and finishing industry, sulfuric acid, tetrafluoroethylene). Pros and cons of the epidemiologic approach are discussed in the context of occupational health and the strength of its methodological apparatus is suggested as a fundamental tool for studying adverse occupational health effects. In contrast, it is stressed how occupational epidemiology has been poorly used in the application of law 626/94. Considering that contemporary epidemiology is much more inclined towards the discovery of new work-related risks (electromagnetic fields, air pollution) than the description of known health effects, the paper suggests that occupational epidemiology enlarge its interests: people and environment outside the factories might be good candidates for study.

  3. [National consensus on the ketogenic diet].

    PubMed

    Armeno, Marisa; Caraballo, Roberto; Vaccarezza, María; Alberti, M Julia; Ríos, Viviana; Galicchio, Santiago; de Grandis, Elizabeth S; Mestre, Graciela; Escobal, Nidia; Matarrese, Pablo; Viollaz, Rocío; Agostinho, Ariela; Díez, Cecilia; Cresta, Araceli; Cabrera, Analía; Blanco, Virginia; Ferrero, Hilario; Gambarini, Victoria; Sosa, Patricia; Bouquet, Cecilia; Caramuta, Luciana; Guisande, Silvina; Gamboni, Beatriz; Hassan, Amal; Pesce, Laura; Argumedo, Laura; Dlugoszewski, Corina; DeMartini, Martha G; Panico, Luis

    2014-09-01

    Introduccion. La epilepsia es una enfermedad cronica que afecta al 0,5-1% de la poblacion, mayormente de inicio durante la infancia. Un tercio de los pacientes evoluciona hacia una forma refractaria al tratamiento con farmacos antiepilepticos, lo que plantea al equipo de salud un desafio terapeutico. La dieta cetogenica (DC) es un tratamiento no farmacologico efectivo utilizado como un metodo alternativo para el tratamiento de la epilepsia refractaria. Objetivos. Es necesario establecer directrices para utilizar la DC adecuadamente y asi expandir su conocimiento y utilizacion en paises hispanoparlantes. El Comite Nacional de Dieta Cetogenica, dependiente de la Sociedad Argentina de Neurologia Infantil, elaboro este consenso para estandarizar el uso de la DC basandose en la bibliografia publicada y la experiencia clinica. El grupo esta formado por neuropediatras, medicos nutricionistas y licenciadas en nutricion de cinco provincias de Argentina pertenecientes a 10 centros que aplican la DC como tratamiento de la epilepsia refractaria. Desarrollo. Se exponen temas tales como la seleccion del paciente, el asesoramiento a la familia antes del tratamiento, las interacciones de la DC con la medicacion anticonvulsionante, los suplementos, el control de efectos adversos y la retirada de dicha dieta. Conclusiones. La DC es un tratamiento util para los pacientes pediatricos con epilepsia intratable. Es fundamental la educacion y colaboracion del paciente y la familia. El tratamiento debe llevarlo a cabo un equipo interdisciplinar experimentado, siguiendo un protocolo. La formacion de un grupo nacional interdisciplinar, y la publicacion de este consenso, ofrece la posibilidad de orientar a nuevos centros en su implantacion.

  4. Efficacy and safety of alendronic acid in the treatment of osteoporosis in children.

    PubMed

    Martín Siguero, Alberto; Áreas Del Águila, Vera Lucía; Franco Sereno, María Teresa; Fernández Marchante, Ana Isabel; Pérez Serrano, Raúl; Encinas Barrios, Carmen

    2015-11-01

    Objetivos: describir la efectividad y seguridad del uso de acido alendronico en el tratamiento de la osteoporosis en ninos y adolescentes, en condiciones distintas a las autorizadas en la ficha tecnica. Métodos: estudio retrospectivo (2008-2014) de todos los pacientes menores de 18 anos a los que se dispenso acido alendronico para esta indicacion. Los criterios para iniciar tratamiento fueron: densidad mineral osea con puntuacion Z-score ≤ -2,5 DE, antecedentes de fracturas oseas sin traumatismo previo y dolor persistente. Las variables recogidas fueron: demograficas, de tratamiento, clinicas y de seguridad. Se considero efectividad del tratamiento al aumento de la densidad mineral osea hasta obtener Z-score > -2,5 DE. Resultados: un total de 12 pacientes, 8 varones, con una media de edad de 11 anos (} 3 DE), fueron tratados con acido alendronico. Tras un tiempo medio de tratamiento de 2,15 anos (} 1,2 DE), se produjo aumento de la densidad mineral osea en todos los pacientes, 9 de los cuales obtuvieron Z-score > -2,5 DE, por lo que el farmaco se considero efectivo en el 75% de los casos. Ningun paciente presento fracturas oseas ni manifesto efectos adversos durante el tratamiento. Conclusiones: el acido alendronico incremento la densidad mineral osea y se tolero bien en todos los pacientes, por lo que se podria considerar como opcion terapeutica en el tratamiento de la osteoporosis infantil.

  5. MANAGEMENT OF DIABETES MELLITUS (PRAMEHA) WITH INULA RACEMOSA AND CINNAMOMUM TAMALA

    PubMed Central

    Singh, T. N.; Upadhyay, B. N.; Tewari, C. M.; Tripathi, S. N.

    1985-01-01

    35 patients of Maturity onset diabetes mellitus having the complaints of polyurea polydypsia and polyphagia etc. have been selected. For the diagnosis of diabetes mellitus the fasting and 1st hour and 2nd hour post parandial blood sugar were estimated. Patients were classified into two groups. 20 patients were treated with powder of C. Tamal leaves in the dose of 2 TSF T. D. S. and 15 patients were treated with Inula racemosa in the dose of 1 TSF T. D. S. for the period of three months. The response was estimated on the parameter of Joslin's Clinica in C. Tamal group 50% cases were in good control. 33.33% were in fair control and 16.67% cases were in poor control. Inula racemosa treated group 100% cases were in good control. Thus it can be inferred that both of the drugs are useful in the treatment of Diabetes mellitus of Maturity onset. However, the response of Inula racemosa is better as compared to C. Tamala. PMID:22557492

  6. [Variability in the clinical presentation of Pompe disease: development following enzyme replacement therapy].

    PubMed

    Ley-Martos, Myriam; Salado-Reyes, María J; Espinosa-Rosso, Raúl; Solera-García, Jesús; Jiménez-Jiménez, Luis

    2015-11-01

    Introduccion. La enfermedad de Pompe es un trastorno generalizado progresivo producido por el deficit de la enzima alfa-glucosidasa acida (AGA) de los lisosomas. Se presentan tres casos manifestados de forma muy diferente y tratados con terapia enzimatica sustitutiva (TES), con evolucion favorable. Casos clinicos. Caso 1: varon de 3 meses, con debilidad y rechazo de la alimentacion, hepatomegalia leve, ligera macroglosia e hipotonia, y aumento de las enzimas musculares. Caso 2: varon de 5 meses, con retraso del desarrollo motor, sordera neurosensorial grave, trastornos respiratorios de repeticion de evolucion torpida, hipotonia y leve elevacion de la creatincinasa. Caso 3: varon de 22 años con disnea progresiva, con antecedentes de elevacion de la creatincinasa y las transaminasas, e hipercolesterolemia. Sufrio insuficiencia respiratoria grave que preciso intubacion endotraqueal. La biopsia muscular presento depositos de glucogeno sugestivos de la enfermedad. En los tres casos, el estudio electromiografico dio un patron caracteristico, con descargas pseudomiotonicas, y se confirmo el deficit de AGA en los linfocitos. Se encontro una mutacion en un caso y dos mutaciones en los otros dos. Todos recibieron TES con evolucion favorable: desaparicion de las alteraciones cardiacas en el caso 1, mejoria en los hitos motores en los dos casos infantiles y retirada del respirador en el caso 3. Conclusion. La enfermedad de Pompe tiene una amplia variabilidad en la expresion clinica. La TES consigue una buena respuesta, especialmente en las formas infantiles. La supervivencia a largo plazo de las formas infantiles tratadas permitira conocer mas aspectos del curso de la enfermedad.

  7. [Exploring the dark continent: medical image and brain].

    PubMed

    Garcia-Molina, A; Ensenat, A

    2017-04-01

    Introduccion. Hasta finales del siglo XIX, el sistema nervioso central es practicamente inaccesible a la observacion directa. El descubrimiento en 1895 de los rayos X y su posterior aplicacion medica constituyen un cambio de paradigma que revoluciona por completo la manera en que se practica la neurologia. La posibilidad de visualizar el interior del encefalo tiene un impacto mayusculo en la practica clinica y enriquece el diagnostico y el tratamiento de patologias cerebrales de una forma hasta entonces inimaginable. Desarrollo. El proposito de este trabajo es describir el nacimiento y el desarrollo de la imagen medica cerebral: partimos del descubrimiento de los rayos X y del inicio de la radiografia hasta llegar a la aparicion en la decada de los setenta de la tomografia computarizada y la resonancia magnetica, tecnicas que cambiarian el mundo del diagnostico por imagen. En este breve recorrido por la historia de la neurorradiologia tambien se incluye el origen de la angiografia y otras tecnicas actualmente en desuso, pero que en su momento constituyeron una autentica revolucion; tal es el caso de la ventriculografia o la neumoencefalografia. Conclusiones. Los procedimientos y tecnicas descritos en este articulo han permitido visualizar el interior del cerebro, facilitando el diagnostico y el tratamiento de multiples procesos neurologicos.

  8. [Neonatal tongue-tie: myths and science].

    PubMed

    Dollberg, Shaul; Botzer, Eyal

    2011-01-01

    Anatomical restraining of tongue movement (tongue-tie, ankyloglossia) has been known for centuries and the subject of dozens of articles. The heated debate persists on its clinical significance and indications for treatment. Most authorities in the field of infant feeding and Lactation agree that breastfeeding problems, such as nipple pain and latching difficulties, are common signs of clinicaLly significant tongue-tie and indications for performing a frenotomy, while the sole presence of a visible lingual frenulum is not. In contrast, the lack of a visible frenulum does not rule out the diagnosis of clinically significant tongue-tie since submucosal ties, also called "posterior tongue-tie", may interfere with efficient breastfeeding. Whether tongue-tie interferes with speech articulation to a significant extent is currently unknown. Theoretically, articulation of some consonants (e.g., /s/, /th/, /r/) would be affected by impeded tongue movement. These articulation problems are, however, Less common than tongue-tie itself, and children and adults characteristically use various compensatory techniques of mouth opening and tongue movements. When it is indicated, frenotomy is performed by lifting the tongue and snipping the frenulum with scissors. Complications of frenotomy are rare and consist mainly of self-limited minor bleeding. The significance of posterior tongue tie and the long-term effects of frenotomy performed during early infancy are unresolved issues.

  9. [Effectiveness of lacosamide in the treatment of refractory neuropathic pain: an open observational trial].

    PubMed

    Gómez-Argüelles, José M; Bermejo, Pedro E; Lara, Manuel; Almajano, Jerónimo; Aragón, Esther; García del Carrizo, Fernando; Blanco, M Victoria; Valenzuela-Rojas, Francisco J; Colás, Juan; Sánchez-Del Valle, Octavio; Ceballos, M Ángeles; Toribio-Díaz, M Elena; Latorre-González, Germán; Costa-Frossard, Lucienne; Morin-Martin, M del Mar

    2014-10-01

    Introduccion. Aunque se dispone de diferentes tratamientos para el dolor neuropatico, en muchas ocasiones estos pacientes son refractarios, lo que hace necesario probar tratamientos que, por su utilidad en otras patologias, podrian ser eficaces en el dolor neuropatico. Pacientes y metodos. Se recogieron las historias clinicas de pacientes que hubieran sido tratados con lacosamida para el dolor neuropatico, en diferentes hospitales de la zona centro peninsular, y que cumplieran unas caracteristicas similares en cuanto a refractariedad a otros tratamientos estandares, en un seguimiento de al menos seis meses, o que hubiesen tenido que suspender el tratamiento con dicho farmaco por cualquier motivo. Se obtuvo una muestra de 114 pacientes, 61 varones y 53 mujeres, con una edad media de 60,5 años. Resultados. Las causas de dolor neuropatico mas frecuentes fueron: polineuropatia diabetica (31,6%), neuralgia postherpetica (22,8%), neuralgia del trigemino (17,5%), neuralgia suboccipital y lumbociatalgia (un 12,3% en ambas). La eficacia fue buena/muy buena en la mayoria de los pacientes, con un descenso medio en la escala analogica visual tras seis meses de 7,7 a 4,8. No se registraron efectos secundarios graves en ningun paciente, pero en 12 y 10 pacientes no hubo registro mas alla de seis meses, por ineficacia e intolerancia al tratamiento, respectivamente. Conclusiones. El tratamiento con lacosamida en el dolor neuropatico de diferentes causas podria considerarse como una alternativa efectiva y bien tolerada para aquellos pacientes que no respondan a los tratamientos estandares.

  10. Scientific publications in laboratory medicine from mainland China, Hong Kong and Taiwan: A ten-year survey of the literature.

    PubMed

    Liu, Ding-Hua; Cui, Wei; Yao, Yun-Tai; Jiang, Qi-Qi

    2010-10-09

    We investigated scientific publications in laboratory medicine originating from mainland China, Hong Kong and Taiwan over the past 10 years. The information about articles published in the included journals were determined by computer-searching on PubMed and data were extracted independently and analyzed in relation to the number of articles. From 2000 to 2009 there were 1166 articles published in laboratory medicine journals from the major Chinese regions (mainland China, Hong Kong and Taiwan). This exceeded Japan, Germany, the United Kingdom and France from 2005 onwards. Also, the number of articles from mainland China exceeded those from Hong Kong and Taiwan from 2004 onwards. The average impact factor (IF) from Hong Kong ranked the first, followed by mainland China, and then Taiwan. Clinica Chimica Acta seems to be the most popular laboratory medicine journal among Chinese authors. Over the past 10 years, Chinese authors have been more and more active in the field of laboratory medicine. Mainland China seems to have caught up to Hong Kong and Taiwan regarding publication of papers in this field. Copyright 2010 Elsevier B.V. All rights reserved.

  11. [Factors associated to the work situation of patients with multiple sclerosis].

    PubMed

    Cores, Evangelina V; Vanotti, Sandra; Burin, Débora I; Politis, Daniel G; Villa, Andrés

    2014-02-16

    Introduccion. La esclerosis multiple es una enfermedad neurologica desmielinizante que suele provocar trastornos motrices, perceptivos, afectivos y cognitivos a quienes la padecen. Estos sintomas pueden llevar a la persona a perder su empleo, y disminuir la calidad de vida del paciente y sus familiares. Objetivo. Revisar estudios sobre variables demograficas, clinicas, cognitivas, psiquiatricas, laborales y sociales asociadas con la situacion laboral. Desarrollo. Estudios transversales y longitudinales han detectado variables relacionadas con el desempleo. Las investigaciones empiricas muestran una influencia clara de la discapacidad fisica, la fatiga y el curso de la enfermedad sobre la situacion laboral. Sin embargo, el genero, la depresion, la edad, la duracion de la enfermedad y las variables cognitivas no poseen el mismo grado de evidencia. Caracteristicas de la ocupacion, como discriminacion laboral, actitud del empleador, leyes laborales, actitud de los compañeros de trabajo y dificultades en el transporte han sido variables poco consideradas. Conclusiones. Muchos de los factores que determinan la perdida de empleo en un paciente con esclerosis multiple pueden identificarse a tiempo para poder modificarlos o compensarlos. Los conocimientos aportados por los estudios reseñados permiten detectar a aquellos pacientes que se encuentran en riesgo de perder su empleo para realizar intervenciones posibles con el objetivo de prevenir esta situacion. En particular, el perfil de vulnerabilidad incluye alta discapacidad fisica y fatiga, curso progresivo de la enfermedad y presencia de deterioro cognitivo, entre otros.

  12. Organophosphate and carbamate intoxication in La Paz, Bolivia.

    PubMed

    Exner, Christopher J; Ayala, Guillermo Urquizo

    2009-05-01

    Intoxication with organophosphate (OP) and carbamate (CM) compounds is a common reason for presentation to the Emergency Department (ED) in La Paz, Bolivia. The objective of this study was to describe the demographics, presenting symptoms, and hospital course of patients presenting with OP or CM intoxication to the ED of the Hospital de Clinicas, La Paz, Bolivia, with the aim of determining which factors might predict a complicated hospital course. This was a retrospective chart review, using predefined criteria, of 300 patients who presented from January 1, 2003 to December 31, 2003. The intoxications were all oral, mostly intentional (97%), and in young patients (mean age 23.9 years, range 13-62 years). Females outnumbered males almost 2:1. The most common symptoms on presentation were abdominal pain (83%), nausea/vomiting (79%), miosis (72%), bronchorrhea (44%), diarrhea (41%), and fasciculations (31%). The most frequent complications were aspiration (18%), cardiopulmonary arrest (9%), and seizure (7%); mortality was 6%. Treatments included gastric lavage in 96% of patients, and atropine (median 5 mg per patient, range 0-48 mg). Miosis, bronchorrhea, diarrhea, and fasciculations at presentation were associated with a higher rate of complications. Although almost all intoxications were suicide attempts, less than half of patients received a psychiatric consultation. OP intoxication is a common cause of self-inflicted morbidity and mortality among young people in La Paz, Bolivia. Presence of miosis, bronchorrhea, diarrhea, and fasciculations at presentation suggest a higher likelihood of complications.

  13. [Illness due the Ebola virus: epidemiology and clinical manifestations within the context of an international public health emergency].

    PubMed

    Carod-Artal, Francisco J

    2015-03-16

    Introduccion. La epidemia causada por el virus del Ebola en Africa occidental afecta a Guinea, Liberia, Sierra Leona, Nigeria, Mali y Senegal, y es la mas grave desde que se tiene noticia de este filovirus causante de fiebre hemorragica. En este articulo se revisan las caracteristicas epidemiologicas y las manifestaciones clinicas asociadas a la enfermedad por el virus del Ebola. Desarrollo. Hasta el 23 de febrero de 2015 se habian contabilizado 23.729 casos de ebola, con un 40,1% de mortalidad. En la actual epidemia, el virus se transmite al ser humano por tres vias: contacto con fluidos y secreciones de sujetos enfermos ya diagnosticados, contacto con cadaveres durante las ceremonias de enterramiento, y contagio a familiares y personal sanitario por enfermos sin diagnosticar. El Ebola causa una enfermedad grave en humanos. Tras un periodo de incubacion variable (2-21 dias), se inicia un sindrome febril, cefalea, mialgias, artralgias, vomitos y diarrea. La fase avanzada cursa con hemorragias, fracaso de multiples organos, hipotension y choque. Se desconoce la incidencia de manifestaciones neurologicas, aunque se han descrito hemorragias cerebrales y sindromes postinfecciosos en otras fiebres he­morragicas virales. Los cuidados de soporte son vitales. No existe un tratamiento efectivo demostrado, aunque varios pacientes han sido tratados con un coctel de anticuerpos monoclonales (ZMapp). Conclusiones. La identificacion y diagnostico precoz de casos sospechosos, el aislamiento de sujetos enfermos y las medidas de proteccion en el personal sanitario son fundamentales para contener esta epidemia.

  14. [The surgical treatment of cervical disk pathology. A review of cases. The long-term clinical and radiographic results].

    PubMed

    Jacchia, G E; Innocenti, M; Giorgetti, A

    1991-01-01

    The experience of the Clinica Ortopedica dell'Università di Firenze in the surgical treatment of cervical disk disease has changed over time due to both the ongoing improvement of surgical techniques and the availability of ever more effective and less invasive diagnostic tests. Although our first experience was indirect and we were not able to review all patients due to the long follow-up period, we believe that our current setup provides valid data, as is demonstrated by the thorough clinical and radiographic evaluation we performed on patients reviewed after a minimum of 5 years. We believe that the anterior-approach procedure, which can currently be recommended thanks to non-invasive diagnostic tests, is effective not only in cases of spinal cord impingement but also in cases of cervicobrachialgia. In the latter, aside from the relief of nerve root impingement, we noticed that intersomatic spinal fusion helped relieve pain at the site of the lesion even after a considerable period of time, whereas cervical pain often remained after laminectomy and frequently increased over time.

  15. Emerging aspects of psychosocial risks: violence and harassment at work.

    PubMed

    Gilioli, R; Campanini, P; Fichera, G P; Punzi, S; Cassitto, M G

    2006-01-01

    In the last twenty years, psychosocial risks have become crucial in Occupational Health. Particularly, there is an increasing interest about psychological and physical violence at the workplaces. Psychological violence (mobbing or workplace bullying) is described as a situation in which the person has been the victim of negative acts directed to the person and work, with offences, discriminations and isolation. Physical violence at work, still underestimated in many parts of the world, is becoming a topical subject both for its frequency and its pathogenic potential and consist of violence among workers (internal violence) and between workers and external persons (external violence). Examples of external violence are bank robberies, which are prevalent in many European countries, particulary in Italy. The costs of psychological and physical workplace violence are very high at all levels; individual, for the implication of violence for health and quality of life as well as organizational, for the increase of absenteeism, turnover and health care demands and claims. The Medical Centre for Occupational Stress and Harassment (CDL) of the "Clinica de Lavoro Luigi Devoto" was set up in 1996 with a day-hospital service for the diagnosis, rehabilitation and prevention of work related psychological diseases. From its opening, about 5000 patients have been examined.

  16. [VITAMIN D AND ITS RELATION WITH THE ANATOMICAL LOCATION OF HIP FRACTURE IN CHILEAN OLDER ADULTS HOSPITALIZED].

    PubMed

    Dinamarca Montecinos, Jose Luis; Vásquez Leiva, Alejandra; Durán Agüero, Samuel; Rubio Herrera, Ramona

    2015-12-01

    Introducción: en los adultos mayores son frecuentes el deficit de vitamina D y las fracturas de cadera (FC). Existe relacion entre ambas condiciones, demostrandose que la suplementacion de vitamina D mejora el pronostico de las FC. En el caso de Chile, existe escasa informacion sobre la relacion entre vitamina D y FC. Objetivo: cuantificar los niveles plasmaticos de vitamina D (NPVD) y relacionarlos con la ubicacion anatomica de la FC. Métodos: estudio transversal. 222 adultos mayores chilenos ≥60 anos hospitalizados por FC entre junio de 2014 y junio de 2015. Se utilizaron los datos de ficha clinica de genero, edad, estacionalidad y ubicacion anatomica (FIC = intra, FEC = extracapsular) de la FC. Se midio NPVD y velocidad de filtrado glomerular (VFG) (MDRD- 6). Se utilizaron la prueba de Kolmogorov-Smirnov y pruebas no parametricas. Para determinar la relacion entre NPVD y el tipo de fractura se uso regresion lineal. Resultados: hubo predominio de mujeres (80,6%), la edad promedio fue 80,7 anos (DE=7,8) y se encontro 43,2% de FIC. Los NPVD promedio fueron 13,3 ng/cc (DE=6,7); los sujetos con FIC tienen 4,52 ng/cc menos de vitamina D que aquellos con FEC (p.

  17. Evaluation of the Hitachi 717 analyser

    PubMed Central

    Biosca, Carmen; Antoja, Felipe; Sierra, Cristina; Douezi, Helene; Macià, Magda; Alsina, María-Jesús; Galimany, Román

    1989-01-01

    The selective multitest Boehringer Mannheim Hitachi 717 analyser was evaluated according to the guidelines of the Comisión de Instrumentación de la Sociedad Española de Química Clinica and the European Committee for Clinical Laboratory Standards. The evaluation was performed in two steps: examination of the analytical units and evaluation in routine operation. The evaluation of the analytical units included a photometric study: the inaccuracy is acceptable for 340 and 405 nm; the imprecision ranges from 0.12 to 0.95% at 340 nm and from 0.30 to 0.73 at 405 nm, the linearity shows some dispersion at low absorbance for NADH at 340 nm, the drift is negligible, the imprecision of the pipette delivery system increases when the sample pipette operates with 3 μl, the reagent pipette imprecision is acceptable and the temperature control system is good. Under routine working conditions, seven determinations were studied: glucose, creatinine, iron, total protein, AST, ALP and calcium. The within-run imprecision (CV) ranged from 0.6% for total protein and AST to 6.9% for iron. The between run imprecision ranged from 2.4% for glucose to 9.7% for iron. Some contamination was found in the carry-over study. The relative inaccuracy is good for all the constituents assayed. PMID:18925247

  18. Evaluation of the Olympus AU-510 analyser

    PubMed Central

    Farré, Carmen; Velasco, Jesús; Ramón, Francisco

    1991-01-01

    The selective multitest Olympus AU-510 analyser was evaluated according to the recommendations of the Comision de Instrumentacion de la Sociedad Española de Quimica Clinica and the European Committee for Clinical Laboratory Standards. The evaluation was carried out in two stages: an examination of the analytical units and then an evaluation in routine work conditions. The operational characteristics of the system were also studied. The first stage included a photometric study: dependent on the absorbance, the inaccuracy varies between +0.5% to -0.6% at 405 nm and from -5.6% to 10.6% at 340 nm; the imprecision ranges between -0.22% and 0.56% at 405 nm and between 0.09% and 2.74% at 340 nm. Linearity was acceptable, apart from a very low absorbance for NADH at 340 nm; and the imprecision of the serum sample pipetter was satisfactory. Twelve serum analytes were studied under routine conditions: glucose, urea urate, cholesterol, triglycerides, total bilirubin, creatinine, phosphate, iron, aspartate aminotransferase, alanine aminotransferase and gamma-glutamyl transferase. The within-run imprecision (CV%) ranged from 0.67% for phosphate to 2.89% for iron and the between-run imprecision from 0.97% for total bilirubin to 7.06% for iron. There was no carryover in a study of the serum sample pipetter. Carry-over studies with the reagent and sample pipetters shows some cross contamination in the iron assay. PMID:18924907

  19. Prevalence of sensitization to methylisothiazolinone in an Italian Skin Allergy Unit.

    PubMed

    Gallo, Rosella; Signori, Alessio; Gervasio, Sonia; Parodi, Aurora

    2017-08-01

    An alarming increase in the prevalence of sensitization to the preservative methylisothiazolinone (MI), alone or in combination with methylchloroisothiazolinone (MCI), has recently been reported, mainly in Northern Europe. Prevalence data from Southern Europe are scanty. We evaluated the prevalence of contact allergy to MI and MCI/MI among 1392 patients consecutively patch tested in 2012-2013 at the Clinica Dermatologica of San Martino Hospital, Genoa, Italy. The patients were patch tested with 2000 ppm MI aq. in addition to the Italian baseline series. The MOAHLFA Index (Male, Occupation, Atopic Dermatitis, Hand, Legs, Face, Age above 40 years) was registered for all patients. Relevant exposures to MI and/or MI/MCI were determined and the patients' clinical outcome after isothiazolinones avoidance was evaluated. The prevalence of sensitization to MI showed a steep increase of prevalence from 2.3% in 2012 to 6.9% in 2013 while sensitization to MI/MCI rose from 6.76% in 2012 to 9.04% in 2013. Hand and face dermatitis were significantly prevalent in MI allergic patients. Cosmetics, followed by household products, were the most common sources of relevant exposure to both MI and MI/MCI. Clinical improvement after avoidance of isothiazolinones containing products was reported by 85.3% of followed up patients. In Italy the prevalence of MI and MI/MCI contact allergy is alarmingly high and it is increasing.

  20. [Cerebellum and language: speech therapy intervention to treat their disorders].

    PubMed

    Ferri, Lluís

    2015-02-25

    Introduccion. Los avances en las tecnicas de neuroimagen han propiciado un creciente interes por el estudio del cerebelo y su participacion en los procesos cognitivos. Es cada vez mas evidente la relacion que existe entre este organo y la produccion linguistica, y entre las patologias cerebelosas y determinados trastornos del lenguaje, como la disartria cerebelosa. Objetivo. Revisar la contribucion del cerebelo a las funciones linguisticas, analizar los trastornos del lenguaje que derivan de las enfermedades cerebelosas y plantear la intervencion logopedica en este tipo de afectaciones. Desarrollo. Se realiza un analisis de la funcion moduladora del cerebelo en el lenguaje, de la disartria cerebelosa, de los factores etiologicos y de las manifestaciones clinicas observables en la produccion verbal. Se plantean los procedimientos para la valoracion funcional y los contenidos del tratamiento logopedico. Conclusiones. La adquisicion del lenguaje en la infancia esta condicionado, entre otros aspectos, por la conformacion anatomica y la actividad neurofisiologica del cerebelo. Las alteraciones en el desarrollo de la estructura cerebelosa, las patologias y las disfunciones neurofisiologicas de este pueden ocasionar trastornos del lenguaje. El diagnostico logopedico ha de servir para iniciar lo mas pronto posible el tratamiento, que incidira en la mejora de la organizacion perceptiva, las habilidades motrices, el perfil cognitivo y las competencias linguisticas. El programa de trabajo se planteara de manera global e interdisciplinar. La intervencion familiar y su participacion en el proceso terapeutico sera una contribucion de gran valor para contar con entornos de recuperacion positivos.

  1. [Passive tactile stimulation and its clinical and neurophysiological repercussions (P300) in blind children with symptoms of attention deficit disorder].

    PubMed

    Serrano-Marugán, Isabel; Herrera, Begoña; Romero, Sara; Nogales, Ramón; Poch-Broto, Joaquín; Quintero, Javier; Ortiz, Tomás

    2014-02-24

    Introduccion. La estimulacion tactil es clave en la reorganizacion de la actividad cerebral y en los procesos de atencion, pero todavia no esta clara su eficacia en trastornos por deficit de atencion (TDA) en niños ciegos. Sujetos y metodos. Para valorar la eficacia de la estimulacion tactil realizamos un estudio en niños ciegos con TDA y sin TDA, consistente en un protocolo de estimulacion tactil diaria en dos sesiones (mañana y tarde), de media hora por sesion, durante seis meses. Se midio la capacidad para detectar un estimulo tactil infrecuente, el tiempo de reaccion, la latencia P300, las fuentes de actividad cerebral y la sintomatologia del TDA, tanto al inicio como al final del entrenamiento. Resultados. La estimulacion tactil en los niños ciegos con TDA mejora significativamente la sintomatologia del TDA, especialmente la atencion, la conducta y el autocontrol de los movimientos involuntarios y tics. Ademas, se observa que el entrenamiento tactil en niños ciegos con TDA cambia el patron de actividad cerebral induciendo una mayor actividad en las areas frontales y occipitales, que podrian estar asociadas a una compensacion del deficit de atencion. Conclusion. La estimulacion tactil pasiva diaria mejora la sintomatologia clinica y reorganiza la actividad cerebral en areas frontooccipitales de niños ciegos con TDA.

  2. Clinical competence in nursing: A concept analysis.

    PubMed

    Notarnicola, Ippolito; Petrucci, Cristina; De Jesus Barbosa, Maria Rosimar; Giorgi, Fabio; Stievano, Alessandro; Lancia, Loreto

    2016-01-01

    Introduzione. In campo infermieristico la ‘competenza clinica’ è una questione centrale per l’assistenza al paziente e è fondamentale una chiara comprensione del concetto sia per la formazione che per la disciplina infermieristiche. Scopo. Effettuare un analisi del concetto di ‘competenza clinica’ in campo infermieristico. Metodo: E’ stato utilizzato il metodo descritto da Walker e Avant. È stata effettuata una revisione sistematica della letteratura su database internazionali ( PubMed, CINAHL, Scopus, Cochrane, Ovid, Open Grey ) dal 1993 al 2015. Negli articoli reperiti è stata esaminata l’utilizzazione del concetto in esame. Risultati. Sono stati descritti tutti gli 8 step previsti dal modello di Walker e Avant sulla base dei risultati della revisione sistematica della letteratura. Sono stati identificati e discussi gli attributi, gli antecedenti, le conseguenze e i riferimenti empirici della competenza clinica in campo infermieristico e sono stati costruiti i casi modello, limite e contrario. E’ stata discussa anche la rilevanza del concetto sia per la formazione che per lo sviluppo professionale in campo infermieristico. Conclusioni. Questa analisi di concetto ha portato a definire la ‘competenza clinica’ in campo infermieristico come ‘un insieme di capacità, conoscenze, attitudini e abilità che ciascun infermiere deve possedere per effettuare in maniera accettabile tutte quelle attività direttamente correlate all’assistenza al paziente, in uno specifico contesto clinico e in specifiche circostanze allo scopo di promuovere, mantenere e ristabilire la salute dei pazienti’.

  3. [Development of integrated support software for clinical nutrition].

    PubMed

    Siquier Homar, Pedro; Pinteño Blanco, Manel; Calleja Hernández, Miguel Ángel; Fernández Cortés, Francisco; Martínez Sotelo, Jesús

    2015-09-01

    Objetivos: desarrollar una aplicacion informatica integral en el soporte nutricional especializado, e integrado en la historia clinica electronica, que detecte de forma automatizada y precoz a los pacientes desnutridos o en riesgo de desarrollar desnutricion, determinando puntos de oportunidad de mejora y evaluacion de resultados. Métodos: se han tenido en cuenta los estandares de calidad publicados por el grupo de trabajo de nutricion de la Sociedad Espanola de Farmacia Hospitalaria (SEFH) y las recomendaciones del grupo de farmacia de la Sociedad Espanola de Nutricion Parenteral y Enteral (SENPE). De acuerdo con dichos estandares de calidad, las etapas o subprocesos asistenciales que debe contemplar el soporte nutricional son: cribado nutricional, valoracion nutricional, plan de cuidados nutricionales, formulacion, elaboracion y administracion. Resultados: la aplicacion permite, de forma automatizada, realizar una valoracion nutricional especifica a los pacientes con riesgo nutricional, instaurando, si fuese preciso, un plan de tratamiento nutricional y realizando el seguimiento y trazabilidad de los resultados derivados de la implantacion de acciones de mejora y, cuantificando en que medida nuestra practica se aproxima a la establecida como estandar. Conclusiones: la aplicacion permite estandarizar el soporte nutricional especializado desde un punto multidisciplinar, introduciendo el concepto de control de calidad por procesos y al paciente como cliente principal.

  4. [Kleine-Levin syndrome: differential diagnosis in recurrent encephalitic syndromes in adolescence].

    PubMed

    Duat-Rodriguez, A; Martinez-Albadalejo, I; Perez-Sebastian, I; Cantarin-Extremera, V; Hedrera-Fernandez, A; Garcia-Penas, J J

    2017-04-01

    Introduccion. El sindrome de Kleine-Levin es una enfermedad rara de causa desconocida que se caracteriza por episodios recurrentes autolimitados de hipersomnia acompañados de alteracion cognitiva y conductual. Entre los episodios, los pacientes tienen un patron de sueño y cognitivo normal. Casos clinicos. Se presentan tres pacientes de 14 años, dos chicos y una chica. Comenzaron tras un desencadenante (vacuna, una infeccion respiratoria por influenza B; en el caso de la chica, coincidian con la menstruacion). En el episodio agudo mostraban tendencia al sueño y en vigilia destacaba bradipsiquia, inquietud motora y gran labilidad emocional, con tendencia al llanto y necesidad de la presencia de los familiares. Presentaron una duracion aproximada de 10-15 dias y periodicidad mensual, y se mostraron asintomaticos entre los episodios. Los tres pacientes fueron valorados por pediatras, diagnosticados y tratados de encefalitis autoinmune. Solo uno cumplia la triada tipica de hipersomnia, hiperfagia e hipersexualidad, pero ninguno de los tres datos se habia recogido en la historia clinica inicial y la familia solo lo referia tras una anamnesis dirigida. Conclusiones. En el sindrome de Kleine-Levin, los sintomas neurologicos durante el cuadro agudo son aun mas frecuentes que los psiquiatricos. La tendencia al sueño y el hecho de que durante la vigilia no esten asintomaticos y se muestren lentos, apaticos, labiles e irascibles, situa en primer lugar la sospecha de sindrome encefalitico. Debemos tener presente esta entidad en encefalitis recurrentes de etiologia no filiada.

  5. [DRG and gastrointestinal surgery].

    PubMed

    Leardi, S; Altilia, F; Pietroletti, R; Risetti, A; Schietroma, M; Simi, M

    1999-01-01

    The diagnosis-related-groups (DRG) is the cost-based system for hospital reimbursement. However, the proceeds does not coincide with the costs. Aim of the study was to identify the profit, which we could gained with 147, 155, 158, 162, 165, 198 gastrointestinal surgery DRG. 30 consecutive patients, undergone to surgery in Clinica Chirurgica of L'Aquila University, had been studied. We had calculated the daily costs of medical and nursing practice, diagnostic tests, drugs, hospitalization, surgical instruments for every patient's therapy. The DRG-proceeds had been correlated with the DRG-costs. The "major gastrointestinal surgery" had not profit (147 DRG: anterior resection of rectum = -354428 Pounds, Miles = -94020 Pounds; 155 DRG: total gastrectomy = -1920641 Pounds). On the contrary, "minimal surgery" had good profits (158 DRG: hemorroidectomy with local anestesia = 1469605 Pounds;162 DRG: sutureless groin hernioplasty = 1561200 Pounds; 198 DRG: videolaparochole-cystectomy: 1208807 Pounds). The study seems to demonstrate the disparity of the reimbursement system related to DRG. However, the surgeons, as managers, must employ warily the resources for producing DRG.

  6. [Practice patterns in Mexican allergologists about skin tests with allergens during 2005-2006].

    PubMed

    Larenas Linnemann, Désirée; Fogelbach, Guillermo Arturo Guidos; Cruz, Alfredo Arias

    2008-01-01

    Immunotherapy has been practiced since over a hundred years. The exact composition of the immunotherapy concentrate, with which the patient is treated, depends partly on the results of the skin prick tests applied to the allergic patient. As such, the effectiveness of the immunotherapy depends heavily on the quality of the skin prick test. The detailed recommendations for the realization of the skin prick tests have evolved and changed over the years, leading to multiple variations in its application in Mexico. We tried to get a picture of the daily practice patterns of the members of CMICA and CoMPedIA concerning the application of skin prick tests. Aquestionnaire was sent in various occasions to all members of the Colegio Mexicano de Inmunologia Clinica y Alergia (CMICA) and of the Colegio Mexicano de Pediatras, Especialistas en Inmunologia y Alergia (CoMPedIA). The results are presented descriptively and by calculation of the frequency/percentages of intervals of replies, in the case of numerical responses. A response rate of 61 (17%) was obtained of the College members, showing consistency in some replies but a wide variation in others, for example in the time certain medication has to be suspended before the execution of the skin prick test. Comparing the replies obtained with recent recommendations in international publications, some discrepancy can be detected. In some aspects of the survey there is coincidence of the skin test practices among the participants; however, in other items there is an important variation.

  7. [The experience of the EPM (Ergonomics of Posture and Movement) Research Unit in risk analysis and the prevention of work-related musculo-skeletal diseases (WMSDs)].

    PubMed

    Occhipinti, E; Colombini, Daniela; Molteni, G

    2003-01-01

    The twenty-year experience of the "Ergonomics of Posture and Movement (epm)" Research Unit for prevention of work-related musculoskeletal disorders (WMSDs) is briefly summarized. The epm research unit is the outcome of an agreement between Milan University (Clinica del Lavoro Luigi Devoto), Milan Polytechnic, Don Gnocchi Foundation IRCCS (Bioengineering Centre) and the Regional Health Service (CEMOC of ICP Hospital). Early activities of epm (1985-1993) are first outlined: they are characterized by a wide range of laboratory studies allowing the development of original methods and criteria for on-site analysis of fixed postures and awkward movements and for ad hoc clinical examination of the musculoskeletal apparatus in working populations. Epm contributions are reviewed for the analysis of working activity involving manual load handling (adapted NIOSH method) and hospital patients (MAPO method) as well as for standardization of health surveillance protocols of spinal diseases. Updated contributions are reported on analysis and prevention of upper limb MSDs connected with upper limb repetitive movements (OCRA method). Finally epm's main collaborations with national and international Authorities are summarized as well as the major technical (health promotion) publications addressed to operators and workers, in different working situations, for prevention of musculoskeletal disorders due to biomechanical overload.

  8. An Overlap Syndrome involving systemic lupus erythematosus and autoimmune hepatitis in an adolescent girl.

    PubMed

    Battagliotti, Cristina; Rispolo Klubek, Daniela; Karakachoff, Mario; Costaguta, Alejandro

    2016-06-01

    La superposición del lupus eritematoso sistémico y la hepatitis autoinmune se describe ocasionalmente. Aunque ambas enfermedades pueden compartir ciertos hallazgos, como poliartralgias, hipergammaglobulinemia y anticuerpo antinúcleo positivo, son consideradas dos diferentes. Se presenta a una paciente de 14 años con lupus eritematoso sistémico, que, luego de dos años, consultó por ictericia. Sin antecedentes de ingesta de drogas, alcohol o exposición a virus hepatotropos. Tenia un aumento de las enzimas hepáticas con anticuerpos antinúcleo, anti-ADN de doble cadena y LKM 1 positivos. La biopsia hepática mostró una hepatitis de interfase con infiltrado linfoplasmocitario. De esta manera, cumplia con los criterios diagnósticos tanto para lupus eritematoso sistémico como para hepatitis autoinmune. Tratada con corticoides y micofenolato mofetil, mejoró su clinica y laboratorio. Conclusión. La hepatitis autoinmune puede ocurrir en el curso del lupus eritematoso sistémico. Un diagnóstico temprano es importante para prevenir el avance de la enfermedad; es obligatoria la realización de la biopsia hepática.

  9. [Three cases of Pallister-Killian syndrome].

    PubMed

    Toledo-Bravo de Laguna, Laura; del Campo-Casanelles, Miguel; Santana-Rodriguez, Alfredo; Santana-Artiles, Alexandre; Sebastian-Garcia, Irma; Cabrera-Lopez, José Carlos

    2014-01-16

    Introduccion. El sindrome de Pallister-Killian se caracteriza por discapacidad intelectual, hipotonia, retraso motor y un fenotipo caracteristico en el que destaca un aspecto facial tosco, alteraciones pigmentarias de la piel y alopecia bitemporal. Es frecuente que se asocie a crisis convulsivas y a malformaciones en otros organos y sistemas. Tiene como causa principal el mosaicismo para la tetrasomia del cromosoma 12p. Casos clinicos. Se presentan tres nuevos casos pediatricos afectos de esta rara entidad, se describen las caracteristicas clinicas y se realiza una revision de la bibliografia. Conclusiones. Debe resaltarse la importancia del conocimiento del sindrome para poder llevar a cabo su diagnostico, puesto que lo habitual es que, sin practicar la biopsia cutanea o el frotis de mucosa bucal, la anomalia cromosomica pasa desapercibida si se usan tecnicas citogeneticas clasicas. Hoy en dia, es posible realizar el diagnostico en sangre mediante array-CGH o array-SNP, si bien la posibilidad de encontrar la anomalia cromosomica depende del porcentaje de mosaicismo.

  10. [Chorea due to TITF1/NKX2-1 mutation: phenotypical description and therapeutic response in a family].

    PubMed

    Salvado, Maria; Boronat-Guerrero, Susanna; Hernández-Vara, Jorge; Álvarez-Sabin, José

    2013-05-16

    Introduccion. El corea por mutacion en el gen TITF1, tambien denominado corea hereditario benigno, es un trastorno autosomico dominante que suele iniciarse antes de los 5 anos. En la mayoria de casos, el corea tiende a mejorar con la edad. Puede asociar hipotiroidismo y problemas respiratorios, como el sindrome de distres respiratorio alveolar neonatal o la enfermedad pulmonar intersticial, ya que TITF1 es un factor de transcripcion esencial para el desarrollo del cerebro, tiroides y pulmon. Casos clinicos. Presentamos el fenotipo clinico de una familia con corea, en la cual dos hermanas presentan hipotiroidismo congenito, y una de ellas, sindrome de distres respiratorio alveolar. En ambas se identifico una mutacion en TITF1 (c.825delC) y se observo mejoria clinica en respuesta al tratamiento con levodopa-carbidopa en dosis bajas. Conclusiones. El corea por mutacion de TITF1 es una causa infradiagnosticada de corea en ninos. Debido a la posibilidad de realizar diagnostico genetico, creemos indicado realizarlo siempre en casos familiares dominantes, teniendo en cuenta la penetrancia variable, asi como en pacientes que presenten afectacion concomitante de pulmon o hipotiroidismo. En casos esporadicos, puede ser recomendable en coreas de causa no filiada, lo que nos permitira evitar otras pruebas, dar un pronostico no degenerativo, permitir un consejo genetico, y hacer ensayos terapeuticos mas dirigidos y eficaces. Por el momento, la levodopa parece el tratamiento sintomatico de eleccion.

  11. [Diffuse superficial siderosis of the central nervous system: four case reports and review of the literature].

    PubMed

    Calvo, Marta; de Miguel, Cristina; Pinel, Ana; Ortega, José M; Aladro, Yolanda

    2014-10-16

    Introduccion. La siderosis superficial difusa del sistema nervioso central (SNC) es una rara condicion debida a depositos de hemosiderina en las capas subpiales del cerebro y la medula espinal. La fuente de sangrado cronico o recurrente en el espacio subaracnoideo se detecta solo en un 50% de los casos. Los sintomas mas caracteristicos son ataxia cerebelosa e hipoacusia neurosensorial. Las secuencias eco de gradiente potenciadas en T2 de resonancia magnetica constituyen el metodo diagnostico de eleccion. Casos clinicos. Presentamos cuatro pacientes con siderosis superficial difusa del SNC relacionada con angiopatia amiloide, anticoagulacion oral, schwannoma del VIII par craneal y sin fuente de sangrado conocida en un caso. Dos pacientes desarrollaron ataxia cerebelosa; tres de ellos, episodios recurrentes de alteracion focal neurologica; uno, demencia; y el cuarto es un hallazgo radiologico. No se objetivo progresion clinica durante el seguimiento (2-11 años) en tres de ellos. El paciente con angiopatia amiloide evoluciono a demencia. Conclusiones. Los episodios recurrentes de alteracion focal neurologica son los sintomas mas frecuentes en nuestros casos de siderosis superficial difusa del SNC. La evolucion natural de esta condicion no se conoce bien y puede constituir un hallazgo radiologico.

  12. A ten-year historic study of paranasal cavity endoscopy in patients with Leprosy.

    PubMed

    Martins, Ana C C; Castro, Jair de Carvalho e; Moreira, João Soares

    2005-01-01

    Leprosy is an infectious condition that has a chronic evolution caused by the Mycobacterium leprae. It very often attacks the nasal cavities mucosa independent of its clinical form, even before skin lesions or lesions to other parts of the body arise, in the presence or not of clinical complaints. To show the efficiency of nasal endoscopy to identify endonasal mucosa lesions and the importance of the Otorhinolaryngologist in the diagnosis and follow-up of Leprosy patients. Clinical history study. A historic study was performed with 173 patient's records without previous treatment from 1990 to 2000 at the Otorhinolaryngology Services, Instituto de Pesquisas Clinicas Hospital Evandro Chagas, Fiocruz. All of the patients showed nasal lesions, 121 with and 52 without clinical complaints. Nasal cavities endoscopy exam enabled early identification of the mucosa alteration in Leprosy patients as well as how to identify the evolution of the lesions. This type of exam also helps to establish local treatment. The evaluation and follow-up of Leprosy patients by the Otorhinolaryngologist in a multidisciplinary team are justified and offer the patient early diagnosis and specific treatment.

  13. Disegno dello studio genomico, ambientale, microbiomico e metabolomico sulla celiachia: un approccio al futuro della prevenzione personalizzata della celiachia

    PubMed Central

    SERENA, GLORIA; LEONARD, MAUREEN M.; CAMHI, STEPHANIE; HUEDO-MEDINA, TANIA B.; FASANO, ALESSIO

    2017-01-01

    Riassunto Negli ultimi anni abbiamo assistito a un fiorire di novità cliniche e scientifiche sulla celiachia (CE), ma forse la novità più importante che influenzerà il futuro della ricerca e della clinica in questo campo riguarda la storia naturale della malattia. Per molti anni si è creduto che la predisposizione genetica e l’esposizione al glutine fossero necessarie e sufficienti allo sviluppo della CE. Studi recenti, però suggeriscono che la perdita di tolleranza al glutine possa apparire in qualsiasi momento della vita a seguito di altri elementi. Inoltre, diversi fattori ambientali conosciuti per il loro ruolo nell’influenzare la composizione della microflora intestinale sono anche stati considerati legati allo sviluppo della CE. Tra questi fattori sono inclusi la modalità di parto, la dieta dell’infante e l’uso di antibiotici. A tutt’oggi, nessuno studio longitudinale di ampia scala ha determinato se e come la composizione del microbioma e il suo profilo metabolomico possano influenzare la perdita di tolleranza al glutine e il successivo sviluppo della CE in soggetti geneticamente predisposti. In questo articolo descriviamo uno studio prospettico, multicentrico e longitudinale su infanti a rischio per la CE che utilizzerà diverse tecniche per approfondire il ruolo che il microbioma intestinale ha durante i primi passaggi dello sviluppo della malattia autoimmune. PMID:27362724

  14. [ANTIBIOTIC SENSITIVITY/RESISTANCY OF MICROBIAL STRAINS, ISOLATED FROM PUERPERAS, NEWBORNS AND SAMPLES OF MATERNITY WARD ENVIRONMENT].

    PubMed

    Kobeshavidze, D D; Chikviladze, D; Gachechiladze, Kh; Mikeladze, M

    2016-03-01

    In this article, there are given data of microorganisms sensitivity/resistancy investigation, to different groups of antibiotics. Microorganisms where isolated from puerperas, newborns and samples of maternity ward environment. Investigation was performed in L.T.D. "Imedis Clinica". Detection of microorganisms sensitivity/resistancy to antibiotics was performed by use of two methods: method of disc diffusion and serial dilution on solid breeding substratum. It was determined that gram positive, as well as gram negative microorganisms had sufficiently high level of resistancy to some penicillines, aminoglycosides, macrolides. Some species of gram negative microorganisms had resistancy to lincomicin in 100% of cases. High level of sensitivity was revealed to such antibiotics as amicalin, amoxiclav, cefepim, ciprofloxacin. Gram negative microorganisms had high level of sensitivity to imipenem-cilastatin and meropenem. Performed investigation confirms necessity of microbiological monitoring in different clinics, because it is one of the most significant components of infection control. It gives opportunity to perform exact antibiotic prophylaxis and if necessary - rational antibiotic therapy.

  15. [Medical evaluation of the climacteric patient].

    PubMed

    Forsbach, G; Lozano, P; Pinto, E; González, O; Calderón, L; Martínez, R; Martínez, G

    1995-10-01

    A pilot program with primary care physicians was established in Clinica Cuauhtémoc y Famosa, focused to evaluate women older than 35 years with climateric symptoms. This program included a survey, a complete gynecological examination with Pap smears, ultrasound pelvic examination and mamography. Also, blood samples were collected for cholesterol, tryglycerides, calcium, phosphorus and alkaline phosphatase. An ECG, bone densitometry of the radius and X-rays of the vertebral column were obtained. This group was formed by 69 women with an age media of 50 years (SD 7.6 years, median 49 years). The survey disclosed that 34/65 women had been hysterectomized, and only 34/64 had received antitetanic immunization in the last 10 years. A preexistent chronic disease occurred in 36/59 women, these were diabetes mellitus, arterial hypertension or degenerative osteoarthritis. Alcohol consumption was recorded in 5/66 women and tabac consumption in 9/66 women, and 32/68 women accepted to be sedentary. Laboratory examinations disclosed hypercholesterolemia in 19/66 women and hypertryglyceridemia in 8/64 women. Osteopenia was detected in 33/60 women. This findings support a systematic plan to provide medical assistance for women in this age, specially if previous epidemiologycal studies have disclosed that coronary disease is the main cause of death for women older than 50 years in this region, that also belongs to the area of highest incidence of diabetes.

  16. [Response to treatment with interferon beta in patients with multiple sclerosis. Validation of the Rio Score].

    PubMed

    Rio, J; Rovira, A; Blanco, Y; Sainz, A; Perkal, H; Robles, R; Ramio-Torrenta, Ll; Diaz, R M; Arroyo, R; Urbaneja, P; Fernandez, O; Garcia-Merino, J A; Reyes, M P; Oreja-Guevara, C; Prieto, J M; Izquierdo, G; Olascoaga, J; Alvarez-Cermeno, J C; Simon, E; Pujal, B; Comabella, M; Montalban, X

    2016-08-16

    Introduccion. Se han propuesto diferentes criterios de respuesta al tratamiento con interferon beta, y el Rio Score es uno de los mas utilizados. El objetivo de este estudio fue validar la utilidad del Rio Score en una cohorte independiente. Pacientes y metodos. Estudio multicentrico, prospectivo y longitudinal de pacientes con esclerosis multiple remitente recurrente tratados con interferon beta. Los pacientes fueron clasificados basandose en la presencia de brotes, lesiones activas (nuevas en T2 o lesiones que captaban gadolinio) en la resonancia magnetica, incremento confirmado de la discapacidad o combinaciones de estas variables (brotes, incremento en la Expanded Disability Status Scale y lesiones activas) tras un año de tratamiento. Se utilizo un analisis de regresion con el fin de identificar las variables de prediccion de respuesta despues de un seguimiento de tres años. Resultados. Se incluyo a 249 pacientes con esclerosis multiple remitente recurrente. El modelo logistico confirmo que la presencia de dos (odds ratio = 6,6; IC 95% = 2,7-16,1; p < 0,0001) o tres (odds ratio = 8,5; IC 95% = 1,6-46; p < 0,01) variables positivas durante el primer año de tratamiento conferia un riesgo significativo de actividad (brotes o progresion) en los siguientes dos años. Conclusiones. Se confirma, en una cohorte independiente, la utilidad del Rio Score para identificar a pacientes con un mayor riesgo de desarrollar actividad clinica o progresion de la discapacidad durante el tratamiento con interferon beta.

  17. [The classics of Italian nephrology: the monograph "La nefropatia diabetica" (Diabetic nephropathy) by Luigi Scapellato (1918-1998)].

    PubMed

    Fogazzi, G B

    2007-01-01

    This monograph, published in 1953, describes the findings observed by the author in a cohort of patients affected by diabetes mellitus and renal disease. From a pathological standpoint, the typical renal lesion is represented by ''nodular intercapillary glomerulosclerosis'', which is present in 8 out of 20 patients at postmortem. Marked proteinuria and edema are the most typical clinical features. Urinary sediment examination is the only test allowing to differentiate diabetic nephropathy from other glomerular diseases. In the initial phases, the glomerular filtration rate is increased rather than reduced. The evolution is almost invariably towards end-stage renal disease, and a hypoglucidic diet and insulin are the only therapeutic modalities available. Today this work shows us, on the one hand, how many uncertainties still existed about diabetic nephropathy 17 years after its first description by Kimmelstiel and Wilson in 1936. On the other hand, it shows how much relevant and still valid information was already known at the time. Luigi Scapellato, who is almost completely forgotten today, began his career at the Clinica Medica of the University of Rome under the guidance of Cesare Frugoni (1881-1978). In 1959, he moved to Syracuse (Sicily) to work as director of the internal medicine unit of the ''Umberto I'' Hospital. In April 1957 he was among the 13 founders of the Italian Society of Nephrology.

  18. Introducing ultrasound-guided vein catheterization into clinical practice: A step-by-step guide for organizing a hands-on training program with inexpensive handmade models.

    PubMed

    Di Domenico, S; Licausi, M; Porcile, E; Piaggio, F; Troilo, B; Centanaro, M; Valente, U

    2008-12-01

    Sommario INTRODUZIONE: Il catetererismo venoso centrale (CVC) riveste un ruolo fondamentale nella gestione del paziente ospedalizzato. La tecnica eco-guidata è la metodica che assicura una più elevata percentuale di successo e permette un più sicuro e rapido posizionamento di CVC rispetto alla tecnica tradizionale. Tuttavia, la diffusione di tale metodica è ostacolata dall'assenza di uno specifico training durante i corsi di specializzazione in anestesia e chirurgia. Al fine di introdurre la tecnica eco-guidata, abbiamo organizzato un training producendo e utilizzando modelli in agar. METODI: Sono stati costruiti tre differenti modelli utilizzando contenitori per alimenti, segmenti di laccio emostatico, tubo in silicone e gelatina a base di agar. RISULTATI: Un training specifico per la puntura ecoguidata è stato effettuato utilizzando i modelli prodotti. Il training ha consentito una rapida acquisizione delle basi tecniche per effettuare il posizionamento di CVC eco-guidato. Il costo medio di ogni modello è risultato inferiore a 5 euro. DISCUSSIONE: I modelli prodotti in agar si sono rivelati un utile strumento per acquisire la coordinazione di base necessaria per la puntura eco-guidata. Il loro basso costo ne può permettere una ampia diffusione e può incentivare la realizzazione di nuovi percorsi educativi al fine di introdurre tale tecnica nella pratica clinica.

  19. [Topiramate in monotherapy or in combination as a cause of metabolic acidosis in adults with epilepsy].

    PubMed

    Ruiz-Granados, Velvet J; Márquez-Romero, Juan M

    2015-02-16

    Objetivo. Determinar la frecuencia de acidosis metabolica y sus factores relacionados en pacientes tratados con topiramato solo o como adyuvante para el tratamiento de epilepsia. Pacientes y metodos. Analisis transversal de la gasometria arterial de pacientes epilepticos que recibieron topiramato durante 2010 en la clinica de epilepsia del Centro Medico Nacional 20 de Noviembre en Mexico. Se registraron datos clinicos concernientes a la epilepsia y su tratamiento, asi como de los sintomas comunes de acidosis metabolica. Resultados. Se estudiaron 32 adultos con epilepsia, quienes recibieron topiramato en monoterapia o en combinacion por lo menos durante un mes. Se encontro acidosis metabolica en todos los pacientes (HCO3 < 22 Eq/L); nueve tomaron solo topiramato y 23 tomaron por lo menos dos farmacos antiepilepticos (FAE). Todos los pacientes fueron asintomaticos. No se encontro correlacion entre los niveles de bicarbonato y la dosis del medicamento o la duracion del tratamiento. La dosis fue significativamente mayor en el grupo de monoterapia y el nivel de bicarbonato fue mas bajo en los pacientes que tomaban mas de un FAE. Conclusiones. El uso concomitante de FAE incrementa los efectos conocidos del topiramato sobre los niveles sericos de bicarbonato y la presencia de acidosis metabolica; estos efectos parecen ser independientes del numero de FAE utilizados.

  20. Outbreak of fungemia caused by Candida parapsilosis in a neonatal intensive care unit: molecular investigation through microsatellite analysis.

    PubMed

    da Silva Ruiz, Luciana; Montelli, Augusto Cezar; Sugizaki, Maria de Fátima; Da Silva, Eriques Gonçalves; De Batista, Georgea Carla Matuura; Moreira, Débora; Paula, Claudete Rodrigues

    2013-01-01

    Opportunistic infections are an increasingly common problem in hospitals, and the yeast Candida parapsilosis has emerged as an important nosocomial pathogen, especially in neonatal intensive care units (NICUs) where it has been responsible for outbreak cases. Risk factors for C. parapsilosis infection in neonates include prematurity, very low birth weight, prolonged hospitalization, indwelling central venous catheters, hyperalimentation, intravenous fatty emulsions and broad spectrum antibiotic therapy. Molecular methods are widely used to elucidate these hospital outbreaks, establishing genetic variations among strains of yeast. The aim of this study was to detect an outbreak of C. parapsilosis in an NICU at the "Hospital das Clinicas", Faculty of Medicine of Botucatu, a tertiary hospital located in São Paulo, Brazil, using the molecular genotyping by the microsatellite markers analysis. A total of 11 cases of fungemia caused by C. parapsilosis were identified during a period of 43 days in the NICU. To confirm the outbreak all strains were molecularly typed using the technique of microsatellites. Out of the 11 yeast samples studied, nine showed the same genotypic profile using the technique of microsatellites. Our study shows that the technique of microsatellites can be useful for these purposes. In conclusion, we detected the presence of an outbreak of C. parapsilosis in the NICU of the hospital analyzed, emphasizing the importance of using molecular tools, for the early detection of hospital outbreaks, and for the introduction of effective preventive measures, especially in NICUs. Copyright © 2012 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.

  1. Vulvar endometriosis and Nuck canal.

    PubMed

    Mazzeo, Carmelo; Gammeri, Emanuele; Foti, Agata; Rossitto, Maurizio; Cucinotta, Eugenio

    2014-12-29

    L’endometriosi è una patologia non ancora del tutto conosciuta che colpisce il 6-10% della popolazione femminile generare e il 35-50% della popolazione femminile affetta da dolore pelvico e infertilità. La sede più frequente di malattia è rappresentata dall’ovaio e ciò sostiene l’ipotesi patogenetica della mestruazione retrograda. Viene descritto un caso di non comune localizzazione vulvare di endometriosi riscontrata in una paziente precedentemente operata per una cisti di Nuck. La donna aveva notato da qualche mese l’insorgenza di una tumefazione nella regione vulvare che le causava dolore e dispareunia che si accentuavano nel periodo mestruale. Il sospetto clinico di endometriosi non aveva avuto conferma negli esami strumentali preoperatori che non avevano evidenziato alterazioni patognomoniche, nè differenze dei reperti in fase pre mestruale e mestruale. Solo l’esame istologico della neoformazione asportata ha confermato la diagnosi. Inoltre gli Autori con la presente nota desiderano sottolineare come nella patogenesi dell’endometriosi vulvare debba essere tenuta in considerazione la presenza della pervietà del dotto peritoneovaginale o dotto di Nuck. Nel caso clinico descritto, infatti, la paziente era stata sottoposta due anni prima ad asportazione di una cisti di Nuck con obliterazione del dotto peritoneovaginale. Tuttavia già in quella fase clinica poteva essersi determinato un impianto endometriosico, che si era poi evidenziato con la formazione del nodulo in sede vulvare asportato chirurgicamente.

  2. [Progressive multifocal leukoencephalopathy associated to natalizumab: the importance of magnetic resonance imaging in its early diagnosis].

    PubMed

    Martí, Glòria; Río, Jordi; Rovira, Àlex; Auger, Cristina; Tintoré, Mar; Sastre-Garriga, Jaume; Vidal, Anka; Castilló, Joaquín; Montalban, Xavier

    2015-02-16

    Introduccion. El natalizumab es un farmaco utilizado en la esclerosis multiple (EM), cuyo principal efecto adverso es el desarrollo de una leucoencefalopatia multifocal progresiva (LMP). Como esta es potencialmente mortal o discapacitante, el tratamiento debe suspenderse inmediatamente ante su sospecha, teniendo en cuenta el posible desarrollo posterior de un sindrome de reconstitucion inmune o rebrote de la EM. Caso clinico. Se describe un caso de LMP, inicialmente asintomatico, en el contexto del tratamiento con natalizumab en una paciente con EM. Como factores de riesgo se determinaron titulos altos de anticuerpos contra el virus John Cunningham (VJC) y mas de dos años de tratamiento. La reaccion en cadena de la polimerasa para el VJC en el liquido cefalorraquideo resulto negativa en dos determinaciones. El periodo entre el diagnostico radiologico y el inicio de la clinica fue de dos meses. Durante el curso de la enfermedad, la paciente desarrollo un sindrome inflamatorio de reconstitucion inmune y rebrotes de su EM. Presento una buena respuesta tras el inicio de tratamiento con fingolimod, una vez estabilizada la LMP. Conclusion. Este caso ilustra la importancia de una estrecha vigilancia clinicorradiologica en pacientes con EM tratados con natalizumab, sobre todo cuando presentan factores de riesgo para el desarrollo de LMP, asi como su potencial incidencia en la supervivencia y estado funcional final.

  3. Effect of vinca alkaloids on ERalpha levels and estradiol-induced responses in MCF-7 cells.

    PubMed

    Martínez-Campa, Carlos; Casado, Pedro; Rodríguez, René; Zuazua, Pedro; García-Pedrero, Juana M; Lazo, Pedro S; Ramos, Sofía

    2006-07-01

    Vinca alkaloids (VAs) such as Vincristine, Vinblastine and Vinorelbine are antineoplastic drugs that inhibit tubulin polymerisation into microtubules, induce mitotic G2/M arrest, activate c-Jun N-terminal kinase (JNK) and induce apoptosis. Although there are many studies evaluating the effect of VAs on breast cancer patients, until now little was known about how these compounds and estradiol signaling pathways might interfere. In this report, we show for the first time that VAs decreased ERalpha protein levels in the human breast cancer cell line MCF-7; VAs induced a parallel decrease in estrogen receptor mRNA. All the VAs tested inhibited estradiol (E2) mediated transactivation at ERE-driven promoters. E2 inhibited VAs-induced AP1 stimulation in MCF-7, but this inhibition was not observed when E2 is added 24 h in advance of VAs treatment. In contrast to the reported preventing effect over taxol-mediated apoptosis, E2 did not prevent VAs-induced cell death and interestingly, addition of E2 24 hours in advance of VAs treatment resulted in an increase of the number of cells undergoing apoptosis. Similar results were observed when E2 is replaced by other proliferation signals such as EGF. These results demonstrate that in the breast cancer cell-line MCF-7, E2-induced proliferation before VAs treatment enhances the apoptotical response to VAs which might have important implications in clinica.

  4. [The Prefrontal Symptoms Inventory (PSI) in acquired brain injury: agreement between the scores of patients, relatives and professionals].

    PubMed

    Huertas-Hoyas, E; Pedrero-Perez, E J; Martinez-Campos, M; Laselle-Lopez, M

    2016-11-01

    Introduccion. El uso de autoinformes sobre sintomas de mal funcionamiento en la vida diaria derivados de deficits funcionales de origen prefrontal se ha generalizado en la practica clinica, dado que permiten aportar validez ecologica incremental a otras pruebas especificas. Sin embargo, queda por determinar si la autoevaluacion es suficiente por si misma o es preferible la participacion de un evaluador externo. Sujetos y metodos. Se administro el inventario de sintomas prefrontales (ISP) a 115 sujetos en tratamiento por diversas patologias cerebrales. La misma prueba, referida al paciente, se administro a algun profesional que siguiera estrechamente la evolucion del caso y, cuando fue posible (n = 88), a un familiar o cuidador. Se exploro la bondad psicometrica del ISP en las tres muestras y se estimo el grado de correlacion y concordancia entre las tres evaluaciones. Resultados. Las tres evaluaciones mostraron correlacion significativa, aunque los pacientes declararon menos sintomas que sus familiares y cuidadores en funcionamiento ejecutivo. Las evaluaciones de familiares y pacientes se superpusieron y mostraron un alto grado de concordancia en perfil y magnitud. Conclusiones. Se recomienda, junto con la obligada evaluacion neuropsicologica, la cumplimentacion de cuestionarios o inventarios de sintomas como el ISP, con probada robustez psicometrica, que permitan explorar el impacto de las disfunciones cerebrales en el funcionamiento cotidiano. Dado que muchas de estas disfunciones se acompañan de diversos grados de anosognosia, se recomienda su administracion a observadores externos, familiares o profesionales, de cara a obtener una evaluacion mas adecuada de la magnitud de las dificultades funcionales.

  5. [Delayed neurological syndrome following carbon monoxide poisoning].

    PubMed

    Vázquez-Lima, Manuel J; Álvarez-Rodríguez, Cesáreo; Cruz-Landeira, Angelines; López-Rivadulla, Manuel

    2015-08-16

    Introduccion. La intoxicacion por monoxido de carbono es la mas frecuente en nuestro medio a consecuencia de la exposicion a gases toxicos. Los efectos de la intoxicacion por monoxido de carbono no se limitan a la exposicion aguda porque, tras la aparente recuperacion de la intoxicacion, pueden aparecer alteraciones neurologicas o del comportamiento. Pacientes y metodos. Se realizo un estudio de las intoxicaciones por monoxido de carbono en un area sanitaria de 80.000 habitantes durante un periodo de 10 años. Posteriormente se hizo un seguimiento de estos pacientes y se valoro la aparicion de sindrome neurologico tardio (SNT) y su relacion con diferentes variables en la exposicion inicial al monoxido de carbono, en el tratamiento administrado o en la gravedad de la intoxicacion. Resultados y conclusiones. Se observo que el 9,1% de los intoxicados por monoxido de carbono detectados en el area sanitaria de Salnes desarrollan el SNT, que es mas frecuente en los pacientes con criterios analiticos de gravedad y muy poco probable en los que no los tienen. Los pacientes con SNT no expresaron manifestaciones clinicas ni analiticas diferentes a los que no presentaron el sindrome; tampoco se observaron diferencias en relacion con la terapia con oxigeno administrada. La tasa de SNT en el area sanitaria de Salnes entre 2002 y 2012 es de 0,84 casos por 100.000 habitantes y año.

  6. Children and adolescents living with diabetes and celiac disease.

    PubMed

    Brancaglioni, Bianca de Cássia Alvarez; Rodrigues, Grasiele Caroline; Damião, Elaine Buchhorn Cintra; Queiroz, Márcia Silva; Nery, Márcia

    2016-03-01

    Objective To understand the experience of children and adolescents living with type 1 diabetes and celiac disease. Method This is a qualitative exploratory-descriptive study. The participants were 3 children and 2 adolescents. The data were collected by means of semi-structured interviews between January and September 2012 at the participant's residence or at the diabetic outpatient clinic of the Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo in São Paulo, Brazil. The content analysis technique was used to process the data. Results The key aspect of the illness experience of the patients was their diet, but with different meanings. The children had difficulty following the diet, while the adolescents reported that they had greater difficulty coping with the social and affective aspects of their diet. Conclusion The results reinforce the importance of nurses who seek strategies, together with the patients and their families, that help minimize the difficulties of these patients, especially with regard to managing the diet imposed by both diseases.

  7. Prevalence of Human Papillomavirus in Women from Mexico City

    PubMed Central

    López Rivera, María Guadalupe; Flores, Maria Olivia Medel; Villalba Magdaleno, José D'Artagnan; Sánchez Monroy, Virginia

    2012-01-01

    Introduction. Cervical cancer is the most common cancer among Mexican women. The goal of the present study was to determine the prevalence and distribution of HPV types in women from Mexico City. Methods. Our study was conducted in the Clinica de Especialidades de la Mujer de la Secretaría de la Defensa Nacional, Mexico. Random samples were taken from 929 healthy women requesting a cervical Papanicolaou examination. Detection and genotyping of HPV were performed by multiplex PCR, with the HPV4A ACE Screening kit (Seegene). Results. 85 of nine hundred twenty-nine women (9.1%) were infected with HPV. Of HPV-positive women, 99% and 1% had high- and low-risk HPV genotypes, respectively. The prevalence of the 16 high-risk (HR) HPV types that were screened was 43% : 42% (18) were HPV positive and 14% (16) were HPV positive, which includes coinfection. Multiple infections with different viral genotypes were detected in 10% of the positive cases. Abnormal cervical cytological results were found in only 15.3% of HPV-positive women, while 84.7% had normal cytological results. Conclusions. We found a similar prevalence of HPV to previous studies in Mexico. The heterogeneity of the HPV genotype distribution in Mexico is evident in this study, which found a high frequency of HPV HR genotypes, the majority of which were HPV 18. PMID:22811590

  8. [Neuropsychology of Tourette's disorder: cognition, neuroimaging and creativity].

    PubMed

    Espert, R; Gadea, M; Alino, M; Oltra-Cucarella, J

    2017-02-24

    Introduccion. El trastorno de Tourette es el resultado de una disfuncion cerebral frontoestriatal que afecta a personas de todas las edades, con un inicio en la primera infancia y continuacion en la adolescencia y la adultez. Desarrollo. Este articulo revisa los principales aspectos cognitivos, de neuroimagen funcional y estudios relacionados con la creatividad en un trastorno caracterizado por un exceso de dopamina en el cerebro. Conclusiones. Dada la especial configuracion cerebral de estos pacientes, deberian esperarse alteraciones neuropsicologicas, especialmente en las funciones ejecutivas. Sin embargo, los hallazgos son poco concluyentes y estan condicionados por factores como la comorbilidad con el trastorno por deficit de atencion/hiperactividad y el trastorno obsesivo compulsivo, la edad o variables metodologicas. Por otro lado, los estudios de neuroimagen realizados a lo largo de la ultima decada han podido explicar la sintomatologia clinica de pacientes con trastorno de Tourette, con especial relevancia del area motora suplementaria y el giro cingulado anterior. Finalmente, a pesar de no existir una relacion lineal entre el exceso de dopamina y la creatividad, la literatura cientifica destaca una asociacion entre el trastorno de Tourette y la creatividad musical, lo que podria traducirse en programas de intervencion basados en la musica.

  9. [Health decision making in AIDS family caregiver].

    PubMed

    Cazenave, Angélica; Ferrer, Ximena; Castro, Soledad; Cuevas, Sandra

    2005-03-01

    AIDS infected patients receive care at home; a family member assumes the caregiver role and takes health decisions that affect the person's life. It is important to know the conflicts that the families are confronting in relation to health decision making, in order to plan intervention strategies according with their real needs. This is a descriptive study, in which a sample of 38 family caregivers of AIDS persons receiving ambulatory care at the Clinica Familia, were used for this research. An O'Connor and Jacobsen instrument was used for this study. the family caregivers are women, the majority of them are mothers that live with their sick son or daughter, and who had assumed the role at least for 2 years. The family caregivers have conflicts about to continuing or not caring for the sick person, and of telling others about the disease. The family caregivers are in one of the phases of the changing process. Consequently, they are receptive to helping strategies that must be based in interventions oriented to listening and supporting, more than just providing information.

  10. [Advances in the management of neonatal hypoxia].

    PubMed

    Riesgo, Rudimar dos Santos; Becker, Michele M; Ranzan, Josiane; Winckler, Maria Isabel B; Ohlweiler, Lygia

    2013-09-06

    Introduccion. Durante el nacimiento, ocurren cambios fisiologicos en practicamente todos los organos del niño, incluyendo el sistema nervioso central. En esta fase de transicion, es posible un cierto grado de hipoxemia, en general bien tolerado por el neonato. Sin embargo, si la hipoxia neonatal es muy intensa y continuada, puede instalarse una encefalopatia neonatal, lo que caracteriza una situacion critica para el recien nacido. Su abordaje adecuado es imprescindible para garantizar un buen pronostico a largo plazo. Desarrollo. Se actualizan las informaciones acerca de la hipoxia neonatal y se revisan publicaciones recientes acerca de los avances en su abordaje a traves de la medicina basada en evidencias. Conclusiones. La encefalopatia neonatal se puede clasificar desde el punto de vista clinico en tres niveles de intensidad. Usualmente, los casos leves tienen un buen pronostico, los casos de intensidad moderada tienen un 30% de posibilidad de secuelas y los de intensidad grave tienen mas del 70% de mortalidad, pero practicamente todos los supervivientes tendran secuelas. Los avances ocurrieron en dos areas: en el diagnostico, con nuevas tecnicas de EEG y RM, y en el tratamiento, con la aparicion de la hipotermia terapeutica. Existe la posibilidad de un uso futuro para la terapia con celulas madre. El pronostico depende de la clasificacion clinica, de los datos de neuroimagen y del EEG.

  11. [Anti-NMDA receptor encephalitis: two paediatric cases].

    PubMed

    González-Toro, M Cristina; Jadraque-Rodríguez, Rocío; Sempere-Pérez, Ángela; Martínez-Pastor, Pedro; Jover-Cerdá, Jenaro; Gómez-Gosálvez, Francisco

    2013-12-01

    Introduccion. La encefalitis asociada a anticuerpos antirreceptores de N-metil-D-aspartato (NMDA) es una patologia neurologica autoinmune documentada en la poblacion pediatrica de manera creciente en los ultimos años. Se presentan dos casos de nuestra experiencia con clinica similar. Casos clinicos. Caso 1: niña de 5 años que inicia un cuadro de convulsiones y alteracion de conciencia, asociando trastornos del movimiento y regresion de habilidades previamente adquiridas que evoluciona a autismo. Caso 2: niña de 13 años que presenta hemiparesia izquierda, movimientos anomalos, trastorno de conducta y disautonomia. En ambos casos se obtienen anticuerpos antirreceptores de NMDA positivos en el liquido cefalorraquideo y se diagnostican de encefalitis antirreceptor de NMDA. En el primer caso se inicia el tratamiento con perfusion intravenosa de corticoides e inmunoglobulinas y es necesario asociar rituximab. En el segundo, corticoides e inmunoglobulinas. La evolucion fue favorable en ambas pacientes, con una leve alteracion del lenguaje como secuela en el primer caso y una recaida en el segundo caso, con resolucion completa. Conclusion. La encefalitis antirreceptor de NMDA es un trastorno tratable y es importante el diagnostico y tratamiento precoz, ya que mejora el pronostico y disminuye las recaidas.

  12. Usefulness of ileostomy defunctioning stoma after anterior resection of rectum on prevention of anastomotic leakage A retrospective analysis.

    PubMed

    Salamone, Giuseppe; Licari, Leo; Agrusa, Antonino; Romano, Giorgio; Cocorullo, Gianfranco; Falco, Nicolò; Tutino, Roberta; Gulotta, Gaspare

    2016-01-01

    Una delle principali e più temute complicanze della resezione anteriore di retto è stata ed è la deiscenza anastomotica. Solitamente, sia essa una scelta di principio od a discrezione del chirurgo operatore, viene confezionata una ileostomia laterale di sicurezza con lo scopo di prevenire tale circostanza. Scopo di tale studio è stato quello di investigare circa la utilità della stomia laterale di sicurezza quale strumento di prevenzione della deiscenza anastomotica, mettendo a paragone il decorso post-operatorio dei paziente con e senza stomia laterale. Le evidenze hanno portato alla conclusione che il confezionamento della stomia laterale di sicurezza è fattore di protezione non tanto dell’evento deiscenza anastomotica in senso stretto, quanto delle complicanze e della evoluzione clinica della stessa, vedasi ad esempio tasso di ricorrenza di deiscenza/quadro clinico in corso di deiscenza/ tempi di degenza, pur rendendosi necessario sottolineare l’assenza di significatività statistica nel tasso di mortalità nei due gruppi in studio. Cosi detto appare dunque sinottico affermare che il confezionamento di ileostomia laterale di sicurezza in corso di resezione anteriore di retto non determina una diretta azione sull’evento “deiscenza anastomotica” né “morte”, purtuttavia modifica certamente in positivo il decorso clinico ed evolutivo dell’evento “deiscenza anastomotica”.

  13. [Joint home follow-up of a patient with complicated diabetes mellitus by the case manager and the community nurse: II].

    PubMed

    López-Pisa, Rosa María; Prats-Guardiola, Marta

    2012-01-01

    This is a continuation of the article published in this journal (Enfermeria Clinica), entitled "Integral approach by the case manager and the community nurse to a complex case of diabetes mellitus in the home". We present the case of a 76 year- old patient with long-term and clinically complex Diabetes Mellitus. The patient was taking part in the Primary Care home care program. This article describes the follow-up of the case in which new complications appeared in the right limb, which led to the amputation of the second limb. A new evaluation following Virginia's Henderson model was performed six months after the initial care plan. Nursing diagnoses were made following the North American Nursing Diagnosis Association (NANDA). These diagnoses led to changes in objectives and performance criteria using, nursing outcomes classification (NOC) and nursing interventions classification (NIC). One of the results obtained was the improvement of her well-being by enabling the patient to interact and integrate socially within her environment after mobilising the corresponding social and family resources.Involvement in clinical practice is important in the prevention of diabetes mellitus and diabetic foot complications. Difficult and complex situations are sometimes beyond the ability of the community nurse. It can be beneficial to take advantage of the clinical support offered by the case management model and the integrated approach of a multidisciplinary team.

  14. An outstanding female figure in the history of occupational health: Ersilia Majno Bronzini.

    PubMed

    Salerno, Silvana

    2010-01-01

    Starting with the obituary "Ersilia Majno Bronzini: an outstanding female figure in Occupational Health", probably written by Luigi Devoto and published in the journal La Medicina del Lavoro (1933), a reappraisal is made of Majno Bronzini's contribution to occupational health. Most references were collected from the archives of the journal Il Lavoro (1901), the archives of the association "Union of Women", the periodical founded by Majno Bronzini (1899) and other material. Majno Bronzini's selected published papers (1895, 1900, 1902) on the working conditions of women and child labour proposing a national occupational health law were found. The importance of a women's network for occupational health is also shown in Majno Bronzini's correspondence with Anna Celli Frantzel and Maria Montessori. In 1902 Angelo Celli officially congratulated Majno Bronzini's (and Anne Kuliscioff's) efforts to promulgate the first law on women and child labour during his speech before the Italian Parliament, published by II Lavoro. Majno Bronzini and Nina Rignano Sullam were the only two women participating in the First International Congress on Occupational Health in Milan (1906). The correspondence between Majno Bronzini and Devoto (1901-1933) and Devoto's formal acknowledgement of Majno Bronzini (1910) when inaugurating the new "Clinica del Lavoro" institute is well documented. Majno Bronzini dedicated a significant part of her life to occupational health, together with Anna Celli Frantzel and Maria Montessori along with many others. This research shows how important her contribution was to occupational health development.

  15. [An update on the pharmacological treatment of attention deficit hyperactivity disorder: lisdexamphetamine and extended-release guanfacine].

    PubMed

    Martin Fernandez-Mayoralas, D; Fernandez-Perrone, A L; Munoz-Jareno, N; Fernandez-Jaen, A

    2017-03-13

    Introduccion. El trastorno por deficit de atencion/hiperactividad (TDAH) es uno de los trastornos del neurodesarrollo mas frecuentes en la poblacion infantil. Su tratamiento es complejo y debe incluir medidas psicoeducativas, ambientales y farmacologicas. En los ultimos años, las principales novedades respecto a su tratamiento farmacologico son la aparicion de la lisdexanfetamina y la guanfacina de liberacion retardada. Objetivo. El aumento del numero de farmacos disponibles para el tratamiento del TDAH permite tratar y cubrir situaciones clinicas muy diversas. El proposito de la presente revision es realizar un analisis de la bibliografia sobre ambos farmacos. Desarrollo. Se establecen los puntos fuertes de ambos tratamientos, atendiendo especialmente a su mecanismo de accion, a su tolerabilidad y a su eficacia. Conclusiones. La guanfacina de liberacion retardada permite tratar situaciones escasamente cubiertas con los estimulantes, tales como los niños con irritabilidad y tics, con un perfil significativo de moderada eficacia y una buena tolerabilidad y seguridad. La aparicion de la lisdexanfetamina ha supuesto un cambio muy importante porque, segun la bibliografia, se trataria de un farmaco completo y efectivo, desde el punto de vista clinico, para mejorar los sintomas del TDAH. Ademas, posee un buen perfil de seguridad.

  16. [Efficacy of lisdexamphetamine to improve the behavioural and cognitive symptoms of attention deficit hyperactivity disorder: treatment monitored by means of the AULA Nesplora virtual reality test].

    PubMed

    Diaz-Orueta, U; Fernandez-Fernandez, M A; Morillo-Rojas, M D; Climent, G

    2016-07-01

    Introduccion. La lisdexanfetamina (LDX) es el farmaco para el trastorno por deficit de atencion/hiperactividad (TDAH) con mayor volumen de investigacion de los ultimos años. No obstante, no hay estudios que certifiquen su utilidad para la mejoria del funcionamiento cognitivo en el TDAH. Objetivo. Evaluar la eficacia de la LDX en la mejora sintomatica conductual y cognitiva en un grupo de pacientes con TDAH. Dicha eficacia fue medida mediante la administracion del test AULA Nesplora de realidad virtual antes de la prescripcion del tratamiento farmacologico y despues del tratamiento con LDX. Pacientes y metodos. La muestra estaba compuesta por 85 pacientes de 6-16 años, con diagnostico clinico de TDAH y que asistian a tratamiento en una consulta de neuropediatria. Todos los pacientes iniciaron el tratamiento farmacologico con la correspondiente dosis de LDX tras la entrevista clinica y la primera administracion del test AULA. Tras un tratamiento medio de 7,5 meses, se les administro AULA nuevamente y se valoro el progreso del tratamiento farmacologico sobre la sintomatologia cognitiva y motora. Resultados. Se apreciaron mejorias muy significativas en la atencion selectiva y sostenida, la calidad del foco atencional y la hiperactividad, mejorias moderadas en la impulsividad, y una incidencia casi nula en la velocidad de procesamiento. Conclusiones. La LDX constituye un tratamiento adecuado para la mejora sustancial de la atencion e hiperactividad, y dicha mejora puede monitorizarse de forma precisa mediante el test de realidad virtual AULA.

  17. [Chronic subdural haematomas. The internal architecture of the haematoma as a predictor of recurrence].

    PubMed

    García-Pallero, M Ángeles; Pulido-Rivas, Paloma; Pascual-Garvi, José M; Sola, Rafael G

    2014-10-01

    Introduccion. La arquitectura interna del hematoma subdural cronico (HSDC) es un factor muy importante que se debe tener en cuenta como predictor de recidiva. Objetivo. Analizar los factores posiblemente asociados a la recidiva de los HSDC, prestando especial atencion a dicha arquitectura. Pacientes y metodos. Hemos revisado 147 pacientes tratados desde 2010 hasta 2013. Dividimos los HSDC en cuatro tipos de acuerdo con la clasificacion de Nakaguchi de 2001. Ademas, hemos recogido diferentes caracteristicas clinicas y las hemos sometido a analisis estadistico para evaluar su posible asociacion con la tasa de recidiva de los HSDC. Resultados. La tasa de recidiva fue del 14,75% y la de mortalidad, del 4,76%. El tratamiento con anticoagulantes, el tipo de hematoma y el no usar drenaje subdural fueron factores de riesgo estadisticamente significativos para la recurrencia del HSDC. Segun la arquitectura interna, la tasa de recidiva fue del 36,36% para el tipo separado, del 15,90% para el laminar, del 8,82% para el homogeneo y del 0% para el trabecular. Dicha tasa fue significativamente mayor en el tipo separado respecto al homogeneo y trabecular. Conclusiones. El tratamiento con anticoagulantes y el no usar drenaje subdural son factores de riesgo de recurrencia de HSDC. Ademas, la division de los HSDC de acuerdo con la clasificacion de Nakaguchi puede ser util para predecir el riesgo de recurrencia, ya que la tasa de recidiva del tipo separado fue significativamente mayor que la del resto de tipos.

  18. [Trends in infective endocarditis in a medium-sized University Hospital in Italy: analysis of 232 cases].

    PubMed

    Pallotto, Carlo; Martinelli, Laura; Baldelli, Franco; Bucaneve, Gianpaolo; Cecchini, Enisia; Malincarne, Lisa; Pasticci, Maria Bruna

    2014-06-01

    The aim of this study was to evaluate the epidemiological and clinical characteristics of 232 cases of infective endocarditis (IE), admitted to the Clinica delle Malattie Infettive of Perugia Italy from 1973 to 2012. The analysis was retrospective until 2004. After this year, all the consecutive IE cases were included by utilizing the same prospective observational protocol of the Italian Study on Endocarditis (SEI). Out of 232 EI cases, 200 (86.2 %) were definite. Over the 40-year period, a statistically significant increase was observed in the patients' age, the rate of IE admissions and prosthetic device IEs. The rate of healthcare-associated IEs also increased in the last 10 years (p=NS). Diabetes mellitus was the most frequent comorbidity. There were no variations in the rate of S. aureus and streptococcal IEs. Central nervous system complications and surgery were reported in 19.4 percent and 29.3 percent of the cases, respectively. The in-hospital mortality was 18.9 percent. In conclusion, the epidemiological and clinical trends of this study are in agreement with the literature. The difference in S. aureus endocarditis, neurological complications and surgery rates may be due to the fact that this was a single centre and, for its first part, a retrospective study. A shared, multidisciplinary protocol may be useful to improve the outcome of patients with IE and its epidemiology.

  19. [Posterior reversible encephalopathy: beyond the original description].

    PubMed

    Avecillas-Chasín, Josué M; Matías-Guiu, Jordi A; Bautista-Balbás, Luis

    2015-07-16

    Introduccion. La encefalopatia posterior reversible (EPR) es una entidad clinicorradiologica caracterizada tipicamente por cuadros de cefalea, alteraciones visuales y crisis epilepticas, asociada a edema vasogeno corticosubcortical reversible en la neuroimagen. Objetivo. Presentar una revision de los aspectos fisiopatologicos de esta entidad y tambien de las asociaciones de la EPR descritas en la bibliografia. Desarrollo. Existe una serie de factores desencadenantes bien conocidos, como las crisis hipertensivas, la eclampsia o ciertos medicamentos. La descripcion de cada vez mas casos atipicos desde un punto de vista clinico y radiologico, asi como de posibles nuevos factores desencadenantes, obliga a una redefinicion de la entidad. Conclusiones. La EPR es un conjunto de manifestaciones clinicas y radiologicas que no se pueden enmarcar dentro la palabra 'sindrome'. Aunque la EPR se ha comunicado como irreversible en ciertos casos, el concepto de reversibilidad debe mantenerse en la definicion de esta entidad, ya que, en la mayor parte de los casos, el rapido control de la condicion desencadenante de la EPR permite la reversibilidad de las lesiones.

  20. Utility of 12-lead electrocardiogram for differentiating paroxysmal supraventricular tachycardias in dogs.

    PubMed

    Santilli, R A; Perego, M; Crosara, S; Gardini, F; Bellino, C; Moretti, P; Spadacini, G

    2008-01-01

    The 12-lead surface ECG is validated for differentiating supraventricular tachycardias (SVT) in humans. Despite the description of SVT in veterinary medicine, no studies have analyzed the electrocardiographic features of this type of arrhythmias in dogs. To describe the specific electrocardiographic criteria used to differentiate the most common SVT in dogs. Twenty-three dogs examined at Clinica Veterinaria Malpensa for SVT with the mechanism documented by electrophysiologic studies (EPS). Twelve-lead electrocardiographic variables obtained from 14 dogs with orthodromic atrioventricular reciprocating tachycardia (OAVRT) and 9 dogs with focal atrial tachycardia (FAT) were compared. Dogs with FAT had faster heart rates (278 +/- 62 versus 229 +/- 42 bpm; P= .049) and less QRS alternans (33 versus 86%; P= .022). P waves appeared during tachycardia in 22 dogs, with a superior axis in 100% of OAVRT and 22% of FAT (P < .001). OAVRT was characterized by a shorter RP interval (85.0 +/- 16.8 versus 157.1 +/- 37.3 ms; P < .001) and smaller RP/PR ratio (0.60 +/- 0.18 versus 1.45 +/- 0.52; P < .001). Repolarization anomalies were present in 64% of OAVRT and no FAT (P < .001). Multivariate analysis identified QRS alternans and a positive P wave in aVR during tachycardia as independent predictors of arrhythmia type. Electrocardiographic criteria used in people for differentiating SVT can also be applied in dogs.

  1. Radiographic changes of the pelvis in Labrador and Golden Retrievers after juvenile pubic symphysiodesis: objective and subjective evaluation.

    PubMed

    Boiocchi, S; Vezzoni, L; Vezzoni, A; Bronzo, V; Rossi, F

    2013-01-01

    The hypothesis of this study was that juvenile pubic symphysiodesis (JPS) results in pelvic changes that can be identified radiographically in adult dogs. The medical records at the Clinica Veterinaria Vezzoni were searched for standard ventro-dorsal views of the pelvis of adult Labrador and Golden Retrievers that had undergone JPS or had not undergone surgery. The objective assessment of radiographs included the analysis of various pelvic measurements. Subjective evaluation of radiographs was undertaken by 18 specialists and 21 general practitioners and was based on five criteria relating to 1) the acetabular fossae, 2) the pubic symphysis, 3) the margin of the cranial pubic area, 4) the pubic rami, and 5) the obturator foramen. The radiographs of 42 Labrador Retrievers and 16 Golden Retrievers were evaluated. The most useful criteria were the radiographic measurement of the shape of the obturator foramen and two different ratios of length to width of the pubic rami; these values were significantly smaller in dogs after JPS. The pelvic canal width was the same in both groups. All objective measurements were repeatable within and between evaluators. The most reliable subjective criterion was number 4, followed by number 5 in Golden Retrievers and by 2 in Labrador Retrievers. Our objective and subjective evaluations were simple and yielded useful and repeatable results. There was no significant difference between general practitioners and specialists with regard to subjective evaluation, which indicates that these evaluation criteria can be used by small animal clinicians after minimal training.

  2. [Sluggish cognitive tempo: an updated review].

    PubMed

    Tirapu-Ustárroz, Javier; Ruiz-García, Beatriz M; Luna-Lario, Pilar; Hernáez-Goñi, Pilar

    2015-10-01

    Introduccion. El estudio del tempo cognitivo lento (TCL) surgio en gran parte de las investigaciones del trastorno por deficit de atencion/hiperactividad (TDAH). Este constructo se define con una gama de sintomas conductuales, como apariencia de somnolencia, soñar despierto, hipoactividad fisica, pobre iniciativa, letargo y apatia. Desarrollo. Se revisa el constructo de TCL a traves de articulos recientemente publicados al respecto sobre caracteristicas clinicas, sintomas asociados, evaluacion, prevalencia, etiologia, comorbilidad, perfiles neuropsicologicos y tratamiento. Los trabajos mas actuales proponen entender el TCL como un cluster de sintomas distintivo del TDAH. Aunque no hay un consenso claro, los datos son cada vez mas consistentes y dotan de gran validez externa al TCL, asociandolo con sintomas internalizantes. Conclusiones. Consideramos necesario anclar los diferentes subtipos de TDAH en modelos conceptuales atencionales. Asi, la red de orientacion atencional se relacionaria con el TCL, la red de vigilancia o atencion sostenida con el TDAH subtipo inatento, y la atencion ejecutiva seria la implicada en el TDAH subtipo combinado. La evidencia hasta la fecha, incluyendo esta revision, apoya la idea de que el TCL es un trastorno de atencion diferenciado del TDAH, pero que, como cualquier trastorno dimensional, puede solaparse con el aproximadamente en la mitad de los casos.

  3. [Therapeutic potential of bone marrow stem cells in cerebral infarction].

    PubMed

    Sánchez-Cruz, Gilberto; Milián-Rodríguez, Lismary

    2015-05-16

    Introduccion. Las celulas madre constituyen una alternativa terapeutica que se encuentra en fase de experimentacion para el infarto cerebral. Objetivo. Mostrar la evidencia cientifica existente sobre el potencial terapeutico de las celulas madre de la medula osea en esta enfermedad. Desarrollo. El infarto cerebral representa el 80% de las enfermedades cerebrovasculares. La trombolisis constituye la unica terapia aprobada, pero, por su estrecha ventana terapeutica, solo se aplica a un bajo porcentaje de los pacientes. De manera alternativa, los tratamientos neurorrestauradores, como el de celulas madre, pueden aplicarse en periodos mas prolongados. Por esta razon se efectuo una busqueda bibliografica en PubMed con el empleo de las palabras clave 'stem cells', 'bone marrow derived mononuclear cells' y 'stroke'. Se encontraron evidencias de seguridad y eficacia de dichas celulas en diferentes momentos evolutivos del infarto cerebral. Se identificaron estudios que en clinica y preclinica las recolectaron por puncion medular y en sangre periferica, y las trasplantaron directamente en el area infartada o por via intravascular. El efecto terapeutico se relaciona con sus propiedades de plasticidad celular y liberacion de factores troficos. Conclusiones. El concentrado de celulas mononucleares autologas, obtenido en sangre periferica o por puncion de la medula osea, y trasplantado por via intravenosa, es una factible opcion metodologica que permitira rapidamente incrementar el numero de ensayos clinicos en diferentes etapas evolutivas del infarto cerebral. Esta terapia muestra seguridad y eficacia; sin embargo, deben ampliarse las evidencias que avalen su generalizacion en humanos.

  4. [What is the benefit of salt reduction on blood pressure? Assessment of the Cochrane Review: Effect of longer-term modest salt reduction on blood pressure. He FJ, Li J, Macgregor GA. Cochrane Database Syst Rev. 2013 Apr 30;4:CD004937].

    PubMed

    Caldeira, Daniel; Vaz-Carneiro, António; Costa, João

    2013-01-01

    No presente artigo avaliamos e comentamos a Revisão Sistemática da Cochrane “Effect of longer-term modest salt reduction on blood pressure. Cochrane Database Syst Rev. 2013 Apr 30;4:CD004937”.Questão Clinica: Qual o impacto a longo prazo (≥ 4 semanas) da restrição moderada de ingestão de sal na pressão arterial.Conclusões: Esta revisão sistemática concluiu que a restrição moderada de ingestão de sal (redução média -4,4 g por dia) diminuide forma significativa a pressão arterial (PA) em indivíduos normotensos (-2,42 mmHg PA sistólica; -1,00 mmHg PA diastólica) ou com hipertensão arterial (-5,39 mmHg PA sistólica; -2,82 mmHg PA diastólica). Verificaram-se ligeiros aumentos da actividade da renina plasmática, aldosterona e norepinefrina. Contudo, não se identificaram alterações significativas do perfil lipídico.

  5. Prostate Cancer, High Cortisol Levels and Complex Hormonal Interaction.

    PubMed

    Fabre, Bibiana; Grosman, Halina; Gonzalez, Diego; Machulsky, Nahuel Fernandez; Repetto, Esteban M; Mesch, Viviana; Lopez, Miguel Angel; Mazza, Osvaldo; Berg, Gabriela

    2016-01-01

    Prostate cancer (PCa) is one of the most common diseases in men. It is important to assess prognostic factors and whether high cortisol levels and complex hormonal interactions could be responsible for PCa development. We evaluated the relationship between cortisol, leptin and estrogens in 141 men, 71 with PCa and the remaining 70 constituting a low risk group (LRG). They were recruited for this study from a total of 2906 middleaged men (ages 4570 years) who completed an evaluation for prostatic diseases at the Urology Division, Hospital de Clinicas "Jose de San Martin", University of Buenos Aires, in May 2009. In this cross sectional study, cortisol, PSA, totaltestosterone, freetestosterone, bioavailable testosterone, LH and estradiol were measured in serum. We observed increased cortisol levels in PCa patients as compared to LRG cases (p=0.004,). Leptin and estradiol levels were also higher in PCa patients (p=0.048; p<0.0001, respectively). Logistic regression analysis indicated that serum cortisol (OR: 1.110 (95% CI 1.0161.213), p=0.022), estradiol (OR: 1.044 (95% CI 1.0081.081), p=0.016) and leptin (OR: 1.248 (95% CI 1.0481.487), p=0.013) explained 27% of the variance of dependent variables, even after adjusting for age, smoking, BMI and waist circumference. We found increased cortisol levels in PCa patients as compared to LRG, as well as an altered circulating hormonal profile.

  6. [Myelopathy secondary to an aneurysmal bone cyst of thoracic spine].

    PubMed

    Navas-García, Marta; Penanes, Juan Ramón; Fraga, Javier; Sola, Rafael G

    2016-02-01

    Introduccion. Los quistes oseos aneurismaticos espinales son lesiones osteoliticas benignas muy infrecuentes constituidas por cavidades hematicas limitadas por septos osteoconectivos y celulas gigantes tipo osteoclastos. Clinicamente se manifiestan con dolor local, sintomas neurologicos secundarios a compresion medular, asi como fracturas, deformidades e inestabilidad vertebral. Presentamos un caso de quiste oseo aneurismatico espinal dorsal con sintomatologia neurologica, tratado mediante una reseccion microquirurgica completa, sin secuelas neurologicas asociadas. Caso clinico. Mujer de 47 años, sin antecedentes traumaticos previos, valorada por presentar un cuadro de parestesias de los miembros inferiores de semanas de evolucion. El estudio radiologico de resonancia magnetica dorsal demostro la existencia de una lesion litica de bordes bien delimitados y esclerosis marginal en D4, con afectacion de los elementos posteriores vertebrales y compresion del cordon medular subyacente. La lesion fue extirpada en su totalidad, con desaparicion de la clinica sensitiva tras la intervencion. El diagnostico anatomopatologico definitivo fue quiste oseo aneurismatico espinal. Conclusion. A pesar de su baja incidencia, los quistes oseos aneurismaticos espinales deben considerarse, en el diagnostico diferencial de los tumores oseos espinales, como una posible causa de mielopatia compresiva subaguda o cronica. La reseccion tumoral completa se considera el tratamiento de eleccion, el cual con frecuencia es curativo y asocia un buen pronostico del paciente a largo plazo.

  7. Correlation between C-Reactive Protein in Peripheral Vein and Coronary Sinus in Stable and Unstable Angina

    PubMed Central

    Leite, Weverton Ferreira; Ramires, José Antonio Franchini; Moreira, Luiz Felipe Pinho; Strunz, Célia Maria Cassaro; Mangione, José Armando

    2015-01-01

    Background High sensitivity C-reactive protein (hs-CRP) is commonly used in clinical practice to assess cardiovascular risk. However, a correlation has not yet been established between the absolute levels of peripheral and central hs-CRP. Objective To assess the correlation between serum hs-CRP levels (mg/L) in a peripheral vein in the left forearm (LFPV) with those in the coronary sinus (CS) of patients with coronary artery disease (CAD) and a diagnosis of stable angina (SA) or unstable angina (UA). Methods This observational, descriptive, and cross-sectional study was conducted at the Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, and at the Hospital Beneficência Portuguesa de Sao Paulo, where CAD patients referred to the hospital for coronary angiography were evaluated. Results Forty patients with CAD (20 with SA and 20 with UA) were included in the study. Blood samples from LFPV and CS were collected before coronary angiography. Furthermore, analysis of the correlation between serum levels of hs-CRP in LFPV versus CS showed a strong linear correlation for both SA (r = 0.993, p < 0.001) and UA (r = 0.976, p < 0.001) and for the entire sample (r = 0.985, p < 0.001). Conclusion Our data suggest a strong linear correlation between hs-CRP levels in LFPV versus CS in patients with SA and UA. PMID:25494014

  8. Effect of the combination of basic fibroblast growth factor and cysteine on corneal epithelial healing after photorefractive keratectomy in patients affected by myopia

    PubMed Central

    Meduri, Alessandro; Scorolli, Lucia; Scalinci, Sergio Zaccaria; Grenga, Pier Luigi; Lupo, Stefano; Rechichi, Miguel; Meduri, Enrico

    2014-01-01

    Background: This study sought to evaluate the effect of basic fibroblast growth factor eye drops and cysteine oral supplements on corneal healing in patients treated with photorefractive keratectomy (PRK). Materials and Methods: One hundred and twenty patients treated bilaterally with PRK for myopia were enrolled at one of two eye centers (Clinica Santa Lucia, Bologna, Italy and Department of Ophthalmology, University of Magna Graecia, Catanzaro, Italy) and were treated at the former center. Sixty patients included in the study group (Group 1) were treated postoperatively with topical basic fibroblast growth factor plus oral L-cysteine supplements, whereas 60 subjects included in the control group (Group 2) received basic fibroblast growth factor eye drops. We recorded the rate of corneal re-epithelialization and patients were followed-up every 30 days for 6 months. Statistical analyses were performed on the collected data. Results: The eyes in Group 1 demonstrated complete re-epithelialization at Day 5, whereas the eyes in Group 2 achieved this status on Day 6. No side-effects were reported. Conclusions: Patients treated with basic fibroblast growth factor eye drops and L-cysteine oral supplements benefit from more rapid corneal re-epithelialization. In human eyes, this combination treatment appeared to be safe and effective in accelerating corneal surfacing after surgery. Financial Disclosure: No author has any financial or proprietary interest in any material or method used in this study. Trial Registration: Current Controlled Trials ISRCTN73824458. PMID:24145571

  9. Evaluation of the Hitachi 717 analyser.

    PubMed

    Biosca, C; Antoja, F; Sierra, C; Douezi, H; Macià, M; Alsina, M J; Galimany, R

    1989-01-01

    The selective multitest Boehringer Mannheim Hitachi 717 analyser was evaluated according to the guidelines of the Comisión de Instrumentación de la Sociedad Española de Química Clinica and the European Committee for Clinical Laboratory Standards. The evaluation was performed in two steps: examination of the analytical units and evaluation in routine operation.THE EVALUATION OF THE ANALYTICAL UNITS INCLUDED A PHOTOMETRIC STUDY: the inaccuracy is acceptable for 340 and 405 nm; the imprecision ranges from 0.12 to 0.95% at 340 nm and from 0.30 to 0.73 at 405 nm, the linearity shows some dispersion at low absorbance for NADH at 340 nm, the drift is negligible, the imprecision of the pipette delivery system increases when the sample pipette operates with 3 mul, the reagent pipette imprecision is acceptable and the temperature control system is good.UNDER ROUTINE WORKING CONDITIONS, SEVEN DETERMINATIONS WERE STUDIED: glucose, creatinine, iron, total protein, AST, ALP and calcium. The within-run imprecision (CV) ranged from 0.6% for total protein and AST to 6.9% for iron. The between run imprecision ranged from 2.4% for glucose to 9.7% for iron. Some contamination was found in the carry-over study. The relative inaccuracy is good for all the constituents assayed.

  10. Human immunodeficiency virus (HIV) seropositivity and hepatitis B surface antigenemia (HBSAG) among blood donors in Benin city, Edo state, Nigeria.

    PubMed

    Umolu, Patience Idia; Okoror, Lawrence Ehis; Orhue, Philip

    2005-03-01

    Human Immunodeficiency Virus and Hepatitis B virus are blood borne pathogens that can be transmitted through blood transfusion and could pose a huge problem in areas where mechanisms of ensuring blood safety are suspect. This study became necessary in a population where most of the blood for transfusion is from commercial blood donors. A total of 130 donors comprising 120 commercial donors and 10 voluntary donors were tested for antibodies to human immunodeficiency virus and hepatitis B surface antigen in Benin city using Immunocomb HIV - 1 and 2 Biospot kit and Quimica Clinica Aplicada direct latex agglutination method respectively. Thirteen (10%) samples were HIV seropositive and 7(5.8%) were HBsAg positive. The age bracket 18 - 25years had the highest numbers of donors and also had the highest number of HBsAg positive cases (7.8%) while the age group 29 - 38years had highest number of HIV seropositive cases. High prevalence of HIV antibodies and Hepatitis B surface antigen was found among commercial blood donors. Appropriate and compulsory screening of blood donors using sensitive methods, must be ensured to prevent post transfusion hepatitis and HIV.

  11. Evaluation of the Olympus AU-510 analyser.

    PubMed

    Farré, C; Velasco, J; Ramón, F

    1991-01-01

    The selective multitest Olympus AU-510 analyser was evaluated according to the recommendations of the Comision de Instrumentacion de la Sociedad Española de Quimica Clinica and the European Committee for Clinical Laboratory Standards. The evaluation was carried out in two stages: an examination of the analytical units and then an evaluation in routine work conditions. The operational characteristics of the system were also studied.THE FIRST STAGE INCLUDED A PHOTOMETRIC STUDY: dependent on the absorbance, the inaccuracy varies between +0.5% to -0.6% at 405 nm and from -5.6% to 10.6% at 340 nm; the imprecision ranges between -0.22% and 0.56% at 405 nm and between 0.09% and 2.74% at 340 nm. Linearity was acceptable, apart from a very low absorbance for NADH at 340 nm; and the imprecision of the serum sample pipetter was satisfactory.TWELVE SERUM ANALYTES WERE STUDIED UNDER ROUTINE CONDITIONS: glucose, urea urate, cholesterol, triglycerides, total bilirubin, creatinine, phosphate, iron, aspartate aminotransferase, alanine aminotransferase and gamma-glutamyl transferase.The within-run imprecision (CV%) ranged from 0.67% for phosphate to 2.89% for iron and the between-run imprecision from 0.97% for total bilirubin to 7.06% for iron. There was no carryover in a study of the serum sample pipetter. Carry-over studies with the reagent and sample pipetters shows some cross contamination in the iron assay.

  12. [National consensus on the modified Atkins diet].

    PubMed

    Vaccarezza, María; Agustinho, Ariela; Alberti, M Julia; Argumedo, Laura; Armeno, Marisa; Blanco, Virginia; Bouquet, Cecilia; Cabrera, Analía; Caraballo, Roberto; Caramuta, Luciana; Cresta, Araceli; de Grandis, Elizabeth S; DeMartini, Martha G; Diez, Cecilia; Diz, Mariana; Dlugoszewski, Corina; Escobal, Nidia; Ferrero, Hilario; Galicchio, Santiago; Gambarini, Victoria; Gamboni, Beatriz; Gonzalez, Lara; Guisande, Silvina; Hassan, Amal; Matarrese, Pablo; Mestre, Graciela; Pesce, Laura; Rios, Viviana; Semprino, Marcos; Sosa, Patricia; Toma, Marisol; Viollaz, Rocío; Panico, Luis

    2016-04-16

    Introduccion. La epilepsia es una enfermedad cronica que afecta al 0,5-1% de la poblacion, y un tercio de los pacientes evoluciona hacia una forma refractaria a los farmacos antiepilepticos. Dentro de los tratamientos no farmacologicos disponibles, la dieta cetogenica Atkins modificada es un tratamiento efectivo utilizado desde 2003 como otra alternativa en niños y adultos con epilepsia refractaria. Desarrollo. El Comite Nacional de Dieta Cetogenica, dependiente de la Sociedad Argentina de Neurologia Infantil, elaboro este consenso sobre dieta Atkins modificada basandose en una revision de la bibliografia y en su experiencia clinica. Este consenso explica los distintos aspectos que hay que tener en cuenta sobre la dieta Atkins modificada, eleccion de pacientes, forma de implementacion, diversos controles y efectos adversos. A diferencia de la dieta cetogenica clasica, se inicia sin ayuno ni hospitalizacion, y no hay restriccion proteica, calorica o hidrica, por lo que mejora la palatabilidad y, consecuentemente, la tolerabilidad. Conclusiones. La dieta Atkins modificada es un tratamiento util para pacientes con epilepsia intratable. La publicacion de este consenso ofrece la posibilidad de orientar a nuevos centros en su implementacion.

  13. [Orofacial alterations and surface electromyography in neurodevelopmental disorders].

    PubMed

    Rosell-Clari, V

    2017-02-24

    Introduccion. La electromiografia de superficie se ha convertido en una tecnica muy utilizada para medir la actividad de distintos grupos musculares. Aunque la fiabilidad y validez de la tecnica se discuten, existe un cuerpo importante de bibliografia cientifica que defiende su uso. Objetivo. Presentar, mediante un estudio de caso, las dos utilidades basicas de la electromiografia de superficie: la medida de la actividad muscular orofacial y su empleo como biofeedback modulador de la propia actividad muscular. Caso clinico. Niña de 10 años con perfil facial dolicocefalico y prognatico, mordida abierta anterior y mordida cruzada bilateral, oclusion clase II de Angle bilateral y deglucion atipica con interposicion lingual. Se utilizo el electromiografo de superficie de ocho canales bipolares MioTool Face, de Miotec Suite 1.0. Se colocaron electrodos de superficie en la musculatura orofacial y los resultados obtenidos se midieron y visualizaron a traves de los programas Miograph y Biotrainer. Conclusiones. Los resultados confirman los obtenidos a traves de la exploracion clinica del paciente y apoyan el uso de estas mediciones para la estimacion y validacion de modelos mecanicos del sistema masticatorio y deglutorio. El biofeedback electromiografico se muestra como una tecnica eficaz para autocontrolar la fuerza que se realiza en grupos musculares claves en actividades primarias como la masticacion y la deglucion.

  14. Prevalence of human papillomavirus in women from Mexico City.

    PubMed

    López Rivera, María Guadalupe; Flores, Maria Olivia Medel; Villalba Magdaleno, José D'Artagnan; Sánchez Monroy, Virginia

    2012-01-01

    Cervical cancer is the most common cancer among Mexican women. The goal of the present study was to determine the prevalence and distribution of HPV types in women from Mexico City. Our study was conducted in the Clinica de Especialidades de la Mujer de la Secretaría de la Defensa Nacional, Mexico. Random samples were taken from 929 healthy women requesting a cervical Papanicolaou examination. Detection and genotyping of HPV were performed by multiplex PCR, with the HPV4A ACE Screening kit (Seegene). 85 of nine hundred twenty-nine women (9.1%) were infected with HPV. Of HPV-positive women, 99% and 1% had high- and low-risk HPV genotypes, respectively. The prevalence of the 16 high-risk (HR) HPV types that were screened was 43% : 42% (18) were HPV positive and 14% (16) were HPV positive, which includes coinfection. Multiple infections with different viral genotypes were detected in 10% of the positive cases. Abnormal cervical cytological results were found in only 15.3% of HPV-positive women, while 84.7% had normal cytological results. We found a similar prevalence of HPV to previous studies in Mexico. The heterogeneity of the HPV genotype distribution in Mexico is evident in this study, which found a high frequency of HPV HR genotypes, the majority of which were HPV 18.

  15. [Cost analysis of the use of botulinum toxin type A in Spain].

    PubMed

    de Andrés-Nogales, F; Morell, A; Aracil, J; Torres, C; Oyagüez, I; Casado, M A

    2014-05-01

    Objetivo: Estimar el coste de tratamiento de blefarospasmo, distoníacervical (DC), espasticidad del brazo del adulto (EBA) yespasticidad del niño con parálisis cerebral infantil (EPCI) con laspresentaciones de neurotoxina botulínica tipo A (NTB-A) enEspaña.Método: Se calculó el coste anual de tratamiento con NTB-A(, 2013; PVL oficial publicado aplicando deducciones del RDL8/2010 y RDL 9/2011), en función de la dosis inicial (di), dosismedia (dm) y dosis máxima (dmax) en base a los viales porsesión según fichas técnicas de Botox® (100U y 50U), Dysport®(500U) y Xeomin® (100U), considerando los músculos comunesen cada indicación. Adicionalmente, se calculó el coste considerandola población total de pacientes según prevalencia y lareutilización de viales en más de un paciente.Resultados: El coste anual/paciente con NTB-A supondría entre265y 2.120con un ahorro entre el 10% y 55% según laNTB-A seleccionada. DC y EBA presentarían el mayor coste/paciente. Botox® generaría un menor coste en EBA (di/dm) y DC(di) y en blefarospasmo y EPCI (di/dm/dmax). Dysport® tiene elmenor coste en DC (dmax) y EBA (dmax) y Xeomin® en DC(dm). El coste anual por población según prevalencia suponeentre 368.392y 13.958.836según indicación, dosis y NTBAseleccionada.Conclusiones: Una selección adecuada de las presentaciones deNTB-A para cada indicación permitiría generar importantesahorros para el Sistema Nacional de Salud. Botox® conseguiríamenores costes anuales/paciente frente al resto de NTB-A en 9de los 12 escenarios considerados.

  16. Development of Educational Resources to Include the Teaching of Astronomy in the First Years of the Basic Education. (Spanish Title: Desarrollo de Recursos Pedagógicos Para Incluir la Enseñanza de la Astronomía en los Primeros Años de la Educación Básica.) Desenvolvimento de Recursos Pedagógicos Para Inserir o Ensino de Astronomia nas Séries Iniciais do Ensino Fundamental

    NASA Astrophysics Data System (ADS)

    da Silva Morett, Samara; de Oliveira Souza, Marcelo

    2010-07-01

    In this report will be presented the development of educational resources for the presentation of concepts of astronomy in the early grades of elementary school. This material is composed by presentations developed with the use of new technological resources, by the development of experiments and by the presentation of curiosities related to this field. The experiments were constructed with low cost material in order to allow the students involved to rework them in other occasions. The material presented aims to emphasize the relationship between Astronomy and the daily life of students. The inclusion of Astronomy in elementary school is a way to demonstrate to students how this area is present in an active way in their daily lives. The classes involved in the project participated in a survey with the aim of providing information about the prior knowledge they had about topics in astronomy that were considered during the project. With the experiments conducted, and the aid of new technologies, the astronomical concepts were presented to students of 4th and 5th years of basic education of a municipal school of Campos dos Goytacazes (RJ). After the presentations new data collections were carried out with the aim of verifying the level of learning obtained and it was observed that the method used was an important tool to aid the process of teaching and learning. The project obtained good results. En este informe se presenta el desarrollo de recursos pedagógicos para la presentación de los conceptos de la astronomía en los primeros grados de la escuela primaria. Este material consiste en las presentaciones hechas con el uso de nuevos recursos tecnológicos, haciendo experimentos y análisis de objetos de interés relacionados con este ámbito. Los experimentos fueron construidos con material de bajo costo a fin de que los estudiantes involucrados podrían rehacer en otras ocasiones. El material presentado tiene como objetivo destacar la relación entre la astronom

  17. [Autism and Early Neurodevelopmental Milestones].

    PubMed

    Ferreira, Xavier; Oliveira, Guiomar

    2016-03-01

    utilidade clinica dos marcadores precoces do desenvolvimento psicomotor nos primeiros anos de vida, como preditores da gravidade da clinica de autismo, cognição e função adaptativa duma vasta população com autismo. Deste modo, estes dados vêm contribuir, em associação com outros, para o prognóstico e previsão da história natural do autismo. Conclusão: Tendo em conta os resultados deste estudo, recomenda-se fortemente o registo da 'idade de aquisição das primeiras frases' a todos os clínicos que tenham contacto com crianças com autismo.

  18. [A study of sexual function in migraine and cluster headache].

    PubMed

    Bellosta-Diago, E; Velazquez-Benito, A; Viloria-Alebesque, A; Iniguez-Martinez, C; Santos-Lasaosa, S

    2016-06-01

    Introduccion. La disfuncion erectil y sexual son sintomas comunes a muchas enfermedades cronicas cuyo diagnostico va a condicionar el manejo terapeutico de los pacientes. Objetivo. Valorar la funcion sexual en varones con migrana o cefalea en racimos (CR) comparandola con un grupo control. Sujetos y metodos. Estudio descriptivo transversal de 34 pacientes con migrana, 31 pacientes con CR y 60 sujetos control de edad inferior a 46 anos. La disfuncion erectil se valoro con el indice internacional de disfuncion erectil (IIEF), y el estado emocional, mediante el inventario de depresion de Beck. Resultados. La puntuacion media en el IIEF fue de 68,41 ± 10,09, 64,26 ± 5,73 y 59,33 ± 15,89 en los grupos control, con migrana y con CR, respectivamente (p = 0,041), y la diferencia es significativa entre controles y con CR (p = 0,036). En el grupo de pacientes migranosos, tres pacientes tenian disfuncion erectil leve, y uno, moderada. En el grupo de pacientes con CR, 12 puntuaron en rango de disfuncion erectil leve y dos cumplieron criterios de disfuncion erectil grave (p < 0,05). Al analizar las diferencias en los diferentes dominios del IIEF, estas fueron significativas en el dominio de satisfaccion global (p = 0,015) entre el grupo control y los pacientes con CR (p = 0,012). Conclusiones. Hemos encontrado una mayor frecuencia de disfuncion erectil y afectacion de la funcion sexual en terminos de satisfaccion global en los pacientes con migrana y con CR. Creemos que la valoracion de la funcion sexual en este tipo de cefaleas debe integrarse en nuestra practica clinica habitual.

  19. Association of triglycerides and new lipid markers with the incidence of hypertension in a Spanish cohort.

    PubMed

    Sánchez-Íñigo, Laura; Navarro-González, David; Pastrana-Delgado, Juan; Fernández-Montero, Alejandro; Martínez, J Alfredo

    2016-07-01

    Triglycerides and high-density lipoprotein cholesterol (HDL-C) are known to be risk factors for cardiovascular disease. However, there has been limited knowledge on the relationship between triglycerides and incident hypertension. The associations of incident hypertension with triglycerides and triglycerides-related indices such as triglycerides to HDL-C ratio (TG/HDL-C) and triglyceride-glucose index (TyG) were evaluated. Data from 3637 participants from the Vascular Metabolic Clinica Universidad Navarra cohort were followed-up during a mean of 8.49 years. A Cox proportional hazard ratio with repeated measures analyses was performed to assess the risk of developing hypertension across the quintiles of triglycerides, TG/HDL-C ratio, and TyG index. The risk of developing hypertension was 47% and 73% greater for those in the fourth and fifth quintiles of triglycerides, after adjusting for age, sex, BMI, cigarette smoking, daily alcohol intake, lifestyle pattern, type 2 diabetes, antiaggregation therapy, low-density lipoprotein cholesterol, SBP, and DBP. In men, those in the top quintile of triglycerides, TG/HDL-C ratio or TyG index were two times more likely to develop hypertension than those in the bottom quintile. In women, the effect was attenuated although the risk of hypertension rose with increasing quintiles (P for trend <0.05). The results were consistent when analyses were restricted to those participants without diabetes and obesity at baseline. Our results evidenced the associations between triglycerides-related variables and incident hypertension independently of adiposity. This association was stronger than those observed for other commonly used lipid parameters or lipid ratios, such as the TC/HDL-C ratio. : http://links.lww.com/HJH/A620.

  20. [Complex febrile crises: should we change the way we act?].

    PubMed

    Martinez-Cayuelas, E; Herraiz-Martinez, M; Villacieros-Hernandez, L; Cean-Cabrera, L; Martinez-Salcedo, E; Alarcon-Martinez, H; Domingo-Jimenez, R; Perez-Fernandez, V

    2014-11-16

    Introduccion. Las convulsiones febriles son una de las causas mas frecuentes de consulta. Hasta ahora, los pacientes con convulsiones febriles complejas (CFC) deben ingresar, dado el mayor porcentaje de epilepsia y complicaciones agudas descrito clasicamente. En la actualidad hay estudios que apoyan ser menos invasivos en el abordaje de estos pacientes. Objetivo. Describir las caracteristicas de los pacientes ingresados por CFC y proponer un nuevo protocolo de actuacion. Pacientes y metodos. Analisis retrospectivo de historias clinicas de ingresados por CFC (enero de 2010-diciembre de 2013). Se ofrecen datos epidemiologicos, clinicos, pruebas complementarias y evolucion. Resultados. Las CFC suponian un 4,2% de los ingresos de neuropediatria (n = 67). Edad media al evento: 25 meses. El 47% tenia antecedentes familiares patologicos, y el 31%, antecedentes personales de convulsion febril previa. En el 54% de los pacientes, la CFC duro menos de cinco minutos; hubo recurrencia, la mayoria con un total de dos crisis y durante el primer dia (las CFC por recurrencia son las mas frecuentes). De las pruebas complementarias realizadas, ninguna de ellas sirvio como apoyo diagnostico en el momento agudo. Durante su seguimiento, cinco pacientes presentaron complicaciones. Los pacientes con antecedentes familiares de convulsiones febriles presentan mayor riesgo de epilepsia o recurrencia (p = 0,02), sin diferencias significativas respecto a la edad, numero de crisis, intervalo de fiebre, estado epileptico o tipo de CFC. Conclusiones. Las CFC no asocian mayores complicaciones agudas; las exploraciones complementarias no permiten discriminar precozmente a los pacientes de riesgo. Su ingreso podria evitarse en ausencia de otros signos clinicos y limitarse a casos seleccionados.

  1. [Waiting time between acute event and rehabilitation: continuity of nursing care and rehabilitation. Analysis and suggestions for a Service of Protected Discharge].

    PubMed

    D'Ilio, Ilaria; Raimondi, Anna Maria; Radice, Laura; Di Mauro, Stefania

    2014-01-01

    INTRODUZIONE. In Italia negli ultimi anni l’aumento della sopravvivenza della popolazione ha comportato il cambiamento dello stato di salute, che vede l’incremento nella prevalenza delle patologie croniche (Osservatorio, 2011). L’ospedale, riservato alla fase acuta delle patologie, si integra necessariamente con le cure primarie. La continuità assume particolare rilevanza per la cura, assistenza e riabilitazione della persona assistita, così come l’appropriato utilizzo delle diverse tipologie di offerta socio sanitaria assistenziale e riabilitativa. OBIETTIVO. Al San Gerardo di Monza, nell’ambito della riabilitazione del paziente post-acuto, si analizza la fase che intercorre tra la dimissione prevista dall’ospedale e la data di accettazione presso gli istituti di riabilitazione. E’ possibile quantificare i tempi di attesa? L’ allocazione delle persone assistite è appropriata? Scopo dello studio osservazionale descrittivo è accertare la distribuzione dei giorni di attesa. Inoltre si ipotizza il ricorso all’Assistenza Domiciliare Integrata e a soluzioni innovative. Obiettivi sono la diminuzione delle giornate di degenza inappropriate e l’utilizzo delle risorse in modo congruo. RISULTATI. Delle 1083 persone in attesa di riabilitazione il 55% (652), a cui sono associate 4505 giornate “inappropriate”, è stato dimesso dall’ospedale oltre i tempi previsti. CONCLUSIONI. L’utilizzo dell’assistenza domiciliare, vantaggiosa per l’ospedale, può essere utilizzata solo per una minoranza di pazienti e in modo diseconomico. Per abbattere la totalità delle giornate, una soluzione innovativa può essere l’istituzione di posti letto a basso costo. E dato che la maggioranza dei casi sono solo ad alta complessità assistenziale ma a bassa intensità clinica potrebbero essere letti gestiti da infermieri.

  2. [Hypomyelination with atrophy of the basal ganglia and cerebellum. Contribution of two new cases to a recently reported entity].

    PubMed

    Tomás-Vila, Miguel; Menor, Francisco; Ley-Martos, Myriam; Jumillas-Luján, M José; Marco-Hernández, Ana V; Barbero, Pedro

    2014-02-16

    Introduccion. La hipomielinizacion con atrofia de ganglios basales y de cerebelo (H-ABC) es una rara entidad descrita recientemente. Se presentan dos nuevos casos pertenecientes a una misma familia. Casos clinicos. Caso 1: niño de 17 meses con retraso grave en todas las areas, ausencia de lenguaje y de contacto visual. En la exploracion destacaba una microcefalia con tetraparesia espastica. En la resonancia magnetica cerebral se apreciaba atrofia cerebelosa de predominio vermiano con perdida de volumen de ambos nucleos del putamen y la cabeza del caudado, y patron de hipomielinizacion de la sustancia blanca. En la electromiografia se objetivo un patron de polineuropatia cronica de predominio motor. Presento un descenso de los valores de acido homovalinico y de acido 5-hidroxindolacetico. El tratamiento con levodopa/carbidopa no fue efectivo. Caso 2: niña de 11 meses, hermana del caso anterior. Presentaba un retraso grave en todas las areas y en la exploracion clinica se detecto una microcefalia con tetraparesia espastica. La resonancia magnetica cerebral mostro hallazgos superponibles a los del hermano, con hipomielinizacion, atrofia cerebelosa y afectacion putaminal y de ambos caudados; en la electromiografia, hallazgos compatibles con polineuropatia motora de caracter desmielinizante. Presento un descenso de los valores de acido homovalinico y acido 5-hidroxindolacetico en el liquido cefalorraquideo. El tratamiento con levodopa/carbidopa resulto ineficaz. Conclusiones. Estos dos nuevos casos ayudan a caracterizar mejor esta entidad y refuerzan la hipotesis del origen genetico del sindrome, dado que se trata de dos casos pertenecientes a una misma familia.

  3. Profile of the newly graduated physicians in southern Brazil and their professional insertion.

    PubMed

    Purim, Kátia Sheylla Malta; Borges, Luiza DE Martino Cruvinel; Possebom, Ana Carolina

    2016-01-01

    Knowledge of the profile and professional integration of new graduates enables adjustments in medical education. This study evaluated 107 graduates from a private institution in the Brazilian South region, using a self-administered electronic questionnaire. There were similar participation of young physicians of both genders and higher male concentration in general surgery. Graduates are inserted in the public and private labor market. Most do extra shifts in emergency services and trauma surgery, where there is greater need for clinical and surgical skills. These findings suggest that adequate surgical training during graduation is critical to employability. RESUMO O conhecimento do perfil e inserção profissional dos recém-formados possibilita ajustes na educação médica. Este estudo avaliou 107 egressos de instituição privada no sul do país, utilizando questionário eletrônico autoaplicável. Houve participação similar de jovens de ambos os sexos e maior concentração masculina na área de cirurgia geral. Os egressos estão inseridos no mercado de trabalho público e privado. A maioria faz plantões extras em serviços de emergência e cirurgia do trauma, onde há maior necessidade de habilidades clinicas e cirúrgica. Esses achados apontam que a formação cirúrgica adequada durante a graduação é fundamental para a empregabilidade.

  4. [Home-based rehabilitation in the functional recovery of patients with cerebrovascular disease].

    PubMed

    López-Liria, Remedios; Ferre-Salmerón, Rocío; Arrebola-López, Clara; Granados-Valverde, Rocío; Gobernado-Cabero, Miguel Ángel; Padilla-Góngora, David

    2013-06-16

    Introduccion. El estudio de la eficacia en los tratamientos de rehabilitacion aplicados a pacientes con secuelas tras una enfermedad cerebrovascular (ECV) resulta decisivo en la actualidad para planificar su abordaje desde la sanidad publica y mejorar las directrices de evaluacion y tratamiento existentes. Objetivo. Describir las caracteristicas que presentan los pacientes que han sufrido ECV atendidos por las unidades moviles de rehabilitacion-fisioterapia (UMRF) y como influyen estos tratamientos sobre su recuperacion funcional. Pacientes y metodos. Estudio descriptivo prospectivo en 124 pacientes derivados a las UMRF de la provincia de Almeria entre 2008 y 2011. Se analizaron variables (pre y postratamiento) como las caracteristicas y antecedentes personales, indice de Barthel, escala de espasticidad de Ashworth modificada, dolor (hombro) y escala neurologica canadiense. Resultados. La muestra final estuvo compuesta por 106 participantes (edad media: 73,72 años). El proceso discapacitante fue isquemico en un 77,4%, y la hipertension, el factor de riesgo mas prevalente (81%). La media del indice de Barthel inicial fue de 31,04, y la media del indice final, de 57,62 (t = –11,75; p < 0,001). La escala canadiense mostro una evolucion favorable en el nivel de conciencia, orientacion y lenguaje (p < 0,001). El 56,2% de los pacientes recibio alta por mejoria, sin precisar rehabilitacion ambulatoria adicional. Conclusiones. Los resultados obtenidos reflejan una importante mejora funcional en los pacientes tratados en las UMRF. La rehabilitacion domiciliaria se plantea como una herramienta necesaria para las personas con mayor vulnerabilidad clinica y sin acceso a los cuidados ambulatorios, que logra los beneficios de tratamientos que son efectivos.

  5. [Prevalence, type of epilepsy and use of antiepileptic drugs in primary care].

    PubMed

    Fernández-Suárez, Elena; Villa-Estébanez, Rubén; Garcia-Martinez, Alberto; Fidalgo-González, José A; Zanabili Al-Sibbai, Ahmad A; Salas-Puig, Javier

    2015-06-16

    Introduccion. La epilepsia es una enfermedad con gran repercusion social y economica. La prevalencia deberia ser usada como la base mas importante para planificar la prevencion secundaria y terciaria. Objetivos. Identificar los pacientes con diagnostico de epilepsia en un centro de atencion primaria y determinar la prevalencia, las caracteristicas demograficas, el tipo de sindrome epileptico y el uso de los farmacos antiepilepticos. Pacientes y metodos. Estudio descriptivo transversal retrospectivo. Incluyo 196 pacientes con diagnostico de epilepsia pertenecientes a un centro de salud y revision de la historia clinica hospitalaria, con el estudio de las variables sociodemograficas y clinicofarmacologicas. Resultados. Prevalencia de epilepsia: 8,4/1.000 habitantes. Edad media: 50,3 años. Sexo: 52,6%, hombres. Ambito: 79,6%, urbano. Antecedentes familiares de epilepsia: 14,8%. Tipo de epilepsia: focal sintomatica por ictus (14,3%), generalizada idiopatica (13,8%), focal criptogenica (8,7%), no clasificada (31,1%). Edad media al inicio de la crisis: 31,6 años. Comorbilidad neurologica o psiquiatrica: 62,8%. Ultima revision: el 18,9% sin tratamiento antiepileptico, el 56,6% en monoterapia y el 24,5% en politerapia. Libres de crisis: 76,5%. Farmacos mas prescritos: acido valproico, carbamacepina, fenitoina, lamotrigina y levetiracetam. Un 78,6% sin efectos secundarios. Fallecimiento: 4,1%. Conclusiones. La prevalencia de pacientes con epilepsia fue de 8,4/1.000 habitantes y predomina la focal sintomatica por ictus. Casi un tercio de los pacientes referia algun factor desencadenante de crisis, principalmente consumo de alcohol o fiebre. Predomina la monoterapia, los efectos secundarios son escasos y, en la ultima revision, la mayoria se hallaba libre de crisis.

  6. Implementation of a quality assurance program for computerized treatment planning systems

    SciTech Connect

    Camargo, Priscilla R. T. L.; Rodrigues, Laura N.; Furnari, Laura; Rubo, Rodrigo A.

    2007-07-15

    In the present investigation, the necessary tests for implementing a quality assurance program for a commercial treatment planning system (TPS), recently installed at Sao Paulo University School of Medicine Clinicas Hospital--Brazil, was established and performed in accordance with the new IAEA publication TRS 430, and with AAPM Task Group 53. The tests recommended by those documents are classified mainly into acceptance, commissioning (dosimetric and nondosimetric), periodic quality assurance, and patient specific quality assurance tests. The recommendations of both IAEA and AAPM documents are being implemented at the hospital for photon beams produced by two linear accelerators. A Farmer ionization chamber was used in a 30x30x30 cm{sup 3} phantom with a dose rate of 320 monitor unit (MU)/min and 50 MU in the case of the dosimetric tests. The acceptance tests verified hardware, network systems integration, data transfer, and software parameters. The results obtained are in good agreement with the specifications of the manufacturer. For the commissioning dosimetric tests, the absolute dose was measured for simple geometries, such as square and rectangular fields, up to more complex geometries such as off-axis hard wedges and for behavior in the build up region. Results were analysed by the use of confidence limit as proposed by Venselaar et al. [Radio Ther. Oncol. 60, 191-201 (2001)]. Criteria of acceptability had been applied also for the comparison between the values of MU calculated manually and MU generated by TPS. The results of the dosimetric tests show that work can be reduced by choosing to perform only those that are more crucial, such as oblique incidence, shaped fields, hard wedges, and buildup region behavior. Staff experience with the implementation of the quality assurance program for a commercial TPS is extremely useful as part of a training program.

  7. High Prevalence of Systemic Autoimmune Diseases in Patients with Menière's Disease

    PubMed Central

    Gazquez, Irene; Soto-Varela, Andres; Aran, Ismael; Santos, Sofia; Batuecas, Angel; Trinidad, Gabriel; Perez-Garrigues, Herminio; Gonzalez-Oller, Carlos; Acosta, Lourdes; Lopez-Escamez, Jose A.

    2011-01-01

    Background Autoimmunity appears to be associated with the pathophysiology of Meniere's disease (MD), an inner ear disorder characterized by episodes of vertigo associated with hearing loss and tinnitus. However, the prevalence of autoimmune diseases (AD) in patients with MD has not been studied in individuals with uni or bilateral sensorineural hearing loss (SNHL). Methods and Findings We estimated the prevalence of AD in 690 outpatients with MD with uni or bilateral SNHL from otoneurology clinics at six tertiary referral hospitals by using clinica criteria and an immune panel (lymphocyte populations, antinuclear antibodies, C3, C4 and proinflammatory cytokines TNFα, INFγ). The observed prevalence of rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and ankylosing spondylitis (AS) was higher than expected for the general population (1.39 for RA, 0.87 for SLE and 0.70 for AS, respectively). Systemic AD were more frequently observed in patients with MD and diagnostic criteria for migraine than cases with MD and tension-type headache (p = 0.007). There were clinical differences between patients with uni or bilateral SNHL, but no differences were found in the immune profile. Multiple linear regression showed that changes in lymphocytes subpopulations were associated with hearing loss and persistence of vertigo, suggesting a role for the immune response in MD. Conclusions Despite some limitations, MD displays an elevated prevalence of systemic AD such as RA, SLE and AS. This finding, which suggests an autoimmune background in a subset of patients with MD, has important implications for the treatment of MD. PMID:22053211

  8. Beers versus STOPP criteria in polyharmacy community-dwelling older patients.

    PubMed

    Nicieza-Garcia, Maria Luisa; Salgueiro-Vázquez, Maria Esther; Jimeno-Demuth, Francisco José; Manso, Gloria

    2016-05-01

    Objetivo: Evaluar la prescripcion potencialmente inapropiada (PPI) mediante la aplicacion de los criterios Beers (version 2012) y STOPP (version 2008) en pacientes mayores, polimedicados y residentes en la comunidad. Metodos: A partir de la informacion recogida en los datos de facturacion de recetas y de las historias clinicas electronicas se selecciono una muestra de 223 pacientes de 65 o mas anos, que tomaban simultaneamente 10 o mas medicamentos/dia. Se aplicaron separadamente los criterios de Beers y STOPP y se compararon los resultados obtenidos con ambos metodos. Resultados: Un total de 141 pacientes (63,2%) presentaban al menos un criterio de Beers. Los dos criterios de Beers independientes del diagnostico observados con mas frecuencia fueron el uso de benzodiazepinas y el uso de antiinflamatorios no esteroideos no selectivos de ciclooxigenasa-2. Con respecto a los criterios de Beers considerando el diagnostico, los mas frecuentes fueron el uso de anticolinergicos en pacientes con sintomas del tracto urinario inferior o con hiperplasia benigna de prostata y el uso de benzodiazepinas, antipsicoticos, zolpidem o antihistaminicos H2, en pacientes con demencia o deterioro cognitivo. Un total de 165 (73,9%) pacientes tenian al menos una PPI segun los criterios STOPP. La duplicidad terapeutica y el uso prolongado de benzodiazepinas de vida media larga fueron los dos criterios STOPP mas comunes. Discusion: Nuestro estudio identifico una alta frecuencia de PPI en pacientes mayores, polimedicados y residentes en la comunidad. La aplicacion simultanea de los criterios de Beers y STOPP constituye una herramienta util para mejorar la prescripcion en este grupo de poblacion.

  9. [Is necessary to perform a transthoracic echocardiogram in all the patients with cryptogenic stroke during hospitalization?].

    PubMed

    Arias-Rivas, Susana; Rodríguez-Yáñez, Manuel; López-Ferreiro, Ana; Santamaría-Cadavid, María; Fernández-Pajarín, Gustavo; González-Juanatey, José Ramón; Castillo, José; Blanco, Miguel

    2013-05-16

    Introduccion. El 15-30% de los ictus isquemicos son de origen cardioembolico. El ecocardiograma transtoracico desempena un papel fundamental en la evaluacion, diagnostico y manejo de la fuente embolica. La ausencia de recomendaciones oficiales para el empleo del ecocardiograma en pacientes con ictus isquemico lleva a una solicitud universal de la prueba, presentando una baja rentabilidad diagnostica. Objetivo. Analizar la rentabilidad diagnostica del ecocardiograma transtoracico en pacientes con ictus isquemico indeterminado tras la aplicacion de criterios clinicos predefinidos de riesgo. Pacientes y metodos. Se analizan los ecocardiogramas realizados a pacientes con ictus isquemico agudo solicitados durante 2009-2011 desde el servicio de neurologia. Se estudia la rentabilidad diagnostica y su aportacion al estudio etiologico. Se aplican unos 'criterios de seleccion de paciente de alto riego con necesidad de realizacion de la prueba durante el ingreso' (edad < 60 anos, alteraciones en el ecocardiograma basal, cardiomegalia en la radiografia de torax basal, antecedentes de cardiopatia, sospecha clinica de endocarditis o neoplasia activa) y se analiza su validez. Resultados. De 930 pacientes, se realizo ecocardiograma a 201 (21,6%) y se detecto una fuente cardioembolica en el 9,95%. Tras la aplicacion de criterios de seleccion, el numero de ecocardiogramas paso a 97 (10,4%). Los criterios propuestos presentan: sensibilidad, 95%; especificidad, 56,9%; valor predictivo positivo, 19,6%, y valor predictivo negativo, 99%. Conclusiones. La aplicacion de nuestros criterios a pacientes con ictus indeterminado identifica con alta eficiencia la fuente cardioembolica, lo que permite la realizacion del ecocardiograma transtoracico ambulatorio en el resto de los pacientes.

  10. Influence of preoperative propranolol on cardiac index during the anhepatic phase of liver transplantation.

    PubMed

    Seiberlich, Emerson; Sanches, Marcelo D; Morais, Bruno S; Maciel, Jader F

    2015-01-01

    Liver transplantation is the best therapeutic option for end-stage liver disease. Non-selective beta-blocker medications such as propranolol act directly on the cardiovascular system and are often used in the prevention of gastrointestinal bleeding resulting from HP. The effects of propranolol on cardiovascular system of cirrhotic patients during liver transplantation are not known. Evaluate the influence of propranolol used preoperatively on cardiac index during the anhepatic phase of liver transplantation. 101 adult patients (73 male [72.2%]) who underwent cadaveric donor orthotopic liver transplantation by piggyback technique with preservation of the retrohepatic inferior vena cava performed at Hospital das Clinicas, Federal University of Minas Gerais were evaluated. There was no difference in severity between groups by the MELD system, p=0.70. The preoperative use of propranolol and the cardiac index outcome were compared during the anhepatic phase of liver transplantation in 5 groups (I: increased cardiac index, II: cardiac index reduction lower than 16%, III: cardiac index reduction equal to or greater than 16% and less than 31%, IV: cardiac index reduction equal to or greater than 31% and less than 46%, V: cardiac index reduction equal to or greater than 46%). Patients in group I (46.4%) who received propranolol preoperatively were statistically similar to groups II (60%), III (72.7%), IV (50%) and V (30.8%), p=0.57. The use of propranolol before transplantation as prophylaxis for gastrointestinal bleeding may be considered safe, as it was not associated with worsening of cardiac index in anhepatic phase of liver transplantation. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  11. [Computer-aided prescribing: from utopia to reality].

    PubMed

    Suárez-Varela Ubeda, J; Beltrán Calvo, C; Molina López, T; Navarro Marín, P

    2005-05-31

    To determine whether the introduction of computer-aided prescribing helped reduce the administrative burden at primary care centers. Descriptive, cross-sectional design. Torreblanca Health Center in the province of Seville, southern Spain. From 29 October 2003 to the present a pilot project involving nine pharmacies in the basic health zone served by this health center has been running to evaluate computer-aided prescribing (the Receta XXI project) with real patients. All patients on the center's list of patients who came to the center for an administrative consultation to renew prescriptions for medications or supplies for long-term treatment. Total number of administrative visits per patient for patients who came to the center to renew prescriptions for long-term treatment, as recorded by the Diraya system (Historia Clinica Digital del Ciudadano, or Citizen's Digital Medical Record) during the period from February to July 2004. Total number of the same type of administrative visits recorded by the previous system (TASS) during the period from February to July 2003. The mean number of administrative visits per month during the period from February to July 2003 was 160, compared to a mean number of 64 visits during the period from February to July 2004. The reduction in the number of visits for prescription renewal was 60%. Introducing a system for computer-aided prescribing significantly reduced the number of administrative visits for prescription renewal for long-term treatment. This could help reduce the administrative burden considerably in primary care if the system were used in all centers.

  12. Ultracision Harmonic Scalpel in oral and oropharyngeal cancer resection.

    PubMed

    Tirelli, Giancarlo; Del Piero, Giulia Carolina; Perrino, Fiorella

    2014-07-01

    The aim of this prospective study was to evaluate the benefits and risks when using an Ultracision Harmonic Scalpel in the surgical treatment of oral and oropharyngeal carcinomas. Prospective non-randomized. Clinica Otorinolaringoiatrica, Azienda Ospedaliero-Universitaria. Trieste, Italy. In this study, conducted from April 2008 to August 2010, 36 consecutive patients underwent resection of oral or oropharyngeal carcinoma and lateral lymphadenectomy using the Ultracision Harmonic Scalpel. Evaluation criteria included length of the surgical procedure, intraoperative blood loss, quantity of neck drainage on the first, second and third postoperative days, postoperative complications, and a subjective assessment of postoperative pain and lymphatic oedema of the neck. Results were compared with previous surgical procedures carried out between May 2006 and March 2008 using cold knife and bipolar haemostasis (n = 36) when the Harmonic Scalpel was not available. In patients treated with the Harmonic Scalpel, operating time was significantly reduced, both for resection of the carcinoma and the lateral lymphadenectomy. Intraoperative blood loss and neck drainage on the first and second postoperative days were significantly less and pain scores were significantly lower than in the cold knife group. No postoperative complications were noted in the Harmonic Scalpel group. The only disadvantage noted in the Harmonic Scalpel group was the high incidence of lymphatic oedema of the neck. Use of the Harmonic Scalpel during resection of oral cancer and lateral lymphadenectomy is safe and confers some advantages over conventional methods. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  13. HIV-1 transmission linkage in an HIV-1 prevention clinical trial

    SciTech Connect

    Leitner, Thomas; Campbell, Mary S; Mullins, James I; Hughes, James P; Wong, Kim G; Raugi, Dana N; Scrensen, Stefanie

    2009-01-01

    HIV-1 sequencing has been used extensively in epidemiologic and forensic studies to investigate patterns of HIV-1 transmission. However, the criteria for establishing genetic linkage between HIV-1 strains in HIV-1 prevention trials have not been formalized. The Partners in Prevention HSV/HIV Transmission Study (ClinicaITrials.gov NCT00194519) enrolled 3408 HIV-1 serodiscordant heterosexual African couples to determine the efficacy of genital herpes suppression with acyclovir in reducing HIV-1 transmission. The trial analysis required laboratory confirmation of HIV-1 linkage between enrolled partners in couples in which seroconversion occurred. Here we describe the process and results from HIV-1 sequencing studies used to perform transmission linkage determination in this clinical trial. Consensus Sanger sequencing of env (C2-V3-C3) and gag (p17-p24) genes was performed on plasma HIV-1 RNA from both partners within 3 months of seroconversion; env single molecule or pyrosequencing was also performed in some cases. For linkage, we required monophyletic clustering between HIV-1 sequences in the transmitting and seroconverting partners, and developed a Bayesian algorithm using genetic distances to evaluate the posterior probability of linkage of participants sequences. Adjudicators classified transmissions as linked, unlinked, or indeterminate. Among 151 seroconversion events, we found 108 (71.5%) linked, 40 (26.5%) unlinked, and 3 (2.0%) to have indeterminate transmissions. Nine (8.3%) were linked by consensus gag sequencing only and 8 (7.4%) required deep sequencing of env. In this first use of HIV-1 sequencing to establish endpoints in a large clinical trial, more than one-fourth of transmissions were unlinked to the enrolled partner, illustrating the relevance of these methods in the design of future HIV-1 prevention trials in serodiscordant couples. A hierarchy of sequencing techniques, analysis methods, and expert adjudication contributed to the linkage

  14. Correlation between brain injury and dysphagia in adult patients with stroke

    PubMed Central

    Nunes, Maria Cristina de Alencar; Jurkiewicz, Ari Leon; Santos, Rosane Sampaio; Furkim, Ana Maria; Massi, Giselle; Pinto, Gisele Sant Ana; Lange, Marcos Christiano

    2012-01-01

    Summary Introduction: In the literature, the incidence of oropharyngeal dysphagia in patients with cerebrovascular accident (AVE) ranges 20–90%. Some studies correlate the location of a stroke with dysphagia, while others do not. Objective: To correlate brain injury with dysphagia in patients with stroke in relation to the type and location of stroke. Method: A prospective study conducted at the Hospital de Clinicas with 30 stroke patients: 18 women and 12 men. All patients underwent clinical evaluation and swallowing nasolaryngofibroscopy (FEES®), and were divided based on the location of the injury: cerebral cortex, cerebellar cortex, subcortical areas, and type: hemorrhagic or transient ischemic. Results: Of the 30 patients, 18 had ischemic stroke, 10 had hemorrhagic stroke, and 2 had transient stroke. Regarding the location, 10 lesions were in the cerebral cortex, 3 were in the cerebral and cerebellar cortices, 3 were in the cerebral cortex and subcortical areas, and 3 were in the cerebral and cerebellar cortices and subcortical areas. Cerebral cortex and subcortical area ischemic strokes predominated in the clinical evaluation of dysphagia. In FEES®, decreased laryngeal sensitivity persisted following cerebral cortex and ischemic strokes. Waste in the pharyngeal recesses associated with epiglottic valleculae predominated in the piriform cortex in all lesion areas and in ischemic stroke. A patient with damage to the cerebral and cerebellar cortices from an ischemic stroke exhibited laryngeal penetration and tracheal aspiration of liquid and honey. Conclusion: Dysphagia was prevalent when a lesion was located in the cerebral cortex and was of the ischemic type. PMID:25991951

  15. HPV Prevalence in Multiple Anatomical Sites among Men Who Have Sex with Men in Peru.

    PubMed

    Blas, Magaly M; Brown, Brandon; Menacho, Luis; Alva, Isaac E; Silva-Santisteban, Alfonso; Carcamo, Cesar

    2015-01-01

    Human Papilloma Virus (HPV) infection is the most common sexually transmitted viral infection worldwide. HPV is highly prevalent in sexually active men who have sex with men (MSM) and has been associated with anal cancer, penile cancer, and oropharyngeal cancer. From March to September 2011, we conducted a cross-sectional study of HPV prevalence among MSM above age 18 years. Participants were recruited using respondent driven sampling at Clinica Cayetano Heredia. All participants provided anal, genital, and oral samples for HPV DNA testing, and blood for HIV and HPV antibody testing. A total of 200 MSM were recruited in the study. The mean age was 34 years (range 18-59 years, SD = 9.4) and101 participants were HIV negative (99 HIV positive). HPV 6/11/16/18 or quadrivalent HPV vaccine (HPV4) genotype seroprevalence among HIV negative and positive MSM was 64.3% (55%-75.9%) and 93.8% (87.6%-99.2%) respectively (p<0.001). HIV positivity was associated with a higher prevalence of HPV4 and HPV 16/18 DNA at external genital sites and the anal canal. HPV4 DNA prevalence at external genital sites among HIV negative and positive MSM was 14.9% and 28.7% (p = 0.02) respectively, at anal canal was 50.9% and 79.0% (p = 0.001), and at the oral cavity was 9.9% and 8.5% (p = 0.6). HPV4 seroprevalence was high in our study among both HIV positives and negatives, with HPV DNA prevalence much lower, and the anal canal being the anatomical site with the highest HPV DNA prevalence. HPV prevention interventions are needed among MSM at high-risk for HIV infection.

  16. [Care for patients with altered states of consciousness in a hospital for chronic and long-stay patients].

    PubMed

    Más-Sesé, Gemma; Sanchis-Pellicer, M José; Tormo-Micó, Esther; Vicente-Más, Josep; Vallalta-Morales, Manuel; Rueda-Gordillo, Diego; Conejo-Alba, Antonia; Berbegal-Serra, Juan; Martínez-Avilés, Pedro; Oltra-Masanet, Joan A; Femenia-Pérez, Miquel

    2015-03-16

    Introduccion. Un 30-40% de los pacientes con daño cerebral presenta alteraciones del nivel de conciencia, y algunos casos, estados alterados de conciencia: sindrome de vigilia sin respuesta (SVSR) o estado de minima conciencia (EMC). La recuperacion es variable y la supervivencia esta amenazada por multiples complicaciones. Objetivos. Presentar la metodologia de trabajo del Hospital La Pedrera (HLP) para pacientes en SVSR o EMC y analizar las caracteristicas clinicas de los pacientes atendidos, la evolucion, y la situacion funcional y cognitiva en el momento del alta. Pacientes y metodos. Estudio descriptivo prospectivo de pacientes atendidos en el HLP durante el periodo 2009-2013, con diagnostico de SVSR o EMC. Resultados. El HLP trabaja mediante el metodo gestion de caso, ofreciendo una atencion integral por un equipo multidisciplinar. Los pacientes se clasifican segun objetivos asistenciales. Los pacientes con SVSR o EMC se incluyen en el programa de cuidados integrales y adaptacion. Se atendio a 23 pacientes (86,9% varones), con una edad media de 54,9 años. Etiologia: hemorragia cerebral, 30,4%; encefalopatia anoxica, 26,6%; encefalopatia metabolica, 17,3%; y otras causas, 17,3%. El 73,9% ingreso en SVSR y el resto en EMC. Evolucion: el 43,4% mejoro su situacion cognitiva inicial y el 88,8% presentaba una situacion de dependencia total en el momento del alta. Las complicaciones mas frecuentes fueron infecciones respiratorias y urinarias (53,6%). El 65,2% de los casos fueron exitus. Conclusiones. La asistencia en SVSR o EMC es compleja y precisa cuidados multidisciplinares. Casi la mitad de los pacientes mejoro su situacion cognitiva, lo que justifica una actitud proactiva que intente mejorar la calidad de vida de los pacientes y sus familias.

  17. [Analysis of a series of cases with an initial diagnosis of acute disseminated encephalomyelitis over the period 2000-2010].

    PubMed

    Rodríguez-Fernández, Cristina; López-Marín, Laura; López-Pino, Miguel Ángel; Gutiérrez-Solana, Luis G; Soto-Insuga, Víctor; Conejo-Moreno, David

    2013-10-01

    Introduccion. La encefalomielitis aguda diseminada (EMAD) es una enfermedad desmielinizante que afecta fundamentalmente a la sustancia blanca del sistema nervioso central. El diagnostico se basa en hallazgos clinicorradiologicos y evolutivos. La resonancia magnetica cerebral es la herramienta diagnostica mas util. El curso suele ser monofasico y el tratamiento inicial de eleccion, los corticoides. Pacientes y metodos. Estudio retrospectivo de 18 pacientes con diagnostico de sospecha inicial de EMAD. Se analizo la sintomatologia, los hallazgos radiologicos, la evolucion y el tratamiento. El diagnostico definitivo se establecio en 12 pacientes, excluyendo un paciente con reaccion en cadena de la polimerasa positiva para el virus herpes simple en el liquido cefalorraquideo, uno con clinica compatible pero resonancia magnetica cerebral normal, y cuatro con inicio similar a EMAD cuyos diagnosticos definitivos fueron: sindrome de Rassmusen, sindrome hemofagocitico, tumor cerebral y MELAS (encefalomiopatia mitocondrial con acidosis lactica y accidentes cerebrovasculares). Resultados. La mediana de edad fue de 31 meses, sin predominio de sexo. La infeccion de la via respiratoria superior fue la causa mas frecuente en niños mayores y la gastrointestinal, en menores de 2 años. Todos presentaron alteracion en el nivel de conciencia y deficits neurologicos multifocales. El hallazgo radiologico mas frecuente fue la alteracion multifocal bihemisferica de la sustancia blanca. Los corticoides fueron el tratamiento de eleccion en la mayoria. La evolucion fue favorable en casi todos los pacientes excepto en dos, que tuvieron secuelas importantes. Conclusiones. La EMAD puede presentarse a cualquier edad, incluyendo lactantes. Hay multiples entidades que pueden simular una EMAD en un inicio.

  18. [Urgent stroke care in hospitals with a stroke unit. Quick Project].

    PubMed

    Masjuán, Jaime; Álvarez-Sabín, José; Arias-Rivas, Susana; Blanco, Miguel; de Felipe, Alicia; Escudero-Martínez, Irene; Fuentes, Blanca; Gállego-Culleré, Jaime; Moniche-Álvarez, Francisco; Muñoz, Lucía; Pérez de la Ossa-Herrero, Natalia; Sahuquillo, Patricia; Santamarina, Estevo; Sanz, Borja; Tembl, José I; Zandio, Beatriz

    2016-04-01

    Introduccion. El ictus es una emergencia medica dependiente del tiempo. La rapidez en su reconocimiento y en la atencion que reciben los pacientes es clave en el pronostico. Objetivos. Analizar los tiempos de actuacion medica, evaluar posibles areas de mejora y estudiar la dotacion de recursos de los centros. Pacientes y metodos. Registro prospectivo de pacientes atendidos en ocho unidades de ictus experimentadas españolas con sospecha de ictus y activacion del codigo ictus. Se recogieron los tiempos inicio-puerta, puerta-tomografia computarizada (TC), puerta-aguja, TC-aguja e inicio-aguja. Tambien se recogieron el metodo de trasporte al hospital, el tipo de ictus y las terapias de reperfusion. En cuanto a la dotacion estructural de los centros, se recogieron la ratio de enfermeria, la monitorizacion de camas, la disponibilidad de TC multimodal y resonancia magnetica, y la realizacion de cursos de informacion o formacion. Resultados. Se incluyeron 197 pacientes, de los cuales fueron validos 181 (151 infartos y 30 hemorragias cerebrales). Las medianas (p25-p75) en minutos fueron: inicio-puerta, 104 (70-188); puerta-TC, 27 (19-41); TC-aguja, 30 (21-43); puerta-aguja, 64 (49-83); e inicio-aguja, 156 (129-202). Se aplicaron terapias de reperfusion en 68 pacientes (el 45% de los infartos cerebrales), de los cuales el 81% fueron trombolisis intravenosas; el 7%, tratamientos endovasculares; y el 12%, una combinacion de ambos. Los recursos de los centros estuvieron de acuerdo con lo recomendado por las guias clinicas. Hubo un bajo porcentaje de pacientes estudiados con resonancia magnetica. Conclusion. El porcentaje de pacientes tratados con trombolisis fue muy elevado y los tiempos de los circuitos intrahospitalarios, aunque buenos, tienen margen de mejora.

  19. Prevalence and Comparison of Diagnostic Methods for Trichomonas vaginalis Infection in Pregnant Women in Argentina

    PubMed Central

    Menghi, Claudia I.; Coppolillo, Enrique F.; Gatta, Claudia; Eliseth, Martha Cora; de Torres, Ramón A.; Vay, Carlos A.; Famiglietti, Angela M. R.

    2010-01-01

    The objectives of this study were to conduct a prevalence survey of trichomoniasis in pregnant women and to evaluate the utility of different methods for its diagnosis. A total of 597 vaginal exudates from pregnant women who were examined at the Hospital de Clinicas in Buenos Aires, Argentina from 1 August 2005 to 31 January 2007, were prospectively and consecutively evaluated. The investigation of Trichomonas vaginalis was made by different microscopic examinations, and culture on liquid medium. The sensitivity and specificity of the microscopic examinations were assessed considering culture on liquid medium as the "gold standard". The prevalence of T. vaginalis obtained by culture on liquid medium was 4.0% (24/597). The prevalence of T. vaginalis obtained by direct wet smear, prolonged May-Grunwald Giemsa staining, and sodium acetate-formalin (SAF)/methylene blue staining-fixing technique was 1.8%, 2.3% and 2.5%, respectively. The sensitivity of the direct wet smear was 45.8%, that of the prolonged May-Grunwald Giemsa staining was 58.3%, and that of the SAF/methylene blue method was 62.5%. Considering the 3 microscopic examinations altogether, the sensitivity rose to 66.7% and the specificity was 100% for all of them. This is the first time that the prevalence data of T. vaginalis by culture in pregnant women are published in Argentina. Due to the low sensitivity obtained by microscopy in asymptomatic pregnant women, the use of the liquid medium is recommended during pregnancy, in order to provide an early diagnosis and treatment. PMID:20333287

  20. [Lo stile di attaccamento insicuro è un fattore di rischio di ridotta densità minerale ossea in donne in menopausa. Uno studio pilota].

    PubMed

    Niolu, Cinzia; Bianciardi, Emanuela; Di Lorenzo, Giorgio; Nicolai, Sara; Celi, Monica; Ribolsi, Michele; Pietropolli, Adalgisa; Ticconi, Carlo; Tarantino, Umberto; Siracusano, Alberto

    2016-01-01

    RIASSUNTO. Introduzione. La depressione maggiore (MD) e l'osteoporosi sono malattie ad alta prevalenza nel genere femminile, associate a morbosità e mortalità. Sebbene alcuni studi abbiano dimostrato un'associazione tra MD, ridotta densità minerale ossea (BMD) e osteoporosi, non sono stati chiariti i meccanismi causali. Lo stile di attaccamento insicuro è stato messo in relazione con la patogenesi e il decorso di malattie croniche come la MD e le malattie cardiovascolari. Obiettivo di questo studio pilota è esplorare la relazione tra MD e BMD. Si ipotizza che lo stile di attaccamento possa agire da mediatore. Metodi. Il campione è formato da 101 donne in menopausa, 49 con MD e 52 controlli sani. La diagnosi di MD è stata formulata con l'intervista clinica e la Beck Depression Inventory. Lo stile di attaccamento è stato esplorato usando il Relationship Questionnaire, la BMD con la Mineralometria Ossea Computerizzata con tecnica DXA (Dual energy X-ray Absorptiometry). Risultati. L'analisi univariata ha mostrato che le donne con MD avevano valori di BMD inferiori rispetto ai controlli sani. Nelle analisi di regressione multipla la MD non è emersa come predittore significativo di ridotta BMD. Lo stile di attaccamento insicuro "preoccupato" è risultato un predittore significativo di ridotta BMD in tutti i siti scheletrici misurati con la DXA: colonna vertebrale lombare (p=0,008) e segmenti femorali: "femoral neck" (p=0,011), "total hip" (p=0,002). Conclusioni. Questo è il primo studio che esplora il possibile ruolo di MD e stile di attaccamento sulla BMD. Lo stile di attaccamento è risultato un predittore di ridotta BMD, indipendentemente dalla MD. L'attaccamento insicuro potrebbe avere un ruolo nella patogenesi dell'osteoporosi anche indipendente dalla MD. Se questi risultati saranno confermati, gli interventi terapeutici focalizzati sullo stile di attaccamento potrebbero contribuire al miglioramento della comorbilità psichiatrica e medica legata all'osteoporosi.

  1. Metastasis of the gallbladder from the breast cancer.

    PubMed

    Fleres, Francesco; Rossitto, Maurizio; Foti, Agata; Macrì, Antonio; Cucinotta, Eugenio

    2014-12-29

    Le lesioni metastatiche della colecisti costituiscono una condizione clinica non frequente. Nella maggior parte dei casi si tratta di metastasi da melanoma, da tumore renale e da tumori della cervice. Lesioni metastatiche colecistiche da tumore primitivo della mammella sono descritte raramente in letteratura. In questa nota viene presentato il caso di una donna di 83 anni, sottoposta ad intervento chirurgico di colecistectomia videolaparoscopica (VL) per colelitiasi, con riscontro all’esame istologico del pezzo operatorio di una lesione di tipo metastatico Il carcinoma della mammella ed in particolare la varietà istologica duttale infiltrante si associa con elevata frequenza a metastasi loco-regionali e a distanza, quest’ultime a carico di ossa, fegato, polmone e SNC. Lesioni metastatiche a carico del tratto gastrointestinale, del peritoneo, del retroperitoneo e della pelvi possono essere causate soprattutto dal carcinoma lobulare invasivo, variante istologica meno frequente rispetto al tumore duttale rappresentando circa il 10% di tutti i carcinomi mammari. In questa nota è stata condotta una analisi dei dati della Letteratura sulle lesioni secondarie della colecisti da carcinoma della mammella che ha permesso di confermare la rarità di tale patologia descritta solamente in 18 pazienti: 12 di origine lobulare infiltrante, 1 di origine duttale e 2 misto duttale e lobulare infiltrante. La prognosi del carcinoma mammario metastatico è considerato incerto e spesso infausto. Clinicamente è difficile sospettare una localizzazione metastatica da carcinoma mammario primario nella colecisti, ma riteniamo che sia necessario conoscere bene questa possibilità di metastasi e da tenere a mente durante il follow-up di pazienti con cancro al seno. Sebbene la colecistectomia sia considerata come trattamento palliativo nelle pazienti con metastasi alla colecisti da carcinoma mammario, è consigliabile nei casi sintomatici.

  2. [Neurological complications of tick-borne relapsing fever].

    PubMed

    Castilla-Guerra, L; Fernandez-Moreno, M C; Vergara-Lopez, S; Merino-Rumin, M; Colmenero-Camacho, M A

    2016-09-16

    Introduccion. La fiebre recurrente transmitida por garrapatas (FRTG) puede producir complicaciones neurologicas. No existen apenas estudios en España sobre el tema. Objetivo. Estudiar la prevalencia y las caracteristicas clinicas de las complicaciones neurologicas de los pacientes con FRTG. Pacientes y metodos. Estudio retrospectivo de los pacientes atendidos con FRTG durante 12 años (2004-2015) en un hospital de una zona rural del sur de España. Resultados. Se incluyeron 75 pacientes, 42 varones (56%), con una edad media de 33 años (rango: 14-72 años). Se observaron picaduras de garrapatas en nueve pacientes (12%). Los sintomas mas frecuentes fueron: fiebre en 64 pacientes (85,3%), cefalea en 41 (54,6%) y vomitos en 26 (34,6%). Se sospecho afectacion meningea en nueve pacientes (12%), de los que tres (4%) tenian signos meningeos en el momento del ingreso. A todos ellos se les realizo una puncion lumbar. Ninguno presento paralisis facial ni otra manifestacion neurologica. Se encontraron alteraciones del liquido cefalorraquideo en los tres pacientes con meningismo. En uno de los casos se visualizo Borrelia en el liquido cefalorraquideo. En los pacientes con afectacion neurologica, el tratamiento utilizado fue penicilina G en un caso y ceftriaxona en dos. Todos los pacientes se recuperaron completamente. Conclusiones. La FRTG es una de las formas menos graves de borreliosis, y menos del 5% de los pacientes presenta complicaciones neurologicas. Sin embargo, los medicos deben saber que Borrelia puede causar meningitis en los sujetos expuestos a garrapatas en regiones endemicas de FRTG.

  3. [Neurological examination in patients undergoing sedation with propofol: a descriptive study].

    PubMed

    Ordas-Bandera, Carlos M; Sanchez-Marcos, Carolina; Janeiro-Lumbreras, David; Jimenez-Martin, M José; Muniz-Castrillo, Sergio; Cuadrado-Perez, M Luz; Porta-Etessam, Jesús

    2014-06-16

    Introduccion. La exploracion neurologica es un recurso en la evaluacion de los pacientes en coma. La anestesia puede ser un factor influyente en los hallazgos. Evaluamos la exploracion del paciente en coma en pacientes anestesiados con propofol para definir su valor clinico. Pacientes y metodos. Estudio prospectivo en sometidos a cirugia cardiaca en los cuidados intensivos de un hospital terciario durante los meses de abril y mayo de 2011. Se analiza la exploracion del coma anestesico, factores farmacologicos o medicos que pueden influir y exploracion neurologica completa tras la recuperacion. Se excluyeron pacientes con sintomas neurologicos previos. Resultados. Se seleccionan 30 pacientes (16 hombres y 14 mujeres); edad media: 72 ± 10 años. Todos los pacientes estaban sedados con propofol. Durante la sedacion, 17 (46,7%) presentaban pupilas arreactivas. En el 100% no se observaron movimientos espontaneos de los ojos. El 23,3% presentaba alteracion ocular en posicion primaria. Los reflejos oculocefalicos estaban ausentes en el 93,3%, y los oculovestibulares, en el 100%; el reflejo corneal, en el 70% (con asimetria); el espinociliar, en el 83,3%. La respuesta motora algesica estaba ausente en el 93,3%; en un 20%, los reflejos cutaneoplantares extensores; e indiferentes, en el 66,7%. Tras la anestesia, la exploracion neurologica fue normal en el 80%, hubo leves alteraciones de orientacion en un 16,7% y se encontro un sindrome hemisferico en un paciente. Conclusiones. La anestesia con propofol altera los reflejos pupilares, del tronco, respuestas motoras y reflejo cutaneoplantar reversibles al retirar la sedacion. Las alteraciones pueden ser asimetricas. No se deberia utilizar la exploracion neurologica en el paciente sedado con propofol para la toma de decisiones clinicas.

  4. [Accidental finding of a cri du chat syndrome in an adult patient by means of array-CGH].

    PubMed

    Ferreirós-Martínez, Raquel; López-Manzanares, Lydia; Alonso-Cerezo, Concepción

    2014-07-16

    Introduccion. El sindrome cri du chat (SCDC) tiene su origen en una delecion parcial o total del brazo corto del cromosoma 5, y es uno de los sindromes de delecion cromosomica mas frecuentes en humanos. La mayoria de los pacientes se diagnostica entre el primer mes y el primer año de vida, si bien aqui se describe el hallazgo de un SCDC en una mujer con sospecha de ataxia espinocerebelar y antecedentes familiares de trastorno bipolar y ataxia, con especial atencion a las caracteristicas clinicas y las tecnicas diagnosticas que permitieron su identificacion. Caso clinico. Mujer de 46 años que presentaba una inteligencia limite, intervenida a los 43 años de faquectomia bilateral. El inicio de la sintomatologia fue durante la infancia, e incluia hipoacusia, ataxia, disartria, disfagia, depresion, deterioro cognitivo y trastorno bipolar. La exploracion fisica revelo microcefalia, micrognatia, pies equinos y ataxia. Se realizo cariotipo y array-CGH en sangre periferica. La paciente presentaba una traslocacion que involucraba los cromosomas 5 y 15, y una inversion del cromosoma 9: 45,XX,inv9(p11q13);t(5,15)(p15.33;q11.2). El array-CGH mostro una delecion de 2,91 Mb en 5p15.33, formula genomica arr 5p15.33 (151537-3057771)x1, que involucraba 20 genes, incluyendo el gen TERT. Conclusiones. La delecion de multiples genes confirmo el diagnostico de SCDC y es la responsable del fenotipo de la paciente. Se pone de manifiesto la importancia de utilizar tecnicas adecuadas de diagnostico (array-CGH, cariotipo en sangre periferica) y la correcta eleccion de estas.

  5. [A descriptive study of non-symptomatic epilepsy according to age at onset at a Neuropediatric Section of regional reference].

    PubMed

    Ochoa-Gomez, L; Lopez-Pison, J; Fernando-Martinez, R; Fuertes-Rodrigo, C; Samper-Villagrasa, P; Monge-Galindo, L; Pena-Segura, J L

    2016-11-16

    Objetivo. Estudio descriptivo de las epilepsias no sintomaticas (idiopaticas y criptogenicas), segun la edad de inicio, controladas en una unidad de neuropediatria de referencia regional durante tres años. Pacientes y metodos. Revision de historias de niños con epilepsia no sintomatica de la base de datos de neuropediatria controlados del 1 de enero de 2008 al 31 de diciembre de 2010. Resultados. De 4.595 niños atendidos en el periodo, se diagnosticaron de epilepsia 605 (13,17%), de las cuales 156 (25,79%) fueron idiopaticas, y 172 (28,43%), criptogenicas. La edad media de inicio del total fue de 4,78 años; 6,31 años en las idiopaticas y 5,43 años en las criptogenicas. El 26,12% del total de epilepsias se inicio en el primer año. Las epilepsias idiopaticas predominan en el grupo de inicio de 6-10 años, y las criptogenicas, en el de 3-6 años. La epilepsia de ausencias y la epilepsia benigna de la infancia con paroxismos centrotemporales son los sindromes epilepticos idiopaticos mas prevalentes. Conclusiones. Existen muchas diferencias de datos epidemiologicos publicados sobre epilepsia infantil por la dificultad que entraña un diagnostico sindromico en la edad pediatrica, debido a la variabilidad clinica y electroencefalografica. La ausencia de una clasificacion universalmente aceptada de los sindromes epilepticos dificulta comparaciones entre series. Todas las epilepsias son sintomaticas, puesto que tienen causa, sea genetica o adquirida. Una clasificacion util es la etiologica, con dos grupos: un gran grupo con las etiologias establecidas o sindromes geneticos muy probables y otro de casos sin causa establecida. La edad de inicio orienta a determinadas etiologias.

  6. The impact of the International Atomic Energy Agency (IAEA) program on radiation and tissue banking in Brazil.

    PubMed

    Herson, Marisa Roma; Mathor, Monica Beatriz; Morales Pedraza, Jorge

    2009-05-01

    Until 2000, efforts into organising tissue banks in Brazil had not progressed far beyond small "in house" tissue storage repositories, usually annexed to Orthopaedic Surgery Services. Despite the professional entrepreneurship of those working as part time tissue bankers in such operations, best practices in tissue banking were not always followed due to the lack of regulatory standards, specialised training, adequate facilities and dedicated personnel. The Skin Bank of the Plastic Surgery Department of the Hospital das Clinicas of Sao Paulo, the single skin bank in Brazil, was not an exception. Since 1956, restricted and unpredictable amounts of skin allografts were stored under refrigeration for short periods under very limited quality controls. As in most "tissue banks" at that time in Brazil, medical and nursing staff worked on a volunteer and informal basis undergoing no specific training. IAEA supported the implementation of the tissue banking program in Brazil through the regional project RLA/7/009 "Quality system for the production of irradiated sterilised grafts" (1998-2000) and through two interregional projects INT/6/049 "Interregional Centre of Excellence in Tissue Banking", during the period 2002-2004 and INT/6/052 "Improving the Quality of Production and Uses of Radiation Sterilised Tissue Grafts", during the period 2002-2004. In 2001-2002, the first two years of operation of the HC-Tissue Bank, 53 skin transplants were carried out instead of the previous 4-5 a year. During this period, 75 individuals donated skin tissue, generating approximately 90,000 cm(2) of skin graft. The IAEA program were of great benefit to Brazilian tissue banking which has evolved from scattered make shift small operations to a well-established, high quality tissue banking scenario.

  7. [Malformations of cortical development in adult patients with epilepsy: a series of 79 cases].

    PubMed

    González-Cuevas, Montserrat; Toledo, Manuel; Santamarina, Esteban; Sueiras-Gil, María; Cambrodí-Masip, Roser; Sarria, Silvana; Quintana, Manuel; Alvarez-Sabín, José; Salas-Puig, Javier

    2014-02-16

    Introduccion. Las malformaciones del desarrollo cortical (MDC) son una causa importante de epilepsia, retraso del desarrollo psicomotor o deficits neurologicos. Objetivo. Describir la evolucion clinica a largo plazo y las caracteristicas diferenciales de los distintos grupos de MDC en adultos con epilepsia. Pacientes y metodos. Pacientes mayores de 16 años con MDC confirmada por resonancia magnetica y epilepsia. Se analizaron las caracteristicas de la epilepsia, la presencia de deficits neurologicos, la discapacidad intelectual, los antecedentes de patologia perinatal y el electroencefalograma. Los pacientes se clasificaron en tres grupos (G) segun la clasificacion de Barkovich. Resultados. Se identificaron 85 pacientes con MDC de 2.630 pacientes con epilepsia, y se incluyeron 79 pacientes. Edad media: 37 años, el 57% mujeres. Edad media al inicio de las crisis: 17,8 años. El 59,5% era farmacorresistente. La distribucion de los casos segun la clasificacion de Barkovich fue: G1 (alteraciones de la proliferacion neuronal): 59,5%; G2 (alteraciones de la migracion): 25,3%; y G3 (alteraciones de la organizacion cortical): 15,2%. El 19% presentaba un deficit neurologico focal y el 34,2% tenia un cociente intelectual < 80. Al analizar por grupos, el G3 mostraba un mayor porcentaje de deficits neurologicos focales y discapacidad intelectual que el G1 y el G2 (p < 0,05). Conclusion. Los pacientes con MDC del G3 tienen mayor probabilidad de tener deficit neurologico, discapacidad intelectual y mejor control de las crisis que los pacientes del G1 y G2, que se manifiestan, predominantemente, con epilepsia farmacorresistente.

  8. [Visual epileptic seizures. Signs and symptoms, and clinical implications].

    PubMed

    González-Cuevas, Montserrat; Toledo, Manuel; Santamarina, Estevo; Sueiras-Gil, María; Cambrodí-Masip, Roser; Sarria, Silvana; Quintana, Manuel; Salas-Puig, Javier

    2015-03-16

    Introduccion. Los fenomenos visuales pueden ser sintomas de crisis epilepticas, aunque con un significado clinico y una relacion con el foco epileptogeno incierto. Objetivo. Describir las implicaciones clinicas de las crisis epilepticas visuales segun su semiologia en adultos. Pacientes y metodos. Durante un año se recoge consecutivamente a pacientes que describian semiologia visual como manifestacion principal de sus crisis y se clasifican los sintomas visuales segun las caracteristicas de la descripcion. Resultados. Se incluye a 78 pacientes con una edad media de 43,5 años. El 97% de los casos eran epilepsias focales. Entre el 63% de las epilepsias sintomaticas, el 57% eran vasculares. Las crisis visuales eran, en un 81,9%, el aura previa a la crisis, y en un 17,9%, crisis visuales aisladas. La coexistencia de crisis visuales y otro tipo de crisis se asocio a farmacorresistencia (p = 0,021). Los sintomas visuales fueron: alucinaciones simples (55,1%), ilusiones (23,1%), alucinaciones complejas (15,4%) y perdida de vision (6,4%). La localizacion lobar de las lesiones era occipital (24,4%), temporoparietooccipital (21,8%), temporal (9%), parietal (3,8%) y frontal (1,3%). Las lesiones occipitales se asociaron con alucinaciones visuales simples (p < 0,001), y las ilusiones visuales y alucinaciones visuales complejas, con lesiones de la encrucijada temporoparietooccipital (p < 0,05). Del 55,1% de los pacientes con lesion unilateral en la resonancia magnetica, el 33% referia los sintomas en el hemicampo visual contralateral. Conclusiones. Las crisis visuales se presentan, principalmente, como auras epilepticas. Las alucinaciones simples se relacionan con el origen occipital, mientras que las alucinaciones complejas se asocian con regiones cerebrales mas anteriores. La aparicion de fenomenos visuales lateralizados nos orienta a un origen en el hemisferio contralateral.

  9. Interconnecting smartphone, image analysis server, and case report forms in clinical trials for automatic skin lesion tracking in clinical trials

    NASA Astrophysics Data System (ADS)

    Haak, Daniel; Doma, Aliaa; Gombert, Alexander; Deserno, Thomas M.

    2016-03-01

    Today, subject's medical data in controlled clinical trials is captured digitally in electronic case report forms (eCRFs). However, eCRFs only insufficiently support integration of subject's image data, although medical imaging is looming large in studies today. For bed-side image integration, we present a mobile application (App) that utilizes the smartphone-integrated camera. To ensure high image quality with this inexpensive consumer hardware, color reference cards are placed in the camera's field of view next to the lesion. The cards are used for automatic calibration of geometry, color, and contrast. In addition, a personalized code is read from the cards that allows subject identification. For data integration, the App is connected to an communication and image analysis server that also holds the code-study-subject relation. In a second system interconnection, web services are used to connect the smartphone with OpenClinica, an open-source, Food and Drug Administration (FDA)-approved electronic data capture (EDC) system in clinical trials. Once the photographs have been securely stored on the server, they are released automatically from the mobile device. The workflow of the system is demonstrated by an ongoing clinical trial, in which photographic documentation is frequently performed to measure the effect of wound incision management systems. All 205 images, which have been collected in the study so far, have been correctly identified and successfully integrated into the corresponding subject's eCRF. Using this system, manual steps for the study personnel are reduced, and, therefore, errors, latency and costs decreased. Our approach also increases data security and privacy.

  10. [Current state of the attention deficit hyperactivity disorder approach in neuropediatrics].

    PubMed

    Cardo, E; Ros-Cervera, G; Eiris-Punal, J; Escofet-Soteras, C; Fernandez-Jaen, A; Mulas, F; Sanchez-Carpintero, R; Sans, A; Grupo de Trabajo de Tdah de la Sociedad Espanola de Neurologia Pediatrica, Grupo de Trabajo de Tdah de la Sociedad Espanola de Neurologia Pediatrica

    2017-02-24

    Objetivo. Conocer el estado actual del enfoque del trastorno por deficit de atencion/hiperactividad (TDAH) entre los neuropediatras. Sujetos y metodos. Se realizo una encuesta telematica que recogia informacion preliminar sobre el interes, las dificultades en el manejo y el tratamiento del TDAH a los 437 socios de la Sociedad Española de Neurologia Pediatrica. Resultados. Respondio un 32,49% de los cuestionarios enviados, con una importante variabilidad geografica. El 97,89% afirmo que el 50% de sus consultas eran niños con trastornos de aprendizaje y TDAH. Respecto a quien iniciaba el tratamiento para el TDAH en su area, la mayoria contesto que el neuropediatra (57,97%), seguido del psiquiatra infantil (34,78%) y del pediatra de atencion primaria (5,31%). Respecto a las mayores dificultades para la valoracion inicial de los niños con sospecha de TDAH, se citaron la falta de un estudio psicopedagogico por parte de la escuela (49,79%), seguido de la falta de tiempo en la consulta (29,11%). Sobre las dificultades en el seguimiento, la mayor queja se produjo por la falta de coordinacion entre los profesionales, la escuela y los padres. Respecto a la medicacion, la mayoria de los pacientes se encontraba en tratamiento con algun tipo de metilfenidato de liberacion prolongada, un porcentaje estable utilizaba metilfenidato de liberacion inmediata como tratamiento unico o combinado, y se observo en un rango inferior el uso de clonidina y atomoxetina, y un incipiente uso de lisdexanfetamina. La adhesion al tratamiento farmacologico al año fue alrededor del 80%. Conclusiones. Es necesario avanzar en la capacitacion y educacion continua de nuestros especialistas neuropediatricos en el manejo del TDAH, y en homogeneizar la practica clinica y la coordinacion con educacion en el territorio español.

  11. [Patients'adherence-related beliefs about medicines prescribed for long-term conditions in HIV patients].

    PubMed

    Haro Márquez, Carmen; Cantudo Cuenca, Maria Rosa; Almeida González, Carmen Victoria; Morillo Verdugo, Ramón

    2015-01-01

    Objetivo: Determinar a adherencia y las creencias hacia la medicacion para patologias cronicas concomitantemente prescrita al TAR en pacientes infectados por el VIH, asi como determinar si existen diferencias significativas en las creencias entre los pacientes adherentes y no adherentes al los tratamientos concomitantes al TAR. Método: Estudio transversal llevado a cabo durante mayo y julio 2014 en pacientes VIH+ con tratamiento antirretroviral y uno o mas medicamentos para patologias cronicas. Se recogieron variables sociodemograficas: edad, sexo, educacion, situacion laboral, si vivia solo; clinicas: modo de transmision de la infeccion, carga viral plasmatica, T-CD4, estadio; y farmacoterapeuticas: tipo de tratamiento antirretroviral, comedicacion y adherencia a esta mediante el cuestionario Morisky. Se midieron las creencias hacia dicha comedicacion mediante el Beliefs about Medicines Questionnare (BMQ), que incluye dos escalas, necesidad y preocupacion. Los datos se analizaron con SPSSR 20.0. Se aplico la prueba t de Student. La fiabilidad del cuestionario se estimo mediante el alfa de Cronbach. Resultados: Se incluyeron 126 pacientes (80.4% hombres, 49}8.3 anos). El numero de medicamentos concomitantes fue 2.9}2.0. Se clasifico como no adherente al 54.0%. El 63.5% tenia sida, que se identifico como una variable independiente predictora de no adherencia. Las diferencias en la escala de preocupacion entre los pacientes no adherentes y adherentes fue estadisticamente significativa (14.6}5.7 vs. 12.1}6.1; p=0.019), mientras que en aquellas relativas a la necesidad no hubo diferencias (17.3}5.6 vs. 18.8}4.4; p=0.188). La fiabilidad del BMQ-especifico, asi como de las escalas de necesidad y preocupacion, fue buena (0.724, 0.794, 0.785, respectivamente). Conclusiones: Los pacientes VIH positivos con otras patologias cronicas no adherentes presentan creencias negativas relacionadas con la preocupacion en cuanto a la comedicacion.

  12. [Urinary tract infections: review of the case records of the 5-year-old population of Novara].

    PubMed

    Alloni, V; Aitink, O; Cadario, F; Chirio, F; Quaglia, P; Bona, G

    2004-10-01

    A feverish high temperature is the symptom that most frequently leads families to take their children to a Pediatric First Aid unit. In the differential diagnosis of the causes of hyperpyrexia the presence of infections of the genito-urinary tract have to be excluded. Infections of the urinary ways are often the cause of high temperatures in infancy, particularly during the 1st year of life; early identification at the moment of examination at the Paediatric First Aid clinic of patients with infections of the urinary ways makes it possible to prevent the onset of renal complications. We carried out a retrospective study with the purpose of evaluating the incidence of infections of the urinary ways and their complications in paediatric patients who had come to the First Aid unit for hyperpirexia and were later hospitalised after examination of the urine revealed and infection of the urinary ways. The study was carried out by consulting the registers listing arrivals at the First Aid unit and the subsequent discharge diagnosis. We then consulted the clinical records of patients who required admission to our Paediatrics Clinic arter the first aid examination. Re-reading the registers of examination carried out and the clinica records of hospitalised patients there emerged an increase in the observation of this pathology, diagnosed at the moment of the First Aid examination by means of rapid tests and thereafter assessed by haematochemical and radiological tests. In our opinion this increase could be attributed to the greater attention paid to diagnosing the causes of fever of apparently unknown origin.

  13. [Hypertrophic pachymeningitis secondary to IgG4-related disease: case report and review of the literature].

    PubMed

    Rodríguez-Castro, Emilio; Fernández-Lebrero, Aida; López-Dequidt, Iria A; Rodríguez-Osorio, Xiana; López-González, Francisco J; Suárez-Peñaranda, José M; Arias, Manuel

    2015-10-01

    Introduccion. La paquimeningitis hipertrofica es un trastorno infrecuente que produce un engrosamiento focal o difuso de la duramadre. Puede ser idiopatica o secundaria a procesos infecciosos, autoinmunes o neoplasicos. La recientemente descrita 'enfermedad relacionada con IgG4' podria ser la causa de bastantes cuadros considerados criptogenicos. Caso clinico. Mujer de 54 años, con historia de asma bronquial, que consulto por cefalea, vertigo y perdida de audicion por su oido izquierdo. En la resonancia magnetica cerebral con gadolinio se objetivo engrosamiento y realce dural, que se extendia desde la pared lateral del seno cavernoso izquierdo y la parte medial del lobulo temporal al angulo pontocerebeloso y parte del tentorio homolaterales. El liquido cefalorraquideo presentaba 10 leucocitos/µL (90% mononucleares), con 1 g/L de proteinas y sin consumo de glucosa. El estudio anatomopatologico mostro fibrosis y un infiltrado linfoplasmocitario, con 16 celulas plasmaticas IgG4+ por campo de gran aumento. El resto de estudios analiticos y microbiologicos resultaron normales o negativos. La tasa plasmatica de IgG4 estaba dentro de los limites normales. Tratada con esteroides, se produjo mejoria clinica acompañada de la practica desaparicion de las alteraciones detectadas en la neuroimagen. Conclusiones. La paquimeningitis hipertrofica como manifestacion de la enfermedad relacionada con IgG4 puede diagnosticarse basandose en los hallazgos de la resonancia magnetica si la IgG4 plasmatica esta elevada. En casos dudosos, habra que recurrir a la biopsia meningea. La corticoterapia suele ser eficaz y representa la primera linea terapeutica.

  14. HPV Prevalence in Multiple Anatomical Sites among Men Who Have Sex with Men in Peru

    PubMed Central

    Blas, Magaly M.; Brown, Brandon; Menacho, Luis; Alva, Isaac E.; Silva-Santisteban, Alfonso; Carcamo, Cesar

    2015-01-01

    Background Human Papilloma Virus (HPV) infection is the most common sexually transmitted viral infection worldwide. HPV is highly prevalent in sexually active men who have sex with men (MSM) and has been associated with anal cancer, penile cancer, and oropharyngeal cancer. Methods From March to September 2011, we conducted a cross-sectional study of HPV prevalence among MSM above age 18 years. Participants were recruited using respondent driven sampling at Clinica Cayetano Heredia. All participants provided anal, genital, and oral samples for HPV DNA testing, and blood for HIV and HPV antibody testing. Results A total of 200 MSM were recruited in the study. The mean age was 34 years (range 18–59 years, SD = 9.4) and101 participants were HIV negative (99 HIV positive). HPV 6/11/16/18 or quadrivalent HPV vaccine (HPV4) genotype seroprevalence among HIV negative and positive MSM was 64.3% (55%-75.9%) and 93.8% (87.6%-99.2%) respectively (p<0.001). HIV positivity was associated with a higher prevalence of HPV4 and HPV 16/18 DNA at external genital sites and the anal canal. HPV4 DNA prevalence at external genital sites among HIV negative and positive MSM was 14.9% and 28.7% (p = 0.02) respectively, at anal canal was 50.9% and 79.0% (p = 0.001), and at the oral cavity was 9.9% and 8.5% (p = 0.6). Conclusions HPV4 seroprevalence was high in our study among both HIV positives and negatives, with HPV DNA prevalence much lower, and the anal canal being the anatomical site with the highest HPV DNA prevalence. HPV prevention interventions are needed among MSM at high-risk for HIV infection. PMID:26437318

  15. [Initial validation of a scale to measure the burden for parents/caregivers of children with asthma and factors associated with this burden in a population of asthmatic children].

    PubMed

    Pedraza, Angela M; Rodríguez-Martínez, Carlos E; Acuña, Ranniery

    2013-01-01

    Despite the high probability of a heavy burden for parents and/or caregivers of children with asthma, instruments intended to measure it have not been validated in the context of asthma. Moreover, factors associated with this burden are unknown. To begin the validation of a scale to measure the burden for parents/caregivers of asthmatic children, and to determine the factors associated with this burden. We performed an analytical cross-sectional and validation of scale study. At the outpatient section of the Clinic of Pediatric Pulmonology in the Hospital Universitario Clinica San Rafael, we measured the burden of parents and/or caregivers of children with asthma using a shortened version of the Zarit scale throughout 2011. We performed a principal components factor analysis and adjusted logistic regression models to identify independent factors associated with a heavy burden. The median (interquartile range) age of the 162 children included in the study was 6 (4-9) years. Out of the total of parents and/or caregivers, 37 (22.8%) were experiencing a heavy burden. Factor analysis of the Zarit scale showed a probable structure of two factors, which together accounted for 61.5% of the variance of the results. Uncontrolled asthma was the only predictor independently associated with a heavy burden in the multivariate analysis (OR 5.38; 95% CI 1.43-20.16, p = 0.012). The Zarit scale used has an adequate factorial structure, an acceptable internal consistency, and an adequate construct validity for measuring the burden for parents and/or caregivers of children with asthma. The level of a child's asthma control is the most important independent predictor of this burden.

  16. Brazil: a clinic for street kids.

    PubMed

    Adams, I K

    1993-01-01

    Physicians at the Federal University of Minas Gerais, Brazil, in 1989 teamed up with the Archdiocese Street Youth Ministry to finance Clinica Ammor, the Street Kids' Clinic of Belo Horizonte. Belo Horizonte is the third largest city in Brazil, with a population of 3.5 million. Although the clinic was established to study risk behavior for HIV, a far greater need was found for medical care and education of which HIV is only a small part. A doctor and a nurse offer drop-in care to children and adolescents who live on the street. More than 600 children came for an average of four visits during the first three years ranging in age from the newborn to over 20 years. 80% of clients, however, have been aged 12-18; 75% are male. The staff encourages complete check-ups, including HIV testing, as part of an ongoing program to develop body and health awareness. Medication and laboratory examinations are provided to the extent that available resources permit. When appropriate, clients are referred to various specialized medical facilities in the city. Sex and drug education focus upon the prevention of HIV infection and other sexually transmitted diseases. Special attention is given to street girls and their babies. The clinic since March 1991 has participated in the Integrated Plan for Attention to Street Youth in Belo Horizonte, a group of 17 governmental and nongovernmental organizations which work with street youth in the city. The clinic would like to add a social worker, a part-time pediatrician, and a part-time gynecologist-obstetrician. Funding is needed to continue and expand services. The author stresses that successful AIDS prevention must be linked to projects concerned with the reality and reasons for the marginalization of street children and promote changes at that level. Intimate staff-client interaction at the clinic conveys to the youths a message of commitment, respect, and self value.

  17. [Prognostic factors of functional recovery from a stroke at one year].

    PubMed

    Moreno-Palacios, J A; Moreno-Martinez, I; Bartolome-Nogues, A; Lopez-Blanco, E; Juarez-Fernandez, R; Garcia-Delgado, I

    2017-01-16

    Introduccion. La recuperacion de la marcha y de la independencia es fundamental para cualquier paciente que sufre un ictus, y existen numerosos factores que pueden influir en ella. Objetivo. Conocer que variables son mas importantes para conseguir una buena recuperacion funcional al año del ictus. Pacientes y metodos. Estudio prospectivo, longitudinal, observacional, realizado en 231 pacientes diagnosticados de ictus en el año 2013. Se analizaron datos sociodemograficos, caracteristicas clinicas, situacion neurologica en el momento del ingreso –National Institute of Health Stroke Scale (NIHSS)–, situacion funcional (escala de Rankin e indice de Barthel) y capacidad de marcha, tanto en el momento del ingreso como en el momento del alta de rehabilitacion y al año. Resultados. La edad media fue de 74,26 ± 13,1 años, y un 55,4% eran hombres. La estancia media hospitalaria fue de 16,24 dias. El 68,9% realizo rehabilitacion, 95,5 sesiones como media. El 51,7% recupero al año una buena capacidad funcional (Rankin < 2 y Barthel > 85), y el 63,5%, la marcha independiente. Los factores que influyeron de forma mas significativa en la recuperacion funcional y de la marcha al año fueron: la menor edad, la NIHSS < 10 en la primera semana, el tipo de ictus (de pequeño vaso), la ausencia de fibrilacion auricular y la mejor situacion funcional previa. Conclusion. La mayoria de los pacientes al año de haber sufrido un ictus recupera la capacidad de marcha independiente y, en menor medida, la independencia en las actividades de la vida diaria.

  18. [Cost-effectiveness of buccal midazolam in the treatment of prolonged convulsive seizures in the outpatient setting in Spain].

    PubMed

    Raspall-Chaure, Miquel; Martinez-Bermejo, Antonio; Sanchez-Carpintero, Rocío; Ruiz-Falco Rojas, M Luz; Verdu-Perez, Alfonso; Smeyers-Dura, Patricia; Camino-Leon, Rafael; Sanmarti, Francesc X; Santos-Borbujo, José; Pico, Gustavo; Blanco-Barca, Oscar; Cebollero, M Antonia

    2014-06-01

    Introduccion. El tratamiento de las crisis epilepticas prolongadas requiere disponer de una medicacion de rescate comoda, segura y efectiva. Actualmente, el tratamiento estandar en la comunidad es el diacepam rectal. La introduccion de una solucion bucal de midazolam abre una perspectiva nueva en el tratamiento. Objetivo. Evaluar el coste-efectividad del midazolam bucal respecto al diacepam rectal para los niños con un diagnostico de epilepsia que presentan crisis convulsivas prolongadas en la comunidad en España. Materiales y metodos. Modelo coste-efectividad desde la perspectiva del Sistema Nacional de Salud (SNS) español, con resultados presentados en terminos de costes y años de vida ajustados por calidad. Los datos se obtuvieron de varias fuentes, incluidas las estimaciones de efectividad clinica de un ensayo clinico, de un panel Delphi en España y de una encuesta nacional a padres de niños con epilepsia para determinar las practicas actuales. Resultados. El tratamiento con midazolam bucal produce un ahorro de costes en comparacion con el diacepam rectal. El ahorro para el SNS español es de 5.484 euros por paciente al año. El tratamiento con midazolam bucal ofrece una mejora en la calidad de vida relacionada con la salud. Esto, unido al ahorro de costes, hace que el midazolam bucal sea dominante frente al diacepam rectal en todos los escenarios examinados. Conclusion. Los resultados del modelo muestran que el midazolam bucal es mas coste-efectivo que el diacepam rectal debido a una reduccion en la necesidad de llamadas a la ambulancia y estancias en el hospital, asi como a una mejora en la calidad de vida relacionada con la salud.

  19. [Design and validation of a classification system for assessing the degree of disability of patients with amyotrophic lateral sclerosis].

    PubMed

    Diaz-Gomez, M F; Ortiz-Corredor, F

    2017-02-01

    Introduccion. Actualmente no existe un sistema de clasificacion validado y de uso comun para estadificar la gravedad de la esclerosis lateral amiotrofica. Pacientes y metodos. Basados en la escala de valoracion funcional para la esclerosis lateral amiotrofica revisada, se establecieron cuatro dominios (bulbar, destrezas manuales, funcion motora gruesa y funcion respiratoria). A cada item se le asigno una puntuacion de 0 si su calificacion era igual o mayor de 3 (independencia), o 1 si su calificacion era menor de 3 (dependencia). La escala de clasificacion funcional se definio desde el estadio 1 (sin perdida de independencia en ningun dominio) hasta el estadio 5 (perdida de independencia en los cuatro dominios). Esta clasificacion se correlaciono con la necesidad de ayudas externas, la calidad de vida aplicando la escala del cuestionario de evaluacion de la esclerosis lateral amiotrofica-40, la fuerza muscular y la sobrevida. Resultados. De un total de 244 pacientes, el 14,3% se encontraba en estadio 1; el 23,8%, en estadio 2; el 21,3%, en estadio 3; el 19,3%, en estadio 4; y el 21,3%, en estadio 5. Fuerza muscular y calidad de vida fueron inversamente proporcionales a la etapa de la enfermedad. La necesidad de ayudas externas se relaciona directamente con el aumento de los estadios de la enfermedad de 1 a 5 (p < 0,012). Se encontro una mayor sobrevida de los pacientes en los estadios 1 y 2 con respecto a los estadios 3, 4 y 5 (p = 0,004). Conclusion. El sistema de clasificacion propuesto es de facil aplicacion y se correlaciona bien con la clinica del paciente, su calidad de vida, el requerimiento de recursos y la sobrevida.

  20. [Association between the frequency and duration, but not the intensity, of headache with mechanical hypersensitivity and the health of patients with tension-type headache].

    PubMed

    Palacios-Cena, M; Fernandez-Munoz, J J; Cigaran-Mendez, M; Moron-Verdasco, A; Fernandez-de-Las-Penas, C

    2015-03-16

    Introduccion. La asociacion entre las variables clinicas de la cefalea y otras variables neurofisiologicas o de salud es controvertida. Objetivo. Determinar la asociacion de la frecuencia, duracion e intensidad del dolor con la sensibilidad mecanica craneocervical, considerando el efecto de otras variables de salud y fisicas. Pacientes y metodos. Se incluyeron 72 pacientes con cefalea de tension. Se mantuvo un diario mensual para determinar la frecuencia, duracion e intensidad del dolor. Se calcularon los umbrales de dolor a la presion (UDP) y la sensibilidad a la palpacion sobre la region craneocervical, calidad de vida (Short Form-36), discapacidad, depresion y movilidad cervical. Se introdujeron todas las variables en modelos de regresion logistica jerarquica para determinar las interacciones. Resultados. Se encontraron correlaciones entre la frecuencia y duracion de la cefalea, pero no la intensidad, con el resto de variables. El analisis de regresion mostro que la combinacion del UDP sobre el temporal, dolor corporal, edad y rol fisico explicaba el 22,3% de la varianza de la frecuencia, mientras que la combinacion de salud general, UDP sobre el trapecio superior y frecuencia del dolor explicaba el 20% de la varianza de la duracion (p < 0,001). Conclusiones. Este estudio ha encontrado que la frecuencia y la duracion de la cefalea, pero no la intensidad, se encuentran asociadas con variables neurofisiologicas, como el UDP sobre el cuello/cabeza o la percepcion de dolor generalizado en la cefalea tensional. Otras variables, como la edad, el rol fisico y la salud general tambien mostraron una asociacion con la frecuencia y la duracion de la cefalea.

  1. [The use of the ketogenic diet as treatment for refractory epilepsy in the paediatric age].

    PubMed

    Pablos-Sánchez, Tamara; Oliveros-Leal, Liliana; Núñez-Enamorado, Noemí; Camacho-Salas, Ana; Moreno-Villares, José Manuel; Simón-De las Heras, Rogelio

    2014-01-16

    Introduccion. El 23-25% de los niños epilepticos son refractarios a farmacos antiepilepticos. El interes por la dieta cetogenica como tratamiento en estos pacientes no candidatos a otras opciones terapeuticas ha resurgido ultimamente. Objetivo. Valorar la eficacia y seguridad del tratamiento con dieta cetogenica en un importante numero de pacientes pediatricos con epilepsia refractaria en nuestro centro y determinar si los resultados obtenidos corroboran otros de publicacion reciente. Pacientes y metodos. Se revisaron retrospectivamente las historias clinicas de 41 niños con epilepsia refractaria que fueron tratados con dieta cetogenica entre 1998 y 2011, la mayoria con dieta tipo Radcliffe II. La mediana de edad al inicio de la dieta fue de 3,92 años. Resultados. A los seis meses del inicio de la dieta se redujeron las crisis en al menos un 50% en un 36,84% de la muestra (el 10,53% de los niños alcanzo mas de un 90% de reduccion y un 5,26% quedo sin crisis). Aproximadamente un 50% por grupo de edad en los mas pequeños respondio de manera positiva. Un 58,54% de los pacientes presento algun efecto secundario, tolerable y transitorio, principalmente elevacion de los niveles de colesterol y estreñimiento, sin observarse variacion en los parametros antropometricos. Conclusiones. La dieta cetogenica supone una buena alternativa terapeutica en los casos de epilepsia refractaria en la edad pediatrica, con mayor probabilidad de beneficio cuanto menor sea la edad del niño al inicio de la dieta. En general, es bien tolerada. Son de gran importancia en estos pacientes las revisiones periodicas con control nutricional.

  2. Hypovitaminosis D and secondary hyperparathyroidism in resident physicians of a general hospital in southern Brazil.

    PubMed

    Premaor, M O; Paludo, P; Manica, D; Paludo, A P; Rossatto, E R; Scalco, R; Furlanetto, T W

    2008-11-01

    To evaluate the prevalence of hypovitaminosis D and secondary hyperparathyroidism in resident physicians of a general hospital in southern Brazil and identify associated factors. Cross-sectional study. Resident physicians of Hospital de Clinicas de Porto Alegre, Porto Alegre, southern Brazil. Seventythree subjects age 26.4+/-1.9. Serum PTH, 25- hydroxyvitamin D [25(OH)D], total calcium, phosphorus, magnesium, creatinine, and alkaline phosphatase were measured. In addition calcium, creatinine, and magnesium were measured in urine. Fractional excretion of calcium and magnesium were calculated. Calcium intake was estimated by a food intake questionnaire. Mean serum levels of 25(OH)D were 17.9+/-8.0 ng/ml and 57.4% presented 25(OH)D below 20 ng/ml. Secondary hyperparathyroidism, defined as serum PTH > or =48 pg/ml and normal or low serum calcium, was identified in 39.7% of the individuals. Mean serum levels of magnesium were higher (p=0.02) and the fractional excretion of calcium was lower (p<0.001) in individuals with secondary hyperparathyroidism. Serum PTH levels were positively correlated with body mass index (r=0.33 and p=0.006) and serum magnesium levels (r=0.33 and p=0.02) and negatively correlated with serum 25(OH)D levels (r=-0.33 and p=0.008), estimated calcium intake (r=-0.25 and p=0.04), and fractional excretion of calcium (r=-0.34 and p=0.009). Vitamin D deficiency and secondary hyperparathyroidism was very common in resident physicians. Therefore, measures to prevent this situation should be recommended.

  3. Safety and tolerability of intrathecal delivery of autologous bone marrow nucleated cells in children with cerebral palsy: an open-label phase I trial.

    PubMed

    Mancías-Guerra, Consuelo; Marroquín-Escamilla, Alma Rosa; González-Llano, Oscar; Villarreal-Martínez, Laura; Jaime-Pérez, José Carlos; García-Rodríguez, Fernando; Valdés-Burnes, Sagrario Lisete; Rodríguez-Romo, Laura Nely; Barrera-Morales, Dinorah Catalina; Sánchez-Hernández, José Javier; Cantú-Rodríguez, Olga Graciela; Gutiérrez-Aguirre, César Homero; Gómez-De León, Andrés; Elizondo-Riojas, Guillermo; Salazar-Riojas, Rosario; Gómez-Almaguer, David

    2014-06-01

    Cerebral palsy (CP) is related to severe perinatal hypoxia with permanent brain damage in nearly 50% of surviving preterm infants. Cell therapy is a potential therapeutic option for CP by several mechanisms, including immunomodulation through cytokine and growth factor secretion. In this phase I open-label clinical trial, 18 pediatric patients with CP were included to assess the safety of autologous bone marrow-derived total nucleated cell (TNC) intrathecal and intravenous injection after stimulation with granulocyte colony-stimulating factor. Motor, cognitive, communication, personal-social and adaptive areas were evaluated at baseline and 1 and 6 months after the procedure through the use of the Battelle Developmental Inventory. Magnetic resonance imaging was performed at baseline and 6 months after therapy. This study was registered in ClinicaTrials.gov (NCT01019733). A median of 13.12 × 10(8) TNCs (range, 4.83-53.87) including 10.02 × 10(6) CD34+ cells (range, 1.02-29.9) in a volume of 7 mL (range, 4-10.5) was infused intrathecally. The remaining cells from the bone marrow aspirate were administered intravenously; 6.01 × 10(8) TNCs (range, 1.36-17.85), with 3.39 × 10(6) cells being CD34+. Early adverse effects included headache, vomiting, fever and stiff neck occurred in three patients. No serious complications were documented. An overall 4.7-month increase in developmental age according to the Battelle Developmental Inventory, including all areas of evaluation, was observed (±SD 2.63). No MRI changes at 6 months of follow-up were found. Subarachnoid placement of autologous bone marrow-derived TNC in children with CP is a safe procedure. The results suggest a possible increase in neurological function. Copyright © 2014 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

  4. HYPERTRIGLYCERIDEMIC WAIST PHENOTYPE AND CARDIOMETABOLIC ALTERATIONS IN BRAZILIAN ADULTS.

    PubMed

    Cabral Rocha, Anna Ligia; Feliciano Pereira, Patricia; Cristine Pessoa, Milene; Gonçalves Alfenas, Rita de Cassia; Segheto, Wellington; da Silva, Danielle Cristina Guimarães; Pacheco Andrade, Marcio; Zarbato Longo, Giana

    2015-09-01

    Objetivos: evaluar la prevalencia de alteraciones cardiometabolicas segun el fenotipo cintura hipertrigliceridemica (CH) en adultos brasilenos. Métodos: estudio transversal, de base poblacional, con 976 (n = 533 mujeres) individuos de 20 a 59 anos. El CH fue definido por un aumento en las concentraciones de trigliceridos y en la circunferencia de la cintura (CC). Todos los analisis fueron ajustados por el efecto del diseno del estudio y ponderados por genero, edad y escolaridad. Fue realizado un análisis descriptivo de promedio y presentados sus respectivos intervalos de confianza (IC 95%). La prevalencia de las alteraciones cardiometabolicas segun la presencia o no del fenotipo CH y segun el sexo fue calculada y comparada a traves del test chi-cuadrado de Pearson. El nivel de significancia estadistica adoptado fue de 0,05. Se estimo la probabilidad de riesgo de evento coronario en 10 anos, a partir del score de Framinghan a traves del grafico de densidad de Kernel. Resultados: la prevalencia del fenotipo CH en la muestra fue de 17,32% (IC 95% 13,54-21,89), no se observo diferencia entre sexos. Se observaron mayores promedios para todos los factores de riesgo cardiometabolico analizados en aquellos con CH. Solo Se verificaron menores valores medianos para el HDL en este grupo. Los individuos con CH presentaban mayor probabilidad de evolucionar hacia un evento cardiovascular en 10 anos que aquellos sin el fenotipo. Conclusión: el fenotipo CH constituye un importante marcador precoz del riesgo cardiovascular. Su utilizacion en la practica clinica debe ser incentivada, ya que se trata de una herramienta sencilla y de bajo coste.

  5. Obstructive sleep apnoea syndrome and HLA in the North of Portugal.

    PubMed

    Silva, Luís; Lopes, João; Ramalheira, João; Cunha, Daniela; Carvalho, Cláudia; Bettencourt, Andreia; Bras, Sandra; Costa, Sandra; Silva, M Berta; Martins-da-Silva, António

    2015-10-01

    Introduccion. El sindrome de apnea obstructiva del sueño (SAOS) es una enfermedad frecuente, compleja y poligenica, con diversas etiologias que interaccionan originando un fenotipo unico. El SAOS puede ocurrir a cualquier edad del individuo y se presume la existencia de agregacion familiar. Han sido descritos diversos factores de predisposicion, como la edad, el sexo y la obesidad. La relacion entre los polimorfismos del antigeno leucocitario humano (HLA) y trastornos del sueño esta confirmada, tanto en poblaciones europeas como no europeas. No obstante, las relaciones descritas entre los alelos HLA y SAOS no han sido coherentes y carecen de valor informativo para la clasificacion del trastorno del sueño. Objetivo. Explorar la asociacion genetica del HLA con el SAOS en una poblacion del norte de Portugal y evaluar el papel de la obesidad en el contexto del HLA en el SAOS. Pacientes y metodos. Se estudio una cohorte de 131 pacientes con SAOS. Los pacientes fueron atendidos en una clinica del sueño ambulatoria donde se valoraron los antecedentes clinicos, se les practico una polisomnografia nocturna, una prueba de latencia multiple del sueño (si lo exigio el diagnostico diferencial), analiticas y estudios demograficos. A efectos comparativos, se utilizo una poblacion de control de 223 personas sanas. Se efectuo el genotipado del HLA-DRB1 con la reaccion en cadena de la polimerasa mediante cebadores de secuencia especifica. Resultados. En esta cohorte, el alelo HLA-DRB1*03 fue identificado como un factor de predisposicion para el SAOS (24% del SAOS frente a 15% de la poblacion de control; p = 0,025; odds ratio = 1,861; intervalo de confianza al 95% = 1,081-3,205). No hubo diferencias significativas en lo referente a otros alelos HLA-DBR1*. Conclusion. El HLA-DRB1*03 es un factor de predisposicion para el SAOS en la poblacion portuguesa.

  6. [Instrumental gait analysis in stroke patients].

    PubMed

    Fernandez-Gonzalez, P; Molina-Rueda, F; Cuesta-Gomez, A; Carratala-Tejada, M; Miangolarra-Page, J C

    2016-11-16

    Introduccion. Las alteraciones en el control motor consecuentes al ictus afectan al patron de marcha, existiendo una importante variabilidad intersujeto. Objetivos. Valorar, a traves de un sistema de captura del movimiento, el patron cinematico de la marcha en sujetos con ictus y establecer que alteraciones del patron de la marcha son comunes entre los participantes. Sujetos y metodos. Participaron nueve pacientes con ictus con capacidad de marcha y diez sujetos controles. Para la captura del movimiento se empleo el sistema VICON Motion System ®. Se analizaron los movimientos articulares de pelvis, cadera, rodilla y tobillo en el plano sagital, y los parametros espaciotemporales de la marcha. Resultados. La funcion motora de los participantes, valorada mediante la escala Fugl-Meyer (seccion del miebro inferior), oscilo entre 15 y 33 puntos. Los participantes presentaron alteraciones en la cinematica comunes entre ellos. En los pacientes con ictus se registro: aumento de la amplitud de movimiento de la pelvis en ambos hemicuerpos (lado afecto y no afecto frente a control, p < 0,01); en la cadera, disminucion de la maxima extension durante la fase de apoyo en el lado afecto (p < 0,01) e incremento de la flexion en las fases de apoyo y oscilacion en el no afecto (p = 0,025); en la rodilla, mayor flexion durante la fase de contacto inicial (lado afecto frente a control, p < 0,01; lado no afecto frente a control, p = 0,02); y en el tobillo, ligera flexion plantar durante la fase de contacto inicial en el lado afecto. Conclusiones. A pesar de la variabilidad clinica, existen alteraciones especificas comunes de la marcha en sujetos con ictus.

  7. Timing, setting and incidence of cardiovascular complications in patients with acute myocardial infarction submitted to primary percutaneous coronary intervention

    PubMed Central

    Giglioli, Cristina; Margheri, Massimo; Valente, Serafina; Comeglio, Marco; Lazzeri, Chiara; Chechi, Tania; Armentano, Corinna; Romano, Salvatore Mario; Falai, Massimiliano; Gensini, Gian Franco

    2006-01-01

    BACKGROUND At the Istituto di Clinica Medica Generale e Cardiologia (Florence, Italy), the widespread use of percutaneous coronary intervention (PCI) has markedly changed the hospital course of patients with acute myocardial infarction (AMI). These patients are typically transferred to the coronary care unit (CCU) only after primary PCI, whereas during the thrombolytic era, patients were first admitted to CCU before reperfusion. OBJECTIVES AND METHODS The incidence, timing and setting of complications from symptom onset to hospital discharge in 689 consecutive AMI patients undergoing PCI were evaluated. RESULTS Ventricular fibrillation occurred in 11% of patients, and most episodes (94.7%) occurred before or during PCI. Of all patients, 6.3% developed complete atrioventricular block (CAVB), and in 86.3% of these cases, the CAVB occurred before or during PCI; in 94.5%, a CAVB resolution occurred in the catheterization laboratory (CL). Thirty-one patients (4.5%) had impending shock on admission to the CL. Cardiogenic shock developed in 29 patients (4.2%), mostly in the prehospital phase or in the CL. Only four patients (less than 1%) developed cardiogenic shock later during their hospital course. Similarly, circulatory and ventilatory support, as well as temporary pacing and cardiac defibrillation, were used mostly in the prehospital phase or in the CL. During the CCU stay, 45 patients (6.5%) had hemorrhagic or vascular complications, and the incidence of post-PCI ischemia and early reocclusion of the culprit vessel were low (2.1% and 0.6%, respectively). Thus, cardiac complications usually associated with AMI were observed mainly before hospital admission or in the CL during the reopening of the target vessel. These complications were rarely observed after a successful PCI. CONCLUSIONS For AMI patients, the CL is not only the site of PCI, it is also where most life-threatening cardiac complications are observed and treated. PMID:17036099

  8. Electronic data capture and DICOM data management in multi-center clinical trials

    NASA Astrophysics Data System (ADS)

    Haak, Daniel; Page, Charles-E.; Deserno, Thomas M.

    2016-03-01

    Providing eligibility, efficacy and security evaluation by quantitative and qualitative disease findings, medical imaging has become increasingly important in clinical trials. Here, subject's data is today captured in electronic case reports forms (eCRFs), which are offered by electronic data capture (EDC) systems. However, integration of subject's medical image data into eCRFs is insufficiently supported. Neither integration of subject's digital imaging and communications in medicine (DICOM) data, nor communication with picture archiving and communication systems (PACS), is possible. This aggravates the workflow of the study personnel, in special regarding studies with distributed data capture in multiple sites. Hence, in this work, a system architecture is presented, which connects an EDC system, a PACS and a DICOM viewer via the web access to DICOM objects (WADO) protocol. The architecture is implemented using the open source tools OpenClinica, DCM4CHEE and Weasis. The eCRF forms the primary endpoint for the study personnel, where subject's image data is stored and retrieved. Background communication with the PACS is completely hidden for the users. Data privacy and consistency is ensured by automatic de-identification and re-labelling of DICOM data with context information (e.g. study and subject identifiers), respectively. The system is exemplarily demonstrated in a clinical trial, where computer tomography (CT) data is de-centrally captured from the subjects and centrally read by a chief radiologists to decide on inclusion of the subjects in the trial. Errors, latency and costs in the EDC workflow are reduced, while, a research database is implicitly built up in the background.

  9. Congenital transmission of Trypanosoma cruzi in Argentina, Honduras, and Mexico: study protocol

    PubMed Central

    2013-01-01

    Background Trypanosoma cruzi has been divided into Discrete Typing Units I and non-I (II-VI). T. cruzi I is predominant in Mexico and Central America, while non-I is predominant in most of South America, including Argentina. Little is known about congenital transmission of T. cruzi I. The specific aim of this study is to determine the rate of congenital transmission of T. cruzi I compared to non-I. Methods/design We are conducting a prospective study to enroll at delivery, 10,000 women in Argentina, 7,500 women in Honduras, and 13,000 women in Mexico. We are measuring transmitted maternal T. cruzi antibodies by performing two rapid tests in cord blood (Stat-Pak, Chembio, Medford, New York, and Trypanosoma Detect, InBios, Seattle, Washington). If at least one of the results is positive, we are identifying infants who are congenitally infected by performing parasitological examinations on cord blood and at 4–8 weeks, and serological follow-up at 10 months. Serological confirmation by ELISA (Wiener, Rosario, Argentina) is performed in cord and maternal blood, and at 10 months. We also are performing T. cruzi standard PCR, real-time quantitative PCR and genotyping on maternal venous blood and on cord blood, and serological examinations on siblings. Data are managed by a Data Center in Montevideo, Uruguay. Data are entered online at the sites in an OpenClinica data management system, and digital pictures of data forms are sent to the Data Center for quality control. Weekly reports allow for rapid feedback to the sites. Trial registration Observational study with ClinicalTrials.gov Identifier NCT01787968 PMID:24119247

  10. [Community acquired urinary tract infections in older adults].

    PubMed

    Leoni, Alberto Francisco; Monterisi, Aida; Acuña, Paula G

    2017-01-01

    Background Community acquired urinary tract infections (caUTI) in adults are common ailments. Older adults are prone to infectious diseases, diagnosis can be difficult, their etiologic and antimicrobial resistance are poorly known. Objectives To evaluate the incidence discriminated by sex, symptoms, and to determine pathogens and their antimicrobial resistance rate. Methods A retrospective, descriptive and comparative study. We analyze uricultures among 2013 in the Hospital Nacional de Clinicas (Córdoba-Argentina). Patients over 65 years old, admitted with a caUTI diagnose were included; we exclude those with urinary catheter. Variables used: Sex, symptoms, pathogen isolation, antimicrobial resistance. For symptom variable was performed a comparative test. Descriptive statistics were used to analyze remaining variables. Results Were analyzed 349 patients: 1) Positive uricultures 191 (case), negative 158 (control). 2) Average age 77 (76% women, 24% men). 3) Symptoms: fever (45%), sepsis criteria (17%), altered mental status (14%), heart failure (11%). 4) Uriculture: monomicrobial 95.29%. 5) Isolation and resistance rate: Escherichia coli (67,7%): ampicillin/sulbactam 52.7%, ciprofloxacin 51.9%, trimethoprim/sulfamethoxazole 45.7%, cefotaxime: 12,9 %, amikacin: 3,9 %, Klebsiella pneumoniae (11,97%): ciprofloxacin 60.8%, trimethoprim/ sulfamethoxazole 50%, cefotaxime 47.8%, amikacin 4.7%. Enterococcus spp. (9,89%): ampicillin 0%, vancomycin 0%. Also isolated: Cándida spp. (3.66%), Proteus mirabilis (2,6%), Staphylococcus aureus (2,6%), Enterobacter cloacae (1,56%), Pseudomonas aeruginosa (1,56%). There were no imipenem resistances among gram negatives. Conclusions Isolations were mostly monomicrobial and at female gender. E. coli was the main uropathogen. The elevated resistance rate to ciprofloxacin, ampicillin/sulbactam and trimethoprim/sulfamethoxazole is remarkable. We suggest to avoid their empiric use in this population.

  11. Emerico Luna, an anatomist and a fervid intellectual.

    PubMed

    Gerbino, Aldo

    2004-01-01

    On 11 March 2004, the Section of Human Anatomy of Palermo was dedicated and registered to the anatomist Emerico Luna (Palermo 1882-1963) with a ceremony (moderated by Giovanni Zummo) with the participation of institutional personalities and Italian anatomists. Luna, who was an acute morphologist and a scholar of Riccardo Versari (1865-1943), was the continuator of Francesco Todaro's Anatomical School and occupied the Chair at the University of Palermo that had belonged to Levi since 1919. His wide histo-anatomical culture culminates in the collaboration to the "Trattato di Neurologia", the richly composed treatise by Bertelli (1931). Then his studies and his teaching reached to the Anatomia Clinica Regionale (1951). In charge of Histology and Normal Human Anatomy in 1920-21, he became a full professor and a master till 1952. He had so many students: among them Ignazio Fàzzari (1889-1986) who had the chair in the University of Florence, Alberto Monroy who had the charge of Compared Anatomy in the University of Palermo and Arcangelo Pasqualino from Marineo. Luna was co-founder and leader of the "Italian Society of Anatomy". He developed an intense research above all on the nervous system, the connective tissues, the arteries of the brain, and the experimental embryology, developing the radiological and clinical anatomy. He also dedicated himself to literature writing in 1953, among the scientific and literary works, a booklet titled Alla Fiera Delle Fantasie where he discuss the fantasy in a style that recall the literary evasion of the last period of crepuscolarism.

  12. [Mining medical knowledge from time-oriented clinical data using existing clinical knowledge].

    PubMed

    Shahar, Y; Moskovitich, R; Klimov, D

    2013-05-01

    The analysis of clinicaL data accumulating over time from multipLe sources, regarding a group of patients, can lead to muLtiple insights. In particular, such an analysis enables: (a) the discovery of temporal patterns repeating above a certain threshold frequency, thus essentially creating clusters of different behaviors over time of various patient sub-groups; and (b) detection amongst the temporal patterns, some of which, together with additional patient data, such as demographic data, might be able to predict future cLinically significant outcomes, such as renal dysfunction in the case of a diabetes patient. The analysis of temporal data is even more efficient when it includes not only time-stamped, point-based raw data, but also time intervals (periods) during which certain context-sensitive, abstract interpretations of the data hold, such as a period of moderate anemia instead of a series of hemoglobin values; or a degradation in liver functions, instead of a series of different enzyme values. Such an interpretation naturally requires an explicit representation of the medical knowledge involved, in a medical knowledge base, in a manner that supports automated computational tools. In this survey, we briefly introduce several of the innovative computational methods developed in our research center, for the purpose of the multivariate analysis of time-oriented clinical data. We mainly demonstrate the use of tools for exploration and knowledge discovery which are intended for use by a cLinicaL user at the point of care, and by cLinical researchers or heaLthcare policy makers. *

  13. Cardiovascular risk factors in chronic treatment with antipsychotic agents used in primary care.

    PubMed

    Mundet-Tudurí, Xavier; Iglesias-Rodal, Manuel; Olmos-Domínguez, Carmen; Bernard-Antoranz, M Lluïsa; Fernández-San Martín, M Isabel; Amado-Guirado, Ester

    2013-12-01

    Objetivo. Comparar la prevalencia de factores de riesgo cardiovascular (FRCV) y eventos vasculares en pacientes tratados con antipsicoticos, comparandolos con los no tratados. Sujetos y metodos. Estudio descriptivo transversal de pacientes atendidos en atencion primaria de la ciudad de Barcelona y tratados con antipsicoticos entre el 2008 y el 2010, comparandolos con una poblacion no tratada. Se registraron las variables antropometricas y clinicas y los FRCV. Se estudio por separado a pacientes adultos y ancianos, y a los tratados con antipsicoticos tipicos y atipicos. Resultados. Un total de 14.087 pacientes habian sido tratados con antipsicoticos (63,4% atipicos). El mas prescrito fue la risperidona. Se aparejaron 13.724 pacientes de la misma edad y genero, pero no tratados (n total = 27.811). Los tratados con antipsicoticos presentaron una prevalencia superior de obesidad (16,9% frente a 10,6%), tabaquismo (22,2% frente a 11,1%), diabetes mellitus (16% frente a 11,9%) y dislipemia (32,8% frente a 25,8%) (p < 0,001). La prevalencia de accidente vascular cerebral fue significativamente superior entre los tratados, tanto en los adultos (odds ratio = 2,33) como en los ancianos (odds ratio = 1,64). La prevalencia de cardiopatia isquemica fue similar en ambos grupos (odds ratio = 0,97). No se observaron diferencias significativas entre los tratados con un antipsicotico tipico o atipico. Conclusiones. Los pacientes tratados con antipsicoticos presentaron una mayor prevalencia de FRCV (diabetes, obesidad y tabaquismo). La presencia de ictus fue superior entre los tratados con antipsicoticos. No se detectaron diferencias importantes entre los pacientes tratados con antipsicoticos tipicos y atipicos.

  14. [Comparison of different methods in order to identify Proteus spp].

    PubMed

    Castro, S T; Rodríguez, C R; Perazzi, B E; Radice, M; Paz Sticott, M; Muzio, H; Juárez, J; Gutkind, G; Famiglietti, A M R; Santini, P I; Vay, C A

    2006-01-01

    Comparison of different methods in order to identify Proteus spp. The objectives were: (a) to identify Proteus strains to species level, following Farmer's and O'Hara's conventional biochemical reactions; b) to evaluate the sensitivity and specificity of both the API 20E method and a schema of reduced reactions (TSI and MIO agar: motility, indole and ornithine) comparing them with conventional methodology, and c) to evaluate the utility of SDS-PAGE (total proteins) in order to identify Proteus strains to species level. Two hundred and five Proteus spp. clinical isolates, were collected between January 1998 and September 2004, from inpatients and outpatients at Hospital de Clinicas. Strains were identified by means of conventional methodology, the API 20E method, and a schema of reduced reactions. SDS-PAGE (total proteins) was used in 48 out of the 205 strains. The API 20E method identified 79 out of 87 (90.8%) strains of P. mirabilis, 103 out of 103 P. vulgaris complex, and 15 out of 15 P. penneri. Eight strains of P. mirabilis were identified as Proteus spp., the acid production from maltose being necessary to identify them to species level. The schema of reduced reactions identified 205 out of 205 (100%) strains, that is, this schema of reduced reactions identified all the strains to species level without any additional tests, in marked contrast to the API 20E method. The SDS-PAGE (total proteins) identified the three species of the genus, even if the strains of P. mirabilis showed different biochemical reactions.

  15. Hypoglycemia in a dog with a leiomyoma of the gastric wall producing an insulin-like growth factor II-like peptide.

    PubMed

    Boari, A; Barreca, A; Bestetti, G E; Minuto, F; Venturoli, M

    1995-06-01

    A 12-year-old mixed-breed male dog was referred to the Clinica Medica Veterinaria of Bologna University for recurrent episodes of seizures due to hypoglycemia with abnormally low plasma insulin levels (18 pmol/l). Resection of a large leiomyoma (780 g) of the gastric wall resulted in a permanent resolution of the hypoglycemic episodes. Insulin-like growth factors I and II (IGF-I and -II) were measured by RIA in serum before and after surgery and in tumor tissue. Results were compared to the serum concentration of 54 normal and to the tissue concentration observed in eight non-hypoglycemic dog gastric wall extracts. Before surgery, circulating immunoreactive IGF-I was 0.92 nmol/l, which is significantly lower than the control values (16.92 +/- 8.44 nmol/l, range 3.53-35.03), while IGF-II was 152 nmol/l, which is significantly higher than the control values (42.21 +/- 3.75, range 31.99-50.74). After surgery, IGF-I increased to 6.80 nmol/l while IGF-II decreased to 45.52 nmol/l. Tumor tissue IGF-II concentration was higher than normal (5.66 nmol/kg tissue as compared to a range in normal gastric wall tissue of 1.14-3.72 nmol/kg), while IGF-I was 0.08 nmol/kg tissue, which is close to the lowest normal value (range in controls, 0.08-1.18 nmol/kg). Partial characterization of IGF-II immunoreactivity extracted from tissue evidenced a molecular weight similar to that of mature IGF-II, thus excluding that peptide released by the tumor is a precursor molecule.(ABSTRACT TRUNCATED AT 250 WORDS)

  16. [Multisite study for norming and standardizing neuropsychological instruments in healthy people for Spanish population: methods and characteristics of Normacog project].

    PubMed

    del Pino, Rocío; Peña, Javier; Schretlen, David J; Ibarretxe-Bilbao, Naroa; Ojeda, Natalia

    2015-07-16

    Introduccion. Muchos de los instrumentos neuropsicologicos utilizados en España se han normalizado en poblacion hispanohablante procedente de Estados Unidos y Sudamerica, con grupos de edad y caracteristicas restrictivas. Utilizar este tipo de normas disminuye potencialmente su representatividad, la interpretacion de los resultados y las decisiones clinicas. Este estudio se enmarca dentro del proyecto Normacog, con el fin de estandarizar instrumentos neuropsicologicos en una muestra representativa de la sociedad española. Objetivo. Presentar la metodologia de normalizacion llevada a cabo en el proyecto Normacog y las caracteristicas sociodemograficas de la poblacion española y de los participantes incluidos en el estudio. Sujetos y metodos. Se reclutaron 711 participantes (rango: 18-90 años) de diferentes areas geograficas de España, incluyendo los datos sociodemograficos, medicos, habitos habituales, lengua materna, bilinguismo y dominancia manual. Cada participante completo 19 instrumentos que evaluaban un amplio rango de dominios cognitivos, como memoria verbal y visual, atencion, funciones ejecutivas, velocidad de procesamiento o fluidez y denominacion verbal. Resultados. La muestra final normativa refleja las caracteristicas sociodemograficas y la representatividad de la poblacion española de acuerdo con los rangos de edad, educacion y sexo. Conclusiones. Se describe la metodologia de normalizacion y las caracteristicas de la muestra incluida en el estudio multicentrico Normacog, mediante el cual se llevara a cabo la estandarizacion y normalizacion de instrumentos neuropsicologicos, teniendo en cuenta las caracteristicas sociodemograficas propias de la poblacion española. El proyecto Normacog proporciona datos normativos adecuados a nuestro medio cultural, y es esencial para poder realizar un diagnostico clinico y neuropsicologico fiable.

  17. [Psychopedagogical intervention in attention deficit hyperactivity disorder].

    PubMed

    Abad-Mas, Luis; Ruiz-Andrés, Rosalía; Moreno-Madrid, Francisca; Herrero, Raquel; Suay, Enrique

    2013-09-06

    Introduccion. Los niños con trastorno por deficit de atencion/hiperactividad (TDAH) presentan alteraciones en los mecanismos atencionales y en los procesos de control inhibitorio (impulsividad e hiperactividad), que afectan de distinta manera a su rendimiento academico, socioemocional y conductual, por lo que es fundamental la consideracion de estrategias de intervencion en el ambito psicopedagogico que puedan incidir de forma favorable en el curso evolutivo de los afectados. Objetivo. Revisar las bases psicopedagogicas en la intervencion sobre el TDAH, considerando la relacion de la anatomia funcional con la sintomatologia clinica y los correspondientes programas de intervencion. Desarrollo. Se destacan los tres sindromes preferentes: orbitofrontal, dorsolateral y en el cingulo a nivel medial. Las fases de la intervencion psicopedagogica deben abarcar tanto al niño como a la familia y el colegio. El entrenamiento neurocognitivo se centra en el niño, basado en programas de entrenamiento de las funciones ejecutivas y en las actuaciones sobre el ambito academico, conductual y socioafectivo. Los programas de modificacion de conducta son complementarios y en muchas ocasiones mejoran el comportamiento comprometido en los niños con TDAH. Las orientaciones psicopedagogicas en la escuela deben considerarse necesarias para una intervencion eficaz en el entorno academico. Conclusiones. La intervencion psicopedagogica de los niños con TDAH debe contemplar la individualizacion del tratamiento dentro de una metodologia multidisciplinar, teniendo en cuenta todos los contextos en los que se desarrolla el niño, su rendimiento cognitivo y las intervenciones farmacologicas apropiadas en cada caso.

  18. DICOM for Clinical Research: PACS-Integrated Electronic Data Capture in Multi-Center Trials.

    PubMed

    Haak, Daniel; Page, Charles-E; Reinartz, Sebastian; Krüger, Thilo; Deserno, Thomas M

    2015-10-01

    Providing surrogate endpoints in clinical trials, medical imaging has become increasingly important in human-centered research. Nowadays, electronic data capture systems (EDCS) are used but binary image data is integrated insufficiently. There exists no structured way, neither to manage digital imaging and communications in medicine (DICOM) data in EDCS nor to interconnect EDCS with picture archiving and communication systems (PACS). Manual detours in the trial workflow yield errors, delays, and costs. In this paper, requirements for a DICOM-based system interconnection of EDCS and research PACS are analysed. Several workflow architectures are compared. Optimized for multi-center trials, we propose an entirely web-based solution integrating EDCS, PACS, and DICOM viewer, which has been implemented using the open source projects OpenClinica, DCM4CHEE, and Weasis, respectively. The EDCS forms the primary access point. EDCS to PACS interchange is integrated seamlessly on the data and the context levels. DICOM data is viewed directly from the electronic case report form (eCRF), while PACS-based management is hidden from the user. Data privacy is ensured by automatic de-identification and re-labelling with study identifiers. Our concept is evaluated on a variety of 13 DICOM modalities and transfer syntaxes. We have implemented the system in an ongoing investigator-initiated trial (IIT), where five centers have recruited 24 patients so far, performing decentralized computed tomography (CT) screening. Using our system, the chief radiologist is reading DICOM data directly from the eCRF. Errors and workflow processing time are reduced. Furthermore, an imaging database is built that may support future research.

  19. Implementation of a quality assurance program for computerized treatment planning systems.

    PubMed

    Camargo, Priscilla R T L; Rodrigues, Laura N; Furnari, Laura; Rubo, Rodrigo A

    2007-07-01

    In the present investigation, the necessary tests for implementing a quality assurance program for a commercial treatment planning system (TPS), recently installed at Sao Paulo University School of Medicine Clinicas Hospital-Brazil, was established and performed in accordance with the new IAEA publication TRS 430, and with AAPM Task Group 53. The tests recommended by those documents are classified mainly into acceptance, commissioning (dosimetric and nondosimetric), periodic quality assurance, and patient specific quality assurance tests. The recommendations of both IAEA and AAPM documents are being implemented at the hospital for photon beams produced by two linear accelerators. A Farmer ionization chamber was used in a 30 x 30 x 30 cm3 phantom with a dose rate of 320 monitor unit (MU)/min and 50 MU in the case of the dosimetric tests. The acceptance tests verified hardware, network systems integration, data transfer, and software parameters. The results obtained are in good agreement with the specifications of the manufacturer. For the commissioning dosimetric tests, the absolute dose was measured for simple geometries, such as square and rectangular fields, up to more complex geometries such as off-axis hard wedges and for behavior in the build up region. Results were analysed by the use of confidence limit as proposed by Venselaar et al. [Radio Ther. Oncol. 60, 191-201 (2001)]. Criteria of acceptability had been applied also for the comparison between the values of MU calculated manually and MU generated by TPS. The results of the dosimetric tests show that work can be reduced by choosing to perform only those that are more crucial, such as oblique incidence, shaped fields, hard wedges, and buildup region behavior. Staff experience with the implementation of the quality assurance program for a commercial TPS is extremely useful as part of a training program.

  20. [Counselling for erectile dysfunction during inpatient rehabilitation after radical prostatectomy].

    PubMed

    Vahlensieck, W; Sommer, F; Mathers, M J; Gilbert, T; Waidelich, R

    2011-04-01

    For men erectile function is essential for quality of life. Besides urine incontinence postsurgical erectile dysfunction (ED) following radical prostatectomy (RPE) represents a significant and prevalent problem. One of the first approaches to this condition should be a consultation performed by professionals in a rehabilitation clinic.A total of 149 patients post RPE participated in this prospective study. All patients were questioned about their understanding of postoperative surgical ED after RPE and if affected they were asked about their own psychological burden as well as their knowledge of possible therapy options. The qualities of presurgical patient information as well as the modules of information pertaining to ED during the rehabilitation were evaluated. Of the patients, 53% expressed that they experienced a considerable burden due to postsurgical ED during their follow-up rehabilitation (AR group) and 70% of the patients during oncological rehabilitation treatment (rehab group). Men who were sexually more active prior to surgery suffered more from postsurgical ED than their less active counterparts. A negative correlation between psychological burden and age was found in the AR group, which however was levelled in the rehab group. Particularly in older patients the burden of ED increases with more time elapsing after the operation. The medical information on ED therapy options provided during the inpatient rehabilitation was considered to be essential by 60% of the men in the AR group and 48% of the patients in the rehab group.Therapeutic possibilities for postsurgical ED following RPE cannot always be given to patients in the preoperative phase or during their stay in the hospital. Since however a large majority of men suffer from postoperative ED following RPE a specialized inpatient urological rehabilitation is suited for a comprehensive consultation.

  1. TGF beta and IL13 in Schistosomiasis mansoni associated pulmonary arterial hypertension; a descriptive study with comparative groups.

    PubMed

    Ferreira, Rita de Cassia dos Santos; Montenegro, Silvia Maria Lucena; Domingues, Ana Lucia Coutinho; Bandeira, Angela Pontes; Silveira, Carlos Antonio da Mota; Leite, Luiz Arthur Calheiros; Pereira, Clara de Almeida; Fernandes, Izolda Moura; Mertens, Alessandra Brainer; Almeida, Milena Oliveira

    2014-05-21

    It is suggested that interleukin (IL)-13 and transforming growth factor (TGF)-beta play a role in the pulmonary vascular changes found in animal models of schistosomiasis. The aim of this study was to assess and compare the serum levels of total TGF-beta and IL-13 of patients with schistosomiasis with pulmonary arterial hypertension (PAH) and patients with schistosomiasis without PAH. 34 patients from the schistosomiasis outpatient clinic of the Hospital das Clinicas, Recife, Pernambuco, Brazil, without PAH assessed by echocardiography and 34 patients from the Reference Centre of Pulmonary Hypertension of Pronto Socorro Cardiológico de Pernambuco, Recife, Brazil with PAH, confirmed by right heart catheterization, were enrolled on the study. Both groups presented with schistosomal periportal fibrosis after abdominal ultrasound. Serum levels of TGF-beta1 and IL-13 were determined by ELISA. Student t test to independent samples, Mann-Whitney test to nonparametric variables, Pearson correlation test for correlation analyses and Fisher Chi-squared test to compare categorical analyses were used. The median value of TGF-beta1 was significantly higher in patients with PAH (22496.9 pg/ml, interquartile range [IR] 15936.7 - 32087.8) than in patients without PAH (13629.9 pg/ml, IR: 10192.2- 22193.8) (p = 0.006). There was no difference in the median value of IL-13 in the group with Sch-PAH compared to patients without Sch-PAH (p > 0.05). Our results suggest that TGF-beta possibly plays a role in the pathogenesis of schistosomiasis-associated PAH.

  2. [High performance of an implantable Holter monitor in the detection of concealed paroxysmal atrial fibrillation in patients with cryptogenic stroke and a suspected embolic mechanism].

    PubMed

    Rojo-Martinez, Esther; Sandín-Fuentes, María; Calleja-Sanz, Ana I; Cortijo-García, Elisa; García-Bermejo, Pablo; Ruiz-Piñero, Marina; Rubio-Sanz, Jerónimo; Arenillas-Lara, Juan F

    2013-09-16

    Introduccion. El holter implantable permite detectar fibrilacion auricular paroxistica (FAP) oculta en pacientes con ictus criptogenico, pero se desconoce que algoritmo de seleccion tiene un mayor rendimiento y la duracion optima de monitorizacion. Objetivo. Conocer la frecuencia y el tiempo hasta detectar la FAP mediante un holter implantable Reveal XT ® en pacientes con ictus criptogenico seleccionados por sospecha elevada de embolismo cerebral. Pacientes y metodos. Criterios de seleccion: ausencia de etiologia del ictus tras el estudio completo incluyendo un ecocardiograma transesofagico, monitorizacion ECG y holter de 24 horas, asi como confirmacion de oclusion aguda embolica de la arteria intracraneal por duplex transcraneal o bien alta sospecha de embolismo por caracteristicas de neuroimagen. Tras implantar el holter Reveal XT se formo a los pacientes para que emprendieran transmisiones todos los meses o ante sintomas. Se reviso la informacion online mensualmente y se realizaron visitas clinicas en las unidades de Neurologia y Cardiologia. Resultados. Se incluyeron 101 pacientes con ictus criptogenico y al menos un mes de seguimiento: edad media de 67 años, 54 mujeres (53,5%). Tiempo medio de seguimiento: 281 ± 212 dias. Se detecto FAP oculta en 34 pacientes (33,7%) y falsos positivos en 23 (22,8%). Mediana desde el implante hasta la deteccion de la arritmia: 102 dias (rango: 26-240 dias). En un 70% de los pacientes se registraron multiples episodios de FAP. El 75% de los eventos se detectaron durante los primeros seis meses de monitorizacion. Conclusiones. El algoritmo de seleccion de pacientes con ictus criptogenico segun sospecha de embolismo cerebral se asocio a una elevada frecuencia (33,7%) de FAP oculta con holter implantable. Uno de cada cuatro eventos sucedio tras los primeros seis meses de monitorizacion.

  3. [Predictors of the recovery of cognitive functions in patients with traumatic brain injury].

    PubMed

    Solís-Marcos, I; Castellano-Guerrero, A M; Domínguez-Morales, R; León-Carrión, J

    2014-04-01

    Introduccion. Tras un traumatismo craneoencefalico (TCE), el funcionamiento cognitivo de los pacientes puede resultar gravemente alterado. Diversos estudios han tratado de identificar las variables que mejor predicen su recuperacion. Objetivos. Evaluar la recuperacion funcional cognitiva de pacientes con TCE tras un programa de neurorrehabilitacion e identificar las variables predictoras de dicha recuperacion. Pacientes y metodos. Estudio pre-post retrospectivo de 58 pacientes adultos con TCE que realizaron un programa de rehabilitacion intensivo. Todos fueron evaluados mediante la subescala de funcionalidad cognitiva de la medida de la independencia funcional + medida de la evaluacion de la funcionalidad (FIM+FAM), al inicio y al final de la rehabilitacion. Ambas puntuaciones fueron comparadas mediante la prueba no parametrica de Wilcoxon. Se calculo el porcentaje de ganancia funcional cognitiva y se correlaciono con todas las variables recogidas. A partir de toda la informacion clinica, demografica y cognitiva recogida, realizamos un analisis de regresion lineal multiple para identificar los mejores predictores de dicha ganancia. Resultados. La funcionalidad cognitiva aumento significativamente del 33,6% al 85% (p < 0,01). Los pacientes con mayor porcentaje de ganancia funcional cognitiva fueron aquellos con menor edad y periodo post-TCE, y mayores puntuaciones en la subescala cognitiva de la FIM+FAM y en las pruebas de atencion condicional y curva de aprendizaje de Luria. Los mejores predictores de la recuperacion funcional fueron el periodo post-TCE y la funcionalidad cognitiva al inicio (R2 ajustado = 55,8%). Conclusiones. El comienzo temprano de la rehabilitacion y la mayor funcionalidad cognitiva al inicio resultaron ser los mejores predictores de la recuperacion funcional cognitiva. Otras variables, como la edad o puntuaciones en pruebas cognitivas, tambien deben considerarse en futuros estudios.

  4. [Vagus nerve stimulation in patients with migraine].

    PubMed

    Mosqueira, Antonio J; López-Manzanares, Lydia; Canneti, Beatrice; Barroso, Alejandro; García-Navarrete, Eduardo; Valdivia, Antonio; Vivancos, José

    2013-07-16

    Introduccion. La estimulacion del nervio vago (ENV) esta aprobada para el tratamiento de la epilepsia refractaria cuando no es posible cirugia resectiva, con una eficacia bien establecida. Series publicadas sugieren un efecto beneficioso de la ENV en la migraña. Objetivos. Determinar el grado de mejoria de la cefalea en pacientes migrañosos a los que se les habia implantado una ENV para tratamiento de la epilepsia refractaria y evaluar que variables se asocian a mayor posibilidad de exito con esta medida. Pacientes y metodos. Estudio observacional y retrospectivo desde el 1 de enero de 1999 hasta el 31 de diciembre de 2010. Se contacto telefonicamente con los pacientes con ENV para epilepsia refractaria, seleccionando a aquellos que cumplian los criterios de la Sociedad Internacional de Cefaleas para la migraña. Se recogieron edad, genero, año de implantacion, edad de inicio de la epilepsia y la migraña, mejoria de crisis y de migraña, presencia de aura migrañosa y coexistencia de sindrome ansiosodepresivo. Se contacto con 94 pacientes con ENV y se selecciono a 13 pacientes migrañosos. Resultados. Tras la implantacion de la ENV, se observo una disminucion de al menos el 50% de los episodios de migraña en nueve pacientes (69%) (p = 0,004), asi como una disminucion del numero de episodios de migraña en aquellos pacientes que tambien habian reducido sus crisis epilepticas (p = 0,012). No se observaron asociaciones estadisticamente significativas en cuanto al sexo, edad, tiempo de evolucion, existencia de aura migrañosa o coexistencia de sindrome ansiosodepresivo. Conclusiones. La ENV podria resultar beneficiosa en pacientes con migraña, especialmente en casos de dificil control. Debido al tipo estudio, hay que tomar estas conclusiones con precaucion. Seran necesarios estudios clinicos prospectivos antes de llevarse a la practica clinica habitual.

  5. [Experience of a centre for the study of occupational adjustment disorders referred to psychological harassment-related diseases at the workplace].

    PubMed

    Buselli, R; Gonnelli, Chiara; Moscatelli, M; Cioni, Valentina; Guglielmi, G; Gattini, V; Foddis, R; Mignani, A; Ottenga, F; Cristaudo, A

    2006-01-01

    The rising awareness of psychological harassment at the workplace means that it is ever more important to collect clinical data and test tools to assess psychiatric disease connected with this phenomenon. The aim of the study was to assess the experience gained by the centre for work maladjustment of the University Hospital of Pisa on a sample of patients, using the methods proposed by the centre at the Clinica del Lavoro "Luigi Devoto". The patients were submitted to a diagnostic protocol consisting of work history, medical examination, psychological assessment, psychiatric examination, subjective questionnaires, mood scale and Neutest. The analysis was made in two phases in which 109 subjects were examined to check occupational stress effects in the period March 2002 - July 2004, after which 50 subjects were selected (45.9%) with the adaptation disorder and a history of adverse working conditions. The data gathered showed a slight predominance of workers from the public administration sector. The most representative range of duration of the psychological violence varied from 6 months to 2 years (46%). From close examination of the causes of the maladjustment disorders, structural changes in organization appeared to be the most frequent (13 cases). Among patients with positive diagnosis of disorder caused by psychological violence at the workplace, three situations were prominent: attitude to being a social outcast, behaviour to ignore proposals, and professional declassing. The multidisciplinary approach was culturally very stimulating and fundamental in reaching a final diagnosis of occupational disease: diagnosis of bullying at work and related disease was possible only thanks to the fact that three specialists agreed on the aetiological role of psychological harassment at the workplace. Our experience confirms that psychological harassment can cause health impairment and the most common diagnosis is maladjustment disorder.

  6. Using consumer-based kiosk technology to improve and standardize medication reconciliation in a specialty care setting.

    PubMed

    Lesselroth, Blake; Adams, Shawn; Felder, Robert; Dorr, David A; Cauthers, Phillip; Church, Victoria; Douglas, David

    2009-05-01

    Discrepancies in medication documentation most often occur at handoffs or transition points in care. A process improvement team at the Portland Department of Veterans Affairs developed a standardized medication reconciliation process for the Portland chemotherapy administration unit, a physically self-contained clinic with a standard intake process and a uniform patient traffic pattern. The team developed the automated patient history intake device (APHID), a reconciliation software program accessed by the patient using a computer terminal kiosk in the clinic lobby. The program simultaneously checks in patients for an appointment and gathers a medication-adherence history by retrieving medication lists from all Veterans Affairs facilities and pairing each medication with a pill picture. Installation of the APHID kiosk included an initial two-week roll-in period beginning in February 2008. During the roll-in period, 91 (82.0%) of 111 patients completed check-in and performed medication reconciliation using the kiosk. Medication lists gathered at the kiosk were compared with existing health record documentation and clinician interviews. For each patient encounter, the process demonstrated an average of 4.59 discrepancies and an average of 1.61 clinically significant or potentially lethal discrepancies. The new process saved approximately 0.24 full-time equivalents of nursing time in the chemotherapy clinic-a nearly 50% reduction in nursing time dedicated to reconciliation activities without an apparent loss in data accuracy. A patient-centered reconciliation model using consumer-based kiosk technology helped providers efficiently retrieve a comprehensive list of medications across a geographically diverse area and improve patient medication recall using visual cues including medication pictures.

  7. Maternal near miss and death among women with severe hypertensive disorders: a Brazilian multicenter surveillance study

    PubMed Central

    2014-01-01

    Background Hypertensive disorders represent the major cause of maternal morbidity in middle income countries. The main objective of this study was to identify the prevalence and factors associated with severe maternal outcomes in women with severe hypertensive disorders. Methods This was a cross-sectional, multicenter study, including 6706 women with severe hypertensive disorder from 27 maternity hospitals in Brazil. A prospective surveillance of severe maternal morbidity with data collected from medical charts and entered into OpenClinica®, an online system, over a one-year period (2009 to 2010). Women with severe preeclampsia, severe hypertension, eclampsia and HELLP syndrome were included in the study. They were grouped according to outcome in near miss, maternal death and potentially life-threatening condition. Prevalence ratios and 95% confidence intervals adjusted for cluster effect for maternal and perinatal variables and delays in receiving obstetric care were calculated as risk estimates of maternal complications having a severe maternal outcome (near miss or death). Poisson multiple regression analysis was also performed. Results Severe hypertensive disorders were the main cause of severe maternal morbidity (6706/9555); the prevalence of near miss was 4.2 cases per 1000 live births, there were 8.3 cases of Near Miss to 1 Maternal Death and the mortality index was 10.7% (case fatality). Early onset of the disease and postpartum hemorrhage were independent variables associated with severe maternal outcomes, in addition to acute pulmonary edema, previous heart disease and delays in receiving secondary and tertiary care. Conclusions In women with severe hypertensive disorders, the current study identified situations independently associated with a severe maternal outcome, which could be modified by interventions in obstetric care and in the healthcare system. Furthermore, the study showed the feasibility of a hospital system for surveillance of severe

  8. Liposuction and lipoinjection treatment for congenital and acquired lipodystrophies in children.

    PubMed

    Giugliano, Carlos; Benitez, Susana; Wisnia, Pamela; Sorolla, Juan Pablo; Acosta, Silvana; Andrades, Patricio

    2009-07-01

    The purpose of this clinical study was to establish liposuction and lipoinjection as a noncosmetic procedure in children to correct lipodystrophies. Liposuction, fat injection, or a combination of both was performed on 30 patients between 1994 and 2006 at Roberto del Rio Hospital or Clinica Alemana, Santiago, Chile. Liposuction was indicated in patients with excessive amounts of fatty tissue or tumor-like swelling. Combined liposuction and lipoinjection was performed on patients with deficit and excess in soft tissues. Lipoinjection was used for patients with soft-tissue insufficiencies. Samples of fat obtained by liposuction were submitted to histopathologic examination. Traditional tumescent technique was used for liposuction. The supernatant obtained by simple filtration was used for fat injection. Short- and long-term postoperative follow-up included registration of complications and assessment of aesthetic and functional outcome. The kappa test was used for statistical analysis. Thirty patients, nine boys and 21 girls, were operated on, with an average age of 11 years (range, 4 to 17 years). A total of 43 procedures were performed: 27 liposuctions, 10 lipoinjections, and six combined procedures. Average hospital stay was 1.1 days. Of a total 20 patients who underwent liposuction, six required revision. Histopathologic study showed 19 lipomatoses and one lipoblastomatosis. Cosmetic outcomes based on Strasser scale were as follows: six excellent, 19 good, four mediocre, and one poor. Liposuction and lipoinjection as sole or combined procedures are safe methods for the pediatric population. They are well tolerated, with a low rate of complications and satisfactory aesthetic results.

  9. Brain abnormalities in attention-deficit hyperactivity disorder: a review.

    PubMed

    Rubia, Katya; Alegría, Analucía A; Brinson, Helen

    2014-02-24

    Objetivo. Revisar los hallazgos de los estudios con resonancia magnetica en el trastorno por deficit de atencion/hiperactividad (TDAH) infantil y adulto. Desarrollo. Dichos estudios han demostrado que el TDAH se caracteriza por la presencia de multiples anomalias de caracter estructural y funcional, primordialmente en los circuitos frontoestriatales, pero tambien en los circuitos frontoparietotemporales, frontocerebelares e, incluso, frontolimbicos. Los datos aportados por los estudios longitudinales de resonancia magnetica estructural demuestran que el TDAH se caracteriza por un retraso en la maduracion estructural del cerebro. Esta conclusion se ve reforzada por los indicios indirectos ofrecidos por los estudios de cortes transversales, que indican la existencia de una inmadurez sustancial tanto en la funcion cerebral como en los patrones de conectividad estructural y funcional, indicios que, sin embargo, estan pendientes de confirmar en estudios longitudinales. La alteracion funcional de la corteza prefrontal ventrolateral parece estar mas afectada en el TDAH que en otros trastornos pediatricos, y existen algunos indicios de anomalias distintivas en los ganglios basales. Un metaanalisis sobre los efectos de los estimulantes en la funcion cerebral demuestra que el mecanismo de accion agudo mas congruente de los farmacos psicoestimulantes consiste en el aumento de la activacion de la corteza prefrontal inferior y los ganglios basales. Los primeros intentos por utilizar los datos de los estudios de neuroimagen para elaborar clasificaciones diagnosticas individuales de los niños con TDAH a partir de tecnicas de reconocimiento de patrones han cosechado resultados alentadores, pero todavia deben ser replicados por mas centros y aparatos de resonancia magnetica. Conclusiones. Durante los ultimos 20 años, las tecnicas de neuroimagen han perfilado los biomarcadores del TDAH, pero es necesario que nuevos estudios descubran la utilidad clinica de esa informacion, como el

  10. [Instituto de Terapéutica Operatoria (1880-1939). Instituto Rubio y Gali, Instituto Moncloa. Contribution to medical specialities and nursing in Spain].

    PubMed

    Vázquez de Quevedo, Francisco

    2005-01-01

    We develop in this paper the activities of "Instituto de Terapeutica Operatoria" during the fifty-seven years of its existence (1880-1939). It was founded by Federico Rubio (1827-1902). We consider three periods of existence for the institute: First: From its foundation (in "Hospital de la Princesa", 1880-1896) and during the next sixteen years. This period saw the beginning of graduate formation for doctors. Second: Building and activities in Moncloa (1896-1902), during six years, while his creator was still alive. He edited the "Revista Iberoamericana de Ciencias Médicas") and started the first Spanish school of infirmary (Santa Isabel de Hungría). Thirth: (1902-1939) About thirty-seven years, until the institute dissapears because of the Spanish Civil War. The Instituto de Terapeutica Operatoria was also know as Instituto Rubio or "Clínica de la Moncloa". Many medical specialities were first created (in Spain) in this place: Surgery, Gynaecology, Urology, Otorhinolaryngology, etc. Rubio, as a surgeon, was a pioneer in many interventions: ovary (1860), uterus (1861), upper maxilar ressection (1864), larynx (1870). His personality and legate was the one of a liberal politician, pedagogyst, writer o academy member (RANM). Many doctors got attached to his teachings: E. Gutiérrez, Ariza, Buissen, Martínez Angel, Pulido, Sarabia, Suender, González Bravo, López Durán, Landete, Cervera, Albitos, Botín, etc. Just in place where the "Instituto" was sited, now there is the "Clinica de la Concepción", built in 1955.

  11. [Diploid/triploid mosaicism: a variable but characteristic phenotype].

    PubMed

    Natera-De Benito, Daniel; Poo, Pilar; Gean, Esther; Vicente-Villa, Asunción; García-Cazorla, Angels; Fons-Estupiña, M Carmen

    2014-08-16

    Introduccion. El mosaicismo diploide/triploide es una alteracion cromosomica poco frecuente. La produce un fallo en la division poscigotica durante el desarrollo embrionario. Da lugar a la coexistencia de dos lineas celulares con diferente constitucion cromosomica (46,XX y 69,XXX) en un mismo individuo. Su fenotipo clinico es caracteristico. Las alteraciones pigmentarias con un patron de distribucion que sigue las lineas de Blaschko son el principal signo guia, asi como las alteraciones de otros tejidos derivados del ectodermo. Casos clinicos. Describimos las caracteristicas clinicas de tres pacientes afectos de mosaicismo diploide/triploide y realizamos una comparacion de su fenotipo clinico con el de los casos publicados previamente en la bibliografia. Las alteraciones observadas con mayor frecuencia fueron alteraciones cutaneas, discapacidad intelectual, obesidad troncular, talla baja, hemihipertrofia, y manos pequeñas y estrechas con clino y camptodactilia. Las caracteristicas fenotipicas de nuestros pacientes fueron similares a las de los casos comunicados previamente. Aunque no existe un fenotipo unico y especifico asociado al mosaicismo diploide/triploide, existen malformaciones caracteristicas que conforman un sindrome malformativo bien definido. El cariotipo realizado en linfocitos de sangre periferica en las tres pacientes fue normal, y se logro el diagnostico mediante cariotipo en fibroblastos cultivados tras biopsia de piel hipopigmentada. Conclusiones. La presencia de discapacidad intelectual asociada a obesidad troncular, talla baja, hemihipertrofia o clino y camptodactilia, ademas de las alteraciones cutaneas, debe hacer pensar en la posible existencia de un mosaicismo diploide/triploide. En la mayoria de los casos, es necesario el estudio del cariotipo en los fibroblastos para llegar al diagnostico.

  12. The contribution of Enrico C. Vigliani (1907-1992) to the international development of occupational medicine and industrial hygiene.

    PubMed

    Riva, M A; Carnevale, F; D'Orso, M I; Iavicoli, S; Bertazzi, P A; Cesana, G

    2012-01-01

    One of the last century's greatest personalities in Occupational Medicine was Enrico Carlo Vigliani (1907-1992), director of the "Clinica del Lavoro" in Milan (1942-1977), editor-in-chief of "La Medicina del Lavoro" (1942-1991), Secretary-Treasurer and then President of the "Permanent Commission and International Association on Occupational Health" (1957-1981), the original nucleus of the ICOH. The 20th anniversary of his death provides us with the opportunity to discuss the role of this brilliant scholar in the international development of Occupational Medicine and Industrial Hygiene. A comprehensive analysis of Vigliani's scientific works was conducted. In addition, his close collaborators and pupils were interviewed. In the 1930s, as a young doctor, Vigliani, first in the world, demonstrated the effect of lead on porphyrin metabolism. Afterwards he conducted pioneering studies on occupational oncology (benzene-induced leukaemia, bladder cancer due to aromatic amines, asbestos-related tumours), pathogenesis of silicosis, encephalopathy in carbon disulfide poisoning, byssinosis and metal fume fever, so influencing international research and the implementation of preventive measures against these conditions. Vigliani's scientific authority was widely recognized internationally, as confirmed by his role in ICOH. During his period of active service, the Commission developed from an academic institution to a more open association, substantially increasing its membership. Furthermore, he contributed to establishing subcommittees devoted to specific topics (now called "scientific committees"), one of the strengths of the present Commission. Vigliani's contribution to the development of Occupational Health may be considered as an expression of his genial eclecticism which ranged from clinical medicine to the environment.

  13. Retrospective review of congenital heart disease in 976 dogs.

    PubMed

    Oliveira, P; Domenech, O; Silva, J; Vannini, S; Bussadori, R; Bussadori, C

    2011-01-01

    Knowledge of epidemiology is important for recognition of cardiovascular malformations. Review the incidence of congenital heart defects in dogs in Italy and assess breed and sex predispositions. Nine hundred and seventy-six dogs diagnosed with congenital heart disease (CHD) of 4,480 dogs presented to Clinica Veterinaria Gran Sasso for cardiovascular examination from 1997 to 2010. A retrospective analysis of medical records regarding signalment, history, clinical examination, radiography, electrocardiography, echocardiography, angiography, and postmortem examination was performed. Breed and sex predisposition were assessed with the odds ratio test. CHD was observed in 21.7% of cases. A total of 1,132 defects were observed with single defects in 832 cases (85%), 2 concurrent defects in 132 cases (14%), and 3 concurrent defects in 12 cases (1%). The most common defects were pulmonic stenosis (PS; 32.1%), subaortic stenosis (SAS; 21.3%), and patent ductus arteriosus (20.9%), followed by ventricular septal defect (VSD; 7.5%), valvular aortic stenosis (AS; 5.7%), and tricuspid dysplasia (3.1%). SAS, PS, and VSD frequently were associated with other defects. Several breed and sex predispositions were identified. The results of this study are in accordance with previous studies, with slight differences. The breed and sex predilections identified may be of value for the diagnosis and screening of CHD in dogs. Additionally, the relatively high percentage of concurrent heart defects emphasizes the importance of accurate and complete examinations for identification. Because these data are from a cardiology referral center, a bias may exist. Copyright © 2011 by the American College of Veterinary Internal Medicine.

  14. [Incidence and lethality of ischaemic stroke among people 60 years or older in the region of Tarragona (Spain), 2008-2011].

    PubMed

    Vila-Corcoles, Ángel; Satue-Gracia, Eva; Ochoa-Gondar, Olga; de Diego-Cabanes, Cinta; Vila-Rovira, Ángel; Blade, Jordi; Bobé, Francesc; Casanova, Raquel; Jariod, Manuel; Reig, Rosaura

    2014-12-01

    Introduccion. La informacion existente sobre la epidemiologia del ictus en nuestro pais es limitada. Este estudio analizo la incidencia y mortalidad por ictus isquemico en la poblacion general mayor de 60 años del area de Tarragona. Pacientes y metodos. Estudio de cohortes de base poblacional que incluyo a 27.204 personas de 60 o mas años adscritas a nueve areas basicas de salud en la comarca del Tarragones. Se realizo un seguimiento prospectivo durante tres años, en los que se seleccionaron todos los episodios de ictus isquemicos ocurridos entre los miembros de la cohorte desde el 1 de diciembre de 2008 hasta el 30 de noviembre de 2011. Se incluyeron exclusivamente episodios con diagnostico validado tras la revision de la historia clinica y se excluyeron aquellos casos sin confirmacion diagnostica por neuroimagen. Resultados. Se observo un total de 343 casos confirmados de ictus isquemico, lo cual supuso una incidencia de 453 episodios por 100.000 personas/año (intervalo de confianza del 95% = 408-504). La incidencia fue mayor en hombres que en mujeres (531 frente a 392 por 100.000 personas/año; p < 0,001) y aumento sustancialmente con la edad (195 frente a 517 y frente a 1.006 por 100.000 personas/año en 60-69, 70-79 y >= 80 años, respectivamente; p < 0,001). La incidencia fue mas de ocho veces superior entre las personas con antecedentes de ictus previo en comparacion con aquellas sin historia de ictus previo (2.962 frente a 340 por 100.000 personas/año; p < 0,001). El indice de letalidad global fue del 13%, y alcanzo el 21% entre las personas de 80 o mas años. Conclusiones. La morbimortalidad por ictus es considerable en nuestra poblacion. Medidas preventivas y tratamientos mas eficaces son imperativos.

  15. [Language comprehension disorders in non-verbal children with autism spectrum disorders and their implications in the family quality of life].

    PubMed

    Garrido, Dunia; Carballo, Gloria; Franco, Vanesa; García-Retamero, Rocío

    2015-03-01

    Introduccion. El nivel de comprension del lenguaje en niños con trastornos del espectro autista (TEA) varia ampliamente. Sin embargo, la evidencia sugiere que estos niños comprenden el lenguaje peor que los de su misma edad con desarrollo tipico, y muestran retraso en el vocabulario receptivo. La investigacion que relaciona calidad de vida y lenguaje es muy escasa. Objetivos. Profundizar en la comprension de aspectos estructurales del lenguaje en niños con TEA y conocer la influencia de los deficits en comprension del lenguaje en niños con TEA en las percepciones sobre calidad de vida en sus familias. Sujetos y metodos. Analizamos la comprension verbal en 26 niños no verbales con TEA (media: 9,8 años) y en 26 niños con desarrollo tipico (media: 3,9 años) igualados en edad de vocabulario, utilizando medidas estandarizadas de lenguaje receptivo. Resultados. Hemos comprobado que el nivel de vocabulario receptivo, comprension auditiva y comprension gramatical en los niños con TEA esta por debajo del que corresponde a su edad, y difiere significativamente de aquel en niños con desarrollo tipico. Asimismo, los padres de niños con TEA informan de graves problemas de comunicacion en sus hijos y falta de apoyo social. La calidad de vida familiar se ve afectada por los problemas linguisticos de los niños con TEA. Conclusiones. Encontramos una importante relacion entre las habilidades de lenguaje receptivo en los niños con TEA y las percepciones sobre la calidad de vida en sus familias. Estos resultados pueden tener importantes implicaciones en el diseño de intervenciones clinicas.

  16. [Tight control of blood pressure after ischemic stroke is associated with nocturnal hypotension episodes].

    PubMed

    Fernandez-Moreno, M C; Castilla-Guerra, L; Lopez-Chozas, J M; Jimenez-Hernandez, M D

    2015-09-16

    Objetivo. Evaluar si un control mas estricto de la presion arterial (PA) en pacientes con ictus isquemico reciente se asocia con la presencia de episodios de hipotension nocturna (HPN). Pacientes y metodos. Se incluyeron 100 pacientes consecutivos que habian sido dados de alta por ictus isquemico en los seis meses previos. Para evaluar el buen control de la PA en estos pacientes, se utilizaron valores de la PA en consulta y monitorizacion ambulatoria de la PA de 24 horas. Resultados. Se estudiaron 63 varones y 37 mujeres; la media de edad fue de 69 ± 11 años. Se incluyeron 68 ictus lacunares y 32 no lacunares. Se observaron episodios de HPN en 59 pacientes. La hipertension clinica estuvo presente en 34 pacientes. Un patron anormal del ritmo circadiano de la PA estaba presente en 72 sujetos. Solo 18 pacientes tenian la PA dentro de limites normales. Los episodios de HPN fueron mas frecuentes en los pacientes con buen control de la PA en comparacion con los pacientes con mal control: 88,8% y 52,4%, respectivamente (p = 0,007). La presencia de episodios de HPN tambien estaba inversamente relacionada con el numero de parametros de PA alterados (p = 0,001). Conclusiones. El control estricto de la PA tras un ictus isquemico se asocia con una alta frecuencia de episodios de HPN. Es probable que una reduccion intensiva de los niveles de la PA dentro del rango de la normalidad tras un ictus isquemico pueda no ser beneficiosa, en particular en los pacientes ancianos.

  17. [Protocol for neurophysiological studies of the pelvic floor to appraise anorectal dysfunction in patients with multiple sclerosis].

    PubMed

    Álvarez-Guerrico, Ion; Royo, Inmaculada; Andreu, Montserrat; Roquer-González, Jaume; Munteis, Elvira

    2016-03-01

    Introduccion. Los pacientes con esclerosis multiple (EM) frecuentemente desarrollan disfuncion anorrectal. Las estructuras neuromusculares del suelo pelvico y los mecanismos de control voluntario de la defecacion pueden afectarse por las lesiones parcheadas de la EM o secundarias a la discapacidad del paciente. La implicacion multifactorial limita la comprension de la fisiopatologia de la disfuncion anorrectal en la EM. Tests neurofisiologicos especificos valoran la funcionalidad de los elementos del sistema nervioso central y periferico implicados en las disfunciones anorrectales. Objetivo. Proponer un protocolo diagnostico de estudios neurofisiologicos estandarizados del suelo pelvico para caracterizar la fisiopatologia de la disfuncion anorrectal en los pacientes con EM. Pacientes y metodos. Se realizaron estudios de electromiografia de esfinter anal externo, potenciales evocados somatosensoriales desde el nervio pudendo interno, registro de reflejos sacros anales y neurografia del nervio pudendo a 16 pacientes con EM definida y criterios de estreñimiento o incontinencia fecal. Resultados. Las caracteristicas clinicas y neurofisiologicas fueron heterogeneas. Nueve pacientes presentaron estreñimiento; dos, incontinencia fecal aislada; y cinco, combinacion de ambos. La abolicion o el retraso de la latencia de los potenciales evocados somatosensoriales fue el hallazgo mas frecuente (n = 12), seguido de la deteccion de contraccion paradojica (n = 11) y de reclutamiento deficitario (n = 8) en la electromiografia de esfinter anal externo. Conclusiones. La correcta interpretacion de cada test neurofisiologico disponible y la correlacion de los hallazgos en conjunto permiten comprender la fisiopatologia de la disfuncion anorrectal. La protocolizacion de estudios neurofisiologicos del suelo pelvico permite ajustar el diagnostico al identificar la lesion nerviosa, central o periferica, determinante de disfuncion anorrectal en los pacientes con EM.

  18. Specialised teams or personal continuity across inpatient and outpatient mental healthcare? Study protocol for a natural experiment

    PubMed Central

    Giacco, Domenico; Bird, Victoria Jane; McCrone, Paul; Lorant, Vincent; Nicaise, Pablo; Pfennig, Andrea; Bauer, Michael; Ruggeri, Mirella; Lasalvia, Antonio; Moskalewicz, Jacek; Welbel, Marta; Priebe, Stefan

    2015-01-01

    Introduction Mental healthcare organisation can either pursue specialisation, that is, distinct clinicians and teams for inpatient and outpatient care or personal continuity of care, that is, the same primary clinician for a patient across the two settings. Little systematic research has compared these approaches. Existing studies subject have serious methodological shortcomings. Yet, costly reorganisations of services have been carried out in different European countries, inconsistently aiming to achieve specialisation or personal continuity of care. More reliable evidence is required on whether specialisation or continuity of care is more effective and cost-effective, and whether this varies for different patient groups and contexts. Design and methods In a natural experiment, we aim to recruit at least 6000 patients consecutively admitted to inpatient psychiatric care in Belgium, Germany, Italy, Poland, and the UK. In each country, care approaches supporting specialisation and personal continuity coexist. Patients will be followed up at 1 year to compare outcomes, costs and experiences. Inclusion criteria are: 18 years of age or older; clinical diagnosis of psychosis, affective disorder or anxiety/somatisation disorder; sufficient command of the language of the host country; absence of cognitive deterioration and/or organic brain disorders; and capacity to provide informed consent. Ethics and dissemination Ethical approval was obtained in all countries: (1) England: NRES Committee North East—Newcastle & North Tyneside (ref: 14/NE/1017); (2) Belgium: Comité d'Ethique hospitalo-facultaire des Cliniques St-Luc; (3) Germany: Ethical Board, Technische Universität Dresden; (4) Italy: Comitati Etici per la sperimentazione clinica (CESC) delle provincie di Verona, Rovigo, Vicenza, Treviso, Padova; (5) Poland: Komisja Bioetyczna przy Instytucie Psychiatrii i Neurologii w Warszawie. We will disseminate the findings through scientific publications and a study

  19. [Traumatic spinal cord injury in children and adolescents in Asturias].

    PubMed

    Álvarez-Pérez, M José; López-Llano, M Luisa

    2015-05-01

    Introduccion. La lesion medular traumatica es rara en la infancia, pero con graves complicaciones. Objetivo. Conocer la incidencia, etiologia y caracteristicas sociodemograficas de los pacientes pediatricos y adolescentes con lesion medular traumatica en Asturias. Pacientes y metodos. Censo de pacientes entre 0-17 años codificados como 'lesion medular traumatica con o sin fractura vertebral' en Asturias entre 1934 y 2013. Se recogen variables sociodemograficas, hospitalarias y clinicas. Resultados. Se registran 72 pacientes, la mayoria varones (79,2%), con una edad media de 16 años (rango: 5-17 años). La incidencia en 2011 fue de 7,3 por millon. Predominaron las lesiones completas (68,1%) y la localizacion dorsal (44,4%). Hubo lesion osea en el 95,8%, y en la mitad de ellos, afectacion de dos o mas vertebras. La etiologia predominante fueron los accidentes de trafico (52,1%), sobre todo de vehiculos de cuatro ruedas (63,4%), con una mayoria de varones con una edad media de 17 años y una localizacion dorsal (46,3%). En segundo y tercer lugar se situaron la etiologia laboral y la deportiva, con el mismo numero de casos. En la laboral predominaron los varones y el nivel toracico (77,8%), y el mecanismo fundamental fue el golpe directo. En la deportiva, la mayoria fueron varones, y la zambullida fue la causa mas importante, de predominio cervical. Conclusiones. Son necesarios estudios centrados en este grupo poblacional que permitan determinar sus caracteristicas diferenciadoras para establecer programas de cuidados adaptados a sus necesidades, asi como las medidas preventivas mas oportunas para reducir las posibilidades de una lesion con tan graves repercusiones.

  20. [Study of the diagnostic agreement on headaches between neurology and primary care].

    PubMed

    Santos-Lasaosa, S; Vinueza-Buitron, P R; Velazquez-Benito, A; Iniguez-Martinez, C; Larrode-Pellicer, P; Lopez Del Val, L J; Mauri-Llerda, J A; Sanchez-Valiente, S; Millan-Morales, J L

    2016-06-16

    Introduccion. La cefalea como sintoma es una patologia frecuente y uno de los principales motivos de consulta por parte de atencion primaria. Objetivo. Analizar las caracteristicas de los pacientes derivados desde atencion primaria a la consulta de neurologia general con cefalea o neuralgia como motivo de consulta, y la concordancia diagnostica. Pacientes y metodos. Estudio descriptivo transversal de todos los pacientes remitidos desde atencion primaria; se recogieron variables demograficas/clinicas y se compararon las hipotesis diagnosticas de atencion primaria y neurologia, determinando su concordancia. Resultados. Se remitieron desde atencion primaria 2.514 pacientes (588 de ellos con caracter preferente); en 378 casos el motivo de la consulta fue cefalea o neuralgia (42,46 años de media; el 77,8%, mujeres). En 139 pacientes se establecio tan solo un diagnostico semiologico y en el resto predominaron la migraña episodica (49,79%), la cefalea tensional cronica (18,41%) y la neuralgia del trigemino (12,13%). Desde neurologia, los diagnosticos mas frecuentes fueron, respectivamente, 33,86%, 24,05% y 18,67%. Se obtuvo un coeficiente kappa de 0,543 (p < 0,05), compatible con una concordancia moderada al considerar solo los pacientes remitidos desde atencion primaria con un diagnostico concreto. Conclusiones. Las cefaleas constituyen un motivo de consulta desde atencion primaria muy frecuente (15%). La concordancia diagnostica es moderada en nuestro sector sanitario, por lo que es necesario diseñar programas de formacion que ayuden a perfilar los criterios de derivacion al especialista y mejorar la atencion a nuestros pacientes.

  1. [Factors associated with post-stroke oropharingeal dysphagia].

    PubMed

    Peña-Chávez, Rodolfo; López-Espinoza, Miguel; Guzmán-Inostroza, Madelein; Jara-Parra, Mirna; Sepúlveda-Arriagada, Claudia; Sepulveda-Arriagada, Constanza; Zapata-Sepúlveda, Priscila

    2015-10-01

    Introduccion. La disfagia neurogena es una secuela del ictus que en ocasiones pone en riesgo la vida del paciente. La magnitud del daño cerebral generado por el ictus comunmente ocasiona la aparicion de otros trastornos que acompañan a la disfagia y agravan la salud del paciente. Objetivo. Analizar posibles asociaciones entre trastornos de la comunicacion, factores propios de la enfermedad, demograficos y comorbidos con disfagia en pacientes que sufrieron un ictus durante el ingreso hospitalario entre los años 2009 y 2011. Pacientes y metodos. Se estudiaron 1.519 historias clinicas de pacientes que presentaron ictus entre los años 2009 y 2011. Resultados. De los registros analizados, 206 presentaron disfagia (13,6%). El 80,1% de los casos de disfagia se concentro en pacientes de 60-89 años. El 66% de ellos permanecio hospitalizado durante mas de 11 dias. La edad (odds ratio = 2,36; p < 0,001), afasia (odds ratio = 4,47; p < 0,001), disartria (odds ratio = 4,95; p < 0,001), tiempo de hospitalizacion (odds ratio = 3,65; p < 0,001) e hipertension arterial (odds ratio = 1,64; p = 0,023) se asociaron estadisticamente con disfagia. Finalmente, en el 73,3% de los casos con disfagia, se presento disfagia mas afasia o disartria o apraxia del habla, mientras que solo el 26,7% tuvo exclusivamente disfagia. Conclusiones. La disfagia neurogena parece concomitar con trastornos de la comunicacion, aumentar el tiempo de hospitalizacion y asociarse a hipertension arterial. Sin embargo, se requieren estudios prospectivos que consideren un gran periodo de tiempo para confirmar estos hallazgos.

  2. Co-morbidities and sleep apnoea severity. A study in a cohort of Portuguese patients.

    PubMed

    Silva, L; Cunha, D; Lopes, J; Ramalheira, J; Freire, M; Novio, S; Nunez, M J; Mendonca, D; Martins-da-Silva, A

    2016-05-16

    Introduccion. El sindrome de apnea obstructiva del sueño (SAOS) se asocia frecuentemente a otras enfermedades que actuan como factores de riesgo que influyen en la morbilidad y mortalidad del SAOS. Objetivos. Analizar la presencia de comorbilidades en pacientes con SAOS, seleccionados en una clinica del sueño ambulatoria en el norte de Portugal y clasificados atendiendo a la gravedad del SAOS. Pacientes y metodos. Una cohorte de 319 pacientes con trastornos del sueño fueron evaluados mediante estudios clinicos y registro videopoligrafico durante el sueño. Del total de pacientes (n = 209) con distres respiratorio durante el sueño, 145 tenian SAOS con gravedad definida segun el indice de apnea/hipopnea (IAH); 64 presentaban ronquidos primarios o distres respiratorio con IAH < 5; y 110 tenian otros trastornos del sueño. Resultados. La presencia de comorbilidades fue del 75% en todos los pacientes con SAOS y del 79,5% en el grupo de pacientes con SAOS grave; 47 pacientes presentaban una unica comorbilidad, la mas comun de las cuales fue la obesidad (56,3%), seguida de hipertension, diabetes y otros trastornos cardiovasculares. La obesidad estuvo presente en el 84% de los casos mas graves de SAOS y en el 100% de casos con multiples comorbilidades. En comparacion con el grupo de pacientes con distres respiratorio durante el sueño, la comorbilidad aparece normalmente relacionada con el SAOS (p = 0,0196). Conclusion. Las comorbilidades se asocian con frecuencia al SAOS, independientemente de la gravedad de la enfermedad. Entre las comorbilidades presentes, la obesidad resulto ser la mas comun en los casos mas graves de SAOS.

  3. [Postmastectomy pain syndrome in our region: characteristics, treatment, and experience with gabapentin].

    PubMed

    de Miguel-Jimeno, Juan M; Forner-Cordero, Isabel; Zabalza-Azparren, Marta; Matute-Tobias, Belinda

    2016-03-16

    Introduccion. El sindrome de dolor posmastectomia puede afectar a mas de la mitad de pacientes intervenidas por cancer de mama. Objetivos. Revisar las caracteristicas clinicas de este sindrome y su evolucion, y evaluar la respuesta al tratamiento farmacologico. Pacientes y metodos. Estudio retrospectivo de 65 pacientes con un seguimiento superior a cinco años. Resultados. El 88% de las pacientes estaba sin diagnosticar. Su edad media era de 56,49 años y permanecieron con dolor un promedio de 29,15 meses. En el 71%, las alteraciones neurologicas correspondieron al segundo nervio intercostobraquial. La media en la puntuacion de dolor antes del tratamiento fue de 66,5 puntos en la escala analogica visual y de 13,14 en el indice de Lattinen. El tratamiento con gabapentina (dosis media: 1.135 mg/dia; duracion media: 14 semanas) disminuyo el dolor en el 80% de las pacientes (p < 0,0001). La mejoria se mantuvo a largo plazo. Un 10% continuo en tratamiento y el 10% debio suspenderlo por efectos secundarios. El numero necesario de pacientes que hubo que tratar fue de 2,13. Recidivo el 35% y preciso cambiar de farmaco el 15,68% de las tratadas con gabapentina, frente al 50% de las tratadas con otros farmacos (p = 0,046). No se encontraron diferencias en la eficacia entre ambos grupos. Conclusiones. El dolor posmastectomia es una patologia infradiagnosticada. El tratamiento (en especial con gabapentina) puede ser eficaz y bien tolerado hasta en el 90% de las pacientes de forma significativa.

  4. [Status epilepticus in paediatrics: a retrospective study and review of the literature].

    PubMed

    Moreno-Medinilla, Esther E; Negrillo-Ruano, Rocío; Calvo-Medina, Rocío; Mora-Ramírez, M Dolores; Martínez-Antón, Jacinto L

    2015-05-01

    Introduccion. El estado epileptico (EE) es la emergencia neurologica mas frecuente en pediatria. Dada la posibilidad de secuelas neurologicas y mortalidad asociadas, requiere un tratamiento agresivo precoz. Pacientes y metodos. Estudio descriptivo retrospectivo a traves de la revision de historias clinicas de pacientes ingresados en nuestro hospital entre 2010-2013 con diagnostico de EE. El objetivo fue describir las caracteristicas epidemiologicas y el manejo de estos pacientes, asi como revisar la bibliografia disponible sobre este tema. Resultados. Hemos recogido 39 pacientes (25 varones) y 51 episodios de EE. Edad media: 4,8 años. Tenian enfermedad de base 22 pacientes. Dieciocho eran epilepticos conocidos y cinco tuvieron un EE previo. De los 51 episodios de EE, 33 fueron sintomaticos, 15 febriles y tres criptogenicos. Los tipos de EE fueron: 25 parciales (de ellos, 16 complejos) y 26 generalizados. El tratamiento de primera eleccion fue benzodiacepinas en 47 pacientes (40, diacepam), fenitoina en tres y acido valproico en uno. Veintisiete pacientes precisaron farmacos de segunda linea: 16, acido valproico; ocho, fenitoina; dos, fenobarbital; y uno, levetiracetam. Diez pacientes precisaron farmacos de tercera linea para la induccion del coma: el midazolam fue el mas utilizado en nuestro centro, seguido del tiopental y el propofol. Dos EE superrefractarios requirieron inmunoglobulinas y corticoides sistemicos por presentarse en el curso de encefalitis autoinmunes. Conclusiones. Debe plantearse el esquema terapeutico del EE desde el inicio de cualquier crisis convulsiva. El tratamiento es escalonado, con benzodiacepinas en la primera etapa, antiepilepticos de amplio espectro y disponibilidad intravenosa en la segunda (acido valproico, levetiracetam en el EE generalizado y fenitoina en el EE focal), mientras que el tercer nivel varia en funcion de la experiencia de cada equipo.

  5. [Stroke in children. Experience in an emergency service].

    PubMed

    Huici-Sánchez, Malka; Escuredo-Argullós, Laura; Trenchs-Sáinz de la Maza, Victoria; Luaces-Cubells, Carles

    2014-08-01

    Objetivos. Describir las caracteristicas de la enfermedad cerebrovascular (ECV) en pacientes atendidos en un servicio de urgencias pediatrico y detectar diferencias clinicas segun sea isquemica o hemorragica. Pacientes y metodos. Estudio retrospectivo, analitico observacional, realizado en el servicio de urgencias pediatrico de un hospital de tercer nivel. Se incluyen pacientes entre 1 mes y 18 años de edad atendidos en el servicio durante 10 años (enero de 2001 a diciembre de 2011) con diagnostico final de ECV. Se excluyen las hemorragias por traumatismos o secundarias a tumores, las trombosis de senos venosos y los pacientes no atendidos en el servicio. Resultados. Se incluyen 61 pacientes, 39 (63,9%) de sexo masculino, con una mediana de edad de 4,6 años (rango: 1,3 meses-17,5 años). De ellos, 26 (42,6%) presentan ECV isquemica y 35 (57,4%) ECV hemorragica. La cefalea (n = 20; 57,1%; p = 0,008) y los vomitos (n = 25; 71,4%; p = 0,001) son mas frecuentes en la ECV hemorragica, y la hemiparesia (n = 17; 65,4%; p < 0,001) y la paralisis facial (n = 7; 26,9%; p = 0,001), en la ECV isquemica. Las principales causas de la ECV hemorragica son las malformaciones arteriovenosas (n = 17; 38,6%), y las de la ECV isquemica, las arteriopatias (n = 6; 42,3%). Al alta, 27 (44,3%) presentaban diferentes grados de discapacidad y 6 (9,8%) fallecieron. Conclusiones. La ECV es una entidad poco frecuente, aunque presenta una elevada morbimortalidad. Se observa un ligero predominio de la ECV hemorragica y se comprueba que la ECV hemorragica se presenta mas con signos de hipertension intracraneal, y la isquemica, con focalidad neurologica.

  6. [Community acquired bacterial meningitis in patients over 60].

    PubMed

    Mora Mora, Luis A; Arco Espinosa, Micke E de; Plumet, Javier; Micheli, Federico

    2015-01-01

    Acute bacterial meningitis has a global mortality rate of 135000 cases per year. In Argentina over the last 12 years, the annual incidence rate has been 5.5/100 000. About 20% of patients present neurological sequelae, which are more common in patients aged 60 or older. Our objective here is to determine the clinical characteristics, the most common causes and to measure evolution in patients over 60 years old diagnosed with meningitis and treated at the Hospital de Clinicas José de San Martín. This is a retrospective study based on a review of medical records from 2003 to 2013 that takes into account patients older than 60 who were diagnosed with acute bacterial meningitis acquired in the community by a microbiological diagnosis of CSF or those included due to a high suspicion of bacterial meningitis (pleocitosis > 2000 cells/mm3, proteins > 220 mg/dl, glycorrhachia < 34 mg/dl, glycorrhachia/glucose index < 0.23). Cases of TB meningitis, nosocomial, postoperative and other nonbacterial meningitis were excluded. Sixty nine patients were included, 45 (65%) were women with an average age of 78 ± 10.6 years. Only 40% had the triad of classical meningitis symptoms (stiff neck, fever and altered mental status). In 52% of the patients germs developed in the CSF, the most frequent being Streptococcus pneumoniae present in 47% of cases. Lethality rate was 41%, all of them by methicillin-sensitive Staphylococcus aureus. Only 24 (35%) cases were admitted into intensive care. The main sequelae present were motor disorders (12%) and hearing loss (5%).

  7. The prognostic value of sentinel lymph node micrometastases in patients with invasive breast carcinoma.

    PubMed

    Cipolla, Calogero; Graceffa, Giuseppa; La Mendola, Roberta; Fricano, Salvatore; Fricano, Martina; Vieni, Salvatore

    2015-01-01

    Il significato prognostico delle micrometastasi nel linfonodo sentinella nelle pazienti affette da carcinoma della mammella è ancora ampiamente dibattuto. Anche se, in assenza di univoche linee guida, nella pratica clinica la linfadenectomia ascellare in queste pazienti non viene più eseguita di routine. Abbiamo condotto uno studio retrospettivo su 746 patienti affette da carcinoma invasivo della mammella con linfonodi ascellari negativi, sottoposte a chirurgia conservativa o a mastectomia totale con biopsia del linfonodo sentinella. Le pazienti in cui è stata diagnostica la presenza di micrometastasi del linfonodo sentinella sono state considerate in due diversi gruppi. In un primo gruppo, trattato con linfadenectomia ascellare totale è stata valutata l’incidenza di metastasi a carico dei rimanenti linfonodi ascellari. Un secondo gruppo non ha ricevuto alcun trattamento aggiuntivo dell’ascella e le pazienti sono state seguite con controlli periodici clinico strumentali. In entrambi i gruppi è stata valutata l’incidenza di eventuali recidive ascellari. All’esame istologico estemporaneo ed al successivo esame istologico definitivo del linfonodo sentinella, in 51 pazienti (6,83%) sono state evidenziate micrometastasi, in 8 pazienti (1,07%) erano presenti cellule tumorali isolate. Quindici di queste pazienti sono state sottoposte a linfadenectomia ascellare totale. Solo in 2 casi (13,33%) sono state ritrovate metastasi a carico dei rimanenti linfonodi ascellari. Quarantaquattro pazienti non hanno ricevuto alcun trattamento aggiuntivo dell’ascella. In queste pazienti nessuna recidiva ascellare è stata registrata durante un follow-up medio di 65,3±9,65 mesi (range 42-78 mesi). Sulla base dei risultati ottenuti in questo studio ed in linea con alcuni recenti trials randomizzati si ci sentiamo di concludere che la linfadenectomia ascellare può essere evitata nei casi con micrometastasi nel linfonodo sentinella. Una sua eventuale indicazione può essere

  8. [Brainstem auditory evoked potentials and somatosensory evoked potentials in Chiari malformation].

    PubMed

    Moncho, Dulce; Poca, María A; Minoves, Teresa; Ferré, Alejandro; Rahnama, Kimia; Sahuquillo, Juan

    2013-06-16

    Introduccion. La malformacion de Chiari (MC) incluye una serie de anomalias congenitas que tienen como comun denominador la ectopia de las amigdalas del cerebelo por debajo del foramen magno, lo que puede condicionar fenomenos compresivos del troncoencefalo, la medula espinal alta y los nervios craneales, alterando las respuestas de los potenciales evocados auditivos del tronco cerebral (PEATC) y de los potenciales evocados somatosensoriales (PESS). Sin embargo, las indicaciones de ambas exploraciones en las MC han sido motivo de estudio en un numero limitado de publicaciones, centradas en series cortas y heterogeneas de pacientes. Objetivo. Revisar los hallazgos de los PEATC y los PESS en los estudios publicados en pacientes con MC tipo 1 (MC-1) o tipo 2 (MC-2), y su indicacion en el diagnostico, tratamiento y seguimiento, especialmente en la MC-1. Desarrollo. Es un estudio de revision realizado mediante analisis de los estudios publicados en Medline desde 1966, localizados mediante PubMed, utilizando combinaciones de las palabras clave 'Chiari malformation', 'Arnold-Chiari malformation', 'Chiari type 1 malformation', 'Arnold-Chiari type 1 malformation', 'evoked potentials', 'brainstem auditory evoked potentials' y 'somatosensory evoked potentials', asi como informacion de pacientes con MC-1 valorados en los servicios de neurocirugia y neurofisiologia clinica del Hospital Universitari Vall d'Hebron. Conclusiones. Los hallazgos mas comunes de los PESS son la reduccion en la amplitud cortical para el nervio tibial posterior, la reduccion o ausencia del potencial cervical del nervio mediano y el aumento del intervalo N13-N20. En el caso de los PEATC, los hallazgos mas frecuentes descritos son el aumento del intervalo I-V y la alteracion periferica o coclear.

  9. [Hemicrania continua and paroxysmal hemicrania: clinical and therapeutic characteristics in a series of 23 patients].

    PubMed

    Benítez-Rivero, Sonia; González-Oria, Carmen; Gómez-Caravaca, Teresa; Bernal Sánchez-Arjona, María; Jiménez-Hernández, M Dolores

    2014-10-16

    Introduccion. Las hemicraneas son cefaleas raras caracterizadas por dolor estrictamente unilateral, bien como una cefalea continua, aunque fluctuante, en la hemicranea continua (HC), o en forma de ataques recurrentes en la hemicranea paroxistica (HP). En ambos tipos de cefalea se describe una respuesta absoluta a la indometacina. Objetivo. Analizar el cumplimiento de los criterios diagnosticos actuales para HC y HP, y la reciente introduccion de la HC en el grupo de las cefaleas trigeminoautonomicas. Pacientes y metodos. Evaluamos retrospectivamente las caracteristicas clinicas y terapeuticas de pacientes diagnosticados de HC o HP. Incluimos informacion demografica, sintomatologia, escala analogica de dolor y respuesta a la indometacina. Resultados. Evaluamos una muestra de 12 pacientes con HC (cuatro hombres y ocho mujeres) de un total de 520 casos (2,3%). Edad media de inicio: 47,1 ± 16,4 años. Intensidad de dolor basal: 3,3 ± 1,9. Exacerbaciones: 9,2 ± 1,1. Ocho casos (66,7%) presentaban sintomas autonomicos, cuatro (33,3%) tenian patron horario y dos (16,7%) no respondieron a la indometacina. Evaluamos una muestra de 11 pacientes con HP (100% mujeres) de 520 casos (2,1%). Edad media de inicio: 37,0 ± 13,9 años. Intensidad de dolor: 8,7 ± 2,7. Nueve casos (81,8%) presentaban sintomas autonomicos, tres (27,3%) tenian patron horario y uno (9,1%) no respondio a la indometacina. Conclusiones. Las hemicraneas son diagnosticos infrecuentes en consultas de cefalea. Su diagnostico requiere el cumplimiento de unos criterios que a veces no se cumplen en su totalidad. Pensamos que se precisa una revision de los criterios y apoyamos que la HC se haya introducido recientemente en el grupo de las cefaleas trigeminoautonomicas.

  10. Immune status at presentation for human immunodeficiency virus clinical care in Rio de Janeiro and Baltimore

    PubMed Central

    Moreira, Ronaldo I.; Luz, Paula M.; Struchiner, Claudio J.; Morgado, Mariza; Veloso, Valdilea G.; Keruly, Jeanne C.; Grinsztejn, Beatriz; Moore, Richard D.

    2011-01-01

    Introduction Late presentation to HIV clinical care increases individual risk of (multiple) clinical events and death, and decreases successful response to highly active antiretroviral therapy (HAART). In Brazil, provision of HAART free of charge to all HIV-infected individuals could lead to increased testing and linkage to care. Methods We assessed the immune status of 2,555 patients who newly presented for HIV clinical care between 1997 and 2009 at the Johns Hopkins Clinical Cohort, in Baltimore, USA and at the Instituto de Pesquisa Clinica Evandro Chagas Clinical Cohort, in Rio de Janeiro, Brazil. The mean change in the CD4 cell count per year was estimated using multivariate linear regression models. Results Overall, from 1997 to 2009, 56% and 54% of the patients presented for HIV clinical care with CD4 count ≤ 350 cells/mm3 in Baltimore and Rio de Janeiro, respectively. On average, 75% of the patients presented with viral load > 10,000 copies/mL. In Rio de Janeiro only, the overall adjusted per year increase in the mean CD4 cell count was statistically significant [5 cells/mm3 (95% CI 1, 10 cells/mm3)]. Discussion We found that, over years, the majority of patients presented late, that is, with a CD4 count < 350 cells/mm3. Our findings indicate that, despite the availability of HAART for more than a decade, and mass media campaigns stimulating HIV testing in both countries, the proportion of patients who start therapy at an advanced stage of the disease is still high. PMID:21857314

  11. Immune status at presentation for HIV clinical care in Rio de Janeiro and Baltimore.

    PubMed

    Moreira, Ronaldo I; Luz, Paula M; Struchiner, Claudio J; Morgado, Mariza; Veloso, Valdilea G; Keruly, Jeanne C; Grinsztejn, Beatriz; Moore, Richard D

    2011-08-01

    Late presentation to HIV clinical care increases individual risk for (multiple) clinical events and death, and decreases successful response to highly active antiretroviral therapy (HAART). In Brazil, provision of HAART free of charge to all individuals infected with HIV could lead to increased testing and linkage to care. We assessed the immune status of 2555 patients who newly presented for HIV clinical care between 1997 and 2009 at the Johns Hopkins Clinical Cohort, in Baltimore, Md, and at the Instituto de Pesquisa Clinica Evandro Chagas Clinical Cohort, in Rio de Janeiro, Brazil. The mean change in the CD4 cell count per year was estimated using multivariate linear regression models. Overall, from 1997 to 2009, 56% and 54% of the patients presented for HIV clinical care with CD4 count ≤350 cells per cubic millimeter in Baltimore and Rio de Janeiro, respectively. On average, 75% of the patients presented with viral load >10,000 copies per millimeter. In Rio de Janeiro only, the overall adjusted per year increase in the mean CD4 cell count was statistically significant (5 cells/mm, 95% confidence interval: 1 to 10 cells/mm). We found that, over years, the majority of patients presented late, that is, with a CD4 count <350 cells per cubic millimeter. Our findings indicate that, despite the availability of HAART for more than a decade, and mass media campaigns stimulating HIV testing in both countries, the proportion of patients who start therapy at an advanced stage of the disease is still high.

  12. [Impact of acquired brain injury towards the community integration: employment outcome, disability and dependence two years after injury].

    PubMed

    Luna-Lario, P; Ojeda, N; Tirapu-Ustarroz, J; Pena, J

    2016-06-16

    Objetivos. Analizar el impacto del daño cerebral adquirido en la integracion comunitaria (trayectoria laboral, discapacidad y dependencia) en una muestra de sujetos con daño cerebral adquirido de etiologia vascular, traumatica y tumoral, durante un periodo de dos años tras la lesion original, y examinar que variables sociodemograficas, datos clinicos premorbidos y relacionados con la lesion predicen la integracion en la comunidad. Pacientes y metodos. Muestra de 106 sujetos adultos con daño cerebral adquirido, atendidos en el Area de Neuropsicologia y Neuropsiquiatria del Complejo Hospitalario de Navarra, con deficit de memoria como secuela principal. Las diferencias entre grupos se analizan con los tests t de Student, chi al cuadrado y U de Mann-Whitney. Resultados. De los participantes que antes de la lesion se encontraban activos laboralmente, el 19% y 29% recuperaron su estatus previo al año y a los dos años, respectivamente; a un 45% de la muestra total se le reconocio la discapacidad, y a un 17%, la dependencia. No se hallo relacion entre las variables sociodemograficas y clinicas y los parametros funcionales contemplados. Conclusiones. La lesion cerebral adquirida impacta con intensidad en la trayectoria vital de los afectados, aunque no se han estudiado antes en España sus consecuencias en el ajuste sociolaboral en los dos años siguientes al daño a traves de parametros funcionales valorados con instrumentos oficiales estatales en una muestra de etiologia vascular, traumatica y tumoral.

  13. Incidence and risk factors for central nervous system relapse in children and adolescents with acute lymphoblastic leukemia

    PubMed Central

    Cancela, Camila Silva Peres; Murao, Mitiko; Viana, Marcos Borato; de Oliveira, Benigna Maria

    2012-01-01

    Background Despite all the advances in the treatment of childhood acute lymphoblastic leukemia, central nervous system relapse remains an important obstacle to curing these patients. This study analyzed the incidence of central nervous system relapse and the risk factors for its occurrence in children and adolescents with acute lymphoblastic leukemia. Methods This study has a retrospective cohort design. The studied population comprised 199 children and adolescents with a diagnosis of acute lymphoblastic leukemia followed up at Hospital das Clinicas, Universidade Federal de Minas Gerais (HC-UFMG) between March 2001 and August 2009 and submitted to the Grupo Brasileiro de Tratamento de Leucemia da Infância - acute lymphoblastic leukemia (GBTLI-LLA-99) treatment protocol. Results The estimated probabilities of overall survival and event free survival at 5 years were 69.5% (± 3.6%) and 58.8% (± 4.0%), respectively. The cumulative incidence of central nervous system (isolated or combined) relapse was 11.0% at 8 years. The estimated rate of isolated central nervous system relapse at 8 years was 6.8%. In patients with a blood leukocyte count at diagnosis ≥ 50 x 109/L, the estimated rate of isolated or combined central nervous system relapse was higher than in the group with a count < 50 x 109/L (p-value = 0.0008). There was no difference in cumulative central nervous system relapse (isolated or combined) for the other analyzed variables: immunophenotype, traumatic lumbar puncture, interval between diagnosis and first lumbar puncture and place where the procedure was performed. Conclusions These results suggest that a leukocyte count > 50 x 109/L at diagnosis seems to be a significant prognostic factor for a higher incidence of central nervous system relapse in childhood acute lymphoblastic leukemia. PMID:23323068

  14. State of malnutrition in cuban hospitals; a needed update.

    PubMed

    Santana Porbén, Sergio

    2015-05-01

    Justificación: El Estudio Cubano de Desnutricion Hospitalaria, conducido en el bienio 1999 – 2001 con 1,905 pacientes atendidos en 12 hospitales de 6 provincias del pais, revelo una tasa de desnutricion hospitalaria del 41.2%. Transcurrida una decada de aquella indagacion, se impone la actualizacion de este estimado. Objetivo: Actualizar el estado de la desnutricion hospitalaria en Cuba. Material y método: La presencia de desnutricion en 1,664 pacientes ingresados en 12 hospitales de 8 provincias del pais entre Marzo del 2012 y Marzo del 2014 se documento mediante la Encuesta Subjetiva Global (ESG). El estado de los procesos hospitalarios de cuidados alimentarios y nutricionales se evaluo con la Encuesta de Nutricion Hospitalaria (ENH). Resultados: La tasa corriente de desnutricion hospitalaria fue del 36.9% (Δ = +4.3%; p < 0.05). Las tasas de completamiento de los ejercicios hospitalarios de evaluacion nutricional y de uso de terapias de replecion nutricional fueron superiores. Conclusiones: Transcurridos 10 anos de la primera edicion del Estudio ELAN CUBA, se aprecian modestos avances en la identificacion y el tratamiento de la desnutricion en los hospitales en Cuba. Se percibe que la formacion e insercion de nutricionistas verticalizados en la actuacion hospitalaria haya contribuido al cambio observado. Asimismo, la actividad de la Sociedad Cubana de Nutricion Clinica y Metabolismo en el avance de las disciplinas de la terapia nutricional, la nutricion artificial y el metabolismo puede haber servido para un mejor reconocimiento del problema de salud representado por la desnutricion hospitalaria.

  15. [La Medicina del Lavoro: 100 volumes].

    PubMed

    Zocchetti, C

    2009-01-01

    With these pages La Medicina del Lavoro starts its 100th volume, so we have yet another historical occasion to celebrate the oldest occupational health journal in the world that is still publishing. Over the last few years we have had many occasions to celebrate, for example several anniversaries of the Journal (the 80th volume in 1989, 90 years in 1992, 100 years in 2001); the centenary of the foundation of the Clinica del Lavoro "Luigi Devoto" of Milan in 2001; the celebration of the 300 years' anniversary of the publication of De Morbis Artificum Diatriba by Bernardino Ramazzini, and we obviously hope to continue for many years to come in this positive outlook. One hundred volumes makes for a very large collection, with the highs and lows ofthe Journal's history (here we mean the variations in number of pages and physical size of the Journal). It is thanks to the Editors-in-chief(there have been very few so we can cite them all: Luigi Devoto, 1901-1936; Luigi Preti, 1936-1941; Enrico Vigliani, 1943-1992; e Vito Foà, 1992 to the present); the contributors who in various ways and with varying degrees of commitment but always with an exceptional personal participation, that it has been possible to reach 100 volumes, starting with C. Moreschi who, along with Luigi Devoto, was the first and sole editor at the Journal's foundation; up to the present extended and impressive editorial board; the printers (from the first. Tipografia Cooperativa, Via dei Molini in Pavia, to the latest: Casa Editrice Mattioli in Fidenza); the sponsors, including the most evident who, via advertising (rather limited as a matter offact), directly gave information about themselves, but also those who have often been or are behind the scenes, ensuring fundamental support which is not visible; content. articles, news, events, reports, ideas, opinions, photographs, tables, numbers... etc, which are really impossible to sum up. But the true collection which, for obvious reasons, cannot be

  16. THE INFLUENCE OF HLA-DQ2 HETERODIMERS ON THE CLINICAL FEATURES AND LABORATORY OF PATIENTS WITH CELIAC DISEASE.

    PubMed

    Akar, H Haluk; Yıldız, Mikdat; Sevinc, Eylem; Sokucu, Semra

    2015-12-01

    Antecedentes y objetivo: el marcador genético esencial relacionado con la enfermedad celíaca (CD) es la molécula HLA-DQ2 codificada por los genes DQA1*0501 y DQB1*0201. El objetivo de este estudio es evaluar el efecto de estos alelos en las características clínicas, serológicas e histológicas de los niños turcos que tienen la enfermedad celíaca. Material y métodos: nosotros hemos dividido los 36 pacientes celíacos en 4 grupos de acuerdo con su genotipo HLA-DQ2 basado en la presencia o la ausencia de los alelos DQA1*0501 y DQB1*0201. Grupo 1: 4 pacientes que no tenían los alelos HLA-DQ2A1*0501 y DQ2B1*0201; Grupo 2: 12 pacientes que tenían por lo menos uno de estos alelos con un estado heterocigoto; Grupo 3: 12 pacientes que tenián ambos alelos con un estado heterocigoto; Grupo 4: 8 pacientes que tenían ambos alelos con un estado heterocigoto. Nosotros hemos comparado los grupos de acuerdo con las características clínicas, serológicas, histológicas y bioquímicas. Resultados: no había significación estadística entre los grupos por edad, índice de masa corporal, (IMC), peso por altura y aparición de síntomas. Sin embargo, en los grupos 3 y 4 comparados con los grupos 1 y 2 se observaron unas diferencias menores en IMC y anticuerpos antigliadina (AGA), sin una significación estadística. De acuerdo con los antiendomisios (EMA), la puntuación Marsh, las presentaciones clínicas y los valores hematológicos y bioquímicos, no había una significación estadística entre los grupos sin estreñimiento respecto a los valores más altos observados en el grupo 4 sin significación estadística. Se detectó hipertiroidismo en un paciente (25%) del grupo de carga genética más baja (grupo 1) con significación estadística (p < 0,046). El resultado: en este estudio, las pequeñas diferencias que se encontraton entre los grupos no dilucidaron el impacto de los alelos HLA-DQ2 A1*0501 y DQ2B1*0201 en las manifectaciones clínicas, serológicas y de

  17. Statistical Reviewers Improve Reporting in Biomedical Articles: A Randomized Trial

    PubMed Central

    Cobo, Erik; Selva-O'Callagham, Albert; Ribera, Josep-Maria; Cardellach, Francesc; Dominguez, Ruth; Vilardell, Miquel

    2007-01-01

    Background Although peer review is widely considered to be the most credible way of selecting manuscripts and improving the quality of accepted papers in scientific journals, there is little evidence to support its use. Our aim was to estimate the effects on manuscript quality of either adding a statistical peer reviewer or suggesting the use of checklists such as CONSORT or STARD to clinical reviewers or both. Methodology and Principal Findings Interventions were defined as 1) the addition of a statistical reviewer to the clinical peer review process, and 2) suggesting reporting guidelines to reviewers; with “no statistical expert” and “no checklist” as controls. The two interventions were crossed in a 2×2 balanced factorial design including original research articles consecutively selected, between May 2004 and March 2005, by the Medicina Clinica (Barc) editorial committee. We randomized manuscripts to minimize differences in terms of baseline quality and type of study (intervention, longitudinal, cross-sectional, others). Sample-size calculations indicated that 100 papers provide an 80% power to test a 55% standardized difference. We specified the main outcome as the increment in quality of papers as measured on the Goodman Scale. Two blinded evaluators rated the quality of manuscripts at initial submission and final post peer review version. Of the 327 manuscripts submitted to the journal, 131 were accepted for further review, and 129 were randomized. Of those, 14 that were lost to follow-up showed no differences in initial quality to the followed-up papers. Hence, 115 were included in the main analysis, with 16 rejected for publication after peer review. 21 (18.3%) of the 115 included papers were interventions, 46 (40.0%) were longitudinal designs, 28 (24.3%) cross-sectional and 20 (17.4%) others. The 16 (13.9%) rejected papers had a significantly lower initial score on the overall Goodman scale than accepted papers (difference 15.0, 95% CI: 4.6–24

  18. CohortExplorer: A Generic Application Programming Interface for Entity Attribute Value Database Schemas.

    PubMed

    Dixit, Abhishek; Dobson, Richard J B

    2014-12-01

    Most electronic data capture (EDC) and electronic data management (EDM) systems developed to collect and store clinical data from participants recruited into studies are based on generic entity-attribute-value (EAV) database schemas which enable rapid and flexible deployment in a range of study designs. The drawback to such schemas is that they are cumbersome to query with structured query language (SQL). The problem increases when researchers involved in multiple studies use multiple electronic data capture and management systems each with variation on the EAV schema. The aim of this study is to develop a generic application which allows easy and rapid exploration of data and metadata stored under EAV schemas that are organized into a survey format (questionnaires/events, questions, values), in other words, the Clinical Data Interchange Standards Consortium (CDISC) Observational Data Model (ODM). CohortExplorer is written in Perl programming language and uses the concept of SQL abstract which allows the SQL query to be treated like a hash (key-value pairs). We have developed a tool, CohortExplorer, which once configured for a EAV system will "plug-n-play" with EAV schemas, enabling the easy construction of complex queries through an abstracted interface. To demonstrate the utility of the CohortExplorer system, we show how it can be used with the popular EAV based frameworks; Opal (OBiBa) and REDCap. The application is available under a GPL-3+ license at the CPAN website. Currently the application only provides datasource application programming interfaces (APIs) for Opal and REDCap. In the future the application will be available with datasource APIs for all major electronic data capture and management systems such as OpenClinica and LabKey. At present the application is only compatible with EAV systems where the metadata is organized into surveys, questionnaires and events. Further work is needed to make the application compatible with EAV schemas where the

  19. Analysis of the microbial load in instruments used in orthopedic surgeries.

    PubMed

    Pinto, Flávia Morais Gomes; de Souza, Rafael Queiroz; da Silva, Cely Barreto; Mimica, Lycia Mara Jenné; Graziano, Kazuko Uchikawa

    2010-04-01

    Because of advances in technology, the number of orthopedic surgeries, mainly hip and knee replacement surgeries, has increased, with a total of 150,000 prosthetic surgeries estimated per year in the United States and 400,000 worldwide. We used an exploratory cross-sectional study, with a quantitative approach to determine the microbial load in instruments used in orthopedic surgeries, quantifying and identifying the microbial growth genus and species, according to the surgical potential of contamination that characterizes the challenge faced by the Material and Sterilization Center at the Institute of Orthopedics and Traumatology of Hospital das Clinicas of the School of Medicine of the University of Sao Paulo, Brazil.The orthopedic surgical instruments were immersed, after their use, in sterilized distilled water, sonicated in an ultrasonic washer, and posteriorly agitated. Subsequently, the wash was filtrated through a 0.45-mum membrane and incubated in aerobic and anaerobic mediums and in medium for fungi and yeasts. In clean surgeries, 47% of the instruments were contaminated; in contaminated surgeries, 70%; and, in infected surgeries, 80%. Regardless of the contamination potential of the surgeries, the highest quantitative incidence of microorganism recovery was located in the 1 to 100 colony-forming unit range, and 13 samples presented a microbial growth potential >300 colony-forming units. Regardless of the contamination potential of the surgeries, there was a convergence in the incidence of negative-coagulase Staphylococcus growth (28%, clean surgeries; 32%, contaminated surgeries; and 29%, infected surgeries) and Staphylococcus aureus (28%, contaminated surgeries; and 43%, infected surgeries). Most of the microorganisms recovered from the analyzed instruments (78%) were vegetative bacteria that presented their death curve at around 80 degrees C, characterizing a low challenge considering the processes of cleaning and sterilization currently employed by

  20. Quality of Life in Children with Obsessive-Compulsive Disorder.

    PubMed

    Vieira, Joana; Ramalho E Silva, Filipa

    2016-09-01

    Introdução: A perturbação obsessiva-compulsiva foi apontada como uma das doenças mais debilitantes do mundo desenvolvido. Contudo, muito pouco é conhecido sobre esta doença relativamente ao modo como ela afeta a qualidade de vida das crianças. Material e Métodos: Conduzimos uma pesquisa na PubMed e Thomson Reuters Web Of Science usando os seguintes termos de pesquisa: ‘Quality of life’, ‘Obsessive-compulsive disorder’, ‘Child’, ‘Pediatrics’ e ‘Adolescent’. Dos 138 artigos obtidos, cinco correspondiam aos objetivos desta revisão. Analisámos a qualidade de vida de crianças com perturbação obsessiva-compulsiva comparando com a população geral e procurando a relação com outras variáveis clinicas como o sexo, idade, comorbilidades, categoria de sintomas, severidade dos sintomas e acomodação familiar. Resultados: Apesar dos estudos não serem concordantes relativamente às diferentes dimensões analisadas, os nossos resultados apontam para um decréscimo global da qualidade de vida em crianças com perturbação obsessiva-compulsiva. A presença de comorbilidades, a severidade dos sintomas e as obsessões de agressão/dano são as variáveis que têm maior influência na qualidade de vida dos pacientes. Discussão: O reduzido número de artigos encontrados e o facto de estes apresentarem uma metodologia extremamente heterogénea torna difícil alcançar conclusões robustas. Apesar disto, os nossos resultados são concordantes com estudos realizados em adultos. Conclusão: A qualidade de vida em crianças e adolescentes deve ser melhor explorada em futuros estudos. Sugerimos a introdução da qualidade de vida como instrumento usado rotineiramente para avaliar a resposta ao tratamento e evolução do paciente.

  1. [BODY ADIPOSITY AND ITS RELATIONSHIP OF METABOLIC SYNDROME COMPONENTS IN COLOMBIAN ADULTS].

    PubMed

    González-Ruíz, Katherine; Correa-Bautista, Jorge Enrique; Ramírez-Vélez, Robinson

    2015-10-01

    Objetivo: recientemente, Bergman et al. desarrollaron el indice de adiposidad corporal (IAC) como un marcador de obesidad por exceso de grasa corporal en la practica clinica. Este estudio valoro la prevalencia de obesidad y de sindrome metabolico (SM), ademas de examinar la relacion del IAC como predictor de riesgo en los componentes e indices aterogenicos asociados al SM en adultos de Bogota, Colombia. Métodos: estudio transversal en 690 hombres del sector educativo y administrativo de Bogota, Colombia. El IAC se estimo con la ecuacion de Bergman et al. Los componentes del SM evaluados fueron (circunferencia de cintura ≥ 90 cm; glucemia en ayunas ≥ 100 mg/dL; presion arterial ≥ 135/85 mmHg; trigliceridemia ≥ 150 mg/dL, y c-HDL ≤ 40 mg/dL. Se calcularon indices aterogenicos (colesterol/c-HDL, c-LDL/c-HDL, trigliceridos/c-HDL, indice lipidico-metabolico [ILM] y score de SM). Resultados: la prevalencia de obesidad por IAC (> 26,1%) y de SM fue de 50,1% y 19,1%, respectivamente. Los sujetos con SM e IAC > 26,1% presentaron menores niveles de c-HDL y mayor frecuencia en los componentes asociados al SM (circunferencia de cintura, colesterol total y trigliceridos sericos). Con relacion a los indices aterogenicos, el IAC fue capaz de predecir en 1,78 (IC95% 1,25- 2,55), 1,46 (IC95% 1,01-2,14), 1,97 (IC95% 1,29-3,02), 2,04 (IC95% 1,23-3,39) y 1,47 (IC95% 1,03-2,11) la elevacion en el c-LDL, ILM, score de SM y los cocientes CT/c-HDL, y trigliceridos/c-HDL, respectivamente (p < 0,05). Conclusión: los participantes con mayores valores en el IAC presentan mayor frecuencia y asociacion positiva con los componentes relacionados al SM.

  2. p27(kipl) protein expression: an independent prognostic factor in rectal carcinoma stages I-III.

    PubMed

    Pucciarelli; Esposito; Fassina; Alaggio; Masin; Toppan; Chieco-Bianchi; Lise

    1999-11-01

    To evaluate the impact of some molecular markers on lymph node metastases, overall (OS) and disease-free survival (DFS) in rectal cancer. We investigated p27(kip1) , p53, nm23, and vascular endothelial growth factor (VEGF) expression in 109 primary rectal cancer specimens (stage I, n=38; stage II, n=24; stage III, n=20; and stage IV, n=27) from patients operated on between 1990 and 1995 at Clinica Chirurgica II. Tumour differentiation (P=0.0469), depth of rectal wall invasion (T status) (P=0.0000), distant metastases (P=0.0000), vascular invasion (P=0.0000), and p27(kip1) expression (P=0.0022) were associated with lymph node metastases (N status). During follow up (median duration 47 months), 48 patients died, and 25 patients (stages I-III) had recurrences. At multivariate analysis, T and N status, and intratumoural necrosis were independent risk factors for OS. The relative risk (RR) of death for patients with lymph node metastases, advanced T status and intratumoural necrosis was 3.3 (P=0.0002), 2.03 (P=0.0127), and 1.47 (P=0.1935), respectively. When analysis included only stage I-III patients, N status and p27(kip1) protein expression were found to be independent risk factors for OS. The RR of death for patients with lymph node metastases and those without p27(kip1) expression was 2.98 (P=0.0251), and 3.57 (P=0.0231), respectively. At multivariate analysis, N status, p27(kip1) expression, and intratumoural necrosis were independent risk factors for DFS. The RR of recurrence for patients with lymph node metastases, intratumoural necrosis and absence of p27(kip1) expression was 6.29 (P=0.0001), 3.04 (P=0.0168), and 3.25 (P=0.0387), respectively. Absence of p27(kip1) expression is a useful marker of tumour aggressiveness in rectal carcinoma stages I-III, and an independent predictor for OS and DFS.

  3. The STENTYS® paclitaxel-eluting stent in the treatment of unprotected distal left main.

    PubMed

    Briguori, Carlo; Visconti, Gabriella; Donahue, Michael; Focaccio, Amelia; Mitomo, Satoru; Kawamoto, Hiroyoshi; Nakamura, Sunao

    2015-09-01

    Vessel tapering represents an important limitation of the balloon-expandable drug-eluting stent (DES) in the treatment of distal unprotected left main coronary artery (ULMCA) lesions. In this study, we assessed the suitability of the STENTYS DES((P)) , a self-apposing nitinol paclitaxel-eluting stent, for use in the treatment of distal ULMCA lesions. From February 2012 to September 2013, 75 consecutive patients with tapered (that is a >1 mm difference in the diameter from the proximal to the distal main vessel) distal ULMCA lesions were treated with the STENTYS DES((P)) (STENTYS-DES group) at the Clinica Mediterranea (Naples, Italy). A matched-group of 75 patients treated with second-generation DES in the same period (Control group) was selected from the database of New Tokyo Hospital (Chiba, Japan). The result was assessed by both quantitative coronary angiography and intravascular ultrasound (IVUS). Although the final balloon diameter was larger in the Control group (4.51 ± 0.51 vs. 3.62 ± 0.49 mm; P < 0.001), the IVUS analysis showed a larger final minimal lumen area in the STENTYS-DES group than in the Control group (left main: 17.45 ± 3.45 vs. 14.84 ± 3.45 mm(2) ; P < 0.001; polygon of confluence: 15.74 ± 3.28 vs. 12.55 ± 5.45 mm(2) ; P < 0.002; ostial left anterior descending artery: 11.73 ± 1.97 vs. 8.56 ± 1.80 mm(2) ; P < 0.001). At 12 ± 5 months, major adverse cardiac events (including death, myocardial infarction, and repeat revascularization) occurred in seven patients in both groups. This pilot study suggests that the self-apposing properties of the STENTYS DES((P)) offer a valid alternative for the treatment of the distal ULMCA lesions. © 2015 Wiley Periodicals, Inc.

  4. NUTRITION THERAPY IN SEPSIS: CHARACTERIZATION AND IMPLICATIONS FOR CLINICAL PROGNOSIS.

    PubMed

    Machado, Raquel Rodrigues Campos; Caruso, Lúcia; Lima, Patricia de Azevedo; Damasceno, Nágila Raquel Teixeira; Soriano, Francisco Garcia

    2015-09-01

    Introducción: la respuesta inflamatoria causada por sepsis provoca cambios metabolicos que pueden provocar una perdida de masa magra significativa en pacientes septicos. Debido a ello, cuando el tracto digestivo es funcional la terapia nutricional (NT) debe iniciarse dentro de las 48 horas de tratamiento intensivo para reducir la perdida de proteina. Objetivo: evaluar la terapia nutricional enteral (TNE) en pacientes septicos adultos con TNE exclusivo para ≥ 72 horas y duracion de ≥ 7 dias de estancia en la Unidad de Cuidados Intensivos y su relacion con el pronostico clinico. Métodos: se analizaron prospectivamente la adecuacion de la nutricion enteral administrada, los factores asociados con la falta de conformidad, la tolerancia gastrointestinal y el resultado. Se utilizaron pruebas estadisticas de chi-cuadrado y la t de Student, asi como las correlaciones de Mann-Whitney y Spearman y Pearson (p < 0,05). Se ha realizado un modelo de regresion logistica multiple mediante el metodo paso a paso para evaluar la asociacion entre factores de prediccion de la evolucion clinica. Resultados: 53 pacientes, 67,9% hombres y 52,8% ancianos se inscribieron en este estudio. El tiempo promedio para el inicio de ENT fue de 30 (23,5) horas, y el 88,7% de los pacientes alcanzaron el objetivo nutricional en 48 horas. El volumen medio entregado en relacion con el prescrito fue 78,9%. Cuando la muestra se estratifico segun calorias prescritas/administradas, los pacientes que recibieron < 80% tenian una tasa de mortalidad mas alta (p = 0,001) y el consumo de calorias ≥ 80% fue el factor determinante en el pronostico clinico de los pacientes (p = 0,021). Conclusión: los pacientes septicos recibieron nutricion enteral precoz. El objetivo nutricional y el volumen medio entregado en relacion con el volumen prescrito cumplen las directrices de cuidados intensivos. El soporte nutricional se asocio con el resultado clinico y la ingesta calorica ≥ 80% para determinar el pronostico

  5. Deaths among the elderly with ICU infections.

    PubMed

    Sousa, Álvaro Francisco Lopes de; Queiroz, Artur Acelino Francisco Luz Nunes; Oliveira, Layze Braz de; Moura, Luana Kelle Batista; Andrade, Denise de; Watanabe, Evandro; Moura, Maria Eliete Batista

    2017-01-01

    to evaluate the clinical outcome of elderly patients admitted to intensive care units who had nosocomial infection, correlating the findings with sociodemographic and clinical variables. descriptive research, performed with 308 elderly patients. The collection was made from medical records and covers the years 2012 to 2015. Uni-/bivariate analyses were performed. a statistical association was found between the clinical outcome types and the variables age, length of stay, presence of previous comorbidities, main diagnosis, respiratory and urinary tract infections, use of central venous and indwelling urinary catheters, mechanical ventilation, and tracheostomy. The survival curve showed higher mortality among the elderly from the age of 80 on. the clinical outcome of the elderly who acquire infection in the intensive care unit is influenced by sociodemographic and clinical variables that increase mortality rates. avaliar o desfecho clínico de idosos que adquiriram infecção hospitalar hospitalizados em Unidades de Terapia Intensiva, correlacionando os achados com variáveis sociodemográficas e clinicas. pesquisa descritiva, realizada com 308 pacientes idosos. A coleta deu-se em prontuários e contempla os anos de 2012 a 2015. Realizaram-se análises uni-/bivariadas. registrou-se associação estatística entre os tipos de desfechos clínicos e as variáveis: faixa etária, tempo de internação, presença de comorbidades prévias, diagnóstico principal, infecção do trato respiratório e urinário, uso de cateteres vesical de demora e venoso central, ventilação mecânica e traqueostomia. A curva de sobrevivência evidenciou maior mortalidade entre idosos a partir de 80 anos. o desfecho clínico de idosos que adquirem infecção na Unidade de Terapia Intensiva é influenciado por variáveis sociodemográficas e clínicas, que incrementam as taxas de mortalidade.

  6. [Change in the therapeutic strategy when faced with an inadequate response to the pharmacological treatment of attention deficit hyperactivity disorder].

    PubMed

    Gandía-Benetó, Rubén; Mulas, Fernando; Roca, Patricia; Ortiz-Sánchez, Pedro; Abad-Mas, Luis

    2015-02-25

    Introduccion. El trastorno por deficit de atencion/hiperactividad (TDAH) es un trastorno del neurodesarrollo cerebral de origen biologico. Se estima que el 3-7% de los niños en edad escolar presentan TDAH. Dentro del tratamiento farmacologico, las anfetaminas y el metilfenidato (MPH) son los mas utilizados. Aunque las tasas de respuesta al MPH son altas, las tasas de remision completa llegan solo al 56%. Un 25% de los pacientes que no responden al MPH si lo haria a otros estimulantes, y viceversa. Objetivo. Valorar clinicamente a los pacientes con deteccion de respuestas inadecuadas y la eficacia de un cambio a lisdexanfetamina dimesilato (LDX). Pacientes y metodos. Estudio observacional prospectivo. Se considero respuesta inadecuada al MPH aquella que presentaba falta de cobertura o de efecto. Se utilizaron las escalas de evaluacion Attention-Deficit/Hyperactivity Disorder Rating Scale IV (ADHD-RS-IV) y Clinical Global Impression-Severity (CGI-S) para la valoracion clinica, asi como la escala de evaluacion del deterioro funcional de Weiss (WFIRS) y el perfil de salud infantil (CHIP-AE). Tambien se recogieron los efectos adversos. Resultados. Cumplieron criterios de respuesta inadecuada al tratamiento 41 pacientes: 13,6 ± 3,4 años, 54,6 ± 13,2 kg, 158,5 ± 17,2 cm e indice de masa corporal de 20,9 ± 3,5 kg/m2. Motivos del cambio (no excluyentes): falta de cobertura (76%), falta de intensidad del efecto (68%) y presencia de efectos adversos con la medicacion anterior (16%). La puntuacion media basal y a los nueve meses, en la ADHD-RS, fue de 24,54 ± 6,3 frente a 12,01 ± 3,2 (p < 0,01), respectivamente, y para la CGI-S, de 5,09 ± 0,5 frente a 2,91 ± 0,8 (p < 0,01), respectivamente. El perfil de seguridad coincidio con el de otros tratamientos estimulantes para el TDAH. Conclusion. Cuando la respuesta al MPH presenta falta de cobertura o falta de efecto, el cambio a LDX se ha mostrado eficaz, con una mejoria en el 86,7% de los casos, similar a la de otros

  7. [Risk of low birth weight in the Plaza de la Habana region].

    PubMed

    Stüsser, R; Paz, G; Ortega, M; Pineda, S; Infante, O; Martín, P; Ordóñez, C

    1993-03-01

    The objective of this study was to confirm the risk factors (RF) for low birth-weight (LBW) and suggest new risk factors, which were analyzed separately and together, in order to define a program to be coordinated by family doctors to reduce the frequency of this problem. For this purpose, a retrospective cross-sectional survey was carried out with 57 cases (mothers who had had LBW babies) and 58 controls (mothers who had not had LBW babies). In addition, data were obtained from the prenatal records of mothers who received care at family doctors' offices and at the clinica in the Plaza de la Habana Area. Estimates were made of the relative risk and the percentage attributable risk of 107 hypothetical RF for LBW from a clinical-epidemiological and social standpoint. One-way analysis of variance, the chi-square test, multiple linear regression, and logistic regression were used to analyze the results, which suggested the following RF for LBW: family dysfunction, family crisis, lack of spousal support, extended family, failure to attend prenatal group sessions for pregnant women, and failure to receive education on how to prevent LBW. The multifactorial risk profile was the following: risk of [corrected] intrauterine growth retardation, family dysfunction, threat of preterm delivery, coffee-drinking, attendance at fewer than 11 prenatal checkups, and failure to attend prenatal group sessions for pregnant women. The variables excluded from the model were: low weight-for-height, lack of spousal support, smoking more than 10 cigarettes a day, and family history of LBW. The findings confirmed 10 of the suspected risk factors for LBW in Cuba and nine of those described in the international literature. Maternal age, spontaneous abortion, and alcohol consumption were not confirmed. Six RF for LBW preventable by the family doctor through his/her actions at the family and community level are identified, as is a multifactorial profile of six RF for LBW. On the basis of these

  8. Statistical reviewers improve reporting in biomedical articles: a randomized trial.

    PubMed

    Cobo, Erik; Selva-O'Callagham, Albert; Ribera, Josep-Maria; Cardellach, Francesc; Dominguez, Ruth; Vilardell, Miquel

    2007-03-28

    Although peer review is widely considered to be the most credible way of selecting manuscripts and improving the quality of accepted papers in scientific journals, there is little evidence to support its use. Our aim was to estimate the effects on manuscript quality of either adding a statistical peer reviewer or suggesting the use of checklists such as CONSORT or STARD to clinical reviewers or both. Interventions were defined as 1) the addition of a statistical reviewer to the clinical peer review process, and 2) suggesting reporting guidelines to reviewers; with "no statistical expert" and "no checklist" as controls. The two interventions were crossed in a 2x2 balanced factorial design including original research articles consecutively selected, between May 2004 and March 2005, by the Medicina Clinica (Barc) editorial committee. We randomized manuscripts to minimize differences in terms of baseline quality and type of study (intervention, longitudinal, cross-sectional, others). Sample-size calculations indicated that 100 papers provide an 80% power to test a 55% standardized difference. We specified the main outcome as the increment in quality of papers as measured on the Goodman Scale. Two blinded evaluators rated the quality of manuscripts at initial submission and final post peer review version. Of the 327 manuscripts submitted to the journal, 131 were accepted for further review, and 129 were randomized. Of those, 14 that were lost to follow-up showed no differences in initial quality to the followed-up papers. Hence, 115 were included in the main analysis, with 16 rejected for publication after peer review. 21 (18.3%) of the 115 included papers were interventions, 46 (40.0%) were longitudinal designs, 28 (24.3%) cross-sectional and 20 (17.4%) others. The 16 (13.9%) rejected papers had a significantly lower initial score on the overall Goodman scale than accepted papers (difference 15.0, 95% CI: 4.6-24.4). The effect of suggesting a guideline to the reviewers

  9. Impact of immunohistochemistry-based molecular subtype on chemosensitivity and survival in Hispanic breast cancer patients following neoadjuvant chemotherapy

    PubMed Central

    Gómez, Rodolfo; Ossa, Carlos Andrés; Montoya, María Elvira; Echeverri, Carolina; Ángel, Gonzalo; Ascuntar, Johana; Borrero, Mauricio; Gil, Mónica; Herrera, Sabrina; Gutiérrez, Eduardo; Herazo, Fernando; Jiménez, Alejo; Madrid, Jorge; Reyes, Pedro Alejandro; Zuluaga, Lina; García, Héctor

    2015-01-01

    Background Neoadjuvant chemotherapy (NAC) is the standard treatment for patients with locally advanced breast cancer, showing improvement in disease-free survival (DFS) and overall survival (OS) rates in patients achieving pathological complete response (pCR). The relationship between immunohistochemistry-based molecular subtyping (IMS), chemo sensitivity and survival is currently a matter of interest. We explore this relationship in a Hispanic cohort of breast cancer patients treated with NAC. Methods A retrospective survival analysis was performed on Colombian females with breast cancer treated at Instituto de Cancerología-Clinica Las Américas between January 2009 and December 2011. Patients were classified according to immunohistochemistry-based subtyping into the following five groups: Luminal A, Luminal B, Luminal B/HER 2+, HER2-enriched, and triple-negative breast cancer. Demographic characteristics, recurrence pattern, and survival rate were reviewed by bivariate and multivariate analysis. Results A total of 328 patients fulfilled the study’s inclusion parameters and the distribution of subtypes were as follows: Luminal A: 73 (22.3%), Luminal B/HER2−: 110 (33.5%), Luminal B/HER2+: 75 (22.9%), HER2-enriched: 30 (9.1%), and triple-negative: 40 (12.2%). The median follow-up was 41 months (interquartile range: 31–52). Pathological response to NAC was as follows: complete pathological response (pCR) in 28 (8.5%) patients, partial 247 (75.3%); stable disease 47 (14.3%), and progression 6 (1.8%) patients. The presence of pCR had a significant DFS and OS in the entire group (p = 0.01) but subtypes had different DFS in Luminal B (p = 0.01) and triple negative (p = 0.02) and also OS in Luminal B (p = 0.01) and triple negative (p = 0.01). Conclusions pCR is associated with an improved overall survival and disease-free survival rates in this group of Hispanics patients. Advanced stages, Luminal B subtypes, triple-negative tumours and non-pCR showed lower DFS

  10. "Poker" association of weekly alternating 5-fluorouracil, irinotecan, bevacizumab and oxaliplatin (FIr-B/FOx) in first line treatment of metastatic colorectal cancer: a phase II study

    PubMed Central

    2010-01-01

    Background This phase II study investigated efficacy and safety of weekly alternating Bevacizumab (BEV)/Irinotecan (CPT-11) or Oxaliplatin (OHP) associated to weekly 5-Fluorouracil (5-FU) in first line treatment of metastatic colorectal carcinoma (MCRC). Methods Simon two-step design: delta 20% (p0 50%, p1 70%), power 80%, α 5%, β 20%. Projected objective responses (ORR): I step, 8/15 patients (pts); II step 26/43 pts. Schedule: weekly 12 h-timed-flat-infusion/5-FU 900 mg/m2, days 1-2, 8-9, 15-16, 22-23; CPT-11 160 mg/m2 plus BEV 5 mg/kg, days 1,15; OHP at three dose-levels, 60-70-80 mg/m2, days 8, 22; every 4 weeks. Results Fifty consecutive, unselected pts < 75 years were enrolled: median age 63; young-elderly (yE) 24 (48%); liver metastases (LM) 33 pts, 66% Achieved OHP recommended dose, 80 mg/m2. ORR 82% intent-to-treat and 84% as-treated analysis. Median progression-free survival 12 months. Equivalent efficacy was obtained in yE pts. Liver metastasectomies were performed in 26% of all pts and in 39% of pts with LM. After a median follow-up of 21 months, median overall survival was 28 months. Cumulative G3-4 toxicities per patient: diarrhea 28%, mucositis 6%, neutropenia 10%, hypertension 2%. They were equivalent in yE pts. Limiting toxicity syndromes (LTS), consisting of the dose-limiting toxicity, associated or not to G2 or limiting toxicities: 44% overall, 46% in yE. Multiple versus single site LTS, respectively: overall, 24% versus 20%; yE pts, 37.5% versus 8%. Conclusion Poker combination shows high activity and efficacy in first line treatment of MCRC. It increases liver metastasectomies rate and can be safely administered. Trial registration Osservatorio Nazionale sulla Sperimentazione Clinica dei Medicinali (OsSC) Agenzia Italiana del Farmaco (AIFA) Numero EudraCT 2007-004946-34 PMID:20958992

  11. Specialised teams or personal continuity across inpatient and outpatient mental healthcare? Study protocol for a natural experiment.

    PubMed

    Giacco, Domenico; Bird, Victoria Jane; McCrone, Paul; Lorant, Vincent; Nicaise, Pablo; Pfennig, Andrea; Bauer, Michael; Ruggeri, Mirella; Lasalvia, Antonio; Moskalewicz, Jacek; Welbel, Marta; Priebe, Stefan

    2015-11-25

    Mental healthcare organisation can either pursue specialisation, that is, distinct clinicians and teams for inpatient and outpatient care or personal continuity of care, that is, the same primary clinician for a patient across the two settings. Little systematic research has compared these approaches. Existing studies subject have serious methodological shortcomings. Yet, costly reorganisations of services have been carried out in different European countries, inconsistently aiming to achieve specialisation or personal continuity of care. More reliable evidence is required on whether specialisation or continuity of care is more effective and cost-effective, and whether this varies for different patient groups and contexts. In a natural experiment, we aim to recruit at least 6000 patients consecutively admitted to inpatient psychiatric care in Belgium, Germany, Italy, Poland, and the UK. In each country, care approaches supporting specialisation and personal continuity coexist. Patients will be followed up at 1 year to compare outcomes, costs and experiences. Inclusion criteria are: 18 years of age or older; clinical diagnosis of psychosis, affective disorder or anxiety/somatisation disorder; sufficient command of the language of the host country; absence of cognitive deterioration and/or organic brain disorders; and capacity to provide informed consent. Ethical approval was obtained in all countries: (1) England: NRES Committee North East-Newcastle & North Tyneside (ref: 14/NE/1017); (2) Belgium: Comité d'Ethique hospitalo-facultaire des Cliniques St-Luc; (3) Germany: Ethical Board, Technische Universität Dresden; (4) Italy: Comitati Etici per la sperimentazione clinica (CESC) delle provincie di Verona, Rovigo, Vicenza, Treviso, Padova; (5) Poland: Komisja Bioetyczna przy Instytucie Psychiatrii i Neurologii w Warszawie. We will disseminate the findings through scientific publications and a study-specific website. At the end of the study, we will develop

  12. Delayed diagnosis is associated with changes in the clinical and ultrasound features of subcutaneous endometriosis near cesarean section scars.

    PubMed

    Francica, G; Scarano, F

    2009-09-01

    Sommario INTRODUZIONE: Scopo dello studio è valutare le caratteristiche ecografiche e cliniche di endometriomi in prossimità di cicatrice di Pfannenstiel in rapporto a ritardo diagnostico segnalato da dimensioni ≥ 30 mm al momento della diagnosi istologica. METODI: Sono stati confrontati i dati clinico-anamnestici, ecografici e Color Doppler di 13 pazienti (età media 31.3 anni) con 13 endometriomi ≥ 30 mm (Ø medio 41.8 mm; range 30–60 mm) e di 17 pazienti (età media 30.7 anni) con 19 endometriomi < 30 mm (Ø medio 18.3 mm; range 7–26). In tutti i casi era disponibile il risultato istologico su campione operatorio. RISULTATI: Nelle pazienti con endometrioma ≥30 mm risultavano più lunghi sia il tempo medio intercorso tra il ricovero e ultimo taglio cesareo (5.5 vs. 3.3 anni; p < 0.01) che la durata media dei sintomi prima del ricovero (43 vs. 17.4 mesi; p < 0.01). Inoltre, indagini diagnostiche diverse dall'ecografia (TC, RM, FNB, celioscopia) o interventi chirurgici incongrui si registravano nel 39% delle pazienti con endometriomi ≥ 30 mm, ma in nessuna di quelle con piccoli noduli (p < 0.05). Dal punto di vista ecografico gli endometriomi ≥ 30 mm mostravano più spesso (p < 0.05) perdita della morfologia ovalare, aree liquide interne, tramiti fistolosi e multipli poli vascolari con aumentata vascolarizzazione intralesionale. CONCLUSIONI: Il ritardo nella diagnosi dell'endometrioma su cicatrice di Pfannenstiel, segnalato da una storia clinica più lunga e complessa, modifica i caratteri ecostrutturali più tipici dell'endometrioma e può rendere ancora più difficile il riconoscimento di questa condizione patologica.

  13. Late surgical complications of subtotal colectomy with antiperistaltic caeco-rectal anastomosis for slow transit constipation A critical analysis.

    PubMed

    Marchesi, Federico; Rapacchi, Chiara; Cecchini, Stefano; Sarli, Leopoldo; Tartamella, Francesco; Roncoroni, Luigi

    2016-01-01

    età avanzata può in questo caso aver contribuito a rendere severamente sintomatica una condizione (la distensione cecale) che nel resto dei pazienti è rara o comunque di modesta rilevanza clinica. Nel caso dei volvoli, la miglior misura preventiva è rappresentata da una tecnica chirurgica che miri ad una minor mobilizzazione possibile del moncone cecale. In conclusione si può affermare che le complicanze tardive specifiche di SCCRA correlate alla presenza di un moncone cecale disfunzionale o mobile possono essere prevenute da una attenta selezione dei pazienti e da una corretta tecnica chirurgica.

  14. Surgical approach for ulcerated locally advanced breast cancer. A single Center experience: a retrospective study.

    PubMed

    Laforgia, Rita; Punzo, Clelia; Panebianco, Annunziata; Volpi, Annalisa; Minafra, Marina; Sederino, Maria Grazia

    2017-01-12

    L’obiettivo del nostro studio è la valutazione della strategia chirurgica più idonea nei casi di LABC (Locally Advanced Breast Cancer) in condizioni di ulcerazione e sanguinamento. La diagnosi clinica del LABC prevede nella maggior parte dei casi una massa mammaria estesa associata ad edema, eritema, retrazione e sanguinamento, dolore, superficie cutanea irregolare e coinvolgimento linfonodale. L’intervento chirurgico di scelta per le forme T3-T4 è la mastectomia radicale che rappresenta un trattamento adeguato per il controllo locale della patologia. In caso di forme localmente avanzate e ulcerate, pur essendo forme inoperabili, l’exeresi chirurgica si rende necessaria per una bonifica locale. La presenza di fenomeni di ulcerazione e sanguinamento non rende possibile avviare un trattamento chemioterapico neoadiuvante ed è necessario eseguire interventi chirurgici palliativi. Il trattamento chirurgico stesso richiede mutilazioni ampie ed associate procedure di chirurgia plastica. Spesso per l’estensione della malattia ed il sovvertimento del corpus mammae durante l’exeresi chirurgica della mammella, la sezione su zone esenti da neoplasia non consente la chiusura immediata dei lembi. Abbiamo considerato, su un campione di 288 pazienti affette da carcinoma mammario, 11 donne con forme avanzate fra T4a e T4c (3.8%). E’ stata posta indicazione a trattamento chirurgico perché pazienti provenienti dal Pronto Soccorso con anemizzazione per neoplasie avanzate ulcerate e sanguinanti, non candidabili in prima istanza a chemioterapia neoadiuvante citoriduttiva. Le procedure adoperate per la ricostruzione della mammella sono state in 2 pazienti la rotazione di un lembo muscolo cutaneo, in 4 casi un innesto cutaneo prelevato dalla coscia, in 4 casi è stata utilizzata una matrice dermica biologica - sostituto cutaneo (INTEGRA) che è stata poi sostituita con un successivo innesto cutaneo a distanza di circa 20-30 giorni. Sono state osservate recidive in 2 casi

  15. Revision curricular a partir de un analisis comparativo de las discrepancias en los curriculos de una escuela de optometria en Puerto Rico con las competencias requeridas para las agencias de revalida y acreditacion 2004

    NASA Astrophysics Data System (ADS)

    Rivera Pacheco, Andres

    El proposito de esta investigacion, un estudio cualitativo de caso, fue comparar y contrastar el curriculo vigente de la Escuela de Optometria de la UIAPR con las competencias y estandares requeridos por las agencias de acreditacion y de revalida. Con este proposito, decidimos realizar una revision y un analisis de documentos: el prontuario de cada uno de los cursos de los curriculos implantados en el 1993 y en el 2001; las competencias y estandares establecidos por las agencias de revalida y de acreditacion; y las estadisticas en las que se analiza el porcentaje de estudiantes que aprueban cada una de las partes de los examenes de revalida entre el 1998 al 2003. Se realizaron entrevistas dirigidas para dar apoyo y complementar la revision y el analisis de estos documentos. Los participantes de las entrevistas fueron tres estudiantes de la clase de optometria del 2004 (ultima clase del curriculo del 1993); tres estudiantes de la clase de optometria del 2005 (primera clase graduanda del curriculo vigente) y tres profesores y/o directores de los Departamentos de Ciencias Basicas, Ciencias Clinicas y Cuidado al Paciente. Esta investigacion se enmarco en el modelo de evaluacion curricular de discrepancia de Malcolm Provus y en el modelo de desarrollo basado en competencias. Uno de los hallazgos mas importantes del estudio es que los cambios que se implantaron al curriculo del 2001 no han logrado que los estudiantes mejoren su ejecucion en los examenes de revalida. Por otro lado, se encontro que el curriculo vigente atiende completamente los estandares de la practica de Optometria, pero no las competencias. Esta informacion fue validada mediante el uso de una tabla de cotejo para el analisis de los cursos y de la informacion obtenida de las entrevistas. El estudio determina y concluye que existen discrepancias entre los prontuarios de los cursos del curriculo y las competencias requeridas por la agencia de revalida. Segundo, que el Departamento de Ciencias Basicas es el

  16. Low Helicobacter pylori primary resistance to clarithromycin in gastric biopsy specimens from dyspeptic patients of a city in the interior of São Paulo, Brazil

    PubMed Central

    2013-01-01

    Background Clarithromycin, amoxicillin, and a pump proton inhibitor are the most common drugs recommended as first-line triple therapy for H.pylori treatment, which results in eradication rates close to 80%, varying regionally, principally due to emergency cases and increases of clarithromycin resistant strains. Nucleotide substitutions at the H. pylori domain V of the 23S rRNA fraction are involved in the macrolide resistance and the A2142G and A2143G mutations are predominant in clinical isolates worldwide including in Brazil. As H. pylori culture is fastidious, we investigated the primary occurrence of H. pylori A2142G and A2143G rDNA 23S mutations using a molecular approach directly on gastric biopsies of dyspeptic patients consecutively attended at Hospital das Clinicas of Marilia, São Paulo, Brazil. Methods Biopsy specimens obtained from 1137 dyspeptic patients, were subjected to histopathology and H. pylori diagnosis by histology and PCR. PCR/RFLP assay was used to detect A2142G and A2143G point mutations at domain V of the H. pylori 23S rDNA associated with clarithromycin resistance. Through the developed assay, a 768 bp PCR amplicon corresponding to1728 to 2495 bp of the 23S H. pylori rDNA is restricted with MboII for A2142G mutation detection and with BsaI for A2143G mutation detection. Occurrence of 23S rDNA A2142G results in two DNA fragments (418 and 350 bp) and of 23S rDNA A2143G results in three DNA fragments (108, 310 and 350pb), due to a conserved BsaI restriction site. Results The PCR method used to diagnose H. pylori presented sensitivity, specificity and accuracy of 77,6%, 79,3% and 78,6%, respectively, compared to histology, the gold standard method for H. pylori diagnosis used in our routine. Prevalence of H.pylori with clarithromycin resistant genotypes was 2,46%, with predominance of A2143G 23S rDNA point mutation. Conclusions The PCR/RFLP assay was a rapid and accurate H.pylori diagnostic and clarithromycin resistance determination

  17. [Obesity and work: proposal for a multidisciplinary intervention model for prevention and its application in an engineering plant].

    PubMed

    Vigna, Luisella; Agnelli, Gianna Maria; Tirelli, Amedea Silvia; Belluigi, Valentina; Aquilina, Tatiana; Riboldi, L

    2011-01-01

    Obesity is often particularly burdensome for subjects at work and leads to hypertension and diabetes preceded by a low grade of inflammation. Measures to promote health at the workplace can be achieved through periodic health surveillance. Simple parameters such as height, weight, body mass index (BMI), waist circumference (CV), blood pressure (BP), as well as taking into account the type of work and tasks, shift work and smoking, are in fact sufficient to identify the most significant features of the working population so as to adequately design the type of intervention required. The paper describes how a health promotion programme aimed at preventing overweight and obesity was implemented based on analysis of the health surveillance data routinely collected by the occupational physician in an engineering plant in northern Italy. Data on weight, height and BMI were collected for 301 workers with different jobs and shifts in an engineering plant; 32 of these workers, (mean age 44+/-8.4) agreed to undergo a diagnosis and treatment programme at the Obesity and Work Centre of the Clinica del Lavoro in Milan. A higher incidence of overweight and obesity was found compared to the national average for similar age classes, therefore meetings were organized at the plant on awareness and information on correct lifestyle and diet targeted for shift workers. The workers who had followed the diagnosis and treatment programme had a mean BMI of 32.6 (SD 2.7) and, considering the parameters investigated, the presence of metabolic syndrome was found in a greater proportion of subjects (62.5%) than the average in our practice (46%) and particularly in workers with three day shifts. CONCLUSIONSThe intervention programme began with assessment of the information obtained in the course of routine periodic health surveillance according to the occupational hazards under study. On the basis of this information it was possible to implement the first awareness campaigns. On completion of

  18. Labeling and defining severe and enduring anorexia nervosa: A systematic review and critical analysis.

    PubMed

    Broomfield, Catherine; Stedal, Kristin; Touyz, Stephen; Rhodes, Paul

    2017-06-01

    With anorexia nervosa (AN) having various presentations, attention has been directed towards particularly durable forms of the condition in both research and clinical contexts. A major hindrance in terms of advancing the field is the inconsistent labeling and defining of this subgroup. This has two implications; first, the inconsistent recruitment of participants when researching this sample, and second, the misdiagnosing of patients who may or may not have a durable course of the disease. The current research had the purpose of providing an overview of the current labels and criteria used for defining cases of severe and enduring AN, and critically analysing the implications of these findings. In accordance with PRISMA guidelines, a literature search was conducted using four electronic databases (PsycINFO, MEDLINE, Web of Science and Scopus) in order to identify 32 records that met the standards stipulated by the criteria. Data extraction included explicit labeling, the definition or criteria used to describe the subgroup, along with participant age and study design. It was found that the terms chronic and severe and enduring were the most commonly used adjectives when referring to this subgroup. In terms of criteria, illness duration and the number of previously failed treatment attempts were the most common defining features within the literature. It is the aim of the authors to inspire further research into what is the most appropriate label and defining features for the subgroup in order to facilitate a better approach and outcome for the individuals affected. Objetivo Con la Anorexia Nervosa (AN) teniendo varias presentaciones, tanto en la investigación como en los contextos clínicos, la atención se ha dirigido particularmente hacia las formas duraderas de esta condición. Un obstáculo importante en términos de avanzar en el campo es la inconsistencia en el etiquetado y definición de este subgrupo. Esto tiene dos implicaciones; Primero, el inconsistente

  19. A 16-year experience of carotid artery stenting for carotid artery stenosis.

    PubMed

    Nano, Giovanni; Stegher, Silvia; Occhiuto, Maria Teresa; Muzzarelli, Lorenzo; Malacrida, Giovanni; Mazzaccaro, Daniela P

    2016-01-01

    Da più di 50 anni l’endoarteriectomia carotidea (CEA) è stata considerata il trattamento standard per le stenosi carotidee gravi asintomatiche e sintomatiche. Lo stenting carotideo (CAS) è progressivamente emerso negli ultimi 15 anni come alternativa alla chirurgia, specialmente nei pazienti ad alto rischio. Da allora, molti studi clinici randomizzati sono stati pubblicati per valutare la superiorità di un metodo rispetto all’altro, tuttavia i risultati dei trials hanno generato più dubbi che certezze nell’interpretazione dei loro risultati, gravati come sono da diverse limitazioni: la principale riguarda la ridotta competenza endovascolare richiesta per gli operatori che hanno eseguito lo stenting carotideo e partecipato ai trials. Inoltre questi trials sono stati eseguiti circa 10 anni fa, con materiali e farmaci differenti rispetto a quelli usati attualmente. Attualmente i registri su larga scala e le casistiche che riportano risultati a lungo termine sono maggiormente rappresentativi di una esperienza reale, che riflette ciò che accade di routine nella pratica clinica. Nella nostra Unità Operativa di Chirurgia Vascolare, il CAS è stato offerto dal 1999 come alternativa alla CEA per il trattamento delle stenosi carotidee sintomatiche e asintomatiche nei pazienti a rischio moderato-alto. Scopo del nostro lavoro è di riportare la nostra esperienza retrospettiva, con alcuni consigli e suggerimenti che derivano da ciò che abbiamo imparato in più di 16 anni. Abbiamo pertanto raccolto e analizzato retrospettivamente i dati di tutti i pazienti consecutivi che sono venuti per una stenosi carotidea significativa dal 1 ° gennaio 1999 al 31 agosto 2015. I risultati basilari sono stati la mortalità e la morbilità cerebrovascolare maggiore (MCE) sia a 30 giorni che a lungo termine. Lo studio è stato condotto su 1017 pazienti (677 maschi, 66.6%, età media 74 anni, IQR 69-79 anni) trattati sia per stenosi carotidea sintomatica (n=392, 38.5%) che

  20. Introduzione Nuove tecnologie in urologia.

    PubMed

    Bianchi, Giampaolo

    2011-03-30

    Negli ultimi anni sono state introdotte in urologia nuove tecniche chirurgiche alcune già applicabili nella pratica clinica, altre ancora in corso di sperimentazione. Quella che ha trovato attualmente applicazione è la LESS (Laparo Endoscopic Single-site Surgery); essa riguarda tutte le metodiche che utilizzano una sola porta (multiaccesso) per eseguire interventi laparoscopici. I vantaggi apparenti di questa metodica rispetto alla laparoscopia tradizionale sono soltanto un dimostrato miglior risultato estetico. Mancano studi prospettici randomizzati. NOTES (Natural Orifices Transluminal Endoscopic Surgery) È una metodica ancor più nuova che sfrutta gli orifizi naturali (bocca, retto, vagina, vescica per accedere alla cavità addominale. Rispetto alla LESS questa tecnica utilizza prevalentemente i gastroscopi e lo strumentario dei gastoenterologi per eseguire interventi demolitivi. In urologia l'impiego di questa metodica è puramente sperimentale, comunque piccoli passi sono stati fatti nel migliorare lo strumentario. I chirurghi stanno consolidando questa metodica sull'uomo riguardo alla colecistectomia, ma i risultati sono scarsi, discordanti sulla via d'accesso e limitati a case reports. Oggi i risultati più incoraggianti li ha descritti Estevao Lima, un ingegnoso portoghese che utilizzando una tecnica NOTES di terza generazione (accesso combinato trans-vescicale e trans-gastrico) è riuscito ad eseguire una serie di nefrectomie sul maiale. Tanto si sa e si è speculato riguardo al robot da Vinci®, che oggi la prostatectomia senza di lui non è più competitiva. Moltissimi sono i centri che lo hanno, molti quelli che lo usano, tanti quelli che hanno risultati migliori rispetto alla tecnica laparoscopica classica. Ancora ad oggi però non esistono studi prospettici randomizzati che dimostrino la sua superiorità; inoltre una spina nel fianco sono i costi. Un ulteriore sviluppo futuro di da Vinci® forse potrebbe vedersi nell'assistere le nuove tecniche

  1. Myalgic encephalomyelitis: International Consensus Criteria

    PubMed Central

    Carruthers, B M; van de Sande, M I; De Meirleir, K L; Klimas, N G; Broderick, G; Mitchell, T; Staines, D; Powles, A C P; Speight, N; Vallings, R; Bateman, L; Baumgarten-Austrheim, B; Bell, D S; Carlo-Stella, N; Chia, J; Darragh, A; Jo, D; Lewis, D; Light, A R; Marshall-Gradisbik, S; Mena, I; Mikovits, J A; Miwa, K; Murovska, M; Pall, M L; Stevens, S

    2011-01-01

    Carruthers BM, van de Sande MI, De Meirleir KL, Klimas NG, Broderick G, Mitchell T, Staines D, Powles ACP, Speight N, Vallings R, Bateman L, Baumgarten-Austrheim B, Bell DS, Carlo-Stella N, Chia J, Darragh A, Jo D, Lewis D, Light AR, Marshall-Gradisbik S, Mena I, Mikovits JA, Murovska M, Pall ML, Stevens S (Independent, Vancouver, BC, Canada; Independent, Calgary, AB, Canada; Department of Physiology and Medicine, Vrije University of Brussels, Himmunitas Foundation, Brussels, Belgium; Department of Medicine,University of Miami Miller School of Medicine and Miami Veterans Affairs Medical Center, Miami, FL, USA; Department of Medicine, University of Alberta, Edmonton, AB, Canada; Honorary Consultant for NHS at Peterborough/Cambridge, Lowestoft, Suffolk, UK; Gold Coast Public Health Unit, Southport, Queensland; Health Sciences and Medicine, Bond University, Robina, Queensland, Australia; Faculty of Health Sciences, McMaster University and St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada; Independent, Durham, UK; Howick Health and Medical Centre, Howick, New Zealand; Fatigue Consultation Clinic, Salt Lake Regional Medical Center; Internal Medicine, Family Practice, University of Utah, Salt Lake City, UT, USA; ME/CFS Center, Oslo University Hospital HF, Norway; Department of Paediatrics, State University of New York, Buffalo, NY; Independent, Pavia, Italy; Harbor-UCLA Medical Center, University of California, Los Angeles, CA; EV Med Research, Lomita, CA, USA; University of Limerick, Limerick, Ireland; Pain Clinic, Konyang University Hospital, Daejeon, Korea; Donvale Specialist Medical Centre, Donvale, Victoria, Australia; Departments or Anesthesiology, Neurobiology and Anatomy, University of Utah, Salt Lake City, Utah, USA; Health Sciences and Medicine, Bond University, Robina, Queensland, Australia; Department of Medicina Nuclear, Clinica Las Condes, Santiago, Chile; Whittemore Peterson Institute, University of Nevada, Reno, NV, USA; Miwa Naika Clinic, Toyama

  2. The clinician’s role in the diagnosis of breast disease

    PubMed Central

    Poma, S.; Longo, A.

    2011-01-01

    patologia mammaria la diagnosi e la terapia di tale patologia sono state a totale appannaggio del chirurgo, situazione che è proseguita fino a qualche decennio fa. Il recente progresso tecnologico ha modificato, in parte, questa situazione e il clinico può entrare nel percorso diagnostico o terapeutico in qualsiasi momento. Se è il primo coinvolto, dopo l’esame e dopo un’ipotesi diagnostica, dovrà, quasi sempre, orientarsi verso indagini strumentali in relazione al sospetto, all’età della paziente ecc., se è l’ultimo anello deve arrivare a una conclusione mettendo insieme tutte le informazioni. L’esame clinico è composto di varie fasi: anamnesi, ispezione, palpazione, ognuna essenziale. Ogni singola fase va affrontata con metodo e tecnica appropriata. La capacità diagnostica dell’esame clinico è influenzata dalla costituzione della mammella, ma ancor di più è condizionata da uno stretto rapporto tra paziente e medico che deve conoscere molto la paziente che gli sta davanti e che non solo deve “visitare”, ma capire, spiegare, accertarsi che si abbia capito, convincere. È inoltre indispensabile che il clinico sia in grado di esaminare le indagini strumentali e non limitarsi a leggere i referti, quindi interagire con gli altri specialisti. L’epoca del clinico o del radiologo o dell’ecografista che lavora da solo credendo che il proprio esame sia sufficiente o sganciato da altri contesti è finita da tempo, tutti hanno bisogno di tutti. È però vero che ciascuno deve essere estremamente competente nel suo settore e deve conoscere i limiti e le aspettative di chi collabora in altre specialità, come rimane valida la regola che la clinica resta comunque il momento centrale, non fosse altro perché poi deve affrontare la terapia. PMID:23396620

  3. The clinician's role in the diagnosis of breast disease.

    PubMed

    Poma, S; Longo, A

    2011-06-01

    mammaria la diagnosi e la terapia di tale patologia sono state a totale appannaggio del chirurgo, situazione che è proseguita fino a qualche decennio fa. Il recente progresso tecnologico ha modificato, in parte, questa situazione e il clinico può entrare nel percorso diagnostico o terapeutico in qualsiasi momento. Se è il primo coinvolto, dopo l'esame e dopo un'ipotesi diagnostica, dovrà, quasi sempre, orientarsi verso indagini strumentali in relazione al sospetto, all'età della paziente ecc., se è l'ultimo anello deve arrivare a una conclusione mettendo insieme tutte le informazioni. L'esame clinico è composto di varie fasi: anamnesi, ispezione, palpazione, ognuna essenziale. Ogni singola fase va affrontata con metodo e tecnica appropriata. La capacità diagnostica dell'esame clinico è influenzata dalla costituzione della mammella, ma ancor di più è condizionata da uno stretto rapporto tra paziente e medico che deve conoscere molto la paziente che gli sta davanti e che non solo deve "visitare", ma capire, spiegare, accertarsi che si abbia capito, convincere. È inoltre indispensabile che il clinico sia in grado di esaminare le indagini strumentali e non limitarsi a leggere i referti, quindi interagire con gli altri specialisti. L'epoca del clinico o del radiologo o dell'ecografista che lavora da solo credendo che il proprio esame sia sufficiente o sganciato da altri contesti è finita da tempo, tutti hanno bisogno di tutti. È però vero che ciascuno deve essere estremamente competente nel suo settore e deve conoscere i limiti e le aspettative di chi collabora in altre specialità, come rimane valida la regola che la clinica resta comunque il momento centrale, non fosse altro perché poi deve affrontare la terapia.

  4. Validating an energy expenditure prediction equation in overweight and obese Mexican patients.

    PubMed

    Quiroz-Olguín, Gabriela; Serralde-Zúñiga, Aurora E; Saldaña-Morales, Maria Vianey; Gulias-Herrero, Alfonso; Guevara-Cruz, Martha

    2014-10-01

    Antecedentes: La prevalencia de sobrepeso y obesidad en Mexico se situa aproximadamente en el 70%; asi, la obtencion de una medicion fiable del gasto energetico en reposo (GER) en estos pacientes tiene una importancia crucial. El objetivo del estudio consistio en obtener una ecuacion de prediccion de GER en pacientes ambulatorios con sobrepeso u obesidad en la poblacion mexicana. Métodos: El estudio fue realizado en el Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran (Mexico, D.F.). Se evaluo a pacientes ambulatorios consecutivos (18-70 anos) en el servicio de Nutriologia Clinica entre marzo de 2010 y agosto 2012 tras un diagnostico de sobrepeso u obesidad (indice de masa corporal [IMC] ≥ 25 kg/ m2). Los pacientes con cualquier enfermedad que pudiera afectar la medicion de intercambio de gases fueron excluidos. Los participantes fueron evaluados mediante calorimetria indirecta (CI), analisis de impedancia bioelectrica (AIB) y mediciones antropometricas para disenar la ecuacion de prediccion de GER. Fueron evaluados dos grupos: un grupo para diseno y otro para validacion. El GER tambien fue calculado empleando las ecuaciones de Harris-Benedict, Mifflin St-Jeor, Ireton-Jones, Carrasco, Kleiber y Owen, calculando el peso actual, el peso ideal y un peso ajustado. Se obtuvo una ecuacion GER mediante regresion lineal multiple basada en las variables evaluadas, y fueron seleccionadas aquellas que aportaron la mayor precision al modelo. Luego se compararon el GER real y el GER estimado, utilizando la prueba de t de student. Para destacar las diferencias entre pares de mediciones se utilizo el metodo de Bland & Altman. Se calcularon los coeficientes de correlacion de Pearson y los coeficientes de determinacion entre valores GER medidos mediante valores de CI y GER con diversas formulas. Resultados: Un total de 77 pacientes fueron incluidos en el grupo de diseno: 38 hombres (49.4%) y 39 mujeres (50.6%). La edad media fue 48.5 } 13.9 anos, y el IMC

  5. Polypoid anal melanoma. A case report and review of the literature.

    PubMed

    Tutino, Roberta; Clerico, Giuseppe; Luc, Alberto Realis; Gallo, Gaetano; Trompetto, Mario

    2016-11-12

    Il melanoma ano-rettale è una patologia rara, rappresentando l’1% dei tumori anali e lo 0.4-1.6% dei melanomi. I suoi sintomi sono simili a quelli delle più comuni malattie benigne della regione anorettale, portando spesso a diagnosi in stadi avanzati, in particolare se la sede del tumore è a livello del canale anale. In ogni caso la prognosi del melanoma anorettale rimane severa con una sopravvivenza a 5 anni che non supera il 22% negli stadi più precoci. La letteratura presenta saltuarie serie monocentriche ed alcuni case report e a tutt’oggi non vi sono linee-guida per il suo management. La classificazione più usata divide la malattia in tre stadi a seconda del coinvolgimento o meno dei linfonodi regionali e della presenza di metastasi a distanza. Un’analisi di popolazione ha mostrato una sopravvivenza a 5 anni del 17%, 18% e 5% rispettivamente per i tre stadi di malattia dopo chirurgia e dello 0%, 0% e 4% in assenza di trattamento. La risonanza magnetica e l’ecoendoscopia sono utili per la valutazione di operabilità locale mentre la TAC e la PET sono indicati per la valutazione di eventuali metastasi a distanza. I fattori di rischio per recidiva sono l’invasione perineurale, la necrosi tumorale, dimensioni superiori a 2 cm ed un’istologia con cellule fusate o miste. I protocolli poli-chemioterapici utilizzati sinora per il melanoma anorettale hanno purtroppo portato a risultati meno soddisfacenti di quelli ottenuti nel trattamento del melanoma cutaneo. La mutazione del c-KIT ed i trattamenti con i suoi inibitori sembrano dimostrare risultati promettenti mentre la radioterapia non sembra attualmente rivestire alcun ruolo terapeutico rilevante. Abbiamo riportato il caso di una donna di 55 anni visitata presso un ambulatorio di coloproctologia per rettorragia saltuaria ed un dolore anale che ha reso impossibile la valutazione clinica locale. La valutazione in anestesia ha rivelato la presenza di una massa polipoide di colorito brunastro del

  6. Hard metal lung disease: a case series.

    PubMed

    Mizutani, Rafael Futoshi; Terra-Filho, Mário; Lima, Evelise; Freitas, Carolina Salim Gonçalves; Chate, Rodrigo Caruso; Kairalla, Ronaldo Adib; Carvalho-Oliveira, Regiani; Santos, Ubiratan Paula

    2016-01-01

    o Paulo, entre 2010 e 2013. Entre 320 pacientes atendidos no período do estudo, 5 (1,56%) foram diagnosticados com DPMD. Todos os pacientes eram do sexo masculino, com média de idade de 42,0 ± 13,6 anos e média de tempo de exposição a metal duro de 11,4 ± 8,0 anos. Os pacientes foram submetidos a avaliação clinica, história ocupacional, TCAR de tórax, prova de função pulmonar, broncoscopia com LBA e biópsia pulmonar. Todos apresentaram distúrbio ventilatório restritivo. O achado de imagem à TCAR de tórax mais frequente foi de opacidades em vidro fosco (em 80%). Em 4 pacientes, o LBA revelou presença de células gigantes multinucleadas. Em 3, foi diagnosticada pneumonia intersticial por células gigantes na biópsia pulmonar. Houve o diagnóstico de pneumonia intersticial descamativa associada à bronquiolite celular em 1 paciente e de pneumonite de hipersensibilidade em 1. Todos foram afastados da exposição e tratados com corticoide. Houve melhora em 2 pacientes e progressão da doença em 3. Apesar de ser uma entidade rara, a DPMD deve ser sempre considerada em trabalhadores com risco ocupacional elevado de exposição a metais duros. A história clínica e ocupacional associada a achados em TCAR de tórax e LBA sugestivos da doença podem ser suficientes para o diagnóstico.

  7. Individual attitudes and perceived social norms: Reports on HIV/AIDS-related stigma among service providers in China

    PubMed Central

    Li, Li; Liang, Li-Jung; Wu, Zunyou; Lin, Chunqing; Wen, Yi

    2009-01-01

    personnelles dans l’étude de la stigmatisation lié au VIH et prōnent l’incorporation de l’existence du capital humain dans les futurs programmes de réduction de la stigmatisation du VIH. En este estudio se examinó el estigma hacia el VIH/SIDA entre proveedores de servicios chinos mediante la comparación de sus actitudes hacia las personas que viven con el VIH/SIDA con su precepción de las normas sociales relacionadas a personas que viven con el VIH/SIDA. Se seleccionaron al azar tres hospitales provinciales, cuatro de la ciudadlhospitales de la prefectura, diez hospitales del condado, 18 clinicas de salud municipales, y 54 clinicas de la aldea de Yunnan, China. Los médicos y las enfermeras fueron incluidos en la muestra de manera aleatoria y considerando la relación enfermera-médico de cada hospital o clínica. Una muestra grande de técnicos de laboratorio fue incluida en el estudio con el fin de garantizar su adecuada representación en los análisis. Un total de 1,101 proveedores de servicios participaron de manera voluntaria en una encuesta anónima, en la cual se evaluaron las caracteristicas demográficas, las actitudes individuales, asi como la percepción de las normas sociales hacia personas que viven con el VIH/SIDA, la intención de discriminación laboral, las actitudes globales de prejuicio y los conocimientos sobre el VIH/SIDA. La mayor parte de la muestra presentó similitudes entre sus opiniones personales y lo que ellos pensaban, eran las creencias de la mayoria de las personas de su sociedad. En una regresión logistica multiple se pudo observar que los participantes más jóvenes o que indicaron un contacto personal con personas que viven con el VIH/SIDA, mostraron de manera más significativa respecto de esta población actitudes personales mucho más liberales que las normas sociales percibidas. El presentar una actitud personal más liberal que las normas sociales percibidas, hacia personas que viven con el VIH/SIDA, estaba significativa y

  8. SEMG analysis of astronaut upper arm during isotonic muscle actions with normal standing posture

    NASA Astrophysics Data System (ADS)

    Qianxiang, Zhou; Chao, Ma; Xiaohui, Zheng

    and fatigue in isometric contractions of upper trapezius muscle by perceived exertion scale and EMG signal[J]. Gait & Posture 6. Eighth Congress of the Italian Society for Clinical Movement Analysis (SIAMOC-Societ?Italiana di Movimento in Clinica). 2008, 28(Supplement 1): 37-38. 7. Strimpakos N, Georgios G, Eleni K, et al. Issues in relation to the repeatability of and correlation between EMG and Borg scale assessments of neck muscle fatigue[J]. Journal of Electromyography and Kinesiology. 2005, 15(??): 452-465. 8. Zhan Benqing, Zhou Qianxiang, Influence of Multi-factors on Fatigue Evaluation of Typ-ical upper Extremity Operation, Space Medicine & Medical Engineering, 2009, 22(??): 313-316.

  9. Efficacy of two different toothbrush heads on a sonic power toothbrush compared to a manual toothbrush on established gingivitis and plaque.

    PubMed

    Nathoo, Salim; Mateo, Luis R; Chaknis, Patricia; Kemp, James H; Gatzemeyer, John; Morrison, Boyce M; Panagakos, Fotinos

    2014-01-01

    triple clean head and the scores of the Colgate ProClinical C200 toothbrush with sensitive head at any comparison time point. The Colgate ProClinicaI C200 toothbrush, with either a triple clean head or a sensitive head, provides statistically significant and clinically relevant levels of efficacy in the removal of supragingival dental plaque in the whole mouth, at the gingival margin, and interproximally after a single tooth brushing and after four weeks of use, as well as a statistically significantly greater level of efficacy in the reduction of gingivitis and gingival bleeding when compared to a manual flat-trim toothbrush.