Evaluación de la función pulmonar en escoliosis idiopática del adolescente manejado con instrumentación posterior con sistema de ganchos sublaminares / Pulmonary function assessment in juvenile idiopathic scoliosis managed with posterior instrumentation with a sublaminar hook system

Resumen: Introducción: La escoliosis es una deformidad de la columna vertebral; se diagnostica por el método de Cobb presentando una angulación mayor de 10o en proyección radiográfica anteroposterior. Produce alteraciones pulmonares de tipo restrictivo en angulaciones mayores a 50o. Su manejo puede ser quirúrgico, mejorando la angulación y el proceso restrictivo pulmonar. Se comparó la función pulmonar pre- y postquirúrgica con espirometría. Material y métodos: 27 pacientes, cirugía correctiva mediante instrumentación posterior con ganchos sublaminares, barras y artrodesis posterolateral. Ambos géneros. 11-15 años. Espirometría prequirúrgica y postquirúrgica a los seis meses. Fueron excluidos quienes carecían de espirometría postquirúrgica y/o aquéllos con evento infeccioso pulmonar postquirúrgico. Índice de Cobb, pre- y postquirúrgico. Espirometría: función pulmonar, la capacidad vital forzada (VCF) y el volumen espiratorio forzado en un segundo (FEV1). Estadística descriptiva, t Student. Resultados: Femenino 78% y masculino 22%, 13.7 ± 1.22 años. Método de Cobb 40 a 110o; prequirúrgico, 64.48 ± 17.79o y postquirúrgico, 30.44 ± 10.90o. No hubo valor de 0o. Capacidad pulmonar: prequirúrgico VCF para los valores de la curva de escoliosis (p < 0.0001) y significativa marginal para FEV1 (p = 0; inicial 40.6-122.0%, media 76.3 ± 18.8%; postquirúrgico 40.75-112.6%, media 76.5 ± 16.8%. FEV1 prequirúrgico 39.83-111.59%, media 73.9 ± 16.8%; post­quirúrgico 42.86-120.79%, media de 69.7 ± 16.5. Diferencia estadísticamente significativa 0.064). Conclusiones: El sistema de ganchos sublaminares en abordaje posterior ofrece mejoría de la curva de la escoliosis idiopática del adolescente evaluada por método de Cobb, detiene el progreso del deterioro de la función pulmonar, con mejoría significativa para el volumen espiratorio forzado en un segundo.

Abstract: Introduction: Scoliosis is a spine deformity diagnosed using Cobb's method when the AP X-ray view shows an angulation greater than 10o. Scoliosis exceeding 50o results in restrictive pulmonary alterations. Surgical management improves the angulation and the pulmonary restrictive process. The pre- and post-operative pulmonary function values were compared using spirometry. Material and methods: 27 patients of both genders, ages 11-15 years, underwent corrective surgery using posterior instrumentation with sublaminar hooks, rods and posterolateral arthrodesis. Spirometry was done preoperatively and six months after the surgery. Patients without a postoperative spirometry and/or a postoperative episode of pulmonary infection were excluded. The pre- and postoperative Cobb index was calculated. Spirometry: lung function at forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). Descriptive statistics, Student t test. Results: Females, 78%; males, 22%; 13.7 ± 1.22 years. Cobb method 40 - 110o, preoperative angle 64.48 ± 17.79o and postoperative angle 30.44 ± 10.90º. There were no 0o values. Lung function: preoperative FVC for the values of the scoliosis curve (p < 0.0001) and significant marginal FEV1 (p = 0. Baseline: 40.6-122.0%, mean: 76.3 ± 18.8%, postoperative: 40.75-112.6%, mean: 76.5 ± 16.8%. Preoperative FEV1: 39.8-111.59%, mean: 73.9 ± 16.8%, postoperative: 42.86-120.79%, mean: 69.7 ± 16.5. The difference was statistically significant, 0.064). Conclusions: The sublaminar hook system with a posterior approach provides improvement of the idiopathic scoliosis curve of adolescents assessed with the Cobb method. It stops the progression of lung function impairment, with a significant improvement in forced expiratory volume in one second.

Tradução e adaptação cultural do WORC: um questionário de qualidade de vida para alterações do manguito rotador / Translation and cultural adaptation of WORC: a quality-of-life questionnaire for rotator cuff disorders

OBJETIVO: Realizar a tradução e a adaptação cultural do questionário WORC (The Western Ontario Rotator Cuff Index) para a língua portuguesa para ulterior validação no Brasil. MÉTODOS: O protocolo aplicado consistiu em: 1) Preparação, 2) Tradução, 3) Tradução de volta à língua original (retro-tradução), 4) Interrogatório Cognitivo e 5) Relato de Informações. Ao serem concluídas as etapas de tradução e retro-tradução, as versões foram enviadas para os autores do WORC original, que as aprovaram para continuação do estudo. A versão em Português foi aplicada a 35 pacientes com disfunções do manguito rotador para verificar o nível de compreensão do instrumento. A idade média foi 57 anos (DP=13), 63 por cento eram do sexo feminino e 74 por cento tinham nível de escolaridade de primeiro grau incompleto. A versão brasileira final do WORC foi definida após se conseguir menos que 15 por cento de "não compreensão" em cada item. Para análise das variáveis, foi utilizada estatística descritiva. RESULTADOS: Realizaram-se mudanças e substituições de termos e expressões para obter equivalência cultural do WORC. Alteraram-se também os termos "não compreendidos" pelos pacientes de acordo com as sugestões feitas por eles. CONCLUSÃO: Após a tradução e adaptação cultural do questionário, foi concluída a versão em Português do WORC que está em processo de validação para ser utilizada no Brasil.

OBJECTIVE: To accomplish the translation of WORC (The Western Ontario Rotator Cuff Index) into Portuguese and its cultural adaptation, for future validation in Brazil. METHOD: The protocol applied consisted of: 1) Preparation; 2) Forward translation; 3) Back translation; 4) Cognitive Debriefing; and 5) Information report. After concluding the forward and back-translations, the versions were sent to the authors of the original questionnaire, who gave their approval for the study to be continued. The Portuguese version was applied to 35 patients with rotator cuff dysfunctions to verify the level of understanding of the instrument. The mean age of these patients was 57 years (SD = 13); 63 percent were female and 74 percent had not completed elementary school. The final Brazilian version of WORC was defined after achieving a "no comprehension" rate of less than 15 percent for each item. Descriptive statistics were used to analyze the variables. RESULTS: Some terms and expressions were changed or replaced to obtain cultural equivalence for WORC. The terms that were incomprehensible to the patients were changed in accordance with their own suggestions. CONCLUSION: After the translation and cultural adaptation of the questionnaire, the final Portuguese version of WORC was concluded and it is now undergoing validation for use in Brazil.

Acción de distintos coagulantes para la eliminación de Cryptosporidium spp. en el proceso de potabilización del agua / The action of different coagulants to remove Cryptosporidium during the process of water treatment

Cryptosporidium es uno de los microorganismos de mayor interés desde el punto de vista de la Salud Pública y constituye un problema prioritario para las plantas y organismos reguladores de agua. Debido a su pequeño tamaño y a su resistencia a la cloración, la eliminación por el proceso de potabilización es una tarea compleja. En este trabajo se analizó la efectividad de distintos coagulantes utilizados comúnmente en tal proceso para lograr la remoción de los ooquistes. Se trabajó con la prueba de jarras (Jar Test). Se halló que: 1) Los coagulantes con agregado de polímeros coadyuvantes producen remociones de ooquistes superiores a 2 log. 2) Un valor bajo de turbiedad no asegura una remoción óptima de los parásitos. 3) La adición de polielectrolitos al cloruro férrico disminuye la variabilidad tanto en la turbiedad final como en la eliminación de Cryptosporidium.

Cryptosporidium is one of the microorganisms of main concern from the point of view of Public Health, being a priority problem for water treatment plants and water regulatory institutions. Due to its small size and resistance to chlorination, Cryptosporidium removal during the process of drinking water treatmentis a hard task. The effectiveness of different coagulants commonly used in the process of removal of oocysts was analyzed. Thetechnique used was the Jar Test. It was found that: 1) coagulants with the addition of polimeric coadjuvants produce over 2 logs of oocyst removal; 2) a low value in turbidity does not necessarily mean optimal parasite removal, and 3) the addition of polyelectrolites to ferric chloride diminishes variability, both in final turbidity and Cryptosporidium removal.

Cryptosporidium y Giardia en aguas superficiales / Cryptosporidium y Giardia in surface water

The aim of this work was to determine Giardia and Cryptosporidium levels in surface water used either as recreational or drinking water source, and to estimate the relationship with bacteriological and physicochemical parameters determining water quality. This study was carried out during 22 months, in Santa Fe and Santo TomÚ cities (Santa Fe Province, Argentina). Cryptosporidium from 100 of the recreational samples (44-2404 oocysts/100 l) and from 92 of water sources (< 20-539 oocysts/100 l) was detected, while Giardia was found in lower concentrations and frequencies: 72 (< 20-670 cysts/100 l) and 31 (< 20-65 cysts/100 l), respectively. Statistically significant relationships were found between these parasites and organic matter, turbidity and bacteriological indicators of contamination (Escherichia coli, streptococci, Enterococcus spp, Pseudomonas aeruginosa). These relationships, however, vary according to the sampling place, the source and levels of contamination.

Dos nuevas localizaciones de transmisores de la enfermedad de Chagas en la Republica Mexicana. / Two new communities with transmissors of Chagas disease in the Mexican Republic

Se informa que en dos localidades, una perteneciente al estado de Queretaro y otra al de Guanajuato, se encontro Triatoma barberi. Se hace enfasis en el hallazgo debido a que estos dos estados aun no se habian senalado en la literatura medica con triatominos transmisores de enfermedad de Chagas. De esta manera se cubre todo el territorio nacional, en el cual existen una o mas poblaciones pertenecientes a cada uno de los estados con informes de hallazgos de triatominos infectados y no infectados en forma natural con Trypanosoma cruzi

Lactancia materna: causas de suspension en dos ciudades de Ecuador. / Breast feeding: causes of suspension in 2 cities of Ecuador

Se estudia la practica de la lactancia materna en dos ciudades de la provincia de Manabi, Ecuador. Para ello se correlaciono las causas de suspension de la lactancia materna con una serie de variables socioeconomicas y biologicas, que motivaron el cambio de alimentacion natural por otra artificial