A Clinical Analysis of Phlebolymphedema and Its Relationship with Physical Activity and Disability

Background: The clinical features and epidemiological data about patients with phebolymphedema or lymphedema related to Chronic Venous Disease in Mexico is limited and has been understudied; at the same time, the relationships between its clinical features, physical activity level and disability remained unknown. Methods: This is a longitudinal cohort study based on the analysis of clinical data of 90 patients gathered between 2021 and 2022. The statistical analysis was carried out using the software SPSS version 25 and GrandhPad Prism 8; a descriptive analysis was developed using measures of central tendency for the variables of a quantitative nature and frequency distribution for those categorical variables. The behavior of the variables was revealed through the Shapiro-Wilk statistic. The mean difference analysis was carried out with the Student’s T for independent samples. To identify the effect of gender, age, and severity of the disease on the study variables, a three-way analysis of variance was obtained with a Sidak comparison analysis. For the associations between qualitative and dichotomous nature variables, the Chi-Square statistic was obtained along with the odds ratio to determine the intensity of the relationships found. Results: A total of 90 patients were included in the analysis; 71% (64) were female and 29% (26) were male; with a mean age of 62.7 years old (± 30.5). A mean BMI of 33.2, 79.9% (77) of patients reached overweight and obesity ranges. 50% (45) of patients reported disability to perform one or more daily life activities related to the disease’s condition (signs, symptoms, volume). Only 12% (10) of all patients performed at or above the minimum physical activity recommended for their population group, and 88% (80) of patients had no physical activity or performed under the proper population group’s recommendation of minimal physical activity. It was found that the practice of physical activity, the number of compromised segments, the stage of the pathology, and the presence of cardiological and metabolic antecedents provide a statistically significant association with disability. Notable statistical difference among sex as a risk factor was not found. Regarding the BMI, the only differences were observed in the level of severity of the disease, regardless of the presence of any disability (p=0.006), evidencing that the greater the severity, the higher the BMI in both men and women. About physical activity, it is observed that inactivity or minimal practice of physical activity is a risk factor for referred disability (p<0.05), since it is prolonged that the non-practice of physical activity increases by 230% the chances of referring a disability associated to the disease compared to those people who referred to practice minimal or above minimal physical activity; the presence of a cardiological and/or metabolic history is related to an increase of about 150% to 180% of presenting disability compared to patients who do not have these pathologies. Conclusion: This study shows clinical and epidemiological features of phlebolymphedema and their relationship with the level of physical activity and reported disability of 90 patients. Further studies are needed to improve and broaden the understanding of the clinical characteristics of phlebolymphedema and its correlations.

Cancer-Related Lymphedema: Clinical and Epidemiological Features in Mexico

Background? There is a lack of clinical and epidemiological knowledge about cancer-related lymphedema in Mexico. The objective of this study is to present a broad and deep report of cancer-related lymphedema’s clinical characteristics and epidemiological features based on the analysis of CRL patients’ data, collected from a specialized rehabilitation clinic in Mexico. Methods? This is a cohort study based on the analysis of clinical data gathered between 2015 and 2022. The study was developed in a private clinic that specializes in oncological patients’ rehabilitation. Clinical assessments and interviews were performed to collect each case’s clinical history, considering diverse clinical characteristics and demographic information, classified in a matrix, and statistically evaluated. Results? Among 307 lymphedema patients, gender distribution was represented by 87.9% (270) female and 12.1% (37) male; mean age of 54.5 years (± 32.5); 79.8% of the patients corresponded to breast cancer diagnosis, the rest of them were associated with other 19 different types of cancer. 90.2% of patients underwent some lymph node removal procedure, 68.1% of patients received fractioned radiotherapy sessions, and 87.7% received some chemotherapy scheme treatment. 64% of patients had a diagnosis of lymphedema and had onset symptoms of lymphedema in the first 5 years after oncological interventions and/or cancer diagnosis, most of them during the first 2 years. The general distribution of clinical staging was: 23.7% in stage 0; 20.1% in stage I; 44.6% in stage II, and in stage III 11.4%. Regarding body mass index, it was found a mean of 26.7 BMI. 61.2% of patients ranged between overweight and obesity. 43.3% of patients with CRL reported a disability to perform one or more activities due to lymphedema. 80% of patients had no physical activity or performed under the minimal physical activity recommended for the population group they belong. Conclusion? This study reports broad epidemiological and clinical features of a group of cancer-related lymphedema patients in Mexico, it was possible to identify diverse potential factors and relations that influence the clinical features of CRL; it is necessary to explore all factors and the interactions among them for a better understanding of CRL patients in the country.

Comportamiento de pacientes con fracturas del pilón tibial tratados mediante fijación externa / Behavior of patients with tibial pilon fractures treated by external fixation

Resumen: Introducción: Las fracturas del pilón tibial constituyen lesiones de difícil manejo por su situación anatómica, mecanismo de producción y daño de las partes blandas que la rodean. El tratamiento quirúrgico es el más empleado, la fijación externa puede utilizarse de forma transitoria o definitiva. Objetivo: Evaluar el uso de la fijación externa en pacientes con fracturas del pilón tibial. Material y métodos: Se realizó un estudio con un nivel de evidencia IV, grado de recomendación B, en 34 pacientes con fractura del pilón tibial, atendidos de Enero de 2014 a Febrero de 2020. Desde el punto de vista estadístico se utilizó la distribución de frecuencias absolutas y relativas para variables cualitativas y para las cuantitativas la prueba de t Student. Resultados: El promedio de edad general fue de 45.8 años, predominó el sexo masculino con una razón de 1.4 a 1 y la fractura cerrada-abierta 1.8 a 1. Predominaron las fracturas tipo A según la clasificación del grupo AO. En relación a las fracturas abiertas predominaron las de tipo 3A. Se detectó significación entre un antes y un después al aplicar las escalas Olreud C y Molander H de la Sociedad Americana del Tobillo y Pie y el Ankle Scoring System. Las complicaciones del procedimiento quirúrgico fueron mínimas. Conclusiones: La fijación externa en pacientes con fracturas del pilón tibial es un método efectivo que puede emplearse de forma inmediata y definitiva en pacientes con fracturas abiertas y cerradas.

Abstract: Introduction: Tibial pylon fractures are difficult to manage injuries due to their anatomical situation, mechanism of production, and damage to the surrounding soft tissue. Surgical treatment is the most widely used, including external fixation that can be used temporarily or permanently. Objective: To evaluate the use of external fixation in patients with tibial pylon fractures. Material and methods: A pre-experimental study with a level of evidence II, recommendation grade B, was carried out in 34 patients with tibial pylon fracture, treated from January 2014 to February 2020. From the statistical point of view, the distribution of absolute and relative frequencies was used for qualitative variables and for quantitative variables, the Student's t test. Results: The general average age was 45.8 years, the male sex predominated with a ratio of 1.4 to 1 and the closed-open fractures 1.8 to 1. Type A fractures predominated according to the classification of the AO group. In relation to open fractures, 3A types predominated. Significance between a before and after was detected when applying the Olreud C and Molander H scales, from the American Ankle and Foot Society, and the Ankle Scoring System. The complications of the surgical procedure were minimal. Conclusions: External fixation in patients with tibial pylon fractures is an effective method that can be used immediately and definitively in patients with both open and closed fractures with few complications.

Electrical Cochlear Response as an Objective Measure of Hearing Threshold and Hearing Performance Evaluation in Pediatric Cochlear Implant Users / Respuesta Coclear Eléctrica como Medida Objetiva del Umbral Auditivo y la Evaluación del Rendimiento Auditivo en Usuarios Pediátricos de Implante Coclear

ABSTRACT The difficulties of applying the audiometry in pediatric populations and its methodological limitations in implanted patients have spurred the development of new alternative auditory evaluation methods. This study aimed to show an objective method to estimate hearing thresholds in pediatric cochlear implanted patients through Electrical Cochlear Response (ECR) and to quantify the hearing performance by using an Auditory Skills Questionnaire (ASQ) and a Calibrated Sounds Test (CST) designed on purpose. Eighteen implanted patients, 1-6 years old underwent standard audiometry, ECR, and ASQ in two evaluation sessions T1 and T2. At T2, in addition, patients underwent CST. For patients ≤3 years old (G1), Pure Tone Averages (PTA and PTAECR)showed a statistically significant difference between them at T1 and T2. At T2 improvements in audiometric and ECR thresholds were observed (p<0.05), regarding T1. Patients older than 3 years (G2) had significantly better ASQ and CST scores. CST detection scores at 40 dBHL for groups G1 and G2, 36% and 70% respectively, showed a better relationship to ECR thresholds. The relationship observed between ECR thresholds and CST detection scores seems to confirm that ECR brings the feasibility of objective hearing threshold estimation and provides a better frequency resolution than audiometry.

RESUMEN Las dificultades para la aplicación de la audiometría en la población pediátrica además de sus limitaciones metodológicas en pacientes usuarios de implante coclear, señalan la necesidad de métodos audiométricos alternos. En el presente trabajo se utiliza el potencial eléctrico, denominado Respuesta Coclear Eléctrica (ECR) observado solamente en usuarios de implante coclear, para la estimación de umbrales auditivos prescindiendo de la participación consiente del paciente, además de evaluar el desempeño auditivo mediante un Cuestionario de Habilidades Auditivas (ASQ) y la Prueba de Sonidos Calibrados (CST). A dieciocho participantes de 1 a 6 años, se les practicó Audiometría, ECR y ASQ en dos sesiones, T1 y T2; adicionalmente, en T2 se aplicó CST. En T1 y T2 los promedios de tonos puros, PTA y PTAECR, de pacientes ≤ 3 años (G1), mostraron una diferencia estadísticamente significativa entre ellos. En T2 los umbrales audiométricos y ECR (p <0.05), mejoraron respecto de T1. Pacientes > 3 años (G2) lograron puntuaciones ASQ y CST significativamente mejores. Los puntajes de detección CST a 40 dBHL, G1(36%) y G2(70%), mostraron mejor relación con los umbrales ECR. Esta relación entre los umbrales ECR y los puntajes de detección CST indican que la ECR permite estimar el umbral de audición, logrando adicionalmente mayor resolución en frecuencia que la audiometría.

Inducción de trabajo de parto en pacientes COVID-19: experiencia en el Hospital San Juan de Dios / Labor induction in COVID-19 patients: experience in the San Juan de Dios Hospital

INTRODUCCIÖN Y OBJETIVOS: Describir la experiencia de los partos en gestantes con diagnóstico confirmado de COVID 19 mediante RT-PCR asintomáticas o con sintomatología leve y aquellas sin la enfermedad, y determinar la tasa de éxito de parto vaginal en inducción de trabajo de parto. MÉTODOS: Análisis retrospectivo de pacientes que tuvieron su parto entre 15 de Abril y 03 de Julio del 2020 en el Hospital San Juan de Dios. Se incluyeron las pacientes inducidas con Dinoprostona, Oxitocina o ambas de manera secuencial y se dividieron según estatus COVID 19 mediante RT-PCR al ingreso. Se caracterizó demográficamente el grupo de pacientes positivas y se determinaron los datos de ambos grupos en relación a la necesidad de inducción de trabajo de parto y su éxito para parto vaginal. RESULTADOS: De un total de 657 nacimientos, hubo un 9.7% (n=64) de pacientes con COVID 19, de las cuales un 23.4% (n=15) requirió inducción de trabajo de parto, con una tasa de éxito para parto vaginal de un 66.7% (n=10). De estas pacientes, un 50% recibió Oxitocina, un 40% Dinosprostona y un 10% ambos medicamentos de forma secuencial. En las pacientes negativas, hubo un total de 568 nacimientos, con un 29.8% (n=169) de usuarias que requirieron inducción. La tasa de éxito para parto vaginal en este grupo fue de 72.2% (n=122), utilizando un 50% Oxitocina; un 27% Dinoprostona; un 14.8% ambas; y un 8.2% Balón de Cook. CONCLUSIONES: Sabemos que los resultados de este estudio están limitados por el bajo número de pacientes incluidas, sin embargo, podemos observar que, en nuestra experiencia con las pacientes que arrojaron PCR SARS-CoV-2 positivas, asintomáticas o con enfermedad leve, se logró realizar la inducción de trabajo de parto según protocolos habituales, obteniendo porcentajes de éxito para partos vaginales, similares a las pacientes sin la enfermedad.

INTRODUCTION AND OBJECTIVES: Describe the experience of deliveries in pregnant women with a confirmed diagnosis of COVID 19 by asymptomatic RT-PCR or with mild symptoms and those without the disease, and determine the success rate of vaginal delivery in the induction of labor. METHODS: Retrospective study of patients who had their delivery between 15th April and 03rd of July, 2020 in the San Juan de Dios Hospital. Patients induced with Dinoprostone, Oxytocin or both sequentially were included, and were divided according to COVID 19 status by RT-PCR on their admission process. The group of positive patients was demographically characterized and the data of both groups was determined in relation to the need for labor induction and its success for vaginal delivery. RESULTS: Of a total of 657 births, there were 9.7% (n = 64) of patients with COVID 19, of which 23.4% (n = 15) required labor induction, with a success rate for vaginal delivery of 66.7% (n = 10). Of these patients, 50% received Oxytocin, 40% Dinosprostone and 10% both drugs sequentially. In the negative patients, there were a total of 568 births, with 29.8% (n = 169) of users requiring labor induction. The success rate for vaginal delivery in this group was 72.2% (n = 122); 50% using Oxytocin; 27% Dinoprostone; 14.8% using both; and 8.2% using Cook's Catheter. CONCLUSIONS: We know that the results of this study are limited by the low number of patients included, however, in our experience, we can observe that, in patients with SARS-CoV-2 PCR positive, asymptomatic or with mild disease, it was possible to perform induction of labor according to standard protocols, achieving success rates for vaginal deliveries, similar to patients without the disease.

Parto prematuro en pacientes COVID-19 en Hospital San Juan de Dios / Premature delivery in COVID-19 patients at San Juan de Dios Hospital

INTRODUCCIÓN Y OBJETIVO: La pandemia por SARS-CoV-2 afecta a las embarazadas con diferentes manifestaciones clínicas; una de ellas es el parto prematuro. El objetivo del presente estudio es caracterizar a las embarazadas con COVID-19 que tuvieron su parto y determinar la razón de aumento de parto prematuro en este grupo en comparación con aquellas que no presentaban la enfermedad. MÉTODOS: Estudio observacional de cohorte retrospectivo donde se incluyeron pacientes embarazadas entre abril y junio del año 2020 en la Maternidad del Hospital San Juan de Dios. Se seleccionaron aquellas que tuvieron su parto y se evaluaron los datos demográficos y médicos, antecedentes obstétricos, información respecto al parto, antecedentes del recién nacido y características de la enfermedad por COVID-19. RESULTADOS: Entre las pacientes COVID-19 un 16.9% tuvo parto prematuro, alcanzando un OR de 1,79 (0,76-3,84 IC 95%) respecto a aquellas sin la enfermedad que, aunque no significativo, evidencia tendencia. Entre las que cursaron con COVID-19 severo todas tuvieron parto prematuro, con un OR significativo (>= 7.84 IC 95%) en comparación con aquellas con cuadro leve o negativas a COVID-19. Un 10.1% de los recién nacidos de madres COVID-19 requirió reanimación neonatal, mientras que en las negativas fue de un 5.5%. CONCLUSIONES: Entre las pacientes COVID-19 se observo una tendencia a aumento del riesgo de parto prematuro respecto a aquellas sin la enfermedad, siendo significativo el aumento del riesgo en aquellas que cursaban con síntomas y aún más significativo si presentaban enfermedad severa.

INTRODUCTION AND OBJECTIVES: The SARS-CoV-2 pandemic has affected pregnant women with different clinical manifestations, one of them premature labor. The objective of this study is to characterize the pregnant patients with COVID-19 who had their delivery and to determine the risk of preterm delivery in this group compared to those who did not have the disease at the Maternity Department in San Juan de Dios Hospital, and determine what the rate of premature delivery is. METHODS: Retrospective observational cohort study where pregnant patients were included between April and June of 2020 at the Maternity Department in San Juan de Dios Hospital. Patients who had their delivery were selected and demographic and medical data, obstetric history, information regarding delivery, newborn history and characteristics of COVID-19 disease were evaluated. RESULTS: Among COVID-19 positives, a 16.9% had premature labor, reaching a nonsignificant OR 1.79 (0.76-3.84 95% CI) compared to those COVID-19 negative. Among those with severe COVID-19, all had preterm birth, with a significant OR (>=7.84 95% CI) compared to those with mild symptoms or COVID-19 negative. 10.1% of newborns of COVID-19 mothers required neonatal resuscitation, while, in the negative ones it was 5.5%. CONCLUSIONS: Among COVID-19 patients, a trend towards increased risk of preterm birth was observed compared to those without the disease, with the increased risk being significant in those with symptoms and even more significant if they had severe disease.

Cetoacidosis normoglicémica en paciente embarazada con neumonía por COVID-19. Reporte de un caso clínico / Euglycaemic ketoacidosis in a pregnant woman with COVID-19 pneumonia. A case report

RESUMEN Introducción: La cetoacidosis en el embarazo es una emergencia médica que requiere tratamiento en Unidad de Cuidados Intensivos debido a su asociación con morbimortalidad maternofetal. Las gestantes pueden presentar una forma atípica del cuadro llamada cetoacidosis normoglicémica, siendo muy infrecuente en pacientes sin antecedente de diabetes. Caso Clínico: Se presenta una gestante cursando tercer trimestre de embarazo, sin antecedente de diabetes, ingresada en Unidad de Paciente Crítico debido a neumonía por COVID-19 y acidosis metabólica con anión gap aumentado. Se realizó diagnóstico de cetoacidosis normoglicémica posterior al ingreso, iniciándose tratamiento intensivo de trastorno ácido-base con buena evolución. Conclusión: La infección por SARS-CoV-2 puede causar cetoacidosis normoglicémicas en embarazadas no diabéticas; se requiere una alta sospecha clínica para realizar el diagnóstico y tratamiento oportuno.

ABSTRACT Introduction: Ketoacidosis in pregnancy is a medical emergency that requires treatment in an intensive care unit due to its association with maternal-fetal morbimortality. Pregnant women may present an atypical form of the condition called normoglycemic ketoacidosis, being very rare in patients with no history of diabetes. Clinical Case: We present a pregnant woman in the third trimester of pregnancy, without history of diabetes, admitted to a critical patient unit due to COVID-19 pneumonia and metabolic acidosis with an increased anion gap. A diagnosis of normoglycemic ketoacidosis was made after admission, and intensive treatment of acid-base disorder was initiated, with good evolution. Conclusion: SARS-CoV-2 infection can cause normoglycemic ketoacidosis in non-diabetic pregnant women; is required a high clinical suspicion to make the diagnosis and appropriate treatment.

Adenoma hipofisario ectópico del seno esfenoidal persistente tras cirugía manejado con tratamiento conservador / Ectopic pituitary adenoma in the sphenoid sinus persistent after surgery managed with conservative treatment

Los adenomas hipofisarios ectópicos (EPA) constituyen un reto diagnóstico, dada su escasa prevalencia y variada presentación en la que puede incluirse un síndrome de hipersecreción de hormonas hipofisarias. La clínica suele ser larvada e inespecífica, no presentan ninguna característica radiológica diferencial y el diagnóstico habitualmente es anatomopatológico. Sin embargo, a pesar de ser tumores benignos, pueden presentar un comportamiento agresivo, con invasión ósea y difícil resección completa, por lo que un diagnóstico de sospecha precoz podría resultar en un tratamiento más eficaz y con un menor número de complicaciones. Presentamos el caso de una paciente con un adenoma hipofisario ectópico silente en el seno esfenoidal con inmunohistoquímica positiva para Hormona de crecimiento (GH) y prolactina que presentaba restos tumorales tras la intervención quirúrgica y ha sido manejada con tratamiento médico conservado, con buenos resultados.

Ectopic pituitary adenomas constitute a diagnostic challenge, given their low prevalence and varied presentation in which a pituitary hormone hypersecretion syndrome may be included. Clinical symptoms are usually latent and nonspecific, they have no differential radiological characteristics and the diagnosis is usually anatomopathological. However, despite being benign tumors, they can exhibit aggressive behavior, with bone invasion and difficult complete resection, so a diagnosis of early suspicion could result in more effective treatment and fewer complications. We present the case of a patient with a silent ectopic pituitary adenoma in the sphenoid sinus with positive immunohistochemistry for Growth Hormone (GH) and prolactin who had tumor remnants after surgery and was managed with conservative medical treatment, with good results.

Propuesta de una dosis de marbofloxacina para el tratamiento de infecciones asociadas a Escherichia coli en cabras de tres semanas de vida

Se estimó una dosis de marbofloxacina (MFX) para tratar infecciones gastrointestinales asociadas a Escherichia coli en cabras de tres semanas de vida. La farmacodinamia de MFX sobre E. coli se evaluó in vitro estimando las concentraciones inhibitoria mínima (CIM), bactericida mínima (CBM) y preventiva de mutantes (CPM). Marbofloxacina se administró en cabras de tres semanas de edad por vía subcutánea a una dosis de 2 mg/kg. Los parámetros farmacocinéticos se estimaron mediante análisis no compartimental. La dosis de MFX capaz de proteger al 95% de una población se calculó considerando la distribución poblacional de los parámetros farmacocinéticos. La eficacia de MFX se evaluó con la relación entre el área bajo la curva y la CPM (ABC/CPM) con un valor de corte de 22 h. Los resultados mostraron que la dosis estimada de MFX para alcanzar la remisión clínica de infecciones gastrointestinales causadas por E. coli y prevenir la emergencia de cepas resistentes en el 95% de una población de cabras de tres semanas de vida fue de 3,179 mg/kg, que a los fines prácticos se fijó en 3,5 mg/kg.

A dose of marbofloxacin (MFX) to treat gastrointestinal infections caused by Escherichia coli in 3-week-old goats was estimated. The pharmacodynamics of MFX against E. coli was evaluated in vitro by estimation of mínimum inhibitory concentration (MIC), mínimum bactericide concentration (MBC) and mutant prevention concentration (MPC). Marbofloxacin was administered to 3-week -old goats by subcutaneous route at the dose of 2 mg/kg. The pharmacokinetic parameters were estimated by non-compartmental analysis. The dose of MFX capable to protect the 95% of population was calculated considering the population distribution of pharmacokinetic parameters. The efficacy of MFX was evaluated by the relationship between the area under curve and MPC (AUC/MPC) with a cut-off value of 22 h. The results showed that the estimated dose of MFX to reach the clinical outcome of gastrointestinal infections caused by E. coli and to prevent the bacterial resistance at the 95% of the population of 3-week-old goats was 3.179 mg/kg, which for practical reasons was fixed at 3.5 mg/kg.

Dificultades en el diagnóstico de enteritis lúpica: presentación de un caso / Lupus enteritis: report of one case

In lupus enteritis, circulating pathological immune complexes and thrombosis of intestinal vessels may occur, resulting in acute abdominal pain. We report a 24-year-old woman without a history of systemic lupus erythematosus (SLE), admitted for abdominal pain. An exploratory laparotomy found an appendicitis along with ascites. An appendectomy was performed, and the patient was discharged from the hospital two days later. Three days after discharge, the patient was admitted to another hospital due to the persistence of abdominal pain. An abdominal computed tomography scan showed diffuse mesenteric congestion, concentric bowel loops (double halo or target sign) and the presence of free fluid in the peritoneal cavity. Suspecting a rheumatic disorder, the diagnosis of SLE was confirmed by immunological studies. The patient was treated with pulses of methylprednisolone with good results.

Utilidad de la quimioterapia con corticoides en la reducción de volumen de las lesiones en fetos con malformación congénita de la vía aérea pulmonar (MCVAP): serie de casos / Usefulness of chemotherapy with corticosteroids in reducing the volume of the lesions in fetuses with congenital pulmonary airway malformation (MCVAP): case series

RESUMEN OBJETIVO: el propósito es describir el efecto de los corticoides prenatales en la malformación congénita de la vía aérea pulmonar (MCVAP) mediante la evaluación secuencial del CVR y mostrar la experiencia en nuestro centro de terapia fetal. MATERIALES Y MÉTODOS: serie de casos en la cual se incluyeron ocho pacientes del Hospital de San José; con diagnóstico de MCVAP; se evaluó edad gestacional, el CVR (longitud x largo x ancho, en cms de la masa) x 0.523/circunferencia cefálica) como factor pronóstico, la desviación mediastínica, la presencia de hidrops, el tipo de MCVAP y la localización. Se aplicó betametasona a dosis de inducción de madurez pulmonar fetal. Se realizó la medición del CVR pre y pos tratamiento. Los datos obtenidos fueron analizados mediante el software estadístico SPSS (Versión 11.0 SPSS Inc. Chicago, IL). Se utilizaron la prueba Wilcoxon y el índice de correlación de Spearman según el caso. Un valor de p<0.05 se consideró significativo. RESULTADOS: ocho pacientes fueron incluidas. La mediana de la edad gestacional fue 30.5 semanas. Cuatro casos fueron tipo I, dos tipo II y dos tipo tres. Cuatro casos presentaron desviación mediastinal. Cinco casos fueron derechos y uno bilateral. Ningún caso presentó hidrops. El CVR pre tratamiento fue 0,93(RIQ:0,17-2,1) y pos tratamiento 0,55(RIQ:0,07-1,39). Se encontró una disminución del CVR pos tratamiento en todos los casos (p 0.0117) e índice de correlación de Spearman 0.9524 CONCLUSIÓN: Después de la aplicación de corticoides encontramos una disminución del CVR en todos los casos descritos. El uso de corticoides podría ser parte de la terapia prenatal con miras a mejorar el pronóstico.

ABSTRACT OBJECTIVE: The purpose of this study is to describe the effect of prenatal corticosteroids in the CPAM by sequential evaluation of the CVR, and to show the experience in our fetal therapy center. MATERIALS AND METHODS: Series of cases in which eight patients from the Hospital of San José were included; with diagnosis of CPAM; gestational age was evaluated, CVR (CVR = length x length x width cm, mass) x 0.523 / head circumference) as a prognostic factor, mediastinal shift, hydrops, type of CPAM, location. Betamethasone was applied to fetal lung maturation dose. In all patients underwent CVR measurement pre and post treatment. The data were analyzed using SPSS statistical software (Version 11.0 SPSS Inc. Chicago, IL). The Wilcoxon test and the Spearman correlation index were used according to the case. A value of p <0.05 was considered significant. RESULTS: eight patients were included. The median of gestational age was 30.5 weeks. Four cases were type I, two type II and two type three. Four cases were mediastinal shift. Five cases were rights and one bilateral. No case presented hydrops. The pretreatment CVR was 0,93(RIQ: 0,17-2,1) and post-treatment 0,55(RIQ: 0,07-1,39). We found a decrease in CVR after treatment in all cases (p 0.0117) and Spearman correlation index 0.9524 CONCLUSION: After application of corticosteroids are a reduction in CVR in all the cases described. The use of corticosteroids may be part of prenatal therapy to improve prognosis.

Comportamiento de pacientes con artrosis patelofemoral / Behavior of patients with patellofemoral osteoarthritis

Resumen: Antecedentes: La artrosis patelofemoral es detectada en un gran número de pacientes y es responsable de múltiples síntomas y signos entre los que predomina el dolor, su tratamiento es variado y va desde el conservador hasta el quirúrgico, en el que destaca la vía artroscópica. Objetivo: Mostrar el comportamiento de un grupo de pacientes con artrosis patelofemoral. Material y métodos: Se realizó un estudio observacional descriptivo en 96 pacientes con el diagnóstico clínico y radiográfico de artrosis patelofemoral desde Enero de 2015 hasta Abril de 2017. La muestra no probabilística e intencionada quedó constituida por 77 pacientes que reunieron los criterios de selección (inclusión y exclusión). Resultados: El promedio de edades fue de 52.2 años, predominó el sexo femenino, la rótula derecha y la causa que más se observó fue la primaria. El dolor durante el reposo es una de sus principales manifestaciones. Existe correlación entre la clasificación de Iwano T y Outerbridge RE. Por lo general, existen otros compartimentos afectados de la articulación, la presencia aislada es muy infrecuente y el tratamiento por vía artroscópica es de gran utilidad. Conclusiones: La artrosis patelofemoral es frecuente, genera síntomas y signos en un grupo grande de pacientes. La presencia de esta afección por lo regular está asociada a otras lesiones de la articulación y los enfermos pueden ser tratados por vía artroscópica.

Abstract: Background: Patellofemoral osteoarthritis affects a great number of patients complaining chiefly of knee pain, treatment vary from conservative to surgical, especially arthroscopy. Objective: The aim of this study was to show the behavior of a group of patients with patellofemoral osteoarthritis. Material and methods: A descriptive and transversal study with a level of evidence IV and recommendation grade C in the provincial teaching hospital Manuel Ascunce Domenech in Camaguey city from January 2015 to April 2017 was performed in 96 patients with the diagnosis of patellofemoral osteoarthritis, but 77 of them were selected as a non-probabilistic sample, based on selected criteria. Results: Mean age was 52.2 years. Female sex, right patella and primary etiology prevailed. Rest pain was the most common symptom. There is a strong correlation between Iwano T and Outerbridge RE classifications systems. In general, more than one compartment of the knee is affected in patellofemoral osteoarthritis, isolated presentation is rare and treatment by arthroscopy is of great help. Conclusions: Patellofemoral osteoarthritis is a common disease, patients usually complain of a great number of symptoms and signs. Patellofemoral osteoarthritis is usually associated to affection of other compartments and patients may be treated by arthroscopy.

Lactato sérico como factor predictivo de mortalidad en pacientes con sangrado del tubo digestivo alto / Serum lactate as predictive factor of mortality in upper digestive tract bleeding

Resumen ANTECEDENTES: Según el reporte de Upper Gastrointestinal Bleeding de Gastroenterology Clinics of North America, en 2008 se registraron 863,000 admisiones hospitalarias por hemorragia gastrointestinal, con mortalidad reportada de 15 a 20%. En México la mortalidad por sangrado del tubo digestivo alto es de 8.5%, pero aumenta hasta 63% cuando coexiste con otras enfermedades. El lactato se ha validado para el pronóstico de mortalidad en distintas áreas. OBJETIVO: Determinar la utilidad del lactato como pronóstico de mortalidad en pacientes con sangrado del tubo digestivo alto. MATERIAL Y MÉTODO: Estudio de cohorte retrospectivo, ambilectivo, observacional, analítico y unicéntrico, en el que de 2015 a 2016 se midió el lactato de pacientes admitidos por sangrado del tubo digestivo alto al momento del ingreso a la sala de urgencias del Hospital General Xoco, Ciudad de México; posteriormente se correlacionó con el diagnóstico de egreso, se buscó correlación entre sangrado del tubo digestivo alto y egreso por defunción. Se evaluaron como objetivos secundarios la relación entre lactato y hemoderivados transfundidos. RESULTADOS: Se incluyeron 30 pacientes. La media de lactato en hombres fue de 5.33 ± 0.53 mmol/L y en mujeres fue de 1.2 ± 3.84 mmol/L con p < 0.01. El tiempo de hospitalización fue de 6.43 ± 5.13 días. El análisis de supervivencia tomó como referencia la media de lactato de 4.78; 29 pacientes egresaron por mejoría, mientras que un paciente falleció sin encontrar relación entre las concentraciones de lactato y defunción como diagnóstico de egreso; sin embargo, no encontramos relación estadísticamente significativa. CONCLUSIONES: Tras realizar el análisis de nuestra población no encontramos una relación estadísticamente significativa entre las concentraciones de lactato a 4.78 mmol/L y la mortalidad. Se buscó también asociación entre las concentraciones de lactato y las complicaciones durante el internamiento; sin embargo, esto tampoco tuvo relación significativa. A pesar de los resultados obtenidos, consideramos que es necesario replantear el estudio con un enfoque distinto ajustando las características de población y el tamaño de la misma con el fin de aportar datos definitivos respecto a este biomarcador.

Abstract BACKGROUND: According to Upper Gastrointestinal Bleeding of Gastroenterology Clinics of North America, in 2008 there were 863,000 hospital admissions for gastrointestinal bleeding, with reported mortality of 15-20%. In Mexico, mortality from upper digestive tract bleeding represents 8.5%, but increases up to 63% when it coexists with other diseases. Lactate has been validated for the prognosis of mortality in different areas. OBJECTIVE: To determine the usefulness of lactate as prognosis factor of mortality in upper digestive tract bleeding. MATERIAL AND METHOD: A retrospective, ambilective, observational, analytical and unicenter cohort study was done measuring lactate in patients admitted for upper digestive tract bleeding at admission to the emergency room of Hospital General Xoco, Mexico City, from 2015 to 2016 later it was correlated with the diagnosis of discharge, seeking a correlation between upper digestive tract bleeding and discharge due to death. Lactate ratio and blood products transfused were evaluated as secondary objectives. RESULTS: There were included 30 patients. The mean lactate in men was 5.33 ± 0.53 mmol/L and in women were 1.2 ± 3.84 mmol/L with a p < 0.01. The hospitalization time was 6.43 ± 5.13 days. The survival analysis was based on the mean lactate of 4.78; 29 patients graduated for improvement, while one patient died without finding a relation between lactate and death levels as a diagnosis of discharge; however, we did not find statistically significant relationship. CONCLUSION: After analyzing our population we did not find a statistically significant relation between lactate levels at 4.78 mmol/L and mortality. We also looked for an association between lactate levels and complications during hospitalization; however, this either had significant relation. Despite of the obtained results, it is necessary to reconsider the study with a different approach adjusting the population characteristics and its size in order to obtain definitive data about this biomarker.

Síndrome de bart: A propósito de un caso / Bart syndrome: Report of a case

El síndrome de Bart es un trastorno congénito poco frecuente, caracterizado por la asociación de epidermólisis ampollosa, ausencia congénita localizada de piel y ocasionalmente anormalidades ungueales. En este artículo se reporta el caso de un neonato masculino, remitido al Hospital para el Niño del IMIEM (Instituto Materno-Infantil del Estado de México), para valoración de lesiones ampollosas extensas y ausencia de piel en miembros inferiores, presentes desde el nacimiento quien después del tratamiento, mostró mejoría con una evolución clínica favorable.

Bart syndrome is a rare congenital disorder characterized by the association of epidermolysis bullosa, localized congenital absence of skin and occasionally nail abnormalities. In this presentation we report the case of a male neonate referred to the Hospital para el Niño of IMIEM for evaluation of extensive blistering lesions and absence of skin in lower limbs, present from birth and who after treatment showed improvement, with a favorable clinical evolution.

Equations based on anthropometry to predict body fat measured by absorptiometry in schoolchildren and adolescents / Equações com base na antropometria para prever a gordura corporal medida por absorciometria em crianças em idade escolar e adolescentes

Abstract Objective: To develop and validate equations to estimate the percentage of body fat of children and adolescents from Mexico using anthropometric measurements. Methods: A cross-sectional study was carried out with 601 children and adolescents from Mexico aged 5-19 years. The participants were randomly divided into the following two groups: the development sample (n = 398) and the validation sample (n = 203). The validity of previously published equations (e.g., Slaughter) was also assessed. The percentage of body fat was estimated by dual-energy X-ray absorptiometry. The anthropometric measurements included height, sitting height, weight, waist and arm circumferences, skinfolds (triceps, biceps, subscapular, supra-iliac, and calf), and elbow and bitrochanteric breadth. Linear regression models were estimated with the percentage of body fat as the dependent variable and the anthropometric measurements as the independent variables. Results: Equations were created based on combinations of six to nine anthropometric variables and had coefficients of determination (r2) equal to or higher than 92.4% for boys and 85.8% for girls. In the validation sample, the developed equations had high r2 values (≥85.6% in boys and ≥78.1% in girls) in all age groups, low standard errors (SE ≤ 3.05% in boys and ≤3.52% in girls), and the intercepts were not different from the origin (p > 0.050). Using the previously published equations, the coefficients of determination were lower, and/or the intercepts were different from the origin. Conclusions: The equations developed in this study can be used to assess the percentage of body fat of Mexican schoolchildren and adolescents, as they demonstrate greater validity and lower error compared with previously published equations.

Resumo Objetivo: Desenvolver e validar equações para estimar o percentual de gordura corporal (%GC) de crianças e adolescentes do México com medidas antropométricas. Métodos: Foi feito um estudo transversal com 601 crianças e adolescentes do México cinco e 19 anos. Os participantes foram divididos aleatoriamente nos seguintes dois grupos: a amostra de desenvolvimento (n = 398) e a amostra de validação (n = 203). A validade das equações publicadas anteriormente (por exemplo, Slaughter) também foi avaliada. O %GC foi estimado por absorciometria de dupla energia de raios X (raios X de dupla energia [DXA]). As medidas antropométricas incluíram estatura, altura sentado, peso, circunferências da cintura e do braço, dobras cutâneas (tríceps, bíceps, subescapular, suprailíaca e panturrilha) e larguras do cotovelo e bitrocantérica. Os modelos de regressão linear foram estimados com o %GC, a variável dependente e as medidas antropométricas como as variáveis independentes. Resultados: As equações foram criadas com base nas combinações de seis a nove variáveis antropométricas e apresentaram coeficientes de determinação (r2) iguais ou superiores a 92,4% para meninos e 85,8% para meninas. Na amostra de validação, as equações desenvolvidas apresentaram altos valores de r2 (≥ 85,6% em meninos e ≥ 78,1% em meninas) em todos os grupos, baixo nível de erros padrão (EP ≤ 3,05% em meninos e ≤ 3,52% em meninas) e os interceptos não foram diferentes da origem (p > 0,050). Com as equações publicadas anteriormente, os coeficientes de determinação foram menores e/ou os interceptos foram diferentes da origem. Conclusões: As equações desenvolvidas neste estudo podem ser usadas para avaliar o %GC das crianças em idade escolar e adolescentes mexicanos, pois têm uma maior validade e menor erro em comparação com as equações publicadas anteriormente.

Control glucémico intensivo y sobretratamiento en pacientes mayores de 60 años con diabetes mellitus / Intensive glycemic control and overtreatment in diabetic patients older than 60 years

Resumen ANTECEDENTES: existe incremento de la prevalência de diabetes mellitus 2 y del envejecimiento. Así, los riesgos asociados con control glucémico intensivo en esta población vulnerable se incrementan. Por ello, debe considerarse la posibilidad de un sobretratamiento en estos pacientes. OBJETIVO: determinar la prevalencia de control glucémico intensivo y sobretratamiento en pacientes con diabetes mellitus tipo 2 mayores de 60 años. MATERIAL Y MÉTODO: estudio retrospectivo, transversal, observacional y analítico. De 2013 a 2015 se evaluaron pacientes mayores de 60 años de edad con diabetes mellitus tipo 2, hemoglobina glucosilada (HbAlc) <7% y administración de hipoglucemiantes. Los pacientes se clasificaron en control glucémico intensivo (HbAlc 6.6-7%) y sobretratamiento (HbAlc <6.5%). Los porcentajes de ambos grupos y sus complicaciones cardiovasculares y no cardiovasculares asociadas se compararon utilizando una prueba Z. RESULTADOS: se incluyeron 13,229 pacientes con diabetes mellitus tipo 2 mayores de 60 años; en 2013, fueron 4,381, 16% (n=701) en control glucémico intensivo y 6% (n=256) en sobretratamiento; en 2014 fueron 4,383, 16% (n=697) en control glucémico intensivo y 6% (n=252) en sobretratamiento; en 2015 fueron 4,465, 16% (n=708) en control glucémico intensivo y 6% (n=260) con sobretratamiento. El control glucémico intensivo causó 5, 3 y 1% de complicaciones durante 2013, 2014 y 2015, respectivamente. En el grupo con sobretratamiento el porcentaje de complicaciones fue de 4% en 2013 y de 6% en 2015. Se obtuvo un valor Z de -2.90 (p<0.05), mostrando mayor número en sobretratamiento. CONCLUSIONES: de la población estudiada, 16% estaba en control glucémico intensivo y 6% en sobretratamiento, con incremento significativo de complicaciones en el grupo con sobretratamiento, la hipoglucemia fue la más frecuente.

Abstract BACKGROUND: Due to increasing prevalence of type 2 diabetes mellitus (T2DM) and the overall aging of the population, the number of elderly patients with T2DM is continuously growing. Given the risks associated with intensive glycemic control of those patients, the possibility of overtreatment must be considered. OBJECTIVE: To determine the prevalence of intensive glycemic control and overtreatment in individuals >60 years with T2DM. MATERIAL AND METHOD: An observational, cross-sectional, retrospective and analytical study was done from 2013 to 2015. Individuals >60 years old with T2DM, glycated hemoglobin (HbA1c) <7%, and use of hypoglycemic agents were included. Patients were divided into two groups: intensive glycemic control (HbA1c 6.6-7%) and overtreatment (HbA1c <6.5%). Cardiovascular and non-cardiovascular complications associated with treatment were compared by Z-test. RESULTS: There were included 13,229 patients older than 60 years with T2DM; 4,381 in 2013, 16% (n=701) was classified as intensive glycemic control and 6% (n=256) as overtreatment; 4,383 in 2014, 16% (n=697) as intensive glycemic control and 6% (n=252) as over-treatment; 4,465 in 2015, 16% (n=708) as intensive glycemic control and 6% (n=260) as overtreatment. By this period, adverse outcomes were reported in 5%, 3% and 1% during 2013, 2014 and 2015, respectively; referring to intensive glycemic control group. Likewise, adverse outcomes were reported in 4% and 6% during 2013 and 2015, respectively; referring to overtreatment group. A value of Z-test -2.90 (p<0.05) was obtained, which was increased in overtreatment group. CONCLUSIONS: All data collected during the study highlights a significant increase of cardiovascular and non-cardiovascular adverse outcomes in patients with strict glycemic management, being hypoglycemia the most frequent; 16% are in intensive glycemic control and 6% in overtreatment.

Reparación de fístula urogenital con interposición de injerto biológico de submucosa intestinal / Urogenital fistula repair with intestinal submucosa biological graft interposition

Resumen ANTECEDENTE: el tratamiento de una fístula genitourinaria compleja es un reto por las múltiples dificultades para conseguir un resultado exitoso; el injerto biológico de intestino porcino puede ser una opción en estos casos. OBJETIVO: describir el diagnóstico de las fístulas genito-urinarias y su reparación con una innovadora interposición de injerto biológico de intestino delgado porcino. MATERIALES Y MÉTODOS: estudio prospectivo de serie de casos con diagnóstico de fístula vésico-vaginal y uretro-vaginal de pacientes atendidas en el Instituto Nacional de Perinatología entre los años 2012 a 2014. Descripción de los datos demográficos de cada paciente, proceso diagnóstico-clínico y estudios de gabinete y laboratorio; características de la fístula, técnica quirúrgica y seguimiento. RESULTADOS: se estudiaron 5 pacientes con fístulas tipo III o vésico-vaginales localizadas en el trígono, 3 de ellas relacionadas con cirugía ginecológica y 2 con un evento obstétrico, y una tipo I o uretrovaginal en la uretra proximal, relacionada con parto instrumentado. En el cierre del segundo plano, para la colocación del injerto biológico, se aplicó la técnica de reparación de Latzko modificada. Una paciente tuvo 4 reparaciones previas, otra una reparación previa y el resto ninguna. El tamaño varió de 0.5 cm a 3 cm. El seguimiento posoperatorio no evidenció recurrencia; una paciente tuvo incontinencia urinaria de esfuerzo un año después. El seguimiento mínimo fue de 1 y el máximo de 2 años. No se registraron complicaciones posoperatorias. CONCLUSIÓN: el injerto de mucosa de intestino delgado porcino para la reparación de fístulas urogenitales complejas y recurrentes fue efectivo en todas las pacientes.

Abstract BACKGROUND: treatment of a complex genitourinary fistula is a challenge given the multiple difficulties to achieve a successful result, the biological grafting of porcine intestine can be an option in these cases. OBJECTIVE: to describe the diagnosis of genitourinary fistulas and their repair with an innovative interposition of small intestine porcine biological graft. MATERIALS AND METHODS: a prospective trial of a series of cases with a diagnosis of vesicovaginal and urethrovaginal fistula in patients of the Instituto Nacional de Perinatología between 2012 to 2014. Description of patient demographics, diagnostic and clinical process, imaging and lab tests; characteristics of the fistula, surgical technique and follow up. RESULTS: 5 patients with type III or vesicovaginal fistulas located in the trigone were studied, 3 of the fistulas are related to gynecological surgery and 2 with an obstetric event and one type 1 or urethrovaginal in the proximal urethra caused by an instrumented delivery. In the closure of the second layer for placement of the biological graft, we applied the modified Latzko repair technique. One patient had 4 previous repairs, another one had one previous repair and the rest had none. The size varied from 0.5 cm to 3 cm. The postoperative follow-up period did not show recurrence; one patient had stress urinary incontinence one year later. The minimum follow-up was 1 year and the maximum 2 years. No postoperative complications were reported. CONCLUSION: the porcine small intestinal submucosa graft for the repair of complex and recurrent urogenital fistulas was effective in all patients.

Diagnóstico final de pacientes con sospecha de accidente cerebrovascular descartado. Experiencia del Hospital de Chillán, chile / Final diagnosis of patients with suspect of ruled out stroke. experience of the Hospital of Chillán, Chile

INTRODUCCIÓN: El accidente cerebrovascular (ACV) es una lesión neurológica aguda con dos subtipos clásicos (isquémico y hemorrágico); siendo un importante problema de salud púbica en Chile. Existen patologías que imitan su presentación, sin embargo, una historia clínica y examen físico orientado permiten discriminar en un alto número de casos entre estas patologías evitando la derivación a especialista y solicitud de exámenes imagenológicos, disminuyendo así, los costos derivados en un gran número de pacientes. MATERIAL Y MÉTODO: Estudio transversal a partir de las fichas clínicas de pacientes ingresados con sospecha de ACV durante febrero y marzo del 2016 en Hospital Clínico Herminda Martín de Chillán para su confirmación diagnóstica por el Servicio de Neurología. RESULTADOS: Se obtuvieron 304 fichas clínicas con sospecha de ACV de las cuales un 26,9% no correspondieron a ACV. De estos, 45,9% eran patologías de especialidades no neurológicas siendo las más frecuentes las derivadas de Medicina Interna. DISCUSIÓN: El ACV es una entidad neurológica clásicamente descrita en base a la ubicación de la lesión vascular. Pese a que su presentación semiológica es conocida, existen muchas patologías que son clínicamente similares, o bien, las características singulares de los pacientes hacen que el patrón clínico sea confuso. Este fenómeno se refleja en una tasa de falsos ACV relativamente similar entre diferentes centros de salud. La tasa de error en diagnóstico de ACV en el estudio es de 26,9%, similar a otras experiencias. Pareciera ser que existe un número basal de falsos ACV, cuyo margen de error clínico, resulta difícil reducir aún con buenas escalas y protocolos estandarizados de atención.

INTRODUCTION: Stroke is an acute neurological lesion with two classic subtypes (ischemic and hemorrhagic), being an important public health problem in Chile. There are pathologies that mimic its presentation, however, a clinical history and oriented physical examination allow to discriminate in a high number of cases between these pathologies avoiding the referral to specialist and request of imaging examinations, thus reducing, the costs derived in a large number of patients. MATERIAL AND METHOD: Cross-sectional study from the clinical records of patients admitted with suspected stroke during February and March of 2016 at Herminda Martin Clinic Hospital from Chile for diagnostic confirmation by the Neurology Service. RESULTS: A total of 304 clinical files were obtained with suspected stroke, of which 26,9% did not correspond to stroke. Of these, 45,9% were pathologies of non-neurological specialties, the most frequent being those derived from internal medicine. DISCUSSION: Stroke is a neurological entity classically described based on the location of the vascular lesion. Although its semiologic presentation is known, there are many pathologies that are clinically similar, or the unique characteristics of the patients make the clinical pattern confusing. This phenomenon is reflected in a relatively similar false stroke rate among different health centers. The error rate in diagnosis of stroke of this study is 26,9%, similar to other experiences. It appears that there is a basal number of false stroke, whose clinical margin of error is difficult to reduce even with good scales and standardized care protocols.

Algoritmo para estimación de ángulo de rodilla en marcha normal: enfoque a trazado de trayectoria en prótesis transfemorales inteligentes / Algorithm to estimate the knee angle in normal gait: trajectory generation approach to intelligent transfemoral prosthesis

Resumen En este trabajo se presenta un algoritmo para estimar el ángulo de rodilla a partir del ángulo de cadera y parámetros de marcha, el cual sólo utiliza un sensor en el muslo para la estimación. Para el desarrollo del algoritmo fue indispensable realizar un análisis de marcha para establecer parámetros de diseño. Se utilizó la correlación natural entre cadera y rodilla para separar los movimientos de flexión-extensión de marcha en dos etapas:1) movimientos donde el pie no está en contacto total con el piso; 2) movimientos de contacto total del pie con el piso. La estimación es para movimientos de marcha, se realiza en tiempo real y la variación de velocidad en la marcha no afecta la estimación del ángulo. Se utilizaron regresores lineales para aproximar el ángulo estimado de rodilla al ángulo real. En todos los casos de estudio de marcha, los resultados mostraron una aproximación aceptable del ángulo de la rodilla; el error promedio de estimación fue de 8.25◦. El principal logro de este trabajo fue desarrollar un algoritmo para dar una posible solución al problema de coordinación entre el cuerpo humano y prótesis transfemorales inteligentes, aun ante cambios de velocidad en la marcha.

Abstract This paper presents an algorithm to estimate the knee angle from hip angle and gait parameters. This algorithm uses a single sensor on the thigh to achieve the estimation. Hip-knee natural correlations were employed in order to analyze the gait flexion-extension movements in two stages: 1) when the foot is not in full contact with the floor (swing phase and heel contact); 2) when the whole sole makes contact with the ground (stance phase). The estimation is developed in real-time for gait movements and speed fluctuations do not distort the angle estimated. In addition, the simple linear regression were used to approximate the estimated angle to actual knee angle. The experimental results obtained from the gait studies, showed an acceptable knee angle approximation; the mean error estimation was 8.25◦. The major goal of this work was the development of an algorithm that can solve the problem of human body-intelligent transfemoral prosthesis coordination, even if there are gait speed fluctuations.

Abordaje endonasal endoscópico para neoplasias malignas de la base craneal / Endonasal endoscopic approach for malignant cranial base neoplasm

Introduction: Malignant cranial base neoplasm constitutes a heterogeneous group of lesions with common seat in this localization. In the last years endonasal endoscopic approach has been more used. Methods: It was carried out a descriptive retrospective study of the database of the Service of Neurosurgery of "Hermanos Ameijeiras" Hospital between September 2009 and September 2015 with the objective of determining the results of endoscopic treatment to these lesions. Results: They were treated a total of 12 patients with wicked lesions of the cranial base inside. Six of them corresponded to anterior cranial base: 5 carcinomas (2 indiferenciate carcinoma, 2 carcinomas of scamous cells and 1 adenocarcinoma) and a metastases of renal carcinoma. Other six corresponded to cordoma (3 patients) and hematopoyetic neoplasm (2 plasmocitomas and 1 linfoma). The age average was of 51,1 years with a masculine-feminine relationship of 1,1:1. Conclusions: Surgical resection according to oncological principles can be used with endoscopic technics that in fact are associate with less morbility, better vision, betercompartiments access, nasolacrimal system and medial canthal tendon, absence of facial scar, craniectomy and brain retraction.

Introducción: Las neoplasias malignas de la base craneal constituyen un grupo heterogéneo de lesiones con asiento común en esta localización. En los últimos años el abordaje endonasal endoscópico ha cobrado mayor auge. Métodos: Se realizó un estudio retrospectivo descriptivo de la base de datos del Servicio de Neurocirugía del Hospital "Hermanos Ameijeiras" durante el período comprendido entre septiembre de 2009 y septiembre de 2015 con el objetivo de determinar los resultados del tratamiento endonasal endoscópico a estas lesiones. Resultados: Fueron tratados un total de 12 pacientes con lesiones malignas de la base craneal, 6 de la base craneal anterior dentro de los cuales 5 correspondieron a carcinomas (2 carcinomas indiferenciados, 2 carcinomas de células escamosas y 1 adenocarcinoma) y una metástasis de carcinoma renal. De los 6 de fosa posterior 3 presentaron cordomas y 3 lesiones hematopoyéticas (2 plasmocitomas y 1 linfoma). El promedio de edad fue de 51,1 años con una relación masculino-femenino de 1,1:1. Conclusiones: La resección quirúrgica acorde a los principios oncológicos se puede realizar utilizando las técnicas endoscópicas que incluso se asocian a menor morbilidad, mayor visión, mejor acceso a determinados compartimentos, preservación del sistema nasolacrimal, del tendón cantal medial, ausencia de cicatriz facial, de craneotomía y de retracción cerebral.