Mecanismos neuroinvasivos y del daño neurológico en las infecciones por coronavirus / Neuroinvasive and neurological damage mechanisms in the infections by coronavirus

Introducción: En diciembre de 2019, en China, se reportaba un nuevo coronavirus, que se clasificó y denominó como síndrome respiratorio agudo severo-coronavirus 2, causante de la enfermedad COVID-19; capaz de provocar síntomas y complicaciones neurológicas. Objetivo: Describir los mecanismos neuroinvasivos y del daño neurológico en las infecciones por coronavirus. Métodos: De las bases datos PubMed, SciELO y Latindex, se seleccionaron artículos publicados desde 2005 hasta mayo de 2020 que trataran: la lesión neurológica directa, la lesión neurológica indirecta y los mecanismos de la muerte neuronal en las infecciones por coronavirus. Se incluyeron estudios en humanos, animales de experimentación y estudios in vitro. Resultados: Las propiedades neuroinvasivas de los coronavirus está demostrada, pero la fisiopatología que media la neuroinvasión y el daño neurológico en la infección por SARS-CoV-2 no está totalmente aclarada. Las propiedades neurotrópicas del nuevo coronavirus, se demostraron por la presencia del virus en líquido cefalorraquídeo y cerebro. Los mecanismos que explican el daño neurológico están presentes en los pacientes con formas graves de la COVID-19 y justifican las manifestaciones clínicas y complicaciones neurológicas de la enfermedad. Consideraciones finales: Los coronavirus son neuroinvasivos y neurotrópicos, con potencialidad para provocar enfermedad neurológica. Las hipótesis fisiopatológicas indican que las manifestaciones en el sistema nervioso se deben a causas inflamatorias. Se necesitan estudios a nivel biomolecular para aceptar o refutar tales teorías. Esto ayudaría a clasificar mejor todo el espectro de la neuropatología y elaborar un consenso sobre las mejores estrategias de diagnóstico y modalidades de tratamiento(AU)

Introduction: On December 2019, it was reported in China a new coronavirus that was classified and named as severe acute respiratory syndrome by coronavirus 2 that caused COVID-19 disease being able to provoque neurologic symptoms and complications. Objective: To describe the neuroinvasive and neurological damage mechanisms in the infections by coronavirus. Methods: From PubMed, SciELO and Latindex databases it was a selection of articles published from 2005 to May 2020 on: direct neurologic lesion, indirect neurologic lesion, and the mechanisms of neuronal death in the infection by coronavirus. Studies in humans, animals for experiments and in vitro studies were included. Results: The neuroinvasive properties of coronavirus are demonstrated, but it is not fully clear the physiopathology that has to do with neuroinvasion and the neurological damage in the infection by SARS-CoV-2. The neurotropic properties of the new coronavirus were proved by the presence of the virus in the spinal fluid and the brain. The mechanisms which explain the neurological damage are present in patients with severe forms of COVID-19 and they justify the clinical manifestations and neurological complications of the disease. Final considerations: The coronaviruses are neuroinvasive and neurotropic, with potential for causing neurologic disease. The physiopathologic hypotheses show that the manifestations in the nervous system are due to inflammatory causes. There is a need of conducting studies in the biomolecular level to accept or refute those theories. That will help to better classify all the spectrum of neuropathologies and to achieve a consensus on the best diagnostic strategies and treatment modalities(AU)

Influence of exposure and vertical transmission of HIV-1 on the neuropsychomotor development in children

Abstract INTRODUCTION: Exposure to human immunodeficiency virus (HIV)-1 during pregnancy is a major risk factor for neurodevelopmental delay and deleterious effects in children. However, limited information about these conditions exists in poor geographical areas in Brazil. Prevention of vertical transmission of HIV-1 is dealt differently in different regions of the country and in poorer areas it is more difficult to evaluate the impact of the prevention methods. The outcomes of the exposure to HIV-1 and the impact of vertical HIV-1 transmission on neuropsychomotor development was evaluated for the first time in children born to HIV-infected mothers in the North region of Brazil, where the majority of the population has poor access to health services. METHODS: Sixty children born to HIV-1-infected mothers (case group) and 58 born to non-infected mothers (control group) were followed for the first 12 months of life in a prospective case-control study. Neuropsychomotor development was assessed using the Denver II test. RESULTS: Suspected neuropsychomotor developmental delays were more frequent in the case group (33.3%), namely in language (38.9%) and gross motor skills (27.8%). These delays were reversed in most children after 12 months of life due to therapeutic intervention. The delays were not reversed in three children, all of whom belonged to the case group. Only one of these was infected with HIV-1, and this child had the poorest neuropsychomotor outcomes. CONCLUSIONS: Maternal HIV-1 infection negatively affected the neuropsychomotor development in children, although other factors may have played a role.

Mechanism of EV71-induced neurological syndrome / 国际儿科学杂志

In recent years,the incidence of hand foot and mouth disease has been on the rise with severe and fatal cases often caused by enterovirus 71(EV71) infection. EV71 possesses powerful ability of neural inva-sion,and severe nerve damage is one of the signs of its infection,including aseptic meningitis,poliomyelitis-like paralysis,acute brainstem encephalitis and other severe neurological syndrome,which may make the neurological sequelae difficult to reverse,and even death. At present,EV71 has become one of the main viral pathogens cau-sing central nervous system diseases in infants and young children,which seriously threatens the life and health of infants and young children. The pathogenesis of EV71 has not yet been totally clarified. Clinically,it mainly focuses on symptomatic supportive care and prevention of complications. This article starts with the introduction of the etiology of EV71 and briefly describes its relative pathogenesis with the view of providing new ideas for its intervention at the level of primary prevention.

Current hospital mortality, neurological deficit, and mid-term survival after surgery for acute type A aortic dissection in Argentina / Mortalidad hospitalaria, déficit neurológico y supervivencia alejada después de cirugía de disección aórtica aguda tipo A en la actualidad en Argentina

Abstract Objective: To present the current in-hospital outcomes and mid-term survival of acute type A aortic dissection (AAAD) surgery performed by a group of dedicated high-volume thoracic aortic surgeons in a University Hospital in Argentina. Methods: A retrospective analysis of prospectively collected data over a 6-year period (2011---2016) was performed on a consecutive series of 53 adult patients who underwent emer- gency cardiac surgery for AAAD in the Buenos Aires University Hospital in Argentina. Results: A mean of 8.8 AAAD repairs were performed yearly during the 6-year period. In-hospital mortality was 17%, and was statistically equivalent to the expected operative mortality rate of 21% (EuroSCORE II) (observed-to-expected mortality ratio 0.81; p = 0.620). New neurological deficit appeared postoperatively in 6% of cases, and the observed major postoperative morbidity rate was 42%. All-cause death cumulative survival probability was 0.711 (SE 0.074), with a mean follow-up period of 49.2 (SE 5.0) months. Cumulative survival probability for in-hospital survivors was 0.903 (SE 0.053), with a mean follow-up period of 62.5 (SE 3.6) months. Conclusion: Although the present results do not reach international standards, AAAD surgery in our institution was associated with an acceptable mortality risk and satisfactory mid-term survival compared with previous local studies. In addition to in-hospital mortality, the incidence of new permanent neurological deficit after surgery must be considered the most devastating complication to avoid. Patient-focused care in referral aortic centers with surgery performed by specialized teams should be encouraged in order to improve surgical outcomes in acute aortic dissection surgery in Argentina.

Resumen Objetivo: Presentar los resultados hospitalarios actuales y la supervivencia a mediano plazo de la cirugía de la disección aguda aórtica tipo A (DAAA) realizada por un grupo de cirujanos de alto volumen de cirugías en un Hospital Universitario de Argentina. Método: Se realizó un análisis retrospectivo de datos recolectados en forma prospectiva durante 6 años (2011-2016) de una serie de 53 adultos sometidos a cirugía de emergencia por DAAA en un Hospital Universitario de Buenos Aires, Argentina. Resultados: Durante 6 años se operaron en promedio 8.8 DAAA por año. La mortalidad hospitalaria fue del 17% y estadísticamente equivalente a una tasa de mortalidad esperada del 21% por el EuroSCORE II (razón de mortalidad observada/esperada 0.81; p = 0.620). El déficit neurológico postoperatorio apareció en el 6% de los casos, y la tasa de morbilidad mayor fue del 42%. La probabilidad acumulada de supervivencia fue de 0.711 (EE 0.074), con un promedio de seguimiento de 49.2 (EE 5.0) meses. La supervivencia acumulada descartando la mortalidad operatoria fue de 0.903 (EE 0.053), con un promedio de seguimiento de 62.5 (EE 3.6) meses. Conclusiones: Aunque estos resultados no alcanzan los estándares internacionales, la cirugía de la DAAA en nuestra institución estuvo asociada a un riesgo aceptable de mortalidad y una supervivencia satisfactoria a mediano plazo comparadas con estudios previos locales. Además de la mortalidad, la incidencia de daño neurológico permanente después de la cirugía debe considerarse la complicación más devastadora a evitar.

Dignidad ocupacional en personas con secuelas secundarias a daño neurológico severo / Occupational dignity in people with side effects to severe neurological damage

La terapia ocupacional es una disciplina socio sanitaria difícil de definir y explicar por su amplio espectro de acción, diversos autores han hecho distintas definiciones de ésta, sin embargo aún cuesta que la sociedad general entienda y conozca el significado de esta profesión, que desde un enfoque contemporáneo está centrada en la participación ocupacional de las personas. (Crepeau, 2011)Tiene como objetivo principal dotar a los individuos, organizaciones o poblaciones que interviene, de los recursos necesarios para su bienestar ocupacional, aprovechando todas las capacidades individuales, colectivas, los recursos cotidianos y el entorno para esto. Según los planteamientos de la Asociación Americana de Terapia Ocupacional, la terapia ocupacional asegura el compromiso con la justicia ocupacional (Aviles, 2010) de las personas, lo cual quiere decir, que indistinto de las características de la situación de discapacidad que presenta una persona, éstas tienen el derecho a lograr participar de las ocupaciones humanas. Esto se vincula con un concepto mayor, propio a la característica de humanidad de nuestra especie, la cual se denomina dignidad humana, a partir de estos dos términos, la experiencia clínica y académica de las autoras en intervención de personas con secuelas secundarias a daño neurológico severo, generan el concepto Dignidad Ocupacional, que hace referencia a que toda persona tiene derecho a disfrutar dignamente de experiencias ocupacionales a pesar de no contar con las destrezas de desempeño necesarias para involucrarse en ellas de manera independiente...

Occupational Therapy is a socio-health discipline which is difficult to define and explain due to its wide range of action. Several authors have defined it, however it is still hard for society to understand and know the meaning of this profession, which from a contemporary approach, is focused on the occupational participation of people (Crepeau, 2011).Its main objective is to deal with individuals, organizations and population to provide the necessary resources for their occupational welfare, taking advantage of all individual and group capacities, as well as daily resources and environment. According to the statements of the American Occupational Therapy Association , occupational therapy ensures the commitment to occupational justice (Aviles, 2010) with people , that is ,no matter the characteristics of the disability situation of a given person, she or he has the right to participate in human occupations. This goes along with a major concept that is inherent to our species human characteristic: human dignity, notion based on considering a person able to offer options to improve the quality of life, independent of his or her condition When it comes to people suffering from severe neurological damage, it is often believed that they only need to satisfy their basic self-care needs, nevertheless, they are people subject to rights, worthy and who deserve equal treatment. Thus, the effort to satisfy the occupations they cannot do by themselves is what we call Occupational Dignity, concept that was born with the blending of human dignity and occupational justice...

Interacciones tempranas madre-niño y predicción de desarrollo motor mediante ecuaciones estructurales: Aplicación del modelo en niños con riesgo de daño neurológico perinatal / Mother-child interactions and early motor development prediction using structural equation: Application of the model in children with perinatal risk of neurological damage

Los impactos más importantes de las expresiones tempranas del daño neurológico en los niños, son las dificultades para establecer intercambios con su medio social, afectando en la etapa inicial las primeras interacciones con su madre. Niños con riesgo biológico muestran grandes dificultades para iniciar interacciones. Cuando las madres se ajustan en una relación bidireccional se logra un aumento en las iniciaciones del niño; si las madres responden menos, los niños disminuyen las iniciaciones y aumentan la irritabilidad. Los programas de intervención temprana que integran en sus estrategias el manejo de las interacciones madre-niño se han considerado exitosos por sus implicaciones directas en el desarrollo del niño. Se requiere mayor soporte empírico sobre la influencia de patrones específicos de interacciones tempranas madre-hijo y el desarrollo posterior de niños con daño neurológico perinatal, en términos de prevención de alteraciones o discapacidad. Se realizó un estudio longitudinal y se reporta el efecto de las interacciones de reciprocidad madre-hijo en el desarrollo motor observado en niños a los 4, 8 y 12 meses de edad, a través del empleo del Modelo de Ecuaciones Estructurales (Curva de Crecimiento Latente). Se concluye que el modelo permitió mostrar que en niños de riesgo perinatal, las interacciones madre-hijo representan un buen predictor del desarrollo motor en el primer año de vida. Estos hallazgos tienen importantes implicaciones en la práctica clínica como estrategia integral para el diseño de acciones de intervención temprana debido a que los logros motores en los primeros meses representan un indicador predictivo del desarrollo infantil posterior.

The most important impact of early expressions of neurological damage in children is the difficulty of mixing up in their social environment which at the beginning affects their interactions with their mother. Children with biological risks show great difficulties to begin interactions. When mothers get adjusted to bidirectional relations with neurologically damaged children, an increase in the commencement of interactions by a child is achieved, while fewer responses of the mother to child produce fewer interactions and increases irritability. Early intervention programs which contain in their strategies management of mother-infant interactions have been considered effective for child development. However, further empirical studies are required, concerning the influence of specific patterns of early mother-infant interaction and future development of children with perinatal neurological damage, in terms of prevention of alterations or disability. The present longitudinal study reports the effect of reciprocity of mother-infant interactions in the motor development observed in children of 4, 8, and 12 months old, latent growth curve in structural equation modeling. This model permits the identifications of causal factors that could affect the results in different age groups and provides predictions of the relations in a more complex form than lineal relations. Based on the model designed, it could be shown that mother-infant interactions of reciprocity best characterized children with higher development level while the absence is seen in children with retarded development. We classified mothers and children in two types, respectively: interactive and organized mothers vs. non-interactive and disorganized ones; interactive and responsive children vs. non-interactive and non-responsive ones. Subjecting these two types of mothers and children to four possible combinations, the model results showed different motor development predictions in the children. On one hand, we estimated regression coefficient of four dyadic systems, obtained by combinations of different types of mothers and children: interactive and organized mother with interactive and responsive child (Dyadic system 1); interactive and organized mother with non-interactive and non-responsive child (Dyadic system 2); non-interactive and disorganized mother with interactive and responsive child (Dyadic system 3); and non-interactive and disorganized mother with non-interactive and non-responsive child (Dyadic system 4). Dyadic system 1 was associated with a better motor development in children with a mayor regression coefficient (19.82), followed by System 2 and System 3 (regression coefficient of 17.54 and 11.46, respectively). System 4 had a negative estimate value of regression coefficient (-11.27) in our model. On the other hand, we estimated intercept values according to the interactive type of these mothers and children. Among the four interactive types, solely two of them had statistically significant intercepts (p < .05), or = 66.13 for interactive children and or = 42.76, for non-interactive children. To predict the motor development of 4, 8, and 12 months old children, the slope with attenuation permitted to give a mayor model fitting, with the regression coefficient of 0, 1 and 1.5, respectively. This model presented excellent values of model fitting indicators (X² = .96, p = .97, CFI = 1.00, RMSEA = .00). This line of study should be widened, because motor development is the principal domain consolidated in the first months of life. It is fundamental in domain organizations of higher complexity as cognition and language. We conclude that this model showed that in high risk perinatal children, early mother-child interactions represent a good predictor of motor development in the first year of life. Moreover, we found that motor achievements in the first months of life can be a strong predictive indicator of future development of a child. These findings suggest the importance in clinical practice of observation and registration of mother-child interactions as part of an integral strategy of child evaluation.

Estado y salud buco-dental del paciente pediátrico con daño neurológico / Status and health oral-dental pediatric patient with neurological damage

Este documento describe a groso modo las características bucales que presentan los pacientes con daño neurológico, además de las consideraciones y el manejo en la atención estomatológica de este grupo de población infantil que puede variar de daño neurológico leve hasta severo, incluyendo a los de atención intrahospitalaria. Este tipo de pacientes sufre de severos problemas bucales especialmente la alta incidencia de caries dental y enfermedades que afectan el periodonto debido a las características propias de su diagnóstico que contribuye y dificulta el cuidado bucal por parte de sus cuidadores y por déficit en la atención estomatológica de los profesionales de la salud bucal, quienes desconocen en su mayoría las consideraciones a tomar en la atención de este grupo de pacientes

This document describes the characteristics of oral that presenting patients with neurological damage, in addition to the considerations and the handling in the stomatological care of this group of children which can vary from mild to severe neurological damage, including those for inpatient care. This type of patients suffering from severe oral problems especially the high incidence of dental caries and diseases which affect the periodont because of the specificity characteristics of her diagnosis that helps and hinders the oral care by their caregivers and deficits in attention stomatological of oral health professionals those who are unaware of the considerations to take care of this patient group

Toxicity of the essential oil of the cytral chemotype of Lippia alba (Mill.) N. E. Brown

The essential oil (EO) of Lippiaalba (Mill.) N. E. Brown (Verbenaceae) has been traditionally used to treat several diseases. In this study, the acute toxic effects of the citral chemotype of L. alba EO were evaluated in mice. Animals were treated via intraperitoneal receiving the L. alba essential oil at doses between 50 and 2500 mg/kg, and the control group received sesame oil (vehicle). The EO induced dose-dependent neurotoxic effects at doses greater than 1000 mg/kg, including decreased locomotion, motor skills and muscle strength, hypotonia, dyspnea, kyphosis and convulsions. The EO was lethal at a dose of 2500 mg/kg. Animals receiving 1000 mg/kg were euthanized at the end of the treatment period and their blood and livers were collected for analysis. Mice exposed to L. alba EOpresented significantly greater plasma alanine aminotransferase (ALT) activities than the control group. Liver histological changes included mild inflammation, in particular, an increase in nuclear size. Compared to vehicle control group, changes in expressionfor selected genes were significant for FABP5, a fatty acid transport related gene. In summary, the intraperitoneal administration of L. alba EO (citral chemotype) causes neurological damage in mice at doses equal or greater than 1500 mg/kg, whereas at 1000 mg/kg, it generates mild liver damage. Therefore, the systemic use of this EO raises concerns about its safety.

El aceite esencial (AE) de Lippia alba(Mill.) NE Brown (Verbenaceae) ha sido utilizado tradicionalmente para tratar varias enfermedades. En este estudio, los efectos tóxicos agudos del AE de Lippia alba quimiotipo citral fueron evaluados en ratones. Los animales fueron tratados por vía intraperitonealrecibiendo el AE en dosis entre 50 y 2500 mg/kg de peso, y el grupo control aceite de sésamo (vehículo). Dosis superiores a 1000 mg/kg del AE mostraron efectos neurotóxicos incluyendo disminución de la locomoción e hipotonía, disnea, cifosis y convulsiones. El AE fue letal a la dosis de 2500 mg/kg. Veinticuatro horas después de que los animales fueron tratados con 1000 mg/kg del AE se les realizó eutanasia y su sangre e hígado fueron recolectados para análisis. Los ratones expuestos al AE de L. alba, presentaron actividad alanina aminotransferasa (ALT) en plasma significativamente mayor que el grupo control. Dentro de los cambios histológicos hepáticos se incluyen inflamación leve, en particular, un aumento del tamaño nuclear. En comparación con el grupo control, la expresión de genes seleccionados tuvo diferencias significativas para FABP5, un gen relacionado con el transporte de ácidos grasos. En conclusión, la administración intraperitoneal del AE de L. alba (quimiotipo citral) causa dañosneurológicos en ratones a una dosis igual o superior a 1500 mg/kg, mientras que a 1000 mg/kg, genera daño hepático leve. Por lo tanto, el uso sistémico de este AE plantea preocupaciones en cuanto a su seguridad.

Adolescentes consumidores de marihuana: implicaciones para la familia y la escuela / Teenage consumers of marijuana: implications for the familiy and the school

Human groups make up for themselves, for the others and for the events they live explanations that, although not scientific, determine the practices that regulate their behavior. In the case of marijuana consumption, the representations of young people in particular and society in general influence the decision about whether or not to continue consuming. The perception of risk associated with consumption by high school students dropped from 60% in 1994 to 36.9% in 2004, which backs up the relationship between high consumption and low risk perception. Cannabis is the illegal drug with the highest indexes of consumption in the world with an increasing growth rate, to which we may add the alarming reduction in the age when people begin consuming it. This research paper is concerned with the effects of consumption on cognitive processes in school and social performance: a drop in performance, more problems getting along with others, absenteeism and drop out. The study aims to know how low marihuana doses affect cognitive ability in post-primary students. There are no studies concerned with the effect of marihuana in non-patient students (i.e. not diagnosed with addictive behavior and not considered socially as drug addicts). Material and methods Sample: The sample comes from high school students in public schools, private subsidized schools and private paying schools. The sample was stratified by non-proportional affixation, considering the sex, course and social economic level variables, and was made up of 304 students in high schools of the Metropolitan Area (Santiago), belonging to low, medium, and high socioeconomic groups (determined by dependence and the city in which the school is located). The research is descriptive, not experimental, ex post facto. Instruments: Group application to the entire sample (n = 304) a) Psychosocial evaluation and consumption questionnaire, abbreviated and adapted, aimed at the collection of demographic data, consumption behaviors and other required information. The young people are identified with a number in order to ensure their anonymity and thus promote the truth of the responses. b) Domino Test (D-48): Evaluates non-verbal intelligence. It controls differences caused by social and educative factors. It is applied on a group basis in order to discard subjects whose IQ is lower than average, regardless of consumption. Individual application to the consumer group and the non-consumer group. a) Rey Complex Figure Test: Widely used in recent studies on the effects of drugs on teenagers. Evaluates neuropsychological functioning. b) Benton Test: Evaluates current intellectual efficiency from the attention span, concentration and immediate retention. c) Verbal memory (Rey): Evaluates immediate verbal memory. Results General: The total results for the three schools polled and evaluated show that 14.5% of the students declared that they consumed marijuana at least four times during the last month. The proportion in the three establishments is not distributed in a homogenous fashion, but is concentrated in the low social economic level school (27.8%), with the lowest percentage in the high social economic level school. With regard to sex, 11% are girls and 15.7% are boys. Although a higher proportion of the boys consumed, the consumption in girls shows a sustained increase in recent years. A significant group is beginning to consume marijuana at age 15 or even earlier. The perception of risk associated with frequent consumption and the possibility of quitting smoking on a voluntary basis show significant differences: among consumers (C), 51% consider that there is no risk or negative effect in consumption, while only 10% of non-consumers (NC) share this perception. Protective factors or those associated with risk The family. In this study, the objective characteristics of families are not researched, but only the perception teenagers have of them. In any case, only 24% of the C state that their families have any influence on what they think, and another 54.8% agrees that they would not do anything, or simply do not know how their parents would react if they found out they consumed. School. The results on the perception of consumers and non-consumers in the school context shows that in general consumers perceive the school as less demanding than non-consumers as far as the existence of disciplinary standards is concerned. Regarding the reactions of teachers who found out that the students consumed, the proportion of NC who perceive the teacher in a more active role is higher: they would scold him (24.1%), they would talk to the student (27.6%). While only 10% believe that they would do nothing, 32.6% of the C share this perception. Around 35% of the total group does not know what the teacher would do. Peer groups. In the case of C, more than half of them (54.2%) state that it is their friends who have more influence on the way they think, compared to 29.5% of the NC who believe the same thing. The friends and classmates of the C are perceived by them (67.4%) as not caring about whether they consume or not. This perception is reversed in the case of the NC, in which the majority (63.7%) consider that the group would try to dissuade their consumption. They add that in 74% of the cases the student states that marijuana is provided by persons close at hand: friends (74%) and acquaintances (12%). Conclusions Regarding group behavior in general: In demographic terms, the results show that the number of consumers in schools belonging to the marginal and economically deprived sectors is higher than that detected in medium and high socio-economic level schools. In all sectors we see people starting to consume marijuana at ever younger ages: 15 years and even less, in a significant percentage of the sample. The results coincide with the majority of studies performed recently, which point to a sustained reduction in the age when people start consuming, which considerably increases the risks of damage. Effects of consumption on cognitive functions: On workstyle. By comparing the results of the two groups (consumers and non-consumers) we can conclude that consumers obtain much lower scores than the control group in tests that evaluate accuracy and workstyle, showing strategies and approaches to the task which could be expected from subjects with possible neurological damage. Visual and verbal memory. As far as visual memory is concerned, the results of consumers indicate scores far lower than those achieved by control groups in tasks that require this kind of memory to be carried out successfully. Despite consumers having obtained somewhat lower scores, verbal memory does not appear to be so damaged. Attention, concentration. According to their performance on tests that evaluate current intellectual efficiency from the ability to focus/concentrate and retain information for a short time, the results are significantly lower in the consumer group. The results suggest a possible alteration in the integration and structuring of spatial stimuli, if we consider the large number of errors made by consumers and that they may indicate organic and cerebral damages. Even though from the results of this work it is not possible to determine with accuracy the magnitude of the damage caused or even if this damage is the direct and exclusive effect of the consumption of marijuana, we can establish: a) a clear association between consumption and a significant drop in scores in the cognitive functions evaluated compared to what was expected, b) scores significantly lower than those obtained by the control groups consisting of non-consumers, and c) deficiencies in the styles and strategies of execution employed in the task and in the organization of the material.

La cannabis es la droga ilegal con más altos índices de consumo en el mundo. Su consumo mantiene un ritmo de crecimiento sostenido y a él se suma una disminución alarmante en la edad de inicio. En los 10 últimos años, la percepción de riesgo asociada al consumo entre estudiantes secundarios descendió de 60% en 1994 a 36.9% en 2004, lo que sustenta una relación entre alto consumo y baja percepción de riesgo. El efecto de la marihuana en pocas dosis y en escolares no consultantes y no rotulados socialmente como drogadictos, no se conoce, es por ello que nuestro estudio pretende averiguar cómo este consumo afecta en las habilidades cognitivas necesarias para el aprendizaje. Material y métodos Muestra: Se conformó con alumnos de educación media de liceos municipalizados, particulares subvencionados y particulares pagados. La muestra se estratificó por afijación no proporcional, considerando las variables sexo, curso y nivel socioeconómico, y estuvo conformada por 304 alumnos de liceos del Área Metropolitana (Santiago), pertenecientes a los niveles socioeconómicos bajo, medio y alto (determinados por dependencia y comuna en que se ubica el establecimiento). La investigación es descriptiva, no experimental, ex post facto. Instrumentos aplicados: a)Cuestionario de Evaluación Psicosocial y Consumo, b)Test de Dominó (D-48),c) Test de la Figura Compleja de Rey, d) Test de Benton, e)Memoria de palabras (Rey). Resultados Los resultados totales para los tres colegios encuestados y evaluados muestran que 14.5% de los alumnos afirman haber consumido marihuana al menos en cuatro ocasiones durante el último mes. La proporción que corresponde a los tres establecimientos no se distribuye homogéneamente, sino que se concentra en el liceo de nivel socioeconómico más bajo (27.8%), con el menor porcentaje en el nivel socioeconómico más alto. En relación con el género, 11% son mujeres y 15.7%, varones. Si bien los varones consumen más, el consumo en mujeres muestra un aumento sostenido en los últimos años. Respecto de la edad de inicio, un grupo importante por el riesgo que representa la precocidad en el inicio comienza a consumir a los 15 años e incluso antes. Del total de consumidores, 51% consideran que no existe ningún riesgo ni efecto negativo en el consumo, mientras sólo 10% de los no consumidores (NC) comparten esa percepción. Factores protectores o asociados a riesgo La familia. En este estudio, no se investigan las características objetivas de las familias, sino solamente la percepción que tienen de ellas los adolescentes. Como quiera que sea, sólo 24% de los consumidores afirman que su familia tiene influencia en lo que piensan, sumado a que 54.8% coinciden en que no harían nada o simplemente no saben cómo reaccionarían sus padres si los descubrieran consumiendo. Colegio. Los resultados sobre la percepción de los consumidores y no consumidores en relación con el colegio muestran que en general los primeros perciben el colegio como menos exigente que los segundos en cuanto a la existencia de normas disciplinarias. Conclusiones En todos los sectores se aprecia un inicio cada vez más precoz del consumo, 15 años e incluso antes, en un importante porcentaje de la muestra, hecho que aumenta considerablemente los riesgos de daño. Efectos del consumo en las funciones cognitivas relacionadas con el rendimiento escolar: a) En estilo de trabajo: podemos concluir que los consumidores obtienen rendimientos significativamente inferiores a los grupos control en las pruebas que evalúan la precisión y el estilo de trabajo; muestran asimismo estrategias y formas de abordaje de la tarea esperables en sujetos menores o con posibles daños neurológicos; b) Memoria visual y verbal: en cuanto a la primera, los resultados de los consumidores indican puntajes muy inferiores a los logrados por los grupos controles, mientras que la memoria verbal no parece estar tan comprometida; c) Atención, concentración y retención inmediata: los resultados son significativamente inferiores en el grupo consumidor. Los resultados sugieren una posible alteración en la integración y estructuración de los estímulos espaciales si se considera el alto número de errores cometidos por los consumidores, los cuales pueden ser indicativos de daños orgánicos cerebrales.

Diagnosis and surgical treatment of sacral fracture accompanied by neurological damage / 中国矫形外科杂志

[Objective]To study the diagnosis and treatment of sacral fracture accompanied by neurological damage.[Method]Twelve patients with sacral fracture accompanied by nerve injuries were treated and analyzed during 1999 to 2004,including 9 males and 3 females. Final diagnosis was given according to the evaluation of physical examination,X-ray,CT and MRI examinations. Dennis classification found 2 cases of I type,6 cases of Ⅱ type and 4 cases of Ⅲ types.The surgical approach of these patients were selected according to the Dennis classification,Type Ⅰ and type Ⅱ were treated with conservative methods,and operations were taken if little symptom was no or a little improved. Posterior approach enlargement for sacral nerve canal,exploration and endoneurolysis on sacral nerve were performed on type Ⅲ as early as possible.Old fracture of type Ⅱ and type Ⅲ with neurologic signs had to be operated early.Conservative and operative treatments were taken 7 and 5 respectively.[Result]After six months to three years following up,two cases of Denis type Ⅰ,six cases of Denis type Ⅱ and one in four Denis type Ⅲ cases were recovered completely.Two cases of Denis Ⅲ were improved significantly while one case was improved a little.[Conclusion]The anatomical position of sacrum is not conspicuous and the symptom caused by neurological damage is too tiny to detect.Carefully physical examination combined with image analysis is necessary to elevate the rate of final diagnosis.Different surgical treatments were used to different type of sacral fracture. Posterior approach enlargement for sacral nerve canal and exploration and endoneurolysis on sacral nerve may be an ideal choice to treat sacral fracture accompanied by neurological damage.Nerves injuries is an critical operation indication for delayed sacral fracture.