Propuesta para la determinación del cambio de velocidad, velocidad instantánea y aceleración con base en el puntaje APACHE II en pacientes en estado crítico / Proposal for the determination of velocity change, instantaneous velocity and aceleration from the APACHE II score in critically ill patients / Proposta para a determinação da mudança de velocidade, velocidade instantânea e aceleração baseada no escore APACHE II em pacientes críticos

Resumen: Las herramientas de evaluación de la gravedad en el enfermo grave proporcionan información objetiva intra e interobservador relacionada con la gravedad de la enfermedad, su evolución en relación al tiempo y la estratificación de riesgo son parte fundamental en la toma de decisiones. El objetivo de este trabajo es presentar una nueva propuesta de la evaluación del APACHE II basada en un modelo matemático de cambio en el tiempo/velocidad, velocidad instantánea y aceleración.

Abstract: The illness severity scoring systems provide objetive measures for inter and intra comparisons with time, provide useful information for comparing the severity of illness are an essencial part of the improvment in clinical decisions and in stratifying patients. Appropiated application of these models helps in decision making at the right time. The aim of this paper is to submit a proposal for the evaluation of the APACHE II score based on a vectorial mathematical model of chance in time/velocity, instant velocity and aceleration.

Resumo: Os instrumentos de avaliação da gravidade do paciente grave fornecem informações objetivas intra e interobservadores relacionadas à gravidade da doença, sua evolução em relação ao tempo, estratificação de risco são fundamentais para tomada de decisão. O objetivo deste trabalho é apresentar uma nova proposta para a avaliação do APACHE II baseada em um modelo matemático de mudança de tempo/velocidade, velocidade instantânea e aceleração.

Correlación entre la clasificación Child-Pugh lactato y la mortalidad en pacientes cirróticos internados en la unidad de terapia intensiva / Relationship between the Child-Pugh+lactate score and mortality in cirrhotic patients in the intensive care unit / Correlação entre a classificação child-pugh lactato e a mortalidade em pacientes cirróticos internados na Unidade de Terapia Intensiva

Resumen: Objetivo: Comprobar la capacidad pronóstica como predictor de mortalidad de la clasificación de Child-Pugh lactato en la población de pacientes cirróticos que ingresan en la Unidad de Cuidados Intensivos de la Fundación Clínica Médica Sur. Material y métodos: Estudio de investigación clínica, cohorte no concurrente, donde se obtuvieron datos en el periodo comprendido del 1 de enero de 2012 al 31 de diciembre de 2014. Resultados: Ingresaron 28 casos a la Unidad de Terapia Intensiva de la Fundación Clínica Médica Sur con diagnóstico de cirrosis hepática; de ellos, fallecieron un total de 16 (57.1%) sujetos dentro de los primeros 40 días posteriores a su ingreso y sobrevivieron 12 (42.9%). Se calculó si existía correlación entre la defunción y el puntaje de la clasificación Child-Pugh lactato mayor de 14, y se encontró una r = 0.708. El puntaje mayor a 14 puntos se asoció a mortalidad en 87.5%, así como el puntaje menor a 14 se vinculó a supervivencia a 40 días en 83.33%. Conclusiones: La clasificación de Child-Pugh más lactato mayor de 14 puntos tiene una fuerte correlación con la mortalidad.

Abstract: Objective: This study aimed to establish if the Child-Pugh+lactate score is a reliable prognostic scoring tool as mortality predictor in cirrhotic patients admitted to the Médica Sur Clinic Foundation Intensive Care Unit. Material and methods: This was a 3-year, single-centered retrospective cohort study performed in a general ICU. Results: Twenty-eight cases were collected in the period from January 1, 2012 to December 31, 2014, of which a total of 16 patients (57.1%) died within the first 40 days after admission and 12 survived (42.9%). It was assessed if there was a correlation between death and a Child-Pugh lactate score greater than 14, finding an r = 0.708. Conclusions: A Child-Pugh+lactate score with a numerical value above 14 points has a direct relation with mortality in cirrhotic patients admitted to the ICU.

Resumo: Objetivo: Comprovar a capacidade prognóstica como preditor de mortalidade da Child Pugh lactato na população de pacientes cirróticos admitidos na terapia intensiva da Fundação Clínica Médica Sur. Material e métodos: Estudo de investigação clínica, coorte não concorrente, onde os dados foram coletados no período de 1 de Janeiro de 2012 a 31 Dezembro de 2014. Resultados: 28 casos admitidos na unidade de terapia intensiva da Fundação Clínica Médica Sur, diagnosticados com cirrose hepática, dos quais faleceram um total de 16 pacientes (57.1%) nos primeiros 40 dias após a admissão e sobreviveram 12 (42.9%). Calculou-se a existência de uma correlação entre a defunção e a Classificação Child Pugh lactato maior de 14 pontos, encontrando um r = 0.708. A pontuação CPL maior a 14 pontos está associado à mortalidade em 87.5% e inferior a 14 foi associado a sobrevida à 40 dias em um 83.33%. Conclusões: A Clasificação Child Pugh lactato maior a 14 pontos tem uma forte correlação com a mortalidade.

Ciencias de la complejidad y caos como herramientas en el análisis de la proliferación de vectores y zoonosis / Sciences of complexity and chaos to analyze vectors and zoonosis

En el presente trabajo se discuten los fundamentos de las ciencias de la complejidad y caos como herramientas en el análisis la proliferación de vectores y zoonosis. En la primera parte del artículo se describen los fundamentos y antecedentes de las ciencias de la complejidad, como una visión diferente para entender y analizar a los sistemas dinámicos, conceptos que han existido desde hace varios siglos y están relacionados con las ideas acerca del origen de la vida misma, que romperán con los paradigmas de la linealidad y el reduccionismo. Se ejemplifica con la utilización de la geometría fractal, mundo pequeño y los análisis de series de tiempo, entre otras herramientas, para entender el comportamiento de los sistemas caóticos que se presentan en la diseminación de enfermedades de origen zoonótico. Se concluye que la mayoría de los contagios, así como la diseminación de enfermedades transmitidas por los animales, tienen tendencia caótica. Dado que 75 % de las enfermedades emergentes son de origen zoonótico, las herramientas de las ciencias de la complejidad y la no linealidad resultan indispensables para entender el dinamismo y comportamientode la diseminación de estas patologías.

The present paper discusses the fundamentals of the sciences of complexity and chaos as tools in the proliferation of vectors and zoonosis. The first part of the article discusses the rationale and history of the sciences of complexity, a different view as to understand and analyze dynamic systems. These concepts explain the dynamics of the origin of life itself and break the paradigms of linearity and reductionism. This is exemplified by using fractal geometry, the law of the small world and time series analysis among other tools to understand the behavior of chaotic systems, which are presented in the form of the spread of zoonotic diseases. We conclude that most infections and the spread of diseases transmitted by animals tend towards being chaotic, and it is mentioned that 75% of emerging diseases are zoonotic in origin. Therefore, the tools are not linear. They are indispensable for understanding the dynamic behavior of the spread of these diseases.

Efectos neurológicos de la ligadura de la carótida común izquierda e hipoxia inducida en ratas neonatas / Neurological effects by occlusion of the carotid artery and induced hypoxia in newborn rats

BACKGROUND: Hypoxic-ischemic encephalopathy is a cause of disability in the infant population. One of the most used animal models in the hypoxic-ischemic encephalopathy in immature brain is the preparation of Levine applied by Rice in newborn rats and consists of the bond of the left common carotid artery followed by induced hypoxia. The objective of this investigation was to study the neurological effects of the bond of the left common carotid and induced hypoxia in newborn rats. METHODS: Five control rats, five sham rats and five rats with hypoxic-ischemic lesion by means of the application of Levine's preparation at 7 days of age were used. On day 42, all rats were evaluated by time of grasping, posterior reflex test and analysis of the spontaneous locomotor activity (number of bipedal movements, number of stepped stalls, grooming time). RESULTS: The lesioned group presented less grasping time, lower number of positive responses to the posterior reflex and lower number of stepped stalls (p = 0.024, 0.002 and 0.0001, respectively). There were no statistically significant differences in grooming time or number of bipedal movements. CONCLUSIONS: Newborn rats in whom Levine preparation was applied presented clinical alterations that may resemble some of the signs that accompany infantile cerebral palsy (grasp problems, wrong response to postural reflexes and alteration in locomotion).

Análisis del llanto en niños hipoacúsicos y normoyentes de 0 a 2 años de edad

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Abstract: Infant crying is a complex phenomenon that implies several functions: breathing, action of laryngeal and supralaryngeal muscles under the control of the neurovegetative systems of the brainstem, and the limbic system, and the association of cortical areas and the cerebellum. Although it is a communication system different to babbling and language, it is related with the future development of phonation. Cry analysis provides information about the neuro-physiologic and psychological states of newborns and the identification of perinatal abnormalities. It is necessary to discuss the subject extensively because there are new data on situations such as laringomalacia, congenital hypothyroidism, deafness and sleep apnea that seem to be associated to infantile crying behaviors. Infant cries can be analyzed as behavioral conditions (hunger, anger and pain cries) allows knowing of mother-child relationship or the effect under diverse cultural conditions, such as stress, emo-tional deprivation or illness. A spectrographic analysis of the cries may identify several characteristics: threshold, latency, duration of phonation, maximum and minimum of the fundamental frequency (F0), occurrence and maximum pitch of shift, gliding, melody, biphonation, bifurcation, noise concentration, quality of the voice, double harmonic break, glottal plosives, vibratos, melody types, F0 stability and inspiratory stridor. To date, it has not been possible to establish alteration patterns. The best studied variables are F0, its harmonics and the duration of each emission; it is accepted that F0 varies between 400 and 600 Hz, during 1.4 ± 0.6s. Under such approaches, diverse alterations and risk factors have been studied: congenital alterations, malnutrition, sudden death, maternal exposition to drugs, prematurely born babies or perinatal asphyxia and disturbances of the central nervous system. Authors have reported F0 equal or less than 300 Hz in cases of sudden death or with high frequencies, near the 1000 Hz in the Cri du chat syndrome, perinatal asphyxia and other cases who died suddenly. During the cry, there is an increase of intra-abdominal pressure, heart rate and blood pressure, reduction of oxygen saturation, increase of the intra cranial-pressure, beginning of stress reactions, depletion of the energy anf oxygen reserves, such as the found in the Valsalva's maneuver. Every event of prolonged cries implies alteration of the breathing control like a Hering-Breuer reflex. Considering that some authors have proposed early vocalizations are a good predictor of deafness, in a previous paper we reported the characteristics of the cry of 20 deaf neonates. However, we were not able to demonstrate differences when comparing them with normal hearing neonates and infants, using only parametric methods. Still, we decided to go further and investgate the quality of infant cries of deaf neonates and infants. Material and methods. Twenty zero-to two-year old cases were studied; they were deaf children of both sexes; all cases were included in a follow-up program on the Human Communication Department of the National Institute of Perinatology of Mexico and were compared with 20 normal hearing children. We re-corded Brain Stem Evoked Auditory Responses (BEAR) and cry recording using a digital Sony recorder during the physical exploration. We analyzed the frequency (Hz) and duration of the espiratory cries, the duration of inspiration between two cry emissions and the characteristics of the spectrogram. Quantitative analysis. The usual estimates of means and standard variation were obtained and they were compared with one way analysis of variance. We organized typologies of frequency by means of cluster techniques (Ward method). The distribution of the duration of the periods of crying and silence was explored with a contingency tables. Qualitative analysis. Two standardized observers visually analyzed all the cries to determine any variation of F0 and of harmonic frequencies. Whenever a variation of F0 was observed, we obtained maximum and minimum frequencies, as well as average duration of each cry emission. The procedure was validated by means of the graphic comparison with a Fouries analysis. Results. Mean duration of cries in the deaf group was 0.5845 ± 0.6150 s (range 0.08-5.2 s), while in the group of normal hearing cases was 0.5387 ± 0.2631 (range 0.06-1.75 s). From the deaf group, five cases had very prolonged duration of cries, without statistical significance. The mean duration of the inspiration was 0.3962 ± 0.2326, with a range of 0.06 to 1.75 in the deaf group and of 0.4083 ± 0.1854, with a range of 0.21 at 0.96, in the controls, without difference among groups. There was no correlation between the time of espiratory cry and that of the inspiration. Three cry topologies were organized: one of shorter duration (mean 0.30 s), with 111 spectrograms, an intermediate one (mean 0.73) with 85 spectrograms and one of prolonged duration (mean 4.5 s) with spectrograms of three cases. Three topologies of the inspiratory period were obtained: one of short periods (mean 0.33 s), with 171 spectrograms, one of intermediate duration (mean 0.80 s) with 18 spectrograms and one of prolonged duration (mean 1.60 s) with three cases. There were no statistical differences of tipologies between the deaf groups and normal hearing cases. On the qualitative analysis of cries, we came across several variations which are interpreted as abnormalities: vibratos, poor melodic control, loss of fundamental frequencies, harmonic limited production, plosives, gliding, bi phonation, and a loss of intensity at end of cry emissions. These changes were also observed on the control cases, but only in a very limited number. Discussion. Cry spectrogram analysis are non invasive indicators of the neonate's neurophysiologic organization. Although cry duration varies in healthy newborns, the accepted variation for a normal range is 1.1 to 2.8 s, with standard deviations around 0.6 s. Consistent differences have not been demonstrated between risk and control groups. However, abnormal cases such as Down syndrome or severe asphyxia have very short cries, whereas on the Cri du chat syndrome the duration of cries is prolonged. Extended cries imply cardiac and respiratory risks which have been associated with later outcomes as development retardation and sudden death. There are also some questions to solve, such as the regulation and control of cry, starting from breathing mechanisms or from a sensorial afferent, mediated by hearing. The deaf infants are constituted in a study model, considering that the auditory afference is suppressed and the control of the cry is restricted to the breathing environment. In the studied spectrograms, the duration of the cry was within reported normal limits by other authors, inasmuch in the normal hearing control cases as in the deaf, except the dissident cases, but without these reaching statistical significance. Further research of brainstem function is needed for the abnormal cases with prolonged cry periods, since such cries are interpreted as an alteration of the breathing reflexes of Hering-Breuer, which might have a pathological meaning in the sense of the sob's spasm or even more severe risk factors as sleep apnea and even sudden death. The qualitative analysis in the deaf individuals demonstrated a poor quality and unstable character of melodic control, with a smaller number of harmonics. The deaf cases lost the relationship between the fundamental frequencies and their harmonics, mainly because of the participation of supraglottic structures that modulate pitch and due to the poorness of melodic control, either for monotony or due to the impossibility of returning to a normal pattern, following variations such as vibrato, plosives or noise concentration. In the cases of prolonged cries, starting from the third second, the sound intensity tends to diminish and the harmonics are lost, perhaps due to a decrease of the subglottal pressure of phonation. This finding supports the auditory control of crying related to breathing mechanisms. Conclusions. In preliminary terms, by means of the melodic analysis of the spectrograms, differences are demonstrated be-tween the cries of the deaf and of the normal hearing cases. The increase of the complexity of the melody of the cry, or their poverty, are indicative of the neuromuscular function and they may support the evaluation of phonation before language development. The study of the spectrograms of deaf individuals does not constitute an element for the detection or for diagnosis since, to date, estimators of sensibility or of specificity have not been established, but they constitute a support for its integral evaluation, with the possibility of evaluating and of improving therapeutic rehabilitation.

Análisis de la conducta vocal en cobayos infantes con o sin hipoacusia provocada / Analisys of the vocal behavior in infant guinea pigs with or without induced deafness

El objeto del trabajo fue analizar el comportamiento de las vocalizaciones en cobayos recién nacidos con audición normal e hipoacúsicos. Para ello se utilizaron 10 camadas de cobayos pigmentados, cada camada consistía en la madre y sus hijos viviendo en jaulas separadas. De cada camada se utilizaron a las dos hijas hembras de mayor peso a una de las cuales se le destruyeron las cócleas al nacimiento. Cinco días a la semana se registraron las vocalizaciones que emitía cada grupo (sordas o normales) hasta el día 40 post nacimiento. Para el análisis de resultados se cuantificó la cantidad de vocalizaciones que emitía cada grupo y se hicieron estudios estadísticos que mostraron diferencia significativa con p<0.05. Los resultados señalan la importancia de la retroalimentación auditiva para la evolución y desarrollo de vocalizaciones en esta especie.

Programa COOL EDIT 96 para el análisis del llanto y del habla en el niño hipoacúsico / COOL EDIT 96 software in the crying and talking of hearing impaired children

Para conocer cualitativa y cuantitativamente el habla y el llanto de los hipoacúsicos, se utilizó el programa Cool Edit 96, que analiza los sonidos, cuantificando la frecuencia (Hz) en función al tiempo (s). Se estudiaron 10 niños normo-oyentes y 10 niños hipoacúsicos para analizar el llanto, así como 10 hipoacúsicos pre-lingüísticos, 10 post-lingüísticos y 10 normo-oyentes adultos para analizar el habla. Los resultados muestran que el llanto en el niño hipoacúsico es arrítmico; el habla de los hipoacúsicos pre-lingüísticos es lenta y elaborada y tiene frecuencia más alta en comparación con los normo-oyentes. Existe diferencia significativa (p=0.05) con los normo-oyentes en lo que respecta al tiempo (s) en que se producía el sonido, no así con la frecuencia del sonido emitido.Los resultados demuestran la importancia de la utilización de la tecnología para el estudio en la adquisición y desarrollo del lenguaje y también para la elaboración de programas rehabilitatorios o habilitatorios.

Modelos biomédicos en audiología y otorrinolaringología / Biomedical models in audiology and otorhinolaryngology

En el presente trabajo se mencionan y discuten algunos de los modelos animales más utilizados en estudios experimentales en los campos de la otorrinolaringología y audiología. Se resalta la importancia que tiene el utilizar modelos experimentales ya probados, y de esta manera optimizar los resultados obtenidos en las investigaciones en donde se utilicen modelos animales

El cobayo como modelo de estudios audiológicos / the guinea pig as a model for audiological research

Se menciona la utilidad del cobayo en la investigación audiológica, describiendo dos acceso quirúrgicos tanto al oído medio como al interno, utilizando estas técnicas para la producción de hipoacusia experimentales. También se discute sobre registros electrofisiológicos obtenidos en animales recién nacidos y adultos, con la finalidad de proponer al cobayo como modelo ideal de estudios audiológicos

Estudio comparativo de la audición por potenciales provocados auditivos del tallo cerebral, en anfibios, reptiles, aves y mamíferos / Comparative study of hearing by brainstem auditory evoked responses on amphibians, reptiles, birds and mammals

Este trabajo compara, mediante potenciales provocados auditivos del tallo cerebral (PEAT), las diferencias funcionales entre especies que representan cuatro grupos taxonómicos de vertebrados terrestres (Anfíbios, reptiles, aves y mamíferos). Se observaron dos ondas, de mayor latencia en Rana catesbeina, cuatro en el Sceloporus torcuatus, cuatro de latencia corta en Columba livia, y siete en humanos con una latencia relativamente mayor. Los umbrales aduditivos descienden conforme se avanza en la escala filogenética

Niveles de contaminación por ruido en una de las principales avenidas de la ciudad de México / Noise pollution levels in a large street in Mexico city

Se reportan los resultados de la medición de los niveles de contaminación por ruido, encontrados en seis horarios a lo largo de las 24 hr del día, en una de las principales avenidad de la ciudad de México en el año de 1993. Las mediciones se efectuaron mediante un sonómetro a las: 4.00, 8.00, 11.00, 15.00, 19.00 y 23.00 hr. El nivel de ruido en el percentil 10 (NR10) en los horarios estudiados fué de 80.3, 104.8, 100.9, 103.8, 95.6 y 95.2 dB "A" a las 4.00, 8.00, 11.00, 15.00, 19.00 y 23.00 hrs. respectivamente. El nivel de ruido en el percentil 50 (NR50) en los horarios estudiados fué de 67.7, 90.5, 87.5, 90.5, 86.5, y 77.2 dB "A" respectivamente. El nivel de ruido en el percentil 90 (NR90) fué de 60.2, 85.6, 82.1, 86.8, 84.7 y 73.9 dB "A". La correlación entre el ruido y la cantidad de automóviles circulantes fué de r=0.86. estos datos muestran que los niveles de ruido en calles de denso tráfico en la ciudad de México, se mantienen por arriba de la norma considerad como saludable (70 dB), a lo largo del día asociados al tráfico automotor

Morfofisiología de la trompa de eustaquio en mamíferos, aves y batracios: estudio comparativo / Morpho-physiology of the eustachian tube in mammals, birds and frogs: comparative estudy

El presente trabajo es un estudio comparativo de la trompa de Eustaquio en mamíferos, aves y batracios, con la finalidad de encontrar un modelo ideal para estudios experimentales de la trompa de Eustaquio. Se describe la anatomía y fisiología de la trompa de Eustaquio en las clases y especies estudiadas, se encontró que la principal diferencia es la situación del torus tubario que varia, pudiéndose encontrar en la rinofaringe o la orofaringe según la especie. Otras diferencias que se describen, en cuanto al funcionamiento del torus tubario en mamíferos, aves y batracios, se relacionan en forma muy especial con el habitat y las circunstancias muy especiales que privan en estos animales, para facilitar la función primordial de la trompa de Eustaquio y el equilibrio de presiones intra y extratimpanicas

Validación del uso de juguetes sonoros mexicanos en la detección temprana de hipoacusias profundas bilaterales / Validation of the use of mexican sonorous toys for the early detection of profound bilateral hering loss

Se informa de los resultados de la validación de una prueba de rastreo de la audición en niños de OVol. 38 No. 4 1993 tres juguetes sonoros (matraca, timbre y palo de lluvia), de manufactura artesanal mexicana en dos poblaciones, una de ellas aleatoria y otra de población abierta. La sensibilidad fue de 88 por ciento y su especificidad fue de 90 por ciento. Se compararon los resultados diagnósticos de la prueba de juguetes sonoros contra la de potenciales provocados auditivos del tallo cerebral, no encontrándose diferencias significativas para identificar sorderas severas a produndas

Estudio morfológico comparativo de la nariz de animales de laboratorio / Morphological study of the nasal cavity and septum in laboratory animals

Se hizo comparación de la anatomía macroscópica e histológica del septum nasal de tres especímenes de perros, gatos, cobayos, conejos, ratas y ratones. Se describen las similitudes y las diferencias entre las porciones anterior, media y posterior en cada especie.

Otitis media espontánea en rata / Spontaneous otitis media in rats

En el presente trabajo se realizó un estudio comparativo y descriptivo en dos grupos de ratas: la cepa Wistar y la cepa Long Evans. Se describen los hallazgos en el oído medio de estos animales. Se realizaron estudios macroscópicos, radiológicos e histológicos de los casos de Otitis Media Espontánea y se analizan los resultados de este modelo espontáneo, que puede ser utilizado para estudiar la Otitis Media.