Consumo de alcohol en escolares de un territorio de la Araucanía-Chile: etnicidad y residencia / Alcohol consumption among high school students from the Araucanía-Chile: ethnicity and residence

INTRODUCCIÓN: Se describe el consumo de alcohol en estudiantes de enseñanza media del territorio costero de la región de La Araucanía, relacionado con etnicidad, género y residencia. SUJETOS Y MÉTODOS: Diseño de corte transversal, con 2.763 estudiantes entre 14-18 años a quienes se les aplicó el test AUDIT. La recolección de datos se realizó mediante a) un formulario con antecedentes sociodemográficos y origen étnico, preguntas sobre autoreporte de consumo de alcohol en el último mes y edad de primer consumo de alcohol, y percepción sobre acceso de alcohol entre los jóvenes; y b) el test AUDIT para evaluar los diversos niveles de consumo de alcohol en los estudiantes. La condición étnica se trianguló con autoadscripción, apellidos, y pertenencia a comunidad Mapuche. Los datos se recolectaron en las salas y horario de clases de los estudiantes con autorización del director, profesor del curso y supervisada por el equipo investigador. El AUDIT es un test autoadministrado que consta de 10 preguntas de formato estructurado en una escala de 0-4, con rango desde 0 a 40 puntos, los cuales representan cuatro categorías de consumo. Se realizó análisis descriptivo e inferencial con t-Student para comparación de promedios, Chi-cuadrado para tablas de asociación, intervalos de confianza 95% para estimación, y 5% para significación estadística. RESULTADOS: 48,1% fueron Mapuche, edad promedio 15,7 años (DS = 1,2), 49,1% mujeres y 50,9% residentes rurales. El consumo de alcohol en el último mes fue 38,2% (39,6% hombres 36,7% mujeres (p < 0,001)); 85% reportó beber antes de los 15 años y 87% indicó fácil acceso al alcohol. La aplicación del AUDIT mostró un consumo en los niveles de riesgo, perjudicial o con síntomas de dependencia (en adelante riesgo-AUDIT) de 13,9% [IC 95%: 12,6-15,2]. Mayor en hombres 20,3% [IC 95%: 18,1-22,4] que en mujeres 7,7% [IC 95%: 6,4-9,1]. Estudiantes Mapuche mostraron menor consumo de riesgo-AUDIT: 12,5% [IC 95%: 10,7-14,3] que los no Mapuche 15,2% [IC 95%: 13,3-17,1]. El 17,4% [IC 95%: 15,2-19,5] de los urbanos presentaron consumo de riesgo-AUDIT en comparación a los rurales, 11,2% [IC 95%: 9,6-12,8]. CONCLUSIONES: El consumo de alcohol fue mayor al observado a nivel nacional, y a medida que aumenta la edad aumenta el nivel de riesgo especialmente en hombres. El consumo de riesgo de alcohol se asoció a etnia, lugar de residencia y género. El ser no Mapuche, residente urbano y hombre son factores asociados al consumo de riesgo de alcohol entre los estudiantes.

INTRODUCTION: This study describes the alcohol consumption in association with residence, gender and ethnicity among high school students from the coastal area of the Araucania Region in Chile. SUBJECTS AND METHOD: Cross-sectional study on a population of 2,763 high school students aged bet ween 14 to 18 years. Statistical analysis: exploratory-descriptive analysis was used for all variables and inferential statistical analysis for associations among variables using 95% confidence interval for the estimates and 5% statistical significance for the statistical test. Data collection: alcohol consumption reported by AUDIT test and sociodemographic records. RESULTS: 48.1% of students were Mapuche, mean age of 15.7 years (SD = 1.2), mostly from rural areas (50.9%). Alcohol consumption in the last month was 38.2%; 39.6% male 36.7% female (p < 0.001). 37.5% drank at least once in their life and 85% did so before age 15. 87% reported easy access to alcohol. According to AUDIT test, the levels of risk, harm and symptoms of dependence are 13.9% [95% CI: 12.6-15.2], 20.3% higher in men [95% CI: 18.2-22.5] than women 7.7% [6.4-9.3]. Mapuche students present risk consumption lower than non-Mapuche ones, 12.5% and 15.2% respectively. Urban-rural residence and risk consumption is 12.6% and 8.2% respectively (p < 0.001). CONCLUSIONS: The alcohol consumption was higher than that observed at the national level, and as age increases, the level of risk increases, especially in men. Alcohol risk consumption was associated with ethnicity, place of residence and gender. The fact of being non-Mapuche, urban resident and man are factors associated with the risk of alcohol con sumption among students.

Evolución del protocolo de trombolisis endovenosa en ataque cerebrovascular isquémico agudo / Intravenous thrombolysis for acute ischemic stroke. A four years’ experience in a Chilean public hospital

Background: Intravenous thrombolysis (IVT) with alteplase (tissue plasminogen activator) is the standard pharmacological treatment in acute ischemic stroke (AIS), reducing disability in patients. Aim: To report the results a thrombolysis protocol during four years in a regional public hospital. Material and Methods: Data from 106 consecutive patients aged 68 ± 13 years (57% men) who were treated with IVT, from May 2012 until April 2016, was analyzed. Results: The median door-to-needle time was 80 minutes (interquartile range = 57-113). The median National Institute of Health Stroke Scale (NIHSS) scores on admission and at discharge were was 11.5 and 5 points respectively. At discharge, 27% of hospitalized patients had a favorable outcome (n = 99), defined as having 0 to 1 points in the modified Rankin scale. Symptomatic intracerebral hemorrhage and mortality rates were 5.7 and 13.1%, respectively. The thrombolysis rate rose from 0.7% in 2012 to 6% in 2016. Conclusions: The implementation of 24/7 neurology shifts in the Emergency Department allowed us to increase the amount and quality of IVT in our hospital, as measured by the rate of thrombolysis and by process indicators such as door-to-needle time.

Encefalitis autoinmune reversible y anticuerpos anti-receptores de N-metil-D-aspartato: Report of one case / Limbic encephalitis with positive anti-N-methyl-D-aspartate antibodies

Background: Limbic encephalitis is a subacute syndrome characterized by memory impairment, confusion, seizures, hypothalamic dysfunction and psychiatric symptoms. It has been associated to tumors located outside of the central nervous system. In 2007, anti-N-methyl-D-aspartate receptors (NMDAr) antibodies were found in serum and CSF of patients with this particular type of encephalitis. We report a 25-year-old female who, following upper respiratory tract symptoms, developed serious behavioral and consciousness impairment that progressed to coma. Cerebrospinal fluid (CSF) analysis showed a lymphocyte pleocytosis, the electroencephalogram was altered with a slow encephalopathic rhythm and a brain magnetic resonance imaging was normal. Infectious etiologies were ruled out. CSF and serum anti NMDA receptors antibodies were positive.

Persistencia de movimientos en espejo congénitos en una hemiplejía por infarto cerebral / Persistance of congenital mirror movements in the hemiplejic side after ischemic stroke

The simultaneous and involuntary displacement of the opposite limb during a volitional movement is called mirror movements. They mimic the gesture, partly or wholly. They can be congenital, familiar or installed in various CNS pathologies. We present a 64 years old woman with familiar history of mirror movements that affect their hands, since childhood. At admission presented confused with left hemiplegia and homolateral sensory involvement. The brain CT defined a right ischemic stroke affecting the posterior limb of the internal capsule, lenticular nucleus, sub insular region and par ventricular white matter. The paretic left hand, unable to perform voluntary movements, presented mirror movements during volitional movements of the contra lateral hand. Neurophysiologic studies have suggested that mirror movements are due the activation of the direct corticospinal pathway or simultaneous discharge of both motor cortexes due inhibitory pathways failures. Cortical origin seems unlikely for the movements in this patient, due to the injury of the internal capsule. Our case could be interpreted by the simultaneously brain innervations on both anterior horns, together with a congenital deregulation of the Central Pattern Generator Networks.

Se denomina movimiento en espejo (ME) el desplazamiento involuntario, imitativo y simultáneo de la extremidad opuesta al de un movimiento volitivo. Los ME pueden tener un origen congénito y familiar o generarse por patologías diversas del sistema nervioso central. Se presenta una mujer de 64 años con el antecedente de ME desde la infancia de carácter familiar. Ingresa en estado confusional y presentando una hemiplejía y hemihipoestesia faciobraquicrural izquierda. La tomografía cerebral mostraba compromiso del brazo posterior de la cápsula interna, núcleo lenticular, región subinsular y de la sustancia blanca paraventricular. La mano izquierda pléjica que era incapaz de realizar movimientos voluntarios, se movía en espejo al mover la mano derecha. Esta curiosa manifestación hace necesario una más ajustada interpretación neurofisiológica de los movimientos en espejo. Se ha postulado una activación de la vía corticoespinal directa, o la descarga simultánea de ambas cortezas motoras por fallas en la natural inhibición transcortical. En este caso parece improbable un origen cortical contralateral de los movimientos, debido a la lesión de la cápsula. Tal vez podrían comprenderse los ME de esta paciente, si se demostrara una doble inervación de ambas astas anteriores, asociada a una falla en la inhibición normal por desregulación congénita de los Circuitos Generadores Centrales.