Validación de un laboratorio básico de neurosonología para la detección de estenosis carotídea cervical / Validation of a basic neurosonology laboratory for detecting cervical carotid artery stenosis

Introducción: La detección de estenosis arterial cervical e intracraneal es fundamental en el estudio del ictus isquémico, al ser el origen aterotrombótico el más prevalente en nuestro entorno. La ultrasonografía se ha convertido, por su accesibilidad y fiabilidad, en la técnica de elección para la primera aproximación al diagnóstico de esta patología, y debe ser validada en cada laboratorio en particular. El objetivo del presente trabajo es validar la técnica Doppler practicada en nuestro laboratorio para la detección de estenosis carotídea crítica. Pacientes y métodos: Se diseñó un estudio descriptivo observacional de evaluación de pruebas diagnósticas. Se compararon los resultados obtenidos sobre pacientes con diagnóstico de ictus mediante la técnica integrada Doppler carotídeo y transcraneal realizada por neurología, con los proporcionados por la técnica dúplex carotídeo, dependiente del servicio de radiología. El gold standard fue el resultado obtenido por una técnica arteriográfica (angio-RM, angio-TC o arteriografía convencional). Resultados: N = 228 pacientes. En la detección de estenosis carotídea > 70%, el Doppler cervical y transcraneal tenía una sensibilidad y especificidad del 96 y el 100%, respectivamente, frente al 87 y el 94% obtenidos por el dúplex exclusivamente cervical. Para las estenosis intracraneales detectadas mediante Doppler transcraneal, esos parámetros fueron del 78 y el 98%, respectivamente. Conclusiones: El estudio Doppler realizado en el laboratorio de neurosonología quedó validado como herramienta diagnóstica útil para la detección de estenosis carotídea cervical, siendo superior al dúplex cervical aislado, pese a la ausencia de modo B. Demostró, además, un valor adicional como técnica de detección de estenosis arterial intracraneal

Introduction: Most of the cases of ischaemic stroke in our setting are of atherothrombotic origin. Detecting intracranial and cervical carotid artery stenosis in patients with ischaemic stroke is therefore essential. Ultrasonography has become the tool of choice for diagnosing carotid artery stenosis because it is both readily accessibility and reliable. However, use of this technique must be validated in each laboratory. The purpose of this study is to validate Doppler ultrasound in our laboratory as a means of detecting severe carotid artery stenosis. Patients and methods: We conducted an observational descriptive study to evaluate diagnostic tests. The results from transcranial and cervical carotid Doppler ultrasound scans conducted by neurologists were compared to those from carotid duplex scans performed by radiologists in patients diagnosed with stroke. Arteriography was considered the gold standard (MR angiography, CT angiography, or conventional arteriography). Results: Our sample included 228 patients. Transcranial and cervical carotid Doppler ultrasound showed a sensitivity of 95% and specificity of 100% for detection of carotid artery stenosis > 70%, whereas carotid duplex displayed a sensitivity of 87% and a specificity of 94%. Transcranial carotid Doppler ultrasound achieved a sensitivity of 78% and a specificity of 98% for detection of intracranial stenosis. Conclusions: Doppler ultrasound in our neurosonology laboratory was found to be a useful diagnostic tool for detecting cervical carotid artery stenosis and demonstrated superiority to carotid duplex despite the lack of B-mode. Furthermore, this technique was found to be useful for detecting intracranial stenosis

Glutamate receptors of the A5 region modulate cardiovascular responses evoked from the dorsomedial hypothalamic nucleus and perifornical area

To assess the possible function of glutamate in the interaction between the dorsomedial hypothalamic nucleus-perifornical area (DMH-PeF) and the A5 pontine region (A5), cardiovascular and respiratory changes were studied in response to electrical stimulation of the DMH-PeF (1 ms pulses, 30-50 miA given at 100 Hz for 5 s) before and after the microinjection of kynurenic acid (non-specific glutamate receptor antagonist; 50 nl, 5 nmol), MK-801 (NMDA receptor antagonist; 50 nl, 50 nmol), CNQX (non-NMDA receptor antagonist; 50 nl, 50 nmol) or MCPG (metabotropic glutamate receptor antagonist; 50 nl, 5 nmol) within the A5 region. DMH-PeF electrical stimulation elicited a pressor (p < 0.001) and tachycardic response (p < 0.001) which was accompanied by an inspiratory facilitation characterised by an increase in respiratory rate (p < 0.001) due to a decrease in expiratory time (p < 0.01). Kynurenic acid within the A5 region decreased the tachycardia (p < 0.001) and the intensity of the blood pressure response (p < 0.001) to DMH-PeF stimulation. After the microinjection of MK-801 and CNQX into the A5 region, the magnitude of the tachycardia and the pressor response were decreased (p < 0.05 and p < 0.01; p < 0.001 and p < 0.05, respectively). After MCPG microinjection into the A5 region, a decrease in the tachycardia (p < 0.001) with no changes in the pressor response was observed during DMH-PeF stimulation. The respiratory response elicited by DMH-PeF stimulation was not changed after the microinjection of kynurenic acid, MK-801, CNQX or MCPG within the A5 region. These results suggest that A5 region glutamate receptors play a role in the cardiovascular response elicited from the DMH-PeF. The possible mechanisms involved in these interactions are discussed

Efectos de un programa de juego basado en técnicas de biofeedback cardíaco en el desarrollo cognitivo de niños / Efeitos de um programa de jogo baseado em técnicas de biofeedback cardíaco no desenvolvimento cognitivo de crianzas / Effects of a game program based on cardiac biofeedback techniques in cognitive development of children

Antecedentes. El biofeedback cardíaco es una técnica electrónica que tiene por finalidad mejorar el bienestar fisiológico y psicológico. Objetivo. Estudiar los efectos crónicos en el desarrollo cognitivo de niños, de un programa de intervención en formato de juego, basado en el principio de aprendizaje de la autorregulación cardiovascular. Método. Cincuenta y dos niños de ambos sexos, con una edad promedio de 9.57 (±0.80) años, distribuidos de manera aleatoria en grupo experimental y control. El grupo experimental realizó una intervención con sesiones de respiración controlada y biofeedback cardíaco. El grupo control no realizó ningún tipo de intervención. Fueron analizados índices de variabilidad de la frecuencia cardíaca e índices cognitivos, de los grupos, en el mismo intervalo de tiempo. Los índices de variabilidad de la frecuencia cardíaca se obtuvieron mediante métodos lineales en el dominio tiempo, y métodos no lineales. Los datos se han generado a través de los informes proporcionados por Kubios(R) y por software en formato MATLAB(R). El análisis de datos se realizó con el software SPSS 22.0 y se utilizó la correlación de Spearman para evaluar el grado de asociación de variables, considerando p≤0.05. Resultados. El grupo experimental tuvo un aumento de la actividad parasimpática representada por disminución de la frecuencia cardíaca (p<0.008), aumento de los valores del intervalo entre las ondas R del complejo QRSRR (p<0.008), aumento del índice derivado directamente del RR (p<0.026), del número de intervalos adyacentes que varían por más de 50ms (p<0.038) y del índice cardíaco vagal (p<0.031). Además, el grupo experimental tuvo mejor rendimiento cognitivo, representado por mayor precisión (p<0.012), estabilidad (p<0.012) y velocidad (p<0.01). Conclusión. La técnica de biofeedback cardíaco produce resultados efectivos en relación con la regulación autonómica y el desarrollo cognitivo de los niños (AU)

Antecedentes. O biofeedback cardíaco é uma técnica eletrônica que tem por finalidade o bem-estar fisiológico e psicológico do indivíduo. Objetivo. Estudar os efeitos crónicos, no desenvolvimento cognitivo de crianças, de um programa em formato de jogo baseado no princípio da aprendizagem de auto regulação cardiovascular. Método. Cinquenta e dois crianças de ambos os sexos, com idade média de 9.57 (±0.80) anos, distribuídas de maneira aleatória em grupo experimental e controle. O grupo experimental realizou sessões de respiração controlada e biofeedback cardíaco. O grupo controle não fez nenhum tipo de intervenção respiratório. Em ambos os grupos foram analisados índices de variabilidade da frequência cardíaca e índices cognitivos. Os índices de variabilidade da frequência cardíaca foram obtidos mediante ao domínio linear do tempo e frequência e a métodos não lineares. Os dados foram gerados através de informes proporcionados por Kubios(R) e por um software em formato MATLAB(R). A análise dos dados foi realizada com o software SPSS 22.0 e foi utilizada a correlação de Spearman para avaliar o grau de correlação entre as variáveis, considerando p≤0.05. Resultados. O grupo experimental obteve um aumento da atividade parassimpática representada pela diminuição da frequência cardíaca (p<0.008), aumento dos valores do intervalo entre as ondas R do complexo QRS (p<0.008), aumento do índice derivado diretamente do RR (p<0.026), do número de intervalos adjacentes que variam mais de 50ms (p<0.038) e do índice cardíaco vagal (p<0.031). Além disso, o grupo experimental obteve melhor rendimento cognitivo, representado por maior precisão (p<0.012), estabilidade (p<0.012) e velocidade (p<0.01). Conclusão. A técnica de biofeedback cardíaco trouxe resultados efetivos em relação a regulação autonômica e ao desenvolvimento cognitivo de crianças (AU)

Background. The cardiac biofeedback is an electronic technique that aims to improve the individual's physiological and psychological well-being. Objective. Study the chronic effects, on children's cognitive development, of a game program intervention based on the principle of self-regulation. Method. Fifty-two children of both sex, with a mean age of 9.57 (±0.80) composed the sample, randomized into experimental and control groups. The experimental group held an intervention with breathing pacer sessions and cardiac biofeedback sessions. The control group didn’t make any kind of breathing intervention. Heart rate variability and cognitive indeces were analyzed in both groups. Heart rate variability indices were obtained by lineal time and frequency domain, and nonlinear methods. The data was generated through the reports provided by Kubios(R) and software in MATLAB(R) format. Data analysis was performed using SPSS 22.0 software and Spearman correlation was used to assess the degree of association of variables, considering p≤0.05. Results. The experimental group had an increased of the parasympathetic activity at rest represented by a decrease in the heart rate (p<0.008), increased the interval between R waves of the QRS complex (p<0.008), increased the index derived directly from RR (p<0.026), the number of adjacent intervals that vary by more than 50ms (p<0.038) and the cardio vagal index (p<0.031). Besides the experimental group had better cognitive performance than the control group: greater accuracy (p<0.012), stability (p<0.012) and speed (p<0.01). Conclusion. The cardiac biofeedback technique brings effective results regarding autonomic regulation and cognitive development of children (AU)

Perfil de consumo de antiepilépticos en los pacientes epilépticos del Área Oeste de Málaga / Consumption patterns of antiepileptic drugs among epileptic patients in the Western Málaga district

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