Prevalence of Spasticity and Postural Patterns in the Upper Extremity Post Stroke.

INTRODUCTION: A high number of patients with stroke develop upper extremity spasticity, causing abnormal postures and patterns. These alterations limit the use of arm in functional activities and affect social participation. AIM: To determine the prevalence of spasticity and postural patterns of the upper extremity post stroke. MATERIALS AND METHODS: A cross-sectional descriptive design was used with a prospective follow-up. The sample included 136 patients. The study included 3 measuring times; at 10 days (T1), applying a record with sociodemographic-clinical data, the evaluation of muscle tone in the elbow and wrist and the postural patterns of the UE, and at 3 months (T2) and 12 months (T3) post stroke, re-evaluating tone and patterns. Prevalence was calculated through the one-sample chi-squared (χ2) test followed by inspection of the standardized residuals (z) in each cell. The Kappa coefficient evaluated the degree of agreement in elbow and wrist tone. RESULTS: The prevalence of spasticity in the elbow was 37.5% at T1, 57.4% at T2, and 57.4% at T3. At each time there was a high degree of agreement between elbow and wrist tone. Patients developed increased elbow tone between T1 and T2, with maintained tone between T2 and T3. Postural pattern III was the most prevalent according to Hefter's classification. CONCLUSION: The prevalence of spasticity in the elbow and wrist increases between 10 days and 3 months post stroke, and is maintained between 3 and 12 months. The onset of spasticity occurs in almost half of patients during the first 10 days post stroke. Postural pattern III according to Hefter's classification presented the greatest prevalence in the spastic UE.

Utility of basic clinical and laboratory parameters to predict Serious Bacterial Infection in children younger than 3 months old hospitalized for Febrile Syndrome without Source. / Utilidad de los parámetros clínicos y de laboratorio básicos para predecir infección bacteriana seria en menores de 3 meses que se hospitalizan por síndrome febril sin foco.

INTRODUCTION: In 20% of children with febrile syndrome, it appears as fever of unknown origin (FUO) syndrome. Management strategies in this group have high sensitivity but low specificity. OBJECTIVES: To cha racterize serious bacterial infections (SBI) in children younger than three months old hospitalized because of FUO syndrome and to evaluate the utility of clinical and laboratory parameters in the identification of patients that are at high risk of SBI. PATIENTS AND METHOD: Prospective study in patients aged < 3 months hospitalized due to FUO syndrome between January 2014 and November 2015 in two pediatric hospitals in the Metropolitan Region. INCLUSION CRITERIA: age 4 days - 3 months, fever > 38°C longer than 72 hours after onset without demonstrable cause. EXCLUSION CRITERIA: anti microbial use up to 7 days before admission, preterm infants < 34 weeks, birth weight < 2 kg, and im munocompromised. Demographic, clinical, and laboratory tests data were recorded as well as blood count and CRP, discharge diagnosis, and ruled out, probable or confirmed SBI. RESULTS: 32% of the patients were discharged with diagnosis of SBI, 28% with diagnosis of viral or probably viral infec tion, 34% with diagnosis of not specified FUO syndrome, and 6% due to other causes. There were no significant differences in the CRP value, altered WBCs count, toxic aspect, or hours of fever at the admission when comparing groups with and without SBI (p < 0.05). The combination of clinical and laboratory parameters showed 27% of sensitivity, 90% of specificity, 60% of PPV, and 71% of NPV. CONCLUSION: It was not possible to establish clinical and laboratory parameters that allow the identifi cation of children younger than 3 months old at high risk of SBI, however, they maintain their value as low risk indicators. It is necessary further investigation of other clinical and laboratory elements that allow discriminating SBI from viral infections.

Utilidad de los parámetros clínicos y de laboratorio básicos para predecir infección bacteriana seria en menores de 3 meses que se hospitalizan por síndrome febril sin foco / Utility of basic clinical and laboratory parameters to predict Serious Bacterial Infection in children younger than 3 months old hospitalized for Febrile Syndrome without Source

Resumen: Introducción: Un 20% de los niños con síndrome febril se presenta como síndrome febril sin foco (SFSF). Las es trategias de manejo en este grupo presentan alta sensibilidad, pero baja especificidad. Objetivos: Ca racterizar las infecciones bacterianas serias (IBS) en menores de 3 meses hospitalizados por SFSF, y evaluar utilidad de parámetros clínicos y de laboratorio en la identificación de pacientes con alto riesgo de IBS. Pacientes y Método: Estudio prospectivo en pacientes < 3 meses hospitalizados entre enero 2014 y noviembre 2015 por SFSF en dos hospitales pediátricos de la Región Metropolitana. Criterios de inclusión: edad 4 días - 3 meses, fiebre > 38°C de < 72 h de evolución sin causa demostra ble. Criterios de exclusión: uso de antimicrobianos hasta 7 días previo a su ingreso, prematuros < 34 semanas, peso de nacimiento < 2 kg e inmunocomprometidos. Se registraron datos demográficos, clínicos, y exámenes de laboratorio, hemograma y PCR, diagnóstico de egreso, IBS descartada, IBS probable o confirmada. Resultados: 32% de los pacientes egresó con diagnóstico de IBS, 28% con diagnóstico de infección viral o probablemente viral, 34% con diagnóstico de SFSF no especificado y 6% SFSF por otras causas. No se encontraron diferencias significativas en PCR, leucocitosis, aspecto tóxico ni horas de fiebre al ingreso al comparar los grupos con y sin IBS (p > 0,05). La combinación de parámetros clínicos y de laboratorio mostro sensibilidad de 27%, especificidad de 90%, VPP 60% y VPN 71%. Conclusión: No fue posible establecer que parámetros clínicos y de laboratorio permitan identificar menores de 3 meses con alto riesgo de IBS, manteniendo su utilidad como indicadores de bajo riesgo. Es necesario contar con otros elementos clínicos y de laboratorio que permitan discrimi nar IBS de infecciones virales.

Abstract: Introduction: In 20% of children with febrile syndrome, it appears as fever of unknown origin (FUO) syndrome. Management strategies in this group have high sensitivity but low specificity. Objectives: To cha racterize serious bacterial infections (SBI) in children younger than three months old hospitalized because of FUO syndrome and to evaluate the utility of clinical and laboratory parameters in the identification of patients that are at high risk of SBI. Patients and Method: Prospective study in patients aged < 3 months hospitalized due to FUO syndrome between January 2014 and November 2015 in two pediatric hospitals in the Metropolitan Region. Inclusion criteria: age 4 days - 3 months, fever > 38°C longer than 72 hours after onset without demonstrable cause. Exclusion criteria: anti microbial use up to 7 days before admission, preterm infants < 34 weeks, birth weight < 2 kg, and im munocompromised. Demographic, clinical, and laboratory tests data were recorded as well as blood count and CRP, discharge diagnosis, and ruled out, probable or confirmed SBI. Results: 32% of the patients were discharged with diagnosis of SBI, 28% with diagnosis of viral or probably viral infec tion, 34% with diagnosis of not specified FUO syndrome, and 6% due to other causes. There were no significant differences in the CRP value, altered WBCs count, toxic aspect, or hours of fever at the admission when comparing groups with and without SBI (p < 0.05). The combination of clinical and laboratory parameters showed 27% of sensitivity, 90% of specificity, 60% of PPV, and 71% of NPV. Conclusion: It was not possible to establish clinical and laboratory parameters that allow the identifi cation of children younger than 3 months old at high risk of SBI, however, they maintain their value as low risk indicators. It is necessary further investigation of other clinical and laboratory elements that allow discriminating SBI from viral infections.

Cuando la enfermedad es nacer antes de tiempo / If the disease is the birth before the end

El parto prematuro se define como aquel que ocurre antes de las 37 semanas de gestación. La inmadurez funcional y metabólica que significa nacer antes de tiempo conlleva riesgos de morbilidad y de mortalidad neonatales. Las patologías que afectan a los recién nacidos prematuros requieren hospitalización y tratamientos prolongados en ocasiones, por lo que familia y recién nacido pueden sufrir desvinculación afectiva. Es necesario que todo el equipo de salud colabore en el establecimiento del vínculo parental de manera de fomentar su recuperación...

Preterm birth is defined as birth of an infant at <37 weeks’ gestation. Preterm infants are less physiologically and metabolically mature than term infants placing them at higher risk of morbidity /mortality. They are exposed to prolonged hospitalization and physical separation from the mother. Thus, they can have adverse physiologicaL/ psychologicaL effects. All healthcare providers should collaborate to establish the parental bond...

Quiste ovárico fetal: diagnóstico prenatal y manejo quirúrgico postnatal exitoso / Prenatal diagnosis of fetal ovarian cyst

Los quistes ováricos son el tumor abdominal mas frecuente en las recién nacidas. Presentan complicadones agudas y a largo plazo. La más frecuente es la torsión anexial que presenta dificultades diagnósticas en la etapa neonatal. El diagnóstico prenatal es fundamental para el manejo oportuno de las pacientes. Existen diferentes alternativas terapéuticas donde la cirugía mínimamente invasiva y conservadora juega un importante rol. Presentamos el caso de una recién nacida macrosómica con diagnóstico prenatal de quiste ovárico no complicado que sufrió torsión durante los primeros días de vida y se resolvió exitosamente en forma quirúrgica conservadora gracias a un manejo multidisciplinario.

Ovarian cysts are the most common abdominal tumor in female newborns. They could develop acute or long term complications. The most frequent complication is adnexal torsion, which presents with diagnostic difficulties in the neonatal period. Prenatal diagnosis is essential for the prompt management of patients. There are different treatment options where conservative and minimally invasive surgery plays an important role. We report a female newborn with prenatal diagnosis of macrosomia and uncomplicated ovarian cyst, which suffered adnexal torsion during the first days of life and was successfully resolved with a conservative surgical management by a multidisciplinary staff.

Escalas de compromiso funcional y de movimientos involuntarios en extremidades superiores en niños con trastornos de movimiento de tipo extrapiramidal / Scales evaluating functional compromise and involuntary upper extremity movements in children with extra pyramidal disorders

Introducción. Los niños con parálisis cerebral de tipo extrapiramidal requieren de una evaluación funcional global que mida cambios antes, durante y después de tratamientos. Objetivo. Validar dos escalas de evaluación: compromiso funcional global y tipo de movimiento involuntario predominante en extremidades superiores. Pacientes y método. 63 pacientes seleccionados aleatoriamente de Teleton-Santiago-Chile-2006, diagnóstico parálisis cerebral, alteración de movimiento de tipo extrapiramidal, de 4–18 años, que cumplieron requisitos de inclusión; se aplicó escala de compromiso funcional (con dimensiones: postura sedente, actividades de la vida diaria y funcionalidad manual) y escala de movimientos Involuntarios (atetosis, coreatetosis y distonía). Resultados. La escala de compromiso funcional muestra alta consistencia interna (α Cronbach 0,94), valor kappa de variabilidad entre observadores de 0,78; validez de constructo constituido por 2 componentes principales que explicaron 75,7% de la funcionalidad. La escala clasificó a los niños en 46% como grave o severo, 25,4% como moderado, 20,6% como leve y sólo al 7,9% como clínicamente normal. La escala de movimientos involuntarios registró confiabilidad con valor kappa de 0,85 y consistencia interna de 0,97; clasificó como distónicos al 38,1% de los niños, coreatetósicos el 33,3% y 28,9% como atetósicos. Conclusión. Las escalas demostraron ser confiables y válidas por lo tanto, pueden ser utilizadas como ayuda en la planificación y evolución terapéutica(AU)

Introduction. Children with extrapyramidal cerebral palsy require a comprehensive functional assessment that records their functions before, and measures the changes during and after the treatments. Objective. Validate two assessment scales: global functionality and type of predominant unintentional movement in upper extremities. Patients and method. 63 patients were randomly selected from Teleton-Santiago-Chile-2006, diagnosed with cerebral palsy, extrapyramidal type alteration movement, 4 to 18 years, which met the inclusion requirements: they were evaluated with the functional compromise scale (with dimensions: sitting posture, daily living activities, and manual functionality) and with the involuntary movements scale (athetosis, choreathetosis and dystonia). Results. The scale of functional assessment shows high internal consistency (α Cronbach 0.94), a kappa value of variability among observers of 0.78, and construct validity, which consists of two main components that explained 75.7% of the functionality. The scale ranked children as: 46% as serious or severe, 25.4% as moderate, 20.6% as mild, and only 7.9% as normal. The scale of involuntary movements showed high reliability with kappa value of 0.85 and internal consistency of 0.97, and ranked 38.1% of the children as dystonic, 33.3% as choreathetosics, and 28.9% as athetosics. Conclusion. The scales proved to be reliable and valid therefore can be used as an aid in planning and therapeutic evaluation(AU)

Adenosine mediates transforming growth factor-beta 1 release in kidney glomeruli of diabetic rats.

Up regulation of the transforming growth factor-beta 1 (TGF-beta1) axis has been recognized as a pathogenic event for progression of glomerulosclerosis in diabetic nephropathy. We demonstrate that glomeruli isolated from diabetic rats accumulate up to sixfold more extracellular adenosine than normal rats. Both decreased nucleoside uptake activity by the equilibrative nucleoside transporter 1 and increased AMP hydrolysis contribute to raise extracellular adenosine. Ex vivo assays indicate that activation of the low affinity adenosine A2B receptor subtype (A2BAR) mediates TGF-beta1 release from glomeruli of diabetic rats, a pathogenic event that could support progression of glomerulopathy when the bioavailability of adenosine is increased.

Aplicación de un protocolo de atención kinésica postquirúrgico en pacientes con fractura de cadera / Application of a postsurgical kinesics protocol to patients with hip fracture

Las fracturas de cadera constituyen una patología de importante repercusión socio-económica y de salud pública, dado por el incremento de la población adulta mayor en las últimas décadas. Esto ha llevado a realizar mejoras en el tratamiento quirúrgico y a renovar los enfoques de los programas de rehabilitación. Este estudio clínico pretende evaluar la aplicación de un protocolo kinésico en pacientes con fractura de cadera, extraído de la tesis de grado "Revisión del tratamiento kinésico postquirúrgico inmediato en pacientes con fractura de cadera" (2001), y además dimensionar su repercusión en la funcionalidad a corto plazo, mediante la utilización de escalas de valoración funcional para la cadera, en pacientes del Servicio de Traumatología del Hospital Regional de Talca entre noviembre del 2001 y enero del 2002.

[High prevalence of subclinical thyroidal disease among individuals attended in health control]. / Alta prevalencia de enfermedad tiroidea subclínica en sujetos que concurren a control de salud.

BACKGROUND: There is no information about the prevalence of thyroidal diseases in the general Chilean population. AIM: To assess the prevalence of thyroidal diseases in individuals attended in occupational health examinations. SUBJECTS AND METHODS: Four hundred seventy two individuals were examined between 1998 and 1999. In all, serum levels of thyroid hormones, TSH and anti thyroidal antibodies (anti microsomal, anti thyroid peroxidase and anti thyroglobulin) were measured. RESULTS: Forty four subjects were excluded from the study due to an incomplete medical record and 18 due to a personal history of thyroidal disease. Abnormal serum levels of thyroid hormones or TSH were detected in 28 subjects (6.8%). Four (1%) had hypothyroidism, 23 a subclinical hypothyroidism (5.6%) and one (0.2%) had hyperthyroidism. In 87 subjects (21.2%) at least one of the antibodies was positive. Positive anti thyroid antibodies were found in 14 of 28 subjects (50%) with abnormal thyroid hormone levels, compared with 73 of 382 subjects (19.1%) with normal thyroid hormone levels. Thyroid dysfunction was twice as frequent in women than in men. CONCLUSIONS: In this sample, a 6.8% prevalence of abnormal thyroid function tests was detected.

[Panic disorder and hyperthyroidism. Report of 2 cases]. / Trastorno de pánico e hipertiroidismo: curso clínico en dos pacientes.

In two females aged 27 and 32 years old, an aggravation of their panic disorder coincided with the appearance of clinical signs of hyperthyroidism. The clinical diagnosis was confirmed with the finding of raised thyroid hormone levels and undetectable TSH levels. These two cases highlight the importance of routine thyroid function assessment in patients with panic disorder, mainly in those with partial response to medications or when symptoms aggravate, despite an adequate treatment.

High prevalence of thyroid abnormalities in a Chilean psychiatric outpatient population.

The aim of the present study was to establish the prevalence of thyroid disturbances in patients consulting for panic and mood disorders. These data may be relevant because thyroid functional alterations affect the success of treatment in these pathologies. We studied prospectively 268 psychiatric outpatients (204 females and 64 males) diagnosed by DSM-IV criteria. We excluded patients with addictive disorders and major medical disease. We measured TSH, Free T4 (FT4) and antimicrosomal antibodies (AMA). We diagnosed classical hypothyroidism when the TSH value was >10 microUI/ml (NV=0.25-4.3) and subclinical hypothyroidism when the TSH value was between 5-10 microUI/ml. Hyperthyroidism was diagnosed when FT4 >1.4 (NV=0.8-1.4), the TSH suppressed and the radioiodine uptake >20% (NV=5-15). Positive antimicrosomal antibodies (AMA) titres were >1:100 dilution. Hypothyroidism was diagnosed in 26/268 patients (9.7%); 10 cases corresponded to the classical form (38.5%) and 16 cases to the subclinical form (61.5%). Hyperthyroidism was found in 6/268 patients (2.2%). Normal thyroid function with positive AMA was found in 28/268 patients (10.4%). Hypothyroidism was more common in patients with mood disorders, and hyperthyroidism in patients with panic disorders. Patients with panic disorder had significant higher levels of FT4. The prevalence of positive AMA, hypothyroidism and hyperthyroidism was higher in women than men. We found a high frequency of thyroid abnormalities in a psychiatric outpatient population. These data suggests that routine evaluation of thyroid function should be considered in patients consulting for mood and panic disorders.

Cardiovascular responses to arginine vasopressin blockade during acute hypoxemia in the llama fetus.

The fetal llama has a marked increase in the peripheral vascular resistance and no augmentation of brain blood flow during hypoxemia. In spite of the substantial plasma arginine-vasopressin (AVP) increase during hypoxemia, up to 8 times greater than in fetal sheep, there are no changes of carotid and femoral blood flows during hypoxemia with a V1 receptor blockade, as is seen in the fetal sheep. The aim of this study was to assess the role of AVP function in mediating the combined ventricular output and organ blood flow in the hypoxemic llama fetus. Six fetal llamas at 0.65 of gestation were instrumented under general anesthesia, and cardiorespiratory responses and blood flows determined under normoxemic and hypoxemic conditions. The AVP effect was determined using a V1 antagonist during normoxemic and hypoxemic conditions. Organ blood flows were measured with the radioactive microsphere technique. No significant differences in organ blood flow or in their vascular resistances were seen between the control and treated fetuses during hypoxemia. We conclude that V1 blockade did not have any important role in the cardiovascular response to acute hypoxemia in the llama fetus, in contrast with lowland fetuses. AVP may be playing a role in other regions, possibly in kidney or lung, during hypoxemia.

Perfil de las denuncias por violencia intrafamiliar contra la mujer efectuadas en el hospital Gustavo Fricke / Denunciations profile of intrafamily violence against women at Hospital Gustavo Fricke

La violencia intrafamiliar es cualquier forma de abuso físico entre personas que tienen algún tipo de relación afectiva. El objetivo del presente trabajo fue describir a la mujer agredida denunciante, su agresor y las circunstancias de la agresión y de la denuncia. Se relizó un estudio retrospectivo de 250 casos de denuncias por violencia intrafamiliar contra la mujer, registradas por personal de Carabineros en la Unidad de Emergencia del Hospital G. Fricke de Viña del Mar, entre el 1º de Enero y el 31 de Junio de 1993. En cuanto a las mujeres denunciantes, tuvieron 29,0 años de edad como mediana y un 50,8 porciento estaban casadas. Su agresor fue de sexo masculino, en un 92,3 porciento con una mediana de edad de 37,7 años; un 73,4 porciento de ellos era o habiá sido la pareja de la victima. La agresión ocurrió en un 78,4 porciento al interior de una casa particular, produciéndose un peak entre las 21 y 24 horas (26,0 porciento) y en los sábados y domingos (42,8 porciento). Un 81,2 porciento de las lesiones fueron leves. En el 45,6 porciento de los casos, la denusncia se efectuó dentro de las primeras 4 horas después de la agresión. Efectuando una generalización, se concluye que el perfil de los casos de denuncias por violencia intrafamiliar contra la mujer es el siguiente: se trata de una mujer adulto-joven, agredida por un hombre, de edad algo mayor, su pareja. La agresión produce lesiones leves, ocurre en una casa particular, de noche, los fines de semana. La denuncia se efectúa a las pocas horas de ocurrida la agresión. Nuestros resultados son similares a los obtenidos en el único estudio efectuado en Chile hasta el momento (Guerra, 1992)

[Early echography subprogramm. Southern Metropolitan Health Service evaluation 1989-1990]. / Subprograma de ecografía precoz. Servicio Salud Metropolitano Sur evaluación 1989-1990.

The results of an early level I ultrasound program performed in the Southern Health Area of Santiago during the years 1989 and 1991 are reported. It was noticed that suspect gestational age constituted the highest number of ambulatory attentions (23.9%) in the High Risk Obstetric Department of Barros Luco Trudeau Hospital in 1987. With this program, in 1990, 82% of pregnant women were examined before 20 weeks' gestation, with a total of 10447 ultrasound examinations. Suspect gestational age descended to 8.6% in 1990 (compared with 23.9% in 1987). Amniocentesis and amnioscopies also diminished abruptly. The value of early routine level I ultrasound program in obstetric population improves maternal, fetal and newborn health indexes. These conditions are discussed.