Imaging characteristics of temporopolar blurring in the context of hippocampal sclerosis.

We present an illustrative case to address anterior temporal lobe atrophy with poor delineation of the temporopolar gray-white matter interface based on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images in patients with temporal lobe epilepsy associated with hippocampal sclerosis (TLE-HS). A 52-year-old woman with pharmacoresistant seizures since the age of six months underwent a previous MRI scan using a suboptimal protocol which was reported as unremarkable. MRI performed according to an epilepsy protocol showed classic signs of left HS and ipsilateral temporal polar atrophy with blurring of the gray-white matter boundary on FLAIR images. She underwent a left amygdalohippocampectomy and anterior temporal resection and remains seizure-free after 24 months. Histopathological analyses showed HS and no signs of focal cortical dysplasia (FCD). Blurring and atrophy of the ipsilateral temporal pole are common in TLE-HS and often misinterpreted as FCD. This relates to delayed myelination in patients with seizures before the age of two, is more pronounced on FLAIR sequences, and gives a false impression of cortical thickening. However, the T1-weighted images show a relatively well-demarcated cortical-subcortical transition and normal cortical thickness. By contrast, the cortical thickening in FCD is observed on both T1-weighted and FLAIR images. Since FCD also occurs in temporal lobe regions, it is important to differentiate the extra-hippocampal MRI abnormalities in TLE-HS from those likely to be FCD. This case highlights the importance of evaluation based on detailed imaging, which should always be conducted considering the EEG, seizure semiology, and other clinical information.

Effects of a Novel Infant Formula on Weight Gain, Body Composition, Safety and Tolerability to Infants: The INNOVA 2020 Study.

Exclusive breastfeeding is recommended for the first six months of life to promote adequate infant growth and development, and to reduce infant morbidity and mortality. However, whenever some mothers are not able to breastfeed their infants, infant formulas mimicking human milk are needed, and the safety and efficacy of each formula should be tested. Here, we report the results of a multicenter, randomized, blinded, controlled clinical trial that aimed to evaluate a novel starting formula on weight gain and body composition of infants up to 6 and 12 months, as well as safety and tolerability. For the intervention period, infants were divided into three groups: group 1 received formula 1 (Nutribén® Innova 1 (Alter Farmacia S.A., Madrid, Spain) or INN (n = 70)), with a lower amount of protein, a lower casein to whey protein ratio by increasing the content of α-lactalbumin, and a double amount of docosahexaenoic acid/arachidonic acid than the standard formula; it also contained a thermally inactivated postbiotic (Bifidobacterium animalis subsp. lactis, BPL1TM HT). Group 2 received the standard formula or formula 2 (Nutriben® Natal (Alter Farmacia S.A., Madrid, Spain) or STD (n = 70)) and the third group was exclusively breastfed for exploratory analysis and used as a reference (BFD group (n = 70)). During the study, visits were made at 21 days and 2, 4, 6, and 12 months of age. Weight gain was higher in both formula groups than in the BFD group at 6 and 12 months, whereas no differences were found between STD and INN groups either at 6 or at 12 months. Likewise, body mass index was higher in infants fed the two formulas compared with the BFD group. Regarding body composition, length, head circumference and tricipital/subscapular skinfolds were alike between groups. The INN formula was considered safe as weight gain and body composition were within the normal limits, according to WHO standards. The BFD group exhibited more liquid consistency in the stools compared to both formula groups. All groups showed similar digestive tolerance and infant behavior. However, a higher frequency of gastrointestinal symptoms was reported by the STD formula group (n = 291), followed by the INN formula (n = 282), and the BFD groups (n = 227). There were fewer respiratory, thoracic, and mediastinal disorders among BFD children. Additionally, infants receiving the INN formula experienced significantly fewer general disorders and disturbances than those receiving the STD formula. Indeed, atopic dermatitis, bronchitis, and bronchiolitis were significantly more prevalent among infants who were fed the STD formula compared to those fed the INN formula or breastfed. To evaluate whether there were significant differences between formula treatments, beyond growth parameters, it would seem necessary to examine more precise health biomarkers and to carry out long-term longitudinal studies.

Coach Encouragement During Soccer Practices Can Influence Players' Mental and Physical Loads.

This study analyzed the influence of the coaches' encouragement on the mental and physical load in soccer practices. The participants were 36 semiprofessional Spanish soccer players (Mage = 22.40; SD = 2.25) belonging to two male teams and one female team. Following the same practices' design and order, two training sessions of each team were completed. In one session, coaches maintained a passive verbal attitude, whereas in the other session, coaches intervened with an active attitude through continuous general encouragement. The mental load and fatigue were measured using self-reported questionnaires (Likert scales), and internal and external physical loads were quantified using the rating of perceived exertion and the Global Position System. A t-test for related samples and magnitude based on an inference spreadsheet was performed. The results demonstrated that mental and internal physical loads increased when coaches participated with active verbal encouragement. Especially, increases in performance satisfaction, mental effort, and RPE values, and decreases in unsafety values were detected due to encouragement interventions. Nevertheless, the external physical load did not show a clear trend. Based on these findings, coaches can use this information to manipulate their verbal encouragement during practices according to their physical and mental objectives with specific soccer strategies.

Microcirculatory Changes in Pediatric Patients During Congenital Heart Defect Corrective Surgery.

A prospective, observational single-center study was carried out. Pediatric patients undergoing congenital heart defect surgery were evaluated before, during, and after surgery. At each time point, sublingual microcirculation and clinical parameters were assessed, along with analytical variables. Twenty-four patients were included. All microcirculatory parameters worsened during cardiopulmonary bypass and returned to baseline values after surgery (p ≤ 0.001). In the intraoperative evaluation, body temperature correlated with perfused small vessel density (p = 0.014), proportion of perfused small vessels (p < 0.001), small vessel microvascular flow index (p = 0.003), and small vessel heterogeneity index (p < 0.002). Patients with cyanotic disease exhibited higher small vessel density (p < 0.008) and higher density of perfused small vessels (p < 0.022) at baseline, and a lower microvascular flow index (p = 0.022) and higher heterogeneity (p = 0.026) in the intraoperative phase. Children with congenital heart disease exhibited decreased vascular density and microvascular blood flow and increased heterogeneity during cardiopulmonary bypass. All these parameters returned to baseline values after surgery.

A network model for determining decomposition, topology, and properties of the woody crown.

The acquisition of resources and airspace of woody crown occur by way of axes supporting annexes. Regardless of age, size, or branching system (monopodial or sympodial), the woody crown shows branched leafy axes implementing an aerial network. We propose here to represent the woody crown through a network comprised of two components, the segments of woody axes named connectors (CO) delimited by nodes (NO) as the branching regions. CO may link NO of different categories (regular, initial, final, and emission) as defined by the relative position of the NO in a crown and how many CO the NO has. The woody crown network (WCN) is similar to a random network with the probability of NO having some CO following an exponential decay. The absence of loops and real hubs weakened the robustness of WCN against failure or attacks on NO. The quantities of NO and CO and the proportions between them were the features of decomposition, and the distances measured in some CO between types of NO captured the topological characteristics of WCN. By combining decomposition and topology, we disclosed some properties of WCN, such as navigability, vulnerability, symmetry, and complexity. Navigability and complexity increased, while vulnerability and symmetry decreased exponentially as the size (ΣNO) of WCN enlarged. The behavior of properties as a function of ΣNO exposed some limits to mitigate the inherent hydraulic resistance during WCN development. Decomposition, topology, and properties of WCN in trees of Cerrado vegetation were interrelated to other crown traits revealing the strategies for acquiring airspace.

Role of short periodic orbits in quantum maps with continuous openings.

We apply a recently developed semiclassical theory of short periodic orbits to the continuously open quantum tribaker map. In this paradigmatic system the trajectories are partially bounced back according to continuous reflectivity functions. This is relevant in many situations that include optical microresonators and more complicated boundary conditions. In a perturbative regime, the shortest periodic orbits belonging to the classical repeller of the open map-a cantor set given by a region of exactly zero reflectivity-prove to be extremely robust in supporting a set of long-lived resonances of the continuously open quantum maps. Moreover, for steplike functions a significant reduction in the number needed is obtained, similarly to the completely open situation. This happens despite a strong change in the spectral properties when compared to the discontinuous reflectivity case. In order to give a more realistic interpretation of these results we compare with a Fresnel-type reflectivity function.

Conducta obstétrica en la osteogénesis imperfecta. A propósito de un caso / Obstetric behavior in osteogenesis imperfect. About a clinical case

La osteogénesis imperfecta (OI) se produce por un trastorno del tejido conectivo que afecta a la producción de colágeno. Los embarazos asociados a la OI están relacionados con una mayor morbilidad. La incidencia de fracturas no se incrementa durante el embarazo, pero sí las deformidades pélvicas, con una mayor incidencia de desproporciones cefalopélvicas y anomalías comunes en la presentación fetal. Resulta imprescindible la valoración preanestésica, pero la inducción al trabajo de parto está contraindicada. La vía del parto debe ser consensuada e individualizada con la gestante, valorando el estado materno y fetal en todo momento. Una actuación correcta, y sobre todo un buen asesoramiento preconcepcional por parte de la matrona, contribuye a disminuir las complicaciones desencadenadas por esta patología

Osteogenesis imperfecta (OI) is produced by a connective tissue disorder that affects the production of collagen. Pregnancies associated with OI are related to increased morbidity, the incidence of fractures does not increase during pregnancy, but pelvic deformities with a higher incidence of cephalopelvic disproportions and common abnormalities in fetal presentation. Preanesthetic assessment is essential and induction of labor is contraindicated. The way of delivery should be agreed and individualized with the woman assessing the maternal and fetal status at all times. A correct performance, and above all a good preconceptional counseling by the midwife, contributes to decrease the complications triggered by this pathology

Leaf Dynamics of Panicum maximum under Future Climatic Changes.

Panicum maximum Jacq. 'Mombaça' (C4) was grown in field conditions with sufficient water and nutrients to examine the effects of warming and elevated CO2 concentrations during the winter. Plants were exposed to either the ambient temperature and regular atmospheric CO2 (Control); elevated CO2 (600 ppm, eC); canopy warming (+2°C above regular canopy temperature, eT); or elevated CO2 and canopy warming (eC+eT). The temperatures and CO2 in the field were controlled by temperature free-air controlled enhancement (T-FACE) and mini free-air CO2 enrichment (miniFACE) facilities. The most green, expanding, and expanded leaves and the highest leaf appearance rate (LAR, leaves day(-1)) and leaf elongation rate (LER, cm day(-1)) were observed under eT. Leaf area and leaf biomass were higher in the eT and eC+eT treatments. The higher LER and LAR without significant differences in the number of senescent leaves could explain why tillers had higher foliage area and leaf biomass in the eT treatment. The eC treatment had the lowest LER and the fewest expanded and green leaves, similar to Control. The inhibitory effect of eC on foliage development in winter was indicated by the fewer green, expanded, and expanding leaves under eC+eT than eT. The stimulatory and inhibitory effects of the eT and eC treatments, respectively, on foliage raised and lowered, respectively, the foliar nitrogen concentration. The inhibition of foliage by eC was confirmed by the eC treatment having the lowest leaf/stem biomass ratio and by the change in leaf biomass-area relationships from linear or exponential growth to rectangular hyperbolic growth under eC. Besides, eC+eT had a synergist effect, speeding up leaf maturation. Therefore, with sufficient water and nutrients in winter, the inhibitory effect of elevated CO2 on foliage could be partially offset by elevated temperatures and relatively high P. maximum foliage production could be achieved under future climatic change.

Responses of woody Cerrado species to rising atmospheric CO2 concentration and water stress: gains and losses.

The rise in atmospheric CO2 concentration ([CO2]) has been accompanied by changes in other environmental factors of global climate change, such as drought. Tracking the early growth of plants under changing conditions can determine their ecophysiological adjustments and the consequences for ecosystem functions. This study investigated long-term ecophysiological responses in three woody Cerrado species: Hymenaea stigonocarpa Mart. ex Hayne, Solanum lycocarpum A. St.-Hil. and Tabebuia aurea (Silva Manso) Benth. and Hook. f. ex S. Moore, grown under ambient and elevated [CO2]. Plants were grown for 515 days at ambient (430mgdm-3) or elevated [CO2] (700mgdm-3). Some plants were also subjected to water stress to investigate the synergy between atmospheric [CO2] and soil water availability, and its effect on plant growth. All three species showed an increase in maximum net photosynthesis (PN) and chlorophyll index under high [CO2]. Transpiration decreased in some species under high [CO2] despite daily watering and a corresponding increase in water use efficiency was observed. Plants grown under elevated [CO2] and watered daily had greater leaf area and total biomass production than plants under water stress and ambient [CO2]. The high chlorophyll and PN in cerrado plants grown under elevated [CO2] are an investment in light use and capture and higher Rubisco carboxylation rate, respectively. The elevated [CO2] had a positive influence on biomass accumulation in the cerrado species we studied, as predicted for plants under high [CO2]. So, even with water stress, Cerrado species under elevated [CO2] had better growth.

Epilepsia del lóbulo frontal como imitadora de trastornos psiquiátricos. Reporte de un caso, Bogotá, 2016 / Frontal lobe epilepsy imitating psychiatric disorders: A case report, Bogota, 2016

La epilepsia del lóbulo frontal se confundió durante años con enfermedades del orden psiquiátrico y, de hecho, en la actualidad sigue constituyéndose un reto clínico dado el amplio espectro de manifestaciones clínicas que limitan la conducta esquizoide. Los desórdenes ictales del lóbulo frontal podrían ser confundidos con una gran variedad de enfermedades, desde trastornos del sueño de predominio nocturno hasta afecciones del movimiento, tales como distonía paroxística nocturna o el síndrome autosómico recesivo de epilepsia nocturna, que se caracteriza por paroxismos hipermotores de corta duración de predominio nocturno. Los artefactos hacen que el electroencefalograma no sea una herramienta suficiente y es por esto que planteamos el reporte de este caso como un verdadero reto diagnóstico.

The frontal lobe epilepsy was confused with psychiatric disorders for years, and in fact it is still a clinical challenge considering the broad spectrum of clinical manifestations that define schizoid conduct. Ictal disorders of the frontal lobe could be confused with a variety of diseases, from predominantly nocturnal sleep disorders to movement disorders, such as nocturnal paroxysmal dystonia or autosomal recessive nocturnal epilepsy syndrome, characterised by hypermotor paroxysms of short duration and nocturnal predominance. These artefacts mean that the electroencephalogram may not be a sufficient tool, and it is for this reason that this case report is presented as a true diagnostic challenge.

Semiología de la crisis epiléptica: un reto clínico / Semiology of epileptic seizures: A clinical challenge

La epilepsia es una afección cerebral crónica caracterizada por crisis recurrentes, autolimitadas y de etiología diversa cuyas manifestaciones clínicas incluyen una variada gama de signos y síntomas en relación con las zonas corticales estimuladas, considerando y diferenciando adecuadamente la zona epileptogénica al igual que la sintomatogénica en el contexto claro del arte de la interpretación semiológica que reúne un adecuado conocimiento de las funciones corticales y el reconocimiento respectivo de lateralizadores y localizadores del foco epileptogénico, para determinar adecuadamente el tipo de epilepsia o síndrome epiléptico. El objetivo de este artículo es plantear de forma clara y concisa los hallazgos en la presentación clínica de las principales formas de epilepsia o síndromes epilépticos en relación con la función cortical por lóbulos, lo que nos permitirá una mayor introspección y habilidad en la práctica clínica en el diagnóstico rápido y oportuno. El diagnóstico de epilepsia depende de un número amplio de factores, particularmente detallados y precisos en la historia de las crisis o semiología.

Epilepsy is a chronic brain disorder characterised by recurrent seizures that are self-limited and of diverse aetiology, in which the clinical manifestations include a wide range of signs and symptoms in relation to the cortical areas stimulated. Semiology consider and properly differentiates the epileptogenic and the symptomatogenic zone in the clear context of the art of semiological interpretation that combines adequate knowledge of cortical functions and the corresponding recognition of lateraliser and localiser signs of the seizure focus, in order to properly determine the type of epilepsy or epileptic syndrome. The aim of this article is to present clear and concise findings in the clinical presentation of the main forms of epilepsy and epileptic syndromes in relation to the function of the cortical lobes, which allow us greater introspection and skill in clinical practice in the rapid and timely diagnosis. The diagnosis depends upon a number of factors, particularly the detailed and accurate recording of the history of the seizure, or semiology.

Fascículo longitudinal inferior: una nueva mirada del lenguaje / Inferior longitudinal fasciculus: A new look at language

El fascículo longitudinal inferior es un conjunto de fibras de materia blanca que se encarga de interconectar regiones frontales y occipitales, pasando en forma horizontal paralela al cuerno temporal del ventrículo lateral, y representa una de las fibras de asociación en conjunto con el cíngulo, el SLF y el medial12. El fascículo inferior fronto occipital (IFOF) es una conexión de sustancia blanca anteroposterior que va desde la corteza frontal inferior y pre- frontal dorso lateral hasta la temporal posterior y occipital, después pasa a través del piso anterior de la capsula externa, el IFOF cursa medialmente en el lóbulo temporal y envía radiaciones mediales e inferiores desde la circunvolución temporal, así como desde el lóbulo occipital...(AU)

Criptococosis cerebral: descripción de una serie de casos con presentaciones típicas y atípicas en el Hospital Universitario San José Infantil de Bogotá / Cerebral cryptococcosis: description of a series of cases of atypical clinical presentation Hospital Universitario San José Infantil de Bogotá

Introducción: la criptococosis cerebral (CC) es la infección fúngica más frecuente del sistema nervioso central; se presenta especialmente en pacientes con algún tipo de inmunodeficiencia, sin embargo también puede encontrarse en inmunocompetentes, casos que son más severos y con manifestaciones neurológicas variables. Si bien las manifestaciones típicas son las más frecuentes, existen manifestaciones atípicas especialmente en pacientes inmunocompetentes que pueden llegar a presentarse en un 60% de los casos según los estudios radiológicos, por lo cual es importante reconocerlas a fin de garantizar un diagnóstico temprano y una intervención oportuna. Objetivo: describir las características clínicas de presentaciones típicas y atípicas de la criptococosis cerebral en el Hospital Universitario San José Infantil de Bogotá. Materiales y métodos: reportamos una serie de casos entre marzo de 2013 y marzo de 2014 en el Hospital Universitario San José Infantil. Se describió un total de ocho casos de criptococosis cerebral. El diagnóstico, en todos los casos, se hizo conforme a los hallazgos histopatológicos o cultivos. Resultados: de los ocho pacientes descritos, seis son hombres (75%), la mayoría menores de 60 años (=42,25 años DE 13,25); siete pacientes (87,5%) fueron inmunosuprimidos, de los cuales cinco resultaron VIH-seropositivos (62,5%). El principal motivo de consulta fue cefalea (87,5%). La clínica resultó más severa en los pacientes VIH-seronegativos. En varios pacientes se evidenciaron trastornos neuropsiquiátricos. En cinco pacientes (62,5%) se encontraron manifestaciones atípicas: criptococoma cerebral en el 25% (n = 2), ventriculitis en el 12,5% (n = 1) y trombosis séptica de senos venosos en el 25% (n = 2). Conclusión: en nuestra población con CC se evidenciaron características clínicas similares a las reportadas en otros estudios, en los que más de la mitad presentó manifestaciones atípicas, especialmente los pacientes VIH-seronegativos. Adicionalmente, se encontraron varias manifestaciones neuropsiquiátricas. Se deben tener en cuenta los cambios neuropsiquiátricos y las presentaciones atípicas sobre todo en los pacientes VIH-seronegativos con el fin de realizar un diagnóstico rápido e iniciar un tratamiento oportuno para la CC.

Introduction: Cerebral Cryptococcosis (CC) is the most common CNS fungal infection, it is especially in patients with some type of immunodeficiency, but can also be found in immunocompetent, being more severe and with variable neurological manifestations in that cases. While the typical manifestations are the most frequently seeing, atypical manifestations especially in immunocompetent patients, may present in 60% of cases as radiological studies, so it is important to recognize in order to ensure early diagnosis and timely intervention. Objective: to describe the clinical characteristics of typical and atypical presentations of cerebral cryptococcosis in Hospital Universitario San José Infantil de Bogotá. Materials and methods: we report a series of cases between March 2013 and March 2014 at the Hospital Universitario San Jose Infantil. A total of 8 cases of cerebral cryptococcosis described. The diagnosis in all cases was done according to the histopathological findings or cultures. Results: in 8 patients described 6 were men (75%), most under 60 years ( = 13.25 = 42.25 years), 7 patients (87.5%) were immunosuppressed, of which 5 HIV-seropositive patients (62.5%). The main complaint was headache (87.5%). The clinical manifestations was more severe in HIV-seronegative patients. Several patients showed neuropsychiatric disorders. In 5 patients (62.5%) atypical manifestations were found: cryptococcoma brain in 25% (n = 2), ventriculitis in 12.5% (n = 1) and septic venous sinus thrombosis in 25% (n = 2). Conclusion: in our population CC was similar to those reported in other studies, where more than half had atypical manifestations especially HIV-seronegative. Additionally several neuropsychiatric manifestations were found. Physicians should consider neuropsychiatric changes and atypical presentations essentially in HIV-seronegative patients in order to make a quick diagnosis and initiate early treatment for CC.

Evaluación de los factores pronósticos en los pacientes con linfoma cerebral / Evaluation of prognostic factors in patients with brain lymphoma

Objetivo: Evaluar los factores pronósticos en los pacientes con linfoma cerebral tratados en el Instituto Nacional de Enfermedades Neoplásicas durante el periodo de enero 1995 a diciembre 2010. Material y métodos: Estudio descriptivo, retrospectivo, analítico y observacional. Se diagnosticaron 35 casos; 31 fueron elegibles. Se evaluaron las variables clinicopatológicas y demográficas, fecha de diagnóstico y último control o fecha de fallecimiento. La sobrevida global fue calculada usando el método de Kaplan-Meier y se estratificaron los pacientes de acuerdo a las variables evaluadas. Adicionalmente, se realizó un análisis multivariado de la supervivencia mediante la regresión de Cox. Resultados: La mediana de sobrevida global fue de 10, 37 meses. No se observaron diferencias en la sobrevida global con respecto a la edad (P=0,624), género (P=0,98), ubicación de la lesión (P=0,16), infiltrado extracerebral (P=0,43), proteínas en líquido cefalorraquídeo (P=0,53), deshidrogenasa láctica sérica (P=0,08), estado inmunológico (P=0,47). Se observaron diferencias con respecto al estado funcional (P<0,001), radioterapia (P<0,001), quimioterapia (P=0,02), cantidad de lesión (P=0,03), tipo de tratamiento (102,3 meses con quimioterapia más radioterapia vs. 22,2 meses de quimioterapia sola, radioterapia sola (P=0,004), tipo de cirugía (P=0,01), toxicidad (P=0,03). La regresión de Cox mostró como factores influyentes al estado funcional y al tipo de tratamiento. Conclusiones: La administración quimioterapia más radioterapia y estado funcional fueron los factores pronósticos de sobrevida global.

Objectives: To evaluate the prognostic factors in patients with brain lymphoma treated at the Instituto Nacional de Enfermedades Neopl sicas during the period January 1995 to December 2010. Material and methods: Descriptive, retrospective, observational and analytical study. Thirty-five patients were diagnosed, 31 were eligible. We evaluated the clinic-pathological variables, date of last visit or death. Overall survival was determined by the Kaplan-Meier method and patients were stratified according to the evaluated variables. Additionally, multivariate survival analysis was done using Cox regression model. Results: The median overall survival for all patients was 10,37 months. Differences were not observed in overall survival in regard to age (P=0,624), gender (P=0,98), injury location (P=0,16), extracerebral infiltrations (P=0,43), CSF proteins (P=0,53), DHL serum (P=0,8), immune status (P=0,47). Statistically significant differences were observed in respect to performance status (P<0,001), radiotherapy (P<0,001), chemotherapy (P=0,02), injury burden (P=0,03), type of treatment (102,3 months with chemotherapy and radiotherapy vs. 22,2 months with chemotherapy alone, radiotherapy alone, P=0,03). Cox regression showed as influential factors performance status and type of treatment. Conclusion: administration of chemotherapy plus radiation therapy and performance status were predictive for overall survival.

Parto vaginal despues de una cesarea previa, Hospital San Juan de Dios, Cali (Colombia): estudio de cohorte / A cohort study of vaginal birth following prior cesarean section in the San Juan de Dios hospital, Cali, Colombia

Objetivo: determinar la incidencia de parto vaginal despues de una cesarea previa y evaluar la capacidad predictiva del puntaje predictor de parto vaginal descrito por Flamm en 1997. Materiales y métodos: estudio de cohorte retrospectivo de mujeres con antecedente de cesarea y embarazo de al menos 37 semanas, que consultaron al Hospital San Juan de Dios de Cali (HSJD) entre mayo 30 de 2007 y mayo 30 de 2008. Se calculo la tasa de parto vaginal y se evaluo la sensibilidad, especificidad, valores predictivos positivo (VPP) y negativo (VPN) y las razones de verosimilitud positiva (RVP) y negativa (RVN) del puntaje predictor de parto vaginal después de una cesárea cuando los valores de estos son de 4 o mas y de 8 o mas. Resultados: la proporcion de parto vaginal en este grupo fue del 20,3%. El 36% de las gestantes con puntajes entre 4 y 7 tuvieron parto vaginal y el 83% de las gestantes con 8 o mas puntos. Con un punto de corte >_ 4 puntos la sensibilidad fue de 85,7%, la especificidad 69,1%, VPP 41,3% y VPN 95%, RVP 2,8 y RVN 0,2. Si el punto de corte fue >_ 8 la sensibilidad fue de 83,3%, la especificidad 82,6%, VPP 17,9% y VPN 99,1%, RVP 4,8 y RVN 0,2. Conclusion: la frecuencia de parto vaginal posterior a cesarea es del 20%. Las gestantes con puntajes menores de 4 tuvieron una baja probabilidad de tener un parto vaginal...

Objective: determining the incidence of vaginal birth following a prior cesarean section and evaluating the predictive ability of the vaginal birth predictor score on the admission scoring system described by Flamm in 1997. Materials and methods: this was a retrospective cohort study of women having undergone a prior cesarean section and then a pregnancy lasting at least 37 weeks who had consulted at the San Juan de Dios hospital in Cali (HSJD) between May 30th 2007 and May 30th 2008. The vaginal birth rate was calculated and sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were evaluated, as were positive (RVP) and negative verisimilitude ratios (RVN) regarding vaginal birth predictor score following a cesarean when their scores were 4 or more and 8 or more. Results: there were 20.3% vaginal births in this group; 36% of the pregnant women having scores between 4 and 7 had undergone vaginal birth and 83% of the expectant mothers scoring 8 or more. A >_ 4 points cut-off point gave 85.7% sensitivity, 69.1% specificity, 41.3% Positive Predictive Value (PPV) and 95% Negative Predictive Value (NPV) and 2.8 Positive likelihood ratio P LR(+) and 0.2 Negative likelihood ratio (NLR). If cut-off point were >_8, then this gave 83.3% sensitivity, 82.6% specificity, 17.9% PPV, 99.1% NPV, 4.8 RVP and 0.2 RVN. Conclusion: vaginal birth frequency following a cesarean section was 20%. Pregnant women having scores less than 4 had a low probability of having a vaginal birth...

RECONSIDERATIONS REGARDING TIME OF FRACTURE HEALING IN PYCNODYSOSTOSIS.

OBJECTIVE: To discuss what has been described so far in the literature regarding the time taken for fracture consolidation in pycnodysostosis. MATERIALS AND METHODS: Thirteen new cases were studied, as available from the medical records and radiographic examinations, thus encompassing a total of 44 fractures in patients evaluated between November 1970 and August 2004 at the Orthopedics Hospital, Goiânia. Field research, simultaneous clinical monitoring for new fractures in two patients and retrospective evaluation of medical records were undertaken. The purpose was to determine the total number of fractures in each patient and to determine which of these were viable for this study. The patient group was composed of three women and two men of mean age 51.4 years. The tibia was the bone most affected, followed by the femur. Fractures for which the follow-up was done at another clinic were excluded. RESULTS: Out of the 12 fractures that were considered fully suitable for the study, nine occurred in femurs (six in the left femur and three in the right femur); one in the right tibia; one in the right clavicle; and one in the left ulna. Among these 12 fractures, eight developed pseudarthrosis after an average of 29.25 months; three consolidated well after an average of 5.83 months; and one evolved with delayed consolidation in just 2 months. CONCLUSION: In combination with genetic and micromorphological evaluations, further studies are awaited for reconfirmation of the diagnosis of such a rare clinical entity.

Reconsiderações sobre o tempo de consolidação das fraturas na picnodisostose / Reconsiderations regarding time of fracture healing in pycnodysostosis

OBJETIVO: Discutir o que vem sendo descrito na literatura até então a respeito do tempo de consolidação das fraturas na picnodisostose. MÉTODOS: Treze novos casos foram estudados por questão de disponibilidade de prontuários e exames radiográficos, totalizando 44 fraturas englobando pacientes avaliados no período de novembro de 1970 a agosto de 2004, no Hospital Ortopédico de Goiânia. Pesquisa em campo, acompanhamento clínico simultâneo, por novas fraturas, de duas pacientes e avaliação retrospectiva de prontuários foram feitos, com base em se determinar o número de fraturas totais de cada paciente e quais destas tinham viabilidade para esta pesquisa. O grupo de pacientes compõe-se de três mulheres e dois homens com idade média de 51,4 anos. A tíbia foi o osso mais acometido, seguido pelo fêmur. Foram excluídas as fraturas cujo acompanhamento tenha sido feito em outro serviço. RESULTADOS: Das 12 fraturas consideradas plenas para o estudo, nove aconteceram em fêmures (seis no fêmur E e três no fêmur D; uma em tíbia (D); uma em clavícula (D) e uma em ulna (E)). Dentre as 12 fraturas, oito evoluíram com pseudartrose em um tempo médio de 29,25 meses; três consolidaram bem em uma média de 5,83 meses e um paciente evoluiu com retardo de consolidação em apenas dois meses. CONCLUSÃO: Associadas à pesquisa gênica e estudos micromorfológicos, aguarda-se novos estudos para reconfirmação diagnóstica numa entidade clínica tão rara.

OBJECTIVE: To discuss what has been described so far in the literature regarding the time of consolidation of fractures in Pycnodysostosis. MATERIALS AND METHODS: Thirteen new cases were studied, as a matter of the availability of medical records and radiographic examinations, totaling 44 patients in the period from November 1970 to August 2004 in the Hospital Ortopédico de Goiânia. Field research and simultaneous clinical monitoring for new fractures in two patients, and the retrospective evaluation of medical records were made on the basis of determining the total number of fractures for each patient to determine which of these were viable for this study. The group of patients is composed of three women and two men aged 51.4 years. The tibia was the bone most affected, followed by the femur. Fractures the follow-up for which had been done in another facility were excluded. RESULTS: Of the 12 fractures fully considered for the study, nine occurred in femurs (six in the femur E and three in the femur D; one in the tibia (D); one in the clavicle (D); and one in the ulna (E)). Among the 12 fractures, eight developed pseudoarthrosis at an average of 29.25 months, three consolidated well in an average of 5.83 months, and one patient progressed with delayed consolidation in just 2 months. CONCLUSION: In combination with genetic and micromorphological studies, we await further studies to reconfirm the diagnosis of such a rare clinical entity.

Impacto do perfil clínico e sociodemográfico na adesão ao tratamento de pacientes de um Centro de Atenção Psicossocial a Usuários de Álcool e Drogas (CAPSad) / Impact of clinical and socio-demographic profiles in treatment adherence of patients attending a day hospital for alcohol and drug abuse

OBJETIVO: O presente estudo compara os perfis sociodemográfico e clínico de pacientes que aderiram ou que não aderiram ao tratamento no Centro de Atenção Psicossocial a Usuários de Álcool e Drogas (CAPSad). MÉTODO: Foram analisados 316 prontuários de pacientes do CAPSad de Campo Grande (MS). RESULTADOS: Com isso, pudemos observar que o grupo de pacientes que aderem ao tratamento são mais comumente homens (p = 0,072), mais velhos (p = 0,008), registrados por pai e por mãe (p = 0,068), usuários de álcool (p = 0,005) e com maior tempo de uso (p = 0,005). CONCLUSÃO: Há a necessidade de reformulação das abordagens atualmente aplicadas aos usuários do CAPSad com perfil de não adesão ao tratamento.

OBJECTIVE: The present study compares the sociodemografic and clinical profile of patients that remain or not in treatment in a specialized center for alcohol and drugs (CAPSad). METHOD: Three hundred and sixteen medical records of a specialized center in Campo Grande (MS) were evaluated. RESULTS: Thus we observed that the group of patients that do not remain in the treatment are commonly men (p = 0,072), elderly (p = 0,008), with father and mother record (p = 0,068), alcoholic (p = 0,005) and with more time of addiction (p = 0,005). CONCLUSION: There is a need to reformulate the approaches applied today in CAPSad, especially among patients with predictors of treatment dropout.