Enfermería de Práctica Avanzada en el Sistema de Salud: evolución, aceptación y reconocimiento / Advanced Practice Nursing in the Health System: evolution, acceptance and recognition

Introducción: se estima escasez de 5.9 millones de profesionistas de la salud a nivel mundial. La Enfermería de Práctica Avanzada (EPA), cuenta con conocimientos, competencias y habilidades clínicas específicas para actuar en situaciones de déficit de personal médico, tratando desde enfermedades agudas hasta crónico degenerativas, preservando tanto la salud mental como física. Objetivo: Determinar el desempeño de la Enfermería de Práctica Avanzada en el Sector Salud. Metodología: revisión sistemática sobre la EPA, que incluyó revisiones y artículos originales del periodo 2013-2022 en español e inglés, acerca de su desempeño: evolución, aceptación y reconocimiento. Para la identificación, cribado e inclusión de los artículos se utilizó el modelo PRISMA 2020. Resultados: de un total de 838 artículos identificados, se incluyeron 20 artículos y 7 de otras fuentes como citas y otros sitios web, obteniendo un total de 27 artículos de revisión, que abordan la evolución, la aceptación y reconocimiento. Se realizó análisis cualitativo. Conclusiones: el desempeño de EPA surge por las demandas poblacionales de atención primaria a la salud, diversos países ya cuentan con EPA, asistiendo a sus habitantes desde sus especialidades. La EPA es diversa y extensa, su profesionalización debe ser continua y permanente. En México falta camino para tomar la EPA como parte del equipo multidisciplinario

Abstract Introduction: About 5.9 millions healthcare professionals lack across the world. The Advanced Practice Nursing (APN), has specific knowledge, competences, and clinical abilities to act in medical absence, taking care from acute illness until chronic diseases, preserving both mental and physical health. Objective: To determine the Advanced Practice Nursing (APN) performance in the Health Sector. Methods: A systematic review about APN, including reviews and original articles from the period 2013-2022 in Spanish and English, about performance: evolution, acceptance and recognition. For the identification, screening, and inclusion of the articles the PRISMA 2020 model was used. Results: Of 838 total identified articles, 20 articles were included from the search and 7 from other sources such as citations and other websites, obtaining 27 total articles to be reviewed, which regard the evolution, acceptance and recognition. A qualitative analysis was performed. Conclusions: The APN performance arose because of demands for primary health care; several countries already have APN, providing care to inhabitants through their different specialties. APN is diverse and extensive, its professionalization must be continuous and permanent. In Mexico there is still some way to go to APN to take part in the multidisciplinary team.

Fully Parallel Stochastic Computing Hardware Implementation of Convolutional Neural Networks for Edge Computing Applications.

Edge artificial intelligence (AI) is receiving a tremendous amount of interest from the machine learning community due to the ever-increasing popularization of the Internet of Things (IoT). Unfortunately, the incorporation of AI characteristics to edge computing devices presents the drawbacks of being power and area hungry for typical deep learning techniques such as convolutional neural networks (CNNs). In this work, we propose a power-and-area efficient architecture based on the exploitation of the correlation phenomenon in stochastic computing (SC) systems. The proposed architecture solves the challenges that a CNN implementation with SC (SC-CNN) may present, such as the high resources used in binary-to-stochastic conversion, the inaccuracy produced by undesired correlation between signals, and the complexity of the stochastic maximum function implementation. To prove that our architecture meets the requirements of edge intelligence realization, we embed a fully parallel CNN in a single field-programmable gate array (FPGA) chip. The results obtained showed a better performance than traditional binary logic and other SC implementations. In addition, we performed a full VLSI synthesis of the proposed design, showing that it presents better overall characteristics than other recently published VLSI architectures.

Adsorption of Pb (II) ions on variable charge oxidic calcined substrates with chemically modified surface.

Background: The paper describes lead ion adsorption on variable charge oxidic calcined substrates with chemically modified surfaces. Amphoteric oxides of iron, aluminum, titanium, and manganese, change their surface electric charge after acid or alkaline treatment, letting cationic or anionic adsorption reactions from aqueous solutions. This property allows using them as adsorbing substrate for heavy metals retention in water treatment systems. Methods: Substrate was prepared by extruding cylindrical strips from a saturate paste of the oxidic lithological material-OLM; dries it up and thermally treated by calcination. The study was performed by triplicated trial, on batch mode, using 2 grams samples of treated with NaOH 0.1N and non-treated substrate. Lead analysis was performed by AAS-GF. Freundlich and Langmuir models were used to fit results. Comparing differential behavior between treated and non-treated substrates showed the variable charge nature of the OLM. Results: Results show L-type isotherms for the adsorption of Pb(II) ions on the activated substrate, suggesting good affinity between Pb(II) ions and OLM's surface. Average value of adsorption capacity ( K) for activated substrate (1791.73±13.06), is around four times greater than the non-activated substrate (491.54±31.97), during the adsorption reaction, 0.35 and 0.26 mmolH + of proton are produced on the activated and non-activated substrate respectively using a 1 mM Pb(II) solution and 72.2 and 15.6 mmolH + using a 10 mM Pb(II) solution. This acidification agrees with the theoretic model of transitional metals chemisorption on amphoteric oxides, present in lithological material used for the preparation of adsorbent substrates, confirming the information given by the L-type isotherms. Conclusions: Results suggest that these variable charge oxidic adsorbent substrate show great potential as an alternative technique for water treatment at small and medium scale using granular filtration system. The easiness and low price make them suitable to apply in rural media where no treating water systems is available.

Implementation of physiotherapy telerehabilitation before and post Covid-19 outbreak: A comparative narrative between South American countries and Australia.

The continuous development in telecommunication tech-nologies has created opportunities for health professionals to optimise healthcare delivery by adopting digital tools into rehabilitation programs (i.e., telerehabilitation). These tech-nological advances, along with the demographic and social characteristics of each country, have made the implementa-tion of telerehabilitation a disparate process across regions. We have gathered the experience of four countries (Australia, Chile, Brazil, and Colombia) in two different regions (Ocea-nia and South America) to recompile the history pre- and post-Covid-19 outbreak until January of 2021, the barriers to, and facilitators of telerehabilitation, and outline the future challenges for these countries.

Fisioterapia respiratoria en la funcionalidad del paciente con CO VID -19 / Respiratory physiotherapy in the functionality of the COVID-19 patient

La pandemia COVID-19 ha causado grandes estragos en los sistemas de salud a nivel mundial. Desde la fisioterapia respiratoria, se propende por realizar intervenciones costo-efectivas basadas en la mejor evidencia disponible, para minimizar los efectos funcionales en dichos pacientes con COVID-19. Por ello, se revisó la literatura para cimentar una revisión teórica desde la funcionalidad en lo relacionado a la fisioterapia respiratoria frente a la pandemia. Los resultados incluyeron publicaciones y guías de manejo en español, inglés y portugués acerca de las acciones de los diferentes países frente a los compromisos funcionales que repercuten en la calidad de vida de estos pacientes. Se concluyó que la fisioterapia respiratoria aplica protocolos de intervención efectos en el COVID-19 para la mitigación de complicaciones físico y funcionales que mejoran la calidad de vida de los pacientes..Au

The COVID-19 pandemic has wreaked great havoc on health systems globally. From respiratory physiotherapy, it tends to carry out cost-effective interventions based on the best available evidence, to minimize the functional effects in said patients with COVID-19. For this reason, the literature was reviewed to establish a theoretical review from the functionality in relation to respiratory physiotherapy in the face of the pandemic. The results included publications and management guides in Spanish, English and Portuguese about the actions of the different countries in the face of functional compromises that affect the quality of life of these patients. It was concluded that respiratory physiotherapy applies intervention protocols effects in COVID-19 for the mitigation of physical and functional complications that improve the quality of life of patients..Au

Intervención educativa en futbolistas para la prevención de lesiones músculo esqueléticas / Educational intervention in footballers for the prevention of musculoskeletal injuries

ANTECEDENTES: La educación en salud basada en intervenciones con nuevas tecnologías de la información y comunicación [TIC] son cada vez más utilizadas en la prevención primaria. La fisioterapia en el ámbito del deporte ha demostrado en los últimos años alcances de práctica basada en la evidencia desde sus intervenciones desde ámbito de la salud pública, clínico terapéutico en el esquema de la rehabilitación integral. OBJETIVO: Comparar la eficacia de una intervención educativa de Fisioterapia en futbolistas, en modalidad presencial (conferencia) frente a una intervención mediada por las tecnologías de la información y comunicación [TIC], sobre el riesgo de lesión medido con el Functional Movement Screen [FMS].MATERIAL Y MÉTODO: Se realizó un ensayo clínico aleatorio [ECA] la población estuvo conformada por 100 participantes distribuidos en dos grupos (TIC n=50) y (Conferencia n=50), con un promedio de edad de 18,2 vs 18,3 años para conferencia y TIC respectivamente. Para la recolección de la información se construyó un cuestionario de evaluación para auto diligenciamiento elaborado a partir de las consideraciones del equipo de ciencias del deporte (médico especialista en deporte, fisioterapeutas, nutricionistas, biomecánico del deporte, entrenadores deportivos, profesional del deporte) del club deportivo. Se establecieron un total de 17 ítems tipo preguntas distribuidas en siete categorías de conocimientos sobre la prevención de lesiones, que debía de abordar el plan de educación para la salud desde Fisioterapia. RESULTADOS: Al realizarse la prueba de T para puntaje de FMS aplicado en relación al grupo de conferencia vs TIC se encontró una significancia bilateral p < 0,001 donde concluye que efectivamente la metodología TIC en relación al aumento de la puntuación en el FMS promedio tras la intervención fue mayor en la metodología que implementó las TIC. CONCLUSIÓN: Una intervención educativa en fisioterapia basada en las Tecnologías de Información y Comunicación es más eficaz que una intervención en conferencia (presencial) para aumentar la puntuación en el cuestionario de conocimientos para la prevención de lesiones deportivas en el fútbol

INTRODUCTION: Health education based on interventions with new information and communication technologies are increasingly used in primary prevention. Physiotherapy in the field of sport has demonstrated in recent years scopes of evidence-based practice since its interventions from the field of public health, therapeutic clinical in the scheme of integral rehabilitation. AIM: To compare the effectiveness of an educational physiotherapy intervention in soccer players, in face-to-face mode (conference) versus an intervention mediated by the technologies of the information and communication [TIC], on the risk of injury measured with the Functional Movement Screen [FMS]. MATERIAL AND METHOD: A randomized clinical trial (RCT ) was carried out. The population consisted of 100 participants di-vided into two groups (TIC n = 50) and (Conference n = 50), with an average age of 18.2 vs 18.3 years for a conference and TIC respectively. For the collection of information, an evaluation questionnaire for self-completion was developed based on the considerations of the sports science team (sports specialist, physiotherapists, nutritionists, sports biomechanics, sports trainers, sports professional) of the club sports. A total of 17 question-type items were distributed in seven categories of knowledge about injury prevention, which should be addressed by the health education plan from Physiotherapy. RESULTS: A T test was performed for the FMS score applied in relation to the conference group vs. TIC, a bilateral significance was found p <0.001, which concluded that the TIC methodology in relation to the increase in the score in the average FMS after the intervention was higher in the methodology that implemented TIC. CONCLUSIONS: An educational intervention in physiotherapy based on Information and Communication Technologies is more effective than a conference intervention (in person) to increase the score in the knowledge questionnaire for the prevention of sports injuries in football

Envejecimiento neural, plasticidad cerebral y ejercicio: Avances desde la óptica de fisioterapia / Neural aging, cerebral plasticity and Exercise: Advances from the Physiotherapy´s perspective

El ejercicio ha demostrado efectividad para promover la plasticidad cerebral en los procesos de envejecimiento neural. Esta revisión narrativa de literatura tiene como objetivo analizar el efecto neural del ejercicio para promover la plasticidad cerebral en el envejecimiento. Los resultados incluyeron publicaciones que mencionan los efectos de la plasticidad cerebral mediada por el ejercicio empleando protocolos de ejercicio con duración, intensidad y frecuencia clínicamente significativa. La revisión documental se organizó en tres apartados: a) envejecimiento neural y procesos fisiológicos interrelacionados, b) plasticidad cerebral mediada por el ejercicio, c) ejercicio para promover el envejecimiento neural saludable. Se pudo concluir que el fisioterapeuta, aplicando protocolos de ejercicio, puede promover cambios positivos en la función cerebral lo cual se traducen en la mejoría del desempeño físico y funcional de los adultos mayores..(AU)

Exercise has shown effectiveness in promoting brain plasticity in neural aging processes.This narrative review of literature aims to analyze the neural effect of exercise to promote brain plasticity in aging. The results included publications that mention the effects of brain plasticity mediated by exercise, using exercise protocols with clinically significant duration, intensity and frequency. Through the documentary review three sections were determined: Neural Aging: Interrelated physiological processes; Exercisemediated brain plasticity; Exercise to promote healthy neural aging. It was concluded that the physiotherapist, applying exercise protocols, can promote positive changes in brain function, which translates into an improvement in the physical and functional performance of older adults..(AU)

Fisioterapia en la inhibición muscular iatrogénica. Revisión de literatura / Physiotherapy in arthrogenic muscle inhibition: literature review

Resumen El objetivo de este estudio fue investigar la efectividad de la Fisioterapia en la inhibición muscular artrogénica. Se realizaron búsquedas en las bases PEDro, Embase, Scielo y PubMed para identificar ensayos controlados aleatorios (ECA) de intervenciones de Fisioterapia en la inhibición muscular artrogénica. La literatura incluyo referencias en inglés, español y portugués, publicados entre Enero de 2000 y Junio de 2017. Se identificaron 7 ensayos clínicos que se incluyeron en esta revisión y 4 Revisiones Sistemáticas/Meta-análisis. Se realizó una evaluación crítica de la literatura y se procesó una descripción narrativa debido al pequeño número de ECA. La evidencia muestra que la intervención fisioterapéutica puede ser beneficiosa para el manejo de la inhibición muscular artrogénica, sin embargo, el resultado de baja calidad de la evaluación crítica y el pequeño número de ensayos sugieren que se requieren ECA de alta calidad para examinar más a fondo los efectos de la intervención fisioterapéutica en el control de la inhibición muscular artrogénica.

Abstract The aim of this study was to investigate the effectiveness of physiotherapy in arthrogenic muscle inhibition. We searched the PEDro, Embase, Scielo and PubMed databases to identify randomized controlled trials (RCTs) of physiotherapy interventions in arthrogenic muscle inhibition. The literature included references in English, Spanish and Portuguese, published between January 2000 and June 2017. We identified 7 clinical trials and 4 Systematic Review/Meta-analysis that were included in this review. A critical evaluation of the literature was made and a narrative description was processed due to the small number of RCTs. Evidence shows that physiotherapeutic intervention may be beneficial for the management of arthrogenic muscle inhibition, however, the low quality result of the critical evaluation and the small number of trials suggest that high quality RCTs are required to further examine the effects of physiotherapeutic intervention in the control of arthrogenic muscle inhibition.

Loss of Muscle Mass Induced by Aging / Pérdida de masa muscular inducida por el envejecimiento / Perda de massa muscular induzida por envelhecimento

Abstract Introduction : The world population ages rapidly, understanding the anatomo-functional changes of the muscle allows the implementation of effective actions in this age group. The objective of this work was to identify, through a review of scientific literature, the current advances in the molecular processes related to the loss of muscle mass induced by aging. Materials and Methods : The molecular causes of muscle mass loss induced by aging were reviewed through scientific articles from 2006 to 2016 on the Pubmed, Scielo and PEDro databases, combining the terms muscular aging, exercise and physical therapy. Results : Three sections were determined: 1) sarcopenia and aging, 2) molecular pathways of muscle mass loss induced by aging and 3) aging, exercise and functionality. Conclusion : Knowing the molecular basis of muscle mass loss induced by aging allows the physiotherapist to understand, evaluate and intervene related mechanisms to perform actions that improve the functionality and quality of life of older adults.

Resumen Introducción : la población mundial envejece rápidamente y comprender los cambios anatomo-funcionales del músculo permite implementar acciones eficaces en este grupo etario. El objetivo de este trabajo fue identificar, por medio de una revisión de literatura científica, los avances actuales de los procesos moleculares relacionados con la pérdida de masa muscular inducida por el envejecimiento. Materiales y métodos : se revisaron las causas moleculares de la pérdida de masa muscular inducida por el envejecimiento, mediante artículos científicos publicados desde 2006 hasta 2016 en las bases Pubmed, Scielo y PEDro, combinando los términos: muscular aging, exercise y physical therapy. Resultados : se determinaron tres apartados: 1) sarcopenia y envejecimiento, 2) vías moleculares de la pérdida de masa muscular inducida por el envejecimiento y 3) envejecimiento, ejercicio y funcionalidad. Conclusión : conocer las bases moleculares de la pérdida de masa muscular inducida por el envejecimiento permite al fisioterapeuta entender, evaluar e intervenir los mecanismos relacionados para realizar acciones que mejoren la funcionalidad y calidad de vida de los adultos mayores.

Resumo Introdução : a população mundial envelhece rapidamente e compreender as mudanças anátomo-funcionais do músculo, permite implementar ações eficazes neste grupo etário. O objetivo deste trabalho foi identificar através de uma revisão de literatura científica, os avanços atuais dos processos moleculares relacionado com a perda de massa muscular induzida pelo envelhecimento. Materiais e métodos : se revisaram as causas moleculares da perda de massa muscular induzida pelo envelhecimento, mediante artigos cientpificos desde 2006 até 2016 nas bases Pubmed, Scielo e PEDro, combinando os termos: muscular aging, exercise e physical therapy. Resultados : determinaram-se três apartados: 1) Sarcopenia e envelhecimento, 2) Vias moleculares da perda de massa muscular induzida pelo envelhecimento, e 3) Envelhecimento, exercício e funcionalidade. Conclusão : conhecer as bases moleculares da perda de massa muscular induzida pelo envelhecimento, permite ao fisioterapeuta compreender, avaliar e intervir os mecanismos relacionados para realizar ações que melhorem a funcionalidade e qualidade de vida dos adultos maiores.

Ejercicio físico en pacientes con Diálisis / Physical exercise in patients with Dialysis

Objetivo: realizar un meta-análisis sobre los efectos del ejercicio físico en la rehabilitación funcional del paciente con diálisis. La enfermedad renal crónica es una patología que puede requerir terapia de reemplazo renal (como la diálisis) para su tratamiento, que, sumada a la sintomatología, deteriora la función física de los sujetos. El ejercicio físico como modalidad de intervención del fisioterapeuta, ha mostrado ser efectivo en la mejoría de la funcionalidad y calidad de vida de estos pacientes. Conocer sus beneficios en estos pacientes, puede repercutir positivamente en la salud del paciente y costos del tratamiento a largo plazo. Materiales y Métodos: se incluyeron ensayos clínicos aleatorizados que aplicaron protocolos de ejercicio físico (flexibilidad, resistencia y fuerza) para mejorar variables físicas, fisiológicas y funcionales. Resultados: se analizaron veinte ensayos clínicos bajo los criterios de la Escala PEDro, con puntuación ≥5 calificados como de alta calidad metodológica y bajo riesgo de sesgo. También se analizaron ocho revisiones sistemáticas/meta-análisis bajo lineamientos PRISMA-equidad. Conclusiones: aplicar protocolos de ejercicio físico, tiene efectos positivos clínicamente relevantes en la función física general y calidad de vida de estos pacientes, pero aún no hay consenso respecto a su aplicación en pacientes en diálisis en el contexto colombiano..(AU)

Objective: to carry out a meta-analysis on the effects of physical exercise in the functional rehabilitation of dialysis patients. Chronic kidney disease is a pathology that may require renal replacement therapy (such as dialysis) for its treatment, which, added to the symptoms, deteriorates the physical function of the subjects. Physical exercise as an intervention modality of the physiotherapist, has been shown to be effective in improving the functionality and quality of life of patients. Knowing their benefits in these patients can have a positive impact on the patient's health and long-term treatment costs. Materials and Methods: randomized clinical trials were included that applied protocols of physical exercise (flexibility, resistance and strength) to improve physical, physiological and functional variables. Results: twenty clinical trials were analyzed under the criteria of the PEDro Scale, with a score ≥5 rated as having high methodological quality and low risk of bias. Eight systematic reviews / meta-analyzes were analyzed under PRISMA-equity guidelines. Conclusions: to apply protocols of physical exercise, has clinically relevant positive effects on the general physical function and quality of life of these patients, but there is still no consensus regarding its application in dialysis patients in the Colombian context..(AU)

Problems and solutions in IGRT for cervical cancer.

The contribution of Image-guided Radiotherapy (IGRT) to modern radiotherapy is undeniable, being the way to bring into daily practice the dosimetric benefits of Intensity-Modulated Radiotherapy (IMRT). Organ and target motion is constant and unpredictable at the pelvis, thus posing a challenge to the safe execution of IMRT. There are potential benefits of IMRT in the radical treatment of cervical cancer patients, both in terms of dose escalation and decrease of toxicity. But it is essential to find IGRT solutions to control the aspects that can lead to geographic miss targeting or organs at risk (OAR) overdose. This review seeks to describe the problems and possible solutions in the clinical implementation of IMRT/IGRT protocols to treat intact cervical cancer patients.

Dolor y Ejercicio / Pain and Exercise

El ejercicio ha demostrado ser efectivo en el control y reducción del dolor en múltiples patologías. Por lo tanto, esta revisión de literatura tiene como objetivo determinar la dosificación de ejercicio y el efecto sistémico del mismo para la modulación del dolor de diferentes causas, comprendiendo la disfunción orgánica subsecuente que causa alteraciones del movimiento corporal humano. Los resultados incluyeron protocolos de ejercicio con duración, intensidad y frecuencia variada que tienen incidencia clínicamente significativa sobre el dolor en la mayoría de los estudios revisados. Se pudo concluir que la Fisioterapia, aplicando protocolos de ejercicio terapéutico, tiene efectos positivos en la disminución de complicaciones físicas, estancia hospitalaria y mejoría del desempeño físico y funcional..(AU)

Exercise has been shown to be effective in controlling and reducing pain in multiple pathologies. Therefore, this review of the literature aims to determine the dosage of exercise and the systemic effect of the same for the modulation of pain of different causes, including subsequent organ dysfunction that causes alterations in human body movement. The results include exercise protocols with varying duration, intensity and frequency have clinically significant incidence on pain in most of the studies reviewed. It was possible to conclude that Physiotherapy, applying protocols of therapeutic exercise, has positive effects in the reduction of physical complications, hospital stay and improvement of the physical and functional performance..(AU)

Efecto de la fisioterapia en paciente con luxación de hombro y lesión de plexo braquial: Reporte de caso / Effect of physiotherapy in a patient with shoulder luxation and brachial plexus damage: Case report

La parálisis del plexo braquial secundario a la luxación anterior del hombro es una lesión poco frecuente, siendo esta patología muy discapacitante para el individuo. Se presenta un caso de luxación anterior traumática del hombro complicado con parálisis del plexo braquial en un miembro superior, desde una perspectiva fisioterapéutica. El proceso de rehabilitación tomó aproximadamente un año y el paciente quedó con rigidez residual en el hombro. (AU)

Brachial plexus palsy following anterior shoulder luxation is a rare condition leading to significant disability. It's present the case of a patient with traumatic anterior shoulder luxation complicated with brachial plexus palsy from a physiotherapeutic perspective. The rehabilitation process took approximately one year and the patient had residual rigidity in the shoulder. (AU)

Can we shorten the overall treatment time in postoperative brachytherapy of endometrial carcinoma? Comparison of two brachytherapy schedules.

PURPOSE: To analyze vaginal-cuff relapses (VCR) and toxicity of two brachytherapy (BT) schedules in postoperative endometrial carcinoma and to correlate vaginal toxicity with vaginal-surface-EQD2Gy3 dose (VS-EQD2Gy3). METHODS/MATERIALS: 319 patients (p) I-IIIC-Figo-stage were treated with 2 BT schedules. One schedule included 166p (Group-1) to whom 3 fractions (Fr) of 4-6Gy per week (w) of BT were administered after external beam radiotherapy (EBI) (125p) and 6Fr/2w of 4-6Gy in exclusive-BT (41p). The second schedule included 153p (Group-2) with BT administered daily with 2Fr/w of 5-6Gy after EBI (94p) and 5-6Gy/4Fr/w in exclusive-BT (59p). Doses were prescribed at 5mm from the vaginal surface. Toxicity was evaluated using RTOG scores for the rectum and bladder and objective LENT-SOMA scores for the vagina. STATISTICS: Chi-square, Fisher and Student's-t tests. RESULTS: Mean follow-up (months): Group-1: 66.55 (7.73-115.40), Group-2: 41.49 (3.13-87.90). VCR: Group-1: 3p (1.88%); Group-2: 2p (1.3%). No differences were found between the two schedules comparing rectal (p=0.170), bladder (p=0.125) and vagina (p=0.680) late toxicities and comparing vagina EBI+BTp vs. exclusive-BTp (p=0.667). Significant differences in VS-EQD23Gy were observed considering EBI+BT (Groups 1+2) vs. exclusive-BT (Groups 1+2) (p<0.0001); nevertheless, no association was found between VS-EQD23Gy and vaginal complications. CONCLUSIONS: No differences were found between the two schedules. No association was found between vaginal toxicity and VS-EQD23Gy. Consequently, treatment with the least number of fractions is preferable.

Cabeza hacia adelante: una mirada desde la biomecánica y sus implicaciones sobre el movimiento corporal humano / Forward head: a biomechanical perspective and its implications for the human body movement

Las condiciones ergonómicas de mobiliario y de equipos, como también la postura incorrecta al estar en posición sedente, de pie o cargando algún peso pueden generar dolores o complicaciones osteomusculares. Dentro de estas, la cabeza hacia adelante es una alteración común detectada en la evaluación postural realizada por los fisioterapeutas. Esta suele asociarse a cambios mecánicos del cuello y columna vertebral, los cuales alteran la funcionalidad de los individuos, causándole discapacidad pues compromete el movimiento de hombros, la movilidad de la articulación temporomandibular, la mecánica respiratoria, desarrollando imbalances musculares, mareos, disfunción vestibular, aumenta el riesgo de fracturas y se asocia con procesos dolorosos como la cervicalgia, dorsalgia y lumbalgia. Por tanto el siguiente artículo tiene por objetivo revisar la fisiopatogénia de la cabeza hacia adelante, desde una perspectiva biomecánica, analizando las implicaciones de esta alteración postural sobre el movimiento corporal humano, proporcionando así herramientas de análisis para el abordaje fisioterapéutico.

The ergonomics of furniture and equipment, as well as improper posture when in a sitting position, standing or carrying some weight can cause pain or musculoskeletal complications. Within these, the forward head is a common alteration detected in the postural assessment by physiotherapists. This is often associated with mechanical changes of the neck and spine, which alters the functionality of individuals, causing disability movement as committed shoulders, temporomandibular joint mobility, respiratory mechanics, developing muscle imbalances, dizziness, vestibular dysfunction, increases the risk of fractures and is associated with painful conditions such as neck pain, dorsal pain and back pain. So the following article is intended to review the pathophysiology of forward head, from a biomechanical perspective, analyzing the implications of this postural change on human body movement, providing analysis tools for addressing physiotherapy.

Efectos de un programa de entrenamiento funcional en la musculatura core en mujeres con fibromialgia / Effects of Functional Training Program in Core Muscles in Women with Fibromyalgia / Efeitos de um programa de treinamento funcional na musculatura do core em mulheres com fibromialgia

Objetivo: Evaluar los efectos de un programa de entrenamiento funcional de músculos core dirigido a las mujeres con fibromialgia. Materiales y métodos: Se realizó un ensayo cuasiexperimental de tipo antes y después de una intervención durante 20 semanas, con frecuencia de 3 días/semana y una duración de 60 minutos cada sesión. En un grupo único de 8 mujeres, se evaluaron los cambios en la fuerza muscular, dolor, calidad de vida relacionada con la salud y el nivel de actividad física. Resultados: Hubo aumento en las repeticiones de la prueba de flexión de tronco, el tiempo en las pruebas puente lateral derecho e izquierdo y puente en prono. Todas las características del dolor disminuyeron y según el S-FIQ hubo disminución en el cansancio matutino, la rigidez y la ansiedad. También los Met´s/minuto-semanas aumentaron después de la intervención. Conclusión: Estos datos sugieren que el programa de entrenamiento funcional de músculos core es eficaz en el aumento de la fuerza muscular, la modulación del dolor, la optimización de rendimiento funcional, así como el aumento de los niveles de actividad física en mujeres con fibromialgia.

Objective: To evaluate the effects of a program of functional muscles core training targeting women with fibromyalgia. Materials and methods: A quasi-experimental type trial was conducted, before and after an intervention, for 20 days, often three days/week, 60 minutes each session. In a single-group of eight women, changes in muscle strength, pain, quality of life related to health and physical activity were evaluated. Results: An increase in repetitions of the test trunk flexion, time on the left and right bridge testing lateral and prone bridge the test were found. All features of pain decreased, and, according to the S-FIQ, a decrease in morning fatigue, stiffness and anxiety was reported. Also Met's/minute-weeks increased after intervention. Conclusion: These data suggest that functional program core muscle training is effective in increasing muscle strength, pain modulation, functional performance optimization, and increased levels of physical activity in women with fibromyalgia.

Objetivo: Avaliar os efeitos de um programa de treinamento funcional dos músculos do core dirigido às mulheres com fibromialgia. Materiais e métodos: realizou-se um ensaio quase-experimental de tipo antes e depois de uma intervenção durante 20 semanas, com frequência de 3 dias/semana e uma duração de 60 minutos cada sessão. Em um grupo único de 8 mulheres, avaliaram-se as mudanças na força muscular, dor, qualidade de vida relacionada com a saúde e o nível de atividade física. Resultados: houve aumento nas repetições do teste de flexão de tronco, o tempo nos testes da ponte lateral direita e esquerda e ponte em prono. Todas as características da dor diminuíram e segundo o S-FIQ houve diminuição no cansaço matutino, a rigidez e a ansiedade. Também os MET/minutos-semanas aumentaram depois da intervenção. Conclusão: estes dados sugerem que o programa de treinamento funcional de músculos do core é eficaz no aumento da força muscular, a modulação da dor, a optimização do rendimento funcional, assim como o aumento dos níveis de atividade física em mulheres com fibromialgia.

Ejercicio terapéutico: Pautas para la acción en fisioterapia / Therapeutic exercise: guildenes for physiotherapy action

Los programas de ejercicio terapéutico son una modalidad de intervención propuestas por orga-nismos internacionales y nacionales. Le permiten al fisioterapeuta manejar conceptos básicos del ejercicio dirigidos a nivel individual o colectivo para intervenir limitaciones funcionales o restric-ciones en los roles de los individuos. El profesional debe conocer los aspectos básicos a tener en cuenta para elegir y diseñar programas de ejercicio acordes a los objetivos terapéuticos derivados de su evaluación. En este artículo se revisaron las pautas generales sobre la óptima prescripción del ejercicio terapéutico, partiendo de los conceptos esenciales, hasta la elaboración de progra-mas de tratamiento con los elementos a tener en cuenta al momento de escoger, plantear y su-pervisar ejercicios para individuos y comunidades con patologías que presenten compromisos del movimiento corporal humano, buscando intervenciones costo efectivas dirigidas a mejorar la capacidad funcional y calidad de vida de los pacientes/clientes a quienes se dirigen

Therapeutic exercise programs are a form of intervention proposed by international and national bodies, which allows the therapist to handle basic exercise concepts of targeted individually or co-llectively to intervene functional limitations or restrictions on the individual's roles. To do, this pro-fessional must know the basics for choosing and designing exercise programs chords to therapeutic targets derived from its evaluation. The following paper seeks to review the general guidelines on the optimal prescription of therapeutic exercise, based on the essential concepts to the development of treatment programs with elements to consider when choosing, raising and monitoring exercises for individuals and communities with pathologies that submit commitments of human body mo-vement, looking for cost-effective interventions to improve functional capacity and quality of life of patients / clients to whom they are addressed

Undifferentiated uterine sarcoma: a rare, not well known and aggressive disease: report of 13 cases.

PURPOSE: Undifferentiated uterine sarcomas (UUS) are rare and aggressive tumor with scarce data on the outcome and best treatment. We aimed to describe the behavior among patients with UUS at our institution. MATERIALS AND METHODS: Thirteen patients with UUS treated in our centre from 1979 to 2010 were analyzed. STATISTICS: descriptive analysis for frequencies and Kaplan-Meier actuarial method for overall survival (OS). RESULTS: Patients mean age was 66 years. Three had FIGO 2009 stage IA, five IB, two IIB, and three IVB. Ten patients underwent surgery and eight received postoperative radiotherapy. Three patients received adjuvant chemotherapy. The median follow-up was 16 months (2-276 months). Stage I patients developed two local relapses and three distant metastases (DM). DM was also observed in stage II patients and in 61.5 % of the entire series. Fifty percent of patients receiving radiotherapy remain alive without relapse. The median OS was 16 months, being 17 months for stage I and 9 for the remainder. CONCLUSIONS: Poor outcome of UUS was associated with a high incidence of DM. Stage I had the best outcome. Radiotherapy seems to have benefited patients, with 100 % of local control and 50 % of long-term survivors. The high incidence of metastasis suggests the need for more accurate initial assessment.

Rol del fisioterapeuta en la prescripción del ejercicio / Physiotherapist s role in exercise prescription

La prescripción de ejercicio es una modalidad de intervención del fisioterapeuta, avalada por la Confederación Mundial de Terapia Física (WCPT) y soportada por la Ley 528, que le permite abarcar conceptos básicos del ejercicio físico y terapéutico dirigido a individuos y comunidades que requieran la acción de este profesional. Este artículo de revisión de tema, busca definir el rol del fisioterapeuta en la prescripción del ejercicio, acreditado por lineamientos a nivel internacional y nacional, que soportan su actuar profesional y cita algunos parámetros básicos para su abordaje. Se revisó literatura disponible en las bases de datos PUBMED y PEDRO, artículos y texto en medio impreso, encontrando información pertinente para determinar el rol del fisioterapeuta y la Prescripción de Ejercicio, clasificándolo en requisitos básicos, así como el fisioterapeuta y la Prescripción de Ejercicio Terapéutico y la prescripción del Ejercicio Físico. Se pudo concluir que la prescripción del ejercicio es una herramienta ampliamente avalada, propia de los fisioterapeutas que les permiten realizar intervenciones efectivas dirigidas a individuos y comunidades aparentemente sanas o con patologías que presenten compromisos del movimiento corporal humano, limitaciones de actividades o restricciones en sus roles…

The exercise prescription is a physiotherapist intervention form, backed by the World Confederation for Physical Therapy (WCPT) and supported by Law 528, which all owsyou to cover basic concepts of physical and therapeutic exercise aimed at individual or collective level where required the actions of this professional. This paper review seeks to define the role of the physiotherapist in the exercise prescription, accreditedby international and national action guidelines to support their professional and givessome basic parameters for its approach. Literature available in the databases PUBMEDand PEDRO, articles and text in print was reviewed, finding relevant to determining therole of the physiotherapist and Prescription Exercise, ranking in basic requirements information and the physiotherapist and Therapeutic Exercise and Physical Exercise prescription. We concluded that the exercise prescription is widely endorsed, own tool physiotherapists that allow them to make effective interventions for apparently healthyor pathologies individuals or communities that present commitments of human body movement, involving limitations of functional activities or restrictions in their roles.

Pathologic prognostic factors in stage I-III uterine carcinosarcoma treated with postoperative radiotherapy.

PURPOSE: To analyse the impact of prognostic factors on specific overall survival (SOS) after postoperative radiotherapy (P-RT) in carcinosarcomas. METHODS: We retrospectively analysed 81 patients who received P-RT from 1977 to 2010 after the diagnosis of carcinosarcomas. 2009 FIGO stage: 25-IA, 20-IB, 6-II, 9-IIIA, 11-IIIC. Age, stage, vascular and lymphatic space invasion (VLSI), myometrial invasion, grade, mitotic index, sarcomatous/epithelial components, tumour size and necrosis were considered for the analysis. STATISTICS: we used the Kaplan-Meier method for survival analysis and the Cox model for risk factor evaluation. RESULTS: The mean follow-up of the series was 78.86 months (range 7-381). The median age was 72 years (range 51-89). 30 out 81 (37 %) patients relapsed and died (22.2 % pelvic and abdominal, 13.5 % exclusive distant metastasis). On univariate and multivariate analysis only stage had a significant impact on SOS. At 5 years, stage I-II had a SOS of 66 % in comparison with stage III with 30 %. CONCLUSIONS: Two groups of patients showing different outcome were found after P-RT in uterine carcinosarcomas: stage I-II patients had a life expectancy 2.5-fold longer compared to stage III patients. New therapeutic strategies are warranted in carcinosarcomas considering the high incidence of distant metastasis.