Características clínicas de pacientes en edad pediátrica con infección por SARS-CoV-2. Cienfuegos, 2020-2021

RESUMEN Fundamento: el aumento significativo en las cifras de pacientes con COVID-19 en Cuba y la creciente tasa de incidencia en la edad pediátrica representan un problema de salud emergente. Objetivo describir las características clínicas y epidemiológicas de los niños confirmados con COVID-19 en Cienfuegos, durante el primer año de pandemia. Métodos estudio observacional, descriptivo, transversal, ambispectivo. El universo de estudio fue de 104 pacientes en edad pediátrica diagnosticados con la enfermedad. El horizonte temporal fue desde marzo 2020 hasta marzo 2021. Se analizaron las variables: edad, sexo, procedencia, antecedentes patológicos personales, sintomatología inicial, estado nutricional, fuente de infección, resultados de laboratorio, persistencia de PCR-RT positivo, manifestaciones clínicas asociadas al tratamiento y evolución. Se confeccionó historia clínica individual durante la hospitalización. Resultados: la edad más representada fue la adolescencia, discreto predominio del sexo masculino. Más del 50 % de los casos estaban asintomáticos. Los síntomas iniciales más frecuentes fueron la fiebre y la secreción nasal. El 94 % de los confirmados fueron autóctonos. Los exámenes complementarios mostraron alteraciones enzimáticas asociadas a la infección viral. El 100 % de los niños tuvo una evolución favorable. Conclusiones: la COVID-19 continúa como problema de salud a nivel mundial. Los niños constituyen un grupo vulnerable que necesita seguimiento continuado. Los signos y síntomas pueden ser similares a otras infecciones respiratorias virales, lo que requiere mantener un alto índice de sospecha de COVID-19 en niños.

ABSTRACT Background: the significant increase in the numbers of COVID-19 patients in Cuba and the increasing incidence rate in the pediatric age represent an emerging health problem. Objective: to describe the clinical and epidemiological characteristics of children confirmed with COVID-19 in Cienfuegos, during the first year of the pandemic. Methods: observational, descriptive, cross-sectional, ambispective study. The study universe consisted of 104 pediatric patients diagnosed with the disease. The time horizon was from March 2020 to March 2021. The analyzed variables were: age, sex, origin, personal pathological history, initial symptoms, nutritional status, source of infection, laboratory results, persistence of positive RT-PCR, associated clinical manifestations to treatment and evolution. An individual medical history was taken during hospitalization. Results: the most frequent age was adolescence, discrete male predominance. More than 50% of the cases were asymptomatic. The most frequent initial symptoms were fever and runny nose. The 94% of those confirmed were autochthonous. The complementary tests showed enzymatic alterations associated with the viral infection. The 100% of the children had a favorable evolution. Conclusions: COVID-19 continues as a health problem worldwide. Children are a vulnerable group that needs continuous monitoring. The signs and symptoms can be similar to other viral respiratory infections, which require maintaining a high index of suspicion for COVID-19 in children.

Contribution of interaction force to the sense of hand ownership and the sense of hand agency.

When performing willed actions, we have the unified and coherent experience of owning and controlling our body. Body ownership is believed to emerge from the integration of coherent multisensory signals, while agency is believed to emerge from the coherence between predicted and perceived outcomes of actions. As a consequence, body ownership and agency can both be modulated by multisensory conflicts. The contribution of active movement generation to ownership and agency has not been parametrically explored. Here, we investigated the contribution of interaction force between the agent and the environment to the sense of hand ownership (SO) and the sense of hand agency (SA). By combining robotics and virtual reality, we manipulated the sensorimotor and visual information during immersive scenarios to induce and quantify altered states of SO and SA. First, we demonstrated that SO and SA could be successfully manipulated by our experimental paradigms. Second, we showed that interaction force strongly contributes to SA, but to a lesser extent to SO. Finally, we showed that SO and SA interact beyond their common multisensory basis. Our results, based on two independent studies, provide a direct link between sensorimotor interactions and subjective body experience and demonstrate a new dissociation between SO and SA.

Fuerza resistencia en la calidad de vida de mujeres con cáncer de seno: Una revisión de sistemática / Strength resistance in the quality of life of women with breast cancer: A systematic review / Resistência de força na qualidade de vida de mulheres com câncer de mama: uma revisão sistemática

Introducción: El ejercicio físico, es comúnmente utilizado como tratamiento primario o coadyuvante de terapia farmacológica, presentando resultados prometedores en la reducción del 30%-40% de padecer cáncer de seno. Objetivo: Determinar los beneficios del entrenamiento en fuerza resistencia sobre la calidad de vida en mujeres diagnosticadas con cáncer de seno, mediante una revisión sistemática de la literatura. Metodología: Revisión sistemática de la literatura acorde con los lineamientos descritos en la de-claración PRISMA y el Manual Cochrane para la conducción de Revisiones Sistemáticas de Intervenciones versión 5.1.0. La búsqueda sistemática se realizó entre los años 1990 y 2018. Resultados: Todos los estudios evaluados incluyeron población con cáncer de seno y evaluaron la calidad de vida mediante diferentes protocolos. Conclusión: El entrenamiento de fuerza resistencia favorece el estado de salud, parámetros psicológicos, síntomas de dolor, funcionalidad física, funcionalidad y disfrute sexual, fatiga, estado de ánimo, salud emocional, salud cognitiva, composición corporal y capacidad física.

Introduction: Physical exercise is commonly used as primary treatment or adjunct to pharmaco-logical therapy, showing promising results in reducing breast cancer by 30% -40%. The aim on this study was to determine the benefits of resistance training on the quality of life in women diagnosed with breast cancer, through a systematic review of the literature. Methodology: Systematic review of the literature according to the guidelines described in the PRISMA statement and the Cochrane Manual for conducting Systematic Reviews of Interventions version 5.1.0. The systematic search was carried out between the years 1990 and 2018. Results: All the evaluated studies included a population with breast cancer and evaluated the quality of life using different protocols. Conclusion: Strength resistance training favors health status, psychological parameters, pain symp-toms, physical functionality, sexual functionality and enjoyment, fatigue, mood, emotional health, cognitive health, body composition and physical capacity.

Introdução: O exercício físico é comumente usado como tratamento primário ou coadjuvante da terapia farmacológica, apresentando resultados promissores na redução do câncer de mama em 30% -40%. Objetivo: Verificar os benefícios do treinamento resistido na qualidade de vida de mulheres com diagnóstico de câncer de mama, por meio de uma revisão sistemática da literatura. Metodologia: Revisão sistemática da literatura de acordo com as diretrizes descritas na declaração PRISMA e no Manual Cochrane para a realização de Revisões Sistemáticas de Intervenções versão 5.1.0. A busca sistemática foi realizada entre os anos de 1990 e 2018. Resultados: Todos os estudos avaliados incluíram uma população com câncer de mama e avaliaram a qualidade de vida por meio de diferentes protocolos. Conclusão: O treinamento de força e resistência favorece o estado de saúde, parâmetros psicológicos, sintomas de dor, funcionalidade física, funcionalidade e prazer sexual, fadiga, humor, saúde emocional, saúde cognitiva, composição corporal e capacidade física.

Automated and Quantitative Assessment of Tactile Mislocalization After Stroke.

Topesthesia, the recognition of tactile stimulation location on the skin, can be severely affected by neurological injuries, such as stroke. Despite topesthesia being crucial for manipulating objects and interacting with the environment during activities of daily living, deficits cannot be quantitatively captured with current clinical assessments and are, as a consequence, not well-understood. The present work describes a novel automated assessment tool for tactile mislocalization in neurological patients with somatosensory deficits. We present two cases of ischemic stroke patients, describe their tactile localization deficits with the automated assessment, and compare the results to a standard manual clinical assessment. Using the automated assessment tool, it was possible to identify, locate, precisely quantify, and depict the patients' deficits in topesthesia. In comparison, the clinical assessment was not sensitive enough and some deficits would remain undetected due to ceiling effects. In addition, an MRI structural analysis of the lesion supported the existence of somatosensory deficits. This novel and quantitative assessment may not only help to raise awareness of the implications of deficits in topesthesia, but would also allow monitoring recovery throughout the rehabilitation process, informing treatment design, and objectively evaluating treatment efficacy.

BOLD signal in sensorimotor regions reveals differential encoding of passive forefinger velocity and displacement amplitude.

Peripheral encoding of movement kinematics has been well-characterized, but there is little understanding of the relationship between movement kinematics and associated brain activation. We hypothesized that kinematics of passive movement is differentially represented in the sensorimotor network, reflecting the well-studied afferent responses to movement. A robotic forefinger manipulandum was used to induce passive kinematic stimuli and monitor interaction force in 41 healthy participants during whole-brain functional magnetic resonance imaging (fMRI). Levels of forefinger displacement amplitude and velocity were presented in flexion and extension. Increases in velocity were linearly associated with activation in contralateral primary somatosensory cortex (S1), bilateral secondary somatosensory cortex (S2), primary motor cortex, and supplementary motor area. No difference in activation was found for direction of the finger movement. Unexpectedly, S1 and S2 activation decreased nonlinearly with increasing displacement amplitude. We conclude that while straightforward relations were found with velocity, the complex neural representation of displacement amplitude suggests a more nuanced relationship between peripheral responses to kinematic stimuli and sensorimotor network activity. Here we present a novel, systematic characterization of the whole-brain response to passive movement kinematics.

High percentages of embryos with 21, 18 or 13 trisomy are related to advanced paternal age in donor egg cycles.

OBJECTIVE: Advanced paternal age is related to poor sperm quality; however, little is known on its effect on aneuploidy embryo rates and, more importantly, on chromosomal abnormalities like trisomy 21, 18 and 13. The objective of this study was to evaluate the effect of advanced paternal age on the trisomy rates of the chromosomes 21, 18 or 13 in embryos obtained from donated oocytes. METHODS: A total of 378 embryos, obtained from 52 IVF/ICSI cycles with donated oocytes in conjunction with PGD, were allocated according to paternal age in three groups: Group A: ≤39 years (n=115 embryos), Group B: 40-49 years (n=157 embryos) and Group C: ≥50 year (n=106 embryos). Fertilization rates, embryo quality at day 3, blastocysts development, and aneuploidy embryo rates were then compared. RESULTS: There was no difference in seminal parameters (volume, concentration and motility) in the studied groups. Fertilization rate, percentages of zygotes that underwent cleavage, and good-quality embryos on Day 3 were similar between the three groups evaluated. The group of men ≥50 years had significantly more sperm with damaged DNA, higher global aneuploidy rates, and significantly more embryos with trisomy 21, 18 or 13 compared to the other two evaluated groups (p<0.05). CONCLUSIONS: Our data shows that advanced paternal age increases global chromosomal abnormalities, and percentages of trisomy 21, 18 or 13 in embryos, and such effect is significantly important as of the age of 50. Embryo genetic screening is highly recommended in patients in which paternal age is ≥50 years old.

Ectopic ovarian pregnancy after intracytoplasmic sperm injection with testicular spermatozoa - a case report.

Ovarian ectopic pregnancy is a rare event in both natural and assisted human reproduction settings. There are few reports of this event after in vitro fertilization. Diagnosis can be challenging, since it requires specific medical expertise. Patients with this condition call for careful management during treatment so as to not affect their fertility potential. This paper describes the case of a woman submitted to ICSI and embryo transfer who subsequently had an ovarian ectopic pregnancy and underwent a laparoscopic partial right oophorectomy.

Delineating the whole brain BOLD response to passive movement kinematics.

The field of brain-machine interfaces (BMIs) has made great advances in recent years, converting thought to movement, with some of the most successful implementations measuring directly from the motor cortex. However, the ability to record from additional regions of the brain could potentially improve flexibility and robustness of use. In addition, BMIs of the future will benefit from integrating kinesthesia into the control loop. Here, we examine whether changes in passively induced forefinger movement amplitude are represented in different regions than forefinger velocity via a MR compatible robotic manipulandum. Using functional magnetic resonance imaging (fMRI), five healthy participants were exposed to combinations of forefinger movement amplitude and velocity in a factorial design followed by an epoch-based analysis. We found that primary and secondary somatosensory regions were activated, as well as cingulate motor area, putamen and cerebellum, with greater activity from changes in velocity compared to changes in amplitude. This represents the first investigation into whole brain response to parametric changes in passive movement kinematics. In addition to informing BMIs, these results have implications towards neural correlates of robotic rehabilitation.

Multisensory origin of the subjective first-person perspective: visual, tactile, and vestibular mechanisms.

In three experiments we investigated the effects of visuo-tactile and visuo-vestibular conflict about the direction of gravity on three aspects of bodily self-consciousness: self-identification, self-location, and the experienced direction of the first-person perspective. Robotic visuo-tactile stimulation was administered to 78 participants in three experiments. Additionally, we presented participants with a virtual body as seen from an elevated and downward-directed perspective while they were lying supine and were therefore receiving vestibular and postural cues about an upward-directed perspective. Under these conditions, we studied the effects of different degrees of visuo-vestibular conflict, repeated measurements during illusion induction, and the relationship to a classical measure of visuo-vestibular integration. Extending earlier findings on experimentally induced changes in bodily self-consciousness, we show that self-identification does not depend on the experienced direction of the first-person perspective, whereas self-location does. Changes in bodily self-consciousness depend on visual gravitational signals. Individual differences in the experienced direction of first-person perspective correlated with individual differences in visuo-vestibular integration. Our data reveal important contributions of visuo-vestibular gravitational cues to bodily self-consciousness. In particular we show that the experienced direction of the first-person perspective depends on the integration of visual, vestibular, and tactile signals, as well as on individual differences in idiosyncratic visuo-vestibular strategies.

Experiencia de un año de trabajo en una unidad de terapia intensiva municipal / One year work experience in a municipal intensive therapy unit

Las Unidades de Terapia Intensiva Municipales (UTIM) fueron creadas en el año 2004, para mejorar la atención a la urgencia y la emergencia en el nivel primario de salud. Caracterizar el funcionamiento de una Unidad de Terapia Intensiva Municipal. Estudio prospectivo, descriptivo, que incluyó 348 pacientes que ingresaron en la unidad durante el año 2004. Se analizaron las siguientes variables: edad, sexo, distribución por enfermedades, evolución de los pacientes, estadía en la unidad, entre otras. Disminuyó el número de remisiones al Hospital Provincial; 183 pacientes fueron egresados a su hogar (más del 50, 0 porciento del total), 165 remitidos al Hospital Provincial de Cienfuegos y 3 fallecieron en la unidad. La angina de pecho fue la primera causa de ingreso, seguida de las arritmias cardiacas y la enfermedad cerebrovascular...(AU)

Conversión de las terapias intermedias en terapias intensivas / Conversion of intermediate therapies into intensive therapies

Las unidades de Cuidados Intensivos se dedican a la prevención, diagnóstico y tratamiento de las condiciones fisiopatológicas que amenazan la vida; su función en los servicios de salud a la población es imprescindible. Dadas las condiciones creadas en el país se orientó la conversión de las Terapias Intermedias en Terapias Intensivas. Caracterizar el Servicio de Terapia Intensiva Clínica y determinar los beneficios que reporta en función del cambio. Estudio descriptivo, prospectivo que caracteriza variables de interés organizativo y resultados asistenciales, docentes y administrativos expresados en frecuencias, porcentajes y tasas. Se redistribuyeron los recursos humanos y materiales; existieron 483 ingresos, con una estadía media de 2,34 días, y con un porciento de necropsia de 95,15; correlación clínico patológica total del 96,66 porciento y parcial del 3,34 porciento; la sepsis nosocomial fue de 4,5 x 100 pacientes, la satisfacción de la población fue de 78,57 porciento con criterio de muy bien y 21,42 porciento bien. La principal causa de ingreso fue la enfermedad cerebrovascualar con 71, 84 porciento, con la inclusión de técnicas y tratamiento de punta en su diagnóstico y tratamiento. Se observó una morbilidad y mortalidad adecuadas. Se obtuvieron resultados loables en la esfera docente e investigativa...(AU)