Characterization of ten white matter tracts in a representative sample of Cuban population.

BACKGROUND: The diffusion tensor imaging technique (DTI) combined with tractography methods, has achieved the tridimensional reconstruction of white matter tracts in the brain. It allows their characterization in vivo in a non-invasive way. However, one of the largest sources of variability originates from the location of regions of interest, is therefore necessary schemes which make it possible to establish a protocol to be insensitive to variations in drawing thereof. The purpose of this paper is to stablish a reliable protocol to reconstruct ten prominent tracts of white matter and characterize them according to volume, fractional anisotropy and mean diffusivity. Also we explored the relationship among these factors with gender and hemispheric symmetry. METHODS: This study aims to characterize ten prominent tracts of white matter in a representative sample of Cuban population using this technique, including 84 healthy subjects. Diffusion tensors and subsequently fractional anisotropy and mean diffusivity maps were calculated from each subject's DTI scans. The trajectory of ten brain tracts was estimated by using deterministic tractography methods of fiber tracking. In such tracts, the volume, the FA and MD were calculated, creating a reference for their study in the Cuban population. The interactions between these variables with age, cerebral hemispheres and gender factors were explored using Repeated Measure Analysis of Variance. RESULTS: The volume values showed that a most part of tracts have bigger volume in left hemisphere. Also, the data showed bigger values of MD for males than females in all the tracts, an inverse behavior than FA values. CONCLUSIONS: This work showed that is possible reconstruct white matter tracts using a unique region of interest scheme defined from standard to native space. Also, this study indicates differing developmental trajectories in white matter for males and females and the importance of taking gender into account in developmental DTI studies and in underlie gender-related cognitive differences.

Intervención de las unidades de gestión clínica de medicina física y rehabilitación en la enfermedad cerebrovascular / Intervention by physical medicine and rehabilitation management units in cases of cerebrovascular disease

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[Home care rehabilitation and physiotherapy in knee prosthesis]. / La rehabilitación y fisioterapia domiciliaria en las prótesis de rodilla.

This review analyzes the existing studies on home care rehabilitation and physiotherapy in patients with a knee prosthesis intervention, identifying and synthesising the results of the interventions measured in terms of muscular strength, function, extension of the joint, walking, patient's quality of life and cost of the service, compared with other alternative treatments. Nine databases have been analysed: IME, ENFISPO, CUIDEN PLUS, PUBMED, EMBASE, CINAHL, PEDro, COCHRANE library Plus and TRIP DATA BASE where 18 studies met the criteria for inclusion with information on 4,996 patients. Home care rehabilitation varies from one place to another and between studies (forms of care, application, duration, variable measures); but the idea is supported that this is as effective and acceptable as that received in an outpatients' department. It accelerates the attainment of functional achievements in the short and medium term, entailing very brief hospital stays and a reduction in costs.

La rehabilitación y fisioterapia domiciliaria en las prótesis de rodilla / Home care rehabilitation and physiotherapy in knee prosthesis

En esta revisión se analizan los estudios sobre rehabilitación y fisioterapia domiciliaria existentes en pacientes intervenidos con prótesis de rodilla, identificando y sintetizando los resultados de las intervenciones medidas en términos de fuerza muscular, función, amplitud articular, marcha, calidad de vida del paciente y coste del servicio, comparados con otras alternativas de tratamiento. Se han revisado nueve bases de datos: IME, ENFISPO, CUIDEN PLUS, PUBMED, EMBASE, CINAHL, PEDro, COCHRANE library Plus y TRIP DATA BASE donde 18 estudios cumplieron los criterios de inclusión con información sobre 4.996 pacientes. La rehabilitación domiciliaria varía de un lugar a otro y entre estudios (formas de atención, aplicación, duración, variables medidas); pero se respalda la idea de que ésta es tan efectiva y aceptable como la recibida ambulatoriamente. Acelera la consecución de logros funcionales a corto y medio plazo, conllevando estancias hospitalarias más breves y reducción de costes(AU)

This review analyzes the existing studies on homecare rehabilitation and physiotherapy in patients with a knee prosthesis intervention, identifying and synthesizing the results of the interventions measured in terms of muscular strength, function, extension of the joint, walking, patient’s quality of life and cost of the service, compared with other alternative treatments. Nine databases have been analysed: IME, ENFISPO, CUIDEN PLUS, PUBMED, EMBASE, CINAHL, PEDro, COCHRANE library Plus and TRIP DATA BASE where 18 studies met the criteria for inclusion with information on 4,996 patients. Home care rehabilitation varies from one place to another and between studies (forms of care, application, duration, variable measures); but the idea is supported that this is as effective and acceptable as that received in an outpatients’ department. It accelerates the attainment of functional achievements in the short and medium term, entailing very brief hospital stays and a reduction in costs(AU)

Características clínicas y funcionales de pacientes con enfermedad cerebrovascular / Clinical and functional features of patients with cerebrovascular disease

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Los servicios de fisioterapia domiciliaria en el sistema sanitario público de la Península Ibérica / Homecare physiotherapy in the iberian peninsula public health system

ObjetivosConocer los principales servicios de fisioterapia domiciliaria que oferta el Sistema Sanitario Público para las personas mayores dependientes de la Península Ibérica (España y Portugal).Estrategia de búsquedaRevisión bibliográfica actualizada y exhaustiva sobre los estudios previos; estancia de investigación en Hospitales, Centros de Salud y organismos financiados por la Administración Pública en ambos países; entrevistas en profundidad a informantes estratégicos.Síntesis de los resultadosSe describe la situación de la fisioterapia domiciliaria en España, desde el año 1987 hasta agosto de 2008. Se detecta que en Portugal la fisioterapia domiciliaria está recogida en la cartera de servicios de atención primaria (Decreto-Ley no 28/2008, del 22 de febrero).ConclusionesExisten pocas investigaciones a nivel de la Península que ofrezcan datos objetivos basados en la evidencia científica sobre la efectividad de estos servicios de fisioterapia, la satisfacción del usuario y las repercusiones que producen con respecto a otros tratamientos; sin embargo, estos estudios son necesarios para la evaluación de las políticas sanitarias, la distribución adecuada de recursos, la revisión de los programas, la metodología de actuación, etc (AU)

ObjectivesTo become acquainted with the principal homecare physiotherapy services that are offered within the Public Health System for dependent elderly patients in the Iberian Peninsula (Spain and Portugal).MethodsA thorough and up-dated review of the literature regarding previous studies, research stays in Hospitals, Primary Health Care Centers and Public Health institutions in both countries financed by the Public Health Administration; in-depth interviews with specific informants.ResultsThe situation of homecare physiotherapy in Spain from the year 1987 to the August 2008 is described. In Portugal, these services are established within the services regulated by Primary Health Care (Decree-Law no. 28/2008, of February 22).ConclusionsThere are few studies in the Iberian Peninsula that offer scientific evidence based information on the effectiveness of these physiotherapy services, user satisfaction and the effect they have in relation to other treatments. However, these studies are needed in order to evaluate the current health legislations, appropriate distribution of resources, to review the clinical programs, clinical action methodologies, etc (AU)

Significância clínica, epidemiologia e microbiologia das bacteremias por estafilococos coagulase-negativos em hospital de ensino / Clinical significance, epidemiology and microbiology of coagulase-negative staphylococcal nosocomial bacteremia at a teaching hospital

Os estafilococos coagulase-negativos (ECN) sao importantes agentes etiológicos das bacteremias hospitalares e freqüentemente considerados como contaminantes de hemoculturas. No período de outubro de 1990 a setembro de 1992, foram estudadas 300 hemoculturas positivas para ECN no Hospital Sao Paulo, sendo 141 bacteremias consideradas de origem hospitalar. Com o objetivo de diferenciar as bacteremias hospitalares verdadeiras das contaminantes por ECN, foram definidos critérios clínicos e microbiológicos. Apenas 20,6 por cento das bacteremias hospitalares por ECN foram consideradas como verdadeiras. A maior freqüência de recém-nascidos internados na unidade de terapia intensiva neonatal, a presença de cateter intravascular e a utilizaçao de nutriçao parenteral foram achados significativos. Nao houve diferença significante quanto a resistência a oxacilina e produçao de SLIME entre os ECN isolados das bacteremias verdadeiras e contaminantes. O critério clínico e a positividade da hemocultura até 48 horas após a incubaçao, utilizados em nossa definiçao, foram úteis para caracterizar as bacteremias verdadeiras por ECN.

[Clinical significance, epidemiology and microbiology of coagulase-negative staphylococcal nosocomial bacteremia at a teaching hospital]. / Significância clínica, epidemiologia e microbiologia das bacteremias por estafilococos coagulase-negativos em hospital de Ensino.

Coagulase-negative staphylococci (CNS) are an important cause of nosocomial bacteremia and they are frequently considered as contaminants of blood-cultures. From October 1990 to September 1992, 300 positive blood-cultures for CNS at the Hospital São Paulo were studied and 141 CNS bacteremias were characterized as nosocomial bacteremias. Clinical and microbiological criteria were defined to differentiate between true CNS bacteremia and contaminated cultures. Only 20.6% of the CNS nosocomial bacteremia were considered as true bacteremia. Most of the CNS true nosocomial bacteremia were detected among newborns admitted to the neonatal intensive care unit; the presence of intravascular catheter and parenteral nutrition were significant findings. We did not detect significant difference between true nosocomial bacteremia and contaminated cultures regarding to resistance to oxacillin and SLIME production. The clinical criteria and the positivity of the blood-cultures up to 48 hours after incubation, utilized in our definitions, were useful parameters to characterize the CNS true nosocomial bacteremia.

Distribution of HLA and haplotypes of Colombian and Jamaican black populations.

To investigate the genetic background of the black populations of Colombia and Jamaica, we determined HLA types of 78 Colombian and 98 Jamaican blacks from 2 different socioeconomic groups (Jamaican #1 and Jamaican #2) and estimated the frequencies of HLA genes and haplotypes. A phylogenetic tree based on the HLA gene frequencies revealed that Jamaican #1 and Jamaican #2 were distinct from each other, Jamaican #1 being closely related to the Colombian blacks and the Jamaican #2 being closely related to Senegalese and Zairean populations. Three-locus HLA haplotypes of Colombian and Jamaican #1 blacks were an admixture between Africans and Caucasians or South American Indians, while Jamaican #2 blacks were relatively homogeneous and appeared to conserve African lineages. The major five-locus HLA haplotypes were not shared among Colombian, Jamaican #1 and Jamaican #2 blacks. These results indicated that the black populations of Colombia and Jamaican were originated from African blacks and admixed variably with Caucasians and South American Indians to make genetic subpopulations in Colombia and Jamaica.

Distribution of HLA and haplotypes of Colombian and Jamaican black populations

To investigate the genetic background of the black populations of Colombia and Jamaica, we determined HLA types of 78 Colombian and 98 Jamaican blacks from 2 different socioeconomic groups (Jamaican #1 and Jamaican #2) and estimated the frequencies of HLA genes and haplotypes. A phylogenetic tree based on the HLA gene frequencies revealed that Jamaican #1 and Jamaican #2 were distinct from each other, Jamaican #1 being closely related to Colombian blacks and the Jamaican #2 being closely related to Senegalese and Zairean populations. Three-locus haplotypes of Colombian and Jamaican #1 blacks were an admixture between Africans and Caucasians or South American Indians while Jamaican #2 blacks were relatively homogeneous and appeared to conserve African lineages. The major five-locus HLA haplotypes were not shared among Colombian, Jamaican #1 and Jamaican #2 blacks. These results indicated that the black populations of Colombia and Jamaica were originated from African blacks and admixed variably with Caucasians and South Americans Indians to make genetic subpopulations in Colombia and Jamaica. (AU)