Chest Decompressions - The Driver of CPR Efficacy: Exploring the Relationship Between Compression Rate, Depth, Recoil Velocity, and End-Tidal CO2.

OBJECTIVE: Cardiopulmonary arrest survival is dependent on optimization of perfusion via high quality cardiopulmonary resuscitation (CPR), defined by a complex dynamic between rate, depth, and recoil velocity. Here we explore the interaction between these metrics and create a model that explores the impact of these variables on compression efficacy. METHODS: This study was performed in a large urban/suburban fire-based emergency medical services (EMS) system over a nine-month period from 2019 to 2020. Manual chest compression parameters [rate/depth/recoil velocity] from a cohort of out-of-hospital cardiac arrest (OOHCA) victims were abstracted from monitor defibrillators (ZOLL X-series) and end-tidal carbon dioxide (ETCO2) from sensors. The mean values of these parameters were modeled against each other using multiple regression and structural equation modeling with ETCO2 as a dependent variable. RESULTS: Data from a total of 335 patients were analyzed. Strong linear relationships were observed between compression depth/recoil velocity (r = .87, p < .001), ETCO2/depth (r = .23, p < .001) and ETCO2/recoil velocity (r = .61, p < .001). Parabolic relationships were observed between rate/depth (r = .39, p < .001), rate/recoil velocity (r = .26, p < .001), and ETCO2/rate (r = .20, p = .003). Rate, depth, and recoil velocity were modeled as independent variables and ETCO2 as a dependent variable with excellence model performance suggesting the primary driver of stroke volume to be recoil velocity rather than compression depth. CONCLUSIONS: We used manual CPR metrics from out of hospital cardiac arrests to model the relationship between CPR metrics. These results consistently support the importance of chest recoil on CPR hemodynamics, suggesting that guidelines for optimal CPR should emphasize the importance of maximum chest recoil.

Emotional State Measurement Trial (EMOPROEXE): A Protocol for Promoting Exercise in Adults and Children with Cerebral Palsy.

BACKGROUND: The protocol described in this paper is part of a research project coordinated between three Spanish universities, where a technology aimed at improving the quality of life of people with cerebral palsy will be developed. Part of the proposed technology will consist of an interface and a series of applications to increase motivation for daily physical activity. The basis of these developments is the measurement of the emotional state of the subjects. METHODS: The experimental protocol is designed with two research objectives, on the one hand to identify the emotional state through physiological signals, and on the other to determine whether music can be a motivating factor to promote physical activity. It is specifically designed for subjects with cerebral palsy, taking into account the special characteristics of this population. These are people with whom it is difficult to use questionnaires to have a basis to contrast with the measured physiological signals, so measurements must be taken in carefully chosen daily-life situations. DISCUSSION: We hope our findings show which physiological parameters are the most robust to measure the emotional state and how to design rehabilitation and physical activity promotion routines that are motivating, in addition to being able to avoid risk factors during the performance of these routines. TRIAL REGISTRATION: NCT05621057.

Physical Activity in Cerebral Palsy: A Current State Study.

This document analyzes a survey conducted in three geographical areas in Spain, focusing on centers for individuals with cerebral palsy (CP). The study aims to determine the adherence rate to recommended physical activity guidelines, assess if there is a decline in interest in physical activity over time, identify the stage at which this decline occurs, and explore potential mechanisms, tools, or strategies to sustain long-term engagement in regular physical activity for this population. The 36-item questionnaire comprises multiple-choice, open-ended, and Likert scale-type questions. Data were collected on physical activity frequency and duration, daily living activities, and demographics. Statistical analysis identified patterns and relationships between variables. Findings reveal that only a 17.6% meets the World Health Organization (WHO) recommendations regarding regular physical activity (RPA), decreasing in frequency or number of days a week, (3.7 d/w to 2.9 d/w; p < 0.01) and duration (50.5 min/d to 45.2 min/d; p < 0.001) with age, especially for those with higher Gross Motor Function Classification System (GMFCS) mobility levels. Obesity slightly correlates with session duration (ρ = -0.207; p < 0.05), not mobility limitations. Gender has no significant impact on mobility, communication, or physical activity, while age affects variables such as body mass index (BMI) and engagement (p < 0.01). A substantial proportion follows regular physical activities based on health professionals' advice, with interest decreasing with age. To improve adherence, focusing on sports-oriented goals, group sessions, and games is recommended. These findings emphasize the importance of personalized programs, particularly for older individuals and those with greater mobility limitations.

Application of Point-of-care Ultrasound for Screening Climbers at High Altitude for Pulmonary B-lines.

INTRODUCTION: High-altitude pulmonary edema (HAPE) occurs as a result of rapid ascent to altitude faster than the acclimatization processes of the body. Symptoms can begin at an elevation of 2,500 meters above sea level. Our objective in this study was to determine the prevalence and trend of developing B-lines at 2,745 meters above sea level among healthy visitors over four consecutive days. METHODS: We performed a prospective case series on healthy volunteers at Mammoth Mountain, CA, USA. Subjects underwent pulmonary ultrasound for B-lines over four consecutive days. RESULTS: We enrolled 21 male and 21 female participants. There was an increase in the sum of B-lines at both lung bases from day 1 to day 3, with a subsequent decrease from day 3 to day 4(P<0.001). By the third day at altitude, B-lines were detectable at base of lungs of all participants. Similarly, B-lines increased at apex of lungs from day 1 to day 3 and decreased on day 4 (P=0.004). CONCLUSION: By the third day at 2,745 meters altitude, B-lines were detectable in the bases of both lungs of all healthy participants in our study. We assume that increasing the number of B-lines could be considered an early sign of HAPE. Point-of-care ultrasound could be used to detect and monitor B-lines at altitude to facilitate early detection of HAPE, regardless of pre-existing risk factors.

Emergency Management Strategies and Antimicrobial Considerations for Nonmammalian Marine Vertebrate Penetrating Trauma in North America, the Caribbean, and Hawaii: A Review Article.

There are numerous emergency department visits in the United States for all types of marine animal injuries each year. These injuries may result in significant morbidity or mortality if not managed appropriately. Accurate identification of the offending species, thorough wound hygiene, and judicious use of antibiotics are important for preventing infections. This review aims to describe management strategies and antimicrobial considerations for nonmammalian marine vertebrate penetrating trauma in North America, the Caribbean, and Hawaii. A literature search was performed to identify studies on this subject. This literature consisted of clinical case reports and case series. Reports extracted included those on sharks, barracuda, eels, catfish, stingrays, lionfish, stonefish, and scorpionfish. The majority of reported trauma occurred to beachgoers, fishermen, or commercial aquarium employees who routinely handle these animals. Injury patterns depended on the species but most commonly affected the lower extremities. Infections were seen from saltwater bacteria, human skin flora, or marine animal oral flora. After thorough wound irrigation and exploration, most authors recommended prophylactic antimicrobials to cover Vibrio species, in addition to other gram-negative and gram-positive species. The literature is notable for the lack of controlled studies. Some authors recommended radiographic and/or ultrasonographic imaging to identify retained foreign bodies, such as spines, sand, or teeth.

A Videogame as a Tool for Clinical Screening of Possible Vulnerability to Impulsivity and Attention Disturbances in Children.

An attention disturbance is a problem that affects many school-aged children. The assessment in children is usually report-based, and as a result, controversy surrounds the diagnosis. To solve this issue, the aim of this study was to develop a new tool to detect possible attention-related problems and impulsive behavior in 4- and 5-year-old children. This tool was developed as an Android app and could be used to provide an early indicator of possible future development problems. A sample of 103 children (48 girls and 55 boys) was randomly selected from primary schools and assessed by Pinky-Piggy, a videogame application based on a classical paradigm in experimental psychology. Data from this app were compared with a Child Neuropsychological Maturity Questionnaire. The subjects displayed different patterns of response to play a very simple game called Pinky-Piggy. The application discriminated between high-responders and low responders. The results showed a relationship between these two profiles and the levels of attention and neurodevelopment in each group. The tool could identify different types of profiles and demonstrated its potential to evaluate endophenotypes to predict attentional problems related to impulsive behavior. Additionally, it required less time and fewer tests to identify possible at-risk populations, thus assisting in clinical diagnosis.

A Study on Physical Exercise and General Mobility in People with Cerebral Palsy: Health through Costless Routines.

Sedentary behavior (SB) is a common problem that may produce health issues in people with cerebral palsy (CP). When added to a progressive reduction in motor functions over time, SB can lead to higher percentages of body fat, muscle stiffness and associated health issues in this population. Regular physical activity (RPA) may prevent the loss of motor skills and reduce health risks. In this work, we analyzed data collected from 40 people (20 children and teenagers, and 20 adults) who attend two specialist centers in Seville to obtain an up-to-date picture regarding the practice of RPA in people with CP. Roughly 60% of the participants showed mostly mid/severe mobility difficulties, while 38% also had communicative issues. Most of the participants performed light-intensity physical activity (PA) at least once or twice a week and, in the majority of cases, had a neutral or positive attitude to exercising. In the Asociación Sevillana de Parálisis Cerebral (ASPACE) sample test, the higher the International Classification of Functioning, Disability and Health (ICF), the higher the percentage of negative responses to doing exercise. Conversely, in the Centro Específico de Educación Especial Mercedes Sanromá (CEEEMS), people likes PA but slightly higher ratios of positive responses were found at Gross Motor Function Classification System (GMFCS) levels V and II, agreeing with the higher personal engagement of people at those levels. We have also performed a literature review regarding RPA in CP and the use of low-cost equipment. As a conclusion, we found that RPA produces enormous benefits for health and motor functions, whatever its intensity and duration. Costless activities such as walking, running or playing sports; exercises requiring low-cost equipment such as elastic bands, certain smartwatches or video-games; or therapies with animals, among many others, have all demonstrated their suitability for such a purpose.

Detecting Attention Levels in ADHD Children with a Video Game and the Measurement of Brain Activity with a Single-Channel BCI Headset.

Attentional biomarkers in attention deficit hyperactivity disorder are difficult to detect using only behavioural testing. We explored whether attention measured by a low-cost EEG system might be helpful to detect a possible disorder at its earliest stages. The GokEvolution application was designed to train attention and to provide a measure to identify attentional problems in children early on. Attention changes registered with NeuroSky MindWave in combination with the CARAS-R psychological test were used to characterise the attentional profiles of 52 non-ADHD and 23 ADHD children aged 7 to 12 years old. The analyses revealed that the GokEvolution was valuable in measuring attention through its use of EEG-BCI technology. The ADHD group showed lower levels of attention and more variability in brain attentional responses when compared to the control group. The application was able to map the low attention profiles of the ADHD group when compared to the control group and could distinguish between participants who completed the task and those who did not. Therefore, this system could potentially be used in clinical settings as a screening tool for early detection of attentional traits in order to prevent their development.

Real-Time Processing Library for Open-Source Hardware Biomedical Sensors.

Applications involving data acquisition from sensors need samples at a preset frequency rate, the filtering out of noise and/or analysis of certain frequency components. We propose a novel software architecture based on open-software hardware platforms which allows programmers to create data streams from input channels and easily implement filters and frequency analysis objects. The performances of the different classes given in the size of memory allocated and execution time (number of clock cycles) were analyzed in the low-cost platform Arduino Genuino. In addition, 11 people took part in an experiment in which they had to implement several exercises and complete a usability test. Sampling rates under 250 Hz (typical for many biomedical applications) makes it feasible to implement filters, sliding windows and Fourier analysis, operating in real time. Participants rated software usability at 70.2 out of 100 and the ease of use when implementing several signal processing applications was rated at just over 4.4 out of 5. Participants showed their intention of using this software because it was percieved as useful and very easy to use. The performances of the library showed that it may be appropriate for implementing small biomedical real-time applications or for human movement monitoring, even in a simple open-source hardware device like Arduino Genuino. The general perception about this library is that it is easy to use and intuitive.

Characterizing Computer Access Using a One-Channel EEG Wireless Sensor.

This work studies the feasibility of using mental attention to access a computer. Brain activity was measured with an electrode placed at the Fp1 position and the reference on the left ear; seven normally developed people and three subjects with cerebral palsy (CP) took part in the experimentation. They were asked to keep their attention high and low for as long as possible during several trials. We recorded attention levels and power bands conveyed by the sensor, but only the first was used for feedback purposes. All of the information was statistically analyzed to find the most significant parameters and a classifier based on linear discriminant analysis (LDA) was also set up. In addition, 60% of the participants were potential users of this technology with an accuracy of over 70%. Including power bands in the classifier did not improve the accuracy in discriminating between the two attentional states. For most people, the best results were obtained by using only the attention indicator in classification. Tiredness was higher in the group with disabilities (2.7 in a scale of 3) than in the other (1.5 in the same scale); and modulating the attention to access a communication board requires that it does not contain many pictograms (between 4 and 7) on screen and has a scanning period of a relatively high t s c a n ≈ 10 s. The information transfer rate (ITR) is similar to the one obtained by other brain computer interfaces (BCI), like those based on sensorimotor rhythms (SMR) or slow cortical potentials (SCP), and makes it suitable as an eye-gaze independent BCI.

La higiene del sueño en el anciano, una labor cercana a la enfermería / Hygiene of sleep in the elderly, a work close to the nursing

Los problemas de sueño que aparecen en nuestros adultos mayores son un inconveniente para quienes lo padecen por cómo influyen en su salud y calidad de vida. Los profesionales sanitarios debemos concienciarnos de que estos trastornos del sueño son más frecuentes en la vejez, en especial el insomnio, y que debemos preocuparnos por formarnos para evitar intervenciones sanitarias inadecuadas. Es labor del profesional de enfermería adquirir las competencias y habilidades que lo capaciten para llevar a cabo una educación sanitaria que ofrezca una asistencia de calidad que englobe los posibles tratamientos de los que se disponen para que sea entre el profesional sanitario y el paciente y/o cuidador quienes decidan la opción que más se adapta a las necesidades y circunstancias de cada anciano

Sleep problems that appear in our older adults are a problem for those who suffer from it by how it affect their health and quality of life. Healthcare professionals should raise awareness that these sleep disorders are most common in the elderly, especially the insomnia and that we should worry for us to avoid inadequate health actions. It is the nursing professional work acquire competences and skills that enables it to carry out a health education offering quality assistance covering the possible treatments are available to make it among the health professional and the patient and/ or caregiver who decide the option that most suits the needs and circumstances of each elder

Sensibilización y detección del maltrato en el anciano. Hacia una atención primaria adaptada a los mayores / Awareness and detection of abuse in the elderly. Towards primary care adapted to the elderly

El maltrato en el anciano se ha convertido en una realidad a la que cada vez se enfrentan con mayor frecuencia los profesionales sanitarios. Este hecho crea la necesidad de que los profesionales sanitarios, de forma multidisciplinar y basándose en una atención lo más cercana posible a la humanización de los cuidados, posean las competencias necesarias que esta demanda sanitaria requiere con el objetivo de garantizar el bienestar y calidad de vida de nuestros mayores. Los profesionales de atención primaria tienen una oportunidad única para identificar e informar del maltrato a personas mayores; por ello es necesario formarlos para ayudarles a detectar, evaluar e intervenir1. En la actualidad no hay instrumentos válidos lo suficientemente sensibles y específicos para la detección de los malos tratos en personas mayores1. Tras revisar las diferentes referencias bibliográficas empleadas nos planteamos como objetivo la elaboración de un "Cuestionario de Ayuda al Profesional de Enfermería de Atención Primaria para la Detección Precoz del Maltrato en las Personas Mayores" (tabla 1)

The elder abuse has become a reality that increasingly health professionals are faced with greater frequency. This fact creates the need for health professionals work in a multidisciplinary team and based on a care as close as possible to the humanization of care; possess the necessary skills required by this health claim with the objective of ensuring the well-being and quality of life of our elders. Primary care professionals have a unique opportunity to identify and report abuse to elderly people, therefore it is necessary to train them to help detect, assess and intervene1. Currently there are no valid, sufficiently sensitive and specific instruments for the detection of child abuse in the elderly1. After reviewing the different used references we have aimed at the elaboration of a "Questionnaire to help professional nursing for early detection of abuse in older people" (table 1)

Factores predictores de mortalidad por trauma craneoencefálico grave / Mortality Predictive Factors in Severe Traumatic Brain Injury

Introducción: conocer el pronóstico de los pacientes graves es una de las piedras angulares de la medicina clínica moderna. Objetivos: determinar los predictores de mortalidad a los 28 días por trauma craneoencefálico grave (Glasgow ≤8) en pacientes ingresados en Terapia Intensiva del Hospital General Universitario Vladimir Ilich Lenin. Métodos: se realizó un estudio de casos y controles (1:1) pareados con la edad, el Injury Severity Score y la necesidad de neurocirugía. Las variables discretas se compararon con Chi cuadrado o la prueba exacta de Fisher según correspondió y las continuas con T-Student para α=0,05. Se construyó un modelo de regresión logística binaria que incluyeron las variables con diferencias estadísticas para determinar las variables predictoras de mortalidad que se ajuste a Hosmer-Lemeshow. Resultados: de 253 pacientes incluidos, el 84,6 % eran hombres. Los fallecidos presentaron mayor edad (48,5±19,3 vs. 55,9±18,7 años, p=0,002), mayor APACHE II [31±20,1 vs. 23±12,1, p<0,001), menor presión arterial media (84,2±12,5 vs 65,3±10,4, p<0,001), menor Glasgow al ingreso y al tercer día (p<0,001) y más frecuentemente hemorragia subaracnoidea (24,6% vs. 37%, p=0,04). El análisis multivariado mostró que las peores lesiones cerebrales (Marshall V-VI) (OR= 2,14, IC: 1,28-3,57, p<0,001), una o ambas pupilas arreactivas (OR=5,46, IC:2,99-9,95, p=0,004), los mayores de 45 años (OR=1,92, IC:1,01-4,12, p=0,049), y la presencia de hematoma subdural (OR=3,25, IC:1,18-9,00, p=0,023), fueron los predictores de mortalidad. Conclusiones: los grados V-VI de Marshall, las alteraciones pupilares, los mayores de 45 años y la presencia de hematoma subdural constituyeron predictores de mortalidad entre los pacientes estudiados.

Introduction: to know the prognosis of patients with some disease is one of the bases of the current clinical medicine. Objectives: to determine the main predictor of mortality at 28 days after severe traumatic brain injury (Glasgow ≤8) patients admitted at intensive care of V. I. Lenin Hospital. Methods: a case-control (1:1) study pared by age, Injury Severity Score, and the need of neurosurgery was performed. Discrete variables were compared using Chi squared test or Fisher exact test as needed and continuous one were compare with T-Student for α=0.05. A binary logistic regression model was established including statistically different variables to determine predictors of mortality according with Hosmer-Lemeshow. Results: of 253 included patients in the study, 84.6 % were males. Mortality was higher among older patients (48.5±19.3 vs. 55.9±18.7 years, p=0.002), >45 year-old (p=0.026), and higher APACHE II score (31±20.1 vs. 23±12.1, p<0.001); Glasgow coma scale on admission and at third day (p<0.001), and mean blood pressure were lower (65.3±10.4 vs. 84.2±12.5, p<0.001). Subarachnoid hemorrhage (24.6% vs. 37%, p=0.04) was associated with mortality. Multivariate analysis showed that a Marshall tomographic score of V-VI (OR=2.14, IC:1.28-3.57, p=0,001), one or both pupils unreactive (OR=5.46, IC: 2.99-9.95), >45 years (OR=1.92, IC:1.01-4.12), and subdural hematoma (OR=3.25, IC:1.18-9.00, p=0,023) were predictors of mortality. Conclusions: tomographic grade V-VI of Marshall, pupillary alterations, age >45 years, and the presence of subdural hematoma were predictors of mortality among the patients included in this research.

Implementación de un protocolo para la separación de la ventilación mecánica de pacientes graves, dirigido por enfermeros intensivistas / Implementation of a Protocol for Separation of Mechanical Ventilation in Critically Ill Patients Managed by Intensive Care Nurses

Introducción: la aplicación de protocolos de separación de la ventilación mecánica parece ser ventajosa aunque los resultados reportados son contradictorios.Objetivo: introducir y evaluar la eficacia de un protocolo de destete dirigido por enfermeros intensivistas para disminuir la letalidad y la duración de la ventilación mecánica.Métodos: se realizó un estudio cuasi experimental (modalidad antes y después) en la Unidad de Cuidados Intensivos del Hospital Lenin de Holguín entre noviembre de 2009 y abril de 2010. Se evaluaron 135 pacientes consecutivos que recibieron ventilación mecánica invasiva >24 h; se excluyeron aquellos con lesiones medulares por encima de C4 y los enfermos terminales. Los pacientes estables clínica y gasométricamente fueron incluidos en el protocolo de separación de la ventilación mecánica. Una hora después de iniciarse el ensayo de ventilación espontánea, se aplicó el índice de respiraciones rápidas superficiales (IRRS) y se consideró exitoso el destete después de 24 h respirando espontáneamente. Las variables discretas se compararon con la prueba de Chi cuadrado y las continuas con t-Student para α=0,05. Resultados: de 135 pacientes evaluados, 66 fueron incluidos. El 65,2 % eran hombres, la edad media fue de 59,4±16,9 años y tenían menor APACHE II (19,9±8,0 vs. 25,4±7,1, p<0,001) que los que no se incluyeron. La primera causa de ventilación mecánica fue el coma. La separación fue exitosa en el 81,8 % aplicando el protocolo (p<0,001). El IRRS no mostró diferencias entre los que fueron separados exitosamente y el resto. Durante la implementación del protocolo se redujo la duración de la VM (6,8±5,9 vs. 5,4±4,5 días, p=0,035) y la letalidad disminuyó aunque sin diferencias significativas (66,9 % vs. 57,8 %, p=0,18). Conclusiones: la introducción del protocolo permitió disminuir la duración de la VM pero no la letalidad en ventilados.(AU)

Introduction: the implementation of protocols for weaning from mechanical ventilation (MV) seems to be advantageous although results are contradictories.Objective: to introduce and evaluate a weaning from MV protocol directed by for intensive care nurses to decrease lethality and MV duration.Methods: a quasi-experimental research with the patients admitted at Intensive Care Unit from V. I. Lenin General University Hospital between November 2009 and April 2010 was performed. One hundred and five consecutive invasive ventilated patients for more than 24 hours were evaluated. Patients with medullary lesion above C4 and those in terminal stage were excluded. A protocol based on rapid-shallow-breathing index measured one hour after the patient had been removed from MV was evaluated. Categorical variables were compared with Chi squared test and continuous variables with t-Student.Results: of 135 evaluated patients, 66 were included. 65.2 % were males with a mean age of 59.4±16.9 years and lower APACHE II (19.9±8.0 vs. 25.4±7.1, p<0.001). The first cause of MV was coma. Successful weaning using the protocol was observed in 81.1 % (p=<0.001). Rapid-shallow-breathing index did not show significant differences between the successful weaned patients and the rest ones. Although the duration of MV was lower (6.8±5.9 vs. 5.4±4.5 days, p=0.035) during the protocol implementation period compared with the six previous months, lethality showed no significant differences (66.9% vs. 57.8 %, p=0.18).Conclusions: the introduction of this protocol allowed to diminish the duration of MV but did not improve lethality between ventilated patients.(AU)

Factores predictores de mortalidad por trauma craneoencefálico grave / Mortality Predictive Factors in Severe Traumatic Brain Injury

Introducción conocer el pronóstico de los pacientes graves es una de las piedras angulares de la medicina clínica moderna.Objetivos: determinar los predictores de mortalidad a los 28 días por trauma craneoencefálico grave (Glasgow ≤8) en pacientes ingresados en Terapia Intensiva del Hospital General Universitario Vladimir Ilich Lenin.Métodos: se realizó un estudio de casos y controles (1:1) pareados con la edad, el Injury Severity Score y la necesidad de neurocirugía. Las variables discretas se compararon con Chi cuadrado o la prueba exacta de Fisher según correspondió y las continuas con T-Student para α=0,05. Se construyó un modelo de regresión logística binaria que incluyeron las variables con diferencias estadísticas para determinar las variables predictoras de mortalidad que se ajuste a Hosmer-Lemeshow.Resultados: de 253 pacientes incluidos, el 84,6 % eran hombres. Los fallecidos presentaron mayor edad (48,5±19,3 vs. 55,9±18,7 años, p=0,002), mayor APACHE II [31±20,1 vs. 23±12,1, p<0,001), menor presión arterial media (84,2±12,5 vs 65,3±10,4, p<0,001), menor Glasgow al ingreso y al tercer día (p<0,001) y más frecuentemente hemorragia subaracnoidea (24,6% vs. 37%, p=0,04). El análisis multivariado mostró que las peores lesiones cerebrales (Marshall V-VI) (OR= 2,14, IC: 1,28–3,57, p<0,001), una o ambas pupilas arreactivas (OR=5,46, IC:2,99–9,95, p=0,004), los mayores de 45 años (OR=1,92, IC:1,01–4,12, p=0,049), y la presencia de hematoma subdural (OR=3,25, IC:1,18–9,00, p=0,023), fueron los predictores de mortalidad.Conclusiones: los grados V-VI de Marshall, las alteraciones pupilares, los mayores de 45 años y la presencia de hematoma subdural constituyeron predictores de mortalidad entre los pacientes estudiados.(AU)

Introduction to know the prognosis of patients with some disease is one of the bases of the current clinical medicine.Objectives: to determine the main predictor of mortality at 28 days after severe traumatic brain injury (Glasgow ≤8) patients admitted at intensive care of V. I. Lenin Hospital.Methods: a case-control (1:1) study pared by age, Injury Severity Score, and the need of neurosurgery was performed. Discrete variables were compared using Chi squared test or Fisher exact test as needed and continuous one were compare with T-Student for α=0.05. A binary logistic regression model was established including statistically different variables to determine predictors of mortality according with Hosmer-Lemeshow.Results: of 253 included patients in the study, 84.6 % were males. Mortality was higher among older patients (48.5±19.3 vs. 55.9±18.7 years, p=0.002), >45 year-old (p=0.026), and higher APACHE II score (31±20.1 vs. 23±12.1, p<0.001); Glasgow coma scale on admission and at third day (p<0.001), and mean blood pressure were lower (65.3±10.4 vs. 84.2±12.5, p<0.001). Subarachnoid hemorrhage (24.6% vs. 37%, p=0.04) was associated with mortality. Multivariate analysis showed that a Marshall tomographic score of V-VI (OR=2.14, IC:1.28–3.57, p=0,001), one or both pupils unreactive (OR=5.46, IC: 2.99–9.95), >45 years (OR=1.92, IC:1.01–4.12), and subdural hematoma (OR=3.25, IC:1.18–9.00, p=0,023) were predictors of mortality.Conclusions: tomographic grade V-VI of Marshall, pupillary alterations, age >45 years, and the presence of subdural hematoma were predictors of mortality among the patients included in this research.(AU)

Leucine and arginine regulate trophoblast motility through mTOR-dependent and independent pathways in the preimplantation mouse embryo.

Uterine implantation is a critical element of mammalian reproduction and is a tightly and highly coordinated event. An intricate and reciprocal uterine-embryo dialog exists to synchronize uterine receptivity with the concomitant activation of the blastocyst, maximizing implantation success. While a number of pathways involved in regulating uterine receptivity have been identified in the mouse, less is understood about blastocyst activation, the process by which the trophectoderm (TE) receives extrinsic cues that initiate new characteristics essential for implantation. Amino acids (AA) have been found to regulate blastocyst activation and TE motility in vitro. In particular, we find that arginine and leucine alone are necessary and sufficient to induce TE motility. Both arginine and leucine act individually and additively to propagate signals that are dependent on the activity of the mammalian target of rapamycin complex 1 (mTORC1). The activities of the well-established downstream targets of mTORC1, p70S6K and 4EBP, do not correlate with trophoblast motility, suggesting that an independent-rapamycin-sensitive pathway operates to induce trophoblast motility, or that other, parallel amino acid-dependent pathways are also involved. We find that endogenous uterine factors act to induce mTORC1 activation and trophoblast motility at a specific time during pregnancy, and that this uterine signal is later than the previously defined signal that induces the attachment reaction. In vivo matured blastocysts exhibit competence to respond to an 8-hour AA stimulus by activating mTOR and subsequently undergoing trophoblast outgrowth by the morning of day 4.5 of pregnancy, but not on day 3.5. By the late afternoon of day 4.5, the embryos no longer require any exposure to AA to undergo trophoblast outgrowth in vitro, demonstrating the existence and timing of an equivalent in vivo signal. These results suggest that there are two separate uterine signals regulating implantation, one that primes the embryo for the attachment reaction and another that activates mTOR and initiates invasive behavior.

Trabeculoesclerectomía profunda no perforante versus trabeculectomía en glaucoma crónico de ángulo abierto / Nonpenetrating deep trabecular sclerostomy versus trabeculectomy in chronic open angle glaucoma

Objetivo: Estudio prospectivo para comparar los resultados de efectividad en la baja de la PIO, complicaciones intraoperatorias y postoperatorias, en pacientes portadores de glaucoma crónico de ángulo Abierto Primario operados con trabeculoesclerectomía profunda no perforante (EPNP) y Trabeculectomía perforante (TREC). Métodos: Se estudian 69 casos de pacientes operados con la técnica EPNP y 35 casos de pacientes operados con TREC, todos portadores de GCAAP. Se analizan los resultados tensionales postoperatorio a los 2, 4, 8, 12 y 18 meses, las complicaciones intra y postoperatorias. Resultados: La baja tensional entre las dos técnicas es similar y la mayor diferencia está en la frecuencia de las complicaciones, que con la técnica no perforante es sólo del 15,5 por ciento a diferencia de la Trabeculectomía perforante en la que el porcentaje de complicaciones es mucho mayor, de 54 por ciento.

Estimulación sensoriomotriz de lactantes con limitación visual severa / Sensitive motor stimulation of infant with severe visual limitation

Se presenta el método de estimulación llamado El Cuartito. Este se basa en desarrollar la presión tan pronto como sea posible y con esto estimular la relación con el medio, la noción de espacio y los otros sentidos del lactante. El método es simple, práctico, barato y probado. Es primordial no retrasar el diagnóstico de ceguera y esto compete al oftalmólogo

Tuberculosis pulmonar poliresistente: presentación de dos casos / Polyresistant pulmonary tuberculosis: report of 2 cases

Se presentan los casos de dos pacientes con tuberculosis pulmonar que presentaron resistencia a múltiples drogas del tratamiento específico. En ambos casos se identificó el Mycobacterium tuberculosis y se efectuaron las pruebas de sensibilidad. Hasta el presente no se habían reportado en nuestro medio casos de resistencia primaria o secundaria a la Rifampicina, droga que ha permitido efectuar un significativo cambio en el esquema y duración del tratamiento de los pacientes con tuberculosis, por lo que estos dos primeros casos presentados deben ser considerados como un alerta, ya que el fenómeno de resistencia bacteriana siempre está latente. La detección de un incremento en los casos de tuberculosis y la aparición de los casos de resistencia que reportamos, nos obligan a revisar este tema y a sugerir que se insista en la educación permanente del médico y del paciente

Incidencia de trauma acústico en la población trabajadora de una industria metalúrgica en la ciudad de Panamá / Acoustic trauma incidence in the worker population of a metallurgic industry in Panama city

Se estudia una población de 40 trabajadores de una industria metalúrgica, que laboran en un ambiente de trabajo ruidoso, cuyos niveles de presión sonora superan el límite máximo permisible (85 dB). El 85% de la población trabajadora, perteneciente al sexo masculino y al área de producción, padecen de diferentes grados de Trauma Acústico (TA) atribuible al ruido industrial. Se hace énfasis en la vulnerabilidad de las células neurales sensitivas de las vías auditivas a los desórdenes y deprivaciones metabólicas orgánicas como lo son el oxigenío y la glucosa, reflejándose en el audiograma una imagen muy similar a las descritas en los casos de TA superficial o medio. Como resultado de esta experiencia se resalta la importancia de una cuidadosa historia clínica en la investigación relativa a pérdidas auditivas por exposición al ruido y la necesidad de la implementación de normas de Higiene y Seguridad laboral, medidas que deben ser respaldadas por una legislación laboral armónica con nuestra realidad