Evidence of involvement of neurone-glia/neurone-neurone communications via gap junctions in synchronised activity of KNDy neurones.

Pulsatile secretion of gonadotrophin-releasing hormone (GnRH)/luteinising hormone is indispensable for the onset of puberty and reproductive activities at adulthood in mammalian species. A cohort of neurones expressing three neuropeptides, namely kisspeptin, encoded by the Kiss1 gene, neurokinin B (NKB) and dynorphin A, localised in the hypothalamic arcuate nucleus (ARC), so-called KNDy neurones, comprises a putative intrinsic source of the GnRH pulse generator. Synchronous activity among KNDy neurones is considered to be required for pulsatile GnRH secretion. It has been reported that gap junctions play a key role in synchronising electrical activity in the central nervous system. Thus, we hypothesised that gap junctions are involved in the synchronised activities of KNDy neurones, which is induced by NKB-NK3R signalling. We determined the role of NKB-NK3R signalling in Ca2+ oscillation (an indicator of neuronal activities) of KNDy neurones and its synchronisation mechanism among KNDy neurones. Senktide, a selective agonist for NK3R, increased the frequency of Ca2+ oscillations in cultured Kiss1-GFP cells collected from the mediobasal hypothalamus of the foetal Kiss1-green fluorescent protein (GFP) mice. The senktide-induced Ca2+ oscillations were synchronised in the Kiss1-GFP and neighbouring glial cells. Confocal microscopy analysis of these cells, which have shown synchronised Ca2+ oscillations, revealed close contacts between Kiss1-GFP cells, as well as between Kiss1-GFP cells and glial cells. Dye coupling experiments suggest cell-to-cell communication through gap junctions between Kiss1-GFP cells and neighbouring glial cells. Connexin-26 and -37 mRNA were found in isolated ARC Kiss1 cells taken from adult female Kiss1-GFP transgenic mice. Furthermore, 18ß-glycyrrhetinic acids and mefloquine, which are gap junction inhibitors, attenuated senktide-induced Ca2+ oscillations in Kiss1-GFP cells. Taken together, these results suggest that NKB-NK3R signalling enhances synchronised activities among neighbouring KNDy neurones, and that both neurone-neurone and neurone-glia communications via gap junctions possibly contribute to synchronised activities among KNDy neurones.

Pseudoautosomal abnormalities in terminal AZFb+c deletions are associated with isochromosomes Yp and may lead to abnormal growth and neuropsychiatric function.

STUDY QUESTION: Are copy number variations (CNVs) in the pseudoautosomal regions (PARs) frequent in subjects with Y-chromosome microdeletions and can they lead to abnormal stature and/or neuropsychiatric disorders? SUMMARY ANSWER: Only subjects diagnosed with azoospermia factor (AZF)b+c deletions spanning to the end of the Y chromosome (i.e. terminal deletions) harbor Y isochromosomes and/or cells 45,X that lead to pseudoautosomal gene CNVs, which were associated with abnormal stature and/or neuropsychiatric disorders. WHAT IS KNOWN ALREADY: The microdeletions in the long arm of the Y chromosome (Yq) that include the loss of one to three AZF regions, referred to as Yq microdeletions, constitute the most important known etiological factor for primary spermatogenic failure. Recently, controversy has arisen about whether Yq microdeletions are associated with gain or loss of PAR genes, which are implicated in skeletal development and neuropsychiatric function. STUDY DESIGN, SIZE, DURATION: We studied a cohort of 42 Chilean patients with complete AZF deletions (4 AZFa, 4 AZFb, 23 AZFc, 11 AZFb+c) from a university medical center, diagnosed over a period of 15 years. The subjects underwent complete medical examinations with special attention to their stature and neuropsychiatric function. PARTICIPANTS/MATERIALS, SETTING, METHODS: All subjects were characterized for Yq breakpoints by PCR, and for CNVs in PARs by multiplex ligation-dependent probe amplification (MLPA), followed by qPCR analysis for genes in PAR1 (SHOX and ZBED1), PAR2 (IL9R) and two single copy genes (SRY and DDX3Y, respectively located in Yp11.3 and AZFa). In addition, karyotypes revision and fluorescence in situ hybridization (FISH) for SRY and centromeric probes for X (DXZ1) and Y (DYZ3) chromosomes were performed in males affected with CNVs. MAIN RESULTS AND THE ROLE OF CHANCE: We did not detect CNVs in any of the 35 AZF-deleted men with interstitial deletions (AZFa, AZFb, AZFc or AZFb+c). However, six of the seven patients with terminal AZFb+c deletions showed CNVs: two patients showed a loss and four patients showed a gain of PAR1 genes, with the expected loss of VAMP-7 in PAR2. In these patients, the Yq breakpoints localized to the palindromes P8, P5 or P4. In the four cases with gain of PAR1, qPCR analysis showed duplicated signals for SRY and DDX3Y and one copy of IL9R, indicating isodicentric Yp chromosomes [idic(Y)] with breakpoint in Yq11.22. The two patients who had loss of PAR1, as shown by MLPA, had an additional reduction for SRY and DDX3Y, as shown by qPCR, associated with a high proportion of 45,X cells, as determined by FISH and karyotype. In agreement with the karyotype analysis, we detected DYZ3++ and DYZ3+ cells by FISH in the six patients, confirming idic(Y) and revealing additional monocentric Y chromosome [i(Y)]. Five patients had a history of major depressive disorders or bipolar disorder, and three had language impairment, whereas two patients showed severe short stature (Z score: -2.75 and -2.62), while a man with bipolar disorder was very tall (Z score: +2.56). LARGE SCALE DATA: N/A. LIMITATIONS, REASONS FOR CAUTION: The number of males studied with Y-chromosome microdeletions and normozoospermic controls with normal karyotypes may not be enough to rule out an association between AZF deletions and PAR abnormalities. The prevalence of Y isochromosomes and/or 45,X cells detected in peripheral blood does not necessarily reflect the variations of PAR genes in target tissues. WIDER IMPLICATIONS OF THE FINDINGS: This study shows that CNVs in PARs were present exclusively in patients with terminal AZFb+c deletions associated with the presence of Y isochromosomes and 45,X cells, and may lead to neuropsychiatric and growth disorders. In contrast, we show that men with interstitial Yq microdeletions with normal karyotypes do not have an increased risk of PAR abnormalities and of phenotypical consequences. Moreover, our results highlight the importance of performing molecular studies, which are not considered in the usual screening for patients with Yq microdeletions. STUDY FUNDING/COMPETING INTERESTS: This work was supported by the National Fund for Scientific and Technological Development of Chile (FONDECYT), grant no. 1120176 (A.C.). The authors declare that no conflicting interests exist.

Outcomes of a multicomponent intervention on occupational performance in persons with unilateral acquired brain injury.

Complications after unilateral acquired brain injury (ABI) can affect various areas of expertise causing (depending on the location of the lesion) impairment in occupational performance. The aim of this study was to analyze and compare the concepts of occupational performance and functional independence, both before and after a multicomponent intervention including occupational therapy, in persons with unilateral brain damage. This was a longitudinal quasi-experimental pretest post-test study in a sample of 58 patients with unilateral brain injury (28 with traumatic brain injury and 30 with ischemic stroke). The patients' level of independence was measured using the short version of the International Classification of Functioning, Disability and Health. We also measured quality of performance using the Assessment of Motor and Process Skills. The findings of this study showed that patients with injury in the right hemisphere improved more than those with left hemisphere damage (p<0.001). All the patients with ABI, especially those with right-sided injury, derived benefit from the multicomponent intervention, except in the area of motor skills. More research is needed on the specific techniques that might address such skills.

Predictores de funcionalidad en el daño cerebral adquirido / Functionality predictors in acquired brain damage

Introducción: La mayoría de las personas que han sobrevivido a un daño cerebral presentan secuelas que afectan a componentes sensoriomotores, cognitivos, emocionales o conductuales. Estos déficits repercuten en la correcta ejecución de actividades de la vida diaria. El objetivo de este estudio es identificar diferencias funcionales entre personas con daño cerebral adquirido (DCA) unilateral, mediante la independencia funcional, la capacidad y la realización de las actividades cotidianas. Método: Diseño transversal descriptivo con una muestra de 58 personas con lesiones derechas (n = 14 TCE, n = 15 ECV) e izquierdas (n = 14 TCE, n = 15 ECV), diestros, con una media de edad de 47 años y una media de 4 ± 3,65 años de evolución. Las medidas utilizadas fueron la FIM FAM y la CIF. Resultados: Los datos apuntan hacia la existencia de diferencias significativas (p < 0,000) y un elevado tamaño del efecto (dr = 0,78) en las estimaciones transversales, otorgando una menor restricción en la participación en las personas con lesión derecha. Las diferencias más destacadas se encuentran en las variables «recepción de mensajes hablados», «escritura» y «habla inteligible». Al hacer una regresión lineal, los resultados muestran que solo 4 variables de la FIM FAM predicen, en su conjunto, un 44% la variancia de la CIF que mide la capacidad del individuo y hasta un 52% de la CIF que mide la realización del sujeto. Tan solo la marcha predeciría un 28% de la variancia. Conclusiones: Se sugiere que las personas con DCA en el hemisferio izquierdo presentan importantes diferencias en variables funcionales y de la comunicación. Los aspectos motores representan un gran factor pronóstico para la rehabilitación funcional

Introduction: Most individuals who have survived an acquired brain injury present consequences affecting the sensorimotor, cognitive, affective or behavioural components. These deficits affect the proper performance of daily living activities. The aim of this study is to identify functional differences between individuals with unilateral acquired brain injury using functional independence, capacity, and performance of daily activities. Method: Descriptive cross-sectional design with a sample of 58 people, with right-sided injury (n = 14 TBI; n = 15 stroke) or left-sided injury (n = 14 TBI, n = 15 stroke), right handed, and with a mean age of 47 years and time since onset of 4 ± 3.65 years. The functional assessment/functional independence measure (FIM/FAM) and the International Classification of Functioning (ICF) were used for the study. Results: The data showed significant differences (P<.000), and a large size effect (dr=0.78) in the cross-sectional estimates, and point to fewer restrictions for patients with a lesion on their right side. The major differences were in the variables ‘speaking’ and ‘receiving spoken messages’ (ICF variables), and ‘Expression’, ‘Writing’ and ‘intelligible speech’ (FIM/FAM variables). In the linear regression analysis, the results showed that only 4 FIM/FAM variables, taken together, predict 44% of the ICF variance, which measures the ability of the individual, and up to 52% of the ICF, which measures the individual's performance. Gait alone predicts a 28% of the variance. Conclusions: It seems that individuals with acquired brain injury in the left hemisphere display important differences regarding functional and communication variables. The motor aspects are an important prognostic factor in functional rehabilitation

Functionality predictors in acquired brain damage.

INTRODUCTION: Most individuals who have survived an acquired brain injury present consequences affecting the sensorimotor, cognitive, affective or behavioural components. These deficits affect the proper performance of daily living activities. The aim of this study is to identify functional differences between individuals with unilateral acquired brain injury using functional independence, capacity, and performance of daily activities. METHOD: Descriptive cross-sectional design with a sample of 58 people, with right-sided injury (n=14 TBI; n=15 stroke) or left-sided injury (n = 14 TBI, n = 15 stroke), right handed, and with a mean age of 47 years and time since onset of 4 ± 3.65 years. The functional assessment/functional independence measure (FIM/FAM) and the International Classification of Functioning (ICF) were used for the study. RESULTS: The data showed significant differences (P<.000), and a large size effect (dr=0.78) in the cross-sectional estimates, and point to fewer restrictions for patients with a lesion on their right side. The major differences were in the variables 'speaking' and 'receiving spoken messages' (ICF variables), and 'Expression', 'Writing' and 'intelligible speech' (FIM/FAM variables). In the linear regression analysis, the results showed that only 4 FIM/FAM variables, taken together, predict 44% of the ICF variance, which measures the ability of the individual, and up to 52% of the ICF, which measures the individual's performance. Gait alone predicts a 28% of the variance. CONCLUSIONS: It seems that individuals with acquired brain injury in the left hemisphere display important differences regarding functional and communication variables. The motor aspects are an important prognostic factor in functional rehabilitation.

[Evidence-based medicine: can we trust the results of well-designed randomized trials?]. / Medicina Basada en Evidencia: ¿podemos confiar en los resultados de los estudios clínicos aleatorizados bien diseñados?

Evidence based medicine assists in clinical decision-making by integrating critically appraised information with patient's values and preferences within an existing clinical context. A fundamental concept in this paradigm is the hierarchy of information. The randomized clinical trial is recognized as one of the designs that is less prone to bias and therefore of higher methodological quality. Clinical guidelines are one of the principal tools that evidence based medicine uses to transfer scientific information to clinical practice and many of their recommendations are based on these type of studies. In this review we present some of the limitations that the results can have, in even well designed and executed randomized clinical trials. We also discuss why valid results in these types of studies could not necessarily be extrapolated to the general population. Although the randomized clinical trial continues to be one of the best methodological designs, we suggest that the reader be careful when interpreting its results.

[Evaluation of the community integration of persons with lateralised post-acute acquired brain injury]. / Valoracion de la integracion en la comunidad de las personas con daño cerebral adquirido postagudo lateralizado.

INTRODUCTION. Hemispheric specialization is a topic of interest that has motivated an enormous amount of research in recent decades. After a unilateral brain injury, the consequences can affect various areas of specialization, leading, depending on the location of the injury, impairment in quality of life and community integration. PATIENTS AND METHODS. Cross-sectional study with a sample of 58 patients, 28 traumatic brain injury (TBI) and 30 cerebrovascular accidents, both lateralized. The level of integration in the community is measured by the Community Integration Questionnaire. RESULTS. There were three groups analyzed by considering unilateral injury (full sample, stroke sample, and TBI sample). Results showed a significantly high community integration of people with right hemisphere injury. However, to measure the level of community integration between TBI and stroke, the results showed no significant differences. CONCLUSION. According to the results of the study people with brain injury in the right hemisphere have a better community integration than people with lesions in the left hemisphere regardless of the origin of the lesions (vascular or traumatic). We discussed the reasons that may motivate the differences and clinical implications.

TITLE: Valoracion de la integracion en la comunidad de las personas con daño cerebral adquirido postagudo lateralizado.Introduccion. La especializacion hemisferica es un tema de interes que ha motivado un gran volumen de investigacion en las ultimas decadas. Tras una lesion cerebral lateralizada, las secuelas pueden afectar a diversas areas de especializacion, provocando, en funcion de la localizacion de la lesion, una afectacion en la calidad de vida y en la integracion comunitaria. Pacientes y metodos. Estudio transversal con una muestra de 58 pacientes, 28 con traumatismos craneoencefalicos (TCE) y 30 con accidentes cerebrovasculares (ACV), ambos lateralizados. El nivel de integracion en la comunidad se midio con el cuestionario de integracion comunitaria (CIQ). Resultados. De los grupos analizados teniendo en cuenta la lesion lateralizada (muestra completa, muestra de ACV y muestra de TCE), los resultados mostraron una significativamente mayor integracion comunitaria de las personas con lesion en el hemisferio derecho. Sin embargo, al medir el nivel de integracion comunitaria entre TCE y ACV, los resultados no mostraron diferencias significativas. Conclusion. Segun los resultados del estudio, las personas con lesion cerebral en el hemisferio derecho presentan una mejor integracion comunitaria que las personas con lesion en el hemisferio izquierdo, con independencia del origen de las lesiones (vascular o traumatica). Se discuten las razones que pueden motivar las diferencias y las implicaciones clinicas.

[Efficacy of nifurtimox for the treatment of chronic Chagas disease]. / Eficacia de nifurtimox para el tratamiento de pacientes con enfermedad de Chagas crónica.

BACKGROUND: Most Chagas patients belong to the chronic indeterminate stage, in which pharmacological treatment has an inconclusive outcome. OBJECTIVE: To evaluate the efficacy of nifurtimox treatment in chronic asymptomatic Trypanosoma cruzi infection. METHODS: We performed a systematic review and meta-analysis of electronically published literature, with no language, type of study, age or gender restrictions, until September 2010. Studies of chronic asymptomatic Chagas disease patients treated exclusively with nifurtimox were included in the analysis. Treatment efficacy was evaluated using parasitological or serological parameters. RESULTS: Of 463 identified studies, 7 were finally selected: 6 observational studies and 1 randomized clinical trial; 4 of the studies were in adults, 3 in children < 14 years. In 6 studies, outcomes were defined by serological techniques. Summary estimate (log odds) was 0.37 (CI9 -1.32 - 2.07). CONCLUSIONS: The analyzed studies gave discordant results. Those might be explained by differences in the populations studied, follow-up periods, diagnostic techniques, and sample size. More studies are necessary to obtain conclusive results about treatment efficacy of nifurtimox in this clinical phase of T. cruzi infection.

Eficacia de nifurtimox para el tratamiento de pacientes con enfermedad de Chagas crónica / Efficacy of nifurtimox for the treatment of chronic Chagas disease

Background: Most Chagas patients belong to the chronic indeterminate stage, in which pharmacological treatment has an inconclusive outcome. Objective: To evaluate the efficacy of nifurtimox treatment in chronic asymptomatic Trypanosoma cruzi infection. Methods: We performed a systematic review and meta-analysis of electronically published literature, with no language, type of study, age or gender restrictions, until September 2010. Studies of chronic asymptomatic Chagas disease patients treated exclusively with nifurtimox were included in the analysis. Treatment efficacy was evaluated using parasitological or serological parameters. Results: Of 463 identified studies, 7 were finally selected: 6 observational studies and 1 randomized clinical trial; 4 of the studies were in adults, 3 in children < 14 years. In 6 studies, outcomes were defined by serological techniques. Summary estimate (log odds) was 0.37 (CI9 -1.32 - 2.07). Conclusions: The analyzed studies gave discordant results. Those might be explained by differences in the populations studied, follow-up periods, diagnostic techniques, and sample size. More studies are necessary to obtain conclusive results about treatment efficacy of nifurtimox in this clinical phase of T. cruzi infection.

Introducción: La mayoría de los pacientes con enfermedad de Chagas se encuentran en fase crónica indeterminada donde los resultados de tratamiento farmacológico no han sido concluyentes. Objetivo: Evaluar la evidencia que apoya la eicacia del tratamiento con nifurtimox en la infección crónica por Trypanosoma cruzi asintomática. Método: Revisión sistemática y meta-análisis de literatura publicada en forma electrónica, sin restricción de lenguaje, tipo de estudio, edad y género, hasta septiembre de 2010. Se incluyeron estudios de pacientes con enfermedad de Chagas crónica asintomáticos que recibieron tratamiento exclusivo con nifurtimox. La eicacia del tratamiento fue evaluada mediante métodos parasitológicos o serológicos. Resultados: Se identiicaron 463 estudios primarios seleccionando inalmente siete: seis observacionales y un ensayo clínico randomizado; cuatro en pacientes adultos y tres en niños bajo14 años de edad. En seis estudios los resultados se midieron mediantes técnicas serológicas. La medida resumen (log de la chance) fue de 0,37 (IC95% -1,32 -2,07). Conclusiones: Los resultados son discordantes. La incertidumbre se maniiesta por las diferencias en las poblaciones estudiadas, periodos de seguimiento, técnicas diagnósticas y tamaño de las muestras. Es necesario realizar nuevos estudios que consideren las fuentes de incertidumbre para obtener resultados concluyentes sobre la eicacia del nifurtimox en esta fase clínica de la infección por T. cruzi.

Estrategias de conservación de la energía en el tratamiento de la fatiga en pacientes con esclerosis múltiple. Estudio piloto / Energy saving strategies in th treatment of fatigue in patients with multiple sclerosis. A pilot study

Introducción. La esclerosis múltiple (EM) es la tercera causa más frecuente de discapacidad neurológica en adultos, y en el 75-95% de los sujetos presenta fatiga, que es el síntoma que interfiere más con las actividades de la vida diaria y es la primera causa de abandono del trabajo. Objetivo. Evaluar la adhesión y eficacia de un curso sobre conservación de la energía en la disminución de la fatiga y el aumento de la calidad de vida en personas con EM. Pacientes y métodos. Estudio piloto cuasi aleatorio (aunque la asignación al grupo control e intervención fue aleatorizada, los investigadores eligieron el número de pacientes asignados a cada grupo) con un grupo control de 14 pacientes con EM que presentaban fatiga. Se realizaron dos sesiones de dos horas del curso de técnicas de conservación de la energía realizado por una terapeuta ocupacional n un grupo de nueve pacientes. Se midió la autoeficacia para realizar la evaluación de las estrategias de conservación de energía, la escala de impacto de la fatiga (FIS), el cuestionario de salud (SF-36) y el cuestionario abierto sobre mejoras en el curso. Resultados. Los participantes tuvieron una alta adhesión al tratamiento (con un aumento de media de 2,17), y en las escalas FIS y SF-36 se obtuvieron mejoras, aunque no estadísticamente significativas. Conclusiones. Los pacientes con EM presentan una alta adhesión a un curso sobre estrategias de conservación de la energía. Aunque no se ha encontrado mejoría estadísticamente significativa, los pacientes refieren mejoría clínica tanto en la fatiga como en la calidad de vida (AU)

Introduction. Multiple sclerosis (MS) is the third most common cause of neurological disability in adults, and 75- 95% of subjects suffer from fatigue, which is the symptom that interferes most with activities of daily living and is the most frequent reason why patients have to stop working. Aim. To evaluate the adherence to and effectiveness of a course on energysaving as a way to diminish fatigue and to increase the quality of life in people with MS. Patients and methods. This pilot study was almost random (although allocation to the control and intervention groups was randomised, the researchers chose the number of patients assigned to each group), with a control group of 14 patients with MS who showed signs of fatigue. Two 2-hour sessions of the course on energy-saving techniques were given by an occupational therapist in a group of nine patients. Measures were made of the self-efficiency to perform the energy-saving strategies assessment, the Fatigue Impact Scale (FIS), the Short-Form health questionnaire (SF-36) and the open questionnaire on improvements in the course. Results. Adherence to treatment by participants was high (with a mean increase of 2.17) and improvements were obtained on the FIS and SF-36 scales, although they were not statistically significant. Conclusions. The degree of adherence to a course on energy-saving strategies by patients with MS is high. Although no statistically significant improvements were found, patients did report clinical improvements in both fatigue and quality of life (AU)

[Energy-saving strategies in the treatment of fatigue in patients with multiple sclerosis. A pilot study]. / Estrategias de conservación de la energía en el tratamiento de la fatiga en pacientes con esclerosis múltiple. Estudio piloto.

INTRODUCTION: Multiple sclerosis (MS) is the third most common cause of neurological disability in adults, and 75-95% of subjects suffer from fatigue, which is the symptom that interferes most with activities of daily living and is the most frequent reason why patients have to stop working. AIM: To evaluate the adherence to and effectiveness of a course on energy-saving as a way to diminish fatigue and to increase the quality of life in people with MS. PATIENTS AND METHODS: This pilot study was almost random (although allocation to the control and intervention groups was randomised, the researchers chose the number of patients assigned to each group), with a control group of 14 patients with MS who showed signs of fatigue. Two 2-hour sessions of the course on energy-saving techniques were given by an occupational therapist in a group of nine patients. Measures were made of the self-efficiency to perform the energy-saving strategies assessment, the Fatigue Impact Scale (FIS), the Short-Form health questionnaire (SF-36) and the open questionnaire on improvements in the course. RESULTS: Adherence to treatment by participants was high (with a mean increase of 2.17) and improvements were obtained on the FIS and SF-36 scales, although they were not statistically significant. CONCLUSIONS: The degree of adherence to a course on energy-saving strategies by patients with MS is high. Although no statistically significant improvements were found, patients did report clinical improvements in both fatigue and quality of life.

Melanoma maligno en población pública de Santiago, Chile: correlación entre localización anatómica, género y edad / Malignant melanoma in public population of Santiago, Chile: correlation between sex, age and anatomical site

Se ha observado un aumento de la incidencia y mortalidad del melanoma maligno (MM) en las últimas décadas en Chile. Recientes investigaciones han señalado la existencia de diferentes mecanismos etiológicos del MM según su localización anatómica. El objetivo de este trabajo fue el de estudiar (a distribución del MM por rangos de edad, par sexo y par localización anatómica. 556 MM de cinco hospitales públicos de Santiago, Chile, fueron analizados. El análisis estadístico fue realizado mediante el test de Student. El porcentaje más alto de MM fue encontrado en el rango de edad de 60-69 añas. La edad promedio de pacientes con MM en la cara fue de 65,2 +/- 15,9 años. Este promedio de edad fue significativamente mayor que el observado en pacientes con MM en piernas (54,4 +/- 17,9) y el observado en pacientes con MM en tranco (51,5 +/- 15,2). No se observaron diferencias significativas en el promedio de edad, entre varones y mujeres, en las localizaciones anatómicas estudiadas (cara, pie, pierna y tronco). En cara y pie se observó un aumenta exponencial del MM con la edad en ambos sexos, con un máxima alcanzado a la edad de 60-69 años. En el tronco ambos sexos registran un aumento a temprana edad, con un máximo entre los 40-50 años; sin embargo, mientras los MM de las mujeres presentan un descenso a los 60 años, los MM en el tronco de los varones aumentan, presentando un segundo modo entre los 70 80 años. Estos resultados muestran distinto patrón de edad, según localización anatómica y sexo, en pacientes con MM. Estas diferencias podrían implicar distintos mecanismos etiológicos del MM.

The incidence and mortality of Malignant Melanoma (MM) have increased persistently over the past decades in Chile. Recent research paints to the co-existence of several biological pathways linked to the anatomical site of the Malignant Melanoma (MM). The purpose of this investigation is to study the distribution of MM by age, sex and anatomical site. 556 MM from five mayor state hospitals in Santiago, Chile, were analyzed. The statistical analysis was performed using the T student test. The highest percentage of MM was found in the 60-69 age groups. The average age of patients with MM in the face was 65.2 +/- 15.9. Patients with facial MM were significantly older than patients with MM in the legs (average: 54.4 +/- 17.9 years old) and those with MM in the trunk (51.5 +/- 15.2 years old). No significant differences in the average age of MM patients between males and females were observed in the studied sites (face, feet, legs and trunk). Face and feet displayed an exponential increase with age in both sexes, with a maximum in the 60-69 age groups. In the trunk, bath sexes registered an increase at early age, with a maximum at 40-50 years old, however, while female MM in the trunk decreased at about age 60, male MM increased with a second peak at age 70-80. These results show a different pattern of age in MM patients according to site and sex. These differences may imply distinct biological pathways of MM.

Valoración manual de la fuerza muscular frente a dinamometría instrumental / No disponible

No disponible

Caídas en el paciente neurogeriátrico / Falls in patients with neurogeriatric disorders

No disponible

Efectos del tapiz rodante con soporte del peso corporal sobre la osteoporosis y la espasticidad en pacientes con lesión medular / The effects of treadmill exercise with body weight support on osteoporosis and spasticity in spinal cord injuries

No disponible

Efectos del ejercicio aeróbico e isocinético sobre la fuerza, la espasticidad y la funcionalidad de los pacientes con accidente cerebrovascular / The effects of aerobic and isokinetic exercise on the strength, spasticity and functionality of stroke patients

No disponible

Fatiga en pacientes con secuelas de poliomielitis. Influencia en la calidad de vida relacionada con la salud y en las actividades de la vida diaria / Fatigue in patients with poliomyelitis sequels. Influence in quality of life related with health and daily life activities

Objetivo. Examinar la prevalencia de fatiga en una muestra de supervivientes de la poliomielitis y describir la repercusión de ésta en las actividades de la vida diaria (AVD) y en la calidad de vida relacionada con la salud. Material y métodos. Se presenta un estudio transversal, con una muestra de 37 sujetos que padecieron poliomielitis. Los instrumentos de medida utilizados fueron: Escala de Severidad de la Fatiga (ESF), escala analógica visual (EAV) para la estimación de la fatiga y del dolor, Nottingham Health Profile, índice de Barthel y escala de Lawton y Brody. Se ha aplicado para el contraste de medias entre grupos la U de Mann Whitney y para valorar la asociación entre dos variables cuantitativas, la correlación de Spearman. El nivel de significación estadística aceptado fue del 5 % (p < 0,05). Resultados. La puntuación media en la ESF fue 5,0 (desviación estándar [DE] 1,3) y en la EAV de fatiga física 45,5 mm (DE 33,3). No se encontró relación entre la presencia de problemas respiratorios en la fase aguda, la edad del ataque agudo o el grado de afectación y una mayor fatiga. La presencia de fatiga influenció en la calidad de vida relacionada con la salud, en las dimensiones energía, relaciones sociales y movilidad. No se encontraron diferencias significativas entre la presencia de fatiga y una mayor dificultad para realizar las AVD. Discusión. Aunque la fatiga no parece influenciar en las AVD, sí afecta a la calidad de vida relacionada con la salud en los pacientes con secuelas de poliomielitis

Objective. To examine the prevalence of fatigue perceived among a sample of polio survivors, and to analyze association between level of fatigue and difficulty to carry out functional activities and how this affects health-related quality of life. Material and methods. A cross-sectional trial with 37 former polio subjects. Measurement instruments used were Fatigue Severity Scale (FSS), visual analogy scale for estimation of fatigue and pain, Nottingham Health Profile, Barthel Index and Lawton and Brody Scale assessments. The Mann-Whitney U-test was used for comparison between independent groups and the Spearman rank correlation test to evaluate the association between quantitative variables. Results. Mean score in FSS was 5.0 (SD 1.3) and in VAS of physical fatigue was 45.5 mm (SD 33.3). No relationship was found between the presence of respiratory problems, age at polio onset and polio involvement and higher perceived fatigue in the sample studied. Presence of fatigue influenced health-related quality of life, mainly in energy, social isolation and physical mobility. No significant difference was found between presence of fatigue and higher perceived difficulty in performing ADL. Discussion. Although fatigue does not seem to influence activities in daily living, it affects health-related quality of life in polio survivors subjects