Pauta de pesquisa para apraxia del habla infantil en hispanohablantes: traducción y validación cultural / Check list for childhood apraxia of speech in spanish-speaking population: translation and validation

La apraxia del habla infantil (AHI) es un trastorno pediátrico poco común, en el que, si el niño o niña no es diagnosticado a tiempo, puede desencadenar graves consecuencias a futuro. Los métodos de diagnóstico existentes para este trastorno se encuentran disponibles en idiomas distintos al español, lo que conlleva una dificultad para encontrar un método de diagnóstico válido y consensuado por los fonoaudiólogos para aplicarse a la población hispanohablantes. Es por estoque este estudio pretende dar un primer aporte, realizando la traducción de una herramienta de pesquisa apta para el idioma español, que permita facilitar la labor fonoaudiológica en el diagnóstico. El método que se utilizará es el de traducción y validación de una herramienta de evaluación en salud, al cual se va a incorporar el análisis de un panel de expertos para brindarle validez al instrumento. Los resultados muestran una amplia aceptación del instrumento (94%resultados positivos) con un buen acuerdo entre jueces (IRR inter rater reliability) presentada como probabilidad de acuerdo para todo el instrumento de 0,57 (57%). En conclusión, este estudio brinda una pauta de pesquisa para la AHI, con el fin de facilitar la evaluación fonoaudiológica temprana de los niños y niñas, permitiendo que los usuarios puedan acceder a una atención especializada y confiable acordes con el diagnóstico.

Childhood apraxia of speech (CAS), is a rare disorder during childhood, and it can trigger serious consequences in the future if not treated promptly. The existing diagnostic methods for this disorder are found in the English language only, which leads to difficulties in finding valid and agreed diagnostic methods by speech therapists to apply to the Spanish-speaking population. Hence, this study aims to provide the translation of an evaluation tool which is suitable for Spanish-speaking countries and that facilitates phonoaudiological work in the diagnosis. The method that will be used is that of translation-retranslation, to which the analysis of an expert opinion will be incorporated to give validity to the instrument. The results expose a wide acceptance of the instrument (94% of positive results) with substantial agreement among experts (IRR inter rater reliability), presented as agreement probability for the entire instrument of 0.57 (57%). In conclusion, this study provides a research pattern for AHI, to facilitate the early phonoaudiological evaluation of children, allowing the patients to access reliable care regarding to diagnosis.

Efficacy and safety of non-immersive virtual reality exercising in stroke rehabilitation (EVREST): a randomised, multicentre, single-blind, controlled trial.

BACKGROUND: Non-immersive virtual reality is an emerging strategy to enhance motor performance for stroke rehabilitation. There has been rapid adoption of non-immersive virtual reality as a rehabilitation strategy despite the limited evidence about its safety and effectiveness. Our aim was to compare the safety and efficacy of virtual reality with recreational therapy on motor recovery in patients after an acute ischaemic stroke. METHODS: In this randomised, controlled, single-blind, parallel-group trial we enrolled adults (aged 18-85 years) who had a first-ever ischaemic stroke and a motor deficit of the upper extremity score of 3 or more (measured with the Chedoke-McMaster scale) within 3 months of randomisation from 14 in-patient stroke rehabilitation units from four countries (Canada [11], Argentina [1], Peru [1], and Thailand [1]). Participants were randomly allocated (1:1) by a computer-generated assignment at enrolment to receive a programme of structured, task-oriented, upper extremity sessions (ten sessions, 60 min each) of either non-immersive virtual reality using the Nintendo Wii gaming system (VRWii) or simple recreational activities (playing cards, bingo, Jenga, or ball game) as add-on therapies to conventional rehabilitation over a 2 week period. All investigators assessing outcomes were masked to treatment assignment. The primary outcome was upper extremity motor performance measured by total time to complete the Wolf Motor Function Test (WMFT) at the end of the 2 week intervention period, analysed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NTC01406912. FINDINGS: The study was done between May 12, 2012, and Oct 1, 2015. We randomly assigned 141 patients: 71 received VRWii therapy and 70 received recreational activity. 121 (86%) patients (59 in the VRWii group and 62 in the recreational activity group) completed the final assessment and were included in the primary analysis. Each group improved WMFT performance time relative to baseline (decrease in median time from 43·7 s [IQR 26·1-68·0] to 29·7 s [21·4-45·2], 32·0% reduction for VRWii vs 38·0 s [IQR 28·0-64·1] to 27·1 s [21·2-45·5], 28·7% reduction for recreational activity). Mean time of conventional rehabilitation during the trial was similar between groups (VRWii, 373 min [SD 322] vs recreational activity, 397 min [345]; p=0·70) as was the total duration of study intervention (VRWii, 528 min [SD 155] vs recreational activity, 541 min [142]; p=0·60). Multivariable analysis adjusted for baseline WMFT score, age, sex, baseline Chedoke-McMaster, and stroke severity revealed no significant difference between groups in the primary outcome (adjusted mean estimate of difference in WMFT: 4·1 s, 95% CI -14·4 to 22·6). There were three serious adverse events during the trial, all deemed to be unrelated to the interventions (seizure after discharge and intracerebral haemorrhage in the recreational activity group and heart attack in the VRWii group). Overall incidences of adverse events and serious adverse events were similar between treatment groups. INTERPRETATION: In patients who had a stroke within the 3 months before enrolment and had mild-to-moderate upper extremity motor impairment, non-immersive virtual reality as an add-on therapy to conventional rehabilitation was not superior to a recreational activity intervention in improving motor function, as measured by WMFT. Our study suggests that the type of task used in motor rehabilitation post-stroke might be less relevant, as long as it is intensive enough and task-specific. Simple, low-cost, and widely available recreational activities might be as effective as innovative non-immersive virtual reality technologies. FUNDING: Heart and Stroke Foundation of Canada and Ontario Ministry of Health.

Intravenous fibrinolysis eligibility: a survey of stroke clinicians' practice patterns and review of the literature.

BACKGROUND: The indications and contraindications for intravenous (IV) recombinant tissue plasminogen activator (rtPA) use in ischemic stroke can be confusing to the practicing neurologist. Here we seek to describe practice patterns regarding decision-making among US stroke clinicians. METHODS: Stroke clinicians (attending and fellow) from the 8 National Institutes of Health SPOTRIAS (Specialized Programs of Translational Research in Acute Stroke) centers were asked to complete a survey ahead of the 2012 SPOTRIAS Investigators' meeting. RESULTS: A total of 51 surveys were collected (71% response rate). Most of the responders were attending physicians (68%). Only 18% of clinicians reported strictly adhering to current American Heart Association guidelines for treatment within 3 hours from symptom onset; this increased to 51% for the European Cooperative Acute Stroke Study (ECASS) III criteria in the 3 to 4.5 hours time frame. All clinicians treat eligible patients in the 3 to 4.5 hours time frame. The great majority will recommend rtPA in the following scenarios: (1) elderly individuals irrespective of age (97%); (2) severe stroke irrespective of National Institutes of Health Stroke Scale (NIHSS) (95%); or (3) suspected stroke with seizures at symptom onset (91%). None recommended rtPA in the setting of an international normalized ratio >1.7. Most clinicians defined mild strokes as an exclusion based on the perceived disability of the deficit (80%) rather than on a specific NIHSS threshold. CONCLUSIONS: Most surveyed stroke clinicians seem to find that the current IV rtPA eligibility criteria for the 3-hour time frame too restrictive. All would recommend rtPA to eligible patients in the 3 to 4.5 hours time frame despite the absence of an U.S. Food and Drug Administration (FDA)-approved indication.

Trends in substance abuse preceding stroke among young adults: a population-based study.

BACKGROUND AND PURPOSE: Approximately 5% of strokes occur in adults aged 18 to 44 years. Substance abuse is a prevalent risk factor for stroke in young adults. We sought to identify trends in substance abuse detection among stroke patients. METHODS: Using a population-based design, we sought to identify all patients aged 18 to 54 years experiencing a stroke (ischemic or hemorrhagic) in the Greater Cincinnati and Northern Kentucky Study region during 1993 to 1994, 1999, and 2005. Demographic and clinical characteristics and substance use data were obtained retrospectively from chart review and adjudicated by physicians. RESULTS: The number of young patients identified with a stroke increased from 1993 to 1994 (297) to 2005 (501). Blacks (61% vs 51%; P<0.02) and men (61% vs 47%; P<0.002) reported substance abuse (current smoking, alcohol, or illegal drug use) more frequently than did whites and women. Overall use of substances increased across study periods, 45% in 1993 versus 62% in 2005 (P=0.003). The trend was significant for illegal drug use (3.8% in 1993 vs 19.8% in 2005) and ever smoking (49% in 1993 vs 66% in 2005). Documentation of both cocaine and marijuana use increased over time. In 2005, half of young adults with a stroke were current smokers, and 1 in 5 abused illegal drugs. CONCLUSIONS: Substance abuse is common in young adults experiencing a stroke. The observed increase in substance abuse is contributing to the increased incidence of stroke in young adults. Patients aged younger than 55 years who experience a stroke should be routinely screened and counseled regarding substance abuse.

Urgencias en un servicio de prótesis estomatológica / Emergencies in a service of dental prosthesis

Se llevó a efecto un estudio descriptivo y transversal de los pacientes que acudieron al Servicio de Prótesis de la Clínica Estomatológica de Palma Soriano, provincia de Santiago de Cuba, en busca de atención inmediata o de urgencia, con historia clínica o sin ella, para sobre la base de las causas que les obligaron a acudir a la instalación, adoptar las medidas pertinentes sin interferir en el cumplimiento de las consultas programadas. Entre los principales resultados sobresalió la primacía del sexo femenino, del área urbana, de la estomatitis subprotésica, de la úlcera traumática, de las afecciones bucales en las personas ancianas, de las reparaciones (dientes fracturados o caídos) y de las cementaciones de restauraciones individuales o puentes dentarios.

A descriptive and cross-sectional study was carried out in patients who attended the Dental Department at the Dental Clinic in Palma Soriano in Santiago de Cuba province, searching immediate or emergent care, with or without medical record, to adopt the corresponding measures on the base of the causes which forced them to attend the service, without interfering in the programmed visits. Among the main results the female sex, the urban area, subprosthesis stomatitis, traumatic ulcer, buccal disorders in old people, repairs (fractured or fallen teeth) and cementations of individual restorations or dental bridges prevailed.

Urgencias en un servicio de prótesis estomatológica / Emergencies in a service of dental prosthesis

Se llevó a efecto un estudio descriptivo y transversal de los pacientes que acudieron al Servicio de Prótesis de la Clínica Estomatológica de Palma Soriano, provincia de Santiago de Cuba, en busca de atención inmediata o de urgencia, con historia clínica o sin ella, para sobre la base de las causas que les obligaron a acudir a la instalación, adoptar las medidas pertinentes sin interferir en el cumplimiento de las consultas programadas. Entre los principales resultados sobresalió la primacía del sexo femenino, del área urbana, de la estomatitis subprotésica, de la úlcera traumática, de las afecciones bucales en las personas ancianas, de las reparaciones (dientes fracturados o caídos) y de las cementaciones de restauraciones individuales o puentes dentarios(AU)

A descriptive and cross-sectional study was carried out in patients who attended the Dental Department at the Dental Clinic in Palma Soriano in Santiago de Cuba province, searching immediate or emergent care, with or without medical record, to adopt the corresponding measures on the base of the causes which forced them to attend the service, without interfering in the programmed visits. Among the main results the female sex, the urban area, subprosthesis stomatitis, traumatic ulcer, buccal disorders in old people, repairs (fractured or fallen teeth) and cementations of individual restorations or dental bridges prevailed(AU)

Uso de férula de descarga en una paciente con bruxismo / Use of unload splint in a patient with bruxism

Se presenta el caso clínico de una paciente con bruxismo, a la cual se colocó una férula intrabucal de acrílico para uso permanente, mientras era tratada por especialistas en prótesis estomatológica para poder eliminar la causa que originó ese hábito y prevenir posibles secuelas como consecuencia de ello. El uso de la férula de descarga permitió realizar el ajuste oclusal y erradicar el dolor, la movilidad dentaria y otros síntomas y signos atribuibles a dicho trastorno, por lo cual se recomienda como una alternativa terapéutica viable en situaciones similares(AU)

The clinical case of a patient with bruxism is reported, in whom an acrylic intraoral splint of permanent use was placed, while she was treated by specialists in dental prosthesis to eliminate the cause of that habit and to prevent potential sequelae. The use of the unload splint allowed to perform occlusal adjustment and to eliminate pain, dental mobility and other symptoms and signs attributable to this dysfunction, reason why it is recommended as a viable therapeutic alternative in similar situations(AU)

Uso de férula de descarga en una paciente con bruxismo / Use of unload splint in a patient with bruxism

Se presenta el caso clínico de una paciente con bruxismo, a la cual se colocó una férula intrabucal de acrílico para uso permanente, mientras era tratada por especialistas en prótesis estomatológica para poder eliminar la causa que originó ese hábito y prevenir posibles secuelas como consecuencia de ello. El uso de la férula de descarga permitió realizar el ajuste oclusal y erradicar el dolor, la movilidad dentaria y otros síntomas y signos atribuibles a dicho trastorno, por lo cual se recomienda como una alternativa terapéutica viable en situaciones similares.

The clinical case of a patient with bruxism is reported, in whom an acrylic intraoral splint of permanent use was placed, while she was treated by specialists in dental prosthesis to eliminate the cause of that habit and to prevent potential sequelae. The use of the unload splint allowed to perform occlusal adjustment and to eliminate pain, dental mobility and other symptoms and signs attributable to this dysfunction, reason why it is recommended as a viable therapeutic alternative in similar situations.

Evaluación genotóxica del extracto acuoso liofilizado de Solanum sessiliflorum Dunal, cocona en células germinales del ratón / Genotoxic evaluation of the lyophilized aqueous extract of Solanum sessiliflorum Dunal, cocona in mouse germ cells

Se ha realizado la evaluación del potencial genotóxico del extracto acuoso liofilizado de los frutos de Solanum sessiliflorum Dunal, mediante el método de anomalías de la cabeza de espermatozoides del ratón. Se utilizaron un total de 21 ratones albinos machos de la cepa Balb/c-53, distribuidos aleatoriamente en tres grupos experimentales con 7 animales por grupo: Solanum sessiliflorum Dunal a dosis de 2000 mg/Kg p.c, ciclofosfamida a dosis de 50 mg/kg p.c. (control positivo) y sohteión salina al 0.9% (control negativo). Se administró el extracto y la solución salina por vía oral y ciclofosfamida por vía intraperitoneal durante 5 días consecutivos. A los 35 días, después de la primera administración, se sacrificaron los animales, se extrajeron los epidídimos, se preparó una solución con tripsina, se coloreó con eosina y se procedió a la extensión de la muestra en láminas porta objetos para su posterior lectura. Se clasificaron los espermatozoides siguiendo el criterio de Wyrobex y Bruce, basado en cabezas normales, amorfas, bananas y sin gancho. No se encontraron diferencias significativas entre el grupo tratado con Solanum sessiliflorum Dunal y el grupo control negativo, por lo que se puede concluir que el extracto acuoso liofilizado de Solanum sessiliflorum Dunal, no posee acción genotóxica a nivel de células germinales.

Actividad analgésica del extracto acuoso liofilizado de las hojas de Bixa orellana L. en ratones albinos / Analgesic activity of the lyophilized aqueous extract of the leaves of Bixa orellana L. in albino mice

Se realizó un estudio experimental con el objetivo de evaluar el efecto analgésico del extracto acuoso liofilizado de las hojas de Bixa orellana L, a dosis de 100 y 150 mgkg-l administrado por vía oraL Para el desarrollo del mismo se utilizaron los Métodos de "Hot-plate" y "Contorsiones abdominales". Los animales seleccionados fueron ratones albinos machos de la cepa Balb/C53, con un peso corporal comprendido entre 23.67+ l.03g. Se utilizaron como controles positivos paracetamol e indometacina a dosis de 400 mgkg-l y 10 mgKg-l, respectivamente. Bixa orellana L. presenta actividad analgésica a nivel periférico, en el modelo de contorsiones abdominales, directamente proporcional a la dosis, bajo las condiciones experimentales.