Quantifying unsupported sitting posture impairments in humans with cervical spinal cord injury using a head-mounted IMU sensor.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To evaluate unsupported sitting posture impairments and identify postural regulatory strategies in cervical spinal cord injury (cSCI) participants via a head-mounted IMU sensor. SETTING: A research lab in the United States of America. METHODS: cSCI participants and controls maintained postural stability during unsupported sitting with eyes either open or closed. The head-mounted IMU sensor recorded accelerometer data to calculate cumulative sway motion. The postural regulatory strategy was analyzed by assessing the normalized power spectral density (PSD) in four frequency bands: 0-0.1 Hz (visual regulation), 0.1-0.5 Hz (vestibular regulation), 0.5-1 Hz (cerebellar regulation), and >1 Hz (proprioception and muscle control). RESULTS: Significant increases in postural sway were observed in cSCI participants compared to controls during unsupported sitting. For cSCI participants, normalized PSD significantly increased in the low-frequency bands (0-0.1 Hz and 0.1-0.5 Hz) but decreased in the high-frequency band (>1 Hz) compared to controls. CONCLUSIONS: cSCI participants were more reliant on visual and vestibular systems for sitting balance, while depending less on proprioception and muscle control compared to controls. These findings suggest that the altered postural regulatory strategy is ineffective in maintaining postural stability during unsupported sitting, emphasizing the importance of proprioception and muscle control for seated postural stability in cSCI participants.

[Experiences of sexual practices associated with BDSM: the limits contemplated within the bounds of what is Healthy, Safe and Consensual]. / Vivencias de las prácticas sexuales asociadas al BDSM: los límites contemplados dentro de lo Sano, Seguro y Consensuado.

BDSM sexual practices related to sadomasochism, domination and submission, represent a vast range of possibilities in terms of paraphernalia, associated emotions, uses and applications that are as diverse as the human beings who practice it. Taking this into account, we conducted a study to understand the practices related to BDSM, under the perspective of its own practitioners. For this, a qualitative methodology was used, with an emergent and projected type of design. We covered 8 in-depth interviews on men and women from Venezuela and the data was analyzed through the constant comparison method in order to generate grounded theory, this paper comes up as part of a larger study. Among the most outstanding findings were the importance of limits, some as irrefutable an others that are meant to break, and the importance of the physical and mental health conditions in the practice.

Las prácticas sexuales BDSM relacionadas con el sadomasoquismo, la dominación y la sumisión, representan un abanico vasto de posibilidades en cuanto a parafernalia, emociones asociadas y usos tan diversos como los seres humanos que lo practican. Debido a esto, realizamos un estudio para entender las prácticas sexuales relacionadas al BDSM, bajo la mirada de sus propios practicantes. Para ello se empleó una metodología cualitativa con un tipo de diseño emergente y proyectado. Se realizaron 8 entrevistas a profundidad a hombres y mujeres en Venezuela, se analizaron los datos a través del método de comparación constante con el fin de generar teoría fundamentada. Este artículo surge como parte de los resultados de un estudio mayor. Entre los hallazgos más resaltantes se encontró la importancia a los límites, algunos como irrefutables y otros que se intentan traspasar y lo primordial de la práctica en condiciones de salud física y mental.

Vivencias de las prácticas sexuales asociadas al BDSM: los límites contemplados dentro de lo Sano, Seguro y Consensuado / Experiences of sexual practices associated with BDSM: the limits contemplated within the bounds of what is Healthy, Safe and Consensual

Resumen Las prácticas sexuales BDSM relacionadas con el sadomasoquismo, la dominación y la sumisión, representan un abanico vasto de posibilidades en cuanto a parafernalia, emociones asociadas y usos tan diversos como los seres humanos que lo practican. Debido a esto, realizamos un estudio para entender las prácticas sexuales relacionadas al BDSM, bajo la mirada de sus propios practicantes. Para ello se empleó una metodología cualitativa con un tipo de diseño emergente y proyectado. Se realizaron 8 entrevistas a profundidad a hombres y mujeres en Venezuela, se analizaron los datos a través del método de comparación constante con el fin de generar teoría fundamentada. Este artículo surge como parte de los resultados de un estudio mayor. Entre los hallazgos más resaltantes se encontró la importancia a los límites, algunos como irrefutables y otros que se intentan traspasar y lo primordial de la práctica en condiciones de salud física y mental.

Abstract BDSM sexual practices related to sadomasochism, domination and submission, represent a vast range of possibilities in terms of paraphernalia, associated emotions, uses and applications that are as diverse as the human beings who practice it. Taking this into account, we conducted a study to understand the practices related to BDSM, under the perspective of its own practitioners. For this, a qualitative methodology was used, with an emergent and projected type of design. We covered 8 in-depth interviews on men and women from Venezuela and the data was analyzed through the constant comparison method in order to generate grounded theory, this paper comes up as part of a larger study. Among the most outstanding findings were the importance of limits, some as irrefutable an others that are meant to break, and the importance of the physical and mental health conditions in the practice.

Percepción de enfermería respecto a la atención hospitalaria otorgada a personas que viven con VIH / Percepção da enfermagem em relação a atenção hospitalar dada para pessoas que vivem com HIV / Nursing perception regarding the attention given in hospitals to patients that live with HIV

Resumen: Dado el contexto epidemiológico en Chile referente al alza de la cantidad de personas con VIH, cobra relevancia el fortalecimiento del cuidado otorgado a estos pacientes. Por esto, el objetivo de esta investigación es conocer la percepción de enfermeras(os) respecto a la atención otorgada a personas que viven con VIH (PVVIH) en un servicio hospitalario de atención terciaria de salud, buscando contribuir a la enfermería. Para ello se utilizó un paradigma de investigación cualitativo tipo estudio de caso, recolectando la información con una entrevista semiestructurada, finalizando con un análisis del discurso de tipo semiótico. Se destacó que en las primeras atenciones se generaba "temor" en la atención a PVVIH, el que desaparecía a medida que aumentaban los conocimientos de la profesional. Enfermeras participantes refirieron la inexistencia de diferencias en la atención entre PVVIH y otros pacientes, evidenciándose una incongruencia entre el discurso y el actuar en enfermería al ocupar mayores medidas de precaución al realizar procedimientos a PVVIH. Como fortalezas identificadas en la atención a PVVIH se encontró el no discriminar a pacientes, la capacidad de enfrentar distintos contextos de atención y la destreza procedimental, entre otras, mientras que los aspectos a mejorar en la atención se vincularon con la relación que se genera con los PVVIH y sus familiares. Como conclusión, las enfermeras no hacen mayores distinciones en la atención con PVVIH. Es importante que las profesionales reconozcan sus habilidades y aspectos a mejorar para seguir humanizando la atención a PVVIH, siendo agentes educadores y de cambio.

Resumo: Dado o contexto epidemiológico no Chile referente ao aumento das pessoas com HIV, é relevante a necessidade de fortalecer os cuidados desses pacientes. Devido a isso, o objetivo de esta pesquisa é conhecer a percepção de enfermeiros(as) em relação a atenção fornecida para as pessoas que vivem com HIV num serviço hospitalar de atenção terciária em saúde, buscando contribuir para a disciplina e profissão de enfermagem. Para isso se utilizou um paradigma de pesquisa qualitativo tipo estudo de caso, o meio para reunir informação foi a entrevista semiestruturada, finalizando com uma análise de discurso. Destacou que nas primeiras atenções de pessoas portadoras de HIV o "temor" era perceptível. "Temor" que desaparecia à medida que o conhecimento do profissional aumentava. Enfermeiros participantes falaram que não existe diferença alguma na forma de atenção de pacientes portadores de HIV, mas se notou uma incongruência entre o discurso e a atuação da enfermagem ao tomar maiores medidas de precaução no momento de realizar procedimentos com esses pacientes. Pontos fortes identificados na atenção de portadores de HIV foram a não discriminação dos pacientes, a capacidade de enfrentar-se a distintos contextos na atenção, as habilidades de procedimentos, entre outras. Enquanto aos aspectos a melhorar na atenção se vincularam com a relação que se gera como os pacientes portadores de HIV e seus familiares Como conclusão os enfermeiros( não fazem maiores distinções na atenção de pacientes com HIV. É importante que os profissionais reconheçam suas habilidades e pontos para melhorar e assim continuar avançando na humanização da atenção dos portadores de HIV conseguindo ser agentes educadores e de mudança.

Abstract: Given the epidemiological context in Chile concerning the increased quantities of people with HIV, improving the care given to these patients becomes relevant. The objective of this research is to find about the perception of nurses concerning the care given to people living with HIV (PLHIV) in a tertiary health care hospital service, seeking to contribute to nursing improvements. In order to accomplish this task a qualitative research paradigm was used as a type of case study, collecting the information with a semi-structured interview, ending with a semiotic analysis of the discourse. It was pointed out that in the first sessions there is some fear generated in the attention to PLHIV, which gradually disappears with the increase of the professional's knowledge. Participating nurses referred to the lack of differences in care between PLHIV and other patients, evidencing an incongruence between the speech and the action by taking greater precautions when performing procedures for PLHIV. The strengths identified in the attention to PLHIV were the no discrimination to these patients, the ability to face different contexts of attention and the procedural skills, among others, while aspects to improvement in care were linked to the relationship that is generated with PLHIV and their families. In conclusion, nurses do not make noticeable distinctions in the care of PLVIH. It is important that professionals recognize their skills and the aspects that can be improved in order to continue humanizing the attention to PLHIV, acting as educators and agents of change.

Effects of depuration on histopathological changes in tilapia (Oreochromis niloticus) after exposure to cylindrospermopsin.

Cylindrospermopsin (CYN) is a highly water-soluble cytotoxin produced by several species of freshwater cyanobacteria and it is considered the second most studied cyanotoxin worldwide. CYN acts as a potent protein and glutathione synthesis inhibitor, as well as inducing genotoxicity, oxidative stress and histopathological alterations. Studies concerning the depuration of cyanobacterial toxins in aquatic organisms, especially in fish, are of great interest for fish economy and public health, but are scarce in the case of CYN. This is the first study reporting the ability of depuration (3 - 7 days) in reversing or ameliorating the histopathological lesions induced in liver, kidney, heart, intestines, and gills of tilapia (Oreochromis niloticus) due to exposure by immersion to repeated doses of a CYN-containing culture of A. ovalisporum for 14 days. The main histopathological changes induced by CYN were glucogenic degeneration and loss of the normal hepatic cord-structure (liver), hyperemia, dilated Bowman's capsule and cellular tumefaction (kidney), myofibrolysis, hemorrhages and edema (heart), necrosis and partial loss of microvilli (gastrointestinal tract), and hyperemia and inflammatory cells infiltrates (gills). After 3 days of depuration, gills were totally recovered, while the liver, kidney, and gastrointestinal tract required 7 days, and longer depuration periods may be needed for a full recovery of the heart. In addition, the morphometric study indicated that depuration managed to reverse the affectation in the hepatocytes nuclear diameters and cross sections of the proximal and distal convoluted tubules induced in CYN-exposed fish. In general, these results validate depuration as an effective practice for detoxification of fish contaminated with CYN. © 2016 Wiley Periodicals, Inc. Environ Toxicol 32: 1318-1332, 2017.

Factores pronósticos de las complicaciones de las fístulas arteriovenosas autólogas para hemodiálisis / Prediction factors of the autologous arteriovenous fistula complications for hemodialysis

Se realizó un estudio retrospectivo, transversal y descriptivo, para determinar los factores pronósticos sobre la aparición de complicaciones en 300 pacientes con una fístula arteriovenosa creada, atendidos en el Servicio de Angiología y Cirugía Vascular del Hospital Provincial Docente "Saturnino Lora" de Santiago de Cuba durante el trienio 2012- 2015. Entre los resultados principales predominaron el sexo femenino (52,7%), el grupo etario de 51-60 años (55,6%), la hipertensión arterial y la diabetes mellitus como factores de riesgo más comunes, así como la complicación de la FAV a nivel de la muñeca, principalmente en las féminas (34,2 %). Se concluyó que las complicaciones de la fístula arteriovenosa dependen de la presencia o no de factores de riesgo, que pueden ser un marcador negativo que afecta la calidad de vida del paciente y por sí mismos determinan el tiempo de supervivencia.

A retrospective, cross-sectional and descriptive study was carried out, to determine the prediction factors about the emergence of complications in 300 patients with a created arteriovenous fistula, assisted in the Angiology and Vascular Surgery Service of "Saturnino Lora" Teaching Provincial Hospital in Santiago de Cuba during the triennium 2012 - 2015. Among the main results the female sex (52.7%), the 51-60 age group (55.6%), hypertension and diabetes mellitus prevailed as the most common risk factors, as well as the AVF complication at wrist level, mainly in females (34.2%). It was concluded that the arteriovenous fistula complications depend on the presence or not of risk factors that can be a negative marker that affects the patient's life quality and per se determine the survival time.

Factores pronósticos de las complicaciones de las fístulas arteriovenosas autólogas para hemodiálisis / Prediction factors of the autologous arteriovenous fistula complications for hemodialysis

Se realizó un estudio retrospectivo, transversal y descriptivo, para determinar los factores pronósticos sobre la aparición de complicaciones en 300 pacientes con una fístula arteriovenosa creada, atendidos en el Servicio de Angiología y Cirugía Vascular del Hospital Provincial Docente Saturnino Lora de Santiago de Cuba durante el trienio 2012- 2015. Entre los resultados principales predominaron el sexo femenino (52,7 por ciento), el grupo etario de 51-60 años (55,6 por ciento), la hipertensión arterial y la diabetes mellitus como factores de riesgo más comunes, así como la complicación de la FAV a nivel de la muñeca, principalmente en las féminas (34,2 por ciento). Se concluyó que las complicaciones de la fístula arteriovenosa dependen de la presencia o no de factores de riesgo, que pueden ser un marcador negativo que afecta la calidad de vida del paciente y por sí mismos determinan el tiempo de supervivencia(AU)

A retrospective, cross-sectional and descriptive study was carried out, to determine the prediction factors about the emergence of complications in 300 patients with a created arteriovenous fistula, assisted in the Angiology and Vascular Surgery Service of Saturnino Lora Teaching Provincial Hospital in Santiago de Cuba during the triennium 2012 - 2015. Among the main results the female sex (52.7 percent), the 51-60 age group (55.6 percent), hypertension and diabetes mellitus prevailed as the most common risk factors, as well as the AVF complication at wrist level, mainly in females (34.2 percent). It was concluded that the arteriovenous fistula complications depend on the presence or not of risk factors that can be a negative marker that affects the patient's life quality and per se determine the survival time(AU)

Efectividad de un programa educativo en pacientes con pie diabético de riesgo / Effectiveness of an educational program in patients with risky diabetic foot

Se realizó un estudio de intervención terapéutica educativa en pacientes con pie diabético de riesgo, atendidos en la Consulta de Angiopatía Diabética del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, desde enero del 2011 hasta igual mes del 2013, a fin de determinar la efectividad de un programa educativo (momento de la intervención) al respecto. Fueron indicativos de pie diabético de riesgo (momento del diagnóstico), la úlcera previa o amputación, la neuropatía periférica con pérdida de sensación protectora, la enfermedad arterial periférica, la hiperqueratosis y la afección grave de las uñas, la deformidad en el pie, la movilidad articular reducida, el calzado inadecuado, el tabaquismo, la edad avanzada, la larga evolución de la diabetes mellitus y la falta de educación diabetológica en pie diabético. La información fue analizada y procesada mediante las pruebas de hipótesis de Mann-Whitney y de comparación de medias, con un error de 5 %, y se obtuvo que con este programa (momento evaluativo) se disminuyera la afectación que el pie diabético ocasiona a la actividad social, laboral y familiar de estas personas, así como el elevado costo económico, tanto para ellos como para el sistema de salud.

An educational therapeutic intervention study was carried out in patients with diabetic foot of risk, assisted in the Diabetic Angiopathy Department of "Saturnino Lora Torres" Clinical Surgical Provincial Hospital in Santiago de Cuba, from January, 2011 to the same month of 2013, in order to determine the effectiveness of an educational program (moment of the intervention) on this respect. The previous ulcer or amputation, the outlying peripheral neuropathy with loss of protective sensation, the peripheral artery disease, the hyperkeratosis and the serious disorder of the fingernails, the foot deformity, the reduced articular mobility, the inadequate shoes, tabaquism, the advanced age, the long clinical course of diabetes mellitus and the lack of diabetological education in diabetic foot, were all indications of diabetic foot of risk (moment of the diagnosis). The information was analyzed and processed by means of Mann-Whitney hypothesis test and that of means comparison, with an error of 5%, and it was obtained that with this program (evaluation moment), there was a decrease in the damage that the diabetic foot causes to the social, working and family activities of these people, as well as in the high economic cost, either for them or for the health system.

Efectividad de un programa educativo en pacientes con pie diabético de riesgo / Effectiveness of an educational program in patients with risky diabetic foot

Se realizó un estudio de intervención terapéutica educativa en pacientes con pie diabético de riesgo, atendidos en la Consulta de Angiopatía Diabética del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, desde enero del 2011 hasta igual mes del 2013, a fin de determinar la efectividad de un programa educativo (momento de la intervención) al respecto. Fueron indicativos de pie diabético de riesgo (momento del diagnóstico), la úlcera previa o amputación, la neuropatía periférica con pérdida de sensación protectora, la enfermedad arterial periférica, la hiperqueratosis y la afección grave de las uñas, la deformidad en el pie, la movilidad articular reducida, el calzado inadecuado, el tabaquismo, la edad avanzada, la larga evolución de la diabetes mellitus y la falta de educación diabetológica en pie diabético. La información fue analizada y procesada mediante las pruebas de hipótesis de Mann-Whitney y de comparación de medias, con un error de 5 por ciento, y se obtuvo que con este programa (momento evaluativo) se disminuyera la afectación que el pie diabético ocasiona a la actividad social, laboral y familiar de estas personas, así como el elevado costo económico, tanto para ellos como para el sistema de salud(AU)

An educational therapeutic intervention study was carried out in patients with diabetic foot of risk, assisted in the Diabetic Angiopathy Department of Saturnino Lora Torres Clinical Surgical Provincial Hospital in Santiago de Cuba, from January, 2011 to the same month of 2013, in order to determine the effectiveness of an educational program (moment of the intervention) on this respect. The previous ulcer or amputation, the outlying peripheral neuropathy with loss of protective sensation, the peripheral artery disease, the hyperkeratosis and the serious disorder of the fingernails, the foot deformity, the reduced articular mobility, the inadequate shoes, tabaquism, the advanced age, the long clinical course of diabetes mellitus and the lack of diabetological education in diabetic foot, were all indications of diabetic foot of risk (moment of the diagnosis). The information was analyzed and processed by means of Mann-Whitney hypothesis test and that of means comparison, with an error of 5 percent, and it was obtained that with this program (evaluation moment), there was a decrease in the damage that the diabetic foot causes to the social, working and family activities of these people, as well as in the high economic cost, either for them or for the health system(AU)

Influence of two depuration periods on the activity and transcription of antioxidant enzymes in tilapia exposed to repeated doses of cylindrospermopsin under laboratory conditions.

The cyanobacterial toxin Cylindrospermopsin (CYN), a potent protein synthesis inhibitor, is increasingly being found in freshwater bodies infested by cyanobacterial blooms worldwide. Moreover, it has been reported to be implicated in human intoxications and animal mortality. Recently, the alteration of the activity and gene expression of some glutathione related enzymes in tilapias (Oreochromis niloticus) exposed to a single dose of CYN has been reported. However, little is known about the effects induced by repeated doses of this toxin in tilapias exposed by immersion and the potential reversion of these biochemical alterations after two different depuration periods (3 or 7 days). In the present study, tilapias were exposed by immersion to repeated doses of a CYN-containing culture of Aphanizomenon ovalisporum during 14 days, and then were subjected to depuration periods (3 or 7 days) in clean water in order to examine the potential reversion of the effects observed. The activity and relative mRNA expression by real-time polymerase chain reaction (PCR) of the antioxidant enzymes glutathione peroxidase (GPx) and soluble glutathione-S-transferases (sGST), and also the sGST protein abundance by Western blot analysis were evaluated in liver and kidney of fish. Results showed significant alterations in most of the parameters evaluated and their recovery after 3 days (GPx activity, sGST relative abundance) or 7 days (GPx gene expression, sGST activity). These findings not only confirm the oxidative stress effects produced in fish by cyanobacterial cells containing CYN, but also show the effectiveness of depuration processes in mitigating the CYN-containing culture toxic effects.

Analysis of MC-LR and MC-RR in tissue from freshwater fish (Tinca tinca) and crayfish (Procambarus clarkii) in tench ponds (Cáceres, Spain) by liquid chromatography-mass spectrometry (LC-MS).

In the present study a new method has been developed and validated for detecting free microcystins (MCs) (MC-RR, MC-LR and MC-YR) by liquid chromatography-mass spectrometry (LC-MS) in the cyprinid Tinca tinca and in the crayfish Procambarus clarkii collected from three ponds in Extremadura (Spain) where the presence of the cyanobacteria species Microcystis aeruginosa and Anabaena spiroides has been confirmed. Once the method had been validated, free MCs were determined in fish (tench, T. tinca) and crayfish from different ponds in order to understand how they are bioaccumulated through the food web. MCs were not detected in any of the fish samples analyzed. It was confirmed that P. clarkii accumulated MCs in their tissues without losing their organoleptic characteristics, with MC-LR (2.3-18.1 µg MC-LR/g body weight) being the predominant MC variant detected in all the crayfish samples. MC-RR was measured in 50% of the samples analyzed, ranging between 1.4 and 7.8 µg MC-RR/g body weight and no MC-YR was detected. The results indicated that crayfish can accumulate free MCs in higher quantities than tench that live in ponds contaminated by toxic cyanobacteria species, and emphasized the need for regular monitoring if the health risks associated with their consumption are to be avoided.

Análisis Costo-Eficacia de la Terapia con Cremas de Propóleos para el Pie Diabético en Cuba / Analysis Efficacy Cost of the Therapy with Propolis Creams for the Diabetic Foot in Cuba

Se desarrolló un estudio clínico con el objetivo de demostrar las ventajas económicas y socia- les del uso de una crema elaborada con el propóleos recolectado en la región de Manzanillo en Cuba, en una muestra de 120 pacientes diabéticos atendidos en los servicios de Angiología de dos hospitales de la provincia de Santiago de Cuba, y uno de Ciudad de La Habana. Se realizó un diseño experimental de com- paración inter-individual o en grupos paralelos, a doble ciego, controlado y con asignación aleatorizada del tratamiento. La relación costo-eficacia se desarrolló a partir de la técnica de evaluación económica de medicamentos denominada Análisis Costo-Efectividad, cuya única diferencia con la seleccionada para la presente investigación, es el nivel de efectos en términos de salud que tiene en consideración, que refleja condiciones reales para la intervención médica. La relación costo-eficacia obtenida con la nueva formula-ción, a ambas concentraciones fue mejor que la alcanzada con la medicación habitualmente empleada para tratar al paciente con pie diabético, alcanzándose una reducción de dicho costo, con respecto a la terapia habitual de un 41.8 por ciento con la formulación al 10por ciento y de un 43.2 por ciento con la preparada al 15 por ciento, con una mayor efectividad terapéutica que el tratamiento convencional, por lo que incuestionablemente la crema de propóleos sometida al estudio, constituye una terapia mucho más ventajosa desde el punto de vista económico que la habitual(AU)

The clinic study was made with the objective to demonstrated the economic and clinical benefit of the use of a cream with Cuban propolis collected in the Manzanillo area, Granma province. The study was realized in 120 diabetic patients who were assisted by the Service of Angiology in 3 Cuban hospitals, two hospitals of the Santiago de Cuba and one hospital of Havana city. The clinic assay was carried out according to the Helsinki Declaration 13, in Phase II, enclosure, double blind, controlled, contingent, stratified according to the size of the hurt and in several centers, with interindividual or in parallel comparison. The relation efficacy-cost was calculated through of the technique to economic evaluation of drugs, known as analysis cost- effectiveness. This analysis has a difference with the relation used in this study that it is to reflect the real conditions for the medical intervention. The relation efficacy-cost obtained with the new formulation, to both concentrations it was better that the obtained with the habitual therapy used for treatment to patients with diabetic foot. We obtained a reduction of the cost with respect to habitual therapy to 41.8 percent with the formulation to 10 percentil and 43.2 percent with the elaborated to 15 percent, with a greatest therapeutic efficacy what the conventional therapy, by that the propolis cream is a therapy with advantage clinical and economic(AU)

Internaciones por traumatismos: alcances de su registro / Hospitalization by traumatisms: Reaches of its registry

Análisis del registro de consultas por traumatismos del Departamento de Urgencias del Hospital Santojanni, de la Ciudad de Buenos Aires. Se intenta utilizar la información para optimizar el manejo de esta patología.

Internaciones por traumatismos: alcances de su registro / Hospitalization by traumatisms: Reaches of its registry

Análisis del registro de consultas por traumatismos del Departamento de Urgencias del Hospital Santojanni, de la Ciudad de Buenos Aires. Se intenta utilizar la información para optimizar el manejo de esta patología.(AU)

Improvement of acromegaly after octreotide LAR treatment.

Octreotide is a somatostatin analog that inhibits growth hormone release showing higher potency than natural somatostatin so it has proved to be effective in acromegaly treatment. The objective of present study was to establish the effects of octreotide LAR (long acting release) preparation in patients with active acromegaly. The following parameters were assessed: clinical response, safety of medication, GH and IGF-1 serum concentrations and pituitary tumor size. Eleven patients (6 men and 5 women) range 41.4 years old with diagnosis of active acromegaly were included. Octreotide was administered at 0.1 mg subcutaneusly dose three times daily for four weeks to test the drug tolerability. Afterwards patients received octreotide LAR 20 mg intramuscularly separated by 28 days periods with an option to continue for 8 months. Basal average GH serum concentrations was 27.6 ng/mL. After 6 months treatment reduction to 5.03 +/- 5.38 ng/mL in 9 patients (p < 0.001) was observed. Basal IGF-1 average serum concentration was 889.55 +/- 167.29 ng/mL with a reduction value to 483.00 +/- 239.71 ng/mL in 9 of 11 patients after 6 months treatment (p < 0.005). The drug was well tolerated with few adverse effects Diarrhea, flatulence and steatorrhea were observed during the administration of subcutaneous octreotide in 18.2% of patients. Two patients had symptomatic biliary lithiasis that was successfully removed by surgery. Clinical symptoms improved and some of them dissapeared such as headaches and sweatings. Tumor shrinkage was observed in 66.7% of cases. Monthly injections of 20 mg of octreotide LAR were effective to reduce GH and IGF-1 levels in patients with active acromegaly accompanied by improvement of clinical symptoms and significant tumor size reduction.

Arterial stiffness and blood pressure self-measurement with loaned equipment.

BACKGROUND: A cross-sectional study was carried out in 415 hypertensive and normotensive subjects to determine the correlation between loaned self-measurement blood pressure (LSEM), arterial stiffness, and the different factors that contribute to it. METHODS: The LSEM model consists of lending a number of sphygmomanometers, property of the clinic, to patients for 3-day periods. Arterial stiffness was evaluated using the carotid-to-femoral pulse wave velocity (PWV), using an automatic apparatus. To determine the importance of each of these factors, a multiple linear regression analysis was carried out. RESULTS: Of the total number of patients, 78% were women, the average age was 57 +/- 12 years, 55.8% were hypertensive, and 38.8% were diabetic. The PWV average for the whole group was 12.1 +/- 4.2 m/sec. The correlation coefficients between the PVW and the self-measurements were 0.49 (P <.001) for the pulse pressure, and 0.46 (P <.001) for the systolic blood pressure (BP), respectively. Both represented 13.0 % of the total variation. The diastolic BP obtained by self-measurement and the serum creatinine values also had an effect on the stiffness, with 2.3 % (P =.05) each one. CONCLUSIONS: The pulse pressure readings with self-measurement correlate better with the arterial stiffness, compared with the readings taken in the office.

Oligodendrogliomas: análisis estadístico del cuadro clínico-patológico y sobrevida en 51 casos / Oligodendroglioma: statistic analysis of the clinical-pathologic disease and survive in 51 cases

Presentamos 51 casos de oligodendrogliomas intracraneales operados en el Instituto de Enfermedades Neoplásicas entre los años 1984-1997. El objetivo principal fue determinar la presencia de factores pronósticos y de riesgo que estuvieran relacionados con la sobrevida. Material-Métodos: de las historias clínicas obtuvimos datos relacionados al paciente y a los procedimientos realizados; calculamos la media de sobrevida por el método del Producto de los Límites de Kaplan-Meier y la comparación de medias de sobrevida con el estadístico del Logaritmo del Rango. Resultados: En 22 casos (43 por ciento) se presentó en la tercera y cuarta década de vida; la edad media fue 35,9 años (rango 5-70), sin predominio en el sexo. La media en el tiempo de enfermedad fue 29 meses. En 29 casos (56,9 por ciento) se presentó convulsiones como síntoma inicial de la enfermedad; cefalea y náuseas-vómitos en el 64,7 por ciento y 39,2 por ciento respectivamente. Los signos más frecuentes al ingreso fueron papiledema (60,8 por ciento) y hemiplejia (35,3 por ciento). Hallazgos de imágenes: 27 tumores (52,9 por ciento) en hemisferio izquierdo, 17 (33,3 por ciento) en hemisferio derecho, cuatro en fosa posterior (7,8 por ciento) y tres (5,9 por ciento) en cuerpo calloso. En 29 casos (56,9 por ciento) el tamaño del tumor fue de 3-5 cm. y mayor de 5 cm. en 22 pacientes (43,1 por ciento). En 22 tumores (43,1 por ciento) se presentó calcificaciones; hipo e isodensidad en 37 casos (72,5 por ciento) y sin captación de contraste en 20 casos (32,9 por ciento). Cuanto más alto fue el puntaje de Karnofski en el preoperatorio, mejores fueron los resultados en el postoperatorio. En 15 casos (29,4 por ciento) se realizó resección total y en 36 pacientes (70,6 por ciento) resección subtotal. La mortalidad operatoria fue 5,9 por ciento (3 casos). Histopatología, según la Organización Mundial de la Salud (OMS): 29 pacientes (56,9 por ciento) fueron oligodendrogliomas bien diferenciados o puros y 22 casos (43, 1 por ciento) oligodendrogliomas anaplásicos. Radioterapia recibieron 45 pacientes, con una dosis total de 44-60 Gys (media 56 Gys). En esta serie, los factores que influyeron positivamente en la sobrevida con valores estadísticamente significativos fueron: el alto puntaje de Karnofski en el preoperatorio, el bajo grado de malignidad del tumor (p<0.0004), la resección quirúrgica total (p<0.0018) y la presencia de calcificación intratumoral (p<0.017).

[Is the cardioprotective effect of estrogens useful in menopause?]. / Es útil el efecto cardioprotector de los estrógenos en la menopausia?

Tendency of coronary mortality to occur about 10 years later in women than in men is a well known fact. This difference has been attributed to the presence of estrogens in women. Despite the performance of many experimental and observational studies on the heart-protecting effect of estrogens, there are a lot of methodological limitations which make it difficult to obtain definitive results. This revision, shows the experimental studies where it has been demonstrated that estrogens do not increase cardiovascular protection. Emphasis is focused on adverse effects, such as the development of breast and endometrial cancer. It is also emphasized that during menopause, a series of life style modifications can be implemented, such as exercising, stop smoking and loosing weight. Undoubtedly, the results will be cardiovascular health benefits, with minimum integral health risks.

Manejo quirúrgico de los macroprolactinomas / Surgical treatment of the macroprolactinomas

Entre 1986 y 1997 se operaron adenomas hipofisarios en el Instituto de Enfermedades Neoplásicas, de este grupo 67 (34,9 por ciento) correspondieron a prolactinomas, todos con diagnóstico histopatológico confirmado; 44 (65,7 por ciento) fueron mujeres y 23 (34,3 por ciento) hombres, relación 2:1. Los síntomas visuales y endocrinos se presentaron en 52 (77,6 por ciento) y 45 (67,2 por ciento) pacientes respectivamente. De acuerdo al nivel de prolactina sérica preoperatoria los prolactinomas se dividieron en cuatro grupos: Grupo A: de 65-200 ng/ml (10 pacientes), Grupo B: de 201-500ng/ml (20 casos), Grupo C: de 501-1000 ng/ml (12 casos) y Grupo D: mayor de 1000 ng/ml (25 pacientes). Según el tamaño, se dividieron en tres grupos: Grupo A§: de 11-30 mm en 20 casos (29,8 por ciento); Grupo B§: de 31-50 mm en 30 pacientes (44,8 por ciento) y Grupo C§: mayor de 50 mm en 17 casos (25,4 por ciento). En 16 pacientes se realizó abordaje transesfenoidal y en 51 casos abordaje transcraneal. Resección total se realizó en 19 (28,3 por ciento) pacientes y subtotal en 48 casos (17,6 por ciento). La radioterapia se administró en 47 pacientes que quedaron con tumor residual en el postoperatorio: fue efectiva en 16 pacientes (34 por ciento) con remisión completa del adenoma residual, en 24 casos (51 por ciento) logró controlar la recurrencia y no fue útil en siete pacientes. Hubo una mejoría importante de los campos visuales, comparando el pre con el postoperatorio (visión normal en el 22,7 por ciento vs 37,8 por ciento; hemianopsia bitemporal en el 37,8 por ciento vs 19,6 por ciento de pacientes, respectivamente). Se demostró que los altos niveles de prolactina sérica en el preoperatorio produjeron bajos niveles de control de enfermedad (70 por ciento, 50 por ciento y 21 por ciento para los grupos B, C y D respectivamente). Asimismo el mayor tamaño tumoral produjo bajo porcentaje de control de enfermedad (76 por ciento, 41 por ciento y 33 por ciento para los grupos A§ y B§ y C§ respectivamente). En conclusión la enfermedad se controló satisfactoriamente en 35 casos (53 por ciento), quedó con persistencia tumoral en 24 pacientes (36, 3 por ciento)...