Intervención ambulatoria basada en categorización por complejidad en neurorehabilitación

Introducción: Existen múltiples factores que dificultan el acceso a la terapia de alta intensidad y pocos estudios han considerado la efectividad de la Neurorehabilitación motora ambulatoria basada en atención directa al paciente, ejercicios guiados por el cuidador y entrenamiento de autogestión en rehabilitación. Objetivo: Evaluar el efecto en los resultados funcionales, de movilidad y equilibrio en los pacientes atendidos por un programa de Neurorehabilitación motora ambulatoria categorizados por complejidad en rehabilitación en el Hospital Carlos van Buren de Valparaíso. Material y Método: Estudio de cohorte retrospectivo. Se analizaron los registros de los pacientes atendidos en 2018 en el policlínico de Neurorehabilitación del Hospital Carlos van Buren, se recopilaron los datos desde las historias clínicas, se categorizaron en tres niveles de complejidad en rehabilitación y se hizo el análisis estadístico. Resultados: Se estudiaron 34 usuarios, el diagnóstico más recurrente fue el accidente cerebro vascular en el 82,3%. En las escalas funcionales, todos los valores cambiaron de mayor a menor severidad, luego de la rehabilitación (Rankin modificado, índice de Barthel, el nivel funcional y velocidad de marcha). En relación con la recuperación proporcional, los pacientes de baja complejidad lograron un 13,5%, los de mediana el 83% y los de alta un 25%. Conclusiones: Los resultados indican que un programa de Neurorehabilitación motora ambulatorio proporciona cambios funcionales favorables a los pacientes de mediana complejidad en rehabilitación. El uso de una categorización de rehabilitación basada en la complejidad es una opción útil en el entorno clínico, pero se requiere de mayores investigaciones.

Background: There are multiple factors that hinder access to high intensity therapies. Few studies have considered the effectiveness of outpatient motor neurorehabilitation based on direct patient care, caregiver-mediated exercises and self-directed exercises. Objetive: Evaluate the effect of an categorized outpatient motor neurorehabilitation program in a Public Hospital with respect to functionality, mobility and balance. Material and Method: Retrospective cohort study. The patients seen in 2018 at the Neurorehabilitation polyclinic of the Carlos Van Buren Hospital were analyzed, the data was collected from the medical records, they were categorized into three levels of complexity in rehabilitation and the statistical analysis was performed. Results: A total of 34 users were studied, the most recurrent diagnosis was stroke in 82.3%. On the functional scales, all values changed from highest to lowest severity post intervention (modified Rankin, Barthel index, functional level and walking speed). In relation to proportional recovery, low complexity patients achieved 13.5%, median 83% and high 25%. Conclusions: The results indicate that an outpatient motor Neurorehabilitation program provides favorable functional changes for patients of medium complexity in rehabilitation. The use of a complexity-based categorization of rehabilitation is a useful option in the clinical setting, but further research is required.

Role of HLA-DRB1*04 in the susceptibility and HLA-DRB1*08 in the protection for development of rheumatoid arthritis in a population of Southern Mexico: brief report.

Rheumatoid arthritis (RA) is an autoimmune inflammatory disease with an increased prevalence in Mexico. Although its etiology is unknown, its development can be influenced by environmental factors such as smoking and viral infections. But among the factors influencing susceptibility, it is the genetic factors that predominate, mainly the HLA-DRB1 genes, and specifically the alleles that have the shared epitope (SE). A transversal study was performed, in which 31 patients (28 women and 3 men) with RA, treated at the autoimmunity clinic of the High Specialty Hospital Ciudad Salud in Tapachula, Chiapas, southern México, were enrolled. Clinical, biochemical, and demographic data were analyzed; ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), RF (rheumatoid factor), and ACPA (anticitrullinated peptide antibody) were recorded. All patients had at least one positive RA biological marker. For HLA alleles frequencies comparison, we enrolled ethnically matched healthy controls in a ratio of 3:1 for 25 cases and 4:1 for 6 cases in order to guarantee the balance between groups regarding the mean of age and proportion of gender (males vs females). HLA-DRB1*04 was found to be significantly increased in patients compared with ethnically matched healthy controls (p 0.0007, OR: 2.8, 95% CI 1.5-5.1); contrarily, DRB1*08 showed a protective effect (p 0.005, OR 0.1). This paper confirmed the involvement of HLA genes on risk determination for RA in a population of Mexican Mestizos from Tapachula, Chiapas. Key Points • HLA-DRB1*04 confirms the increased risk of rheumatoid arthritis. • HLA-DRB1*08 showed a more definite protective effect in southern Mexicans mestizos, a population with more Amerindian ancestry.

Reconocimiento de los síntomas del ictus y respuesta frente a ellos en la población / Knowledge about stroke symptoms and attitude towards them in the population

Introducción. Conocer el significado de los síntomas de un ictus y tener percepción de urgencia ante ellos es un factor decisivo para reducir la demora extrahospitalaria. El objetivo es analizar el grado de reconocimiento de sus síntomas en los pacientes con un ictus, su actitud ante ellos y los factores que influyen en el conocimiento de la enfermedad. Métodos. Se estudian prospectivamente 292 pacientes consecutivos diagnosticados de ictus mediante un protocolo de recogida de datos que incluye 76 variables. Se realiza análisis univariante y multivariante para identificar las variables que se asocian independientemente con una mejor interpretación de sus síntomas y percepción de urgencia. Resultados. Sólo un 34% de pacientes reconoció saber que estaba sufriendo un ictus. El antecedente de ictus previo (OR: 3,97), vivir en una residencia (odds ratio [OR]: 3,20), tener síntomas motores (OR: 1,92) y un ictus más grave (OR: 1,05) se asociaron de forma independiente a un mejor reconocimiento de los síntomas. Sólo un 31,8 % de pacientes (41% de los que reconocieron los síntomas del ictus) decidió acudir inmediatamente al hospital o llamó a una ambulancia. La etiología cardioembólica del infarto (OR: 2,62), no tener hipertensión (OR: 0,48) y reconocer correctamente sus síntomas (OR: 0,62) son factores asociados de forma independiente a una mayor percepción de urgencia. Conclusión. Sólo un 14 % de los pacientes tienen un buen conocimiento del ictus y actúan correctamente cuando éste ocurre. Es necesario desarrollar programas de formación de la población en los que se resalte la urgencia ante la presencia de síntomas sugestivos de ictus (AU)

Introduction. To know the meaning of stroke symptoms and to perceive them as an emergency is a decisive factor to reduce hospital admission delay. The aim of the study is to analyze the degree of recognition of stroke symptoms by the patients, their attitude towards them, and which factors contribute to a better knowledge on cerebrovascular diseases. Methods. A total of 292 patients diagnosed of stroke were studied prospectively, following a protocol designed for data collection that included 76 variables. Univariate and multivariate analyses were conducted to identify which variables were independently associated with a better interpretation of stroke symptoms and emergency perception. Results. Only 34% of all patients recognized they were suffering a stroke. The background that was independently associated with a better interpretation of symptoms included previous stroke (odds ratio [OR]: 3.97), institutionalized subjects (old people's home) (OR: 3.20), motor symptoms (OR: 1.92) and more serious stroke (OR: 1.05). Only 31% of all patients, 41% of whom had recognized stroke symptoms, decided to go immediately to hospital or call for an ambulance. Variables that were independently associated with a better perception of emergency included cardioembolic stroke (OR: 2.62), not having hypertension (OR: 0.48) and a correct interpretation of stroke symptoms (OR: 0.62). Conclusion. Only 14% of all patients have a good knowledge about stroke and correctly act when it occurs. It is necessary to develop education programs aimed at the population that emphasize the emergency when symptoms suggesting stroke appear (AU)

[Knowledge about stroke symptoms and attitude towards them in the population]. / Reconocimiento de los síntomas del ictus y respuesta frente a ellos en la población.

INTRODUCTION: To know the meaning of stroke symptoms and to perceive them as an emergency is a decisive factor to reduce hospital admission delay. The aim of the study is to analyze the degree of recognition of stroke symptoms by the patients, their attitude towards them, and which factors contribute to a better knowledge on cerebrovascular diseases. METHODS: A total of 292 patients diagnosed of stroke were studied prospectively, following a protocol designed for data collection that included 76 variables. Univariate and multivariate analyses were conducted to identify which variables were independently associated with a better interpretation of stroke symptoms and emergency perception. RESULTS: Only 34% of all patients recognized they were suffering a stroke. The background that was independently associated with a better interpretation of symptoms included previous stroke (odds ratio [OR]: 3.97), institutionalized subjects (old people's home) (OR: 3.20), motor symptoms (OR: 1.92) and more serious stroke (OR: 1.05). Only 31% of all patients, 41% of whom had recognized stroke symptoms, decided to go immediately to hospital or call for an ambulance. Variables that were independently associated with a better perception of emergency included cardioembolic stroke (OR: 2.62), not having hypertension (OR: 0.48) and a correct interpretation of stroke symptoms (OR: 0.62). CONCLUSION: Only 14% of all patients have a good knowledge about stroke and correctly act when it occurs. It is necessary to develop education programs aimed at the population that emphasize the emergency when symptoms suggesting stroke appear.

Organochlorine pesticides in placentas from Southern Spain and some related factors.

During pregnancy, lipophilic xenobiotics stored in maternal adipose tissue can be mobilized and enter her blood circulation and reach the placenta. This study measured residues of oestrogen-mimicking organochlorine pesticides (OCs) in 150 placenta samples from women in Southern Spain. OCs were extracted from placenta by solid-liquid technique and purified by preparative liquid chromatography. Gas chromatography/electron-capture detection and mass spectrometry were used to identify and quantify p,p'-DDT and congeners/metabolites, endosulphan and congeners/metabolites, lindane, aldrin/dieldrin/endrin, hexachlorobenzene, methoxychlor and mirex. A mean of eight pesticides per placenta were detected (range, 3-15 pesticides). Endosulphan-ether, endosulphan-diol, endosulphan-I, p,p'-DDE, o,p'-DDD, p,p'-DDT, o,p'-DDT and lindane were detected in >or=50% of samples; p,p'-DDE was the most frequent (96.03%), followed by endosulphan-diol (76.86%) and lindane (74.17%). Presence of more pesticides was significantly associated with lower birth weight. Mean concentration of p,p'-DDE was 2.37+/-2.80 ng/g of placenta or 76.62+/-104.85 ng/g of lipid. Higher maternal body mass index was significantly associated with higher endosulphan concentrations in placenta, and greater maternal weight gain was significantly associated with higher p,p'-DDE concentrations. Prenatal exposure to OC xenoestrogens may be a causative factor in adverse reproductive health trends, and further studies are required to identify and describe pathways of this exposure to enhance preventive measures.

Evaluacion prospectiva del estado nutricional del nino hospitalizado. / Prospective evaluation of nutrional status of the hospitalized child

Se evaluo en forma prospectiva el efecto de la hospitalizacion sobre el estado nutricional del lactante hospitalizado por patologia de moderada intensidad. A los 14 dias de internacion, la mitad de los ninos (16/32) mostraban deterioro del estado nutricional evaluado por medio del examen antropometrico.Entre el 54 y 60% lo expresaron en los valores de albumina serica, hematocrito y concentracion hemoglobinica corpuscular media (CHCM). El mayor deterioro se presento en el recuento de linfocitos: 69%; el 18,7% de los ninos mostraban un recuento inferior a 1500/ mm3. A los 21 dias de internacion presentaban deterioro del peso, peso para la altura y pliegue subcutaneo del triceps (PST) el 33% de los ninos aun internados. Un mayor deterioro mostraban la circunferencia del brazo, circunferencia muscular del brazo (CMB) y recuento de linfocitos: 50%. Se concluye que el estado nutricional del lactante se deteriora durante la internacion. Se sugiere una actitud nutricional prioritaria

Evaluacion prospectiva del estado nutricional del nino hospitalizado. / Prospective evaluation of nutrional status of the hospitalized child

Se evaluo en forma prospectiva el efecto de la hospitalizacion sobre el estado nutricional del lactante hospitalizado por patologia de moderada intensidad. A los 14 dias de internacion, la mitad de los ninos (16/32) mostraban deterioro del estado nutricional evaluado por medio del examen antropometrico.Entre el 54 y 60% lo expresaron en los valores de albumina serica, hematocrito y concentracion hemoglobinica corpuscular media (CHCM). El mayor deterioro se presento en el recuento de linfocitos: 69%; el 18,7% de los ninos mostraban un recuento inferior a 1500/ mm3. A los 21 dias de internacion presentaban deterioro del peso, peso para la altura y pliegue subcutaneo del triceps (PST) el 33% de los ninos aun internados. Un mayor deterioro mostraban la circunferencia del brazo, circunferencia muscular del brazo (CMB) y recuento de linfocitos: 50%. Se concluye que el estado nutricional del lactante se deteriora durante la internacion. Se sugiere una actitud nutricional prioritaria