Characterization and classification of kinesthetic motor imagery levels.

Objective.Kinesthetic Motor Imagery (KMI) represents a robust brain paradigm intended for electroencephalography (EEG)-based commands in brain-computer interfaces (BCIs). However, ensuring high accuracy in multi-command execution remains challenging, with data from C3 and C4 electrodes reaching up to 92% accuracy. This paper aims to characterize and classify EEG-based KMI of multilevel muscle contraction without relying on primary motor cortex signals.Approach.A new method based on Hurst exponents is introduced to characterize EEG signals of multilevel KMI of muscle contraction from electrodes placed on the premotor, dorsolateral prefrontal, and inferior parietal cortices. EEG signals were recorded during a hand-grip task at four levels of muscle contraction (0%, 10%, 40%, and 70% of the maximal isometric voluntary contraction). The task was executed under two conditions: first, physically, to train subjects in achieving muscle contraction at each level, followed by mental imagery under the KMI paradigm for each contraction level. EMG signals were recorded in both conditions to correlate muscle contraction execution, whether correct or null accurately. Independent component analysis (ICA) maps EEG signals from the sensor to the source space for preprocessing. For characterization, three algorithms based on Hurst exponents were used: the original (HO), using partitions (HRS), and applying semivariogram (HV). Finally, seven classifiers were used: Bayes network (BN), naive Bayes (NB), support vector machine (SVM), random forest (RF), random tree (RT), multilayer perceptron (MP), and k-nearest neighbors (kNN).Main results.A combination of the three Hurst characterization algorithms produced the highest average accuracy of 96.42% from kNN, followed by MP (92.85%), SVM (92.85%), NB (91.07%), RF (91.07%), BN (91.07%), and RT (80.35%). of 96.42% for kNN.Significance.Results show the feasibility of KMI multilevel muscle contraction detection and, thus, the viability of non-binary EEG-based BCI applications without using signals from the motor cortex.

Isoniazid preventive therapy completion in children under 5 years old who are contacts of tuberculosis cases in Lima, Peru: study protocol for an open-label, cluster-randomized superiority trial.

BACKGROUND: Children < 5 years old in contact with TB cases are at high risk for developing severe and fatal forms of TB. Contact investigation, BCG vaccination, and isoniazid preventive therapy (IPT) are the most effective strategies to prevent TB among children. However, the implementation of IPT faces challenges at several stages of the cascade of care of TB infection among children, particularly those less than 5 years old. In Peru, a large proportion of children do not complete IPT, which highlights the need to design effective interventions that enhance preventive therapy adherence and completion. Although the body of evidence for such interventions has grown, interventions in medium TB incidence settings are lacking. This study aims to test the effectiveness, acceptability, and feasibility of an intervention package to increase information and motivation to complete IPT among children < 5 who have been prescribed IPT. METHODS: An open-label, cluster-randomized superiority trial will be conducted in two districts in South Lima, Peru. Thirty health facilities will be randomized as clusters, 10 to the intervention and 20 to control (standard of care). We aim to recruit 10 children from different households in each cluster. Participants will be caretakers of children aged < 5 years old who initiated IPT. The intervention consists of educational material, and short message services (SMS) reminders and motivators. The primary outcomes will be the proportion of children who picked up > 90% of the 24 weeks of IPT (22 pick-ups) and the proportion of children who picked up the 24 weeks of IPT. The standard of care is a weekly pick-up with monthly check-ups in a health facility. Feasibility and acceptability of the intervention will be assessed through an interview with the caretaker. DISCUSSION: Unfavorable outcomes of TB in young children, high effectiveness of IPT, and low rates of IPT completion highlight the need to enhance adherence and completion of IPT among children < 5 years old. Testing of a context-adapted intervention is needed to improve IPT completion rates and therefore TB prevention in young children. TRIAL REGISTRATION: ClinicalTrials.gov NCT03881228. Registered on March 19, 2019.

Hypofractionated whole breast irradiation after IORT treatment is safe in patients receiving adjuvant chemotherapy.

INTRODUCTION: Hypofractionated whole breast irradiation (hWBI) and intraoperative radiotherapy (IORT) could be associated in breast cancer patients showing high-risk factors of local recurrence after breast conserving therapy (BSC). The aim of this trial was to evaluate, for the first time, the toxicity and cosmesis of hWBI after photon-IORT in high-risk patients treated by adjuvant chemotherapy. MATERIALS AND METHODS: Thirty-one high-risk localized breast cancer patients treated by BCS, IORT (20 Gy), and adjuvant chemotherapy were included from February 2019 to August 2020 in this prospective trial, of hWBI (40.5 Gy/2.67 Gy/15 fractions). Acute and late toxicity (CTCAEv5.0) and cosmesis (Harvard scale), were assessed after treatment. RESULTS: All patients completed their treatment and were evaluable after treatment. No patients showed severe (G3) acute/late toxicity. Excellent/good cosmesis at least 6 months after completing the treatment, was present in 93.6% of the patients. CONCLUSION: hWBI in high-risk localized breast cancer patients treated by chemotherapy seems to have similar toxicity and cosmetic results than conventionally fractionated WBI in combination to photon-IORT after BCS.

Hypofractionated whole breast irradiation after IORT treatment: evaluation of acute toxicity and cosmesis.

INTRODUCTION: Hypofractionated whole breast irradiation (HWBI) is the current standard of treatment after breast conservative surgery (BCS). Intraoperative radiotherapy (IORT) must be associated to WBI in patients showing high-risk factors of local recurrence in the definitive pathology report. The aim of this trial was to evaluate, for the first time, the acute toxicity and cosmesis of HWBI after photon-IORT. MATERIALS AND METHODS: Twenty-six luminal breast cancer patients treated by BCS and IORT(20 Gy) were included between February and December 2019, in this prospective trial, of adjuvant HWBI (40.5 Gy/2.67 Gy/15 fractions). Acute toxicity (CTCAEv5.0) and cosmesis (Harvard scale), were assessed 3 months after treatment. RESULTS: All patients completed their treatment without interruptions. All cases were evaluable 3 months after treatment showing no toxicity ≥ G3 and excellent/good cosmesis assessment in 88% of the patients. CONCLUSION: HWBI seems to have similar acute toxicity and cosmesis results than conventionally fractionated WBI in combination to photon-IORT after BCS.

Immunohistochemical analysis of cancer-associated fibroblasts and podoplanin in head and neck cancer.

BACKGROUND: To immunohistochemically evaluate the association between the presence of cancer-associated fibroblasts (CAFs) and the tumour expression of podoplanin (PDPN) in head and neck squamous cell carcinoma (HNSCC) and their association with clinicopathological variables. MATERIAL AND METHODS: A tissue microarray (TMA) with biopsy sections from patients diagnosed with HNSCC was stained with antibodies against the CAFs marker, α-smooth muscle actin (α-SMA), and PDPN. We subsequently evaluated their expression to determine the association between them and with clinicopathological variables including age, primary tumour site, TNM stage, and tumour differentiation grade. RESULTS: Positive reaction to α-SMA was observed in the tumour stroma, revealing spindle-shaped cells compatible with CAFs, which showed a high expression in 62% of cases and a significant association with laryngeal carcinomas, advanced clinical stages, and lower tumour differentiation (P ≤ 0.05). PDPN staining on tumour cells showed low expression in 72% of cases, and it was not associated with any clinicopathological variable or with the presence of CAFs. CONCLUSIONS: The presence of CAFs in the tumour stroma is related to an aggressive phenotype and could increase as the disease progresses, although based on our findings, it would have no relationship, at least directly, with the expression of PDPN.

Biomechanical and functional effects of shoulder kinesio taping® on cerebral palsy children interacting with virtual objects.

The reaching of objects is usually practiced by CP children in conventional or Virtual Reality-based therapies to enhance motor skill performance. Recently, Kinesio Taping® method has been studied to increase mechanical stability and improve functional movement of the upper limb; however, its influence on CP children´s upper limb motion has been rarely quantified due to lack of sensory measurement. Therefore, in this paper, we evaluate the biomechanical and functional effects of applying shoulder Kinesio Taping® on CP children in the reaching-transporting of virtual objects, by using a low-cost tracking device, exact robust differentiation of data and a simple nonlinear biomechanical dynamic model of the trunk and arm.

Extraperitoneal laparoscopic ventral hernia repair: one step beyond.

PURPOSE: The objective of the study was to analyze the experience of the Department of Surgery of two institutions of high complexity in Colombia, with the extra peritoneal ventral hernia repair by laparoscopy during the last 2 years and characterize the clinical and surgical aspects most relevant in the procedures performed. METHODS: Observational, descriptive, retrospective study, case series type: collection of data by clinical history and analysis thereof including calculation of frequency and central tendency measurements. RESULTS: 59 Cases of Ventral Hernia Repair by laparoscopy, 41 with Transabdominal Preperitoneal approach and 18 totally Extraperitoneal. In total, 7 complications were presented as follows: 1 Case of recurrence, 1 case of chronic pain, 2 complications Dindo-Clavien IIIa and 1 complication IIIb. CONCLUSIONS: The repair of the ventral hernia by Extraperitoneal route is an innovative approach of increasing popularity, which avoids the contact of the mesh with the intestines, thus avoiding the potential complications that this situation generates with good outcomes and at a lower cost.

Juxtaoral organ: an anatomical finding to be considered.

The juxtaoral organ (JOO) is a vestigial anatomical structure which is not usuallydescribed in lectures and classic texts of general histology and oral histology, despiteit being included in the "Terminologia Histologica: International terms for humancytology and histology". Although there is evidence about its histological structure,there are no macroscopic anatomical reports about it. We report the finding ofa structure of glandular macroscopic appearance in a horizontal section of a plastinatedhuman head belonging to the Morphology Laboratory of the Department ofBiomedical Basic Sciences at the University of Talca. Due to its location, dimensionsand anatomical relations, we determined it to be the JOO. Using a digital calliper, wemeasured the anteroposterior and transverse dimensions of the JOO and observedits anatomical relationships with neighbouring structures of clinical relevance. Weconclude that the JOO is relevant to surgical practice due to its anatomical relationswith relevant structures such as inferior third molar and lingual nerve. Its clinicalapplication lies in the differential diagnosis with invasive processes of malignantneoplasia originating in the oral cavity.

[Determination and hierarchy of clinical signs for early detection of cerebrotendinous xanthomatosis]. / Determinación y jerarquización de signos clínicos para diagnóstico temprano de xantomatosis cerebrotendinosa.

BACKGROUND: Cerebrotendinous Xanthomatosis (CTX) is an autosomal recessive disease caused by mutations in the CYP27A1 gene resulting in a decreased synthesis of bile acids. An early diagnosis and treatment would reduce the longterm complications observed in this disease. AIM: To identify and hierarchize initial clinical signs of CTX to establish an early diagnostic suspicion index. MATERIAL AND METHODS: Clinical information was collected from 387 patients diagnosed with CTX, published in MEDLINE between 1968 and 2016. Clinical manifestations were identified, determining their prevalence and age of onset. Sensitivity, specificity and the positive Likelihood ratio (LR+) was calculated for each clinical sign evaluated. RESULTS: The average ages for early symptoms' onset and CTX diagnosis were 13.3 ± 10.6 years and 34.6 ± 12.6 years respectively. The early clinical signs and their respective LR+ were: juvenile cataracts (143), epilepsy (81), chronic diarrhea (15.6) and psychomotor development delay (3.4). The presence of consanguinity among parents resulted in a LR+ of 31. The combination of two early signs increased the post-test probability to 30%. If the early diagnostic criteria would have been applied in three Chilean patients with diagnosis of CTX, their disease would have been diagnosed from 12 to 25 years earlier. CONCLUSIONS: The use of a hierarchical system of predictive clinical signs allows an early screening of CTX, which may avoid the natural progression of the disease using an appropriate treatment.

Determinación y jerarquización de signos clínicos para diagnóstico temprano de xantomatosis cerebrotendinosa / Determination and hierarchy of clinical signs for early detection of cerebrotendinous xanthomatosis

Background: Cerebrotendinous Xanthomatosis (CTX) is an autosomal recessive disease caused by mutations in the CYP27A1 gene resulting in a decreased synthesis of bile acids. An early diagnosis and treatment would reduce the longterm complications observed in this disease. Aim: To identify and hierarchize initial clinical signs of CTX to establish an early diagnostic suspicion index. Material and Methods: Clinical information was collected from 387 patients diagnosed with CTX, published in MEDLINE between 1968 and 2016. Clinical manifestations were identified, determining their prevalence and age of onset. Sensitivity, specificity and the positive Likelihood ratio (LR+) was calculated for each clinical sign evaluated. Results: The average ages for early symptoms' onset and CTX diagnosis were 13.3 ± 10.6 years and 34.6 ± 12.6 years respectively. The early clinical signs and their respective LR+ were: juvenile cataracts (143), epilepsy (81), chronic diarrhea (15.6) and psychomotor development delay (3.4). The presence of consanguinity among parents resulted in a LR+ of 31. The combination of two early signs increased the post-test probability to 30%. If the early diagnostic criteria would have been applied in three Chilean patients with diagnosis of CTX, their disease would have been diagnosed from 12 to 25 years earlier. Conclusions: The use of a hierarchical system of predictive clinical signs allows an early screening of CTX, which may avoid the natural progression of the disease using an appropriate treatment.

[Relationship between grief support and burnout syndrome in professionals and technicians of pediatric health]. / Relación entre apoyo en duelo y el síndrome de Burnout en profesionales y técnicos de la salud infantil.

Detect the presence of Burnout and bereavement support of health professionals in oncology and pediatric intensive care units in Chilean public hospitals. SUBJECTS AND METHOD: Transversal design of descriptive correlational type. Auto-evaluation using the Maslach Burnout Inventory and Grief Support Health Care Scale instruments in 210 professionals and technicians. For the analysis of a means comparison, the t-student test was used and for the comparison between the variables, the correlations of Pearson and Spearman were used, considering a level of significance of 5%. RESULTS: 4% of the participants presented with Burnout and 71% were at risk of suffering it. 52% had a high level of perception of bereavement support, especially in women and oncology personnel. When correlating support in bereavement and Burnout, the data suggests that both the recognition of the bond, as well as the loss after death of a patient, helps decrease the depersonalization of the professional and improves their personal fulfillment. CONCLUSION: Professionals in areas of high pediatric complexity are at high risk of Burnout, due to greater emotional exhaustion and low personal accomplishment. However, a greater perception of recognition and support in their bereavement is a factor that can reduce that risk. Therefore, continuous intervention programs are required within these units, with concrete strategies for accompaniment, teamwork and mourning rituals.

Relación entre apoyo en duelo y el síndrome de burnout en profesionales y técnicos de la salud infantil / Relationship between grief support and burnout syndrome in professionals and technicians of pediatric health

Conocer la presencia de Burnout y de apoyo en duelo de profesionales de la salud en unidades de oncología y cuidados intensivos pediátricos de hospitales públicos chilenos. Sujetos y Método: Diseño trasversal de tipo descriptivo correlacional. Auto aplicación de los instrumentos Maslach Burnout Inventory y Grief Support Health Care Scale en 210 profesionales y técnicos. Para el análisis de comparación de medias se usó la prueba de t-student y para la comparación entre las variables, las correlaciones de Pearson y Spearman, considerando un nivel de significancia del 5%. Resultados: El 4% de los participantes presentaron Burnout y el 71%, estaba en riesgo de padecerlo. El 52% presentó alto nivel de percepción de apoyo en duelo, en especial en mujeres y personal de oncología. Al correlacionar el apoyo en duelo y el Burnout, los datos sugirieron que tanto el reconocimiento del vínculo como de la pérdida tras la muerte de un paciente, disminuye la despersonalización del profesional y mejora su realización personal. Conclusión: Los profesionales de unidades de alta complejidad pediátrica presentan alto riesgo de padecer Burnout, por un mayor cansancio emocional y baja realización personal. Sin embargo, una mayor percepción de reconocimiento y apoyo en sus duelos, es un factor que puede disminuir dicho riesgo. Por lo que se requiere de programas de intervención continua dentro de las unidades, con estrategias concretas de acompañamiento, trabajo en equipo y rituales de duelo.

Detect the presence of Burnout and bereavement support of health professionals in oncology and pediatric intensive care units in Chilean public hospitals. Subjects and Method: Transversal design of descriptive correlational type. Auto-evaluation using the Maslach Burnout Inventory and Grief Support Health Care Scale instruments in 210 professionals and technicians. For the analysis of a means comparison, the t-student test was used and for the comparison between the variables, the correlations of Pearson and Spearman were used, considering a level of significance of 5%. Results: 4% of the participants presented with Burnout and 71% were at risk of suffering it. 52% had a high level of perception of bereavement support, especially in women and oncology personnel. When correlating support in bereavement and Burnout, the data suggests that both the recognition of the bond, as well as the loss after death of a patient, helps decrease the depersonalization of the professional and improves their personal fulfillment. Conclusion: Professionals in areas of high pediatric complexity are at high risk of Burnout, due to greater emotional exhaustion and low personal accomplishment. However, a greater perception of recognition and support in their bereavement is a factor that can reduce that risk. Therefore, continuous intervention programs are required within these units, with concrete strategies for accompaniment, teamwork and mourning rituals.

Total thyroidectomy versus hemithyroidectomy for patients with follicular neoplasm. A cost-utility analysis.

INTRODUCTION: Thyroid nodules are a common condition. Overall, 20% of the nodules assessed with FNAB correspond to the follicular pattern. A partial thyroidectomy is the minimal procedure that should be performed to determine the nature of these nodules. Some authors have suggested performing a total thyroidectomy based on the elimination of reoperation and ultrasound follow-up. The aim of this study was to evaluate the most cost-useful surgical strategy in a patient with an undetermined nodule, assessing complications, reoperation, recurrence and costs. MATERIAL AND METHODS: A cost-utility study was designed to compare hemithyroidectomy and total thyroidectomy. The outcomes were complications (definitive RLN palsy, permanent hypoparathyroidism, reoperation for cancer, and recurrence of the disease), direct costs and utility. We used the payer perspective at 5 years. A deterministic and probabilistic sensitivity analysis was completed. RESULTS: In a deterministic analysis, the cost, utility and cost-utility ratio was COP $12.981.801, 44.5 and COP $291.310 for total thyroidectomy and COP $14.309.889, 42.0 and $340.044 for partial thyroidectomy, respectively. The incremental cost-utility ratio was -$535.302 favoring total thyroidectomy. Partial thyroidectomy was more cost-effective when the risks of RLN injury and definitive hypoparathyroidism were greater than 8% and 9% in total thyroidectomy, respectively. In total, 46.8% of the simulations for partial thyroidectomy were located in the quadrant of more costly and less effective. CONCLUSION: Under a common range of complications, and considering the patient's preference and costs, total thyroidectomy should be selected as the most cost-effective treatment for patients with thyroid nodules and follicular patterns.

Effects of dietary antioxidant of tomato extract and lycopene on Carassius auratus and Xiphophorus maculatus / Efecto antioxidante de un extracto de jitomate y licopeno en Carassius auratus y Xiphophorus maculatus

Objective. Evaluate the effect on tegument pigmentation, survival, growth and antioxidant capacity in diets supplemented with tomato extract and lycopene as additives in experimental feed for Carassius auratus and Xiphophorus maculatus. Materials and methods. The additives were added in different concentrations to a basic diet. We performed beginning and an ending biometrics for 100% of the population in each bioassay. The growth and survival of organisms were evaluated. The antioxidant capacity was analyzed by ABTS assay, both in the tomato extract sample as well as in foods used in different bioassays. The concentration of lycopene was determined in food and liver and muscle samples of fish fed with it. Acquired pigmentation of fish was assessed through photographs analyzed with Adobe Photoshop®. The results were evaluated by analysis of variance, and when differences were found (p<0.05) the means were compared by the Tukey test. Results. No significant effect (p>0.05) on pigmentation and growth of the organisms under the established experimental conditions was obtained. Significant differences in antioxidant capacity (p<0.05) were obtained in foods with added lycopene. Conclusions. The inclusion of lycopene or tomato extract in food for the organisms used is not recommended to improve pigmentation, but further studies are needed to demonstrate antioxidant effect.

Objetivo. Evaluar el efecto sobre la coloración de la piel, la sobrevivencia, el crecimiento y la capacidad antioxidante por dietas suplementadas con extracto de jitomate y licopeno como aditivos en la alimentación de Carassius auratus y de Xiphophorus maculatus. Materiales y métodos. Los aditivos se añadieron en diferentes concentraciones a una dieta base. Se realizó una biometría inicial y una final del 100% de la población en cada bioensayo. Se evaluó el crecimiento y supervivencia de los organismos. La capacidad antioxidante se analizó a través del ensayo ABTS, tanto a la muestra de extracto de jitomate como a los alimentos utilizados en diferentes bioensayos. Se determinó la concentración de licopeno a los alimentos y en muestras de hígado y músculo de peces alimentados con ellos. La pigmentación adquirida por los peces se evaluó a través de fotografías analizadas con el programa de Adobe Photoshop®. Los resultados fueron evaluados con análisis de varianza, cuando se encontraron diferencias (p<0.05) las medias fueron comparadas mediante la prueba de Tukey. Resultados. No se obtuvo un efecto significativo (p>0.05) sobre la pigmentación y el crecimiento de los organismos en estudio bajo las condiciones experimentales establecidas. Se obtuvieron diferencias significativas (p<0.05) en la capacidad antioxidante en los alimentos adicionados con licopeno. Conclusiones. La inclusión de licopeno o de extracto de jitomate en alimentos para los organismos utilizados no es recomendable con el fin de mejorar la pigmentación, aunque se requieren otros estudios para demostrar su efecto antioxidante.

El transitar del sobrevivir al revivir: comprender la vivencia de padres y madres que han perdido a sus hijos a causa del cáncer / Moving from survival to revival: understanding pareents who have lost children due to cancer

Introduction: A child's death due to cancer impacts parents deeply, and generates great suffering. However, some parents manage to overcome this pain, and discover a new purpose for their lives. Objective: To understand the experiences which assist fathers and mothers to revive after the death of a child due to cancer. Patients and Methods: A qualitative phenomenological model was applied. In-depth-interviews of consenting fathers and mothers who took part in a group called "Corporación Re-Viviendo" ("Re-Living"), were recorded and transcribed verbatim. For the analysis of the data, methodological precision and ethical criteria were utilized. Results: Data analysis revealed a dynamic and continuous process of multiple lived experiences, facilitating a transition from survival to revival for the participants. Conclusion: Through a process of personal growth and active renewal, parents can give meaning to the life, agony and death of a son or daughter. Thus, they allow themselves to develop the course of grief.

Introducción: La muerte de un hijo a causa del cáncer genera un gran impacto y sufrimiento en los padres, sin embargo algunos de ellos logran sobreponerse y encontrar un nuevo sentido a su vida, Objetivo: Investigar sobre las experiencias vividas que ayudan a los padres y madres a revivir después de la muerte de un hijo(a) por cáncer. Metodología: Estudio cualitativo fenomenológico, en el que se recogieron las vivencia a través de entrevistas en profundidad a padres y madres que participaban en la Corporación Re-Viviendo, las que fueron grabadas y transcritas textualmente, con previo consentimiento de los participantes. Para el análisis de los datos se cumplió con el rigor metodológico. Resultados: Tras analizar las entrevistas, se develó un proceso dinámico y continuo de múltiples vivencias que permitieron a los participantes transitar desde la sobrevivencia tras la pérdida, hasta el revivir a sí mismos. Conclusiones: Mediante un proceso de crecimiento personal y activo, los padres logran atribuirle sentido a la vida, agonía y muerte de su hijo(a), lo que les permite elaborar el duelo.

Human papillomavirus prevalence, cervical abnormalities and risk factors among female sex workers in Lima, Peru.

Female sex workers (FSWs) are at high risk of human papillomavirus (HPV) infection. Questionnaires were administered to 200 FSWs aged 18-26 years in Lima, Peru, to gather risk behaviours, and cervical swab samples were collected for Pap smears and HPV DNA testing as part of a longitudinal study. Participants reported a median of 120 clients in the past month, and 99.2% reported using condoms with clients. The prevalence of any HPV in cervical samples was 66.8%; 34 (17.1%) participants had prevalent HPV 16 or 18, and 92 (46.2%) had one or more oncogenic types. Fifteen women had abnormal Pap smears, 13 of which were HPV DNA positive. Fewer years since first sex was associated with oncogenic HPV prevalence in a model adjusted for previous sexually transmitted infection (STI) status and condom use with partners (prevalence ratio = 0.77, 95% confidence interval [CI] = 0.60-0.97). Our data confirm the high rates of HPV transmission among FSWs in Peru, highlighting the need for early and effective strategies to prevent cervical cancer.

[Evolution of the treatment of distal radius fractures in Spain. Is this the right way to go?]. / Evolución del tratamiento de las fracturas de radio distal en España. Es el camino correcto?

OBJECTIVE: To assess the changes in the treatment of distal radius fractures that have occurred in recent years at our center. To analyze the changes that have occurred and their possible causes. MATERIAL AND METHODS: We analyzed the hospital admission data from our center, both total admissions and those due to distal radius fractures. Surgical activity records show the evolution of the surgical treatment of distal radius fractures throughout time. Using the data from 2 research works done at our center we assessed the radiological and functional results obtained with an external fixator and nails and with buttress plates. We reviewed the updated bibliography trying to identify new evidence leading to treatment changes. RESULTS: Objective evidence shows a marked evolution towards the use of open reduction and internal fixation to treat distal radius fractures. We did not identify data in our studies that show poor results with the use of external fixators and nails or a clear superiority of the open reduction methods. These data are not available in the current bibliography. CONCLUSION: The treatment of distal radius fractures is being modified. This change is not based on contrasted clinical or bibliographic data. We need to ask whether this is due to commercial pressure or to a perception of surgeons that is yet to be proven in quality studies.

La necesidad de una guía clínica kinésica para la atención del linfedema en Complejo Asistencial Barros Luco / The need of a clinical guidelines in physical therapy for the lymphedema treatment: Complejo Asistencial Barros Luco experience

Información previa: El desconocimiento, tanto de la incidencia de linfedema como del tratamiento y cuidados pertinentes del linfedema, hace de éste, una patología de alto impacto psicosocial en el Complejo Asistencia Barros Luco (CABL). Objetivo: Dar a conocer la realidad de los pacientes con linfedema en el CABL; proveer información y recomendaciones para tratantes y pacientes, en cuanto al manejo, de linfedema en CABL. Opciones: Drenaje linfático manual, sistema elástico compresivo, bombas de compresión neumáticas, terapias físicas, tratamiento farmacéutico, educación. Resultado: Obtención de datos reales de la población afectada por linfedema en el CABL, optimización de recursos dentro de la Institución, prevenir y/o mejorar las alteraciones funcionales del paciente, calidad de vida, mayor acceso a tratamiento. Evidencia: Revisiones sistemáticas de la literatura en inglés y español obtenida principalmente desde MEDLINE (Octubre - Diciembre 2006). Conclusiones: El linfedema continúa siendo un problema de larga duración para los pacientes que sobreviven al cáncer. El tratamiento conservador ha demostrado ser efectivo para diferentes casos de linfedema. El CABL es un centro "en potencia" para desarrollar protocolos o guías clínicas para pacientes post tratamiento de cáncer. Dada la complejidad del tratamiento, este debe ser realizado por kinesiólogos con formación en el área. Proyecciones: promover la formación de un equipo transdisciplinario que apunte a una rehabilitación integral del paciente portador de linfedema, lograr la creación de una guía clínica que se ajuste a la realidad del CABL.

Background: The lack of knowledge of the incidence, treatment and appropriate care of Iymphedema has a high psicosocial impact at the CABL. Objective: To provide information about the reality of the patients with Iymphedema at the CABL; to provide information and recommendations for patients and their physicians when making decisions about the management of Iymphedema at the CABL. Options: Manual Lymphatic drainage, Compression garments, pneumatic compression pumps, physical therapies, pharmaceutical treatments and education. Results: To obtain real data of the Iymphedema affected population at the CABL, resource optimization at CABL, to prevent and/or improve the functional impairments of the patient, quality of life and more access to treatment. Evidence: Systematic review of English / Spanish - language literature retrieved primarily from MEDLINE (October - December 2006). Conclusions: The Iymphedema continues to be a long term issue for patient who survives cancer. The conservative treatment has been proven effective for different cases of Iymphedema. The CABL is a potential Medical Centre to develop protocols or Clinical practice guidelines for patients post cancer treatment. Because this is a complex treatment it must be developed by physical therapist with extensive preparation in the field. Future projections: To encourage the formation of an Transdisciplinary health team, which will offer a holistic rehabilitation to the patient with Iymphedema, to achieve the creation of a clinical practice guideline that fits the reality of the CABL.

Instilación ocular casual con cianoacrilato / Unexpected occular instillation with cyanocrilate

The cyanocrilate is utilized in ophthalmology for the processing of small corneal drillings. We present the case of a male of 37 years that itself autoinstilo adhesive of cianoacrilatoin accidental form in its left eye. In spite of the spectacularness of the situation and the diligence of the extraction of the plates, evolution of the patient was good with reepitelización corneal complete and without subsequent consequences. The bibliographical references in ophthalmology refer to the instilaciones accidental, we contribute this clinical case along with a revision of the bibliography.