Experiencia con cuatro casos clínicos, ¿puede la encefalopatía traumática crónica estar asociada a un traumatismo craneoencefálico único? / Experience with 4 clinical cases. Traumatic encephalopathy may be associated with a single traumatic brain injury?

La encefalopatía traumática crónica (ETC) es una enfermedad neurodegenerativa que afecta a personas que han padecido traumatismos craneales repetitivos. No obstante, también durante el seguimiento de los pacientes con traumatismo craneoencefálico (TCE) único se pueden observar cambios respecto de su situación previa. Presentamos cuatro casos clínicos de pacientes visitados en la consulta externa del Instituto Guttmann entre 2017 y 2019, afectos de secuelas leves de TCE grave y único que han desarrollado posteriormente una enfermedad neurodegenerativa sin un diagnóstico concreto y que pudiesen cumplir criterios clínicos de síndrome de encefalopatía traumática crónica. Los médicos rehabilitadores son los profesionales con mayor posibilidad de identificar estos pacientes, indicando las exploraciones complementarias necesarias y estableciendo nuevos objetivos de rehabilitación.(AU)

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that affects people who had repetitive head trauma. Also, in single traumatic brain injury (TBI), changes may be found during the follow-up visits.We present four clinical cases of patients visited at the Institut Guttmann clinic between 2017 and 2019. They were affected by mild sequelae of severe and unique TBI who have subsequently developed a neurodegenerative disease without a specific diagnosis, and who could meet clinical criteria for chronic traumatic encephalopathy syndrome. Rehabilitation doctors are the professionals with the greatest possibility of identifying a suggestive clinic of this pathology, they can order the appropriate studies and indicate the new rehabilitation goals according to the new neurological situation.(AU)

[Experience with 4 clinical cases. Traumatic encephalopathy may be associated with a single traumatic brain injury?] / Experiencia con cuatro casos clínicos, ¿puede la encefalopatía traumática crónica estar asociada a un traumatismo craneoencefálico único?

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease that affects people who had repetitive head trauma. Also, in single traumatic brain injury (TBI), changes may be found during the follow-up visits. We present four clinical cases of patients visited at the Institut Guttmann clinic between 2017 and 2019. They were affected by mild sequelae of severe and unique TBI who have subsequently developed a neurodegenerative disease without a specific diagnosis, and who could meet clinical criteria for chronic traumatic encephalopathy syndrome. Rehabilitation doctors are the professionals with the greatest possibility of identifying a suggestive clinic of this pathology, they can order the appropriate studies and indicate the new rehabilitation goals according to the new neurological situation.

Polycystin-1 mitigates damage and regulates CTGF expression through AKT activation during cardiac ischemia/reperfusion.

During ischemia/reperfusion (I/R), cardiomyocytes activate pathways that regulate cell survival and death and release factors that modulate fibroblast-to-myofibroblast differentiation. The mechanisms underlying these effects are not fully understood. Polycystin-1 (PC1) is a mechanosensor crucial for cardiac function. This work aims to assess the role of PC1 in cardiomyocyte survival, its role in profibrotic factor expression in cardiomyocytes, and its paracrine effects on I/R-induced cardiac fibroblast function. In vivo and ex vivo I/R and simulated in vitro I/R (sI/R) were induced in wild-type and PC1-knockout (PC1 KO) mice and PC1-knockdown (siPC1) neonatal rat ventricular myocytes (NRVM), respectively. Neonatal rat cardiac fibroblasts (NRCF) were stimulated with conditioned medium (CM) derived from NRVM or siPC1-NRVM supernatant after reperfusion and fibroblast-to-myofibroblast differentiation evaluated. Infarcts were larger in PC1-KO mice subjected to in vivo and ex vivo I/R, and necrosis rates were higher in siPC1-NRVM than control after sI/R. PC1 activated the pro-survival AKT protein during sI/R and induced PC1-AKT-pathway-dependent CTGF expression. Furthermore, conditioned media from sI/R-NRVM induced PC1-dependent fibroblast-to-myofibroblast differentiation in NRCF. This novel evidence shows that PC1 mitigates cardiac damage during I/R, likely through AKT activation, and regulates CTGF expression in cardiomyocytes via AKT. Moreover, PC1-NRVM regulates fibroblast-to-myofibroblast differentiation during sI/R. PC1, therefore, may emerge as a new key regulator of I/R injury-induced cardiac remodeling.

Síndrome De Cotard Y Catatonía: Reporte De Un Caso / Cotard's Syndrome And Catatonia: A Case Report

Resumen El Síndrome de Cotard es una condición neuropsiquiátrica poco frecuente, descrito inicialmente por Jules Cotard como un delirio hipocondríaco y luego como Delirio de negación, en que el paciente niega la existencia de partes de su cuerpo, la propia existencia y/o del mundo entero. La aparición de un Síndrome Catatónico junto al Síndrome de Cotard es aún más infrecuente. Se presenta el caso de una paciente de 72 años con una Depresión psicótica, que desarrolla un Síndrome de Cotard y posteriormente Catatonía. Logra buena respuesta tras la adición de Lorazepam y Venlafaxina al esquema farmacológico en curso, por lo que se desestima el uso de Terapia Electroconvulsiva. Se constata remisión total de síntomas y posterior recuperación funcional ad integrum, siendo evaluada a través de entrevista clínica, Hamilton Depression Rating Scale, Bush-Francis Catatonia Rating Scale e Índice de Barthel. Además, se revisan otros reportes de caso sobre esta comorbilidad, y a diferencia de la mayoría de éstos, se destaca la favorable evolución de la paciente sin necesidad de Terapia Electroconvulsiva. Aún no se ha dilucidado la relación entre ambos síndromes, aunque algunos autores han planteado la hipótesis de vías neurobiológicas compartidas y otros han postulado la aparición de síntomas catatónicos como la progresión del Síndrome de Cotard. Para aclarar estas interrogantes, son necesarios más estudios al respecto que permitan conocer la etiopatogenia de esta inusual combinación.

Cotard's Syndrome is a rare neuropsychiatric condition, initially described by Jules Cotard as a hypochondriacal delusion and then as Delusion of negation, in which the patient denies the existence of parts of his body, his own existence and / or the entire world. The appearance of a Catatonic Syndrome together with Cotard Syndrome is even more infrequent. We present the case of a 72-year-old patient with a psychotic depression, who developed Cotard's Syndrome and later Catatonia. She achieves good response after the addition of Lorazepam and Venlafaxine to the current pharmacological treatment, so the use of Electroconvulsive Therapy is dismissed. Total remission of symptoms and subsequent functional recovery ad integrum was observed, being evaluated through clinical interview, Hamilton Depression Rating Scale, Bush-Francis Catatonia Rating Scale and Barthel Index. In addition, other case reports on this comorbidity are reviewed, and unlike most of these, the favorable evolution of the patient stands out without the need for Electroconvulsive Therapy. The relationship between the two syndromes has not been elucidated, although some authors have proposed the hypothesis of shared neurobiological pathways and others have postulated the appearance of catatonic symptoms such as the progression of Cotard's Syndrome. To clarify these questions, more studies are needed in order to know the etiopathogenesis of this unusual combination.

Metacognición en esquizofrenia: déficits metacognitivos y psicoterapia / Metacognition in schizophrenia: metacognitive deficits and psychotherapy

Resumen El concepto de Metacognición, definido inicialmente por Flavell, se refiere a la capacidad de tener estados mentales sobre otros estados mentales, propios y ajenos, en orden de resolver los desafíos que plantea la vida. A través de una hipótesis modular de Metacognición, Semerari y Lysaker han identificado dominios que abarcan diversas áreas de ésta, siendo de gran utilidad en la comprensión de los pacientes con trastornos psiquiátricos graves: Autorreflexividad, Comprensión de la mente de Otros, Descentración y Maestría. Estos dominios se han estudiado fundamentalmente por medio de la Metacognitive Assessment Scale-Abbreviated (MAS-A). El presente trabajo revisa el conocimiento actual de los déficits metacognitivos en Esquizofrenia, el método de evaluación, y su relación con la sintomatologia, función neurocognitiva, funcionamiento social y alianza terapéutica en estos pacientes. Finalmente, se presentan los diversos modelos de psicoterapias integrativas, que abordan con un enfoque rehabilitador los déficits metacognitivos de los pacientes con Esquizofrenia, profundizando en la evidencia existente sobre la más estudiada actualmente, la Metacognitive Reflection and Insight Therapy (MERIT).

The concept of Metacognition, initially defined by Flavell, refers to the ability to have mental states about their own mental states, and the mental states of others, in order to solve the challenges of life. Through a modular hypothesis of Metacognition, Semerari and Lysaker have identified domains that cover diverse areas of this, being very useful in the understanding of patients with serious psychiatric disorders: Self-reflectivity, Understanding of others' minds, Decentration and Mastery. These domains have been studied mainly through the Metacognitive Assessment Scale-Abbreviated (MAS-A). The present work reviews the current knowledge of the metacognitive deficits in Schizophrenia, the evaluation method, and its relation with the symptomatology, neurocognitive function, social functioning and therapeutic alliance in these patients. Finally, the different models of integrative psychotherapies are presented, with a rehabilitative approach over the metacognitive deficits of patients with schizophrenia, reviewing the most studied currently, the Metacognitive Reflection and Insight Therapy (MERIT).

[Transcranial direct current stimulation for the treatment of fibromyalgia: a systematic review]. / Estimulacion transcraneal por corriente directa en la fibromialgia: revision sistematica.

INTRODUCTION: Fibromyalgia is a multisymptomatic diffuse chronic musculoskeletal pain syndrome with evidence of central nervous system dysfunction. Accordingly, non-invasive brain stimulation techniques such as transcranial direct current stimulation (tDCS) may be a complementary therapeutic resource to reduce pain perception. AIMS: To review the potential effectiveness of tDCS to reduce pain in fibromyalgia, to identify the most effective neurostimulation parameters and to delimit its safety. PATIENTS AND METHODS: Systematic review of prospective studies reported in PubMed and Cochrane reviews. RESULTS: The anodal tDCS of the left primary motor cortex, at 2mA for 20 minutes with 35 cm2 electrodes on five consecutive days, provides better results in reducing pain (14-59%), and improving sleep quality, with greater accentuation on the fifth day. The clinical improvement persists up to a minimum of 60 days (11-20% reduction of pain). Adverse effects are well tolerated and few. CONCLUSIONS: The experience with tDCS in fibromyalgia is still limited. However, the anodal tDCS in the left primary motor cortex can be recommended with level B (probable therapeutic efficacy) and appears to act through the modification of the sensorial processing of the pain of thalamic inhibitory circuitry.

TITLE: Estimulacion transcraneal por corriente directa en la fibromialgia: revision sistematica.Introduccion. La fibromialgia es un sindrome de dolor cronico difuso musculoesqueletico multisintomatico, con evidencias de una disfuncion del sistema nervioso central. Consecuentemente, tecnicas de estimulacion cerebral no invasiva, como la estimulacion transcraneal con corriente directa (tDCS), pueden ser un recurso terapeutico complementario para reducir la percepcion de dolor. Objetivos. Revisar la potencial efectividad de la tDCS para reducir el dolor en la fibromialgia, identificar los parametros mas efectivos de neuroestimulacion y delimitar su seguridad. Pacientes y metodos. Revision sistematica de estudios prospectivos registrados en PubMed y revisiones Cochrane. Resultados. La tDCS anodica de la corteza motora primaria izquierda, a 2 mA durante 20 minutos con electrodos de 35 cm2 durante cinco dias consecutivos, es la que proporciona mejores resultados en la reduccion del dolor (14-59%) y mejora de la calidad del sueño, con mayor acentuacion en el quinto dia. La mejora clinica persiste hasta un minimo de 60 dias (11-20% de reduccion del dolor). Se tolera bien y tiene escasos efectos adversos. Conclusiones. La experiencia con la tDCS en fibromialgia es todavia limitada. No obstante, la tDCS anodica en la corteza motora primaria izquierda puede recomendarse con un nivel B (probable eficacia terapeutica) y podria actuar mediante la modificacion del procesamiento sensorial del dolor de circuitos inhibitorios talamicos.

Efectividad de la terapia láser de baja intensidad en pacientes con artritis reumatoide: una revisión sistemática de ensayos clínicos / Effectiveness of laser therapy of low intensity in patients with rheumatoid arthritis: a systematic review of clinical trials

Objetivo: Determinar la evidencia científica sobre la efectividad de la terapia láser de baja intensidad en la artritis reumatoide (AR). Estrategia de búsqueda: Se identificaron 1.008 artículos mediante búsqueda electrónica en las bases de datos de PEDro, TRIP, DIALNET, OVIDSP, Cochrane, EMBASE, Pub Med y Enfispo. Se incluyeron ensayos clínicos, controlados, aleatorizados y con simple o doble ciego, publicados entre el 1 de enero de 1990 hasta el 31 de diciembre del 2013, en lengua española e inglesa. Selección de estudios: Se realizó por 2 revisores, de manera no cegada e independiente, y se llevó a cabo una clasificación de los estudios mediante la escala PEDro. Resultados: Se seleccionaron 6 estudios. Estos no obtuvieron resultados estadísticamente significativos sobre el uso de la terapia láser de baja intensidad en la AR. Conclusiones:Existe evidencia limitada sobre el uso del tratamiento con láser en la AR, por lo que es necesario ampliar la investigación sobre este tema

Objective: to determine scientific evidence on the effectiveness of low level laser therapy in rheumatoid arthritis. Search strategy: 1008 articles were identified by searching electronic databases PEDro, TRIP, DIALNET OVIDSP, Cochrane, EMBASE, Pub Med and ENFISPO. We included controlled clinical trials, randomized and single or double-blind studies published between January 1 st 1990 until December 31st 2013, both in Spanish and in English. Study screening: it was performed by two reviewers independently and unblinded manner, and conducted a classification studies using the PEDro scale. Results: 6 studies were selected. They did not obtain statistically significant results on the use of low intensity laser therapy in RA. Conclusions: There is limited evidence on the use of laser therapy in the treatment of RA, so it is necessary to extend the research on this topic

Multiple sclerosis following a spinal cord injury: a rare and unfortunate case.

This is a case report and review of literature with the objective report of the case of a young man with physical disability following a traumatic spinal cord injury (SCI) who was later newly diagnosed with multiple sclerosis (MS) in an inpatient SCI rehabilitation center. (Barcelona, Spain). A 24-year-old male sustained a traumatic spinal cord lesion (T9 AIS A) as the result of a motorcycle accident. He completed his rehabilitation process without complications and returned to the community having adjusted to his new disability. Two and a half years after his initial injury, he attended the clinic after experiencing 2 months of paresthesias in his left hand, progressing to his right upper limb, and difficulty with fine hand movements. An magnetic resonance imaging (MRI) was arranged and although post-traumatic syringomyelia was ruled out, demyelinating areas in the cervical spinal cord were found. A brain MRI revealed multiple demyelinating lesions suggestive of MS. The diagnosis of MS was confirmed by a neurologist and treatment was started with daily doses of glatiramer acetate. At this time the patient was still independent in transfers, activities of daily living and wheelchair management. In young patients with SCI, adequate follow-up is important to detect subsequent complications that may lead to clinical and functional deterioration with a view to uncommon causes such as MS.

[Students' perceptions comparing standardized and non-standardized oral exams in internal medicine]. / Percepción de examen oral estandarizado vs no estandarizado en el internado de medicina interna.

BACKGROUND: Oral examinations are a useful tool to appraise certain medical skills compared to other examinations. However, they have some disadvantages that might be reduced with standardization. AIM: To compare students' perception comparing a standardized oral exam (SOE) versus a traditional, non-standardized oral exam (NSOE). MATERIAL AND METHODS: During the first semester of 2013 a NSOE was applied to internal medicine undergraduate students. During the second semester, a SOE was applied. An anonymous and voluntary perception questionnaire, consisting in 10 questions based on a 5-level Likert scale, was answered by these students. Statistical analysis was done using the Mann-Whitney U test. RESULTS: Among the 118 students, 50.8% were evaluated using NSOE and 49.2% using SOE. Questionnaire response rate was 84%. Among respondents, 52% took the SOE and 48%, the NSOE. Students evaluated using SOE perceived that the degree of complexity of clinical cases was similar for all examinees (p < 0.05), that exam duration was standardized (p < 0.05), and that grades obtained were less influenced by the clinical site where the exam was taken (p < 0.05). However, anxiety level remained high in both groups, as well as the overall satisfaction experience. CONCLUSIONS: Standardization of an oral examination improves the perception of medical students about levels of difficulty, duration and external influences on the final grade.

Percepción de examen oral estandarizado vs no estandarizado en el internado de medicina interna / Students’ perceptions comparing standardized and non-standardized oral exams in internal medicine

Background: Oral examinations are a useful tool to appraise certain medical skills compared to other examinations. However, they have some disadvantages that might be reduced with standardization. Aim: To compare students’ perception comparing a standardized oral exam (SOE) versus a traditional, non-standardized oral exam (NSOE). Material and Methods: During the first semester of 2013 a NSOE was applied to internal medicine undergraduate students. During the second semester, a SOE was applied. An anonymous and voluntary perception questionnaire, consisting in 10 questions based on a 5-level Likert scale, was answered by these students. Statistical analysis was done using the Mann-Whitney U test. Results: Among the 118 students, 50.8% were evaluated using NSOE and 49.2% using SOE. Questionnaire response rate was 84%. Among respondents, 52% took the SOE and 48%, the NSOE. Students evaluated using SOE perceived that the degree of complexity of clinical cases was similar for all examinees (p < 0.05), that exam duration was standardized (p < 0.05), and that grades obtained were less influenced by the clinical site where the exam was taken (p < 0.05). However, anxiety level remained high in both groups, as well as the overall satisfaction experience. Conclusions: Standardization of an oral examination improves the perception of medical students about levels of difficulty, duration and external influences on the final grade.

Evaluación de la concentración de mercurio en arroz (Oryza sativa) crudo y cocido procedente del municipio de San Marcos- Sucre y zona aurífera del municipio de Ayapel - Córdoba / Evaluation of the concentration of mercury in rice (Oryza sativa) raw and cooked from the municipality of San Marcos - Sucre and township gold zone Ayapel - Cordoba

Introducción: Los metales se encuentran en todos los alimentos, siendo de mayor preocupación la presencia de metales tóxicos como el mercurio, debido a los efectos adversos que causa en la salud del hombre, lo que lo ha convertido en un grave problema de salud pública. Objetivo: Evaluar la concentración de mercurio en arroz (Oryza sativa) crudo y cocido procedente del municipio de San Marcos - Sucre y zona aurífera del municipio de Ayapel - Córdoba. Metodología: El presente estudio es de tipo exploratorio y experimental. La toma de muestras fue realizada en tiempo de recolección del arroz (septiembre) y se tomaron tres repeticiones de cada tipo o variedad de arroz (Fedearroz 2000 - LD 473). La cocción del alimento fue realizada en el laboratorio en condiciones similares a las utilizadas por habitantes de las comunidades donde fueron recolectadas las muestras. Para los análisis de relación estadística entre los tratamientos de cocción y la concentración de mercurio total en muestras, fue realizado un análisis de correlación simple. La determinación de diferencias estadísticamente significativas entre las muestras de arroz crudo y cocido fue realizada mediante un t-test y Anova. Resultados: Se presentaron concentraciones bajas de mercurio total y metilmercurio en las muestras de arroz crudo y cocido. Además, fue detectado que el proceso de cocción del alimento disminuye las concentraciones de HgT, en los diferentes tratamientos de tiempo de cocción. Conclusiones: Los habitantes de los municipios en estudio están expuestos a concentraciones mínimas de mercurio que podrían ser perjudiciales para su salud, debido a la alta ingesta de este cereal en la dieta de las comunidades.

Introduction: Metals are found in mostly all kind of food. Presence of toxic metals such as mercury are relevant for public health safety, due to the adverse effects it has on human health. Objective: To evaluate mercury concentrations in raw and cooked rice (Oryza sativa) from San Marcos municipality in Sucre and Ayapel gold zone in Córdoba. Methodology: The present study is exploratory and experimental. Sample collection was conducted in rice harvesting time (September) and three repetitions of each type or variety of rice were taken (Fedearroz 2000 - LD 473). Cooking of rice was made under laboratory standards similar to those used by residents of the communities where the samples were collected. For statistical analysis of the relationship between cooking treatment and the concentration of total mercury in samples, we carried out a simple correlation analysis. Determination of statistically significant differences, between samples of raw and cooked rice, was performed using a t-test and Anova. Results: Low concentrations of total mercury and methylmercury were presented in raw and cooked rice. Furthermore, it was found that food cooking processes decreases HgT concentrations. Conclusion: Inhabitants of the municipalities under study are exposed to minimal concentrations of mercury that could be harmful to their health due to high intake of this cereal in their communities' diet.

Síndrome pinzamiento mesentérico: a propósito de un caso de hiperemesis / Superior mesenteric aartery syndrome: in relation to a case of hypermesis

INTRODUCCIÓN: El Síndrome de Arteria Mesentérica (SAMS) o Pinzamiento Mesentérico es un trastorno adquirido poco frecuente. Su característica principal es la obstrucción de origen vascular de la tercera porción duodenal, entre la arteria mesentérica superior y la aorta abdominal. CASO CLÍNICO: Mujer de 42 años de edad con antecedentes de trastorno depresivo, colecistectomizada en 1994 y múltiples hospitalizaciones por hiperemesis desde 1995 con estudios no concluyentes. Ingresó en diciembre de 2011 por vómitos alimentarios, con gran compromiso nutricional. Se le realizaron múltiples estudios que descartaron enfermedades reumatológicas, hepáticas e infecciosas. Entre los estudios imagenológicos, la endoscopía digestiva alta mostró esofagitis congestiva leve y gastritis crónica antral, al igual que todas las endoscopias previas. En la radiografía seriada esófago-gastroduodenal se observa severo reflujo gastroesofágico,y compresión compatible con pinzamiento. La tomografía computarizada de abdomen y pelvis mostraba el estómago de mayor tamaño que lo habitual y el duodeno presentaba nuevamente esta compresión compatible con pinzamiento. En base a estos últimos hallazgos imagenológicos, y luego de descartar variados diagnósticos diferenciales se planteó un SAMS y se decidió realizar bypass duododenoyeyunal, con buena evolución posterior. DISCUSIÓN: El diagnostico de SAMS es muchas veces de exclusión, basado en la clínica y la imagenología abdominal que descarta otros cuadros clínicos. En este caso se tiene el antecedente de múltiples hospitalizaciones sin diagnóstico concluyente. Finalmente por la larga evolución del cuadro se decide una resolución quirúrgica.

INTRODUCTION: The Superior Mesenteric Artery Syndrome (SMAS) is an uncommon acquired disorder. The main characteristic is the obstruction due to compression of the third portion of the duodenum, between the superior mesenteric arthery and the abdominal aorta. CLINICAL CASE: 42-year-old female patient with a record of depressive disorder, cholecystectomyperformed in 1994 and multiple hospitalizations due to hyperemesissince 1995, with inconclusive studies. Was admitted to the hospital on December 2011 because to alimentary vomit associated with great nutritional compromise. Multiple exams were performed to discard rheumatologic, hepatic and infectious diseases. The imaging test showed high digestive endoscopy with mild esophagitis and antral chronic gastritis, as in previous endoscopies. Stomach-esophagus-duodenum radiography with gastroesophageal reflux and extrinsic compression of the duodenum. Abdominal and pelvic computed tomography revealed a larger than usual stomach’s size and a compression in the duodenum compatible with pinching. Based on these last results and after we discard other options, we diagnosed a superior mesenteric artery syndrome and it was decided to perform a duodenojejunal bypass, with favorable evolution. DISCUSSION: The diagnosis of SMAS many times is made by exclusion based on the clinic and the abdominal images, discarding other pathologies. In this case, multiple hospitalizations with inconclusive diagnostics led to performing several tests for a variety of illnesses. Finally, based on the large evolution of the case it was decided a surgical resolution.

Exposición al humo de tabaco del niño asmático y su asociación con la gravedad del asma / Environmental tobacco smoke exposure in children and its relationship with the severity of asthma

Introducción: La exposición pasiva al humo de tabaco produce en el niño problemas respiratorios graves. El objetivo fue evaluar si la exposición al humo de tabaco del niño asmático incide sobre la gravedad del asma. Material y métodos: Estudio prospectivo multicéntrico en niños asmáticos, y sus padres, en 2007-2008, con encuesta de exposición, estudio de función pulmonar, determinación de cotinina en orina, y valoración de la gravedad del asma según la Guía GEMA. Las características de muestra se resumen empleando los estadígrafos adecuados y las comparaciones se realizan mediante las pruebas de la χ2 de Pearson, de la U de Mann-Whitney o de la t de Student, según la variable y la cantidad de grupos entre los que es comparada. Resultados: Se incluyeron 484 grupos familiares, de 7 comunidades autónomas, 61% de niños del género masculino, el 56% con conviviente fumador en su entorno, 34% padres, 31% madres y 17% ambos. El 37% de los casos estaba expuesto en el domicilio, el 11% diariamente. El 94% eran fumadores pasivos desde su nacimiento. El 20% había sido expuesto durante todo el embarazo a 5±1 cigarrillos/día. Los expuestos lo estuvieron a 6±1 cigarrillos/día, un 27% hasta 10 cigarrillos/día y un 10% a más de 10. La gravedad del asma durante la encuesta fue mayor en los expuestos (episódica-ocasional 47%, episódica-frecuente 35% y persistente-moderada 18% versus 59%, 25% y 16%, respectivamente; p=0,040). La gravedad en el último año fue mayor en los expuestos (episódica-ocasional 22%, episódica-frecuente 37% y persistente-moderada 50% versus 38%, 28% y 25%, respectivamente; p=0,037). Los valores espirométricos patológicos fueron 64% en expuestos frente a 36% en no expuestos para FEV1 (p=0,003), 63% vs 38% para FVC (p=0,038) y 54% vs 46% para el PEF (p=0,050). La cotinina era mayor en expuestos: 51 (0-524) ng/ml vs 27 (0-116) ng/ml (p=0,032). Se observó asociación entre la cotinina y el grado de exposición: 120 (0-590) ng/ml para >10 cigarrillos/día frente a 44 (0-103) ng/ml para ≤10 cigarrillos/día (p=0,035), que corrobora la consistencia de los datos recabados. Conclusión: La exposición al humo de tabaco del niño asmático incide sobre la gravedad de su asma (AU)

Introduction: Environmental tobacco smoke (ETS) exposure produces serious respiratory problems in childhood. The aim of the study was to evaluate if environmental tobacco smoke affects the severity of asthma in asthmatic children. Material and methods: A prospective, multicentre study was conducted on asthmatic children and their parents in 2007-2008, using an exposure questionnaire, pulmonary function, level of cotinine in urine, and evaluation of the severity of asthma according to GEMA guide. The characteristics of the sample are summarised using the appropriate statistical tools, and the comparisons were made using the Pearson chi2 test, Mann-Whitney U test or Student’ t, according to the variable and number of groups compared. Results: Four hundred and eighty four households in 7 Autonomous Communities were included. The population included, 61% male children with asthma, 56% with a smoking caregiver in their home, 34% fathers, 31% mothers and 17% both. Home exposure was 37%, with 11% daily and 94% passive smokers since birth. There was 20% with exposure during whole period of pregnancy of 5±1 cigarettes/day. Children exposed to 6±1 cigarettes/day, 27%, up to 10 cigarettes/day, and 10% to more than 10. Severity of asthma during the survey was worse among those exposed (episodic-occasional 47%, episodic-frequent 35% and persistent-moderate 18% versus 59%, 25% and 16%, respectively, P=.040). Severity of asthma in the last year was worse in those exposed (episodic - occasional 22%, episodic - frequent 37% and persistent - moderate 50% versus 38%, 28% and 25% respectively, P=.037). The spirometry was abnormal in 64% of the exposed against to 36% in the non-exposed for FEV1 (P=.003, 63% vs 38% for FVC (P=0.038), and 54% vs 46% for the PEF (P=0.050). The cotinine was higher in exposed: 51 (0-524) ng/ml vs 27 (0-116) ng/ml (P=0.032). A relationship was observed between cotinine and level of exposure: 120 (0-590) ng/ml for >10 cigarettes/day as opposed to 44 (0-103) ng/ml ≤10 cigarettes/day (P=0.035), which corroborates the consistency of the data collected. Conclusions: The exposure of children with asthma to environmental tobacco smoke has a highly negative effect on the severity of their asthma (AU)

[Environmental tobacco smoke exposure in children and its relationship with the severity of asthma]. / Exposición al humo de tabaco del niño asmático y su asociación con la gravedad del asma.

INTRODUCTION: Environmental tobacco smoke (ETS) exposure produces serious respiratory problems in childhood. The aim of the study was to evaluate if environmental tobacco smoke affects the severity of asthma in asthmatic children. MATERIAL AND METHODS: A prospective, multicentre study was conducted on asthmatic children and their parents in 2007-2008, using an exposure questionnaire, pulmonary function, level of cotinine in urine, and evaluation of the severity of asthma according to GEMA guide. The characteristics of the sample are summarised using the appropriate statistical tools, and the comparisons were made using the Pearson chi2 test, Mann-Whitney U test or Studentis t, according to the variable and number of groups compared. RESULTS: Four hundred and eighty four households in 7 Autonomous Communities were included. The population included, 61% male children with asthma, 56% with a smoking caregiver in their home, 34% fathers, 31% mothers and 17% both. Home exposure was 37%, with 11% daily and 94% passive smokers since birth. There was 20% with exposure during whole period of pregnancy of 5±1 cigarettes/day. Children exposed to 6±1 cigarettes/day, 27%, up to 10 cigarettes/day, and 10% to more than 10. Severity of asthma during the survey was worse among those exposed (episodic-occasional 47%, episodic-frequent 35% and persistent-moderate 18% versus 59%, 25% and 16%, respectively, P=.040). Severity of asthma in the last year was worse in those exposed (episodic - occasional 22%, episodic - frequent 37% and persistent - moderate 50% versus 38%, 28% and 25% respectively, P=.037). The spirometry was abnormal in 64% of the exposed against to 36% in the non-exposed for FEV(1) (P=.003, 63% vs 38% for FVC (P=.038), and 54% vs 46% for the PEF (P=.050). The cotinine was higher in exposed: 51 (0-524) ng/ml vs 27 (0-116) ng/ml (P=.032). A relationship was observed between cotinine and level of exposure: 120 (0-590) ng/ml for >10 cigarettes/day as opposed to 44 (0-103) ng/ml ≤10 cigarettes/day (P=.035), which corroborates the consistency of the data collected. CONCLUSIONS: The exposure of children with asthma to environmental tobacco smoke has a highly negative effect on the severity of their asthma.

Terapia ocupacional precoz e intensiva en la prevención del delirium en adultos mayores ingresados a unidades de paciente crítico: ensayo clínico randomizado: resultados preliminares / Early and intensive occupational therapy in prevention of delirium in older adults admitted to critical patient unit: randomized clinical trial: prelimary results

Objetivo: comparar la eficacia de la prevención no farmacológica estándar (PnFE) versus la prevención no farmacológica reforzada (PnFR), consistente en prevención no farmacológica estándar más terapia ocupacional (TO) precoz e intensiva, en la incidencia del delirium en adultos mayores (AM) ingresados a unidad de pacientes críticos (UPC). Diseño: ensayo clínico randomizado, en UPC del Hospital Clínico de la Universidad de Chile (HCUCH). Sujetos: 70 pacientes de edad igual o superior a 60 años, ingresados al HCUCH entre abril y octubre del 2011, con necesidad de ingreso a UPC para monitorización, hospitalización por enfermedad aguda/crónica descompensada, con consentimiento del paciente o familiar y sin presencia de delirium al ingreso ni deterioro cognitivo previo al estudio. Materiales y métodos: PnFE (grupo control) consiste en: reorientación, movilización precoz, corrección de déficit sensoriales, manejo ambiental, protocolo de sueño y reducción de fármacos anticolinérgicos, versus PnFR (grupo experimental), que considera las siguientes áreas de intervención de TO: estimulación polisensorial, posicionamiento, estimulación cognitiva, entrenamiento en actividades de la vida diaria básica, estimulación motora de extremidades superiores y participación familiar; durante 5 días, dos veces al día. Se evaluó la presencia del delirium, con el CAM dos veces al día durante 5 días, y la severidad de éste con DRS; previo al alta se evaluó, independencia funcional con FIM, estado cognitivo con MMSE y fuerza de garra con dinamómetro de Jamar. Resultados: la PnFR de TO se asocia a menor incidencia de delirium, afectando al 16,1 por ciento del grupo con prevención no farmacológica estándar versus un 3,1 por ciento del con prevención no farmacológica reforzada, así como a menos días de hospitalización (20,6 días versus 10,4 p=.009). La independencia funcional al alta se mantiene en aspectos cognitivos (32,5 versus 32,9) mientras que en aspectos motores aumenta...

Objective: to compare the efficacy of standard non pharmacological prevention of delirium versus intensified prevention of delirium (standard prevention plus early and intensive occupational therapy) in the incidence of delirium in older adults (OA) admitted to critical patient unit (CPU). Desing: randomized control trial, blinded to outcome evaluator, in the CPU of Hospital Clínico Universidad de Chile. Subjects: 70 patients aged 60 years or older, admitted to CPU between April and October of 2011, with need for admission to CPU for monitoring, acute or decompensated chronic illness, without cognitive impairment and consent by patient or family member. Materials and methods: standard prevention group consisted in: reorienting, early mobilization, correction of sensory deficit, environmental management, protocol of sleep and reduction of drugs, and intensified prevention based on standard measured plus early and intensive Occupational therapy: multisensory stimulation, positioning, cognitive stimulation, training in activities of daily living, motor stimulation of the upper extremities and family participation, twice a day for 5 days. Delirium was evaluated (twice a day for 5 days) with CAM and severity with DRS. Primary outcome was delirium incidence, and secondarily were functional independence (FIM), cognitive status (MMSE) and strength of grip with jamar dynamometer at leaving. Results: early intervention and intensive occupational therapy is associated with lower incidence of delirium, affecting 16.1 percent of non-pharmacological standard prevention group and 3.1 percent of intensified prevention group, as well as fewer days of hospitalization (20, 6 days versus 10,4, p= 0,009). The functional independence at leaving keeps in cognitive (32.5 versus 32.9) and is increases significantly in motor aspects (46.5 versus 58.3 l, P =. 03). Conclusion: standard prevention plus early intensive intervention of occupational therapy is effective in...

Identificación clínica y patológica de las diversas formas de la enfermedad de Creutzfeldt Jakob en Chile / Clinical and pathologic identification of different forms of Creutzfeldt Jakob disease in Chile

Background: The identification of clinical and pathological forms of Creutzfeldt Jakob Disease (CJD) started with the first cases of the disease. Genetic and biomolecular prion status assessment are allowing now a better classification. Aim: To identify the clinical forms of the disease that exist in Chile, based on clinical and neuropathological data. Patients and Methods: Review of records of 40 patients with CJD in whom a complete history, clinical details and neuropathological studies were available. Clinical aspects were grouped into five categories: behavioral and cognitive changes, sleep and alertness, visual impairment, motor disturbances, myoclonus and epilepsy. The neuropathological examination in each case allowed us to evaluate the damage of 13 areas of the central nervous system. Results: Five forms of CJD were identified. The classic form was present in 28 patients (70%), the Heidenhain form was present in five (12.5%), the ataxic form in four (10%), the form with Kuru plaques in two (5%) and the Vacuolar was present in one patient (2.5%). Conclusions: The variety and forms of CJD in Chile do not differ substantially from those found abroad.

Penfigoide gestacional "Herpes gestationis": revisión a partir de un caso clínico / Gestational pemphigoid "Herpes gestationis": review from a clinical case

La embarazada es susceptible a cambios en la piel y fanéreos que pueden ser fisiológicos como patológicos. El reconocimiento de estas entidades es fundamental para un correcto manejo. La clasificación y nomenclatura de las dermatosis del embarazo ha sido controversial y confusa, principalmente dado el pobre conocimiento que se tiene sobre el origen de estas entidades. El objetivo de esta revisión es informar sobre el conocimiento actual del penfigoide gestacional a partir de un caso clínico, centrándose en su diagnóstico y tratamiento como patología multidiscilpinaria.

The pregnant woman is susceptible to both physiologic and pathologic changes of the skin and appendages. Recognition of these entities is important for appropriate management. The classification and nomenclature have been controversial and confusing, mainly because of the poor knowledge that we have regarding the origin of this entities. The purpose of this review is to contribute to the current knowledge of pemphigoid gestationis, based on a case-report its diagnosis and treatment as a multidisciplinary pathology.

Expression analysis of phytochromes A, B and floral integrator genes during the entry and exit of grapevine-buds from endodormancy.

A common molecular regulatory pathway that involves PHYA, PHYB and floral integrator genes CONSTANS (CO), FLOWERING LOCUS T (FT) and SUPRESSOR OF OVEREXPRESSION OF CO1 (SOC1) has been suggested to participate in the regulation of photoperiod dependent processes such as flowering and dormancy. In grapevines (Vitis vinifera L.), decreasing photoperiod and low temperatures trigger the transition of buds into endodormancy (ED), a process that is accompanied by drastic changes in gene expression of VvPHYA and B in leaves. To analyse the relationship of VvPHYA, VvPHYB, and grape homologues of Arabidopsis floral integrator genes VvCO, VvFT, VvMADS8, with ED, a comparative expression analysis of these genes was performed in grapevine-leaves and buds before, during and after the transition of buds into ED. The expression of all the above genes in the bud-tissue, and the fact that photoperiod regulates differently the expression of VvPHYA and B in buds than in leaves, suggests that the bud might be an autonomous or semi-autonomous organ in perceiving and transducing the photoperiod signal. On the other hand, the coordinated down-regulation of VvFT in leaves and buds during the transition of buds into ED, and its subsequent up-regulation following the application of dormancy-breaking compounds, hydrogen cyanamide (HC) and sodium azide, suggests that VvFT could play a key role in stimulating bud-growth by repressing their entry into ED.

Cortical auditory adaptation in the awake rat and the role of potassium currents.

Responses to sound in the auditory cortex are influenced by the preceding history of firing. We studied the time course of auditory adaptation in primary auditory cortex (A1) from awake, freely moving rats. Two identical stimuli were delivered with different intervals ranging from 50 ms to 8 s. Single neuron recordings in the awake animal revealed that the response to a sound is influenced by sounds delivered even several seconds earlier, the second one usually yielding a weaker response. To understand the role of neuronal intrinsic properties in this phenomenon, we obtained intracellular recordings from rat A1 neurons in vitro and mimicked the same protocols of adaptation carried out in awake animals by means of depolarizing pulses of identical duration and intervals. The intensity of the pulses was adjusted such that the first pulse would evoke a similar number of spikes as its equivalent in vivo. A1 neurons in vitro adapted with a similar time course but less than in awake animals. At least two potassium currents participated in the in vitro adaptation: a Na(+)-dependent K(+) current and an apamin-sensitive K(+) current. Our results suggest that potassium currents underlie at least part of cortical auditory adaptation during the awake state.