Association of Handgrip Strength with Quality of Life in Breast Cancer Survivors: A Systematic Review and Meta-Analysis.

OBJECTIVE: Handgrip strength (HGS) is an indicator of general muscular strength and in cancer patients acts as a relevant marker associated with mortality and health. This study aimed to evaluate the association between peripheral muscle function and health-related quality of life (HRQoL) in breast cancer (BC) survivors. METHODS: Systematic review registered on PROSPERO under number: CRD 42021225206. The searches were carried out on MEDLINE via Pubmed, PEDro, Cochrane Library, Embase, CINAHL via EBSCO and Science Direct databases. Observational studies evaluating the association between handgrip strength (HGS) and HRQoL in adult female BC survivors were included. No linguistic or time restrictions were applied. Two reviewers reviewed full texts for inclusion and performed data extraction and risk of bias using the Newcastle and Ottawa scale (NOS). RESULTS: Five articles were included and involved 587 patients, mean age of 47 to 59 years. The percentage of decreased HGS ranged from 38.3% to 60.3%. HGS was associated with different quality of life measures. From meta-analysis including 220 patients, the correlation coefficient between HGS and HRQoL was 0.26 (95% CI: 0.07-0.35). CONCLUSIONS: Breast cancer survivors face decline of HGS. In this population HGS was correlated with HRQoL. However, more evidence are necessary.

Nosocomial Outbreak of Extensively Drug-Resistant (Polymyxin B and Carbapenem) Klebsiella pneumoniae in a Collapsed University Hospital Due to COVID-19 Pandemic.

We correlated clinical, epidemiological, microbiological, and genomic data of an outbreak with polymyxin B (PB)- and carbapenem-resistant Klebsiella pneumoniae during the COVID-19 pandemic. Twenty-six PB- and carbapenem-resistant K. pneumoniae were isolated from patients in the COVID-19 ICU (Intensive Care Unit), non-COVID-19 ICU (Intensive Care Unit), clinical, or surgical ward. Bacterial identification, drug susceptibility tests, and DNA sequencing were performed, followed by in silico resistance genes identification. All isolates showed extensively drug-resistant (XDR) phenotypes. Four different sequence types (ST) were detected: ST16, ST11, ST258, and ST437. Nineteen isolates were responsible for an outbreak in the ICU in September 2020. They belong to ST258 and harbored the 42Kb IncX3plasmid (pKP98M3N42) with the same genomic pattern of two K. pneumoniae identified in 2018. Twenty-four isolates carried bla-KPC-2 gene. No plasmid-mediated colistin (mcr) resistance genes were found. Eight isolates presented mgrB gene mutation. The clonal isolates responsible for the outbreak came from patients submitted to pronation, with high mortality rates in one month. XDR-K. pneumoniae detected during the outbreak presented chromosomal resistance to PB and plasmid-acquired carbapenem resistance due to KPC production in most isolates and 42Kb IncX3(pKP98M3N42) plasmid carrying blaKPC-2 was associated with ST258 isolates. The outbreak followed the collapse of the local healthcare system with high mortality rates.

Caracterización de pacientes hospitalizados con sospecha de disfagia en el Hospital San Camilo de San Felipe, Chile / Characterization of hospitalized patients with suspected dysphagia at Hospital San Camilo, San Felipe

Resumen Introducción: El trastorno de la deglución, se denomina disfagia y presenta como complicaciones fundamentales la deshidratación, desnutrición y neumonía por aspiración, situaciones que condicionan desfavorablemente el estado de salud, incrementando la morbimortalidad. En Chile, existen escasas publicaciones a la fecha que den cuenta de antecedentes clínicos que permitan describir a los pacientes con sospecha de disfagia. Objetivo: Describir las características clínicas de pacientes hospitalizados con sospecha de disfagia en el Hospital San Camilo de San Felipe, Chile. Material y Método: Estudio descriptivo de 767 registros de pacientes, entre los años 2017 y 2019. Se revisó información demográfica y antecedentes clínicos. Para variables cualitativas, se utilizaron proporciones y distribuciones frecuenciales, para variables cuantitativas, se usaron medidas de tendencia central. Resultados: El 58,54% de los pacientes era de sexo masculino y el 79,4% correspondió a personas mayores (79,4%). Las patologías neurológicas representaron el diagnóstico de ingreso más frecuente (61,93%). El 14,73% presentó antecedentes de intubación endotraqueal, el 8,34% tenía traqueostomía y el 84,09% era edéntulo parcial o total. En la evaluación con alimentos, las degluciones múltiples y la presencia de tos correspondieron a las alteraciones de eficacia y seguridad más frecuentes. En el 82,01% se diagnosticó disfagia y la mayoría de etiología neurogénica (68,45%). Conclusión: El presente estudio permitió conocer las características clínicas de los pacientes con sospecha de disfagia hospitalizados. En este contexto los pacientes extubados, traqueostomizados y las personas mayores con trastornos neurológicos o patologías respiratorias se presentan como potenciales candidatos para la evaluación de deglución.

Abstract Introduction: The swallowing disorder is called dysphagia and presents complications such as dehydration, malnutrition and aspiration pneumonia, situations that unfavorably condition the state of health, increasing morbidity and mortality. In Chile, there are few publications to date that provide an account of clinical history that allow the description of patients with suspected dysphagia. Aim: To describe the clinical characteristics of hospitalized patients with suspected dysphagia at Hospital San Camilo de San Felipe, Chile. Material and Method: Descriptive study of 767 patient records, between the years 2017 and 2019. Demographic information and clinical history were reviewed. For qualitative variables, proportions and frequency distributions were used, for quantitative variables, measures of central tendency were used. Results: 58.54% of the patients were male and 79.4% corresponded to elderly people (79.4%). Neurological pathologies represented the most frequent admission diagnosis (61.93%). 14.73% had a history of endotracheal intubation, 8.34% had a tracheostomy, and 84.09% were partial or total edentulous. In the evaluation with food, multiple swallows and the presence of cough corresponded to the most frequent alterations in efficacy and safety. In 82.01%, dysphagia was diagnosed and the majority of neurogenic etiology (68.45%). Conclusion: The present study allowed us to describe the clinical characteristics of hospitalized patients with suspected dysphagia. In this context, extubated, tracheostomized patients and the elderly with neurological disorders or respiratory pathologies are presented as potential candidates for swallowing evaluation.

Migraine With Aura Is Related to Delayed Motor Control Reaction and Imbalance Following External Perturbations.

Background: It is evidenced that migraineurs present balance deficits. However, the balance recovery following unexpected ground perturbations, which reflect conditions of everyday activities, has not been investigated in this population. Aim: We aimed to assess the reactive postural responses among patients with migraine with and without aura, chronic migraine, and controls. We further aimed to assess the factors associated with greater self-report of falls. Methods: Ninety patients diagnosed by headache specialists were equally classified into three migraine subgroups according to the presence of aura and chronic migraine. Thirty controls were also recruited. All participants underwent the motor control test (MCT) and adaptation test (ADT) protocols of dynamic posturography tests (EquiTest®, NeuroCom, USA). Clinical and headache features and information on falls in the previous year, fear of falling, and vestibular symptoms were also assessed. Results: Patients with aura presented a greater sway area in most of the MCT conditions than the other three groups (p = 0.001). The aura group also presented delayed latency responses after perturbations compared with controls and patients without aura (p < 0.03). In the ADT, a greater sway area was observed in patients with aura than in groups without aura, chronic migraine, and controls (p < 0.0001). The MCT and ADT sway area, the frequency of aura, and the fear of falling explained 46% of the falls in the previous 12 months. Conclusion: Patients with aura exhibited greater delay and sway area after unexpected ground perturbations than controls and other migraine subgroups, which are related to the reported number of falls.

Enfrentamiento del paciente con dolor abdominal / Approach to the patient with abdominal pain

El dolor abdominal es una causa frecuente de consulta ambulatoria, sus causas son múltiples e incluyen patologías de riesgo vital u otras de bajo riesgo que requieren principalmente tratamiento y no requieren mayores estudios. La historia clínica y el examen físico son las herramientas principales para poder sospechar la etiología de la enfermedad que está causando el dolor abdominal. Es por esto que realizar una historia completa, haciendo preguntas dirigidas a confirmar o descartar sospechas diagnósticas, asociado a un examen físico completo y sistemático, es la principal forma de orientar el diagnóstico y estudio posterior del paciente. Conocer el cuadro clínico de las enfermedades que dentro de sus síntomas pueden presentar dolor abdominal, especialmente aquellas que son de riesgo vital permite poder diagnosticarlas con la rapidez que se requiere. Así mismo, es necesario reconocer aquellas enfermedades que son más frecuentes y que no requieren mayores estudios sino tratamiento básico, habitualmente ambulatorio. Existen personas que, por sus condiciones de salud o edad, pueden tener presentaciones atípicas de cuadros habituales o mayores riesgos de tener enfermedades infrecuentes o de mayor riesgo vital, que es importante reconocer al momento de la evaluación.

Abdominal pain is a common complaint in ambulatory medicine. It has multiples causes,including lifethreatening pathologies and other benign in which the need in treatment and no other tests. The clinical history and physical examination are the key to suspect the etiology of the underlying disease. A complete history includes make direct questions to confirm or discard the diagnostic suspects and with a complete and systematic physical examination are the main way to get the diagnosis and treatment of the patient. The clinician must know the syndromes which includes abdominal pain, especially those life-threatening which requires urgent treatment or surgery. Also needs to know the frequent benign syndromes that can be safely treated symptomatically with no further investigation. Older adults or patients with comorbidities may present with unusual causes of abdominal pain or may have an atypical presentation of common disorders. Also, may present more frequent serious etiologies that may require urgent interventions.

Nutrition as an etiological factor causing diseases in endangered huemul deer.

OBJECTIVES: Distinct diseases prevent endangered huemul deer (Hippocamelus bisulcus) recovery. Fundamental etiological factors include nutriments, a mayor component of habitat quality. Undernutrition affects growth, skeletal development, osteopathology, reproduction and immunocompetence: this paper amplifies data corroborating micro-nutrient deficiencies among huemul. RESULTS: In Argentina, 57% huemul cadavers exhibited osteopathology, with new cases reported here. Recently, 86% live huemul had osteopathology: cranial lesions involved antemortem tooth loss, reducing feeding efficiency and body condition, with starvation deaths. This population had tissues well deficient compared to other cervids, averaging 0.28 ppm selenium, 4.98 ppm copper, whereas for manganese 55% were deficient (2.52 ppm) and 45% adequate (42.79 ppm). Recently, lesions in one Chilean huemul were interpreted to stem from parapoxvirus. That population also has cases with cranial osteopathologies, high disease susceptibility (parapoxvirus, parasitism, foot lesions), crippled antlers, and low density, indicative of marginal habitat and primary etiological factors like undernutrition and immunosuppression. The reported atypical symptoms attributed to parapoxvirus may relate to probable diagnostic limitations, but does support presence of nutritional deficiencies. Patagonia has selenium deficient plants and livestock, including severe muscular dystrophy, and soil levels in extant huemul areas considered very deficient. Moreover, 73% of Chilean huemul were selenium deficient and 64% severely deficient with concomitant cranial osteopathology.

Model to estimate the nursing workload required by trauma victims on intensive care unit discharge.

AIM: To validate a model to estimate the nursing workload required by trauma victims on intensive care unit (ICU) discharge. BACKGROUND: Identifying a reliable model of nursing workload measurement that can assist professionals. METHODS: A prospective cohort study conducted in 2010 (first phase) and 2015 (second phase) with 342 trauma victims admitted into the ICU of four hospitals located in São Paulo, Brazil. The original model was created during the first phase and included the Simplified Acute Physiology Score and New Injury Severity Score variables. Coefficients of determination (R2 ) were calculated to identify the reliability. RESULTS: The original model presented high reliability (R2  = 44%) in the hospital of origin, and unsatisfactory performance (R2  < 4%) in the other institutions. An improvement in R2 was observed after adjusting the coefficients for each hospital. CONCLUSION: For the Nursing Activities Score prediction of survivors for ICU discharge, trauma centres must validate the original model with coefficient adjustments for their population, or preferably derive their own models. IMPLICATIONS FOR NURSING MANAGEMENT: Although models are useful in predicting discharge of these ICU patients, for treatment continuity after critical care and for organising services, the study showed that they should be evaluated prior to use for nursing management.

Traduccion, adaptacion cultural y validacion de una escala de funcion del miembro superior: DASH / Translation, cultural adaptation and validation of the DASH - upper extremity functional scale

Introducción El objetivo del estudio fue realizar la traducción, adaptación cultural y validación de una escala de función del miembro superior, denominada DASH, por sus siglas en inglés (discapacidad del brazo, el hombro y la mano). Materiales y métodos Se realizó un estudio metodológico de validación de escalas: traducción (constó de traducciones inglés-español, comité de expertos inicial, dos contratraducciones, un segundo comité de expertos y una traducción definitiva); evaluación de confiabilidad (pruebas de coherencia interna, test-retest y cambio mínimo detectable); respuesta al cambio (mediciones en pacientes antes y después de tratamiento), y estudio de validez (se hicieron pruebas de validez de apariencia, de constructo y de criterio). Resultados La prueba traducida fue aplicada a 338 pacientes con enfermedades de mano y hombro, 311 fueron utilizables. La consistencia interna, mediante alfa de Cronbach, se estimó > 0,96; el resultado del coeficiente de concordancia de Lin fue 0,86. El cambio mínimo detectable fue 15,88, la capacidad de respuesta al cambio mediante la prueba de la t de Student aplicada sobre la diferencia en la puntuación arrojó una p < 0,001; adicionalmente se corrió una correlación no paramétrica de Spearman entre la diferencia en la puntuación DASH y la diferencia en la escala visual analógica de cambio en estado de salud (EVA SALUD) y se obtuvo un r = 0,62 (p < 0,001). Discusión La escala DASH traducida y adaptada al español demostró una buena fiabilidad, estabilidad y capacidad de respuesta al cambio, logró discriminar entre diferentes enfermedades y tiene una validez estimada buena en cuanto a contenido, constructo y criterio.

Introduction The objective of the study was to perform translation, cultural adaptation and validation of a function scale of the upper limb, called DASH, for its acronyms in English (disability of the arm, shoulder and hand). Materials and methods A methodological study of scale validation was performed: translation (consisting of English-Spanish translations, initial expert committee, two backtranslations, a second committee of experts and a definitive translation); reliability assessment (internal consistency tests, test-retest and minimum detectable change); response to change (measurements in patients before and after treatment), and validity study (validity tests of appearance, construct and criteria were performed). Results The translated test was applied to 338 patients with hand and shoulder diseases, 311 were usable. The internal consistency, using Cronbach's alpha, was estimated to be > 0.96; The result of the Lin coefficient of agreement was 0.86. The minimum detectable change was 15.88, the ability to respond to change using the Student t test applied on the difference in score yielded a p <0.001; A nonparametric Spearman correlation was recorded between the difference in the DASH score and the difference in the visual analogue scale of change in health status (EVA HEALTH) with r = 0.62 (p <0.001). Discussion The DASH scale, translated and adapted to Spanish demonstrated good reliability, stability and responsiveness to change, managed to discriminate between different diseases and has an estimated validity in terms of content, construct and criteria.

Nasal Drug Delivery of Anticancer Drugs for the Treatment of Glioblastoma: Preclinical and Clinical Trials.

Glioblastoma (GBM) is the most lethal form of brain tumor, being characterized by the rapid growth and invasion of the surrounding tissue. The current standard treatment for glioblastoma is surgery, followed by radiotherapy and concurrent chemotherapy, typically with temozolomide. Although extensive research has been carried out over the past years to develop a more effective therapeutic strategy for the treatment of GBM, efforts have not provided major improvements in terms of the overall survival of patients. Consequently, new therapeutic approaches are urgently needed. Overcoming the blood-brain barrier (BBB) is a major challenge in the development of therapies for central nervous system (CNS) disorders. In this context, the intranasal route of drug administration has been proposed as a non-invasive alternative route for directly targeting the CNS. This route of drug administration bypasses the BBB and reduces the systemic side effects. Recently, several formulations have been developed for further enhancing nose-to-brain transport, mainly with the use of nano-sized and nanostructured drug delivery systems. The focus of this review is to provide an overview of the strategies that have been developed for delivering anticancer compounds for the treatment of GBM while using nasal administration. In particular, the specific properties of nanomedicines proposed for nose-to-brain delivery will be critically evaluated. The preclinical and clinical data considered supporting the idea that nasal delivery of anticancer drugs may represent a breakthrough advancement in the fight against GBM.

Transition period produces changes in blood and body composition in mares / Período de transição produz alterações na composição do sangue e do corpo em éguas

Clinical and metabolic evaluation is necessary for the monitoring of pregnant and lactating mares, as they reflect the health of the animal. The body condition of the mare is an indicator of reproductive efficiency. The study aimed to determine the possible variations in body and metabolic condition in Mangalarga Marchador mares during the transition period. Forty-eight mares distributed in two groups were used: Maintenance Group (MG), composed of non-pregnant and non-lactating mares, and Transition Group (TG), formed by pregnant mares and who after delivery became lactating. Analyzes were performed in the times T-60, T-30 and T-15 before delivery, first six hours (T0) after delivery and T15, T30 and T60 days after delivery. MG was evaluated only at one time (T-60). Body weight and fat-free mass differed (P<0.05) between the groups. The percentage of fat was lower in MG. Mares had a higher fat percentage in TG at T-60 and T-30 times. There was a difference (P<0.05) in the amount of cholesterol between MG and TG (T0, T15 and T30). Triglycerides were different between the groups. TG showed higher concentrations of non-esterified fatty acids (P<0.05). There was a higher amount of glucose in TG (delivery and lactation) when compared to mares in MG. Changes in body condition and metabolic constituents occurred in the animals resulting from physiological adaptations of the transition period. The energetic components are the most affected from the transition period, with intense fat mobilization to supply the body demands.(AU)

Avaliações clínicas e metabólicas são necessárias para o monitoramento de éguas gestantes e lactantes, pois refletem a saúde do animal. A condição corporal da égua pode ser um indicador da eficiência reprodutiva. O estudo objetivou determinar as possíveis variações na condição corporal e metabólica em éguas Mangalarga Marchador durante o período de transição. Foram utilizadas 48 éguas distribuídas em dois grupos: Grupo em Manutenção (GM) composto por éguas não gestantes e não lactantes; Grupo em Transição (GT) formado por éguas gestantes e que após o parto tornaram-se lactantes. As análises foram realizadas nos tempos T-60, T-30 e T-15 antes do parto, primeiras seis horas (T0) após o parto e T15, T30 e T60 dias após o parto. O GM foi avaliado apenas uma vez (T-60). O peso corporal e a massa livre de gordura diferiram (P<0,05) entre os grupos. O percentual de gordura foi menor em GM. As éguas apresentaram maior porcentagem de gordura no GT no T-60 e no T-30. Houve diferença (P<0,05) na quantidade de colesterol entre GM e GT (T0, T15 e T30). Triglicérides foram diferentes entre os grupos. GT apresentou maiores concentrações de ácidos graxos não esterificados (P<0,05). Houve maior quantidade de glicose no GT (parto e lactação) quando comparada às éguas no GM. Mudanças na condição corporal e nos constituintes metabólicos ocorreram nos animais resultantes de adaptações fisiológicas do período de transição. Os componentes energéticos são os mais afetados neste período, existindo intensa mobilização de gordura para suprir demandas corporais.(AU)

Transition period produces changes in blood and body composition in mares / Período de transição produz alterações na composição do sangue e do corpo em éguas

Clinical and metabolic evaluation is necessary for the monitoring of pregnant and lactating mares, as they reflect the health of the animal. The body condition of the mare is an indicator of reproductive efficiency. The study aimed to determine the possible variations in body and metabolic condition in Mangalarga Marchador mares during the transition period. Forty-eight mares distributed in two groups were used: Maintenance Group (MG), composed of non-pregnant and non-lactating mares, and Transition Group (TG), formed by pregnant mares and who after delivery became lactating. Analyzes were performed in the times T-60, T-30 and T-15 before delivery, first six hours (T0) after delivery and T15, T30 and T60 days after delivery. MG was evaluated only at one time (T-60). Body weight and fat-free mass differed (P<0.05) between the groups. The percentage of fat was lower in MG. Mares had a higher fat percentage in TG at T-60 and T-30 times. There was a difference (P<0.05) in the amount of cholesterol between MG and TG (T0, T15 and T30). Triglycerides were different between the groups. TG showed higher concentrations of non-esterified fatty acids (P<0.05). There was a higher amount of glucose in TG (delivery and lactation) when compared to mares in MG. Changes in body condition and metabolic constituents occurred in the animals resulting from physiological adaptations of the transition period. The energetic components are the most affected from the transition period, with intense fat mobilization to supply the body demands.(AU)

Avaliações clínicas e metabólicas são necessárias para o monitoramento de éguas gestantes e lactantes, pois refletem a saúde do animal. A condição corporal da égua pode ser um indicador da eficiência reprodutiva. O estudo objetivou determinar as possíveis variações na condição corporal e metabólica em éguas Mangalarga Marchador durante o período de transição. Foram utilizadas 48 éguas distribuídas em dois grupos: Grupo em Manutenção (GM) composto por éguas não gestantes e não lactantes; Grupo em Transição (GT) formado por éguas gestantes e que após o parto tornaram-se lactantes. As análises foram realizadas nos tempos T-60, T-30 e T-15 antes do parto, primeiras seis horas (T0) após o parto e T15, T30 e T60 dias após o parto. O GM foi avaliado apenas uma vez (T-60). O peso corporal e a massa livre de gordura diferiram (P<0,05) entre os grupos. O percentual de gordura foi menor em GM. As éguas apresentaram maior porcentagem de gordura no GT no T-60 e no T-30. Houve diferença (P<0,05) na quantidade de colesterol entre GM e GT (T0, T15 e T30). Triglicérides foram diferentes entre os grupos. GT apresentou maiores concentrações de ácidos graxos não esterificados (P<0,05). Houve maior quantidade de glicose no GT (parto e lactação) quando comparada às éguas no GM. Mudanças na condição corporal e nos constituintes metabólicos ocorreram nos animais resultantes de adaptações fisiológicas do período de transição. Os componentes energéticos são os mais afetados neste período, existindo intensa mobilização de gordura para suprir demandas corporais.(AU)

Formative assessment scores in tutorial sessions correlates with OSCE and progress testing scores in a PBL medical curriculum.

BACKGROUND: Effective assessments programs are a challenge in problem-based learning (PBL). One of the main principles of this educational setting is the Formative Assessment (FA). We hypothesized that students' performance assessed by FA in tutorial sessions in a PBL curriculum is related to other summative assessments. OBJECTIVE: To investigate the correlation among FA in tutorial sessions with grades obtained in Objective Structured Clinical Evaluation (OSCE) and Progress Testing (PT) to better understand the assessment process in PBL medical teaching approach and to predict student's future performance. DESIGN: An observational cross-sectional study was conducted comparing FA, OSCE and PT scores from 4th to 8th semester medical students. Correlation analyses were performed using pooled and separate data from the 4th and 8th semesters. RESULTS: From the 5th to 8th semester, OSCE scores were smaller compared to the FA, while PT scores were lower in all stages. In the pooled data, the correlation analysis showed a significant positive relationship between grades on FA and OSCE, FA and PT and OSCE and PT. A significant correlation among the three assessments strategies was also detected in the 8th semester, but not in the 4th semester. CONCLUSIONS: Assessment strategies in PBL approach, including FA, OSCE and PT, have positive correlations, which increases as the medical course becomes more complex.

Evaluación clínica y por imágenes de la esclerosis múltiple progresiva / Clinical and radiological outcomes measures in progressive multiple sclerosis

Durante los últimos años, el desarrollo de medidas de evaluación de la acumulación de la discapacidad y la actividad inflamatoria en las formas progresivas de esclerosis múltiple (EM) ha sido un punto central de investigación de diversos grupos. Se han desarrollado y aplicado distintos instrumentos con el fin de identificar en forma precisa y precoz la actividad y la progresión en este fenotipo de EM. Muchas de esas herramientas, con mayor o menor sensibilidad, han sido utilizadas en ensayos clínicos, aunque su uso en la práctica asistencial no es del todo familiar para los profesionales involucrados en el cuidado de pacientes con EM. El objetivo de esta revisión es describir las medidas de evaluación clínica y por imágenes implementadas durante los últimos años para la identificación de la actividad y evolución de esta enfermedad en sus formas progresivas.

During recent years, the development of measures to assess the accumulation of disability and inflammatory activity in the progressive forms of multiple sclerosis (MS) has been a central point of research in various groups. Several instruments have been developed and implemented in order to accurately and early identify the activity and progression in this MS phenotype. Many of these tools, with greater or lesser sensitivity, have been used in clinical trials, although their use in healthcare practice is not entirely familiar to professionals involved in the care of patients with MS. The objective of this review is to describe the clinical and imaging evaluation measures implemented during the last years to identify the activity and the evolution of the disease in its progressive forms.

[Clinical and radiological outcomes measures in progressive multiple sclerosis]. / Evaluación clínica y por imágenes de la esclerosis múltiple progresiva.

During recent years, the development of measures to assess the accumulation of disability and inflammatory activity in the progressive forms of multiple sclerosis (MS) has been a central point of research in various groups. Several instruments have been developed and implemented in order to accurately and early identify the activity and progression in this MS phenotype. Many of these tools, with greater or lesser sensitivity, have been used in clinical trials, although their use in healthcare practice is not entirely familiar to professionals involved in the care of patients with MS. The objective of this review is to describe the clinical and imaging evaluation measures implemented during the last years to identify the activity and the evolution of the disease in its progressive forms.

Transition period produces changes in blood and body composition in mares

ABSTRACT: Clinical and metabolic evaluation is necessary for the monitoring of pregnant and lactating mares, as they reflect the health of the animal. The body condition of the mare is an indicator of reproductive efficiency. The study aimed to determine the possible variations in body and metabolic condition in Mangalarga Marchador mares during the transition period. Forty-eight mares distributed in two groups were used: Maintenance Group (MG), composed of non-pregnant and non-lactating mares, and Transition Group (TG), formed by pregnant mares and who after delivery became lactating. Analyzes were performed in the times T-60, T-30 and T-15 before delivery, first six hours (T0) after delivery and T15, T30 and T60 days after delivery. MG was evaluated only at one time (T-60). Body weight and fat-free mass differed (P 0.05) between the groups. The percentage of fat was lower in MG. Mares had a higher fat percentage in TG at T-60 and T-30 times. There was a difference (P 0.05) in the amount of cholesterol between MG and TG (T0, T15 and T30). Triglycerides were different between the groups. TG showed higher concentrations of non-esterified fatty acids (P 0.05). There was a higher amount of glucose in TG (delivery and lactation) when compared to mares in MG. Changes in body condition and metabolic constituents occurred in the animals resulting from physiological adaptations of the transition period. The energetic components are the most affected from the transition period, with intense fat mobilization to supply the body demands.

RESUMO: Avaliações clínicas e metabólicas são necessárias para o monitoramento de éguas gestantes e lactantes, pois refletem a saúde do animal. A condição corporal da égua pode ser um indicador da eficiência reprodutiva. O estudo objetivou determinar as possíveis variações na condição corporal e metabólica em éguas Mangalarga Marchador durante o período de transição. Foram utilizadas 48 éguas distribuídas em dois grupos: Grupo em Manutenção (GM) composto por éguas não gestantes e não lactantes; Grupo em Transição (GT) formado por éguas gestantes e que após o parto tornaram-se lactantes. As análises foram realizadas nos tempos T-60, T-30 e T-15 antes do parto, primeiras seis horas (T0) após o parto e T15, T30 e T60 dias após o parto. O GM foi avaliado apenas uma vez (T-60). O peso corporal e a massa livre de gordura diferiram (P 0,05) entre os grupos. O percentual de gordura foi menor em GM. As éguas apresentaram maior porcentagem de gordura no GT no T-60 e no T-30. Houve diferença (P 0,05) na quantidade de colesterol entre GM e GT (T0, T15 e T30). Triglicérides foram diferentes entre os grupos. GT apresentou maiores concentrações de ácidos graxos não esterificados (P 0,05). Houve maior quantidade de glicose no GT (parto e lactação) quando comparada às éguas no GM. Mudanças na condição corporal e nos constituintes metabólicos ocorreram nos animais resultantes de adaptações fisiológicas do período de transição. Os componentes energéticos são os mais afetados neste período, existindo intensa mobilização de gordura para suprir demandas corporais.

Evaluación de la responsabilidad criminal en una muestra de reclusos(as) en la ciudad de Barranquilla, Colombia, con el R-CRAS / Evaluation of the criminal liability in a sample of inmates in Barranquilla, Colombia with the R-CRAS / Avaliação da responsabilidade criminal em uma amostra de prisioneiros(as) na cidade de Barranquilla, Colômbia, com o R-CRAS

Resumen La responsabilidad criminal es un concepto objeto de estudio para la psicología forense. Se ha definido como la capacidad cognitiva de una persona para apreciar la naturaleza de lo injusto de su acto. En Latinoamérica, y de manera más específica en Colombia, no ha sido ampliamente estudiada, y existe escasa literatura sobre los instrumentos que permiten evaluarla. En este estudio se buscó establecer la responsabilidad criminal de 154 reclusos(as) sindicados y acusados por el delito de homicidio, utilizando el instrumento R-CRAS de Rogers (1986), el cual ha sido adaptado para Colombia por Mebarak y Jiménez (2010), con el fin de ampliar esta línea de investigación. Se pudo encontrar que a pesar de que la mayoría de reclusos reconocen su participación, culpa e implicaciones en los eventos relacionados con el crimen por el cual se encuentran recluidos, existe un porcentaje que aún no logra comprender la ilicitud de su acto (19,8%). Además, mucha información que se requiere para realizar una evaluación completa no era proporcionada por los centros carcelarios, y esto dejó un amplio vacío. Frente a esta situación, se necesitan mayores intervenciones de la psicológica forense en las prisiones, y sobre todo el desarrollo de instrumentos de evaluación que permitan una mejor aproximación frente a esta problemática. Se discuten las implicaciones.

Abstract Criminal responsibility is a concept under consideration in the field of forensic psychology. It has been defined as the cognitive capacity of a person to appreciate the nature of unfairness of his act. In Latin America, and more specifically in Colombia, it has not been widely studied and there is little literature on the instruments that allow it to be evaluated. This study aims to determine the criminal responsibility of 154 Colombian homicides, using the R-CRAS instrument of Rogers (1986) which has been adapted in Colombia by Mebarak and Jiménez (2010), in order to broaden this line of research. It was found that the most of the of inmates recognize their participation, guilt and implications in the events related to the crime for which they are being held, there is a percentage (19,8%) of them who have not understood the illicitness of their act yet. Also, a lot of information required to develop a comprehensive evaluation was not provided by the prison, leaving a substantial gap. Faced with this situation, there is a need for greater forensic psychological intervention in prisons and, above all, the development of evaluation instruments that allow a better approach to this problem. The implications of these findings are discussed.

Resumo A responsabilidade criminal é um conceito objeto de estudo para a psicologia forense. Tem sido definida como a habilidade cognitiva de uma pessoa para apreciar a natureza do injusto do seu ato. Na América Latina, y de maneira mais específica na Colômbia, não tem sido amplamente estudada, e existe escassa literatura sobre os instrumentos que permitem avaliá-la. No estudo se procurou estabelecer a responsabilidade criminal de 154 prisioneiros(as) indiciados e acusados pelo delito de homicídio, utilizando o instrumento R-CRAS de Rogers (1986), o qual tem sido adaptado para Colômbia por Mebarak e Jiménez (2010), com o fim de ampliar essa linha de pesquisa. Foi possível identificar que apesar de que a maioria dos prisioneiros reconhecem sua participação, culpa e implicações nos eventos relacionados com o crime pelo qual foram presos, existe uma porcentagem que ainda não consegue compreender a ilicitude do seu ato (19,8%). Além, muita informação requerida para fazer uma avaliação completa não era proporcionada pelos centros penitenciários, e isso deixou um amplo vácuo. Diante dessa situação, se necessitam maiores intervenções da psicologia forense nas prisões, e sobretudo o desenvolvimento de instrumentos de avaliação que permitam uma melhor aproximação perante dessa problemática. Se discutem as implicações.

Pesquisa sobre vacunación y oportunidades de prevención y educación para la salud: Experiencia en una residencia pediátrica mediante el Mini-Clinical Evaluation Exercise / Vaccination status inquiry and hierarchy of prevention and health education opportunities: Experience in a Pediatric Residency using the Mini-Clinical Evaluation Exercise

Introducción. El Mini-Clinical Evaluation Exercise (Mini-CEX) es una herramienta formativa. Dentro de sus ítems, evalúa la pesquisa del estado de vacunación y la jerarquización de oportunidades de prevención. Objetivos. Determinar porcentaje de pesquisa de dichos ítems en controles de salud y demanda. Comparar desempeño entre primer y tercer año. Materiales y métodos. Análisis retrospectivo de las planillas del Mini-CEX de residentes. Resultados. Se evaluaron 119 residentes. La prevalencia de pesquisa de vacunación en controles fue 94,9% (intervalo de confianza -IC-: 91,09-98,91); en demanda, 73,1% (IC: 65,2-81; OR 5,33; IC: 2,23-12,75; p= 0,00004). La prevalencia de aprovechamiento de oportunidades en controles fue 69,8% (IC: 61,6-78); en demanda, 62,2% (IC: 53,5-70,9; OR 1,034; IC: 0,46382,306; p= 0,4673). En 32 residentes se comparó su desempeño entre primer y tercer año en demandas, sin diferencia significativa. Conclusiones. Se detectó alta prevalencia de pesquisa de vacunación y menor prevalencia de aprovechamiento de oportunidades en controles, con menor pesquisa de ambos ítems en demandas.

Introduction. The Mini-Clinical Evaluation Exercise (Mini-CEX) is a formative tool with two descriptors assessing the inquiry of vaccination status and the hierarchy of prevention opportunities. Objectives. Determine the prevalence of both items in pediatric controls and spontaneous demands. Compare the performance between first and third year of their training. Material and methods. Retrospective analysis based on trainees Mini-CEX charts. Results. There were 119 residents evaluated during their first year. The prevalence of vaccination status screening in controls was 94.9% (confidence interval -CI-: 91.09-98.91); in demands 73.1% (CI: 65.2-81; OR 5.33; CI: 2.2312.75; p 0.00004). The prevalence of prevention opportunities in controls was 69.8% (CI: 61.678); in demands 62.2% (CI: 53.5-70.9; OR 1.034; CI: 0.4638-2.306; p= 0.4673). There were 32 trainees compared between their first and third year performance in demands, without significant difference. Conclusions. We found high prevalence of vaccination inquiry and lower prevalence of hierarchization of prevention opportunities in controls, with less inquiry in demands.

[Evaluation Exercise Vaccination status inquiry and hierarchy of prevention and health education opportunities. Experience in a Pediatric Residency using the Mini-Clinical Evaluation Exercise]. / Pesquisa sobre vacunación y oportunidades de prevención y educación para la salud. Experiencia en una residencia pediátrica mediante el Mini-Clinical.

INTRODUCTION: The Mini-Clinical Evaluation Exercise (Mini-CEX) is a formative tool with two descriptors assessing the inquiry of vaccination status and the hierarchy of prevention opportunities. Objectives. Determine the prevalence of both items in pediatric controls and spontaneous demands. Compare the performance between first and third year of their training. MATERIAL AND METHODS: Retrospective analysis based on trainees Mini-CEX charts. RESULTS: There were 119 residents evaluated during their first year. The prevalence of vaccination status screening in controls was 94.9% (confidence interval -CI-: 91.09-98.91); in demands 73.1% (CI: 65.2-81; OR 5.33; CI: 2.23- 12.75; p 0.00004). The prevalence of prevention opportunities in controls was 69.8% (CI: 61.6- 78); in demands 62.2% (CI: 53.5-70.9; OR 1.034; CI: 0.4638-2.306; p= 0.4673). There were 32 trainees compared between their first and third year performance in demands, without significant difference. CONCLUSIONS: We found high prevalence of vaccination inquiry and lower prevalence of hierarchization of prevention opportunities in controls, with less inquiry in demands.

Introducción. El Mini-Clinical Evaluation Exercise (Mini-CEX) es una herramienta formativa. Dentro de sus ítems, evalúa la pesquisa del estado de vacunación y la jerarquización de oportunidades de prevención. Objetivos. Determinar porcentaje de pesquisa de dichos ítems en controles de salud y demanda. Comparar desempeño entre primer y tercer año. Materiales y métodos. Análisis retrospectivo de las planillas del Mini-CEX de residentes. Resultados. Se evaluaron 119 residentes. La prevalencia de pesquisa de vacunación en controles fue 94,9% (intervalo de confianza ­IC­: 91,09-98,91); en demanda, 73,1% (IC: 65,2-81; OR 5,33; IC: 2,23-12,75; p= 0,00004). La prevalencia de aprovechamiento de oportunidades en controles fue 69,8% (IC: 61,6-78); en demanda, 62,2% (IC: 53,5-70,9; OR 1,034; IC: 0,4638- 2,306; p= 0,4673). En 32 residentes se comparó su desempeño entre primer y tercer año en demandas, sin diferencia significativa. Conclusiones. Se detectó alta prevalencia de pesquisa de vacunación y menor prevalencia de aprovechamiento de oportunidades en controles, con menor pesquisa de ambos ítems en demandas.

Evolução da vítima com trauma cranioencefálico na sala de emergência / Evolution of the victim with traumatic brain injury in the emergency room

Introdução: A frequência de vítimas de traumatismo cranioencefálico (TCE) nos serviços de emergência vem aumentando no mundo e conhecer a evolução dessas vítimas nas primeiras horas após lesão é um caminho importante para padronizar sua avaliação e alcançar melhores resultados no seu tratamento. Objetivos: Analisar, durante permanência na sala de emergência (SE), a evolução das vítimas que apresentaram TCE contuso como lesão principal e identificar, entre as variáveis demográficas, os indicadores de gravidade e as características do atendimento pré e intra-hospitalar, os fatores associados ao tempo de permanência na SE dessas vítimas. Método: Estudo do tipo corte prospectivo, com dados coletados na admissão da vítima de TCE na SE e 2, 4 e 6 horas após, ou até a transferência para tratamento definitivo em unidades específicas, ou óbito. Participaram desse estudo vítimas de TCE contuso como lesão principal, com idade 15 anos, admitidas em serviço de emergência referência para neurocirurgia, até 1 hora após trauma. A evolução das vítimas foi descrita pelas diferenças na pontuação Rapid Emergency Medicine Score (REMS) entre as avaliações na admissão na SE e 2, 4 e 6 horas após. Análises descritivas foram utilizadas para caracterização dos casos e descrever a evolução das vítimas. Testes estatísticos foram aplicados para verificar associação entre tempo de permanência na SE e idade, sexo, gravidade e características do atendimento pré e intra-hospitalar. Resultados: A casuística foi composta de 46 vítimas, 84,7% do sexo masculino, idade média de 34,7 anos (dp=15,1), 63% envolvidas em acidentes de trânsito. Na admissão na SE, o REMS médio dessas vítimas foi de 4,0 (dp=2,5), as médias do Injury Severity Score (ISS) e New Injury Severity Score (NISS) foram de 11,8 (dp=7,7) e 17,2 (dp=12,7), respectivamente. A Escala de Coma de Glasgow(ECGl) indicou 54,4% de casos de TCE grave e o Maximum Abbreviated Injury Scale/ região cabeça (MAIS/cabeça) apresentou média de 2,7 (dp=1,1). Entre a admissão na SE e 2 horas após, foram observadas mudanças desfavoráveis em 35,1% das vítimas e favoráveis em 27%; entre 2 e 4 horas, a evolução desfavorável foi constatada em 13,6% e favorável em 27,3%; entre 4 e 6 horas, constatou-se piora em 42,8% dos casos e melhora em 28,6%. Em média, as vítimas que tiveram piora apresentaram diferença de 2,8 (dp=2,3) no REMS entre admissão e 2 horas, de 2 (dp=0) entre 2 e 4 horas e de 2,3 (dp=0,5) entre 4 e 6 horas. Houve diferença estatisticamente significativa no tempo de permanência na SE somente em relação à variável uso de suporte hemodinâmico nesse serviço. Conclusão: A melhora de cerca de mais de » das vítimas de TCE contuso ocorreu em todos os períodos de avaliação, porém a frequência dos casos de evolução desfavorável foi maior do que favorável entre admissão e 2 horas e ainda mais elevada após permanência de 4 horas na SE. O maior tempo de permanência na SE esteve relacionado com uso de suporte hemodinâmico nesse serviço.

Introduction: The frequency of traumatic brain injury (TBI) in emergency services is increasing worldwide and knowing the evolution of these victims in the first hours after injury is an important way to standardize their evaluation and achieve better treatment outcomes. Objectives: To analyze the evolution of the victims whose main lesion was blunt TBI and to identify, among demographic variables, severity indicators and characteristics of pre and in-hospital care, as well as factors associated with length of stay in the emergency room (ER) of these victims. Method: A prospective study, with data collected at the admission of the TBI victim at ER and 2, 4 and 6 hours after, or until transfer to definitive treatment in specific units, or death. Participants of this study presented blunt TBI as the main lesion, age 15 years and were admitted at ER for neurosurgery up to 1 hour after trauma. The evolution of the victims was described by the differences in the Rapid Emergency Medicine Score (REMS) among the assessments on admission at ER and 2, 4 and 6 hours after. Descriptive analyzes were used to characterize the cases and describe the evolution of the victims. Statistical tests were applied to verify the association between length of stay in ER and age, sex, severity and characteristics of pre and in-hospital care. Results: The casuistry consisted of 46 victims, 84.7% were male, mean age was 34.7 years (SD=15.1), and 63% were involved in traffic accidents. On admission at ER, the mean REMS of these victims was 4.0 (SD=2.5), the mean Injury Severity Score (ISS) and New Injury Severity Score (NISS) were 11.8 (SD=7.7) and 17.2 (SD=12.7), respectively. Glasgow Coma Scale (GCS) indicated 54.4% of cases of severe TBI and the Maximum Abbreviated Injury Score/ head region (MAIS/head) showed an average of 2.7 (SD=1.1). From admission at ER until 2 hours later, unfavorable changes were observed in 35.1% of the victims and favorable changes were seen in 27%; between 2 and 4 hours, the unfavorable evolution was observed in 13.6% and favorable evolution was noted in 27.3%; between 4 and 6 hours, it was found worsening in 42.8% of the cases and improvement in 28.6%. On average, patients who experienced worsening had a difference of 2.8 (SD=2.3) in REMS from admission to 2 hours, 2 (SD=0) between 2 and 4 hours and 2.3 (SD=0.5) between 4 and 6 hours. There was a statistically significant difference in the lenght of stay in ER only in relation to the variable use of hemodynamic support in this service. Conclusion: The improvement of more than » of the victims of blunt TBI occurred in all the evaluation periods, but the frequency of unfavorable cases was higher than favorable between admission and 2 hours and even higher after 4 hours in ER. The longer time in ER was related to the use of hemodynamic support in this service.

Validación de la versión en español de la escala de función del miembro superior abreviada: Quick Dash / Validation of the Spanish version of the short Disabilities of the Arm, Shoulder and Hand Scale - Quick DASH

Introducción El objetivo del estudio es validar la versión corta de la escala de discapacidades de brazo, hombro y mano (QuickDASH) en español mediante pruebas de confiabilidad, consistencia y validez. Materiales y métodos Sobre 394 cuestionarios DASH de 298 sujetos participantes de un estudio previo, se corrieron pruebas de confiabilidad, consistencia, precisión, respuesta al cambio y validez. Resultados La confiabilidad medida mediante el coeficiente de concordancia de Lin fue de 0.8 IC95%: 0.67 a 0.93. La precisión transversal se estimó con intervalo de confianza de 95% en 12.72 y la precisión longitudinal (cambio mínimo detectable) se determinó en 20 puntos. Se obtuvo valores satisfactorios de capacidad de detectar respuesta al cambio y validez. Estas pruebas demostraron un comportamiento comparable entre el QuickDASH y el DASH ya validado en español. Discusión La versión abreviada de la escala perdió precisión tanto transversal como longitudinal debido a la disminución en la consistencia interna y en la estabilidad en la muestra estudiada, sin embargo conservó la capacidad de discriminar y de detectar cambio, estos resultados permiten recomendar su uso en ambiente clínico y de investigación. Nivel de Evidencia: II

Background aim of the study was to validate the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) in Spanish by testing reliability, consistency, and validity. Materials and methods A total of 394 DASH questionnaires, from 298 participants of a previous study, were tested for reliability, consistency, accuracy, validity and responsiveness to change. Results Reliability, measured by Lin concordance coefficient was 0.8, 95% CI: 0.67 to 0.93. Cross-sectional precision was estimated with a 95% confidence interval as 12.72, and longitudinal precision (minimum detectable change) was determined as 20 points. Satisfactory values regarding ability to detect response to change and validity were obtained. These tests showed comparable performance between QuickDASH and DASH and validated in Spanish. Discussion The shortened version of the scale lost both cross-sectional and longitudinal precision, due to the decrease in internal consistency and stability in the sample studied. As it retained the ability to discriminate and detect change, these results enable it to be recommended for use in the clinical and research setting. Evidence Level: II