Exploratory study on gastrostomy in patients with neurological diseases: usefulness and impact.

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is a useful intervention for patients with impaired swallowing and a functional gastrointestinal system. Neurological diseases that cause neuromotor dysphagia, brain tumors, and cerebrovascular disease are the most frequent indications; complications are rare, and morbidity and mortality rates are low. OBJECTIVE: To describe the usefulness of PEG in patients with neurological diseases, and its impact on care, survival, and costs and benefits. MATERIAL AND METHODS: We performed a retrospective observational study, reviewing clinical files of patients hospitalised at the National Institute of Neurology and Neurosurgery (years 2015-2017) who underwent PEG placement. RESULTS: The sample included 51 patients: 62.7% were women and the mean (SD) age was 54.4 (18.6) years (range, 18-86). Diagnosis was tumor in 37.3% of cases and cerebrovascular disease in 33.3%. Sixteen patients (33.3%) died and 11 presented minor complications. The PEG tube remained in place for a mean of 9.14 months; in 52.9% of patients it was removed due to lack of improvement and/or tolerated oral intake, with removal occurring after a mean of 5.1 (4.4) months. Among patients' family members, 78.4% reported a great benefit, 43.1% reported difficulty caring for the PEG, and 45.1% reported complicated care in general. The monthly cost of maintaining the PEG was €175.78 on average (range, 38.38-293.45). DISCUSSION AND CONCLUSIONS: This preliminary study reveals that PEG was well indicated in patients with neurological diseases, with survival rates similar to those reported in other studies with long follow-up periods. In patients with cerebrovascular disease, the PEG tube remained in place a mean of 9.14 months, during recovery of swallowing function; however, the cost is high for our population.

Exploratory study on gastrostomy in patients with neurological diseases: usefulness and impact. / Estudio exploratorio sobre gastrostomía en pacientes con enfermedades neurológicas: utilidad e impacto.

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is a useful intervention for patients with impaired swallowing and a functional gastrointestinal system. Neurological diseases that cause neuromotor dysphagia, brain tumors, and cerebrovascular disease are the most frequent indications; complications are rare, and morbidity and mortality rates are low. OBJECTIVE: To describe the usefulness of PEG in patients with neurological diseases, and its impact on care, survival, and costs and benefits. MATERIAL AND METHODS: We performed a retrospective observational study, reviewing clinical files of patients hospitalised at the National Institute of Neurology and Neurosurgery (years 2015-2017) who underwent PEG placement. RESULTS: The sample included 51 patients: 62.7% were women and the mean (SD) age was 54.4 (18.6) years (range, 18-86). Diagnosis was tumor in 37.3% of cases and cerebrovascular disease in 33.3%. Sixteen patients (33.3%) died and 11 presented minor complications. The PEG tube remained in place for a mean of 9.14 months; in 52.9% of patients it was removed due to lack of improvement and/or tolerated oral intake, with removal occurring after a mean of 5.1 (4.4) months. Among patients' family members, 78.4% reported a great benefit, 43.1% reported difficulty caring for the PEG, and 45.1% reported complicated care in general. The monthly cost of maintaining the PEG was €175.78 on average (range, 38.38-293.45). DISCUSSION AND CONCLUSIONS: This preliminary study reveals that PEG was well indicated in patients with neurological diseases, with survival rates similar to those reported in other studies with long follow-up periods. In patients with cerebrovascular disease, the PEG tube remained in place a mean of 9.14 months, during recovery of swallowing function; however, the cost is high for our population.

Filtering by nonlinear systems.

Synchronization of nonlinear systems forced by external signals is formalized as the response of a nonlinear filter. Sufficient conditions for a nonlinear system to behave as a filter are given. Some examples of generalized chaos synchronization are shown to actually be special cases of nonlinear filtering.

Multimodal synchronization of chaos.

An elementary notion of master-slave synchronization that accepts multimodal synchronization is introduced. We prove rigorously that the attractor of a coupled pair in a regime of multimodal synchronization is the graph of a multivalued function. Our framework provides the theoretical basis for some practical tools for detection of multimodal synchrony in experiments. Results are illustrated with the analysis of experiments with coupled electronic oscillators.

A class of cellular automata modeling winnerless competition.

Neural units introduced by Rabinovich et al. ("Sensory coding with dynamically competitive networks," UCSD and CIT, February 1999) motivate a class of cellular automata (CA) where spatio-temporal encoding is feasible. The spatio-temporal information capacity of a CA is estimated by the information capacity of the attractor set, which happens to be finitely specified. Two-dimensional CA are studied in detail. An example is given for which the attractor is not a subshift. (c) 2002 American Institute of Physics.

[Trends in cesarean section procedures in three locations of the Mexican Social Security Institute Medical Services during the period 1981-1995]. / Tendencia de la operación cesárea en tres ámbitos de atención médica del Instituto Mexicano del Seguro Social en el período 1981-1995.

UNLABELLED: The trend of the cesarean section in three setting of the Instituto Mexicano del Seguro Social (IMSS); the local: Hospital Gineco-pediátrico No. 2, in Los Mochis, Sinaloa, was determined the state's: included all of the medical units of IMSS in the state of Sinaloa and the national, which included all of the medical units of IMSS in the country. It was an analytic, retrospective study medical units of IMSS cesarean deliveries in the three setting of IMSS, from 1981 to 1995. SOURCE OF INFORMATION: State Committee of the Information Processing of the State of Sinaloa retrospective measurement of the total of deliveries and cesarean sections to calculate frequency of this event for each year and setting. Lineal regress analysis was made to determine trend of cesarean sections and correlation coefficient (r). RESULTS: Local frequency: 24.3 +/- 6.1%, range 14.7-33.6%; state's: 21.6 +/- 5.8%, range 13.2-30.3, national 24.4 +/- 5.5%, range 16.6-33.6; r per setting: local: +0.98 (Cl 95% 0.8793 = 0.99), state's +0.99 (Cl 95% 0.94-0.99) and national: +0.99 (Cl 95% 0.95-1.0). Positive trend in performance of cesarean sections in the three setting during the period of study; if no intervention on the matter at IMSS, the national trend will reach 39.2% in the 2000 year, state's: 37.4% and the local: 39.4%.

Feature enhancement of images using maximal contrast pixel to pixel.

A digital processing method is proposed to enhance image contrast with significant visibility of details. The technique is based on the local contrast associated with each pixel with a given surrounding point.