End-tidal carbon dioxide levels in patients with post-concussion syndrome during neurocognitive and physical tasks compared to a normative control group.

PRIMARY OBJECTIVE: Recent findings suggest breathing may negatively affect performance after concussion. The aim of the study was to examine group differences between individuals with and without post-concussion syndrome (PCS) in end-tidal carbon dioxide (ETCO2) and respiratory rate (RR) during neurocognitive and physical tasks. HYPOTHESIS: Individuals in the PCS group will have elevated ETCO2 and lower RR compared to the control group. METHODS: A quasi-experimental study was used in which a capnography unit collected ETCO2 and RR breathing data from 22 participants (control = 17; PCS = 5) during rest, the completion of the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) battery and while slow and fast walking. Four repeated measures mixed factorial ANOVAs, with an alpha level set at p ≤ 0.05, were used to examine group and task differences. RESULTS: Both groups displayed similar breathing responses to cognitive and physical stress; however, PCS participants had significantly elevated ETCO2 throughout the study (during rest, the ImPACT and while walking) compared to the control. Conversely, no significant group differences were found in RR. CONCLUSION: Cerebral physiological alterations and deficits in the autonomic nervous system may cause abnormal ETCO2 in individuals after concussion. Future research evaluating breathing patterns in PCS may be warranted.

Implementing a structured exercise program for persistent concussion symptoms: a pilot study on the effects on salivary brain-derived neurotrophic factor, cognition, static balance, and symptom scores.

PRIMARY OBJECTIVE: Persistent concussion symptoms (PCS) affect 10-30% of individuals after sports-related concussion. This study evaluated the effect of exercise-based rehabilitation on symptom scores, brain-derived neurotrophic factor (BDNF), cognitive functions and static balance in a sample of participants with PCS. RESEARCH DESIGN: One group pre-test post-test pilot study. METHODS AND PROCEDURE: Nine participants with PCS received a structured exercise-based rehabilitation program. Changes in symptom scores, BDNF, cognitive functions and measures of static balance were used to evaluate the utility of the exercise program. MAIN OUTCOME AND RESULTS: The results of this pilot study indicate a significant improvement in symptom scores following treatment, as well as some associated benefits in regards to cognitive function and static balance. BDNF levels in the participants with PCS within this study are notably lower than in a previous study on healthy controls. CONCLUSIONS: The preliminary evidence reported in the current pilot study is clinically relevant as our findings suggest exercise-based treatments may improve PCS outcomes in a more favourable manner than rest-based treatment.

Evaluating the Wizards of Motion Cardiovascular Disease Prevention Module.

This study evaluated the level of change in students' knowledge of and attitudes toward healthy lifestyle behaviors and prevention of cardiovascular disease (CVD) following implementation of a Cardiovascular Disease Prevention Module in Grade 5 science classes. Two classes of students ( n1 = 39) were identified as the intervention group and two classes ( n2 = 31) were designated as controls. The intervention group participated in the module initially, whereas the control groups participated after the data collection was completed. A two-group, pre-post comparison design was used to evaluate results on both a knowledge test and an attitude questionnaire. The results indicated that although both the intervention and the control groups began with similar knowledge and attitudes toward CVD and healthy behaviors, the intervention group demonstrated an improved level of knowledge and attitudes. Further research is needed to determine whether this CVD module could provide a sustained impact on adoption of healthy behaviors among adolescents.

Shockwave therapy and fibromyalgia and its effect on pain, blood markers, imaging, and participant experience - a multidisciplinary randomized controlled trial.

BACKGROUND: Patients with fibromyalgia experience chronic, widespread pain. It remains a misunderstood disorder with multimodal treatments providing mixed results. OBJECTIVES: To examine the effects of radial shockwave therapy (RSWT) compared to placebo on pain, pain catastrophizing, psychological indices, blood markers, and neuroimaging. Study-related experiences were also explored qualitatively. METHODS: Quantitative sensory testing (QST), Visual Analog Scale (VAS), Beighton Scoring Screen (BSS), Pain Catastrophizing Scale (PCS), blood biomarker (Interleukin (IL)-6 and IL-10), and brain fMRI were measured pre- and post-treatment along with a post-treatment survey. The RSWT group received five treatments (one week apart over five-week period) to the three most painful areas (500 shocks at 1.5 bar and 15 Hz, then 1000 shocks at 2 bar and 8 Hz, and finally 500 shocks at 1.5 bar and 15 Hz) versus sham treatment for the placebo group. RESULTS: There were no statistically significant differences in the BSS for hypermobility (p = .21; d = .74), PCS (p = .70; d = .22), VAS (p = .17-.61; d = .20-.83) scores, QST for skin temperature and stimuli (p = .14-.65; d = .25-.88), and for the pressure pain threshold (p = .71-.93; d = .05-.21). The VAS scores had clinically significant changes (MCID greater than 13.90) with improved pain scores in the RSWT group. Neuroimaging scans revealed no cortical thickness changes. Post-treatment surveys revealed pain and symptom improvements and offered hope to individuals. CONCLUSION: RSWT was implemented safely, without any negative treatment effects reported, and acted as a pain modulator to reduce sensitivity. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov identification number NCT02760212.

Ankle bracing's effects during a modified agility task: analysis of sEMG, impulse, and time to complete using a crossover, repeated measures design.

This study explored the effects of no braces, softshell (AE), and semi-rigid (T1) ankle braces on time to complete a modified agility task, as well as lower extremity muscle activity and impulse during the change of direction component of the task. Thirty-nine healthy, active individuals completed a modified agility task under the three brace conditions. Time to complete the modified agility task, along with mean surface electromyographic activity (sEMG) and impulse during the deceleration and propulsive phases of the task were measured. There were no significant differences across conditions with respect to sEMG or impulse measures during the deceleration or propulsive phases. There was a significant change in time to complete the modified agility task, F(2,76) = 17.242, p< 0.001, ηp2 = 0.312. Post-hoc analysis revealed a significant increase in time to complete the modified agility task when wearing the AE (0.16 (95% CI, 0.062 to 0.265) seconds, p< 0.001) and T1 (0.20 (95% CI, 0.113 to 0.286) seconds, p< 0.001) ankle braces compared to no braces. It appears that performance on a modified agility task may be diminished when wearing ankle braces, although sEMG activity and impulse are unaffected.

Evaluation of two rotational helmet technologies to decrease peak rotational acceleration in cycling helmets.

The risk of brain trauma has been associated with the rotational kinematics leading to the development of helmets with a variety rotational management technologies. The purpose of this paper was to employ a rotation specific test protocol to evaluate the effectiveness of two of these technologies. Dynamic response of the head was measured to assess the performance of each technology. Three cycling helmets with identical construction were included in this study. One helmet with no rotational technology, an established, commercial technology and a novel helmet rotational technology designed and assembled by the authors were tested. A drop test onto a 45° anvil was used to measure the ability of each helmet to manage the dynamic response of the head form during a series of impacts. The results revealed both rotational helmet technologies resulted in lower peak rotational acceleration and brain strain, however each technology demonstrated unique performance characteristics depending on the impact condition.

Effect of Neck Strength on Simulated Head Impacts During Falls in Female Ice Hockey Players.

This study examined the effect of isometric cervical strength and impact location of the hockey helmet in mitigating the risk of concussions for two different mechanisms of injury from a fall during head impact simulation testing. Isometric cervical strength was measured on 25 female hockey players to compute and model neck strength on a mechanical neckform. A dual-rail vertical drop system with a helmet mounted on a surrogate headform simulated the mechanisms of injury causing concussions on female ice hockey players. Measures of peak linear acceleration and risk of injury due to a head collision (GSI) were used to assess the magnitude of the head impact due to a fall across three neck strength measures (weak, average, strong), three helmet locations (front, rear, side), and two mechanisms of injury (direct, whiplash+impact). A three-way ANOVA revealed a significant main effect for impact mechanism on the magnitude of peak linear acceleration and GSI, with the whiplash+impact mechanism generating significantly greater peak linear acceleration and GSI than the direct impact mechanism. A significant two-way interaction effect was found between impact location and mechanism of injury on peak linear acceleration measures, with the direct impact on the side location generating significantly greater peak linear acceleration than the frontal location. On the contrary, the whiplash+impact mechanism revealed that the frontal impact location produced significantly greater peak linear acceleration than the side location. This outcome suggests the geometry of the helmet material and the type of mechanism of injury both play a role in concussion risk.

The effect of patellar taping on lower extremity running kinematics in individuals with patellofemoral pain syndrome.

Purpose: To investigate the effects of patellar taping (Leukotape® (LT), Pinetown, South Africa, Kinesio Tape (KT), Dortmund, Germany, or no tape) on lower extremity kinematics in runners with and without patellofemoral pain syndrome (PFPS). Methods: In total, 20 healthy individuals and 12 with PFPS ran on a treadmill under different taping conditions and lower extremity kinematics and stride characteristics were obtained using Peak Motus Software, Colorado, USA. Data were analyzed using descriptive statistics and mixed factorial analysis of variance (p < 0.05). Results: Significant taping effects were found for hip (F(2,60) = 16.79, p = 0.0001) and knee (F(2,60) = 17.27, p = 0.0001) flexion angles at initial contact, and peak hip flexion angles during swing (F(2,60) = 6.55, p = 0.003). Increased flexion was noted with LT more than KT and no tape conditions. Similarly, peak knee flexion angles during stance (F(2,60) = 3.51, p = 0.03) and flight time (F(2,60) = 5.01, p = 0.01) revealed significant taping effects, with LT resulting in more flexion (p = 0.04) and shorter flight times (p = 0.01) than the no tape condition. Furthermore, a significant taping effect was seen for peak knee flexion angle during swing (F(2,60) = 4.96, p = 0.01), with the KT resulting in less flexion than LT (p = 0.04) and no tape conditions (p = 0.04). Conclusion: The application of tape during running may impact on hip and knee flexion angles at initial contact, as well as flight time.

The Effects of Ankle Braces on Lower Extremity Electromyography and Performance During Vertical Jumping: A Pilot Study.

Ankle braces have been hypothesized to prevent ankle injuries by restricting range of motion (ROM) and improving proprioception at the ankle. As such, ankle braces are commonly worn by physically active individuals to prevent ankle injuries. Despite their widespread use, the effects that ankle braces have on athletic performance measures, such as vertical jumping, remains unclear. Furthermore, although ankle braces are known to restrict normal ROM at the ankle, little is known about the effects that ankle braces have on the lower extremity proximal to the ankle, specifically muscular activation. Therefore, the purpose of this pilot study was to determine if lower extremity surface electromyographic activity (sEMG) and performance was affected in 5 males and 5 females by wearing softshell (AE) and semi-rigid (T1) ankle braces during a Vertical Jump Test, and to establish a basis for future investigation. Vertical jump height was not significantly affected (p > .05) in the AE (37.49 ± 11.61 cm) and T1 (36.3 ± 11.77 cm) ankle brace conditions, relative to the no brace (38.17 ± 12.01 cm) condition. No significant differences in sEMG of the lateral gastrocnemius and biceps femoris were present across conditions. There was a tendency for sEMG of the rectus femoris to decrease when wearing AE (195.71 ± 100.43 %MVC) and T1 (183.308 ± 92.73 %MVC) braces, compared to no braces (210.08 ± 127.46 %MVC), and warrants further investigation using a larger sample. Until more research is conducted, however, clinicians should not be concerned about ankle braces significantly affecting proximal muscle activation during vertical jumping.

Ankle bracing's effects on lower extremity iEMG activity, force production, and jump height during a Vertical Jump Test: An exploratory study.

OBJECTIVE: To determine if softshell (AE) and semi-rigid (T1) ankle braces affect lower extremity iEMG activity, force, and jump height during a Vertical Jump Test. DESIGN: Repeated measures, crossover. SETTING: Laboratory. PARTICIPANTS: 42 healthy, active individuals. OUTCOME MEASURES: Vertical jump height, iEMG activity, peak vGRF. RESULTS: There was significant change across conditions in lateral gastrocnemius (LG) iEMG activity, F(2,70) = 5.31, p = .007, ηp2 = 0.132, with T1 LG iEMG being significantly less (-2.08(99% CI, -3.98 to 0.18) %MVIC, p = .004) than no brace. Significant changes were seen in rectus femoris (RF) iEMG activity, F(2,68) = 6.36, p = .003, ηp2 = 0.158, with T1 RF iEMG activity being significantly less than AE RF iEMG activity (-2.78(99% CI, -5.36 to -0.19) %MVIC, p = .005). There was a significant change in vertical jump height across conditions, F(2,78) = 22.13, p < .0005, ηp2 = 0.362, with a significant decrease in the AE (-2.41(99% CI, -3.66 to -1.17) cm, p < .0005) and T1 conditions (-2.89(99% CI,-4.56 to -1.23) cm, p < .0005), compared to no brace. CONCLUSION: Vertical jump height is significantly reduced when wearing ankle braces. Effects on lower extremity iEMG activity are dependent upon brace type.

Starting with the "right" foot minimizes sprint start time.

Although asymmetries in hand and foot performance have been examined using a variety of movement tasks that require the fine control of the timing and amplitude of force generation, foot asymmetries in a functional gross motor movement task, such as the track and field sprint start, have yet to be examined. Twenty individuals (10 experienced, 10 inexperienced) were assessed for pedal asymmetries using the track and field sprint start. Each participant performed 48 starts (24 right foot starts and 24 left foot starts). The pattern of pedal asymmetries was consistent with that of manual asymmetries in that a left foot (i.e., left foot in rear position) reaction time advantage was found while there was a right foot (i.e., right foot in rear position) advantage for movement time and total response time (time from stimulus presentation until the end of the movement). These results are consistent with a right hemisphere specialization for spatio-temporal and attentional processes, and a left hemisphere specialization for movement execution.

Evaluation of spring-loaded cane ground reaction forces during walking using time and frequency domain analysis.

This study examined the effect of a spring-loaded cane stiffness reduction on upper and lower extremity ground reaction forces in time and frequency domain during cane-aided walking. Twenty-nine participants walked five times over two force plates with a spring-loaded cane set at four different stiffnesses and T-scope knee brace set at 30° of knee flexion to simulate a foot injury. Time-frequency domain analyses revealed an increase in ground reaction forces at the simulated injured foot and a decrease in ground reaction forces at the hand via the shaft of the cane for each spring loaded-cane stiffness reduction during walking. The results build on existing literature and highlight the use of spring-loaded canes, braking and propulsive ground reaction force measures, and frequency domain analysis to more accurately assess and monitor the rehabilitation and prevention of upper and lower extremity injuries during cane-aided walking.

Intralimb coordination in children with and without developmental coordination disorder in one-handed catching.

There is a gap in the literature in regard to analysis of intralimb coordination exhibited by children with (n = 10) and without developmental coordination disorder (DCD; n = 9) in 1-handed catching. The functional data showed that children without DCD (M age = 10.6 years, SD = 1.08 years) were nearly perfect. Children with DCD (M age = 11.0 years, SD = 1.16 years) caught significantly fewer balls, and this was despite the fact that not all of them had difficulties organizing their actions at intralimb level of coordination. The analysis of the coinciding actions revealed differences at the distal (elbow-wrist relations), but not at the proximal joints where both groups exhibited decoupling between the shoulder and elbow joints. Large variability within the groups also suggested that the notion of universal coordinative tendencies at intralimb level of coordination has to be treated with caution. This is particularly true for children with DCD as different subgroups emerged in the present sample.

Moralidad, empatia, inteligencia emocional y liderazgo transformacional: un modelo de rutas en estudiantes de posgrados gerenciales en una universidad venezolana / Morality, Empathy, Emotional Intelligence and Transformational Leadership: A Path Analysis Model in Post-graduate Management Students at a Venezuelan University

En el artículo se contrasta un modelo de rutas (path analysis) para las relaciones causales entre el nivel de desarrollo moral posconvencional, la preocupación empática, el autoconocimiento emocional y la autorregulación emocional sobre el estilo de liderazgo transformacional. La muestra de estudio la conformaron estudiantes de posgrado en gerencia de una universidad pública venezolana, y estaba compuesta por profesionales de ambos sexos provenientes de distintas profesiones (N = 162; media edad = 31,37; D.T. = 4,67). Se utilizaron diversos instrumentos como el Test de Definición de Criterios Morales (DIT), el índice de Reactividad Interpersonal (IRI), la Subescala de Comprensión Empática, entre otros. Los resultados muestran que el modelo de rutas propuesto resultó parcialmente válido, evidenciando que la comprensión de las relaciones entre las variables del modelo resulta más compleja de lo que se plantea en la literatura; en tal sentido, la empatía es la variable más influyente en el modelo, al hallarse efectos directos altos y significativos sobre el desarrollo moral posconvencional y la capacidad de autoconocimiento y autocontrol emocional.

A path analysis model was contrasted to establish causal relationships between the level of post-conventional moral development, empathic concern as a measure of empathy, emotional selfawareness and emotional self-regulation on transformational leadership style. The study sample was made up of graduate students in management of a public Venezuelan University and was composed of professionals of both sexes from different disciplinary fields (N = 162, mean age = 31,37, SD = 4,67). The instruments used among others, were the Defining Issues Test (DIT), the Interpersonal Reactivity Index (IRI) and the Sub-Scale of Empathic Understanding. Results show that the proposed model was partially valid; this indicates that the understanding of the relationships between the model variables is more complex than what is proposed in the literature; in this regard, empathy is the most influential variable in the model. As a matter of fact, there are high and significant direct effects on post-conventional moral development and the self-knowledge and emotional self-control ability.

Desarrollo moral en estudiantes de odontología moral / Moral development in dentist students

En el presente trabajo se estudió el nivel de desarrollo moral en estudiantes de Odontología de una Universidad de la región capital de Venezuela. La muestra estuvo constituida por 192 estudiantes, 155 de género femenino y 37 de género masculino cursantes de primero y cuarto año de la carrera. Se utilizó una versión del instrumento Defining Issues Test -DIT- (Rest,1979) adaptado al contexto venezolano por Zerpa y Ramírez (2004). Los resultados sugieren que los estudiantes se encuentran preponderantemente en el nivel moral convencional o de mantenimiento de normas y han alcanzado niveles moderados de desarrollo moral de principios - índice P- (M = 27,45), no encontrándose diferencias entre cursantes de recién ingreso y terminales de la carrera. Un análisis de componentes principales (ACP) sugiere que las personas con mayor índice P, son de género femenino, con edades comprendidas entre 21 y 22 años y de nivel socio-económico bajo. Finalmente, con base en los resultados, se discuten algunas implicaciones para la creación de un eje de formación moral-educación en valores en la carrera de Odontología

The following essay assessed the level of moral development in Odontology students of a University in the capital region of Venezuela. The sample included 192 students, 155 female and 37 male, of the first and fourth year of their career. A version of the instrument Defining Issues Test -DIT- (Rest, 1979), adapted to the Venezuelan context by Zerpa and Ramirez, was used for this study. The results suggest that the students are preponderantly in the conventional moral level or obeying norms, and they have reached have reached moderate levels of moral development. P- Index (M = 27.45). No differences were found when comparing students who are at the beginning or at end of their career. An analysis of the principal components (ACP) suggests that the people with the higher P Index are female, with ages between 21 y 22 years and low social-economic level. Finally, based on the results, there is a debate regarding the implications of creating an axis of moral-education values development in the Odontology career

Desarrollo moral en estudiantes de medicina y enfermeria de la Universidad Centroccidental Lisandro Alvarado (UCLA) - Venezuela / Moral development in medical and nursing students at the Universidad Centroccidental Lisandro Alvarado (UCLA) - Venezuela

Se realizó un estudio no experimental, de campo, de tipo correlacional con el fin de establecer posibles relaciones entre el nivel de desarrollo moral y el nivel de estudios de pregrado alcanzado por estudiantes de medicina y enfermería de la Universidad Centroccidental Lisandro Alvarado (UCLA), Barquisimeto - Venezuela. La muestra se seleccionó de forma probabilística y estratificada quedando conformada por 87 estudiantes de Medicina y 44 de Enfermería. Para evaluar el nivel de desarrollo moral, se utilizó una adaptación del Defining Issues Test (DIT), versión de tres dilemas, traducida, adaptada y validada al contexto venezolano. Los resultados obtenidos muestran que los estudiantes poseen un nivel de desarrollo moral convencional y un índice de moral de principios similar al que obtienen muestras latinoamericanas. No se encontraron diferencias significativas entre el desarrollo moral y el nivel de estudios alcanzado por la muestra. Los resultados permiten justificar y orientar el diseño e implantación de un eje curricular de formación moral-educación en valores dirigido a estudiantes del Decanato de Ciencias de la Salud de la Institución

A non experimental correlational study was conducted for purposes of establishing a possible relationship between moral development and academic level of Health Science students from Universidad Centro-Occidental Lisandro Alvarado (UCLA), Barquisimeto Venezuela. A probabilistic and stratified sample consisting of 131 students, 87 from the Medicine School and 44 from the Nursing School was used. An adapted version of the "Defining Issues Test" (DIT) was run to assess the group moral development. Such test is a version of the three dilemma model which was translated and validated to the Venezuelan context. According to test results, students have a conventional moral development and a moral principles index (Index P) similar to those obtained from Latin-American samples. Non-significant relationship between the moral development and academic level was found. Also, test results set the basis for justifying and designing a new curriculum for the students of the University’s Health Science Faculty based on moral development

[Prevalence and relation of dyspepsia to irritable bowel syndrome in a native community of the Peruvian jungle]. / Prevalencia y asociación de la dispepsia y el síndrome de intestino irritable en una comunidad de la selva peruana.

INTRODUCTION: Dyspepsia and irritable bowel syndrome (IBS) are two of the most frequent syndromes in gastroenterology. However, very few epidemiological studies have been conducted in Peru and none in the Peruvian Jungle. OBJECTIVES: The objective of this study is to determine the prevalence of dyspepsia and irritable bowel syndrome in a jungle community of Peru and the recurrence percentage of these syndromes. MATERIALS AND METHODS: A sample was taken from 231 persons randomly selected using the "home by home" method, according to the map provided by Punta del Este Medical Center (city of Tarapoto - Department of San Mart n). The persons, considered to best typify the general population of the city, took two tests (Dyspepsia Test and Manning Test) that were previously validated during the months of January through March 1999. RESULTS: The prevalence of dyspepsia was 37.6%, and that of IBS, 22.0%. From those with dyspepsia, 38% had also IBS. From those with IBS, 65% reported dyspepsia symptoms. Prevalence of IBS was higher in individuals with dyspepsia (37.9%) than in individuals without dyspepsia (12.5% p< 0.01). The prevalence of both dyspepsia and IBS decreases as age increases. A statistically significant difference related to ethnicity was found in individuals with IBS. Dyspepsia and ethnicity were associated in 31.4% to individuals having both pathologies (p< 0.0001 and OR=4.28). The dyspepsia/IBS ratio was 1.7/1. CONCLUSION: There is a high prevalence of IBS and dyspepsia in the study population. The high association found between both syndromes may be due to the common etiopathogenic mechanisms they share such as: a visceral hypersensibility due to peripheral or central mechanisms, bowel motility disturbances or parasitosis. Our study suggests that both dyspepsia and IBS are the manifestations of the same digestive disorder, which has not been fully clarified yet.

Síndrome de Alport autosómico recesivo: a propósito de un caso / Autosomal recessive Alport Syndrome: a case report

Mujer, de 14 años de edad procedente de San Martín (Perú), ingresó al hospital con historia de tres meses de disnea, palidez e hiporexia, y disminución del volumen urinario en el último mes. Dos semanas antes de su ingreso presentó cefalea global, diplopía y náuseas y vómitos. Acudió al hospital de su localidad donde le indicaron tratamiento con ampicilina y gentamicina, por sospecha de pielonefritis aguda; al no observar mejoría fue trasladada a nuestro hospital. No había antecedentes personales ni familiares de importancia, salvo que os padres eran consanguíneos. A examen se encontró palidez, opacidades bilaterales en el cristalino, hipoacusia bilateral y flapping. Los exámenes de laboratorio mostraron anemia y retención nitrogenada (urea 233 mg/dL y creatinina 15 mg/dL). El examen de orina mostró alteraciones tubulares, proteinuria y hematuria. La ecografía renal mostró riñones pequeños. El examen ocular reveló catarata nuclear polar posterior en ojo derecho y catarata total en el ojo izquierdo y la audiometría, sordera neurosensorial bilateral.

Woman, 14 year old from San Martin (Peru), was admitted to hospital with a history of three months of dyspnea, pallor and hyporexia, and decreased urine volume in the last month. Two weeks before his admission presented overall headache, nausea and vomiting. She went to his local hospital where indicated treatment with ampicillin and gentamicin, on suspicion of acute pyelonephritis; but not observe improvement was transferred to our hospital. There were no important personal or family history, except her parents were consanguineous. On physical examination we found pallor, bilateral opacities in the lens, bilateral hearing loss and flapping. Laboratory test showed anemia and azotemia (creatinine 15 mg/dL and urea 233 mg/dL). Urianalysis revealed tubular abnormalities, proteinuria and hematuria. Renal ultrasonography showed small kidneys. Ocular examination revealed nuclear polar cataract in her right eye and total cataract in the left eye. Audiometry revealed bilateral sensorineural hearing loss.

Prevalencia y asociación de la dispepsia y el síndrome de intestino irritable en una comunidad de la selva peruana / Prevalence and relation of dyspepsia to irritable bowel syndrome in a native community of the peruvian jungle

Introducción: La dispepsia y el síndrome del intestino irritable(SII) son dos de los síndromes más frecuentes en la gastroenterología. Sin embargo, existen muy pocos trabajos epidemiológicos en el Perú y ninguno realizado en la selva peruana. Objetivos. El objetivo del presente trabajo es determinar la prevalencia de la dispepsia y el SII en una comunidad de la selva peruana y el porcentaje de co-ocurrencia de estos síndromes. Material y métodos: Se tomó una muestra de 231 personas escogidas al azar mediante la modalidad "casa por casa" según el mapa proporcionado por el Centro de Salud de Punta del Este (Tarapoto-Dpto San Martín) y considerada representativa de la población general de esa ciudad, a las cuales se les aplicaron dos encuestas (Test de dipepsia y Test de Manning) validadas previamente durante los meses de enero a marzo de 1999. Resultados: La prevalencia de la dispepsia fue de 37.6, por ciento y de SII de 22.0 por ciento. De los sujetos con dispepsia el 38 por ciento tuvieron SII. De los sujetos con SII el 65 por ciento reportó síntomas de dispepsia. La prevalencia del SII fue mayor en sujetos con dispepsia (37.9 por ciento) que en sujetos sin dispepsia (12.5 por ciento); p <0.01). La prevalencia tanto de la dispepsia como del SII disminuye conforme aumenta la edad . En las personas con SII se encontró una diferencia estadísticamente significativa en cuanto a la etnia. La dispepsia y el SII se asociaron en el 31.4 por ciento de las personas con ambas entidades (p<0.0001 y OR=4.28). La relación dispepsia/SII fue de 1.7/1. Conclusión: Existe una alta prevalencia del SII y dispepsia en la población estudiada. La alta asociación encontrada entre ambos síndromes se puede deber a que comparten mecanismos etiopatogénicos comunes como son: hipersensibilidada visceral debida a mecanismos periféricos o centrales, disturbios en la motilidad intestinal o parasitosis. Nuestro estudio sugiere que tanto la dispepsia como el SII son manifestaciones de un mismo desorden digestivo, aún no dilucidado por completo.