Condición física, nivel de actividad física y capacidad funcional en el adulto mayor: instrumentos para su cuantificación / Physical fitness, physical activity level and functional capacity in older adults: instruments for their quantification

Las personas pasan por un proceso de envejecimiento, que está manifestado en los cambios biológicos y en la declinación fisiológica, lo cual, tiene un impacto significativo en el desarrollo de las actividades básicas de la vida diaria. En ese sentido, se hace necesario determinar cuáles son los instrumentos de medición más empleados para la evaluación de la condición física, capacidad funcional y niveles de actividad física de esta población. A través de una revisión sistemática de publicaciones científicas, se logró establecer que, para la medición de la condición física, la batería más utilizada es la SPPB (Short Physical Performance Battery); respecto al nivel de actividad física, la acelerometría es uno de los métodos directos más empleados, junto a los cuestionarios de autoreporte y para identificar la capacidad funcional, el índice de katz es el reportado con mayor frecuencia.

People go through a process of aging that is manifested in biological changes and physiological decline, which has a significant impact on the development of basic activities of daily living. In this sense, it is necessary to determine which are the most used measurement instruments for the evaluation of the physical condition, functional capacity and levels of physical activity of this population. Through a systematic review of scientific publications, it was possible to establish that for the measurement of the physical condition the battery most used is the SPPB (Short Physical Performance Battery); Regarding the level of physical activity, accelerometry is one of the direct methods most used together with self-report questionnaires and to identify functional capacity, the katz index is the most frequently reported.

Note: A 1-m Foucault pendulum rolling on a ball.

We have built a short Foucault pendulum of 1-m length. The aim of this work was to increase the sensitivity to elliptical trajectories from other longer pendula. The design was a semi-rigid pendulum that rolls over a small ball. The measurements of the movements (azimuth and elliptical trajectory) were done by an optical method. The resulting pendulum works in a medium satisfactory way due to problems of the correct choice of the mass of the bob together with the diameter of the supporting ball. It is also important to keep the rolling surface very clean.

Room-temperature I-V characteristics of a single hollow La2/3Ca1/3MnO3 microparticle.

In this work we present an electrical characterization of La2/3Ca1/3MnO3 particles obtained by spray pyrolysis. We optimized the synthesis conditions to obtain the desired compound with the expected structure and the ferromagnetic transition at the same temperature as the bulk material. We found that a post-deposition thermal treatment enhances the magnetic properties of the samples. The study of structural, morphological and magnetic properties shows that the walls of the hollow spheres are constituted by grains on the nanometer scale. The I-V characterization shows typical signatures of tunneling transport. This behavior can be associated with the grain boundaries within the microparticle's wall acting as tunnel barriers.

[Mixedematous ileus; acute abdomen exacerbate.]. / Ileo mixedematoso;exacerbante de abdomen agudo.

The surgical literature contains few reports about effects of hypothyroidism in patients with acute abdomen; has been reported that a glycoprotein infiltrate the lining of the bowel leading to denervation. We report the case of a woman with acute abdomen secondary to pyosalpynx with uncontrolled hypothyroidism postoperative complications.Hypothyroidism is called "big mimicker"because its clinic spectrum ranges from anasymptomatic subclinical condition to the rare,life-threatening myxedema coma, and thus can bea challenging diagnosis to make. Unrecognized hypothyroidism may lead to unnecessary surgery or even a potentially fatal outcome. A heightened awareness of this not so uncommon entity is mandatory

Grazing behaviour and performance of lactating suckler cows, ewes and goats on partially improved heathlands.

The foraging behaviour (grazing time and diet composition), live-weight (LW) changes and parasitic infection (faecal egg counts of gastrointestinal nematodes) of 12 beef cows, 84 ewes and 84 goats suckling their offspring, managed in mixed grazing on heathlands with 24% of improved pasture of perennial ryegrass-white clover, were studied during the years 2003 and 2006. The results showed that goats tended to graze for a longer time, and utilised significantly more heathland vegetation than cattle and sheep, including in their diet in an average of 0.39 herbaceous plants, 0.11 gorse and 0.51 heather over the grazing season, comparing with respective mean values of 0.85, 0.02 and 0.13 in cattle and sheep. Dietary overlap was higher between cattle and sheep (0.76) than between sheep and goats (0.53) or between cattle and goats (0.47). Despite the high performance of autumn-calving cows in spring, sheep had the best LW changes per livestock unit (LU) during the whole grazing season. Goats' performance per LU was lower than in sheep but higher than in spring-calving cows. Regarding offspring production, lambs had higher LW gains per LU than calves and kids. Mean nematode eggs/g fresh faeces (epg) during the grazing season were higher in goats (91 epg) compared with sheep (34 epg) and cattle (14 epg), particularly from September to December. In conclusion, sheep performed best on these heathlands with improved pasture areas if the entire grazing season was considered, despite the good level of production in spring from autumn-calving cows. The results suggested the complementary use of goats in order to increase the effective utilisation of the available vegetation, achieving production levels similar to those from spring-calving cows. Therefore, mixed flocks of sheep and goats would be the most appropriate sustainable systems from the animal production and vegetation use points of view.

Risk factors associated with Helicobacter pylori infection. A population-based study conducted in the province of Ourense.

OBJECTIVES: to identify the relationship between Helicobacter pylori infection and various factors that have been described in other studies in the general adult population in the province of Ourense. MATERIAL AND METHODS: three hundred and eighty-three participants were enrolled in a study on the prevalence of Helicobacter pylori infection. All participants filled in a questionnaire under supervision, and the data obtained were examined by means of a univariate analysis. The odds ratio corresponding to each variable studied was calculated with their corresponding 95% confidence intervals. Furthermore, a multivariate analysis was performed. RESULTS: the univariate analysis revealed an association between infection and: age, place of residence during childhood, current social status based on the head of the family s profession, current blue collar/white collar profession of the head of the family, sharing a bedroom during childhood, type of drinking water, and contact with animals during childhood. No association was found with respect to the presence of dyspeptic symptoms. The multivariate analysis disclosed that only age is an independent risk factor associated with infection. CONCLUSION: age has been identified as the only independent risk factor associated with Helicobacter pylori infection in this population-based study. The univariate analysis has detected other factors. No association has been identified with respect to dyspeptic symptoms.

Prevalence of Helicobacter pylori infection in the general adult population of the province of Ourense.

OBJECTIVES: to determine the prevalence of Helicobacter pylori infection in the general adult population of the province of Ourense. MATERIAL AND METHODS: a cross-sectional study was carried out with a randomly selected populational sample. The diagnosis of Helicobacter pylori infection was reached using the 13C-urea breath test. RESULTS: three hundred and eighty-three subjects were studied, with a prevalence rate of 69.1% (95% CI: 61.7-75.1%); 69.8% (95% CI: 63.2-76.6%) in males and 68.4% (95% CI: 61.5-75.4%) in females (difference not statistically significant). Prevalence increases with age up to a maximum of 88.4% in the 45-54 years age group, and decreases thereafter to a rate of 57.1% in individuals over the age of 84 years. CONCLUSION: this study reveals that the prevalence rate of Helicobacter pylori infection is high in the general adult population of the province of Ourense. It increases with age until it peaks in the group of middle-aged individuals and is similar in both sexes.

Unanticipated plasma concentrations in two clozapine-treated patients.

OBJECTIVE: To report two cases of lower than anticipated clozapine plasma concentrations despite near maximum recommended doses of clozapine 800-900 mg/d in two medication-compliant schizophrenic inpatients. CASE SUMMARIES: Clozapine therapy was initiated in two male schizophrenic inpatients for treatment of psychotic symptoms refractory to other typical and atypical antipsychotics. Despite receiving adequate doses of clozapine for at least two months, these patients remained symptomatic. Therapeutic drug monitoring was used to target a clozapine plasma concentration of > or =250 ng/mL, the minimum value reported in the literature to be associated with increased clinical response. Clozapine plasma concentrations remained at 200 ng/mL in one patient despite dosage increases from 600 to 800 mg/d. In the second patient, administration of the maximum recommended dose resulted in concentrations between 200 and 250 ng/mL. Increasing the clozapine dosage to 1000 mg/d did not increase the clozapine plasma concentration. Evaluation of the ratio of clozapine plasma concentration clozapine to dose yielded lower than expected values compared with those reported in the literature. DISCUSSION: These two patients exhibited lower than anticipated clozapine plasma concentrations despite receiving high doses of clozapine. Several studies evaluating clozapine serum concentrations and clinical response have suggested threshold concentrations of > or =350 ng/mL, > or =370 ng/mL, or > or =420 ng/mL. The only study that randomized patients to three concentration ranges found that patients who achieved a clozapine serum concentration in a medium range (mean 251 ng/mL) responded better than patients in a low range (mean 91 ng/mL) and similar to patients in a high range (mean 396 ng/mL). However, attaining plasma concentrations in this range for these patients proved difficult. Reasons for the low concentrations are unclear and may be related to increased metabolic activity at several cytochrome P450 isoenzymes involved in the metabolism of clozapine. CONCLUSIONS: These cases illustrate lower than anticipated clozapine plasma concentrations despite high-dose clozapine therapy. Strategies to increase clozapine plasma concentrations in such patients might include adding a drug to partially inhibit the metabolism of clozapine. If those strategies are unacceptable based on risk assessment, patient compliance, or other reasons, clinicians may consider addition of a low-dose typical or other atypical antipsychotic drug to augment clozapine response.

[Transmesenteric intestinal plication for intestinal occlusion secondary to disseminated adhesions. A 12-year experience]. / Plicatura intestinal transmesentérica para la oclusión intestinal secundaria a adherencias diseminadas. Experiencia de 12 años.

OBJECTIVE: To report the experience with intestinal plication in patients with adhesive intestinal obstruction that was followed up to 12 years. BACKGROUND: To diminish the high recurrence rate of adhesive intestinal obstruction, there are surgical techniques of intestinal plication. In 1977 Blanco modified a pre-existing transmesenteric technique that is the used in our institution. METHOD: We studied the medical records of 32 patients who underwent intestinal plication using the transmesenteric technique. The postoperative evaluation was based in recurrence and mortality. RESULTS: There were 32 patients, 56% women and 44% men, with a mean age of 50 years. All patients had a history of intraabdominal surgical procedures. The postoperative evaluation was satisfactory. The success rate was over 90%. The recurrence rate was 9.3% and we had no mortality. The mean follow-up was 3.5 years (median 3 [range 1-12] years). There were no significant differences between this technique and the Noble and Childs-Phillips plication techniques. CONCLUSIONS: This technique of intestinal plication is useful in the surgical management of patients with adhesive intestinal obstruction.

[Esophageal perforation caused by balloon dilatations in a patient with achalasia]. / Perforación esofágica por dilataciones con balón en un paciente con acalasia.

OBJECTIVE: To present a case of esophagic perforation due to a pneumatic dilatations of the cardias in a patient with achalasia. BACKGROUND: Achalasia of the esophagus is a primary motor alteration with an unknown cause. The principal characteristics are the lower or absent peristaltic waves in the esophagic body and the impared lower esophagic sphincter relaxation during deglution. The management is palliative with pneumatic dilatations, pharmacologic therapy or with surgery. When a esophagic perforation occurs, it must be diagnosed and treated as soon as possible because a delay in diagnosis and management affect directly the patient prognosis. METHOD: To present a case of esophagic perforation due to pneumatic dilatations of the cardias in a patient with achalasia. CONCLUSIONS: An useful palliative management for achalasia is the pneumatic forceful dilatation, however it carries some risk of perforation; in every patient who was treated with dilatations is mandatory to think in perforation when the clinical condition is different after the procedure. The success of surgical management of the perforated esophagus and the control of sepsis and mediastinitis depends directly of the clinical condition of the patient and the time within perforation and surgical therapy.

[Retrograde intussusception posterior to gastrojejunal anastomosis. Report of a case]. / Intususcepción retrógrada posterior a gastroyeyunoanastomosis. Informe de un caso.

OBJECTIVE: We report a case of retrograde jejunogastric intussusception in a patient with previous gastric surgery who required surgical treatment for its resolution. BACKGROUND: While intussusception is relatively common in children, it is infrequently seen in adults. Five percent of all cases occur in adults and in 90% of these, there is a lead point, a well-definable pathologic abnormality. Retrograde jejunogastric intussusception is a rare complication after gastrojejunostomy. The most common symptoms are pain, nausea, vomiting and blood per rectum. Diagnosis of adult intussusception is often difficult and is base in clinical suspicion and noninvasive techniques. METHOD: A case of a retrograde intussusception in a patient after gastric surgery who presented with abdominal pain and gastrointestinal bleeding. RESULTS: The patient underwent surgical treatment with reduction of the intussusception. The postoperative evolution was satisfactory. CONCLUSIONS: Management of intussuception in adults is usually laparotomy and in 90% of cases, a pathologic lesion will be identified. Retrograde jejunogastric intussusception is also managed surgically and simple reduction is the accepted form of treatment in most cases.

[Dynamic pancreatography: the diagnosis of pancreatic necrosis and the identification of the risk factors of severity]. / Pancreatografía dinámica: diagnóstico de necrosis pancreática e identificación de factores de riesgo de gravedad.

BACKGROUND: Dynamic pancreatography (DP) can establish the development of tissue damage and demonstrate pancreatic necrosis (PN). OBJECTIVE: To prospectively evaluate the usefulness of DP in patients with acute pancreatitis (AP), analyzing its capabilities for determining the incidence of necrosis, and as a prognostic predictor. MATERIAL AND METHODS: All patients with AP seen at our department during 4 years were included. All patients were scheduled to DP. Findings were classified in five groups: I, interstitial AP; II, secondary fluid collections; III, peripancreatic necrosis; IV, pancreatic necrosis < 50% and pancreatic necrosis > 50%. Also included for analysis were: demographic variables, etiology, APACHE-II score, and Ranson's signs; when infection was suspected, cultures were done. PD and operative findings were correlated to calculate sensibility (S), specificity (Sp), positive and negative predictive values (PPV, NPV), and the diagnostic accuracy (DA) of the test. Correlation between severity/mortality and morphologic alterations according to the classified group were also performed. RESULTS: 244 patients. Biliary associated pancreatitis in 47% and alcohol induced in 37%. DP in 207 patients showed, 34 patients in group I; 36 in group II, 67 in group III, 47 and 60 in groups IV and V, respectively. Secondary pancreatic infection was present in 48%. One hundred seventy-two patients underwent surgery; the surgical indication was to interrupt the pathogenesis of complications in 52%. DP correlated with the prognostic signs and APACHE-II score as predictors of complications with an overall (S) of 93%, (Sp) 98%, (PPV) 91%, (NPV) 98%, and (DA) 97%. Greater scores values are all directly proportional with PD necrosis findings (P < 0.05). There was not PD related morbidity. CONCLUSIONS: We found correlation between PD classification and prognostic factors. Morphologic alterations were accurately identified. PD as preoperative work-up allows surgeons design operative strategies and as is useful follow-up of the patients after necrosectomy.

[Gastrointestinal neurofibromatosis. A rare cause of abdominal surgery]. / Neurofibromatosis gastrointestinal. Una causa poco frecuente de cirugía abdominal.

OBJECTIVE: Report two cases of gastrointestinal neurofibromatosis that required surgical intervention for their resolution. BACKGROUND: Neurofibromatosis is a congenital disease which is classified in two types. In neurofibromatosis type 1 or Von Recklinghausen's disease the patients have some classical manifestations as cafe au lait pigmentation, bony abnormalities and neurofibromas of both peripheral and central nerves. In up to 25% of the patients with neurofibromatosis 1, the gastrointestinal tract is involved. The most affected organs are the stomach and the jejunum. The symptoms of the patients with gastrointestinal neurofibromatosis are related to gastrointestinal bleeding or obstruction. METHOD: Two patients with gastrointestinal neurofibromatosis that required surgical intervention for the resolution of their manifestations. RESULTS: Two cases of gastrointestinal neurofibromatosis, one of them had as her main clinical feature gastrointestinal bleeding, and the other patient intestinal obstruction. They were submitted to exploratory laparotomy finding gastrointestinal neurofibromatosis in both as the cause of their symptomatology. CONCLUSIONS: The management of gastrointestinal neurofibromatosis could need surgical intervention, and when this is done the postoperative evolution is satisfactory.

[Acute mesenteric ischemia. Profile of an aggressive disease]. / Isquemia mesentérica aguda. Semblanza de una enfermedad agresiva.

Acute mesenteric ischemia is an abdominal emergency due to inadequate tissue perfusion with a mortality rate between 60 and 100%. Intestinal damage by ischemia depends on general circulation, collateral blood flow, response of the mesenteric vasculature to autonomic stimuli, circulating vasoactive substances, local humoral factors, and the normal and abnormal products of cellular metabolism before and after reperfusion of the ischemic segment. Four physiopathologic phenomenon are present: superior mesenteric artery embolism; superior mesenteric artery thrombosis; non-occlusive acute mesenteric ischemia, and superior mesenteric venous thrombosis; embolism event is the most frequent. The injury observed after 3 of ischemia (blood flow reduced to 20% of normal) and 1 of reperfusion is more severe than 4 of ischemia. Clinical diagnosis of mesenteric ischemia required a high suspect index, specially in elderly patients with cardiovascular problems. Abdominal pain and hemodynamic and/or metabolic changes are the most frequent symptoms. Although some authors have questioned the need for angiography, this study is the key not only to making a diagnosis of acute mesenteric ischemia before bowel infarction and prior to laparotomy, but also to initiate intra-arterial mesenteric angiography therapy with vasodilators. Patients who persist with acute abdomen will require exploratory celiotomy and vascular exploration. The outcome depends on early diagnosis and therapy to avoid ischemia progression and reperfusion injury.

[Morbidity and mortality in surgery for gastric cancer]. / Morbilidad y mortalidad en cirugía por cáncer gástrico.

BACKGROUND DATA: Surgery stays as the only effective therapy against gastric cancer. Several factors have been postulated to influence morbidity and mortality risk in gastric cancer surgery. OBJECTIVE: Determine morbidity and mortality of gastric cancer surgery and establish risk factors. METHOD: We reviewed the charts of patients who underwent surgery for gastric adenocarcinoma. Morbidity and mortality is reported. Demographic factors, preoperative physical evaluation, biochemical parameters, surgical technique and tumor biology were analyzed as risk factors for morbidity and mortality. RESULTS: During a seven year period, 120 patients were operated for gastric cancer. Median age was 58.07 years. Subtotal gastrectomy was the most common surgical procedure in 51 patients (42.5%). Morbidity was 26.66% (n = 32). Medical most common complication was renal failure (n = 6, 14.63%) and surgical most common complication was wound infection (n = 7, 17.07%). Mortality was 13.33% (n = 16). Statistically significant risk factors for morbidity were age, ECOG status, Goldman Cardiac Risk Index and a total lymphocyte count. Statistically significant risk factors for mortality were Goldman Cardiac Risk Index, albumin, creatinine, and total lymphocyte count. CONCLUSIONS: Morbidity and mortality after gastric cancer surgery is influenced by preoperative conditions of patients.