Mirror Therapy and Action Observation Therapy to Increase the Affected Upper Limb Functionality in Children with Hemiplegia: A Randomized Controlled Trial Protocol.

The movements of the affected upper limb in infantile hemiplegia are slower and clumsy. This leads to a decrease in the use of the affected hand. The visual effect obtained using the mirror box and the observation of actions in another individual can activate the same structural neuronal cells responsible for the execution of these actions. This research will study the affected upper limb functionality in hemiplegia infantile from 6 to 12 years old after the application of two intervention protocols: observation action therapy and mirror therapy combined with observation action therapy. Children with a diagnose of congenital infantile hemiplegia will be recruited to participate in a randomized controlled trial with two intervention protocols during four weeks (1 h per/day; 5 sessions per/week): Mirror Therapy Action Observation (MTAO) or Action Observation Therapy (AOT). The study variables will be: spontaneous use, measured with the Assisting Hand Assessment (AHA); manual ability measured with the Jebsen Taylor Hand Function Test (JTHFT); surface electromyography of the flexors and extensors muscles of the wrist and grasp strength through a grip dynamometer. Four assessments will be performed: At baseline situation, at the end of treatment, 3 and 6 months after treatment (follow-up assessments). This study will study the effects of these therapies on the use of the affected upper limb in children with hemiplegia.

Respuesta a diferentes escenarios y complicaciones hematológicas en COVID-19 / Response to different scenarios and hematological complications in COVID-19.

Las enfermedades infecciosas emergentes y reemergentes son desafíos constantes para la salud pública en todo el mundo. Los casos recientes de neumonía de causa desconocida en Wuhan, China, han llevado al descubrimiento de un nuevo tipo de Coronavirus (2019-nCoV), que son virus de Ácido Ribonucleico (RNA) envueltos, de forma común encontrados en humanos, otros mamíferos y aves, capaces de causar enfermedades respiratorias, entéricas, hepáticas y neurológicas 1. La amenaza a la salud de la infección por Coronavirus 2 asociado al SRAS (SARS-CoV-2) y la enfermedad que produce el mismo llamada Enfermedad por Coronavirus (COVID-19) ya está estable- cida con sus tasas de infección y mortalidad de manera considerable más altas si se lo compara con otros virus respiratorios adquiridos en la comunidad 2. En tal sentido es necesario dar una respuesta por parte de la Unidad Técnica de Hematología en relación a esta pandemia con el ánimo de aportar al manejo integral de estos pacientes, homogeneizar criterios clínicos, lidiar de mejor manera con la incertidumbre en el diagnóstico y tratamiento de COVID-19. El SARS CoV-2 y su enfermedad COVID-19, en la mayoría de pacientes tiene una presentación con síntomas leves. Sin embargo, en el 5% de los casos diagnosticados requerirán de una Unidad de Cuidados Intensivos (UCI)3, ya que presentan Síndrome de Dificultad Respiratoria Aguda (SDRA), shock séptico, Insuficiencia Multiorgánica y coagulopatía hemorrágica, así como trombótica, incluyendo Coagulación Intravascular Diseminada (CID), alcanzado en las salas de UCI una tasa mortalidad por COVID-19 entre el 22% al 62% en algunas series 4. Adicional, se ha observado que el grupo de pacientes con mala evolución presentan un estado hiperinflamatorio, asemejándose al cuadro clínico descrito de una linfohistiocitosis hemofagocítica secundaria, que en este caso sería desencadenada por SARS CoV-2 5. Un grupo de Hematólogos de diferentes hospitales de la ciudad de Quito: Especialidades Carlos Andrade Marín-Instituto Ecuatoriano de Seguridad Social (HECAM-IESS), Metropolitano; y, hospitales de la ciudad de Guayaquil: Teodoro Maldonado Carbo-IESS, Hospital Luis Vernaza y Clínica Gilbert, basados en la evidencia científica disponible y experticia profesional, elaboraron éste protocolo con las recomendaciones según los diferentes escenarios y complicaciones hematológicas.

Emerging and reemerging infectious diseases are constant challenges to public health worldwide. Recent cases of pneumonia of unknown cause in Wuhan, China have led to the discovery of a new type of Coronavirus (2019-nCoV), which are enveloped ribonucleic acid (RNA) viruses, commonly found in humans, other mammals, and birds, capable of cause respiratory, enteric, liver and neurological diseases 1. The health threat of SARS-associated coronavirus 2 (SARS-CoV-2) and the disease that produces it called COVID-19 has already been established with its considerably higher infection and mortality rates compared to other respiratory viruses acquired in the community 2. In this sense, it is necessary to give a response from the Hematology Technical Unit in relation to this pandemic in order to contribute to the comprehensive management of these patients, homogenize clinical criteria, better deal with uncertainty in the diagnosis and treatment of COVID-19. SARS CoV-2 and its disease COVID-19, in the majority of patients have a presentation with mild symptoms. However, in 5% of diagnosed cases they will require an Intensive Care Unit (ICU) 3, since they present Acute Respiratory Distress Syndrome (ARDS), septic shock, Multiple Organ Failure and hemorrhagic coagulopathy, as well as thrombotic, including Coagulation Disseminated Intravascular (DIC), achieved in the ICU wards a mortality rate for COVID-19 between 22% and 62% in some series 4. Additionally, it has been observed that the group of patients with poor evolution present a hyperinflammatory state, resembling the clinical picture of secondary hemopha- gocytic lymphohistiocytosis, which in this case would be triggered by SARS CoV-2 5. The group of Hematologists from the hospitals of the city of Quito: Specialties Carlos Andrade Marín HECAM-IESS, Metropolitano; and, hospitals in the city of Guayaquil: Teodoro Maldonado Carbo-IESS, Luis Vernaza Hospital and Gilbert Clinic, based on the available scientific evidence and professional expertise, prepared this protocol with the recommendations according to the different hematological scenarios and complications.

Obtención e infusión de plasma convaleciente de paciente recuperado de infección COVID-19 para uso compasivo / Obtaining and infusing convalescent plasma from a patient recovered from COVID-19 infection for compassionate use

El 30 de enero de 2020, la Organización Mundial de la Salud (OMS) declara que el brote de Enfermedad por Coronavirus (COVID-19) constituye una Emergencia Sanitaria de Salud de Preocupación Internacional/Public Health Emergencies of International Concern (PHEIC). El 11 de marzo de 2020, la OMS declara la pandemia1,2. El COVID-19 es una enfermedad respiratoria aguda causada por un coronavirus zoonótico de reciente aparición1. Los coronavirus son una familia de virus que se descubrió en la década de los 60 pero cuyo origen es todavía desconocido. Pueden causar enfermedades tanto en animales como en humanos. En los humanos se sabe que varios coronavirus (229E, OC43, NL63 y HUK 1) son responsables del resfriado común y en raras ocasiones se pueden producir infecciones graves de las vías respiratorias inferiores. Dos de los coronavirus causan infecciones en los seres humanos muchos más graves e incluso a veces mortales; estos son: el Coronavirus del Síndrome Respiratorio de Oriente Medio (MERS-CoV), y el Coronavirus tipo 2 asociado al SARS (SARS-CoV), que produce el síndrome respiratorio agudo grave3,4. La pandemia debida al virus SARS-CoV-2 requiere de medidas sanitarias urgentes encaminadas a reducir el riesgo de transmisión de la infección3,4. Al momento, no existe tratamiento eficaz para abordar la enfermedad por SARS-CoV-2 (COVID-19). La OMS emitió un informe que los primeros resultados con el uso de Plasma de Convaleciente (CP) puede ser una modalidad de tratamiento potencialmente útil para el COVID-193-5.En este sentido, se señaló la oportunidad de que los Sistemas Transfusionales de cada país realicen una evaluación de riesgos para calibrar su capacidad de extraer, preparar y almacenar este tipo de donaciones. Esto incluye recursos humanos y suministros críticos adecuados, así como un control exhaustivo de procedimientos e infraestructuras. En este marco, se sugiere el inicio de contactos con los servicios hospitalarios para que colaboren en la selección de pacientes, que habiendo superado la enfermedad del COVID-19, pudieran ser candidatos para donación de plasma sin mermar en sus derechos1. La decisión de desarrollar esta opción requiere una revisión rápida, pero exhaustiva, del agente etiológico o agentes relacionados y la respuesta inmune a ellos para evaluar los posibles beneficios y riesgos de la inmunización pasiva. Los principios generales establecidos en los documentos de posición de la Red de Reguladores de Sangre (BRN) de la OMS sobre el uso de plasma convaleciente, como elemento de respuesta a brotes anteriores de virus emergentes (2017) y como respuesta al Coronavirus del Síndrome Respiratorio de Oriente Medio (2014) siguen siendo aplicables también a esta pandemia de SARS-CoV-26,7. La falta de evidencia clínica concluyente del uso del plasma convaleciente en infección por SARS-CoV-2 no debería ser razón para abandonar el uso del plasma convaleciente. Los ensayos clínicos aleatorios están en curso y los resultados no estarán disponibles durante meses en tanto no hay justificación basada en la evidencia disponible y la ética profesional para negar categóricamente el uso del plasma convaleciente en los hospitales que no participan en un ensayo clínico aleatorio. El siguiente protocolo ha tomado algunas de las recomendaciones del Comité Científico para la Seguridad Transfusional del Ministerio de Sanidad de España Versión 1.0 ­ 26 marzo de 20201. Y ha sido modificado para tratar de adaptarlo a la realidad de nuestra institución.

On January 30, 2020, the World Health Organization (WHO) declared that the COVID-19 outbreak constitutes a public health emergency of international concern (PHEIC). On March 11, 2020, the WHO declared the pandemic1,2. COVID-19 is an acute respiratory disease caused by a newly emerging zoonotic coronavirus1. Coronaviruses are a family of viruses that was discovered in the 1960s but whose origin is still unknown. They can cause disease in both animals and humans. In humans, several coronaviruses (229E, OC43, NL63, and HUK 1) are known to be responsible for the common cold, and serious infections of the lower respiratory tract can rarely occur. Two of the coronaviruses cause much more serious and even sometimes fatal infections in humans; These are: MERS-CoV, as the cause of respiratory syndrome in the Middle East, and SARS-CoV, which produces severe acute respiratory syndrome3,4. The pandemic due to the SARS-CoV-2 virus requires urgent sanitary measures aimed at reducing the risk of transmission of the infection3,4. Currently, there is no effective treatment to address SARS-CoV-2 disease (COVID-19). The WHO issued a report that early results with the use of convalescent plasma (PC) may be a potentially useful treatment modality for COVID-193-5. In this sense, the opportunity for the Transfusion Systems of each country to carry out a risk assessment to gauge their ability to extract, prepare and store this type of donation. This includes adequate critical human resources and supplies, as well as a comprehensive control of procedures and infrastructure. In this framework, it is suggested that contacts with hospital services be initiated so that they collaborate in the selection of patients who, having overcome the COVID-19 disease, may be candidates for plasma donation without diminishing their rights1. The decision to develop this option requires a rapid, but comprehensive, review of the etiologic agent or related agents and the immune response to them to assess the possible benefits and risks of passive immunization. The general principles established in the position papers of the WHO Blood Regulators Network (BRN) on the use of convalescent plasma, as an element of response to previous outbreaks of emerging viruses (2017) and as a response to the syndrome coronavirus respiratory problems of the Middle East (2014) are still applicable to this SARS-CoV-2 pandemic6,7. The lack of conclusive clinical evidence of the use of convalescent plasma in SARS-CoV-2 infection should not be a reason to abandon the use of convalescent plasma. Randomized clinical trials are ongoing and results will not be available for months as there is no justification based on available evidence and professional ethics to categorically deny the use of convalescent plasma in hospitals that do not participate in a randomized clinical trial. The following protocol has taken some of the recommendations of the Scientific Committee for Transfusion Safety of the Spanish Ministry of Health Version 1.0 - March 26, 20201. And it has been modified to try to adapt it to the reality of our institution.

Clinical trial on stimulation of suction in preterm cases using neuromotor reactions.

INTRODUCCIÓN: La succión nutritiva es un hito importante para la correcta alimentación del neonato. Los prematuros no tienen desarrollada esta habilidad, por lo que se han diseñado diferentes maneras de estimular su aparición. OBJETIVO: Comprobar si la estimulación de los reflejos orales innatos, a través de reacciones neuromotrices, disminuye el tiempo para adquirir la destreza de succión nutritiva. MATERIAL Y MÉTODOS: Se estudiaron neonatos nacidos antes de la semana 34 de gestación y alimentados mediante sonda por succión ineficaz. El grupo control estuvo constituido por los recién nacidos con las mismas características nacidos durante el año 2016. El grupo experimental fue estimulado mediante reacciones neuromotrices hasta el retiro de la sonda. Las variables observadas fueron el tiempo de transición a la alimentación oral completa, el peso, la talla y el perímetro craneal al alta, la saturación periférica de oxígeno y la frecuencia cardiaca antes y después de la intervención, así como la calidad de la succión mediante la escala ECLES. RESULTADOS: Completaron el estudio 23 niños en el grupo de intervención y 25 en el grupo de control histórico. Los niños del grupo intervenido mostraron transición acelerada a la alimentación oral independiente y valores más elevados de altura (p = 0.01), peso (p < 0.001) y perímetro craneal (p = 0.04) en el momento del alta hospitalaria. La edad gestacional al alta y la duración total de la hospitalización no mostraron diferencias entre grupos (p > 0.05). CONCLUSIONES: La estimulación mediante reacciones neuromotrices disminuye el tiempo necesario para alcanzar la succión nutritiva en los neonatos pretérmino. BACKGROUND: Nutritive suction is an important milestone for correct newborn feeding. Premature infants do not develop this ability therefore, several proposals for their appearance have being designed. OBJECTIVE: Assess whether the stimulation of the innate oral reflexes using neuromotor reactions reduces the time to acquire sucking behavior. MATERIAL AND METHODS: Newborns before 34 weeks of gestation, fed by tube feeding due to an ineffective suction, were studied. Control group consisted of newborns with the same characteristics born during 2016. Experimental group was stimulated by neuromotor reactions until the tube feeding was retired. Observed variables included transition time to complete oral feeding, weight, height and cranial perimeter at discharge, peripheral oxygen saturation and heart rate before and after intervention, as well as quality of suction behavior using ECLES scale. RESULTS: A total of 23 babies from intervention group completed the study, and 25 from historical control group. Children of intervention group showed an accelerated transition to independent oral feeding and higher values of height (p = 0.01), weight (p < 0.001) and cranial perimeter (p = 0.04), at the time of hospital discharge. Gestational age at discharge and total duration of hospitalization did not show differences between groups (p > 0.05). CONCLUSION: Oral stimuli intervention by means of neuromotor reactions reduced the time necessary to reach suction behavior in preterm babies.

Impact of obesity and Down syndrome on peak heart rate and aerobic capacity in youth and adults.

Individuals with Down syndrome (DS) exhibit reduced aerobic capacity with reduced peak heart rate (HRpeak). This condition is often coexistent with higher level of obesity compared to individuals without DS. The purpose of this study is to investigate the effects of obesity and Down syndrome (DS) on peak heart rate (HRpeak) and peak oxygen consumption (VO2peak) in children and adults both with and without intellectual disabilities (ID)s. VO2peak and HRpeak from individualized treadmill tests on 654 individuals were analyzed. Body mass index was used to categorize individuals' weight status using standard cut-offs. DS groups had the lowest HRpeak (167bpm±14, p<0.05) compared to individuals with (183bpm±12) without ID (187bpm±12). Obesity did not affect HRpeak among adults and children with DS. VO2peak was lower among individuals with DS (25.2mL/kg/min±6.3, p<0.05) when compared individuals with (37.0mL/kg/min±10.5) and without ID (36.1mL/kg/min±10.4). Obese adults with DS had lower VO2peak (24.3mL/kg/min±6.9, p=0.001) compared to the normal weight (26.7±7.1mL/kg/min) and overweight groups (27.0mL/kg/min±6.1) with DS. Conversely, in children, obesity level did not impact VO2peak in individuals with DS. Our results suggest that DS attenuates both VO2peak and HRpeak, regardless of obesity status and age group. However, obesity was associated with lower VO2peak in all adults, but not in children with DS.

Effects of whole-body vibration training on explosive strength and postural control in young female athletes.

This study aimed to evaluate the effectiveness of a whole-body vibration training program to improve neuromuscular performance in young elite female athletes. Twenty-three women basketball players (14-18 years old) were randomly assigned to a control group (CG, n = 11) or to a whole-body vibration group (WBVG, n = 12). During the study period, both groups continued their usual training program, but the WBVG also underwent a 15-week vibration training program. We analyzed the countermovement jump test (CMJ), the 1-leg hop test for the right leg and for the left leg, and the single-limb standing balance for both legs and with eyes open and closed at 3 time points: before training (T1), after an 8-week training period (T2), and after a further 7-week training period (T3). Compared with the CG, CMJ increased significantly in the WBVG from T1 to T2 (6.47%, p < 0.001), T1 to T3 (10.07%, p = 0.005), and T2 to T3 (3.38%, p < 0.001). One-leg hop test for the right and left legs also showed significantly higher values in WBVG from T1 to T2 (10.12%, p < 0.001 and 9.63%, p = 0.002, respectively) and T1 to T3 (14.17%, p = 0.001 and 15.17%, p = 0.004, respectively). Lateral deviation of the center of pressure in the closed eyes test decreased significantly in WBVG for both right and left leg, from T1 to T2 (-22.20%, p = 0.043 and -34.77%, p < 0.001, respectively) and from T1 to T3 (-33.14%, p = 0.027 and -33.58%, p = 0.043, respectively) compared with the CG. In conclusion, our results show that a 15-week whole-body vibration training program improves explosive strength and postural stability in adolescent female basketball players.

Prediction of VO2peak from the 20-m shuttle-run test in youth with Down syndrome.

This study examined whether 20-m shuttle-run performance, sex, body mass index (BMI), age, height, and weight are associated with peak oxygen uptake (VO2peak) in youth with Down syndrome (DS; n = 53; 25 women, age 8-20 years) and whether these variables can be used to develop an equation to predict VO2peak. BMI, 20-m shuttle-run performance, and sex were significantly associated with VO2peak in youth with DS, whereas age, height, and weight were not. A regression model included only shuttle-run performance as a significant predictor of VO2peak; however, the developed prediction equation had low individual predictability. Therefore, 20-m shuttle-run performance alone does not provide valid prediction of VO2peak in youth with DS. Sex, BMI, age, height, and weight do not improve the prediction of VO2peak.

Sex differences in linear and nonlinear heart rate variability during early recovery from supramaximal exercise.

Women demonstrate greater RR interval variability than men of similar age. Enhanced parasympathetic input into cardiac regulation appears to be not only greater in women, but also protective during periods of cardiac stress. Even though women may have a more favorable autonomic profile after exercise, little research has been conducted on this issue. This study was designed to examine the cardiac autonomic response, in both male and female participants, during the early recovery from supramaximal exercise. Twenty-five individuals, aged 20 to 33 years (13 males and 12 females), performed a 30-s Wingate test. Beat-to-beat RR series were recorded before and 5 min after exercise, with the participants in the supine position and under paced breathing. Linear (spectral analysis) and nonlinear analyses (detrended fluctuation analysis (DFA)) were performed on the same RR series. At rest, women presented lower raw low frequency (LF) power and higher normalized high frequency (HF) power. Under these conditions, the LF/HF ratio of women was also lower than that of men (p<0.05), but there were no differences in the short-term scaling exponent (α1). Even though both sexes showed a significant modification in linear and nonlinear measures of heart rate variability (HRV) (p<0.05), women had a greater change in LF/HF ratio and α1 than men from rest to recovery. This study demonstrates that the cardiac autonomic function of women is more affected by supramaximal exercise than that of men. Additionally, DFA did not provide additional information about sexual dimorphisms, compared with conventional spectral HRV techniques.

Acute effects of supramaximal exercise on carotid artery compliance and pulse pressure in young men and women.

The purpose of this study was to determine the cumulative effects of repeated cycling sprints (Wingate tests) on carotid compliance and blood pressure (BP). Fourteen young, healthy men and women completed this study. Vascular and hemodynamic measurements were taken at rest, 5 min following a first Wingate test, 25 min following the first Wingate test, 5 min following a second Wingate test, and 25 min following the second Wingate test. At each time point, the measurements taken included brachial and carotid pulse pressure (PP), heart rate, carotid artery maximum and minimum diameters, and carotid compliance. Carotid BP was obtained with applanation tonometry. Carotid diameters were obtained using ultrasonography and compliance was calculated from carotid diameters and BP. Carotid and brachial PP increased significantly (P < 0.05) 5 min after each Wingate test and returned to near baseline 25 min after each Wingate test. No cumulative PP effects were seen. A cumulative effect was seen for carotid compliance: 5 min following the second sprint, carotid arterial compliance decreased significantly more than 5 min following the first sprint (P < 0.05). A single cycling sprint reduces carotid artery compliance immediately after exercise. Performance of a second identical cycling sprint further compounds this vascular change, reducing carotid artery compliance beyond levels seen following a single cycling sprint.

Reliability of Wingate testing in adolescents with Down syndrome.

The Wingate anaerobic test (WAnT) has not been used to assess individuals with Down syndrome (DS) and it is unknown if it is reliable in this population. We investigated the reliability of the WAnT in 19 adolescents with DS (age = 14.8 yrs; weight = 52.7 kg; height = 146.3 cm). Participants completed, on separate days, two standards WAnT using a resistance of 0.7 Nm x body weight (kg) in individuals > 14 years old, and 0.5 Nm x body weight (kg) in participants < 14 years of age. Data were analyzed using intraclass correlation coefficient (ICC), dependent t tests and Bland-Altman plots. There was a significant difference between days for peak power (210.37 W vs. 236.26 W; ICC = 0.93), but not for mean power (158.72 vs. 168.71 W; ICC = 0.86), time to peak power (6.67 vs. 6.28 s; ICC = 0.69), or the fatigue index (9.33 vs. 5.43 W/sec; ICC = 0.09). Adolescents with DS exhibit low WAnT performance compared with previously published data on adolescents without DS and the reliability of WAnT is questionable in this population.

Age-related changes in aerobic capacity in individuals with mental retardation: a 20-yr review.

INTRODUCTION: Persons with mental retardation (MR), particularly individuals with Down syndrome (DS), have been found to have attenuated peak exercise responses in previous research. However, it is unknown if the pattern of age-associated changes in HR or aerobic capacity (VO2peak) is similar to individuals without disabilities. PURPOSE: To investigate age-related changes in aerobic capacity in persons with MR, with and without DS, using a retrospective analysis. METHODS: Data were collected in university research laboratories, using 180 persons with MR without DS, 133 persons with MR with DS, and 322 persons without disabilities in four age categories: 9-15, 16-21, 22-29, and 30-45 yr. Subjects underwent treadmill testing with peak HR and VO2peak measurements. RESULTS: Relative VO2peak was lowest for persons with DS across all age groups. VO2peak did not change after 16 yr in the individuals with DS, whereas the other groups exhibited a slight decline (approximately 10 mL x kg(-1) x min(-1)) with age. Peak HR was overall different between all three groups (P < 0.001), and the youngest age group had the highest peak HR versus the other three age groups (P < 0.0001). CONCLUSIONS: Persons with MR without DS exhibit similar age-related changes in VO2peak and peak HR as individuals without disabilities. Similar age-related changes were also observed for peak HR in individuals with DS, despite overall lower levels. However, relative VO2peak did not decline with age in persons with DS, suggesting that aerobic capacity exhibits a different age-related response in individuals with DS.

Heart rate variability at rest and during exercise in persons with Down syndrome.

OBJECTIVES: To determine whether autonomic dysfunction explains chronotropic incompetence observed in persons with Down syndrome (DS) and to measure heart rate variability (HRV) at rest and during exercise in persons with mental retardation with and without DS. DESIGN: Comparative study. SETTING: University exercise science laboratory. PARTICIPANTS: Thirty-one subjects with mental retardation (age, 20.2 y) with DS (n=16; 10 men, 6 women) and without DS (n=15; 8 men, 7 women). INTERVENTIONS: Not applicable. Main outcome measures HRV was determined at rest and at 2 steady-state exercise intensities on the treadmill in both time (standard deviation of the R-R interval, percentage of R-R intervals deviating by more than 50 ms from the previous R-R interval [deviation >50], square root of the mean squared differences of successive differences) and frequency (low-frequency power [LF]), high-frequency power [HF], the LF/HF ratio) domains. RESULTS: The DS group demonstrated a statistically lower peak heart rate (161 beats/min vs 178 beats/min, P<.05), and peak oxygen consumption (27.4 mL.kg(-1).min(-1) vs 34.3 mL. kg(-1).min(-1), P<.05) than did the group with mental retardation without DS. At rest, all time domain measures of HRV and absolute HF power were significantly higher in the DS group (P<.05). Yet, LF power and LF/HF values did not differ between groups. All HRV variables decreased significantly at both exercise intensities, with no differences between groups during exercise (P<.05). CONCLUSIONS: People with DS have greater parasympathetic activity at rest, but group differences disappear with the onset of exercise, which suggests that other variables are responsible for chronotropic incompetence in persons with DS.

Chronotropic incompetence in persons with down syndrome.

OBJECTIVE: To investigate the chronotropic response to exercise through peak heart rate and the Chronotropic Response Index (CRI) in participants with Down syndrome (DS) and in nondisabled control participants. DESIGN: Comparative study describing the acute exercise heart rate response. SETTING: University sports medicine facility. PARTICIPANTS: Twenty participants with DS (mean age +/- standard deviation, 24.2+/-3.5y) and 20 control participants without disabilities (age, 21.2+/-2.8y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Maximal treadmill exercise tests with metabolic and heart rate measurements. Maximal heart rate and the CRI were considered main outcomes. RESULTS: The peak oxygen consumption (41.7 vs 31.8mL. kg(-1).min(-1)) and peak heart rate (165+/-14.7 vs 192+/-7.7 beats/min) were significantly lower in participants with DS than in controls (P<.05). The CRI was below normal (.84+/-.25) in participants with DS and was normal (.97+/-.07) in controls. CONCLUSION: Both the CRI and the peak heart rates were indicative of chronotropic incompetence in participants with DS, but not in controls. The CRI of the participants with DS was similar to that reported for nondisabled populations who have a true chronotropic response to exercise. The CRI indicated that the low peak heart rate in our participants with DS was a true chronotropic response.

Leucemia mieloide aguda secundaria a un adenocarcinoma mamario: presentación de un caso clínico / secondary acute mieloide Leukemia to adenocarcinoma mammary: presentation of a clinical case

Se presenta un caso clínico de un paciente de sexo femenino, de 53 años, diagnosticada de adenocarcinoma mamario derecho, tratada con cuadrantectomía más vaciamiento ganglionar axilar. Recibió quimioterapia con ciclofosfamida (CFA), metotrexate (MXT) y 5-fluouracilo (5-FU) por seis ciclos y tratamiento adyuvante con radioterapia (RT) ciclo mamario completo, 5000cgy. Treinta y dos meses después de su diagnóstico inicial, desarrolló leucemia mieloide aguda secundaria (LMas), con actividad tumoral de su cáncer primario de mama, evidenciado por citología del líquido pleural positiva para adenocarcinoma metastásico.