Ultrasound evaluation of a new surface reference line to describe sural nerve location and safe zones to consider in posterior leg approaches.

PURPOSE: Several authors have described methods to predict the sural nerve pathway with non-proportional numerical distances, but none have proposed a person-proportional, reproducible method with anatomical references. The aim of this research is to describe ultrasonographically the distance and crossing zone between a surface reference line and the position of the sural nerve. METHODS: Descriptive cross-sectional study, performed between January and April 2022 in patients requiring foot surgery who met inclusion criteria. The sural nerve course in the posterior leg was located and marked using ultrasound. Landmarks were drawn with a straight line from the medial femoral condyle to the tip of the fibula. Four equal zones were established in the leg by subdividing the distal half of the line. This way, areas based on simple anatomical proportions for each patient were studied. The distance between the marking and the ultrasound nerve position was measured in these 4 zones, creating intersection points and safety areas. Location and distances from the sural nerve to the proposed landmarks were assessed. RESULTS: One-hundred and four lower limbs, 52 left and 52 right, assessed in 52 patients were included. The shortest median distance of the nerve passage was 2.9 mm from Point 2. The sural nerve intersection was 60/104 (57.7%) in Zone B, 21/104 (20.1%) in Zone C and 19/104 (18.3%) in Zone A. Safety zones were established. Average 80.5% of coincidence in sural nerve localization was found in the distal half of the leg, in relation to the surface reference line when comparing both legs of each patient. CONCLUSIONS: This study proposes a simple, reproducible, non-invasive and, for the first time, person-proportional method, that describes the distance and location of the main areas of intersection of the sural nerve with points and zones (risk and safe zones) determined by a line guided by superficial anatomical landmarks. Its application when surgeons plan and perform posterior leg approaches will help to avoid iatrogenic nerve injuries. LEVEL OF EVIDENCE: IV.

Data-Analytics Modeling of Electrical Impedance Measurements for Cell Culture Monitoring.

High-throughput data analysis challenges in laboratory automation and lab-on-a-chip devices' applications are continuously increasing. In cell culture monitoring, specifically, the electrical cell-substrate impedance sensing technique (ECIS), has been extensively used for a wide variety of applications. One of the main drawbacks of ECIS is the need for implementing complex electrical models to decode the electrical performance of the full system composed by the electrodes, medium, and cells. In this work we present a new approach for the analysis of data and the prediction of a specific biological parameter, the fill-factor of a cell culture, based on a polynomial regression, data-analytic model. The method was successfully applied to a specific ECIS circuit and two different cell cultures, N2A (a mouse neuroblastoma cell line) and myoblasts. The data-analytic modeling approach can be used in the decoding of electrical impedance measurements of different cell lines, provided a representative volume of data from the cell culture growth is available, sorting out the difficulties traditionally found in the implementation of electrical models. This can be of particular importance for the design of control algorithms for cell cultures in tissue engineering protocols, and labs-on-a-chip and wearable devices applications.

Entamoeba histolytica P-glycoprotein (EhPgp) inhibition, induce trophozoite acidification and enhance programmed cell death.

Programmed cell death (PCD) is induced in Entamoeba histolytica by a variety of stimuli in vitro and in vivo. In mammals, intracellular acidification serves as a global switch for inactivating cellular processes and initiates molecular mechanisms implicated in the destruction of the genome. In contrast, intracellular alkalinization produced by P-glycoprotein overexpression in multidrug-resistant cells has been related to apoptosis resistance. Our previous studies showed that overexpression of E. histolytica P-glycoprotein (PGP) altered chloride-dependent currents and triggered trophozoite swelling, the reverse process of cell shrinkage produced during PCD. Here we showed that antisense inhibition of PGP expression produced a synchronous death of trophozoites and the enhancement of biochemical and morphological characteristics of PCD induced by G418. The nucleus was contracted, and the nuclear membrane was disrupted. Moreover, chromatin was extensively fragmented. Ca(2+) concentration was increased, while the intracellular pH (ipH) was acidified. In contrast, PGP overexpression prevented intracellular acidification and circumvented the apoptotic effect of G418.

Contribution of Outpatient Ultrasound Transvaginal Biopsy and Puncture in the Diagnosis and Treatment of Pelvic Lesions: A Bicenter Study.

BACKGROUND: The use of transvaginal ultrasound guided biopsy and puncture of pelvic lesions is a minimally invasive technique that allows for accurate diagnosis. It has many advantages compared to other more invasive (lower complication rate) or non-invasive techniques (accurate diagnosis). Furthermore, it offers greater availability, it does not radiate, enables the study of pelvic masses accessible vaginally with ultrasound control in real time, and it is possible to use the colour Doppler avoiding puncturing large vessels among others. The main aim of the work is to describe a standardized ambulatory technique and to determine its usefulness. METHODS: This is a retrospective study of ultrasound transvaginal punctures (core needle biopsies and cytologies) and drainages of pelvic lesions performed on an outpatient basis during the last two years. The punctures were made with local anesthesia, under transvaginal ultrasound guidance with an automatic or semi-automatic 18G biopsy needle with a length of 20-25 cm and a penetration depth of 12 or 22 mm. The material obtained was sent for anatomopathological, cytological and/or microbiological study if necessary. RESULTS: A total of 42 women were recruited in two centers. Fifty procedures (nine punctures, seven drains, and 34 biopsies) were performed. In five cases the punction and drain provided clinical relief in benign pelvic masses. Regarding material of the biopsies performed, 15 were vaginal in women previously histerectomized, finding 10 carcinomas, eight were ovarian tumours in advanced stages or peritoneal carcinomatosis obtaining the appropriate histology in each case, seven were suspicious cervical biopsies finding carcinomas in five of them, three were myometrial biopsies including one breast carcinoma metastasis in the miometrium and a benign placental nodule, and a periurethral biopsy was performed on a woman with a history of endometrial cancer confirming recurrence. The pathological diagnosis was satisfactory in all cases, confirming the nature of the lesion (25 malignant-ten vaginal recurrences of previous gynaecological cancers, eight cases of primary ovarian/peritoneal carcinoma, four new diagnosis of cervical malignant masses, one cervical metastasis of lymphoma, one periurethral recurrence of endometrial carcinoma and one recurrence of breast cancer in the myometrium-and 23 benign). The tolerance was excellent and no complications were detected. CONCLUSION: The ambulatory ultrasound transvaginal puncture and drainage technique is useful for obtaining a sample for pathological and microbiological diagnosis with excellent tolerance that can be used to rule out the recurrence of malignant lesions or progression of the disease, diagnose masses not accessible to gynecological exploration (vaginal vault, myometrium or cervix) and for early histologic diagnosis in cases of advanced peritoneal carcinomatosis or ovarian carcinoma as well as drainage and cytological study of cystic pelvic masses.

OPTimizing Irradiation through Molecular Assessment of Lymph node (OPTIMAL): a randomized open label trial.

BACKGROUND: Conservative surgery followed by breast and nodal irradiation is the standard loco-regional early breast cancer (BC) treatment for patients with four or more involved lymph nodes. However, the treatment strategy when fewer nodes are involved remains unclear, especially when lymphadenectomy has not been performed. Sensitive nodal status assessment molecular techniques as the One-Step Nucleic Acid Amplification (OSNA) assay can contribute to the definition and standardization of the treatment strategy. Therefore, the OPTIMAL study aims to demonstrate the feasibility of incidental irradiation of axillary nodes in patients with early-stage BC and limited involvement of the SLN. METHODS: BC patients who underwent conservative surgery and whose SLN total tumour load assessed with OSNA ranged between 250-15,000 copies/µL will be eligible. Patients will be randomized to receive irradiation on the breast, tumour bed, axillary and supraclavicular lymph node areas (intentional arm) or only on the breast and tumour bed (incidental arm). All areas, including the internal mammary chain, will be contoured. The mean, median, D5% and D95% doses received in all volumes will be calculated. The primary endpoint is the non-inferiority of the incidental irradiation of axillary nodes compared to the intentional irradiation in terms of 5-year disease free survival. Secondary endpoints comprise the comparison of acute and chronic toxicity and loco-regional and distant disease recurrence rates. DISCUSSION: Standardizing the treatment and diagnosis of BC patients with few nodes affected is crucial due to the lack of consensus. Hence, the quantitative score for the metastatic burden of SLN provided by OSNA can contribute by improving the discrimination of which BC patients with limited nodal involvement can benefit from incidental radiation as an adjuvant treatment strategy. TRIAL REGISTRATION: ClinicalTrial.gov, NCT02335957; https://clinicaltrials.gov/ct2/show/NCT02335957.

The anterior limited approach of the elbow for the treatment of capitellum and trochlea fractures: Surgical technique and clinical experience in eight cases.

When a coronal fracture affects the capitellum and the trochlea, the Kocher lateral approach may be inadequate for the correct visualisation, reduction and fixation of the fracture. In such cases an associated medial elbow approach may be required, or a posterior transolecranon approach may be preferred. The anterior limited approach to the elbow (ALAE) could be a valid option when treating these types of fracture, as it does not involve the detachment of any muscle group or ligament, thereby facilitating the recovery process. We can also treat associated injuries such as fractures of the radial head or coronoid process with this approach. We describe the surgical technique and the functional outcome of eight patients with a mean of 66 years of age (range, 53-76) who where treated with open reduction and internal fixation for capitellar and trochlear fractures through the ALAE. Patient outcomes were assessed with physical and radiological evaluation, range-of-motion measurements with a follow-up from 24 to 60 months. Two different quality of life questionnaires were carried out: the EuroQol Five Dimensions Questionnaire (EQ-5D) and the patient-answered questionnnaire of the Liverpool Elbow Score patient (PAQ-LES). Four fractures involved the capitellum, one involved the capitellum with the lateral ridge of the trochlea, and three involved the capitellum and trochlea as separate fragments. The patients presented a favorable clinical evolution at a median of 33 months (range, 24-60), with an average of motion of 10-138°. Four patients presented a fracture of the head of the radius (Mason type 2) and 3 fractures of the coronoid (Bryan-Morrey Type 1) associated. All the patients presented radiological consolidation without signs of osteonecrosis, being the average EQ-5D 0.857 (range, 0.36-1.0) and the PAQ-LES of 35 (range 17 to 36). Patients with isolated capitellar fractures had better results than those with trochlear involvement. The presence of associated fractures does not seem to worsen the results. We believe that the ALAE is a technical option to consider for the open surgical treatment of a capitellar fracture with or without involvement of the trochlea. LEVEL OF EVIDENCEIS: Therapeutic Level III.

Olecranon mayo IIA fractures treated with transosseous high strength suture: A series of 29 cases.

BACKGROUND: The aim of this study is to assess the causes and rates of re-operation in olecranon fractures in adults treated with transosseous suture. METHODS: We prospectively recruited 29 patients who were treated with this technique between 2010 and 2018. The type of suture used, tourniquet time and surgical time were analyzed for each one. X-rays were taken after 2 weeks, 6 weeks and 6 months, recording complications, causes, rates of re-operation and the final clinical condition. RESULTS: Median time for ischemia and surgery were 51 (95% CI:48;62) and 45 (95% CI:42;55) minutes respectively. The radiologic studies showed diastasis of the posterior cortex in the X-rays taken after 2 weeks and after 6 weeks in 7 (24,1%) cases. Of these cases, two (6,8%) were no longer followed-up after 6 months. There was only one case of aseptic non-union. Among these cases, two patients (6.8%) required surgical debridement due to acute soft tissue infection. No complication had any clinical impact, maintaining all patients full range of motion and no pain. Osteosynthesis removal was not necessary in any case. CONCLUSION: Transosseous suture with high strength thread is a valid alternative for treating Mayo IIA olecranon fractures in adult patients, decreasing re-operation rates for implant removal. There may be, in a moderate percentage of cases, radiologic diastasis of the posterior cortex at the fracture site, without causing pain nor limiting mobility LEVEL OF EVIDENCE: III.

Role of Extra-articular Tibiotalocalcaneal Arthrodesis and Posterior Approach in Highly Complex Cases.

BACKGROUND: Tibiotalocalcaneal (TTC) arthrodesis is a procedure commonly used as salvage surgery for various pathologic processes that compromise the ankle and subtalar joints. It is a reasonably standardized procedure when performed as a primary surgery in advanced stages of TTC arthritis. For such cases, there are several alternative approaches, fixation materials, and bone substitutes that can be used. Most represent valid options with similar results in the literature. However, in highly complex cases requiring TTC arthrodesis, the options for the approach and fixation material can be limited. Understanding the alternative approaches and techniques is of great help to the surgeon when faced with highly complex cases, such as patients with multiple previous operations, lack of bone stock, severe deformities, or compromise of associated soft tissues. In this article, we describe the role of the posterior approach with some technical variation that allows extra-articular arthrodesis in highly complex cases, and we present a series of patients with tibiotalocalcaneal arthrodesis who were operated on using this technique. METHODS: Retrospective review of all patients who underwent tibiotalocalcaneal arthrodesis via posterior approach between 2008 and 2016. The surgeries were performed by 2 different surgeons with the same technique (posterior approach with sliding graft) but 2 different fixation methods. Radiographs and computed tomographic (CT) studies were reviewed and patient satisfaction was rated using the Coughlin scale. Mean follow-up was 38 months. We identified 20 patients. The mean age was 51.2 years; 11 patients had post-traumatic arthritis whereas the others had other causes of arthritis (inflammatory disease, neurologic deformity, etc). RESULTS: The arthrodesis was performed using a tibiotalocalcaneal plate in 9 patients and retrograde intramedullary nail in 11 patients. Radiographic fusion was observed at an average of 3.1 months. Four patients had complications and 15 reported good or excellent results after surgery. CONCLUSION: Our study found a fusion rate comparable to other studies in highly complex cases. There were no operative wound complications. We observed that the posterior approach, with an extra-articular fusion procedure, was a valid option for salvage surgery in highly complex cases that require tibiotalocalcaneal fusion. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Recomendaciones basadas en la evidencia sobre la nutrición e hidratación en los últimos días de vida / Evidence-based recommendations on nutrition and hydration in the last days of life

Resumen: Introducción: Los cuidados paliativos en México son contemplados como una necesidad en todos los niveles de atención. La nutrición e hidratación en estos enfermos hacia sus últimos días de vida es controversial. Objetivo: Identificar las recomendaciones basadas en la evidencia sobre la nutrición e hidratación en los últimos días de vida. Material y métodos: Se realizó una búsqueda documental sobre la nutrición e hidratación hacia el final de la vida tomando como marco temporal las últimas horas y/o los últimos días de vida del enfermo en el contexto hospitalario. Resultados: Con los criterios de búsqueda seleccionados se identificaron 83 documentos. No se encontraron metaanálisis. Existen dos revisiones sistematizadas de la literatura, un ensayo clínico, cuatro guías de práctica clínica, cuatro reportes de caso y 17 revisiones. Se desglosan los resultados relevantes de lo seleccionado. Conclusiones: Se identifica que existen controversias de fondo sobre la alimentación al final de la vida. Sobre la hidratación existe cierto consenso. Es indispensable contar con un nutriólogo dentro de los servicios de cuidados paliativos de la Nación.

Abstract: Introduction: Palliative care in Mexico is considered a necessity at all levels of care. Nutrition and hydration in these patients towards the last days of life is controversial. Objective: To identify evidence-based recommendations on nutrition and hydration in the last days of life. Material and methods: A documentary search on nutrition and hydration towards the end of life was carried out taking as a time frame the last hours and/or the last days of life of the patient in the hospital context. Results: With the selected search criteria, 83 documents were identified. No meta-analyses were found. There are two systematized literature reviews, one clinical trial, four clinical practice guidelines, four case reports and 17 reviews. The relevant results of the selected documents are broken down. Conclusions: It is identified that there are fundamental controversies about feeding at the end of life. On hydration there is some consensus. It is essential to have a nutritionist within the palliative care services of the Nation.

Comparative analysis of thermoplastic masks versus vacuum cushions in stereotactic body radiotherapy.

BACKGROUND: To compare thermoplastic masks (TMP) and vacuum cushion system (VCS) to assess differences in interfraction set up accuracy in patients treated with stereotactic radiotherapy (SBRT) for oligometastatic lung cancer. Secondarily, to survey radiotherapy technologists to assess their satisfaction with the two systems. METHODS: Retrospective study of patients treated with lung SBRT between 2008 to 2012 at our institution. Immobilization was performed for 73 treatment sessions (VCS = 40; TMP = 33). A total of 246 cone-beams were analysed. Patients considered ineligible for surgery with a life expectancy ≥6 months and performance status > 1 were included. Target lesion location was verified by cone beam computed tomography (CBCT) prior to each session, with displacements assessed by CBCT simulation prior to each treatment session. Couch shifts were registered prospectively in vertical, longitudinal, and latero-lateral directions to obtain Kernel coordinates (3D representation). Technologists were surveyed to assess their satisfaction with indexing, positioning, and learning curve of the two systems. Setup displacements were obtained in all patients for each treatment plan and for each session. To assess differences between the immobilization systems, a t-test (Welch) was performed. RESULTS: Mean displacements for the TMP and VC systems, respectively, were as follows: session one, 0.64 cm vs 1.05 cm (p = 0.0002); session two, 0.49 cm vs 1.02 cm (p < 0.0001), and session three, 0.56 vs 0.97 cm (p = 0.0011). TMP resulted in significantly smaller shifts vs. VCS in all three treatment sessions. Technologists rated the learning curve, set up, and positioning more highly for TMP versus VCS. CONCLUSIONS: Due to the high doses and steep gradients in lung SBRT, accurate and reproducible inter-fraction set up is essential. We found that thermoplastic masks offers better reproducibility with significantly less interfractional set up displacement than vacuum cushions. Moreover, radiotherapy technologists rated the TMP system higher. Taken together, these two findings suggest that TMP may be preferable to VCS. However, more research is needed to determine both inter- and intrafraction error to identify the optimal immobilisation system for use in lung SBRT.

[Therapeutic compliance in patients with cardiovascular diseases]. / Cumplimiento terapéutico en pacientes con enfermedades cardiovasculares.

BACKGROUND: Our purpose was to establish, by means of a survival analysis, the duration of therapeutic compliance and the probability of abandonment or prescription drugs in cardiovascular patients, as well as the prognostic factors that determine it. PATIENTS AND METHOD: Longitudinal observational study (1996-1998). By means of a consecutive sampling, 493 patients who initiated a cardiovascular treatment were selected. Through interviews, we obtained information on cardiovascular problems and treatment, concomitant diseases, consumption of other drugs and social and demographic variables. The consumption of prescribed drugs was established across 6 periodic observations. RESULTS: During the observational period, 39.4% of drugs prescribed by the general practitioner (GP) were abandoned, as compared to 22.4% of those prescribed by specialists (p < 0.05). The degree of abandonment was significantly higher among consumers of vasodilators and vasoprotective agents. Cardiac glycosydes and angiotensin converting enzyme inhibitors were among the therapeutic subgroups in which a longer survival time was observed (average: 19.8 and 16.5 months, respectively). By a Cox regression analysis, we noticed that the risk of abandonment was higher in patients who took two or more doses of the drug per day (OR = 2.8; 95% IC, 21-37), in consumers of medicines with a daily cost lower than ptas. 100 (OR = 1.4); 95% CI, 1.0-1.8) and in subjects younger than 65 years (OR = 1.3; 95% CI, 1.0-1.8). CONCLUSIONS: A higher degree of abandonment of cardiovascular medication occurs when it is administered in primary health-care (i.e., drugs prescribed by the GP), mainly in relation to a greater prescription of agents with a low therapeutic effectiveness. Abandonment is influenced by patients' social and demographic factors and also by the specific characteristics of the treatment.

The influence of clinical situation on health-related quality of life in paediatric chronic kidney disease patients.

BACKGROUND: Studies examining health-related quality of life (HRQOL) in adults with chronic kidney disease (CKD) have demonstrated that certain clinical situations such as number of hospitalisations and anaemia can affect patient quality of life. Very few such studies have been carried out in children. OBJECTIVE: To analyse the impact of laboratory variables and various clinical situations on HRQOL of paediatric CKD patients. PATIENTS AND METHOD: We carried out a cross-sectional study using the TECAVNER questionnaire in 71 children with CKD and their parents (33 transplanted patients, 11 on peritoneal dialysis, 5 on haemodialysis, and 22 on conservative treatment). We analysed laboratory variables (blood urea nitrogen, creatinine, haematocrit, and albumin), clinical situation (short stature, arterial hypertension, and bone deformities), number of hospitalisations, and days spent in the hospital in the previous 6 months, as well as number of drugs administered and fluids/diet restrictions. RESULTS: The factor that most heavily affected the quality of life of our patients was water restrictions. In addition, hypertension affected cognitive function in these children. A haematocrit value >35% improved physical activity and functionality. We observed no association between albumin and HRQOL. CONCLUSIONS: These results confirm previous hypotheses and contribute to the validity of the TECAVNER questionnaire.

[What do we know about atypical fractures in patients on biphosphonates treatment? A literature review using a case series]. / ¿Qué sabemos de las fracturas atípicas en los pacientes en tratamiento con bifosfonatos? Revisión bibliográfica a raíz de una serie de casos.

AIM: Retrospective review of long term biphosphonates treated patients who sustained a subtrochanteric or diaphyseal femoral fracture with an atypical pattern. A literature review is presented as an update of the topic. MATERIAL AND METHODS: A retrospective study was conducted on 13 subtrochanteric or diaphyseal fractures in female patients treated with biphosphonates at our institution from September 2007 to March 2011. RESULTS: Four cases of subtrochanteric fractures and 13 diaphyseal fractures were detected. Four patients had bilateral fractures. All cases but one (that affected only the lateral cortex) were complete fractures. Surgically, these kinds of fractures are demanding due to the hardness of the bones. DISCUSSION: It is difficult to know if there is any relationship between bisphosphonates treatment and atypical femoral fractures. Nevertheless, current literature supports a greater benefit of their use in preventing vertebral and non-vertebral fractures. For this reason, biphosphonates continue being considered as a first choice in the prevention of osteoporotic fractures. CONCLUSIONS: Patients on long-term treatment with bisphosphonates may present atypical femoral fractures as a complication. It is considered that the maximum period for biphosphonates treatment should not exceed 5 years.

Mycobacterium marinum osteomyelitis of the first metatarsal.

Mycobacterium marinum (MM) infections secondary to injuries occurring in the aquatic environment have been widely described in literature, especially in immunosuppressed patients. The most frequent locations are the hands and forearms in patients exposed to water. The infection usually presents as a granuloma affecting superficial structures. However, due to the difficulty of diagnosis and the chronic course of the condition, deeper structures may eventually become affected. Late presentation of deep-seated infections in bones in the foot is exceptional. We report a case of osteomyelitis of the first metatarsal bone caused by MM after accidental puncture injury by a sea urchin requiring surgical treatment in a not immunosuppressed patient.

Efficacy and safety of 'rescue therapy' with mycophenolate mofetil in resistant primary glomerulonephritis--a multicenter study.

BACKGROUND: Studies of mycophenolate mofetil (MMF) in primary glomerulonephritis have varied in their inclusion criteria, regimen and follow-up compromising assessments of efficacy and optimal dose. METHOD: This multicentre study analysed the safety and efficacy of MMF monotherapy in a large cohort with primary glomerulonephritis that was resistant to other conventional therapies. A total of 98 patients with biopsy-proven primary glomerulonephritis resistant to other drugs received MMF monotherapy for 1 year. Primary outcome measures were urinary protein excretion and the number of patients with complete or partial remission of proteinuria. Secondary analyses were time to remission and changes in the slope of creatinine clearance. RESULTS: Fifty-four percent of the patients achieved either complete or partial remission of proteinuria with no significant differences between glomerulonephritis types. Median (range) dose of MMF was 2 g/day (1.5-2 g/day) Mean (SD) treatment time to remission was 141.5 (+/-61.1) days with no significant differences between glomerulonephritis types. Serum albumin increased (P<0.01), whereas proteinuria (P<0.01) serum LDL-cholesterol (P<0.01) and mean blood pressure (P<0.05) decreased post-treatment. No significant changes were observed in glomerular filtration rate (GFR), serum creatinine or slopes of GFR. The reduction of urinary protein excretion was significantly higher in patients with basal nephrotic proteinuria and preserved renal function; it did not arise from an increased dose of angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists, since, among responders, mean blood pressure significantly decreased and the number of anti-hypertensive drugs could be reduced. CONCLUSIONS: MMF monotherapy causes a moderate decrease in proteinuria in >50% of the patients who do not have other treatment options. The response to therapy is largely influenced by a preserved renal function and requires sustained MMF treatment.

[Definition of intrauterine growth retardation]. / Zur Definition der intrauterinen Wachstumsretardierung.

In order to answer the question as to the limit of intrauterine foetal growth retardation, we compared three weight values at birth: two standard deviations below the mean, namely the fifth and tenth percentiles. The comparisons were made on the intrapartum and early neonatal mortality rates of 19,256 infants born during 1980 in "La Paz" Maternity Hospital of Madrid. Our results show that we have to consider as newborn with a growth retardation those infants whose weight at birth is lower than the fifth percentile for their gestational age and sex. In this group of infants, the intrapartum and early neonatal mortality rates are significantly higher than among newborn with a superior weight. At the same time, we found that the mortality among newborn with a weight between the fifth and tenth percentile was not significantly higher than that observed among infants with a weight at birth greater than the tenth percentile.

Evaluación del desarrollo psicoevolutivo en niños menores de 7 años / Evaluation of the psichoevolutive development in children under 7 years

Con el objetivo de evaluar el desarrollo psicoevolutivo de los niños menores de 7 años se realizó un estudio prospectivo, de campo a nivel descriptivo con 80 niños que acudieron a la consulta de Medicina Familiar del Barrio Bolivariano. Guacara. de agosto a noviembre de 1994. Los datos fueron recolectados mediante: 1) Entrevista sobre antecedente pre, peri y postnatales, nivel socioeconómico y examen físico. 2)Test de Denver. Los resultados fueron: en grupo etario predominaron los preescolares (67,6 por ciento), ambos sexos se distribuyeron equitativamente, los niños pertenecían a los estratos obrero y marginal. El test de denver, versión corta, detectó 60 niños (75 por ciento) calificados como normales; los 20 niños restantes (25 por ciento): 17 (21,3 por ciento) con calificación anormal y 3 (3,7 por ciento) con calificación dudosa. Estos últimos, al aplicarle la versión larga del test de denver, resultaron todos con calificación anormal. El área de mayor afectación fué la del lenguaje (45,7 por ciento), seguida de personal-social (22,9 por ciento). En el examen físico se encontró que el porcentaje de alteración en peso y talla, perímetro cefálico, visión, audición y reflejos fueron: 11,5 por ciento, 11,3 por ciento, 5 por ciento, 2,5 por ciento y 5,8 por ciento, respectivamente. Al relacionar los factores de riesgo con el desarrollo psicoevolutivo, este presentaron fallas en un desarrollo psicoevolutivo según el test de denver. Las áreas con mayor afectación fueron la del lenguaje (45,7 por ciento) y personal-social (22,9 por ciento).

Tasa de gasto fecal durante la rehidratación oral en niños con diarrea aguda: compración entre el tratamiento con una solución estándar y otra de baja osmolaridad / Diarrheal output durin oral rehydration period in children with acute diarrhea: comparizon between the treatment with a standard solution and other low osmolarity solution

Se presenta el estudio prospectivo, aleatorio en 50 lactantes masculinos con diarrea aguda y deshidratación secundaria. El objetivo fue determinar el impacto sobre la tasa de gasto fecal de una solución de rehidratación oral hipoosmolar (SRO-60) en comparación con la solución de rehidratación oral con 90 mosm/l de sodio (SRO-90). Las variables de la respuesta fueron: tiempo de rehidratación, gasto fecal, volumen de suero oral ingerido por kilo/hora, número de éxitos y porcentaje de ganancia de peso. Los resultados muestran que los grupos fueron comparables puesto que no hubo diferencjas en las características de ingreso. Las variables de respuesta al uso de los dos tipos de suero no mostraron diferencia entre los dos grupos. La tasa de gasto fecal para el grupo SRO-60ñDS) fue de 7.13 ñ 602 ml/Kg/h, y para el grupo SRO-90 (xñDS), 6.37 ñ 5.1 ml/Kf/h. Sin embargo, los pacientes cpn desnutrición II o III mostraron menor tasa fecal con una solución hipoosmolar. Se concluye que el uso de una solución hipoosmolar a la recomendada por la Organización Mundial de la Salud no ofrece ventajas durante la etapa de rehidratación en relación a la tasa de éxitos, al volumen de suero ingerido, al gasto fecal y al incremento de peso