[Development of the Spanish version of the Wisconsin Gait Scale. Reliability and consistency analysis of spatial and temporal parameters with gait assessment in stroke patients]. / Desarrollo de la versión española de la Wisconsin Gait Scale. Análisis de consistencia de los parámetros temporo-espaciales con la valoración de la marcha en pacientes con ictus.

BACKGROUND AND OBJECTIVE: We aimed to perform a cross-cultural adaptation of the Wisconsin Gait Scale (WGS) to Spanish and ensure its reliability, validity and sensitivity. MATERIAL AND METHOD: A cross-sectional descriptive study was conducted in patients with stroke between September 2017 and March 2019. We developed the Spanish version through the translation-back-translation method, and reached a consensus on the problematic items. The Spanish version of the WGS was applied in 25 post-stroke patients, assessed in the Hospital Movement Analysis Unit. All patients were evaluated by 2 independent evaluators, subsequently performing the instrumented gait analysis using the Elite System (BTS), SMART System. Interobserver confirmation (intraclass correlation coefficient), internal consistency (Cronbach's alpha), and validation were verified by checking their relationship with spatial and temporal parameters and sensitivity to change (Pearson's correlation). RESULTS: After the translation-back-translation, the committee found cultural equivalence in all but 2 items and reached a consensus on the final version. Interobserver reliability had an intraclass coefficient of 0.99 for the total score, and > 0.7 for each item; Cronbach's alpha was > 0.8; the validity between the WGS and the spatial and temporal parameters was significant (p < 0.05). Sensitivity to change was significant on comparison of the results of the scale at baseline and at 1 month (correlation coefficient 0.92). CONCLUSION: The Spanish version of the WGS is a culturally equivalent instrument to the original version, providing an objective means to document observational analysis of gait in post-stroke patients by rehabilitation teams.

Effectiveness of self-managed medication abortion between 13 and 24 weeks gestation: A retrospective review of case records from accompaniment groups in Argentina, Chile, and Ecuador.

OBJECTIVES: In settings where abortion is legally restricted or inaccessible, grassroots feminist networks provide evidence-based information and support to individuals who self-manage abortions-a model of care known as abortion accompaniment. This study aims to fill a gap in existing evidence about out-of-clinic abortion beyond 12 weeks gestation. STUDY DESIGN: We conducted a retrospective analysis of anonymized case records from accompaniment groups based in Argentina, Chile, and Ecuador of abortions supported between 13 and 24 weeks gestation. We report on the reproductive histories of individuals who had accompanied abortions, as well as medication regimens, and outcomes. RESULTS: Between 2016 and 2018, 316 individuals received accompaniment support for 318 self-managed medication abortions between 13 and 24 weeks gestation. Individuals most commonly used mifepristone-misoprostol (n = 297, 93%), with sublingual misoprostol administration (n = 288, 88%). Medication alone resulted in 241 complete abortions (76%); 37 (12%) individuals underwent manual vacuum aspiration or dilation and curettage within the formal health system, and 16 people (5%) required an additional medication abortion attempt at a later date, resulted in ongoing pregnancy, or were lost to follow-up. After accounting for additional interventions or monitoring at a healthcare facility, 302 of 318 (95%) abortion attempts completed overall. We had complete information regarding complications only from Chile (n = 78); of these, 12 (15%) experienced potential complications, including delayed placental expulsion and/or heavy bleeding (n = 5, 6%), high fever (n = 3, 4%), and hypotension, panic attack, or vomiting (n = 3, 4%). No abortions resulted in transfusion or hysterectomy. CONCLUSIONS: Self-managed medication abortion, with accompaniment network support and linkages to the formal health system in the event that complications arise, may be an effective and safe option for abortion beyond the first trimester - particularly in legally restrictive settings. IMPLICATIONS: These results build on an emerging body of evidence suggesting that self-managed medication abortion beyond 12 weeks gestation, conducted with accompaniment support and referrals to formal health care services as needed, can be an effective model of abortion care - and can provide a safe alternative to clandestine surgical procedures.

Modificaciones del ambiente oral en el tratamiento con ortodoncia fija / Modifications of the oral environment due fixed orthodontic treatment

Objetivo. Evaluar las condiciones del ambiente oral de distintos sectores de la boca de pacientes previo y durante el tratamiento ortodóntico. Métodos. Estudio prospectivo en 46 pacientes con tratamiento de ortodoncia fija. Los parámetros clínicos, microbiológicos de saliva y placa bacteriana fueron registrados antes del tratamiento (t0) y a los 45 (t1), 90 (t2) y 135 días (t3) del inicio. Resultados. Antes del tratamiento se registraron valores elevados del componente "cariados" del índice CPO-D y niveles regulares del IHOs. El 57% de los pacientes mostró apiñamiento dental inferior. Durante el tratamiento, el índice de placa ortodóntica IPO disminuyó respecto al IHOs a t0, aunque mantuvo valores no deseables para la salud bucal (p=0,001). La capacidad amortiguadora disminuyó en t1 y t2 pero recuperó los valores iniciales en t3 (p=0,001). Se aislaron Streptococcus mutans, Candida albicans y Lactobacillus en todas las muestras de placa bacteriana, con un aumento significativo en el sector posterior (p<0,0001). Los niveles de S. mutans, Lactobacillus y α-amilasa salival en la placa bacteriana de la zona posterior aumentaron durante el tratamiento (p =0,0002; p=0,002 y p=0,0059, respectivamente). Conclusiones. La conjunción de factores de riesgo cariogénico, tales como apiñamiento dental, baja capacidad amortiguadora salival, altos niveles de α-amilasa y S. mutans en la placa bacteriana, altos valores de IPO y el bajo flujo salival a tiempos cortos, demuestra la importancia del monitoreo individualizado de los pacientes al inicio el tratamiento ortodóntico, en especial en los sectores bucales de difícil acceso para la higiene bucal.

Objective. To evaluate the conditions of the oral environment of different sectors of the mouth in patients before and during orthodontic treatment. Methods. A prospective study in 46 patients with fixed orthodontic treatment. Clinical and microbiological parameters of saliva and bacterial plaque were collected before treatment (t0) and at 45 (t1), 90 (t2), and 135 days (t3) after the start of treatment. Results. Before treatment, high values of 'decayed' component of the DMF-T and regular levels of the OHIs were registered. Fifty-seven percent of patients showed lower dental crowding. During treatment, the orthodontic plaque index OPI decreased with respect to OHIs at t0, although it maintained undesirable values for oral health (p=0.001). The buffering capacity decreased at t1 and t2 but recovered to initial values at t3 (p=0.001). Streptococcus mutans, Candida albicans, and Lactobacillus were isolated in all the bacterial plaque samples, with a significant increase in the posterior sector (p<0.0001). Levels of S. mutans, Lactobacillus, and α-salivary amylase in the bacterial plaque of the posterior area were increased during treatment (p=0.0002; p=0.002; p=0.0059, respectively). Conclusions. The conjunction of cariogenic risk factors, such as dental crowding, low salivary buffering capacity, high levels of α-amylase and S. mutans in bacterial plaque, high values of OPI, and low salivary flow at short times, demonstrates the importance of individualized monitoring of patients at the beginning of orthodontic treatment, especially in oral sectors where oral hygiene is more difficult.

Successive Oral Immunizations Against Piscirickettsia Salmonis and Infectious Salmon Anemia Virus are Required to Maintain a Long-Term Protection in Farmed Salmonids.

Currently, there is a growing demand to determine the protective status of vaccinated fish in order to prevent diseases outbreaks. A set of different parameters that include the infectious and immunological status of vaccinated salmonids from 622 Chilean farms were analyzed during 2011-2014. The aim of this study was to optimize the vaccination program of these centers through the determination of the protective state of vaccinated fish using oral immunizations. This state was determined from the association of the concentration of the immunoglobulin M (IgM) in the serum and the mortality rate of vaccinated fish. Salmonids were vaccinated with different commercial mono- or polyvalent vaccines against salmonid rickettsial septicemia (SRS) and infectious salmon anemia (ISA), first by the intraperitoneal injection of oil-adjuvanted antigens and then by the stimulation of mucosal immunity using oral vaccines as a booster vaccination. The results showed that high levels of specific IgM antibodies were observed after injectable vaccination, reaching a maximum concentration at 600-800 degree-days. Similar levels of antibodies were observed when oral immunizations were administrated. The high concentration of antibodies [above 2750 ng/mL for ISA virus (ISAv) and 3500 ng/mL for SRS] was maintained for a period of 800 degree-days after each vaccination procedure. In this regard, oral immunizations maintained a long-term high concentration of anti-SRS and anti-ISAv specific IgM antibodies. When the concentration of antibodies decreased below 2000 pg/mL, a window of susceptibility to SRS infection was observed in the farm, suggesting a close association between antibody levels and fish protective status. These results demonstrated that, in the field, several oral immunizations are essential to uphold a high level of specific anti-pathogens antibodies and, therefore, the protective status during the whole productive cycle.

Prevalence of human papillomavirus infection in rural villages of the Bolivian Amazon.

Cervical cancer constitutes a major health problem in developing countries like Bolivia. The roles of certain genotypes of human papillomaviruses (HPVs) in the pathogenesis of cervical cancer is well established. The prevalence of HPV infection among sexually active women varies greatly. Information regarding HPV infection in Bolivia is very much scarce, specially in regions like the Amazonian lowland. We studied 135 healthy women living in four rural localities of the Bolivian Amazon. Presence of HPV in DNA extracted from cervical swabs was analyzed using a reverse line hybridization assay. The estimated overall HPV infection prevalence among the studied rural localities was 5.9% (ranging from 0-16.6%). These values were unexpectedly low considering Bolivia has a high incidence of cervical cancer. The fact that Amazonian people seem to be less exposed to HPV, makes it likely that some other risk factors including host lifestyle behaviors and genetic background may be involved in the development of cervical cancer in this population.

Black Hispanic and Black non-Hispanic breast cancer survival data analysis with half-normal model application.

BACKGROUND: Breast cancer is the second leading cause of cancer death for women in the United States. Differences in survival of breast cancer have been noted among racial and ethnic groups, but the reasons for these disparities remain unclear. This study presents the characteristics and the survival curve of two racial and ethnic groups and evaluates the effects of race on survival times by measuring the lifetime data-based half-normal model. MATERIALS AND METHODS: The distributions among racial and ethnic groups are compared using female breast cancer patients from nine states in the country all taken from the National Cancer Institute's Surveillance, Epidemiology, and End RESULTS cancer registry. The main end points observed are: age at diagnosis, survival time in months, and marital status. The right skewed half-normal statistical probability model is used to show the differences in the survival times between black Hispanic (BH) and black non-Hispanic (BNH) female breast cancer patients. The Kaplan-Meier and Cox proportional hazard ratio are used to estimate and compare the relative risk of death in two minority groups, BH and BNH. RESULTS: A probability random sample method was used to select representative samples from BNH and BH female breast cancer patients, who were diagnosed during the years of 1973-2009 in the United States. The sample contained 1,000 BNH and 298 BH female breast cancer patients. The median age at diagnosis was 57.75 years among BNH and 54.11 years among BH. The results of the half-normal model showed that the survival times formed positive skewed models with higher variability in BNH compared with BH. The Kaplan-Meir estimate was used to plot the survival curves for cancer patients; this test was positively skewed. The Kaplan-Meier and Cox proportional hazard ratio for survival analysis showed that BNH had a significantly longer survival time as compared to BH which is consistent with the results of the half-normal model. CONCLUSIONS: The findings with the proposed model strategy will assist in the healthcare field to measure future outcomes for BH and BNH, given their past history and conditions. These findings may provide an enhanced and improved outlook for the diagnosis and treatment of breast cancer patients in the United States.

Tumor sólido pseudopapilar de páncreas / Solid-pseudopapillary neoplasm of pancreas

Introducción: El tumor sólido pseudopapilar del páncreases un tumor epitelial de baja malignidad que afecta a mujeresjóvenes y corresponde de 1 a 2 % de todas las neoplasias delpáncreas. Se reporta el caso de una mujer, 20 años, con 1 año deevolución de dolor en hipocondrio izquierdo con anemia leve.La ecografía abdominal mostró una tumoración en hemiabdomenizquierdo correspondiente a una masa mixta en páncreas. Serealizó pancreatectomía distal y esplenectomía. La anatomía patológicareportó neoplasia epitelial sólida y pseudopapilar de 13cm del cuerpo y cola del páncreas, sin compromiso esplénico.Conclusión: El tumor sólido pseudopapilar del páncreas esuna neoplasia de etiología desconocida más frecuente en mujeresjóvenes, que debe formar parte de los diagnósticos diferencialesante un tumor en páncreas. La cirugía por sí sola tiene unnivel de curación excelente

Enfisema lobar congénito: reporte de 2 casos y revisión de la literatura / Congenital lobar emphysema: report of two cases and review of the literature

Introducción: el enfisema lobar congénito es la distensiónanormal del parénquima pulmonar, de etiología variable. Generalmentese manifiesta a temprana edad, durante los primerosmeses de vida. La presentación clínica más frecuente es condificultad respiratoria de intensidad creciente. Los estudios deimágenes, concretamente la radiografía y la tomografía axialcomputada del tórax permiten hacer el diagnóstico y decidir lapauta terapéutica a seguir. La lobectomía del lóbulo afectadoes el tratamiento de elección. La anatomía patológica confirmael diagnóstico. Objetivos: reportar dos casos anátomo-clínicosde enfisema lobar congénito en dos lactantes de 7 y 2 mesesde edad, respectivamente, haciendo énfasis en la forma de presentaciónclínica, el tratamiento instaurado y su confirmaciónpor anatomía patológica. Resultados: Dos pacientes lactantesingresaron al servicio de urgencia pediátrica por dificultad respiratoria.Uno de ellos presentó además fiebre y VDRL 1:64 porlo que fue tratado con antibióticos, desapareciendo la infecciónpero no la dificultad respiratoria. En ambos casos, la placa detórax mostró una imagen radiolúcida del lado afecto. La tomografíaaxial computarizada de tórax confirmó las anomalíaspulmonares en ambos casos. El tratamiento instaurado fue lalobectomía. La anatomía patológica confirmó el diagnóstico.Conclusión: el enfisema lobar congénito es una patología quesiempre debe ser considerada entre los diagnósticos probablesante un lactante con dificultad respiratoria y radiolucidez pulmonar.Debe evitarse el retraso diagnóstico ya que la remociónquirúrgica del lóbulo afectado es el único tratamiento eficaz ydebe aplicarse con celeridad para evitar el óbito, especialmenteen pacientes con marcada dificultad respiratoria.

Neoplasia blástica de células dendríticas plasmocitoides: reporte de un caso / Blastic plasmacytoid dendritic cell neoplasm, a case report

La neoplasia blástica de células dendríticas plasmocitoides es una rara entidad, y la afectación cutánea es la más frecuente. Clínicamente, se caracteriza por pápulas o placas ertiemato-violáceas infiltradas, en cara y parte superior del tronco. Presentamos el caso de un paciente de 61 años con esta entidad y la revisión de la literatura.

Teratoma congénito de órbita izquierda / Congenital Teratoma of the left orbit

Introducción: El teratoma es un tumor congénito pocofrecuente que se origina de una célula embrionaria pluripotencialcapaz de desarrollar tejidos que derivan de las tres capasgerminales: ectodermo, mesodermo y endodermo. Objetivo:Reportar un caso anátomo-clínico de proptosis congénita secundariaa teratoma orbitario. Se trata de un recién nacido desexo femenino, de 10 días de edad, que presentó una tumoraciónen la región hemifacial izquierda. Se realizó resonancia magnéticanuclear (RMN) de cráneo, donde se visualizó un aumentosignificativo de volumen de la región orbitaria izquierda, conáreas quísticas y sólidas, sin aparentes signos de infiltración afosa craneal. Se procedió a la exéresis de la tumoración, y posteriorestudio anatomopatológico. Conclusión: Los teratomas sonlesiones benignas y raramente sufren malignización. Su tamañoy velocidad de crecimiento dentro de la órbita pueden causardestrucción importante en etapas tempranas de su desarrollo ycon la extirpación se obtiene un buen resultado.

Prevalence of human papillomavirus infection in rural villages of the Bolivian Amazon

Cervical cancer constitutes a major health problem in developing countries like Bolivia. The roles of certain genotypes of human papillomaviruses (HPVs) in the pathogenesis of cervical cancer is well established. The prevalence of HPV infection among sexually active women varies greatly. Information regarding HPV infection in Bolivia is very much scarce, specially in regions like the Amazonian lowland. We studied 135 healthy women living in four rural localities of the Bolivian Amazon. Presence of HPV in DNA extracted from cervical swabs was analyzed using a reverse line hybridization assay. The estimated overall HPV infection prevalence among the studied rural localities was 5.9 percent (ranging from 0-16.6 percent). These values were unexpectedly low considering Bolivia has a high incidence of cervical cancer. The fact that Amazonian people seem to be less exposed to HPV, makes it likely that some other risk factors including host lifestyle behaviors and genetic background may be involved in the development of cervical cancer in this population

Morfología dentaria externa de los molares permanentes / External tooth morphology of permanent molars

La morfología externa de los molares superiores e inferiores permanentes estudia las características comunes al grupo dentario y las individualidades que se corresponden con las funciones que cumplen. En el presente trabajo se realiza una revisión bibliográfica con el objeto de presentar las características comunes y diferenciales que permitan identificar cada uno de los molares permanentes. Con el propósito de que sirva como material de consulta para docentes y alumnos.