Escala de conocimientos, comodidad, abordaje y actitud hacia la sexualidad en personas con lesión medular: validación y adaptación al español / Knowledge, Comfort, Approach and Attitude to wards sexuality scale in spinal cord injured population: Adaptation and validation to Spanish language

Introducción. La alteración de la función sexual es una secuela común posterior a una lesión de la médula espinal. No existen escalas validadas en idioma español para evaluar conocimientos, comodidad, abordaje y actitudes del personal de salud hacia la sexualidad en pacientes con trauma de médula espinal. Objetivo. Validar la escala Knowledge, Comfort, Approach and Attitude towards Sexuality Scale (KCAASS) al idioma español. Materiales y métodos. El proceso incluyó la traducción, retrotraducción, la adaptación cultural, la validez de apariencia y contenido de la escala en profesionales involucrados con la rehabilitación sexual del paciente con lesión medular en Colombia. Un total de 122 profesionales participaron para establecer la validez del constructo y la confiabilidad. Resultados. El comité de expertos determinó que la versión en español de la escala evalúa conocimientos, comodidad, abordaje y actitud hacia la sexualidad en el paciente con lesión de médula espinal, por parte de los profesionales de la salud. En cuanto relevancia, claridad y suficiencia, el índice de validez de contenido fue mayor de 0,8 en el 75,6% de los ítems y para el 100 % de los dominios. El valor del alfa de Cronbach general fue 0,95 y el análisis factorial evidenció valores propios por encima de 1,5 en 4 factores. Conclusión. La versión en español de la escala KCAASS cuenta con una adecuada confiabilidad, validez de apariencia, contenido y constructo y puede ser utilizada para evaluar las necesidades de formación en dominios específicos de los profesionales del área de rehabilitación sexual de las personas con lesión medular.

Introduction. Impaired sexual function is a common sequela following spinal cord injury. There are no validated scales in Spanish language to assess knowledge, comfort, approach and attitudes of health personnel towards sexuality in patients with spinal cord trauma. Objective. To validate the Knowledge, Comfort, Approach and Attitude towards Sexuality Scale (KCAASS) in Spanish. Materials and methods. The process included translation, back-translation, cultural adaptation, face and content validity of the scale in professionals involved in the sexual rehabilitation of patients with spinal cord injury in Colombia. A total of 122 professionals participated to establish construct validity and reliability.Results. The expert committee determined that the Spanish version of the scale evaluates knowledge, comfort, approach and attitude towards sexuality in the patient with spinal cord injury by health professionals. In terms of relevance, clarity and sufficiency, the content validity index was greater than 0.8 in 75.6% of the items and for 100% of the domains. The overall Cronbach's alpha value was 0.95 and the factor analysis showed eigenvalues above 1.5 in 4 factors. Conclusion. The Spanish version of the KCAASS scale has adequate reliability, face, content and construct validity and can be used to assess the training needs in specific domains of professionals in the area of sexual rehabilitation of people with spinal cord injury.

Experiencia personal en mano metacarpiana / Personal experience in metacarpal hand

Antecedentes y Objetivos. La mano forma parte no solo de la apariencia física del individuo, sino también de las funciones evolutivas más importantes del ser humano. La amputación de múltiples dedos genera una importante limitación y afecta a la calidad de vida de estos pacientes. Pacientes y Método. Exponemos la técnica quirúrgica realizada por nuestro equipo en casos de transferencias del segundo artejo, así como la transferencia combinada del segundo y tercer dedos para el tratamiento de la denominada mano metacarpiana. Resultados. Detallamos los resultados obtenidos en una serie de 5 pacientes. Conclusiones. La reconstrucción de la mano metacarpiana mediante transferencia de dedos de los pies se convierte en la mejor alternativa para devolver la funcionalidad a la mano y mejorar la calidad de vida (AU)

Background and Objectives. The hand is part of not only the physical appearance of the individual but also of the most important evolutionary functions of human beings. The amputation of multiple fingers generates a major constraint affecting the quality of life of these patients. Patients and Methods. In this article we present the surgical technique performed by our team in cases of transfer from the second toe and of combined transfer from the second and third toes for the treatment of the metacarpal hand. Results. We detail the results obtained in a group of 5 patients. Conclusions: Reconstruction of metacarpal hand by transferring toes becomes the best alternative to restore hand functionality and improve quality of life (AU)

[Toward a national plan to control health effects of mercury in Colombia]. / Hacia un plan nacional para el control de los efectos del mercurio en la salud en Colombia.

INTRODUCTION: The problem of mercury effects on humans and the environment is global, and it has different impacts on health. It is necessary, therefore, to address this issue from a broad overview to identify populations at risk of exposure, health effects, the production processes involved and the actions aimed at reducing exposure and mitigating the impact. OBJECTIVE: To design a conceptual and operational framework to develop strategies for prevention, control and mitigation of mercury effects on health and on the environment in Colombia. MATERIALS AND METHODS: We conducted a two-phase study: a literature review following the Cochrane methodology and forums with national and international experts using a comprehensive planning methodology to identify priority actions and establish a national research agenda. RESULTS: The results of the review were structured into four components: mercury effects on health, legal framework in Colombia, emission inventory for the country and health plans and programs. We made recommendations for the design of an intervention plan considering five lines of action: technologies for exposure management, institutional strengthening for exposure prevention and control, strategies for strengthening diagnosis and care, health education on mercury risks, and knowledge generation. CONCLUSION: We detected information gaps, technical weaknesses, and the need of administrative and other resources in this field in Colombia. We proposed priority actions to reduce the economic, social and health impact from exposure to mercury.

Hacia un plan nacional para el control de los efectos del mercurio en la salud en Colombia / Toward a national plan to control health effects of mercury in Colombia

Introducción. La problemática del uso del mercurio es global y afecta tanto a los humanos como al ambiente. Los efectos del mercurio en la salud son diversos, por eso es necesario abordar el problema desde una perspectiva amplia, identificando las poblaciones en riesgo de exposición, sus efectos en la salud, los procesos productivos involucrados y las acciones para disminuir la exposición y mitigar el impacto. Objetivo. Diseñar un marco conceptual y operativo para desarrollar estrategias de prevención, control y mitigación de los efectos del mercurio sobre la salud y el ambiente en Colombia. Materiales y métodos. Se hizo un estudio en dos fases: una revisión de la literatura científica siguiendo la metodología Cochrane, y foros con expertos nacionales e internacionales orientados a la planificación integral para identificar las acciones prioritarias y construir la agenda de investigación nacional . Resultados. Los resultados de la revisión se estructuraron en cuatro componentes: efectos del mercurio en la salud, marco legal en Colombia, inventario de emisiones en el país, y planes y programas existentes en el sector de la salud. Se presentaron recomendaciones para diseñar un plan de intervenciones considerando cinco líneas de acción: gestión tecnológica para la prevención de la exposición, fortalecimiento institucional para la prevención y el control de la exposición, fortalecimiento de estrategias de diagnóstico y atención, educación en salud sobre los riesgos del mercurio y generación de conocimiento . Conclusiones. Se visibilizaron vacíos de información, así como debilidades técnicas, administrativas y necesidad de recursos en Colombia, y se propusieron acciones prioritarias para disminuir el impacto económico, social y en salud de la exposición al mercurio.

Introduction: The problem of mercury effects on humans and the environment is global, and it has different impacts on health. It is necessary, therefore, to address this issue from a broad overview to identify populations at risk of exposure, health effects, the production processes involved and the actions aimed at reducing exposure and mitigating the impact. Objective: To design a conceptual and operational framework to develop strategies for prevention, control and mitigation of mercury effects on health and on the environment in Colombia. Materials and methods: We conducted a two-phase study: a literature review following the Cochrane methodology and forums with national and international experts using a comprehensive planning methodology to identify priority actions and establish a national research agenda. Results: The results of the review were structured into four components: mercury effects on health, legal framework in Colombia, emission inventory for the country and health plans and programs. We made recommendations for the design of an intervention plan considering five lines of action: technologies for exposure management, institutional strengthening for exposure prevention and control, strategies for strengthening diagnosis and care, health education on mercury risks, and knowledge generation. Conclusion: We detected information gaps, technical weaknesses, and the need of administrative and other resources in this field in Colombia. We proposed priority actions to reduce the economic, social and health impact from exposure to mercury.

Mini cincha suburetral con anestesia local para cura de incontinencia urinaria de esfuerzo

Objetivos: Evaluar la cura de incontinencia urinaria de esfuerzo con mini cincha y anestesia local sin sedación, tomando en cuenta su tolerabilidad y eficacia a corto plazo. Métodos: Es un estudio propectivo de tipo clínico no controlado. Se incluyeron 18 pacientes con incontinencia urinaria clínica y urodinámica, a las que se les colocó mini cinchas Ophira® o Miniarc®, con lidocaína local, siendo valoradas a las 24 horas, 15 días, 1 y 3 meses del posoperatoria. Resultados: De las 18 pacientes seleccionadas 2 fueron excluidas por mostrar cifras tensionales elevadas durante el procedimiento, de las 16 restantes 1 no pudo ser evaluada con escala visual análoga para dolor, por presentar ansiedad y se les administró sedación consciente con midazolan durante el procedimiento. 9 pacientes presentaron incontinencia urinaria de esfuerzo tipo I y 7 presentaron incontinencia urinaria de esfuerzo tipo II, con cura objetiva del 100 %. El promedio de dosis de lidocaína al 2 % y tiempo operatorio fue de 16,72 cm3 y de 8,58 minutos, con escala visual análoga para dolor intraoperatorio de 0,4 puntos y 0 Puntos a las 24 horas. La extrusión fue la única complicación posoperatoria observada (6,25 %) la cual revirtió con estrógenos locales tópicos durante 2 meses. Conclusiones: Las mini cinchas con anestesia local representan una alternativa para tratar la incontinencia urinaria de esfuerzo por lo bien tolerado del procedimiento, bajo porcentaje de complicaciones y buena eficacia.

Objectives: To evaluate the cure of stress urinary incontinence with mini sling and local anesthesia without sedation, taking into account tolerability and efficacy in the short term. Methods: We included 18 patients with clinical and urodynamic urinary incontinence, to whom a mini sling Miniarc® or Ophira® was placed under local lidocaine, being postoperative evalued at 24 hours,15 days, 1 and 3 months. Results: Of the 18 patients selected, 2 were excluded for showing high pressure values during the procedure, from the remaining 16, 1 could not be assessed by visual analog scale for pain, because present edanxiety and given conscious sedation with midazolam during the procedure. 9 patients had stress urinary incontinence type I and 7 had stress urinary incontinence type II , with 100 % objective cure. The average dose of lidocaine 2 % was 16.72 cm3 and operating time was 8.58 minutes with visual analog scale for pain intraoperative 0.4 points and 0 Points after 24 hours. The extrusion was the only post operative complication observed (6.25 %) which reversed using local estrogen for 2 months. Conclusions: The mini sling with local anesthesia represent an alternative to treat stress urinary incontinence, it is a well tolerated procedure, with low rate of complications and good efficacy.

Experiencia en el tratamiento del prolapso de órganos pélvicos con mallas vaginales en el Hospital Universitario de Caracas

Objetivo: Describir la experiencia en el tratamiento del prolapso de órganos pélvicos con materiales protésicos en la Unidad de Patología de Piso Pélvico del Hospital Universitario de Caracas. Métodos: Estudio retrospectivo, descriptivo. Se incluyeron pacientes con diagnóstico de prolapso, intervenidas con mallas transvaginales entre enero de 2010 y diciembre de 2011, con seguimiento durante 12 meses (N = 49). Resultados: La edad promedio fue 57 ± 5 años. El índice de masa corporal promedio fue 27 kg/m². El 50,9 % de los prolapsos fueron grado II, 37,7 % grado III y 9,4 % grado IV. De los grados II, el 90 % fueron anteriores el 7 % posteriores y 3 % apicales. De los grados III el 58 % fueron anteriores, 37 % apicales y 5 % posteriores. Se observó 66,8 % de complicaciones. La complicación más frecuente fue la extrusión (25 %), seguido de la dispareunia y el acortamiento vaginal mayor de 1 cm, (10,4 % en ambos). Se presentó 6,3 % de urgencia de novo y 4,2 % de incontinencia urinaria de esfuerzo de novo. El hematoma, la obstrucción infravesical y la fístula vesico-vaginal se presentaron en 2,1 % de los casos. La cura objetiva fue de 95,7 % al año de seguimiento. Se observó 4,3 % de recidiva y 12,5 % de prolapso de novo. Conclusión: Las mallas vaginales representan una alternativa quirúrgica segura y eficiente para la corrección del prolapso genital. Las complicaciones son frecuentes, pero de poca gravedad. Sin embargo, la alta incidencia de erosiones puede afectar la calidad de vida de las pacientes. Palabras clave: Prolapso de órganos pélvicos. Mallas transvaginales. Erosión vaginal.

Objective: To describe the experience of pelvic organ prolapse treatment with transvaginal mesh in the Pelvic Floor Pathology Unit at the Hospital Universitario de Caracas. Methods: Retrospective and descriptive study. We included patients with pelvic organ prolapse treated with transvagynal mesh between January 2010 and December 2011, and with a follow up of 12 months (N=49). Results: The mean age was 57 ± 5 years, and the mean body mass index was 27 kg/m². A 50,9 % of pelvic organ prolapse were grade II, 37,7 % were grade III, and 9,4 % were grade IV. Among grade II prolapse, 90 % were anterior, 7 % posterior and 3 % apical. Among grade III prolapse, 58 % were anterior, 37.% posterior and 5 % apical. Complications were observed in 66,8 % of the cases. The most common complication was vaginal erosion (25 %), followed by dyspareunia and vaginal shortening (10,4 % both of them). The novo urgency was observed in 6,3 % of the cases, and de novo urinary stress incontinence in 4,2.%. Hematoma, vesicovaginal fistula, and voiding dysfunction were observed in 2,1 %. The objective cure was 95,7 % at 1 year of follow-up. A 4,3 % of recurrence and 12,5 % of de novo prolapse were observed. Conclusion: Vaginal meshes are a safe and effective alternative in pelvic organ prolapse treatment. Complications are frequent, but most of them are mild. However, the high incidence of vaginal erosion can affect the quality of life of most patients.

Estudio de la Microscopía Virtual en el Mundo / An analysis about Virtual Microscopy in the World / An analysis about Virtual Microscopy in the World

La microscopía virtual (MV) es un método de adquisición y transmisión de imágenes, que se basa en la digitalización de muestras de láminas de cristal adquiridas por medio de un microscopio con la ayuda de dispositivos tecnológicos. La MV tiene diversos campos de aplicación: en medicina, docencia e investigación científica. De acuerdo a su funcionamiento se divide en: estática, dinámica robotizada, dinámica no robotizada y microscopio de campo amplio. El objetivo del artículo es realizar un estudio para conocer el estado actual de la microscopía virtual en el mundo y los aspectos funcionales y técnicos de los métodos presentados. Para esto se llevó a cabo una revisión de la literatura, en donde se analizó el dominio de aplicación de cada método a nivel mundial, concluyendo que la MV es más aplicada para diagnóstico, siendo el método estático el más empleado...

Microscopia Virtual (MV) é um método para a digitalização e transmissão de imagens de amostras de células obtidas através de um microscópio com auxílio de recursos tecnológicos. A MV tem se tornado cada vez mais importante para os domínios de aplicação de medicina, ensino, e pesquisa científica. Adicionalmente, a MV pode ser categorizada como: estática, dinâmica robotizada, dinâmica não robotizada, e microscópio de campo amplo. Nessa perspectiva, o principal objetivo deste artigo é realizar um estudo para estabelecer o estado atual da microscopia virtual no mundo. Além disso, são apresentados os aspectos funcionais e técnicos dos métodos de microscopia virtual encontrados no estado da arte. Com essa finalidade, realizou-se uma revisão da literatura. Assim mesmo, analisou-se o domínio de aplicação onde cada método é utilizado, e concluiu-se que a MV estática é a técnica mais usada principalmente para diagnóstico médico...

Virtual Microscopy (VM) is a method to digitize and transmit cell samples obtained from a microscope and technological resources. VM have been more and more important for medicine, teaching, and scientific research. Moreover, the VM can be classified as: static, dynamic-robotic, dynamic-non-robotic, and wide microscopy. In this perspective, the main objective of this work is to establish the current state of the VM in the world. Additionally, functional and technical aspects of VM, that were found in the state of the art, are also presented. For this, it was conducted a literature review. Furthermore, it was analyzed the application domains where each VM technique has been used. In this context, it was concluded that static VM is the most used technique, principally for medical diagnosis...

Tratamiento de la incontinencia urinaria de esfuerzo con cinchas suburetrales: experiencia en el hospital universitario de Caracas / Treatment of urinary incontinence with girths suburethral: experience at the hospital universitario de Caracas

Objetivo: Describir la experiencia en el tratamiento de la incontinencia urinaria de esfuerzo con cinchas en las pacientes de la Unidad de Patología de Piso Pélvico del Hospital Universitario de Caracas. Métodos: Estudio retrospectivo y descriptivo. Se incluyeron pacientes con diagnóstico clínico y urodinámico de incontinencia de esfuerzo, intervenidas con cincha transobturatriz y minicinchas entre enero de 2010 y diciembre de 2011, con seguimiento durante 12 meses (N=81). Resultados: Edad promedio: 54,9 años, índice de masa corporal promedio: 27,6 kg/m2. El 77,7 % presentaba prolapso de órganos pélvicos. La incontinencia de esfuerzo tipo I fue la más observada con 45,7 %. El 76,5 % se trataron con cinchas y el 23,5 % con minicinchas. La complicación más frecuente fue la infección urinaria baja (17,7 %), seguida de la urgencia de novo (16,1 %) y la extrusión (8 %). Se observó 7 % de recidiva. El tiempo quirúrgico fue 10,8 y 7,8 minutos para cinchas y minicinchas respectivamente. La cura objetiva fue de 93 % y la cura subjetiva osciló entre 93,8 % y 100 % al año de seguimiento para las cinchas, mientras que en el caso de las minicinchas la cura subjetiva osciló entre 50 % y 100 % durante el mismo período. Conclusión: El tratamiento de la incontinencia urinaria de esfuerzo mediante cinchas y minicinchas resulta satisfactorio, con baja tasa de recidivas y complicaciones menores.

Objective: To describe the experience of stress urinary incontinence treatment with slings in the Unidad de Patologia de Piso Pelvico of the Hopital Universitario de Caracas. Methods: Retrospective, descriptive study. We included patients with clinical and urodinamic urinary incontinence who were treated with transobturator slings and minislings between January 2010 and December 2011, and had a follow up of 12 months (N = 81). Results: The average age was 54,96 years old, average body mass index was 27.6 kg/m2 and 77.7 % had pelvic organ prolapse. Type I urinary incontinence was the most frequent (45.7 %). Most of the patients were treated with transobturators slings (76.5 %), and 23.5 % with minislings. The most frequent complication was lower urinary tract infection (17.7 %), followed by de novo urgency (16.1 %), and vaginal erosion (8 %). A 7 % of recurrence was observed. The objective cure was 93 % and the subjective cure ranged between 93.8 % and 100 % during 1 year follow up in the slings group. In de minisling’s group the subjective cure ranged between 50 % and 100 %. Conclusion: The treatment of stress urinary incontinence with transobturators slings and minislings resulted satisfactory due to the low risk of complications and few recurrences.

Lateral visual hemifield asymmetry and sex differences in recognizing low and high spatial frequency filtered faces

The present study investigated whether low and high spatial frequency filtered images of faces were recognized differently when briefly presented in the right and the left visual fields of men and women. The method of confidence rating was applied to assess pooled Receiver Operating Characteristic curves based on z scores and the d´ parameter of Signal Detection Theory for recognition indices, in addition to response times. The results showed that men better recognized low spatial frequency filtered faces than high spatial frequency filtered faces in both visual fields, suggesting that both the right and left hemispheres in males prioritize low spatial frequencies to recognize faces. The results for women were similar to men only when the faces were shown in the left visual field. When the faces were presented in the right visual field, women better recognized high spatial frequency filtered faces, suggesting that the left hemisphere in females prioritizes high spatial frequencies, whereas the right hemisphere in females prioritizes low spatial frequencies to recognize faces...

Lateral visual hemifield asymmetry and sex differences in recognizing low and high spatial frequency filtered faces

The present study investigated whether low and high spatial frequency filtered images of faces were recognized differently when briefly presented in the right and the left visual fields of men and women. The method of confidence rating was applied to assess pooled Receiver Operating Characteristic curves based on z scores and the d´ parameter of Signal Detection Theory for recognition indices, in addition to response times. The results showed that men better recognized low spatial frequency filtered faces than high spatial frequency filtered faces in both visual fields, suggesting that both the right and left hemispheres in males prioritize low spatial frequencies to recognize faces. The results for women were similar to men only when the faces were shown in the left visual field. When the faces were presented in the right visual field, women better recognized high spatial frequency filtered faces, suggesting that the left hemisphere in females prioritizes high spatial frequencies, whereas the right hemisphere in females prioritizes low spatial frequencies to recognize faces.(AU)

A atratividade facial feminina em função da etapa do ciclo menstrual

A visibilidade da etapa fértil na mulher é uma questão polêmica e tem sido muito discutida nas últimas décadas. Alguns autores argumentam que no transcorrer da evolução a ovulação ficou oculta. Em paralelo, outros pesquisadores afirmam que a ovulação na mulher não se manifesta de forma tão visível como em alguns primatas que apresentam sinais muito notórios da ovulação, por exemplo, a tumefação vaginal. Mas diversas pesquisas têm fornecido evidência que mostram que o período fértil na mulher é perceptível de maneira sutil, sem que se tenha consciência do processo perceptual envolvido. Os achados destas pesquisas apontam para o fato de diversas características (como a face, a proporção cintura quadril, a simetria de tecidos brandos pareados e o cheiro) serem percebidas como mais atraentes na etapa fértil. O presente estudo teve por objetivo investigar se em alguma etapa (folicular tardia ou lútea) do ciclo menstrual a face da mulher se torna mais atraente para o sexo oposto devido a mudanças morfológicas induzidas pelos níveis hormonais. Foram apresentados, apenas para participantes masculinos, 36 slides com fotografias de faces frontais de mulheres em idade reprodutiva. Em cada slide foram mostradas simultaneamente duas fotos da mesma mulher, uma das fotos obtida na Fase Folicular Tardia (FFT) do ciclo e a outra obtida na Fase Lútea (FL)...(AU)

Visibility of fertile period in women is a controversial topic that has been broadly discussed during the last decades. Some authors argue that ovulation became hidden in the course of evolution. In contrast, some other researchers state that ovulation in woman is not manifested as visibly as in other primates, which present very evident signals of ovulation like, e.g., vaginal tumefaction. However, several studies have provided evidence showing that fertile period in women is perceptible in a subtle way, without being aware of the perceptual process involved. Findings of those works points to the fact that some characteristics such as face, waist hip ratio, paired soft tissues symmetry and smell are perceived as more attractive in the fertile stage. The present work aimed to find out whether in any stage (late follicular or luteal) of menstrual cycle woman face appears more attractive to opposite sex, due to morphological changes induced by hormonal levels. 36 slides with frontal face photographs of woman in reproductive age were shown to male participants. In each slide two pictures of the same woman, one obtained in the late follicular phase and the other obtained in the luteal phase were exposed. Participants chose the more attractive picture and then they assessed the attractiveness through a visual analogical scale (VAS), in whose left and right extremes the legends not attractive at all and very attractive were marked, respectively. Results showed that female facial attractiveness changes as a function of the menstrual cycle stage. Faces of women who did not take contraceptives did not differ significantly between FFT and FL...(AU)