Sustained attention in school-age children with congenital hypothyroidism: Influence of episodes of overtreatment in the first three years of life. / Atención sostenida en niños con hipotiroidismo congénito en edad escolar. Influencia de los episodios de sobretratamiento en los primeros 3 años de vida.

INTRODUCTION: Children with congenital hypothyroidism (CH) are at risk of developing mild cognitive impairment despite normal overall intellectual performance. These deficits may be caused by disease-related and treatment-related factors. This study explores the impact of abnormal thyroid function during the first 3 years of life on attention performance at school age. METHODS: We included 49 children diagnosed with CH and receiving treatment for the condition: 14 boys (mean age 9.5±2.8 years) and 35 girls (9.6±2.6 years). The number of episodes of normal, under-, and overtreatment were estimated based on TSH levels during their first 3 years of life (at 12, 18, 24, 30, and 36 months). Children were assessed using a computerised version of a Sustained attention test. General linear models were calculated with the attention index as the dependent variable and sex, aetiology, and number of episodes of normal, under-, and overtreatment as independent variables. RESULTS: Higher numbers of episodes of overtreatment (low TSH level) were associated with poorer attention performance at school age (P=.005, r=-0.45). CONCLUSIONS: Children with CH should be monitored closely during the first 3 years of life in order to prevent not only hypothyroidism but also any adverse effects of overtreatment that may affect attentional function at school age.

Automated angiodysplasia detection from wireless capsule endoscopy.

We present a novel system for the automatic detection of angiodysplasia lesions from capsule endoscopy images. The approach identifies potential regions of interest and classifies them using a combination of color-based, texture, statistical and morphological features. A boosted decision tree classification method is used in order to overcome the problem of unbalanced sampling between pathological and non-pathological regions. The lesion detection method has been designed and validated using a lesion database labelled by an expert. The approach achieves a sensitivity of 89.51% and a specificity of 96.8%, thus providing a high performance in the detection of angiodysplasia lesions.

La atención farmacéutica comunitaria en pacientes incluidos en programas de cuidados paliativos. Revisión bibliográfica / Community pharmaceutical care in patients in palliative care programs

OBJETIVO: Identificar y conocer qué rol o papel representa el farmacéutico comunitario en la atención a los pacientes y familia al final de la vida, dentro de los planes y programas de cuidados paliativos (CP) en el ámbito nacional, autonómico e internacional. MATERIAL Y MÉTODOS: Revisión bibliográfica de la literatura científica, en inglés o español, a través de los buscadores Pubmed, Google Académico y web del SACYL Biblioteca virtual, plataforma de editoriales de revistas electrónicas (Editorial Elsevier y Elsevier Doyma), la web del PORTALFARMA (Revista del farmacéutico, Panorama actual del medicamento y Pliegos de rebotica) y Cochrane.completando la revisión con la lectura de los distintos planes o programas de CP a nivel nacional y autonómico. Resultado: En los países de habla inglesa (Reino Unido, Australia, EE. UU. , etc. ), se ha comenzado a valorar la intervención del farmacéutico comunitario como farmacéutico colaborador o dentro de un equipo interdisciplinar de CP, a través de su inclusión en guías, documentos de consenso o programas piloto. No se ha encontrado ningún estudio que recoja la intervención del farmacéutico comunitario en la prestación de CP en nuestro país. Tan solo los planes de CP de la comunidad de Madrid y de la región de Murcia recogen la intervención del farmacéutico aunque de forma muy general, poco específica y sin referencia concreta al farmacéutico de oficina de farmacia o farmacia comunitaria. CONCLUSIONES: En España existen programas de atención a pacientes crónicos en los que interviene el farmacéutico comunitario, pero no hay ninguna referencia con relación al paciente con enfermedad avanzada o terminal. Se podría afirmar que los profesionales farmacéuticos comunitarios, con relación a la prestación de servicios asistenciales al paciente terminal y su familia, han quedado fuera del sistema y eso, a pesar de que se ha llegado a afirmar que los CP son «cosa de todos». La integración del farmacéutico comunitario en la atención a los pacientes en CP formando parte de un equipo interdisciplinar o como «farmacéutico colaborador» debería ser un recurso a tener en cuenta y valorar

OBJECTIVES: To identify and determine the role or function the community pharmacist as regards terminal patients and their families within the palliative-care (PC) plans and programmes on a national, regional and international scale. MATERIALS AND METHODS: A review was made of the scientific literature in English and Spanish, through the web search engines, PubMed, Google Scholar, and the SACYL online virtual Library website, network of publishing companies with electronic journals (Elsevier publishing house and Elsevier Doyma), PORTALFARMA website (Pharmacist Journal, Present-day Medicament Scene and Pharmacy Specifications), and the Cochrane Library. The review is concluded with the description of a variety of plans and/or programmes on PC at regional, national and international level. RESULTS: In the English-speaking countries (such as the United Kingdom, Australia, and the United States), it has been started to assess the community pharmacist's contribution as a collaborator or within an interdisciplinary team by means of their inclusion in handbooks, consensus documents, or pilot programmes. No research has been found so far that includes the community pharmacist's contribution in providing PC on a nationwide scale. Only in the Autonomous region of Madrid and the Region of Murcia do PC Plans include the pharmacist's contribution, although, in a very general and vague way. CONCLUSIONS: There are some programmes implemented in our country for chronic patients with input of the community pharmacist, but there is no reference to patients suffering from advanced or terminal disease. It could be stated that professional community pharmacists have been left out of the system as regards the provision of welfare services to terminal patients and their families, although it has been asserted that PC is "everybody's concern". The integration of the community pharmacist in patient care in PC, forming part of an interdisciplinary team, or as a 'collaborator pharmacist', should be an option to be taken into account and assessed

Mixed origin of neovascularization of human endometrial grafts in immunodeficient mouse models.

BACKGROUND: In vivo mouse models have been developed to study the physiology of normal and pathologic endometrium. Although angiogenesis is known to play an important role in endometrial physiology and pathology, the origin of neovasculature in xenografts remains controversial. The aim of this study was to assess the origin of the neovasculature of endometrial grafts in different mouse models. METHODS: Human proliferative endometrium (n = 19 women) was grafted s.c. in two immunodeficient mouse strains: nude (n = 8) and severely compromised immunodeficient (SCID; n = 20). Mice were also treated with estradiol, progesterone or levonorgestrel. Fluorescence in-situ hybridization using a centromeric human chromosome X probe, immunohistochemistry (von Willebrand factor and collagen IV) and lectin perfusion were performed to identify the origin of the vessels. RESULTS: More than 90% of vessels within xenografts were of human origin 4 weeks after implantation. Some vessels (9.67 +/- 2.01%) were successively stained by human or mouse specific markers, suggesting the presence of chimeric vessels exhibiting a succession of human and murine portions. No difference in staining was observed between the two strains of mouse or different hormone treatments. Furthermore, erythrocytes were found inside human vessels, confirming their functionality. CONCLUSION: This article shows that human endometrial grafts retain their own vessels, which connect to the murine vasculature coming from the host tissue and become functional.

Development of an animal experimental model to study the effects of levonorgestrel on the human endometrium.

BACKGROUND: This study was designed to develop an animal model to test the response of endometrium to local progestin delivery. METHODS: Proliferative human endometrium was subcutaneously grafted in two groups of SCID mice that received, 2 days before, a subcutaneous estradiol (E(2)) pellet and, for half of them, an additional implant of levonorgestrel (LNG). Mice were sacrificed 1, 2, 3 or 4 weeks after endometrial implantation and grafts were histologically analysed. Proliferation, steroid hormone receptors, blood vessels and stromal decidualization in both groups (E(2) and LNG) were immunohistologically evaluated and compared with proliferative endometrium and endometrium from women with an LNG intrauterine device. RESULTS: Grafts presented normal morphological endometrial characteristics. The expression of progesterone receptors was significantly decreased in glands and stroma of the LNG group as compared with the E(2) group at all times. A significant decrease was also observed in the stromal expression of estrogen receptor-alpha in the LNG group. At 4 weeks, the mean cross-sectional area of vessels was significantly higher after LNG treatment. CONCLUSIONS: These morphological and immunohistochemical characteristics are similar to those observed in women treated with local LNG. This mouse model might facilitate further investigations needed to understand the mechanisms responsible for the breakthrough bleeding frequently observed in progestin users.

[Stressful environmental events in the Intensive Care Unit]. / Factores ambientales estresantes percibidos por los pacientes de una Unidad de Cuidados Intensivos.

UNLABELLED: The high standard of specialization of the Intensive Care Units (ICU) creates a stressful setting that generates anxiety and stress for the patients. This has been related to delirium or acute confusional syndrome. OBJECTIVES: To describe the stressful environmental events as perceived by patients an, to establish the differences between patients who suffered from delirium in ICU and those who did not suffer from it. MATERIAL AND METHODS: Descriptive crosssectional study that includes a qualitative part. A total of 91 patients were interviewed, 33 patients diagnosed of delirium in the ICU and 58 patients without this diagnosis. Ballard's Environmental stressful events scale with 43 items was used to determine the most stressful events. In addition, an open interview was carried out in which the patients could narrate their experiences in the ICU. Descriptive statistic was used to show the characteristics of patients selected and to determine the frequency distributions for each item inthe questionnaire. RESULTS: The factors perceived as the most stressful were: thirst(62.6%), sleep deprivation (42.9%), tubes in mouth or nose (35.2)and not knowing what time it was (34.1). Patients who suffered from delirium perceive disorientation or hallucinations as stressants CONCLUSIONS: As in previous investigations, ICU patiens, who did not suffered from delirium, perceived phisycal needs as most streesfull events.

[Delirium in intensive care. Incidence and risk factors]. / Incidencia del delirio en Cuidados Intensivos y factores relacionados.

Delirium has been documented as a common and serious problem in hospital settings, but its recognition in critically ill patients is made difficult by the inability to interview intubated patients and by the presence of drugs. The objectives of this study were to describe the incidence of delirium in the Intensive Care Unit (ICU) and to determine some of the risk factors. It is an analytical, observational and prospective study in an 8-bed general ICU. The participants were 112 consecutive patients aged 18 and older admitted to the ICU for three or more days. Drug consumers and patients with psychiatric disease or cerebral disease were excluded. Daily ratings of the Intensive Care Delirium Screening Checklist (ICDSC) were made by the staff nurses. Other data such as patient's diseases, drug prescriptions and APACHE II were collected. Delirium was present in 11 out of 100 patients-day. APACHE II > or = 15, sedative drugs and mechanical ventilation were risk factors for delirium in ICU. The conclusions of this study have determined that delirium is a frequent complication in ICU and that severity of illness, sedative drugs and being intubated are risk factors. Moreover, screening for delirium in the ICU with a validated scale can be made by the staff nurses.

Factores ambientales estresantes percibidos por los pacientes de una Unidad de Cuidados Intensivos / Stressful environmental events in the Intensive Care Unit

La alta especialización de las Unidades de Cuidados Intensivos (UCI) crea un ambiente estresante, generador de ansiedad y estrés para el paciente, que ha sido relacionado con la aparición de delirio o síndrome confusional agudo. Objetivos. Por una parte, conocer los factores ambientales desencadenantes de estrés percibidos como tales por los propios pacientes y, por otra, establecer diferencias entre el grupo de pacientes diagnosticado de delirio durante su estancia en UCI y el grupo que no padeció delirio. Material y método. Estudio descriptivo transversal, al que se añade una parte cualitativa. Se entrevistó a 91 pacientes, de los cuales 33 desarrollaron delirio en UCI y 58 no. Para la valoración de las situaciones más estresantes se utilizó la Escala de estresores ambientales de Ballard (1981), que consta de 43 ítems. Además, se realizó una entrevista abierta donde el paciente narraba sus experiencias en la UCI. Se realizó estadística descriptiva para expresar las características de la muestra y determinar la distribución de frecuencias en cada uno de los ítems del cuestionario. Resultados. Los factores percibidos como más estresantes fueron: sed (62,6%) dificultad/imposibilidad para dormir (42,9%), tubos en nariz o boca (35,2%)y no saber la hora (34,1%). Los pacientes que padecieron delirio percibieron como estresores la desorientación o alucinaciones. Conclusiones. Al igual que en previas investigaciones, las necesidades físicas son las que más ansiedad generan en los pacientes críticos que no han padecido delirio

The high standard of specialization of the Intensive Care Units (ICU) creates a stressful setting that generates anxiety and stress for the patients. This has been related to delirium or acute confusional syndrome. Objectives. To describe the stressful environmental events as perceived by patients an, to establish the differences between patients who suffered from delirium in ICU and those who did not suffer from it. Material and methods. Descriptive crosssectional study that includes a qualitative part. A total of 91 patients were interviewed, 33 patients diagnosed of delirium in the ICU and 58 patients without this diagnosis. Ballard's Environmental stressful events scale with 43 items was used to determine the most stressful events. In addition, an open interview was carried out in which the patients could narrate their experiences in the ICU. Descriptive statistic was used to show the characteristics of patients selected and to determine the frequency distributions for each item inthe questionnaire. Results. The factors perceived as the most stressful were: thirst(62.6%), sleep deprivation (42.9%), tubes in mouth or nose (35.2)and not knowing what time it was (34.1). Patients who suffered from delirium perceive disorientation or hallucinations as stressants Conclusions. As in previous investigations, ICU patiens, who did not suffered from delirium, perceived phisycal needs as most streesfull events

Incidencia del delirio en Cuidados Intensivos y factores relacionados / Delirium in Intensive Care. Incidence and risk factors

El delirio ha sido reconocido como un común y serio problema en las áreas de hospitalización, pero su diagnóstico en pacientes críticos es dificultoso debido a la imposibilidad de interrogar al paciente intubado y a la presencia de sedantes. Los objetivos de este estudio son describir la incidencia del delirio en la Unidad de Cuidados Intensivos (UCI) y determinar algunos de los factores de riesgo. Es un estudio analítico, observacional y prospectivo llevado a cabo en una UCI polivalente de ocho camas. La muestra fue de 112 pacientes consecutivos, mayores de 18 años y con estancia igual o superior a 3 días. Se excluyeron los consumidores de sustancias psicoactivas, enfermedad psiquiátrica o enfermedad del sistema nervioso central. Se llevaron a cabo mediciones diarias de la Escala de Delirio en UCI (Bergeron) realizadas por las enfermeras y se recogieron datos de enfermedades asociadas, medicación prescrita e índice pronóstico APACHE II. Se obtuvo una tasa de incidencia de 11 casos de delirio/100 pacientes-día. APACHE II $ 15, sedación, relajación muscular y ventilación mecánica son factores de riesgo para la aparición de delirio en la UCI. Se concluye que el delirio es una complicación frecuente en la UCI y que la gravedad del paciente, los fármacos sedantes y el estar intubado son factores que guardan relación con su aparición. Por otra parte, queda demostrado que el diagnóstico de delirio mediante una escala validada puede llevarse a cabo por el personal de enfermería

Delirium has been documented as a common and serious problem in hospital settings, but its recognition in critically ill patients is made difficult by the inability to interview intubated patients and by the presence of drugs. The objectives of this study were to describe the incidence of delirium in the Intensive Care Unit (ICU) and to determine some of the risk factors. It is an analytical, observational and prospective study in an 8-bed general ICU. The participants were 112 consecutive patients aged 18 and older admitted to the ICU for three or more days. Drug consumers and patients with psychiatric disease or cerebral disease were excluded. Daily ratings of the Intensive Care Delirium Screening Checklist (ICDSC) were made by the staff nurses. Other data such as patient's diseases, drug prescriptions and APACHE II were collected. Delirium was present in 11 out of 100 patients-day. APACHE II $ 15, sedative drugs and mechanical ventilation were risk factors for delirium in ICU. The conclusions of this study have determined that delirium is a frequent complication in ICU and that severity of illness, sedative drugs and being intubated are risk factors. Moreover, screening for delirium in the ICU with a validated scale can be made by the staff nurses

Escala de calidad de vida para el ictus (ECVI-38): evaluación de su aceptabilidad, fiabilidad y validez / Stroke-specific quality of life scale (ecvi-38): an evaluation of its acceptance, reliability and validity

Introducción y objetivos. La calidad de vida relacionada con la salud (CVRS) actualmente es clave en la evaluación de ensayos clínicos para el ictus. Las escalas ictus específicas existentes se desarrollaron en países anglosajones y la mayoría no reúnen los requisitos de validez necesarios. Por ello, se desarrolló la primera escala hispana para evaluar calidad de vida (CV) en sobrevivientes a un ictus (ECVI-38). En este trabajo se evaluaron las propiedades psicométricas de esta medida resumen. Pacientes y métodos. Se estudiaron 63 pacientes con ictus, entre 2 meses y 2años de su ocurrencia, para evaluar la aceptabilidad, fiabilidad yla validez de la ECVI-38, con la utilización de métodos psicométricos estandarizados. Resultados. La ECVI-38 demostró buena aceptabilidad; solamente tres elementos tuvieron alto porcentaje de datos perdidos debido a la edad de los pacientes de la muestra; los efectos piso y techo estuvieron dentro de los límites aceptados. La escala mostró buena consistencia interna ( α de Cronbach0,79-0,97, correlaciones interelemento 0,53-0,90) y buena estabilidad en la prueba test-retest (coeficientes de correlación intraclase0,89-0,98). En cuanto a su validez de construcción (correlacion estotales entre dominios correctas, r = 0,57-0,90 convergente ,r = 0,19-0,39 discriminante), sus resultados fueron muy buenos; así como los estudios de validez contra criterio externo (diferencia entre grupos con estado neurológico conocido, y validez de convergencia). Conclusiones. La ECVI-38 es una medida aceptable, fiable y válida para la evaluación de la CV en pacientes que sufrieron un ictus. Se necesitan nuevas pruebas para evaluar su sensibilidad e investigar su utilidad en la práctica clínica e investigadora (AU)

Introduction and aims. Health-related quality of life (HRQL) is currently essential in the evaluation of stroke-related clinical trials. Existing stroke-specific scales were developed in English-speaking countries and most of them do not satisfy the necessary standards of validity. In consequence, the first Spanish-language scale for evaluating the quality of life (QL) of stroke survivors was developed (ECVI-38). In this work the psychometric properties of this summary measure were assessed. Patients and methods. A group of 63 stroke patients were studied, between 2 months and 2 years after the event, to evaluate the acceptability, reliability and validity of the ECVI-38, using standardised psychometric methods. Results. The ECVI-38 proved to have an important degree of acceptability; only three elements showed a high percentage of data loss due to the age of the patients in the sample; the floor and ceiling effects were within the accepted limits. The scale displayed good internal consistency (Cronbach’s α 0.79-0.97, correlations between elements 0.53-0.90) and good stability in the test-retest trial (intraclass correlation coefficients 0.89-0.98). As regards its construct validity (total correlations among correct domains, convergent r = 0.57-0.90, discriminating r = 0.19-0.39), the results were very good, as were the findings of the studies of validity vs. external criteria (difference between groups with a known neurological status, and convergence validity). Conclusions. The ECVI-38 is a measure that is acceptable, reliable and valid for evaluating QL in patients who have had a stroke. Further tests are needed to evaluate its sensitivity and to explore its value in both clinical and research practice (AU)

[Stroke-specific quality of life scale (ECVI-38): an evaluation of its acceptance, reliability and validity]. / Escala de calidad de vida para el ictus (ECVI-38): evaluación de su aceptabilidad, fiabilidad y validez.

INTRODUCTION AND AIMS: Health-related quality of life (HRQL) is currently essential in the evaluation of stroke-related clinical trials. Existing stroke-specific scales were developed in English-speaking countries and most of them do not satisfy the necessary standards of validity. In consequence, the first Spanish-language scale for evaluating the quality of life (QL) of stroke survivors was developed (ECVI-38). In this work the psychometric properties of this summary measure were assessed. PATIENTS AND METHODS: A group of 63 stroke patients were studied, between 2 months and 2 years after the event, to evaluate the acceptability, reliability and validity of the ECVI-38, using standardised psychometric methods. RESULTS: The ECVI-38 proved to have an important degree of acceptability; only three elements showed a high percentage of data loss due to the age of the patients in the sample; the floor and ceiling effects were within the accepted limits. The scale displayed good internal consistency (Cronbach's alpha 0.79-0.97, correlations between elements 0.53-0.90) and good stability in the test-retest trial (intraclass correlation coefficients 0.89-0.98). As regards its construct validity (total correlations among correct domains, convergent r = 0.57-0.90, discriminating r = 0.19-0.39), the results were very good, as were the findings of the studies of validity vs. external criteria (difference between groups with a known neurological status, and convergence validity). CONCLUSIONS: The ECVI-38 is a measure that is acceptable, reliable and valid for evaluating QL in patients who have had a stroke. Further tests are needed to evaluate its sensitivity and to explore its value in both clinical and research practice.

[The development of a scale to evaluate the quality of life in stroke survivors]. / Desarrollo de una escala para evaluar la calidad de vida en supervivientes a un ictus.

INTRODUCTION: The selection of a measure that can be used to evaluate the outcome of therapeutic interventions in stroke patients has had a conceptual problem in that there is a need to detect a wide range of deficiencies, disabilities and handicaps as part of a patient-based model. It has also suffered from a methodological problem due to the lack of systematic attention given to the development of standard instruments. AIMS: We conducted this study with the aim of getting over these limitations by developing a scale to evaluate the quality of life in stroke survivors. SUBJECTS AND METHODS: We followed a methodology that had previously been standardised by other authors based on using the opinion given by patients and caregivers in the generation of the items to be included. This has several stages that include individual interviews with patients, caregivers and experts, focal groups with patients and experts, quantitative and qualitative analyses of these interviews, two panels of experts to actually draw up the instrument, and a pilot test carried out in a sample of 50 patients to reduce and group the items. This reducing and grouping process was performed taking into account the following: 1. The percentage of responses left unanswered; 2. A factorial analysis of the main components; 3. Cronbach's alpha coefficient. RESULTS: We interviewed 20 patients and 12 experts; these results were later used to classify the above mentioned aspects in order of priority according to the frequency with which they appeared in the surveys. Then, we elaborated the questionnaire with four areas or subscales by including the questions or items in these categories: I. Physical status (17 items); II. Emotional status (13 items); III. Activities of daily living (13 items); IV. Social and familial functions (13 items). After the pilot study 38 items were reorganised into eight domains, according to the factorial analysis: 1. Physical problems; 2. Communication; 3. Cognition; 4. Emotions; 5. Feelings; 6. Activities of daily living; 7. Familial functions; 8. Social functions. They displayed high coefficients of internal consistency. CONCLUSIONS: We developed a new scale for evaluating the quality of life for stroke patients and it is now ready to undergo its validation process.

Desarrollo de una escala para evaluar la calidad de vida en los supervivientes a un ictus / The development of a scale to evaluate the quality of life in stroke survivors

Introducción. La selección de una medida para evaluar el resultado de las intervenciones terapéuticas en los pacientes con ictus ha tenido un problema conceptual en la necesidad de detectar un amplio intervalo de deficiencias, discapacidades y minusvalías, como parte de un modelo basado en el paciente, y un problema metodológico en la falta de atención sistemática para el desarrollo de instrumentos estándares. Objetivo. Para resolver estas limitaciones realizamos este trabajo, con el objetivo de desarrollar una escala para evaluar la calidad de vida en los supervivientes a un ictus. Sujetos y métodos. Seguimos una metodología estandarizada por otros autores, que se basa en la opinión de los pacientes y los cuidadores para generar los ítems a incluir. Ésta tiene varias etapas, que incluyen: entrevistas individuales a pacientes, cuidadores y expertos, grupos focales con pacientes y expertos, análisis cuantitativo y cualitativo de estas entrevistas, dos paneles de consenso para la confección del instrumento y prueba piloto para reducir y agrupar los ítems en una muestra de 50 pacientes. Para reducir y agrupar los ítems tuvimos en cuenta: 1. El porcentaje de respuestas en blanco; 2.El análisis factorial de componentes principales, y 3. El coeficiente de Cronbach. Resultados. Entrevistamos a 20 pacientes y 12 expertos; con esos resultados, ordenamos los aspectos mencionados en orden de prioridad según la frecuencia de aparición en las encuestas. Posteriormente, confeccionamos el cuestionario con cuatro áreas o subescalas, que incluían las preguntas o ítems en las siguientes categorías: I. Estado físico (17 ítems); II. Estado emocional (13 ítems); III. Actividades de la vida diaria (13 ítems); IV. Funciones sociofamiliares (13 ítems). Después del estudio piloto se reorganizaron 38 ítems en ocho dominios, de acuerdo al análisis factorial: 1.Problemas físicos; 2. Comunicación; 3. Cognición; 4. Emociones; 5. Sentimientos; 6. Actividades de la vida diaria; 7. Funciones familiares; 8. Funciones sociales. Mostraron altos coeficientes de consistencia interna. Conclusión. Se ha desarrollado una nueva escala para evaluar la calidad de vida para el ictus, que se encuentra lista para su proceso de validación (AU)

Infección por inermicapsifer madagarcariensis

Se reportó un caso de parasitismo por Inermicapsifer Madagascariensis, en un joven de 24 años de edad de raza blanca. Este cestodo es más común en los primeros años de vida pero como se observa hay que tenerlo en cuenta en otras edades[AU]

[Prognosis of cognition in congenital hypothyroidism following early treatment. Double effect hypothesis]. / Pronostico de la cognicion en el hipotiroidismo congenito tratado precozmente. Hipotesis del doble efecto.

INTRODUCTION: The prevention of mental retardation due to congenital hypothyroidism by treating it at an early stage is one of the great achievements of contemporary preventive medicine. Nevertheless, the children suffering from this disease are affected by selective cognitive deficits whose origin remains a controversial issue. PATIENTS AND METHODS: We describe the results from a cohort of 100 children who have been diagnosed as suffering from congenital hypothyroidism in La Havana since 1989 and whose cognitive performance has since been periodically evaluated. The mean age at each evaluation was as follows: 1.1 years (mean and typical deviation: 0.3) and 8.2 years (mean and typical deviation: 1.2). RESULTS: During the first two years of life the developmental quotients are within the normal range of values, although fine oculomotor coordination is significantly diminished. The duration of fetal hypothyroidism is linked to postural control, and the initial biochemical severity of the disease is associated to language development. Oculomotor coordination is not linked to any variable concerning the severity of the disease or with the effectiveness of therapy. At school age, intelligence quotients (IQ) are also within the normal range of values. A multiple regression analysis indicated that the total IQ can be predicted from the scores in oculomotor coordination during the first two years of life and from the initial doses of levothyroxine. CONCLUSIONS: The relations between the variables capable of forecasting intellectual development in these children are analysed and we also discuss the hypothesis which suggests that some of the persisting neurocognitive deficits are probably due to genetic influences that exist regardless of the effectiveness of the therapy.

[Effect of the availability of a medicalized mobile ICU (MMICU) on the hospital admissions after an out-of-hospital cardiorespiratory arrest (OH-CRA)]. / Efecto de la disponibilidad de una UVI móvil medicalizada en los ingresos hospitalarios tras una parada cardiorrespiratoria extrahospitalaria.

Patients admitted in an ICU after OH-CRA before and after the implementation of a MMICU were evaluated. During a period of 11 years, divided into a pre-MMICU period (1988-1993) and a post-MMICU period (1994-1998), 39 patients were admitted in the pre period and 64 patients in the post period. The basal characteristics, the etiologies of OH-CRA and of death in ICU they were similar. The incidence of severe anoxic encephalopathy (SAE) it doubled in the post period. There were not significant differences both to the discharge from ICU and to the hospital discharge. We conclude that after implementing a MMICU more patients are admitted in ICU resuscitated after OH-CRA. The survival does not vary, but the incidence of SAE increases.

Efecto de la disponibilidad de una UVI móvil medicalizada en los ingresos hospitalarios tras una parada cardiorrespiratoria extrahospitalaria / Effect of the availability of a medicalized mobile ICU

Se analizaron pacientes (px) ingresados en UCI tras una parada cardiorrespiratoria extrahospitalaria (PCR-E) antes y después de implantar una UVI móvil medicalizada (UVIMM). Durante 11 años, divididos en período pre-UVIMM (1988-1993) y post-UVIMM (1994-1998), ingresaron 39 px en el período pre y 64 px en el post-UVIMM. Las características basales, las etiologías de PCR-E y de fallecimiento en UCI fueron similares. La incidencia de encefalopatía anóxica severa (EAS) se duplicó en el período post. No hubo diferencias significativas tanto al alta de UCI como al alta hospitalaria. Concluimos que tras implantar una UVIMM ingresan en UCI más px reanimados tras una PCR-E. La supervivencia no varía, pero aumenta la incidencia de EAS (AU)

[Standardised environmental conditions for neurocognitive laboratories]. / Condiciones de uniformidad ambiental para laboratorios de neurocognición.

INTRODUCTION AND AIMS: The exploration of neurocognition in neurology departments has gone a long way from the traditional psychometric tests to the present day use of high technology methods in cognitive neurophysiology, as is the case of event related potentials. Given the increased sensitivity of these procedures, it has become absolutely essential to control the influence of environmental variables that may exert non controlled effects on the patient s response. Many neurocognitive laboratories have been set up in premises in which the spatial layout and the environmental characteristics have been determined beforehand and consequently technical staff has had to prepare these rooms in an empirical way. This gives rise to two types of drawbacks: interferences in the patient s concentration and low reproducibility of the results in other laboratories. METHOD: In this paper we present a proposed set of standardised conditions for a neurocognitive laboratory from an architectural perspective, and more specifically with regard to interior design. We outline the functional design of the premises, the conditions for workplaces where VDU computers (Video Display Units) are used and where psychometric evaluation is carried out. We also discuss the criteria to be followed when placing the laboratory within a hospital, lighting parameters, air conditioning and suggestions about psychological input. CONCLUSIONS: Although we do not seek to establish a rigid set of norms, these conditions will raise the quality of evaluations and facilitate the comparison of results because of the reduced variability from the environment.