[Virtual reality rehabilitation in paediatric patients with hemophilia. Retrospective study]. / Rehabilitación con realidad virtual en pacientes pediátricos con hemofilia. Estudio retrospectivo.

INTRODUCTION: Joint affection is a frequent complication of hemophilia. Virtual reality programs offer the patient a dynamic plan with maximum functional benefit. The objective of this work is to evaluate the effect of a rehabilitation program combined with conventional therapy and virtual reality on joint function, in patients with hemophilic arthropathy and the impact on the gait. MATERIAL AND METHODS: Eleven pediatric patients with hemophilia and history of hemophilic arthropathy grade I or II were evaluated. An 8-week rehabilitation program was carried out with Xbox KinectTM and mechanotherapy. Movement analysis laboratory to evaluate the gait pattern and the Joint Health Scale was performed at the beginning and end of the program. RESULTS: A reduction of 50% (p = 0.000), 68% (p = 0.016) and 48% (p = 0.000) were observed in the Total Joint Health score (STA), Global Gait Score (PMG) and Total Score of the Joint Health Scale (P-HJHS-T) respectively. There is a decrease in the support phase and right stride, and increase in cadence, step length, left stride and swing phase. CONCLUSIONS: The overall improvement of the patients makes us conclude that this pilot study opens a window of opportunity to continue the study of an integral rehabilitation program based on the use of virtual reality in pediatric patients with hemophilic arthropathy.

INTRODUCCIÓN: La afección articular es una complicación frecuente de la hemofilia. Los programas de realidad virtual ofrecen al paciente pediátrico un esquema dinámico con máximo beneficio funcional. El objetivo de este trabajo es evaluar el efecto de un programa de rehabilitación combinado con terapia convencional y realidad virtual sobre la función articular en pacientes con artropatía hemofílica y el impacto sobre el patrón de la marcha. MATERIAL Y MÉTODOS: Se evaluaron 11 pacientes pediátricos con hemofilia A o B y antecedente de artropatía hemofílica en grado I o II. Se sometieron a un programa de rehabilitación de ocho semanas con Xbox KinectTM y mecanoterapia. Se utilizó el laboratorio de análisis de movimiento para evaluar el patrón de marcha y la escala de salud articular al inicio y término del programa. RESULTADOS: Se redujo 50% (p = 0.000), 68% (p = 0.016) y 48% (p = 0.000) el puntaje de la escala de salud total articular (STA), puntaje marcha global (PMG) y puntaje total de la escala de salud articular (P-HJHS-T) respectivamente. Se observó disminución en la fase de apoyo y zancada derecha y aumento en cadencia, longitud de paso, zancada izquierda y fase de balanceo. CONCLUSIONES: La mejoría global de los pacientes nos hace concluir que este estudio piloto abre una ventana de oportunidades para continuar el estudio de un programa integral de rehabilitación con base en el uso de la realidad virtual en pacientes pediátricos con artropatía hemofílica.

[Indomethacin in the prevention of subependymal-intraventricular hemorrhage in preterm newborns with conventional mechanical ventilation]. / Indometacina en la prevención de la hemorragia subependimaria-intraventricular del recién nacido pretérmino con ventilación mecánica convencional.

The results of a double blind study to evaluate the efficiency of prophylactic endovenous indomethacin versus placebo for prevention of intraventricular hemorrhage (IVH) in newborn infants between 28 to 36 weeks of age who were intubated at the delivery room and required mechanical ventilation in NICU are presented. Fourty six patients required mechanical ventilation, but 14 neonates had IVH evaluated by ultrasound when were admitted to the Unit. At least 32 infants were studied, 16 for each group. There were no differences between the groups in weight, gestational age, sex and delivery way. The mobility was the same in relation to hialine membrane disease, sepsis, pneumonie and pneumotorax. The placebo group had more frequency of PDA and mortality (P < 0.5). There were no differences in mean airway pressure and arterial gases, also in glucose, platelets and urinary volume. The indomethacin group had mayor urinary density and FeNa but the results were always in normal ranges. The IVH was the same in both groups. We concluded that the indomethacin at the levels used did not produced alterations, and if the IVH is not prevented, were observed lesser severity of the same and the frequency of PDA and mortality are lesser. But still is necessary more number of cases for best conclusions.

[Survival of very low birth weight newborns (less than 1,500 grams) in relation to conventional mechanical ventilation]. / Sobrevida en recién nacidos de muy bajo peso al nacer (menores de 1.500 gramos) con relación a la ventilación mecánica convencional.

One hundred and five very low birth weight neonates, selected through convenience sampling during 1989, were subdivided into those who received mechanical ventilation (MCV) and those who did not receive mechanical ventilation (W/O MCV) and later analyzed. The maternal morbidity in both groups were very similar; 66 of the cases were placed in group MCV and 39 in the W/O MCV. There were differences in birth weight, gestational age, severe asphyxia and hospital stay in the patients with MCV. The neonatal morbidity (SDR, intraventricular hemorrhaging, bronchopulmonary dysplasia, etc.) was more frequently seen in this group. The global mortality was 47%, all of the cases were from the ventilated group. The ventilated patients who died were in the hospital a lesser number of days and had a lesser frequency of prenatal control. We conclude that low weight neonates who require mechanical respiratory assistance have a greater risk of morbidity and mortality. The lesser weight and gestational age, the greater the risk. A group of neonates will have a lesser capacity to synthesize phospholipids and therefore a greater risk of dying. Physicians should be more attentive to the complications related to ventilated low-weight premature neonates.

[Massive production of Entamoeba histolytica cysts under axenic conditions]. / Producción masiva de quistes de Entamoeba histolytica en condiciones axénicas.

After an exponential phase of growth, HK9 strain amebas, kept in the axenic medium PEHPS, spontaneously acquire a form morphologically similar to various natural cysts, as well as a resistance to hypotonic shock, due to the effect of a wall, partially composed of polysaccharides. The number of differentiated amebas increases gradually, although their viability diminishes, in function of the incubation time. On the ninth day, 96% of the population is made up of these cells, although only 6% are viable. The ultramicroscopic structure of the great majority of differentiated amebas corresponds to that of immature cysts. These, and the PEHPS medium, constitute a good model for a characterization of the start of the differentiation of E. histolytica, and open the opportunity of obtaining in axenic conditions, massive cultures of mature cysts.