Uso de ecografía en trauma pediátrico en el servicio de urgencia / Use of ultrasound in pediatric trauma in the emergency department

Introducción: La ecografía es una herramienta fundamental al momento de enfrentarse a un paciente grave en el servicio de urgencia. El protocolo "Focused Assessment with Sonography for Trauma" (FAST), es la utilización del ultrasonido en contexto de trauma, el cual está extensamente validado para medicina de urgencia de adultos. Sin embargo, en pediatría existen escasas publicaciones que resuman la evidencia relacionada. Objetivo: Dar a conocer la evidencia actualizada del uso de ecografía bajo el protocolo FAST en el trauma abdominal contuso pediátrico en el servicio de urgencia. De forma secundaria describir los pasos para realizar el examen e interpretación de sus hallazgos. Metodología: Revisión bibliográfica en las principales bases de datos, en idioma inglés o español, desde el año 2000 hasta la actualidad. Se seleccionaron estudios de rendimiento diagnóstico y revisiones narrativas relacionadas con el tratamiento y pronóstico del trauma general y abdominal en pediatría. Resultados: Se encontraron 998 artículos, de los cuales 22 fueron seleccionados y considerados para la revisión. La ecografía permite la identificación de líquido libre, que se relaciona con lesión intraabdominal en el contexto de trauma pediátrico. El protocolo FAST en el contexto de trauma contuso abdominal tiene una alta especificidad y una baja sensibilidad para su diagnóstico. El uso de ecografía en pediatría evita la exposición a los efectos dañinos de las radiaciones ionizantes. Conclusión: El uso de ecografía por parte de la medicina de urgencia se ha transformado en una herramienta esencial y segura al momento de evaluar pacientes. La presencia de un hallazgo positivo nos permite realizar diagnóstico de lesiones intraabdominales, pero un hallazgo negativo, no nos permite descartarlo, requiriendo exámenes complementarios.

Introduction: Ultrasound is an essential tool in diagnosing trauma in critical patients in the emergency room. The "Focused Assessment with Sonography for Trauma" (FAST) is the ultrasound protocol in the trauma context. It has been extensively validated for adult patients. However, few reviews have exposed and summarized the related evidence in pediatric emergency medicine. Objective: To present the FAST ultrasound protocol updated evidence in pediatric blunt abdominal trauma in the emergency department. Secondarily, to describe the steps to perform the examination and interpretation of their findings. Methodology: A bibliographical review was carried out in the main English or Spanish databases from 2000 to the present. Diagnostic studies and reviews of trauma treatment and prognosis in pediatrics were selected and summarized. Results: We found 998 articles, of which 22 were selected and screened for review. Ultrasound allows the identification of free fluid related to intra-abdominal injury in the context of pediatric trauma. Using ultrasound avoids children's exposure to the harmful effects of ionizing radiation. The FAST protocol in the context of blunt abdominal trauma has high specificity and low sensitivity for its diagnosis. Conclusion: The use of ultrasound in the field of emergency medicine has become an essential and safe tool. A positive finding allows us to diagnose intra-abdominal injuries, but a negative finding does not allow us to rule it out, requiring additional tests. The scientific evidence in the pediatric setting is more limited compared to adults.

Relación entre fuerza prensil e indicadores antropométricos en personas mayores residentes en establecimientos de larga estancia / Relationship between prehensile strength and anthropometric indicators in elderly residents in long-stay facilities

Fundamentos: El aumento en la proporción de personas mayores genera eventos como disminución en la calidad de vida y deterioro físico, cuyas características son disminución demasa muscular y menor fuerza muscular. El objetivo del presente estudio es relacionar la fuerza prensil con diferentesvariables antropométricas, aportando datos cuantificables que contribuyan a reforzar la necesidad de intervención en la población de adultos mayores.Métodos: Estudio descriptivo de corte transversal (n = 84). Se identificaron variables sociodemográficas y antropométricas en personas mayores de 60 años residentes en establecimientos de larga estancia. Resultados: El 26,7% de los adultos mayores presenta malnutrición por exceso, mientras que el 20,2% y 32,9% de hombres y mujeres respectivamente, tienen masa muscular disminuida. Se observó una correlación positiva entre fuerza prensil y la circunferencia de pantorrilla y el IMC.Conclusiones: Existe una correlación entre la fuerza prensil y la masa muscular, lo que sugiere la necesidad urgente de generar programas preventivos en población mayor, integrando tanto la intervención nutricional, como kinésica, que en conjunto y bajo la mirada oportuna, permitiría mejorar la calidad de vida de las personas mayores. (AU)

Background: The increase in the proportion of older peoplegenerates events such as decreased quality of life and physicaldeterioration, whose characteristics are decreased muscle mass and reduced muscle strength. The objective of the present study was to relate prehensile strength with different anthropometric variables, providing quantifiable data that contribute to reinforce the need of intervention in the adult population.Methods: Descriptive cross-sectional study (n = 84). Sociodemographic and anthropometric variables were identified in people over 60 years old living in long-stay facilities. Results: Malnutrition due to excess was found in 26.7%, while 20.2% and 32.9% of men and women, respectively, had decreased muscle mass. A positive correlation is observed between prehensile strength with calf circumference and BMI. Conclusions: The existing correlation between prehensilestrength and muscle mass is confirmed, which suggests the urgent need to generate preventive programs in the elderly population, integrating both nutritional and kinesic interventions, which together and under the appropriate consideration, would allow to improve the quality of life of the elderly. (AU)

Chaperone Mediated Autophagy Degrades TDP-43 Protein and Is Affected by TDP-43 Aggregation.

TAR DNA binding protein 43 kDa (TDP-43) is a ribonuclear protein regulating many aspects of RNA metabolism. Amyotrophic Lateral Sclerosis (ALS) and Frontotemporal Lobar Degeneration (FTLD) are fatal neurodegenerative diseases with the presence of TDP-43 aggregates in neuronal cells. Chaperone Mediated Autophagy (CMA) is a lysosomal degradation pathway participating in the proteostasis of several cytosolic proteins including neurodegenerative associated proteins. In addition, protein oligomers or aggregates can affect the status of CMA. In this work, we studied the relationship between CMA and the physiological and pathological forms of TDP-43. First, we found that recombinant TDP-43 was specifically degraded by rat liver's CMA+ lysosomes and that endogenous TDP-43 is localized in rat brain's CMA+ lysosomes, indicating that TDP-43 can be a CMA substrate in vivo. Next, by using a previously reported TDP-43 aggregation model, we have shown that wild-type and an aggregate-prone form of TDP-43 are detected in CMA+ lysosomes isolated from cell cultures. In addition, their protein levels increased in cells displaying CMA down-regulation, indicating that these two TDP-43 forms are CMA substrates in vitro. Finally, we observed that the aggregate-prone form of TDP-43 is able to interact with Hsc70, to co-localize with Lamp2A, and to up-regulate the levels of these molecular components of CMA. The latter was followed by an up-regulation of the CMA activity and lysosomal damage. Altogether our data shows that: (i) TDP-43 is a CMA substrate; (ii) CMA can contribute to control the turnover of physiological and pathological forms of TDP-43; and (iii) TDP-43 aggregation can affect CMA performance. Overall, this work contributes to understanding how a dysregulation between CMA and TDP-43 would participate in neuropathological mechanisms associated with TDP-43 aggregation.

Análisis descriptivo de pacientes diabéticos del Programa Cardiovascular en CESFAM Pinares, Chiguayante, Chile, año 2015 / Statistical analysis of patients from Cardiovascular Program in CESFAM Pinares, Chiguayante, Chile 2015

INTRODUCCIÓN: La Diabetes Mellitus ocupa muchos recursos sanitarios en atención primaria, por eso indagamos factores condicionantes que la acompañan. OBJETIVOS: Conocer el estado de salud y tratamiento de los diabéticos que acuden al Programa Cardiovascular del Centro de Salud Familiar Pinares, Chiguayante, Chile. MATERIALES Y MÉTODOS: Estudio descriptivo de corte transversal de una muestra de 120 pacientes durante Marzo y Mayo de 2015. Se usaron las variables: sexo, edad, estado nutricional, patología crónica asociada, presión arterial, adherencia a terapia farmacológica y dietética, y compensación. RESULTADOS: 63% eran mujeres y 37% hombres, con promedio de edad 65,6 años, en un rango entre 41 y 89 años. 80% presentaba malnutrición por exceso, con 20% sobrepeso y 60% obesidad. 77% presentaban hipertensión arterial, 43% Dislipidemia, 20% artrosis, 17% enfermedad renal crónica, entre los resultados más relevantes. CONCLUSIONES: Se debe seguir trabajando por un buen control y educación con el binomio paciente diabético-médico para el éxito del tratamiento.

INTRODUCTION: Diabetes Mellitus occupies many health resources in primary care, so we investigate determinants that accompany it. OBJECTIVES: Knowing the health status and treatment of diabetics who attend the cardiovascular program at the Family Health Pinares, Chiguayante, Chile. MATERIALS AND METHODS: A descriptive cross-sectional study of a sample of 120 patients during March and May 2015. The variables were used:Sex, age, nutritional status, chronic comorbidity, blood pressure, and dietary adherence to drug therapy, and compensation. RESULTS: 63% were women and 37% men, mean age 65.6 years, ranging between 41 and 89 years. 80% had mal-nutrition by excess, with 20% overweight and 60% obese. 77% had hypertension, 43% had dyslipidemia, 20% osteoarthritis, 17% chronic kidney disease, the most relevant results. CONCLUSIONS:We must continue to work for good control and education binomial diabetic patient-doctor for treatment success.