Fatiga e independencia funcional en personas con esclerosis múltiple / Fatigue and Functional Independence in People with Multiple Sclerosis

RESUMEN Objetivo: Establecer la relación entre la fatiga y el nivel de independencia funcional en actividades de la vida diaria en personas con esclerosis múltiple. Material y método: Se realizó un estudio descriptivo trasversal con alcance correlacional. Participaron 107 personas con esclerosis múltiple, mayores de 18 años, con puntuaciones entre 0 y 8 en la Escala Ampliada del Estado de Discapacidad de Kurtzke. Se evaluó la fatiga con la Escala de Gravedad de la Fatiga, las actividades básicas cotidianas con el Índice de Barthel y las instrumentales con la Escala de Lawton y Brody. Se correlacionaron estas variables y se realizaron pruebas de homogeneidad entre la severidad de la fatiga y variables sociodemográficas y clínicas. Resultados: Se encontró una relación significativa inversamente proporcional entre el grado de severidad de la fatiga y las variables de dependencia para las actividades básicas e instrumentales de la vida diaria (p<0,001). No se evidenció relación significativa entre la severidad de la fatiga con la edad, el sexo y el tiempo de evolución de la esclerosis múltiple (p>0,05). Se encontraron diferencias significativas en el nivel de fatiga respecto al uso de ayudas externas, hipertensión arterial, diabetes mellitus, compromiso motor, trastornos de la sensibilidad, alteraciones del control de esfínteres, deterioro cognitivo y depresión. Conclusiones: Se encontró que la fatiga fue el síntoma más predominante (>75 %). Las personas que informan altos niveles de fatiga mostraron menor independencia para las actividades de la vida diaria.

ABSTRACT Objective: To establish the relationship between fatigue and the level of functional independence in activities of daily living in people with multiple sclerosis. Material and Method: A cross-sectional descriptive study was carried out 107 people with multiple sclerosis participated, over 18 years old, with scores between 0 and 8 in the Kurt-zke Expanded Disability Status Scale. Fatigue was assessed with the Fatigue Severity Scale, the daily basic activities with the Barthel Index (BI) and instrumentals with the Lawton and Brody Scale. These variables were correlated, and homogeneity tests were performed between the severity of fatigue and socio-demographic and clinical variables. Results: A significant inversely proportional relationship was found between the degree of severity of fatigue and the dependence variables for the basic and instrumental activities of daily life (p <0.001). No significant relationship was found between the severity of fatigue with age, sex and time of evolution of multiple sclerosis (p> 0.05). Significant differences were found in the fatigue level regarding the use of external aids, hypertension, diabetes mellitus, motor commitment, sensitivity disorders, sphincter control alterations, cognitive impairment and depression. Conclusions: It was found that fatigue was the most predominant symptom (> 75%). People reporting high levels of fatigue showed less independence for activities of daily living.

Decellularization and In Vivo Recellularization of Abdominal Porcine Fascial Tissue.

BACKGROUND: Tissue decellularization has evolved as a promising approach for tissue engineering applications. METHODS: In this study, we harvested fascial tissue from porcine anterior abdominal wall and the samples were decellularized with a combination of agents such as Triton X-100, trypsin and DNAase. Afterwards, we evaluated cell removal by histological analysis and DNA quantification. Mechanical functionality was evaluated by applying a range of hydrostatic pressures. A sample of decellularized fascia was transplanted into a rabbit and after 15 days a biopsy of this tissue was examined; the animal was observed during 6 months after surgery. RESULTS: The extracellular matrix was retained with a complete decellularization as evidenced by histologic examination. The DNA content was significantly reduced. The scaffold preserved its tensile mechanical properties. The graft was incorporated into a full thickness defect made in the rabbit abdominal wall. This tissue was infiltrated by granulation and inflammatory cells and the histologic structure was preserved 15 days after surgery. The animal did not develop hernias, infections or other complications, after a 6-months of follow up. CONCLUSIONS: The protocol of decellularization of fascial tissue employed in this study proved to be efficient. The mechanical test demonstrated that the samples were not damaged and maintained its physical characteristics; clinical evolution of the rabbit, recipient of the decellularized fascia, demonstrated that the graft was effective as a replacement of native tissue.In conclusion, a biological scaffold derived from porcine fascial tissue may be a suitable candidate for tissue engineering applications.

¿Intervenimos adecuadamente las hernias inguinales? / Do we adequately intervene inguinal hernias?

Introducción. La herniorrafia inguinal es la intervención quirúrgica más frecuente en el ámbito de la cirugía general. El uso de técnicas quirúrgicas con malla ha traído numerosos beneficios, entre los que se pueden mencionar la disminución de la tasa de recidiva y de las complicaciones posoperatorias, y la reducción del tiempo de convalecencia y de reintegración a las actividades cotidianas. Materiales y métodos. Se llevó a cabo un estudio de tipo observacional retrospectivo desde noviembre de 2010 hasta septiembre de 2012 de pacientes diagnosticados con hernia inguinal, que fueron intervenidos quirúrgicamente en una institución de tercer nivel de atención en salud. La recolección de la información se hizo mediante un formato estructurado y la revisión de las historias clínicas. Resultados. De 102 pacientes intervenidos en este lapso de tiempo, 86,3 % eran hombres y 13,7 % mujeres, entre los 14 y 88 años. El 57 % tenía una hernia indirecta unilateral y 28 % presentó una directa unilateral. En 68 % de los pacientes se usó malla y, de estos, a todos se les practicó fijación de la misma. El tipo de malla usada fue mayormente de polipropileno (88 %). El 18,6 % de los pacientes presentó complicaciones posoperatorias. Discusión. La institución estudiada presentó una tasa de utilización de la técnica de Lichtenstein menor a la esperada con relación a otros estudios. La tasa de morbilidad general fue menor, pero el hematoma se presentó el doble de veces que en la mayoría de los reportes de la literatura científica.

Background. Inguinal herniorraphy is the most common surgical procedure performed in general surgery. Using mesh surgical techniques has greatly reduced the relapse rate after the procedure, postoperative complications, recovery time and reintegration to daily activities. Methods. A retrospective observational study of patients diagnosed and surgically treated of inguinal hernia from November 2010 to September 2012 in a third level of care general hospital was performed. The data collection was done through a structured format and review of medical records. Results. In a total of 102 patients, 86.3% were male and 13.7% female, with ages ranging from14 to 88 years old. Most of them had a unilateral indirect hernia (57%) and 28% had a unilateral direct hernia 68 % of the patients were intervened with a mesh technique and all patients received mesh fixation. Most of mesh's type used in the procedures was polypropylene (88%); 18.6 % of patients presented posoperative complications (POP). Discussion. The studied institution showed a lower utilization rate of the Lichtenstein technique than expected according to current literature. The general morbidity rate was lower, but hematoma occurred twice as often than in most literature reports.

Evaluation of an educational, theater-based intervention on attitudes toward organ donation in Risaralda, Colombia / Evaluación del impacto de una intervención basada en teatro sobre las actitudes hacia la donación de órganos en Risaralda, Colombia

Introduction:The shortage of organs for transplantation is aworldwide problem and the main cause is the refusal of familymembers to donate. Consent to donate is influenced by manyfactors and educational interventions are strongly recommen-ded.Objective:To evaluate the impact of an educational, theater-based strategy on the attitudes toward organ donation.Methodology:This study employed an intervention usingtheater as the central tool. The impact of this interventionon the intention to donate was assessed through a controlled,prospective, nonrandomized designed study. The sample con-sisted of 1,038 people. All the participants answered a surveythat asked about sex, age and intent to donate. Afterward, oneportion of the sample was exposed to the play, The Gift of Life,and a subsequent discussion forum that was guided by experts.The same survey was administered again after the interven-tion.Results:Before the intervention, donation attitudes were posi-tive in 68.3 percent of the responses, negative in 6.8 percent and uncertainin 24.9 percent. Females showed a greater intent to donate while agehad no apparent influence on the donation decision. Those ex-posed to the intervention were found to be more likely to do-nate and show a favorable change in attitude toward donationthan those who were not exposed to the intervention.Conclusion:An educational intervention using theater is aneffective tool to generate a short-term change in the intent todonate. Educational strategies should be employed to increasethe rates of organ donation.

Evaluation of an educational, theater-based intervention on attitudes toward organ donation in Risaralda, Colombia.

INTRODUCTION: The shortage of organs for transplantation is a worldwide problem and the main cause is the refusal of family members to donate. Consent to donate is influenced by many factors and educational interventions are strongly recommended. OBJECTIVE: To evaluate the impact of an educational, theaterbased strategy on the attitudes toward organ donation. METHODS: This study employed an intervention using theater as the central tool. The impact of this intervention on the intention to donate was assessed through a controlled, prospective, nonrandomized designed study. The sample consisted of 1,038 people. All the participants answered a survey that asked about sex, age and intent to donate. Afterward, one portion of the sample was exposed to the play, The Gift of Life, and a subsequent discussion forum that was guided by experts. The same survey was administered again after the intervention. RESULTS: Before the intervention, donation attitudes were positive in 68.3% of the responses, negative in 6.8% and uncertain in 24.9%. Females showed a greater intent to donate while age had no apparent influence on the donation decision. Those exposed to the intervention were found to be more likely to donate and show a favorable change in attitude toward donation than those who were not exposed to the intervention. CONCLUSION: An educational intervention using theater is an effective tool to generate a short-term change in the intent to donate. Educational strategies should be employed to increase the rates of organ donation.

INTRODUCCIÓN: La escasa disponibilidad de órganos para transplantes es un problema de escala mundial y la principal causa es la negativa de los familiares del donante. El consentimiento para donar está influenciado por una multitud de factores y las intervenciones educativas han sido intensamente recomendadas. OBJETIVO: Evaluar el impacto de una estrategia pedagógica basada en el teatro sobre las actitudes hacia la donación de órganos. METODOLOGÍA: Este estudio utilizó una intervención teatral como herramienta central de trabajo y evaluó su impacto sobre la intención de donación usando un diseño controlado, prospectivo y no aleatorizado. La muestra consistió de 1,038 personas. Todos los participantes respondieron una encuesta que preguntaba acerca del género, edad e intención de donación. Después de ésta, una parte de la muestra fue expuesta a la obra teatral El Regalo de la Vida, seguida de un foro de discusión con expertos. La misma encuesta inicial fue aplicada de nuevo después de la intervención. RESULTADOS: Antes de la intervención, las actitudes hacia la donación fueron positivas en 68.3% de los casos, negativa en 6.8% e incierta en 24.9%. Las mujeres mostraron una mayor intención de donación mientras que la edad no tuvo ninguna influencia. Aquellas personas expuestas a la intervención estuvieron más inclinadas hacia la donación y mostraron un cambio favorable en su actitud que aquellas que no fueron expuestas a ésta. CONCLUSIÓN: Una intervención educativa usando el teatro es una herramienta efectiva para generar un cambio en al intención de donación de órganos. Estrategias educativas similares a ésta deben implementarse para incrementar la tasa de donación de órganos entre la población general.

Hemotórax espontáneo: una forma inusual de presentación de la porfiria intermitente aguda / Acute intermittent porphyria presenting as spontaneous hemothorax

Las porfirias son un grupo de alteraciones metabólicas de la síntesis del hem, de carácter hereditario. Son condiciones relativamente raras, de difícil diagnóstico, pero con una respuesta impresionante al tratamiento y con buen pronóstico, si se identifican y tratan a tiempo. La más común de las formas agudas es la porfiria intermitente aguda. Se presenta el caso de un hombre de 23 años que consultó por dolor abdominal y que, concomitantemente presentaba un hemotórax espontáneo de dos litros, presentación inusual nunca antes descrita para la porfiria intermitente aguda. Se incluye una breve revisión de los aspectos más relevantes de la porfiria intermitente aguda, epidemiología, diagnóstico, clínica y manejo, además de una serie de reflexiones sobre cómo sospechar tempranamente el diagnóstico.

The porphyrias are inherited disorders of the heme biosynthetic pathway. They are relatively rare and often misdiagnosed; however, acute episodes can be curtailed by early administration of heme arginate. Acute intermittent porphyria is the commonest of acute forms of porphyria. Here, a case is presented of a 23-year-old male with acute intermittent porphyria who came to the emergency clinic with an unexplained abdominal pain. In addition, he exhibited spontaneous hemothorax (two liters of blood accumulated in the chest) as an unusual manifestation of the disease. The most relevant aspects of acute intermittent porphyria are discussed, along with its epidemiology, diagnosis, clinical presentation and treatment. Complexities and diagnostic requirements in making a diagnosis of porphyria are described.

[Acute intermittent porphyria presenting as spontaneous hemothorax]. / Hemotórax espontáneo: una forma inusual de presentación de la porfiria intermitente aguda.

The porphyrias are inherited disorders of the heme biosynthetic pathway. They are relatively rare and often misdiagnosed; however, acute episodes can be curtailed by early administration of heme arginate. Acute intermittent porphyria is the commonest of acute forms of porphyria. Here, a case is presented of a 23-year-old male with acute intermittent porphyria who came to the emergency clinic with an unexplained abdominal pain. In addition, he exhibited spontaneous hemothorax (two liters of blood accumulated in the chest) as an unusual manifestation of the disease. The most relevant aspects of acute intermittent porphyria are discussed, along with its epidemiology, diagnosis, clinical presentation and treatment. Complexities and diagnostic requirements in making a diagnosis of porphyria are described.

Fraude y engaño en la investigación biomédica / Fraud and mistake in biomedical research

Historia: La imagen tradicional de un científico es la de una persona motivada por nobles ideales, trabajando incansablemente en la búsqueda de la verdad, pero tristemente el fraude en la investigación biomédica es una innegable verdad como lo demuestra esta breve revisión histórica de los casos más publicitados. Definición: Hoy en día esta claramente definida la tipología del fraude. Se definen los principales actos considerados como conducta impropia en la investigación científica. Consecuencias: El impacto potencial del fraude es incalculable. El fraude amenaza la confianza pública en la ciencia y puede generar cambios en las acciones médicas y en las políticas de salud con irreparables consecuencias sociales. Evaluación del problema: Aunque la prevalencia del fraude no ha sido establecida, cada día son mas los países reportando casos de fraude. Las políticas referentes al proceso científico pueden estar contribuyendo a la presentación del fraude. La situación en Colombia: Colombia carece de políticas claras para encontrar y enfrentar el fraude en la investigación. Como enfrentar el problema: Finalmente se dan algunas recomendaciones para prevenir, descubrir y tratar el fraude en la investigación biomédica