Handgrip strength and upper limb functional performance measures in people over 18 years old: Analysis of relationships and influencing factors.

BACKGROUND: Handgrip strength is a common, simple, and inexpensive method to measure muscle strength. On the other hand, the functional performance measurement involves a usual task which implies repeating elements between the individuals' interaction and the environment. This is fundamental for projecting their results to daily life situation. PURPOSE: To explore the relationship between grip strength and measures of functional performance of the upper limbs (ULs) in people over 18 years of age, and to determine the influence of sociodemographic and anthropometric variables on the relationship. STUDY DESIGN: A cross-sectional study was conducted under the analytical empirical approach, using linear associations between handgrip strength and functional performance measurement tests (correspondence analysis). METHODS: Three hundred sixty-two male and female individuals between 18 and 91 years of age from 4 Colombian cities participated. The grip strength of both ULs measured with a digital dynamometry was associated with the Box and Block Test (BBT, manual dexterity), Nine-Hole Peg Test (NHPT, daily living tasks), and Jebsen-Taylor Hand Function Test (JJT, ability to grasp, pick up, and place). Multiple linear regression analyzes were performed to assess possible explanatory factors of a sociodemographic and anthropometric order. RESULTS: A significant association was found between the grip strength of dominant and non-dominant ULs with all functional performance tests (ρ > 0.27 and p < .001), except for the writing and simulated feeding subtests of the JJT (ρ ≤ 0.16). An interactive effect of age was found in the relationship between grip strength and the 3 functional performance tests. CONCLUSIONS: These results support the association between grip strength with the NHPT, JJT, and BBT measures and the interactive effect of age on the performance of all tests.

The Trail Making Test (part B) is associated with working memory: A concurrent validity study.

The Test Making Test (TMT) was originally created as a distributed attention test. Part B (TMT-B) has been proposed as representative of executive functions as effective problem solving and working memory. This study aimed to explore the validity of the TMT-B as an indicator of working memory in adults. A cross-sectional study was conducted by using linear correlation coefficients between the TMT-B and neuropsychological and electrophysiological tests of working memory. Fifty-six individuals participated, all of which had normal cognitive functioning and were aged between 19 and 55 years old. Results show a significant correlation among the TMT-B scores with all subtests, the overall score of the Corsi Block-Tapping Test, the Working Memory Index of the WAIS-IV (Wechsler Adult Intelligence Scale) (p ≤ .05) and the auditory Event Related Potentials (p < .01) with the N200 and P300 latencies and amplitudes. These findings are preliminary evidence of the validity of the TMT-B for the evaluation of working memory in adults. Additional studies are required to assess the differential validity of the TMT-B in the evaluation of working memory, through comparative correlational analyzes with the results of various neuropsychological tests that assess other cognitive functions.

Teorías cognitivas dinámicas o de tercera generación: análisis documental de artículos originales de investigación cualitativa / Dynamic or Third-Generation Cognitive Theories: A Documentary Analysis of Original Qualitative Research Articles

Resumen En los últimos años ha crecido el interés por la búsqueda de evidencia científica sobre el nuevo paradigma de la cognición dinámica, pero la gran mayoría de publicaciones se han hecho a partir de diseños cuantitativos, lo que evidencia que es necesario complementar la investigación con diseños cualitativos. El objetivo del presente manuscrito es valorar la cantidad y calidad de la publicación científica basada en diseños de investigación cualitativos, en el área de las teorías dinámicas de la cognición o teorías cognitivas de tercera generación. Estas teorías proponen que la cognición es un fenómeno corporeizado, extendido, situado y enactivo. Se realizó un análisis documental en las principales bases de datos internacionales sobre artículos científicos con diseño cualitativo. Se seleccionaron catorce (14) artículos que cumplieron los criterios de inclusión y respondían al objetivo de la revisión. Se encontró que, aunque la investigación cualitativa en este campo es escasa, comparada con la investigación cuantitativa, se observó un potencial de estos diseños en el estudio de las teorías cognitivas dinámicas en distintos ámbitos, a saber, psicología, salud, funcionamiento y discapacidad, educación, actividad física y deporte, arte, lingüística, filosofía de la mente, entre otros. Los resultados y conclusiones de las investigaciones revisadas aportan sustento teórico de la cognición corporeizada, enactiva, extendida y situada, y soportan el objeto de estudio de las ciencias cognitivas emergentes: "el sistema cerebro-cuerpo-en el mundo".

Abstract In recent years, there has been a growing interest in the search for scientific evidence on the new paradigm of dynamic cognition, but the vast majority of publications have been based on quantitative designs, evidencing the need to complement research with qualitative designs. This manuscript aims to assess the quantity and quality of scientific publications based on qualitative research designs in the area of dynamic theories of cognition or third-generation cognitive theories. These theories propose that cognition is an embodied, extended, situated, and enactive phenomenon. A documentary analysis was carried out in the main international databases on scientific articles with qualitative design. Fourteen articles were selected that fully met the inclusion criteria and responded to the objective of the literature review. Although qualitative research in this field is scarce compared to quantitative research, the potential of these designs is observed in the study of dynamic cognitive theories in different fields: psychology, health, functioning and disability, education, physical activity and sport, art, linguistics, philosophy of mind, among others. The results and conclusions of the research reviewed provide theoretical support for embodied, enactive, extended, and situated cognition, and support the object of study of emerging cognitive sciences: "the brain/body-in-the-world system."

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.

Programa propioceptivo a futbolistas pre-juveniles de un club deportivo, ciudad de Manizales / Proprioceptive program for pre-junior soccer players of a sports club, city of Manizales

El objetivo de esta experiencia fue analizar el efecto de un programa de propiocepción sobre el equilibrio en un grupo de jóvenes futbolistas. Se planteó un programa de 8 ejercicios, los cuales fueron extraídos del programa de calentamiento realizado por Bizzini, Junge, & Dvorak (2007) "11+ un programa completo de calentamiento para prevenir las lesiones en el fútbol", los cuales fueron adaptados y aplicados durante 4 semanas, 4 veces, en sesiones de 15 a 20 minutos. Se aplicó en un grupo de 17 deportistas cuyas edades oscilaban entre 14 y 15 años, pertenecientes a la escuela de fútbol del Club Deportivo Once Caldas S.A. a los cuales se les administró un pre-test y post-test con la prueba de Romberg y Romberg sensibilizado. Los resultados al final del programa mostraban la mejora en el equilibrio estático, aumentando este en un 18% según el test de Romberg y un 29% en el test de Romberg sensibilizado. Como conclusión se destaca la eficacia del programa de propiocepción para mejorar equilibrio en este grupo.

The target of this study was to analyze the effect of a propioception program on the balance in a group of young soccer players. A program of 8 exercises was proposed, which were extracted from the warm-up program developed by Bizzini, Junge, & Dvorak (2007) "11 + a finished warm-up program to prepare for injuries in the soccer", which were adapted and applied for 4 weeks, 4 times a week in meetings that lasted between 15 and 20 minutes. It was applied to a group of 17 athletics whose ages range between 14 and 15 years old, belonging to the Eleven Caldas S.A school of soccer club, to which a previous evaluation was applied with the Romberg test and the Romberg sensitive test. The athletics were reevaluated after having finished the four week program obtaining results, that were positive and demonstrated the propioception program improved their balance, with an increase of 18% in the Romberg test and 29% in the Romberg sensitive test. As conclusions, one emphasizes the efficacy of propioception program to improve balance.

Adherencia a procesos de neurorrehabilitación funcional y su relación con la discapacidad y la calidad de vida en adultos colombianos con lesión medular / Adherence to functional neurorehabilitation processes and their relation to disability and quality of life in Colombian adults with spinal cord injury

Resumen Introducción. El conocimiento de la adherencia terapéutica en condiciones crónicas de salud como la lesión medular y su relación con la discapacidad y la calidad de vida puede reflejar mejores resultados en procesos de rehabilitación. Objetivo. Establecer el nivel de adherencia a procesos de neurorrehabilitación funcional y su relación con la discapacidad y la calidad de vida relacionada con la salud (CVRS) en adultos colombianos con lesión medular. Materiales y métodos. Estudio descriptivo correlacional con 330 participantes en el que se aplicaron diferentes instrumentos de medición: SMAN para adherencia a procesos de neurorrehabilitación funcional, SCI-DAS para discapacidad en lesiones medulares y WHOQOL-BREF para CVRS. Resultados. En el 80% la discapacidad global fue leve y moderada. 66% de los participantes reportaron niveles medio y alto de adherencia. El promedio de calidad de vida general fue de 68/100. Se encontró correlación significativa, por un lado, entre el componente ambiental de la discapacidad con la adherencia global y sus factores socio-económico, equipo de asistencia sanitaria, tratamiento y paciente y, por el otro, entre el dominio ambiental de la CVRS con la adherencia global y todos sus factores (p<0.001). Conclusión. Los principales determinantes de la adherencia a procesos de neurorrehabilitación funcional son los componentes ambientales de la discapacidad y la CVRS.

Abstract Introduction: Knowledge on adherence to treatment in chronic health conditions, such as spinal cord injury, and their relation with disability and quality of life may reflect better results in rehabilitation processes. Objective: To establish the level of adherence to functional neurorehabilitation processes and its relation to disability and health-related quality of life (HRQOL) in Colombian adults with spinal cord injury. Materials and methods: Descriptive correlational study with 330 participants in which different measuring instruments were applied: SMAN for adherence to functional neurorehabilitation processes, SCI-DAS for disability in spinal cord injuries, and WHOQOL-BREF for HRQOL. Results: In 80% of cases, overall disability was mild to moderate. 66% of participants reported medium and high adhesion levels. The average overall quality of life was 68/100. On the one hand, significant correlation between the environmental component of disability regarding adherence and the socio-economic, health care team, treatment and patient factors were found, and on the other, between the environmental domain of HRQOL and the overall adherence and all its factors (p<0.001). Conclusion: The main determinants of adherence to functional neurorehabilitation processes are environmental components of disability and HRQOL.

Protocolo para disminuir las infecciones asociadas a catéteres centrovenosos en unidades de cuidados críticos / Protocol to diminish the infections associated with central venous catheters in critical care units

Introducción: las infecciones asociadas al empleo de catéteres centrovenosos son una complicación frecuente en la Unidad de Cuidados Intensivos del Hospital Provincial General Docente Dr. Antonio Luaces Iraola de Ciego de Ávila y, hasta el momento, no se aplica una estrategia estandarizada encaminada a su prevención.Método: se realizó un estudio experimental, en el período de abril de 2012 a diciembre de 2013, con el propósito de evaluar un protocolo para disminuir las infecciones asociadas al empleo de catéteres centrovenosos. El universo estuvo constituido por 101 pacientes a quienes se les realizó cateterismo centrovenoso; de los pacientes que cumplieron los criterios de inclusión del estudio se seleccionó una muestra holística que se dividió en dos grupos: en uno se aplicó el paquete de medidas del protocolo, mientras que en el otro se realizó el procedimiento estándar de cuidados al catéter.Resultados: los bacilos gramnegativos fueron los gérmenes más frecuentemente implicados en infecciones relacionadas al empleo de estos dispositivos en la Unidad de Cuidados Intensivos (75 por ciento) de los casos). Mediante la aplicación del protocolo disminuyeron las infecciones asociadas al uso del catéter centrovenoso (14,2 por ciento), así como sus subtipos específicos, y los casos de colonización asintomática del dispositivo (este último aspecto resultó estadísticamente significativo).Conclusiones: se demostró la eficacia del protocolo para disminuir la aparición de infecciones asociadas a catéteres centrovenosos, las infecciones locales relacionadas, y las complicaciones derivadas, por lo que se propone su adopción permanente en la realización de este procedimiento en la Unidad de Cuidados Intensivos(AU)

Introduction: the infections associated to the use of central venous catheters are a common complication in the Intensive Care Unit of the Provincial General Teaching Hospital Dr. Antonio Luaces Iraola in Ciego de Ávila and, so far, a standardized strategy for prevention is not apply.Method: an experimental study was carried out between April 2012 and December 2013, with the purpose of evaluating a protocol to decrease the infections associated with the use of central venous catheters. The universe was composed of 101 patients who underwent central venous catheterization; of patients who met the inclusion criteria of the study, a holistic sample divided into two groups was selected: in one group the protocol package was applied, while in the other the standard procedure catheter care was carried out.Results: gramnegative bacilli were the germs most frequently involved in infections related to the use of these devices in the Intensive Care Unit (75 percent of cases). By applying the protocol, the infections associated to the use of central venous catheter decreased (14,2 percent), as well as their specific subtypes, and cases of asymptomatic colonization of the device (this last aspect was statistically significant).Conclusions: the effectiveness of the protocol to decrease the occurrence of infections associated with central venous catheters, related local infections, and related complications was demonstrated, so its permanent adoption is proposed in performing this procedure in the Intensive Care Unit (AU)

Lengua negra vellosa / Beautiful black tongue

La lengua negra vellosa es una patología benigna relativamente frecuente, caracterizada por una coloración pardo-negruzca de la superficie lingual asociada a hipertrofia de papilas filiformes dando aspecto de vellosidades. Los factores de riesgo son amplios y de exposición cotidiana (antibióticos, alcohol, tabaco, higiene dental deficiente). Entre sus diagnósticos diferenciales es útil recordar aquellos asociados con neoplasias o inmunocompromiso (acantosis nigricans oral, leucoplasia vellosa, etc.). Su diagnóstico es clínico; sin embargo, cuando las causas o historia no son claras, la exploración clínica es atípica o hay refractariedad sistemática a los tratamientos habituales, se debe plantear un estudio ampliado (AU)

Black hairy tongue is a relatively common benign disease, characterized by brown-black discoloration and hypertrophic tongue surface, giving aspect of villi. Risk factors are broad and from daily exposure (antibiotics, alcohol, tobacco, poor dental hygiene). Among its differential diagnoses it is useful to recall those associated with malignancies or immunocompromise (oral acanthosis nigricans, hairy leukoplakia, etc.). Diagnosis is clinical, but when the causes are unclear, history or clinical examination is atypical, or treatment is refractory, it should be considered an extended study (AU)

Comparación de sistema de sellado de vasos y ligadura convencional en tiroidectomías / Comparison of vessel sealing system and conventional ligation in thyroidectomy

Cada día es más frecuente en la cirugia tiroidea, el uso de sistemas electromecánicos como método hemostático, en oposicion a la hemostasia convencional. Se realiza un estudio comparativo entre el sistema de sellado de vasos sanguíneos LigaSure® y la hemostasia convencional con ligadura. Se analizaron 113 historias de pacientes sometidos a cirugia tiroidea, evaluando estudios preoperatorios, indicación quirúrgica, complicaciones intra y postoperatorias, reintervención, tiempo quirúrgico, días de hospitalización y resultados de anatomía patológica. Entre enero 2002 y diciembre del 2012, se realizaron 113 tiroidectomías; 52 con el método habitual de ligadura y en 61 pacientes se utilizó como método hemostático el LigaSure®. El promedio de edad fue de 41,3 y 46 años respectivamente; el diagnóstico fue de carcinoma papilar en 19,2% y 22,9%. El tiempo de duración del acto quirúrgico en el grupo de hemostasia convencional fue de 78,8 minutos y en el grupo con sellado de vaso de 74,4 minutos, con un drenaje postoperatorio de 85 y 71 cc para cada grupo. Los días de hospitalizacion fue 3,1 y 2,19. En cuanto a complicaciones: el hematoma post operatorio, con reintervencion (2 casos en ligadura convencional, 1 con el LigaSure®); lesión del nervio recurrente laríngeo (1 caso en cada grupo), hipocalcemia transitoria (3 casos en el grupo convencional y 1 caso en el grupo de LigaSure®); un paciente ameritó traqueostomía en el grupo de LigaSure®. En conclusión, la hemostasia en la tiroidectomía utilizando el metodo de sellado de vasos con LigaSure®, permite la realización del acto quirurgico con comodidad y seguridad, con una ligera ventaja que al utilizar métodos convencionales.

Every day, it is more common in thyroid surgery, the use of electromechanical systems, as hemostatic method in thyroid surgery, as opposed to conventional hemostasis. A comparative study between blood vessel sealing system LigaSure® and conventional hemostasis with ligation was carried out. 113 patients records who underwent thyroid surgery, evaluating preoperative studies, surgical indication, intra and postoperative complications, reoperation, surgical time, days of hospitalization and pathological anatomy results were analized. Between january 2002 and december 2012, 113 thyroidectomies were performed; 52 with the usual ligature method and 61 patients with the LigaSure® hemostatic method. The average age was 41.3 and 46 years respectively; papillary carcinoma was diagnosed in 19,2% and 22,9%. The duration of surgery in the conventional hemostasis group was 78.8 minutes and 74.4 minutes in the vessel sealing group, with a postoperative drainage of 85 and 71 cc for each group. The days of hospitalization were 3.1 and 2.19. In terms of complications: postoperative hematoma with reoperation (2 cases in the conventional group and 1 case in the LigaSure® group); recurrent laryngeal nerve lesion (1 case in each group), transient hypocalcemia (3 cases in the conventional group and 1 case in the LigaSure® group); one patient required tracheostomy in the LigaSure® group. In conclusion, hemostasis in thyroidectomy using the LigaSure® vessel sealing method, allows the realization of surgery in comfort and safety with a slight advantage to conventional methods.

Validez de apariencia y concurrente de un instrumento de evaluación de la discapacidad en personas con lesión medular crónica, basado en el core set abreviado de la CIF / Appearance and Concurrent Validity of an Instrument for Assessing Disability in People with Chronic Spinal Cord Injury, Based on the ICF Core Set / Validade de aparência e concorrente de um instrumento de avaliação de incapacidade em pessoas com lesão medular crônica baseado no core set abreviado da CIF

Objetivo. Determinar la validez de apariencia y concurrente de un instrumento de evaluación de la discapacidad en personas con lesión medular crónica (SCI-DAS), basado en el core set abreviado de la CIF. Metodología. Participaron 100 personas con lesión medular de más de seis meses de evolución de cuatro ciudades colombianas, así como ocho fisioterapeutas con una experiencia profesional promedio de 6,75 años. La validez de apariencia se evaluó a través de un grupo focal y una encuesta a los observadores, se calcularon los coeficientes de variación de los ítems y los índices de pertinencia y adecuación. Mediante el coeficiente de correlación de Spearman se analizó la validez concurrente con la escala de deficiencia AIS (American Spinal Injury Association [ASIA] Impairment Scale), y la escala de discapacidad WHO-DAS II. Resultados. La pertinencia y adecuación global del instrumento arrojaron una media de 4,83/5 y 4,48/5 con un coeficiente de variación de 0,03. El índice de acuerdo entre observadores para las calificaciones de buena y excelente fue de 0,96 para pertinencia y 0,86 para adecuación. La discapacidad medida con el SCI-DAS mostró correlación significativa moderada con el nivel neurológico, los índice motor y sensitivo AIS, y alta con la discapacidad medida con el WHO-DAS II (p<0,001). Se encontró correlación baja estadísticamente marginal con la escala de compromiso funcional AIS (p=0,052). Conclusiones. Se encontró, en general, buena validez de apariencia del instrumento SCI-DAS, así mismo se evidenció la validez concurrente del instrumento SCI-DAS con la escala de deficiencia AIS y con la escala de discapacidad de la OMS-WHO-DAS II.

Objective. To determine the appearance and concurrent validity of an instrument for assessing disability in people with chronic spinal cord injury (SCI-DAS), based on the ICF Core Set. Metodology. The study was launched among a group of 100 Colombians from four cities suffering spinal cord injury for longer than six months. Eight physical therapists, with an average professional experience of over 6.75 years, participated in this study. Appearance validity was assessed through a focus group and a survey of observers, the items of coeficient of variation and the relevance and appropriateness index were calculated. Concurrent validity was analyzed with AIS (American Spinal Injury Association [ASIA] Impairment Scale) and Disability Scale WHO-DAS II, using the Spearman correlation coefficient. Results. The overall relevance and adequacy of the instrument yielded an average of 4.83/5 and 4.48/5, with a variation coefficient of 0.03. The agreement index among observers for qualifications of good and excellent reached 0.96 for relevance, and 0.86 for adequacy. The disability measured by the SCI-DAS showed a moderate significant correlation with the neurological level, the AIS motor and sensory indices, and a high correlation with disability, measured by WHO-DAS II (p<0. 001). A marginal statistically low-level correlation of functional compromise scale AIS (p = 0. 052) was found. Conclusions. In general, a good appearance validity of the instrument (SCI-DAS) was found. The concurrent validity of the instrument (SCI-DAS) through the impairment scale AIS and the Disability Scale - WHO-DAS II was also evidenced.

Objetivo. Determinar a validade de aparência e concorrente de um instrumento de avaliação de incapacidade em pessoas com lesão medular crônica (SCI-DAS), com base no core set abreviado da CIF. Metodologia. Participaram 100 pessoas com lesão medular de mais de seis meses de evolução de quatro cidades colombianas, assim como oito isioterapeutas com uma experiência professional media de 6,75 anos. A validade da aparência foi avaliada por meio de um grupo focal e um inquérito aos observadores, calcularem- sem os coeficientes de variação dos itens e os índices de pertinência e adequação. Mediante o coeiciente de correlação de Spearman se analisou a validade concorrente com a escala de deficiência AIS (American Spinal Injury Association [ASIA] Impairment Scale), e a Escala de Discapacidade WHO-DAS II. Resultados. A relevância e adequação global do instrumento resultou em uma média de 4,83/5 e 4,48/5 com um coeficiente de variação de 0,03. A taxa de concordância entre observadores para as classificações de boa e excelente foi 0,96 para relevância e 0,86 para a adequação. A incapacidade medida com o SCI-DAS mostrou correlação significativa moderada com o nível neurológico, os índices motor e sensorial AIS, e alta com a incapadidade medida com o WHO-DAS II (p <0,001). Foi encontrada correlação baixa estatisticamente marginal com a escala de compromisso funcional AIS (p = 0,052). Conclusões. No geral, foi encontrada boa validade de aparência do instrumento SCI-DAS, assim como também se evidenciou a validade concorrente do instrumento SCI-DAS com a Escala de Deficiência AIS e com a Escala de Incapacidade da OMS-WHO-DAS II.

Relación entre complicaciones clínicas y discapacidad en población colombiana con lesión medular: resultados desde el WHO-DAS II / Relationship between Clinical Complications and Disability in Colombians with Spinal Cord Injury: Results from WHO-DAS II / Relação entre complicações clínicas e deficiências em população colombiana com lesão medular: resultados a partir do WHO-DAS II

Introducción: las complicaciones clínicas en personas con lesión medular se asocian al aumento de la morbimortalidad, agravamiento de la condición de discapacidad y a la prolongación de los procesos de rehabilitación. Es importante su reconocimiento para el desarrollo de estrategias de prevención y atención temprana más eficaces que atenúen su impacto sobre la discapacidad y mejoren la calidad de vida de esta población. Objetivo: establecer las relaciones entre complicaciones clínicas y el grado de discapacidad en población colombiana con lesión medular. Materiales y métodos: se determinó la frecuencia de complicaciones clínicas en el último año y se estableció la relación entre estas con el grado de discapacidad, evaluado con el WHO-DAS II, a través de la prueba t de Student y de la exploración de modelos de regresión lineal simple. Participaron 363 personas mayores de 18 años con lesión medular de más de seis meses de evolución, de ocho ciudades colombianas. Resultados: el promedio de complicaciones clínicas fue de siete por paciente. Las complicaciones más frecuentes fueron las infecciones urinarias, espasticidad, hiperestesias, estrés psicológico y dolor crónico. Las complicaciones que mejor explican la discapacidad utilizando modelos de regresión simple son la depresión y el estrés psicológico, seguido de complicaciones respiratorias, problemas intestinales, úlceras de presión, desnutrición y espasticidad (p < 0,01). Conclusiones: las complicaciones clínicas asociadas a la lesión medular siguen siendo condiciones frecuentes en nuestro medio a pesar de los avances en los procesos de atención y rehabilitación. Muchas de estas complicaciones se asocian en gran medida a la generación de discapacidad.

Introduction: Clinical complications in persons with spinal cord injury are associated with increased morbidity and mortality, aggravated disability and prolonged rehabilitation processes. Recognizing these difficulties is important to developing strategies for prevention and early detection to mitigate their impact on disability and to improve the quality of life for this population. Objective: The study was intended to identify the relationship between clinical complications and the degree of disability among Colombians with spinal cord injury. Materials and methods: The frequency of clinical complications in the last year was determined and the relationship between these complications and the degree of disability was identified, evaluated with WHO-DAS II, through the Student's t-test and an exploration of simple linear regression models. The participants included 363 persons over 18 years of age with a spinal cord injury sustained more than six months before. The participants were from eight Colombian cities. Results: There were seven clinical complications per patient, on average. The most frequent complications were urinary tract infections, spasticity, hyperesthesia, psychological stress and chronic pain. The complications that best explain the disability, using simple regression models, are depression and psychological stress, followed by respiratory complications, intestinal problems, pressure ulcers, malnutrition and spasticity (p < 0.01). Conclusions: The clinical complications associated with spinal cord injury are still frequent in Colombia, despite the improvement in processes for care and rehabilitation. Many of these complications are associated fundamentally with the generation of disability.

Introdução: as complicações clínicas em pessoas com lesão muscular se associam ao aumento da morbimortalidade, agravamento da condição de deficiência e à prolongação dos processos de reabilitação. É importante seu reconhecimento para o desenvolvimento de estratégias de prevenção e tenro atendimento mais eficazes que amenizem seu impacto sobre a deficiência e melhorem a qualidade de vida dessa população. Objetivo: estabelecer as relações entre complicações clínicas e o grau de deficiência em população colombiana com lesão medular. Materiais e métodos: determinou-se a frequência de complicações clínicas no último ano e se estabeleceu a relação entre estas com o grau de deficiência avaliado com o WHO-DAS II, por meio da prova t de Student e da exploração de modelos de regressão linear simples. Participaram 363 pessoas maiores de 18 anos com lesão medular de mais de seis meses de evolução, de oito cidades colombianas. Resultados: a média de complicações clínicas foi de sete por paciente. As complicações mais frequentes foram as infecções urinárias, espasticidade, hiperestesia, estresse psicológico e dor crônica. As complicações que melhor explicam a deficiência utilizando modelos de regressão simples são a depressão e o estresse psicológico, seguido de complicações respiratórias, problemas intestinais, úlceras de pressão, desnutrição e espasticidade (p < 0,01). Conclusões: as complicações clínicas associadas à lesão medular continuam sendo condições frequentes em nosso meio apesar dos avanços nos processos de atendimento e reabilitação. Muitas dessas complicações se associam em grande medida à geração de deficiência.

Resultados de la aplicación de un protocolo para el destete de la ventilación mecánica / Results of the application of a protocol for weaning from mechanical ventilation

Con el objetivo de validar un protocolo de destete precoz y seguro para disminuir el tiempo de ventilación y las complicaciones asociadas a la ventilación mecánica, en el Hospital Provincial General Docente Dr. Antonio Luaces Iraola de Ciego de Ávila, se realizó un estudio pre experimental con grupo único. El universo estuvo constituido por 107 pacientes ventilados por más de 24 horas que ingresaron en el período comprendido de marzo del 2006 a febrero del 2010 y cumplieron los criterios de destete (por antecedentes patológicos antes del destete y predictores seleccionados en el protocolo. La aplicación del protocolo permitió minimizar los intentos fallidos en el destete, con lo cual disminuyó el tiempo de ventilación, el fallo del destete y las complicaciones asociadas a la ventilación mecánica (AU)

With the objective to validate a protocol of early and safe weaning to diminish the time of ventilation and the complications associated to mechanical ventilation, in the Provincial Teaching Hospital Dr. Antonio Luaces Iraolafrom Ciego de Avila, a pre experimental study with unique group was carried out. The universe was constituted by 107 patients ventilated for more than 24 hours from March 2006 to February 2010 and fulfilled the criteria of weaning (by pathological antecedents before the weaning and predictors selected in the protocol).The protocol application allowed to diminish vain attempts in the weaning, which it reduced the ventilation time , the weaning failure and the complications associated to mechanical ventilation (AU)

Comportamiento de la morbilidad en el Área Intensiva de Cayo Coco durante dos años de trabajo / Behavior of the morbidity in the intensive area of Cayo Coco during two years of work

Se realizó un estudio observacional descriptivo con carácter retrospectivo de los pacientes atendidos en el Área Intensiva del polo turístico de Cayo Coco desde enero del 2008 a diciembre del 2009. La muestra estuvo constituida por 152 turistas y 74 pacientes nacionales, con el objetivo de determinar el comportamiento de la morbilidad; se estableció que el 65% de los pacientes pertenecían al grupo de 15 a 60 años, predominó el sexo masculino y los turistas canadienses fueron los que más se atendieron. Entre los extranjeros la causa de ingreso más frecuente fue la gastroenterocolitis con desequilibrios hidroelectrolíticos con 40 pacientes, seguido de las urgencias cardiovasculares con 31; entre los cubanos estas últimas fueron las primeras con 27 pacientes. El 59,9 por ciento de los turistas y el 54.4 por ciento de los pacientes nacionales permanecieron ingresados por más de 2 horas. El 63.2 por ciento de los turistas resolvió su enfermedad en la sala, se requirió remitir solo el 36,8 por ciento, mientras que el 68.8 por ciento de los nacionales necesitaron ser remitidos al hospital de Morón(AU)

t was realized a descriptive observational study with retrospective character of the patients attended in the Intensive Area of the tourist pole of Cayo Coco from January of the 2008 to December of the 2009. The sample was constituted by 152 tourists and 74 national patients, with the objective to determine the behaviour of the morbidity; , it was establish that 65 percent of the patients belonged to the group of 15 to 60 years, predominating the masculine sex and that the Canadian tourists were those that more were attended. The cause of entry more frequent between the foreigners was the gastroenterocolitis with hydro electrolytic disequilibrium, with 40 patients, followed of the cardiovascular urgencies with 31; between the Cuban patients these last were the first cause with 27 patients. 59.9 percent of the tourists and 54.4 percent of the national patients remained entered by more than 2 hours. 63.2 percent of the tourist resolved his illness in the room, requiring remit only 36.8 percent, whereas 68.8 percent of the national needed to be remitted to Moróns hospital(AU)

Comportamiento de la morbilidad en el Área Intensiva de Cayo Coco durante dos años de trabajo / Behavior of the morbidity in the intensive area of Cayo Coco during two years of work

Se realizó un estudio observacional descriptivo con carácter retrospectivo de los pacientes atendidos en el Área Intensiva del polo turístico de Cayo Coco desde enero del 2008 a diciembre del 2009. La muestra estuvo constituida por 152 turistas y 74 pacientes nacionales, con el objetivo de determinar el comportamiento de la morbilidad; se estableció que el 65% de los pacientes pertenecían al grupo de 15 a 60 años, predominó el sexo masculino y los turistas canadienses fueron los que más se atendieron. Entre los extranjeros la causa de ingreso más frecuente fue la gastroenterocolitis con desequilibrios hidroelectrolíticos con 40 pacientes, seguido de las urgencias cardiovasculares con 31; entre los cubanos estas últimas fueron las primeras con 27 pacientes. El 59,9 por ciento de los turistas y el 54.4 por ciento de los pacientes nacionales permanecieron ingresados por más de 2 horas. El 63.2 por ciento de los turistas resolvió su enfermedad en la sala, se requirió remitir solo el 36,8 por ciento, mientras que el 68.8 por ciento de los nacionales necesitaron ser remitidos al hospital de Morón.

It was realized a descriptive observational study with retrospective character of the patients attended in the Intensive Area of the tourist pole of Cayo Coco from January of the 2008 to December of the 2009. The sample was constituted by 152 tourists and 74 national patients, with the objective to determine the behaviour of the morbidity; , it was establish that 65 percent of the patients belonged to the group of 15 to 60 years, predominating the masculine sex and that the Canadian tourists were those that more were attended. The cause of entry more frequent between the foreigners was the gastroenterocolitis with hydro electrolytic disequilibrium, with 40 patients, followed of the cardiovascular urgencies with 31; between the Cuban patients these last were the first cause with 27 patients. 59.9 percent of the tourists and 54.4 percent of the national patients remained entered by more than 2 hours. 63.2 percent of the tourist resolved his illness in the room, requiring remit only 36.8 percent, whereas 68.8 percent of the national needed to be remitted to Morón’s hospital.

Situación de discapacidad de la población adulta con lesión medular de la ciudad de Manizales / Disability situation of adults with spinal cord injury In the city of Manizales / Situaçãode incapacidade em adultos com lesão medular Na cidade de manizales

Objetivo: describir el grado de discapacidad y correlacionarla con características sociodemográficas, clínicas y de acceso, suficiencia y satisfacción con los servicios de rehabilitación, de adultos con lesión medular de Manizales (Colombia). Materiales y métodos: se realizó un estudio descriptivo correlacional con 45 personas mayores de 18 años con lesión medular de variada etiología, nivel neurológico y completitud, con más de seis meses de evolución, en instituciones de salud y rehabilitación de Manizales (Colombia), durante el segundo semestre del 2009 y el primero del 2010. Se utilizó el WHO-DAS II y la Escala de Deficiencia ASIA. Resultados: todos los participantes presentaron algún grado de discapacidad. Se encontraron relaciones significativas entre la discapacidad general con tipo de afiliación al sistema de salud, situación ocupacional, nivel neurológico, zona de preservación parcial, índices motor y sensitivo ASIA, tiempo de evolución de la lesión y cantidad de complicaciones. Entre estas se obtuvieron: asociación significativa con infecciones urinarias, dolor articular, disrreflexia autonómica y problemas intestinales. En cuanto a la utilización de servicios de rehabilitación no se hallaron relaciones significativas con ninguna de las variables, pero sí se encontraron diferencias significativas entre grupos que recibieron y no recibieron aditamentos y orientación vocacional, laboral y educativa. Conclusiones: las relaciones encontradas entre los elementos sociodemográficos, clínicos y contextuales con la situación de discapacidad de las personas con lesión medular indican la necesidad de implementar intervenciones en salud pública orientadas a disminuir su incidencia, prevenir las complicaciones asociadas y favorecer los procesos integrales de rehabilitación que propicien la inclusión social.

Objective: To describe the degree of disability in adult population with spinal cord injury and correlate it with social-demographic, clinical and access features as well as sufficiency and satisfaction with rehabilitation services in the city of Manizales (Colombia). Materials and methods: a descriptive correlational study with forty-five 18 year old people with varied etiology, neurological level and completeness with more than six months evolution was carried out in health and rehabilitation Institutions in Manizales (Colombia) between the second semester 2009 and the first semester 2010. The WHO DAS II and the ASIA Impairment Scale were used. Results: all participants reported some degree of disability. Significant associations were found between the type of general disability and the type of affiliation to the public health system, professional situation, neurological level, zone of partial preservation, sensory and motor ASIA rates, the lesion evolution time, and number of complications. The complications significantly associated with disability were: urinary tract infections, joint pain, autonomic dysreflexia and intestinal problems. As far as the use of rehabilitation services no meaningful relationship was found with any of the variables but meaningful differences were found between the groups that received accessories and vocational, labour, and educational guidance and those that did not receive such guidance. Conclusions: the correlations found between social-demographic, clinical and contextual variables concerning the situation of disabled people with spinal cord injury indicated the need to implement public health interventions aimed at reducing its incidence, prevent associated complications and promote integrated rehabilitation processes that foster social inclusion.

Objetivo: descrever o grau de deficiência física e co- relaciona- lá com características sócio-demograficos, clinicas e de aceso, suficiência e satisfação com os serviços de reabilitação, de adultos com lesão medular de Manizales (Colômbia). Materiais e métodos: realizou se uma pesquisa descritiva co-relacional com 45 pessoas e maiores de 18 anos com lesão de variada etiologia, nível neurológico e com plenitude, com mais de seis meses de evolução, em instituições de saúde e reabilitação de Manizales (Colômbia), durante o segundo semestre de 2009 e o primeiro de 2010. Utilizou se o WHO-DAS II e a Escada de Deficiência ASIA. Resultados: todos os participantes apresentaram algum grau de deficiência física. Encontraram se relações significativas entre a deficiência geral com tipo de afiliação ao sistema de saúde, situação ocupacional, nível neurológico, zona de preservação parcial, índices motor e sensitivo ASIA, tempo de evolução de a lesão e quantidade de complicações. Entre estas se obtiveram: associação significativa com infecções urinaria dor articular, disreflexia autonômica e problemas intestinais. Em quanto à utilização de serviços reabilitação não encontraram se relaciones significativas com nenhuma das variáveis, mas sim encontraram se diferencias significativas entre grupos que receberam e não receberam aditamentos e orientação vocacional, laboral e educativa. Conclusões: As relações encontradas entre os elementos sócio-demograficos, clínicos e contextuais com a situação de deficiência das pessoas com lesão medular indicam a necessidade de levar a pratica intervenções em saúde publica orientadas a diminuir sua incidência, prevenir as complicações associadas e favorecer os processos integrais de reabilitação que propiciem a inclusão social.

Reporte de los primeros lesionados por el pez león atendidos en la Clínica de Cayo Coco, Ciego de Ávila / Report of the first injured persons for the fish lion attended in the Clinic of Cayo Coco, Ciego of Avila

Se describe el comportamiento clínico de los seis pacientes lesionados por pez león atendidos en la Clínica Internacional de Cayo Coco durante el periodo de dos años (2009 y 2010). Los seis pacientes fueron lesionados cuando realizaban acciones de pesca, al entrar en contacto de forma accidental con el pez; las lesiones las recibieron en las manos, todos presentaron dolor quemante y edema inflamatorio en el área lesionada; solo un paciente que recibió tres hincadas tuvo manifestaciones sistémicas. Todos los pacientes recibieron tratamiento local; se les administraron analgésicos y esteroides y solo uno necesitó resucitación con volumen. Ningún paciente falleció ni quedó con secuelas(AU)

It is described the clinical behavior of six patients injured by lion fish attended in the International Clinic of Cayo Coco during the period of two years (2009 and 2010). Six patients were injured when they realized actions of fishing, on having contacted of accidental form the fish; the injuries were received in the hands, they all presented burning pain and inflammatory edema in the disabled area; only a patient who received three punctures had systemic manifestations. All the patients received local treatment; analgesics and steroids were administered to them and only one needed volume resuscitation. No patient died nor stayed with aftermath(AU)

Npc1 deficiency in the C57BL/6J genetic background enhances Niemann-Pick disease type C spleen pathology.

Niemann-Pick type C (NPC) disease is an autosomal recessive neurovisceral lipid storage disorder. The affected genes are NPC1 and NPC2. Mutations in either gene lead to intracellular cholesterol accumulation. There are three forms of the disease, which are categorized based on the onset and severity of the disease: the infantile form, in which the liver and spleen are severely affected, the juvenile form, in which the liver and brain are affected, and the adult form, which affects the brain. In mice, a spontaneous mutation in the Npc1 gene originated in the BALB/c inbred strain mimics the juvenile form of the disease. To study the influence of genetic background on the expression of NPC disease in mice, we transferred the Npc1 mutation from the BALB/c to C57BL/6J inbred background. We found that C57BL/6J-Npc1(-/-) mice present with a much more aggressive form of the disease, including a shorter lifespan than BALB/c-Npc1(-/-) mice. Surprisingly, there was no difference in the amount of cholesterol in the brains of Npc1(-/-) mice of either mouse strain. However, Npc1(-/-) mice with the C57BL/6J genetic background showed striking spleen damage with a marked buildup of cholesterol and phospholipids at an early age, which correlated with large foamy cell clusters. In addition, C57BL/6J Npc1(-/-) mice presented red cell abnormalities and abundant ghost erythrocytes that correlated with a lower hemoglobin concentration. We also found abnormalities in white cells, such as cytoplasmic granulation and neutrophil hypersegmentation that included lymphopenia and atypias. In conclusion, Npc1 deficiency in the C57BL6/J background is associated with spleen, erythrocyte, and immune system abnormalities that lead to a reduced lifespan.

Modelo predictivo del grado de discapacidad en adultos con lesión medular: resultados desde el WHO-DAS II / A prediction model for establishing the disability degree in adults with spinal cord injury: results based on WHO-DAS II perspective / Modelo preditivo de o grau de incapacidade em adultos com lesão medular: resultados da WHO-DAS II

Objetivo: Establecer un modelo predictivo del grado de discapacidad en adultos con lesión medular a partir de la utilización del WHO-DAS II. Materiales y Métodos: Se correlacionó el grado de discapacidad (por áreas y final) con variables sociodemográficas, clínicas y relacionadas con los servicios de rehabilitación y se construyó un modelo de regresión lineal múltiple para discapacidad. Participaron 45 personas con lesión medular de variada etiología, nivel neurológico y completitud, mayores de 18 años con más de seis meses de evolución. Se utilizó el WHO-DAS II y la escala de deficiencia ASIA. Resultados: Las variables que evidenciaron relación significativa con la discapacidad fueron: situación ocupacional, tipo de afiliación al sistema público de salud, tiempo de evolución, nivel neurológico, zona de preservación parcial, índices motor y sensitivo ASIA y número de complicaciones clínicas en el último año. Las complicaciones que se asociaron significativamente con la discapacidad fueron dolor articular, infecciones urinarias, problemas intestinales y disreflexia autonómica. Ninguna de las variables asociadas a servicios de rehabilitación presentó asociación significativa con la discapacidad. Los únicos servicios que mostraron diferencia significativa entre el grupo que los recibió y el que no, en relación con la discapacidad, fueron el suministro de aditamentos y la orientación vocacional, laboral o educativa. Conclusiones: El mejor modelo predictivo de discapacidad en adultos con lesión medular con más de seis meses de evolución se construyó con las variables tiempo de evolución, índice sensitivo ASIA y desempleo por la lesión.

Objective: To establish a prediction model of the degree of disability in adults with Spinal Cord Injury (SCI) based on the use of the WHO-DAS II. Methods: The disability degree was correlated with three variable groups: clinical, sociodemographic and those related with rehabilitation services. A model of multiple linear regression was built to predict disability. 45 people with SCI exhibiting diverse etiology, neurological level and completeness participated. Patients were older than 18 and they had more than a six-month post-injury. The WHO-DAS II and the ASIA impairment scale (AIS) were used. Results: Variables that evidenced a significant relationship with disability were the following: occupational situation, type of affiliation to the public health care system, injury evolution time, neurological level, partial preservation zone, AIS motor and sensory scores and number of clinical complications during the last year. Complications significantly associated to disability were joint pain, urinary infections, intestinal problems and autonomic disreflexia. None of the variables related to rehabilitation services showed significant association with disability. The disability degree exhibited significant differences in favor of the groups that received the following services: assistive devices supply and vocational, job or educational counseling. Conclusions: The best prediction disability model in adults with SCI with more than six months post-injury was built with variables of injury evolution time, AIS sensory score and injury-related unemployment.

Objetivo: Estabelecer um modelo preditivo do grau de deficiência em adultos com lesão medular a partir da utilização do WHO-DAS II Metodologia: correlacionou-se o grau de deficiência (por áreas e final) com variáveis sócio-demográficas, clínicas e relacionadas com os serviços de reabilitação e construiu-se um modelo de regressão lineal múltiple para deficiência. Participaram 45 pessoas com lesão medular de variada etologia, nível neurológico e plenitude, maiores de 18 anos, com mais de seis meses de evolução. Utilizou-se o WHO-DAS II e a escala de deficiência ASIA. Resultados: As variáveis que evidenciaram relação significativa com a discapacidade foram: situação ocupacional, tipo de afiliação ao sistema público de saúde, tempo de evolução, nível neurológico, zona de preservação parcial, índices motor e sensitivo ASIA e número de complicações clínicas no último ano. As complicações se associaram significativamente com a deficiência foram dor articular, infecções urinarias, problemas intestinais e disreflexia autonômica. Nenhuma das variáveis associadas a serviços de reabilitação apresentou associação significativa com a deficiência. Os únicos serviços que mostraram diferença significativa entre o grupo que os recebeu e o grupo que não, em relação com a deficiência, foram o fornecimento de aditamentos e a orientação vocacional, laboral ou educativa. Conclusões: o melhor modelo preditivo de deficiência em adultos com lesão medular com mais de 6 meses de evolução se construiu com as variáveis: tempo de evolução, índice sensitivo ASIA e desemprego pela lesão.