[Clinical and epidemiological differences and similarities of viral pneumonias in two pandemics]. / Diferencias y similitudes clínicas y epidemiológicas de la neumonía viral en dos pandemias.

BACKGROUND: In a decade, we faced two pandemic viruses, influenza A H1N1pdm09 and SARS CoV-2, whose most serious manifestation is pneumonia. AIM: To compare the clinical, epidemiological and management aspects of pneumonias caused by each pandemic virus in adults requiring hospitalization. MATERIAL AND METHODS: Comparative, observational study carried out at a regional Chilean hospital, including 75 patients with influenza A H1N1pdm09 prospectively studied in 2009 and 142 patients with SARS-CoV-2 studied in 2020. RESULTS: Patients with SARS-CoV-2 pneumonia were older (56 and 39.7 years respectively, p < 0.01) and had significantly more comorbidities. Cough, fever and myalgias were more frequent in influenza. Dyspnea was more frequent in COVID-19. Patients with COVID-19 had more extensive lung involvement and a longer hospitalization (13.6 and 8.6 days respectively, p = 0.01). There was no difference on ICU admission requirements and mortality attributable to pneumonia. Patients with influenza had greater APACHE scores and a higher frequency of a PaO2/FiO2 ratio ≤ 200. During COVID-19pandemic chest sean replaced x-ray examination. Also high-flow nasal cannulas and awake prone position ventilation were added as treatments. CONCLUSIONS: COVID-19 patients were older, had fewer classic flu symptoms but more dyspnea and longer hospitalization periods than patients with influenza.

[Features of patients admitted with COVID-19 to a Chilean regional hospital during the first stages of the pandemic]. / COVID-19 en adultos en el Hospital de Puerto Montt en la primera etapa de la pandemia.

BACKGROUND: The COVID-19 pandemic posed a great strain in health services. AIM: To describe the epidemiological and clinical features of patients with SARS-CoV-2 admitted to a regional hospital in southern Chile between April and August 2020. MATERIAL AND METHODS: Clinical records of all hospitalized patients with RT-PCR (+) for SARS-CoV-2 were retrospectively analyzed. RESULTS: During the study period 226 patients aged 55 ± 18 years (55% men) were admitted. The main comorbidities were high blood pressure in 45%, diabetes in 31% and obesity in 21%. The main symptoms were dyspnea in 70%, cough in 69%, fever in 62% and myalgia in 47%. Pneumonia was the main cause of admission in 66%. Images on admission were compatible with pneumonia in 81%, and with a typical COVID-19 pattern in 84%. In 76% there was five-lobe involvement. Eighty-seven cases (39%) were admitted to critical care, with an APACHE score of 10.9 ± 7.1. Invasive mechanical ventilation was used in 16%, 30% required prone position and 13%, a high-flow nasal cannula. The mean stay in critical care was 13.3 days. The mean duration of invasive mechanical ventilation was 14.1 days. Antimicrobials were used in 55% and dexamethasone in 36%. Twenty-two (9.7%) patients aged 71.7 ± 14 died. A Charlson comorbidity index > 3, heart failure and connection to invasive mechanical ventilation were independent risk factors for death. An age > 65 years alone and other comorbidities were not risk factors. CONCLUSIONS: Viral pneumonia is the main cause of hospitalization for COVID-19, usually extensive and bilateral. The greater severity and poor prognosis of these patients are mainly related to comorbidities.

COVID-19 en adultos en el Hospital de Puerto Montt en la primera etapa de la pandemia / Features of patients admitted with COVID-19 to a Chilean regional hospital during the first stages of the pandemic

BACKGROUND: The COVID-19 pandemic posed a great strain in health services. AIM: To describe the epidemiological and clinical features of patients with SARS-CoV-2 admitted to a regional hospital in southern Chile between April and August 2020. MATERIAL AND METHODS: Clinical records of all hospitalized patients with RT-PCR (+) for SARS-CoV-2 were retrospectively analyzed. RESULTS: During the study period 226 patients aged 55 ± 18 years (55% men) were admitted. The main comorbidities were high blood pressure in 45%, diabetes in 31% and obesity in 21%. The main symptoms were dyspnea in 70%, cough in 69%, fever in 62% and myalgia in 47%. Pneumonia was the main cause of admission in 66%. Images on admission were compatible with pneumonia in 81%, and with a typical COVID-19 pattern in 84%. In 76% there was five-lobe involvement. Eighty-seven cases (39%) were admitted to critical care, with an APACHE score of 10.9 ± 7.1. Invasive mechanical ventilation was used in 16%, 30% required prone position and 13%, a high-flow nasal cannula. The mean stay in critical care was 13.3 days. The mean duration of invasive mechanical ventilation was 14.1 days. Antimicrobials were used in 55% and dexamethasone in 36%. Twenty-two (9.7%) patients aged 71.7 ± 14 died. A Charlson comorbidity index > 3, heart failure and connection to invasive mechanical ventilation were independent risk factors for death. An age > 65 years alone and other comorbidities were not risk factors. CONCLUSIONS: Viral pneumonia is the main cause of hospitalization for COVID-19, usually extensive and bilateral. The greater severity and poor prognosis of these patients are mainly related to comorbidities.

Diferencias y similitudes clínicas y epidemiológicas de la neumonía viral en dos pandemias / Clinical and epidemiological differences and similarities of viral pneumonias in two pandemics

BACKGROUND: In a decade, we faced two pandemic viruses, influenza A H1N1pdm09 and SARS CoV-2, whose most serious manifestation is pneumonia. AIM: To compare the clinical, epidemiological and management aspects of pneumonias caused by each pandemic virus in adults requiring hospitalization. Material and Methods: Comparative, observational study carried out at a regional Chilean hospital, including 75 patients with influenza A H1N1pdm09 prospectively studied in 2009 and 142 patients with SARS-CoV-2 studied in 2020. RESULTS: Patients with SARS-CoV-2 pneumonia were older (56 and 39.7 years respectively, p < 0.01) and had significantly more comorbidities. Cough, fever and myalgias were more frequent in influenza. Dyspnea was more frequent in COVID-19. Patients with COVID-19 had more extensive lung involvement and a longer hospitalization (13.6 and 8.6 days respectively, p = 0.01). There was no difference on ICU admission requirements and mortality attributable to pneumonia. Patients with influenza had greater APACHE scores and a higher frequency of a PaO2/FiO2 ratio ≤ 200. During COVID-19pandemic chest sean replaced x-ray examination. Also high-flow nasal cannulas and awake prone position ventilation were added as treatments. Conclusions: COVID-19 patients were older, had fewer classic flu symptoms but more dyspnea and longer hospitalization periods than patients with influenza.

Eficacia y percepción del dolor en técnicas de estiramientos hold-relax y electroestimulación / Efficiency and Perception of Pain in Hold-Relax Stretching Techniques and Electrostimulation

Se analizó el efecto de la técnica de estiramiento HOLD RELAX sin (HR) y con electroestimulación (HR+EE) sobre la mejora y retención del rango de movimiento (ROM) activo (AROM) y pasivo (PROM) de cadera en flexión, y la percepción del dolor durante su aplicación. 42 deportistas fueron asignados a tres grupos: control, HR y HR+EE. El ROM fue medido con el test Straight-Leg-Raise antes, al finalizar el entrenamiento y trascurridas 2 semanas de su finalización. La valoración del dolor se realizó con la escala EVA. El ANOVA mostró un aumento significativo del PROM (p < 0,001) en HR y HR+EE, no así del AROM. No se observaron pérdidas significativas del PROM en la retención de sendos grupos. En cuanto al dolor, no existieron diferencias significativas en los valores de EVA al aplicar ambas técnicas. Tanto HR como HR+EE fueron bien toleradas en cuanto a la percepción del dolor

The objective of this study was to analyze the effect of the Hold-Relax stretching technique without (HR) and with electrostimulation (HR+EE) on the improvement and retention of active movement range (AROM) and passive (PROM) of hip in flexion, and the perception of pain during its application. 42 athletes were assigned to three groups: control, HR+EE and HR. The range of motion of the hip flexion was measured by test straight-leg-rise before, once completed and after 2 weeks of completion the training. Pain assessment was performed in all sessions with the EVA scale. The ANOVA showed a very significant increase in PROM (p < 0.001) in HR and HR+EE, but not in AROM. No significant PROM losses were observed in the retention of both groups. Regarding pain, there were no significant differences in EVA values when applying both techniques. Both HR and HR+EE were well tolerated in terms of pain perception

Effect of melatonin administration on the PER1 and BMAL1 clock genes in patients with Parkinson's disease.

Sleep disorders are a widespread condition in patients with Parkinson's disease (PD), which has been linked to a deregulation of the circadian cycle and therefore of the clock genes. The aim of this study was to evaluate the effect of melatonin (MEL) on the PER1 and BMAL1 clock genes in patients with PD. A double-blind, cross-over, placebo-controlled randomized clinical trial pilot study was conducted in 26 patients with stage 1-3 PD according to the Hoehn & Yahr scale, who received either 25 mg of MEL or a placebo at noon and 30 min before bedtime for three months. The relative expression of the PER1 and BMAL1 genes was measured, as well as the presence of daytime, nocturnal, and global sleepiness, and the progression of PD. The levels of the PER1 and BMAL1 genes at baseline were 0.9 (0.1-3) vs. 0.56 (0.1-2.5), respectively; while after the intervention with MEL or placebo the BMAL1 levels increased to 2.5 (0-3.70) vs. 2.2 (0.10-3.30), respectively (d = 0.387). Fifty percent (50 %) of patients had daytime sleepiness and sixty-five percent (65 %) had abnormal nighttime sleepiness, yet neither group showed changes after the intervention. Patients with PD exhibited an alteration in the levels of the clock genes: MEL increased the levels of BMAL1, but the PER1 levels remained unchanged.

Comparación de técnicas de entrenamiento de flexibilidad (FNP) con y sin electroestimulación / Comparison of flexibility training techniques (Pnf) with and without electrostimulation

El objetivo de este estudio fue analizar el efecto de la técnica de estiramiento Contract-Relax Agonist Contract con (CRAC+EE) y sin (CRAC) electroestimulación sobre la mejora y retención del rango de movimiento activo (AROM) y pasivo (PROM) de cadera en flexión, en extremidad inferior dominante. 34 estudiantes universitarios fueron asignados a tres grupos: control, CRAC+EE y CRAC. AROM y PROM fueron evaluados antes, una vez finalizada y tras dos semanas de la finalización del entrenamiento. El entrenamiento tuvo una duración de cuatro semanas, a razón de tres sesiones semanales. El ANOVA mostró un aumento muy significativo de AROM (p<0,001 y p<0,005) y PROM (p<0,001 y p<0,01) en ambos grupos experimentales respectivamente. En la retención, se mantienen valores superiores con respecto a la medida pre-test. Como conclusión, la aplicación de CRAC+EE y CRAC mejoró AROM y PROM, siendo además efectivas en la retención de sendos rangos de movimiento

The objective of this study was to analyze the effect of the Contract-Relax Agonist Contract stretching technique with (CRAC+EE) and without (CRAC) electrostimulation on the improvement and retention of active movement range (AROM) and passive (PROM) of hip in flexion, in dominant lower extremity. 34 university students were assigned to three groups: control, CRAC+EE and CRAC. AROM and PROM were evaluated before, once completed and after 2 weeks of completion the training. The training lasted 4 weeks, with 3 sessions per week.The ANOVA showed a very significant increase in AROM (p<0.001 and p<0.005) and PROM (p<0.001 and p<0.01) in both experimental groups respectively. In the retention, higher values are maintained with respect to the pre-test measurement. In conclusion, the application of CRAC++EE and CRAC improved AROM and PROM, being also effective in the retention of two types of range of motion

Batería Funcional ARISTO en Gimnasia Rítmica: protocolo de test específicos para la evaluación de jóvenes gimnastas en un ámbito de entrenamiento saludable / Bateria Funcional em Ginastica Rítmica ARISTO: protocolo de testes específicos para avaliação de jovens ginastas em um ambiente de treino saudável / ARISTO Functional Battery in Rhythmic Gymnastics: Protocol of specific tests for the evaluation of young gymnasts in a field of healthy training

Objetivo. Presentar una batería de test para evaluar de manera específica las diferentes capacidades implícitas en el rendimiento de gimnasia rítmica. Método. La propuesta de los test se ha basado en un estudio del perfil motor de la gimnasia rítmica, así como en una revisión teórica de test existentes en este deporte y en especialidades gimnásticas similares con el fin de cubrir todas las capacidades relevantes inherentes en esta modalidad. Se realizó un estudio piloto con el objetivo de diagnosticar la viabilidad de la batería de test y se consensuó con los 11 socios del proyecto europeo en el que está enmarcado el trabajo («Asociaciones europeas en el ámbito del deporte»). Por último se configuró el soporte audiovisual del protocolo. Resultados. Se obtuvo una batería de 10 pruebas de fácil aplicación y que no reclaman un tiempo excesivo de los entrenamientos para su desarrollo. Igualmente supone un mínimo gasto económico, ya que el material utilizado es el que se encuentran en la propia sala de entrenamiento. Su aplicación permitirá medir: equilibrio, flexibilidad activa, flexibilidad pasiva, agilidad, fuerza-resistencia, coordinación y fuerza explosiva. Conclusión. El protocolo ARISTO de gimnasia rítmica se podría considerar una herramienta útil para facilitar una valoración de calidad de los entrenamientos en jóvenes practicantes de este deporte a nivel europeo (AU)

Objetivos. Apresentar uma bateria de testes para avaliar especificamente as diferentes habilidades implícitas no desempenho da ginástica rítmica. Método. A proposta dos testes foi baseada em um estudo do perfil motor das ginastas rítmicas, assim como em uma revisão teórica dos testes existentes nesse esporte e em especialidades de ginasticas semelhantes, a fim de abranger todas as capacidades relevantes inerentes a esta modalidade. Foi realizado um estudo piloto com objetivo de diagnosticar a viabilidade da bateria de testes e foi acordado a 11 parceiros do projeto europeu em que está enquadrado esta investigação (“Associação Européia no Domínio do Desporto”). Finalmente foi configurada o suporte audiovisual do protocolo foi configurado. Resultados. Foi obtida uma bateria de 10 testes, cada um de fácil aplicação e que não requerem um tempo excessivo de treino para o seu desenvolvimento. Igualmente pressupõe uma despesa económica mínima, uma vez que o material utilizado é o que se encontra na própria sala de treino. Sua aplicação permitirá medir: equilíbrio, flexibilidade ativa, flexibilidade passiva, agilidade, força-resistência, coordenação e força explosiva. Conclusão. O protocolo ARISTO de ginástica rítmica pode ser considerado uma ferramenta útil para facilitar a avaliação da qualidade do treinamento em jovens praticantes deste esporte a nível europeu (AU)

Objective. To present a battery of tests to evaluate specifically the different abilities implicit in the performance of the rhythmic gymnastic. Methods. The test proposal has been based on a study of the motor profile of rhythmic gymnasts, as well as a theoretical review of existing tests in this sport and similar gymnastic specialties in order to cover all relevant abilities inherent in this modality. A pilot study was carried out in order to diagnose the viability of the test battery and it was agreed with the 11 partners of the European project in which this research is framed (“European Actions in the field of Sport”). Finally the audiovisual support of the protocol was configured. Results. A battery of 10 tests was obtained, each one of easy application and that do not require an excessive time of training for its development. Equally it supposes a minimum economic expense, since the material used is the one that is in the own training room. Its application will be enable to measure: balance, active flexibility, passive flexibility, agility, strength-resistance, coordination and explosive force. Conclusion. The ARISTO rhythmic gymnastics protocol might be considered as a useful tool to facilitate the assessment of the quality of the training in young practitioners of this sport at European level (AU)

Análisis de las lesiones deportivas en jóvenes practicantes de gimnasia rítmica de competición en categoría infantil / Análise das lesões desportivas em jovens praticantes de ginástica rítmica de competição na categoria infantil / Analysis of sports injuries in young athletes of competitive rhythmic gymnastics in the infantile category

Objetivo. El propósito de este estudio ha sido identificar y analizar las lesiones más comunes en gimnasia rítmica de competición en base a las características del entrenamiento, así como las áreas potenciales sobre las que se podrían aplicar medidas de prevención. Método. Se ha llevado a cabo un estudio descriptivo transversal retrospectivo mediante un cuestionario-entrevista a 64 gimnastas (edad: 11.84±1.81 años; peso: 38.43±7.86kg; talla: 1.47±0.11m). Las variables objeto de estudio fueron el tiempo de práctica y las lesiones sufridas por los gimnastas (localización, tipología, severidad, mecanismo de producción y el momento en el que se producen). Resultados. Se registraron un total de 50 lesiones, 19 leves (38%), 23 moderadas (46%) y 8 graves (16%). La región corporal más afectada fue la espalda con un (42%) seguida del tobillo con un 16%. Las lesiones más frecuentes fueron las contracturas musculares (48%), esguinces (20%), tendinopatías (16%) y roturas/microrroturas fibrilares (6%). Respecto a los mecanismos lesionales, se deben destacar la sobrecarga (44%) y el mal apoyo (30%). La fase con mayor incidencia lesional fue el calentamiento (50%). Conclusiones. Predominan las lesiones de tipo muscular y tendinoso, siendo la espalda la zona más afectada. Estos resultados deben tenerse en cuenta para optimizar programas de prevención (AU)

Objective. The purpose of this study has been to identify and analyze the most common injuries in rhythmic gymnastic based on the characteristics of training, as well as the potential areas in which prevention measures could be applied. Method. This is a descriptive retrospective longitudinal study using a questionnaire-interview given to 64 gymnasts (age: 11.84±1.81 years; body mass: 38.43±7.86kg; height: 1.47±0.11m). The variables studied were the practice time and the injuries suffered by the gymnasts (location, typology, severity, production mechanism and the moment in which they occurred). Results. A total of 50 injuries was registered; 19 mild (38%), 23 moderate (46%) and 8 severe (16%). The most affected body region was the back (42%) followed by ankle with a 16%. The most frequent injuries were muscle contractures (48%), sprains (20%), tendinopathy (16%) and muscle micro-tears/tears (6%). Regarding the injury mechanisms, we would highlight the overtraining (44%) and bad support (30%). The phase with the highest injury incidence was the warm-up (50%). Conclusions. The most common injuries were muscular and tendon type, back was the most affected area. Results indicate the need for preventive measures, overall to the lower body joints, ankle and knee (AU)

Objetivo. O objetivo deste estudo foi identificar e analisar as lesões mais comuns em ginástica rítmica de competição com base nas características do treinamento, assim com as áreas potenciais sobre quais se podem aplicar medidas de prevenção. Método. Foi realizado um estudo descritivo transversal retrospectivo mediante um questionário de entrevista para 64 ginastas (idade=11,8 ±1,81 anos, peso=38,43±7,86kg, altura=1,47±0,11m). As variáveis estudadas foram o tempo de prática e as lesões sofridas pelas ginastas (localização, tipo, severidade, mecanismo de produção e o momento em que ocorrem). Resultados. Foram registradas um total de 50 lesões, 19 leves (38%), 23 moderadas (46%) e 8 graves (16%). A região do corpo mais afetada foi as costas (42%), seguida do tornozelo com 16%. As lesões mais frequentes foram espasmos musculares (48%), entorses (20%), tendinopatias (16%), rupturas/micro-rupturas fibrilares (6%). Em relação aos mecanismos de lesão se destaca a sobrecarga (44%) e mal apoio (30%). A fase de maior incidência de lesão foi o aquecimento (50%). Conclusões. Predominam as lesões musculares e do tendão, sendo as costas a área mais afetada. Estes resultados devem ser levados em conta para otimizar os programas de prevenção (AU)

Tacrolimus and the risk of solid cancers after liver transplant: a dose effect relationship.

Although increased rates of solid organ cancers have been reported following liver transplantation (LT), the impact of quantitative exposure to calcineurin inhibitors (CNI) remains unclear. We have therefore probed the relationship between the development of solid organ cancers following LT and the level of CNI exposure. This prospective single-center study was conducted between 1995 and 2008 and is based on 247 tacrolimus-treated liver transplant recipients who survived at least 1 year following surgery. The incidence of cancer was recorded, and the mean blood concentration of tacrolimus (TC) was determined at 1 and 3 years following LT. The study results indicate that 43 (17.4%) patients developed de novo solid cancers. Mean TC during the first year after LT was significantly higher in patients who developed solid organ tumors (10.3 ± 2.1 vs. 7.9 ± 1.9 ng/mL, p < 0.0001). Independent risks factors in multivariate analysis were tobacco consumption before LT (OR = 5.42; 95% CI [1.93-15.2], p = 0.0014) and mean annual TC during the first year after LT (p < 0.0001; OR = 2.01; 95% CI [1.57-2.59], p < 0.0001). Similar effects were observed in 216 patients who received tacrolimus continuously for ≥3 years. It appears therefore that CNI should be used with caution after LT, and that new immunosuppressive therapies could deliver significant clinical benefits in this regard.

Acute effect of active isolated stretching technique on range of motion and peak isometric force.

AIM: The aim of the study was to ascertain the acute effect of stretching technique Active Isolated Stretching (AIS) over the range of active and passive movement of the hip in flexion and peak isometric force (PIF) knee flexion. METHODS: The left and right leg of seventeen male Physical Education students (Mean age±SD=23±1 yrs, body mass=71.77±7.78 kg, height=175.5±7.5 cm) were treated as control and experimental groups and each leg was assessed separately for active (AROM) and passive (PROM) range of motion (ROM) and force. Immediately after the pretest, training was conducted with a single stretching session using AIS technique, consisting of 4 sets of 12 repetitions. Upon completion of the session, after 15s, the post-test was performed to evaluate ROM and isometric strength. RESULTS: The factorial ANOVA showed significant increases in AROM (P<0.05) and PROM (P<0.001) after the application of AIS in the experimental group. Only in AROM the value obtained in the experimental group was significantly greater than for the control group (p=0.018) AIS treatment did not affect stretching PIF values. CONCLUSION: We concluded that technique of AIS on the hamstring muscles was effective in improving acute ROM and caused no significant changes in PIF of knee flexion.

Effect of three types of flexibility training on active and passive hip range of motion.

AIM: The aim of this study was to measure the effect of 3 types of flexibility training, hold-relax (HR, N.=9), active isolated stretching (AIS, N.=9) and passive static stretching (PSS, N.=11) on passive and active range of motion of hip flexion after 9 weeks of flexibility training. METHODS: The subjects were physical education college students (14 men and 15 women) whose ages ranged between 20 and 24 years (age mean 21.79, SD: 2.45). A multigroup pre- post-test design with three experimental groups was used. The range of movement was measured by digitalization of pre-test and post-test images. RESULTS: Significant differences were found among the pre- and post-test for the three groups (P<0.05) on passive range of motion of the hip flexion, although there were no significant post-test differences between experimental groups. However, on the active range of motion of hip flexion there was only significant improvement among the pre-test and post-tests for PSS group (P<0.05). CONCLUSION: The results suggest that PSS is the best option for the improvement of both active and passive range of motion.

Ivermectina como alternativa terapéutica en neurocisticercosis resistente al tratamiento farmacológico convencional / Ivermectin as therapeutic alternative in neurocysticercosis that is resistant to conventional pharmacological treatment

La neurocisticercosis es un problema de salud pública con amplia distribución en el mundo, especialmenteen países en vías de desarrollo, y cada vez más creciente en países desarrollados, debido a las altas tasas de inmigración. El tratamiento cisticida en neurocisticercosis ha sido controvertido, porque su eficacia es parcial contra formas quísticasvesiculares y coloidales ante la persistencia del parásito después de un curso de albendazol o praziquantel, las dos únicas opciones terapéuticas disponibles actualmente. La ivermectina es un antiparasitario veterinario y humano de gran eficacia, seguro, con ocasionales y mínimos efectos colaterales, usada desde hace más de 25 años en endoparasitosis de difícil control, como filariasis, oncocercasis, estrongiloidiasis, etc., y también en ectoparasitosis, como pediculosis capitis y miasis.Actúa en la unión mioneural sobre los receptores en el canal de cloro, aumentando su permeabilidad causando parálisis en gusanos adultos, o por un mecanismo inmune mediado cuando actúa sobre formas inmaduras. Casos clínicos. Se presentan cuatro pacientes tratados previamente con albendazol en forma reiterada con evidencia radiológica, que demuestra la persistenciade quistes viables en forma vesicular o coloidal y crisis epilépticas persistentes, a quienes se les suministró ivermectina 10 mg/día durante 15 días consecutivos o 10 mg/día por medio durante 30 días, con excelente evolución clínica y radiológica.Conclusiones. La ivermectina fue eficaz y careció de eventos adversos al tratar a estos cuatro pacientes resistentes al tratamiento convencional con albendazol y/o praziquantel

Neurocysticercosis is a public health problem that can be found in many parts of the world, especiallyin developing countries, and today’s high rates of immigration are making it increasingly more common in developed countries. Cysticidal treatment of neurocysticercosis is a controversial issue because it is only partially effective againstvesicular and colloidal-shaped cysts when the parasite persists after a course of albendazole or praziquantel, the only two therapeutic options that are currently available. Ivermectin is a very effective, safe veterinary and human antiparasitic drug,with occasional very mild side effects. It has been used for over 25 years in cases of endoparasitosis that do not respond well to treatment, such as filariasis, oncocerciasis, strongyloidiasis, etc. and also in ectoparasitoses, such as pediculolsis capitisand myasis. It acts in the myoneural junction on the receptors in the chloride channel by increasing their permeability and causing paralysis in adult worms or by a mediated immune mechanism when it acts on immature forms. Case reports. We report the cases of four patients who were previously treated with albendazole reiteratively with radiological evidence, whichshows the persistence of viable vesicular or colloidal-shaped cysts. These patients were given 10 mg/day of ivermectin for 15 consecutive days or 10 mg/day as an average for 30 days, with excellent clinical and radiological progress. Conclusions.Ivermectin was effective and did not give rise to any side effects when used to treat these four patients, who were resistant to conventional treatment with albendazole and/or praziquantel

[Ivermectin as a therapeutic alternative in neurocysticercosis that is resistant to conventional pharmacological treatment]. / Ivermectina como alternativa terapéutica en neurocisticercosis resistente al tratamiento farmacológico convencional.

INTRODUCTION: Neurocysticercosis is a public health problem that can be found in many parts of the world, especially in developing countries, and today's high rates of immigration are making it increasingly more common in developed countries. Cysticidal treatment of neurocysticercosis is a controversial issue because it is only partially effective against vesicular and colloidal-shaped cysts when the parasite persists after a course of albendazole or praziquantel, the only two therapeutic options that are currently available. Ivermectin is a very effective, safe veterinary and human antiparasitic drug, with occasional very mild side effects. It has been used for over 25 years in cases of endoparasitosis that do not respond well to treatment, such as filariasis, oncocerciasis, strongyloidiasis, etc. and also in ectoparasitoses, such as pediculolsis capitis and myasis. It acts in the myoneural junction on the receptors in the chloride channel by increasing their permeability and causing paralysis in adult worms or by a mediated immune mechanism when it acts on immature forms. CASE REPORTS: We report the cases of four patients who were previously treated with albendazole reiteratively with radiological evidence, which shows the persistence of viable vesicular or colloidal-shaped cysts. These patients were given 10 mg/day of ivermectin for 15 consecutive days or 10 mg/day as an average for 30 days, with excellent clinical and radiological progress. CONCLUSIONS: Ivermectin was effective and did not give rise to any side effects when used to treat these four patients, who were resistant to conventional treatment with albendazole and/or praziquantel.

Diagnóstico prenatal de estenosis aórtica crítica y fibroelastosis endocárdica / Prenatal diagnosis of critical aortic stenosis and endocardial fibroelastosis

La fibroelastosis endocárdica (FE) se caracteriza por un engrosamiento difuso de la pared ventricular. Su etiología y patogenia no son bien conocidas y presenta un pronóstico variable, en general grave. Los casos de FE descritos prenatalmente suelen diagnosticarse en el segundo y tercer trimestres. A continuación, describimos un caso de diagnóstico prenatal de estenosis aórtica crítica y fibroelastosis endocárdica efectuado a las 26 semanas de gestación

Endocardial fibroelastosis is characterized by a diffuse thickenning of the ventricular endocardium. The cause and natural history of endocardial fibroelastosis is uncertain and controversial. Prognosis of endocardial fibroelastosis is variable and use to be severe. Prenatal diagnosis has been reported in a few cases, predominantley detected in the second and third trimester. Here we report the prenatal diagnosis of critical aortic estenosis and endocardial fibroelastosis at 26th weeks of gestational age

Violencia contra la mujer. Resultados de una encuesta hospitalaria / Domestic violence against women. Results of a hospital survey

Objetivo: Conocer, en los servicios de urgencia hospitalarios, la prevalencia de los malos tratos a la mujer por parte de su pareja. Material y métodos: Encuesta realizada a mujeres mayores de 18 años que acudieron por motivos distintos de los malos tratos. Las entrevistas fueron voluntarias, respetando siempre el anonimato y la confidencialidad. El análisis de los datos se hizo con el programa SPSS. Resultados: El 20 por ciento de las mujeres había recibido malos tratos a lo largo de su vida, y el 16 por ciento durante el último año. El 13 por ciento los había recibido cuando estaban embarazadas, y el 7 por ciento de las que estaban embarazadas recibió malos tratos. Sólo a un 10 por ciento de las mujeres les habían preguntado alguna vez en las consultas médicas sobre el tema. Conclusiones: Conocer la existencia del maltrato es el primer paso para proporcionar cuidados y atención a la mujer (AU)

Histerectomías en Andalucía en el año 2000 / Hysterectomies in Andalusia (Spain) in 2000

Objetivo: Conocer la tasa de histerectomías, las características demográficas y los diagnósticos y procedimientos asociados con las histerectomías, según los registros del Conjunto Mínimo Básico de Datos Andaluz (CMBDA).Material y métodos: Comparar los diagnósticos y procedimientos de las histerectomías con anexectomía bilateral y sin anexectomía bilateral realizadas en los 33 hospitales públicos de la comunidad andaluza en el año 2000.Resultados: Del total de 5.628 histerectomías, 2.728 se hicieron sin anexectomía bilateral y 2.846 con anexectomía bilateral. Las primeras fueron más frecuentes entre las mujeres de 40-50 años y las segundas entre las de 35-39 y las de 60-70 años. La tasa general estimada fue de 152 histerectomías por 100.000 mujeres, o 200 histerectomías por 100.000 mujeres mayores de 20 años. La tasa más alta correspondió a las mujeres entre 45-50 años (600 histerectomías por 100.000 mujeres). Hay diferencia de tasas entre provincias y entre hospitales. El 17 por ciento de las histerectomías se hicieron por patología maligna y el resto por patología benigna, de ellas, el 56 por ciento por leiomioma y el 24 por ciento por prolapso genital. El 65 por ciento de las histerectomías fueron abdominales totales y el 1,6 por ciento fueron vaginales asistidas por laparoscopia (LAVH).Conclusiones: Más de la mitad de las histerectomías realizadas por patología benigna se hicieron por diagnóstico de leiomioma en mujeres perimenopáusicas, acompañadas de anexectomía bilateral, con variación entre diferentes hospitales. La revisión periódica de la tasa de histerectomías nos permitirá, en un futuro, evaluar el impacto de las nuevas técnicas, como la histerescopia o el tratamiento hormonal local, en la reducción de este tipo de cirugía (AU)

Anomalías congénitas en Andalucía según el CMBDA del año 2000. Consideraciones para el diagnóstico prenatal precoz / Congenital anomalies in Andalucia according to CMBDA, 2000. Study for the prenatal diagnosis

Objetivo. Conocer el número de nacidos y diagnosticados con anomalías congénitas durante el primer año de vida, por órganos y sistemas. Material y métodos. A partir de los registros al alta de los hospitales públicos de la Comunidad Autónoma de Andalucía se analizan la frecuencia de anomalías congénitas y la estimación de la prevalencia en cada provincia y la estimación de la prevalencia en nacidos vivos por órganos y sistemas. Resultados. La. prevalencia estimada de nacidos vivos con anomalías congénitas es de 230 casos por 10.000 nacidos. Hay diferencias entre provincias. Por órganos y sistemas la tasa más alta corresponde a las de corazón y grandes vasos (77,1 por 10.000 nacidos vivos), y dentro de ellas el defecto del tabique ventricular tiene una tasa específica de 22,33 por 10.000 nacidos. El síndrome de Down tiene una tasa de 5 por 10.000 nacidos y la tasa de espina bífida es de 2,4 por 10.000 nacidos. Conclusiones. Los registros de alta hospitalaria de Andalucía son una herramienta útil para conocer la prevalencia de anomalías congénitas en nacidos vivos, aunque no pueden suplir un registro general de base poblacional (AU)

Diagnóstico prenatal de aneurisma subvalvular de ventrículo izquierdo / Prenatal diagnosis of subvalvular left ventricular aneurysm

El aneurisma congénito del ventrículo izquierdo es una malformación cardíaca infrecuente caracterizada por la dilatación de la pared ventricular, cuya historia natural no es bien conocida y, al contrario de lo que ocurre en el divertículo ventricular congénito, no se asocia con otras malformaciones. El pronóstico de esta afección depende de su tamaño y localización, así como de su crecimiento durante el embarazo. En el aneurisma congénito del ventrículo izquierdo subvalvular el pronóstico empeora por la alteración de la función de la válvula mitral. En nuestro caso, así como en el único caso publicado hasta la fecha, se produjo un considerable crecimiento del aneurisma, lo que finalmente condujo a un desenlace perinatal desfavorable. (AU)

Diagnóstico prenataltemprano de síndrome de regresión caudal asociado con diabetes mellitus / Early prenatal diagnosis of caudal regression syndrome associated with diabetes mellitus

El síndrome de regresión caudal (SRC) es un cuadro malformativo que se observa con mayor frecuencia en los embarazos de madres con diabetes mellitus pregestacional, con mal control metabólico. En este artículo describimos los hallazgos ecográficos, que incluyen la brusca interrupción de la columna lumbar y la posición en postura de Buda de los miembros inferiores, encontrados en un caso de SRC diagnosticado a las 17 semanas de embarazo en una gestante con diabetes mellitus pregestacional (AU)