Effectiveness of a telerehabilitation intervention using ReCOVery APP of long COVID patients: a randomized, 3-month follow-up clinical trial.

The main objective of this study is to analyze the clinical efficacy of telerehabilitation in the recovery of Long COVID patients through ReCOVery APP for 3 months, administered in the Primary Health Care context. The second objective is to identify significant models associated with an improvement in the study variables. An open-label randomized clinical trial was conducted using two parallel groups of a total of 100 Long COVID patients. The first group follows the treatment as usual methods established by their general practitioner (control group) and the second follows the same methods and also uses ReCOVery APP (intervention group). After the intervention, no significant differences were found in favour of the group intervention. Regarding adherence, 25% of the participants made significant use of the APP. Linear regression model establishes that the time of use of ReCOVery APP predicts an improvement in physical function (b = 0.001; p = 0.005) and community social support (b = 0.004; p = 0.021). In addition, an increase in self-efficacy and health literacy also contribute to improving cognitive function (b = 0.346; p = 0.001) and reducing the number of symptoms (b = 0.226; p = 0.002), respectively. In conclusion, the significant use of ReCOVery APP can contribute to the recovery of Long COVID patients. Trial Registration No.: ISRCTN91104012.

Symptoms and pathophysiology of cluster headache. Approach to combined occipital and supraorbital neurostimulation.

Cluster headache (CH) is included under section 3 - Trigeminal autonomic cephalalgias (TAC) of the International Headache Society (IHS) classification. It is one of the most frequent, painful and disabling primary headaches. Acute and preventive pharmacological treatments are often poorly tolerated and of limited effectiveness. Due to improved understanding of the pathophysiology of CH, neuromodulation devices are now considered safe and effective options for preventive and acute treatment of CH. In this paper, we review the information available to date, and present the case of a patient with disabling cluster headache highly resistant to medical treatment who underwent implantation of a peripheral nerve neurostimulation system to stimulate the supraorbital nerves (SON) and greater occipital nerve (GON) in our Pain Unit. We also review the diagnostic criteria for CH, the state of the knowledge on the pathophysiology of CH, and the role played by neuromodulation in treating this condition.

Clínica y fisiopatología de la cefalea en racimos. Acercamiento a la indicación de neuroestimulación combinada occipital y supraorbitaria / Symptoms and pathophysiology of cluster headache. Approach to combined occipital and supraorbital neurostimulation

La cefalea en racimos (CR) se encuadra dentro del apartado 3 de la clasificación de la Sociedad Internacional de Cefaleas (IHS), que es el reservado para las llamadas cefaleas trigémino autonómicas (CTA). Se trata de uno de los procesos de cefalea primaria más frecuentes, dolorosos e incapacitantes. Los tratamientos farmacológicos agudos y preventivos son, en muchos casos, mal tolerados y de efectividad limitada. Debido a la mejora en la comprensión de su fisiopatología de la CR, los dispositivos de neuromodulación se han posicionado como opciones seguras y eficaces de tratamiento preventivo y el tratamiento agudo de la CR. Haremos un recorrido sobre la información disponible hasta el momento y además, exponemos el caso de un paciente con CR incapacitante, muy resistente al tratamiento médico, tratado en nuestra Unidad del Dolor con el implante de un sistema de neuroestimulación de nervio periférico de nervios supraorbitario (SON) y nervio occipital mayor (GON). A continuación revisaremos los criterios diagnósticos que la definen la CR, lo datos que conocemos, a día de hoy, sobre su fisiopatología y la posición que ocupa actualmente la neuromodulación en el abordaje terapéutico de la misma. Con la descripción del caso clínico de un paciente tratado en nuestra Unidad del Dolor con una cefalea especialmente severa y resistente al tratamiento farmacológico.(AU)

Cluster headache (CH) is included under section 3 - Trigeminal autonomic cephalalgias (TAC) of the International Headache Society (IHS) classification. It is one of the most frequent, painful and disabling primary headaches. Acute and preventive pharmacological treatments are often poorly tolerated and of limited effectiveness. Due to improved understanding of the pathophysiology of CH, neuromodulation devices are now considered safe and effective options for preventive and acute treatment of CH. In this paper, we review the information available to date, and present the case of a patient with disabling cluster headache highly resistant to medical treatment who underwent implantation of a peripheral nerve neurostimulation system to stimulate the supraorbital nerves (SON) and greater occipital nerve (GON) in our Pain Unit. We also review the diagnostic criteria for CH, the state of the knowledge on the pathophysiology of CH, and the role played by neuromodulation in treating this condition.(AU)

Utility of capsule endoscopy in the diagnosis of gastrointestinal graft-versus-host disease.

INTRODUCTION AND AIM: Graft-versus-host disease (GvHD) is a complication of hematopoietic cell transplantation, and the small bowel is one of the main targets in the gastrointestinal tract. Capsule endoscopy is a safe procedure and can be useful in the diagnosis of GvHD. The aim of the present study was to compare the diagnostic yield of capsule endoscopy with the histopathologic findings in GvHD. MATERIALS AND METHODS: A retrospective diagnostic test study included all the patients with suspected GvHD that underwent gastroscopy and colonoscopy, with histopathologic evaluation of the biopsies taken, and capsule endoscopy, within the time frame of July 2015 and July 2019. Capsule endoscopy findings were compared with the histopathologic diagnosis, considered the gold standard. RESULTS: Twenty-one patients with GvHD (7 [33%] women; 37 ± 11.9 years of age) were included, 20 (95%) of whom had acute GvHD. The median gastric transit time of the capsule was 55 minutes (20-113) and the median small bowel transit time was 261 minutes (238-434). The entire small bowel was visualized through capsule endoscopy in 17 cases (80.95%). The histopathologic findings and capsule endoscopy findings resulted in the diagnosis of GvHD in 17 and 16 cases, respectively. There was agreement between the histopathologic and capsule endoscopy findings in 18 cases (15 positive and 3 negative). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic yield of capsule endoscopy were 88%, 75%, 94%, 60%, and 85%, respectively. CONCLUSIONS: Capsule endoscopy is a safe tool for the diagnosis of GvHD, with high sensitivity and positive predictive value, as well as moderate agreement with histopathologic findings.

Construcción y validación de un cuestionario para medir función gastrointestinal en adultos / Construction and validation of a questionnaire to measure gastrointestinal function in adults

INTRODUCCIÓN: La función gastrointestinal puede alterarse por distintas circunstancias clínicas o por efectos secundarios de algún tratamiento, tal es el caso de los pacientes oncológicos, ya sea por la localización del tumor en el aparato digestivo o por los efectos que produce la quimioterapia, la radioterapia o la cirugía y manifestarse con síntomas que pueden poner en riesgo el estado de nutrición. OBJETIVO: Por la importancia de evaluar la función gastrointestinal el objetivo de este estudio fue crear y validar un cuestionario que permita medirla en población adulta. MATERIAL Y MÉTODOS: La construcción del cuestionario se basó en la realización de distintas versiones que se fueron modificando después de la opinión y observaciones de parte un panel de expertos y de un pilotaje a 100 pacientes con cáncer. La validación se basó en la aplicación del cuestionario a 898 personas con y sin cáncer; para analizar la validez se utilizó Análisis factorial exploratorio y para la confiabilidad Alpha de Cronbach. RESULTADOS: La versión final quedó compuesta por 9 ítems que miden tanto los síntomas gastrointestinales como el ritmo intestinal. Se obtuvo el valor KMO de 0.850 y la prueba de Esfericidad de Bartlett de 2914.41 (gl. de 36). La extracción de los factores mediante el método de Componentes Principales distribuyó a los 9 ítems en 2 dimensiones con pesos factoriales ≥ 0.40, los cuales representan una varianza acumulada del 58.89%. En cuanto a la confiabilidad, se determinó por el análisis de Alpha de Cronbach, para el total del instrumento (9 ítems) y se obtuvo un valor de 0.844. CONCLUSIONES: El diseño de este cuestionario permite conocer la función gastrointestinal en personas adultas ya que identifica el nivel de gravedad de los síntomas gastrointestinales. Los niveles de confiabilidad nos aseguran que el cuestionario valora adecuadamente la función gastrointestinal

INTRODUCTION: Gastrointestinal function can be altered by different clinical circumstances, for example side effects of a treatment. In cancer patients, the gastrointestinal function is modified either due to the location of the tumor in the digestive system or by the side effects of chemotherapy, radiotherapy or surgery. This can be manifested with symptoms that could be a nutritional risk. AIM: To create and validate a questionnaire to measure gastrointestinal function in adults. MATERIAL AND METHODS: The construction of the questionnaire was based on different versions. The questionnaire was modified after the opinion and observations of expert panels and a pilot study of 100 patients with cancer. The validation was performed based on the application of the questionnaire to 898 participants. For the statistical analysis Cronbach's Alpha and Exploratory Factor analysis was performed. RESULTS: The final version of the questionnaire was integrated with 9 items that measure both gastrointestinal symptoms and intestinal rhythm. The KMO value was 0.850 and Bartlett's Sphericity test was 2914.41 (gl. of 36). The extraction of the factors by Principal Components Analysis distributed the 9 items in 2 dimensions with factors ≥ 0.40, which represent an accumulated variance of 58.89%. About trustworthy was determined by Cronbach's Alpha analysis, for the total 9 items the value obtained was 0.844. CONCLUSIONS: The design of this questionnaire allows to measure the gastrointestinal function in adults, also the identification of the level of severity of the gastrointestinal symptoms. The confidence levels assure that the questionnaire assess the gastrointestinal function adequately

Effect of parenteral glutamine in patients with gastrointestinal cancer undergoing surgery.

INTRODUCTION: Background and objective: malnutrition during cancer treatment is common in patients; therefore, nutritional intervention has an important role in cancer prognosis. Total parenteral nutrition is indicated for patients subjected to a major surgery with gastrointestinal complications. Nutritional support could be improved with glutamine (Gln). Therefore, in this work, the effect of parenteral glutamine in patients with gastrointestinal cancer undergoing surgery was studied. Material and methods: patients were classifi ed into two groups: non-supplemented and supplemented (Gln; 0.4 g/kg/day). Both groups received parenteral nutrition. One and seven days after surgery the nutritional status was evaluated. Hematic cytometry, protein metabolism and biochemical data were analyzed. A questionnaire was also applied to assess gastrointestinal function. Results: after the intervention, the nutritional status in both groups improved. However, the nutritional condition improved signifi cantly better (p = 0.008) in the supplemented group. According to the gastrointestinal function evaluation, the supplemented group changed from severe to mild dysfunction (p = 0.0001). The non-supplemented group progressed from moderate to severe dysfunction, but no changes in blood cell markers were observed. The supplemented group improved its concentration of lymphocytes (p = 0.014). The plasma albumin concentration did not change in groups, but prealbumin improved signifi cantly (p = 0.012) in the group that was supplemented with Gln. Conclusions: intravenous nutritional support supplemented with glutamine can improve gastrointestinal function, improving the absorption of nutrients, which leads to a better state of nutrition. It also has positive effects on plasma concentration of lymphocytes, monocytes and prealbumin.

INTRODUCCIÓN: Introducción y objetivo: los pacientes con cáncer desarrollan desnutrición durante el tratamiento antineoplásico, es por ello que el soporte nutricio tiene un rol importante. La nutrición parenteral es el soporte indicado para pacientes que fueron sometidos a cirugía con complicaciones gastrointestinales; este soporte puede ser suplementado con glutamina. Evaluamos el efecto de la glutamina parenteral en pacientes con cáncer gastrointestinal sometidos a cirugía. Material y métodos: se aleatorizaron los pacientes en dos grupos. Ambos grupos recibieron nutrición parenteral, en un grupo no suplementada y en otro grupo suplementada con glutamina (0,4 g/kg/día). Las medidas se tomaron el día uno y el día siete posteriores a la cirugía; en ambas mediciones se evaluó el estado nutricional, se tomó una muestra sanguínea para analizar parámetros bioquímicos y se aplicó un cuestionario de función gastrointestinal. Resultados: después de la intervención, el estado nutricional mejoró en ambos grupos, sin embargo, en el grupo suplementado mejoró significativamente (p = 0,008). De acuerdo a la función gastrointestinal, el grupo suplementado progresó de disfunción severa a leve (p = 0,0001), mientras que el grupo no suplementado progresó de disfunción moderada a severa. En cuanto a los parámetros bioquímicos, no hubo cambios en el grupo no suplementado. En ambos grupos no hubo cambios en las concentraciones plasmáticas de albúmina. En el grupo suplementado mejoraron de manera signifi cativa las concentraciones de linfocitos (p = 0,014) y prealbúmina (p = 0,012). Conclusión: el apoyo nutricio endovenoso suplementado con glutamina puede mejorar la función gastrointestinal, mejorando la absorción de nutrimentos, lo que conlleva a un mejor estado de nutrición. Asimismo, tiene efectos positivos en las concentraciones plasmáticas de linfocitos y monocitos y prealbúmina.

Effect of parenteral glutamine in patients with gastrointestinal cancer undergoing surgery / Efecto de la glutamina parenteral en pacientes con cáncer gastrointestinal sometidos a cirugía

Background and objective: malnutrition during cancer treatment is common in patients; therefore, nutritional intervention has an important role in cancer prognosis. Total parenteral nutrition is indicated for patients subjected to a major surgery with gastrointestinal complications. Nutritional support could be improved with glutamine (Gln). Therefore, in this work, the effect of parenteral glutamine in patients with gastrointestinal cancer undergoing surgery was studied. Material and methods: patients were classifi ed into two groups: non-supplemented and supplemented (Gln; 0.4 g/kg/day). Both groups received parenteral nutrition. One and seven days after surgery the nutritional status was evaluated. Hematic cytometry, protein metabolism and biochemical data were analyzed. A questionnaire was also applied to assess gastrointestinal function. Results: after the intervention, the nutritional status in both groups improved. However, the nutritional condition improved signifi cantly better (p = 0.008) in the supplemented group. According to the gastrointestinal function evaluation, the supplemented group changed from severe to mild dysfunction (p = 0.0001). The non-supplemented group progressed from moderate to severe dysfunction, but no changes in blood cell markers were observed. The supplemented group improved its concentration of lymphocytes (p = 0.014). The plasma albumin concentration did not change in groups, but prealbumin improved signifi cantly (p = 0.012) in the group that was supplemented with Gln. Conclusion: intravenous nutritional support supplemented with glutamine can improve gastrointestinal function, improving the absorption of nutrients, which leads to a better state of nutrition. It also has positive effects on plasma concentration of lymphocytes, monocytes and prealbumin

Introducción y objetivo: los pacientes con cáncer desarrollan desnutrición durante el tratamiento antineoplásico, es por ello que el soporte nutricio tiene un rol importante. La nutrición parenteral es el soporte indicado para pacientes que fueron sometidos a cirugía con complicaciones gastrointestinales; este soporte puede ser suplementado con glutamina. Evaluamos el efecto de la glutamina parenteral en pacientes con cáncer gastrointestinal sometidos a cirugía. Material y métodos: se aleatorizaron los pacientes en dos grupos. Ambos grupos recibieron nutrición parenteral, en un grupo no suplementada y en otro grupo suplementada con glutamina (0,4 g/kg/día). Las medidas se tomaron el día uno y el día siete posteriores a la cirugía; en ambas mediciones se evaluó el estado nutricional, se tomó una muestra sanguínea para analizar parámetros bioquímicos y se aplicó un cuestionario de función gastrointestinal. Resultados: después de la intervención, el estado nutricional mejoró en ambos grupos, sin embargo, en el grupo suplementado mejoró significativamente (p = 0,008). De acuerdo a la función gastrointestinal, el grupo suplementado progresó de disfunción severa a leve (p = 0,0001), mientras que el grupo no suplementado progresó de disfunción moderada a severa. En cuanto a los parámetros bioquímicos, no hubo cambios en el grupo no suplementado. En ambos grupos no hubo cambios en las concentraciones plasmáticas de albúmina. En el grupo suplementado mejoraron de manera significativa las concentraciones de linfocitos (p = 0,014) y prealbúmina (p = 0,012). Conclusión: el apoyo nutricio endovenoso suplementado con glutamina puede mejorar la función gastrointestinal, mejorando la absorción de nutrimentos, lo que conlleva a un mejor estado de nutrición. Asimismo, tiene efectos positivos en las concentraciones plasmáticas de linfocitos y monocitos y prealbúmina

Oral allergy syndrome amongst young Mexicans: prevalence and associated factors.

Summary: Background. Oral allergy syndrome (OAS) is the most common food allergy manifestation amongst adults. However, population studies aimed at estimating its prevalence and associated factors are scarce in Mexi-co. Objectives. To establish the prevalence of OAS in a sample of university students and to describe their clinical characteristics and its associated factors. Methods. From a sample group made up of 25,269 university students, the data corresponding to 1,200 students aged 18 to 25 was analyzed with a cross-sectional approach. A structured questionnaire was used to identify OAS, its symptoms and related foods, and the personal history of atopic diseases. The associations between variables were calculated through logistical regression analysis. Results. The prevalence of OAS was 3.4%, with a 95% confidence interval (95% CI) of 2.5 to 4.6. The main oral symptoms reported were lip pruritus, edema and the sensation of pharyngeal oppression. Among the extra-oral complaints were: reddish coloration of the skin, body pruritus, abdominal pain, and abdominal bloating. The foods that were most frequently associated with OAS were fruits (68.5%), vegetables (22.0%) and seafood (19.3%). Through multivariate analyses, allergy to pollen and latex were found to be associated with OAS, OR 3.29; 95%: CI 1.53 to 7.10 and OR 5.53; 95% CI: 1.08 to 28.2, respectively. Conclusions. Notably, the prevalence of OAS varies according to the geographic area. Personal histories of allergy to pollen or latex were the main factors linked to OAS.

Self-reported hypersensitivity and allergy to foods amongst Mexican adolescents: Prevalence and associated factors.

BACKGROUND: The prevalence of food allergy is on the rise on a global scale. OBJECTIVE: To determine the prevalence of food hypersensitivity (FHS) and probable food allergy (PFA), as well as the foods and factors associated with these occurrences. METHODS: A cross-sectional study was carried out among 1992 adolescents (aged 15-18 years). Each adolescent answered a structured questionnaire. A multivariate analysis was used to identify the association between the variables. RESULTS: The prevalence of FHS was 10.6% (the most commonly associated foods were shrimp, cow's milk and avocado) and the PFA was 7.8% (shrimp, cow's milk and pecan). The prevalences of oral allergy syndrome, food-associated urticaria and systemic reaction were 4.9%, 3.6% and 1.5%, respectively. The following factors were associated with FHS: personal history of asthma (OR 1.63; 95% CI: 1.11-2.41), allergic rhinitis (OR 2.60; 95% CI: 1.75-3.87), atopic dermatitis (OR 2.07; 95% CI: 1.25-3.43), maternal history of asthma (OR 1.80; 95% CI: 1.02-3.16), atopic dermatitis (OR 6.11; 95% CI: 2.45-15.29), and female sex (OR 1.89; 95% CI: 1.38-2.59). PFA was associated with a personal history of asthma (OR 1.65; 95% CI: 1.06-2.56), allergic rhinitis (OR 2.46; 95% CI: 1.56-3.88), atopic dermatitis (OR 2.02; 95% CI: 1.15-3.54), paternal allergic rhinitis (OR 2.52; 95% CI: 1.15-5.51), maternal atopic dermatitis (OR 7.46; 95% CI: 2.93-19.00), and female sex (OR 1.89; 95% CI: 1.31-2.72). CONCLUSION: The adverse reactions associated with foods among late adolescents are a frequent occurrence, and the most commonly associated factor is atopy.

Dolor en la articulación sacroilíaca: estudio prospectivo, aleatorizado, experimental y comparativo de la radiofrecuencia térmica con el bloqueo de la articulación sacroilíaca / Sacroiliac joint pain: Prospective, randomised, experimental and comparative study of thermal radiofrequency with sacroiliac joint block

Objetivo. Comparar el bloqueo con la radiofrecuencia térmica bipolar para el dolor de la articulación sacroilíaca. Método. Estudio prospectivo, aleatorizado y experimental en 60 pacientes, seleccionados en 9 meses en 2 centros, con dolor intenso (escala visual analógica [EVA] > 6) de > 3 meses de duración. Fueron divididos en 3 grupos (n = 20). Grupo A: pacientes a los que se les realizaron 2 bloqueos intraarticulares, con control ecográfico en 7 días. Grupo B: radiofrecuencia bipolar «palisade» utilizando 6 agujas perpendiculares a la zona dorsal del sacro, a una distancia de 1 cm, para producir lesiones contiguas entre los forámenes S1-S2-S3 y la línea articular. Grupo C: radiofrecuencia bipolar «palisade» modificada (distancia entre agujas > 1 cm). Los pacientes fueron evaluados al mes, a los 3 y a los 12 meses del tratamiento. Se valoraron los datos demográficos (en la visita basal), la eficacia analgésica y los efectos secundarios (en el resto). Resultados. Al mes, la reducción del dolor en los 3 grupos fue > 50% (p ≤ 0,001). A los 3 y 12 meses el grupo A no refirió disminución significativa del dolor. El grupo B, a los 3 meses, alivio cercano al 50% (p = 0,03), y < 25% (23,8) a los 12 meses (p = 0,01). En el grupo C, alivio próximo al 50% a los 3 y 12 meses (p < 0,001) respecto al basal. Todos los pacientes finalizaron el estudio. Conclusiones. La radiofrecuencia bipolar «palisade», especialmente aumentando la distancia entre las agujas, ha sido eficaz, a más largo plazo, que el bloqueo con anestésicos y corticoides en el alivio del dolor de la articulación sacroilíaca (AU)

Objective. To compare the analgesic effects between the blockade and bipolar thermal radiofrequency in the treatment of sacroiliac joint pain. Method. Prospective, randomised and experimental study conducted on 60 patients selected in the two hospitals over a period of nine months, who had intense sacroiliac joint pain (Visual Analogue Scale [VAS] > 6) that lasted more than 3 months. Patients were randomised into three groups (n = 20): Group A (two intra-articular sacroiliac injections of local anaesthetic/corticosteroid guided by ultrasound in 7 days). Group B: conventional bipolar radiofrequency «palisade». Target points were the lateral branch nerves of S1, S2, and S3, distance needles 1 cm. Group C: modified bipolar radiofrequency «palisade» (needle distance > 1 cm). Patients were evaluated at one month, three months, and one year. Demographic data, VAS reduction, and side effects of the techniques were assessed. Results. One month after the treatment, pain reduction was > 50% in the three groups P < .001. Three and 12 months after the technique, the patients of the group A did not have a significant reduction in pain. At 3 months, almost 50% patients of the group B referred to improvement of the pain (P = .03), and < 25% at 12 months, and those results were statistically significant (P = .01) compared to the baseline. Group C showed an improvement of 50% at 3 and 12 months (P < .001). All patients completed the study. Conclusions. Bipolar radiofrequency «palisade», especially when the distance between the needles was increased, was more effective and lasted longer, compared to join block and steroids, in relieving pain sacroiliac joint (AU)

Sacroiliac joint pain: Prospective, randomised, experimental and comparative study of thermal radiofrequency with sacroiliac joint block.

OBJECTIVE: To compare the analgesic effects between the blockade and bipolar thermal radiofrequency in the treatment of sacroiliac joint pain. METHOD: Prospective, randomised and experimental study conducted on 60 patients selected in the two hospitals over a period of nine months, who had intense sacroiliac joint pain (Visual Analogue Scale [VAS]>6) that lasted more than 3 months. Patients were randomised into three groups (n=20): Group A (two intra-articular sacroiliac injections of local anaesthetic/corticosteroid guided by ultrasound in 7 days). Group B: conventional bipolar radiofrequency "palisade". Target points were the lateral branch nerves of S1, S2, and S3, distance needles 1cm. Group C: modified bipolar radiofrequency "palisade" (needle distance >1cm). Patients were evaluated at one month, three months, and one year. Demographic data, VAS reduction, and side effects of the techniques were assessed. RESULTS: One month after the treatment, pain reduction was >50% in the three groups P<.001. Three and 12 months after the technique, the patients of the group A did not have a significant reduction in pain. At 3 months, almost 50% patients of the group B referred to improvement of the pain (P=.03), and <25% at 12 months, and those results were statistically significant (P=.01) compared to the baseline. Group C showed an improvement of 50% at 3 and 12 months (P<.001). All patients completed the study. CONCLUSIONS: Bipolar radiofrequency "palisade", especially when the distance between the needles was increased, was more effective and lasted longer, compared to join block and steroids, in relieving pain sacroiliac joint.

Mecanismos celulares y bioquímicos involucrados en la fisiopatogenia de la púrpura trombocitopénica autoinmune / Cellular and biochemical mechanisms involved in physiopathogenesis of autoimmune thrombocytopenic purpura

Autoimmune thrombocytopenic purpura (ATP) is a bleeding disorder caused by excessive destruction of antibody-coated platelets. It is known that platelet destruction takes place in macrophages of reticulo-endothelial system, but immunological mechanisms involved in such destruction are unknown. The objective of this article is to review the literature concerning pathogenesis of ATP: to have controlled experimental conditions some animal laboratory models have been used. The (NZW X BXSB) F1 mice have been studied as autoimmune disease model and Harrington mouse as an immune purpura model. Studies in humans suggest that there are some differences in pathogenesis of acute or chronic ATP, particularly in reactive T cells. For example, in chronic form there are high levels of The (CD4+) activity concomitant with low levels of T suppressor (CD8+) activity, while in acute form there is no dominance of any particular T cell activity or CD4+ is even decreased. Mitogen lymphocyte proliferation is increased in chronic ATP but decreased in acute form.

[Prediction of mortality and quality of life in polytraumatized patients: APACHE II versus APACHE III]. / Predicción de mortalidad y calidad de vida en politraumatizados: APACHE II frente a APACHE III.

OBJECTIVE: To evaluate the APACHE II and III prognostic assessment systems as predictors of mortality in polytraumatized patients and to compare each system's admission assessments to the patient's quality of life one month, six months and one year later. PATIENTS AND METHODS: A prospective study of 130 polytraumatized patients admitted to the critical care unit was carried out. A polytraumatized patient was defined as "presenting two or more traumatic lesions that were immediately or eventually life-threatening". We studied age, sex, type of trauma, mortality, mean APACHE II and APACHE III scores during the first three days in the critical care unit for patients who survived and those who died, estimating relative risk of mortality by APACHE II and APACHE III, and quality of life one month, six months and one year after admission using Karnofsky scores (KPS). RESULTS: Mean patient age was 46.47 +/- 20.19 years; 78% were men and 22% women. Overall mortality was 20%. The most frequent trauma was craniocerebral (70.76%), followed by injuries ot the chest (53.8%) and extremities (46.15%). Mean APACHE II and APACHE III scores during the first three days were 10.22 +/- 5.33 and 32.75 +/- 16.42, respectively. Mean APACHE II and III scores were significantly higher (p = 0.02) in patients who died than in survivors (14.33 +/- 5.43 and 9.7 +/- 5.2, respectively, for APACHE II; and 43.27 +/- 17.68 and 30.16 +/- 15.79, respectively, for APACHE III). For each point increase of APACHE II or III scores, relative risk of mortality increased 1.09% (p = 0.03) and 1.02% (p = 0.03), respectively. Patients with APACHE II scores over 12 were 3.53 times more likely to die (p = 0.02). Patients with APACHE III scores over 35 were 3.05 times more likely to die (p = 0.02). One month after admission, 6.4% of patients had a KPS of 100 (normal, as before trauma), 35.8% achieved this score six months after admission and 82% after one year (p = 0.01). Mean APACHE III upon admission was significantly lower (p = 0.045) in patients who achieved KPS 100. CONCLUSIONS: The APACHE II and APACHE III prognostic systems predict relative risk of death in polytraumatized patients. APACHE III, but not APACHE II, at admission is significantly related to quality of life one year later.

[Thoracic epidural analgesia in the postoperative period of pediatric surgery for the repair of pectus excavatum and pectus carinatum]. / Analgesia epidural torácica en el postoperatorio de la cirugía pediátrica reparadora del pectus excavatum y del pectus carinatum.

To assess thoracic analgesia by continuous infusion in surgery to repair pectus excavatum and carinatum in children. This prospective study enrolled 14 children aged 6 to 14 years old scheduled for surgery to correct pectus excavatum and carinatum. After induction of general anesthesia, the T8-T9 epidural space was accessed and a catheter was inserted to T3-T7 with radioscopic monitoring. A loading dose of 0.03-0.04 ml/kg per segment to be blocked (5 segments: T3-T8) of 0.125% bupivacaine and 3 micrograms/ml fentanyl was given to children under 7 years of age; a dose of 0.02-0.03 ml/kg per segment was administered to children over the age of 7 years. A continuous perfusion of 0.1-0.4 ml/kg/h was maintained, with the possibility of additional boluses of 1 ml at 20 min intervals during surgery and the first three days thereafter. An intraoperative bolus was given when the level of blockade was not reached or when mean blood pressure and heart rate increased 15% over baseline. Pain relief was assessed on a numerical scale of 0 to 5 or on a scale of facial icons, depending on the patient's age. During the postoperative period, the pediatric ICU nurse administered a bolus if pain was [symbol see text]3 or heart rate increased 75% over age-based reference values. Top-up analgesia was provided with Metamizole at a dose of 25 mg/kg. No complications attributable to the technique or to sympathetic blockade were observed. All tubes were removed in the operating room. The thoracic epidural catheter was left in place for 70.3 +/- 2.6 h. Mean initial doses of analgesia were 0.45 microgram/kg of fentanyl and 0.2 mg/kg of bupivacaine. The mean number of complementary boluses was 3 +/- 1 during surgery, 5 +/- 2 on the first postoperative day and 4 +/- 1 on the second day. No patient required top-up analgesia on the third day. Hemodynamic stability during surgery and the postoperative period was good. Analgesia was excellent (< 2) for 78.5% of the patients on the first day after surgery, for 85.7% on the second day and for all patients on the third day. We recorded one case of pruritus (7.1%), three of nausea (21.4%) that subsided when butorphanol was given epidurally (20 micrograms/kg), and two cases of light sedation. Thoracic epidural analgesia is effective for alleviating postoperative pain from corrective thoracic surgery in children. Side effects were minimal and no anesthetic complications were observed.

[Tuberculosis of the biliary system: presentation of a case and review of the literature]. / Tuberculosis de la vía biliar: presentación de un caso y revisión de la literatura.

We present the case of a female patient with tuberculosis of the gallbladder, the adipose tissue and lymph nodes surrounding the common bile duct; the patient presented with obstructive jaundice. We discuss the diagnostic criteria, approach to the biliary tract and treatment of this type of patients.