Marcadores Neurales como Indicadores de Funciones Predictivas en Pacientes con Traumatismo Cerebral Moderado a Severo / Neural Markers as Indicators of Predictive Functions in Patients with Moderate to Severe Brain Trauma

Introducción. El traumatismo encéfalo craneano moderado a severo (TEC-MS) es una condición compleja que cambia la estructura y función del cerebro, afectando a personas de distintas edades. Los problemas cognitivos y motores son la mayor causa de discapacidad en individuos con TEC-MS crónico. Sin embargo, muchas de estas dificultades no son visibles de inmediato clasificándose como una "Epidemia silenciosa". Las principales alteraciones reportadas por los pacientes tienen relación con problemas de la memoria, atención y lentitud psicomotora, los cuales tienen un impacto en su independencia y funcionalidad. Objetivo. Este estudio tiene por objetivo discutir y revisar la evidencia disponible acerca de la capacidad de los pacientes crónicos con TEC-MS para generar predicciones en diferentes niveles de procesamiento cerebral. Métodos. Para esto, utilizamos desde las neurociencias el modelo teórico del código predictivo para explicar las respuestas neurofisiológicas adquiridas bajo un paradigma de predicción auditiva. Esta información es complementada con el reporte de datos preliminares de sujetos con TEC-MS y sujetos control, con el fin de ilustrar los aspectos teóricos discutidos. Conclusiones. Esto podría contribuir a una mejor comprensión de los mecanismos neurales detrás de los déficits cognitivos en esta población, aportando una perspectiva que nos oriente al desarrollo de nuestras estrategias terapéuticas.

Background. Moderate to severe traumatic brain injury (TBI-MS) is a complex condition that changes the structure and function of the brain, affecting people of different ages. Cognitive and motor problems are the major cause of disability in individuals with chronic ECT-MS. However, many of these difficulties are not immediately visible, classifying them as a "Silent Epidemic." The main alterations reported by patients are related to problems with memory, attention and psychomotor slowness, which have an impact on their independence and functionality. Objetive. This study aims to discuss and review the available evidence about the ability of chronic ECT-MS patients to generate predictions at different levels of brain processing. Methods. For this, we use the theoretical model of the predictive code from neuroscience to explain the neurophysiological responses acquired under an auditory prediction paradigm. This information is complemented with the report of preliminary data from subjects with ECT-MS and control subjects, in order to illustrate the theoretical aspects discussed. Conclusions. This could contribute to a better understanding of the neural mechanisms behind cognitive deficits in this population, providing a perspective that guides us in the development of our therapeutic strategies.

Role of Arthroscopic Eminoplasty in the Management of the Habitual Dislocation of Temporomandibular Joint.

AIM: To evaluated the effectiveness of arthroscopic eminoplasty in the management of habitual dislocation of the temporomandibular joint (TMJ). PATIENTS AND METHODS: The study is based on a retrospective evaluation of 11 patients (20 joints) with chronic habitual dislocations of TMJ treated with arthroscopic eminoplasty. Maximal postoperative mouth opening, complications related to surgery, duration of postoperative hospital stay, and recurrence rate (at 2 years follow up) were analyzed. RESULTS: Six patients presented complete dislocation (non self-reducible), while 5 patients reported a history of repetitive subluxations that altered their quality of life. Arthroscopic eminoplasty showed great outcomes in terms of recurrence rate, complications related to surgery and hospital stay. DISCUSSION: Arthroscopic eminoplasty represents a safe and effective technique to treat habitual dislocation of the TMJ. Moreover, the integrity of the TMJ capsule-ligament system is respected with this approach and this is extremely important in terms of joint stability.

Arthroscopic Eminoplasty of Temporomandibular Joint: Surgical Technique.

Temporomandibular joint (TMJ) is one of the most used joint of the body. Moreover, it is common knowledge that TMJ may show degenerative changes 10 years earlier than other joints. Recently, the use of arthroscopic surgery is revolutionizing the classic management of TMJ pathologies. In fact, the minimal invasiveness of this procedure allows faster results and fewer complications than other procedures. In this article, we present our arthroscopic technique. In this line, we would like to emphasize that we used this approach in different temporomandibular disorders such as anchored disk syndrome, habitual dislocation of TMJ, and internal derangement. Furthermore, we wish to underline that our efforts have been rewarded with great results.

Arthroscopic eminoplasty: a new choice of treatment for TMJ internal derangement.

BACKGROUND: Temporomandibular joint (TMJ) internal derangement is a common disabling disorder that is often underestimated by society. The main goal of our study was to show the clinic improvement experienced by patients that underwent arthroscopic eminoplasty as a treatment for TMJ in our center. METHODS: Nineteen patients (1 male, 18 females) agreed to participate voluntarily in our study. These patients presented signs and symptoms of TMJ internal derangement and pathological MRI images, and underwent arthroscopic eminoplasty in our center. A patient database was created to record Wilkes stages, type of surgical intervention, complications, and preoperative and postoperative pain and mouth opening. RESULTS: Our data showed that TMJ pain (measured 6 months before surgery) was higher (M=7.44, SD=1.44; t(18)=8.37, P<0.01) than the pain registered eighteen months after surgery (M=3.10, SD=2.40). Moreover, postoperative mouth opening (M=33.6 SD=7.92) was greater than preoperative mouth opening. CONCLUSIONS: The results indicate that this technique is effective in reducing pain and increasing mouth opening with minimal postoperative morbidity. Specifically, this technique minimizes the stress suffered by the joint disc at the narrowest points of joint space and increases articular stability.

Tapia's syndrome: pathogenetic mechanisms, diagnostic management, and proper treatment: a case series.

BACKGROUND: Tapia's syndrome is an uncommon disease described in 1904 by Antonio Garcia Tapia, a Spanish otolaryngologist. It is characterized by concomitant paralysis of the hypoglossal (XIIth) and pneumogastric (Xth) nerves. Only 69 cases have been described in the literature. Typically, the reported patients presented with a history of orotracheal intubation. Common symptoms are dysphonia, tongue deviation toward the affected side, lingual motility disturbance, and swallowing difficulty. CASE PRESENTATION: In the report, we describe three cases of Tapia's syndrome in three Caucasian patients who underwent surgery with general anesthesia. Two of these patients underwent neck abscess drainage, and the third had an open reduction of a shoulder fracture. The clinical symptoms of Tapia's syndrome appeared after extubation. All three of our patients recovered their lost function at 3 months after diagnosis. CONCLUSIONS: We underline the importance of performing airway endoscopy and a specific program of swallowing rehabilitation for the proper management of Tapia's syndrome.

Estudio sobre el trabajo del estudiante en la adaptación al Espacio Europeo de Educación Superior a través del indicador DAA (dedicación alumno-asignatura) / Study of the student’s work in the adaptation to the European Area of Higher Education through the indicator ‘dedication-student-subject’ (DAA)

INTRODUCCIÓN: Uno de los objetivos del proceso de Bolonia es mejorar la calidad de la enseñanza y ello ha supuesto un cambio en la orientación de la actividad docente, con una mayor carga de trabajo para el profesorado y para el estudiante al requerir una mayor autonomía mediante trabajo no presencial. De esta manera, se antoja necesario contemplar la información que facilita el alumnado, de forma directa o mediante la recogida y posterior transformación de datos en indicadores, proporcionando al profesorado universitario una herramienta para la mejora de la organización de actividades en las materias impartidas. SUJETOS Y MÉTODOS: Diseño observacional de corte transversal y tipo descriptivo, con una muestra compuesta por 116 estudiantes de fisioterapia de la Universidad de Vigo (curso académico 2007-2008). El objetivo de este trabajo es la construcción de un indicador del esfuerzo requerido para cada asignatura, cuya aplicación resulte pragmática y fiable para señalar asignaturas donde la relación entre carga de trabajo y créditos asignados es significativa con respecto a las demás asignaturas. RESULTADOS: Se comprobó que sólo el 18,51% de las asignaturas impartidas en el Grado de Fisioterapia están planificadas acorde al número de créditos ECTS asignados en la planificación docente. CONCLUSIONES: El indicador que se presenta, al basarse en los residuos de un modelo de regresión individual para cada estudiante, se muestra independientemente porque no toma en consideración respuestas poco fidedignas, por lo que ayudará al profesorado a una mejor planificación docente

INTRODUCTION: One of the objectives of the Bologna process is to improve the quality of teaching and this has meant a change in the orientation of teaching, with a greater workload for both teacher and student by requiring greater autonomy through non-presential work. It seems necessary to contemplate information that facilitates students, directly or through the collection and subsequent transformation of data on indicators, providing a tool for the improvement of the organization’s activities in the subjects taught to the faculty. SUBJECTS AND METHODS: Through a cross-sectional and descriptive observational design, a sample of 116 Physiotherapy students at the University of Vigo (academic year 2007-2008). The aim of this paper was the construction of an indicator of the effort required for each subject, which is pragmatic and reliable to designate subjects where the relationship between workload and assigned credits are meant with respect to the other subject. RESULTS: Only the 18.51% of the subjects in the degree of Physical Therapy are planned according to the number of ECTS credits allocated in the educational planning. CONCLUSIONS: The indicator that is presented, based on the waste of a regression model individual for each student, shown independently since not taking into account some credible answers, so it will help teachers to better teaching planning

Oral health care for patients with epidermolysis bullosa--best clinical practice guidelines.

OBJECTIVE: To provide the users with information on the current best practices for managing the oral health care of people living with EB. METHODS: A systematic literature search, in which the main topic is dental care in patients with Epidermolysis Bullosa, was performed. Consulted sources, ranging from 1970 to 2010, included MEDLINE, EMBASE, CINAHL, The Cochrane Library, DARE, and the Cochrane controlled trials register (CENTRAL). In order to formulate the recommendations of the selected studies the SIGN system was used. The first draft was analysed and discussed by clinical experts, methodologists and patients representatives on a two days consensus meeting. The resulting document went through an external review process by a panel of experts, other health care professionals, patient representatives and lay reviewers. The final document was piloted in three different centres in United Kingdom, Czech Republic and Argentina. RESULTS: The guideline is composed of 93 recommendations divided into 3 main areas: 1) Oral Care--access issues, early referral, preventative strategies, management of microstomia, prescriptions and review appointments 2) Dental treatment: general treatment modifications, radiographs, restorations, endodontics, oral rehabilitation, periodontal treatment, oral surgery and orthodontics, and 3) Anaesthetic management of dental treatment. CONCLUSIONS: A preventive protocol is today's dental management approach of choice.

[Prognostic value of noninvasive markers of coronary reperfusion compared to TIMI 3 flow in patients treated with primary angioplasty]. / Valor pronóstico de marcadores no invasivos de reperfusión coronaria frente a flujo TIMI 3 en pacientes tratados con angioplastia primaria.

INTRODUCTION AND OBJECTIVES: The aim of this study was to compare the prognostic value of TIMI 3 flow versus noninvasive markers of coronary artery reperfusion on the outcome of patients with a recent acute myocardial infarction (AMI) treated with primary angioplasty. PATIENTS AND METHOD We analyzed 172 consecutive patients with AMI and ST-segment elevation, who were treated with primary angioplasty within 12 hours of admission. Mean age was 6113 years, 77% were men, and 56% had a history of previous AMI. RESULTS: In-hospital mortality was 3.6%; 16.6% developed heart failure, and 11.1% had complex arrhythmias during their hospital stay. The noninvasive criterion for successful reperfusion was the presence of two or more markers of reperfusion based on ECG changes or CK levels after angioplasty. Reperfusion was successful in 87.7% of the patients, and TIMI 3 flow was achieved in 87%. There was no significant concordance between the two methods (kappa index = 0.012). Multivariate analysis showed that both successful reperfusion (OR=0.028; 95% CI, 0.003-0.268) and TIMI 3 flow (OR=0.104; 95% CI, 0.019-0.563) were protective for in-hospital mortality. However, in the multivariate analysis only successful reperfusion was a protective factor for heart failure and complex arrhythmias. CONCLUSION: Our findings confirm that both TIMI 3 flow and successful coronary reperfusion evaluated noninvasively show independent prognostic value in patients with AMI treated with primary angioplasty. Noninvasive markers of coronary reperfusion should be used as complementary to angiography in these patients.

Valor pronóstico de marcadores no invasivos de reperfusión coronaria frente a flujo TIMI 3 en pacientes tratados con angioplastia primaria / Prognostic value of noninvasive markers of coronary reperfusion compared to TIMI 3 flow in patients treated with primary angioplasty

Introducción y objetivos. La angioplastia primaria ha resultado ser el tratamiento más eficaz para pacientes con infarto agudo de miocardio (IAM). Tanto la obtención de un flujo coronario óptimo, grado TIMI 3, como la asociación de indicadores no invasivos de reperfusión coronaria han demostrado ser métodos útiles para predecir el pronóstico inmediato y a medio plazo de pacientes con IAM tratados con trombólisis o angioplastia primaria. El objetivo es comparar el valor pronóstico del flujo TIMI 3 con la asociación de indicadores no invasivos de reperfusión coronaria (disminución del supradesnivel del segmento ST > 50 por ciento a los 90 min, inversión de la onda T dentro de las 24 h y elevación máxima de la creatincinasa [CK] 70 por ciento, valor máximo de CK) demostró que tanto la reperfusión exitosa como el flujo TIMI 3 resultaron ser protectores frente a la mortalidad intrahospitalaria (odds ratio [OR] = 0,028; intervalo de confianza [IC] del 95 por ciento, 0,003-0,268, y OR = 0,104; IC del 95 por ciento, 0,019-0,563, respectivamente). Sin embargo, sólo la reperfusión exitosa resultó ser protectora frente a la insuficiencia cardíaca y las arritmias complejas en la evolución intrahospitalaria y en la mortalidad a medio plazo al ajustar por ambos criterios en el análisis multivariado. Conclusión. Se confirma que tanto el flujo TIMI 3 como la reperfusión coronaria exitosa evaluada a través de indicadores no invasivos tienen un valor pronóstico independiente en pacientes con IAM tratados con angioplastia primaria. Sin embargo, la reperfusión coronaria exitosa resultó ser un indicador de pronóstico independiente para la mortalidad intrahospitalaria y a medio plazo, el desarrollo de insuficiencia cardíaca y arritmias complejas. Los indicadores no invasivos de reperfusión coronaria debieran emplearse en forma complementaria a la angiografía en estos pacientes (AU)

Reoperaciones coronarias: análisis retrospectivo de 16 años de experiencia / Coronary artery bypass grafting reoperation: a 16 years retrospective analysis

Background: Coronary artery bypass grafting (CABG) reoperation is being performed with increasing frequency. Aim: To assess the early and long term results of coronary reoperations in our institution and to identify prognostic factors. Patients and methods: 214 patients subjected to coronary reoperations between 1983 and 1999 were retrospectively studied. Results: Mean age was 64.2 years (range 42-79 years), 202 (94.4 per cent) were male and 12 (5.6 per cent) female. The mean interval between the operations was 125.7 months (range 6-252 months). 10 (4,6 per cent) were emergency surgeries. Overall operative mortality was 5.6 per cent (11 deaths) and in 5 patients (3.4 per cent) a perioperative myocardial infarction was noted. Univariate analysis identified moderate or severe left ventricular failure (p=0.048) as predictor of increased operative mortality, meanwhile age over 75 years (p=0.02) and moderate or severe left ventricular failure (p=0.01) were identified as predictors of increased in hospital mortality in the multivariate analysis. Follow up of in hospital survivors (mean interval 65 months, range 4 to 190 months) documented a 5 years survival rate of 82.9 per cent, a 10 years survival rate of 73.1 per cent and a 15 years survival rate of 53.4 per cent. Moderate or severe left ventricular failure (p <0.0001) and emergency surgeries (p=0.007) were identified as factors influencing the late survival in the stepwise logistical regression analysis. Multivariate analysis identified left ventricular failure (p=0.01) and peripheral vascular disease (p=0.01) as predictors of decreased late survival. Conclusions: Coronary reoperation has a low mortality in patients with a normal ventricular function and also has an excellent overall and disease free survival in the first 10 years of follow up. Left ventricular function is an independent risk factor increasing in hospital and late mortality

La hiperuricemia es un marcador del umbral anaeróbico en la insuficiencia cardíaca crónica / Hyperuricemia is a marker for anaerobic threshold in chronic cardiac failure

Background: Patients with chronic cardiac failure often have elevated plasma uric acid levels, that are associated to a dismal prognosis. Aim: To investigate possible metabolic mechanisms to explain elevated uric acid levels in these patients. Patients and methods: Eighteen patients with chronic cardiac failure aged 61 ñ 10 years old, without gout or renal failure and not using high doses of diuretics (equal or less than 80 mg/day furosemide or 50 mg/day hydrochlorothiazide) were studied. Plasma uric acid levels were correlated with anaerobic threshold, maximal oxygen uptake, plasma noradrenaline and creatinine and left ventricular ejection fraction, measured radioisotopically. Results: Mean maximal oxygen uptake was 16.6 ñ 4.2 ml/kg/min. There was a negative correlation between uric acid levels and maximal oxygen uptake or maximal oxygen uptake/body surface area (r=0.521 and -0.533 respectively, p<0.05). Patients with uric acid levels over 7 mg/dl had a lower anaerobic threshold than patients with lower levels (9.81 ñ 2.41 and 13.08 ñ 3.28 ml/kg/min respectively, p<0.05). No significant differences in maximal oxygen uptake were observed in these two groups of patients (15.5 ñ 4.24 and 18.08 ñ 3.86 ml/kg/min respectively). Uric acid levels did not correlate with plasma noradrenaline, creatinine or lefi ventricular ejection fraction. Conclusions: These results suggest that a defect in cellular oxygenation contributes to the elevation of plasma uric acid levels in patients with chronic cardiac failure

Tratamiento de la insuficiencia cardíaca avanzada mediante trasplante de corazón / Heart transplantation as a treatment for advanced heart failure

Background: Heart transplantation currently provides the most effective treatment for advanced heart failure. However, medical therapy for this condition has also improved, heart donors are scarce and the cost of the procedure is high. Therefore the indications and management of these patients need reevaluation. Aim: To analyze the results of 24 patients submitted to heart transplantation for end-stage heart failure needing repeated hospitalizations and i.v. inotropes for compensation. Patients and methods: The group was comprised by 21 men and 3 women with a mean age of 36.8 years, mean left ventricular ejection fraction 19ñ4.5 percent, mean systolic pulmonary artery pressure 48ñ13 mmHg (24-70) and mean pulmonary vascular resistance 2.6 Wood Units (1-5). Fourteen patients (58 percent) had a previous median sternotomy. Immunosupression did not include induction therapy and steroids were discontinued early...

Rechazo humoral en transplante cardíaco: comunicación de dos casos / Humoral rejection in heart transplantation: report of 2 cases

Heart transplantation is a therapeutic alternative for selected patients with refractory heart failure. Acute allograft rejection is one of the main causes of early death after transplantation. The cellular rejection is characterized by cellular infiltrates with or without miocyte necrosis. However, some patients develop left ventricular dysfunction due to rejection without evidence of cellular infiltration. In these patients, the rejection is mediated by antibodies and complement. Humoral rejection is a relative rare but potentially fatal form of acute allograft rejection. We report two patients with left ventricular dysfunction secondary to humoral rejection, shortly after cardiac transplantation. Both patients were treated with methylprednisolone, and azathioprine was substituted by cyclophosphamide. One patient underwent plasmapheresis. The clinical outcome was satisfactory and the left ventricular function returned to normal in both cases. The diagnostic and therapeutic strategies for the management of humoral rejection are reviewed

Hipertensión pulmonar e infección por VIH: comunicación de un caso / Pulmonary hypertension and HIV infection: 1 case report

Pulmonary hypertension associated to HIV infection has been reported in the literature with increased frequency. Apparently, this condition has a faster clinical evolution and a higher mortality than primary pulmonary hypertension. The pathogenic mechanisms of HIV associated pulmonary hypertension and the influence of its treatment on patientÕs evolution are not well known. We report a 32 years old homosexual male that developed a severe dyspnea in a period of 2 months. Echocardiogram demonstrated right ventricular dilatation and a systolic pulmonary artery pressure of 86 mm Hg. No other causes for pulmonary hypertension were found. Antiviral therapy and vasodilator treatment with a calcium channel blocker were started and the patient had an important subjective clinical improvement

Solución GIK en el infarto agudo al miocardio: el resurgimiento de una antigua terapia / Glucose-insulin-K solution for acute myocardial infarction: rebirth of an old form of therapy

La terapia con solución de glucosa insulina y potasio en el infarto o solución GIK fue inicialmente utilizada por Sodi-Pallares. Desde entonces muchos trabajos con esta solución han sido publicados con resultados disímiles. Sin embargo el resultado de un meta-análisis reciente, que incluye sólo trabajos randomizados con dosis adecuadas de GIK, parece confirmar la disminución de la mortalidad asociada a solución GIK. Para comprender mejor los fundamentos y posibles mecanismos de beneficio con el empleo de la solución GIK en el infarto del miocardio, revisaremos primero el metabolismo miocárdico normal y en condiciones de isquemia, luego el daño por reperfusión post infarto y los efectos de la solución GIK en el miocardio. Por último, analizaremos las experiencias clínicas publicadas con esta terapia

Predictores de rehospitalización en pacientes con insuficiencia cardíaca congestiva / Predictors of readmission in patients with congestive heart failure

Repeated hospitalizations among patients (pts) with congestive heart failure (CHF) are common. Purpose: This retrospective study was designed to determine predictors of readmission. Methods: Inclusion criteria: admitted to University Hospital with a primary diagnosis of CHF between 10/1/94-9/30/95: lived in Jefferson county. Exclusions: cardiac transplant during study period; major comorbidity (e.g. malignancy, advanced renal failure). Predictors of readmission were determined by stepwise logistic regression analysis and predictor of time to readmission with Cox Proportionate Hazards modeling p<0.05 was considered statistically significant. Results: Mean age of the 237 pts was 66.5 yrs; 56 percent women. Mean left ventricular ejection fraction (LVEF) was 29 percent; 96 percent were in NYHA Class III/IV. Mean length of stay was 5 days; 52 pts (22 percent) had >1 admission. CHF etiologies: Ischemic (42 percent), hypertensive (37 percent), idiopathic (12 percent). Demographic characteristics and insurance status did not predict readmission risk. Predictors of readmission in the logistic and Cox models were similar. Increased risk of readmission was associated with myocardial ischemia (logistic OR 42.7), past NYHA Class III and IV (OR 32.8), plasmatic creatinine at discharge (OR 1.9) and continued smoking (OR 3.26). History of CABG was associated with a decreased risk of rehospitalization (OR 0.12). Beta-blocker use was associated with decreased risk, but did not achieve statistical significance. ACE-I use (prescribed in 78 percent of pts), did not contribute to the model. Diabetes Mellitus and a lower LVEF were more frequent in the readmitted group, but they did not predict readmission. Conclusion: CHF pts who have evidence of ischemia, advanced symptoms, renal dysfunction, and who continue to smoke are at increased risk for hospital readmission. Pts with these characteristics should be identified prior to hospital discharge and considered for intensive outpatient intervention