Resultados funcionales de un programa de prehabilitación en cirugía electiva de cáncer colorrectal / Functional results of a prehabilitation program in elective colorectal cancer surgery

Resumen Introducción: El cáncer colorrectal (CCR) es el segundo tipo más frecuente de cáncer en el mundo. La cirugía es la intervención terapéutica más común y se asocia con la reducción de 20-40% en la capacidad fisiológica y funcional. Un programa de prehabilitación podría mejorar la condición funcional basal de los pacientes previo a la cirugía. Objetivo: Describir los resultados funcionales de un programa de prehabilitación en personas adultas candidatos a cirugía electiva de CCR. Materiales y Método: Estudio descriptivo, longitudinal y retrospectivo. Se registraron los antecedentes sociodemográficos, clínicos y las variables funcionales como capacidad cardiorrespiratoria, fuerza de presión manual, fatiga, independencia en actividades de la vida diaria (AVDs) y equilibrio dinámico de 50 personas que ingresaron a un programa de prehabilitación entre mayo 2019 y febrero de 2020. Los datos fueron analizados con estadística descriptiva y pruebas de diferencia entre tiempo de evaluación, previo y posterior a la prehabilitación. Resultados: Posterior al programa de prehabilitación, los pacientes mejoraron la capacidad cardiorrespiratoria, fatiga, equilibrio dinámico y fuerza prensil (p 0,05; tamaño de efecto: 0,01). Conclusión: Un programa estructurado de prehabilitación para pacientes candidatos a cirugía electiva de CCR basado en ejercicios y educación, logró cambios significativos en los resultados funcionales en un período de 3 a 4 semanas previo a la cirugía.

Introduction: Colorectal cancer (CRC) is the second most frequent type of cancer in the world. Surgery is the most common therapeutic intervention and is associated with a 20-40% reduction in physiological and functional capacity. A prehabilitation program could improve the baseline functional condition of patients prior to surgery. Aim: To describe the functional results of a prehabilitation program in adults who will undergo elective surgery CCR. Materials and Method: Descriptive, longitudinal and retrospective study. The sociodemographic, clinical and functional variables such as cardiorespiratory capacity, manual pressure force, fatigue, independence in activities of daily living and dynamic balance of 50 people who entered a pre-rehabilitation program between may 2019 and february 2020 were compiled. Data were analyzed with descriptive statistics and difference tests between evaluation time, before and after prehabilitation. Results: After the prehabilitation program, the patients improved cardiorespiratory capacity, fatigue, dynamic balance and grip strength (p 0.05; effect size: 0.01). Conclusión: A structured prehabilitation program for patients who are candidates for elective colorectal cancer surgery based on exercises and education, achieved significant changes in functional results in a period of 3 to 4 weeks prior to surgery.

Neurofisiología de la empatía: una revisión de investigaciones / Neurophysiology of empathy: a review of investigations

La empatía es un constructo con múltiples definiciones y modelos explicativos, los cuales se han conformado a partir de observaciones e investigaciones en humanos y otros animales. En el presente, se revisaron estudios en humanos sanos, que vincula empatía con conducta motora, sistema nervioso autónomo y central. La evidencia presentada apoya la asociación entre empatía y el sistema de neuronas en espejo, la imitación facial, el contagio pupilar, el sistema autonómico, la interocepción, la conectividad neuronal, la ínsula, el cíngulo, entre otras. Finalmente, esta revisión incentiva el estudio, investigación y desarrollo de las múltiples áreas y disciplinas que tratan con la empatía.

Proposed diagnostic criteria for apathy in Alzheimer's disease and other neuropsychiatric disorders.

There is wide acknowledgement that apathy is an important behavioural syndrome in Alzheimer's disease and in various neuropsychiatric disorders. In light of recent research and the renewed interest in the correlates and impacts of apathy, and in its treatments, it is important to develop criteria for apathy that will be widely accepted, have clear operational steps, and that will be easily applied in practice and research settings. Meeting these needs is the focus of the task force work reported here. The task force includes members of the Association Française de Psychiatrie Biologique, the European Psychiatric Association, the European Alzheimer's Disease Consortium and experts from Europe, Australia and North America. An advanced draft was discussed at the consensus meeting (during the EPA conference in April 7th 2008) and a final agreement reached concerning operational definitions and hierarchy of the criteria. Apathy is defined as a disorder of motivation that persists over time and should meet the following requirements. Firstly, the core feature of apathy, diminished motivation, must be present for at least four weeks; secondly two of the three dimensions of apathy (reduced goal-directed behaviour, goal-directed cognitive activity, and emotions) must also be present; thirdly there should be identifiable functional impairments attributable to the apathy. Finally, exclusion criteria are specified to exclude symptoms and states that mimic apathy.

Influence of patient age on Streptococcus pneumoniae serotypes causing invasive disease.

All clinical S. pneumoniae specimens isolated from patients with invasive or sterile-site infections admitted to one regional general hospital in southern Chile were collected during a 5-year period (February 1994 to September 1999). A total of 247 strains belonging to 50 serotypes were isolated in this survey: 69 in patients under 5 years of age, 129 in patients 5 to 64 years old, and 49 from patients 65 years and older. Eight serotypes were identified in all age groups, while all other serotypes were found exclusively in one age group or in patients over 4 years of age. Serotype 3 was never found in patients under 5 years old, and serotype 14 was not found in patients >64 years of age. There was no difference in the serotypes causing infection in each one of the 5 years of the survey. Our results suggest that both bacterial virulence factors and host factors play an important role in the selection of S. pneumoniae serotypes causing invasive infection. Possible host factors include age-related differences in the immune response. Comparative studies with other areas of the world may help to further understanding of our observations in southern Chile.

[Estimation of severity of illness in intensive care: validation of physiologic stability index]. / Estimación de gravedad en cuidados intensivos: validación de índice de estabilidad fisiológica.

Physiological stability index (PSI) is a score proposed to evaluate the severity of different diseases in pediatric intensive care units (PICU) by giving scores to the deterioration of 34 measurable physiological variables. In order to validate PSI, it was prospectively applied to 132 patients who entered our PICU. A significant difference (p less than 0.001) was found between the average score of those patients who survived (means: 6.1) versus those who did not (means: 21); No difference was found between theoretical mortality rates obtained by logistic regression analysis and those obtained according to PSI score ranks even thought direct hemodynamic measurements like cardiac output and capillary (wedge) pulmonary pressure were not considered in this study. In conclusion, the PSI is a useful method to measure the severity of illness in pediatric intensive care and to compare results among PICU.

[Application of a physiologic stability index at a pediatric intensive care unit]. / Aplicación de un índice de estabilidad fisiológica en unidad de cuidados intensivos pediátrica.

This study was conducted to evaluate usefulness of the physiologic stability index (PSI) in a pediatric intensive care Unit (PICU) of a University based hospital at Santiago, Chile. Subjects include all patients (n = 152) consecutively admitted to our PICU between april 1987 and august 1988. The PSI system was applied during the first four days from admission. The age of the patients ranged from 10 days to 15 years. Scores obtained from survivors and non survivors were compared using an analysis of variance. For maximum PSI, survivors had significantly lower scores (9.39 points) that non survivors (21.71 points). Multiple logistic regression was used to display associations between mean obtained scores and probability of death and a curve was plotted which is similar to that obtained in previous experiences from other countries.