Thermosensitive/thermochromic silicone and infrared thermography mapping in 60 consecutive cases of epilepsy surgery.

Background: Epilepsy surgery represents a therapeutic opportunity for those patients who do not respond to drug therapy. However, an important challenge is the precise identification of the epileptogenic area during surgery. Since it can be hard to delineate, it makes it necessary to use auxiliary tools as a guide during the surgical procedure. Electrocorticography (ECoG), despite having shown favorable results in terms of reducing post-surgical seizures, have certain limitations. Brain mapping using infrared thermography mapping and a new thermosensitive/thermochromic silicone (TTS) in epilepsy surgery has introduced a new resource of noninvasive and real-time devices that allow the localization of irritative zones. Methods: Sixty consecutive patients with drug-resistant epilepsy with surgical indications who decided to participate voluntarily in the study were included in the study. We measured brain temperature using two quantitative methods and a qualitative method: the TTS sheet. In all cases, we used ECoG as the gold standard to identify irritative areas, and all brain tissue samples obtained were sent to pathology for diagnosis. Results: In the subgroup in which the ECoG detected irritative areas (n = 51), adding the results in which there was a correlation with the different methods, the efficiency obtained to detect irritative areas is 94.11% (n = 48/51, P ≤ 0.0001) while the infrared thermography mapping method independently has an efficiency of 91.66% (P ≤ 0.0001). The TTS has a sensitivity of 95.71% and a specificity of 97.9% (P ≤ 0.0001) to detect hypothermic areas that correlate with the irritative zones detected by ECoG. No postoperative infections or wound dehiscence were documented, so the different methodologies used do not represent an additional risk for the surgical proceedings. Conclusion: We consider that the infrared thermography mapping using high-resolution infrared thermography cameras and the TTS are both accurate and safe methods to identify irritative areas in epilepsy surgeries.

Determinación de intersecciones probabilísticas relacionadas con daño cerebral adquirido a partir de la determinación de probabilidades a priori y a posteriori.

BACKGROUND: The acquired brain damage is a common neurological disorder. OBJECTIVE: Determine the probabilistic intersections of variables related to acquired brain damage from the determination of a priori and a posteriori probabilities. METHOD: Analytical retrospective study. A descriptive analysis was carried out, confidence intervals were calculated to obtain the mean and the proportion with α = 0.05 considering the age of the patient and the diagnosis. An analysis of probabilistic intersection, a priori and a posteriori probability was performed considering diagnosis, sex and age decade; finally, chi squared was calculated. RESULTS: 736 patients were analyzed. The most frequent diagnosis was language disorder. The patients diagnosed with memory disorder were the youngest and those diagnosed with degenerative cognitive disorder the oldest. The probability that a patient with sequelae due to acquired brain damage arrives at the hospital, at the language pathology service, to be diagnosed with a language disorder and that this patient is also a man is 29.06%. CONCLUSIONS: The high prevalence of short and long-term disability generated by acquired brain damage highlights the importance of an early and timely detection and diagnosis so that it favors prompt and efficient specialized care.

ANTECEDENTES: El daño cerebral adquirido es un trastorno neurológico común. OBJETIVO: Determinar las intersecciones probabilísticas de variables relacionadas con daño cerebral adquirido a partir de la determinación de probabilidades a priori y a posteriori. MÉTODO: Estudio retrospectivo analítico. Se realizó análisis descriptivo y se calcularon intervalos de confianza para la media y para la proporción con α = 0.05 considerando la edad del paciente y el diagnóstico. Se realizó análisis de intersección probabilística, probabilidad a priori y a posteriori considerando el diagnóstico, el sexo y la década de edad; por último, se utilizó la prueba χ2. RESULTADOS: Se analizaron 736 pacientes. El diagnóstico más frecuente fue el trastorno del lenguaje. Los pacientes diagnosticados con trastorno de memoria fueron los más jóvenes y los diagnosticados con trastorno cognitivo degenerativo los más longevos. La probabilidad de que llegue al hospital, al servicio de patología de lenguaje, un paciente con secuelas por daño cerebral adquirido, sea diagnosticado con trastorno del lenguaje y sea hombre es del 29.06%. CONCLUSIONES: La alta prevalencia de discapacidad a corto y largo plazo generada por el daño cerebral adquirido indica la importancia de la detección y el diagnóstico temprano y oportuno que favorezcan una pronta y eficiente atención especializada.

Face mask and protective eyewear-associated headache among healthcare workers during the COVID-19 pandemic.

OBJECTIVE: The objective of this study was to investigate the prevalence, clinical features, and factors related to personal protective-associated headaches. METHODS: We conducted a cross-sectional study among healthcare workers using an online questionnaire. RESULTS: We surveyed 305 participants. The N95 face-mask was the most used device by 93%. Of 305 respondents, 206 experienced headaches while wearing protective equipment; 36.06% suffered from a headache disorder before the pandemic. The prevalence of de novo headache was 39.01%. Gender, age, or exposure to coronavirus disease were not determining factors to develop headache. Headache intensity was higher in front-line healthcare workers and was correlated (r = 0.728) with the time wearing protective equipment. The more days per month the participants wore personal protective equipment the shorter the time to headache onset after donning equipment. CONCLUSION: Our study confirms the relationship between frequent and prolonged use of protection devices with headaches and reaffirms the implication of external pressure as a primary mechanism.

OBJETIVO: Investigar la prevalencia, las características clínicas y los factores relacionados con las cefaleas asociadas al equipo de protección personal. MÉTODOS: Realizamos un estudio transversal entre trabajadores de la salud por medio de un cuestionario en línea. RESULTADOS: Encuestamos a 305 participantes. La mascarilla N95 fue el dispositivo más utilizado opor 93%. Del total de encuestados, 206 experimentaron cefalea mientras usaban el equipo de protección; el 36.06% padecía algun trastorno cefalálgico antes del inicio de la pandemia. La prevalencia de cefalea de novo fue del 39.01%. El género, la edad o la exposición a la enfermedad por coronavirus no fueron factores determinantes para desarrollar cefalea. La cefalea fue de mayor intensidad en los trabajadores de primera línea y se correlacionó (r = 0.728) con el tiempo que se uso el equipo de protección personal. Mientras más días por mes los participantes usaron el equipo de protección personal menor fue el tiempo de inicio de la cefalea tras la colocación del equipo cada vez. CONCLUSIONES: Nuestro estudio confirma la asociación del uso frecuente y prolongado de dispositivos de protección con el desarrollo de cefalea y reafirma la implicación de la compresión externa como mecanismo primario.

Analysis of the economic effects on biopsychosocial homeostasis from a three-dimensional probability measurement system.

OBJECTIVE: Describes the economic effects on bio-psychosocial homeostasis from a three-dimensional analysis of the joint interaction of biological, psychological and economic-social comorbidities, in order to know the probabilities of occurrence of these conditions simultaneously. METHOD: It is a cross-sectional study and random quota sampling. 353 men and women over 20 years of age participated, and answered a 27 questions application (bio-psycho-economic-social), the data was analyzed three-dimensionally in order to know the probability of occurrence of the variables studied and their possible location in the probabilistic unit cube. RESULTS: Based on the unit cube proposal, it can be observed that in the block of people with incomes from 2200 to 6600 pesos in the group of men there is a probability of 12.9 per 1000 inhabitants of presenting debt problems, overweight and severe depression, while in the case of women, the probability is 2.08 per 1000 inhabitants. CONCLUSIONS: There is a priority axis that determines the change of the remaining variables, in this case it is the economic axis the one that determines the biological and psychological conditions.

OBJETIVO: Describir los efectos económicos en la homeostasis biopsicosocial a partir de un análisis tridimensional de la interacción conjunta de la comorbilidad biológica, psicológica y económico-social, con la finalidad de conocer las probabilidades de ocurrencia a partir de estas condiciones de forma simultánea. MÉTODO: Estudio transversal y muestreo aleatorio por cuotas. Participaron 353 hombres y mujeres mayores de 20 años que contestaron un cuestionario con 27 preguntas (biopsicosociales-económicas). Se analizaron los datos tridimensionalmente con la finalidad de conocer la probabilidad de ocurrencia de las variables estudiadas y su posible localización en el cubo unitario probabilístico. RESULTADOS: Con base en la propuesta del cubo unitario se obtiene que, en las personas con ingresos de 2200 a 6600 pesos, en los hombres existe una probabilidad de 12.9 por cada 1000 habitantes de presentar deudas, sobrepeso y depresión grave; en las mujeres, la probabilidad es de 2.08 por cada 1000 habitantes. CONCLUSIONES: Existe un eje prioritario que determina el cambio de las variables restantes, en este caso el eje económico que determina las condiciones biológicas y psicológicas.

Clinical and sociodemographic findings in a cohort of 4632 pediatric patients with language, speech and learning disorders.

OBJETIVO: Describir y analizar aspectos clínicos y sociodemográficos de una cohorte de pacientes con trastornos del lenguaje, del habla y del aprendizaje. MÉTODO: Estudio retrospectivo descriptivo. Se seleccionaron expedientes de 4632 pacientes (años 2011 a 2015). Se calcularon medias, desviaciones estándar, porcentajes y frecuencias, Con la finalidad de evaluar si existía diferencia significativa entre variables se utilizó la prueba de ji al cuadrado y se realizó un análisis de probabilidad condicional entre las variables para obtener la probabilidad a priori y a posteriori. RESULTADOS: Los trastornos del lenguaje, del habla y del aprendizaje se presentaron con mayor frecuencia en el sexo masculino, con 3358 pacientes (72.5%). El diagnóstico más frecuente fue el trastorno del lenguaje, diagnosticado en 2924 pacientes (63.1%). Se encontraron mayores incidencia y prevalencia de retraso del lenguaje en el sexo masculino (p < 0.05). CONCLUSIONES: De todas las variables estudiadas, solo la incidencia de retraso en el desarrollo del lenguaje con respecto al sexo masculino fue significativa; de cada cuatro pacientes, tres eran de sexo masculino y uno de sexo femenino. OBJECTIVE: To describe and analyze clinical and sociodemographic aspects of a cohort of patients with language, speech and learning disorder. METHOD: Descriptive retrospective study. Patient records (2011 to 2015) were selected, making up a total of 4632. Averages, standard deviations, percentages and frequencies were calculated; in order to assess whether there was a significant difference between variables, chi squared test and a conditional probability analysis was performed between the variables to obtain a priori and a posteriori probability. RESULTS: Disorders of language, speech and learning occurred more frequently in males, 3358 patients (72.5%). The most frequent diagnosis was language development disorder, diagnosed in 2924 patients (63.1%). A higher incidence and prevalence of language delay were found for the male sex (p < 0.05). CONCLUSIONS: Of all the variables studied, only the incidence of delay in language development with respect to the male sex was significant; three out of four patients were male and 1 female.

[Uncertainty, dynamic systems, principles of quantum mechanics and their relationship to the health-disease process (analysis proposal).] / Incertidumbre, sistemas dinámicos, principios de mecánica cuántica y su relación con el proceso salud-enfermedad (propuesta de análisis).

The purpose of this work is to discuss the importance and possible application of some foundations of quantum mechanics in the health-disease process, considering for this, that the laws and foundations of atomic theory are the same that govern displacement in space and time in human beings. Based on the impossibility of determining the displacement of subatomic particles in a given space and time, as a consequence of not having measuring instruments for said microscales, we propose feasible that the same happens with the uncertainty generated by the times and movements of human beings in really large spaces, reason why the analysis of the temporo-spatial location of a moving subject, in a certain time and space is impossible, fact that we consider, could represent the behavior in Pandemics. The foundations of quantum mechanics that have been considered for this purpose are dynamic systems, the Schrödinger cat paradox, the Heisenberg uncertainty principle, the law of gases, times and movements, and the Maxwell-Boltzmann entropy. On the other hand, it is proposed to consider the adaptation of measurement ecis ecisión statistical procedures (decisión tree and set theory) and finally the implementation of a unitary probabilistic cube is proposed, which allows locating a subject immersed in the health process disease through three axes developed considering the definition of health stipulated by the WHO.

El presente trabajo tuvo como finalidad discutir la importancia y la posible aplicación de algunos fundamentos de la mecánica cuántica en el proceso de salud-enfermedad, considerando para esto que las leyes y fundamentos de la teoría atómica son los mismos que rigen los desplazamientos en el espacio y el tiempo en los seres humanos. Con base en la imposibilidad de determinar el desplazamiento de las partículas subatómicas en un espacio y tiempo determinado, como consecuencia de no contar con instrumentos de medición para dichas microescalas, consideramos factible que lo mismo suceda con la incertidumbre generada por los tiempos y movimientos de los seres humanos en espacios realmente grandes, por lo que el análisis de la ubicación temporo-espacial de un sujeto en movimiento, en un tiempo y en un espacio determinado, es imposible. Creemos que este hecho podría representar el comportamiento en las pandemias. Los fundamentos de la mecánica cuántica que se han considerado con dicho fin son: los sistemas dinámicos; la paradoja del gato de Schrödinger; el principio de incertidumbre de Heisenberg; la ley de gases, tiempos y movimientos; la entropía de Maxwell-Boltzmann. Por otra parte, se propone considerar la adaptación de herramientas de medición basadas en procedimientos estadísticos (árbol de decisiones y teoría de conjuntos) y, finalmente, se propone la implementación de un cubo probabilístico unitario, el cual permita ubicar a un sujeto inmerso en el proceso de salud-enfermedad mediante tres ejes desarrollados según la definición de salud estipulada por la Organización Mundial de la Salud.

Ten years of experience of the Mexican Academy of Surgery in the promotion of the next generations of researchers.

OBJECTIVE: To describe the productivity of the research works presented in the Interuniversity and resident doctors Competition of the Mexican Academy of Surgery since its origin in 2010. METHOD: Observational cross-sectional descriptive study in which the variables are considered: category of participation (university/resident) type of work (research, clinical case, etc.), university and institution of origin, type of presentation [poster/oral]) Descriptive statistics was used. RESULTS: Since 2010, 9 interuniversity competitions and 8 resident doctors have been developed. A total of 974 papers were presented, predominantly residents (65.29%), oral presentations (54.51%) and original works (58.11%). 8.9% of the published works. CONCLUSIONS: The Contest is a good forum to disseminate research in the new generations of doctors.

OBJETIVO: Describir los primeros 10 años del Concurso Interuniversitario y de Médicos Residentes de la Academia Mexicana de Cirugía. MÉTODO: Estudio observacional de tipo transversal descriptivo en el que se consideran las variables categoría de participación (universitario/residente), tipo de trabajo (investigación, caso clínico, etc.), universidad e institución de procedencia, y tipo de presentación (cartel/oral). Se empleó estadística descriptiva. RESULTADOS: Desde 2010 se han desarrollado nueve concursos interuniversitarios y ocho de médicos residentes. En total se han presentado 974 trabajos, predominando los de residentes (65.29%), las presentaciones orales (54.51%) y los trabajos originales (58.11%). El 8.9% de los trabajos han sido publicados. CONCLUSIONES: El Concurso es un buen foro para difundir la investigación de las nuevas generaciones de médicos.

Equations to establish a regression between current units with respect to patient`s age and the use time of cochlear implants.

OBJECTIVE: Propose a system of multivariate multiple regression equations in order to establish a mathematical association that allows estimating the current units needed during the adjustment phase with respect to age and time that were used the implants. METHOD: Descriptive cross-sectional study. A total of 41 pediatric patients with a unilateral cochlear implant participated. Three groups were formed and multivariable multiple regression equations were constructed. RESULTS: For Group 1, in electrode Groups 3 and 4, there is a lower standard deviation and a similar index of asymmetry of the current units; in Group 2, the groups of electrodes with similar index of asymmetry were 2 and 4, while group of electrodes 3 presented average of 21.54 and dispersion smaller (16.25); in Group 3, groups of electrodes 3 and 4 presented similar standard deviation and average and smaller standard deviation. With respect to the standard estimation error, the lowest variability of current units was obtained in Group 2 for electrode Group 3. CONCLUSION: The proposed equations could be used in the clinical area by knowing the units current needed with respect to age and time of use the implant.

OBJETIVO: Proponer un sistema de ecuaciones de regresión múltiple multivariable para establecer una asociación matemática que permita estimar las unidades de corriente necesarias durante la fase de ajuste con respecto a la edad y el tiempo de uso del implante coclear. MÉTODO: Estudio transversal descriptivo. Participaron 41 pacientes pediátricos con implante coclear unilateral. Se conformaron tres grupos y se construyeron ecuaciones de regresión múltiple multivariable. RESULTADOS: Para el grupo 1 se observa en los grupos de electrodos 3 y 4 menor desviación estándar y similar índice de asimetría de las unidades de corriente; en el grupo 2, los grupos de electrodos con similar índice de asimetría fueron el 2 y el 4, y el grupo de electrodos 3 presentó un promedio de 21.54 y una dispersión más pequeña (16,25); en el grupo 3, los grupos de electrodos 3 y 4 presentaron similar desviación estándar y promedio y desviación estándar más pequeños. Con respecto al error estándar de estimación, se obtuvo una menor variabilidad de unidades de corriente en el grupo 2 para el grupo de electrodos 3. CONCLUSIÓN: Las ecuaciones propuestas son de utilidad clínica al conocer las unidades de corriente necesarias considerando la edad y el tiempo de uso del implante coclear.

Incertidumbre, sistemas dinámicos, principios de mecánica cuántica y su relación con el proceso salud-enfermedad (propuesta de análisis) / Uncertainty, dynamic systems, principles of quantum mechanics and their relationship to the health-disease process (analysis proposal)

El presente trabajo tuvo como finalidad discutir la importancia y la posible aplicación de algunos fundamentos de la mecánica cuántica en el proceso de salud-enfermedad, considerando para esto que las leyes y fundamentos de la teoría atómica son los mismos que rigen los desplazamientos en el espacio y el tiempo en los seres humanos. Con base en la imposibilidad de determinar el desplazamiento de las partículas subatómicas en un espacio y tiempo determinado, como consecuencia de no contar con instrumentos de medición para dichas microescalas, consideramos factible que lo mismo suceda con la incertidumbre generada por los tiempos y movimientos de los seres humanos en espacios realmente grandes, por lo que el análisis de la ubicación temporo-espacial de un sujeto en movimiento, en un tiempo y en un espacio determinado, es imposible. Creemos que este hecho podría representar el comportamiento en las pandemias. Los fundamentos de la mecánica cuántica que se han considerado con dicho fin son: los sistemas dinámicos; la paradoja del gato de Schrödinger; el principio de incertidumbre de Heisenberg; la ley de gases, tiempos y movimientos; la entropía de Maxwell-Boltzmann. Por otra parte, se propone considerar la adaptación de herramientas de medición basadas en procedimientos estadísticos (árbol de decisiones y teoría de conjuntos) y, finalmente, se propone la implementación de un cubo probabilístico unitario, el cual permita ubicar a un sujeto inmerso en el proceso de salud-enfermedad mediante tres ejes desarrollados según la definición de salud estipulada por la Organización Mundial de la Salud

The purpose of this work is to discuss the importance and possible application of some foundations of quantum mechanics in the health-disease process, considering for this, that the laws and foundations of atomic theory are the same that govern displacement in space and time in human beings. Based on the impossibility of determining the displacement of subatomic particles in a given space and time, as a consequence of not having measuring instruments for said microscales, we propose feasible that the same happens with the uncertainty generated by the times and movements of human beings in really large spaces, reason why the analysis of the temporo-spatial location of a moving subject, in a certain time and space is impossible, fact that we consider, could represent the behavior in Pandemics. The foundations of quantum mechanics that have been considered for this purpose are dynamic systems, the Schrödinger cat paradox, the Heisenberg uncertainty principle, the law of gases, times and movements, and the Maxwell-Boltzmann entropy. On the other hand, it is proposed to consider the adaptation of measurement ecis ecisión statistical procedures (decisión tree and set theory) and finally the implementation of a unitary probabilistic cube is proposed, which allows locating a subject immersed in the health process disease through three axes developed considering the definition of health stipulated by the WHO

Comparison of ocular vestibular myogenic response by acoustic stimulation at 500 and 1000 Hz in healthy subjects.

OBJECTIVE: To compare the amplitude of potentials by acoustic stimulation at 500 Hz versus 1000 Hz in healthy subjects. METHODS: 25 subjects; potentials were performed with acoustic stimuli burst-type at 500 and 1000 Hz with a stimulation rate of 5.1 at 100 dB in both ears. Descriptive statistics tests were performed, confidence intervals were calculated for the mean with 95% reliability, standard error graphs and t-test for related samples. RESULTS: The values obtained in amplitude when performing an acoustic stimulus at 1000 Hz show a faster response compared to that obtained in the frequency of 500 Hz. The t-test showed a significant difference in the amplitude in the 1000 Hz frequency between ears with a significance value of p < 0.025. CONCLUSIONS: It is strengthened the hypothesis that in the amplitude of potentials by aerial acoustic stimulation in the frequency of 1000 Hz a greater amplitude is generated in relation to the one generated in the frequency of 500 Hz.

OBJETIVO: Comparar la amplitud de los potenciales miogénicos vestibulooculares por estimulación acústica a 500 y 1000 Hz en sujetos sanos. MÉTODO: Se estudiaron 25 sujetos y se realizaron potenciales con estímulos acústicos tipo burst a 500 y 1000 Hz con una tasa de estimulación de 5.1 a 100 dB en ambos oídos. Se realizaron pruebas de estadística descriptiva y se calcularon los intervalos de confianza para la media con un 95% de confiabilidad, las gráficas de error estándar y la prueba t para muestras relacionadas. RESULTADOS: Los valores obtenidos en amplitud al realizar estímulo acústico a 1000 Hz muestran una respuesta más rápida en comparación con la obtenida en la frecuencia de 500 Hz. La prueba t mostró una diferencia significativa en la amplitud en la frecuencia 1000 Hz entre oídos, con un valor de significancia p < 0.025. CONCLUSIONES: Se fortalece la hipótesis de que en los potenciales por estimulación acústica aérea en la frecuencia de 1000 Hz se genera una mayor amplitud en relación con la generada en la frecuencia de 500 Hz.

Acoustic analysis of voice in children with cleft lip and palate following vocal rehabilitation. Preliminary report.

BACKGROUND: Cleft lip and palate (CLP) is the most common craniofacial anomaly. CLP affects resonance, voice and speech. Besides the most frequently reported resonance and speech disorders, several reports have addressed acoustic abnormalities in the voice of patients with CLP. However, there are just a few reports focusing on vocal treatment in this population. OBJECTIVE: To study whether a Speech and Language Pathology (SLP) intervention including vocal rehabilitation for children with CLP and velopharyngeal insufficiency (VPI) provides significant improvement of abnormal acoustic parameters of voice. MATERIAL AND METHODS: Fifteen children with cleft lip and palate (CLP) and velopharyngeal insufficiency (VPI) were studied. Age ranged 4-5 years. A matched control group of children without craniofacial anomalies and adequate speech, resonance and voice was assembled. All children underwent acoustic analysis of voice at the onset and at the end of SLP intervention including vocal rehabilitation. RESULTS: Hypernasality persisted unchanged following SLP intervention. Mean Fundamental Frequency (F0) did not demonstrate a significant difference between the control and the active groups. At the onset of the intervention mean shimmer and jitter were significantly higher in all patients with CLP as compared to controls. At the end of the intervention shimmer and jitter significantly decreased in patients with CLP showing no differences as compared to controls. CONCLUSION: SLP intervention including vocal rehabilitation improves abnormal acoustic parameters of voice. Besides surgical treatment for VPI the SLP intervention in children with CLP should also address vocal rehabilitation.

Propuesta para la determinación del cambio de velocidad, velocidad instantánea y aceleración con base en el puntaje APACHE II en pacientes en estado crítico / Proposal for the determination of velocity change, instantaneous velocity and aceleration from the APACHE II score in critically ill patients / Proposta para a determinação da mudança de velocidade, velocidade instantânea e aceleração baseada no escore APACHE II em pacientes críticos

Resumen: Las herramientas de evaluación de la gravedad en el enfermo grave proporcionan información objetiva intra e interobservador relacionada con la gravedad de la enfermedad, su evolución en relación al tiempo y la estratificación de riesgo son parte fundamental en la toma de decisiones. El objetivo de este trabajo es presentar una nueva propuesta de la evaluación del APACHE II basada en un modelo matemático de cambio en el tiempo/velocidad, velocidad instantánea y aceleración.

Abstract: The illness severity scoring systems provide objetive measures for inter and intra comparisons with time, provide useful information for comparing the severity of illness are an essencial part of the improvment in clinical decisions and in stratifying patients. Appropiated application of these models helps in decision making at the right time. The aim of this paper is to submit a proposal for the evaluation of the APACHE II score based on a vectorial mathematical model of chance in time/velocity, instant velocity and aceleration.

Resumo: Os instrumentos de avaliação da gravidade do paciente grave fornecem informações objetivas intra e interobservadores relacionadas à gravidade da doença, sua evolução em relação ao tempo, estratificação de risco são fundamentais para tomada de decisão. O objetivo deste trabalho é apresentar uma nova proposta para a avaliação do APACHE II baseada em um modelo matemático de mudança de tempo/velocidade, velocidade instantânea e aceleração.

Causas y efectos del daño cerebral adquirido traumático y no traumático en una cohorte de 736 pacientes / Causes and effects of traumatic and non-traumatic acquired brain damage in a cohort of 736 patients

Antecedentes: el daño cerebral adquirido es un importante problema de salud pública y la principal causa de muerte y discapacidad, la cual abarca no solo aspectos motrices, sino también del lenguaje, habla, memoria y/o habilidades cognitivas que afectan de manera sustancial la vida de quienes la padecen. Objetivo: analizar y describir causas y efectos del daño cerebral adquirido traumático y no traumático. Material y métodos: estudio analítico transversal retrospectivo; se seleccionaron expedientes de pacientes (2011 a 2015) conformando un total de 736. Se calcularon medias, desviaciones estándar, porcentajes y frecuencias; con la finalidad de evaluar si existía diferencia significativa entre variables se calculó χ2 y dependencia estadística mediante análisis de probabilidad condicional. Resultados: el daño cerebral de origen traumático se presentó en 169 (22.9%) pacientes (138 hombres y 31 mujeres). Las causas principales fueron accidentes automovilísticos (27.8%) y caídas (24.8%); 567 (77%) pacientes (286 hombres, 281 mujeres) presentaron daño por etiología no traumática, principalmente por evento vascular isquémico (377 pacientes, 51.22%). Los diagnósticos establecidos con mayor frecuencia fueron los trastornos del lenguaje y de memoria. Conclusiones: la enfermedad vascular cerebral se está convirtiendo en un problema de salud, por lo que es necesario generar campañas preventivas e informativas sobre la adecuada atención y tratamiento con la finalidad de disminuir la incidencia y la gravedad de la discapacidad de los pacientes afectados

Background: acquired brain damage is a major public health problem and the main cause of death and disability, which encompasses not only motor aspects, but also language, speech, memory and/or cognitive abilities that substantially affect the lives of those suffering from them. Objective: to analyze and describe causes and effects of traumatic and non-traumatic acquired brain damage. Materials and methods: this is a retrospective cross-sectional analytical review. Patient files were selected (2011 to 2015), making a total of 736. Means, standard deviations, percentages and frequencies were calculated; with the purpose of evaluating if there was a significant difference between variables was calculated and statistical dependence through conditional probability analysis. Results: acquired brain injury of traumatic origin occurred in 169 (22.9%) patients (138 men and 31 women). The main causes were car accidents (27.8%) and falls (24.8%); 567 (77%) patients (286 men and 281 women) presented damage due to non-traumatic etiology, mainly due to ischemic vascular event (377 patients, 51.22%). The most commonly established diagnoses were language and memory disorders. Conclusions: cerebral vascular disease is becoming a health problem, so it is necessary to create preventive and informative campaigns about the adequate care and treatment in order to reduce the incidence and severity of the disability of affected patients

Point-of-care gastrointestinal and urinary tract sonography in daily evaluation of gastrointestinal dysfunction in critically ill patients (GUTS Protocol).

There is currently a lack of universally accepted criteria for gastrointestinal (GI) failure or dysfunction in critical care. Moreover, the clinical assessment of intestinal function is notoriously difficult and thus often goes unrecognized, contributing to poor outcomes. A recent grading system has been proposed to define acute gastrointestinal injury (AGI) in conjunction with other organ function scores (e.g., SOFA). Ultrasonography has become widely accepted as a diagnostic tool for GI problems and pathology. We propose a sonographic examination of the abdomen, using the GUTS protocol (gastrointestinal and urinary tract sonography) in critically ill patients as part of the point-of-care ultrasound evaluation in patients with AGI. This article reviews possible applications of ultrasonography that may be relevant to monitor the GI function in critically ill patients. The GI ultrasound protocol (GUTS) focuses on four gastrointestinal endpoints: gastrointestinal diameter, mucosal thickness, peristalsis, and blood flow. Moreover, it is possible to examine the urinary tract and kidney function. Real-time ultrasound with the GUTS protocol is a simple, inexpensive, bedside imaging technique that can provide anatomical and functional information of the GI tract. Further studies are needed to investigate the utility of GUTS with other parameters, such as GI biomarkers, AGI class, and clinical outcomes.

[Conditional probability analysis between tinnitus and comorbidities in patients attending the National Rehabilitation Institute-LGII in the period 2012-2013]. / Análisis de probabilidad condicional entre el acúfeno y comorbilidades asociadas en pacientes que acudieron al Instituto Nacional de Rehabilitación-LGII en el periodo 2012-2013.

BACKGROUND: Tinnitus is defined as the conscious perception of a sensation of sound that occurs in the absence of an external stimulus. This audiological symptom affects 7% to 19% of the adult population. The aim of this study is to describe the associated comorbidities present in patients with tinnitus usingjoint and conditional probability analysis. PATIENTS: Patients of both genders, diagnosed with unilateral or bilateral tinnitus, aged between 20 and 45 years, and had a full computerised medical record, were selected. METHODS: Study groups were formed on the basis of the following clinical aspects: 1) audiological findings; 2) vestibular findings; 3) comorbidities such as, temporomandibular dysfunction, tubal dysfunction, otosclerosis and, 4) triggering factors of tinnitus noise exposure, respiratory tract infection, use of ototoxic and/or drugs. RESULTS: Of the patients with tinnitus, 27 (65%) reported hearing loss, 11 (26.19%) temporomandibular dysfunction, and 11 (26.19%) with vestibular disorders. When performing the joint probability analysis, it was found that the probability that a patient with tinnitus having hearing loss was 2742 0.65, and 2042 0.47 for bilateral type. The result for P (A ∩ B)=30%. Bayes' theorem P (AiB) = P(Ai∩B)P(B) was used, and various probabilities were calculated. Therefore, in patients with temporomandibulardysfunction and vestibular disorders, a posterior probability of P (Aі/B)=31.44% was calculated. CONCLUSIONS: Consideration should be given to the joint and conditional probability approach as tools for the study of different pathologies.

Correlación entre la clasificación Child-Pugh lactato y la mortalidad en pacientes cirróticos internados en la unidad de terapia intensiva / Relationship between the Child-Pugh+lactate score and mortality in cirrhotic patients in the intensive care unit / Correlação entre a classificação child-pugh lactato e a mortalidade em pacientes cirróticos internados na Unidade de Terapia Intensiva

Resumen: Objetivo: Comprobar la capacidad pronóstica como predictor de mortalidad de la clasificación de Child-Pugh lactato en la población de pacientes cirróticos que ingresan en la Unidad de Cuidados Intensivos de la Fundación Clínica Médica Sur. Material y métodos: Estudio de investigación clínica, cohorte no concurrente, donde se obtuvieron datos en el periodo comprendido del 1 de enero de 2012 al 31 de diciembre de 2014. Resultados: Ingresaron 28 casos a la Unidad de Terapia Intensiva de la Fundación Clínica Médica Sur con diagnóstico de cirrosis hepática; de ellos, fallecieron un total de 16 (57.1%) sujetos dentro de los primeros 40 días posteriores a su ingreso y sobrevivieron 12 (42.9%). Se calculó si existía correlación entre la defunción y el puntaje de la clasificación Child-Pugh lactato mayor de 14, y se encontró una r = 0.708. El puntaje mayor a 14 puntos se asoció a mortalidad en 87.5%, así como el puntaje menor a 14 se vinculó a supervivencia a 40 días en 83.33%. Conclusiones: La clasificación de Child-Pugh más lactato mayor de 14 puntos tiene una fuerte correlación con la mortalidad.

Abstract: Objective: This study aimed to establish if the Child-Pugh+lactate score is a reliable prognostic scoring tool as mortality predictor in cirrhotic patients admitted to the Médica Sur Clinic Foundation Intensive Care Unit. Material and methods: This was a 3-year, single-centered retrospective cohort study performed in a general ICU. Results: Twenty-eight cases were collected in the period from January 1, 2012 to December 31, 2014, of which a total of 16 patients (57.1%) died within the first 40 days after admission and 12 survived (42.9%). It was assessed if there was a correlation between death and a Child-Pugh lactate score greater than 14, finding an r = 0.708. Conclusions: A Child-Pugh+lactate score with a numerical value above 14 points has a direct relation with mortality in cirrhotic patients admitted to the ICU.

Resumo: Objetivo: Comprovar a capacidade prognóstica como preditor de mortalidade da Child Pugh lactato na população de pacientes cirróticos admitidos na terapia intensiva da Fundação Clínica Médica Sur. Material e métodos: Estudo de investigação clínica, coorte não concorrente, onde os dados foram coletados no período de 1 de Janeiro de 2012 a 31 Dezembro de 2014. Resultados: 28 casos admitidos na unidade de terapia intensiva da Fundação Clínica Médica Sur, diagnosticados com cirrose hepática, dos quais faleceram um total de 16 pacientes (57.1%) nos primeiros 40 dias após a admissão e sobreviveram 12 (42.9%). Calculou-se a existência de uma correlação entre a defunção e a Classificação Child Pugh lactato maior de 14 pontos, encontrando um r = 0.708. A pontuação CPL maior a 14 pontos está associado à mortalidade em 87.5% e inferior a 14 foi associado a sobrevida à 40 dias em um 83.33%. Conclusões: A Clasificação Child Pugh lactato maior a 14 pontos tem uma forte correlação com a mortalidade.

[Quantitative evaluation proposal of a ultrasonographic protocol for weaning from mechanichal ventilation]. / Propuesta de evaluación cuantitativa en el protocolo ultrasonográfico para retiro de la ventilación mecánica invasiva (GMEMI score).

INTRODUCTION: Mechanical ventilation is a therapy for vital support used in a significant proportion of critically ill patients. The right time to successfully discontinue this therapy is a challenge for the intensive care specialist. For this reason it is still a subject for research. The echocardiographic evaluation of the diastolic dysfunction, the diaphragm, and the lung have become an invaluable tool for weaning from mechanical ventilation protocols, especially in patients with difficult or prolonged weaning from mechanical ventilation. There is still a need to validate, in controlled trials, the efficacy of an ultrasound protocol for weaning from mechanical ventilation that integrates the three modalities in a single protocol. METHODS: Based on current literature, we developed a score justified by a mathematical model based on inequations. When χ ⇒ 5 the risk of failure in the weaning process rises, the weaning process should be suspended; when χ ⇒ 1 the risk of failure is low, the weaning process should be continued. CONCLUSIONS: The use of math models for decision-making is of great importance, as it sets an objective parameter within the existing evaluations. We proposed the use of inequations to set intervals of solution with the three points of care for ultrasound-guided weaning from mechanical ventilation. With this, the inequations proposed generate an area of certainty within the proposed values and the solution intervals.

Standardization of Sonographic Diaphragm Thickness Evaluations in Healthy Volunteers.

BACKGROUND: B-mode ultrasound can be used to measure diaphragm thickness at the zone of apposition. We believe it is necessary to develop normal values for diaphragm thickness at rest in a large group of healthy subjects and compare them with international results. METHODS: Ultrasound measurements of diaphragm thickness at expiratory rest were taken in 109 healthy individuals, with results stratified by sex, body mass index, and thorax circumference. The following methods were used for analysis and interpretation. Multivariable databases with descriptive statistical analyses were made. The Pearson chi-square test was used to evaluate the distribution between variables. Additionally, mean and SD values were calculated. For standardization, the data were separated by sex within a 95% CI, and we calculated a Z test. A 95% CI was also constructed for proportion analyses. RESULTS: One hundred nine healthy volunteers were included in the study, and the correlation between the body mass index and thorax circumference values with a Pearson chi-square test resulted in an r = 0.69. Additionally, the average value of diaphragmatic thickness was 0.19 ± 0.04 cm (95% CI 0.17-0.20 cm) for men and 0.14 ± 0.03 cm (95% CI 0.13-0.15 cm) for women (P = .001). There was no relation between body mass index thorax circumference, and diaphragmatic thickness. CONCLUSION: Real-time ultrasound of the diaphragm is a simple, inexpensive, and portable imaging technique that can provide qualitative anatomical information. The findings in this study show that sonographic diaphragm evaluations can be applied to the general population.