Transplant renal artery stenosis: Study of incidence using doppler ultrasound, risk factors and analysis is effect in graft outcomes.

INTRODUCTION AND OBJECTIVES: Transplant renal artery stenosis (TRAS) is a vascular complication after kidney transplantation which estimated incidence is 13%. It could cause refractory arterial hypertension, kidney dysfunction and premature death in transplant recipients. METHODS: We carried out a retrospective study including every patient who underwent renal transplantation between 2014 and 2020. They were evaluated with a systematic post-transplant renal Doppler ultrasound. To identify independent risk factors for transplant renal artery stenosis we performed a multivariate analysis. RESULTS: Seven hundred twenty-four kidney transplants were included, 12% ​​were living donors and 88% were deceased donors. The mean age was 54.8 in recipients and 53 in donors. Transplant renal artery stenosis was diagnosed in 70 (10%) recipients, the majority in the first 6 months after surgery. 51% of patients with transplant renal artery stenosis were managed conservatively. The multivariate analysis showed diabetes mellitus, graft rejection, arterial resuture and donor body mass index as independent risk factors for transplant renal artery stenosis. Survival of the grafts with transplant renal artery stenosis was 98% at 6 months and 95% at two years. CONCLUSIONS: The systematic performance of Doppler ultrasound in the immediate post-transplant period diagnosed 10% of transplant renal artery stenosis in our cohort. Despite the above risk factors, an adequate monitoring and treatment could avoid the increased risk of graft loss in patients with transplant renal artery stenosis.

[Incidence of pelvic and acetabular fractures in the elderly due to high energy trauma]. / Incidencia de fracturas de pelvis y acetábulo en el adulto mayor por trauma de alta energía.

INTRODUCTION: as the population pyramid gets inverted, more active and longer lives are lived, geriatric patients with high energy trauma (HET) become more frequent; requiring more resources, getting worse results with more perioperative complications, coupled with a fragile state of health and osteopenia, make these fractures difficult to manage. With the hypothesis that the incidence of pelvic and acetabular fractures in the elderly due to HET is higher than that reported in the world literature, the research question was generated: What is the incidence of pelvic and acetabular fractures in the elderly due to HET, in a 5-year period? MATERIAL AND METHODS: with the authorization of the Ethics Committee, an observational study of a retrospective cohort was carried out, using medical records, identifying the incidence of these fractures, surgically treated in our institution Clínica Las Vegas, Medellin, Colombia, a level III hospital, from July 1, 2016 to June 30, 2021. RESULTS: a cumulative incidence of 1.95 new cases per 100,000 person-years was calculated, a prevalence of 13.8%; resulting in a higher incidence and prevalence, confirming our hypothesis. CONCLUSION: treatment should be aimed at improving quality of life with stable fixation, identification and treatment of associated injuries, minimizing the risk of mechanical complications and prioritizing the reinforcement of preventive measures, also in the improvement of male role behavior, whom, as it seems, will keep carrying out risky activities despite their age.

INTRODUCCIÓN: a medida que se invierte la pirámide poblacional, se viven vidas más largas y activas, se vuelven más frecuentes los pacientes geriátricos con trauma de alta energía; requiriendo más recursos, obteniéndose peores resultados, con más complicaciones perioperatorias, hacen a estas fracturas difíciles de manejar. Establecida la hipótesis de que la incidencia de las fracturas de pelvis y acetábulo, en el adulto mayor por trauma de alta energía, es superior a la reportada en la literatura mundial, se generó la pregunta de investigación: ¿Cuál es la incidencia de fracturas de pelvis y acetábulo por trauma de alta energía en el adulto mayor en un período de cinco años? MATERIAL Y MÉTODOS: una vez obtenida la autorización del Comité de Ética, se realizó un estudio observacional de una cohorte retrospectiva, utilizando registros médicos, identificando la incidencia de estas fracturas, tratadas quirúrgicamente en nuestro hospital de III nivel, Clínica Las Vegas, Medellín, Colombia, del 1 de Julio de 2016 a 30 de Junio de 2021. RESULTADOS: se calculó una incidencia acumulada de 1.95 nuevos casos por cada 100,000 personas-año, una prevalencia de 13.8%; resultando en una mayor incidencia y prevalencia, confirmándose nuestra hipótesis. CONCLUSIÓN: el tratamiento debe orientarse a mejorar la calidad de vida con una fijación estable, identificación y tratamiento de lesiones asociadas, minimizando el riesgo de complicaciones mecánicas y priorizar el reforzamiento de medidas preventivas y a la mejora del comportamiento del rol masculino, que aparentemente, seguirán realizando actividades de riesgo a pesar de su edad.

Lesión medular asociada a hematoma epidural espinal espontáneo / Spinal cord injury associated with spontaneous spinal epidural hematoma

Introducción: El hematoma epidural espinal espontáneo (HEEE) es una entidad de baja incidencia, de elevada morbimortalidad y que causa una importante limitación funcional en la vida de los pacientes. Material y métodos: Con el objetivo de determinar la incidencia del HEEE y el tipo de lesión medular provocada y su repercusión funcional en este centro hospitalario, se realizó un estudio descriptivo retrospectivo analizando variables demográficas, de la lesión (ISCNSCI) y de la funcionalidad (SCIMIII). Resultados: Se revisaron los casos de HEEE atendidos en este centro. El 75% eran varones, con una mediana de edad de 55años. Todas las lesiones fueron incompletas. La localización más frecuente de las lesiones fue a nivel cervical bajo y dorsal alto. La mitad de los sangrados se produjeron en la región medular anterior. Se objetivó mejoría funcional tras el programa específico de rehabilitación. Conclusión: El HEEE podría considerarse de buen pronóstico funcional, relacionado con lesiones medulares habitualmente posteriores e incompletas sensitivo-motoras que se beneficiarían de un tratamiento rehabilitador específico precoz.(AU)

Introduction: Spontaneous spinal epidural hematoma (SSEH) is a disease with low incidence and high morbidity/mortality. It can cause severe loss of function. Material and methods: In order to determine the incidence, type of spinal injury and functional impact, a descriptive and retrospective study was developed, analysing demographic data, functional scores (SCIMIII) and neurological scores (ISCNSCI). Results: Cases of SSEH were reviewed. Seventy-five percent were male, median age was 55years old. All of the spinal injuries were incomplete and were frequently in the lower cervical and thoracic regions. Fifty percent of bleedings occurred in the anterior spinal cord. Most showed with a progress after an intensive rehabilitation program. Conclusion: SSEH could be considered to have a good functional prognosis, related to usually posterior and incomplete sensory-motor spinal cord injuries that would benefit from early specific rehabilitative treatment.(AU)

Aplicación de la telemedicina en la asistencia a pacientes con cefaleas: situación actual y recomendaciones del Grupo de Estudio de Cefaleas de la Sociedad Española de / NeurologíaTelemedicine in the management of patients with headache: current situation and recommendations of the Spanish Society of Neurology's Headache Study Group

Introducción: La pandemia COVID-19 ha provocado un inusitado impulso a la telemedicina(TM). Analizamos el impacto de la pandemia en la TM aplicada en las consultas de cefaleasespañolas, revisamos la literatura y lanzamos unas recomendaciones para implantar la TM enlas consultas. Método: Tres fases: 1) Revisión de la base Medline desde el año 1958 (primera experienciade TM); 2) Formulario Google Forms enviado a todos los neurólogos del Grupo de Estudio de Cefaleas de la Sociedad Espa˜nola de Neurología (GECSEN), y 3) Consenso on-line de expertosGECSEN para emitir recomendaciones para implantar la TM en España. Resultados: La pandemia por COVID-19 ha empeorado los tiempos de espera presenciales,incrementando el uso de todas las modalidades de TM antes y después de abril de 2020: teléfonofijo (del 75% al 97%), teléfono móvil (del 9% al 27%), correo electrónico (del 30% al 36%) yvideoconsulta (del 3% al 21%). Los neurólogos son conscientes de la necesidad de ampliar laoferta con videoconsultas, claramente in crescendo, y otras herramientas de e-health y m-health. Conclusiones: Desde el GECSEN recomendamos y animamos a todos los neurólogos que asis-ten a pacientes con cefaleas a implantar recursos de TM, teniendo como objetivo óptimo lavideoconsulta en menores de 60-65 a˜nos y la llamada telefónica en mayores, si bien cada casodebe individualizarse. Se deberá contar previamente con la aprobación y asesoramiento de losservicios jurídicos e informáticos y de la dirección del centro. La mayoría de los pacientes concefalea y/o neuralgia estable son candidatos a seguimiento mediante TM, tras una primeravisita que tiene que ser siempre presencial.(AU)

Introduction: The COVID-19 pandemic has caused an unexpected boost to telemedicine. Weanalyse the impact of the pandemic on telemedicine applied in Spanish headache consultations,review the literature, and issue recommendations for the implementation of telemedicine inconsultations. Method: The study comprised 3 phases: 1) review of the MEDLINE database since 1958 (firstreported experience with telemedicine); 2) Google Forms survey sent to all members of theSpanish Society of Neurology’s Headache Study Group (GECSEN); and 3) online consensus ofGECSEN experts to issue recommendations for the implementation of telemedicine in Spain.Results: COVID-19 has increased waiting times for face-to-face consultations, increasing theuse of all telemedicine modalities: landline telephone (from 75% before April 2020 to 97% after),mobile telephone (from 9% to 27%), e-mail (from 30% to 36%), and video consultation (from 3%to 21%). Neurologists are aware of the need to expand the availability of video consultations,which are clearly growing, and other e-health and m-health tools. Conclusions: The GECSEN recommends and encourages all neurologists who assist patients withheadaches to implement telemedicine resources, with the optimal objective of offering videoconsultation to patients under 60-65 years of age and telephone calls to older patients, althougheach case must be considered on an individual basis. Prior approval and advice must be soughtfrom legal and IT services and the centre’s management. Most patients with stable headacheand/or neuralgia are eligible for telemedicine follow-up, after a first consultation that mustalways be held in person.(AU)

Telemedicine in the management of patients with headache: current situation and recommendations of the Spanish Society of Neurology's Headache Study Group.

INTRODUCTION: The COVID-19 pandemic has caused an unexpected boost to telemedicine. We analyse the impact of the pandemic on telemedicine applied in Spanish headache consultations, review the literature, and issue recommendations for the implementation of telemedicine in consultations. METHOD: The study comprised 3 phases: 1) review of the MEDLINE database since 1958 (first reported experience with telemedicine); 2) Google Forms survey sent to all members of the Spanish Society of Neurology's Headache Study Group (GECSEN); and 3) online consensus of GECSEN experts to issue recommendations for the implementation of telemedicine in Spain. RESULTS: COVID-19 has increased waiting times for face-to-face consultations, increasing the use of all telemedicine modalities: landline telephone (from 75% before April 2020 to 97% after), mobile telephone (from 9% to 27%), e-mail (from 30% to 36%), and video consultation (from 3% to 21%). Neurologists are aware of the need to expand the availability of video consultations, which are clearly growing, and other e-health and m-health tools. CONCLUSIONS: The GECSEN recommends and encourages all neurologists who assist patients with headaches to implement telemedicine resources, with the optimal objective of offering video consultation to patients under 60-65 years of age and telephone calls to older patients, although each case must be considered on an individual basis. Prior approval and advice must be sought from legal and IT services and the centre's management. Most patients with stable headache and/or neuralgia are eligible for telemedicine follow-up, after a first consultation that must always be held in person.

An Integrated Platform for in vivo Electrophysiology in Spatial Cognition Experiments.

Spatial cognition research requires behavioral paradigms that can distinguish between different navigational elements, such as allocentric (map-like) navigation and egocentric (e.g., body centered) navigation. To fill this need, we developed a flexible experimental platform that can be quickly modified without the need for significant changes to software and hardware. In this paper, we present this inexpensive and flexible behavioral platform paired with software which we are making freely available. Our behavioral platform serves as the foundation for a range of experiments, and though developed for assessing spatial cognition, it also has applications in the non-spatial domain of behavioral testing. There are two components of the software platform, 'Maze' and 'Stim Trigger'. Both programs can work in conjunction with electrophysiology acquisition systems, allowing for precise time stamping of neural events with behavior. The Maze program includes functionality for automatic reward delivery based on user defined zones. 'Stim Trigger' permits control of brain stimulation via any equipment that can be paired with an Arduino board. We seek to share our software and leverage the potential by expanding functionality in the future to meet the needs of a larger community of researchers.

Evaluation of the burden of migraine on the partner's lifestyle.

BACKGROUND: Despite the number of research studies regarding the individual burden of migraine, few studies have examined its impact on the patients' partners. We aim to assess migraine effects on the patients' partners on sentimental relationship, children relationship, friendship, and work, as well as the caregiver burden, anxiety and/or depression. METHODS: A cross-sectional observational study was conducted through an online survey of partners of patients with migraine followed-up in 5 Headache Units. Questions about the 4 areas of interest and 2 scales (Hospital Anxiety and Depression Scale and Zarit scale) were included. Scores were compared against the population prevalence. RESULTS: One hundred and fifty-five answers were analysed. Among the patient's partners 135/155 (87.1%) were men, with a mean age of 45.6 ± 10.1 years. Migraine's main effects on partners were observed in the sentimental relationship and items concerning children and friendships, with a minor impact at work. Partners showed a moderate burden (12/155 = 7.7% [4.1%-13.1%]), and a higher moderate-severe anxiety rate (23/155 = 14.8% [9.6%-21.4%]), and similar depression rate (5/155 = 3.2% [1.1%-7.3%]) compared to the National Health Survey. CONCLUSIONS: The burden of migraine impacts the partners' personal relationship, childcare, friendship and work. Moreover, certain migraine partners showed a moderate burden according to Zarit scale and higher anxiety levels than the Spanish population.

Estudio sobre el subtriaje del Sistema de Triaje de Manchester en pacientes que acuden a Urgencias por cefalea / Study about the Manchester Triage System subtriage in patients that visited the Emergency Department due to headache

Introducción: La cefalea es un motivo de consulta urgente frecuente, siendo la prioridad detectar a pacientes con cefalea secundaria, especialmente cefaleas secundarias de alto riesgo (CESAR). Para ello, se emplean sistemas de triaje como el Sistema de Triaje de Manchester (STM). Pretendemos evaluar la frecuencia de subtriaje en pacientes que acudieron a Urgencias por cefalea. Material y métodos: Estudio de serie de casos consecutivos. Se analizaron pacientes que acudieron a Urgencias refiriendo cefalea y tuvieron algún dato de alarma, definido como la presencia de datos que motivasen la solicitud de neuroimagen urgente y/o la valoración por Neurología de guardia. El diagnóstico de referencia fue realizado por neurólogos. Se evaluó el nivel de triaje asignado por el STM y la presencia de datos de alarma que implicaría el triaje en un nivel superior al asignado. Resultados: Hubo 1.120 visitas a Urgencias por cefalea, siendo elegibles 248 pacientes (22,8%). Se diagnosticó cefalea secundaria en 126 casos (50,8% de la muestra, 11,2% del total), siendo 60 CESAR (24,2% y 5,4%). El STM clasificó a dos pacientes como críticos (0,8%), 26 emergencias (10,5%), 147 urgencias (59,3%), 68 como estándar (27,4%) y cinco como no urgente (2%). El porcentaje de pacientes infravalorados durante el triaje fue del 85,1% en el nivel «emergencia» y 23,3% en el de «urgencia». Conclusión: Durante el periodo de estudio, al menos uno de cada diez pacientes que acudió a Urgencias por cefalea tenía una cefalea secundaria y uno de cada veinte una CESAR. El STM subvaloró a la mayoría de los pacientes con datos que implicarían una potencial emergencia.(AU)

Introduction: Headache is a frequent cause of consultation; it is important to detect patients with secondary headache, particularly high-risk secondary headache. Such systems as the Manchester Triage System (MTS) are used for this purpose. This study aims to evaluate the frequency of sub-triage in patients attending the Emergency Department due to headache. Material and methods: We studied a series of consecutive patients who came to the Emergency Department with headache and presenting some warning sign, defined as the presence of signs leading the physician to request an emergency neuroimaging study and/or assessment by the on-call neurologist. The reference diagnosis was established by neurologists. We evaluated the MTS triage level assigned and the presence of warning signs that may imply a higher level than that assigned. Results: We registered a total of 1,120 emergency department visits due to headache, and 248 patients (22.8%) were eligible for study inclusion. Secondary headache was diagnosed in 126 cases (50.8% of the sample; 11.2% of the total), with 60 cases presenting high-risk secondary headache (24.2%; 5.4%). According to the MTS, two patients were classified as immediate (0.8%), 26 as very urgent (10.5%), 147 as urgent (59.3%), 68 as normal (27.4%), and five as not urgent (2%). The percentage of patients under-triaged was 85.1% in the very urgent classification level and 23.3% in the urgent level. Conclusion: During the study period, at least one in 10 patients attending the Emergency Department due to headache had secondary headache; one in 20 had high-risk secondary headache. The MTS under-triaged most patients with warning signs suggesting a potential emergency.(AU)

A comprehensive resilience assessment of Mexican tree species and their relationship with drought events over the last century.

The resilience of forests to drought events has become a major natural resource sustainability concern, especially in response to climate change. Yet, little is known about the legacy effects of repeated droughts, and tree species ability to respond across environmental gradients. In this study, we used a tree-ring database (121 sites) to evaluate the overall resilience of tree species to drought events in the last century. We investigated how climate and geography affected the response at the species level. We evaluated temporal trends of resilience using a predictive mixed linear modeling approach. We found that pointer years (e.g., tree growth reduction) occurred during 11.3% of the 20th century, with an average decrease in tree growth of 66% compared to the previous period. The occurrence of pointer years was associated with negative values of the Standardized Precipitation Index (SPI, 81.6%) and Palmer Drought Severity Index (PDSI, 77.3%). Tree species differed in their resilience capacity, however, species inhabiting xeric conditions were less resistant but with higher recovery rates (e.g., Abies concolor, Pinus lambertiana, and Pinus jeffreyi). On average, tree species needed 2.7 years to recover from drought events, with extreme cases requiring more than a decade to reach pre-drought tree growth rates. The main abiotic factor related to resilience was precipitation, confirming that some tree species are better adapted to resist the effects of droughts. We found a temporal variation for all tree resilience indices (scaled to 100), with a decreasing resistance (-0.56 by decade) and resilience (-0.22 by decade), but with a higher recovery (+1.72 by decade) and relative resilience rate (+0.33 by decade). Our results emphasize the importance of time series of forest resilience, particularly by distinguishing the species-level response in the context of legacy of droughts, which are likely to become more frequent and intense under a changing climate.

Study about the Manchester Triage System subtriage in patients that visited the Emergency Department due to headache.

INTRODUCTION: Headache is a frequent cause of consultation; it is important to detect patients with secondary headache, particularly high-risk secondary headache. Such systems as the Manchester Triage System (MTS) are used for this purpose. This study aims to evaluate the frequency of undertriage in patients attending the emergency department due to headache. MATERIAL AND METHODS: We studied a series of consecutive patients who came to the emergency department with headache and presenting some warning sign, defined as the presence of signs leading the physician to request an emergency neuroimaging study and/or assessment by the on-call neurologist. The reference diagnosis was established by neurologists. We evaluated the MTS triage level assigned and the presence of warning signs that may imply a higher level than that assigned. RESULTS: We registered a total of 1120 emergency department visits due to headache, and 248 patients (22.8%) were eligible for study inclusion. Secondary headache was diagnosed in 126 cases (50.8% of the sample; 11.2% of the total), with 60 cases presenting high-risk secondary headache (24.2%; 5.4%). According to the MTS, 2 patients were classified as immediate (0.8%), 26 as very urgent (10.5%), 147 as urgent (59.3%), 68 as normal (27.4%), and 5 as not urgent (2%). The percentage of patients undertriaged was 85.1% in the very urgent classification level and 23.3% in the urgent level. CONCLUSION: During the study period, at least one in 10 patients attending the emergency department due to headache had secondary headache; one in 20 had high-risk secondary headache. The MTS undertriaged most patients with warning signs suggesting a potential emergency.

Characterisation of the management of patients with migraine in the primary care setting in Spain. Analysis of the results of the European My-LIFE anamnesis project.

INTRODUCTION: Migraine affects more than 4.5 million people in Spain, resulting in a considerable socioeconomic impact. Although national and international guidelines have been published, the management of patients with migraine, especially those with chronic migraine, is inadequate. SUBJECTS AND METHODS: We conducted a survey among 40 primary care (PC) physicians in Spain as part of a European project involving 201 physicians from 5 countries. RESULTS: Most participants issued diagnoses of episodic migraine and chronic migraine (93% vs 65%); 82.5% indicated that they did not refer these patients to specialists, and 100% of PC physicians stated that they were responsible for patient follow-up. The main tools used in PC for diagnosis and follow-up were clinical interviews, medical histories, and the patient diaries. Our data revealed that the treatments prescribed were not in accordance with the national and international guidelines. Participants who did not refer patients estimated that only 48% of patients received preventive treatment, and that the assessment of efficacy was based on patient perception. Seventy percent of respondents indicated a need for migraine training. Finally, 100% of participants considered that a guide for medical history taking and referral would be essential or useful for the management of migraine in PC. CONCLUSIONS: The survey results revealed a need for training and guidance in PC to improve the diagnosis and management of patients with migraine, particularly chronic migraine.

Estimulación temporal mediante cable de fijación activa / Temporal stimulation by active fixation lead

Resumen Objetivo: Determinar seguridad y eficacia del marcapasos temporal mediante cable de fijación activa vía yugular y/o subclavia. Métodos: Se analizaron pacientes desde 2017 a 2021 postextracción de marcapasos dependientes de estimulación. Resultados: Se colocó estimulación temporal en 25 pacientes con una edad media de 68 ± 16 años. La media de duración de la estimulación temporal fue cinco días. No se registró mortalidad asociada a la estimulación temporal, sin embargo en un paciente se presentó desplazamiento de cable y falla de captura a los cuatro días de la colocación. Conclusiones: La estimulación temporal mediante cable de fijación activa es segura y eficaz.

Abstract Objective: To determine the efficacy and safety of temporary pacing with an active fixation lead placed trough the internal jugular vein and/or subclavian vein. Methods: We analyzed a consecutive series of 25 out of 73 patients that had a pacemaker extraction and were pacing dependent requiring temporary pacing with an active fixation lead until the new pacemaker implant, from 2017 to 2021. Results: After extraction 25 patients age 68 years ±16 years, required temporary pacing, the media for temporary pacing was 5 days. There were no mortality associated to temporary stimulation. Only one patient (4%) had a complication 4 days after the implant with capture fail due to a microdislogement requiring reintervention. Conclusion: Temporary stimulation through active fixation pacemaker lead it is safe and effective.

[Spinal cord injury associated with spontaneous spinal epidural hematoma]. / Lesión medular asociada a hematoma epidural espinal espontáneo.

INTRODUCTION: Spontaneous spinal epidural hematoma (SSEH) is a disease with low incidence and high morbidity/mortality. It can cause severe loss of function. MATERIAL AND METHODS: In order to determine the incidence, type of spinal injury and functional impact, a descriptive and retrospective study was developed, analysing demographic data, functional scores (SCIMIII) and neurological scores (ISCNSCI). RESULTS: Cases of SSEH were reviewed. Seventy-five percent were male, median age was 55years old. All of the spinal injuries were incomplete and were frequently in the lower cervical and thoracic regions. Fifty percent of bleedings occurred in the anterior spinal cord. Most showed with a progress after an intensive rehabilitation program. CONCLUSION: SSEH could be considered to have a good functional prognosis, related to usually posterior and incomplete sensory-motor spinal cord injuries that would benefit from early specific rehabilitative treatment.

[Temporal stimulation by active fixation lead.] / Estimulación temporal mediante cable de fijación activa.

Objective: To determine the efficacy and safety of temporary pacing with an active fixation lead placed trough the internal jugular vein and/or subclavian vein. Methods: We analyzed a consecutive series of 25 out of 73 patients that had a pacemaker extraction and were pacing dependent requiring temporary pacing with an active fixation lead until the new pacemaker implant, from 2017 to 2021. Results: After extraction 25 patients age 68 years ±16 years, required temporary pacing, the media for temporary pacing was 5 days. There were no mortality associated to temporary stimulation. Only one patient (4%) had a complication 4 days after the implant with capture fail due to a microdislogement requiring reintervention. Conclusion. Conclusion: Temporary stimulation through active fixation pacemaker lead it is safe and effective.

Objetivo: Determinar seguridad y eficacia del marcapasos temporal mediante cable de fijación activa vía yugular y/o subclavia. Métodos: Se analizaron pacientes desde 2017 a 2021 postextracción de marcapasos dependientes de estimulación. Resultados: Se colocó estimulación temporal en 25 pacientes con una edad media de 68 ± 16 años. La media de duración de la estimulación temporal fue cinco días. No se registró mortalidad asociada a la estimulación temporal, sin embargo en un paciente se presentó desplazamiento de cable y falla de captura a los cuatro días de la colocación. Conclusiones: La estimulación temporal mediante cable de fijación activa es segura y eficaz.

Bioactive peptides of whey: obtaining, activity, mechanism of action, and further applications.

Bioactive peptides derived from diverse food proteins have been part of diverse investigations. Whey is a rich source of proteins and components related to biological activity. It is known that proteins have effects that promote health benefits. Peptides derived from whey proteins are currently widely studied. These bioactive peptides are amino acid sequences that are encrypted within the first structure of proteins, which required hydrolysis for their release. The hydrolysis could be through in vitro or in vivo enzymatic digestion and using microorganisms in fermented systems. The biological activities associated with bio-peptides include immunomodulatory properties, antibacterial, antihypertensive, antioxidant and opioid, etc. These functions are related to general conditions of health or reduced risk of certain chronic illnesses. To determine the suitability of these peptides/ingredients for applications in food technology, clinical studies are required to evaluate their bioavailability, health claims, and safety of them. This review aimed to describe the biological importance of whey proteins according to the incidence in human health, their role as bioactive peptides source, describing methods, and obtaining technics. In addition, the paper exposes biochemical mechanisms during the activity exerted by biopeptides of whey, and their application trends.