Estado cognitivo y funcional a largo plazo en supervivientes de una hemorragia subaracnoidea aneurismática: análisis de una cohorte retrospectiva / Long-term cognitive and functional status in survivors of an aneurysmal subarachnoid hemorrhage: Analysis of a retrospective cohort

Objetivo: Existe poca información sobre los resultados funcionales y cognitivos a largo plazo en pacientes con hemorragia subaracnoidea aneurismática (HSA). El objetivo principal fue evaluar la situación cognitiva, funcional, anímica y la calidad de vida en personas con HSA a largo plazo. Pacientes y método: Estudio de corte transversal de una cohorte de 40 pacientes (edad media 58,2 [DE 9,9] años) con HSA ingresados en la unidad de Rehabilitación neurológica entre enero del 2010 a julio del 2017. Variables de resultado: estado cognitivo (cuestionario de Pfeiffer), nivel funcional (índice de Barthel), depresión (escala de Hamilton) y calidad de vida (European Quality of Life-5 Dimensions [EQ-5D]), así como las terapias de rehabilitación realizadas en un seguimiento mínimo de seis meses post-HSA. Resultados: De 35 pacientes con alteraciones cognitivas en fase aguda, solo 12 realizaron terapia cognitiva tras el alta hospitalaria. En el seguimiento a largo plazo, los déficits cognitivos persistían en 22 casos, y en comparación con el resto, presentaban peores puntuaciones en el índice de Barthel (15,5 [IC 95% 1,2 a 29,7]), la escala de Hamilton (-0,8 [IC 95% -1,27 a -0,37]), y la EQ-5D (27,6 [IC 95% 12,4 a 19]). Conclusión: La prevalencia de déficits cognitivos a largo plazo en supervivientes de una HSA es alta y su presencia se relaciona con un peor estado funcional, más depresión y peor calidad de vida. El bajo porcentaje de individuos que realizan terapia cognitiva en su proceso de rehabilitación junto con las repercusiones clínicas observadas apoyan la necesidad de incluir las terapias neurocognitivas en los programas de rehabilitación de las HSA.(AU)

Objective: Little data is available on long-term functional and cognitive outcomes in patients with aneurysmal subarachnoid hemorrhage (ASH). The main objective of this study was to assess cognition, functional state, mood disorders, and quality of life in patients with SAH at least six months following the ASH. Patients and methods: Cross-sectional study of 40 patients (aged 58.2 [SD 9.9] years) with ASH, discharged from a Neurologic Rehabilitation unit between January 2010 and July 2017. Main outcome variables: functional status (Barthel index), cognition (Pfeiffer questionnaire), depression (Hamilton scale), and health-related quality of life (European Quality of Life-5 Dimensions [EQ-5D]), as well as type and duration of therapeutic rehabilitation procedures after discharge. Results: From 35 patients with cognitive disorders, only 12 received cognitive therapy at hospital discharge. In the long-term follow-up, cognitive impairment persisted in 22 patients. When compared with those without cognitive impairment, they presented significantly worse mean differences in the Barthel index (15.5 [95% CI: 1.2-29.7]), Hamilton scale (-0.8 [95% CI: -1.27 to -0.37]), and EQ-5D (27.6 [95% CI: 12.4-19]). Conclusion: The prevalence of long-term cognitive impairments in survivors of a SAH episode is high, and their presence is associated with worse functional status, more depression and worse quality of life. The low percentage of subjects who received cognitive therapies through their recovery process and the clinical implications observed, support the need of including neuropsychological therapies in the rehabilitation programs after an SAH event.(AU)

[Long-term cognitive and functional status in survivors of an aneurysmal subarachnoid hemorrhage: Analysis of a retrospective cohort]. / Estado cognitivo y funcional a largo plazo en supervivientes de una hemorragia subaracnoidea aneurismática: análisis de una cohorte retrospectiva.

OBJECTIVE: Little data is available on long-term functional and cognitive outcomes in patients with aneurysmal subarachnoid hemorrhage (ASH). The main objective of this study was to assess cognition, functional state, mood disorders, and quality of life in patients with SAH at least six months following the ASH. PATIENTS AND METHODS: Cross-sectional study of 40 patients (aged 58.2 [SD 9.9] years) with ASH, discharged from a Neurologic Rehabilitation unit between January 2010 and July 2017. MAIN OUTCOME VARIABLES: functional status (Barthel index), cognition (Pfeiffer questionnaire), depression (Hamilton scale), and health-related quality of life (European Quality of Life-5 Dimensions [EQ-5D]), as well as type and duration of therapeutic rehabilitation procedures after discharge. RESULTS: From 35 patients with cognitive disorders, only 12 received cognitive therapy at hospital discharge. In the long-term follow-up, cognitive impairment persisted in 22 patients. When compared with those without cognitive impairment, they presented significantly worse mean differences in the Barthel index (15.5 [95% CI: 1.2-29.7]), Hamilton scale (-0.8 [95% CI: -1.27 to -0.37]), and EQ-5D (27.6 [95% CI: 12.4-19]). CONCLUSION: The prevalence of long-term cognitive impairments in survivors of a SAH episode is high, and their presence is associated with worse functional status, more depression and worse quality of life. The low percentage of subjects who received cognitive therapies through their recovery process and the clinical implications observed, support the need of including neuropsychological therapies in the rehabilitation programs after an SAH event.

Geographic and ontogenetic variations in parasite communities of intertidal fish species from the south-eastern Pacific coast.

Parasite composition can be affected by physiological and ecological changes during host ontogeny. Intertidal fish do not travel long distances and live in the same area throughout their lifetimes, meaning that parasite communities can differ across geographic ranges. The objective of this study was to analyse the parasite communities of three fish species (Hypsoblennius sordidus, Helcogrammoides cunninghami and Scartichthys viridis) collected from the Chilean coast. The composition of parasite species was compared among host ontogenetic stages (larvae, juveniles and mature fish) and geographic areas. A total of 184 larval, 252 juveniles and 217 mature individuals were collected in the northern area (c. 24°S), and 186 larval, 192 juveniles and 112 mature individuals from the central area (c. 33°S). Ectoparasites were most prevalent in fish from the central area, whereas endoparasites were most prevalent in the northern area. The parasite species richness varied significantly between geographical areas for H. sordidus and H. cunninghami, but the parasite composition varied significantly between geographical areas for all fish species analysed. Therefore, the geographical area was the most important factor determining the parasite composition of intertidal fish species. The absence of endoparasites in fish larvae and the increased infestation in juvenile and mature fish may be explained by the shift in habitat from the water column to intertidal pools where prey abundance and availability are higher. On the other hand, hydrographic barriers affecting prey distributions may also offer an explanation as to the differences in parasite composition.

Relación miofuncional y tratamiento de ortodoncia en paciente con síndrome de Turner. Reporte de caso / Myofunctional relation and orthodontic treatment in patient with Turner syndrome. Case report

El síndrome de Turner es un desorden cromosómico, generado por la pérdida parcial o total de un cromosoma X. Las mujeres que lo presentan, pueden tener una serie de altera- ciones físicas y funcionales. El objetivo de este estudio es exponer el caso de una paciente con diagnóstico de síndrome de Turner, hipotonía muscular y maloclusión severa que fue tratada con terapia muscular craneofacial, combinada con ortodoncia en la Unidad de Malformación Craneofacial de la Facultad de Odontología de la Universidad de Chile.

The Turner Syndrome is a chromosome disorder produced by the total or partial absent of an X chromosome. The women who presents Turner syndrome can have a series of physical and functional alterations. The aim of this study is to present the case of a patient diagnosed with Turner syndrome, muscular hypotony and severe malocclusio treated with craneofacial muscular therapy combined with orthodontics at the Craneo- facial Malformations Unit of the Faculty of Dentistry, University of Chile.

Consumo, características y perfil del consumidor de suplementos nutricionales en gimnasios de Santiago de Chile / Consumo, características e perfil do consumidor de suplementos nutricionais em academias de Santiago do Chile / Consumption, characteristics, and profile: consumers of nutritional supplements in gymnasiums in Santiago, Chile

Introducción. Los deportistas son los principales consumidores de suplementos nutricionales; presentan en general la utilización más alta. En Chile existe un creciente interés por consumir estos suplementos, sin tener mucho conocimiento de sus efectos. Objetivos. Determinar el perfil del consumidor, quiénes lo recomiendan, los productos más usados y distinguir posibles diferencias de acuerdo al sexo, la finalidad de su uso y otras variables. Métodos. Se aplica un cuestionario de 19 preguntas abiertas y cerradas a 446 voluntarios hombres y mujeres, asistentes a 6 gimnasios de la ciudad de Santiago de Chile durante el año 2013, pertenecientes a un grupo etario de entre 17 y 49 años de edad. Resultados. Los hombres son los mayores consumidores de suplementos, lo cual aumenta de acuerdo al tiempo de entrenamiento semanal que realizan. Ellos prefieren batidos proteicos con el objetivo de aumentar su masa muscular. Las mujeres consumen principalmente vitaminas y agentes lipolíticos con el objetivo de disminuir la masa grasa. Un alto porcentaje cree que el consumo de suplementos les ayuda a cumplir sus objetivos. Conclusión. Un número considerable de personas que asiste regularmente a los gimnasios consume suplementos sin la orientación especializada y posiblemente sin tener que utilizarlos realmente, pero es necesario regular el uso irracional y potencialmente inseguro de los suplementos nutricionales en mejora del rendimiento físico (AU)

Introduction. Athletes are the principle consumers of nutritional supplements, and generally present the highest rate of usage. In Chile, there is a growing interest in consuming these supplements, although there is little knowledge of their effects. Objectives. To determine the consumer profile, who recommends the usage of these nutritional supplements, what the most used products are, and to distinguish possible differences in variables like sex, the purpose of their use, and others. Methods. A survey with 19 open and closed questions was given to 446 men and women volunteers, from between the ages of 17 and 49, who were participants from six gymnasiums in Santiago, Chile, in 2013. Results. Men are the greatest consumers of supplements, and usage increases according to the amount of time spent training every week. This group prefers protein shakes with the aim of increasing muscle mass. Women principally consume vitamins and lipolytic agents with the aim of reducing fatty mass. A high percentage believes that consuming supplements aids in meeting their goals. Conclusion. A considerable number of those who regularly attend a gymnasium consume supplements without specialized orientation and (possibly) without the real need of doing so. It is necessary to regulate irrational and potentially unsafe use of nutritional supplements in bettering physical output (AU)

Introdução. Os atletas são os principais consumidores de suplementos nutricionais, e geralmente apresentam a maior taxa de uso. No Chile, há um crescente interesse em consumir estes suplementos, embora haja pouco conhecimento de seus efeitos. Objetivos. Determinar o perfil do consumidor, quem recomenda, os produtos mais utilizados e distinguir possíveis diferenças de acordo com sexo, a finalidade do seu uso e outras variáveis. Métodos. Foi aplicado um questionário com 19 perguntas abertas e fechadas a 446 voluntários homens e mulhere pertencentes a faixa etária de 17 a 49 anos de idade, participantes de 6 academias na cidade de Santiago do Chile, durante o ano de 3013. Resultados. Os homens são os maiores consumidores de suplementos, o qual aumenta de acordo com o tempo de treinamento semanal que realizam. Eles preferem shakes de proteína, a fim de aumentar a sua massa muscular. Principalmente as mulheres consomem vitaminas e agentes lipolíticos, a fim de reduzir a massa gorda. Uma percentagem alta acredita que o consumo de suplementos irá ajudá-lo a cumprir seus objetivos. Conclusão. Um número considerável de pessoas que frequentam regularmente academias, consomem suplementos sem orientação especializada e, possivelmente, nenhuma necessidade real para isso, portanto é necessário regulamentar o uso irracional e potencialmente inseguro de suplementos nutricionais para melhorar o desempenho (AU)

Puente adhesivo en paciente con labio leporino y fisura velopalatina: una solución temporal con compromiso estético / Adhesive bridge in a patient with cleft lip and palate: a temporary solution with esthetic commitment

En la actualidad el aumento de la demanda estética y la necesidad de procedimientos mínimamente invasivos ha llevado a un aumento de la técnica adhesiva. Ribbond® es una marca de fibra de polietileno que permite un eficiente traspaso de fuerzas, es virtualmente plegable y se adapta fácilmente a la morfología dentaria y al contorno del arco dentario. Dentro de sus principales características podemos encontrar: Biocompatibilidad, inerte, translúcido y durable. Dentro de la odontología se le han dado distintos usos para esta fibra, ya sea como mantenedor de espacio, puente adhesivo, poste y núcleo endodóntico, ferulización, restauraciones tipo inlay y estabilización postortodóncica. En el caso de los pacientes fisurados se ha hecho relevante el uso de Ribbond® como puente adhesivo ya que permite mejorar la estética y rehabilitar temporalmente los espacios desdentados causados por la ausencia de un incisivo, principalmente una vez terminado el tratamiento de ortodoncia y en espera de una rehabilitación definitiva, aún más cuando el paciente no ha terminado su crecimiento y desarrollo. En este artículo se presenta un caso clínico de un paciente con labio leporino y fisura velopalatina operado demostrativo de la técnica de rehabilitación con Ribbond®.

Today the increasing demand of aesthetic and minimally invasive procedures has led to a boom of the adhesive technique. Ribbond® is a polyethylene fiber that allows an efficient transfer of forces, is virtually foldable and is easily adapted to tooth morphology and dental arch contour. Among its main features we can find: Biocompatibility, inert, translucent and durable. In dentistry, different uses have been given to this fiber, whether as space maintainer, adhesive bridge, endodontic post and core, splinting, inlay type restorations and postorthodontic stabilization. In the case of cleft lip and palate patients the use of Ribbond® as an adhesive bridge has become relevant, as it improves aesthetics and temporarily rehabilitates the edentulous spaces caused by the absence of an incisor. It is used especially after completion of the orthodontic treatment and waiting for a final rehabilitation, even when the patient has not completed their growth and development. This article presents a clinical case of a patient with lip and cleft palate operated with the rehabilitation technique using Ribbond®.

Efectos del entrenamiento muscular inspiratorio/espiratorio sobre función respiratoria de pacientes tetrapléjicos / Effects of inspiratory/expiratory muscular training on respiratory function in quadriplegic patients

Introduction: Functional impairment in patients with high spinal cord injuries is associated to ventilatory dysfunction due to paretic respiratory muscles, which causes alterations in the ventilatory and in the cough mechanisms. Respiratory muscle training has been studied as a therapeutic alternative for this group of patients with no conclusive results, whereas a mixed protocol, which stimulates both inspiratory and expiratory muscles, had not been previously investigated. Objective: To evaluate the effects of systematic respiratory muscle training during four months, on pulmonary function, respiratory muscles strength and effort tolerance, cough efficacy and dyspnea perception, in a group of quadriplegic patients with at least one year of evolution post injury. Method: A quasi-experimental design was used. Six adults with cervical spinal cord injuries were enlisted and incorporated in a mixed respiratory muscles training for four months. Pulmonary function, respiratory muscles strength and resistance, cough efficacy and dyspnea perception were assessed pre and post training. Results: The application of the mixed training protocol significantly improved inspiratory muscle strength (p = 0,028),respiratory muscles effort tolerance (p = 0,028) and cough efficacy (p = 0,034).The other measures did not reach statistical significance. Conclusion: Mixed(inspiratory/expiratory) muscular training, shows partially favorable results in the improvement of pulmonary function. Studies using greater numbers of patients are necessary to achieve more categorical results.

Introducción: El compromiso funcional en pacientes con lesiones medulares altas se asocia a disfunción ventilatoria por paresia de musculatura respiratoria y provoca alteraciones ventilatorias y en el mecanismo de la tos. El entrenamiento de la musculatura respiratoria ha sido analizado como alternativa terapéutica para neumo este grupo de pacientes sin resultados concluyentes, mientras que un protocolo mixto, que estimule músculos inspiratorios y espiratorios no ha sido estudiado con anterioridad. Objetivo: Evaluar la respuesta del sistema respiratorio al entrenamiento sistemático de la musculatura respiratoria durante cuatro meses, sobre la función pulmonar, fuerza y tolerancia al esfuerzo de la musculatura respiratoria, eficacia de la tos y percepción de disnea de un grupo de pacientes tetrapléjicos. Materiales y Métodos: Se aplicó un diseño cuasi-experimental. Seis pacientes con lesiones medulares cervicales de al menos un año de evolución fueron reclutados e incluidos en un programa de entrenamiento mixto de la musculatura respiratoria durante 4 meses. Se evaluó la función pulmonar, fuerza y resistencia de la musculatura respiratoria, eficacia de la tos y percepción de disnea antes y después del período de entrenamiento. Resultados: El protocolo de entrenamiento mixto aplicado incrementó significativamente la fuerza muscular inspiratoria (p= 0,028), la tolerancia al esfuerzo de los músculos respiratorios (p = 0,028) y la eficacia de la tos (p = 0,034). El incremento en todas las otras variables medidas no alcanzó significancia estadística. Conclusión: El entrenamiento muscular mixto(inspiratorio/espiratorio) muestra resultados parcialmente favorables en la mejoría de indicadores de función pulmonar. Estudios de mayor número de pacientes son necesarios para acceder a resultados más categóricos.

Nuevo método para impartir el curso de electrocardiografía al tercer año de la carrera de Medicina

Se desarrolló una investigación prospectiva, en el curso 2003 2004 con la totalidad de los estudiantes del tercer año de la carrera de medicina con el objetivo de comprobar la eficacia de un nuevo método para impartir el curso de electrocardiografía en el Hospital Universitario Camilo Cienfuegos de Sancti Spíritus. A través de la creación de dos grupos (estudio y control) se demostró, que con el método propuesto, se lograron mejores resultados en lo concerniente a: motivación, comprensión y aptitudes de los estudiantes, siendo fundamental la alta efectividad alcanzada en la demostración final de la competencia