[Core data set for real world data in multiple sclerosis: customization for latin america from a global task force recommendation]. / Core data set para la generación de datos de la vida real en esclerosis múltiple: adaptación de una iniciativa global para América Latina.

INTRODUCTION: The primary objective of the core data set is to reduce heterogeneity and promote harmonization among data sources in EM, thereby reducing the time needed to execute real life data collection efforts. Recently, a group led by the Multiple Sclerosis Data Alliance has developed a core data set for collecting real-world data on multiple sclerosis (MS) globally. Our objective was to adapt this global data set to the needs of Latin America, so that it can be implemented by the registries already developed and in the process of development in the region. MATERIAL AND METHODS: A working group was formed regionally, the core data set created globally was adapted (translation process into Spanish, incorporation of regional variables and consensus on variables to be used). Consensus was obtained through the remote Delphi methodology of a round of questionnaires and remote discussion of the core data set variables. RESULTS: A total of 25 professionals from Latin America carried out the adaptation process between November 2022 and July 2023. Agreement was established on a core data set of nine categories and 45 variables, version 2023 to suggest its implementation in developed or developing registries, and MS cohorts in the region. CONCLUSION: The core data set seeks to harmonize the variables collected by registries and cohorts in MS in Latin America in order to facilitate said collection and allow collaboration between sources. Its implementation will facilitate real life data collection and collaboration in the region.

TITLE: Core data set para la generación de datos de la vida real en esclerosis múltiple: adaptación de una iniciativa global para América Latina.Introducción. Los objetivos primarios del core data set son reducir la heterogeneidad y promover la armonización entre las fuentes de datos en la esclerosis múltiple (EM), reduciendo así el tiempo necesario para ejecutar esfuerzos en la recolección de datos de vida real. Recientemente, un grupo liderado por la Multiple Sclerosis Data Alliance ha desarrollado un core data set para la recolección de datos del mundo real en EM a nivel global. Nuestro objetivo ha sido adaptar y consensuar este conjunto de datos globales a las necesidades de América Latina para que pueda ser implementado por los registros ya desarrollados y en proceso de desarrollo en la región. Material y métodos. Se conformó un grupo de trabajo regionalmente y se adaptó el core data set creado globalmente (proceso de traducción al español, incorporación de variables regionales y consenso sobre variables que se iban a utilizar). El consenso se obtuvo a través de la metodología Delphi remoto de ronda de cuestionarios y discusión a distancia de las variables del core data set. Resultados. Veinticinco profesionales de América Latina llevaron adelante el proceso de adaptación entre noviembre de 2022 y julio de 2023. Se estableció un acuerdo sobre un core data set de nueve categorías y 45 variables, versión 2023, con la sugerencia de implementarlo en registros desarrollados o en vías de desarrollo y cohortes de EM en la región. Conclusión. El core data set busca armonizar las variables recolectadas por los registros y las cohortes de EM en América Latina con el fin de facilitar dicha recolección y permitir una colaboración entre fuentes. Su implementación facilitará la recolección de datos de vida real y la colaboración en la región.

Beyond Janzen's Hypothesis: How Amphibians That Climb Tropical Mountains Respond to Climate Variation.

Janzen's hypothesis (JH) posits that low thermal variation selects for narrow physiological tolerances, and thus small species distributional ranges and high species turnover along tropical elevational gradients. Although this hypothesis has been intensely revisited, it does not explain how many tropical species may exhibit broad distributions, encompassing altitudinal gradients. Moreover, the physiological responses of tropical species remain largely unknown, limiting our understanding on how they respond to climate variation. To fill these knowledge gaps, we tested a major component of JH, the climate variability hypothesis (CVH), which predicts broader thermal tolerance breadth (Tbr = CTmax - CTmin) with broader temperature variation. Specifically, we sampled populations of five amphibian species distributed in two mountain ranges in Brazil's Atlantic Forest to test how CTmin and CTmax vary along elevational gradients. Since both thermal and water balance traits are pivotal to the evolutionary history of amphibians, we also measured rates of dehydration and rehydration and their relations with thermal tolerances. We found that broader temperature variation with increasing altitude did not always lead to broader Tbr, since changes in CTmin and CTmax were species-specific. In addition, we found that water balance did not show consistent variation with altitude, also with low correlations between hydric and thermal traits. While we also found that highland populations are at lower risk of thermal stress than lowland counterparts, both are living far from their upper thermal limits. As a consequence of intraspecific variation in physiological traits and spatial variation in climate along altitude, responses to climate variation in tropical amphibian species were context-dependent and heterogeneous. Together with recent studies showing thermal tolerances of some tropical amphibians comparable to temperate taxa, our findings highlight that several responses to climate variation in tropical species may not conform to predictions made by either the CVH or other important hypotheses concerning physiological variation. This reinforces the need to overcome geographical bias in physiological data to improve predictions of climate change impacts on biodiversity. (Portuguese abstract) Resumo A Hipótese de Janzen (JH) postula que a baixa variação térmica seleciona tolerâncias fisiológicas estreitas e, portanto, amplitudes restritas de distribuição das espécies e alta substituição de espécies ao longo de gradientes altitudinais tropicais. Embora intensamente revisitada, essa hipótese não explica como espécies tropicais podem exibir amplas distribuições geográficas, abrangendo gradientes altitudinais. Além disso, as respostas fisiológicas das espécies tropicais permanecem amplamente desconhecidas, limitando nossa compreensão sobre como elas respondem à variação climática. Para preencher essas lacunas de conhecimento, testamos um componente importante da JH, a Hipótese de Variabilidade Climática (CVH), que prevê uma maior amplitude de tolerância térmica (Tbr = CTmax - CTmin) quando a variação da temperatura ambiental é mais ampla. Especificamente, amostramos populações de cinco espécies de anfíbios distribuídas em duas cadeias montanhosas na Mata Atlântica do Brasil para testar como CTmin e CTmax variam ao longo de gradientes de altitude. Dado que parâmetros térmicos e do balanço hídrico são fundamentais para a história evolutiva dos anfíbios, também medimos as taxas de desidratação e reidratação e suas relações com as tolerâncias térmicas. Encontramos que uma variação de temperatura ambiental mais ampla com o aumento da altitude nem sempre conduz a uma Tbr mais ampla, uma vez que as mudanças em CTmin e CTmax foram espécie-específicas. Além disso, encontramos que o balanço hídrico não apresentou variação consistente com a mudança de altitude, e que as correlações entre parâmetros hídricos e térmicos foram baixas. Embora populações das maiores altitudes apresentaram menor risco de estresse térmico do que populações da mesma espécie em altitudes menores, ambas estão vivendo longe de seus limites térmicos superiores. Em consequência da variação intraespecífica em parâmetros fisiológicos e variação espacial no clima ao longo da altitude, as respostas à variação climática em espécies de anfíbios tropicais foram contexto-dependentes e heterogêneas. Juntamente com estudos recentes indicando tolerâncias térmicas de alguns anfíbios tropicais comparáveis a de táxons temperados, nossas descobertas destacam que várias respostas à variação climática em espécies tropicais podem não estar de acordo com as previsões feitas pela CVH ou outras hipóteses importantes sobre a variação fisiológica. Isso reforça a necessidade de superar o viés geográfico em dados fisiológicos para aperfeiçoar previsões dos impactos das mudanças climáticas sobre a biodiversidade. (Spanish abstract) Resumen La hipótesis de Janzen (JH) postula que la baja variación térmica selecciona tolerancias fisiológicas estrechas y, por lo tanto, rangos de distribución de especies restringidos con alta rotación de especies a lo largo de gradientes de elevación tropicales. Aunque esta hipótesis ha sido intensamente discutida, no explica cómo várias especies tropicales pueden exhibir distribuciones amplias, abarcando gradientes altitudinales. Además, las respuestas fisiológicas de las especies tropicales siguen siendo bastante desconocidas, lo que limita la comprensión de cómo responden a la variación climática. Para llenar estos vacíos de conocimiento, examinamos un componente importante de JH, la Hipótesis de Variabilidad Climática (CVH), que predice mayor amplitud de tolerancia térmica (Tbr = CTmax - CTmin) cuando la variación de temperatura es más amplia. Específicamente, tomamos muestras de poblaciones de cinco especies de anfibios distribuidas en dos cadenas montañosas en el Bosque Atlántico de Brasil para verificar cómo CTmin y CTmax varían a lo largo de este gradiente de elevación. Dado que los rasgos de equilibrio térmico y hídrico son fundamentales para la historia evolutiva de los anfibios, también medimos las tasas de deshidratación y rehidratación y sus relaciones con las tolerancias térmicas. Encontramos que una variación de temperatura más amplia con el aumento de la altitud no siempre conduce a una Tbr más amplia, ya que los cambios en CTmin y CTmax son específicos de la especie. Además, encontramos que el balance hídrico no muestra variación consistente con la altitud, con bajas correlaciones también entre los rasgos hídricos y térmicos. Si bien las poblaciones de las tierras altas tienen un menor riesgo de estrés térmico que las contrapartes de las tierras bajas, ambas se encuentran lejos de sus límites térmicos superiores. Como consecuencia de la variación intraespecífica en los rasgos fisiológicos y la variación espacial en el clima a lo largo de la altitud, las respuestas a la variación climática en las especies de anfibios tropicales fueron dependientes del contexto y heterogéneas. Junto con estudios recientes que muestran tolerancias térmicas de algunos anfibios tropicales comparables a los taxones de zonas templadas, nuestros hallazgos resaltan que varias respuestas a la variación climática en especies tropicales pueden no ajustarse a las predicciones hechas por el CVH u otras hipótesis importantes sobre la variación fisiológica. Esto refuerza la necesidad de superar el sesgo geográfico en los datos fisiológicos para mejorar las predicciones de los impactos del cambio climático en la biodiversidad.

Heterozygous CAPN3 missense variants causing autosomal-dominant calpainopathy in seven unrelated families.

AIMS: Recessive variants in CAPN3 gene are the cause of the commonest form of autosomal recessive limb girdle muscle dystrophy. However, two distinct in-frame deletions in CAPN3 (NM_000070.3:c.643_663del21 and c.598_621del15) and more recently, Gly445Arg and Arg572Pro substitutions have been linked to autosomal dominant (AD) forms of calpainopathy. We report 21 affected individuals from seven unrelated families presenting with an autosomal dominant form of muscular dystrophy associated with five different heterozygous missense variants in CAPN. METHODS: We have used massively parallel gene sequencing (MPS) to determine the genetic basis of a dominant form of limb girdle muscular dystrophy in affected individuals from seven unrelated families. RESULTS: The c.700G> A, [p.(Gly234Arg)], c.1327T> C [p.(Ser443Pro], c.1333G> A [p.(Gly445Arg)], c.1661A> C [p.(Tyr554Ser)] and c.1706T> C [p.(Phe569Ser)] CAPN3 variants were identified. Affected individuals presented in young adulthood with progressive proximal and axial weakness, waddling walking and scapular winging or with isolated hyperCKaemia. Muscle imaging showed fatty replacement of paraspinal muscles, variable degrees of involvement of the gluteal muscles, and the posterior compartment of the thigh and minor changes at the mid-leg level. Muscle biopsies revealed mild myopathic changes. Western blot analysis revealed a clear reduction in calpain 3 in skeletal muscle relative to controls. Protein modelling of these variants on the predicted structure of calpain 3 revealed that all variants are located in proximity to the calmodulin-binding site and are predicted to interfere with proteolytic activation. CONCLUSIONS: We expand the genotypic spectrum of CAPN3-associated muscular dystrophy due to autosomal dominant missense variants.

Prison infrastructure, the right to health and a suitable environment for the inmates of the Women's Annex in Chorrillos Prison (Peru).

OBJECTIVES: Decide how prison infrastructure guarantees health's right a suitable environment of Establecimiento Penitenciario Anexo de Mujeres de Chorrillos (EPAMCh) prisoners. MATERIAL AND METHOD: For the materials was used an interview guide addressed to 10 specialist and interview guide addressed to 30 prisoners. About the method, it was selected the qualitative approach, the applied type with the phenomenological design. RESULTS: The interview experts said that Establecimiento Penitenciario Anexo de Mujeres de Chorrillos current infrastructure and don´t give minima sanitary services. In the polls, the prisoners unanimously answered that conditions were precarious, but mostly said that they were willing to incorporate to a health education program and bet for a preventive medicine without forget the curative. DISCUSSION: Is Important foment the preventive medicine in order to get a strong health education in jails. To reverse this reality would mean change a guarantee in their health rights and a suitable environment.

Utilización de sensores inerciales para la evaluación de la movilidad espinal en pacientes con espondiloartritis axial / Use of inertial sensors for the assessment of spinal mobility in axial spondyloarthritis patients

Introducción: La espondiloartritis axial (EspAx) es una enfermedad reumática que afecta a toda la columna del paciente (lumbar, dorsal y cervical) y produce una reducción de la movilidad a medida que la enfermedad avanza. Diversas herramientas metrológicas se han propuesto para evaluar esta movilidad. El objetivo de nuestro estudio es evaluar el uso de sensores inerciales (Inertial Measuring Unit) como herramienta para la medición de la movilidad espinal en pacientes con EspAx. Material y método: Estudio descriptivo y transversal donde se define la movilidad espinal por el movimiento cervical y dorsolumbar en los planos frontal, lateral y trasversal. Se utilizaron 7 pacientes con EspAx y 7 individuos sanos como grupo control. La movilidad se midió de forma sincronizada con un sistema basado en sensores inerciales y otro sistema de captura de movimiento basado en vídeo (UCOTrack©). Además, se obtuvieron medidas de metrología convencional. Finalmente se calcularon índices compuestos basados en estas medidas: BASMI, UCOASMI e iUCOASMI. Resultados: Tanto las medidas individuales como el índice obtenido a partir de los sensores, iUCOASMI, presentaron buena fiabilidad y concordancia con coeficientes de correlación intraclase superiores a 0,7 (¿0,95 en el grupo de pacientes) y excelente correlación (p<0,01) con UCOASMI y BASMI. En un ajuste de correlación lineal de iUCOASMI/UCOASMI se obtuvo una R2 de 0,97. Discusión: Los resultados obtenidos indican que los sensores inerciales podrían ser útiles para analizar la movilidad espinal en pacientes con EspAx de forma más precisa y fiable que la metrología convencional, y más flexible y económica que otros sistemas avanzados

Introduction: Axial Spondyloarthritis (AxSpa) is a rheumatic disease that affects the entire spine of the patient (lumbar, dorsal and cervical) and produces a reduction of mobility as the disease progresses. Several metrological tools have been proposed to assess this mobility. The objective of our study is to evaluate the use of inertial sensors "Inertial Measuring Unit" (IMU) as a tool for the measurement of spinal mobility in patients with AxSpA. Material and method: Descriptive and transversal study where spinal mobility is defined by cervical and dorsal-lumbar movement in frontal, lateral and transverse planes; by means of non-probabilistic sampling, 7 patients with AxSpA and 7 healthy subjects were recruited as control group. Mobility was measured synchronously with a system based on inertial motion sensors (IMU) and another video-based motion capture system (UCOTrack©). In addition, measurements of conventional metrology. Finally the BASMI (Bath Ankylosing Spondylitis Metrology Index), UCOASMI (University of Cordoba Ankilosing Spondylitis Metrology Index) and iUCOASMI index were obtained. Results: Both the individual measures obtained with the IMU and the composite index obtained from these measures, the iUCOASMI, show good reliability and concordance with intraclass correlation coefficients (ICC) above .7 (ICC¿.95 in the patient group), and an excellent correlation (P<.01) between iUCOASMI with UCOASMI and BASMI. In an adjustment of linear correlation of iUCOASMI/UCOASMI a R2 of .97 was obtained. Discussion: Results obtained shown that inertial sensors could be useful for analyzing spinal mobility in patients with AxSpA in a more accurate and reliable way than conventional metrology, and more flexible and economical than other advanced systems

Caracterización cinemática 3D del gesto técnico del remate en jugadoras de voleibol / Caracterização cinemática tridimensional do gesto técnico do ataque em jogadores de voleibol / Tridimensional kinematic characterization of female volleyball spike

Objetivo. Caracterizar cinemáticamente el gesto técnico del remate en voleibol en un grupo de jugadoras experimentadas de categoría sénior utilizando un sistema de captura y análisis del movimiento tridimensionalmente. Método. Se utilizó un sistema de captura de movimiento con cinco cámaras de alta velocidad (100Hz). Se definió un modelo de marcadores de 27 marcas reflectantes. Resultados. Se analizaron 38 parámetros cinemáticos, entre ellos: tiempos entre eventos, posición del centro de masas, velocidades y altura del remate. Se describieron parámetros como tiempo de vuelo, velocidad de impulsión vertical, salida del balón y rango de movimientos en brazo ejecutor, entre otros, con valores cercanos a los publicados por otros autores. Conclusiones. El presente estudio ha permitido definir un protocolo y modelo de informe como herramienta para el entrenamiento personalizado en función de las deficiencias observadas y para prevenir posibles lesiones a medio/largo plazo (AU)

Objetivo. Caracterizar cinematicamente o gesto técnico do ataque em voleibol em um grupo de jogadoras experientes de categoria sênior utilizando um sistema de captura e análise do sistema de movimento tridimensional. Método. Foi utilizado um sistema de movimento com cinco câmeras de alta velocidade (100Hz). Foi definido um modelo de marcadores reflexivos com 27 marcadores definido. Resultados. Foram analisados 38 parâmetros cinemáticos, entre eles: tempos entre eventos, posição do centro de massas, velocidade e altura do ataque. Foram descritos parâmetros como o tempo de vôo, velocidade de impulsão vertical, saída da bola e amplitude de movimento do braço executor, entre outros, com valores próximos aos publicados por outros autores. Conclusão. O presente estudo permitiu definir um modelo de protocolo e relatório como uma ferramenta para treinamento personalizado em função das deficiências observadas e para prevenir possíveis lesões a médio/longo prazo (AU)

Objective. Characterize the kinematic parameters in a group of experienced women senior class volleyball players using a 3D motion capture and analysis system. Method. A motion capture system connected to five high-speed cameras (100Hz) was used. A marker set was defined using 27 reflective marks. Results. Thirty eight kinematic parameters were analyzed: time between events, centre of mass, speed, height of spike. Many parameters were described as flight time, vertical impulsion speed, ball speed after spiking and range of movement in executor arm, among others, with similar values to those published by other authors. Conclusions. This study has defined a protocol and a custom report as tool for personalized training according to deficiencies detected and to prevent injuries at medium/long term (AU)

Fiabilidad y validez de la medida de la movilidad cervical en pacientes con espondiloartritis axial utilizando un sensor inercial / Reliability and validity of cervical mobility analysis measurement using an inertial sensor in patients with axial spondyloarthritis

Introducción. La espondiloartritis axial (EA) produce una reducción de la movilidad debido a la inflamación y el daño estructural a nivel vertebral. El análisis de la movilidad cervical es un componente fundamental en la evaluación de pacientes con EA. Diversos índices y herramientas se han propuesto para analizar la movilidad cervical en estos pacientes, si bien, algunos de ellos carecen de precisión y sensibilidad y otros necesitan amplios recursos para ser usados. Los sensores de movimiento inerciales (IMU) podrían ser útiles para este cometido, pero se necesitan procesos de validación. Material y método. Se evaluó el movimiento cervical en tres planos (flexión frontal, lateral y rotación cervical) utilizando un IMU y un sistema de captura de movimiento de forma sincronizada. Se hizo una prueba test/retest del sensor. Se tomaron otras medidas habitualmente usadas para monitorizar a los pacientes con EA. Resultados. El análisis de fiabilidad según el índice de correlación intraclase fue muy bueno (0,99) para el test/retest del sensor IMU y para la comparación con el sistema de captura de movimiento. Las diferencias en grados fueron pequeñas (2-9°). Discusión. La tecnología IMU proporciona una forma flexible y económica de medir la movilidad en este tipo de patologías. Según nuestros resultados, la comparativa con respecto a la captura de movimiento como «gold standard», ha sido satisfactoria. Es por esto que esta tecnología puede ser útil para analizar la movilidad cervical en la EA (AU)

Introduction. Axial spondyloarthritis (AS) reduces mobility due to inflammation and structural damage in the vertebra. Analysis of cervical mobility is a key component of the assessment of patients with AS. Several indices and tools have been proposed to analyse cervical mobility in these patients, but some of them lack accuracy and sensitivity and others require extensive resources for their use. Inertial motion sensors (IMU) might be useful for this purpose, but require validation. Material and method. Cervical movement was assessed synchronously in three planes (frontal flexion, lateral flexion and cervical rotation) by using an inertial sensor (IMU) and a motion capture system. A test/retest with the sensor was also performed. Other measurements commonly used to monitor AS patients were taken. Results. The reliability analysis using the intraclass correlation index was very good (0.99) for the test/retest with the IMU sensor and for the comparison with the motion capture system. Differences in degrees were small (2-9°). Discussion. IMU technology provides a flexible and economic way to measure mobility in this type of disease. In this study, the results of IMU versus motion capture as the gold standard were satisfactory. This technology can be useful for analysing cervical mobility in AS (AU)

Síndrome de guillain-barré e infección por virus zika en ciudad bolívar, venezuela (2015- 2016) / Guillain-barre syndrome and infection by ZIKA virus in Ciudad Bolívar, Venezuela (2015-2016)

El Virus ZIKA se extendió por muchos países y se vinculó a Sindrome de Guillain Barre en una alta proporción de pacientes. Objetivos: determinar el comportamiento clínicoepidemiológico de Síndrome de Guillain Barré (SGB) e infección por ZIKV en el Hospital Ruíz y Páez, Ciudad Bolívar, Estado Bolívar, Venezuela, en 2015-2016. Métodos: estudio descriptivo, prospectivo, diseño longitudinal. La muestra correspondió a 30 pacientes ingresados con diagnóstico de SGB e infección por ZIKV. Resultados: Los síntomas principales fueron: debilidad muscular progresiva (66.67%), parestesias (40.00%) y parálisis (26.67%). El 40.00% refirió infección previa por ZIKV; Se realizaron pruebas serológicas al 100% de los pacientes y en 93.33% se encontró hiperproteinorraquia; De acuerdo a los criterios de Brighton se estableció que todos los pacientes en estudio eran casos de SGB (nivel de certeza tipo 2) Al menos 63.33% eran nivel de certeza tipo 1, al tener los reportes electrofisiológicos. Todos, cumplían con los criterios de Asbury & Cornblath (1990) para diagnóstico de SGB. Evolución: recibió plasmaféresis el 46,66% de la muestra y 83.33% egresó por mejoría. Conclusión: Los resultados expuestos establecen clara vinculación ZIKV-SGB(AU)

ZIKA virus has extended to many countries and was the cause of Guillain-Barre Syndrome in a high proportion of the patients. Objectives: to determinate the clinical and epidemiological behavior of this combination in the Hospital Ruíz y Páez, Ciudad Bolívar, Venezuela. Methods: this was a descriptive, prospective, longitudinal study. The sample was of 30 patients admitted with Guillain-Barre´s Syndrome (GBS) and ZIKA Virus infection. Results: the major symptoms were: progressive muscular weakness 66.67%, paresthesias 40.00% and paralysis 26.67%. 40.00% had presented previous ZIKV. In 93.33% high contents in CSF were found. Serologic studies were realized in all patients: positive ZIKV IgM was present in 73.33% and IgG in 26.67% positiva para ZIKV. Due to their clinical conditions, 36.67% wwere admitted to the ICU. Following Brighton´s criteria and Asbury & Cornblath, all had the diagnosis of GBS. Evolutión: plasmapheresis was used in 46,66% and 83.33% improved and left the hospital. Conclusion: In this study there was a clear evidence of ZIKV infection in patients con GBS(AU)

Inter-rater reliability of clinical mobility measures in ankylosing spondylitis.

BACKGROUND: Several measurements are often used in daily clinical practice in the assessment of Ankylosing Spondylitis (AS) patients. The Assessment in SpondyloArthiritis International Society (ASAS) recommend in its core set: chest expansion modified Schöber test, Occiput to wall distance, lateral lumbar flexion, cervical rotation and The Bath Ankylosing Spondylitis Metrology Index (BASMI). BASMI also includes five measurements, some of them recommended by ASAS. Three versions of BASMI have been published with different scales and intervals for each component of the index. Though studies about reliability of these measurements are needed. The aim of this study was to analyze inter-rater reliability of recommended spinal mobility measures in AS. METHODS: We examined reproducibility of spinal mobility measurements on 33 AS patients performed by two experienced rheumatologists in the same day. Descriptive statistics, Intraclass Correlation Coefficients (ICC), and Smallest Detectable Difference (SDD) using the Bland-Altman criteria were obtained for all the measurements. RESULTS: Chest expansion showed the lowest value of ICC (0.66) and occiput-wall the highest (0.97). SDD was 2.43 units for BASMI2 and 1.27 units for BASMI10. CONCLUSIONS: Reliability according to ICC was moderate to high in all measurements. BASMI10, instead BASMI2, must be used: measurements used to calculate are the same but there is better reliability. Inter-rater variation, expressed as SDD, must be taken in account: smaller improvements do not demonstrate the efficacy of treatment because they can be due to experimental error and not to the treatment itself.

Enfermedad diarreica aguda en pacientes con nutrición enteral en Unidad de Cuidados Intensivos: serie de casos / Case Studies of Acute Diarrhea in ICU Patients on Enteral Nutrition

La administración de nutrición enteral (NE) se menciona de modo frecuente como causa de aparición de diarrea en el paciente en la Unidad de Cuidados Intensivos (UCI), por lo cual existe la tendencia a disminuir su aporte o incluso suspenderla, conducta que en muchas ocasiones causa un retraso en la recuperación nutricional del paciente, incrementando además el riesgo de infecciones asociadas. Realizamos un estudio descriptivo de serie de casos, realizado en la UCI de la Clínica Reina Sofía entre los meses de julio y octubre de 2015, siendo el principal criterio de inclusión la aparición de diarrea en pacientes a quienes se les inició NE en la UCI. El análisis estadístico se realizó mediante distribuciones de frecuencias absolutas y relativas expresadas en porcentajes. En variables cuantitativas se utilizaron medidas de tendencia central (promedio y mediana) y medidas de dispersión (rango y desviación estándar). La normalidad se analizó con el estadístico de Shapiro-Wilks. Hay que agregar que durante el período de estudio se identificaron siete pacientes con NE y episodios de EDA. La edad promedio de los pacientes incluidos fue de 73 años. Sin embargo, en ninguno de los casos se pudo establecer una relación directa entre los episodios de EDA y la administración de nutrición enteral

The administration of enteral nutrition (EN) is frequently mentioned as a cause of diarrhea in patients in Intensive Care Units (ICUs). Because of this, there is a tendency to reduce the use of EN or to even suspend it which often delays patients’ nutritional recovery and incurs risks of associated infections. This is a descriptive study of seven patients that was conducted in the ICU of the Clínica Reina Sofía from July to October 2015. The main criterion for inclusion was the occurrence of diarrhea in patients had been started on EN in the ICU. Statistical analyses used distributions of absolute and relative frequencies expressed in percentages. Measures of central tendency (mean and median) and measures of dispersion (range and standard deviation) were used for quantitative variables. The Shapiro-Wilk test was used to analyze normality. During the study period seven patients receiving EN who had episodes of diarrhea were identified. The average age of the patients was 73 years. No direct relationships between episodes of of diarrhea and administration of enteral nutrition could be established

A sexually dimorphic hypothalamic response to chronic high-fat diet consumption.

In this review, we discuss the observations that, following chronic high-fat diet (HFD) exposure, male mice have higher levels of saturated fatty acids (FAs) and total sphingolipids, whereas lower amounts of polyunsaturated FAs in the central nervous system (CNS) than females. Furthermore, males, when compared with female mice, have higher levels of inflammatory markers in the hypothalamus following exposure to HFD. The increase in markers of inflammation in male mice is possibly due to the reductions in proliferator-activated receptor gamma coactivator 1 alpha (PGC-1α) and estrogen receptor alpha (ERα), which is not recapitulated in female mice. Consistently, hypothalamic inflammation is induced both in male and female ERα total-body knockout mice when exposed to a HFD, thus confirming the key role of ERα in the regulation of HFD-induced hypothalamic inflammation. Finally, the HFD-induced depletion of hypothalamic ERα is associated with dysregulation in metabolic homeostasis, as evidenced by reductions in glucose tolerance and decrements in myocardial function.

Lepra lepromatosa / Lepromatosis leprosy

La lepra es una enfermedad infecciosa crónica causada por el Mycobacterium leprae. Afecta la piel, mucosa de las vías respiratorias altas, ojos y nervios periféricos. El período de incubación de la enfermedad es, en promedio, de cinco años. Los síntomas pueden tardar hasta veinte años en aparecer. Es una enfermedad muy antigua; las antiguas civilizaciones de China, Egipto e India, muestran evidencia de casos de lepra, aproximadamente hacia el año 600 a. C. Actualmente existen zonas con alta incidencia en África, Asia y América Latina. En el presente artículo se describe un caso de Lepra lepromatosa, proveniente del suroriente de Venezuela y sus características inmunológicas, clínicas y diagnósticas con el fin de generar interés por la sospecha diagnóstica en pacientes con manifestaciones como las vistas en este paciente.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. It affects the skin, upper respiratory mucosae, eyes and peripheral nerves. The incubation period of the disease is, on average, five years. Symptoms can take up to twenty years to appear. It is a very ancient disease, the eartly civilizations of China, Egypt and India, show evidence of leprosy cases, around the year 600 B. C. referido a nuestro hospital, donde se ingresa. Currently there are areas with high incidence in Africa, Asia and Latin America. In this article a case of lepromatous leprosy, from the southeastern Venezuela and its immunological characteristics are described in order to generate interest and social conscience in this epidemiological problem.

Uso de fibrina autóloga en cirugía parcial de riñón / No disponible

La nefrectomía parcial laparoscópica supone un reto en la práctica para los urólogos debido a su complejidad técnica. En la actualidad está indicada en tumores renales cada vez de mayor tamaño (hasta T1b) con el fin de preservar la mayor parte de la unidad funcional renal, siempre que se respete la seguridad oncológica. Una de las complicaciones más temidas de este tipo de cirugía es la hemorragia intraoperatoria y postoperatoria. Ha quedado demostrada la eficacia que aportan algunos agentes hemostáticos en el lecho quirúrgico. El objetivo de este trabajo es presentar nuestra experiencia en la preparación y manejo y control del sangrado en este tipo de cirugía utilizando fibrina autóloga frente al uso de otros hemostáticos. La fibrina es una proteína insoluble que conforma un coágulo sanguíneo. Resulta de la acción de una enzima, la trombina, sobre el fibrinógeno, logrando ser un potente fijador de las plaquetas y produciendo una liberación gradual de las mismas, además presenta un papel en proporcionar la matriz de crecimiento para la angiogénesis (AU)

Partial laparoscopic Nephrectomy means a challenge for the urologists who practice it due to its technical complexity. At present it is recommended in kidney tumors every time of bigger size (up to T1b) in order to preserve most of the kidney functional unit as long asthe oncological safety is respected. One of the most feared complications of this type of surgery is the intrasurgery and post-surgery hemorrhage. The efficiency that some hemostatic agents provide in the surgical site has been proved. The goal of this task is to present our experience on the preparation and handling and control of the bleeding in this type of surgery using Autologic Fibrin opposite of the use of other hemostatic. Fibrin is an insoluble protein that forms a blood clot. It results from the action of an enzyme, thrombin on fibrinogen, managing to be a powerful fixerof wafers and producing a gradual release of them besides it presents a role in providing the growth matrix for angiogenesis (AU)

Morphological evolution in Tropidurinae squamates: an integrated view along a continuum of ecological settings.

Variation in squamate foot morphology is likely relevant during evolutionary processes of habitat colonization because distinct surfaces differ in energetic and functional demands for locomotion. We combined new foot morphological data with published information of limb and tail lengths to investigate evolutionary changes possibly associated with the differential usage of ecological settings by Tropidurinae species. Several traits exhibited significant phylogenetic signal, and we performed conventional and phylogenetic regressions of PC scores (retained from Principal Components Analyses of morphometric traits) on continuous ecological indices. Tropidurines from sandy habitats exhibit larger foot soles, opposite to the evolution of narrow feet in species that use branches and rocks. Also, species that usually move along trunks present longer femora. This study provides evidence for morphological adaptations associated with substrate usage in Tropidurinae, and suggests that opposite morphological profiles might evolve associated with the use of surfaces energetically and functionally contrasting, possibly leading to trade-offs.

Development of a short olfactory test based on the Connecticut Test (CCCRC).

OBJECTIVE: To create a short olfactory test, Connecticut Smell Test (CST), based on the CCCRC (Connecticut Chemosensor and Clinical Research Center). DESIGN: A prospective patient-based study. SETTINGS: Smell and Taste Outpatient Clinic at the Fundación Hospital Alcorcón, Madrid, Spain. MATERIAL AND METHODS: We compared a short test based on the CCCRC with the Pocket Smell Test (PST) based on the University of Pennsylvania Smell Identification Test) UPSIT in 40 patients with nasal polyposis, in order to determine the specificity, sensitivity, positive predictive and negative predictive values. The validity index was 95% with an accuracy rate of 10%. We determined unit cost, the time required to perform the test in the outpatient office and the difficulty to perform the test. RESULTS: The sensibility was 93.3% and the specificity was 76% with a positive predictive value of 70% and a negative predictive value of 95%. The unitary cost of CST was euro0.65 when it is performed by a doctor. The unitary cost of PST is euro1.76. Our short test took 34 seconds to perform. More than 96% of the patients thought the test was easy to do. CONCLUSION: Our test is a valid, easy and quick test to be used in patients with nasal polyposis.

Meningitis por enterovirus en recién nacidos / Neonatal enteroviral meningitis

La meningitis por enterovirus es una entidad poco frecuente en recién nacidos, que puede infradiagnosticarse ante la normalidad de las pruebas habituales. El estudio de virus en el líquido cefalorraquídeo de neonatos febriles sin foco puede orientar su diagnóstico. Se presentan dos nuevos casos (AU)

Enteroviral meningitis is uncommon in the newborn infant. It may be underdiagnosed because the usual laboratory tests, except that performed in cerebrospinal fluid, may be normal. Two new cases in newborn infants are reported (AU)