Isolated Ptosis Following a Vipera aspis Bite.

In Spain, snakebites are uncommon medical emergencies that cause barely 100 hospitalizations annually. Most of the venomous bites are by snakes of the Viperidae family. Venom from Vipera snakes is reported to have cytotoxic and hematotoxic effects, and neurological effects have also been described. Ptosis (cranial nerve III palsy) is the most common sign, although any cranial nerve can be affected. We describe isolated ptosis, which was very likely after a Vipera aspis bite in the East Catalonian Pyrenees. No antivenom was administered. The ptosis resolved spontaneously within 10 h. Although neurologic findings are usually mild, they indicate a moderate or severe envenomation. Treating snakebites can be challenging for clinicians, especially when there are uncommon clinical manifestations. A toxicologist at a poison center should be consulted to help guide management. Development of local protocols may provide clinical support.

El factor humano en los accidentes de esquí alpino y snowboard / Human factors in alpine skiing and snowboarding accidents

Introducción: Cientos de millones de personas practican deportes de invierno en todo el mundo. A la práctica de esquíalpino y snowboard se le asocia un posible riesgo de lesión. Existen al menos tres factores importantes que pueden afectar ala seguridad en las actividades del medio natural (factores ambientales, factores técnicos y factores humanos). El conocimientode los principales factores humanos nos permitiría reducir el riesgo en los deportes de invierno. Material y método: El objetivo de este estudio es el conocer, por medio de una encuesta personal auto-cumplimentadaexplicativa transversal, cómo y qué factores humanos intervienen en los accidentes de esquí alpino y snowboard. Resultados: Se realizaron 219 encuestas de un total 3911 pacientes atendidos en los distintos puntos de asistencia sanitaria.El mayor porcentaje de encuestados relacionaron su accidente con la distracción o el exceso de confianza, ambos en un 72,2%de los encuestados. Otros factores que fueron señalados por más del 50% de los encuestados fueron; la falta de conocimientos(un 60,4% de los encuestados), la falta de seguimiento de las normas (58,5%), la fatiga (57,5%), la falta de conciencia situacional(57%) y el estrés con (53,8%). Conclusiones: Identificados estos factores humanos más frecuentes durante actividades de esquí alpino y snowboard sepodrán realizar acciones para prevenir o contener el error humano.(AU)

Introduction: Hundreds of millions of people practice winter sports worldwide. Alpine skiing and snowboarding are associatedwith a possible risk of injury. There are at least three important factors that can affect safety in wilderness activities (environmentalfactors, technical factors and human factors). Awareness of human factors would allow us to reduce the risk in winter sports. Material and method: The objective of this study is to find out, through a self-explanatory cross-sectional personal survey,what and how human factors are involved in alpine skiing and snowboarding accidents. Results: 219 surveys were carried out of a total of 3,911 patients attended at the different health care points. The highestpercentage of respondents related their accident to distraction or complacency, both in 72.2% of the respondents. Otherfactors that were pointed out by more than 50% were; lack of knowledge (60.4%), lack of following the norms (58.5%), fatigue(57.5%), lack of situational awareness (57%) and stress with (53.8% of the respondents). Conclusions: By identifying these most frequent human factors during downhill skiing and snowboarding, actions can betaken to prevent or contain human error.(AU)

Elevación de la troponina cardiaca I en corredoras de raids de aventura / Cardiac troponin I increases in female adventure racers

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Prescripción de ejercicio físico: indicaciones, posología y efectos adversos / Exercise prescription: indications, dosage and side effects

La prescripción de ejercicio físico es útil especialmente para prevenir la mortalidad prematura de cualquier causa, la cardiopatía isquémica, la enfermedad cerebrovascular, la hipertensión arterial, el cáncer de colon y mama, la diabetes tipo 2, el síndrome metabólico, la obesidad, la osteoporosis, la sarcopenia, la dependencia funcional y las caídas en ancianos, el deterioro cognitivo, la ansiedad y la depresión. Dicho beneficio se observa en ambos sexos y es mayor cuanto mayor es el volumen o la intensidad del ejercicio físico. Para obtener dichos beneficios, debe realizarse ejercicio aeróbico moderado durante un mínimo de 30 minutos, 5 días por semana, o ejercicio intenso durante un mínimo de 20 minutos, 3 días por semana. Se recomienda añadir un mínimo de 2 días no consecutivos cada semana para practicar 8-10 ejercicios que desarrollen la fuerza de la mayor parte de grupos musculares (brazos, hombros, tórax, abdomen, espalda, caderas y piernas), con 10-15 repeticiones de cada ejercicio. También es recomendable dedicar 2 sesiones de 10 minutos a la semana para realizar 8-10 ejercicios que mantengan la flexibilidad de la mayor parte de grupos de músculos y tendones. El ejercicio físico puede comportar lesiones del aparato locomotor y un riesgo cardiovascular, pero el beneficio supera al riesgo

The prescription of exercise is particularly useful for preventing premature death from all causes, ischemic heart disease, stroke, hypertension, colon and breast cancer, type 2 diabetes, metabolic syndrome, obesity, osteoporosis, sarcopenia, functional dependence and falls in the elderly, cognitive impairment, anxiety and depression.This benefit is observed in both sexes and increases with the volume or intensity of exercise. These benefits are obtained through moderate aerobic exercise for at least 30minutes 5days per week or vigorous exercise for at least 20minutes 3days a week. It is recommended to add a minimum of 2 nonconsecutive days, each week, to practice 8-10 exercises that develop the strength of most muscle groups (arms, shoulders, chest, abdomen, back, hips and legs). It is also advisable to spend 2 sessions of 10minutes per week to practice 8-10 exercises that maintain the flexibility of most groups of muscles and tendons. The exercise may involve musculoskeletal injuries and cardiovascular risk, but the benefit outweighs the ris

[Exercise prescription: indications, dosage and side effects]. / Prescripción de ejercicio físico: indicaciones, posología y efectos adversos.

The prescription of exercise is particularly useful for preventing premature death from all causes, ischemic heart disease, stroke, hypertension, colon and breast cancer, type 2 diabetes, metabolic syndrome, obesity, osteoporosis, sarcopenia, functional dependence and falls in the elderly, cognitive impairment, anxiety and depression. This benefit is observed in both sexes and increases with the volume or intensity of exercise. These benefits are obtained through moderate aerobic exercise for at least 30 minutes 5 days per week or vigorous exercise for at least 20 minutes 3 days a week. It is recommended to add a minimum of 2 nonconsecutive days, each week, to practice 8-10 exercises that develop the strength of most muscle groups (arms, shoulders, chest, abdomen, back, hips and legs). It is also advisable to spend 2 sessions of 10 minutes per week to practice 8-10 exercises that maintain the flexibility of most groups of muscles and tendons. The exercise may involve musculoskeletal injuries and cardiovascular risk, but the benefit outweighs the risk.

Hipotermia accidental / Accidental hypothermia

La hipotermia es un proceso poco frecuente e infradiagnosticado que cada año produce víctimas mortales. Su tratamiento requiere termómetros que midan la temperatura central. En el hospital se usa la sonda esofágica; sobre el terreno y en la hipotermia moderada es suficiente la medición epitimpánica. El tratamiento inicial consiste en soporte vital y recalentamiento. Los movimientos bruscos pueden desencadenar arritmias que no responden a fármacos ni a desfibrilación hasta que se alcanzan los 30°C. El recalentamiento externo pasivo es el método de elección en la hipotermia leve y es un método suplementario en la hipotermia moderada y grave. El recalentamiento externo activo está indicado en la hipotermia moderada o leve refractaria al recalentamiento externo pasivo y como método suplementario en la hipotermia grave. El recalentamiento interno activo está indicado en la hipotermia grave o moderada refractaria al recalentamiento externo activo y en pacientes hemodinámicamente inestables. Los pacientes con hipotermia grave, parada cardiorrespiratoria y potasio inferior a 12mmol/l pueden requerir by-pass cardiopulmonar (AU)

Accidental hypothermia is an infrequent and under-diagnosed pathology, which causes fatalities every year. Its management requires thermometers to measure core temperature. An esophageal probe may be used in a hospital situation, although in moderate hypothermia victims epitympanic measurement is sufficient. Initial management involves advance life support and body rewarming. Vigorous movements can trigger arrhythmia which does not use to respond to medication or defibrillation until the body reaches 30°C. External, passive rewarming is the method of choice for mild hypothermia and a supplementary method for moderate or severe hypothermia. Active external rewarming is indicated for moderate or severe hypothermia or mild hypothermia that has not responded to passive rewarming. Active internal rewarming is indicated for hemodynamically stable patients suffering moderate or severe hypothermia. Patients with severe hypothermia, cardiac arrest or with a potassium level below 12 mmol/l may require cardiopulmonary bypass treatment (AU)

[Accidental hypothermia]. / Hipotermia accidental.

Accidental hypothermia is an infrequent and under-diagnosed pathology, which causes fatalities every year. Its management requires thermometers to measure core temperature. An esophageal probe may be used in a hospital situation, although in moderate hypothermia victims epitympanic measurement is sufficient. Initial management involves advance life support and body rewarming. Vigorous movements can trigger arrhythmia which does not use to respond to medication or defibrillation until the body reaches 30°C. External, passive rewarming is the method of choice for mild hypothermia and a supplementary method for moderate or severe hypothermia. Active external rewarming is indicated for moderate or severe hypothermia or mild hypothermia that has not responded to passive rewarming. Active internal rewarming is indicated for hemodynamically stable patients suffering moderate or severe hypothermia. Patients with severe hypothermia, cardiac arrest or with a potassium level below 12 mmol/l may require cardiopulmonary bypass treatment.

Medicina antártica en el año 2008: Año Polar Internacional y 20. o aniversario de la Base Antártica Española / Antarctic medicine in 2008; International Polar Year and 20th anniversary of the Spanish Antarctic Base

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