Microbial dynamics in anaerobic digestion reactors for treating organic urban residues during the start-up process.

Anaerobic digestion of organic residues offers economic benefits via biogas production, still methane (CH4 ) yield relies on the development of a robust microbial consortia for adequate substrate degradation, among other factors. In this study, we monitor biogas production and changes in the microbial community composition in two semi-continuous stirred tank reactors during the setting process under mesophilic conditions (35°C) using a 16S rDNA high-throughput sequencing method. Reactors were initially inoculated with anaerobic granular sludge from a brewery wastewater treatment plant, and gradually fed organic urban residues (4·0 kg VS m-3  day-1 ) . The inocula and biomass samples showed changes related to adaptations of the community to urban organic wastes including a higher relative proportion of Clostridiales, with Ruminococcus spp. and Syntrophomonas spp. as recurrent species. Candidatus Cloacamonas spp. (Spirochaetes) also increased from ~2·2% in the inoculum to >10% in the reactor biomass. The new community consolidated the cellulose degradation and the propionate and amino acids fermentation processes. Acetoclastic methanogens were more abundant in the reactor, where Methanosaeta spp. was found as a key player. This study demonstrates a successful use of brewery treatment plant granular sludge to obtain a robust consortium for methane production from urban organic solid waste in Mexico. SIGNIFICANCE AND IMPACT OF THE STUDY: This study describes the selection of relevant bacteria and archaea in anaerobic digesters inoculated with anaerobic granular sludge from a brewery wastewater treatment plant. Generally, these sludge granules are used to inoculate reactors digesting organic urban wastes. Though, it is still not clearly understood how micro-organisms respond to substrate variations during the reactor start-up process. After feeding two reactors with organic urban residues, it was found that a broader potential for cellulose degradation was developed including Bacteroidetes, Firmicutes and Spirochaetes. These results clarify the bacterial processes behind new reactors establishment for treating organic wastes in urban areas.

Development of a Novel Non-invasive Metabolomics Assay to Predict Implantation Potential of Human Embryos.

Can a set of metabolites present in embryo culture media correlate with embryo implantation? Case-control study in two phases: discovery phase (101 samples) and validation phase (169 samples), collected between 2018 and 2022, with a total of 218 participants. Culture media samples with known implantation outcomes were collected after blastocyst embryo transfer (including both PGT and non-PGT cycles) and were analyzed using chromatography followed by mass spectrometry. The spectra were processed and analyzed using statistical and machine learning techniques to identify biomarkers associated with embryo implantation, and to develop a predictive model. In the discovery phase, 148 embryo implantation biomarkers were identified using high resolution equipment, and 47 of them were characterized. Our results indicate a significant enrichment of tryptophan metabolism, arginine and proline metabolism, and lysine degradation biochemical pathways. After transferring the method to a lower resolution equipment, a model able to assign a Metabolite Pregnancy Index (MPI) to each embryo culture media was developed, taking the concentration of 36 biomarkers as input. Applying this model to 20% of the validation samples (N=34) used as the test set, an accuracy of 85.29% was achieved, with a PPV (Positive Predictive Value) of 88% and a NPV (Negative Predictive Value) of 77.78%. Additionally, informative results were obtained for all the analyzed samples. Metabolite concentration in the media after in vitro culture shows correlation with embryo implantation potential. Furthermore, the mathematical combination of biomarker concentrations using Artificial Intelligence techniques can be used to predict embryo implantation outcome with an accuracy of around 85%.

When do patients prefer a direct oral anticoagulant over a vitamin K antagonist?

BACKGROUND: The reasons for patients to change their usual vitamin K antagonist (VKA) treatment to a direct oral anticoagulant (DOAC) are unexplored. METHOD: A random sample of 200 patients treated with VKAs for the indication of atrial fibrillation from the Thrombosis Service in Amsterdam was selected. A survey, using the treatment trade-off technique, was sent to participants. The trade-off included four scenarios: 1 (no need for laboratory controls); 2 (less bleeding); 3 (less interactions); 4 (more effective). RESULTS: Under scenario 1, 57% of the patients would have made the switch, with a further increase to 65% with scenario 2 (trend value, p = 0.006, 95% CI 1.11-1.85). In addition, in each scenario patients who were less satisfied with their current treatment were more likely to switch to a DOAC compared with satisfied patients. The variables duration of treatment, gender, age and educational level did not affect the preference for a DOAC. CONCLUSION: Patients considered no requirement for regular laboratory control and a lower risk of bleeding the most important arguments to switch to a DOAC.

[Protein-calorie malnutrition and degree of hepatic failure in chronic hepatopathy]. / Malnutrición calórico-protéica y grado de insuficiencia hepática en hepatopatías crónicas.

BACKGROUND: Malnutrition is often associated with chronic liver disease, particularly in alcoholics. Its objective assessment by means of methods which are useful and accessible to daily clinical practice is nowadays considered to be necessary for an adequate diagnosis and treatment of these problems, being also a necessary requirement in the selection of the candidates for a liver transplant. Besides, the still insufficiently known relation between nutritional status and the degree of liver dysfunction is of great interest, which has given rise to the present study. PATIENTS AND METHODS: The level of malnutrition and of hepatic function of 48 patients suffering from chronic liver disease hospitalized in Internal Medicine is evaluated, by means of the Ratio of Protein-Caloric Malnutrition proposed by Pomar et al and the Ratio obtained from Clinical and Laboratory data proposed by Orrego et al, respectively. RESULTS: All the patients showed different levels of malnutrition, 27% of the cases being severe, 69% moderate and the remaining 4% mild. The serum albumin and the response to cutaneous antigens were the most frequently altered tests, while the brachial muscular extent was the less altered parameter. A lineal correlation between the degree of malnutrition and that of liver dysfunction (r = 0.3998, p < 0.01) is also made evident. CONCLUSIONS: Malnutrition is often associated with chronic liver disease, is of mixed characteristics (marasmus and Kwashiorkor disease), and seems to aggravate with the progression of the liver dysfunction.

[Complications in the hemiplegic patient in the first year after the stroke]. / Complicaciones en el paciente hemipléjico durante el primer año tras el ictus.

INTRODUCTION: After a cerebrovascular accident (CVA) a hemiplegic patient is at risk from numerous complications after leaving hospital. OBJECTIVE: To analyze the frequency of occurrence of the commonest complications characteristic of the hemiplegic syndrome, during the first year after the stroke. PATIENTS AND METHODS: We evaluated 73 hemiplegic patients admitted to the rehabilitation department for treatment after a stroke. At each medical consultation, on admission and three, six and twelve months after the CVA, the complications 'belonging' to the hemiplegic syndrome were evaluated. These included contractures, painful shoulder, sympathetic-reflex dystrophy, fractures and thalamic pain. RESULTS: During the first year of the illness 81% of the patients had some type of complication. A painful shoulder was the commonest complication, seen in 40% of the patients, followed by contractures (23%). Sympathetic-reflex dystrophy of the paretic arm occurred in 11 patients (15%). CONCLUSION: The commonest complication in patients during the first year after their stroke are painful shoulder and contractures.

[Occupational exposure of the anesthesiologist to nitrous oxide and halothane. Control measures]. / Exposición laboral del anestesiólogo al óxido nitroso y halotano. Medidas de control.

Anesthetic gas spillage does occur in the operating room. Anesthesiologists and other operating room personnel are likely exposed to health hazards caused by chronic exposure to anesthetic gases and vapours. The aim of the present study is to elucidate the possible relationship between the chronic exposure to anesthetic gases and their adverse effects on the health. Present data, while controversial, do not establish a cause-effect relationship. Nevertheless, until solid data refutes the existence of a health hazard for operating room personnel, the anesthesiologist must try to reduce the anesthetic contamination level, with preventive and technical measures.

[Determination of subanesthetic concentrations of halothane in the environment of operating and recovery rooms]. / Determinación de las concentraciones subanestésicas de halotano en el ambiente de los quirófanos y salas de despertar.

Concentrations of halothane in parts per million (ppm) in the air were determined during 4 days in the operating rooms and the recovery room of pediatric surgery during the course of surgical anesthesia by inhalation. The operating rooms did not have an anesthetic gas scavenging system. Eighteen samples of air were taken by passive diffusion in sampling tubes of activated charcoal (mode Dräger Orsa 5). The samples were analysed by gas chromatography). We found concentrations between 4.7 ppm and 34.2 ppm that exceed those considered as admissible that range from 2 to 5 ppm. Our present recommendations to reduce the atmospheric contaminating anesthetic gases are the use of scavenging equipment, air-conditioned rooms and routine inspection and leak detection of apparatus and anesthetic circuits.

[Subacute care of stroke-affected patients. Satisfaction and results]. / Atención subaguda al paciente con ictus. Satisfacción y resultados.

OBJECTIVE: To determine the satisfaction of the stroke inpatients and their caregivers in Rehabilitation Service and to analyze the effectiveness, social risk, and discharge destination. MATERIAL AND METHOD: Prospective longitudinal cohort multicenter study. An analysis was made of the social risk (Gijón Scale), co-morbidity (Charlson Index), disability (Barthel Index), effectiveness of the rehabilitation treatment, satisfaction (Pound Questionnaire) and discharge destination of 241 patients. An evaluation was also made on 119 caregivers 6 months post-stroke, recording age, family relationship, time care-giving, satisfaction with the information/training, and accessibility to the rehabilitation team. RESULTS: The patient profile is a 71 year-old male, with low/intermediate social risk, high co-morbidity and total/severe dependence, with 27.1% living alone. Almost all (96.6%) of the patients claimed to be satisfied/very satisfied with the treatment, with satisfaction with the recovery being lower (80.3%). The effectiveness was 32.5 ± 20.4. Home was the discharge destination of 81.7% of the patients.The average age of the caregivers was 58.8 ± 12.3 years, and 73.9% were women. The time dedicated to care-giving was over 6 hours per day in the 62% of the cases. Being satisfied/very satisfied with the received information was recorded by 89.9% of the caregivers. CONCLUSIONS: Patients admitted for stroke rehabilitation achieve significant functional gain during hospitalization and return to their homes in most cases. The satisfaction with the rehabilitation treatment and received information is high. The training of the caregiver is an aspect that needs improving.

Rehabilitation efficiency and destination on discharge after stroke.

BACKGROUND: Predicting functional recovery of patients is key for setting the objectives of the rehabilitation programme and making decisions on their destination on discharge. Many variables have an impact on disability and quality of life after stroke, including patient age, comorbidity, severity of neurological deficit, state of mind and social risk. Accordingly, it is also essential from a care perspective to optimise the functional recovery and efficiency of rehabilitation programmes, exploring their relationship with these variables. AIM: To analyze the efficiency of post-stroke rehabilitation, identifying factors that most strongly influence functional recovery and destination on discharge. DESIGN: Multicentre prospective cohort study SETTING/POPULATION: All patients admitted to the Rehabilitation Units of the two hospitals after stroke over eight months METHODS: Collected data on sociodemographic characteristics, social risk (Gijón Scale), comorbidity (Charlson Index), neurological severity (National Institute of Health Stroke Scale), daily living functioning scale (Barthel Index), length of hospital stay and destination on discharge. RESULTS: We included 241 patients, with a mean stay of 35±22 days, 81.5% returning home on discharge. On admission 45.2% were totally dependent, and this figure fell to 12.8% on discharge, the mean Barthel Index score increasing by 32.5 points. Neurological severity, hemiparetic severity, impairment of deep sensation and trunk control on admission were the mayor variables influence on rehabilitation efficiency (P<0.001). Destination on discharge was most closely associated with civil status, social risk and Barthel Index score (P<0.001). The likelihood of transferring to residential care is 3- and 2.71-fold higher among patients with total dependence and high comorbidity scores, respectively. CONCLUSION: Many variables influence on outcomes of stroke inpatient rehabilitation. CLINICAL REHABILITATION IMPACT: Comprehensive assessments are required to predict patient recovery, efficiency and plan for discharge.

Atención subaguda al paciente con ictus. Satisfacción y resultados / Subacute care of stroke-affected patients. Satisfaction and results

Objetivo: Conocer la satisfacción de los pacientes con ictus y sus cuidadores durante su hospitalización en rehabilitación y analizar la efectividad del tratamiento, el riesgo social y el destino del paciente al alta. Material y método: Estudio multicéntrico de cohorte longitudinal prospectivo. Se valoró el riesgo social (escala Gijón), la comorbilidad (índice de Charlson), la discapacidad (índice de Barthel), la efectividad del tratamiento rehabilitador, la satisfacción con la atención (cuestionario de Pound) y el destino al alta en 241 pacientes. De 119 cuidadores evaluados a los 6 meses postictus se recogieron la edad, el parentesco, las horas diarias dedicadas al cuidado y la satisfacción con la información/formación y con la accesibilidad del equipo rehabilitador. Resultados: El perfil del paciente era el de un varón de 71 años, con riesgo social bajo/intermedio, comorbilidad alta y dependencia total/severa. Un 27,1% vivían solos. El 96,6% referían estar satisfechos/muy satisfechos con el tratamiento, siendo menor la satisfación con la recuperación (80,3%). La efectividad fue de 32,5 ± 20,4. El 81,7% de los pacientes regresaron a su domicilio. La media de edad de los cuidadores fue de 58,8 ± 12,3 años y el 73,9% eran mujeres. La dedicación a los cuidados era superior a 6 h diarias en el 62%. El 89,9% de los cuidadores estaban satisfechos/muy satisfechos con la información recibida. Conclusiones: Los pacientes ingresados para tratamiento rehabilitador tras un ictus obtienen una ganancia funcional significativa durante su hospitalización y regresan a su domicilio en la mayoría de los casos. La satisfacción con el tratamiento rehabilitador y la información es elevada. Un campo especialmente mejorable es la formación del cuidador (AU)

Objective: To determine the satisfaction of the stroke inpatients and their caregivers in Rehabilitation Service and to analyze the effectiveness, social risk, and discharge destination. Material and method: Prospective longitudinal cohort multicenter study. An analysis was made of the social risk (Gijón Scale), co-morbidity (Charlson Index), disability (Barthel Index), effectiveness of the rehabilitation treatment, satisfaction (Pound Questionnaire) and discharge destination of 241 patients. An evaluation was also made on 119 caregivers 6 months post-stroke, recording age, family relationship, time care-giving, satisfaction with the information/training, and accessibility to the rehabilitation team. Results: The patient profile is a 71 year-old male, with low/intermediate social risk, high comorbidity and total/severe dependence, with 27.1% living alone. Almost all (96.6%) of the patients claimed to be satisfied/very satisfied with the treatment, with satisfaction with the recovery being lower (80.3%). The effectiveness was 32.5 ± 20.4. Home was the discharge destination of 81.7% of the patients.The average age of the caregivers was 58.8 ± 12.3 years, and 73.9% were women. The time dedicated to care-giving was over 6 hours per day in the 62% of the cases. Being satisfied/very satisfied with the received information was recorded by 89.9% of the caregivers. Conclusions: Los pacientes ingresados para tratamiento rehabilitador tras un ictus obtienen una ganancia funcional significativa durante su hospitalización y regresan a su domicilio en la mayoría de casos. Patients admitted for stroke rehabilitation achieve significant functional gain during hospitalization and return to their homes in most cases. The satisfaction with the rehabilitation treatment and received information is high. The training of the caregiver is an aspect that needs improving

Calidad de vida a los 6 meses tras un ictus / Quality of life 6 months after a stroke

Objetivo. Describir la calidad de vida (CV) de los pacientes a los 6 meses de evolución del ictus y su relación con variables sociodemográficas, clínicas y funcionales. Material y métodos. Estudio multicéntrico de cohortes longitudinal (n = 157). Los pacientes incluidos ingresaron en la fase subaguda tras un ictus en 2 Servicios de Rehabilitación. Se recogieron los siguientes datos a los 6 meses postictus: género, edad, riesgo social, comorbilidad, disfagia, afasia, estado cognitivo, depresión y grado de discapacidad evaluado mediante el índice de Barthel modificado. Se evaluó la influencia de estas variables en la CV, para lo que se empleó la escala específica de calidad de vida para el ictus ECVI-38. Resultados. La media de edad fue de 70,93 ± 11,85 años; fue significativamente superior en las mujeres. El paciente tipo presentó una elevada comorbilidad, un bajo riesgo social y dependencia moderada. La puntuación media total de la escala ECVI-38 fue de 35,30 ± 16,17 y los dominios más afectados los referentes a las actividades comunes y básicas de la vida diaria. Las variables que más se relacionan con la CV fueron el género, la afasia, la disfagia, la depresión, el déficit cognitivo y el estado funcional. El dolor de elevada intensidad estuvo presente en un 21% de los pacientes. Conclusión. Son muy diversas las variables que influyen en la CV del paciente con ictus que se deben considerar, para su potencial abordaje, en la planificación de las intervenciones rehabilitadoras (AU)

Objective. To describe quality of life (QoL) in patients at 6 months poststroke and its relationship with sociodemographic, clinical and functional characteristics. Material and method. This multicenter longitudinal cohort study (n = 157) included patients from 2 hospital rehabilitation services who were admitted for stroke in the subacute phase. The following data were gathered at 6 months poststroke: gender, age, social risk, comorbidity, dysphagia, aphasia, cognitive status, depression, and disability measured by the modified Barthel Index. The influence of these variables on QoL was evaluated using the stroke-specific quality of life scale, ECVI-38. Results. The mean age was 70.93 ± 11.85 years and was significantly higher in women. Most of the patients had high comorbidity, low social risk and moderate dependence. The mean total score on the ECVI-38 scale was 35.30 ± 16.17 and the most affected domains were those concerning common and basic activities of daily living. The variables associated with QoL were gender, aphasia, dysphagia, depression, cognitive impairment, and functional status. High-intensity pain was present in 21% of patients. Conclusion. Numerous variables influence QoL in patients with stroke and should be considered in the planning of rehabilitation interventions (AU)

Kawasaki disease: a maturational defect in immune responsiveness.

Kawasaki disease (KD), an acute febrile disease in children of unknown etiology, is characterized by a vasculitis that may result in coronary artery aneurysms (CAAs). In new patients with KD, a selective and prolonged T cell unresponsiveness to activation via the T cell antigen receptor CD3 was observed, whereas proliferation to other stimuli was intact. This "split T cell anergy" delineated KD from other pediatric infections and autoimmune diseases and correlated with CAA formation (P<.001). A transient immune dysfunction was also suggested by an incomplete responsiveness to measles-mumps-rubella (MMR) vaccination in patients with KD versus controls (P<.0001; odds ratio, 15.6; 95% confidence interval, 4.8-51.1), which was overcome by revaccination(s). The reduced responsiveness to MMR in patients with KD suggests a subtle and predetermining immune dysfunction. An inherent immaturity to clear certain antigens may be an important cause that precipitates KD and the immune dysregulation during acute disease.

Sobrecarga del cuidador informal del paciente con ictus a largo plazo / Long term overload of the informal caregiver of the stroke patient

Introducción. Habitualmente son los miembros de la familia los que asumen los cuidados del paciente con ictus. Los objetivos de este estudio son conocer la sobrecarga del cuidador informal del paciente tras un ictus, y analizar la relación entre esta sobrecarga y la situación funcional del paciente. Pacientes y método. Se incluyeron todos los pacientes ingresados para tratamiento rehabilitador tras un ictus, y dados de alta hospitalaria de julio de 2007 a febrero de 2008. La sobrecarga del cuidador se valoró mediante la Escala de Sobrecarga de Zarit, y la situación funcional del paciente mediante el valor de la Medida de Independencia Funcional (FIM) recogido al alta hospitalaria. Resultados. El tiempo medio transcurrido al realizar las encuestas fue de 15 meses (DT 2,07). De los 114 cuidadores que participaron en el estudio, el 78% fueron mujeres. Su edad media fue de 61 años. El cónyuge fue el familiar más implicado como cuidador (69,2%), seguido de los hijos (20,1%). Se recibió el cuestionario de Zarit de 69 cuidadores, que obtuvo una puntuación media de 33,62 (DE 17,23). No se halló correlación entre el valor FIM y el Zarit (p=0,83). Conclusiones. La mayoría de los pacientes con ictus viven en su domicilio, atendidos por un familiar. El cuidador principal habitualmente es una mujer, que experimenta una elevada sobrecarga por los cuidados que presta. El grado de discapacidad del paciente no determina por sí solo la sobrecarga experimentada por su cuidador(AU)

Introduction. The members of the family are generally those who assume the care of stroke patients. This study has aimed to know the overload of informal caregivers of stroke patients and to analyze the relationship between this overload and the functional performance of the patients. Patients and method. All of the patients who were admitted in our hospital to receive rehabilitation treatment after stroke and who were discharged from July 2007 to February 2008 were included in the study. The caregiver overload was assessed on the Zarit Overload Scale and the functional performance of the patient was evaluated with the Functional Independence Measure (FIM) value at the time of hospital discharge. Results. The average time from hospital admission to when the surveys were administered was 15 months (SD 2.07). A total of 78% of the 114 caregivers who participated in the study were women, with a mean age of 61 years. The spouse was the relative most involved as caregiver (69.2%), followed by the children (20.1%). We received the Zarit survey from 69 caregivers, with a mean score of 33.62 (SD 17.23). There was no correlation between the FIM values and the Zarit Scale (p=0.83). Conclusions. Most of the stroke patients live at home, attended by a relative. The usual caregiver is a woman, who suffers a great overload caused by the care she gives. The degree of disability of the patient does not determine, by itself, the overload experienced by the caregiver(AU)

Manejo de vía aérea difícil secundario a bocio multinodular gigante / No disponible

No disponible

Escuela de espalda. Nuestra experiencia / Back school. Our experience

Introducción. Los objetivos del presente trabajo son conocer el perfil clínico, funcional y de calidad de vida de los pacientes atendidos en la escuela de espalda (EE), su evolución a los 6 meses, su opinión y grado de satisfacción. Pacientes y métodos. Se realizó una valoración inicial a 220 pacientes que incluyó las siguientes variables: sociodemográficas, clínicas, escala analógica visual (EAV), situación funcional (escala Oswestry), y calidad de vida (test SF-36). Además se les entregó un cuestionario de satisfacción y opinión. A los primeros 116 pacientes que completaron el programa se les realizó de forma prospectiva una valoración clínica, funcional y de calidad de vida a los 6 meses. Resultados. Un 80 % de los pacientes tenían antecedente de lumbalgia previa. La puntuación media en la EAV fue 3,93 y de 3,54 a los 6 meses. No se obtuvo una variación significativa en las medias del Oswestry al sexto mes respecto a las iniciales, y sí en 5 categorías del SF-36. El 96 % de los pacientes refiere estar satisfecho tras su paso por la EE. Cuarenta pacientes aportaron sus opiniones y/o sugerencias en la encuesta. Conclusiones. Los pacientes atendidos en la EE refieren un alto nivel de satisfacción y cambio de actitud ante el dolor. Tras pasar por la EE no se objetiva una mejoría significativa en la intensidad del dolor o en la realización de las actividades de la vida diaria, y sí en algunas facetas de la calidad de vida

Introduction. This study aims to know the clinical and functional profile as well as the quality of life of patients attended in the back school, their evolution at six months, their opinion and degree of satisfaction. Patients and methods. An initial appraisal was carried out with 220 patients, which included, among others, the following variables: sociodemographic, clinical, visual analogue scale (VAS), functional state (Oswestry scale), and quality of life (SF-36 test). A satisfaction and opinion questionnaire was given to all of them. At six months a clinical, functional and quality of life prospective evaluation was carried out with the 116 patients who completed the program during the first year and a half after starting the back school activity. Results. 80 % of the patients had previous history of low back pain. Mean score in the VAS was 3.93 and 3.54 at six months. We did not obtain a significant change in the mean score of the Oswestry test at the sixth month, in relation to the initial score, but we obtained it in five categories of the SF-36 test. 96 % of the patients reported being satisfied after taking part in the back school. Forty patients gave their opinions and/or suggestions in the questionnaire. Conclusions. The patients attended in the back school report high level of satisfaction and a change in their attitude towards pain. After taking part in the back school, a significant improvement in the intensiveness of pain or in making their activities of daily living is not seen, but this improvement is shown in some facets of quality of life

Complicaciones en el paciente hemipléjico durante el primer año tras el ictus / Complications in hemiplegic patients during the first year after the stroke

Introducción. Tras el accidente cerebrovascular (ACV), el paciente hemipléjico tiene riesgo de sufrir numerosas complicaciones una vez es dado de alta hospitalaria. Objetivo. Analizar la frecuencia de aparición de las complicaciones características del síndrome hemipléjico, durante el primer año tras el ictus. Pacientes y métodos. Se valoraron 73 pacientes hemipléjicos ingresados en un servicio de rehabilitación para tratamiento tras un ictus. En cada revisión, realizada al ingreso, al tercer mes, al sexto mes y al año del ACV, se evaluó la presencia de complicaciones `propias' del síndrome hemipléjico como son, entre otras, las contracturas, el hombro doloroso, la distrofia simpaticorrefleja, las fracturas y el dolor talámico. Resultados. El 81 por ciento de los pacientes presentaron algún tipo de complicación durante el primer año de evolución. El hombro doloroso fue la complicación más frecuente, presente en el 40 por ciento de los pacientes, seguido por las contracturas (23 por ciento). Once pacientes (15 por ciento) presentaron distrofia simpaticorrefleja en la extremidad superior parética. Conclusión. Las complicaciones más frecuentes de los pacientes durante el año de seguimiento tras el episodio ictal son dolor en el hombro y contracturas (AU)