Revisión sistemática de la literatura para el manejo de dolor central en esclerosis múltiple

El dolor es un síntoma muy común en pacientes con Esclerosis Múltiple, pues del 42 al 65% de los enfermos lo presentan, y es calificado como el síntoma más severo entre el 8 y el 32%. Todos los síndromes dolorosos centrales se presentan por lesión o disfunción del sistema nervioso central, causando discapacidad severa y deterioro de la calidad de vida de los pacientes.

Alteración del centro de gravedad y riesgo de caída en pacientes con trastornos neurológicos. Bogotá. 2014

Introducción: el objetivo de la rehabilitación en los pacientes neurológicos es reducir su discapacidad, potencializar su funcionalidad y promover su independencia para así permitirle desempeñar un rol activo en la comunidad. Por esta razón, es de gran importancia prevenir la aparición de eventos adversos en esta población mediante la detección temprana de factores de riesgo que conllevan a pacientes con enfermedad cerebro vascular a presentar caídas y a su vez le permita a los profesionales de la salud generar estrategias para minimizar su incidencia, complicaciones y/o secuelas. Objetivo: determinar los factores relacionados con la alteración del centro de gravedad y riesgos de caída en paciente con trastornos neurológicos Metodología: se realizó un estudio cuantitativo descriptivo exploratorio retrospectivo donde se tuvieron en cuenta pacientes diagnóstico de enfermedades neurológicas que presentaron o no antecedentes de caídas junto con otros criterios de inclusión y exclusión, tomados de las bases de datos de la institución Mobility Group. Resultados: Se evaluaron en total 19 sujetos (52,6 % hombres) con edad media de 48,37 años. Se clasificaron en dos grupos (alto y bajo riesgo de caída ) de pacientes según la aplicación de la escala de riesgo de caída de J.H. Downton a los cuales se aplicó estadística descriptiva para describir su comportamiento en referencia a factores como diagnóstico clínico, presencia de dolor, fuerza y tono de miembros inferiores en los principales grupos musculares , clasificación de espasticidad y finalmente con la alteración de la trayectoria del centro de gravedad según la valoración realizada con el dispositivo THERA-TRAINER BALANCE.

Prevalencia de delirium en población adulta en cuidado intensivo.

Introducción: El delirium es un trastorno de conciencia de inicio agudo asociado a confusión o disfunción cognitiva, se puede presentar hasta en 42% de pacientes, de los cuales hasta el 80% ocurren en UCI. El delirium aumenta la estancia hospitalaria, el tiempo de ventilación mecánica y la morbimortalidad. Se pretendió evaluar la prevalencia de periodo de delirium en adultos que ingresaron a la UCI en un hospital de cuarto nivel durante 2012 y los factores asociados a su desarrollo. Metodología Se realizó un estudio transversal con corte analítico, se incluyeron pacientes hospitalizados en UCI médica y UCI quirúrgica. Se aplicó la escala de CAM-ICU y el Examen Mínimo del Estado Mental para evaluar el estado mental. Las asociaciones significativas se ajustaron con análisis multivariado. Resultados: Se incluyeron 110 pacientes, el promedio de estancia fue 5 días; la prevalencia de periodo de delirium fue de 19.9%, la mediana de edad fue 64.5 años. Se encontró una asociación estadísticamente significativa entre el delirium y la alteración cognitiva de base, depresión, administración de anticolinérgicos y sepsis (p< 0,05). Discusión Hasta la fecha este es el primer estudio en la institución. La asociación entre delirium en la UCI y sepsis, uso de anticolinérgicos, y alteración cognitiva de base son consistentes y comparables con factores de riesgo descritos en la literatura mundial.

Etiologia, perfil de sensibilidade aos antimicrobianos e aspectos epidemiológicos na otite canina: estudo retrospectivo de 616 casos

A retrospective study of etiology, antimicrobial susceptibility profile and multiple drug resistance, and major epidemiological aspects were investigated in 616 cases of canine otitis. Staphylococcus beta hemolitic (26.27%), Malassezia pachydermatis (12.35%), and Pseudomonas aeruginosa (8.8%) were the most common microorganisms identified. The isolates were susceptible mainly to norfloxacin (89.62%), gentamicin (83.25%), and ofloxacin (80.16%). High occurrence of resistance of isolates was observed to neomicin (30.84%) and cephalexin (27.63%). Multiple drug resistance to three or more and five or more of antimicrobials tested was observed in 34.9% and 15.5% of isolates, respectively. The cases of canine otitis occurred predominantly in first years of age, in mixed breeds animals, at autumn season. The presence of itch, bad smell, and secretion in ear conduct were the major signs observed at clinical examination.

PRECESSING JETS AND X-RAY BUBBLES FROM NGC 1275 (3C 84) IN THE PERSEUS GALAXY CLUSTER: A VIEW FROM THREE-DIMENSIONAL NUMERICAL SIMULATIONS

The Perseus galaxy cluster is known to present multiple and misaligned pairs of cavities seen in X-rays, as well as twisted kiloparsec-scale jets at radio wavelengths; both morphologies suggest that the active galactic nucleus (AGN) jet is subject to precession. In this work, we performed three-dimensional hydrodynamical simulations of the interaction between a precessing AGN jet and the warm intracluster medium plasma, whose dynamics are coupled to a Navarro-Frenk-White dark matter gravitational potential. The AGN jet inflates cavities that become buoyantly unstable and rise up out of the cluster core. We found that under certain circumstances precession can originate multiple pairs of bubbles. For the physical conditions in the Perseus cluster, multiple pairs of bubbles are obtained for a jet precession opening angle >40 degrees acting for at least three precession periods, reproducing both radio and X-ray maps well. Based on such conditions, assuming that the Bardeen-Peterson effect is dominant, we studied the evolution of the precession opening angle of this system. We were able to constrain the ratio between the accretion disk and the black hole angular momenta as 0.7-1.4. We were also able to constrain the present precession angle to 30 degrees-40 degrees, as well as the approximate age of the inflated bubbles to 100-150 Myr.

EVALUATION OF ONYX HD-500 EMBOLIC SYSTEM IN THE TREATMENT OF 84 WIDE-NECK INTRACRANIAL ANEURYSMS

OBJECTIVE: We report our results using Onyx HD-500 (Micro Therapeutics, Inc., Irvine, CA) in the endovascular treatment of wide-neck intracranial aneurysms, which have a high rate of incomplete occlusion and recanalization with platinum coils. METHODS: Sixty-nine patients with 84 aneurysms were treated. Most of the aneurysms were located in the anterior circulation (80 of 84 aneurysms), were unruptured (74 of 84 aneurysms), and were incidental. Ten presented with subarachnoid hemorrhage, and 15 were symptomatic. All aneurysms had wide necks (neck >4 mm and/or dome-to-neck ratio <1.5). Fifty aneurysms were small (<12 mm), 30 were large (12 to <25 mm) and 4 were giant. Angiographic follow-up was available for 65 of the 84 aneurysms at 6 months, for 31 of the 84 aneurysms at 18 months, and for 5 of the 84 aneurysms at 36 months. RESULTS: Complete aneurysm occlusion was seen in 65.5% of aneurysms on immediate control, in 84.6% at 6 months, and in 90.3% at 18 months. The rates of complete occlusion were 74%, 95.1%, and 95.2% for small aneurysms and 53.3%, 70%, and 80% for large aneurysms at the same follow-up periods. Progression from incomplete to complete occlusion was seen in 68.2% of all aneurysms, with a higher percentage in small aneurysms (90.9%). Aneurysm recanalization was observed in 3 patients (4.6%), with retreatment in 2 patients (3.3%). Procedural mortality was 2.9%. Overall morbidity was 7.2%. CONCLUSION: Onyx embolization of intracranial wide-neck aneurysms is safe and effective. Morbidity and mortality rates are similar to those of other current endovascular techniques. Larger samples and longer follow-up periods are necessary.

Recurrent gains and losses of large (84-109 bp) repeats in the rDNA internal transcribed spacer 2 (ITS2) of rhipicephaline ticks

We studied the internal transcribed spacer 2 (ITS2) in twenty-two spp. of ticks from the subfamily Rhipicephalinae. A 104-109 base pair (bp) region was Imperfectly repeated In most ticks studied. Mapping the number of repeat copies on to a phylogeny from the ITS2 showed that there have been many Independent gains and losses of repeats. Comparison of the sequences of the repeat copies Indicated that in most taxa concerted evolution had played little if any role in the evolution of these regions, as the copies clustered by sequence position rather than species, In our putative secondary structure, each repeat copy can fold into a distinct and almost identical stem-loop complex; a gain or loss of a repeat copy apparently does not impair the function of the ITS2 in these ticks.

Numerical optimization experiments using the hyperbolic smoothing strategy to solve MPCC

In this work we solve Mathematical Programs with Complementarity Constraints using the hyperbolic smoothing strategy. Under this approach, the complementarity condition is relaxed through the use of the hyperbolic smoothing function, involving a positive parameter that can be decreased to zero. An iterative algorithm is implemented in MATLAB language and a set of AMPL problems from MacMPEC database were tested.

A comparison of bryophyte diversity in the Macaronesian Islands: island versus habitat approach

In this paper, we present a comparison of richness patterns and floristic similarity for bryophytes in the five most important altitudinal habitat types in the Macaronesian islands. We evaluate the importance of different factors discussed in the literature in predicting species diversity applying the traditional island approach and within the framework of the new habitat approach, including area, isolation, climatic factors, geological age and human influence. From the analysis of patterns of bryophyte species distribution for selected habitats across islands and archipelagos, we specifically test the hypothesis that (i) floristic similarity is primarily determined by climatic factors, but not by geographical distance due to high dispersal ability in this species group and (ii) bryophyte richness is best predicted by area, but not by geological age of the habitat due to very low endemicity or speciation rate and high colonization rate.

Students' engagement in school : analyses according to peer victimization and grade, throughout adolescence

8th International Technology, Education and Development Conference, Valencia 10th, 11th and 12th of March, 2014.

Methodology for in-game certification in serious games

Serious games are starting to attain a higher role as tools for learning in various contexts, but in particular in areas such as education and training. Due to its characteristics, such as rules, behavior simulation and feedback to the player's actions, serious games provide a favorable learning environment where errors can occur without real life penalty and students get instant feedback from challenges. These challenges are in accordance with the intended objectives and will self-adapt and repeat according to the student’s difficulty level. Through motivating and engaging environments, which serve as base for problem solving and simulation of different situations and contexts, serious games have a great potential to aid players developing professional skills. But, how do we certify the acquired knowledge and skills? With this work we intend to propose a methodology to establish a relationship between the game mechanics of serious games and an array of competences for certification, evaluating the applicability of various aspects in the design and development of games such as the user interfaces and the gameplay, obtaining learning outcomes within the game itself. Through the definition of game mechanics combined with the necessary pedagogical elements, the game will ensure the certification. This paper will present a matrix of generic skills, based on the European Framework of Qualifications, and the definition of the game mechanics necessary for certification on tour guide training context. The certification matrix has as reference axes: skills, knowledge and competencies, which describe what the students should learn, understand and be able to do after they complete the learning process. The guides-interpreters welcome and accompany tourists on trips and visits to places of tourist interest and cultural heritage such as museums, palaces and national monuments, where they provide various information. Tour guide certification requirements include skills and specific knowledge about foreign languages and in the areas of History, Ethnology, Politics, Religion, Geography and Art of the territory where it is inserted. These skills are communication, interpersonal relationships, motivation, organization and management. This certification process aims to validate the skills to plan and conduct guided tours on the territory, demonstrate knowledge appropriate to the context and finally match a good group leader. After defining which competences are to be certified, the next step is to delineate the expected learning outcomes, as well as identify the game mechanics associated with it. The game mechanics, as methods invoked by agents for interaction with the game world, in combination with game elements/objects allows multiple paths through which to explore the game environment and its educational process. Mechanics as achievements, appointments, progression, reward schedules or status, describe how game can be designed to affect players in unprecedented ways. In order for the game to be able to certify tour guides, the design of the training game will incorporate a set of theoretical and practical tasks to acquire skills and knowledge of various transversal themes. For this end, patterns of skills and abilities in acquiring different knowledge will be identified.

TRAILER – e-Portfolio for collecting and recognizing informal learning process and outcomes

Informal learning is becoming more and more important: Nowadays people learn more this way, through the Internet, than in schools or normal trainings. But they don’t get any certificateswhich attest this fact. So they can't show the employer or teacher etc. that they have learned something. TRAILER project aim is to solve this problem by developing a special tool for managing of all competences and skills acquired through informal learning experiences. Both from the perspective of the user and the perspective of an institution or a company. We’ll present the IT tool to show how people can make their informal learning outcomes visible. TRAILER helps users to gather all information about process and outcomes of their informal learning. Users can share this with friends, colleagues or their employees, teachers and so on. They can create an interactive e-portfolio which can be attached to their CV, cover letter or Knowledge Management system etc. After the presentation of the tool we will discuss possible areas and fields to use this tool. Also we would like to discuss all possible use of the tool by the participants and another needs in this area. Moreover we want to discuss other problems in informal learning process, ways to solve the problems and discuss other ideas of different IT tools which could help in informal learning process. During the discussion we’ll use an interactive respond system which can be used on mobile devices: it makes possible for participants to share their opinions individually before knowing another persons' opinion.

Manifestações neurológicas nas endocardites infecciosas - revisão de 103 casos estudados - 84 casos do Hospital dos Servidores do Estado-R.J. (1947-1978) e 19 casos do Hospital Estadual São Sebastião-R.J. (1975-1978)

Os autores fazem uma revisão de 103 casos de endocardites infecciosas, dos quais 52 apresentaram manifestações neurológicas. Dos 52 que não tiveram problemas neurológicos, 39 faleceram 175%), enquanto que dos 51 que não tiveram alterações do sistema nervoso, apenas 18 evoluíram para o óbito 135,3%). A endocardite infecciosa com manifestações neurológicas, na presente série, foi dominante no sexo masculino. Os grupos etários mais envolvidos foram as crianças, adolescentes e adultos jovens. Houve outro pico importante em pacientes acima de 50 anos. Os critérios para o diagnóstico de endocardite infecciosa utilizados no presente estudo, foram os clássicos, acrescidos de outros considerados de extrema utilidade, à medida que a experiência foi sendo acumulada, acompanhando paralelamente as modificações dos padrões etiológicos, assim como as alterações dos espectros clínicos da doença, conseqüentes a muitos fatores aqui discutidos. Os principais distúrbios neurológicos observados foram as manifestações meningeias, 25/52 148,1%), alterações do comportamento, 20/52 (38,4%), fenômenos motores (paralisias e paresias), 20/52 (38,4%). Alterações do nível de consciência (torpor ou coma), ao lado de outras menos comuns, como cefaléia 16/52 (26,9%), convulsões, 10/52 (19,2%), afasia 7/52 (13,5%) e manchas de Roth, 7/53 (13,5%). As manifestações neurológicas frequentemente foram múltiplas em um mesmo paciente. Nas formas de endocardite, foram em muitos casos praticamente as alterações que abriram e dominaram a cena clínica. As mais comuns foram: síndrome meningeia, síndrome vascular e encefalopatia tóxica. Foi difícil, em conseqüência de múltiplas manifestações neurológicas num mesmo paciente, estabelecer critérios entre a lesão neurológica e o prognóstico, embora o coma profundo, as convulsões, os distúrbios motores acentuados, a meningite e as alterações do comportamento, isoladamente ou em associação, façam com que o mesmo seja bem mais sério. O germe mais encontrado em nossa série foi oStaphylococcus aureus, relacionado com formas agudas da infecção endocárdica, aliado a processos destrutivos valvulares e a sérias alterações neurológicas tais como meningite, encefalite, infartos, hemorragias e abcessos cerebrais. Os principais achados neurológicos referentes à patologia, no estudo de 15 casos, são apresentados ao lado de conclusões tiradas de reflexões sobre o material analisado e da experiência vivida. Uma revisão da literatura é feita desde os trabalhos iniciais sobre a doença até os dias de hoje, ficando evidenciada a importância do tema pelas grandes contribuições apresentadas pelos diferentes autores.