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It has been described that the frequency ranges at which theta, mu and alpha rhythms oscillate is increasing with age. The present report, by analyzing the spontaneous EEG, tries to demonstrate whether there is an increase with age in the frequency at which the cortical structures oscillate. A topographical approach was followed. The spontaneous EEG of one hundredand seventy subjects was recorded. The spectral power (from 0.5 to 45.5 Hz) was obtained by means of the Fast Fourier Transform. Correlations of spatial topographies among the different age groups showed that older groups presented the same topographical maps as younger groups, but oscillating at higher frequencies. The results suggest that the same brain areas oscillate at lower frequencies in children than in older groups, for a broad frequency range. This shift to a higher frequency with age would be a trend in spontaneous brain rhythm development.
RESUMEN
BACKGROUND: Since 2007, Ciudad Juárez, Chihuahua has been considered as one of the most violent cities in the world. The General Hospital in this city is the main facility where patients with gunshot wounds are taken. The increased number of admissions of patients with these injuries to many hospitals in the country deserves special attention, as it has an impact on hospital resources and management protocols. OBJECTIVES: To disseminate the epidemiology of fractures caused by gunshot wounds and the hospital care of these patients. METHODS: A retrospective, observational cohort study was conducted of patients admitted to the Traumatology and Orthopedics Service, Cd. Juárez General Hospital, in Chihuahua, Mexico, from January 2008 to December 2010. All of them sustained fractures resulting from gunshot wounds. RESULTS: A total of 1281 patients with a diagnosis of gunshot wounds were admitted to the hospital; 402 of them were included in this study with 559 fractures; 329 were males and 73 females. Of the 559 fractures, 257 involved the upper limb, 294 the lower limb, and 8 the pelvis. Gunshot wounds-related fractures were classified according to the Gustilo classification. Seventy-nine patients had grade I fractures, 302 grade III, and 21 patients had both grades. Conservative treatment was used in 44.3% of fractures and osteosynthesis in 55%. One patient underwent amputation upon admission. The most widely used osteosynthesis methods were external fixator (37%), straight plates (21%) and intramedullary nail (17%). Five patients (1.3%) underwent amputation: two with femur fracture and 3 with humeral fracture. There were 27 deep infections (6%); one of them resulted in late amputation of the pelvic limb. The most common associated injuries included: chest injuries in 20 patients and abdominal injuries in 17. The range of hospital stay was 1-18 days, with a mean stay of 11 days. The overall mortality rate considering the total number of patients admitted (1,281) was 99 patients (7.72%). CONCLUSIONS: From 2006 to 2010 the incidence of musculo-skeletal injuries due to gunshot wounds increased 800% at the hospital. There are multiple factors and variables related with the diagnosis and treatment, many of which are not well defined and are controversial and others are well established; knowing them gives us the opportunity of improving these patients' prognosis. Treatment aimed at preserving life and the limb should be multidisciplinary. Caring for gunshot wounds warrants specialized knowledge: terminal ballistics, the affected region, the structures involved, the magnitude of the injured tissues and the biomechanics of the implants used. The two-category Gustilo classification is thought to be insufficient to classify all fractures resulting from gunshot wounds.
Asunto(s)
Heridas por Arma de Fuego/epidemiología , Adolescente , Adulto , Anciano , Niño , Preescolar , Estudios de Cohortes , Femenino , Hospitales Generales , Humanos , Lactante , Masculino , México/epidemiología , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
INTRODUCTION AND OBJECTIVES: The underlying mechanism of syncope induced by head-up tilt test is still incompletely understood. It has been proposed a sudden increase in parasympathetic's activity induced by the excessive activation of the cardiac mechanoreceptors. The aim of our study was to evaluate the clinical, electrocardiographic and hemodynamic responses to head-up tilt test before and after treatment with transdermal Scopolamine (anticholinergic agent). METHODS: We studied 17 patients (8 females, 9 males; mean age 43 +/- 19 years) with > or = 2 syncopal episodes of unknown origin and a positive tilt test (a positive response to tilt testing alone or in conjunction with an infusion of isoproterenol was defined as the appearance of syncope or presyncope associated to hypotension and/or bradycardia). Symptoms developed in 12 patients during the baseline tilt (Group I) and in 5 patients after infusion of isoproterenol (Group II). Mean time to symptoms was 8.5 +/- 7.9 minutes in group I. All patients were them treated with transdermal Scopolamine (1.5 mg/24 hours) and 48 hours later tilt test was repeated. RESULTS: In group I, 8 patients (66.6%) became tilt test negative and in the remaining 4 patients mean time before the appearance of symptoms was increased (8.5 +/- 7.9 vs 16.2 +/- 2.5 minutes; p < 0.05). In group II, 3 patients (60%) became tilt test negative and in the remaining 2 patients symptoms developed after an infusion of higher doses of isoproterenol than in the first study. So, with transdermal scopolamine 11 out of 17 patients became tilt test negative and time to symptoms was increased in all of the remaining 6 patients. CONCLUSIONS: Our study suggest that transdermal scopolamine is an usefull treatment in the prevention of neuro-cardiogenic syncope induced by head-up tilt test.