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Introducción: El mundo ha experimentado un proceso de cambio que implica múltiples transiciones, como la demográfica y epidemiológica. En México, la prevalencia de las enfermedades demenciales como el Alzheimer tiene una tendencia al aumento, de ahí que sea necesario estudiar y analizar sus repercusiones en la población. Objetivo: Determinar el grado de dependencia en adultos mayores con enfermedad de Alzheimer en un hospital de segundo nivel en Nayarit, México. Métodos: Estudio descriptivo, corte transversal y enfoque cuantitativo. Se aplicó el índice de Barthel para evaluar las actividades básicas de la vida diaria a 29 cuidadores principales de los pacientes registrados en la base de datos del hospital. Las variables elegidas fueron: sexo, edad, municipio y grado de dependencia. El análisis de los datos se realizó mediante el programa SPSS de IBM versión 20. Resultados: La edad media fue de 79 años; el 62,1 por ciento fueron mujeres y el 37,9 por ciento hombres; el municipio con mayor número de pacientes fue Tepic (44,8 por ciento); con respecto al grado de dependencia, la independencia fue la más frecuente (27,6 por ciento), seguido de dependencia total (24,1 por ciento). Se evidenció correlación entre defunciones y grado de dependencia con un nivel de significancia por debajo de 0,000 (error α). Conclusiones. En Nayarit existe dependencia en los adultos mayores con enfermedad de Alzheimer. Los cuidadores primarios reciben poca o ninguna capacitación para el cuidado de estos pacientes. El subdiagnóstico de esta enfermedad de alguna manera favorece la dependencia, pues no se orienta o no se otorgan las medidas básicas terapéuticas a la familia para el apoyo del enfermo, esto a su vez es de especial interés debido a que existe una correlación estrecha entre defunción y dependencia(AU)

Introduction: The world has undergone a process of change that involves multiple transitions, such as demographic and epidemiological. In Mexico, the prevalence of dementia diseases such as Alzheimer's has an increasing trend, hence it is necessary to study and to analyze its impact on the population. Objective: To determine the degree of dependence in aged adults with Alzheimer's disease in a second-level hospital in Nayarit, Mexico. Methods: This is a descriptive study with cross-sectional and quantitative approach. The Barthel index was applied to assess the basic activities of daily living to 29 main caregivers of the patients registered in the hospital database. The variables chosen were sex, age, municipality and degree of dependency. Data analysis was performed using the IBM SPSS version 20 program. Results: The mean age was 79 years; 62.1percent were women and 37.9percent men; the municipality with the highest number of patients was Tepic (44.8percent). Regarding the degree of dependence, independence was the most frequent (27.6percent), followed by total dependence (24.1percent). Correlation between deaths and degree of dependence was evidenced with a level of significance below 0.000 (α error). Conclusions: In Nayarit there is dependence in aged adults suffering from Alzheimer's disease. Primary caregivers receive little or no training in caring for these patients. The underdiagnoses of this disease in some way favors dependence, since the family is not guided or the basic therapeutic measures are not given to support the patient, this in turn is of special interest because there is close correlation between deaths and dependency(AU)

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Objective: The purpose of this study was to evaluate the effects of a telerehabilitation program for COVID-19 survivors on their functionality, aerobic capacity, upper-lower body strength and skeletal muscle mass index. Methods: Fifty patients (22 M); age 54.1±15.4 who became ill with COVID-19 during 2020 completed a 24-session telerehabilitation program. The following measures were taken: Barthel's index, two minutes step test (2MST), elbow flexion one-repetition maximal (1RM), short physical performance battery (SPPB), hand grip strength, 30-second chair stand, skeletal muscle index (SMI), body fat percentage, resting pulse, arterial blood pressure, and pulse oximetry. Results: There was a significant increase in the Barthel index (p≤0.0001), 2MST (p≤0.0001), 1RM elbow flexion (p≤0.0001), SPPB (p≤0.0001), hand grip strength (p≤0.0001), 30-second chair stand (p≤0.000l), and SMI (p≤0.0001). Conclusion: A 24 session in-home telerehabilitation program promoted the recovery of physical independence and increases in skeletal muscle mass index and physical fitness.

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There are many medications available to treat spasticity, but the tolerability of medications is the main issue for choosing the best treatment. The objectives of this study were to compare the efficacy and adverse effects of tolperisone compared to baclofen among patients with spasticity associated with spinal cord injury. Patients received baclofen plus physical therapy (BAF+PT, n=135) or tolperisone plus physical therapy (TOL+PT, n=116), or physical therapy alone (PT, n=180). The modified Ashworth scale score, the modified Medical Research Council score, the Barthel Index score, and the Disability Assessment scale score were improved (P<0.05 for all) in all the patients at the end of 6 weeks compared to before interventions. After 6 weeks, the overall coefficient of efficacy of the intervention(s) in the BAF+PT, TOL+PT, and PT groups were 1.15, 0.45, and 0.05, respectively. The patients of the BAF+PT group reported asthenia, drowsiness, and sleepiness and those of the TOL+PT group reported dyspepsia and epigastric pain as adverse effects. When comparing drug interventions to physical therapy alone, both baclofen plus physical therapy and tolperisone plus physical therapy played a significant role in the improvement of daily activities of patients. Nonetheless, baclofen plus physical therapy was tentatively effective. Tolperisone plus physical therapy was slightly effective. In addition, baclofen caused adverse effects related to the sedative manifestation (Level of Evidence: III; Technical Efficacy Stage: 4).

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Improving the quality of life of patients with complete spinal cord injuries is an urgent objective of the Chinese Department of Health. For better management of spinal cord injuries, it is necessary to understand the background of the patients. A total of 392 patients aged ≥18 years with traumatic spinal cord injuries (≥1 year of history) were attending the rehabilitation center of the Institutes. A total of 7 (2%) patients reported low quality of life, 200 (51%) patients reported moderate quality of life, 181 (46%) patients reported good quality of life, and 4 (1%) patients reported excellent quality of life. Male patients (P=0.042), patients with college or more education (P=0.039), incomplete spinal cord injuries (P=0.045), paraplegia (P=0.046), and absence of pressure injury (P=0.047) were associated with higher quality of life. A total of 81 (21%) patients were dependent on the caregiver, 85 (22%) patients were highly dependent on the caregiver, 155 (40%) patients were moderately dependent on the caregiver, 60 (15%) patients were mildly dependent on the caregiver, and 11 (2%) patients were independent for activities of daily living. An incomplete spinal cord injury (P=0.045) and paraplegia (P=0.041) were associated with higher independence in activities of daily living of patients. The independence in activities of daily living and quality of life of the Chinese population with complete spinal cord injury and tetraplegia are poor (Level of Evidence: IV; Technical Efficacy Stage: 5).

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The higher prevalence rates of depression in visually-impaired individuals than the general population indicates that the condition per se increases the risk of depression. A person that is aware of the progressive loss of visual acuteness may have feelings of insecurity, anxiety, loss of independence and changes in social functioning, leading to depression. Several studies assessing the association between depressive symptoms and severity of vision loss have yielded inconsistent results. Some do not show any association, whereas others reported that depression severity is higher in those with substantial vision loss. The general aim of this manuscript was to determine the prevalence of depression in patients diagnosed with legal blindness in the Eye Care Service at the Hospital Córdoba between June 2016 and June 2017. The study sample consisted of 41 patients. The level of depression was assessed using the Zung scale and the degree of dependence in daily life activities was defined using the Barthel index. Data was anonymized for inclusion in a computer database and statistical confidentiality was protected. Data was analyzed using InfoStat statistical software. The results revealed a relation between legal blindness, degrees of dependency and depressive symptoms in patients of the Eye Care Service of the Hospital Córdoba. It is very important for health professionals to be trained to detect early signs and symptoms of depression and have the necessary tools for such an approach.

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Introducción: La discapacidad no es una enfermedad, es una condición, comprende las barreras físicas y actitudinales que impiden la participación plena y efectiva en igualdad de condiciones con los demás. Objetivos: Determinar los tipos, grados y etiología de la discapacidad. Materiales y métodos: Estudio descriptivo, observacional, de corte trasversal donde se estudiaron a 68 adultos con discapacidad, de la comunidad de San Juan Nepomuceno, Departamento de Caazapá. Resultados: Se registraron 54% de discapacidad motora, 12% de discapacidad sensorial y, 21% de multidiscapacidad. Según el grado de dependencia, el 32% son independientes, el 32% dependencia moderada y el 24% dependencia grave. El origen de la discapacidad, por enfermedad 47%, de nacimiento 46% y por accidentes 7%. Discusión: En el estudio predomina la discapacidad motora, seguida de la multidiscapacidad, la condición de pobreza vincula el grado de discapacidad, observándose una mayor proporción de dependencia física. El origen que prevalece es la adquirida, muy cercana al de origen congénita y, un tercio de las personas no tienen escolaridad, exacerbando su condición de vulnerabilidad.

Introduction: Disability is not a disease, it is a condition, it includes physical and attitudinal barriers that prevent full and effective participation on equal terms with others. Objectives: Determine the types, degrees and etiology of the disability. Materials and methods: Descriptive, cross-sectional observational study where 68 adults with disabilities of the people of the community of San Juan Nepomuceno, Department of Caazapá were studied. Results: 54% of motor disability, 12% of sensory disability, 21% of multidisability were registered. Depending on the degree of dependence, 32% are independent, 32% moderate dependence and 24% severe dependence. The origin of the disability, due to illness 47%, birth 46% and accidents 7%. Discussion: In the study, motor disability predominates, followed by multidisability, the condition of poverty links the degree of disability, observing a greater proportion of physical dependence. The origin that prevails is that acquired very close to that of congenital origin. Almost a third of people do not have schooling, exacerbating their vulnerability.

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A doença de Huntington (DH) é uma desordem neurodegenerativa, que cursa com distúrbios motores, cognitivos e comportamentais que contribuem para o comprometimento da funcionalidade. Este estudo investigou o grau de funcionalidade e acometimento de indivíduos portadores da DH, com o Índice de Barthel Modificado (IBM) e por meio do Disease Burden Score (DBS). As variáveis analisadas de cada indivíduo foram: a idade atual, o gênero, a idade de início da doença e o número das repetições CAG (gene HTT). Seis indivíduos foram avaliados, três do sexo masculino 63,6 anos (±10,9) e três do sexo feminino 58,3 anos (±14,2) com o diagnóstico genético positivo para DH provenientes do município de Ervália/MG. O sexo feminino apresentou a idade de início menor comparado ao sexo masculino, com média de 38,3 anos (±8,9) e 46,6 anos (±7,6), respectivamente. O valor médio do número de repetições CAG no sexo feminino foi de 46,3 (±4,1) e no sexo masculino, 42,33 (±1,5). O grau de desempenho funcional determinado pelo IBM foi de 9,3 (±1,1) para o sexo feminino, com dependência total, e para o sexo masculino, 36 (±4,3), com dependência severa. O valor médio obtido pelo DBS no sexo feminino foi de 596,8 (±101,9), com maior grau de acometimento da doença comparado ao sexo masculino com 425,1 (±39,2). O grupo de mulheres com DH apresentou início dos sintomas mais cedo com maior número de expansões CAG quando comparado ao grupo masculino. Todos os pacientes apresentaram dependência total em relação à execução das atividades de vida diária. Sugere-se que pesquisas futuras sejam realizadas com maior número de indivíduos afetados pela DH para que os resultados observados sejam confirmados.

Huntington's disease (HD) is a neurodegenerative disorder, presenting with motor, cognitive and behavioral impairments that contribute to the decrease of the functional performance. This study investigated the degree of functionality and impairment of individuals with HD using the Modified Barthel Index (MBI) and the Disease Burden Score (DBS). The following variables were investigated : the age of onset, the gender, the current age and the number of CAG (HTT gene) repeats. Six HD patients from the municipality of Ervália-MG, three males 63.6 years old (±10.9) and three females 58.3 years old (±14.2), who had a positive genetic diagnosis for HD, were investigated. The female group had the lowest age of onset with an average of 38.3 years (±8.9), compared to the male group, with 46.6 years (±7.6). The mean of the number of CAG repeats in the female gender was 46.3 (±4.1) and in the male, 42.33 (±1.5). The degree of functional performance assessed by IBM was 9.3 (±1.1) for the female group, with total dependence, and for the male group, 36 (±4.3), with severe dependence. The mean of DBS value in the female group was 596.8 (±101.9) with a higher degree of disease involvement compared to the male group 425.1 (±39.2). The group of women with HD showed earlier onset of symptoms with a greater number of CAG repeats when compared to the male group. All patients presented total dependence on daily living activities. We strongly suggest further research involving a larger group of individuals affected by HD for statistical validation.

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A complete battery of geriatric and psychometric tests was used to determine whether plasma-borne zinc (Zn), a key ion in neuroplasticity, can be associated with the severity of functional, psychological and cognitive impairment in non-demented older individuals. There was a significant positive correlation between plasma Zn levels and the concentration subcategory measured with the Mini-Mental State Examination (MMSE) test (p < 0.001), but not the total MMSE score, and the levels were significantly reduced in polymedicated patients (defined as concurrent administration of >5 drugs). No correlations were found between plasma Zn levels and depressive symptoms measured with the Yesavage scale for geriatric depression or the Barthel Index - a measurement of the ability of individuals to perform the activities of daily living. Depressive symptoms were associated with poor sleep quality and polymedication (p < 0.001 and p < 0.05, respectively). Our results suggest that peripheral Zn concentration may play a role in the physiopathology of some domain of cognitive function. No correlation to depressive symptoms in the geriatric population under antidepressant drug treatment was observed. However, further studies are needed to understand the relationship between circulating Zn and concentration deficits in order to determine whether Zn represents a candidate early biomarker for cognitive impairment.

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INTRODUCCIÓN: describir nuestra experiencia en el tratamiento de las MAVs analizando: procedimientos endovasculares utilizados, resultados postoperatorios y complicaciones asociadas, estadificación según escalas de Barthel y Rankin modificadas. MATERIAL Y MÉTODOS: la población de estudio se constituyó por 52 pacientes con MAVs la cual fue analizada y estudiada mediante examen neurológico pre y postoperatorio, TC cerebral, RM cerebral y arteriografía de 4 vasos de cuello, la totalidad fue tratada mediante cirugía convencional en nuestro Servicio durante el período comprendido entre los años 2000 a 2010. RESULTADOS: recibieron tratamiento endovascular previo a la cirugía 16 MAVs (30,76 %). Todas fueron operadas. Doce pacientes mejoraron en el postoperatorio (23,07 %), 30 pacientes (57,69%) no sufrieron modificaciones y 10 de ellos (19,23%) empeoraron durante el postoperatorio. La mortalidad fue de 7 casos (13,46 %). CONCLUSIÓN: consideramos a los procedimientos endovasculares y la radiocirugía una herramienta de indudable valor terapéutico. Creemos que el subgrupo de MAVs grados III, IV y V representa una entidad singular que las distingue del resto, como una subtipo que requiere más aun de una compleja toma de decisiones. Tuvimos las mayores complicaciones postoperatorias en MAVs grados III y IV. Nuestra mortalidad postoperatoria coincide con la bibliografía consultada

INTRODUCTION: to describe our experience in treating AVMs based on the endovascular procedures used, postoperative results and associated complications, staging according to Barthel Index and modified Rankin Scale. PATIENTS AND METHOD: we present 52 patients with AVMs which were analysed and studied by Pre and Post-Surgery Neurological exam, brain CT, Brain IRM and four Neck vessels arteriography. All the patients were treated by conventional Surgery at our Department of Neurosurgery for the 2000­2010 period. RESULTS: Sixteen patients with AVMs (30.76%) underwent endovascular treatment prior to surgery. 100% were operated. 12 patients (23.07%) improved their clinical condition in the postoperative period, 30 patients (57.69%) showed no changes, and 10 of them (19.23%) experienced deterioration during the postoperative period. There were 7 mortal cases (13.46%). CONCLUSION: we believe that endovascular procedures and radiosurgery are tools of immense therapeutic value. We also consider that the subgroup of AVMs grade III, IV and V have unique features that distinguish them among the rest as a subtype, thus requiring extreme care when making decisions. Most postoperative complications occurred with AVMs grade III and IV. The mortal cases in the postoperative period coincided with those mentioned in the bibliography consulted

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Introducción: Se realizó un estudio observacional prospectivo de los pacientes con diagnóstico de infarto cerebral de territorio vascular carotídeo, de perfil crónico, que ingresaron en la Clínica de Lesiones Estáticas Encefálicas del Centro Internacional de Restauración Neurológica. Objetivo: Determinar el pronóstico de recuperación funcional en pacientes con infarto cerebral, en tratamiento de rehabilitación intensivo, Métodos: Se estudiaron 80 pacientes del Centro Internacional de Restauración Neurológica (año 2007-2010), durante 4 sem. Se crearon 2 grupos, según la presencia de recuperación funcional, utilizando el índice de Barthel. Se realizaron comparaciones según edad, sexo, factores de riesgo vascular y condición neurológica y funcional inicial. Resultados: La edad promedio de los casos recuperados fue de 58,04 años (±12,18), superior a la de los casos no recuperados, de 51,09 a±os (±11,19) (t pareada p= 0,01), El sexo y los factores de riesgo no mostraron asociación con la recuperación funcional (X² p= 0,05). La recuperación funcional resultó significativa para pacientes moderados según la escala escandinava para ictus (36,73 por ciento X²p= 0,000) y severos según índice de Barthel (51,02 por ciento X²p= 0,000). Conclusión: La condición neurológica y funcional constituye un buen predictor de respuesta al tratamiento(AU)

Introduction: An observational and prospective study was done to the patients with diagnostic of chronic cerebral infarction of carotid vascular part, which were studied at the Clinic of Statics Encefalic Injury from the International Center Neurological Restoration. Objective: To determine the functional recovery prognosis in patients presenting with cerebral infarction under intensive rehabilitation treatment. Methods: Eighty patients were studied from the International Center of Neurological Restoration (2007-2010) for 4 weeks. Two groups were created according to presence of a functional recovery using the Barthel index. Comparisons according to age, sex, vascular risk factors and the neurological and functional initial condition were made. Results: The mean age of recovered cases was of 58,04 years (±11,19) (matched t p= 0.01). Sex and risk factors have not association with the functional recovery (X² p= 0,05). The functional recovery was significant for moderate patients according the Scandinavian scale for ictus (36,73 percent X² p= 0,000) y severe according the Arthel index (51,02 percent X² p= 0,000). Conclusion: The neurological and functional condition is a good predictor of the response to treatment(AU)

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Introducción: Se realizó un estudio observacional prospectivo de los pacientes con diagnóstico de infarto cerebral de territorio vascular carotídeo, de perfil crónico, que ingresaron en la Clínica de Lesiones Estáticas Encefálicas del Centro Internacional de Restauración Neurológica. Objetivo: Determinar el pronóstico de recuperación funcional en pacientes con infarto cerebral, en tratamiento de rehabilitación intensivo, Métodos: Se estudiaron 80 pacientes del Centro Internacional de Restauración Neurológica (año 2007-2010), durante 4 sem. Se crearon 2 grupos, según la presencia de recuperación funcional, utilizando el índice de Barthel. Se realizaron comparaciones según edad, sexo, factores de riesgo vascular y condición neurológica y funcional inicial. Resultados: La edad promedio de los casos recuperados fue de 58,04 años (±12,18), superior a la de los casos no recuperados, de 51,09 años (±11,19) (t pareada p= 0,01), El sexo y los factores de riesgo no mostraron asociación con la recuperación funcional (X² p= 0,05). La recuperación funcional resultó significativa para pacientes moderados según la escala escandinava para ictus (36,73 por ciento X²p= 0,000) y severos según índice de Barthel (51,02 por ciento X²p= 0,000). Conclusión: La condición neurológica y funcional constituye un buen predictor de respuesta al tratamiento

Introduction: An observational and prospective study was done to the patients with diagnostic of chronic cerebral infarction of carotid vascular part, which were studied at the Clinic of Statics Encefalic Injury from the International Center Neurological Restoration. Objective: To determine the functional recovery prognosis in patients presenting with cerebral infarction under intensive rehabilitation treatment. Methods: Eighty patients were studied from the International Center of Neurological Restoration (2007-2010) for 4 weeks. Two groups were created according to presence of a functional recovery using the Barthel index. Comparisons according to age, sex, vascular risk factors and the neurological and functional initial condition were made. Results: The mean age of recovered cases was of 58,04 years (±11,19) (matched t p= 0.01). Sex and risk factors have not association with the functional recovery (X² p= 0,05). The functional recovery was significant for moderate patients according the Scandinavian scale for ictus (36,73 percent X² p= 0,000) y severe according the Arthel index (51,02 percent X² p= 0,000). Conclusion: The neurological and functional condition is a good predictor of the response to treatment

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Introducción: La gravedad, las implicancias neurológicas y el alto costo del tratamiento de la fractura cervical, hacen de esta lesión un tema de suma importancia. Esta injuria provoca graves limitaciones e invalidez a los afectados, en su mayoría en plena actividad laboral, impactando en lo médico, social y económico. Objetivos: Describir los pacientes tratados quirúrgicamente de fractura cervical traumática en el Hospital Regional Rancagua, por el equipo de Neurocirugía dentro de un periodo de 4 años. Materiales y Métodos: Se evaluó - 24 pacientes con antecedente de fractura cervical el mecanismo del trauma, el tiempo transcurrido desde el ingreso hospitalario hasta la cirugía, nivel y compromiso de la lesión medular, tipo de abordaje quirúrgico, complicaciones médicas, quirúrgicas y seguimiento post-operatorio, entre otros. Resultados: 5 mujeres y 19 hombres, edad promedio 39 años (rango de edad 14 a 75 años), principales mecanismos de trauma fueron los accidentes automovilísticos-atropello (58 por ciento). El nivel medular más frecuentemente lesionado fue C4-C5 (25 por ciento). En el 50 por ciento de los pacientes se clasificó de entrada como Frankel A, por lo que un 50 por ciento de todos los pacientes ingresaron tetrapléjicos, y de estos, un 33 por ciento egresó tetraparéticos. Del ingreso a cirugía hubo un tiempo de espera promedio 5 días. Dentro de las complicaciones médicas la causa respiratoria (46 por ciento) fue la más frecuente, necesitando 64 por ciento de estos pacientes ventilación mecánica. Se registró 1 infección de herida operatoria donde el abordaje fue posterior. El Índice de Barthel promedio de 14 pacientes fue de 49 puntos. De 6 pacientes con puntaje Cero, 85 por ciento de estos ingresaron como Frankel A y 50 por ciento egresaron tetrapléjicos. Los pacientes se rehabilitaron en promedio de 2.5 meses. Discusión: Logramos objetivar nuestra realidad. La técnica quirúrgica fue prácticamente uniforme entre los pacientes, sin complicaciones...

Introduction: Gravity, neurological implications and high costs of treating cervical fracture, makes of this injury an issue of most importance. This injury causes severe limitations and disability to those affected, mostly in full working activity, impacting on the medical, social and economic. Objectives: To describe patients surgically treated for traumatic cervical fracture at the Rancagua Regional Hospital, by the team of Neurosurgery Department, within a period of 4 years. Materials and Methods: We evaluated 24 patients with an history of cervical fracture mechanism of trauma, the time from hospital admission to surgery, and commitment level of spinal cord injury, type of surgery, medical and surgical complications and follow-up post -operation, among others. Results: 5 women and 19 men, average age 39 years (ranging age from 14 to 75 years), major trauma mechanisms were motor vehicle accidents (58 percent). The most frequently injured spinal level was C4-C5 (25 percent). 50 percent of patients were classified as Frankel A at the admission, so that 50 percent of all patients admitted were quadriplegics, and of these, 33 percent were discharged as tetraparétic. Admission to the surgery were an average of 5 days. Within cause respiratory medical complications (46 percent) was the most frequent, requiring 64 percent of these patients mechanical ventilation. There was only 1 wound infection where the approach was posterior. The average Barthel Index of 14 patients was 49 points. In 6 patients with zero score, 85 percent were admitted as Frankel A and 50 percent egressed as tetraplejic. Patients were rehabilitated an average of 2.5 months. Conclusions: We were able to objectify our reality. The surgical technique was nearly uniform among patients without severe postoperative surgical complications...

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