Resumen Se presentan los resultados de la investigación realizada en grupos de individuos prehispánicos del estado de Yucatán y Oaxaca. Nuestro objetivo es comprender los procesos microadaptativos fenotípicos que se dieron entre individuos del área maya peninsular y de los valles centrales de Oaxaca. En este sentido, fueron seleccionados 107 fémures de 14 sitios de la península de Yucatán del periodo Clásico (300 dC a 900 dC) de la costa y de la planicie. Y de Oaxaca, un grupo de 37 fémures provenientes de los valles centrales (Monte Albán y otros sitios) del periodo Clásico (200-1000 dC) y Posclásico (10001400 dC). Estos grupos se ubican en regiones geográficas diferentes, el primero en una planicie de baja altitud (0 a 100 msnm) y el segundo a 2000 msnm. Con formas de organización social similares y estrategias de subsistencias basadas en el maíz. Para tal propósito, se utilizan imágenes tomográficas computarizadas (TC-Scan) de la sección transversal del fémur, se estiman las características biomecánicas de estos grupos (primeros y segundos momentos de inercia) tomando en cuenta las diferencias asociadas con estrategias de subsistencia y actividad física. Los resultados muestran, para ambos grupos, una influencia más significativa en la estructura corporal del entorno sociopolítico que del geográfico.

Abstract We present the results of the research carried out on groups of pre-Hispanic individuals from the state of Yucatan and Oaxaca. Our objective is to understand the phenotypic microadaptive processes that occurred among individuals from the peninsular Mayan area and from the central valleys of Oaxaca. To this end, 107 femurs were selected from 14 sites on the coast and plain of the Yucatan peninsula from the Classic period (300 AD to 900 AD). From Oaxaca, a group of 37 femurs was selected from the central valleys (Monte Alban and other sites) from the Classic period (200-1000 AD) and Postclassic period (1000-1400 AD). These groups are located in different geographical regions, the first on a low-lying plain (0 to 100 masl) and the second at 2,000 masl, with similar forms of social organization and subsistence strategies based on corn. For this purpose, we used computed tomographic images (CT scans) of the femur cross section, estimating the biomechanical characteristics of these groups (first and second moments of inertia) by taking into account the differences associated with subsistence strategies and physical activity. For both groups, the results show a more significant influence on body structure from their sociopolitical environment than their geographical one.

Abstract Drawing on the transformational leadership theory, this study aimed to analyze the psychometric properties of a version adapted to the educational environment of the Multifactor Leadership Questionnaire (MLQ-5X). A total of 1551 Spanish students (M = 15.47 years ± 0.72; 679 boys and 872 girls) from 31 secondary schools participated in the study. The confirmatory factor analysis of the initial nine-factor structure of the scale determined the need to eliminate two items of the passive exception management factor, grouping passive leadership into a single factor. A second eight-factor model found high correlations between the factors of transformational leadership, revealing the need to establish a first-order factor. Finally, a third model, which obtained adequate values of validity and reliability, was composed of 34 items distributed in 4 main factors (transformational leadership, contingent reward, leadership by active exception, and passive leadership) and 5 secondary factors for transformational leadership (idealized influence behavior, attributed idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration). The Spanish version of the MLQ-5X in the educational field can be used to assess the students' perception of teacher leadership.

Resumen Desde la teoría del liderazgo transformacional, este estudio tenía como objetivo analizar las propiedades psicométricas de una versión adaptada al ámbito educativo del Multifactor Leadership Questionnaire (MLQ-5X). Un total de 1551 estudiantes españoles (M = 15,47 años ± 0,72; 679 chicos y 872 chicas) de 31 centros de secundaria participaron en el estudio. El análisis factorial confirmatorio de la estructura inicial de nueve factores de la escala determinó necesario eliminar dos ítems del factor dirección por excepción pasiva, agrupando en un solo factor el liderazgo pasivo. Un segundo modelo de ocho factores encontró altas correlaciones entre los factores del liderazgo transformacional, haciendo necesario establecer un factor de primer orden. Finalmente, un tercer modelo obtuvo valores adecuados de validez y fiabilidad, compuesto por 34 ítems distribuidos en 4 factores principales (liderazgo transformacional, recompensa contingente, dirección por excepción activa y liderazgo pasivo) y 5 factores secundarios para el liderazgo transformacional (influencia idealizada conducta, influencia idealizada atribuida, motivación inspiracional, estimulación intelectual y consideración individualizada). Por tanto, la versión española del MLQ-5X en el ámbito educativo puede utilizarse para evaluar el liderazgo docente desde la percepción del alumnado.

ABSTRACT BACKGROUND: Leg length discrepancy (LLD) may play a key role in exercise biomechanics. Although the Podoprint platform has been used in dynamic pressure studies, there are no data regarding the reliability and repeatability of dynamic measurements under simulated LLD conditions. OBJECTIVES: To determine the intra and intersession repeatability and reliability of dynamic parameters of the Podoprint pressure platform under simulated LLD conditions. DESIGN AND SETTING: Observational cross-sectional study at a public university. METHODS: Thirty-seven healthy volunteers participated in this study. LLD was simulated using ethyl vinyl acetate plantar lifts with heights of 5 mm, 10 mm, 15 mm and 20 mm located under the right shoe of each volunteer. The procedure was performed to capture the dynamic parameters of each participant under five different simulated LLD conditions. Stance time, mean pressure and peak pressure measurements were registered in three trials for each foot and each LLD level. Data were collected during two separate testing sessions, in order to establish intrasession and intersession reliability. RESULTS: The intraclass correlation coefficients (ICCs) for intrasession reliability ranged from 0.775 to 0.983 in the first session and from 0.860 to 0.985 in the second session. The ICCs for intersession reliability ranged from 0.909 to 0.990. Bland-Altman plots showed absence of systematic measurement errors. CONCLUSIONS: The results from this study indicate that the Podoprint platform is a reliable system for assessing dynamic parameters under simulated LLD conditions. Future studies should evaluate plantar pressures under LLD conditions, in association with exercise, biomechanics and musculoskeletal disorders.

RESUMO CONTEXTO Até a data, não há estudos transversais considerando a influência do nível de incapacidade em pacientes com dor de garganta crônica não específica. Portanto, o objetivo principal deste estudo foi determinar a diferença entre os níveis de diminuição do colesterol cervical (Crom) e o limiar por dor de pressão (PPT) entre diferentes níveis de incapacidade (leve, moderada e grave) em indivíduos com dor crônica não específica no pescoço e sujeitos assintomáticos. MÉTODOS Estudo descritivo transversal. Os indivíduos foram recrutados de um centro de saúde primário e de um hospital do departamento ambulatorial. Uma amostra total de 128 indivíduos, 96 indivíduos com dor no pescoço crônica não específica e 32 indivíduos assintomáticos, foi recrutada. O NDI foi usado para dividir os indivíduos com dor no pescoço crônica em três grupos (incapacidade leve, moderada e grave). A principal medida de resultados foi a Tampa Scale of Kinesiophobia (TSK-11). As medidas de resultado secundário foram a Escala Analógica Visual (VAS), PPT (trapézio e tibial anterior), Crom (flexão, extensão, rotação e inclinação lateral) e duração da dor. RESULTADOS Nos resultados da Anova revelados nas comparações entre os grupos, diferenças estatisticamente significativas para o VAS foram observadas entre os grupos leve-grave (P<0,01) e moderado-grave (P<0,01), mas não entre os grupos moderado-moderado (P>0,05). Para o TSK, as diferenças não foram estatisticamente significativas (P>0,05). CONCLUSÃO A cinesiofobia pode não ser influenciada pelo nível de incapacidade em pacientes com dor no pescoço crônica não específica. No entanto, a intensidade da dor e a cronicidade de pacientes com deficiência grave do pescoço são aumentadas em relação ao índice de incapacidade leve e moderada.

BACKGROUND To date, there are no cross-sectional studies considering the influence of disability level in patients with non-specific chronic neck pain. Therefore, the main aim of this study was to determine kinesiophobia, active cervical range of movement (CROM), and pressure pain threshold (PPT) differences between different disability levels (mild, moderate, and severe) in subjects with non-specific chronic neck pain and asymptomatic subjects. METHODS A descriptive cross-sectional study. Subjects were recruited from a primary health care center and an outpatient department hospital. A total sample of 128 subjects, 96 of them with nonspecific chronic neck pain and 32 asymptomatic, were recruited. The NDI was used to divide the subjects with chronic neck pain into 3 groups (mild, moderate, and severe disability). The main outcome measurement was the Tampa Scale of kinesiophobia (TSK-11). The secondary outcome measurements were the Visual Analogue Scale (VAS), PPT (trapezius and tibialis anterior), CROM (flexion, extension, rotation, and lateral inclination) and pain duration. RESULTS The ANOVA results revealed, in the comparisons between groups, statistically significant differences for the VAS between the mild-severe (P < 0.01) and moderate-severe groups (P < 0.01), but not between the mild-moderate groups (P > 0.05); for the TSK, differences were not statistically significant (P > 0.05). CONCLUSION Kinesiophobia may not be influenced by disability level in patients with chronic non-specific neck pain. Nevertheless, pain intensity and chronicity of patients with severe neck disability are increased with respect to mild and moderate disability index.

Intestinal intussusception, defined as penetration of an intestinal segment into an adjacent, is a rare cause of intestinal obstruction in adults. The aim of this paper is to present the case of an adult patient with ileocolic intussusception as presenting a non-Hodgkin lymphoma of the small intestine. This patient has a rare cause of intestinal intussusception. Because of its non-specific clinical, etiologic diagnosis is usually intraoperative, requiring resection of the culprit lesion and, in the case of our patient, adjuvant chemotherapy.

La intususcepción intestinal, definida como la penetración de un segmento intestinal en otro adyacente, es una causa infrecuente de obstrucción intestinal en el adulto. El objetivo de este trabajo es presentar el caso de un paciente adulto con intususcepción ileocólica como presentación de un linfoma no Hodgkin de intestino delgado. Este paciente presenta una causa poco frecuente de intususcepción intestinal. Dada lo inespecífico de la clínica, el diagnóstico etiológico suele ser intraoperatorio, precisando resección de la lesión causante y, en el caso de nuestro paciente, quimioterapia adyuvante.

Objective: To identify the factors associated with prolonged length of hospital stay in patients admitted for acute heart failure. Methods: Multipurpose observational cohort study including patients from the EAHFE registry admitted for acute heart failure in 25 Spanish hospitals. Data were collected on demographic and clinical variables and on the day and place of admission. The primary outcome was length of hospital stay longer than the median. Results: We included 2,400 patients with a mean age of 79.5 (9.9) years; of these, 1,334 (55.6%) were women. Five hundred and ninety (24.6%) were admitted to the short stay unit (SSU), 606 (25.2%) to cardiology, and 1,204 (50.2%) to internal medicine or gerontology. The mean length of hospital stay was 7.0 (RIC 4-11) days. Fifty-eight (2.4%) patients died and 562 (23.9%) were readmitted within 30 days after discharge. The factors associated with prolonged length of hospital stay were chronic pulmonary disease; being a device carrier; having an unknown or uncommon triggering factor; the presence of renal insufficiency, hyponatremia and anaemia in the emergency department; not being admitted to an SSU or the lack of this facility in the hospital; and being admitted on Monday, Tuesday or Wednesday. The factors associated with length of hospital stay≤7days were hypertension, having a hypertensive episode, or a lack of treatment adherence. The area under the curve of the mixed model adjusted to the center was 0.78 (95% CI: 0.76-0.80; p < 0.001). Conclusions: A series of factors is associated with prolonged length of hospital stay and should be taken into account in the management of acute heart failure.

Objetivo: Identificar los factores asociados al tiempo de estancia hospitalaria prolongado en pacientes ingresados/as por insuficiencia cardiaca aguda. Método: Estudio observacional de cohorte multipropósito que incluyó pacientes del registro EAHFE (Epidemiology Acute Heart Failure in Emergency) ingresados/as por insuficiencia cardiaca aguda en 25 hospitales españoles. Se recogieron variables demográficas y clínicas, el día y el lugar del ingreso. La variable resultado principal fue el tiempo de estancia hospitalaria mayor que la mediana. Resultados: Se incluyeron 2400 pacientes con una edad media de 79,5 (±9,9) años, de los cuales 1334 (55,6%) eran mujeres. Quinientos noventa (24,6%) ingresaron en la unidad de corta estancia (UCE), 606 (25,2%) en cardiología y 1204 (50,2%) en medicina interna o geriatría. La mediana del tiempo de estancia hospitalaria fue de 7,0 (intervalo intercuartílico: 4-11 días). Cincuenta y ocho (2,4%) pacientes fallecieron y 562 (23,9%) sufrieron un reingreso a los 30 días tras el alta. Los factores independientes asociados a un tiempo de estancia hospitalaria prolongado fueron la enfermedad pulmonar obstructiva crónica, ser portador de un dispositivo, tener un factor precipitante desconocido o no común, la presencia en urgencias de insuficiencia renal, hiponatremia y anemia, no ingresar en una UCE o no disponer de dicha unidad e ingresar un lunes, martes o miércoles; y los asociados a un tiempo de estancia hospitalaria ≤7 días fueron la hipertensión arterial y tener como factor precipitante una crisis hipertensiva o la falta de adherencia al tratamiento. El área bajo la curva del modelo mixto ajustado al centro fue de 0,78 (intervalo de confianza del 95%: 0,76-0,80; p <0,001). Conclusiones: Hay una serie de factores asociados con un tiempo de estancia hospitalaria prolongado que deben ser considerados para la gestión del proceso de la insuficiencia cardiaca aguda.

Objective: To identify the factors associated with prolonged length of hospital stay in patients admitted for acute heart failure. Methods: Multipurpose observational cohort study including patients from the EAHFE registry admitted for acute heart failure in 25 Spanish hospitals. Data were collected on demographic and clinical variables and on the day and place of admission. The primary outcome was length of hospital stay longer than the median. Results: We included 2,400 patients with a mean age of 79.5 (9.9) years; of these, 1,334 (55.6%) were women. Five hundred and ninety (24.6%) were admitted to the short stay unit (SSU), 606 (25.2%) to cardiology, and 1,204 (50.2%) to internal medicine or gerontology. The mean length of hospital stay was 7.0 (RIC 4-11) days. Fifty-eight (2.4%) patients died and 562 (23.9%) were readmitted within 30 days after discharge. The factors associated with prolonged length of hospital stay were chronic pulmonary disease; being a device carrier; having an unknown or uncommon triggering factor; the presence of renal insufficiency, hyponatremia and anaemia in the emergency department; not being admitted to an SSU or the lack of this facility in the hospital; and being admitted on Monday, Tuesday or Wednesday. The factors associated with length of hospital stay≤7days were hypertension, having a hypertensive episode, or a lack of treatment adherence. The area under the curve of the mixed model adjusted to the center was 0.78 (95% CI: 0.76-0.80; p < 0.001). Conclusions: A series of factors is associated with prolonged length of hospital stay and should be taken into account in the management of acute heart failure.

Objetivo: Identificar los factores asociados al tiempo de estancia hospitalaria prolongado en pacientes ingresados/as por insuficiencia cardiaca aguda. Método: Estudio observacional de cohorte multipropósito que incluyó pacientes del registro EAHFE (Epidemiology Acute Heart Failure in Emergency) ingresados/as por insuficiencia cardiaca aguda en 25 hospitales españoles. Se recogieron variables demográficas y clínicas, el día y el lugar del ingreso. La variable resultado principal fue el tiempo de estancia hospitalaria mayor que la mediana. Resultados: Se incluyeron 2400 pacientes con una edad media de 79,5 (±9,9) años, de los cuales 1334 (55,6%) eran mujeres. Quinientos noventa (24,6%) ingresaron en la unidad de corta estancia (UCE), 606 (25,2%) en cardiología y 1204 (50,2%) en medicina interna o geriatría. La mediana del tiempo de estancia hospitalaria fue de 7,0 (intervalo intercuartílico: 4-11 días). Cincuenta y ocho (2,4%) pacientes fallecieron y 562 (23,9%) sufrieron un reingreso a los 30 días tras el alta. Los factores independientes asociados a un tiempo de estancia hospitalaria prolongado fueron la enfermedad pulmonar obstructiva crónica, ser portador de un dispositivo, tener un factor precipitante desconocido o no común, la presencia en urgencias de insuficiencia renal, hiponatremia y anemia, no ingresar en una UCE o no disponer de dicha unidad e ingresar un lunes, martes o miércoles; y los asociados a un tiempo de estancia hospitalaria ≤7 días fueron la hipertensión arterial y tener como factor precipitante una crisis hipertensiva o la falta de adherencia al tratamiento. El área bajo la curva del modelo mixto ajustado al centro fue de 0,78 (intervalo de confianza del 95%: 0,76-0,80; p <0,001). Conclusiones: Hay una serie de factores asociados con un tiempo de estancia hospitalaria prolongado que deben ser considerados para la gestión del proceso de la insuficiencia cardiaca aguda.

About the theoretical base of the Autodetermination Theory, the present research has tried to analyse the effect of the mobile applications which are related to the control of training about the basic psychological needs, the level of self-determination towards sport practice and fun. In order to do that, a quasi-experimental research was carried out in which 54 students (M = 16.4; SD = 1.51), both male and female, of different state schools of secondary education of Extremadura. The subjects of the experimental group (n=27) developed a programme of intervention of autonomous training of aerobic kind which was recorded and controlled with the mobile application "Endomondo Sport Tracker", with an eight- week duration. The components of the group of experimental control (n=27) recorded the same programme of autonomous training in a record sheet provided by the research group. The results showed that the satisfaction of the need for competence, the self-determination towards the fulfillment of the activity and the fun when carrying it out were higher in those students who used the application in regard to those who did not. In spite of that, no meaningful differences were noticed in most of the variables analyzed in the study, therefore, deeper research in this field must be carried out.

Com base teórica da Teoria da Autodeterminação, o presente estudo teve como objetivo analisar o efeito de aplicações móveis relacionados com a formação de monitoramento das necessidades psicológicas básicas, o nível de auto-determinação para o esporte e diversão, Sexo masculino (n = 32) e feminino (n = 22) de cinco escolas secundárias na comunidade; para fazer isso, um estudo quasi-experimental, em que 54 alunos (M = 1,51 DP = 16,4) participaram desenvolvido Extremadura autônoma. Os indivíduos do grupo experimental (n = 27) desenvolveram um programa de intervenção treinamento aeróbio autônomo registrado e controlado nas "Endomondo Sports Tracker" aplicativo móvel oito semanas. Os componentes do grupo de controle experimental (n = 27) tiveram o mesmo programa de treinamento autônomo em um formulário de inscrição fornecido pelo grupo de pesquisa. Os resultados mostraram que a satisfação da necessidade de competência, auto-determinação para a realização da atividade e divertido de ser realizada foram maiores nos participantes que utilizaram o aplicativo com relação àqueles que não usaram. No entanto, não foram observadas diferenças significativas na maioria das variáveis analisadas no estudo, por isso é considerada necessária para continuar o trabalho nesta linha de trabalho.

Sobre la base teórica de la Teoría de la Autodeterminación, con el presente estudio se pretendía analizar el efecto de las aplicaciones móviles relacionadas con el control del entrenamiento, sobre las necesidades psicológicas básicas, el nivel de autodeterminación hacia la práctica deportiva y la diversión. Para ello, se desarrolló un estudio cuasiexperimental en el que participaron 54 alumnos (M = 16.4; DT = 1.51), de género masculino (n = 32) y de género femenino (n = 22) de cinco centros de enseñanza secundaria de la comunidad autónoma de Extremadura. Los sujetos del grupo experimental (n = 27) desarrollaron un programa de intervención de entrenamiento autónomo de tipo aeróbico registrado y controlado en la aplicación móvil "Endomondo Sport Tracker" de ocho semanas de duración. Los componentes del grupo de control experimental (n = 27) registraron el mismo programa de entrenamiento autónomo en una ficha de registro facilitada por el grupo investigador. Los resultados demostraron que la satisfacción de la necesidad de competencia, la autodeterminación hacia la realización de la actividad y la diversión al realizarla fueron mayores en aquellos participantes que utilizaron la aplicación respecto a aquellos que no la utilizaron. A pesar de ello, no se registraron diferencias significativas en la mayoría de las variables analizadas en el estudio, por lo que se considera necesario seguir indagando en esta línea de trabajo.

La visión computacional desempeña un papel fundamental en el campo de la robótica móvil, dada la gran cantidad de información sobre el entorno que puede ser extraída de una imagen. El objetivo del trabajo desarrollado es conseguir un comportamiento autónomo de un robot comercial de bajo coste denominado Rovio, en la tarea de seguir un objeto móvil de forma autónoma. Para lograrlo, ha sido necesario desarrollar un conjunto de funciones, unas de manejo del robot y otras para llevar a cabo la comunicación y transferencia de datos con él.

The computer vision plays a key role in the field of mobile robotics, given the large amount of information about the environment that can be extracted from an image. The aim of the work developed is to get a robot autonomous behavior of a low cost commercial called Rovio on the task of following a moving object independently. To achieve this, it has been necessary to develop a set of functions, ones for robot management and others to carry out communication and data transfer with it. Tests are performed to determine the stability of the proposed and implemented to measure the precision obtained.

Basic information about watershed relief, drawn from analytical-descriptive methodologies, allows for the physical parameters necessary to the study of natural resources, such as watershed integrated management, environmental impact, soil degradation, deforestation, water resource conservation, among others. All these processes linked to a strong spatial component allow the use of geographic information systems. Digital elevation models (DEMs) and their derivatives are an important component of these data sources. In this work we evaluated DEMs generated from indirect source data (digitized points from existing contour maps) to determine whether elevation accuracy varies with DEM spatial resolution (grid size). We also assessed the possible existence of some interaction between grid size and the software used that could influence the altimetric quality of the DEM. It was concluded that spatial resolution affects DEM quality. We also found that it is possible to find an ideal grid size in terms of the altimetric accuracy and computer weight size of the generated DEM. Regarding the existence of an interaction between grid size and the software used, which could affect the quality of models obtained based on the methodology of source data acquisition, we found that this possibility does exist when the database is generated from digitized points.

La información básica sobre el relieve de cuencas hidrográficas, mediante metodologías analítico-descriptivas permite contar con los parámetros físicos necesarios para el estudio de los recursos naturales tales como manejo integrado de cuencas, impacto ambiental, degradación de suelos, deforestación, conservación de los recursos hídricos, entre otros. Todos estos procesos ligados a una fuerte componente espacial permiten el uso de sistemas de información geográfica. Los Modelos Digitales de Elevación (DEM) y sus derivados son un componente relevante de estas fuentes de datos. En este trabajo se planteó evaluar los DEMs, generados por captura indirecta de datos fuente, (puntos digitalizados sobre un plano, en formato papel, con curvas de nivel) para determinar si su calidad altimétrica varía con la resolución espacial del mismo (tamaño de grilla). Asimismo se evaluó la posible existencia de alguna interacción entre el software utilizado y los tamaños de grilla, que podría influir sobre la calidad altimétrica del DEM. Se concluyó que la resolución espacial afecta la calidad altimétrica del DEM. Se constató, asimismo, que es posible encontrar un tamaño de grilla ideal en cuanto a calidad altimétrica y peso informático del modelo digital de elevaciones generado. Respecto de la existencia de una interacción entre el tamaño de grilla y el software, que pudieran afectar la calidad de los modelos obtenidos en función de la metodología de adquisición de datos fuente, se demostró que existe esta posibilidad cuando la base de datos se genera a partir de puntos digitalizados.

Most of the hemoglobin variants are the result of single amino acid replacement in one of the globin chains. In many cases, these hemoglobinopathies are harmless, while in others they determine alterations in the physical and chemical properties, raising clínical manifestations of variable severity. In the unstable hemoglobinopathies, the changes reduce solubility, inducing the formation of precipítales of denaturated hemoglobin (Heinz bodies), which damage the membrane and finally destroy the red blood cells prematurely. Up to now, more than 150 different unstable hemoglobins have been described; most of them cause chronic hemolysis, increa-sed by infections or drugs. We report the clinical presentation of an unstable hemoglobin (hemoglobin Hammersmith) in a girl with severe hemolytic anemia, splenomegaly and red blood cell requirement.

Las variantes estructurales de la hemoglobina resultan, en su mayoría, de sustituciones concretas de aminoácidos en una de las cadenas de globina. En muchos casos, estas hemoglobinopatías son inocuas, pero en otros determinan alteraciones de las propiedades físicas y químicas, cuyas manifestaciones clínicas son de gravedad variable. En el caso de las hemoglobinas inestables, las alteraciones disminuyen la solubilidad y facilitan la formación de complejos de hemoglobina precipitada y desnaturalizada (cuerpos de Heinz), que ocasionan el daño de la membrana y, finalmente, la destrucción prematura de los eritrocitos. Hasta la actualidad se han descrito más de 150 hemoglobinas inestables diferentes, la mayoría ocasionan hemolisis crónica, exacerbada por infecciones o la ingesta de medicamentos. Presentamos un caso clínico de hemoglobina inestable (hemoglobina Hammersmith) en una niña con anemia hemolítica grave, esplenomegalia y requerimiento transfusional.

Background: The outcome oí' mechanically ventilated patients can be inñuenced byfactors such as the indication of mechanical ventilation (MV) and ventilator parameters. Aim: To describe the characterístics of patients receiving MV in Chilean critical care uníts. Material and methods: Prospective cohort of consecutive adult patients admitted to 19 intensive care uníts ([CU) from 9 Chilean cities who received MV for more than 12 hours between September lst, 2003, and September 28th, 2003. Demographic data, severity of illness, reason for the initiation of MV, ventilation modes and settings as well as weaning strategies were registered at the initiation and then, daily throughout the course of MV for up to 28 days. ¡CU and hospital mortality were recorded. Resulte: Of 588 patients admitted, 156 (26.5%) received MV (57% males). Mean age and Simplified Acute Physiology Score-II (SAPSII) were 54.6±18years and 40.6±16.4 points respectively The most common indications for MV were acute respiratory failure (71.1%) and coma (22.4%). Assist-control mode (71.6%) and synchronized intermittent mandatory ventilation (SIMV) (14,2%) were the most frequently used. T-tube was the main weaning strategy. Mean duration of MV and length of stay in ICU were 7.8±8.7 and 11.1± 14 days respectively. OverallICUmortality was 33.9% (53patients). The main factors independently associated with increased mortality were (1) SAPS II ≥ 60 points (Odds Patio (OR), 10.5; 95% CI, 1.04-106.85) and (2) plateaupressure ≥ 30 cm Hfi atsecond day (OR, 3.9; 95% CI, 1.17-12.97). Conclusions: Conditionspresent at the onsetofMVand ventilator management were similar to those reported in the literature. Magnitude ofmultiorgan dysfunction and high plateau pressures are the most important factors associated with mortality).

Objectives: To describe the clinical findings and prognostic factors of SLE in the medical ICU in Hospital Nacional Cayetano Heredia. Materials and methods: Retrospective data gathering of clinical and laboratory findings of patients with SLE in our medical ICU during 1999-2004. Statistic descriptive analysis and univariate analysis for discrete and continuous variables were performed. APACHE II score was calculated and its prognostic value was evaluated. Results: There were 26 patients with SLE, recovering 21 complete records of them. SLE prevalence in our hospital ICU was 1.49% and was the most frequent rheumatic disease in this setting. Mortality was 57.69%. The most frequent cause of ICU admission was respiratory failure, mostly due to infectious etiologies. Data significantly associated to mortality were high ESR, severe anemia, severe hypoalbuminemia, PaFi02 less than 200 on admission. APACHE II score was significantly higher in the deceased group. Acute renal failure required dialysis and mechanical ventilation were significantly associated with mortality. Conclusions: SLE patients in Hospital Nacional Cayetano Heredia medical ICU have a high mortality, even higher than previous studies. Poor prognostic factors were: high ESR, severe anemia, severe hypoalbuminemia, PaFi02 less than 200, high APACHE II score, necesity of hemodialysis and mechanical ventilation. (Rev Med Hered 2007;18: 192-199).

Objetivos: Describir las características clínicas y factores pronósticos del Lupus Eritematoso Sistémico (LES) en la Unidad de Cuidados Intensivos (UCI) de Medicina del Hospital Nacional Cayetano Heredia (HNCH). Material y métodos: Colección retrospectiva de hallazgos clínicos y de laboratorio de historias clínicas de pacientes con LES en la UCI del HNCH en el periodo 1999-2004. Se hizo estudio estadístico descriptivo y análisis univariado para variables continuas y discretas. Se calculó el score APACHE II y se evaluó su significado pronóstico. Resultados: Hubo 26 pacientes con LES de los cuales se encontraron historias clínicas de 21 de ellos. La frecuencia de LES en la UCI del HNCH es de 1,49%, es la patología reumática más frecuente en UCI. La mortalidad fue de 57,69%. El motivo de admisión más frecuente fue insuficiencia respiratoria (52,4%), mayormente debido a causa infecciosa.Las variables que se asociaron significativamente a mortalidad fueron: velocidad de sedimentación globular (VSG) alta, anemia severa, hipoalbuminemia severa, la relación presión arterial de oxígeno entre la fracción inspirada de oxígeno (PaFi) < 200 al ingreso. El score APACHE II en el grupo de fallecidos fue significativamente más alto (19,9) (p < 0,01). La insuficiencia renal aguda que requirió hemodiálisis y la necesidad de ventilación mecánica se asociaron significativamente a mayor mortalidad. Conclusiones: El LES en la UCI del HNCH tiene una alta mortalidad, mayor que la reportada en estudios previos. Los factores de mal pronóstico fueron VSG alta, anemia severa, hipoalbuminemia severa, PaFi<200, score APACHE II alto, necesidad de hemodiálisis y de ventilación mecánica. (Rev Med Hered 2007;18: 192-199).