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Bortezomib (Velcade®) is a proteasome pathway inhibitor that has improved multiple myeloma (MM) overall survival. Bortezomib-induced peripheral neuropathy (BIPN) is a frequent adverse event, requiring delay, dose reduction or cessation of therapy. Although most of the symptoms resolve after discontinuation or dose-reduction, almost 25% develop chronic symptoms, affecting quality of life and limiting the therapeutic choices. There is limited evidence regarding the strategies to prevent bortezomib-induced polyneuropathy (BIPN). We conducted a review of the published data to summarize the available information regarding BIPN prevention strategies. Our search included literature published in the Cochrane Library databases, Medline/PubMed, SciELO, Google Scholar, and Trip Database in the last ten years, including observational analytic studies, experimental studies, systematic reviews, and metanalysis, which reported the efficacy of interventions to prevent BIPN. Eight studies have been included. The subcutaneous administration of bortezomib has shown a protective effect of all grades of BIPN (OR=0.40, 95% CI 0.27 to 0.59, p 30 mg/m2 is significantly associated with a higher risk of BIPN. Other therapies as Acetyl-l-carnitine (ALC), dexamethasone in partnered dosing (day of/after bortezomib), high-dose intravenous mecobalamin (HDIME), and the combination of docosahexaenoic acid, α-lipoic acid, vitamin C 60 mg, and vitamin E have been assessed but their efficacy for BIPN prevention has not been confirmed. We conclude that the subcutaneous route of administration of bortezomib effectively prevents BIPN while other strategies lack robust evidence to be recommended.

Dear editor, This letter is in response to Chaudhary, Shrestha, and Pathak, who highlighted various aspects of our previous manuscript "Prevalence of Anaemia in Children Diagnosed with Pneumonia in a Tertiary Hospital in Quito, Ecuador." I want to respond to each point referred to in a similar extension as used by the authors. We agreed on the fact that it is prompt to conclude in nutritional deficiencies as a risk factor to suffer pneumonia in Ecuadorian children that is why we express this conclusion as a possibility. Nevertheless, as evidenced in the meta-analysis presented by Jackson et al., the Odds Ratio (OR) meta-estimate for under nutrition as a risk factor for acute lower respiratory infections was 4.5 (95% CI 2.1-9.5)1. To add, in the same paper, the OR meta-estimate for anaemia, vitamin D deficiency, and zinc supplementation, was 3.9 (95% CI 2.4-6.3), 7.3 (95% CI 2.5 to 21.5), and 0.5 (95% CI 0.3 to 0.9), respectively 1. Moreover, in a study conducted in Malawi including 9 533 children, severe malnutrition and moderate malnutrition were associated not only with a pneumonia risk but with an increased risk of inpatient mortality, with Odds Ratios (OR) of 4.63 (3.08, 6.97) and 1.73 (1.21, 2.48) respectively. Therefore, there is supporting evidence globally of the suggested risk 2. I am glad that the authors in the letter bring to the table a discussion of pneumonia diagnosis. In our study, the evaluation of pneumonia started with the clinical assessment including parameters with an acceptable sensitivity (Sen%) or specificity (Spe%), such as; fever on examination (Sen% 47, Spe% 68), history of fever (Sen% 92, Spe% 21), tachypnoea (Sen% 13, Spe% 95), rhonchi (Sen% 26, Spe% 98), crackles (Sen% 43, Spe% 73), wheezing (Sen% 4, Spe% 98) (3). However, as referred to in the original paper, the evaluation was not limited to these factors "Hypoxemia, defined as a sustained saturation of peripheral oxygen (SpO2)

Resumen Introducción: la anemia y ferropenia son condiciones muy prevalentes en hemodiálisis asociadas al incremento en la morbimortalidad. Objetivo: describir las características de la ferropenia y anemia de pacientes con enfermedad renal terminal en hemodiálisis, y analizar los parámetros del hemograma para predecir la deficiencia de hierro en ellos. Materiales y métodos: estudio descriptivo transversal realizado en la unidad de hemodiálisis del Hospital de Especialidades de las Fuerzas Armadas N°1 y CLINEF Norte, Quito, Ecuador, durante diciembre de 2018 y enero de 2019. El análisis se basó en la comparación de dos grupos, pacientes ferropénicos y no ferropénicos. Resultados: se incluyeron 268 pacientes con edad promedio de 16 y 59 años; 89 pacientes (33,21 %) fueron ferropénicos, sin embargo presentaron parámetros hematimétricos normales en la mayoría de ellos. Encontramos además que el 80,22 % de los pacientes incluidos eran anémicos, con poca frecuencia de microcitosis e hipocromía. Entre ellos, el 33,21 % fueron ferropénicos, siendo la hemoglobina un pobre marcador de ferropenia. Adicionalmente, para predecir ferropenia, y de no contar con ferritina o saturación de transferrina, encontramos útil la hemoglobina corpuscular media, el volumen corpuscular medio, el ancho de distribución eritrocitaria y el índice de Srivastava, sin embargo el valor predictivo se incrementó al incluir la sideremia como en nuestro modelo propuesto. Conclusiones: dada la alta frecuencia de anemia sin hipocromía o microcitosis en los pacientes con enfermedad renal terminal en hemodiálisis, incluso en ferropenia, es fundamental la evaluación regular del metabolismo férrico, así como el análisis del hemograma con enfoque en el paciente dialítico. Abstract Introduction: Anemia and iron deficiency are very prevalent conditions in hemodialysis and have been associated with an increase in morbidity and mortality. Objective: Describe the characteristics of iron deficiency and anemia in patients with end-stage renal disease on hemodialysis, and analyze the parameters of the blood count to predict iron deficiency in them. Materials and methods: A cross-sectional descriptive study carried out in the hemodialysis unit of the Specialties Hospital of the Armed Forces No. 1 and CLINEF Norte, Quito, Ecuador, during December 2018 and January 2019. The analysis was based on the comparison of two groups, ferropenic and non-ferropenic patients. Results: We included 268 patients with an average age of 59.16 years; 89 patients (33.21%) were ferropenic. However, they presented normal hematimetric parameters in most of them. We also found that 80.22% of the patients included were anemic, with little frequency of microcytosis and hypochromia. Among them, 33.21% were ferropenic, being hemoglobin a poor marker of iron deficiency. Additionally, to predict ferropenia, and not to have ferritin or transferrin saturation, we find especially useful the mean corpuscular hemoglobin, mean corpuscular volume, erythrocyte distribution width, and Srivastava index, however the predictive value increases when including the syderemia as in our proposed model. Conclusions: Given the high frequency of anemia without hypochromia or microcytosis in patients with end-stage renal disease on hemodialysis, even in iron deficiency, regular evaluation of ferric metabolism is essential, as well as the analysis of the blood count with a focus on the dialysis patient.

Posterior reversible encephalopathy syndrome (PRES) is a clinical–radiological disorder that may include encephalopathy, seizures, headache, and visual disturbances. It is associated with conditions that induce endothelial damage, causing vasogenic cerebral edema that can be observed in magnetic resonance scans. It occurs in

Resumen El sindrome de encefalopatia posterior reversible (PRES) es un trastorno clinico-radiologico caracterizado por encefalopatia, convulsiones, cefalea y alteraciones visuales. Se asocia a entidades que ocasionan dano endotelial, causando edema cerebral vasogenico evidente en resonancia magnetica. En pacientes con lupus eritematoso sistemico (LES) se presenta en

Background and aims. Multiple myeloma is a frequent hematologic malignancy, in which the International Stratification Score (ISS) is widely used to estimate the overall survival. However, there are no studies in Latin America evaluating its performance. This study aims to describe the ISS performance in the overall survival estimation for newly diagnosed multiple myeloma patients in Uruguay. Methods. This is a retrospective registry‐based survival analysis through the Grupo Uruguayo de Mieloma Múltiple (GUMMA) database, including newly diagnosed multiple myeloma patients from January 2001 until May 2019. Results. 249 patients were included, 51.81% males and an average age of 63.49 years. According to ISS and Durie-Salmon score (DSS), 47.79% and 82.3% were ISS III and DSS III, respectively. Also, 32.3% were DSS B. Auto hematopoietic stem cell transplantation was performed in 31.73% of patients, and bortezomib was used in 44.18% as frontline therapy. The overall survival was 80% for ISS1, 64.9% ISS2, and 48.6% ISS3 (Log-Rank; p

Background Multiple myeloma (MM) is an incurable hematological neoplasm. However, new therapies have improved overall survival (OS). In relapsed/refractory MM (RRMM) and a resource-limited environment, optimizing treatment options is essential. Autologous hematopoietic stem cell transplantation (ASCT) is an available strategy, frontline and at relapse Objective to analyze overall survival (OS2) and progression-free survival (PFS2) in RRMM patients comparing second-line consolidation strategies. Methods This retrospective survival analysis study, based on the Uruguayan Multiple Myeloma Registry, included all RRMM adult patients Results Fifty-nine patients were included, with a median age at diagnosis of 56 years (IQR 12), 49.1% were male, 70.10% IgG, 84.75% were Durie-Salmon stage (DS) III and 37.3% ISS-III, 27.1% ISS-II, and 30.5% ISS-I. Age, ISS, and DS were not statistically different between therapeutic groups. Most (69.5%) patients had received a first ASCT, and 35.6% received maintenance as first-line therapy. Maintenance therapy was lenalidomide in 20.3%, thalidomide in 6.8%, and 8.5% other options. Eleven patients (18.6%) received salvage ASCT and maintenance, 18.6% received only ASCT, 16.9% received only maintenance and 45.8% neither ASCT nor maintenance. The median OS2 was 34 months, and PFS2 was 26 months. The 3-year OS2 and 3-year PFS2 were 47.2% and 32.2% for the entire cohort, respectively. The combination of ASCT and maintenance achieved a 3-year OS2 of 75.0% whereas OS2 in the non-combined therapy (NCT)(ASCT or maintenance) was 50.7% (HR 0.1, CI95% 0.01 to 0.6, p=0.01). ASCT and maintenance achieved a 3-year PFS2 of 43.1% whereas PFS2 was 37.6% for the NCT (HR 0.2, CI95% 0.1 to 0.7, p=0.01). The 3-year OS2 was 50.7% for those who received ASCT or maintenance vs. 28.4% for those without second-line consolidation (HR 0.3, CI95% 0.2 to 0.9, p=0.02). The 3-year PFS2 was 37.6% for patients who received any of the consolidative strategies vs 19.1% (HR 0.4, CI95% 0.2 to 0.9, p=0.02) in those who did not receive salvage ASCT or maintenance Conclusion ASCT has been recommended for patients relapsing after primary therapy, including an ASCT with an initial remission duration of >18 months. The role of salvage ASCT in patients who received lenalidomide maintenance has not been determined. In our analysis, the combination of ASCT and maintenance improved the OS2 and PFS2 compared to those treated with only ASCT or maintenance. Not receiving second-line consolidation was associated with inferior PFS2 and OS2.

Background: Urinary tract infections (UTI) are among the most common infections in pediatric patients. The main etiopathogenic agent is Escherichia coli. The purpose of this study was to determine the antimicrobial resistance pattern of E. coli in pediatric patients and to understand their main clinical and laboratory manifestations. Methods: Fifty-nine patients were included in the study and classified into two groups: hospitalization (H) and external consultation (EC). Every patient presented urine cultures with the isolation of E. coli that included an antibiogram. Clinical signs and symptoms, urinalysis, complete blood count (CBC) and serum inflammatory markers were analyzed. Results: The most common clinical manifestations were fever (H: 76.5%; EC: 88%), vomiting (H: 32.4%; EC: 32%), hyporexia (H: 20.6%; EC: 16%), abdominal pain (H: 20.6%: EC: 28%), and dysuria (H: 14.7%; EC: 32%). Ten patients (16.95%) presented UTI for extended spectrum beta-lactamase (ESBL) E. coli. Ampicillin, nalidixic acid, and trimethoprim-sulfamethoxazole showed a higher resistance rate, being ampicillin the most significant (H: 88.2%; EC: 92%). Leukocyturia, bacteriuria and urine nitrites were frequent alterations in urinalysis (H: 52.9%; EC: 92%). In ESBL E. coli patients, a positive correlation was found between leukocytes in CBC and C-reactive protein (r = 0.9, p < 0.01). Diarrhea and foul-smelling urine were associated with E. coli resistance. Conclusions: The presence of leukocytes, bacteria, nitrites and the Gram stain are the most common indicators. Nitrofurantoin and phosphomycin are good therapeutic options. However, an antibiogram must be conducted to determine the best therapeutic agent.

Background: Multiple myeloma is a disease of the elderly. However, 40% of patients are diagnosed before 65 years old. Outcomes regarding age as a prognostic factor in MM are heterogeneous. Method: We retrospectively analyzed clinical characteristics, response to treatment and survival of 282 patients with active newly-diagnosed multiple myeloma, comparing results between patients younger and older than 65 years. Main results: The frequency of multiple myeloma in those younger than 66 years was 53.2%. Younger patients presented with a more aggressive disease, more advanced Durie-Salmon stage (85.3% vs 73.5%; p = 0.013), extramedullary disease (12.7% vs 0%; p < 0.001), osteolytic lesions (78.7% vs 57.6%; p < 0.001) and bone plasmacytoma (25.3% vs 11.4%; p = 0.003). In spite of this, the overall response rate was similar between groups (80.6% vs 81.4%; p = 0.866). The overall survival was significantly longer in young patients (median, 65 months vs 41 months; p = 0.001) and higher in those who received autologous hematopoietic stem cell transplantation. The main cause of death was disease progression in both groups. Multivariable analysis revealed that creatinine ≥2 mg/dl, extramedullary disease, ≤very good partial remission and non-autologous hematopoietic stem cell transplantation are independent risk factors for shorter survival. Conclusion: Although multiple myeloma patients younger than 66 years of age have an aggressive presentation, this did not translate into an inferior overall survival, particularly in those undergoing autologous hematopoietic stem cell transplantation.

BACKGROUND Pulmonary embolism (PE) is a potentially fatal disease related to venous thromboembolism. Information regarding this pathology in the Ecuadorian population is limited. This study aims to present the PE hospital mortality rates (HMR) in Ecuador, analyze its trend and risk factors. METHODS An epidemiological, descriptive and cross-sectional study based on the reporting and trend analysis of pulmonary embolism HMR in the Ecuadorian population from 2011 to 2018 through the governmental database of the Ecuadorian National Statistics and Census Institute, was conducted. RESULTS In Ecuador, PE hospital discharges (HD) varied from 358 in 2011 to 424 in 2018. More than 60% of patients were older than 60 years. Also, the frequency of PE with acute cor pulmonale increased from 3.07% in 2011 to 16.98% in 2018 (P

Introduction: Pulmonary embolism (PE) is a common cause of cardiovascular death, with hospital mortality rates in South America around 14%. However, there is limited information regarding Ecuador. Objectives: To present a survival analysis of Ecuadorian patients affected by PE. Methods: We performed a survival analysis study based on the retrospective review of the hospital discharges by PE in Ecuador from 2011 to 2018 through the Ecuadorian National Statistics and Census Institute databases. Results: We found 2974 cases of PE. From them, 505 (16.98%) patients deceased, 59.72% were females, 64.79% had an age ≥60 years with an average of 65.04 years, 19.80% were treated outside their canton of residence, and 7.57% were associated to acute cor pulmonale (ACP). Using the Cox regression model, being treated outside the canton of residence (HR 1.40, p

The aim of this paper is to present the first outcomes of an international project titled “Development of innovative Training contents based on the applicability of Virtual Reality in the field of Stroke Rehabilitation”. Particularly two aspects were described: (1) recognition of educational needs of medics who support neurological patients in their rehabilitation process, (2) the concept of structure and contents of an e-learning course about this topic.

The aim of this paper is to present a spectrum of virtual reality and biomechanical technologies that can be potentially used in supporting the rehabilitation of people after stroke, in both clinical and home conditions. The methodology was based on a systematic review of up-to-date, published research works available in Elsevier Science Direct database including peer-reviewed journal articles. As a result, trends, possible promising solutions and gaps in the area of innovative rehabilitation tools for post-stroke patients were recognized and discussed. Particularly, the new knowledge and good practices focused on the applicability of biomechanical systems and Virtual Reality (VR) technologies in stroke treatment were searched, which is the subject of an educational and international Erasmus+ project entitled “Development of innovative training contents based on the applicability of virtual reality in the field of stroke rehabilitation- Brain4Train”. The training content, which is one of the project outcomes, will be provided to all interested professionals engaged in post-stroke patients’ rehabilitation, in order to make them capable to develop customized rehabilitation programs based on techno-innovative rehabilitation models.

Background and aims. Cancer is a leading cause of death in Ecuador with high social and economic impact. This study aims to determinate the influence of living at a high altitude on the risk of developing or dying from cancer among the Ecuadorian population.Methods. This is an ecological and epidemiological analysis of cancer mortality and prevalence rates, based on national data from the Ecuadorian National Statistics and Census Institute, corresponding to the period between 2005 and 2014. This study includes the analysis of various types of cancer: gastric, colorectal, hepatic/bile duct, breast, uterine/cervix, and lymphatic/hematopoietic, using rates of mortality and prevalence. Additionally, the association between the risk of getting or dying from cancer and living at high altitude was investigated. This comparison was made between the population living in Highlands, over 2000 meters above sea level, and low-lying regions.Results. Living at high altitude was associated with a higher prevalence of cancer and also with a high mortality rate due to cancer. Risk of getting cancer was related to living at a higher altitude, as well as an increased risk of death by cancer: gastric (OR:1.204; p

Current methods for the assessment of the outcome after anterior knee pain or lateral patellar instability treatment have several limitations, for example their subjectivity. Therefore, new technologies are needed to objectively evaluate the outcomes of treatments for patellofemoral disorders. Kinematic and kinetic analyses during dynamic activities under realistic loading conditions that trigger or aggravate the symptoms can: (1) evaluate the patellofemoral patient in an objective way before surgery; (2) analyse the defense mechanisms the patient develops in order to reduce pain and/or instability; (3) improve our knowledge of the aetiopathogeny and therefore of a suitable treatment for patellofemoral disorders; and (4) objectively evaluate the result of the treatment. However, the kinetic and kinematic analyses are not diagnostic tools.

Background: Currently, a suitable and reliable noninvasive method to evaluate rotational stability in vivo in anterior cruciate ligament-deficient knees, particularly during sports movements, does not exist. We speculated that if there is a rotational instability, the patient would avoid reaching a high pivoting moment during pivoting activities as a defense mechanism, and that the ground reaction moment, as registered by dynamometric platforms, would be reduced. On the basis of this hypothesis, we developed a study using kinetic analysis to evaluate rotational stability under dynamic loading. Methods: Thirty recreationally active athletes, including fifteen healthy subjects and fifteen with an anterior cruciate ligament-deficient knee, were recruited for this study. Patients performed jumping with pivoting with internal tibial rotation and external tibial rotation on the dynamometric platform with both the healthy and the injured limb. The quantitative results were graphically plotted, and the following parameters were evaluated: loading moment, pivoting moment, torque amplitude, loading slope, pivoting slope, percentage of pivoting with load, loading impulse, pivoting impulse, and maximum body rotation angle. Results: There were no significant differences between the dominant and nondominant knees in the control group during the jumping with pivoting and external tibial rotation test with regard to the pivoting moment (p = 0.805), pivoting slope (p = 0.716), pivoting impulse 2 (p = 0.858), and pivoting impulse 3 (p = 0.873). In patients with a chronic tear of the anterior cruciate ligament, there was a significant decrease of the pivoting moment (p = 0.02), pivoting slope (p = 0.005), pivoting impulse 2 (p = 0.006), and pivoting impulse 3 (p = 0.035) during the jumping with pivoting and external tibial rotation test in the anterior cruciate ligament-deficient knee compared with the healthy, contralateral knee. Conclusion: Kinetic analysis with use of a dynamic platform can objectively detect alterations of rotational stability in anterior cruciate ligament-deficient knees, which may allow this to be a useful research tool for evaluating treatment strategies in patients with anterior cruciate ligament injuries. Level of Evidence: Diagnostic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Study design Classification and functional assessment model for nonspecific low back pain (LBP) patients and controls on the basis of kinematic analysis parameters. Objective Develop a logistic regression model using kinematic analysis variables to (1) discriminate between LBP patients and controls and (2) obtain objective parameters for LBP functional assessment. Summary of background data Functional assessment of spinal disorders has been carried out traditionally by means of subjective scales. Objective functional techniques have been developed, which usually involve the application of external loads or the analysis of highly standardized trunk flexion-extension maneuvers. Few studies have used everyday activities such as sit-to-stand or lifting an object from the ground. They have shown that the motion patterns of LBP patients differ from those of healthy subjects. Nevertheless, very few studies have tried to correlate objective findings to the results of subjective scales, and no previous study has developed a LBP classification and functional assessment model on the basis of kinematic analysis of everyday activities. Methods Sixteen controls and 39 LBP patients performed a sit-to-stand task, and lifted three different weights from a standing position. The vertical forces exerted and the relative positions of the lower limb and the cervical, thoracic, lumbar, and sacroiliac regions were recorded. Reliability was determined from repetitions of the tests performed by the control group. Binary logistic regression analyses were computed. The results of the selected regression equation were correlated to the Oswestry Disability Index scale results, to check the validity of the procedure for the measurement of functional disability. Results Reliability of the parameters was good. The selected regression model used two variables, and correctly classified 97.3% of the patients. High correlations were found between the results of this regression equation and the Oswestry Disability Index scale. Conclusion It is possible to distinguish LBP patients from healthy subjects by means of the biomechanical analysis of everyday tasks. This kind of analysis can produce objective and reliable indexes about the patients' degree of functional impairment.

Objectives: The purpose of this study was to determine the patterns of lumbopelvic motion and erector spinae (ES) activity during trunk flexion-extension movements and to compare these patterns between patients with recurrent low back pain (LBP) in their pain-free periods and matched asymptomatic subjects. Methods: Thirty subjects participated (15 patients with disc herniation and recurrent LBP in their pain-free periods and 15 asymptomatic control subjects). A 3-dimensional videophotogrammetric system and surface electromyography (EMG) were used to record the angular displacements of the lumbar spine and hip in the sagittal plane and the EMG activity of the ES during standardized trunk flexion-extension cycles. Variables were maximum ranges of spine and hip flexion; percentages of maximum lumbar and hip flexion at the start and end of ES relaxation; average percentages of EMG activity during flexion, relaxation, and extension; and flexion-extension ratio of myoelectrical activity. Results: Recurrent LBP patients during their pain-free period showed significantly greater ES activation both in flexion and extension, with a higher flexion-extension ratio than controls. Maximum ranges of lumbar and hip flexion showed no differences between controls and patients, although patients spent less time with their lumbar spine maximally flexed. Conclusions: This study showed that reduced maximum ranges of motion and absence of ES flexion-relaxation phenomenon were not useful to identify LBP patients in the absence of acute pain. However, these patients showed subtle alterations of their lumbopelvic motion and ES activity patterns, which may have important clinical implications.

There are many diagnostic clinical tests (e.g., apprehension patellar test or the moving patellar apprehension test), outcome measures (general health and knee scales [IKDC form, Kujala scale, Fulkerson scale, Lysholm knee scoring scale, Tegner activity level scale, short form-36]), and instrumented measurements of patellar mobility (static stability), to assess lateral patellar instability.7,10,15,16 However, according to Smith and colleagues,15 the sensitivity/specificity – reliability/validity of such tests and outcome tools remain unclear for this patient population. These authors conclude that further work is needed to assess the appropriateness of these tests and outcomes.15Moreover, there are many surgical techniques to treat patients with chronic lateral patellar instability, all of them based on level of evidence IV or V.4 This is due, in part, to the lackof prospective randomized trials, and also to the lack of an objective, suitable, reliable, valid, and reproducible noninvasive in vivo method to evaluatelateral patellar instability in the clinical setting. This makes it difficult to compare different surgical treatments in order to find the best surgical technique to treat patients with chronic lateral patellar instability.

Background: Whiplash-associated disorders have usually been explored by analyzing changes in the cervical motor system function by means of static variables such as the range of motion, whereas other behavioural features such as speed, variability or smoothness of movement have aroused less interest. Methods: Whiplash patients (n=30), control subjects (n=29) and a group of people faking the symptoms of whiplash-associated-disorders (Simulators, n=30) performed a cyclical flexion–extension movement. This movement was recorded by means of video-photogrammetry. The computed variables were: range of motion, maxima angular velocity and acceleration, and two additional variables that quantify the repeatability of a motion and its spontaneity. Two comparisons were made: Control vs. Patients and Patients vs. Simulators. At each comparison we used ANOVA to detect differences between groups and discriminant analysis to evaluate the ability of these variables to classify individuals. Findings: Comparison between Controls and Patients showed significant reductions in the range of motion, and both the maximum of angular velocity and acceleration in the Patients. The most efficient discriminant model only included the range of motion and maximum angular velocity. Comparison between Patients and Simulators showed a significant reduction in all measured variables in the Simulators. The best classification model was obtained with maximum angular velocity, spontaneity and repeatability of motion. Interpretation: Our results suggest that the pathological patterns differ from those of Controls in amplitude and speed of motion, but not in repeatability or spontaneity of movement. These variables are especially useful for detecting abnormal movement patterns., This research has been partially supported by the Spanish Government grant DPI2006-14722-C02-01, cofinanced by EU FEDER funds. We would like to thank Hospital Mutua Asepeyo of Sant Cugat del Valles (Spain) for their collaboration.

Objetivo: medir la asociación entre el nivel de conocimientos sobre la resolución de problemas en la utilización de los métodos anticonceptivos y la presencia de embarazo no planeado en mujeres que usan métodos anticonceptivos de corta acción. Establecer la prevalencia del embarazo no planeado y describir actitudes, percepciones y características de la atención en las actividades de planificación familiar.Materiales y métodos: estudio analítico de corte transversal. Se incluyeron mujeres entre 14 y 49 años de edad, que acudieron a realizarse una prueba de embarazo a una institución de salud del sector público, de bajo nivel de complejidad, que atiende población del régimen de aseguramiento subsidiado por el Estado en la ciudad Medellín (Colombia). Antes de obtener el resultado de la prueba de embarazo se les realizó una encuesta estructurada y un test coacerca de su conocimiento para resolver situaciones que pueden afectar la efectividad de los métodos de anticoncepción dependientes de la mujer.Resultados: se realizaron 471 encuestas, el 75,2 % de las mujeres no planeaban embarazarse y el 57 % tuvieron un embarazo no planeado. La mediana del nivel de conocimientos fue del 50 % (p25: 37,5 %, p75: 62,5 %). La razón de prevalencias de embarazo no planeado con nivel medio y alto de conocimientos fue 0,56 (IC 95 %: 0,34-0,92).Conclusión: el conocimiento sobre la resolución de los problemas que afectan la efectividad de los métodos anticonceptivos que dependen del buen uso de la mujer para garantizar esa efectividad se asocia a menor frecuencia de embarazo no planeado.