Neuralgia de Arnold en paciente en fase de prueba de SCS por síndrome de espalda fallida / Occipital neuralgia during stimulation trial period of SCS in failed back surgery sindrome

El síndrome de espalda fallida es una de las patologías más frecuentes para estimulación de los cordones posteriores. Aunque es una técnica segura, no está exenta de complicaciones. Presentamos un caso poco habitual de migración en SCS

Failed back surgery syndrome is one of the most common indications for spinal cord stimulation. Although is a safe technique, it has some complications such electrode migration. Here is an unusual migration case of a SCS electrode in a FBSS patient

Manejo del reservorio venoso subcutáneo por las enfermeras / Subcutaneous venous reservoir management by nursing staff

Introducción: Los reservorios venosos subcutáneos (RVS) son una alternativa útil durante el tratamiento prolongado o crónico que requiere acceso vascular. Debido a los múltiples movimientos de personal en los hospitales, hemos advertido que las enfermeras de nueva incorporación y sustitutas de verano tienen dificultad en el manejo de los reservorios, ya que muchas no lo han utilizado anteriormente o coexisten diferentes protocolos. Objetivo: Mejorar el conocimiento y difusión de esta vía de abordaje del sistema venoso central para facilitar el manejo del RVS a las enfermeras; unificar los criterios del manejo del RVS; aprender a resolver los problemas que puedan surgir en el manejo del reservorio, así como aprender la colocación y retirada correctas de los bombas de infusión elastomérica (bombas de perfusión continua con quimioterapia). Material: Se creó un grupo de trabajo de enfermeras con experiencia. Se hizo una revisión detallada de la literatura para resumir la evidencia científica relevante. El grupo identificó los aspectos más relevantes del manejo de RVS y se unificaron criterios. Para finalizar, se propuso y elaboró una guía de actuación. Resultados: Realización de una guía del manejo del RVS para unificar criterios y ayudar en su manejo. Conclusiones: Una guía estandarizada sobre el manejo de RVS aumenta los conocimientos suficientes sobre la técnica de punción y sellado del reservorio subcutáneo, aumenta la calidad y la seguridad de los enfermeros a la hora de manejar estos dispositivos y disminuye la variabilidad en la práctica clínica, con el consecuente aumento de seguridad y disminución de la ansiedad por parte del paciente

Introduction: Subcutaneous venous reservoirs (SVR) is a useful alternative to chronic or long-term venous access. It has been observed that newly incorporated nurses and summer-time substitutes confront higher difficulties in SVR management due to: frequent changes in hospital staff, lack of previous knowledge and/or coexistence of different protocols. Developing a common protocol could help to reduce possible complications related to SVR management. Objetives: To improve knowledge and information dissemination on SVR with the aim of easing SVR management for nursing staff; to unify the SVR management criteria providing resources to solve most frequent complications and problems derived from it; and to learn about proper application and removal of elastomeric infusion pumps (continuous perfusion pumps for chemotherapy). Methods: A task force conformed by experienced nurses was established, which conducted a detailed literature review to summarize all available relevant evidence. The most salient aspects on SVR management were identified, unifying criteria through agreement by all task force members. During the last stage of the assessment, a clinical practice guideline was proposed. Results: A guideline based on unified criteria for SVR management was developed. Conclusion: A standardized guideline for SVR management increases knowledge on puncture technique and sealing procedures, improving nursing staff quality and security while handling these devices. A reduction in clinical practice variability improves safety and diminishes patients’ anxiety

Trombocitopenia como factor de riesgo trombótico en pacientes con anticuerpos antifosfolipídicos sin criterios de enfermedad / Thrombocytopenia as a thrombotic risk factor in patients with antiphospholipid antibodies without disease criteria

Introducción: El síndrome antifosfolípido (SAF) es un trastorno inmunitario adquirido, definido por la presencia de trombosis (arterial y/o venosa) y/o morbilidad del embarazo junto con la presencia de anticuerpos antifosfolipídicos (aFL) positivos. Existe una relación clara entre los aFL y algunas manifestaciones no incluidas en los criterios clínicos, entre ellas, las hematológicas. Objetivos: a) estudiar la probabilidad de desarrollar SAF clínico en pacientes con aFL positivos y trombocitopenia; b) identificar posibles factores de riesgo para trombosis, y c) estudiar la asociación entre trombocitopenia y aFL. Métodos: Estudio retrospectivo de 138 pacientes con aFL positivos sin cumplir criterios clínicos de SAF. Se definió trombocitopenia como una cifra de plaquetas≤100.000/μl. Se excluyeron los pacientes con otras causas de trombocitopenia. Resultados: Diecisiete de los 138 (12%) pacientes incluidos en el estudio presentaban trombocitopenia. La cifra media de plaquetas fue de 60.000/μl. El riesgo para desarrollar trombocitopenia fue mayor en los pacientes fumadores (OR 2,8; p=0,044), en aquellos con anticoagulante lúpico (OR 13,5; p<0,001) y en los que tenían una mayor carga de aFL (OR 50,8; p<0,001). Tras un seguimiento medio de 146±60,3 meses, 5 pacientes con trombocitopenia (29,4%) desarrollaron trombosis. Conclusiones: En nuestra serie, la incidencia de trombocitopenia es del 12%. Los pacientes con aFL positivos que desarrollan trombocitopenia tienen un riesgo potencial de desarrollar trombosis. El tabaco podría ser un factor de riesgo para trombocitopenia. La carga de autoanticuerpos es un factor de riesgo para el desarrollo de trombocitopenia (AU)

Introduction: The antiphospholipid syndrome (APS) is an acquired immune disorder defined by the presence of thrombosis (arterial and/or venous) and/or pregnancy morbidity along with the presence of positive antiphospholipid antibodies (aPL). There is a clear relationship between aPL and some events not included in the clinical criteria, including haematologic. Objectives: a) to study the probability of developing clinical APS in patients with positive aPL and thrombopenia; b) to identify potential risk factors for thrombosis, and c) to study the association between thrombocytopenia and aPL. Methods: A retrospective study of 138 patients with positive aPL without fulfilling clinical criteria for APS. Thrombocytopenia was defined as a platelet count≤100,000/μl. Patients with other causes of thrombocytopenia were excluded. Results: Seventeen of the 138 (12%) patients in the study had thrombocytopenia. The mean platelet count was 60,000/μl. The risk of developing thrombocytopenia was higher in smokers (OR 2.8; P=.044), in those with lupus anticoagulant (OR 13.5; P<.001) and those with higher burden of aPL (OR 50.8; P<.001). After a mean follow-up of 146±60.3 months, 5 patients with thrombocytopenia (29.4%) developed thrombosis. Conclusions: In our series, the incidence of thrombocytopenia is 12%. aPL-positive patients who develop thrombocytopenia have a potential risk of developing thrombosis. Tobacco could be a risk factor for thrombocytopenia. Autoantibodies load is a risk factor for the development of thrombocytopenia (AU)

Thrombocytopenia as a thrombotic risk factor in patients with antiphospholipid antibodies without disease criteria. / Trombocitopenia como factor de riesgo trombótico en pacientes con anticuerpos antifosfolipídicos sin criterios de enfermedad.

INTRODUCTION: The antiphospholipid syndrome (APS) is an acquired immune disorder defined by the presence of thrombosis (arterial and/or venous) and/or pregnancy morbidity along with the presence of positive antiphospholipid antibodies (aPL). There is a clear relationship between aPL and some events not included in the clinical criteria, including haematologic. OBJECTIVES: a) to study the probability of developing clinical APS in patients with positive aPL and thrombopenia; b) to identify potential risk factors for thrombosis, and c) to study the association between thrombocytopenia and aPL. METHODS: A retrospective study of 138 patients with positive aPL without fulfilling clinical criteria for APS. Thrombocytopenia was defined as a platelet count≤100,000/µl. Patients with other causes of thrombocytopenia were excluded. RESULTS: Seventeen of the 138 (12%) patients in the study had thrombocytopenia. The mean platelet count was 60,000/µl. The risk of developing thrombocytopenia was higher in smokers (OR 2.8; P=.044), in those with lupus anticoagulant (OR 13.5; P<.001) and those with higher burden of aPL (OR 50.8; P<.001). After a mean follow-up of 146±60.3 months, 5 patients with thrombocytopenia (29.4%) developed thrombosis. CONCLUSIONS: In our series, the incidence of thrombocytopenia is 12%. aPL-positive patients who develop thrombocytopenia have a potential risk of developing thrombosis. Tobacco could be a risk factor for thrombocytopenia. Autoantibodies load is a risk factor for the development of thrombocytopenia.

Certolizumab Pegol, a New Anti-TNF-α in the Armamentarium against Ocular Inflammation.

PURPOSE: To study the efficacy and tolerance of certolizumab pegol (CZP) in active uveitis. METHODS: Retrospective case series at 4 referral centers. Patients treated with CZP for active uveitis during at least 6 months were eligible. Inflammation by SUN scores, visual acuity (VA) (logMAR), and central macular thickness (CMT) were compared from baseline until final follow-up. Quiescence was defined as 0+ to 0.5+ in anterior chamber and vitreous haze scores and no CMT increase. RESULTS: Four males and 3 females (14 eyes) were included, mean age 42.4 ± 8.8 years. All were long-lasting chronic-relapsing uveitis with prior failure to other anti-TNF-α. After a mean follow-up of 10.4 ± 4.8 months, 5/7 patients (71.4%) achieved quiescence with CZP. VA improved significantly from +0.52 ± 0.68 to +0.45 ± 0.68 (p = 0.032) at 1 month and to +0.44 ± 0.64 (p = 0.035) at 6 months. No adverse events were found. CONCLUSION: CZP can be an effective alternative in refractory uveitis.