[Secondary syphilis with pulmonary involvement]. / Sífilis secundaria con compromiso pulmonar.

We present the case of a 62-year-old woman who consulted for fever (38°), stabbing thoracic pain (on one side), and pruritic skin lesions. She underwent peripheral blood tests, chest X-rays and CT. Her symptoms were interpreted as severe communityacquired pneumonia. After a treatment with antibiotics, her skin lesions persisted, and other symptoms were only partially relieved. A skin biopsy was performed, which revealed Treponema pallidum. Such finding was confirmed through positive serum VDRL and FTA-ABS tests. The patient received 4 doses of benzathine penicillin G with favorable evolution of skin lesions and improvement of radiological images.

La sífilis es una enfermedad de transmisión sexual causada por una espiroqueta, Treponema palidum. Presentamos el caso de una mujer de 62 años de edad, que consultó por fiebre de 38°, dolor torácico en puntada de costado y lesiones pruriginosas en piel. Se realizó examen de laboratorio de sangre periférica, radiografía y tomografía de tórax. Recibió tratamiento antibiótico y fue diagnosticada como neumonía aguda de la comunidad. Debido a la respuesta parcial de los síntomas y persistencia de lesiones pruriginosas se realizó biopsia de piel que informó Treponema palidum, el cual fue confirmado con test serológico VDRL y FtA-abs positivo. La paciente recibió 4 dosis de penicilina G benzatínica con favorable evolución de las lesiones en piel y mejoría de las imágenes radiológicas.

Sífilis secundaria con compromiso pulmonar / Secondary syphilis with pulmonary involvement

La sífilis es una enfermedad de transmisión sexual causada por una espiroqueta, Treponema palidum. Presentamos el caso de una mujer de 62 años de edad, que consultó por fiebre de 38°, dolor torácico en puntada de costado y lesiones pruriginosas en piel. Se realizó examen de laboratorio de sangre periférica, radiografía y tomografía de tórax. Recibió tratamiento antibiótico y fue diagnosticada como neumonía aguda de la comunidad. Debido a la respuesta parcial de los síntomas y persistencia de lesiones pruriginosas se realizó biopsia de piel que informó Treponema palidum, el cual fue confirmado con test serológico VDRL y FtA-abs positivo. La paciente recibió 4 dosis de penicilina G benzatínica con favorable evolución de las lesiones en piel y mejoría de las imágenes radiológicas.

We present the case of a 62-year-old woman who consulted for fever (38°), stabbing thoracic pain (on one side), and pruritic skin lesions. She underwent peripheral blood tests, chest X-rays and CT. Her symptoms were interpreted as severe community-acquired pneumonia. After a treatment with antibiotics, her skin lesions persisted, and other symptoms were only partially relieved. A skin biopsy was performed, which revealed Treponema pallidum. Such finding was confirmed through positive serum VDRL and FTA-ABS tests. The patient received 4 doses of benzathine penicillin G with favorable evolution of skin lesions and improvement of radiological images.

Impact of levamisole in co-administration with benznidazole on experimental Chagas disease.

Levamisole (Lms) is an anthelminthic drug with immunomodulatory activity. Chagas disease (CD) is caused by Trypanosoma cruzi and there is very low access to the drugs available, benznidazole (Bz) and nifurtimox, both far from ideal. In a drug-repurposing strategy to test potential activity as antiparasitic and immunomodulatory agent for CD, Lms was assayed on acute T. cruzi murine infection, alone and in co-administration with Bz. During protocol standardization, 100 and 10 mpk of Bz given for five consecutive days resulted in parasitaemia suppression and 100% animal survival only with the highest dose. Flow cytometry showed that both optimal (100 mpk) and suboptimal (10 mpk) doses of Bz equally decreased the plasma levels of cytokines commonly elevated in this acute infection model. Lms alone (10-0.5 mpk) did not decrease parasitaemia nor mortality rates. Co-administration was investigated using the suboptimal dose of Bz and different doses of Lms. While Bz 10 mpk did not alter parasitaemia, the combo partially reduced it but only slightly promoted animal survival. This effect could be related to Th1-response modulation since interleukin-6 and interferon-γ were higher after treatment with the combo.

Monitoreo de la ventilación domiciliaria crónica: Experiencia basada en un modelo de hospital de día / Monitoring of chronic home ventilation. Experience based on a day hospital model

Introducción: La ventilación mecánica domiciliaria representa un estándar de cuidados en la insuficiencia de la bomba ventilatoria. El modelo de atención podría ser determinante de deficiencias en el control de calidad de este tratamiento. Material y métodos: Con la finalidad de monitorear el cumplimiento de la ventilación mecánica domiciliaria y optimizar su eficacia, propusimos un programa mediante hospital de día conducido por médicos neumonólogos y kinesiólogos respiratorios. Se diseñó un estudio descriptivo sobre una base de datos de recolección sistemática. Participaron pacientes consecutivos con ventilación no invasiva o asistencia respiratoria mecánica invasiva asistidos en el Servicio de Neumonología entre julio de 2014 y diciembre de 2016. Resultados: Participaron 94 pacientes; 52 hombres (55%), edad 64.4 ± 15.9 años; el 50% presentaban obesidad o sobrepeso (índice de masa corporal 28.6 ± 8.46 kg/m²). Recibían ventilación mecánica domiciliaria 80 pacientes (84%); no invasiva en 77 casos e invasiva en tres (4%). Se admitieron para evaluar la indicación de ventilación mecánica domiciliaria 14 pacientes (14.8%). Los modos de ventilación no invasiva utilizados fueron; bilevel S/T: 59 (62.7%), presión de soporte con volumen promedio asegurado (AVAPS average volume-assured pressure support ventilation); 4 (4.2%), presión positiva continua en la vía aérea (CPAP (continuous positive airway pressure): 6 (6.4%), servo-ventilación: 1 (1%). Tres pacientes recibían ventilación volumétrica. La media de cumplimiento fue de 8.1 horas. Cuatro pacientes no utilizaban el dispositivo. Permanecieron hipercápnicos el 42.5%. Se cambió la programación en 37 pacientes (46.2%), modo ventilatorio en 2 (2.5%) y se suspendió la ventilación en dos (2.5%). En pacientes individuales los ajustes fueron clínicamente significativos. Conclusión: El programa permitió mejorar el entrenamiento e identificar un alto porcentaje de ventilación mecánica domiciliaria ineficaz, permitiendo ajustes en la modalidad de tratamiento.

Introduction: Home mechanical ventilation (HMV) represents a standard of care for chronic ventilatory pump failure. The care model could be determinant in deficiencies in the control of quality of HMV. Material and methods: In order to monitoring compliance during home mechanical ventilation and optimize its effectiveness, we proposed a program through a day hospital conducted by pulmonology doctors and respiratory physiotherapist. A descriptive study was designed on a systematic collection database. Participants were consecutive patients with NIV or mechanical invasive ventilation (MIV) assisted in the Pulmonology Service between July 2014 and December 2016. Results: During 30 months we included 94 patients; 52 men (55%), age 64.4 ± 15.9 years and BMI of 28.6 ± 8.46 kg / m². Fifty percent were obese or overweight. 80 were found with HMV (84%) noninvasive (NIV) in 77 cases and invasive in three (4%). 15 patients (16%) were admitted to evaluate indication of VMD. The NIV modes used were; Bilevel S / T: 59 (62.7%), AVAPS; 4 (4.2%), CPAP: 6 (6.4%), servo-ventilation: 1 (1%). Three patients received volumetric ventilation. The mean compliance objectively measured was 8.1 hours. Four patients did not use the device. Remained with hypercapnia 42.5%. The setting was changed in 37 patients (46.2%), ventilatory mode in 2 (2.5%) and HMV was suspended in two (2.5%). In individual patients adjustments were clinically significant. Conclusion: This program allowed to improve the training and to identify a high percentage of patients with ineffective HMV, allowing adjustments in the modality of treatment.

Monitoring of Chronic Home Ventilation: Experience based on a Day Hospital Model

Introduction: Home mechanical ventilation (HMV) represents a standard of care for ventilatory pump failure. The standard of care could be a determinant of deficiencies in the quality control of the treatment. Materials and Methods: In order to monitor compliance during home mechanical ventilation and optimize its effectiveness, we proposed a program through a day hospital conducted by pulmonologists and respiratory physiotherapists. A descriptive study was designed basing on a systematic collection database. Participants were consecutive patients with noninvasive ventilation or invasive mechanical respiratory assistance treated in the Pulmonology Service between July 2014 and December 2016. Results: 94 patients were included: 52 men (55%), age 64.4 ± 15.9 years, where 50% were obese or overweight (body mass index of 28.6 ± 8.46 kg / m²). 80 patients (84%) received home mechanical ventilation: noninvasive in 77 cases and invasive in three cases (4%). 14 patients (14.8%) were admitted to evaluate the indication of home mechanical ventilation. The following noninvasive ventilation modes were used: Bilevel S/T, 59 (62.7%); average volume-assured pressure support ventilation (AVAPS), 4 (4.2%); continuous positive airway pressure (CPAP), 6 (6.4%); servo-ventilation, 1 (1%). Three patients received volumetric ventilation. Mean compliance was 8.1 hours. Four patients did not use the device. 42.5% of patients remained hypercapnic. The setting was changed in 37 patients (46.2%), ventilatory mode was set in 2 (2.5%) and ventilation was suspended in two (2.5%). Adjustments in individual patients were clinically significant. Conclusion: This program let us improve training and identify a high percentage of patients with ineffective home mechanical ventilation, allowing for adjustments in the modality of treatment.

Acute response to 7-day therapy with CPAP in patients with moderate to severe obstructive sleep apnea and cardiac arrhytmia.

INTRODUCTION: Obstructive Sleep Apnea (OSA) has been associated with an elevated risk of cardiac arrhythmia. Continuous positive airway pressure (CPAP) is the selected treatment for moderate to severe OSA and could improve arrhythmias in the long term. However, the acute effect of CPAP has not been studied in detail. METHODS: We conducted a prospective study with 25 patients with moderate to severe OSA diagnosed by home respiratory polygraphy (RP) and arrhythmia and/or pauses in 24-hour Holter ECG. We analyzed inflammatory parameters and the rate of arrhythmias/pauses after 7 days of auto-adjusting CPAP. RESULTS: 92.5% of the patients were men with a mean age of 61.7±1.9 years. Body mass index (BMI) was 59.5±2.2 kg/m2, with a mean apnea hypopnea index (AHI) of 37.7±3.8 events/hour (ev/h), and a residual AHI (AHIr) of 5.3±0.53 ev/h. After short treatment with CPAP we observed a tendency to improvement in both the severity and number of ventricular extrasystoles (VE) (1595.0±850.3 vs. 926.4±434.5 respectively), pauses and the inflammatory parameters (CRP 3.9±3.1 vs. 1.7±1.2, glycemia 131.4±11.6 vs. 121.9±9.8, HOMA 24.4±3.1 vs. 21.7±2.8, insulin 7.6±1.4 vs. 7.2±1.2 (p>0.5). CONCLUSION: We didn't find significant changes in pauses, VE and inflammatory parameters with CPAP short therapy in CPAP naive patients recently diagnosed with OSA.

Titulaciones de CPAP autoajustable domiciliarias y correlación entre un algoritmo automático y la fórmula de Hoffstein / Auto-adjusting CPAP Titrations at Home and Correlation between an Automatic Algorithm and the Hoffstein Formula

Introducción: La presión positiva en la vía aérea (CPAP) ha demostrado ser eficaz en el síndrome de apneas e hipopneas obstructivas durante el sueño (SAHOS). La presión efectiva se adquiere tradicionalmente con polisomnografía (PSG). El desempeño de estrategias no convencionales, como la CPAP autoajustable (APAP) y fórmulas de titulación (Ft) varía según la población donde se aplican. Objetivo: Describir la titulación con APAP y correlacionar la presión media en la vía aérea (Pmed), la Pef y la presión por Ft de Hoffstein y Mateikas (Fhoff). Resultados: Incluimos 192 pacientes; 52 mujeres (27%) y 140 hombres, edad; 60.2 años ± 11.7 e IMC de 33.8 ± 6.7 kg/m². El índice de apneas e hipopneas (IAH) fue: 33.1 ± 16.6 en mujeres y 36.5 ± 16 en varones (p > 0.24) y 190 casos (98.9%) presentaron IAH > 15 ev/hora. El cumplimiento medio con APAP fue: 380 minutos ± 101 mujeres y 370 ± 91.2 en hombres (p > 0.54). Menos del 10% de la población tuvo criterios de inaceptabilidad del registro. Hallamos correlación entre Pmed y la Pef; rho: 0.73 (IC95% 0.57-0.84) p < 0.001. Sin embargo entre Pef y Fhoff; β: 0.519 y r²: 0.269 (p < 0.001) existió subestimación por Fhoff: - 1.98 cm H2O (IC95% 1.48-2.49) e índice de correlación intraclase: 0.60 (IC95%: 0.47-0.80) p < 0.0001. Conclusiones: Una elevada proporción de pacientes titulan en domicilio con APAP sin vigilancia y con criterios de aceptabilidad. No hallamos adecuada correlación entre Fhoff y Pef en nuestra población.

Introduction: Continuous positive airway pressure (CPAP) has proven to be effective in the treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS). Effective pressure is traditionally acquired with a polysomnography (PSG). The performance of unconventional strategies, such as auto-adjusting positive airway pressure (APAP) and titration formulas (Tf) varies according to the population where they are applied. Objective: To describe the APAP titration and correlate the mean airway pressure (Mean p), the Eff p and the Hoffstein and Mateika Tf pressure (Hoff f). Results: We included 192 patients, 52 female (27%) and 140 male; age, 60.2 years old ± 11.7 and BMI (body mass index) of 33.8 ± 6.7 kg/m². The apnea-hypopnea index (AHI) was: 33.1 ± 16.6 in females and 36.5 ± 16 in males (p > 0.24); and 190 cases (98.9%) had an AHI > 15 ev/hour. Mean compliance with APAP was: 380 minutes ± 101 in females and 370 ± 91.2 in males (p > 0.54). Less than 10% of the population presented unacceptability criteria. We found a correlation between the Mean p and the Eff p; rho: 0.73 (95% CI [confidence interval] 0.57-0.84) p < 0.001. However, between the Eff p and the Hoff f β: 0.519 and r²: 0.269 (p < 0.001) there was an underestimation by Hoff f: - 1.98 cm H2O (95% CI, 1.48-2.49) and intraclass correlation index: 0.60 (95% CI: 0.47-0.80) p < 0.0001. Conclusions: A high proportion of patients titrate at home with APAP without supervision and with acceptability criteria. We did not find a suitable correlation between the Hoff f and the Eff p in our population.

Auto-adjusting CPAP Titrations at Home and Correlation between an Automatic Algorithm and the Hoffstein Formula

Introduction: Continuous positive airway pressure (CPAP) has proven to be effective in the treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS). Effective pressure is traditionally acquired with a polysomnography (PSG). The performance of unconventional strategies, such as auto-adjusting positive airway pressure (APAP) and titration formulas (Tf) varies according to the population where they are applied. Objective: To describe the APAP titration and correlate the mean airway pressure (Meanp), the Effp and the Hoffstein and Mateika Tf pressure (Hofff). Results: We included 192 patients, 52 female (27%) and 140 male; age, 60.2 years old ± 11.7 and BMI (body mass index) of 33.8 ± 6.7 kg/m2. The apnea-hypopnea index (AHI) was: 33.1 ± 16.6 in females and 36.5 ± 16 in males (p > 0.24); and 190 cases (98.9%) had an AHI > 15 ev/hour. Mean compliance with APAP was: 380 minutes ± 101 in females and 370 ± 91.2 in males (p > 0.54). Less than 10% of the population presented unacceptability criteria. We found a correlation between the Meanp and the Effp; rho: 0.73 (95% CI [confidence interval] 0.57-0.84) p < 0.001. However, between the Effp and the Hofff ß: 0.519 and r2: 0.269 (p < 0.001) there was an underestimation by Hofff: - 1.98 cm H2O (95% CI, 1.48-2.49) and intraclass correlation index: 0.60 (95% CI: 0.47-0.80) p < 0.0001. Conclusions: A high proportion of patients titrate at home with APAP without supervision and with acceptability criteria. We did not find a suitable correlation between the Hofff and the Effp in our population

Use of Noninvasive Parameters to Evaluate Swiss Webster Mice During Trypanosoma cruzi Experimental Acute Infection.

Until now, there has been neither an agreed-upon experimental model nor descriptors of the clinical symptoms that occur over the course of acute murine infection. The aim of this work is to use noninvasive methods to evaluate clinical signs in Swiss Webster mice that were experimentally infected with the Y strain of Trypanosoma cruzi during acute phase (Inf group). Infected mice showed evident clinical changes beginning in the second week of infection (wpi) when compared to the noninfected group (NI): (1) animals in hunched postures, closed eyes, lowered ears, peeling skin, increased piloerection, prostration, and social isolation; (2) significant decrease in body weight (Inf: 26.2 ± 2.6 g vs. NI: 34.2 ± 2.5 g) and in chow (1.5 ± 0.3 vs. 6.3 ± 0.5 mg) and water (2.4 ± 0.5 vs. 5.8 ± 0.7 ml) intake; (3) significant decrease of spontaneous activity as locomotor parameters: distance (0.64 ± 0.06 vs. 1.8 ± 0.13 m), velocity (1.9 ± 0.3 vs. 6.7 ± 1.5 cm/sec), and exploratory behavior by frequency (1.0 ± 0.5 vs. 5.7 ± 1.0 events) and duration (1.4 ± 0.3 vs. 5.1 ± 0.5 sec in central arena region); (4) significant increase in the PR (41.7 ± 8.7 vs. 27.6 ± 1.9 msec) and QT intervals (39.7 ± 2.0 vs. 27.5 ± 4.0 msec), and a decreased cardiac frequency (505 ± 52.8 vs. 774 ± 17.8 msec), showing a marked sinus bradycardia and an atrioventricular block. At 3 and 4 wpi, the surviving animals showed a tendency of recovery in body weight, food intake, locomotor activity, and exploratory interest. Through the use of noninvasive parameters, we were able to monitor the severity of the infection in individuals prior to death. Our perspective is the application of noninvasive methods to describe clinical signs over the course of acute infection complementing the preclinical evaluation of new agents, alone or in combination with benznidazole.

Use of haloperidol and risperidone in highly aggressive Swiss Webster mice by applying the model of spontaneous aggression (MSA).

Aggression is defined as the act in which an individual intentionally harms or injures another of their own species. Antipsychotics are a form of treatment used in psychiatric routine. They have been used for decades in treatment of patients with aggressive behavior. Haloperidol and risperidone promote the control of psychiatric symptoms, through their respective mechanisms of action. Experimental models are obtained by behavioral, genetic, and pharmacological manipulations, and use a reduced number of animals. In this context, we applied the model of spontaneous aggression (MSA), originating the presence of highly aggressive mice (AgR) when reassembled in adulthood. We administered haloperidol and risperidone in escalating doses, for ten consecutive days. Using positive and negative control groups, we evaluated the effectiveness of these drugs and the reversal of the aggressive behavior, performing the tail suspension test (TST) and open field test (OFT) on 10th day of treatment and 10 days after its discontinuation. The results showed that both antipsychotic drugs were effective in AgR and reversed the aggressive phenotype, reducing the number of attacks by AgR and the extent of lesions in the subordinate mice (AgD) exposed to the pattern of aggressive behavior (PAB) of the aggressors. This conclusion is based on the reduction in the animals' motor and exploratory activity, and on the reversal of patterns of aggressive behavior. The association between the MSA and experiments with other therapeutic protocols and different antipsychotics can be an important methodology in the study of aggressive behavior in psychiatric patients.

Cardiovascular disease predicts diabetic peripheral polyneuropathy in subjects with type 2 diabetes: A 10-year prospective study.

BACKGROUND: The relationship between cardiovascular disease and diabetic peripheral neuropathy is mainly sustained by data retrieved from cross-sectional studies focused on cardiovascular risk factors. We aimed to assess the presence of cardiovascular disease as a risk factor for developing diabetic peripheral neuropathy in a type 2 diabetes mellitus population. METHOD: A 10-year prospective, primary care, multicentre study in a randomly selected cohort. Cardiovascular disease presence included stroke, coronary artery disease and/or peripheral ischaemia. Diabetic peripheral neuropathy diagnosis was based on clinical neurological examination as well as the neuropathy symptoms score and nerve conduction studies. RESULTS: Three hundred and ten (N=310) patients were initially recruited. Two-hundred and sixty seven (N=267) patients were included in the study. Diabetic peripheral neuropathy cumulative incidence was 18.3% (95% confidence intervals 14.1-23.4; N=49). Diabetic peripheral neuropathy development was significantly more frequent in participants presenting with cardiovascular disease at baseline (P=0.01). In the final logistic regression analysis, the presence of cardiovascular disease remained associated with an increased risk for diabetic peripheral neuropathy (odds ratio 2.32, 95% confidence intervals 1.03-5.22) in addition to diabetes duration and low density lipoprotein-cholesterol levels. CONCLUSIONS: In our series, type 2 diabetes mellitus patients with cardiovascular disease at baseline present with an increased risk of developing diabetic peripheral neuropathy at 10 years of follow-up. Our results suggest that measures aimed at the prevention, control and treatment of cardiovascular disease can also help prevent diabetic peripheral neuropathy development.

Relación entre el índice de masa corporal, sexo, edad y anormalidades respiratorias durante el sueño / Relationship between Body Mass Index, Sex, Age and Respiratory Abnormalities during Sleep

Introducción: Obesidad, sexo y edad constituyen factores que predisponen a padecer SAHOS. Con el objeto de conocer su impacto en los indicadores tradicionales de la poligrafía respiratoria (PR) se evaluaron las relaciones del índice de apneas/hipopneas (IAH), índice de desaturación (IDO) y el tiempo con menos de 90% de satuarción (T = < 90%) en pacientes clasificados según el índice de masa corporal (IMC), sexo y edad. Métodos: Estudio retrospectivo en 635 pacientes con SAHOS. Las variables IAH, IDO y T < 90% y sus relaciones en pacientes obesos y no obesos se analizaron utilizando el test de Kruskal-Wallis y el test de comparaciones múltiples de Dunns. Resultados: Se encontró un incremento en el IAH, relacionado con la edad en las mujeres, mientras que en los hombres fue dependiente del IMC. El tiempo de desaturación menor al 90% (T < 90%) se asoció a la obesidad en ambos sexos. La concordancia entre IAH e IDO fue mayor en aquellos pacientes con IMC < 30 y fue disminuyendo proporcionalmente al incremento del IMC tanto en hombres como en mujeres. La escala de Epworth reveló resultados similares en todos los grupos; sin embargo, el porcentaje de pacientes con alto riesgo en el cuestionario de Berlín resultó mayor en los obesos (p < 0.05). Conclusiones: Este estudio permitió comprender las diferencias del SAHOS entre hombres y mujeres, y reveló hallazgos que sugieren la importancia del rol de la oximetría en obesos. La relación entre los indicadores de la PR podría contribuir con la comprensión de la severidad del SAHOS y la obesidad.

Introduction: Obesity, sex and age are factors that predispose to obstructive sleep apnea (OSA). In order to understand its impact on the indicators of respiratory polygraphy (RP), this study evaluated the relationship of the apnea/hypopnea index (AHI), the desaturation index (ODI) and time of less than 90% saturation (T < 90%) in patients classifed by body mass index (BMI), sex and age. Methods: Retrospective study of 635 patients with OSA. The values of IAH, ODI and T <90% and their relationships in obese and non-obese patients were analysed using Kruskal-Wallis and Dunn's multiple comparisons tests. Results: We found an increase in the AHI, which was related to age in women and related to BMI in men. The T < 90% was associated with obesity in both, females and males. The agreement between IAH and IDO was higher in patients with BMI < 30 and it was decreasing proportionally with the increase of BMI, in both sexes. Epworth scale revealed similar results in all groups; however the percentage of high-risk obese patients in the Berlin questionnaire was higher than in non-obese patients (p < 0.05). Conclusions: This study contributes to understand the OSA differences between men and women, and the findings suggest the important role of oximetry in obese patients. The relationship between the indicators could contribute to better understand OSA severity and obesity.

Tracheobronchial Tuberculosis Without Lung Involvement.

Endotracheal tuberculosis (ETTB) is an infrequent form of tuberculosis whose major feature is the infection of the tracheobronchial tree by Mycobacterium tuberculosis. This case presents a 73-year-old man admitted to our hospital with fatigue, weakness, dry cough and weight loss. His chest X-ray was normal but the high resolution computed tomography (HRCT) showed normal parenchyma images with mediastinal and hilar lymphadenopathy. There was inflammation of the tracheal wall and infiltrates in pavement epithelium; however, the tracheal biopsy for acid-fast bacilli was negative. He was finally diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of the lymph nodes. Four drugs were prescribed and symptoms improved. EBUS-TBNA contributed to prompt diagnosis. The patient was treated and evolved without complications, such as tracheal stenosis.

Red de complejidad creciente en el diagnóstico de SAHOS: estrategia de transmisión de datos con equipos de nivel III / Network for the Diagnosis of SAHOS

Introducción: El diagnóstico del síndrome de apneas del sueño (SAHOS) requiere confirmación por polisomnografía (PSG) o poligrafía respiratoria (PR). La PR en domicilio con técnica de auto-colocación y transmisión de datos podría facilitar el acceso al diagnóstico de poblaciones alejadas. El objetivo fue describir una experiencia piloto de telemedicina con PR auto-administrada con equipos de nivel III en centros de atención ambulatoria (CAA) satélites (Vicente López y Barrio Norte) al Hospital Británico de Buenos Aires. Material y métodos: Técnicos de CAA fueron entrenados en adquisición de cuestionarios Epworth (ESS), STOP-BANG y Berlín, y manejo de PR. Se utilizó software conectado a intranet para enviar señales crudas al HB central donde expertos realizaron la puntuación e informe definitivo. Resultados: Durante un año se realizaron 103 PR en 99 pacientes; 72 hombres (72.7%) con las siguientes características (medias y desvío estándar): edad; 55.77 años ± 14.53, IMC; 30.63 ± 7.3, ESS; 8.39 ± 4.92, ESS > 11 puntos; 26.3%, escolaridad primaria; 10.1% y alto riesgo por Berlín; 93.9%. Los indicadores poligráficos fueron; TTR: 443.6 minutos ± 99.26, tiempo válido para el análisis manual; 368.2 ± 115.7, IAH; 16.98 ± 18.61, IDO (criterio 3%); 17.61 ± 17.49 y tiempo bajo 90% (T < 90); 19% ± 24.3. La distribución por severidad mostró; 29 roncadores (30%), 29 leves (30%), 21 moderados (22.2%) y 20 severos (20.2%). Se indicó CPAP a 32 pacientes (32.3%). Las demoras fueron: adquisición; 5.3 días ± 3.7, transmisión; 1.64 días ± 2.3 e informe; 1.1 día ± 0.9. Conclusiones: La estrategia mostró demoras aceptables que permitieron la indicación de tratamiento a un tercio de la población estudiada.

Introduction: The diagnosis of Sleep Apnea Hypopnea Obstructive Syndrome (SAHOS) requires confirmation by polysomnography (PSG) or respiratory polygraphy (RP). The RP at home using self-administered technique and data transmission could facilitate access to diagnosis in isolated populations. The objective was to describe a telemedicine pilot experience using self-administered home RP with level III devices in satellite outpatient care centers (OCC) (Vicente Lopez and Barrio Norte) to British Hospital of Buenos Aires. Material and Methods: OCC technicians were trained in the managing Epworth (ESS), STOP-BANG and Berlin questionnaires and the handling of RP devices. RP systems were connected to intranet to send respiratory records unprocessed to Central British Hospital, where experts carried out the scoring and final report. Results: During a year, one hundred and three RP records were performed in 99 patients, 72 male (72.7%), with the following characteristics (mean and standard deviation): age 55.77 years ± 14.53, BMI 30.63 ± 7.3, ESS 8.39 ± 4.92, ESS > 11 points 26.3%, no further education beyond primary schooling 10.1% and high risk in Berlin questionnaire 93.9%. Polygraphic indicators show; Recording Total Time (RTT): 443.6 minutes ± 99.26; RTT valid for manual analysis time: 368.2 ± 115.7; AIH: 16.98 ± 18.61; oxygen desaturation index, ODI (criterion 3%): 17.61 ± 17.49 and time under 90% (T < 90): 19% ± 24.3. The distribution by severity was: 29 snorers (30%), 29 mild (30%), 21 moderate (22.2%) and 20 severe (20.2%). Continuous Positive Airway Pressure (CPAP) therapy was prescribed to 32 patients (32.3%). The delays were: acquisition: 5.3 days ± 3.7, transmission: 1.64 days ± 2.3 and reports: 1.1 day ± 0.9. Conclusion: The strategy showed acceptable delays and CPAP treatment was available to a third of the study population.

Estenosis subglótica idiopática, reporte de un caso

La estenosis subglótica es un estrechamiento de la luz laríngea a nivel del cartílago cricoides en la vía aérea superior. Existen múltiples causas, dividiéndose la etiología principalmente en estenosis traumática y no traumática. La estenosis subglótica idiopática (ESI) es una rara entidad de etiología desconocida, cuya incidencia no ha sido establecida hasta el momento. Se ha visto mayor prevalencia en mujeres jóvenes (30 y 40 años). La manifestación clínica más importante es la disnea y el estridor que se correlacionan con el grado de estenosis. Para poder abordar una terapéutica adecuada es necesario descartar el resto de las etiologías mediante examen físico, estudios complementarios y fundamentalmente con la histología para poder abordar una terapéutica adecuada. El tratamiento de la estenosis subglótica en caso de ser idiopática es la dilatación localizada mediante láser, reconstrucción traqueal o dilatación con balón. Presentamos un caso de una mujer joven con estridor como síntoma principal y con diagnóstico final de estenosis subglótica idiopática, así como revisión de literatura.(AU)

Idiopathic subglottic stenosis is a narrowing of the larynx at the cricoid cartilage level with unknown etiology. There are multiple causes, but its etiology can be mainly divided into traumatic and non traumatic stenosis. It is a rare condition for which the real incidence has never been established due to the difficulty of making the diagnosis. There is a preponderance of young females affected between 30-40 years old. Its development in adult patients shows clinical signs such as stridor and progressive dyspnea. The diagnosis is established by the histological study. All the other causes of tracheal stenosis should be excluded before initiating the appropriate treatment. The tracheal stenosis is managed by means of endobronchial laser therapy, laryngotracheal reconstruction or bronchoscopic dilatation. We present a case of a young woman with stridor as the only symptom and a final diagnosis of idiopathic subglottic stenosis. The literature is reviewed.(AU)

Estenosis subglótica idiopática, reporte de un caso / A Case Report of Idiopathic Subglottic Stenosis

La estenosis subglótica es un estrechamiento de la luz laríngea a nivel del cartílago cricoides en la vía aérea superior. Existen múltiples causas, dividiéndose la etiología principalmente en estenosis traumática y no traumática. La estenosis subglótica idiopática (ESI) es una rara entidad de etiología desconocida, cuya incidencia no ha sido establecida hasta el momento. Se ha visto mayor prevalencia en mujeres jóvenes (30 y 40 años). La manifestación clínica más importante es la disnea y el estridor que se correlacionan con el grado de estenosis. Para poder abordar una terapéutica adecuada es necesario descartar el resto de las etiologías mediante examen físico, estudios complementarios y fundamentalmente con la histología para poder abordar una terapéutica adecuada. El tratamiento de la estenosis subglótica en caso de ser idiopática es la dilatación localizada mediante láser, reconstrucción traqueal o dilatación con balón. Presentamos un caso de una mujer joven con estridor como síntoma principal y con diagnóstico final de estenosis subglótica idiopática, así como revisión de literatura.

Idiopathic subglottic stenosis is a narrowing of the larynx at the cricoid cartilage level with unknown etiology. There are multiple causes, but its etiology can be mainly divided into traumatic and non traumatic stenosis. It is a rare condition for which the real incidence has never been established due to the difficulty of making the diagnosis. There is a preponderance of young females affected between 30-40 years old. Its development in adult patients shows clinical signs such as stridor and progressive dyspnea. The diagnosis is established by the histological study. All the other causes of tracheal stenosis should be excluded before initiating the appropriate treatment. The tracheal stenosis is managed by means of endobronchial laser therapy, laryngotracheal reconstruction or bronchoscopic dilatation. We present a case of a young woman with stridor as the only symptom and a final diagnosis of idiopathic subglottic stenosis. The literature is reviewed.

Cumplimiento y abandono de la CPAP en pacientes con síndrome de apneas del sueño: Encuesta luego de un programa de reuniones grupales

Introducción: Uno de los problemas en el tratamiento de los pacientes con síndrome de apneas del sueño (SAHOS) es la escasa adherencia a la CPAP. Estrategias educativas se han comunicado para incrementar el cumplimiento y prevenir el abandono. Objetivo: Describir el cumplimiento de la CPAP y relacionarlo con la participación en el programa educativo: "escuela de CPAP". Material y métodos: Entre mayo del 2010 y mayo del 2012 se realizaron 20 reuniones grupales para pacientes con SAHOS con indicación de utilizar CPAP. Durante las mismas se brindó una exposición educativa sobre el SAHOS y un taller práctico del uso de los equipos. En el mes de junio del 2012 fueron entrevistados mediante una encuesta telefónica estandarizada. Se indagó acerca de accesibilidad a la CPAP, cumplimiento, abandono, concurrencia al programa y opinión sobre su utilidad. Resultados: 184 pacientes con indicación de CPAP fueron invitados a participar del programa. Fue posible analizar los datos obtenidos de 140 pacientes (76% de la muestra). 92 (65.7%) pacientes asistieron al programa (grupo 1) y 48 individuos con invitación de concurrir a la escuela de CPAP no asistieron (grupo 2). La intención de tratamiento, definida por uso inicial de la CPAP, ocurrió en 87 (94.5%) pacientes del grupo 1 y 38 (79.1%) del grupo 2. Las principales causas de abandono fueron: intolerancia a la presión (20.51%), falta de cobertura por el sistema (15.38%) e imposibilidad de costear la terapia (10.25%). 16 pacientes que concurrieron al programa abandonaron la CPAP (69% lo habían usado transitoriamente) vs. 24 del grupo 2 (60% con uso transitorio). El análisis comparativo demostró que 76 (82.6%) del grupo 1 continúan utilizando la CPAP a 8 meses de haber iniciado el tratamiento vs. 24 del grupo 2 (50%). Los pacientes que cumplen tratamiento con CPAP y refieren disminuir de peso fueron 21 (27.6%) del grupo 1 vs. 5 (20.83%) del grupo 2. Del grupo adherente a la CPAP, 92 pacientes (92%) refieren sentirse mejor o mucho mejor y 8 dicen estar igual que antes del tratamiento. Ningún paciente relata sentirse peor. Se indagó somnolencia diurna en los no adherentes, utilizando una escala de 4 opciones. El 41% del grupo abandono describe somnolencia diurna en situaciones pasivas, 7% en situaciones activas y 2% en situaciones de riesgo. Conclusiones: 65.7% de los pacientes con SAHOS e indicación de CPAP concurrieron al programa de educación. El 96% de estos considera que la escuela de CPAP dio aportes al tratamiento. El uso transitorio de la CPAP demuestra una elevada intención de tratamiento de 89.28%. Sin embargo, el cumplimiento actual muestra diferencias entre quienes concurrieron al programa (82.6%) y aquellos que no lo hicieron (50%).(AU)

Introduction: Low adherence to Continuous Positive Airway Pressure (CPAP) treatment is one of the usual problems when treating patients with Obstructive Sleep Apnea (OSA). Educational strategies have been described to increase compliance and prevent patients from abandoning treatment. Objective: To describe compliance to CPAP treatment in patients who participated in an educational program: "School of CPAP". Design: We performed 20 meetings among patients with OSA who were prescribed to initiate CPAP treatment between May 2010 and May 2012. An educational talk and a practical workshop about equipment use were provided to all participants. On June 2012 all the patients were contacted for a telephone standarized survey. We inquired in relation to CPAP availability, adherence, attendance to the program and personal opinion about the CPAP education usefulness. Results: 184 patients were invited to participate. Data from 140 patients were available for analysis (76%). 92 (65.7%) patients were included in the program (group 1) and 48 subjects did not attend the "school CPAP" (group 2). Intention to be treated, defined as initiating CPAP therapy, occurred in 87 (94.5%) patients in group 1 and 38 (79.1%) in group 2. Main causes of non adherence were: intolerance to airway pressure (20.51%); lack of health system coverage (15.38%) and others coverage issues (10.25%). 16 patients who had attended the program abandoned CPAP (69% with transient use) compared to 23 in group 2 (60% with transient use). Comparative analysis showed that 76 patients in group 1 (82.6%) continued using CPAP 8 months after therapy initiation vs. 24 in group 2 (50%). Among patients who adhered to CPAP, loss weight was reported in 21 (27.6%) in group 1 and in 5 (20.83%) in group 2. In the group which adhered to CPAP, 92 patients (92%) reported to feel better or much better and 8 reported to feel the same than at the beginning of treatment. No patient had worsening with CPAP. We asked about day sleepiness in non adherent patients using a 4 level scale. 41% of the group described sleepiness in passive situations, 7% in active situations and 2% in risk situations. Conclusions: 65.7% of patients with Sleep Apnea / Hypopnea Obstructive Syndrome (SAHOS) and CPAP attended the educational program. 96% of them felt that "school of CPAP" was a useful treatment aid. Transient use of CPAP showed a high intention to be treated (89.28%). Nevertheless, actual adherence was different between those who attended the program (82.6%) and those who did not (50%).(AU)

Cumplimiento y abandono de la CPAP en pacientes con síndrome de apneas del sueño: Encuesta luego de un programa de reuniones grupales / t CPAP Compliance and Default among Patients with Sleep Apnea Syndrome. A Survey after a Program of Group Meetings

Introducción: Uno de los problemas en el tratamiento de los pacientes con síndrome de apneas del sueño (SAHOS) es la escasa adherencia a la CPAP. Estrategias educativas se han comunicado para incrementar el cumplimiento y prevenir el abandono. Objetivo: Describir el cumplimiento de la CPAP y relacionarlo con la participación en el programa educativo: "escuela de CPAP". Material y métodos: Entre mayo del 2010 y mayo del 2012 se realizaron 20 reuniones grupales para pacientes con SAHOS con indicación de utilizar CPAP. Durante las mismas se brindó una exposición educativa sobre el SAHOS y un taller práctico del uso de los equipos. En el mes de junio del 2012 fueron entrevistados mediante una encuesta telefónica estandarizada. Se indagó acerca de accesibilidad a la CPAP, cumplimiento, abandono, concurrencia al programa y opinión sobre su utilidad. Resultados: 184 pacientes con indicación de CPAP fueron invitados a participar del programa. Fue posible analizar los datos obtenidos de 140 pacientes (76% de la muestra). 92 (65.7%) pacientes asistieron al programa (grupo 1) y 48 individuos con invitación de concurrir a la escuela de CPAP no asistieron (grupo 2). La intención de tratamiento, definida por uso inicial de la CPAP, ocurrió en 87 (94.5%) pacientes del grupo 1 y 38 (79.1%) del grupo 2. Las principales causas de abandono fueron: intolerancia a la presión (20.51%), falta de cobertura por el sistema (15.38%) e imposibilidad de costear la terapia (10.25%). 16 pacientes que concurrieron al programa abandonaron la CPAP (69% lo habían usado transitoriamente) vs. 24 del grupo 2 (60% con uso transitorio). El análisis comparativo demostró que 76 (82.6%) del grupo 1 continúan utilizando la CPAP a 8 meses de haber iniciado el tratamiento vs. 24 del grupo 2 (50%). Los pacientes que cumplen tratamiento con CPAP y refieren disminuir de peso fueron 21 (27.6%) del grupo 1 vs. 5 (20.83%) del grupo 2. Del grupo adherente a la CPAP, 92 pacientes (92%) refieren sentirse mejor o mucho mejor y 8 dicen estar igual que antes del tratamiento. Ningún paciente relata sentirse peor. Se indagó somnolencia diurna en los no adherentes, utilizando una escala de 4 opciones. El 41% del grupo abandono describe somnolencia diurna en situaciones pasivas, 7% en situaciones activas y 2% en situaciones de riesgo. Conclusiones: 65.7% de los pacientes con SAHOS e indicación de CPAP concurrieron al programa de educación. El 96% de estos considera que la escuela de CPAP dio aportes al tratamiento. El uso transitorio de la CPAP demuestra una elevada intención de tratamiento de 89.28%. Sin embargo, el cumplimiento actual muestra diferencias entre quienes concurrieron al programa (82.6%) y aquellos que no lo hicieron (50%).

Introduction: Low adherence to Continuous Positive Airway Pressure (CPAP) treatment is one of the usual problems when treating patients with Obstructive Sleep Apnea (OSA). Educational strategies have been described to increase compliance and prevent patients from abandoning treatment. Objective: To describe compliance to CPAP treatment in patients who participated in an educational program: "School of CPAP". Design: We performed 20 meetings among patients with OSA who were prescribed to initiate CPAP treatment between May 2010 and May 2012. An educational talk and a practical workshop about equipment use were provided to all participants. On June 2012 all the patients were contacted for a telephone standarized survey. We inquired in relation to CPAP availability, adherence, attendance to the program and personal opinion about the CPAP education usefulness. Results: 184 patients were invited to participate. Data from 140 patients were available for analysis (76%). 92 (65.7%) patients were included in the program (group 1) and 48 subjects did not attend the "school CPAP" (group 2). Intention to be treated, defined as initiating CPAP therapy, occurred in 87 (94.5%) patients in group 1 and 38 (79.1%) in group 2. Main causes of non adherence were: intolerance to airway pressure (20.51%); lack of health system coverage (15.38%) and others coverage issues (10.25%). 16 patients who had attended the program abandoned CPAP (69% with transient use) compared to 23 in group 2 (60% with transient use). Comparative analysis showed that 76 patients in group 1 (82.6%) continued using CPAP 8 months after therapy initiation vs. 24 in group 2 (50%). Among patients who adhered to CPAP, loss weight was reported in 21 (27.6%) in group 1 and in 5 (20.83%) in group 2. In the group which adhered to CPAP, 92 patients (92%) reported to feel better or much better and 8 reported to feel the same than at the beginning of treatment. No patient had worsening with CPAP. We asked about day sleepiness in non adherent patients using a 4 level scale. 41% of the group described sleepiness in passive situations, 7% in active situations and 2% in risk situations. Conclusions: 65.7% of patients with Sleep Apnea / Hypopnea Obstructive Syndrome (SAHOS) and CPAP attended the educational program. 96% of them felt that "school of CPAP" was a useful treatment aid. Transient use of CPAP showed a high intention to be treated (89.28%). Nevertheless, actual adherence was different between those who attended the program (82.6%) and those who did not (50%).