Dormir bien para vivir y trabajar mejor / To sleep well to live and work better

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Un enfoque práctico del manejo terapéutico del paciente con migraña / A practical approach to the therapeutic management of the migraine patient

Existen en la actualidad una serie de agentes terapéuticos eficaces en la migraña, lo que permite plantear un manejo terapéutico individualïzado en función del paciente y de la fase de la enfermedad. Se comentan los diferentes agentes disponibles, sus mecanismos de acción y su lugar en el esquema terapéutico, destacando la necesidad de una información al paciente correcta, completa, desdramatizada y positiva (AU)

[The sudden infant death syndrome. II. Its prevention by home monitoring]. / Síndrome de muerte súbita del lactante. II. Profilaxis mediante monitorización a domicilio.

Sudden infant death syndrome (SIDS) is a very dramatic situation with a very high incidence rate. Children with a high risk of SIDS can be identified by clinical/epidemiological scorings. The preventive usefulness of home monitoring is now a matter of study. Our experience is reported in this article. Thirty-nine infants at high risk were selected, although the monitoring program was finally achieved in only 36 cases. A cardiorespiratory impedance monitor (Centurion, Clinical Data, Boston, USA) was used. The tachycardia alarm was set at 200 b/min, bradycardia at 60 b/min and apnea > 20 seconds. The parents were trained in running the monitor and received technical support by phone during 24 hour per day. They filled out a daily record sheet with the observed anomalies. The mean time of monitoring was 8.2 months. After the withdrawal of the monitor, the parents answered a form with 26 questions. Twenty-four of the children needed, at least at some occasion, a light stimulation and 12 (33.3%) required a strong one. Meanwhile, the other 12 did not need any type of stimulus during monitoring. A simultaneous apnea/bradycardia alarm occurred in 17 cases. The home monitoring program was considered positive by the parents and only 4 families had technical difficulties. After the second week the fear and anxiety disappeared and only 1 family continued to be nervous throughout the monitoring program. The mean number of false alarms was 13.3/child, as opposed to 15.6 alarms due to apnea, 11.6 due to tachycardia and 0.9 due to apnea plus bradycardia. In conclusion, we think that home monitoring is easy, it reassures the families and their acceptance of the program is good.

[Sudden death syndrome in infancy. I. Methods for the identification of high risk infants]. / Síndrome de muerte súbita del lactante. I. Sistemas para identificar niños con alto riesgo.

Sudden infant death syndrome (SIDS) occurs with a high frequency, about 2 in every 1,000 live newborns, and could be prevented by home monitoring. However, identification of infants at high risk must first be made. In this paper, we report the epidemiological factors of 36 selected infants with a well known high risk of SIDS. Two different scorings for the evaluation of high risk SIDS were compared and used in these children. The Sheffield scoring showed high risk in 11 (30.5%) of the cases versus 7 (9.7%) in the normal control group (p = 0.013). By using the multistage scoring method, 27 (75.0%) of the cases had a high risk versus 8 (11.1%) in the controls (p < 0.001). Nevertheless, by the latter method, too many normal infants (41 = 56.9%) were predicted to have a moderate risk of SIDS. The multistage test seems more useful than the Sheffield test, but has the limitation of having to be evaluated at one month of age, whereas results of the Sheffield test are obtained at birth. The epidemiological circumstances could be different in every social level or geographical area, so the usefulness of each scoring procedure must be evaluated in the normal population previous to being used in study groups.

[Sudden infant death syndrome (SIDS): identification of infants at risk and their home monitoring. Apropos of 25 cases]. / El síndrome de la muerte súbita del lactante (SMSL): identificación de lactantes de riesgo y su monitorización domiciliaria. A propósito de 25 casos.

The SIDS problem is an important medicosocial question therefore it is necessary to identify the high risk infants in order to try to avoid it. We discuss our two years experience in a Home Apnea Monitoring Program. This article includes the first 25 children on home monitoring: 13 infants. 4 preterms and 8 SIDS siblings. We explain the apnea presentation form, the differential diagnosis methods and the diagnosis protocol for the different high risk groups. We speak about the different information obtained through the Pneumocardiogram (PNG), pH metric, the polysomnogram (PSG).... and the indications for Home Apnea Monitoring and the family role in this program. At the end we indicate that it is necessary to have more information and investigation about SIDS in our country.