Narcolepsia y olor: resultados preliminares / Narcolepsy and odour: preliminary report

Objetivo. El propósito de este estudio es probar la hipótesis de un olor corporal característico en narcolépticos como indicador de diagnóstico. Métodos. Se testan muestras de sudor de 12 narcolépticos y 22 controles sanos de forma independiente por 2 perros entrenados. Su detección, positiva o negativa, se compara con el diagnostico gold standard de narcolepsia. Ni adiestrador ni perros conocían el tipo de muestra seleccionada o su emplazamiento en el dispositivo de búsqueda. Doce pacientes con narcolepsia, de ambos sexos y distintas edades, reclutados entre abril de 2011 y junio de 2012 y diagnosticados según criterios estándar mediante su historia clínica y la polisomnografía nocturna seguida de test de latencia múltiple del sueño, conforman el grupo de pacientes. El grupo control está formado por 22 voluntarios sanos, de ambos sexos y distintas edades, sin trastorno del sueño. Las muestras de sudor, tanto de pacientes como de controles, se recogieron siguiendo el mismo protocolo para evitar contaminación y fueron testadas de forma independiente por 2 perros entrenados. Resultados. Once narcolépticos son detectados positivamente por los perros frente a solo 3 controles sanos. Conclusión. Parece que los pacientes con narcolepsia tienen un olor corporal típico que los perros entrenados pueden detectar. El desarrollo de un test de olfato para el diagnóstico de narcolepsia abre nuevas áreas de investigación (AU)

Objectives: This study has been carried out to test the clinical hypothesis of personal smell as a hint to the diagnosis of narcoleptic patients. Methods: Sweat samples from narcoleptic and healthy controls were tested independently by two trained dogs and their positive or negative detection compared to the gold standard diagnosis for narcolepsy. Neither trainer nor dog knew the source of the sample selected or its placement in the search device. Twelve narcoleptic patient, both sexes and various ages, recruited from April 2011 to June 2012 and diagnosed according to standard criteria, through their clinical records and nocturnal polysomnography plus multiple sleep latency test, made up the patient group. The control group was made up of 22 healthy volunteer without sleep disorders, both sexes and various ages. Sweat samples from both patients and controls were collected following the same protocol to avoid contamination, and tested independently for two trained dogs. Results: Eleven narcoleptic were detected positive by the dogs while only three controls. Conclusion: It seems that narcoleptic patients have a distinct typical odour that trained dogs can detect. The development of olfactory test could be a useful method in the screening of narcolepsy while opens a new research area (AU)

Narcolepsy and odor: preliminary report / Narcolepsia y olor: resultados preliminares

Objetivo: El propósito de este estudio es probar la hipótesis de un olor corporal característico en narcolepticos como indicador de diagnóstico. Métodos: Se testan muestras de sudor de 12 narcolepticos y 22 controles sanos de forma independiente por dos perros entrenados y su detección, positiva o negativa, se compara con el diagnostico ‘‘gold standard’’ de narcolepsia. Ni adiestrador ni perros conocían el tipo de muestra seleccionada o su emplazamiento en el dispositivo de búsqueda. 12 pacientes con narcolepsia, de ambos sexos y distintas edades, reclutados entre abril de 2011 y junio de 2012, y diagnosticados de acuerdo a criterios estándar, a través de su historia clínica y polisomnografía nocturna seguida de test de latencia múltiple del sue˜no, conforman el grupo de pacientes. El grupo control está formado por 22 voluntarios sanos, de ambos sexos y distintas edades, sin trastorno del sue˜no. Las muestras de sudor, tanto de pacientes como de controles, se recogieron siguiendo el mismo protocolo para evitar contaminación y fueron testadas de forma independiente por dos perros entrenados. Resultados: 11 narcolepticos son detectados positivamente por los perros frente a solo 3 controles sanos. Conclusión: Parece que los pacientes con narcolepsia tienen un olor corporal típico que perros entrenados pueden detector. El desarrollo de un test de olfato para el diagnostico de narcolepsia abre nuevas áreas de investigación (AU)

Objectives. This study has been carried out to test the clinical hypothesis of personal smell as a hint to the diagnosis of narcoleptic patients. Methods. Sweat samples from narcoleptic and healthy controls were tested independently by two trained dogs and their positive or negative detection compared to the gold standard diagnosis for narcolepsy. Neither trainer nor dog knew the source of the sample selected or its placement in the search device. Twelve narcoleptic patients, both sexes and various ages, recruited from April 2011 to June 2012 and diagnosed according to standard criteria, through their clinical records and nocturnal polysomnography plus multiple sleep latency test, made up the patient group. The control group was made up of 22 healthy volunteer without sleep disorders, both sexes and various ages. Sweat samples from both patients and controls were collected following the same protocol to avoid contamination, and tested independently by two trained dogs. Results. Eleven narcoleptic were detected positive by the dogs while only three controls. Conclusion. It seems that narcoleptic patients have a distinct typical odor that trained dogs can detect. The development of olfactory test could be a useful method in the screening of narcolepsy while opens a new research area (AU)

Narcolepsy and odor: preliminary report.

OBJECTIVES: This study has been carried out to test the clinical hypothesis of personal smell as a hint to the diagnosis of narcoleptic patients. METHODS: Sweat samples from narcoleptic and healthy controls were tested independently by two trained dogs and their positive or negative detection compared to the gold standard diagnosis for narcolepsy. Neither trainer nor dog knew the source of the sample selected or its placement in the search device. Twelve narcoleptic patients, both sexes and various ages, recruited from April 2011 to June 2012 and diagnosed according to standard criteria, through their clinical records and nocturnal polysomnography plus multiple sleep latency test, made up the patient group. The control group was made up of 22 healthy volunteer without sleep disorders, both sexes and various ages. Sweat samples from both patients and controls were collected following the same protocol to avoid contamination, and tested independently by two trained dogs. RESULTS: Eleven narcoleptic were detected positive by the dogs while only three controls. CONCLUSION: It seems that narcoleptic patients have a distinct typical odor that trained dogs can detect. The development of olfactory test could be a useful method in the screening of narcolepsy while opens a new research area.

Apnea obstructiva del sueño. Hipoxia / Obstructive sleep apnea. Hypoxemia

Presentamos el caso de un niño de 17 meses, cuyos padres consultan por un trastorno del crecimiento grave y un déficit del desarrollo psicomotor, ambos sin un claro origen, habiéndose descartado causas genéticas o intrauterinas. Se realiza un primer estudio polisomnográfico, en el que se diagnostica el caso como un síndrome de apnea-hipopnea durante el sueño grave, secundario a una hipertrofia amigdalar. Se realizaron una amigdalectomía y una adenoidectomía que permitieron corregir el cuadro. La hipoxemia sostenida desde los primeros meses de vida provoca consecuencias que interfiere en el desarrollo físico, neurocognitivo y conductual de los niños, el aprendizaje, etc. En todo retraso grave del crecimiento y del desarrollo psicomotor de un niño hay que valorar en el examen físico la hipertrofia amigdaloadenoidea. Si existe hipertrofia, hay que realizar un estudio polisomnográfico, ya que es la causa más frecuente de trastorno del sueño en los niños (AU)

We present the case of a 17-months-old boy presented with severe alteration in growth and a deficit in psychomotor development, both without any clear etiology, or showing genetic nor intrauterus causes. The first polysomnography study reported a severe obstructive sleep apnea due to hypertrophic tonsil. A tonsillectomy and an adenoidectomy were performed correct the illness. The hypoxemia beginning in the first months of life, results in many negative consequences in physical development, neurocognitive development, behavior, learning capacity, etc., affecting the general development of the child. In severe alterations in growth and psychomotor development in a child, we have to consider hypertrophic adenoid and lingual tonsil. For patients with hypertrophic adenoid and lingual tonsil the physician should order a polysomnography study because it is the main cause of sleep disorders in children (AU)

[Lithium intoxication]. / Intoxicación con litio.

Lithium intoxication has a low prevalence, the 75% of patients with treatment with lithium could have toxic levels of lithium during the treatment. Asymptomatic patients have been observed with doses under 2.5 mmol/L. Systems with high prevalence of symptoms are the nervous system, gastrointestinal tube and cardiovascular. Symptoms could appear from two hours to four hours after ingestion. Early hours after lithium ingestion, levels of lithium are not related with severity. However, monitoring seric levels is necessary to lead therapeutic approach and to give a prognosis. Induce urine with isotonic solution, is used during therapeutic approach. Other therapeutic option is dialysis. In summary, intoxication with lithium could be a severe situation. It is necessary to describe therapeutic protocols in this entity.

Intoxicación con litio / Litium intoxication

La intoxicación aguda por litio no es frecuente, entre el 75% al 90% de los pacientes con terapia de mantenimiento de litio pueden haber mantenido niveles tóxicos durante su tratamiento. La dosis por debajo de 2,5 mmol/L no suelen asociarse a la aparición de síntomas. Los sistemas más afectados son el neurológico, gastrointestinal y cardiovascular. Los síntomas aparecen desde las dos y las cuatro horas postingesta. En las horas posteriores a la ingestión de litio, los niveles de litio no reflejan la severidad del cuadro clínico, no obstante la monitorización hormonal es importante para dirigir la agresividad terapéutica y marcar el pronóstico del cuadro. La utilización de forzar diuresis con solución salina isotópica, son mencionadas por diversos autores. Entre otras opciones también descritas está la diálisis. En resumen, la intoxicación por litio puede ser un cuadro potencialmente frecuente y grave, por ello es necesario escribir unas normas de manejo terapéutico de esta entidad

Litium intoxication has a low prevalence, the 75% of patients with treatment with litium could have toxic levels of litium during the treatment. Asyntomatic patients have been observed with doses under 2.5 mmol/L. Systems with high prevalence of symptoms are the nervious system, gastrointestinal tube and cardiovascular. Symptoms could appear from two hours to four hours after ingestion. Early hours after Litium ingestion, levels of litium are not related with severity. However, monitoring seric levels is necessary to lead therapeutic approach and to give a prognosis. Induce urine with isotonic solution, is used during therapeutic approach. Other therapeutic option is dialysis. In summary, intoxication with litium could be a severe situation. It is necessary to describe therapeutic protocols in this entity

Sleep protects against chemotherapy induced emesis.

BACKGROUND: We present a clinical trial to assess the hypothesis that chemotherapy related emesis is reduced when drugs delivered while the patient is sleeping. METHODS: Adults without previous sleep disturbances of vomit inducing conditions who were going to receive their first courses of 100 mg/m2 cisplatin were included. We reduced antiemetic prophylaxis consisting of ondansetron and dexamethasone in subsequent groups of patients. RESULTS: Twenty-one individuals were needed to decrease the antiemetic prophylaxis to zero. Significant vomiting was observed only when prophylaxis was abolished but not in previous steps employing negligible doses of prophylaxis. CONCLUSIONS: Our data show that when cisplatin is administered during sleep, the reduction of antiemetic prophylaxis id not followed by the expected increase in emetic toxicity. This antiemetic property of sleep is, as far as we know, unassessed in a controlled way. Further study of the clinical utility of this method in the prevention of chemotherapy related emesis is indicated.

[Narcolepsy and alopecia areata: a new association?]. / Narcolepsia y alopecia areata: una nueva asociación?

We here present three cases with Alopecia Areata and Narcolepsy, an association we believe to be hitherto undescribed. Narcolepsy is a low-frequency (0.5%) disorder. It is now accepted that the majority of patients with narcolepsy are DR2 positive. Alopecia Areata is a disease whose incidence in Caucasian population is between 0.05% and 1%. In both diseases there is a set of common data and the origins of the two diseases have been related to an autoimmunity mechanism. In both, a higher than normal incidence of diabetes has been recorded, together with a predominant HLA type pattern. We believe that this association is not casual although epidemiological studies are needed to test our working hypothesis.