Valoración ecográfica de la dinámica diafragmática en pacientes con enfermedad pulmonar obstructiva crónica tras tratamiento con indacaterol/glicopirronio / Ultrasound assessment of diaphragmatic dynamics in patients with chronic obstructive pulmonary disease after treatment with indacaterol/glycopyrronium

Introduction Air trapping is one of the main determinants of dyspnea in patients with chronic obstructive pulmonary disease (COPD). An increase in air trapping leads to a change in the normal diaphragmatic configuration with associated functional impairment. Said deterioration improves with bronchodilator therapy. Chest ultrasound (CU) has been used to assess changes in diaphragmatic motility after short-acting bronchodilator therapy, but there are no previous studies on these changes after long-acting bronchodilator treatment. Material and methods Interventional prospective study. Patients with COPD and moderate to very severe ventilatory obstruction were included in the study. Diaphragm motion and thickness were assessed by CU before and after 3 months of treatment with indacaterol/glycopirronium 85/43 mcg. Results Thirty patients were included (56.6% men, mean age: 69.4 ± 6.2 years). Pre- and post-treatment diaphragmatic mobility measured during resting breathing, deep breathing, and nasal sniffing were 19.9 ± 7.1 mm and 26.4 ± 8.7 mm (p < 0.0001); 42.5 ± 14.1 mm and 64.5 ± 25.9 mm (p < 0.0001); and 36.5 ± 17.4 mm and 46.7 ± 18.5 mm (p = 0.012), respectively. A significant improvement was also found in the minimum and maximum diaphragm thickness (p < 0.05), but there were no significant changes in the diaphragmatic shortening fraction after treatment (p = 0.341). Conclusions Treatment with indacaterol/glycopyrronium 85/43 mcg every 24 hours for 3 months improved diaphragmatic mobility in patients with COPD with moderate to very severe airway obstruction. CU may be useful for assessing the response to treatment in these patients (AU)

Introducción El atrapamiento aéreo en la enfermedad pulmonar obstructiva crónica (EPOC) es uno de los principales responsables de la disnea en estos enfermos. Su incremento conlleva que el diafragma pierda su configuración habitual y se afecte así su funcionalidad, la cual parece mejorar tras la administración de terapia broncodilatadora. La ecografía torácica (ET) se ha utilizado para evaluar estos cambios tras el uso de broncodilatadores de acción corta, pero no hay estudios que valoren estas variaciones con el empleo de broncodilatadores de acción larga. Material y métodos Estudio prospectivo intervencionista de 3 meses de seguimiento donde se valoró el movimiento/grosor diafragmático con ET antes y después del inicio del tratamiento con indacaterol/glicopirronio 85/43 mcg en pacientes EPOC con obstrucción moderada-muy grave al flujo aéreo. Resultados Treinta pacientes fueron incluidos (56,6% hombres, edad media: 69,4 ± 6,2 años). La movilidad diafragmática pre y postratamiento en respiración a volumen corriente, profunda y sniff nasal fue de 19,9 ± 7,1 mm y 26,4 ± 8,7 mm (p < 0,0001), 42,5 ± 14,1 mm y 64,5 ± 25,9 mm (p < 0,0001) y 36,5 ± 17,4 mm y 46,7 ± 18,5 mm (p = 0,012), respectivamente. También existió una mejora significativa en el grosor diafragmático mínimo y máximo (p < 0,05) pero no en la fracción de engrosamiento diafragmático tras tratamiento (p = 0,341). Conclusione El tratamiento con indacaterol/glicopirronio 85/43 mcg cada 24 horas durante 3 meses mejoró la movilidad diafragmática en paciente con EPOC con obstrucción moderada-muy grave al flujo aéreo. La ET puede ser útil en la valoración de la repuesta al tratamiento de estos pacientes (AU)

Ultrasound assessment of diaphragmatic dynamics in patients with chronic obstructive pulmonary disease after treatment with indacaterol/glycopyrronium.

INTRODUCTION: Air trapping is one of the main determinants of dyspnea in patients with chronic obstructive pulmonary disease (COPD). An increase in air trapping leads to a change in the normal diaphragmatic configuration with associated functional impairment. Said deterioration improves with bronchodilator therapy. Chest ultrasound (CU) has been used to assess changes in diaphragmatic motility after short-acting bronchodilator therapy, but there are no previous studies on these changes after long-acting bronchodilator treatment. MATERIAL AND METHODS: Interventional prospective study. Patients with COPD and moderate to very severe ventilatory obstruction were included in the study. Diaphragm motion and thickness were assessed by CU before and after 3 months of treatment with indacaterol/glycopirronium 85/43 mcg. RESULTS: Thirty patients were included (56.6% men, mean age: 69.4 ± 6.2 years). Pre- and post-treatment diaphragmatic mobility measured during resting breathing, deep breathing, and nasal sniffing were 19.9 ± 7.1 mm and 26.4 ± 8.7 mm (p < 0.0001); 42.5 ± 14.1 mm and 64.5 ± 25.9 mm (p < 0.0001); and 36.5 ± 17.4 mm and 46.7 ± 18.5 mm (p = 0.012), respectively. A significant improvement was also found in the minimum and maximum diaphragm thickness (p < 0.05), but there were no significant changes in the diaphragmatic shortening fraction after treatment (p = 0.341). CONCLUSIONS: Treatment with indacaterol/glycopyrronium 85/43 mcg every 24 hours for 3 months improved diaphragmatic mobility in patients with COPD with moderate to very severe airway obstruction. CU may be useful for assessing the response to treatment in these patients.

Papiledema secundario a meningitis tuberculosa en paciente con diabetes mellitus tipo 1 / Papilledema secondary to tuberculous meningitis in a patient with type 1 diabetes mellitus

Caso clínico: Mujer de 29 años de edad, que refería cefalea de varios días de evolución, con posterior pérdida de visión y dolor en su ojo izquierdo. Como antecedentes: diabetes mellitus tipo 1, de 3 años de evolución y ser inmigrante de Ecuador. El examen fundoscópico reveló un papiledema. La reacción en cadena de la polimerasa (PCR) en líquido cefalorraquídeo fue positiva para Mycobacterium tuberculosis (MTB). Posteriormente al tratamiento con tuberculostáticos presentó una mejoría marcada. Discusión: La tercera parte de la población mundial presenta una infección latente por MTB; existe una comorbilidad entre diabetes mellitus y tuberculosis, principalmente en los países en vías de desarrollo (AU)

Case report: The case is presented of a 29-year-old woman who complained of headache over a period of several days, with loss of visual acuity and pain in her left eye. She had a 3-year history of type 1 diabetes mellitus, and was an immigrant from Ecuador. The funduscopic examination revealed a papilledema. The polymerase chain reaction (PCR) study of the cerebrospinal fluid was positive for Mycobacterium tuberculosis (MTB). She showed a marked improvement after treatment with anti-TB drugs. Discussion: About a third of the world's population has a latent infection of MTB, comorbidity between diabetes mellitus and tuberculosis has been reported, particularly in undeveloped countries (AU)

[Papilledema secondary to tuberculous meningitis in a patient with type 1 diabetes mellitus]. / Papiledema secundario a meningitis tuberculosa en paciente con diabetes mellitus tipo 1.

CASE REPORT: The case is presented of a 29-year-old woman who complained of headache over a period of several days, with loss of visual acuity and pain in her left eye. She had a 3-year history of type 1 diabetes mellitus, and was an immigrant from Ecuador. The funduscopic examination revealed a papilledema. The polymerase chain reaction (PCR) study of the cerebrospinal fluid was positive for Mycobacterium tuberculosis (MTB). She showed a marked improvement after treatment with anti-TB drugs. DISCUSSION: About a third of the world's population has a latent infection of MTB, comorbidity between diabetes mellitus and tuberculosis has been reported, particularly in undeveloped countries.

Cross-cultural adaptation of the Brazilian-Portuguese version of the chronic urticaria quality-of-life questionnaire - CU-Q2oL.

BACKGROUND: Chronic urticaria (CU) is a debilitating skin disorder that affects patients' health related quality of life and the only questionnaire prepared specifically to CU is the Chronic Urticaria Quality of Life Questionnaire (CU-Q(2)oL). OBJECTIVE: The purpose of this study was to cross-culturally adapt and validate the CU-Q(2)oL Brazilian-Portuguese version. METHODS: Forward and back translation by three bilingual translators followed by pre-test was used to adapt the questionnaire. The CU-Q(2)oL was self-administered along with the Dermatology Life Quality Index (DLQI) in 112 patients with CU. Disease activity was assessed using the Urticaria Activity Score. Factor analysis was used to identify scales of the Brazilian portuguese CU-Q(2)oL. Internal consistency, convergent validity and known-group validity was determined. Reproducibility was evaluated by interclass correlation coefficient (ICC). Multiple linear regression was used to determine the predicting factors of CU-Q(2)oL results. RESULTS: Factor analysis revealed a three-dimensional structure: sleep/mental status/eating (I), pruritus/impact on life activities (II) and swelling/limits/look (III), which explained 52.49% of the total variance. All scales showed excellent internal consistency. External construct validity was supported by correlations between the CU-Q(2)oL and DLQI. The tool was found to be able to differentiate between patients with high and low levels of urticaria activity. Test-retest reliability was good to excellent (ICC = 0.69-0.86). Disease severity and urticaria type were the only factors predicting results. CONCLUSIONS: The CU-Q(2)oL Brazilian portuguese version was easily filled out, well accepted by the patients, demonstrated an acceptable validity and reliability and might be used to evaluate treatment outcomes and in clinical research.

Solitary oral ulceration as the first appearance of lymphomatoid papulosis: a diagnostic challenge.

Lymphomatoid papulosis (LyP) may involve any cutaneous site but the oral areas seems to be an unusual location. We report a 72-year-old patient who presented with a 1-week history of a solitary oral ulcer on the lateral tongue, which had raised and indurated borders. Although squamous cell carcinoma was initially diagnosed, the morphological, phenotypical and genotypical studies confirmed diagnosis of LyP. We are not aware of previous reports of definite LyP presenting as oral lesions, which may pose a diagnostic challenge. The differential diagnosis includes several neoplastic, reactive and infectious disorders. LyP should be considered in patients showing solitary, rapidly developing ulcers with raised, indurated borders in the oral cavity.

La opacificación capsular posterior: un factor a tener en cuenta en la valoración del nervio óptico / Posterior capsular opacification: One factor to be considered for the study of the optic nerve

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Effect of posterior capsular opacification removal on macular optical coherence tomography.

PURPOSE: To evaluate the influence of posterior capsular opacification (PCO) on macular optical coherence tomography (OCT) imaging quality and measurements of macular retinal thickness. METHODS: In this prospective interventional case series, 32 eyes of 23 patients with PCO were recruited. Best-corrected visual acuity (BCVA), a complete ophthalmologic assessment, and macular OCT scans (OCT Stratus 3000) before and after Nd:YAG capsulotomy were performed. Two parameters for image quality (signal strength (SS) and number of tomographic messages) and 10 macular retinal thickness measurements were compared. Spearman correlations between BCVA and SS and macular retinal thickness measurements before and after capsulotomy were also performed. RESULTS: PCO removal was associated with an increase of best-corrected visual acuity (p<0.0001). The mean SS (n=32) went from 3.34+/-2.31 to 6.38+/-1.93 (p<0.0001) after Nd:YAG capsulotomy. The SS improved in 26 of 32 eyes. No significant difference between mean preoperative and postoperative macular retinal thickness measurements was observed (p<0.05) in valuable scans. Before capsulotomy, a correlation existed between BCVA and SS. After capsulotomy this correlation was no longer found. CONCLUSIONS: OCT image quality is influenced by PCO. Nd:YAG capsulotomy results in a measurable improvement in SS and improvement in the number of valuable examinations. Valuable OCT scans in patients with PCO seem to yield reliable measurements of macular retinal thickness even in the presence of severe PCO. The correlation between BCVA and SS before capsulotomy suggests that the SS could be considered an objective indicator of the degree of PCO.

Safety of long-term treatment with cyclosporin A in resistant chronic plaque psoriasis: a retrospective case series.

BACKGROUND: An intermittent short course of cyclosporin A (CyA) therapy is a good choice in the treatment of severe psoriasis. Nevertheless, some severe or resistant patients might benefit from long-term treatment. Adverse effects of long-term use of CyA are investigated and the results are compared with the literature. PATIENTS AND METHODS: A retrospective study of adverse effects of CyA treatment in a group of 53 patients suffering from psoriasis. The mean treatment time was 31.4 +/- 23.2 months with a minimum of 4 months to a maximum of 95 months, with very few short interruptions of treatment (from 2 to 5 months in five patients). RESULTS: The group consisted of 29 women and 24 men, ranging in age from 18 to 65 years, with an average age of 44.49 years. Arterial hypertension appeared in 45.3% of patients during treatment. Pharmacological treatment was required in 32% of these patients to control the condition. Serum creatinine levels were transiently elevated in 11.3% of the cases, but withdrawal of treatment was required in none of them. DISCUSSION: Long-term CyA treatment might be necessary in some patients and this study shows that it could be sustained with a close follow-up. This involves regular visits depending on each patient, as well as common test protocol and clinical evaluation. In conclusion, this retrospective study seems to confirm the relative safety of long-term CyA treatment when patients are adequately monitored.

Tratamiento del carcinoma basocelular con radiaciones ionizantes / Ionizing radiation treatment of basal cell carcinoma

El conocimiento y correcto empleo de las diferentes técnicas de radioterapia suponen una gran ayuda en el manejo de los pacientes con carcinomas basocelulares. En nuestro Servicio continuamos empleando la técnica de radioterapia de contacto para estas neoplasias en un número elevado de enfermos. Hemos recogido los datos referentes a los tumores tratados durante los años 1997, 1998 y 1999, un total de 279, y hemos analizado los datos epidemiológicos de la muestra, edad, sexo y fototipo, así como tamaño, tipo clínico, localización, cicatrización y recidivas de los tumores. Empleamos una técnica desarrollada por nuestro equipo, consistente en tres sesiones de 10 Gy, hasta un total de 30 Gy, lo cual supone un buen balance entre la comodidad del enfermo y los resultados médicos en tasas de curación y resultado estético de las cicatrices. Los pacientes tratados fueron en su mayoría de pelo oscuro en la edad adulta y ojos claros. Hemos tratado lesiones de 0,5 a 3,5 cm de diámetro con un 5% de recidivas y un 22,3% de cicatrices imperceptibles (AU)