Efectividad de la terapia de presión negativa en la cura de úlceras de pie diabético: revisión sistemática / Effectiveness of negative pressure therapy in diabetic foot ulcer: systematic review

Introducción: Las úlceras de pie diabético son una de las mayores causas de incapacidad en pacientes con Diabetes Mellitus (DM). La Terapia de Presión Negativa (TPN) se presenta como uno de los mejores procedimientos en su tratamiento, estimulando la granulación, drenando el exudado y reduciendo el edema. Objetivos: Realizar una revisión sistemática acerca de la efectividad y la aplicabilidad clínica real del uso de la TPN en las úlceras de pie diabético. Material y métodos: Búsqueda bibliográfica realizada en noviembre de 2016 en las bases de datos PubMed, CINAHL, SciELO y Web of Science, con las palabras clave («negative pressure wound therapy» OR «vacuum assisted closure» OR «vacuum sealing drainage») AND («diabetic foot» OR «diabetic wound» OR «diabetic ulcer»). Se seleccionaron las publicaciones cuyos diseños fueran ensayos clínicos aleatorizados (ECA), según los criterios de la declaración PRISMA, y analizaran el objetivo planteado. Resultados: Se encontraron 12 ECAs de calidad metodológica suficiente. 7 de los ECAs utilizaron como variable principal la superficie del lecho de la herida y 5 utilizaron el tiempo hasta la granulación. Conclusiones: La TPN consigue una mayor superficie de tejido de granulación, un menor tiempo de cicatrización y una diminución del tiempo hasta que comienza la granulación (AU)

Background: Diabetic foot ulcers are one of the major causes of disability in patients with Diabetes Mellitus (DM). The Negative Pressure Wound Therapy (NPWT) is one of the major procedures in his treatment, estimulating granulation, draining exudate and reducing edema.e Objectives: To realize a systematic review about the effectiveness and the real clinical application of NPWT use in diabetic foot ulcers. Methods: The literature search has been made in November 2016 in PubMed, CINAHL, SciELO and Web of Science databases, with the kew words («negative pressure wound therapy» OR «vacuum assisted closure» OR «vacuum sealing drainage») AND («diabetic foot» OR «diabetic wound» OR «diabetic ulcer»). Were selected publications whose designs were randomized clinical trials (RCTs), according PRISMA declaration criteria, and whose objective was to analyze the study objective. Results: Twelve RCTs were found with sufficient methodological quality. 7 of the RCTs used as the main variable the surface of the wound bed and 5 used the time to granulation. Conclusions: NPWT get a greater granulation area, a smaller wound healing time and a minor time to start the granulation (AU)

Diabetes mellitus y cáncer de páncreas / Pancreatic adenocarcinoma and diabetes mellitus

La asociación existente entre diabetes mellitus (DM) y cáncer de páncreas está ampliamente establecida, ahora bien, si la DM es causa o consecuencia del cáncer de páncreas, es aún discutible. Se estima que, alrededor de un 50% de los pacientes con neoplasia de páncreas desarrolla DM. En contrapartida, alrededor del 1% de los principios diabéticos en mayores de 50 años desarrollará una neoplasia pancreática en un período no superior a 2,5 años. Presentamos el caso de varón de 65 años diagnosticado hace 15 meses de adenocarcinoma de páncreas irresecable que comienza con vómitos posprandiales incoercibles, abdomialgia, estreñimiento y confusión mental transitoria sin patrón circadiano. El estadio final de las neoplasias de páncreas a menudo incluye el síndrome oclusivo como manifestación clínica. Igualmente, no es infrecuente, el inicio de la diabetes en las últimas fases de la enfermedad (AU)

Diabetes mellitus (DM) is widely considered to be associated with pancreatic cancer; however DM as a cause or consequence of pancreatic cancer is controversial. It is estimated that approximately 50% of patients with pancreatic neoplasia develops diabetes mellitus. In contrast, about 1% of diabetic onsets at age fifty developed a pancreatic neoplasia in a period not exceeding 2.5 years. We report the case of a sixty-five year old man diagnosed 15 months ago with unresectable pancreatic adenocarcinoma that began with postprandial vomiting uncontrollably, abdominal pain, constipation and a transient mental disorder with no circadian pattern. The final stage of neoplasia of the pancreas often includes occlusive syndrome as a clinical sign. Similarly, diabetes onset is not uncommon in the final stages of the disease (AU)

[Ophthalmic presentation of two cases of esthesioneuroblastoma]. / Debut oftalmológico de dos casos de estesioneuroblastoma.

PURPOSE/METHOD: To report the ophthalmologic presentation of two cases of esthesioneuroblastoma (ENB). A comprehensive ophthalmic assessment was made, including magnetic resonance imaging. A paranasal sinus mass was biopsied in one case and a nasal mass biopsied in the other. CASES REPORT/DISCUSSION: Two women, aged 85 and 32 years respectively, presented to the emergency room with ophthalmic symptoms and signs. The first reported orbital pain and eyelid edema and the second, who was 22 weeks pregnant, reported a spontaneous lower eyelid haematoma, orbital pain and rhinorrhoea. ENB is a rare malignant tumour and its presentation with ophthalmologic symptoms and signs is very infrequent.

Debut oftalmológico de dos casos de estesioneuroblastoma / Ophthalmic presentation of two cases of esthesionneuroblastoma

Objetivo/Método: Presentar el debut de dos casos de estesioneuroblastoma (ENB) con manifestaciones oftalmológicas. Se realizó una exploración oftalmológica completa y estudios de imagen consistentes de Resonancia Magnética (RM). En un caso se realizó biopsia de una masa sinusal y en el otro de una masa nasal. Caso clínico/Discusión: Dos mujeres de 85 y 32 años, esta última embarazada de 21 semanas, acudieron de urgencia por síntomas y signos oculares. El primer caso refería dolor orbitario y edema de párpado y el segundo hematoma palpebral inferior espontáneo, dolor orbitario y rinorrea. El ENB es un tumor maligno poco frecuente que puede debutar con sintomatología oftalmológica

Purpose/Method: To report the ophthalmologic presentation of two cases of esthesioneuroblastoma (ENB). A comprehensive ophthalmic assessment was made, including magnetic resonance imaging. A paranasal sinus mass was biopsied in one case and a nasal mass biopsied in the other. Cases Report/Discussion: Two women, aged 85 and 32 years respectively, presented to the emergency room with ophthalmic symptoms and signs. The first reported orbital pain and eyelid edema and the second, who was 22 weeks pregnant, reported a spontaneous lower eyelid haematoma, orbital pain and rhinorrhoea. ENB is a rare malignant tumour and its presentation with ophthalmologic symptoms and signs is very infrequent (Arch Soc Esp Oftalmol 2008; 83: 317-320)

[Painful ophthalmoplegia (pseudotumor of the orbit and Tolosa-Hunt syndrome)]. / Oftalmoplejía dolorosa (pseudotumor y síndrome de Tolosa-Hunt).

INTRODUCTION: The Tolosa-Hunt Syndrome (THS) and the Pseudotumor of the Orbit (PTO) each have three common clinical hallmarks: unilateral periorbital pain, cranial nerve palsies and a fast response to corticosteroid therapy. CASE REPORT: 48-year-old female with a right VI nerve paralysis, later develops a right III nerve paralysis. It is important to be able to differentiate between THS and PTO, and this is done on the basis of the complementary tests. DISCUSSION: Apart from neuroradiologic findings, the clinical presentation and histopathology of these two conditions are very similar, making it difficult to distinguish between them. Aspects common to both pathological processes are discussed.

Oftalmoplejía dolorosa (pseudotumor y síndrome de Tolosa-Hunt) / Painful ophthalmoplegia (pseudotumor of the orbit and Tolosa-Hunt syndrome)

Introducción: El Síndrome de Tolosa-Hunt (STH) y el Pseudotumor Inflamatorio Orbitario (PTO) presentan tres características clínicas comunes: dolor periorbitario unilateral, parálisis de pares craneales y rápida respuesta a corticoides. Caso clínico: Mujer de 48 años con paresia del VI par derecho, añadiéndose posteriormente paresia del III par derecho. Se plantea diagnóstico diferencial entre STH y PTO, resolviéndose en base a pruebas complementarias. Discusión: Aparte de las pruebas neuroradiológicas, la presentación clínica e histopatológica similar hace que sean dos enfermedades difíciles de diferenciar, discutiéndose los aspectos comunes de ambas enfermedades

Introduction: The Tolosa-Hunt Syndrome (THS) and the Pseudotumor of the Orbit (PTO) each have three common clinical hallmarks: unilateral periorbital pain, cranial nerve palsies and a fast response to corticosteroid therapy. Case Report: 48-year-old female with a right VI nerve paralysis, later develops a right III nerve paralysis. It is important to be able to differentiate between THS and PTO, and this is done on the basis of the complementary tests. Discussion: Apart from neuroradiologic findings, the clinical presentation and histopathology of these two conditions are very similar, making it difficult to distinguish between them. Aspects common to both pathological processes are discussed

Prognostic factors for pneumococcal bacteremia in a university hospital.

The records of adult patients with pneumococcal bacteremia who were seen over an 8-year-period at an 1,100-bed university teaching hospital were reviewed in order to revise the clinical and laboratory findings and to identify the risk factors associated with mortality. A total of 156 patients were studied, 101 men and 55 women. The mean age of the patients was 65 years. Eighty-seven percent of the patients had community-acquired bacteremia and 13% had nosocomial pneumococcal bacteremia. The overall mortality was 33.9% and the related mortality was 20.5%. The following factors were associated with an increased risk of adverse outcome in the univariate analysis: mechanical ventilation (risk ratio [RR]=3.40; 95% confidence interval [95% CI]=1.44-8.05), administration of parenteral nutrition (RR=3.40; 95% CI =1.44-8.05), and the presence of an intravenous catheter (RR=2.33; 95% CI=1.27-4.24). In the multivariate analysis, the independent prognostic factors for mortality were as follows: development of clinical complications during the episode of bacteremia, rapidly fatal illness, advanced age and administration of parenteral nutrition. The results suggest that the overall mortality due to pneumococcal bacteremia continues to be high. Four independent risk factors associated with increased mortality were identified. Prevention and immunization with polyvalent pneumococcal polysaccharide vaccine should be practiced more widely.

[Safety of meningococcal A and C vaccine. Data from the Spanish drug surveillance system. Meningococcal Vaccine Research Group of the Spanish System of Drug Surveillance]. / Seguridad de la vacuna antimeningocócica A+C. Datos recogidos por el Sistema Español de Farmacovigilancia. Grupo de Investigación sobre la vacuna antimeningocócica del Sistema Español de Farmacogigilancia.

OBJECTIVE: Data on meningococcal vaccines safety are scanty. In 1997 several vaccination campaign took place in Spain. Thus, this situation was used to improve our knowledge about the safety profile of this vaccine. METHODS: An inquiry was carried out to the Regional Centers of the Spanish Pharmacovigilance System to know the number of vaccinated people and the type and number of suspected cases of adverse reactions. RESULTS: There were 133 identified cases of suspected adverse reactions associated with meningococcal A and C vaccine until June 1st, 1998. Most of them affected the skin (25,3%) or nervous system (similar proportion). Those of allergic reactions accounted for 35,2%. Two cases were considered as severe, although they were resolved without secuelae. CONCLUSIONS: Serious risks were not detected. The Spanish Pharmacosurveillance System as an epidemiological surveillance resource has been useful to know the safety problems associated with antimeningococcal vaccine in the community.