Multiple sclerosis prevalence in Salta City, Argentina.

INTRODUCTION: Multiple Sclerosis (MS) is one of the leading causes of disability in young adults. Its prevalence varies according to different countries. In Argentina there is a wide heterogeneity regarding data published in different areas of the country. Prevalence established in most studies is 17 cases per 100,000 inhabitants; however, most of the available data comes from studies that took place in Buenos Aires. There is little or no information from other provinces, especially from Northwest of Argentina (NOA), where there are no studies of the disease prevalence. The aim of this study is to investigate MS prevalence, phenotypes and epidemiological characteristics in Salta, Argentina, in order to contribute to the current knowledge of MS epidemiology and distribution in our country. METHODS: A descriptive, observational, transversal study was carried out in the capital city of Salta. Researchers from all public and private hospitals with a Neurology Department have participated. Private researchers who are well known leaders in demyelinating diseases in the city provided valuable information. Patients who did not have medical control for the past two years as well as patients whose last address was not registered in Salta were excluded. RESULTS: 120 registries were obtained from the four hospitals that participated and from the 12 private researchers. Ten patients were excluded due to overlapping data. The population of the area based on 2010 census was 535,310, so we estimated an MS prevalence 23.8 cases per 100,000 inhabitants (95% CI 20.1-27.4), 24.1 cases per 100,000 inhabitants in female population (95% CI 21.2-28.6) and 18.2 cases per 100,000 inhabitants (95% CI 15.2-21.1) in male population. In our analysis, 64 (58.2%) were female and the average age was 42.1 years. 81.8% are recurrent remitting forms, 16.4% secondary progressive and 1.8% primary progressive. CONCLUSION: This is the first study that provides epidemiological data on the prevalence and clinical forms of MS in Salta City as well as in the entire Northwest Region of Argentina(NOA). We estimate a prevalence of 23.8 cases per 100,000 inhabitants, which establishes a moderate risk area for MS.

Exposure to pets and risk of sensitisation to house dust mite, cat and dog allergens in a pre-school children population of an Andalusian seaside town

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Uso de recuperador de sangre durante la artroplastía de rodilla / Cell saver use during knee arthroplasty

Antecedentes: La gonartrosis es una patología degenerativa que limita de forma importante la funcionalidad de una persona. Se recurre al manejo quirúrgico cuando el paciente presenta una limitación funcional importante así como dolor intenso. La artroplastía de rodilla es una de las cirugías con mejores resultados funcionales en pacientes con esta patología, pero dentro de sus limitaciones está la posibilidad de un sangrado importante y, por consiguiente, la necesidad de hemotransfundir al paciente. El objetivo de este estudio fue evaluar la necesidad de hemotransfundir a los pacientes operados de artroplastía de rodilla que utilizaron recuperador sanguíneo en el postoperatorio y las diferencias entre los costos del recuperador sanguíneo y la transfusión clásica. Métodos: Estudio retrospectivo, transversal y retrolectivo de 300 expedientes de pacientes operados en el Hospital Ángeles de Querétaro de artroplastía de rodilla que utilizaron recuperador sanguíneo que requirieron hemotransfusión alogénica entre Octubre 2001 y Junio 2013. Resultados: De las 246 rodillas operadas, solamente tres requirieron hemotransfusión alogénica. Ninguna complicación/infección con el uso de recuperador sanguíneo. La edad promedio de los pacientes fue de 67.1 ± 9.78 años con un predominio femenino siendo éstos 141 (60.5%) en comparación con 92 (39.5%) masculinos. La sangre recolectada vía recuperador sanguíneo varió de 150 a 1,225 ml con un promedio de 318 ± 100.6 ml, la cual fue retransfundida a cada paciente. Conclusiones: El uso de recapturador sanguíneo en pacientes postoperados de artroplastía de rodilla disminuye de forma importante la necesidad de hemotransfusión alogénica.

Backgound: Gonarthrosis is a degenerative condition that importantly limits an individual's performance. Surgical treatment is used in patients with important functional limitation and severe pain. Knee arthroplasty is one of the surgeries with the best functional results in patients with this condition. However, its limitations include the risk of heavy bleeding and the resulting need for blood transfusion. The objective of this study was to assess the need for blood transfusion in patients undergoing knee arthroplasy in whom the cell saver was used postoperatively and find out the cost differences between the cell saver and standard blood transfusion. Methods: Retrospective, cross-sectional, retrolective trial including 300 records of patients who underwent knee arthroplasty at Hospital Ángeles Querétaro that included the use of the cell saver and allogeneic blood transfusion from October 2001 to June 2013. Results: Only 3 of the 246 operated knees required allogeneic blood transfusion. There were no complications/infections resulting from the use of the cell saver. Mean age of patients was 67.1 ± 9.78 years; females were predominant, as they were 141 (60.5%), compared to 92 (39.5%) males. The blood collected with the cell saver ranged from 150 to 1,225 ml with a mean of 318 ± 100.6 ml and was retransfused to each patient. Conclusions: Cell saver use in patients subjected to knee arthroplasty importantly decreases the need for allogeneic blood transfusion.

[Cell saver use during knee arthroplasty]. / Uso de recuperador de sangre durante la artroplastía de rodilla.

BACKGOUND: Gonarthrosis is a degenerative condition that importantly limits an individua's performance. Surgical treatment is used in patients with important functional limitation and severe pain. Knee arthroplasty is one of the surgeries with the best functional results in patients with this condition. However, its limitations include the risk of heavy bleeding and the resulting need for blood transfusion. The objective of this study was to assess the need for blood transfusion in patients undergoing knee arthroplasy in whom the cell saver was used postoperatively and find out the cost differences between the cell saver and standard blood transfusion. METHODS: Retrospective, cross-sectional, retrolective trial including 300 records of patients who underwent knee arthroplasty at Hospital Angeles Querétaro that included the use of the cell saver and allogeneic blood transfusion from October 2001 to June 2013. RESULTS: Only 3 of the 246 operated knees required allogeneic blood transfusion. There were no complications/infections resulting from the use of the cell saver. Mean age of patients was 67.1 +/- 9.78 years; females were predominant, as they were 141 (60.5%), compared to 92 (39.5%) males. The blood collected with the cell saver ranged from 150 to 1,225 ml with a mean of 318 +/- 100.6 ml and was retransfused to each patient. CONCLUSIONS: Cell saver use in patients subjected to knee arthroplasty importantly decreases the need for allogeneic blood transfusion.

[Risk Factors and extraneurological complications of stroke patients]. / Factores de riesgo y complicaciones extraneurológicas de pacientes internados por Accidente Cerebrovascular en el Hospital Nacional de Clínicas de Córdoba.

INTRODUCTION: Stroke is the third leading cause of death globally , act on modifiable risk factors is now the best prevention strategy. Medical complications are common in patients hospitalized for stroke , the valuation of income NIHSS , is associated with the final result in terms of duration of hospitalization, survival and discharge location. OBJETIVE: Determining risk factors ( RF) in patients hospitalized for stroke in Hospital Nacional de Clinicas de Córdoba (HNC) and characterize neurological complications NIHSS relative to income. MATERIAL AND METHODS: Prospective study of patients admitted to the Service of Neurology at HNC diagnosed with the first of September , 2010 to December 30, 2012 , we applied the admission NIHSS scale. Were determined cerebrovascular risk factors , we evaluated neurological complications during hospitalization. RESULTS: The total number of patients admitted for stroke was 200 , with 168 ischemic stroke ( 84%) and hemorrhagic stroke 32 (16 % ) . The FR Hypertension was the most frequent ( 83.5 %), over 40% had 3 or more FR for stroke. Had complications : 32 % of patients , the respiratory infection was the most frequent (14.5 % ). Patients with NIHSS greater than 10 points had a higher rate of complications. CONCLUSION: The multiple RF control is an effective strategy to decrease the incidence of stroke . Prevention of medical complications enable better patient care and reduce morbidity associated with stroke.

El Accidente cerebro vascular (ACV) constituye la tercera causa de muerte a nivel mundial; actuar sobre los factores de riesgo modificables constituye hoy la mejor estrategia de prevención. Las complicaciones médicas son frecuentes en los pacientes internados por ACV; la valoración del NIHSS de ingreso, está asociado al resultado final en términos de duración de internación, supervivencia y ubicación al alta. Objetivo. Determinar los factores de riesgo (FR) en pacientes internados por ACV en el HNC de Córdoba y caracterizar las complicaciones no neurológicas en relación al NIHSS de ingreso. Material y métodos. Estudio prospectivo de pacientes internados en el HNC con diagnóstico de ACV del primero de septiembre de 2010 al 30 de diciembre de 2012, se aplicó la escala de NIHSS al ingreso. Se determinaron los factores de riesgo cerebrovasculares; se evaluaron las complicaciones no neurológicas durante la internación. Resultados. El total de pacientes ingresados por ACV fue de 200, con ACV isquémico 168 (84%) y ACV hemorrágico 32(16%). La Hipertensión Arterial fue el FR más frecuente (83,5%); más del 40% tenía 3 o más FR para ACV. Tuvieron complicaciones: 32% de los pacientes, la Infección respiratoria fue la más frecuente (14.5%)Pacientes con NIHSS superior a 10 puntos presentaron mayor porcentaje de complicaciones. Conclusión. El control de FR múltiples constituye una estrategia efectiva para disminuir la incidencia de ACV. La prevención de las complicaciones médicas permiten un mejor cuidado del paciente y reducen la morbilidad relacionada al ACV.

Factores de riesgo y complicaciones extraneurológicas de pacientes internados por Accidente Cerebrovascular en el Hospital Nacional de Clínicas de Córdoba. / [Risk Factors and extraneurological complications of stroke patients].

INTRODUCTION: Stroke is the third leading cause of death globally , act on modifiable risk factors is now the best prevention strategy. Medical complications are common in patients hospitalized for stroke , the valuation of income NIHSS , is associated with the final result in terms of duration of hospitalization, survival and discharge location. OBJETIVE: Determining risk factors ( RF) in patients hospitalized for stroke in Hospital Nacional de Clinicas de Córdoba (HNC) and characterize neurological complications NIHSS relative to income. MATERIAL AND METHODS: Prospective study of patients admitted to the Service of Neurology at HNC diagnosed with the first of September , 2010 to December 30, 2012 , we applied the admission NIHSS scale. Were determined cerebrovascular risk factors , we evaluated neurological complications during hospitalization. RESULTS: The total number of patients admitted for stroke was 200 , with 168 ischemic stroke ( 84

) and hemorrhagic stroke 32 (16

) . The FR Hypertension was the most frequent ( 83.5

), over 40

had 3 or more FR for stroke. Had complications : 32

of patients , the respiratory infection was the most frequent (14.5

). Patients with NIHSS greater than 10 points had a higher rate of complications. CONCLUSION: The multiple RF control is an effective strategy to decrease the incidence of stroke . Prevention of medical complications enable better patient care and reduce morbidity associated with stroke.

Factores de riesgo y complicaciones extraneurológicas de pacientes internados por Accidente Cerebrovascular en el Hospital Nacional de Clínicas de Córdoba / [Risk Factors and extraneurological complications of stroke patients].

INTRODUCTION: Stroke is the third leading cause of death globally , act on modifiable risk factors is now the best prevention strategy. Medical complications are common in patients hospitalized for stroke , the valuation of income NIHSS , is associated with the final result in terms of duration of hospitalization, survival and discharge location. OBJETIVE: Determining risk factors ( RF) in patients hospitalized for stroke in Hospital Nacional de Clinicas de Córdoba (HNC) and characterize neurological complications NIHSS relative to income. MATERIAL AND METHODS: Prospective study of patients admitted to the Service of Neurology at HNC diagnosed with the first of September , 2010 to December 30, 2012 , we applied the admission NIHSS scale. Were determined cerebrovascular risk factors , we evaluated neurological complications during hospitalization. RESULTS: The total number of patients admitted for stroke was 200 , with 168 ischemic stroke ( 84

) and hemorrhagic stroke 32 (16

) . The FR Hypertension was the most frequent ( 83.5

had 3 or more FR for stroke. Had complications : 32

of patients , the respiratory infection was the most frequent (14.5

). Patients with NIHSS greater than 10 points had a higher rate of complications. CONCLUSION: The multiple RF control is an effective strategy to decrease the incidence of stroke . Prevention of medical complications enable better patient care and reduce morbidity associated with stroke.

Mesa redonda. Patología traqueal: Introducción / No disponible

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Tratamiento del cuerpo extraño intrabronquial. Broncoscopia combinada en Neumología Infantil / Foreign body management. Combined bronchoscopy in a Paediatric Pulmonology Unit

La aspiración de cuerpo extraño (CE) es una causa importante de morbimortalidad en la infancia. La gravedad de la obstrucción aguda de la vía aérea superior así como las complicaciones derivadas de la presencia de un CE en la vía aérea inferior hacen necesarios un diagnóstico y un tratamiento precoz. Clásicamente, en el paciente pediátrico, la extracción del CE se realizaba a través de broncoscopio rígido bajo anestesia general, por lo que estaba limitada a especialidades quirúrgicas. En el momento actual existen aportaciones de extracción mediante broncoscopio flexible, y resurge el debate acerca de qué instrumento es el más apropiado: flexible o rígido. La fibrobroncoscopia es un procedimiento mínimamente invasivo que permite confirmar el diagnóstico y localizar el CE, pero sólo en casos seleccionados y en manos muy expertas puede conseguir su extracción en estos pacientes. Dadas las características de la vía aérea del niño, para garantizar la seguridad del paciente y el éxito del procedimiento sigue avalándose la broncoscopia rígida como el más eficaz. Sin embargo, dada la complementariedad de ambos instrumentos, su tratamiento combinado parece ser la opción más adecuada. Presentamos 5 casos de tratamiento de CE en un procedimiento combinado con broncoscopia flexible y rígida (AU)

The foreign body (FB) aspiration is a significant of morbidity and mortality in childhood. The severity of the acute obstruction of the upper airway and the complications that the FB creates in the lower airway requires early diagnosis and treatment. Classically, the FB is removed with a rigid bronchoscope, with general anaesthesia, by surgeons. Nowadays, there are publications on removing FB with flexible bronchoscopy. There is now discussion on which is the best instrument, rigid or flexible bronchoscope. Flexible bronchoscopy is a minimal invasive procedure that allows the diagnosis to be made and locate the FB, which can only be removed in selected cases. Therefore, authors believe that FB removal is more effective with rigid bronchoscopy. It guarantees patient safety and the success of the procedure. However, both, flexible and rigid bronchoscopes are complementary, so their combined use is the most appropriate choice. We report the management of five cases of FB in paediatric patients with a combined procedure using flexible and rigid bronchoscopy (AU)

[Foreign body management. Combined bronchoscopy in a Paediatric Pulmonology Unit]. / Tratamiento del cuerpo extraño intrabronquial. Broncoscopia combinada en Neumología Infantil.

The foreign body (FB) aspiration is a significant of morbidity and mortality in childhood. The severity of the acute obstruction of the upper airway and the complications that the FB creates in the lower airway requires early diagnosis and treatment. Classically, the FB is removed with a rigid bronchoscope, with general anaesthesia, by surgeons. Nowadays, there are publications on removing FB with flexible bronchoscopy. There is now discussion on which is the best instrument, rigid or flexible bronchoscope. Flexible bronchoscopy is a minimal invasive procedure that allows the diagnosis to be made and locate the FB, which can only be removed in selected cases. Therefore, authors believe that FB removal is more effective with rigid bronchoscopy. It guarantees patient safety and the success of the procedure. However, both, flexible and rigid bronchoscopes are complementary, so their combined use is the most appropriate choice. We report the management of five cases of FB in paediatric patients with a combined procedure using flexible and rigid bronchoscopy.

Suplementación con ácidos grasos poliinsaturados a largo plazo en pacientes con fibrosis quística / Long term polyunsaturated fatty acid supplement in patients with cystic fibrosis

Objetivo: valorar el efecto de la suplementación oral de una combinación a dosis bajas de diversos ácidos grasos sobre parámetros respiratorios e inflamatorios en pacientes adultos con fibrosis quística(FQ).Método: 17 pacientes recibieron diariamente: 324 mg de ácido eicosapentaenoico (EPA), 216 mg de docosahexaenoico (DHA),480 mg de linoleico (LIN) y 258 mg de gammalinolénico (GLA)durante un año. Se valoraron parámetros espirométricos, número y gravedad de las reagudizaciones respiratorias, uso de antibióticos y marcadores inflamatorios. Resultados: se ha observado un incremento de parámetros espirométricos, así como una reducción estadísticamente significativa en el número de reagudizaciones (totales y graves) y en los días totales de tratamiento antibiótico, comparado con el año previo a la suplementación. Concomitantemente se observó una reducción significativa de los niveles del factor de necrosis tumoral alfa (TNF alfa)así como un incremento de los receptores solubles del TNF alfa. Conclusiones: la suplementación con una mezcla definida de ácidos grasos durante un año parece mejorar parámetros espirométricos, clínicos (menor número de reagudizaciones y tandas de antibióticos)e inflamatorios en pacientes adultos con FQ (AU)

Objective: to evaluate the effect of a combination of low doses oral supplement of various fatty acids on respiratory and inflammatory parameters in adult patients with cystic fibrosis (CF). Method: 17 patients received: 324 mg of eicosapentaenoic acid(EPA), 216 mg of docosahexaenoic acid (DHA), 480 mg of linoleicacid (LIN) and 258 mg of gamma-linolenic acid (GLA) daily during a one-year period. The parameters evaluated included spirometry, number and severity of the acute respiratory attacks, use of antibiotics and inflammatory markers. Results: an increase in spirometry parameters was observed, as well as a statistically significant reduction in the number of acute respiratory attacks (total and severe) and in the total number of days of antibiotic treatment, compared with the year prior to taking the supplement. At the same time, there was a reduction in the levels of the alpha tumor necrosis factor (alpha TNF), as well as an increase of the soluble receptors of alpha TNF. Conclusions: supplements with a specific mix of fatty acids for the period of one year appears to improve spirometry, clinical (lower number of the acute respiratory attacks and rounds of antibiotics) and inflammatory parameters in adults with CF (AU)

Fundamentos de la oxigenoterapia en situaciones agudas y crónicas: indicaciones, métodos, controles y seguimiento / Oxygen therapy in acute and chronic conditions: Indications, oxygen systems, assessement and follow-up

La oxigenoterapia es una herramienta fundamental para el tratamiento de la insuficiencia respiratoria, tanto aguda como crónica. Los objetivos principales que llevan a su empleo son tratar o prevenir la hipoxemia, tratar la hipertensión pulmonar y reducir el trabajo respiratorio y miocárdico. En situaciones agudas, su utilidad está ampliamente aceptada y en situaciones crónicas se ha extendido de forma importante. Sin embargo, sigue sin haber consenso en puntos fundamentales y son pocos los aspectos en los que la actuación entre los diferentes centros esté estandarizada. El Grupo de Trabajo de Técnicas de la Sociedad Española de Neumología Pediátrica acordó elaborar unas recomendaciones avaladas por esta Sociedad sobre el empleo de este tratamiento, e incorporó las diferentes formas de actuación recogidas en revisiones recientes para intentar establecer sus indicaciones, disminuir los efectos colaterales y procurar una correcta adecuación del gasto económico. Se han incluido aspectos generales del tratamiento con oxígeno, como los mecanismos fisiológicos, las indicaciones para su empleo, tanto en situaciones agudas como crónicas, y los medios disponibles para su correcta administración. Se aborda asimismo el tratamiento del paciente con oxigenoterapia en domicilio y las situaciones especiales que pueden producirse (AU)

Oxygen therapy has become a major tool for infants with acute and chronic respiratory failure. Appropriate goals when prescribing supplemental oxygen are reduction and prevention of hypoxemia, prevention and treatment of pulmonary hypertension and decrease in respiratory and cardiac overload. This is commonplace in the acute setting and is also becoming widespread in chronic pathologies. However, there is a lack of consensus on many fundamental issues, such as appropriate indications, desirable targets and outcome measures amongst centres, reflecting a variety of clinical practices. The Techniques Group of the Spanish Society of Pediatric Pneumology undertook to design recommendations for a rational approach to oxygen therapy, reviewing the existing literature in order to establish its indications, benefits and potential risks as well as its cost-effectivenes. General aspects of oxygen treatment are reviewed including physiological mechanisms, indications, delivery systems and assessment methods. Management of patients on home oxygen therapy is also addressed with discussion of benefits and potential risks of supplemental oxygen use (AU)

[Oxygen therapy in acute and chronic conditions: Indications, oxygen systems, assessement and follow-up]. / Fundamentos de la oxigenoterapia en situaciones agudas y crónicas: indicaciones, métodos, controles y seguimiento.

Oxygen therapy has become a major tool for infants with acute and chronic respiratory failure. Appropriate goals when prescribing supplemental oxygen are reduction and prevention of hypoxemia, prevention and treatment of pulmonary hypertension and decrease in respiratory and cardiac overload. This is commonplace in the acute setting and is also becoming widespread in chronic pathologies. However, there is a lack of consensus on many fundamental issues, such as appropriate indications, desirable targets and outcome measures amongst centres, reflecting a variety of clinical practices. The Techniques Group of the Spanish Society of Pediatric Pneumology undertook to design recommendations for a rational approach to oxygen therapy, reviewing the existing literature in order to establish its indications, benefits and potential risks as well as its cost-effectivenes. General aspects of oxygen treatment are reviewed including physiological mechanisms, indications, delivery systems and assessment methods. Management of patients on home oxygen therapy is also addressed with discussion of benefits and potential risks of supplemental oxygen use.

Actualización en el manejo delas bronquiectasias / No disponible

No disponible

Interpretation of a serial Mantoux test taking into account the annual risk of tuberculous infection.

BACKGROUND: Interpretation of tuberculin tests (TSTs) can be difficult. However, it is even more difficult to classify an individual as infected or non-infected if he or she has undergone a prior TST, as the difference between the booster effect and true conversion is not always clear. OBJECTIVE: To determine the size of the induration that is indicative of true infection after a second Mantoux test, based on the fact that the annual risk of tuberculous infection (ARTI) is equivalent, regardless of whether it is calculated directly or indirectly. METHOD: We performed two TSTs in the same population (aged 6 years at the first examination) with a 1-year interval. We calculated the prevalence of infection the first year (1.16%, 95%CI 0.67-1.65) and the ARTI using the indirect method (0.18%, 95%CI 0.00-0.37). For the second year, we considered different induration sizes and finally accepted a diameter of >10 mm as the criterion according to which the ARTI, calculated directly, corresponded to the value of the previous year (0.18%). CONCLUSION: Although they served as an aid in the interpretation of the TST, calculations of this type will probably be unnecessary in the future, when in vitro diagnostic tests for tuberculosis are made available in every health centre, thus enabling the classification of those individuals with indurations of intermediate size in the TST.

Tuberculosis endobronquial que simula un enfisema lobar congénito / Endobronchial tuberculosis simulating congenital lobular emphysema

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Hemoptisis tras maniobra de Heimlich / Haemoptysis after Heimlich manoeuvre

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