Nen amb adenopaties doloroses occipitals i febreta: TIBOLA / A child with tender occipital limph nodes the low-grade fever: Tibola

Las enfermedades transmitidas por garrapatas son poco frecuentesen nuestro medio, aunque el antecedente de picadura y la presenciade síntomas como la fiebre y el rash obligan a descartar lafiebre botonosa o la enfermedad de Lyme.Una enfermedad emergente es la llamada TIBOLA o DEBONEL, quese presenta como una linfadenitis occipital con escara en el cuerocabelludo. Es una enfermedad transmitida por garrapatas que sepuede diagnosticar por las características clínicas que presenta.Se describe el caso de un niño de 9 años que consulta por adenopatíasdolorosas en zona occipital y cervical posterior y febrícula.Nen amb adenopaties doloroses occipitalsi febreta: TIBOLAAsunción Clopés, Rosa Rovira, Manuel Andrés Samper, Francisco J. Sanchís, Luis-EnriqueDelgado, Pilar TerradasServei de Pediatria. Pius Hospital de Valls. Valls. TarragonaEl diagnóstico de sospecha ante la presencia de escara en el cuerocabelludo y el antecedente de picadura de garrapata se confirmópor una serología cruzada positiva a Rickettsia conorii. Se efectuótratamiento con eritromicina con buena respuesta clínica y conuna alopecia cicatricial como secuela.Esta enfermedad está provocada por Rickettsia slovaca, germentransmitido por garrapatas, siendo un cuadro con pocas referenciasen nuestro medio, habitualmente por confundir la reacciónadenopática con una sobreinfección bacteriana.Ante un paciente con adenitis occipital y el antecedente de picadurapor garrapata y/o escara en el cuero cabelludo el diagnósticode TIBOLA es el más probable(AU)

Tick-borne diseases are rare in our environment; for usual differentialdiagnosis of, fever and rash in the presence of history oftick-bite, boutoneusse fever or Lyme disease should be considered.TIBOLA is an emergent tick-borne disease that presents with occipitallymphadenitis and a scalp eschar; this entity should be easyto diagnose based on its clinical presentation.We describe the case of a 9 year-old boy who presented with tenderoccipital lymphadenopathies and low-grade fever. In the presenceof a scalp eschar and the history of tick-bite, the diagnosisof TIBOLA was suspected, which was confirmed with cross-positiveserology to Rickettsia conorii. Treatment with erythromycin wasadministered, with prompt improvement of the symptoms and theonly sequel of residual alopecia at the eschar site.TIBOLA is caused by Rickettsia slovaca; there are few reports ofthis entity in our region, probably because it is often misdiagnosedas bacterial lymphadenitis.TIBOLA should be suspected in any patient that presents with occipitallymphadenitis and history of tick-bite or scalp eschar(AU)

Seguimiento de un grupo de pacientes tratadas por un trastorno del comportamiento alimentario durante la adolescencia / Disorders (ED) have a bad prognosis and generally evolve to chronicity

Objetivos; estudiamos la evolución de un grupo de 30 pacientes con trastornos del comportamiento alimentario ( TCA), tratadas en la unidad de trastornos del comportamiento alimentaria(UTCA), del hospital universitario de Tarragona Joan XXIII, a los 2-4 años después del alta. Resultados: el 80% de los pacientes encuestadas mantienen una buena salud física, psíquica y social, siendo la depresión el diagnostico principal de la recaída, y en dos casos, el trastorno alimentario no especifico .predicen un peor pronóstico, el abandonar el tratamiento, el disminuir el tiempo de tratamiento y el tener antecedentes familiares de enfermedad mental(AU)

Objective: We studied the evolution of a group of 30 patients with ED treated at the ED unit of the Joan XXIII university hospital of Tarragona, until up to 2-4 years after discharge. Results: 80% of the interviewed patients maintained good physical and social health, depression being the main diagnosis of relapse and, in two cases, non-specific ED. Treatment interruption, diminishing the time of treatment and having a family background with mental disease, predicted a worse prognosis (AU)

MRI findings in aphasic status epilepticus.

Ictal-MRI studies including diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), and MR-angiography (MRA) in patients with aphasic status epilepticus (ASE) are lacking. In this report, we aim to describe the consequences of the ASE on DWIs and its impact on cerebral circulation. We retrospectively studied eight patients with ASE confirmed by ictal-EEG, who underwent ictal-MRI shortly after well-documented onset (mean time delay 3 h). ASE consisted in fluctuating aphasia, mostly associated with other subtle contralateral neurological signs such as hemiparesia, hemianopia, or slight clonic jerks. In MRI, six patients showed cortical temporoparietal hyperintensity in DWI and four of them had also ipsilateral pulvinar lesions. Five patients showed close spatial hyperperfusion areas matching the DWI lesions and an enhanced blow flow in the middle cerebral artery. Parenchymal lesions and hemodynamic abnormalities were not associated with seizure duration or severity in any case. The resolution of DWI lesions at follow-up MRI depended on the length of the MRIs interval. In patients with ASE, lesions on DWI in the temporo-parietal cortex and pulvinar nucleus combined with local hyperperfusion can be observed, even when they appear distant from the epileptic focus or the language areas.

Rotura espontánea de bazo en un caso de leishmaniasis visceral / Spontaneous rupture of the spleen in a patient with visceral leishmaniasis

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Usefulness of a hypertension education program.

BACKGROUND: Our objective was to assess knowledge about hypertension, its medical consequences in hospitalized patients with hypertension and in their relatives, and to evaluate the usefulness of a simple education program to improve such knowledge. METHOD: As part of a cohort study, six clinical physicians reviewed the medical charts of all hospitalized patients in the departments of medicine, general surgery, and orthopedic surgery. Patients with the antecedent of hypertension, patients without the antecedent of hypertension but with at least two measurements of blood pressure above normal limits during hospitalization, and the relatives or friends who were accompanying patients with known or unknown hypertension were included. Patients received an education program about hypertension. Knowledge about hypertension and its complications was assessed on the basis of three items before the education program and 4 months later. RESULTS: A total of 102 patients entered the study and 95 completed it. An association was found between higher education level and knowledge about hypertension; differences were significant with two of the three employed items (P < 0.005). Compared with baseline, knowledge about hypertension was improved 4 months after the education program; differences were significant with the three employed items (P < 0.005). CONCLUSIONS: Simple and easy-to-implement programs can be useful in improving knowledge about hypertension.