Prevalencia y factores asociados a la enfermedad arterial periférica en pacientes con diabetes mellitus tipo 2 en Atención Primaria / Prevalence and factors associated with peripheral artery disease in patients with type 2 diabetes mellitus in Primary Care

Introducción: La enfermedad arterial periférica de las extremidades inferiores (EAP) conlleva una mayor morbimortalidad en pacientes con diabetes mellitus tipo 2 (DM2); este trabajo evalúa la prevalencia en dichos pacientes y su asociación con variables socio-demográficas y clínicas. Material y métodos: Estudio descriptivo transversal con muestreo consecutivo de pacientes con DM2, entre 50-80 años, en Atención Primaria. La presencia de EAP fue diagnosticada mediante un índice tobillo-brazo (ITB) ≤ 0,9. Variables independientes: socio-demográficas, clínicas y de laboratorio. Para determinar qué factores se asociaban a ITB bajo se hizo un análisis bivariado y regresión logística múltiple. Resultados: Muestra de 251 pacientes, de los que el 52,6% eran mujeres; la edad media ± desviación estándar fue de 68,5 ± 8,5 años. Presentaron ITB bajo el 18,3% (intervalo de confianza del 95% [IC del 95%], 13,3-23,3%); 6 sujetos (2,4%) estaban diagnosticados previamente de EAP. Tras el análisis multivariante, los factores que se vieron asociados con un ITB bajo fueron la edad (OR = 1,07; IC del 95%, 1,02-1,12) y la presencia de retinopatía (OR = 2,69; IC del 95%, 1,06-6,81). Conclusiones: Hay un bajo porcentaje de pacientes diagnosticados de EAP, a pesar de su elevada prevalencia en pacientes con DM2 seguidos en Atención Primaria, especialmente aquellos de mayor edad y con retinopatía, por lo que hay que insistir en la recomendación de realizar sistemáticamente el ITB en esta población de riesgo (AU)

Introduction: Peripheral artery disease in the lower limbs (PAD) is a prevalent condition that entails high morbidity in diabetic patients; this study assesses PAD in these patients and its socio-demographic and clinic associated variables. Material and methods: Descriptive study in a systematic sample of diabetic patients (DM2) aged 50-80 years, in Primary Care settings. The dependent variable was the presence of PAD diagnosed by ankle-brachial index (ABI) ≤ 0.9; independent variables: socio-demographic, clinical and laboratory. Statistics: bivariate and multiple logistic regression analyses were performed to determine the variables associated with low ABI. Results: A sample of 251 patients, 52.6% women; mean age: 68.5 ±8.5. A low ABI was detected in 18.3% (95% Confidence Interval (95% CI):13.3-23.3%), with 6 subjets (2.4%) previously diagnosed as suffering PAD. Age (OR = 1.07; 95% CI: 1.02-1.12) and retinopathy (OR = 2.69; 95% CI: 1.06-6.81) were associated (multiple logistic regression analysis) with ABI. Conclusions: The percentage of patients diagnosed with PAD is very low, although PAD prevalence is high among DM2 patients attending Primary Care clinics, especially in older patients and those with retinopathy. We emphasize the recommendation of performing the ABI test in this population at risk (AU)

[Prevalence and factors associated with peripheral artery disease in patients with type 2 diabetes mellitus in Primary Care]. / Prevalencia y factores asociados a la enfermedad arterial periférica en pacientes con diabetes mellitus tipo 2 en Atención Primaria.

INTRODUCTION: Peripheral artery disease in the lower limbs (PAD) is a prevalent condition that entails high morbidity in diabetic patients; this study assesses PAD in these patients and its socio-demographic and clinic associated variables. MATERIAL AND METHODS: Descriptive study in a systematic sample of diabetic patients (DM2) aged 50-80 years, in Primary Care settings. The dependent variable was the presence of PAD diagnosed by ankle-brachial index (ABI) ≤ 0.9; independent variables: socio-demographic, clinical and laboratory. STATISTICS: bivariate and multiple logistic regression analyses were performed to determine the variables associated with low ABI. RESULTS: A sample of 251 patients, 52.6% women; mean age: 68.5 ±8.5. A low ABI was detected in 18.3% (95% Confidence Interval (95% CI):13.3-23.3%), with 6 subjets (2.4%) previously diagnosed as suffering PAD. Age (OR=1.07; 95% CI: 1.02-1.12) and retinopathy (OR=2.69; 95% CI: 1.06-6.81) were associated (multiple logistic regression analysis) with ABI. CONCLUSIONS: The percentage of patients diagnosed with PAD is very low, although PAD prevalence is high among DM2 patients attending Primary Care clinics, especially in older patients and those with retinopathy. We emphasize the recommendation of performing the ABI test in this population at risk.

Agreement between telerehabilitation involving caregivers and face-to-face clinical assessment of lymphedema in breast cancer survivors.

Lymphedema is a lifetime complication of breast cancer survivors that can limit their participation in recreational or strenuous daily activities. Follow-up of lymphedema using an Internet application could help patients to determine the influence on their condition of these activities and adapt them accordingly. We aimed to determine the level of agreement between lymphedema assessment by telerehabilitation and by the traditional face-to-face method. Thirty breast cancer survivors participated in a descriptive study of repeated measures using a crossover design. Patients attended a session for clinical face-to-face and real-time online telerehabilitation assessments of lymphedema. There was a 120-min interval between these two sessions. The order of sessions was randomly selected for each patient. A caregiver (relative or friend) conducted the telerehabilitation assessment using a system that includes a specific tool based on an arm diagram for measuring the participant's arm circumferences via a telehealth application. All outcome measures showed reliability estimates (α) ≥ 0.90; the lowest reliability was obtained for the total volume on the non-affected side (α = 0.90). The diagnosis of lymphedema by the two methods also showed good inter-rater reliability (Rho = 0.89). These preliminary findings support the use of an Internet-based system to assess lymphedema in breast cancer survivors, offering carers a useful role in helping patients to follow up this lifetime health problem.

Oxigenoterapia de alto flujo en cánulas nasales: empleo en una planta de hospitalización / High-flow nasal cannula oxygen therapy: employment in ward

Objetivo: La oxigenoterapia de alto flujo (OAF) es un soporte respiratorio normalmente empleado en las unidades de cuidados intensivos. En nuestro hospital lo llevamos utilizando en planta (lactantes y escolares) desde abril de 2009. El objetivo de este estudio es comprobar los resultados clínicos y su seguridad, así como valorar la aceptación de su uso por parte de enfermería. Pacientes y métodos: Se ha revisado el empleo de OAF en la insuficiencia respiratoria aguda (IRA) durante 2011, estableciendo tres grupos: G1, bronquiolitis; G2, menores de 2 años con episodios previos, y G3, mayores de 2 años con episodios previos. Prospectivamente, hemos valorado la gravedad de la IRA y comparado más tarde su mejoría, considerando el paso de grave a moderado a las 6 y 12 horas de su inicio. Asimismo, se ha realizado una encuesta al personal de enfermería sobre su percepción de la OAF (montaje y mantenimiento, interferencia con medicaciones, alimentación, efectos secundarios, tolerancia...). Resultados: Han recibido OAF 33 pacientes. En conjunto, mejoran todos (p <0,001), sin diferencias significativas entre ellos. Separadamente, hay mejoría en los tres grupos: G1 (p <0,001), G2 (p= 0,003) y G3 (p= 0,006). La percepción del personal de enfermería es que se trata de un sistema de fácil aplicación, y de forma generalizada se tiene una impresión positiva de este soporte respiratorio. Conclusiones: La OAF supone un soporte respiratorio de evidente beneficio clínico, de fácil aplicación y bien asumido por la enfermería. Creemos que es aplicable en una planta de hospitalización, pero sin olvidarnos de que se aplica a pacientes graves que requieren la máxima vigilancia y que no todos responderán favorablemente (AU)

Objective: The high-flow nasal cannula (HFNC) oxygen therapy is a respiratory support usually used in intensive care units. In our hospital we used it in the pediatric ward (infants and children) since April 2009. Our aim is to test the clinical out­comes, security, and assess the acceptance of its use by the nursing service. Patients and methods: We reviewed the use of HFNC in acute respiratory failure (ARF) during 2011, establishing three groups: G1, bronchiolitis; G2, children under 2 years with previous episodes, and G3, children over 2 years with previous episodes. Prospectively, we assessed the severity of the ARF, comparing the improvement of the patients, considering the transition of severe distress to moderate distress at 6 respectively 12 hours of the clinical onset. We also realized a survey to all the paediatric ward nurses about their perception of the HFNC (installation and maintenance, interference with medications, diet, side effects, tolerance...). Results: In our study, 33 patients received HNCF. We saw an improvement in all three groups (p <0.001), without significant differences between them. Taking separately, we found an improvement in each one of them, G1 (p <0.001), G2 (p= 0.003) and G3 (p= 0.006). The perception of nursing about the HFNC is that it's easy to apply, so generally, they had a positive impression about this respiratory support. Conclusions: The HFNC it's a respiratory support with obvious clinical benefits, easy to use, well accepted by nurses and, as we think, applicable in a hospital ward. Anyway, we mustn't forget that are critically patients requiring maximum vigilance and that not all of them respond favorably (AU)

Crisis epilépticas generalizadas asociadas a intoxicación pasiva por cocaína en un lactante / Generalized epileptic seizures in an infant due to passive exposure to cocaine

Fundamento. Las crisis convulsivas sin fiebre en lactantesimplican un diagnóstico diferencial amplio.Caso clínico. Lactante mujer de 7 meses que presenta,estando afebril, dos crisis generalizadas tónico-clónicasbreves en 23 horas. Su desarrollo psicomotor y estaturo-ponderal seguía un curso normal. Se obtuvo analíticade sangre, ecografía cerebral y electroencefalograma,normales. Debido a una situación sociofamiliar desfavorable,se realizaron tóxicos en orina, positivos paracocaína en dos muestras sucesivas; se negativizaronen 48 horas. Estuvo en contacto con humo ambientalhoras previas al inicio de las crisis. Sin crisis en lossiguientes 6 meses, con desarrollo normal, sigue bajovigilancia por asistencia social.Discusión. La inhalación pasiva de humo de cocaína seasocia a crisis convulsivas en lactantes. Este riesgo escasi desconocido en nuestro país, a pesar del aumentodel consumo de crack. Ante una primera crisis epilépticaafebril en cualquier edad, se debe incluir de formarutinaria la detección de tóxicos en orina(AU)

Background. The differential diagnosis of afebrile seizuresin the first year of life is extensive.Case report. A 7-month old infant presented two afebrilegeneralized tonic-clonic seizures in 23 hours; her psychomotorand growth development followed a normalcourse. Laboratory analysis, cerebral echography andelectroencephalogram were normal. Urine toxicologywas positive for cocaine on two occasions. A negativeurine sample was obtained 48 hours later. The parentsdenied drug abuse but explained a recent exposure tosmoke some hours before the episode. The patient hadno seizures in the following six months, with normal psychomotordevelopment.Discussion. Passive inhalation of cocaine is associatedwith seizures in infants. There is no perception ofthe risk of passive exposure to cocaine in our country,despite the increasing consumption of crack in youngadults. Urine toxicology should be systematicallyincluded in the study of a first afebrile seizure in aninfant(AU)

[Paraneoplastic opsoclonus myoclonus ataxia syndrome]. / Síndrome opsoclono-mioclono-atáxico paraneoplásico.

Opsoclonus myoclonus ataxia syndrome (OMAS) is a very infrequent paraneoplastic or postinfectious movement disorder, which may occur at any age, most commonly between 6 and 36 months of age. In four days, a previously healthy 30-month-old girl progressively developed gait instability, intention tremor, dysarthric speech, irritability and altered sleep. Physical and neurological examination did not reveal additional deficits. She had had a transient exanthema without fever three weeks before. Basic blood analysis, serologies, cultures, urine toxin detection, EEG and cerebral CT were normal. Lumbar puncture showed minimal lymphocytosis. On the fifth day following the onset of symptoms, the ataxia worsened, precluding sitting, and the tremor was aggravated by intentional myoclonus. Chaotic saccadic, large amplitude multidirectional but conjugated eye movements appeared. An opsoclonus was suspected and a chest X-ray and CT revealed a paravertebral thoracic mass. Surgery confirmed a localized ganglioneuroblastoma. Blood neuron-specific enolase and urine catecholamine levels were normal. Opsoclonus disappeared with high doses of prednisone and following surgery. Ataxia improved but the patient still required low daily doses of steroids for one year.

Síndrome opsoclono-mioclono-atáxico paraneoplásico / Paraneoplastic opsoclonus myoclonus ataxia syndrome

El síndrome opsoclono-mioclono-atáxico (SOMA)es un trastorno del movimiento muy infrecuente, de origenautoinmune y de aparición a cualquier edad, másprobable entre los 6-36 meses.Se presenta el caso de una niña de 30 meses, previamentesana, que desarrolló progresivamente en cuatrodías marcha inestable, temblor intencional, habla escandida,irritabilidad y trastorno del sueño. El resto de laexploración física y neurológica era normal. Presentóexantema leve tres semanas antes. Al ingreso, la analíticageneral, cultivos, tóxicos en orina, serologías, electroencefalogramay tomografía cerebral (TC) fueron normales.La punción lumbar mostró linforraquia leve. Al quintodía desde el inicio, la ataxia impedía la sedestación y eltemblor era generalizado agravado probablemente pormioclonias intencionales. Aparecieron entonces movimientosoculares rápidos, sacádicos, multidireccionales,aunque conjugados. Ante el diagnóstico de opsoclono,se solicitó radiografía de tórax observando una masa torácicaparavertebral, corroborada en la TC torácica. Lacirugía confirmó un ganglioneuroblastoma localizado. Laenolasa neuronal específica en sangre y catecolaminasen orina fueron normales. El opsoclono desapareció conprednisona oral a altas dosis y tras cirugía. Un año despuésprecisaba dosis mínima de corticoide por apariciónde leve inestabilidad de la marcha e irritabilidad al suspenderla medicación(AU)

Opsoclonus myoclonus ataxia syndrome (OMAS)is a very infrequent paraneoplastic or postinfectiousmovement disorder, which may occur at any age, mostcommonly between 6 and 36 months of age.In four days, a previously healthy 30-month-oldgirl progressively developed gait instability, intentiontremor, dysarthric speech, irritability and altered sleep.Physical and neurological examination did not revealadditional deficits. She had had a transient exanthemawithout fever three weeks before. Basic blood analysis,serologies, cultures, urine toxin detection, EEG and cerebralCT were normal. Lumbar puncture showed minimallymphocytosis. On the fifth day following the onsetof symptoms, the ataxia worsened, precluding sitting,and the tremor was aggravated by intentional myoclonus.Chaotic saccadic, large amplitude multidirectionalbut conjugated eye movements appeared. An opsoclonuswas suspected and a chest X-ray and CT revealeda paravertebral thoracic mass. Surgery confirmed alocalized ganglioneuroblastoma. Blood neuron-specificenolase and urine catecholamine levels were normal.Opsoclonus disappeared with high doses of prednisoneand following surgery. Ataxia improved but the patientstill required low daily doses of steroids for one year(AU)

[Generalized epileptic seizures in an infant due to passive exposure to cocaine]. / Crisis epilépticas generalizadas asociadas a intoxicación pasiva por cocaína en un lactante.

BACKGROUND: The differential diagnosis of afebrile seizures in the first year of life is extensive. CASE REPORT: A 7-month old infant presented two afebrile generalized tonic-clonic seizures in 23 hours; her psychomotor and growth development followed a normal course. Laboratory analysis, cerebral echography and electroencephalogram were normal. Urine toxicology was positive for cocaine on two occasions. A negative urine sample was obtained 48 hours later. The parents denied drug abuse but explained a recent exposure to smoke some hours before the episode. The patient had no seizures in the following six months, with normal psychomotor development. DISCUSSION: Passive inhalation of cocaine is associated with seizures in infants. There is no perception of the risk of passive exposure to cocaine in our country, despite the increasing consumption of crack in young adults. Urine toxicology should be systematically included in the study of a first afebrile seizure in an infant.

In vitro susceptibility of Ornithobacterium rhinotracheale to several antimicrobial drugs.

As part of the basic characterization of Ornithobacterium rhinotracheale, the minimal inhibitory concentrations of 10 antimicrobial drugs were determined for reference strains and Mexican isolates by a broth microdilution method. For optimal growth of the organisms, a supplemented brain-heart infusion broth was used. The susceptibility of O. rhinotracheale to amoxicillin, enrofloxacin, and oxytetracycline was variable. However, consistent higher minimal inhibitory concentrations values were obtained for gentamicin, fosfomycin, trimethoprim, sulfamethazine, sulfamerazine, sulfaquinoxaline, and sulfachloropyridazine. Obtained results among Mexican isolates indicate a marked antimicrobial drug resistance trend.

Hydrogen peroxide mediates vascular cell adhesion molecule-1 expression from interleukin-18-activated hepatic sinusoidal endothelium: implications for circulating cancer cell arrest in the murine liver.

The mechanism of intrasinusoidal arrest of circulating cancer cells, which is a critical step in liver metastasis, appears to be facilitated by tumor-derived proinflammatory factors that increase sinusoidal cell adhesion receptors for cancer cells. However, how this prometastatic microenvironment is up-regulated remains unknown. Using intrasplenically injected B16 melanoma (B16M) cells, we show that the expression of vascular cell adhesion molecule-1 (VCAM-1) significantly increased in hepatic sinusoidal endothelium (HSE) cells over physiologic baseline within the first 24 hours of metastatic cancer cell infiltration in the liver. This correlated with increased in vitro adhesion of B16M cells to HSE cells isolated from B16M cell-injected mice. In vivo VCAM-1 blockade with specific antibodies before B16M cell injection decreased sinusoidal retention of luciferase-transfected B16M cells by 85%, and metastasis development by 75%, indicating that VCAM-1 expression on tumor-activated HSE cells had a prometastatic contribution. Because VCAM-1 expression is oxidative stress-inducible, recombinant catalase was in vivo administered, resulting in a complete abrogation of both VCAM-1 expression and B16M cell adhesion increases in HSE cells isolated from B16M cell-injected mice. Catalase also abrogated the proadhesive response of HSE cells to B16M-conditioned medium (B16M-CM) in vitro, although this did not affect the concomitant release of major proinflammatory cytokines by HSE cells. HSE cells treated with B16M-CM released interleukin (IL)-18 via tumor necrosis factor-alpha (TNF-alpha)-dependent IL-1beta in vitro. In turn, H(2)O(2) production from B16M-CM-treated HSE cells was regulated by IL-18. Thus, liver-infiltrating B16M cells activated their adhesion to HSE through a sequential process involving TNF-alpha-dependent IL-1beta, which induced IL-18 to up-regulate VCAM-1 via H(2)O(2). The pivotal position of H(2)O(2) was further supported by the fact that incubation of HSE cells with nontoxic concentrations of H(2)O(2) directly enhanced VCAM-1-dependent B16M cell adhesion in vitro without proinflammatory cytokine mediation, which emphasizes the key role of oxidative stress in the pathogenesis of liver inflammation and metastasis.

[Acid-base and gasometric findings at the admission of 150 children clinically diagnosed as in status asthmaticus]. / Hallazgos gasométricos y acidobásicos al ingreso en 150 niños diagnosticados clínicamente como en "Status asthmaticus".

"Status Asthmaticus" (SA) is a severe complication of asthma in which the clinical concept should be accompanied by biochemical alterations. Biochemical determinations were made on admission of 150 children clinically diagnosed as in SA. The Astrup method was used, following the technique advised by Stamm, Sharp and others. Most of the children were asthmatic grade III, with a predominance of the male sex, and 70.66% were in good nutrition. It was found that 90 patients had altered pCO2 (60%); 88 patients had a low per cent saturation of hemoglobin (58.66%), and 49 patients had altered pH (32.66%). Having in mind Bocles' classification for SA, it was observed that 30% of the children did not present biochemical alterations and could not be considered as in SA, in spite of the clinical impression. The rest of the patients really filled the criteria of SA and the most frequently found was Bocles' stage IV (41.33%), that is the most severe. Finally, considerations are made on the SA treatment, for the different Bocles' stages.