Cáncer pulmonar el peor efecto del tabaquismo / Lung cancer the worst effect of smoking

Lung cancer is the first cause of death in Chilean cancer patients. Globally it accounts for more than 8 million annual deaths. Of the new cases of cancer, more than 6 million are smoking related, making smoking the most important cancer risk factor and the cause of about 20 % of the global cancer-related mortality. The incidence of lung cancer is directly associated with smoking exposure levels during life, exposure that increases the risk of this disease up to 30 times. This risk decreases exponentially with smoking cessation, especially if it occurs in early life stages. In Chile, 85 % of lung cancers in men and 40 % in women may be explained by smoking, equivalent to 1926 per year. Brief counseling is recommended according to the Clinical Guidelines for the Treatment of Smoking in Chile 2017, and if that is not possible, all smokers with cancer should be referred to smoking cessation therapy, which may be done by telephone (6003607777, Salud Responde Program, MINSAL; the number is on cigarette packets).

El cáncer de pulmón constituye la primera causa de muerte por cáncer en Chile. A nivel mundial da cuenta de más de 8 millones de fallecimientos anuales, de los nuevos casos de cáncer, más de 6 millones están relacionados con tabaco, constituyendo el tabaquismo un importante factor de riesgo y causa directa de cerca del 20% de la mortalidad global asociada a cáncer. La incidencia de cáncer de pulmón está directamente relacionada el nivel de exposición a tabaquismo durante la vida, la exposición puede aumentar el riesgo de esta enfermedad hasta 30 veces. El riesgo disminuye exponencialmente con la cesación de esta adicción, especialmente si ocurre en etapas tempranas de la vida. En Chile el 85% de los cánceres de pulmón en hombres y el 40% en mujeres estarían explicados por tabaquismo, equivalentes a 1926 anuales, siendo la recomendación realizar consejería breve según las Guías Clínicas de Tratamiento del Tabaquismo Chile 2017 y si no es posible derivar a todos los fumadores con cáncer a terapia de cesación del tabaquismo que puede ser telefónica Salud Responde MINSAL 6003607777, el numero está en las cajetillas de cigarrillos.

Cáncer pulmonar el peor efecto del tabaquismo / Lung cancer the worst effect of smoking

Resumen El cáncer de pulmón constituye la primera causa de muerte por cáncer en Chile. A nivel mundial da cuenta de más de 8 millones de fallecimientos anuales, de los nuevos casos de cáncer, más de 6 millones están relacionados con tabaco, constituyendo a el tabaquismo un importante factor de riesgo y causa directa de cerca del 20% de la mortalidad global asociada a cáncer. La incidencia de cáncer de pulmón está directamente relacionada el nivel de exposición a tabaquismo durante la vida, la exposición puede aumentar el riesgo de esta enfermedad hasta 30 veces. El riesgo disminuye exponen-cialmente con la cesación de esta adicción, especialmente si ocurre en etapas tempranas de la vida. En Chile el 85% de los cánceres de pulmón en hombres y el 40% en mujeres estarían explicados por tabaquismo, equivalentes a 1926 anuales, siendo la recomendación realizar consejería breve según las Guías Clínicas de Tratamiento del Tabaquismo Chile 2017 y si no es posible derivar a todos los fumadores con cáncer a terapia de cesación del tabaquismo que puede ser telefónica Salud Responde MINSAL 6003607777, el número está en los envases de cigarrillos.

Lung cancer is the first cancer death in Chile. Globally accounts for more than 8 million annual deaths, of the new cases of cancer, more than 6 million are smoking related, making smoking the most important cancer risk factor and cause of about 20% of the global cancer-related mortality. The incidence of lung cancer is directly related to smoking exposure level during life, exposure that increases the risk of this disease up to 30 times. This risk decreases exponentially with smoking cessation, especially if it occurs in early life stages. In Chile, 85% of lung cancers in men and 40% in women would be explained by smoking, equivalent to 1926 per year, being recommended to conduct brief counseling according to the Clinical Guidelines for the Treatment of Smoking in Chile 2017, and if it is not possible to refer all smokers with cancer to smoking cessation therapy that may be by telephone Salud Responde, MINSAL 6003607777, the number is in the cigarette packets.

Tabaquismo y diabetes mellitus: evidencia científica e implicancias en salud pública / Smoking and diabetes mellitus: scientific evidence and public helath implications

Noncommunicable diseases (NCDs) are the leading cause of death and disability worldwide. Among them, diabetes has been identified as the condition causing more disabilities, being blindness, kidney failure and limb amputation the major causes. The literature indicates that these diseases are explained by four factors: unhealthy diet, sedentary lifestyle, tobacco smoking and hazardous alcohol consumption. Of these risk factors, tobacco consumption is being studied lately as a risk condition for diabetes, finding in the international literature several studies that confirm a causal association between both and a dose-response as well. Several mechanisms have been proposed by which the association would be possible, pointing out to a connection with a release of insulin hormone antagonist, a decrease of the insulin sensitivity and high blood levels of FFA, hypotheses that need to be tested in detail. Various international organizations have called for action to prevent NCDs and their risk factors. Among this, the prevention and cessation of tobacco smoking gain great relevance in the country, since the new law protects from exposure to second hand tobacco smoke. At clinical level, one of the challenges that need to be faced is the implementation of smoking cessation programs.

Enfermedades neurológicas complejas. Atención neuropediátrica del Hospital Universitario La Paz, de Madrid / Complex neurological diseases. Neuropediatric care of the Hospital Universitario la Paz of Madrid

La neurología pediátrica es una especialidad pediátrica plenamente implantada en España que se encarga de la atención a los niños y adolescentes con problemas neurológicos. En el Hospital Infantil Universitario la Paz se atienden toda la patología neurológica general disponiendo además de varias unidades multidisciplinarias que atienden problemas neurológicos específicos y también aspectos neurológicos de muchas enfermedades raras. Entre ellas destacan las epilepsias refractarias, neurología neonatal, trastornos del sueño, espasticidad grave, trastornos del movimiento, neurofibromatosis NF1, trastornos del neurodesarrollo, parálisis braquial obstétrica, patología neuromuscular, ataxias hereditarias y paraplejía espática familiar (AU)

The paediatric neurology is a specility paediatric fully operational in Spain that is responsible for the care of children and adolescents with neurological problems. At University Children´s Hospital La Paz will attend all general neurologic pathology also having several multidisciplinary units serving specific neurological problems and neurological aspects of many rare diseases. These include refractory epilepsy, neonatal neurology, sleep disorders, severe spasticity movements disorders, neurofibromatosis NF1, neurodevelopmental disorders, congenital brachial palsy, neuromuscular disease, hereditary ataxias and familial spastic paraplegia (AU)

Episodios de crisis convulsiva y hemiplejía / Episodes of convulsive crisis and hemiplegia

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Cambios neuropsicológicos y neurofisiológicos en la enfermedad de Fahr / Neuropsychological and neurophysiological features of Fahr's disease

BACKGROUND: Fahr's disease (basal ganglia calcification) is characterized by bi hemispherical calcium deposition in basal ganglia, dentate nucleus and semioval center. Its clinical manifestations are a rigid hypokinetic syndrome, mood disorders and cognitive impairment. AIM: To report to the results of a neurological assessment of three siblings with Fahr disease. PATIENTS AND METHODS: Three sisters, aged 55, 56 and 58 years, were studied. All had a rigid hypokinetic clinical picture associated with cerebellar involvement and a cognitive impairment that progressed in 8, 6 and 10 years respectively. Brain CAT scans showed symmetric and extensive calcifications of cerebellar white matter and dentate nuclei, pons, mesencephalon, lenticular nuclei, thalami and semioval centers. Hypoparathyroidism was ruled out. Cognition was assessed with WAIS and Benton tests and Weschler memory scale. The time of reaction to visual stimuli was studied. The processing speed of visual information and the interhemispheric conduction time of such information, were calculated. Cognitive evoked potentials (P 300) were also studied. RESULTS: Cognitive impairment involved verbal and visual-spatial memory, planning, attention and concentration capacities and visual constructive skills. There was a prolongation of reaction time latencies and loss of the normal asymmetry of interhemispheric transmission (without right to left facilitation). P 300 evoked potentials were absent. CONCLUSIONS: These observations suggest that the pathogenesis of cognitive and motor changes in Fahr's disease is based in a dysfunction of cortico basal connections and their interhemispheric relations. This defines a subcortical dementia secondary to mineral deposits in subcortical structures.

[The prevalence of headache in a population of patients with coeliac disease]. / Prevalencia de cefalea en una población de enfermos celíacos.

INTRODUCTION: Headache is the commonest clinical symptom during childhood and adolescence, from a neurologist s point of view. The pathophysiology of migraine and tension headache involve personality and biochemical factors, such as serotonin, which are also common in coeliac disease. OBJECTIVE: To establish the prevalence of headache in children and adolescents with coeliac disease, and any possible relation between these conditions. PATIENTS AND METHODS: We made a randomized selection of 86 patients with coeliac disease. All were on gluten-free diets and had no current gastroenterological symptoms. They had direct interviews and full physical and neurological examinations. The diagnosis of headache was based on criteria of the International Headache Society in 1988. RESULTS: The average age was 12.71 +/- 4.5 years (range 5-24). Headache occurred in 34 (39.5%) of the 86 patients studied. In 18 cases (20.9%) headache was of tension type and in 16 (18.6%) of migraine type. Of the latter, 10 cases had auras and 6 did not. There was no significant sex difference. CONCLUSIONS: An increased prevalence of both migraine and tension headaches was observed in the coeliac patients studied as compared with data published in the literature. In the former patients there was also a lower frequency in histories of migraine in first degree family members. This data is probably related to the personality of the patient or to his family or social circumstances in the case of tension headaches. In the case of migraine it may be due to biochemical factors such as a lowered plasma serotonin, seen both in coeliac disease and in migraine.

[Subcortical dementia in HTLV-I tropical spastic paraparesis. Study of 43 cases]. / Demencia subcortical en paraparesia espástica tropical asociada a HTLV-I: estudio de 43 casos.

BACKGROUND: Central nervous system damage associated to HTLV-I does not limit itself to the spinal cord, but also involves subcortical structures, producing cognitive impairment and behavioral changes which eventually could conform a new form of subcortical dementia. AIM: To study cognitive changes in patients with HTLV-I associated myelopathy. PATIENTS AND METHODS: Forty three patients (31 female) with Tropical Spastic Paraparesis, aged 52 years old as a mean and with a disease lasting a mean of 7.5 years, were studied. The diagnosis was based on clinical, radiological and neurophysiological changes. The virus was identified with ELISA, indirect immunofluorescence, Western Blot or proviral DNA identification. Cognitive assessment was done using the Wechler Adult Intelligence Scale (WAIS) and Benton Visual Retention Test (form D). Patients were grouped according to their motor disability in; 23 patients with independent spastic gait, 11 patients that needed support to walk and 9 patients unable to walk. RESULTS: WAIS test demonstrated cognitive impairment with special deficit in some subtests such as Digit Span, Digit Symbol, Picture Arrangement and Object Assembly. Benton Test also disclosed cognitive impairment. There was a positive relationship between cognitive and motor performance. CONCLUSIONS: At least 50% of patients with Tropical Spastic Paraparesis have certain degree of intellectual and affective impairment.

[New form of subcortical dementia: encephalopathy due to infection with human lymphotropic T virus (HTLV-1). Clinical case]. / Nueva forma de demencia subcortical: encefalopatía por infección del virus linfotrópico T humano (HTLV-I). Caso Clínico.

We report a 45 years old female with a HTLV-I associated myelopathy, followed up for 10 years who, five years ago, developed personality changes and intellectual deterioration, assessed with the Wais-Benton test. She also had alterations in the electroencephalogram and a nuclear magnetic resonance imaging of the brain showed hypodensity in T1 and hyperdensity in T2 subcortical regions. The progression of intellectual impairment was related to an increase in proviral DNA, assessed with polymerase chain reaction.

Progressive spastic paraparesis associated with human T-cell leukemia virus type I (HTLV-I).

Patients with progressive spastic paraparesis (PSP), commonly middle-aged women, are distributed throughout the country of Chile. During the three years from 1987 to 1990, we collected 83 cases of PSP from among 225 patients with various neurological diseases. The clinical picture was of a bilateral pyramidal syndrome, with sensory deficits in only 15.5% of the cases, and a slow illness progression in the majority of them. In patients with PSP, antibody to human T-cell leukemia virus type I (HTLV-I) was analyzed by enzyme linked immunosorbent assay (ELISA) and confirmed by western blot analysis. Forty-five (54.2%) patients were anti-HTLV-I antibody positive in cerebrospinal fluid (CSF) and peripheral blood. Among them, 2 patients had leukemia/lymphoma and one had Sjögren syndrome. In the laboratory study of seropositive PSP, mononuclear pleocytosis was found in 35.7%; there was an abnormal increase of the IgG index in 66.6% and an increase in CD2 in blood and CSF, and CD4 in blood. A delayed latency of somatosensory evoked potentials was observed in 90.9%. The neuropsychological study revealed a WAIS with a mean verbal IQ of 80.7 and a mean performance IQ of 84.8. The most impaired items were digit symbol and digit span. Seven subjects (18.9%) with anti-HTLV-I antibody were found among 37 relatives from 19 anti-HTLV-I positive cases of PSP.

[Experience of the National Autonomous Board for Certification of Medical Specialties]. / La experiencia de la Corporación Nacional Autónoma de Certificación de Especialidades Médicas.

After 6 years of operation of a National (autonomous) Board for Certification of Medical Specialists, the number, distribution and training of medical specialists is analyzed. Problems regarding significant differences in the quality of training and imbalance among different specialties are identified. The medical profession has expressed its confidence and feels supported by the activities of the Board. However, health care deliverers and users in general are expected to increase their support and consideration for the information provided by the Board, in order to fulfill the purpose for which it was established.