[Haemorrhagic posterior reversible encephalopathy syndrome and COVID-19]. / Síndrome de encefalopatía posterior reversible hemorrágica y COVID-19.

TITLE: Síndrome de encefalopatía posterior reversible hemorrágica y COVID-19.

Fístula arteriovenosa dural intracraneal y hemorragia subaracnoidea perimesencefálica. A propósito de un caso / Intracranial dural arteriovenous fistula and perimesencephalic subarachnoid haemorrhage. A case study

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[Subarachnoid haemorrhage with negative tomographic angiography without vasospasm: is it necessary to perform angiographic controls?] / Hemorragia subaracnoidea con angiotomografía negativa sin vasoespasmo: ¿es necesario realizar controles angiográficos?

INTRODUCTION: In about 15% of cases, the lesion causing subarachnoid haemorrhage (SAH) is not detectable by imaging studies, and some controversy exists as regards how the diagnosis should be performed in these patients. AIM: To analyse the diagnostic performance of digital subtraction angiography (DSA) carried out on a significant cohort of patients with SAH and negative tomographic angiography, without cerebral vasospasm, based on the distribution of bleeding in a simple CT scan. PATIENTS AND METHODS: A retrospective analysis is performed of the centre's radiological database over an eight-year period. The inclusion criteria were patients with SAH of a perimesencephalic or diffuse distribution with a negative tomographic angiography result, without cerebral vasospasm, with at least one DSA control of the brain vessels. RESULTS: A total of 125 patients met the inclusion criteria: 61 had a perimesencephalic SAH and 64 had a diffuse SAH. The first DSA revealed vascular injury in seven patients (5.6%): one was in the perimesencephalic SAH group (1.6% yield) and six in the diffuse SAH group (9.4% yield). A second DSA was performed on 86 patients, a third on 28 and a fourth on five of them. CONCLUSION: The absence of vasospasm in the first DSA performed in patients with SAH and negative tomographic angiography could be a useful criterion for establishing an optimal follow-up protocol in these patients, without exposing them to unnecessary risks and radiation.

TITLE: Hemorragia subaracnoidea con angiotomografía negativa sin vasoespasmo: ¿es necesario realizar controles angiográficos?Introducción. Aproximadamente en un 15% de los casos, la lesión causante de hemorragia subaracnoidea (HSA) no es detectable por estudios de imagen, y existe controversia sobre cómo debe ejecutarse el diagnóstico en estos pacientes. Objetivo. Analizar el rendimiento diagnóstico de las angiografías por sustracción digital (ASD) realizadas en una cohorte significativa de pacientes con HSA y angiotomografía negativa, sin vasoespasmo cerebral, basándose en la distribución del sangrado en la tomografía computarizada simple. Pacientes y métodos. Se realiza un análisis retrospectivo de la base de datos radiológica del centro en un período de ocho años. Los criterios de inclusión fueron pacientes con HSA de distribución perimesencefálica o difusa con resultado negativo en la angiotomografía, sin vasoespasmo cerebral, con al menos un control realizado mediante ASD de los vasos cerebrales. Resultados. Un total de 125 pacientes cumplieron los criterios de inclusión: 61 tenían una HSA perimesencefálica y 64 presentaban una HSA difusa. La primera ASD reveló una lesión vascular en siete pacientes (5,6%): uno de ellos correspondía al grupo de HSA perimesencefálica (rendimiento del 1,6%) y seis al de HSA difusa (rendimiento del 9,4%). Se realizó una segunda ASD en 86 pacientes, una tercera en 28 y una cuarta en cinco. Ninguno de estos estudios reveló la presencia de lesiones causantes de la HSA. Conclusión. La ausencia de vasoespasmo en la primera ASD realizada en pacientes con HSA y angiotomografía negativa podría ser un criterio útil para establecer un protocolo óptimo de seguimiento en estos pacientes, sin exponerlos a riesgos y radiación innecesarios.

Risk scores for type 2 diabetes mellitus in Latin America: a systematic review of population-based studies.

AIM: To summarize the evidence on diabetes risk scores for Latin American populations. METHODS: A systematic review was conducted (CRD42019122306) looking for diagnostic and prognostic models for type 2 diabetes mellitus among randomly selected adults in Latin America. Five databases (LILACS, Scopus, MEDLINE, Embase and Global Health) were searched. type 2 diabetes mellitus was defined using at least one blood biomarker and the reports needed to include information on the development and/or validation of a multivariable regression model. Risk of bias was assessed using the PROBAST guidelines. RESULTS: Of the 1500 reports identified, 11 were studied in detail and five were included in the qualitative analysis. Two reports were from Mexico, two from Peru and one from Brazil. The number of diabetes cases varied from 48 to 207 in the derivations models, and between 29 and 582 in the validation models. The most common predictors were age, waist circumference and family history of diabetes, and only one study used oral glucose tolerance test as the outcome. The discrimination performance across studies was ~ 70% (range: 66-72%) as per the area under the receiving-operator curve, the highest metric was always the negative predictive value. Sensitivity was always higher than specificity. CONCLUSION: There is no evidence to support the use of one risk score throughout Latin America. The development, validation and implementation of risk scores should be a research and public health priority in Latin America to improve type 2 diabetes mellitus screening and prevention.

[Spasticity and progressive ataxia due to vanishing white matter]. / Espasticidad y ataxia progresiva por sustancia blanca evanescente.

TITLE: Espasticidad y ataxia progresiva por sustancia blanca evanescente.

Espasticidad y ataxia progresiva por sustancia blanca evanescente / Spasticity and progressive ataxia due to vanishing white matter

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Encefalopatía hepática: el manganeso también brilla en T1 / Hepatic encephalopathy: manganese also shines in T1

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[Coverage of the 23-valent pneumococcal vaccine in those older than 64 years of age in the region of Castellon and Valencia, Spain]. / Cobertura de la vacuna antineumocócica 23-valente en los mayores de 64 años en el area de Castellón y Valencia.

The different serotypes of Streptococcus pneumoniae isolated from adults aged over 64 years in the Valencia and Castellon health region of Spain from June 1999 to December 2003 were analyzed. A total of 163 strains were evaluated; 58.3% were invasive, 47.24% were from respiratory source, and 4.9% were from exudates. The greatest percentage of samples was obtained from the group of patients aged 65 to 75 years (60.7%), while the lowest percentage was obtained from the group of patients aged over 85 years (10.4%). In the latter group, 53% of the strains were invasive and 29.4% were isolated from sputum. A total of 21 serotypes were identified, with the most common (> 3%) being: serotype 3 (22.1%); serotype 19 (12.9%); serotype 6 (12.3%); serotype 9 (8.6%); serotype 14 (10.4%); serotype 23 (8%); serotype 29 (3.7%); and serotype 18 (3.1%). Serotype 3 was the most common serotype found in all samples, with the exception of exudate, while serotype 23 was not isolated in blood. In this population group, the coverage of the 23-valent vaccine was 88.4%. Serotypes not included in this vaccine but isolated from invasive samples were serotypes 16, 24, 29 and 35. No changes were observed in serotype distribution over the 4-year period of the study. However, it is necessary to continue epidemiological monitoring to determine whether serotype substitution occurs.

Serotipos y sensibilidad antibiótica de Streptococcus pneumoniae en niños del área de Valencia y Castellón: estudio prospectivo multicéntrico / Serotypes and antibiotic susceptibility of Streptococcus pneumoniae in children in the health district of Valencia and Castellón, Spain: a multicenter, prospective trial

Se ha realizado un estudio para conocer los serotipos, la cobertura de la vacuna conjugada heptavalente (VCN 7-v) y la sensibilidad a los antibióticos de Streptococcus pneumoniae aislados en niños (<15 años) del área sanitaria de las provincias de Castellón y Valencia desde junio de 1999 hasta diciembre de 2002. En total se evaluaron 271 cepas, de las cuales el 15,5 por ciento fueron invasoras, el 63,5 por ciento de origen respiratorio y el 22,5 por ciento de exudados conjuntivales y óticos. El 67,2 por ciento de las cepas pertenecían a niños menores de 2 años. La distribución de los serotipos cambia ligeramente con la edad y el origen de la muestra; los más frecuentes fueron 19, 6, 23, 14, 3, 9 y 11, pero en los niños menores de 2 años el orden cambia a 19, 6, 14 y 23, 9, 11 y 3, y en las cepas invasoras es 19, 6, 14, 3 y 23. El 27,2 por ciento de las cepas fueron sensibles a los diez antibióticos probados. Frente a la penicilina, el 50,4 por ciento tuvieron sensibilidad disminuida y el 5,8 por ciento fueron altamente resistentes; el 98,3 por ciento fueron sensibles a la ampicilina y a amoxicilina-ácido clavulánico, y el 80,7 por ciento a la cefuroxima. El 52,5 por ciento fueron resistentes a la eritromicina y el 43,7 por ciento a la clindamicina. Ninguna cepa fue resistente a la rifampicina, la vancomicina, el levofloxacino ni la cefotaxima. Los serotipos más sensibles fueron el 3 y el 11, y los más resistentes el 14 (que siempre fue resistente a un antibiótico), 19, 6 y 23.Según los datos, la cobertura teórica de la VCN 7-v sería del 80,1 por ciento en los niños menores de 2 años y del 73,43 por ciento en los de 0 a 14 años (AU)

[Serotypes and antibiotic susceptibility of Streptococcus pneumoniae in children in the health district of Valencia and Castellón, Spain: a multicenter, prospective trial]. / Serotipos y sensibilidad antibiótica de Streptococcus pneumoniae en niños del área de Valencia y Castellón: estudio prospectivo multicéntrico.

A study was conducted to determine the serotypes, the coverage of the heptavalent conjugate vaccine (VCN 7-v) and the antibiotic susceptibility of Streptococcus pneumoniae in children (<15 years) in the health districts of the provinces of Castellon and Valencia, Spain, from June 1999 to December 2002. A total of 271 strains were evaluated, 15.5% of which were invasive, 63.5% were of respiratory origin and 22.5% were from conjunctival and otitic exudates; 67.2% of the strains were found in children younger than 2 years of age. The distribution of the serotypes showed slight changes according to age and the origin of the sample: the most common serotypes were 19, 6, 23, 14, 3, 9 and 11; however, in children younger than 2 years of age the order changed to 19, 6, 14 and 23, 9, 11 and 3, and in the invasive strains to 19, 6, 14, 3 and 23. A total of 27.2% of the stains were susceptible to the ten antibiotics tested. For penicillin, reduced susceptibility was found in 50.4% and high resistance in 5.8%; 98.3% were susceptible to ampicillin and amoxicillin-clavulanic acid, and 80.7% to cefuroxime; 52.5% were resistant to erythromycin and 43.7% to clindamycin. No strains were resistant to rifampicin, vancomycin, levofloxacin or cefotaxime. The most susceptible serotypes were 3 and 11, and the most resistant was 14 (which consistently showed resistance to an antibiotic), 19, 6 and 23. According to these data, the theoretical coverage of VCN 7-v would be 80.1% in children younger than 2 years and 73.43% in those aged 0-14 years.

[Applications of the polymerase chain reaction (PCR) to the diagnosis of central nervous system infections]. / Aplicaciones de la reacción en cadena de polimerasa (PCR) al diagnóstico de infecciones del sistema nervioso central.

The utility of polymerase chain reaction (PCR) is described for the diagnosis in three patients suffering from central nervous system infections, tuberculous meningitis, herpetic encephalitis and cerebral toxoplasmosis. PCR was performed in the cerebrospinal fluid after processing the specimen by two methods, proteinase K digestion and phenol extraction of DNA. Amplification was realized using primers previously described that amplify specific DNA fragments of each microorganisms (insertion sequence IS6110 of Mycobacterium tuberculosis, B1 gene of Toxoplasma gondii, and DNA polymerase gene of Herpes simplex virus). In all three cases, PCR was positive after amplification of the specimen extracted with proteinase K, as well as when a complete DNA extraction with phenol was realized. In all cases a band of amplified products was observed in agarose gels. In conclusion, in all three patients described, PCR would had allowed the diagnosis in seven hours, and PCR should be consider a rapid sensitive and relatively simple method.

[Measles seroprevalence in the schoolchildren of Valencia. The Measles Study Group]. / Seroprevalencia del sarampión en escolares valencianos. Grupo para el Estudio del Sarampión.

BACKGROUND: People born between 1978 and 1982 were the most affected by measles in the outbreaks occurring in the Valencian Community (Spain) in 1993. This age group has not been systematically immunized against measles and has not suffered the last large measles epidemics. HYPOTHESIS: global seroprevalence against measles in this age group is inadequate to prevent new outbreaks. METHODS: Prospective seroepidemiologic study in a sample of school-attending children, born between 1978 and 1982. Randomized sampling of all classrooms 5th to 8th grade high school of a Health Area; stratification depending on the population of the village (< 5,000, 5,001-20,000, > 20,000 inhabitants). Antecedents of measles immunization and the disease were collected. Measles IgG antibodies were measured by enzyme immunoassay, antibody titers 1:80 or higher were considered protective. RESULTS: Sample of 410 subjects, belonging to 17 classes. Measles antibody prevalence was 80.2% (95% CI: 76.6-83.8%), and was higher in less populated villages (p < 0.03). Immunization status was known in 253 subjects (61.7%). Protective titers were present in 86.1% of the vaccinated and in 68.1% of the non vaccinated (p < 0.001). CONCLUSIONS: There is a large percentage of subjects born between 1978 and 1982 unprotected against measles. Elimination of the disease will not be able unless an extraordinary vaccination campaign to include these subjects is taken.

The utility of polymerase chain reaction (PCR) in the diagnosis of pulmonary tuberculosis.

A fragment of DNA of 123 bp belonging to insertion sequence IS6110, specific of Mycobacterium tuberculosis complex, was amplified by polymerase chain reaction (PCR) of respiratory samples, for the diagnosis of pulmonary tuberculosis. A total of 314 samples (286 sputum and 28 bronchoalveolar lavages) from 242 patients were evaluated by PCR, and the results were compared with the those obtained by acid-fast-stained smears, culture, and clinical diagnosis. Mycobacterium tuberculosis was detected by PCR in 102 of 105 patients with clinical diagnosis of pulmonary tuberculosis. All smear and culture-positive samples were PCR positive. The sensitivity of PCR, culture, and staining was 97%, 88%, and 65%, respectively, and the specificity was 100% in all cases. In ten patients with old residual lesions, but no active disease, M tuberculosis genome was detected by PCR. In our experience, PCR proved to be a useful method for the rapid diagnosis of pulmonary tuberculosis.

[Do patients with duodenal ulcer transmit Helicobacter pylori to their relatives?]. / Los pacientes con úlcera duodenal transmiten el Helicobacter pylori a sus familiares?

The prevalence of IgG antibodies to Helicobacter pylori was determined with an enzyme-linked immunosorbent assay in 80 families who lived together with 40 duodenal ulcer patients in whom Helicobacter pylori had been cultured from a gastric biopsy (34 spouses, 31 children, 10 parents, 4 sisters and 1 brother) and in 112 controls from the same habitat and with similar age. The antibodies were positive in 38.4% of the relatives and in 36.6% of the controls, the difference was not significant. Among spouses of patients, 38.4% of those aged 25-39 years and 66.6% of those aged 40-67 years were positive, whereas controls showed a 29.2% and a 58.3% of positives respectively. The differences between both groups were not significant. Among children, 17.2% were positive and in parents 50%, whereas among controls with a similar age 26.3% and 62.5% respectively were positive. The differences between relatives and controls were not significant. We conclude that in our environment among consanguineous families living together and between spouses, person-to-person spread of Helicobacter pylori does not usually occur or it happens uncommonly.