Clinical characteristics of oral chronic graft-versus-host disease according to the 2014 National Institutes of Health (USA) consensus criteria

Background: Chronic graft-versus-host disease (cGVHD) is a serious and common complication of allogeneic hematopoietic cell transplantation (alloHCT). The oral cavity is the second most common site affected by cGVHD. In 2014, the 2005 National Institutes of Health (NIH) consensus criteria were revised to address areas of controversy. The aim of this study was to evaluate the clinical characteristics of oral cGVHD using the 2014 NIH consensus criteria. Material and methods: The baseline data of oral manifestation of patients, who were diagnosed with oral cGVHD, in the first dental visit were analyzed (n=22). The oral mucosal disease was evaluated by NIH modified Oral Mucosa Rating Scale (OMRS) and Thongprasom sign score. The salivary gland disease and sclerotic disease were determined by the presence of signs and symptoms. The functional impact was assessed by the organ-specific severity score. Results: The median time from transplant to oral cGVHD diagnosis was 11.9 months. White striae with an erosive area was found in 72.7% of the patients. The mean ± SD of NIH modified OMRS was 6.1 ± 3.0. The most common and severely affected site of lichen planus-like features was buccal mucosa. Xerostomia, superficial mucocele and limited mouth opening were found in 18.2%, 9.1%, and 9.1%, respectively, of the patients. Almost all patients (90.9%) had partial limitation of oral intake. There were no significant differences in NIH modified OMRS or organ-specific severity score among the patient characteristic groups. Moreover, there was no association between the oral manifestations of cGVHD and the patient characteristics. Conclusions: The most common oral manifestation of cGVHD was white striae with an erosive area of oral mucosal disease, followed by xerostomia, superficial mucocele, and limited mouth opening. The 2014 NIH consensus criteria for diagnostic and severity assessment are informative and feasible in real-world practice. (AU)

Escala de ictus de los National Institutes of Health adaptada y validada al español / Adapted and validated Spanish version of the National Institutes of Health and stroke scale

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La escala de ictus del National Institute of Health (NIHSS) y su adaptación al español / NIH stroke scale and its adaptation to Spanish

Introducción. En los últimos años la escala de ictus del NIH (National Institute of Health Stroke Scale, NIHSS) se ha convertido en la escala más utilizada para valorar el estado neurológico inicial y final de los pacientes neurovasculares que reciben medicaciones experimentales. Uno de los problemas que plantea su uso en España es la cuestión del idioma, por lo que se hace indispensable la adaptación de esta escala al español. Objetivo. Obtener una versión española de la NIHSS y comprobar que presenta las mismas ventajas y utilidades que la versión original. Métodos. Se obtuvo una traducción al español de la versión original de la NIHSS. La versión española final de los diferentes ítems fue consensuada por todo el equipo de la unidad neurovascular, así como las instrucciones para llevar a cabo cada uno de los ítems. Los listados de palabras y las frases, así como las láminas de los objetos y la empleada para valorar extinción visual se obtuvieron del test de afasia de Boston (adaptado previamente a nuestro idioma). Una vez adaptada la versión española de la NIHSS se han correlacionado las puntuaciones obtenidas durante la fase aguda del ictus con el volumen del infarto cerebral y con la localización de la oclusión arterial. Resultados. Como era previsible, existe una buena correlación entre la situación neurológica del paciente (NIHSS) y la presencia de una oclusión de la arteria cerebral media valorada por doppler transcraneal. Se relaciona de forma significativa (p = 0,001) la situación del doppler basal, de 12, 24 Y 48 h con la NIHSS en cualquier momento. Existe una buena correlación entre la puntuación de la NIHSS y el volumen del infarto cerebral medido mediante tomografía computarizada (n = 72; r = 0,794; P < 0,0001) y mediante dífusión por resonancia magnética (n = 38; r = 0,674; P < 0,001). Conclusión. Esta adaptación de la NIHSS al español permitirá una mayor difusión de la misma, así como su uso rutinario en las unidades de ictus

Introduction: In recent years, the NIH stroke scale (National Institute of Health Stroke Scale, NIHSS) has become the most popular used scale to assess the initial and final neurological status of stroke patients who receive experimental drugs. One of the problems with this scale in our country is the language question, making mandatory to adapt it into Spanish. Objective: To obtain a Spanish version of the NIHSS and verify that it has the same advantages and utilities as the original version. Methods: A Spanish translation of the original version of NIHSS was obtained. The final Spanish version for the different items and the instructions to carry out each one of the items were decided by consensus by the neurovascular unit team. The word list and sentences and the drawings of objects and that used to assess visual extinction were obtained from the Boston aphasia test (adapted previously to our language). Once adapted to the Spanish version, the NIHSS, scores obtained during the acute stroke phase were correlated with the cerebral infarct volumes and with the location of the arterial occlusion. Results: As predictable, there is a good correlation between the neurological situation of the patient (NIHSS) and the presence of middle cerebral artery occlusion assessed by Transcranial Doppler. Doppler situation at baseline, 12, 24 and 48 hours was significantly related (p = 0.001) with the NIHSS at any time. There is a good correlation between the NIHSS score and cerebral infarct volumes measured by computed tomography (n = 72; r = 0.794; p < 0.0001) and by magnetic resonance diffusion- 192 weighted image (n = 38; r = 0.674; p < 0.001). Conclusion: This adaptation of the NIH stroke scale to Spanish will allow wider availability and routine use in the stroke units

Partnerships in technology transfer. An innovative program to enhance biomedical research and global health

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Estudio AREDS y degeneración macular asociada a la edad / AREDS and age-related macular degeneration

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Autocontrol y educación del paciente asmático / Self-care and education for the asthmatic patient

El asma constituye una de las enfermedades crónicas más frecuentes de la edad infantil y aunque supone en la mayoría de los casos una enfermedad leve, su curso crónico, la limitación de actividades que conlleva y la posibilidad de aparición de exacerbaciones graves la convierten en una patología de gran impacto sociosanitario. En los últimos años parece estar produciéndose un incremento tanto de la prevalencia como de la morbilidad y la mortalidad del asma. Por otra parte se conoce que las consecuencias más graves del asma son en gran medida prevenibles y existen desde hace años experiencias de prevención que han demostrado su eficacia en otros países. Numerosos programas de intervención y promoción de la salud en asma han puesto en evidencia que la educación de los pacientes y su inclusión en programas de autocuidados mejora el cumplimiento terapéutico, permite alcanzar mayor calidad de vida, e incide favorablemente en el curso de la enfermedad. En las guías y consensos sobre el tratamiento del asma se insiste en que la educación del paciente debe comenzar en el momento del diagnóstico y debe estar integrada en una asistencia continuada incluyendo a todos los implicados en el tratamiento del paciente: especialista, primaria y enfermería. El clínico debe instruir al paciente sobre la naturaleza del asma, sobre las opciones de tratamiento, e indicar un plan de tratamiento simple pero compatible con un cuidado óptimo, animando a la participación activa. Se puede realizar una educación individualizada pero se manejará también la utilización de recursos educativos adicionales, en grupo, y apoyados en programas establecidos. Para lograr sus objetivos, un programa de salud debe adaptarse a las características epidemiológicas y culturales de la población a la que va dirigido, seleccionando grupos de pacientes lo más homogéneos posible en cuanto a gravedad, edad y características demográficas. Resultan necesarios unos criterios rigurosos a la hora de saber qué tipo de pacientes pueden obtener mayores beneficios de los programas de autocuidados con objeto de rentabilizar al máximo los recursos (AU)

Asthma constitutes one of the most frequent chronic illnesses during infant ages and although is represents a minor illness in the majority of cases, its chronic course, the limitation of activities that it implies and the possibility that serious exacerbations appear, make it a pathology that has great impact on a social-health level. Over the last few years it appears that there is an increase in both the occurrence as well as the morbidity and the mortality of asthma. On the other hand, it is know that the most serious consequences of asthma can, to a large extent, be prevent and we can compare prevention experiences that have been going on for a long time, that have demonstrated their efficiency in other countries. Numerous health control and promotion programmes for asthma have shown that the patients education and their inclusion in programmes on self care improves the therapeutic performance, allowing patients to have a better quality of live and they influence favourably on the course of the illness. The guides and the consensus on the treatment of asthma insist that the education of the patient should start at the moment the illness is diagnosed and that he should be integrated into a continual assistance programme that includes all the people related to the patients treatment, the specialist, the doctors and nurses. The clinic should instruct the patient on the nature of asthma, on the treatment options, and should indicate a treatment plan that is simple, but compatible, with optimum care and encourage an active participation. A personalised education can be carried out but additional education resources will also be involved, in groups, and supported by established programmes. In order to achieve this objectives, the health programme should be adapted to the epidemiological and cultural characteristics of the population it is aimed at, choosing groups of patients that are as homogenous as possible, taking into account the seriousness of the illness, the patients age and the demographic characteristics. It is necessary to use strict criteria when knowing which patients can obtain the greatest benefits from the self care programmes, aiming at making the resources as beneficial as possible (AU)