A Novel Digital Educational Strategy Improves Treatment Adherence and Quality of Life in Patients with Multiple Myeloma.

Multiple myeloma, the second most common hematologic malignancy worldwide, is an aggressive disease with high morbidity and mortality rates. Although myeloma remains incurable, new treatments have improved patients' life expectancy and quality of life. However, as these therapies are administered for prolonged and often indefinite periods, their success depends on high treatment adherence and significant patient engagement. This study aimed to evaluate the impact of a novel digital educational strategy on treatment adherence, quality of life, and the development of complications in patients with newly diagnosed myeloma. To this end, a two-arm, randomized, prospective, double-blind study was conducted to compare the conventional educational approach alone or combined with the novel digital strategy. This strategy was based on some principles of the Persuasive Systems Design model and incorporated the educational recommendations of patients and caregivers. Compared to the control group that only received information through the conventional educational approach, patients randomized to the digital strategy showed significantly higher treatment adherence and quality of life, associated with increased functionality and rapid reincorporation into daily routines. The digital strategy empowered patients and caregivers to understand the disease and therapeutic options and helped patients recall treatment information and implement healthy lifestyle habits. These results support that patient-targeted educational strategies can positively influence treatment adherence and thus improve their quality of life.

Individual-specific levels of CTG•CAG somatic instability are shared across multiple tissues in myotonic dystrophy type 1.

Myotonic dystrophy type 1 is a complex disease caused by a genetically unstable CTG repeat expansion in the 3'-untranslated region of the DMPK gene. Age-dependent, tissue-specific somatic instability has confounded genotype-phenotype associations, but growing evidence suggests that it also contributes directly toward disease progression. Using a well-characterized clinical cohort of DM1 patients from Costa Rica, we quantified somatic instability in blood, buccal cells, skin and skeletal muscle. Whilst skeletal muscle showed the largest expansions, modal allele lengths in skin were also very large and frequently exceeded 2000 CTG repeats. Similarly, the degree of somatic expansion in blood, muscle and skin were associated with each other. Notably, we found that the degree of somatic expansion in skin was highly predictive of that in skeletal muscle. More importantly, we established that individuals whose repeat expanded more rapidly than expected in one tissue (after correction for progenitor allele length and age) also expanded more rapidly than expected in other tissues. We also provide evidence suggesting that individuals in whom the repeat expanded more rapidly than expected in skeletal muscle have an earlier age at onset than expected (after correction for the progenitor allele length). Pyrosequencing analyses of the genomic DNA flanking the CTG repeat revealed that the degree of methylation in muscle was well predicted by the muscle modal allele length and age, but that neither methylation of the flanking DNA nor levels of DMPK sense and anti-sense transcripts could obviously explain individual- or tissue-specific patterns of somatic instability.

Experimental Solution of Chitosan and Nanochitosan on Wettability in Root Dentine: In Vitro Model Prior Regenerative Endodontics.

AIMS: To compare the effect of CS and CSnp on the wettability in root dentine with other irrigation protocols with an experimental in vitro model prior regenerative endodontics. Methods and Material. An in vitro experimental study that included eighty hemisected human root distributed into 8 groups: G1- distilled water; G2- 1% NaOCl/17% EDTA; G3- hypochlorous acid 0.025% HOCl, G4- 1% NaOCl/0.025% HOCl/17% EDTA, G5- 0.2 g/100 mL CS, G6- 1% NaOCl/0.2 g/100 mL CS, G7- CSnp, and G8- 1% NaOCl/CSnp. The wettability analysis calculated the contact angle (θ) between a drop of a blood-like and root dentinal surface; topographic characterization with scanning electron microscopy (SEM) quantified the diameter and number of tubules per area; spectroscopy infrared analyses (IR-S) identified chemical changes in the inorganic (phosphate/carbonate) and organic phase (amide/methyl). Statistical analysis: a linear mixed model, Kruskal-Wallis, and Holm-Bonferroni correction (P < 0.05) were used. RESULTS: Significantly higher wettability for G2 (27.1 (P = 0.0001)) was found. A mean value of 67°±°for experimental groups (P = 0.07) was found, and we did not identify differences between them. The SEM identified greater tubular opening and erosion for G4 and greater dentinal permeability per area for NaOCl/CS. IR-S identified dentinal organic integrity with NaOCl-CS/CSnp compared to organic reduction promoted for NaOCl/EDTA. CONCLUSIONS: This in vitro dentin determined an indirect association between the wettability and organic contents. The oxidative effect of NaOCl could be neutralized by CS-CSnp, and consequently, the wettability of the substrate decreases.

Compromiso cardiaco en distrofias musculares: a propósito de un caso / Cardiac involvement in muscular dystrophies: a clinical case

Resumen Para las distrofias musculares no miotónicas como la Distrofia de Duchenne y la Distrofia de Becker, la cardiopatía forma parte inherente de su espectro clínico. La expresión clínica de éstas se puede manifestar con insuficiencia cardíaca des- compensada, arritmias o muerte súbita; gran parte de ellos cursan asintomáticos en el transcurso del tiempo, pero cuando se manifiestan constituyen una de las principales causas de muerte en estos pacientes, por lo que su detección temprana y tratamiento óptimo influyen en gran medida en el pronóstico clínico de estos pacientes. A continuación, se presenta el caso de un paciente en quien se encontró de forma incidental el compromiso cardíaco de uno de estos desórdenes neuromusculares.

Abstract Cardiac involvement in muscular dystrophies: a clinical case For non-myotonic muscular dystrophies such as Duchenne Dystrophy and Becker Dystrophy, heart disease is an inherent part of its clinical spectrum. The clinical expression of these diseases can be manifested with decompensated heart failure, arrhythmias or sudden death; A large part of them are asymptomatic over time, but when they manifest they constitute one of the main causes of death in these patients, so their early detection and optimal treatment greatly influence the clinical prognosis of these patients. The following is the case of a patient in whom the cardiac involvement of one of these neuromuscular disorders was found incidentally.

Efficacy and safety of growing rods in the treatment of scoliosis in children under 10 / Eficácia e segurança de hastes de crescimento no tratamento da escoliose em crianças menores de 10 / Eficacia y seguridad de las barras de alargamiento en el tratamiento de escoliosis en niños menores de 10 años

ABSTRACT Objective: To determine the efficacy and safety of growing rods in the treatment of scoliosis in children aged under 10 years. Methods: A retrospective review of medical records of patients under 10 with scoliosis, treated with growing rods from the period between 1997 and 2012. Results: We identified 35 patients treated with growing rods who met the selection criteria. The average age at the start of treatment was 5.9 ± 2.3 years. Most of the patients (51.4%) showed idiopathic etiology scoliosis. Pre-surgery and post-surgery radiographic change showed a 47.7% reduction in Cobb angle (p>0.001). We identified 8 patients with some complication, the most prevalent being instrumentation failure (22.9%). The only predicting factor for post-operative complications was the total number of lengthenings performed (OR=7.03; CI 95% [1.1-45.4]; p=0.040). Conclusions: Treatment of scoliosis with growing rods in patients aged under 10 achieved a significant reduction in the magnitude of the deformity before final bone fusion. However, the rate of complications is rather high, therefore we recommend reducing the frequency of lengthenings to the minimum needed to maintain correction and longitudinal growth of the spine. Level of Evidence IV; Case series.

RESUMO Objetivo: Determinar a eficácia e segurança de hastes de crescimento no tratamento de escoliose em crianças menores de 10 anos. Métodos: Revisão retrospectiva de prontuários de pacientes menores de 10 anos com escoliose, tratados com hastes de crescimento entre 1997 e 2012. Resultados: Identificamos 35 pacientes, que foram tratados com hastes de crescimento, que satisfizeram os critérios de seleção. A idade média no início do tratamento foi de 5,9 ± 2,3 anos. A maioria dos pacientes (51,4%) apresentou escoliose de etiologia idiopática. A alteração radiográfica pré e pós-operatória mostra uma redução de 47,7% do ângulo de Cobb (p> 0,001). Foram identificados 8 pacientes com alguma complicação, sendo falha de instrumentação a mais prevalente (229%). O único fator preditivo para complicações pós-operatórias foi o número total de alongamentos realizados (OR = 7,03; IC95% [1,1-45,4]; p = 0,040). Conclusão: O tratamento para escoliose em pacientes com menos de 10 anos com hastes de crescimento alcançou uma redução significativa na magnitude da deformidade antes da fusão óssea final. No entanto, a frequência de complicações é bastante alta e, para isso, recomendamos reduzir ao mínimo a frequência de alongamentos, a fim de manter a correção e o crescimento longitudinal da coluna. Nível de Evidência IV; Série de casos.

RESUMEN Objetivo: Determinar la eficacia y seguridad de las barras de alargamiento en el tratamiento de la escoliosis en niños menores de 10 años. Métodos: Revisión retrospectiva de registros médicos de pacientes menores de 10 años con escoliosis, tratados mediante barras de alargamiento entre 1997 y 2012. Resultados: Se identificaron 35 pacientes tratados con barras de alargamiento que satisfacían los criterios de selección. El promedio de edad al inicio del tratamiento fue de 5,9 ± 2,3 años. La mayoría de los pacientes (51,4%) tenían escoliosis de etiología idiopática. El cambio radiográfico prequirúrgico y postquirúrgico mostró reducción del 47,7% en el ángulo de Cobb (p > 0,001). Se identificaron 8 pacientes con alguna complicación, siendo el fallo del instrumental más prevalente (22,9%). El único factor predictor de complicaciones postoperatorias fue el número total de alargamientos realizados (OR = 7,03; IC 95% [1,1-45,4]; p = 0,040). Conclusiones: El tratamiento de la escoliosis con barras de alargamiento en pacientes menores de 10 años logró una reducción significativa de la magnitud de la deformidad antes de la fusión ósea definitiva. Sin embargo, la tasa de complicaciones es bastante alta, por lo cual se recomienda disminuir la frecuencia de alargamientos al mínimo necesario para mantener la corrección y el crecimiento longitudinal de la columna vertebral. Nivel de Evidencia IV; Serie de Casos.

Complicaciones postoperatorias del manejo quirúrgico de escoliosis / Post-operative complications after surgical management of scoliosis

Introducción La tasa de complicaciones en cirugía de escoliosis sigue siendo alta. Lo que buscamos con este estudio es saber que características de los pacientes se relacionan con la presentación de complicaciones perioperatorias y poder usar esta informacion para la toma de medidas preventivas. Materiales y métodos Estudio descriptivo de corte transversal retrospectivo. Se incluyeron pacientes con escoliosis llevados a cirugía para corrección de su deformidad, obteniendo 230 pacientes y 318 procedimientos. Variables sociodemográficas fueron evaluadas con medidas de tendencia central, posteriormente se realizó un análisis bivariado y finalmente un análisis de regresión logística multinomial. Resultados Con una p<0,005 se encontró por diagnostico: escoliosis neuromuscular y sindromática un 28,8 y 16,66% de neumonías y una prevalencia de 15,87 y 33,33% de derrame pleural respectivamente. Escoliosis Congénita 1,88% tuvo Infección de vías urinarias. Se realizó un modelo de regresión logística obteniendo a la edad como principal predictor para presentación de complicaciones, siendo más frecuentes en los pacientes más jóvenes (p<0,000). Discusión Se encontró que a menor edad mas frecuente era la presentación de complicaciones, resultado no reportado previamente, pero que sirve para respaldar la conducta conservadora en pacientes con escoliosis de inicio temprano. Las complicaciones mas comunes fueron las pulmonares. Escoliosis neuromuscular es el diagnostico que mas complicaciones reportó. Datos comparables con la literatura que se deben tener en cuenta para tomar medidas de prevención y el desarrollo de planes de mejoramiento.

Background The rate of complications in scoliosis surgery remains high. This study intends to determine the characteristics of the patients that are related to the presentation of perioperative complications, and to be able to use this information to take preventive measures. Material and Method Descriptive cross-sectional retrospective study, including 230 patients and 318 procedures, was conducted on patients with scoliosis who underwent surgery to correct their deformity. Socio-demographic variables were evaluated using measures of central tendency measurements, followed by a bivariate analysis, and finally a multinomial logistic regression analysis. Results A significance of P<.005 was found for diagnosis: neuromuscular and syndromic scoliosis presented with 28.8 and 16.66% of pneumonias, and a prevalence of 15.87 and 33.33% for pleural effusion, respectively. A urinary tract infection (1.88%) was observed in Congenital Scoliosis. A logistic regression model was performed, observing age as the main predictor for presenting with complications, and being more frequent in younger patients (P<.000). Discussion It was found that more complications were present in younger patients. This outcome has not been previously reported, but can be used to support conservative behaviour in patients with early-onset scoliosis. The most common complication was pulmonary, with neuromuscular scoliosis being the diagnosis with more complications reported. These data are comparable with those in the literature, and should be taken into account when taking preventive measures and for the development of improvement plans.

Evaluation of the veptr system in the management of spinal deformities between 2008 and 2014 at the roosevelt institute / Avaliação do sistema veptr no tratamento das deformidades espinais entre 2008 e 2014 no instituto roosevelt / Evaluación del sistema veptr en el manejo de deformidades espinales entre 2008 a 2014, en el instituto roosevelt

ABSTRACT Objective: Traditional surgical treatments, such as on-site fusion and hemiepiphysiodesis, have not addressed chest deformity in its three dimensions, and are usually insufficient and unpredictable for the management of congenital and neuromuscular scoliosis. The application of the Vertical Expandable Prosthetic Titanium Rib (VEPTR) is a technique developed to treat early-onset progressive scoliosis that elongates the spine and thoracic wall, allowing adequate lung development. Methods: A case series retrospective study was conducted. We included 23 patients, including fifteen females and eight males diagnosed with congenital and neuromuscular scoliosis, who were treated with VEPTR type implants between January 2008 and May 2014. We obtained data about the implant and pre and postoperative radiographic images to assess the magnitude of the curve, and we measured the Cobb angle and length after lengthening, as well as evaluating the complications found. Results: There was an improvement in the postoperative Cobb angle. In patients with congenital scoliosis, deformity correction was 8.6% (p=0.014), and in neuromuscular scoliosis, we observed deformity correction of 19.5% (p=0.009). Likewise, we found gains in thoracic height through the device, which results in an average 10% lengthening of the spine in congenital scoliosis. In this study, we identified complications such as material migrations, rib synostosis, pressure zones, rib fracture, hemothorax, and deep wound infection. Conclusion: The natural history of progressive spinal deformity was improved in most of the minors, through the use of VEPTR. This allows us to continue managing patients in the future, in order to make a deeper assessment of its performance in treatment of early onset scoliosis. Level of Evidence III; Therapeutic studies - Investigating the results of a treatment.

RESUMO Objetivo: Os tratamentos cirúrgicos tradicionais, como a fusão no local e o hemiepifisiodese, não abordam a deformidade torácica em suas três dimensões e, em geral, revelam-se insuficientes e imprevisíveis para o tratamento da escoliose congênita e neuromuscular. A aplicação de Rib Vertical de Titânio Protético Expansível (VEPTR) é uma técnica desenvolvida para tratar a escoliose progressiva de início precoce, que alonga a parede da coluna e do tórax, permitindo um desenvolvimento pulmonar adequado. Métodos: Foi realizado um estudo retrospectivo de série de casos. Foram incluídos 23 pacientes, incluindo quinze mulheres e oito homens diagnosticados com escoliose congênita e neuromuscular, que foram tratados com implantes do tipo VEPTR entre janeiro de 2008 e maio de 2014. Foram obtidos dados sobre o implante; imagens radiográficas pré e pós-operatórias para avaliar a magnitude da curva e medimos o ângulo de Cobb e o comprimento após o alongamento, assim como avaliamos as complicações encontradas. Resultados: Melhora no ângulo pós-operatório de Cobb. Nos pacientes com escoliose congênita, a correção da deformidade foi de 8,6% (p = 0,014), e na escoliose neuromuscular observamos uma correção da deformidade de 19,5% (p = 0,009). Da mesma forma, encontramos ganhos na altura torácica através do dispositivo, o que resulta em uma média de 10% de alongamento da coluna vertebral na escoliose congênita. Neste estudo, identificamos complicações como migração de material, sinostose de costelas, zonas de pressão, fratura de costela, hemotórax e infecção profunda da ferida. Conclusão: A história natural da deformidade da coluna vertebral progressiva melhorou na maioria dos menores, através do uso de VEPTR. Isso nos permite continuar administrando pacientes no futuro, a fim de fazer uma avaliação mais profunda de seu desempenho no tratamento da escoliose de início precoce. Nível de evidência III; Estudos terapêuticos - Investigação dos resultados do tratamento.

RESUMEN Objetivo: Los tratamientos quirúrgicos tradicionales, como la fusión in situ y la hemiepifisiodesis no abordan la deformidad torácica en sus tres dimensiones y, en general, resultan insuficientes e impredecibles para el tratamiento de la escoliosis congénita y neuromuscular. El uso del sistema VEPTR (prótesis vertical expansible de titanio) es una técnica desarrollada para tratar la escoliosis progresiva de inicio temprano alargando la pared de la columna y del tórax, que permite el desarrollo pulmonar adecuado. Métodos: Se realizó un estudio retrospectivo de serie de casos. Se incluyeron 23 pacientes, quince mujeres y ocho hombres con diagnóstico de escoliosis congénita y neuromuscular, tratados con implante tipo VEPTR entre enero de 2008 y mayo de 2014. Se obtuvieron datos sobre el implante e imágenes radiográficas pre y posoperatorias para evaluar la magnitud de la curva, y se midieron el ángulo de Cobb y la longitud luego del alargamiento, así como evaluamos complicaciones encontradas. Resultados: Se demostró mejoría en el ángulo de Cobb postoperatorio. En los pacientes con escoliosis congénita, la corrección de la deformidad fue del 8,6% (p = 0,014) y en la escoliosis neuromuscular, observamos corrección del 19,5% (p = 0,009). De la misma forma, encontramos aumentos en la altura torácica con el dispositivo, lo que resulta en un alargamiento promedio del 10% de la columna vertebral en escoliosis congénita. En este estudio, identificamos complicaciones como migración de material, sinostosis de costillas, zonas de presión, fractura de costillas, hemotórax e infección profunda de la herida. Conclusión: La historia natural de la deformidad progresiva de la columna vertebral mejoró en la mayoría de los niños con el uso del VEPTR. Esto nos permite seguir tratando pacientes en el futuro, a fin de hacer una evaluación más profunda de su desempeño en el tratamiento de la escoliosis de inicio temprano. Nivel de evidencia III; Estudios terapéuticos - Investigación de los resultados del tratamiento.

Outcomes and complications of S2 alar iliac fixation technique in patients with neuromuscular scoliosis: experience in a third level pediatric hospital.

BACKGROUND: Multiple techniques are utilized for distal fixation in patients with neuromuscular scoliosis. Although there is evidence of benefit with S2 alar iliac (S2AI) fixation, this remains controversial. The objective of this study is to evaluate the radiological outcomes and complications associated with this surgical technique in a pediatric population. METHODS: An observational retrospective case series study was performed. All pediatric patients between January 2011 and February 2014 diagnosed with neuromuscular scoliosis associated with pelvic obliquity, which required surgery with fixation unto S2AI, were included. Clinical, radiological findings, and adverse events were presented with measures of central tendency. Comparison of deformity correction was carried out using a non-parametric analysis for related samples (Wilcoxon signed-rank test). Significance was set at P<0.05. RESULTS: A total of 31 patients diagnosed with neuromuscular scoliosis that met inclusion criteria were analyzed. The leading cause of neuromuscular scoliosis in 23 (74.2%) patients was spastic cerebral palsy (CP). The correction of pelvic obliquity in the immediate postoperative period was of 76%, which is statistically significant. The extent of correction that patients maintained at the end of the follow-up was analyzed, and it was found that there were no significant differences in this magnitude, compared with the immediate postoperative pelvic obliquity. The mean follow-up time was 9±7 months. Regarding postoperative adverse events, occurred in 64.5% of patients, the most common outcome was pneumonia (14.8%). The overall rate of complications related to instrumentation was low (1.9%), which corresponds to one patient with an intra-articular screw in the left hip that required repositioning. CONCLUSIONS: S2AI fixation for the treatment of neuromuscular scoliosis is a safe alternative, in which the onset of adverse events is related to the comorbidities of patients instead of the surgical procedure itself. An approximate correction of 76% of pelvic obliquity is maintained during the follow-up.

Bilateral C1 laminar hooks combined with C2 pedicle screw fixation in the treatment of atlantoaxial subluxation after Grisel syndrome.

BACKGROUND CONTEXT: Many etiologies can lead to atlantoaxial subluxaion. In Grisel syndrome (GS), this subluxation occurs spontaneously after inflammatory processes of the head and neck. Diagnosis is typically based on clinical history and a strong suspicion of this syndrome. Nonsurgical treatment most often resolves the symptoms; however, in some cases surgical treatment is necessary to repair the subluxation. Various surgical techniques and instrumentation systems have been used to treat atlantoaxial subluxation, although there is no consensus regarding the best treatment method for the pediatric population. PURPOSE: To describe a case of atlantoaxial subluxation in a child with GS treated surgically with an alternative construct. STUDY DESIGN/SETTING: This is a case report and literature review. MATERIALS AND METHODS: Our case study involves a 5-year-old girl with a 6-month history of unresolved Fielding type II atlantoaxial subluxation caused by GS. Despite conservative treatment, the patient's symptoms continued to progress. After two failed closed reduction attempts, open reduction and C1-C2 fusion were performed with atlas laminar hook and axis pedicle polyaxial screws. A literature review of the surgical treatment of GS was also performed. RESULTS: After surgery, the patient exhibited full clinical and functional recovery with complete resolution of symptoms. At the 36-month follow-up examination, there was continual evidence of satisfactory reduction and fusion. No complications were observed. Upon completion of the literature review, eight GS cases were found to have been treated surgically with the minimum patient age being 9 years. CONCLUSIONS: Conservative management of GS is the most common and effective treatment; however, a few surgical cases have been reported in the literature with good results. Satisfactory clinical results and fusion at 36 months post surgery were seen in a pediatric patient with atlantoaxial subluxation and instability using atlas laminar hook and axis pedicle polyaxial screws.

Lignin as a Binder Material for Eco-Friendly Li-Ion Batteries.

The industrial lignin used here is a byproduct from Kraft pulp mills, extracted from black liquor. Since lignin is inexpensive, abundant and renewable, its utilization has attracted more and more attention. In this work, lignin was used for the first time as binder material for LiFePO4 positive and graphite negative electrodes in Li-ion batteries. A procedure for pretreatment of lignin, where low-molecular fractions were removed by leaching, was necessary to obtain good battery performance. The lignin was analyzed for molecular mass distribution and thermal behavior prior to and after the pretreatment. Electrodes containing active material, conductive particles and lignin were cast on metal foils, acting as current collectors and characterized using scanning electron microscopy (SEM), electrochemical impedance spectroscopy (EIS) and galvanostatic charge-discharge cycles. Good reversible capacities were obtained, 148 mAh·g-1 for the positive electrode and 305 mAh·g-1 for the negative electrode. Fairly good rate capabilities were found for both the positive electrode with 117 mAh·g-1 and the negative electrode with 160 mAh·g-1 at 1C. Low ohmic resistance also indicated good binder functionality. The results show that lignin is a promising candidate as binder material for electrodes in eco-friendly Li-ion batteries.

The effect of platelet-altering medications on bleeding from minor oral surgery procedures.

PURPOSE: This study was performed to assess the extent of bleeding from minor oral surgical procedures in patients taking platelet-altering medications. They were compared with patients who were not taking platelet-altering medicines to assess differences in extent of blood loss. MATERIALS AND METHODS: A prospective observational study design was used to quantitatively assess the amount and severity of bleeding encountered with dentoalveolar surgery in 2 groups. The experimental group consisted of people taking therapeutic doses of platelet-altering medications, and the control group was composed of patients who had not taken a platelet-altering medication for at least 10 days prior to surgery. Surgical blood loss was measured, and the groups were compared for statistically significant differences in blood loss. RESULTS: There was no difference in blood loss detected between the experimental or control groups. No bleeding complications were encountered. CONCLUSION: Our data suggest that patients on aspirin and NSAIDs can safely undergo routine minor outpatient oral surgical procedures without modification of their platelet-altering medication.

Validación de la versión al español del Fibromylia Impact Questionnaire. (FIQ/S) / Validation of the spanish version of the Fibromyalgia Impact Questionnnaire (FIQ)

El test adaptado al habla hispana no retiene las mismas características del cuestionario original americano, ya que se le realizaron ciertas modificaciones teniendo en cuenta nuestras características sociodemográficas. Pero a pesar de estos cambios, se encontró que el FIQ adaptado al español, presenta una confiabilidad y una validez similar a los estudios referebciados anteriormente. Por tento, el FIQ adaptado al español es un instrumento válido y confiable ara medir la alteración funcional y el estado general en pacientes con fibromialgia de habla hispana.

Diagnóstico diferencial entre recurrencia tumoral vs. radionecrosis mediante la utilización del PET / Differential prognosis between cerebral recurrence tumour and radionecrosis through the use of positron emission tomography

Se presenta el caso de un paciente al cual le fue diagnosticado un astrocitoma de lóbulo frontal, el mismo fue resecado quirúrgicamente y recibió como terapia coadyuvante cilos de radioterapia y quimioterapia. Diez meses después en un TAC control se demuestra una lesión sugestiva de recidiva turmoral, por lo cual se decide intervenirlo nuevamente. El reporte de patología evidencia en la biopsia lesiones por radionecrosis. En el presente artículo se revisan las causas, fisiopatología y diagnóstico de esta entidad, así como la utiliad de la Tomografía de emisión de positrones (PET) en la diferenciación de estas. Palabras claves: astrocitoma, tomografía axial, computarizada (TAC), resonancia magnética (RM), tomografía de emisión de positrones (PET), radionecrosis.

Toxoplasmosis en el inmunosuprimido / Toxoplasmosis in immunosupressed patients

La toxoplasmosis cerebral (TC) es la principal causa de lesiones neurológicas en los pacientes infectados por el VIH. Su diagnóstico es de crucial importancia pues el tratamiento es altamente efectivo si es tratada a tiempo. En un estudio reciente se encontró que la prevalencia de anticuerpos IgG anti-Toxoplasma en pacientes colombianos es de 63/100, lo cual demostró la alta exposición a Toxoplasma en la población de inmunosuprimidos y la necesidad de enfatizar la profilaxis primaria y secundaria para esta infección. De otra parte la TC fue la primera manifestación de infección por VIH en 66/100 de los pacientes que consultaron el Hospital San Juan de Dios de Santafe de bogota. El tratamiento llevó a la mejoría en 13 casos (73/100) y la mortalidad fue del 27/100. La TC en nuestra población es una complicación frecuente a pesar de contar con profilaxis antibiótica.

Tratamiento de la fase aguda de la toxoplasmosis cerebral con Clindamicina - Falcidar (pirimetamina - sulfadoxina) en pacientes infectados por VIH / Treatment of acute cerebral toxoplasmosis by Clindamicina - Fansidar (pyrimethamine - sulfadiazine) in patients with HIV infected

Objetivos: en Colombia y otros países no se consigue piretamina o sulfadiazina solas. La única combinación disponible es la piremetamina - sulfadoxina (Falcidar) sobre la cual no se han hecho reportes acerca de su uso para toxoplasmosis cerebral. Este estudio revisa los resutlados con la combinación Clindamicina + Falcidar. Diseño y lugar: se estudia retrospectivamente una serie de 18 casos de toxoplasmosis cerebral (TC) atendidos en el Hospital San Juan de Dios en Santafe de Bogotá. Colombia, durante el periódo de enero de 1995 a marzo de 1999 y que tenían un diagnóstico confirmado de infección por VIH. Resultados: El promedio de edad de los pacientes de 35 años (rango: 24 - 46); 16 casos fueron hombres y 2 mujeres. La TC fue la primera manifestación de SIDA en 66 por ciento de los pacientes. La serología IgG anti-toxoplasma por inmunofluorescencia indirevta se realizó en 16 casos, fue positiva en 15(93 por ciento). El tratamiento llevo a mejoría clínica completa de 13 de 15 casos que no murieron (86 por ciento). Tres casos fallecieron pero estos fue probablemente asociado con lar ga evolución previa. Hubo reacciones alérgicas a las sulfonamidad en 5 casos (27 por ciento), una de ellas como síndrome de Steven - Johnson. Conclusiones: la TC es frecuentemente la primera manifestación de SIDA. La focalización neurológica de alteración de la conciencia, la cefalea y las convulsiones son manifestaciones frecuentes. La IgG anti-toxoplasma es casi siempre positiva, y frecuentemente en títulos altos (>=1:512). El tratamiento con Clindamicina + pirimetamina-sulfadoxina fue efectivo en proporciones semejantes a las reportada en la literatura com pirimetamina-sulfadiazina

VIH/SIDA en el trópico / HIV/AIDS in the tropic

Los cuatro primeros patógenos causantes de mortalidad en los países en desarrollo del trópico son los siguientes: Plasmodium falciparum causante de malaria o paludismo, virus de inmunodeficiencia humana causante del Sindrome de Inmunodeficiencia Adquirida, Mycobacterium tuberculosis causante de tuberculosis y virus del sarampión. Este artículo se centrará sobre los efectos del VIH en las enfermedades consideradas como tropicales y la posible interacción entre estas entidades endémicas en los países en desarrollo. Los efectos del VIH sobre otras infecciones endémicas son los siguientes: 1) facilita la co-infección. 2) Aumenta la razón de enfermedad: infección. 3) Cambia la presentación de la enfermedad. 4) Acelera el curso de la enfermedad. En el caso de las enfermedades tropicales la co-infección del VIH tiene comparativamente escasos efectos sobre su curso clínico y sus efectos epidemiológicos. No se ha encontrado ninguna alteración del curso natural en la mayoría de éstas. Sin embargo, cuando la co-infección está caracterizada por una baja prevalencia, interacciones biológicas débiles, una generalizada dificultad diagnóstica o una baja prioridad para ser investigada, la interacción puede pasar inadvertida. Ciertas entidades oportunistas en el Trópico son más frecuentes que en los países desarrollados: 1) tuberculosis. 2) Diarrea crónica. 3) Fiebre prolongada de origen desconocido. 4) Sindrome de emaciación. 5) Enfermedades pulmonares

Valor diagnóstico de la medición de IG G, Ig M e IG A en pacientes infectados por VIH / Diagnostic value of IgG, IgM and IgA measure in HIV infected patients

Objetivo: determinar el valor diagnóstico de las pruebas serológicas y IgG, y IgM e IgA anti - toxoplasma en suero de pacientes con o sin toxoplasmosis cerebral. Población: trece pacientes infectados por hiv con toxoplasmosis cerebral (TC) y 17 pacientes infectados por vih sin TC (8 asintomáticos y 9 con otras enfermedades). Metología: se utilizó la prueba de inmunofluorescencia indirecta para IgG anti - toxoplasma (IFI - IgG) y la prueba de ISAgA para estudiar el IgM e IgA anti - toxoplasma. Resultados: la prueba IFI - IgG fue positiva en el 100 por ciento de los casos con TC a nivel de los títulos fue mayor en los pacientes con TC quye aquellos sin TC (mediana 2048 vs 64; p 0,01). La prueba ISAgA IgM fue positiva en 7 de 13 casos de TC y en 2 de 17 sin TC. La medica del puntaje de IgM en pacientes con TC fue de 6 y de 0 en pacientes sin TC (p 0,011). la IgA fue positiva en 11 de 13 casos con TC y en 4 de 17 casos sin TC. La medida de puntaje de IgA en pacientes con TC fue de 9 0 en pacientes sin TC (p 0,011). Conclusiones: estos datos sugieren que los niveles de IgG y la presencia de IgM e IgA anti - toxoplasma son marcadores valiosos para el diangóstico de una TC

Tumores de hipófisis, síndrome de Cushing / Pituitary tumors, Cushing's syndrome

La enfermedad de Cushing, representa para el neurocirujano y el endocrinólogo un reto interesante en su diagnóstico y tratamiento. Se han realizado numerosas investigaciones al respecto, desde que el Doctor Harvey W. Cushing describiera ésta patología como un Sindrome Basofílico en 1932. Los cuatro casos clínicos presentados en este artículo, tienen las características clínicas como hormonales de la clásica Enfermedad de Cushing. Se realizaron pruebas hormonales basales que demostraron, el hipercortisismo, la pérdida del ritmo circadiano de la secreción del cortisol y la supresión parcial con dexametasona en los niveles de cortisol. La región de la Silla Turca fue estudiada por radiografías simples, tomografía axial computarizada y las imágenes por resonancia magnética. Estas últimas demostraron las lesiones tumorales bien delimitadas a nivel de hipofisis. Los tumores fueron resecados pos vía transfrontal con una recuperación adecuada; el análisis histopatológico demostró las características células basófilas sin embargo, en uno de los casos bien documentado, éstas estaban acompañando una mayor cantidad de células nerviosas y fibras nerviosas algunas con aspecto displásico. Algunos tumores que producen esta enfermedad se pueden originar del lóbulo intermedio de la hipofisis.