Treatment of psoriasis with biologic and non-biologic targeted therapies in patients with latent tuberculosis infection or at risk for tuberculosis disease progression: Recommendations from a SPIN-FRT expert consensus.

Tuberculosis (TB), caused by Mycobacterium tuberculosis, is a significant global health problem. In immunocompetent individuals, the microorganism can remain in a latent, non-contagious form, however, it may become active under conditions of immunosuppression. Tumour necrosis factor (TNF) inhibitors, which are frequently used for the management of immune-mediated disorders like psoriasis, have been associated with a significantly increased risk of reactivating latent TB. Consequently, international guidelines recommend TB screening and preventive treatment before starting anti-TNF therapy. These recommendations have extended to IL-12/23, IL-17, IL-23 and TYK2 inhibitors under a caution principle, despite their different mechanisms of action. However, current evidence suggests that some of these agents are arguably not associated with an increased risk of TB reactivation or development of TB disease after infection, which calls for a critical reassessment of these guidelines. We have conducted a literature search evaluating the risk of TB reactivation associated with these innovative therapies, integrating findings from both randomized clinical trials and real-world evidence. The identified evidence is limited but the low number of identified cases of reactivation with IL-17 and IL-23 inhibitors prompts reconsidering the need for preventive treatment for latent TB in all cases, regardless of biologic class or individual patient's risk of TB reactivation or drug toxicity. This review, along with the clinical insight of a panel of experts on behalf of the SPIN-FRT, led to the development of these consensus recommendations for managing psoriasis treatment in patients with latent TB infection or at risk of TB infection, who are receiving or are intended to receive biologic and non-biologic targeted therapies. These recommendations highlight the need for updates to the existing guidelines, aiming to provide a more differentiated approach that reflects the evolving landscape of psoriasis treatment and its implications for TB management.

Bradicardia asociada a crisis epilépticas: Casos clínicos / Bradycardia during epileptic seizures: Report of two patients

Cardiac rate and rhythm due to autonomic activation, may occur during epileptic seizures. They are probably a consequence of the spreading seizure activity to structures involved in the autonomic control of cardiac rhythm. Sinus tachycardia is the most frequent finding (90 percent). Letal bradycardia is rare and life threatening asystoles require cardiac pacemaker insertion. We report two patients with a right frontal seizure associated to bradycardia, during simultaneous EEG/ECG monitoring. Interictal autonomic function tests showed preserved sympathetic and cardiac vagal responses. Normal interictal autonomic function tests, suggested a transient failure of sympatho-vagal balance.

Uso de CPAP nasal en el largo plazo en síndrome de apnea-hipopnea del sueño / Long-term continuous positive airway pressure (CPAP) use in obstructive sleep apnea

Background: The use of CPAP is the conventional therapy for the Obstructive Sleep Apnea Syndrome (OSAS). Aim To establish the proportion of OSAS patients with CPAP indication who use it in the long-term and to determine predictive factors of adherence. Patients and Methods: Structured survey through personal interview or phone call, applied to all patients who had polisomnographically documented OSAS and CPAP titration at the Pontificia Universidad Católica de Chile Sleep Disorders Center between January 1998 and November 2001. Patients were divided in "Permanent Users" (Group I) and "Non Users" (Group II). Results: Of 440 patients that fulfilled inclusion criteria, 162 (32.8 percent) answered the survey. Seventy percent (114/162) of these patients had used CPAP and 86 percent (98/114) continued to use it at the time of the interview, with a mean follow-up of 12.3 months (Group I 60.5 percent of the interviewed population). Group II included 64 patients (39.5 percent of the interviewed patients). Among the latter, 25 percent (16/64) stopped using CPAP due to intolerance, 25 percent (16/64) could not use it because of economical restrictions, 20.5 percent (13/64) preferred other therapies and 29.5 percent (15/64) merely refused treatment. Predictors of long-term use of CPAP were number of respiratory events (p <0.01), hypersomnolence (p <0.01) and age (p =0.03). Conclusions: Approximately two thirds of patients with OSAS, with an indication for CPAP, continue to use this therapy in the long term in a Chilean population. This figure is similar to other reports from abroad. It is also possible to identify predictive factors for CPAP discontinuation in this population.

La utilización de recursos sanitarios en pacientes infectados por el virus de la inmunodeficiencia humana: creación de una base de datos y obtención de resultados de costes / Health care resources utilization in HIV-infected patients: creation of a data base and cost results

Objetivos: Elaborar y validar una base de datos que permita recoger información acerca de la evolución clínica y el consumo de recursos sanitarios de pacientes infectados por el Virus de la Inmunodeficiencia Humana (VIH). Obtener datos sobre costes de la utilización de recursos a partir de la información recogida durante el proceso de validación. Métodos: Se ha diseñado una base de datos, en soporte informático, que consta de varios apartados: datos demográficos, datos clínicos y datos de utilización de recursos asistenciales. Se han seleccionado 109 pacientes de cinco hospitales españoles y se han seguido durante seis meses (enero a junio de 1997). Los costes de los recursos sanitarios consumidos se han obtenido de la contabilidad analítica de un centro hospitalario y de tarifas oficiales. Resultados: El soporte informático diseñado es un instrumento útil y apropiado para recoger la información de estos pacientes. El coste anual promedio es de 2,5 millones de pesetas, variando, según la fase de la enfermedad, desde 1 millón de pesetas para los asintomáticos, hasta 3,8 millones para los pacientes en fase sida. La comparación de los costes resultantes con otros estudios anteriores muestra un significativo incremento de los costes en los pacientes asintomáticos. Conclusiones: Los resultados constituyen una primera información sobre la utilización de servicios sanitarios por pacientes infectados por el VIH y confirman la viabilidad de trabajar, en un futuro, con el instrumento diseñado. La implantación de un sistema de seguimiento es un imperativo si se desea disponer de un sistema de información rápido y preciso sobre la evolución de variables clínicas y de sus repercusiones económicas en pacientes de una enfermedad de pronóstico incierto y cambiante (AU)

Electroencefalograma poligráfico computarizado continuo en el diagnóstico de convulsiones ocultas en recién nacido de muy bajo peso / Prolonged computarized poligraphic electroencephalogram in the diagnosis of occult convulsions in very low birth weight newborns

El desarrollo de unidades de cuidados intensivos neonatales (UCIN) ha permitido elevar la supervivenvia de recién nacidos de muy bajo peso (RNMBP; menos de 1.500 g al nacer). Este grupo muestra morbilidad neurológica aguda crónica en 35 a 75 porciento de los casos, siendo una de las más frecuentes las convulsiones neonatales. Por otra parte, existe una grave dificultad clínica para reconocer y determinar la naturaleza de eventos episódicos presentes en RNMBP. Un importante obstáculo se debe a que el electrocardiograma (EEG) estándar si bien es útil como pronóstico global, se estima muy insuficiente como método diagnóstico complementario en eventos episódicos, tanto por la limitada duración del muestreo (30 minutos) como por la casi ausencia de actividad irritativa interictal (espigas, puntas) en el neonato. Así un registro ictal es el método definitivo para establecer el caracter comicial o no de un episodio, el que puede obtenerse sólo con monitoreo EEG continuo. El presente estudio analiza monitoreo poligráfico video/EEG computarizado portátil continuo en 52 neonatos hospitalizados en la UCIN del Hospital Clínico de la PUC, 33 prematuros <2kg al nacer (63 porciento, grupo A, RNMBP) y 19 RN >2 kg al nacer (37 porciento, grupo B). Este registro permitió demostrar convulsiones ocultas en un tercio de los RNMBP (33 porciento de los prematuros y ninguno del grupo B), demostrando ser un método diagnóstico de gran utilidad, ya que la precocidad diagnóstica en convulsiones ocultas es esencial para el pronóstico neurológico del recién nacido

Trastorno conductual del sueño REM en dos casos documentados con polisomnogragía / REM sleep behavior disorder: report of two cases

We report a 69 years old male with a parkinsonian syndrome and a 50 years old female without neurological problems who showed violent behavior during REM sleep. Polysomnography showed that both had tonic or phasic muscular activity during REM sleep and a REM sleep behavior disorder was diagnosed. Clonazepam was used in both, with good clinical response. This condition is frequently unrecognized and confused with nightmares, nocturnal delirium or other parasomnias

La red nacional de laboratorios SUMA: soporte tecnológico en el pesquisaje seroepidemiológico del VIH-SIDA en Cuba / SUMA laboratories National Net: technological support for the HIV-AIDS

Formação de um sistema de laboratório semi-automático com um suporte analítico-instrumental sem afetar os critérios de reprudutibilidade estabelecidos para os ensaios clássicos e os níveis essenciais de qualidade interna e externa