Validation of the Spanish-language version of the simplified modified Rankin Scale telephone questionnaire.

INTRODUCTION: The modified Rankin Scale (mRS) is the main functional assessment tool used after stroke. The simplified mRS questionnaire (smRSq) has recently been validated in English, and represents a simpler, reliable scale with an excellent reproducibility via telephone. The present study aims to validate a Spanish-language version of the telephone smRSq. METHODS: We conducted a prospective cohort study, assessing 50 patients 3 months after they presented an ischaemic stroke. We assessed the Spanish-language smRSq by telephone and in person, the mRS with a structured interview, the Spanish-language smRSq, and the Stroke Impact Scale-16. Inter-rater reliability, test-retest reliability, construct validity, and criterion validity were assessed. RESULTS: Inter-rater reliability showed strong agreement (k = 0.810); test-retest reliability and criterion validity showed moderate agreement (k = 0.639 and k = 0.759, respectively), and construct validity showed moderate agreement (Spearman correlation coefficient = -0.728). CONCLUSIONS: The Spanish-language telephone smRSq is reliable and simple, and saves time in the functional assessment after a stroke.

Epidemiology and characteristics of ischaemic stroke in young adults in Aragon.

INTRODUCTION: Stroke affects around 15 million people per year, with 10%-15% occurring in individuals under 50 years old (stroke in young adults). The prevalence of different vascular risk factors and healthcare strategies for stroke management vary worldwide, making the epidemiology and specific characteristics of stroke in each region an important area of research. This study aimed to determine the prevalence of different vascular risk factors and the aetiology and characteristics of ischaemic stroke in young adults in the autonomous community of Aragon, Spain. METHODS: A cross-sectional, multi-centre study was conducted by the neurology departments of all hospitals in the Aragonese Health Service. We identified all patients aged between 18 and 50 years who were admitted to any of these hospitals with a diagnosis of ischaemic stroke or TIA between January 2005 and December 2015. Data were collected on demographic variables, vascular risk factors, and type of stroke, among other variables. RESULTS: During the study period, 786 patients between 18 and 50 years old were admitted with a diagnosis of ischaemic stroke or TIA to any hospital of Aragon, at a mean annual rate of 12.3 per 100 000 population. The median age was 45 years (IQR: 40-48 years). The most prevalent vascular risk factor was tobacco use, in 404 patients (51.4%). The majority of strokes were of undetermined cause (36.2%), followed by other causes (26.5%). The median NIHSS score was 3.5 (IQR: 2.0-7.0). In total, 211 patients (26.8%) presented TIA. Fifty-nine per cent of the patients admitted with a diagnosis of ischaemic stroke (10.3%) were treated with fibrinolysis. CONCLUSIONS: Ischaemic stroke in young adults is not uncommon in Aragon, and is of undetermined aetiology in a considerable number of cases; it is therefore necessary to implement measures to improve study of the condition, to reduce its incidence, and to prevent its recurrence.

Síndrome de atrapamiento del nervio cutáneo anterior: una causa de dolor abdominal crónico en niños frecuentemente pasada por alto / Anterior cutaneous nerve entrapment syndrome: a frequently overlooked cause of chronic abdominal pain in children

El síndrome de atrapamiento del nervio cutáneo anterior (ACNES) con frecuencia no se tiene presente enel diagnóstico diferencial del dolor abdominal crónico(DAC).Presentamos el caso de un varón de 11 años conDAC estudiado previamente en servicios de urgencia ydigestivo sin detectar patología orgánica, sugiriéndoseun origen psicosomático. En la exploración mostró doloren la pared abdominal localizado en el área de la ramaterminal del nervio intercostal T11, con signo de Carnettpositivo y respuesta favorable a la inyección con anestésico local en el punto gatillo. Los potenciales evocadossomatosensoriales revelaron neuropatía del nervio delmúsculo recto anterior derecho. Se diagnosticó de ACNES. Como tratamiento se administró en el punto gatillouna inyección subfascial ecoguiada de lidocaína y dexametasona. Tras cuatro meses, permanece asintomático.Para el tratamiento de ACNES en población pediátrica, recomendamos una estrategia terapéutica escalonadacomenzando con inyecciones en el punto gatillo y reservar la neurectomía anterior para cuando estas fracasan.(AU)

Anterior cutaneous nerve entrapment syndrome(ACNES) is often overlooked in the differential diagnosis of chronic abdominal pain (CAP).An 11-year-old boy with CAP previously studied inemergency and digestive services without detectingorganic pathology, suggesting a psychosomatic origin.On examination, he showed pain in the abdominal walllocated to the area of the terminal branch of the T11intercostal nerve, with a positive Carnett’s sign and afavorable response to injection with local anestheticat the trigger point. Somatosensory evoked potentialsrevealed right anterior rectus nerve neuropathy. Hewas diagnosed with ACNES. As treatment, an ultrasound-guided subfascial injection with lidocaine anddexamethasone into the trigger point was administered. After four months, he remains asymptomatic.For the treatment of ACNES in pediatrics patients,a step-up strategy should be applied, starting with trigger point injections of lidocaine and dexamethasoneand reserving anterior neurectomy for those cases withlimited effect of these injections.(AU)

[Anterior cutaneous nerve entrapment syndrome: a frequently overlooked cause of chronic abdominal pain in children].

Anterior cutaneous nerve entrapment syndrome (ACNES) is often overlooked in the differential diagnosis of chronic abdominal pain (CAP). An 11-year-old boy with CAP previously studied in emergency and digestive services without detecting organic pa-thology, suggesting a psychosomatic origin. On examination, he showed pain in the abdominal wall located to the area of the terminal branch of the Th11 intercostal nerve, with a positive Carnett's sign and a favorable response to injection with local anesthetic at the trigger point. Somatosensory evoked potentials revealed right anterior rectus nerve neuropathy. He was diagnosed with ACNES. As treatment, an ultrasound-guided subfascial injection with lidocaine and dexame-thasone into the trigger point was administered. After four months, he remains asymptomatic. For the treatment of ACNES in pediatrics patients, a step-up strategy should be applied, starting with trigger point in-jections of lidocaine and dexamethasone and reserving anterior neurectomy for those cases with limited effect of these injections.

Epidemiology and characteristics of ischaemic stroke in young adults in Aragon. / Epidemiología y características del ictus isquémico en el adulto joven en Aragón.

INTRODUCTION: Stroke affects around 15 million people per year, with 10%-15% occurring in individuals under 50 years old (stroke in young adults). The prevalence of different vascular risk factors and healthcare strategies for stroke management vary worldwide, making the epidemiology and specific characteristics of stroke in each region an important area of research. This study aimed to determine the prevalence of different vascular risk factors and the aetiology and characteristics of ischaemic stroke in young adults in the autonomous community of Aragon, Spain. METHODS: A cross-sectional, multi-centre study was conducted by the neurology departments of all hospitals in the Aragonese Health Service. We identified all patients aged between 18 and 50 years who were admitted to any of these hospitals with a diagnosis of ischaemic stroke or TIA between January 2005 and December 2015. Data were collected on demographic variables, vascular risk factors, and type of stroke, among other variables. RESULTS: During the study period, 786 patients between 18 and 50 years old were admitted with a diagnosis of ischaemic stroke or TIA to any hospital of Aragon, at a mean annual rate of 12.3 per 100 000 population. The median age was 45 years (IQR: 40-48 years). The most prevalent vascular risk factor was tobacco use, in 404 patients (51.4%). The majority of strokes were of undetermined cause (36.2%), followed by other causes (26.5%). The median NIHSS score was 3.5 (IQR: 2.0-7.0). In total, 211 patients (26.8%) presented TIA. Fifty-nine per cent of the patients admitted with a diagnosis of ischaemic stroke (10.3%) were treated with fibrinolysis. CONCLUSIONS: Ischaemic stroke in young adults is not uncommon in Aragon, and is of undetermined aetiology in a considerable number of cases; it is therefore necessary to implement measures to improve study of the condition, to reduce its incidence, and to prevent its recurrence.

Validation of the Spanish-language version of the simplified modified Rankin Scale telephone questionnaire. / Validación del cuestionario simplificado de la escala modificada Rankin (smRSq) telefónico en castellano.

INTRODUCTION: The modified Rankin Scale (mRS) is the main functional assessment tool used after stroke. The simplified mRS questionnaire (smRSq) has recently been validated in English, and represents a simpler, reliable scale with an excellent reproducibility via telephone. The present study aims to validate a Spanish-language version of the telephone smRSq. METHOD: We conducted a prospective cohort study, assessing 50 patients 3 months after they presented an ischaemic stroke. We assessed the Spanish-language smRSq by telephone and in person, the mRS with a structured interview, the Spanish-language smRSq, and the Stroke Impact Scale-16. Inter-rater reliability, test-retest reliability, construct validity, and criterion validity were assessed. RESULTS: Inter-rater reliability showed strong agreement (k=0.810); test-retest reliability and criterion validity showed moderate agreement (k=0.639 and k=0.759, respectively), and construct validity showed moderate agreement (Spearman correlation coefficient=-0.728). CONCLUSIONS: The Spanish-language telephone smRSq is reliable and simple, and saves time in the functional assessment after a stroke.

[Signs predicting early growth of intracerebral haemorrhage in computer tomography without enhancement and mortality]. / Signos predictores de crecimiento precoz de la hemorragia intracerebral en la tomografia computarizada sin contraste y mortalidad.

INTRODUCTION: Intracerebral haemorrhage is associated with high morbidity and mortality, and an increase in its volume in the early phases entails a poorer prognosis. The blend sign, the heterogeneous density, the irregular morphology and a fluid level in the haematoma are related to an early growth of the haematoma. AIM: To determine whether these four characteristics are associated with greater mortality at 7, 30 and 90 days of the occurrence of the intracerebral haemorrhage. PATIENTS AND METHODS: A retrospective cohort study that included all the patients attended in our hospital between 2010 and 2015 for spontaneous intracerebral haemorrhage with a computed tomography brain scan performed in the first six hours following the onset of symptoms. RESULTS: Of the 158 patients included in the sample, 23 (14.6%) presented blend sign; 39 (24.7%), heterogeneity; 53 (33.5%), irregularity; and 33 (20.9%), fluid level. In the bivariate analysis, only heterogeneity and irregularity were associated with increased mortality at 7, 30 and 90 days. In the multivariate logistic regression analysis, previous treatment with an antiplatelet drug, a score on the Glasgow Coma Scale below 13 and irregularity were associated with higher mortality in the first seven days. CONCLUSION: The study shows an association between irregularity of the haematoma and mortality in the first seven days. Irregularity would allow identification of patients with a more unfavourable prognosis; in these cases, strict surveillance, especially of factors related to the growth of the haematoma, could improve their prognosis.

TITLE: Signos predictores de crecimiento precoz de la hemorragia intracerebral en la tomografia computarizada sin contraste y mortalidad.Introduccion. La hemorragia intracerebral esta asociada a una elevada morbimortalidad y su aumento de volumen en fases iniciales conlleva un peor pronostico. El signo de la mezcla, la densidad heterogenea, la morfologia irregular y un nivel liquido en el hematoma se relacionan con un crecimiento precoz del hematoma. Objetivo. Determinar si esas cuatro caracteristicas se asocian a una mayor mortalidad a los 7, 30 y 90 dias de ocurrida la hemorragia intracerebral. Pacientes y metodos. Estudio de cohortes retrospectivo que incluyo a todos los pacientes atendidos en nuestro hospital, entre 2010 y 2015, por una hemorragia intracerebral espontanea con tomografia computarizada cerebral realizada en las primeras seis horas tras el inicio de los sintomas. Resultados. De los 158 pacientes incluidos, 23 (14,6%) presentaban signo de la mezcla, 39 (24,7%) heterogeneidad, 53 (33,5%) irregularidad y 33 (20,9%) nivel liquido. En el analisis bivariante, solo la heterogeneidad y la irregularidad se asociaron a mayor mortalidad a los 7, 30 y 90 dias. En el analisis por regresion logistica multivariante, el tratamiento previo con antiagregante plaquetario, una puntuacion en la escala de coma de Glasgow menor de 13 y la irregularidad se asociaron a una mayor mortalidad en los siete primeros dias. Conclusion. El estudio muestra asociacion entre la irregularidad del hematoma y la mortalidad en los siete primeros dias. La irregularidad permitiria identificar a pacientes con peor pronostico, en los que una vigilancia estricta, especialmente de factores relacionados con el crecimiento del hematoma, podria mejorar su pronostico.

[Association between myasthenia gravis and systemic lupus erythematosus: is it safe to use hydroxychloroquine?] / Asociacion entre miastenia grave y lupus eritematoso sistemico: es seguro el uso de hidroxicloroquina?

TITLE: Asociacion entre miastenia grave y lupus eritematoso sistemico: es seguro el uso de hidroxicloroquina?

Pseudomonas syringae pv. phaseolicola isolated from weeds in bean crop fields.

UNLABELLED: Pseudomonas syringae pv. phaseolicola, the causative agent of halo blight in common bean (Phaseolus vulgaris L.), was isolated from weeds associated with bean crops in Spain. The bacterium was recovered from Fumaria sp, Mercurialis annua, Solanum nigrum and Sonchus oleraceus. Ps. s. pv. phaseolicola had previously been isolated from leguminous plants and S. nigrum, but to our knowledge, this is the first time it was recovered from the other three species. The isolates were phenotypically and genetically characterized, and they were compared with isolates recovered from common beans. Five different genotypic profiles were detected by PmeI-PFGE, two of them being of new description. Weed isolates were as pathogenic on bean plants as bean isolates, but they were not pathogenic on S. nigrum. Regarding the survival of the pathogen in weeds, Ps. s. pv. phaseolicola was isolated from So. oleraceus 11 weeks after the end of the bean crop. These results strongly support the idea of weeds as a potential source of inoculum for halo blight in bean. SIGNIFICANCE AND IMPACT OF THE STUDY: It has traditionally been considered that the main source of inoculum of Pseudomonas syringae pv. phaseolicola causing halo blight disease in Phaseolus vulgaris are the bean seeds, and that the host range of the bacterium is almost restricted to leguminous plants. In this study, the bacterium was recovered from four nonleguminous weed species collected in bean fields, and its permanence in weeds for at least 11 weeks after the harvesting of the beans was demonstrated. We have also proved that the strains isolated from weeds were pathogenic on bean plants. Accordingly, the host range of Ps. s. pv. phaseolicola could be broader than previously thought and weeds appear to be acting as a reservoir of the pathogen until the next crop.