Green Synthesis for Carbon Quantum Dots via Opuntia ficus-indica and Agave maximiliana: Surface-Enhanced Raman Scattering Sensing Applications.

In this study, we present an alternative method for synthesizing carbon quantum dots (CQDs) using a green synthesis approach via extracts from Agave maximiliana and Opuntia ficus-indica(Ofi). The extracts from both plants were used as the carbon source for the CQDs. The synthesis method employs mesoporous zeolite 4A as a refractory for the thermal treatment of the samples. Transmission electron microscopy analysis established that the size of the CQDs shows a narrow distribution centered around 2 nm with a maximum size of less than 3 nm for both cases. The CQDs exhibit absorption bands associated with π-π* transitions located around 220 nm. In both cases, photoluminescence (PL) phenomenon was detected by irradiating the samples with a UV wavelength and detecting emissions close to the blue wavelength. Additionally, both kinds of CQDs were tested as surface-enhanced Raman scattering (SERS) substrates against methylene blue (MB), indicating an enhancement associated with ring deformation and stretching modes of the v(C-C) and v(C-N) bonds located around 1400 and 1620 cm-1, respectively. Complementarily, in the framework of density functional theory, H2nC2(2m+1) structures (with n = 3-5 and m = 1-3) were used as a theoretical representation of CQDs in interaction with the MB molecule. It is used for developing the analysis of charge transfer effects between both systems and for specifying elements that generate the SERS effect associated with the chemical enhancement mechanism.

Best practices for the care of pregnant people living with TB.

BACKGROUND: Each year more than 200,000 pregnant people become sick with TB, but little is known about how to optimize their diagnosis and therapy. Although there is a need for further research in this population, it is important to recognize that much can be done to improve the services they currently receive.METHODS: Following a systematic review of the literature and the input of a global team of health professionals, a series of best practices for the diagnosis, prevention and treatment of TB during pregnancy were developed.RESULTS: Best practices were developed for each of the following areas: 1) screening and diagnosis; 2) reproductive health services and family planning; 3) treatment of drug-susceptible TB; 4) treatment of rifampicin-resistant/multidrug-resistant TB; 5) compassionate infection control practices; 6) feeding considerations; 7) counseling and support; 8) treatment of TB infection/TB preventive therapy; and 9) research considerations.CONCLUSION: Effective strategies for the care of pregnant people across the TB spectrum are readily achievable and will greatly improve the lives and health of this under-served population.

Therapeutic drug monitoring of antitubercular agents for disseminated Mycobacterium tuberculosis during intermittent haemodialysis and continuous venovenous haemofiltration.

WHAT IS KNOWN AND OBJECTIVE: There is a lack of data regarding therapeutic drug monitoring (TDM) of antitubercular agents in the setting of continuous venovenous haemofiltration (CVVH). We describe TDM results of numerous antitubercular agents in a critically ill patient during CVVH and haemodialysis. CASE SUMMARY: A 49-year-old man was initiated on treatment for disseminated Mycobacterium tuberculosis. During hospital admission, the patient developed critical illness and required renal replacement therapy. TDM results and pharmacokinetic calculations showed adequate serum concentrations of rifampin, ethambutol and amikacin during CVVH and of rifampin, pyrazinamide, ethambutol and levofloxacin during intermittent haemodialysis. WHAT IS NEW AND CONCLUSION: The presence of critical illness and renal replacement therapy can induce pharmacokinetic changes that may warrant vigilant TDM to ensure optimal therapy. To our knowledge, this is the first report to describe TDM for several antitubercular agents during CVVH in a critically patient with disseminated M. tuberculosis.

Immunopathological evaluation of recombinant mycobacterial antigen Hsp65 expressed in Lactococcus lactis as a novel vaccine candidate.

Bovine tuberculosis (TBB) is a zoonotic disease distributed worldwide and is of great importance for public health and the livestock industry. Several experimental vaccines against this disease have been evaluated in recent years, yielding varying results. An example is the Bacillus Calmette-Guérin (BCG) vaccine, which has been used extensively in humans and tested in cattle showing mixed results related to protection (0-80%) against Mycobacterium bovis. In this study, we used the food-grade bacterium Lactococcus lactis as an expression system for production of mycobacterial protein Hsp65. For this purpose, the construction of a replicable plasmid in strain NZ9000 L. lactis (pVElepr) was conducted, which expressed the Mycobacterium leprae Hsp65 antigen, and was recognized by traded anti-Hsp65 antibodies. The strain NZ9000-pVElepr was applied to calves that were negative to tuberculin test and the immune response was monitored. The results showed that immune response was not significantly increased in calves with NZ9000-pVElepr with respect to control groups, and no injury was observed in any lung or lymph of the calves. Finally, this study suggest that the recombinant NZ9000 strain of L. lactis may protect against the development of M. bovis infection, although studies with longer exposure to this pathogen are necessary to conclude the matter.

Nanowire networks and hollow nanospheres of Ag-Au bimetallic alloys at room temperature.

Due to their physicochemical properties, metallic nanoalloys have potential applications in biomedicine, electrocatalysis and electrochemical sensors, among many other fields. New alternative procedures have emerged in order to reduce production costs and the use of toxic substances. In this study we present a novel low-toxicity synthesis method for the fabrication of nanowire networks (NWNs) and Ag-Au hollow nanospheres. The synthesis process is performed at room temperature without any sophisticated equipment, such as special cameras or furnaces, etc. Transmission electron microscopy showed that the NWNs contain random alloys with a diameter of between 10-13 nm. The radius for the hollow nanospheres is approximately located between 70-130 nm. The absorption bands in the UV-vis spectrum associated with the surface plasmon in Ag-Au bimetallic nanoparticles are highlighted at 385 nm for the NWNs and 643 nm for the hollow nanospheres. The study was performed with low-toxicity substances, such as rongalite, ascorbic acid and sucrose, and showed high efficiency for the fabrication of these types of nanostructures, as well as good stability for long periods of time.

Nivel de estrés del personal de enfermería de la Unidad de Cuidados Intensivos de un hospital clínico universitario / Stress level assessment of the nursing staff in the Intensive Care Unit of a university hospital

El objetivo fue determinar el nivel de estrés laboral en profesionales de enfermería de una unidad de cuidados intensivos de un hospital general universitario y analizar su relación con las distintas variables sociodemográficas y laborales de la muestra estudiada. El diseño de la investigación fue cuantitativo, descriptivo y transversal. La población de estudio fue el personal de enfermería seleccionado mediante muestreo no aleatorio. Como instrumento se utilizó el Job Content Questionnaire. El análisis de datos se realizó con el programa SPSS 20, calculándose media, rango y desviación típica para cada variable, realizándose posteriormente un análisis bivariante respecto a las variables sociolaborales de la muestra. La tasa de participación fue del 80,90% (N = 89). Se registró una media para la dimensión de Apoyo social de 3,13 ± 0,397, para la dimensión de Demandas psicológicas en el trabajo de 3,10 ± 0,384, y para la dimensión de Control sobre el trabajo de 2,96 ± 0,436. En el análisis realizado respecto a las variables sociodemográficas y laborales únicamente resultó significativa la variable categoría profesional, registrando las enfermeras valores superiores en percepción de demandas laborales y control sobre su trabajo en comparación con las auxiliares de enfermería. Como conclusión, resaltamos una percepción moderada de estresores laborales en los profesionales analizados. Entre las fuentes de estrés laboral destacan el escaso control en la toma de decisiones por parte de los profesionales, unido a la exigencia de aprender continuamente cosas nuevas. Por otro lado, el apoyo recibido por los compañeros de trabajo es valorado de manera positiva

The objective was to determine the work stress level among nursing staff in the Intensive Care Unit of a university hospital and to analyse its relationship with the various sociodemographic and working variables of the studied sample. A study was designed using a quantitative, descriptive and cross-sectional approach. The target population of the study was the nursing staff selected by non-random sampling. The instrument used was the Job Content Questionnaire. Data analysis was performed using SPSS 20. The mean, ranges and standard deviation for each of the variables were calculated. A bivariate analysis was also performed on the social and occupational variables of the sample. The participation rate was 80.90% (N = 89). The mean of the Social support dimension was 3.13 ± 0.397, for the Psychological demands at work dimension it was 3.10 ± 0.384, with a mean of 2.96 ± 0.436 being obtained for the Control over the work dimension. In the analysis of sociodemographic and work variables of the sample, only the professional category was significant, with nurses recording higher values in perception of job demands and control over their work compared to nursing assistants. In conclusion, there is a moderate perception of work stress in the analysed group of professionals. Among the sources of stress in the workplace was the low control in decision-making by practitioners, as well as the need to continually learn new things. On the other hand, the support received from colleagues is valued positively by the sample

Effect of short-term estrogen therapy on endothelial function: a double-blinded, randomized, controlled trial.

OBJECTIVE: To evaluate the effect of short-term hormone replacement therapy with 0.625 mg conjugated estrogens daily on endothelial function of healthy postmenopausal women, using flow-mediated dilation (FMD) of the brachial artery. METHODS: We performed a double-blinded, randomized, controlled trial over 3 years. Randomization was performed using computer-generated sorting. All participants were blinded to the use of conjugated equine estrogens (CEE) or placebo and FMD was assessed by a blinded examiner, before and after 28 days of medication. A total of 64 healthy postmenopausal women were selected and randomly assigned into two groups of treatment: 0.625 mg of CEE or placebo. RESULTS: FMD values were statistically different between the groups (p = 0.025): the group receiving CEE showed a FMD value of 0.011 compared to the placebo group (FMD = -0.082). The two groups were additionally evaluated for homogeneity through the Shapiro-Wilk test in respect to variables that could interfere with endothelial function such as age (p = 0.729), body mass index (p = 0.891), and time since menopause (p = 0.724). Other variables were excluded during selection of the participants such as chronic vascular conditions, smoking, and sedentary lifestyle. CONCLUSION: Our results demonstrate that the administration of 0.625 mg CEE for 28 days is effective in improving vascular nitric oxide-dependent dilation assessed by FMD of the brachial artery in postmenopausal women. CLINICAL TRIAL REGISTRATION: NCT01482416.

Embolización de arterias uterinas para manejo de miomatosis: experiencia con 200 pacientes / Uterine arteries embolization for the treatment of leiomyomatosis: experience with 200 patients

Objetivos: Evaluar la eficacia y seguridad de la embolización de arterias uterinas en la reducción del volumen uterino, tamaño de miomas, signos y síntomas relacionados a la enfermedad y la satisfacción del paciente. Diseño: Estudio clínico, retrospectivo y longitudinal. Locación: Instituto de Radiología Intervencionista Brazzini. Participantes: Doscientos pacientes sometidos a EAU bilateral. Intervención: Embolización de arterias uterinas realizado con partículas de polyvinyl alcohol de 355 a 500 μm y micro esferas embolizantes de 500 a 900 micras. El seguimiento fue de tres, seis, doce y hasta setenta y dos meses, que incluyeron ecografías uterinas pre y post embolización, reporte de mejoría sintomatológica por pacientes (EAV 0 a 10), satisfacción postratamiento, complicaciones y datos epidemiológicos relevantes. Resultados: De los 200 pacientes estudiados, los síntomas que impulsaron la consulta fueron, en primer lugar y con 42%, los trastornos menstruales, y en segundo lugar con 17%, la anemia. El tipo de mioma más frecuente fue, con 54%, el mioma intramural. La reducción media en el tamaño uterino y del mioma dominante fue 43,4% y 59%, respectivamente. De las pacientes, 56,5% tenía indicación de histerectomía al llegar a la consulta (N° 113), y de estos, luego del tratamiento, dos pacientes fueron sometidas a este procedimiento (1,02%). Las mujeres refirieron mejoría de sus síntomas en la escala análoga visual (0 a 10) de 6,7 puntos (Pre: 9 puntos, Post: 2,3 puntos). La mayoría (95%) refirió estar satisfecha con el procedimiento realizado. Conclusiones: La EAU redujo el tamaño de los miomas, el tamaño total de útero y como resultado del tratamiento se evidenció una disminución significativa de los síntomas. Las pacientes intervenidas refirieron estar satisfechas con el procedimiento, tenían una mejor calidad de vida y estaban contentas de haber evitado someterse a un procedimiento quirúrgico mayor.

Objectives: To determine safety and efficacy of uterine artery embolization (UAE) for uterine volume reduction, leiomyoma size, symptoms relief and patient satisfaction. Design: Clinical retrospective and longitudinal study. Setting: Brazzini Interventional Radiology Institute. Participants: Two hundred patients who underwent a UAE. Interventions: Bilateral UAE with hydrogel microspheres and polyvinyl alcohol particles sized 500-900 microns were applied to 200 women. Follow-up was from three, six, twelve and up to 72 months, and included pre and post embolization uterine ultrasound, complications, and relevant epidemiological data. Results: The most common symptoms were menstrual abnormalities (42%) and anemia (17%), among others. Most common type of leiomyoma was intramural (54%). Median uterine and dominant fibroid volume reductions were 43.4% and 59%, respectively. Out of the 200 women, 113 had previous indication of hysterectomy, and 2 patients were treated surgically (1.02%). Visual analog scale assessment showed improvements of 6.7 points (0 to 10). 95% of the studied and treated population reported satisfaction with the treatment. Conclusions: UAE reduced uterine total volume and fibroids size, resulting in significant symptom relief. Treated patients reported improvements in quality of life and treatment satisfaction.

[Stress level assessment of the nursing staff in the Intensive Care Unit of a university hospital]. / Nivel de estrés del personal de enfermería de la Unidad de Cuidados Intensivos de un hospital clínico universitario.

The objective was to determine the work stress level among nursing staff in the Intensive Care Unit of a university hospital and to analyse its relationship with the various sociodemographic and working variables of the studied sample. A study was designed using a quantitative, descriptive and cross-sectional approach. The target population of the study was the nursing staff selected by non-random sampling. The instrument used was the Job Content Questionnaire. Data analysis was performed using SPSS 20. The mean, ranges and standard deviation for each of the variables were calculated. A bivariate analysis was also performed on the social and occupational variables of the sample. The participation rate was 80.90% (N=89). The mean of the Social support dimension was 3.13±0.397, for the Psychological demands at work dimension it was 3.10±0.384, with a mean of 2.96±0.436 being obtained for the Control over the work dimension. In the analysis of sociodemographic and work variables of the sample, only the professional category was significant, with nurses recording higher values in perception of job demands and control over their work compared to nursing assistants. In conclusion, there is a moderate perception of work stress in the analysed group of professionals. Among the sources of stress in the workplace was the low control in decision-making by practitioners, as well as the need to continually learn new things. On the other hand, the support received from colleagues is valued positively by the sample.

Short-term tibolone does not interfere with endothelial function: a double-blinded, randomized, controlled trial.

Objective To evaluate the effect of short-term hormone replacement therapy with tibolone 2.5 mg daily on endothelial function of healthy postmenopausal women, using flow-mediated dilation (FMD) of the brachial artery. Methods We performed a randomized, double-blinded, placebo-controlled study. A total of 100 healthy postmenopausal women were randomly allocated to receive tibolone (n = 50) or placebo (n = 50) for 28 days. Measurement of the FMD of the brachial artery was performed before and after the use of tibolone and placebo. Results A total of 31 women completed the study in the tibolone group, and 32 women completed the study in the control group. The results of the FMD measurements obtained from the women in the two groups before treatment were similar (0.018 and 0.091, for tibolone and placebo, p = 0.57). The values of the FMD in women who used tibolone and placebo, before and after the treatment, were similar in both groups. The numbers of women who presented an increase in the values of the FMD in both groups were also similar. Conclusion Our results demonstrate that the administration of 2.5 mg tibolone to healthy postmenopausal women for 28 days does not promote endothelial-dependent vasodilation, measured by FMD of the brachial artery.

Serological Survey of Hantavirus in Inhabitants from Tropical and Subtropical Areas of Brazil

Brazil has reported more than 1,600 cases of hantavirus cardiopulmonary syndrome (HPS) since 1993, with a 39% rate of reported fatalities. Using a recombinant nucleocapsid protein of Araraquara virus, we performed ELISA to detect IgG antibodies against hantavirus in human sera. The aim of this study was to analyze hantavirus antibody levels in inhabitants from a tropical area (Amazon region) in Rondonia state and a subtropical (Atlantic Rain Forest) region in Sao Paulo state, Brazil. A total of 1,310 serum samples were obtained between 2003 and 2008 and tested by IgG-ELISA, and 82 samples (6.2%), of which 62 were from the tropical area (5.8%) and 20 from the subtropical area (8.3%), tested positive. Higher levels of hantavirus antibody were observed in inhabitants of the populous subtropical areas compared with those from the tropical areas in Brazil

Anemia en pacientes ingresados en el Hospital Roosevelt / Anemia in patients admitted to the Roosevelt Hospital

Antecedentes: Según la Organización Mundial de la Salud, la prevalencia mundial de la anemia es de 24.80%.Es frecuente en el paciente hospitalizado y causa de agravamiento de las patologías de base. En Centro América no se han realizado estudios sobre la prevalencia de anemia en pacientes hospitalizados. Metodología: Se realizó un estudio transversal con estadística descriptiva primaria y analítica secundaria, para determinar la prevalencia de anemia y los factores de riesgo en pacientes hospitalizados en el Departamento de Medicina Interna del Hospital Roosevelt, agosto de 2013...(AU)

Background: According to the World Health Organization, the global prevalence of anemia is 24.80%. It is common in hospitalized patients and cause of worsening in the underlying pathologies. In Central America, studies have not been performed on the prevalence of anemia in hospitalized patients. Methodology: A cross-sectional study was performed using descriptive and analytical statistics, to determine the prevalence of anemia and risk factors for patients hospitalized in the Department of Internal Medicine at the Roosevelt Hospital, august 2,013. Results: 117 patients were included in the study of which 64/117 (55%) were female, the average age was 47 years (range 12-92 years), with an average hospital stay of 13 days (range 2 - 44 days). On admission the diagnosis of anemia was documented on the files of 26/117 (22%) patients, according to hemoglobin level at admission 69/117 (58%) and hemoglobin last control 74/117 (63%). It was found that 5 phlebotomy or more a week and a hospital stay longer than 15 days were 70% and 84% higher risk of developing anemia respectively, but without statistical significance. Conclusions: Anemia has a high prevalence in hospitalized patients (63%) and is under diagnosed in the emergency unit of Internal Medicine at the Roosevelt Hospital.(AU)

Diagnostic accuracy and clinical role of rapid C-reactive protein testing in HIV-infected individuals with presumed tuberculosis in South Africa.

OBJECTIVE: To determine the accuracy and role of rapid C-reactive protein (CRP) testing in human immunodeficiency virus (HIV) infected individuals with presumed tuberculosis (TB). DESIGN: We enrolled HIV-infected adults (≥18 years)with a cough of ≥2 weeks and negative sputum smears for acid-fast bacilli in KwaZulu-Natal, South Africa. Participants were evaluated for pulmonary TB (PTB) by a nurse with rapid CRP, and independently by a physician by chest radiograph. Rapid CRP test results were compared with laboratory CRP and sputum sent for confirmation of TB. RESULTS: Among 93 participants, 55 (59%) were female, the mean age was 35 years, and the median CD4 count was 177/mm3. Forty-five (54%) participants were diagnosed with PTB. Diagnostic sensitivity and specificity were respectively 95% (95%CI 74­99) and 51%(95%CI 35­66) for rapid CRP >8 mg/l, 87% (95%CI 73­96) and 53% (95%CI 38­68) for nurse assessment, and 69% (95%CI 52­83) and 76% (95%CI 61­87) for physician examination. Combining a negative rapid CRP(≤8 mg/l) with nurse and physician assessments reduced the post-test probability of PTB from 22% to 6% and from 32% to 6%, respectively. CONCLUSION: Rapid CRP testing helped exclude PTB,and may be a valuable test in assisting nurses and physicians in TB-endemic regions.

HIV-positive patients treated for multidrug-resistant tuberculosis: clinical outcomes in the HAART era.

SETTING: Multidrug-resistant tuberculosis (MDR-TB) and the human immunodeficiency virus (HIV) pose two of the greatest threats to global tuberculosis (TB) control. Given expanding global access to antiretroviral therapy (ART) and second-line TB drugs, more data are needed on experiences treating MDR-TB and HIV co-infection in resource-poor settings. OBJECTIVE: To describe the clinical characteristics, management, outcomes, and factors associated with survival among HIV-positive individuals receiving treatment for MDR-TB. DESIGN: This was a retrospective case series of 52 HIV-positive individuals receiving treatment for MDR-TB in Lima, Peru. We used Cox proportional hazards regression models to identify risk factors for mortality. RESULTS: A total of 31 (57%) of the cohort died on treatment, with the majority of deaths due to MDR-TB. Low baseline weight predicted a three-fold increased rate of death (aHR 3.1, 95%CI 1.5-6.7), while individuals receiving highly active ART experienced a significantly lower rate of death compared to those who were not (aHR 0.4, 95%CI 0.2-0.9). CONCLUSION: Early ART is likely a key component of effective MDR-TB management in co-infected individuals.

Programmatic management of multidrug-resistant tuberculosis: models from three countries.

BACKGROUND: Although multidrug-resistant tuberculosis (MDR-TB) is a major global health problem, there is a gap in programmatic treatment implementation. METHODS: This study describes MDR-TB treatment models in three countries--Peru, Russia and Lesotho-- using qualitative data collected over a 13-year period. RESULTS: A program analysis is presented for each country focusing on baseline medical care, initial implementation and program evolution. A pattern analysis revealed six overarching themes common to all three programs: 1) importance of baseline assessments, 2) early identification of key collaborators, 3) identification of initial locus of care, 4) minimization of patient-incurred costs, 5) targeted interventions for vulnerable populations and 6) importance of technical assistance and funding. Site commonalities and differences in each of these areas were analyzed. CONCLUSIONS: It is recommended that all programs providing MDR-TB treatment address these six areas during program development and implementation.

Detection of hantaviruses in Brazilian rodents by SYBR-Green-based real-time RT-PCR.

Current knowledge of the pathogenic hantavirus indicates that wild rodents are its primary natural reservoir. Specific primers to detect the presence of viral genomes were developed using an SYBR-Green-based real-time RT-PCR protocol. One hundred sixty-four rodents native to the Atlantic Forest biome were captured in São Paulo State, Brazil, and their tissues were tested. The presence of hantavirus RNA was detected in sixteen rodents: three specimens of Akodon montensis, three of Akodon cursor, two of Necromys lasiurus, one of Juliomys sp., one of Thaptomys nigrita, five of Oligoryzomys nigripes, and one of Oryzomys sp. This SYBR Green real-time RT-PCR method for detection of hantavirus may be useful for surveying hantaviruses in Brazil.

Recidiva en intestino delgado de tumor de GIST de bajo riesgo: caso clínico y revisión de la literatura / Recurrence of low risk small bowel GIST tumor: case report and revision of the literature

Gastrointestinal stromal tumors (GIST) are the most common mesenchymatic neoplasm in the digestive tract, representing about 1 percent of malignant gastrointestinal lesions. Seventy to eighty percent are benign according to their size and mitotic index as predictors of malignancy. However, in the presence of relapses in patients with low risk according to the current classification and in light of new adjuvant therapies (Imatinib Mesylate), have defined new parameters for estimation of malignant potential.

Los tumores del estroma gastrointestinal (GIST) son las neoplasias mesenquemáticas más comunes del tracto digestivo representando cerca del 1 por ciento de las lesiones neoplásicas gastrointestinales. El 70 por ciento-80 por ciento de ellas son benignas siendo clasificados según su tamaño e índice mitótico como predictores de malignidad. Sin embargo, ante la presencia de recidivas en pacientes con bajo riesgo según la clasificación actual y a la luz de nuevas terapias adyuvantes (Mesilato de Imatinib), se han definido nuevos parámetros para su estimación de potencial maligno.

[Rendu-Osler-Weber disease as an infrequent cause of stroke]. / Enfermedad de Rendu-Osler-Weber como causa infrecuente de ictus.

INTRODUCTION: Hereditary haemorrhagic telangiectasia, or Rendu-Osler disease, is a congenital vascular disease that is associated with the presence of arteriovenous fistulas that cause paradoxical embolisms. CASE REPORT: An 83-year-old female with clinical signs and symptoms of convulsive attacks and multiple cerebral infarctions in the acute phase. She also presented a history of multiple haemorrhages and iron deficiency anaemia with no clear aetiological causation. A thorough examination of her medical history revealed a family history of haemorrhages and a sister who had been diagnosed with Rendu-Osler disease, which suggested the possible existence of a pulmonary arteriovenous fistula as the aetiological causation of her cerebrovascular disease. Neurovascular Doppler ultrasonography with bubble contrast test was positive, and the presence of the fistula was confirmed by a computerised axial tomographic angiography scan of the lungs. CONCLUSIONS: Rendu-Osler disease is a rare cause of stroke due to the fact that it is usually associated with arteriovenous fistulas that can cause paradoxical embolisms. Neurovascular Doppler ultrasound scanning is useful for detecting these pulmonary fistulas by means of the bubble contrast test, which is a non-invasive test that can be carried out easily by neurologists themselves.

Enfermedad de Rendu-Osler-Weber como causa infrecuente de ictus / Rendu-osler-weber disease as an infrequent cause of stroke

La telangiectasia hemorrágica hereditaria o enfermedad de Rendu-Osler es una enfermedad vascularcongénita que se asocia con la presencia de fístulas arteriovenosas que son causa de embolias paradójicas. Caso clínico. Mujer de 83 años que ingresa con clínica de crisis epilépticas y múltiples infartos cerebrales en fase aguda. Asocia historiaprevia de múltiples hemorragias y anemia ferropénica sin clara causa etiológica. Tras una exhaustiva anamnesis, se descubre historia familiar de hemorragias y una hermana diagnosticada de enfermedad de Rendu-Osler-Weber, lo que sugiere la posible existencia de una fístula arteriovenosa pulmonar como causa etiológica de su enfermedad cerebrovascular. Se realiza Doppler neurovascular con infusión de test de burbujas con resultado positivo, lo cual confirma la presencia de la fístula mediante angiotomografía axial computarizada pulmonar. Conclusión. La enfermedad de Rendu-Osler es una causa poco frecuente de ictus debido a que suele asociar fístulas arteriovenosas que pueden ser causa de embolias paradójicas. El Doppler neurovascular es útil para la detección de estas fístulas pulmonares mediante el test de infusión de burbujas; se trata de unaprueba no cruenta y de fácil realización por parte de los propios neurólogos

Hereditary haemorrhagic telangiectasia, or Rendu-Osler disease, is a congenital vascular diseasethat is associated with the presence of arteriovenous fistulas that cause paradoxical embolisms. Case report. An 83-year-old female with clinical signs and symptoms of convulsive attacks and multiple cerebral infarctions in the acute phase. She also presented a history of multiple haemorrhages and iron deficiency anaemia with no clear aetiological causation. A thoroughexamination of her medical history revealed a family history of haemorrhages and a sister who had been diagnosed with Rendu-Osler disease, which suggested the possible existence of a pulmonary arteriovenous fistula as the aetiological causation of her cerebrovascular disease. Neurovascular Doppler ultrasonography with bubble contrast test was positive, and the presence of the fistula was confirmed by a computerised axial tomographic angiography scan of the lungs. Conclusions. Rendu-Osler disease is a rare cause of stroke due to the fact that it is usually associated with arteriovenous fistulas that can cause paradoxical embolisms. Neurovascular Doppler ultrasound scanning is useful for detecting these pulmonary fistulas by means of the bubble contrast test, which is a non-invasive test that can be carried out easily by neurologists themselves