Neurovascular Complications of Iatrogenic Fusarium solani Meningitis.

A multinational outbreak of nosocomial fusarium meningitis occurred among immunocompetent patients who had undergone surgery with epidural anesthesia in Mexico. The pathogen involved had a high predilection for the brain stem and vertebrobasilar arterial system and was associated with high mortality from vessel injury. Effective treatment options remain limited; in vitro susceptibility testing of the organism suggested that it is resistant to all currently approved antifungal medications in the United States. To highlight the severe complications associated with fusarium infection acquired in this manner, we report data, clinical courses, and outcomes from 13 patients in the outbreak who presented with symptoms after a median delay of 39 days.

Relación entre carga laboral y burnout en enfermeras de unidades de diálisis / Relationship between workload and burnout in nurses in dialysis units

La hemodiálisis requiere personal de enfermería con altos niveles de capacitación por su complejidad tecnológica, las peculiaridades del tratamiento y la necesidad de tomar decisiones relevantes para la seguridad del paciente en breve espacio de tiempo: Esto condiciona que estos profesionales estén expuestos a múltiples estresores que están directamente relacionados con la aparición de síndrome de Burnout. El objetivo de esta revisión fue conocer la relación entre la sobrecarga laboral y los factores que desencadenan la aparición del síndrome Burnout en el personal de enfermería de las unidades de hemodiálisis. La metodología utilizada fue una búsqueda en bases de datos a través de la colección electrónica del Sistema de Bibliotecas de la Pontificia Universidad Católica de Chile. Cuarenta y tres artículos fueron revisados para analizar los predictores descritos en trabajadores de salud, entre los que destacan: sobrecarga laboral, frecuencia y tiempo dedicado a la atención de pacientes, participación en la toma de decisiones, riesgos laborales y riesgo de afectación psíquica y la incorporación constante de nuevas tecnologías y conocimientos. La evidencia apoya que altos niveles de satisfacción con el puesto de trabajo, relaciones interprofesionales colaborativas, trabajo en equipo, respeto al conocimiento y a la experiencia clínica por parte de los directivos, junto a la posibilidad de participar en la toma de decisiones son factores percibidos por las enfermeras/os como protectores de síndrome de Burnout (AU)

Haemodialysis requires highly skilled nursing staff because of its technological complexity, the peculiarities of the treatment and the need to make relevant decisions for the patient’s safety in a short space of time: T his means that these professionals are exposed to multiple stress factors that are directly related to the appearance of burnout syndrome. The purpose of this review was to find out the relationship between excessive workload and the factors that lead to the appearance of burnout syndrome in nursing staff in haemodialysis units. The methodology used was a database search through the electronic collection of the System of Libraries of the Pontifical Catholic University of Chile. Forty-three articles were reviewed to analyse the predictors described in healthcare workers, notable among which were: excessive workload, frequency and time dedicated to patient care, participation in decision making, occupational risks and risk of psychological impact and the constant incorporation of new technologies and knowledge. The evidence supports the view that high levels of job satisfaction, collaborative interprofessional relationships, teamwork, management’s respect for clinical knowledge and experience, together with the possibility of participating in decision making are factors perceived by nurses as protectors against burnout syndrome (AU)

Enfermedad de Hodgkin en otorrinolaringología / Hodgkin’s lymphoma in otorhinolaryngology

Objetivos: Evaluar la implicación de la enfermedad de Hodgkin en patología otorrinolaringológica. Material y métodos: Estudio longitudinal y retrospectivo de pacientes diagnosticados, tratados y controlados por linfoma de Hodgkin (LH) en nuestro centro entre los años 1996 y 2010. Resultados: De cuatrocientos trece individuos atendidos por linfoma, 120 fueron etiquetados de LH (29%). Fueron varones el 76% y se observó mayor incidencia entre los 15-30 años y los 45-60 años. En 84 casos se obtuvo muestra para estudio biópsico procedente de adenopatías, 61 cervicales, mientras que en 15 la muestra fue de origen extranodal. El hallazgo más frecuente en la consulta fueron la presencia de adenopatías cervicales (86%), axilares (68%) y síntomas B (37%). El anillo de Waldeyer sólo se vio afectado en un 4%. La forma histopatológica más frecuente resultó el LH en su variedad clásica con esclerosis nodular (50%), seguido de la decelularidad mixta (28%). Los pacientes fueron más frecuentemente diagnosticados en estadio I (28%) y II (47%). Se detectó recidiva de enfermedad cervical tras terapia oncológica convencional en 17 pacientes, en 7 de los cuales el informe histopatológico había variado. El índice de mortalidad fue del 8%. Los principales factores de mal pronóstico para recidiva de enfermedad fueron las formas con depleción linfocitaria, las adenomegalias mayores de 10 cm y los síntomas B. Conclusiones: Los hallazgos clínicos del LH se relacionan fuertemente con el área de cabeza y cuello obligando a su sospecha en el diagnóstico diferencial de las masas cervicales (AU)

Objectives: To evaluate the implication of Hodgkin’s lymphoma (HL) in Otorhinolaryngology. Patients and methods: A longitudinal retrospective study on patients with HL diagnosed, treated and followed-up in our Centre from 1996 to 2010. Results: From 413 individuals having lymphoma, 120 were labelled as HL (29%). Patients were males in 76% and greater incidence was observed in ages between 15 and 30 years old, as well as between 45 and 60. Samples for biopsy from adenopathies were obtained in 84 cases (61 from the neck), and in 15 its origin was extranodal. The most usual finding at physical exploration was the presence of cervical (86%) and axillary nodes (68%), followed by B symptoms (37%). Waldeyer’s ring was affected in 4%. The most frequent histopathological variety was classic HL with nodular sclerosis (50%) and mixed cellularity (28%). Patients were usually diagnosed at stages I (28%) and II (47%). Recurrence of disease in the neck after conventional oncologic therapies was detected in 17 patients, in 7 of which the pathologic study had varied. Mortality was 8%. The main unfavourable prognostic factors for neoplasm recurrence were lymphocytedepletion variety, lymphadenopathy larger than 10 cm and B symptoms. Conclusions: Clinical HL findings are strongly associated with the head and neck area, making its suspicion obligatory in differential diagnosis on cervical nodes (AU)

[Hodgkin's lymphoma in otorhinolaryngology]. / Enfermedad de Hodgkin en otorrinolaringología.

OBJECTIVES: To evaluate the implication of Hodgkin's lymphoma (HL) in Otorhinolaryngology. PATIENTS AND METHODS: A longitudinal retrospective study on patients with HL diagnosed, treated and followed-up in our Centre from 1996 to 2010. RESULTS: From 413 individuals having lymphoma, 120 were labelled as HL (29%). Patients were males in 76% and greater incidence was observed in ages between 15 and 30 years old, as well as between 45 and 60. Samples for biopsy from adenopathies were obtained in 84 cases (61 from the neck), and in 15 its origin was extranodal. The most usual finding at physical exploration was the presence of cervical (86%) and axillary nodes (68%), followed by B symptoms (37%). Waldeyer's ring was affected in 4%. The most frequent histopathological variety was classic HL with nodular sclerosis (50%) and mixed cellularity (28%). Patients were usually diagnosed at stages I (28%) and II (47%). Recurrence of disease in the neck after conventional oncologic therapies was detected in 17 patients, in 7 of which the pathologic study had varied. Mortality was 8%. The main unfavourable prognostic factors for neoplasm recurrence were lymphocyte depletion variety, lymphadenopathy larger than 10 cm and B symptoms. CONCLUSIONS: Clinical HL findings are strongly associated with the head and neck area, making its suspicion obligatory in differential diagnosis on cervical nodes.

The impact of intensive patient education on clinical outcome in a clinic-based migraine population.

OBJECTIVE: To determine whether the addition of patient education to routine medical management improves the clinical status of migraine patients and reduces their utilization of healthcare resources. BACKGROUND: Optimal migraine management typically requires effective patient education. Such education often is difficult to accomplish in the busy clinic setting. METHODS: One hundred consecutive patients with migraine presenting to an university-based headache clinic were randomized to receive or not receive a standardized course of didactic instruction regarding migraine biogenesis and management. The course consisted of 3 classes taught by lay migraineurs who themselves previously had undergone intensive training. All patients were evaluated initially and at 1, 3, and 6 months by a neurologist blinded as to the results of randomization. Clinical variables examined included headache frequency/severity, migraine disability assessment (MIDAS) scores, patient compliance, presence versus absence of analgesic use/overuse, and headache-related unscheduled visits or phone calls. Comparisons were made between baseline findings and findings at the 6-month follow-up visit, with the change in mean MIDAS score serving as the primary outcome variable. RESULTS: At 6 months the group randomized to receive intensive education exhibited a significantly greater reduction in mean MIDAS score than the group randomized to routine medical management only (24 vs. 14 points; P < .05). Those patients also experienced a reduction in mean headache days per month and a greater reduction in functionally incapacitating headache days per month, exhibited less analgesic overuse and need for abortive therapy, were more compliant with prophylactic therapy prescribed, and made fewer headache-related calls to the clinic or unscheduled visits. CONCLUSION: Intensive education of migraine patients by trained lay instructors may convey significant benefit to those patients and reduce their utilization of healthcare resources.

Predictors of a negative response to topiramate therapy in patients with chronic migraine.

OBJECTIVE: To identify variables predictive of a negative response to prophylactic therapy with topiramate in patients with chronic migraine. BACKGROUND: While certain of the newer antiepileptic drugs (AEDs) have emerged as promising or definitely effective therapies for migraine prevention, we continue to lack biologic or clinical variables predictive of treatment response to these or other widely used prophylactic therapies. METHODS: A consecutive series of 170 patients with IHS-defined migraine who were experiencing 15 or more days of headache per month were treated with topiramate according to a uniform dosing protocol. Variables examined for their potential value in predicting treatment response included age, gender, prior experience with prophylactic therapy, prior experience with divalproex sodium specifically, headache frequency and, if present, duration of chronic daily headache (CDH). A positive treatment response was defined as a 50% or greater reduction in headache days during the second treatment month relative to the patient's pretopiramate baseline. Only patients who completed the treatment phase and achieved the 50 mg BID target dose were analyzed (efficacy analysis). Each variable prospectively selected was evaluated in regards to treatment outcome via a paired t-test, and a multiple regression analysis of all variables subsequently was performed. RESULTS: A total of 116 patients completed at least 60 days of treatment and consequently were available for analysis. In the efficacy analysis, 45 (38.8%) of the 116 responded positively to topiramate. Neither age nor gender influenced treatment response. Those patients with CDH of more than 6 months duration, patients who previously had tried and failed more than three prophylactic agents and patients who previously had failed to respond to divalproex sodium were more likely to be nonresponders, but after multiple regression analysis the only statistically significant predictor of a negative treatment response was CDH of more than 6 months duration (P<.001). CONCLUSIONS: Patients with chronic migraine who are treated with topiramate may respond positively at a rate approaching that reported from placebo-controlled trials involving topiramate or other AEDs administered to less severely afflicted migraineurs. Our analysis suggests that patients with chronic migraine least likely to respond to topiramate would be those with extensive and negative previous experience with prophylactic therapy, previous failure to respond to divalproex sodium, CDH, and, most notably, CDH of more than 6 months duration.