Severe pulmonary hypertension and circulatory failure associated with Congenital syphilis. Case report.

BACKGROUND: Congenital syphilis is a vertical infection caused by Treponema pallidum. Despite the implementation of preventive strategies during pregnancy, its incidence is increasing, and it constitutes an important public health problem. Most patients with congenital syphilis are asymptomatic; however, a small group may develop severe disease at birth with the need of advanced resuscitation in the delivery room, acute hypoxemic respiratory failure, and hemodynamic instability. Therefore, awareness is needed. METHODS AND RESULTS: This series describes the clinical course of two late preterm infants with congenital syphilis who developed acute hypoxemic respiratory failure, pulmonary hypertension, and circulatory collapse early after birth. Integrated hemodynamic evaluation with neonatologist-performed echocardiography (NPE) and therapeutic management is provided. CONCLUSIONS: A comprehensive hemodynamic evaluation including early and serial functional echocardiography in these patients is needed to address the underlying complex pathophysiology and to help to establish accurate treatment.

Calidad de vida, adherencia y satisfacción en pacientes con fibrilación auricular tratados con dabigatrán o antagonistas de la vitamina K / Quality of life, adherence and satisfaction of patients with auricular fibrillation treated with dabigatran or vitamin K antagonists

Objetivo: Analizar la calidad de vida, la adherencia y la percepción del grado de satisfacción del tratamiento con dabigatrán frente a antagonistas de vitamina K (AVK) en pacientes con fibrilación auricular no valvular (FANV) atendidos en consultas de cardiología en España. Métodos: Estudio observacional, comparativo, prospectivo y multicéntrico en pacientes con FANV atendidos en Cardiología, que iniciaron tratamiento con dabigatrán o AVK en el mes previo a la visita basal. El seguimiento fue de 6 meses. Se analizaron la calidad de vida mediante el cuestionario validado AF-QoL 18 (0: mínimo; 100: máximo), la adherencia mediante el test de Morisky-Green y la percepción del cardiólogo mediante un cuestionario específico (0: completamente insatisfecho; 10: totalmente satisfecho). Resultados: Se analizó a 1.015 pacientes (73,3+/- 9,4 años; 57% varones; CHA2DS2VASc: 3,4+/- 1,5; HAS-BLED: 1,5+/- 1,0), tratados con dabigatrán (74,7%) o con AVK (25,3%). Las puntuaciones totales de calidad de vida se mantuvieron constantes durante el seguimiento (47,9+/- 23,5 basalmente vs. 48,6+/- 24,4 a los 6 meses; p=NS), pero superiores a los 6 meses en el grupo de dabigatrán (50,6+/- 24,7 vs. 42,8+/- 22,5; p<0,001). La adherencia al tratamiento fue elevada durante el estudio, pero superior con dabigatrán a los 6 meses (89,2% vs. 81,1%; p=0,001). Existió una mejor percepción del cardiólogo sobre la satisfacción de los pacientes tratados con dabigatrán a los 6 meses (9,0+/-1,2 vs. 6,6+/-2,2; p<0,001). Conclusiones: En pacientes con FANV y alto riesgo tromboembólico atendidos en consultas de Cardiología, tanto la adherencia como la satisfacción y la calidad de vida fueron superiores en los pacientes tratados con dabigatrán que con AVK

Objective: To analyse the quality of life, adherence and satisfaction of patients with nonvalvular auricular fibrillation (NVAF) treated with dabigatran versus vitamin K antagonists (VKA) in cardiology consultations in Spain. Methods: We conducted an observational, comparative, prospective and multicentre study of patients with NVAF treated in cardiology departments, who started treatment with dabigatran or VKA in the month prior to the baseline visit. The follow-up lasted 6 months. We analysed quality of life (using the validated AF-QoL 18 questionnaire [0, minimum; 100, maximum]), adherence (using the Morisky-Green test) and the cardiologist's perception (using a specific questionnaire [0, completely dissatisfied; 10, completely satisfied]). Results: We analysed 1015 patients (mean age, 73.3+/-9.4 years; 57% men; CHA2DS2VASc, 3.4+/-1.5; HAS-BLED, 1.5+/-1.0) who were treated with dabigatran (74.7%) or with VKA (25.3%). The total quality-of-life scores remained constant throughout the follow-up (47.9+/-23.5 and 48.6+/-24.4 at baseline and at 6 months, respectively; P=NS) but were higher at 6 months for the dabigatran group (50.6+/-24.7 vs. 42.8+/-22.5; P<.001). Treatment adherence was high during the study but greater with dabigatran at 6 months (89.2% vs. 81.1%; P=.001). There was a better perception of the cardiologist regarding the satisfaction of the patients treated with dabigatran at 6 months (9.0+/-1.2 vs. 6.6+/-2.2; P<.001). Conclusions: For patients with NVAF and high thromboembolic risk treated in cardiology consultations, the adherence, satisfaction and quality of life were higher for the patients treated with dabigatran than for those treated with VKA

Quality of life, adherence and satisfaction of patients with auricular fibrillation treated with dabigatran or vitamin K antagonists. / Calidad de vida, adherencia y satisfacción en pacientes con fibrilación auricular tratados con dabigatrán o antagonistas de la vitamina K.

OBJECTIVE: To analyse the quality of life, adherence and satisfaction of patients with nonvalvular auricular fibrillation (NVAF) treated with dabigatran versus vitamin K antagonists (VKA) in cardiology consultations in Spain. METHODS: We conducted an observational, comparative, prospective and multicentre study of patients with NVAF treated in cardiology departments, who started treatment with dabigatran or VKA in the month prior to the baseline visit. The follow-up lasted 6 months. We analysed quality of life (using the validated AF-QoL 18 questionnaire [0, minimum; 100, maximum]), adherence (using the Morisky-Green test) and the cardiologist's perception (using a specific questionnaire [0, completely dissatisfied; 10, completely satisfied]). RESULTS: We analysed 1015 patients (mean age, 73.3±9.4 years; 57% men; CHA2DS2VASc, 3.4±1.5; HAS-BLED, 1.5±1.0) who were treated with dabigatran (74.7%) or with VKA (25.3%). The total quality-of-life scores remained constant throughout the follow-up (47.9±23.5 and 48.6±24.4 at baseline and at 6 months, respectively; P=NS) but were higher at 6 months for the dabigatran group (50.6±24.7 vs. 42.8±22.5; P<.001). Treatment adherence was high during the study but greater with dabigatran at 6 months (89.2% vs. 81.1%; P=.001). There was a better perception of the cardiologist regarding the satisfaction of the patients treated with dabigatran at 6 months (9.0±1.2 vs. 6.6±2.2; P<.001). CONCLUSIONS: For patients with NVAF and high thromboembolic risk treated in cardiology consultations, the adherence, satisfaction and quality of life were higher for the patients treated with dabigatran than for those treated with VKA.

Prevención de riesgos frente a radiaciones no ionizantes en fisioterapia / Risk prevention against nonionizing radiation in physical therapy

El objetivo del presente artículo consiste en actualizar la información normativa y legislativa existente referida al campo de las radiaciones no ionizantes (RNI) y, en concreto, en relación con el ámbito de la fisioterapia. El eje fundamental de éste discurre en torno a las medidas existentes para trabajar en unas condiciones óptimas de protección de la salud.Organizaciones del ámbito nacional e internacional han emitido recomendaciones y directrices para mejorar la seguridad y la salud en el trabajo ante la exposición a RNI. En concreto, la Directiva 2004/40/CE del Parlamento Europeo refleja las disposiciones mínimas de seguridad y salud relativas a la exposición de los trabajadores a riesgos derivados de agentes físicos. En dicho documento se describen los valores límite de la exposición y los valores que dan lugar a una acción.Existen propuestas encaminadas a reducir el riesgo de exposición: sistemas de apantallamiento, gafas de protección, distancias de seguridad, señalización o atención a las normas del fabricante. Por su parte, el empresario se ve directamente implicado, pues tiene la obligación de evaluar, medir y calcular la exposición de sus trabajadores a los campos electromagnéticos.La concienciación del fisioterapeuta, el compromiso del empresario y la aplicación de la normativa vigente suponen tres pilares fundamentales en el largo camino que queda por recorrer hacia la búsqueda de un entorno laboral saludable(AU)

This article aims to up-date the present regulatory and legislative information regarding the field of nonionizing radiations (NIR) and specifically in relationship to the physical therapy setting. Its fundamental axis develops in regards to the existing measures to work under the best conditions for health protection.National and international organizations have issued recommendations and guidelines to improve safety and health at work when exposed to NIR. Specifically, Directive 2004/40/CE of the European Parliament reflects the minimum safety and health stipulations regarding exposure of the workers to risks derived from physical agents. Said documents describe the borderline values of exposure and the values that give rise to an action.There are proposals aimed at reducing risk of exposure: screening systems, protection glasses, safety distances, signs, and attention to manufacturing guidelines. On its part, the employer is directly involved since the employer has the obligation to evaluate, measure and calculate the exposure of its workers to the electromagnetic fields.Making the physiotherapist aware, the commitment of the employer and the application of the existing regulations are three fundamental cornerstones in the long road ahead towards the search for a healthy work setting(AU)

[Lateralization as alternative to static prone decubitus in patients with ARDS]. / Lateralización como alternativa al decúbito prono estático en pacientes con SDRA.

UNLABELLED: According to Phillips, Continuous Lateral Rotation (CLR) or Kinetic Therapy (KT) together with the technological advances obtain some important benefits in mechanically ventilated patients. OBJECTIVE: Compare Static Prone Decubitus (PD) with DP in CRL. PATIENTS AND METHODS: We analyzed 2 groups with a total of 41 patients in the period of January 1998 to April 2003. The DP group (25 patients) remained static and the lateral group (16 patients) in CLR every 2 h. The groups had 56 +/- 16 vs 64 +/- 17 years, 77 +/- 20 vs 71 +/- 23 kg and 24% vs 31% of survival, respectively. RESULTS: We maintained the PD 37 +/- 30 vs 27 +/- 36 h for group 1 and 2. The response as Responders is 68% and 69%. pO2/FiO2 of supine pre-DP to supine post-DP is 79 +/- 21 to 146 +/- 68 versus 80 +/- 20 to 138 +/- 57 and pulmonary compliance 22 +/- 10 to 21 +/- 10 vs 31 +/- 10 to 32 +/- 9. Mean blood pressure of S to S was 87 +/- 16 to 85 +/- 15 vs 82 +/- 10 to 80 +/- 9, and mean Heart rate 108 +/- 21 to 95 +/- 24 vs 85 +/- 32 to 75 +/- 28. Complications by groups were: facial edema of 84% vs 63%, gastric retention 36% to 38%, vomiting/regurgitation 12% to 0%, epistaxis 8% to 31%. Pressure Sore (PS) Incidence decreased from 36% to 12%, together with seriousness. CONCLUSION: We consider that lateralization if PD is a technique comparable to static PD on the respiratory and hemodynamics level. CLR in PD may prevent some complications.

Lateralización como alternativa al decúbito prono estático en pacientes con SDRA / Lateralization as alternative to static prone decubitus in patients with ARDS

Según Phillips1, la continua rotación lateralizada (RCL) o terapia cinética (TC) unida a los avances tecnológicos, obtiene unos importantes beneficios en los pacientes ventilados mecánicamente. Objetivo. Comparar el decúbito prono (DP) estático con el DP en RCL. Pacientes y métodos. Se analizaron 2 grupos con un total de 41 pacientes en el período enero de 1998 hasta abril de 2003. El grupo DP (25 pacientes) permaneció estático y el grupo lateralizado (16 pacientes) en RCL cada 2 h. Los grupos tenían 56 ± 16 frente a 64 ± 17 años, 77 ± 20 frente a 71 ± 23 kg y un 24 frente a un 31% de supervivencia, respectivamente. Resultados. Se mantuvo el DP 37 ± 30 frente a 27 ± 36 h por grupos 1 y 2. La respuesta como respondedores fue del 68 y del 69%. La pO2/FiO2 de supino pre-DP a supino post-DP fue de 79 ± 21 a 146 ± 68 frente a 80 ± 20 a 138 ± 57, y la distensibilidad pulmonar 22 ± 10 a 21 ± 10 frente a 31 ± 10 a 32 ± 9. La presión arterial media de S a S fue de 87 ± 16 a 85 ± 15 frente a 82 ± 10 a 80 ± 9, y la frecuencia cardíaca media 108 ± 21 a 95 ± 24 frente a 85 ± 32 a 75 ± 28. Las complicaciones por grupos fueron: edema facial el 84 frente al 63%; retención gástrica el 36 frente al 38%; vómito/regurgitación el 12 frente al 0%, y epistaxis el 8 frente al 31%. La incidencia de úlceras por presión (UP) se redujo del 36 al 12% junto con la gravedad. Conclusión. Se considera que la lateralización en DP es una técnica equiparable al DP estático respiratorio y hemodinámico. La RCL en DP puede prevenir algunas complicaciones

According to Phillips, Continuous Lateral Rotation (CLR) or Kinetic Therapy (KT) together with the technological advances obtain some important benefits in mechanically ventilated patients. Objective. Compare Static Prone Decubitus (PD) with DP in CRL. Patients and methods. We analyzed 2 groups with a total of 41 patients in the period of January 1998 to April 2003. The DP group (25 patients) remained static and the lateral group (16 patients) in CLR every 2 h. The groups had 56 ± 16 vs 64 ± 17 years, 77 ± 20 vs 71 ± 23 kg and 24% vs 31% of survival, respectively. Results. We maintained the PD 37 ± 30 vs 27 ± 36 h for group 1 and 2. The response as Responders is 68% and 69%. pO2/FiO2 of supine pre-DP to supine post-DP is 79 ± 21 to 146 ± 68 versus 80 ± 20 to 138 ± 57 and pulmonary compliance 22 ± 10 to 21 ± 10 vs 31 ± 10 to 32 ± 9. Mean blood pressure of S to S was 87 ± 16 to 85 ± 15 vs 82 ± 10 to 80 ± 9, and mean Heart rate 108 ± 21 to 95 ± 24 vs 85 ± 32 to 75 ± 28. Complications by groups were: facial edema of 84% vs 63%, gastric retention 36% to 38%, vomiting/regurgitation 12% to 0%, epistaxis 8% to 31%. Pressure Sore (PS) Incidence decreased from 36% to 12%, together with seriousness. Conclusion. We consider that lateralization if PD is a technique comparable to static PD on the respiratory and hemodynamics level. CLR in PD may prevent some complications