Validación de cinco pulsioxímetros / Validation of five pulse oximeters

Resumen: ANTECEDENTES: la pulsioxímetria estima la saturación arterial de oxígeno mediante la absorción de un haz de luz infrarroja por la oxihemoglobina. OBJETIVO: determinar la validez y la confiabilidad interinstrumento de cinco pulsioxímetros comúnmente usados en la práctica clínica. MATERIAL Y MÉTODO: estudio transversal, analítico, realizado del 1 de enero de 2015 al 30 de octubre de 2016, en el que se incluyeron pacientes mayores de 18 años de edad, con línea arterial para toma de gasometría y se midió simultáneamente la saturación de oxígeno con cinco pulsioxímetros de uso habitual. Se determinaron medianas y porcentajes de los cinco pulsioxímetros entre sí mediante prueba de Friedman. RESULTADOS: se incluyeron 101 pacientes, 63 hombres y 38 mujeres. Se encontró similitud en las mediciones realizadas por cada pulsioxímetro con p = 0.08; todos los oxímetros se correlacionaron de manera positiva contra la prueba patrón de referencia (correlación de Pearson). Oxímetro 1: r = 0.90; oxímetro 2: r = 0.64; oxímetro 3: r = 0.57; oxímetro 4: r = 0.84 y oxímetro 5: r = 0.89; el área bajo la curva mostró oxímetro 1 (0.89), oxímetro 2 (0.88), oxímetro 3 (0.87), oxímetro 4 (0.83), oxímetro 5 (0.85) con p < 0.05. CONCLUSIONES: el pulsioxímetro número 1 muestra el mejor rendimiento comparado con la gasometría. Al comparar los oxímetros entre sí el rendimiento es igual.

Abstract: BACKGROUND: Pulse oximetry estimates the arterial oxygen saturation by absorption of an infrared light beam by oxyhemoglobin. OBJECTIVE: To determine the intraclass validity and reliability of five pulse oximeters commonly used in clinical practice. MATERIAL AND METHOD: A cross-sectional analytical study was done from January 1st 2015 to October 30 2016, including patients over 18 years old, with arterial line for blood gas sample and simultaneously oxygen saturation was measured with 5 pulse oximeters commonly used. Medians and percentages of the 5 pulse oximeters were determined by Friedman's test RESULTS: There were included 101 patients, 63 men and 38 women, with similarity in the measurements performed by each pulse oximeter with p = 0.08; all oximeters were positively correlated against the standard gold test (Pearson's correlation). Oximeter 1: r = 0.90; oximeter 2: r = 0.64; oximeter 3: r = 0.57; oximeter 4: r = 0.84 and oximeter 5: r = 0.89. The area under the curve showed oximeter 1 (0.89), oximeter 2 (0.88), oximeter 3 (0.87), oximeter 4 (0.83), oximeter 5 (0.85) with p < 0.05. CONCLUSIONS: The pulse oximeter number 1 shows a better performance when compared to the gasometry. When the oximeters are compared to each other the performance is the same.

[Non-convulsive epileptic status associated with Lafora disease: two case reports]. / Estado epiléptico no convulsivo asociado a enfermedad de Lafora: presentación de dos casos.

INTRODUCTION: Lafora s disease is a type of progressive myoclonic epilepsy with poor prognosis, is characterized by myoclonic crisis, tonic clonic seizures, absence or partial complex seizures and other neurological manifestations with a progressive course and a poor response to the treatment. It has not been considered as a cause of epileptic status. CASE REPORTS: Two women without important past medical history with normal psychomotor development before their suffering, with manifestations of 2 years of evolution the first one and 8 years on the second case characterized by myoclonic generalized, partial complex seizures and progressive deterioration of the mental functions that joined to our institution in a non convulsive epileptic status and they featured with a different evolution. The first patient with favorable control of the event with a single medication and functionality recover later, the second one with torpid evolution complicated with an epileptic status convulsive widespread condition and a prolonged permanency in the unit of intensive therapy. In both patients the diagnosis of Lafora s disease was established based in the findings of the skin axilar biopsy. DISCUSSION AND CONCLUSION: We believe that Lafora s disease must be suspected as a probable cause of non convulsive epileptic status in patients with myoclonic epilepsy associated with other neurological manifestations and a refractary response to the medical treatment. The evolution and clinical response will depend on the evolutionary stage of the disease.

Estado epiléptico no convulsivo asociado a enfermedad de Lafora: presentación de dos casos / Non-convulsive epileptic status associated with lafora disease: two case report

Introducción. La enfermedad de Lafora (EL) es una forma de epilepsia mioclónica progresiva con un pronóstico fatal; se asocia a la presencia de crisis mioclónicas, tonicoclónicas, de ausencia o parciales complejas, asociadas a otras manifestaciones neurológicas, con un curso progresivo y una mala respuesta al tratamiento. No se considera una causa de estado epiléptico (EE). Casos clínicos. Dos mujeres sin antecedentes perinatales ni personales de importancia, con un desarrollo psicomotor normal hasta antes de su padecimiento, con manifestaciones de dos años de evolución la primera y ocho años la segunda, caracterizadas por mioclonías generalizadas, crisis parciales complejas y deterioro progresivo de las funciones mentales, que ingresaron en nuestra institución en EE no convulsivo y presentaron diferente evolución. La primera paciente, con un adecuado control del evento con un sólo fármaco y funcionalidad completa posterior; la segunda, con evolución tórpida complicada con un estado convulsivo generalizado y permanencia prolongada en la Unidad de Terapia Intensiva. En las dos pacientes se estableció el diagnóstico de EL con base en los hallazgos de la biopsia de músculo esquelético y de piel axilar. Discusión. Consideramos que la EL debe sospecharse como probable causa de EE no convulsivo en pacientes con epilepsia mioclónica asociada a otras manifestaciones neurológicas y mala respuesta al tratamiento médico. La evolución y respuesta clínica dependerán de la etapa evolutiva de la enfermedad (AU)

Introduction. Lafora’s disease is a type of progressive myoclonic epilepsy with poor prognosis, is characterized by myoclonic crisis, tonic-clonic seizures, absence or partial complex seizures and other neurological manifestations with a progressive course and a poor response to the treatment. It has not been considered as a cause of epileptic status. Case reports. Two women without important past medical history with normal psychomotor development before their suffering, with manifestations of 2 years of evolution the first one and 8 years on the second case characterized by myoclonic generalized, partial complex seizures and progressive deterioration of the mental functions that joined to our institution in a non convulsive epileptic status and they featured with a different evolution. The first patient with favorable control of the event with a single medication and functionality recover later, the second one with torpid evolution complicated with an epileptic status convulsive widespread condition and a prolonged permanency in the unit of intensive therapy. In both patients the diagnosis of Lafora’s disease was established based in the findings of the skin axilar biopsy. Discussion and conclusion. We believe that Lafora’s disease must be suspected as a probable cause of non convulsive epileptic status in patients with myoclonic epilepsy associated with other neurological manifestations and a refractary response to the medical treatment. The evolution and clinical response will depend on the evolutionary stage of the disease (AU)