Alteraciones del sueño, un síndrome olvidado en los pacientes con malformación de Chiari tipo I / Sleep disturbance: a forgotten syndrome in patients with Chiari I malformation

Introducción: La malformación de Chiari tipo I (MC-I) se caracteriza por la existencia de una ectopia de las amígdalas del cerebelo que se sitúan por debajo del foramen mágnum, lo que puede asociarse a fenómenos compresivos del tronco del encéfalo, de la médula espinal alta y de los pares craneales. Las manifestaciones clínicas más frecuentes suelen ser las cefaleas occípitonucales y los mareos, aunque el cortejo sintomático puede ser muy extenso. Sin embargo, un aspecto menos conocido es la repercusión de la malformación sobre las alteraciones respiratorias nocturnas y los trastornos del sueño. Fuentes: MEDLINE e información de pacientes con MC-I valorados en los servicios de neurocirugía y neurofisiología del Hospital Universitario Vall d’Hebron. Desarrollo: Artículo de revisión realizado a partir del análisis de todos los estudios publicados en MEDLINE a partir del año 1966, localizados a través del motor de búsqueda PubMed, utilizando combinaciones de las palabras clave: «Chiari malformation» o «Arnold-Chiari malformation» y «sleep apnea» o «sleep disorders». Conclusiones: Los pacientes con una MC-I presentan una mayor prevalencia de trastornos del sueño que la población general. En algunos estudios el 50% de los pacientes con MC-I presentan un síndrome de apnea-hipopnea del sueño (SAHS), habiéndose descrito incluso casos de muerte súbita probablemente relacionados con estos fenómenos. Estos resultados recomiendan incluir el análisis de los parámetros respiratorios nocturnos en el estudio de los pacientes con MC-I. Identificar la presencia de un SAHS contribuye a optimizar el tratamiento de estos pacientes, mejorando la calidad de vida y su pronóstico

Introduction: Chiari type I malformation (CM-I) is characterised by caudal ectopia of the cerebellar tonsils through the foramen magnum. This is associated with brain stem, high spinal cord, and cranial nerve compression phenomena. The most frequent symptoms are occipital headaches and dizziness. Less well-known symptoms are sleep disorders and nocturnal respiratory abnormalities. Sources: MEDLINE and information from patients evaluated at the Neurosurgery and ClinicalNeurophysiology Departments at Hospital Universitario Vall d’Hebron. Development: Review article based on data obtained from MEDLINE articles since 1966, using combinations of the following keywords: «Chiari malformation» or «Arnold-Chiari malformation» and «sleep apnea» or «sleep disorders». Conclusions: CM-I patients show a higher prevalence of sleep disorders than that observed in the general population. Some studies report a 50% prevalence of sleep apnea-hypopnea syndrome (SAHS), probably associated with sudden death in some cases. These results support analysing sleep respiratory parameters in theses patients. Identifying SAHS symptoms may help optimise treatment, thereby improving quality of life and prognosis

Sleep disturbance: a forgotten syndrome in patients with Chiari I malformation.

INTRODUCTION: Chiari type I malformation (CM-I) is characterised by caudal ectopia of the cerebellar tonsils through the foramen magnum. This is associated with brain stem, high spinal cord, and cranial nerve compression phenomena. The most frequent symptoms are occipital headaches and dizziness. Less well-known symptoms are sleep disorders and nocturnal respiratory abnormalities. SOURCES: MEDLINE and information from patients evaluated at the Neurosurgery and Clinical Neurophysiology Departments at Hospital Universitario Vall d'Hebron. DEVELOPMENT: Review article based on data obtained from MEDLINE articles since 1966, using combinations of the following keywords: «Chiari malformation¼ or «Arnold-Chiari malformation¼ and «sleep apnea¼ or «sleep disorders¼. CONCLUSIONS: CM-I patients show a higher prevalence of sleep disorders than that observed in the general population. Some studies report a 50% prevalence of sleep apnea-hypopnea syndrome (SAHS), probably associated with sudden death in some cases. These results support analysing sleep respiratory parameters in theses patients. Identifying SAHS symptoms may help optimise treatment, thereby improving quality of life and prognosis.

A novel DNA profiling application for the monitoring of cross-contamination in autologous chondrocyte implantation.

BACKGROUND: Autologous chondrocyte implantation (ACI) is a cell-based treatment that can be used to regenerate chondral defects. European legislation specifically classifies such produced chondrocytes as "medicinal for advanced cell therapy" that have to be manufactured in pharmaceutical factories according to specific rules, named Good Manufacturing Practices (GMPs). One main requirement of cell manipulation in advanced therapy is to prevent the risk of any contamination. AIM: The aim of this study was to verify if chondrocyte cultures suitable for ACI were free of cross-contamination by means of DNA profiling techniques. MATERIALS AND METHODS: Cell cultures were carried on in a Hospital Cell Factory in compliance with European current Good Manufacturing Practices. DNA profiling, by means of Short Tandem Repeats and miniShort Tandem Repeats analyses, was performed on expanded chondrocytes and their related control blood samples. Mitochondrial DNA was analysed to further confirm the results and to evaluate possible mutations occurred in the samples. RESULTS: Our findings demonstrated the absence of cross-contamination between chondrocyte cultures and, thus, their identity maintenance until the end of the manipulation. CONCLUSIONS: DNA profiling technique can be a suitable test for quality control not only for chondrocyte manipulation, but for cell therapy in general.

[In vitro evaluation of bactericidal activity of an over-heated saturated dry atomized steam electro-medical device on inert contaminated surfaces]. / Valutazione in vitro dell'efficacia battericida di un'apparec- chiatura elettro-medicale con erogazione di vapore saturo secco surriscaldato ad alta temperatura applicata a superfici contaminate.

Surface disinfection together with cleaning practises and aseptic procedures are established measures for effective prevention of infectious diseases reducing infection risks. In this study, we evaluated the bactericidal effectiveness in vitro of the electro-medical device Sani System, an over-heated saturated dry-steam disinfection system, against predetermined bacterial load dried on inert surfaces. In particular we have tested different materials, representative of operating rooms furnishing and walls commonly used in healthcare setting, with Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii. As a result of treatment, the mean bacterial load on all the test surfaces was reduced by a factor of 102 in the contact plate experimental study and by a factor of 10 in the total bioburden experimental study. The Sani System Polti proved to be efficacious in killing 100% of the bacteria in all experimental conditions, therefore it could help to reduce the risk of spreading nosocomial infections in healthcare facilities.

Clinical evaluation of three toothbrush models tested by schoolchildren.

AIM: The aim of this single-blind cross-over study was to compare the performance of three different toothbrush models in the control of dental biofilm and maintaining a healthy gingival condition. METHODS: Twenty-seven schoolchildren (aged 9-10 years) participated in the study. Three toothbrushes with different bristle arrangements were used: T1 - bristles on the same plane, straight arrangement; T2 - bristles on different planes, straight arrangement; T3 - bristles on different planes, straight and circular arrangement. The participants were then randomly divided into three groups for brushing with one of the three toothbrushes. Each experimental period lasted 15 days each, with three daily brushings and a 7-day washout interval was used between periods. The oral hygiene and gingival bleeding indices were recorded by a single, calibrated examiner blind to the brush used. Bristle wear was measured with a digital calliper at the end of each period. The data were analysed using parametric (anova and Student's t-test) and non-parametric (Cochran's Q and McNemar) tests. RESULTS: The toothbrushes achieved similar results (P>0.05) for the clinical parameters investigated. The three models exhibited a similar degree of bristle wear (P>0.05). CONCLUSION: The arrangement of the bristles had little influence over the removal of biofilm and gingival conditions. Thus, there is no clinical justification for replacing conventional toothbrushes with more expensive models.

[Community-acquired, methicillin-resistant Staphylococcus aureus acute osteomyelitis and pneumonia]. / Osteomielitis aguda y neumonía comunitaria por Staphylococcus aureus resistente a meticilina.

The appearance of a community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a increasingly important problem. We describe the case of a child suffering a CA-MRSA osteomyelitis complicated with a non-necrotizing pneumonia. The fast resolution of the pulmonary infection contrasts with the poor evolution of the septic bone. We emphasise the importance of correct surgical drainage to clear the infection. We review the literature on this emergent pathogen.

Osteomielitis aguda y neumonía comunitaria por Staphylococcus aureus resistente a meticilina / Community-acquired, methicillin-resistant Staphylococcus aureus acute osteomyelitis and pneumonia

La aparición de infecciones por estafilococo dorado resistente a meticilina en la comunidad es un problema de creciente importancia. Presentamos el caso de una niña que padeció una osteomielitis aguda complicada con una neumonía no necrotizante. Cobra interés la buena evolución del proceso neumónico que contrasta con la refractariedad en la resolución del foco óseo. Destacamos la importancia del correcto drenaje del acúmulo séptico como pilar de una adecuada evolución. Revisamos la literatura médica sobre este patógeno emergente (AU)

The appearance of a community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a increasingly important problem. We describe the case of a child suffering a CA-MRSA osteomyelitis complicated with a non-necrotizing pneumonia. The fast resolution of the pulmonary infection contrasts with the poor evolution of the septic bone. We emphasise the importance of correct surgical drainage to clear the infection. We review the literature on this emergent pathogen (AU)

Anfotericina B liposomal y leishmaniasis visceral en un paciente inmunocompetente / Liposomal amphotericin B and visceral leishmaniasis in an immunocompetent patient

Presentamos el caso de un lactante de 19 meses, previamente sano, con antecedentes de vivir en una zona semirrural y de tener un perro como animal de compañía, que presentaba la clínica de fiebre de 2 semanas de evolución y esplenomegalia gigante. La pancitopenia y la hipergammaglobulinemia características de la enfermedad estaban presentes. En la biopsia de médula ósea no se detectó el parásito, pero la serología para Leishmania infantum resultó positiva. Se comenta la sensibilidad del aspirado de médula ósea en el diagnóstico. El paciente recibió tratamiento con anfotericina B liposomal, y la respuesta fue excelente. Este caso amplía la poca experiencia acumulada respecto al tratamiento de esta enfermedad con anfotericina B liposomal, en particular en niños menores de 2 años

We report the case of a previously healthy 19-month-old boy whose family lived in the countryside and had a dog. He presented with a two-week history of fever and massive splenomegaly. The characteristic pancytopenia and hypergammaglobulinemia were also detected. Bone marrow biopsy was negative, but serology was positive for Leishmania infantum. We point out the sensitivity of the bone marrow aspirate in the diagnosis. The child was treated with liposomal amphotericin B with an excellent response. This case broadens the limited cumulative experience in treating this disease with liposomal amphotericin B, in particular, in children less than two years old

Rotavirus y su papel en la génesis de convulsiones / Rotavirus and its role in the genesis of afebrile seizures

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[Nonvaccine Streptococcus pneumoniae serotypes causing acute bacterial meningitis]. / Streptococcus pneumoniae serotipo no vacunal como agente causal de meningitis bacteriana aguda.

The pneumococcal heptavalent conjugate vaccine protects children aged less than 2 years old from invasive pneumococcal disease (IPD). Efficacy is 89-93% in the US population and 71-86% in European studies. The vaccine confers active immunization against the main serotypes causing IPD (4, 6B, 9V, 14, 18C, 19F y 23F). We describe 2 children who presented with pneumococcal meningitis caused by nonvaccine serotypes. As a result of the widespread use of the heptavalent vaccine, there may be a shift in the serotypes causing IPD.

Streptococcus pneumoniae serotipo no vacunal como agente causal de meningitis bacteriana aguda / Nonvaccine Streptococcus pneumoniae serotypes causing acute bacterial meningitis

La vacuna conjugada heptavalente protege a niños de menos de 2 años de la enfermedad neumocócica invasiva (ENI) en el 89-93 % en población estadounidense y en el 71-86 % en población europea. Confiere una inmunización activa frente a los serotipos mayoritariamente causantes de ENI (4, 6B, 9V, 14, 18C, 19F y 23F). Presentamos 2 casos de meningitis neumocócica por serotipos no vacunales. Es posible que haya un desplazamiento de serotipos causantes de ENI, como consecuencia de la generalización de la vacuna heptavalente

The pneumococcal heptavalent conjugate vaccine protects children aged less than 2 years old from invasive pneumococcal disease (IPD). Efficacy is 89-93 % in the US population and 71-86 % in European studies. The vaccine confers active immunization against the main serotypes causing IPD (4, 6B, 9V, 14, 18C, 19F y 23F). We describe 2 children who presented with pneumococcal meningitis caused by nonvaccine serotypes. As a result of the widespread use of the heptavalent vaccine, there may be a shift in the serotypes causing IPD

Osteomielitis aguda bacteriana multifocal en un niño con antecedentes de malformación cardíaca / Acute bacterial multifocal osteomyelitis in a boy with congenital cardiac malformation

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Bacterial contamination of musculoskeletal allografts.

Based on the indications in the literature of the transmission of highly pathogenic bacteria in musculoskeletal allograft implants, the cultural results for allografts removed and implanted in conditions of asepsis between 1997 and 2000 in BTM were analyzed: 4014 allografts (3117 from a living donor, 897 from a cadaver) and 3479 implants (2191 with allografts from living donors and 1288 with allografts from cadavers). Explanted tissues: these were positive to culture in 292 out of 3117 (9.4%) allografts from living donors; the bacteria isolated showed low pathogenicity. Out of 897 allografts 117 cadaver donors bacteria with low pathogenicity were isolated in 68 (7.6%) and high pathogenicity in 12 (1.3%). Implants: cultures were positive in 116/2191 (5.3%) implants with allografts from living donors and in 55/1288 (4.3%) implants with allografts from cadavers. The bacteria isolated are the same as those shown in the explants. In living donors contamination is similar as regards incidence and type of microorganism to that observed in surgical theatres during routine surgery. Contamination seems to be greater in allografts removed from cadavers who died as a result of trauma, in the presence of positive hemocultures, prolonged catheterization and intubation, explantation of the pelvis and removal of several organs and tissues prior to musculoskeletal allograft.