EVALUATION OF THE TRANSITION FROM INTRAVENOUS TO SUBCUTANEOUS VEDOLIZUMAB IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE. / VALORACIÓN DE LA TRANSICIÓN DE VEDOLIZUMAB INTRAVENOSO A SUBCUTÁNEO EN PACIENTES CON ENFERMEDAD INFLAMATORIA INTESTINAL.

AIMS: The aim of the study is to evaluate the clinical and biochemical response of inflammatory bowel disease (IBD) patients treated with vedolizumab, 16 weeks after transitioning from intravenous (iv) to subcutaneous (sc). METHODS: An observational, prospective, single-center cohort study was performed. Patients with IBD and maintenance treatment with vedolizumab, stable for at least 4 months, were offered to switch to sc formulation. At the same time of treatment administration a blood test was performed, with vedolizumab levels and fecal calprotectin. RESULTS: 43 patients were included, 12 of them (27.9%) chose to transition to sc formulation. All included patients remained in remission during follow-up. At week 16 (w16), no significant differences were found in terms of calprotectin levels in patients on iv treatment (mean 146.6 ± SD 45.9) vs sc (159.26 ± 53.9) (p 0.9). Vedolizumab serum levels at w16 were higher in the sc group (22364.3 ± 5141.6) vs. iv (11425.9 ± 1514.2) (p 0.009). At w16, 9 (75%) of the patients in the SC group were highly satisfied with the medication and 11 (91.7%) considered it easy to administer. 4 patients (12.9%) in the iv group and 2 (16.6%) in the sc group presented mild adverse effects. The 2 cases (100%) of the sc group the adverse event was local inflammation at the injection site. CONCLUSION: In our experience, vedolizumab sc is a convenient alternative to iv administration. Vedolizumab serum levels in patients who transitioned to sc were higher than iv formulation.

Incidencia de úlceras por presión secundarias al decúbito prono en pacientes ingresados en unidades de cuidados intensivos por SARS-CoV-2 / Incidence of pressure ulcers due to prone position in patients admitted to the ICU for Covid-19

La aparición de úlceras por presión (UPP) es una de las complicaciones frecuentes del decúbito prono (DP), debido a la presión prolongada y las fuerzas de cizallamiento. Objetivos: Comparar la incidencia de UPP secundarias a la posición del decúbito prono y describir su localización entre 4 unidades de cuidados intensivos (UCI) de hospitales públicos. Metodología: Estudio observacional descriptivo retrospectivo multicéntrico. La población estuvo formada por pacientes ingresados en la UCI entre febrero de 2020 y mayo 2021, diagnosticados de COVID-19 que precisaron decúbito prono. Las variables estudiadas fueron sociodemográficas, días de ingreso en la UCI, horas totales en DP, prevención de UPP, localización, estadio, frecuencia de cambios posturales, nutrición y aporte de proteínas. La recogida de datos se realizó a través de la historia clínica de las diferentes bases de datos informatizadas de cada hospital. Se realizó análisis descriptivo y asociación entre las variables, utilizando el programa SPSS vs.20.0.Resultados: Ingresaron 574 pacientes por COVID-19, el 43,03% fueron pronados. El 69,6% fueron hombres, la mediana de edad fue 66 (RIC: 55-74) y el IMC de 30,7 (RIC: 27-34,2). La mediana de estancia en la UCI fue de 28 días (RIC: 17-44,2) y la mediana de horas en DP por paciente 48h (RIC: 24-96). La incidencia de aparición de UPP fue del 56,3% y el 76,2% de los pacientes la presentaron; la localización más frecuente fue la frente (74,9%). Existen diferencias significativas entre hospitales en cuanto a la incidencia de UPP (p<0,001), su localización (p=0,000) y la duración media de horas por cada episodio de DP (p=0,001). Conclusiones: La incidencia de UPP secundarias al DP fue muy elevada. Existe gran variabilidad en cuanto a incidencia de UPP entre hospitales, la localización y la duración media de horas por cada episodio de DP.(AU)

The appearance of pressure ulcers (PU) is one of the frequent complications of prone position (PP), due to prolonged pressure and shear forces. Objectives: To compare the incidence of pressure ulcers secondary to prone position and describe their location among four Intensive Care Units (ICU) of public hospitals. Methods: Multicenter descriptive and retrospective observational study. The population consisted of patients admitted to the ICU between February 2020 and May 2021, diagnosed with Covid-19 who required prone decubitus. The variables studied were sociodemographic, days of admission to the ICU, total hours on PP, PU prevention, location, stage, frequency of postural changes, nutrition and protein intake. Data collection was carried out through the clinical history of the different computerized databases of each hospital. Descriptive analysis and association between variables were performed using SPSS vs.20.0. Results: A total of 574 patients were admitted for Covid-19, 43.03% were pronated. 69.6% were men, median age was 66 (IQR 55-74) and BMI 30.7 (RIC 27-34.2). Median ICU stay was 28 days (IQR 17-44.2), median hours on PD per patient 48h (IQR 24-96). The incidence of PU occurrence was 56.3%, 76.2% of patients presented a PU, the most frequent location was the forehead (74.9%). There were significant differences between hospitals in terms of PU incidence (p=0.002), location (p<0.001) and median duration of hours per PD episode (p=0.001). Conclusions: The incidence of pressure ulcers due to the prone position was very high. There is great variability in the incidence of pressure ulcers between hospitals, location and average duration of hours per episode of prone position.(AU)

[Incidence of pressure ulcers due to prone position in patients admitted to the ICU for Covid-19]. / Incidencia de úlceras por presión secundarias al decúbito prono en pacientes ingresados en unidades de cuidados intensivos por SARS-CoV-2.

The appearance of pressure ulcers (PU) is one of the frequent complications of prone position (PP), due to prolonged pressure and shear forces. Objectives: To compare the incidence of pressure ulcers secondary to prone position and describe their location among four Intensive Care Units (ICU) of public hospitals. Methods: Multicenter descriptive and retrospective observational study. The population consisted of patients admitted to the ICU between February 2020 and May 2021, diagnosed with Covid-19 who required prone decubitus. The variables studied were sociodemographic, days of admission to the ICU, total hours on PP, PU prevention, location, stage, frequency of postural changes, nutrition and protein intake. Data collection was carried out through the clinical history of the different computerized databases of each hospital. Descriptive analysis and association between variables were performed using SPSS vs.20.0. Results: A total of 574 patients were admitted for Covid-19, 43.03% were pronated. 69.6% were men, median age was 66 (IQR 55-74) and BMI 30.7 (RIC 27-34.2). Median ICU stay was 28 days (IQR 17-44.2), median hours on PD per patient 48 h (IQR 24-96). The incidence of PU occurrence was 56.3%, 76.2% of patients presented a PU, the most frequent location was the forehead (74.9%). There were significant differences between hospitals in terms of PU incidence (p = 0.002), location (p < 0.001) and median duration of hours per PD episode (p = 0.001). Conclusions: The incidence of pressure ulcers due to the prone position was very high. There is great variability in the incidence of pressure ulcers between hospitals, location and average duration of hours per episode of prone position.

Incidence of pressure ulcers due to prone position in patients admitted to the ICU for Covid-19.

The appearance of pressure ulcers (PU) is one of the frequent complications of prone position (PP), due to prolonged pressure and shear forces. OBJECTIVES: To compare the incidence of pressure ulcers secondary to prone position and describe their location among four Intensive Care Units (ICU) of public hospitals. METHODS: Multicenter descriptive and retrospective observational study. The population consisted of patients admitted to the ICU between February 2020 and May 2021, diagnosed with Covid-19 who required prone decubitus. The variables studied were sociodemographic, days of admission to the ICU, total hours on PP, PU prevention, location, stage, frequency of postural changes, nutrition and protein intake. Data collection was carried out through the clinical history of the different computerized databases of each hospital. Descriptive analysis and association between variables were performed using SPSS vs.20.0. RESULTS: A total of 574 patients were admitted for Covid-19, 43.03% were pronated. 69.6% were men, median age was 66 (IQR 55-74) and BMI 30.7 (RIC 27-34.2). Median ICU stay was 28 days (IQR 17-44.2), median hours on PD per patient 48 h (IQR 24-96). The incidence of PU occurrence was 56.3%, 76.2% of patients presented a PU, the most frequent location was the forehead (74.9%). There were significant differences between hospitals in terms of PU incidence (P = .002), location (P = .000) and median duration of hours per PD episode (P = .001). CONCLUSIONS: The incidence of pressure ulcers due to the prone position was very high. There is great variability in the incidence of pressure ulcers between hospitals, location and average duration of hours per episode of prone position.

Silicone key device for maxilla orientation and occlusal plane recording in a digital workflow.

This article describes a technique for recording the maxilla's orientation in esthetically driven oral rehabilitation and transferring its position by using computer-aided design and computer-aided manufacturing (CAD-CAM) technology. The protocol uses a Fox plane and a bubble level to orient an addition silicone key of the maxilla parallel to the occlusal reference plane. The silicone reference key was scanned, superimposed over the maxilla intraoral standard tessellation language (STL) file, and adequately oriented in a CAD software program.

Cardiometabolic profile of 15057 elderly Spanish workers: association of sociodemographic variables and tobacco consumption.

BACKGROUND: Aging of the world population is one of the most significant demographic changes of our time. Populations older than 60 years are heterogeneous, and age is an independent cardiovascular risk factor aggravated by frailty, obesity, and diabetes, and influenced by several factors, including sex and socioeconomic status. The objective of this study was to calculate cardiovascular risk in workers of both sexes over 60 years of age and to assess whether there are difference s by sex, social class, smoking, and type of job. METHODS: A cross-sectional study was carried out in 15,057 elderly Spanish workers from different autonomous communities in Spain and with different labor occupations. Anthropometric, sociodemographic, clinical, and laboratory values were determined. People were classified according to age from 60 to 64 years inclusive and from 65 to 69 years, smokers and non-smokers, and both blue-collar and white-collar workers. Subsequently, a multivariate analysis was carried out. RESULTS: Men, blue-collar workers, smokers, and aging were factors that influenced cardiovascular risk: with an OR of 3.27 (95% CI: 2.64-4.05) in people 65 years of age or older versus the younger group, and an OR of 3.15 (95% CI: 2.69-3.69) in smokers versus non-smokers. A stronger independent association was found between smoking, age, and cardiovascular risk. The risk of developing non-alcoholic fatty liver and liver fibrosis was much higher in men than in women, with an OR of 4.06 (95% CI: 3.66-4.50) for the former and an OR of 2.10 (95% CI: 1.95-2.26) for the BARD index. CONCLUSIONS: The highest risk groups were observed in male subjects with a history of smoking and blue-collar workers and, as such, should be considered for cardiovascular risk screening programs.

[Left atrial appendage occlusion in elderly]. / Fermeture d'auricule gauche percutanée chez le sujet âgé.

Left atrial appendage occlusion (LAAO) is an alternative option to oral anticoagulation therapy in patients with non-valvular atrial fibrillation. According to French regulations, this procedure is currently reserved for patients with formal contraindications to VKA and direct thrombin inhibitors. LAAO procedures reduce ischemic and stroke risks compared to no treatment and also reduce bleeding events compared to VKA therapy in eligible patients. The peri-procedural complications risk has been reported to be limited in the different series published so far. Although elderly patients (>75 years) have either higher ischemic and bleeding risk than younger subjects, they hardly benefit from optimal anticoagulation. Thus, these subjects might greatly benefit from LAAO. Published studies reported excellent feasibility and efficiency of LAAO procedure in elderly patients. Yet there is a trend towards a higher incidence of peri-procedural complications (including tamponade), long-term safety is excellent and comparable to what is observed in patients<75 years. Therefore, interventional percutaneous LAAO is an attractive strategy in elderly patients with atrial fibrillation that should be incorporated in a multidisciplinary management.

Visual hallucinations in patients with acute stroke: a prospective exploratory study.

BACKGROUND AND PURPOSE: The incidence, underlying physiopathology, features and association with lesion topography of visual hallucinations in acute stroke have scarcely been investigated. METHODS: Patients with a diagnosis of acute stroke (ischaemic or haemorrhagic) in any vascular territory, admitted within 24 h after the onset of symptoms, were consecutively included in the study. Patients with a previous history of psychosis or cognitive impairment were excluded. They and/or their caregivers answered a structured hallucination and sleep questionnaire at admission, within the first 15 days and at the clinical follow-up 3-6 months after discharge. Lesion location (IMAIOS online atlas) and leukoaraiosis (Wahlund scale) were determined by magnetic resonance imaging or computed tomography scan. Subsets of patients also underwent a neuropsychological evaluation (N = 50) and an electroencephalogram (N = 33) before discharge. RESULTS: In all, 77 patients with a mean age of 71 ± 12 years were included of whom 57.1% were men. The incidence of visual hallucinations was 16.7%. These hallucinations were mostly complex, in black and white and self-limited. The appearance of hallucinations was not influenced by age, sex, neuropsychological performance during admission or modified Rankin scale score at discharge. Visual hallucinations were associated with occipital cortex lesions (P = 0.04), and with sleep disturbances during and before admission (P = 0.041 and P = 0.03 respectively). CONCLUSIONS: Visual hallucinations are relatively frequent in patients with acute stroke and they are self-limited. Patients with occipital lesions and sleep disturbances are more likely to suffer them.

Neutrophils in atherosclerosis. A brief overview.

Atherosclerosis is a chronic inflammation of the arterial wall and the continuous infiltration of leukocytes into the plaque enhances the progression of the lesion. Because of the scarce detection of neutrophils in atherosclerotic plaques compared to other immune cells, their contribution was largely neglected. However, in the last years studies have accumulated pointing towards the contribution of neutrophils to atherogenesis. In addition, studies are emerging implying a role for neutrophils in advanced atherosclerosis and/or plaque destabilization. Thus, this brief review delivers an overview of the role of neutrophils during early and late stage atherosclerosis.

Effectiveness of daily versus non-daily granulocyte colony-stimulating factors in patients with solid tumours undergoing chemotherapy: a multivariate analysis of data from current practice.

We conducted a multicentre, retrospective, observational study including patients with solid tumours (excluding breast cancer) that received granulocyte colony-stimulating factors (G-CSF) and chemotherapy. We investigated the effectiveness of daily vs. non-daily G-CSFs (pegfilgrastim) adjusting by potential confounders. The study included 391 patients (211 daily G-CSF; 180 pegfilgrastim), from whom 47.3% received primary prophylaxis (PP) (57.8% pegfilgrastim), 26.3% secondary prophylaxis (SP: initiation after cycle 1 and no reactive treatment in any cycle) (51.5% pegfilgrastim) and 26.3% reactive treatment (19.4% pegfilgrastim). Only 42.2% of patients with daily G-CSF and 46.2% with pegfilgrastim initiated prophylaxis within 72 h after chemotherapy, and only 10.5% of patients with daily G-CSF received it for ≥ 7 days. In the multivariate models, daily G-CSF was associated with higher risk of grade 3-4 neutropenia (G3-4N) vs. pegfilgrastim [odds ratio (OR): 1.73, 95% confidence interval (CI): 1.004-2.97]. Relative to SP, PP protected against G3-4N (OR for SP vs. PP: 6.0, 95%CI: 3.2-11.4) and febrile neutropenia (OR: 3.1, 95%CI: 1.1-8.8), and was associated to less chemotherapy dose delays and reductions (OR for relative dose intensity <85% for SP vs. PP: 3.1, 95%CI: 1.7-5.4) and higher response rate (OR: 2.1, 95%CI: 1.2-3.7). Data suggest that pegfilgrastim, compared with a daily G-CSF, and PP, compared with SP, could be more effective in preventing neutropenia and its related events in the clinical practice.

Utilización del atomizador intranasal para la administración de Midazolam en emergencias pediátricas / Use of intranasal spray for Midazolam administration in pediatric emergencies

Introducción: La administración de midazolam por atomizador nasal podría ser eficaz y segura en emergencias pediátricas. Objetivos: describir la administración de midazolam utilizando el atomizador nasal; conocer las complicaciones asociadas. Métodos: Diseño: descriptivo, prospectivo. Pacientes que recibieron midazolam mediante MAD®, entre el 01/08/2007 y el 30/03/2008. Resultados: el dispositivo fue usado 28 veces; niños con edad media de 38 meses, 64% de sexo masculino. Motivos de uso: procedimientos 71,43% y convulsiones 28,57%. Procedimientos: la media de dosis utilizada fue 0,27mg/kg, la media de comienzo de acción 3 minutos. En las convulsiones febriles, luego de fracasar la búsqueda de un acceso endovenoso, se procedió a la administración de la droga por MAD® siendo el tiempo medio desde el inicio del episodio convulsivo hasta el comienzo de la administración de la droga de 3.42 minutos y la dosis media 0.3 mg/kg. No se observaron complicaciones. Conclusiones:1) la administración de midazolam por el atomizador nasal es segura y eficaz; 2) no hubo complicaciones.

Introduction: Midazolam administration using an intranasal spray (MAD®) may be efficacious and safe in pediatric emer-gencies. Objectives: 1) To describe midazolam administration using an intranasal atomizer. 2) To assess the complications associated with intranasal midazolam. Methods: Design: A descriptive and prospective study in patients who were ad-ministered midazolam via MAD® between 01/08/2007 and 30/03/2008. Results: Intranasal midazolam was used 28 times in children with a mean age of 38 months (SD 28.44); 64% were boys. Reasons for administrartion were: Procedures in 71.43% (n=20) and seizures in 28.57% (n=8). Procedures: Mean dose used was 0.27 mg/kg (SD 0.35), and mean time to effect onset was 3 minutes (SD 3.5). In febrile seizures, after search for intravenous access had failed, midazolam was administered using MAD® with a mean time interval between seizure onset and drug administration of 3.42 (SD 6.61) min-utes and at a mean dose of 0.3 mg/kg. No complications were observed. Conclusions: 1) Intranasal midazolam administration was safe and efficacious. 2) No complications were observed.

Cefalea e inmigración. Estudio en la consulta externa del Hospital de la Santa Creu i Sant Pau de Barcelona / Headache and immigration. A study in the outpatient department of the Hospital de la Santa Creu i Sant Pau in Barcelona

Introducción. La población inmigrante es cada vez más numerosa en la consulta neurológica. No está bien establecido si existen diferencias geográficas en la prevalencia de las cefaleas primarias y la posible influencia de la emigración. Pacientes y métodos. Estudio retrospectivo (12 meses) y prospectivo (18 meses) de las primeras visitas en la Unidad de Cefaleas del Hospital de la Santa Creu i Sant Pau. Identificamos el país de origen, parámetros temporales de la cefalea y de la inmigración, diagnósticos según criterios de la Sociedad Internacional de Cefaleas y tratamientos realizados. Se considera cefalea relacionada la que se inicia en el período de un año tras la inmigración. Resultados. La población inmigrante representa el 13,6% (n = 142) del total de las primeras visitas por cefalea (n = 1.044). Proceden principalmente de Latinoamérica (83,9%). La cefalea comenzó posteriormente a la inmigración en el 40,1% de los casos, sin existir relación temporal con la inmigración. La distribución de los diagnósticos de la cefalea son semejantes a los de la población autóctona; los más frecuentes son migraña (57,7%) y cefalea tensional (15,5%). Al comparar los tratamientos anteriores y posteriores a la inmigración, encontramos diferencias en el uso de triptanes (2,1% frente a 46,2%), ergotamina (9,8% frente a 2,1%) y utilización de tratamientos preventivos (2% frente a 45%). Conclusiones. La población inmigrante representa el 13% de las primeras visitas de cefalea y sus diagnósticos son similares a los de la población autóctona. El hecho de la emigración no es desencadenante ni agravante de la cefalea en nuestra serie. El tratamiento sintomático y preventivo difiere significativamente entre el período anterior a la inmigración y el posterior(AU)

Introduction. The immigrant population (IP) is visiting neurology departments on an increasingly more frequent basis. Research has still not made it clear whether there are geographical differences in the prevalence of primary headaches and the possible influence of emigration. Patients and methods. We conducted a retrospective (12 months) and prospective study (18 months) of the first visits to the Headache Unit at the Hospital de la Santa Creu i Sant Pau. Data collected included the country of birth, time parameters of the headache and of the immigration, diagnoses according to the criteria of the IHS and treatments that had been used. Related headaches were considered to be those that began within one year of having immigrated. Results. The IP represents 13.6% (n = 142) of the total number of first visits because of headaches (n = 1044). Immigrants came mostly from Latin America (83.9%). Headaches began after immigration in 40.1% of cases without the existence of any temporal relation with immigration. The distribution of the diagnoses of headache is similar to those of the local population, the most frequent being migraine (57.7%) and tension-type headache (15.5%). On comparing treatments prior to and following immigration, we find differences in the use of triptans (2.1% versus 46.2%), ergotamine (9.8% versus 2.1%) and in the use of preventive treatments (2% versus 45%). Conclusions. The IP accounts for 13% of all first visits due to headaches and their diagnoses are similar to those of the local population. Emigration is neither a precipitating nor an aggravating factor for headaches in our series. There is a significant difference in symptomatic and preventive treatment between the period prior to immigration and afterwards (AU)

[Headache and immigration. A study in the outpatient department of the Hospital de la Santa Creu i Sant Pau in Barcelona]. / Cefalea e inmigracion. Estudio en la consulta externa del Hospital de la Santa Creu i Sant Pau de Barcelona.

INTRODUCTION: The immigrant population (IP) is visiting neurology departments on an increasingly more frequent basis. Research has still not made it clear whether there are geographical differences in the prevalence of primary headaches and the possible influence of emigration. PATIENTS AND METHODS: We conducted a retrospective (12 months) and prospective study (18 months) of the first visits to the Headache Unit at the Hospital de la Santa Creu i Sant Pau. Data collected included the country of birth, time parameters of the headache and of the immigration, diagnoses according to the criteria of the IHS and treatments that had been used. Related headaches were considered to be those that began within one year of having immigrated. RESULTS: The IP represents 13.6% (n = 142) of the total number of first visits because of headaches (n = 1044). Immigrants came mostly from Latin America (83.9%). Headaches began after immigration in 40.1% of cases without the existence of any temporal relation with immigration. The distribution of the diagnoses of headache is similar to those of the local population, the most frequent being migraine (57.7%) and tension-type headache (15.5%). On comparing treatments prior to and following immigration, we find differences in the use of triptans (2.1% versus 46.2%), ergotamine (9.8% versus 2.1%) and in the use of preventive treatments (2% versus 45%). CONCLUSIONS: The IP accounts for 13% of all first visits due to headaches and their diagnoses are similar to those of the local population. Emigration is neither a precipitating nor an aggravating factor for headaches in our series. There is a significant difference in symptomatic and preventive treatment between the period prior to immigration and afterwards.

Nosocomial outbreak of Blastoschizomyces capitatus associated with contaminated milk in a haematological unit.

In July 2002, Blastoschizomyces capitatus was isolated from four neutropenic patients in a haematology unit. Two patients died due to disseminated infection while the other two had oropharyngeal colonisation. Nosocomial acquisition of the fungus was suspected and epidemiological and environmental studies were undertaken. To determine the potential source for the acquisition of the fungus, epidemiological relationships between the patients were investigated. We performed surveillance cultures on all patients and took environmental cultures of air, inanimate surfaces, food samples, blood products and chemotherapy drugs. No direct contact transmission between patients was found and B. capitatus was isolated only in vacuum flasks used for breakfast milk distribution. All isolates were compared by four independent molecular typing methods: pulsed-field gel electrophoresis, genomic DNA restriction endonuclease analysis, randomly amplified polymorphic DNA, and polymerase chain reaction fingerprinting using a single primer specific for one minisatellite or two microsatellite DNAs. Milk vacuum flasks and clinical strains were genetically indistinguishable by all typing techniques. Milk vacuum flasks were withdrawn from all hospital units and no further B. capitatus infection was detected. Our findings suggest that clonal dissemination of a single strain of B. capitatus from vacuum flasks used for milk distribution was responsible for this nosocomial outbreak in the haematological unit.

Concordancia de antígenos de dengue en el ELISA de captura de IgM (MAC ELISA) en el IICS-UNA / Concordance of dengue antigens M antibody-capture ELISA (MAC ELISA) in the IICS-UNA

El dengue es una enfermedad aguda grave considerada actualmente como infección reemergente, cuyo vector principal es el Aedes aegypti. En Paraguay en el 2007 fueron reportados 28.181 casos, 55 se clasificaron como fiebre hemorrágica del dengue de los cuales 7 fallecieron. El 90% de los casos fueron de Asunción y del Departamento Central,10% del resto del país. En los últimos años se han desarrollado diferentes sistemas inmunoenzimáticos para el diagnóstico del dengue, entre ellos el ELISA de captura de IgM (MAC ELISA). El objetivo de este estudio observacional analítico de corte transverso fu ecomparar la prueba del MAC ELISA desarrollada en el Instituto de Investigaciones en Ciencias de la Salud (IICS) utilizando antígenos suministrados por el Instituto Pedro Kouri(IPK) de Cuba y el Evandro Chagas de Brasil, con el kit comercial ELISA IgM por capturapara virus del dengue (Focus Diagnostics Inc. Cypress, CA, USA). Fueron seleccionados alazar 92 sueros de pacientes codificados que concurrieron al IICS con sospecha de dengue, respetándose la confidencialidad de los mismos. La concordancia obtenida fue del94.6% (Índice Kappa: 0.891) utilizando el antígeno del IPK y 96.7% (Índice Kappa:0.9350) con el antígeno del Evandro Chagas, mostrándose alta significancia estadística(p<0.00001) en ambos casos. La excelente concordancia obtenida con los dos antígenos indica que los mismos pueden ser utilizados indistintamente en la prueba del MAC ELISA desarrollada en el IICS, a fin de apoyar el diagnóstico del dengue a menor costo y quesería de producción local.

Dengue is an acute disease currently considered a re-emerging infection, whose main vector is Aedes aegypti. In 2007, 28,181 cases were reported in Paraguay, 55 were classified as dengue hemorrhagic fever and seven of them died. Ninety percent of the cases were from Asunción and the Central Department and the remaining 10% from the rest of the country. In recent years various immunoenzymatic systems have been developed immunoassay for the diagnosis of dengue, including the M antibody captureELISA (MAC ELISA). The aim of this cross-sectional observational study was to compare the MAC ELISA test developed at the Instituto de Investigaciones en Cienciad de la Salud(IICS) using antigens supplied by the Instituto Pedro Kouri (IPK) of Cuba and Evandro Chagas of Brazil with a commercial kit of M antibody capture ELISA for dengue virus (Focus Diagnostics Inc. Cypress, CA, USA). Ninety two coded serum samples wererandomly selected from patients who attended the IICS with suspected dengue, respecting their confidentiality. The concordance obtained was 94.6% (Kappa Index: 0.891) using the IPK antigen and 96.7% (Kappa index: 0.9350) with the antigen from Evandro Chagas showing high statistical significance (p<0.00001) in both cases. The excellent concordance obtained with the two antigens indicates that they can be used indistinctly in the MAC ELISA test developed in the IICS to support the diagnosis of dengue at a lower cost and would be locally produced.

Concordancia entre las pruebas de ELISA avidez IgG desarrollados en el Instituto de Investigaciones en Ciencias de la Salud y un ELISA avidez comercial / Concordance between the IgG avidity ELISA tests developed at the Instituto de Investigaciones en Ciencias de la Salud and a commercial avidity ELISA

La infección aguda de toxoplasmosis en la mujer durante el embarazo en su mayor parte es asintomática y detectable solo por anticuerpos lo que podría afectar severamenteal feto si no es diagnosticada y tratada precozmente. En este estudio observacionalanalítico de corte transverso se comparó la prueba de ELISA Avidez IgG paratoxoplasmosis desarrollado en el Instituto de Investigaciones en Ciencias de la Salud(IICS) con un test comercial de avidez InmunoLISA Organics USA. Para la concordanciase utilizó 41 sueros mantenidos a -20 ºC procedentes de la seroteca del Departamento de Producción-Bioquímica seleccionados al azar. La concordancia obtenida fue de 92.7% y un índice de Kappa de 0.820 con IC95% (0.6-1) y p<0.0001. El índice bajo de avidez sugiere una infección aguda pero para el diagnóstico debería estar acompañado de otras pruebas serológicas y la clínica del paciente. En cambio un índice alto es diagnóstico de una infección crónica.

The acute infection caused by Toxoplasma gondii in pregnant women is mostly asymptomatic and detectable only by antibodies that could severely affect the fetus if the infection is not diagnosed and treated precociously. In this cross-sectional observational,the analytical the IgG avidity ELISA test for toxoplasmosis, developed at the Instituto de Investigaciones en Ciencias de la Salud (IICS), was compared to a commercial avidity kit InmunoLISA (Organics, USA). For the concordance, 41 serum samples kept at -20ºC atthe Department of Production-Biochemistry of IICS were tested. The concordance obtained was 92.7% and a Kappa index of 0.820 with IC95% (0.6-1) and p <0.0001. The low avidity index suggests an acute infection but for diagnosis this result should beaccompanied by other serologic tests and clinical symptoms. Instead, a high avidity index suggests a chronic infection.

[Psychopathological symptoms in patients suffering from chronic cephalea with or without fibromyalgia]. / Síntomas psicopatológicos en pacientes afectos de cefalea crónica con o sin fibromialgia.

INTRODUCTION: The presence of psychopathological symptoms as anxiety and depression in chronic daily headache and in fibromyalgia is common. AIM: To study whether there are any difference in the psychopathological profile and treatment response between patients with chronic headache and fibromyalgia (CHFM) and patients with chronic headache without fibromyalgia (CH). PATIENTS AND METHODS: A comprehensive psychological test battery was administered to 30 patients with CH and 30 patients with CHFM, diagnosed by a rheumatologist. We included chronic migraine and chronic tensional headache in CH group. Patients were matched for age and gender. Depression, anxiety and obsession scores, and the profile of psychopathological symptoms (MMPI-2, SCL-90-R) were compared (t-test). Correlations between symptoms and treatment response were examined. RESULTS: Patients with CHFM showed significant highest scores on hypochondriasis, depression, hysteria, paranoia, psychasthenia and schizophrenia (MMPI-2) and more somatization, obsession and anxiety according to SCL-90-R. A poorer response to treatment was observed in CHFM (17.85%) versus CH (42,85%) group. CONCLUSIONS: Patients with CHFM showed a psychopathological profile with highest scores and symptoms than patients without fibromyalgia. These differences correlated with the therapeutic response.

Síntomas psicopatológicos en pacientes afectos de cefalea crónica con o sin fibromialgia / Psychopathological symptoms in patients suffering from chronic cephalea with or without fibromyalgia

Introducción. La presencia de sintomatología psicopatológica, como la ansiedad y la depresión, en las cefaleascrónicas y en la fibromialgia es común. Objetivos. Estudiar si existen diferencias en el perfil psicopatológico entre pacientescon cefalea crónica y fibromialgia (CCFM) y pacientes con cefalea crónica sin fibromialgia (CC), y si existen diferencias enla respuesta al tratamiento entre ambos grupos. Pacientes y métodos. Se administra una batería de test de evaluación de síntomaspsicopatológicos a 30 pacientes con CC y a 30 pacientes con CCFM diagnosticados por un reumatólogo. Incluimos enla CC a pacientes con migraña crónica y cefalea tensional crónica. El diseño es con datos apareados de edad y sexo. Se comparanlas puntuaciones de depresión, ansiedad, obsesión y perfil de sintomatología psicopatológica –inventario multifásicode personalidad de Minnessota (MMPI-2) y cuestionario de 90 síntomas revisado (SCL-90-R)– (prueba t). Se correlacionanlos datos con la respuesta al tratamiento. Resultados. Los pacientes con CCFM muestran puntuaciones significativamente superioresen las escalas de hipocondriasis, depresión, histeria, paranoia, psicastenia y esquizofrenia (MMPI-2), y más somatizaciones,obsesión y ansiedad según el SCL-90-R. La respuesta favorable al tratamiento es inferior en el grupo CCFM(17,85%) que en el CC (42,85%). La hipocondriasis se correlaciona con una peor respuesta (regresión logística). Conclusiones.Los pacientes con CCFM muestran un perfil psicopatológico con mayores puntuaciones y síntomas que los pacientes sinfibromialgia. Esta diferencia se correlaciona con la respuesta terapéutica(AU)

Introduction. The presence of psychopathological symptoms as anxiety and depression in chronic daily headacheand in fibromyalgia is common. Aim. To study whether there are any difference in the psychopathological profile andtreatment response between patients with chronic headache and fibromyalgia (CHFM) and patients with chronic headachewithout fibromyalgia (CH). Patients and methods. A comprehensive psychological test battery was administered to 30 patientswith CH and 30 patients with CHFM, diagnosed by a rheumatologist. We included chronic migraine and chronic tensionalheadache in CH group. Patients were matched for age and gender. Depression, anxiety and obsession scores, and the profileof psychopathological symptoms (MMPI-2, SCL-90-R) were compared (t-test). Correlations between symptoms and treatmentresponse were examined. Results. Patients with CHFM showed significant highest scores on hypochondriasis, depression,hysteria, paranoia, psychasthenia and schizophrenia (MMPI-2) and more somatization, obsession and anxiety accordingto SCL-90-R. A poorer response to treatment was observed in CHFM (17.85%) versus CH (42,85%) group. Conclusions.Patients with CHFM showed a psychopathological profile with highest scores and symptoms than patients without fibromyalgia.These differences correlated with the therapeutic response(AU)